Subject(s)
Antineoplastic Agents, Hormonal/adverse effects , Estrogen Receptor Modulators/adverse effects , Sinus Thrombosis, Intracranial/chemically induced , Tamoxifen/adverse effects , Anticoagulants/therapeutic use , Antineoplastic Agents, Hormonal/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Confusion/etiology , Estrogen Receptor Modulators/therapeutic use , Female , Heparin/therapeutic use , Humans , Mastectomy , Middle Aged , Risk Factors , Sinus Thrombosis, Intracranial/complications , Sinus Thrombosis, Intracranial/drug therapy , Tamoxifen/therapeutic useABSTRACT
INTRODUCTION: The lateral bulbar syndrome is a heterogeneous clinical condition. It is usually of vascular origin, due to a reduction in postero inferior cerebellar artery (PICA) and vertebral artery blood flow. CASE REPORT: We studied two cases: a woman aged 59 years and a man of 49 years, who were admitted with Wallenberg s syndrome. The diagnosis was confirmed on magnetic resonance which showed an ischaemic lesion in the lateral bulbar region ipsilateral to the clinical signs. On angioresonance there was lack of filling of the vertebral artery involved, and the PICA was not seen. CONCLUSIONS: At the present time, the most sensitive technique available for the diagnosis of the lateral bulbar syndrome is cranial magnetic resonance (it even appears to be useful for making aetiopathogenic hypotheses). Similarly, arteriography is widely used for assessing disorders of the posterior cerebral circulation, although it is not without risk. According to recent studies, angioresonance gives sensitivity and specificity of over 75% when used to assess anomalies of the vertebral and basilar arteries. So our observations corroborate the finding that angioresonance is a very sensitive, specific investigation for showing disorders of the vertebral arteries and PICA, which spares patients the morbidity associated with conventional arteriography.
Subject(s)
Lateral Medullary Syndrome/complications , Magnetic Resonance Angiography/methods , Thrombosis/complications , Thrombosis/pathology , Vertebral Artery/pathology , Female , Horner Syndrome/complications , Horner Syndrome/diagnosis , Humans , Lateral Medullary Syndrome/diagnosis , Male , Middle AgedABSTRACT
Introducción. El síndrome bulbar lateral es un cuadro clínico heterogéneo, habitualmente de origen vascular, caracterizado por disminución del flujo en la arteria cerebelosa posteroinferior (ACPI) y, eventualmente, de la arteria vertebral. Casos clínicos. Estudiamos dos casos, mujer de 59 años y varón de 49 años que ingresan con un síndrome de Wallenberg. La resonancia magnética confirma el diagnóstico mostrando una lesión isquémica en región bulbar lateral ipsilateral a la clínica. En la angiorresonancia se observa una falta de relleno de la arteria vertebral responsable, sin que se visualice la ACPI. Conclusiones. En la actualidad, la técnica más sensible para el diagnóstico del síndrome bulbar lateral es la resonancia magnética craneal (incluso parece ser útil para formular hipótesis etiopatogénicas). Del mismo modo, la arteriografía se utiliza ampliamente para evaluar trastornos de la circulación cerebral posterior, aun sin estar exenta de riesgos. La angiorresonancia demuestra, según los últimos estudios, una sensibilidad y una especificidad superiores al 75 por ciento en la valoración de anomalías en las arterias vertebrales y basilar. De esta forma, nuestra observación corrobora que la angioresonancia es una prueba muy sensible y específica para la demostración de patología en las arterias vertebrales y la ACPI, ahorrando al paciente la morbilidad que conlleva la arteriografía convencional (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Thrombosis , Vertebral Artery , Lateral Medullary Syndrome , Magnetic Resonance Angiography , Horner SyndromeABSTRACT
We report a case of a 32-year-old woman who developed paroxysmal episodes of right hemidystonia 2 days after taking fluoxetine. The attacks subsided 2 days after fluoxetine was withdrawn and did not recur afterwards. To our knowledge, this is the first report of paroxysmal dystonia induced by fluoxetine.
Subject(s)
Dystonia/chemically induced , Fluoxetine/adverse effects , Acute Disease , Adult , Depression/drug therapy , Dystonia/diagnosis , Female , Fluoxetine/therapeutic use , HumansABSTRACT
La lesión de un nervio craneal por daño vascular en la protuberancia generalmente se acompaña de afectación de los tractos nerviosos colindantes y es excepcional la presentación como mononeuropatía craneal aislada. Describimos el caso de una mujer de 57 años hipertensa, que presentó de forma brusca parestesias e hipoestesis tactoalgésica en las tres ramas del quinto nervio craneal derecho sin afectación motora y con preservación de los reflejos corneal y maseterino. La resonancia magnética craneal revelaba un pequeño infarto dorsolateral pontino en la salida del trigémino derecho. La neuropatía trigeminal sensitiva aislada es una rara forma de presentación del infarto pontino (AU)
Subject(s)
Middle Aged , Female , Humans , Touch , Trigeminal Nerve , Pons , Paresthesia , Trigeminal Nerve Diseases , Cerebral Infarction , Hypesthesia , FaceABSTRACT
Lesion of cranial nerves due to vascular damage at pontine level generally associates affectation of near nerve tracts. Isolated fifth nerve palsy due to vascular pontine lesions has been scarcely reported. We present a hypertense 57 year old woman who suffered from sudden paresthesias and hypoesthesia on the three divisions of trigeminal nerve without motor involvement and with preservation of corneal and masseter reflexes. Cranial magnetic resonance showed small dorsolateral pontine infarct over the right fifth cranial nerve entry. Isolated sensitive trigeminal neuropathy is a rare debut form of pontine infarct.
