RESUMO
We describe three cases of patients with Alzheimer's disease who presented with cardiac syncope soon after initiation of a cholinesterase inhibitor therapy (donepezil). Bradyarrhythmia was documented in two patients, considered probable in one, and was presumed related to the cholinergic therapy. Pacemaker implantation seemed justified rather than donepezil cessation. More over, it permitted an increase in donepezil dosage.
Assuntos
Doença de Alzheimer/tratamento farmacológico , Inibidores da Colinesterase/efeitos adversos , Indanos/efeitos adversos , Piperidinas/efeitos adversos , Síncope/etiologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Bradicardia/induzido quimicamente , Bradicardia/prevenção & controle , Inibidores da Colinesterase/uso terapêutico , Donepezila , Feminino , Humanos , Indanos/uso terapêutico , Masculino , Marca-Passo Artificial , Piperidinas/uso terapêuticoRESUMO
The case of a woman with short neuralgiform paroxysmal attacks located in orbital-periorbital area and associated with autonomic features of ten years duration is reported. This headache syndrome is compared with trigeminal neuralgia involving the first branch of the nerve. Duration, intensity, spreading of the pain and presence of accompanying ipsilateral vasomotor phenomena may be of help in the differential diagnosis. According to the latest reports, sex distribution which passed from 17 men/2 women to 18/6 and effect of the carbamazepine on pain would not appear to have an effect. Nevertheless other reports are needed to distinguish these two clinical syndromes and to develop an etiological and pathogenesis hypothesis.
Assuntos
Doenças da Túnica Conjuntiva/diagnóstico , Cefaleia/diagnóstico , Doenças do Aparelho Lacrimal/diagnóstico , Neuralgia/diagnóstico , Idoso , Analgésicos não Narcóticos/uso terapêutico , Carbamazepina/uso terapêutico , Doenças da Túnica Conjuntiva/complicações , Diagnóstico Diferencial , Feminino , Cefaleia/complicações , Humanos , Doenças do Aparelho Lacrimal/complicações , Neuralgia/complicações , Neuralgia/tratamento farmacológico , SíndromeRESUMO
A thirty-three-year-old patient developed polyradiculoneuritis with several post-therapeutic relapses despite excellent response to treatment by intravenous polyvalent gammaglobulin. After the second relapse, positive titres for Borrelia burgdorferi were found in serum and C.S.F. We gave her intravenous antibiotic and clinical signs and electrophysiological data improved. Our report and the literature can distinguish two clinical and electrophysiological presentations of neurological peripheral involvement in Lyme disease: meningoradiculoneuritis with axonal involvement and polyradiculoneuritis with demyelinization.
