Asunto(s)
Traumatismos del Nacimiento/terapia , Lesiones Encefálicas/terapia , Estimulación Encefálica Profunda , Trastornos Distónicos/terapia , Complicaciones del Embarazo/terapia , Adolescente , Adulto , Lesiones Encefálicas/congénito , Distonía/terapia , Trastornos Distónicos/congénito , Femenino , Humanos , EmbarazoRESUMEN
Remote cerebellar hemorrhage (RCH) is an infrequent but serious complication after lumbar herniation surgery. Little is known about this complication but excessive cerebrospinal fluid (CSF) leakage is thought to be a leading cause of RCH. We describe the case of a patient suffering from a life-threatening RCH, which occurred a few hours after lumbar disc herniation surgery.
Asunto(s)
Enfermedades Cerebelosas/etiología , Enfermedades Cerebelosas/terapia , Desplazamiento del Disco Intervertebral/cirugía , Hemorragias Intracraneales/terapia , Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/terapia , Encéfalo/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo , Rinorrea de Líquido Cefalorraquídeo/etiología , Femenino , Escala de Coma de Glasgow , Escala de Consecuencias de Glasgow , Humanos , Persona de Mediana Edad , Procedimientos Ortopédicos/efectos adversos , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Anestésicos Intravenosos/farmacología , Encéfalo/crecimiento & desarrollo , Fármacos Neuroprotectores , Piperidinas/farmacología , Apoptosis/efectos de los fármacos , Encéfalo/efectos de los fármacos , Humanos , Recién Nacido , N-Metilaspartato/fisiología , Receptores de N-Metil-D-Aspartato/efectos de los fármacos , Receptores de N-Metil-D-Aspartato/genética , RemifentaniloRESUMEN
Experiments performed in mammals, including non-human primates, have demonstrated an increase in neuronal death rates normally seen in normal brain development. Such an increase is encountered in diseases but also after exposure of the brain to various class of anaesthetics. In living animals, it can (but not always) result in persistent cognitive impairment. Most of the experiments have been conducted in animals which were never exposed to any pain, which questions their relevancy. On the clinical side, all data comes from retrospective studies. Given the multiple bias, they cannot definitely state that a protocol, if toxic, is more or less when compared to another. Until now, prospective follow-up of children exposed to anaesthetics in utero or during the first months of life do not suggest a major deleterious effect. Yet, a minor one, if existing, would be hard to detect among polluting variables (e.g. pathology requiring anaesthesia, long hospitalization after birth, preterm birth, environmental stress...). For sure, when surgery is mandatory during pregnancy, it is generally for maternal indication and should not be a motif strong enough for foetal extraction, especially in terms where the baby has few chances to survive. Second, it is known for years than anaesthesia before 1 year of age is much riskier than after 1 year, whatever the theorical neurotoxicity is. Third, this enforces the need to develop tools enhancing the precision of anaesthesia as much as possible. Meanwhile, when an infant has undergone numerous general anaesthesias, we strongly recommend a long-time neurological follow-up.
Asunto(s)
Sedación Consciente/efectos adversos , Enfermedades del Sistema Nervioso/etiología , Envejecimiento/fisiología , Anestésicos Generales/antagonistas & inhibidores , Anestésicos Generales/farmacología , Anestésicos Generales/toxicidad , Animales , Cesárea , Cuidados Críticos , Agonistas de Aminoácidos Excitadores/farmacología , Femenino , Trastornos del Espectro Alcohólico Fetal/fisiopatología , Humanos , Hipnóticos y Sedantes/farmacología , Hipnóticos y Sedantes/toxicidad , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidados Intensivos , N-Metilaspartato/farmacología , Enfermedades del Sistema Nervioso/patología , Síndromes de Neurotoxicidad/etiología , Síndromes de Neurotoxicidad/terapia , Embarazo , Primates/fisiología , Transmisión Sináptica/efectos de los fármacos , Teratógenos , Ácido gamma-Aminobutírico/farmacologíaRESUMEN
About fifty to sixty percent of patients with septic shock acquire acute adrenal insufficiency. This insufficiency is most often relative, but can sometimes be absolute. Bilateral adrenal haemorrhage is a rare aetiology of absolute acute adrenal insufficiency. It is classically described in patients with severe meningococcemia (purpura fulminans), who commonly present many of the risk factors associated with bilateral adrenal haemorrhage (shock, coagulation disorders, sepsis). We report a case of bilateral adrenal haemorrhage during a peritonitis complicated by a septic shock, with no coagulation disorder. This observation shows up that this bilateral adrenal haemorrhage can complicate severe sepsis of various origins, and not only severe meningococcemia. It can be suspected in face of a septic shock with an unfavourable evolution despite adequate treatment.