Effect of transcranial direct current stimulation on neurological injury markers and prognosis in patients with acute and severe carbon monoxide poisoning / 中华劳动卫生职业病杂志

Objective: To observe the effects of transcranial direct current stimulation (tDCS) on nerve injury markers and prognosis in patients with acute severe carbon monoxide poisoning (ASCOP) . Methods: In May 2021, 103 ASCOP patients were treated in the emergency department of Harrison International Peace Hospital of Hebei Medical University from November 2020 to January 2021. The patients were divided into two groups according to whether they received tDCS treatment. The control group (50 cases) were given oxygen therapy (hyperbaric oxygen and oxygen inhalation) , reducing cranial pressure, improving brain circulation and cell metabolism, removing oxygen free radicals and symptomatic support, and the observation group (53 cases) was treated with 2 weeks of tDCS intensive treatment on the basis of conventional treatment. All patients underwent at least 24 h bispectral index (BIS) monitoring, BIS value was recorded at the hour and the 24 h mean value was calculated. Neuron-specific enolase (NSE) and serum S100B calcium-binding protein (S100B) were detected after admission, 3 d, 7 d and discharge. Follow-up for 60 days, the incidence and time of onset of delayed encephalopathy (DEACMP) with acute carbon monoxide poisoning in the two groups were recorded. Results: The NSE and S100B proteins of ASCOP patients were significantly increased at admission, but there was no significant difference between the two groups (P=0.711, 0.326) . The NSE and S100B proteins were further increased at 3 and 7 days after admission. The increase in the observation group was slower than that in the control group, and the difference was statistically significant (P(3 d)=0.045, 0.032, P(7 d)=0.021, 0.000) ; After 14 days, it gradually decreased, but the observation group decreased rapidly compared with the control group, with a statistically significant difference (P=0.009, 0.025) . The 60 day follow-up results showed that the incidence of DEACMP in the observation group was 18.87% (10/53) , compared with 38.00% (19/50) in the control group (P=0.048) ; The time of DEACMP in the observation group[ (16.79±5.28) d] was later than that in the control group[ (22.30±5.42) d], and the difference was statistically significant (P=0.013) . Conclusion: The early administration of tDCS in ASCOP patients can prevent the production of NSE and S100B proteins, which are markers of nerve damage. and can improve the incidence and time of DEACMP.

The Pathology of Primary Familial Brain Calcification: Implications for Treatment / 神经科学通报·英文版

Primary familial brain calcification (PFBC) is an inherited neurodegenerative disorder mainly characterized by progressive calcium deposition bilaterally in the brain, accompanied by various symptoms, such as dystonia, ataxia, parkinsonism, dementia, depression, headaches, and epilepsy. Currently, the etiology of PFBC is largely unknown, and no specific prevention or treatment is available. During the past 10 years, six causative genes (SLC20A2, PDGFRB, PDGFB, XPR1, MYORG, and JAM2) have been identified in PFBC. In this review, considering mechanistic studies of these genes at the cellular level and in animals, we summarize the pathogenesis and potential preventive and therapeutic strategies for PFBC patients. Our systematic analysis suggests a classification for PFBC genetic etiology based on several characteristics, provides a summary of the known composition of brain calcification, and identifies some potential therapeutic targets for PFBC.

Manifestaciones neurológicas graves de la gripe durante la temporada gripal 2018-2019: serie de casos de 13 pacientes pediátricos / Severe neurological manifestations of influenza during 2018-2019 influenza season: Case series of 13 pediatric patients

La gripe se asocia al aparato respiratorio, especialmente en invierno, y puede causar complicaciones neurológicas. Se evaluó a pacientes pediátricos con manifestaciones neurológicas graves por gripe desde septiembre de 2018 hasta febrero de 2019 para determinar características clínicas, neuroimagenología, tratamiento y resultados. El objetivo fue evaluar la encefalitis asociada a la gripe y destacar diferentes manifestaciones neurológicas y cambios de neuroimagenología. El estudio incluyó a 13 pacientes. Los síntomas neurológicos ocurrieron tras los síntomas típicos de la gripe. Los cambios de neuroimagenología incluyen alteraciones de señal de la sustancia blanca cortical y subcortical, edema localizado o generalizado y lesiones multifocales simétricas bilaterales en el tálamo y la médula del cerebelo. Las opciones terapéuticas incluyen metilprednisolona en inyección intravenosa, inmunoglobulina intravenosa, plasmaféresis y oseltamivir. Es fundamental considerar la encefalitis asociada a la gripe en pacientes con convulsiones, la encefalopatía con hallazgos radiológicos compatibles, e iniciar el tratamiento lo antes posible

Influenza is mostly associated with the respiratory tract system, especially in the winter season. Various neurological complications could occur due to influenza infection. Pediatric patients who had severe neurological manifestations due to influenza infection from September 2018 to February 2019 were evaluated for clinical characteristics, neuroimaging studies, treatment, and outcome. We aimed to assess Influenza-associated encephalitis in children, emphasize different neurological manifestations and neuroimaging changes. Thirteen patients were included in the study. Neurological symptoms occurred after flu-like symptoms. Neuroimaging changes of influenza-associated encephalitis/encephalopathy include cortical and subcortical white matter signal alterations, localized or generalized edema, and bilateral symmetrical multifocal lesions on the thalamus and cerebellar medulla. Pulse methylprednisolone, intravenous immunoglobulin, plasma exchange, and oseltamivir are the therapy choices. It is essential to consider influenza-associated encephalitis in patients with seizures, encephalopathy with supporting radiological findings, especially during the influenza season and starting treatment as fast as possible for better outcomes.

Encefalopatia reversível induzida por contraste após embolização com espiras por epistaxe / Reversible contrast-induced encephalopathy after coil embolization of epistaxis

RESUMO Uma mulher com 37 anos de idade, gestante de 35 semanas, foi admitida em um hospital local em razão de epistaxe grave, que resultou em choque e em necessidade de realização de cesárea emergencial. Após falha do tamponamento para controlar a hemorragia, decidiu-se por tratamento angiográfico. Após o procedimento, ela foi admitida à unidade de terapia intensiva neurocrítica, encontrando-se confusa e agitada, com necessidade de sedação e intubação orotraqueal. Na unidade de terapia intensiva, as investigações incluíram exames de ressonância magnética, punção lombar com painel viral, eletroencefalograma, testes para autoimunidade e avaliações hidroeletrolítica e metabólica. O exame de ressonância magnética mostrou área puntiforme restrita na corona radiata esquerda nas sequências de imagens pesadas em difusão, além de leve edema cortical posterior (sem restrição à difusão), e o eletroencefalograma mostrou atividade lenta difusa moderada, atividade frontoparietal lenta e escassos componentes paroxísticos associados no hemisfério esquerdo. Outros exames não mostraram alterações relevantes. Por causa da relação temporal e da história clínica, assim como imagens de ressonância magnética, formulou-se o diagnóstico de encefalopatia induzida por contraste. A sedação foi retirada após 2 dias na unidade de terapia intensiva, e a paciente foi extubada, verificando-se completa recuperação neurológica dentro das 24 horas seguintes.

ABSTRACT A 37-year-old woman (35 weeks pregnant) was admitted to a local hospital due to severe epistaxis resulting in shock and the need for emergency cesarean section. After failure to tamponade the bleeding, angiographic treatment was provided. After the procedure, she was admitted to the neurocritical intensive care unit and was confused and agitated, requiring sedation and endotracheal intubation. In the intensive care unit, diagnostic investigations included brain magnetic resonance imaging, lumbar puncture with viral panel, electroencephalogram, tests for autoimmunity, and hydroelectrolytic and metabolic evaluations. Magnetic resonance imaging showed a puntiform restricted diffusion area on the left corona radiata on diffusion weighted imaging and mild cortical posterior edema (without restricted diffusion), and an electroencephalogram showed moderate diffuse slow activity and fronto-temporal slow activity of the left hemisphere with associated scarce paroxysmal components. The other exams did not show any relevant alterations. Due to the temporal relationship, the clinical history and the magnetic resonance imaging results, a diagnosis of contrast-induced encephalopathy was made. After 2 days in the intensive care unit, sedation was withdrawn, the patient was extubated, and total neurological recovery was verified within the next 24 hours.

Bruns Syndrome Caused by Intraventricular Neurocysticercosis: Literature Review

Bruns syndrome is one of the clinical presentations of intraventricular neurocysticercosis, and it is characterized by episodes of headache, vertigo and vomiting. The intraventricular form of neurocysticercosis occurs in 7% to 20% of the cases, and it is more serious than the intraparenchymal form. The management is primarily surgical, associated with pharmacological therapy with anthelmintic drugs and corticosteroids. We report the case of a patient who presented Bruns syndrome due to neurocysticercosis.

Terapia de oxigenación hiperbárica en el tratamiento del dolor / Hyperbaric oxygenation therapy in pain treatment

El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)

Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)

Complications of otitis media - a potentially lethal problem still present / Complicações das otites média - um problema potencialmente letal ainda presente

ABSTRACT INTRODUCTION: It is an erroneous but commonly held belief that intracranial complications (ICCs) of chronic and acute otitis media (COM and AOM) are past diseases or from developing countries. These problems remain, despite improvements in antibiotic care. OBJECTIVE: This paper analyzes the occurrence and clinical characteristics and course of the main ICCs of otitis media (OM). METHODS: Retrospective cohort study of 51 patients with ICCs from OM, drawn from all patients presenting with OM to the emergency room of a large inner-city tertiary care hospital over a 22-year period. RESULTS: 80% of cases were secondary to COM of which the incidence of ICC was 0.8%; 20% were due to AOM. The death occurrence was 7.8%, hearing loss in 90%, and permanent neurological sequelae in 29%. Patients were 61% male. In the majority, onset of ear disease had occurred during childhood. Delay of diagnosis of both the initial infection as well as the secondary ICC was significant. ICCs included brain abscess and meningitis in 78%, and lateral sinus thrombosis, empyema and otitic hydrocephalus in 13%, 8% and 1% of cases, respectively. Twenty-seven neurosurgical procedures and 43 otologic surgery procedures were performed. Two patients were too ill for surgical intervention. CONCLUSION: ICCs of OM, although uncommon, still occur. These cases require expensive, complex and long-term inpatient treatment and frequently result in hearing loss, neurological sequelae and mortality. It is important to be aware of this potentiality in children with COM, especially, and maintain a high index of suspicion in order to refer for otologic specialty care before such complications occur.

Resumo Introdução: É uma crença comum, porém errônea, que complicações intracranianas (CICs) de otite média tanto aguda (OMA) quanto crônica (OMC) sejam doenças do passado ou de países em desenvolvimento. No entanto, esses problemas continuam, apesar de melhorias na terapia antimicrobiana. Objetivo: Analisar a ocorrência, as características clínicas e a evolução das principais CICs secundárias às otites médias (OM) Método: Estudo de coorte retrospectivo de 51 pacientes com CIC secundárias a OM, provenientes do pronto-socorro de um Hospital Universitário ao longo de um período de 22 anos. Resultado: No total, 80% dos casos de CICs foram secundários a OMC, cuja incidência foi de 0,8%, e apenas 20% foram secundárias a OMA. A letalidade foi de 7,8%, perda auditiva em 90%, com sequela neurológica permanente em 29%. Dentre os pacientes, 61% eram do sexo masculino. Na maioria, o início da doença otológica tinha ocorrido durante a infância. A demora no diagnóstico, tanto da infecção primária como da complicação secundária, foi significativa. CICs, incluindo abscesso cerebral e meningite, corresponderam a 78%, e trombose do seio lateral, empiema e hidrocefalia otítica em 13%, 8% e 1% dos casos, respectivamente. Foram realizados 27 procedimentos neurocirúrgicos e 43 cirurgias otológicas. Dois pacientes não apresentavam condições clínicas para a intervenção cirúrgica Conclusão: CICs de OM, embora incomuns, ainda ocorrem. Esses casos exigem tratamento hospitalar oneroso, complexo e de longo prazo, e frequentemente resultam em perda auditiva, sequelas neurológicas e mortalidade. É importante estar ciente dessa potencialidade especialmente em crianças com OMC e manter um alto índice de suspeita, encaminhar para avaliação otológica e antecipar a ocorrências de tais complicações.

Caracterización sociodemográfica y clínica de la población atendida en el Instituto Teletón de Santiago / Sociodemographic and clinical characteristic of the population attended in the Instituto Teletón de Santiago

Los Institutos Teletón atienden al 85% de la población infantil chilena con discapacidad neuro-músculo-esquelética, concentrando el mayor porcentaje de esta población. Sin embargo, no existen registros que permitan caracterizar esta población. Objetivo: Caracterizar la población de pacientes atendidos en el Instituto Teletón de Santiago durante el año 2012. Pacientes y método: Se analizaron las características sociodemográficas de los registros electrónicos del Instituto Teletón de Santiago de los pacientes activos que se atendieron durante el año 2012. Resultados: Durante el año 2012 se atendió un total de 8.959 pacientes en el Instituto Teletón de Santiago. En relación con el nivel socioeconómico, un 33,3% de estos correspondieron a extrema pobreza, y un 28,7% a nivel medio bajo. Con respecto a los diagnósticos clínicos principales se encontró que la parálisis cerebral y otras encefalopatías que también llevan a discapacidad motora concentran el 55,4% de los casos. Conclusiones: Como producto de esta caracterización, sería adecuado fomentar la necesidad de optimizar el registro nacional de la población infantil con discapacidad y sus características particulares, para así poder tomar decisiones de políticas públicas, como destinación de fondos o programas de apoyo.

The Institutos Teletón care for 85% of the Chilean child population with neuromusculoskeletal disability, the large percentage concentrating in this population. However, there are no registers that enable a profile to be determined on this population. Objective: To determine the profile of patients attending the Instituto Teletón de Santiago during the year 2012. Patients and method: The sociodemographic characteristics were analyzed from the computerised records of the Instituto Teletón de Santiago on active patients who were seen during the year 2012. Results: A total of 8,959 patients were seen during the study year in the Instituto Teletón de Santiago. As regards socioeconomic level, 33.3% were in extreme poverty, 28.7% to low-middle level. The main clinical diagnoses were cerebral palsy and other encephalopathies that also lead to motor disability, and accounted for 55.4% of the cases. Conclusions: As a result of determining this profile, it would be appropriate to encourage the need for a national register of the child population with disability, as well as their particular characteristics in order to make decisions on public policy, as a destination for funds or support programs.

Presente y futuro de la estimulación magnética transcraneal / Present and future of the transcranial magnetic stimulation

La estimulación magnética transcraneal ha llamado la atención de neurocientíficos y público en general por la posibilidad de estimular y “controlar” el sistema nervioso de forma no invasiva, realizar diagnósticos más exactos, y aplicar tratamientos y programas de rehabilitación más efectivos en múltiples enfermedades que afectan el sistema nervioso. Así mismo, esta novedosa herramienta ha ayudado a develar la complejidad del comportamiento neural, sus conexiones y su modulación plástica. La estimulación magnética aplicada de manera simple o pareada, se ha convertido en una alternativa útil en el diagnóstico de enfermedades como esclerosis múltiple, enfermedad de Parkinson, epilepsia, distonía, esclerosis lateral amiotrófica, enfermedad cerebro vascular, así como el sueño y sus trastornos, entre otras alteraciones. A nivel terapéutico, se ha sugerido el uso de la estimulación magnética repetitiva con diferentes niveles de evidencia en depresión refractaria a tratamiento farmacológico convencional, tinitus, afonía psicógena, enfermedad de Alzheimer, autismo, enfermedad de Parkinson, distonías, accidente cerebro vascular, epilepsia, trastornos de ansiedad generalizada, estrés post-traumático, alucinaciones auditivas, dolor crónico, afasias, trastorno obsesivo compulsivo, disquinesias inducidas por L-Dopa, manía y síndrome de Rasmussen, entre otros trastornos. Su beneficio en neurorehabilitación es una realidad inocultable, en cuyo caso se ha podido usar con efectividad y, prácticamente, sin efectos secundarios.

Magnetic stimulation has called the attention of neuroscientists and the public due to the possibility to stimulate and “control” the nervous system in a non-invasive way. It has helped to make more accurate diagnosis, and apply more effective treatments and rehabilitation protocols in several diseases that affect the nervous system. Likewise, this novel tool has increased our knowledge about complex neural behavior, its connections as well as its plastic modulation. Magnetic stimulation applied in simple or paired-pulse protocols is a useful alternative in the diagnosis of diseases such as multiple sclerosis, Parkinson disease, epilepsy, dystonia, amyotrophic lateral sclerosis, cerebrovascular disease, and sleep disorders. From the therapeutic perspective, magnetic stimulation applied repetitively has been found useful, with different degrees of efficacy, in treating resistant depression, tinnitus, psychogenic dysphonia, Alzheimer disease, autism, Parkinson disease, dystonia, stroke, epilepsy, generalized anxiety as well as post traumatic stress disorder, auditory hallucinations, chronic pain, aphasias, obsessive-compulsive disorders, L-dopa induced dyskynesia, mania and Rasmussen syndrome, among others. The potential of magnetic stimulation in neurorehabilitation is outstanding, with excellent range of safety and, in practical terms, without side effects.

Clínica de crianças com transtornos: quando a preocupação está para além do orgânico / Clinic of children with neuromotor disorders: when the concern is beyond organic / Clínica de niños con trastornos neuromotores: cuando la preocupación está más allá de lo orgánico

Apesar de a constituição do sujeito não residir somente no orgânico, não podemos desconsiderar que limitações no real do corpo podem impor obstáculos no processo de constituição subjetiva. A partir de questionamentos da minha experiência clínica como fisioterapeuta neuropediátrica e do meu percurso acadêmico no curso de especialização em atendimento clínico - ênfase psicanálise, alguns interrogantes sobre a prática clínica com crianças com transtornos neuromotores foram surgindo. Testemunhando uma carência na articulação entre esses saberes, busquei encadear conhecimentos das duas especificidades objetivando propor uma clínica que tome a criança como um sujeito em constituição e não apenas preocupada com o real orgânico da lesão.

Even though the subject's constitution doesn't reside only in the organic, we can't disrespect that limitations in the real of body can impose obstacles in the process of the constitution of the subjectivity. Based on questions of my clinic experience as a neuropediatric physiotherapist and on a specialization course in clinical service with emphasis in psychoanalysis, some questions about clinical practice with children with disabilities came up. Attesting a scarcity on the articulation between these fields of knowledge, my attempt is to articulate knowledge of both specialties in order to propose a clinic that takes the child as a subject in constitution and not only concerned with the organic real of the lesion.

A despecho de la constitución sujetiva no residir solo en lo orgánico, no podemos desconsiderar que las limitaciones en lo real del cuerpo pueden imponer obstáculos en el proceso de constitución del sujeto. A partir de cuestionamientos de mi experiencia clínica como fisioterapeuta neuropediátrica y de mi percurso académico en el curso de especialización en atendimiento clínico - énfasis psicoanálisis, fueron surgiendo algunos interrogantes sobre la práctica clínica de niños con trastornos neuromotores. Percibiendo una carencia en la articulación entre esos saberes, busqué articular conocimientos de las dos especificidades a fin de proponer una clínica que tome al niño como un sujeto en constitución y no solamente preocupada con lo real orgánico de la lesión.

Resultados obtenidos en el manejo de enfermedades cerebrales mediante terapia endovascular / Results obtained in the management of brain disorders with endovascular therapy

Antecedentes: La terapia endovascular neurológica ha evolucionado rápidamente en un período de tiempo relativamente corto. Esta técnica ha pasado de sus propósitos iniciales, enfocados a pacientes en los que la cirugía abierta no representaba una buena opción, a convertirse en una corriente de la práctica cotidiana. Objetivo: Exponer los resultados obtenidos en pacientes con diversas patologías cerebrales abordados por terapia endovascular, durante un período de 24 meses, con la finalidad de analizar los beneficios de este método terapéutico. Metodología: Estudio observacional, retrospectivo, analítico, que incluye como población todos los pacientes con patología cerebral intervenidos mediante terapia endovascular, en el Grupo Hospitalario Kennedy, Centro de Intervencionismo Angio Manabí, Hospital Luis Vernaza y Clínica Guayaquil; durante el período comprendido entre junio de 2010 a mayo de 2012. Resultados: Las patologías más diagnosticadas fueron aneurismas cerebrales con 75 por ciento (n = 175) de los casos, seguido por malformaciones arteriovenosas con 14 por ciento (n = 33). Las complicaciones observadas fueron migración de coil y ruptura de un aneurisma durante su embolización. Se observó una mortalidad total de 2,82 por ciento, relacionada con mal estado clínico y alto grado imagenológico de pacientes con aneurismas cerebrales. Posterior a la intervención, 96,23 por ciento (n = 204) de los pacientes permanecen en grado Rankin 1. Conclusiones: La terapia endovascular neurológica ha obtenido resultados altamente satisfactorios en diversas patologías del sistema nervioso, con bajo índice de complicaciones y morbimortalidad; constituyendo así una excelente elección en el manejo de estas patologías.

Background: Endovascular therapy has evolved rapidly over a relatively short period of time. This technique has evolved from its initial purposes, to treat patients for whom no good open surgical option existed, to become a mainstream of everyday practice. Objective: To present obtained results in patients with brain diseases approach by endovascular therapy, for a period of 24 months, in order to analyze the benefits of this therapeutic method. Methodology: Observational, retrospective, analytical study, of all patients with brain diseases treated by endovascular therapy at Grupo Hospitalario Kennedy, Centro de Intervencionismo AngioManabí, Hospital Luis Vernaza and Clínica Guayaquil, from June 2010 to May 2012. Results: Conditions most commonly diagnosed were brain aneurysms with 75 percent (n = 175) of cases, followed by arteriovenous malformations with 14 percent (n = 33). Complications observed were coil migration in two cases, and aneurysms rupture during the embolization. There was a total mortality of 2,82 percent, related to poor clinical condition and high imaging grade in patients with intracranial aneurysms. After intervention, 96,23 percent (n = 204) of the patients are in Rankin grade 1. Conclusions: Endovascular therapy has achieved highly satisfactory results in several diseases of the nervous system, with low rate of complications and morbid-mortality, making it an excellent choice in the management of these pathologies.

Empiema cerebral por Escherichia coli en un lactante de 5 meses: reporte de caso y revisión del tema / Brain empyema due to Escherichia coli in a 5 month-old infant: a case report and literature review

Introducción: el empiema cerebral en pediatría es una rara infección intracraneal que puede ser secundaria a una meningitis, sinusitis, o por mecanismos como trauma craneal, cirugía neurológica o como resultado de la diseminación hematógena desde un sitio remoto. Objetivo: describir un caso de empiema cerebral causado por Escherichia coli en un lactante. Metodología: presentar un caso clínico, con aislamiento de Escherichia coli fuera del periodo gris de la meningitis. Se realiza una revisión acerca de los factores de riesgo, la etiología y tratamiento del empiema cerebral en niños. Resultados: masculino de 5 meses, sin inmunodeficiencia, cráneo con plagiocefalia; antecedente de otitis de 3 semanas de evolución previo a su ingreso al hospital. El paciente manifestó fiebre, crisis convulsivas y deterioro rostro-caudal. El líquido cefalorraquídeo con pleocitosis e hipoglucorraquia. Las imágenes tomográficas revelaron la presencia de empiema cerebral. Se logró el aislamiento de Escherichia coli en el cultivo, requirió drenaje quirúrgico y antibioticoterapia sistémica por 4 semanas. Conclusiones: el empiema cerebral por Escherichia coli en lactantes después del periodo gris es muy raro. Su tratamiento consiste en la evacuación quirúrgica oportuna, la erradicación del foco infeccioso primario y la administración apropiada de antimicrobianos sistémicos.

Introduction: Brain empyema in children is a rare intracranial infection that may result from meningitis, sinusitis, or mechanisms such as head trauma, neurological surgery or hematogenous spread from a remote site. Objective: To describe a case of brain empyema caused by Escherichia coli in an infant. Methodology: A case report is presented with isolation of Escherichia coli arising after the overlap period of meningitis (1-3 months). A literature review of the risk factors, etiology and treatment of brain empyema in children is conducted. Results: The case report is about a 5 month-old male infant with no history of immunodeficiency, plagiocephalic, and with a 3 week-long history of otitis prior to admission. The patient had fever, seizures and rostro-caudal deterioration, cerebrospinal fluid pleocytosis and hypoglycorrhachia. The tomographic images revealed brain empyema. It was posible to isolate Escherichia coli from culture and surgical drainage was required plus systemic antibiotic therapy for 4 weeks. Conclusions: Brain empyema caused by Escherichia coli in infants after the overlap period are very rare. Treatment consists in prompt surgical evacuation, eradication of the primary infection and proper administration of systemic antimicrobials.

Stereotactic surgery: diagnostic and therapeutic role in the management of brain disorders and our experience at Ibn Sina hospital

To present the results of our experience with stereotactic surgery, which is a safe and minimally invasive technique, in the field of neurosurgery. Prospective study. Department of Neurosurgery, Ibn Sina Hospital, Kuwait. Forty patients underwent stereotactic surgery for diagnostic and therapeutic purposes during the five years between 2006 and 2011. There were 26 male and 14 female patients with a mean age of 47 years [range 9 - 70 yrs]. Twenty seven [67.5%] patients had diagnostic brain procedures and 13 [32.5%] had diagnostic as well as therapeutic procedures. The stereotactic surgery was carried out with the help of computerized tomography [CT] - guided Leksell stereotactic frame[registered] and Leksell SurgiPlan[registered] software. Stereotactic surgery. Outcome of surgery and complications. Stereotactic biopsies confirmed 28 [70%] patients with brain tumors; six [14%] with cerebral infections, four [10%] with multiple sclerosis and one with cerebral infarction. Stereotactic aspirations were performed in nine patients; four with cystic brain tumors and five with brain abscesses. Stereotactic insertion of Ommaya reservoir was performed in four patients with cystic brain lesions. Complication, related to the procedure was observed only in one patient and was managed conservatively. No other morbidity or mortality was noted. Stereotactic surgery is a minimal invasive technique that helps the neurosurgeon in further planning of an appropriate treatment after tissue biopsy. It can also be used as primary mode of treatment in patients with brain abscesses, cysts and intracranial hematomas

Sepsis-associated encephalopathy: not just delirium

Sepsis is a major cause of mortality and morbidity in intensive care units. Organ dysfunction is triggered by inflammatory insults and tissue hypoperfusion. The brain plays a pivotal role in sepsis, acting as both a mediator of the immune response and a target for the pathologic process. The measurement of brain dysfunction is difficult because there are no specific biomarkers of neuronal injury, and bedside evaluation of cognitive performance is difficult in an intensive care unit. Although sepsis-associated encephalopathy was described decades ago, it has only recently been subjected to scientific scrutiny and is not yet completely understood. The pathophysiology of sepsis-associated encephalopathy involves direct cellular damage to the brain, mitochondrial and endothelial dysfunction and disturbances in neurotransmission. This review describes the most recent findings in the pathophysiology, diagnosis, and management of sepsis-associated encephalopathy and focuses on its many presentations.

La eficacia de la terapia de movimiento inducido por restricción se relaciona con la neuroplasticidad: [revisión] / Constraint-induced movement therapy promotes neuroplasticity after stroke: mechanisms of neuroplasticity: [review]

Existe cada vez más información que permite sugerir que no es únicamente el cerebro el que controla e interpreta las experiencias. En cambio, las experiencias individuales pueden tener un efecto recíproco sobre la estructura y el funcionamiento cerebral. Dicho efecto fue observado en humanos a nivel macroscópico mediante resonancia magnética estructural funcional y, a nivel sináptico, en roedores. En el presente estudio se evaluó el efecto de las experiencias sobre la estructura cerebral y el modo de obtención de neuroplasticidad mediante paradigmas de rehabilitación con el objetivo de fomentar una recuperación funcional más adecuada luego del daño neuronal.

Therapeutic Hypothermia for Neonatal Encephalopathy Implications for Neonatal Units in India.

Therapeutic hypothermia has recently emerged from bench to bedside. Three large multicenter trials from industrialized countries and three independent meta-analyses have shown its efficacy in reducing death and disability following neonatal encephalopathy due a perinatal hypoxic event. Many neonatal units in well-resourced settings now offer hypothermia as standard care in neonatal encephalopathy. However, these results cannot be extrapolated to low resource settings due to differences in population, risk benefits and high cost. Use of therapeutic hypothermia in low resource settings should be considered experimental and should therefore be restricted to well equipped level 2 and 3 neonatal units. The safety and efficacy of hypothermia using novel low technology methods need to be examined in rigorously controlled multicenter randomized controlled trials in these neonatal units before it can be offered as a standard care, as the risks may outweigh the benefits. The current practice of maintaining normothermia should continue, until such evidence is available.

Prevenção das doenças cerebrovasculares no Brasil, no âmbito da atenção primária à saúde / Prevention of cerebrovascular diseases in Brazil within primary health care

As doenças crônicas não transmissíveis (DCNT) estão posicionadas no topo das enfermidades em termos de morbimortalidade, no Brasil e no mundo. Entre estas, as doenças cardiovasculares (DCV), e particularmente, as cerebrovasculares (DCbV), produzem um impacto significativo sobre a autonomia das pessoas, desfalcando a força de trabalho das nações e gerando um alto custo para a previdência social de todos os países. No Brasil, só muito recentemente as enfermidades circulatórias passaram a ser contempladas por políticas públicas formuladas pelo Ministério da Saúde (MS), não só pela manutenção destas doenças em altos patamares de morbimortalidade, mas também pelo crescimento exponencial de alguns dos seus fatores de risco. Partindo do pressuposto que as políticas e programas oficiais não estão sendo efetivamente implementados no âmbito da Atenção Primária à Saúde (APS), o objetivo do presente estudo foi investigar e analisar como estas iniciativas do MS vem sendo efetivamente executadas em Juiz de Fora- MG. A estratégia utilizada para essa investigação consistiu em uma pesquisa qualiquantitativa com base em observação, documentos e entrevistas semi-estruturadas com os diferentes componentes profissionais das Equipes de Saúde da Família de três unidades básicas de saúde do município citado. Foram entrevistados 40 profissionais de saúde, entre médicos, enfermeiros e agentes comunitários de saúde, buscando-se entender como os programas governamentais com interface com a prevenção das doenças cardiovasculares e, em especial, cerebrovasculares, vêm sendo implementados ao nível do Programa de Saúde da Família. Na comparação entre o que é recomendado nos programas governamentais e o que vem sendo executado nas UBS, concluiu-se que ainda há um longo caminho a ser percorrido para que estes programas sejam efetivamente implementados na porta de entrada do sistema de saúde.

Encefalitis aguda: Manifestaciones neuropsiquiátricas como expresión de infección por virus de influenza / Acute encephalitis: Neuropsychiatric manifestations as expression of influenza virus infection

El objetivo fue revisar la encefalitis en niños y adolescentes, su etiología, manifestaciones clínicas, fisiopatología, métodos diagnósticos y tratamiento, enfatizando las manifestaciones neuropsiquiátricas de la encefalitis durante una epidemia de influenza. La encefalitis se considera una inflamación del sistema nervioso central (SNC) que compromete el cerebro. Se manifiesta usualmente por cefaleas, fiebre y trastorno del estado de conciencia. Puede además manifestarse por convulsiones, cambios en la personalidad y manifestaciones obsesivas (síntomas neuropsiquiátricos). Las manifestaciones dependerán del tipo de virus y las células afectadas. La encefalitis puede ser causada por una gran variedad de agentes infecciosos incluyendo virus, bacterias, hongos y parásitos. Causas virales de encefalitis incluyen herpesvirus, arbovirus, rabia y enterovirus. Casos establecidos de bacterias incluyen Borrelia burgdorferi y rickettsia y el Mycoplasma neumoniae, al cual se atribuyen varios casos de encefalitis. Otros agentes como el hongo Coccidioides immitis e Histoplasma capsulatum pueden también generarla. Más de 100 agentes se han asociado a encefalitis. El diagnóstico de encefalitis constituye un reto para el clínico, y su etiología infecciosa usualmente se identifica entre el 40% al 70% de casos. El diagnóstico se hace con absoluta certeza sólo con una biopsia cerebral. La epidemiología depende de ciertos factores como la edad, la localización geográfica, la época del año, las condiciones climáticas y la inmunocompetencia del huésped. El tratamiento temprano puede disminuir el riesgo de muerte y las secuelas. Describimos cuatro pacientes con encefalitis y manifestaciones neuropsiquiátricas durante una epidemia de influenza, con el fin de alertar sobre esta asociación.

The aim is to review the encephalitis in infants and adolescents as well as its etiology, clinical manifestation, epidemiology, physiopathology, diagnostic methods and treatment, and the neuropsyquiatric signs appearing an influenza epidemy. Encephalitis is an inflammation of the central nervous system (CNS) which involves the brain. The clinical manifestations usually are: headache, fever and confusional stage. It could also be manifested as seizures, personality changes, or psiqyiatric symptoms. The clinical manifestations are related to the virus and the cell type affected in the brain. A meningitis or encephalopathy need to be ruled out. It could be present as an epidemic or isolated form, beeing this the most frequent form. It could be produced by a great variety of infections agents including virus, bacterias, fungal and parasitic. Viral causes are herpesvirus, arbovirus, rabies and enterovirus. Bacterias such as Borrelia burgdorferi, Rickettsia and Mycoplasma neumoniae. Some fungal causes are: Coccidioides immitis and Histoplasma capsulatum. More than 100 agents are related to encephalitis. The diagnosis of encephalitis is a challenge for the clinician and its infectious etiology is clear in only 40 to 70% of all cases. The diagnosis of encephalitis can be established with absolute certainty only by the microscopic examination of brain tissue. Epidemiology is related to age of the patients, geographic area, season, weather or the host immune system. Early intervention can reduce the mortality rate and sequels. We describe four patients with encephalitis and neuropsychiatric symptoms during an influenza epidemic.

Cerebral aspergillosis presenting as a mass lesion

Fungal infections of the central nervous system (CNS) are almost always a surprising finding. Their presentation is usually subtle, often without any diagnostic characteristics, and they are frequently mistaken for pyogenic abscesses, or brain tumors. Aspergillosis of the central nervous system is an uncommon infection, mainly occurring in immunocompromised patients. It may present in several forms, including meningitis, mycotic aneurysms, infarcts and a tumoral form. We report an intracranial granuloma due to Aspergillus fumigatus involving the anterior cranial fossa and the frontal lobe. The clinical symptoms began one year before admission. Final diagnosis was made after craniotomy. The patient was treated with an extensive excision of the cerebral mass and medical antifungal therapy (intravenous amphotericin B), but she failed to respond to these treatments and died.

[Determination of sialyl transferase activity and effect of phosphorylation and dephosphorylation mechanisms]

Previous reports show that phosphorylation and dephosphorylation mechanisms involve in regulation of sialyl transferase activity. The aim of this research was to study sialyl transferase activity with phosphorylation and dephosphorylation mechanisms. This experimental trial study performed on 25 rats without signs of illness. Rat brains were pulled out and brain homogenization was done and then sialyl transferase purified from rat brain. Homogenization of rat brain is performed in the cephadex chromatography. We added protein kinaseokadaic acid and forbol to different groups. Data were statistically analyzed using SPSS soft wave. Results showed a significant increase in sialyl transferase activity in the control group, comparing with protein kinase C and okadaic acid groups. Results showed a significant decrease in sialyl transferase activity in control group, comparing with protein phosphatase and forbol groups. Our findings show that sialyl transferase of rat brain with protein kinase decreases enzyme activity and these results were in accordance with other studies in this respect. We found that treatment of rat brain sialyl transferase by protein phosphatase increases its activity