F.C. 81-years-old men was addressed to our department
due to suffering from clonic tonics movements and dysarthria
but conscious on. He had headache for 3 days, and from the
pathological history, arterial hypertension, Malta fever and dizziness
were verified. The general evaluation (EKG, blood tests, chest x-ray)
was an unremarkable neurological exam and an ophthalmologic exam
which show a progressive axial exophthalmos as well as decresed
visual acurity in the left eye and vascular episcleral congestion. Cranial
CT reported intraparenquimatoso bleeding. Therefore, CT angiography
was requested in order to confirm malformations or DAVFs., and
cerebral angiography was also done to definite the diagnosis. Finally,
s state was discussed with neurosurgery dept. and the
treatment with Levetirazetam and a sugery were ordered.
DAFVs are very interesting pathological entities. The
treatment is complex in most case and surgery is sometimes necessary
to complete the cure or to evacuate a hemorrhagic post rupture
hematoma. The meticulous angiographic study of venous drainage is
the key of treatment.
Unrecognized polycythemia vera
M.M. Luís, A.A. Sousa, C. Rozeira, M. Oliveira, A. Oliveira, D. Pinheiro,
V. Paixão Dias.
Polycythemia vera (PV) is a clonal disorder involving a
multipotente hematopoietic progenitor cell. The etiology is unknown.
Uncontrolled erythrocytosis causes hyperviscosity, leading to neuro-
logic symptoms. Case description. 79 year-old man. Hypertension
and dyslipidemia. Bifrontal headache. Decreased visual acuity.
Papilledema. Normal cranial CT scan. Aggravation of pain. Intracranial
hypertension. Lumbar puncture was performed. Magnetic resonance
angiography revealed thrombosis of sigmoid and transversus sinuses
and right jugular vein. Anticoagulation was started. Possible occult
malignancy. Probable peripherical embolization of the fifth right toe,
with amputation. Persistently elevated hematocrits. Low eritropoetin.
Ecographic splenomegaly. Thoracic, abdominal and pelvic scan with
no other abnormalities. JAK2 positivity. Bone marrow biopsy
supported hypothesis of high risk PV. Hydroxyurea and acetilsalic
acid were started. On follow up, complete remission on symptoms.
Magnetic resonance angiography documented partial recanalization.
Discussion. Clinical course in PV is complicated by thrombotic and
hemorrhagic events. The former may manifest in the preclinical
process. Acquired thrombophilias should be looked up in these
Cardiovocal syndrome; a case report
V. Price, A. Michael, A. McGrath.
Russells Hall Hospital, Dudley, UK
A 90-year-old patient noticed gradual progressive loss of
voice for 12 months. Her medical history includes severe congestive
cardiac failure. On examination she was
and difficult to
hear. Her JVP was elevated with ankle oedema. Auscultation revealed
murmurs of AS and MR and bilateral basal crackles. Her FBC, LFTs, Ca
and TSH were normal. CXR demonstrated marked cardiomegaly with
no lung pathology. Echocardiography demonstrated severely dilated
left atrium (volume is 171 mm), mildly dilated right atrium (volume
is 22 mm), severe AS, severe MR, moderate TR and pulmonary
hypertension (estimated PASP 54
59 mmHg). The ENT surgeon
clinically diagnosed recurrent laryngeal nerve palsy however laryn-
goscopy was unsuccessful due to exaggerated gag reflex. She refused
CT of the neck and chest.
The gradual progressive loss of voice in presence of marked
cardiomegaly with biatrial enlargement and pulmonary hypertension
and in the absence of evidence of malignancy suggest cardiovocal
Cardiovocal syndrome or Ortner
s syndrome is hoarseness of voice due
to left recurrent laryngeal nerve palsy caused by mechanical effect on
the nerve by enlarged cardiovascular structures.
Hoarseness of voice is a common symptom; recurrent
laryngeal nerve lesion can be the cause. Surgical trauma and malig-
nant tumours are the most common causes of unilateral recurrent
laryngeal nerve injury. Compression of left recurrent laryngeal nerve
by enlarged cardiovascular structures can rarely be the cause of
hoarseness. Nobert Ortner in 1897 described three patients with
hoarseness of voice and severe mitral stenosis. He attributed the
hoarseness to compression of the left recurrent laryngeal nerve by
the enlarged left atrium. Subsequently hoarseness of voice was
described in patients with congenital heart disease, mitral regurgita-
tion, isolated ductus aneurysm, pulmonary hypertension either
primary or secondary, tortuosity of the great vessels and ventricular
and aortic aneurysms.
Postulated mechanisms of left recurrent laryngeal nerve palsy include
compression from a dilated pulmonary artery, atherosclerotic pul-
monary artery, right ventricular hypertrophy, ligamentum arteriosum,
the left bronchus, inflammation or scarring in the aortic window
or compression of the left recurrent laryngeal nerve between the
pulmonary artery and the aorta.
Prognosis depends on the underlying cause of the nerve palsy and
reversibility depends on the duration of injury.
Diuretics use in patients with Parkinson
s disease or Parkinsonism
, J. Barnes
Russells Hall Hospital,
Dudley CCG, NHS,
Urinary symptoms are common in Parkinson
(PD); mainly irritative due to detrusor over activity. Obstructive
symptoms may also be seen due to obstructive uropathy, antic-
holinergics or point to multiple system atrophy. Diuretics increase
these symptoms and may cause incontinence.
The BNF licensed indications for diuretics are pulmonary or peripheral
oedema due to heart failure. They should not be used continuously on
a long-term basis for gravitational oedema.
Diuretics increase the risk of falling in view of hyponatraemia,
hypotension, postural hypotension and increase of urine frequency.
Diuretics are not the best option in older people especially those
with poor mobility, lack of balance, overactive bladder syndrome or
To study the use of diuretics in patients with PD and
Prospective study of diuretics use in 200 consecutive patients
attending PD clinic in a UK teaching hospital. Patients
electronic records were reviewed. Data were collected on excel and
descriptive statistics were used.
200 patients were included; 115 males and 85 females with
mean age of 73 and 72 years respectively. 88% of patients had PD,
10% had secondary Parkinsonism and 2% had Parkinson
syndrome. 33% of patients had 1 or 2 falls in the previous 6 months,
18% had 3 or more falls. 8% had a previous fracture.
31% of patients (62) were on diuretics; 21% of whom (13 patients) had
left ventricular failure, 10% (6 patients) had congestive cardiac failure
and 69% (43 patients) were prescribed the diuretic for oedema.
Diuretics are commonly prescribed. In this study 31% of
Parkinsonian patients were on diuretics however just 31% of these had
Use of diuretics in older people in general and Parkinsonian patients in
particular should be limited to the licensed indications. Alternative,
age friendly, medications should be considered first.
Monitoring of cohort of patients with moderate or severe aortic
, R. Toro
, M. Quezada
, J.G. Pavón
, G. Cristofori
, R. Ayala
Department of Cardiology, Hospital Universitario Central Cruz Roja,
Department of Internal Medicine, University Hospital Puerta del
Department of Geriatrics, Hospital Universitario Central Cruz
Roja, Madrid, Spain
Poster presentations / European Geriatric Medicine 7S1 (2016) S29