ramipril and Syndrome

In the list of named numerical neuro-ophthalmological syndromes, such as one-and-a-half syndrome and others, we report for the first time twenty-and-a-half syndrome, which is characterized by one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy (1.5 + 7 + 7 + 5 = 20.5) in a patient with ischemic stroke.. A 45-year-old Asian Hindu woman presented with vomiting and imbalance of 1 day's duration. She had left-sided ataxic hemiparesis with one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy. Magnetic resonance imaging of her brain revealed acute non-hemorrhagic infarct in the right posterolateral aspect of pons and medulla, with normal brain vessels angiography. We described her disorder as twenty-and-a-half syndrome. She was put on antiplatelet therapy.. Twenty-and-a-half syndrome is reported for the first time. It is due to posterior circulation stroke; in our case, it was due to lacunar infarcts in the pons and medulla, manifesting as one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy.

Topics: Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Atorvastatin; Brain; Brain Ischemia; Cranial Nerve Diseases; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Magnetic Resonance Imaging; Middle Aged; Paresis; Physical Therapy Modalities; Platelet Aggregation Inhibitors; Ramipril; Stroke; Syndrome

A patient with loin pain haematuria syndrome suffering chronic throbbing pulsing pain overlaid with prolonged periods of incapacitating colic and overnight vomiting was presented 10 months following diagnosis. Ultrasound was normal. No renal or ureteral stones, or filling defects were seen on CT. At cytoscopy, bladder and urethra were normal, and bloody urine effluxed from the left ureteric orifice. The ureters were normal at diagnosis, and developed new abutting non-penetrating calcifications by 8 months. Pain episodes of complete incapacitating intensity of 2-4 h duration were reduced to 10 min with 5 mg crushed tadalafil administered at onset. If tadalafil was delayed to after onset, the original course of agony resulted. Daily tadalafil reduced loin pain intensity, but not the exacerbations. Tadalafil efficacy may indicate that the pain exacerbations are due to spasm of ureter smooth muscle. 5 mg tadalafil taken at onset alleviated severe loin pain exacerbations in this case of loin pain haematuria syndrome.

Topics: Adult; Analgesics, Opioid; Drug Administration Schedule; Female; Hematuria; Humans; Pain, Intractable; Pelvic Pain; Phosphodiesterase 5 Inhibitors; Ramipril; Recurrence; Syndrome; Tadalafil; Treatment Outcome; Ureter

Topics: Adolescent; Adult; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Benzimidazoles; Benzoates; Cataract; Female; Hearing Loss, Sensorineural; Humans; Kidney Diseases; Losartan; Male; Molecular Motor Proteins; Mutation; Myosin Heavy Chains; Proteinuria; Ramipril; Renin-Angiotensin System; Syndrome; Telmisartan; Thrombocytopenia

Topics: Aged; Anemia, Hemolytic; Angiotensin-Converting Enzyme Inhibitors; Autoimmune Diseases; Female; Gastrointestinal Hemorrhage; Humans; Ramipril; Syndrome