RESUMO
BACKGROUND: The presence of Aspergillus in the central nervous system (CNS) is rare in immunocompetent patients but not in immunocompromised patients who may have a more common infection. This article describes a case of an adult immunocompetent patient with a diagnosis of cerebral aspergillosis and with a clinical process of rapidly progressive dementia which simulated a Creutzfeldt-Jakob syndrome. CASE DESCRIPTION: A 34-year-old adult was previously healthy and had no medical history of any significance. The patient had suffered only facial trauma 8 months before admission. One month prior to admission, he showed rapidly progressing changes in his behavior and higher mental functions. He was admitted to the emergency room with an occipital headache with 2 months of history. By the time he arrived, he suffered from total disability and was prostrate. He was diagnosed with meningeal and demential syndrome in the process of being studied. After starting the diagnostic approach by investigating cerebrospinal fluid, a magnetic resonance of the skull, an electroencephalogram, a brain biopsy was indicated. The histopathological study reported the presence of the hyphae characteristics of Aspergillus. The patient died 7 days after the diagnosis. CONCLUSION: Cerebral aspergillosis is a common aggressive disease in immunosuppressed patients. However, the disease is rare in individuals with respected immunity and in individuals with neurological impairment and a rapid and progressive deterioration of mental functions. The suspected diagnosis should always be considered given its poor prognosis and the encouraging efficacy of antifungal treatment administered in a timely manner.
RESUMO
BACKGROUND: No-reflow phenomenon is a common event in patients with acute myocardial infarction with ST elevation (STEMI) who underwent primary percutaneous coronary intervention. The objective is to determine the cumulative incidence of no-reflow phenomenon and some predictors related to its occurrence. METHODS: We retrospectively analyzed the reports of 71 patients with STEMI. Subjects were categorized in two groups, those with no-reflow phenomenon and those without it; their clinical findings were compared. Predictive factors were identified by logistic regression analysis. RESULTS: We identified 20 patients with no-reflow phenomenon (with a cumulative incidence of 28.1 %) and 51 with adequate reperfusion. In the univariate analysis the following predictors were related to the no-reflow phenomenon: CK-MB = 160 UI/L, Killip class = II, TIMI flow 0, having more than two Q waves in ECG, the form of reperfusion therapy and the presence of intracoronary thrombus. The multivariate logistic regression analysis identified Killip class = II (OR = 9.3, p = 0.008), = two Q waves in ECG (OR = 1.8, p = 0.05), angioplasty as unique reperfusion therapy (OR = 19.9, p = 0.017) and the presence of intracoronary thrombus (OR = 11.9, p = 0.008) as predictors of no-reflow phenomenon. CONCLUSIONS: The early detection of predictors of no-reflow phenomenon will establish measures aimed to reduce its presentation.
Introducción: el fenómeno de no reflujo es un evento común en sujetos con infarto agudo al miocardio con elevación del ST (IAM-CEST) que son sometidos a intervención coronaria percutánea primaria. El objetivo de este artículo es determinar la incidencia acumulada del fenómeno de no reflujo y algunos predictores relacionados con su presentación. Métodos: se analizaron retrospectivamente los reportes de 71 pacientes con IAM-CEST. Los sujetos fueron categorizados entre aquellos con fenómeno de no reflujo y quienes no lo presentaron; los hallazgos clínicos de ambos grupos fueron comparados. Los factores predictores fueron identificados mediante análisis de regresión logística. Resultados: se identificaron 20 pacientes con fenómeno de no reflujo (incidencia acumulada: 28.1 %) y 51 con reperfusión adecuada. En el análisis univariado se relacionaron con el fenómeno de no reflujo: CPK MB = 160 UI/L, clase de Killip = II, fl ujo TIMI 0, tener = 2 ondas Q en el ECG, método de reperfusión utilizado y presencia de trombo intracoronario. Los análisis de regresión logística multivariada identificaron como predictores a la clase de Killip = II (RM = 9.3, p = 0.008), = 2 ondas Q en el ECG (RM = 1.8, p = 0.05), angioplastia exclusiva como método de reperfusión empleado (RM = 19.9, p = 0.017) y presencia de trombo intracoronario (RM = 11.9, p = 0.008). Conclusión: la detección anticipada del fenómeno de no reflujo permitirá establecer medidas tendientes a disminuir su presentación.