ABSTRACT
Se describe el caso de un paciente de 19 años que ingresó en Urgencias de nuestro hospital con un cuadro de movimientos disautonómicos y desconexión del medio tras ingesta de anfetamina 4 días antes, evolucionando a un síndrome catatónico y finalmente a estatus epiléptico. El diagnóstico definitivo fue encefalitis por anticuerpos antirreceptores de NMDA, una inflamación límbica aguda de origen autoinmune en la que el diagnóstico y el tratamiento tempranos son clave en el pronóstico. En el caso descrito, las pruebas iniciales normales y el antecedente de intoxicación por metanfetamina hicieron que el diagnóstico se viera retrasado, pues la intoxicación por metanfetamina inhalada produce una clínica similar. Adicionalmente, esta intoxicación podría haber producido un estado inmunitario sobre el paciente y favorecer el desarrollo de la enfermedad (AU)
A 19-year-old male came to the Emergency Room of our hospital due to an episode of dystonic movements and disorientation 4 days after consuming methamphetamine, which evolved to a catatonic frank syndrome and eventually to status epilepticus. Definitive diagnosis was anti-NMDA receptor encephalitis, an acute inflammation of the limbic area of autoimmune origin in which early diagnosis and treatment are key elements for the final outcome. In this case, initial normal tests and previous methamphetamine poisoning delayed diagnosis, because inhaled-methamphetamine poisoning causes similar clinical symptoms to anti-NMDA receptor encephalitis. Methamphetamine poisoning may have caused an immune response in the patient, bringing on the progress of the pathology (AU)
Subject(s)
Humans , Male , Adult , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/drug therapy , Anti-N-Methyl-D-Aspartate Receptor Encephalitis , Diagnosis, Differential , Limbic Encephalitis/chemically induced , Limbic Encephalitis/complications , Paranoid Disorders/chemically induced , Paranoid Disorders/complications , Nervous System Diseases/complications , Nervous System Diseases/drug therapy , Neuroimmunomodulation , Methamphetamine/adverse effects , Methamphetamine/toxicity , Biomarkers, Tumor/analysis , Electroencephalography , Electroencephalography/methodsABSTRACT
A 19-year-old male came to the Emergency Room of our hospital due to an episode of dystonic movements and disorientation 4 days after consuming methamphetamine, which evolved to a catatonic frank syndrome and eventually to status epilepticus. Definitive diagnosis was anti-NMDA receptor encephalitis, an acute inflammation of the limbic area of autoimmune origin in which early diagnosis and treatment are key elements for the final outcome. In this case, initial normal tests and previous methamphetamine poisoning delayed diagnosis, because inhaled-methamphetamine poisoning causes similar clinical symptoms to anti-NMDA receptor encephalitis. Methamphetamine poisoning may have caused an immune response in the patient, bringing on the progress of the pathology.
Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Methamphetamine/poisoning , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/etiology , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/immunology , Anticonvulsants/therapeutic use , Autoantibodies/cerebrospinal fluid , Benzodiazepines/therapeutic use , Catatonia/etiology , Catatonia/therapy , Delayed Diagnosis , Diagnosis, Differential , Diagnostic Errors , Diazepam/therapeutic use , Electroconvulsive Therapy , Emergencies , Epilepsies, Partial/chemically induced , Epilepsies, Partial/diagnosis , Hallucinations/drug therapy , Hallucinations/etiology , Humans , Infectious Encephalitis/diagnosis , Male , Olanzapine , Poisoning/diagnosis , Poisoning/immunology , Receptors, N-Methyl-D-Aspartate/immunology , Status Epilepticus/drug therapy , Status Epilepticus/etiology , Young AdultABSTRACT
Se estudia la derivación a rehabilitación de pacientes afectos de algias y entesopatías directamente desde atención primaria (AP) o a través del servicio de traumatología, con el objetivo de comparar el tiempo de espera tras la derivación directa desde el médico de AP a rehabilitación, con derivación indirecta (DI), esto es, llegar a rehabilitación tras haber pasado por consulta de traumatología y analizar qué aporta la consulta de traumatología, además del aumento en la demora. El objetivo último de este trabajo es comparar la efectividad de las derivaciones. Material y métodos. Se seleccionan 787 pacientes remitidos a rehabilitación entre julio de 2007 y julio de 2008 por patología del aparato locomotor, que se agrupan en dos categorías, 239 corresponden a procesos cuya derivación a través de traumatología es incuestionable y 548 que llamamos «algias y entesopatías». Material y métodos. De esas 548, un 66% proceden de traumatología (DI) y un 34% han sido derivadas directamente desde AP. Material y métodos. Se describen las características de los pacientes y se analiza qué le aporta la consulta de traumatología a los de DI. Resultados y conclusión. La derivación directa desde AP a rehabilitación para algias y entesopatías puede contribuir a evitar demoras innecesarias y consultas duplicadas (AU)
We studied the referral to rehabilitation of patients affected by joint pain and enthesophatiy directly from Primary Care or by an orthopaedist. The aim of the study is to compare waiting times following direct referral from a primary care physician to rehabilitation, with those following indirect referral, that is, arriving at Rehabilitation after orthopaedist consultation. We also studiet the orthopaedist consultation contribution apart from increased delay. The goald of this paper is to seek improved effectiveness of referral. Material and methods. We selected 787 patientes referred to Rehabilitation between July 2007 and July 2008 due to musculoskeletal pathology. These were then grouped into two categories, 239 related to patients whose referral via orthopaedist is irrefutable, and 548 wich we call "Joint and Enthesophaty". Of these 548, 66% came from orthopaedist (Indirec referral) and 34% were referred directly from Primary Care. Material and methods. We described the patients charactheristics and discussed the orthopaedist consultation contribution to those patients who were indirectly referred. Results and conclusion. Direct referral from Primary care to Rehabilitation for Joint Pain and Enthesophaty can help avoid unnecessary delais and duplicateds consultation (AU)
