RESUMO
A young patient with PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome developed an unusual cerebral arterial vasculopathy/vasculitis (CAV) that resulted in subarachnoid hemorrhage from a ruptured dissecting posterior cerebral artery (PCA) aneurysm. This aneurysm was successfully treated by endovascular coil sacrifice of the affected segment of the PCA. The patient made an excellent recovery with no significant residual neurologic deficit.
Assuntos
Acne Vulgar/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Artrite Infecciosa/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Cerebral Posterior/diagnóstico por imagem , Pioderma Gangrenoso/diagnóstico por imagem , Vasculite do Sistema Nervoso Central/diagnóstico por imagem , Acne Vulgar/cirurgia , Dissecção Aórtica/cirurgia , Artrite Infecciosa/cirurgia , Angiografia Cerebral , Diagnóstico Diferencial , Procedimentos Endovasculares/métodos , Humanos , Aneurisma Intracraniano/cirurgia , Angiografia por Ressonância Magnética , Staphylococcus aureus Resistente à Meticilina , Artéria Cerebral Posterior/cirurgia , Pioderma Gangrenoso/cirurgia , Infecções Estafilocócicas/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento , Vasculite do Sistema Nervoso Central/cirurgiaRESUMO
A young patient with PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome developed an unusual cerebral arterial vasculopathy/vasculitis (CAV) that resulted in subarachnoid hemorrhage from a ruptured dissecting posterior cerebral artery (PCA) aneurysm. This aneurysm was successfully treated by endovascular coil sacrifice of the affected segment of the PCA. The patient made an excellent recovery with no significant residual neurologic deficit.
Assuntos
Acne Vulgar/patologia , Aneurisma Roto/patologia , Dissecção Aórtica/patologia , Artrite Infecciosa/patologia , Aneurisma Intracraniano/patologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pioderma Gangrenoso/patologia , Infecções Estafilocócicas/patologia , Vasculite/etiologia , Acne Vulgar/complicações , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Roto/cirurgia , Antibacterianos/uso terapêutico , Artrite Infecciosa/complicações , Cefazolina/uso terapêutico , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Metilprednisolona/uso terapêutico , Pioderma Gangrenoso/complicações , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico por imagem , Resultado do Tratamento , Vasculite/microbiologiaRESUMO
OBJECTIVE: The purpose of this study was to review the experience with herpes simplex encephalitis at the Hospital for Sick Children over the past 12 years. METHODS: All patients who were admitted to our institution with acute encephalitis between January 1994 and December 2005 were enrolled prospectively in an encephalitis registry. Children from the registry with herpes simplex encephalitis were included in this study; we detailed the clinical presentations, laboratory findings, electroencephalographic findings, diagnostic imaging findings, treatments, and outcomes for all cases. RESULTS: Of 322 cases of acute encephalitis, 5% were caused by herpes simplex virus. Initially negative herpes simplex virus cerebrospinal fluid polymerase chain reaction results were found in 2 cases (13%), but results became positive in repeat cerebrospinal fluid analyses. Classic clinical presentations were seen in 75% of cases, cerebrospinal fluid pleocytosis was found in 94%, elevated cerebrospinal fluid protein levels were found in 50%, electroencephalographic changes were observed in 94%, and diagnostic imaging abnormalities were noted in 88%. All patients were treated with intravenous acyclovir. Neurologic sequelae occurred in 63% of cases, including seizures in 44% and developmental delays in 25%. There were no deaths in this study group. CONCLUSIONS: Herpes simplex encephalitis continues to be associated with poor long-term neurologic outcomes despite appropriate therapy. Cerebrospinal fluid polymerase chain reaction results may be negative early in the course of herpes simplex encephalitis; therefore, repeat cerebrospinal fluid analysis should be considered if herpes simplex encephalitis is suspected. Atypical forms of herpes simplex virus central nervous system disease may occur in children.
