RESUMO
Three cirrhotic patients with chronic acquired hepatocerebral degeneration (CAHD) received neurologic, neuropsychologic and neuroimaging assessment before and after liver transplantation (LT). Before transplantation, neurologic dysfunction consisted in severe bradykinesia, dystonia, dyskinesia, ataxia and dysarthria. Cognitive impairment affected mainly attentional and executive domains. Brain MRI showed bilateral hyperintensities of the basal ganglia on T1-weighted images. After transplantation, motor manifestations promptly resolved. Cognitive testing showed a major improvement in two patients, whereas cognitive performances were slightly worsened in the third, reasonably due to the effects of a head injury before LT and a tacrolimus-related encephalopathy arising early after LT. MRI images 12 months later showed a slight reduction of the previously disclosed abnormalities in all three patients. None of them experienced recurrence of CAHD. Our observation reinforces the assumption that surgery is the best treatment option for CAHD and that severe neurological impairment in CAHD should not be considered a contraindication for LT.
Assuntos
Degeneração Hepatolenticular/etiologia , Degeneração Hepatolenticular/cirurgia , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Transplante de Fígado/métodos , Doença Crônica , Degeneração Hepatolenticular/patologia , Humanos , Cirrose Hepática/patologia , Transplante de Fígado/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
We report an unusual case of sudden isolated transient amnesia triggered by acute marijuana use. The memory disorder, apart from the long duration, had the characteristics of a transient global amnesia-like episode. Acute marijuana intoxication can affect memory more globally and severely than previously reported.
Assuntos
Amnésia Global Transitória/induzido quimicamente , Fumar Maconha/psicologia , Doença Aguda , Adulto , Amnésia Global Transitória/fisiopatologia , Amnésia Global Transitória/psicologia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Eletroencefalografia , Humanos , Masculino , Fumar Maconha/fisiopatologia , Testes Neuropsicológicos , Tomografia Computadorizada de Emissão de Fóton ÚnicoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antivirais/uso terapêutico , Citarabina/uso terapêutico , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Adulto , Feminino , Humanos , Leucoencefalopatia Multifocal Progressiva/etiologia , MasculinoAssuntos
Adenoma/complicações , Ataxia/complicações , Neoplasias do Sistema Nervoso Central/complicações , Meningite/complicações , Oftalmoplegia/complicações , Adenoma/diagnóstico , Idoso , Ataxia/diagnóstico , Neoplasias do Sistema Nervoso Central/diagnóstico , Feminino , Humanos , Masculino , Meningite/diagnóstico , Pessoa de Meia-Idade , Oftalmoplegia/diagnóstico , Reflexo Anormal , SíndromeRESUMO
BACKGROUND AND PURPOSE: The incidence of stroke among inpatients is not known. The aim of our study was to investigate the incidence of stroke not preceded by evident iatrogenic factors such as surgical or medical procedures in a cohort of inpatients in a large Italian general hospital. METHODS: From January 1, 1992, to December 31, 1992, we evaluated patients referred to our neurology department with a suspected diagnosis of stroke that occurred during hospitalization. Patients presenting with stroke as a complication of iatrogenic causes were excluded. We calculated the incidence rate of first-ever stroke in our cohort (crude and among patients aged older than 50 years), thereafter adjusting these rates for age to the general population of the city district of Bologna (Italy). RESULTS: In 1992, 22 inpatients had a first-ever stroke with no evidence of iatrogenic factors. The crude stroke incidence rate was 11.08/1000 per year (95% confidence interval, 6.95 to 16.73). The age-adjusted rate was 5.46 (95% confidence interval 3.42 to 8.24). CONCLUSIONS: The incidence rate of first-ever stroke among hospitalized patients is higher than those reported in community-based studies. Higher frequency of coronary artery disease among our patients could explain our findings. Further studies are needed to identify possible predisposing factors (individual or environmental) for stroke among inpatients.
Assuntos
Transtornos Cerebrovasculares/epidemiologia , Pacientes Internados , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais com mais de 500 Leitos , Hospitais Gerais , Humanos , Doença Iatrogênica , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Prevalência , Fatores Sexuais , Procedimentos Cirúrgicos OperatóriosRESUMO
A case of transient global amnesia associated with an arachnoid cyst occupying the middle cranial fossa of the non dominant hemisphere is reported. The relationship between the two conditions is discussed and the value of CT brain scanning in patients with TGA emphasized.