RESUMO
We report the case of a patient with ruptured middle cerebral artery aneurysm, subarachnoid hemorrhage and frontal intracerebral hemorrhage, who secondarily presented with delayed cerebral ischemia and bilateral occipital infarcts, with complete vision loss, visual anosognosia, and confabulations as the main symptoms. Additionally, the patient had defined features of Cotard syndrome, as revealed by persistent nihilistic delusions. The brain imaging studies showed a bilateral occipital ischemic lesion, as well as frontal and parietal hemorrhagic lesions in the right hemisphere. We address the general theories of anosognosia, confabulation and the problem of why a bilateral occipital lesion is not enough for these metacognitive defects to exist. The presence of right frontal and or parietal hemisphere lesions could be necessary features in most cases.
RESUMO
Nonbacterial thrombotic endocarditis, formerly known as marantic endocarditis, it is an infrequent entity in which sterile, fibrin vegetations develop on heart valve leaflets. It is often diagnosed at the time of autopsy or in latestage malignancies. The most common malignancies associated with nonbacterial thrombotic endocarditis are lung, pancreatic, gastric cancer and adenocarcinomas of an unknown primary site. Diagnosis requires ruling out infective endocarditis and establishing the presence of valvular vegetations using echocardiography. We report the case of a patient with a recent diagnosis of advanced gastric adenocarcinoma who presented with cortical blindness. The computed tomography was compatible with cerebral ischemia. The transoesophageal echocardiogram showed two vegetations in mitral valve. Blood cultures were negative. We emphasize the importance of suspecting nonbacterial thrombotic endocarditis in patients with cancer and systemic embolism.
Assuntos
Cegueira Cortical/etiologia , Endocardite não Infecciosa/complicações , Adenocarcinoma/complicações , Idoso , Cegueira Cortical/diagnóstico por imagem , Cegueira Cortical/patologia , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/patologia , Endocardite não Infecciosa/patologia , Feminino , Humanos , Neoplasias Gástricas/complicações , Tomografia Computadorizada por Raios X/métodosRESUMO
Las manifestaciones clínicas del ACV son muy variables, no sólo la clásica hemiplejia facio-braquio-crural, déficit sensitivo contralateral y afasia, sino que también puede presentarse, en menos frecuencia, por déficit neurológicos de variada índole, tal es el caso del síndrome de Anton, en que debido a un afección del territorio cortical visual primario bilateral (área 17 de Brodmann) y al área de asociación vecina, caracterizado por ceguera cortical y anosognosia. Comunicamos el caso de un hombre que presenta este síndrome, que debido a dos ACVs, uno antiguo y otro reciente, cuyo diagnóstico fue confirmado por TAC de cerebro.
Clinical manifestations of stroke are highly variable, not only the classic hemiplegia facio-brachio-crural, contralateral sensory loss and aphasia, but can also occur, less frequently, neurological deficits of various kinds, as in the case of the syndrome in Anton, a condition that due to the territory bilateral primary visual cortex (Brodmann area 17) and the neighboring association area, characterized by cortical blindness and anosognosia. We report the case of a man who has this syndrome, due to two LCAs, one old and one recent, whose diagnosis was confirmed by brain CT.