Asunto(s)
Neurosífilis/diagnóstico , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Encéfalo/diagnóstico por imagen , Electroencefalografía , Humanos , Imagen por Resonancia Magnética , Masculino , Neurosífilis/diagnóstico por imagen , Neurosífilis/tratamiento farmacológico , Penicilina G/administración & dosificación , Penicilina G/uso terapéutico , Penicilina G Benzatina/administración & dosificación , Penicilina G Benzatina/uso terapéutico , Punción Espinal , Factores de Tiempo , Tomografía Computarizada por Rayos X , Ácido Valproico/administración & dosificación , Ácido Valproico/uso terapéuticoRESUMEN
INTRODUCTION: Brucellosis is a form of anthropozoonosis that is found the world over. It has a particularly high incidence rate in Spain, above all in rural areas such as Extremadura, Castile and Leon, Castile-La Mancha and Aragon, largely due to the consumption of non-pasteurised milk and cheese. Neurobrucellosis can be defined as a set of either early or late neurological complications caused by Brucella. It is difficult to determine its frequency, although it oscillates between 2-18% of all cases of brucellosis. CASE REPORTS: We report the cases of four patients diagnosed as having neurobrucellosis. The different presenting clinical symptoms, the complementary explorations, treatment and duration are all described. CONCLUSIONS: The clinical features of neurobrucellosis vary greatly and, in general, tend to be chronic. Many of the laboratory procedures usually employed in the diagnosis of brucellosis frequently give negative results. For these reasons, and because it is a disease that is both treatable and curable, the degree of suspicion must be high, especially in endemic areas, so that an early diagnosis can be made to allow suitable treatment to be established.
Asunto(s)
Brucelosis , Adolescente , Adulto , Anciano , Animales , Antibacterianos/uso terapéutico , Brucella , Brucelosis/diagnóstico , Brucelosis/tratamiento farmacológico , Brucelosis/fisiopatología , Bovinos , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Listeria monocytogenes is a gram-positive bacillus which causes sporadic infections in immunocompromised humans, with a special propensity for the central nervous system, in the form of acute, subacute or chronic meningitis, rhombencephalitis or abscesses in the brain or spinal cord. The final diagnosis is established by germ culture in blood or in cerebrospinal fluid (CSF). Preferred treatment is ampicillin in association with aminoglycosides. CASE REPORT: We report the case of a 70-year-old male patient with a history of arterial hypertension and chronic lymphatic leukaemia with no specific treatment, who suffered meningoencephalitis and brain abscesses caused by L. monocytogenes. Symptoms were a 48-hour history of headache and a febrile condition. The CSF showed lymphocytic pleocytosis with hypoglycorrhachia. Magnetic resonance scans of the brain revealed areas of cerebritis and multiple brain abscesses in the right frontal lobe. Specific treatment was established with ampicillin for 13 weeks, associated with gentamicin and vancomycin during the first few weeks, until x-rays showed the lesions to be resolved. CONCLUSIONS: L. monocytogenes infections must be investigated in all patients with cellular immunosuppression who present febrile symptoms. The central nervous system may be the only area of the body infected. Moreover, this site will need studying in patients who present neurological focus data or an alteration in the state of consciousness and bacteraemia due to L. monocytogenes. Establishing suitable treatment as early as possible can improve the prognosis.
Asunto(s)
Absceso Encefálico , Listeria monocytogenes , Listeriosis/diagnóstico , Listeriosis/patología , Anciano , Antibacterianos/uso terapéutico , Absceso Encefálico/diagnóstico , Absceso Encefálico/microbiología , Absceso Encefálico/patología , Humanos , Listeriosis/tratamiento farmacológico , Imagen por Resonancia Magnética , MasculinoRESUMEN
INTRODUCTION: Dopamine blocking agents can induce gravel types of 'tardive syndromes' (buccolinguomasticatory syndrome, dystonia, akathisia, and less frequently tremor, tourettism, and myoclonus). To our knowledge, orthostatic tremor has not been previously described as a complication of exposure to these drugs. CASE REPORTS: We report four patients who developed orthostatic tremor after exposure to dopamine blocking drugs. Two of them had orthostatic tremor as the predominant but not exclusive type of tremor, and the other two had 'pure' high-frequency orthostatic tremor. Tremor disappeared completely in 3 patients and improved markedly in the other one after gradual withdrawal of the offending drugs (metoclopramide in case 1, sulpiride and thyethylperazine in case 2, and sulpiride in cases 3 and 4). CONCLUSIONS: We propose that this 'tardive orthostatic tremor' could be considered into the spectrum of drug-induced movement disorders.