RESUMO
Human parechovirus infection is an increasingly recognized cause of neonatal meningoencephalitis. We describe characteristic clinical features and brain MR imaging abnormalities of human parechovirus meningoencephalitis in 6 infants. When corroborated by increasingly available polymerase chain reaction-based testing of the CSF, the distinctive MR imaging appearance may yield a specific diagnosis that obviates costly and time-consuming further clinical evaluation. In our study, infants with human parechovirus presented in the first 35 days of life with seizures, irritability, and sepsis. MR imaging consistently demonstrated low diffusivity within the thalami, corpus callosum, and subcortical white matter with a frontoparietal predominance. T1 and T2 shortening connoting white matter injury along the deep medullary veins suggests venous ischemia as an alternative potential pathogenetic mechanism to direct neuroaxonal injury.
Assuntos
Meningoencefalite/diagnóstico por imagem , Meningoencefalite/diagnóstico , Parechovirus , Infecções por Picornaviridae/diagnóstico por imagem , Infecções por Picornaviridae/diagnóstico , Encéfalo/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Lactente , Recém-Nascido , Humor Irritável , Masculino , Meningoencefalite/líquido cefalorraquidiano , Neuroimagem , Infecções por Picornaviridae/líquido cefalorraquidiano , Reação em Cadeia da Polimerase , Convulsões/etiologia , Sepse/etiologiaRESUMO
The present health care environment requires creative change, a thought that evokes both excitement and apprehension and offers a clear challenge for the contemporary nurse. In this era of capitation, re-engineering, and redesign in the health care system, nursing programs must prepare nurses who can successfully perform in an environment that demands innovative problem solving. Integrating creative problem solving into this BSN program has (1) provided students with information and experience in the creative process, (2) fostered the personal creative development of nurses, (3) challenged students to use creative thinking in solving nursing problems, and most important, (4) further established and reinforced a new, higher level of nursing practice--a level that appropriately sees the nurse as a creative and innovative member of the health care team.