Implante percutáneo de válvula aórtica con apoyo de circulación extracorpórea en paciente con insuficiencia aórtica severa / Trans catheter aortic valve implantation with extra corporeal circulation support in a patient with severe aortic insufficiency

An 84-year man with prior coronary artery bypass surgery and endovascular repair of an abdominal aortic aneurysm developed congestive heart failu-re. He had calcific aortic valve disease with severe regurgitation. A #29 Edwards-Sapien aortic valve via trans-apical approach was implanted with the patient connected to extra corporeal circulation. The patient recovered successfully and remained in functional class II 8 months after hospital dis-charge.

Manifestaciones neuropsiquiátricas de la neurolúes: presentación de un caso de parálisis general neurosifilítica / Neuropsychiatric manifestations of neurosyphilis: a case of general paresis

Introducción: La parálisis general se debe a la lesión tardía y degenerativa de la sustancia gris cerebral por el Treponema pallidum, caracterizada por demencia, signos oculares, neurológicos y humorales. Es frecuente su comienzo con manifestaciones delictuales. Caso clínico: Describimos el caso de un paciente de 61 años, masculino, sin antecedentes. Ingresa para comprobar imputabilidad (asesinó a su primo); atento, vigil, desorientado, disártrico, musita, pensamiento detallista y concreto. No sabe causa de acusación ni argumenta en su defensa; sin productividad psicótica. Signos vitales estables, exámenes de laboratorio normales. Se ingresa con diagnóstico de deterioro psicoorgánico. Se maneja con clorpromazina 12,5 mg en la mañana, tarde y 50 mg noche. Evoluciona con temblor, rigidez, enlentecimiento, alucinaciones visuales, auditivas y soliloquios. Por sospecha de impregnación se suspende la clorpromazina, se solicitan exámenes y se evaluó por neurólogo. Inatento, apráxico, marcha con aumento de base de sustentación, adiadococinesia, dismetría, Romberg (+) y pupilas de Argyll Robertson. VDRL de 1/512 sérico y 1/8 en el LCR. Se diagnostica parálisis general neurosifilítica. Se maneja con penicilina G acuosa 6 millones UI c/ 6 h IV por 14 días y olanzapina 20 mg c/noche con respuesta parcial. Conclusión: La parálisis general es poco frecuente pero debe ser sospechada en pacientes de edad media con demencia y signos característicos neuro-oculares.

Introduction: General Paresis is caused by a late and degenerative injury by Treponema pallidum to cerebral grey matter, characterized by dementia, as well as ocular, neurological, and mood changes. It generally first manifests in criminal activity. Clinical case: We describe the case of a 61-year-old male patient, with no past medical history. Admitted to prove imputability (he assasinated his cousin). Attentive, alert, disoriented. Dysarthria and murmured speech. Highly detailed and concrete thinking. He does not know the cause of the accusation, and he does not argue in his defense neither. No psychotic symptoms. Stable vital signs and normal laboratory exams. Admitted with a diagnosis of psycho-organic deterioration. Controlled with clorpromazine 12.5 mg BID and 50 mg/night. Evolution with tremor, rigidity, slowing. Visual and auditory hallucinations and soliloquy. On suspicion of neuroleptic impregnation we discontinue clorpromazina. Laboratory tests and neurologist evaluationare requested. Inattentive, apraxia, adiadochokinesia, dysmetria, Romberg (+) and Argyll Robertson pupils. Serum VDRL 1/512 and CSF1/8. Diagnose general paresis (neurospyhilisis). Treatment with aqueous penicillin G 6 million Ul every 6 hours IV for 14 days and olanzapine 20 mg every night with partial response. Conclusion: General paresis is infrequent but should be suspected in middle-aged patients with dementia and characteristic neuro-ocular signs.