Aspergillosis of the central nervous system in a previously healthy patient that simulated Creutzfeldt-Jakob disease.

BACKGROUND: The presence of Aspergillus in the central nervous system (CNS) is rare in immunocompetent patients but not in immunocompromised patients who may have a more common infection. This article describes a case of an adult immunocompetent patient with a diagnosis of cerebral aspergillosis and with a clinical process of rapidly progressive dementia which simulated a Creutzfeldt-Jakob syndrome. CASE DESCRIPTION: A 34-year-old adult was previously healthy and had no medical history of any significance. The patient had suffered only facial trauma 8 months before admission. One month prior to admission, he showed rapidly progressing changes in his behavior and higher mental functions. He was admitted to the emergency room with an occipital headache with 2 months of history. By the time he arrived, he suffered from total disability and was prostrate. He was diagnosed with meningeal and demential syndrome in the process of being studied. After starting the diagnostic approach by investigating cerebrospinal fluid, a magnetic resonance of the skull, an electroencephalogram, a brain biopsy was indicated. The histopathological study reported the presence of the hyphae characteristics of Aspergillus. The patient died 7 days after the diagnosis. CONCLUSION: Cerebral aspergillosis is a common aggressive disease in immunosuppressed patients. However, the disease is rare in individuals with respected immunity and in individuals with neurological impairment and a rapid and progressive deterioration of mental functions. The suspected diagnosis should always be considered given its poor prognosis and the encouraging efficacy of antifungal treatment administered in a timely manner.

Síndrome meningeo como manifestación de apoplejia hipofisiaria, análisis prospectivo de siete casos / Meningeal syndrome as manifestation of pituitary apoplexy, prospective analysis of seven cases

Introducción: la apoplejía hipofisiaria es una grave pero poco frecuente emergencia médico -neuroquirúrgica, con una incidencia global reportada del 1 por ciento a 2 por ciento Es causado por una hemorragia o infarto en relación a la glándula pituitaria, pudiendo existir extravasación de contenido necrótico o hemorrágico al espacio subaracnoideo, manifestándose como un síndrome meníngeo aséptico o hemorrágico. Sin embargo, su frecuencia no está estudiada. Material y Métodos: Se realizó un registro prospectivo entre enero de 2013 y agosto de 2014, para el estudio de líquido céfalo raquídeo, en pacientes con diagnóstico clínico- imagenológico de apoplejía hipofisiaria. Además un registró detallado de las manifestaciones clínicas y de laboratorio. Resultados: En este período se reclutaron 8 casos con apoplejía hipofisiaria clínica, de los cuales 7 fueron incluidos, siendo excluido un paciente por rechazar su participación en el estudio. De los 7 pacientes restantes, se evidenciaron signos meníngeos clínicos en el 86 por ciento (6/7), confirmando alteraciones del estudio cito-químico en todos ellos. En cada caso se descartó patología infecciosa o vascular como etiología. Conclusión: Si bien el debut de una apoplejía hipofisiaria como un síndrome meníngeo aséptico o hemorragia subaracnoidea, se encuentra documentado como casos anecdóticos, nuestros resultados apuntan a que sería una manifestación frecuente e importante a considerar para un adecuado diagnóstico diferencial y monitoreo de complicaciones infrecuentes.

Introduction: pituitary apoplexy is a serious but rare neurosurgical emergency, with an overall reported incidence of 1 percent to 2 percent. It is caused by bleeding or infarction related to the pituitary gland, there may be necrotic or hemorrhagic extravasation content to the subarachnoid space, manifesting as an aseptic o hemorrhagic meningeal syndrome. However, their frequency is not studied. Material and Methods: A prospective registry between January 2013 and August 2014, for the study of cerebro spinal fluid in patients with clinical and imaging diagnosis of pituitary apoplexy was performed. In addition, a detailed analysis of the clinical sintoms and laboratory was recorded. Results: In this period, 8 cases with clinical pituitary apoplexy were recluted, of which 7 were included, being excluded from a patient who refuses to participate in the study. Of the remaining 7 patients,clinical meningeal signs were evident in 86 percent (6/7), confirming alterations cyto-chemical study all of them. In each case infectious or vascular pathology was ruled out as a cause. Conclusion: While the debut of a pituitary apoplexy as an aseptic meningeal syndrome or subarachnoid hemorrhage, is documented as anecdotal cases, our results would suggest that is a common and important manifestation, to consider an appropriate differential diagnosis and monitoring of rare complications.

Variabilidad en las manifestaciones clínicas de la meningoencefalitis por tuberculosis / Variability in the clinical manifestations of meningeal encephalitis due to tuberculosis

Con el objetivo de describir las manifestaciones clínicas de pacientes con meningoencefalitis por tuberculosis (TBC), se realizó un estudio descriptivo, retrospectivo mediante la revisión de historias clínicas de 15 pacientes adultos, evaluados por el servicio de Neurología en el SAHUM durante el periodo de Enero 2002 a Diciembre 2008. Se analizó: edad, sexo, procedencia, manifestaciones clínicas, tiempo entre el inicio de los síntomas y la hospitalización y tratamiento. De los 15 pacientes, 10 (66,67%) fueron de sexo femenino, 9 (60,0%) entre 20 y 29 años de edad. El 53,34% eran procedentes de los Municipios Mara y Páez. Las manifestaciones clínicas fueron; cefalea y rigidez de nuca 14 (93,33%), alteración de la consciencia 13 (86,67%), alteración mental 7 (46,66%), convulsión 8 (53,33%), hipertensión intracraneana 5 (33,33%), déficit Motor 3 (20,00%), alteración de pares craneales 2 (13,33%) como falso signo localizador y en 2 (13,33%) diplopía. La citoquímica del líquido cefalorraquídeo reveló hipoglucorraquia en el 100,00% de los pacientes e hiperproteinorraquia. La coloración de Ziehl Neelsen fue positiva en 1 (6,67%). 6 pacientes (40,00%) tenían más de 1 mes con TBC. Se concluye que son diversas las manifestaciones clínicas de meningoencefalitis por TBC, siendo más frecuente el síndrome meníngeo

With the objective of describing clinical manifestations in patients with meningeal encephalitis due to tuberculosis (TBC), a descriptive, retrospective study was made by reviewing clinical histories of 15 adult patients with a diagnosis of TBC in the SAHUM neurology service from January 2002 to December 2008. Age, sex, clinical manifestations, hospitalization and treatment were analyzed. Of the 15 patients, 10 (66.67%) were female, 9 (60.0%) were between 20 and 29 years of age; 53.34% came from the Mara and Páez Municipalities. The clinical manifestations were: headache and nape of the neck rigidity, 14 (93.33%); alteration of consciousness, 13 (86.67%); alteration of mental state, 7 (46.66%); convulsions, 8 (53.33%); intracranial hypertension, 5 (33.33%); motor deficit, 3 (20.00%); alteration of cranial pairs, 2 (13.33%) as a false locator sign and diplopia, 2 (13.33%). Cytochemical study of the cerebrospinal fluid revealed hypoglycorrhachia in 100.00% of the patients. Ziehl Neelsen coloration was positive in 1 (6.67%). Six patients (40.00%) had had the disease for more than 1 month. Conclusions were that the clinical manifestations of meningeal encephalitis due to TBC are diverse, with the meningeal syndrome as the most frequent