RESUMO
We present a patient with peritoneal carcinosarcoma who was treated with the alkylating agent ifosfamide and experienced a rapid decline in mental status. Electroencephalogram (EEG) displayed generalized periodic epileptiform discharges, which raised suspicion for nonconvulsive status epilepticus (NCSE). Following administration of midazolam, the patient's clinical condition and EEG improved. We review the 8 documented cases of ifosfamide-induced NCSE, and demonstrate the similarity in clinical features when compared with ifosfamide neurotoxicity that is not classified as NCSE. EEG findings suggesting an ictal pattern are subtle and heterogeneous, but they are essential for a diagnosis. Since it is unlikely that EEGs are uniformly obtained in instances of ifosfamide neurotoxicity, many cases of NCSE may go unrecognized.
Assuntos
Carcinossarcoma/tratamento farmacológico , Eletroencefalografia/efeitos dos fármacos , Epilepsia Generalizada/induzido quimicamente , Ifosfamida/efeitos adversos , Ifosfamida/uso terapêutico , Neoplasias Peritoneais/tratamento farmacológico , Processamento de Sinais Assistido por Computador , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/fisiopatologia , Diagnóstico Diferencial , Epilepsia Generalizada/diagnóstico , Epilepsia Generalizada/tratamento farmacológico , Potenciais Evocados/efeitos dos fármacos , Evolução Fatal , Feminino , Humanos , Midazolam/uso terapêutico , Pessoa de Meia-IdadeRESUMO
Autoimmune autonomic ganglionopathy (AAG) and myasthenia gravis (MG) are both autoimmune channelopathies mediated by antibodies directed against nicotinic acetylcholine receptors. While both diseases target acetylcholine receptors, skeletal muscle and ganglionic receptor subtypes have key immunologic and genetic distinctions, and reports of patients with both AAG and MG are rare. We report a patient with antibody-confirmed AAG and elevated levels of ACh binding antibodies that did not meet clinical or electrodiagnostic criteria for MG. We presume that his skeletal muscle nAChR seropositivity was a false positive, perhaps due to the cross reactivity of the patient's ganglionic nAChR antibodies with skeletal nAChR subtypes.
Assuntos
Autoanticorpos/biossíntese , Doenças Autoimunes do Sistema Nervoso/diagnóstico , Doenças Autoimunes do Sistema Nervoso/imunologia , Doenças do Sistema Nervoso Autônomo/imunologia , Miastenia Gravis/imunologia , Receptores Nicotínicos/imunologia , Idoso de 80 Anos ou mais , Autoanticorpos/sangue , Doenças Autoimunes do Sistema Nervoso/sangue , Doenças do Sistema Nervoso Autônomo/sangue , Doenças do Sistema Nervoso Autônomo/diagnóstico , Reações Cruzadas/imunologia , Diagnóstico Diferencial , Reações Falso-Positivas , Gânglios Autônomos/imunologia , Gânglios Autônomos/patologia , Gânglios Autônomos/fisiopatologia , Humanos , Masculino , Miastenia Gravis/sangue , Miastenia Gravis/diagnóstico , Receptores Nicotínicos/classificaçãoRESUMO
Acquired cerebellar tonsillar herniation is a known complication of lumboperitoneal shunt (LPS) for any indication, including idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri.(1) While the underlying pathophysiology of IIH remains unknown, increasing body mass index is a clear risk factor for the development of IIH. We describe an obese patient with IIH unresponsive to LPS who developed symptoms of intracranial hypotension and cerebellar tonsillar herniation after bariatric surgery and a 50-kg weight loss.