RESUMO
BACKGROUND: Listeria monocytogenes is an opportunistic gram-positive, facultative intracellular bacterium that causes invasive diseases mostly in pregnant women and immunosuppressed patients. Despite the predilection toward the central nervous system (CNS), it usually causes meningitis and meningoencephalitis, whereas brain abscesses are very uncommon. CASE PRESENTATION: We describe the case of a 69-year-old homeless patient with a brain abscess due to L. monocytogenes who was successfully treated surgically by a guided stereotactic aspiration and antibiotic therapy with ampicillin and gentamicin. Our patient was discharged after 4 weeks of therapy without neurologic deficits. Additionally, we provide a review of the literature of brain abscesses caused by L. monocytogenes. CONCLUSIONS: This case highlights the need to drain cerebral abscesses and culture pus to correctly treat patients with antibiotics, especially given the high mortality rate of this infectious entity.
Assuntos
Abscesso Encefálico , Listeria monocytogenes , Idoso , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Drenagem/efeitos adversos , HumanosRESUMO
INTRODUCTION: This study investigates the diagnostic value of optic nerve sheath diameter (ONSD) assessed by transorbital sonography for estimation of intracranial pressure (ICP) in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: Simultaneous measurements of the ONSD and ICP in 27 patients suffering from SAH and acute hydrocephalus after placement of an extraventricular drain. RESULTS: Despite normal mean ICP values ONSD was significantly higher in patients with SAH compared with healthy volunteers and no relevant decline of ONSD over time could be identified. In addition, no correlation between ONSD and ICP was observed. CONCLUSIONS: In patients with SAH and acute hydrocephalus after aneurysm rupture, the ONSD remains expanded after normalization of ICP. This is most likely due to an impaired retraction capability of the optic nerve sheath. This finding should be considered when using transorbital sonography in the neuromonitoring of aneurysmal SAH.
Assuntos
Encéfalo/diagnóstico por imagem , Pressão Intracraniana/fisiologia , Nervo Óptico/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Adulto , Encéfalo/patologia , Encéfalo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Óptico/patologia , Tamanho do Órgão/fisiologia , Estudos Prospectivos , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/fisiopatologia , UltrassonografiaRESUMO
BACKGROUND AND PURPOSE: To assess the accuracy of ocular B-mode sonography and of standard head computed tomography (CT) as screening tools for intraocular hemorrhages related to subarachnoid hemorrhage (SAH). METHODS: 46 patients with spontaneous SAH were examined using ocular B-mode sonography and underwent funduscopy as gold standard for detection of ocular hemorrhages (OH). Additionally, all head CT scans done during the hospital stay of the study population were rated by a neuroradiologist for the presence of OH. RESULTS: Funduscopy revealed vitreous and/or preretinal hemorrhages in ten eyes and retinal hemorrhages in nine eyes. In comparison with funduscopy, ocular sonography showed a sensitivity and specificity for the detection of vitreous and/or preretinal hemorrhages of 100%, while identification of retinal hemorrhages was less reliable with a sensitivity/specificity of 44%/100%. Standard head CT showed a lower sensitivity/specificity of 60%/96% for vitreous and/or preretinal hemorrhages, and 32%/95% for the diagnosis of any ocular bleeding. CONCLUSION: Ocular sonography identifies SAH-related preretinal and vitreous hemorrhages with high accuracy and is superior to standard head CT. It may be considered as new and useful bedside diagnostic tool for routine clinical care of patients with SAH.