Síndrome posterior do tronco cerebral e o uso de ventilação assistida ajustada neuralmente (nava) em lactente / Dorsal brainstem syndrome and the use of neurally adjusted ventilatory assist (nava) in an infant

RESUMO Objetivo: Relatar um caso raro de síndrome posterior do tronco cerebral em um lactente após um episódio hipóxico-isquêmico devido a sepse grave, e o uso da ventilação assistida ajustada neuralmente no auxílio diagnóstico e no desmame da ventilação mecânica. Descrição do caso: Lactente masculino de 2 meses de idade, previamente hígido, apresentou sepse grave que evoluiu para síndrome posterior do tronco encefálico, entidade que pode ocorrer após lesão hipóxico-isquêmica em neonatos e lactentes e que apresenta imagens de ressonância magnética muito particulares. Devido à lesão neurológica, permaneceu em ventilação mecânica. Optou-se por iniciar ventilação assistida ajustada neuralmente para verificar a patência da condução do nervo frênico ao diafragma e auxiliar no desmame da ventilação mecânica. Comentários: A síndrome posterior do tronco cerebral é uma entidade rara que deve ser considerada em lactentes após evento hipóxico-isquêmico.

ABSTRACT Objective: To report a rare case of dorsal brainstem syndrome in an infant after hypoxic-ischemic episode due to severe sepsis and the use of neurally adjusted ventilatory assist (NAVA) to aid in diagnosis and in the removal of mechanical ventilation. Case description: A 2-month-old male infant, previously healthy, presented with severe sepsis that evolved to dorsal brainstem syndrome, which usually occurs after hypoxic-ischemic injury in neonates and infants, and is related to very specific magnetic resonance images. Due to neurological lesions, thei nfant remained in mechanical ventilation. A NAVA module was installed to keep track of phrenic nerve conduction to the diaphragm, having successfully showed neural conduction and helped removing mechanical ventilation. Comments: Dorsal brainstem syndrome is a rare condition that should be considered after hypoxic-ischemic episode in infants.

DORSAL BRAINSTEM SYNDROME AND THE USE OF NEURALLY ADJUSTED VENTILATORY ASSIST (NAVA) IN AN INFANT. / SÍNDROME POSTERIOR DO TRONCO CEREBRAL E O USO DE VENTILAÇÃO ASSISTIDA AJUSTADA NEURALMENTE (NAVA) EM LACTENTE.

OBJECTIVE: To report a rare case of dorsal brainstem syndrome in an infant after hypoxic-ischemic episode due to severe sepsis and the use of neurally adjusted ventilatory assist (NAVA) to aid in diagnosis and in the removal of mechanical ventilation. CASE DESCRIPTION: A 2-month-old male infant, previously healthy, presented with severe sepsis that evolved to dorsal brainstem syndrome, which usually occurs after hypoxic-ischemic injury in neonates and infants, and is related to very specific magnetic resonance images. Due to neurological lesions, thei nfant remained in mechanical ventilation. A NAVA module was installed to keep track of phrenic nerve conduction to the diaphragm, having successfully showed neural conduction and helped removing mechanical ventilation. COMMENTS: Dorsal brainstem syndrome is a rare condition that should be considered after hypoxic-ischemic episode in infants.

OBJETIVO: Relatar um caso raro de síndrome posterior do tronco cerebral em um lactente após um episódio hipóxico-isquêmico devido a sepse grave, e o uso da ventilação assistida ajustada neuralmente no auxílio diagnóstico e no desmame da ventilação mecânica. DESCRIçÃO DO CASO: Lactente masculino de 2 meses de idade, previamente hígido, apresentou sepse grave que evoluiu para síndrome posterior do tronco encefálico, entidade que pode ocorrer após lesão hipóxico-isquêmica em neonatos e lactentes e que apresenta imagens de ressonância magnética muito particulares. Devido à lesão neurológica, permaneceu em ventilação mecânica. Optou-se por iniciar ventilação assistida ajustada neuralmente para verificar a patência da condução do nervo frênico ao diafragma e auxiliar no desmame da ventilação mecânica. COMENTÁRIOS: A síndrome posterior do tronco cerebral é uma entidade rara que deve ser considerada em lactentes após evento hipóxico-isquêmico.

Case Report: Severe acute respiratory distress by tracheal obstruction due to a congenital thyroid teratoma.

Congenital teratoma is a rare condition and is a germ cell tumor composed of elements from one or more of the embryonic germ layers and contain tissues usually foreign to the anatomic site of origin. We report a case of a neck tumor diagnosed during pregnancy, initially thought to be a goiter. After birth the neck mass kept growing until it compressed the trachea and produced respiratory failure. The infant had a difficult tracheal intubation because of the compressing mass. The staff decided to surgically remove the neck mass. After that, the infant became eupneic. The histological analysis showed a mature teratoma with no atypias.

Hemorragia intracraniana espontânea em pediatria: relato de paciente hemofílico que sobreviveu devido a cisto cerebral / Spontaneous intracranial hemorrhage in children: report of a hemophilia patient who survived due to a brain cyst

RESUMO Relatamos o caso de um uma criança de 2 anos de idade que sobreviveu após um episódio agudo de hemorragia intracraniana espontânea grave com sinais clínicos e radiológicos de hipertensão intracraniana e herniação transtentorial. O paciente foi para cirurgia de urgência para drenagem do hematoma, sendo inserido um cateter para monitorar a pressão intracraniana. Na análise da tomografia de crânio inicial, antes da drenagem do hematoma, constatou-se um cisto cerebral contralateral ao hematoma que, segundo análise do neurocirurgião e do neuroradiologista, possivelmente evitou um desfecho pior, visto que o cisto serviu de acomodação para o cérebro após a hemorragia maciça. Após investigação, constatou-se tratar de um caso de hemofilia tipo A sem diagnóstico prévio. O paciente foi tratado em terapia intensiva com controle da pressão intracraniana, reposição de fator VIII e obteve alta sem sequelas neurológicas evidentes.

ABSTRACT We report the case of a 2-year-old child who survived an acute episode of severe spontaneous intracranial hemorrhage with clinical and radiological signs of intracranial hypertension and transtentorial herniation. The patient underwent emergency surgery to drain the hematoma, and a catheter was inserted to monitor intracranial pressure. In the initial computed tomography analysis performed prior to hematoma drainage, a brain cyst was evident contralateral to the hematoma, which, based on the analysis by the care team, possibly helped to avoid a worse outcome because the cyst accommodated the brain after the massive hemorrhage. After the investigation, the patient was determined to have previously undiagnosed hemophilia A. The patient underwent treatment in intensive care, which included the control of intracranial pressure, factor VIII replacement and discharge without signs of neurological impairment.

Case Report: Pulmonary Alveolar Calcification as a Result of Severe Hypercalcemia due to Acute Lymphoblatic Leukemia.

Severe hypercalcemia is a rare metabolic disorder in pediatric medicine. This report describes a rare case of severe hypercalcemia and its clinical manifestations in a 2-year-old toddler. The radiological findings caused by hypercalcemia and osteolysis were emblematic of the osteolytic lesions. Hypercalcemia led to massive pulmonary alveolar calcification. The hypercalcemia was successfully treated with pamidronate, a bisphosphonate drug class. Further investigation resulted in a diagnosis of acute lymphoblastic leukemia (ALL). The patient is currently on chemotherapy and has a favorable prognosis. Although severe hypercalcemia alone is an unusual finding as the first sign for ALL, this should be considered, not to mention the radiological images resulted from calcium deposits.

Spontaneous intracranial hemorrhage in children: report of a hemophilia patient who survived due to a brain cyst.

We report the case of a 2-year-old child who survived an acute episode of severe spontaneous intracranial hemorrhage with clinical and radiological signs of intracranial hypertension and transtentorial herniation. The patient underwent emergency surgery to drain the hematoma, and a catheter was inserted to monitor intracranial pressure. In the initial computed tomography analysis performed prior to hematoma drainage, a brain cyst was evident contralateral to the hematoma, which, based on the analysis by the care team, possibly helped to avoid a worse outcome because the cyst accommodated the brain after the massive hemorrhage. After the investigation, the patient was determined to have previously undiagnosed hemophilia A. The patient underwent treatment in intensive care, which included the control of intracranial pressure, factor VIII replacement and discharge without signs of neurological impairment.