Objectives The antiphospholipid syndrome (APS) is an autoimmune disease associated with thrombotic and non-thrombotic neurologic manifestations. APS is classified as primary (PAPS) or secondary (SAPS) when it co-exists with another autoimmune disease. We aim to describe the spectrum of acute cerebrovascular disease among patients with APS, their differences between stroke subtypes, and long-term functional outcomes. Methods Retrospective cohort study including adult (≥18 years) patients with APS followed in the stroke clinic of a tertiary-care reference center for autoimmune diseases in Mexico from 2009 to 2019. Results We studied 120 cases; 99 (82.5%) women; median age 43 years (interquartile range 35–52); 63.3% with SAPS. Demographics, comorbidities, and antiphospholipid antibodies (aPL) positivity were similar between APS type and stroke subtypes. Amongst index events, we observed 84 (70%) acute ischemic strokes (AIS), 19 (15.8%) cerebral venous thromboses (CVT), 11 (9.2%) intracerebral hemorrhages (ICH), and six (5%) subarachnoid hemorrhages (SAH). Sixty-seven (55.8%) were known patients with APS; the median time from APS diagnosis to index stroke was 46 months (interquartile range 12–96); 64.7% of intracranial hemorrhages (ICH or SAH) occurred ≥4 years after APS was diagnosed (23.5% anticoagulation-related); 63.2% of CVT cases developed before APS was diagnosed or simultaneously. Recurrences occurred in 26 (22.8%) patients, AIS, in 18 (69.2%); intracranial hemorrhage, in eight (30.8%). Long-term functional outcomes were good (modified Rankin Scale ≤2) in 63.2% of cases, during follow-up, the all-cause mortality rate was 19.2%. Conclusion We found no differences between stroke subtypes and APS types. aPL profiles were not associated with any of the acute cerebrovascular diseases described in this cohort. CVT may be an initial thrombotic manifestation of APS with low mortality and good long-term functional outcome.
Introducción: El Síndrome de Acento Extranjero (SAE) una entidad rara, los pacientes desarrollan cambios en el ritmo y tono del habla (prosodia), percibidos como un acento diferente al de su lengua natal. Existen tres tipos de SAE: neurogénico, psicogénico y mixto. El SAE es infrecuente en EM, y aún más como síntoma debut. Objetivo. Revisión del SAE, tipos, fisiopatología y presentación en EM y evolución. Desarrollo. El SAE Las lesiones corticales en EM se correlacionan con deterioro cognitivo, discapacidad motora, síntomas psiquiátricos, alteraciones del lenguaje, síntomas conversivos y crisis epilépticas. La mayoría de los casos publicados de SAE han sufrido lesión en el hemisferio dominante, en corteza prerrolándica y áreas adyacentes, áreas motoras frontales de asociación, en putamen, ganglios basales, fosa posterior (protuberancia, cerebelo), por diferentes etiologías siendo la más frecuente la vascular. Compartimos un caso clínico: mujer, 44 años debuta con SAE interpretado inicialmente como infarto cerebral en quien finalmente se concluyó el diagnóstico de esclerosis múltiple. Ha tenido mejoría parcial de los síntomas posterior a rehabilitación fonoaudiológica. Conclusiones. SAE es una presentación infrecuente de debut de EM. Debe considerarse la etiología desmielinizante en pacientes jóvenes, con escasos o sin factores de riesgo vascular y apoyarse en estudios complementarios de neuroimágenes.
Meningiomas are the most common benign intracranial tumors accounting for up to 30% of non-glial tumors of the central nervous system (CNS); on neuroimaging studies, they usually appear as a lobular, extra-axial mass with well-circumscribed margins mostly located in the parasagittal aspect of the cerebral convexity. On magnetic resonance imaging (MRI) of the brain, meningiomas are typically isointense to hypointense relative to grey matter in the T1-weighted sequence and isointense to slight hyperintense relative to grey matter on the T2-weighted sequence with avid homogeneous enhancement after contrast administration. A thin linear enhancement along the dura infiltrating away from the lesion, known as the dural tail sign, was once thought to be a pathognomonic feature of meningiomas, but this non-specific sign can also be seen in other meningioma-like lesions. Several benign and malignant pathologies may mimic some of the neuroimaging characteristics of meningiomas; among them dural metastases of lymphomas. When approaching a patient with suspected meningioma, close attention to the neuroimaging features may help distinguish them from meningioma-like lesions. Here we present the case of a woman with CNS involvement of non-Hodgkin lymphoma that presented with a dural mass resembling the neuroimaging characteristics of a meningioma.
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