RESUMEN
INTRODUCTION: To assess clinical and/or imaging features useful to distinguish between Susac syndrome (SuS) and primary angiitis of central nervous system (PACNS). METHODS: Multicenter retrospective analysis of two cohorts of Argentine patients diagnosed with SuS and PACNS. RESULTS: 13 patients diagnosed with SuS (6 women and 7 men, mean age 35⯱â¯10â¯years) and 15 with PACNS (10 women and 5 men, mean age 44⯱â¯18â¯years) were analyzed. Cognitive impairment (11 out of 13 patients vs. 5 out of 15, pâ¯=â¯.006), ataxia (7 out of 13 vs. 2 out of 15, pâ¯=â¯.042) and auditory disturbances (7 out of 13 vs. 0 out of 15, pâ¯=â¯.003) were more frequent in SuS patients; whereas seizures were more frequent in PACNS patients (8 out of 15 vs. 1 out of 13, pâ¯=â¯.035). On MRI, corpus callosum (CC) involvement was observed more often in SuS, with abnormalities in CC genu, in 13 out of 13 SuS patients vs. only 2 out of 15 PACNS patients (pâ¯<â¯.001); in CC body these were present in 13 out of 13 SuS patients vs. 1 out of 15 PACNS patients, (pâ¯<â¯.001); and in CC splenium in 12 out of 13 Sus patients vs. 1 of 15 PACNS, pâ¯<â¯.001). Cortical lesions were more frequent in PACNS patients (10 out of 15 vs. 3 out of 13 SuS patients, pâ¯=â¯.02), as were hemorrhages (5 out of 15 vs. 0 out of 13 SuS, pâ¯=â¯.04) and multiple basal ganglia infarcts (7 out of 15 vs. 1 out of 13 Sus, pâ¯=â¯.037). CONCLUSION: Specific clinical and/or MRI findings may help distinguish SuS from PACNS with potential therapeutic implications.
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Encéfalo/diagnóstico por imagen , Síndrome de Susac/diagnóstico , Vasculitis del Sistema Nervioso Central/diagnóstico , Adulto , Percepción Auditiva , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Disfunción Cognitiva/diagnóstico , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Terapia de Inmunosupresión , Masculino , Recurrencia , Estudios Retrospectivos , Síndrome de Susac/patología , Síndrome de Susac/terapia , Vasculitis del Sistema Nervioso Central/patología , Vasculitis del Sistema Nervioso Central/terapiaRESUMEN
BACKGROUND: Neuromyelitis optica is a relapsing inflammatory, secondarily demyelinating astrocytopathy that most commonly affects the optic nerves and the spinal cord. OBJECTIVE: This study aimed to evaluate the psychopathological profile, presence of current depression, and suicidality in patients with neuromyelitis optica spectrum disorders (NMOSD) in an Argentinean cohort, and compare these parameters to those in patients with multiple sclerosis (MS) and in healthy controls (HCs). METHODS: Twenty patients with NMOSD, 18 with MS, and 20 healthy controls were included. The presence and grade of current depression were assessed using Beck's depression inventory (BDI), while psychiatric disease and suicidality were assessed using the Mini-International Neuropsychiatric Interview. RESULTS: The prevalence of psychiatric disease in the NMOSD group was 45%, significantly higher than in the MS group (16%, p = 0.06) and the HCs (5%, p = 0.008). Recurrent major depressive disorder was the most frequent psychiatric disease and was diagnosed in four (20%) patients in the NMOSD group and in two (11%) patients in the MS group. In the NMOSD group, two (10%) patients were diagnosed with past manic episodes, one (5%) with current dysthymic disorder, one (5%) with lifetime psychotic disorder, and one (5%) with bulimia nervosa. One patient (5.5%) in the MS group and one in the HC (5%) were diagnosed with current generalized anxiety disorder. Ten patients (50%) in the NMOSD group had current depressive symptoms versus five (28%) patients in the MS group (p = 0.16) and two (10%) in the HC group (p = 0.02). Six (30%) patients with NMOSD versus only one (5.5%) patient with MS had attempted suicide at least once, this difference was statistically significant (p = 0.05). Current suicide risk was high in patients with NMOSD (8, 40%) and moderate in patients with MS (4, 22%). CONCLUSIONS: Our study shows that the prevalence of psychiatric comorbidities in patients with NMOSD is significantly higher than in patients with MS and healthy controls. Given the high frequency of suicidality, assessment of pertinent psychiatric disorders in such patients to optimize monitoring and comprehensive treatment is required.
Asunto(s)
Trastornos Mentales/epidemiología , Esclerosis Múltiple/epidemiología , Neuromielitis Óptica/epidemiología , Intento de Suicidio/estadística & datos numéricos , Adulto , Anciano , Argentina/epidemiología , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Choriocarcinoma is one of the most serious forms of gestational trophoblastic tumor. It is a malignant tumor from the epithelium of the chorionic villi. The most frequent location site is the uterus. Associated with ectopic pregnancy, it is extremely rare and in general, very aggressive. In 75% of the cases, it items from distant metastasis; therefore, a histological examination of the tubes must be performed in all ectopic pregnancies. Our patient was a 33-year-old woman who was admitted to emergency room (ER) with an intense pain in the right, iliac cavity, and limited genital bleeding. During the exploration, there was abdominal pain, with doubtful signs of peritoneal irritation. The vaginal ultrasound offered an image that was compatible with an extra uterine pregnancy in the left appendages. At emergency, right salpingectomy was performed via laparotomy. The patient was treated with polychemotherapy and contraceptives for a year, with no recurrence of the disease. Control follow-up was performed using beta-human chorionic gonadotropin (HCG) testing on a weekly basis during the first month and then bi-monthly during the first year of follow-up.