RESUMO
A 55-year-old immunocompetent man presented with headache, nausea, progressive bilateral upper lid ptosis, and diplopia. Examination showed bilateral asymmetric upper lid ptosis with limited adduction and elevation of both eyes. Cranial magnetic resonance imaging revealed enhancing intra-axial and extra-axial midbrain lesions. Blood and cerebrospinal fluid were positive for cryptococcal antigen and cerebrospinal fluid fungal cultures grew Cryptococcus neoformans. Treatment with liposomal amphotericin B and flucytosine resulted in complete resolution of his neurological deficits and lesions on neuroimaging. Patients with cryptococcal meningitis may rarely present with bilateral cranial nerve III dysfunction.
Assuntos
Blefaroptose/etiologia , Cryptococcus neoformans/isolamento & purificação , Diplopia/etiologia , Meningite Criptocócica/complicações , Doenças do Nervo Oculomotor/etiologia , Encefalopatias/diagnóstico , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite Criptocócica/diagnóstico , Pessoa de Meia-Idade , Miastenia Gravis/diagnósticoRESUMO
Wilson's disease is an inborn error of copper metabolism characterized by inability of the liver to excrete copper into the bile, with excessive deposition of copper primarily in the liver and in the brain. The lentiform nuclei are involved, most often followed by involvement of the thalami, the pons, midbrain, superior and inferior cerebellar peduncles, and the cerebellar nuclei. Predominant involvement of the thalami and brainstem with no significant involvement of the lentiform nuclei is not common. We present a case of Wilson's disease with minimal involvement of the lentiform nuclei, with marked lesions involving the thalami, midbrain, and pons.
RESUMO
Bone pain, especially back pain, is a common presenting feature of myeloma patients. We report three multiple myeloma patients with exacerbations of back pain and referred shoulder pain resulting from vertebral infections. Two patients were treated with surgery, and one patient had computerized tomography-guided percutaneous needle aspiration for diagnostic purposes. All three patients received a prolonged course of antibiotics. Vertebral infection resolved with this treatment in all three patients without any recurrence. Previous dexamethasone therapy, together with an episode of bacteraemia, appears to be a predisposing factor for vertebral infection. Magnetic resonance imaging enabled the diagnosis in all three patients.
