Slow pseudoperiodic lateralized epileptiform discharges in nonconvulsive status epilepticus in a patient with cerebral palsy and a large central meningioma.

The presence of cerebral palsy and that of slow growing brain tumors are risk factors for convulsive and nonconvulsive status epilepticus. Nonconvulsive status epilepticus (NCSE) needs electroencephalographic (EEG) monitoring to be confirmed as it may be clinically subtle. Furthermore, it may present with a variety of ictal EEG morphologies. We report a case of a patient with cerebral palsy and a large central meningioma. Electroencephalogram showed a slow pattern of periodic lateralized epileptiform discharges (PLEDs) (a pattern considered as being situated in the ictal-interictal continuum) on an alpha background. The patient was treated for NCSE successfully with benzodiazepines followed by up-titration of his antiepileptic drug doses.

Isolated brainstem involvement in a patient with hypertensive encephalopathy.

Hypertensive encephalopathy typically presents with headache, confusion, and bilateral parietooccipital vasogenic edema. Brainstem edema in hypertensive encephalopathy usually occurs in association with typical supratentorial parieto-occipital changes and is usually asymptomatic. We report here a patient with hypertensive encephalopathy, with isolated brain stem involvement on magnetic resonance imaging (MRI). Rapid treatment of hypertension resulted in clinical and radiological improvement. Prompt recognition of the condition and aggressive treatment of hypertension in such patients is crucial to relieve edema and prevent life-threatening progression.

Bio-repository of DNA in stroke: a study protocol of three ancestral populations.

Stroke is a leading cause of death and disability in the world. Identifying the genes underlying stroke risk may help us to improve our understanding of the mechanisms that cause stroke and also identify novel therapeutic targets. To have sufficient power to disentangle the genetic component of stroke, large-scale highly phenotyped DNA repositories are necessary. The BRAINS (Bio-repository of DNA in stroke) study aims to recruit subjects with all subtypes of stroke as well as controls from UK, India, Sri Lanka and Qatar. BRAINS-UK will include 1500 stroke patients of European ancestry as well as British South Asians. BRAINS-South Asia aims to recruit 3000 stroke subjects and 3000 controls from across India and Sri Lanka. BRAINS-Middle East aims to enrol 1500 stroke patients from Qatar. The controls for BRAINS-Middle East will be recruited from a population-based Qatari Biobank. With the addition of new recruitment centres in India and Qatar, we present an updated version of the BRAINS study protocol. This is the first international DNA biobank for stroke patients and controls from the Middle East. By investigating the influence of genetic factors on stroke risk in European, South Asian and Middle Eastern populations, BRAINS has the potential to improve our understanding of genetic differences between these groups and may lead to new population-specific therapeutic targets.

Ischaemic posterior circulation stroke in State of Qatar.

BACKGROUND: Ischaemic stroke features may show regional differences. Posterior circulation stroke (PCS) is of special interest, as symptomatology, course and outcome are usually different and complex. No significant studies or registries have reported on the characteristics and outcomes of PCS in our region. METHODS: We prospectively collected data of 116 patients with PCS admitted from 2005 through 2008 in the only stroke admitting hospital in Qatar. Demographics, risk factors, clinical signs/symptoms, pattern of presentation, aetiology, imaging features, complications and outcome at discharge and follow-up were recorded. RESULTS: Mean age was 53 years with 25% aged < or = 45, 85% were males. Demographically 47% were Arabs and 51% of South-Asian origin. Mean duration from onset to presentation was 29 h. Major risk factors were obesity (66%) and hypertension (61%). Minimal or fluctuating symptoms were present in 64%, while 9% had maximal deficit at onset. Thirty nine per cent had lesions in proximal territory and 23% in multiple territories. Around 41% had no occlusion, 16% had vertebro-basilar, 16% vertebral, 8% basilar occlusion. Etiologically 53% patients had large artery disease, 16% small vessel disease, and 17% cardioembolism. Seventy per cent of patients were discharged home, while 10% expired. Modified Rankin score (mRS) at discharge was < or = 2 in 53% and > or = 4 in 13% patients. At 30-day follow-up, 68% had mRS of < or = 2. Ninety-day survival status showed 89% alive with mRS < or = 2 in 73%. CONCLUSION: The aetiology and lesion topography of PCS in this heterogeneous population differs from the pattern observed in other populations.

Cianuro y monóxido de carbono en la intoxicación por humo de incendio. Réplica / Cyanide and carbon monoxide in intoxication by smoke in a fire. Reply

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Intoxicación por monóxido de carbono, rabdomiólisis, petequias cerebrales y evolución fatal

La intoxicación por monóxido de carbono (CO) es una urgencia médica que, de no tratarse oportunamente, puede dejar considerables secuelas neurológicas o incluso provocar la muerte del paciente. El cuadro clínico desencadenado por la intoxicación por CO depende de la intensidad de la exposición a este gas y varía según el grado de afectación de los distintos órganos y sistemas involucrados. El sistema nervioso, dadas sus características de especial dependencia de una adecuada oxigenación, es extremadamente sensible a la presencia del CO en el organismo, debido a su afinidad por la hemoglobina, unas 200 veces mayor que la del oxígeno; por ello, mínimas cantidades de CO a un nivel constante pueden desencadenar daños considerablesen personas susceptibles. El espectro de síntomas neurológicos es variable y depende de la intensidad de la exposición y de una serie de factores predisponentes que puedeninclinar la balanza según el caso...

Intoxicación por monóxido de carbono, rabdomiólisis, petequias cerebrales y evolución fatal / Carbon monoxide poisoning, rhabdomyolysis, cerebral petechiae and fatal course

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[Crossed pattern of sensory loss with left thoracic level in a right dorsolateral medullary infarction]. / Infarto bulbar dorsolateral derecho con nivel sensitivo torácico contralateral.

INTRODUCTION: Medullary infarctions as consequence of vertebro-basilar strokes are frequent findings in clinical practice. Medulla oblongata, the lowest segment of the brainstem, is a dense anatomic structure with different conglomerate of nuclei, ascending and descending pathways within a very small area and tiny insults can present with expressive clinical manifestations. Sensory dysfunction is often a noteworthy element in lateral medullary infarctions and its distribution depends of the site and shape of the lesion within the medulla oblongata. From etiological point of view the most frequent cause of lateral medullary infarctions is atherosclerosis although vertebral dissection has to be carefully ruled out. CASE REPORT: A 65 year-old man with a left pain and temperature sensory level up to T4 in a right lateral medullary infarctions due to ipsilateral PICA territory infarction. Crossed pattern of sensory loss with a sensory level is a quite unusual presentation of lateral medullary infarctions and expresses the involvement of the most external aspect of the spinothalamic tract.

Infarto bulbar dorsolateral derecho con nivel sensitivo torácico contralateral / Crossed pattern of sensory loss with left thoracic level in a right dorsolateral medullary infarction

Introducción. Los infartos medulares secundarios a ictus vertebrobasilares son poco frecuentes en la práctica Clínica. El bulbo raquídeo, el segmento más bajo del tronco encefálico, es una estructura anatómica densa con distintas aglomeraciones de núcleos, vías ascendentes y descendentes dentro de un área muy reducida y pueden aparecer lesiones muy pequeñas con manifestaciones clínicas significativas. Con frecuencia, la disfunción sensitiva es un elemento destacado en casos de infarto medular lateral, y su distribución depende de la localización y forma de la lesión dentro del bulbo raquídeo. Etiológicamente, la causa más frecuente del infarto medular lateral es la aterosclerosis, aunque es necesario asegurarse de que no se trate de una disección vertebral. Caso clínico. Varón de 65 años de edad con un nivel de sensibilidad térmica y dolorosa en el lado izquierdo hasta el nivel D4 en un infarto medular lateral derecho debido a un infarto en el territorio de la PICA ipsilateral. Un patrón cruzado de pérdida sensitiva con un nivel de sensibilidad es una presentación relativamente poco frecuente de infarto medular lateral, e indica la afectación de la cara más externa del tracto espinotalámico(AU)

Introduction. Medullary infarctions as consequence of vertebrobasilar strokes are frequent findings in clinical practice. Medulla oblongata, the lowest segment of the brainstem, is a dense anatomic structure with different conglomerate of nuclei, ascending and descending pathways within a very small area and tiny insults can present with expressive clinical manifestations. Sensory dysfunction is often a noteworthy element in lateral medullary infarctions and its distribution depends of the site and shape of the lesion within the medulla oblongata. From etiological point of view the most frequent cause of lateral medullary infarctions is atherosclerosis although vertebral dissection has to be carefully ruled out. Case report. A 65 year-old man with a left pain and temperature sensory level up to T4 in a right lateral medullary infarctions due to ipsilateral PICA territory infarction. Crossed pattern of sensory loss with a sensory level is a quite unusual presentation of lateral medullary infarctions and expresses the involvement of the most external aspect of the spinothalamic tract(AU)

Infarto bulbar dorsolateral derecho con nivel sensitivo torácico contralateral / Crossed pattern of sensory loss with left thoracic level in a right dorsolateral medullary infarction

Introducción. Los infartos medulares secundarios a ictus vertebrobasilares son poco frecuentes en la práctica clínica. El bulbo raquídeo, el segmento más bajo del tronco encefálico, es una estructura anatómica densa con distintas aglomeraciones de núcleos, vías ascendentes y descendentes dentro de un área muy reducida y pueden aparecer lesiones muy pequeñas con manifestaciones clínicas significativas. Con frecuencia, la disfunción sensitiva es un elemento destacado en casos de infartomedular lateral, y su distribución depende de la localización y forma de la lesión dentro del bulbo raquídeo. Etiológicamente, la causa más frecuente del infarto medular lateral es la aterosclerosis, aunque es necesario asegurarse de que no se trate de una disección vertebral. Caso clínico. Varón de 65 años de edad con un nivel de sensibilidad térmica y dolorosa en el lado izquierdohasta el nivel D4 en un infarto medular lateral derecho debido a un infarto en el territorio de la PICA ipsilateral. Un patrón cruzado de pérdida sensitiva con un nivel de sensibilidad es una presentación relativamente poco frecuente de infarto medular lateral, e indica la afectación de la cara más externa del tracto espinotalámico

Introduction. Medullary infarctions as consequence of vertebro-basilar strokes are frequent findings in clinical practice. Medulla oblongata, the lowest segment of the brainstem, is a dense anatomic structure with different conglomerate of nuclei, ascending and descending pathways within a very small area and tiny insults can present with expressive clinicalmanifestations. Sensory dysfunction is often a noteworthy element in lateral medullary infarctions and its distribution depends of the site and shape of the lesion within the medulla oblongata. From etiological point of view the most frequent cause of lateral medullary infarctions is atherosclerosis although vertebral dissection has to be carefully ruled out. Case report. A 65 year-old man with a left pain and temperature sensory level up to T4 in a right lateral medullary infarctions due to ipsilateralPICA territory infarction. Crossed pattern of sensory loss with a sensory level is a quite unusual presentation of lateral medullary infarctions and expresses the involvement of the most external aspect of the spinothalamic tract

Catatonic stupor in a case of pontine and extrapontine myelinolysis: clinical and radiological dissociation

A 23-year-old Nepali man presented with confusion, compulsive eating and generalized catatonia. There was no past history of chronic alcohol abuse, exposure to neuroleptic drugs or toxic chemicals. Three weeks earlier he was discharged in good health after being admitted with mild disorientation and hyponatremia (127 mmol/L). At that time, all other biochemical parameters were normal. The ultrasound abdomen, CT brain, CSF analysis and electroencephalogram were also reported to be normal. The hyponatremia was corrected with normal saline (7 mmol/L in 24 h) and he was discharged after one week...

Infarto masivo del tallo cerebral como consecuencia de la oclusión aterotrombótica de la arteria basilar

El tallo cerebral, como parte esencial del territorio de la circulaciónposterior, es una estructura anatómica con enormes implicaciones funcionales dada la densa concentración de conglomerados de neuronas y de vías que conectan distantes zonasdel sistema nervioso. Los ataques isquémicos en esta zona seexpresarán según el área dañada y en más de un 70 por ciento de los casosdesde el inicio existe algún grado de déficit motor o deterioro del nivel de conciencia. Presentamos un caso que se manifestó desde el inicio como un estado de coma profundo conpocos elementos de focalización...

Infarto masivo del tallo cerebral como consecuencia de la oclusión aterotrombótica de la arteria basilar / Massive infarction of the brain stem as a consequence of atherothrombotic occlusion of the basilar artery

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Lepra, diagnóstico a simple vista

La lepra es una causa común de neuropatía en el tercer mundo. La sospecha de lepra debeexistir en aquellos inmigrantes que provienen de zonas endémicas (sur de Asia, África, Latinoamérica),aunque se describen casos aisladosen países desarrollados de Europa.Las formas tuberculoides, en pacientes con una inmunidad celular relativamente intacta, placas hipoestésicas eritematosas bien delimitadas o máculas hipocrómicas, se asocian con déficit sensoriales o motores en la distribuciónde uno o más nervios dañados. Adicionalmente, existe pérdida del cabello en las porciones distales de las extremidades inferiores, así como lesiones que tienden a cicatrizar defectuosamente en los muslos, las pantorrillas y los dedos, producto de quemadas o heridas previas. Se ven afectadas particularmente lasáreas de piel fría (pina auricular, las extremidades dístales y la punta de la nariz).....

Lepra, diagnóstico a simple vista / Leprosy, its diagnosis by the naked eye

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