parkinsonismo

Parkinsonismo y deterioro cognitivo rápidamente progresivo en un paciente con lupus eritematoso sistémico y síndrome antifosfolípido triple positivo. Parkinsonism and rapidly progressive cognitive decline in a patient with systemic lupus erythematosus and triple-positive antiphospholipid syndrome.

Background: The association between parkinsonism and systemic lupus erythematosus is inadequately described, and to date, the underlying pathophysiological mechanisms are not fully established, ranging from vascular impairments to immunomediated phenomena. Literature analysis identified only 28 cases of parkinsonism in patients with systemic lupus erythematosus, underscoring the limited attention to these associations and their respective therapeutic approaches.

Case Report: We present a case of a patient with an atypical presentation of systemic lupus erythematosus and a diagnosis of triple-positive antiphospholipid syndrome. Despite the absence of lupus activity, the patient developed symptoms of parkinsonism and rapidly progressive cognitive decline. No other underlying causes or thrombotic events in brain imaging were found to explain the atypical clinical presentation. Simultaneous administration of immunosuppressive therapy and levodopa/carbidopa resulted in symptom improvement.

Conclusion: Insufficient research has been conducted on the correlation between systemic lupus erythematosus and parkinsonism, primarily due to its seemingly low incidence in the medical literature. Consequently, this case report offers additional insights into this association, potentially laying the groundwork for future structured and well-designed studies. The efficacy of levodopa and immunosuppressive therapy in treating these patients remains uncertain and necessitates further investigation.

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Palabras clave: autoinmunidad, lupus eritematoso sistémico, parkinsonismo, Síndrome antifosfolípido,

Keywords: Antiphospholipid syndrome, autoimmunitys, parkinsonism, systemic lupus erythematosus,

Atrofia multisistémica, estudio por imagen de un caso. Multisystem atrophy, imaging study of a case

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Palabras clave: Atrofia multisistémica, cruz, parkinsonismo,

Keywords: cross, Multisystem atrophy, parkinsonism,

Demencia por Cuerpos de Lewy, un Reto Diagnóstico. Dementia With Lewy Bodies, A Diagnostic Challenge.

Dementia with Lewy bodies is a neurodegenerative disease of unknown etiology, it is the second cause of dementia of the sixth decade of life; Its diagnosis is a challenge, because certain signs and symptoms that it presents are typical of Parkinson’s Disease and Alzheimer’s Disease. The following case report is one of the few documented patients with Dementia with Lewy bodies in Ecuador. We report this in order to state the diagnostic difficulty that this pathology generates and describe the main characteristics that differentiate it from other dementia syndromes, highlighted in the recently updated criteria by the Consortium of Dementia with Lewy bodies. A meticulous neurological examination and neuropsychological assessment were essential in the study and prognosis of the patient. Dementia with Lewy bodies requires a thorough diagnosis, due to the challenge that originates its early recognition; the criteria described accelerated their recognition due the update of the recommendations on the clinical diagnosis of Dementia with Lewy bodies.

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Palabras clave: Demencia por cuerpos de Lewy, deterioro cognitivo, Hiponatremia, parkinsonismo,

Keywords: cognitive impairment, Dementia with Lewy bodies, Hyponatremia, parkinsonism,

Parkinsonismo y Mielinolisis Osmótica. Descripción de caso

Introduction: Osmotic demyelination syndrome is a rare medical condition in which parkinsonian signs are relatively non frequent. Objective: To report a case of a patient with hyponatremia rapidly corrected and treated with neuroleptics. The cranial MRI showed demyelinating lesions in pons and basal ganglia. The patient clinically developed parkinsonism, with no response to dopamine. Conclusion: The inadequate correction of hyponatremia causes demyelinating lesions. As we appreciate in this case, the prescription of neuroleptic drugs may negatively affect the response to dopaminergic therapy.

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Palabras clave: Hiponatremia, Mielinolisis osmótica, neurolépticos, parkinsonismo,

Keywords: Hyponatremia, Neuroleptics, Osmotic myelinolysis, parkinsonism,

Tuberculous Encephalitis Associated With Basal Ganglia Lesions And Movement Disorders

An increasing number of autoimmune disorders with predominant involvement of the basal ganglia which result in movement disorders and psychiatric symptoms have been described. We report a 26 year old patient who, three weeks after initiation of treatment for tuberculous meningitis, presented with acute right hemichorea-ballism and confusion One week later the patient presented acute left hemiparkinsonism. The CSF showed oligoclonal bands. The MRI showed bilateral lesions in the basal ganglia in the T1W and FLAIR sequences. Antituberculous therapy with concomitant steroids and L dopa treatment ,resulted in clinical improvement .To our knowledge this is the first report of tuberculous encephalopathy associated with involvement of the basal ganglia and movement disorders.This case suggests involvement of the basal ganglia through an immune mediated pathogenesis.

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Palabras clave: corea, encefalitis tuberculosa, lesión de ganglios basales, parkinsonismo, patogénesis,

Keywords: basal ganglia lesion, corea, parkinsonism, pathogenesis, tuberculous encephalitis,

Parkinsonismo inducido por neurolépticos. Caracterización clínica.

Background: Neuroleptic-induced parkinsonism is the most common clinical form of extrapyramidal syndrome induced by drugs. The objective of this research was to characterize its clinical spectrum.

Materials and methods: We collected the results of clinical neurological evaluation of 28 patients with chronic psychosis and parkinsonism, in treatment with parenteral decanoate of flufenacine and other classical antipsychotic drugs. The parkinsonism was confirmed by a specialist in neurology and was completed with the implementation of the motor section of the unified scale for the assessment of Parkinson’s disease (UPDRS).

Results: The mean age was 45.6 years and the relationship male / female 0.86:1. The average time of treatment with decanoate of flufenacine was 5 years and the 60.7% of patients had other neuroleptic associated. The parkinsonism is associated with the triad of bradicinesia, stiffness and tremor. We found no significant asymmetries and the predominant involvement was in the upper limbs. Generally these are mild forms that do not produce severe disability.

Conclusions: The drug-induced parkinsonism is different from Parkinson’s disease for more bilateral involvement of dominance in the upper limbs. And it can coexist with others extrapyramidal manifestations.

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Palabras clave: decanoato de flufenacina, neurolépticos, parkinsonismo,

Keywords: decanoate flufenacine, Neuroleptic-induced parkinsonism,

Sindrome parkinsoniano “rígido-acinético” debido a mielinosis extrapontina y mielinosis pontina asintomática secundarios a corrección rápida de hiponatremia.

The osmotic demyelinating syndromes are not always restricted to the pons. The extrapontine myelinolysis is seen in 10% of patients with central pontine myelinolysis. We present a 62-year-old woman who developed hyponatremia due to repeated vomiting. An acute akinetic-rigid syndrome followed rapid correction of hyponatremia. Bilateral putaminal and caudate lesions were seen on MRI. There were no clinical features of pontine involvement even though a typical lesion was seen on MRI. She recovered well with only symptomatic treatment. Although the exact pathogenesis is unknown, the most widely accepted hypothesis is that cellular edema secondary to the fluctuating osmotic forces, with rapid correction of hyponatremia, results in fibre-tract compression and demyelination. In contrast to the generally expected poor outcome in this condition, patients do have good recovery with symptomatic treatment and good nursing care.

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Palabras clave: Enfermedades desmielinizantes, Extrapontino, Hiponatremia, Mielinolisis, parkinsonismo, Puente,

Keywords: Demyelinating disease, Extrapontine, Hyponatremia, Myelinolysis, parkinsonism, Pons,

Demencia y Parkinsonismo como Síntomas Iniciales en un Paciente con SIDA.

Dementia and Parkinsonism as early symptoms of AIDS are infrequent. We report the case of a male patient 62 years old, with a history of diabetes – insulin dependent and illicit drug use, who began his symptomatology with dementia and parkinsonism two months before his death.