Occipital ischaemic stroke after visual snow phenomenon – a case report

Cephalalgia ◽  
2021 ◽  
pp. 033310242098544
Author(s):  
Teresa Catarci
Keyword(s):  
Case Report ◽  
Visual Field ◽  
Migraine With Aura ◽  
Cerebral Ischaemia ◽  
Brain Ischaemia ◽  
Inhibitory Circuits ◽  
Patient Reported ◽  
Migrainous Infarction ◽  
Entire Visual Field ◽  
Contralateral Cortex

Background Persistent migraine with aura and neuroimaging examinations revealing ischaemia in the contralateral cortex may be associated with migrainous infarction. Despite being a neurological symptom that is distinct from migraine with aura, the visual snow phenomenon may also be associated with cerebral ischaemia. Here we describe a patient who reported short-lasting daily symptoms of visual snow that affected his entire visual field before becoming continuous and left-sided following acute occipital brain ischaemia. Case report In February 2017, a 74-year-old retired male was referred to our headache outpatient clinic with a diagnosis of recent right occipital cerebral ischaemia and migraine with aura. The patient reported visual snow symptoms that had changed from being bilateral and temporary to left-sided and permanent one day upon awakening; after being admitted to hospital a few hours later, he discovered he had had a stroke. He said he had never had any symptoms of migraine with aura. The visual snow phenomenon disappeared completely after about 1 year. Conclusions In our patient, a temporary daily visual snow phenomenon reversed to a persistent one. This phenomenon occurred in the part of his visual field that had been affected by the ischaemic occipital stroke, as typically happens in migrainous infarction. We hypothesise that the occipital lesion disrupted the inhibitory circuits, leading to a quadrantopic persistent visual snow. Since the mechanism may be the same as that observed in migrainous infarction, though with a different pathophysiology, it is possible to speculate that the aura in this case is the result, as opposed to the cause, of stroke in most patients.

Dysmetropsia and Cotard's syndrome due to migrainous infarction – or not?

Cephalalgia ◽  
2014 ◽  
Vol 34 (9) ◽  
pp. 717-720 ◽  
Author(s):  
Natalie E Parks ◽  
Heather B Rigby ◽  
Gordon J Gubitz ◽  
Jai J Shankar ◽  
R Allan Purdy
Keyword(s):  
Case Report ◽  
Migraine With Aura ◽  
Cortical Spreading Depression ◽  
Spreading Depression ◽  
Imaging Findings ◽  
Vascular Territory ◽  
Cortical Laminar Necrosis ◽  
Migrainous Infarction ◽  
Cortical Laminar ◽  
Laminar Necrosis

Introduction Migrainous infarction accounts for 12.8% of ischemic strokes of unusual etiology. Case report A 59-year-old woman with longstanding migraine with aura experienced what appeared to be migrainous infarction characterized by dysmetropsia and transient Cotard’s syndrome. Imaging demonstrated right temporal-parietal-occipital changes with apparent cortical laminar necrosis. Conclusion The spectrum of the pathophysiology of migrainous infarction has not been established; however, cortical spreading depression may explain the appearance of imaging findings that do not obey a vascular territory.

Pediatric Visual Snow Syndrome (VSS): A Case Series

2019 ◽  
pp. 249-254
Author(s):  
Kenneth J. Ciuffreda ◽  
MH Esther Han ◽  
Barry Tannen
Keyword(s):  
Visual Field ◽  
Case Series ◽  
Therapeutic Interventions ◽  
Visual Condition ◽  
Visual Phenomena ◽  
Entire Visual Field ◽  
The Individual ◽  
Vision Therapy ◽  
Abnormal Visual

Visual snow syndrome (VSS) is a relatively rare, unusual, and disturbing abnormal visual condition. The individual perceives “visual snow” (VS) throughout the entire visual field, as well as other abnormal visual phenomena (e.g., photopsia). Only relatively recently has treatment been proposed (e.g., chromatic filters) in adults with VSS, but rarely in the pediatric VSS population (i.e., medications). In this paper, we present three well-documented cases of VSS in children, including their successful neuro-optometric therapeutic interventions (i.e., chromatic filters and saccadic-based vision therapy)

scholarly journals AB0858 SUCCESSFUL TERM PREGNANCY IN A PATIENT WITH GRANULOMATOSIS WITH POLYANGIITIS AFTER UNDERGOING RITUXIMAB THERAPY - CASE REPORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1452.2-1453
Author(s):  
O. Sirenko ◽  
O. Kuryata ◽  
T. Lysunets ◽  
A. Legkobyt ◽  
H. Mostova
Keyword(s):  
Case Report ◽  
Granulomatosis With Polyangiitis ◽  
Disease Onset ◽  
Biological Agents ◽  
Term Pregnancy ◽  
Aseptic Necrosis ◽  
Azathioprine Therapy ◽  
Disease Remission ◽  
Obstetric Medicine ◽  
Patient Reported

Background:Granulomatosis with polyangiitis (GWP) is a relatively rare disease with the lack of experience in the management of pregnancy currently. Potentially negative factors of pregnancy prognosis are both disease-related and teratogenic effects of specific vasculitis therapy [1].Objectives:To describe a clinical case of Successful term pregnancy in a patient with Granulomatosis with polyangiitis after undergoing rituximab therapy.Methods:19 years-old woman was admitted to the rheumatology department of Clinical Regional Hospital After Mechnicov in 2013 with the debut of Granulomatosis with polyangiitis. Her disease course included recurrent rhinitis and sinusitis, Granulomatosis of the eye orbits. Positive ANCA titers were present in the disease onset. In the preceding 7 years she had been treated with corticosteroids, cyclophospan (discontinuated in 2017 because of lack of efficiency), than azathioprine. Aseptic necrosis of the both femoral head was estimated on fifth disease year. In 2018 azathioprine therapy had been discontinued owing to the disease progression and biological agents were prescribed – rituximab with positive effect. The disease remission was achived by rituximab therapy, the patient was warned about the need for contraception. The last dose of rituximab was introduced in February 2020. However, in March 2020, the patient reported pregnancy and therapy was discontinued. At the onset of pregnancy she was treated with 6 mg oral methylprednisolone. Daily and this dose was stable till all pregnancy period. Fetal growth assessment, congenital abnormalities screening test, and laboratory tests for gestational diabetes and preeclampsia were unremarkable during all gestational trimesters. The ANCA titers remained negative and renal function was normal and there was no flare during all pregnancy period.Results:At 38 weeks’ gestation a spontataneous labor started without induction. A 3270-g healthy boy delivered with APGAR score of 9 at 1 minute and 5 minutes. Postpartum the disease remained in remission, and the patient was maintained on corticosteroids. The infant was healthy, with normal development.Conclusion:Thus, the use of biological agents therapy in patients with GWP shows possible ways to safe reproductive potential with disease remission achievement.References:[1]Daher A, Sauvetre G, Girszyn N, Verspyck E, Levesque H, Le Besnerais M. Granulomatosis with polyangiitis and pregnancy: A case report and review of the literature. Obstetric Medicine. 2020;13(2):76-82. doi:10.1177/1753495X18822581Disclosure of Interests:None declared

scholarly journals Concurrent Glossopharyngeal Neuralgia and Hemi-Laryngopharyngeal Spasm (HeLPS): A Case Report and a Review of the Literature

Neurosurgery ◽  
2019 ◽  
Vol 87 (5) ◽  
pp. E573-E577
Author(s):  
C Michael Honey ◽  
Marie T Krüger ◽  
Alan R Rheaume ◽  
Josue M Avecillas-Chasin ◽  
Murray D Morrison ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Microvascular Decompression ◽  
Medical Condition ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Conversion Disorder ◽  
Glossopharyngeal Neuralgia ◽  
Neurovascular Compression ◽  
Patient Reported

Abstract BACKGROUND AND IMPORTANCE Hemi-laryngopharyngeal spasm (HeLPS) has been recently described but is not yet widely recognized. Patients describe intermittent coughing and choking and can be cured following microvascular decompression of their Xth cranial nerve. This case report and literature review highlight that HeLPS can co-occur with glossopharyngeal neuralgia (GN) and has been previously described (but not recognized) in the neurosurgical literature. CLINICAL PRESENTATION A patient with GN and additional symptoms compatible with HeLPS is presented. The patient reported left-sided, intermittent, swallow-induced, severe electrical pain radiating from her ear to her throat (GN). She also reported intermittent severe coughing, throat contractions causing a sense of suffocation, and dysphonia (HeLPS). All her symptoms resolved following a left microvascular decompression of a loop of the posterior inferior cerebellar artery that was pulsating against both the IXth and Xth cranial nerves. A review of the senior author's database revealed another patient with this combination of symptoms. An international literature review found 27 patients have been previously described with symptoms of GN and the additional (but not recognized at the time) symptoms of HeLPS. CONCLUSION This review highlights that patients with symptoms compatible with HeLPS have been reported since 1926 in at least 4 languages. This additional evidence supports the growing recognition that HeLPS is another neurovascular compression syndrome. Patients with HeLPS continue to be misdiagnosed as conversion disorder. The increased recognition of this new medical condition will require neurosurgical treatment and should alleviate the suffering of these patients.

scholarly journals Tablets at the bedside - iPad-based visual field test used in the diagnosis of Intrasellar Haemangiopericytoma: a case report

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Nisha Nesaratnam ◽  
Peter B. M. Thomas ◽  
Ramez Kirollos ◽  
Algis J. Vingrys ◽  
George Y. X. Kong ◽  
...  
Keyword(s):  
Case Report ◽  
Visual Field ◽  
Field Test ◽  
Visual Field Test

Occipitoparietal alpha-band responses to the graded allocation of top-down spatial attention

2014 ◽  
Vol 112 (6) ◽  
pp. 1307-1316 ◽  
Author(s):  
Isabel Dombrowe ◽  
Claus C. Hilgetag
Keyword(s):  
Visual Field ◽  
Spatial Attention ◽  
Brain Regions ◽  
Alpha Band ◽  
Top Down ◽  
Attentional Resources ◽  
Parietal Lobes ◽  
Visual Spatial ◽  
Entire Visual Field ◽  
Band Activity

The voluntary, top-down allocation of visual spatial attention has been linked to changes in the alpha-band of the electroencephalogram (EEG) signal measured over occipital and parietal lobes. In the present study, we investigated how occipitoparietal alpha-band activity changes when people allocate their attentional resources in a graded fashion across the visual field. We asked participants to either completely shift their attention into one hemifield, to balance their attention equally across the entire visual field, or to attribute more attention to one-half of the visual field than to the other. As expected, we found that alpha-band amplitudes decreased stronger contralaterally than ipsilaterally to the attended side when attention was shifted completely. Alpha-band amplitudes decreased bilaterally when attention was balanced equally across the visual field. However, when participants allocated more attentional resources to one-half of the visual field, this was not reflected in the alpha-band amplitudes, which just decreased bilaterally. We found that the performance of the participants was more strongly reflected in the coherence between frontal and occipitoparietal brain regions. We conclude that low alpha-band amplitudes seem to be necessary for stimulus detection. Furthermore, complete shifts of attention are directly reflected in the lateralization of alpha-band amplitudes. In the present study, a gradual allocation of visual attention across the visual field was only indirectly reflected in the alpha-band activity over occipital and parietal cortexes.

scholarly journals Apexification Using Mineral Trioxide Aggregate and Modified Internal Matrix: A Case Report

2021 ◽  
Vol 33 (2) ◽  
Keyword(s):  
Case Report ◽  
Mineral Trioxide Aggregate ◽  
Tissue Formation ◽  
Enamel Hypoplasia ◽  
Hard Tissue ◽  
Radiographic Evidence ◽  
Radiographic Findings ◽  
Immature Teeth ◽  
Patient Reported ◽  
Treatment Alternatives

When pulpal necrosis occurs in immature teeth, one of the treatment alternatives is the creation of an artificial apical barrier through the placement of an apical plug. However, controlling the mineral trioxide aggregate (MTA) during placement has proven difficult. Several studies evaluated the use of resorbable barriers to act as an internal matrix to prevent accidental extrusion of MTA. The aim of this case report was to document the effectiveness of Surgicel as a modified internal matrix for proper placement of MTA during management of immature teeth with necrotic pulp using the apical plug technique. A 12-year-old female patient reported with the chief complaint of a badly mutilated lower right second premolar. The tooth suffered enamel hypoplasia and had a defective coronal structure. It was asymptomatic except for slight tenderness to percussion. Based on the clinical and radiographic findings, a diagnosis of pulpal necrosis with symptomatic apical periodontitis was made. The 3- and 6-month followup showed radiographic evidence of continued root and hard tissue formation. Based on these findings, we infer that Surgicel can be used as a modified internal matrix to prevent extrusion of the MTA into the periapical area and allow for proper MTA placement. Keywords: Apexification; Apical plug; Mineral trioxide aggregate; Calcium hydroxide; Surgicel; Modified internal matrix

scholarly journals Early Recognition of Stroke by Confrontation Visual Field Test – Is It Possible?

2020 ◽  
Keyword(s):  
Case Report ◽  
Visual Field ◽  
Cerebral Artery ◽  
Vision Loss ◽  
Posterior Cerebral Artery ◽  
Early Recognition ◽  
Past History ◽  
Neurological Deficits ◽  
Visual Field Defects ◽  
Axial Tomography

Introduction: Visual field loss is often the first sign of lesion of the anterior or posterior visual pathways. Screening for visual field defects should be a part of all routine eye examinations, mainly when neurological lesions are suspected. A confrontation visual field (CVF) test provide a rapid and practical method of visual field assessment, allowing the recognition of major neurological deficits. Materials and Research Methods: To report a case of posterior cerebral artery (PCA) stroke early suspected by CVF test. Case-Report: A 77 year-old male presented to our emergency department with vision blurring complaints and a strange sensation of a vision loss on one side on the left eye (OS), for the previous 15 days. He explained that symptoms initiated after an episode of dizziness followed by lipothymia. He denied diplopia or headaches. Past history revealed hypertension and diabetes as cardiovascular risk factors. The best corrected visual acuity was 20/25 on right eye (OD) and 20/60 on OS and pupillary reflexes were normal. CVF test was performed and showed a decrease on left hemicampus of OS. The biomicroscopy was normal and the fundus examination showed optic nerve edema bilaterally, also documented by Optical Coherence Tomography. Considering the findings and the history, neuroimaging and a neurological observation were requested. Computerized axial tomography revealed a hypodense lesion in right occipital posterior region, with hematic density. He was hospitalized for proper treatment with the diagnosis of posterior cerebral artery ischemic stroke, with further hemorrhagic transformation. Discussion: In acute stroke, visual disorders may form all or part of the initial presentation. Homonymous visual field deficits are well-known almost universal characteristics of PCA ischemia, however, due to the absent of cognitive impairment or speech problems associated to many cases, the diagnosis can be challenging at early stages. Our case-report highlights the importance of using CVF test to an immediate inspection of the peripheral visual field, in order to detect acute major defects, including homonymous deficits, to understand if a further prompt neurological examination is mandatory.

scholarly journals Inferior alveolar nerve paraesthesia after overfilling into the mandibular canal, confirmed by cone-beam computed tomography: a case report

2021 ◽  
Vol 24 (2) ◽  
Author(s):  
Claudemir de Souza Júnior ◽  
Ricardo Machado ◽  
Renee Ashley Batts ◽  
Lucas da Fonseca Roberti Garcia
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Cone Beam Computed Tomography ◽  
Root Canal ◽  
Inferior Alveolar Nerve ◽  
Mandibular Canal ◽  
Cone Beam ◽  
Filling Material ◽  
Mandibular Molar ◽  
Patient Reported

The filling material should be restricted to the root canal, and not extend to the periradicular tissues. Overextension occurs when there is an overflow of gutta-percha and sealer, whereas overfilling refers to the overflow only of sealer beyond the apical foramen. Both may cause several negative clinical consequences. Nevertheless, an accurate diagnosis of where they occurred cannot always be performed by conventional radiographic examination, because of the two-dimensional aspect of the image. This paper describes a clinical case of labiomandibular paraesthesia after overfilling into the mandibular canal (MC), as diagnosed by cone-beam computed tomography (CBCT), later used to perform the treatment planning. A 34-year-old Caucasian female patient sought a private dental clinic complaining of pain in the right mandibular posterior region. After taking the anamnesis and performing clinical and radiographic exams, the patient was diagnosed with pulp necrosis in the second right mandibular molar, and underwent root canal treatment. The final radiography showed overextension or overfilling, probably into the MC. About 2 hours after the procedure, the patient reported paraesthesia of her lower right lip and chin. A CBCT confirmed a small overfilling into the MC. For this reason, vitamin B12 was prescribed as the first treatment option. After 7 days, the patient reported a significant decrease in paraesthesia, and was completely normal after 15 days. This case report shows that CBCT is an effective radiographic diagnostic tool that can be used as an alternative in clinical cases of labiomandibular paraesthesia caused by overextension or overfilling.   Keywords Endodontic treatment; Overfilling; Paraesthesia; Conebeam computed tomography.

scholarly journals “This Is Not the Original Timeline”: A Case Report of an Extended Dissociative Episode in a Healthy Young Male Accompanied with Severe Decline in Mental State

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Godwin Tong ◽  
Kieran Groom ◽  
Louisa Ward ◽  
Muhammad Naeem
Keyword(s):  
Case Report ◽  
Mental State ◽  
Young Male ◽  
Obsessive Compulsive ◽  
Psychiatric Admission ◽  
Compulsive Disorder ◽  
Psychiatric Setting ◽  
Patient Reported ◽  
History Of ◽  
Core Symptoms

Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who he or she is. Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal. No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to a psychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signs of improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7 days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patient reported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given. This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission.

Sign in / Sign up

Export Citation Format

Share Document