RESUMO
PRIMARY OBJECTIVE: Early treatment of epilepsy is warranted to avoid possible severe consequences. This study aimed to assess the value of treatment in a patient who developed epilepsy after major brain surgery. DESIGN: Case description. A 51 years-old man had a history of putative petit mal seizures since adolescence and left frontotemporal lobectomy after a major traffic accident at age 17. He subsequently developed quickly generalizing partial complex seizures, associated with severe behavioural alterations and personality changes; the condition was left untreated. A further seizure-related loss of consciousness led to another traffic accident at age 47. METHODS AND PROCEDURES: The patient was administered 200 mg/day topiramate, 600 mg/day quetiapine, 1000 mg/day valproate, 1200 mg/day gabapentin and 800 mg/day carbamazepine. MAIN OUTCOMES AND RESULTS: The instituted anti-epileptic treatment reduced seizure frequency and severity, but did not affect psychiatric symptomatology, which even worsened. An association between anti-epileptic drugs with mood stabilizing properties and an atypical anti-psychotic dramatically improved psychiatric symptoms, but did not prevent the patient from needing long-term healthcare. CONCLUSIONS: Long-term untreated epilepsy may expose to accident proneness and further psychiatric deterioration. Early diagnosis and treatment of epilepsy may help in avoiding a potentially lethal vicious circle.
Assuntos
Acidentes de Trânsito , Agressão , Anticonvulsivantes/uso terapêutico , Lesões Encefálicas/fisiopatologia , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Transtornos da Personalidade/fisiopatologia , Acidentes de Trânsito/psicologia , Agressão/psicologia , Aminas/uso terapêutico , Lobectomia Temporal Anterior/efeitos adversos , Lesões Encefálicas/complicações , Lesões Encefálicas/tratamento farmacológico , Lesões Encefálicas/psicologia , Carbamazepina/uso terapêutico , Ácidos Cicloexanocarboxílicos/uso terapêutico , Dibenzotiazepinas/uso terapêutico , Progressão da Doença , Diagnóstico Precoce , Epilepsia/etiologia , Epilepsia/fisiopatologia , Epilepsia/psicologia , Frutose/análogos & derivados , Frutose/uso terapêutico , Gabapentina , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/tratamento farmacológico , Transtornos da Personalidade/etiologia , Transtornos da Personalidade/psicologia , Fumarato de Quetiapina , Fatores de Tempo , Topiramato , Resultado do Tratamento , Ácido Valproico/uso terapêutico , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
Aorto-enteric fistulas are serious complications of aortic surgery that require swift, effective surgical intervention. We report a case of a secondary aortoenteric fistula treated with prosthesis replacement and an intestinal suture subsequently complicated by the dehiscence of the previously constructed anastomosis. We opted for reconstruction re-intervention, closing the intestinal lesion by means of a mechanical suture above the jejunal dehiscence, making a side-to-end jejuno-jejunal Roux anastomosis and an end-to-side anastomosis at the base of the loop. The operation was completed by performing a gastrostomy and transforming the fistula into a jejunostomy. This intervention enabled us to discharge the patient in good general condition after 30 days.
