RESUMEN
BACKGROUND AND OBJECTIVE: Giant pituitary adenomas (GPAs) are benign tumours with a diameter ≥ 4 cm [1]. They can cause symptoms and signs due to the possible hyper-secretion of one or more pituitary hormones, and involvement of the surrounding structures whereas the compression of the pituitary itself can lead to hypopituitarism. METHODS: We report on a young woman with acromegaly due to an inoperable giant GH-secreting pituitary adenoma extending to right cavernous sinus, right orbital cavity, ethmoid, right maxillary sinus, sphenoid sinus, clivus and right temporal fossa, in which medical treatment with Octreotide- LAR was able to promptly relieve headache and bilateral hemianopsia due to optic chiasm involvement, improve acromegaly symptoms and, over the time, control tumor expansion, improving fertility and therefore allowing the patient to become pregnant. RESULTS: Octreotide-LAR therapy was withdrawn during pregnancy and the patient did not experience complications and gave birth to a healthy son. On magnetic resonance, the size of the tumor at the end of pregnancy and in the subsequent follow up was not increased. CONCLUSION: The history we report, therefore, confirms previous experiences reporting a possible favourable outcome of pregnancy in patients affected by acromegaly and adds further information about the behaviour of giant pituitary tumors in patients underwent pregnancy.
Asunto(s)
Adenoma/tratamiento farmacológico , Adenoma Hipofisario Secretor de Hormona del Crecimiento/tratamiento farmacológico , Octreótido/uso terapéutico , Complicaciones Neoplásicas del Embarazo/tratamiento farmacológico , Acromegalia/diagnóstico , Acromegalia/tratamiento farmacológico , Acromegalia/etiología , Acromegalia/patología , Adenoma/complicaciones , Adenoma/diagnóstico , Adenoma/patología , Adulto , Antineoplásicos Hormonales/uso terapéutico , Femenino , Adenoma Hipofisario Secretor de Hormona del Crecimiento/complicaciones , Adenoma Hipofisario Secretor de Hormona del Crecimiento/diagnóstico , Adenoma Hipofisario Secretor de Hormona del Crecimiento/patología , Hemianopsia/diagnóstico , Hemianopsia/tratamiento farmacológico , Hemianopsia/etiología , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/tratamiento farmacológico , Síndromes de Compresión Nerviosa/etiología , Embarazo , Complicaciones Neoplásicas del Embarazo/diagnóstico , Complicaciones Neoplásicas del Embarazo/patología , Resultado del Embarazo , Carga TumoralRESUMEN
Homonymous hemianopsia (HH) is a common adverse outcome after stroke. Spontaneous improvement more than 6 months poststroke is thought to be unlikely, and traditional visual rehabilitation techniques lack clear evidence of efficacy. The case presented is of a 22-year-old woman who demonstrated improved compensation of her stroke-induced HH after the initiation of a selective serotonin reuptake inhibitor (SSRI). There is evidence supporting the use of SSRIs to improve poststroke cognitive impairment, motor impairment, and depression. This is the first case, however, demonstrating the potential novel use SSRIs to improve HH compensation after stroke, to our knowledge. LEVEL OF EVIDENCE: V.
Asunto(s)
Cognición/efectos de los fármacos , Hemianopsia/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Accidente Cerebrovascular/complicaciones , Enfermedad Crónica , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Hemianopsia/diagnóstico por imagen , Hemianopsia/etiología , Humanos , Imagen por Resonancia Magnética/métodos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/diagnóstico , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Adulto JovenAsunto(s)
Enfermedad de Alzheimer/diagnóstico , Hemianopsia/diagnóstico , Campos Visuales , Enfermedad de Alzheimer/tratamiento farmacológico , Atrofia , Inhibidores de la Colinesterasa/uso terapéutico , Donepezilo , Femenino , Hemianopsia/tratamiento farmacológico , Humanos , Indanos/uso terapéutico , Imagen por Resonancia Magnética , Persona de Mediana Edad , Pruebas Neuropsicológicas , Lóbulo Occipital/diagnóstico por imagen , Lóbulo Occipital/patología , Lóbulo Parietal/diagnóstico por imagen , Lóbulo Parietal/patología , Piperidinas/uso terapéutico , Pruebas del Campo VisualRESUMEN
We report an extremely rare case of Porphyromonas gingivalis causing brain abscess in a patient with recurrent periodontitis. The patient presented with right-sided homonymous hemianopsia and right hemiparesis. Emergent surgical drainage was performed and antibiotics were administered. P. gingivalis was identified from the anaerobic culture of the abscess. The clinical course of the patient improved with full recovery of the neurologic deficit.
Asunto(s)
Absceso Encefálico/microbiología , Hemianopsia/microbiología , Paresia/microbiología , Periodontitis/microbiología , Porphyromonas gingivalis/patogenicidad , Antibacterianos/uso terapéutico , Absceso Encefálico/complicaciones , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/cirugía , Genotipo , Hemianopsia/complicaciones , Hemianopsia/tratamiento farmacológico , Hemianopsia/cirugía , Humanos , Masculino , Persona de Mediana Edad , Paresia/complicaciones , Paresia/tratamiento farmacológico , Paresia/cirugía , Periodontitis/complicaciones , Periodontitis/tratamiento farmacológico , Periodontitis/cirugía , Porphyromonas gingivalis/crecimiento & desarrollo , Porphyromonas gingivalis/aislamiento & purificación , Recurrencia , Succión , Resultado del TratamientoRESUMEN
A 51-year-old man with rheumatoid arthritis and diabetes mellitus presented with new onset left-sided hemiparesis, left-sided neglect, and left-sided incongruous, denser inferiorly, homonymous hemianopsia. Magnetic resonance image of the brain showed prominent swelling of the right frontal, parietal, and occipital lobes greater than on the left with significant change in the fluid-attenuated inversion recovery signal in the gray matter. Perinuclear antineutrophil cytoplasmic antibodies titers were elevated, and skin biopsy demonstrating leukocytoclastic vasculitis. He showed marked clinical and radiographic improvement in association with recovery of vascular abnormalities after the initiation of prednisone, pulse therapy with methylprednisolone, and methotrexate. Clinicians should be aware of the possibility of neuro-ophthalmic manifestations of rheumatoid arthritis, including rheumatoid arthritis-related vasculitis causing homonymous hemianopsia.
Asunto(s)
Artritis Reumatoide/diagnóstico , Hemianopsia/diagnóstico , Vasculitis del Sistema Nervioso Central/diagnóstico , Vasculitis Leucocitoclástica Cutánea/diagnóstico , Anticuerpos Anticitoplasma de Neutrófilos/sangre , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/inmunología , Diabetes Mellitus/diagnóstico , Diagnóstico Diferencial , Quimioterapia Combinada , Glucocorticoides/uso terapéutico , Hemianopsia/tratamiento farmacológico , Hemianopsia/inmunología , Humanos , Inmunosupresores/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Metotrexato/uso terapéutico , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Prednisona/uso terapéutico , Quimioterapia por Pulso , Vasculitis del Sistema Nervioso Central/tratamiento farmacológico , Vasculitis del Sistema Nervioso Central/inmunología , Vasculitis Leucocitoclástica Cutánea/tratamiento farmacológico , Vasculitis Leucocitoclástica Cutánea/inmunología , Pruebas del Campo Visual , Campos VisualesAsunto(s)
Hemianopsia/tratamiento farmacológico , Hemianopsia/parasitología , Neuroesquistosomiasis/diagnóstico , Neuroesquistosomiasis/tratamiento farmacológico , Parestesia/tratamiento farmacológico , Parestesia/parasitología , Animales , Cefalea/tratamiento farmacológico , Cefalea/parasitología , Humanos , Masculino , Persona de Mediana Edad , Filipinas , Schistosoma mansoni/aislamiento & purificación , Viaje , Estados UnidosRESUMEN
The case of a 37-year-old woman suffering from a relapsing-remitting tumefactive inflammatory disease of the central nervous system (CNS) is described. The patient had four severe relapses over eight years, and was treated with steroids, immunosuppression and plasma-exchange with modest benefit. No magnetic resonance imaging or cerebrospinal spinal fluid findings suggestive of multiple sclerosis emerged during the eight-year follow-up. 'Relapsing-remitting tumefactive inflammation' seems to have the features of a distinct inflammatory CNS disease.
Asunto(s)
Neoplasias Encefálicas/patología , Encéfalo/patología , Enfermedades Desmielinizantes/patología , Encefalitis/patología , Hemianopsia/patología , Adulto , Neoplasias Encefálicas/líquido cefalorraquídeo , Neoplasias Encefálicas/tratamiento farmacológico , Enfermedades Desmielinizantes/líquido cefalorraquídeo , Enfermedades Desmielinizantes/tratamiento farmacológico , Encefalitis/líquido cefalorraquídeo , Encefalitis/tratamiento farmacológico , Femenino , Glucocorticoides/uso terapéutico , Hemianopsia/líquido cefalorraquídeo , Hemianopsia/tratamiento farmacológico , Humanos , Imagen por Resonancia Magnética , Metilprednisolona/uso terapéutico , Recurrencia , SíndromeRESUMEN
A 54-year-old woman presented to the ophthalmology emergency department with a 10-day history of blurred vision. The best-corrected visual acuities and Ishihara colour vision were bilaterally reduced with a left relative afferent pupillary defect. Slit-lamp examination was otherwise normal. Retrobulbar optic neuritis (ON) was presumed as she had suffered with this previously and was known to have multiple sclerosis (MS). She was recalled the following week for visual field (VF) testing, which was not available at the time of presentation. VFs demonstrated an incongruous left homonymous hemianopia. She was immediately referred to the medical team to investigate for a stroke, which was subsequently excluded. Thereafter, a trial of pulsed methylprednisolone was commenced, resulting in near complete resolution of the hemianopia. This case demonstrates not only the importance of VF testing, but also how ON may present with any field defect, including mimicking a stroke, a point valuable to ophthalmologists and medics alike.
Asunto(s)
Hemianopsia/diagnóstico , Esclerosis Múltiple Recurrente-Remitente/complicaciones , Neuritis Óptica/diagnóstico , Trastornos de la Pupila/diagnóstico , Accidente Cerebrovascular/diagnóstico , Agudeza Visual , Campos Visuales , Femenino , Glucocorticoides/uso terapéutico , Hemianopsia/tratamiento farmacológico , Hemianopsia/etiología , Humanos , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Neuritis Óptica/complicaciones , Neuritis Óptica/tratamiento farmacológico , Trastornos de la Pupila/tratamiento farmacológico , Trastornos de la Pupila/etiología , Pruebas del Campo VisualAsunto(s)
Venas Cerebrales , Hemianopsia/etiología , Trombosis de los Senos Intracraneales/complicaciones , Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Enoxaparina/uso terapéutico , Femenino , Hemianopsia/diagnóstico , Hemianopsia/tratamiento farmacológico , Humanos , Imagen por Resonancia Magnética , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Pruebas del Campo Visual , Campos Visuales , Warfarina/uso terapéutico , Adulto JovenRESUMEN
Introdução: A hemianopsia homônima ocorre apenas na presença de lesão retroquiasmática, sendo uma rara apresentação de doença desmielinizante. Objetivo: Relatar um caso raro de hemianopsia homônima como manifestação inicial de síndrome clinicamente isolada. Método: Foi realizada uma revisão de 809 prontuários médicos de pacientes com esclerose múltipla (EM) tratados no Hospital da Lagoa (Rio de Janeiro) entre 1995 e 2011, para identificação de casos de hemianopsiahomônima como manifestação inicial da doença. Relato de caso: Paciente do sexo feminino, 48 anos, apresentou em agosto de 2011 quadro de hemianopsia homônima esquerda incongruente associada à lesão em topografia do trato óptico direito, evidenciada na RM de crânio, que também revelou lesões periventriculares e em substância branca subcortical, compatíveis com doença desmielinizante. O exame do líquido cefalorraquidiano (LCR) revelou hiperproteinemia leve com síntese intratecal de IgG e IgM, e o estudo do potencial visual evocado mostrou comprometimento parcial das vias ópticas bilateralmente. Concluído o diagnóstico de síndrome clinicamente isolada, a paciente foi submetida à pulsoterapia com metilprednisolona, com remissão das queixas visuais e melhora acentuada do campo visual no segundo exame realizado. O diagnóstico de EM foi concluído em dezembro de 2011, com o resultado da segunda RM, que revelou redução no tamanho da lesão em topografia do trato óptico direito e persistência das lesões focais periventriculares e subcorticais, com o surgimento de novas lesões frontais captantes de contraste. Conclusão: Embora a neurite óptica seja a manifestação ocular mais frequente da síndrome clinicamente isolada, deve-se estar atento a outras formas atípicas de apresentação para que se possa fazer um diagnóstico precoce. Os defeitos de campo visual na EM geralmente têm bom prognóstico com o tratamento adequado...
Introduction: Homonymous hemianopia occurs only in the presenceof retrochiasmatic injury, being a rare presentation of demyelinatingdisease. Objective: To report a rare case of homonymoushemianopia as the initial manifestation of clinically isolated syndrome.Method: We conducted a review of medical records of 809 patientswith multiple sclerosis (MS) treated at Hospital da Lagoa (Rio de Janeiro) between 1995 and 2011, being found only one case of homonymous hemianopia as the initial manifestation of the disease. Case report: Female patient, 48 years old, presented in August 2011 incongruous left homonymous hemianopia associated with lesion in topography of the right optic tract evidenced in MRI, which also revealed lesions in periventricular and subcortical white matter, consistent with demyelinating disease. CSF revealed mild hyperproteinemia with intrathecal synthesis of IgG and IgM, and visual evoked potential study showed partial compromise of the optic pathways bilaterally. Completed the diagnostic of clinically isolated syndrome, the patient underwent pulse therapy with methylprednisolone, with remission of visual complaints and marked improvement of the visual in the second examination performed. The diagnosis of MS was completed in December 2011 with the result of the second MRI, which revealed a reduction in the lesion size in the right optic tract topography and persistence of periventricular and subcortical focal lesions, with theemergence of new frontal lesions uptake of contrast. Conclusion:Although optic neuritis is the most common ocular manifestation ofclinically isolated syndrome, we should be mindful of other atypicalforms of presentation so that we can make an early diagnosis. Thevisual defects in MS usually have a good prognosis with appropriatetreatment...
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Esclerosis Múltiple/diagnóstico , Hemianopsia/diagnóstico , Hemianopsia/tratamiento farmacológico , Neuritis Óptica , Cráneo , Enfermedades Autoinmunes Desmielinizantes SNC , Examen Neurológico/métodos , Imagen por Resonancia Magnética , Metilprednisolona/uso terapéuticoAsunto(s)
Encéfalo/patología , Dislexia/etiología , Hemianopsia/etiología , Deficiencia de Vitamina B 12/complicaciones , Dislexia/tratamiento farmacológico , Dislexia/patología , Hemianopsia/tratamiento farmacológico , Hemianopsia/patología , Humanos , Masculino , Vitamina B 12/uso terapéutico , Deficiencia de Vitamina B 12/tratamiento farmacológico , Deficiencia de Vitamina B 12/patologíaAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Hemianopsia/diagnóstico , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/patología , Recurrencia Local de Neoplasia/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Biopsia con Aguja , Bleomicina/uso terapéutico , Ciclofosfamida/uso terapéutico , Progresión de la Enfermedad , Doxorrubicina/uso terapéutico , Etopósido/uso terapéutico , Femenino , Estudios de Seguimiento , Hemianopsia/tratamiento farmacológico , Hemianopsia/etiología , Enfermedad de Hodgkin/complicaciones , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Prednisona/uso terapéutico , Procarbazina/uso terapéutico , Vincristina/uso terapéuticoRESUMEN
BACKGROUND: Patients with posterior ischemic stroke were usually excluded from thrombolytic treatment in clinical trials and clinical practice, and little is known about effectiveness of thrombolysis treatment in such patients who may end up with severe disability. AIMS OF THE STUDY: We aimed to describe the outcome of acute ischemic stroke patients presenting with isolated homonymous hemianopia and treated with intravenous thrombolysis. METHODS: A case report of three patients presenting with homonymous hemianopia owing to posterior circulation stroke treated with intravenous thrombolysis at the Helsinki University Central Hospital. Main outcome measures were modified Rankin Scale and neuropsychological examination at 3 months after thrombolysis. We further evaluated Goldmann visual field examination at 6 months. RESULTS: No acute findings appeared on admission non-contrast head-computed tomography scan. All patients had a perfusion deficit on admission-computed tomography perfusion imaging. All patients scored 0 on 3-month modified Rankin Scale, and their neuropsychological evaluation was normal. Goldmann examination revealed no visual field deficit in both female patients, and a modest visual field defect was detected in the male patient. CONCLUSIONS: Our experience encourages application of intravenous thrombolytic treatment (especially when supported with multimodality neuroimaging) in patients with homonymous hemianopia, for which rehabilitation options are limited.
Asunto(s)
Fibrinolíticos/administración & dosificación , Hemianopsia/tratamiento farmacológico , Hemianopsia/etiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/tratamiento farmacológico , Administración Intravenosa , Adulto , Anciano , Infarto Encefálico/etiología , Infarto Encefálico/patología , Angiografía Cerebral , Femenino , Hemianopsia/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Campos Visuales/efectos de los fármacosRESUMEN
We reported a patient who suffered from complex visual hallucinations with left homonymous hemianopsia. Brain imaging showed an acute haemorrhage infarct at the right occipital lobe. Charles Bonnet syndrome (CBS) was suspected and aripiprazole was prescribed at 5 mg daily. After 3 weeks, the symptoms of hallucinations and anxiety were relieved. Although some CBS patients might be self-limited without discomfort, low-dose aripiprazole can be considered as a safe medication for significantly anxious patients with CBS.
Asunto(s)
Antipsicóticos/administración & dosificación , Infarto Cerebral/tratamiento farmacológico , Alucinaciones/tratamiento farmacológico , Hemianopsia/tratamiento farmacológico , Lóbulo Occipital/irrigación sanguínea , Lóbulo Occipital/efectos de los fármacos , Piperazinas/administración & dosificación , Quinolonas/administración & dosificación , Campos Visuales/efectos de los fármacos , Anciano , Aripiprazol , Infarto Cerebral/fisiopatología , Dominancia Cerebral/efectos de los fármacos , Dominancia Cerebral/fisiología , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Alucinaciones/fisiopatología , Hemianopsia/fisiopatología , Humanos , Síndrome , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Campos Visuales/fisiologíaRESUMEN
The pathogenesis of migraine with aura has not been fully established yet. The release of vasoactive substances and intracranial extracerebral blood vessel vasodilatation are probably related to stimulation of meningeal blood vessels through trigeminal afferents. Here, we report a 67 year old woman developing migraine with aphasia and right hemianopsia, lasting 4 days in duration. After spontaneous recovery, she experienced the same symptoms without migraine lasting for 15 h. MRI, performed during this last episode, revealed increased perfusion and leakage of contrast into subarachnoid space. In migraine with prolonged aura hyperperfusion with vasogenic edema might explain cortical function impairment and contribute to neurological deficits.
Asunto(s)
Afasia/patología , Encéfalo/patología , Hemianopsia/patología , Migraña con Aura/patología , Anciano , Afasia/tratamiento farmacológico , Encéfalo/efectos de los fármacos , Medios de Contraste , Femenino , Flunarizina/uso terapéutico , Estudios de Seguimiento , Lateralidad Funcional , Hemianopsia/tratamiento farmacológico , Humanos , Migraña con Aura/tratamiento farmacológico , Espacio Subaracnoideo/efectos de los fármacos , Espacio Subaracnoideo/patología , Factores de Tiempo , Vasodilatadores/uso terapéuticoRESUMEN
A 58-year-old woman presented with a problem with her peripheral vision. Computed tomography scan showed an occipital hemorrhagic stroke. She subsequently suffered gastrointestinal bleeding and at surgery biopsy of a portion of the middle colic artery aneurysm revealed changes consistent with polyarteritis nodosa.
Asunto(s)
Hemorragia Cerebral/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemianopsia/diagnóstico , Poliarteritis Nudosa/diagnóstico , Accidente Cerebrovascular/diagnóstico , Hemorragia Cerebral/tratamiento farmacológico , Ciclofosfamida/uso terapéutico , Quimioterapia Combinada , Femenino , Hemorragia Gastrointestinal/tratamiento farmacológico , Hemorragia Gastrointestinal/cirugía , Hemianopsia/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéutico , Angiografía por Resonancia Magnética , Persona de Mediana Edad , Poliarteritis Nudosa/tratamiento farmacológico , Prednisona/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Agudeza Visual , Campos VisualesRESUMEN
BACKGROUND: Internal carotid artery (ICA) dissection is a well-known cause of anterior circulation stroke, but its association with posterior circulation stroke has been less commonly reported. The latter situation can arise when there is persistent fetal circulation of the posterior cerebral artery and has, to our knowledge, never been reported in the setting of fibromuscular dysplasia (FMD) involving the ICA. METHODS: A 52-year-old man awoke with severe headache and noted visual loss. Examination confirmed a congruous left homonymous hemianopsia. A head computed tomography scan revealed an acute right posterior parietal infarct. Carotid ultrasonography demonstrated complete occlusion of the right ICA. Conventional angiography confirmed this and was diagnostic of FMD with dissection. A right-sided persistent fetal circulation was also noted. Magnetic resonance imaging revealed right parietal and right occipital infarctions. RESULTS: The patient received ASA and clopidogrel and his visual deficit resolved within days. One year later, he remained asymptomatic and there was no suggestion of FMD in other vascular beds. CONCLUSIONS: Although infrequently reported, carotid disease, including dissection, can be responsible for posterior circulation infarcts. Cervical artery dissection can be related to underlying arteriopathies such as FMD, which must be differentiated from vasculitis and vasospasm.
Asunto(s)
Disección de la Arteria Carótida Interna/etiología , Infarto Cerebral/etiología , Displasia Fibromuscular/complicaciones , Hemianopsia/etiología , Síndrome de Circulación Fetal Persistente/complicaciones , Aspirina/administración & dosificación , Aspirina/uso terapéutico , Disección de la Arteria Carótida Interna/diagnóstico por imagen , Angiografía Cerebral , Infarto Cerebral/diagnóstico , Infarto Cerebral/tratamiento farmacológico , Clopidogrel , Cefalea/etiología , Hemianopsia/tratamiento farmacológico , Humanos , Hipercolesterolemia/complicaciones , Recién Nacido , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Migraña sin Aura/complicaciones , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/uso terapéutico , Ticlopidina/administración & dosificación , Ticlopidina/análogos & derivados , Ticlopidina/uso terapéutico , UltrasonografíaRESUMEN
We report a rare case of a 57-year-old woman of neuro-Behçet disease with homonymous quadrantanopsia due to an inflammatory lesion involving the lateral geniculate body. She had oral and genital ulcers since 1983, and uveitis since May 1985. She received diagnosis of incomplete Behçet disease and was prescribed cyclophosphamide since June 1985. After the treatment, she recovered completely from uveitis in July 1985. Painful subcutaneous nodules appeared in her right leg on June 21, 2004 and she had a high fever, headache and left visual disturbance on June 29, 2004. Therefore, she was admitted to our hospital on July 1, 2004. Physical and neurological examination showed erythema nodosum in the right lower extremity and left lower homonymous quadrantanopsia. Laboratory findings on admission showed leucocytosis, increased erythrocyte sedimentation rate and C-reactive protein, and positive HLA-B51. Cerebrospinal fluid analysis showed pleocytosis and a markedly high level of protein and interleukin-6. Brain magnetic resonance imaging (MRI) of T2-weighted images showed high intensity lesions in the circumference of the caudal thalamus, optic radiations, and right occipital cortex. T1-weighted images with gadolinium enhancement showed an enhanced lesion in the circumference of the right lateral geniculate body. From these results, she was diagnosed as having an acute relapsing phase of neuro-Behçet disease and she received steroid pulse therapy. Immediately after steroid pulse therapy, she received high-dose prednisolone which was gradually tapered. Brain MRI after treatment showed a high intensity lesion in the right lateral geniculate body. Homonymous quadrantanopsia remained nearly unchanged.
Asunto(s)
Síndrome de Behçet/complicaciones , Encefalitis/etiología , Cuerpos Geniculados , Hemianopsia/etiología , Síndrome de Behçet/tratamiento farmacológico , Encefalitis/diagnóstico , Encefalitis/tratamiento farmacológico , Femenino , Cuerpos Geniculados/patología , Hemianopsia/tratamiento farmacológico , Humanos , Imagen por Resonancia Magnética , Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Prednisolona/administración & dosificación , Quimioterapia por Pulso , Resultado del TratamientoRESUMEN
Four patients each developed a reversible homonymous hemianopia caused by non-ketotic hyperglycemia. In two patients the homonymous hemianopia was the first manifestation of diabetes mellitus type 2. All four patients had abnormal MRI scans; in the three patients who had late follow-up scans the abnormalities resolved completely. In one patient the progressive visual field defect and unusual MRI findings initially caused concern for a tumor.
Asunto(s)
Encefalopatías Metabólicas/etiología , Diabetes Mellitus Tipo 2/complicaciones , Hemianopsia/etiología , Hiperglucemia/complicaciones , Adulto , Anciano , Encéfalo/metabolismo , Encéfalo/patología , Encéfalo/fisiopatología , Encefalopatías Metabólicas/tratamiento farmacológico , Encefalopatías Metabólicas/fisiopatología , Deshidratación/etiología , Deshidratación/fisiopatología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/fisiopatología , Diagnóstico Diferencial , Progresión de la Enfermedad , Hemianopsia/tratamiento farmacológico , Hemianopsia/fisiopatología , Humanos , Hiperglucemia/tratamiento farmacológico , Hiperglucemia/fisiopatología , Insulina/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Fibras Nerviosas Mielínicas/metabolismo , Fibras Nerviosas Mielínicas/patología , Neuroglía/metabolismo , Neuroglía/patología , Convulsiones/etiología , Convulsiones/fisiopatología , Resultado del Tratamiento , Vías Visuales/metabolismo , Vías Visuales/patología , Vías Visuales/fisiopatologíaRESUMEN
A 34-year-old woman with eclampsia and the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome developed encephalopathy, cardiomyopathy, pulmonary edema, liver failure, and disseminated intravascular coagulation (DIC), all of which resolved. She also had retinal hemorrhages in both eyes and a hemorrhagic infarct in the left occipital lobe that resulted in a permanent right homonymous hemianopia and a persistently depressed acuity of 20/100 OS. This case is unusual in demonstrating permanent visual deficits. In nearly all cases of preeclampsia or eclampsia, visual deficits are reversible. The superimposition of the HELLP syndrome may create more neurologic damage. Clinicians should be alert to patients at risk for HELLP syndrome and manage them aggressively.