ABSTRACT
Abstract INTRODUCTION In patients with HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) gait disturbance is a predominant feature that leads to falls and fractures, which can further aggravate disability. We sought to evaluate the impact of fractures and orthopedic surgeries in patients with HAM/TSP. METHODS: We retrieved the medical records of HAM/TSP patients enrolled in our study center's HTLV-1 clinical cohort between 1989-2018. The selection criteria included: (1) diagnosis of HTLV-1 infection using two enzyme-linked immunosorbent assays and/or a confirmatory test, (2) clinical diagnosis of HAM/TSP by neurological assessment, and (3) fractures associated with HAM/TSP. RESULTS: We identified 24 cases of fractures, 70% of which were females. The median age at the time of fracture was 60 years (IQR=24). Six cases reported fractures in patients under 45 years old. Ten patients (42%) had hip/coccyx fractures, seven (29%) were in the lower extremities, and four (17%) in the upper extremities. Half of these patients reported the use of wheelchairs. Five patients who had previously used canes required the use of wheelchairs after the reported fracture. Eight patients underwent corrective orthopedic surgery as a result of the fracture. CONCLUSIONS: For HAM/TSP patients, fractures are a complication that can exacerbate their severe impairment.
Subject(s)
Humans , Male , Female , Human T-lymphotropic virus 1 , HTLV-I Infections , Paraparesis, Tropical Spastic , Orthopedic Procedures , Cohort Studies , Middle AgedABSTRACT
Las cefaleas en emergencia suelen ser un reto diagnóstico para el evaluador cuando se trata de diferenciarlas entreprimaria o secundaria a un trastorno neurológico subyacente.Objetivo: Describir la frecuencia de las señales de alarma en cefaleas secundarias y primarias en pacientes que acuden a emergencia.Materiales y Métodos: Estudio prospectivo de series de casos, que acuden a la Emergencia de Medicina de Adultos del Hospital Nacional CayetanoHeredia por cefalea, en un mes. Se excluyeron a los pacientes con cefalea traumática. Se usó un formato para laobtención de datos. Se clasificó a los pacientes en cefalea primaria o secundaria y se determinó la presencia de señales de alarma. Resultados:Se registraron 32 pacientes. Veintiséis (81%) tuvieron cefalea secundaria. De éstas, 9 se debieron a causas infecciosas y 9 a trastornos vasculares intracraneales. La cantidad de señales de alarma presentes en las cefaleas secundarias vario de 3 a 8, con una moda de 5; y en las primarias de 0 a 2, con una moda de 2. El empeoramiento progresivo y el examen neurológico anormal se presentaron en 96% de los casos de cefalea secundaria. Conclusiones: Las señales de alarma, empeoramiento progresivo y examen neurológico anormal fueronlos más frecuentes. Las cefaleas secundarias fueron más comunes que las cefaleas primarias. Se hace énfasis en la utilidad de usar esta metodología en emergencia
Headaches in the emergency room are usually a diagnostic challenge for the physician when they having to differentiate between a primary and secondary headaches and an underlying neurological disorder. Objectives: Describe the frequency of presentation of red flags in primary and secondary headaches, in patients presenting to an emergency department. Methods: A case-series prospective study was conducted in the Emergency room of Hospital Nacional Cayetano Heredia. All patients presenting with headaches within a month were evaluated. Trauma related headaches were excluded. A data collection form was used to determine the presence of red flags as well as other clinical data. The quantity of red flags was assessed in both types of headaches. Results: Thirty two patients were included for study. Twenty-six (81%) had secondary headaches. Nine of them were found to be secondary to infection and other 9 to intracranial vascular disorders. The quantity of red flags present on secondary headaches ranged from 3 to 8 with a mode of 5; on primary headaches they ranged from 0 to 2 with a mode of 2. Progressive worsening of headache and abnormal neurologic exam were present in 25 cases of secondary headache Conclusions: Red flags were progressive worsening of headache and abnormal neurologic exam. Thus the clinical assessment of red flags is useful in the evaluation of patients with secondary headache in the emergency room.