ABSTRACT
Introducción: La cerebelitis aguda es una rara afección inflamatoria con curso clínico muy variable: desde proceso autolimitado benigno hasta presentación fulminante con riesgo vital por compresión de fosa posterior, hidrocefalia aguda e hipertensión endocraneal. Métodos: Revisión de los hallazgos clínicos, analíticos y radiológicos de niños diagnosticados de cerebelitis aguda en el periodo comprendido entre mayo del 2007 y noviembre del 2016. Se analizan los tratamientos empleados y la evolución clínica y radiológica. Resultados: Nueve niños cumplían criterios de cerebelitis. La cefalea, los vómitos y la somnolencia fueron los síntomas de presentación más frecuentes; la ataxia, la disartria y la dismetría fueron los signos cerebelosos más frecuentes. La resonancia magnética fue el método diagnóstico mostrando afectación cerebelosa (uni o bilateral), mientras que la tomografía computarizada fue normal o solo mostraba signos indirectos como hidrocefalia triventricular por compresión extrínseca del acueducto de Silvio. Los corticoides fueron el tratamiento más empleado, administrados en 6 de los pacientes. Un paciente requirió intervención quirúrgica por hidrocefalia triventricular. Ocho pacientes tuvieron recuperación completa, mientras que uno presenta déficits neurológicos. Conclusiones: La cerebelitis es una urgencia médico-quirúrgica. Precisa un alto índice de sospecha y la realización de resonancia magnética cerebral urgente. Es un síndrome clínico-radiológico: encefalopatía aguda o subaguda, con hipertensión endocraneal y síndrome cerebeloso junto a hiperintensidad en córtex cerebeloso (uni o bilateral) en secuencias T2 y FLAIR y posible dilatación triventricular. El tratamiento es con corticoides a dosis altas y puede precisar derivación ventricular externa y cirugía descompresiva
Introduction: Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension. Methods: We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression. Results: Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae. Conclusions: Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Central Nervous System Infections/diagnosis , Brain Edema/diagnosis , Hydrocephalus/diagnosis , Intracranial Hypertension/diagnosis , Central Nervous System Infections/complications , Headache/etiology , Ataxia/etiology , Retrospective Studies , Adrenal Cortex Hormones/therapeutic useABSTRACT
INTRODUCTION: Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension. METHODS: We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression. RESULTS: Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae. CONCLUSIONS: Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery.
Subject(s)
Cerebellar Diseases/complications , Cerebellar Diseases/pathology , Cerebellum/pathology , Adrenal Cortex Hormones/therapeutic use , Ataxia , Cerebellar Ataxia , Cerebellar Diseases/diagnostic imaging , Cerebellar Diseases/therapy , Cerebellum/diagnostic imaging , Cerebral Ventricles/diagnostic imaging , Child , Child, Preschool , Encephalitis , Female , Humans , Hydrocephalus , Inflammation , Intracranial Hypertension , Magnetic Resonance Imaging , Male , Tomography, X-Ray ComputedABSTRACT
El carcinoma de páncreas es una neoplasia cada vez más frecuente en nuestro medio, y su elevada tasa de mortalidad apenas ha variado en las dos últimas décadas. Un diagnóstico inicial precoz y una estadificación precisa son primordiales para desarrollar una correcta actitud terapéutica, con el fin de mejorar la supervivencia en aquellos pacientes en los que la resección completa es posible y minimizar la morbimortalidad quirúrgica en pacientes con alto riesgo de enfermedad residual tras la intervención. Existen diversas técnicas de imagen implicadas en la estadificación tumoral: la tomografía computarizada multidetector, la resonancia magnética, la PET-TC, la ecoendoscopia y la laparoscopia diagnóstica. Actualmente, la tomografía computarizada multidetector es la técnica de elección para el estudio de este tipo de neoplasias. Por ello, el propósito de este artículo es revisar el estado actual de la estadificación del adenocarcinoma de páncreas, basándose principalmente en las aplicaciones y limitaciones de esta técnica (AU)
Pancreatic carcinoma is becoming more common in our environment; the mortality rate for this tumor has barely changed over the last 20 years. Early diagnosis and accurate staging are crucial to ensure an appropriate therapeutic approach, which should aim to improve survival in patients in whom complete resection is possible and to minimize surgical morbidity and mortality in those with a high risk of residual disease after the intervention. Various imaging techniques are used for tumor staging: multidetector computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)-CT, endoscopic ultrasound, and diagnostic laparoscopy. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors; thus, this article aims to review the state of the art in staging adenocarcinoma of the pancreas, focusing mainly on the applications and limitations of this technique (AU)
Subject(s)
Humans , Pancreatic Neoplasms/diagnostic imaging , Carcinoma, Pancreatic Ductal/diagnostic imaging , Neoplasm Staging/methods , Multidetector Computed Tomography/methodsABSTRACT
Pancreatic carcinoma is becoming more common in our environment; the mortality rate for this tumor has barely changed over the last 20 years. Early diagnosis and accurate staging are crucial to ensure an appropriate therapeutic approach, which should aim to improve survival in patients in whom complete resection is possible and to minimize surgical morbidity and mortality in those with a high risk of residual disease after the intervention. Various imaging techniques are used for tumor staging: multidetector computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)-CT, endoscopic ultrasound, and diagnostic laparoscopy. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors; thus, this article aims to review the state of the art in staging adenocarcinoma of the pancreas, focusing mainly on the applications and limitations of this technique.
Subject(s)
Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/pathology , Tomography, X-Ray Computed , Humans , Neoplasm Metastasis , Neoplasm Staging , Pancreatic NeoplasmsABSTRACT
No disponible
Subject(s)
Humans , Female , Infant , Intracranial Hemorrhages/etiology , Vitamin K Deficiency Bleeding/complications , Home Childbirth/adverse effectsABSTRACT
Introducción. Las afecciones cerebrovasculares tienen un gran interés en los recién nacidos a término (RNT), siendo poco frecuentes en relación con los pretérmino por ser causa importante de morbimortalidad neonatal, debiéndose considerar ante la aparición de síntomas neurológicos, principalmente convulsiones. Objetivo. Revisar los accidentes cerebrovasculares focales isquémicos o hemorrágicos en RNT par aun mejor conocimiento de estas afecciones en nuestro medio, tratando de identificar posibles factores cáusales y pronósticos. Pacientes y métodos. Se han estudiado retrospectivamente los RNT con diagnóstico de accidente cerebrovascular focal isquémico o hemorrágico y clínica neurológica precoz, ingresados en la dos últimas décadas (enero 1990 a julio 2009) en la sección de Neonatología del Hospital Universitario Miguel Servet de Zaragoza y controlados posteriormente en la policlínica de seguimiento. De cada caso se recogieron antecedentes familiares y personales, gestación, parto, clínica, exploración, estudios complementarios, así como su evolución neurológica. Resultados. De los 21 casos recogidos, 12 fueron infartos de la arteria cerebral media (la mayoría izquierdos) y 9 hemorragias. En 4 casos de hemorragia existía antecedente de traumatismo intraparto y en los restantes no se encontró una causa que los justificara. La mayoría se manifestaron como convulsiones focales asociadas a movimientos sutiles. La neuroimagen fue esencial para el diagnóstico. El déficit motor es la secuela principal, en dos de ellos asociada a déficit cognitivo y epilepsia, siendo en 8 casos el desarrollo psicomotor normal. Conclusiones. Son entidades poco frecuente, desconociéndose su etiología en la mayoría de los casos. La convulsión focal precoz asociada a movimientos sutiles es la manifestación principal y los estudios de neuroimagen son esenciales para el diagnóstico. La evolución neurológica suele ser favorable en la mayoría y las secuelas más importantes son las motoras. No suele existir factores pronósticos (AU)
Introduction. Cerebrovascular diseases are very important in full-term newborns, being rare compared to preterm and it is an important cause of neonatal morbidity, and it must be consider with the appearance before of neurological symptoms, mainly seizures. Objective. The review focal ischemic or hemorrhagic stroke in term newborn to a better understanding of these conditions in our country, trying to identify possible causal factors and prognosis. Patients and Methods. Term newborns with a diagnosis of focal ischemic or hemorrhagic stroke an early neurological symptoms admitted during the last two decades (January 1990 to July 2009) in the section of Neonatology of the University Hospital Miguel Servet in Zaragoza and controlled later in the follow-up clinical have been studied. In each case we collected personal and family history, pregnancy, childbirth, clinical examination, complementary studies and their neurological development. Results. Of the 21 cases reported, 12 were strokes of the middle cerebral artery (most left) and 9 bleeding. In 4 cases there was history of trauma hemorrhage intrapartum and in the raining we did not find a cause. Most appeared as focal seizures associated with subtle movements. The neuroimaging was essential for diagnosis. The motor deficit is the main sequelae, two of them associated with cognitive impairment and epilepsy. With 8 cases having normal psychomotor development. Conclusions. These are rare entities of unknown etiology in most cases. The early focal seizure associated with subtle movements is the main manifestation and neuroimaging studies are essential for diagnosis. The neurological outcome is usually favourable in the majority and the most important sequelaes are motor deficit. There are usually no prognostic factors (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Seizures/etiology , Brain Ischemia/diagnosis , Cerebral Hemorrhage/diagnosis , Cerebral Infarction/diagnosis , Ischemic Attack, Transient/diagnosis , Retrospective Studies , NeuroimagingSubject(s)
Humans , Male , Adolescent , Pneumonia/etiology , Foreign Bodies/complications , Airway Obstruction/etiologyABSTRACT
INTRODUCTION: The progress made in perinatal health care in recent years has changed the epidemiology of neurological diseases during the neonatal period. The reduction in neonatal mortality has been accompanied by an increasingly large number of patients suffering from disabling diseases or with a risk of suffering from them; a prolonged follow-up and the joint efforts of neonatologists and neuropaediatricians are therefore essential. DEVELOPMENT: We review the welfare work and demand for health care for newborn infants with neurological disorders in our service, as well as perinatal neurological morbidity, the functioning of the follow-up outpatients department, and we also report some of the findings from our experience in following up high-risk newborn infants. CONCLUSIONS: The demand for neonatal health care is increasing, and it is important to take this into account so as to be able to plan better strategies for the use of health care resources and for caring for patients. In our population, preterm delivery and asphyxia are the chief perinatal factors leaving neurological sequelae, with an overall incidence that is similar to that reported in other research and a high proportion of severe sequelae. The follow-up programmes must be made cost-effective by better selection of the high risk population to be monitored and coordination with primary care paediatricians. Early detection of the deficits is essential to be able to implement early intervention, and this can be aided by a series of recommendations aimed at professionals and relatives, as well as by improved coordination between the different multidisciplinary groups involved in prevention and care programmes.
Subject(s)
Nervous System Diseases , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant Care/supply & distribution , Infant, Newborn , Male , Nervous System Diseases/complications , Nervous System Diseases/epidemiology , Nervous System Diseases/therapyABSTRACT
Introducción. Los avances producidos en la asistencia perinatal han cambiado la epidemiología de las enfermedades neurológicas durante el período neonatal. Con la disminución de la mortalidad neonatal nos venimos enfrentando a un elevado y creciente número de pacientes afectos de enfermedades discapacitantes o con riesgo de padecerlas, y, por ello, es imprescindible un seguimiento prolongado y la labor conjunta de neonatólogos y neuropediatras. Desarrollo. Revisamos la labor asistencial y demanda de la asistencia del recién nacido neurológico en nuestro servicio, morbilidad neurológica perinatal,funcionamiento de la policlínica de seguimiento, y comunicamos algunos resultados de nuestra experiencia en el seguimiento de neonatos de riesgo. Conclusiones. La demanda de asistencia neurológica neonatal va aumentando, lo que es importanteconocer para una mejor planificación de los recursos sanitarios y la atención de los pacientes. En nuestro medio, la prematuridad y la asfixia son los principales factores perinatales de secuelas neurológicas, cuya incidencia global es similar a la de otros trabajos, con una alta proporción de secuelas graves. Los programas de seguimiento deben ser rentables, a través de una mejor selección de la población de riesgo que se debe controlar y de la coordinación con los pediatras de atención primaria. La detección precoz de las deficiencias es esencial para una intervención temprana, a lo que contribuye una serie de recomendaciones dirigidas a los profesionales y familias, así como una mejor coordinación de los diferentes grupos pluridisciplinarios en los programas de prevención y atención necesaria
Introduction. The progress made in perinatal health care in recent years has changed the epidemiology of neurological diseases during the neonatal period. The reduction in neonatal mortality has been accompanied by an increasingly large number of patients suffering from disabling diseases or with a risk of suffering from them; a prolonged follow-up and the jointefforts of neonatologists and neuropaediatricians are therefore essential. Development. We review the welfare work anddemand for health care for newborn infants with neurological disorders in our service, as well as perinatal neurological morbidity, the functioning of the follow-up outpatients department, and we also report some of the findings from our experience in following up high-risk newborn infants. Conclusions. The demand for neonatal health care is increasing, and it is important to take this into account so as to be able to plan better strategies for the use of health care resources and forcaring for patients. In our population, preterm delivery and asphyxia are the chief perinatal factors leaving neurological sequelae, with an overall incidence that is similar to that reported in other research and a high proportion of severe sequelae. The follow-up programmes must be made cost-effective by better selection of the high risk population to be monitored and coordination with primary care paediatricians. Early detection of the deficits is essential to be able to implement earlyintervention, and this can be aided by a series of recommendations aimed at professionals and relatives, as well as by improved coordination between the different multidisciplinary groups involved in prevention and care programmes
