RESUMO
Primary or secondary hemifacial spasm (HFS) can be caused by a variety of conditions, one of which is caused by neurovascular contact with a vertebrobasilar dolichoectasia (VBD). Microvascular decompression (MVD) had been known for the treatment of neurovascular contact that gives best outcome, however there were still limitations which surgery cannot be performed. In that case, conservative treatment plays essential role. Our case reported A 69-year-old man with chief complaint right HFS for four years that getting better with conservative treatment (blood pressure management and clonazepam oral).
RESUMO
Fahr syndrome is an uncommon (prevalence < 1/1.000.000) neurological disorder characterized by abnormal calcified deposits in the basal ganglia, nucleus dentatus, and cerebral cortex. These calcification can lead to various neurological manifestations. Distinguishing Fahr syndrome from Fahr disease is crucial due to differences in their etiology, location of lesions, prognosis, and therapy. Currently, Fahr disease lacks a specific treatment, while Fahr syndrome requires target intervention based on the underlying cause. A 35 years old female patient was presented to the emergency department with recurrent tonic-clonic seizures followed by the decreased consciousness. The patient had history of thyroidectomy surgery 7 years before, behavioral disturbances, hallucinations for past 1 week, and cataracts in both eyes. Laboratory examination showed low calcium levels (4 mg/dL), which can trigger seizures, and low PTH levels, indicating hypoparathyroid. A head CT scan without contrast displayed extensive bilateral calcification, particularly in the basal ganglia. Following stabilization, an EEG recording discovered diffuse encephalopathy. The patient received seizure management and maintenance medication of calcium with vitamin D. During the 3 months follow up, no sign of relapses were observed. Intracranial calcifications are often physiological but should be suspected as pathology in certain symptoms and calcification patterns. The presence of multiple intracranial calcifications, specifically in the basal ganglia, indicates Fahr disease or Fahr syndrome, which can cause various neurological manifestations. One of the etiologies of Fahr syndrome to consider is hypoparathyroid. Therefore, identifyisng and managing this etiology is crucial for preventing the progression of Fahr syndrome.
RESUMO
BACKGROUND: Tuberculosis (TB) remains one of the highest Asia's health problems. Spondylitis TB in diabetes mellitus (DM) and hypothyroidism patients is a rare case of extrapulmonary tuberculosis. However, there is a lack of therapeutic guidelines to treat spondylitis TB, particularly with type 2 DM (T2DM) and hypothyroidism as comorbidities. Here we present a case of spondylitis TB with T2DM and hypothyroidism in a relatively young patient and its therapeutic procedure. CASE SUMMARY: We report the case of a 35-year-old male patient from Surabaya, Indonesia. Based on anamnesis, physical examination, and magnetic resonance imaging, the patient has been categorized in stage II of spondylitis TB with grade 1 paraplegia. Surprisingly, the patient also had a high HbA1c level, high thyroid stimulating hormone, and low free T4 (FT4), which indicated T2DM and hypothyroidism. A granulomatous process was observed in the histopathological section. The antituberculosis drugs isoniazid and rifampicin were given. In addition, insulin, empagliflozin, and linagliptin were given to control hyperglycemia conditions, and also levothyroxine to control hypothyroidism. CONCLUSION: The outcome was satisfactory. The patient was able to do daily activities without pain and maintained normal glycemic and thyroid levels. For such cases, we recommend the treatment of spondylitis TB by spinal surgery, together with T2DM and hypothyroidism therapies, to improve the patients' condition. Prompt early and non-invasive diagnoses and therapy are necessary.
