[Urinary tract infections in patients with neurogenic lower urinary tract dysfunction]. / Infections urinaires chez les patients avec dysfonction neurogène du bas appareil urinaire.

Urinary tract infections (UTIs) are one of the main causes of morbidity and mortality in patients with neurogenic lower urinary tract dysfunction (nLUTD). In most cases, these are patients whose symptoms manifest differently from non-neurological patients, and it can be difficult to decide whether the infection should be treated or whether it is asymptomatic bacteriuria for which treatment is not indicated. Recurrent urinary tract infections should be investigated for an underlying urological cause. This article reviews the diagnosis and management of urinary tract infections in adults with neurogenic lower urinary tract dysfunction.

Les infections urinaires sont l'une des principales causes de morbidité et mortalité chez les patients souffrant d'une dysfonction neurogène du bas appareil urinaire (nLUTD) d'origine médullaire. Dans la plupart des cas, les symptômes se manifestent différemment des patients non neurologiques. Il peut être difficile de décider si l'infection doit être traitée ou s'il s'agit d'une bactériurie asymptomatique pour laquelle le traitement n'est pas indiqué. Les infections urinaires récidivantes doivent faire rechercher une cause urologique sous-jacente. Cet article revoit le diagnostic et la prise en charge des infections urinaires de l'adulte atteint d'un dysfonctionnement neurogène du bas appareil urinaire.

Syndrome of the Trephined and Paroxysmal Sympathetic Hyperactivity in a 17-year-old minimally conscious state patient: A Case Report.

Purpose: Syndrome of the Trephined (SoT) is one of the most unknown complications of the Decompressive Craniectomy (DC) after Traumatic Brain Injury (TBI). A combination of neurological clinical criteria and radiological signs after DC is necessary to make its diagnosis. In our case, as the patient was in a minimally conscious state (MCS), it was impossible to clinically assess any neurological deterioration according to the criteria found in the literature. There is no description of clinical diagnostic criteria suitable for patients with MCS apart from the visible 'Skin Flap.'Method: A 17-year-old patient sustained a severe TBI. Two months after the TBI and a DC he exhibited an MCS with a Glasgow Coma Scale (GCS) of 7 and a Wessex Head Injury Matrix (WHIM) of 5. He presented several paroxysmal sympathetic hyperactivity (PSH) episodes a day and developed a sinking skin flap. A cranioplasty was performed. Then, we noticed the gradual disappearance of PSH episodes plus an improvement of the CRS and the WHIM. Results: The evolution of the WHIM data revealed a statistically significant difference (p 0.0047). Conclusion: Further studies should be conducted to assess whether the WHIM and the frequency of PSH episodes may be part of the diagnostic criteria for SoT in MCS patients.