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1.
Med J Aust ; 213(8): 352-353.e1, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32946596

Assuntos
Doenças dos Nervos Cranianos/diagnóstico , Herpes Zoster/diagnóstico , Mononeuropatias/diagnóstico , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/tratamento farmacológico , Doenças do Nervo Abducente/fisiopatologia , Doenças do Nervo Abducente/virologia , Idoso , Doenças dos Nervos Cranianos/tratamento farmacológico , Doenças dos Nervos Cranianos/fisiopatologia , Doenças dos Nervos Cranianos/virologia , Diagnóstico Diferencial , Diplopia/fisiopatologia , Dor de Orelha/fisiopatologia , Edema/fisiopatologia , Doenças do Nervo Facial/diagnóstico , Doenças do Nervo Facial/tratamento farmacológico , Doenças do Nervo Facial/fisiopatologia , Doenças do Nervo Facial/virologia , Paralisia Facial/fisiopatologia , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/tratamento farmacológico , Doenças do Nervo Glossofaríngeo/fisiopatologia , Doenças do Nervo Glossofaríngeo/virologia , Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/virologia , Herpes Zoster/tratamento farmacológico , Herpes Zoster/fisiopatologia , Humanos , Masculino , Mononeuropatias/tratamento farmacológico , Mononeuropatias/virologia , Osteomielite/diagnóstico , Otite Externa/diagnóstico , Prednisolona/uso terapêutico , Base do Crânio , Doenças do Nervo Vago/diagnóstico , Doenças do Nervo Vago/tratamento farmacológico , Doenças do Nervo Vago/fisiopatologia , Doenças do Nervo Vago/virologia , Doenças do Nervo Vestibulococlear/diagnóstico , Doenças do Nervo Vestibulococlear/tratamento farmacológico , Doenças do Nervo Vestibulococlear/fisiopatologia , Doenças do Nervo Vestibulococlear/virologia , Ativação Viral
2.
Neurology ; 95(5): e601-e605, 2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32303650

RESUMO

OBJECTIVE: To report 2 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented acutely with Miller Fisher syndrome and polyneuritis cranialis, respectively. METHODS: Patient data were obtained from medical records from the University Hospital "Príncipe de Asturias," Alcalá de Henares, and the University Hospital "12 de Octubre," Madrid, Spain. RESULTS: A 50-year-old man presented with anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia, areflexia, albuminocytologic dissociation, and positive testing for anti-GD1b-immunoglobulin G antibody. Five days previously, he had developed a cough, malaise, headache, low back pain, and fever. A 39-year-old man presented with ageusia, bilateral abducens palsy, areflexia, and albuminocytologic dissociation. Three days previously, he had developed diarrhea, a low-grade fever, and poor general condition. Oropharyngeal swab test for SARS-CoV-2 by qualitative real-time reverse transcriptase PCR assay was positive in both patients and negative in the CSF. The first patient was treated with IV immunoglobulin and the second with acetaminophen. Two weeks later, both patients made a complete neurologic recovery, except for residual anosmia and ageusia in the first case. CONCLUSIONS: Our 2 cases highlight the rare occurrence of Miller Fisher syndrome and polyneuritis cranialis during the coronavirus disease 2019 (COVID-19) pandemic. These neurologic manifestations may occur because of an aberrant immune response to COVID-19. The full clinical spectrum of neurologic symptoms in patients with COVID-19 remains to be characterized.


Assuntos
Infecções por Coronavirus/fisiopatologia , Doenças dos Nervos Cranianos/fisiopatologia , Síndrome de Miller Fisher/fisiopatologia , Neurite (Inflamação)/fisiopatologia , Pneumonia Viral/fisiopatologia , Adulto , Ageusia/etiologia , Ageusia/fisiopatologia , Betacoronavirus , Infecções por Coronavirus/complicações , Doenças dos Nervos Cranianos/etiologia , Doenças dos Nervos Cranianos/imunologia , Gangliosídeos/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Miller Fisher/etiologia , Síndrome de Miller Fisher/imunologia , Neurite (Inflamação)/etiologia , Neurite (Inflamação)/imunologia , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Pandemias , Pneumonia Viral/complicações , Índice de Gravidade de Doença , Espanha
3.
Arthritis Rheumatol ; 72(1): 67-77, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31390162

RESUMO

OBJECTIVE: To determine the frequency, clinical characteristics, associations, and outcomes of different types of peripheral nervous system (PNS) disease in a multiethnic/multiracial, prospective inception cohort of systemic lupus erythematosus (SLE) patients. METHODS: Patients were evaluated annually for 19 neuropsychiatric (NP) events including 7 types of PNS disease. SLE disease activity, organ damage, autoantibodies, and patient and physician assessment of outcome were measured. Time to event and linear regressions were used as appropriate. RESULTS: Of 1,827 SLE patients, 88.8% were female, and 48.8% were white. The mean ± SD age was 35.1 ± 13.3 years, disease duration at enrollment was 5.6 ± 4.2 months, and follow-up was 7.6 ± 4.6 years. There were 161 PNS events in 139 (7.6%) of 1,827 patients. The predominant events were peripheral neuropathy (66 of 161 [41.0%]), mononeuropathy (44 of 161 [27.3%]), and cranial neuropathy (39 of 161 [24.2%]), and the majority were attributed to SLE. Multivariate Cox regressions suggested longer time to resolution in patients with a history of neuropathy, older age at SLE diagnosis, higher SLE Disease Activity Index 2000 scores, and for peripheral neuropathy versus other neuropathies. Neuropathy was associated with significantly lower Short Form 36 (SF-36) physical and mental component summary scores versus no NP events. According to physician assessment, the majority of neuropathies resolved or improved over time, which was associated with improvements in SF-36 summary scores for peripheral neuropathy and mononeuropathy. CONCLUSION: PNS disease is an important component of total NPSLE and has a significant negative impact on health-related quality of life. The outcome is favorable for most patients, but our findings indicate that several factors are associated with longer time to resolution.


Assuntos
Doenças dos Nervos Cranianos/fisiopatologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/fisiopatologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Adulto , Fatores Etários , Estudos de Coortes , Doenças dos Nervos Cranianos/etiologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Mononeuropatias/etiologia , Mononeuropatias/fisiopatologia , Análise Multivariada , Doenças do Sistema Nervoso Periférico/etiologia , Modelos de Riscos Proporcionais , Índice de Gravidade de Doença , Adulto Jovem
4.
Clin Neurol Neurosurg ; 184: 105443, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31336359

RESUMO

OBJECTIVE: To retrospectively analyze the data of 72 patients with tuberculous meningitis (TBM) combined with cranial nerve palsy, to explore the incidence, clinical features, CSF assay changes and outcome in patients with TBM. PATIENTS AND METHODS: A total of 72 patients were diagnosed as TBM with cranial nerve palsy. The gender, age, clinical manifestations, CSF examinations, cerebral magnetic resonance imaging (MRI) enhancement scan were collected. All these patients had completed at least 2 months of follow up after anti-tuberculous treatment. RESULTS: This study retrospectively evaluated 486 patients; include 254 (52.3%) men and 232 (47.7%) women. The mean age was 35.2 ±â€¯17.0 years. 72 patients (14.8%) were diagnosed as TBM with cranial nerve palsy. Among them, 38 cases (52.8%) had optic nerve palsy (the 2nd nerve), 41 cases (56.9%) had oculomotor nerve palsy (the 3rd nerve), 3 cases (4.2%) had abducens nerve palsy (the 6th nerve), and 10 cases (13.9%) had auditory nerve palsy (the 8th nerve). 16 patients (22.2%) had two groups of cranial nerve involvement (oculomotor nerve and optic nerve in 10 cases, optic nerve and auditory nerve in 5 cases, and optic nerve and abducens nerve in 1 case). Two patients (2.8%) had three groups of cranial nerve involvement (oculomotor nerve, optic nerve and abducens nerve). CSF MTB was detected by acid fast bacilli (no patient was positive), MTB DNA detection by multiplex polymerase chain reaction (PCR) (3 patients were positive) and MTB cultures (2 patients were positive). There was no significant difference of CSF cells and biochemistry investigations between the patients with or without cranial nerve palsy. Magnetic resonance imaging (MRI) enhancement scan were done in 66 (91.7%) patients after admission. It was abnormal in 57 (86.3%) patients. 15 cases (26.3%) had meningeral enhancement, 25 cases (43.9%) had tuberculoma, 11 cases (19.3%) had hydrocephalus and 6 cases (10.5%) with infarct. All patients were followed up after 2 months of anti-tuberculous treatment. 70 patients (97.2%, 70/72) with the cranial nerve palsy were fully recovered without obvious sequel. CONCLUSION: The complications of cranial nerve palsy in TBM patients are not uncommon, and the rate of misdiagnosis is high, which makes them vulnerable to emergencies such as disturbance of consciousness. Effective anti-tuberculous treatment can restore most cranial nerve palsy.


Assuntos
Doenças do Nervo Abducente/fisiopatologia , Doenças dos Nervos Cranianos/fisiopatologia , Doenças do Nervo Oculomotor/fisiopatologia , Tuberculose Meníngea/fisiopatologia , Doenças do Nervo Abducente/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/epidemiologia , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/complicações , Doenças do Nervo Oculomotor/etiologia , Tuberculose Meníngea/complicações , Tuberculose Meníngea/epidemiologia , Adulto Jovem
5.
Handb Clin Neurol ; 161: 327-342, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307611

RESUMO

Electrophysiologic techniques are available to measure many of the cranial nerves. The procedures can be done using equipment available in standard clinical neurophysiology laboratories. These studies can aid in localization of cranial nerve lesions as well help identify the underlying pathology and possibly aid in prognosis. The trigeminal pathways can be measured using the blink and masseter responses. The facial nerve is measured by the blink response and by direct facial stimulation; techniques such as lateral spread can identify specific abnormalities. The spinal accessory nerve is measured using nerve conduction techniques. Needle examination can be routinely performed on muscles innervated by cranial nerves V, VII, X, XI and XII. These studies reliably measure the functional integrity of cranial nerves and their central pathways. Intraoperative monitoring of the cranial nerves is useful in certain surgeries. This chapter reviews current techniques used to evaluate cranial nerves, emphasizing the methods available in most clinical neurophysiology laboratories.


Assuntos
Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/fisiopatologia , Eletrodiagnóstico/métodos , Humanos , Monitorização Neurofisiológica Intraoperatória/métodos
6.
BMJ Case Rep ; 12(4)2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30996066

RESUMO

Brainstem gliomas are rare tumours in adults, accounting for only 1%-2% of all intracranial gliomas. They are recognised as a heterogeneous group, in which most are malignant tumours. Brainstem gliomas are classified into four major groups according to the growth pattern on imaging, namely diffuse, focal, exophytic and cervicomedullary. Such a classification system is also useful for surgical decision making. The exophytic variant is extremely rare having anecdoctal reports in the literature. We report the case of an adult patient affected by an exophytic glioblastoma of the pons, which was submitted to subtotal resection followed by radiation therapy and chemotherapy with a longer overall survival. To the best of our knowledge, this is the seventh adult patient reported of an exophytic brainstem glioblastoma.


Assuntos
Neoplasias do Tronco Encefálico/patologia , Tronco Encefálico/patologia , Doenças dos Nervos Cranianos/diagnóstico por imagem , Glioblastoma/diagnóstico por imagem , Neuroimagem , Ponte/patologia , Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/terapia , Quimiorradioterapia , Doenças dos Nervos Cranianos/etiologia , Doenças dos Nervos Cranianos/fisiopatologia , Evolução Fatal , Glioblastoma/patologia , Glioblastoma/terapia , Humanos , Hidrocefalia/fisiopatologia , Hemorragias Intracranianas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Ponte/diagnóstico por imagem , Fatores de Tempo
7.
World Neurosurg ; 128: e81-e86, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30974276

RESUMO

BACKGROUND: Intracranial meningioma is the most common brain tumor operated in the 2 teaching hospitals in Ethiopia. This study reviews the clinical outcome of intracranial meningiomas in a resource-limited setup. METHODS: This is a retrospective study undertaken at 2 neurosurgical teaching hospitals: Black Lion Specialized Hospital and Myungsung Christian Medical Center. It includes all operated patients with intracranial meningioma during the time period January 2009 to December 2013. Patient data regarding sociodemographics, presenting complaint, focal neurologic deficit, preoperative imaging, postoperative neurologic findings, intraoperative findings, and histopathologic results were collected and analyzed. RESULTS: A total of 91 patients were enrolled in the study. Tumor size was estimated in 79 cases (86.8%). Fifty-one tumors (64.6%) were >5 cm in diameter, whereas 28 (35.4%) were ≤5 cm. Only 4 patients had tumors <3 cm (5.1%). Tumor size was shown to be related to postoperative functional outcome (P = 0.032). The surgical mortality rate, which was defined as death within 1 month, was 14.3%. Among 88 patients with a postoperative Karnofsky Performance Status Scale score, 43% achieved a postoperative score ≥70. CONCLUSIONS: Meningioma size determines the outcome of the patients. It was shown that the functional outcome of patients is encouraging even though further improvement on neurosurgical care is needed.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Adolescente , Adulto , Idoso , Anticonvulsivantes/uso terapêutico , Criança , Doenças dos Nervos Cranianos/etiologia , Doenças dos Nervos Cranianos/fisiopatologia , Etiópia/epidemiologia , Feminino , Glucocorticoides/uso terapêutico , Cefaleia/etiologia , Cefaleia/fisiopatologia , Hospitais de Ensino , Humanos , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/fisiopatologia , Meningioma/complicações , Meningioma/patologia , Meningioma/fisiopatologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Adulto Jovem
8.
Neurology ; 92(21): e2406-e2420, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31028126

RESUMO

OBJECTIVE: To characterize the full spectrum, relative frequency, and prognosis of the neurologic manifestations in Zika virus (ZIKV) postnatal infection. METHODS: We conducted an observational study in consecutive ZIKV-infected patients presenting with neurologic manifestations during the French West Indies 2016 outbreak. RESULTS: Eighty-seven patients, including 6 children, were enrolled. Ninety-five percent of all cases required hospitalization. Guillain-Barré syndrome was the most frequent manifestation (46.0%) followed by encephalitis or encephalomyelitis (20.7%), isolated single or multiple cranial nerve palsies (9.2%), other peripheral manifestations (6.9%), and stroke (1.1%). Fourteen patients (16.1%), including one child, developed a mixed disorder involving both the central and peripheral nervous system. Mechanical ventilation was required in 21 cases, all of whom had ZIKV RNA in at least one biological fluid. Two adult patients died due to neuroZika. Clinical follow-up (median 14 months; interquartile range, 13-17 months) was available for 76 patients. Residual disability (modified Rankin Scale score ≥2) was identified in 19 (25.0%) patients; in 6 cases (7.9%), disability was severe (modified Rankin Scale score ≥4). Among patients with ZIKV RNA detected in one biological fluid, the risk of residual disability or death was higher (odds ratio 9.19; confidence interval 1.12-75.22; p = 0.039). CONCLUSIONS: NeuroZika spectrum represents a heterogeneous group of clinical neurologic manifestations. During an outbreak, clinicians should consider neuroZika in patients presenting with cranial nerve palsies and a mixed neurologic disorder. Long-term sequelae are frequent in NeuroZika. ZIKV reverse-transcription PCR status at admission can inform prognosis and should therefore be taken into consideration in the management of hospitalized patients.


Assuntos
Doenças dos Nervos Cranianos/terapia , Encefalite Viral/terapia , Encefalomielite/terapia , Síndrome de Guillain-Barré/fisiopatologia , Infecção por Zika virus/terapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Doenças dos Nervos Cranianos/metabolismo , Doenças dos Nervos Cranianos/fisiopatologia , Encefalite Viral/metabolismo , Encefalite Viral/fisiopatologia , Encefalomielite/metabolismo , Encefalomielite/fisiopatologia , Feminino , Hospitalização , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , RNA Viral/sangue , RNA Viral/líquido cefalorraquidiano , RNA Viral/urina , Respiração Artificial , Resultado do Tratamento , Índias Ocidentais , Infecção por Zika virus/metabolismo , Infecção por Zika virus/fisiopatologia
9.
BMJ Case Rep ; 12(2)2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30796075

RESUMO

Neurosyphilis is a rare disease that until the 2000s was almost eradicated due to population awareness of HIV and efficient treatment. Since then, the prevalence of the entity is rising due to risk-associated behaviour such as unprotected intercourse. Neurosyphilis is still a difficult entity to diagnose especially when combined with acute HIV infection which can influence the usual clinical course of disease. In rare occasions, both acute HIV and early syphilis infection can present as mono or multiple cranial nerve palsies. This case demonstrates a rare manifestation of misdiagnosed early syphilis infection combined with acute HIV infection in a 34-year-old man with prior history of unprotected sex with men.


Assuntos
Antibacterianos/uso terapêutico , Doenças dos Nervos Cranianos/microbiologia , Paralisia Facial/microbiologia , Infecções por HIV/imunologia , Perda Auditiva/microbiologia , Neurossífilis/microbiologia , Penicilina G/uso terapêutico , Adulto , Doenças dos Nervos Cranianos/diagnóstico por imagem , Doenças dos Nervos Cranianos/fisiopatologia , Disartria/microbiologia , Disartria/fisiopatologia , Paralisia Facial/fisiopatologia , Infecções por HIV/fisiopatologia , Perda Auditiva/fisiopatologia , Homossexualidade Masculina , Humanos , Imagem por Ressonância Magnética , Masculino , Neuroimagem , Neurossífilis/tratamento farmacológico , Neurossífilis/fisiopatologia , Resultado do Tratamento , Sexo sem Proteção
10.
J Stroke Cerebrovasc Dis ; 28(2): 344-346, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30396840

RESUMO

Our objective is to present a case of Vernet's syndrome (cranial nerve (CN) IX, X, and XI palsy) associated with cerebral venous thrombosis (CVT) in an internal jugular vein. The patient presented with acutely developed dysphagia. The weakness of the left sternocleidomastoid and trapezius muscles was observed. The initial magnetic resonance imaging and computed tomography (CT) with contrast enhancement showed contrast-filling defect in the left internal jugular vein inside the jugular foramen. The magnetic resonance venography with contrast enhancement revealed a partial filling defect in the left sigmoid sinus and total occlusion of the left internal jugular vein. Under the diagnosis of CVT associated with CN IX, X palsy, anticoagulation therapy with low-molecular-weighted heparin was initiated. Despite the continued anticoagulation therapy for 3 months, neither the burden of thrombosis in the left sigmoid sinus and internal jugular vein on neck CT nor dysphagia symptoms improved. Clinicians need to be aware of internal jugular venous thrombosis as one of the differential diagnoses in Vernet's syndrome in patients in a hypercoagulable state. Further reporting of similar cases is needed to confirm the association between CVT and Vernet's syndrome.


Assuntos
Doenças dos Nervos Cranianos/etiologia , Veias Jugulares , Trombose Venosa/complicações , Idoso , Anticoagulantes/administração & dosagem , Angiografia por Tomografia Computadorizada , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/fisiopatologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Veias Jugulares/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Força Muscular , Flebografia/métodos , Músculos Superficiais do Dorso/inervação , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
12.
J Spinal Cord Med ; 42(2): 260-264, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29485364

RESUMO

CONTEXT: Syringobulbia is a very rare progressive disorder of central nervous system, with several possible underlying conditions. Rarely, it is also encountered as a late complication of syringomyelia. FINDINGS: In the present manuscript, a case of a paraplegic patient, due to traumatic spinal cord injury (thoracolumbar fracture), presenting after years progressively developing symptoms of the lower cranial nerves and upper extremities, owed to syringomyelia and syringobulbia, the surgical treatment applied and its outcomes are described. We performed a syringo-peritoneal shunting procedure using a T-tube. The patient's symptoms resolved postoperatively and the cavity's size was reduced to a great degree. CONCLUSION/CLINICAL RELEVANCE: The late appearance of cranial nerve deficits or symptoms-signs of the upper extremities in a patient with traumatic thoracic spinal cord injury should raise suspicion that post-traumatic syringomyelia or syringobulbia has occurred. In such cases, radiologic evaluation and early surgical drainage of the cyst as a means of preventing significant delayed neurologic deficit is advocated.


Assuntos
Encefalopatias/patologia , Tronco Encefálico/patologia , Derivações do Líquido Cefalorraquidiano , Traumatismos da Medula Espinal/complicações , Siringomielia/patologia , Adulto , Encefalopatias/complicações , Encefalopatias/etiologia , Encefalopatias/cirurgia , Tronco Encefálico/cirurgia , Doenças dos Nervos Cranianos/etiologia , Doenças dos Nervos Cranianos/fisiopatologia , Humanos , Masculino , Siringomielia/complicações , Siringomielia/etiologia , Siringomielia/cirurgia , Extremidade Superior/fisiopatologia
14.
Ophthalmic Res ; 60(3): 152-160, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29895036

RESUMO

PURPOSE: This study aimed to investigate the association of the frequency of optic disk hemorrhage (DH) and progression of normal tension glaucoma (NTG) between each group based on the location of the initial retinal nerve fiber layer (RNFL) defect. METHODS: In this retrospective, observational cohort study, 142 NTG patients who underwent more than 5 reliable visual field tests with initial superior hemifield (group 2, n = 51), inferior hemifield (group 1, n = 44), or both hemifield (group 3, n = 47) defects were included. The number of DHs was inspected in serial optic disk photographs by 2 different ophthalmologists. Progression rates, which are the slope of mean thresholds from the 52 points, were calculated using a linear mixed effect model. RESULTS: The mean follow-up period was 8.19 ± 3.30 years. DHs related with the initial RNFL defect occurred significantly more frequently in group 2 (35 in inferior hemifield) than in group 1 (6 in superior hemifield) (p = 0.009) or group 3 (6 in inferior hemifield) (p = 0.006). The progression rate in group 2 was significantly faster than in group 1 (p = 0.019) or the superior hemifield of group 3 (p = 0.001). The progression rate of subjects showing recurrent DH was significantly faster than those showing single DH from all groups (-0.5460 vs. -0.2867 dB/year, p = 0.0053). CONCLUSIONS: More careful examination and caution are required when NTG patients show recurrent DH in the inferior hemifield related to the initial RNFL defect.


Assuntos
Doenças dos Nervos Cranianos/fisiopatologia , Glaucoma de Baixa Tensão/fisiopatologia , Disco Óptico/fisiopatologia , Células Ganglionares da Retina/patologia , Hemorragia Retiniana/fisiopatologia , Transtornos da Visão/fisiopatologia , Adulto , Idoso , Análise de Variância , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Campos Visuais/fisiologia
15.
Medicine (Baltimore) ; 97(15): e0303, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29642156

RESUMO

RATIONALE: Neurolymphomatosis (NL) is a rare syndrome of lymphoma and leukemic infiltration of cranial or peripheral nerves. PATIENT CONCERNS: We report a case of non-Hodgkin Lymphoma (NHL) in a 24-year-old man presented with difficulty in swallowing, hypersalivation, hoarseness, ptosis, facial paralysis, and facial hypoesthesia associated with NL. DIAGNOSIS: NL was diagnosed based upon cranial magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. INTERVENTIONS: The patient was treated with intrathecal methotreaxate (12.5 mg) and cytosine arabinoside (70 mg), systemic high-dose methotrexate therapy, and cranial radiotherapy. OUTCOME: Due to the deterioration of general condition of the patient, he was admitted to intensive care unit, but died 22 days after the onset of symptoms in spite of aggressive treatment. LESSONS: In this case, we present a patient with T cell lymphoma and multineuritis of NL diagnosed by MRI and as far as we know, this is the first reported case in which so many cranial nerves (3, 5, 7, 8, 9, and 10 th) were involved. Briefly, in a patient with hematologic malignancy and neurological complaints, NL should be considered. Early and effective use of imaging modalities such as positron emission tomography (PET-CT), MRI, and aggressive therapies are important for prolonged survival.


Assuntos
Doenças dos Nervos Cranianos , Nervos Cranianos/patologia , Citarabina/administração & dosagem , Infiltração Leucêmica/patologia , Linfoma não Hodgkin , Doença de Marek , Metotrexato/administração & dosagem , Radioterapia/métodos , Animais , Antimetabólitos Antineoplásicos/administração & dosagem , Líquido Cefalorraquidiano , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Doenças dos Nervos Cranianos/fisiopatologia , Doenças dos Nervos Cranianos/terapia , Evolução Fatal , Humanos , Injeções Espinhais , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Doença de Marek/diagnóstico , Doença de Marek/etiologia , Doença de Marek/fisiopatologia , Neuroimagem/métodos , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
16.
J Neurovirol ; 24(3): 379-381, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29532442

RESUMO

Vernet syndrome is a unilateral palsy of glossopharyngeal, vagus, and accessory nerves. Varicella zoster virus (VZV) infection has rarely been described as a possible cause. A 76-year-old man presented with 1-week-long symptoms of dysphonia, dysphagia, and weakness of the right shoulder elevation, accompanied by a mild right temporal parietal headache with radiation to the ipsilateral ear. Physical examination showed signs compatible with a right XI, X, and XI cranial nerves involvement and also several vesicular lesions in the right ear's concha. He had a personal history of poliomyelitis and chickenpox. Laringoscopy demonstrated right vocal cord palsy. Brain MRI showed thickening and enhancement of right lower cranial nerves and an enhancing nodular lesion in the ipsilateral jugular foramen, in T1 weighted images with gadolinium. Cerebrospinal fluid (CSF) analysis disclosed a mild lymphocytic pleocytosis and absence of VZV-DNA by PCR analysis. Serum VZV IgM and IgG antibodies were positive. The patient had a noticeable clinical improvement after initiation of acyclovir and prednisolone therapy. The presentation of a VZV infection with isolated IX, X, and XI cranial nerves palsy is extremely rare. In our case, the diagnosis of Vernet syndrome as a result of VZV infection was made essentially from clinical findings and supported by analytical and imaging data.


Assuntos
Encéfalo/virologia , Doenças dos Nervos Cranianos/virologia , Herpesvirus Humano 3/imunologia , Infecção pelo Vírus da Varicela-Zoster/virologia , Paralisia das Pregas Vocais/virologia , Nervo Acessório/diagnóstico por imagem , Nervo Acessório/imunologia , Nervo Acessório/fisiopatologia , Nervo Acessório/virologia , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/imunologia , Encéfalo/fisiopatologia , Doenças dos Nervos Cranianos/diagnóstico por imagem , Doenças dos Nervos Cranianos/imunologia , Doenças dos Nervos Cranianos/fisiopatologia , Nervo Glossofaríngeo/diagnóstico por imagem , Nervo Glossofaríngeo/imunologia , Nervo Glossofaríngeo/fisiopatologia , Nervo Glossofaríngeo/virologia , Herpesvirus Humano 3/isolamento & purificação , Humanos , Imagem por Ressonância Magnética , Masculino , Nervo Vago/diagnóstico por imagem , Nervo Vago/imunologia , Nervo Vago/fisiopatologia , Nervo Vago/virologia , Infecção pelo Vírus da Varicela-Zoster/diagnóstico por imagem , Infecção pelo Vírus da Varicela-Zoster/imunologia , Infecção pelo Vírus da Varicela-Zoster/fisiopatologia , Paralisia das Pregas Vocais/diagnóstico por imagem , Paralisia das Pregas Vocais/imunologia , Paralisia das Pregas Vocais/fisiopatologia
18.
Clin Med (Lond) ; 17(6): 575-577, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29196362

RESUMO

In this case study, we summarise the inpatient investigations and management of a 68-year-old woman with Takotsubo cardiomyopathy secondary to a Varicella zoster encephalitis and the difficulties inherent with making this diagnosis. She presented with evolving cranial nerve neuropathies, which started with a vagal nerve mononeuritis and eventually included left-sided sensorineural hearing loss and a facial nerve palsy. These symptoms were concomitant with a variety of cardiac abnormalities, including fast atrial fibrillation and electrocardiographic changes. We summarise some of the current understanding of Takotsubo cardiomyopathy and the criteria for its diagnosis. Although left ventricular apical ballooning has been described in association with severe infections and states of high stress, we have not seen it reported in association with a Varicella zoster encephalitis.


Assuntos
Fibrilação Atrial/diagnóstico , Doenças dos Nervos Cranianos/fisiopatologia , Encefalite por Varicela Zoster/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Aciclovir/uso terapêutico , Idoso , Antivirais/uso terapêutico , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Doenças dos Nervos Cranianos/etiologia , Eletrocardiografia , Encefalite por Varicela Zoster/complicações , Encefalite por Varicela Zoster/tratamento farmacológico , Encefalite por Varicela Zoster/fisiopatologia , Doenças do Nervo Facial/etiologia , Doenças do Nervo Facial/fisiopatologia , Paralisia Facial/etiologia , Paralisia Facial/fisiopatologia , Feminino , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/fisiopatologia , Humanos , Cardiomiopatia de Takotsubo/sangue , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Troponina/sangue , Doenças do Nervo Vago/etiologia , Doenças do Nervo Vago/fisiopatologia
19.
Am J Med Genet C Semin Med Genet ; 175(4): 496-506, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29082627

RESUMO

CHARGE syndrome is an autosomal dominant genetic condition that is primarily diagnosed based on clinical features, with genetic testing available for confirmation. The CHARGE mnemonic stands for some of the common characteristics: coloboma, heart defects, atresia/stenosis of the choanae, retardation of growth/development, genitourinary anomalies, and ear abnormalities (CHARGE). However, many of the common clinical features are not captured by this mnemonic, including cranial nerve dysfunction, considered by some to be one of the major diagnostic criteria. Over 90% of individuals experience feeding and gastrointestinal dysfunction, which carries great morbidity and mortality. The aim of this review is to examine the nature of gastrointestinal (GI) symptoms and feeding difficulties in CHARGE syndrome, focusing on their underlying pathology, associated investigations, and available treatment options. We also provide information on available tools (for parents, clinicians, and researchers) that are important additions to the lifelong healthcare management of every individual with CHARGE syndrome. We review how cranial nerve dysfunction is one of the most important characteristics underlying the pervasive GI and feeding dysfunction, and discuss the need for future research on gut innervation and motility in this genetic disorder.


Assuntos
Síndrome CHARGE/diagnóstico , Síndrome CHARGE/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Trato Gastrointestinal/anormalidades , Trato Gastrointestinal/fisiopatologia , Fenótipo , Anormalidades Múltiplas/genética , Anormalidades Múltiplas/fisiopatologia , Animais , Síndrome CHARGE/terapia , Doenças dos Nervos Cranianos/genética , Doenças dos Nervos Cranianos/fisiopatologia , Feminino , Motilidade Gastrointestinal/genética
20.
Med Arch ; 71(4): 293-295, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28974853

RESUMO

INTRODUCTION: Varicella Zoster Virus (VZV) is associated with many disorders of the central and peripheral nervous systems including neuralgia, meningitis, meningoencephalitis, cerebellitis, vasculopathy, myelopathy, Ramsay-Hunt syndrome, and polyneuritis cranialis. Cranial nerves V, VI, VII, VIII, IX, X, XI, and/or XII may be affected. The neurological disorders caused by VZV usually present with rash, but may rarely present without rash. CASE REPORT: We herein present a case of polyneuritis cranialis without rash caused by VZV affecting cranial nerves VII, VIII, IX, and X. After excluding other causes of the condition, we diagnosed VZV infection based on VZV DNA in the CSF and an elevated anti-VZV IgG level in serum. The patient responded well to antiviral therapy. CONCLUSION: VZV infection should be kept in mind during the differential diagnosis of polyneuritis cranialis; it is important to note that VZV re-activation may occur without rash.


Assuntos
Doenças dos Nervos Cranianos/virologia , Doenças do Nervo Facial/virologia , Herpes Zoster/complicações , Herpesvirus Humano 3 , Neuralgia Pós-Herpética/virologia , Polineuropatias/virologia , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Doenças dos Nervos Cranianos/tratamento farmacológico , Doenças dos Nervos Cranianos/fisiopatologia , Doenças do Nervo Facial/tratamento farmacológico , Doenças do Nervo Facial/fisiopatologia , Herpes Zoster/virologia , Herpesvirus Humano 3/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia Pós-Herpética/tratamento farmacológico , Neuralgia Pós-Herpética/fisiopatologia , Polineuropatias/tratamento farmacológico , Polineuropatias/fisiopatologia , Resultado do Tratamento
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