RESUMO
Cerebral amyloid angiopathy as a cause of recurrent small cortical strokes is under-recognised. These patients need haemosiderin-sensitive MRI to make a diagnosis and intensive antiplatelet treatment is dangerous.
Assuntos
Infarto Encefálico/etiologia , Angiopatia Amiloide Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Infarto Encefálico/patologia , Angiopatia Amiloide Cerebral/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , NeuroimagemAssuntos
Angioplastia/economia , Angioplastia/instrumentação , Doenças das Artérias Carótidas/economia , Doenças das Artérias Carótidas/terapia , Centers for Medicare and Medicaid Services, U.S./economia , Política de Saúde/economia , Reembolso de Seguro de Saúde , Stents/economia , Angioplastia/efeitos adversos , Angioplastia/legislação & jurisprudência , Centers for Medicare and Medicaid Services, U.S./legislação & jurisprudência , Medicina Baseada em Evidências , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Seleção de Pacientes , Formulação de Políticas , Medição de Risco , Fatores de Risco , Estados UnidosRESUMO
BACKGROUND AND PURPOSE: Convexity subarachnoid haemorrhage (cSAH) has recently been recognised as a cause of recurrent aura-like symptoms, mimicking transient ischaemic attacks (TIAs). Subarachnoid haemorrhage and recurrent aura-like episodes can occur in patients with cerebral amyloid angiopathy (CAA), which has been the presumed cause in the majority of reported cases. However, this syndrome can occur following cSAH secondary to other conditions, and it is important for clinicians to investigate and manage such patients appropriately. METHOD: Case series. RESULTS: We describe two patients who presented with recurrent stereotyped transient neurological symptoms in the setting of acute cSAH identified on MRI. In one patient, SAH occurred secondary to cerebral venous sinus thrombosis. In the other, SAH was due to extension of a traumatic subdural haematoma. CONCLUSIONS: Conditions other than CAA can cause the clinicoradiological syndrome of cSAH with recurrent TIA-like events. Gradient echo or susceptibility-weighted imaging should be included in the diagnostic work-up of patients presenting with such events. When cSAH is detected, the full differential diagnosis for this should be considered. Aetiologies other than CAA can cause this syndrome and management can vary greatly depending on the underlying cause.
Assuntos
Epilepsia/diagnóstico , Epilepsia/etiologia , Hemorragia Subaracnóidea/complicações , Idoso , Idoso de 80 Anos ou mais , Angiopatia Amiloide Cerebral/diagnóstico , Diagnóstico Diferencial , Epilepsia/patologia , Feminino , Hematoma Subdural Intracraniano/complicações , Humanos , Ataque Isquêmico Transitório/diagnóstico , Masculino , Trombose dos Seios Intracranianos/complicações , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/patologiaRESUMO
Reversible cerebral vasoconstriction is a rare and poorly understood syndrome, without clear diagnostic criteria. It has been described in association with multiple disorders, but has only been reported rarely in the setting of carotid artery dissection and, to our knowledge, never before in association with renal artery stenosis.
Assuntos
Encéfalo/irrigação sanguínea , Dissecação da Artéria Carótida Interna/complicações , Obstrução da Artéria Renal/complicações , Vasoconstrição , Adulto , Anti-Hipertensivos/uso terapêutico , Encéfalo/patologia , Dissecação da Artéria Carótida Interna/patologia , Circulação Cerebrovascular/efeitos dos fármacos , Circulação Cerebrovascular/fisiologia , Feminino , Transtornos da Cefaleia Primários/etiologia , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Nimodipina/uso terapêutico , Obstrução da Artéria Renal/patologia , Vasodilatadores/uso terapêuticoRESUMO
The spectrum of central nervous system (CNS) vascular pathology in systemic lupus erythematosus (SLE) includes small vessel vasculopathy, thromboembolism, perivascular lymphocytic infiltration and, rarely, overt transmural vasculitis. We present the case of a patient, who experienced three CNS relapses over total disease duration of 26 years, with otherwise indolent disease. The first two relapses were suspicious of vasculitis and the last was proven at autopsy. The short duration between final relapse onset and death in this SLE CNS vasculitis case was, to our knowledge, unique. Histopathological investigation demonstrated multiple confluent areas of haemorrhage in the medulla due to an acute small vessel leucocytoclastic vasculitis.
Assuntos
Tronco Encefálico/irrigação sanguínea , Hemorragias Intracranianas/etiologia , Lúpus Eritematoso Sistêmico/complicações , Vasculite do Sistema Nervoso Central/complicações , Vasculite Leucocitoclástica Cutânea/complicações , Adulto , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Imageamento por Ressonância Magnética , Vasculite do Sistema Nervoso Central/diagnóstico , Vasculite Leucocitoclástica Cutânea/diagnósticoRESUMO
Paraneoplastic chorea occurs most commonly in association with small cell lung cancer, often in combination with other paraneoplastic phenomena and sometimes with distinctive basal ganglia T2-weighted MRI hyperintensities. A case of acute-onset chorea is presented in which this phenomenon, combined with transverse myelitis, neuropathy and the described characteristic MRI changes prompted positron emission tomography scanning, in which evidence of probable small cell cancer was uncovered.
Assuntos
Coreia/etiologia , Neoplasias Pulmonares/complicações , Mielite Transversa/etiologia , Doenças do Sistema Nervoso Periférico/etiologia , Carcinoma de Pequenas Células do Pulmão/complicações , Idoso , Feminino , Fluordesoxiglucose F18 , Humanos , Neoplasias Pulmonares/diagnóstico , Imageamento por Ressonância Magnética/métodos , Tomografia por Emissão de Pósitrons/métodos , Carcinoma de Pequenas Células do Pulmão/diagnósticoRESUMO
Late-life onset aura-like symptoms are not rare and can be potentially misdiagnosed as transient ischaemic attacks. The cause is often obscure. Four cases of recurrent aura-like symptoms are presented in whom acute convexity subarachnoid haemorrhage (SAH) contralateral to symptoms was demonstrated. Three experienced subsequent events or groups of events triggered by recurrent SAH. Negative diffusion-weighted imaging, normal electroencephalography and slow symptom march with complete resolution argued against ischaemic and epileptic causes. Aura-like symptoms in the elderly should be investigated with imaging modalities most sensitive for detecting subarachnoid blood, in particular gradient echo magnetic resonance imaging.
