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1.
Dement. neuropsychol ; 15(3): 413-418, Sept. 2021. tab
Article in English | LILACS | ID: biblio-1339787

ABSTRACT

ABSTRACT Rasmussen encephalitis is a rare disease consisting of a chronic, slowly progressive inflammatory reaction of brain tissues. The objective of this study was to describe the case of an 18-year-old female patient, studying on the fourth grade of elementary school, and right-handed, who underwent left hemispherectomy in a neurological rehabilitation program. Her seizures began at 10 years of age and were unresponsive to drug treatment, with functional repercussions. She underwent hemispherectomy in March 2019, with 7 years of ongoing disease, and was admitted for the rehabilitation program with a multidisciplinary team in June 2020. The quality-of-life questionnaire (WHOQOL-BREF) was applied as a comparison measure before and after the rehabilitation program, along with measures of participation on the program activities. Despite the patient's short time in a rehabilitation program, data show the importance of an interdisciplinary intervention through the establishment of specific and contextualized objectives in chronic patients.


RESUMO A encefalite de Rasmussen representa uma doença rara, que consiste em uma reação inflamatória dos tecidos cerebrais, de modo crônico e lentamente progressivo. O objetivo deste estudo foi descrever o caso de uma paciente, submetida à hemisferectomia à esquerda, em março de 2019, em programa de reabilitação neurológica. Paciente do sexo feminino, 18 anos de idade, 4ª série do ensino fundamental, destra, que participou de programa de reabilitação neurológica interdisciplinar após hemisferectomia. Início das crises convulsivas aos 10 anos de idade, refratárias ao tratamento medicamentoso, com repercussão funcional. Foi submetida à hemisferectomia em março de 2019, com sete anos de doença em curso. Foi internada para programa de reabilitação, com equipe multiprofissional, em junho de 2020. Aplicou-se o questionário de qualidade de vida (WHOQOL-BREF), como medida de comparação antes e após o programa de reabilitação, além de medidas de participação nas atividades do programa. Os dados, apesar do pouco tempo da paciente em programa de reabilitação, mostram a importância da intervenção interdisciplinar, por meio do estabelecimento de objetivos realísticos e contextualizados.


Subject(s)
Humans , Patient Care Team , Chronic Disease , Encephalitis , Neurological Rehabilitation
2.
Arch. argent. pediatr ; 119(2): e142-e148, abril 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1152045

ABSTRACT

La gripe se asocia al aparato respiratorio, especialmente en invierno, y puede causar complicaciones neurológicas. Se evaluó a pacientes pediátricos con manifestaciones neurológicas graves por gripe desde septiembre de 2018 hasta febrero de 2019 para determinar características clínicas, neuroimagenología, tratamiento y resultados. El objetivo fue evaluar la encefalitis asociada a la gripe y destacar diferentes manifestaciones neurológicas y cambios de neuroimagenología. El estudio incluyó a 13 pacientes. Los síntomas neurológicos ocurrieron tras los síntomas típicos de la gripe. Los cambios de neuroimagenología incluyen alteraciones de señal de la sustancia blanca cortical y subcortical, edema localizado o generalizado y lesiones multifocales simétricas bilaterales en el tálamo y la médula del cerebelo. Las opciones terapéuticas incluyen metilprednisolona en inyección intravenosa, inmunoglobulina intravenosa, plasmaféresis y oseltamivir. Es fundamental considerar la encefalitis asociada a la gripe en pacientes con convulsiones, la encefalopatía con hallazgos radiológicos compatibles, e iniciar el tratamiento lo antes posible


Influenza is mostly associated with the respiratory tract system, especially in the winter season. Various neurological complications could occur due to influenza infection. Pediatric patients who had severe neurological manifestations due to influenza infection from September 2018 to February 2019 were evaluated for clinical characteristics, neuroimaging studies, treatment, and outcome. We aimed to assess Influenza-associated encephalitis in children, emphasize different neurological manifestations and neuroimaging changes. Thirteen patients were included in the study. Neurological symptoms occurred after flu-like symptoms. Neuroimaging changes of influenza-associated encephalitis/encephalopathy include cortical and subcortical white matter signal alterations, localized or generalized edema, and bilateral symmetrical multifocal lesions on the thalamus and cerebellar medulla. Pulse methylprednisolone, intravenous immunoglobulin, plasma exchange, and oseltamivir are the therapy choices. It is essential to consider influenza-associated encephalitis in patients with seizures, encephalopathy with supporting radiological findings, especially during the influenza season and starting treatment as fast as possible for better outcomes.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Brain Diseases/diagnostic imaging , Encephalitis/diagnostic imaging , Influenza, Human/complications , Turkey/epidemiology , Brain Diseases/therapy , Encephalitis/therapy , Neuroimaging , Neurologic Manifestations
3.
Pesqui. vet. bras ; 41: e06782, 2021. tab, graf
Article in English | ID: biblio-1340352

ABSTRACT

This research reports the use of different diagnostic tests in cattle, naturally infected by Rabies lyssavirus (RABV), and correlates the positivity of the tests with the clinical moment of euthanasia, the intensity of the inflammatory lesion and viral load. It also highlights the possibility of euthanasia in early stages of the disease as a way to improve animal welfare. For that, samples of 34 bovine brains were collected for analysis, preserved in 10% buffered formaline and refrigerated with subsequent freezing. The samples were subjected to direct immunofluorescence antibody technique (DFAT) tests, viral isolation in cell culture (VICC), histopathology with hematoxylin and eosin staining (HE), immunohistochemistry (IHC), Shorr stainied neural tissue smears (DSS), Reverse transcription polymerase chain reaction (RT-PCR) and polymerase chain reaction by quantitative reverse transcriptase (qRT-PCR). The areas used for analysis were the cerebellum, parietal telencephalon and thalamus. Samples with Negri bodies (NBs) or immunostaining in at least one of the analyzed areas were considered positive. For the study of the intensity of histological lesions, the lesions were classified into grades 0, 1, 2 and 3 and the positivity of the test in the presence or absence of NBs in one of the three areas analyzed. To verify the influence of the disease clinical evolution, 4-four groups of analysis were created according to the animal's clinical status at moment of the euthanasia, being: M1 = animal euthanized while standing, M2 = euthanized when in sternal recumbence, M3 = euthanized when in lateral recumbence, M4 = animal with natural death. Of the 34 brains evaluated, IHC was positive in 100% of cases, DFAT was positive in 97.05% of them, and in this negative sample the presence of RABV was confirmed by VICC. NBs ere seen in 88.23% of the cases, and the DSS test was positive in 82.35% of them. All diagnostic techniques showed positive cases in all groups analyzed. Each case was positive in at least two diagnostic methods. All cases that contained NBs were positive for rabies in the other tests. In this study, it was observed that the variables analyzed (intensity of injury and clinical evolution at the moment of euthanasia) had an influence only on HE and DSS techniques, which are based on NB research to form the diagnosis, but did not interfere with the effectiveness of the diagnosis performed by detecting the viral antigen performed by DFAT and IHC. All isolated RABV samples included in the present study have a genetic lineage characteristic of hematophagous bats Desmodus rotundus. The evaluation of qRT-PCR showed that the amount of virus did not interfere in the positivity of the tests. This work shows that IHC and DFAT are safe diagnostic techniques. They are capable of detecting RABV even in euthanized animals in the early stages of clinical evolution with mild intensities of histological lesions.(AU)


Esta pesquisa relata a utilização de diferentes testes de diagnóstico em bovinos, naturalmente infectados pelo Rabies lyssavirus (RABV), e correlaciona a positividade dos testes com o momento clínico da eutanásia, a intensidade da lesão inflamatória, e a carga viral. Salienta também a possibilidade da eutanásia em estágios precoces da doença como forma de melhorar o bem-estar animal. Para isso amostras de 34 encéfalos bovinos foram coletados para análise, conservadas em formol tamponado 10% e sob refrigeração com posterior congelamento. As amostras foram submetidas aos testes de imunofluorescência direta (IFD), isolamento viral em cultivo de células (IVCC), histopatologia com coloração de hematoxilina e eosina (HE), imuno-histoquímica (IHQ), esfregaço direto com coloração de Shorr (EDS), reação da polimerase em cadeia por transcriptase reversa (RT-PCR) e reação da polimerase em cadeia por transcriptase reversa quantitativo (qRT-PCR). As áreas utilizadas para análise foram o cerebelo, telencéfalo parietal e tálamo. Foram consideradas positivas as amostras que apresentaram Corpúsculo de Negri (CNs) ou imuno-marcação em ao menos uma das áreas analisadas. Para o estudo da intensidade das lesões histológicas, as lesões foram classificadas em graus 0, 1, 2 e 3 e a positividade do teste na presença ou ausência de CN em uma das três áreas analisadas. Para verificar a influência da evolução clínica da doença foram criados 4 grupos de análise conforme o estado clínico do animal no momento da eutanásia, sendo: M1 = animal eutanasiado em estação, M2 = eutanasiado em decúbito esternal, M3 = eutanasiado em decúbito lateral, M4 = animal com morte natural. Dos 34 encéfalos avaliados a IHQ foi positiva em 100% dos casos, a IFD foi positiva em 97,05%, sendo que na amostra negativa a presença de RABV foi confirmada por IVCC. A histologia com HE, através da visualização das CNs, foi positiva em 88,23 % dos casos, e o teste de EDS, foi positivo em 82,35%. Todas as técnicas de diagnóstico apresentaram casos positivos em todos os grupos analisados. Cada caso foi positivo em, pelo menos, dois métodos de diagnóstico. Todos os casos que continham CN foram positivos para raiva nos demais testes. Nesse estudo observou-se que as variáveis analisadas intensidade de lesão e evolução clínica no momento da eutanásia tiveram influência somente nas técnicas de HE e EDS, que se baseiam na pesquisa do CN para formação do diagnóstico, mas não interferiram na eficácia do diagnóstico realizado através da detecção do antígeno viral realizado por IFD e IHQ. Todas as amostras RABV isoladas incluídas no presente estudo apresentam linhagem genética característica de morcegos hematófagos Desmodus rotundus. A avaliação de qRT-PCR demostrou que a quantidade de vírus não interferiu na positividade dos testes. Esse trabalho mostra que a IHQ e a IFD são técnicas seguras de diagnóstico e que mesmo em animais eutanasiados em estágios iniciais de evolução clínica com intensidades leve de lesões histológicas, são capazes de detectar o RABV.(AU)


Subject(s)
Animals , Cattle , Cattle/injuries , Euthanasia , Viral Load/veterinary , Rabies virus , Wounds and Injuries/diagnosis , Encephalitis
4.
Dement. neuropsychol ; 14(4): 434-437, Oct.-Dec. 2020. graf
Article in English | LILACS | ID: biblio-1142831

ABSTRACT

ABSTRACT. Rasmussen encephalitis (RE) is a classic disorder in the child age group, and only 10% of cases are described in adults. We bring two proven cases of RE in older adults aged over 55 years. Objective: To describe the clinical characteristics, progression, diagnostic assessment, neuropathological findings, and treatment of RE in two clinical cases of patients over 55 years of age. Furthermore, we address progressive cognitive decline as an important feature of the RE presentation in older adults in association with focal epilepsy. Methods: This is a case series from two tertiary hospitals from São Paulo - Brazil. Retrospective data were collected from one case. Results: Two male individuals aged >55 years with clinical presentation of focal epilepsy along with progressive cognitive deterioration. Conclusions: RE could be considered the cause of progressive cognitive decline in older adults, especially if focal epilepsy is described together with asymmetrical neuroimaging findings.


RESUMO. A encefalite de Rasmussen (ER) é um distúrbio clássico da faixa etária infantil e apenas 10% dos casos são descritos em adultos. Trazemos dois casos comprovados de ER em idosos, com idade acima de 55 anos de idade. Objetivo: Descrever as características clínicas, evolução, avaliação diagnóstica, achados neuropatológicos e tratamento da ER em dois casos clínicos com mais de 55 anos de idade. Além disso, atentar para o declínio cognitivo progressivo como uma característica importante na apresentação ER idosos em associação à epilepsia focal. Métodos: Série de casos de dois Hospitais Terciários em São Paulo, Brasil. Dados retrospectivos foram coletados de um caso. Resultados: Dois indivíduos do sexo masculino com idade >55 anos e apresentação clínica de epilepsia focal associada a deterioração cognitiva progressiva. Conclusão: A ER pode ser considerada a causa do declínio cognitivo progressivo em idosos, especialmente se for descrita epilepsia focal associada a achados assimétricos em neuroimagem.


Subject(s)
Humans , Dementia , Encephalitis , Epilepsy , Cognitive Dysfunction
6.
Rev. Assoc. Med. Bras. (1992) ; 66(9): 1172-1178, Sept. 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1136362

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Encephalitis , Hashimoto Disease , Brazil
7.
Acta bioquím. clín. latinoam ; 54(3): 321-331, set. 2020. ilus, graf
Article in Spanish | LILACS | ID: biblio-1130606

ABSTRACT

Los flavivirus transmitidos por mosquitos son una amenaza actual y emergente en todo el mundo. Dentro de este género, el virus Encefalitis San Luis (VESL) causa una forma severa de enfermedad neuroinvasiva donde la respuesta inmune es un componente crucial de la defensa del huésped. En este trabajo se investigó la interacción entre VESL y células de la inmunidad innata, en un modelo de infección in vitro de monocitos humanos (células U937) con cepas de distinta virulencia y condiciones epidemiológicas de aislamiento (CbaAr-4005 y 78V-6507). Se evaluó la capacidad de infectar y replicar del virus, como también el efecto citopático y la cinética de viabilidad de monocitos durante la infección. Los resultados demostraron la susceptibilidad de los monocitos a la infección, replicación y muerte por ambas cepas virales. Sin embargo, se hallaron diferencias significativas entre ellas. La cepa epidémica y de mayor virulencia CbaAr-4005 registró una tasa de infección y replicación superior a la de la cepa endémica y de menor virulencia 78V-6507. Se comprobó también que el VESL indujo la muerte de monocitos humanos, dependiendo del tiempo post-infección (pi) y de la cepa. Así, CbaAr-4005 provocó a partir del día 3 pi el doble de mortalidad celular que 78V-6507. Además, en los monocitos infectados se observaron alteraciones de parámetros morfológicos que podrían relacionarse con el tipo de mecanismo de muerte celular asociado a la infección por VESL.


Mosquitoes borne Flavivirus infections are an actual and emergent worldwide threat to human health. Within this genus, Saint Louis Encephalitis Virus (SLEV) causes a severe neuroinvasive disease where immune response is crucial for host survival. In this study the interaction between SLEV and innate immune cells was evaluated. An in vitro infection model with human monocytes (U937 cells) and strains with variations in virulence and isolation conditions (CbaAr-4005 and 78V-6507) were used. Infection capacity, replication capacity, cytopathic effect and monocyte viability kinetics were measured. The results showed susceptibility to infection and replication to both strains. However, significant differences were found among them. CbaAr-4005, the epidemic and more virulent strain, showed higher infection and replication ratios compared to 78V-6507. SLEV infection that induces cell death of human monocytes was also found in a post-infection time and in a strain dependent manner. Since day 3 post-infection, twice the mortality in CbaAr-4005 infected cells was observed. Furthermore, infected monocytes showed alterations in morphologic parameters that could be related with apoptosis mechanisms associated to SLEV infections.


Os Flavivírus transmitidos por mosquitos são uma ameaça atual e emergente no mundo todo. Nesse gênero, o vírus Encefalite Saint Louis (VESL) causa uma forma grave de doença neuroinvasiva onde a resposta imune é um componente crucial da defesa do hospedeiro. Neste trabalho nos investigamos a interação entre VESL e células de imunidade inata em um modelo de infecção in vitro de monócitos humanos (células U937) com estirpe de diferentes virulências e condições epidemiológicas de isolamento (CbaAr-4005 e 78V-6507). Foi avaliada a capacidade do vírus de infectar e replicar , assim como o efeito citopático e a viabilidade cinética dos monócitos durante a infecção. Os resultados demonstraram a suscetibilidade dos monócitos à infecção, replicação e morte por ambas as estirpes virais. No entanto, foram detectadas diferenças significativas entre eles. A estirpe epidémica e de maior virulenta CbaAr-4005 teve uma maior taxa de infecção e replicação do que a estirpe endémica e menos virulenta 78V-6507. Foi comprovado também que o VESL induziu a morte de monócitos humanos, dependendo do tempo pós-infecção (pi) e da estirpe. Assim, a CbaAr-4005 causou a partir do dia 3 pi o dobro da mortalidade celular o que a 78V- 6507. Além disso, alterações nos parâmetros morfológicos foram observadas nos monócitos infectados que poderiam estar relacionadas ao tipo de mecanismo de morte celular associado à infecção pelo VESL.


Subject(s)
Humans , Male , Female , Virulence , Flavivirus Infections , U937 Cells , Encephalitis , Encephalitis Virus, St. Louis , Encephalitis Viruses/growth & development , Flavivirus , Patient Isolation , Viruses , In Vitro Techniques , Kinetics , Cells , Disease , Incidence , Causality , Mortality , Apoptosis , Reference Parameters , Culicidae
8.
Rev. chil. pediatr ; 91(4): 614-619, ago. 2020.
Article in Spanish | LILACS | ID: biblio-1138679

ABSTRACT

Resumen: La enfermedad por coronavirus ha extendido su compromiso más allá del sistema respiratorio con reportes crecientes de compromiso en diferentes sistemas, uno de ellos, el Sistema Nervioso. El potencial neuroinvasivo de este agente patógeno se explicaría por su neurotropismo dada la presencia de receptores de ACE2 a nivel de encéfalo y médula espinal, además del importante com promiso inflamatorio sistémico. El compromiso neurológico debido a la infección se ha dividido en Sistema Nervioso Central, destacando síntomas inespecíficos y leves como mareos y cefalea, así como cuadros graves con encefalitis y patología cerebrovascular, y Sistema Nervioso Periférico en donde la mayor relevancia guarda relación con la anosmia, ageusia y miositis. A nivel pediátrico el compromiso parece ser menor que en adultos, pero existe un reporte creciente en la literatura respecto a estos hallazgos. Es de gran importancia de contar con un adecuado registro y anamnesis que permita identificar precozmente el compromiso neurológico.


Abstract: Coronavirus disease has extended its involvement beyond the respiratory system, with increasing reports of involving different systems, such as Nervous System. The neuroinvasive potential of this pathogen would be explained by its neurotropism given the presence of ACE2 receptors in the brain and spinal cord, in addition to the important systemic inflammatory involvement. The neu rological involvement due to infection is divided between the central nervous system, highlighting non-specific and mild symptoms such as dizziness and headache, as well as severe symptoms with encephalitis and cerebrovascular pathology, and the peripheral nervous system, which mainly pre sents anosmia, ageusia, and myositis. Clinical symptomatology in pediatric patients seems to be less than in adults, but there is a growing report in the literature regarding these findings. There fore, it is very important to have an adequate registry and anamnesis that allow early identification of neurological involvement.


Subject(s)
Humans , Child , Pneumonia, Viral/complications , Coronavirus Infections/complications , Peptidyl-Dipeptidase A/metabolism , Nervous System Diseases/virology , Pediatrics , Age Factors , Encephalitis/virology , Headache/virology , Nervous System Diseases/physiopathology
9.
Rev. Soc. Peru. Med. Interna ; 33(2): 82-84, abr.-jun. 2020. ilus
Article in Spanish | LILACS, LIPECS | ID: biblio-1103790

ABSTRACT

Se presenta el caso de un varón de 53 años de edad con un tiempo de enfermedad de tres días, con malestar general, fiebre, dolor faríngeo, y tos seca. Al ingresar al hospital, se le halló febril y presentó convulsiones tónicas-clónicas y desorientación. La tomografía pulmonar mostró lesiones compatibles con COVID-19; TAC cerebral normal; y, rT-PCR para COVID-19: positivo. La punción lumbar mostró solo hiperglucorraquia, El paciente falleció al tercer día. Se concluye que se trató de un paciente con COVID-19 y compromiso neurológico tipo encefalitis. (AU)


This is the case of a 53-year-old male with a three-day disease time, with malaise, fever, pharyngeal pain and dry cough. Upon entering the hospital, he was febrile and had tonic-clonic seizures and disorientation. The pulmonary tomography showed COVID-19-compatible lesions; normal brain CT; and, rT-PCR for COVID-19: positive. The lumbar puncture showed only hyperglucorraquia, The patient died on the third day. It is concluded that it was a patient with COVID-19 and neurological involvement type encephalitis. (AU)


Subject(s)
Humans , Male , Middle Aged , Seizures , Coronavirus Infections , Encephalitis
10.
Arch. argent. pediatr ; 118(3): e333-e337, jun. 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1117361

ABSTRACT

El síndrome anti-GQ1b reúne el síndrome de Miller-Fisher y la encefalitis del tronco cerebral de Bickerstaff, entre otras entidades. Tienen etiopatogenia común, constituida por la presencia de anticuerpos anti-GQ1b que reaccionan contra los sitios GQ1b del sistema nervioso según sea su accesibilidad. La prevalencia anual del síndrome de Miller-Fisher es de 0,09 casos por 100 000 habitantes por año y no existen estudios epidemiológicos sobre la encefalitis del tronco cerebral de Bickerstaff, que sería menos frecuente. De evolución natural hacia la mejoría, se beneficia del tratamiento con gammaglobulina endovenosa.Se presenta a un paciente de 12 años con síndrome de Miller-Fisher­Bickerstaff tras un episodio de diarrea aguda por Campylobacter jejuni en el que los anticuerpos anti-GQ1b resultaron positivos. Es nuestro objetivo comunicar sobre un síndrome de presentación poco habitual en pediatría a fin de advertir acerca de la necesidad de su sospecha precoz y solicitud de estudios de laboratorio específico


Miller-Fisher syndrome and Bickerstaff brainstem encephalitis, among others, constitute the anti-GQ1b syndrome, with a common immune pathophysiologic pathway characterized by the presence of anti-GQ1b antibodies, which react against the different nervous system GQ1b sites according to their different accessibility. The Miller-Fisher syndrome has a prevalence of 0.09 cases per 100 000 people-year but there are not epidemiological studies about Bickerstaff brainstem encephalitis, that it seems to be less frequent. In spite of having a good natural outcome, the immunoglobulin administration has been established as efficacious at improving it. A twelve-year-old boy suffering from Miller-Fisher-Bickerstaff syndrome after an acute Campylobacter jejuni diarrhea with positive titers of anti-GQ1b and anti-QGT1a antibodies is presented. We communicate a very uncommon pediatric disease with the aim of warning about the importance of its early suspicion and the need of specific laboratory determination


Subject(s)
Humans , Male , Child , Miller Fisher Syndrome , gamma-Globulins/therapeutic use , Diarrhea , Diplopia , Encephalitis , Antibodies
11.
Article in English | WPRIM | ID: wpr-828995

ABSTRACT

Pseudorabies virus (PRV), a veterinary pathogen that infects domestic animals as well as wild animals such as wild boar and feral swine, was recently reported to infect human and led to endophthalmitis and encephalitis. A retrospective seroepidemiologic survey was conducted using 1,335 serum samples collected from patients with encephalitis and ELISA positive rates were 12.16%, 14.25%, and 6.52% in 2012, 2013, and 2017, respectively. The virus neutralizing antibody titers of positive samples correlated well with ELISA results. The pseudorabies virus antibody positive rate of patients with encephalitis were higher than that of healthy people in 2017. The above results suggest that some undefined human encephalitis cases may be caused by PRV infection.


Subject(s)
Adult , Animals , Antibodies, Viral , Blood , China , Encephalitis , Allergy and Immunology , Virology , Enzyme-Linked Immunosorbent Assay , Female , Herpesvirus 1, Suid , Allergy and Immunology , Humans , Male , Middle Aged , Prevalence , Pseudorabies , Blood , Allergy and Immunology , Virology , Retrospective Studies , Seroepidemiologic Studies , Young Adult
12.
Medwave ; 20(7): e8006, 2020.
Article in English, Spanish | LILACS | ID: biblio-1122649

ABSTRACT

Una de las principales causas de neumonía en niños entre 5 y 15 años es el Mycoplasma pneumoniae, una bacteria que causa manifestaciones clínicas atípicas como la miositis y encefalitis. Reportamos un caso de una niña de cinco años que presentó limitación funcional en extremidades inferiores precedida por una infección respiratoria superior. Posteriormente, se complicó con neumonía y encefalitis. Se administraron antibióticos y antivirales debido al deterioro clínico del paciente. La serología de inmunoglobulinas para Mycoplasma pneumoniae fue positiva; mientras que los demás estudios virales fueron negativos. El curso clínico fue favorable con disminución progresiva de la dificultad respiratoria, trastorno del sensorio y mejoría en la limitación funcional en las extremidades inferiores a los 15 días de tratamiento.


One of the leading causes of pneumonia in children between 5 to 15 years is Mycoplasma pneumoniae, a bacterium that causes atypical clinical manifestations such as myositis and encephalitis. We report a 5-year-old girl who presented functional limitations of the lower extremities preceded by an upper respiratory infection. Later on, she developed pneumonia and encephalitis. Antibiotics and antivirals were administered due to the clinical deterioration of the patient. IgM serology for Mycoplasma pneumoniae was positive, while the other viral studies were negative. The clinical course was favorable with a progressive decrease in respiratory distress, sensorial disorder, and improvement in the functional limitations of the lower limbs after 15 days of treatment.


Subject(s)
Humans , Female , Child, Preschool , Pneumonia, Mycoplasma/diagnosis , Encephalitis/diagnosis , Mycoplasma pneumoniae/isolation & purification , Myositis/diagnosis , Pneumonia, Mycoplasma/microbiology , Pneumonia, Mycoplasma/drug therapy , Acute Disease , Encephalitis/microbiology , Encephalitis/drug therapy , Anti-Bacterial Agents/administration & dosage , Myositis/microbiology , Myositis/drug therapy
13.
Medwave ; 20(7): e7984, 2020.
Article in English, Spanish | LILACS | ID: biblio-1122502

ABSTRACT

Existen limitados reportes de síntomas neurológicos en la población pediátrica con COVID-19. Reportamos el caso de una niña de 13 años con tres días de enfermedad caracterizada por cefalea, vómitos no explosivos, fiebre y trastorno del sensorio de inicio brusco asociado a dificultad para la bipedestación y hemiparesia en extremidades, sin evidencia de signos meníngeos. La tomografía cerebral reveló edema cerebral difuso y el estudio de líquido cefalorraquídeo era concordante con una infección viral. El diagnóstico de COVID-19 fue mediante pruebas serológicas. La paciente tuvo una evolución clínica desfavorable a pesar del tratamiento con hidroxicloroquina, azitromicina y corticoides, falleciendo al tercer día de hospitalización. La encefalitis en un paciente con COVID-19 es una asociación poco descrita en la población pediátrica. Esta infección debe ser considerado como diagnóstico diferencial en los pacientes que llegan a la emergencia con trastorno de sensorio o sintomatología neurológica en el contexto de la actual pandemia.


There are limited reports of neurological symptoms in the pediatric population with COVID-19. We report a 13-year-old girl with three days of illness characterized by headache, non-explosive vomiting, fever, and sudden-onset sensory disorder associated with difficulty in standing and hemiparesis in limbs without evidence of meningeal signs. Brain tomography revealed diffuse brain edema, and the cerebrospinal fluid study was consistent with a viral infection. COVID-19 was diagnosed based on serology. The patient had an untoward clinical course despite treatment with hydroxychloroquine, azithromycin, and corticosteroids, dying on the third day of hospitalization. Encephalitis in a patient with COVID-19 is not frequently reported in the pediatric population. It should be considered in the differential diagnosis in patients who arrives at the emergency with a sensory disorder or neurological symptomatology in the context of the COVID-19 pandemic.


Subject(s)
Humans , Female , Adolescent , Encephalitis/diagnosis , SARS-CoV-2/isolation & purification , COVID-19/complications , Fatal Outcome , Diagnosis, Differential , Encephalitis/virology , Pandemics , COVID-19 Testing , COVID-19/diagnosis , COVID-19/drug therapy
14.
Rev. MED ; 27(2): 113-120, jul.-dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1115233

ABSTRACT

Resumen: La encefalitis por anticuerpos contra el receptor de NMDA es un desorden grave, tratable y potencialmente reversible, caracterizado por la presencia de alteraciones en el comportamiento, convulsiones y trastornos del movimiento. La presencia de anticuerpos contra el receptor del glutamato (anti-NMDA) en plasma o líquido cefalorraquídeo es específico para el diagnóstico de la enferme -dad. El reconocimiento temprano de la enfermedad es vital para el pronóstico del paciente, dado que el manejo precoz facilita la recuperación y reducción de la morbimortalidad. El tratamiento consiste en la utilización de corticoides, inmunoglobulina intravenosa o plasmaféresis como primera línea de terapia; además de otros inmunomoduladores, como ciclofosfamida o rituximab, como segunda línea. La recuperación es lenta, pero presenta mejoría en la medida en que los títulos de anticuerpos disminuyen y llega a una recuperación completa hasta en 75 % de los pacientes.


Abstract: Anti-NMDA receptor encephalitis is a severe, treatable, and potentially reversible disorder characterized by the presence of behavioral disturbances, seizures, and movement disorders. The presence of antibodies against the glutamate receptor (anti-NMDA) in plasma or cerebrospinal fluid is specific to the diagnosis of the disease. Early recognition of the disease is vital for the patient's prognosis since early management facilitates recovery and reduction of morbidity and mortality. Treatment consists of corticosteroids, intravenous immunoglobulin, or plasmapheresis as the first line of therapy, in addition to other immunomodulators, such as cyclophosphamide or rituximab, as the second line. Recovery is slow but improves as antibody titers decrease. Complete recovery occurs in up to 75 % of patients.


Resumo: A encefalite causada por anticorpos contra o receptor NMDA é um distúrbio grave, tratável e potencialmente reversível, caracterizado pela presença de alterações comportamentais, convulsões e transtornos de movimento. A presença de anticorpos contra o receptor de glutamato (anti-NMDA) no plasma ou no líquido cefalorraquidiano é específica para o diagnóstico da doença. O reconhecimento precoce da doença é vital para o prognóstico do paciente, visto que o tratamento precoce facilita a recuperação e a redução da morbimortalidade. O tratamento consiste no uso de corticoides, imunoglobulina intravenosa ou plasmaférese como primeira linha de terapia. Além de outros imunomoduladores, como ciclofosfamida ou rituximabe, como segunda linha. A recuperação é lenta, mas apresenta melhora à medida que os títulos de anticorpos diminuem e a recuperação completa ocorre em até 75% dos pacientes.


Subject(s)
Humans , Female , Child , Anti-N-Methyl-D-Aspartate Receptor Encephalitis , Immunologic Factors , Encephalitis , Encephalitis/drug therapy
16.
Medicina (B.Aires) ; 79(supl.3): 54-59, set. 2019. tab
Article in Spanish | LILACS | ID: biblio-1040551

ABSTRACT

Las encefalitis autoinmunes (EA) se definen como síndromes neurológicos de instalación subaguda de compromiso de conciencia, alteración de la memoria de trabajo y trastornos psiquiátricos frecuentemente asociados a movimientos anormales y crisis epilépticas y que se producen por la acción de anticuerpos anti neuronales específicos que se fijan a receptores de neurotransmisores o proteínas de membrana. El anticuerpo anti NMDAR es el que origina la mayoría de los casos de EA en niños y adultos jóvenes, seguido por el anticuerpo anti LGI1 de presentación en el adulto. Las EA han aumentado en la última década, en la que se ha descrito un gran número de nuevos anticuerpos que producen en su mayoría síndromes neurológicos que involucran al sistema nervioso central, con predominio de signología psiquiátrica, excepto en niños en los que predominan movimientos anormales, crisis epilépticas y compromiso de conciencia. Se asocian frecuentemente a tumores en el adulto pero en los niños esta asociación es más rara. Todas las EA responden a terapia inmunomoduladora aunque en diferente medida según el tipo de anticuerpo involucrado. Generalmente la evolución a la mejoría es lenta y puede completarse en meses o incluso en un año o más. En esta revisión se destaca los principales cuadros de EA relacionados con anticuerpos específicos mencionando también los inmunofenotipos descubiertos recientemente.


Autoimmune encephalitis (AE) is defined as neurological syndromes of subacute installation of compromise of consciousness, alteration of working memory and psychiatric disorders associated with abnormal movements and epileptic seizures and that are produced by the action of anti-neuronal antibodies. They bind to neurotransmitter receptors or membrane proteins. Antibody to NMDAR is the origin of the majority of cases of AD in children and young adults, followed by anti-LGI1 antibody for presentation in adults. The AE has increased in the last decade, with a large number of new agents described that produce mostly neurological syndromes that involve the central nervous system, with predominance of psychiatric signaling, except in children and the predominant abnormal movements, epileptic seizures and compromise of conscience. They are frequently associated with tumors in adults but in children this association is more infrecuent. All AEs respond to immunomodulatory therapy although in different measures depending on the type of antibody involved. In general, the evolution to improvement is slow and can be completed in months or even in one year or more. In this review, the main EA clinical pictures related to specific antibodies are highlighted, also mentioning recently discovered immunophenotypes.


Subject(s)
Humans , Male , Female , Autoantibodies/adverse effects , Encephalitis/diagnosis , Encephalitis/etiology , Hashimoto Disease/diagnosis , Hashimoto Disease/etiology , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/immunology , Encephalitis/classification , Encephalitis/epidemiology , Hashimoto Disease/classification , Hashimoto Disease/epidemiology
17.
Rev. méd. Chile ; 147(7): 922-927, jul. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058622

ABSTRACT

Neurological manifestations associated with influenza virus infection include encephalitis, encephalopathy, acute necrotizing encephalitis, transverse myelitis, acute disseminated encephalomyelitis, mild encephalitis with reversible splenial syndrome (MERS), and Guillaín Barré syndrome. We report a 16-year-old female who was admitted at our emergency department with seizures, confusion, nystagmus and motor clumsiness five days after an upper a respiratory tract infection. Influenza type B virus infection was confirmed by chain polymerase reaction analysis. The initial electroencephalogram demonstrated a pattern of global slowness without epileptic discharges. One week later, it showed a progression to slow-wave focal bilateral discharges at both temporal and occipital lobes. The patient had a favorable evolution and was discharged 19 days after admission with phenytoin to prevent seizures.


Subject(s)
Humans , Female , Adolescent , Influenza B virus/isolation & purification , Encephalitis/virology , Influenza, Human/complications , Electroencephalography , Encephalitis/diagnosis , Influenza, Human/diagnosis , Influenza, Human/virology
18.
Rev. bras. neurol ; 55(2): 33-35, abr.-jun. 2019.
Article in Portuguese | LILACS | ID: biblio-1010041

ABSTRACT

OBJETIVO: Descrever um quadro clínico subagudo pós-infeccioso caracterizado por ataxia de tronco e flutter ocular. RELATO DE CASO: Um homem de 37 anos previamente hígido, pouco após um quadro sistêmico inespecífico que se resolveu espontaneamente, deu início a movimentos involuntários hipercinéticos dos olhos, da cabeça e desequilíbrio importante. Os sintomas evoluíram em poucos dias. Ao exame, apresentava ataxia de tronco e presença de flutter ocular. O líquor mostrou pleocitose discreta. Ressonância magnética (RM) de crânio e exames laboratoriais normais. Houve melhora espontânea e total dos sintomas em cerca de três semanas. CONCLUSÃO: A síndrome de flutter ocular e ataxia de tronco é rara e é destacado a benignidade do quadro.


OBJECTIVE: To describe a post-infectious subacute clinical picture characterized by truncal ataxia and ocular flutter. CASE REPORT: A healthy 37-year-old man, a few days after spontaneously resolved nonspecific systemic disease, initiated involuntary hyperkinetic movements of the eyes, head, and major imbalance. The symptoms progressed within a few days. He presented ataxia of the trunk and presence of ocular flutter. CSF showed pleocytosis. Magnetic resonance of the skull and laboratory tests were normal. There was spontaneous and total improvement of symptoms in about three weeks. CONCLUSION: The ocular flutter syndrome and truncal ataxia is rare and the benignity of the condition is highlighted.


Subject(s)
Humans , Male , Adult , Ataxia/diagnosis , Ocular Motility Disorders/diagnosis , Ocular Motility Disorders/etiology , Ocular Motility Disorders/physiopathology , Infections/complications , Remission, Spontaneous , Follow-Up Studies , Encephalitis
19.
Rev. colomb. psiquiatr ; 48(2): 127-130, ene.-jun. 2019. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1042855

ABSTRACT

RESUMEN La encefalitis asociada a anticuerpos contra el receptor de N-metil-D-Aspartato (NMDAr) es una entidad clínica recientemente descrita con un número creciente de casos reporta dos. Los síntomas psiquiátricos en etapas tempranas de la enfermedad conforman un reto diagnóstico para el médico tratante. Presentamos dos casos clínicos: el caso clínico 1, un hombre de 26 arios y el caso clínico 2, un joven de 18 arios, ambos abordados como primer episodio de psicosis y hospitalizados en instituciones psiquiátricas. Posteriormente, ambos casos fueron diagnosticados como encefalitis anti-NMDAr. La alta prevalencia de síntomas psiquiátricos en la encefalis anti-NMDAr demanda a los médicos psiquiatras y neurólogos a tener un alto índice de sospecha en presencia de síntomas atípicos en pacientes evaluados por primer episodio de psicosis.


ABSTRACT Anti-N-methyl-D-Aspartate receptor (NMDAr) encephalitis is a recently described clinical entity with an increasing number of reported cases. Psychiatric symptoms in the early stages of the disease constitute a diagnostic challenge for the treating physician. We present two clinical cases: clinical case 1, a 26-year-old man, and clinical case 2, an 18-year-old man; both presented with a first episode of psychosis and were hospitalized as psychiatric disorders. Subsequently, both cases were diagnosed as anti-NMDAr encephalitis. The high prevalence of psychiatric symptoms in anti-NMDAr encephalitis forces psychiatrists and neurologists to have a high degree of suspicion in the presence of atypical symptoms in patients evaluated for the first episode of psychosis.


Subject(s)
Humans , Male , Adult , Psychotic Disorders , Anti-N-Methyl-D-Aspartate Receptor Encephalitis , Psychiatry , N-Methylaspartate , Emblems and Insignia , Encephalitis , Neurologists , Mental Disorders , Antibodies
20.
Acta neurol. colomb ; 35(1): 30-35, ene.-mar. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-989195

ABSTRACT

RESUMEN El virus de Epstein Barr (VEB) infecta a cerca del 90 % de las personas en la primera década de vida y, como los demás herpes virus, se mantiene en estado de latencia con riesgo de reactivaciones posteriores. La infección por VEB puede tener un curso asintomático o causar mononucleosis infecciosa (MI), especialmente en adolescentes y adultos. Rara vez, es responsable de infecciones en el sistema nervioso central como encefalitis, cerebelitis, mielitis, neuritis, encefalomielitis aguda diseminada y, más comúnmente, en relación con la infección por el virus de inmunodeficiencia humana (VIH), relacionado con el linfoma primario del sistema nervioso central (SNQ. La encefalitis por VEB no difiere en su presentación clínica de las demás encefalitis virales. Su diagnóstico se realiza mediante detección serológica de anticuerpos de respuesta aguda contra el virus o por reacción en cadena de la polimerasa (PCR) en líquido cefalorraquídeo (LCR). Las opciones terapéuticas en el momento son limitadas y con una baja evidencia de efectividad. A continuación, se presenta el caso de una mujer adulta, inmunocompetente, con clínica de encefalitis aguda severa y marcadas anormalidades en las neuroimágenes. El diagnóstico se hizo mediante la detección de ADN viral en LCR, apoyado por la exclusión de otros agentes patógenos y otras posibles etiologías mediante estudios microbiológicos, patológicos y serológicos.


SUMMARY Epstein Barr virus (EBV) infects about 90 % of people in the first decade of life and, like other herpes viruses, remains dormant with risk of subsequent reactivations. EBV infection can have an asymptomatic course or cause infectious mononucleosis (IM), especially in teenagers and adults. Rarely, it can be responsible for infections in the central nervous system such as encephalitis, cerebellitis, myelitis, neuritis, acute disseminated encephalomyelitis and, more commonly, primary lymphoma of the central nervous system (PLCNS) related to infection by human immunodeficiency virus (HIV). VEB encephalitis does not differ from other viral encephalitis in its clinical presentation. Its diagnosis is performed by serological detection of acute antibody response against the virus or by polymerase chain reaction (PCR) in cerebrospinal fluid (CSF). Treatment options are limited and with a low evidence of effectiveness. We report an unusual case of an immunocompetent mid adult woman, who presented clinically severe acute encephalitis and marked abnormalities in neuroimaging. The diagnosis was made by EBV DNA detection in CSF, supported by the exclusion of the presence of other pathogens and etiologies by microbiological and pathological studies.


Subject(s)
Basal Ganglia , Polymerase Chain Reaction , Herpesvirus 4, Human , Epstein-Barr Virus Infections , Encephalitis
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