RESUMEN
We report a series of seven patients in whom a combined pattern of complex movement disorders restricted to one upper extremity emerged as a result of posterolateral thalamic lesions of vascular origin. This disorder was mainly characterized by choreiform and dystonic movements associated with variable, rhythmic, alternating movements of low frequency (myorhythmia). All cases showed, on computed tomography scan and/or magnetic resonance imaging, focal lesions involving the posterolateral quadrant of the thalamus. Review of similar cases reported with identical clinico-radiologic features allows us to conclude that it is possible to establish an accurate anatomoclinical correlation based on the clinical phenomenology, even before imaging studies are performed, in these cases. The opposite is not entirely possible, however, because lesions in the same quadrant of the thalamus are often associated with different patterns of abnormal movements or present without abnormal movements.
Asunto(s)
Isquemia Encefálica/diagnóstico , Corea/diagnóstico , Distonía/diagnóstico , Hemorragias Intracraneales/diagnóstico , Núcleos Talámicos Posteriores/irrigación sanguínea , Enfermedades Talámicas/diagnóstico , Adulto , Anciano , Brazo/inervación , Isquemia Encefálica/fisiopatología , Mapeo Encefálico , Infarto Cerebral/diagnóstico , Infarto Cerebral/fisiopatología , Corea/fisiopatología , Dominancia Cerebral/fisiología , Distonía/fisiopatología , Electromiografía , Femenino , Humanos , Hemorragias Intracraneales/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Núcleos Talámicos Posteriores/fisiopatología , Enfermedades Talámicas/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
Clozapine (CZP) is an atypical antipsychotic drug that does not appear to block striatal dopamine receptors. In six patients who met the criteria of HIV-associated psychosis and who had previously developed moderate parkinsonism as a result of the use of typical neuroleptic agents, CZP was added in an open, rising dose study. Subjects were evaluated at baseline after at least 7 days without neuroleptic drugs and then monthly for 3 months of the experimental treatment using three rating scales: Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), and motor examination of the Unified Parkinson's Disease Rating Scale (UPDRS). A significant reduction in psychopathology as represented in the BPRS total score (54.2 at baseline versus 23.9 at month 3) and CGI (2 and 8, respectively) was obtained with a mean CZP dose of 27.08 mg/day. Parkinsonism also improved by an average of 76.5% at the end of the study. One patient did not complete the study as a result of a progressive decrease in leukocyte count while on CZP. These preliminary results suggest that the pharmacologic properties of CZP may be of value in the management of HIV-psychotic patients.
Asunto(s)
Complejo SIDA Demencia/tratamiento farmacológico , Antipsicóticos/uso terapéutico , Clozapina/uso terapéutico , Trastornos Neurocognitivos/tratamiento farmacológico , Enfermedad de Parkinson Secundaria/inducido químicamente , Complejo SIDA Demencia/diagnóstico , Adulto , Antipsicóticos/efectos adversos , Clozapina/efectos adversos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Humanos , Masculino , Trastornos Neurocognitivos/diagnóstico , Examen Neurológico/efectos de los fármacos , Enfermedad de Parkinson Secundaria/diagnóstico , Enfermedad de Parkinson Secundaria/tratamiento farmacológico , Escalas de Valoración PsiquiátricaRESUMEN
Brainstem tuberculoma is exceptionally observed. We report a 44 year-old immunocompetent man with proven diagnosis of miliary tuberculosis (TBC) who developed a complex neurological syndrome characterized by right ophtalmoplegia, left-sided hemiparesis and hemihypoesthesia and a gross ipsilateral postural and action tremor with hand dystonia. A ponto-mesencephalic mass was detected by CT and MRI studies of the brain. Clinical, bacteriological and neuroimaging studies allowed to suspect a ponto-mesencephalic tuberculoma. Long-term therapy with anti-TBC drugs and steroids was started, achieving clinical and imaging improvement which retrospectively confirmed the diagnosis. Although with less amplitude, tremor persisted but a complete disappearance of focal dystonia was observed. The pathogenesis of both abnormal movements is particularly discussed since hand dystonia has never been mentioned in the literature as a consequence of brainstem damage.
Asunto(s)
Tronco Encefálico/patología , Distonía/etiología , Temblor/etiología , Tuberculoma/complicaciones , Tuberculoma/patología , Adulto , Antiinflamatorios/uso terapéutico , Antituberculosos/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Esteroides , Tuberculoma/tratamiento farmacológico , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/tratamiento farmacológicoAsunto(s)
Quelantes/uso terapéutico , Degeneración Hepatolenticular/complicaciones , Trastornos del Movimiento/etiología , Penicilamina/uso terapéutico , Conducta Estereotipada , Adulto , Ganglios Basales/patología , Femenino , Pie , Degeneración Hepatolenticular/tratamiento farmacológico , Degeneración Hepatolenticular/patología , Degeneración Hepatolenticular/fisiopatología , Humanos , Imagen por Resonancia Magnética , Trastornos del Movimiento/tratamiento farmacológico , Trastornos del Movimiento/patología , Trastornos del Movimiento/fisiopatología , Conducta Estereotipada/efectos de los fármacosRESUMEN
We report a patient with a progressive motor disorder dominated by pyramidal signs in all four extremities and cervical dystonia in the form of torticollis, who had imaging features of cervical cord tumor on magnetic resonance imaging (MRI) scanning. Ependymoma was the final diagnosis by histology. Cervical dystonia presenting as a manifestation of an identified focal central nervous system (CNS) lesion is infrequent. We believe our patient to be the first adult example of cervical cord tumor giving rise to cervical dystonia. Adding this entity to the list of differential diagnosis of torticollis is considered, and its mechanisms are discussed.