A 45-year-old man presented with 2-month-history of progressive gait disturbances and behavioral changes. Examination showed vibration sense compromise and pyramidal signs of release. Blood test revealed low serum vitamin B12 (120 pg/mL; normal range>200 pg/mL). Brain MRI disclosed hyperintense signal in corticospinal tracts, a similar pattern observed in motor neuron disease (MND) (Figure).Replacement therapy was started and there were motor and cognitive improvements.Vitamin B12 deficiency may present with different neurological syndromes 1 . Encephalopathy related to B12 deficiency presents with nonspecific white matter changes 2 . Although MTC brain MRI sequence was normal, our patient presented neuroimaging features observed in MND 3 .
Progressive ataxia and palatal tremor (PAPT) is a rare distinct clinical entity characterized by symptomatic palatal tremor associated with progressive ataxia 1,2 . Few cases have been described in literature, and MRI findings show, in most cases, cerebellar atrophy and bilateral olivary hypertrophy with signal change 1 . We report a case where MRI study at 3T demonstrated marked bilateral olivary complex hyperintensity at T1, with magnetization transfer contrast pulse (MTC) sequence, which was subtle at conventional T2 and FLAIR sequences at 1,5 and 3 T. CASEA 54-year-old male patient presented with a 10-year history of predominantly truncal ataxia manifested mainly by difficulty in climbing stairs with associated oscillopsia and spontaneous nystagmus with closed eyes. He showed significant gait instability on heel-to-toe test and also a 2Hz palatal tremor. Familial history of ataxia was negative , as well as genetic tests for spinocerebellar ataxia 1, 2, 3 and 7. Routine blood analysis, thyroid-stimulating hormone, vitamin B12 and antinuclear antibodies were normal.MRI examinations at 1,5 and 3,0 T showed only moderate cerebellar atrophy and subtle signal change in olivary nuclei on conventional FSE T1, T2 and FLAIR sequences, which were overlooked at the first report. Additional images on 3 T using FSE T1-weighted with magnetization transfer pulse (TR1000, TE 20) showed marked signal alteration of olivary complexes (Figure). DISCUSSIONProgressive ataxia and palatal tremor (PAPT) is a rare disorder more commonly found as a sporadic condition with no identifiable cause. Most cases manifest as slowly progressing ataxia, that can be associated with visual changes, dysarthria and dysphagia 1,2 . Typical MRI abnormalities are cerebellar atrophy, hypertrophy and hyperintensity at T2-weighted and proton density sequences at olivary complexes. The main differential diagnosis of sporadic PAPT is hypertrophic olivary degeneration, a
Os autores desta obra: 1. Atestam não possuir qualquer interesse comercial que constitua um conflito de interesses em relação ao artigo científico publicado; 2.Declaram que participaram ativamente da construção dos respectivos manuscritos, preferencialmente na: a) Concepção do estudo, e/ou aquisição de dados, e/ou análise e interpretação de dados; b) Elaboração do artigo ou revisão com vistas a tornar o material intelectualmente relevante; c) Aprovação final do manuscrito para submissão.; 3. Certificam que os artigos científicos publicados estão completamente isentos de dados e/ou resultados fraudulentos; 4. Confirmam a citação e a referência correta de todos os dados e de interpretações de dados de outras pesquisas; 5.Reconhecem terem informado todas as fontes de financiamento recebidas para a consecução da pesquisa; 6. Autorizam a edição da obra, que incluem os registros de ficha catalográfica, ISBN, DOI e demais indexadores, projeto visual e criação de capa, diagramação de miolo, assim como lançamento e divulgação da mesma conforme critérios da Atena Editora. DECLARAÇÃO DA EDITORA A Atena Editora declara, para os devidos fins de direito, que: 1. A presente publicação constitui apenas transferência temporária dos direitos autorais, direito sobre a publicação, inclusive não constitui responsabilidade solidária na criação dos manuscritos publicados, nos termos previstos na Lei sobre direitos autorais (Lei 9610/98), no art. 184 do Código Penal e no art. 927 do Código Civil; 2. Autoriza e incentiva os autores a assinarem contratos com repositórios institucionais, com fins exclusivos de divulgação da obra, desde que com o devido reconhecimento de autoria e edição e sem qualquer finalidade comercial; 3. Todos os e-book são open access, desta forma não os comercializa em seu site, sites parceiros, plataformas de ecommerce, ou qualquer outro meio virtual ou físico, portanto, está isenta de repasses de direitos autorais aos autores; 4. Todos os membros do conselho editorial são doutores e vinculados a instituições de ensino superior públicas, conforme recomendação da CAPES para obtenção do Qualis livro; 5. Não cede, comercializa ou autoriza a utilização dos nomes e e-mails dos autores, bem como nenhum outro dado dos mesmos, para qualquer finalidade que não o escopo da divulgação desta obra. Métodos e estratégias para fortalecer o alicerce científico da medicina Capítulo 1
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the progressive loss of upper and lower motor neurons (AMN) and resulting in loss of voluntary control of movement. The presence of hyposignal in the motor cortex on the magnetic susceptibility sequence (SWI) may indicate a lesion in the SMN. The aim was to verify the presence of hyposignal in the motor cortex on cranial magnetic resonance (MR) SWI in patients diagnosed with ALS. This is a descriptive study that evaluated data from 20 ALS patients and 20 controls. The statistical significance of the variables was verified using the t test and the linear regression test, with alpha levels of 0.01 and 0.05, respectively. Clinical variables did not statistically influence the presence of hyposignal in the motor cortex of patients with ALS, but in the control group there was statistical significance of age in the presence of hyposignal, being more present in the elderly. When comparing the presence of hyposignal in patients with ALS and healthy individuals, there was a static difference, being more frequent in patients with ALS. There was also a statistical influence of MT hypersignal on the presence of hyposignal in the motor cortex in SWI. It was concluded that the presence of hyposignal in the motor cortex of patients with ALS is not influenced by clinical variables, despite being more frequent in patients with ALS than in healthy individuals. Age can influence the presence of hyposignal in healthy individuals, but in the ALS group there was no such relationship, which may suggest neurodegeneration. Patients who had hyposignal in the cortex also had hypersignal in the LMCA, which would make it possible to use the SWI as another tool for detecting lesions in the SMN and, thus, help in the final diagnosis of ALS.
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