ABSTRACT
Entre as bactérias Gram-negativas, o Acinetobacter sp tornou-se um importante patógeno hospitalar, devido ao aumento do número de cepas multi-resistentes. Esta espécie é responsável por um número crescente de infecções pósoperatórias caracterizadas por alta mortalidade. A ocorrência de bactérias Gram-negativas multirresistentes levou a um aumento no número de infecções do sistema nervoso central. Em particular, a ocorrência de bactérias resistentes à cefalosporinas de quarta geração e carbapenênicos resultou em uma redução significativa de opções terapêuticas para o tratamento destas infecções. Acinetobacter baumannii é um importante agente hospitalar e sua resistência aos antibióticos mais modernos aumenta a cada dia, o que é uma grave ameaça aos pacientes infectados. Descrevemos um caso de um paciente submetido a neurocirurgia e colocação de derivação ventricular externa evoluindo com ventriculite por Acinetobacter baumannii resistente a cefalosporinas de quarta geração e meropenem.
Subject(s)
Acinetobacter baumannii , Acinetobacter InfectionsABSTRACT
OBJECTIVE: To describe published cases of cerebral mansoni schistosomiasis and three others and discuss the diagnosis and treatment of cerebral pseudotumoral schistosomiasis. CASE DESCRIPTIONS: In case 1, a 20-year-old man presented with occipital headache, intense dizziness, visual alterations, nausea, decreased appetite, and asthenia. Cranial computed tomography (CT) revealed an expansive cerebellar lesion in the right hemisphere with no contrast enhancement. The patient had complete resection of the lesion. Anatomicopathological examination revealed a schistosomal granuloma. In case 2, a 22-year-old man presented with generalized tonic-clonic seizure. Cranial CT and magnetic resonance imaging (MRI) revealed an expansive bilateral middle frontal lesion, with contrast uptake close to the cingulate gyrus and corpus callosum. The patient underwent left frontal craniotomy, and an interhemispheric approach was used to resect part of the lesion. In case 3, a 32-year-old man presented with generalized tonic-clonic seizures. Cranial CT showed a hyperdense intense intracranial expansive lesion that presented contrast uptake in the left temporal region. The patient had complete resection of the lesion. CONCLUSIONS: A surgical approach with lesion resection or stereotaxic biopsy is warranted to determine the diagnosis definitively. Antiparasitic drugs must be administered to complete treatment.
Subject(s)
Pseudotumor Cerebri/surgery , Schistosomiasis mansoni/surgery , Adult , Anticonvulsants/therapeutic use , Brain/diagnostic imaging , Brain/parasitology , Cerebellum/diagnostic imaging , Cerebellum/surgery , Craniotomy , Epilepsy, Tonic-Clonic/etiology , Frontal Lobe/pathology , Frontal Lobe/surgery , Granuloma/pathology , Humans , Magnetic Resonance Imaging , Male , Neurosurgical Procedures , Praziquantel/therapeutic use , Pseudotumor Cerebri/diagnostic imaging , Pseudotumor Cerebri/parasitology , Schistosomiasis mansoni/diagnostic imaging , Schistosomiasis mansoni/parasitology , Schistosomicides/therapeutic use , Tomography, X-Ray Computed , Young AdultABSTRACT
BACKGROUND: Pituicytomas originate from pituicytes, modified glial cells derived from ependymal lineage that are found in the stalk and posterior lobe of pituitary gland. The clinical presentation is similar to other pituitary tumors and imaging exams may suggest pituitary adenoma. The diagnostic is based on histopathological analysis. Surgical treatment can be performed by transsphenoidal approach with good results. The prognostic is good after total tumor resection. CASE DESCRIPTION: We describe here the case of a 17-year-old patient with a history of persistent headache and visual disturbances. Magnetic resonance imaging demonstrated an enhancing solid sellar mass suggestive of pituitary adenoma. The intrasellar mass was resected through a transsphenoidal approach and the diagnosis of pituicytoma was made after histopathological analysis. CONCLUSION: Pituicytomas are rare tumors of the neurohypophysis derived from pituicytes. Their clinical presentation resembles that of non-functional pituitary adenomas, but these two types of tumors are histologically well distinct.
ABSTRACT
Aspergilose do sistema nervoso central (SNC) é uma doença rara. O uso de corticosteróides tem elevado o número de casos na atualidade. Trata-se de uma doença com uma elevada taxa de letalidade e deve ser tratada de forma agressiva.Métodos: A literatura foi revisada, sendo identificados 38 casos envolvendo aneurismas cerebrais causadas por Aspergillus.Conclusão: A infecção por Aspergillus é muito rara no mundo, mas sua frequência vem se elevando porque a falha de imunocompetência está crescendo. Não há uma apresentação específica desta doença, tornando o diagnóstico muito difícil.O prognóstico é ruim, portanto a doença deve ser tratada precocemente.
Subject(s)
Humans , Male , Female , Aneurysm, Infected , Aspergillus fumigatus , Intracranial AneurysmABSTRACT
OBJECTIVE: To determine the causes of early shunt complications in 46 children with hydrocephalus. METHOD: A retrospective study was conducted on 46 children submitted to ventriculoperitoneal shunt surgery between February 2005 and February 2007. RESULTS: Thirteen (28%) patients presented complications, which were due to infection in 9 (69%) and to malfunction of the shunt system in 4 (31%).The mean number of surgical procedures performed on patients who presented complications was 2.8 per patient, with a total of 46 surgeries in this group. All patients with infectious complications were identified during their hospital stay. CONCLUSIONS: Infection was the most common complication. The infection rate was proportional to the length of hospital stay. All patients with hydrocephalus due to tumors or myelomeningocele presented complications. A higher incidence of infections was observed in children older than 2 years.
Subject(s)
Hydrocephalus/surgery , Ventriculoperitoneal Shunt/adverse effects , Child , Child, Preschool , Female , Humans , Male , Postoperative Complications , Retrospective StudiesABSTRACT
OBJECTIVE: To determine the causes of early shunt complications in 46 children with hydrocephalus. METHOD: A retrospective study was conducted on 46 children submitted to ventriculoperitoneal shunt surgery between February 2005 and February 2007. RESULTS: Thirteen (28 percent) patients presented complications, which were due to infection in 9 (69 percent) and to malfunction of the shunt system in 4 (31 percent).The mean number of surgical procedures performed on patients who presented complications was 2.8 per patient, with a total of 46 surgeries in this group. All patients with infectious complications were identified during their hospital stay. CONCLUSIONS: Infection was the most common complication. The infection rate was proportional to the length of hospital stay. All patients with hydrocephalus due to tumors or myelomeningocele presented complications. A higher incidence of infections was observed in children older than 2 years.
OBJETIVO: Determinar e as causas das complicações precoces nas válvulas de hidrocefalia de 46 crianças. MÉTODO: Um estudo retrospectivo foi realizado com 46 crianças submetidas a colocação de válvula de hidrocefalia no período de fevereiro de 2005 a fevereiro de 2007. RESULTADOS: Obtivemos 13 (28 por cento) pacientes com complicações sendo 9 (69 por cento) causadas por infecção e 4 (31 por cento) por mal funcionamento da válvula de hidrocefalia. A média de procedimentos cirúrgicos realizados nos pacientes com complicações foi de 2,8 por paciente, sendo o total de 46 cirurgias neste grupo. Todos os pacientes com complicações infecciosas foram detectados durante a internação hospitalar. CONCLUSÕES: Infecção foi a complicação mais comum. O índice de infecção foi proporcional ao tempo de permanência hospitalar. Todos os pacientes portadores de hidrocefalia secundária a tumores ou mielomeningocele complicaram. As crianças maiores de 2 anos de idade tiveram maior incidência de infecções.
