Asunto(s)
Disección Aórtica , Arteria Basilar , Síndrome de Enclaustramiento , Humanos , Arteria Basilar/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/complicaciones , Síndrome de Enclaustramiento/diagnóstico por imagen , Síndrome de Enclaustramiento/complicaciones , Masculino , Persona de Mediana Edad , Angiografía Cerebral , Angiografía por Tomografía Computarizada/métodos , FemeninoAsunto(s)
Trastornos Relacionados con Anfetaminas , Síndrome de Enclaustramiento , Puente , Humanos , Masculino , Trastornos Relacionados con Anfetaminas/complicaciones , Síndrome de Enclaustramiento/etiología , Síndrome de Enclaustramiento/complicaciones , Síndrome de Enclaustramiento/diagnóstico por imagen , Puente/diagnóstico por imagen , Puente/irrigación sanguínea , Adulto , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/etiología , Imagen por Resonancia Magnética/métodosRESUMEN
Coronavirus Disease 2019 (COVID-19) can be associated with various neurological manifestations including acute strokes. Hyper acute diagnosis and treatment are key factors which decrease mortality and morbidity in stroke patients. The COVID-19 pandemic has introduced a great strain on the healthcare system, and as a result clinicians are facing several barriers in diagnosing and treating strokes. Delayed presentation of strokes is a problem as some in the general population defer the decision to seek immediate medical attention fearing contracting the virus. Also playing a role is the paucity of healthcare professionals available during a pandemic. Recent literature demonstrates the association of acute strokes in young patients with COVID-19. Lack of clear pathophysiology of the neurological manifestations from COVID-19 intensifies the problem. A thorough examination of the intensive care unit patient has always been a challenge owing to several factors including use of sedatives, sepsis, uremia, and encephalopathy secondary to medications. Locked-In Syndrome (LIS) secondary to stroke is much more challenging to diagnose as patients are unable to communicate or elicit any motor functions apart from certain ocular movements. We present the case of a 25 year old patient with no known history of coagulopathy, but had developed COVID-19 cytokine storm which culminated in LIS secondary to pontine strokes.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Síndrome de Enclaustramiento/etiología , Neumonía Viral/complicaciones , Adulto , COVID-19 , Femenino , Humanos , Síndrome de Enclaustramiento/diagnóstico por imagen , Pandemias , SARS-CoV-2 , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiologíaAsunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Síndrome de Enclaustramiento/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Polirradiculoneuropatía/diagnóstico por imagen , Enfermedad Aguda , COVID-19 , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Humanos , Inmunoglobulinas Intravenosas/administración & dosificación , Síndrome de Enclaustramiento/complicaciones , Síndrome de Enclaustramiento/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/tratamiento farmacológico , Polirradiculoneuropatía/complicaciones , Polirradiculoneuropatía/tratamiento farmacológico , SARS-CoV-2RESUMEN
BACKGROUND: Lumbar puncture is a common procedure that can be safely performed in most patients. Certain populations may have increased risk for complications following lumbar puncture, but the significance of basilar invagination is often underappreciated. CASE DESCRIPTION: A 45-year-old woman with basilar invagination received multiple lumbar punctures in the workup of acute meningitis. Preprocedural computed tomography was obtained. Following lumbar puncture, the patient developed locked-in syndrome. Magnetic resonance imaging obtained several days later demonstrated severe compression and infarction of the medulla and inferior cerebellum by the odontoid process and ectopic cerebellar tonsils. The patient was transferred but at this point, surgical decompression was not possible. She did not regain significant neurologic function. CONCLUSIONS: Basilar invagination is a risk factor for devastating neurologic complications following lumbar puncture. Awareness of this complication and prompt recognition of its occurrence may prevent future morbidity of lumbar puncture in patients with basilar invagination.
Asunto(s)
Infartos del Tronco Encefálico/diagnóstico por imagen , Síndrome de Enclaustramiento/diagnóstico , Bulbo Raquídeo/irrigación sanguínea , Bulbo Raquídeo/diagnóstico por imagen , Meningitis Neumocócica/diagnóstico , Platibasia/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico , Punción Espinal/efectos adversos , Infartos del Tronco Encefálico/etiología , Cerebelo/anomalías , Cerebelo/diagnóstico por imagen , Femenino , Humanos , Síndrome de Klippel-Feil/complicaciones , Síndrome de Klippel-Feil/cirugía , Síndrome de Enclaustramiento/diagnóstico por imagen , Síndrome de Enclaustramiento/etiología , Imagen por Resonancia Magnética , Meningitis Neumocócica/complicaciones , Persona de Mediana Edad , Apófisis Odontoides/anomalías , Apófisis Odontoides/diagnóstico por imagen , Platibasia/complicaciones , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Fusión Vertebral , Streptococcus pneumoniae , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: In the United States, cocaine is a commonly used drug of abuse. It is also a recognized contributing factor for both hemorrhagic and ischemic strokes. However, cocaine-induced basilar artery thrombosis has rarely been reported in the literature. CASE PRESENTATION: Our patient was a 51-year-old African American woman with a history of polysubstance abuse who presented to the emergency department for acute behavior changes. Later, during admission, she had a dramatic decrease in motor strength in all extremities and a positive Babinski reflex bilaterally. The results of her toxicology reports were positive for cocaine; in addition, results of magnetic resonance angiography and magnetic resonance imaging were consistent with acute thrombosis and subsequent infarction of the basilar artery. Her mental status improved, but she was only able to communicate via movements of her eyes. CONCLUSION: Our patient developed locked-in syndrome after use of cocaine. Given the prevalence of its use in the United States, cocaine use should be included among the potential causes of locked-in syndrome.
Asunto(s)
Arteria Basilar/patología , Trastornos Relacionados con Cocaína/fisiopatología , Cocaína/administración & dosificación , Cocaína/efectos adversos , Infarto/inducido químicamente , Trombosis Intracraneal/patología , Síndrome de Enclaustramiento/inducido químicamente , Arteria Basilar/diagnóstico por imagen , Trastornos Relacionados con Cocaína/complicaciones , Trastornos Relacionados con Cocaína/psicología , Resultado Fatal , Femenino , Humanos , Infarto/diagnóstico por imagen , Infarto/fisiopatología , Trombosis Intracraneal/inducido químicamente , Trombosis Intracraneal/diagnóstico por imagen , Síndrome de Enclaustramiento/diagnóstico por imagen , Síndrome de Enclaustramiento/patología , Angiografía por Resonancia Magnética , Persona de Mediana Edad , Problema de Conducta/psicología , Reflejo de BabinskiAsunto(s)
Estado de Descerebración/etiología , Hemorragias Intracraneales/complicaciones , Síndrome de Enclaustramiento/etiología , Puente , Tractos Piramidales/fisiopatología , Adolescente , Estado de Conciencia/fisiología , Estado de Descerebración/diagnóstico por imagen , Estado de Descerebración/fisiopatología , Humanos , Hemorragias Intracraneales/diagnóstico por imagen , Síndrome de Enclaustramiento/diagnóstico por imagen , Síndrome de Enclaustramiento/fisiopatología , Masculino , Puente/diagnóstico por imagen , Puente/patología , Puente/fisiopatología , Tractos Piramidales/diagnóstico por imagenRESUMEN
Locked-in syndrome (LIS) is a state of quadriplegia and anarthria with preserved consciousness, which is generally triggered by a disruption of specific white matter fiber tracts, following a lesion in the ventral part of the pons. However, the impact of focal lesions on the whole brain white matter microstructure and structural connectivity pathways remains unknown. We used diffusion tensor magnetic resonance imaging (DT-MRI) and tract-based statistics to characterise the whole white matter tracts in seven consecutive LIS patients, with ventral pontine injuries but no significant supratentorial lesions detected with morphological MRI. The imaging was performed in the acute phase of the disease (26 ± 13 days after the accident). DT-MRI-derived metrics were used to quantitatively assess global white matter alterations. All diffusion coefficient Z-scores were decreased for almost all fiber tracts in all LIS patients, with diffuse white matter alterations in both infratentorial and supratentorial areas. A mixture model of two multidimensional Gaussian distributions was fitted to cluster the white matter fiber tracts studied in two groups: the least (group 1) and most injured white matter fiber tracts (group 2). The greatest injuries were revealed along pathways crossing the lesion responsible for the LIS: left and right medial lemniscus (98.4% and 97.9% probability of belonging to group 2, respectively), left and right superior cerebellar peduncles (69.3% and 45.7% probability) and left and right corticospinal tract (20.6% and 46.5% probability). This approach demonstrated globally compromised white matter tracts in the acute phase of LIS, potentially underlying cognitive deficits.
Asunto(s)
Tronco Encefálico/diagnóstico por imagen , Imagen de Difusión Tensora , Síndrome de Enclaustramiento/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Adulto , Anciano , Vías Auditivas/diagnóstico por imagen , Vías Auditivas/fisiopatología , Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/fisiopatología , Tronco Encefálico/fisiopatología , Sistema Nervioso Central/diagnóstico por imagen , Sistema Nervioso Central/fisiopatología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/diagnóstico por imagen , Trastornos del Conocimiento/fisiopatología , Femenino , Humanos , Síndrome de Enclaustramiento/diagnóstico , Síndrome de Enclaustramiento/fisiopatología , Masculino , Persona de Mediana Edad , Distribución Normal , Tractos Piramidales/diagnóstico por imagen , Tractos Piramidales/fisiopatología , Sustancia Blanca/lesiones , Sustancia Blanca/fisiopatologíaRESUMEN
BACKGROUND: Locked-in syndrome (LIS) is a rare neurologic disorder characterized as quadriplegia with anarthria. The diagnosis of LIS is challenging and requires a high index of suspicion. The syndrome is typically caused by an infratentorial lesion to the ventral pons, regardless of etiology. LIS secondary to supratentorial injury is extremely rare, and to our knowledge, this is the first reported case. CASE DESCRIPTION: We report the case of a 26-year-old woman who sustained a gunshot to the left suboccipital area, with supratentorial extension. A diagnosis of incomplete LIS was made on the day of admission, with eye movement preservation. Imaging studies confirmed bilateral injury of the motor homunculus. The clinical course was that of progressive improvement, aided by intensive care unit (ICU) supportive care and early physiotherapy rehabilitation. Her condition improved, and she was discharged to a rehabilitation facility at the end of week 7 postadmission. CONCLUSIONS: This is a unique case of incomplete LIS after supratentorial injury. Initial ICU care and early rehabilitation likely played a major role in the full recovery of this patient. The influence of etiology and site of injury on outcome prognosis is also suggested. Although severe diffuse brain injury may occur in the face of an unremarkable computed tomography (CT) scan, the emerging role of magnetic resonance imaging in optimally evaluating traumatic brain injury with discordant clinical and CT information is highlighted and is useful in cases of LIS where prognosis prediction is important.