Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Reportes de Casos Clínicos

 

CLIPPERS (Inflamación crónica linfocítica con realce perivascular pontino y respuesta a esteroides) con compromiso longitudinalmente extenso de la médula espinal. Una presentación atípica. CLIPPERS (Chronic lymphocytic inflammation with pontine perivascular enhancement and steroid response) with longitudinally extensive spinal cord involvement. An atypical presentation

CLIPPERS (Chronic Lymphocytic Inflammation with Perivascular Pontine Enhancement and Steroid Response) is a recently described neuroinflammatory disorder in which symptoms involving the brainstem predominate, with variable pattern on neuroimaging and a perivascular infiltrate of T lymphocytes on brain biopsy. We present a case of a 50-year-old male who presented symptoms of asthenia, adynamia, weakness in lower limbs extremities, sphincter disorder and ataxia. Patient was extensively studied to rule out infectious, neoplastic, autoimmune, and demyelinating conditions. Diagnosis was made taking into account significant clinical-imaging elements, remarking the spinal cord involvement in this patient. Treatment with steroids and steroid-sparing agents, such as methotrexate, was found to be effective. Very few cases in the literature to date describe CLIPPERS-associated spinal cord involvement.

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Trombectomía mecánica eficaz en paciente con ictus e infección por SARS-Cov-2 con desenlace fatal. Effective mechanical thrombectomy in a patient with stroke and SARS-Cov-2 infection with fatal outcome

Ischemic stroke has been reported in patients with SARS-CoV-2 infection. It is not clear if COVID-19 is causal or simply coexists or triggers the onset of stroke. Stroke is relatively rare in the context of COVID-19 and mostly occurs in the elderly with vascular risk factors. The underlying mechanism of stroke is multiple. We present an 84-year-old male with a stroke due to large vessel occlusion coincident with severe COVID-19 infection, that despite an initial successful mechanical thrombectomy, had a fatal outcome due to respiratory complications and contralateral massive cerebral infarction due to early recurrence. Consequently, vigilance in this type of patients should be extreme since ischemic stroke with active SARS-CoV-2 infection may have a poor prognosis.

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Neuroimagen en síndrome de desmielinización osmótica. Neuroimaging in asmotic demyelination syndrome

The osmotic demyelination syndrome includes pontine and extrapontine myelinolysis, the first being its classic form of presentation. Usually related to rapid corrections of hyponatremia (serum sodium less than 135mEq/L), it has been described in multiple conditions that can alter plasma osmolality. The symptoms are varied and include spastic tetra paresis, pseudobulbar paralysis, coma, seizures or the characteristic “locked in” syndrome, as well as behavioral disorders such as lack of impulse control, aggressiveness, depressive syndromes, catatonia, mutism, and emotional lability. Years ago, it was a very difficult entity to diagnose, but with the introduction of magnetic resonance imaging, many oligosymptomatic or asymptomatic cases have been detected, although there is no known treatment, spontaneous recovery can occur.

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Bilateral necrosis of the globus pallidus after binge-drinking. Necrosis bilateral de globos pálidos luego de ingesta excesiva y sostenida de alcohol

A 77-year-old man developed progressive slurry speech, action tremor in both upper limbs, generalized bradykinesia, and unsteady and shuffling gait several weeks after heavy binge-drinking followed by an unconsciousness state in which the patient did not respond to verbal commands or painful stimuli. MRI disclosed bilateral and symmetrical necrosis of globus pallidus as well as severe cortical and hippocampal atrophy. Damage of the globus pallidus was likely related to respiratory acidosis during the event. Pallidal Parkinsonism should be considered in the differential diagnosis of a progressive movement disorder after an acute toxic or hypoxic insult to the nervous system.

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Hemorragia intracerebral espontánea en pacientes con Covid-19 severa: Reporte de dos casos. Spontaneous Intracerebral Hemorrhage in severe Covid-19 patients: Report of two cases

The respiratory system is mainly affected by the SARS-CoV-2 infection, producing a severe acute respiratory syndrome known as COVID-19 (Coronavirus disease 2019), patients with severe disease usually develop multiorgan failure; among these we can focus on the nervous system, due to its potential neurotropism. Recent clinical data reveal that patients may manifest symptoms such as anosmia, dysgeusia, impaired consciousness, headache, seizures, and cerebrovascular disease (CVD). We describe two physically active male patients with complicated SARS-CoV-2 infection without significant comorbidities related to the development of intracranial hemorrhage, nor a history of head trauma or documented anatomic malformations. Both were admitted by the emergency department and during their stay in the ICU they developed intracranial hemorrhage diagnosed by computed tomography. The paraclinical findings in the two cases were compatible with a prothrombotic state as possible etiologies of bleeding in both.

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Alteración del estado de conciencia secundario a intoxicación por litio. Altered state of consciousness secondary to lithium intoxication

Introduction: Lithium is a pharmacological molecule that is commonly used in patients with bipolar affective disorder. Due to its chemical similarity to sodium, alterations in the latter have a direct effect on its plasma concentrations. Among the complications that can occur are nephrogenic diabetes insipidus, thyroid dysfunction, and some central nervous system defects such as nystagmus, ataxia, tremor, fasciculations, seizures, and coma.

Objective: To present the case of a patient with a syndrome of altered state of consciousness secondary to lithium poisoning coincide.

Clinical case: 61-year-old woman with a history of bipolar affective disorder who presented the syndrome of altered state of consciousness associated with lithium poisoning, for which reason the drug was withdrawn and hemodialysis sessions were carried out, obtaining an adequate response. with improvement of renal function and normalization of serum lithium values (0.76 mmol / L).

Conclusions: Lithium may involve alterations at the renal level that are associated with modifications in serum electrolytes. This can facilitate the appearance of neurological symptoms or symptoms, as evidence in the present case.

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Canalopatía de calcio CACNA1E: Nueva encefalopatía epiléptica en un paciente pediátrico. CACNA1E calcium channelopathy: New epileptic encephalopathy in a pediatric patient

Introduction: Epileptic and developmental encephalopathies, related to voltage-associated calcium channel mutations, are heterogeneous entities recently described in pediatric population.

Objective: To describe the case of pediatric patient with epileptic and developmental encephalopathy caused by a mutation in the CACNA1E gene that codes for a calcium channel.

Clinical case: Preschool male patient with refractory epilepsy starting at two months of life, associated with global developmental delay, behavioral disorder, hyperkinetic movements (dystonia) and hypotonia, with multifocal interictal activity and normal brain resonance, with pathogenic mutation in the gene CACNA1E.

Conclusion: Mutations in the CACNA1E gene cause functional alteration of the calcium channel CaV2.3, originating a clinical picture of a recently described phenotype.

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Aplasia unilateral del nervio vestibulococlear. Unilateral Vestibulocochlear nerve aplasia

Introduction: Vestibulo cochlear aplasia is an embryological defect in the formation of the inner ear that causes a sensorineural hearing loss. We report the case of an 8 year-old boy with left sided hearing loss, not previously detected. On neurological examination, a hearing loss in the left ear was found. Through imaging studies, the diagnosis is confirmed.

Conclusion: When hearing loss is suspected, imaging studies are the ideal method for detecting pathological findings in the inner ear.

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Síndrome de Arlequín. Harlequin syndrome

We herein report the case of a 37-year-old woman who sought medical attention due to facial erythema on the right side of her face as well as diaphoresis following stressful events or exercise. Clinical examination was unremarkable. Blood tests and Thorax CT excluded any structural causes. Given this, she was diagnosed with Harlequin syndrome. Therapeutic options were explained, and follow-up provided.

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Asterixis and dysarthria-clumsy hand originated of lacunar infarction: A series of six cases. Asterixis y disartria-mano torpe originado a partir de los infartos lacunares: Una serie de seis casos

La asterixis y la disartria-mano torpe son signos neurológicos poco frecuentes que pertenecen a los trastornos del movimiento después de un accidente cerebrovascular. Clínicamente ellos son clasificados como parte del infarto lacunar y la mayoría de los casos se resuelven espontáneamente en un periodo entre 10 semanas y un mes. El objetivo de este estudio fue reportar seis casos de pacientes masculinos con infarto lacunar y describir los síntomas, localización y tamaño de las lesiones. Se describen casos de infarto lacunar y síntomas motores leves (disartria y asterixis) sin ningún indicio de demencia. En conclusión, nuestros casos presentan movimientos neurológicos anormales como asterixis y disartria-mano torpe en pacientes con hipertensión y / o diabetes mellitus tipo 2. Debido a la transitoriedad de esos movimientos, el diagnóstico en el tiempo adecuado es importante, a partir de eso los médicos pueden solicitar los exámenes de imagen, tratar al paciente y luego acompañarlo previniendo futuros ictus con consecuencias aún más graves. Así, estudios como el nuestro pueden contribuir al correcto diagnóstico de los infartos lacunares.

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Giant bilateral open-lip schizencephaly. Esquizencefalia bilateral gigante de labio abierto

La esquizencefalia es una malformación cerebral congénita caracterizada por hendiduras en la corteza cerebral, se clasifica en Tipo I (labio abierto) y tipo II (labio cerrado). Los pacientes con esquizencefalia presentan convulsiones, hidrocefalia, déficit motor y mental. La ecografía se utiliza para el diagnóstico intra útero y recién nacidos, y la resonancia magnética o tomografía computarizada en pacientes ya nacidos. El manejo de la esquizencefalia es conservador, con rehabilitacción de los déficits motores o mentales, medicación o cirugía para convulsiones y derivación en hidrocefalia con aumento de la presión intraacraneal. En la literatura, solo se han informado unos pocos casos bilaterales gigantes. Presentamos un caso de esquizencefalia gigante bilateral de labio abierto, en un paciente masculino de 10 días, que se presenta con hipotonía leve y sin convulsiones. Este caso es raro debido a las características relativamente beningnas en comparación con otros casos notificados.

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Aplicación móvil de realidad virtual para el entrenamiento de la mano espástica. Virtual reality mobile application for spastic hand training

Background: The hand is a structure with a complex neuromuscular organization that in hemiparesis is compromised, affecting function.

Aim: To determine the changes in the motor function of the spastic hand of an adult with hemiparesis through the use of a mobile application for virtual reality.

Method: Case report of a 29-year-old adult with hemiparesis, evaluated with the Fugl Meyer upper extremity assessment (FMA-ES), the Trail Making test and the force dynamometry test. A therapeutic intervention was performed with exercises of the least affected hand for 12 sessions using special glasses for a total immersion 20 minutes using mobile application Mirror box Therapy VR®.

Results: The virtual reality therapy applied through the Mirror Box Therapy VR® mobile application, shows in a short time favorable changes in the motor and sensory hand function of the patient.

Discussion: Virtual reality provides a functional interaction, making it an effective tool to motivate patients during sessions.

Conclusion: An intervention through the use of virtual reality generates changes in the motor and sensory function of the hand of a patient with hemiparesis after 12 work sessions.

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Tuberculoma intramedular espinal que simulaba una lesión tumoral, en un paciente con desnutrición y consumo de estupefacientes. Spinal intramedullary tuberculoma that simulates a tumor lesion, in a patient with malnutrition and drug use

Intramedullary spinal tuberculoma is a rare form of extrapulmonary tuberculosis. In most cases the diagnosis is made by biopsy of the lesion and histopathological study. We present the case of a 28-year-old male with a history of malnutrition and drug use who presented progressive paraparesis with sphincter compromise secondary to a dorsal intramedullary tuberculoma. At the beginning a tumor lesion was suspected, however, findings of pulmonary tuberculosis, lymph node biopsy and a positive tuberculin protein derivative study confirmed the clinical diagnosis of spinal tuberculoma.

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Síndrome alcohólico fetal. Reporte de un caso. Fetal alcohol syndrome. Case report

Prenatal exposure to alcohol is one of the main preventable causes of birth defects and developmental disabilities. Fetal alcohol spectrum disorder (FASD) is a term used to describe the physical, behavioral, and neurodevelopmental disorders that can be detected in an individual who was prenatally exposed to alcohol.

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Encefalitis autoinmune. Autoimmune encephalitis

Autoimmune encephalitis is a recently described pathology as inflammatory disease of the central nervous system, previously characterized as a paraneoplastic syndrome. However, advances in technology have allowed to categorize it as an entity, with an specific physiopathology, and a clinical presentation based on the developed auto-antibody, but, the wide clinical presentation, the insidious development of the symptoms, the mimic with other pathologies and the lack of knowledge of this condition in the emergency room and hospitalization services, does not permit to diagnose this condition, leading to potentially fatal complications. We report the case of a 26-years-old female with autoimmune encephalitis, and a literature review regarding this topic.

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Discapacidad asociada a manifestaciones neurológicas de COVID-19. Disability associated with COVID-19’s neurological manifestations

Introduction: COVID-19 is mainly a respiratory illness, however, with an incidence in nearly a third of patients of neurological manifestations secondary to affection to the central or peripheral nervous system, used to be more frequent in severe illness, having a wide range of disability and mortality.

Clinical case: We present the clinical case of a 39 years old female ,previously healthy, with diagnosis of COVID-19, initiating her illness with encephalitis and status epilepticus, posteriorly longitudinally extensive myelitis and anoxic-ischemic encephalopathy, which, despite of opportune diagnosis and treatment, she had a poor outcome developing persistent vegetative state.

Conclusions: COVID-19’s neurological manifestations could lead to a high risk of disability and mortality, needing an opportune detection and treatment, with a high suspicion of encephalitis and status epilepticus in patients with decrease of alertness and focal motor symptoms.

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Estatus epiléptico no convulsivo por Lupus Eritematoso Sistémico y Síndrome Antifosfolípido. Non convulsive status epilepticus due to Systemic Lupus Erythematosus and Anti- phospholipid syndrome

Systemic Lupus Erythematosus is a chronic disease, with the presence of autoantibodies and lymphocyte hyperactivity. The presence of antiphospholipid antibodies is associated with seizures and vasculocerebral disease. We present the case of a patient with atypical absence seizures and mild cognitive impairment.

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Calcificaciones en Ganglios de la Base en un Caso de Hipoparatiroidismo Primario. Basal Ganglia Calcification In A Case Of Primary Hypoparathyroidism

Hypoparathyroidism is characterized by an insufficient production of parathyroid hormone, resulting in hypocalcemia and hyperphosphatemia, that without proper treatment can lead to multiple complications in different organs. We present the case of a patient with primary hypoparathyroidism, with basal ganglia calcifications as a complication of the disease and the therapeutic challenge it presents to improve the symptoms and quality of life.

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Síndrome Lumbocostovertebral Asociado a Mielomeningocele. Lumbo-Costovertebral Syndrome Associated With Myelomeningocele

Lumbo-costo-vertebral syndrome is a rare anomaly that affects the vertebral bodies, the ribs and the muscles of the abdo- minal wall, and multiple additional congenital abnormalities requiring multidisciplinary management and early surgical inter- vention to avoid complications. Case presentation: A 10-day-old male infant presents with two right lumbar tumors, one that increased in size with crying consistent with a lumbar hernia, and the other a myelomeningocele. In complementary studies, it was found that the patient had fusion of the 1st and 2nd, 3rd and 4th and 11th and 12th ribs on the right, a 13th accessory rib on the right, and a 13th and 14th accessory rib on the left in addition to multiple defects in the fusion of the lumbar and sacral vertebral bodies, and a 1cm defect in the abdominal wall with protrusion of abdominal contents. The patient was diagnosed with LCVS with an associated myelomeningocele and underwent a simple closure and repair of the abdominal defect with a bovine pericardial patch, and plasty of the myelomeningocele without complications. We present this case due to the rarity with which it is reported in the literature. Conclusions: LCVS is a rare entity that merits early surgical resolution to avoid complications, in addition to multidisciplinary management.

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Carcinoma de Células de Merkel en Paciente con Esclerosis Múltiple en Tratamiento con Fingolimod. Merkel Cell Carcinoma In A Patient With Multiple Sclerosis Treated With Fingolimod

Fingolimod is a disease-modifying therapy widely used in Relapsing-Remittent Multiple Sclerosis. It blocks the capacity of lymphocytes to leave the lymph nodes, causing lymphopenia. This increases the risk of infections, but also non-melanocytic skin tumours. We report a case of Merkel cell carcinoma in a patient treated with fingolimod and a review of the literature, which helps to understand the relation between immunosuppression, opportunistic infections and cancer.

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Síndrome de Persona Rígida de Causa Paraneoplásica. Claves Diagnósticas en una Entidad Rara. Stiff Person Syndrome Of Paraneoplastic Cause. Diagnostic Keys In A Rare Entity

Introduction: Paraneoplastic disorders exert their effect through immunological mechanisms and not by direct invasion of the tumor; in this way tumors located outside the nervous system induce the production of antibodies against antigens: on the neu- ronal surface, intracellular or synaptic and affect distant sites from its location to either the central or peripheral nervous system, thus producing various clinical manifestations. One of these syndromes is the Stiff Person syndrome, which, apart from being a rare entity, occurs as a paraneoplastic syndrome in only 5% of cases.

Clinical Case: A 72-year-old male patient, a 2-month evolution that began with painful muscle spasms in the dorsal and lumbar region, evolved to rigidity with posture in axial and appendicular hyperextension, pseudospastic gait, hyperekplexia; due to the suspicion of Stiff Person syndrome a diagnostic work-up was begun finding high levels of Ab anti GAD65 and later a Non- Hodgkin’s Lymphoma. The patient received immunotherapy and cancer treatment.

Conclusion: Paraneoplastic syndromes must be identified according to the clinical phenotype and the determination of an- tineuronal antibodies. High suspicion and rapid diagnosis are necessary to achieve timely treatment and avoid permanent injury.

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Síndrome de Joubert Asociado a Apnea Central del Sueño en un Adulto de Colombia. Joubert Syndrome Associated With Central Sleep Apnea In An Adult From Colombia

Introduction: The Joubert syndrome is an autosomal recessive disorder, classified as a ciliopathy. The primary cilia have a role in neuronal proliferation and axonal migration in the cerebellum and brainstem. Marie Joubert and colleagues in 1969 pu- blished four cases with partial or total agenesis of the cerebellar vermis and apnea-hyperpnea neonatal episodic disorder. From an early age the principal manifestations are: abnormal breathing pattern, nystagmus, swallowing alterations, hypotonia, ataxia and intellectual disability. Classically, the neonatal breathing disorder improve with age.

Clinical case: A 39 years old, with intellectual disability and a history of a movement disorder involving a lower extremity, snoring, episodes of central apnea, hypotonia and nystagmus. He was the second child, with an uncomplicated, full-term gestation. In the clinical exam was found dysarthria, short term and semanticmemory loss, Epworth scale: 9/24. Brain magnetic resonance imaging (MRI) showed cerebellar vermis hypoplasia and elongation of the hemispheres as the “molar tooth sign.” Moreover, a polysomnography study found a central sleep apnea disorder.

Discussion: It is fundamental to recognize this syndrome to establish a prenatal or an early age diagnosis, for a multidisciplinary approach and an early genetic counseling. The treatment of the sleep disorder in these patients is crucial for a better quality of life.

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Cómo Reconocer el Meningioma Intraóseo: Etiología y Hallazgos por Imagen. How To Recognize Intraosseous Meningioma: Etiology And Imaging Findings

Meningiomas are the most common primary brain tumors. Primary intraosseous meningioma is a rare extradural meningioma subtype. They are usually asymptomatic but may cause proptosis or neurological symptoms depending on size and location. The most common finding in imaging tests is hyperostosis although a lytic or even mixed pattern can also be observed, so it should be considered in the differential diagnosis of cranial sclerotic bone tumors. Although most are benign, they are more likely to develop malignancy than intradural meningiomas. Imaging techniques (CT and MRI) are very useful in preoperative diagnosis and evaluation of adjacent anatomical structures. Surgical resection followed by cranial reconstruction is the treatment of choice.

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Razonamiento Clínico: Mujer de 38 Años de Edad en Puerperio Alejado con Debilidad Muscular en Hemicara Derecha. Clinical Reasoning: 38-Year-Old Woman In Remote Puerperium With Weakness In Right Side Of The Face

A case of 38-year-old woman is presented with muscular weakness in right side of the face during her remote puerperium. We reviewed the history, physical examination, and analyze the differential diagnosis, etiology and the final diagnosis.

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Tuberculosis Meníngea en un Paciente Pediátrico: Reporte de un Caso Clínico. Meningeal Tuberculosis In A Pediatric Patient: A Case Report

Tuberculosis is a global public health problem. In pediatric ages it represents between 3% and 40% of the total disea- se. In countries with high incidence, such as Ecuador, the presence of cases of childhood tuberculosis always indicates the circulation of Mycobacterium tuberculosis or contact with an untreated patient or undiagnosed. In our country there is a high percentage of underdiagnosis of childhood tuberculosis and a lower burden than expected, mainly in children under 5 years of age. Meningeal tuberculosis is the most serious form of presentation of infection by M. tuberculosis in pediatric age since it causes many deaths and disability. The diagnosis of tuberculous meningitis is achieved considering epidemiological criteria, laboratory studies in blood, cerebrospinal fluid, and neuroimaging. Early treatment improves the prognosis, but the problem lies in making an early diagnosis, since it has different forms of clinical presentation ranging from nonspecific symptoms to severe neurological involvement.

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Parálisis periódica hipocalémica: reporte de caso. Hypokalemic periodic paralysis: case report

Hypokalemic periodic paralysis is a disease included in the skeletal muscle channelopathies, characterized by attacks of muscle weakness secondary to dysfunction of Cav1.1 calcium or Nav1.4 sodium channels. We report a case of a patient with a diagnosis of episodic hypokalemic paralysis confirmed by genetic study, and a brief discussion regarding the importance of genetic analysis, its clinical and therapeutic implications.

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Hallazgos histológicos en epilepsia temporal familiar en una familia de ascendencia Maya. Histological findings in familial temporal epilepsy in a Mayan descent family

Familial temporal lobe epilepsy is a heterogeneous genetic syndrome, initially recognized in studies with twins. In this condition, many members of a family are affected by psychic or autonomic auras and focal seizures with altered consciousness. We describe two brothers, children of non-blood parents, with different phenotypes of familial temporal lobe epilepsy and drug resistance who were referred to our center for epilepsy and functional neurosurgery. The family, of Mayan descent, has a history of epilepsy in other relatives. Epilepsy surgery was performed on the two brothers while remaining seizure-free today. The histological findings in both cases were consistent with cortical focal dysplasia IIIa. It is the first Latin American report of siblings with evidence of a correlation between familial temporal lobe epilepsy and histological changes suggestive of cortical focal dysplasia IIIa.

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Cerebelo: No Sólo Función Motora – A Propósito de un Caso. Cerebellum: Not Just Motor Function – About A Case.

The cerebellum constitutes a nervous structure with multiple bidirectional connections with the prefrontal cortex. This relationship allows us to understand its importance on neurocognitive processes. Multidisciplinary evaluation of neurological conditions allows us to study in depth its impact on the emotional and cognitive sphere.

Present case study aims to analyze the neurological and neuropsychological characteristics of a 64-year-old patient with cerebellar degeneration (novo progressive cerebellar atrophy) , which has 15 years of evolution but evaluated by the neuropsychology area the last four years.

After clinical evaluation carried out in two stages, and after check standardized neurocognitive tests, significant qualitative data are observed. A progressive decline in the patient’s neurocognitive sphere is evident, mainly in executive processes, such as bradypsychia, attention deficit, cognitive rigidity, foresight deficit, and categorical evocation.

The results suggest deterioration evidenced probably related to underlying cerebellar disorder, and evidence of cortex-cerebellar circuits, such dysfunction will influence on neurocognitive processes of executive type.

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Ictus no comunicable en un adulto joven con parálisis cerebral portador del genotipo MTHFR variante C677T homocigótica. Noncommunicable stroke in a young adult with cerebral palsy carrying the homozygous variant MTHFR C677T genotype.

Cerebral palsy (CP) is a group of disorders that affect movement and muscle tone or posture. It is caused by damage that occurs in the immature brain as it develops, most often before birth.

Although there are few studies in the literature, it has been seen that the risk of stroke is increased in this type of patients. We present the case of a young adult with a recent stroke and CP carrying. The homozygous variant MTHFR C677T genotype, decreased folic acid and vitamin D were found. Stroke in CP context is a challenge for the clinician. Therefore, we think that the possibility of stroke should be considered in every patient with CP, suggesting primary prevention measures in every patient with CP.

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Mielopatía Espondilótica Cervical Como Un Imitador De Accidente Cerebrovascular. Cervical Spondylotic Myelopathy As A Stroke Mimic.

Cervical spondylotic myelopathy (CSM) is the most common nontraumatic spinal cord condition in people over 55 years of age. This disorder is due to compression of the spinal cord by a stenotic cervical canal. A 55-year-old hypertensive patient with a clinical picture that simulated a stroke is described, due to a sudden onset of a right brachiocrural motor deficit, with elevated blood pressure levels in the range of hypertensive crisis. Hours later the patient presented the same motor deficit contralaterally: Computed tomography and magnetic resonance imaging of the brain showed no abnormality. The finding of atrophy in the interosseous muscles was striking. Cervical magnetic resonance imaging was performed showing a narrow spinal canal, with spinal cord hyperintensity in T2 sequences at levels C2 to C6. The most frequent causes of stroke mimics are tumors and metabolic toxic disorders. Spinal disorders represent 1.7% of all cases, CSM being a rare cause.

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