ABSTRACT
Cerebrovascular accident in young adults is not rare and the most common causes are: cardiac embolism, arterial dissection and migraine. The unknown etiology, in spite of extensive studies, is described in the literature in about one third of patients under 45 years of age. The mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) may occur with symptoms that simulate a stroke. The <
Subject(s)
Critical Care/methods , Intensive Care Units , MELAS Syndrome/diagnosis , MELAS Syndrome/rehabilitation , Adolescent , Diagnosis, Differential , Hospitalization , Humans , MaleABSTRACT
El accidente cerebrovascular en adultos jóvenes no es infrecuente y las causas más comunes son la embolia cardíaca, la disección arterial y la migraña. La etiología desconocida, a pesar de estudios exhaustivos, está descrita en la literatura en aproximadamente un tercio de los pacientes menores de 45 años. El síndrome de encefalopatía mitocondrial, acidosis láctica y episodios stroke-like (MELAS) puede presentarse con síntomas que simulan un ictus. Los episodios stroke-like generalmente afectan a la parte posterior del cerebro y los mecanismos básicos del insulto pueden ser metabólicos más que isquémicos. Describimos el caso de un paciente de 18 años que ingresó en la Unidad de Cuidados Intensivos debido a un cuadro brusco de ceguera. El estudio oftalmológico fue normal y los estudios de neuroimagen mostraron infartos en ambos lóbulos occipitales. Exponemos los diferentes aspectos clínicos, métodos diagnósticos, terapéuticos y pronóstico de la enfermedad
Cerebrovascular accident in young adults is not rare and the most common causes are: cardiac embolism, arterial dissection and migraine. The unknown etiology, in spite of extensive studies, is described in the literature in about one third of patients under 45 years of age. The mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) may occur with symptoms that simulate a stroke. The «stroke-like» episodes generally affect the posterior part of the brain and the basic insult mechanisms may be metabolic more than ischemic. We describe the case of an 18-year old patient who was admitted to the Intensive Care Unit due to a sudden picture of blindness. The ophthalmologic study was normal and the neuroimaging studies showed infarction in both occipital lobules. We explain the different clinical features, diagnostic, therapeutic and prognostic methods of the disease
Subject(s)
Humans , Male , Adolescent , Critical Care/methods , Stroke/diagnosis , MELAS Syndrome/diagnosis , Diagnosis, Differential , Mitochondrial Encephalomyopathies/diagnosisABSTRACT
No disponible
No disponible
Subject(s)
Female , Aged , Humans , Pneumonia, Mycoplasma/complications , Respiratory Distress Syndrome/etiologySubject(s)
Pneumonia, Mycoplasma/complications , Respiratory Distress Syndrome/etiology , Aged , Female , HumansABSTRACT
No disponible
Subject(s)
Male , Middle Aged , Humans , Aortic Aneurysm/complications , Aortic Aneurysm/diagnosis , Aortic Aneurysm/surgery , Ischemia/complications , Ischemia/diagnosis , Ischemia/surgery , Thiopental/administration & dosage , Thiopental/therapeutic use , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/diagnosis , Magnetic Resonance Spectroscopy , Risk Factors , Intraoperative Complications/diagnosis , Intraoperative Care/standards , Paraplegia/complications , Paraplegia/epidemiology , Paraparesis, Tropical Spastic/complications , Paraparesis, Tropical Spastic/epidemiology , Barbiturates/administration & dosage , Barbiturates/therapeutic useABSTRACT
Presentamos el caso de una paciente con hemorragia subaracnoidea espontánea, secundaria a rotura de un aneurisma de la arteria cerebral media derecha, que presentó alteraciones electrocardiográficas sugestivas de isquemia, acompañadas además de anomalías segmentarias de la contractilidad ventricular izquierda, que se observaron en el estudio ecocardiográfico. La monitorización eléctrica, hemodinámica y ecocardiográfica puso de manifiesto que ambas alteraciones fueron transitorias, y se recuperaron espontáneamente y sin ocasionar en ningún momento arritmias, elevación de enzimas cardíacas por encima del rango normal ni inestabilidad hemodinámica.La paciente fue tratada de su proceso cerebral y su pronóstico vino determinado por dicha lesión (AU)
Subject(s)
Female , Middle Aged , Humans , Intracranial Aneurysm/complications , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/physiopathology , Heart Ventricles/physiopathology , Electrocardiography , EchocardiographyABSTRACT
The causes of malnutrition in chronic terminal kidney failure are reviewed in the situation both before and after dialysis, as are the malnutrition rates in both circumstances and their treatment. Malnutrition has a high prevalence in terminal kidney patients, partly as a result of the therapeutic restriction on calories and proteins, but also due to the metabolic reactions typical of the disease and to anorexia. In patients subjected to dialytical methods, certain other mechanisms are added. In addition to malnutrition, there are alterations in the metabolism of calcium, phosphorus and potassium, as well as lipids, thus limiting nutritional therapy's ability to restore the nutritional status to normal. An awareness of energy expenditure in chronic terminal kidney failure and the consequences of malnutrition have led to new challenges in nutritional therapy, both in the dose and quality of the proteins, with a debate raging over the advantages of ketoanalogues, and also in the methods for providing nutrients. The ideal nutritional method for repletion is oral administration, but this can be enhanced with artificial support such as oral supplements, parenteral nutrition during dialysis or such alternatives as enteral nutrition at home in the case of chronic kidney problems in children, using percutaneous endoscopic gastrostomy (PEG), in order to nourish the patients and minimize growth disorders.
