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1.
Arch. argent. pediatr ; 119(2): e142-e148, abril 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1152045

RESUMO

La gripe se asocia al aparato respiratorio, especialmente en invierno, y puede causar complicaciones neurológicas. Se evaluó a pacientes pediátricos con manifestaciones neurológicas graves por gripe desde septiembre de 2018 hasta febrero de 2019 para determinar características clínicas, neuroimagenología, tratamiento y resultados. El objetivo fue evaluar la encefalitis asociada a la gripe y destacar diferentes manifestaciones neurológicas y cambios de neuroimagenología. El estudio incluyó a 13 pacientes. Los síntomas neurológicos ocurrieron tras los síntomas típicos de la gripe. Los cambios de neuroimagenología incluyen alteraciones de señal de la sustancia blanca cortical y subcortical, edema localizado o generalizado y lesiones multifocales simétricas bilaterales en el tálamo y la médula del cerebelo. Las opciones terapéuticas incluyen metilprednisolona en inyección intravenosa, inmunoglobulina intravenosa, plasmaféresis y oseltamivir. Es fundamental considerar la encefalitis asociada a la gripe en pacientes con convulsiones, la encefalopatía con hallazgos radiológicos compatibles, e iniciar el tratamiento lo antes posible


Influenza is mostly associated with the respiratory tract system, especially in the winter season. Various neurological complications could occur due to influenza infection. Pediatric patients who had severe neurological manifestations due to influenza infection from September 2018 to February 2019 were evaluated for clinical characteristics, neuroimaging studies, treatment, and outcome. We aimed to assess Influenza-associated encephalitis in children, emphasize different neurological manifestations and neuroimaging changes. Thirteen patients were included in the study. Neurological symptoms occurred after flu-like symptoms. Neuroimaging changes of influenza-associated encephalitis/encephalopathy include cortical and subcortical white matter signal alterations, localized or generalized edema, and bilateral symmetrical multifocal lesions on the thalamus and cerebellar medulla. Pulse methylprednisolone, intravenous immunoglobulin, plasma exchange, and oseltamivir are the therapy choices. It is essential to consider influenza-associated encephalitis in patients with seizures, encephalopathy with supporting radiological findings, especially during the influenza season and starting treatment as fast as possible for better outcomes.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Encefalopatias/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Influenza Humana/complicações , Turquia/epidemiologia , Encefalopatias/terapia , Encefalite/terapia , Neuroimagem , Manifestações Neurológicas
2.
BMJ Case Rep ; 14(3)2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33722909

RESUMO

Symptomatic brainstem compression from vertebral artery dolichoectasia is rare. There are no recognised diagnostic or treatment criteria to guide management of this disease. We report a case of medullary compression and cerebral ischaemia from an enlarged and tortuous vertebral artery. Our patient developed progressive dysphonia and dysphagia. Cerebral MRI revealed compression of the medulla oblongata by a right ectatic vertebral artery and a right occipital lobe infarct. Other causes of bulbar dysfunction were ruled out. He was treated with anticoagulation and underwent percutaneous endoscopic gastrostomy. We review selected literature on the presentation, diagnosis and management of this rare neurologic condition.


Assuntos
Encefalopatias , Artéria Vertebral , Idoso de 80 Anos ou mais , Encefalopatias/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Bulbo
3.
JAMA Netw Open ; 4(3): e211489, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33720371

RESUMO

Importance: There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19-related encephalopathy and guide clinical management. Objectives: To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19-related encephalopathy. Design, Setting, and Participants: This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020. Exposures: Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest. Main Outcomes and Measures: Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records. Results: Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple microhemorrhages, and white matter-enhancing lesions. Fifty-five patients showed biological abnormalities, including dysnatremia, kidney failure, and liver dysfunction, the same day as the EEG. The results of cerebrospinal fluid analysis were negative for SARS-Cov-2 for all tested patients. Nine patients who had no identifiable cause of brain injury outside COVID-19 were further isolated; their brain injury was defined as COVID-19-related encephalopathy. They represented 1% (9 of 644) of patients with COVID-19 requiring hospitalization. Six of these 9 patients had movement disorders, 7 had frontal syndrome, 4 had brainstem impairment, 4 had periodic EEG discharges, and 3 had MRI white matter-enhancing lesions. Conclusions and Relevance: The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19-related encephalopathy and guide treatment strategy.


Assuntos
Encefalopatias/diagnóstico por imagem , /diagnóstico por imagem , Estudos de Coortes , Eletroencefalografia , Registros Eletrônicos de Saúde , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
4.
No Shinkei Geka ; 49(2): 413-417, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762466

RESUMO

Mild encephalitis/encephalopathy with a reversible splenial lesion(MERS)is a clinically and radiologically benign condition that has been described within the past two decades. MRI findings include isolated symmetrical ovoid lesions of the splenium with a high-intensity signal on DWI and decreased apparent diffusion coefficient. These findings have been associated with viral infections, epilepsy, antiepileptic drug usage, and metabolic disturbances, among others. These conditions may present with severe clinical features, such as consciousness disturbance or cytokine storm; however, patients usually recover completely with optimal treatment. Some pathological conditions with splenic lesions, such as Marchiafava-Bignami disease, may be irreversible. Therefore, diseases with splenic lesions require careful attention.


Assuntos
Encefalopatias , Encefalite , Encefalopatias/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , Corpo Caloso/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Encefalite/diagnóstico por imagem , Encefalite/tratamento farmacológico , Humanos , Imagem por Ressonância Magnética
5.
Br J Radiol ; 94(1119): 20200714, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33533635

RESUMO

OBJECTIVE: To investigate the effects of beam hardening by the skull on the measured radiodensity of the brain. To test a hypothesis that these effects of beam hardening are decreased using a monochromatic energy source. METHODS: Selected clinical cases were reviewed in illustration. An anthropomorphic skull and brain phantom was created and scanned in a clinical CT scanner with skull, without skull, and with hemicraniectomy. The effects of beam hardening were illustrated by scanning the phantom with mono- and poly-chromatic X-ray sources. RESULTS: In clinical cases, the HU values of the brain were consistently lower when the X-ray beam traversed the skull than when it did not. An anthropomorphic skull-and-brain phantom further demonstrated these effects, which were evident with a polychromatic energy source and absent with a virtual monochromatic energy source. CONCLUSIONS: Beam hardening by the skull lowers the measured HU values of the brain. The effects, which can impact quantitative imaging, may be mitigated by a virtual monochromatic energy source. ADVANCES IN KNOWLEDGE: Beam hardening by the skull lowers the measured radiodensity of the brain. The effects may be mitigated by a virtual monochromatic energy source.


Assuntos
Artefatos , Encefalopatias/diagnóstico por imagem , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Imagens de Fantasmas , Razão Sinal-Ruído
6.
BMC Neurol ; 21(1): 85, 2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33618681

RESUMO

BACKGROUND: The mu-opioid agonist methadone is administered orally and used in opioid detoxification and in the treatment of moderate-to-severe pain. Acute oral methadone-use and -abuse have been associated with inflammatory and toxic central nervous system (CNS) damage in some cases and cognitive deficits can develop in long-term methadone users. In contrast, reports of intravenous methadone adverse effects are rare. CASE PRESENTATION: Here, we report a patient who developed acute bilateral hearing loss, ataxia and paraparesis subsequently to intravenous methadone-abuse. While the patient gradually recovered from these deficits, widespread magnetic resonance imaging changes progressed and delayed-onset encephalopathy with signs of cortical dysfunction persisted. This was associated with changes in the composition of monocyte and natural killer cell subsets in the cerebrospinal fluid. CONCLUSION: This case suggests a potential bi-phasic primary toxic and secondary inflammatory CNS damage induced by intravenous methadone.


Assuntos
Analgésicos Opioides/envenenamento , Ataxia/induzido quimicamente , Encefalopatias/induzido quimicamente , Disfunção Cognitiva/induzido quimicamente , Perda Auditiva Bilateral/induzido quimicamente , Metadona/envenenamento , Paraparesia/induzido quimicamente , Abuso de Substâncias por Via Intravenosa , Administração Intravenosa , Ataxia/fisiopatologia , Encéfalo/diagnóstico por imagem , Encefalopatias/diagnóstico por imagem , Encefalopatias/imunologia , Encefalopatias/fisiopatologia , Edema Encefálico/induzido quimicamente , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/imunologia , Edema Encefálico/fisiopatologia , Disfunção Cognitiva/imunologia , Disfunção Cognitiva/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Perda Auditiva Bilateral/fisiopatologia , Humanos , Inflamação/imunologia , Células Matadoras Naturais/imunologia , Imagem por Ressonância Magnética , Masculino , Monócitos/imunologia , Síndromes Neurotóxicas/diagnóstico por imagem , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/imunologia , Síndromes Neurotóxicas/fisiopatologia , Paraparesia/fisiopatologia , Adulto Jovem
7.
Br J Radiol ; 94(1119): 20200265, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33605783

RESUMO

Brain magnetic resonance elastography (MRE) is an imaging technique capable of accurately and non-invasively measuring the mechanical properties of the living human brain. Recent studies have shown that MRE has potential to provide clinically useful information in patients with intracranial tumors, demyelinating disease, neurodegenerative disease, elevated intracranial pressure, and altered functional states. The objectives of this review are: (1) to give a general overview of the types of measurements that have been obtained with brain MRE in patient populations, (2) to survey the tools currently being used to make these measurements possible, and (3) to highlight brain MRE-based quantitative biomarkers that have the highest potential of being adopted into clinical use within the next 5 to 10 years. The specifics of MRE methodology strategies are described, from wave generation to material parameter estimations. The potential clinical role of MRE for characterizing and planning surgical resection of intracranial tumors and assessing diffuse changes in brain stiffness resulting from diffuse neurological diseases and altered intracranial pressure are described. In addition, the emerging technique of functional MRE, the role of artificial intelligence in MRE, and promising applications of MRE in general neuroscience research are presented.


Assuntos
Encefalopatias/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Encéfalo/diagnóstico por imagem , Humanos
8.
BMJ Case Rep ; 14(2)2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622758

RESUMO

Neurological conditions are being more recognised in patients with COVID-19, with encephalopathy being the most prevalent problem. Posterior reversible encephalopathy is suspected to occur due to elevated blood pressure and overproduction of inflammatory markers, both of which have been reported in the setting of COVID-19 infection. Encephalopathy was the main presentation in this case, without respiratory dysfunction initially, and with imaging findings indicative of posterior reversible encephalopathy syndrome as an aetiology. Follow-up imaging showed resolution of the abnormal results with mental status returning to baseline upon discharge.


Assuntos
Encefalopatias/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Idoso de 80 Anos ou mais , Encefalopatias/virologia , Humanos , Hipertensão/virologia , Imagem por Ressonância Magnética , Masculino , Síndrome da Leucoencefalopatia Posterior/virologia
9.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526531

RESUMO

This report describes two patients with acute-onset ptosis, oculomotor dysfunction, ataxia and drowsiness, referable to the midbrain tegmentum. Both patients had previously suffered severe closed head injuries requiring craniotomy for cerebral decompression. Serial brain scans in both cases revealed a newly developing cleft in the midbrain, with features suggestive of abnormal cerebrospinal fluid (CSF) flow across the aqueduct. A trial of acetazolamide was initiated to reduce CSF production, followed by a third ventriculostomy for CSF diversion in one patient, which resulted in arrested disease progression and partial recovery. There are only two previous reports in the literature of midbrain clefts that developed as remote sequelae of head trauma. We postulate that altered CSF flow dynamics in the aqueduct, possibly related to changes in brain compliance, may be contributory. Early recognition and treatment may prevent irreversible structural injury and possible death.


Assuntos
Encefalopatias/diagnóstico por imagem , Lesões Encefálicas Difusas/diagnóstico por imagem , Aqueduto do Mesencéfalo/diagnóstico por imagem , Craniectomia Descompressiva , Traumatismos Cranianos Fechados/cirurgia , Mesencéfalo/diagnóstico por imagem , Acetazolamida/uso terapêutico , Ataxia/fisiopatologia , Blefaroptose , Encefalopatias/fisiopatologia , Encefalopatias/terapia , Lesões Encefálicas Difusas/fisiopatologia , Inibidores da Anidrase Carbônica/uso terapêutico , Líquido Cefalorraquidiano , Progressão da Doença , Disartria/fisiopatologia , Humanos , Hidrodinâmica , Imagem por Ressonância Magnética , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Ventriculostomia , Adulto Jovem
12.
Neurol Sci ; 42(2): 479-489, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33409828

RESUMO

OBJECTIVE: To describe the clinical, neurological, neuroimaging, and cerebrospinal fluid (CSF) findings associated with encephalopathy in patients admitted to a COVID-19 tertiary reference center. METHODS: We retrospectively reviewed records of consecutive patients with COVID-19 evaluated by a consulting neurology team from March 30, 2020 through May 15, 2020. RESULTS: Fifty-five patients with confirmed SARS-CoV-2 were included, 43 of whom showed encephalopathy, and were further divided into mild, moderate, and severe encephalopathy groups. Nineteen patients (44%) had undergone mechanical ventilation and received intravenous sedatives. Eleven (26%) patients were on dialysis. Laboratory markers of COVID-19 severity were very common in encephalopathy patients, but did not correlate with the severity of encephalopathy. Thirty-nine patients underwent neuroimaging studies, which showed mostly non-specific changes. One patient showed lesions possibly related to CNS demyelination. Four had suffered an acute stroke. SARS-CoV-2 was detected by RT-PCR in only one of 21 CSF samples. Two CSF samples showed elevated white blood cell count and all were negative for oligoclonal bands. In our case series, the severity of encephalopathy correlated with higher probability of death during hospitalization (OR = 5.5 for each increment in the degree of encephalopathy, from absent (0) to mild (1), moderate (2), or severe (3), p < 0.001). CONCLUSION: In our consecutive series with 43 encephalopathy cases, neuroimaging and CSF analysis did not support the role of direct viral CNS invasion or CNS inflammation as the cause of encephalopathy.


Assuntos
Encefalopatias/etiologia , /complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Encefalopatias/líquido cefalorraquidiano , Encefalopatias/diagnóstico por imagem , Encefalopatias/imunologia , /terapia , Feminino , Mortalidade Hospitalar , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Centros de Atenção Terciária
13.
Lancet Child Adolesc Health ; 5(3): 167-177, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33338439

RESUMO

BACKGROUND: The CNS manifestations of COVID-19 in children have primarily been described in case reports, which limit the ability to appreciate the full spectrum of the disease in paediatric patients. We aimed to identify enough cases that could be evaluated in aggregate to better understand the neuroimaging manifestations of COVID-19 in the paediatric population. METHODS: An international call for cases of children with encephalopathy related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and abnormal neuroimaging findings was made. Clinical history and associated plasma and cerebrospinal fluid data were requested. These data were reviewed by a central neuroradiology panel, a child neurologist, and a paediatric infectious diseases expert. The children were categorised on the basis of their time of probable exposure to SARS-CoV-2. In addition, cases were excluded when a direct link to SARS-CoV-2 infection could not be established or an established alternate diagnostic cause could be hypothesised. The accepted referral centre imaging data, from ten countries, were remotely reviewed by a central panel of five paediatric neuroradiologists and a consensus opinion obtained on the imaging findings. FINDINGS: 38 children with neurological disease related to SARS-CoV-2 infection were identified from France (n=13), the UK (n=8), the USA (n=5), Brazil (n=4), Argentina (n=4), India (n=2), Peru (n=1), and Saudi Arabia (n=1). Recurring patterns of disease were identified, with neuroimaging abnormalities ranging from mild to severe. The most common imaging patterns were postinfectious immune-mediated acute disseminated encephalomyelitis-like changes of the brain (16 patients), myelitis (eight patients), and neural enhancement (13 patients). Cranial nerve enhancement could occur in the absence of corresponding neurological symptoms. Splenial lesions (seven patients) and myositis (four patients) were predominantly observed in children with multisystem inflammatory syndrome. Cerebrovascular complications in children were less common than in adults. Significant pre-existing conditions were absent and most children had favourable outcomes. However, fatal atypical CNS co-infections developed in four previously healthy children infected with SARS-CoV-2. INTERPRETATION: Acute-phase and delayed-phase SARS-CoV-2-related CNS abnormalities are seen in children. Recurring patterns of disease and atypical neuroimaging manifestations can be found and should be recognised being as potentially due to SARS-CoV-2 infection as an underlying aetiological factor. Studies of paediatric specific cohorts are needed to better understand the effects of SARS-CoV-2 infection on the CNS at presentation and on long-term follow-up in children. FUNDING: American Society of Pediatric Neuroradiology, University of Manchester (Manchester, UK). VIDEO ABSTRACT.


Assuntos
/complicações , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Doenças do Sistema Nervoso Central/etiologia , Neuroimagem , Adolescente , Argentina/epidemiologia , Encefalopatias/diagnóstico por imagem , Encefalopatias/fisiopatologia , Brasil/epidemiologia , Criança , Pré-Escolar , Coinfecção/mortalidade , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Encefalomielite Aguda Disseminada/fisiopatologia , Feminino , França/epidemiologia , Humanos , Índia/epidemiologia , Lactente , Masculino , Peru/epidemiologia , Arábia Saudita/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
14.
Biochim Biophys Acta Gen Subj ; 1865(3): 129832, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33358866

RESUMO

BACKGROUND: Increasing evidence from pathological and biochemical investigations suggests that mitochondrial metabolic impairment and oxidative stress play a crucial role in the pathogenesis of mitochondrial diseases, such as mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome, and various neurodegenerative disorders. Recent advances in molecular imaging technology with positron emission tomography (PET) and functional magnetic resonance imaging (MRI) have accomplished a direct and non-invasive evaluation of the pathophysiological changes in living patients. SCOPE OF REVIEW: In this review, we focus on the latest achievements of molecular imaging for mitochondrial metabolism and oxidative stress in mitochondrial diseases and neurodegenerative disorders. MAJOR CONCLUSIONS: Molecular imaging with PET and MRI exhibited mitochondrial metabolic changes, such as enhanced glucose utilization with lactic acid fermentation, suppressed fatty acid metabolism, decreased TCA-cycle metabolism, impaired respiratory chain activity, and increased oxidative stress, in patients with MELAS syndrome. In addition, PET imaging clearly demonstrated enhanced cerebral oxidative stress in patients with Parkinson's disease or amyotrophic lateral sclerosis. The magnitude of oxidative stress correlated well with clinical severity in patients, indicating that oxidative stress based on mitochondrial dysfunction is associated with the neurodegenerative changes in these diseases. GENERAL SIGNIFICANCE: Molecular imaging is a promising tool to improve our knowledge regarding the pathogenesis of diseases associated with mitochondrial dysfunction and oxidative stress, and this would facilitate the development of potential antioxidants and mitochondrial therapies.


Assuntos
Acidose Láctica/diagnóstico por imagem , Encefalopatias/diagnóstico por imagem , Síndrome MELAS/diagnóstico por imagem , Mitocôndrias/metabolismo , Miopatias Mitocondriais/diagnóstico por imagem , Doenças Neurodegenerativas/diagnóstico por imagem , Acidose Láctica/metabolismo , Acidose Láctica/patologia , Encefalopatias/metabolismo , Encefalopatias/patologia , Transporte de Elétrons/genética , Ácidos Graxos/metabolismo , Glucose/metabolismo , Humanos , Ácido Láctico/metabolismo , Síndrome MELAS/metabolismo , Síndrome MELAS/patologia , Imagem por Ressonância Magnética , Mitocôndrias/genética , Mitocôndrias/patologia , Miopatias Mitocondriais/metabolismo , Miopatias Mitocondriais/patologia , Imagem Molecular , Doenças Neurodegenerativas/metabolismo , Doenças Neurodegenerativas/patologia , Estresse Oxidativo , Tomografia por Emissão de Pósitrons , Índice de Gravidade de Doença
15.
Int J Infect Dis ; 103: 457-463, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33310027

RESUMO

OBJECTIVES: To cross-sectionally describe brain alterations in PLHIV aged above 50 years old, receiving antiretroviral treatment (ART) and living in Senegal compared to HIV-negative subjects. METHODS: Twenty PLHIV and 26 HIV-negative subjects with comparable socio-demographic and clinical characteristics underwent an MRI exam (3D-T1 and FLAIR sequences). Global atrophy and White Matter Hyperintensities (WMH) were evaluated. After assessing the feasibility and acceptability of MRI scans in this population, we described atrophy and WHM prevalence and associated factors using logistic regressions. RESULTS: Overall, 43.5% of the study sample were aged ≥60 years, 58.7% were women, and 28.3% had hypertension. The overall prevalence of atrophy and WMH was 19.6% [95% CI: 8.1-31.1] and 30.4% [95% CI: 17.1-43.7]. HIV status had no significant effect on atrophy or WMH. Unemployment and hypertension were significantly associated with atrophy, whereas women were less likely to present atrophy. Aged ≥60 years was the only factor associated with WMH. CONCLUSIONS: A high prevalence of atrophy and WMH was observed in West African adults aged over 50 years without a clear HIV impact. As brain MRI studies are critical to better understand cognitive and emotional outcomes, we encourage those studies in older PLHIV in West Africa.


Assuntos
Encefalopatias/diagnóstico por imagem , Encefalopatias/etiologia , Infecções por HIV/complicações , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Estudos Transversais , Feminino , Humanos , Hipertensão/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Senegal
16.
J Stroke Cerebrovasc Dis ; 30(3): 105542, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33341023

RESUMO

OBJECTIVE: To report six consecutive patients with confirmed coronavirus disease-2019 (COVID-19) who underwent Transcranial Doppler (TCD) ultrasonography evaluation for cerebral microemboli in the setting of suspected or confirmed acute ischemic stroke. METHODS: Patient data were obtained from medical records from Northwestern Memorial Hospital, Chicago, IL between May and June 2020. All patients with confirmed COVID-19 who underwent clinical TCD ultrasonography for microemboli detection were included. RESULTS: A total of eight TCD studies were performed in six patients with COVID-19 (4 men and 2 women, median age 65±5), four with confirmed ischemic stroke and two with refractory encephalopathy. Microemboli were detected in three male patients, two patients had suffered a confirmed ischemic stroke and one who developed prolonged encephalopathy. Microemboli of varying intensity were identified in multiple vascular territories in two patients, and microemboli persisted despite therapeutic anticoagulation in a third patient. Of the three patients without evidence of microemboli on TCD ultrasonography, two patients had suffered a confirmed ischemic stroke, while one remained with refractory encephalopathy. CONCLUSIONS: TCD ultrasonography for microemboli detection identified three patients with confirmed COVID-19 with evidence of cerebral arterial microemboli, including one who was therapeutically anticoagulated. TCD ultrasonography provides a non-invasive method for evaluating cerebral microemboli in patients with COVID-19 and may be useful in assessing response to treatment in cases with suspected or confirmed disorders of hypercoagulability. Further studies investigating the prevalence of cerebral microemboli and associated risk factors are needed to characterize their pathogenic mechanism and guide therapeutic interventions in hospitalized COVID-19 patients.


Assuntos
/complicações , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Idoso , Anticoagulantes/uso terapêutico , Encefalopatias/diagnóstico por imagem , Encefalopatias/etiologia , Angiografia Cerebral , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/terapia , Embolia Intracraniana/terapia , /etiologia , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Trombectomia , Ultrassonografia Doppler Transcraniana
17.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(6): 306-312, nov.-dic. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-197925

RESUMO

Isolated neurosarcoidosis is a very rare disease, which makes up 5-15% of sarcoidosis cases. Hydrocephalus is a rare clinical feature with a prevalence of 6% among these patients. Considering neurosarcoidosis in the differential diagnosis of a unique parenquimal mass lesion could help in the early identification of this disease. We report the case of a 27-year-old African man who developed with a sole intracranial mass lesion mimicking radiologically a glioma, which finally came out as an isolated neurosarcoidosis. There is a difficulty in diagnosis when isolated neurosarcoidosis appears. In addition, the low prevalence of the disease entails a not standardized medical treatment. Natural outcome is poor even when hydrocephalus is resolved. Multimodal treatments including complete pharmacological treatment do not seem to assure a better outcome in these patients until date


La neurosarcoidosis cerebral aislada es una enfermedad muy rara, que representa entre el 5-15% de los casos de sarcoidosis. La hidrocefalia es una característica clínica poco frecuente, con una prevalencia del 6% entre estos pacientes. Considerar la neurosarcoidosis en el diagnóstico diferencial de una lesión de tipo masa parenquimatosa única puede ayudar en la identificación temprana de esta enfermedad. Presentamos el caso de un varón africano de 27 años de edad, que presenta una lesión de tipo masa única intracraneal que simulaba radiológicamente un glioma, y que finalmente se reveló como una neurosarcoidosis aislada. Es difícil establecer un diagnóstico cuando aparece una neurosarcoidosis cerebral aislada. Además, la baja prevalencia de la enfermedad conlleva un tratamiento médico no estandarizado. El pronóstico natural es malo, incluso cuando se resuelve la hidrocefalia. Hasta la fecha, los tratamientos multimodales, incluido el tratamiento farmacológico completo, no parecen asegurar un mejor resultado en estos pacientes


Assuntos
Humanos , Masculino , Adulto , Sarcoidose/diagnóstico por imagem , Sarcoidose/cirurgia , Hidrocefalia/cirurgia , Edema Encefálico/diagnóstico por imagem , Doenças do Sistema Nervoso Central/patologia , Hidrocefalia/diagnóstico por imagem , Diagnóstico Diferencial , Encefalopatias/diagnóstico por imagem , Biópsia , Corticosteroides/uso terapêutico , Edema Encefálico/patologia , Edema Encefálico/cirurgia
18.
Nutr. hosp ; 37(6): 1285-1288, nov.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198319

RESUMO

INTRODUCCIÓN: la vitamina cobalamina es esencial para el buen funcionamiento del SNC, la hematopoyesis y la síntesis de ADN. Su déficit es frecuentemente secundario a la anemia perniciosa o a las dietas vegetarianas estrictas. CASO CLÍNICO: lactante varón de 18 meses con disminución del nivel de conciencia y trastorno del movimiento (temblor y movimientos coreiformes) de horas de duración. Como antecedentes, presenta retraso de la adquisición de los hitos motores (no bipedestación, lenguaje monosilábico) y pérdida progresiva de los mismos en las últimas semanas (sostén cefálico y sedestación). Alimentado mediante lactancia materna desde el nacimiento. La familia sigue una alimentación vegetariana. En las pruebas de neuroimagen, la TC y la RM craneales muestran atrofia supratentorial generalizada de ambas sustancias y de los ganglios basales. Se inicia tratamiento con vitamina B12 intramuscular, aumentando sus niveles. Posteriormente se procede a la diversificación alimentaria y la administración de cianocobalamina oral, con normalización clínica al cabo de 6 meses y radiológica al cabo de 7 meses. DISCUSIÓN: recalcamos la importancia de la suplementación con B12 durante el embarazo y la lactancia tanto en la mujer como en el lactante


INTRODUCTION: the vitamin cobalamin is essential for a proper functioning of the CNS, hematopoiesis, and DNA synthesis. Its deficiency is frequently secondary to pernicious anemia or strict vegetarian diets. CASE REPORT: an 18-month-old male infant presented with a decreased level of consciousness and movement disorder (tremor and choreiform movements) of several hours' standing. He had a history of delayed acquisition of motor milestones (not standing, monosyllabic language), and progressive loss of these over the last few weeks (head support and sitting). He had been breastfed from birth. His family has a vegetarian diet. In neuroimages, cranial CT and MRI scans showed generalized supratentorial atrophy involving both matters and the basal ganglia. Treatment was started with intramuscular vitamin B12, which increased its levels. Subsequently, the patient was subjected to dietary diversification and oral cyanocobalamin, with clinical normalization after 6 months and radiological normalization after 7 months. DISCUSSION: we emphasize the importance of vitamin B12 supplementation during pregnancy and lactation in vegetarian mothers and their infants


Assuntos
Humanos , Masculino , Lactente , Encefalopatias/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , Deficiência de Vitamina B 12/terapia , Terapia Nutricional/métodos , Vitamina B 12/administração & dosagem , Terapia Nutricional/efeitos adversos , Transtornos da Consciência/complicações , Tremor/complicações , Neuroimagem , Tomografia Computadorizada por Raios X
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