RESUMO
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Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Meningites Bacterianas/diagnóstico , Streptococcus pneumoniae/isolamento & purificação , Infecções Pneumocócicas/diagnóstico , Encefalite por Varicela Zoster/diagnóstico , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Pandemias , Diagnóstico DiferencialRESUMO
Los corticoides se utilizan ampliamente en la práctica clínica habitual en neurooncología. Sin embargo, pese a lo extendido de su uso, no existe un consenso establecido sobre sus indicaciones, dosis y posología. En este artículo se realiza una revisión bibliográfica del mecanismo de acción de los corticoides, sus indicaciones de uso, efectos secundarios y manejo adecuado, dosis y duración de la terapia, así como el papel de nuevos tratamientos actuales para el edema cerebral. El corticoide con un uso mas extendido en neurooncología es la dexametasona, probablemente por su escaso efecto mineralocorticoide y por su elevada vida media. Su efecto sobre el edema cerebral es fundamental en el control sintomático de los pacientes con tumores cerebrales. Se recomienda iniciar tratamiento únicamente en pacientes sintomáticos, en dosis de 4-8 mg/24 h, buscando siempre la mínima dosis eficaz. Los efectos secundarios asociados al uso de corticoides son frecuentes e impactan negativamente en la calidad de vida de los pacientes
Corticosteroids are widely used in routine clinical practice in neuro-oncology. However, despite their widespread use, there is no established consensus on their indications, dosages and dosage schedule. This article reviews the mechanism of action of corticosteroids, their indications for use, side effects and the appropriate management, dosage and duration of therapy, as well as the role of new treatments currently being use to treat cerebral oedema. The most widely used corticosteroid in neuro-oncology is dexamethasone, probably due to its low mineralocorticoid effect and its long half-life. Its effect on cerebral oedema is fundamental in the symptomatic control of patients with brain tumours. It is recommended to start treatment only in symptomatic patients, in doses of 4-8 mg/24 h, always seeking the minimum effective dosage. Side effects associated with corticosteroid use are common and have a negative impact on patients' quality of life
Assuntos
Humanos , Esteroides/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Edema Encefálico/tratamento farmacológico , Esteroides/efeitos adversos , Imageamento por Ressonância MagnéticaRESUMO
Among 249 patients with teratoma-associated encephalitis, 211 had N-methyl-D-aspartate receptor antibodies and 38 were negative for these antibodies. Whereas antibody-positive patients rarely developed prominent brainstem-cerebellar symptoms, 22 (58%) antibody-negative patients developed a brainstem-cerebellar syndrome, which in 45% occurred with opsoclonus. The median age of these patients was 28.5 years (range = 12-41), 91% were women, and 74% had full recovery after therapy and tumor resection. These findings uncover a novel phenotype of paraneoplastic opsoclonus that until recently was likely considered idiopathic or postinfectious. The triad of young age (teenager to young adult), systemic teratoma, and high response to treatment characterize this novel brainstem-cerebellar syndrome.
