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1.
Rev. chil. neuro-psiquiatr ; Rev. chil. neuro-psiquiatr;62(1)2024.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1559688

RESUMO

Desde el inicio de la pandemia por COVID-19 (coronavirus disease), en el 2019, se han descrito numerosas manifestaciones clínicas de la enfermedad causada por este virus, destacando el compromiso respiratorio, hematológico, cardiovascular y neurológico. Dentro de las manifestaciones y/o complicaciones neurológicas, se encuentra la mielitis aguda transversa por COVID-19(1), cuyo diagnóstico se ha realizado principalmente clínico-imagenológico y PCR (reacción de polimerasa en cadena), o serología (+) para COVID-19, con manejos y resultados no siempre afortunados. Presentamos el caso de un paciente con mielitis aguda transversa longitudinalmente extensa en relación a COVID-19, tratada con éxito clínico con rituximab.


Since the beginning of the COVID-19 pandemic in 2019, numerous clinical manifestations of the disease caused by this virus have been described, highlighting respiratory, hematological, cardiovascular, and neurological compromise. Among the neurological manifestations and/or complications, there is acute transverse myelitis due to COVID-19(1), whose diagnosis has been made mainly clinical-imaging and PCR or serology (+) for COVID-19, with management and results not always lucky. We present the case of a patient with longitudinally extensive acute transverse myelitis in relation to COVID-19, treated with clinical success with rituximab.

2.
Rev. med. Chile ; 150(9): 1180-1187, sept. 2022. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1431899

RESUMO

BACKGROUND: Mechanical thrombectomy is the accepted treatment for acute ischemic stroke in Large Vessel Occlusion. The Barros Luco Trudeau hospital developed endovenous thrombolysis in 2010, and since 2012, implemented endovascular management, becoming the neurovascular center in the southern area of the metropolitan region. AIM: To describe endovascular management of acute ischemic stroke in a Chilean public hospital. Material and Methods: Analysis of patients with acute ischemic stroke that were treated with mechanical throm-bectomy from 2012 to 2019 in the Barros Luco Hospital. RESULTS: In the study period, a mechanical thrombectomy was carried out in 149 patients aged 61 ± 15 years (46% females). The average National institute of Health Stroke Scale (NIHSS) at presentation was 19 ± 4-5. Anterior or posterior circulation involvement was present in 89.9 and 10.1 % of patients. Twenty-five percent of patients were referred from other public centers. The mean lapse between onset of symptoms and thrombectomy was 266 ± 178 in. Ninety days after the procedure, 58% of patients had minimal or absent disability (Modified Ranson score of 0-2), and 19,2% died. CONCLUSIONS: Mechanical thrombectomy, according to this experience, has favorable clinical outcomes in patients with high NIHSS scores at entry.


Assuntos
Humanos , Masculino , Feminino , Isquemia Encefálica/etiologia , Acidente Vascular Cerebral/cirurgia , Acidente Vascular Cerebral/etiologia , Procedimentos Endovasculares/métodos , AVC Isquêmico/etiologia , Chile , Estudos Retrospectivos , Resultado do Tratamento , Trombectomia/métodos , Hospitais Públicos
3.
Rev Med Chil ; 150(9): 1180-1187, 2022 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-37358128

RESUMO

BACKGROUND: Mechanical thrombectomy is the accepted treatment for acute ischemic stroke in Large Vessel Occlusion. The Barros Luco Trudeau hospital developed endovenous thrombolysis in 2010, and since 2012, implemented endovascular management, becoming the neurovascular center in the southern area of the metropolitan region. AIM: To describe endovascular management of acute ischemic stroke in a Chilean public hospital. MATERIAL AND METHODS: Analysis of patients with acute ischemic stroke that were treated with mechanical throm-bectomy from 2012 to 2019 in the Barros Luco Hospital. RESULTS: In the study period, a mechanical thrombectomy was carried out in 149 patients aged 61 ± 15 years (46% females). The average National institute of Health Stroke Scale (NIHSS) at presentation was 19 ± 4-5. Anterior or posterior circulation involvement was present in 89.9 and 10.1 % of patients. Twenty-five percent of patients were referred from other public centers. The mean lapse between onset of symptoms and thrombectomy was 266 ± 178 in. Ninety days after the procedure, 58% of patients had minimal or absent disability (Modified Ranson score of 0-2), and 19,2% died. CONCLUSIONS: Mechanical thrombectomy, according to this experience, has favorable clinical outcomes in patients with high NIHSS scores at entry.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , AVC Isquêmico , Acidente Vascular Cerebral , Feminino , Humanos , Masculino , Acidente Vascular Cerebral/cirurgia , Acidente Vascular Cerebral/etiologia , AVC Isquêmico/etiologia , Chile , Resultado do Tratamento , Isquemia Encefálica/etiologia , Trombectomia/métodos , Hospitais Públicos , Estudos Retrospectivos , Procedimentos Endovasculares/métodos
4.
Rev. argent. neurocir ; 35(1): 79-94, mar. 2021. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1397843

RESUMO

Objetivo: Determinar la confiabilidad de rm funcional motora (rmfm) en la localización de la corteza motora primaria en condiciones patológicas causadas por la proximidad de lesiones expansivas cerebrales con el uso intraoperatorio de electro estimulación cortical directa (ecd) Material y método: Se incluyeron 48 pacientes portadores de tumores intra axiales (nº 25) y extraaxiales (nº23) próximas al área motora, con capacidad de realizar la tarea funcional motora por rmf, y que fueron sometidos a cirugía con ecd. Durante la cirugía se realizaron 220 registros de ecd en total de la población de pacientes estudiados. La población estuvo constituida por una serie consecutiva de casos, el estudio se planificó de manera prospectiva entre los años 2007-2019, y tiene como objetivo la evaluación de la eficacia de pruebas diagnósticas (stard 2015).Se realizó una comparación sitio por sitio entre la imagen por rmfm y la ecm con la ayuda del neuronavegador. Discusión: Los resultados estadísticos de la prueba fueron: sensibilidad 82.2%, Especificidad: 76,5%, lr+:3.49, Lr-: 0,23; vpp: 74.8%, Vpn: 83.5%; Odds Postest+:2.96, Odds postest-: 0,19 y fueron publicados acordes con los standards stard 2015. Conclusiones: Las técnicas de rmfm basadas en tareas, no son suficientes para la toma de decisiones críticas intraoperatorias. No obstante, la integración de la rmfm por neuronavegación implica una planificación espacial muy confiable que permite asociar el área de activación bold a la topografía del tumor y a la tractografía, de esta forma orientar una validación por ecd rápida y segura en la resección de los tumores cerebrales


Assuntos
Neoplasias , Neuronavegação , Cérebro , Córtex Motor
5.
Ter. psicol ; 38(3): 427-445, dic. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1390442

RESUMO

Resumen: Los datos preliminares confirman el impacto psicológico que la crisis por COVID-19 está provocando en niños y adolescentes de población comunitaria. Se desconoce cómo afecta a la población infantil que sufre maltrato intrafamiliar. El objetivo del estudio fue examinar el impacto emocional adicional que supone la medida de confinamiento en menores de edad expuestos a violencia de pareja hacia la mujer que recibían atención psicológica en la Región de Murcia. Ciento ochenta y cinco madres informaron vía telefónica cómo el confinamiento afectó a 269 niños/as de entre 0 y 18 años. También los 108 menores que tenían 6 años o más, cumplimentaron el listado sobre su propio estado emocional. El incremento en la incidencia de alteraciones psicológicas en esta población ha sido baja (1.1-4.8%), si bien entre aquellos que aumentó la sintomatología predominaron la desorganización comportamental y la alteración emocional. Asimismo, se comprobó que algunas variables (sexo, edad, días de confinamiento, conflicto familiar) contribuyeron al incremento de desorganización comportamental y estrés traumático/depresión. Es preciso desarrollar más trabajos en esta línea por las implicaciones que se pueden derivar tanto a nivel de diagnóstico como de tratamiento.


Abstract: Preliminary data confirm the psychological impact that the COVID-19 crisis is causing in children and adolescents in the community population. It is unknown how it affects the child population who suffer intrafamilial abuse. The objective of the study was to examine the additional emotional impact of the measure of confinement in minors exposed to intimate partner violence towards women who received psychological attention in the Region of Murcia. One hundred and eighty-five mothers reported, by telephone comunication, how the confinement affected to 269 children between the ages of 0 and 18. Also the 108 minors who were 6 years old or older completed the list on their own emotional state. The incidence increasement of psychological disorders within this population has been low (1.1-4.8%), although among those with increased symptoms, behavioral disorganization and emotional disturbance was predominant. Likewise, it was found that some variables (sex, age, days of confinement, family conflict) contributed to increase the behavioral disorganization and traumatic stress/depression. It is necessary to develop more research in this line due to the derived implications both at diagnosis and treatment levels.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem
7.
J Fish Biol ; 89(5): 2419-2433, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27592692

RESUMO

In order to identify the best tools for stock assessment studies using fish parasites as biological indicators, different host traits (size, mass and age and their interaction with sex) were evaluated as descriptors of cumulative patterns of both parasite abundance and infracommunity species richness. The effect of such variables was analysed for a sample of 265 specimens of Percophis brasiliensis caught in the Argentine Sea. The abundances and species richness were modelled using generalized linear mixed models (GLMMs) with negative binomial and Poisson distribution respectively. Due to collinearity, separate models were fitted for each of the three main explanatory variables (length, mass and age) to identify the optimal set of factors determining the parasite burdens. Optimal GLMMs were selected on the basis of the lowest Akaike information criteria, residual information and simulation studies based on 10 000 iterations. Results indicated that the covariates length and sex consistently appeared in the most parsimonious models suggesting that fish length seems to be a slightly better predictor than age or mass. The biological causes of these patterns are discussed. It is recommended to use fish length as a measure of growth and to restrict comparisons with fish of similar length or to incorporate length as covariate when comparing parasite burdens. Host sex should be also taken into account for those species sexually dimorphic in terms of morphology, behaviour or growth rates.


Assuntos
Interações Hospedeiro-Parasita , Modelos Estatísticos , Perciformes/parasitologia , Acantocéfalos , Animais , Tamanho Corporal , Cestoides , Feminino , Pesqueiros , Peixes/parasitologia , Masculino , Carga Parasitária , Perciformes/fisiologia , Rabditídios , Fatores Sexuais
9.
Rev. ANACEM (Impresa) ; 6(1): 43-47, abr. 2012. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-640041

RESUMO

INTRODUCCIÓN: El Síndrome de Budd-Chiari es una obstrucción del drenaje venoso hepático. Las principales etiologías son los síndromes mieloproliferativos y anti-fosfolípido. La clínica que predomina deriva insuficiencia hepática crónica igual que sus complicaciones. El diagnóstico es mediante imágenes o biopsia hepática. El tratamiento va a depender de la causa y tiene una supervivencia de 75 por ciento a diez años. PRESENTACIÓN DEL CASO Mujer de 26 años con antecedentes de Policitemia Vera, Síndrome de Budd-Chiari y aborto espontáneo secundario a trombosis placentaria, consulta en Servicio de Urgencia del Hospital San Juan de Dios de San Fernando por vómitos rojizos asociados a melena. A su ingreso se plantearon los siguientes diagnósticos: hemorragia digestiva alta, anemia severa, anasarca, síndrome de Budd-Chiari, Policitemia Vera e insuficiencia hepática crónica; además de Child-Pugh C. La paciente se hospitaliza en Unidad de Cuidados Intermedios con tratamiento en base a suero fisiológico, transfusiones sanguíneas, omeprazol, vitamina K y furosemida. Endoscopia digestiva alta revela signos de hipertensión portal y várices esofágicas medianas con signo rojo presente. Luego de ocho días de hospitalización cede la hemorragia digestiva y se decide dar el alta, con control en siete días. DISCUSIÓN: El sangrado gastrointestinal es una complicación que alcanza un 10 por ciento a 15 por ciento en pacientes con síndrome de Budd-Chiari, y puede ocurrir en los que están recibiendo terapia anticoagulante, así como en aquellos con hipertensión portal secundaria a insuficiencia hepática crónica.


INTRODUCTION: Budd-Chiari syndrome is an obstruction of hepatic venous drainage. The main causes are myeloproliferative and anti-phospholipid syndromes. The predominant clinical results are from chronic liver failure as well as its complications. Diagnosis is by imaging or liver biopsy. Treatment will depend on the cause and have a survival of 75 percent at ten years. CASE REPORT: A 26 year old woman with history of polycythemia vera, Budd-Chiari syndrome and spontaneous abortion secondary to placental thrombosis, consulted in the Emergency Service in Hospital San Juan de Dios of San Fernando because of red vomits associated with melena. On admission were raised the following diagnoses: Upper gastrointestinal tract hemorrhage, severe anemia, anasarca, Budd Chiari Syndrome, Polycythemia Vera and Chronic Liver failure; Child-Pugh C. The patient was hospitalized on intermediate care unit with treatment based on physiological saline, blood transfusions, omeprazole, vitamin K and furosemide. Upper gastrointestinal endoscopy revealed signs of portal hypertension and esophageal medium varices with red sign. After eight days hospitalized, gastrointestinal bleeding stops, the patient is discharged and control is decided in seven more days. DISCUSSION: Gastrointestinal bleeding is a complication that achieves 10 percent to 15 percent in patients with Budd-Chiari syndrome, and can occur in the ones who are receiving anticoagulant therapy, as well in those with portal hypertension secondary to chronic liver failure.


Assuntos
Humanos , Adulto , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Síndrome de Budd-Chiari/complicações , Algoritmos , Policitemia Vera/complicações
10.
Rev. méd. Chile ; 139(9): 1118-1127, set. 2011. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-612234

RESUMO

Background: The only accepted treatment for acute ischemic stroke is thrombolysis with recombinant tissue plasminogen activator (t-PA). It was implemented in Chile in 1996, although its use was mainly restricted in Chile to private clinics. Recently, at year 2009, we have implemented this treatment in a public hospital. Aim: To describe the results of treatment of acute ischemic stroke with t-PA in a public hospital in Chile. Material and Methods: Prospective analysis of all eligible patients with acute ischemic stroke that were admitted within 4 hours of its onset and had no contraindications for thrombolysis. Results: In an eight months period, a total of 19 intravenous thrombolyses were performed in 12 males and seven females aged 28 to 79 years old. The mean lapse between onset of symptoms and onset of thrombolysis was 190 ± 57 min. Results were favorable, according to Rankin and National Institute of Health Stroke scales. Ninety days after treatment, 63 percent of patients had minimal or absent disability, 26 percent had moderate disability and only one (5 percent) had severe disability. One patient had a clinically not significant intracranial hemorrhage and one patient died six days after thrombolysis. Conclusions: These results indicate that thrombolysis can be successfully implemented in Chilean public hospitals. The limitations for its use in this setting are mostly administrative.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Chile , Protocolos Clínicos , Hospitais Públicos , Estudos Prospectivos , Proteínas Recombinantes/uso terapêutico , Reprodutibilidade dos Testes , Resultado do Tratamento
11.
Rev Med Chil ; 139(9): 1118-27, 2011 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-22215389

RESUMO

BACKGROUND: The only accepted treatment for acute ischemic stroke is thrombolysis with recombinant tissue plasminogen activator (t-PA). It was implemented in Chile in 1996, although its use was mainly restricted in Chile to private clinics. Recently, at year 2009, we have implemented this treatment in a public hospital. AIM: To describe the results of treatment of acute ischemic stroke with t-PA in a public hospital in Chile. MATERIAL AND METHODS: Prospective analysis of all eligible patients with acute ischemic stroke that were admitted within 4 hours of its onset and had no contraindications for thrombolysis. RESULTS: In an eight months period, a total of 19 intravenous thrombolyses were performed in 12 males and seven females aged 28 to 79 years old. The mean lapse between onset of symptoms and onset of thrombolysis was 190 ± 57 min. Results were favorable, according to Rankin and National Institute of Health Stroke scales. Ninety days after treatment, 63% of patients had minimal or absent disability, 26% had moderate disability and only one (5%) had severe disability. One patient had a clinically not significant intracranial hemorrhage and one patient died six days after thrombolysis. CONCLUSIONS: These results indicate that thrombolysis can be successfully implemented in Chilean public hospitals. The limitations for its use in this setting are mostly administrative.


Assuntos
Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Adulto , Idoso , Chile , Protocolos Clínicos , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Proteínas Recombinantes/uso terapêutico , Reprodutibilidade dos Testes , Resultado do Tratamento
12.
Rev. chil. neuro-psiquiatr ; Rev. chil. neuro-psiquiatr;49(3): 283-287, 2011.
Artigo em Espanhol | LILACS | ID: lil-608781

RESUMO

La muerte encefálica es una causa válida en la certificación del deceso de un paciente, especialmente en condiciones de donación de órganos. Existen escasas situaciones en las que el legislador ha propuesto la realización de exámenes complementarios para su certificación. Presentamos el caso de un paciente con un síndrome de Guillain Barré, que llegó a simular un estado de muerte encefálica, debido al compromiso motor completo, incluyendo musculatura ocular intrínseca. La falta de una condición suficiente y necesaria para declarar la muerte del paciente lleva a la solicitud de exámenes complementarios, en este caso un electroencefalograma, los que determinan la normalidad de la actividad eléctrica cerebral. Se recalca la necesidad de cumplir estrictamente los criterios para determinar la muerte encefálica y el no inhibirse de solicitar exámenes complementarios en condiciones de duda, aún cuando la ley no siempre lo contemple.


Brain death is a valid cause of death certification in a patient, especially in terms of organ donation. There are few situations in which the legislator has proposed further examination for certification. We report the case of a patient with Guillain Barré syndrome, which came to simulate a state of brain death due to motor impairment in full, including intrinsic ocular muscles. The lack of a necessary and sufficient condition for declaring the patient's death led to request additional examinations, in this case an electroencephalogram, which determine the normality of brain electrical activity. It emphasizes the need to comply strictly with the criteria for determining brain death and not to request additional examinations inhibited in a position of doubt, even though the law does not always contemplated.


Assuntos
Humanos , Masculino , Adulto , Morte Encefálica/diagnóstico , Morte Encefálica/fisiopatologia , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/fisiopatologia , Diagnóstico Diferencial , Eletroencefalografia , Imageamento por Ressonância Magnética , Doadores de Tecidos , Vias Eferentes/fisiopatologia
13.
Rev. chil. neuro-psiquiatr ; Rev. chil. neuro-psiquiatr;49(2): 165-170, 2011. ilus
Artigo em Espanhol | LILACS | ID: lil-597570

RESUMO

Neurosyphilis (NS) is caused by the presence of Treponema Pallidum (TP) spirochete within the Central Nervous System (CNS), mainly affecting the meninges and cerebrospinal fluid (CSF). 5 percent to 10 percent of untreated syphilitic patients are deemed to develop symptomatic NSÕ. Its incidence and clinical spectrum have changed over the years with prevalence of early clinical stages of meningitic and meningovascular (MV) NS and exceptional occurrence of late clinical stages (tabes dorsalis, general paresis, and gummata) in the age of antibiotics. The case under analysis deals with aggressive MV and concomitant brain gumma (BG) NS. The case subject is a human inmunodeficiency virus (HIV)-seronegative, 44-year-old woman with 2-year symptomatic latency. Her medical record showed recurrent sensorimotor vascular involvement, fast cognitive damage and chronic, daily cephalea. She met clinical diagnosis, cerebrospinal fluid and serologic criteria for NS. Brain computerized tomography (CT) and magnetic resonance (MR) reported lenticulostriate artery infarction and bilateral ganglionic syphilitic gummata. She underwent Penicillin G-based treatment, making progress with neurological, cognitive-motor sequelae. Although NS has anticipated and speeded up its several clinical stages in connection with HIV/Syphilis co-infection, the peculiarity of this case is the concurrence of early and late NS manifestations in HIV-seronegative patient. The conclusion is that NS is a disease that still prevails and that appropriate diagnosis and treatment prevent irreversible neurological sequelae.


La Neurosífilis (NS) es causada por la invasión del Sistema Nervioso Central (SNC) por la espiroqueta Treponema Pallidum (TP), afectando primariamente las meninges y líquido cefalorraquídeo. Entre 5 a 10 por ciento de los pacientes sifilíticos no tratados desarrollarán una NS sintomáticaÕ. Su incidencia y espectro clínico ha cambiado a lo largo del tiempo, siendo las formas clínicas precoces meníngea y meningovascular (MV) las más prevalentes. En contraste, las formas tardías (tabes dorsal, parálisis general y gomas) son de ocurrencia excepcional en la era antibiótica. Se analiza un caso de NS menigovascular y gomas cerebrales concomitantes, de curso clínico agresivo. En una mujer de 44 años, seronegativa para virus de inmunodeficiencia humana (VIH), con latencia sintomática de dos años. Presentaba una historia de focalidad sensitivo-motor de perfil vascular recurrente, rápido deterioro cognitivo-motor y cefalea crónica diaria. Cumplía criterios diagnósticos clínicos, licuorales y serológicos para NS. La Tomografía computada (TC) y Resonancia Magnética (RM) cerebral mostró infartos arteriolares lentículo-estriados y gomas sifilíticas ganglionares bilaterales. Recibió tratamiento con Penicilina G, evolucionando con secuelas neurológicas cognitivas-motoras. Si bien, la NS actualmente, ha anticipado y acelerado sus diferentes formas clínicas en relación a co-infección VIH/Sífilis. Lo llamativo de este caso, es la presentación concomitante de con manifestaciones precoces y tardías de NS en paciente VIH seronegativo. Se concluye que la NS sigue siendo una enfermedad vigente y su diagnóstico y tratamiento oportuno previene secuelas neurológicas irreversibles.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Encefalopatias/complicações , Encefalopatias/diagnóstico , Meningites Bacterianas/complicações , Meningites Bacterianas/diagnóstico , Neurossífilis/complicações , Neurossífilis/diagnóstico , Antibacterianos/uso terapêutico , Encefalopatias/líquido cefalorraquidiano , Soronegatividade para HIV , Imageamento por Ressonância Magnética , Meningites Bacterianas/líquido cefalorraquidiano , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/tratamento farmacológico , Penicilina G/uso terapêutico , Tomografia Computadorizada por Raios X , Treponema pallidum
14.
Rev. chil. neuro-psiquiatr ; Rev. chil. neuro-psiquiatr;48(4): 279-291, dic. 2010. ilus
Artigo em Espanhol | LILACS | ID: lil-582986

RESUMO

Pregnancy produces a series of physiological changes in women which may trigger several neurologic pathologies or decompensation in pre-existing diseases. There are neurologic complications in pathological pregnancies such as: Wernicke's encephalopathy; posterior reversible encephalopathy which is a form of eclampsia; previous diseases such as epilepsies that entail a high obstetric risk due to the possibility of presenting embriopathies associated to the use of antiepileptic drugs (AEDs) and also because of the risk of a convulsive crisis in the fetus; cerebrovascular diseases which are rare although with high maternal mortality; extrapyramidal pathologies which are infrequent except for the chorea gravidarum and the restless legs syndrome; cerebral neoplasms in which due to haemodynamic changes at the end of the second quarter and the increase of estrogen and progesterone many tumors may raise their volume; and peripheral alterations like myasthenia gravis (MG); intervertebral disk displacement and entrapment neuropathies like carpal tunnel syndrome and meralgia paresthetica. Anyhow because of cellular immunity in multiple sclerosis pregnancy is protected from new outbreaks.


El embarazo provoca una serie de cambios en la fisiología de la mujer lo que puede desencadenar diferentes patologías, entre ellas neurológicas y/o descompensar enfermedades previas. Existen cuadros como complicaciones neurológicas de embarazos patológicos: encefalopatía de Wernicke, la encefalopatía posterior reversible que corresponde a una forma de manifestación de eclampsia, enfermedades previas como epilepsias que conllevan un alto riesgo obstétrico; por un lado por la posibilidad de presentar embriopatías asociadas al uso de fármacos antiepilépticos (FAE) y por otro el riesgo que representa una crisis convulsiva en el feto, enfermedades cerebrovasculares, complicación rara pero con una alta mortalidad materna, enfermedades extrapiramidales, infrecuentes, salvo el corea gravídico y el síndrome de piernas inquietas, esclerosis múltiple, en que el embarazo previene la aparición de brotes, debido al predominio de la inmunidad celular, neoplasias intracerebrales en que por los cambios hemodinámicos que ocurren al final del segundo trimestre y el aumento del estrógeno y progesterona, muchos tumores pueden aumentar su masa, y alteraciones periféricas como miastenia gravis (MG), hernias discales y aparición de neuropatías por atrapamiento como el síndrome del túnel del carpo y la meralgia parestésica.


Assuntos
Humanos , Feminino , Gravidez , Doenças do Sistema Nervoso Central/complicações , Complicações na Gravidez , Eclampsia , Encefalopatias/complicações , Epilepsia/complicações , Esclerose Múltipla/complicações , Hiperêmese Gravídica , Neurologia , Transtornos Cerebrovasculares/complicações
15.
Rev. chil. neuro-psiquiatr ; Rev. chil. neuro-psiquiatr;48(supl.1): 9-92, mar. 2010. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-556191

RESUMO

Multiple Sclerosis (MS) is a chronic disease of the central nervous system. It is manifested in the young adult who presents at the beginning alternation between transient neurological dysfunction and normality, followed by a progressive level of disability. MS affects the quality of life in the young adults in their full productive and creative age limiting not only in their personal lives but also affects to the whole society in terms of "dreams and life projects". Besides, this illness also influences the family group who has to assume progressively the help and care for the patient. In healthcare aspect MS implies intensive and progressive resources. In Chile, although we don't have epidemiological studies that indicate which is the MS prevalence it exist a projection that states 14 per 100.000 inhabitants. Considering a population of 16.5 million of inhabitants our expectative of patients with MS is of 2310 cases in our country. The MS immunomodulating injectable disease-modifying therapies are of high cost and were not available in a regular way in the state health care system of Chile (FONASA) that attends the 70 percent of the population; the other 30 percent has different private health insurances. In 2008 the ministry of health decided to initiate and pilot (exploratory) program which had a great meaning and impact concerning to start offering immunomodulating therapies to relapsing remitting MS, for patients belonging to FONASA system. The pilot program was thought with a double mission, on the one hand to achieve that a very limited group of MS patients belonging to FONASA system (80 cases) from all over the country had access to immunomodulating injectable disease-modifying therapies of high cost in a regular way. The second objective was to obtain clinical and epidemiological information which let us to evaluate the clinical and administrative obstacles generated by the incorporation of this treatment in the public health...


Introducción El presente documento corresponde al informe del primer año de trabajo operativo del "Programa piloto de tratamiento con inmunomoduladores, para pacientes beneficiarios de Fonasa1, que padecen esclerosis múltiple (EM)", elaborado por el equipo del centro de referencia nacional, para este programa, con sede en el Servicio de Neurología del Complejo Asistencial Barros Luco (CABL) del SSMS2. Dado su origen no incluye antecedentes del proceso de gestión ni toma de decisiones del nivel Minsal3 o Fonasa. Este trabajo, no es ni aspira ser: un ensayo clínico, una guía de práctica clínica, una revisión bibliográfica, ni una puesta al día sobre el tratamiento de la Esclerosis Múltiple (EM), es simplemente el informe anual de un centro de referencia, para una tarea específica, a la autoridad ministerial competente. El informe incluye algunos antecedentes generales y referencias presentadas como "notas al pie", sólo para contextualizar la información presentada4. La EM es una enfermedad crónica del SNC, de origen incierto, inmunológicamente mediada, bien definida en sus características inmunopatogénicas, patológicas, imagenológicas y clínicas. Se expresa en el adulto joven, quien presenta inicialmente alternancia entre disfunción neurológica transitoria y normalidad y cuya progresión determina múltiples efectos discapacitantes. La EM afecta la calidad de vida de adultos jóvenes en plena edad productiva y creativa limitando tanto los "sueños y proyectos de vida" como el desarrollo laboral, social y afectivo. Además trasciende al grupo familiar, cuando deben asumir la asistencia del paciente. En lo sanitario, la EM, genera uso intensivo y progresivo de recursos. Las terapias inmunomoduladores para la EM, que tienen la posibilidad de detener o reducir la evolución de la modalidad recurrente remitente de la EM, no se encontraban disponibles en forma regular en el sector público de salud de nuestro país, por esto el presente programa piloto...


Assuntos
Humanos , Masculino , Feminino , Esclerose Múltipla/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Programas Nacionais de Saúde , Setor Público , Chile , Seguro Saúde , Interferon beta/uso terapêutico , Seleção de Pacientes , Projetos Piloto , Peptídeos/uso terapêutico
16.
Rev Chilena Infectol ; 25(2): 122-6, 2008 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-18483645

RESUMO

We present a clinical case of a patient who consulted for a cerebelous syndrome and diplopia associated to 10 kg weight loss in six months and multiple adenopathies. Cerebral imagenology study evidenced the presence of granulamatous masses at the cerebellum and midbrain level, there were no cerebrospinal fluid abnormalities. Systemic tuberculosis (TB) diagnosis was done based in finding of acid-fast bacilli positive staining in urine and lymph node biopsy. HIV infection was documented by ELISA serology. CD4 cell count was 590 cell/mm3, classifying the case a AIDS Cl stage. TB was treated according to national guidelines leading to good clinical and imagenology evolution. The clinical case scenario of infratentorial tuberculomas without meningitis as a first manifestation of TB and AIDS is unusual, generating our interest in reporting this case.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Antituberculosos/uso terapêutico , Doenças Cerebelares/microbiologia , Tuberculoma Intracraniano/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/tratamento farmacológico
17.
Rev. chil. infectol ; Rev. chil. infectol;25(2): 122-126, abr. 2008. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-483190

RESUMO

Presentamos el caso clínico de un paciente que consultó por un síndrome cerebeloso y diplopía, asociados a pérdida de peso de 10 kilos en 6 meses y adenopatías múltiples. El estudio imagenológico cerebral demostró la presencia de lesiones de aspecto granulomatoso a nivel cerebeloso y mesencefálico, sin alteración citoquímica del líquido cefalorraquídeo. Las baciloscopias de orina y de la biopsia ganglionar fueron positivas y permitieron el diagnóstico de tuberculosis (TBC) sistémica. La serología para VIH resultó positiva en sangre con un recuento de linfocitos CD4 de 590 cel/mm3, clasificándose el caso como SIDA etapa Cl. El paciente fue tratado con el esquema antituberculoso según norma nacional, con buena respuesta clínica e imagenológica. La presentación de tuberculomas infratentoriales sin meningitis, como primera causa de pesquisa de TBC y SIDA no es habitual, de allí nuestro interés por comunicar el caso.


We present a clinical case of a patient who consulted for a cerebelous syndrome and diplopia associated to 10 kg weight loss in six months and multiple adenopathies. Cerebral imagenology study evidenced the presence of granulamatous masses at the cerebellum and midbrain level, there were no cerebrospinal fluid abnormalities. Systemic tuberculosis (TB) diagnosis was done based in finding of acid-fast bacilli positive staining in urine and lymph node biopsy. HIV infection was documented by ELISA serology. CD4 cell count was 590 cell/mm3, classifying the case a AIDS Cl stage. TB was treated according to national guidelines leading to good clinical and imagenology evolution. The clinical case scenario of infratentorial tuberculomas without meningitis as a first manifestation of TB and AIDS is unusual, generating our interest in reporting this case.


Assuntos
Adulto , Humanos , Masculino , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Antituberculosos/uso terapêutico , Doenças Cerebelares/microbiologia , Tuberculoma Intracraniano/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/tratamento farmacológico , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/tratamento farmacológico
18.
Rev. méd. Chile ; 134(10): 1310-1314, oct. 2006. ilus
Artigo em Espanhol | LILACS | ID: lil-439924

RESUMO

The objective of high activity antiretroviral therapy (HAART) in patients with AIDS, is to obtain immune restoration. This means a reduction of the viral load and restitution of the CD4 cell count. A decreased rate of HIV replication improves both the number and function of CD4 cells. Nevertheless, this treatment sometimes results in the reappearance of previous symptoms from treated conditions due to opportunistic infections (ie: tuberculosis, criptococcosis, hepatitis, Pneumocystis jirovesi, toxoplasmosis, etc) or non infectious condition such as sarcoidosis, Graves disease or Kaposi sarcoma. This is known as Inflammatory Reconstitution Immune Syndrome (IRIS). We report a 37 year-old woman in stage C3-AIDS with a previous criptococcal meningitis. She was treated, achieving a marked improvement with treatment and subsequent suppressive therapy with fluconazole 200 mg/day. IRIS appeared after 8 months of ongoing antiretroviral therapy with immune restoration with the development of aseptic meningitis and intracranial hypertension. The opportunistic agent could not be identified by cultures. Additional laboratory tests excluded toxoplasmosis, tuberculosis, bacterial cerebral abscesses, syphilitic cerebral gummas, and lymphoma. Brain CT and magnetic resonance studies were compatible with brain vasculitis and leptomeningitis. The patient condition improved with general measures, such as a repeated lumbar punctures and non steroidal anti-inflammatory drugs. We conclude that this patient had an IRIS due to a Cryptococcus neoformans antigen.


Assuntos
Adulto , Feminino , Humanos , Infecções Oportunistas Relacionadas com a AIDS/induzido quimicamente , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/complicações , Meningite Criptocócica/induzido quimicamente , Infecções Oportunistas Relacionadas com a AIDS/líquido cefalorraquidiano , Cryptococcus neoformans , Síndrome Inflamatória da Reconstituição Imune/líquido cefalorraquidiano , Síndrome Inflamatória da Reconstituição Imune/imunologia , Meningite Criptocócica/líquido cefalorraquidiano , Carga Viral
19.
Rev. chil. obstet. ginecol ; 71(3): 201-206, 2006. tab
Artigo em Espanhol | LILACS | ID: lil-464958

RESUMO

Se analizan 19 embarazos en 9 pacientes con miastenia gravis. Hubo 2 exacerbaciones de la enfermedad, una de esta asociada al uso de aminoglicósidos en el tratamiento de pielonefritis aguda. En un caso la enfermedad debutó a las 24 semanas de gestación. Hubo tres casos de miastenia gravis neonatal en la misma gestante, 2 de los recién nacidos fallecieron a los 29 y 25 días respectivamente, pese al tratamiento. Hubo un recién nacido de pretérmino y 6 casos (35 por ciento) de restricción del crecimiento intrauterino.


Assuntos
Feminino , Gravidez , Recém-Nascido , Adolescente , Adulto , Humanos , Miastenia Gravis Neonatal/complicações , Complicações na Gravidez , Miastenia Gravis Neonatal/terapia , Resultado da Gravidez
20.
Rev. chil. neuro-psiquiatr ; Rev. chil. neuro-psiquiatr;43(3): 217-225, sept. 2005. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-420110

RESUMO

El diagnóstico precoz de la infección por Aspergillus del Sistema Nervioso Central (SNC) es un gran desafío, donde la sospecha clínica fundamentada es clave por la alta letalidad de la entidad aún con tratamiento oportuno. La importante dificultad diagnostica es favorecida por algunas características de la entidad: baja incidencia, compromiso de individuos inmunocomprometidos que presentan múltiples infecciones, manifestaciones neurológicas clínicas e imagenológicas inespecíficas y métodos diagnósticos etiológicos de resultados tardíos. Presentamos el caso de un paciente diabético y alcohólico, con aspergilosis meningovascular precedida en 8 meses por un foco fúngico pulmonar. La presentación clínica fue a la manera de una meningoencefalitis subaguda con: cefalea, vértigo, compromiso de lenguaje, hemiparesia, alteración de conciencia y crisis convulsiva. Se trato con Anfotericina B con recuperación clínica completa. En este artículo revisamos algunos aspectos del compromiso por Aspergillus del SNC: mecanismos patogénicos, formas clínicas, factores de riesgo, principales métodos diagnósticos y alternativas de tratamiento.


Assuntos
Masculino , Adulto , Humanos , Aspergilose/diagnóstico , Aspergilose/patologia , Aspergilose/terapia , Antifúngicos/uso terapêutico , Aspergillus/isolamento & purificação , Aspergilose/etiologia , Líquido Cefalorraquidiano/microbiologia , Mananas , Meningoencefalite/etiologia , Fatores de Risco , Síndromes de Imunodeficiência/complicações , Vasculite do Sistema Nervoso Central/complicações
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