Encefalitis aguda con síndrome cerebeloso secundario a neuroborreliosis

La enfermedad de Lyme es la infección transmitida por garrapatas más común en Norteamérica y Europa. Sin embargo, en América Latina se han reportado pocos datos. Borrelia burgdorferi es capaz de invadir el sistema nervioso central causando la neuroborreliosis de Lyme. Se comunica el caso de una mujer joven con encefalitis y síndrome cerebeloso, una presentación poco frecuente, que se manifestó con cefalea, marcha atáxica, nistagmo y ptosis palpebral. Se realizó el diagnóstico con serología positiva por Western blot para Borrelia burgdorferi en suero. Recibió tratamiento con mejoría clínica. El diagnóstico de neuroborreliosis es difícil, ya que no existen hallazgos neurológicos o de imagen específicos. Se recomienda tener un mayor nivel de vigilancia epidemiológica en Latinoamérica, así como los antecedentes recreativos o viajes, que deben incluirse en la historia clínica para mejorar la aproximación diagnóstica.

Lyme disease is the most common tick-borne disease in North America and Europe. However, in Latin America, few data have been reported. Borrelia burgdorferi is capable of invading the central nervous system causing Lyme neuroborreliosis. This is a case report of a female with encephalitis and cerebellar syndrome, a rare manifestation, presented with generalized headache ataxic gait, nystagmus and palpebral ptosis. Serologic diagnosis was made for Borrelia burgdorferi and treatment was initiated with clinical improvement. Neuroborreliosis is a very difficult diagnosis, since there are no neurologic or imaging findings specific. It is recommended to physicians to have an enhanced level of surveillance in Latin America, as well as recreational/travel history of the patient, which should be included in the clinical record to improve the diagnostic approach.

Replication of Rocio virus in primary cultures of mouse neural cells

ABSTRACT Objective This study verified the replication efficiency of the Rocio virus in a primary culture of mouse neural cells. Methods Mixed primary cultures (neurons/glia) obtained from the brains of newborn isogenic BALB/c mice were inoculated with Rocio virus on the 7 th day of culture, and the development of cytopathogenic effects was monitored. The infection was confirmed via immunocytochemistry (anti-ROCV), while viral replication was quantified in infected primary cultures. The titration method used depended on the infection period. Results Rocio virus efficiently infected primary cultured neural cells, with the highest viral titer causing cytopathic changes was observed at 2 days post infection. The virus-infected primary culture survived for up to 7 days post infection, and viral load quantitation showed viral replication kinetics compatible with the cell death kinetics of cultures. Conclusion The findings of this study suggest that mouse neural cell primary cultures support Rocio virus replication and could be used as an alternative system for studying Flavivirus infection in the central nervous system.

Current researches of the role of dural immunity in neuroinfectious and neuroimmune diseases / 中华神经科杂志

Dura mater, rich in vasculature and immune cells, is the outermost layer of the central nervous system, and thus acts as the first barrier to protect brain. Meningeal lymphatic vessels and immune cells are main components of dural immunity, which respond to a variety of central nervous system diseases. Meanwhile, compared with brain parenchyma, dura mater communicates more with peripheral tissues and is more susceptible to medical interventions. Therefore, dura mater is a promising target to prevent, diagnose and treat intracranial diseases. Here dural immunity is clarified based on meningeal lymphatic vessels and dural immune cells, and current researches inquiring the role of dural immunity in infectious and immune diseases of central nervous system are summarized.

Comparative study of metagenomics next generation sequencing of cerebrospinal fluid in the diagnosis test of the pathogen of neurobrucellosis / 中华神经科杂志

Objective:To explore the value of metagenomics next generation sequencing of cerebrospinal fluid in the diagnosis test of the pathogen of neurobrucellosis.Methods:Medical records of neurobrucellosis patients who were admitted to Xuanwu Hospital, Capital Medical University from May 2017 to February 2021 were reviewed. Seven patients who underwent cerebrospinal fluid metagenomics next generation sequencing were enrolled. Their clinical characteristics, cerebrospinal fluid results, serological and pathogenic results were analyzed.Results:Among the seven neurobrucellosis patients, including five males and two females, the age was from 21 to 49 [38 (24, 47)] years. Three patients had a history of exposure to cattle and sheep. The duration from onset to diagnosis was 2 to 30 [12 (5, 18)] months. The main neurological manifestations were headache for seven patients, loss of hearing for three patients, paralysis for four patients and urinary and fecal dysfunction for four patients. The blood tests showed that the rose bengal test was positive in three of seven patients, Brucella serum agglutination test was positive in four of six patients, and the blood culture was negative in four patients. The cerebrospinal fluid tests showed that rose bengal test was positive in one of five patients, Brucella serum agglutination test was positive in two of four patients, and the cerebrospinal fluid culture was positive in two of five patients. Cerebrospinal fluid metagenomics next generation sequencing was positive for Brucella in five patients.Conclusions:Comparing with the cerebrospinal fluid Brucella serum agglutination test and cerebrospinal fluid culture, cerebrospinal fluid metagenomics next generation sequencing is sensitive to the diagnosis of neurobrucellosis. It is recommended to perform cerebrospinal fluid metagenomics next generation sequencing in patients with clinically suspected neurobrucellosis or central nervous system infections of which the pathogen cannot be confirmed.

Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature / Encefalomielite disseminada aguda associada a COVID-19: relato de dois casos e revisão de literatura

ABSTRACT Background: Neurological manifestations of COVID-19 are still incompletely understood. Neurological manifestations may be due to direct viral effect on neurons and glial cells, to an immune-mediated response to the virus, or to a hypercoagulable state and associated endothelial damage, as well as to severe systemic disease with prolonged intensive care unit stay. Objective: To describe two patients with severe SARS-CoV-2 infection and delayed recovery of consciousness after sedation withdrawal, in whom MRI disclosed multifocal white matter brain lesions, compatible with the diagnosis of acute disseminated encephalomyelitis. Methods: Observational report of two cases of severe COVID-19 infection in patients from two tertiary hospitals in São Paulo, Brazil. Results: These patients underwent neurologic and systemic evaluation for delayed awakening after sedation withdrawal. MRI displayed multifocal centrum semiovale lesions, suggestive of demyelinating inflammation. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for SARS-CoV-2 was negative in both cases. Conclusion: A recurrent pattern of multifocal white matter lesions can occur in COVID-19 patients, possibly associated with delayed awakening. Additional studies are necessary to elucidate the role of the viral infection and of inflammatory and immune-mediated associated changes in neurological manifestations of COVID-19.

RESUMO Introdução: As manifestações neurológicas causadas pela COVID-19 ainda não estão completamente elucidadas. O comprometimento neurológico pode decorrer de um efeito viral direto em neurônios ou em células gliais, a efeito imunomediado em resposta à infecção viral, ou de um efeito secundário a estados de hipercoagulabilidade e danos endoteliais, assim como decorrente de complicações sistêmicas graves relacionadas a cuidados intensivos prolongados na unidade de terapia intensiva. Objetivo: Descrever dois pacientes com recuperação tardia do nível de consciência após a retirada da sedação associados à infecção grave pelo SARS-CoV-2, que apresentaram lesões multifocais de substância branca, compatíveis com o diagnóstico de encefalomielite disseminada aguda. Métodos: Estudo observacional, com relato de dois casos de infecção grave pela COVID-19, em dois hospitais terciários na cidade de São Paulo, Brasil. Resultados: Os pacientes foram submetidos à investigação sistêmica e neurológica para avaliação de estado alterado de consciência após retirada de sedação. A ressonância magnética de crânio evidenciou lesões multifocais no centro semioval, sugestivos de processo inflamatório desmielinizante. Análise liquórica evidenciou PCR negativo para SARS-CoV-2 em ambos os casos. Conclusão: Lesões multifocais de substância branca podem ocorrer em pacientes com COVID-19, possivelmente associadas a estados alterados de consciência. Estudos adicionais são necessários para determinar o processo fisiopatológico da infecção viral e dos estados inflamatórios e imunomediados na gênese das manifestações neurológicas causadas pela COVID-19.

Utilidad de las técnicas de biología molecular en neuroinfecciones / Usefulness of molecular biology techniques in neuroinfectious diseases / Utilidade das técnicas de biologia molecular em neuroinfecções

Resumen: Introducción: un porcentaje de las infecciones del sistema nervioso central permanece sin diagnóstico etiológico. Las técnicas de amplificación de ácidos nucleicos mediante reacción en cadena de la polimerasa en tiempo real pueden disminuir este porcentaje. Objetivo: describir la etiología de las neuroinfecciones y valorar la utilidad de las técnicas de biología molecular en el diagnóstico y su impacto en el tratamiento antimicrobiano. Metodología: estudio observacional, descriptivo, retrospectivo a partir de registros clínicos. Se incluyeron mayores de 18 años asistidos en un hospital público de Montevideo durante un período de 32 meses, a quienes que se les realizaron técnicas de biología molecular en líquido cefalorraquídeo por sospecha clínica de neuroinfección. Resultados: se incluyeron 109 pacientes. En pacientes sin infección por VIH ni antecedentes neuroquirúrgicos (67%), se identificó microorganismo responsable en 16 casos, 8 bacterias y 9 virus. Todos identificados por técnicas de biología molecular modificando el tratamiento antimicrobiano empírico en 25 casos (34,2%). En portadores de VIH (25,7%), se detectaron microorganismos en 14 pacientes (50%). Seis virus, 5 bacterias y 7 hongos (Cryptococcus neoformans). El estudio por técnicas de biología molecular determinó el diagnóstico de 17 microorganismos y modificó el plan antimicrobiano inicial en 12 casos (42,9%). En pacientes con antecedente de neurocirugía reciente (7,3%), se aislaron seis microorganismos, tres de ellos exclusivamente mediante cultivo. Se modificó el tratamiento en tres casos (37,5%). Conclusiones: las técnicas de biología molecular deben considerarse complementarias. El impacto que generan en el diagnóstico y tratamiento justifica el uso de estas técnicas a pesar de su mayor costo.

Summary: Introduction: a certain percentage of infections of the central nervous system have no etiological diagnosis. Nucleic acids amplification techniques by means of a polymerase chain reaction in real time may reduce this percentage. Objective: to describe etiology of neuroinfectious diseases and assess the usefulness of molecular biology techniques in their diagnosis, as well as its impact on antimicrobial treatment. Method: observational, descriptive, retrospective study based on clinical records which included patients older than 18 years old, who had been assisted in a public hospital in Montevideo for over 32 months and had undergone molecular biology techniques with cerebrospinal fluid (CSF) given the clinical suspicion of neuroinfection. Results: 109 patients were included in the study. Among non-HIV infected patients who had not undergone neurosurgeries the responsible microorganism was identified in 16 cases (8 bacteria and 9 virus). They were all identified by molecular biology techniques by modifying the empiric antimicrobial therapy in 25 cases (34.2%). In carriers of HIV (25.7%), microorganisms were identified in 14 patients (50%). Six virus, 5 bacteria and 7 fungi (Cryptococcus neoformans). Molecular biology techniques defined the diagnosis of 17 microorganisms and modified the initial antimicrobial plan in 12 cases (42.9%). In patients with a history of recent neurosurgery (7.3%), 6 microorganisms were isolated, 3 of them exclusively through cultures. Treatment was modified in 3 cases (37.5%). Conclusions: molecular biology techniques need to be regarded as a complement. The impact that have in diagnosis and therapy justify their use despite its higher cost.

Resumo: Introdução: uma proporção das infecções do sistema nervoso central permanece sem diagnóstico etiológico. As técnicas de ampliação de ácidos nucléicos por reação em cadeia da polimerase em tempo real, podem diminuir esta proporção. Objetivo: descrever a etiologia das neuro infecções e avaliar a utilidade das técnicas de biologia molecular no diagnóstico e seu impacto no tratamento antimicrobiano. Metodologia: estudo observacional, descritivo, retrospectivo de prontuários de pacientes. Foram incluídos pacientes maiores de 18 anos, atendidos em um hospital público de Montevidéu, durante um período de 32 meses. Foram realizadas técnicas de biologia molecular ao líquido cefalorraquidiano por suspeita clínica de neuroinfecção. Resultados: foram incluídos 109 pacientes. Em pacientes sem infecção por VIH e sem antecedentes neurocirúrgicos (67%), o microrganismo responsável em 16 casos, sendo 8 bactérias e 9 vírus. Todos foram identificados por técnicas de biologia molecular modificando el tratamento antimicrobiano empírico em 25 casos (34,2%). Em portadores de VIH (25,7%), foram detectados microrganismos em 14 pacientes (50%). Seis vírus, 5 bactérias e 7 leveduras (Cryptococcus neoformans). O estudo por técnicas de biologia molecular permitiu o diagnóstico de 17 microrganismos e modificou o tratamento antimicrobiano inicial em 12 casos (42,9%). Em pacientes com antecedentes de neurocirurgia recente (7,3%), foram isolados 6 microrganismos, em 3 casos exclusivamente por cultura. O tratamento foi modificado em 3 casos (37,5%). Conclusões: as técnicas de biologia molecular devem ser consideradas como complementares. O impacto que causam sobre o diagnóstico e o tratamento justifica seu uso apesar de seu maior custo.

Prevención y tratamiento de las infecciones del sitio operatorio en neurocirugía. Estado del arte / Prevention and treatment of surgical site infections in neurosurgery: state of the art

RESUMEN El manejo adecuado de las infecciones del sitio operatorio (ISO) en neurocirugía es fundamental para la disminución de la carga de morbilidad y mortalidad en estos pacientes. La sospecha y confirmación diagnóstica asociadas al aislamiento microbiológico son esenciales para asegurar el tratamiento oportuno y el adecuado gerenciamiento de antibióticos. En esta revisión se presenta de forma resumida los puntos fundamentales para la prevención y el tratamiento de infecciones del sitio operatorio en neurocirugía y se incluye un apartado sobre el uso de antibióticos intratecales/intraventriculares.

SUMMARY The adequate management of surgical wound infections in neurosurgery is fundamental for reducing the burden of morbidity and mortality in these patients. The suspicion and diagnostic confirmation associated with microbiological isolation are essential to ensure timely treatment and proper management of antibiotics. Therefore, in this review we present, in a synthetic manner, the main points for the prevention and treatment of surgical site infections in neurosurgery, which includes a section on the use of intrathecal/intraventricular antibiotics.

Asociación entre meningitis y punción dural en ratas bacterémicas. Un análisis crítico / The Association between meningitis and dural puncture in bacteremic rats. A critical análisis

INTRODUCTION: The presence of an active bacteremia has been considered a relative contraindication to perform an intrathecal puncture due to the risk of causing meningitis or epidural abscess. However, a clear and definite causal relationship has not yet been demonstrated. OBJECTIVES: To determine the relationship between intrathecal puncture and the development of meningitis in sub-jects with bacteremia. MATERIALS AND METHODS: Experimental study in rats with chronic bacteremia to which dural puncture was performed. Meningitis was then evaluated by direct drainage of the cisterna magna and histopathological studies of brain tissue. RESULTS AND CONCLUSION: 12 of 40 bacteremic rats that underwent intrathecal puncture developed meningitis. Previous administration of antibiotics seems to reduce this risk.

INTRODUCCIÓN: Se ha considerado la presencia de una bacteremia activa como contraindicación relativa para realizar una punción intratecal por el riesgo de provocar meningitis o absceso peridural. Sin embargo, aún no se ha podido demostrar una relación causal clara y definida. OBJETIVOS: Determinar la relación entre punción intratecal y el desarrollo de meningitis en sujetos con bacteremia. MATERIALES Y MÉTODOS: Estudio experimental en ratas con bacteremia crónica a las que se les realizó punción dural, luego se evaluó la presencia o no de meningitis mediante drenaje directo de la cisterna magna y estudios histopatológicos de tejido cerebral. RESULTADOS Y CONCLUSIÓN: 12 de 40 ratas bacterémicas a las que se le realizó punción intratecal desarrollaron meningitis. La adminis-tración previa de antibiótico parece disminuir este riesgo.

The value of common infection markers combined with cerebrospinal fluid routine analysis for identifying the etiology of intracranial infection in children / 中华检验医学杂志

Intracranial infection is a common central nervous system disease that seriously endangers children′s health. Early diagnosis and reasonable treatment in time are of great significance to improve the long-term prognosis of children. This paper describes the improvement of routine laboratory methods for intracranial infection, and discusses the role of common infection markers including C-reactive protein, procalcitonin, tumor necrosis factor-α, interleukin-6 and heparin binding protein in the differential diagnosis of intracranial infection.

Cerebral Venous Sinus Thrombosis with Meningitis and Septicemia due to Haemophilus influenzae Type f in an Immunocompetent Child

Since the implementation of conjugate Haemophilus influenzae serotype b (Hib) vaccine, the rate of infections caused by Hib has dramatically decreased, and the proportion of infections caused by non-type b H. influenzae has increased. Cerebral venous sinus thrombosis (CVST) is rare; however, it should be considered as a potential complication of bacterial meningitis. Herein, we report about a child who developed CVST after being diagnosed with H. influenzae serotype f meningitis.

The value of common infection markers combined with cerebrospinal fluid routine analysis for identifying the etiology of intracranial infection in children / 中华检验医学杂志

Intracranial infection is a common central nervous system disease that seriously endangers children's health. Early diagnosis and reasonable treatment in time are of great significance to improve the long-term prognosis of children. This paper describes the improvement of routine laboratory methods for intracranial infection, and discusses the role of common infection markers including C-reactive protein, procalcitonin, tumor necrosis factor-α, interleukin-6 and heparin binding protein in the differential diagnosis of intracranial infection.

Neurocisticercosis ventricular: manejo multimodal y revisión de la bibliografía / Ventricular neurocysticercosis: multimodal management and bibliographic review

Resumen La neurocisticercosis es la infección parasitaria más común del sistema nervioso central; es causada por Taenia solium en su estado de larva. Se estima que existen millones de personas afectadas en países en desarrollo, es la primera causa de convulsiones y de epilepsia adquirida. Comunicamos el caso de una paciente de 40 años, sin antecedentes importantes, que de forma súbita tuvo pérdida del estado de alerta y datos clínicos de hipertensión intracraneana. En la tomografía axial computada se encontró edema cerebral e hidrocefalia no comunicante, por lo que se le colocó una válvula de derivación ventrículo-peritoneal. El abordaje se complementó con una resonancia magnética en secuencia FIESTA en la que se observó el quiste del cisticerco intraventricular anterior. El abordaje terapéutico multidisciplinario incluyó la extracción del quiste por neuroendoscopia y tratamiento farmacológico con esteroides y cisticidas. La paciente evolucionó favorablemente, con recuperación total del estado de alerta y como única secuela tuvo alteración de la memoria del trabajo. En los últimos años, el desarrollo del tratamiento antiparasitario y de técnicas de neurocirugía mínimamente invasivas ha mejorado el pronóstico de los pacientes.

Abstract Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system caused by Taenia solium in its larval stage. It is estimated that there are millions of people affected in developing countries, being the first cause of seizures and acquired epilepsy. We present the case of a 40-year-old woman, with no relevant history, who presented sudden loss of alertness and clinical data of intracraneal hypertension, which was confirmed by CT in addition to finding non-communicating hydrocephalus, the patient underwent to the placement of a ventriculo-peritoneal bypass valve without complications and the approach was complemented by a magnetic resonance in a FIESTA sequence in which the cysticercus cyst intraventricular was observed. The patient underwent removal of the cyst by neuroendoscopy and treatment based on steroids and cysticides. The patient evolved favorably, with full recovery of alertness and the only sequelae was the alteration of work memory. In recent years, the development of antiparasitic therapy and minimally invasive neurosurgery techniques has improved the prognosis of patients.

Meningoencefalitis herpética en mujer adulta

RESUMEN Se presenta el caso de una mujer adulta mayor, previamente sana, con antecedente de astenia y cuadro confusional de seis días de evolución, con sensación febril y episodio convulsivo en una oportunidad. Presenta hemiparesia braquiocrural derecha y rigidez de nuca. Tomografía simple de cráneo con imagen hipodensa en región frontotemporal izquierda. Líquido cefalorraquídeo muestra leucocitos a predominio de mononucleares, PCR para herpes simple tipo 1 positivo. Resonancia magnética encefálica con imágenes sugerentes de encefalitis herpética. Recibió tratamiento con aciclovir con lo que recupera la fuerza muscular en los miembros, pero alternan periodos de lucidez e incoherencia.

ABSTRACT We present the case of an older adult woman, previously healthy, with a history of asthenia and confusion symptoms of six days of evolution, febrile sensation and convulsive episode in one occassion. She presents right brachiocrural hemiparesis and neck stiffness. Simple skull tomography with hypodense image in the left frontotemporal region. Cerebrospinal fluid shows predominantly mononuclear leukocytes, PCR for herpes simplex type 1 positive. Encephalic magnetic resonance with images suggestive of herpetic encephalitis. She was treated with acyclovir recovering muscle strength in the limbs, but periods of lucidity and incoherence alternate.

Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients / Achados de ressonância magnética em criptococose do sistema nervoso central: comparação entre pacientes imunocompetentes e imunossuprimidos

Abstract Objective: To assess the magnetic resonance imaging (MRI) patterns associated with central nervous system infection with Cryptococcus sp. in relation to patient immune status. Materials and Methods: This was a retrospective study of MRI data for 19 patients with neurocryptococcosis who underwent the examination between January 2000 and March 2014. The MRI characteristics examined included lesion topography, aspects of diffusion, T1-weighted images, T2-weighted images, and contrast enhancement patterns. Results: In all cases, cryptococcal infection was confirmed by cerebrospinal fluid analysis. Of the 19 patients, 10 were immunocompromised and 9 were immunocompetent. Abnormal imaging patterns occurred alone or in conjunction with other manifestations. The imaging patterns found in immunocompromised patients included the following: leptomeningeal enhancement, in 6; pachymeningeal enhancement, in 3 (due to intracranial hypotension in 2); perivascular space involvement, in 4; granulomas, in 2; hydrocephalus, in 2; miliary nodules, in 1; and plexitis, in 1. In immunocompetent patients, the following imaging patterns were observed: leptomeningeal enhancement, in 5; perivascular space involvement, in 3; granulomas, in 3; cryptococcoma, in 1; ventriculitis, in 1; and hydrocephalus, in 1. In 2 immunocompetent patients, diffusion-weighted imaging showed diffusion restriction in cerebral cryptococcal granuloma. Conclusion: In both groups, the most common imaging finding was leptomeningeal enhancement, followed by dilatation of perivascular spaces with the presence of mucoid material. Rare presentations, such as miliary nodules, plexitis, ventriculitis, and pachymeningeal enhancement, were also observed. None of the imaging patterns common to immunocompetent and immunocompromised patients differed significantly in frequency between them.

Resumo Objetivo: Avaliar os padrões de ressonância magnética (RM) associados à infecção do sistema nervoso central por Cryptococcus sp. em relação ao status imunológico dos pacientes. Materiais e Métodos: Dados de RM de 19 casos de neurocriptococose foram analisados retrospectivamente de janeiro de 2000 a março de 2014. As características de RM examinadas incluíram: sítio da lesão, aspectos em difusão, imagens ponderadas em T1 e T2 e padrões de realce pelo contraste. Resultados: A infecção por Cryptococcus sp. foi confirmada pela análise do liquor em todos os casos. Dos 19 pacientes, 10 eram imunossuprimidos e 9 eram imunocompetentes. Os padrões de imagem anormais ocorreram isoladamente ou em associação com outras manifestações. Os padrões de imagem encontrados nos pacientes imunossuprimidos incluíram: realce leptomeníngeo (n = 6), realce paquimeníngeo (n = 3; 2 devidos a hipotensão intracraniana), envolvimento do espaço perivascular (n = 4), granulomas (n = 2), hidrocefalia (n = 2), nódulos miliares (n = 1) e plexite (n = 1). Em pacientes imunocompetentes, os padrões de imagem incluíram: realce leptomeníngeo (n = 5), envolvimento do espaço perivascular (n = 3), granulomas (n = 3), criptococoma (n = 1), ventriculite (n = 1) e hidrocefalia (n = 1). As sequências ponderadas em difusão mostraram restrição em 2 pacientes imunocompetentes com granulomas intracerebrais por criptococose. Conclusão: O achado mais comum de imagem em ambos os grupos foi realce leptomeníngeo, seguido de dilatação dos espaços perivasculares pela presença do material mucoide. Apresentações raras como nódulos miliares, plexite, ventriculite e realce paquimeníngeo foram também observadas. Nenhum dos padrões de imagem comuns aos pacientes imunocompetentes e imunossuprimidos diferiu significativamente em frequência entre eles.

Surgical treatment of neurocysticercosis. Retrospective cohort study and an illustrative case report / Tratamento cirúrgico da neurocisticercose. Estudo de coorte retrospectivo e um caso ilustrativo

ABSTRACT CONTEXT AND OBJECTIVE: Neurocysticercosis is prevalent in developing countries and manifests with several neurological signs and symptoms that may be fatal. The cysts may be parenchymal or extraparenchymal and therefore several signs and symptoms may occur. Depending on their location, neurosurgical procedures may be required, sometimes as emergencies. The aim here was to review 10-year statistics on all surgical neurocysticercosis cases at a large public tertiary-level hospital. DESIGN AND SETTING: Retrospective cohort at a large public tertiary-level hospital. METHODS: All surgical neurocysticercosis cases seen between July 2006 and July 2016 were reviewed. Parenchymal and extraparenchymal forms were considered, along with every type of surgical procedure (shunt, endoscopic third ventriculostomy and craniotomy). The literature was reviewed through PubMed, using the terms “neurocysticercosis”, “surgery”, “shunt” and “hydrocephalus”. RESULTS: 37 patients underwent neurosurgical procedures during the study period. Most were male (62.16%) and extraparenchymal cases predominated (81%). Patients aged 41 to 50 years were most affected (35.13%) and those 20 years or under were unaffected. Ventricular forms were most frequently associated with hydrocephalus and required permanent shunts in most cases (56.57%). CONCLUSIONS: The treatment of neurocysticercosis depends on the impairment: the parenchymal type usually does not require surgery, which is more common in the extraparenchymal form. Hydrocephalus is a frequent complication because the cysts often obstruct the cerebrospinal flow. The cysts should be removed whenever possible, to avoid the need for permanent shunts.

RESUMO CONTEXTO E OBJETIVO: A neurocisticercose é prevalente em países em desenvolvimento e manifesta-se com vários sinais e sintomas neurológicos que podem ser fatais. Os cistos podem ser parenquimatosos ou extraparenquimatosos, portanto vários sinais e sintomas podem estar presentes. Dependendo da sua localização, procedimentos neurocirúrgicos podem ser necessários, às vezes em caráter emergencial. O objetivo foi revisar dados estatísticos de um período de 10 anos de todos os casos cirúrgicos de neurocisticercose num grande hospital público terciário. TIPO DE ESTUDO E LOCAL: Coorte retrospectiva de um grande hospital público terciário. MÉTODOS: Todos os casos cirúrgicos de neurocisticercose de pacientes tratados entre julho 2006 e julho 2016 foram revisados. As formas parenquimatosas e extraparenquimatosas foram consideradas, assim como tipo de procedimento cirúrgico (derivação, terceiroventriculostomia endoscópica e craniotomia). A literatura foi revisada por meio da PubMed, utilizando-se os termos “neurocysticercosis”, “surgery”, “shunt” e “hydrocephalus”. RESULTADOS: 37 pacientes foram submetidos a procedimentos neurocirúrgicos nesse período, a maioria do sexo masculino (62.16%%) e casos extraparenquimatosos predominaram (81%). Pacientes com idade 41-50 anos foram os mais afetados (35,13%) e aqueles com 20 anos ou menos não foram afetados. As formas ventriculares mais frequentemente estiveram associadas a hidrocefalia e necessitaram da realização de shunts definitivos na maior parte dos casos (56,57%). CONCLUSÕES: O tratamento depende da forma de acometimento: o tipo parenquimatoso usualmente não necessita de cirurgia que é mais comum na forma extraparenquimatosa. Hidrocefalia é uma complicação frequente pois muitas vezes os cistos obstruem o fluxo liquórico. A remoção dos cistos deve ser realizada sempre que possível para evitar a necessidade de derivações definitivas.

Neurobrucellosis: a clinical analysis of 30 cases / 中华神经科杂志

Objective To investigate the clinical features of neurobrucellosis and improve the diagnosis and treatment of the disease.Methods The epidemiological information,clinical manifestation,laboratory examination,and imaging characteristics of 30 cases with neurobrucellosis were summarized retrospectively.Results There were 23 men,seven women in this group of cases.The mean age was 43 years.There were six cases with definite history of brucellosis,24 with exposure history of cattle and sheep or their diary products.Brucella blood serum agglutination tests were all positive in 30 cases.Meningitis or meningoencephalitis (29 cases),spinal cord lesion (20 cases) and auditory nerve's damage (18 cases) were the most common forms of neurobrucellosis in these patients.In the cerebral spinal fluid inspection tests,there were 29 cases with increasing leukocyte ((10-599) × 106/L),30 cases with elevated protein (0.5-4.0 g/L),29 cases with decreased glucose (0.8-2.6 mmol/L) in this group of patients.There were 17 cases with white matter lesion on cranial magnetic imaging.The combinations of doxycycline,rifampin and ceftriaxone sodium were given to most cases.The prognosis was good in most cases.Conclusions Neurobrucellosis is not unusual clinically,clinical presentation of which varies greatly.The most common form is meningitis or meningoencephalitis,whereas spinal cord damage and hearing damage are also common.Patients who come from epidemic area and develop unexplained neurological symptoms should be screened and distinguished with neurobrucellosis.

Paradoxical Response after a Voriconazole Treatment in an Immunocompetent Host with a Skull Base Osteomyelitis due to Invasive Aspergillosis

BACKGROUND: We describe a case of skull base osteomyelitis due to invasive aspergillosis which had been aggravated after antifungal treatment but significantly recovered by dexamethasone. CASE REPORT: A 74-year-old male patient presented to neurology clinic complaining of sudden onset right-sided facial palsy and headache. Brain magnetic resonance imaging (MRI) and sphenoid sinus biopsy confirmed Aspergillus infection of skull base. He was treated with voriconazole for two months, but his headache was not relieved, and he additionally complained of vertigo and dysphagia. A subsequent MRI showed reduced enhancement of initial lesions, but increased thickness of surrounding dura mater. With an impression of paradoxical inflammatory response after antifungal treatment, parenteral dexamethasone was administered for one month while maintaining voriconazole. His symptoms improved thereafter. CONCLUSION: A paradoxical inflammatory response during antifungal treatment in the skull base aspergillosis aggravates the neurological symptom by thickening the dura mater, which can be recovered by dexamethasone.

Human Parechovirus as an Important Cause of Central Nervous System Infection in Childhood

PURPOSE: Human parechovirus (HPeV) is an increasingly recognized pathogenic cause of central nervous system (CNS) infection in neonates. However, HPeV infections have not been studied in older children. This study determined the prevalence and clinical features of HPeV CNS infection in children in Korea. METHODS: Reverse transcription polymerase chain reaction assays were performed using HPeV-specific, 5′ untranslated, region-targeted primers to detect HPeV in cerebrospinal fluid (CSF) samples from children presenting with fever or neurologic symptoms from January 1, 2013, to July 31, 2014. HPeV genotyping was performed by sequencing the viral protein 3/1 region. Clinical and laboratory data were retrospectively abstracted from medical records and compared with those of enterovirus (EV)-positive patients from the same period. RESULTS: Of 102 CSF samples, six (5.9%) were positive for HPeV; two of 21 EV-positive samples were co-infected with HPeV. All samples were genotype HPeV3. Two HPeV-positive patients were <3 months of age and four others were over 1 year old. While HPeV-positive infants under 1 year of age presented with sepsis-like illness without definite neurologic abnormalities, HPeV-positive children over 1 year of age presented with fever and neurologic symptoms such as seizures, loss of consciousness, and gait disturbance. The CSF findings of HPeV-positive patients were mostly within the normal range, whereas most (73.7%) EV-positive patients had pleocytosis. CONCLUSIONS: Although HPeV is typically associated with disease in young infants, the results of this study suggest that HPeV is an emerging pathogen of CNS infection with neurologic symptoms in older childhood.

Absceso cerebral en pacientes pediatricos / Brain abscess in pediatric patients

El absceso cerebral se constituye como un área central supurativa dentro del parénquima cerebral, dentro de una envoltura ampliamente vascularizada. Los patógenos ampliamente aislados en la patogénesis de esta entidad en niños son los Streptococos spp. A pesar del avance en la terapia antimicrobiana, las técnicas neuroquirúrgicas e imagenológicas, que permiten su diagnóstico y ubicación oportuna, el absceso cerebral aún se considera un problema de salud pública, con una importante incidencia, morbilidad y mortalidad en países en vía de desarrollo. Para el manejo de este tipo de infección del SNC, se requerirá de un abordaje multidisciplinario que involucre terapia médico quirúrgica. El objetivo de esta revisión es hacer un abordaje amplio sobre la patobiología del absceso cerebral relacionada con la labor concerniente al neurocirujano.

Brain abscess is formed as a central suppurativa area within the brain parenchyma, within an envelope extensively vascularized. Microorganisms largely isolated in the pathogenesis of this condition in children are Streptococos spp. Despite the progress in antimicrobial therapy, neurosurgical techniques and imagenologic support, which enabling timely diagnosis and location, brain abscess is still considered a public health problem and has an important incidence, morbidity and mortality in developing countries. To handle this type of CNS infection, will require a multidisciplinary approach involving surgical medical therapy. The aim of this review is to make a comprehensive approach on the pathobiology of brain abscess related to the work concerning the neurosurgeon.