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Fraiman P, Valente AL, Barreto MESF, Silva NL, Rezende Filho FM, Braga VL, Moraes MP, Pedroso JL, Barsottini OGP. Sarcoid optic neuropathy. Pract Neurol 2024; 24:141-143. [PMID: 37932041 DOI: 10.1136/pn-2023-003939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
A 45-year-old woman presented with sudden complete vision loss in her left eye and retroorbital pain worsened by eye movements. A previous milder episode of vision loss had occurred in the same eye 1 year before, with complete recovery after high-dose intravenous methylprednisolone. She had no light perception in the left eye with a swollen optic disc, but with a normal right optic disc. There were no systemic manifestations or infections. MR scan of the brain showed extensive enlargement and enhancement of the left optic nerve and optic chiasm. After excluding infections and autoimmune markers, a left optic nerve biopsy confirmed non-caseating granulomas, leading to a diagnosis of neurosarcoidosis.
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Affiliation(s)
- Pedro Fraiman
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, UNIFESP, Sao Paulo, Brazil
| | - André Lopes Valente
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, UNIFESP, Sao Paulo, Brazil
| | | | - Nathália Lopes Silva
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, UNIFESP, Sao Paulo, Brazil
| | - Flavio Moura Rezende Filho
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, UNIFESP, Sao Paulo, Brazil
| | - Vinícius Lopes Braga
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, UNIFESP, Sao Paulo, Brazil
| | - Marianna Pinheiro Moraes
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, UNIFESP, Sao Paulo, Brazil
| | - José Luiz Pedroso
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, UNIFESP, Sao Paulo, Brazil
| | - Orlando G P Barsottini
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, UNIFESP, Sao Paulo, Brazil
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de Almeida IM, Rezende Filho FM, Pedroso JL, Barsottini O. Teaching NeuroImage: Mobile Hypopyon as a Clinical Clue for the Diagnosis of Behçet Disease. Neurology 2023; 100:307-308. [PMID: 36357189 PMCID: PMC9946181 DOI: 10.1212/wnl.0000000000201577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/06/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Flavio Moura Rezende Filho
- From the Division of General Neurology and Ataxia Unit, Department of Neurology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Gambirasio BG, Amaral RM, Yoshinaga Tonholo Silva T, Costa DMC, Rezende Filho FM, Caldeira Brant PHR, Escorcio-Bezerra ML, Barsottini OGP, Pedroso JL. Ischaemic lumbosacral plexopathy following aortic dissection. Pract Neurol 2023; 23:67-70. [PMID: 35995555 DOI: 10.1136/pn-2022-003462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 02/02/2023]
Abstract
A 57-year-old man was diagnosed with acute myocardial infarction and Stanford type A aortic dissection that had spread to the common iliac arteries. He underwent a Bentall procedure for vascular repair. Immediately after surgery, he developed numbness and severe weakness in his left leg. On examination, he had hypotonia, absent deep tendon reflexes, weakness in the left leg (Medical Research Council (MRC) scale for muscle strength - 0/5 distal, 3/5 proximal) and reduced sensation in the left leg. Electromyography confirmed subacute involvement of the left lumbar and lumbosacral plexus. MR scan of the lumbar plexus showed diffuse muscle oedema involving the left gluteus maximus. We diagnosed ischaemic lumbosacral plexopathy secondary to extensive aorta dissection and internal iliac artery occlusion. We discuss the clinical features of ischaemic plexopathy and the diagnostic approach and review the vascular anatomy of the lumbosacral plexus.
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Affiliation(s)
| | - Rodrigo Matos Amaral
- Department of Neurology, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | - Orlando G P Barsottini
- Department of Neurology, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - José Luiz Pedroso
- Department of Neurology, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
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Pedroso JL, Braga-Neto P, Escorcio-Bezerra ML, Abrahão A, de Albuquerque MVC, Filho FMR, de Souza PVS, de Rezende Pinto WBV, Borges FRP, Saraiva-Pereira ML, Jardim LB, Barsottini OGP. Non-motor and Extracerebellar Features in Spinocerebellar Ataxia Type 2. Cerebellum 2017; 16:34-39. [PMID: 26825292 DOI: 10.1007/s12311-016-0761-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant degenerative disease. Pathological studies have demonstrated not only cerebellar and brainstem atrophy, but substantia nigra, motoneurons, basal ganglia, thalamus, and peripheral nerves involvement. These findings may explain non-motor and extra-cerebellar features in SCA2. We accessed the non-motor symptoms and extra-cerebellar signs in SCA2 patients in order to provide a better understanding on pathophysiological mechanisms and natural history of brain degeneration in the disease. Thirty-three SCA2 patients were evaluated and compared with 26 healthy subjects. We investigated the following variables: sleep disorders, cognitive deficit, olfactory impairment, urinary dysfunction, psychiatric symptoms, cramps, pain, movement disorders, and weight loss. SCA2 had a high frequency of REM sleep behavior disorder (48.48 %, N = 16) as well as excessive daytime sleepiness (42.42 %, N = 14). Chorea was present in 15.15 % (N = 5), dystonia in 27.27 % (N = 9), and parkinsonism in 27.27 % (N = 9). Slow saccadic pursuit was present in 87.87 % (N = 29) and ophtalmoparesis in 78.78 % (N = 26) of patients. Regarding sleep disorders, 18.18 % (N = 6) of patients had restless leg syndrome. Dysphagia was present in 39.39 % (N = 13), weight loss 24.24 % (N = 8), and urinary dysfunction 27.27 % (N = 9). Cramps was present in only 6 % of patients (N = 2). This study highlighted the high frequency of non-motor symptoms and extra-cerebellar signs in SCA2. Our findings demonstrate the widespread of nervous system involvement in SCA2 patients and contribute to better understand the natural history of brain degeneration in this genetic condition.
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Affiliation(s)
- José Luiz Pedroso
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Pedro Braga-Neto
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Center of Health Sciences, Universidade Estadual do Ceará, CE, Brazil
| | | | - Agessandro Abrahão
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Franklin Roberto Pereira Borges
- Department of Neurophysiology and Department of Neurosurgery, Fundação Beneficente, Hospital de Cirurgia, Aracaju, SE, Brazil
| | - Maria Luiza Saraiva-Pereira
- Department of Biochemistry and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Bannach Jardim
- Department of Internal Medicine and Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Orlando G P Barsottini
- Department of Neurology, Ataxia Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Rezende Filho FM, Rocha E, Dutra LA, Pedroso JL, Barsottini OGP. Frontal lobes white matter abnormalities mimicking cystic leukodystrophy in Wilson's disease. Arq Neuropsiquiatr 2017; 75:260-261. [PMID: 28489149 DOI: 10.1590/0004-282x20170003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/08/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Flavio Moura Rezende Filho
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Divisão de Neurologia Geral, São Paulo SP, Brasil
| | - Eva Rocha
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Divisão de Neurologia Geral, São Paulo SP, Brasil
| | - Lívia Almeida Dutra
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Divisão de Neurologia Geral, São Paulo SP, Brasil
| | - José Luiz Pedroso
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Divisão de Neurologia Geral, São Paulo SP, Brasil
| | - Orlando G P Barsottini
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, Divisão de Neurologia Geral, São Paulo SP, Brasil
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