[Multiple sclerosis. Treatment interactions].
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Biomedical subjects
Publications and source records attributed to C Roig.
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In 50 patients with a diagnosis of brain metastasis, a study was made commencing with the appearance of the first neurological symptom. Severe headaches were observed in 48% of the patients, followed by a change in character in 11% and motor disorders in 11%. The search for initial neurological signs will help dictate the precise moment of using the scanner to confirm the diagnosis, thus hopefully allowing for a quicker treatment and improving the survival rates of these patients.
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A nuclear oculomotor nerve syndrome is rarely caused by mesencephalic lesions. We describe 5 patients, 4 with unilateral syndrome (3 due to ischemia and 1 to mesencephalic hemorrhage) and 1 with bilateral nuclear ischemia of the third cranial nerve. These patients represent 0.2% of those admitted with cerebral vascular pathology over the last 12 years. Symptoms are consistent with descriptions of the anatomic organization of this nucleus, with peripheral paralysis of the contralateral superior rectus and possible bilateral involvement of the eyelid elevator and the pupillary constrictor muscles. A noteworthy symptom seen in these cases is supranuclear paralysis of the upward gaze on the side of the lesion, with ocular elevation achieved in response to oculocephalic stimuli in 2 cases and with Bell's synkinesis in 4. We analyze the nature of 22 published cases of unilateral nuclear damage and of 14 published cases of bilateral nuclear damage. Unilateral damage may or may not lead to ipsilateral pupillary involvement, uni- or bilateral eyelid ptosis, contralateral ocular hypotropia, and possible horizontal paresis of the contralateral gaze. Associated deficits are hemiparesis or crossed hemiataxia. Unresponsive pupils and bilateral ptosis associated with tetraparesis, bilateral ataxia and altered states of consciousness were seen with bilateral nuclear lesions. Infarction is the main cause (in 32 out of 41) and recovery of full ocular movement is uncommon.
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The case of a 58-year-old male who, after 47 months of treatment with cervical radiotherapy for labial carcinoma, developed brachial plexopathy and six months later cervical myelopathy is herewith presented. Involvement of both the brachial plexus and the spinal cord in the same patient secondary to radiotherapy is exceptional.