[Occlusion of the right common carotid artery due to oral estrogen overdose]

INTRODUCTION

Continuous use of oral anticontraceptive agents has been related to adverse vascular changes in the form of venous or arterial thromboses and cerebrovascular accidents (CVA). In our case, we describe a CVA due to occlusion of the common carotid artery after an acute massive overdose of estrogens due to error of dosage when using Yuzpe's system or emergency post-coital therapy.

CLINICAL CASE

We describe a 26 year old woman with no previous clinical history, who smoked 20 cigarettes per day, did not take oral contraceptive pills and suffered an acute left facial-brachial-crural hemiplegia together with reduced level of consciousness. Imaging tests showed acute occlusion of the right common carotid artery. Etiological study of the patient's cerebral vascular accident was negative. The only etiopathogenic factor to be related was having taken oral contraceptive agents for three days after coitus as emergency post-coital treatment. This treatment was incorrect, since the dose of estrogens was four times that recommended.

CONCLUSIONS

The continued use of estrogens, especially at doses over 30 micrograms per day, was considered responsible for approximately 10% of CVAs in young people. The risk of cerebral vascular accident is greater when there is associated migraine and/or smoking. We describe a patient who showed that the acute use of high doses of estrogens may also cause arterial occlusion, in this case in the common carotid artery.

Detection of occult disease in tissue donors by routine autopsy

The transmission of infectious and neoplastic diseases is a potential risk of tissue allografting. In this study, we analyzed the occurrence of occult disease in tissue donors as detected by standard screening and autopsy. Whereas 18% of the potential donors initially evaluated were eliminated on the basis of their medical and social histories, laboratory screening and autopsy revealed that an additional 9% of tissue donors had undetected, transmissible disease that prohibited tissue donation. This report emphasizes once again the risk of occult disease being transplanted with grafts and the need for autopsy to reduce the likelihood of this occurring. If donor selection, appropriate screening tests, and autopsy are carefully carried out, the risk of transmitting diseases from tissue allografts can be kept to a minimum.

An unusual clinical presentation of bilateral schizencephaly

We present a case with a characteristic magnetic resonance image (MRI) of bilateral open-lipped schizencephaly and atypical clinical presentation. The patient is still alive and in good health in her forties, she has never presented seizures, and although the motor dysfunction is well correlated with cerebral lobe involvement, neurobehavioral dysfunction is not proportional to the MR image of the cerebral malformation.

Central nervous system disease in Sjögren's syndrome

Our prospective study consisted of a general and neurological evaluation in 48 patients (41 females, 7 males; mean age: 58.2 years) with primary Sjögren's syndrome (PSS). We performed serologic studies and cranial magnetic resonance imaging (MRI). Main extraglandular features were arthralgias and non-erosive arthritis (37.5%). Raynaud (21%) and pulmonary fibrosis (12.5%). Antinuclear antibodies were positive in 42.5% and anti-SS-A (Ro) in 20%. Migraine (52%), neuropsychiatric disease (29%) and a past history of focal acute neurological deficits (23%), were the central nervous system (CNS) manifestations more frequently observed. Cranial MRI examination detected hyperintense small subcortical lesions in 51.3% of patients and in 36.6% of age and sex matched controls (P < 0.001). CNS disease was not serious concerning vital prognosis, but produced significant morbidity in some patients. Late onset "migraine-like" episodes with prolonged sensoromotor deficits and coexisting neuropsychiatric disease emerged as a characteristic clinical spectrum in those patients diagnosed in a neurological setting. Cranial MRI was frequently abnormal, but findings were not specific. Neurologic manifestations reminiscent of multiple sclerosis were rarely seen.

Anti-Ri-associated paraneoplastic neurologic disorder without opsoclonus in a patient with breast cancer

A 59-year-old woman with breast cancer and anti-Ri antibodies developed a neurologic paraneoplastic disorder characterized by nausea, vomiting, vertigo, paresis of upward gaze, and gait ataxia, without opsoclonus. The absence of opsoclonus does not rule out the possibility of an anti-Ri-associated paraneoplastic neurologic disorder.

[Serologic activity against retrovirus in patients with Sjögren syndrome]

BACKGROUND

The primary Sjögren's syndrome (SS) is a systemic disease which destroys the exocrine glands by autoimmune mechanisms. The etiology of this syndrome is unknown although different virus are involved in its genesis.

METHODS

The presence of serologic reactivity IgG and IgM versus the human immunodeficiency virus (HIV-1), HIV-2, HTLV-I and HTLV-II were studied in 14 patients with SS and in 15 controls. Likewise, the presence of retroviral genomic sequences was analyzed in 7 of these patients by polymerase chain reaction (PCR).

RESULTS

All the patients with SS were negative by enzymoimmunoassay (EIA) versus known retrovirus. However, more than 70% presented reactivity versus different nuclear proteins, particularly versus p24 of HTLV-I in Western blot (WB). These results were negative in the control group. Genomic analysis by PCR did not confirm the presence of specific sequences in any of the known human retroviruses in the patients with SS, nonetheless, in 3 of the 7 samples analyzed by PCR, related retroviral sequences were detected.

CONCLUSIONS

The presence of serologic reactivity in Western blot versus some viral proteins and the similarity of genomic sequences in some cases suggests that a retrovirus related with those which are currently known, particularly with the HTLV-I, may be involved in the genesis of Sjögren's syndrome.

Multiple sclerosis and Hashimoto's thyroiditis

A case of multiple sclerosis and Hashimoto's thyroiditis confirmed by cytology is reported. The association of multiple sclerosis with other autoimmune diseases is infrequent but supports the immune hypothesis of the pathogenesis of multiple sclerosis. The authors suggest the inclusion of immunological tests in the screening of all patients diagnosed as having multiple sclerosis.