Leishmaniasis is a tropical infectious disease caused by Leishmania spp. protozoa and is transmitted by insects from the Phlebotominae subfamily. It can manifest as cutaneous leishmaniasis, a painless ulcer that can develop into a more serious systemic affliction as the protozoa spreads lymphatically or hematogenously, depending on the host's immunity. In this case series, the authors present a rare form of genital mucocutaneous leishmaniasis, with consideration of epidemiologic characteristics, clinical presentation, differential diagnosis, and treatments offered.
We report the case of a healthy 25-year-old man presenting with sudden onset dizziness, strabismus, and cloudy vision that improved when he closed one of his eyes. He denied pain with eye movement or color desaturation, as well as history of recent immunization or febrile illness. He did not present any other neurologic symptom, but he affirmed having had a limited episode of a discrete strabismus four months before. In his first assessment at the emergency room his neurologic examination revealed a 30° exotropia of the right eye on the primary gaze position along with adduction deficit and abduction nystagmus bilaterally on conjugated horizontal eye movement, characterizing an internuclear ophthalmoplegia on both eyes. He also presented with asymmetrical convergence deficit, with inability on completing adduction on his right eye. On the vertical upward gaze there was also a vertical nystagmus. Eye fundus examination did not show retinal and optic nerve alterations. Visual acuity was normal. This set of findings qualified a WEBINO (wall-eyed bilateral internuclear ophthalmoplegia). During investigation, lumbar puncture showed mild hyperproteinrachia, with absence of oligoclonal bands and normal CSF (cerebrospinal fluid GigG (immunoglobulin G) index. He was submitted to a course of pulse therapy with methylprednisolone. Neuroaxis magnetic resonance imaging evidenced a demyelinating periaqueductal lesion, involving medium longitudinal fasciculus, ponto-mesencephalic junction and mesencephalic tegmentum, without gadolinium enhancement. As he remained symptomatic, plasmapheresis was indicated, with complete remission of symptoms afterwards. Following his investigation the tests for both anti-aquaporin-4 and anti-MOG antibodies were negative, and until the conclusion of this report, a diagnosis of clinical isolated syndrome remained as the main hypothesis.
An 84-year-old man with cardiomyopathy and a pacemaker was admitted to our hospital due to a focal impaired awareness seizure. Computed tomography (CT) scan on admittance evidenced right parieto-occipital hypodensity with mild mass effect. A non-contrast CT scan realized in an outer institution seven months earlier showed that such hypodensity, considered then as a stroke, was present, but slowly progressing. He was submitted to therapy with phenytoin upon entry and his electroencephalogram showed increased slow-wave activity. Cerebrospinal fluid showed hyperproteinrachia, normal cell count and slightly reduced glycorrhachia. With such findings, the main hypothesis of neoplasm and neuroinfection emerged. Magnetic resonance imaging (MRI) could not be realized at first due to his pacemaker. Empiric treatment with acyclovir was initiated but, in spite of that, he maintained somnolence and left hemiparesis. The cardiology team was activated, and his pacemaker was set to do an MRI. His scan evidenced a T2/FLAIR hyperintense mass lesion on the right parieto-occipital area. SWI sequences showed microbleeds along the cerebral cortex and chronic lobar hematoma simulating cortical superficial siderosis. Hence, Cerebral Amyloid AngiopathyRelated Inflammation (CAA-ri) was diagnosed and pulse therapy with methylprednisolone was indicated. By closure of this report, he was started on antibiotics for urinary tract infection, and would be initiated on corticosteroids after 48 hours. CAA-ri is a rare yet reversible etiology of seizures, encephalopathy and focal neurological signs in patients with amyloid angiopathy, an entity that occurs mainly in the elderly as a deposit of amyloid protein on vessel walls. MRI is essential as it shows characteristic cortical-subcortical hemorrhagic lesions. Suggestive findings allows treatment with corticosteroids, optimizing neurological recovery and minimizing future deficits.
An artifact is a feature present in an image which is not part of the original structure. It can occur as a consequence of several factors. It may be mistaken for pathologic conditions, leading to adverse consequences for the patients. The aim of the present study is to present a selection of the main artifacts described in brain and spinal magnetic resonance images to improve the ability of the physicians to recognize them and to reduce their interference on the final interpretation of a scan. The authors searched the scientific community for artifacts in magnetic resonance imaging (MRI), which were selected to focus on central nervous system (CNS) findings. With the Picture Archiving and Communication System (PACS) database from the center where this study was conducted, the authors designated brain and spine MRI scans with conspicuous artifacts to compose the present study. The artifacts were then classified as those that contribute to the diagnosis and those that must be distinguished from pathologic lesions. Considering the novel classification proposed by the present study, physicians might be stimulated to reevaluate their opinions regarding artifacts, perhaps considering them helpful to evaluate certain conditions even if they cannot be fully corrected, as shown by this distinct approach to artifacts with specific findings concerning differential diagnosis of CNS conditions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.