RESUMO
Cervical artery dissection (CAD) recurrences are rare but the risk could be higher during the first month. Twenty-seven consecutive patients admitted for an acute CAD were investigated using a standardized imaging protocol. An early asymptomatic recurrence was observed in three patients 49 to 53 days after the initial diagnosis. Anticoagulation was maintained and the prognosis remained good. Early CAD recurrences may have been underestimated previously, because asymptomatic recurrences seem to be more frequent than symptomatic ones.
Assuntos
Dissecção Aórtica , Adulto , Dissecção Aórtica/tratamento farmacológico , Dissecção Aórtica/etiologia , Anticoagulantes/uso terapêutico , Isquemia Encefálica/etiologia , Dissecação da Artéria Carótida Interna/complicações , Estenose das Carótidas/complicações , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Manipulação Quiroprática/efeitos adversos , Pessoa de Meia-Idade , Recidiva , Fumar/efeitos adversos , Fatores de Tempo , Dissecação da Artéria Vertebral/complicaçõesRESUMO
The syndrome of peduncular hallucinosis in characterized by transient visual hallucinations which often consist in animated and mobile characters or animals, and which are often associated with disordered sleep. Although vivid and life) like, these hallucinations are generally not mistaken for reality. In view of the associated neurological symptoms, this syndrome was first believed to occur only with lesions of the mesencephalon. Lesions restricted to the mesencephalon have been identified with MRI in a few cases and were demonstrated by pathological verification in one patient with this syndrome. We describe a patient who experienced very similar hallucinations following a unilateral infarct restricted to the cerebellum, rostral protuberance and posterior thalamus. No lesion was seen in the mesencephalon with MRI. This case confirms that the lesions responsible for peduncular hallucinosis are not restricted to the mesencephalon, which suggests that several interconnected neural structures are probably involved in the genesis of this type of visual hallucinations. During the days following the stroke, our patient also experienced transient sensations of pleasure which he considered as abnormal. In view of the site of the lesions in this case, the visual hallucinations may be explained by a disinhibition of ponto-geniculo-occipital waves. A transient activation of reward-system pathways traveling in the brainstem ventral tegmentum may have contributed to the occurrence of the abnormal sensations of pleasure.