RESUMEN
INTRODUCTION: Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis is a rare syndrome resolving within less than 3 months. CASE REPORT: A young 17-year-old woman without previous medical history was admitted to the hospital because of right motor weakness and language disturbances. The symptoms resolved in a few hours and were followed by severe left headaches with important vegetative signs. Several similar episodes were noted in the previous 10 days. Cranial MRI was normal. EEG showed important slowing of the cerebral electrogenesis. More than 250 lymphocytic cells were found at CSF analysis. Outcome was spontaneously favorable, without similar symptoms after 6-month follow-up. CONCLUSION: Pseudomigraine with lymphocytic pleocytosis seems to be a particular syndrome of unknown origin. This is an elimination diagnosis, generally with a benign course.
Asunto(s)
Trastornos del Conocimiento/complicaciones , Linfocitosis/líquido cefalorraquídeo , Trastornos Migrañosos , Aciclovir/uso terapéutico , Adolescente , Antivirales/uso terapéutico , Encéfalo/anatomía & histología , Encéfalo/fisiopatología , Diagnóstico Diferencial , Electroencefalografía , Femenino , Humanos , Linfocitosis/tratamiento farmacológico , Imagen por Resonancia Magnética , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/fisiopatologíaRESUMEN
BACKGROUND: Postpartum is known to be an important risk factor for stroke. Bromocriptine may induce cerebral angiopathy. CASE DESCRIPTION: We report the case of a 26-year-old postpartum woman who presented with headaches, seizures, hypertension and acute renal failure eight days after the beginning of a treatment with bromocriptine prescribed for lactation suppression. Brain MRI and MR angiogram excluded cortical vein thrombosis and revealed multiple abnormal areas of increased signal in the cortex with segmental arterial narrowings of intracranial vasculitis. The patient completely recovered within one week after drug withdrawal. Biological and radiological abnormalities were also reversible. Following the chronology bromocriptine was most likely responsible for this adverse cerebral and systemic event. CONCLUSION: Clinicians should be aware of bromocripine-related postpartum cerebral angiopathy, a rarely described but serious complication of bromocriptine used to prevent postpartum breast engorgement.
Asunto(s)
Bromocriptina/efectos adversos , Enfermedades Arteriales Cerebrales/inducido químicamente , Antagonistas de Hormonas/efectos adversos , Trastornos Puerperales/inducido químicamente , Adulto , Femenino , HumanosRESUMEN
Inflammatory polyneuropathies are mainly known by their acute form, Guillain-Barré syndrome, but there are also chronic cases and all are considered as having an autoimmune mechanism. In each form, peripheral nerve biopsies show scattered macrophages in the endoneurium and in certain cases macrophages invade the Schwann cell cytoplasm and destroy the myelin sheath. In rarer cases there is a primary axonal degeneration. The authors studied two chronic cases, which both exhibited mixed primitive axonal and demyelinating lesions, with peculiar histiocytes in the endoneurium. These rounded cells were characteristically well marked by KP1 but showed well-developed rough endoplasmic reticulum cysternae at ultrastructural examination. Such plasmacytoid histiocytes have mainly been studied in subacute lymphadenopathies and have been only briefly illustrated in a few cases of peripheral neuropathies due to Lyme disease or HIV infection. The two cases reported here had no associated diseases and probably correspond to a peculiar subacute autoimmune reaction.
Asunto(s)
Histiocitos/ultraestructura , Nervios Periféricos/ultraestructura , Células Plasmáticas/ultraestructura , Polirradiculoneuropatía/patología , Adulto , Anciano , Axones/patología , Membrana Basal/ultraestructura , Enfermedades Desmielinizantes/patología , Femenino , Humanos , Masculino , Microscopía Electrónica , Vaina de Mielina/patología , Regeneración Nerviosa , Orgánulos/ultraestructura , Nervio Peroneo/patologíaRESUMEN
The authors report an angiographic observation, where a stenosis of the left middle cerebral artery, with Moya-Moya networks, is described. The anatomical study has shown an atresy of the middle cerebral artery, and has confirmed the hypothesis of a supplying role played by the Moya networks. Most of their anatomical findings are in agreement with a malformative aspect, which is speculated by the authors to be related to the failure, at the embryon level, of a good development of the middle cerebral artery; in this way, Moya might represent the remaining features of primitive plexiform networks. From this particular anatomical observation, the authors discuss some nosological problems and propose the hypothesis of several groups, which may be related to the moment when the stenosis is suspected to occur.