Atypical clinical presentation of meningococcal meningitis: a case report.

A young woman was examined in the Emergency Department for fever, pharyngitis and widespread petechial rash. Physical examination, including neurological evaluation, did not show any other abnormalities. Chest X-ray was negative. Blood exams showed leukocytosis and CPR 20 mg/dL (nv<0.5 mg/dL). On the basis of these results and petechial rash evidence, lumbar puncture was performed. CSF was opalescent; physico-chemical examination showed: total proteins 2.8 (nv 0.15-0.45), glucose 5 (nv 59-80), WBC 7600/µL (nv 0-4/ µL). In the hypothesis of meningococcal meningitis, antimicrobial therapy was started. Blood and cerebrospinal fluid cultures were positive for N. meningitidis. During the first hours the patient experienced hallucinations and mild psychomotor agitation, making a spontaneous recovery. A brain MRI showed minimal extra-axial inflammatory exudates. She was discharged after 10 days in good condition. We underline the need to consider meningococcal meningitis diagnosis when any suggestive symptom or sign is present, even in the absence of the classic meningitis triad, to obtain earlier diagnosis and an improved prognosis.

(123) I-2ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortropane single photon emission computed tomography and (123) I-metaiodobenzylguanidine myocardial scintigraphy in differentiating dementia with lewy bodies from other dementias: A comparative study.

OBJECTIVE: To compare the diagnostic value of striatal (123) I-2ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ((123) I-FP-CIT) single photon emission computed tomography (SPECT) and (123) I-metaiodobenzylguanidine ((123) I-MIBG) myocardial scintigraphy in differentiating dementia with Lewy bodies (DLB) from other dementia types. METHODS: This prospective longitudinal study included 30 patients with a clinical diagnosis of DLB and 29 patients with non-DLB dementia (Alzheimer disease, n = 16; behavioral variant frontotemporal dementia, n = 13). All patients underwent (123) I-FP-CIT SPECT and (123) I-MIBG myocardial scintigraphy within a few weeks of clinical diagnosis. All diagnoses at each center were agreed upon by the local clinician and an independent expert, both unaware of imaging data, and re-evaluated after 12 months. Each image was visually classified as either normal or abnormal by 3 independent nuclear physicians blinded to patients' clinical data. RESULTS: Overall, sensitivity and specificity to DLB were respectively 93% and 100% for (123) I-MIBG myocardial scintigraphy, and 90% and 76% for (123) I-FP-CIT SPECT. Lower specificity of striatal compared to myocardial imaging was due to decreased (123) I-FP-CIT uptake in 7 non-DLB subjects (3 with concomitant parkinsonism) who had normal (123) I-MIBG myocardial uptake. Notably, in our non-DLB group, myocardial imaging gave no false-positive readings even in those subjects (n = 7) with concurrent medical illnesses (diabetes and/or heart disease) supposed to potentially interfere with (123) I-MIBG uptake. INTERPRETATION: (123) I-FP-CIT SPECT and (123) I-MIBG myocardial scintigraphy have similar sensitivity for detecting DLB, but the latter appears to be more specific for excluding non-DLB dementias, especially when parkinsonism is the only "core feature" exhibited by the patient. Our data also indicate that the potential confounding effects of diabetes and heart disease on (123) I-MIBG myocardial scintigraphy results might have been overestimated. Ann Neurol 2016;80:368-378.

Consecuencias psicosociales de la privación de la libertad en imputados inocentes / Psychosocial consequences of innocent persons being deprived of their liberty / Consequências psicossociais da privação da liberdade em imputados inocentes

El objetivo de este estudio fue describir las consecuencias psicosociales en sujetos privados de la libertad que resultaron inocentes. El marco teórico incluyó los conceptos de psicología jurídica, presunción de inocencia, verdad jurídica, privación de la libertad, efectos de la prisionización y estigmatización social. El instrumento empleado para la recolección de información fue una entrevista semiestructurada, que logró dar cuenta de los efectos psicológicos y sociales de la privación de la libertad en personas que fueron imputadas y que resultaron finalmente inocentes, según la verdad jurídica. Se concluye con la ratificación de las consecuencias psicosociales del hecho de estar privados de la libertad, y con una reflexión acerca de la actuación de los operadores del sistema judicial y la dificultad para detectar los errores.

O objetivo deste estudo é descrever as consequências psicossociais nos sujeitos privados da liberdade que ficaram inocentes. O quadro teórico incluiu os conceitos da psicologia legal, da presunção do inocência, da verdade legal, da privação da liberdade, dos efeitos do encarceramento e da estigmatização social. O instrumento usado para a coleta das informações foi uma entrevista semiestruturada, e evidenciou os efeitos psicológicos e sociais da privação da liberdade nas pessoas que foram imputadas e ficaram inocentes, de acordo com a verdade legal. O artigo conclui com o ratificação das consequências psicossociais do fato de estar privados da liberdade, e com uma reflexão sobre o desempenho dos operadores do sistema judicial e da dificuldade para detectar os erros.

This study was aimed at describing the psychosocial consequences affecting individuals who after having been deprived from their liberty were found innocent. The theoretical frame included concepts such as legal psychology, the presumption of innocence and the in dubio pro-reo, i. e. “when in doubt, for the accused” principles, judicial truth, deprivation of liberty, and the effects of prisonization and social stigmatization. The instrument used in the gathering of information was a semi-structured interview which succeeded in accounting for the psychological and social consequences of deprivation of liberty for innocent people wrongfully convicted, according to the juridical truth. The study concludes with the ratification of such effects and consequences and the usual difficulty in error detecting and correcting.