Context: Stroke is a considerable cause of morbidity and mortality nowadays. It is known the incidence, risk factors and etiology in mid-adults differ notably from older patients. When are young stroke patients, should investigate, besides traditional risk factors, a congenital heart disease, inflammatory and infectious causes, and the use of drugs to prevent new events. Case report: A 29-year-old woman, white, with hypothyroidism and history of surgical resection of retinoblastoma at 3 years of age, with sequelae of bilateral amaurosis, admitted with a history of neurological deficit in the left hemibody, with progression in 14 days until complete left hemiparesis provided. The cranial tomography showed infarction in the territory of the right middle cerebral artery and arteriography showed occlusion of the right internal carotid and dissection of the supraclinoid portion of this artery. Conclusions: While much is known about risk factors, pathophysiology and prognosis of extracranial arterial dissection, data are rare when it comes to the dissection of the intracranial portion of the internal carotid, no case was found that evidenced internal carotid artery occlusion of one side and contralateral dissection. The importance of knowing about the internal carotid dissection is the fact that this etiology is suspected when diagnosis young stroke patients.
Introduction: The diagnosis of Hashimoto Encephalopathy (HE) is generally considered in patients with a wide range of neurological symptoms, accompanied by normal or nonspecific findings on magnetic resonance imaging and CSF, normal thyroid function or mild hypothyroidism, increased serum levels of thyroid peroxidase antibodies, and clinical response to steroids. Case report: We attended a 76-year-old patient, brought by lowering the level of consciousness 3 days ago, insidiously. Neurological exam: did not obey commands, and only said incomprehensible sounds. Myoclonus in upper limbs and random multidirectional movements of the eyes with horizontal nystagmus, rapid phase to the left. Cranial tomography had only signs of microangiopathy. Electroencephalogram: diffuse slow waves, with no signs of status epilepticus. Laboratory tests: there were increased protein in CSF (107mg/dl) and Anti-TPO serum (>1000 U/ml) levels, without other specific alterations. After these results, therapy with Methylprednisolone 1g/day for 5 days, and Levothyroxine, were chosen. There was a gradual improvement in the neurological condition from the 3rd day of treatment. Conclusion: immediate recognition of Hashimoto encephalopathy is important. Although the pathogenesis is unknown, the disorder is treatable. This entity should always be remembered for the proper direction of therapeutic approaches, thus enabling better outcomes to the patient.
Introduction: Vertebral artery dissections are responsible for 2% of all ischemic strokes and correspond to more than 25% of events in young adults. Its main etiologies, such as spontaneous and traumatic, which compromise the structural integrity of the arterial wall, allowing blood to accumulate between the layers of the vessel as an intramural hematoma, which can progress to stenosis or luminal occlusion in stroke. Case report: We attended a woman, 29 years old, who suffered a mild trauma in the cervical region during weight training in the gym presenting symptoms hours after the accident, a sudden headache of strong intensity irradiated to cervical, which evolves to a picture of cerebral ischemia characterized by changes in balance and coordination. The diagnosis was confirmed through complementary examinations of cranial tomography and angiotomography and treatment was composed by a combination of aspirin and clopidogrel with favorable evolution of the condition. Conclusion: The report illustrates that the change in cerebral circulation due to ischemia can occur either suddenly or even days after the injury, and it is likely that many cases classified as “spontaneous” without identifying the cause, may have been caused by minor trauma. In general, there is a good prognosis if early recognition and correct management.
Introduction: Phenytoin is an anticonvulsant used routinely for about eight decades. However, depending on the dose and plasma concentration, its use may be associated with side effects due to toxicity, such as ataxic syndrome. Case report: We attended a 37-year-old patient, epileptic since childhood, who had been using Divalproate Sodium 250mg 8 / 8h, Phenobarbital 150mg once a day and Phenytoin 100mg 8/8 for a long time. He denied smoking and drinking. He was admitted due to acute rotational vertigo, nausea, motor incoordination and impaired speech and gait, progressing for 7 days. Neurological examination revealed drunken dysarthria, pendular patellar reflexes, signs of axial and appendicular incoordination and ataxic gait. Cranial nerves: there was decomposition of the eye movement and hypometric saccades to the vertical upward look, horizontal nystagmus with alternating phases to the extreme looks. Laboratory exams, cranial tomography with and without contrast, brain magnetic resonance with gadolinium): within the normal range. Given the above, our diagnostic hypothesis was Phenytoin Poisoning. After gradually replacing it, there was a progressive improvement in the neurological condition. His serum level was not determined due to the unavailability of this test in our service. Conclusion: In view of its routine use, excluding other etiologies, this diagnosis should always be remembered.
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