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2.
Arq. neuropsiquiatr ; 78(5): 290-300, May 2020. tab, graf
Article in English | LILACS | ID: biblio-1131705

ABSTRACT

ABSTRACT Background: As the COVID-19 pandemic unfolds worldwide, different forms of reports have described its neurologic manifestations. Objective: To review the literature on neurological complications of SARS-CoV-2 infection. Methods: Literature search performed following systematic reviews guidelines, using specific keywords based on the COVID-19 neurological complications described up to May 10th, 2020. Results: A total of 43 articles were selected, including data ranging from common, non-specific symptoms, such as hyposmia and myalgia, to more complex and life-threatening conditions, such as cerebrovascular diseases, encephalopathies, and Guillain-Barré syndrome. Conclusion: Recognition of neurological manifestations of SARS-CoV-2 should be emphasized despite the obvious challenges faced by clinicians caring for critical patients who are often sedated and presenting other concurrent systemic complications.


RESUMO Introdução: À medida que a pandemia da COVID-19 se desenvolve em todo o mundo, diferentes tipos de publicações descreveram suas manifestações neurológicas. Objetivo: Revisar a literatura sobre complicações neurológicas da infecção por SARS-CoV-2. Métodos: A pesquisa bibliográfica foi realizada seguindo diretrizes de revisões sistemáticas, usando palavras-chave específicas baseadas nas complicações neurológicas da COVID-19 descritas até 10 de maio de 2020. Resultados: Foram selecionados 43 artigos, incluindo descrições que variam de sintomas comuns e inespecíficos, como hiposmia e mialgia, a condições mais complexas e com risco de vida, como doenças cerebrovasculares, encefalopatias e síndrome de Guillain-Barré. Conclusão: O reconhecimento das manifestações neurológicas da SARS-CoV-2 deve ser enfatizado apesar dos óbvios desafios enfrentados pelos clínicos que cuidam de pacientes críticos, muitas vezes sedados e apresentando outras complicações sistêmicas concomitantes.


Subject(s)
Humans , Pneumonia, Viral/complications , Coronavirus Infections/complications , Nervous System Diseases/complications , Brain Diseases/complications , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/physiopathology , Coronavirus Infections , Guillain-Barre Syndrome/complications , Ageusia/complications , Pandemics , Myalgia/complications , Olfaction Disorders/complications , Nervous System Diseases/physiopathology
3.
Geriatr., Gerontol. Aging (Impr.) ; 14(1): 71-75, 31-03-2020. ilus
Article in English, Portuguese | LILACS | ID: biblio-1097171

ABSTRACT

Creutzfeldt-Jakob disease (CJD) is a rare spongiform encephalopathy characterized by a rapid neurodegenerative progress, caused by a misfolded variant of the cellular prion protein (PrP) known as PrPSc. The clinical presentation of sCJD includes a wide range of neurological signs of cortical, subcortical, or cerebellar origin, either isolated or in various combinations. Due to this protean clinical presentation form, sCJD must be distinguished from other dementias. In this case report, we discuss the Heidenhain variant of Creutzfeldt-Jakob disease (HvCJD), a rare variant characterized by early visual symptoms and typical findings in imaging scans. Our patient presented rapidly progressive dementia and a history of visual hallucinations. As for other prion diseases, only symptomatic treatment is available for HvCJD. Thirty years of clinical investigation of patients with prion disease have resulted in little progress in either defining or evaluating potential treatments.


A doença de Creutzfeldt-Jakob (DCJ) é uma encefalopatia rara caracterizada por rápida progressão neurodegenerativa, causada pelo enovelamento incorreto da proteína priônica celular (PrP), conhecido como PrPSc. O quadro clínico da DCJ esporádica inclui um amplo espectro de sinais neurológicos de origens cortical, subcortical ou cerebelar, seja de forma isolada, seja combinada. Por causa da sua apresentação clínica variável, a DCJ esporádica deve ser distinguida de outras demências. Neste relato de caso, discutimos a variante Heidenhain da DCJ (vHDCJ), uma variante rara caracterizada por sintomas visuais precoces e características específicas no exame de imagem. Nossa paciente apresentou demência rapidamente progressiva e histórico de alucinações visuais. Assim como para as demais doenças priônicas, apenas o tratamento sintomático está disponível para a vHDCJ. Trinta anos de investigação clínica de pacientes com doença priônica têm resultado em pouco progresso, seja definindo os potenciais tratamentos, seja avaliando-os.


Subject(s)
Humans , Female , Middle Aged , Brain Diseases , Creutzfeldt-Jakob Syndrome/complications , Creutzfeldt-Jakob Syndrome/diagnosis , Prion Diseases/complications , Prion Diseases/diagnosis , Brain Diseases/complications , Brazil , Neurodegenerative Diseases , Prion Proteins
4.
Ann. afr. med ; 18(3): 127-131, 2019.
Article in English | AIM | ID: biblio-1258907

ABSTRACT

Background: Brain metastasis is a dreaded complication that significantly reduces the quality of life in breast cancer patients. The treatment options are limited by the inability of many chemotherapeutic agents to cross the blood­brain barrier. Surgery also has a limited role, except in few selected patients with oligometastasis. Therefore, whole-brain radiotherapy (WBRT) remains the available option that gives a gratifying result. However, the benefit of this treatment modality in our resource-poor environment needs to be investigated. Materials and Methods: The data of breast cancer patients with brain metastasis who were treated with WBRT using cobalt-60 equipment between 2005 and 2009 were retrospectively collected from the departmental medical record unit. The information extracted included biodata, presenting symptoms, imaging modality for confirmation of brain metastasis, treatment records, performance status pre-WBRT and 4 weeks post-WBRT, and other supportive treatments. Results: A total of 52 female patients were reviewed between 2005 and 2009. The mean age of patients was 44.7 years. The common clinical features on presentation were headache, nausea, and visual impairment in 30.8% of patients with the WHO performance status score ranging between 2 and 4. Patients with more than three brain deposits accounted for 71.2% of all the brain metastases. The mean radiation dose used for WBRT was 30 Gy in 10 fractions, and total responses recorded were 86.5% with 53.8% complete improvement in patients' performance status 4 weeks after WBRT treatment. Conclusion: WBRT is an effective treatment modality for patients with brain metastasis in our resource-poor environment. However, improvement of patients' performance status declined with advancing age


Subject(s)
Brain Diseases/complications , Breast Neoplasms , Female , Heavy Ion Radiotherapy , Nigeria , Patients
5.
Rev. cuba. pediatr ; 90(2): 313-320, abr.-jun. 2018.
Article in Spanish | LILACS | ID: biblio-901491

ABSTRACT

Introducción: la hiponatremia es la anomalía electrolítica más común en pacientes hospitalizados. Está relacionada con la administración de fluidos hipotónicos en pacientes con niveles elevados de hormona antidiurética. La complicación más grave de la hiponatremia es la encefalopatía hiponatrémica, que puede ser fatal, o provocar una lesión cerebral irreversible, si no se trata adecuadamente. Presentación del caso: lactante de 6 meses de edad, eutrófica, con antecedentes de salud y un desarrollo psicomotor acorde con su edad, que ingresa en el Hospital Pediátrico de Cienfuegos con el diagnóstico de una enfermedad diarreica aguda por rotavirus. Se decidió suspender la alimentación e iniciar hidratación de mantenimiento por intolerancia de la vía oral. Se empleó una solución en base a dextrosa al 5 por ciento con 0,18 por ciento de NaCl. Transcurridas 14 horas en la sala, la paciente se traslada a Cuidados Intensivos por convulsiones, que estuvieron relacionadas con hiponatremia severa. Inicialmente el valor del sodio fue normal. En la tomografía de cráneo realizada 13 días después presentaba signos de atrofia cortical. Al momento de realizar este trabajo la niña se seguía en consulta de Fisiatría y Neuropediatría por una cuadriparesia flácida. Conclusiones: los fluidos hipotónicos siguen siendo recomendados como líquidos de mantenimiento en pacientes agudamente enfermos, a pesar de la fuerte asociación entre su uso y el desarrollo de hiponatremia. Es hora de que se dejen de usar fluidos hipotónicos en estados de enfermedad asociados con exceso de hormona antidiurética, pues no existe razón para que esta práctica continúe(AU)


Introduction: hyponatremia is the most common electrolytic abnormality in hospitalized patients. It is related to the administration of hypotonic fluids in patients with high levels of antidiuretic hormone. The most serious complication of hyponatremia is hyponatremic encephalopathy which can be fatal, or cause irreversible brain damage if not treated properly. Case presentation: a 6-month-old, eutrophic infant with health history and psychomotor development according to her age that was admitted in the Pediatric Hospital of Cienfuegos with the diagnosis of an acute diarrheal disease by rotavirus. It was decided to suspend the feeding and initiate maintenance hydration due to intolerance in the oral route. A solution based on 5 percent dextrose with 0.18 percent of NaCl was used. After 14 hours in the ward, the patient was transferred to Intensive Care due to convulsions, which were related to severe hyponatremia. Initially the sodium value was normal. The cranial tomography performed 13 days later showed signs of cortical atrophy. At the time of doing this work the girl was being followed in consultation of Physiatry and Neuropediatrics by a flabby quadriparesia. Conclusions: hypotonic fluids are still recommended as maintenance fluids in acutely ill patients, despite the strong association among their use and the development of hyponatremia. It is time to stop using hypotonic fluids in disease states associated with excess of antidiuretic hormone, because there is no reason for this practice to continue(AU)


Subject(s)
Humans , Female , Infant , Brain Diseases/complications , Atrophy/diagnostic imaging
6.
Rev. cuba. pediatr ; 90(1): 185-190, ene.-mar. 2018. ilus
Article in Spanish | LILACS | ID: biblio-901477

ABSTRACT

La epilepsia benigna con puntas centrotemporales o rolándicas se caracteriza por crisis parciales motoras en la infancia y un electroencefalograma en que observan descargas de puntas en las regiones centrotemporales medias. Ha sido reconocida como benigna, debido a la ausencia de déficits neurológicos evidentes; sin embargo, en los últimos años en la literatura médica internacional han aparecido varias publicaciones que cuestionan su evolución favorable. El objetivo de este trabajo es actualizar algunos criterios que no concuerdan con el buen pronóstico referido inicialmente. Representa una etapa fundamental en la historia de la epilepsia, debido a que es la primera vez que se describió una epilepsia focal o parcial en la que se presumía que no existía una lesión cortical subyacente. La evolución de esta forma de epilepsia puede mostrar elementos que niegan su benignidad. Se recomienda en un futuro efectuar en nuestro servicio un estudio que confirme los criterios expuestos en la literatura médica internacional(AU)


Benign epilepsy with centrotemporal spikes, aka benign rolandic epilepsy, is characterized by partial motor crisis in childhood and electroencephalography showing point discharges in medial centrotemporal regions. The condition has been recognized as benign due to the absence of evident neurological deficits. However, in recent years several publications have appeared in international medical literature in which its favorable evolution is questioned. The objective of the present study is to update some criteria differing from the good prognosis initially stated. It constitutes a fundamental stage in the history of epilepsy, since for the first time a case of focal or partial epilepsy was being described in which presumably there did not exist an underlying cortical lesion. The evolution of this form of epilepsy may display features denying its benignity. It is recommended that in the future a study be conducted in our service confirming the criteria expounded in international medical literature(AU)


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Cognition Disorders/diagnostic imaging , Epilepsy, Rolandic/complications , Brain Diseases/complications , Multicenter Studies as Topic , Prospective Studies
7.
Arch. pediatr. Urug ; 86(3): 192-196, set. 2015. tab
Article in Spanish | LILACS | ID: lil-763418

ABSTRACT

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.


Subject(s)
Humans , Male , Adolescent , Brain Diseases/complications , Brain Diseases/etiology , Cognition Disorders/etiology , Acute Pain , Acute Pain/etiology , Schizencephaly/complications , Nonverbal Communication
8.
Acta pediátr. hondu ; 4(2): 318-322, oct.- 2013. ilus.
Article in Spanish | LILACS | ID: biblio-884624

ABSTRACT

La mordedura de serpiente venenosa es una condición de emergencia pediátrica, que predomina en países tropicales y subdesarrollados, afecta a millones de personas a nivel mundial, produciendo alta morbilidad y mortalidad. Las complicaciones neurológicas pueden ser producidas por efecto de neurotoxinas o por alteraciones en la cascada de coagulación. Se presenta caso de un adolescente mordido por una serpiente barba amarilla que no recibió tratamiento oportuno y manifestó desde las primeras 48 horas, alteraciones hematológicas y a partir del cuarto día de evolución presentó signos de encefalopatía. Posteriormente se analiza el mecanismo mediante el cual se produjeron estos eventos...(AU)


Subject(s)
Humans , Child , Animals, Poisonous/injuries , Brain Diseases/complications , Neurotoxicity Syndromes/complications , Snake Bites/mortality
9.
Med. infant ; 20(2): 117-121, jun. 2013. tab, graf
Article in Spanish | LILACS | ID: lil-774384

ABSTRACT

El síndrome de Sotos se caracteriza por macrosomía, retraso del desarrollo, rasgos faciales típicos y alteraciones cerebrales. En el año 2002 se identificó al gen responsable de ésta patología NSD1, localizado en el brazo largo del cromosoma 5 (5q35.2-q35.3). El objetivo del trabajo fue describir las curvas de crecimiento de 6 niños con diagnóstico clínico de síndrome de Sotos seguidos en los Servicios de Crecimiento y Desarrollo y Genética del Hospital de Pediatría J. P. Garrahan. Material y Métodos: Se realizó un estudio de serie de casos, retrospectivo, observacional, descriptivo por revisión de historias clínicas, de los datos antropométricos (peso, estatura, perímetro cefálico, longitud tronco, estatura de ambos padres) edad ósea, desarrollo puberal y características clínicas. Se analizaron las curvas de distancia. Se calculó la diferencia de puntaje z de estatura y perímetro cefálico al nacer, 2, 6 años y al final del seguimiento. Resultados: la mediana de peso y longitud corporal al nacer fue estadísticamente mayor que la población argentina (p<0,05). Durante el primer y segundo año de vida se observó aceleración del crecimiento, siendo más evidente en estatura y perímetro cefálico que en peso. Luego de esa edad todos los niños mostraron macrocefalia y el 83% (5/6) alta estatura para la población con crecimiento normal. La mediana de puntaje z de IMC fue 0,61 (r: 0,12/1,80). Todos los niños mostraron tendencia a miembros largos. 67% presentó edad ósea avanzada. Uno de cinco niños mostró inicio puberal temprano: 9,21 años de edad. Conclusiones: La curva de crecimiento de estos seis niños con diagnostico de síndrome de Sotos muestran un patrón similar. La macrocefalia y alta estatura, presentes a partir de los dos años de edad, fue la principal característica de estos niños. El IMC fue normal en todos los niños.


Subject(s)
Humans , Male , Female , Infant, Newborn , Child, Preschool , Developmental Disabilities/complications , Developmental Disabilities/diagnosis , Brain Diseases/complications , Follow-Up Studies , Growth and Development , Musculoskeletal Development , Fetal Macrosomia/diagnosis , Fetal Macrosomia/genetics , Argentina , /genetics
10.
Rev. chil. neuro-psiquiatr ; 50(4): 234-238, dic. 2012. ilus
Article in Spanish | LILACS | ID: lil-671279

ABSTRACT

Epidermoid cyst are benign lesions representing 0,3-1,5 percent of intracranial tumors. They originate from inclusions of epithelials cells during closure of neural tube. Symptoms result from compression of adjacent structures or rarely due to rupture causing Chemical meningitis. In this report, we present the case of a 34 years old male with history of ictal headache and meningeal signs. Brain CT showed hypodense suprasellar lesion with signs of rupture into the ventricular system. MRI showed a hypointense lesion on T1 and hyperintense on T2, suspecting epidermoid tumor. The Patient was operated and the sample demonstrated an epidermoid cyst. Spontaneous cyst rupture and spillage of the content into subarachnoid space or ventricles manifest as meningeal syndrome and cause high morbidity. Cyst rupture into de ventricle is infrequently described in literature.


Los quistes epidermoides son lesiones benignas en su mayoría, representando un 0,3 al 1,5 por ciento de los tumores intracraneanos y se originan por la inclusión de elementos epiteliales en el momento del cierre del tubo neural. Su presentación clínica está dada por compresión de estructuras adyacentes y con menor frecuencia secundaria a la rotura espontánea causando meningitis química. Se presenta el caso clínico de un paciente de 34 años de sexo masculino que debuta con un cuadro de cefalea ictal y signos de irritación meníngea. La Tomografía computada de cerebro muestra una lesión hipodensa supraselar con signos de rotura hacia el sistema ventricular. La Resonancia Nuclear Magnética muestra una lesión predominantemente hipointensa en T1 e hiperintensa en T2 planteándose entre los diagnósticos posibles un quiste epidermoide. El paciente es operado y la biopsia informa un quiste epidermoide. La rotura de los quistes epidermoide hacia el espacio subaracnoideo o al ventrículo ocurre de forma espontánea, presentándose clínicamente con un síndrome meníngeo y puede ser causa de gran morbilidad. La rotura hacia el ventrículo es una presentación clínica descrita con poca frecuencia en la literatura.


Subject(s)
Humans , Male , Adult , Brain Diseases/surgery , Brain Diseases/complications , Epidermal Cyst/surgery , Epidermal Cyst/complications , Cerebral Ventricles , Brain Diseases/diagnosis , Lipids , Magnetic Resonance Imaging , Epidermal Cyst/diagnosis , Rupture, Spontaneous , Tomography, X-Ray Computed
11.
West Indian med. j ; 60(5): 571-572, Oct. 2011. tab
Article in English | LILACS | ID: lil-672787

ABSTRACT

BACKGROUND: A retrospective review was undertaken of all patients referred for computed tomography (CT) scans of the head for acute onset of confusion, not consequent on head trauma, during the period June 1, 2004 to May 31, 2007. METHOD: Data were obtained by Microsoft Word search of the reports of the Radiology Department of the University Hospital of the West Indies, Kingston, Jamaica. Two hundred and twenty-one patients were reviewed: 103 men and 118 women. The mean age of the sample was 64 years; 168 patients (76%) were 50 years old or older. RESULT: Computed tomography scans were reported normal in 170 (76.9%) patients; 45 patients (20.4%) had definite acute intracranial CT findings. Findings were equivocal in three patients (1.4%) and unavailable for three (1.4%); 23.2% and 15.6% of patients above and below the age of 50 years respectively showed acute abnormalities on CT. The most common acute finding on CT scan was an ischaemic infarct (68%). Other abnormalities included intracerebral haemorrhage and metastases 6.2% each, toxoplasmosis and primary brain tumour 4.2% each and subdural haematoma and meningitis 2.1% each. The diagnoses of toxoplas-mosis were made based on appearances typical of toxoplasmosis on CT scans in patients whose request stated that they were HIV positive. CONCLUSION: In the sample reviewed, most patients who presented with acute confusion were above the age of 50 years. Overall, 20.4% of patients from all age groups had acute abnormalities on CT with a relative higher proportion, 23.2% versus 15.6% of those over 50 years, having acute pathology. The most common abnormality was an ischaemic infarct. This finding is similar to that in developed countries and unlike that seen in other developing countries where infectious aetiologies predominate.


ANTECEDENTES: Durante el período de junio, 2004 a mayo 31, 2007, se llevó a cabo una revisión retrospectiva de todos los pacientes remitidos para escaneos mediante tomografía computarizada (TC escáner) de la cabeza, en casos de ataques de confusión aguda, no originados por traumas en la cabeza. MÉTODO: Los datos fueron obtenidos mediante búsqueda con Microsoft Word de los informes del Departamento de Radiología del Hospital Universitario de West Indies, Kingston, Jamaica. Se revisaron doscientos veintiún pacientes: 103 hombres y 118 mujeres. La edad promedio de la muestra fue 64 años; 168 pacientes (76%) tenían 50 años de edad o más. RESULTADO: Los escaneos mediante tomografía computarizada fueron reportados como un procedimiento normal en 170 (76.9%) pacientes; 45 pacientes (20.4%) tuvieron hallazgos agudos intracraneales definidos por TC. Los hallazgos fueron equívocos en tres pacientes (1.4%) y no disponibles en tres (1.4%); 23.2% y 15.6% de los pacientes por encima y por debajo de la edad de 50 años respectivamente, mostraron anormalidades agudas en la TC. El hallazgo agudo más común con el escaneo de TC fue el infarto isquémico (68%). Otras anormalidades incluyeron hemorragias intracerebrales y metástasis, 6.2% respectivamente; toxoplasmosis y tumor primario del cerebro, 4.2% respectivamente, y hematoma subdural y meningitis, 2.1% respectivamente. CONCLUSIÓN: En la muestra revisada, la mayoría de los pacientes que presentaron confusión aguda se hallaban por encima de 50 años de edad. En general, 20.4% de los pacientes de todos los grupos etarios presentaban anormalidades agudas en la TC en una proporción relativamente más alta, siendo el caso que el 23.2% frente al 15.6% de aquéllos por encima de 50 años, presentaban patologías agudas. La anormalidad más común fue el infarto isquémico. Este hallazgo es similar al de los países desarrollados, y diferente al que se observa en otros países en vías de desarrollo, dónde predominan las etiologías infecciosas.


Subject(s)
Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Brain Diseases/complications , Brain Diseases , Confusion/etiology , Confusion , Tomography, X-Ray Computed , Acute Disease , Chi-Square Distribution , Jamaica , Retrospective Studies , Risk Factors
12.
Ciênc. Saúde Colet. (Impr.) ; 16(4): 2123-2132, abr. 2011.
Article in Portuguese | LILACS | ID: lil-586561

ABSTRACT

Este artigo analisa o uso de neuroimageamento nas pesquisas da síndrome da fadiga crônica. Revisam-se alguns dos estudos publicados sobre o assunto na década de 1990 e analisa-se um ponto específico desses estudo, que é a busca de alterações na ativação cerebral ou outros tipos de anormalidade que possam fornecer um padrão para diagnóstico e tratamento da doença. Analisa-se o entendimento da síndrome da fadiga crônica como uma doença reduzida aos achados cerebrais, argumentando em favor de uma visão mais ampliada da doença, que leve em conta os elementos psicossociais da vida do paciente em detrimento de explicações reduzidas ao somático.


This article analyzes the use of neuroimaging in research into chronic fatigue syndrome. It reviews some works published in the 1990s and investigates a specific aspect of these studies, namely the search for a cerebral abnormality, in the form of an altered activation pattern, which could provide a pattern for diagnosis and treatment of the disease. The understanding of chronic fatigue syndrome as a disease reduced to some cerebral findings is analyzed, arguing in favor of a broader vision of this disease that includes psychosocial elements of the patient's life as opposed to entirely somatic explanations.


Subject(s)
Humans , Fatigue Syndrome, Chronic/diagnosis , Magnetic Resonance Imaging , Brain Diseases/complications , Fatigue Syndrome, Chronic/etiology , Positron-Emission Tomography
13.
Rev. chil. neuro-psiquiatr ; 49(2): 165-170, 2011. ilus
Article in Spanish | LILACS | ID: lil-597570

ABSTRACT

Neurosyphilis (NS) is caused by the presence of Treponema Pallidum (TP) spirochete within the Central Nervous System (CNS), mainly affecting the meninges and cerebrospinal fluid (CSF). 5 percent to 10 percent of untreated syphilitic patients are deemed to develop symptomatic NSÕ. Its incidence and clinical spectrum have changed over the years with prevalence of early clinical stages of meningitic and meningovascular (MV) NS and exceptional occurrence of late clinical stages (tabes dorsalis, general paresis, and gummata) in the age of antibiotics. The case under analysis deals with aggressive MV and concomitant brain gumma (BG) NS. The case subject is a human inmunodeficiency virus (HIV)-seronegative, 44-year-old woman with 2-year symptomatic latency. Her medical record showed recurrent sensorimotor vascular involvement, fast cognitive damage and chronic, daily cephalea. She met clinical diagnosis, cerebrospinal fluid and serologic criteria for NS. Brain computerized tomography (CT) and magnetic resonance (MR) reported lenticulostriate artery infarction and bilateral ganglionic syphilitic gummata. She underwent Penicillin G-based treatment, making progress with neurological, cognitive-motor sequelae. Although NS has anticipated and speeded up its several clinical stages in connection with HIV/Syphilis co-infection, the peculiarity of this case is the concurrence of early and late NS manifestations in HIV-seronegative patient. The conclusion is that NS is a disease that still prevails and that appropriate diagnosis and treatment prevent irreversible neurological sequelae.


La Neurosífilis (NS) es causada por la invasión del Sistema Nervioso Central (SNC) por la espiroqueta Treponema Pallidum (TP), afectando primariamente las meninges y líquido cefalorraquídeo. Entre 5 a 10 por ciento de los pacientes sifilíticos no tratados desarrollarán una NS sintomáticaÕ. Su incidencia y espectro clínico ha cambiado a lo largo del tiempo, siendo las formas clínicas precoces meníngea y meningovascular (MV) las más prevalentes. En contraste, las formas tardías (tabes dorsal, parálisis general y gomas) son de ocurrencia excepcional en la era antibiótica. Se analiza un caso de NS menigovascular y gomas cerebrales concomitantes, de curso clínico agresivo. En una mujer de 44 años, seronegativa para virus de inmunodeficiencia humana (VIH), con latencia sintomática de dos años. Presentaba una historia de focalidad sensitivo-motor de perfil vascular recurrente, rápido deterioro cognitivo-motor y cefalea crónica diaria. Cumplía criterios diagnósticos clínicos, licuorales y serológicos para NS. La Tomografía computada (TC) y Resonancia Magnética (RM) cerebral mostró infartos arteriolares lentículo-estriados y gomas sifilíticas ganglionares bilaterales. Recibió tratamiento con Penicilina G, evolucionando con secuelas neurológicas cognitivas-motoras. Si bien, la NS actualmente, ha anticipado y acelerado sus diferentes formas clínicas en relación a co-infección VIH/Sífilis. Lo llamativo de este caso, es la presentación concomitante de con manifestaciones precoces y tardías de NS en paciente VIH seronegativo. Se concluye que la NS sigue siendo una enfermedad vigente y su diagnóstico y tratamiento oportuno previene secuelas neurológicas irreversibles.


Subject(s)
Humans , Female , Middle Aged , Brain Diseases/complications , Brain Diseases/diagnosis , Meningitis, Bacterial/complications , Meningitis, Bacterial/diagnosis , Neurosyphilis/complications , Neurosyphilis/diagnosis , Anti-Bacterial Agents/therapeutic use , Brain Diseases/cerebrospinal fluid , HIV Seronegativity , Magnetic Resonance Imaging , Meningitis, Bacterial/cerebrospinal fluid , Neurosyphilis/cerebrospinal fluid , Neurosyphilis/drug therapy , Penicillin G/therapeutic use , Tomography, X-Ray Computed , Treponema pallidum
14.
SQUMJ-Sultan Qaboos University Medical Journal. 2011; 11 (1): 119-121
in English | IMEMR | ID: emr-110250
15.
Rev. chil. neuro-psiquiatr ; 48(4): 279-291, dic. 2010. ilus
Article in Spanish | LILACS | ID: lil-582986

ABSTRACT

Pregnancy produces a series of physiological changes in women which may trigger several neurologic pathologies or decompensation in pre-existing diseases. There are neurologic complications in pathological pregnancies such as: Wernicke's encephalopathy; posterior reversible encephalopathy which is a form of eclampsia; previous diseases such as epilepsies that entail a high obstetric risk due to the possibility of presenting embriopathies associated to the use of antiepileptic drugs (AEDs) and also because of the risk of a convulsive crisis in the fetus; cerebrovascular diseases which are rare although with high maternal mortality; extrapyramidal pathologies which are infrequent except for the chorea gravidarum and the restless legs syndrome; cerebral neoplasms in which due to haemodynamic changes at the end of the second quarter and the increase of estrogen and progesterone many tumors may raise their volume; and peripheral alterations like myasthenia gravis (MG); intervertebral disk displacement and entrapment neuropathies like carpal tunnel syndrome and meralgia paresthetica. Anyhow because of cellular immunity in multiple sclerosis pregnancy is protected from new outbreaks.


El embarazo provoca una serie de cambios en la fisiología de la mujer lo que puede desencadenar diferentes patologías, entre ellas neurológicas y/o descompensar enfermedades previas. Existen cuadros como complicaciones neurológicas de embarazos patológicos: encefalopatía de Wernicke, la encefalopatía posterior reversible que corresponde a una forma de manifestación de eclampsia, enfermedades previas como epilepsias que conllevan un alto riesgo obstétrico; por un lado por la posibilidad de presentar embriopatías asociadas al uso de fármacos antiepilépticos (FAE) y por otro el riesgo que representa una crisis convulsiva en el feto, enfermedades cerebrovasculares, complicación rara pero con una alta mortalidad materna, enfermedades extrapiramidales, infrecuentes, salvo el corea gravídico y el síndrome de piernas inquietas, esclerosis múltiple, en que el embarazo previene la aparición de brotes, debido al predominio de la inmunidad celular, neoplasias intracerebrales en que por los cambios hemodinámicos que ocurren al final del segundo trimestre y el aumento del estrógeno y progesterona, muchos tumores pueden aumentar su masa, y alteraciones periféricas como miastenia gravis (MG), hernias discales y aparición de neuropatías por atrapamiento como el síndrome del túnel del carpo y la meralgia parestésica.


Subject(s)
Humans , Female , Pregnancy , Central Nervous System Diseases/complications , Pregnancy Complications , Eclampsia , Brain Diseases/complications , Epilepsy/complications , Multiple Sclerosis/complications , Hyperemesis Gravidarum , Neurology , Cerebrovascular Disorders/complications
16.
Managua; s.n; 2010. 42 p. tab.
Thesis in Spanish | LILACS | ID: lil-592872

ABSTRACT

El presente estudio fue realizado en Hospital Antonio Lenin Fonseca, con el objetivo de conocer el beneficio del tratamiento endoscopico con ligaduras en pacientes con sangrado digestivo alto de etiologia variceal atendidos en el 2009. Es un estudio tipo descriptivo, I cohortes, prospectivo, longitudinal. Los datos más levantes concluyen que el grupo etáreo predominante fue el de mayor de 50 años con el 68.4% (39), siendo el sexo masculino el mas afectado en el 68.4% (39) de los casos. El 53.6% correspondió a várices esofágicas grado III y en el 47.4% al grado IV, siendo la etilogía de la cirrosis en el 63,2% (36) la etilica. El 19.05% (4) reingresaron por sangrado de etiología variceal, y de éstos un caso estusvo asociado a encefalopatía hepática lo que contribuyo a una mayor estancia hospitalaria. Todos los pacientes recibieron tratamiento coadyuvante con betabloqueantes. En el período en estudio no se registraron muertes por sangrado de etiología variceal...


Subject(s)
Liver Cirrhosis/complications , Brain Diseases/complications , Hemorrhage/prevention & control , Hemorrhage/therapy , Varicose Veins/etiology
17.
Article in English | WPRIM | ID: wpr-164236

ABSTRACT

A yeast-like strain was isolated from the brain abscess of a patient diagnosed with astrocytoma. Morphological and molecular analysis on D1/D2 domain in the 26S rRNA gene and internal transcript spacer region of the strain revealed that the strain belonged to the genus Pseudozyma. To the best of our knowledge, this is the first report on the isolation of a Pseudozyma strain from brain abscess.


Subject(s)
Aged , Astrocytoma/complications , Brain Abscess/complications , Brain Diseases/complications , DNA, Fungal/genetics , Humans , Male , Mycological Typing Techniques , Phylogeny , RNA, Ribosomal/genetics , Ustilaginales/classification
18.
Article in English | WPRIM | ID: wpr-178651

ABSTRACT

The permanent impairment evaluation for children in developmental stage is very difficult and it is even impossible in some cases. The impairment evaluation for developing children has not yet been included in the guideline of the American Medical Association. Due to frequent medical and social demands in Korea, we developed an impairment evaluation guideline for motor impairment, intellectual disability/mental retardation, developmental speech-language disorder and epilepsy caused by pediatric cerebral injuries, or cerebral lesions other than the developmental disorders such as autism. With the help of various literature and foreign institutions, we developed our in order to develop a scientific guideline for pediatric impairment that is suited to Korean cultural background and social condition.


Subject(s)
Brain/physiopathology , Brain Diseases/complications , Brain Injuries/complications , Child , Developmental Disabilities/classification , Disability Evaluation , Disabled Children , Humans , Korea , Language Development Disorders/classification , Mental Disorders/classification , Program Development , Seizures/classification , Severity of Illness Index
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