RESUMEN
INTRODUCTION: Non-ketosic hyperglycemia (NKH) may increase the likelihood of focal epileptic seizures, including commonly motor expression; rarely, they can have a visual expression. METHODS: The authors describe the observation of two men, who were hospitalized for visual manifestations; with episodes of homonymous hemianopia and hallucinations, revealing occipital seizure, secondary to NKH. Clinical data and characteristics of the investigations, including radiological imaging (MRI) and electrophysiological results of visual evoked potentials (VEP) are specified. RESULTS: MRI showed transitory low signal on T2 and FLAIR in occipital areas. Spectro-MR identified a moderate diminution of the NAA and lipids spikes, compatible with laminar necrosis. VEP revealed a transient decrease of the P100 amplitude. DISCUSSION: These two observations underline the existence of acute symptomatic seizures with a visual starting point which is often indicative of diabetes. Through these observations with a review of 28 patients from the literature, MR imaging characteristics and possible anomalies collected on VEP are discussed. Such seizures are resistant to anticonvulsant treatment and respond best to insulin and rehydration. CONCLUSION: The visual manifestations indicative of seizures with an occipital starting point in the context of NKH are possible enabling rapid initiation of effective symptomatic treatment with insulin.
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Diabetes Mellitus Tipo 2/complicaciones , Electroencefalografía , Epilepsias Parciales/etiología , Potenciales Evocados Visuales , Alucinaciones/etiología , Hemianopsia/etiología , Imagen por Resonancia Magnética , Lóbulo Occipital/fisiopatología , Convulsiones/etiología , Anticonvulsivantes/uso terapéutico , Glucemia/análisis , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Imagen de Difusión por Resonancia Magnética , Quimioterapia Combinada , Epilepsias Parciales/sangre , Epilepsias Parciales/diagnóstico , Epilepsias Parciales/tratamiento farmacológico , Epilepsias Parciales/patología , Hemoglobina Glucada/análisis , Humanos , Insulina/uso terapéutico , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética , Masculino , Persona de Mediana Edad , Lóbulo Occipital/patología , Convulsiones/sangre , Convulsiones/diagnóstico , Convulsiones/tratamiento farmacológico , Convulsiones/patología , Campos VisualesRESUMEN
INTRODUCTION: Serious leukoencephalopathy can be related to heroin injection or inhalation. OBSERVATION: We report the first case of leukoencephalopathy observed three weeks after a 46-year-old man sniffed heroin. The clinical presentation included cognitive and behaviour disorders, pyramidal irritation and slight gait instability. Blood and cerebrospinal fluid analyse were normal. Brain magnetic resonance imaging showed diffuse, symmetrical supratentorial white matter lesions producing high intense signals on FLAIR and b1000-weighted sequences. Proton spectroscopy revealed an increased rate of cholin, in favour of active demyelinated lesions. Brain biopsy showed intramyelinic oedema with reactive gliosis. After two and a half years, moderate attentional fluctuations and difficulties in initiating activities persisted. Repeated MRI showed a reduction of the leukoencephalopathy. CONCLUSION: Heroin could be a cause more common than thought of leukoencephalopathy. The clinical and radiological expression and prognosis could be related to the mode of consummation (inhalation, intravenous injection, sniffing). This parameter may modulate severity and localization of brain lesions. More systematic use of MRI for patients with psychiatric symptoms after heroin intoxications could lead to a better evaluation of heroin-related neurotoxicity and potentially improve prevention.
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Heroína/efectos adversos , Leucoencefalopatías/inducido químicamente , Narcóticos/efectos adversos , Administración por Inhalación , Biopsia , Química Encefálica/efectos de los fármacos , Edema Encefálico/patología , Colina/metabolismo , Trastornos del Conocimiento/inducido químicamente , Trastornos del Conocimiento/psicología , Enfermedades Desmielinizantes/patología , Gliosis/patología , Heroína/administración & dosificación , Dependencia de Heroína/complicaciones , Dependencia de Heroína/patología , Dependencia de Heroína/psicología , Humanos , Leucoencefalopatías/patología , Leucoencefalopatías/psicología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Narcóticos/administración & dosificación , PronósticoRESUMEN
The superior mesenteric artery (SMA) syndrome is an atypical cause of high intestinal obstruction in adults. Formerly considered controversial, this syndrome has now been recognized as a real clinical entity which results from extrinsic compression of the third portion of the duodenum by reduction of the angle formed between the SMA and the aorta, usually favoured by rapid and dramatic weight loss. We report a case observed in a 25-year-old female. The abdominal scan provided the diagnosis. Laparoscopic duodenojejunostomy provided cure after failure of initial conservative treatment.
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Obstrucción Intestinal/etiología , Síndrome de la Arteria Mesentérica Superior/diagnóstico , Adulto , Medios de Contraste , Duodenostomía , Femenino , Humanos , Yeyunostomía , Laparoscopía , Síndrome de la Arteria Mesentérica Superior/cirugía , Tomografía Computarizada por Rayos X , Vómitos , Pérdida de PesoRESUMEN
This is a new case of Susac syndrome in a 27-year-old woman with polymorphic neurological disorders, her brain MRI showed multifocal hyperintense signals on T2-weighted images with possible effects on the corpus callosum. However, visualization of an occlusion in the retinal arterial branch of the right eye and hypoacusia on the right side allowed confirmation of the diagnosis. In this case report, we describe the imaging aspects of Susac syndrome and demonstrate that brain MRI allows the syndrome to be diagnosed at an early stage.
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Encéfalo/patología , Pérdida Auditiva/patología , Imagen por Resonancia Magnética/métodos , Oclusión de la Arteria Retiniana/patología , Síndrome de Susac/patología , Trastornos de la Visión/patología , Adulto , Angiografía , Cuerpo Calloso/patología , Femenino , Lateralidad Funcional , Pérdida Auditiva/diagnóstico , Humanos , Arteria Retiniana/patología , Oclusión de la Arteria Retiniana/diagnóstico , Síndrome de Susac/diagnóstico , Trastornos de la Visión/diagnósticoAsunto(s)
Hernia Abdominal/diagnóstico por imagen , Hernia Abdominal/cirugía , Íleon , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/cirugía , Epiplón , Tomografía Computarizada por Rayos X , Anciano , Diagnóstico Diferencial , Procedimientos Quirúrgicos del Sistema Digestivo , Femenino , Hernia Abdominal/complicaciones , Humanos , Obstrucción Intestinal/etiología , Enfermedades Raras , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del TratamientoAsunto(s)
Enfermedad de Erdheim-Chester , Mesenterio , Enfermedades Peritoneales , Biopsia , Enfermedad de Erdheim-Chester/diagnóstico , Enfermedad de Erdheim-Chester/diagnóstico por imagen , Enfermedad de Erdheim-Chester/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Mesenterio/patología , Persona de Mediana Edad , Enfermedades Peritoneales/diagnóstico , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/patología , Tomografía Computarizada por Rayos XAsunto(s)
Tumores Estromáticos Endometriales/diagnóstico , Endosonografía , Imagen por Resonancia Magnética , Enfermedades Raras , Ultrasonografía Doppler , Adulto , Diagnóstico Diferencial , Tumores Estromáticos Endometriales/patología , Tumores Estromáticos Endometriales/cirugía , Endometrio/patología , Femenino , Humanos , HisterectomíaAsunto(s)
Infecciones por Chlamydia/complicaciones , Chlamydia trachomatis , Enfermedad Inflamatoria Pélvica/diagnóstico por imagen , Enfermedad Inflamatoria Pélvica/microbiología , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/microbiología , Tomografía Computarizada por Rayos X , Medios de Contraste , Femenino , Humanos , Síndrome , Tomografía Computarizada por Rayos X/métodos , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: The first part of this study assessed the potential of MDCT with a CTA examination of the aorta and the coronary, cervical, and intracranial vessels in the etiologic work-up of TIA or ischemic stroke compared with established imaging methods. The objective of the second part of this study was to assess the atherosclerotic extent by use of MDCT in these patients. MATERIALS AND METHODS: From August 2007 to August 2011, a total of 96 patients with ischemic stroke or TIA without an evident cardioembolic source were enrolled. All patients underwent MDCT. Atherosclerotic extent was classified in 0, 1, 2, 3, and 4 atherosclerotic levels according to the number of arterial territories (aortic arch, coronary, cervical, intracranial) affected by atherosclerosis defined as ≥ 50% cervical, intracranial, or coronary stenosis or ≥ 4-mm aortic arch plaque. RESULTS: There were 91 patients who had an interpretable MDCT. Mean age was 67.4 years (± 11 years), and 75 patients (83.3%) were men. The prevalence of 0, 1, 2, 3, and 4 atherosclerotic levels was 48.3%, 35.2%, 12.1%, 4.4%, and 0%, respectively. Aortic arch atheroma was found in 47.6% of patients with 1 atherosclerotic level. The combination of aortic arch atheroma and cervical stenosis was found in 63.6% of patients with ≥ 2 atherosclerotic levels. Patients with ≥ 2 atherosclerotic levels were older than patients with < 2 atherosclerotic levels (P = .04) in univariate analysis. CONCLUSIONS: MDCT might be useful to assess the extent of atherosclerosis. It could help to screen for high-risk patients who could benefit from a more aggressive preventive strategy.
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Aterosclerosis/complicaciones , Aterosclerosis/diagnóstico por imagen , Isquemia Encefálica/etiología , Ataque Isquémico Transitorio/etiología , Tomografía Computarizada Multidetector/métodos , Accidente Cerebrovascular/etiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Blood supply to the human thalami is complex and multiple variants exist. The artery of Percheron is one of those variants and is characterized by a solitary arterial trunk that branches from one of the proximal segments of either posterior cerebral artery and supplies blood to the paramedian thalami. Its occlusion results in bilateral paramedian thalamic infarction sometimes extending to the midbrain. We report six cases of bithalamic infarction secondary to occlusion of the artery of Percheron. We will illustrate the complex clinical symptomatology and underscore the role of imaging, especially MRI, for diagnosis.