RESUMO
AIM: To investigate the cause of morphology in non-ovoid multiple sclerosis (MS) lesions lacking a radial course and typical shape. MATERIALS AND METHODS: Non-ovoid atypical lesions without perpendicular extensions to the ventricle were investigated in 95 MS patients by retrospective examination of T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. The relationship between the morphology of these atypical lesions detected in 38 patients and central vein anatomy was examined using susceptibility-weighted imaging (SWI). RESULTS: A central venous structure was observed in 107 (65.6%) of 163 atypical lesions in 38 patients. The distribution of atypical lesions grouped by their shape was as follows: (1) V- or Y-shaped lesions (n=27, 48.6%) were observed where veins bifurcated; (2) crescent-shaped lesions (n=9, 8.4%) were observed where veins formed an arc; (3) patchy lesions comprised 48.6% (n=52) of the atypical lesions and involved multiple medullary veins or medullary veins showing a "caput medusae" distribution; (4) ovoid lesions with a non-radial course (n=19, 17.7%) were generally observed where medullary veins converged to form internal cerebral vein branches. CONCLUSION: Unlike typical MS plaques, non-ovoid atypical lesions make the differential diagnosis of MS challenging. Demonstration of the relationship between venous anatomy and lesion morphology in atypical lesions using SWI will aid in the differential diagnosis.
Assuntos
Encéfalo/irrigação sanguínea , Esclerose Múltipla/patologia , Veias/patologia , Adolescente , Adulto , Diagnóstico Diferencial , Suscetibilidade a Doenças , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Estudos Retrospectivos , Adulto JovemRESUMO
Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with which a variety of neuropathic disorders have been associated. Among these, the acute inflammatory demyelinating polyradiculoneuropathy variant of Guillain-Barré syndrome has been well established. However, acute axonal lumbosacral polyradiculoneuropathy accompanied by albuminocytological dissociation in the cerebrospinal fluid has been extremely rarely reported in SLE. We report on a 47-year-old woman with discoid lupus presenting with acute onset of flaccid paraplegia. Extensive investigations suggested the diagnoses of axonal lumbosacral polyradiculoneuropathy and SLE. Treatment with intravenous methylprednisolone and cyclophosphamide resulted in clinical recovery. Development of immune-mediated polyneuropathy in a patient with discoid lupus should forewarn the clinician regarding transformation into the systemic form of the disease.
Assuntos
Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/fisiopatologia , Lúpus Eritematoso Sistêmico/etiologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Polirradiculoneuropatia/etiologia , Feminino , Humanos , Lúpus Eritematoso Discoide/patologia , Lúpus Eritematoso Sistêmico/patologia , Pessoa de Meia-IdadeRESUMO
Several abnormal synkinetic eye movements during jaw movements may often be seen after trauma or congenitally in the Marcus Gunn jaw winking phenomenon. The most frequent type consists of unilateral ptosis and retraction of the ptotic lid upon moving the jaw. The authors describe a case with isolated simultaneous adduction of the left eye upon jaw movement. This paper presents a rare case of Marcus Gunn jaw winking with trigemino-oculomotor synkinesis.