Assuntos
Transtornos da Cefaleia , Herpesvirus Humano 7/patogenicidade , Linfocitose , Infecções por Roseolovirus , Adulto , Eletroencefalografia , Transtornos da Cefaleia/líquido cefalorraquidiano , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/etiologia , Transtornos da Cefaleia/fisiopatologia , Herpesvirus Humano 7/isolamento & purificação , Humanos , Linfocitose/líquido cefalorraquidiano , Linfocitose/diagnóstico , Linfocitose/etiologia , Imageamento por Ressonância Magnética , Masculino , Infecções por Roseolovirus/líquido cefalorraquidiano , Infecções por Roseolovirus/complicações , Infecções por Roseolovirus/diagnósticoRESUMO
La narcolepsia es trastorno neurológico infrecuente, incluido dentro del catálogo de enfermedades raras. Pese a la existencia de criterios diagnósticos precisos, se encuentra infradiagnosticada. Se caracteriza por una excesiva somnolencia diurna asociada a cataplejías, y en algunos casos puede aparecer alucinaciones hipnagógicas e hipnopómpicas, alucinaciones auditivas y/o ideación delirante. La presencia de síntomas psicóticos dificulta enormemente el diagnóstico diferencial (narcolepsia, esquizofrenia o la concomitancia de ambas). Además, el manejo terapéutico puede resultar complejo, ya que el tratamiento de una patología puede empeorar la otra. El siguiente caso clínico corresponde a una paciente con esta infrecuente comorbilidad entre ambos trastornos, en el que quedan patentes las importantes dificultades tanto en el diagnóstico diferencial como en el manejo terapéutico, una vez alcanzado el diagnóstico de certeza
Narcolepsy is an infrequent neurological disorder, included in the catalog of rare diseases. Despite the existence of precise diagnostic criteria, this entity remains underdiagnosed. It is characterized by excessive daytime sleepiness associated with cataplexy; in some cases, hypnagogic or hypnopompic hallucinations, auditory hallucinations, and/or delusional ideation may appear. The occurrence of psychotic symptoms makes differential diagnosis extremely difficult (narcolepsy, schizophrenia, or both). Furthermore, therapeutic management may be complex, since the treatment of one of the disorders may worsen the other. Here we describe the case of a patient with this rare comorbidity, which illustrates the major difficulties associated to both differential diagnosis and therapeutic management once a definitive diagnosis has been reached
Assuntos
Humanos , Feminino , Adulto , Narcolepsia/complicações , Narcolepsia/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/complicações , Cataplexia/complicações , Transtornos Psicóticos Afetivos/complicações , Transtornos Psicóticos/diagnóstico , Doenças do Sistema Nervoso/complicações , Doenças Raras/classificação , Alucinações/complicações , Diagnóstico DiferencialRESUMO
Narcolepsy is an infrequent neurological disorder, included in the catalog of rare diseases. Despite the existenceof precise diagnostic criteria, this entity remains underdiagnosed. It is characterized by excessive daytime sleepiness associated with cataplexy; in some cases, hypnagogic or hypnopompic hallucinations, auditory hallucinations, and/or delusional ideation may appear. The occurrence of psychotic symptoms makes differential diagnosis extremely difficult (narcolepsy, schizophrenia, or both). Furthermore, therapeutic management may be complex, since the treatment of one of the disorders may worsen the other. Here we describe the case of a patient with this rare comorbidity, which illustrates the major difficulties associated to both differential diagnosis and therapeutic management once a definitive diagnosis has been reached.
Assuntos
Narcolepsia/diagnóstico , Transtornos Psicóticos/diagnóstico , Adulto , Antipsicóticos/uso terapêutico , Cataplexia/etiologia , Comorbidade , Diagnóstico Diferencial , Feminino , Alucinações/etiologia , Humanos , Narcolepsia/tratamento farmacológico , Transtornos Psicóticos/tratamento farmacológicoAssuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Benzimidazóis/uso terapêutico , Compostos de Bifenilo/uso terapêutico , Hipertensão/prevenção & controle , Estilo de Vida , Tetrazóis/uso terapêutico , Doenças Cardiovasculares , Comportamentos Relacionados com a Saúde , Humanos , Fatores de RiscoRESUMO
BACKGROUND: Neurosyphilis (NS) is nowadays a less frequent disease. Its incidence and clinical spectrum have changed over time. OBJECTIVE: To estimate the incidence of NS and describe the clinical spectrum of NS in immunocompetent patients in the last decade. METHODS: Demographic and clinical features, cerebrospinal fluid (CSF) changes, neuroimaging findings and outcome were retrospectively analyzed. RESULTS: Forty-three patients met NS criteria. The yearly incidence was 0.2- 2.1 cases per 100,000 inhabitants. The mean age was 48.1 years, males being more frequently involved. The most frequent clinical patterns were meningovascular (30.2%), meningeal (25.6%) and general paresis (25.6%). Compared to prepenicillin series, we observed a decrease in late forms, mainly tabes dorsalis. CSF titers studied by the Venereal Disease Research Laboratory were higher in early NS. Neuroimaging findings were nonspecific. Outcome was better for early forms. CONCLUSIONS: Compared to the preantibiotic era, a lower frequency of late NS was observed, similar to that reported in other modern series which include patients with HIV infection. Therefore, this trend seems to be due to the impact of antibiotics rather than to HIV infection.