Hemiballismus is an unusual complication of brain metastasis of lung cancer. A 62-year-old woman suddenly presented with an acute movement disorder characterized by irregular, involuntary, and largeamplitude movements of the left half of her body. Brain magnetic resonance imaging (MRI) revealed metastasis in the right thalamic region. A whole-body CT scan revealed a lung tumor, while a biopsy showed small cell lung carcinoma. Vascular lesions that affect the basal ganglia, particularly the subthalamic nucleus, are the most common cause of hemiballismus. Hemiballismus is generally treated with antipsychotics such as tetrabenazine and haloperidol, but the primary treatment is the causal one. This was demonstrated in our patient since, after completion of the radio-chemotherapy sessions, the hemiballismus gradually decreased.
Neurological paraneoplastic syndromes are a rare entity that affects patients with cancer. Anti-Ri antibodies affect the brain stem and produce a heterogeneous rapidly progressive subacute syndrome depending on the involvement of the different regions concerned. The most common clinical presentation is opsoclonusmyoclonus syndrome and paraneoplastic cerebellar degeneration. Here we report a case of a 60-year-old woman with a subacute static-kinetic cerebellar syndrome, cervical dystonia, and multiple cranial nerve palsies revealing a mammary adenocarcinoma. Anti-Ri antibodies were positive in her blood. Our observation underscored the importance of the identification of the tumor for early treatment management to avoid irreversible neurological manifestations.
Creutzfeldt-Jakob disease is a rare, transmissible neurodegenerative disorder, most prevalent between the ages of 50 and 70 years old, that is incurable and fatal. It's caused by a slow, infectious protein agentdesignated prion. The most common clinical presentations are sleep disturbances, personality changes, ataxia, aphasia, visual disturbances, weakness, and myoclonus combined with progressive dementia. Here we report the case of a patient with disturbance of consciousness, restlessness, and myoclonia who died two weeks after admission. The analysis of his cerebrospinal fluid reveals that the presence of 14-3-3 protein was positive, which supports the diagnosis of Creutzfeldt-Jakob disease. Our observation underscores the importance of the quick fatality of this case.
Fat embolism syndrome is potentially lethal. It is frequently a complication of long bone fractures and/or orthopedic surgery. Cerebral fat embolism is an unusual condition characterized by purely cerebral involvement. Neurological signs can be variable and brain MRI has a pivotal role in the diagnosis. We report the case of a 69-year-old male who presented motor impairment and a disorder of consciousness in the early postoperative course of total hip arthroplasty for a left femoral neck fracture, which occurred 24 hours before surgery. He had no dermatologic or respiratory signs. No respiratory or dermatologic signs were found. Blood samples showed moderate thrombopenia and hemolytic anemia. Multiple lesions were found on brain MRI. Diagnosis of cerebral fat embolism was established after ruling out differentials.
We report the rare case of a 22-year-old female admitted for headaches, nausea, and an isolated lesion of the splenium of the corpus callosum (SCC) found on brain magnetic resonance imaging (MRI). A lumbar puncture test was performed, and Pseudomonas aeruginosa meningitis was found. Twenty days before the symptoms, she had spinal anesthesia for a cesarean section.As soon as the diagnosis was made, antibiotic therapy was initiated. Nonetheless, no signs or symptoms were related to this lesion, which spontaneously disappeared within one month on the control MRI.Pseudomonas aeruginosa is a gram-negative bacillus and may cause rare and severe meningitis. Therefore, a history of a neurosurgical procedure or spinal anesthesia should be sought in the anamnesis.
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