RESUMO
We present a patient with laboratory-confirmed coronavirus disease who subsequently developed encephalopathy. The patient was brought to a primary care center due to slight symptoms, however the patient presented a seizure with generalized tonic-clonic movements with respiratory depression and reversible cardiorespiratory arrest, requiring orotracheal intubation and midazolam. After that the patient was transferred to the NICU where he was admitted with signs of dehydration, and he presented another reversible cardiac arrest. Given an inadequate response to weaning from mechanical ventilation, troponin increasing and chest X-ray suggestive of a pneumonic process, ampicillin sulbactam was considered. and took a tracheal secretion cultures and COVID-19 test, finding and methicillin sensitive , as well as a COVID-19 positive PCR test antibiotic management for bacterial pneumonia was started. It is to highlight the importance of recognizing that acute encephalitis is one of the most serious complications of pediatric viral infections, since it can lead to motor and intellectual sequelae, and even epilepsy in some cases.
Presentamos el caso de un paciente de 6 meses que presentó cuadro clínico de emesis, convulsiones tónico-clónicas generalizadas y dos paradas cardiorrespiratorias, requiriendo intubación orotraqueal y soporte inotrópico en la UCIN. Se obtuvo prueba de PCR COVID-19 positiva, se realizó el diagnóstico de encefalitis viral aguda y se inició manejo con antiepiléptico intravenoso, sedoanalgesia, soporte inotrópico, corticoide intravenoso, inmunoglobulina humana, N-acetilcisteína y tromboprofilaxis. Debido a la instauración atípica de la infección por COVID-19 en este grupo de edad, discutimos el espectro de presentación de la encefalitis viral en pediatría y su manejo desafiante.
Assuntos
Humanos , Masculino , Lactente , Encefalite Viral/complicações , Encefalite Viral/tratamento farmacológico , COVID-19/complicações , Convulsões , Encefalite Viral/diagnóstico por imagem , Tratamento Farmacológico da COVID-19 , Anticonvulsivantes/uso terapêuticoRESUMO
BACKGROUND: Viral meningoencephalitis is highly heterogeneous, varying by geographic location. The aim of this study was to characterize the etiology and reporting the clinical findings and outcome of viral encephalitis in children in southern Brazil. METHODS: A cross-Sectional study was conducted at Hospital Pequeno Príncipe, Curitiba, Brazil, between January 2013 and December 2017. It included patients younger than 18 years, who fulfilled the criteria: altered mental status as a major criteria and 2 or more minor criteria (1) fever, (2) seizures, (3) focal neurologic findings, (4) central system fluid white cell count of ≥5 cells/mm, (5) abnormal brain imaging, and/or (6) electroencephalogram abnormalities. RESULTS: Viral meningoencephalitis was diagnosed in 270 children, with median age of 2 years (interquartile range: 0-4), The etiology of viral meningoencephalitis was confirmed in 47% of patients. Enterovirus (18%) was the major cause of encephalitis in Southern Brazilian children, and a high prevalence of Epstein-Barr virus (6%) was demonstrated. Most patients presented with fever (81%), followed by vomiting (50%), focal neurologic findings (46%), seizures (31%) and headache (30%). Few abnormalities were detected on electroencephalograms and brain magnetic resonance images. On discharge from hospital, symptoms resolved completely in 87% of children. Sequelae were mainly observed in patients with focal neurologic symptoms (P<0.001), presence of seizures (P<0.001) and electroencephalogram abnormalities (P=0.024). CONCLUSIONS: Enterovirus was the major cause of encephalitis. Etiologic agent of encephalitis seems to be influenced by the local virologic pattern. A poor outcome was identified in patients with seizures, focal neurologic findings and electroencephalogram abnormalities.
Assuntos
Encefalite Viral/epidemiologia , Vírus/patogenicidade , Doença Aguda/epidemiologia , Adolescente , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/virologia , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Eletroencefalografia , Encefalite Viral/complicações , Encefalite Viral/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Espectroscopia de Ressonância Magnética , Masculino , Convulsões/etiologia , Vírus/classificaçãoRESUMO
Chikungunya, an alphavirus infection presenting with fever, rash, and polyarthritis, is most often an acute febrile illness. Neurologic complications of chikungunya infection have been reported. Here we report the clinical and neuroimaging data of 2 patients with chikungunya-associated encephalitis during the recent Brazilian epidemic.
Assuntos
Febre de Chikungunya/complicações , Encefalite Viral/virologia , Idoso , Brasil/epidemiologia , Febre de Chikungunya/epidemiologia , Surtos de Doenças , Encefalite Viral/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
The symptoms of chikungunya virus (CHIKV) infection include fever, headache, muscle aches, skin rash, and polyarthralgia, characterized by intense pain, edema, and temporary functional impairment. This is the first report of encephalitis caused by CHIKV infection associated with an atypical presentation of syndrome of inappropriate antidiuretic hormone secretion, evolving to cognitive impairment and apraxia of speech.
Assuntos
Febre de Chikungunya/complicações , Encefalite Viral/diagnóstico por imagem , Encefalite Viral/virologia , Síndrome de Secreção Inadequada de HAD/virologia , Feminino , Humanos , Síndrome de Secreção Inadequada de HAD/diagnóstico por imagem , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
Abstract Chikungunya, an alphavirus infection presenting with fever, rash, and polyarthritis, is most often an acute febrile illness. Neurologic complications of chikungunya infection have been reported. Here we report the clinical and neuroimaging data of 2 patients with chikungunya-associated encephalitis during the recent Brazilian epidemic.
Assuntos
Humanos , Masculino , Idoso , Encefalite Viral/virologia , Febre de Chikungunya/complicações , Brasil/epidemiologia , Imageamento por Ressonância Magnética , Surtos de Doenças , Encefalite Viral/diagnóstico por imagem , Febre de Chikungunya/epidemiologia , Pessoa de Meia-IdadeRESUMO
Abstract The symptoms of chikungunya virus (CHIKV) infection include fever, headache, muscle aches, skin rash, and polyarthralgia, characterized by intense pain, edema, and temporary functional impairment. This is the first report of encephalitis caused by CHIKV infection associated with an atypical presentation of syndrome of inappropriate antidiuretic hormone secretion, evolving to cognitive impairment and apraxia of speech.
Assuntos
Humanos , Feminino , Encefalite Viral/virologia , Encefalite Viral/diagnóstico por imagem , Febre de Chikungunya/complicações , Síndrome de Secreção Inadequada de HAD/virologia , Imageamento por Ressonância Magnética , Síndrome de Secreção Inadequada de HAD/diagnóstico por imagem , Pessoa de Meia-IdadeAssuntos
Neoplasias Encefálicas/diagnóstico por imagem , Infecções por Citomegalovirus/diagnóstico , Encefalite Viral/diagnóstico , Lobo Frontal/patologia , Transplante de Rim , Neuroimagem/métodos , Antivirais/farmacologia , Infecções por Citomegalovirus/diagnóstico por imagem , Infecções por Citomegalovirus/tratamento farmacológico , Diagnóstico Diferencial , Encefalite Viral/diagnóstico por imagem , Encefalite Viral/tratamento farmacológico , Lobo Frontal/diagnóstico por imagem , Ganciclovir/farmacologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurologia/educaçãoRESUMO
Introducción: La encefalitis por herpes simple (EHS) en niños y adultos, es producida por el virus herpes simple serotipo 1 (VHS 1), y constituye la causa más común de encefalitis fatales no epidémicas. El tratamiento precoz con antivirales disminuye significativamente la morbimortalidad. El diagnóstico de EHS puede establecerse por análisis de líquido cefalorraquídeo (LCR), aunque las técnicas habitualmente utilizadas pueden arrojar resultados normales dentro de la primera semana del comienzo de los síntomas. Actualmente el diagnóstico temprano se establece con los datos clínicos y electroencefalográficos, apoyados en los hallazgos de imágenes por Resonancia Magnética (RM). Casos presentados: Se presentan 5 casos de EHS estudiados por tomografía computada (TC) y RM. Se analizan los hallazgos en imágenes por RM en estadio agudo, subagudo y crónico, y se discuten brevemente los mecanismos patogénicos y las características clínicas y EEG de la enfermedad. Conclusión: Las imágenes por RM muestran cambios patológicos tempranos con elevada sensibilidad, por lo que ante la sospecha clínica de EHS constituyen el método de diagnóstico por imágenes de elección (AU)
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Encefalite Viral/diagnóstico , Cérebro/diagnóstico por imagem , Herpesvirus Humano 1/patogenicidade , Tomografia Computadorizada por Raios X/normas , Imageamento por Ressonância Magnética , Encefalite Viral/mortalidade , Encefalite Viral/diagnóstico por imagemRESUMO
A case of epilepsia partialis continua (EPC) in a eight year old girl is presented. The episode EPC involved the left side of the face and the left arm and leg with progressive neurologic deficit and mental impairment. The focal seizures did not respond to treatment with a wide variety of antiepileptic drugs. The patient was studied with a 99mTc HMPAO-SPECT in addition to EEG, CT and MRI procedures. During the ictal period the SPECT showed an increased cerebral blood flow in the right hemisphere especially in the Rolandic area and the temporal lobe; during the interictal period a decreased flow was seen in the same regions. The EEG showed marked epileptogenic activity consisting of continued spike and slow wave discharges over the right brain hemisphere; the CT scan was normal and the MRI showed an increased signal intensity in the white and gray matter in the right hemisphere, especially in the frontal and temporal lobes. A temporal lobectomy and a frontal corticectomy were done. The pathologic specimens showed changes consistent with viral encephalitis (Rasmussen's syndrome). The patient has not had seizures in the ten months after surgery. She returned to school three months after surgery, and her IQ was normal. This report illustrates the usefulness of the 99mTc HMPAO-SPECT technique for the diagnosis and the management of EPC cases.