Assuntos
Doenças do Sistema Nervoso Central/patologia , Cerebelo/patologia , Sarcoidose/patologia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/fisiopatologia , Cerebelo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico , Sarcoidose/fisiopatologiaRESUMO
Chikungunya fever is an Aedes mosquito-transmitted infection caused by chikungunya virus, an RNA virus in the family Togaviridae. The disease is characteristically manifested as fever, arthralgia, and/or rash. Various neurological manifestations like meningoencephalitis, myelitis, and myeloneuropathy have been mentioned in various reports. We present a rare case of chikungunya fever presenting with mild encephalitis with a reversible lesion of the splenium (MERS), which showed complete clinical and radiological recovery.
Assuntos
Febre de Chikungunya/diagnóstico por imagem , Vírus Chikungunya/genética , Corpo Caloso/diagnóstico por imagem , Encefalite Viral/diagnóstico por imagem , RNA Viral/genética , Febre de Chikungunya/patologia , Febre de Chikungunya/terapia , Febre de Chikungunya/virologia , Vírus Chikungunya/isolamento & purificação , Corpo Caloso/patologia , Corpo Caloso/virologia , Diagnóstico Diferencial , Encefalite Viral/patologia , Encefalite Viral/terapia , Encefalite Viral/virologia , Hidratação , Escala de Coma de Glasgow , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da PolimeraseRESUMO
Purple glove syndrome is a rare and poorly understood complication of phenytoin use, occurring almost always with its intravenous formulation. This syndrome comprises of pain, purple discoloration, and edema distal to the site of intravenous administration of phenytoin. We hereby report an unusual case, wherein purple glove syndrome was seen on oral formulation of phenytoin in its therapeutic dose.
Assuntos
Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Cianose/induzido quimicamente , Edema/induzido quimicamente , Mãos , Fenitoína/administração & dosagem , Fenitoína/efeitos adversos , Estado Epiléptico/tratamento farmacológico , Administração Oral , Adulto , Humanos , Masculino , SíndromeRESUMO
Mild encephalitis with reversible lesion in the splenium (MERS) is a clinicoradiological syndrome presenting as a solitary lesion in the central portion of the splenium of the corpus callosum (SCC) with a radiological finding of restricted diffusion and low apparent diffusion coefficient (ADC) values. Complete resolution of the lesion on follow-up imaging and full clinical recovery are the hallmarks of this syndrome, even with only supportive therapy. MERS is usually associated with normal Cerebrospinal fluid (CSF) findings and an excellent prognosis, even without corticosteroid therapy. Magnetic resonance imaging (MRI) is the ideal modality for initial diagnosis and follow-up. Not many cases of this uncommon clinicoradiological syndrome with transient elevation of CSF proteins have been reported. In the subsequent sections, we present a case report of this unusual clinicoradiological entity with raised CSF protein. We also elaborate on possible differential diagnoses and the syndrome's proposed pathophysiology.
RESUMO
Herpes zoster is reactivation of the varicella zoster virus that has remained dormant in the dorsal root ganglia since an earlier episode of chickenpox. Herpes zoster has variable clinical presentations, but meningo-encephalitis is not frequently encountered. There is growing evidence of both large and small vessel involvement in immunocompetent and immunocompromised patients, in contrast with the previous opinion that immunocompetent patients have vasculopathy in the large vessels while immunosuppressed patients have vasculopathy in the small vessels. We present the case of a patient in whom herpes zoster meningoencephalitis was complicated with multifocal vasculopathy with peripheral vascular disease; this is an unusual co-occurrence.
Assuntos
Encefalite por Varicela Zoster/complicações , Encefalite por Varicela Zoster/diagnóstico , Herpesvirus Humano 3/isolamento & purificação , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/patologia , Encéfalo/diagnóstico por imagem , Encefalite por Varicela Zoster/patologia , Face/patologia , Gangrena/etiologia , Gangrena/patologia , Mãos/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , RadiografiaAssuntos
Soropositividade para HIV/complicações , Leucoencefalopatia Multifocal Progressiva/patologia , Ponte/patologia , Adulto , Progressão da Doença , Soropositividade para HIV/diagnóstico , Soropositividade para HIV/patologia , Humanos , Leucoencefalopatia Multifocal Progressiva/diagnóstico , Leucoencefalopatia Multifocal Progressiva/etiologia , MasculinoRESUMO
Dyke-Davidoff-Masson syndrome is a relatively rare syndrome with its typical clinical and radiological features including facial asymmetry, hemiplegia, cerebral hemiatrophy, mental retardation with calvarial thickening, hypertrophy of sinuses and elevated petrous ridge on imaging. We present here a case of congenital type Dyke-Davidoff-Masson syndrome with some additional features in the form of microcephaly, hypospadias and pachygyria.
Assuntos
Cabeça/anormalidades , Hemiplegia/complicações , Convulsões/complicações , Anticonvulsivantes/uso terapêutico , Encéfalo/patologia , Criança , Diagnóstico Diferencial , Cabeça/diagnóstico por imagem , Humanos , Deficiência Intelectual/complicações , Masculino , Neuroimagem , Convulsões/tratamento farmacológico , Síndrome , Tomografia Computadorizada por Raios XRESUMO
Atrial myxomas are the most common benign cardiac tumors. Neurological manifestations associated with left atrial myxoma are seen infrequently in the form of embolic stroke of intracranial hemorrhage. Psychiatric manifestations are however exceedingly rare. We hereby present a case who presented with acute psychosis as a sole manifestation of an underlying left atrial myxoma.
Assuntos
Neoplasias Cardíacas/complicações , Mixoma/complicações , Transtornos Psicóticos/etiologia , Doença Aguda , Adulto , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Ecocardiografia , Feminino , Átrios do Coração , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/psicologia , Humanos , Mixoma/diagnóstico , Mixoma/psicologia , Neuroimagem , Tomografia Computadorizada por Raios XRESUMO
Central nervous system involvement is observed in no more than 10% of patients with systemic tuberculosis. Although CNS tuberculosis is not rare in endemic countries, such as India, intramedullary tuberculosis is not commonly reported. In this study, we report a case of a 40-year-old female who presented with a six-year history of insidious onset, gradually progressive, asymmetric quadriparesis. She was diagnosed with intramedullary tuberculoma at the craniovertebral junction and showed significant clinico-radiological improvement with medical management alone. To the best of our knowledge, this report describes the first case of intramedullary tuberculoma at the craniovertebral junction to be reported. With the increased availability of MRI in developing countries, it is now possible for clinicians to diagnose this condition without performing a biopsy. It is important for the clinicians in developed countries to be highly suspicious of intramedullary tuberculoma, as there has been a resurgence of CNS tuberculosis due to the emergence of the HIV pandemic.
Assuntos
Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/patologia , Tuberculoma/diagnóstico , Tuberculoma/patologia , Adulto , Anti-Inflamatórios/uso terapêutico , Antituberculosos/uso terapêutico , Feminino , Humanos , Índia , Imageamento por Ressonância Magnética , Quadriplegia/diagnóstico , Quadriplegia/etiologia , Radiografia , Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/tratamento farmacológico , Resultado do Tratamento , Tuberculoma/complicações , Tuberculoma/tratamento farmacológicoRESUMO
Alexia without agraphia (pure alexia) was the first of the disconnection syndromes to be described by Dejerine who reported a patient of alexia without agraphia secondary to an embolic occipital lobe infarct. We herein report a 55-year-old man who presented with alexia without agraphia with magnetic resonance imaging suggestive of left posterior cerebral artery infarct involving left occipital lobe and splenium of corpus callosum. Alexia without agraphia is a relatively uncommon clinical condition, which should always be thought in a patient presenting with difficulty in reading with normal visual acuity. Ophthalmologists should also be aware of this disconnection syndrome as many patients initially take their advice due to predominant visual complaints. Early diagnosis and treatment of this condition help in ensuring the patient and attendants about nonprogressive nature of the disease and may prevent further episodes of stroke.
Assuntos
Alexia Pura/etiologia , Doenças Arteriais Cerebrais/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Alexia Pura/diagnóstico , Doenças Arteriais Cerebrais/complicações , Infarto Cerebral/complicações , Infarto Cerebral/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Acidente Vascular Cerebral/complicaçõesRESUMO
Neurocysticercosis is the most frequent neuroparasitosis and is caused by Taenia solium larvae (cysticerci). Its most common presenting feature is seizure, although it may present as headache,focal deficits, hydrocephalous, or as features of raised intracranial pressure. We herein report a case of 40-year-old male who presented with features of acute encephalitis and raised intracranial pressure with magnetic resonance imaging suggestive of multiple neurocysticerci with diffuse cerebral edema. A diagnosis of cysticercotic encephalitis was made, which is a syndrome of encephalitis with clinical and radiologic evidences of diffuse cerebral edema caused by parenchymal cysticercosis. It is important for the clinicians to be aware of this medical emergency requiring urgent attention as delay may lead to fatal outcome.
Assuntos
Neurocisticercose/diagnóstico , Neurocisticercose/tratamento farmacológico , Adulto , Anticonvulsivantes/uso terapêutico , Diagnóstico Diferencial , Diagnóstico por Imagem , Quimioterapia Combinada , Eletroencefalografia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Manitol/uso terapêuticoRESUMO
Leucodystrophies are a heterogeneous group of progressive white matter diseases which may be inherited in dominant, recessive or X-linked fashion depending on the type. Adrenoleucodystrophy (ALD) and metachromatic leucodystrophy (MLD) are rather commoner forms of leucodystrophies whereas krabbes disease, alexander disease, cannavans disease etc. are of less common type. Adult-onset autosomal dominant leucodystrophy (ADLD) is a lately described rarer form of leucodystrophy with perhaps no case report from India. Various leucodystrophies may have different clinical presentations, ranging from subtle cognitive and psychiatric manifestations to gross motor disabilities, visual impairment and seizure. Psychiatric manifestations in the form of psychoses and frank schizophrenia are commonly described in MLD. Depression though uncommonly reported in MLD, cyclic mood disorders have been rarely described in any form of leucodystrophies. We are reporting an eye opener, a case of ADLD which masqueraded as a rapid cyclic mood disorder for initial four years, later to be followed by progressive neurological signs and symptoms. To the best of our knowledge, this is perhaps the first case report of ADLD presenting as rapid cyclic mood disorder in the world literature.
Assuntos
Transtorno Depressivo Maior/etiologia , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/complicações , Adulto , Encéfalo/patologia , Transtorno Depressivo Maior/patologia , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/patologia , Humanos , Índia , Imageamento por Ressonância Magnética , MasculinoRESUMO
Tubercular abscess is a rare presentation of central nervous system tuberculosis (TB), which commonly presents as tuberculoma or meningitis. Most of the published cases of tubercular brain abscess have been dealt with by surgical treatment along with medical management. We here report a case of intracranial tubercular abscess in a 17-year-old girl presenting with fever, headache and right hemiparesis who showed significant clinicoradiological improvement with medical management alone. Thus, in a country like India where TB is highly endemic, TB should be considered as a possible aetiology for any intracranial lesion with radiological appearance suggestive of an abscess and surgical treatment can be kept as an option in case of neurological deficits, hydrocephalus or treatment failure.
Assuntos
Antituberculosos/uso terapêutico , Tuberculoma Intracraniano/tratamento farmacológico , Adolescente , Feminino , Humanos , Radiografia , Indução de Remissão , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/diagnóstico por imagemRESUMO
OBJECTIVE: To report a case of cycloserine-induced acute psychosis in a young female while on second line antitubercular treatment (ATT) for tubercular meningitis. METHOD: Case report. RESULTS: A 20-year-old female, known case of tubercular meningitis on ATT since 8 months, presented with a 10-days history of headache, vomiting, and photophobia. A provisional diagnosis of drug-resistant tuberculosis was made, and second-line ATT including cycloserine (750 mg/day) and levofloxacin (750 mg/day) was added. Three days after the start of cycloserine and levofloxacin, the patient developed psychosis with delusions and hallucinations. Since the patient was on several drugs with potential to cause psychotic reaction, we considered a provisional diagnosis of drug-induced acute psychosis. Two days following cycloserine withdrawal, the patient improved significantly, and on the third day, she was absolutely normal with disappearance of psychotic symptoms. CONCLUSION: Our case highlights the importance of awareness regarding psychiatric adverse events of antitubercular agents and the reversible nature of the adverse events on drug withdrawal. We also suggest that caution should be exercised while administering cycloserine in MDR-TB patients because of a higher risk of psychiatric adverse events.
Assuntos
Antibióticos Antituberculose/efeitos adversos , Ciclosserina/efeitos adversos , Psicoses Induzidas por Substâncias/etiologia , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Feminino , Humanos , Adulto JovemAssuntos
Doenças Desmielinizantes/diagnóstico , Disartria/etiologia , Adulto , Anticonvulsivantes/uso terapêutico , Encéfalo/patologia , Carbamazepina/uso terapêutico , Meios de Contraste , Doenças Desmielinizantes/complicações , Disartria/tratamento farmacológico , Feminino , Humanos , Imageamento por Ressonância Magnética , Recidiva , Coluna Vertebral/patologiaAssuntos
Anti-Inflamatórios/farmacologia , Metilprednisolona/farmacologia , Rigidez Muscular Espasmódica/diagnóstico , Administração Intravenosa , Idoso , Anti-Inflamatórios/administração & dosagem , Autoanticorpos , Glutamato Descarboxilase , Humanos , Masculino , Metilprednisolona/administração & dosagem , Rigidez Muscular Espasmódica/sangue , Rigidez Muscular Espasmódica/líquido cefalorraquidiano , Rigidez Muscular Espasmódica/tratamento farmacológico , Resultado do TratamentoRESUMO
Anti-NMDA receptor encephalitis was first described in 2005 when psychiatric features, memory loss and altered consciousness were found in four women with ovarian teratoma. We report a case of anti-NMDA receptor encephalitis in a 16-year-old female who presented with psychiatric features followed by autonomic dysfunction and orofacial dyskinesias that showed drastic improvement to intravenous immunoglobulin. As many patients of anti-NMDAR encephalitis initially present with psychiatric features, it is important for psychiatrists to have high index of suspicion for this disease and thus avoid the delay in diagnosing this treatable condition which may be otherwise fatal.
Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Imunoglobulinas Intravenosas/uso terapêutico , Transtornos Mentais/etiologia , Transtornos dos Movimentos/etiologia , Adolescente , Encefalite Antirreceptor de N-Metil-D-Aspartato/tratamento farmacológico , Feminino , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos dos Movimentos/tratamento farmacológico , Resultado do TratamentoRESUMO
Tuberculosis is the most common chronic central nervous system infection in developing countries like India. Non-osseous spinal cord involvement is a rare manifestation of tuberculosis. The use of MRI, as an imaging modality of choice, has revolutionised the imaging of tuberculomas with reasonable certainty and thereby avoiding unnecessary surgical intervention. We report an unusual presentation of intradural extramedullary and intracranial tuberculomas with communicating syringomyelia complicated with tubercular meningitis.
Assuntos
Siringomielia/complicações , Tuberculoma Intracraniano/complicações , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Neuroimagem , Siringomielia/diagnóstico , Siringomielia/patologia , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/patologia , Adulto JovemRESUMO
Spontaneous spinal epidural hematoma accounts for most cases of spinal epidural hematoma, but very few cases of recurrent spontaneous spinal epidural hematoma have been published to date. We herein report a case of a 20-year-old man who presented with 10-day history of pain in the interscapular region, followed by paraparesis and sensory loss below umbilicus along with urinary retention. The patient gave history of 2 similar episodes in the last 3 months, with complete spontaneous recovery. His magnetic resonance imaging of dorsal spine was suggestive of subacute spinal epidural hematoma. On reviewing previous 2 magnetic resonance images of dorsal spine, it was apparent that the patient had recurrent hematoma at the same site. Thus, a provisional diagnosis of recurrent spontaneous spinal hematoma at the level of upper dorsal spine was kept and was managed accordingly. Patient with recurrent spontaneous spinal epidural hematoma should be educated about the nature of the disease and advised to consult a neurosurgeon as early as possible in case of a relapse, so that they can undergo surgical management preferably within 8 hours and not later than 36 hours.