ABSTRACT
PURPOSE: To report a case of Wernicke's encephalopathy in a nonalcoholic woman with secondary hypoadrenalism. METHODS: A 58-year-old Italian woman developed Wernicke's syndrome secondary to recurrent vomiting due to secondary hypoadrenalism. RESULTS: Recurrent vomiting and resulting malnutrition caused a depletion of the patient's body stores of thiamine and the development of mental confusion and an oculomotor deficit. On the diagnostic suspicion of encephalitis in this patient with immunosuppression due to prolonged cortisone-based therapy, she underwent magnetic resonance imaging, which showed typical bilateral abnormal lesions pathognomonic of Wernicke's encephalopathy. The patient improved after parenteral administration of vitamin B1. CONCLUSIONS: Wernicke's encephalopathy must be regarded as a medical emergency that should be suspected in all cases presenting with a sudden deficit or lack of coordination of the ocular movements associated with ataxia and general degeneration of the mental faculties, in patients who have suffered recurrent vomiting or malnutrition for different reasons.
ABSTRACT
The addition of intrathecal methotrexate to treatment protocols has increased survival rates in children with acute lymphoblastic leukemia but is also associated with varying degrees of neurotoxicity. We describe a 15-year-old female patient diagnosed with acute lymphoblastic leukemia presenting with status epilepticus after receiving intrathecal methotrexate. Magnetic resonance imaging showed reversible cortical and subcortical changes consisting of high-intensity lesions on T2-weighted and fluid-attenuated inversion recovery sequences with postgadolinium enhancement, low signal intensity on diffusion-weighted imaging and increased apparent diffusion coefficient. These findings were consistent with the posterior reversible encephalopathy syndrome. We report our conventional magnetic resonance and diffusion-weighted imaging findings and briefly discuss the pathophysiology of the syndrome.
Subject(s)
Antimetabolites, Antineoplastic/adverse effects , Brain Diseases/chemically induced , Brain Diseases/pathology , Methotrexate/adverse effects , Status Epilepticus/chemically induced , Status Epilepticus/pathology , Adolescent , Antimetabolites, Antineoplastic/administration & dosage , Antimetabolites, Antineoplastic/therapeutic use , Brain/blood supply , Brain/drug effects , Brain/pathology , Diffusion Magnetic Resonance Imaging , Female , Follow-Up Studies , Humans , Injections, Spinal , Magnetic Resonance Imaging , Methotrexate/administration & dosage , Methotrexate/therapeutic use , Phlebography , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , SyndromeABSTRACT
Fetal stroke can occur between the 14th week of pregnancy and the beginning of labor. The incidence is approximately 17-35 of 100,000 live births. Risk factors are correlated to the mother, the pregnancy, or the factors associated with the fetus itself. Computerized tomography and magnetic resonance imaging are the most commonly used imaging techniques. The authors studied 3 cases with neurological symptoms by magnetic resonance imaging and magnetic resonance-angiography. In these cases, the authors found massive involvement of the left hemisphere that was presumptively correlated with the persistence of the oval foramen. Magnetic resonance-angiography showed a flow reduction in the left cerebral vessels, and in 1 case, there was also persistence of the fetal primitive trigeminal artery. The discrepancy between the extent of the cerebral lesions and the neurological symptoms is associated with cerebral plasticity, which is greater in damage occurring early in fetal life.
