RESUMO -Objetivo: Avaliar o impacto da cirurgia estereotáxica sobre a realização das atividades da vida diária dos paciente com doença de Parkinson (DP). Método: Foram avaliados 30 pacientes com DP forma idiopática submetidos a cirurgia estereotáxica nos períodos pré-operatório, 1º, 3º, 6º e 12º mês pós-operatório, segundo as escala UPDRS -Item II (escala unificada para DP), Schwab & England e Hoehn & Yahr. Destes, nove pacientes foram também avaliados no 24º mês pós-operatório. Resultados: Foram realizadas nove palidotomias póstero-ventrais (PPV), sendo duas à esquerda e sete à direita; duas PPV bilaterais no mesmo tempo cirúrgico; 17 talamotomias ventro-laterais (TVL), sendo 12 à esquerda e cinco à direita; duas TVL à esquerda com PPV à direita no mesmo tempo cirúrgico. Os escores médios, na fase off, das escalas utilizadas foram: 65,6 no pré-operatório,74 no 1º mês, 76,6 no 3º mês, 75,6 no 6º mês e 72,3 no 12º mês pós-operatório (Schwab & England); 21 no pré-operatório, 12,3 no 1º mês, 14,7 no 3º mês, 15,27 no 6º mês e 17,1 no 12º mês pós-operatório (UPDRS); 3,1 no pré-operatório, 2,8 no 1º mês, 2,7 no 3º mês, 2,8 no 6º mês e 2,85 no 12º mês pós-operatório (Hoehn & Yarh). Conclusão: A TVL e a PPV são procedimentos capazes de melhorar a independência dos pacientes para realização das atividades cotidianas, sendo constatado benefício maior nos seis primeiros meses de pós-operatório. PALAVRAS-CHAVE: doença de Parkinson, cirurgia estereotáxica, atividades da vida diária.Daily living activities in P Daily living activities in P Daily living activities in P Daily living activities in P Daily living activities in Parkinson's disease patients underwent to stereotactic surgery arkinson's disease patients underwent to stereotactic surgery arkinson's disease patients underwent to stereotactic surgery arkinson's disease patients underwent to stereotactic surgery arkinson's disease patients underwent to stereotactic surgery ABSTRACT -Objective: To evaluate the impact of stereotactic surgery on daily activities of Parkinson's disease (PD) patients. Method: Thirty patients with idiopathic PD were evaluated before surgery and one, three, six and twelve months after surgery. Patients were evaluated with the UPDRS -part II (Unified Parkinson's Disease Rating Scale) and the Schwab & England scales. Nine of the patients had also been evaluated after twenty four months. Results: We performed nine posteroventral pallidotomies (PVP), two on the left hemisphere and seven on the right; 17 ventrolateral thalamotomies (VLT), 12 on the left and five on the right; two VLT on the left associated with PVP on the right at the same surgical procedure. The mean "off" phase scores of Schwab & England scale were: 60.6 before surgery, 74 after the first, 76.6 after the third, 75.6 after the sixth, 72.3 after the twelfth and 71.1 after the twenty fourth months after surgery. The mean "off" phase scores of UPDRS -part II scale were: 21 before surgery, 12.3 after the first, 14.7 after the third, 15.27 after the sixth, 17.1 after the twelfth and 17....
Introduction: Tolosa Hunt syndrome (THS) is a rare condition, incidence of 1/1.000.000 case per year, characterized by unilateral painful ophthalmoparesis caused by idiopathic inflammation in the cavernous sinus. The oculomotor nerve is most commonly involved (80%), followed by abducens nerve (70%), ophthalmic branch of trigeminal nerve (30%), trochlear nerve (29%). Case presentation: Male, 77 years old, admitted with an acute moderate-intensity orbitofrontal headache on the left, envolving with palpebral ptosis of the left eye. Neurological examination: complete palpebral ptosis on the left and ophthalmoplegia of the entire ipsilateral extrinsic ocular musculature. A complete investigation was carried out: metabolic, rheumatological, serological tests without significant alterations and study of the cerebrospinal fluid with mild hyperproteinorachia, without pleocytosis. Magnetic resonance imaging (MRI) of the skull showed thickening of the cavernous sinus on the left, with contrast enhancement; Angio-MRI of the Skull and Neck without alterations. Therefore, THS was diagnosed and treatment with Methylprednisolone 1 g for five days, with complete improvement of headache and partial improvement of ophthalmoparesis. The patient was discharged with 60 mg of prednisone orally with instructions for gradual weaning off, return to the neurology outpatient clinic. Discussion: THS diagnosis is based on the International Classification of Headache Disorders: unilateral periorbital headache; granulomatous inflammation of the cavernous sinus, superior orbital fissure or orbit on cranial MRI; paralysis of one or more of the oculomotor nerves; the headache must precede the ophthalmoparesis by up to two weeks or appear concomitantly. The exclusion of secondary causes is essential. Treatment of choice is cortico steroids, improvement of headache in the first days, and of ophthalmoparesis in 2–8 weeks. Conclusion: Unilateral headache with ipsilateral ophthalmoparesis should raise the suspicion of THS.
Context: Parkinsonian syndromes are routinely identified by neurologists. However, the differential diagnosis among probable etiologies can be challenging and complex. In Fahr’s syndrome, calcifications of the basal ganglia secondary to disorders of calcium metabolism are observed. A possible clinical presentation associated with this entity is the presence of a parkinsonian syndrome. Case report: A 54-years-old female patient presented with a progressive tremor in the right upper and lower limbs associated with bradykinesia. Seizures were observed during the course of the disease. After extensive clinical workup, primary hypoparathyroidism was diagnosticated along with the recognition of a mutation in the calcium activator gene. Computed tomography and magnetic resonance imaging of the head showed bilateral coarse calcifications in thalami and basal ganglia compatible with Fahr’s syndrome. We began treatment for control of the underlying disease, as well as for symptomatic control of parkinsonism. Conclusions: Different pathologies could justify the parkinsonian syndrome observed initially in the case described. Among them: Iidiopathic Parkinson’s Disease, Multiple System Atrophy, Progressive Supranuclear Palsy. In our patient, the atypical evolution in a young woman led to the research of possible secondary treatable causes. A diagnosis of Fahr’s syndrome related to hypoparathyroidism was unveiled. The differential diagnosis of Parkinson’s Syndrome is broad and difficult. We must be aware of the possible atypical presentations due to the possibility of a secondary condition whose etiology could be effectively treated.
A 67-years-old woman, with no significant medical history, presents herself at Hospital do Servidor Público do Estado de São Paulo after a seizure episode following two weeks of a moderate heat trauma at home. At initial evaluation, no neurological deficit was found, but computed tomography showed a mild subdural hemorrhage in the left frontal area that was promptly drained. The patient was discharged with oral phenytoin 100 mg each eight hours. After thirty days, the patient returns to the hospital reporting the progressive onset of involuntary abnormal movements of upper limbs and head, associated with gait difficulties. The neurological exam revealed ataxia of limbs and trunk, severe gait ataxia, in addition to choreic movements involving superior limbs, neck, orofacial muscles and pathological horizontal nystagmus. The work-up for acute cerebellar ataxia and chorea was performed resulting in normal metabolic and inflammatory blood tests, cerebrospinal fluid analysis, neoplastic screening and brain magnetic resonance imaging, the only exception was serum phenytoin level: 29.4 μg/ml (therapeutic range: 10–20 μg/ml). After an extensive evaluation and differential diagnosis exclusion, a slowly withdraw was conducted, leading to marked symptom’s improvement. At discharge, the patient was completely asymptomatic with no other treatment. The phenytoin has an extensive well described list of neurological side effects, commonly ataxia, headache, dizziness and insomnia, but choreic movements are rarely reported. It is due to the disturbance of dopamine metabolism at basal ganglia, involving both direct and indirect pathways. The choreic symptoms have no dose dependent relation, affecting mostly infants, previously brain injured patients, or concomitant drugs that inhibit hepatic metabolism. Our case elucidates a rare cause of chorea induced by a common pharmacological treatment, which demonstrates the importance of searching for uncommon drugs side effects.
Leucoencefalopatia multifocal progressiva (LMP) é uma doença desmielinizante do sistema nervoso central (SNC) causada pelo JC vírus e que acomete indivíduos imunossuprimidos. Neste trabalho apresentamos o quadro clínico e radiológico, a evolução, os diagnósticos diferenciais e os achados anatomopatológicos de um paciente HIV positivo que desenvolveu LMP.
Objective Herpes zoster virus can cause inflammatory neuropathy of the facial nerve. However, studies evaluating the prevalence of this agent in peripheral facial palsy are heterogeneous regarding sample group selection, laboratory analysis method and variables studied. In addition, there are a lack of epidemiological data in the Brazilian population on this serological phenomenon in peripheral facial palsy. This study estimated herpes zoster reactivation prevalence in serological samples through chemiluminescence immunoassay for quantitative determination of specific antibodies directed against the virus. Methods This cross-sectional study sought to determine the prevalence of viral reactivation by herpes zoster in subjects with idiopathic peripheral facial palsy through analysis of serological samples over a year. Results Forty-seven patients (32 females and 15 males) participated. Severe paralysis was more common in older patients (p = 0.017). Facial pain (p = 0.02) and vertigo (p = 0.001) were related to a worse evolution of facial palsy. The rate of serological reactivation of the virus was 12.76 per cent. Conclusion The rate of serological reactivation of herpes virus in idiopathic peripheral facial palsy in our population is similar to foreign literature data, suggesting similar aetiological mechanisms in the genesis of this morbidity.
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
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.