Subject(s)
Leg/physiopathology , Paresis/etiology , Paresis/pathology , Pyramidal Tracts/pathology , Spinal Cord Injuries/complications , Aged, 80 and over , Female , Functional Laterality , Humans , Infarction/complications , Infarction/pathology , Magnetic Resonance Imaging , Pyramidal Tracts/diagnostic imagingABSTRACT
BACKGROUND AND IMPORTANCE: We describe a patient who developed complete right oculomotor nerve palsy after endovascular coiling for a ruptured posterior communicating artery aneurysm caused by migration of the coils outside the aneurysm. CLINICAL PRESENTATION: A 50-year-old woman was admitted with an acute subarachnoid hemorrhage. She underwent, on the day of admission, endovascular coiling of a ruptured posterior communicating artery aneurysm. Four hours postcoiling, complete right oculomotor nerve palsy developed because of extrusion of the coils outside the aneurysm. The patient recovered completely after surgical exploration with removal of the migrated coils and microsurgical repair of the oculomotor nerve. CONCLUSION: This report illustrates that oculomotor nerve palsy is a rare complication after coiling of a posterior communicating artery aneurysm, and it should serve as a reminder to encourage neurovascular teams to consider surgical exploration in cases of third nerve palsy after endovascular coiling.
Subject(s)
Endovascular Procedures/adverse effects , Microsurgery/methods , Nerve Regeneration , Oculomotor Nerve Injuries/etiology , Oculomotor Nerve Injuries/surgery , Cerebral Angiography , Embolization, Therapeutic , Female , Foreign-Body Migration , Humans , Intracranial Aneurysm/surgery , Magnetic Resonance Imaging , Middle Aged , Recovery of Function , Tomography, X-Ray ComputedABSTRACT
Cerebrotendinous xanthomatosis (CTX) is a rare inherited neurometabolic disease. Clinical symptoms are caused by increased deposition of cholestanol and cholesterol in various tissues. Progressive neurological symptoms are one of the principal manifestations. We report the case of a 44-year-old man who presented with asymmetric parkinsonism. In addition, there were mild bilateral pyramidal signs and a mild polyneuropathy. Brain MRI showed bilateral lesions in the dentate nucleus of the cerebellum and in the substantia nigra. Nuclear brain imaging using I-123-FP-CIT demonstrated an asymmetric reduced presynaptic dopaminergic function of the putamen and caudate nucleus, correlating well with his lateralized bradykinetic-rigid syndrome. CTX was diagnosed based on an increased plasma level of cholestanol, typical cerebellar brain lesions and the causative genetic mutation. CTX presenting with parkinsonism is considered rare and data on the neuroimaging of the dopaminergic deficit are limited.
Subject(s)
Parkinsonian Disorders/diagnostic imaging , Tomography, Emission-Computed, Single-Photon , Tropanes , Xanthomatosis, Cerebrotendinous/diagnostic imaging , Adult , Caudate Nucleus/diagnostic imaging , Caudate Nucleus/pathology , Cerebellum/diagnostic imaging , Cerebellum/pathology , Humans , Male , Parkinsonian Disorders/complications , Putamen/diagnostic imaging , Putamen/pathology , Xanthomatosis, Cerebrotendinous/complicationsABSTRACT
We present the case of an elderly woman chronically treated with valproate as migraine prophylaxis. She developed acute chorea secondary to valproate dose increase. Choreiform movements ceased following valproate discontinuation. Chorea is a rare and dose dependent side effect of valproate.
Subject(s)
Anticonvulsants/adverse effects , Chorea/chemically induced , Migraine with Aura/prevention & control , Valproic Acid/adverse effects , Acute Disease , Aged, 80 and over , Anticonvulsants/administration & dosage , Dose-Response Relationship, Drug , Female , Humans , Valproic Acid/administration & dosageABSTRACT
We describe a farmer who presented with a clinical picture of a transverse thoracic myelitis. MRI showed inflammatory lesions in brain and thoracic spinal cord. Toxocariasis was suspected because of eosinophilia in blood and cerebrospinal fluid, and this diagnosis was confirmed immunologically. He was successfully treated with antihelminthics in combination with corticosteroids. Neurotoxocariasis is rare and diagnosis can be difficult because of the different and atypical clinical manifestations. It should be considered in every case of central neurological syndrome associated with eosinophilia.
ABSTRACT
We describe the case of a 36-year-old man presenting with cognitive impairment and personality change. General paresis of the insane, the chronic cerebral parenchymatous form of neurosyphilis, was diagnosed. MRI showed the typical severe frontotemporal atrophy. Despite antibiotic treatment his mental state further declined. General paresis is rare and diagnosis is difficult because of the non-specific neuropsychiatric symptoms. Early diagnosis and treatment are important.
Subject(s)
Mental Disorders/complications , Neurosyphilis/complications , Neurosyphilis/diagnosis , Adult , Cognition Disorders/etiology , Humans , Male , Mental Disorders/pathology , Personality , Psychiatric Status Rating ScalesABSTRACT
Following chronic daily headache, neoplastic meningitis was diagnosed in a non-smoking 44-year-old man. A bronchial adenocarcinoma was found to be the primary tumor. He was treated with erlotinib. Meningitis as the first manifestation of a malignancy is very rare.
