RESUMEN
Introduction: Treatment options for hydrocephalus related to posterior fossa tumors have been extensively studied in the pediatric population, but the value of endoscopic third ventriculostomy in hydrocephalus secondary to vestibular schwannoma in adults, is controversial. A systematic search of the medical literature was carried out in Pubmed/Medline and SciElo for the identification and inclusion of articles, in addition to the preprint servers bioRxiv and medRxiv. The following descriptors were used: hydrocephalus and vestibular schwannomas or acoustic neuromas or acoustic neurinomas and endoscopic third ventriculostomy. The initial search found 195 articles. After selection, 5 articles were chosen for the study. Objective: To specify the role of the endoscopic third ventriculostomy in hydrocephalus secondary to vestibular schwannomas. Development: The articles included a total of 82 patients, in which an improvement of the symptoms was achieved in 86.6 percent of the cases. The decrease in ventricular diameter was reported in 82.9 percent of the cases and was only found explicit in 3 articles. Although the failure criteria used were varied, 2 of them predominated: the persistence of progressive symptomatic hydrocephalus and/or the need for shunt placement. Endoscopic third ventriculostomy failure only represented 14.6 percent. Conclusions: Third ventriculostomy is an acceptable technique with relative success for the treatment of symptomatic obstructive hydrocephalus secondary to vestibular schwannomas(AU)
Introducción: Las opciones de tratamiento para la hidrocefalia relacionada con tumores de fosa posterior han sido ampliamente estudiadas en la población pediátrica, pero es controvertido el valor de la tercer ventriculostomía endoscópica, en la hidrocefalia secundaria a schwanoma vestibular en adultos, previo a la resección del tumor. Se realizó una búsqueda sistemática de la literatura médica en Pubmed/Medline y SciElo para la identificación e inclusión de artículos, además de los servidores de preprint bioRxiv y medRxiv. Se utilizaron los siguientes descriptores: hydrocephalus y vestibular schwannomas o acoustic neuromas o acoustic neurinomas y endoscopic third ventriculostomy. La búsqueda inicial encontró 195 artículos. Después de la selección, se eligieron 5 artículos para el estudio. Objetivo: Especificar el papel de la tercer ventriculostomía endoscópica en la hidrocefalia secundaria a schwanomas vestibulares. Desarrollo: Los artículos incluyeron un total de 82 pacientes, en los que se logró una mejoría de los síntomas en el 86,6 por ciento de los casos. La disminución del diámetro ventricular se reportó en el 82,9 por ciento de los casos y solo se encontró explícita en 3 artículos. Aunque los criterios de fracaso utilizados fueron variados, predominaron dos de ellos: la persistencia de hidrocefalia sintomática progresiva o la necesidad de colocación de derivación. La falla de la tercer ventriculostomía endoscópica solo representó el 14,6 por ciento. Conclusiones: La tercera ventriculostomía endoscópica es una técnica aceptable y con relativo éxito para el tratamiento de la hidrocefalia obstructiva sintomática secundaria a schwanomas vestibulares(AU)
Asunto(s)
Humanos , Ventriculostomía/métodos , Neuroma Acústico , Hidrocefalia/tratamiento farmacológicoRESUMEN
BACKGROUND: The knowledge of central nervous system (CNS) histoplasmosis is limited to case reports and series. OBJECTIVES: Our objective was to synthesise clinical, radiological and laboratory characteristics of CNS histoplasmosis to improve our understanding of this rare disease. METHODS: We performed a systematic review using Pubmed/MEDLINE, Embase and LILACS databases accessed on March 2023 without publication date restrictions. Inclusion criteria comprised: (1) histopathological, microbiological, antigen or serological evidence of histoplasmosis; (2) CNS involvement based on cerebrospinal fluid pleocytosis or neuroimaging abnormalities. We classified the certainty of the diagnosis in proven (CNS microbiological and histopathological confirmation), probable (CNS serological and antigen confirmation) or possible (non-CNS evidence of histoplasmosis). Metaproportion was used to provide a summary measure with 95% confidence intervals for the clinical, radiological and laboratory characteristics. Chi-squared test was used to compare mortality between pairs of antifungal drugs. RESULTS: We included 108 studies with 298 patients. The median age was 31 years, predominantly male, and only 23% were immunocompromised (134/276, 95%CI: 3-71), mainly due to HIV infection. The most common CNS symptom was headache (130/236, 55%, 95%CI: 49-61), with a duration predominantly of weeks or months. Radiological presentation included histoplasmoma (79/185, 34%, 95%CI: 14-61), meningitis (29/185, 14%, 95%CI: 7-25), hydrocephalus (41/185, 37%, 95%CI: 7-83) and vasculitis (18/185, 6%, 95%CI: 1-22). There were 124 proven cases, 112 probable cases and 40 possible cases. The majority of patients presented positive results in CNS pathology (90%), serology (CSF: 72%; serum: 70%) or CSF antigen (74%). Mortality was high (28%, 56/198), but lower in patients who used liposomal amphotericin B and itraconazole. Relapse occurred in 13% (23/179), particularly in HIV patients, but less frequently in patients who used itraconazole. CONCLUSION: Central nervous system histoplasmosis usually presents subacute-to-chronic symptoms in young adults. Neuroimaging patterns included not only focal lesions but also hydrocephalus, meningitis and vasculitis. Positive results were commonly found in CSF antigen and serology. Mortality was high, and treatment with liposomal amphotericin B followed by itraconazole may decrease mortality.
Asunto(s)
Infecciones por VIH , Histoplasmosis , Hidrocefalia , Meningitis , Vasculitis , Adulto Joven , Humanos , Masculino , Adulto , Femenino , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Itraconazol/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Antifúngicos/uso terapéutico , Sistema Nervioso Central , Meningitis/diagnóstico , Hidrocefalia/inducido químicamente , Hidrocefalia/tratamiento farmacológico , Vasculitis/inducido químicamente , Vasculitis/tratamiento farmacológicoRESUMEN
According to experimental studies with healthy dogs, omeprazole might decrease the CSF production by about 26%; therefore, book texts have been suggested the usage of omeprazole in medical protocols for hydrocephalus treatment. However, to the best knowledge of the authors, the usage and medical response of the omeprazole with substantial group of illness dogs, such as hydrocephalic animals, was lacking. This report describes clinical, diagnostic, and therapeutic findings in 12 dogs with hydrocephalus in which omeprazole were used for medical treatment. The diagnosis of hydrocephalus was accomplished by transcranial sonography (TCS) and/or computed tomography. The ventricular measurement was assessed periodically by TCS during medical treatment. Six dogs were diagnosed with non-obstrutive hydrocephalus and in the other 6 cases hydrocephalus occurred with other concomitant anomalous encephalic disease often related with obstructive hysdrocephalus, such as quadrigeminal cist, arachnoid cyst, chiary-like malformation, and syringomyelia. All of them had medical improvement after the use of omeprazole and the most of the cases had ventricular size reduction. In 10 dogs, the omeprazole was used as single drug, and in 2 dogs medical treatment with steroids and/or diuretics was previously being performed, and omeprazole was added because conventional treatment was resulting in mild to unsatisfactory medical control of the neurological status. The results of this paper shown that omeprazole may be used to ameliorate the neurological status in symptomatic hydrocephalic dogs. This work may represent the first description about the use of omeprazole in order to treat a substantial group of affected dogs with suspected increased intracranial pressure by hydrocephalus, probably due to limitation of CSF production.(AU)
O omeprazol diminui a produção do fluido cerebrospinal (FCE) por cerca de 26% de acordo com estudos experimentais em cães saudáveis. Segundo o conhecimento dos autores, embora utilizado na prática clínica e recomendado em livros textos, não há até o momento estudos clínicos em um grupo substancial de animais avaliando a resposta terapêutica ao uso do omeprazol em pacientes enfermos, tais como cães hidrocefálicos sintomáticos. Este trabalho descreve os achados clínicos, diagnósticos e terapêuticos em 12 cães com hidrocefalia que foram submetidos ao tratamento com omeprazol para o manejo médico de hidrocefalia. O diagnóstico de hidrocefalia e doenças neurológicas concomitantes foi realizado por ultrassonografia transcraniana (USTC) e/ou tomografia computadorizada. A mensuração do tamanho ventricular foi realizada pela USTC durante o tratamento médico. Seis cães foram diagnosticados com hidrocefalia não obstrutiva e os outros 6 casos apresentaram hidrofalia concomitante com outras afecções encefálicas anômalas comumente associada à hidrocefalia obstrutiva, tal como cisto quadrigêmio, cisto aracnóide, síndrome de chiari-like e seringomegalia. Em 10 cães o omeprazol foi utilizado como droga única e em 2 cães a terapia inicial foi a convencional utilizando esteroides e diuréticos, e o omeprazol foi adicionado, pois a resposta clínica a terapia convencional foi insatisfatória. Todos os animais obtiveram melhora dos parâmetros neurológicos e a maioria teve uma redução do tamanho ventricular após o uso do omeprazol. Os resultados deste estudo demonstram que o omeprazol pode ser utilizado para melhorar o estado neurológico em cães com hidrocefalia. Este estudo representa a primeira descrição clínica usando o omeprazol para tratar uma série de cães com suspeita de aumento da pressão intracraniana devido à hidrocefalia, provavelmente pela capacidade do fármaco em limitar a produção do FCE.(AU)
Asunto(s)
Animales , Perros , Omeprazol/uso terapéutico , Hidrocefalia/tratamiento farmacológico , Hidrocefalia/veterinaria , Presión Intracraneal , Hidrocefalia/diagnóstico por imagenRESUMEN
According to experimental studies with healthy dogs, omeprazole might decrease the CSF production by about 26%; therefore, book texts have been suggested the usage of omeprazole in medical protocols for hydrocephalus treatment. However, to the best knowledge of the authors, the usage and medical response of the omeprazole with substantial group of illness dogs, such as hydrocephalic animals, was lacking. This report describes clinical, diagnostic, and therapeutic findings in 12 dogs with hydrocephalus in which omeprazole were used for medical treatment. The diagnosis of hydrocephalus was accomplished by transcranial sonography (TCS) and/or computed tomography. The ventricular measurement was assessed periodically by TCS during medical treatment. Six dogs were diagnosed with non-obstrutive hydrocephalus and in the other 6 cases hydrocephalus occurred with other concomitant anomalous encephalic disease often related with obstructive hysdrocephalus, such as quadrigeminal cist, arachnoid cyst, chiary-like malformation, and syringomyelia. All of them had medical improvement after the use of omeprazole and the most of the cases had ventricular size reduction. In 10 dogs, the omeprazole was used as single drug, and in 2 dogs medical treatment with steroids and/or diuretics was previously being performed, and omeprazole was added because conventional treatment was resulting in mild to unsatisfactory medical control of the neurological status. The results of this paper shown that omeprazole may be used to ameliorate the neurological status in symptomatic hydrocephalic dogs. This work may represent the first description about the use of omeprazole in order to treat a substantial group of affected dogs with suspected increased intracranial pressure by hydrocephalus, probably due to limitation of CSF production.(AU)
O omeprazol diminui a produção do fluido cerebrospinal (FCE) por cerca de 26% de acordo com estudos experimentais em cães saudáveis. Segundo o conhecimento dos autores, embora utilizado na prática clínica e recomendado em livros textos, não há até o momento estudos clínicos em um grupo substancial de animais avaliando a resposta terapêutica ao uso do omeprazol em pacientes enfermos, tais como cães hidrocefálicos sintomáticos. Este trabalho descreve os achados clínicos, diagnósticos e terapêuticos em 12 cães com hidrocefalia que foram submetidos ao tratamento com omeprazol para o manejo médico de hidrocefalia. O diagnóstico de hidrocefalia e doenças neurológicas concomitantes foi realizado por ultrassonografia transcraniana (USTC) e/ou tomografia computadorizada. A mensuração do tamanho ventricular foi realizada pela USTC durante o tratamento médico. Seis cães foram diagnosticados com hidrocefalia não obstrutiva e os outros 6 casos apresentaram hidrofalia concomitante com outras afecções encefálicas anômalas comumente associada à hidrocefalia obstrutiva, tal como cisto quadrigêmio, cisto aracnóide, síndrome de chiari-like e seringomegalia. Em 10 cães o omeprazol foi utilizado como droga única e em 2 cães a terapia inicial foi a convencional utilizando esteroides e diuréticos, e o omeprazol foi adicionado, pois a resposta clínica a terapia convencional foi insatisfatória. Todos os animais obtiveram melhora dos parâmetros neurológicos e a maioria teve uma redução do tamanho ventricular após o uso do omeprazol. Os resultados deste estudo demonstram que o omeprazol pode ser utilizado para melhorar o estado neurológico em cães com hidrocefalia. Este estudo representa a primeira descrição clínica usando o omeprazol para tratar uma série de cães com suspeita de aumento da pressão intracraniana devido à hidrocefalia, provavelmente pela capacidade do fármaco em limitar a produção do FCE.(AU)
Asunto(s)
Animales , Perros , Omeprazol/uso terapéutico , Hidrocefalia/tratamiento farmacológico , Hidrocefalia/veterinaria , Presión Intracraneal , Hidrocefalia/diagnóstico por imagenRESUMEN
Hydrocephalus is a major concern in neurocysticercosis (NCC), and its management is more challenging than that of hydrocephalus caused by other etiologies. Even though albendazole is a well-established drug for the treatment of NCC, the death of the parasites may worsen the clinical symptoms and eventually, deteriorate the course of hydrocephalus. The aim of this study was to analyze the effects of treatment with albendazole on the course of hydrocephalus as well as on animal behavior in a ratmodel of NCC-induced hydrocephalus in order to verify whether the course of hydrocephalus and the animal behavior were changed. Ventricle volumes before and after treatment showed a slight but non-statistically significant difference (168.11 mm3 versus 184.98 mm3, p » 0.45). The distribution and location of the cysts were unaffected. In addition, the behavioral patterns before and after the treatment were not significantly different, as assessed by the open field test. On histologic assessment, mononuclear leukocyte infiltration was present in diverse sites, such as the perivascular and peri-ependymal regions, choroid plexus, and meningeal membranes. A positive correlation was found between the degree of ventricle enlargement and tissue damage. Further studies with long-term comparisons are required.
Asunto(s)
Animales , Ratas , Volumen Sistólico/efectos de los fármacos , Albendazol/administración & dosificación , Albendazol/uso terapéutico , Neurocisticercosis/complicaciones , Hidrocefalia/tratamiento farmacológico , Proyectos de Investigación , Ratas Wistar , Estadísticas no ParamétricasRESUMEN
INTRODUCTION: Focal hydrocephalus including trapped temporal horn (TTH), isolated lateral and fourth ventricles, is caused by obstruction and/or adhesion related to various etiologies. With the advent of the neuroendoscope, endoscopic procedures have become an alternative in selected cases. CASE REPORT: A 2-year-old male from a rural town in México was referred to our institution because of multiple supra- and infra-tentorial abscesses and hydrocephalus. The patient had progressive deterioration and developed bilateral trapped temporal horn related to multi-septated hydrocephalus, so we performed an endoscopic ventricular-cistern-ventriculostomy through a single right temporal burr hole. POSTOPERATIVE COURSE: Bilateral TTH and multi-septated hydrocephalus were effectively treated with a single external ventricular drainage (EVD) catheter, from the right temporal horn to the left temporal horn through the interpeduncular cistern; after clamping the EVD for 3 days with no evidence of hydrocephalus, the EVD was removed. The size of the ventricles remained stable afterwards, and no clinical or radiological evidence of hydrocephalus was observed after 3 months of follow-up. DISCUSSION: Endoscopic ventriculocisternostomy is effective in selected cases of TTH. We know that dilatation of the temporal horn widens the window between the anterior choroidal artery and optic tract superiorly, and the posterior communicating and CN III inferiorly, making the described procedure feasible, even in the approach to the contralateral side. Even though this is a rare condition, we believe it is a safe and effective option to eliminate multiple shunts and/or to reduce the number of catheters needed to treat bilateral THH related to multi-septated hydrocephalus.
Asunto(s)
Ventrículos Cerebrales/diagnóstico por imagen , Cisterna Magna/diagnóstico por imagen , Micosis/diagnóstico por imagen , Neuroendoscopía/métodos , Lóbulo Temporal/diagnóstico por imagen , Ventriculostomía/métodos , Antifúngicos/uso terapéutico , Ventrículos Cerebrales/cirugía , Preescolar , Cisterna Magna/efectos de los fármacos , Cisterna Magna/cirugía , Humanos , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/tratamiento farmacológico , Masculino , Micosis/tratamiento farmacológico , Micosis/cirugía , Lóbulo Temporal/cirugía , Resultado del TratamientoAsunto(s)
Hidrocefalia/diagnóstico por imagen , Hidrocefalia/etiología , Síndrome de Leucoencefalopatía Posterior/complicaciones , Síndrome de Leucoencefalopatía Posterior/diagnóstico por imagen , Femenino , Humanos , Hidrocefalia/tratamiento farmacológico , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Inhibidores de Agregación Plaquetaria/uso terapéutico , Síndrome de Leucoencefalopatía Posterior/tratamiento farmacológico , Adulto JovenRESUMEN
UNLABELLED: Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. CONCLUSION: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.
Asunto(s)
Acetamidas/uso terapéutico , Antiinfecciosos/uso terapéutico , Ventrículos Cerebrales/microbiología , Encefalitis/tratamiento farmacológico , Enterococcus faecium/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Oxazolidinonas/uso terapéutico , Resistencia a la Vancomicina , Encefalitis/microbiología , Enterococcus faecium/efectos de los fármacos , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Hidrocefalia/tratamiento farmacológico , Hidrocefalia/microbiología , Lactante , Linezolid , Masculino , Resultado del Tratamiento , Derivación VentriculoperitonealRESUMEN
Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. Conclusion: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.
Asunto(s)
Humanos , Lactante , Masculino , Acetamidas/uso terapéutico , Antiinfecciosos/uso terapéutico , Ventrículos Cerebrales/microbiología , Encefalitis/tratamiento farmacológico , Enterococcus faecium/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Oxazolidinonas/uso terapéutico , Resistencia a la Vancomicina , Encefalitis/microbiología , Enterococcus faecium/efectos de los fármacos , Infecciones por Bacterias Grampositivas/microbiología , Hidrocefalia/tratamiento farmacológico , Hidrocefalia/microbiología , Resultado del Tratamiento , Derivación VentriculoperitonealRESUMEN
We describe 3 previously healthy Costa Rican children who had Listeria monocytogenes meningitis, an uncommon cause of bacterial meningitis beyond the newborn period in normal subjects. Two of them had initial normal brain computed tomography, but all 3 developed acute hydrocephalus at days 7, 3, and 5, respectively. All required immediate ventriculostomy placement and only 1 of 3 survived. L. monocytogenes should be considered among the etiologies of bacterial meningitis in children who do not respond initially to conventional antimicrobial treatment or who deteriorate rapidly.
Asunto(s)
Hidrocefalia/etiología , Meningitis por Listeria/complicaciones , Enfermedad Aguda , Amicacina/uso terapéutico , Cefotaxima/uso terapéutico , Niño , Preescolar , Terapia Combinada , Costa Rica , Dexametasona/uso terapéutico , Resistencia a Medicamentos , Quimioterapia Combinada/uso terapéutico , Urgencias Médicas , Resultado Fatal , Femenino , Humanos , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/tratamiento farmacológico , Hidrocefalia/cirugía , Masculino , Meningitis por Listeria/tratamiento farmacológico , Meropenem , Rifampin/uso terapéutico , Tienamicinas/uso terapéutico , Tomografía Computarizada por Rayos X , Vancomicina/uso terapéutico , VentriculostomíaRESUMEN
In a prospective open study, 15 patients with hydrocephalus secondary to cysticercosis who required insertion of a ventriculoperitoneal (VP) shunt were treated with 50 mg of prednisone given orally three times a week. Treatment began in the 1st postoperative week, with isoniazid and pyridoxine administered daily as antituberculous chemoprophylaxis. The drug regimen was continued with close follow up for 24 months. Clinical status, Karnofsky performance status (KPS) scores, and postoperative course in the prednisone-treated group were compared with 30 control patients with hydrocephalus due to cysticercosis. The control patients were matched by age and sex, underwent surgical shunting in the same period, and were followed routinely by the neurosurgery staff. Lumbar cerebrospinal fluid (CSF) was studied in 2, 16, and 32 weeks postoperatively in the prednisone group. At 24-month follow up two (13%) of 15 patients in the prednisone group and 19 (60%) of 30 patients in the control group required surgical shunt revisions for symptomatic shunt obstruction (p=0.002). Follow-up studies of CSF performed at 32 weeks in the prednisone group revealed improvement of abnormal values with statistically significant differences for glucose (p<0.02). Serial imaging studies in the prednisone group revealed persistence of cysticercal cysts with no change in size. Mean initial KPS scores were similar in both groups. At the end of the follow-up period, the mean KPS score was significantly higher in the prednisone group (p=0.003). Prednisone and chemoprophylactic drugs were well tolerated. These results suggest that in selected patients with hydrocephalus secondary to cysticercosis, intermittent long-term prednisone therapy after VP shunting may reduce shunt malfunction and improve the functional status of the patients.
Asunto(s)
Cisticercosis/tratamiento farmacológico , Hidrocefalia/tratamiento farmacológico , Prednisona/uso terapéutico , Derivación Ventriculoperitoneal , Adolescente , Adulto , Anciano , Cisticercosis/complicaciones , Femenino , Humanos , Hidrocefalia/complicaciones , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
A cortisol curve was practiced on 32 healthy persons with an average age of 38.7 years, being the morning amount at 8 o'clock of 10 mg/100 ml o higher. Later we practiced the same study in 42 patients with an average age of 41.4 years, that were under a corticosteroid therapy higher than 10 mg per day of prednisone during more than three months of an uninterrupted prescription and said treatment was stopped 48 previous hours to the study. We found that 27 of them (64.2%) had lowe morning amount of cortisol to those of the control group, and the patients with rheumatoid arthritis being the lowest. It is concluded that the type of systemic disease could be another factor in the suppression of the axis H-H-A of patients under a higher dosis than 10 mg of prednisone and a durability longer than three continuous months.
Asunto(s)
Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisario/efectos de los fármacos , Sistema Hipófiso-Suprarrenal/efectos de los fármacos , Prednisona/farmacología , Hormona Adrenocorticotrópica , Adulto , Enfermedades Autoinmunes/sangre , Enfermedades Autoinmunes/tratamiento farmacológico , Ritmo Circadiano , Depresión Química , Femenino , Humanos , Hidrocefalia/sangre , Hidrocefalia/tratamiento farmacológico , Hidrocortisona/sangre , Sistema Hipotálamo-Hipofisario/metabolismo , Masculino , Sistema Hipófiso-Suprarrenal/metabolismo , Prednisona/administración & dosificación , Prednisona/efectos adversos , Prednisona/uso terapéutico , Trastornos Respiratorios/sangre , Trastornos Respiratorios/tratamiento farmacológicoRESUMEN
El presente caso describe un caso de histoplasmosis del sistema nervioso central con hidrocefalia obstructiva, que ha estado presente durante 8 años sin mayores secuelas o evidencias clínicas de infección activa en otros órganos, en un huésped inmunocompatible. La punción lumbar y el análisis del líquido cefalorraquídeo (LCR) revelaron un elevado nivel de proteínas, linfocitosis e hipoglucorraquia. Los títulos de fijación de complementos séricos y del LCR para histoplasma fueron positivos. La tomografía computada (TC) demostró que existía hidrocefalia y dos lesiones periventriculares con un marcado refuerzo con contraste. Se inició el tratamiento con altas dosis de ketoconazol y a continuación se administró fluconazol con una mejoría parcial del estado clínico y los valores de LCR. Finalmente se le practicó al paciente un tratamiento con anfotericina mostrando una completa remisión clínica, pero sin curación con valores variables en los controles de seguimiento a largo plazo de los títulos de complemento sérico y del LCR. En la actualidad, el paciente permanece asintomático y está tratado con itraconazol oral
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hidrocefalia/etiología , Histoplasmosis/complicaciones , Lesión Encefálica Crónica/etiología , Enfermedad Crónica , Meninges/patología , Hidrocefalia/diagnóstico , Hidrocefalia/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Manifestaciones Neurológicas , Fluconazol/uso terapéutico , Cetoconazol/uso terapéutico , Anfotericina B/uso terapéutico , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológicoRESUMEN
El presente caso describe un caso de histoplasmosis del sistema nervioso central con hidrocefalia obstructiva, que ha estado presente durante 8 años sin mayores secuelas o evidencias clínicas de infección activa en otros órganos, en un huésped inmunocompatible. La punción lumbar y el análisis del líquido cefalorraquídeo (LCR) revelaron un elevado nivel de proteínas, linfocitosis e hipoglucorraquia. Los títulos de fijación de complementos séricos y del LCR para histoplasma fueron positivos. La tomografía computada (TC) demostró que existía hidrocefalia y dos lesiones periventriculares con un marcado refuerzo con contraste. Se inició el tratamiento con altas dosis de ketoconazol y a continuación se administró fluconazol con una mejoría parcial del estado clínico y los valores de LCR. Finalmente se le practicó al paciente un tratamiento con anfotericina mostrando una completa remisión clínica, pero sin curación con valores variables en los controles de seguimiento a largo plazo de los títulos de complemento sérico y del LCR. En la actualidad, el paciente permanece asintomático y está tratado con itraconazol oral
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Histoplasmosis/complicaciones , Meninges/patología , Enfermedad Crónica , Hidrocefalia/etiología , Lesión Encefálica Crónica/etiología , Fluconazol/uso terapéutico , Anfotericina B/uso terapéutico , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Cetoconazol/uso terapéutico , Hidrocefalia/diagnóstico , Hidrocefalia/tratamiento farmacológico , Manifestaciones Neurológicas , Tomografía Computarizada por Rayos XRESUMEN
Despite its effectiveness, cerebrospinal shunting for hydrocephalus continues to be accompanied by considerable complications and morbidity. Medical therapy with acetazolamide 100 mg/kg/day and furosemide 1 mg/kg/day can be an effective alternative to shunting by halting progression of hydrocephalus until such time as sutures can become fibrosed and spontaneous arrest can occur. In an appropriately selected population older than 2 weeks with hydrocephalus of varied origin, our success rate in avoiding shunting is greater than 50%. The dramatic difference between the number of hospitalizations of patients with shunts and those treated medically, and the potential to avoid shunt dependence would appear to make an initial trial with medical therapy worthwhile.
Asunto(s)
Acetazolamida/administración & dosificación , Furosemida/administración & dosificación , Hidrocefalia/tratamiento farmacológico , Acetazolamida/efectos adversos , Desequilibrio Ácido-Base/inducido químicamente , Factores de Edad , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Quimioterapia Combinada , Estudios de Seguimiento , Furosemida/efectos adversos , Humanos , Hidrocefalia/etiología , Hidrocefalia/cirugía , Lactante , Recién Nacido , Tiempo de InternaciónRESUMEN
Increased intracranial pressure was found in 36 of 49 children with tuberculous meningitis. Four patients who presented with acute onset died early. Eight patients with obstructive hydrocephalus were treated surgically. In the 24 patients who had communicating hydrocephalus and were treated with acetazolamide and repeated lumbar punctures, treatment was successful in all but two, in whom shunt surgery was needed.