RESUMEN
OBJECTIVES: This study aims to describe resting state networks (RSN) in patients with disorders of consciousness (DOC)s after acute severe traumatic brain injury (TBI). METHODS: Adult patients with TBI with a GCS score <8 who remained in a coma, minimally conscious state (MCS), or unresponsive wakefulness syndrome (UWS), between 2017 and 2020 were included. Blood-oxygen-level dependent imaging was performed to compare their RSN with 10 healthy volunteers. RESULTS: Of a total of 293 patients evaluated, only 13 patients were included according to inclusion criteria: 7 in coma (54%), 2 in MCS (15%), and 4 (31%) had an UWS. RSN analysis showed that the default mode network (DMN) was present and symmetric in 6 patients (46%), absent in 1 (8%), and asymmetric in 6 (46%). The executive control network (ECN) was present in all patients but was asymmetric in 3 (23%). The right ECN was absent in 2 patients (15%) and the left ECN in 1 (7%). The medial visual network was present in 11 (85%) patients. Finally, the cerebellar network was symmetric in 8 patients (62%), asymmetric in 1 (8%), and absent in 4 (30%). CONCLUSIONS: A substantial impairment in activation of RSN is demonstrated in patients with DOC after severe TBI in comparison with healthy subjects. Three patterns of activation were found: normal/complete activation, 2) asymmetric activation or partially absent, and 3) absent activation.
Asunto(s)
Lesiones Traumáticas del Encéfalo , Trastornos de la Conciencia , Humanos , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/fisiopatología , Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Masculino , Femenino , Adulto , Persona de Mediana Edad , Trastornos de la Conciencia/fisiopatología , Trastornos de la Conciencia/etiología , Trastornos de la Conciencia/diagnóstico por imagen , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/fisiopatología , Imagen por Resonancia Magnética , Anciano , Adulto Joven , Descanso/fisiología , Estado Vegetativo Persistente/fisiopatología , Estado Vegetativo Persistente/diagnóstico por imagen , Estado Vegetativo Persistente/etiologíaAsunto(s)
Trastornos de la Conciencia , Insuficiencia Multiorgánica , Sepsis , Humanos , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/diagnóstico , Sepsis/complicaciones , Niño , Trastornos de la Conciencia/etiología , Unidades de Cuidado Intensivo Pediátrico , Enfermedad AgudaRESUMEN
At least one in three women experience intimate partner violence (IPV) in their lifetime. The most commonly sustained IPV-related brain injuries include strangulation-related alterations in consciousness (S-AICs) and traumatic brain injuries (TBIs). Moreover, survivors of IPV-related S-AICs and/or TBIs often demonstrate psychological distress such as depression, anxiety, and post-traumatic stress. However, the co-occurrence of S-AICs and TBIs, and whether such TBIs may be moderate to severe, has not been systematically examined, and most data have been collected from women in North America. The purpose of this study was to examine the co-occurrence of IPV-related S-AICs and TBIs across a range of geographical locations and to determine the extent to which these S-AICs are related to psychological distress. Women who had experienced physical IPV (n = 213) were included in this secondary analysis of retrospectively collected data across four countries (Canada, the United States, Spain, and Colombia). The Brain Injury Severity Assessment (BISA) was used to assess IPV-related BI across all sites. Because various questionnaires were employed to assess levels of depression, anxiety, and post-traumatic stress disorder at each site, we created a standardized composite score by converting raw scores into Z-scores for analysis. Mann-Whitney U tests and chi-square tests were conducted to examine differences between women with and without experience of S-AICs and to discover if there was a relationship between the occurrence of S-AICs and TBIs. Analysis of variance and analysis of covariance (to control for the potential confounding effects of age, education, and non IPV-related TBI) were used to compare levels of psychological distress in women who had or had not experienced S-AICs. Approximately, 67% of women sustained at least one IPV-related BI (i.e., TBI and/or S-AIC). In a subsample of women who sustained at least one IPV-related BI, approximately 37% sustained both S-AICs and TBIs, 2% sustained only S-AICs (with no TBIs), and 61% sustained TBIs exclusively (with no S-AICs). Furthermore, women who had sustained S-AICs (with or without a TBI) were more likely to have experienced a moderate-to-severe BI than those who had not sustained an S-AIC (BISA severity subscale: U = 3939, p = 0.006). In addition, women who experienced S-AICs (with or without a TBI) reported higher levels of psychological distress compared with women who never experienced S-AICs, irrespective of whether they occurred once or multiple times. These data underscore the importance of assessing for S-AIC in women who have experienced IPV and when present, to also assess for TBIs and the presence of psychological distress. Unfortunately, there were methodological differences across sites precluding cross-site comparisons. Nonetheless, data were collected across four culturally and geographically diverse countries and, therefore, highlight IPV-related BIs as a global issue that needs to be aggressively studied with policies established and then implemented to address findings.
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Lesiones Traumáticas del Encéfalo , Violencia de Pareja , Distrés Psicológico , Humanos , Femenino , Adulto , Lesiones Traumáticas del Encéfalo/psicología , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/epidemiología , Violencia de Pareja/psicología , Persona de Mediana Edad , Estados Unidos/epidemiología , Colombia/epidemiología , Canadá/epidemiología , España/epidemiología , Trastornos de la Conciencia/epidemiología , Trastornos de la Conciencia/etiología , Trastornos de la Conciencia/psicología , Estudios Retrospectivos , Adulto JovenRESUMEN
To determine the role of early acquisition of blood oxygen level-dependent (BOLD) signals and diffusion tensor imaging (DTI) for analysis of the connectivity of the ascending arousal network (AAN) in predicting neurological outcomes after acute traumatic brain injury (TBI), cardiopulmonary arrest (CPA), or stroke. A prospective analysis of 50 comatose patients was performed during their ICU stay. Image processing was conducted to assess structural and functional connectivity of the AAN. Outcomes were evaluated after 3 and 6 months. Nineteen patients (38%) had stroke, 18 (36%) CPA, and 13 (26%) TBI. Twenty-three patients were comatose (44%), 11 were in a minimally conscious state (20%), and 16 had unresponsive wakefulness syndrome (32%). Univariate analysis demonstrated that measurements of diffusivity, functional connectivity, and numbers of fibers in the gray matter, white matter, whole brain, midbrain reticular formation, and pontis oralis nucleus may serve as predictive biomarkers of outcome depending on the diagnosis. Multivariate analysis demonstrated a correlation of the predicted value and the real outcome for each separate diagnosis and for all the etiologies together. Findings suggest that the above imaging biomarkers may have a predictive role for the outcome of comatose patients after acute TBI, CPA, or stroke.
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Trastornos de la Conciencia , Vías Nerviosas , Adulto , Anciano , Nivel de Alerta , Biomarcadores , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Lesiones Encefálicas/fisiopatología , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/diagnóstico , Coma/diagnóstico por imagen , Coma/etiología , Coma/fisiopatología , Estado de Conciencia/fisiología , Trastornos de la Conciencia/diagnóstico por imagen , Trastornos de la Conciencia/etiología , Trastornos de la Conciencia/fisiopatología , Imagen de Difusión Tensora , Femenino , Paro Cardíaco/complicaciones , Paro Cardíaco/diagnóstico , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Vías Nerviosas/diagnóstico por imagen , Vías Nerviosas/fisiopatología , Saturación de Oxígeno , Pronóstico , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnósticoRESUMEN
The children who remain in a prolonged disorder of consciousness (PDOC) present a complex clinical, ethical, and legal challenge to health professionals and other caregivers. PDOC is defined as any disorder of consciousness that has continued for at least 4 weeks following sudden-onset brain injury. The PDOC includes the vegetative state/unresponsive wakefulness syndrome (EV/ UWS), and the minimally conscious state (MCS). Patients with PDOC lack of mental capacity to make decisions regarding their care and treatment, so these decisions have to be made for them based on their best benefits. These benefits may vary from patient to patient, between physicians, family, and the general public, creating conflict within their respective efforts to do what they belie ve is right for the patient. The diagnosis is based on clinical evaluations. These evaluations have an estimated misdiagnosis rate up to 45%, therefore they should be complemented with standardized clinical guidelines, and often with neuroimaging and neurophysiological studies. Other aspects that difficult the evaluation are variable definitions and subcategorizations of PDOC, among di fferent groups at the international level. The objective of this review is to present an update of the different types of PDOC, their definition, subcategorization, etiology, prognostic, comprehensive evaluation, and treatment in pediatrics, to contribute to the best clinical practice based on cu rrently available evidence.
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Trastornos de la Conciencia , Lesiones Encefálicas/complicaciones , Niño , Estado de Conciencia , Trastornos de la Conciencia/clasificación , Trastornos de la Conciencia/diagnóstico , Trastornos de la Conciencia/etiología , Trastornos de la Conciencia/terapia , Diagnóstico Diferencial , Errores Diagnósticos/estadística & datos numéricos , Humanos , Neuroimagen/métodos , Estado Vegetativo Persistente/diagnóstico , Pronóstico , Factores de TiempoRESUMEN
Coronaviruses cause respiratory and gastrointestinal disorders in animals and humans. The current SARS-CoV-2, the COVID-19 infectious agent, belongs to a subgroup called betacoronavirus including the SARS-CoV and MERS-CoV responsible for epidemics in 2002 and 2012, respectively. These viruses can also infect the nervous system due to their affinity for the human angiotensin-converting enzyme 2 (ACE2) expressed in neurons and glial cells. Infections with SARS-CoV, MERS-CoV, and now SARS-CoV-2 also produce neurological signs such as acute cerebrovascular disease, impaired consciousness, and muscle injury, as well as dizziness, hypogeusia, hyposmia, hypoxia, neuralgia, and hypoxic encephalopathy. For this reason, close attention should be paid to the neurological manifestations of COVID-19 patients.
Los coronavirus son una familia de virus que se caracterizan por producir afectaciones respiratorias y gastrointestinales en animales y en seres humanos. El actual SARS-CoV-2, agente infeccioso de la COVID-19, pertenece a un subgrupo denominado betacoronavirus del que hacen parte el SARS-CoV y MERS-CoV, virus responsables de epidemias en el 2002 y el 2012, respectivamente. Estos virus también pueden infectar el sistema nervioso debido a su afinidad con la enzima convertidora de angiotensina humana 2 (ACE2), la cual se expresa en neuronas y células gliales. Se ha demostrado que las infecciones con SARS-CoV y MERS-CoV, y ahora también con el SARS-CoV-2, ocasionan condiciones neurológicas como la enfermedad cerebrovascular aguda, la conciencia alterada y las lesiones musculares, así como mareos, hipogeusia, hiposmia, hipoxia, neuralgia y encefalopatía hipóxica. Por ello debe prestarse mucha atención a las manifestaciones neurológicas de los pacientes de COVID-19.
Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/complicaciones , Coronavirus del Síndrome Respiratorio de Oriente Medio/patogenicidad , Enfermedades del Sistema Nervioso/etiología , Neumonía Viral/complicaciones , Síndrome Respiratorio Agudo Grave/complicaciones , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo/patogenicidad , COVID-19 , Líquido Cefalorraquídeo/virología , Trastornos Cerebrovasculares/etiología , Trastornos de la Conciencia/etiología , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Predicción , Humanos , Enfermedades Musculoesqueléticas/etiología , Pandemias , Neumonía Viral/epidemiología , Síndrome de Dificultad Respiratoria/etiología , SARS-CoV-2 , Trastornos de la Sensación/etiología , Síndrome Respiratorio Agudo Grave/epidemiología , Latencia del VirusRESUMEN
Introduction: Traumatic brain injury is a leading worldwide cause of death and disability in young people. Severity classification is based on the Glasgow Coma Scale. However, the neurological worsening in an acute setting does not always correspond to the initial severity suggesting an underestimation of the real magnitude of the injury. Objective: To study the correlation between the initial severity according to the Glasgow Coma Scale and the patient outcome in the context of different clinical and tomography variables. Materials and methods: We analyzed a retrospective cohort of 490 patients with closed traumatic brain injury requiring a stay in the intensive care unit of two third-level hospitals in Barranquilla. The risk was estimated by calculating the OR (95% CI). The significance level was established at an alpha value of 0.05. Results: Forty-one percent of all patients required orotracheal intubation; 51.2% were initially classified with moderate trauma and 6,0% as mild. The delay in the aggressive management of the traumas affected mainly those patients with traumas classified as moderate in whom lethality increased to 100% when there was delay in the detection of the neurological worsening and in the establishment of the aggressive treatment beyond 4 to 8 hours while the lethality in patients who received this treatment within the first hour reduced to <20%. Conclusions: The risk of lethality in traumatic brain injury increases with the delayed detection of neurological worsening in an acute setting, especially when aggressive management is performed after the first hour post-trauma.
Introducción. El trauma craneoencefálico es una de las principales causas de muerte y discapacidad en adultos jóvenes. Su gravedad se define según la escala de coma de Glasgow. Sin embargo, el deterioro neurológico agudo no siempre concuerda con la gravedad inicial indicada por la escala, lo que implica una subestimación de la magnitud real de la lesión. Objetivo. Estudiar la correlación entre la gravedad inicial del trauma craneoencefálico según la escala de coma de Glasgow y la condición final del paciente, en el contexto de diferentes variables clínicas y de los hallazgos de la tomografía. Materiales y métodos. Se analizó una cohorte retrospectiva de 490 pacientes con trauma craneoencefálico cerrado que requirieron atención en la unidad de cuidados intensivos de dos centros de tercer nivel de Barranquilla. La estimación del riesgo se estableció con la razón de momios (odds ratio, OR) y un intervalo de confianza (IC) del 95 %. Se utilizó un alfa de 0,05 como nivel de significación. Resultados. El 41,0 % de los pacientes requirió intubación endotraqueal; el 51,2 % había presentado traumas inicialmente clasificados como moderados y, el 6,0 %, como leves. El retraso en la implementación de un tratamiento agresivo afectó principalmente a aquellos con trauma craneoencefálico moderado, en quienes la letalidad aumentó al 100 % cuando no se detectó a tiempo el deterioro neurológico y, por lo tanto, el tratamiento agresivo se demoró más de 4 a 8 horas. Por el contrario, la letalidad fue de menos de 20 % cuando se brindó el tratamiento agresivo en el curso de la primera hora después del trauma. Conclusiones. El riesgo de letalidad del trauma craneoencefálico aumentó cuando el deterioro neurológico se detectó tardíamente y el tratamiento agresivo se inició después de transcurrida la primera hora a partir del trauma.
Asunto(s)
Lesiones Traumáticas del Encéfalo/complicaciones , Trastornos de la Conciencia/etiología , Adolescente , Adulto , Anciano , Lesiones Traumáticas del Encéfalo/mortalidad , Lesiones Traumáticas del Encéfalo/terapia , Niño , Colombia/epidemiología , Coma/etiología , Terapia Combinada , Intervalos de Confianza , Craniectomía Descompresiva , Femenino , Fundaciones , Escala de Coma de Glasgow , Hospitales Universitarios , Humanos , Soluciones Hipertónicas/uso terapéutico , Hipnóticos y Sedantes/uso terapéutico , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Hemorragia Subaracnoidea Traumática/complicaciones , Hemorragia Subaracnoidea Traumática/mortalidad , Hemorragia Subaracnoidea Traumática/terapia , Adulto JovenRESUMEN
Resumen: Mujer de 71 años, institucionalizada con antecedentes de esquizofrenia y tabaquismo. Consulta en el servicio de urgencias tras ser encontrada a la intemperie comprometida de conciencia. Al llegar la ambulancia se constata mal perfundida, bradipsíquica y bradicárdica, siendo trasladada al servicio de Urgencia. A su ingreso el ECG mostró bradicardia sinusal con trastorno de la conducción intraventricular y prolongación del intervalo QT. Los exámenes de laboratorio al ingreso resultaron dentro de límites normales. La historia clínica y los trazados electrocardiográficos son presentados, siendo discutidos junto al manejo médico.
Abstracts: A 71year old woman, institutionalized with a history of schizophrenia and smoking. She was transported to a local emergency room after being found laying outside unconscious. She was hypoperfused, bradypsychic and bradycardic, being transferred to the emergency service. On admission, the ECG showed sinus bradycardia with intraventricular conduction delay and QT prolongation. Laboratory tests were normal. Clinical history, physical examination and ECG tracings are presented and management is discussed.
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Humanos , Femenino , Anciano , Bradicardia/fisiopatología , Trastornos de la Conciencia/etiología , Hipotermia/complicaciones , Bradicardia/diagnóstico , Bradicardia/etiología , Electrocardiografía , Hipotermia/fisiopatologíaRESUMEN
Resumen Introducción: El Episodio Hipotonía-Hiporreactividad (EHH) es un efecto adverso tras la vacuna ción, asociado principalmente a vacunas anti-pertussis de células enteras. Se caracteriza por un inicio súbito de flacidez muscular, reducida respuesta a estímulos y palidez cutánea o cianosis. Aunque el EHH es infrecuente, está considerado como un efecto adverso severo. Objetivo: Reportar un caso de EHH posterior a la administración de la vacuna combinada pentavalente con: difteria, tétanos, pertussis celular, hepatitis B y Haemophilus influenzae tipo b (DTwP-HB-Hib), que está incluida en el Programa Nacional de Inmunizaciones (PNI) de Chile, con la finalidad de difundir esta infrecuente complicación de evolución benigna, auto-limitada y de carácter no recurrente. Caso clínico: Lactante de 6 meses de edad, 3 h post-vacunación con la tercera dosis de vacuna DTwP-HB-Hib, presentó compromiso del estado de conciencia interpretado como convulsión atónica y que finalmente se consideró como EHH. El lactante evolucionó favorablemente después de 2 h y fue dado de alta tras 24 h de vigilancia clínica; se cambió el esquema de inmunización del lactante con vacunas anti-per tussis acelulares como medida preventiva. Conclusiones: El desconocimiento sobre el EHH puede desalentar la inmunización infantil. Por lo tanto, es importante que el personal médico informe a los padres de los pacientes sobre este evento benigno, autolimitado y no recurrente. En estos casos, se re comienda continuar con el programa de inmunización del lactante con formulaciones que contengan componentes anti-pertussis acelulares.
Abstract Introduction: Hypotonic-Hyporesponsive Episode (HHE) is an adverse event after vaccination, mainly associated with whole-cell pertussis vaccines. It is characterized by a sudden onset of muscle flaccidity, reduced response to stimuli and pallor or cyanosis. Although the HHE is infrequent, it is considered a severe adverse event. Objective: To report a case of HHE following the administration of the whole-cell pertussis combination vaccine (DTwP-HB-Hib), which is included in National Im munization Program (PNI) of Chile, and to contributing to the knowledge of this adverse event in the country. Case report: A 6-month-old infant, 3 hours post-vaccination with the third dose of DTwP-HB-Hib vaccine, presented a decreased level of consciousness that was interpreted as atonic seizure but finally considered as EHH. The infant progressed favorably after 2 hours of clinical observation and was discharged 24 hours later. Parents were suggested to continue the immunization schedule of the infant with acellular pertussis vaccines as a preventive measure. Conclusions: The lack of knowledge about the EHH may discourage childhood immunization. Therefore, it is important for the medical staff to inform parents of the patients about this benign, self-limited and non-recurrent adverse event. In these cases, it is recommended to continue the immunization schedule of the infant with acellular pertussis vaccines.
Asunto(s)
Humanos , Masculino , Lactante , Palidez/etiología , Vacuna contra Difteria, Tétanos y Tos Ferina/efectos adversos , Vacunas contra Hepatitis B/efectos adversos , Vacunas contra Haemophilus/efectos adversos , Trastornos de la Conciencia/etiología , Hipotonía Muscular/etiologíaRESUMEN
INTRODUCTION: Nonconvulsive seizures (NCS) are frequent in hospitalized patients and may further aggravate injury in the already damaged brain, potentially worsening outcomes in encephalopathic patients. Therefore, both early seizure recognition and treatment have been advocated to prevent further neurological damage. OBJECTIVE: Evaluate the main EEG patterns seen in patients with impaired consciousness and address the effect of treatment with antiepileptic drugs (AEDs), continuous intravenous anesthetic drugs (IVADs), or the combination of both, on outcomes. METHODS: This was a single center retrospective cohort study conducted in a private, tertiary care hospital. Consecutive adult patients with altered consciousness submitted to a routine EEG between January 2008 and February 2011 were included in this study. Based on EEG pattern, patients were assigned to one of three groups: Group Interictal Patterns (IP; EEG showing only interictal epileptiform discharges or triphasic waves), Group Rhythmic and Periodic Patterns (RPP; at least one EEG with rhythmic or periodic patterns), and Group Ictal (Ictal; at least one EEG showing ictal pattern). Groups were compared in terms of administered antiepileptic treatment and frequency of unfavorable outcomes (modified Rankin scale ≥3 and in-hospital mortality). RESULTS: Two hundred and six patients (475 EEGs) were included in this analysis. Interictal pattern was observed in 35.4% (73/206) of patients, RPP in 53.4% (110/206) and ictal in 11.2% (23/206) of patients. Treatment with AEDs, IVADs or a combination of both was administered in half of the patients. While all Ictal group patients received treatment (AEDs or IVADs), only 24/73 (32.9%) IP group patients and 55/108 (50.9%) RPP group patients were treated (p<0.001). Hospital length of stay (LOS) and frequency of unfavorable outcomes did not differ among the groups. In-hospital mortality was higher in IVADs treated RPP patients compared to AEDs treated RPP patients [11/19 (57.9%) vs. 11/36 (30.6%) patients, respectively, p = 0.049]. Hospital LOS, in-hospital mortality and frequency of unfavorable outcomes did not differ between Ictal patients treated exclusively with AEDs or IVADs. CONCLUSION: In patients with acute altered consciousness and abnormal routine EEG, antiepileptic treatment did not improve outcomes regardless of the presence of periodic, rhythmic or ictal EEG patterns.
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Trastornos de la Conciencia/diagnóstico , Trastornos de la Conciencia/psicología , Estado de Conciencia , Electroencefalografía , Anciano , Anciano de 80 o más Años , Anticonvulsivantes/uso terapéutico , Lesiones Traumáticas del Encéfalo/complicaciones , Comorbilidad , Estado de Conciencia/efectos de los fármacos , Trastornos de la Conciencia/tratamiento farmacológico , Trastornos de la Conciencia/etiología , Diagnóstico por Imagen , Femenino , Humanos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento , Flujo de TrabajoRESUMEN
INTRODUCTION: Hypotonic-Hyporesponsive Episode (HHE) is an adverse event after vaccination, mainly associated with whole-cell pertussis vaccines. It is characterized by a sudden onset of muscle flaccidity, reduced response to stimuli and pallor or cyanosis. Although the HHE is infrequent, it is considered a severe adverse event. OBJECTIVE: To report a case of HHE following the administration of the whole-cell pertussis combination vaccine (DTwP-HB-Hib), which is included in National Im munization Program (PNI) of Chile, and to contributing to the knowledge of this adverse event in the country. CASE REPORT: A 6-month-old infant, 3 hours post-vaccination with the third dose of DTwP-HB-Hib vaccine, presented a decreased level of consciousness that was interpreted as atonic seizure but finally considered as EHH. The infant progressed favorably after 2 hours of clinical observation and was discharged 24 hours later. Parents were suggested to continue the immunization schedule of the infant with acellular pertussis vaccines as a preventive measure. CONCLUSIONS: The lack of knowledge about the EHH may discourage childhood immunization. Therefore, it is important for the medical staff to inform parents of the patients about this benign, self-limited and non-recurrent adverse event. In these cases, it is recommended to continue the immunization schedule of the infant with acellular pertussis vaccines.
Asunto(s)
Trastornos de la Conciencia/etiología , Vacuna contra Difteria, Tétanos y Tos Ferina/efectos adversos , Vacunas contra Haemophilus/efectos adversos , Vacunas contra Hepatitis B/efectos adversos , Hipotonía Muscular/etiología , Palidez/etiología , Humanos , Lactante , MasculinoRESUMEN
Subthalamic deep brain stimulation (STN-DBS) is used to treat refractory motor complications in Parkinson disease (PD), but its effects on nonmotor symptoms remain uncertain. Up to 80% of patients with PD may have pain relief after STN-DBS, but it is unknown whether its analgesic properties are related to potential effects on sensory thresholds or secondary to motor improvement. We have previously reported significant and long-lasting pain relief after DBS, which did not correlate with motor symptomatic control. Here we present secondary data exploring the effects of DBS on sensory thresholds in a controlled way and have explored the relationship between these changes and clinical pain and motor improvement after surgery. Thirty-seven patients were prospectively evaluated before STN-DBS and 12 months after the procedure compared with healthy controls. Compared with baseline, patients with PD showed lower thermal and mechanical detection and higher cold pain thresholds after surgery. There were no changes in heat and mechanical pain thresholds. Compared with baseline values in healthy controls, patients with PD had higher thermal and mechanical detection thresholds, which decreased after surgery toward normalization. These sensory changes had no correlation with motor or clinical pain improvement after surgery. These data confirm the existence of sensory abnormalities in PD and suggest that STN-DBS mainly influenced the detection thresholds rather than painful sensations. However, these changes may depend on the specific effects of DBS on somatosensory loops with no correlation to motor or clinical pain improvement.
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Trastornos de la Conciencia/etiología , Estimulación Encefálica Profunda/métodos , Dolor/etiología , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Umbral Sensorial/fisiología , Subtálamo/fisiología , Adulto , Anciano , Trastornos de la Conciencia/terapia , Femenino , Humanos , Hiperalgesia/terapia , Masculino , Persona de Mediana Edad , Movimiento/fisiología , Evaluación de Resultado en la Atención de Salud , Manejo del Dolor , Enfermedad de Parkinson/psicología , Estimulación Física , Calidad de Vida , Estadísticas no ParamétricasRESUMEN
The prevalence of drug-associated toxic encephalopathy is unknown, but it is an uncommon condition. Toxic leukoencephalopathy was described associated with heroin consumption, it has been less commonly described with the use of cocaine and there are no reports of its association with consumption pasta base of cocaine (PBC). We report two females aged 31 years and a male aged 19 years, consumers of PBC who developed a fatal toxic leukoencephalopathy. They initiated their disease with severe and persistent headache, sequential focal neurologic deficits and a progressive impairment of consciousness that culminated with their death. Laboratory parameters such as blood count, cerebrospinal fluid analyses or infectious biological indices were normal. MRI showed multifocal lesions in brain white matter of both hemispheres confirming the leukoencephalopathy. There was no response to the use of methylprednisolone.
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Adulto , Femenino , Humanos , Masculino , Adulto Joven , Cocaína/efectos adversos , Leucoencefalopatías/inducido químicamente , Trastornos de la Conciencia/etiología , Resultado Fatal , Cefalea/etiología , Leucoencefalopatías/complicaciones , Leucoencefalopatías/diagnóstico , Imagen por Resonancia Magnética , Síndromes de Neurotoxicidad/complicaciones , Síndromes de Neurotoxicidad/diagnósticoAsunto(s)
Dolor Abdominal/etiología , Trastornos de la Conciencia/etiología , Hiperamonemia/etiología , Fallo Hepático/etiología , Síndrome de Reye/diagnóstico , Enfermedad Aguda , Traumatismos del Tobillo/complicaciones , Artralgia/etiología , Aspirina/efectos adversos , Niño , Diagnóstico Diferencial , Fatiga/etiología , Femenino , Trastornos Hemorrágicos/etiología , Humanos , Hipoglucemia/etiología , Hipotensión/etiología , Lactulosa/uso terapéutico , Fallo Hepático/sangre , Fallo Hepático/diagnóstico , Síndrome de Reye/complicaciones , Fiebre Reumática/diagnóstico , Vitamina K/uso terapéuticoRESUMEN
The prevalence of drug-associated toxic encephalopathy is unknown, but it is an uncommon condition. Toxic leukoencephalopathy was described associated with heroin consumption, it has been less commonly described with the use of cocaine and there are no reports of its association with consumption pasta base of cocaine (PBC). We report two females aged 31 years and a male aged 19 years, consumers of PBC who developed a fatal toxic leukoencephalopathy. They initiated their disease with severe and persistent headache, sequential focal neurologic deficits and a progressive impairment of consciousness that culminated with their death. Laboratory parameters such as blood count, cerebrospinal fluid analyses or infectious biological indices were normal. MRI showed multifocal lesions in brain white matter of both hemispheres confirming the leukoencephalopathy. There was no response to the use of methylprednisolone.
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Cocaína/efectos adversos , Leucoencefalopatías/inducido químicamente , Adulto , Trastornos de la Conciencia/etiología , Resultado Fatal , Femenino , Cefalea/etiología , Humanos , Leucoencefalopatías/complicaciones , Leucoencefalopatías/diagnóstico , Imagen por Resonancia Magnética , Masculino , Síndromes de Neurotoxicidad/complicaciones , Síndromes de Neurotoxicidad/diagnóstico , Adulto JovenAsunto(s)
Trastornos de la Conciencia/etiología , Disnea/etiología , Fiebre/etiología , Infecciones por VIH/complicaciones , Infecciones por Klebsiella/complicaciones , Klebsiella pneumoniae/aislamiento & purificación , Enfermedades Pulmonares Parasitarias/complicaciones , Meningitis Bacterianas/complicaciones , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/complicaciones , Adulto , Animales , Bacteriemia/complicaciones , Bacteriemia/microbiología , Líquido del Lavado Bronquioalveolar/parasitología , Coinfección , Diagnóstico Diferencial , Parálisis Facial/etiología , Resultado Fatal , Femenino , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/diagnóstico , Infecciones por Klebsiella/microbiología , Enfermedades Pulmonares Parasitarias/diagnóstico , Enfermedades Pulmonares Parasitarias/parasitología , Meningitis Bacterianas/microbiología , Insuficiencia Multiorgánica , Paresia/etiología , Síndrome de Dificultad Respiratoria/etiología , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/parasitología , Toxoplasmosis Cerebral/complicaciones , Infecciones Urinarias/complicaciones , Infecciones Urinarias/microbiologíaAsunto(s)
Adulto , Animales , Femenino , Humanos , Trastornos de la Conciencia/etiología , Disnea/etiología , Fiebre/etiología , Infecciones por VIH/complicaciones , Infecciones por Klebsiella/complicaciones , Klebsiella pneumoniae/aislamiento & purificación , Enfermedades Pulmonares Parasitarias/complicaciones , Meningitis Bacterianas/complicaciones , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/complicaciones , Bacteriemia/complicaciones , Bacteriemia/microbiología , Líquido del Lavado Bronquioalveolar/parasitología , Coinfección , Diagnóstico Diferencial , Resultado Fatal , Parálisis Facial/etiología , Síndrome Inflamatorio de Reconstitución Inmune/diagnóstico , Infecciones por Klebsiella/microbiología , Enfermedades Pulmonares Parasitarias/diagnóstico , Enfermedades Pulmonares Parasitarias/parasitología , Insuficiencia Multiorgánica , Meningitis Bacterianas/microbiología , Paresia/etiología , Síndrome de Dificultad Respiratoria/etiología , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/parasitología , Toxoplasmosis Cerebral/complicaciones , Infecciones Urinarias/complicaciones , Infecciones Urinarias/microbiologíaRESUMEN
The aim of this study was to identify potential risk factors linked to neurologic events (NE) occurring after liver transplantation (LT) and use them to construct a model to predict such events. From odds ratios (OR) of risk factors, a scoring system was assessed using multivariate regression analysis. Forty-one of 307 LT patients presented NE (13.3%), with prolonged hospital stay and decreased post-LT survival. On multivariate analysis, factors associated with NE included: severe pre-LT ascites OR 3.9 (1.80-8.41; P = 0.001), delta sodium ≥12 mEq/l OR 3.5 (1.36-8.67; P = 0.01), and post-LT hypomagnesemia OR 2.9 (1.37-5.98; P = 0.005). Points were assigned depending on ORs as follows: ascites 4 points, and hypomagnesemia and delta sodium ≥12 mEq/l, 3 points each (score range = 0-10 points). ROC curve analysis suggested good discriminative power for the model, with a c-statistic of 0.72 (CI 0.62-0.81; P < 0.0001), best performance for a cutoff value >3 points (71% sensitivity, 60% specificity). NE risk increased progressively from 6.4%, to 10.3%, 12.8%, 31.5% and 71.0% as scores rose from 0 to 3, 4, 6-7 and 10 cumulative points, respectively. The score described helps to identify patients potentially at risk for neurologic events, and its prevention would decrease morbidity and mortality after LT.
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Trastornos de la Conciencia/epidemiología , Delirio/epidemiología , Disartria/epidemiología , Trasplante de Hígado , Trastornos del Movimiento/epidemiología , Complicaciones Posoperatorias/epidemiología , Convulsiones/epidemiología , Trastornos de la Visión/epidemiología , Adulto , Anciano , Intervalos de Confianza , Trastornos de la Conciencia/etiología , Delirio/etiología , Disartria/etiología , Femenino , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación/estadística & datos numéricos , Magnesio/sangre , Masculino , Persona de Mediana Edad , Trastornos del Movimiento/etiología , Oportunidad Relativa , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Riesgo , Convulsiones/etiología , Sodio/sangre , Trastornos de la Visión/etiologíaRESUMEN
Heat stroke (HS) is a medical emergency characterized by increased core body temperature with associated systemic inflammatory response leading to a syndrome of multi-organ damage in which encephalopathy predominates. We describe a case of a 29 year old male recruit presenting with altered mental status during military training in Puerto Rico. Associated symptoms included high grade fever, dizziness, nausea, vomiting, blurred vision and profuse sweating followed by loss of consciousness. Upon arrival to medical evaluation the patient was found with dry skin and depressed Glasgow Coma Score. Initial laboratories, clinical evolution of symptoms and imaging studies were consistent with the diagnosis of HS. Patient was managed with mechanical ventilatory support, intravenous fluids and external cooling measures. He was later discharged home without any neurological sequelae. To our knowledge this is the first documented case of HS in Puerto Rico.