ABSTRACT
The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo-gical examination excluded mycotic etiology of the aneu-rysm and "normal aneurysm wall" was described. The brain stem haemorrhage - Duret bleeding - was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.
Subject(s)
Aneurysm, Ruptured/diagnostic imaging , Cerebellum/blood supply , Hematoma, Subdural/etiology , Hematoma, Subdural/surgery , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Cerebral Angiography , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/surgery , Computed Tomography Angiography , Female , Headache , Humans , Intracranial Aneurysm/complications , Middle Aged , Treatment OutcomeABSTRACT
BACKGROUND: Unilateral weakness of an upper extremity is most frequently caused by traumatic nerve injury or compression neuropathy. In rare cases, lesion of the central nervous system may result in syndromes suggesting peripheral nerve damage by the initial examination. Pseudoperipheral hand palsy is the best known of these, most frequently caused by a small lesion in the contralateral motor cortex of the brain. The 'hand knob' area refers to a circumscribed region in the precentral gyrus of the posterior frontal lobe, the lesion of which leads to isolated weakness of the upper extremity mimicking peripheral nerve damage. The etiology of this rare syndrome is almost exclusively related to an embolic infarction. CASE PRESENTATION: We present the case of a 70-year-old male patient with isolated left sided upper extremity weakness and clumsiness without sensory disturbance suggesting a lesion of the radial nerve. Nerve conduction studies had normal results excluding peripheral nerve damage. Neuroimaging (cranial CT and MRI) detected 3 space occupying lesions, one of them in the right precentral gyrus. An irregularly shaped tumor was found by CT in the left lung with multiple associated lymph node conglomerates. The metastasis from this mucinous tubular adenocarcinoma with solid anaplastic parts to the 'hand knob' area was responsible for the first clinical sign related to the pulmonary malignancy. CONCLUSIONS: Pseudoperipheral palsy of the upper extremity is not necessarily the consequence of an embolic stroke. If nerve conduction studies have normal results, neuroimaging - preferably MRI - should be performed, as lesion in the hand-knob area of the precentral gyrus can also be caused by a malignancy.
Subject(s)
Brain Neoplasms/complications , Brain Neoplasms/secondary , Muscle Weakness/diagnosis , Muscle Weakness/etiology , Upper Extremity/physiopathology , Aged , Brain Neoplasms/diagnosis , Fatal Outcome , Humans , Immunohistochemistry , Male , Multimodal Imaging/methods , Symptom AssessmentABSTRACT
In this case study, a co-infection with coxsackievirus A5 (family Picornaviridae) and norovirus GII.4 (family Caliciviridae) was detected by RT-PCR in a faecal sample from a six-year-old girl with symptoms of severe acute encephalopathy subsequently diagnosed as the intermittent form of maple syrup urine disease (MSUD). The two co-infecting viruses, which had been detected previously, appeared to have triggered the underlying metabolic disorder. Here, we describe the genotyping of the viruses, as well as the chronological course, laboratory test results, and clinical presentation of this case, which included recurrent vomiting without diarrhoea, metabolic acidosis, unconsciousness, seizure and circulatory collapse, but with a positive final outcome.
Subject(s)
Brain Diseases/virology , Enterovirus A, Human/isolation & purification , Maple Syrup Urine Disease/virology , Norovirus/isolation & purification , Brain Diseases/diagnosis , Child , Coinfection , Enterovirus A, Human/genetics , Enterovirus A, Human/physiology , Feces/virology , Female , Genotype , Humans , Maple Syrup Urine Disease/diagnosis , Norovirus/genetics , Norovirus/physiologyABSTRACT
Thromboangiits obliterans (Buerger's disease) is a non-atherosclerotic, segmental inflammatory and obliterative disease affecting small and medium sized arteries and veins. The etiology is still unknown, but it is in close relationship with tobacco use. Symptoms begin under the age of 45 years and the undulating course is typical. Patients usually present with acute and chronic ischemic or infectious acral lesions. Diagnosis is usually based on clinical and angiographic criteria and it is important to exclude autoimmune disease, thrombophilia, diabetes, and proximal embolic sources. Even though Buerger's disease most commonly involves the arteries of the extremities, the pathologic findings sometimes affect the cerebral, coronary and internal thoracic, renal and mesenteric arteries as well. The authors present the history of a patient with known Buerger's disease and acute ischemic stroke. Brain imaging detected acute and chronic ischemic lesions caused by middle cerebral non-atherosclerotic arteriopathy on the symptomatic side. Other etiology was excluded by detailed investigations. Orv. Hetil., 2016, 157(30), 1207-1211.
Subject(s)
Brain Ischemia/complications , Brain Ischemia/diagnosis , Cerebral Arteries/pathology , Stroke/diagnosis , Stroke/etiology , Thromboangiitis Obliterans/complications , Thromboangiitis Obliterans/pathology , Brain Ischemia/diagnostic imaging , Brain Ischemia/etiology , Cerebral Angiography , Cerebral Arteries/diagnostic imaging , Diffusion Magnetic Resonance Imaging , Humans , Male , Middle Aged , Stroke/diagnostic imaging , Stroke/pathologySubject(s)
Basal Ganglia Diseases/diagnosis , Brain Neoplasms/diagnosis , Cerebral Cortex/pathology , Hemangioma, Cavernous, Central Nervous System/diagnosis , Siderosis/diagnosis , Thalamus/pathology , Basal Ganglia Diseases/etiology , Brain Neoplasms/complications , Female , Hemangioma, Cavernous, Central Nervous System/complications , Humans , Middle Aged , Siderosis/etiology , SyndromeABSTRACT
OBJECTIVES: Otogenic lateral sinus thrombosis is a rare complication of acute otitis media whose clinical presentation has changed with the early use of antibiotics. The aim of this study was to analyze the changing clinical signs, vaccination status, therapeutic management and outcome of these patients. METHODS: Retrospective chart review of 10 children treated with otogenic lateral sinus thrombosis in a tertiary level teaching hospital in Budapest, Hungary, from January 1998 till August 2013. RESULTS: Patients were divided into Early and Late presenting groups. In the Early presenting group, sepsis developed within one week after the onset of acute otitis media. At admission otological symptoms were predominant. The Late presenting group experienced acute otitis media several weeks prior to presentation and in this group neurologic symptoms dominated the clinical picture at admission. All patients received antibiotics. Eight of them were also treated with low molecular weight heparin. All children underwent cortical mastoidectomy. After surgery, the clinical signs of elevated intracranial pressure transiently worsened. This manifested as progression of papilledema in seven children, causing severe visual disturbance in two cases. After medical treatment and serial lumbar punctures all patients except one recovered. This child has permanent visual acuity failure of 0.5D unilaterally. At one year follow up complete and partial recanalization were noted in five and two patients, respectively. CONCLUSIONS: After mastoidectomy the signs of elevated intracranial pressure can transiently worsen, papilledema can progress. Daily bedside monitoring of visual acuity and regular ophthalmoscopy with neurologic examination is recommended during hospitalization. Close follow up is advised up to one year. When the dominant sinus is occluded, the clinical scenario is more protracted and severe.
Subject(s)
Intracranial Hypertension/complications , Intracranial Hypertension/etiology , Lateral Sinus Thrombosis/etiology , Papilledema/etiology , Acetazolamide/therapeutic use , Acute Disease , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Anticonvulsants/therapeutic use , C-Reactive Protein/analysis , Child , Child, Preschool , Female , Heparin, Low-Molecular-Weight/therapeutic use , Hospitalization , Humans , Intracranial Hypertension/therapy , Lateral Sinus Thrombosis/therapy , Leukocyte Count , Male , Mastoid/surgery , Neurologic Examination , Otitis Media/complications , Papilledema/therapy , Retinal Hemorrhage/etiology , Retinal Hemorrhage/therapy , Retrospective Studies , Sepsis/drug therapy , Sepsis/etiology , Thrombectomy , Vision Disorders/etiology , Vision Disorders/therapyABSTRACT
Wernicke's encephalopathy is an acute, potentially life-threatening, neurological syndrome resulting from thiamine deficiency. The disorder is still greatly underdiagnosed and, without prompt treatment, the condition can lead to the chronic form of the disease, Korsakoff's syndrome or even death. In developed countries Wernicke's encephalopathy has been associated with alcoholism, but in recent years there has been an increasing number of non-alcoholic cases. Authors report the case of a 23-year-old woman who developed oculomotor dysfunction, encephalopathy and ataxia as a result of an extreme diet and use of diet pills. The diagnosis of Wernicke's encephalopathy was supported by the resolution of neurological signs after parenteral thiamine replacement. This case is presented because of the rare etiology and diagnostic difficulty, and the latest diagnostic and therapic guidelines are also highlighted.
Subject(s)
Diet, Reducing/adverse effects , Thiamine Deficiency/complications , Thiamine/administration & dosage , Vitamin B Complex/administration & dosage , Wernicke Encephalopathy/diagnosis , Wernicke Encephalopathy/etiology , Alcoholism/complications , Ataxia/etiology , Feeding Behavior , Female , Humans , Oculomotor Nerve Diseases/etiology , Thiamine Deficiency/etiology , Weight Loss , Wernicke Encephalopathy/complications , Wernicke Encephalopathy/drug therapy , Wernicke Encephalopathy/metabolism , Young AdultABSTRACT
Type IV collagen α1 and α2 chains form heterotrimers that constitute an essential component of basement membranes. Mutations in COL4A1, encoding the α1 chain, cause a multisystem disease with prominent cerebrovascular manifestations, including porencephaly, bleeding-prone cerebral small vessel disease, and intracranial aneurysms. Mutations in COL4A2 have only been reported in a few porencephaly families so far. Herein, we report on a young adult patient with recurrent intracerebral hemorrhage, leukoencephalopathy, intracranial aneurysms, nephropathy, and myopathy associated with a novel COL4A2 mutation. We extensively investigated a 29-year-old male patient with recurrent deep intracerebral hemorrhages causing mild motor and sensory hemisyndromes. Brain MRI showed deep intracerebral hemorrhages of different age, diffuse leukoencephalopathy, multiple cerebral microbleeds and small aneurysms of the carotid siphon bilaterally. Laboratory work-up revealed significant microscopic hematuria and elevation of creatine-kinase. Genetic testing found a de novo glycine mutation within the COL4A2 triple helical domain. The presented case completes the spectrum of cerebral and systemic manifestations of COL4A2 mutations that appears to be very similar to that in COL4A1 mutations. Therefore, we emphasize the importance of screening both COL4A1 and COL4A2 in patients showing recurrent intracerebral hemorrhage of unknown etiology, particularly if associated with leukoencephalopathy.
Subject(s)
Cerebral Hemorrhage/genetics , Collagen Type IV/genetics , Leukoencephalopathies/genetics , Adult , Cerebral Hemorrhage/diagnosis , Genetic Testing , Glycine/genetics , Humans , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/genetics , Kidney Diseases/diagnosis , Kidney Diseases/genetics , Leukoencephalopathies/diagnosis , Magnetic Resonance Imaging , Male , Muscular Diseases/diagnosis , Muscular Diseases/genetics , Mutation/genetics , RecurrenceABSTRACT
We report the first European case of cerebral iodized lipid embolism post transcatheter arterial embolization for hepatocellular carcinoma. Lipiodol emboli and corresponding multifocal brain ischemia were documented with computed tomography (CT) and magnetic resonance (MR) in the acutely symptomatic patient. Transcranial Doppler sonography with contrast indicated a right-to-left shunt, while on a follow-up CT scan lipiodol embolization was detected in both lungs. Dilated pulmonary vessels and thick vascular channels were seen in the vicinity of the right diaphragm suggestive of pulmonary arteriovenous shunt. The patient symptoms regressed with supportive care alone, but he died 5 months later due to hepatic failure unrelated to the procedure.
Subject(s)
Arteriovenous Shunt, Surgical , Carcinoma, Hepatocellular/complications , Embolization, Therapeutic/adverse effects , Ethiodized Oil/administration & dosage , Intracranial Embolism/therapy , Pulmonary Artery/abnormalities , Pulmonary Veins/abnormalities , Antineoplastic Agents/administration & dosage , Carcinoma, Hepatocellular/therapy , Fatal Outcome , Humans , Intracranial Embolism/etiology , Liver Neoplasms/complications , Liver Neoplasms/therapy , Male , Middle AgedABSTRACT
Authors, most of them Japanese, have recently published an increasing number of articles on mild encephalitis/encephalopathy with a reversible splenial lesion. We report on two new white European patients and compare published data with our own observations. A 15-year-old girl developed headache, fever, dizziness, vomiting and nuchal rigidity over four days. CSF showed elevated protein and cell count, with the lowest serum Na being 131 mmol/L. MRI on day seven was normal, but she remained febrile, had cerebral edema and episodes of confusion. MRI on day 11 showed a small T2-hyperintense lesion with restricted diffusion in the callosal splenium. Adenoviral infection was proved, and the girl underwent a protracted course of recovery. MRI signal changes improved in six days and disappeared after four months. A 12.5-year-old girl developed headache, lethargy, drowsiness and vomiting. On day five she experienced right-sided numbness, weakness and inability to speak which lasted 12 hours. She was confused and disoriented. MRI disclosed a tiny area of increased T2-signal and restricted diffusion in the splenium. Serum Na was 133 mmol/L, CSF cell count and protein was markedly elevated, and enteroviral infection was detected. Echocardiography showed no changes predisposing to clot formation and no thrombophilia was found. Her symptoms resolved in a week and MRI was normal two months later. These two non-epileptic children increase the small number of white European patients with MERS reported so far. Both had hyponatremia and encephalitis and patient 2 had transient ischemic attack, possibly due to the cerebral edema also resulting in the splenial lesion.
Subject(s)
Brain/pathology , Encephalitis/diagnosis , Magnetic Resonance Imaging , Adolescent , Anti-Inflammatory Agents/administration & dosage , Antipyretics/administration & dosage , Aspirin/administration & dosage , Brain Edema/etiology , Brain Edema/pathology , Child , Corpus Callosum/pathology , Diuretics, Osmotic/administration & dosage , Encephalitis/complications , Encephalitis/drug therapy , Encephalitis/pathology , Encephalitis, Viral/diagnosis , Female , Humans , Ischemic Attack, Transient/etiology , Ischemic Attack, Transient/pathology , Magnetic Resonance Angiography , Mannitol/administration & dosage , Methylprednisolone/administration & dosage , Neuroprotective Agents/administration & dosage , Treatment OutcomeSubject(s)
Central Nervous System Neoplasms/diagnosis , Central Nervous System Neoplasms/etiology , Leukoencephalopathies/complications , Lymphoma, B-Cell, Marginal Zone/diagnosis , Lymphoma, B-Cell, Marginal Zone/etiology , Adult , Age of Onset , Central Nervous System Neoplasms/pathology , Female , Humans , Leukoencephalopathies/diagnosis , Leukoencephalopathies/epidemiology , Leukoencephalopathies/pathology , Lymphoma, B-Cell, Marginal Zone/pathology , Magnetic Resonance Imaging , Medical History Taking , Time FactorsSubject(s)
Inflammation/complications , Leukoencephalopathy, Progressive Multifocal/complications , Leukoencephalopathy, Progressive Multifocal/diagnosis , Lymphoma, Follicular/complications , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Humans , Inflammation/therapy , Leukoencephalopathy, Progressive Multifocal/therapy , Lymphoma, Follicular/therapy , Male , Middle Aged , Splenectomy , Time Factors , Treatment OutcomeABSTRACT
Authors report a case of a 35-year-old male with right-sided mild paresis, incontinence, dysexecutive syndrome, short-term memory loss and behavioral changes. Bilateral cerebral infarcts in the region of the caudate nuclei and the adjacent white matter were proved by brain MRI and multiple stenoses of the branches of Willis-circle were confirmed by MR angiography. Elevated protein level and pleocytosis were found in the cerebrospinal fluid with intrathecal IgG synthesis. Serum rapid plasma reagin, Treponema pallidum Particle Agglutination test, Treponema pallidum ELISA, liquor Venereal Disease Research Laboratory tests were positive. Meningovascular neurosyphilis was diagnosed. 24M U/day intravenous penicillin-G treatment was given for 14 days. The patient has vascular dementia due to the bilateral strategic infarcts disconnecting the prefrontal circuits; his symptoms are similar to general paresis. Laboratory and radiologic improvement was observed. Still, the patient have severe residual cognitive decline.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/microbiology , Meninges , Neurosyphilis/diagnosis , Neurosyphilis/drug therapy , Penicillin G/administration & dosage , Treponema pallidum/isolation & purification , Adult , Agglutination Tests , Cerebrovascular Disorders/cerebrospinal fluid , Cerebrovascular Disorders/drug therapy , Dementia, Vascular/microbiology , Enzyme-Linked Immunosorbent Assay , Humans , Infusions, Intravenous , Magnetic Resonance Imaging , Male , Meninges/blood supply , Meninges/microbiology , Neurosyphilis/cerebrospinal fluid , Paresis/microbiology , Syphilis Serodiagnosis , Treponema pallidum/immunologyABSTRACT
Neuromyelitis optica (NMO, Devic-syndrome) is a rare, relapsing autoimmune disease of the central nervous system, which is distinguished from other demyelinating disorders by a recently identified, specific autoantibody. By demonstrating the anti-aquaporin-4 IgG in the serum, a heterogenous group of syndromes can be defined, called NMO-spectrum. In the future, optical coherence tomography may support this diagnosis besides the clinical features, imaging examinations and presence of serum antibody. Early recognition and treatment can improve clinical outcome even in serious condition. Long-term immunosuppressive therapy is advised to prevent further relapses and to stabilize or improve clinical status. Hereby, we report a case of a 51-year-old woman, under treatment for one and a half years. We summarize the current knowledge about the pathomechanism, diagnostic strategy and therapy of neuromyelitis optica. We review recent findings and the diagnostic value of a new, non-invasive ophtalmological examination, the optical coherence tomography. According to the first results, this method may be helpful in the early differential diagnosis of optic neuritis.
Subject(s)
Neuromyelitis Optica/diagnosis , Neuromyelitis Optica/therapy , Early Diagnosis , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Neuromyelitis Optica/cerebrospinal fluid , Tomography, Optical CoherenceABSTRACT
We report the association of ipsilateral trigemino-autonomic headache to a case of right-sided nuclear facial and abducens palsy (Gasperini syndrome), ipsilateral hypacusis and right hemiataxia, caused by the occlusion of the right anterior inferior cerebellar artery. Short-lasting attacks of mild to moderate ipsilateral fronto-periorbital head pain, accompanied by lacrimation and mild conjunctival injection during more severe attacks, were present from the onset of symptoms, with a gradual worsening over the next few months and remitting during naproxen therapy. Magnetic resonance imaging showed an infarct in the right cerebellar peduncle, extending toward the pontine tegmentum, also involving the ipsilateral spinal trigeminal nucleus and tract and the trigeminal entry zone. Gasperini syndrome may be accompanied by ipsilateral trigemino-autonomic head pain.
Subject(s)
Brain Stem Infarctions/diagnosis , Brain Stem/pathology , Trigeminal Autonomic Cephalalgias/diagnosis , Trigeminal Nuclei/pathology , Vertebrobasilar Insufficiency/diagnosis , Aged , Brain Stem/blood supply , Brain Stem Infarctions/etiology , Brain Stem Infarctions/pathology , Cerebellum/blood supply , Cerebellum/pathology , Diagnosis, Differential , Humans , Male , Syndrome , Trigeminal Autonomic Cephalalgias/etiology , Trigeminal Autonomic Cephalalgias/pathology , Trigeminal Nuclei/blood supply , Vertebrobasilar Insufficiency/etiology , Vertebrobasilar Insufficiency/pathologyABSTRACT
Aspergillus infection of the central nervous system is a rare disease, occasionally seen among immunocompromised patients. The most frequent pathway is hematogenic dissemination. Less known is the direct propagation from the paranasal sinuses, which is usually observed in immunocompetent patients. We report a patient who developed cavernous sinus syndrome due to an invasive intracranial aspergilloma after longlasting chemo- and steroid therapy for chronic lymphoid leukemia and immunhemolytic anemia. The characteristic features seen on radiological images--brain CT and MRI--suggested the possibility of invasive aspergilloma. Postoperative histology defined the diagnosis. Our case review highlights the importance of considering the possibility of an invasive opportunistic infection of the CNS in an immunocompromised patient presenting a new neurological sign.
Subject(s)
Cavernous Sinus , Immunocompromised Host , Neuroaspergillosis/diagnostic imaging , Neuroaspergillosis/pathology , Aged , Cavernous Sinus/parasitology , Humans , Magnetic Resonance Angiography , Male , Neuroaspergillosis/surgery , Syndrome , Tomography, X-Ray ComputedABSTRACT
Spontaneous intracranial hypotension is a rare complication of connective tissue disorders. One of them is Marfan syndrome. It predisposes the patient to meningeal diverticula. Possibly after minor unrecognised head trauma or secondary to Valsalva manoeuvre cerebrospinal fluid leak from meningeal diverticula can happen. It causes postural headache. We describe a 15 year old adolescent female newly diagnosed with Marfan syndrome, who presented with intractable postural headache. Our patient's brain MRI showed bilateral frontal subdural effusion, narrow ventricles, downward displacement of the brainstem, enlarged cervical venous plexi, dural ectasias and wide nerve root sleeves. Radionuclide cisternography demonstrated CSF leaks at multiple sites. She could not be treated conservatively, but was successfully treated by epidural saline injections. Control brain and cervical MRI confirmed her healing, too. At the two and half year follow up visit, she was completely well. So we recommend this easy technique to be used before epidural autologous blood patches.
Subject(s)
Intracranial Hypotension/diagnosis , Intracranial Hypotension/etiology , Marfan Syndrome/complications , Marfan Syndrome/diagnosis , Subdural Effusion/etiology , Adolescent , Female , Headache/etiology , Humans , Injections, Epidural , Intracranial Hypotension/pathology , Intracranial Hypotension/therapy , Isotonic Solutions/administration & dosage , Magnetic Resonance Imaging , Marfan Syndrome/therapy , Sodium Chloride/administration & dosage , Subdural Effusion/complicationsABSTRACT
Juxtafacet cysts of the cervical and thoracic spine are rare and often cause radiculopathy or myelopathy. We present a case of a patient with radicular pain and early onset myelopathy. A juxtafacet cyst at the cervico-thoracic junction combined with discal herniation and spina bifida occulta was diagnosed with computed tomography (CT) and magnetic resonance imaging (MRI). Laminectomy with removal of the cyst was the treatment and the patient recovered rapidly.
Subject(s)
Laminectomy/methods , Spinal Cord Diseases/diagnosis , Spinal Diseases/diagnosis , Spinal Dysraphism/diagnosis , Synovial Cyst/diagnosis , Zygapophyseal Joint/pathology , Adult , Cervical Vertebrae/pathology , Follow-Up Studies , Gadolinium , Humans , Magnetic Resonance Imaging/methods , Male , Neck Pain/diagnosis , Neck Pain/etiology , Pain Measurement , Rare Diseases , Risk Assessment , Severity of Illness Index , Spinal Cord Diseases/etiology , Spinal Diseases/complications , Spinal Diseases/surgery , Spinal Dysraphism/complications , Synovial Cyst/complications , Synovial Cyst/surgery , Thoracic Vertebrae/pathology , Tomography, X-Ray Computed , Treatment Outcome , Zygapophyseal Joint/surgeryABSTRACT
Systemic lupus erythematosus is a frequent autoimmune disease, affecting several organs, including the brain, spinal cord and nerves. Cerebral vasculitis, transverse myelitis and polyneuropathy are the most common neurological manifestations. We report a case of a 46 years old woman who suffered incomplete transverse myelitis at the age of 44. After 2 years the second relapse presented with arthralgias, painful paraesthesias and weakness of the lower limbs. Neurological signs suggested involvement of the central and the peripheral nervous system. Based upon clinical and laboratory findings systemic lupus erythematosus was diagnosed. Magnetic resonance imaging revealed two hyperintense lesions on T2 weighted scans within the cervical spinal cord. The brain scan was normal. Protein content was slightly elevated in the cerebrospinal fluid, with normal cell count. Electrophysiological examinations diagnosed a subacute sensory-motor axonal polyneuropathy. On methylprednisolone treatment her condition improved. Simultaneous development of central and peripheral lesions of the nervous system in cases with systemic lupus erythematosus may lead to a challenge to establish the diagnosis.
Subject(s)
Central Nervous System/physiopathology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Peripheral Nervous System/physiopathology , Anti-Inflammatory Agents/therapeutic use , Arthralgia/etiology , Female , Humans , Lower Extremity , Lupus Erythematosus, Systemic/physiopathology , Magnetic Resonance Imaging , Methylprednisolone/therapeutic use , Middle Aged , Muscle Weakness , Myelitis/etiology , Neuroprotective Agents/therapeutic use , Paresthesia/etiology , Polyneuropathies/etiologyABSTRACT
The biomedical analysis of the infant cry is aimed to find connections between several diseases during infancy and their influence on the human sound production system. A new, non-invasive diagnostic tool could be created, if these connections were fully discovered. Various reports have already dealt with the analysis of the crying sound for physiological, psychic, physical, developmental, etc. reasons. In these studies characteristic attributes of the infant cry were obtained and analyzed. In the time domain mostly absolute and normalized durations, in the frequency domain frequency components, intervals were determined. The melody of crying was analyzed occasionally as there were no exact methods for categorizing the shapes of the melodies. In this paper the authors introduce a new system for categorizing the melodies. By this system the analysis of the melodies can be evaluated in an easy and objective way that it could be included in further biomedical researches dealing with the infant cry.