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RESUMEN Introducción: El virus SARS-CoV-2, responsable de la COVID-19 presenta una alta tasa de contagio y es capaz de producir afecciones a diferentes niveles en el organismo, e incluye el sistema nervioso central, con manifestaciones como crisis convulsiva febril y afebril, estado de mal epiléptico, encefalopatías y encefalitis. Objetivo: Describir un paciente con encefalopatía, como forma de presentación de la COVID-19. Caso clínico: Paciente de 25 años con antecedentes de hidrocefalia obstructiva postraumática, con derivación ventrículo - peritoneal, positivo a la COVID-19, quien desarrolló manifestaciones neurológicas, en ausencia de manifestaciones respiratorias. Fue tratado según el protocolo para pacientes con la COVID-19, medidas antiedema cerebral y uso del péptido CIGB-258. Tuvo una evolución favorable hacia la recuperación. Conclusiones: En pacientes con encefalopatía de causa desconocida, en el contexto de la pandemia por la COVID-19, debe considerarse la infección por SARS-CoV-2. La evolución puede ser favorable con el uso de medidas generales y antiedema cerebral.
ABSTRACT Introduction: SARS-CoV-2 virus, responsible for COVID-19, has a high contagion rate and is capable of producing conditions at different levels in the body, and includes the central nervous system, with manifestations such as febrile and afebrile seizures, status epilepticus, encephalopathies and encephalitis. Objective: To describe a patient with encephalopathy, as a form of presentation of COVID-19. Clinical case: A 25-year-old patient with a history of post-traumatic obstructive hydrocephalus, with ventricular peritoneal shunt, positive for COVID-19, who developed neurological manifestations, in the absence of respiratory manifestations. He was treated according to the protocol for patients with COVID-19, anti-cerebral edema measures and use of the CIGB-258 peptide. The patient had a favorable evolution towards recovery Conclusions: In patients with encephalopathy of unknown cause, in the context of the COVID-19 pandemic, SARS-CoV-2 infection should be considered. The evolution can be favorable with the use of general measures and anti-cerebral edema.
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Objective To identify factors related to ventricular-peritoneal shunt (VPS) complications in pediatric patients at a high-risk maternity hospital. Methods Prospective study, conducted between September/2018 and June/2019, with selected newborns without previous ventricular bypass who underwent neurosurgery for VPS placement in a high-risk maternity hospital in the state of Sergipe, Brazil. Diagnosis of hydrocephalus occurred by transfontanelle ultrasound. The variables were analyzed by Student t-test, adopting p < 0.05 as statistical significance. Results Seven newborns participated in the study, 3 male and 4 female. Folic acid supplementation during pregnancy was considered a positive influencing factor in the 1st minute Apgar.Hydrocephalus secondary to premature hemorrhagewas present inmost newborns. Prematurity, 1st minute Apgar score < 7, and birth weight< 2,500 g did not represent a significant negative risk factor for prolonged hospitalization after neurosurgery. One newborn had cerebrospinal fluid infection and was the only one with heart disease. Conclusion This is the first scientific research that associates the benefits of maternal use of folic acid during pregnancy to better newborn Apgar scores. Only one newborn developed complications after neurosurgery, the only one with an associated comorbidity. Further studies are needed to provide more evidence on risk factors related to complications of VPS implantation in newborns. This neurosurgical procedure in a highrisk maternity contributed to the early management of hydrocephalus.
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Humanos , Masculino , Feminino , Recém-Nascido , Índice de Apgar , Derivação Ventriculoperitoneal/efeitos adversos , Ácido Fólico/uso terapêutico , Hidrocefalia/cirurgia , Complicações Pós-Operatórias , Estudos Prospectivos , Interpretação Estatística de Dados , Derivação Ventriculoperitoneal/métodos , Gravidez de Alto Risco/líquido cefalorraquidiano , Maternidades , Hidrocefalia/diagnóstico por imagem , Neurocirurgia/métodosRESUMO
El siguiente trabajo constituye una nota técnica sobre un nuevo proceder endoscópico de colocación de catéteres ventriculares permanente a través del cuerno occipital. Se colocaron 20 catéteres permanentes utilizando el sistema DECK con un endoscopio Hopkins II de 30°, diámetro 2,7 mm y longitud 30 cm, con vainas y canales de trabajos. La posición del catéter fue evaluada por tomografía de cráneo realizada a las 24 horas de la cirugía, obteniéndose una posición a (óptima) en el 95 por ciento de los casos, con una distancia promedio de 10,5 cm desde la tabla externa del hueso occipital al cuerno frontal. En ninguno de los casos disfuncionó el sistema derivativo y un solo paciente presentó como complicación un hematoma del lecho quirúrgico.
The following papers is a technical note about a new endoscopic access to lateral ventricle through occipital horn to place ventricles catheters, 20 patient was operated using Deck System of endoscopy with lens of 30 grades, 2,7 mm of diameter and 30 cm of larger, sheets and working canals including. CT scan was performing 24 hours after surgery and optimal position was obtained in 95 percent. Median distance from occipital bon to frontal horn of the ventricles was 10,5 cm. Any patient present dysfunction of the system and only one patient had a hematoma of the surgical area.
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Humanos , Pessoa de Meia-Idade , Catéteres , Derivação Ventriculoperitoneal/métodos , Endoscopia/métodos , Osso Occipital , Ventrículos Cerebrais/cirurgia , Ventriculografia Cerebral , Plexo Corióideo , HematomaRESUMO
La derivación ventrículo peritoneal, constituye el tratamiento quirúrgico de elección para la hidrocefalia o aumento del volumen ventricular que genera un aumento de la presión intracraneal, patología que sin tratamiento puede llevar al daño cerebral irreversible o en caso contrario su resolución tardía en secuelas irreversibles para los pacientes; pero además el tratamiento quirúrgico tiene complicaciones que pueden deteriorar o complicar la recuperación del paciente. En este apartado nos referimos a las complicaciones menos frecuentes que se presentan después del tratamiento quirúrgico, que algunas de las cuales se presentaron en los niños del Hospital Manuel Ascencio Villarroel, con el objetivo de tenerlas siempre presentes, y considerar que aun siendo raras debemos tomarlas en cuenta.
Ventricular peritoneal shunt is the surgical treatment ofchoice for hydrocephalus or increased ventricular volume causes increased intra-cranial pressure pathology without treatment can lead to irreversible brain damage, otherwise its late resolution irreversible consequences for patients, but also surgical treatment has complications that may impair or complicate recovery. In this section we refer to the less common complications that occur after surgery at some patients in the Niñ@ Manuel Ascencio Villarroel Hospital, with the aim of having them always present, and consider that even being rare we must take into account.