RESUMEN
Parkinsonism as well as dystonic signs are rarely seen in central pontine myelinolysis and extrapontine myelinolysis. A 51 year old woman developed central pontine myelinolysis and extrapontine myelinolysis with parkinsonism after severe vomiting which followed alcohol and drug intake, even though marked hyponatraemia had been corrected gradually over six days. Parkinsonism resolved four months after onset, but she then exhibited persistent retrocollis, spasmodic dysphonia, and focal dystonia of her left hand. Although the medical literature documents three similar patients, this patient is different as dystonic symptoms only developed four months after parkinsonian signs had resolved.
Asunto(s)
Distonía/diagnóstico , Mielinólisis Pontino Central/diagnóstico , Enfermedad de Parkinson Secundaria/diagnóstico , Núcleo Caudado/patología , Distonía/etiología , Femenino , Humanos , Hiponatremia/complicaciones , Hiponatremia/etiología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Mielinólisis Pontino Central/etiología , Examen Neurológico , Enfermedad de Parkinson Secundaria/etiología , Puente/patología , Putamen/patología , Tálamo/patologíaRESUMEN
The dramatic therapeutic response of disseminated superficial actinic porokeratosis (DSAP) to retinoid plus psoralens with ultraviolet A prompted a review of clinical, histologic, and etiologic data of all of the DSAP cases available in the English and German literature. The review showed that many case reports lack adequate documentation to confirm actinic induction. More than one third of the patients have observed no exacerbations during the summer. Histologic damage after long-term ultraviolet (UV) exposure could not be observed in every case. In addition, cases do exist in which lesions are distributed mainly in non-UV-exposed skin. These data cause doubt about the importance of actinic induction of DSAP.