RESUMO
OBJECTIVE: The purpose of this study is to bring attention to a case of acute encephalitis not concurrent with acute cerebellitis. CASE PRESENTATION: Five days after onset of common cold symptoms, a 17-months-old girl suffered convulsions, vomiting and respiratory arrest. On exam, she had pharyngeal inflammation, brisk deep tendon reflexes, respiratory acidosis, leukocytosis, negative rapid antigen tests, and segmental pneumonia. Brain CT and MRI/MRA were negative, and EEG was consistent with acute encephalitis. Following hypothermic therapy, methylprednisolone pulse therapy and cefotaxime, she recovered. Four days after discharge, she sustained limb and truncal ataxia associated with normal EEG, followed by bilateral intention tremor. Blood and CSF chemistry and cell counts were normal. Brain MRI revealed high intensity signals in the dentate nuclei and enhancement in the cerebellar white matter, suggestive of acute cerebellitis/cerebellopathy. SPECT imaging showed reduced blood flow in the cerebellum, right thalamus and brain stem. Following short-term administration of g-globulin and prednisolone, she regained her ability to sit and, eventually, to walk. Four months after initial presentation, her brain MRI was normal. No relapse has occurred in 5 years. CONCLUSIONS: The uncommon sequential development of acute encephalitis followed by acute cerebellitis suggests an immune-mediated cerebellar ataxia.
Assuntos
beta-Globulinas/uso terapêutico , Doenças Cerebelares/tratamento farmacológico , Encefalite/tratamento farmacológico , Prednisolona/uso terapêutico , Doença Aguda , beta-Globulinas/administração & dosagem , Doenças Cerebelares/patologia , Encefalite/patologia , Feminino , Humanos , Lactente , Prednisolona/administração & dosagemRESUMO
In 1981, President Ronald Reagan became the first incumbent president of the United States to survive being struck by a would-be assassin's bullet. Had President Reagan not survived, the history of this country and the world most certainly would have been changed. This report is the only first-hand account of the details of his medical care and complications following the assassination attempt, an event that emphasizes the vulnerability of presidents to would-be assassins and the importance of readily available expert medical care and facilities to their survival.
Assuntos
Pessoas Famosas , Traumatismos Torácicos , Ferimentos por Arma de Fogo , Idoso , beta-Globulinas/uso terapêutico , Hepatite B/etiologia , Hepatite B/prevenção & controle , História do Século XX , Administração Hospitalar , Humanos , Masculino , Meios de Comunicação de Massa , Padrões de Prática Médica , Sobreviventes , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/história , Traumatismos Torácicos/terapia , Reação Transfusional , Estados Unidos , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/história , Ferimentos por Arma de Fogo/terapia , gama-Globulinas/uso terapêuticoRESUMO
Injection of blood serum alpha-beta-globulins during burn shock normalizes the amount of middle mass molecular peptides, acid proteinase activity, acid-base balance, and hemodynamics in irradiated rats. The survival of animals in this period increases from 23% to 52%.