Clinical characteristics and short-term prognosis of 22 cases with SARS-CoV-2 infection associated acute encephalopathy / 中华儿科杂志

Objective: To investigate the clinical features and short-term prognosis of patients with SARS-CoV-2 infection associated acute encephalopathy (AE). Methods: Retrospective cohort study. The clinical data, radiological features and short-term follow-up of 22 cases diagnosed with SARS-CoV-2 infection associated AE in the Department of Neurology, Beijing Children's Hospital from December 2022 to January 2023 were retrospectively analyzed. The patients were divided into cytokine storm group, excitotoxic brain damage group and unclassified encephalopathy group according to the the clinicopathological features and the imaging features. The clinical characteristics of each group were analyzed descriptively. Patients were divided into good prognosis group (≤2 scores) and poor prognosis group (>2 scores) based on the modified Rankin scale (mRS) score of the last follow-up. Fisher exact test or Mann-Whitney U test was used to compare the two groups. Results: A total of 22 cases (12 females, 10 males) were included. The age of onset was 3.3 (1.7, 8.6) years. There were 11 cases (50%) with abnormal medical history, and 4 cases with abnormal family history. All the enrolled patients had fever as the initial clinical symptom, and 21 cases (95%) developed neurological symptoms within 24 hours after fever. The onset of neurological symptoms included convulsions (17 cases) and disturbance of consciousness (5 cases). There were 22 cases of encephalopathy, 20 cases of convulsions, 14 cases of speech disorders, 8 cases of involuntary movements and 3 cases of ataxia during the course of the disease. Clinical classification included 3 cases in the cytokine storm group, all with acute necrotizing encephalopathy (ANE); 9 cases in the excitotoxicity group, 8 cases with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and 1 case with hemiconvulsion-hemiplegia syndrome; and 10 cases of unclassified encephalopathy. Laboratory studies revealed elevated glutathione transaminase in 9 cases, elevated glutamic alanine transaminase in 4 cases, elevated blood glucose in 3 cases, and elevated D-dimer in 3 cases. Serum ferritin was elevated in 3 of 5 cases, serum and cerebrospinal fluid (CSF) neurofilament light chain protein was elevated in 5 of 9 cases, serum cytokines were elevated in 7 of 18 cases, and CSF cytokines were elevated in 7 of 8 cases. Cranial imaging abnormalities were noted in 18 cases, including bilateral symmetric lesions in 3 ANE cases and "bright tree appearance" in 8 AESD cases. All 22 cases received symptomatic treatment and immunotherapy (intravenous immunoglobulin or glucocorticosteroids), and 1 ANE patient received tocilizumab. The follow-up time was 50 (43, 53) d, and 10 patients had a good prognosis and 12 patients had a poor prognosis. No statistically significant differences were found between the two groups in terms of epidemiology, clinical manifestations, biochemical indices, and duration of illness to initiate immunotherapy (all P>0.05). Conclusions: SARS-CoV-2 infection is also a major cause of AE. AESD and ANE are the common AE syndromes. Therefore, it is crucial to identify AE patients with fever, convulsions, and impaired consciousness, and apply aggressive therapy as early as possible.

Research progress on head imaging features of carbon monoxide poisoning and delayed encephalopathy / 中华劳动卫生职业病杂志

Acute carbon monoxide poisoning and its delayed encephalopathy have obvious damage to the central nervous system. There are different neuroimaging changes in different stages of the disease, and they are relatively specific. This article reviews the clinical research progress on the imaging changes of carbon monoxide poisoning and delayed encephalopathy, including computed tomography (CT) , conventional magnetic resonance imaging (MRI) , diffusion weighted imaging (DWI) , diffusion tensor imaging (DTI) , diffusion kurtosis imaging (DKI) , magnetic resonance spectroscopy (MRS) and other imaging changes reflecting the function and metabolic state of the brain tissue.

Encefalopatía subaguda en una paciente con policondritis recidivante: caso clínico / Subacute encephalopathy associated with relapsing polychondritis: report of one case

Relapsing polychondritis (RP) is a rare multisystemic autoimmune disorder characterized by the inflammation and destruction of cartilages, with preference for auricular, nasal and laryngotracheal cartilages. RP may also affect proteoglycan-rich structures, such as, blood vessels, eyes, kidneys, and heart. The central nervous system (CNS) is involved in less than 3% of patients. We report a 32-year-old female with RP associated with a progressive subacute encephalopathy characterized by behavioral disturbances, auditory and visual hallucinations. The EEG showed generalized slow activity and a mononuclear pleocytosis with increased protein was found in the cerebrospinal fluid. The brain magnetic resonance imaging showed multiple supra and infratentorial nodular inflammatory lesions. After initiating treatment with corticosteroids and cyclophosphamide, a significant improvement in chondritis and neurological status was observed.

Evolución y secuelas cognitivas en un paciente con encefalopatía por VIH/SIDA con tratamiento antirretroviral / Evolution and cognitive consequences in a patient with HIV/AIDS encephalopathy with antiretroviral treatment

El VIH/SIDA es una enfermedad neurotrópica que afecta al sistema nervioso central y dependiendo de la fase clínica de la enfermedad genera deterioro neurológico, psiquiátrico y neuropsicológico en grado variable. Se describe el caso de un paciente que presentó un cuadro de deterioro cognitivo severo (demencia SIDA) con posterior mejoría de signos y síntomas, y establecimiento posterior de secuelas neuropsicológicas después de un año de su diagnóstico. Se comparó una evaluación neuropsicológica en etapa de deterioro cognitivo severo con otra de seguimiento, realizada un año después de iniciar el tratamiento antirretroviral. Se presentan las características clínicas del paciente utilizando el estudio de caso como herramienta metodológica y sobre la base de un procedimiento clínico y psicométrico.

HIV/AIDS is a neurotropic disease that affects the central nervous system and depending on the clinical phase of the disease generates neurological, psychiatric and neuropsychological impairment to varying degrees. The case of a patient who presented severe cognitive impairment (AIDS dementia) is described with subsequent remission of signs and symptoms, and establishment of neuropsychological sequelae after one year of diagnosis. A neuropsychological evaluation in stage of severe cognitive impairment was compared with another follow-up one year after initiating antiretroviral treatment. The clinical characteristics of the patient are presented using the case study as a methodological tool and based on a clinical and psychometric procedure.

Evaluation of Glucosamine Effect Against Heart and Brain Damage Induced by Y-radiation or Aluminium Chloride in Female Rats

Abstract Glucosamine is known as anti-inflammatory, antioxidant and as neuroprotective as well as using to treat many of diseases. This work aimed to investigate the remedial effect of glucosamine (20mg/kg b.wt) against the damage induced by a single dose of γ-radiation (8Gy) or aluminium chloride (AlCl3) (100mg/kg b.wt) in the heart and brain tissues of female rats. Serum aspartate aminotransferase (AST), cholesterol, triglycerides (TGs), LDH and creatine kinase (CPK) were measured. Moreover, gene expression of amyloid protein precursor (APP) and seladin-1 were estimated in the brain tissue. Also, acetylcholinesterase activity (AChE) and p-tau protein expression were estimated in brain homogenate. Metallothioneine (MT) was estimated in the heart and brain tissues. Heart and brain histopathological examination was performed. Irradiation significantly decreased serum AST, CPK and LDH, as well as MT levels in heart and brain tissues. Also, gene expression of seladin-1 decreased. On the other hand, irradiation significantly increased serum TGs level and brain AchE activity, tau protein, and β-amyloid percursor (APP). AlCl3 administration (21 days) induced disturbance in most of the estimated parameters, especially AST, TGs, and MT. Glucosamine treatment with irradiation or AlCl3 improved most of the measured parameters. In addition, histopathological examination confirmed the biochemical results. In conclusion: Glucosamine could be used to improve the heart and brain damages induced by γ-radiation exposure or AlCl3.

Síndrome de Susac: Una causa poco frecuente de encefalopatía / Susac syndrome, a rare cause of encephalopathy

El síndrome de Susac es una enfermedad rara causada por oclusión autoinmune de la microvasculatura del cerebro, de la retina y del oído interno, lo que provoca la triada clínica característica de disfunción del sistema nervioso central, trastornos visuales y déficit vestíbulo-coclear. El diagnóstico se basa en las manifestaciones clínicas y en estudios complementarios que demuestren el compromiso de los tres sistemas. Existen diferentes tratamientos que incluyen combinaciones de varios fármacos inmunosupresores como corticoides, inmunoglobulina intravenosa, micofenolato mofetilo, entre otros. Presentamos el caso de una mujer de 26 años que manifestó hipoacusia izquierda, zumbidos y episodios de vértigo recurrente. Cuatro semanas después agregó visión borrosa bilateral, ataxia cerebelosa y encefalopatía. La resonancia magnética de cerebro mostró múltiples lesiones redondeadas hiperintensas en t2 y FLAIR (fluid-attenuated inversion recovery), hipointensas en t1 a nivel medial del cuerpo calloso, cápsula interna, cerebelo y pedúnculo cerebeloso medio derecho. La audiometría evidenció hipoacusia perceptual bilateral a predominio del oído izquierdo y en la angiografía por tomografía de coherencia óptica se observó obstrucción de arterias de la capa profunda de la retina. Se diagnosticó síndrome de Susac y se inició tratamiento con pulsos de metilprednisolona por 5 días y mantenimiento con micofenolato, revirtiendo totalmente la encefalopatía, con persistencia de leve ataxia e hipoacusia. Es importante conocer la triada clínica característica y los estudios complementarios necesarios para arribar al diagnóstico, ya que muchas veces se puede demorar el tratamiento inmunosupresor. Nuestro caso tuvo una excelente respuesta a los corticoides.

Susac syndrome is a rare disorder caused by autoimmune-mediated occlusions of microvessels in the brain, retina and inner ear. These occlusions lead to a characteristic clinical triad of central nervous system dysfunction, visual disturbances and vestibule-cochlear deficits. The diagnosis is based on clinical manifestations and complementary studies, which demonstrate the involvement of three systems. There are different treatments that include various immunosuppressive drugs combinations such as corticosteroids, intravenous immunoglobulin, mycophenolate mofetil, among others. We present the case of a 26-year-old woman with left hearing loss, tinnitus and episodes of recurrent vertigo, four weeks after bilateral blurred vision, cerebellar ataxia and encephalopathy. Magnetic resonance imaging of the brain showed multiple rounded hyperintense lesions in t2 and fluid-attenuated inversion recovery (FLAIR), hypointense in t1, at the middle level of the corpus callosum, internal capsule, cerebellum and right middle cerebellar peduncle. The audiometry evidenced bilateral perceptual hearing loss, predominantly in the left ear. Angiography by optical coherence tomography showed obstruction in the deep layer retina arteries. The Susac syndrome was diagnosed and treatment started with methylprednisolone pulses therapy, intravenously 1000 mg/ day for 5 days, followed by maintenance with mycophenolate, which completely reversed the encephalopathy, with persistence of mild ataxia and hearing loss. It is important to know the clinical triad characteristic and the complementary studies necessary to arrive at the diagnosis, since immunosuppressive treatment can often be delayed. Our case had an excellent response to corticosteroids.

Encefalopatía asociada a enfermedad tiroídea, un diagnóstico a tener en mente / Encephalopathy associated with thyroid disease, a diagnosis to take into account

Mujer de 54 años con antecedentes de Hipertensión arterial e Hipotiroidismo. Historia de aproximadamente 3 meses de evolución caracterizado al inicio por ánimo bajo, cambios en el comportamiento con aparición progresiva de conductas extraña, ideas delirantes y alucinaciones visuales y auditivas, junto con disminución en requerimientos de hormonas tiroídeas hasta la suspensión. Consulta en varios centros donde se cataloga como Trastorno depresivo severo con síntomas psicóticos, Síndrome confusional, Síndrome Psicótico. En este contexto se pesquisa Hipertiroidismo con títulos elevados de Anticuerpos Antitiroídeos e inicia tratamiento con Metimazol y Betabloqueo. Tras extenso estudio que descartan causas infecciosas, neoplásicas y autoinmunes; se inicia tratamiento con pulsos de Metilprednisolona con excelente y rápida respuesta clínica, la cual mantiene durante el curso del seguimiento con dosis decrecientes de corticoides.

A 54-year-old woman with a history of arterial hypertension and hypothyroidism. History of approximately 3 months of evolution characterized at the beginning by low mood, changes in behavior with progressive appearance of bizarre behaviors, delusional ideas and visual and auditory hallucinations. Consultation in several centers where it is classified as severe Depressive disorder with psychotic symptoms, Confusional syndrome, Psychotic syndrome. Hyperthyroidism is investigated with high titers of Antithyroid Antibodies and initiates treatment with Methimazole and Betablock. After extensive study that ruled out infectious, neoplastic and autoimmune causes; Treatment with Methylprednisolone pulses is initiated with excellent and rapid clinical response, which is maintained during the course of follow-up with decreasing doses of corticosteroid.

Síndrome de Susac: caso clínico y revisión / Susac syndrome: clinical case and literature review

RESUMEN El síndrome de Susac (SS) es una enfermedad autoinmune microangiopática poco frecuente, caracterizada por la tríada clínica: encefalopatía, alteraciones visuales e hipoacusia. Es una entidad de prevalencia desconocida dado su difícil diagnóstico debido a que la mayoría de las veces no se presenta con la tríada clínica clásica, y, dado que presenta múltiples diagnósticos diferenciales. Se reporta un caso de SS presentado en el Hospital del Salvador, con descripción de sus manifestaciones clínicas, estudio y manejo inicial. Además de una revisión en la literatura sobre la variabilidad de los hallazgos clínicos y el manejo de esta patología.

ABSTRACT Susac syndrome (SS) is a rare autoimmune micronagiopathic disease, characterized by the clinical triad of, encephalopathy, visual impairment and hearing loss. It is a difficult entity to diagnose since most of the time it does not present itself with the classical clinical triad, and it may be confused with other differential diagnoses. One clinical case of a patient with SS is described, its clinical manifestations, diagnosis and initial treatment. In addition, a literature review about the multiple clinical findings and management of these disease.

Liver transplantation for acute liver failure due to antitubercular drugs - a single-center experience

OBJECTIVES: Patients receiving treatment for tuberculosis are at risk of developing acute liver failure due to the hepatotoxicity of antitubercular drugs. We aimed to describe our experience with liver transplantation from deceased donors in this situation. METHODS: We identified patients undergoing transplantation for acute liver failure due to antitubercular drugs in our prospectively maintained database. RESULTS: Of 81 patients undergoing transplantation for acute liver failure, 8 cases were attributed to antitubercular drugs during the period of 2006-2016. Regarding the time of tuberculosis treatment until the onset of jaundice, patients were on antitubercular drugs for a mean of 64.7 days (21-155 days). The model for end-stage liver disease (MELD) score of patients ranged from 32 to 47 (median 38), and seven patients underwent transplantation under vasopressors. The 1-year survival was 50%. Three patients died during the week following transplantation due to septic shock (including a patient with acute liver failure due to hepatic/disseminated tuberculosis), and the remaining patient died 2 months after transplantation due to pulmonary infection. There were 2 cases of mild rejection and 1 case of moderate rejection. Of the surviving patients, all were considered cured of tuberculosis after alternative drugs were given. CONCLUSION: Patients arrived very sick and displayed poor survival after deceased donor transplantation.

Intractable intraoperative brain herniation secondary to tension pneumocephalus: a rare life-threatening complication during drainage of subdural empyema / Herniação cerebral intratável secundária a pneumoencéfalo hipertensivo no intraoperatório: uma complicação rara com risco para a vida durante a drenagem de empiema subdural

Abstract Tension pneumocephalus is rare but has been well documented following trauma and neurosurgical procedures. It is a surgical emergency as it can lead to neurological deterioration, brainstem herniation and death. Unlike previous cases where tension pneumocephalus developed postoperatively, we describe a case of intraoperative tension pneumocephalus leading to sudden, massive open brain herniation out of the craniotomy site. The possible causative factors are outlined. It is imperative to rapidly identify possible causes of acute intraoperative brain herniation, including tension pneumocephalus, and institute appropriate measures to minimize neurological damage.

Resumo O pneumoencéfalo hipertensivo é raro, mas foi bem documentado após trauma e procedimentos neurocirúrgicos. Trata-se de uma emergência cirúrgica porque pode levar à deterioração neurológica, herniação do tronco cerebral e morte. Ao contrário de casos anteriores, nos quais o pneumoencéfalo hipertensivo se desenvolveu no pós-operatório, descrevemos um caso de pneumoencéfalo hipertensivo desenvolvido no período intraoperatório que levou a uma herniação cerebral súbita, maciça e aberta para fora do local da craniotomia. Os possíveis fatores causais são destacados. É imperativo identificar rapidamente as possíveis causas da herniação cerebral aguda no intraoperatório, incluindo o pneumoencéfalo hipertensivo, e instituir medidas apropriadas para minimizar os danos neurológicos.

Recurrent Hyperammonemia After Abernethy Malformation Type 2 Closure: a Case Report

ABSTRACT The Abernethy malformation is a rare congenital malformation defined by the presence of an extrahepatic portosystemic shunt. Although most patients are asymptomatic, clinical encephalopathy is present in 15% of cases. We present a patient with type 2 Abernethy malformation, hyperammonemia, and encephalopathy. Shunt closure was performed successfully using interventional angiography; however, hyperammonemia recurred 3 months later. The diagnosis of Abernethy malformation can be made easily, but the ideal patient management strategy has not yet been established. This is the first reported patient with recurrence of hyperammonemia after interventional treatment; we discuss the therapeutic options for Abernethy malformation.(AU)

Endocarditis infecciosa: ¿afectan su pronóstico las complicaciones neurológicas? / Neurologic complications of infective endocarditis: do they have an impact on prognosis?

De acuerdo a la literatura, en un 20 a 40% de las endocarditis infecciosas se producen complicaciones neurológicas. Nuestro objetivo fue determinar la frecuencia de compromiso neurológico en pacientes con endocarditis infecciosa de válvulas izquierdas, considerando la presentación clínica, tipo de lesión en las imágenes y su influencia en la evolución. Se incluyeron en forma prospectiva 98 pacientes con endocarditis infecciosa de válvulas izquierdas. El 47% (46 casos) presentó compromiso neurológico. En 28 casos (61%) el síntoma fue el déficit focal, en 9 (20%) la alteración de estado de conciencia; el 17% (8) fue asintomático y 2% (1 caso) presentó convulsiones. En las imágenes, la isquemia cerebral (76%) fue la lesión más frecuente. El tamaño de la vegetación mayor a 1 cm se asoció a compromiso neurológico (57% vs. 31%, p = 0.01). Aquellos pacientes con compromiso neurológico tuvieron mayor frecuencia de reemplazo valvular (70% vs. 44%, p = 0.01) y la mortalidad hospitalaria también fue mayor (20% vs. 15%, p = 0.5). El tiempo total de internación fue significativamente más prolongado en sujetos con compromiso neurológico (32 ± 27 vs. 21 ± 15 días, p = 0.01) y la discapacidad fue mayor en los que tenían manifestaciones neurológicas (74% vs. 36% p = 0.0001). En nuestra serie, el síntoma más frecuente fue el déficit focal, y en las imágenes la isquemia cerebral fue el patrón más común. Los casos con lesión neurológica presentaron mayor tiempo de internación y grado de discapacidad al alta, pero no mayor mortalidad hospitalaria.

Neurologic complications of infective endocarditis have been observed in 20-40% of cases. Our aim was to determine the frequency of neurologic involvement, clinical manifestations, lesional patterns and evolution in patients with infective endocarditis. This was a prospective cohort study. We included 98 patients with left-sided infective endocarditis. Forty seven percent presented neurologic involvement at some time of the disease. The frequency of symptoms was: focal deficit 61%, sensory disturbance 17% and seizures 2%, while 20% remain asymptomatic. The most prevailing lesion was cerebral ischemia (76%). Vegetations larger than 1 cm were associated to neurologic involvement (57% vs. 31%, p = 0.01). Valvular replacement was more common among patients with neurologic involvement (70% vs. 44%, p = 0.01). Hospital mortality was 20% in patients with neurologic manifestation versus 15% of those without it (p = 0.5). The length of stay was significantly prolonged in patients with neurologic affection (32 ± 27 vs. 21 ± 15 days, p = 0.01) and a favorable Rankin assessment at the discharge was less likely in patients with neurologic involvement (36% vs. 74%, p = 0.0001). In this cohort, the most frequent clinical manifestation was focal deficit and the most prevalent pattern of lesion was cerebral ischemia. Those with neurologic involvement presented an increased length of stay and more disability at the discharge but not statistical significant difference in hospital mortality.

Complications of otitis media - a potentially lethal problem still present / Complicações das otites média - um problema potencialmente letal ainda presente

ABSTRACT INTRODUCTION: It is an erroneous but commonly held belief that intracranial complications (ICCs) of chronic and acute otitis media (COM and AOM) are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care. OBJECTIVE: This paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM). METHODS: Retrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period. RESULTS: 80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention. CONCLUSION: ICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur.

Resumo Introdução: É uma crença comum, porém errônea, que complicações intracranianas (CICs) de otite média tanto aguda (OMA) quanto crônica (OMC) sejam doenças do passado ou de países em desenvolvimento. No entanto, esses problemas continuam, apesar de melhorias na terapia antimicrobiana. Objetivo: Analisar a ocorrência, as características clínicas e a evolução das principais CICs secundárias às otites médias (OM) Método: Estudo de coorte retrospectivo de 51 pacientes com CIC secundárias a OM, provenientes do pronto-socorro de um Hospital Universitário ao longo de um período de 22 anos. Resultado: No total, 80% dos casos de CICs foram secundários a OMC, cuja incidência foi de 0,8%, e apenas 20% foram secundárias a OMA. A letalidade foi de 7,8%, perda auditiva em 90%, com sequela neurológica permanente em 29%. Dentre os pacientes, 61% eram do sexo masculino. Na maioria, o início da doença otológica tinha ocorrido durante a infância. A demora no diagnóstico, tanto da infecção primária como da complicação secundária, foi significativa. CICs, incluindo abscesso cerebral e meningite, corresponderam a 78%, e trombose do seio lateral, empiema e hidrocefalia otítica em 13%, 8% e 1% dos casos, respectivamente. Foram realizados 27 procedimentos neurocirúrgicos e 43 cirurgias otológicas. Dois pacientes não apresentavam condições clínicas para a intervenção cirúrgica Conclusão: CICs de OM, embora incomuns, ainda ocorrem. Esses casos exigem tratamento hospitalar oneroso, complexo e de longo prazo, e frequentemente resultam em perda auditiva, sequelas neurológicas e mortalidade. É importante estar ciente dessa potencialidade especialmente em crianças com OMC e manter um alto índice de suspeita, encaminhar para avaliação otológica e antecipar a ocorrências de tais complicações.

Microcalcificaciones cerebrales en un recién nacido con tuberculosis congénita / Cerebral microcalcifications in a newborn with congenital tuberculosis

La tuberculosis es un problema grave de salud pública a nivel mundial. La Organización Mundial de la Salud estimaba que en el 2012 se habían presentado 8,6 millones de casos nuevos y 1,3 millones de muertes a causa de la enfermedad. En Colombia, la incidencia en 2011 fue de 24 casos por 100.000 habitantes. No hay información sobre la tuberculosis en las mujeres gestantes y la infección congénita se considera una enfermedad rara, de difícil diagnóstico, que genera alta mortalidad y puede confundirse con la adquirida después del nacimiento. La tuberculosis se ha relacionado con la infección por el virus de la inmunodeficiencia humana en madres y neonatos. Por otra parte, los casos de sífilis congénita han aumentado en el mundo y, en Colombia, la prevalencia es de 2,5 casos por 1.000 nacimientos, en tanto que, en el Instituto Materno Infantil-Hospital La Victoria, la frecuencia es de un caso por 57 nacimientos. Se presenta el caso de un recién nacido en tratamiento para sífilis congénita que presentó microcalcificaciones detectadas en una ecografía transfontanelar, lo que alertó sobre la existencia de otro agente infeccioso. La prueba de PCR fue negativa para citomegalovirus, así como los títulos de IgM para toxoplasma, rubéola y herpes I y II. Dado el antecedente de un tratamiento incompleto para tuberculosis en la mujer gestante, se sospechó la presencia de infección por el bacilo de la tuberculosis. No se encontraron bacilos ácido-alcohol resistentes en tres muestras de jugo gástrico, y la prueba de PCR-IS 6110 fue positiva en líquido cefalorraquídeo y en orina, pero no en sangre. El recién nacido recibió tratamiento con penicilina cristalina durante 10 días, así como con isoniacida, rifampicina, pirazinamida y estreptomicina. Actualmente se le hace seguimiento clínico.

Tuberculosis is a serious public health problem worldwide. In 2012, the World Health Organization estimated 8.6 million new cases and 1.3 million deaths due to the disease. In 2011, the incidence in Colombia was 24 cases per 100,000 inhabitants. There is little information about tuberculosis in pregnant women, and congenital infection is considered a rare disease that is difficult to diagnose, leads to high mortality, and may be confused with tuberculosis acquired after birth. In addition, it has been associated with HIV infection in mothers and infants. Moreover, there is increasing incidence of congenital syphilis in the world. In Colombia, the prevalence is 2.5 cases per 1,000 births and its frequency in the Instituto Materno Infantil-Hospital La Victoria is one case per 57 births. We report the case of a newborn under treatment for congenital syphilis and in whom microcalcifications were found in a transfontanelar ultrasound. This finding warned about the existence of another infectious agent. PCR was negative for cytomegalovirus, and IgM titers for toxoplasma, rubella and herpes I and II were also negative. After learning about a history of incomplete treatment for tuberculosis in the mother, we suspected the presence of an infection by the tubercle bacillus in the newborn. No acid-fast bacilli were demonstrated in three gastric juice samples. The IS 6110 PCR assay was found positive in cerebrospinal fluid and urine, but not in blood. The newborn was treated with crystalline penicillin for 10 days along with isoniazid, rifampicin, pyrazinamide and streptomycin. The patient is currently under clinical monitoring.

Neuropsychiatric symptoms of the elderly with Alzheimer's disease and the family caregivers' distress / Sintomas neuropsiquiátricos do idoso com doença de Alzheimer e o desgaste do cuidador familiar / Síntomas neuropsiquiátricos de adultos mayores con enfermedad de Alzheimer y el desgaste de los cuidadores familiares

ABSTRACT Objective: to analyze the relationship between the distress of the family caregiver and the presence of neuropsychiatric symptoms in elderly patients with Alzheimer's disease or mixed dementia. Method: a descriptive, cross-sectional study conducted in the Geriatric and Dementias Clinic of a general tertiary hospital, with 96 elderly people with Alzheimer's disease or mixed dementia and their family caregivers. Questionnaires to characterize the elderly and caregivers, and the Neuropsychiatric Inventory were used. Descriptive statistics and Pearson correlation test were performed. Results: 68.7% of the elderly were women, average age 80.8 years, 56.2% had Alzheimer's disease and 43.7%, mixed dementia. Among caregivers, 90.6% were women, average age 56, 70.8% took care of parents and 64.6% lived with the elderly. There was a strong (r = 0.82) and significant (p <0.01) correlation between the total score on the Neuropsychiatric Inventory and the total score on the Neuropsychiatric Inventory-Distress and strong (r = 0.80) and significant (p <0 01) correlation between the total score on the Neuropsychiatric Inventory Distress and the number of neuropsychiatric symptoms, i.e., the higher the number, frequency and severity of these symptoms in the elderly, the more intense is the caregiver distress. Conclusion: the presence of neuropsychiatric symptoms in the elderly was related to increased distress in caregivers.

RESUMO Objetivo: analisar a relação entre o desgaste do cuidador familiar e a presença de sintomas neuropsiquiátricos em idosos com doença de Alzheimer ou demência mista. Método: estudo descritivo, transversal, realizado no Ambulatório de Geriatria e Demências de um Hospital Geral Terciário, com 96 idosos com doença de Alzheimer ou demência mista e seus cuidadores familiares. Foram utilizados o questionário para caracterização dos idosos e cuidadores e o Inventário Neuropsiquiátrico. Foram realizadas estatísticas descritivas e o teste de correlação de Pearson. Resultados: 68,7% dos idosos eram mulheres, média de idade 80,8 anos, 56,2% possuíam doença de Alzheimer e 43,7%, demência mista. Dos cuidadores, 90,6% eram mulheres, média de idade 56 anos, 70,8% cuidavam do pai/mãe e 64,6% moravam com o idoso. Houve correlação forte (r=0,82) e significativa (p<0,01) entre o escore total do Inventário Neuropsiquiátrico e o escore total do Inventário Neuropsiquiátrico Desgaste e correlação forte (r=0,80) e significativa (p<0,01) entre o escore total do Inventário Neuropsiquiátrico Desgaste e o número de sintomas neuropsiquiátricos, ou seja, quanto maiores o número, a frequência e a gravidade destes sintomas nos idosos maior é o desgaste do cuidador. Conclusão: a presença dos sintomas neuropsiquiátricos nos idosos apresentou relação com maior desgaste nos cuidadores.

RESUMEN Objetivo: analizar la relación entre el desgaste del cuidador familiar y la presencia de síntomas neuropsiquiátricos en pacientes ancianos con enfermedad de Alzheimer o demencia mixta. Método: estudio descriptivo, transversal, realizado en la clínica de Geriatría y Demencias de un hospital general terciario, con 96 ancianos con enfermedad de Alzheimer o demencia mixta y sus cuidadores familiares. Se utilizaron cuestionarios para caracterizar los ancianos y cuidadores y el Inventario Neuropsiquiátrico. Se realizaron estadísticas descriptivas y prueba de correlación de Pearson. Resultados: el 68,7% de los ancianos eran mujeres, con una edad promedio de 80,8 años, el 56,2% tenían enfermedad de Alzheimer y el 43,7%, demencia mixta. Entre los cuidadores, el 90,6% eran mujeres, con una media de 56 años, el 70,8% se hacía cargo del padre / madre y el 64,6% vivía con los ancianos. Hubo una fuerte (r = 0,82) y significativa (p <0,01) correlación entre la puntuación total en el Inventario Neuropsiquiátrico y la puntuación total en el Inventario Neuropsiquiátrico-Desgaste y fuerte correlación (r = 0,80) y significativa (p <0 01) entre la puntuación total en el Inventario Neuropsiquiátrico-Desgaste y el número de síntomas neuropsiquiátricos, es decir, cuanto mayor sea el número, la frecuencia y la severidad de estos síntomas en los ancianos, mayor es el desgaste del cuidador. Conclusión: la presencia de síntomas neuropsiquiátricos en los ancianos estaban relacionados con un mayor desgaste en los cuidadores.

Abordaje del dolor persistente severo en un niño portador de encefalopatía crónica con trastorno cognitivo / Managing severe persistent pain in children suffering from chronic encelopathy with cognitive impairment

El dolor es un problema frecuente y significativo en niños portadores de encefalopatía crónica con trastorno cognitivo. Esta población es muy vulnerable a la falta de reconocimiento y tratamiento del dolor. Habitualmente pueden presentar múltiples fuentes y mecanismos de dolor, nociceptivo como resultado de lesión tisular e inflamación y neuropático por lesión, disfunción o alteración del sistema nervioso. Pueden asociar problemas como: espasticidad, disautonomías, distonías, considerados fuentes adicionales de incomodidad, que deben ser tenidos en cuenta para guiar el tratamiento. El uso de escalas validadas puede contribuir a una mejor objetivación de la intensidad. Un protocolo basado en guías internacionales que integre medidas farmacológicas, apoyado por terapias no farmacológicas conforma una estrategia integral para el alivio de dolor en esta población.

Pain is a common and significant problem in children with chronic encephalopathy with cognitive impairment. This population is very vulnerable to the lack of recognition and undertreatment of pain. Usually they may have multiple sources and mechanisms of pain, nociseptive as a result of tissue damage and inflammation and neuropathic injury, dysfunction or disorder of the nervous system. They may have associated problems such as spasticity, dysautonomia, dystonias, considered additional sources of discomfort, which must be included to guide treatment. The use of validated scales can contribute to a better evaluation of intensity. A protocol based on international guidelines that integrates pharmacological measures, supported by non-pharmacological therapies presents an integral strategy for the relief of pain in this population.

One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital / Um ano de seguimento da condição neurológica de pacientes pós-parada cardiorrespiratória atendidos no pronto-socorro de um hospital universitário

ABSTRACT Objective: To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up. Methods: A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were included. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation. Results: Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed. Conclusion: There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed. .

RESUMO Objetivo: Identificar a condição neurológica e os fatores associados de sobreviventes pós-parada cardiorrespiratória na alta hospitalar, após 6 e 12 meses de seguimento. Métodos: Estudo de coorte, prospectivo e descritivo, realizado em um pronto-socorro. Foram incluídos pacientes em parada cardiorrespiratória que sobreviveram à alta. A amostra foi consecutiva por um ano, sendo composta por 285 pacientes, e os sobreviventes (n=16) foram acompanhados por um ano após alta. O estado neurológico foi avaliado pela Categoria de Performance Cerebral antes da parada, na alta, 6 e 12 meses após alta. Foram investigados os seguintes fatores: comorbidades, presença de consciência na admissão, parada cardiorrespiratória prévia, parada cardiorrespiratória testemunhada, local, causa e ritmo inicial da parada, número de paradas, intervalo entre colapso e início da ressuscitação cardiopulmonar, e entre colapso e término da ressuscitação, e duração da ressuscitação. Resultados: Dos pacientes atendidos, 4,5% (n=13) sobreviveram após 6 e 12 meses de seguimento. Na alta, 50% dos pacientes permaneceram com Categoria de Performance Cerebral prévia à parada, e 50% tiveram piora da mesma. Após 6 meses, 53,8% permaneceram com mesma Categoria de Performance Cerebral, e 46,2% tiveram melhora em relação à alta. Após 12 meses, a totalidade dos pacientes permaneceu com mesma Categoria de Performance Cerebral em relação aos 6 meses anteriores. Não houve associação estatisticamente significativa entre evolução neurológica durante o seguimento e variáveis de interesse. Conclusão: Observou-se piora neurológica na alta, mas houve melhora ou estabilização no decorrer de 1 ano. Não foi encontrada associação entre Categoria de Performance Cerebral e variáveis de interesse. .

Chronic renal disease and reversible posterior leukoencephalopathy syndrome after liver transplantation / Enfermedad renal crónica y síndrome de leucoencefalopatía posterior reversible después del trasplante del hígado

This is a case report of a patient who developed chronic renal dysfunction and neurologic emergency with multiple cranial lesions after liver transplantation. Immune-complex glomerulonephritis was confirmed on the basis of histopathologic evaluation of the renal biopsy. According to clinical features and brain magnetic resonance imaging follow-up, neuroradiographic atypical reversible posterior leukoencephalopathy syndrome (RPLS) was finally diagnosed.

Este es un reporte de caso de un paciente que desarrolló una disfunción renal crónica y requirió emergencia neurológica con múltiples lesiones craneales luego de un trasplante del hígado. La evaluación histopatológica de la biopsia renal permitió confirmar una glomerulonefritis por complejos inmunes. De acuerdo con las características clínicas y el seguimiento mediante tomografía por resonancia magnética del cerebro (de la resonancia magnética cerebral, finalmente se diagnóstico un síndrome de leucoencefalopatía posterior reversible atípico neuroradiográfico (SLPR).