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We describe a 29-year-old woman with chronic migraine and psychiatric comorbidities that presented with new transient left-sided hemiparesis and hemi-hypoesthesia and were found to have right vertebral artery hypoplasia (VAH). We briefly review the association of VAH and migraine and the influence of psychiatric disorders and VAH as possible risk factors for chronification of episodic migraine. Despite uncertain mechanisms, VAH may be one of thecontributing factors for the chronicity of migraine.

Made available in DSpace on 2022-04-29T08:39:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Porphyria is a metabolic disorder caused by a mutation in the heme biosynthetic pathway, with vague symptomatology and rare prevalence. A triad of hyponatremia, intermittent seizures, and abdominal pain should raise suspicion for porphyria. The diagnosis is based on increased blood porphobilinogen levels and genetic mutations. Treatment involves Dextrose-10 administration followed by hematin infusions as soon as possible. A maintenance dose of hematin is required in some cases. Here, we report a delayed diagnosis of acute intermittent porphyria (AIP) in an 18-year-old female, who first presented with severe anemia attributed to iron deficiency from menstrual blood loss. After discharge, she was readmitted with bilateral lower extremity and abdominal pain, hyponatremia, and seizure attributed to polypharmacy. During this second hospitalization, she was transferred to our hospital complaining of chest pain, shortness of breath, markedly decreased weakness, dysphagia, and hallucinations. After an extensive workup, she was diagnosed with AIP, and Dextrose-10 and hemin infusion were started. Our patient was found to have a missense mutation in the Hydroxymethylbilane synthase gene. She recovered after an extended ICU stay of 45 days and was discharged with a moderate improvement of weakness. Early diagnosis is necessary to prevent severe manifestations and long-term sequelae, such as axonal neuropathy, which occurred in the presented case. University of Florida Health at Jacksonville University of Florida Departamento de Neurologia Psicologia e Psiquiatria UNESP University of Florida College of Medicine - Jacksonville Departamento de Neurologia Psicologia e Psiquiatria UNESP

Made available in DSpace on 2022-04-29T08:30:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-09-01 Post-traumatic syringomyelia develops years to decades after spinal trauma in up to 28% of patients. We report a case of a man who developed extensive syringomyelia 14 years after spinal trauma, but had only minimal symptoms. Presumed pathophysiology of this condition and options for surgical management are briefly reviewed. Department of Neurology Psychology and Psychiatry Botucatu Medical School of Sao Paulo State University (UNESP) Kaiser Permanente Bernard J. Tyson School of Medicine Department of Neurology Psychology and Psychiatry Botucatu Medical School of Sao Paulo State University (UNESP)