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1.
BMC Surg ; 21(1): 55, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482777

RESUMO

BACKGROUND: There are few articles about the surgical techniques of thalamic glioma and the lesions in the basal ganglia area. According to three existing cases and the literature review (Twelve articles were summarized which mainly described the surgical techniques), we discuss the surgical characteristics of lesions of the thalamus and basal ganglia area and summarize the relevant surgical skills. CASE PRESENTATION: Of the three cases, two were thalamic gliomas and one was brain abscess in basal ganglia. According to the three-dimensional concept of the "Four Walls, Two Poles", lesions of the thalamus and basal ganglia were surgically removed, and the operative effect was analysed by relevant surgical techniques. Surgical resection of the lesions of the thalamus and basal ganglia area according to the three-dimensional concept of the "Four Walls, Two Poles" has achieved good surgical results. Relevant surgical techniques, such as the use of retractors, the use of aspirators, the choice of surgical approaches, and the haemostasis strategy, also played an important role in the operation process. CONCLUSIONS: In the presented three cases the three-dimensional concept of the "Four Walls, Two Poles" allowed for safe surgical resection of lesions of the thalamus and basal ganglia.


Assuntos
Doenças dos Gânglios da Base/cirurgia , Gânglios da Base , Abscesso Encefálico/cirurgia , Glioma/cirurgia , Procedimentos Neurocirúrgicos , Tálamo , Adulto , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/cirurgia , Doenças dos Gânglios da Base/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Competência Clínica , Glioma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas , Tálamo/diagnóstico por imagem , Tálamo/cirurgia , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 13(10)2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33040042

RESUMO

The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre's syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre's syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.


Assuntos
Abscesso Encefálico , Infecções por Coronavirus , Cuidados Críticos/métodos , Diagnóstico Tardio , Fusobacterium necrophorum , Abscesso Hepático Piogênico , Nódulos Pulmonares Múltiplos , Pandemias , Pneumonia Viral , Quarentena , Doenças Dentárias , Antibacterianos/administração & dosagem , Anticoagulantes/administração & dosagem , Betacoronavirus , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Deterioração Clínica , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Diagnóstico Diferencial , Fusobacterium necrophorum/isolamento & purificação , Fusobacterium necrophorum/patogenicidade , Humanos , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/etiologia , Síndrome de Lemierre/fisiopatologia , Abscesso Hepático Piogênico/diagnóstico por imagem , Abscesso Hepático Piogênico/etiologia , Abscesso Hepático Piogênico/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/etiologia , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena/métodos , Quarentena/psicologia , Tomografia Computadorizada por Raios X/métodos , Doenças Dentárias/complicações , Doenças Dentárias/diagnóstico , Doenças Dentárias/microbiologia , Resultado do Tratamento , Adulto Jovem
4.
BMC Infect Dis ; 20(1): 389, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487026

RESUMO

BACKGROUND: Intracranial infections with Corynebacterium striatum (C. striatum) have been described sporadically in the literature over the last two decades. However, C. striatum meningitis combined with multiple abscesses has not been published before. CASE PRESENTATION: In this report, we describe the clinical and imaging findings in a 54-year-old woman with meningitis caused by C. striatum and combined with suspected brain and lung abscesses. This patient who underwent multiple fractures and a recent cut presented with headache and paraphasia. C. striatum was isolated in cerebrospinal fluid and supposedly transmitted from the skin purulent wound through blood. The patient was treated with intravenous vancomycin and had a transient improvement, but died finally. Multiple abscesses, especially in the brain, could be a reason to explain her conditions were deteriorating rapidly. CONCLUSIONS: Note that C. striatum can cause life-threatening infections. Early identification and diagnosis, early administration of antibiotics to which the bacterium is susceptible, and treatment of complications will be beneficial in patients with C. striatum-related infection.


Assuntos
Abscesso Encefálico/microbiologia , Infecções por Corynebacterium/complicações , Abscesso Pulmonar/microbiologia , Meningites Bacterianas/microbiologia , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Líquido Cefalorraquidiano/microbiologia , Corynebacterium/isolamento & purificação , Corynebacterium/patogenicidade , Infecções por Corynebacterium/tratamento farmacológico , Feminino , Humanos , Traumatismos da Perna/microbiologia , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/tratamento farmacológico , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Pessoa de Meia-Idade , Vancomicina/uso terapêutico
5.
BMC Infect Dis ; 20(1): 378, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460724

RESUMO

BACKGROUND: Brain abscesses are the rare and most severe form of actinomycosis, which usually manifests as abscesses of the occipital or parietal lobe due to direct expansion from an adjacent area, the oral cavity. In the medical literature, there are only a few reported cases of brain abscess caused by Actinomyces meyeri. In this report, we present a 35-year-old male patient who experienced an insidious headache and left-sided weakness and was diagnosed with an Actinomyces meyeri brain abscess. CASE PRESENTATION: A 35-year-old Nepalese man came to our institute with the primary complaint of insidious onset of headache and left-sided weakness. His physical examination was remarkable for the left-sided weakness with power 2/5 on both upper and lower limbs, hypertonia, hyperreflexia and positive Babinski sign, with intact sensory function. Cardiac examination revealed systolic murmur with regular S1 and S2, and lung examination was normal. The patient had poor dental hygiene. Biochemistry and haematology panel were normal. Urinalysis, chest X-ray and electrocardiogram revealed no abnormality. A transthoracic echocardiogram revealed mitral regurgitation. However, there was no evidence of valvular vegetation. A magnetic resonance imaging (MRI) of the brain was performed, which showed a bi-lobed rim enhancing lesion with a conglomeration of two adjoining round lesions in the right parietal parasagittal region. Perilesional oedema resulting in mass effect over the right lateral ventricle and mid-right uncal herniation with midline shift was noted. Craniotomy was performed, and the lesion was excised. Gram staining of the extracted sample revealed gram variable filamentous rods. Creamy white, moist, confluent colonies were observed after performing anaerobic culture in chocolate agar. On the gram staining, they showed gram-positive filamentous rods. Actinomyces meyeri was identified based on matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology. Based on the susceptibilities, he was successfully treated with ampicillin-sulbactam. CONCLUSIONS: In conclusion, Actinomyces should be considered in the differential diagnosis of brain abscess in patients with poor dental hygiene, and early diagnosis and appropriate treatment can lead to better results.


Assuntos
Actinomyces/isolamento & purificação , Actinomicose/microbiologia , Abscesso Encefálico/microbiologia , Actinomyces/genética , Actinomyces/fisiologia , Actinomicose/diagnóstico , Actinomicose/diagnóstico por imagem , Adulto , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/diagnóstico por imagem , Cefaleia/diagnóstico , Cefaleia/diagnóstico por imagem , Cefaleia/microbiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Radiografia
6.
BMC Infect Dis ; 20(1): 370, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448130

RESUMO

BACKGROUND: Brain abscesses, a severe infectious disease of the CNS, are usually caused by a variety of different pathogens, which include Streptococcus intermedius (S. intermedius). Pulmonary arteriovenous fistulas (PAVFs), characterized by abnormal direct communication between pulmonary artery and vein, are a rare underlying cause of brain abscesses. CASE PRESENTATION: The patient was a previous healthy 55-year-old man who presented with 5 days of headache and fever. Cerebral magnetic resonance imaging (MRI) suggested a brain abscess. Thoracic CT scan and angiography demonstrated PAVFs. Aiding by metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid (CSF) sample which identified S. intermedius as the causative pathogen, the patient was switched to the single therapy of large dose of penicillin G and was cured precisely and economically. CONCLUSIONS: It is an alternative way to perform mNGS to identify causative pathogens in patients with brain abscesses especially when the results of traditional bacterial culture were negative. Further thoracic CT or pulmonary angiography should also be undertaken to rule out PAVFs as the potential cause of brain abscess if the patient without any known premorbid history.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Penicilina G/uso terapêutico , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus intermedius/genética , Fístula Arteriovenosa/complicações , Abscesso Encefálico/líquido cefalorraquidiano , Abscesso Encefálico/microbiologia , Angiografia por Tomografia Computadorizada , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Infecções Estreptocócicas/líquido cefalorraquidiano , Infecções Estreptocócicas/microbiologia , Streptococcus intermedius/isolamento & purificação , Resultado do Tratamento
7.
Am J Trop Med Hyg ; 103(2): 713-718, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32342852

RESUMO

Clinical worsening or new manifestation of cryptococcal disease following initiation of anti-retroviral therapy (ART) in an HIV patient is a hallmark of cryptococcal immune reconstitution inflammatory syndrome (C-IRIS). However, it can be difficult to distinguish IRIS from worsening or new infection. Here, we present a case of severe C-IRIS involving multiple cerebellar, spinal, and intradural abscesses and spinal arachnoiditis 7 months after ART initiation in an AIDS patient with uncertain prior ART compliance. He had multiple prior episodes of cryptococcal meningitis with complications necessitating ventriculoperitoneal shunt placement and was on suppressive fluconazole when he developed worsening brain manifestations. He received empiric anti-cryptococcal re-induction without improvement. All cerebrospinal fluid cultures remained sterile, with negative Cryptococcus PCR testing, and his condition continued to worsen prior to corticosteroid initiation. Ultimately, C-IRIS was diagnosed by brain biopsy. This case demonstrates an extreme in severity of C-IRIS and in the timeline of presentation after ART initiation.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Antirretrovirais/uso terapêutico , Antifúngicos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Empiema Subdural/diagnóstico por imagem , Síndrome Inflamatória da Reconstituição Imune/diagnóstico por imagem , Meningite Criptocócica/tratamento farmacológico , Anfotericina B/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Aracnoide-Máter/patologia , Aracnoidite/congênito , Aracnoidite/diagnóstico por imagem , Aracnoidite/tratamento farmacológico , Biópsia , Encéfalo/patologia , Abscesso Encefálico/tratamento farmacológico , Edema Encefálico/diagnóstico por imagem , Doenças Cerebelares/diagnóstico por imagem , Doenças Cerebelares/tratamento farmacológico , Empiema Subdural/tratamento farmacológico , Fluconazol/uso terapêutico , Flucitosina/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Recidiva
8.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(2): 68-74, mar.-abr. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196346

RESUMO

PROPÓSITO: La identificación precisa de los gliomas de bajo grado (GBG; grados I y II de la Organización Mundial de la Salud) y su diferenciación de las lesiones por inflamación cerebral (BIL) sigue siendo difícil; sin embargo, es esencial para el tratamiento. Este estudio evaluó si un protocolo de un día para la PET/TC con 18F-FDG y 13N-amonio con análisis de desacoplamiento de la captación podría diferenciar los GBG de las BIL. MATERIALES Y MÉTODOS: Veintiocho pacientes con GBG y 16 pacientes con BIL se sometieron a PET/TC con 18F-FDG y 13N-amonio el mismo día antes de cualquier tipo de terapia. La puntuación de desacoplamiento y la relación tumor/tejido normal (T/N) de 18F-FDG y 13N-amonio se calcularon en cada localización. Se utilizó la prueba t de Student para comparar valores, y el análisis de la curva ROC para establecer un valor de corte para la relación T/N y la puntuación de desacoplamiento. Se calculó el área bajo la curva (AUC) para evaluar la eficacia diferencial. RESULTADOS: Se observaron diferencias significativas en la relación T/N de 13N-amonio (p = 0,018) y en la puntuación de desacoplamiento (p = 0,003) entre los GBG y las BIL; sin embargo, la relación T/N de 18F-FDG no mostró ninguna diferencia (p = 0,413). Los valores de corte óptimos para la relación T/N de 18F-FDG, la relación T/N de 13N-amonio y la puntuación de desacoplamiento fueron 0,73, 0,97 y 2,31, respectivamente, con AUC correspondientes de 0,48, 0,68 y 0,77. Los respectivos parámetros de sensibilidad, especificidad y precisión que utilizan estos valores de corte fueron 53,6%, 62,5% y 56,8%, respectivamente, para 18F-FDG; 50,0%, 75,0% y 59,1%, respectivamente, para 13N-amonio; y 60,7%, 93,8% y 72,7%, respectivamente, para la puntuación de desacoplamiento. CONCLUSIONES: La puntuación de desacoplamiento de la captación de 18F-FDG/13N amonio se puede utilizar para discriminar entre GBG y BIL. El uso de un mapa de desacoplamiento de estos dos trazadores puede mejorar el análisis visual y la precisión del diagnóstico


PURPOSE: Accurate identification of low-grade gliomas (LGGs; World Health Organization grades I and II) and their differentiation from brain inflammation lesions (BILs) remains difficult; however, it is essential for treatment. This study assessed whether a one-day protocol for voxel-wise 18F-FDG and 13N-ammonia PET/CT with uptake decoupling analysis could differentiate LGGs from BILs. MATERIALS AND METHODS: Twenty-eight patients with LGGs and 16 patients with BILs underwent 18F-FDG and 13N-ammonia PET/CT on the same day before any type of therapy. The decoupling score and tumor-to-normal tissue (T/N) ratio of 18F-FDG and 13N-ammonia were calculated at each location. Student's t-test was used to compare values, and ROC curve analysis was used to establish a cut-off value for the T/N ratio and decoupling score. Area under the curve (AUC) was calculated to evaluate differential efficacy. RESULTS: Significant differences were observed in 13N-ammonia T/N ratio (p = 0.018) and decoupling score (p = 0.003) between LGGs and BILs; however, the 18F-FDG T/N ratio did not show any differences (p = 0.413). Optimal cut-off values for 18F-FDG T/N ratio, 13N-ammonia T/N ratio, and decoupling score were 0.73, 0.97, and 2.31, respectively, with corresponding AUCs of 0.48, 0.68, and 0.77. The respective sensitivity, specificity, and accuracy parameters using these cut-off values were 53.6%, 62.5%, and 56.8%, respectively, for 18F-FDG; 50.0%, 75.0%, and 59.1%, respectively, for 13N-ammonia; and 60.7%, 93.8%, and 72.7%, respectively, for decoupling score. CONCLUSIONS: 18F-FDG/13N-ammonia uptake decoupling score can be used to discriminate between LGGs and BILs. Use of a decoupling map of these two tracers can improve visual analysis and diagnostic accuracy


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Neoplasias Encefálicas/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Fluordesoxiglucose F18 , Glioma/diagnóstico por imagem , Radioisótopos de Nitrogênio , Tomografia Computadorizada por Raios X/métodos , Compostos Radiofarmacêuticos , Área Sob a Curva , Cérebro/diagnóstico por imagem , Cérebro/metabolismo , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/metabolismo , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Doenças Desmielinizantes/diagnóstico por imagem , Doenças Desmielinizantes/metabolismo , Encefalite/metabolismo , Fluordesoxiglucose F18/farmacocinética , Glioma/metabolismo , Glioma/patologia , Gradação de Tumores , Radioisótopos de Nitrogênio/farmacocinética , Tomografia por Emissão de Pósitrons , Curva ROC , Compostos Radiofarmacêuticos/farmacocinética , Estudos Retrospectivos , Sensibilidade e Especificidade
9.
Medicine (Baltimore) ; 99(10): e18954, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150046

RESUMO

RATIONALE: In patients receiving biological therapies, serious infections are a major concern. Infections associated with anti-tumor necrosis factor antibody therapy include tuberculosis, viral, fungal, and bacterial infections. Likewise, severe infections of the upper and lower respiratory tract, lung, skin and soft tissue, urinary tract, gastrointestinal tract, joint, and bone have also been reported previously. However, infections involving the central nervous system are rare, especially an intracranial infection caused by odontogenic infection. To date, only few cases have been reported of this infection. This is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. PATIENT CONCERNS: A 39-year-old male with psoriatic arthritis receiving adalimumab treatment came to the emergency department with initial presentation of sudden onset convulsions. He had been receiving adalimumab treatment for 1 month. Two days after the third injection, the patient had an episode of sudden-onset general convulsion for nearly 5 min with the upgazing and general tonic presentation. Magnetic resonance imaging (MRI) showed left frontal lobe brain abscess. Pus culture from the brain abscess detected Streptococcus sanguinis (S. sanguinis), Fusobacterium nucleatum (F. nucleatum), and Parvimonas micra (P. micra). DIAGNOSIS: Brain abscess with odontogenic infection. INTERVENTIONS: The patient received left frontal craniotomy, abscess drainage and systemic empiric antibiotics treatment with vancomycin, cefepime, and metronidazole. Due to drug rash with eosinophilia and systemic symptoms during the treatment, vancomycin and metronidazole were discontinued, and systemic antibiotics were switched to teicoplanin and ceftriaxone. OUTCOMES: A brain MRI follow-up performed after 1 month of initial treatment revealed the reduced size of the abscess lesion and minimal oedema. The patient was discharged with stable condition. LESSONS: To the best of our knowledge, this is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. Such a rare diagnosis must be kept in mind when patients treated with adalimumab present with sudden-onset convulsions. Careful dental examination should be performed before administration of adalimumab.


Assuntos
Adalimumab/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Psoriásica/tratamento farmacológico , Abscesso Encefálico/diagnóstico , Cérebro , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Abscesso Encefálico/microbiologia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Terapia Combinada , Craniotomia , Diagnóstico Diferencial , Firmicutes/isolamento & purificação , Fusobacterium nucleatum/isolamento & purificação , Humanos , Imagem por Ressonância Magnética , Masculino , Periodontite/complicações , Streptococcus/isolamento & purificação , Streptococcus sanguis , Teicoplanina/administração & dosagem , Teicoplanina/uso terapêutico
10.
Can Assoc Radiol J ; 71(2): 186-194, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063011

RESUMO

The tectal plate comprises the posterior portion of the midbrain, borders the quadrigeminal cistern, and includes the superior and inferior colliculi. Benign and malignant pathologies occurring in this location may lead to aqueductal stenosis, obstructive hydrocephalus, and Parinaud syndrome. Both computed tomography and magnetic resonance imaging can be used to further characterize lesions involving the tectal plate. In this pictorial essay, we review various tectal plate lesions and their imaging features.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Cistos/diagnóstico por imagem , Glioma/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Teto do Mesencéfalo/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/secundário , Lipoma/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem
11.
Rev. neurol. (Ed. impr.) ; 70(1): 19-22, 1 ene., 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-187124

RESUMO

Introducción: La tromboflebitis del seno cavernoso es una enfermedad infecciosa grave con alta mortalidad y morbilidad. Su diagnóstico suele ser tardío y requiere múltiples visitas a urgencias en la mayoría de casos, y el pronóstico es altamente dependiente de su rápido tratamiento. A pesar de su gravedad, la evidencia con respecto al tratamiento con corticoides y anticoagulación es escasa y controvertida. Entre sus complicaciones se encuentra la arteritis, la cual puede confundirse con una vasculitis de mediano-gran vaso, como en este caso. Caso clínico: Mujer de 26 años, que acude por una cefalea y un edema palpebral izquierdo. En las pruebas de imagen se evidencia trombosis del seno cavernoso izquierdo y una estrechez importante de la arteria carótida interna. Se interpreta el cuadro como secundario a un proceso vascular inflamatorio y se inician corticoides, con buena respuesta. Sin embargo, al poco tiempo se presenta fiebre y edema palpebral contralateral. En los hemocultivos se obtiene un crecimiento de Streptococcus intermedius y se diagnostica una tromboflebitis del seno cavernoso. A pesar del inicio de antibióticos y anticoagulación, sufre una hemiplejía derecha secundaria a la formación de abscesos frontotemporales. Se procede al drenaje quirúrgico y la paciente cursa con buena evolución. Ante la ausencia de otros focos infecciosos, y debido a la procedencia oral del germen, se realiza una exodoncia múltiple profiláctica. Conclusión: Se recomienda considerar la tromboflebitis como una opción diagnóstica tanto en las cefaleas con síntomas oculares como en la arteritis de mediano-gran vaso para su tratamiento oportuno


Introduction: Thrombophlebitis of the cavernous sinus is a severe infectious disease with high mortality and morbidity. It is usually diagnosed at a late stage and requires a number of visits to the emergency department in most cases, and the prognosis is highly dependent on prompt treatment. Despite its severity, evidence regarding treatment with corticosteroids and anticoagulation therapy is scarce and controversial. One of its complications is arteritis, which can be mistaken for medium to large vessel vasculitis, as in this case. Case Report: A 26-year-old female, who visited due to headache and left palpebral oedema. Imaging tests revealed thrombosis in the left cavernous sinus and significant narrowing of the internal carotid artery. The clinical picture was interpreted as secondary to an inflammatory vascular process and treatment with corticosteroids was initiated, with a good response. However, soon afterwards, fever and contralateral palpebral oedema developed. In the blood cultures a growth of Streptococcus intermedius was obtained and thrombophlebitis of the cavernous sinus was diagnosed. Despite initiating antibiotic and anticoagulation therapy, the patient suffered a right hemiplegia secondary to the formation of frontotemporal abscesses. Surgical drainage was performed and the patient progressed well. In the absence of other infectious foci, and due to the oral origin of the germ, a prophylactic multiple exodontia was performed. Conclusion: Thrombophlebitis should be considered as a diagnostic option both in headaches with ocular symptoms and in medium to large vessel arteritis so that they can be treated in a timely manner


Assuntos
Humanos , Feminino , Adulto , Trombose do Corpo Cavernoso/complicações , Tromboflebite/diagnóstico por imagem , Vasculite/complicações , Abscesso Encefálico/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Seio Cavernoso/diagnóstico por imagem , Trombose do Corpo Cavernoso/diagnóstico por imagem , Streptococcus intermedius/isolamento & purificação , Artérias Carótidas/patologia , Abscesso Encefálico/patologia , Cefaleia/etiologia , Corticosteroides/administração & dosagem , Trombose do Corpo Cavernoso/tratamento farmacológico , Anticoagulantes/uso terapêutico , Tomografia por Emissão de Pósitrons
12.
World Neurosurg ; 135: 96-99, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31841721

RESUMO

BACKGROUND: Endovascular embolization is being increasingly used to treat cerebral arteriovenous malformations. Common complications associated with embolization include intracranial hemorrhage and ischemic stroke; intracranial infections seldomly occur and are even less frequently reported. Although abscess formation after embolization is exceedingly rare, it is a serious condition that warrants immediate attention. CASE DESCRIPTION: This 53-year-old male with a ruptured left temporal-occipital arteriovenous malformation. He underwent uncomplicated 2-stage embolization with Onyx and was discharged. Five weeks after embolization, he returned to the hospital with worsening aphasia and contralateral hemiparesis, and a cerebral abscess was detected at the site of embolization. Bacterial cultures were positive for Escherichia coli, and he was treated successfully with surgical excision of the abscess and Onyx material, followed by long-term antibiotics. CONCLUSIONS: Although rare, formation of an intracranial abscess after endovascular embolization is a potential complication in the treatment of arteriovenous malformations.


Assuntos
Abscesso Encefálico/etiologia , Embolização Terapêutica , Malformações Arteriovenosas Intracranianas/terapia , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/terapia , Procedimentos Endovasculares , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
13.
BMJ Case Rep ; 12(12)2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31796437

RESUMO

A cerebral abscess (focal infection of brain parenchyma) carries a high mortality and morbidity. Iatrogenic cerebral abscesses are less common and make up 10% of all cases. The presence of a cerebral abscess can rarely improve a patient's prognosis and quality of life, however this case illustrates an abscess and its treatment following a prolonged course of antibiotics leading to resolution of a severe psychotic disorder. This is a case report of a 32-year-old female inpatient at a psychiatric hospital with a long-standing history of congenital hydrocephalus, cerebral palsy and organic delusional disorder who developed an iatrogenic cerebral abscess after insertion of an implantable intracranial pressure monitoring device. After receiving treatment of 6 weeks of intravenous meropenem the patient's mental condition rapidly improved, she became stable and euthymic and was discharged home. The patient has since had no delusions or hallucinations and is living independently at home.


Assuntos
Abscesso Encefálico/tratamento farmacológico , Doença Iatrogênica , Meropeném/administração & dosagem , Esquizofrenia Paranoide/tratamento farmacológico , Administração Oral , Adulto , Antibacterianos/administração & dosagem , Abscesso Encefálico/complicações , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/microbiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Monitorização Neurofisiológica/efeitos adversos , Monitorização Neurofisiológica/instrumentação , Indução de Remissão , Esquizofrenia Paranoide/complicações
14.
Medicine (Baltimore) ; 98(48): e18156, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770258

RESUMO

RATIONALE: Streptococcus anginosus mostly colonizes the digestive and genitourinary system, including the oropharyngeal region. It commonly causes invasive pyogenic infection, but less likely causes infective endocarditis (IE). PATIENT CONCERNS: An 18-year-old woman who had an underlying mitral valve prolapse without mitral regurgitation presented to our hospital with low-grade fever, left leg weakness, and left abdominal pain. She was diagnosed with brain infarction and microabscess as well as IE. The patient totally recovered after the 6-week course of intravenous antibiotics. DIAGNOSIS: Brain magnetic resonance imaging revealed brain infarction and microabscess. Abdominal computed tomography revealed splenic and left renal infarction. Three sets of blood culture were positive for S anginosus. Transthoracic echocardiogram identified mitral valve prolapse with moderate eccentric mitral valve regurgitation, and a 0.3 × 0.6-cm vegetation was found on the left mitral valve. All of these results meet the modified Duke criteria. INTERVENTIONS: The abdominal pain and left leg weakness were improving after 2 weeks of intravenous antibiotics treatment. No neurological sequelae were noted after completing the 6-week course of medical treatment. OUTCOMES: The patient was successfully treated and discharged after completing the 6-week intravenous antibiotics treatment. LESSONS: IE should be considered in young patients with native valve disease who have prolonged fever. Though S anginosus commonly causes invasive pyogenic infection, patients with native valve disease should be checked for IE.


Assuntos
Antibacterianos/administração & dosagem , Abscesso Encefálico , Infarto Encefálico , Endocardite , Prolapso da Valva Mitral , Infecções Estreptocócicas , Streptococcus anginosus/isolamento & purificação , Administração Intravenosa , Adolescente , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Ecocardiografia/métodos , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Feminino , Humanos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Recuperação de Função Fisiológica , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento
18.
Pediatr Neurosurg ; 54(5): 354-358, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31487714

RESUMO

AIM: Management of thalamic abscess is being considered as a contentious issue in neurosurgery. Regarding these lesions, besides removing the abscess, the most minimal morbidity is targeted during surgery and planning. MATERIAL AND METHOD: A 5-year-old female presented with the symptoms of altered consciousness and left hemiparesis. Her medical history pointed out that she was being followed up for a congenital cardiac anomaly consisting of transposition of the great arteries and a ventricular septal defect. A cranial MRI revealed 2 masses with peripheral contrast enhancement in the right frontal and thalamic regions. She was operated immediately and the right frontal mass, compatible with abscess, was totally excised with frontal mini craniotomy. The patient was hospitalized and followed up under intensive parenteral antibiotics. Control cranial imaging revealed progression in the size of the thalamic abscess, which was corroborative with the increased left hemiparesis. MR tractography was obtained and the patient underwent MR navigation and tractography combined neuronavigation-assisted transcranial neuroendoscopic aspiration of the thalamic abscess. RESULTS: The patient was stable in the early and late postoperative periods and her hemiparesis showed a dramatic recovery with no additional neurological deficits. CONCLUSION: Neuronavigation is considered as one of the techniques that aid the neurosurgeon to augment the success of surgery and minimize the morbidity, especially in critically localized lesions, i.e., eloquent areas. Combining MR navigation with MR tractography images and using them during neuronavigation to assist endoscopic procedures may decrease the surgical morbidity as much as possible.


Assuntos
Abscesso Encefálico/cirurgia , Imagem de Tensor de Difusão/métodos , Imagem por Ressonância Magnética/métodos , Neuroendoscopia/métodos , Neuronavegação/métodos , Tálamo/cirurgia , Abscesso Encefálico/diagnóstico por imagem , Pré-Escolar , Feminino , Humanos , Paracentese/métodos , Tálamo/diagnóstico por imagem
19.
Medicine (Baltimore) ; 98(36): e17044, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490396

RESUMO

RATIONALE: A single atrium is a rare congenital heart disease (CHD) involving zero atrial septal traces and preserved intact ventricular septum and atrioventricular valves, requiring careful surgical intervention. However, developing to Eisenmenger syndrome (ES) makes the surgery complicated. Based on bidirectional cardiac shunting, vegetation easily develops in case of bacterial infection. PATIENT CONCERN AND DIAGNOSES: We reported a 35-year-old woman with a single atrium, patent ductus arteriosus, pulmonary hypertension, and ES who developed infective endocarditis on her left ventricular outflow tract and complicated cerebral abscess and who underwent challenged medical treatment. INTERVENTION: Infection was successfully controlled after 4-time change in antibiotics over 4 months. However, surgery is complicated for her. OUTCOMES: The patient presented a relatively good outcome during follow-up for >6 months. LESSONS: This case report suggests that patients with complex CHD should accept surgery therapy earlier before developing ES. It is imperative to avoid invasive interventions to prevent infectious endocarditis.


Assuntos
Abscesso Encefálico/complicações , Permeabilidade do Canal Arterial/complicações , Complexo de Eisenmenger/complicações , Endocardite/complicações , Átrios do Coração/anormalidades , Adulto , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Feminino , Humanos
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