Assuntos
Proteínas Reguladoras de Apoptose , Hemangioma Cavernoso do Sistema Nervoso Central , Adulto , Humanos , Proteínas Reguladoras de Apoptose/genética , Genótipo , Hemangioma Cavernoso do Sistema Nervoso Central/genética , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Imageamento por Ressonância Magnética , Proteínas de Membrana/genética , Proteínas Proto-Oncogênicas/genéticaAssuntos
Doenças dos Gânglios da Base , Encefalopatias , Calcinose , Humanos , Genótipo , Calcinose/diagnóstico por imagem , Calcinose/genética , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Proteínas Cotransportadoras de Sódio-Fosfato Tipo III/genética , Proteínas Cotransportadoras de Sódio-Fosfato Tipo III/metabolismo , Encefalopatias/diagnóstico por imagem , Encefalopatias/genética , Mutação , Linhagem , Doenças dos Gânglios da Base/genéticaRESUMO
The posterior interosseous nerve is the terminal motor branch of the radial nerve that innervates the extensor carpi ulnaris and the extensors of the thumb and fingers. We describe a case of a posterior interosseous neuropathy presenting with the typical 'finger drop' and partial 'wrist drop'. We focus on the clinical signs that distinguish it from a more proximal radial neuropathy, clarified by nerve conduction studies and needle electromyography. Multimodal imaging of the forearm did not identify a compressive lesion. Persistent symptoms prompted surgical exploration 5 years after initial onset. It identified compression of the posterior interosseous nerve in the region of the arcade of Frohse and leash of Henry. The sites were decompressed and concurrent salvage secondary reconstructive tendon transfers were required in view of the severe axonal loss with minimal chance of functional reinnervation.
Assuntos
Neuropatia Radial , Cotovelo , Dedos , Antebraço , Humanos , Nervo Radial/diagnóstico por imagem , Neuropatia Radial/diagnóstico , Neuropatia Radial/cirurgiaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Leucoencefalopatia Multifocal Progressiva/diagnóstico , Leucoencefalopatia Multifocal Progressiva/etiologia , Neoplasias Ovarianas/complicações , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina/administração & dosagem , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/tratamento farmacológico , Paclitaxel/administração & dosagemRESUMO
Rheumatoid meningitis (RM) is a rare extra-articular manifestation of rheumatoid arthritis (RA). A 59-year-old man presented with a 10-day history of right-sided frontal headache and a 7-day history of subacute left-sided weakness. He had no history of RA. He was febrile (38.2°C). Left ankle dorsiflexion and plantarflexion were graded at 4+/5. He developed focal onset motor seizures. He was intermittently febrile with minimal improvement despite intravenous antivirals and antimicrobials. Serology revealed elevated rheumatoid factor 88.2 IU/mL and anti-cyclic citrullinated peptide (anti-CCP) IgG >340 AU/mL. Initial cerebrospinal fluid (CSF) was predominantly lymphocytic 96%, with elevated protein 672 mg/L and normal glucose 3.4 mmol/L. Interval CSF revealed newly low glucose 2.6 mmol/L. Extensive CSF microbiology tests were negative. CSF cytology confirmed reactive lymphocytes. MRI brain revealed right frontoparietal leptomeningeal enhancement. Brain and leptomeningeal biopsy demonstrated florid leptomeningeal mixed inflammatory infiltrate without granulomas. The combination of elevated anti-CCP IgG, erosive arthropathy, CSF lymphocytosis, asymmetrical leptomeningeal enhancement and biopsy findings confirmed RM.