Com finalidade de orientar e oferecer subsídios para a conduta diagnóstica e terapêutica em diferentes situações dentro das doenças cerebrovasculares, a Sociedade Brasileira de Doenças Cerebrovasculares constituiu um comitê composto por especialistas de diferentes áreas do Brasil, que emitiram um parecer, denominado "Opinião Nacional", redigido nos moldes dos consensos. O presente artigo analisa a "Doença Carotídea na Fase Aguda do AVC", abordando separadamente os seguintes tópicos: métodos de detecção de estenose carotídea na fase aguda; quando e como intervir sobre a carótida na fase aguda; tratamento clínico e marcadores de inflamação. São apresentados os comentários, baseados na literatura e na opinião pessoal dos participantes, e é descrito, como conclusão em cada item, a opinião do grupo.
Neurophysiological examination before and after the administration of benzonidazole, has shown peripheral polyneuropathy induced by this drug in most of the patients treated for chronic Chagas' disease. The polyneuropathy was mostly axonal and it was dose dependent being more severe in patients who had denervation of skeletal muscles before receiving the drug.
A case of a girl (10 years old) with a psycho-organic syndrome plus headache without signs of clear intracranial hypertension is related. The diagnosis of neurocysticercosis was made by CSF abnormalities. PLEDs over the left cerebral hemisphere were recorded at the first day after treatment with praziquantel (50mg/kg/day during 21 days). The first CT scan was normal and just after the treatment showed a prominent left cerebral hemisphere involvement, despite parenchymatous dissemination of cysticerci was bilateral. The treatment was successful and the patient became asymptomatic in the two years follow-up. The neurophysiologic aspects of this EEG abnormality is also discussed.
Cerebral edema secondary to ischemia can threaten life, mainly due to frequent failure of medical management. Imminent herniation of the temporal lobe can be timely detected by clinical signs and CT-scan. Eight patients (4M, 4F; 48-74 years, mean 62) with ischemic stroke and imminent herniation, were surgically decompressed by a standard temporal lobectomy as described by Olivier for temporal lobe epilepsy. Six patients survived, two died and were considered failure of the procedure, probably due to late surgical indication. In conclusion, temporal lobectomy is life-saving for patients with large ischemic cerebral infarction with mass effect and deteriorating signs of brain stem compression.
, Sebastião Eurico de Melo-Souza 6RESUMO -A mielinólise pontina está classicamente associada à rápida correção de hiponatremia crônica. Recentemente, fatores importantes adicionais tem sido descritos na patogênese dessa condição. Relatamos o caso de um paciente de 43 anos, etilista, desnutrido, que apresentou quadro agudo de insuficiência cardíaca por "Shoshin beribéri", insuficiência renal com tratamento por diálise. Evoluiu com tetraparesia e coma. Apresentou mielinólise pontina central e extra-pontina à ressonância magnética de crânio e anormalidades no potencial evocado auditivo. PALAVRAS-CHAVE: mielinólise pontina e extra-pontina, alcoolismo, Shoshin beribéri.Central pontine and extra-pontine myelinosis in alcoholic patient with Shoshin beriberi ABSTRACT -The central pontine myelinosis is classically related with rapid correction of chronic hyponatremia. Recently, important aditional factors have been described in the pathogenesis of this condition. We report the case of a 43-year-old alcoholic malnourished man, with acute renal failure with dialytic treatment, and output failure Shoshin beriberi. He had tetraplegy and coma. Confirmation of pontine and extrapontine myelinosis by magnetic resonance imaging, and abnormalities on auditive evoked potentials are described.KEY WORDS: central pontine and extra-pontine myelinosis, alcoholism, Shoshin beriberi.beribéri. Fez teste terapêutico com vitamina B1 endovenosa, recuperando-se do quadro de choque cardiogê-nico rapidamente. Para IRA, foi necessária diálise tendo recuperado completamente a função renal ao final do tratamento. Evoluiu com coagulação intravascular disseminada, com plaquetopenia de consumo e elevação de d-dímeros. Teve parada cardio-respiratória com imediata reanimação, mas permaneceu em estado vegetativo persistente, com ciclo sono-vigília. Está atualmente em programa de reabilitação motora.O estudo do líquor não mostrou alterações infecciosas, ou inflamatórias. Foi admitido com sódio sérico de 136 meq/l, sofrendo oscilação até 160 meq/l, durante a diálise, sem correção eletrolítica. Sódio permaneceu após esse episódio em torno de 140 meq/l. Eletrencefalograma-Disfunção córtico-subcortical contínua severa, difusa, não específica e depressão da atividade elétrica cerebral contínua e difusa.Ressonância magnética do crânio -lesão arredondada com hipersinal em T2 e Flair na porção central da ponte e adjacente ao IV ventrículo. Lesões arredondadas com as mesmas características de sinal foram identificadas na face mediana dos pedúnculos cerebelares médios de ambos os lados, adjacente ao IV ventrículo. Essas alterações foram sugestivas de mielinólise pontina/extraponMielinólise pontina (MP) é enfermidade desmielinizante do encéfalo que acomete principalmente a região da ponte, mas que pode atingir também regiões extra-pontinas (MEP), Está classicamente associada à rápida correção de hiponatremia crô-nica. Recentemente, evidências de fatores adicionais significativos para a patogênese da doença têm sido relacionados. Um subgrupo particularmente predispon...
The Sneddon's syndrome consists of neurologic manifestations associated to the presence of livedo reticularis and cyanosis of the extremities. The pathological process is an endothelial obliteration of arterioles, leading to a reticular appearance of the skin, despite the environment temperature. The authors present three new cases, caucasian males with 7, 16 and 54 years of age. The youngest started with hemilateralized motor seizures and showed a porencefalic area in the CT scan. The oldest had livedo reticularis, acrocyanosis and started with hemilateralized motor seizures, and a hemiparesis as sequela; CT scan with parasagittal infarct and occlusion presented of one anterior cerebral artery on angiography. The third patient started with hemifacial seizures, developed a labioglossolaringeal paresis and dysarthria as sequela; CT scan and MRI showed multiple infarcts, with multiple occlusions of cortical branches on angiography. The skin biopsies showed endothelial vascular hyperplasia in all cases. Only one (54 years old) patient had a positive IgG antiphospholipid antibodies. The Sneddon's syndrome seems not to be so rare and have to be considered in the etiological investigation of cerebral infarcts, mainly in young people.
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