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1.
Br J Radiol ; 93(1106): 20190467, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31899660

RESUMEN

Recognition of key concepts of structural and functional anatomy of the cerebellum can facilitate image interpretation and clinical correlation. Recently, the human brain mapping literature has increased our understanding of cerebellar anatomy, function, connectivity with the cerebrum, and significance of lesions involving specific areas.Both the common names and numerically based Schmahmann classifications of cerebellar lobules are illustrated. Anatomic patterns, or signs, of key fissures and white matter branching are introduced to facilitate easy recognition of the major anatomic features. Color-coded overlays of cross-sectional imaging are provided for reference of more complex detail. Examples of exquisite detail of structural and functional cerebellar anatomy at 7 T MRI are also depicted.The functions of the cerebellum are manifold with the majority of areas involved with non-motor association function. Key concepts of lesion-symptom mapping which correlates lesion location to clinical manifestation are introduced, emphasizing that lesions in most areas of the cerebellum are associated with predominantly non-motor deficits. Clinical correlation is reinforced with examples of intrinsic pathologic derangement of cerebellar anatomy and altered functional connectivity due to pathology of the cerebral hemisphere. The purpose of this pictorial review is to illustrate basic concepts of these topics in a cross-sectional imaging-based format that can be easily understood and applied by radiologists.


Asunto(s)
Cerebelo/anatomía & histología , Encefalopatías/patología , Encefalopatías/fisiopatología , Cerebelo/fisiología , Imagen de Difusión Tensora/métodos , Humanos , Imagen por Resonancia Magnética/métodos
2.
Adv Exp Med Biol ; 1232: 11-17, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893388

RESUMEN

In the adult brain, it is well known that increases in local neural activity trigger changes in regional blood flow and, thus, changes in cerebral energy metabolism. This regulation mechanism is called neurovascular coupling (NVC). It is not yet clear to what extent this mechanism is present in the premature brain. In this study, we explore the use of transfer entropy (TE) in order to compute the nonlinear coupling between changes in brain function, assessed by means of EEG, and changes in brain oxygenation, assessed by means of near-infrared spectroscopy (NIRS). In a previous study, we measured the coupling between both variables using a linear model to compute TE. The results indicated that changes in brain oxygenation were likely to precede changes in EEG activity. However, using a nonlinear and nonparametric approach to compute TE, the results indicate an opposite directionality of this coupling. The source of the different results provided by the linear and nonlinear TE is unclear and needs further research. In this study, we present the results from a cohort of 21 premature neonates. Results indicate that TE values computed using the nonlinear approach are able to discriminate between neonates with brain abnormalities and healthy neonates, indicating a less functional NVC in neonates with brain abnormalities.


Asunto(s)
Encéfalo , Acoplamiento Neurovascular , Espectroscopía Infrarroja Corta , Adulto , Encéfalo/fisiopatología , Encefalopatías/diagnóstico , Encefalopatías/fisiopatología , Electroencefalografía , Entropía , Humanos , Recién Nacido , Acoplamiento Neurovascular/fisiología
3.
Zhonghua Er Ke Za Zhi ; 58(1): 35-40, 2020 Jan 02.
Artículo en Chino | MEDLINE | ID: mdl-31905474

RESUMEN

Objective: To investigate the genotype and phenotype of children with KCNA2 gene related developmental and epileptic encephalopathy (DEE). Methods: Clinical data including the manifestations and electroencephalogram of 8 children with KCNA2 variants treated in the Department of Pediatrics, Peking University First Hospital from March 2017 to June 2019 were collected and analyzed retrospectively. Results: Among the 8 epileptic patients with KCNA2 variants, 5 were males and 3 were females. The age of onset was from 1 day to 11 months. The age at last follow-up ranged from 4 months to 86 months. Two variants including c.1214C>T (loss-of-function) and c.1120A>G (gain-and loss-of-function) were identified. The variant of c.1214C>T was found in six patients (case 1-6). For these patients, the age of onset was from 5 to 11 months and they were characterized by multiple seizure types. All had focal seizures and had normal development before seizure onset with developmental regression after seizure onset. The first electroencephalogram showed epileptic discharges in Rolandic region in two, epileptic discharges in Rolandic region combined with generalized discharge in one, generalized discharge with posterior predominance in two (combined with or transferred to Rolandic region during the course) and epileptic discharges in posterior region combined with generalized discharge in one. And in 5 of them the Rolandic discharges developed into epileptic electrical status (ESES) during sleep. All the six patients were still treated with a combination of multiple antiepileptic drugs. Two of them had seizure controlled at 80 months and 68 months, respectively. The variant of c.1120A>G were identified in two of eight patients (case 7 and 8) and they had seizure onset on the 1st day after birth. Their epileptic seizures were frequent and difficult to control. They had remarkably developmental delay and microcephaly since birth. One case (case 8) had a wide forehead. They had frequent seizures up to the last follow-up. In case 7, the early electroencephalogram showed epileptic discharges in temporal region, and interictal electroencephalogram at 3 months of age showed multifocal discharge with posterior and temporal region predominance. In case 8, the early electroencephalogram was normal and electroencephalogram showed burst suppression at 2 months of age, and it developed epileptiform discharge in posterior region at 1 year of age. Conclusions: KCNA2 gene variants can lead to DEE with multiple seizures types. Among them, loss-of-function c.1214C>T is the most common, and these patients have seizure onset at infancy with Rolandic discharges tended to develop into to ESES pattern. The variant of c.1120A>G is a gain-of- and loss-of-function variant, patients with c.1120A>G have seizure onset in neonatal period, the phenotype overlaps with the former but is more severe.


Asunto(s)
Encefalopatías/genética , Epilepsia/diagnóstico , Canal de Potasio Kv.1.2/genética , Convulsiones , Edad de Inicio , Encéfalo/fisiopatología , Encefalopatías/fisiopatología , Niño , Preescolar , Discapacidades del Desarrollo/fisiopatología , Epilepsia/complicaciones , Epilepsia/genética , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Lactante , Recién Nacido , Masculino , Fenotipo , Estudios Retrospectivos
4.
Life Sci ; 240: 117099, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31760098

RESUMEN

Obviously, delivery of the medications to the brain is more difficult than other tissues due to the existence of a strong obstacle, which is called blood-brain barrier (BBB). Because of the lipophilic nature of this barrier, it would be a complex (and in many cases impossible) process to cross the medications with hydrophilic behavior from BBB and deliver them to the brain. Thus, novel intricate drug-carriers in nano scales have been recently developed and suitably applied for this purpose. One of the most important categories of these hydrophilic medications, are reactivators for acetyl cholinesterase (AChE) enzyme that facilitates the breakdown of acetylcholine (as a neurotransmitter). The AChE function is inhibited by organophosphorus (OP) nerve agents that are extremely used in military conflicts. In this review, the abilities of the nanosized drug delivery systems to perform as suitable vehicles for AChE reactivators are comprehensively discussed.


Asunto(s)
Encefalopatías/tratamiento farmacológico , Encéfalo/efectos de los fármacos , Reactivadores de la Colinesterasa/administración & dosificación , Reactivadores de la Colinesterasa/uso terapéutico , Sistemas de Liberación de Medicamentos , Animales , Barrera Hematoencefálica/efectos de los fármacos , Portadores de Fármacos , Humanos , Nanoestructuras , Relación Estructura-Actividad
5.
Toxicol Lett ; 319: 66-73, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31726083

RESUMEN

Thallium ion (Tl+) and its neurotoxic products are widely known to cause severe neurological complications. However, the exact mechanism of action remains unknown, with limited therapeutic options available. This study aims to examine the toxic effects of Thallium (I) Nitrate (TlNO3) on primary hippocampal neurons of E17-E18 Wistar rat embryos, and the potential neuroprotective role of Nrf2- Keap1 signaling pathway against thallium-induced oxidative stress and mitochondrial dysfunction. TlNO3 induces a significant increase in reactive oxygen species levels and mitochondrial dysfunction in primary hippocampal neurons. Furthermore, the Nrf2-Keap1 signaling pathway played a protective role against TlNO3-induced hippocampal neuronal cytotoxicity. Moreover, mitochondrial fusion protein Mitofusin 2 (Mfn2) levels significantly decreased in hippocampal neurons when exposed to TlNO3, indicating that Mfn2 protein levels are linked to TlNO3-induced neurotoxicity. t-BHQ, a Nrf2 and phase II detoxification enzyme inducer, counteracted the oxidative damage in hippocampal neurons by activating the Nrf2-Keap1 signaling pathway after TlNO3 exposure; the activated Nrf2-Keap1 pathway could then maintain Mfn2 function by regulating Mfn2 protein expression. Thus, Nrf2-Keap1 pathway activation plays a protective role in Tl+-induced brain damage, and specific agonists have been identified to have great potential for treating thallium poisoning.


Asunto(s)
Hipocampo/efectos de los fármacos , Proteína 1 Asociada A ECH Tipo Kelch/efectos de los fármacos , Mitocondrias/efectos de los fármacos , Factor 2 Relacionado con NF-E2/efectos de los fármacos , Neuronas/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Transducción de Señal/efectos de los fármacos , Talio/toxicidad , Animales , Encefalopatías/inducido químicamente , Encefalopatías/patología , Encefalopatías/prevención & control , Femenino , Hipocampo/citología , Proteínas de la Membrana/efectos de los fármacos , Proteínas de la Membrana/metabolismo , Proteínas Mitocondriales/efectos de los fármacos , Proteínas Mitocondriales/metabolismo , Cultivo Primario de Células , Ratas , Ratas Wistar , Especies Reactivas de Oxígeno/metabolismo
7.
Brain Dev ; 42(1): 98-99, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30803731
8.
Zool Res ; 41(1): 3-19, 2020 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-31840949

RESUMEN

Hypobaric hypoxia (HH) exposure can cause serious brain injury as well as life-threatening cerebral edema in severe cases. Previous studies on the mechanisms of HH-induced brain injury have been conducted primarily using non-primate animal models that are genetically distant to humans, thus hindering the development of disease treatment. Here, we report that cynomolgus monkeys ( Macaca fascicularis) exposed to acute HH developed human-like HH syndrome involving severe brain injury and abnormal behavior. Transcriptome profiling of white blood cells and brain tissue from monkeys exposed to increasing altitude revealed the central role of the HIF-1 and other novel signaling pathways, such as the vitamin D receptor (VDR) signaling pathway, in co-regulating HH-induced inflammation processes. We also observed profound transcriptomic alterations in brains after exposure to acute HH, including the activation of angiogenesis and impairment of aerobic respiration and protein folding processes, which likely underlie the pathological effects of HH-induced brain injury. Administration of progesterone (PROG) and steroid neuroprotectant 5α-androst-3ß,5,6ß-triol (TRIOL) significantly attenuated brain injuries and rescued the transcriptomic changes induced by acute HH. Functional investigation of the affected genes suggested that these two neuroprotectants protect the brain by targeting different pathways, with PROG enhancing erythropoiesis and TRIOL suppressing glutamate-induced excitotoxicity. Thus, this study advances our understanding of the pathology induced by acute HH and provides potential compounds for the development of neuroprotectant drugs for therapeutic treatment.


Asunto(s)
Androstanoles/farmacología , Hipoxia/veterinaria , Macaca fascicularis , Enfermedades de los Monos/prevención & control , Progesterona/farmacología , Transcriptoma , Androstanoles/administración & dosificación , Animales , Encefalopatías/prevención & control , Encefalopatías/veterinaria , Calcio/metabolismo , Regulación de la Expresión Génica , Hipoxia/patología , Leucocitos/metabolismo , Masculino , Fármacos Neuroprotectores/farmacología , Presión , Progesterona/administración & dosificación
9.
Radiol Clin North Am ; 58(1): 167-185, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31731899

RESUMEN

A brief introduction is provided of the different imaging modalities encountered in the intensive care unit (ICU). The spectrum of intracranial pathology as well as potential postsurgical complications is reviewed, with a focus on pearls and pitfalls. A brief overview also is provided of imaging of the spine in an ICU patient.


Asunto(s)
Encefalopatías/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Neuroimagen/métodos , Tomografía Computarizada por Rayos X/métodos , Encéfalo/diagnóstico por imagen , Cuidados Críticos/métodos , Humanos , Unidades de Cuidados Intensivos
10.
Radiol Clin North Am ; 58(1): 187-197, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31731900

RESUMEN

Neuroimaging is an invaluable diagnostic tool for sorting through the vast array of etiologies that underlie altered mental status (AMS). Head computed tomography (CT) without contrast is the primary modality for evaluation of AMS and should be complemented by MR imaging in cases of negative CT but high clinical concern. Studies to maximize brain imaging efficiency and improve the yield of positive scans through the utilization of clinical and laboratory pre-scan diagnostics are ongoing. However, imaging remains the gold standard due to its rapidity with which certain diagnoses can be made or excluded.


Asunto(s)
Encefalopatías/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Neuroimagen/métodos , Tomografía Computarizada por Rayos X/métodos , Encéfalo/diagnóstico por imagen , Humanos
11.
Medicine (Baltimore) ; 98(49): e18199, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804341

RESUMEN

BACKGROUND: Approximately 10% to 30% patients develop delayed encephalopathy after acute CO poisoning (DEACMP). No specific treatment is available and poor prognosis is a characteristic of this disease. We aimed to evaluate the efficacy and safety of all therapies that have been tried in randomized controlled trial (RCT) for DEACMP. METHODS: We conducted a systematic search of the Cochrane, Embase, PubMed, and Web of Science databases. RESULTS: Overall, 4 RCTs were identified in our study. Both hyperbaric oxygen (HBO) and mesenchymal stem cell (MSC) transplantation were effective in DEACMP, and MSC seemed to be superior to HBO. The addition of dexamethasone, N-butylphthalide, or XingZhi-YiNao granules into HBO, or butylphthalide into MSC could achieve better neurological recovery in DEACMP patients but did not significantly increase the incidence of adverse events. CONCLUSION: Several therapies have shown positive results in treating DEACMP and need to be proven by further studies.


Asunto(s)
Encefalopatías/etiología , Encefalopatías/terapia , Intoxicación por Monóxido de Carbono/complicaciones , Benzofuranos/uso terapéutico , Dexametasona/uso terapéutico , Medicamentos Herbarios Chinos/uso terapéutico , Humanos , Oxigenación Hiperbárica/métodos , Trasplante de Células Madre Mesenquimatosas/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo
12.
Ludovica pediátr ; 22(3): 11-17, sept. 2019.
Artículo en Español | LILACS, BDNPAR, ARGMSAL | ID: biblio-1046980

RESUMEN

La encefalitis necrotizante aguda (ENA) es una rara enfermedad del SNC de curso fulminante con necrosis tisular, de carácter parainfeccioso. Presenta secuelas neurológicas graves. Se presenta de manera aguda con depresión del sensorio y convulsiones. El mismo es precedido por un cuadro infeccioso. El diagnóstico se basa en lesiones características del SNC. Afecta principalmente a niños pequeños y jóvenes, requiriéndose su reconocimiento precoz y tratamiento apropiado. Nuestro objetivo es reportar 3 casos de encefalopatía necrotizante aguda que ingresaron a nuestro hospital, mostrar su presentación clínica y hallazgos neurorradiológicos que orientaron al diagnóstico. Todos los casos presentaban criterios sugestivos de ENA


Acute necrotizing encephalitis (ENA) is a rare CNS condition of fulminating parainfectious course with tissue necrosis during the course of viral infection. It presents severe neurological sequelae. It associates acute encephalopathy with sensory depression and seizures, which is preceded by an infectious disease. The diagnosis is based on characteristic lesions of the CNS. It mainly affects kids and young children, requiring early recognition and appropriate treatment. Our objective is to report 3 cases of acute necrotizing encephalopathy that entered our hospital. Show your clinical presentation and neuroradiological findings that guided the diagnosis. All the cases presented criteria suggestive of ENA


Asunto(s)
Encefalopatías , Niño , Neuroimagen
13.
Zhen Ci Yan Jiu ; 44(12): 859-62, 2019 Dec 25.
Artículo en Chino | MEDLINE | ID: mdl-31867902

RESUMEN

Brain science is the "ultimate territory" for human beings to understand the nature. In the present paper, the authors introduce the current state of brain science research projects in the USA, European countries, Japan and China. In recent years, with the continuous innovations of technologies in brain imaging, biosensors, human-computer interaction and big data, the brain science has become an important frontier field with interdisciplinarity and a focus of science and technology strategies in various countries. As a scientific and technological resource with original advantages in China, traditional Chinese medicine (TCM) is abundant in knowledge of brain, almost covering all kinds of encephalopathy in modern medicine. At present, TCM is increasingly becoming an effective tool to conquer mental and nervous diseases. With the intersection and penetration of multi-disciplines, an increasing close association between the traditional theory of TCM about prevention and treatment of encephalopathy and modern basic biological research appears, and new ideas, new technologies and new achievements have constantly been coming out, particularly in the field of acupuncture medicine. In the present historical juncture when the development of science and technology in China is changing from the "follower" to the "parallel runner", even the "top runner" in some fields, the progress of brain science research in TCM will make enormous contributions to explore brain disease and exploit cutting-edge technologies of TCM, as well as accelerate the modernization of TCM.


Asunto(s)
Terapia por Acupuntura , Encefalopatías , Encéfalo , Encefalopatías/terapia , China , Europa (Continente) , Humanos , Medicina China Tradicional
14.
Medicine (Baltimore) ; 98(51): e18075, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860957

RESUMEN

RATIONALE: Dyke-Davidoff-Masson syndrome (DDMS) is a rare syndrome commonly occurring in children and characterized by cerebral hemiatrophy, hypertrophy of the skull, epilepsy, and mental retardation. However, few have been reported in China, especially in teenagers. This case investigated its possible cause and explored a relative effective solution. PATIENT CONCERNS: A 24-year-old female came to department having experienced recurrent seizures for 12 years. DIAGNOSIS: DDMS was diagnosed from its manifestations, biochemistry indexes, and imaging (computed tomography angiography, magnetic resonance venography, and so on). INTERVENTIONS: Several drugs are used to treat the disease, including valproate, carbamazepine, topiramate, and ginkgo biloba extract. OUTCOMES: Under the medicine treatment of magnesium valproate with carbamazepine, the patient experienced partial seizures approximately once per month that lasted 30 to 60 seconds each without any complications observed during a follow-up period of 24 months. CONCLUSION: The imaging and clinical features of DDMS in this teenager were similar to those in classic infantile-onset cases. A potential cause of the disease could be brain trauma, which impaired the middle cerebral artery and reduced cerebral blood supply, leading to epilepsy and hemiatrophy. LESSONS: It was concluded early diagnosis and pharmacotherapy are the keys to preventing intellectual decline in DDMS patients. Moreover, the combination of magnesium valproate and carbamazepine could significantly reduce the frequency and duration of seizures, despite not eliminating them completely.


Asunto(s)
Encefalopatías/diagnóstico por imagen , Discapacidad Intelectual/diagnóstico , Imagen por Resonancia Magnética/métodos , Convulsiones/diagnóstico , Convulsiones/tratamiento farmacológico , Encefalopatías/tratamiento farmacológico , Carbamazepina/uso terapéutico , China , Enfermedad Crónica , Femenino , Humanos , Discapacidad Intelectual/tratamiento farmacológico , Pronóstico , Recurrencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Síndrome , Tomografía Computarizada por Rayos X/métodos , Ácido Valproico , Adulto Joven
15.
J Clin Neurophysiol ; 36(6): 396-404, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31688322

RESUMEN

The brainstem contains ocular motor and vestibular structures that, when damaged, produce specific eye movement disorders. In this review, we will discuss three brainstem syndromes with characteristic ocular motor and vestibular findings that can be highly localizing. First, we will discuss the lateral medullary (Wallenberg) syndrome, focusing on ocular lateropulsion, saccadic dysmetria, and the ocular tilt reaction. Second, we will review the medial longitudinal fasciculus syndrome including the ocular tilt reaction, nystagmus, and the vestibular-ocular reflex. Lastly, we will discuss hypertrophic olivary degeneration and oculopalatal tremor, which may develop weeks to months after a brainstem or cerebellar lesion. In these syndromes, the clinical ocular motor and vestibular examination is instrumental in localizing the lesion.


Asunto(s)
Encefalopatías , Tronco Encefálico , Trastornos de la Motilidad Ocular , Enfermedades Vestibulares , Encefalopatías/complicaciones , Tronco Encefálico/patología , Tronco Encefálico/fisiopatología , Humanos , Trastornos de la Motilidad Ocular/etiología , Trastornos de la Motilidad Ocular/fisiopatología , Síndrome , Enfermedades Vestibulares/etiología , Enfermedades Vestibulares/fisiopatología
16.
Adv Exp Med Biol ; 1192: 139-158, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31705494

RESUMEN

Neuroimaging-based personalized medicine is emerging to characterize brain disorders and their evolution at the patient level. In this chapter, we present the most classic methods used to infer large-scale brain connectivity based on functional MRI. We adopt a modeling perspective where every connectivity measure is linked to a specific model that allows to interpret the connectivity estimate. This perspective allows to analyze the quality of retrieved connectivity profiles in terms of modeling error and estimation error. In the first part of the chapter, we present undirected functional connectivity (Pearson's correlation and MI) and effective connectivity (partial correlation), as well as directed effective connectivity (VAR, MOU, Granger causality, DCM). In addition, some of these measures correspond to fully connected graphs (Pearson's correlation) while others to sparse ones (MOU, DCM), where the sparsity can come from the integration of functional and structural data. In the second part, we claim that machine learning tools are better suited than null-hypothesis testing to link the estimated connectomes with diagnosis and prognosis of neuropsychiatric diseases. Finally, we propose that linear models and features selection are preferable to more complex and nonlinear tools (when prediction performance is on a par) for building interpretable algorithms to predict clinical variables.


Asunto(s)
Encefalopatías , Conectoma , Encéfalo , Humanos , Modelos Lineales , Imagen por Resonancia Magnética
17.
Medicine (Baltimore) ; 98(44): e17638, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689772

RESUMEN

INTRODUCTION: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) was shown to have a transient reduction in diffusion. Such changes would be used as an early detection to reduce excessive treatments and promote recovery without sequelae. The current research evaluated the high b-value (b = 3000 s/mm) diffusion-weighted imaging (DWI) assessment in MERS. METHODS: Sixteen pediatric patients showed MERS used DWI (b = 1000 and 3000 s/mm). To record number of lesions, the signal intensities, signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), contrast ratios (CRs), the apparent diffusion coefficients (ADCs) were measured in the normal parenchyma and lesions. RESULTS: Lesions were more apparent with high b-value. The ADC values and CNR in the lesions and surrounding normal brain parenchyma were relatively low at a high compared to standard b-value DWI (SNR: 144.67 ±â€Š33.03, 85.72 ±â€Š31.50; CNR: 20.82 ±â€Š17.64, 49.62 ±â€Š33.06; for b = 1000 and 3000 s/mm). The CR was significantly higher at a high compared to low b-value DWI (CR: 0.06 ±â€Š0.07 versus 0.40 ±â€Š0.14). CONCLUSION: High b-value DWI could detect more lesions and could obviously improve the detection of lesions in pediatric patients with MERS.


Asunto(s)
Encefalopatías/diagnóstico , Encefalopatías/patología , Cuerpo Calloso/diagnóstico por imagen , Cuerpo Calloso/patología , Encefalopatías/diagnóstico por imagen , Niño , China , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Masculino , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Relación Señal-Ruido
18.
Medicine (Baltimore) ; 98(44): e17794, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689856

RESUMEN

RATIONALE: Bing-Neel syndrome (BNS) is a rare manifestation of Waldenström macroglobulinemia (WM) with <200 cases reported in the literature. Herein, we describe a case of newly diagnosed BNS treated with a novel therapeutic strategy. PATIENT CONCERNS: A 67-year-old woman diagnosed with asymptomatic WM 3 years ago presented with gradual vision deterioration the past 3 months. Ophthalmologic examination revealed bilateral reduction in visual acuity (7/10) and bilateral optic disc swelling which was more prominent in the left eye. DIAGNOSES: Brain imaging revealed bilateral swelling of optic nerves extending from the retina to the optic chiasm and swelling of the left optic tract. Patchy enhancement of optic nerves was also shown upon intravenous contrast administration. Flow cytometry of the cerebrospinal fluid (CSF) revealed the presence of κ-light chain restricted, monoclonal B-lymphocytes. CSF protein electrophoresis showed a monoclonal band in the gamma region and immunofixation was positive for immunoglobulin M and kappa light chain. Thus, the diagnosis of BNS was established. INTERVENTIONS: The patient was initially treated with intrathecal methotrexate and systemic chemotherapy. Following 2 intrathecal methotrexate infusions, CSF flow cytometry did not detect any cells, whereas the patient reported improvement in visual acuity. Therefore, we opted to start maintenance treatment with IV rituximab and per os ibrutinib. OUTCOMES: Following 1 year posttreatment initiation, visual problems have resolved completely and the patient remains on hematologic and imaging complete response. LESSONS: We propose a novel sequential chemoimmunotherapy approach for BNS treatment aiming both at rapid disease control and deep and durable remission with minimization of induced toxicity.


Asunto(s)
Encefalopatías/tratamiento farmacológico , Inmunoterapia/métodos , Quimioterapia de Inducción/métodos , Neuritis Óptica/tratamiento farmacológico , Macroglobulinemia de Waldenström/tratamiento farmacológico , Anciano , Encefalopatías/inmunología , Femenino , Humanos , Neuritis Óptica/inmunología , Síndrome , Macroglobulinemia de Waldenström/inmunología
19.
Rev Med Suisse ; 15(673): 2210-2212, 2019 Nov 27.
Artículo en Francés | MEDLINE | ID: mdl-31778052

RESUMEN

Since 2017 the world suffers from a piperacillin/tazobactam shortage. Cefepime is then proposed as a broad spectrum antibiotic alternative. Up to 15 % of the patients under treatment develop neurotoxicity, mostly in kidney failure settings. Cefepime serum concentration and electroencephalogram guide diagnosis. Treatment consists in withholding or reducing the dose. Most of the patients recover without neurologic sequelae.


Asunto(s)
Encefalopatías/inducido químicamente , Cefepima/efectos adversos , Antibacterianos/efectos adversos , Antibacterianos/provisión & distribución , Antibacterianos/uso terapéutico , Encefalopatías/sangre , Encefalopatías/diagnóstico , Cefepima/administración & dosificación , Cefepima/sangre , Cefepima/uso terapéutico , Humanos , Insuficiencia Renal/sangre , Insuficiencia Renal/complicaciones , Insuficiencia Renal/tratamiento farmacológico
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