Subject(s)
Demyelinating Diseases , Humans , Demyelinating Diseases/diagnostic imaging , Demyelinating Diseases/pathology , Demyelinating Diseases/complications , Epilepsy/etiology , Epilepsy/complications , Epilepsy/diagnostic imaging , Frontal Lobe/diagnostic imaging , Frontal Lobe/pathology , Male , Female , Magnetic Resonance Imaging , AdultSubject(s)
Brain Diseases , Neurology , Humans , Brain Diseases/complications , Brain Diseases/diagnostic imagingSubject(s)
Muscle Spasticity/diagnostic imaging , Muscle Spasticity/genetics , Spinocerebellar Ataxias/congenital , Cerebellar Ataxia/diagnostic imaging , Cerebellar Ataxia/genetics , Child , Diagnosis, Differential , Female , Humans , Male , Pedigree , Spinocerebellar Ataxias/diagnostic imaging , Spinocerebellar Ataxias/genetics , Young AdultSubject(s)
Cerebral Infarction/diagnosis , Esotropia/diagnosis , Ophthalmoplegia/diagnosis , Thalamic Diseases/diagnosis , Cerebral Infarction/drug therapy , Diagnosis, Differential , Diagnostic Imaging , Esotropia/drug therapy , Female , Glasgow Coma Scale , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Middle Aged , Ophthalmoplegia/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Thalamic Diseases/drug therapyABSTRACT
Natalizumab treatment of multiple sclerosis (MS) is associated with a risk of developing progressive multifocal leukoencephalopathy (PML), a rare opportunistic viral demyelinating disease caused by reactivation of John Cunningham virus (JCV). Herein, we report a case of a 40-year-old woman who developed refractory temporal lobe epilepsy; one year after recovery form Natalizumab-induced PML. Localisation related epilepsy, which may be refractory in nature, as in this case report, is a potential chronic disabling complication of PML. Epilepsy in this context, likely reflects grey matter involvement, which may then act as cortical epileptogenic zone.
Subject(s)
Drug Resistant Epilepsy/etiology , Epilepsy, Temporal Lobe/etiology , Immunologic Factors/adverse effects , Leukoencephalopathy, Progressive Multifocal/etiology , Natalizumab/adverse effects , Adult , Brain/diagnostic imaging , Brain/drug effects , Diagnosis, Differential , Drug Resistant Epilepsy/diagnostic imaging , Drug Resistant Epilepsy/physiopathology , Epilepsy, Temporal Lobe/diagnostic imaging , Epilepsy, Temporal Lobe/physiopathology , Female , Humans , Immunologic Factors/therapeutic use , Leukoencephalopathy, Progressive Multifocal/diagnostic imaging , Leukoencephalopathy, Progressive Multifocal/physiopathology , Multiple Sclerosis/diagnostic imaging , Multiple Sclerosis/drug therapy , Natalizumab/therapeutic useABSTRACT
We describe a 64-year-old man who presented to the emergency department with a two-day history of left perioral and hand numbness. Examination revealed impaired sensation of the left corner of the mouth and ipsilateral fingers. Neuroimaging showed an acute right thalamic lacunar infarct consistent with the diagnosis of cheiro-oral syndrome. In this report, we discuss the importance of recognising this syndrome and instituting appropriate management to prevent further cerebrovascular events.
Subject(s)
Hand/innervation , Hypesthesia/etiology , Mouth Diseases/complications , Mouth/innervation , Stroke, Lacunar/complications , Humans , Male , Middle Aged , SyndromeABSTRACT
Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) is a rare chronic inflammatory disorder of the central nervous system. Herein, we describe the case of a 62-year-old female who presented with right sided facial tingling, gait ataxia and diplopia. Neuroimaging revealed pontine curvilinear enhancing lesions with extension into cerebellar peduncles, characteristic of CLIPPERS. This report discusses the differential diagnosis and the importance of prolonged immunomodulatory treatment for this rare neuro-inflammatory disorder. Long-term immunosuppression appears to be mandatory in order to achieve sustained remission and prevent disability related to atrophy of the structures involved in repeated attacks.
