Progressive obtundation in a young woman with bilateral corpus striatum infarction: a case report

Amin, Osama Shukir Muhammed; Shwani, Sa'ad Seud; Zangana, Hero M; Ameen, Nawa A

doi:10.1186/1752-1947-5-324

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…Sin embargo, como se pudo evidenciar con la evolución clínica en el presente caso, la afectación simultánea de estas estructuras se asocia con daños importantes en múltiples funciones mentales superiores. En la literatura se reporta que las alteraciones del globo pálido se han asociado con enfermedades neuropsiquiátricas como trastornos de ansiedad, síndrome de Tourette, déficit de atención, distonías adquiridas, acatisia y otras alteraciones del movimiento de tipo extrapiramidal; además de relacionarse con alteraciones en las vías de la recompensa y de las emociones placenteras (12,13,14,15,16). Con respecto a la neuroanatomía funcional, se conoce que estas estructuras se dividen en los segmentos externo e interno y junto con el putamen constituyen los núcleos lenticulares.…”

Section: Discussionunclassified

“…Son áreas de alta densidad axonal, actuando como centro de conjunción de vías de neurotransmisión por dopamina, glutamato y GABA (13,18). Dada la complejidad de los circuitos neuronales que confluyen a nivel subcortical, ganglio basal y talámico, usualmente se requiere una lesión bilateral y sincrónica para general alteraciones clínicamente evidentes (16,19,20,21); Tabla 1. Conjunto de hallazgos patológicos en neuroimágenes asociados con la intoxicación aguda y crónica por medicamentos opioides.…”

Section: Discussionunclassified

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¿Psicosis luego de sobredosis por opioides? Lesión isquémica bilateral del globo pálido como causa orgánica insospechada.

Leal¹,

Hoyos-Zuluaga

Álvarez³

2022

Rev Neuropsiquiatr

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El abordaje de pacientes intoxicados que presentan antecedentes de patología psiquiátrica supone un reto en la atención médica. La presencia de una patología dual puede conducir a que algunos síntomas somáticos sean desestimados y no se consideren como manifestación de una posible patología grave subyacente. Se reporta el caso de una paciente que, durante su hospitalización debida a un episodio depresivo, presentó una sobredosis incidental de opioides. Al recuperarse de ella, sin embargo, presentó comportamiento desorganizado e ideas delirantes, inicialmente atribuidas a la depresión. Estudios ulteriores demostraron una causa orgánica grave subyacente: lesión isquémica bilateral del globo pálido. Se analiza el cuadro clínico a la luz de la literatura pertinente, abordando los temas de delirium, espectro clínico debido a las lesiones del globo pálido y finalizando con una breve descripción sobre la sobredosis y neurotoxicidad por opioides. Frente a síntomas no concordantes con la evolución usual de una descompensación psicopatológica o una intoxicación por drogas, debe ahondarse en la exploración de posibles causas orgánicas, objetivo para el cual se sugiere considerar estudios de neuroimágenes en todo paciente que experimente una sobredosis de opioides y que posteriormente presente graves manifestaciones de una alteración cognitiva.

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Section: Discussionunclassified

¿Psicosis luego de sobredosis por opioides? Lesión isquémica bilateral del globo pálido como causa orgánica insospechada.

Leal¹,

Hoyos-Zuluaga

Álvarez³

2022

Rev Neuropsiquiatr

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Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes

et al. 2023

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Bilateral basal ganglia hemorrhages (BBGHs) represent rare accidents, with no clear standard of care currently defined. We reviewed the literature on BBGHs and analyzed the available conservative and surgical strategies. PubMed, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies reporting patients with BBGHs. Clinical characteristics, management, and outcomes were analyzed. We included 64 studies comprising 75 patients, 25 (33%) traumatic and 50 (67%) non-traumatic. Traumatic cases affected younger patients (mean age 35 vs. 46 years, p =0.014) and males (84% vs. 71%, p =0.27) and were characterized by higher proportion of normal blood pressures at admission (66% vs. 13%, p =0.0016) compared to non-traumatic cases. Most patients were comatose at admission (56%), with a mean Glasgow Coma Scale (GCS) score of 7 and a higher proportion of comatose patients in the traumatic than in the non-traumatic group (64% vs. 52%, p =0.28). Among the traumatic group, motor vehicle accidents and falls accounted for 79% of cases. In the non-traumatic group, hemorrhage was most associated with hypertensive or ischemic (54%) and chemical (28%) etiologies. Management was predominantly conservative (83%). Outcomes were poor in 56% of patients with mean follow-up of 8 months. Good recovery was significantly higher in the traumatic than in the non-traumatic group (48% vs. 17%, p =0.019). BBGHs are rare occurrences with dismal prognoses. Standard management follows that of current intracerebral hemorrhage guidelines with supportive care and early blood pressure management. Minimally invasive surgery is promising, though substantial evidence is required to outweigh the potentially increased risks of bilateral hematoma evacuation. Supplementary Information The online version contains supplementary material available at 10.1007/s10143-023-02044-x.

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Localizing parkinsonism based on focal brain lesions

Joutsa

Horn

Hsu

et al. 2018

Brain

134

129

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Bradykinesia, rigidity, and tremor frequently co-occur, a clinical syndrome known as parkinsonism. Because this syndrome is commonly seen in Parkinson's disease, symptoms are often attributed to cell loss in the substantia nigra. However, parkinsonism occurs in several other neurological disorders and often fails to correlate with nigrostriatal pathology, raising the question of which brain region(s) cause this syndrome. Here, we studied cases of new-onset parkinsonism following focal brain lesions. We identified 29 cases, only 31% of which hit the substantia nigra. Lesions were located in a variety of different cortical and subcortical locations. To determine whether these heterogeneous lesion locations were part of a common brain network, we leveraged the human brain connectome and a recently validated technique termed lesion network mapping. Lesion locations causing parkinsonism were functionally connected to a common network of regions including the midbrain, basal ganglia, cingulate cortex, and cerebellum. The most sensitive and specific connectivity was to the claustrum. This lesion connectivity pattern matched atrophy patterns seen in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy, suggesting a shared neuroanatomical substrate for parkinsonism. Lesion connectivity also predicted medication response and matched the pattern of effective deep brain stimulation, suggesting relevance as a treatment target. Our results, based on causal brain lesions, lend insight into the localization of parkinsonism, one of the most common syndromes in neurology. Because many patients with parkinsonism fail to respond to dopaminergic medication, these results may aid the development of alternative treatments.

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Progressive obtundation in a young woman with bilateral corpus striatum infarction: a case report

Cited by 4 publications

References 16 publications

¿Psicosis luego de sobredosis por opioides? Lesión isquémica bilateral del globo pálido como causa orgánica insospechada.

¿Psicosis luego de sobredosis por opioides? Lesión isquémica bilateral del globo pálido como causa orgánica insospechada.

Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes

Localizing parkinsonism based on focal brain lesions

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