RESUMEN
En este artículo se presenta el caso clínico de un paciente de sexo masculino de 34 años que fue remitido al Instituto Neurológico de Colombia e internado en la unidad de cuidados intensivos neurológicos, por la sospecha inicial de un síndrome de Guillain-Barré. La presencia de alteraciones cognitivas durante su evolución, llevó a reconsiderar el diagnóstico presuntivo inicial por el de encefalitis de Bickerstaff. Se describen el tratamiento instaurado y la evolución del paciente, se hacen la revisión de la literatura y la discusión.
We describe the case of a 34-year-old male patient, who was referred to the Instituto Neurológico de Colombia with probable Guillain-Barré syndrome, requiring intensive care management. The presence of cognitive alterations during his evolution, lead the team to reconsider the initial diagnosis for the Bickerstaff´s brainstem encephalitis diagnosis. We aim to describe the patient´s treatment and evolution, as well as a brief review and discussion.
Asunto(s)
Adulto , Humanos , Masculino , Tronco Encefálico , Encefalitis/diagnósticoRESUMEN
We describe the case of a 34-year-old male patient, who was referred to the Instituto Neurológico de Colombia with probable Guillain-Barré syndrome, requiring intensive care management. The presence of cognitive alterations during his evolution, lead the team to reconsider the initial diagnosis for the Bickerstaff's brainstem encephalitis diagnosis. We aim to describe the patient's treatment and evolution, as well as a brief review and discussion.
Asunto(s)
Tronco Encefálico , Encefalitis/diagnóstico , Adulto , Humanos , MasculinoRESUMEN
OBJECT: Acute subdural hematoma (SDH) is one of the most lethal forms of intracranial injury; several risk factors predictive of a worse outcome have been identified. Emerging research suggests that patients with coagulopathy and intracerebral hemorrhage have a worse outcome than patients without coagulopathy but with intracerebral hemorrhage. The authors sought to determine if such a relationship exists for patients with acute SDH. METHODS: The authors conducted a retrospective analysis of consecutive patients admitted to a neurosciences intensive care unit with acute SDH over a 4-year period (January 1997-December 2001). Demographic data, laboratory values, admission source, prior functional status, medical comorbidities, treatments received, and discharge disposition were recorded, as were scores on the Acute Physiology, Age, and Chronic Health Evaluation III (APACHE III). Coagulopathy was defined as an internal normalized ratio>1.2 or a prothrombin time>or=12.7 seconds. Univariate and multivariate analyses were performed on 244 patients to determine factors associated with worse short-term outcomes. RESULTS: The authors identified 248 patients with acute SDH admitted to the neurointensive care unit during the study period, of which 244 had complete data. Most were male (61%), and the mean age of the study population was 71.3+/-15 years (range 20-95 years). Fifty-three patients (22%) had coagulopathy. The median APACHE III score was 43 (range 11-119). Twenty-nine patients (12%) died in the hospital. Independent predictors of inhospital death included APACHE III score (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.4-13.4, p=0.011) and coagulopathy (OR 2.7, 95% CI 1.1-7.1, p=0.037). Surgical evacuation of acute SDH was associated with reduced inhospital deaths (OR 0.2, 95% CI 0.1-0.6, p=0.003). CONCLUSIONS: Coagulopathy is independently associated with inhospital death in patients with acute SDH. Time to treatment to correct coagulopathy using fresh frozen plasma and/or vitamin K was prolonged.
Asunto(s)
Trastornos de la Coagulación Sanguínea/mortalidad , Hematoma Subdural Agudo/mortalidad , Mortalidad Hospitalaria , Pacientes Internos/estadística & datos numéricos , APACHE , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de la Coagulación Sanguínea/tratamiento farmacológico , Femenino , Hematoma Subdural Agudo/tratamiento farmacológico , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Plasma , Estudios Retrospectivos , Vitamina K/uso terapéutico , Vitaminas/uso terapéuticoRESUMEN
BACKGROUND AND PURPOSE: Dedicated stroke units are associated with improved patient outcomes after acute ischemic stroke in general. However, it is unknown whether the population of critically ill ischemic stroke patients admitted to the neurocritical care unit (NCCU) benefit from primary management by a specialized neurocritical care team (NCT). This study is intended to investigate such benefit. METHODS: A retrospective chart review in a large academic university hospital identified 400 patients with acute ischemic stroke admitted to the NCCU, from January 1997 to April 2000, aged 65 +/- 14 years. We examined the short- and long-term outcomes of these patients before and after institution of a specialized NCT. We used logistic regression models to determine independent association between outcome and availability of NCT. RESULTS: The presence of a NCT was associated with a decreased length of NCCU stay (2.9 +/- 2.0 vs. 3.7 +/- 2.9 days, P < 0.01), decreased length of hospital stay (7.5 +/- 4.7 vs. 9.9 +/- 7.6, P < 0.001), and increased proportion of home discharges (47% vs. 36%, P < 0.05). The only independent predictor of in-hospital and long-term mortality was the underlying severity of disease as determined by the APACHE III score. CONCLUSIONS: In critically ill acute ischemic stroke patients, institution of a dedicated NCT was associated with a reduction in resource utilization and improved patient outcomes at hospital discharge. Several factors including improved patient care protocols may explain this association.
Asunto(s)
Isquemia Encefálica/terapia , Cuidados Críticos/organización & administración , Grupo de Atención al Paciente/organización & administración , Accidente Cerebrovascular/terapia , APACHE , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/complicaciones , Isquemia Encefálica/mortalidad , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Retrospectivos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidadRESUMEN
A pesar del avance en nuevas terapias para el tratamiento de las enfermedades reumatológicas no se ha logrado cambiar la mortalidad a largo plazo, y en estudios recientes se ha mostrado un incremento de la mortalidad debido a enfermedad cardiovascular. Ello probablemente se da por el papel que juega la inflamación crónica en estas enfermedades, a la vez que por el uso de dosis elevadas y continuas de esferoides y otros medicamentos que se sabe incrementan el riesgo de enfermedad aterosclerótíca. Para tratar de corregir algunos de los factores de riesgo de la aterosclerosis acelerada se ha venido postulando el uso de las estatinas. En los análisis de los estudios se encontró que el beneficio de las estatinas aparecía en un corto periodo de tratamiento, en donde la regresión de la placa aterosclerótica no había sucedido, por lo tanto se empezaron a explicar los beneficios por efectos adicionales o pleiotrópicos. Algunos de estos efectos afectan la aterogénesis e incluyen una mejoría en la función de la célula endotelial, disminución del proceso inflamatorio, inmunomodulación, entre otros beneficios. Todos estos efectos nos ayudarían en el control de las enfermedades reumáticas y, teniendo en cuenta la mortalidad por enfermedad aterosclerótica, podrían ser una de las herramientas en su manejo