Acometimento de nervos cranianos na granulomatose com poliangeíte (GPA) C-ANCA negativo / Cranial nerve impairment in granulomatosis with polyangeitis (GPA) C-ANCA negative

RESUMO O presente relato tem o objetivo de mostrar um caso incomum de Granulomatose com Poliangeíte (GPA), que previamente era denominada Granulomatose de Wegener. Trata-se de é uma doença multissistêmica, caracterizada por inflamação granulomatosa necrotizante e vasculite que envolve principalmente o trato respiratório superior e inferior, embora não raramente, exista comprometimento neurológico.

ABSTRACT This report aims to show an unusual case of granulomatosis with polyangeitis (GPA), previously known as Wegener's granulomatosis. It is a multisystemic disease characterized by necrotizing granulomatous inflammation and vasculitis involving mainly the upper and lower respiratory tract, although not infrequently, there is neurological impairment.

Síndrome de Collet-Sicard como forma de presentación de fracturas combinadas del atlas y cóndilos occipitales / Collet-Sicard syndrome as a presentation of combined fractures of atlas and occipital condyles

El síndrome de Collet - Sicard consiste en una afectación unilateral y combinada de los nervios craneales bajos, originado por lesiones en la base craneal. CASO CLÍNICO: Paciente masculino con antecedentes de sufrir accidente del tránsito. A su llegada al hospital refiere dolor cervical alto, voz apagada y dificultad para tragar. Al examen físico se contacta paresia de pares craneales bajos. Se realizan Rx de columna cervical y tomografía axial de región cráneo espinal. Se diagnostica una fractura de los cóndilos occipitales y una fractura tipo II del atlas. Se coloca un Halo chaleco. Se consulta al paciente al final del primer mes de tratamiento con alivio del dolor cervical y sin empeoramiento neurológico. CONCLUSIONES: La afectación de pares craneales bajos puede ser la forma clínica de presentación de las lesiones traumáticas de la región cráneo espinal. Su reconocimiento temprano favorece el pronóstico de estos pacientes

Collet syndrome - Sicard is a combined unilateral involvement and lower cranial nerves, caused by damage to the cranial base. Case report. Male patient with a history of developing traffic accident. Upon arrival at the hospital referred high cervical pain, muffled voice and difficulty swallowing. Physical examination contact lower cranial nerve paresis. Rx are performed CT cervical spine and skull spinal region. Was diagnosed with a fracture of the occipital condyles and type II fracture of the atlas. Place a Halo vest. They see patients at the end of the first month of treatment with cervical pain relief without neurological deterioration. CONCLUSIONS: The lower cranial nerve involvement may be the clinical presentation of traumatic injuries of the skull spinal region. Its early recognition and the prognosis of these patients.

ANCA-Negative Wegener's Granulomatosis with Multiple Lower Cranial Nerve Palsies

Wegener's granulomatosis (WG) is a systemic vasculitis affecting small and medium-sized vessels with granulomatous formation. Though it is known for respiratory tract and kidney involvement, neurologic manifestation has been also reported. Herein we report a patient who suffered pansinusitis with multiple lower cranial nerve palsies but reached remission by immunosuppressant after the diagnosis of WG. A 54-yr-old female visited with headache, hearing difficulty, and progressive bulbar symptoms. She experienced endoscopic sinus surgeries due to refractory sinusitis. Neurologic examination revealed multiple lower cranial nerve palsies. Vasculitic markers showed no abnormality. Nasal biopsy revealed granulomatous inflammation and vasculitis involving small vessels. Given cyclophosphamide and prednisolone, her symptoms were prominently improved. WG should be considered in the patient with multiple cranial nerve palsies, especially those with paranasal sinus disease. Because WG can be lethal if delayed in treatment, prompt immunosuppressant is warranted after the diagnostic tissue biopsy.

Frontal Sinus Lymphoma Presenting As Progressive Multiple Cranial Nerve Palsy

Primary frontal sinus lymphoma is a very uncommon disease. In all the previously reported cases, the presenting symptoms have been due to the tumor mass effect. We present an unusual case report of an immunocompetent patient who presented with facial palsy, and then progressively developed other cranial nerve palsies over several months. He was later diagnosed with diffuse large B cell lymphoma originating from the frontal sinus. The patient underwent chemotherapy, but eventually had to receive autologous peripheral blood stem cell transplantation. He is currently disease-free. The clinical course, diagnostic workup, and therapeutic outcome are described.

Horner syndrome and VI nerve paresis as a diagnostic clue to a hidden lesion.

A 33-year-old man treated elsewhere for an isolated VI cranial nerve paresis underwent an attempted transnasal biopsy of a large space-occupying lesion in the cavernous sinus and petrous apex seen on a CT scan. During the procedure, he developed severe bleeding and hypovolaemic shock. When he came to us 2 years later, he had Horner syndrome along with a mild VI nerve paresis that aided in localizing the lesion to the carotid canal and the posterior cavernous sinus. Digital subtraction angiography revealed a large internal carotid artery aneurysm of the laceral and petrous segments within the carotid canal, mushrooming into the posterior cavernous sinus.

Avaliação por imagem das lesões isoladas do III par craniano / Imaging assessment of isolated lesions affecting cranial nerve III

Este trabalho tem por objetivo fazer uma revisão da anatomia e das principais doenças do III par craniano, demonstrando-as através de estudos por imagem, com ênfase em ressonância magnética. Os métodos de imagem são peça fundamental na avaliação de pacientes com suspeita de lesão do nervo oculomotor, uma vez que o quadro clínico é freqüentemente inespecífico e a gama de doenças que podem acometê-lo é bastante ampla. Realizamos também breve levantamento da literatura.

Maxillary zoster with corneal involvement.

A case, of maxillary zoster with corneal involvement in a young patient is described. Corneal involvement in maxillary zoster (Medline search) is rare.

Homeopatia nas neuropatias da infância: relato de caso de Acidente Vascular Cerebral Neonatal / Homeopathy in childhood neuropathies: report of neonatal cerebral vascular cases

O presente estudo tem o objetivo de relatar o acompanhamento de um caso de uma paciente com seqüelas neurológicas de Acidente Vascular Cerebral intra-útero, com terapêutica homeopática, que iniciou acompanhamento clínico no ambulatório homeopático, a partir do quinto mês de vida, com terapêutica baseada inicialmente nos níveis de similitude dos diagnósticos, em razão dos poucos dados da história clínica do ponto de vista da anamnese homeopática. A criança apresentou uma evolução muito favorável até 1 ano e 5 meses de vida, quando começou a apresentar manifestações convulsivas, mas continuou evoluindo bem nas aquisições motoras e aparentemente nas cognitivas também

Multiple cranial nerve palsy in an HIV-positive patient.

We report the case of a 32 -year- old HIV-positive Indian male who presented with sixth nerve (bilateral), ninth, tenth and twelfth nerve palsies; cerebellar and posterior column involvement. CT scan showed gyriform enhancement in the right occipital lobe and nodular leptomeningeal enhancement in the left frontal lobe. Cytomegalovirus serology was positive and the patient was treated as presumed CMV. HIV can present with multiple cranial neuropathy and varied neurological involvement.

Hypocomplementemic urticarial vasculitis and lower cranial nerve palsies.

A 55 years post menopausal lady presented with puffiness of face, and a pruritic urticarial rash over face and upper trunk of one week duration with accompanying dysphagia. Clinical examination revealed an urticarial rash over face and upper trunk, two small ulcers over floor of mouth and evidence of bilateral VIII, IX and Xth cranial nerve palsies. Hypocomplementemia, negative immune profile and evidence of vasculitis on skin biopsy suggested a diagnosis of hypocomplementemic urticarial vasculitis. The patient responded to a course of steroids.

Multiple cranial neuropathy in Cogan's syndrome.

A 20 year old woman presented with recurrent alternative keratitis for four months. One month before admission, she developed progressive hearing loss, visual impairment, facial diparesis and bilateral trigeminal neuropathy. Cogan's syndrome was diagnosed. Prompt treatment with corticosteroid resulted in dramatic improvement of the ocular, otological and neurological dysfunctions.

Multiple cranial neuropathy: a common diagnostic problem.

Syndrome of multiple cranial palsies is a common clinical problem routinely encountered in neurological practice. Anatomical patterns of cranial nerves involvement help in localizing the lesion. Various infections, malignant neoplasms and autoimmune vasculitis are common disorders leading to various syndromes of multiple cranial nerve palsies. A large number of diffuse neurological disorders (e.g. Gullian-Barre syndrome, myopathies) may also present with syndrome of multiple cranial nerve palsies. Despite extensive biochemical and radiological work-up the accurate diagnosis may not be established. Few such patients represent "idiopathic" variety of multiple cranial nerve involvement and show good response to corticosteroids. Widespread and sequential involvements of cranial nerves frequently suggest possibility of malignant infiltration of meninges, however, confirmation of diagnosis may not be possible before autopsy.

Hypoglossal nerve palsy due to infections mononucleosis

Mononeuritis is least reported complication of infectious mononucleosis. A case of hypoglossal nerve palsy due to infectious mononucleosis is reported and other reported cases are reviewed. The prognosis for complete recovery is good

Disseminated Burkitt's lymphoma presenting as multiple cranial nerve palsies.

A case of disseminated Burkitt's lymphoma with nervous system involvement in a HIV negative 35 year old lady is described. She primarily presented with multiple cranial nerve palsies. At autopsy, diffuse involvement of parenchymatous organs and lymphomatous meningitis with conspicuous sparing of gastrointestinal system was observed. In addition, there was an unusual feature of paraneoplastic demyelinating peripheral neuropathy. Incidentally, a large hydatid cyst was also seen in the left lobe in addition to the lymphomatous involvement of the liver.

Critérios para o diagnóstico eletrocardiográfico de vagotonia: existe consenso na opiniäo de especialistas? / Diagnostic Criteria for Vagotonia in the Standard 12-Lead Electrocardiogram. Is there a Consensus in the Opinion of Specialists ?

Objetivo - Identificar os critérios mais valorizados par ao diagnóstico eletrocardiográfico de vagotomia na opiniäo de cardiologistas. Métodos - Questionário distribuído a 40 cardiologistas durante o 9§ Congresso brasileiro de Arritmias Cardíacas (Säo José do Rio Preto, SP). A amostra representou cerca de 15 por cento dos participantes e foi propositalmente viesada para incluir 70 por cento dos palestrantes e apresentadores de temas-livres, e excluir profissionais näo-médicos, a fim de aumentar a validade de conteúdo das respostas. Foi dividido em duas partes: 1ª de resposta espontânea, preenchida sem conhecimento da seguinte; e 2ª, de resposta induzida, onde foram apresentados, em ordem randômica, critérios de eletrocardiograma (ECG) da literatura. Nas duas partes, foi solicitado que as respostas seguissem uma escala decrescente de importância. Resultados - Na 1ª arte. 35 diferentes critérios foram apontados, mas somente 3 foram citados por mais de 25 por cento dos entrevistados: bradicardia sinusal (95 por cento), presença de onda T apiculada (30 por cento) e repolarizaçäo precoce (27,5 por cento). Na 2ª parte, o critério melhor classificado foi a bradicardia sinusal, seguido pelo supradesnível do ponto J e pelo supradesnível do segmento ST. Conclusäo. Entre cardiologistas com interesse em eletrocardiografia e arritmias cardíacas, com exceçäo da bradicardia sinusal, näo existe um claro consenso quanto ao grupo de critérios a serem valorizados para a identificaçäo vagotonia no ECG. Estudos adicionais säo necessários para validar objetivamente os critérios mais comuns identificados nesta pesquisa