Surgical Treatment of Falcotentorial Meningioma: An Illustrative Case Report and Literature Review.

Falcotentorial meningiomas are rare tumors, representing only 2-3% of all intracranial meningiomas. These tumors can grow rapidly, leading to severe neurological complications. They grow at the junction of the tentorium cerebelli and the falx cerebri, in close proximity to the great vein of Galen. The surgical approach depends on several factors, such as the tumor's size, the patency of the straight sinus, and its location, either above or below the tentorium. Complete removal of the tumor in this area is difficult due to its deep location near major neurovascular structures. Various surgical approaches can be employed to remove these tumors, and the decision on which approach to use should be based on its advantages and disadvantages.

Genetic Characterization of the Factor VIII Gene in a Cohort of Colombian Patients with Severe Hemophilia A with Inhibitors.

Hemophilia A is an X-linked bleeding disorder caused by mutations in the FVIII gene. Genetic factors have been shown to be a risk factor for the development of inhibitors. We aimed to identify the specific variations of the FVIII gene of patients with hemophilia A with inhibitors and their association with the inhibitor titer. Methods: Cross-sectional descriptive study. We included 12 Colombian patients from a health care provider, "Integral Solutions SD", who underwent analysis of genetic material (DNA), which was reported by the Molecular Hemostasis Laboratory in Bonn, Germany. Results: All of these patients were diagnosed with severe hemophilia A with inhibitors; ages ranged between 6 and 48 years, with a median age of 13.5 years. Molecular analysis showed the inversion of intron 22 in six patients (50.0%), a small duplication in two patients (16.7%), the inversion of intron 1 in one patient (8.3%), a large deletion (8.3%), a nonsense mutation (8.3%) and a splice-site (8.3%), findings similar to those of other studies. A total of 58.3% of the patients presented inversion mutations with a high risk of developing inhibitors A total of 83.3% of the evaluated patients presented null mutations; however the presence of high inhibitor titers was 66.7%. The most frequent mutation was the inversion intron 22. Knowing the type of mutation and its association as a risk factor for generating inhibitors invites us to delve into other outcomes such as residual values of coagulation FVIII as well as its impact on the half-life of the exogenous factor applied in prophylaxis.

[Optic neuritis after a bee sting]. / Neuritis óptica por picadura de abeja.

Optic neuritis is an acute inflammation of the optic nerve and, in its atypical form, is caused by inflammation of the optic nerve as part of infectious, immune, granulomatous, or contiguity processes. Hymenoptera stings (bees, wasps and ants) have been associated with different clinical presentations, ranging from local events to systemic manifestations, such as anaphylaxis, glomerulonephritis and central nervous system involvement (ischemic vascular lesions, optic neuritis and demyelinating lesions). This is a report of the case of a 62-year-old woman that after three days of being stung by a bee in the left lower eyelid, showed decreased visual acuity of both eyes and central scotoma, concomitant bilateral headache and eye pain, exacerbated by eye movements. The ophthalmological examination showed that visual acuity was decreased and the bilateral fundus examination revealed blurred optic disks edges. Hyperintense thickening of the left optic nerve was observed with an ocular MRI. Due to the clinical manifestations and epidemiological history, the diagnosis of bilateral optic neuritis was established. Treatment with pulses of 1 g/daily of methylprednisolone was initiated, for three days, with clinical improvement within 24 hours after receiving the first dose. Since 1960, cases of optic neuritis associated with hymenoptera stings have been documented, which take the form of anterior optic neuritis. A case of a patient who presented clinical features of bilateral optic neuritis after been stung by a bee, with a good clinical outcome after treatment with methylprednisolone is reported.

[Infective endocarditis by Rhizobium radiobacter. A case report]. / Endocarditis infecciosa por Rhizobium radiobacter. Reporte de un caso.

Rhizobium radiobacter is a Gram-negative, nitrogen-fixing bacterium, which is found mainly on the ground. It rarely causes infections in humans. It has been associated with bacteremia, secondary to colonization of intravascular catheters, in immunocompromised patients. The aim of this paper was to report the case of an infective endocarditis caused by R. radiobacter, in a 47-year-old male, diagnosed with chronic kidney disease stage 5, on replacement therapy with hemodialysis and who attended the medical center with fever of two weeks duration. The patient was hospitalized and samples of peripheral blood were taken for culture. Empirical antibiotic therapy was started with cefotaxime plus vancomycin. The transthoracic echocardiogram revealed fusiform vegetation on the tricuspid valve, with grade III-IV/IV regurgitation. On the seventh day after the start of antibiotic therapy, the patient had a clinical and paraclinical improvement. The bacterium identified by blood culture was Rhizobium radiobacter, ceftriaxone-resistant and sensitive to imipenem, amikacin, ampicillin and ampicillin/sulbactam. Because of the clinical improvement, it was decided to continue treatment with vancomycin and additionally, with imipenem. At 14 days after the start of antibiotic therapy, the patient was discharged with outpatient treatment with imipenem up to six weeks of treatment. The control echocardiogram showed the absence of vegetation on the tricuspid valve. This case suggests that R. radiobacter can cause endocarditis in patients with intravascular catheters.

Neuritis óptica por picadura de abeja / Optic neuritis after a bee sting

La neuritis óptica es la inflamación aguda del nervio óptico y su forma atípica se produce por la inflamación del nervio óptico como parte de un proceso de causa infecciosa, inmune, granulomatosa, o por contigüidad. Las picaduras por himenópteros (abejas, avispas, hormigas) han sido asociadas con diferentes cuadros clínicos, que van desde manifestaciones locales hasta cuadros sistémicos como anafilaxis, glomerulonefritis y afectación del sistema nervioso central (lesiones vasculares e isquémicas, neuritis óptica y lesiones desmielinizantes). Desde 1960 se han documentado casos de neuritis ópticas asociadas a las picaduras de himenópteros, que adoptan las formas de neuritis óptica anterior isquémica e inflamatoria. Se presenta el caso de una paciente, mujer de 62 años de edad, que luego de tres días de haber sufrido picadura por abeja en párpado inferior izquierdo, presentó disminución de la agudeza visual de ambos ojos y escotoma central, concomitante con cefalea y dolor ocular bilateral exacerbado con los movimientos oculares. Al examen oftalmológico la agudeza visual se encontraba disminuida (visión en bultos). En el fondo de ojo se evidenció de forma bilateral discos ópticos de bordes borrados. En la resonancia magnética ocular se observó engrosamiento hiperintenso del nervio óptico izquierdo. Por las características clínicas y el antecedente epidemiológico se planteó el diagnóstico de neuritis óptica bilateral. Se inició pulsos de metilprednisolona, con posterior mejoría de la clínica.

Optic neuritis is an acute inflammation of the optic nerve and, in its atypical form, is caused by inflammation of the optic nerve as part of infectious, immune, granulomatous, or contiguity processes. Hymenoptera stings (bees, wasps and ants) have been associated with different clinical presentations, ranging from local events to systemic manifestations, such as anaphylaxis, glomerulonephritis and central nervous system involvement (ischemic vascular lesions, optic neuritis and demyelinating lesions). This is a report of the case of a 62-year-old woman that after three days of being stung by a bee in the left lower eyelid, showed decreased visual acuity of both eyes and central scotoma, concomitant bilateral headache and eye pain, exacerbated by eye movements. The ophthalmological examination showed that visual acuity was decreased and the bilateral fundus examination revealed blurred optic disks edges. Hyperintense thickening of the left optic nerve was observed with an ocular MRI. Due to the clinical manifestations and epidemiological history, the diagnosis of bilateral optic neuritis was established. Treatment with pulses of 1g/daily of methylprednisolone was initiated, for three days, with clinical improvement within 24 hours after receiving the first dose. Since 1960, cases of optic neuritis associated with hymenoptera stings have been documented, which take the form of anterior optic neuritis. A case of a patient who presented clinical features of bilateral optic neuritis after been stung by a bee, with a good clinical outcome after treatment with methylprednisolone is reported.

Endocarditis infecciosa por Rhizobium radiobacter: Reporte de un caso / Infective endocarditis by Rhizobium radiobacter: A case report

Rhizobium radiobacter es una bacteria Gram-negativa, fijadora de nitrógeno que se encuentra principalmente en el suelo. Rara vez causa infecciones en humanos. Ha sido asociada a bacteriemia secundaria a colonización de catéteres intravasculares en pacientes inmunocomprometidos. El objetivo de este trabajo es informar un caso de endocarditis infecciosa por R. radiobacter. Se trata de paciente masculino, de 47 años de edad, con diagnóstico de enfermedad renal crónica estadio 5 en tratamiento sustitutivo con hemodiálisis, quien acude a centro asistencial por presentar fiebre de dos semanas de evolución. Es hospitalizado, se toman muestras de sangre periférica para hemocultivo y se inicia antibioticoterapia empírica con cefotaxime más vancomicina. El ecocardiograma transtorácico revelo vegetación fusiforme en válvula tricúspide con regurgitación grado III-IV/IV. Al séptimo día del inicio de la antibioterapia el paciente presenta mejoría clínica y paraclínica. La bacteria identificada por hemocultivo es Rhizobium radiobacter resistente a ceftriaxona y sensible a imipenem, amikacina, ampicilina y ampicilina/sulbactam. Debido a la mejoría clínica se decide continuar tratamiento con vancomicina y se anexa imipenem. A los 14 días de iniciada la antibioterapia el paciente es dado de alta con tratamiento ambulatorio con imipenen hasta cumplir seis semanas de tratamiento. En el ecocardiograma control se evidencio ausencia de la vegetación en la válvula tricúspide. Este caso sugiere que R. radiobacter puede ser una causa de endocarditis en pacientes portadores de catéteres intravasculares.

Rhizobium radiobacter is a Gram-negative, nitrogen-fixing bacterium, which is found mainly on the ground. It rarely causes infections in humans. It has been associated with bacteremia, secondary to colonization of intravascular catheters, in immunocompromised patients. The aim of this paper was to report the case of an infective endocarditis caused by R. radiobacter, in a 47-year-old male, diagnosed with chronic kidney disease stage 5, on replacement therapy with hemodialysis and who attended the medical center with fever of two weeks duration. The patient was hospitalized and samples of peripheral blood were taken for culture. Empirical antibiotic therapy was started with cefotaxime plus vancomycin. The transthoracic echocardiogram revealed fusiform vegetation on the tricuspid valve, with grade III-IV/IV regurgitation. On the seventh day after the start of antibiotic therapy, the patient had a clinical and paraclinical improvement. The bacterium identified by blood culture was Rhizobium radiobacter, ceftriaxone-resistant and sensitive to imipenem, amikacin, ampicillin and ampicillin/ sulbactam. Because of the clinical improvement, it was decided to continue treatment with vancomycin and additionally, with imipenem. At 14 days after the start of antibiotic therapy, the patient was discharged with outpatient treatment with imipenem up to six weeks of treatment. The control echocardiogram showed the absence of vegetation on the tricuspid valve. This case suggests that R. radiobacter can cause endocarditis in patients with intravascular catheters.

Esquizencefalia de labio cerrado bilateral: a propósito de un caso / Schizencephaly of bilateral closed lip: speaking of one case

La esquizencefalia es un desorden de la migración neuronal, caracterizada por hendiduras de sustancia gris en los hemisferios cerebrales que se extienden desde la superficie pial a los ventrículos laterales. Esta patología es el resultado final de una amplia variedad de factores genéticos, tóxicos, metabólicos y de agentes infecciosos que ocurren durante un período crítico del desarrollo cerebral. Esta malformación puede ser unilateral o bilateral y puede ser dividida en dos subtipos: de ¨labios cerredos" o tipo I, o de "Labios abierto" o tipo II. Presentamos el caso de una paciente demenina de 37 años de edad con epilepsia y hallazgos neurorradiológicos de esquizencefalia de "labios cerrados" bilateral

Schizencephaly is a rare developmental of neuronal migration, characterized by congenital clefts spanning the cerebral hemisphere from the pial surface to the lateral ventricle and lined by cortical gray matter. The lesion is the final result of a variety of etiologies including genetic, toxic, metabolic and infectious agents during a critical period of the development of the brain. This malformation can be unilateral or bilateral and may be divided in two subtypes: "closed tips" or type I and "open tips" or type II. We present 37 years old female patient with epilepsy and neuroradiological findings of bilateral "closed lips" schizencephaly

Síndrome de Wallenberg: a propósito de un caso / Wallenberg syndrome: report of a case

Se trata de paciente de sexo masculino, de 47 años de edad, quien ingresa a la emergencia del Hospital “Dr Héctor Nouel Joubert” del IVSS de Ciudad Bolívar por presentar disartria de aparición brusca, disfagia, hemiparesia derecha e hipo intermitente. Al examen físico se encontraron cifras tensionales elevadas (160/80mmHg), voz ronca, lengua lateralizada a la derecha, ptosis velopalatina derecha discreta, hemihipoestesia facial derecha con hemihipoestesia térmica izquierda, hemiparesia derecha, reflejo nauseoso ausente en el lado derecho, todo por afectación de los pares craneales: V, VII, IX, X y XII. Se realizó resonancia magnética contrastada con énfasis en fosa posterior, revelando imagen de 6 mm en bulbo raquídeo, correspondiente a oclusión aterotrombótica de la arteria cerebelosa posterior izquierda, lo cual explica la clínica del paciente. Debe resaltarse el inicio brusco de la sintomatología del paciente y que, a diferencia de otros casos presentados, éste no comenzó con vértigo, náuseas y vómitos, así como tampoco la presencia del Síndrome de Horner ipsilateral, descrito en algunos casos de Síndrome de Wallenberg

A 47-years old male patient admitted to the emergency service of the Dr. Héctor Nouel Joubert Venezuelan Institute of Social Security Hospital of Ciudad Bolivar presented with sudden-onset dysarthria, dysphagia, right-sided hemiparesis, and intermittent hiccups. A physical evaluation revealed high blood pressure (160/80mmHg), hoarseness, tongue deviation to the right, discrete ptosis of the soft palate, right facial hemihypoesthesia with left thermal hemihypoesthesia, right-sided hemiparesis and absent gag reflex on the right side all due to impairment of cranial nerves V, VII, IX, X, and XII. A contrast-enhanced MRI with focus on the posterior fossa revealed a 6mm image in the medulla oblongata, corresponding to an atheroembolic occlusion of the left posterior cerebellar artery, which explains the patient’s bodily disorder. It is worth noting that the symptoms appeared suddenly and, unlike in other cases, they did not include vertigo, nausea, pr vomits, nor the ipsilateral Horner’s Syndrome described in some cases of Wallenberg’s Syndrome