RESUMEN
Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts.
Asunto(s)
Infecciones por VIH , Neurocisticercosis , Toxoplasmosis Cerebral , Humanos , Toxoplasmosis Cerebral/complicaciones , Toxoplasmosis Cerebral/diagnóstico , Estudios de Seguimiento , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Neurocisticercosis/complicaciones , Neurocisticercosis/diagnóstico , Edema/etiologíaRESUMEN
Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts.
Asunto(s)
Humanos , Calcinosis/complicaciones , Infecciones por VIH/complicaciones , Toxoplasmosis Cerebral/complicacionesRESUMEN
ABSTRACT Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts.
RESUMEN
O vírus varicela zoster (VVZ) causa a varicela como infecção primária e sua reativação leva à herpes zóster, que é uma erupção cutânea vesicular dolorosa na distribuição de um dermátomo associado à neuralgia. A sua reativação no sistema nervoso central também é possível e acontece sob a forma de meningite, meningoradiculite, mielopatia, vasculite e síndrome de Ramsay-Hunt. Neste relato, descrevemos o caso de um paciente de 22 anos do sexo masculino e previamente hígido, que apresentou hemiplegia à direita e paralisia facial periférica associada a vesículas dolorosas em pavilhão auditivo ipsilateral, febre e cefaleia. A ressonância magnética de encéfalo com estudo dos vasos arteriais evidenciou achados compatíveis com vasculite em segmento longo da artéria carótida interna à esquerda. Apesar das pesquisas dos vírus da família herpes por biologia molecular terem sido negativas no líquor, pudemos documentar altos títulos de anticorpos IgG para varicela zoster em duas amostras diferentes de sangue periférico. Decorridas duas semanas do início do tratamento com aciclovir parenteral, o paciente já se encontrava assintomático e com melhora expressiva dos déficits neurológicos. O presente relato ressalta a importância de incluir a reativação do VVZ como causa de meningite e vasculite em indivíduos jovens, sem comorbidades e aparentemente imunocompetentes.
Asunto(s)
Humanos , Vasculitis/complicaciones , Herpes Zóster Ótico/diagnóstico por imagen , Infección por el Virus de la Varicela-Zóster/complicaciones , Meningitis Viral/complicacionesAsunto(s)
Síndrome de Kallmann/complicaciones , Síndrome de Kallmann/patología , Trastornos del Movimiento/etiología , Tractos Piramidales/patología , Adulto , Imagen de Difusión Tensora , Proteínas de la Matriz Extracelular/genética , Humanos , Imagenología Tridimensional , Síndrome de Kallmann/diagnóstico por imagen , Síndrome de Kallmann/genética , Masculino , Corteza Motora/diagnóstico por imagen , Trastornos del Movimiento/diagnóstico por imagen , Mutación/genética , Proteínas del Tejido Nervioso/genética , Desempeño Psicomotor/fisiología , Tractos Piramidales/diagnóstico por imagenAsunto(s)
Ataxia Cerebelosa/diagnóstico , Músculos Palatinos , Paladar Blando , Temblor/diagnóstico , Atrofia , Ataxia Cerebelosa/etiología , Cerebelo , Progresión de la Enfermedad , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen/métodos , Temblor/etiologíaRESUMEN
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neurodegenerative disorder characterized by late-infantile onset spastic ataxia and other neurological features. ARSACS has a high prevalence in northeastern Quebec, Canada. Several ARSACS cases have been reported outside Canada in recent decades. This is the first report of typical clinical and neuroimaging features in a Brazilian family with probable diagnosis of ARSACS.
Asunto(s)
Espasticidad Muscular/diagnóstico , Ataxias Espinocerebelosas/congénito , Adulto , Amitriptilina/análogos & derivados , Amitriptilina/uso terapéutico , Baclofeno/uso terapéutico , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Relajantes Musculares Centrales/uso terapéutico , Espasticidad Muscular/tratamiento farmacológico , Linaje , Ataxias Espinocerebelosas/diagnóstico , Ataxias Espinocerebelosas/tratamiento farmacológicoRESUMEN
Neuromyelitis optica (NMO) is a demyelinating disease consisting of relapsing-remitting optic neuritis and myelitis with a more severe course than Multiple Sclerosis. Recently, it has been shown that almost 50% of patients with NMO can have brain magnetic resonance imaging (MRI) abnormalities. We report on six Brazilian patients with NMO, fulfilling the 1999 Wingerchuck criteria for this disease, with abnormal brain MRI and discuss their clinical and radiological features.
Asunto(s)
Encéfalo/patología , Neuromielitis Óptica/diagnóstico , Adolescente , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuromielitis Óptica/patología , Estudios RetrospectivosRESUMEN
Neuromyelitis optica (NMO) is a demyelinating disease consisting of relapsing-remitting optic neuritis and myelitis with a more severe course than Multiple Sclerosis. Recently, it has been shown that almost 50 percent of patients with NMO can have brain magnetic resonance imaging (MRI) abnormalities. We report on six Brazilian patients with NMO, fulfilling the 1999 Wingerchuck criteria for this disease, with abnormal brain MRI and discuss their clinical and radiological features.
Neuromielite óptica (NMO) é doença desmielinizante, remitente-recorrente, com acometimento predominante dos nervos ópticos e medula espinal e uma evolução mais grave comparada à esclerose múltipla. Estudos recentes demonstraram que até 50 por cento dos pacientes com NMO podem apresentar lesões encefálicas à ressonância magnética (RM). Relatamos seis pacientes brasileiros com NMO, que satisfazem os critérios diagnósticos de Wingerchuck (1999) para NMO, com alterações encefálicas em RM de encéfalo e discutimos seus dados clínicos e de imagem.
Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encéfalo/patología , Neuromielitis Óptica/diagnóstico , Imagen por Resonancia Magnética , Neuromielitis Óptica/patología , Estudios RetrospectivosRESUMEN
BACKGROUND: Naa/Cr ratio in normal appearing white matter (NAWM) of patients with multiple sclerosis (MS) is altered beyond plaques, suggesting early axonal loss, and correlates to clinical disability. Brain lesions not typical of MS have been described in Neuromyelitis optica (NMO), and correspond to brain aquaporin-4 channel sites, but the evaluation of Naa/Cr ratio in NAWM of patients with NMO and its association to the presence of brain lesions and clinical disability have not been described. OBJECTIVES: To evaluate the Naa/Cr of normal appearing white matter (NAWM) in 16 patients with NMO compared to healthy controls. METHODS: We performed brain magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) of 16 patients with NMO and compared to age matched healthy controls. RESULTS: NAWM Naa/Cr did not show statistical difference among patients and controls, neither between patients that had normal brain MRI and atypical brain lesions. CONCLUSION: NAWM was found to have a normal Naa/Cr in patients with NMO, reinforcing the concept that the white matter is not primarily affected in this disease.