RESUMEN
BACKGROUND: Blood culture-negative endocarditis (BCNE) is diagnosed in 2-7% of patients with infective endocarditis (IE) and recent antibiotic use is a known risk factor. Altered mental status may be a presenting symptom. Besides empiric antibiotics, intravenous anticoagulation using heparin may have a role in the management of such patients. CASE PRESENTATION: A 23-year-old male patient was referred to our center with fever, altered mental status and abnormal gait. Neurologic examination revealed Wernicke's aphasia. Cardiac auscultation revealed systolic murmur at the left sternal border. ECG (electrocardiogram) was unremarkable. Brain MRI showed multiple cerebellar lesions. Transthoracic echocardiography (TTE) demonstrated three large masses on the right ventricle (RV), tricuspid valve (TV), and anterior mitral valve (MV) leaflet. Blood cultures (three sets) were negative. Intravenous heparin therapy was administered. After 48 h, the second TTE demonstrated that one valvular lesion disappeared and the other two lesions showed a significant decrease in size. The patient's neurological symptoms resolved gradually. Further workup for collagen vascular disorders did not show any abnormality. CONCLUSION: BCNE should be considered in patients with fever and neurologic manifestations. TTE should be performed to detect valvular abnormalities. Intravenous heparin could be used in such patients when TTE demonstrate valvular vegetations.
Asunto(s)
Anticoagulantes/uso terapéutico , Afasia de Wernicke/tratamiento farmacológico , Cultivo de Sangre , Ecocardiografía , Endocarditis Bacteriana/diagnóstico por imagen , Heparina/uso terapéutico , Administración Intravenosa , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Anticoagulantes/administración & dosificación , Afasia de Wernicke/microbiología , Endocarditis Bacteriana/sangre , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Heparina/administración & dosificación , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/patología , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/patología , Adulto JovenRESUMEN
Aphasia is one of the most common neurologic deficits occurring after stroke. Although the speech-language therapy is a mainstream option for poststroke aphasia, pharmacotherapy is recently being tried to modulate different neurotransmitter systems. However, the efficacy of those treatments is still controversial. We present a case of a 53-year-old female patient with Wernicke aphasia, after the old infarction in the territory of left middle cerebral artery for 8 years and the recent infarction in the right middle cerebral artery for 4 months. On the initial evaluation, the Aphasia Quotient in Korean version of the Western Aphasia Battery was 25.6 of 100. Baseline brain F-18 fluorodeoxyglucose positron emission tomographic images demonstrated a decreased cerebral metabolism in the left temporoparietal area and right temporal lobe. Donepezil hydrochloride, a reversible acetylcholinesterase inhibitor, was orally administered 5 mg/d for 6 weeks after the initial evaluation and was increased to 10 mg/d for the following 6 weeks. After the donepezil treatment, the patient showed improvement in language function, scoring 51.0 of 100 on Aphasia Quotient. A subtraction analysis of the brain F-18 fluorodeoxyglucose positron emission tomographic images after donepezil medication demonstrated increased uptake in both middle temporal gyri, extended to the occipital area and the left cerebellum. Thus, we suggest that donepezil can be an effective therapeutic choice for the treatment of Wernicke aphasia.
Asunto(s)
Afasia de Wernicke , Fluorodesoxiglucosa F18/metabolismo , Indanos/uso terapéutico , Infarto de la Arteria Cerebral Media/complicaciones , Nootrópicos/uso terapéutico , Piperidinas/uso terapéutico , Tomografía de Emisión de Positrones , Afasia de Wernicke/tratamiento farmacológico , Afasia de Wernicke/etiología , Afasia de Wernicke/patología , Encéfalo/diagnóstico por imagen , Encéfalo/efectos de los fármacos , Donepezilo , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Persona de Mediana EdadAsunto(s)
Afasia de Broca/diagnóstico , Afasia de Broca/fisiopatología , Afasia de Wernicke/diagnóstico , Afasia de Wernicke/fisiopatología , Infarto Cerebral/diagnóstico , Infarto Cerebral/fisiopatología , Imagen de Difusión por Resonancia Magnética , Dominancia Cerebral/fisiología , Imagenología Tridimensional , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Habla/fisiología , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler Dúplex , Anciano , Aorta Torácica/patología , Aorta Torácica/cirugía , Afasia de Broca/tratamiento farmacológico , Afasia de Wernicke/tratamiento farmacológico , Arteria Carótida Común/patología , Arteria Carótida Común/cirugía , Corteza Cerebral/irrigación sanguínea , Infarto Cerebral/tratamiento farmacológico , Revascularización Cerebral , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico , Arteria Subclavia/patología , Arteria Subclavia/cirugía , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Insuficiencia Vertebrobasilar/diagnóstico , Insuficiencia Vertebrobasilar/cirugíaRESUMEN
A 62-year-old right-handed woman had presented progressive speech impediment over 4 months. She was alert without any convulsions or involuntary movements. Neurological examination showed Wernicke's aphasia, constructional apraxia. Her magnetic resonance imaging (MRI) showed an old cerebral infarction in the left parieto-occipital area, in addition to ischemic changes in the bilateral deep white matter. Electroencephalography (EEG) revealed periodic lateralized epileptiform discharges (PLEDs) predominant in the posterior left hemisphere. The PLEDs as well as the cortical symptoms improved after an administration of anti-convulsive agents, thus establishing the diagnosis of non-convulsive status epilepticus (NSE). It should be emphasized that NSE manifesting as Wernicke's aphasia should be distinguished from dementia syndrome because it is a treatable disorder.
Asunto(s)
Afasia de Wernicke/etiología , Estado Epiléptico/complicaciones , Anticonvulsivantes/uso terapéutico , Afasia de Wernicke/tratamiento farmacológico , Infarto Cerebral/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Periodicidad , Estado Epiléptico/tratamiento farmacológicoRESUMEN
We report a patient with MELAS treated for 24 months with idebenone and riboflavin, during which no stroke-like episodes occurred. Moreover neurological symptoms clearly improved, and a recovery of brain MRI and EEG abnormalities was observed. We conclude that the combined treatment with idebenone and riboflavin may restore the metabolic impairment in MELAS, possibly improving the long-term prognosis in these patients.