Behavior Changes and Gait Unsteadiness: The Value of Imaging and Prompt Neurosurgical Intervention

Authors

  • Andreia Costa Neurology Department. Centro Hospitalar São João. Porto. Portugal. Department of Clinical Neurosciences and Mental Health. Faculty of Medicine. University of Porto. Porto. Portugal.
  • Cláudia Marques-Matos Neurology Department. Centro Hospitalar São João. Porto. Portugal. Department of Clinical Neurosciences and Mental Health. Faculty of Medicine. University of Porto. Porto. Portugal.
  • Carina Reis Neuroradiology Department. Centro Hospitalar São João. Porto. Portugal.
  • Marta Carvalho Neurology Department. Centro Hospitalar São João. Porto. Portugal. Department of Clinical Neurosciences and Mental Health. Faculty of Medicine. University of Porto. Porto. Portugal.
  • Madalena Pinto Neurology Department. Centro Hospitalar São João. Porto. Portugal.

DOI:

https://doi.org/10.20344/amp.7523

Keywords:

Cognition Disorders, Gait Disorders, Neurologic, Hemangioma, Cavernous, Magnetic Resonance Imaging, Neurosurgical Procedures, Tomography, X-Ray Computed, Ventriculostomy

Abstract

Cavernous angiomas are central nervous system malformations. Most common manifestations are seizures and acute focal neurological deficits. We present a case report of a seventy-one year-old man with a two-month history of behavior changes, attention deficit and indifference followed by gait unsteadiness. Neuropsychological evaluation showed severe cognitive impairment and executive dysfunction. Head computed tomography depicted a supraventricular hydrocephaly. Magnetic resonance imaging revealed a small hemorrhage, contiguous to a mesencephalic cavernous angioma, obstructing the Sylvius aqueduct, causing secondary hydrocephalus. Four months after endoscopic ventriculocisternostomy, neuropsychological evaluation showed improvement and the patient regained autonomy. Parenchyma cavernous angiomas causing direct hemorrhage and subsequent obstruction of the Sylvian aqueduct are uncommon. Sub-acute behavior and mental state abnormalities are rare first manifestations of cavernous angioma and requires high clinical suspicion for its correct diagnosis. Magnetic resonance imaging evaluation is crucial in the detection of such patients as prompt neurosurgical intervention may substantially improve cognitive function.

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Published

2017-01-31

How to Cite

1.
Costa A, Marques-Matos C, Reis C, Carvalho M, Pinto M. Behavior Changes and Gait Unsteadiness: The Value of Imaging and Prompt Neurosurgical Intervention. Acta Med Port [Internet]. 2017 Jan. 31 [cited 2024 Mar. 29];30(1):77-9. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7523

Issue

Section

Case Report