ABSTRACT
Background: Acute disseminated encephalomyelitis is an autoimmune and demyelinating disease. It is rare in adults. It has 3 main variants. One of them is Weston-Hurst syndrome, also called acute hemorrhagic leukoencephalitis. The objective was to share the experience in the diagnostic and therapeutic approach of this rare disease, as well as make a review of the current bibliography, in order to collaborate in the knowledge of this disease. Clinical case: 27-year-old woman, with a viral respiratory infection 2 weeks prior to the development of a neurological syndrome characterized by paresthesia, motor deficit, status epilepticus and acute encephalopathy, progressing rapidly to coma, with evidence in MRI of diffuse hemorrhagic lesions in cerebral white matter with demyelination and peripheral edema. It was administered steroid treatment for 5 days, with improvement of symptoms, but with motor and sensory deficits persisting. Conclusion: Acute disseminated encephalomyelitis and its variants are rare entities, with an important range of differential diagnosis, which must be identified and quickly treated to avoid their lethal or disabling outcome.
Introducción: la encefalomielitis aguda diseminada es una enfermedad autoinmune y desmielinizante. Es rara en el adulto. Cuenta con tres variantes principales. Una de ellas es el síndrome de Weston Hurst, también conocido como leucoencefalitis hemorrágica aguda. El objetivo fue compartir la experiencia en el abordaje diagnóstico y terapéutico de esta rara enfermedad, así como hacer una revisión de la bibliografía actual, a fin de colaborar con el conocimiento de esta. Caso clínico: mujer de 27 años con cuadro de infección respiratoria viral 2 semanas previas al desarrollo de síndrome neurológico caracterizado por parestesias, déficit motor, estatus epiléptico y encefalopatía aguda, el cual progresó a estado de coma y evidenció en resonancia magnética lesiones difusas hemorrágicas en sustancia blanca cerebral con desmielinización y edema periférico. Se inició tratamiento con esteroides por 5 días con mejora de síntomas, aunque persistió el déficit motor y sensitivo. Conclusión: la encefalomielitis aguda diseminada y la variante hemorrágica de esta son entidades raras, con una importante gama de diagnóstico diferencial, que deben ser identificadas y tratadas de forma rápida para evitar su letal o incapacitante desenlace.
Subject(s)
Encephalomyelitis, Acute Disseminated , Leukoencephalitis, Acute Hemorrhagic , Status Epilepticus , Adult , Female , Humans , Leukoencephalitis, Acute Hemorrhagic/diagnosis , Leukoencephalitis, Acute Hemorrhagic/etiology , Leukoencephalitis, Acute Hemorrhagic/pathology , Encephalomyelitis, Acute Disseminated/diagnosis , Encephalomyelitis, Acute Disseminated/etiology , Encephalomyelitis, Acute Disseminated/pathology , Magnetic Resonance Imaging/adverse effectsABSTRACT
Ascites is the fluid accumulation in the peritoneal cavity, and it is the consequence of a wide variety of entities, being liver cirrhosis the most common one. In this kind of patients, the development of ascites results from splanchnic vasodilation; decreased effective circulating volume; the activation of the sympathetic nervous system and the reninangiotensinaldosterone system; and a systemic inflammatory process. Its management is diverse and depends on the severity of the hemodynamic disturbance and other clinical manifestations. In recent years, therapeutic strategies have been developed, but they tend to result unconventional, so new evidence demonstrates the advantages of non-selective beta-blockers for the survival rate of patients with end-stage cirrhosis and ascites.(AU)
La ascitis es la acumulación de líquido en la cavidad peritoneal, y es consecuencia de una amplia variedad de entidades, siendo la cirrosis la más frecuente. En este tipo de pacientes, el desarrollo de ascitis resulta de la vasodilatación esplácnica, el volumen circulante efectivo disminuido, la activación del sistema nervioso simpático y el sistema renina-angiotensina-aldosterona, así como un proceso inflamatorio sistémico. Su tratamiento es diverso, y depende de la gravedad de la alteración hemodinámica y otras manifestaciones clínicas. En años recientes se han desarrollado estrategias terapéuticas poco convencionales, así como nueva evidencia demuestra los beneficios de los betabloqueadores no selectivos en la tasa de supervivencia de los pacientes con cirrosis en etapa terminal y ascitis.(AU)
Subject(s)
Humans , Ascites , Peritoneal Cavity , Vasodilation , Sympathetic Nervous System , Fibrosis , Hypertension, Portal , Liver Cirrhosis , Gastroenterology , Gastrointestinal Diseases , Liver DiseasesABSTRACT
Ascites is the fluid accumulation in the peritoneal cavity, and it is the consequence of a wide variety of entities, being liver cirrhosis the most common one. In this kind of patients, the development of ascites results from splanchnic vasodilation; decreased effective circulating volume; the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system; and a systemic inflammatory process. Its management is diverse and depends on the severity of the hemodynamic disturbance and other clinical manifestations. In recent years, therapeutic strategies have been developed, but they tend to result unconventional, so new evidence demonstrates the advantages of non-selective beta-blockers for the survival rate of patients with end-stage cirrhosis and ascites.
Subject(s)
Adrenergic beta-Antagonists , Ascites , Liver Cirrhosis , Humans , Ascites/drug therapy , Ascites/etiology , Liver Cirrhosis/complications , Renin-Angiotensin System/drug effects , Renin-Angiotensin System/physiology , Vasodilation/drug effects , Vasodilation/physiology , Adrenergic beta-Antagonists/pharmacology , Adrenergic beta-Antagonists/therapeutic use , Splanchnic Circulation/drug effects , Splanchnic Circulation/physiologyABSTRACT
BACKGROUND: Renal transplants (RTs) from deceased donors have increased in Mexico because of the high need of people with terminal kidney damage. The objective of this study is to determine the impact of cold ischemia time (CIT) on clinical outcomes in the deceased donor kidney transplant. METHODS: A retrospective, observational study of deceased donor RTs performed from 2013 to 2017 in the RT unit of the CMN Siglo XXI was completed. Data were collected from 202 patient records in this period; 7 clinical outcomes were determined, and logistic regression analysis was performed with CIT and extended criteria. The statistical package SPSS version 25 was used. RESULTS: No risk was observed for clinical outcomes with a CIT of 1080 minutes, risk of delayed function and medical complications was observed with a CIT of 1260 minutes, and risk of surgical complications was observed with a CIT of 1309 minutes. There was a correlation of 0.556 between the Maryland classification score and post-transplant medical complications. The extended criteria are related to risk for death with an odds ratio of 6.91 (95% CI, 2.27-21.01; P = .001) CONCLUSIONS: CIT continues to be an extremely important factor in renal graft survival and post-transplant clinical conditions. The extended criteria represent a considerable risk of death.
