ABSTRACT
Moyamoya disease is a chronic and unusual cerebrovascular disorder characterized by progressive stenosis and occlusion of the distal portions of internal carotid arteries and its main branches within the circle of Willis. Posterior circulation (vertebral and basilar arteries) may also be affected; however, this presentation is uncommon. As well as stenosis of the terminal portion of intracranial arteries, it is seen the development of a network of collateral vessels abnormally dilated at the base of the brain with an aspect of a "puff of smoke," whose term in Japanese is described as "moyamoya." The present study aims to report two consecutive cases of patients who presented to our service with different clinical manifestations. Further investigation with digital subtraction angiography showed a moyamoya pattern.
Subject(s)
Humans , Male , Adolescent , Central Nervous System Neoplasms/surgery , Hemangioma, Cavernous, Central Nervous System/surgery , Occipital Lobe/surgery , Occipital Lobe/injuries , Hemangioma, Cavernous, Central Nervous System/diagnostic imaging , Microsurgery/methodsABSTRACT
A stroke is a rare entity in pediatrics patients; that implies a very important clinical challenge. It is produced by the interruption of flow at the vascular level, producing neurological focus. Causes of childhood stroke are varied and different from adults; constituting one of the 10 leading causes of childhood mortality. We present of previously healthy 6 years old male patient who was admitted for hemiparesis, who was studied with neuroimaging and laboratory; diagnosed of ischemic stroke
Subject(s)
Humans , Male , Child , Brain Ischemia/therapy , Stroke/diagnosis , Stroke/etiology , Ischemic Stroke , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed , Brain Ischemia/epidemiology , Stroke/epidemiology , Computed Tomography AngiographyABSTRACT
RESUMEN La vasculitis primaria del sistema nervioso central es una enfermedad infrecuente que puede afectar a adultos y población pediátrica. Puede comprometer los vasos sanguíneos cerebrales tanto de mediano o gran calibre como los de pequeño calibre y estar asociada a procesos inflamatorios, infecciosos, tumorales o ser de origen idiopático. Describimos el caso de un adolescente con deterioro neurológico focal dado por hemiplejía derecha en quien se descartaron otras causas más frecuentes de isquemia cerebral, con diagnóstico final de vasculitis primaria del sistema nervioso central asociada a infección por virus de Epstein Barr.
ABSTRACT Primary angiitis of the central nervous system is an uncommon disease that may affect adults and the paediatric population. It can involve both the medium-large and small sized cerebral blood vessels, and can be associated with inflammatory, infectious, tumour processes, or of idiopathic origin. The case is presented of an adolescent with focal neurological impairment due to right hemiplegia, in whom other more frequent causes of cerebral ischaemia were ruled out. The final diagnosis was Epstein Barr virus associated with primary angiitis of the central nervous system.
Subject(s)
Humans , Child , Adolescent , Child Health , Herpesvirus 4, Human , Vasculitis, Central Nervous System , Vasculitis , Blood Vessels , HemiplegiaABSTRACT
La arteriopatía cerebral autosómica dominante con infartos subcorticales y leucoencefalopatía, es poco frecuente y con escasos informes en la literatura médica y tiene una mayor prevalencia en el continente europeo. Este cuadro clínico se caracteriza por migrañas con aura, enfermedad cerebrovascular isquémica, demencia y alteraciones psiquiátricas. Su diagnóstico se confirma cuando se detecta una alteración genética característica y/o por cambios anatomopatológicos ocurridos en la piel. Se presenta el caso de un paciente del sexo masculino, de 49 años de edad que ha presentado manifestaciones neurológicas episódicas de cefalea tipo migraña y hemiparesia derecha. Se realizó biopsia de piel, encontrándose alteraciones típicas de esta enfermedad. Se describe la evolución clínica detallada a través del tratamiento neurorehabilitador en un paciente con arteriopatía cerebral hereditaria. Se aplica este tratamiento por 21 días, basado en técnicas de ejercicios neurológicos, cuidados posturales, terapia ocupacional, acupuntura, ozonoterapia, psicológicos, para obtener una mayor independencia en las actividades de la vida diaria, restablecer funciones y mejorar la discapacidad que presenta el paciente. Se describen los cambios ocurridos en las actividades de la vida diaria del paciente y su evolución favorable después del tratamiento neurorehabilitador. La arteriopatía cerebral autosómica dominante con infartos subcorticales y leucoencefalopatía es un terreno poco transitado por los centros de rehabilitación. La ausencia de un tratamiento etiológico hace que la rehabilitación aplicada y practicada permita mantener -periódicamente- un grado mayor de independencia con una mejora de la calidad de vida del paciente y sus familiares. El diagnóstico precoz y la fisioterapia brindan nuevas oportunidades al paciente(AU)
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy is rare and there are few reports in the literature, with a higher prevalence in Europe. This clinical condition is characterized by migraine with aura, ischemic cerebrovascular disease, dementia and psychiatric disorders. It is done a detailed clinical description of the evolution and diagnosis of this hereditary disease. Diagnosis is confirmed by detecting a characteristic and / or pathological changes in the skin. We present the case of a 49-year-old male patient who has presented episodic neurological manifestations of migraine-type headache and right hemiparesis. A skin biopsy was performed, finding typical alterations of this disease. Detailed clinical course is described through neuro-rehabilitating treatment in a patient with hereditary cerebral arteriopathy. This treatment is applied for 21 days, based on techniques of neurological exercises, postural care, occupational therapy, acupuncture, ozone therapy, psychological, to obtain greater independence in daily living activities, restore functions and improve the disability in this patient. This paper describes the changes that occurred in the patient daily life activities and his favorable evolution after the neuraorehabilitator treatment. Autosomal dominant cerebral arteriopathy with subcortical infarctions and leukoencephalopathy is a gray area for rehabilitation centers. The absence of an etiological treatment means that the rehabilitation applied and practiced allows greater degree of independence to be maintained periodically with an improvement in the quality of life of the patient and family. Early diagnosis and physiotherapy offer new opportunities for the patient(AU)
Subject(s)
Humans , Male , Middle Aged , Physical Therapy Modalities/adverse effects , CADASIL/therapy , CADASIL/diagnostic imaging , Quality of LifeABSTRACT
A wide range of underlying systemic factors have been reported in the setting of childhood stroke. Emerging research demonstrates that non-atherosclerotic intracerebral arteriopathies are the main risk factors. Minor infections may play a role in arteriopathies. Nonspecific presentation and doctor' s lacking awareness of pediatric stroke both contribute to initial misdiagnoses that result in delays in management. Acute management of children with stroke is primarily supportive including control of fever, blood pressure normalization to accepted age ranges, normalization of glucose, and maintenance of normal oxygenation, but there is no golden standard therapy at home and abroad. For secondary stroke prevention, the majority of children are treated with adult stroke therapeutic schedule. The prognosis of childhood stroke is not satisfactory. Many of these children are left with permanent neurologic deficits including injury of motor, sensory and cognitive defect and epilepsy.