ABSTRACT
RESUMEN La paracoccidioidomicosis (PMC) es una micosis endémica que afecta a diferentes regiones de América Central y América del Sur. Esta enfermedad es causada por el Paracoccidioides brasiliensis y por el Paracoccidioides lutzii. Su presentación clínica puede ser aguda, subaguda o crónica y afectar a diversos sistemas, incluido el sistema nervioso central. El compromiso pulmonar y el de mucosa suelen ser los más comunes. La neuroparacoccidioidomicosis (NPCM) se presenta hasta en un 25 % de los pacientes con PMC y puede ser clasificada como meníngea o pseudotumoral. Sus síntomas neurológicos pueden ir desde cefalea hasta déficit motor, dependiendo de la localización. El estudio del líquido cefalorraquídeo es inespecífico y el aislamiento microbiológico es muy raro. Las lesiones observadas en neuroimágenes pueden confundirse con otras infecciones micóticas o incluso tumores. El estudio histológico permite confirmar el diagnóstico. Para el tratamiento de la NPCM se puede utilizar trimetoprim-sulfametaxazol, anfotericina B y fluconazol. Algunos casos pueden requerir manejo quirúrgico.
SUMMARY Paracoccidioidomycosis (PMC) is an endemic mycosis that affects different regions of Central and South America. This disease is caused by Paracoccidioides brasiliensis and Paracoccidioides lutzii. Its clinical presentation can be acute, subacute or chronic, affecting different systems including the central nervous system. Lung and mucosal involvement are the most common. Neuroparacoccidioidomycosis (NPCM) occurs in 25 % of patients with PMC, it can be classified as meningeal or pseudotumoral form. Its neurological symptoms can present as headache or motor deficit, that depends on the location. The study of cerebrospinal fluid is nonspecific and microbiological isolation is very rare. Lesions seen on neuroimaging can be confused with other fungal infections or even tumors. Histological study confirms the diagnosis. Trimethoprim-sulfamethaxazole, amphotericin B, and fluconazole can be used for the treatment of NPCM. Some cases may require surgical management.
Subject(s)
Transit-Oriented DevelopmentABSTRACT
Introducción: El síndrome de limb-shaking o sacudida de extremidades como presentación de un ataque isquémico transitorio es raro y suele asociarse con estenosis de las arterias carótidas internas. El principal diagnóstico diferencial es con crisis convulsivas. Presentación del caso: presentamos el caso de un paciente con estenosis carotídea intracraneal bilateral que cursó con sacudidas en extremidades y tuvo mejoría clínica satisfactoria tras un procedimiento con stent.
Limb-shaking syndrome or involuntary shaking movements of the affected limbs as a manifestation of a transient ischemic attack is rare and often is associated with internal carotid artery stenosis. The main differential diagnosis is a convulsive seizure. We present the case of a patient with bilateral intracranial carotid artery stenosis presenting as limb shaking syndrome, showing satisfactory clinical improvement after undergoing stent revascularization.
Subject(s)
Humans , Male , Aged , Carotid Stenosis , Ischemic Stroke , Stents , Ischemic Attack, Transient , Stroke , DyskinesiasABSTRACT
RESUMEN El trauma craneoencefálico suele estar acompañado por cefalea, con una prevalencia que varía entre 30 y 90 %. La cefalea postraumàtica representa una condición altamente incapacitante, parece tener una mayor relación con traumatismos leves y se subdivide en cefalea aguda y persistente. Sus características clínicas son similares a la cefalea tipo migraña y tipo tensional, con algunos detalles diferenciales. Varios mecanismos fisiopatológicos se han visto involucrados y esto podría explicar los diferentes fenotipos que presenta. El diagnóstico se basa en los síntomas y los criterios establecidos. Se presenta un caso clínico de cefalea postraumàtico manejado en el servicio de urgencias con el cual se busca profundizar en los aspectos clínicos y terapéuticos de esta entidad.
SUMMARY Traumatic brain injury is frequently accompanied by headache, the prevalence is variable from 30-90 %. Posttraumatic headache represents a highly disabling condition, could be more related to mild injury, and is classified as acute or persistent headache. The clinical characteristics are similar to migraine-type headache and tension-type headache, with some differential details. Different pathophysiological mechanisms have been involved, this could explain the different phenotypes. Diagnosis is based on symptoms and specific criteria. Below we present a clinical case of post-traumatic headache managed in the emergency department with which we seek to delve into the clinical and therapeutic aspects of this disease.
Subject(s)
Transit-Oriented DevelopmentABSTRACT
Myasthenia gravis is a neuromuscular autoimmune disease characterized by fatigable weakness of skeletal muscles that results from an antibody-mediated immunological attack directed at acetylcholine postsynaptic receptors. Autologous hematopoietic stem cell transplantation is considered as a treatment option in refractory cases of myasthenia gravis. A 56-year-old Colombian male presented with six months of progressive hoarseness and dysphagia, with a positive repetitive stimulation test suggestive of end plate neuromuscular disease. Myasthenia gravis was confirmed with serology testing that reported presence of circulating acetylcholine postsynaptic receptors antibodies. The patient received several lines of pharmacological treatment and thymectomy without control of symptoms, requiring admission to the intensive care unit and mechanical ventilation in two occasions. Patient underwent autologous hematopoietic stem cell transplantation and has been in complete clinical remission for 65 months. Hematopoietic stem cell transplantation is a well-tolerated treatment that should be considered over conventional therapy in selected patients with refractory myasthenia gravis.
Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Myasthenia Gravis/therapy , Autoantibodies , Humans , Male , Middle Aged , Myasthenia Gravis/immunology , Myasthenia Gravis/surgery , Receptors, Cholinergic/immunology , Thymectomy , Transplantation, Autologous , Treatment OutcomeABSTRACT
AIM: To assess the performance of the Finnish Diabetes Risk Score (FINDRISC) questionnaire for detecting and predicting type 2 diabetes mellitus (DM2) in a Colombian population. METHODS: This is a longitudinal observational study conducted in Floridablanca, Colombia. Adult subjects (age ≥ 35 years) without known diabetes, were included. A modified version of FINDRISC was completed, and the glycemia values from all the subjects were collected from the hospital's database. Firstly, a cross-sectional analysis was performed and then, the subsample of prediabetic participants was followed for diabetes incidence. RESULTS: A total of 772 subjects were suitable for the study. The overall prevalence of undiagnosed DM2 was 2.59%, and the incidence of DM2 among the prediabetic participants was 7.5 per 100 person-years after a total of 265257 person-years follow-up. The FINDRISC at baseline was significantly associated with undiagnosed and incident DM2. The area under receiver operating characteristics curve of the FINDRISC score for detecting undiagnosed DM2 in both men and women was 0.7477 and 0.7175, respectively; and for predicting the incidence of DM2 among prediabetics was 71.99% in men and 67.74% in women. CONCLUSION: The FINDRISC questionnaire is a useful screening tool to identify cross-sectionally unknown DM2 and to predict the incidence of DM2 among prediabetics in the Colombian population.
