Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.343
Filtrar
1.
Am Fam Physician ; 103(7): 422-428, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33788511

RESUMEN

Cerebrospinal fluid (CSF) analysis is a diagnostic tool for many conditions affecting the central nervous system. Urgent indications for lumbar puncture include suspected central nervous system infection or subarachnoid hemorrhage. CSF analysis is not necessarily diagnostic but can be useful in the evaluation of other neurologic conditions, such as spontaneous intracranial hypotension, idiopathic intracranial hypertension, multiple sclerosis, Guillain-Barré syndrome, and malignancy. Bacterial meningitis has a high mortality rate and characteristic effects on CSF white blood cell counts, CSF protein levels, and the CSF:serum glucose ratio. CSF culture can identify causative organisms and antibiotic sensitivities. Viral meningitis can present similarly to bacterial meningitis but usually has a low mortality rate. Adjunctive tests such as CSF lactate measurement, latex agglutination, and polymerase chain reaction testing can help differentiate between bacterial and viral causes of meningitis. Immunocompromised patients may have meningitis caused by tuberculosis, neurosyphilis, or fungal or parasitic infections. Subarachnoid hemorrhage has a high mortality rate, and rapid diagnosis is key to improve outcomes. Computed tomography of the head is nearly 100% sensitive for subarachnoid hemorrhage in the first six hours after symptom onset, but CSF analysis may be required if there is a delay in presentation or if imaging findings are equivocal. Xanthochromia and an elevated red blood cell count are characteristic CSF findings in patients with subarachnoid hemorrhage. Leptomeningeal carcinomatosis can mimic central nervous system infection. It has a poor prognosis, and large-volume CSF cytology is diagnostic.


Asunto(s)
Infecciones del Sistema Nervioso Central/líquido cefalorraquídeo , Carcinomatosis Meníngea/líquido cefalorraquídeo , Hemorragia Subaracnoidea/líquido cefalorraquídeo , Infecciones Bacterianas del Sistema Nervioso Central/líquido cefalorraquídeo , Infecciones Bacterianas del Sistema Nervioso Central/diagnóstico , Infecciones Fúngicas del Sistema Nervioso Central/líquido cefalorraquídeo , Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico , Infecciones del Sistema Nervioso Central/diagnóstico , Infecciones Parasitarias del Sistema Nervioso Central/líquido cefalorraquídeo , Infecciones Parasitarias del Sistema Nervioso Central/diagnóstico , Enfermedades Virales del Sistema Nervioso Central/líquido cefalorraquídeo , Enfermedades Virales del Sistema Nervioso Central/diagnóstico , Líquido Cefalorraquídeo/química , Líquido Cefalorraquídeo/citología , Líquido Cefalorraquídeo/microbiología , Proteínas del Líquido Cefalorraquídeo/líquido cefalorraquídeo , Técnicas de Cultivo , Eosinófilos , Glucosa/líquido cefalorraquídeo , Humanos , Leucocitos , Linfocitos , Carcinomatosis Meníngea/diagnóstico , Meningitis Criptocócica/líquido cefalorraquídeo , Meningitis Criptocócica/diagnóstico , Neurosífilis/líquido cefalorraquídeo , Neurosífilis/diagnóstico , Neutrófilos , Reacción en Cadena de la Polimerasa , Valores de Referencia , Punción Espinal , Hemorragia Subaracnoidea/diagnóstico , Tuberculosis del Sistema Nervioso Central/líquido cefalorraquídeo , Tuberculosis del Sistema Nervioso Central/diagnóstico
2.
Int J Mol Sci ; 22(5)2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33669083

RESUMEN

Phelan McDermid syndrome (PMcD) is a neurogenetic disease associated with haploinsufficiency of the SHANK3 gene due to a spectrum of anomalies in the terminal region of the long arm of chromosome 22. SHANK3 is the abbreviation for SH3 domain and ankyrin repeat-containing protein, a gene that encodes for proteins of the postsynaptic density (PSD) of excitatory synapses. This PSD is relevant for the induction and plasticity of spine and synapse formation as a basis for learning processes and long-term potentiation. Individuals with PMcD present with intellectual disability, muscular hypotonia, and severely delayed or absent speech. Further neuropsychiatric manifestations cover symptoms of the autism spectrum, epilepsy, bipolar disorders, schizophrenia, and regression. Regression is one of the most feared syndromes by relatives of PMcD patients. Current scientific evidence indicates that the onset of regression is variable and affects language, motor skills, activities of daily living and cognition. In the case of regression, patients normally undergo further diagnostics to exclude treatable reasons such as complex-focal seizures or psychiatric comorbidities. Here, we report, for the first time, the case of a young female who developed progressive symptoms of regression and a dystonic-spastic hemiparesis that could be traced back to a comorbid multiple sclerosis and that improved after treatment with methylprednisolone.


Asunto(s)
Enfermedades Autoinmunes/tratamiento farmacológico , Trastornos de los Cromosomas/complicaciones , Metilprednisolona/administración & dosificación , Esclerosis Múltiple/complicaciones , Regresión Psicológica , Anomalías Múltiples/genética , Anomalías Múltiples/fisiopatología , Administración Intravenosa , Adulto , Trastorno del Espectro Autista/complicaciones , Enfermedades Autoinmunes/líquido cefalorraquídeo , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/inmunología , Deleción Cromosómica , Trastornos de los Cromosomas/líquido cefalorraquídeo , Trastornos de los Cromosomas/diagnóstico por imagen , Trastornos de los Cromosomas/genética , Cromosomas Humanos 21-22 e Y/genética , Cromosomas Humanos Par 22/genética , Femenino , Humanos , Imagen por Resonancia Magnética , Esclerosis Múltiple/líquido cefalorraquídeo , Proteínas del Tejido Nervioso/genética , Eliminación de Secuencia , Punción Espinal
3.
Lancet Neurol ; 20(3): 203-212, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33609478

RESUMEN

BACKGROUND: Isolated rapid-eye-movement (REM) sleep behaviour disorder (IRBD) can be part of the prodromal stage of the α-synucleinopathies Parkinson's disease and dementia with Lewy bodies. Real-time quaking-induced conversion (RT-QuIC) analysis of CSF has high sensitivity and specificity for the detection of misfolded α-synuclein in patients with Parkinson's disease and dementia with Lewy bodies. We investigated whether RT-QuIC could detect α-synuclein in the CSF of patients with IRBD and be used as a biomarker of prodromal α-synucleinopathy. METHODS: In this longitudinal observational study, CSF samples were obtained by lumbar puncture from patients with video polysomnography-confirmed IRBD recruited at a specialised sleep disorders centre in Barcelona, Spain, and from controls free of neurological disease. CSF samples were stored until analysed using RT-QuIC. After lumbar puncture, participants were assessed clinically for neurological status every 3-12 months. Rates of neurological disease-free survival were estimated using the Kaplan-Meier method. Disease-free survival rates were assessed from the date of lumbar puncture to the date of diagnosis of any neurodegenerative disease, or to the last follow-up visit for censored observations. FINDINGS: 52 patients with IRBD and 40 healthy controls matched for age (p=0·20), sex (p=0·15), and duration of follow-up (p=0·27) underwent lumbar puncture between March 23, 2008, and July 16, 2017. The CSF α-synuclein RT-QuIC assay was positive in 47 (90%) patients with IRBD and in four (10%) controls, resulting in a sensitivity of 90·4% (95% CI 79·4-95·8) and a specificity of 90·0% (95% CI 76·9-96·0). Mean follow-up from lumbar puncture until the end of the study (July 31, 2020) was 7·1 years (SD 2·8) in patients with IRBD and 7·7 years (2·9) in controls. During follow-up, 32 (62%) patients were diagnosed with Parkinson's disease or dementia with Lewy bodies a mean 3·4 years (SD 2·6) after lumbar puncture, of whom 31 (97%) were α-synuclein positive at baseline. Kaplan-Meier analysis showed that patients with IRBD who were α-synuclein negative had lower risk for developing Parkinson's disease or dementia with Lewy bodies at 2, 4, 6, 8, and 10 years of follow-up than patients with IRBD who were α-synuclein positive (log-rank test p=0·028; hazard ratio 0·143, 95% CI 0·019-1·063). During follow-up, none of the controls developed an α-synucleinopathy. Kaplan-Meier analysis showed that participants who were α-synuclein negative (ie, five patients with IRBD plus 36 controls) had lower risk of developing Parkinson's disease or dementia with Lewy bodies at 2, 4, 6, 8 and 10 years after lumbar puncture than participants who were α-synuclein positive (ie, 47 patients with IRBD plus four controls; log-rank test p<0·0001; hazard ratio 0·024, 95% CI 0·003-0·177). INTERPRETATION: In patients with IRBD, RT-QuIC detects misfolded α-synuclein in the CSF with both sensitivity and specificity of 90%, and α-synuclein positivity was associated with increased risk of subsequent diagnosis of Parkinson's disease or dementia with Lewy bodies. Detection of α-synuclein in the CSF represents a potential prodromal marker of Parkinson's disease and dementia with Lewy bodies. If these findings are replicated in additional cohorts, detection of CSF α-synuclein by RT-QuIC could be used to enrich IRBD cohorts in neuroprotective trials, particularly when assessing interventions that target α-synuclein. FUNDING: Department of Health and Social Care Policy Research Programme, the Scottish Government, and the Weston Brain Institute.


Asunto(s)
Trastorno de la Conducta del Sueño REM/líquido cefalorraquídeo , alfa-Sinucleína/líquido cefalorraquídeo , Anciano , Sistemas de Computación , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Enfermedad por Cuerpos de Lewy/etiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/etiología , Polisomnografía , Síntomas Prodrómicos , Trastorno de la Conducta del Sueño REM/complicaciones , Medición de Riesgo , Sensibilidad y Especificidad , Punción Espinal
8.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547096

RESUMEN

A 34-year-old woman presented with an unrelenting headache which had been ongoing since discharge from hospital 4 days before. She initially presented 2 weeks earlier with a 7 days history of severe headache, for which she had a CT scan, lumbar puncture and treatment for possible viral meningitis. The headache got worse 4 days after the lumbar puncture. Despite analgesics and bed rest, the headache persisted. A subsequent magnetic imaging scan demonstrated bilateral subdural effusions. She was given supportive treatment, which included advice concerning strict bed rest and analgesia. The headache took several months to abate. A third of patients suffer from post lumbar puncture headaches and this should be explained during informed consenting and post procedure. Not all post lumbar puncture headaches are simple headaches. A post lumbar puncture headache continuing for more than 7-14 days after the procedure requires further investigation to exclude life-threatening intracranial complications.


Asunto(s)
Hipotensión Intracraneal/complicaciones , Cefalea Pospunción de la Duramadre/etiología , Punción Espinal/efectos adversos , Efusión Subdural/diagnóstico por imagen , Efusión Subdural/etiología , Adulto , Analgésicos/uso terapéutico , Reposo en Cama , Diagnóstico Tardío , Femenino , Humanos , Cefalea Pospunción de la Duramadre/terapia
10.
J Zoo Wildl Med ; 51(4): 1056-1061, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33480590

RESUMEN

Brucella ceti, associated with neurobrucellosis, has been isolated from cerebrospinal fluid (CSF) of postmortem cetaceans. A 106-kg, stranded female bottlenose dolphin (Tursiops truncatus) presented with serum antibodies to Brucella spp. via competitive enzyme-linked immunosorbent assay and fluorescence polarization assay. Polymerase chain reaction (PCR) and culture of whole blood, bronchoalveolar fluid, and rectal, nasal, and genital swabs for Brucella spp. were consistently negative. Serial computed tomography revealed mild focal dilatation of brain ventricles. CSF sampling was warranted to exclude neurobrucellosis. Sedation was achieved with 30 mg diazepam (0.28 mg/kg) orally 2.5 hours prior to arrival in hospital, followed by 5.3 mg midazolam (0.05 mg/kg) intramuscularly, and anesthetic induction with 2.5 mg midazolam (0.02 mg/kg) and 200 mg propofol (2 mg/kg) administered slowly intravenously, followed by intubation and maintenance on sevoflurane using controlled mechanical and apneustic anesthesia ventilation. The atlanto-occipital joint was opened by flexing the upper cervical region with the animal in left lateral recumbency. A 20-ga × 6-inch spinal needle was advanced into the cisterna magna using radiographic guidance. CSF was collected successfully with no neurological deficits appreciable on recovery. Brucella spp. was not identified via PCR or culture. This represents the first report of an antemortem CSF tap in a cetacean.


Asunto(s)
Anestesia General/veterinaria , Delfín Mular/líquido cefalorraquídeo , Brucella/aislamiento & purificación , Punción Espinal/veterinaria , Animales , Brucelosis/líquido cefalorraquídeo , Brucelosis/diagnóstico , Brucelosis/veterinaria , Femenino , Punción Espinal/métodos
11.
Neurosurgery ; 88(3): 698-706, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-33313901

RESUMEN

BACKGROUND: Posthemorrhagic hydrocephalus (PHH) is associated with neurological morbidity and complex neurosurgical care. Improved tools are needed to optimize treatments and to investigate the developmental sequelae of PHH. OBJECTIVE: To examine the relationship between diffusion magnetic resonance imaging (dMRI) and cerebrospinal fluid (CSF) biomarkers of PHH. METHODS: A total of 14 preterm (PT) infants with PHH and 46 controls were included. PT CSF was collected at temporizing surgery in PHH infants (PHH PT CSF) or lumbar puncture in controls. Term-equivalent age (TEA) CSF was acquired via implanted device or at permanent CSF diversion surgery in PHH (PHH-TEA-CSF) or lumbar puncture in controls. TEA dMRI scans were used to measure fractional anisotropy (FA) and mean diffusivity (MD) in the genu of corpus callosum (gCC), posterior limb of internal capsule (PLIC), and optic radiations (OPRA). Associations between dMRI measures and CSF amyloid precursor protein (APP), neural cell adhesion-1 (NCAM-1), and L1 cell adhesion molecule (L1CAM) were assessed using Pearson correlations. RESULTS: APP, NCAM-1, and L1CAM were elevated over controls in PHH-PT-CSF and PHH-TEA-CSF. dMRI FA and MD differed between control and PHH infants across all tracts. PHH-PT-CSF APP levels correlated with gCC and OPRA FA and PLIC MD, while L1CAM correlated with gCC and OPRA FA. In PHH-TEA-CSF, only L1CAM correlated with OPRA MD. CONCLUSION: Tract-specific associations were observed between dMRI and CSF biomarkers at the initiation of PHH treatment. dMRI and CSF biomarker analyses provide innovative complementary methods for examining PHH-related white matter injury and associated developmental sequelae.


Asunto(s)
Hemorragia Cerebral/líquido cefalorraquídeo , Hemorragia Cerebral/diagnóstico por imagen , Hidrocefalia/líquido cefalorraquídeo , Hidrocefalia/diagnóstico por imagen , Enfermedades del Prematuro/líquido cefalorraquídeo , Enfermedades del Prematuro/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Precursor de Proteína beta-Amiloide/líquido cefalorraquídeo , Biomarcadores/líquido cefalorraquídeo , Hemorragia Cerebral/complicaciones , Ventrículos Cerebrales/diagnóstico por imagen , Ventrículos Cerebrales/cirugía , Derivaciones del Líquido Cefalorraquídeo , Imagen de Difusión por Resonancia Magnética/métodos , Femenino , Humanos , Hidrocefalia/etiología , Hidrocefalia/cirugía , Lactante , Recién Nacido , Recien Nacido Prematuro , Masculino , Molécula L1 de Adhesión de Célula Nerviosa/líquido cefalorraquídeo , Punción Espinal/métodos , Sustancia Blanca/cirugía
13.
BMJ Case Rep ; 13(12)2020 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-33310837

RESUMEN

A 24-year-old woman presented with bilateral blurring of her distance vision and 'dizzy spells'. She had no other neurological symptoms or medical history. She consulted an optometrist, and optical coherence tomography (OCT) was performed, which demonstrated papilloedema. She was referred to the local eye clinic for assessment and from there was referred for neurological assessment.Her initial investigations revealed no abnormalities, and brain imaging was reported to be normal. In the absence of an alternative diagnosis, idiopathic intracranial hypertension (IIH) was considered and a lumbar puncture was performed. This showed elevated protein but normal cerebrospinal fluid (CSF) pressure. MRI of the brain the next day revealed a large cerebellopontine lesion in keeping with vestibular schwannoma. She was referred to neurosurgery for operative management.This case highlights three interesting points: the aetiology of her papilloedema without raised intracranial pressure, the decision to perform a lumbar puncture in suspected IIH and community OCT as a clinical adjunct.


Asunto(s)
Neuroma Acústico/complicaciones , Neuroma Acústico/diagnóstico , Papiledema/etiología , Femenino , Humanos , Presión Intracraneal/fisiología , Imagen por Resonancia Magnética , Neuroma Acústico/cirugía , Papiledema/diagnóstico por imagen , Punción Espinal , Tomografía de Coherencia Óptica , Tomografía Computarizada por Rayos X , Adulto Joven
14.
Medicine (Baltimore) ; 99(50): e23213, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327239

RESUMEN

Cryptococcosis caused by Cryptococcus gattii, is a life threatening fungal infection with recently increasing prevalence. C. gattii is a species complex comprising multiple independent species. However, many biological characteristics and clinical features of cryptococcosis due to C. gattii are relatively less well defined. In this paper, we identify two cases of C. gattii infection, and laboratory findings of genotype VGI and VGII in two groups of apparently immunocompetent Chinese individuals respectively. Upon detailed review of all 35 cases of C. gattii infections, it was observed that C. gattii can cause debilitating illness in both immunocompetent and immunocompromised individuals. Cryptococcosis due to C. gattii is a serious systemic fungal infection, with pulmonary central nervous system tropism. Epidemiologically, C. gattii infection is not only restricted in tropical and subtropical regions, but also in other geographical settings.


Asunto(s)
Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico , Criptococosis/diagnóstico , Criptococosis/microbiología , Cryptococcus gattii/genética , Administración Intravenosa , Adolescente , Adulto , Anciano , Anfotericina B/administración & dosificación , Anfotericina B/uso terapéutico , Antifúngicos/administración & dosificación , Antifúngicos/uso terapéutico , Grupo de Ascendencia Continental Asiática/genética , Infecciones Fúngicas del Sistema Nervioso Central/líquido cefalorraquídeo , Infecciones Fúngicas del Sistema Nervioso Central/epidemiología , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Criptococosis/líquido cefalorraquídeo , Criptococosis/tratamiento farmacológico , Quimioterapia Combinada , Femenino , Flucitosina/administración & dosificación , Flucitosina/uso terapéutico , Genotipo , Geografía , Humanos , Huésped Inmunocomprometido/inmunología , Masculino , Persona de Mediana Edad , Prevalencia , Recurrencia , Punción Espinal/métodos , Resultado del Tratamiento , Negativa del Paciente al Tratamiento , Adulto Joven
15.
Cephalalgia ; 40(13): 1452-1458, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33146040

RESUMEN

BACKGROUND: Headache is a frequent complaint in COVID-19 patients. However, no detailed information on headache characteristics is provided in these reports. Our objective is to describe the characteristics of headache and the cerebrospinal fluid (CSF) profile in COVID-19 patients, highlighting the cases of isolated intracranial hypertension. METHODS: In this cross-sectional study, we selected COVID-19 patients who underwent lumbar puncture due to neurological complaints from April to May 2020. We reviewed clinical, imaging, and laboratory data of patients with refractory headache in the absence of other encephalitic or meningitic features. CSF opening pressures higher than 250 mmH2O were considered elevated, and from 200 to 250 mmH2O equivocal. RESULTS: Fifty-six COVID-19 patients underwent lumbar puncture for different neurological conditions. A new, persistent headache that prompted a CSF analysis was diagnosed in 13 (23.2%). The pain was throbbing, holocranial or bilateral in the majority of patients. All patients had normal CSF analysis and RT-qPCR for SARS-CoV-2 was negative in all samples. Opening pressure >200 mmH2O was present in 11 patients and, in six of these, > 250 mmH2O. 6/13 patients had complete improvement of the pain, five had partial improvement, and two were left with a daily persistent headache. CONCLUSIONS: In a significant proportion of COVID-19 patients, headache was associated to intracranial hypertension in the absence of meningitic or encephalitic features. Coagulopathy associated with COVID-19 could be an explanation, but further studies including post-mortem analysis of areas of production and CSF absorption (choroid plexuses and arachnoid granulations) are necessary to clarify this issue.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Hipertensión Intracraneal/virología , Neumonía Viral/complicaciones , Adulto , Anciano , Betacoronavirus , Presión del Líquido Cefalorraquídeo , Infecciones por Coronavirus/líquido cefalorraquídeo , Estudios Transversales , Femenino , Cefalea/líquido cefalorraquídeo , Cefalea/etiología , Humanos , Hipertensión Intracraneal/líquido cefalorraquídeo , Hipertensión Intracraneal/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/líquido cefalorraquídeo , Estudios Retrospectivos , Punción Espinal
16.
JAMA ; 324(14): 1419-1428, 2020 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-33048155

RESUMEN

Importance: Coagulopathy may deter physicians from performing a lumbar puncture. Objective: To determine the risk of spinal hematoma after lumbar puncture in patients with and without coagulopathy. Design, Setting, and Participants: Danish nationwide, population-based cohort study using medical registries to identify persons who underwent lumbar puncture and had cerebrospinal fluid analysis (January 1, 2008-December 31, 2018; followed up through October 30, 2019). Coagulopathy was defined as platelets lower than 150 × 109/L, international normalized ratio (INR) greater than 1.4, or activated partial thromboplastin time (APTT) longer than 39 seconds. Exposures: Coagulopathy at the time of lumbar puncture. Main Outcomes and Measures: Thirty-day risk of spinal hematoma. Risks were provided as numbers and percentages with 95% CIs. Secondary analyses included risks of traumatic lumbar puncture (>300 × 106 erythrocytes/L after excluding patients diagnosed with subarachnoid hemorrhage). Adjusted hazard rate ratios (HRs) were computed using Cox regression models. Results: A total of 83 711 individual lumbar punctures were identified among 64 730 persons (51% female; median age, 43 years [interquartile range, 22-62 years]) at the time of the procedure. Thrombocytopenia was present in 7875 patients (9%), high INR levels in 1393 (2%), and prolonged APTT in 2604 (3%). Follow-up was complete for more than 99% of the study participants. Overall, spinal hematoma occurred within 30 days for 99 of 49 526 patients (0.20%; 95% CI, 0.16%-0.24%) without coagulopathy vs 24 of 10 371 patients (0.23%; 95% CI, 0.15%-0.34%) with coagulopathy. Independent risk factors for spinal hematoma were male sex (adjusted hazard ratio [HR], 1.72; 95% CI, 1.15-2.56), those aged 41 through 60 years (adjusted HR, 1.96; 95% CI, 1.01-3.81) and those aged 61 through 80 years (adjusted HR, 2.20; 95% CI, 1.12-4.33). Risks did not increase significantly according to overall severity of coagulopathy, in subgroup analyses of severity of coagulopathy by pediatric specialty or medical indication (infection, neurological condition, and hematological malignancy), nor by cumulative number of procedures. Traumatic lumbar punctures occurred more frequently among patients with INR levels of 1.5 to 2.0 (36.8%; 95% CI, 33.3%-40.4%), 2.1 to 2.5 (43.7%; 95% CI, 35.8%-51.8%), and 2.6 to 3.0 (41.9% 95% CI 30.5-53.9) vs those with normal INR (28.2%; 95% CI, 27.7%-28.75%). Traumatic spinal tap occurred more often in patients with an APTT of 40 to 60 seconds (26.3%; 95% CI, 24.2%-28.5%) vs those with normal APTT (21.3%; 95% CI, 20.6%-21.9%) yielding a risk difference of 5.1% (95% CI, 2.9%-7.2%). Conclusions and Relevance: In this Danish cohort study, risk of spinal hematoma following lumbar puncture was 0.20% among patients without coagulopathy and 0.23% among those with coagulopathy. Although these findings may inform decision-making about lumbar puncture by describing rates in this sample, the observed rates may reflect bias due to physicians selecting relatively low-risk patients for lumbar puncture.


Asunto(s)
Trastornos de la Coagulación Sanguínea/complicaciones , Hematoma/etiología , Enfermedades de la Columna Vertebral/etiología , Punción Espinal/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de la Coagulación Sanguínea/sangre , Líquido Cefalorraquídeo/química , Niño , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Humanos , Relación Normalizada Internacional , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Modelos de Riesgos Proporcionales , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Punción Espinal/estadística & datos numéricos , Trombocitopenia/epidemiología , Factores de Tiempo , Adulto Joven
17.
Medicine (Baltimore) ; 99(41): e22622, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031321

RESUMEN

Validation of the anatomically complex configurations of the Lumbar Puncture Simulator II (KYOTO KAGAKU CO., LTD., 15 Kitanekoya-cho Fushimi-ku Kyoto, Japan 612-8388) have not been reported. Previous validation of the normal anatomic configuration has been reported. This study aims to evaluate evidence for construct and content validity of 4 interchangeable lumbar puncture (LP) complex anatomic configurations of this simulator.We performed a cross-sectional study between April 2018 and May 2019. Novice volunteer medical students and expert physicians who had performed over 30 LP procedures performed sequential LP procedures on each of 4 simulated interchangeable anatomic LP puncture blocks (normal, obesity, geriatric, combined geriatric/obesity). Primary outcome measures compared between groups for each LP procedure were return of cerebrospinal fluid within 5 minutes and a calculated performance score. Subjective face validity and content validity 5-point Likert questionnaires were completed by participants.35 novice (n = 19) and expert (n = 16) subjects completed 140 procedures. Significant differences were found between novice and expert groups for both cerebrospinal fluid success rates and performance scores for normal (P = .001/P = .001) geriatric (P = .005/P = .002) and obesity (P = .003/P = < .001) configurations. There were no differences for the geriatric/obesity configuration. Expert median score of simulator realism (face validity) was 4 (range 3-4); median score of utility as a training tool (content validity) was 4 (range 4-5).We provide evidence for construct validity for each of the complex LP configurations, except combined geriatric/obesity. Expert physicians found the simulator sufficiently realistic to effectively teach LP skills.


Asunto(s)
Entrenamiento Simulado , Punción Espinal , Estudios Transversales , Humanos
19.
Med. clín (Ed. impr.) ; 155(8): 335-339, oct. 2020. graf, tab
Artículo en Inglés | IBECS | ID: ibc-197036

RESUMEN

INTRODUCTION/OBJECTIVES: To describe the clinical, radiological and microbiological characteristics of vertebral osteomyelitis patients, analysing the factors that played a role on their outcome. PATIENTS AND METHODS: Single-centre retrospective observational study including patients diagnosed with vertebral osteomyelitis, based on the combination of clinical presentation with either a definitive bacteriological diagnosis and/or imaging studies. RESULTS: 116 adult patients were included with a mean age of 62.75 (14.98) years. Males predominated (68.10%). Eighteen patients (15.51%) were immunosuppressed. The most frequent symptom was back pain (99.14%) followed by fever, which was detected in 45 patients (38.79%). Puncture-aspiration or biopsy was performed in 84 patients (72.10%) and its culture was positive in 48 samples (57.14%). Gram positive species predominated (73.86%) on cultures, followed by Gram negative (12.5%), mycobacteria (10.23%) and fungi (3.41%). No microorganism was identified in 28 patients (24.14%). On imaging, most of the patients (92.24%) had paravertebral or epidural abscess. 63 cases (54.31%) showed vertebral destruction and 39 (33.62%) cord compression. Twenty-two patients (18.97%) required further surgical procedures and 13 (11.21%) died. CONCLUSIONS: The average patient is middle aged (often male) with a history of subacute back pain, sometimes presenting fever and/or neurological damage on diagnosis. Acute phase reactants are frequently raised. Diabetes mellitus, endocarditis and immunosuppressed patients may have the worst chance of a good outcome, therefore these patients should be more carefully managed (always try to obtain an imaging-guided biopsy, correct antibiotic treatment, and a functional and clinical follow-up)


INTRODUCCIÓN/OBJETIVOS: Describir las características clínicas, radiológicas y microbiológicas de pacientes con osteomielitis vertebral en nuestro centro, analizando qué variables tuvieron influencia pronóstica. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio observacional, unicéntrico y retrospectivo incluyendo pacientes adultos diagnosticados de osteomielitis vertebral sobre la base de la combinación de las manifestaciones clínicas con un diagnóstico microbiológico y/o radiológico compatible. RESULTADOS: Se incluyeron un total de 116 pacientes con una media de edad de 62,75 (14,98) años, predominando el género masculino (68,10%). Dieciocho de ellos (15,51%) estaban inmunosuprimidos. El síntoma más frecuente fue el dolor lumbar (99,14%) seguido de la fiebre, detectada en 45 pacientes (38,79%). Se realizó punción-biopsia en 84 pacientes (72,10%) con positividad en el cultivo en 48 muestras (57,14%) donde predominó el crecimiento de Gram positivos (73,86%) seguido de Gram negativos (12,5%), micobacterias (10,23%) y hongos (3,41%). En 28 pacientes (24,14%) no se pudo identificar el agente causal. En el estudio de resonancia magnética, la mayoría de los pacientes tenían abscesificación paravertebral o epidural (92,24%); 63 pacientes (54,31%) tenían hallazgos compatibles con destrucción vertebral y 39 (33,62%), compresión medular. En 22 casos (18,97%) se requirió un abordaje quirúrgico posterior. Trece pacientes (11,21%) fallecieron a causa de la infección o de sus complicaciones. CONCLUSIONES: El paciente promedio es un varón de edad media, con historia de dolor lumbar de curso subagudo e insidioso, con presencia inconstante de fiebre, presente en menos de la mitad de los casos. Con relativa frecuencia se ha detectado una exploración neurológica patológica en la presentación clínica. Los reactantes de fase aguda estaban elevados en la mayoría de los pacientes. Los casos en los que exista comorbilidad (sobre todo diabetes mellitus o inmunosupresión), así como la concomitancia con endocarditis, debe de implicar un manejo más cauto


Asunto(s)
Humanos , Masculino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Osteomielitis/diagnóstico por imagen , Osteomielitis/microbiología , Dolor de la Región Lumbar/etiología , Osteomielitis/patología , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/patología , Estudios Retrospectivos , Punción Espinal/métodos , Infecciones/complicaciones , Tomografía Computarizada por Tomografía de Emisión de Positrones
20.
Pain Physician ; 23(4S): S305-S310, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32942790

RESUMEN

BACKGROUND: A primary concern in the use of EBP in these patients is the possibility of seeding the virus in the CNS. Another important concern is related to the known hypercoagulable state in COVID-19 positive patients and associated organ dysfunction that may alter the metabolism of anticoagulants. The safety of the providers performing the EBP, the position of the patient and choices for image guidance (blind, fluoroscopic) are also key considerations to review. It is also important to explore the current state of knowledge about using allogenic instead of autologous blood as well as emerging techniques to eliminate the coronavirus from the blood. OBJECTIVES: In this article we pose the questions of how to manage PDPH in the COVID-19 positive patient and more specifically, the use of epidural blood patch (EBP). METHODS: Literature review. RESULTS: EBP is usually considered after the failure of conservative and pharmacological treatments. Because of the additional risks of EBP in COVID-19 patients it is important to also consider less traditional pharmacological treatments such as theophylinnes and cosyntropin that may offer some additional benefit for COVID-19 patient. Finally, other interventions other than EBP should also be considered including occipital nerve blocks, sphenopalatine ganglion blocks (infratemporal or transnasal). LIMITATIONS: A narrative review with paucity of literature. CONCLUSION: Going forward, an effective treatment for COVID-19 or a safe vaccine and a deeper understanding of the pathophysiology of the virus will certainly change the risk calculus involved in performing an EBP in a COVID-19 patient.


Asunto(s)
Parche de Sangre Epidural/métodos , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Cefalea Pospunción de la Duramadre/terapia , Punción Espinal/efectos adversos , Adulto , Betacoronavirus , Tratamiento Conservador/métodos , Femenino , Humanos , Bloqueo Nervioso/efectos adversos , Bloqueo Nervioso/métodos , Pandemias , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...