RESUMO
Acute hemiplegia is a common neurological presentation that usually occurs due to a cerebrovascular accident. A similar presentation may also be seen in several other conditions such as postictal (Todd's) paralysis, hemiplegic migraine, brain abscess, and extradural or subdural hemorrhage. We present the case of a 32-year-old South Indian female who was brought to the emergency department with acute hemiplegia and decreased responsiveness for one day. She was provisionally diagnosed with an ischemic stroke at presentation; however, contrast-enhanced computed tomography (CECT) of the brain with CT angiography and venography revealed no focal lesions or filling defects. CSF examination showed gram-positive cocci in pairs, concerning brain abscess. Magnetic resonance imaging (MRI) of the brain was suggestive of multiple evolving abscesses in the right frontal and parietal lobes. Her hemiplegia was attributed to the abscess, and she was given six weeks of intravenous (IV) antibiotics, after which she recovered completely. Maintaining a high index of clinical suspicion enabled the correct diagnosis in a patient who did not have any typical features of acute meningitis.
RESUMO
The occurrence of ischemia of the digits or digital gangrene is a well-known complication of systemic autoimmune diseases, such as systemic sclerosis, systemic lupus erythematosus, and anti-phospholipid syndrome, among others. The pathophysiological mechanisms are small vessel vasculitis, vasospasm of Raynaud's phenomenon, microthrombi due to antiphospholipid syndrome, and/or accompanying accelerated atherosclerosis. Digital ischemia can also occur in the context of disseminated bacterial infections and sepsis. We present here the case of a patient who had digital ischemia and positive antinuclear antibodies but without well-defined clinical features of a connective tissue disease. A diagnosis of undifferentiated connective tissue disease was made.
