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1.
Rinsho Shinkeigaku ; 59(10): 636-640, 2019 Oct 26.
Artigo em Japonês | MEDLINE | ID: mdl-31564700

RESUMO

The case is a 30-year-old woman. From the age of 25 years, she had several episodes of cortical blindness and visited a local doctor. Mitochondrial disease was suspected based on findings of cerebral infarction-like imaging and a history of diabetes. However, serum and cerebrospinal fluid lactate levels were normal and no abnormal muscle pathology was found. At the age of 30 years, she visited our hospital with impaired consciousness, cortical blindness, and tremor-like involuntary movements in the neck and right fingers. Brain MRI showed abnormal signals in bilateral basal ganglia, with an increased lactate peak by magnetic resonance spectroscopy and high cerebrospinal fluid lactate levels. Mitochondrial gene analysis identified a m.4296G>A gene mutation. Consequently, we reached a diagnosis of mitochondrial encephalopathy. Adult-onset mitochondrial encephalopathy with m.4296G>A gene mutation is extremely rare. This case showed clinical features caused by damage of both the cerebral cortex and subcortical basal ganglia.


Assuntos
DNA Mitocondrial/genética , Mitocôndrias/genética , Encefalomiopatias Mitocondriais/genética , Mutação , Adulto , Gânglios da Base/diagnóstico por imagem , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Cegueira Cortical/etiologia , Feminino , Humanos , Lactatos/sangue , Lactatos/líquido cefalorraquidiano , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Encefalomiopatias Mitocondriais/complicações , Encefalomiopatias Mitocondriais/diagnóstico
2.
BMJ Case Rep ; 12(7)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31371327

RESUMO

A 65-year-old man, a known case of advanced pancreatic cancer on cisplatin and gemcitabine-based chemotherapy, presented with sudden bilateral painless loss of vision with altered sensorium. Clinical examination showed a normal pupillary light reaction, normal anterior segment and normal fundus. MRI brain showed bilateral parieto-occipital infarct. This report highlights the incidence of cortical blindness due to thromboembolism at the cerebral level in pancreatic cancer. Cerebral ischaemic events occur at an advanced stage of pancreatic cancer already diagnosed at stroke onset and portend a poor prognosis. Anticoagulation therapy, especially low molecular weight heparin, remains the best strategy to prevent recurrences.


Assuntos
Cegueira Cortical/etiologia , Infarto Cerebral/etiologia , Neoplasias Pancreáticas/complicações , Idoso , Humanos , Masculino
5.
J Stroke Cerebrovasc Dis ; 28(1): 227-228, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30314761

RESUMO

BACKGROUND: Anton's syndrome is a rare neurological disorder characterized by a combination of visual anosognosia and confabulation of visual experience, most often seen after bilateral ischemic damage to the posterior occipital cortex. CASE REPORT: We report the first case of an acute synchronous P2 occlusion as confirmed by multiparametric computed tomography (CT) including perfusion. After the administration of Recombinant tissue plasminogen activator (rtPA), Anton's syndrome completely resolved. CONCLUSION: Multiparametric CT imaging may aid in quickly proving the underlying stroke in Anton's syndrome, especially helpful considering the discrepancy between the patient's perception and clinical examination results.


Assuntos
Cegueira Cortical/tratamento farmacológico , Cegueira Cortical/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Administração Intravenosa , Idoso de 80 Anos ou mais , Cegueira Cortical/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Lobo Occipital/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Ativador de Plasminogênio Tecidual/administração & dosagem
6.
World Neurosurg ; 119: 123-131, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30077753

RESUMO

BACKGROUND: We presented 3 cases of transient cortical blindness secondary to contrast medium toxicity after endovascular procedures for intracranial aneurysms. We also reviewed the literature and found 12 cases of contrast-induced cortical blindness after endovascular procedures for intracranial aneurysms. CASE DESCRIPTION: Two patients (cases 1 and 2) noted bilateral blindness 5 and 6 hours, respectively, after awakening from general anesthesia following aneurysm treatment. The third patient (case 3) noted bilateral blindness during vertebral angiography under local anesthesia. Immediate angiography was performed in case 1 and showed no arterial occlusion. Computed tomography was performed in case 2 and showed brain edema. Magnetic resonance imaging was performed in all 3 cases, and cases 2 and 3 showed abnormal presentation on fluid attenuated inversion recovery sequences. With the use of corticosteroid and intravenous hydration, cortical blindness resolved within 1 week in 2 patients (Cases 1 and 2). The remaining patient (case 3) had incomplete quadrantanopia 3 months after blindness onset. CONCLUSIONS: Based on our experience and the literature reports, we advocate corticosteroid and intravenous hydration for patients with contrast-induced cortical blindness after endovascular procedures for intracranial aneurysms.


Assuntos
Cegueira Cortical/etiologia , Procedimentos Endovasculares/efeitos adversos , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias , Cegueira Cortical/diagnóstico por imagem , Cegueira Cortical/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/tratamento farmacológico
8.
Indian J Ophthalmol ; 66(6): 812-815, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29785989

RESUMO

Purpose: The aim of this study is to identify common causes, associated ophthalmological abnormalities, and systemic comorbidities in children in Andhra Pradesh, India, with cerebral visual impairment (CVI). Methods: A retrospective review of case records of all children aged <16 years with diagnosis of CVI seen between January 2016 and December 2016 was carried out. Data were collected for their age, gender, cause of CVI, refraction, accommodation, anterior and posterior segment examination findings, and systemic problems. Results: A total of 124 patients were identified and studied (80 boys and 44 girls, mean age 5.23 years, 44.8% aged <2 years). The most common causes of CVI were hypoxic-ischemic encephalopathy (HIE) (34.4%), undetermined etiology (32.8%), neonatal seizures, and infantile spasms (16% each). The most common presenting complaints were poor vision (76%) and squint (11.2%). Profound visual impairment was seen in 88.8%, and 11.2% had high functioning CVI. Fifty-eight (46.4%) patients had significant refractive errors, 40 (32.25%) had strabismus, 4 (3.2%) had visually significant cataract, and 40 (32%) had optic atrophy. Motor delay was observed in 39.5%, speech delay was evident in 22.4%, and cognitive delay in 16%. Conclusion: HIE is the most common cause (one-third) of CVI in our population, and the majority of them presented at age <2 years (44.8%) with profound visual impairment (88.8%). A significant number of them have treatable ophthalmic conditions such as refractive errors (46.4%), accommodative insufficiency (12.1%), and cataract (3.2%), and more than one-third of them also have delay in other areas of development.


Assuntos
Cegueira Cortical/etiologia , Doenças do Sistema Nervoso/complicações , Acuidade Visual/fisiologia , Vias Visuais/fisiopatologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Adolescente , Cegueira Cortical/epidemiologia , Cegueira Cortical/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Masculino , Doenças do Sistema Nervoso/epidemiologia , Prevalência , Prognóstico , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 97(16): e0332, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29668582

RESUMO

RATIONALE: Splenic artery embolization (SAE) is a common procedure in trauma patients with blunt splenic injuries. We report a case of acute ischemic stroke following orthopedic surgery in a patient with post-SAE reactive thrombocytosis. PATIENT CONCERNS: A 37-year-old woman with idiopathic thrombocytopenic purpura (ITP) suffered from multiple trauma scheduled for open reduction and internal fixation for right tibial and left radius fracture five days after SAE. The patient did not have any thromboembolic complications, although the platelet counts increased from 43 × 10/L to 568 × 10/L within two days after SAE. Surgery was completed under general anesthesia with tracheal intubation without complications. The patient complained of visual loss followed by limb weakness on the fourth and eighth hour postoperatively. DIAGNOSES: Magnetic resonance imaging (MRI) of head demonstrated ischemic change over bilateral basal ganglia, and occipital areas, suggesting the diagnosis of cortical blindness. INTERVENTIONS: To suppress platelet count and avoid platelet hyper-aggregation, anti-platelet drug (i.e., oral aspirin 100 mg daily), hydration, and hydroxyurea (i.e., 20 mg/kg daily) were used for the treatment of reactive thrombocytosis. OUTCOMES: Although right-sided hemiparesis persisted, the patient reported mild visual recovery. She was discharged four months after SAE with active rehabilitation. LESSONS: Our report highlights an increased risk of acute arterial thromboembolic events in patients with reactive thrombocytosis, especially those undergoing surgery.


Assuntos
Aspirina/administração & dosagem , Cegueira Cortical , Isquemia Encefálica , Embolização Terapêutica , Púrpura Trombocitopênica Idiopática/complicações , Baço , Acidente Vascular Cerebral , Trombocitose/tratamento farmacológico , Ferimentos não Penetrantes/terapia , Adulto , Cegueira Cortical/diagnóstico , Cegueira Cortical/tratamento farmacológico , Cegueira Cortical/etiologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Inibidores da Agregação de Plaquetas/administração & dosagem , Contagem de Plaquetas/métodos , Baço/irrigação sanguínea , Baço/lesões , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/patologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Trombocitose/diagnóstico , Trombocitose/etiologia , Resultado do Tratamento
10.
J Neurointerv Surg ; 10(8): e21, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29563211

RESUMO

Cerebral hyperperfusion syndrome (CHS) is a well-documented complication after carotid endarterectomy or stenting. In contrast, CHS following vertebral revascularization is extremely rare. Here we present a case of a 77-year-old man with high-grade vertebral stenosis who subsequently underwent balloon angioplasty, complicated by hemorrhagic CHS manifesting as cortical blindness, although strict postoperative blood pressure control was administered. To our knowledge, cortical blindness as a presentation of hemorrhagic CHS has not previously been reported. This study highlights the fact that identifying high-risk patients, as well as making an individual therapeutic plan, is important prior to revascularization. Further studies are needed to elucidate the exact mechanism of this condition and thereby prevent it.


Assuntos
Angioplastia com Balão/efeitos adversos , Cegueira Cortical/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Revascularização Cerebral/efeitos adversos , Insuficiência Vertebrobasilar/diagnóstico por imagem , Idoso , Cegueira Cortical/etiologia , Hemorragia Cerebral/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Stents/efeitos adversos , Síndrome , Insuficiência Vertebrobasilar/terapia
12.
Epileptic Disord ; 19(4): 486-490, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29258967

RESUMO

Ulegyria refers to scarring of the cerebral cortex usually arising from perinatal ischaemia. The scarring has a specific configuration in which small atrophic circumvolutions at the bottom of a sulcus underlie an intact spared gyral apex. This disconnection of overlying cortex may allow an "epileptogenic" island of cortex to generate seizures. Ulegyria is often associated with epilepsy and developmental delay, however, the syndromic association of visual impairment with epilepsy due to occipital ulegyria may not be recognised as a specific entity. Here, we report a series of five patients with occipital ulegyria who presented with widely variable seizure semiology and an array of visual deficits. In some patients, the link between the epilepsy and the visual impairment was not appreciated until they attended an epilepsy clinic.


Assuntos
Asfixia Neonatal/complicações , Cegueira Cortical/etiologia , Epilepsia Resistente a Medicamentos/etiologia , Hipóxia-Isquemia Encefálica/complicações , Lobo Occipital/patologia , Adulto , Asfixia Neonatal/patologia , Cegueira Cortical/patologia , Epilepsia Resistente a Medicamentos/patologia , Feminino , Humanos , Hipóxia-Isquemia Encefálica/patologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
BMJ Case Rep ; 20172017 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-29084739

RESUMO

Cerebral hyperperfusion syndrome (CHS) is a well-documented complication after carotid endarterectomy or stenting. In contrast, CHS following vertebral revascularization is extremely rare. Here we present a case of a 77-year-old man with high-grade vertebral stenosis who subsequently underwent balloon angioplasty, complicated by hemorrhagic CHS manifesting as cortical blindness, although strict postoperative blood pressure control was administered. To our knowledge, cortical blindness as a presentation of hemorrhagic CHS has not previously been reported. This study highlights the fact that identifying high-risk patients, as well as making an individual therapeutic plan, is important prior to revascularization. Further studies are needed to elucidate the exact mechanism of this condition and thereby prevent it.


Assuntos
Cegueira Cortical/diagnóstico , Constrição Patológica/cirurgia , Hemorragia Intracraniana Hipertensiva/diagnóstico , Stents , Artéria Vertebral , Idoso , Angioplastia com Balão/efeitos adversos , Cegueira Cortical/diagnóstico por imagem , Cegueira Cortical/etiologia , Constrição Patológica/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Hemorragia Intracraniana Hipertensiva/etiologia , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X
14.
Arq Bras Oftalmol ; 80(5): 324-326, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29160546

RESUMO

We report a case of cortical blindness secondary to posterior leukoencephalopathy syndrome, which was successfully treated by blood pressure management. A 66-year-old white man presented at the emergency room complaining of severe frontal headache, disorientation, and progressive blurred vision. The initial physical examination disclosed a blood pressure of 200/176 mmHg. One hour later the patient exhibited mental confusion and bilateral blindness. Computed tomography and magnetic resonance imaging were performed, and a systemic workup was conducted, resulting in a diagnosis of posterior leukoencephalopathy syndrome. This syndrome is a rare manifestation of systemic hypertension that requires proper diagnosis and management to avoid irreversible brain damage. Early recognition of this condition and prompt control of the patient's blood pressure are essential because they may bring about a reversal of the syndrome, which may otherwise result in permanent brain damage.


Assuntos
Cegueira Cortical/etiologia , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Idoso , Anti-Hipertensivos/uso terapêutico , Cegueira Cortical/diagnóstico por imagem , Cegueira Cortical/fisiopatologia , Humanos , Hipertensão/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Vasodilatadores/uso terapêutico
16.
Medicine (Baltimore) ; 96(34): e7454, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28834867

RESUMO

RATIONALE: The conception that multiple sclerosis may be challenging to distinguish from demyelinating manifestations of Sjögren's syndrome (SS) was introduced more than 30 years ago. However, it is now recognized that the neuromyelitis optica spectrum disorder (NMOSD) may occur more frequently in SS as opposed to multiple sclerosis. Characteristic NMOSD features can include severe attacks of optic neuritis, myelitis which is frequently longitudinally-extensive (spanning at least three vertebral segments on magnetic resonance imaging [MRI]), and an association with anti-aquaporin-4 antibodies. In addition, whereas NMOSD was initially thought to spare the brain, it is now recognized that brain lesions occur in a majority of NMOSD patients. Therefore, it is important for the multi-disciplinary team of physicians who care for SS patients to understand this widening spectrum of NMOSD as encompassing brain lesions. In this case-report we describe clinical features, radiographic findings, and treatment of a SS NMOSD patient presenting with severely decreased visual acuity, visual hallucinations, and encephalopathy. PATIENT CONCERNS: The SS NMOSD patient presented with rapid, bilateral onset of severely decreased visual acuity and was therefore suspected as having bilateral optic neuritis. DIAGNOSIS: However, the patient lacked stigmata of optic neuritis, instead had visual hallucinations and encephalopathy suggestive of cortical blindness, and was noted to have occipital lobe lesions on brain MRI. Other radiographic findings included simultaneous enhancement of brainstem and periventricular lesions. INTERVENTIONS: The patient was initially treated with methylprednisolone with no change in her neurological deficits. She was then treated with plasma exchange therapy. OUTCOMES: The patient had resolution of decreased visual acuity, visual hallucinations, encephalopathy, and contrast-enhancing brain lesions in response to plasma exchange therapy. LESSON: We provide the first example of severely decreased visual acuity in a NMOSD patient due to cortical blindness and not bilateral optic neuritis. This finding expands the spectrum of central nervous system syndromes and brain lesions which may occur in NMOSD. The synchronous enhancement of a brainstem lesion (known to occur in NMOSD) with occipital lobe lesions also suggests that our patient's occipital lobe findings were due to NMOSD. All of our patient's findings had an excellent clinical and radiographic response to plasma exchange therapy.


Assuntos
Cegueira Cortical/diagnóstico , Cegueira Cortical/etiologia , Neuromielite Óptica/complicações , Síndrome de Sjogren/complicações , Idoso , Cegueira Cortical/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Neurite Óptica/diagnóstico
18.
Neurologist ; 22(3): 82-84, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28471896

RESUMO

INTRODUCTION: Transient cortical blindness (TCB) is a rare complication after angiography and is proposed to be related to contrast extravasation. We present the first case of TCB after angiography that was evaluated using serial arterial spin-labeling magnetic resonance perfusion (ASLMRP) and susceptibility-weighted imaging (SWI). CASE REPORT: A 65-year-old woman with dyslipidemia who had been treated for left vertebral artery dissection 3 months previously presented with dizziness and right hemiparesis. Magnetic resonance imaging of the brain revealed suspected dissection of the V4 segment of the left vertebral artery. Cerebral angiography was performed using a total of 46 mL of nonionic contrast material. Approximately 3 hours after the procedure, the patient started complaining of a slight headache and nausea along with bilateral cortical blindness. The 6-hour ASLMRP and SWI of the brain, respectively, revealed hypoperfusion and increased oxygen extraction fraction in the bilateral occipital lobes. The patient gradually regained vision over the next 12 hours, and follow-up ASLMRP and SWI revealed normal perfusion and normal SWI findings, respectively. CONCLUSIONS: Hypoperfusion on ASLMRP and increased oxygen extraction fraction on SWI results derived for a patient presenting with TCB were demonstrated. Thus, we hypothesize that endothelin-related vasoconstriction is a pathophysiologic mechanism for TCB. To the best of our knowledge, this report is the first to describe ASLMRP and SWI findings in TCB after angiography.


Assuntos
Cegueira Cortical/diagnóstico por imagem , Cegueira Cortical/etiologia , Angiografia Cerebral/efeitos adversos , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética , Complicações Pós-Operatórias
19.
Ann Card Anaesth ; 20(2): 256-258, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28393793

RESUMO

Postoperative blindness (PB) primarily involves reception and conductance parts of the visual pathway due to ischemia following cessation of blood supply, for example, retinal vascular occlusion. Although a rare cause of PB, cortical blindness (CB), which results from ischemia/infarction of visual cortex, has a poor outcome due to its mostly nonreversible nature. Ischemic optic neuropathy is the most common cause of PB following cardiac surgeries. CB following cardiac surgeries involving cardiopulmonary bypass has been rarely reported. Only a few of those articles reported partial or complete reversal of CB. We report an incidence of transient CB in an 11-year-old child who was operated for double chambered right ventricle with ventricular septal defect.


Assuntos
Cegueira Cortical/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Comunicação Interventricular/cirurgia , Complicações Pós-Operatórias/etiologia , Cegueira Cortical/terapia , Criança , Tratamento Conservador/métodos , Humanos , Masculino , Complicações Pós-Operatórias/terapia
20.
Neurology ; 88(19): 1856-1864, 2017 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-28404802

RESUMO

OBJECTIVE: To assess if visual discrimination training improves performance on visual perimetry tests in chronic stroke patients with visual cortex involvement. METHODS: 24-2 and 10-2 Humphrey visual fields were analyzed for 17 chronic cortically blind stroke patients prior to and following visual discrimination training, as well as in 5 untrained, cortically blind controls. Trained patients practiced direction discrimination, orientation discrimination, or both, at nonoverlapping, blind field locations. All pretraining and posttraining discrimination performance and Humphrey fields were collected with online eye tracking, ensuring gaze-contingent stimulus presentation. RESULTS: Trained patients recovered ∼108 degrees2 of vision on average, while untrained patients spontaneously improved over an area of ∼16 degrees2. Improvement was not affected by patient age, time since lesion, size of initial deficit, or training type, but was proportional to the amount of training performed. Untrained patients counterbalanced their improvements with worsening of sensitivity over ∼9 degrees2 of their visual field. Worsening was minimal in trained patients. Finally, although discrimination performance improved at all trained locations, changes in Humphrey sensitivity occurred both within trained regions and beyond, extending over a larger area along the blind field border. CONCLUSIONS: In adults with chronic cortical visual impairment, the blind field border appears to have enhanced plastic potential, which can be recruited by gaze-controlled visual discrimination training to expand the visible field. Our findings underscore a critical need for future studies to measure the effects of vision restoration approaches on perimetry in larger cohorts of patients.


Assuntos
Cegueira Cortical/etiologia , Cegueira Cortical/reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/complicações , Percepção Visual , Adulto , Idoso , Cegueira Cortical/patologia , Medições dos Movimentos Oculares , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Luminosa , Estudos Retrospectivos , Acidente Vascular Cerebral/patologia , Resultado do Tratamento , Córtex Visual/patologia , Testes de Campo Visual
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