RESUMEN
Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are related sleep disorders that occur with increased frequency in spinal cord disease. Effective treatment may be obtained with dopaminergic or opioid drugs, while anticonvulsants, benzodiazepines, and possibly baclofen may be helpful. This report describes a patient who developed RLS and PLMD after acute transverse myelitis associated with infectious mononucleosis, and failed to respond to intrathecal baclofen. All symptoms of RLS/PLMD resolved after treatment with pergolide.
Asunto(s)
Antiparkinsonianos/uso terapéutico , Baclofeno/uso terapéutico , Relajantes Musculares Centrales/uso terapéutico , Mielitis Transversa/complicaciones , Mielitis Transversa/tratamiento farmacológico , Síndrome de Mioclonía Nocturna/tratamiento farmacológico , Síndrome de Mioclonía Nocturna/etiología , Pergolida/uso terapéutico , Síndrome de las Piernas Inquietas/tratamiento farmacológico , Síndrome de las Piernas Inquietas/etiología , Enfermedad Aguda , Antiparkinsonianos/administración & dosificación , Baclofeno/administración & dosificación , Electromiografía , Electrooculografía , Humanos , Inyecciones Espinales , Masculino , Persona de Mediana Edad , Relajantes Musculares Centrales/administración & dosificación , Síndrome de Mioclonía Nocturna/diagnóstico , Pergolida/administración & dosificación , Polisomnografía , Síndrome de las Piernas Inquietas/diagnóstico , Sueño REM/fisiología , Resultado del TratamientoAsunto(s)
Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/secundario , Ependimoma/tratamiento farmacológico , Terapia Genética , Glioma/tratamiento farmacológico , Humanos , Inmunoterapia , Meduloblastoma/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológicoAsunto(s)
Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/secundario , Quimioterapia Adyuvante , Germinoma/tratamiento farmacológico , Glioma/tratamiento farmacológico , Humanos , Inmunoterapia , Infusiones Intraarteriales , Linfoma/tratamiento farmacológico , Tumores Neuroectodérmicos Primitivos/tratamiento farmacológicoAsunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/terapia , Antineoplásicos/efectos adversos , Neoplasias Encefálicas/patología , Quimioterapia Adyuvante , Niño , Preescolar , Ensayos Clínicos como Asunto , Terapia Combinada , Glioma/terapia , Humanos , Inmunoterapia , Metástasis de la NeoplasiaAsunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/terapia , Inmunoterapia/métodos , Antineoplásicos/efectos adversos , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/secundario , Niño , Ensayos Clínicos como Asunto , Terapia Combinada , Glioma/terapia , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Nine patients with leptomeningeal disease are reported who were treated with intraventricular alpha-interferon (alpha-IFN). In seven of these patients, a progressive vegetative state developed during treatment. The patients became unresponsive to verbal commands but opened their eyes with auditory or tactile stimulation. It took an average of 3 weeks for these patients to become verbally responsive after treatment was discontinued. Electroencephalographic findings showed evidence of irritative involvement of the deep midline nuclei in 80% of patients. Periventricular white matter changes developed during treatment in three of six patients who underwent computed tomographic scans. All patients with this severe neurotoxicity received whole-brain irradiation before treatment. Possible mechanisms for the development of this neurotoxic syndrome are discussed. The neurotoxicity of alpha-IFN and brain irradiation may be additive, suggesting a cautious approach when using this combination for treatment.
Asunto(s)
Coma/etiología , Interferón Tipo I/efectos adversos , Neoplasias Meníngeas/tratamiento farmacológico , Adulto , Neoplasias de la Mama/patología , Coma/diagnóstico , Evaluación de Medicamentos , Electroencefalografía , Femenino , Humanos , Neoplasias Pulmonares/patología , Linfoma/patología , Masculino , Melanoma/tratamiento farmacológico , Melanoma/secundario , Neoplasias Meníngeas/mortalidad , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/secundario , Persona de Mediana Edad , Tasa de Supervivencia , Tomografía Computarizada por Rayos XRESUMEN
Hyperthermia delivered by scanned focused ultrasound was combined with external beam radiation to treat 15 patients with primary malignant tumors of the brain. A preliminary craniectomy was performed to avoid attenuation of the ultrasound beam by the skull, and multiple thermal sensors were employed to ascertain intratumoral temperatures. The target temperature was 42.5 degrees C at the tumor boundary. This was attained at more than one point during every complete treatment, while a mean temperature in excess of 42 degrees C was achieved within the scanned tumor volume during at least 1 treatment in 11 patients. Technical problems and toxicities are described.
Asunto(s)
Neoplasias Encefálicas/terapia , Glioblastoma/terapia , Hipertermia Inducida , Adolescente , Adulto , Anciano , Astrocitoma/radioterapia , Astrocitoma/cirugía , Astrocitoma/terapia , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Terapia Combinada , Femenino , Glioblastoma/radioterapia , Glioblastoma/cirugía , Humanos , Hipertermia Inducida/efectos adversos , Hipertermia Inducida/instrumentación , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/terapia , Terapia por Ultrasonido/efectos adversos , Terapia por Ultrasonido/instrumentaciónAsunto(s)
Neoplasias Encefálicas/terapia , Adulto , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/secundario , Carmustina/administración & dosificación , Carmustina/efectos adversos , Carmustina/uso terapéutico , Niño , Terapia Combinada , Glioma/tratamiento farmacológico , Glioma/terapia , Humanos , InmunoterapiaRESUMEN
We describe the case of a patient with acquired immunodeficiency syndrome (AIDS) who had internuclear ophthalmoplegia (INO) and subsequent rapid neurologic deterioration. To our knowledge, this is the first report of a patient with AIDS and INO.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Oftalmoplejía/etiología , Adulto , Humanos , MasculinoAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Intraductal no Infiltrante/tratamiento farmacológico , Cateterismo/efectos adversos , Senos Craneales , Embolia y Trombosis Intracraneal/diagnóstico , Anciano , Ciclofosfamida/administración & dosificación , Dexametasona/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Fluorouracilo/administración & dosificación , Heparina/administración & dosificación , Humanos , Embolia y Trombosis Intracraneal/tratamiento farmacológico , Embolia y Trombosis Intracraneal/etiología , Tomografía Computarizada por Rayos XRESUMEN
We reviewed records of 387 patients with cancer who had Ommaya reservoirs placed between October 1967 and December 1982. Complications of reservoir placement were reported in 27 patients, including intracranial hemorrhage (5 patients) and reservoir malfunction (15 patients). In 15 of 19 patients with meningitis, the infection was linked to the reservoir. The organism most frequently implicated was Staphylococcus epidermidis. Seizures, leukoencephalopathy, and pericatheter necrosis were seen in 10 patients who had received intraventricular chemotherapy.
Asunto(s)
Antineoplásicos/administración & dosificación , Inyecciones Espinales/instrumentación , Neoplasias/tratamiento farmacológico , Adulto , Anciano , Quimioterapia/métodos , Femenino , Humanos , Infecciones/etiología , Inyecciones Intraventriculares , Masculino , Complicaciones Posoperatorias , Infecciones Estafilocócicas/etiologíaRESUMEN
Eight patients were treated with leukocyte interferon for a variety of neurological malignancies that had failed or recurred after conventional therapy. Three patients with malignant astrocytoma received intratumoral interferon in dosages up to 9 million units 3X/week, with total dosages of up to 160 million units. Interferon was administered intraventricularly in 4 patients with leptomeningeal metastases and one patient with multiple brain metastases. Dosages increased from 1 to 10 million units 3X/week, and total dosages of up to 113 million units were given intraventricularly. Acute side effects of fever, nausea, vomiting, and headache occurred almost exclusively with intraventricular injections, and these subsided after the initial injection. Fatigue, loss of appetite, weight loss, and hematologic toxicity developed a few weeks after onset of treatment, independent of the dose given. A modest tumor regression was seen on CT scans of one patient with a malignant astrocytoma, who was treated with interferon for 8 months. In all 4 patients with leptomeningeal metastases, the CSF became free of malignant cells for 6 to 10 weeks, while clinical improvement was less dramatic.
Asunto(s)
Neoplasias Encefálicas/tratamiento farmacológico , Interferón Tipo I/uso terapéutico , Adulto , Astrocitoma/tratamiento farmacológico , Neoplasias Encefálicas/secundario , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma de Células Renales/tratamiento farmacológico , Carcinoma de Células Renales/secundario , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/secundario , Evaluación de Medicamentos , Femenino , Humanos , Neoplasias Renales/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Linfoma/tratamiento farmacológico , Linfoma/secundario , Masculino , Persona de Mediana Edad , Glándula Pineal/efectos de los fármacos , PronósticoRESUMEN
A case of isolated leptomeningeal recurrence of an epithelial ovarian cancer was recently diagnosed and treated successfully with methotrexate placed via an Ommaya reservoir in combination with radiation therapy. A review of the literature revealed no other cases of epithelial ovarian leptomeningeal malignancy similarly treated.
Asunto(s)
Neoplasias Meníngeas/secundario , Neoplasias Ováricas/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Combinada , Implantes de Medicamentos , Femenino , Humanos , Laparotomía , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/terapia , Metotrexato/administración & dosificación , Persona de Mediana Edad , Estadificación de Neoplasias , RadioterapiaAsunto(s)
Metronidazol/uso terapéutico , Compresión de la Médula Espinal/etiología , Neoplasias de la Columna Vertebral/radioterapia , Adolescente , Adulto , Anciano , Ensayos Clínicos como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/radioterapia , Parálisis/etiología , Estudios Prospectivos , Sensación , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/secundarioRESUMEN
Forty-one patients with recurrent primary malignant brain tumors were treated with 2,5-diaziridinyl 3,6-bis (carboethoxyamino), 1,4-benzoquinone (AZQ) at an initial dose of 6-8 mg/m2/day X 5 days. Courses were repeated monthly upon recovery of myelosuppression. Six of 25 evaluable patients (24%) showed definite tumor regression, and 7 (28%) showed disease stability as determined by monthly CT scans and neurologic examination. For all patients receiving one course of AZQ, the response rate was 16% (6 of 37 patients) and the stable disease rate 19%. The estimated median time to tumor progression with AZQ was 54 weeks for the responding patients and 36 weeks for the stable patients. Toxicity consisted of myelosuppression, primarily thrombocytopenia, which was delayed and cumulative. Other toxicities were uncommon. Further clinical trials in patients with malignant primary brain tumors, including combination studies with other drugs, are indicated.
Asunto(s)
Antineoplásicos/uso terapéutico , Astrocitoma/tratamiento farmacológico , Aziridinas/uso terapéutico , Azirinas/uso terapéutico , Benzoquinonas , Neoplasias Encefálicas/tratamiento farmacológico , Glioblastoma/tratamiento farmacológico , Glioma/tratamiento farmacológico , Recurrencia Local de Neoplasia , Adolescente , Adulto , Anciano , Antineoplásicos/efectos adversos , Aziridinas/efectos adversos , Enfermedades de la Médula Ósea/inducido químicamente , Evaluación de Medicamentos , Humanos , Persona de Mediana EdadRESUMEN
We reviewed 76 cases of the empty sella syndrome. Headache was the chief complaint in 47 cases (62%), and 45 patients (60%) presented with signs and symptoms related to increased intracranial pressure and/or pituitary dysfunction. The CSF pressure was elevated in 35 of the 62 patients who had lumbar puncture, suggesting that increased intracranial pressure may play an important role in the pathogenesis of "empty" sella.