RESUMO
Treatment of radiation myelopathy remains a challenge. Supportive and rehabilitative therapy is the mainstay of treatment. This article describes a case of central nervous system (CNS) toxicity of radiation with a progressive improvement in the clinicoradiological picture following high dose steroid treatment. A female patient was admitted to the neurology department of our hospital 7 months after a course of radiotherapy in another centre for lingual epidermoid cancer. Neurological examination revealed a heavy spastic quadriplegia syndrome. On MRI examination, T2 weighted hyperintensities were observed in cerebral and cerebellar peduncles, periventricular regions and medulla spinalis at Th1-Th2 levels. The patient was treated with high dose methylprednisolone, 1 g day(-1) for 5 days (pulse therapy) followed by oral methylprednisolone 80 mg day(-1) for a week, tapered over 3 weeks. Within the first week of pulse therapy, she regained muscle strength of upper limbs against gravity. At the 2 year follow-up, MRI demonstrated obvious regression of the lesions in the medulla and cerebellum with disappearance of contrast enhancement. This case report is notable with the complete disappearance of MRI lesions at the 2 year follow-up after the treatment with high dose steroid.
Assuntos
Glucocorticoides/administração & dosagem , Metilprednisolona/administração & dosagem , Quadriplegia/etiologia , Lesões por Radiação/complicações , Radioterapia/efeitos adversos , Encéfalo/patologia , Encéfalo/efeitos da radiação , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Esquema de Medicação , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Quadriplegia/tratamento farmacológico , Quadriplegia/patologia , Coluna Vertebral/patologia , Coluna Vertebral/efeitos da radiação , Vértebras Torácicas , Neoplasias da Língua/patologia , Neoplasias da Língua/radioterapiaAssuntos
Apraxia Ideomotora/diagnóstico , Infarto Cerebral/diagnóstico , Lobo Frontal/irrigação sanguínea , Doenças do Nervo Oculomotor/diagnóstico , Lobo Parietal/irrigação sanguínea , Arterite de Takayasu/diagnóstico , Apraxia Ideomotora/fisiopatologia , Infarto Cerebral/fisiopatologia , Diagnóstico Diferencial , Fixação Ocular/fisiologia , Seguimentos , Lobo Frontal/fisiopatologia , Humanos , Aumento da Imagem , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/fisiopatologia , Lobo Parietal/fisiopatologia , Acompanhamento Ocular Uniforme/fisiologia , Arterite de Takayasu/fisiopatologiaRESUMO
Musicogenic epilepsy has a strong correlation with the temporal lobe with a right-sided preponderance. We report the case of a 48-year-old woman whose seizures began at the age of 32 years. Her prenatal, natal and childhood histories were unremarkable and her family history was negative for epilepsy. She had typical complex partial seizures with chewing automatisms. Cranial computed tomography, magnetic resonance imaging (MRI) and interictal SPECT showed no abnormality. Interictal EEG showed paroxysmal bitemporal sharp wave discharges predominant on the right side. Ictal EEG showed a combination of high voltage sharp and slow sharp waves and spikes that originated from the right temporal leads and then became generalized. Ictal activity on EEG started 4-5 min after the music stimulus. For the ictal SPECT study, i.v. injection of 20 mCi of HMPAO was administered approximately 30 s after the ictal activity started. Ictal SPECT demonstrated a right anterior and mesial temporal hyperperfusion. These results seem to support the dominant role of the right temporal lobe and the possible relation of mesial temporal structures to the affective content of music in musicogenic epilepsy.