RESUMO
INTRODUCTION: We report a case of periarteritis nodosa revealed by a cerebral angiitis which recovered under treatment. OBSERVATION: A 52-year-old patient suddenly presented with a left sensory syndrome and a fluctuating aphasia due to ischemia involving both parietal lobes. The diagnosis of periarteritis nodosa was based on the following criteria: severe loss of weight, renal insufficiency, hypertension, angiography suggesting an arteritis. Instead of an ileo-cecal perforation, the patient recovered under corticosteroid and immunosuppressive therapy. CONCLUSIONS: Stroke in periarteritis nodosa may occur early be and associated with a good outcome.
Assuntos
Poliarterite Nodosa/complicações , Vasculite do Sistema Nervoso Central/etiologia , Afasia/etiologia , Isquemia Encefálica/etiologia , Angiografia Cerebral , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Intracranial vertebral artery dissecting aneurysms are a recognized cause of subarachnoid hemorrhage and the hemorrhagic recurrence risk after a first rupture of the dissecting aneurysm is high and of poor prognosis. However, when the dissection is discovered in a patient with vertebrobasilar territory ischemia, little is known about the risk of hemorrhagic rupture risk and there is no consensus on management. OBSERVATION: We report the case of a 49-year-old man who developed subarachnoid hemorrhage 48 hours after the occurrence of a latero-bulbar syndrome caused by a spontaneous dissection with occlusion of the right vertebral artery. The subsequent angiography showed a V4 dissecting aneurysm of the right vertebral artery which was treated by stenting and coiling without any complications. CONCLUSION: This case underlines the hemorrhagic risk of an intradural vertebral artery dissection and its possible progression to aneurysm. Subsequent angiographic imaging must be carefully examined to search for aneurysms which may require early specific treatment because of the high risk of recurrent bleeding.
Assuntos
Infarto Encefálico/etiologia , Hemorragia Subaracnóidea/etiologia , Dissecação da Artéria Vertebral/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Strokes are rarely secondary to spontaneous carotid artery thrombosis. The objectives of this retrospective analysis were to define characteristic features and the clinical course. The study population included eight patients (6 females/2 males) seen at six university neurological centers. Age of onset was 46.5 years (range 38-52). Half of the patients had no vascular risk factor. Symptoms were TIA (n=1), strokes (n=7). Echotomography revealed intraluminal thrombus, with occlusion in 2 cases. Thrombi were found in common carotid artery (n=3), carotid bifurcation (n=2) and internal carotid artery (n=3). The thrombus was mobile in 4 cases. Seven patients were treated by anticoagulation therapy, one by surgery because of recurrent TIA. Further echotomographic exams revealed total resolution (3 cases) or decrease of the thrombus (3 cases). Occlusion was definitive in one patient. A cause was identified in six patients: acute leukemia (n=1), thrombocytopenic purpura (n=1), iron deficiency anemia (n=4).
Assuntos
Trombose das Artérias Carótidas/patologia , Adulto , Anemia Ferropriva/complicações , Anticoagulantes/uso terapêutico , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Trombose das Artérias Carótidas/complicações , Trombose das Artérias Carótidas/diagnóstico por imagem , Feminino , Humanos , Leucemia/complicações , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Púrpura Trombocitopênica/complicações , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , UltrassonografiaRESUMO
The authors describe the principal pitfalls and sources of error encountered during the application and interpretation of continuous ultrasonography examinations of the carotid artery. These include poor examination technique, limitations of the ultrasonography examination, and incorrect interpretation of results. The effects of these errors in relation to each segment of the carotid axis are discussed, and the importance of comparing the results obtained with those of palpation and auscultation of the cervical region is emphasized. The greatest difficulty is the certain recognition of a pathological signal from the internal carotid artery: acceleration, turbulence, absence of signal. This latter anomaly may be present both when there exists an occlusion of the internal carotid artery and a pseudo-occlusive stenosis of this artery. The difference is fundamental from the therapeutic point of view. Ultrasonography does not therefore replace arteriography but can assist the decision to undertake urgent or delayed operative therapy.
Assuntos
Doenças das Artérias Carótidas/diagnóstico , Erros de Diagnóstico , Ultrassonografia , Auscultação , Artéria Carótida Interna/fisiopatologia , Diagnóstico Diferencial , Humanos , PalpaçãoRESUMO
Preliminary results of the use of the ultrasound Duplex Scanner are reported and correlated with angiographic findings. The main interest of this examination resides in its application in cases of atheromatous obstruction of cervical vessels to the brain: definition of type of obstruction: occlusion or stenosis; assessment of hemodynamic alterations: modification of frequency spectrum, of pulsed Doppler signal to 5 degrees as defined by Strandness as a function of extent of narrowing of arterial lumen. Pre-occlusive lesions may be difficult to distinguish from an occlusion. In contrast, minor anomalies: plaque producing little or no stenosis, calcifications, appear to be simpler to detect than by angiography. In intracranial vascular malformations: arteriovenous fistulas and particularly intracranial angiomas of a certain size, this examination provides data on the increase in diameter and acceleration of flow in vessels supplying the malformation. In cases of brain death, the ultrasound Duplex Scanner demonstrates absence or marked reduction in internal carotid artery flow, whereas flow is normal in the external carotid arteries in the absence of collapse. Confirmation of reliability of this non-invasive exploratory procedure requires further evidence of correlations.
Assuntos
Arteriosclerose/diagnóstico , Doenças das Artérias Carótidas/diagnóstico , Reologia , Ultrassonografia , Idoso , Fístula Arteriovenosa/diagnóstico , Encéfalo/irrigação sanguínea , Morte Encefálica , Artéria Carótida Interna , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Vertebrobasilar ischemic disease cannot be adequately explored by echo-Doppler ultrasonic investigating procedures, since they do not permit the study of the intracranial arteries. The transcranial pulsed Doppler (2 MHZ) velocity detection method developed by R. Aaslid now offers such possibilities, although it has not yet been validated in this field. The authors relate their experience and methodological criteria (patient's position, deepness of access, flow direction, response to compression tests). They conducted 2 studies, one bearing on the detection of 14 cases of 75% stenosis of the superior segment, or of arteriographically-confirmed endocranial vertebral/basilar artery occlusion; the other one was concerned with assessing the basilar hemodynamic consequences of vertebral-subclavian steal syndromes. Out of 17 steal syndrome cases, of which 5 were symptomatic (4 pre-steal cases, 7 permanent, 6 intermittent), basilar flow determined spontaneously or following postischemic hyperemic test of the upper limb, was moderately changed in 30% of cases. Transcranial pulsed Doppler ultrasonic examination could be recommended in addition to the regular echo-Doppler velocity detection test, and thus contribute to exploring and monitoring transient or full-blown ischemic accidents of the vertebrobasilar circulation, in expectation of medical, surgical or angioplastic management.
Assuntos
Síndrome do Roubo Subclávio/diagnóstico , Ultrassonografia , Insuficiência Vertebrobasilar/diagnóstico , Angiografia , Feminino , Humanos , Masculino , Síndrome do Roubo Subclávio/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagemRESUMO
Four cases of basilar artery occlusion with a follow-up from 7 to 12 years are reported. The first patient, a 60 year old woman, had a proximal occlusion which was revealed by an acute brain stem ischemia. The second case was a 63 year old man with an aortic aneurysm who had a single episode of vertebro-basilar insufficiency. Cerebral angiography demonstrated a lower basilar artery occlusion. The third patient, a 60 year-old woman, had been operated from right carotid artery and left vertebral artery stenosis; 8 years later, without clinical manifestations, a left carotid artery stenosis and an occlusion of the lower part of the basilar artery were discovered. The evolution was eventless after a left carotid endarterectomy. The last case was a 60 year old man who had a lower basilar artery occlusion associated with a left internal carotid occlusion. There was a full recovery after a hemiplegic stroke. From our personal cases and the review of the literature, long term survival after basilar artery occlusion may occur in occlusions restricted to the lower or middle part of the basilar artery and with a good collateral supply from carotid and cerebellar arteries.
Assuntos
Arteriopatias Oclusivas/complicações , Artéria Basilar , Arteriopatias Oclusivas/mortalidade , Isquemia Encefálica/etiologia , Tronco Encefálico , Artéria Carótida Interna/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Artéria Vertebral/diagnóstico por imagemRESUMO
POEMS syndrome is characterized by Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes. Papilledema is a common finding but ophthalmological complaints are rare. We report a case of POEMS syndrome in a 42-year old man which was revealed by oscillopsia and blurred vision. An osteosclerotic myeloma of the fifth lef rib was found, but there was no improvement after removal of the rib. The patient died two months later from pulmonary embolism.
Assuntos
Síndrome POEMS/diagnóstico , Transtornos da Visão/etiologia , Adulto , Neoplasias Ósseas/complicações , Neoplasias Ósseas/cirurgia , Evolução Fatal , Humanos , Masculino , Mieloma Múltiplo/complicações , Mieloma Múltiplo/cirurgia , Osteosclerose/complicações , Osteosclerose/cirurgia , Síndrome POEMS/complicações , Embolia PulmonarRESUMO
In adults, neurological complications of VZV virus usually occur after herpes zoster infection in patients with AIDS. We report a case of acute and benign cerebellar ataxia after chickenpox in a patient without immunodeficiency.
Assuntos
Ataxia Cerebelar/diagnóstico , Varicela/diagnóstico , Encefalite Viral/diagnóstico , Aciclovir/administração & dosagem , Adulto , Ataxia Cerebelar/tratamento farmacológico , Encefalite Viral/tratamento farmacológico , Humanos , Masculino , Exame NeurológicoRESUMO
We report a case of multiple sclerosis which began at the age of 12 years. Clinical symptoms at onset were acute, regressive cerebellovestibular ataxia and optic neuritis. Twenty-four years later vertigo, motor and sensory deficit of the right lower limb and grand mal seizures developed. CSF and MRI were suggestive of multiple sclerosis. The patient is now free of neurological symptoms with an 8 years' follow-up.
Assuntos
Esclerose Múltipla/diagnóstico , Criança , Epilepsia Tônico-Clônica/etiologia , Seguimentos , Humanos , Masculino , Esclerose Múltipla/complicaçõesRESUMO
A 31-year old patient presented a right hemiparesis related to a left basis pontis infarction. Laboratory investigations revealed both neurosyphilis and HIV infection. The patient was treated with two courses of penicillin and recovered from hemiparesis. The occurrence of strokes due to syphilitic arteritis in AIDS is emphasized.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Infarto Cerebral/etiologia , Neurossífilis/complicações , Ponte/irrigação sanguínea , Adulto , Humanos , MasculinoRESUMO
Twenty-three cases of vertebro-basilar aneurysms observed in a neurology department are reported. Ten were located on the basilar artery (7 at the basilar bifurcation), 5 on the postero-inferior cerebellar arteries, 4 on the superior cerebellar arteries, 3 on the vertebro-basilar junction and 1 on the anteroinferior cerebellar artery. There were 6 fusiform and giant aneurysms, others were sacciform. In 5 cases, there was no clear relationship between the clinical data and the aneurysm, which was discovered by chance at angiography or MRI. One giant aneurysm of the basilar artery was mimicking a tumor of the posterior cerebral fossa. Two other cases were revealed by brain stem ischaemia. Aneurysmal rupture was present in 15 cases: there were signs of meningeal haemorrhage in all cases and clinical signs of posterior cerebral fossa involvement in 7 cases. CT scan, performed in 8 cases, showed in all of them a meningeal haemorrhage, with a brain stem haematoma in 3 cases. All the aneurysms were shown by angiography; 7 were associated with a vasospasm. Five patients were not operated upon; all died. In one case, clipping the aneurysm was impossible, but there was a good recovery with a 12 year follow-up. Nine patients were operated, 3 recovered completely, 2 had neurological sequelae, 1 a late worsening; 3 patients died of brain stem ischaemia.
Assuntos
Aneurisma/diagnóstico , Artéria Basilar , Artéria Vertebral , Adolescente , Adulto , Idoso , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea , Tomografia Computadorizada por Raios XRESUMO
A 61-year-old patient had complained of sciatica in the left lower limb for three years. The pain was located in the posterior area of the thigh and leg and radiated to the first toe. Examination showed a tumor of the middle part of the thigh. A sciatic nerve tumor was confirmed at operation. Pathological examination revealed a neurofibrosarcoma. The patient died from pulmonary metastasis 17 months later.
Assuntos
Neurofibroma/complicações , Neoplasias do Sistema Nervoso Periférico/complicações , Nervo Isquiático , Ciática/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Neurofibroma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Coxa da PernaRESUMO
An acute polyradiculoneuritis with tetraplegia and respiratory failure was observed in a 27 year-old heroin addict 3 hours after an intravenous injection of heroin. Full recovery was obtained after respiratory assistance and plasma exchanges. The biological and morphological changes (sural nerve biopsy) suggested an immune mediated mechanism. Three years after the recovery, the patient was tested for HIV antibody and was seropositive. The role of HIV infection and of the injection of heroin are discussed.
Assuntos
Soropositividade para HIV/diagnóstico , Heroína/efeitos adversos , Polirradiculoneuropatia/induzido quimicamente , Doença Aguda , Adulto , Feminino , Humanos , Injeções Intravenosas , Fatores de TempoRESUMO
A patient with relapsing cutaneous vasculitis presented 3 times in 10 years with an acute extensive neuropathy and respiratory failure which fully recovered. The relationships between Guillain-Barré syndrome and vasculitis are discussed.
Assuntos
Síndrome de Guillain-Barré/complicações , Vasculite Leucocitoclástica Cutânea/complicações , Adulto , Feminino , Síndrome de Guillain-Barré/tratamento farmacológico , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Oftalmoplegia/etiologia , Nervos Periféricos/fisiopatologia , Quadriplegia/etiologia , Recidiva , Vasculite Leucocitoclástica Cutânea/tratamento farmacológico , Distúrbios da Voz/etiologiaRESUMO
INTRODUCTION: Pheochromocytoma is rarely disclosed by intracranial hemorrhage. We report two cases. OBSERVATION: The first 26-year-old patient developed subarachnoid hemorrhage due to a ruptured aneurysm of the middle cerebral artery. The second patient, aged 44 years, had a temporal hematoma. Diagnosis was suggested in both patients by hypertension and elevated urinary catecholamines and confirmed by imaging and MIBG scintigraphy. Adrenal gland tumors, on both glands in the first patient and on the right gland in the second were successfully removed; cranial hypertension totally regressed. Von Hippel Lindau disease was diagnosed by molecular genetics in the first patient. Paroxysmal hypertension could explain the brain hemorrhage in the first patient and may have favored aneurysmal rupture in the second. CONCLUSION: The relationships between pheochromocytoma and cerebral aneurysm are discussed.
Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Hemorragia Cerebral/complicações , Feocromocitoma/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adulto , Catecolaminas/urina , Angiografia Cerebral , Hemorragia Cerebral/cirurgia , Hematoma/etiologia , Humanos , Hipertensão/complicações , Aneurisma Intracraniano/complicações , Imageamento por Ressonância Magnética , Masculino , Artéria Cerebral Média/patologia , Procedimentos Neurocirúrgicos , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/cirurgia , Cintilografia , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/patologia , Tomografia Computadorizada por Raios X , Doença de von Hippel-Lindau/diagnóstico , Doença de von Hippel-Lindau/etiologia , Doença de von Hippel-Lindau/genéticaRESUMO
INTRODUCTION: VZV virus-related peripheral neuropathies usually occur after shingles in adults and more rarely after chickenpox in childhood. CASE REPORT: A 54-year-old patient presented with a right VIIth nerve palsy following a chickenpox rash and recovered after antiviral treatment. CSF analysis revealed lymphocytic meningitis and the virus was identified by PCR. CONCLUSIONS: Although previous chickenpox was not found in the patient's past history, the probability of reinfection is likely. The virus can be assumed to affect the nervous system directly; the axonal or demyelinating mechanism of the neuropathy may be discussed.
Assuntos
Varicela/complicações , Doenças do Nervo Facial/etiologia , Paralisia Facial/etiologia , Herpesvirus Humano 3 , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Varicela/tratamento farmacológico , Varicela/fisiopatologia , Doenças Desmielinizantes/etiologia , Doenças Desmielinizantes/patologia , Doenças do Nervo Facial/tratamento farmacológico , Paralisia Facial/tratamento farmacológico , Paralisia Facial/fisiopatologia , Humanos , Masculino , Meningite/tratamento farmacológico , Meningite/etiologia , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: The clinical spectrum of peripheral neuropathies in Lyme disease is very wide. We report a case which was revealed by an ataxic sensory neuropathy. OBSERVATION: A 77-year-old patient presented with a subacute ataxic sensory neuropathy which occurred 2 weeks after a skin lesion involving the right lower limb. He fully recovered after specific antibiotic treatment. EMG was suggestive of a predominantly axonal neuropathy. Diagnosis of Lyme disease was assessed by progressive elevation of serum antibodies, demonstration of a lymphocytic meningitis and intrathecal synthesis of antibodies. CONCLUSION: Lyme disease may be added to the list of diseases which may induce subacute sensory neuropathies.
Assuntos
Ataxia/etiologia , Doença de Lyme/complicações , Idoso , Humanos , MasculinoRESUMO
A 24 year-old patient presented with chronic intracranial hypertension, palsy of both abducens nerves and upward gaze, and right hypoesthesia. CT scan and MRI showed a left thalamic tumor infiltrating the left cerebral peduncle. A stereotactic biopsy revealed a germ cell tumor. Following radiotherapy the patient recovered except for ophthalmoplegia. The tumor totally disappeared on CT scan and MRI.
Assuntos
Neoplasias Encefálicas/diagnóstico , Disgerminoma/diagnóstico , Adulto , Neoplasias Encefálicas/radioterapia , Disgerminoma/radioterapia , Humanos , Masculino , Mesencéfalo , Prognóstico , Dosagem Radioterapêutica , Técnicas Estereotáxicas , Tálamo , Tomografia Computadorizada por Raios XRESUMO
A primary T-cell lymphoma of the central nervous system was diagnosed at autopsy in a 73-year-old woman. The course of the illness was made of multiple neurological episodes: hypersomnia, palsies of cranial nerves, aphasia, hemiparesis, epileptic fits during 4 years, with fast recoveries under corticosteroid therapy. CT scan and MRI abnormalities were also dramatically improved by the treatment.