ABSTRACT
PURPOSE: To report the "salt and pepper"(SP) eye pain as a herald symptom of pontine ischemia. DESIGN: Observational case series. METHODS: We reviewed clinical and neuroimaging findings of four patients who presented initially with the sensation of SP in the eyes and then developed paramedian pontine infarcts confirmed by neuroimaging. RESULTS: All of the patients developed other neurologic symptoms or signs, either in association with the sensation of SP in the eyes, from hours to days later. Magnetic resonance imaging (MRI) showed paramedian pontine infarcts in all of the patients and angiography showed basilar artery occlusive disease in three of them. CONCLUSION: Impending pontine ischemia is an important differential diagnosis in patients with acute ocular pain. Prompt neurovascular evaluation and treatment may avoid devastating brainstem infarcts that cause death or long-term disability, particularly in patients with basilar artery occlusive disease.
Subject(s)
Arterial Occlusive Diseases/diagnosis , Basilar Artery/pathology , Brain Ischemia/diagnosis , Eye Diseases/diagnosis , Pain/diagnosis , Pons/blood supply , Adult , Angiography, Digital Subtraction , Brain Stem Infarctions/diagnosis , Cerebral Angiography , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Pain Measurement , Prognosis , Severity of Illness IndexABSTRACT
INTRODUCTION: Cognitive evaluation is usually performed in the assessment of patients with suspected dementia, but is not generally performed in patients with other neurological diseases. OBJECTIVE: To investigate the relevance of a systematic cognitive examination in patients with different neurological conditions. METHOD: One-hundred and five patients consecutively attended over a one-year period in a general Neurology outpatient clinic from a public-affiliated hospital, with no complaints of cognitive changes, were submitted to the following cognitive tests: Mini-Mental State Examination (MMSE), digit span (forward and backward), delayed recall of ten simple figures, category fluency and clock drawing. Whenever possible, the cut-off scores were adjusted as function of educational level. RESULTS: Nearly 2/3 of the patients presented impaired performance in at least one of the tests. The MMSE was altered in 20% of the patients. Performance at digit span was impaired in 50.4% of cases (29.5% forward and 20.9% backward), delayed recall in 14.2% of the patients, category fluency in 27.6% and clock drawing in 40.0%. CONCLUSION: These results reinforce the need of including cognitive evaluation as a routine part of the neurological examination, independently of the presence of specific complaints in this domain.
Subject(s)
Cognition Disorders/diagnosis , Dementia/diagnosis , Mental Status Schedule , Neuropsychological Tests , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Attention/physiology , Brazil , Cognition/physiology , Educational Status , Female , Humans , Male , Memory/physiology , Middle AgedABSTRACT
INTRODUÇÃO: O exame das funções cognitivas é habitual na avaliação das demências, porém não é usualmente realizado em pacientes com outras doenças neurológicas. OBJETIVO: Investigar a relevância da semiologia cognitiva sistemática em pacientes com doenças neurológicas diversas. MÉTODO: Foram avaliados 105 pacientes consecutivamente atendidos no período de um ano em ambulatório de neurologia geral de hospital universitário público, sem queixas de alterações cognitivas. Os pacientes foram submetidos aos seguintes testes cognitivos: mini-exame do estado mental (MEEM), extensão de dígitos, testes de memória de figuras, fluência verbal e desenho do relógio. Sempre que possível as notas de corte foram corrigidas em função da escolaridade. RESULTADOS: Cerca de 2/3 dos pacientes apresentaram alterações do desempenho em pelo menos um teste. O MEEM mostrou-se alterado em 20 por cento dos pacientes, o teste da extensão de dígitos apresentou alteração em 50,4 por cento (29,5 por cento na ordem direta e 20,9 por cento na indireta). A evocação tardia esteve alterada em 14,2 por cento dos casos, a fluência verbal esteve abaixo da nota de corte em 27,6 por cento dos pacientes e o desenho do relógio, em 40,0 por cento. CONCLUSÃO: Os dados obtidos comprovam a necessidade da inclusão da avaliação cognitiva como parte obrigatória do exame neurológico, mesmo em pacientes sem queixas relacionadas.
INTRODUCTION: Cognitive evaluation is usually performed in the assessment of patients with suspected dementia, but is not generally performed in patients with other neurological diseases. OBJECTIVE: To investigate the relevance of a systematic cognitive examination in patients with different neurological conditions. METHOD: One-hundred and five patients consecutively attended over a one-year period in a general Neurology outpatient clinic from a public-affiliated hospital, with no complaints of cognitive changes, were submitted to the following cognitive tests: Mini-Mental State Examination (MMSE), digit span (forward and backward), delayed recall of ten simple figures, category fluency and clock drawing. Whenever possible, the cut-off scores were adjusted as function of educational level. RESULTS: Nearly 2/3 of the patients presented impaired performance in at least one of the tests. The MMSE was altered in 20 percent of the patients. Performance at digit span was impaired in 50.4 percent of cases (29.5 percent forward and 20.9 percent backward), delayed recall in 14.2 percent of the patients, category fluency in 27.6 percent and clock drawing in 40.0 percent. CONCLUSION: These results reinforce the need of including cognitive evaluation as a routine part of the neurological examination, independently of the presence of specific complaints in this domain.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cognition Disorders/diagnosis , Dementia/diagnosis , Mental Status Schedule , Neuropsychological Tests , Age Factors , Attention/physiology , Brazil , Cognition/physiology , Educational Status , Memory/physiologyABSTRACT
A vertigem postural fóbica (VPF), o segundo diagnóstico mais freqüente em ambulatório de distúrbios vestibulares, é síndrome somatoforme caracterizada por desequilíbrio subjetivo e ataques breves de vertigem em situações específicas. Em período de 18 meses, a VPF foi observada em 41 pacientes, de 251 atendidos. Vinte e seis apresentavam VPF primária; em 65 por cento havia distúrbios de ansiedade ou depressão, e 15 pacientes tiveram diagnóstico de VPF secundária. O exame neurológico e a avaliação complementar foram normais na maioria dos casos. Observou-se resposta favorável ao tratamento (antidepressivos, benzodiazepínicos, psicoterapia e/ou orientações) em 62 por cento dos pacientes, sem diferença entre os grupos de VPF primária e VPF secundária. Apesar da alta prevalência, a VPF é subdiagnosticada. Entretanto, seu reconhecimento é importante para o tratamento adequado, evitando recorrência e incapacitação.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Phobic Disorders/diagnosis , Vertigo/diagnosis , Diagnosis, Differential , Depressive Disorder/complications , Depressive Disorder/diagnosis , Depressive Disorder/therapy , Electronystagmography , Neurologic Examination , Phobic Disorders/complications , Phobic Disorders/therapy , Retrospective Studies , Tomography, X-Ray Computed , Vertigo/complications , Vertigo/therapyABSTRACT
Phobic postural vertigo (PPV) is the second most common diagnosis on a dizziness unit. It is a somatoform syndrome characterized as a chronic and incapacitating condition with subjective imbalance and short attacks of dizziness. During a period of 18 months, PPV was observed in 41 patients among 251 of a dizziness unit. Twenty-six had primary PPV, among whom 65% had depressive or anxiety disorders, and 15 patients were diagnosed at secondary PPV. Normal neurological examination and diagnostic tests were observed in most cases. A favorable response to treatment (antidepressants, benzodiazepines, psychotherapy and/or orientation) was observed in 62% of all patients, without difference between both groups -- primary and secondary PPV. Despite the high prevalence, PPV is misdiagnosed. Therefore one must attempt to recognize it, since its appropriate treatment prevents recurrence and incapacitation.
