We present the case of a 21-year-old male patient who was diagnosed with metastatic brain choriocarcinoma after presenting with a spontaneous cerebral hemorrhage. The treatment performed for this patient was an open surgery with full excision of the lesion. It is known that this kind of tumor is usually found in women, with low incidence in men. With this information as a baseline, we found multiple pulmonary metastases and a primary pure choriocarcinoma in his testicle.
Context: Dermatomyositis is an inflammatory myopathy, which results from loss of tolerance to a select group of autoantigens, with an incidence of approximately 0.8 to 1.2 per 100,000, of bimodal distribution, more frequent in women, with important relationship with paraneoplasia, usually responsive to treatment. Case report: female, 65 years old, black, rural worker, with history of increased skin pigmentation in early 2019. After two months, she was bedridden, with dysphagia. Physical examination revealed paresis, poikiloderma on the face, alopecia, remnants of uper back shawl sign, Heliotrope and Gotron sign. Complementary investigation showed: aldolase 20.4 / 31; CPK: 521/220/207. Anatomopathological examination of skin biopsy reveald superficial and discrete lymphocytic dermatitis with focal pigmentary incontinence; electroneuromyography presented myopathic pattern in the four limbs. Paraneoplastic investigation was negative. There was a response to corticosteroids and metotrexato. Conclusions: The case shows a rapid progression from cutaneous symptoms to chronic symptoms and highlights the importance of recognizing skin lesions in view of the possible differential diagnoses in the neurology specialty, prior to the onset of the classic clinical picture and the appearance of chronic symptoms.
Context: Fahr’s syndrome is a rare disorder characterized by bilateral and symmetrical abnormal calcifications in basal ganglia and cerebral cortex. Those calcified deposits are due to changes in calcium and phosphorus metabolisms that can be caused by endocrine disorders, mitochondrial myopathies, dermatological and infectious diseases. Clinical manifestations may include a variety of extrapyramidal, cerebelar and neuropsychiatric syndromes. Case report: This study describes a 75-year-old female patient that underwent total thyroidectomy in 1985 due to a multinodular goiter and presented postsurgical hypoparathyroidism. The patient missed follow-up apppoointments with Endocrinology and stopped treating her parathyroid condition. Some time later, she presented with change in behavior, drowsiness, paraesthesias, limb spasms and seizures. A CT scan of the brain was performed, showing multiple and extensive calcifications reaching the cerebellar hemispheres, basal ganglia, thalamus and white subcortical substance symmetrically. Laboratory examinations revealed hypocalcemia, hyperphosphatemia, and low parathyroid hormone (PTH) levels. Intravenous calcium gluconate was used to corret the Ca/P dysfunction. Additionally, appropriate antiepileptic drugs for seizures were used. She presented with progressive improvement of symptoms after treatment. Conclusions: This case report demonstrates the importance of post- thyroidectomy follow-up and early recognition of Fahr syndrome’s symptoms, which prevents the progression of neurological conditions.
Context: Creutzfeld Jakob disease, a rare prion disease that leads to rapidly progressive dementia and movement disorders, through its pathophysiology will determine brain damage. Regardless of the cause, the course of the disease will be rapid and will invariably lead to death. Objective: The reason why the case is described is due to the low incidence of this disease and its unusual course in the case described. Case report: A 67-year-old male, had a personal history of smoking and obesity . Referred to our service due to sudden ataxia, in the presence of an unchanged MRI scan. The first sympton started when he woke up with a dizzying and inability to walk due to imbalance. In the initial assessment, the patient had appendicular ataxia in all 4 limbs, with an examination of his mental status without changes. New head MRI exam showing alterations compatible with CJD. Interned with hipotheses diagnoses of Wilson’s disease, encephalitis or CJD, he developed abdominal distension with surgical need and immediately after the procedure he already presented a comatose, spastic, and myoclonic condition compatible with the final phase of CJD, later protein 14-3-3 was found in the CSF. Conclusions: CJD, usually presents with rapidly progressive cognitive deficit associated with movement disorder. In the case presented, initially there was no change in cognition and after an urgent surgical procedure, there was an important advance in a shorter than expected period for the disease.
A non-traumatic intra-cystic hemorrhage in an arachnoid cyst is a rare event, with few cases reported in the literature. We present a case of an eleven-year-old boy patient, which presented a spontaneous acute subdural hematoma and intra-cystic hemorrhage after a strong headache episode. The results were evidenced by a computed tomography (CT) scan and surgical findings. We perform a brief literature review on the arachnoid cyst and its suggested treatments. In our case, the patient underwent a surgical treatment with a complete resolution of the case.
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