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1.
Medicine (Baltimore) ; 100(23): e26241, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115012

RESUMO

RATIONALE: Todd paralysis (a stroke-like presentation in some patients with epilepsy) caused by limbic encephalitis (LE) is not easily distinguished from acute ischemic stroke by clinicians in the emergency room. PATIENT CONCERNS: We report a contactin-associated protein-like 2-antibody (CASPR2-Ab)-positive patient who presented with atypical LE. DIAGNOSES: CASPR2-Ab-positive LE was the presumed diagnosis. Re-evaluation of cerebrospinal fluid (CSF) samples revealed autoantibodies targeting CASPR2 at an immunoglobulin G titer of 1:1. The clinical presentation of subacute onset seizures, abnormal electroencephalography, hypermetabolism on positron emission tomography, good immunotherapy response, and the presence of specific antibodies in serum supports a diagnosis of autoimmune LE. INTERVENTION: The patient received glucocorticoids (1 g for 3 days and 500 mg for 3 days), immunoglobulin (25 g for 3 days), sodium valproate (1 g for 3 days), and clonazepam (1 mg for 3 days). OUTCOMES: Remission of temporal lobe epilepsy symptoms and cognitive dysfunction was observed. Follow-up analysis of CSF and serological examination were not approved by the patient. His Mini-Mental State Examination score improved to 21/30. Stable remission of symptoms was achieved throughout the follow-up period of 50 days. LESSONS: Autoimmune encephalitis (AE) should be considered in cases of late-onset epilepsy following meningioma peritumoral brain edema and resection. A diagnosis of AE should be considered in patients presenting with stroke-like symptoms if the magnetic resonance imaging abnormality does not match a known vascular territory. Early and correct diagnosis is crucial because immunotherapy is usually effective for this disease.


Assuntos
Encefalite Límbica/diagnóstico , Proteínas de Membrana/análise , Meningioma/diagnóstico , Proteínas do Tecido Nervoso/análise , Biomarcadores/análise , Biomarcadores/sangue , Disfunção Cognitiva/etiologia , Humanos , Encefalite Límbica/complicações , Imageamento por Ressonância Magnética/métodos , Masculino , Proteínas de Membrana/sangue , Meningioma/complicações , Pessoa de Meia-Idade , Proteínas do Tecido Nervoso/sangue , Paresia/etiologia , Convulsões/etiologia , Convulsões/fisiopatologia , Tomografia Computadorizada por Raios X/métodos
2.
NeuroRehabilitation ; 48(4): 513-522, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33967063

RESUMO

BACKGROUND: In hemiparetic patients, the skeletal muscle is mainly affected with a combination of abnormalities (denervation, remodeling, spasticity, and eventually muscular atrophy). OBJECTIVE: This study examined the role of eccentric exercise in strengthening muscles of the lower extremity and ultimately improving autonomy in patients with post-stroke hemiparesis during gait. METHODS: Thirty-seven patients hemiparetic adults were recruited, randomized into a control group (n = 19) and an intervention group receiving eccentric muscle strengthening (n = 18). The protocol consisted of three sets of five repetitions of eccentric contraction of the paretic limb after determining the maximum repetition (1 MRI). Evaluation of the 1RM, 10 meters and 6WMT was performed before and after the exercise for each group. Manova test was used to compare the differences between the control and intervention groups. RESULTS: The paretic limb showed significant increase in one-repetition maximum (1RM) between before and after rehabilitation (p≤0.00003). The two groups of Patients increased their walking speed (p≤0.0005), but we observed a significant difference between groups only for the 6MWT and not on the 10 meters Test. CONCLUSIONS: Eccentric training can be useful in strengthening the muscles of the lower limbs, and promoting gait performance. Eccentric training could complement other methods of managing patients with post-stroke hemiparesis.


Assuntos
Terapia por Exercício/métodos , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Velocidade de Caminhada , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Paresia/etiologia , Acidente Vascular Cerebral/patologia
3.
J Neuroeng Rehabil ; 18(1): 81, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985543

RESUMO

BACKGROUND: Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. METHODS: Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the 'distance' between pathological and normal movement, (a) the bidirectional Kullback-Liebler divergence (BKLD) and (b) Hellinger's distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. RESULTS: Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. CONCLUSIONS: The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.


Assuntos
Atividade Motora/fisiologia , Espasticidade Muscular/fisiopatologia , Exame Neurológico/métodos , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Fenômenos Biomecânicos , Articulação do Cotovelo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Espasticidade Muscular/etiologia , Paresia/etiologia , Reflexo de Estiramento/fisiologia , Extremidade Superior
4.
Medicine (Baltimore) ; 100(16): e25212, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879656

RESUMO

ABSTRACT: Gait rehabilitations have been abundantly performed for post-stroke patients, because gait is the most important factor for the return of post-stroke patients to daily life. However, conventional uniform gait rehabilitations tend to be tedious and reduce motivation. The aim of this study was to contribute to the development of personalized rehabilitation of gait by identifying differences in gait recovery pattern according to the paralyzed side of post-stroke patients.The gait analysis was performed on stroke patients who are right-handed and can walk independently. We retrospectively analyzed the results of pelvic movements and displacement of center of pressure (COP) during gait using corresponding equipments. To show the difference of gait recovery pattern according to the paralyzed side, we divided subjects into two groups, right (n = 19) and left (n = 20) hemiparesis group. The measured variables were as follows: tilt, obliquity, and rotation symmetries of pelvis; area, velocity, and lateral symmetry of COP.First, in the left hemiparesis group, obliquity (P < .01) and rotation (P < .01) symmetries of the movement of the pelvis were significantly improved in the follow-up compared to the initial gait analysis. In the right hemiparesis group, tilt (P < .001), obliquity (P < .001), and rotation (P < .05) symmetries were significantly improved in the follow-up compared to the initial gait analysis. Second, COP area and COP velocity values in the follow-up were significantly smaller than those in the initial gait analysis in the left (P < .001, P < .05) and right (P < .001, P < .01) hemiparesis groups. The positive value of lateral symmetry increased, although not a significant difference statistically, as walking ability improved in both groups. In the correlation analysis among variables obtained using Treadmill, there were significant positive linear relationships between the lateral symmetry and the COP area (P < .05), and between the COP velocity and the lateral symmetry (P < .001) of the follow-up gait analysis in the right hemiparesis group.It was confirmed that the gait recovery pattern differs according to the paralyzed side of post-stroke patients and the role of the intact side, such as moving the COP to the intact side, is important for the improvement of gait function in both groups.This study was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002984) and was approved by the Institutional Review Board (IRB) of the WKUGH (WKIRB [2018-25], November 28, 2018).


Assuntos
Transtornos Neurológicos da Marcha/reabilitação , Paresia/reabilitação , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Acidente Vascular Cerebral/fisiopatologia , Idoso , Teste de Esforço , Feminino , Lateralidade Funcional , Marcha/fisiologia , Análise da Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Paresia/etiologia , Pelve/fisiopatologia , República da Coreia , Estudos Retrospectivos , Resultado do Tratamento
5.
J Stroke Cerebrovasc Dis ; 30(6): 105750, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33812174

RESUMO

OBJECTIVE: Vertebral artery compression of the medulla is a rare vascular finding that causes a variety of clinical presentations, from asymptomatic to neurological disability. This article presents the largest literature review to date on medullary compression of the vertebral arteries. METHODS: An English literature search was performed using the PubMed database and the keywords vertebral artery tortuosity, vertebral artery compression, and medullary compression. RESULTS: A comprehensive literature search yielded 68 patients (57% male) with medullary compression by an intracranial vertebral artery (ICVA). The left side of the medulla was compressed in 44, the right side in 19, and bilateral in 7. The most common clinical symptom was weakness - 26 patients (36%) - 6 had quadriparesis and 6 had hemiparesis. 21 patients reported imbalance; 12 various sensory symptoms; 4 patients were asymptomatic. CONCLUSIONS: Understanding the anatomy of the vasculature can help mitigate future debilitating stroke symptoms. Concrete guidelines for revascularization surgery in symptomatic patients may also be effective. Future studies are needed to further clarify the prevalence, natural history, vascular etiology, and treatment of this condition, including asymptomatic patients and the likelihood that they will develop further neurological signs and disability.


Assuntos
Encefalopatias/etiologia , Bulbo/fisiopatologia , Malformações Vasculares/complicações , Artéria Vertebral/anormalidades , Adulto , Idoso , Idoso de 80 Anos ou mais , Encefalopatias/diagnóstico por imagem , Encefalopatias/fisiopatologia , Feminino , Humanos , Masculino , Bulbo/diagnóstico por imagem , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Equilíbrio Postural , Prognóstico , Quadriplegia/etiologia , Quadriplegia/fisiopatologia , Transtornos das Sensações/etiologia , Transtornos das Sensações/fisiopatologia , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Adulto Jovem
6.
J Clin Neurosci ; 86: 139-144, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33775318

RESUMO

We report the case of a patient who experienced recurrent ipsilateral hemiparesis in the setting of predominantly-uncrossed corticospinal tracts, with concomitant neuronal reorganization of the cortical motor maps, and the presence of aberrant interhemispheric connections. Their presence was supported by our results from diffusion tensor imaging tractography, functional magnetic resonance imaging, and transcranial magnetic stimulation. To our knowledge, this has never been reported before, and provides valuable insights into the mechanisms behind post-stroke motor recovery.


Assuntos
Córtex Motor/diagnóstico por imagem , Paresia/diagnóstico por imagem , Tratos Piramidais/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Paresia/etiologia , Paresia/fisiopatologia , Tratos Piramidais/fisiopatologia , Recidiva , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
7.
No Shinkei Geka ; 49(2): 356-361, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762457

RESUMO

A woman in her 60s was admitted to our hospital because of sudden-onset right hemiparesis, paresthesia, and neck pain. At first, a head CT scan was performed to rule out stroke, which did not detect any abnormalities. Subsequently, a neck CT scan was performed, which revealed a mild high-density structure compressing the dural sac within the cervical spinal canal. She was suspected to have a spinal hematoma. A MRI scan revealed a spindle-shaped structure with a heterogeneous high signal on T2-weighted and a mild high signal on T1-weighted sagittal images, which led to the diagnosis of a spontaneous spinal epidural hematoma. The patient was treated with conservative therapy upon which her symptoms improved. She was discharged seven days after admission. Spontaneous cervical spinal epidural hematoma often causes neck pain followed by unilateral spinal cord compression symptoms(such as hemiparesis and paresthesia)and can be misdiagnosed as a stroke. In cases of hemiparesis with sudden-onset neck pain, cervical lesions should be considered in the differential diagnoses in addition to stroke.


Assuntos
Hematoma Epidural Craniano , Hematoma Epidural Espinal , Compressão da Medula Espinal , Feminino , Hematoma Epidural Espinal/diagnóstico , Hematoma Epidural Espinal/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Pescoço , Paresia/diagnóstico por imagem , Paresia/etiologia
8.
Sao Paulo Med J ; 139(2): 190-195, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33605306

RESUMO

BACKGROUND: Although it is known that the new coronavirus disease (COVID-19), which was first seen in Wuhan, China, in December 2019 and has affected the whole world, mainly targets the respiratory tract, cases of this disease with a wide clinical spectrum are emerging as information is shared. CASE REPORT: We present the case of a pregnant woman who was diagnosed with venous sinus thrombosis after she developed headache and hemiparesis. Polymerase chain reaction (PCR) positivity lasted for two weeks after COVID-19 had been diagnosed. CONCLUSIONS: In patients with suspected COVID-19, especially in the presence of causes of hypercoagu- lability and presence of atypical features, venous sinus thrombosis needs to be kept in mind in making the differential diagnosis.


Assuntos
COVID-19/complicações , Cefaleia/etiologia , SARS-CoV-2 , Trombose Venosa/diagnóstico , COVID-19/diagnóstico , Teste para COVID-19 , China , Feminino , Humanos , Paresia/etiologia , Reação em Cadeia da Polimerase , Gravidez , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombofilia
9.
BMJ Open ; 11(1): e041444, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468454

RESUMO

INTRODUCTION: Perinatal stroke leads to cerebral palsy (CP) and lifelong disability for thousands of Canadian children. Hemiparesis, referring to impaired functionality in one side of the body, is a common complication of perinatal stroke. Standard long-term care for hemiparetic CP focuses on rehabilitation therapies. Early research suggests that patients with hemiparesis may benefit from adjunctive neuromodulation treatments such as transcranial direct current stimulation (tDCS). tDCS uses electric current to stimulate targeted areas of the brain non-invasively, potentially enhancing the effects of motor learning therapies. This protocol describes an economic evaluation to be conducted alongside a randomised controlled trial (RCT) to assess the incremental cost of tDCS added to a camp-based therapy compared with camp-based therapy alone per quality-adjusted life year (QALY) gained in children with hemiparetic CP. METHODS AND ANALYSIS: The Stimulation for Perinatal Stroke Optimising Recovery Trajectories (SPORT) trial is a multicentre RCT evaluating tDCS added to a 2-week camp-based therapy for children aged 6-18 years with perinatal ischaemic stroke and disabling hemiparetic CP affecting the upper limb. Outcomes are assessed at baseline, 1 week, 2 months and 6 months following intervention. Cost and quality of life data are collected at baseline and 6 months and results will be used to conduct a cost-utility analysis (CUA). The evaluation will be conducted from the perspectives of the public healthcare system and society. The CUA will be conducted over a 6-month time horizon. ETHICS AND DISSEMINATION: Ethical approval for the SPORT trial and the associated economic evaluation has been given by the research ethics boards at each of the study sites. The findings of the economic evaluation will be submitted for publication in a peer reviewed academic journal and submitted for presentation at conference. TRIAL REGISTRATION NUMBER: NCT03216837; Post-results.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adolescente , Canadá , Criança , Análise Custo-Benefício , Humanos , Estudos Multicêntricos como Assunto , Paresia/etiologia , Paresia/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia
10.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509859

RESUMO

A high functioning 74-year-old man with systemic lupus erythematosus presented to the emergency department with acute anxiety. He was found to have elevated cardiac enzymes and admitted to the cardiology service for investigation. In hospital, he developed an erythematous papular rash, and deteriorated to being somnolent and bedridden. He was found to have new multiterritory ischaemic strokes. It was eventually noted that he had persistent eosinophilia, present even on admission, which had been overlooked as the total leucocyte count was normal. Serology for antiphospholipid antibody syndrome (APS) was positive. He was diagnosed with hypereosinophilic syndrome (HES) secondary to new APS, and responded to high-dose steroids. This case highlights the importance of fully evaluating a leucocyte differential to make a diagnosis of HES. We discuss the definition, clinical manifestations, diagnostic approach and management of this important condition.


Assuntos
Síndrome Antifosfolipídica/diagnóstico , Cardiomiopatias/diagnóstico , Síndrome Hipereosinofílica/diagnóstico , AVC Isquêmico/diagnóstico por imagem , Diagnóstico Ausente , Idoso , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/fisiopatologia , Cardiomiopatias/sangue , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/etiologia , Creatina Quinase/sangue , Estado Terminal , Exantema/etiologia , Glucocorticoides/uso terapêutico , Humanos , Síndrome Hipereosinofílica/tratamento farmacológico , Síndrome Hipereosinofílica/etiologia , Síndrome Hipereosinofílica/fisiopatologia , Imunossupressores/uso terapêutico , AVC Isquêmico/etiologia , Contagem de Leucócitos , Lúpus Eritematoso Sistêmico/complicações , Imageamento por Ressonância Magnética , Masculino , Paresia/etiologia , Sonolência , Tomografia Computadorizada por Raios X , Troponina/sangue
11.
J Stroke Cerebrovasc Dis ; 30(3): 105518, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33388631

RESUMO

OBJECTIVES: The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST) proved to be highly efficient in the treatment of emergent large vessel occluding (ELVO) strokes in the anterior circulation. To achieve a timely diagnosis, a robust combination of few and simple signs to identify ELVOs in AIS patients applicable by paramedics in the prehospital triage is worthwhile. MATERIALS AND METHODS: This retrospective single-center study included 904 AIS patients (324 ELVO, 580 non-ELVO) admitted between 2010 and 2015 in a tertiary stroke center. We re-evaluated two symptoms based on NIHSS items, gaze deviation and hemiparesis of the limbs ("Gaze deviation and Paresis Score, GPS") for the pre-hospital prediction of ELVO. RESULTS: A positive GPS AIS in patients predicted ELVO with a sensitivity of 0.89, specificity = 0.97, positive predictive value (PPV) = 0.95, negative predictive value (NPV) = 0.94 and diagnostic odds ratio (DOR) = 34.25 (CI: 20.75-56.53). The positive Likelihood-ratio (LR+) was 29.67, the negative Likelihood ratio (LR-) 0.11. NIHSS of patients with positive GPS (gaze palsy NIHSS ≥ 0, Motor arm NIHSS ≥2 and Motor leg NIHSS ≥2) was markedly higher compared to negative GPS patients (p < 0.001). CONCLUSIONS: The GPS proved to be similarly accurate in detecting ELVO in the anterior circulation of AIS patients and even more specific than other published clinical scores. Its simplicity and clarity might enable non-neurological medical staff to identify ELVO AIS patients with high certainty in a preclinical setting.


Assuntos
Avaliação da Deficiência , Serviços Médicos de Emergência , Fixação Ocular , AVC Isquêmico/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Paresia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Procedimentos Endovasculares , Feminino , Humanos , AVC Isquêmico/etiologia , AVC Isquêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia , Paresia/etiologia , Paresia/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Triagem
12.
BMC Infect Dis ; 21(1): 65, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441090

RESUMO

BACKGROUND: West Nile virus (WNV) infections have become increasingly prevalent in certain European countries, including Hungary. Although most human infections do not cause severe symptoms, in approximately 1% of cases WNV infections can lead to severe WNV neuroinvasive disease (WNND) and death. The goal of our study was to assess the neurological status changes of WNV -infected patients admitted to inpatient care and to identify potential risk factors as underlying reasons for severe neurological outcome. METHODS: We conducted a retrospective chart review of 66 WNV-infected patients from four Hungarian medical centers. Patients' neurological status at hospital admission and at two follow-up intervals (1st follow-up, within 60-90 days and 2nd follow-up, within 150-180 days, after hospital discharge) were assessed. All of the 66 patients in the initial sample had some type of neurological symptoms and 56 patients were diagnosed with WNND. The modified Rankin Scale (mRS) and the West Nile Virus Neurological Index (WNV-N Index), a scoring system designed for the purpose of this study, were used for neurological status assessment. Patients were dichotomized into two categories, "moderately severe" and "severe" based on their neurological status. Descriptive analysis for sample description, stratified analysis for calculation of odds ratio (OR) and logistic regression for continuous input variables, were performed. RESULTS: The average number of days between the onset of neurological symptoms and hospital admission (the neurological symptom interval) was 6.01 days. Complications during the hospital stay arose in almost a fifth of the patients (18.2%) and 5 patients died. Each day's increase in the neurological symptom interval significantly increased the risk for developing a severe neurological status following hospital admission (0.799-fold and 0.688-fold, based on the WNV-N Index and mRS, respectively). Patients' age, comorbidity, presence of complications and symptoms of malaise, and gait uncertainty were shown to be independent risk factors for severe neurological status. CONCLUSIONS: Timely hospital admission of patients with neurological symptoms as well as risk assessment by clinicians - possibly with an optimal assessment tool for estimating neurological status- could improve the neurological outcome of WNV-infected patients.


Assuntos
Coma/etiologia , Meningoencefalite/etiologia , Paresia/etiologia , Febre do Nilo Ocidental/complicações , Vírus do Nilo Ocidental/imunologia , Adulto , Idoso , Comorbidade , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Hungria/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Febre do Nilo Ocidental/epidemiologia , Febre do Nilo Ocidental/virologia , Vírus do Nilo Ocidental/isolamento & purificação
13.
J Med Case Rep ; 15(1): 14, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33461603

RESUMO

BACKGROUND: Leiomyosarcomas are rare malignant tumors which originate from smooth muscle cells and very seldom give rise to intracerebral metastases. Nearly all cases of intracranial metastases stem from leiomyosarcomas of the uterus. We present a 61-year-old Caucasian man who developed multiple intracranial and extracranial metastases from leiomyosarcoma of the right forearm, diagnosed and treated 9 years before the current presentation. CASE PRESENTATION: The Caucasian patient presented to the emergency department due to a progressive hemiparesis on the left side. Magnetic resonance imaging scans of the neurocranium showed multiple intracerebral masses with perifocal edema. One of these was located in the right parietal lobe, corresponding to the hemiparesis. The patient underwent microsurgical complete resection of the parietal mass and was subsequently subjected to further radiotherapy. Histopathological studies revealed metastasis of the former leiomyosarcoma. CONCLUSIONS: Leiomyosarcomas represent a rare entity of mesenchymal tumors. Intracerebral metastasis of these tumors is even less frequent. This case shows the importance of long-term follow-up in patients with leiomyosarcoma.


Assuntos
Neoplasias Encefálicas/secundário , Leiomiossarcoma/secundário , Neoplasias de Tecidos Moles/patologia , Neoplasias da Coluna Vertebral/secundário , Neoplasias Gástricas/secundário , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/terapia , Irradiação Craniana , Antebraço , Humanos , Avaliação de Estado de Karnofsky , Leiomiossarcoma/complicações , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/terapia , Imageamento por Ressonância Magnética , Masculino , Melena/etiologia , Metastasectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Procedimentos Neurocirúrgicos , Paresia/etiologia , Antro Pilórico , Radioterapia , Sacro , Neoplasias de Tecidos Moles/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias Gástricas/complicações , Tela Subcutânea , Fatores de Tempo
19.
Rinsho Shinkeigaku ; 61(1): 39-42, 2021 Jan 29.
Artigo em Japonês | MEDLINE | ID: mdl-33328423

RESUMO

A 63-year-old Japanese female in an immunocompetent state developed right Ramsay Hunt syndrome and left shoulder pain, and left upper limb motor paresis with herpes zoster (HZ) duplex in the right auricle and left shoulder regions. With her Ramsay Hunt syndrome, neural deafness, tinnitus and vestibular symptoms were observed, and she lacked facial nerve palsy. Cerebrospinal fluid (CSF) findings revealed an increase in lymphocytes (21 cells/µl) and protein content (29 mg/dl), and polymerase chain reaction for varicella-zoster virus DNA in CSF was negative. Cervical root MRI using 3D Nerve VIEW (Philips) imaging showed high-intensity lesions on the C5-C8 spinal roots with contrast enhancements. No abnormalities were observed in the median or ulnar motor sensory nerve conduction velocity conduction studies including the F wave. PubMed search revealed no report of a patient with this profile, and to the best of our knowledge HZ duplex with concomitant neurological impairments has not been reported. We compare our present case with several similar cases from the literature.


Assuntos
Herpes Zoster da Orelha Externa/complicações , Herpes Zoster/complicações , Imunoglobulinas Intravenosas/administração & dosagem , Ombro , Feminino , Herpes Zoster/diagnóstico , Herpes Zoster/tratamento farmacológico , Herpes Zoster da Orelha Externa/diagnóstico , Herpes Zoster da Orelha Externa/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Paresia/etiologia , Polirradiculoneuropatia/diagnóstico , Polirradiculoneuropatia/tratamento farmacológico , Polirradiculoneuropatia/etiologia , Raízes Nervosas Espinhais/diagnóstico por imagem
20.
Artigo em Russo | MEDLINE | ID: mdl-33340294

RESUMO

OBJECTIVE: To analyze the effectiveness of the developed technique of «3D audio-visualization¼ in restoring the motor function of the upper limb in the acute period of stroke. MATERIAL AND METHODS: The study included 20 patients in the acute period of stroke. All patients had impaired motor function of the upper limb in the form of paresis of the proximal muscle groups. The control group was enrolled according to standard methods. The treatment was well tolerated, there were no adverse effects. RESULTS: In the study group, a more complete restoration of the motor function of the upper limb is observed compared with the control group. There is also a positive effect of the proposed technique on patients in the acute period of stroke. CONCLUSION: The prospective and cost effective technique is suggested. It can be also used by the patient in the outpatient rehabilitation phase.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Paresia/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento , Extremidade Superior
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