RESUMO
Background: Melanosis is a blackened pigmentation resulting from the accumulation of melanocytes in tissues that are not normally pigmented. This change in the color of the organs occurs due to the agglomeration of melanocytes originating from abnormal migration during embryogenesis and does not cause dysfunction to the affected organ. Although melanosis frequently occurs in several species and affects several organs such as the brain and spinal cord leptomeninges, involvement in the thalamus region is unusual. The objective of this work was to report 2 cases of thalamic melanosis in goats, determining the pathological and histochemical aspects that assist in the diagnosis of this condition. Cases: Two cases of thalamic melanosis in goats were diagnosed. In both cases, the animals had no nervous history disease and clinical signs. The cause of death in cases 1 and 2 was established based on anatomopathological findings and clinical signs being diagnosed with mycoplasmosis and asphyxia, respectively. After fixing and making cross-sections of the brain, a focal lengthy blackened area was observed on the thalamus surface in both cases. Microscopically, lesions in the brain were similar in both cases and exclusively affected the thalamus. These cells had abundant cytoplasm, well delimited with brownish granular pigment. The nuclei were difficult to visualize and in some cells, it was rounded, well-defined, morphologically compatible with melanocytes. Melanocytes were mainly distributed around neurons and often distended the perivascular space of multiple blood vessels. In Fontana Masson staining, the granules in the cytoplasm of these cells stained strongly black. The Prussian Blue, Periodic Acid- Schiff's, Von Kossa, and Giemsa stains were negative, and the pigment remained brown. In the unstained slides, assembled after the deparaffinization and clarification process, it was observed the permanence of cells with blackish-brown pigment in the cytoplasm. In immunohistochemistry, strong immunostaining of pigmented cells with the Anti-MelanA antibodies was observed in both cases. Discussion: The diagnosis of thalamic melanosis in goats was carried out based on the characteristic pathological findings, in which melanin pigments were demonstrated and identified through HE, Fontana-Masson staining, and unstained slides and confirmed by the IHC. The use of complementary histochemical techniques was fundamental for the classification of the pigment as melanin, demonstrating to be an accessible and reliable tool for the diagnosis of pathological processes that lead to the accumulation of pigments and or material in the tissues. The occurrence of melanin in the thalamus may be associated with a failure in the migration of melanoblasts, which would go to the optical pathways or to the thalamus. This erratic migration of melanoblasts can be explained by the fact that the forebrain is the embryogenic origin of the optic and diencephalon pathways. Macroscopically, thalamic melanosis must be differentiated mainly from neoplastic processes such as melanoma and hemangiosarcoma, pigmented fungus infections, Phalaris angusta poisoning, listeriosis, neurocutaneous melanosis, and neuromelanin. It was concluded that thalamic melanosis is an uncommon alteration in goats and although it has been diagnosed as an incidental necropsy finding, should be included in the differential diagnosis of diseases that affect the central nervous system, especially those that have a color change associated with the deposition of pigments in the tissues.
Assuntos
Animais , Doenças Talâmicas/veterinária , Tálamo/patologia , Ruminantes , Melaninas/análise , Melanose/veterinária , Imuno-Histoquímica/veterináriaRESUMO
Congenital Zika virus syndrome (CZVS) is associated with severe neurological deficits. Clinical characteristics of epilepsy and the electroencephalographic (EEG) pattern in CZVS were documented in infancy. In this study, we aimed to describe the EEG findings observed during the follow-up of children with CZVS. Seventy-six EEGs of 55 children (60% female; mean age = 50 months) with confirmed CZVS were analyzed, considering the background, interictal, and ictal epileptiform discharges. Continuous (or almost continuous) epileptiform discharges during non-rapid eye movement sleep were identified in 22 (40%) patients. In 20 (90.1%) patients, the pattern was symmetrical, with an anterior predominance of the epileptiform activity. All patients with this pattern had epilepsy, which was severe in 15 (68.2%) and demanded polytherapy in 19 (86.4%). Subcortical calcifications (77.3%) and multifocal EEGs (72.8%) in earlier ages occurred more often in patients with this pattern. Other unspecific interictal EEG patterns were focal epileptiform discharges in 23 (41.8%) and multifocal activity in six (10.9%). In CZVS, continuous (or almost continuous) epileptiform discharges during sleep emerge as a pattern after the second year of life. This was associated with severe and drug-resistant epilepsy, but not necessarily with an apparent regression. Subcortical calcifications and multifocal epileptiform discharges in infancy are associated with this pattern.
Assuntos
Encéfalo/fisiopatologia , Epilepsia/fisiopatologia , Malformações do Desenvolvimento Cortical/fisiopatologia , Sono , Infecção por Zika virus/congênito , Infecção por Zika virus/fisiopatologia , Anticonvulsivantes/uso terapêutico , Doenças dos Gânglios da Base/diagnóstico por imagem , Doenças dos Gânglios da Base/fisiopatologia , Encéfalo/diagnóstico por imagem , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/patologia , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , Pré-Escolar , Progressão da Doença , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Epilepsia Resistente a Medicamentos/fisiopatologia , Eletroencefalografia , Epilepsias Parciais/diagnóstico por imagem , Epilepsias Parciais/tratamento farmacológico , Epilepsias Parciais/fisiopatologia , Epilepsia/diagnóstico por imagem , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , Malformações do Desenvolvimento Cortical/diagnóstico por imagem , Tamanho do Órgão , Polimicrogiria/diagnóstico por imagem , Polimicrogiria/fisiopatologia , Índice de Gravidade de Doença , Síndrome , Doenças Talâmicas/diagnóstico por imagem , Doenças Talâmicas/fisiopatologia , Infecção por Zika virus/diagnóstico por imagemRESUMO
ABSTRACT. The ability to repeat words is almost always preserved in thalamic aphasia. The pathophysiology of both thalamic aphasia and preservation of repetition are not fully understood. In a case of severe aphasia with preserved repetition after a left thalamic hemorrhage, MRI disclosed left thalamic lesion and loss of fractional anisotropy in the left centrum semiovale. FDG-PET showed severe hypometabolism in the left cerebral hemisphere, except for superior and transverse temporal gyri, calcarine fissure and frontopolar regions. Primary sensory function may be less functionally dependent on thalamic connections than heteromodal and paralimbic areas, which have connections with several thalamic nuclei. The extensive cortical hypometabolism due to diaschisis may have been responsible for the severity of the aphasia, whereas the less severe reduction of metabolism in the superior and transverse temporal gyri, and also, albeit less evident, in Broca's area, might explain the preservation of repetition.
RESUMO. A capacidade de repetir palavras é quase sempre preservada na afasia talâmica. A fisiopatologia da afasia talâmica assim como a da preservação da repetição não são totalmente compreendidas. Em um caso de afasia grave com repetição preservada após hemorragia talâmica esquerda, a RM revelou lesão talâmica esquerda e perda de anisotropia fracionada no centro semioval. O FDG-PET revelou hipometabolismo grave no hemisfério cerebral esquerdo, exceto nos giros temporais superiores e transversos, fissura calcarina e regiões frontopares. A função sensorial primária pode ser menos funcionalmente dependente das conexões talâmicas do que as áreas heteromodais e paralímbicas, que têm conexões com vários núcleos talâmicos. O hipometabolismo cortical extenso devido à diasquise pode ter sido responsável pela gravidade da afasia, enquanto a redução menos severa do metabolismo nos giros temporal superior e transverso, e também, embora menos evidente, na área de Broca, poderia explicar a preservação da repetição.
Assuntos
Humanos , Afasia , Doenças Talâmicas , NeuroimagemRESUMO
Se presenta el caso clínico de un paciente de 67 años de edad, quien ingresó en el Servicio de Neurología del Hospital General Docente Dr Juan Bruno Zayas Alfonso, Santiago de Cuba, con manifestaciones clínicas neurológicas y cifras elevadas de tensión arterial, además de alteraciones electrocardiográficas que semejaban isquemia miocárdica. Ante la ausencia de dolor precordial u otros signos clínicos de isquemia miocárdica fue imposible diagnosticar un síndrome coronario agudo, por lo cual se le realizó una tomografía axial computarizada simple de cráneo, cuyo resultado confirmó que se trataba de una hemorragia intracerebral talámica. Finalmente, los biomarcadores de necrosis miocárdica resultaron negativos.
The case report of a 67 year-old patient is presented who was admitted in the Neurology Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital, Santiago de Cuba, with neurological clinical manifestations and high values of blood pressure, besides electrocardiographical changes similar to myocardial ischemia. As there was absence of precordial pain or other clinical signs of myocardial ischemia, it was impossible to diagnose an acute coronary syndrome, reason why a simple skull on-line axial tomography was carried out which result confirmed that it was an intracerebralthalamic hemorrhage. Finally, the biomarkers of myocardial necrosis were negative.
Assuntos
Humanos , Masculino , Idoso , Doenças Talâmicas , Hemorragia Cerebral , Síndrome Coronariana Aguda , Eletrocardiografia , Cardiopatias/diagnósticoRESUMO
Huntington's disease (HD) is a neurologic disorder that is not completely understood; its fundamental physiological mechanisms and chemical effects remain somewhat unclear. Among these uncertainties, we can highlight information about the concentrations of brain metabolites, which have been widely discussed. Concentration differences in affected, compared to healthy, individuals could lead to the development of useful tools for evaluating the progression of disease, or to the advance of investigations of different/alternative treatments. The aim of this study was to compare the thalamic concentration of metabolites in HD patients and healthy individuals using magnetic resonance spectroscopy. We used a 2.0-Tesla magnetic field, repetition time of 1500 ms, and echo time of 135 ms. Spectra from 40 adult HD patients and 26 control subjects were compared. Quantitative analysis was performed using the LCModel method. There were statistically significant differences between HD patients and controls in the concentrations of N-acetylaspartate+N-acetylaspartylglutamate (NAA+NAAG; t-test, P<0.001), and glycerophosphocholine+phosphocholine (GPC+PCh; t-test, P=0.001) relative to creatine+phosphocreatine (Cr+PCr). The NAA+NAAG/Cr+PCr ratio was decreased by 9% and GPC+PCh/Cr+PCr increased by 17% in patients compared with controls. There were no correlations between the concentration ratios and clinical features. Although these results could be caused by T1 and T2 changes, rather than variations in metabolite concentrations given the short repetition time and long echo time values used, our findings point to thalamic dysfunction, corroborating prior evidence.
Assuntos
Doença de Huntington/metabolismo , Espectroscopia de Ressonância Magnética , Doenças Talâmicas/metabolismo , Tálamo/fisiopatologia , Adolescente , Adulto , Idoso , Ácido Aspártico/análogos & derivados , Ácido Aspártico/análise , Estudos de Casos e Controles , Creatina/análise , Deutério , Dipeptídeos/análise , Feminino , Glicerilfosforilcolina/análise , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Fosfocreatina/análise , Fosforilcolina/análise , Doenças Talâmicas/diagnóstico , Repetições de Trinucleotídeos , Adulto JovemRESUMO
Huntington's disease (HD) is a neurologic disorder that is not completely understood; its fundamental physiological mechanisms and chemical effects remain somewhat unclear. Among these uncertainties, we can highlight information about the concentrations of brain metabolites, which have been widely discussed. Concentration differences in affected, compared to healthy, individuals could lead to the development of useful tools for evaluating the progression of disease, or to the advance of investigations of different/alternative treatments. The aim of this study was to compare the thalamic concentration of metabolites in HD patients and healthy individuals using magnetic resonance spectroscopy. We used a 2.0-Tesla magnetic field, repetition time of 1500 ms, and echo time of 135 ms. Spectra from 40 adult HD patients and 26 control subjects were compared. Quantitative analysis was performed using the LCModel method. There were statistically significant differences between HD patients and controls in the concentrations of N-acetylaspartate+N-acetylaspartylglutamate (NAA+NAAG; t-test, P<0.001), and glycerophosphocholine+phosphocholine (GPC+PCh; t-test, P=0.001) relative to creatine+phosphocreatine (Cr+PCr). The NAA+NAAG/Cr+PCr ratio was decreased by 9% and GPC+PCh/Cr+PCr increased by 17% in patients compared with controls. There were no correlations between the concentration ratios and clinical features. Although these results could be caused by T1 and T2 changes, rather than variations in metabolite concentrations given the short repetition time and long echo time values used, our findings point to thalamic dysfunction, corroborating prior evidence.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Doença de Huntington/metabolismo , Espectroscopia de Ressonância Magnética , Doenças Talâmicas/metabolismo , Tálamo/fisiopatologia , Ácido Aspártico/análise , Ácido Aspártico/análogos & derivados , Estudos de Casos e Controles , Creatina/análise , Deutério , Dipeptídeos/análise , Glicerilfosforilcolina/análise , Atividade Motora , Fosfocreatina/análise , Fosforilcolina/análise , Repetições de Trinucleotídeos , Doenças Talâmicas/diagnósticoRESUMO
Thalamic dysfunction has been associated with schizophrenia and other psychotic disorders. We describe an adult patient with a lacunar infarct in the posterior region of the right thalamus exhibiting a paranoid schizophrenia-like psychosis as the only clinical manifestation. Neuropsychological assessment showed alterations in visuospatial memory and executive functions at follow up. This case highlights the role of information processing by the thalamus in the development of delusions. We suggest that dysfunction of the right mediodorsal and pulvinar thalamic nuclei disrupts both thalamic sensory processing and thalamo-prefrontal circuits mediating belief evaluation, leading to delusional beliefs.
Assuntos
Esquizofrenia Paranoide/etiologia , Acidente Vascular Cerebral Lacunar/psicologia , Doenças Talâmicas/psicologia , Adulto , Antipsicóticos/uso terapêutico , Delusões/etiologia , Delusões/psicologia , Humanos , Masculino , Transtornos da Memória/etiologia , Transtornos da Memória/psicologia , Testes Neuropsicológicos , Risperidona/uso terapêutico , Esquizofrenia Paranoide/tratamento farmacológico , Esquizofrenia Paranoide/psicologia , Psicologia do Esquizofrênico , Acidente Vascular Cerebral Lacunar/complicações , Doenças Talâmicas/complicações , Doenças Talâmicas/tratamento farmacológico , Núcleos Talâmicos/patologia , Percepção Visual/fisiologia , Escalas de WechslerRESUMO
BACKGROUND: The term "central post-stroke pain" is more appropriate to describe neuropathic pain following a cerebrovascular accident. Most patients complain of burning and other symptoms like lacerating and shooting pain. Treatment options for central pain are limited in number and efficacy. CASE REPORT: This paper reports on a 47-year-old man with central post-stroke pain refractory to treatment. The patient underwent insertion of a deep brain stimulator utilizing the Leksell frame. The target was the left centromedian thalamic nuclei. He had a qualitative symptomatic improvement. CONCLUSION: Deep brain stimulation can be a useful tool when all other modalities have failed. It is a minimally invasive neurosurgical procedure that may improve the quality of life in carefully selected (often desperate) patients with central post-stroke pain.
Assuntos
Estimulação Encefálica Profunda/métodos , Dor Intratável/terapia , Doenças Talâmicas/terapia , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor Intratável/etiologia , Dor Intratável/patologia , Acidente Vascular Cerebral/complicações , Doenças Talâmicas/etiologia , Doenças Talâmicas/patologia , Resultado do TratamentoRESUMO
Se trata de una paciente con antecedentes de hipertensión arterial que presentó súbitamente un déficit motor y sensitivo en el hemicuerpo izquierdo por lo que fue hospitalizada y se le halló una hemorragia en el tálamo derecho. Presentó movimientos coreoatetósicos en dicho hemicuerpo, trastornos del comportamiento y de la conducta así como ánimo depresivo. Un año más tarde, solo se consiguió alivio parcial de la coreoatetosis.
A woman patient with past history of arterial hypertension developed right hemihypoestesia and hemiplegia. She was hospitalized and a thalamic hemorrhage was found. Then, she presented hemicoreoathetosis, behavior alterations and depressive mood. One year later, a partial amelioration of choreoathetosis was obtained.
Assuntos
Humanos , Feminino , Adulto , Doenças Talâmicas , Hemorragia , Síndrome de Lesch-NyhanRESUMO
BACKGROUND AND OBJECTIVES: Cerebrovascular diseases are responsible for a large proportion of deaths in the world. Among survivors, the majority of limiting sequelae observed is motor in origin; but when sensorial pathways or centers are affected patients can evolve with sensorial changes in the body region represented by the area of the brain affected. When the affected area is related to the thalamus the patient might develop thalamic syndrome. The objective of this report was to demonstrate the use of electroacupuncture as adjuvant in the treatment of central pain, diagnosed as thalamic syndrome difficult to control with pharmacologic therapy. CASE REPORT: This is a 46 year-old female with history of ischemic stroke in the left temporoparietal region in April 2003 that evolved to right hemiparesis and hemitaxia. One year later, the patient developed continuous, insidious pain on the right side of the body with allodynia and hyperalgia, diagnosed as thalamic syndrome. In January 2006, she was admitted to the department of pain therapy and palliative care of Santa Casa de Misericórdia de São Paulo where pharmacologic treatment was instituted with poor response; she was scheduled for neurofunctional surgery. In July 2009, electroacupuncture, in an attempt to obtain better pain control, was proposed to the patient. Electroacupuncture was done on points in the scalp. After the 11(th) session, her pain was controlled, with no use of opioids or topical amitriptyline, her well-being had increased, her motor coordination improved, she presented global pain reduction, complete in hand and face. CONCLUSIONS: The efficacy of electroacupuncture in pain control and well-being are in agreement with modern studies which demonstrated activation of antinociceptive pathways in the brain. Controlled prospective studies are required to reaffirm and consolidate electroacupuncture as an important technique in controlling central pain.