Neurología : publicación oficial de la Sociedad Española de Neurología
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Multiple sclerosis is the most important disabling neurological disease in young adulthood in our environment. However, its etiology remains unknown. It has been proposed that multiple sclerosis is caused by an interaction of genetic and environmental factors. In particular, Epstein-Barr virus infection could play a fundamental role in the pathophysiology of multiple sclerosis. ⋯ Based on the published evidence, Epstein-Barr virus infection can be considered to have a causal role in the etiology of multiple sclerosis. Further research should be conducted to elucidate the mechanisms underlying this association and to assess its potential for multiple sclerosis prevention and treatment.
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We report three patients with ischemic stroke as initial manifestation of left atrial myxomas. ⋯ The three patients had ischemic stroke at a young age. The initial manifestation of the myxoma was a transient ischemic attack in two of them. Diagnosis was delayed more than 3 years in two of the patients. The second episode of the third patient affected all the left internal carotid territory including the posterior cerebral artery arising from the internal carotid and branches of the central retinal artery. Comparing the magnetic resonance with the previous one, new hyperintense images on T2 with gadolinium enhancement were found in the left hemisphere consistent with subacute infarcts that had stabilized 5 months later.
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Drug use is a well-kown risk factor for cerebrovascular disease in young people. Cannabis is the most widely consumed among the illicit drugs worldwide, but it has only exceptionally been associated to cerebrovascular disease. ⋯ The review of the literature on this topic reveals another 18 patients with stroke in association to cannabis use. They all were young people with ischemic stroke. Although a causal relationship is difficult to establish due to the widespread use of cannabis, this drug may play an etiologic role in ischemic stroke.
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American trypanosomiasis, known as Chagas' disease (CD) is a major Public Health problem in South America. Chronic cardiomyopathy is the most common clinical form of CD. Chagasic cardiomyopathy affects about 30 % of CD patients, and its manifestations begin on average 10-40 years after the initial infection. ⋯ Prevalence of apical aneurysm in CD stroke patients has been estimated in 37%. The diagnosis of CD may be established after stroke presentation in at least 40% of patients. Chagasic cardiomyopathy should be included in the differential diagnosis of the etiology of stroke, being a potential source of cardioembolic stroke.
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Recently the case of a woman who reported cessation of dreaming after a bilateral PCA stroke but without REM sleep loss has been reported, suggesting that deep bilateral occipital lobe damage including the right inferior lingual gyrus may represent the "minimal lesion extension" necessary for dream loss. ⋯ Our patient demonstrates that a unilateral left temporo-occipital injury could be sufficient for losing dreams.