Search

Introduction: Isolated acute amnesia is an exceptional presenting symptom of thalamic stroke. This study analyses the clinical profile, the diagnosis, the treatment and the prognosis of these patients., Case Reports: We conducted a retrospective review of the cases of thalamic infarct that presented exclusively as acute amnesia in our university tertiary hospital (n = 3) and a review of similar cases in PubMed (n = 20). 48% presented at least one risk factor of stroke (arterial hypertension, dyslipidaemia, diabetes mellitus, atrial fibrillation or a previous stroke). Amnesia was anterograde in three cases (13%) and global in the remaining 20 (87%). The infarct was detected in neuroimaging studies carried out within the first 24 hours in one patient (4%) and later in all the others; the average time until a diagnosis was established was 11 days. The initial CT scan was normal in five patients (22%). Eight cases (35%) required magnetic resonance imaging to detect the infarct. Of these, four subjects were studied directly with MR imaging. Amnesia clearly improved in eight patients (35%), and three of them (13%) made a full recovery. Fifteen patients (65%) presented mnemonic sequelae that interfered with their functional capacity. The clinical picture lasted less than 24 hours in two patients (9%). None of the cases received revasculisation therapy in the acute phase., Conclusion: The diagnosis of thalamic infarcts that begin exclusively with amnesia is very difficult and this has negative repercussions on their treatment in the acute phase. These infarcts can produce a functionally disabling memory deficit in a high percentage of patients.

In vitro studies have shown that the cerebrospinal fluid of patients with multiple sclerosis transports compounds which may affect the function or viability of central nervous system cell function. The presence of nerve ion channel blockers and other molecules, as yet unidentified, which may cause the death of nerve cells or oligodendrocytes has been shown, although their relevance and clinical correlation is still not clear. If their usefulness is proved, these methods may be useful in the search for inhibitors of the noxious effects of the substances mentioned.

Objective: We present a case of progressive amyotrophy of a limb as the presenting symptom of the anchored spinal cord syndrome and review the principal clinical features of the syndrome, diagnostic tests which are useful in differentiating it from other conditions and its treatment., Clinical Case: We describe a case of a young woman in whom the spinal cord was anchored by a spinal lipoma. At the onset of the disorder she complained of progressive muscular atrophy of the right leg and difficulty in dorsi-flexion of her right foot. Plain X-ray of the pelvis showed partial agenesis of the right lower hemisacrum and partial sacralization of L5. Lumbosacral CT and MR showed a lipoma to be present within the spinal canal and the thickened filum terminale anchored within the lipoma. During the next five months after diagnosis, the clinical picture worsened with paresia of flexo-extension of the right knee and of flexion of the right foot. Surgical treatment was therefore indicated., Conclusions: The anchored spinal cord syndrome should be considered in the differential diagnosis of spinal cord disorders presenting in adults, when there are other malformations such as agenesis of the sacrum. Surgical treatment is always indicated when there is evidence of worsening clinical condition.

Introduction: Wallerian degeneration (WD) is the irreversible axonal and myelin damage after the injury to the proximal portion of the axon or its cell body. The most frequent cause of WD in the central nervous system is ischemic stroke. Various studies have related the presence of pyramidal tract WD with the severity of motor deficit and partial motor improves. We present a patient with pyramidal tract WD without motor sequelae., Clinical Case: A 55 years old man, hypertense and heavy smoker, suffered a sudden episode of dysarthria and left hemiparesis. Routine analysis showed hypercholesterolemia and an aortic valvular sclerosis on an echocardiogram. Cranial magnetic resonance imaging (MRI) showed multiple supratentorial lacunar infarctions. He was discharged without deficits, antiaggregated with aspirin. Six months later, he suffered a sudden episode of dysarthria. A new cranial MRI disclosed WD of the right pyramidal tract without pyramidal signs on neurologic exam., Conclusions: Presence of WD on the pyramidal tract is related with pyramidal disability in diverse degree but can develop a complete motor rehabilitation. We present a case of WD of the pyramidal tract without pyramidal deficits that supports the role of supplementary motor areas on motor rehabilitation.

Introduction: Herpetic encephalitis (HE) is the commonest cause of acute sporadic encephalitis in the United States and Europe. In 20% of cases, the clinical course is atypical and this may lead to delay in diagnosis and treatment., Clinical Case: A 24 year old patient presented with aseptic meningitis, which had been present for the previous 10 days and which then became complicated by fever and aphasia. The cerebrospinal fluid (CSF) showed marked pleocytosis and increased protein. Cerebrospinal puncture was found to be positive for DNA of the herpes simplex virus. Magnetic resonance (MR) imaging showed a temporal lesion with intense uptake of contrast. Treatment was started with acyclovir and the patient improved over the days following this., Conclusions: At present the diagnosis of herpetic encephalitis is based on polymerase chain reaction (PCR) studies of the CSF and MR imaging. The correlation between patients with HE with cerebrospinal puncture showing positive for herpes and alterations on MR is 89%. In view of the 20% of atypical forms, a high degree of clinical suspicion is necessary to try to obtain early diagnosis and treatment.

Introduction: Neurological paraneoplastic syndromes (NPS) are usually found in association with bronchogenic and gynecological tumors. Any part of the central or peripheral nervous system may be involved, and the clinical presentation may therefore take any of a large number of forms. Intestinal tumors rarely lead to NPS. We present the case of a patient with adenocarcinoma of the colon, in whom the first clinical sign was NPS., Clinical Case: A 72 year old man presented with subacute onset of generalized myoclonus, predominantly of action, ataxia on walking and changes in speech associated with a constitutional syndrome. There were no ocular changes. Laboratory investigations including immunology, serology and tumour markers were normal. Anti-Hu, Yo and Ri antibodies were negative. Study of the CSF showed the blood-brain barrier to be damaged. Cranial MR, EEG, thoraco-abdominal CT and osseous gammagraphy showed no significant changes. On colonoscopy there was a tumour in the medial zone of the transverse colon (an adenocarcinoma). Treatment was started with high dose steroids and the condition progressively improved. After right hemicolectomy steroid treatment was stopped, and there was complete recovery of the condition., Conclusions: The presence of cerebellar syndromes and myoclonus of unknown aetiology should lead one to the diagnosis of a paraneoplastic syndrome. Adenocarcinoma of the colon should be included in the differential diagnosis.