Cerebrospinal Fluid Infection with External Ventricular Drainage: Analysis of the Risk Factors in 110 Patients of a Single Institution

Objectives External ventricular drainage (EVD) is extensively used in the neurosurgical practice with the purpose of monitoring the intracranial pressure and draining the cerebrospinal fluid (CSF). Despite its remarkable benefits, the technique is not devoid of risks, notably infections, which have been reported in up to 45% of the cases. Methods A retrospective analysis of the main risk factors for CSF infection in neurosurgical patients submitted to EVD at a single institution. We recorded and submitted to statistical comparison every risk factor for CSF infection present or absent in each of the 110 EVD patients enrolled, 53 males and 57 females, with an average age of 52.9 years, with different underlying neurosurgical conditions. Results Infection of the CSF occurred in 32 patients (29%). The rate of mortality related to CSF infection was of 18.7% (6 of 32). The risk factors that showed statistical significance for CSF infection in this series were: emergency surgery; length of stay at the intensive care unit (UCI); duration of the EVD; parenchymal and/or intraventricular hemorrhage; simultaneous infections; time of bladder catheterization; and the use of non-disposable adhesive drapes as part of the preparation of the wound area. Conclusions Infection of the CSF in patients submitted to EVD is multifactorial and a challenge in terms of prevention. Further studies proposing scores with blended risk factors may be useful to prevent and reduce the morbidity and mortality associated with CSF infection.

Infecciones en pacientes con tumores sólidos de sistema nervioso central y de cabeza y cuello / Infections in patients with solid tumors of the central nervous system and head and neck

Los tumores sólidos representan el 90% de las patologías oncohematológicas que se diagnostican en Argentina. Las infecciones son una de las complicaciones más frecuentes, causando una importante morbimortalidad, y en muchos casos retrasan la prosecución de los tratamientos específicos. La incidencia y tipo de infección depende del sitio específico del tumor, los fenómenos post obstructivos, el tipo e intensidad del tratamiento que se administre, las comorbilidades del paciente y la epidemiología local, entre otros factores. En forma constante se van incorporando nuevos tratamientos al arsenal terapéutico, tales como nuevos esquemas de quimioterapia, terapias blanco e inmunoterapia, y el manejo de las complicaciones asociadas a los mismos representa un desafío para el equipo tratante.En esta revisión abordamos la epidemiología, prevención y manejo de las complicaciones infecciosas más frecuentes en los pacientes con tumores de sistema nervioso central y de cabeza y cuello

Solid tumours represent 90 percent of the oncohematologic pathologies diagnosed in Argentina. Infections are one of the most frequent complications causing important morbidity and mortality and delay in prosecution of their specific treatment. The type of infection depends on the specific site of the tumour, the presence of post obstructive phenomena, the treatment administered, comorbidity and local epidemiology, among others. New therapies are being continuously incorporated to the armamentarium of cancer treatment such as new chemotherapies regimes, target therapy and immunotherapy. The management of adverse events and infectious complications associated with them are a challenge for the physician in charge of these patients.The epidemiology, prevention and management of the most frequent infectious complications in patients with tumours of the central nervous system and head and neck are reviewed in this paper

Management of status epilepticus.

Status epilepticus is a medical emergency, if not treated in time and effectively may cause significant mortality and morbidity. Medical therapy has been the mainstay of treatment but in refractory status surgical resection, multiple subpial transection, electroconvulsive therapy, caudate stimulation and acupuncture play important role. The present operational definition for adults and older children considers status as > or = 5 minutes of continuous seizure or two or more discrete seizures without regaining of full consciousness. Status epilepticus accounts for 1-8% of all hospital admissions for epilepsy. Physiological changes in generalised convulsive status epilepticus include transient or early (0-30 minutes) and late (after 30 minutes) changes. Temporal changes occur as tonic-clonic status epilepticus progresses. Management can be considered in two ways--out hospital management and inpatient management. Benzodiazepine is considered 1st line of treatment outside hospital. Emergency/inpatient management includes basic life support (0-10 minutes) and pharmacological management (10-60 minutes). Drugs used in pharmacological management are lorazepam, midazolam, propofol, phenobarbital, phenytoin, fosphenytoin, i.v. valproate, rectal diazepam, etc. The classical definition of refractory status epilepticus includes seizure that has not responded to sequential treatment of lorazepam, phenytoin or phenobarbitone or seizure continuing > 60-90 in spite of adequate treatment.

Rhinocerebral mucormycosis in a pregnant woman with diabetic ketoacidosis.

Rhinocerebral mucormycosis (RCM) is a rare but often fatal condition characterized by aggressive necrotizing infection originating from nose and spreading to paranasal sinuses, orbit and central nervous system. Although Fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate fulminant infections in patients with underlying debilitating conditions. A case of RCM in a pregnant woman with diabetic keto-acidosis successfully treated by supportive care, amphotericin B and surgery is reported.

Sordera Central y Emisiones Otoacusticas: reporte de Tres Casos / Otoacustic emissions in central deafness: report of three cases

Propósito. Reportar tres pacientes con sordera adquirida y emisiones otoacústicas evocadas (EOAsPD) normales. Hallazgos. Caso 1. Niño de 7 años, después de infección cerebelosa viral presentó sordera con logoaudiometría (LA) en cero de captación y umbrales tonales (UT) planos, 64 dB promedio (oído derecho) y 74 (oído izquierdo). Timpanometría normal, no aparecieron reflejos estapediales (RE) ni potenciales evocados de tallo (PETC). Estudios de imagen inaccesibles. Emisiones otoacústicas por productos de distorsión normales. Caso 2. Hombre de 34 años con trauma cráneo-encefálico (TCE) en la infancia con crisis epilépticas como secuela. En 1996 sufrió "cirugía de epilepsia" quedando con incapacidad para la comunicación verbal. La LA mostró 0 de captación, los UT (simétricos) presentaban pérdida promedio de 26 dB hasta 2000 Hz, con caída subsecuente hasta 95 dB. Timpanometría (TM) y RE normales. PETC anormales. Estudios de imagen inaccesibles. EOAsPD normales. Caso 3. Mujer de 21 años, con TCE 5 años antes, en coma 4 meses, se recuperó con ataxia y sordera. LA 0 de captación, UT esencialmente planos promediaban 90 dB (oído derecho) y 78 (izquierdo). TM normal bilateral. RE ipsilaterales en oído derecho a 100 dB. 1, 3 y 4 Khz; en izquierdo, solo a 100 dB, 3 y 4 Khz. Los PETC mostraron solamente ondas I. Los estudios de imagen mostraron múltiples cicatrices pequeñas de tipo vascular en el tallo cerebral y en el cerebelo. Un estudio video-electro-nistagmográfico mostró daño central a los reflejos opto-vestíbulo-oculomotores. Las (EOAsPD)fueron normales

Mielopatia em pacientes com Síndrome de imunodeficiência Adquirida / Myelopathy in a patient with the acdquired immunodeficiency syndrome

Alteraçöes neurológicas säo freqüentes causa de morbidade e mortalidade na Síndrome da Imunodeficiência Adquirida (SIDA). Na maioria dos casos em adultos, doença neurológica aparece quando já há manifestaciones sistêmicas. Contudo, estas podem ser a apresentaçäo inicial ou o único iondicativo da presença da SIDA. Doenças neurológicas causadas diretamente pelo vírus da imunodeficiência humana (HIV) no sistema nervoso central (SNC) säo a meningite asséptica, a demência relacionada a SIDA e, possivelmente, uma mielopatia vacuolar que ocorre em aproximadamente 30% dos pacientes. Os autores apresentam um caso de mielopatia em um paciente sem sintomas sistêmicos e com infecçäo comprovada pelo HIV