RESUMO
Opercular myoclonic-anarthric status epilepticus (OMASE) is a rare form of epilepsia partialis continua presenting as fluctuating dysarthria, or even anarthria. The condition is caused by an epileptogenic lesion involving the opercular cortex of either hemisphere. Speech impairment is secondary to bilateral epileptic activity affecting the glossopharyngeal muscles. This bilateral nature of the condition is due to the fact that innervation of cranial nerves V, VII, IX, X and XII from the opercular area of the primary motor cortex is bilateral. The aetiology of the condition varies, and includes vascular lesions, tumours, and encephalitis, among other causes. A low threshold for clinical suspicion is necessary in order to ensure the timely initiation of antiepileptic treatment, thereby preventing the condition from becoming drug resistant. We present two cases of OMASE which differ in terms of aetiology, clinical course, and treatment response. [Published with video sequences on www.epilepticdisorders.com].
Assuntos
Encéfalo/fisiopatologia , Disartria/diagnóstico , Estado Epiléptico/diagnóstico , Idoso , Anticonvulsivantes/uso terapêutico , Encéfalo/diagnóstico por imagem , Disartria/tratamento farmacológico , Disartria/fisiopatologia , Eletroencefalografia , Humanos , Masculino , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/fisiopatologia , Resultado do TratamentoRESUMO
Carotid artery web is considered an exceptional cause of recurrent ischemic strokes in the affected arterial territory. The underlying pathology proposed for this entity is an atypical fibromuscular dysplasia. We present the case of a 43-year-old woman with no cardiovascular risk factors who had experienced 2 cryptogenic ischemic strokes in the same arterial territory within an 11-month period. Although all diagnostic tests initially yielded normal results, detailed analysis of the computed tomography angiography images revealed a carotid web; catheter angiography subsequently confirmed the diagnosis. Carotid surgery was performed, since which time the patient has remained completely asymptomatic. The histological finding of intimal hyperplasia is consistent with previously reported cases of carotid artery web. Carotid artery web is an infrequent cause of stroke, and this diagnosis requires a high level of suspicion plus a detailed analysis of vascular imaging studies.
Assuntos
Isquemia Encefálica/etiologia , Doenças das Artérias Carótidas/complicações , Artéria Carótida Interna/patologia , Displasia Fibromuscular/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Aspirina/uso terapêutico , Atorvastatina/uso terapêutico , Biópsia , Isquemia Encefálica/diagnóstico por imagem , Fármacos Cardiovasculares/uso terapêutico , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/tratamento farmacológico , Doenças das Artérias Carótidas/patologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/efeitos dos fármacos , Angiografia por Tomografia Computadorizada , Feminino , Displasia Fibromuscular/diagnóstico por imagem , Displasia Fibromuscular/tratamento farmacológico , Displasia Fibromuscular/patologia , Humanos , Hiperplasia , Neointima , Recidiva , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagemRESUMO
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