Parkinsonism and defects of praxis following methanol poisoning.
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Adult↗
Biomedical subjects
B Indakoetxea
Publications and source records attributed to B Indakoetxea.
[Multiple nerve root tumors and neurofibromatosis: contribution of magnetic resonance imaging].
Three patients (two females and one male) with radiculospinal neurologic involvement secondary to different forms of neurofibromatosis are reported. The first two met the diagnostic criteria for NF-1, although case 2 had a posterior fossa meningioma, which is an uncommon finding in this group. The male patient had an apparently sporadic NF-2, with bilateral acoustic nerve neurinoma, multiple meningioma, multiple radicular neurinoma and an intraspinal tumor apparent in magnetic resonance imaging. In the three cases the whole central nervous system was evaluated with gadolinium-enhanced magnetic resonance imaging. A great number of radicular tumors, many of which were asymptomatic, were detected. In spite of the severity of the clinical features, the three patients showed a dramatic improvement after the surgical removal of the symptomatic tumors. The use of magnetic resonance is encouraged, owing to its high resolution and safety, for the assessment of incidence, character and localization of tumors in neurofibromatosis and to establish a good clinico-lesional correlation before surgery. This technique may help to a better understanding of the spectrum of abnormalities in each type of neurofibromatosis, thus facilitating the evaluation of this complex condition.
Adult↗
[Coma associated with migraine].
INTRODUCTION: Basilar migraine is a particular form of migraine with an aura in which crises of headache are accompanied by symptoms of dysfunction in the vertebro-basilar territory, including alteration of consciousness in the form of stupor or coma. CLINICAL CASES: We report four patients, three men of 14, 17 and 83 years of age and one woman of 21. All had previous histories of migraine and presented with transitory episodes of coma. During the coma, the woman woke up spontaneously with intense bulimia. In the three men, it was seen, on injecting flumazenil, that the state of consciousness and the EEG returned to normal transiently. Neuroimaging studies (CT and MR) were normal in all patients. CONCLUSIONS: Migraine-coma is an exceptional, emergency condition in which structural, infectious, toxic and metabolic pathology of the Central Nervous System should be ruled out. As well as in patients with basilar migraine, the association of migraine and coma may also be seen in patients with familial hemiplegic migraine and CADASIL and MELAS syndromes. It may be that gabaergic mechanisms are involved in the theoretical dysfunction of the ascending reticular activating system causing alteration of consciousness, since in the three patients in whom flumazenil was injected, there was a response.
Adolescent↗
[Parkinsonism after methyl alcohol poisoning].
Two cases of parkinsonism due to methyl alcohol poisoning are reported. In the first patient, parkinsonism features were mild and stable, while in the second they progressively developed in the weeks following the poisoning. None of the two patients had significant visual abnormalities during the clinical evolution. Both patients had symmetrical putaminal lesions in CT, and one in NMR imaging. The response to antiparkinsonism drugs was absent in one case and it could not be evaluated in the other because of patient's death. On the basis of theses two cases the clinical and therapeutic features of this type of striatal parkinsonism are compared with those with parkinsonism due to other toxic agents. In view of the topography of the lesions of this poisoning, which is shared by other conditions such as Leber's disease or Leigh's syndrome, and the analogy with the presynaptic action of MPP+ in the parkinsonism due to MPTP, a possible implication of mitochondrial metabolism in the pathogenesis of this syndrome is discussed. The lack of knowledge of the real incidence of this complication in the survivors of methyl alcohol poisoning suggests the need to perform studies with a prolonged and systematic clinical follow up.
Adult↗