RESUMEN
Convulsive seizures caused by hyponatremia occur when this condition is severe and develops quickly, resulting in a brain's adaptive inability to contain brain swelling. Seizures are rarely the cause of shoulder fractures. This is a case report of bilateral humerus fracture following a single epileptic seizure caused by drug hyponatremia, an unconventional event in medical practice. A 69-year-old woman was admitted to the emergency room after a single tonic-clonic seizure with spontaneously ceased sphincter relaxation, showing Glasgow 6. No falls or restraint were reported by observers. When alert, the patient reported pain and difficulty moving both arms. During examination, the movement was li- mited to the right and left. Anteroposterior radiographs revealed bilateral fracture at the neck of humerus. To complement inves- tigation for further lesions, a computed tomography confirmed bilateral fracture-dislocation with impaction of the humeral head with the glenoid. Atraumatic bilateral fracture-dislocation of the humerus after epileptic seizure is a very rare event. It is believed that some of these diagnoses have been neglected due to the difficulty of characterizing the patient's pain in a postictal state. The importance of a detailed physical examination shall be emphasized in risk groups such as the polymedicated elderly.
Convulsive seizures caused by hyponatremia occur when this condition is severe and develops quickly, resulting in a brain's adaptive inability to contain brain swelling. Seizures are rarely the cause of shoulder fractures. This is a case report of bilateral humerus fracture following a single epileptic seizure caused by drug hyponatremia, an unconventional event in medical practice. A 69-year-old woman was admitted to the emergency room after a single tonic-clonic seizure with spontaneously ceased sphincter relaxation, showing Glasgow 6. No falls or restraint were reported by observers. When alert, the patient reported pain and difficulty moving both arms. During examination, the movement was li- mited to the right and left. Anteroposterior radiographs revealed bilateral fracture at the neck of humerus. To complement inves- tigation for further lesions, a computed tomography confirmed bilateral fracture-dislocation with impaction of the humeral head with the glenoid. Atraumatic bilateral fracture-dislocation of the humerus after epileptic seizure is a very rare event. It is believed that some of these diagnoses have been neglected due to the difficulty of characterizing the patient's pain in a postictal state. The importance of a detailed physical examination shall be emphasized in risk groups such as the polymedicated elderly.
Asunto(s)
Humanos , Femenino , Anciano , Convulsiones/complicaciones , Luxación del Hombro/etiología , Fracturas del Hombro/etiología , Epilepsia Tónico-Clónica/complicaciones , Luxación del Hombro/cirugía , Luxación del Hombro/rehabilitación , Luxación del Hombro/diagnóstico por imagen , Fracturas del Hombro/cirugía , Fracturas del Hombro/rehabilitación , Fracturas del Hombro/diagnóstico por imagen , Radiografía , Tomografía Computarizada por Rayos X , Modalidades de Fisioterapia , Amnesia Anterógrada/etiología , Hidroclorotiazida/efectos adversos , Hiponatremia/inducido químicamente , Antihipertensivos/efectos adversosRESUMEN
INTRODUCTION: Postictal neurogenic pulmonary oedema is an infrequent condition of varying severity, probably related to sudden unexpected death in epilepsy (SUDEP). It is more frequent in patients with generalised tonic-clonic seizures of long duration or with status epilepticus. AIM: Based on a review of the literature, the aim is to describe the clinical characteristics, pathophysiology, radiological findings, treatment and prognosis of patients with postictal pulmonary oedema. DEVELOPMENT: A search of the literature was performed in the PubMed, Embase, Cochrane Database of Systematic Reviews and BVS databases using a combination of free terms. The limits of the search applied were: papers published between 1 January 2000 and 26 April 2018, and papers for which the abstract was available. Altogether 23 papers were found, most of which were clinical cases, and used to extract the information needed to carry out the review. CONCLUSIONS: In postictal pulmonary oedema, generalised tonic-clonic seizures are the most frequently reported type. The most common clinical manifestations were dyspnoea and tachycardia appearing within a few minutes after the seizure. Among the paraclinical findings the most frequent was leukocytosis. In general terms, a good prognosis was found in most cases, with improvement of the oedema within a period of between 12 and 96 hours. Only two of the 21 patients reported died. In addition, in a clinical pathology study in patients with SUDEP, pulmonary oedema appeared in most cases.
TITLE: Edema pulmonar postictal: revision de la bibliografia.Introduccion. El edema pulmonar neurogeno postictal es una patologia poco frecuente con gravedad variable, probablemente en relacion con la muerte subita asociada a la epilepsia (SUDEP). La frecuencia es mayor en pacientes con crisis tonicoclonicas generalizadas de larga duracion o con estado epileptico. Objetivo. Por medio de una revision de la bibliografia se pretende describir las caracteristicas clinicas, la fisiopatologia, los hallazgos radiologicos, el tratamiento y el pronostico de los pacientes con edema pulmonar postictal. Desarrollo. Se realizo una busqueda de la bibliografia en las bases de datos PubMed, Embase, Cochrane y BVS empleando una combinacion de terminos libres. Se aplicaron como limites de busqueda: articulos publicados desde el 1 de enero de 2000 hasta el 26 de abril de 2018 y articulos que contaran con el resumen disponible. En total se revisaron 23 articulos, en su mayoria casos clinicos, de los cuales se obtuvo la informacion para desarrollar la revision. Conclusiones. En el edema pulmonar postictal, el tipo de crisis mas frecuentemente comunicada es la tonicoclonica generalizada. Las manifestaciones clinicas mas habituales fueron disnea y taquicardia de aparicion en los minutos posteriores a la crisis. En los paraclinicos, el hallazgo mas frecuente fue leucocitosis. En general se encontro un buen pronostico en la mayoria de los casos, con mejoria del edema entre las 12 y las 96 horas. Unicamente dos de los 21 pacientes comunicados fallecieron. Ademas, en un estudio clinico de patologia en pacientes con SUDEP, el edema pulmonar aparecio en la mayoria de los casos.
Asunto(s)
Epilepsia/complicaciones , Edema Pulmonar/etiología , Convulsiones/complicaciones , Adolescente , Adulto , Anciano , Permeabilidad Capilar , Preescolar , Terapia Combinada , Epilepsia/clasificación , Epilepsia/fisiopatología , Epilepsia Tónico-Clónica/complicaciones , Epilepsia Tónico-Clónica/fisiopatología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pronóstico , Circulación Pulmonar , Edema Pulmonar/diagnóstico , Edema Pulmonar/epidemiología , Edema Pulmonar/fisiopatología , Convulsiones/fisiopatología , Muerte Súbita e Inesperada en la Epilepsia/patología , Vasoconstricción , Adulto JovenRESUMEN
La infección por Virus de Inmunodeficiencia Humana y el Síndrome de Inmunodeficiencia Adquirida en fase avanzada de la infección, propician condiciones de vulnerabilidad para las infecciones oportunistas. Caso Clínico: Paciente femenina de 21 años, sin antecedentes conocidos, se presentó a emergencia con historia de convulsión tónico-clónica de dos minutos de duración, acompañada de oculogiros, sin relajación de esfínteres; pérdida ponderal de ocho meses de evolución, acompañada de astenia, adinamia, hiporexia y tos seca. En el examen físico de tórax: a la inspección de piel se observó costra serohematica impetiginizada en hemitórax izquierdo, sin cruzar la línea media, acompañado de dolor y seguía el trayecto dermatomérico; a la auscultación, crépitos escasos en lóbulo medio de pulmón derecho. Durante la evaluación de ingreso presentó dos episodios convulsivos similares. Se practicó radiografía de tórax posteroanterior, se observó masa circular en lóbulo medio de pulmón derecho; hematología demostró falla renal aguda, anemia normocitica-normocromica y sospecha de inmunosupresión. Se diagnosticó Infección por Virus de Inmunodeficiencia Humana/Síndrome Inmunodeficiencia Adquirida mediante serología y conteo de linfocitos CD4, histoplasmosis sistémica, herpes zóster y tuberculosis pulmonar; se instauró tratamiento. Al finalizar terapia y la evolución clínica se decide su egreso, para control ambulatorio. Conclusión: la intervención temprana y la terapia adecuada son esenciales para la evolución y desenlace clínico; la paciente tuvo evolución satisfactoria posterior al inicio de una terapia antifimica profiláctica, se egresó y se dio control en consulta externa de Infectología del Hospital Escuela Universitario...(AU)
Asunto(s)
Humanos , Femenino , Adulto , Síndrome de Inmunodeficiencia Adquirida , Epilepsia Tónico-Clónica/complicaciones , Herpes Zóster , Histoplasma/inmunología , VIHRESUMEN
El Síndrome de Sandifer es un trastorno neuroconductual con movimientos de hiperextensión de cuello, cabeza y tronco, con rotación de cabeza, que generalmente se presentan durante o inmediatamente después de la ingesta de alimentos y cesa durante el sueño, secundario a enfermedad por reflujo gastroesofágico. Se caracteriza por esofagitis, anemia por deficiencia de hierro y son confundidos con frecuencia como crisis de origen epiléptico. Lactante masculino de 5 meses referido por movimientos de tónico-clónicos generalizados, de segundos de duración, con una frecuencia de 30 episodios al día, que no ceden con el uso de 3 anticonvulsivantes. Disfagia a alimentos pastosos. Hospitalización al mes de vida por episodio de amenazante de la vida. Estudios neurológicos normales. Paraclínica: anemia microcítica e hipocrómica. Videodeglutoscopia: Disfagia de fase oral leve, disfagia fase esofágica a estudiar (Regurgitación), reflujo faringolaringeo según escala de Belafsky y Larigomalacia grado I; pHmetría de 24 horas con impedancia, puntación de Boix-Ochoa de 26%, durante la colocación de la sonda se observo posición anómala de la cabeza e hiperextensión del dorso. Estudio contrastado de esófago, estómago y duodeno sin anormalidad anatómica. Endoscopia digestiva superior: Esofagitis no erosiva, Hernia hiatal. El Síndrome de Sandifer es una de las presentaciones atípicas de RGE en lactantes. Amerita la evaluación de un equipo multidisciplinario para establecer el diagnóstico. El manejo medico incluyó medidas antireflujo, esomeprazol y técnica de alimentación adecuada con evolución satisfactoria. La diversidad de enfermedades relacionadas con RGE exige el uso de variadas técnicas para lograr diagnósticos más asertivos
Sandifer's syndrome is a neurobehavioral disorder with hyperextension movements of neck, head and trunk, head rotation, which usually occur during or immediately after food intake and ceases during sleep, secondary to gastroesophageal reflux disease. It is characterized by esophagitis, anemia and iron deficiency are often confused as a crisis of epileptic origin. A male infant of 5 months reported by tonic-clonic movements of widespread, lasting seconds, with a frequency of 30 episodes per day, which do not yield with the use of 3 anticonvulsants. Pasty food dysphagia. Hospitalization month of life-threatening episode of life. Normal neurological studies. Paraclinical: hypochromic microcytic anemia. Videodeglutoscopia: mild oral phase dysphagia, esophageal dysphagia to study phase (regurgitation), pharyngolaryngeal reflux as Belafsky and Larigomalacia scale grade I, ph-metry of 24 hours with impedance, Boix-Ochoa score of 26% during the placement of probe was observed abnormal head position and hyperextension of the back. Contrast study of esophagus, stomach and duodenum without anatomical abnormality. Upper gastrointestinal endoscopy: nonerosive esophagitis, hiatal hernia. Sandifer Syndrome is one of the atypical presentations of GER in infants. Warrants evaluation by a multidisciplinary team to establish the diagnosis. The medical management included antireflux measures, esomeprazole and proper feeding technique with satisfactory outcome. The diversity of diseases associated with GER requires the use of various diagnostic techniques to get more assertive
Asunto(s)
Lactante , Epilepsia Tónico-Clónica/complicaciones , Epilepsia Tónico-Clónica/diagnóstico , Epilepsia Tónico-Clónica/patología , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/patología , Trastornos de Deglución , Enfermedades Gastrointestinales , PediatríaRESUMEN
The acute neurogenic pulmonary edema (NPE) is a kind of pulmonary edema that occurs as a result of a variety of injuries of the central nervous system. Usually it is underdiagnosed. It has been reported in many diseases and direct injuries of the central nervous system. We present the clinical case of a middle age women with a neurogenic pulmonary edema secondary to a epileptic seizure. We made a review of the literature with special emphasis on clinical implications and treatment.
El edema pulmonar agudo neurogénico (EPN) es un tipo de edema pulmonar que ocurre como consecuencia de una variada gama de lesiones del sistema nervioso central. Generalmente es subdiagnosticado. Se ha reportado en múltiples patologías y lesiones directas del sistema nervioso central. Presentamos el caso clínico de una mujer de mediana edad, con edema pulmonar agudo secundario a una crisis convulsiva epiléptica. Se realiza una revisión de la literatura con especial énfasis en las implicancias clínicas y tratamiento.
Asunto(s)
Humanos , Femenino , Adulto , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiología , Edema Pulmonar/terapia , Epilepsia Tónico-Clónica/complicaciones , Enfermedades del Sistema Nervioso Central/complicacionesRESUMEN
The authors report two cases of Brazilian children with most of the common syndromic features of Proteus syndrome, such as asymmetric overgrowth of tissues, skin abnormalities, hypotonia and mental retardation. In both patients, a refractory epilepsy, compatible with Ohtahara syndrome, as well as hemimegalencephaly, with asymmetric distribution of facial fat, were also diagnosed.
Asunto(s)
Epilepsia Tónico-Clónica/complicaciones , Malformaciones del Desarrollo Cortical/complicaciones , Malformaciones del Sistema Nervioso/complicaciones , Síndrome de Proteo/complicaciones , Anticonvulsivantes/uso terapéutico , Electroencefalografía , Epilepsia Tónico-Clónica/patología , Femenino , Fondo de Ojo , Humanos , Lactante , Recién Nacido , Imagen por Resonancia Magnética , Malformaciones del Desarrollo Cortical/patología , Malformaciones del Sistema Nervioso/patología , Pronóstico , Síndrome de Proteo/patología , Convulsiones/tratamiento farmacológico , Convulsiones/etiología , SíndromeRESUMEN
Neurogenic pulmonary edema (NPE) is an underdiagnosed clinical entity. Its pathophysiology is multifactorial but largely unknown. We report two cases of NPE and review the literature on NPE cases reported since 1990. A 21-year-old man had a seizure episode following cranioplasty. He became increasingly dyspneic, and clinical and laboratory signs of respiratory failure were evident. Chest radiography and computed tomography showed bilateral diffuse infiltrates. After supportive measures were taken, complete respiratory recovery occurred in 72 hours. A 52-year-old woman had several seizure episodes following subarachnoid hemorrhage due to a cavernoma. She became increasingly dyspneic upon arrival at the hospital. After tracheostomy and oxygen support were established, chest radiography showed bilateral diffuse infiltrates. Respiratory recovery was excellent, and the patient was eupneic with normal results of chest radiography 48 hours later. Fourteen reports (21 cases) were found. Thirteen patients were female, and the mean age of the patients was 31.6 years. The most frequent underlying factor was subarachnoid hemorrhage (42.9%). Symptom onset occurred <4 hours after the neurologic event in 71.4% of cases. One third of the patients presented with pink frothy sputum. Chest radiography showed bilateral diffuse infiltrates in 90.5% of cases. Supportive measures included oxygen support and vasoactive drugs. Recovery was usually very rapid: 52.4% of patients recovered in <72 hours. Almost 10% of patients died of NPE. Our two cases had clinical and laboratory features in common with most NPE cases. Physicians should remember NPE when neurologic patients suddenly become dyspneic. The mortality rate is high, but surviving patients usually recover very quickly.
Asunto(s)
Edema Pulmonar/etiología , Enfermedad Aguda , Adulto , Sistema Nervioso Autónomo/fisiopatología , Traumatismos Craneocerebrales/complicaciones , Cuidados Críticos , Epilepsia Tónico-Clónica/complicaciones , Femenino , Cefalea/diagnóstico por imagen , Cefalea/etiología , Humanos , Masculino , Persona de Mediana Edad , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/terapia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine whether the clinical features of neonatal seizures are of value in predicting outcome. STUDY DESIGN: Demographic features, clinical seizure types, etiologic factors, and laboratory findings of all 77 patients with seizures admitted to our neonatal intensive care unit over a consecutive 7-year period were extracted from the medical records. RESULTS: Twenty-three (30%) died; 59% of the survivors had abnormal neurologic examinations, 40% were mentally retarded, 43% had cerebral palsy, and 21% were epileptic at mean follow-up of 3.5 years. Compared with patients with other seizure types, those with subtle and generalized tonic seizures had a significantly higher prevalence of epilepsy (P =.04 and P =.01 respectively); mental retardation (P =.02; P =.007), and cerebral palsy (P =.03; P =.002). Subtle seizures were, in addition, more likely to be associated with abnormalities on the neurologic examination at follow-up (P =.03). Similar outcome comparisons for those with focal and multifocal clonic, focal tonic, and multifocal myoclonic seizures revealed no significant differences. However, patients with >or=2 seizure types were significantly more likely to have epilepsy (P =.02), mental retardation (P =.001), cerebral palsy (P =.001), and abnormal examinations (P =.05). CONCLUSIONS: Clinical semiology is predictive of outcome in neonates with seizures and suggests the presence of unique pathophysiologic processes for different seizure types.
Asunto(s)
Convulsiones/complicaciones , Parálisis Cerebral/complicaciones , Epilepsia Tónico-Clónica/complicaciones , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro , Discapacidad Intelectual/complicaciones , Masculino , Examen Neurológico , Estudios Retrospectivos , Convulsiones/etiología , Convulsiones/fisiopatologíaRESUMEN
Os autores descrevem um caso de associaçäo entre crise convulsiva tipo grande mal e edema pulmonar. Trata-se de uma paciente de 40 anos, portadora de crises convulsivas há quatro anos e meio, geralmente seguidas da apresentaçäo de escarro hemóptico. Deu entrada no Pronto Socorro por ter apresentado, há uma hora, crise convulsiva tipo grande mal, com duraçäo referida de poucos minutos, e que em seguida começou a apresentar escarro hemóptico. O exame físico estava normal, com exceçäo da presença de estertores subcrepitantes pulmonares bilaterais. O radiograma de tórax, realizado na entrada, revelou imagem compatível com edema pulmonar e estava normal 24 horas após, sem uso de qualquer medicaçäo. É feita também uma revisäo sumária da literatura