Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.974
Filtrar
1.
BMC Anesthesiol ; 21(1): 64, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653264

RESUMO

BACKGROUND: Few studies have evaluated muscle strength in COVID-19 ICU survivors. We aimed to report the incidence of limb and respiratory muscle weakness in COVID-19 ICU survivors. METHOD: We performed a cross sectional study in two ICU tertiary Hospital Settings. COVID-19 ICU survivors were screened and respiratory and limb muscle strength were measured at the time of extubation. An ICU mobility scale was performed at ICU discharge and walking capacity was self-evaluated by patients 30 days after weaning from mechanical ventilation. RESULTS: Twenty-three patients were included. Sixteen (69%) had limb muscle weakness and 6 (26%) had overlap limb and respiratory muscle weakness. Amount of physiotherapy was not associated with muscle strength. 44% of patients with limb weakness were unable to walk 100 m 30 days after weaning. CONCLUSION: The large majority of COVID-19 ICU survivors developed ICU acquired limb muscle weakness. 44% of patients with limb weakness still had severely limited function one-month post weaning.


Assuntos
/complicações , Debilidade Muscular/etiologia , Idoso , Braço/fisiopatologia , Estudos Transversais , Feminino , Seguimentos , França , Humanos , Perna (Membro)/fisiopatologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , Estudos Retrospectivos
2.
Chest ; 159(3): e151-e154, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33678283

RESUMO

CASE PRESENTATION: A 64-year-old previously healthy man presented with 8 weeks of progressive dyspnea on exertion and cough. Prior to presentation, the patient was able to bicycle > 60 miles per week and work full-time in a home improvement store. He was up-to-date with age-appropriate cancer screening and immunizations, and home medications included famotidine for reflux and nonsteroidal antiinflammatories for osteoarthritis, both as-needed. He had no significant respiratory exposure, aside from previous work as an electrician. His symptoms began in mid-February 2020 amid the coronavirus disease 2019 pandemic, although he had no known exposure to the virus.


Assuntos
/diagnóstico , Frutose-Bifosfato Aldolase/sangue , Glucocorticoides/administração & dosagem , Pulmão/diagnóstico por imagem , Miosite , Troca Plasmática/métodos , Rituximab/administração & dosagem , Treonina-tRNA Ligase/imunologia , Autoanticorpos/sangue , Diagnóstico Diferencial , Progressão da Doença , Humanos , Imunossupressores/administração & dosagem , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Miosite/sangue , Miosite/diagnóstico , Miosite/fisiopatologia , Miosite/terapia , Oxigenoterapia/métodos , Prognóstico , Resultado do Tratamento
3.
Int J Mol Sci ; 22(3)2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33540821

RESUMO

Colorectal cancer (CRC) is a leading cause of cancer-related death, and the prevalence of CRC in young adults is on the rise, making this a largescale clinical concern. Advanced CRC patients often present with liver metastases (LM) and an increased incidence of cachexia, i.e., musculoskeletal wasting. Despite its high incidence in CRC patients, cachexia remains an unresolved issue, and animal models for the study of CRC cachexia, in particular, metastatic CRC cachexia, remain limited; therefore, we aimed to establish a new model of metastatic CRC cachexia. C57BL/6 male mice (8 weeks old) were subcutaneously (MC38) or intrasplenically injected (mMC38) with MC38 murine CRC cells to disseminate LM, while experimental controls received saline (n = 5-8/group). The growth of subcutaneous MC38 tumors was accompanied by a reduction in skeletal muscle mass (-16%; quadriceps muscle), plantarflexion force (-22%) and extensor digitorum longus (EDL) contractility (-20%) compared to experimental controls. Meanwhile, the formation of MC38 LM (mMC38) led to heighted reductions in skeletal muscle mass (-30%; quadriceps), plantarflexion force (-28%) and EDL contractility (-35%) compared to sham-operated controls, suggesting exacerbated cachexia associated with LM. Moreover, both MC38 and mMC38 tumor hosts demonstrated a marked loss of bone indicated by reductions in trabecular (Tb.BV/TV: -49% in MC38, and -46% in mMC38) and cortical (C.BV/TV: -12% in MC38, and -8% in mMC38) bone. Cell culture experiments revealed that MC38 tumor-derived factors directly promote myotube wasting (-18%) and STAT3 phosphorylation (+5-fold), while the pharmacologic blockade of STAT3 signaling was sufficient to preserve myotube atrophy in the presence of MC38 cells (+21%). Overall, these results reinforce the notion that the formation of LM heightens cachexia in an experimental model of CRC.


Assuntos
Adenocarcinoma/secundário , Caquexia/etiologia , Neoplasias Colorretais/complicações , Neoplasias Hepáticas/secundário , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Animais , Caquexia/patologia , Caquexia/fisiopatologia , Linhagem Celular Tumoral , Neoplasias Colorretais/patologia , Progressão da Doença , Fêmur/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Contração Muscular , Fibras Musculares Esqueléticas/ultraestrutura , Debilidade Muscular/etiologia , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Atrofia Muscular/etiologia , Fator de Transcrição STAT3 , Tela Subcutânea , Microtomografia por Raio-X
5.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547108

RESUMO

We describe a rare case of a 4-month-old girl presenting with a several month history of reduced movement to the left arm accompanied by a maculopapular rash to the limbs. X-ray findings included inflammatory periosteal changes to the radius and ulna. Treponema pallidum IgM was detected in both baby and mother, and a diagnosis of congenital syphilis was made. This case is an interesting clinical picture with a variety of important differential diagnoses, including non-accidental injury, malignancy, autoimmune disease and other congenital infections. With an increasing rate of congenital syphilis infection in the developed world, it is vital that clinicians are able to recognise symptoms to ensure prompt diagnosis and treatment. In this respect, we can attempt to avoid the chronic and potentially life-threatening complications of untreated infection.


Assuntos
Debilidade Muscular/diagnóstico , Sífilis Congênita/diagnóstico , Terapia Combinada , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Debilidade Muscular/etiologia , Debilidade Muscular/terapia , Sífilis Congênita/complicações , Sífilis Congênita/terapia
7.
Lancet ; 397(10270): 220-232, 2021 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-33428867

RESUMO

BACKGROUND: The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity. METHODS: We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5-6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences. FINDINGS: In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0-65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0-199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5-6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5-6, and median CT scores were 3·0 (IQR 2·0-5·0) for severity scale 3, 4·0 (3·0-5·0) for scale 4, and 5·0 (4·0-6·0) for scale 5-6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80-3·25) for scale 4 versus scale 3 and 4·60 (1·85-11·48) for scale 5-6 versus scale 3 for diffusion impairment; OR 0·88 (0·66-1·17) for scale 4 versus scale 3 and OR 1·77 (1·05-2·97) for scale 5-6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58-0·96) for scale 4 versus scale 3 and 2·69 (1·46-4·96) for scale 5-6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up. INTERPRETATION: At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery. FUNDING: National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, and Peking Union Medical College Foundation.


Assuntos
/complicações , Qualidade de Vida , Idoso , /psicologia , China/epidemiologia , Estudos de Coortes , Comorbidade , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/epidemiologia , Debilidade Muscular/etiologia , Pandemias , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários
8.
J Stroke Cerebrovasc Dis ; 30(4): 105623, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33486342

RESUMO

In the present report, we discussed the case of a 57-year-old man with unilateral masticatory muscle weakness, nystagmus, skew deviation and facial hypesthesia due to pontine tegmental infarction. Trigeminal motor neuropathy attributed to brain infarction is very rare. Brain magnetic resonance imaging revealed a small dot-like infarction lesion in the pontine tegmentum. Masticatory muscle weakness was confirmed by an electrophysiological study performed on the day after admission in which there was an incomplete interference pattern without spontaneous denervation activity, suggesting that the patient's masseter muscle weakness was caused by an infarction of the trigeminal motor nucleus proper or trigeminal motor nerve fascicles rather than Wallerian degeneration of the trigeminal nerve or the progression of masseter muscle degeneration.


Assuntos
Infartos do Tronco Encefálico/complicações , Paralisia Facial/etiologia , Músculo Masseter/inervação , Debilidade Muscular/etiologia , Núcleo Motor do Nervo Trigêmeo/irrigação sanguínea , Doenças do Nervo Trigêmeo/etiologia , Doença Aguda , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Paralisia Facial/diagnóstico , Paralisia Facial/fisiopatologia , Humanos , Masculino , Mastigação , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/fisiopatologia
10.
Emerg Med Clin North Am ; 39(1): 173-180, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218656

RESUMO

Weakness has a broad differential diagnosis. A paradigm for organizing possibilities is to consider what part of the nervous system is involved, ranging from brain, spinal cord, nerve roots, and peripheral nerves to the neuromuscular junction. The clinician can consider internal versus external causes. Some neurologic conditions have subtle presentations yet carry a risk of short-term decompensation if not recognized. It is helpful to consider whether an emergency department presentation of weakness is a new disease process or represents an exacerbation of an established condition. Emergency presentations of weakness are challenging, and one must carefully consider potential serious causes.


Assuntos
Debilidade Muscular/diagnóstico , Doença Aguda , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Humanos , Debilidade Muscular/etiologia
11.
Lancet ; 397(10271): 334-346, 2021 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-33357469

RESUMO

Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.


Assuntos
Viroses do Sistema Nervoso Central/diagnóstico por imagem , Viroses do Sistema Nervoso Central/reabilitação , Infecções por Enterovirus/epidemiologia , Hipotonia Muscular , Debilidade Muscular , Mielite/diagnóstico por imagem , Mielite/reabilitação , Doenças Neuromusculares/diagnóstico por imagem , Doenças Neuromusculares/reabilitação , Viroses do Sistema Nervoso Central/líquido cefalorraquidiano , Viroses do Sistema Nervoso Central/virologia , Criança , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por Enterovirus/complicações , Saúde Global , Humanos , Imagem por Ressonância Magnética , Hipotonia Muscular/etiologia , Debilidade Muscular/etiologia , Mielite/líquido cefalorraquidiano , Mielite/virologia , Doenças Neuromusculares/líquido cefalorraquidiano , Doenças Neuromusculares/virologia , Avaliação de Resultados da Assistência ao Paciente
14.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370939

RESUMO

Slowly progressing unilateral upper limb weakness in a previously healthy child can occur due to number of causes which requires a thorough history, physical examination followed by radiological examination, electromyography and so on. Among the various aetiologies, a rare condition such as Hirayama disease is one of the differentials to be considered. There has been a wealth of literature reported on this disease and our case is a learning lesson for all paediatricians to be aware of Hirayama disease and its current concepts.


Assuntos
Braquetes , Debilidade Muscular/etiologia , Medula Espinal/patologia , Atrofias Musculares Espinais da Infância/diagnóstico , Adolescente , Vértebras Cervicais/diagnóstico por imagem , Diagnóstico Diferencial , Eletromiografia , Humanos , Imagem por Ressonância Magnética , Masculino , Debilidade Muscular/diagnóstico , Debilidade Muscular/terapia , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Pescoço , Medula Espinal/diagnóstico por imagem , Atrofias Musculares Espinais da Infância/complicações , Atrofias Musculares Espinais da Infância/terapia , Extremidade Superior/inervação
15.
Pan Afr Med J ; 35(Suppl 2): 150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193965

RESUMO

The new coronavirus 2019 epidemic declared in China on December 31, 2019 soon spread to the rest of the world, becoming the subject of an unprecedented health pandemic according to the World Health Organization's declaration of March 11, 2020. It is a disease that has the potential to cause multiple systemic infections. We report here the case of an acute polyradiculoneuritis of the Guillain-Barré type (GBS) indicative of a COVID-19 infection. This is a 41 year old patient seen for ascending, symmetrical and bilateral, progressive and acute tetraparesis with in a context of influenza syndrome and digestive infections treated 2 weeks earlier. During a COVID-19 infection, certain inflammatory cells stimulated by the virus produce inflammatory cytokines creating immune-mediated processes. The same mechanism is observed in GBS being also an immune-mediated disorder. The management of this disease in COVID-19 positive patients does not differ from that of patients who do not carry the virus. The risk of respiratory distress in COVID-19 positive patients becomes twice as great in patients with GBS who test positive for COVID-19 at the same time. Monitoring for hemodynamic disorders and respiratory distress in a neuro-intensive care unit may be fruitful.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/etiologia , Pneumonia Viral/complicações , Adulto , Fibrilação Atrial/complicações , Azitromicina/uso terapêutico , Betacoronavirus/isolamento & purificação , Cloroquina/efeitos adversos , Cloroquina/uso terapêutico , Técnicas de Laboratório Clínico , Terapia Combinada , Contraindicações de Medicamentos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Diagnóstico Precoce , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/fisiopatologia , Síndrome de Guillain-Barré/terapia , Humanos , Masculino , Debilidade Muscular/etiologia , Nasofaringe/virologia , Transtornos do Olfato/etiologia , Oxigenoterapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Quadriplegia/etiologia , Respiração Artificial , Incontinência Urinária/etiologia
16.
Ideggyogy Sz ; 73(9-10): 339-344, 2020 Sep 30.
Artigo em Húngaro | MEDLINE | ID: mdl-33035415

RESUMO

Pompe disease is a rare lysosomal storage disease inherited in a recessive manner resulting muscular dystrophy. Due to the lack of the enzyme alpha glucosidase, glycogen accumulates in the cells. In the infantile form of Pompe disease hypotonia and severe cardio-respiratory failure are common leading to death within 2 years if left untreated, while the late-onset form is characterized with limb-girdle and axial muscle weakness accompanied with respiratory dysfunction. Pompe disease has been treated with regular intake of the missing enzyme since 2006, which significantly improved the survival and severity of symptoms in patients of both subtypes. The enzyme replacement therapy (ERT) is safe and well tolerated. However, limited data are available on its use in pregnancy. Our goal is to share our experience and review the literature on the safety of enzyme replacement therapy for Pompe disease during pregnancy and post partum.


Assuntos
Terapia de Reposição de Enzimas/efeitos adversos , Doença de Depósito de Glicogênio Tipo II/terapia , Complicações na Gravidez/terapia , alfa-Glucosidases/uso terapêutico , Feminino , Doença de Depósito de Glicogênio Tipo II/diagnóstico , Humanos , Debilidade Muscular/etiologia , Período Pós-Parto , Gravidez , Resultado da Gravidez , Resultado do Tratamento
17.
Lancet Child Adolesc Health ; 4(11): 828-836, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33068549

RESUMO

BACKGROUND: Acute flaccid myelitis (AFM) is characterised by rapid onset of limb weakness with spinal cord grey-matter abnormalities on MRI scan. We aimed to assess whether detection of enterovirus in respiratory or other specimens can help predict prognosis in children with AFM. METHODS: In this nationwide, longitudinal study, we evaluated the significance of detection of enterovirus in any sample in predicting outcomes in a cohort of Canadian children younger than 18 years presenting with AFM to tertiary paediatric hospitals in Canada in 2014 and 2018. All patients fulfilled the 2015 US Centers for Disease Control and Prevention case definition for definite AFM or probable AFM. Clinical data, laboratory findings, treatment, and neuroimaging results were collected (follow up period up to 5 years). We assessed neurological function and motor outcomes using Kurtzke's Expanded Disability Status Scale (EDSS) and a Weakest Limb Score. FINDINGS: 58 children with AFM (median age 5·1 years, IQR 3·8-8·3) were identified across five of Canada's ten provinces and three territories. 25 (43%) children had enterovirus detected in at least one specimen: 16 (64%) with EV-D68, two (8%) with EV-A71, two (8%) with coxsackievirus, 10 (40%) with untyped enterovirus. Children who were enterovirus positive were more likely than those that were negative to have had quadriparesis (12 [48%] of 25 vs four [13%] of 30; p=0·028), bulbar weakness (11 [44%] of 25 vs two [7%] of 30; p=0·028), bowel or bladder dysfunction (14 [56%] of 25 vs seven [23%] of 30; p=0·040), cardiovascular instability (nine [36%] of 25 vs one [3%] of 30; p=0·028), and were more likely to require intensive care unit admission (13 [52%] of 25 vs 5 [17%] of 30; p=0·028). On MRI, most children who were enterovirus positive showed brainstem pontine lesions (14 [61%] of 23), while other MRI parameters did not correlate with enterovirus status. Median EDSS of enterovirus positive (EV+) and enterovirus negative (EV-) groups was significantly different at all timepoints: baseline (EDSS 8·5, IQR 4·1-9·5 vs EDSS 4·0, IQR 3·0-6·0; p=0·0067), 3 months (EDSS 4·0, IQR 3·0-7·4 vs EDSS 3·0, IQR 1·5-4·3; p=0·0067), 6 months (EDSS 3·5, IQR 3·0-7·0 vs EDSS 3·0, IQR 1·0-4·0; p=0·029), and 12 months (EDSS 3·0, IQR 3·0-6·9 vs EDSS 2·5 IQR 0·3-3·0; p=0·0067). Kaplan-Meier survival analysis of a subgroup of patients showed significantly poorer motor recovery among children who tested positive for enterovirus than for those who tested negative (p=0·037). INTERPRETATION: Detection of enterovirus in specimens from non-sterile sites at presentation correlated with more severe acute motor weakness, worse overall outcomes and poorer trajectory for motor recovery. These results have implications for rehabilitation planning as well as counselling of families of children with these disorders. The findings of this study support the need for early testing for enterovirus in non-CNS sites in all cases of AFM. FUNDING: None.


Assuntos
Viroses do Sistema Nervoso Central , Enterovirus/isolamento & purificação , Debilidade Muscular , Mielite , Doenças Neuromusculares , Medula Espinal/diagnóstico por imagem , Canadá/epidemiologia , Viroses do Sistema Nervoso Central/diagnóstico , Viroses do Sistema Nervoso Central/epidemiologia , Viroses do Sistema Nervoso Central/microbiologia , Viroses do Sistema Nervoso Central/terapia , Pré-Escolar , Enterovirus/classificação , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Destreza Motora , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Mielite/diagnóstico , Mielite/epidemiologia , Mielite/microbiologia , Mielite/terapia , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/microbiologia , Doenças Neuromusculares/terapia , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Recuperação de Função Fisiológica
18.
Medicine (Baltimore) ; 99(43): e22900, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120840

RESUMO

RATIONALE: Spinal cord infarction (SCI) accounts for only 1% to 2% of all ischemic strokes and 5% to 8% of acute myelopathies. Magnetic resonance imaging (MRI) holds a role in ruling out non-ischemic etiologies, but the diagnostic accuracy of this procedure may be low in confirming the diagnosis, even when extensive cord lesions are present. Indeed, T2 changes on MRI can develop over hours to days, thus accounting for the low sensitivity in the hyperacute setting (ie, within 6 hours from symptom onset). For these reasons, SCI remains a clinical diagnosis. Despite extensive diagnostic work-up, up to 20% to 40% of SCI cases are classified as cryptogenic. Here, we describe a case of cryptogenic longitudinally extensive transverse myelopathy due to SCI, with negative MRI and diffusion-weighted imaging at 9 hours after symptom onset. PATIENT CONCERNS: A 51-year-old woman presented to our Emergency Department with acute severe abdominal pain, nausea, vomiting, sudden-onset of bilateral leg weakness with diffuse sensory loss, and paresthesias on the trunk and legs. DIAGNOSES: On neurological examination, she showed severe paraparesis and a D6 sensory level. A 3T spinal cord MRI with gadolinium performed at 9 hours after symptom onset did not detect spinal cord alterations. Due to the persistence of a clinical picture suggestive of an acute myelopathy, a 3T MRI of the spine was repeated after 72 hours showing a hyperintense "pencil-like" signal mainly involving the grey matter from T1 to T6 on T2 sequence, mildly hypointense on T1 and with restricted diffusion. INTERVENTIONS: The patient was given salicylic acid (100 mg/d), prophylactic low-molecular-weight heparin, and began neuromotor rehabilitation. OUTCOMES: Two months later, a follow-up neurological examination revealed a severe spastic paraparesis, no evident sensory level, and poor sphincteric control with distended bladder. LESSONS: Regardless of its relatively low frequency in the general population, SCI should be suspected in every patient presenting with acute and progressive myelopathic symptoms, even in the absence of vascular risk factors. Thus, a clinical presentation consistent with a potential vascular syndrome involving the spinal cord overrides an initially negative MRI and should not delay timely and appropriate management.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Doenças da Medula Espinal/diagnóstico , Isquemia do Cordão Espinal/diagnóstico por imagem , Assistência ao Convalescente , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Serviço Hospitalar de Emergência , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Exame Neurológico/métodos , Paraparesia/etiologia , Parestesia/diagnóstico , Parestesia/etiologia , Ácido Salicílico/administração & dosagem , Ácido Salicílico/uso terapêutico , Doenças da Medula Espinal/etiologia , Isquemia do Cordão Espinal/tratamento farmacológico , Isquemia do Cordão Espinal/patologia , Isquemia do Cordão Espinal/reabilitação
19.
Medicine (Baltimore) ; 99(43): e22924, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120846

RESUMO

RATIONALE: Polymyxin B has been used to treat extensively drug-resistant gram-negative bacteria and shown a better antibacterial effect in the clinic at present. Meanwhile, polymyxin B is associated with several adverse effects. However, there is a lack of awareness that polymyxin B can cause rhabdomyolysis. In this study, we firstly report a case of polymyxin B-induced rhabdomyolysis during antiinfection therapy. PATIENT CONCERNS: A 70-year-old woman suffering from rheumatic heart disease underwent aortic and mitral valve replacement at our institute. Subsequently, she developed bacteremia and pneumonia caused by extensively drug resistance-acinetobacter baumannii. Polymyxin B was administered for 5 days. During treatment, the patient complained of muscle pain and limb weakness, and her serum creatine phosphokinase and myoglobin levels rose. DIAGNOSIS: The clinical symptoms and laboratory examination confirmed rhabdomyolysis, and polymyxin B-induced rhabdomyolysis was considered. INTERVENTION: We ceased polymyxin B treatment and monitored the patient daily. OUTCOMES: Serum creatine phosphokinase levels returned to normal, myoglobin levels decreased, and muscle pain was significantly alleviated after cessation of polymyxin B. We identified this as a case of polymyxin B-induced rhabdomyolysis. LESSONS: Here, we report the first reported case of rhabdomyolysis induced by polymyxin B administration. The awareness of rare adverse reaction helps ensure the clinical safety of polymyxin B treatment.


Assuntos
Antibacterianos/efeitos adversos , Polimixina B/efeitos adversos , Rabdomiólise/induzido quimicamente , Acinetobacter baumannii/isolamento & purificação , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Conscientização , Bacteriemia/tratamento farmacológico , Creatina Quinase/sangue , Feminino , Humanos , Debilidade Muscular/etiologia , Mialgia/etiologia , Mioglobina/sangue , Pneumonia/tratamento farmacológico , Pneumonia/microbiologia , Polimixina B/administração & dosagem , Polimixina B/uso terapêutico , Rabdomiólise/diagnóstico , Suspensão de Tratamento
20.
BMJ Case Rep ; 13(10)2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33122241

RESUMO

We report the first case of Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection in Japan. A 54-year-old woman developed neurological symptoms after SARS-CoV-2 infection. We tested for various antiganglioside antibodies, that had not been investigated in previous cases. The patient was diagnosed with GBS based on neurological and electrophysiological findings; no antiganglioside antibodies were detected. In previous reports, most patients with SARS-CoV-2-infection-related GBS had lower limb predominant symptoms, and antiganglioside antibody tests were negative. Our findings support the notion that non-immune abnormalities such as hyperinflammation following cytokine storms and microvascular disorders due to vascular endothelial damage may lead to neurological symptoms in patients with SARS-CoV-2 infection. Our case further highlights the need for careful diagnosis in suspected cases of GBS associated with SARS-CoV-2 infection.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Eletromiografia/métodos , Feminino , Síndrome de Guillain-Barré/terapia , Humanos , Hipestesia/diagnóstico , Hipestesia/etiologia , Japão , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...