Assuntos
Anticoagulantes , Hematoma Epidural Espinal , Humanos , Hematoma Epidural Espinal/induzido quimicamente , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/etiologia , Anticoagulantes/efeitos adversos , Remissão Espontânea , Masculino , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
Objectives: Demyelinating diseases of central nervous system (CNS) are a broad spectrum of conditions with autoimmune process against myelin. In a resource limited country like India, it is imperative to perform proper clinical evaluation, neuroimaging to differentiate among various categories of CNS demyelinating diseases to decide regarding further workup and treatment. The objective of our study was to determine clinical presentation, imaging findings, serology results, diagnosis, and treatment outcome of primary demyelinating disorders of CNS. Materials and Methods: In this prospective study, a total of 44 patients were enrolled over a period of 1 year. After proper evaluation, patients were categorized into different groups applying newer diagnostic criteria. Patients were treated with steroids, appropriate immunomodulatory therapy, and outcomes were analyzed. Results: The majority of cases were of neuromyelitis optica spectrum disorder (NMOSD) (45.5%) with an overall female-to-male ratio of 3.4:1 and mean age of presentation was 30.5 ± 11.15. Myelitis (52.3%) followed by optic neuritis (45.5%) was the most common initial presentation. The most common site of involvement on magnetic resonance imaging was the spinal cord (particularly the cervicodorsal cord). The majority showed good response to therapy (77.27%) and two patients did not survive. Conclusion: Higher disability observed among seropositive NMOSD patients warrants aggressive treatment during the first attack itself. It is important to suspect myelin oligodendrocyte glycoprotein antibody disease in patients with preceding viral infection. A good outcome in the majority is likely due to the availability of serological assays and aggressive immunomodulatory therapy.
RESUMO
We report about two young males who developed significant proximal weakness of all four limbs secondary to intracranial hypertension due to intracranial venous sinus thrombosis. Intracranial venous sinus thrombosis can manifest in a variety of ways which includes isolated intracranial hypertension, focal neurological symptoms or signs and acute or subacute encephalopathy. Various false localising signs have been reported to occur in patients with raised intracranial pressure including cranial nerve palsies and extensive radiculopathy. In a patient presenting with flaccid areflexic quadriparesis and papilledema, the possibility of a potentially reversible dysfunction of the cranial nerves and spinal nerve roots due to a marked rise in intracranial and intraspinal pressure must be recognised. Lumboperitoneal shunt to reduce the intraspinal pressure on the spinal nerve roots has been advocated to reverse the symptoms of extensive radiculopathy in such patients. Both of our patients showed remarkable improvement in symptoms and signs with medical treatment of CVT.
Assuntos
Hipertensão Intracraniana , Papiledema , Polirradiculopatia , Trombose dos Seios Intracranianos , Cavidades Cranianas , Humanos , Masculino , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico por imagemAssuntos
Anormalidades Múltiplas/diagnóstico , Cerebelo/anormalidades , Anormalidades do Olho/diagnóstico , Doenças Renais Císticas/diagnóstico , Retina/anormalidades , Convulsões/etiologia , Adulto , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância MagnéticaAssuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/etiologia , Trombose do Seio Lateral/complicações , Trombose do Seio Lateral/diagnóstico por imagem , Angiografia Digital , Evolução Fatal , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
Strokes involving posterior inferior cerebellar arteries (PICA) are rare and usually unilateral. They can involve either the lateral division or the medial division of PICA. Sudden simultaneous cerebellar infarctions in the medial PICA territories are extremely rare. We report one such patient who presented with acute bilateral cerebellar infarctions in the medial PICA territories. She was a diabetic and had features of diffuse atherosclerotic vertebrobasilar disease. We discuss the anatomical peculiarities of PICA and its blood supply along with the clinical features differentiating the medial and lateral PICA infarctions. We also list out the possible mechanisms of bilateral medial PICA territory infarction. Though bilateral they generally have a good prognosis considering the very small area of blood supply.
Assuntos
Cerebelo/irrigação sanguínea , Artérias Cerebrais , Infarto Cerebral , Infarto Cerebral/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Acidose Tubular Renal/etiologia , Hipopotassemia/etiologia , Paralisia/etiologia , Síndrome de Sjogren/complicações , Acetazolamida/uso terapêutico , Acidose Tubular Renal/diagnóstico , Acidose Tubular Renal/terapia , Adulto , Feminino , Humanos , Hipopotassemia/diagnóstico , Hipopotassemia/terapia , Imunossupressores/uso terapêutico , Potássio/uso terapêutico , Prednisolona/uso terapêutico , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/etiologia , Síndrome de Sjogren/terapia , Resultado do TratamentoAssuntos
Anestesia Geral/efeitos adversos , Cegueira/etiologia , Síndromes Compartimentais/etiologia , Descompressão Cirúrgica/efeitos adversos , Imageamento por Ressonância Magnética , Músculos Oculomotores/diagnóstico por imagem , Doenças Orbitárias/etiologia , Adulto , Cegueira/diagnóstico , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/tratamento farmacológico , Humanos , Vértebras Lombares/cirurgia , Masculino , Metilprednisolona/uso terapêutico , Oftalmoplegia/diagnóstico , Oftalmoplegia/tratamento farmacológico , Oftalmoplegia/etiologia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/tratamento farmacológico , Complicações Pós-Operatórias/diagnóstico , Decúbito Ventral , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/etiologiaAssuntos
Encéfalo/patologia , Hemorragia Cerebral/diagnóstico , Eclampsia/diagnóstico , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Hemorragia Cerebral/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/etiologia , Gravidez , Adulto JovemRESUMO
Parry-Romberg syndrome is a rare clinical entity characterised by progressive hemifacial atrophy with appearance of 'saber'. Various neurological and otorhinolaryngological disorders are associated with this syndrome. The association of Parry -Romberg syndrome with Spasmodic dysphonia has rarely been reported. A 37 year old female presented with progressive atrophy of tissues of left side of face for 10 years and change in voice for 1 year. On examination, wasting and atrophy of tissues including tongue was noted on left side of the face. ENT examination revealed adductor spasmodic dysphonia. We report the rare association of Parry -Romberg syndrome with spasmodic dysphonia.