ABSTRACT
INTRODUCTION: Pneumococcal meningitis is a condition associated with a high rate of morbidity and mortality. CASE REPORT: We report the clinical case of a 41-year-old man who, following meningitis caused by Streptococcus pneumoniae, developed subsequent complications such as thoracic transverse myelitis, which caused paralysis in the lower extremities, abolition of all sensory modalities and dysautonomic disorders, as well as an alteration of the anterior horn cells at the cervical level that produced paralysis in the upper extremities, but with preservation of sensibility. This implies the need for a differential diagnosis between what is known as 'poliomyelitis-like' disorder and acute disseminated encephalomyeloradiculitis. The examination and the radiological and neurophysiological study showed a full clinical recovery of the upper extremities, thanks in part to early neurorehabilitation. CONCLUSIONS: Complications of the spinal cord within the context of infection of the central nervous system are very rare. Involvement of the anterior horn cells of the spinal cord has only been described anecdotally, and no bibliographical references have been found that associate it with S. pneumoniae.
TITLE: Multineuritis craneal y mielitis transversa como complicaciones de una meningitis neumocócica.Introducción. La meningitis neumocócica es una patología que asocia una elevada tasa de morbimortalidad. Caso clínico. Presentamos el caso clínico de un varón de 41 años que, tras una meningitis causada por Streptococcus pneumoniae, tuvo como complicaciones posteriores una mielitis transversa torácica que le ocasionó una plejía en las extremidades inferiores, abolición de todas las modalidades sensitivas y trastornos disautonómicos, así como una alteración de las astas anteriores a nivel cervical que produjo plejía en las extremidades superiores, pero con conservación de la sensibilidad. Esto plantea un diagnóstico diferencial entre la afectación denominada 'poliomielitis like' y una encefalomielorradiculitis diseminada aguda. La exploración y el estudio radiológico y neurofisiológico avalaron una recuperación clínica completa en las extremidades superiores, gracias, en parte, a una neurorrehabilitación precoz. Conclusiones. Las complicaciones medulares en el contexto de una infección del sistema nervioso central son muy infrecuentes. La afectación medular de astas anteriores se ha descrito únicamente de forma anecdótica, y no se han encontrado referencias bibliográficas que la asocien con S. pneumoniae.
Subject(s)
Meningitis, Pneumococcal , Myelitis, Transverse , Adult , Humans , Male , Meningitis, Pneumococcal/complications , Myelitis, Transverse/etiology , Paralysis , SkullABSTRACT
Introducción: La meningitis neumocócica es una patología que asocia una elevada tasa de morbimortalidad. Caso clínico: Presentamos el caso clínico de un varón de 41 años que, tras una meningitis causada por Streptococcus pneumoniae, tuvo como complicaciones posteriores una mielitis transversa torácica que le ocasionó una plejía en las extremidades inferiores, abolición de todas las modalidades sensitivas y trastornos disautonómicos, así como una alteración de las astas anteriores a nivel cervical que produjo plejía en las extremidades superiores, pero con conservación de la sensibilidad. Esto plantea un diagnóstico diferencial entre la afectación denominada poliomielitis like y una encefalomielorradiculitis diseminada aguda. La exploración y el estudio radiológico y neurofisiológico avalaron una recuperación clínica completa en las extremidades superiores, gracias, en parte, a una neurorrehabilitación precoz. Conclusiones: Las complicaciones medulares en el contexto de una infección del sistema nervioso central son muy infrecuentes. La afectación medular de astas anteriores se ha descrito únicamente de forma anecdótica, y no se han encontrado referencias bibliográficas que la asocien con S. pneumoniae.(AU)
Introduction: Pneumococcal meningitis is a condition associated with a high rate of morbidity and mortality. Case report: We report the clinical case of a 41-year-old man who, following meningitis caused by Streptococcus pneumoniae, developed subsequent complications such as thoracic transverse myelitis, which caused paralysis in the lower extremities, abolition of all sensory modalities and dysautonomic disorders, as well as an alteration of the anterior horn cells at the cervical level that produced paralysis in the upper extremities, but with preservation of sensibility. This implies the need for a differential diagnosis between what is known as poliomyelitis-like disorder and acute disseminated encephalomyeloradiculitis. The examination and the radiological and neurophysiological study showed a full clinical recovery of the upper extremities, thanks in part to early neurorehabilitation. Conclusions: Complications of the spinal cord within the context of infection of the central nervous system are very rare. Involvement of the anterior horn cells of the spinal cord has only been described anecdotally, and no bibliographical references have been found that associate it with S. pneumoniae.(AU)
Subject(s)
Humans , Male , Adult , Meningitis, Pneumococcal/complications , Myelitis, Transverse , Mononeuropathies , Streptococcus pneumoniae , Inpatients , Physical Examination , Neurology , Neurological RehabilitationABSTRACT
INTRODUCTION: High levels of homocysteine linked to treatment with levodopa have been observed in patients with Parkinsons disease (PD). Our aim was to assess the influence of serum homocysteine levels and other PD-related on the sympathetic skin response. PATIENTS AND METHODS: An observational, cross-sectional study was conducted that consecutively included patients with PD. We unilaterally assessed the sympathetic skin response in the upper limbs. We measured the influence of PD severity (measured by the Hoehn and Yahr and the Schwab and England scales, and the Unified Parkinson Disease Rating Scale) and blood homocysteine, vitamin B12 and folic acid levels on the latency and amplitude of the sympathetic skin response. RESULTS: A total of 78 patients were enrolled, and all achieved a sympathetic skin response. In the bivariate analysis, latency was significantly correlated with age, age at PD onset and homocysteinaemia levels. The presence of hyper-homocysteinemia was associated with a longer latency. The amplitude was only correlated with the score on the Schwab and England scale. In the multivariate analysis, age was the only variable that showed a significant association with the latency duration and homocysteine levels. CONCLUSION: A direct association could not be established between the increase in homocysteinaemia levels and sympathetic skin response dysfunction in PD. The results of the multivariate analysis suggest that latency prolongation in elderly patients could be due to the fact that these patients have higher blood levels of homocysteinaemia.
TITLE: Relacion entre homocisteinemia y respuesta simpaticocutanea en la enfermedad de Parkinson.Introduccion. En la enfermedad de Parkinson (EP) se han observado niveles elevados de homocisteina en relacion con el tratamiento con levodopa. Nuestro objetivo ha sido valorar su influencia y la de otras variables relacionadas con la propia EP sobre la respuesta simpaticocutanea. Pacientes y metodos. Estudio observacional, transversal, en el que se incluyo de forma consecutiva a pacientes con EP. Se valoro la respuesta simpaticocutanea de forma unilateral en los miembros superiores, y se determino la influencia de la gravedad de la EP segun la Unified Parkinson Disease Rating Scale, y las escalas de Hoehn y Yahr y de Schwab y England, y de los niveles sanguineos de homocisteina, vitamina B12 y acido folico sobre la latencia y amplitud de la respuesta simpaticocutanea. Resultados. Se incluyo a 78 pacientes. La respuesta simpaticocutanea se obtuvo en todos ellos. En el analisis bivariante, la latencia se correlaciono significativamente con la edad, con la edad de inicio de la EP y con los niveles de homocisteina. La presencia de hiperhomocisteinemia se relaciono con una latencia mas prolongada. La amplitud solo se correlaciono con la puntuacion en la escala de Schwab y England. En el analisis multivariante, la edad fue la unica variable que demostro una asociacion significativa tanto con la duracion de la latencia como con los niveles de homocisteina. Conclusion. No pudo establecerse una asociacion directa entre el aumento de homocisteinemia y la disfuncion de la respuesta simpaticocutanea. Los resultados del analisis multivariante sugieren que la prolongacion de la latencia en los pacientes de una mayor edad podria deberse a que estos presentan unos mayores niveles sanguineos de homocisteina.
Subject(s)
Antiparkinson Agents/therapeutic use , Hyperhomocysteinemia/physiopathology , Levodopa/therapeutic use , Parkinson Disease/drug therapy , Parkinson Disease/physiopathology , Skin Physiological Phenomena , Sympathetic Nervous System/physiopathology , Aged , Cross-Sectional Studies , Female , Humans , Hyperhomocysteinemia/complications , Male , Parkinson Disease/complicationsABSTRACT
Cryptosporidia are sporozoan parasites that infect epithelial cells of the gastrointestinal tract. Infection with cryptosporidia has been found most commonly in a variety of animal species and only rarely in man. The authors report a case of an immunosuppressed renal-transplant recipient with IgA deficiency who experienced diarrhea and fever and was found to have cryptosporidia in a jejunal biopsy specimen and in air-dried smears of the specimen. By electron microscopy, trophozoite, schizont, and macrogamete forms were identified, and these forms ahd morphologic features similar to those of cryptosporidia previously found in guinea pigs. Treatment of the cryptosporidial infection in this case was with trisulfapyrimidines. The efficacy of this treatment could not be evaluated because of complications.
Subject(s)
Coccidiosis/complications , Immunoglobulin A , Immunologic Deficiency Syndromes/complications , Kidney Transplantation , Apicomplexa/ultrastructure , Humans , Jejunum/parasitology , Male , Middle Aged , Transplantation, HomologousABSTRACT
Using orcein staining and indirect immunofluorescence on paraffin sections, the authors demonstrated HBs Ag in 64% of 25 hepatocellular carcinomas (including "bone metastasis") in Vietnam. The main findings in the literature suggesting a causal role for hepatitis B virus in primary liver cancer are discussed.
Subject(s)
Carcinoma, Hepatocellular/immunology , Hepatitis B Surface Antigens/isolation & purification , Liver Neoplasms/immunology , Antigens, Neoplasm/isolation & purification , Female , Fluorescent Antibody Technique , Humans , Male , Middle AgedABSTRACT
From a review of 94 original cases of mycetoma, a description of the most important histo-pathological features of these tumors is given. The microscopic diagnosis of mycetoma is easy and so is generally the identification of the responsible agent, either a bacteria or a fungus. In every case and specially in atypic ones a mycological study is necessary to ascertain the aetiological diagnosis.
Subject(s)
Mycetoma/pathology , Africa , Humans , Mycetoma/diagnosis , Mycetoma/epidemiologyABSTRACT
TITLE: Paralisis aislada de la mano debido a un infarto isquemico.