Subject(s)
Basal Ganglia Diseases/diagnosis , Calcinosis/diagnosis , Epilepsy/diagnosis , Neurodegenerative Diseases/diagnosis , Pseudohypoparathyroidism/diagnosis , Adult , Basal Ganglia Diseases/etiology , Calcinosis/etiology , Diagnosis, Differential , Epilepsy/etiology , Humans , Male , Neurodegenerative Diseases/etiology , Pseudohypoparathyroidism/complicationsABSTRACT
The authors report a case of Dropped Head Syndrome with an unusually rapid onset after an accident in a patient with a history of Hodgkin's lymphoma cured by chemotherapy and mantle field radiotherapy and compare this case to the rare published cases of chronic Dropped Head Syndrome occurring after this type of treatment. A 56-year-old man was treated at the age 36 years for supra-diaphragmatic Hodgkin's lymphoma by chemotherapy and mantle field radiotherapy according to a standard technique and standard doses (40Gy, 20 fractions, 27 days). Seventeen years after the end of treatment, he experienced a violent whiplash injury, rapidly followed by a Dropped Head Syndrome, similar to the cases of chronic Dropped Head Syndrome already described in the context of Hodgkin's lymphoma (permanent flexion of the head, only reduced in the supine position). Physical and neurophysiological examination, electromyogram, and magnetic resonance imaging confirmed the diagnosis of Dropped Head Syndrome. Very few treatment options are available for the major disability related to Dropped Head Syndrome. This type of subacute onset of Dropped Head Syndrome has not been previously described. The good results of radiation therapy after chemotherapy allow a dose reduction to 30Gy in the involved regions. This, together with recent progress in treatment planning, should allow eradication of these complications.
Subject(s)
Cervical Plexus/radiation effects , Hodgkin Disease/radiotherapy , Muscle Weakness/etiology , Neck Muscles/innervation , Radiation Injuries/etiology , Radiotherapy, High-Energy/adverse effects , Whiplash Injuries/complications , Accidents, Traffic , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bleomycin/administration & dosage , Cervical Plexus/injuries , Cervical Plexus/physiopathology , Cervical Vertebrae , Combined Modality Therapy , Dacarbazine/administration & dosage , Dose Fractionation, Radiation , Doxorubicin/administration & dosage , Electromyography , Hodgkin Disease/complications , Hodgkin Disease/drug therapy , Humans , Magnetic Resonance Imaging , Male , Mechlorethamine/administration & dosage , Middle Aged , Muscle Weakness/physiopathology , Neck Muscles/physiopathology , Osteoarthritis/complications , Prednisone/administration & dosage , Procarbazine/administration & dosage , Radiation Injuries/physiopathology , Radiotherapy Dosage , Remission Induction , Vinblastine/administration & dosage , Vincristine/administration & dosageABSTRACT
INTRODUCTION: Intramedullary spinal cord abscesses are rare, frequently associated with meningitis, sometimes with epidural abscesses. They are frequently responsible for paraplegia. Staphylococcus aureus is the predominant organism. MRI shows an intramedullary collection giving a low-intensity signal on T1-weighted images with peripheral contrast uptake on enhanced TI-weighted studies and a high-intensity signal on T2-weighted images with generally extended adjacent medullary edema. They may be multiple. CASE REPORT: We report the case of a man who presented meningitis with intramedullary and epidural abscesses. The number of the lesions did not allow chirurgical drainage. The paraplegia did not resolve despite appropriate antibiotic therapy. CONCLUSION: Appropriate antibiotic therapy and early surgical drainage, if feasible, are key factors for better outcome and prognosis.
Subject(s)
Discitis/complications , Epidural Abscess/complications , Meningitis, Bacterial/complications , Paraplegia/etiology , Spinal Cord Diseases/complications , Staphylococcal Infections/complications , Abscess/complications , Abscess/diagnostic imaging , Abscess/etiology , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/pathology , Discitis/diagnostic imaging , Discitis/etiology , Epidural Abscess/diagnostic imaging , Epidural Abscess/etiology , Humans , Male , Medulla Oblongata/diagnostic imaging , Medulla Oblongata/pathology , Meningitis, Bacterial/diagnostic imaging , Middle Aged , Paraplegia/diagnosis , Paraplegia/diagnostic imaging , Radiography , Radionuclide Imaging , Spinal Cord/diagnostic imaging , Spinal Cord/pathology , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/etiology , Spinal Cord Diseases/pathology , Staphylococcal Infections/diagnostic imaging , Staphylococcus aureus/physiologyABSTRACT
INTRODUCTION: Paraneoplastic neurological syndrome associated with anti-CV2/CRMP5 antibodies are rare. Various clinical manifestations can occur, cerebellar ataxia, polyneuropathy, optic neuritis with NORB or uveitis. Small cell lung carcinoma is generally responsible. CASE REPORT: We report the case of a 64-year-old man who developed visual symptoms with papilledema, cerebellar signs, polyneuropathy confirmed with a neurophysiological studies. Anti-CV2/CRMP5 antibodies were present. A small cell lung carcinoma was responsible for this paraneoplastic syndrome revealing the cancer. The paraneoplastic syndrome improved with radio chemotherapy of the cancer alone. CONCLUSION: A paraneoplastic neurological syndrome must be evoked in case of an atypic neurological syndrome. This diagnostic can be confirmed by the presence of anti-neuronal antibodies. In this case, a small cells cancer of the lung must be research.
Subject(s)
Autoantibodies/isolation & purification , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Paraneoplastic Syndromes, Nervous System/diagnosis , Paraneoplastic Syndromes, Nervous System/therapy , Small Cell Lung Carcinoma/diagnosis , Small Cell Lung Carcinoma/therapy , Antineoplastic Protocols , Autoantibodies/blood , Autoimmune Diseases of the Nervous System/blood , Autoimmune Diseases of the Nervous System/diagnosis , Autoimmune Diseases of the Nervous System/etiology , Autoimmune Diseases of the Nervous System/immunology , Autoimmune Diseases of the Nervous System/therapy , Diagnosis, Differential , Humans , Hydrolases , Lung Neoplasms/complications , Lung Neoplasms/immunology , Male , Microtubule-Associated Proteins , Middle Aged , Nerve Tissue Proteins/immunology , Paraneoplastic Syndromes, Nervous System/blood , Paraneoplastic Syndromes, Nervous System/immunology , Small Cell Lung Carcinoma/complications , Small Cell Lung Carcinoma/immunology , Treatment OutcomeABSTRACT
INTRODUCTION: Neurological complications of metronidazole are rare, predominantly peripheral neuropathies, especially in patients on a long-term high-dose regimen. Cerebellar syndrome or seizures are less frequently reported. The concomitant occurrence of the three complications is exceptional. CASE REPORT: We report herein a case with these three complications as side effects of metronidazole. For the cerebellar syndrome, the T2-weighted brain MRI showed a rounded and well-delimited zone of high signal intensity in the cerebellar dentate nuclei, extending up to the protuberance and the subthalamic nucleus, bilaterally and symmetrically. CONCLUSION: Neurological complications are possible when a treatment with metronidazole is prescribed for a long duration or at high dose. In our patient, the clinical abnormalities and MRI signs regressed a few months after treatment withdrawal.
Subject(s)
Cerebellar Diseases/chemically induced , Metronidazole/adverse effects , Neuritis/chemically induced , Seizures/chemically induced , Aged , Cerebellar Diseases/pathology , Cerebellum/pathology , Epilepsies, Myoclonic/chemically induced , Epilepsies, Myoclonic/physiopathology , Humans , Liver Transplantation , Magnetic Resonance Imaging , Male , Neuritis/pathology , Seizures/pathology , Subthalamic Nucleus/pathology , X-Ray DiffractionABSTRACT
Central nervous system localizations of sarcoidosis remain rare. The brain, mainly the posterior fossa, or the spinal cord, mainly cervical, may be involved. We report the case of a white female presenting a stroke of the head of the caudate nuclei with spontaneous hemorrhage transformation related to and associated with rare encephalic and spinal cord sarcoidosis. The magnetic resonance angiography (MRA) of the intracranial vessels showed images of vasculitis. Treatment of the neurologic localizations was difficult.
Subject(s)
Brain Diseases/pathology , Medulla Oblongata/pathology , Sarcoidosis/pathology , Brain/pathology , Caudate Nucleus/pathology , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/pathology , Cranial Fossa, Posterior/pathology , Female , Humans , Magnetic Resonance Angiography , Middle Aged , Middle Cerebral Artery/pathology , Spinal Cord/pathology , Stroke/etiology , Stroke/pathologyABSTRACT
We report a case of a resolutive late cerebral ischemic event, related to radiation induced vasculopathy of the left posterior cerebral artery, documented by MRI, situated in the irradiated volume 24 years before, for an astrocytome with malignant potential.
Subject(s)
Arteritis/complications , Cerebral Arteries/radiation effects , Cerebral Infarction/etiology , Adolescent , Adult , Arteritis/etiology , Astrocytoma/radiotherapy , Brain Neoplasms/radiotherapy , Humans , Male , Radiotherapy/adverse effects , Time FactorsABSTRACT
Opsoclonus-myoclonus syndrome was observed in a patient treated for small-cell lung cancer. Opsoclonus presented as anarchic involuntary eye movements associated with myoclonies of the limbs and trunk. Opsoclonus-myoclonus is exceptional and a specific expression among several paraneoplastic manifestations described in small-cell lung cancer. These manifestations develop late after diagnosis of cancer. Presence of anti-neuronal antibodies in the serum (inconstant) is a factor of very poor prognosis.
Subject(s)
Carcinoma, Small Cell/complications , Lung Neoplasms/complications , Paraneoplastic Syndromes, Nervous System/etiology , Aged , Female , HumansABSTRACT
A 37-year-old woman had a histologically documented occipitovertebral metastasis from an invasive epidermoid carcinoma of the uterine cervix. The metastasis was found 3 months after the primary and was treated by local radiation therapy followed by systemic chemotherapy. Radiation therapy was highly effective in relieving the pain but was not associated with changes in magnetic resonance imaging findings. Lymph node involvement and local extension occurred. The patient died 1 year after the diagnosis of the metastasis. Involvement of the occipitovertebral junction by uterine cervix carcinoma metastasis is exceedingly rare. The relevant literature is reviewed.
Subject(s)
Carcinoma, Squamous Cell/secondary , Cranial Nerve Diseases/etiology , Skull Neoplasms/secondary , Spinal Neoplasms/secondary , Uterine Cervical Neoplasms/pathology , Adult , Carcinoma, Squamous Cell/complications , Female , Humans , Magnetic Resonance Imaging , Skull Neoplasms/complications , Spinal Neoplasms/complications , Tomography, X-Ray ComputedABSTRACT
We report a case of paraneoplastic myasthenic syndrome with clinical features suggesting Lambert Eaton syndrome but without the electromyographic elements required for diagnosis. Anti-calcium channel antibodies were also lacking. The electromyogram evidenced a block and the Tensilon test was positive. The efficacy of anticholinesterases argued in favor of myasthenia but anti-acetylcholine receptor antibodies were negative. The block was more of a mixed nature, involving both presynaptic transmission as in Lambert Eaton syndrome and post-synaptic transmission as in paraneoplastic myasthenia. The primary tumor was identified as a small-cell neuroendocrine lung carcinoma on mediastinal biopsies obtained directly on CT-scan guided puncture of a mediastinal node. Thoracotomy was thus avoided. The Lambert Eaton syndrome is a paraneoplastic manifestation of small-cell lung cancer in 50% of the cases unlike generalized myasthenia which apparently is never associated with small-cell lung cancer. A mixed paraneoplastic neuro-muscle junction disorder with aspects of each can be exceptionally observed.
Subject(s)
Carcinoma, Neuroendocrine/diagnosis , Carcinoma, Small Cell/diagnosis , Lambert-Eaton Myasthenic Syndrome/diagnosis , Lung Neoplasms/diagnosis , Myasthenia Gravis/diagnosis , Paraneoplastic Syndromes/diagnosis , Antineoplastic Agents/therapeutic use , Antineoplastic Agents, Phytogenic/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy , Carboplatin/therapeutic use , Carcinoma, Neuroendocrine/complications , Carcinoma, Neuroendocrine/pathology , Carcinoma, Small Cell/drug therapy , Carcinoma, Small Cell/pathology , Carcinoma, Small Cell/radiotherapy , Combined Modality Therapy , Diagnosis, Differential , Etoposide/therapeutic use , Female , Humans , Lung/pathology , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Lung Neoplasms/radiotherapy , Middle Aged , Radiotherapy Dosage , Tomography, X-Ray ComputedABSTRACT
Intramedullary metastases are uncommon. We report two cases in patients with small cell bronchogenic cancer. The clinical diagnosis was supported by T1 magnetic resonance imaging after gadolinium injection. A unique medullary metastasis associated with other metastatic localizations was observed in the first patient and multiple intramedullary metastases alone in the second. These secondary intramedullary localizations were highly sensitive to chemotherapy after the first monthly cure in the first patient and after the third in the second patient. We emphasize the importance of chemotherapy in such cases, usually associated with focal radiotherapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Bronchogenic/pathology , Carcinoma, Bronchogenic/secondary , Lung Neoplasms/pathology , Spinal Cord Neoplasms/pathology , Spinal Cord Neoplasms/secondary , Aged , Carcinoma, Bronchogenic/drug therapy , Carcinoma, Small Cell/drug therapy , Carcinoma, Small Cell/pathology , Carcinoma, Small Cell/secondary , Female , Humans , Lung Neoplasms/drug therapy , Magnetic Resonance Imaging , Male , Middle Aged , Spinal Cord Neoplasms/drug therapySubject(s)
Cerebral Ventricle Neoplasms/diagnosis , Neurocytoma/diagnosis , Adult , Humans , Magnetic Resonance Imaging , MaleABSTRACT
Epilepsy, frequently with complex partial seizures, is observed in 5.5 p. 100 of all cases of celiac sprue. Bilateral parieto-occipital calcifications in the cortical or subcortical areas are found in about one-half of these patients. This triple association is apparently not fortuitous. Prognosis of epilepsy would depend on how early the gluten-free diet was started. The diagnosis of celiac sprue should be entertained in patients with brain calcifications and epilepsy. Search for anti-endomysium antibodies could provide useful information although villosity atrophy in the proximal portion of the small bowel and its regression with gluten-free diet remain the essential elements for the diagnosis of celiac sprue.
Subject(s)
Brain Diseases/etiology , Calcinosis/etiology , Celiac Disease/complications , Epilepsy, Complex Partial/etiology , Female , Humans , Infant , PrognosisSubject(s)
Arm/physiopathology , Psychomotor Agitation/etiology , Arm/innervation , Female , Humans , Iatrogenic Disease , Middle AgedABSTRACT
Between 1990 and 1993 we observed 10 cases of spinal tuberculosis. Magnetic resonance imaging largely contributed to diagnosis and detection of early neurological complications. Medical treatment is essential and must be given for a sufficient duration. Indications for surgery are exceptional and are usually reserved for severe neurological complications.
Subject(s)
Tuberculosis, Spinal , Adult , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Time Factors , Tuberculosis, Spinal/complications , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/therapySubject(s)
Lyme Disease/complications , Vocal Cord Paralysis/etiology , Adult , Humans , Male , RecurrenceABSTRACT
Over a period of 10 years, a 49-year-old man had 3 episodes of recurrent cranial nerve palsy regressing within a few weeks. Each episode was accompanied with acute inaugural headache and diplopia and once with sensory impairment of the trigeminal nerf and once with tinnitus. The diagnosis of Goujerot-Sjögren's syndrome was retained after demonstration of hypergammaglobulinaemia, a positive Rose Bengale test and histological examination of biopsy specimens from the accessory salivary glands which revealed advanced typical lesions. Clinically, impaired secretion was not obvious.