Catatonia em um adolescente após uso de mefedrona como droga recreativa / Catatonia in a teenager after use of mephedrone as a recreational drug

Objetivos: Os autores relatam um caso de catatonia secundária à exposição a mefedrona, um derivado semissintético do alcalóide catinona, e fazem uma revisão da literatura sobre essa substância que vem sendo usada crescentemente como droga recreativa.Descrição do caso: Um adolescente de 14 anos foi levado ao serviço de emergência por apresentar quadro de agitação psicomotora grave com auto e heteroagressividade seguido de estupor, mutismo e acinesia. Ao exame na admissão apresentava-se sem resposta a estímulos. A investigação complementar não mostrou alterações relevantes. Durante a hospitalização apresentou dois episódios de agitação psicomotora grave e no restante do tempo manteve estado pseudocomatoso. Após ser conhecido o consumo de mefedrona previamente ao início do quadro, e perante a hipótese diagnóstica de catatonia, iniciou-se com lorazepam, com o que o paciente apresentou recuperação rápida ecompleta.Conclusões: Segundo a bibliografia consultada, este é o primeiro relato publicado de catatonia associada ao consumo de mefedrona. O caso ilustra uma manifestação psiquiátrica grave secundária à exposição a essa droga recreativa, facilmente adquirida pelos adolescentes apesar de já terem sido descritos casos fatais associados ao seu consumo.

Aims: The authors report a case of catatonia secondary to exposure to mephedrone, a semisynthetic derivativeof the alkaloid cathinone, and review the literature on this substance that has been increasingly used as a recreational drug.Case description: A 14 year old boy was taken to the emergency room presenting severe psychomotor agitation with self and heteroaggressiveness followed by stupor, mutism and akinesia. On the admission examination the patient was unresponsive to stimuli. Complementary examination showed no significant changes. During hospitalization he had two episodes of severe psychomotor agitation and in the rest of the time he kept a pseudo-comatose state. After knowledge on the consumption of mephedrone prior to the onset of symptoms and facing the diagnostic hypothesis of catatonia, lorazepam was started, after which the patient showed rapid and complete recovery.Conclusions: According to the reviewed literature, this is the first published report of catatonia associated with consumption of mephedrone. The case illustrates a severe psychiatric manifestation secondary to exposure to this recreational drug, easily acquired by adolescents despite fatalities associated with its consumption have already been described.

Persistent hyperlactacidaemia: about a clinical case.

Lactate is the endogenous end product of the anaerobic glycolysis, whose production is favoured in situations of hypoperfusion or mitochondrial dysfunction. Leigh syndrome is a rare, progressive encephalomyopathy that represents a spectrum of mitochondrial genetic diseases phenotypically distinct, but with neuroradiological and pathological uniform presentation. We present the case of a 7-month-old infant, with a history of prematurity, psychomotor retardation and epilepsy, admitted to the paediatric intensive care unit (PICU) due to cardio-respiratory arrest because of respiratory infection. Hyperlactacidaemia was detected and was persistent. The study of redox potential was normal but MRI with spectroscopy identified bilateral and symmetrical lesions involving thalamic and basal ganglia, with small lactate peaks at T2 flair, findings that were suggestive of Leigh syndrome. Subsequent enzymatic study identified lack of pyruvate dehydrogenase. Persistent hyperlactacidaemia, in the appropriate clinical context, should lead to the screening of mitochondrial diseases.

[Sickle cell disease and cerebrovascular stroke: a preventable event]. / Anemia de células falciformes e acidente vascular cerebral: uma história evitável.

INTRODUCTION: About 75% of the children presenting with cerebrovascular stroke have an identified cause. For black children, the most common underlying condition is sickle cell disease. This case report describes a preventable natural history, with an unusual presenting feature. CASE PRESENTATION: 27th month black infant without relevant background, presented with an acute focal neurological deficit. Brain computed tomography scan showed extensive acute infarction, and magnetic resonance also revealed previous silent cerebral infarct. Blood sample showed normocytic anemia and spontaneous sickling of the red blood cells, with 87% hemoglobin S. Exchange transfusion was made. CONCLUSION: Stroke, as a sickle cell disease complication, can occur at early ages and being the presenting sign. We consider that it would be worth spread the antenatal hemoglobinopathy screening programme, and evaluating the cost-effectiveness of a neonatal screening programme for sickle cell disease in Portugal.

[Lúpus erythematosus]. / Lúpus Eritematoso Sistémico.

Systemic Lúpus Erythematosus (SLE) is an auto-imune disorder, with multiple organ involvement, characterized by vascular and connective tissue inflammation, as well as antinuclear antibodies (ANA). We report a case of a black teenager with a past of arthritis of knees, fever and astenia during the year previous to this admission. She was admitted to the Pediatric Intensive Care Unit (PICU) for bilateral Streptococcus pneumoniae pneumonia complicated by pleural effusion. She also had generalized edema and macroscopic hematúria. She was started on antibiotics, with improvement. The studies were compatible with active SLE, poliserositis, nephrotic proteinúria, lupic nephritis class IV and serious anemia. During the admission, she had symptomatic hypertension with tonic-clonic seizure. She was transferred to Italy, clinically stable, medicated with steroids, anti-hypertensive and anti-convulsant drugs.