Lance-Adams Syndrome in the Intensive Care Unit: A Case Report.

Lance-Adams syndrome (LAS), or chronic post-hypoxic myoclonus, is a myoclonic disorder following acute cerebral hypoxia after successful cardiopulmonary resuscitation (CPR). LAS is distinct from acute post-hypoxic myoclonus (acute PHM), presenting with myoclonic jerks and cerebellar ataxia after regaining consciousness. However, the overlap at the onset complicates differentiation and may lead to the withdrawal of life-sustaining measures, especially in sedated ICU patients. The presented case involves a 77-year-old male diagnosed with LAS post-CPR. Despite the presence of early myoclonic jerks EEG, laboratory testing, and neuroimaging showed no definitive proof of irreversible neurological damage. Once diagnosed, treatment involved sequential antiseizure medications and physical therapy when the patient achieved full consciousness. However, the patient ultimately faced severe disabilities and was unable to recover. This case report emphasizes the importance of limiting sedation, comprehensive clinical examination, and the use of complementary tests when no definitive proof of irreversible neurological damage is present after acute cerebral hypoxia. While LAS has a better vital prognosis than acute PHM, it is associated with poor neurofunctional recovery and chronic disability in most cases. Further research is essential for evidence-based management.

Hemicorea-hemibalismo secundario a infarto en el área motora primaria: presentación atípica del síndrome moyamoya / Hemichorea-hemiballism secondary to infarction in the primary motor area: an atypical form of presentation of Moya moya syndrome

No disponible

Lesiones incidentales desmielinizantes en resonancia magnética: estudio de 11 casos con seguimiento clinicorradiológico y revisión de la bibliografía / Demyelinating lesions as incidental findings in magnetic resonance imaging: a study of 11 cases with clinico-radiological follow-up and a review of the literature

Introducción. La extensa aplicación de estudios de resonancia magnética (RM) conlleva un aumento en la detección de alteraciones de la sustancia blanca del sistema nervioso central. Objetivo. Investigar la evolución de pacientes sin síntomas neurológicos previos, con hallazgos de RM altamente sugestivos de esclerosis múltiple (EM). Pacientes y métodos. Estudio descriptivo de once pacientes con RM sugestiva de EM. Mediante seguimiento longitudinal se determinaron la progresión radiológica y la conversión a síndrome neurológico aislado y EM clínicamente definida. Resultados. Se identificó a 11 pacientes (7 mujeres y 4 varones), con una edad media de 36 años (rango: 28-48 años), sometidos a RM por cefalea (n = 2), prolactinoma (n = 2), radiculalgia (n = 3), traumatismo craneoencefálico (n = 1), síncope (n = 1), patología nerviosa periférica (n = 1) y crisis epiléptica (n = 1). El número medio de criterios Barkhof-Tintoré en la RM inicial fue de 3. El estudio de bandas oligoclonales fue positivo en 6 casos y en 9 pacientes se realizaron potenciales evocados visuales (3 patológicos). El seguimiento medio fue de 2,9 años (rango: 2 meses-11,9 años). El tiempo medio entre la primera y la segunda RM fue de 2,03 años. Se identificó una progresión radiológica en 7 casos (5 de ellos con captación de gadolinio). Cinco pacientes convirtieron a síndrome neurológico aislado, con un tiempo medio desde la RM inicial de 4,13 años. De ellos, tres pacientes presentaron conversión a EM clínicamente definida, dos en forma recurrenteremitente (tras 8,54 años de media desde la RM inicial) y otro en forma primaria progresiva. Conclusión. La identificación de lesiones incidentales altamente sugestivas de EM podría ayudar a constituir un grupo de sujetos con riesgo aumentado de desarrollar EM (AU)

Introduction. The widespread application of magnetic resonance imaging (MRI) has brought with it an increase in the detection of alterations in the white matter of the central nervous system. Aim. To investhighly suggestive of multiple sclerosis (MS). Patients and methods. We conducted a descriptive studigate the evolution of patients with no previous neurological symptoms, but in whom MRI findings are y of 11 patients with MRI findings suggesting MS. A longitudinal follow-up was used to determine the radiological progression and conversion into an isolated neurological syndrome and clinically defined MS. Results. Eleven patients (seven females and four males) were identified, with a mean age of 36 years (range: 28-48 years), who had been submitted to an MRI scan due to headache (n = 2), radiculalgia (n = 3), traumatic brain injury (n = 1), syncope (n = 1), peripheral nervous pathology (n = 1) and epileptic seizures (n = 1). The mean number of Barkhof-Tintoré criteria in the initial MRI scan was three. The oligoclonal band study was positive in six cases and in nine patients visual evoked potentials were performed (three pathological). The mean follow-up time was 2.9 years (range: 2 months-11.9 years). The mean amount of time elapsed between the first and the second MRI scan was 2.03 years. A radiological progression was identified in seven cases (five of them with gadolinium uptake). Five patients became cases of isolated neurological syndrome, with a mean amount of time since the initial MRI scan of 4.13 years. Of these, three patients presented conversion into clinically defined MS, two into the relapsing-remitting form (after an average of 8.54 years since the initial MRI scan) and another into the primary progressive form (AU)