RESUMEN
INTRODUCTION: Although neurological complications are well recognized in patients with sickle cell disease, myelopathy has been rarely described, with few reported cases of compressive and ischemic myelopathy. We present the first case report of longitudinally extensive myelitis (LETM) in SCD and review the differential diagnosis of myelopathy in these patients. CASE PRESENTATION: We report the case of a 29-year-old African-Brazilian man with SCD, who experienced a subacute flaccid paraparesis, with T2 sensory level and urinary retention. Cerebrospinal fluid analysis showed a lymphocytic pleocytosis and increased protein levels. MRI disclosed a longitudinally extensive spinal cord lesion, with a high T2/STIR signal extending from C2 to T12. We searched Medline/PubMed, Embase, Scopus, and Google Scholar databases for myelopathy in SCD patients. DISCUSSION: Spinal cord compression by vertebral fractures, extramedullary hematopoietic tissue, and Salmonella epidural abscess have been reported in SCD. We found only three case reports of spinal cord infarction, which is unexpectedly infrequent compared to the prevalence of cerebral infarction in SCD. We found only one case report of varicella-zoster myelitis and no previous report of LETM in SCD patients. Specific and time-sensitive causes of myelopathy should be considered in SCD patients. In addition to compression and ischemia, LETM is a possible mechanism of spinal cord involvement in SCD patients.
Asunto(s)
Anemia de Células Falciformes , Mielitis , Compresión de la Médula Espinal , Enfermedades de la Médula Espinal , Adulto , Anemia de Células Falciformes/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Mielitis/diagnóstico , Mielitis/etiología , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/etiologíaAsunto(s)
Encéfalo/diagnóstico por imagen , Ciclofosfamida/administración & dosificación , Diabetes Insípida Neurogénica , Lupus Eritematoso Sistémico/complicaciones , Metilprednisolona/administración & dosificación , Mielitis Transversa , Médula Espinal/diagnóstico por imagen , Antirreumáticos/administración & dosificación , Diabetes Insípida Neurogénica/diagnóstico , Diabetes Insípida Neurogénica/tratamiento farmacológico , Diabetes Insípida Neurogénica/etiología , Diabetes Insípida Neurogénica/fisiopatología , Diagnóstico Diferencial , Femenino , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/inmunología , Imagen por Resonancia Magnética/métodos , Mielitis Transversa/diagnóstico , Mielitis Transversa/etiología , Mielitis Transversa/fisiopatología , Mielitis Transversa/terapia , Gravedad del Paciente , Intercambio Plasmático/métodos , Médula Espinal/patología , Brote de los Síntomas , Resultado del Tratamiento , Adulto JovenRESUMEN
Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. Methods Retrospective data on patients with arterial dissection related to sports and recreation. Results Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. Conclusion Arterial dissection may be a complication from practicing sports.
A dissecção das artérias cervicais é uma emergência médica. Embora de forma relativamente rara, certas atividades descritas como esportes e recreação podem ser a causa de dissecção arterial independentemente de trauma de crânio ou cervical. O propósito do presente estudo é apresentar uma série de casos de dissecção de artérias cérebro-cervicais em indivíduos durante ou logo após a prática destas atividades desportivas. Métodos Dados retrospectivos de pacientes com dissecção arterial relacionada à prática de esportes e recreação. Resultados Quarenta e um casos foram identificados. A artéria mais frequentemente afetada foi a vertebral. Uma grande variedade de atividades teve relação temporal com a dissecção arterial, sendo a corrida a mais frequente delas. Esta é a maior série de casos da literatura. Conclusão Dissecção arterial pode ser uma complicação da prática de esportes.
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Traumatismos en Atletas/complicaciones , Disección de la Arteria Carótida Interna/etiología , Recreación , Deportes/estadística & datos numéricos , Disección de la Arteria Vertebral/etiología , Angiografía Cerebral , Disección de la Arteria Carótida Interna/patología , Cefalea/etiología , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/etiología , Disección de la Arteria Vertebral/patologíaRESUMEN
UNLABELLED: Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. METHODS: Retrospective data on patients with arterial dissection related to sports and recreation. RESULTS: Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. CONCLUSION: Arterial dissection may be a complication from practicing sports.
Asunto(s)
Traumatismos en Atletas/complicaciones , Disección de la Arteria Carótida Interna/etiología , Recreación , Deportes/estadística & datos numéricos , Disección de la Arteria Vertebral/etiología , Adolescente , Adulto , Anciano , Disección de la Arteria Carótida Interna/patología , Angiografía Cerebral , Femenino , Cefalea/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/etiología , Disección de la Arteria Vertebral/patología , Adulto JovenRESUMEN
OBJECTIVE: To describe characteristics and provision of care for patients admitted with cerebrovascular disorders (CVD), focusing on ischemic stroke (IS), in a large, public, academic hospital in São Paulo, Brazil. METHOD: We retrieved information about 357 patients with CVD admitted to the Neurology Emergency Department (NED) and Neurology Ward (NW) of our institution. We described patient characteristics and management of IS in NED and in NW. RESULTS: IS was diagnosed in 79.6% of CVD patients admitted to NED; 2.7% were submitted to thrombolysis. Extent of IS investigation and management were significantly different in NED and NW. CONCLUSION: IS patients in our center were younger than in developed countries. IS management was significantly influenced by patient characteristics. This information can aid in planning strategies to decrease stroke burden.
Asunto(s)
Servicios Médicos de Urgencia/normas , Hospitalización/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Adolescente , Adulto , Anciano , Brasil/epidemiología , Países Desarrollados , Servicios Médicos de Urgencia/estadística & datos numéricos , Servicio de Urgencia en Hospital , Métodos Epidemiológicos , Femenino , Hospitales Universitarios , Humanos , Ataque Isquémico Transitorio/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To describe characteristics and provision of care for patients admitted with cerebrovascular disorders (CVD), focusing on ischemic stroke (IS), in a large, public, academic hospital in São Paulo, Brazil. METHOD: We retrieved information about 357 patients with CVD admitted to the Neurology Emergency Department (NED) and Neurology Ward (NW) of our institution. We described patient characteristics and management of IS in NED and in NW. RESULTS: IS was diagnosed in 79.6 percent of CVD patients admitted to NED; 2.7 percent were submitted to thrombolysis. Extent of IS investigation and management were significantly different in NED and NW. CONCLUSION: IS patients in our center were younger than in developed countries. IS management was significantly influenced by patient characteristics. This information can aid in planning strategies to decrease stroke burden.
OBJETIVO: Descrever características e manejo de pacientes internados com diagnóstico de doença cerebrovascular (DCV), enfocando principalmente o acidente vascular cerebral isquêmico (AVCI), em um hospital público universitário em São Paulo. MÉTODO: Coletamos informações de 357 pacientes com DCV internados no Pronto-Socorro de Neurologia (PSN) e na Enfermaria de Neurologia (EN) de nossa instituição. Descrevemos características dos pacientes e manejo do AVCI no PSN e na EN. RESULTADOS: O AVCI foi diagnosticado em 79,6 por cento dos pacientes com DCV admitidos no PSN; 2,7 por cento foram submetidos a trombólise. A extensão da investigação e o manejo da doença foram significativamente diferentes no PSN e na EN. CONCLUSÃO: os pacientes com AVCI em nosso centro foram mais jovens que em países desenvolvidos. O manejo do AVCI foi influenciado significativamente pelas características dos pacientes. Estas informações podem auxiliar no planejamento de estratégias para diminuir as conseqüências das DCV em nosso meio.
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Servicios Médicos de Urgencia/normas , Hospitalización/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Brasil/epidemiología , Países Desarrollados , Servicio de Urgencia en Hospital , Métodos Epidemiológicos , Servicios Médicos de Urgencia/estadística & datos numéricos , Hospitales Universitarios , Ataque Isquémico Transitorio/tratamiento farmacológico , Accidente Cerebrovascular/epidemiología , Adulto JovenRESUMEN
O acometimento do sistema nervoso central pela tuberculose pode se manifestar de duas formas principais: tuberculose meníngea ou tuberculoma. Esta forma é uma condição que vinha decrescendo progressivamente, mas que encontrou nos dias atuais condições ideais para o seu desenvolvimento. O presente estudo discorre sobre três pacientes que desenvolveram expansão paradoxal de lesões de tuberculose cerebral durante o uso de tuberculostáticos, o que demonstra ser importante o acompanhamento tomográfico de pacientes que apresentem sinais neurológicos no curso do tratamento para a tuberculose. Os dois primeiros pacientes apresentaram o acometimento neurológico associado a tuberculose pulmonar, enquanto no terceiro havia história de tuberculose meníngea prévia. A tomografia computadorizada foi o exame utilizado para o acompanhamento desses pacientes. O tratamento constou do uso de tuberculostáticos e corticóides.