Objectives: To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease... more Objectives: To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease. Clinical Presentation and Intervention: A 56-year-old man initially presented with a 6-month duration of a continuous, diffuse headache of mild to moderate and sometimes of severe intensity. A CT of the brain was normal. Neurological examination was normal, including absence of symptoms and signs of meningismus. During the last 2 months, an intermittent eye pain, redness, and gradual loss of vision in both eyes was detected and subsequently he had tinnitus, malaise, nausea and mild meningismus. He was diagnosed as having VKH disease. Ophthalmologic examination revealed high intraocular pressure, requiring trabeculectomy with surgical iridectomy. The patient is now being treated with systemic steroids. Conclusion: VKH disease may initially present as sustained headache, without specific ophthalmologic symptoms and it should be considered in the differential diagnosis in patients with at...
Introduction Paraneoplastic limbic encephalitis remains a challenging clinical diagnosis with poo... more Introduction Paraneoplastic limbic encephalitis remains a challenging clinical diagnosis with poor outcome if it is not recognized and treated early in the course of the disease. Case Presentation A 65-year-old Caucasian woman presented with generalized tonic-clonic seizures and increasing confusion shortly after a lung biopsy that led to the diagnosis of small-cell lung cancer. She had a complicated hospital course, and had recurrent respiratory distress due to aspiration pneumonia, and fluctuating mental status and seizures that were refractory to anti-epileptic drug treatment. Routine laboratory testing, magnetic resonance imaging of the brain, electroencephalogram, lumbar puncture, serum and cerebrospinal fluid tests for paraneoplastic antibodies, and chest computed tomography were performed on our patient. The diagnosis was paraneoplastic limbic encephalitis in the setting of small-cell lung cancer with positive N-type voltage-gated calcium channel antibody titer. Anti-epilepti...
To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease. A 56-year-... more To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease. A 56-year-old man initially presented with a 6-month duration of a continuous, diffuse headache of mild to moderate and sometimes of severe intensity. A CT of the brain was normal. Neurological examination was normal, including absence of symptoms and signs of meningismus. During the last 2 months, an intermittent eye pain, redness, and gradual loss of vision in both eyes was detected and subsequently he had tinnitus, malaise, nausea and mild meningismus. He was diagnosed as having VKH disease. Ophthalmologic examination revealed high intraocular pressure, requiring trabeculectomy with surgical iridectomy. The patient is now being treated with systemic steroids. VKH disease may initially present as sustained headache, without specific ophthalmologic symptoms and it should be considered in the differential diagnosis in patients with atypical but relentless headache.
Objective: To describe a case of limbic encephalitis which initially presented as viral limbic en... more Objective: To describe a case of limbic encephalitis which initially presented as viral limbic encephalitis and during the clinical evaluation a renal carcinoma was diagnosed. Case report: Patient with history of peripheral paresis of right facial nerve, 1 month after symptoms appearance and treatment, developed fever, vomiting, grand mal seizure, decreased level of consciousness, confusion, hallucinations and agitation. The patient initially presented a clinical picture of viral LE. which confirmed by CSF. MRI brain showed areas with pathological intensity signal in the region of limbic system unilateral. During the clinical evaluation a renal carcinoma was discovered and a nephrectomy has been performed. Conclusions: Although PLE typically presents as a chronic or subacute disease, it may be fulminant and clinically indistinguishable from an acute HSVE. This association pose the problem of a possible relation between this two syndromes and the correct diagnosis is very important, because there are effective treatments.
This case attempts to explicit the importance of clinical examination in the differential diagnos... more This case attempts to explicit the importance of clinical examination in the differential diagnosis of two similar clinical entities namely astereognosia and stereoanesthesia. The patient presented below involves a multiple sclerosis patient whose symptoms were considered at first to be a case of astereognosia since she mainly complained of an inability to recognize and name the form and nature of objects by touch. However, a thorough clinical examination and the results of neurophysiological and neuroimaging testing demonstrated that it involved a case of stereoanesthesia due to a demyelinating lesion at the cervical region of the spinal cord.
Objectives: To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease... more Objectives: To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease. Clinical Presentation and Intervention: A 56-year-old man initially presented with a 6-month duration of a continuous, diffuse headache of mild to moderate and sometimes of severe intensity. A CT of the brain was normal. Neurological examination was normal, including absence of symptoms and signs of meningismus. During the last 2 months, an intermittent eye pain, redness, and gradual loss of vision in both eyes was detected and subsequently he had tinnitus, malaise, nausea and mild meningismus. He was diagnosed as having VKH disease. Ophthalmologic examination revealed high intraocular pressure, requiring trabeculectomy with surgical iridectomy. The patient is now being treated with systemic steroids. Conclusion: VKH disease may initially present as sustained headache, without specific ophthalmologic symptoms and it should be considered in the differential diagnosis in patients with at...
Introduction Paraneoplastic limbic encephalitis remains a challenging clinical diagnosis with poo... more Introduction Paraneoplastic limbic encephalitis remains a challenging clinical diagnosis with poor outcome if it is not recognized and treated early in the course of the disease. Case Presentation A 65-year-old Caucasian woman presented with generalized tonic-clonic seizures and increasing confusion shortly after a lung biopsy that led to the diagnosis of small-cell lung cancer. She had a complicated hospital course, and had recurrent respiratory distress due to aspiration pneumonia, and fluctuating mental status and seizures that were refractory to anti-epileptic drug treatment. Routine laboratory testing, magnetic resonance imaging of the brain, electroencephalogram, lumbar puncture, serum and cerebrospinal fluid tests for paraneoplastic antibodies, and chest computed tomography were performed on our patient. The diagnosis was paraneoplastic limbic encephalitis in the setting of small-cell lung cancer with positive N-type voltage-gated calcium channel antibody titer. Anti-epilepti...
To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease. A 56-year-... more To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease. A 56-year-old man initially presented with a 6-month duration of a continuous, diffuse headache of mild to moderate and sometimes of severe intensity. A CT of the brain was normal. Neurological examination was normal, including absence of symptoms and signs of meningismus. During the last 2 months, an intermittent eye pain, redness, and gradual loss of vision in both eyes was detected and subsequently he had tinnitus, malaise, nausea and mild meningismus. He was diagnosed as having VKH disease. Ophthalmologic examination revealed high intraocular pressure, requiring trabeculectomy with surgical iridectomy. The patient is now being treated with systemic steroids. VKH disease may initially present as sustained headache, without specific ophthalmologic symptoms and it should be considered in the differential diagnosis in patients with atypical but relentless headache.
Objective: To describe a case of limbic encephalitis which initially presented as viral limbic en... more Objective: To describe a case of limbic encephalitis which initially presented as viral limbic encephalitis and during the clinical evaluation a renal carcinoma was diagnosed. Case report: Patient with history of peripheral paresis of right facial nerve, 1 month after symptoms appearance and treatment, developed fever, vomiting, grand mal seizure, decreased level of consciousness, confusion, hallucinations and agitation. The patient initially presented a clinical picture of viral LE. which confirmed by CSF. MRI brain showed areas with pathological intensity signal in the region of limbic system unilateral. During the clinical evaluation a renal carcinoma was discovered and a nephrectomy has been performed. Conclusions: Although PLE typically presents as a chronic or subacute disease, it may be fulminant and clinically indistinguishable from an acute HSVE. This association pose the problem of a possible relation between this two syndromes and the correct diagnosis is very important, because there are effective treatments.
This case attempts to explicit the importance of clinical examination in the differential diagnos... more This case attempts to explicit the importance of clinical examination in the differential diagnosis of two similar clinical entities namely astereognosia and stereoanesthesia. The patient presented below involves a multiple sclerosis patient whose symptoms were considered at first to be a case of astereognosia since she mainly complained of an inability to recognize and name the form and nature of objects by touch. However, a thorough clinical examination and the results of neurophysiological and neuroimaging testing demonstrated that it involved a case of stereoanesthesia due to a demyelinating lesion at the cervical region of the spinal cord.
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