RESUMEN
Introdução: Abscessos cerebrais são caracterizados por uma coleção de exsudato no parênquima encefálico capazes de acometer indivíduos de qualquer idade, raça e sexo. Atençãoespecial deve ser dada a esses casos, pois sua apresentação clínica pode simular outros agravos, tornando importante ampliar o raciocínio para diversos diagnósticos diferenciais. O presente estudo visa o relato de caso de uma paciente admitida na Santa Casa de Misericórdia de Sobral com quadro sugestivo de cefaléia secundária. Material e Métodos: MEMA, 22 anos,universitária, evoluiu em 11 dias com cefaléia unilateral em região frontal esquerda e pulsátil. Essa cefaléia tinha caráter habitual, apresentava intensidade progressiva, associava-se a náuseas, melhorava com repouso e analgésicos, não havendo relato defator desencadeante. Resultados: O exame neurológico evidenciou alteração no estado mental, com déficit de memória imediata e recente, compreensão e nomeação; além de desorientação temporo-espacial. Observou-se na Tomografia Computadorizada de Crânio (TCC) uma imagem hipodensa temporal esquerda,com halo hiperdenso de reforço após administração de contraste. Conclusão: A mortalidade nos pacientes com abscesso cerebral pode variar entre 10-40%, sendo bastante influenciada pelo estado clínico dos pacientes na admissão. Os sinais de alerta da cefaléia, também conhecidos como red flags, são de alto valor preditivo para agravos secundários cerebrais e devem ser considerados pelos profissionais de saúde que atuam em serviço de prontoatendimento. A TCC é uma importante ferramenta de diagnóstico e de avaliação dos abscessos cerebrais, sendo sua precocidade de realização fator prognóstico decisivo para o paciente.
Introduction: Brain abscesses are characterized by a exudate collection in the brain parenchyma able to reachindividuals of any age, race and sex. Special attention should be given to these cases because their clinical presentation may mimic other diseases, making it important to extend the reasoning of possible differential diagnoses. This study is a case of a patient admitted to the Santa Casa de Misericórdia de Sobral with cluessuggestive of secondary headache. Methods: MEMA, 22 years, university, developed in eleven days unilateral headache in the left frontal region and pulsatile. The headache was of normal character, intensity was progressive, associated to nausea, improves withrest and analgesics and no reports of triggering factor. Results: Neurological examination revealed changes in mental status, with lack of immediate and recent memory, understanding and naming, in addition to temporo-spatial disorientation. It was observed in CT scan of skull (CTS) a left temporal hypodense image with hyperdense halo of enhancement after administration of contrast. Conclusion: The mortality in patients with brain abscess can varybetween 10-40% and is strongly influenced by the clinical status of patients on admission. The warning signs of a headache, also known as red flags, are of high predictive value for secondary brain injuries and should be considered by health professionals who work in service of the emergency room. The CTS is an important tool for diagnosis and assessment of brain abscesses, and its early implementation of decisive prognostic factor for patients.
Asunto(s)
Humanos , Femenino , Adulto Joven , Absceso Encefálico/diagnóstico , Cefalea , Diagnóstico Diferencial , Sistema Nervioso Central , Tomografía Computarizada por Rayos XRESUMEN
A retrospective chart review was performed on patients diagnosed as having myasthenia gravis in Ceará State, Brazil and who were followed from October 1981 to June 2009. Clinical and epidemiologic aspects were evaluated. In this work, 122 patients were studied, of whom 85 (69.7 percent) were females and 37 (30.3 percent) were males. The disease duration ranged from five months to 50 years (8.9±8.1 years). Age at the first symptoms varied from 0 to 74 years (31.9±14.4 years). The first main symptoms and signs were ptosis, diplopia and limb weakness. Generalized myasthenia was the most common clinical presentation, but 5.1 percent (n=6) persisted as ocular myasthenia. Thymectomy was performed in 42.6 percent (n=52) of myasthenic patients. A thymoma was present in 10 patients. Serum acetylcholine receptor (AChR) antibodies were present in 80 percent (n=20) of specimens tested. The data presented are similar to those of studies performed in other countries.
Foram analisados, retrospectivamente, os prontuários de pacientes miastênicos, diagnosticados e seguidos entre outubro de 1981 e junho de 2009 no Estado do Ceará, Brasil. Foram coletados dados clínicos e epidemiológicos. Na casuística foram estudados 122 pacientes: 85 (69,7 por cento) do sexo feminino e 37 (30,3 por cento) do sexo masculino. O tempo de doença variou de 5 meses a 50 anos (8,9±8,1 anos). A idade de inicio da doença variou de 0 a 74 anos (31,9±14,4 anos). Na amostra estudada, os primeiros sintomas foram principalmente ptose, diplopia e fraqueza dos membros. A maioria dos pacientes apresentou a forma generalizada, enquanto 5,1 por cento (n= 6) persistiram com miastenia ocular. Timectomia foi realizada em 42,6 por cento (n=52) dos pacientes. Timoma estava presente em 10 pacientes. Anticorpo anti-receptor de acetilcolina foi positivo em 80 por cento (n=20) das amostras testadas. Os aspectos clínicos e epidemiológicos da amostra estudada têm semelhança com aqueles estudados em outros países.
Asunto(s)
Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Adulto Joven , Miastenia Gravis/epidemiología , Brasil/epidemiología , Miastenia Gravis/diagnóstico , Miastenia Gravis/terapia , Prevalencia , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
A retrospective chart review was performed on patients diagnosed as having myasthenia gravis in Ceará State, Brazil and who were followed from October 1981 to June 2009. Clinical and epidemiologic aspects were evaluated. In this work, 122 patients were studied, of whom 85 (69.7%) were females and 37 (30.3%) were males. The disease duration ranged from five months to 50 years (8.9±8.1 years). Age at the first symptoms varied from 0 to 74 years (31.9±14.4 years). The first main symptoms and signs were ptosis, diplopia and limb weakness. Generalized myasthenia was the most common clinical presentation, but 5.1% (n=6) persisted as ocular myasthenia. Thymectomy was performed in 42.6% (n=52) of myasthenic patients. A thymoma was present in 10 patients. Serum acetylcholine receptor (AChR) antibodies were present in 80% (n=20) of specimens tested. The data presented are similar to those of studies performed in other countries.