RESUMO
A healthy 26-year-old man, without initially presenting fever, rapidly developed a focal right pontomedullary deficit associated with an aseptic lymphocytic meningitis. The diagnosis of Listeria infection was confirmed by blood cultures. CT and MRI demonstrated an abscess extending from the superior cerebellar peduncle to the lateral portion of the medulla. Immunological controls gave no indication of deficiency. With ampicillin therapy, started on the 5th day, clinical recovery was almost complete, but a soft palate right paresis persisted as the unique sequel. Antibiotic therapy was maintained for 5 months up to normal CSF and CT. One year after the onset, MRI was also normal. The rare nature of listerial abscess in the brainstem is discussed with regard to rhombencephalitides.
Assuntos
Ampicilina/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Tronco Encefálico/microbiologia , Meningite por Listeria/tratamento farmacológico , Adulto , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/microbiologia , Abscesso Encefálico/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite por Listeria/diagnóstico por imagem , Meningite por Listeria/patologia , Tomografia Computadorizada por Raios XRESUMO
The outcome of anoxic coma following cardiac arrest depends on the aetiological circumstances, on pre-existing visceral deficiencies and on the duration of inefficient circulation. Outside the extreme cases of prompt return to consciousness or early death, in many patients this course is marked by neurological sequelae of varying severity which may result in a persistent vegetative state. Initially, there is nothing that can predict the quality of survival, but within 72 hours the neurological examination usually makes it possible to foresee irreversible situations with permanent loss of consciousness. The decisional problems that ensue are discussed.