Assuntos
Doenças das Artérias Carótidas/diagnóstico , Seio Carotídeo , Infarto da Artéria Cerebral Média/etiologia , Massagem/efeitos adversos , Doença Aguda , Idoso de 80 Anos ou mais , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Infarto da Artéria Cerebral Média/tratamento farmacológico , Síncope/diagnóstico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Falha de TratamentoRESUMO
Botulism is a rare but potentially fatal disease caused by toxins produced by Clostridium botulinum. We report botulism in two adult females, one of them just tasting from "bad" asparagus and the other eating the full portion. Both patients survived after intermittent mechanical ventilation and trivalent antitoxin administration. The diagnosis was confirmed by detection of botulinum toxin. Acute onset of bilateral cranial neuropathies associated with symmetric descending weakness as well as some key features of the botulism syndrome including absence of fever, symmetric neurologic deficits, the patients remaining responsive and no sensory deficits, with the exception of blurred vision, led to the clinical diagnosis in the first presenting case which was then easily made in the second. Despite the fact that amount of toxin ingested, time-to-symptom development, and time-to-recovery markedly differed in the two patients, their maximal disease severity was similar.
Assuntos
Antitoxina Botulínica/uso terapêutico , Botulismo/terapia , Verduras , Adulto , Botulismo/patologia , Botulismo/reabilitação , Cuidados Críticos , Feminino , Conservação de Alimentos , Humanos , Pessoa de Meia-Idade , Respiração ArtificialRESUMO
Giant cell arteritis is a systemic vasculitis with segmentary vascular localisation, usually manifesting as temporal arteritis (Horton's disease). The predominant localisation in different vascular districts leads to clinical heterogeneity and poses a considerable diagnostic challenge. We describe a 77-year old woman with atypical presentation of giant cell arteritis, suffering from fever, weight loss and fatigue, but without classical symptoms such as polymyalgias, arthralgias and headache. The findings of pericardial effusion and thickening of aortic wall in chest-CT suggested the diagnosis of giant cell arteritis, fully confirmed by the following biopsy and histologic examination of a macroscopically and palpatory normal arteria temporalis. Undergoing an appropriate corticosteroid-medication the patient has been free of symptoms since 8 months.