Maria Zurru

Embolic stroke secondary to cardiac papillary fibroelastoma.

Introduction:Papillary fibroelastoma is the most common primary cardiac valvular tumor. Historically, papillary fibroelastoma was an incidental autopsy finding, deemed to have no clinical significance. More recently, reports of symptomatic cases of papillary fibroelastoma with complications such as myocardial infarction and stroke suggest it should be considered a potentially dangerous lesion. In this report, we describe the clinical and echocardiographic findings of 3 patients with cardiac papillary fibroelastoma who presented with cerebral vascular events. Objective:To describe the clinical and echocardiographic findings of 3 patients with cardiac papillary fibroelastoma (CPF) who presented cerebral vascular events. Methods:Describe the findings of 3 patients and review of the literature. Results:We report 3 cases with cerebral ischemic events associated with the presence of CPF that were confirmed by histopathological examination. Conclusions:Cardiogenic embolism is recognized increasingly as an important cause of stroke, accounting of 20% of ischemic strokes. Cardioembolic stroke is largely preventable. The likelihood of recurrence is relatively high for most cardioembolic sources and therefore secondary stroke prevention is fundamental. TEE allowed to characterize well-established sources of embolism, and it was the best diagnostic approach in our patients. Magnetic resonance imaging was used in 1 of these patients, while it confirmed the presumptive diagnosis of cardiac tumor. The first-choice treatment of symptomatic CPF is surgical excision which must be performed as early as possible to reduce the risk of early recurrences of embolic events. The use of TEE in the evaluation of cerebral vascular events is not routinely performed, this method must be considered in patients for whom the cause of cerebrovascular ischemia is unclear, after noninvasive neurovascular studies.

Romboencefalitis por Listeria. Presentación de 2 casos en adultos sanos

Resumen Introduccion Cerca del 1% de todos los casos de meningitis son causados por Listeria monocytogenes. La rombencefalitis es una forma infrecuente de neurolisteriosis que se presenta mas habitualmente en inmunocomprometidos. Descripcion de caso Describimos dos mujeres previamente sanas que padecieron infeccion por L. monocytogenes. Se aislo el germen en cultivos de sangre y liquido cefalorraquideo. Las neuroimagenes mostraron lesiones del tronco cerebral. Conclusion En el paciente febril con signos de compromiso del tronco cerebral debe sospecharse la neurolisteriosis y administrarse ampicilina mas gentamicina. La resonancia magnetica puede contribuir al diagnostico.

Transesophageal Echocardiography Findings in Lacunar Stroke

BACKGROUND Transesophageal echocardiography (TEE) constitutes a valuable tool in patients with stroke and cardiac embolization, but its indication is controversial in lacunar stroke. The purpose of this study was to assess the findings of TEE in lacunar stroke. METHODS Initial symptoms, brain computed tomography or magnetic resonance imaging, and TEE were performed for all patients with ischemic stroke admitted consecutively to our department of neurology. The subtype of ischemic stroke (lacunar v large-vessel stroke) was also reviewed. RESULTS In all, 124 patients with ischemic stroke were identified and lacunar syndrome occurred in 46. Major risk factor of embolization in patients with lacunar stroke and indication for anticoagulation were detected in 20% (9 of 46). We compared findings in both groups (lacunar v nonlacunar stroke) to evaluate the differences in the presence of major risk factor for embolization, Chi square = 0.07, P = .8 (odds ratio 95% CI = 0.35-2.18). Characteristics of the 9 patients with lacunar stroke and major risk of embolization show that history of lacunar ischemic stroke was present in all the patients of this group. DISCUSSION The results of the study suggest that TEE may be necessary to obtain a complete evaluation to optimize preventive treatment in patients with clinical and radiologic presentation that suggest lacunar infarct, particularly in cases with a history of ischemic stroke, in which a potential cardiac source of embolization may be detected.

Hidrosiringomielia no comunicante asociada a lesión desmielinizante

La siringomielia no comunicante ha sido descrita en asociacion con diversas patologias medulares, pero raramente ha sido reportada en relacion con lesiones desmielinizantes. Presentamos un paciente de 39 anos, varon, con antecedentes de herpes zoster craneal en 1996 que evoluciono con omalgia izquierda y cervicalgia persistente. La resonancia magnetica (RM) de medula cervical evidencio lesion intramedular focal a nivel C4-C5 de aspecto desmielinizante, y la presencia de hidrosiringomielia nivel C6. El paciente rehuso nuevos procedimientos. En 1998 agrega signo de Lhermitte. Una nueva RM espinal mostro reduccion de la lesion intramedular cervical con persistencia de la siringomielia no comunicante. La RM cerebral objetivo una unica lesion puntiforme en el brazo posterior de la capsula interna derecha. Las serologias para HIV, herpes, HTLV I-II, VDRL y potenciales evocados fueron normales. En septiembre de 1998 se encontraba asintomatico, con examen neurologico normal y sin cambios en el control por imagenes. La evolucion clinica y hallazgos neurorradiologicos sugieren una lesion primariamente desmielinizante versus un mecanismo postinfeccioso La patogenesis de la siringomielia no comunicante asociada a lesiones desmielinizantes es discutida: se postula dilatacion ependimaria mecanica por obstruccion al flujo del liquido cefalorraquideo causado por el edema de la placa espinal, versus dilatacion ependimaria secundaria a mielomalacia. Pese a su baja prevalencia y a la dificultad diagnostica que plantea la ausencia de un patron radiologico caracteristico, la patologia desmielinizante deberia considerarse entre los diagnosticos diferenciales de lesiones intramedulares asociadas a hidromielia, ya que en estos casos el abordaje quirurgico no estaria indicado.