ABSTRACT
OBJECTIVE: To present a case of two identical twins presenting concurrently with symptoms and subsequent initial diagnosis of neuromyelitis optica spectrum disorder (NMOSD). METHODS: Clinical, laboratory and MRI findings for both twins were reviewed and presented here. RESULTS: Twin A presented with right eye pain and subsequent blurred vision in right eye. MRI of the brain and spine demonstrated pre-chiasmal right optic nerve enhancement and T2 hyperintense lesions in the spinal cord at T7 and T9 levels. Cerebrospinal fluid (CSF) analysis was remarkable for NMO/aquaporin-4 (AQP4) fluorescence-activated cell sorting (FACS) titre of 1:32 and a serum NMO/AQP4-IgG positive titre of 1:10 000. Twin B presented with diplopia. MRI of the brain and spine demonstrated T2 hyperintense lesions in the periventricular cerebral white matter, in the periaqueductal white matter of the pons, in the midbrain and the cervical spinal cord. Neurological examination findings revealed incomplete right trochlear palsy, rotatory nystagmus, an incomplete left internuclear ophthalmoplegia and hyper-reflexia. CSF analysis was remarkable for NMO/AQP4 FACS titre of 1:256 and a serum NMO-IgG positive titre of 1:10 000. Both twins responded well to intravenous steroid therapy. There was no adverse environmental exposure present. CONCLUSION: We present an interesting and rare case of identical twins presenting concurrently and for the first time with NMOSD.
Subject(s)
Aortic Dissection/diagnosis , Carotid Artery, Internal , Low Back Pain/therapy , Manipulation, Chiropractic/adverse effects , Aortic Dissection/diagnostic imaging , Aortic Dissection/etiology , Carotid Artery, Internal/diagnostic imaging , Diagnosis, Differential , Humans , Male , Middle Aged , Radiography , UltrasonographyABSTRACT
Intravenous (IV) administration of tissue plasminogen activator (tPA) given to patients during acute cerebral ischemia according to National Institute of Neurological Disorders and Stroke (NINDS) guidelines improves clinical outcome by 11% to 14%. The success of IV tPA stroke therapy is dependent on several previously reported factors. The authors suggest that the presence of calcification within an embolus may represent an additional important factor. This report describes a patient with an acute stroke secondary to a spontaneous calcific cerebral embolus who had a negative outcome despite receiving proper thrombolytic therapy.
Subject(s)
Fibrinolytic Agents/therapeutic use , Intracranial Embolism/complications , Stroke/drug therapy , Tissue Plasminogen Activator/therapeutic use , Aged , Calcinosis/complications , Female , Humans , Intracranial Embolism/diagnostic imaging , Stroke/diagnostic imaging , Stroke/etiology , Tomography, X-Ray Computed , Treatment FailureABSTRACT
Meningocele is recognized as a rare, usually asymptomatic condition not associated with acute neurologic symptoms. We herein describe the case of a patient with a longstanding history of a lower back "mass" and recurrent syncope who became acutely unresponsive and developed bilateral retinal hemorrhages when she was placed in the supine position to undergo carotid sonography. MR imaging revealed a large, dorsal lumbar meningocele. The episode likely was caused by acutely increased intracranial pressure caused by displacement of CSF from the meningocele intracranially.
