RESUMO
The involvement of the nervous system may occur in 36.4% of patients with COVID-19. Cases have been described of cerebrovascular diseases, encephalitis, encephalopathies, and changes in smell and taste. Two months after being discharged from hospital with COVID-19, a 63-year-old male patient presented with a predominantly demyelinating multiple sensory and motor mononeuropathy. A diagnostic possibility of multiple sensory and motor demyelinating mononeuropathy (Lewis-Sumner syndrome) was made. Treatment with human immunoglobulin was initiated. COVID-19 may be associated with multiple demyelinating sensory and motor mononeuropathy.
Assuntos
Encefalopatias , COVID-19 , Transtornos Cerebrovasculares , Mononeuropatias , Encefalopatias/complicações , COVID-19/complicações , Transtornos Cerebrovasculares/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mononeuropatias/complicaçõesRESUMO
Se realizó una revisión bibliográfica con el objetivo de obtener información actualizada acerca de las características, diagnóstico y tratamiento del síndrome del uno y medio. Se emplearon principalmente las bases de datos disponibles en Infomed, Google Scholar y Pubmed. El síndrome del uno y medio es una entidad infrecuente, que se caracteriza por parálisis de la mirada conjugada horizontal y alteración del fascículo longitudinal medial ipsilateral secundario a diversas etiologías, entre las que se incluyen la enfermedad cerebrovascular y la esclerosis múltiple. Clínicamente se presenta con exotropía y nistagmo a la abducción. Su diagnóstico puede ser establecido en la exploración por las alteraciones típicas de los movimientos oculares, mientras que la imagen de resonancia magnética cerebral resulta indispensable para el diagnóstico diferencial y etiológico(AU)
One and a half syndrome is an infrequent condition characterized by conjugate horizontal gaze palsy and ipsilateral medial longitudinal fasciculus alteration secondary to various etiologies, including cerebrovascular disease and multiple sclerosis. Clinically, it presents with exotropia and abduction nystagmus. Its diagnosis may be established during exploration, due to the typical eye movement alterations, whereas brain magnetic resonance imaging is indispensable for differential and etiological diagnosis. A bibliographic review was conducted to obtain updated information about the characteristics, diagnosis and treatment of one and a half syndrome. Use was made of the databases available in Infomed, Google Scholar and Pubmed(AU)
Assuntos
Humanos , Imageamento por Ressonância Magnética/métodos , Transtornos Cerebrovasculares/etiologia , Exotropia/diagnóstico , Diagnóstico Diferencial , Esclerose Múltipla/etiologia , Literatura de Revisão como Assunto , Bases de Dados BibliográficasRESUMO
The reversible cerebral vasoconstriction syndrome is a variable, segmental, and multifocal constriction of brain arteries, usually with a benign course. We describe the case of a 49-year-old woman who presented with headaches, visual symptoms, and seizures. Three days after admission, vasoconstriction areas were found in at least two vascular territories in two segments of the same arteries. The patient was admitted to the intensive care unit where her blood pressure was monitored and she received medical treatment. Surprisingly, the patient presented an unpredicted evolution in developing malignant cerebral edema on the seventh day after admission. She then suffered brain death and was taken to organ donation. A guided nervous system necropsy was later performed. The pathology discarded vasculitis and exhibited hemorrhage areas in the cerebral convexity. Herein, we discuss the most relevant aspects of cases with fulminant evolution reported in the literature. The reversible cerebral vasoconstriction syndrome is usually associated with fatal outcomes when patients exhibit focalization, their first neuroimaging typically shows disturbances, and a rapid clinical deterioration occurs. It is crucial to identify factors linked to poor prognosis and set intervention strategies and early prevention.
El síndrome de vasoconstricción cerebral reversible se produce por la constricción variable, segmentaria y multifocal, de las arterias cerebrales y, generalmente, es de curso benigno. Se describe el caso de una mujer de 49 años que consultó por cefalea, síntomas visuales y convulsiones; tres días después, presentaba áreas de vasoconstricción en, por lo menos, dos territorios vasculares y dos segmentos de las mismas arterias. Fue internada en la unidad de cuidados intensivos para controlarle la presión arterial y recibir tratamiento médico. Tuvo una evolución tórpida y, en el séptimo día de hospitalización, desarrolló edema cerebral maligno, tras lo cual ocurrió la muerte cerebral. Se inició entonces el plan de donación de órganos y, posteriormente, se practicó una autopsia guiada del cerebro. El estudio de patología descartó vasculitis y reveló áreas de hemorragia en la convexidad cerebral. Se discuten los aspectos más relevantes de los casos con evolución fulminante informados en la literatura científica. El síndrome de vasoconstricción cerebral reversible se asocia con resultados fatales cuando los pacientes tienen una deficiencia neurológica focal, la neuroimagen inicial muestra alteraciones y hay un deterioro clínico rápido. Es importante conocer los factores asociados con un mal pronóstico, y establecer estrategias tempranas de intervención y prevención.
Assuntos
Transtornos Cerebrovasculares , Encéfalo , Transtornos Cerebrovasculares/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Neuroimagem , Doenças Raras , VasoconstriçãoRESUMO
EXpanding Treatment for Existing Neurological Disease (EXTEND) investigated whether hydroxycarbamide lowers transcranial Doppler (TCD) velocities in Jamaican children with sickle cell anaemia (SCA) and elevated TCD velocity with or without previous stroke. Forty-three children (age 2-17 years) with baseline maximum time-averaged mean velocity (TAMV) ≥ 170 cm/s were stratified into three risk categories based on treatment status and stroke history: Group 1 (no history of stroke, on hydroxycarbamide, n = 12); and Groups 2 (no stroke, no hydroxycarbamide, n = 21) and 3 (previous stroke, no hydroxycarbamide, n = 10). Open-label hydroxycarbamide at 20 mg/kg/day was commenced, with escalation to maximum tolerated dose (MTD) based on mild marrow suppression (average dose 25·4 ± 4·5 mg/kg/day). TCD was performed every six months with brain magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) at baseline and after 18-months of hydroxycarbamide. The maximum TAMV decreased significantly compared to baseline (24 ± 30 cm/s, P < 0·0001), with similar declines in all groups. Clinical stroke occurred in five children, one in Group 1, none in Group 2, and four in Group 3, P = 0·0032, comparing group incidence rates. Brain MRI/MRA was stable in children without clinical stroke. EXTEND documents the feasibility and benefits of hydroxycarbamide at MTD to lower TCD velocities and reduce stroke risk in children with SCA and no history of primary stroke in low-resource settings without transfusion management.
Assuntos
Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/uso terapêutico , Circulação Cerebrovascular , Transtornos Cerebrovasculares/etiologia , Hidroxiureia/uso terapêutico , Ultrassonografia Doppler Transcraniana , Adolescente , Anemia Falciforme/fisiopatologia , Velocidade do Fluxo Sanguíneo , Transtornos Cerebrovasculares/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Jamaica , Imageamento por Ressonância Magnética , Masculino , Neuroimagem , Estudos Prospectivos , Recidiva , Método Simples-Cego , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
A letter to the editor to discuss several uses of brain magnetic resonance imaging (MRI) in the investigation of neurological manifestations of covid-19. Described several situations in which the MRI is needed. Brain MRI is an important diagnostic method in the covid-19 scenario, to investigate possible neurological complications of the disease.
Assuntos
COVID-19/complicações , COVID-19/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/etiologia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/etiologia , Cefaleia/diagnóstico por imagem , Cefaleia/etiologia , HumanosRESUMO
La presión intraocular es considerada el único factor causal potencialmente modificable con el propósito de prevenir la ceguera por glaucoma. Esta es una enfermedad multifactorial y, aunque es el factor de riesgo más importante en su desarrollo, la reducción de sus valores no garantiza el cese de la progresión del daño glaucomatoso. El glaucoma primario de ángulo abierto y el glaucoma de presión normal comparten factores de riesgo similares en la patogénesis y se pueden clasificar en categorías mecánicas y vasculares. La evidencia científica actual ha logrado demostrar que existe una importante asociación entre las enfermedades sistémicas con compromiso vascular, como la migraña, la apnea obstructiva del sueño, la hipotensión arterial de diferentes causas, la hipertensión arterial, la enfermedad cerebrovascular, la cardiopatía isquémica y la diabetes mellitus con los hallazgos a nivel ocular en pacientes con neuropatía óptica glaucomatosa. Esta correlación orienta a considerar estas enfermedades en conjunto para que cada profesional dedicado a la salud visual considere siempre imprescindible la evaluación de los aspectos que vinculan estas enfermedades para actuar en consecuencia. Se realiza una búsqueda sobre el glaucoma y las enfermedades sistémicas con compromiso vascular(AU)
Intraocular pressure is considered to be the only potentially modifiable causative factor to prevent glaucoma blindness. However, glaucoma is a multifactorial disease, and true as it is that its main risk factor is intraocular pressure, its reduction does not ensure cessation of the progress of glaucomatous damage. Primary open angle glaucoma and normal pressure glaucoma share similar pathogenetic risk factors, and may be classified as mechanical or vascular. According to current scientific evidence, an important association exists between systemic diseases with vascular involvement, such as migraine, obstructive sleep apnea, arterial hypotension of various causes, arterial hypertension, cerebrovascular disease, ischemic heart disease and diabetes mellitus, and ocular findings in patients with glaucomatous optic neuropathy. In view of this correlation, these diseases should be considered jointly, so that visual health professionals always bear in mind the evaluation of their common characteristics and act in consequence. A search was carried out on glaucoma and systemic diseases with vascular compromise(AU)
Assuntos
Humanos , Glaucoma/diagnóstico , Fatores de Risco , Pressão Intraocular , Literatura de Revisão como Assunto , Transtornos Cerebrovasculares/etiologia , Hipertensão/etiologiaRESUMO
Coronaviruses cause respiratory and gastrointestinal disorders in animals and humans. The current SARS-CoV-2, the COVID-19 infectious agent, belongs to a subgroup called betacoronavirus including the SARS-CoV and MERS-CoV responsible for epidemics in 2002 and 2012, respectively. These viruses can also infect the nervous system due to their affinity for the human angiotensin-converting enzyme 2 (ACE2) expressed in neurons and glial cells. Infections with SARS-CoV, MERS-CoV, and now SARS-CoV-2 also produce neurological signs such as acute cerebrovascular disease, impaired consciousness, and muscle injury, as well as dizziness, hypogeusia, hyposmia, hypoxia, neuralgia, and hypoxic encephalopathy. For this reason, close attention should be paid to the neurological manifestations of COVID-19 patients.
Los coronavirus son una familia de virus que se caracterizan por producir afectaciones respiratorias y gastrointestinales en animales y en seres humanos. El actual SARS-CoV-2, agente infeccioso de la COVID-19, pertenece a un subgrupo denominado betacoronavirus del que hacen parte el SARS-CoV y MERS-CoV, virus responsables de epidemias en el 2002 y el 2012, respectivamente. Estos virus también pueden infectar el sistema nervioso debido a su afinidad con la enzima convertidora de angiotensina humana 2 (ACE2), la cual se expresa en neuronas y células gliales. Se ha demostrado que las infecciones con SARS-CoV y MERS-CoV, y ahora también con el SARS-CoV-2, ocasionan condiciones neurológicas como la enfermedad cerebrovascular aguda, la conciencia alterada y las lesiones musculares, así como mareos, hipogeusia, hiposmia, hipoxia, neuralgia y encefalopatía hipóxica. Por ello debe prestarse mucha atención a las manifestaciones neurológicas de los pacientes de COVID-19.
Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Coronavírus da Síndrome Respiratória do Oriente Médio/patogenicidade , Doenças do Sistema Nervoso/etiologia , Pneumonia Viral/complicações , Síndrome Respiratória Aguda Grave/complicações , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/patogenicidade , COVID-19 , Líquido Cefalorraquidiano/virologia , Transtornos Cerebrovasculares/etiologia , Transtornos da Consciência/etiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Previsões , Humanos , Doenças Musculoesqueléticas/etiologia , Pandemias , Pneumonia Viral/epidemiologia , Síndrome do Desconforto Respiratório/etiologia , SARS-CoV-2 , Transtornos de Sensação/etiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Latência ViralAssuntos
Adenocarcinoma/complicações , Encéfalo/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Neoplasias Parotídeas/complicações , Idoso , Angiografia Digital , Encéfalo/irrigação sanguínea , Angiografia Cerebral , Transtornos Cerebrovasculares/etiologia , Circulação Colateral , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Paresia/etiologia , Remissão Espontânea , Tomografia Computadorizada por Raios X , Válvulas VenosasRESUMO
TITLE: Sindrome de vasoconstriccion cerebral reversible secundario a un paraganglioma yugular secretor de metanefrinas.