ABSTRACT
The authors describe the case of a patient with transient ischemic attacks (TIAs) from the ipsilateral occluded internal carotid artery (carotid stump syndrome). The patient was submitted to surgical resection of the stump with relief of the symptoms. Thromboembolism from the stump via the anastomotic supply is responsible for the TIAs and is worsened by the blood flow turbulence at this level.
Subject(s)
Arterial Occlusive Diseases/complications , Carotid Artery Diseases/complications , Ischemic Attack, Transient/etiology , Aged , Angiography , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/surgery , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/surgery , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/surgery , Humans , Ischemic Attack, Transient/diagnostic imaging , Ischemic Attack, Transient/surgery , Male , Thromboembolism/etiologyABSTRACT
Os autores relatam o caso de um paciente com ataques isquêmicos transitórios (AITs) cuja fonte de êmbolos originou-se ipsilateralmente ao fundo de saco de uma carótida interna ocluída (carotid stump syndrome). O paciente foi submetido a ressecçäo cirúrgica do "coto" (stump), com alívio total dos sintomas. O tromboembolismo decorrente do fundo de saco ou coto, documentado por arteriografia, se faz através das artérias anastomóticas, sendo agravado pela turbulência do fluxo sangüíneo a esse nível
Subject(s)
Humans , Male , Aged , Arterial Occlusive Diseases/complications , Carotid Artery Diseases/complications , Ischemic Attack, Transient/complications , Carotid Artery, Internal/surgery , Carotid Artery, Internal , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/surgery , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/surgery , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/surgery , Thromboembolism/etiologyABSTRACT
Um estudo aberto, retrospectivo e näo-controlado, foi realizado para avaliar a eficácia e tolerabilidade do tratamento imunossupressor instituído no período de 1982 a 1990 em pacientes com diagnóstico de esclerose múltipla clinicamente definida. Dos 42 pacientes, 18 (43//) foram tratados com uma só droga e 24 (57//) com mais de uma. A tolerabilidade foi avaliada após 6 meses de tratamento em 42 pacientes, dos quais receberam tratamento com predinisona, 26 com azatioprina, 17 com metilpredinisolona e 15 com pulsos de ciclofosfamida. Ocorreram efeitos colaterais reversíveis, de intensidade leve a moderada, em 54// dos pacientes em uso de azatioprina, sendo necessário diminuir a dose ou suspender definitivamente a medicaçäo. Foram observados efeitos adversos em 40// dos pacientes em uso de pulsos de ciclofosfamida e em 12// dos pacientes em tratamento com pulsos de metilprednisolona. Efeitos colaterais relacionados ao uso crônico dos corticódes ocorreram em 83// dos pacientes. Avaliaçäo da eficácia após 2 anos de tratamento imunossupressor, em 15 pacientes com seguimento adequaçäo, mostrou aparente parada do progresso da doença, sugerindo benefício da imunossupressäo em casos com evoluçäo rápida e inabilidade crescente
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Multiple Sclerosis/drug therapy , Immunosuppression Therapy , Immunosuppressive Agents/therapeutic use , Azathioprine/therapeutic use , Cyclophosphamide/therapeutic use , Drug Administration Schedule , Drug Evaluation , Drug Therapy, Combination , Follow-Up Studies , Methylprednisolone/therapeutic use , Prednisone/therapeutic use , Retrospective StudiesABSTRACT
An open, retrospective, uncontrolled study was carried out to evaluate efficacy and tolerability of immunosuppressive therapy used in the period 1982-1990 in patients with clinically definite multiple sclerosis. Of 42 patients 43% were treated with one drug, and the others with more than one. Tolerability was evaluated after at least 6 months of therapy in 6 patients on prednisone, 26 on azathioprine, 17 on methyl-prednisolone and 15 on cyclophosphamide pulses. Reversible mild or moderate side-effects were noted in 54% of the patients on azathioprine, leading to change in dose or withdrawal. There were similar side-effects in 83% of the patients on prednisone, 40% of those on cyclophosphamide, and in 12% of those on methylprednisolone. Efficacy was evaluated in 15 patients with a follow-up of at least 2 years, measured by objective scales. The results indicated therapy appeared to arrest progress of disability. We conclude that this study supports the use of immunosuppression in selected cases with rapidly evolving neurological deficits.
Subject(s)
Immunosuppression Therapy , Immunosuppressive Agents/therapeutic use , Multiple Sclerosis/drug therapy , Adolescent , Adult , Azathioprine/therapeutic use , Cyclophosphamide/therapeutic use , Drug Administration Schedule , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Male , Methylprednisolone/therapeutic use , Middle Aged , Prednisone/therapeutic use , Retrospective StudiesABSTRACT
Antiepileptic drugs, especially carbamazepine and phenytoin, are potent liver enzyme inducers. Since praziquantel, the drug used to treat neurocysticercosis, undergoes extensive liver first-pass metabolism, we carried out a prospective study to verify whether there was a decrease in oral bioavailability induced by carbamazepine and phenytoin. Carbamazepine and phenytoin significantly decreased concentrations of praziquantel, due to increased clearance secondary to induction of first pass-liver metabolism. The magnitude of the decrease is surprisingly high and may be responsible for failures of treatment.
Subject(s)
Carbamazepine/pharmacology , Epilepsy/complications , Phenytoin/pharmacology , Praziquantel/metabolism , Adult , Biological Availability , Carbamazepine/blood , Carbamazepine/therapeutic use , Epilepsy/blood , Epilepsy/drug therapy , Female , Humans , Male , Phenytoin/blood , Phenytoin/therapeutic use , Praziquantel/cerebrospinal fluidABSTRACT
The wide clinical spectrum of neurocysticercosis has led to many attempts at clinical, radiological, CSF and other classifications. Based on an objective review of the relevant literature and on a prospective study of 42 patients with active neurocysticercosis, a new classification is proposed, based on clinical, tomographic, magnetic resonance and CSF evidence of viability of cysts. The first step is to define whether the disease is active or not. Inactive disease may be parenchymal calcifications or hydrocephalus. Active disease may be intraparenchymal, extraparenchymal or mixed. Statistical analysis of 42 cases with active disease shows intraparenchymal disease to occur in younger patients, perhaps more frequently in females, and to have a better prognosis than extraparenchymal of mixed disease. The latter appears to have the worst prognosis. Therapeutic implications are that only active disease warrants etiological therapy. There remain doubts about the best therapy for some infrequent subtypes of extraparenchymal and mixed disease.
Subject(s)
Central Nervous System Diseases/diagnosis , Cysticercosis/diagnosis , Adolescent , Adult , Central Nervous System Diseases/cerebrospinal fluid , Central Nervous System Diseases/drug therapy , Central Nervous System Diseases/etiology , Child , Child, Preschool , Cysticercosis/cerebrospinal fluid , Cysticercosis/drug therapy , Cysticercosis/etiology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Praziquantel/therapeutic use , Prospective Studies , Tomography, X-Ray ComputedABSTRACT
O amplo espectro clínico da neurocisticercose deu espaço a muitas tentativas de classificaçöes clínicas, radiológicas e de LCR, entre outras. Baseados em revisäo objetiva da literatura relevante e em estudo prospectivo de 42 casos de doença ativa, nova classificaçäo é proposta com base em evidências clínicas, tomográficas, de ressonância magnética ou LCR indicando viabilidade de cistos. O primeiro passo é establelecer se a doença é ou näo ativa. Doença ativa pode ser intra ou extraparenquimatosa, ou mista. Análise estatística de 42 casos com doença ativa demonstra que doença intraparenquimatosa ocorre em um grupo mais jovem, talvez mais no sexo feminino, e tem melhor prognóstico que doença extraparenquimatosa ou mista. Doença mista parece ter o pior prognóstico. Implicaçöes terapêuticas säo que somente doença ativa deve receber tratamento etiológico. Permanecem dúvidas sobre a melhor conduta em algumas formas infreqüentes de doença extraparenquimatosa ou mista
Subject(s)
Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Cysticercosis/cerebrospinal fluid , Central Nervous System Diseases/cerebrospinal fluid , Central Nervous System Diseases/diagnosis , Central Nervous System Diseases/etiology , Cysticercosis/diagnosis , Cysticercosis/drug therapy , Cysticercosis/etiology , Magnetic Resonance Imaging , Praziquantel/therapeutic use , Prospective Studies , Tomography, X-Ray ComputedABSTRACT
Serum and CSF concentrations of praziquantel were analyzed in 8 patients with active neurocysticercosis aged 35 +/- 16 (mean +/- sd) years, in order to determine factors that may improve the therapeutic ratio. Praziquantel was given orally at 6-h intervals for 10 days at a daily dose of 100 mg/kg. Serum concentrations were determined at 1, 2 and 4 h, and CSF concentrations at 2 h after the morning dose. Peak serum concentrations occurred between 1 and 2 h after administration. There was a trend towards a drop in serum concentration from Days 1 through 5 to 10 of therapy. A fourfold increase in oral dose led to an eightfold rise in serum and CSF concentration, indicating saturation of hepatic metabolism. There were linear correlations (p less than 0.01) between serum and CSF concentrations of praziquantel, indicating free flow across the blood-brain barrier, above an apparent threshold, which may be related to occupation of plasma protein-binding sites. The results indicate that monitoring of serum concentrations may be clinically useful.
Subject(s)
Cysticercosis/drug therapy , Praziquantel/therapeutic use , Administration, Oral , Humans , Praziquantel/administration & dosage , Praziquantel/blood , Praziquantel/cerebrospinal fluidABSTRACT
Between 1982 and 1988 24 women and 6 men with myasthenia gravis were included in a prospective and standardized diagnostic and therapeutic protocol. Age varied between 10 and 74 years (34 +/- 16, mean +/- standard deviation). Three patients with the ocular form were treated with pyridostigmine. Four patients with the generalized form and advanced age received steroids and/or azathioprine. Twenty-three patients with the generalized form underwent thymectomy followed by prednisone and/or azathioprine. One patient died after complex thymectomy for invasive thymoma. Another died soon after admission in myasthenic/cholinergic crisis. Two other patients had minor complications of thymectomy. Of 19 patients followed for 1-60 (mean 24) months, 11 (58%) are in remission, one of them without any medication.
Subject(s)
Azathioprine/therapeutic use , Immunosuppression Therapy , Myasthenia Gravis/therapy , Prednisone/therapeutic use , Thymectomy , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Child , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Myasthenia Gravis/surgery , Postoperative Complications , Prognosis , Prospective Studies , Thymectomy/adverse effectsABSTRACT
Standard therapeutic regimens of praziquantel for neurocysticercosis use daily doses of 50 mg/kg for 15-21 days, with prolonged remission being achieved in 60-80% patients. In this prospective study, 100 mg/kg daily was used for 10 days in 13 patients aged 32 +/- 15 years (mean +/- SD) with severe intra-, extra-parenchymal or mixed forms of neurocysticercosis. Patients were monitored with computerized tomography and cerebrospinal fluid (CSF) examination on days 1, 5 and 10. Full blood count, sedimentation rate, blood sugar, urea, creatinine, bilirubin, liver transaminases, alkaline phosphatase, urine analysis and electrocardiogram were carried out before and after treatment. Doses of dexamethasone and of other drugs used concomitantly were controlled. There was no toxicity, clinical or detected by the methods employed in the study. After 22 +/- 5 (mean +/- SD) months follow-up, 6 patients needed ventriculoperitoneal shunting, 2 had died, 7 were improved and led useful lives and 4 were in prolonged remission. There was no correlation between serum or CSF praziquantel correlation and outcome of treatment. The proposed regimen is well tolerated, may be as efficient as previously advocated regimens, requires less hospitalization time and may be adopted routinely for therapy of neurocysticercosis.
Subject(s)
Cysticercosis/drug therapy , Nervous System Diseases/drug therapy , Praziquantel/therapeutic use , Adolescent , Adult , Cerebral Ventricles/surgery , Cerebrospinal Fluid Shunts , Child , Child, Preschool , Cysticercosis/cerebrospinal fluid , Female , Humans , Hydrocephalus/physiopathology , Infant , Intracranial Pressure , Male , Middle Aged , Nervous System Diseases/cerebrospinal fluid , Nervous System Diseases/psychology , Praziquantel/administration & dosage , Praziquantel/adverse effects , RecurrenceABSTRACT
A 33-year-old female with neurofibromatosis and intracranial vascular lesions of the Moya-Moya type is reported. Clinical and angiographic aspects of both syndromes are discussed with respect to earlier reports of this rare association, with the conclusion that it produces slow intellectual and motor deterioration in adolescents or young adults. There are no specific guidelines to therapy, and the prognosis is mixed, some patients ceasing to progress at least for a few years.
Subject(s)
Arterial Occlusive Diseases/complications , Moyamoya Disease/complications , Neurofibromatosis 1/complications , Adult , Cerebral Angiography , Female , Humans , Moyamoya Disease/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
O caso de uma paciente de 33 anos com neurofibromatose e lesöes vasculares intracranianas do tipo Moya-Moya é discutido com relaçäo a aspectos clínicos e angiográficos. Revisäo da literatura mostra que esta rara associaçäo produz lenta e progressiva deterioraçäo intelectual e motora em adolescentes e adultos jovens. Näo há linhas específicas de tratamento e o prognóstico é variável, alguns pacientes parecendo cessar de progredir na sua deterioraçäo por pelo menos alguns anos
