RESUMEN
INTRODUCTION: Hoigne's syndrome is characterized by the development of acute clinical manifestations which are mainly psycho-sensorial. Classically, these features immediately follow the injection of procaine penicillin G. CASE REPORT: We report a 59-year-old man who presented with psycho-organic manifestations that occurred just after the intravenous injection of ceftriaxone; to our knowledge, this is the first case of Hoigne's syndrome reported after an injection of this antibiotic. CONCLUSION: The pathophysiologic basis of this syndrome is still unknown. It is important to keep in mind its clinical characteristics, which may mimic immuno-allergic symptoms. It should be differentiated from anaphylactic manifestations because Hoigne's syndrome allows the continuation of the treatment.
Asunto(s)
Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Ceftriaxona/administración & dosificación , Ceftriaxona/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Absceso Encefálico/tratamiento farmacológico , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , SíndromeRESUMEN
INTRODUCTION: Intracranial vertebral artery dissecting aneurysms are a recognized cause of subarachnoid hemorrhage and the hemorrhagic recurrence risk after a first rupture of the dissecting aneurysm is high and of poor prognosis. However, when the dissection is discovered in a patient with vertebrobasilar territory ischemia, little is known about the risk of hemorrhagic rupture risk and there is no consensus on management. OBSERVATION: We report the case of a 49-year-old man who developed subarachnoid hemorrhage 48 hours after the occurrence of a latero-bulbar syndrome caused by a spontaneous dissection with occlusion of the right vertebral artery. The subsequent angiography showed a V4 dissecting aneurysm of the right vertebral artery which was treated by stenting and coiling without any complications. CONCLUSION: This case underlines the hemorrhagic risk of an intradural vertebral artery dissection and its possible progression to aneurysm. Subsequent angiographic imaging must be carefully examined to search for aneurysms which may require early specific treatment because of the high risk of recurrent bleeding.
Asunto(s)
Infarto Encefálico/etiología , Hemorragia Subaracnoidea/etiología , Disección de la Arteria Vertebral/complicaciones , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: We report a case of periarteritis nodosa revealed by a cerebral angiitis which recovered under treatment. OBSERVATION: A 52-year-old patient suddenly presented with a left sensory syndrome and a fluctuating aphasia due to ischemia involving both parietal lobes. The diagnosis of periarteritis nodosa was based on the following criteria: severe loss of weight, renal insufficiency, hypertension, angiography suggesting an arteritis. Instead of an ileo-cecal perforation, the patient recovered under corticosteroid and immunosuppressive therapy. CONCLUSIONS: Stroke in periarteritis nodosa may occur early be and associated with a good outcome.
Asunto(s)
Poliarteritis Nudosa/complicaciones , Vasculitis del Sistema Nervioso Central/etiología , Afasia/etiología , Isquemia Encefálica/etiología , Angiografía Cerebral , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
Strokes are rarely secondary to spontaneous carotid artery thrombosis. The objectives of this retrospective analysis were to define characteristic features and the clinical course. The study population included eight patients (6 females/2 males) seen at six university neurological centers. Age of onset was 46.5 years (range 38-52). Half of the patients had no vascular risk factor. Symptoms were TIA (n=1), strokes (n=7). Echotomography revealed intraluminal thrombus, with occlusion in 2 cases. Thrombi were found in common carotid artery (n=3), carotid bifurcation (n=2) and internal carotid artery (n=3). The thrombus was mobile in 4 cases. Seven patients were treated by anticoagulation therapy, one by surgery because of recurrent TIA. Further echotomographic exams revealed total resolution (3 cases) or decrease of the thrombus (3 cases). Occlusion was definitive in one patient. A cause was identified in six patients: acute leukemia (n=1), thrombocytopenic purpura (n=1), iron deficiency anemia (n=4).
Asunto(s)
Trombosis de las Arterias Carótidas/patología , Adulto , Anemia Ferropénica/complicaciones , Anticoagulantes/uso terapéutico , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/patología , Trombosis de las Arterias Carótidas/complicaciones , Trombosis de las Arterias Carótidas/diagnóstico por imagen , Femenino , Humanos , Leucemia/complicaciones , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Púrpura Trombocitopénica/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/patología , UltrasonografíaRESUMEN
INTRODUCTION: Pheochromocytoma is rarely disclosed by intracranial hemorrhage. We report two cases. OBSERVATION: The first 26-year-old patient developed subarachnoid hemorrhage due to a ruptured aneurysm of the middle cerebral artery. The second patient, aged 44 years, had a temporal hematoma. Diagnosis was suggested in both patients by hypertension and elevated urinary catecholamines and confirmed by imaging and MIBG scintigraphy. Adrenal gland tumors, on both glands in the first patient and on the right gland in the second were successfully removed; cranial hypertension totally regressed. Von Hippel Lindau disease was diagnosed by molecular genetics in the first patient. Paroxysmal hypertension could explain the brain hemorrhage in the first patient and may have favored aneurysmal rupture in the second. CONCLUSION: The relationships between pheochromocytoma and cerebral aneurysm are discussed.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Hemorragia Cerebral/complicaciones , Feocromocitoma/complicaciones , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Adulto , Catecolaminas/orina , Angiografía Cerebral , Hemorragia Cerebral/cirugía , Hematoma/etiología , Humanos , Hipertensión/complicaciones , Aneurisma Intracraneal/complicaciones , Imagen por Resonancia Magnética , Masculino , Arteria Cerebral Media/patología , Procedimientos Neuroquirúrgicos , Feocromocitoma/diagnóstico por imagen , Feocromocitoma/cirugía , Cintigrafía , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/patología , Tomografía Computarizada por Rayos X , Enfermedad de von Hippel-Lindau/diagnóstico , Enfermedad de von Hippel-Lindau/etiología , Enfermedad de von Hippel-Lindau/genéticaRESUMEN
INTRODUCTION: VZV virus-related peripheral neuropathies usually occur after shingles in adults and more rarely after chickenpox in childhood. CASE REPORT: A 54-year-old patient presented with a right VIIth nerve palsy following a chickenpox rash and recovered after antiviral treatment. CSF analysis revealed lymphocytic meningitis and the virus was identified by PCR. CONCLUSIONS: Although previous chickenpox was not found in the patient's past history, the probability of reinfection is likely. The virus can be assumed to affect the nervous system directly; the axonal or demyelinating mechanism of the neuropathy may be discussed.
Asunto(s)
Varicela/complicaciones , Enfermedades del Nervio Facial/etiología , Parálisis Facial/etiología , Herpesvirus Humano 3 , Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Varicela/tratamiento farmacológico , Varicela/fisiopatología , Enfermedades Desmielinizantes/etiología , Enfermedades Desmielinizantes/patología , Enfermedades del Nervio Facial/tratamiento farmacológico , Parálisis Facial/tratamiento farmacológico , Parálisis Facial/fisiopatología , Humanos , Masculino , Meningitis/tratamiento farmacológico , Meningitis/etiología , Persona de Mediana EdadRESUMEN
INTRODUCTION: The clinical spectrum of peripheral neuropathies in Lyme disease is very wide. We report a case which was revealed by an ataxic sensory neuropathy. OBSERVATION: A 77-year-old patient presented with a subacute ataxic sensory neuropathy which occurred 2 weeks after a skin lesion involving the right lower limb. He fully recovered after specific antibiotic treatment. EMG was suggestive of a predominantly axonal neuropathy. Diagnosis of Lyme disease was assessed by progressive elevation of serum antibodies, demonstration of a lymphocytic meningitis and intrathecal synthesis of antibodies. CONCLUSION: Lyme disease may be added to the list of diseases which may induce subacute sensory neuropathies.
Asunto(s)
Ataxia/etiología , Enfermedad de Lyme/complicaciones , Anciano , Humanos , MasculinoRESUMEN
Pituitary non Hodgkin malignant lymphomas are rare. We report a case of large cell systemic lymphoma with pituitary and meningeal localizations in a 40-year-old patient. The clinical picture was panhypopituitarism with MRI appearance of pituitary adenoma and VII and VIII cranial nerves involvement. Diagnosis was made by identification of lymphomatous cells in CSF. The patient deceased in less than one year despite chemotherapy.
Asunto(s)
Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/patología , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/patología , Adulto , Diagnóstico Diferencial , Nervio Facial/patología , Resultado Fatal , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patología , Neoplasias Hipofisarias/tratamiento farmacológico , Nervio Vestibulococlear/patologíaRESUMEN
A 29-year-old patient presented with Takayasu's arteritis which was revealed by heart failure, epilepsy, right hemiparesis and fever. Transient abnormalities of MRI and CSF (raised protein and cell content) were initially observed. The hypothesis of a hypertensive encephalopathy is suggested.
Asunto(s)
Encefalopatía Hipertensiva/etiología , Arteritis de Takayasu/complicaciones , Aciclovir/uso terapéutico , Adulto , Antimetabolitos/uso terapéutico , Aortografía , Angiografía Cerebral , Electroencefalografía , Femenino , Fiebre/etiología , Humanos , Encefalopatía Hipertensiva/líquido cefalorraquídeo , Encefalopatía Hipertensiva/diagnóstico , Imagen por Resonancia Magnética , Paresia/etiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Arteritis de Takayasu/líquido cefalorraquídeo , Arteritis de Takayasu/diagnósticoRESUMEN
A 24-year-old patient presented with flaccid quadriplegia due to severe hypokaliemia, initially presumed to have been induced by glycyrrhizin. Persistence of low potassium levels and hypertension led to the diagnosis of primary hyperaldosteronism related to an adrenal cortical tumor. After surgery, the patient recovered from hypertension and hypokaliemia.
Asunto(s)
Neoplasias de la Corteza Suprarrenal/complicaciones , Parálisis Periódica Hipopotasémica/etiología , Adulto , Humanos , MasculinoRESUMEN
A patient with relapsing cutaneous vasculitis presented 3 times in 10 years with an acute extensive neuropathy and respiratory failure which fully recovered. The relationships between Guillain-Barré syndrome and vasculitis are discussed.
Asunto(s)
Síndrome de Guillain-Barré/complicaciones , Vasculitis Leucocitoclástica Cutánea/complicaciones , Adulto , Femenino , Síndrome de Guillain-Barré/tratamiento farmacológico , Síndrome de Guillain-Barré/fisiopatología , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Oftalmoplejía/etiología , Nervios Periféricos/fisiopatología , Cuadriplejía/etiología , Recurrencia , Vasculitis Leucocitoclástica Cutánea/tratamiento farmacológico , Trastornos de la Voz/etiologíaRESUMEN
INTRODUCTION: Cerebral hemorrhages due to rupture of mycotic aneurysms are rare but severe complications of infective endocarditis. We report two cases with a good outcome. EXEGESIS: The first patient presented with a parieto-occipital hematoma which occurred in the course of a relapsing infective endocarditis due to Streptococcus mitis. She fully recovered after neurosurgical treatment. In the second case, a right frontal hematoma revealed two mycotic aneurysms and an infective endocarditis due to Streptococcus gordonii. Motor weakness partially recovered after antibiotic therapy and angiography demonstrated complete resolution of aneurysms. CONCLUSION: Ruptured mycotic aneurysms are poor prognosis factors in infective endocarditis. Adapted antibiotic therapy is the first-intent treatment. Neurosurgery is indicated when hematomas are poorly tolerated and in cases requiring anticoagulant therapy.
Asunto(s)
Aneurisma Roto/diagnóstico , Hemorragia Cerebral/etiología , Endocarditis Bacteriana/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Adulto , Hemorragia Cerebral/fisiopatología , Hemorragia Cerebral/cirugía , Femenino , Humanos , Procedimientos Neuroquirúrgicos , PronósticoRESUMEN
The role of transcranial Doppler ultrasonography (TCD) in individual risk assessment of embolic complications and the development of prevention strategies during coronary angiography remains to be determined. The purpose of this study was to assess the prevalence, time of occurrence and potential significance of microembolic signals (MES) detected with TCD during femoral left heart catheterization. TCD monitoring of the right and left middle cerebral artery was performed in 51 consecutive patients (36 men, 15 women) who were referred for coronary angiography. Percutaneous coronary angioplasty was performed during the same procedure in 16 patients. MES were counted manually during and after (off-line analysis) the procedure. Two patients were excluded from analysis because of the absence of an adequate acoustic temporal window. No neurological event occurred within 24 h in the 49 included patients. MES were detected in all except 2 patients (mean number 17.1 +/- 12.8 per patient), mainly during left ventriculography (38%) and contrast media injection into the coronary arteries (55%), suggesting their gaseous origin. There was no statistically significant association between the number of MES and patient age, cardiovascular history and risk factors, or catheterization results. The presence of coronary artery disease was inversely related to the number of MES (15.8 +/- 0.3 compared to 21.8 +/- 0.2 per patient when a normal angiogram was present; p < 0.05). In conclusion, although asymptomatic microemboli commonly occur during left heart catheterization, the majority of them are probably of gaseous origin, since they occurred predominantly during contrast media injection in this study, and were not related to cardiovascular history or to atheroma risk factors. Because air embolism has been reported to be harmful, attempts to reduce its occurrence during catheter-based procedures could be pertinent.
Asunto(s)
Cateterismo Cardíaco/efectos adversos , Enfermedad Coronaria/terapia , Embolia Intracraneal/diagnóstico por imagen , Anciano , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Ultrasonografía Doppler TranscranealAsunto(s)
Infarto Cerebral/fisiopatología , Temblor Esencial/fisiopatología , Accidente Cerebrovascular/fisiopatología , Enfermedades Talámicas/fisiopatología , Anciano , Temblor Esencial/diagnóstico por imagen , Temblor Esencial/patología , Femenino , Humanos , Radiografía , Recuperación de la Función , Remisión Espontánea , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/patologíaRESUMEN
Two cases of acute presentation of cervical syringomyelia associated with Chiari malformation are reported. In the first case, dysphagia was the main symptom; the second patient had symptoms suggesting acute brain stem ischemia. The mechanism of this acute onset of the illness is discussed.
Asunto(s)
Siringomielia/diagnóstico , Enfermedad Aguda , Adulto , Malformación de Arnold-Chiari/diagnóstico , Vértebras Cervicales/patología , Trastornos de Deglución/etiología , Diagnóstico Diferencial , Femenino , Humanos , Ataque Isquémico Transitorio/diagnóstico , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Médula Espinal/patología , Siringomielia/etiologíaRESUMEN
Basilar occlusions treated with conventional therapy (anticoagulants or antiplatelets) have a poor outcome (80p. cent mortality). This unfavorable outcome may require a treatment within 6 hours by intra-arterial thrombolysis, sometimes followed by percutaneous transluminal angioplasty (PTA) in case of atherothrombotic occlusion due to a tight atherosclerotic stenosis. A 48 year-old patient, presented with left hemiparesis, left multimodal hypoesthesia, paralytic dysarthria. CT-scan showed a spontaneous hyperdensity of the basilar artery and arterial occclusion was confirmed by angiography, which showed an atherothrombotic occlusion involving the proximal part of the vessel. Intra-arterial thrombolysis began five hours after the onset with 0,25mg/kg of Rt-Pa (Actilyse((R))), given by bolus followed by 4 others bolus of 10mg. After a total dose of 60mg, arterial recanalization was obtained showing a tight atherosclerotic stenosis involving the proximal part of the basilar artery. PTA was performed 18 hours later with a ballon inflation at 6 atmospheres during 20 seconds. It allowed to decrease the stenosis from 80p. cent to 60p. cent. The patient recovered and MRI at D20 showed a small right lateral infarct involving the pons. Our study confirms the usefulness of intra-arterial thrombolysis in basilar artery occlusion. Consecutive PTA may be proposed in case of associated atherosclerotic stenosis, and the interest of PTA is further discussed.
Asunto(s)
Angioplastia de Balón , Arteriosclerosis/terapia , Fibrinolíticos/uso terapéutico , Activador de Tejido Plasminógeno/uso terapéutico , Insuficiencia Vertebrobasilar/terapia , Arteriosclerosis/diagnóstico por imagen , Arteriosclerosis/tratamiento farmacológico , Disartria/etiología , Fibrinolíticos/administración & dosificación , Humanos , Inyecciones Intraarteriales , Masculino , Persona de Mediana Edad , Paresia/etiología , Activador de Tejido Plasminógeno/administración & dosificación , Tomografía Computarizada por Rayos X , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/tratamiento farmacológicoRESUMEN
In adults, neurological complications of VZV virus usually occur after herpes zoster infection in patients with AIDS. We report a case of acute and benign cerebellar ataxia after chickenpox in a patient without immunodeficiency.
Asunto(s)
Ataxia Cerebelosa/diagnóstico , Varicela/diagnóstico , Encefalitis Viral/diagnóstico , Aciclovir/administración & dosificación , Adulto , Ataxia Cerebelosa/tratamiento farmacológico , Encefalitis Viral/tratamiento farmacológico , Humanos , Masculino , Examen NeurológicoRESUMEN
Fourteen cases of infective endocarditis revealed by neurological manifestations are reported: 8 strokes (one transient ischemic attack, one regressing and 6 completed strokes), 2 intracranial hematomas (one due to ruptured mycotic aneurysm), 2 toxic encephalopathies, one grand mal seizure, one suppurative meningitis. Most of them were native valve endocarditis, and streptococcus was the most frequently responsible bacteria. The outcome was characterized by a high mortality (6 cases) and morbidity (4 cases). This emphasizes the usefulness of preventing antibiotherapy in patients with known predisposing factors and the necessity for these patients to be admitted in neurological intensive care units.
Asunto(s)
Endocarditis Bacteriana/complicaciones , Enfermedades del Sistema Nervioso/microbiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Dural puncture with corticosteroid could be a predisposing factor for cerebral venous thrombosis (CVT). A 35-year-old woman using oral contraception was treated with corticosteroid epidural infiltration for L5 radiculalgia. The following day a postural headache developed and accidental dural puncture was suspected. Four days later, she presented with fever and consciousness impairment requiring mechanical ventilation. Magnetic resonance angiography (MRA) confirmed thrombosis of the superior sagittal sinus. Recanalization was observed three weeks later and the patient fully recovered. Blood tests for thrombophilia showed a moderate decrease in the C protein level (chronometric activity 44%, N = 65-130). CVT has been reported after spinal anaesthesia or peridural anaesthesia with accidental puncture. After dural puncture the decrease of cerebrospinal fluid pressure induces a rostrocaudal sagging effect with traumatic damage to the fragile venous endothelial wall, and may trigger a venous vasodilatation with resultant stasis. CVT has also been described in patients after lumbar puncture and oral corticoid treatment for multiple sclerosis and after corticosteroid intrathecal infiltration. Therefore, corticosteroids can be considered as a potential additional procoagulant stimuli.