Less pronounced median nerve swelling measured by ultrasonography may indicate a less severe stage of CTS, which is more likely to respond to treatment with a corticosteroid injection.
Despite the fact that 47 cases of PMA have been reviewed in this paper, many questions remain. The cases that have been described so far show inconsistent data with respect to the results of functional studies as well as treatment effects. The pathophysiology of PMA is still largely a matter of conjecture.
Objective: The pathophysiology of migraine with aura is thought to be related to cortical spreading depression and cortical hypersensitivity, in which inhibitory interneurons may play a role. Persistent migraine aura (PMA) without infarction is defined as auras that last longer than 1 week in the absence of infarction. We describe a case of persistent aura with a small occipital cortical infarction and discuss implications of this case and PMA for pathophysiological concepts of migrainous auras. Methods: We present a case and discuss the implications for pathophysiological concepts. Results: The case presented cannot be diagnosed as PMA as the patient was found to have an occipital cortical infarction with hypoactivity on fluorodeoxyglucose-positron emission tomography. Nevertheless, the patient suffered from persistent aura (with infarction). We argue that the infarction may have been responsible for an increased imbalance in one of the primary visual cortex networks that was already hyperexcitable due to the migraine aura condition. Conclusion: PMA with occipital infarction has not been reported previously. We believe the findings of the present case and PMA cases reported in the past may support the intracortical disinhibition hypothesis in migraine.
We present a 67-year-old women with subacute onset of corticobasal-, partial Balint syndrome and exaggerated startle response as the presenting symptoms of Creutzfeld-Jakob disease (CJD). The previous 3 months she complained of a non-specific dizziness. Since 2 weeks she had trouble with using the coffee machine and dressing. Last week she started bumping into obstacles on her left side. Also, she seemed to ignore the food on the left side of her platter. Her left hand made "strange" unpurposeful movements.At admission, the patient was bradyphrenic and disoriented in time. Vital parameters were normal. There was apraxia with imitation (see video 1 ) and left-sided visual-and sensory extinction. We saw uncontrolled slow posturing movements of her left arm and hand as well as "arm levitation" (see video 1), which we interpreted as "alien limb phenomenon". Overall, movements were hypo-and bradykinetic and there was slight left-sided rigidity. The left leg displayed action-myoclonus (see video 2 ). FIG. 1. MRI showing cortical ribboning in right parieto-occipital region on DWI. FIG. 2. MRI showing cortical ribboning in right parieto-occipital region on ADC.
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