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Context: Primary central nervous system lymphomas (PCNSL) are a rare but very aggressive subtype of extranodal non-Hodgkin lymphomas. They represent only 4% of primary central nervous system lesions and are more common in patients with aggressive non-Hodgkin lymphomas, who are HIV positive. Moreover, PCNSL, usually presents as intraparenchymal supratentorial expansive lesions, while secondary CNS lymphomas tend to present as metastases in the leptomeninges. Although they are more common in immunocompromised patients, their incidence has increased with advancing age. Due to its uniqueness in findings, rarity, and severity of the case, we present an immunocompetent elderly patient with a primary lesion of the posterior fossa. Case report: A 85-year-old female was admitted to the emergency room with incoercible vomiting for 48 hours. Initial clinical examination showed dysmetry, and dysbasia. There was no clinical history compatible with immunosuppression. The initial magnetic resonance imaging revealed two non-enhancing contrast lesions in T1 and hyperintense in T2/Flair in the left caudate nucleus, and at the right cerebellar hemisphere near the fourth ventricle and a third parafalcine lesion with homogenous contrast-enhancing on T1 compatible with an incidental meningioma. PET scan, thyroid and breast ultrasonography, and abdominal MRI were done to rule out metastasis, and all results were negative. The histopathological analysis after a stereotactic biopsy performed on the caudate nucleus lesion confirmed the presence of primary central nervous system lymphoma. Conclusions: The pattern of PCNSL is changing due to aging. Knowing this is indispensable for the correct diagnosis and management.
Introduction: Human gait is defined by the sequence of repetitive movements of the lower limbs that leads the body forward, providing postural stability. In Austist Spectrum Disorder (ASD), in addition to social and linguistic impairment, this movement dynamic may be altered. Objectives: To characterize gait changes in individuals with ASD. Design and setting: Integrative review of the literature, University of Pernambuco, Recife. Methods: We reviewed articles indexed in the databases: MEDLINE/Pubmed, SciELO and Google Scholar. The descriptors “Autism Spectrum Disorder” and “Gait Disorders, Neurologic” were used, according to DeCS / MeSH. Articles in Portuguese and English that contemplated the objectives of the review, published between 2011-2021 were selected. Results: 13 articles were included. It was shown that children with ASD, compared to neurotypical (NT), showed atypical gait, using different strategies to load the body and mitigate the impact of movement. Alterations included: toe walking; increased hip flexion and stance phase; greater pelvic anteversion; reduced gait speed; shorter steps; greater asymmetry; difficulties walking in a straight line; less distribution of plantar pressure and wide-based gait. They also have greater variability in joint movement. Finally, we noticed that there is a scarcity of clinical studies that analyze biomechanical and neurophysiological data together, and a lack of uniformity in the methodological criteria.
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