[Malignant external otitis caused by Pseudomonas aeruginosa. Report of 3 cases]. / Otite externa maligna por Pseudomonas aeruginosa. Relato de três casos.

The cases of three patients aged over sixty, diabetic for a long time and having clinical, otological, neurological and microbiological findings of malignant external otitis by Pseudomonas aeruginosa are registered. The first patient, a 62 years old woman, had important neurological alterations, such as proven P. aeruginosa meningitis and involvement of the 6th, 7th, 8th, 9th and 10th left cranial nerves. Although mortality and morbidity rates of cases with these characteristics are reported to be high, this patient survived. The second was a 64 years old male with the classical complaints of this condition consisting of persistent and intensive ear pain, serous purulent discharge and an emerging tumourous lesion in the left external ear canal. Good results were obtained with the surgical treatment administered along with an antimicrobial plan which remained incomplete because the patient has requested his discharge from the hospital. In less than one month, he was again hospitalized already presenting neurological manifestations (paralysis of the 6th cranial nerve) following a fatal course in a few days. The third was also a male patient, 70 years old, whose initial complaints occurred after a month a butterfly penetrated his right ear during his sleep. In spite of the presence of neurological troubles (facial paralysis and stupor) he survived with a prolonged antibiotic therapy. After a literature revision on this pathology, considerations are made concerning its pathogeny, clinical findings, diagnosis, therapy and prognosis.

Endocardite infecciosa. Acometimento neurologico em cinco casos. / Infectious endocarditis. Neurological involvement in 5 cases

Dando maior enfase as alteracoes neurologicas, sao analisadas as caracteristicas clinicas de cinco pacientes com endocardite infecciosa. Os disturbios neuropsiquiatricos, em muitos casos desta patologia, sao os que abrem a cena clinica do enfermo ou sao as alteracoes que dominam a atencao do examinador, na fase inicial dificultando o reconhecimento da verdadeira origem dos achados de exame clinico.A presenca de sindromes neurologicas, na endocardite infecciosa, ensombrece o prognostico, sendo responsavel por morbidade e mortalidade. Os achados de exame fisico, de tomografia computadorizada cerebral, de cirurgia e de necropsia sao apresentados, demonstrando a multiplicidade e gravidade desta ocorrencia que parece nao ter diminuido com a introducao dos antibioticos.Nesta enfermidade, mesmo em presenca de queixas pequenas, tais como cefaleia persistente, estados confusionais, disturbios psiquiatricos ou, ainda, de discretas alteracoes liquoricas torna-se cada vez mais premente que realizemos uma investigacao completa, incluindo tomografia computadorizada cerebral e estudos angiograficos, para esclarecimentos e/ou determinar a conduta medica a ser seguida