RESUMEN
PURPOSE OF REVIEW: Antidepressant-associated movement disorders are a well-described phenomenon. However, antidepressant-associated bruxism, jaw pain, or jaw spasm, while reported in dental literature, is less commonly recognized among neurologists. We summarize the clinical features and treatment of antidepressant-associated bruxism and associated jaw pain through a systematic review of case reports. RECENT FINDINGS: Antidepressant-associated bruxism may occur in pediatric and adult patients, most commonly among female patients. Patients may develop symptoms with short-term and long-term antidepressant use. Fluoxetine, sertraline, and venlafaxine were the most commonly reported offending agents. Symptoms may begin within 3-4 weeks of medication initiation and may resolve within 3-4 weeks of drug discontinuation, addition of buspirone, or substitution with another pharmacologic agent. The incidence of this phenomenon is unknown. SUMMARY: Bruxism associated with antidepressant use is an underrecognized phenomenon among neurologists, and may be treated with the addition of buspirone, dose modification, or medication discontinuation.
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Traumatic brain injury (TBI) secondary to blast exposure is a common injury in the Global War on Terrorism, but little is known about the acute effects, recovery, pathophysiology, and neuropathology of blast-induced mild TBI (mTBI) in humans in a battlefield environment. Moreover, there is ongoing debate whether blast-induced mTBI is a different injury with a unique pathophysiology compared with mTBI from blunt trauma. In the case series reported here from Craig Joint Theater Hospital at Bagram Airfield, Afghanistan, 15 military service members with acute concussion/mTBI associated with blast exposure were evaluated within the first 24 hours after concussion and on days 2, 3, 5, and 7 with a Graded Symptom Checklist and a balance assessment, the Balance Error Scoring System. These data suggest that the recovery in blast-induced mTBI follows the pattern of recovery in sports-related concussion reported in The National Collegiate Athletic Association Concussion Study. In this retrospective case series, we provide the first description of the natural history of acute recovery in blast-induced mTBI, and we suspect, given our experience treating military service members, that further observations of the natural history of recovery in blast-induced mTBI will continue to mirror the natural history of recovery in sports concussion.
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Traumatismos en Atletas/rehabilitación , Conmoción Encefálica/rehabilitación , Personal Militar/psicología , Adulto , Campaña Afgana 2001- , Afganistán , Conmoción Encefálica/complicaciones , Lesiones Encefálicas/fisiopatología , Traumatismos Difusos del Encéfalo/fisiopatología , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
A 50-year-old male presented with complaints of fatigue, confusion, and memory problems. Neurological evaluation revealed altered cognition, unsteady gait, ataxia, dysmetria, and weakness. MRI of the brain was initially unremarkable. Over several days, the patient experienced improvement of symptoms and a follow-up MRI revealed a small lesion in the splenium of the corpus callosum seen on diffusion weighted and T2 sequences. The patient was discovered to have elevated anti-voltage gated potassium channel serum autoantibodies. Follow-up MRI revealed resolution of the splenial lesion. The patient was treated with intravenous immune globulin, and improved back to his pre-treatment baseline. We believe this to be the first case of a reversible splenial lesion syndrome as a manifestation of the anti-voltage gated potassium channel autoantibody syndrome, and propose a pathophysiologic mechanism.
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Autoanticuerpos/sangre , Encefalopatías/sangre , Encefalopatías/patología , Cuerpo Calloso/patología , Canales de Potasio KCNQ/inmunología , Encefalopatías/complicaciones , Encefalopatías/diagnóstico por imagen , Cuerpo Calloso/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To describe the neurological and neuroradiological features of acquired hemophagocytic lymphohistiocytosis (HLH) in adulthood by reporting a series of cases. METHODS: Ten consecutive patients who were diagnosed with HLH at Medstar Georgetown University Hospital and Walter Reed National Military Medical Center were evaluated for neurological involvement. All underwent clinical neurological evaluation, and when indicated CSF analysis and MR imaging of the brain. Data were gathered and analyzed retrospectively. RESULTS: Seven of the ten patients with HLH had neurological involvement. Mean age at onset was 50 (range: 21 to 73). Four patients were males. Prominent clinical features included mild to severe encephalopathy and seizures. Other findings included hemiparesis and spastic tetraparesis. Neuroimaging revealed a wide spectrum of abnormalities including cortical and subcortical edema, gadolinium enhancement, hemorrhage, and diffusion restriction. Basal ganglia involvement was present in four out of seven patients. Three patients died due to multisystem organ failure, and the other patients displayed varying degrees of recovery. CONCLUSIONS: The neurological features of acquired HLH in adults have not been previously reported. These seven patients demonstrate the spectrum of neurological involvement that can occur. The diagnosis of HLH should be considered in patients who are systemically ill with unexplained fevers and hyperferritinemia who have evidence of inflammation in the CNS.
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Encéfalo/patología , Linfohistiocitosis Hemofagocítica/complicaciones , Linfohistiocitosis Hemofagocítica/diagnóstico , Adulto , Anciano , Encefalopatías/complicaciones , Encefalopatías/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Convulsiones/complicaciones , Convulsiones/diagnóstico , Adulto JovenAsunto(s)
Ataxia/diagnóstico , Síndrome del Cromosoma X Frágil/diagnóstico , Temblor/diagnóstico , Ataxia/genética , Ataxia/patología , Ataxia/fisiopatología , Encéfalo/patología , Diagnóstico Diferencial , Proteína de la Discapacidad Intelectual del Síndrome del Cromosoma X Frágil/genética , Síndrome del Cromosoma X Frágil/genética , Síndrome del Cromosoma X Frágil/patología , Síndrome del Cromosoma X Frágil/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Actividad Motora , Temblor/genética , Temblor/patología , Temblor/fisiopatologíaRESUMEN
Mild traumatic brain injury (mTBI) or concussion is a common battlefield and in-garrison injury caused by transmission of mechanical forces to the head. The energy transferred in such events can cause structural and/or functional changes in the brain that manifest as focal neurological, cognitive, or behavioral dysfunction. Current diagnostic criteria for mTBI are highly limited, variable, and based on subjective self-report. The subjective nature of the symptoms, both in quantity and quality, together with their large overlap in other physical and behavioral maladies, limit the clinician's ability to accurately diagnose, treat, and make prognostic decisions after such injuries. These diagnostic challenges are magnified in an operational environment as well. The Department of Defense has invested significant resources into improving the diagnostic tools and accuracy for mTBI. This focus has been to supplement the clinician's examination with technology that is better able to objectify brain dysfunction after mTBI. Through this review, we discuss the current state of three promising technologies--soluble protein biomarkers, advanced neuroimaging, and quantitative electroencephalography--that are of particular interest within military medicine.
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Conmoción Encefálica/diagnóstico , Lesiones Encefálicas/diagnóstico , Biomarcadores/análisis , Tecnología Biomédica/métodos , Electroencefalografía/métodos , Humanos , Neuroimagen/métodos , Proteínas/análisisRESUMEN
OPINION STATEMENT: The DoD has established clinical guidelines and policies creating a system of care for the management of battlefield concussion. Within these instructions, medical providers have standardized guidance for screening and diagnosing concussion, along with guidelines for treating common concussion symptoms. Underlying these policies is the principle that concussion is an important injury, and SMs need to be removed from combat during the acute period to ensure full recovery before return to duty. As our understanding of concussion advances, the DoD will incorporate these advances into the current system of care, ensuring that SMs have the highest level of care possible for concussions sustained on the battlefield.
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Military physicians deploy primarily to care for traumatic injuries. However, critically ill medical patients are also evaluated and treated in theater with similar capability as hospitals in the United States because of the close proximity of medical and surgical specialists and advanced equipment in combat support and theater hospitals. We report a case of a 33-year-old soldier diagnosed with a basilar infarct, treated with fibrinolytics, and reversal of severe neurological deficits while treated in the U.S. operational Afghanistan Theater.
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Arteriopatías Oclusivas/tratamiento farmacológico , Arteria Basilar , Fibrinolíticos/uso terapéutico , Activador de Tejido Plasminógeno/uso terapéutico , Adulto , Campaña Afgana 2001- , Angiografía , Arteriopatías Oclusivas/diagnóstico , Fibrinolíticos/administración & dosificación , Humanos , Infusiones Intraarteriales , Imagen por Resonancia Magnética , Masculino , Activador de Tejido Plasminógeno/administración & dosificaciónRESUMEN
Hemiballism is a rare movement disorder characterized by a high amplitude movement of an entire limb or limbs on one side of the body. The acute development of hemiballismus is often caused by focal lesions in the contralateral basal ganglia and STN. Many etiologies exist for this rare disorder with vascular causes and nonketotic hyperglycemia being the most common. Clearer understanding of the pathophysiology of hemiballism has led to important insights into the function and interaction of structures within the basal ganglia. Newer models of basal ganglia function have been proposed based on the study of the pathophysiology of hemiballism. Prognosis is favorable for most patients with complete resolution with or without treatment. Medical and surgical treatments are often successful in reducing or completely ameliorating the movements in those patients with more severe movements.
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Discinesias/fisiopatología , Discinesias/terapia , Animales , Ganglios Basales/fisiopatología , Discinesias/diagnóstico , Humanos , Sustancia Negra/fisiopatologíaRESUMEN
Dystonia in association with peripheral trauma is a well-described clinical syndrome. The syndrome goes by many names--"traumatic" dystonia, "fixed" dystonia, peripherally induced dystonia, or complex region pain syndrome (CRPS) dystonia. We reviewed the role of peripheral trauma in the development of dystonia, focusing on 4 subtypes--cervical dystonia, focal limb dystonia, CRPS dystonia, and psychogenic dystonia. We show that peripheral trauma inducing, provoking, or precipitating structural changes within the CNS leading to dystonia is not an accepted concept, and current evidence supporting a pathophysiologic mechanism is virtually nonexistent. A better approach to this clinical syndrome is to define it as fixed abnormal posturing that is most commonly psychogenic. While symptomatic treatment of pain and spasms with medication can be beneficial, early psychological evaluation and patient-specific treatment is important. Modalities such as physical and occupational therapy should be utilized early. Finally, it should be emphasized that like many psychogenic movement disorders, it remains a highly disabling and distressing disorder.
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Trastornos Distónicos/complicaciones , Enfermedades del Sistema Nervioso Periférico/complicaciones , Heridas y Lesiones/complicaciones , Trastornos Distónicos/diagnóstico , Trastornos Distónicos/terapia , Humanos , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/terapia , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/terapiaAsunto(s)
Tauopatías , Anciano , Carbidopa/uso terapéutico , Agonistas de Dopamina/uso terapéutico , Combinación de Medicamentos , Humanos , Levodopa/uso terapéutico , Imagen por Resonancia Magnética/métodos , Masculino , Tauopatías/tratamiento farmacológico , Tauopatías/patología , Tauopatías/fisiopatologíaRESUMEN
Multiple system atrophy (MSA) is an adult-onset, progressive, neurodegenerative condition that has several different initial presentations. Ultimately affected patients develop parkinsonian features, autonomic dysfunction, cerebellar ataxia, and corticospinal deficits. Patients with MSA are often misdiagnosed as having Parkinson disease. This article discusses the epidemiology and pathophysiology of MSA, in addition to addressing clinical and diagnostic signs and symptoms, and the limited treatment options available to physicians.
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Sistema Nervioso Autónomo/fisiopatología , Sistema Nervioso Central/fisiopatología , Atrofia de Múltiples Sistemas/diagnóstico , Atrofia de Múltiples Sistemas/fisiopatología , Degeneración Nerviosa/fisiopatología , Vías Nerviosas/fisiopatología , Sistema Nervioso Autónomo/patología , Sistema Nervioso Central/patología , Humanos , Atrofia de Múltiples Sistemas/terapia , Degeneración Nerviosa/patología , Degeneración Nerviosa/terapia , Vías Nerviosas/patologíaRESUMEN
Essential tremor (ET) is one of the most common movement disorders. Although often considered a monosymptomatic disorder (postural and kinetic tremor), ET has more recently been considered a more heterogeneous syndrome, with motor and nonmotor features. The diagnosis is clinical and pharmacologic and surgical therapies exist. ET is frequently misdiagnosed as Parkinson disease or dystonia. The traditional notion of ET as a benign disorder has been challenged by those who view ET as a slowly progressive neurodegenerative disorder.
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Brazo/fisiopatología , Temblor Esencial/diagnóstico , Temblor Esencial/fisiopatología , Trastornos del Movimiento/diagnóstico , Trastornos del Movimiento/fisiopatología , Edad de Inicio , Brazo/inervación , Diagnóstico Diferencial , Temblor Esencial/terapia , Humanos , Trastornos del Movimiento/terapiaRESUMEN
We report an under recognized magnetic resonance postcontrast and fluid-attenuated inversion recovery sequence finding characteristic of adult Moyamoya disease in a young woman who presented with new onset headache and a history of migraine. The imaging finding of the "ivy sign" is presented, along with a brief discussion of the pathophysiology of this radiologic presentation of adult Moyamoya disease.
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Enfermedad de Moyamoya/patología , Adulto , Arterias Carótidas/patología , Femenino , Gadolinio , Humanos , Aumento de la Imagen/métodos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética/métodos , Lóbulo Occipital/patologíaRESUMEN
Acquired focal dystonia is often precipitated by minor local traumatic injury, resulting in severe pain and disability. An active duty soldier with shoulder dystonia, after a fall, that responded partially to botulinum toxin A is described. Post-traumatic dystonia as a neurological illness is discussed, with emphasis on mechanisms, precipitating causes, differential diagnosis, and treatment implications for battlefield clinicians.
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Trastornos Distónicos/etiología , Medicina Militar , Personal Militar , Lesiones del Hombro , Heridas y Lesiones/complicaciones , Adulto , Toxinas Botulínicas Tipo A/uso terapéutico , Diagnóstico Diferencial , Trastornos Distónicos/fisiopatología , Humanos , Masculino , Factores de TiempoRESUMEN
INTRODUCTION: A 34-year-old man presented with herpes simplex encephalitis (HSE), with magnetic resonance imaging (MRI) showing dense foci of restricted diffusion in the temporal lobe. CASE REPORT: With treatment and clinical improvement, follow-up MRI done 8 days later showed complete resolution of the restricted diffusion abnormalities, whereas other MRI sequences suggested interval progression. DISCUSSION: Restricted diffusion abnormalities on MRI in patients with HSE may be more sensitive to and correlate better with disease activity in HSE.
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Imagen de Difusión por Resonancia Magnética , Encefalitis por Herpes Simple/patología , Adulto , Progresión de la Enfermedad , Encefalitis por Herpes Simple/tratamiento farmacológico , Humanos , Masculino , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
We present a case of severe posterior headache and diplopia following an epidural steroid injection for lumbar pain.