RESUMO

OBJECTIVE: To evaluate the relationship between impaired brain growth and structural brain abnormalities at term-equivalent age (TEA) and neurodevelopment in extremely low-birth-weight (ELBW) infants over the first 2 years. METHODS: ELBW infants born from 2009 through 2018 and undergoing brain magnetic resonance imaging (MRI) at TEA were enrolled in this retrospective cohort study. MRI scans were reviewed using a validated quali-quantitative score, including several white and gray matter items. Neurodevelopment was assessed at 6, 12, 18, and 24 months using the Griffiths scales. The independent associations between MRI subscores and the trajectories of general and specific neurodevelopmental functions were analyzed by generalized estimating equations. RESULTS: One hundred-nine ELBW infants were included. White matter volume reduction and delayed myelination were associated with worse general development (b = -2.33, P = .040; b = -6.88, P = .049 respectively), social skills (b = -3.13, P = .019; b = -4.79, P = .049), and eye-hand coordination (b = -3.48, P = .009; b = -7.21, P = .045). Cystic white matter lesions were associated with poorer motor outcomes (b = -4.99, P = .027), while white matter signal abnormalities and corpus callosum thinning were associated with worse nonverbal cognitive performances (b = -6.42, P = .010; b = -6.72, P = .021, respectively). Deep gray matter volume reduction correlated with worse developmental trajectories. CONCLUSIONS: Distinctive MRI abnormalities correlate with specific later developmental skills. This finding may suggest that TEA brain MRI may assist with neurodevelopmental prediction, counseling of families, and development of targeted supportive interventions to improve neurodevelopment in ELBW neonates.

Assuntos

RESUMO

Resumen ANTECEDENTES: La incidencia de la corea gravídica es de 1 caso por cada 2275 embarazos. El diagnóstico diferencial se establece con distintas enfermedades neurológicas. El tratamiento de la causa subyacente implica la curación espontánea del cuadro clínico. OBJETIVO: Reportar el caso de una paciente que inició con corea gravídica secundaria a síndrome antifosfolipídico y revisar la bibliografía al respecto. CASO CLÍNICO: Paciente de 37 años, con 28 semanas de embarazo, que consultó por alteraciones del comportamiento. Los estudios de laboratorio reportaron anticuerpos antifosfolipídicos y anti-beta 2 glicoproteína elevados en dos determinaciones separadas por 12 semanas, con ANCA y ANA negativos. En la resonancia magnética cerebral no se informaron hallazgos patológicos. Se estableció el diagnóstico de corea gravídica, secundaria a síndrome antifosfolipídico. La reacción al tratamiento con anticoagulantes y corticosteroides fue satisfactoria; en la actualidad, la paciente permanece asintomática y sin tratamiento. CONCLUSIONES: Las pruebas analíticas y de neuroimagen son útiles para establecer el origen de la corea. El tratamiento con anticoagulantes se indica para prevenir eventos trombóticos en pacientes con corea secundaria a síndrome antifosfolipídico. La eficacia de los corticosteroides en el control de los síntomas neurológicos es variable; no obstante, la paciente del caso tuvo una reacción favorable y desaparición completa de los síntomas.

Abstract BACKGROUND: Chorea gravidarum has an estimated incidence of 1:2275 pregnancies. The differential diagnosis of this entity characterized by involuntary spontaneous movements together with behavioral alterations but be made with different neurological diseases. Generally, treatment of the underlying cause involves spontaneous cure of the condition. OBJETIVES: To report the case of a patient who debuted with a chorea gravidarum secondary to antiphospholipid syndrome and to review the literature. CASE DESCRIPTION: 37-years-old patient, 28 weeks pregnant, who consulted for behavioral alterations. Laboratory test showed elevated anti phospholipid and anti-beta 2 glycoprotein antibodies in two determinations 12 weeks apart, with negative ANCA and ANA. There was no pathological finding in brain magnetic resonance. She was diagnosed with corea gravidarum secondary to antiphospholipid syndrome. She was treated effectively with anticoagulants and corticosteroids, and is currently asymptomatic and without treatment. CONCLUSIONS: Analytical and neuroimaging tests are helpful in establishing the etiology of chorea. anticoagulants are indicated to prevent thrombotic events in chorea secondary to antiphospholipid syndrome. Corticosteroids have variable efficacy in the control of neurological symptoms, although in our case complete remission of the symptoms will be overcome.

RESUMO

Resumen OBJETIVO: Describir las características clínicas e imagenológicas de pacientes con encefalopatía posterior reversible atendidas en una unidad de cuidados intensivos. MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo y transversal de serie de casos efectuado en pacientes con diagnóstico de encefalopatía posterior reversible secundaria a trastornos hipertensivos atendidas en la unidad de cuidados intensivos del Hospital Universitario de la Samaritana, Bogotá, Colombia, entre el 1 de enero de 2013 y el 31 de diciembre de 2020. RESULTADOS: Se encontraron 12 pacientes con encefalopatía posterior reversible; 8 de ellas con inicio durante el puerperio inmediato y 4 en el puerperio mediato. Se diagnosticó eclampsia en 6 pacientes durante el embarazo y en 5 durante el posparto. Los síntomas más comunes fueron: cefalea y convulsiones. Los hallazgos imagenológicos mostraron edema con mayor frecuencia en los lóbulos posteriores del cerebro; sobre todo en el occipital bilateral y parietooccipital. Todas las pacientes fueron dadas de alta del hospital sin lesiones neurológicas irreversibles. CONCLUSIONES: La encefalopatía posterior reversible es poco común pero debe considerarse en las pacientes con síntomas neurológicos concomitantes con los trastornos hipertensivos del embarazo. Si bien la muestra es de pocos casos, sí puede mencionarse que el diagnóstico radiológico con resonancia magnética cerebral, el tratamiento oportuno y las intervenciones multidisciplinarias disminuyen el riesgo de lesiones neurológicas irreversibles y el desenlace fatal.

Abstract OBJECTIVE: To describe the clinical and imaging characteristics of patients with posterior reversible encephalopathy seen in an intensive care unit. MATERIALS AND METHODS: Retrospective, descriptive, cross-sectional case series study performed in patients with a diagnosis of reversible posterior encephalopathy secondary to hypertensive disorders attended in the intensive care unit of the Hospital Universitario de la Samaritana, Bogotá, Colombia, between January 1, 2013 and December 31, 2020. RESULTS: We found 12 patients with reversible posterior encephalopathy; 8 of them with onset during the immediate puerperium and 4 in the mediate puerperium. Eclampsia was diagnosed in 6 patients during pregnancy and in 5 during the postpartum period. The most common symptoms were headache and convulsions. Imaging findings showed edema most frequently in the posterior lobes of the brain, especially in the bilateral occipital and parietooccipital lobes. All patients were discharged from the hospital without irreversible neurological lesions. CONCLUSIONS: Reversible posterior encephalopathy is uncommon but should be considered in patients with neurologic symptoms concomitant with hypertensive disorders of pregnancy. Although the sample is small, it can be mentioned that radiological diagnosis with brain magnetic resonance imaging, timely treatment and multidisciplinary interventions decrease the risk of irreversible neurological lesions and fatal outcome.

RESUMO

In asphyxiated newborn infants treated with hypothermia, 31 of 50 (62%) deaths occurred in unstable infants electively extubated before completing hypothermia treatment. Later deaths occurred after consultation with palliative care (13/19) or clinical ethics (6/19) services, suggesting these decisions were challenging and required support, particularly if nutrition and hydration were withdrawn (n = 4).

Assuntos

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiologic entity not yet understood, that presents with transient neurologic symptoms and particular radiological findings. Few papers show the differences between pregnant and non-pregnant patients. We review the cases of 38 women diagnosed with PRES, in order to find significant differences between pregnant (18) and non-pregnant (20) patients. We found differences among the age of patients (25.83 years old in pregnant and 29.31 years old in non pregnant; P=0.001); in the mean of highest systolic blood pressure, that was higher in non-pregnant group (185:162 mmHg; P=0.121); and in creatinine levels that was higher in non-pregnant group (3.47:1.04 mg/dL; P=0.001). To our knowledge, just a few papers analyzed whether PRES syndrome presented in the same way in pregnant and non-pregnant patients. The differences and the possible pathophisiology of this syndrome still remain enigmatic.

RESUMO

La migraña oftalmopléjica es una condición de la infancia caracterízada por crisis de severa cefalea hemicraneal seguida de parálisis ipsolateral de los nervios tercero, cuarto o sexto. Modernamente se explica mediante la teoría trigémino-vascular de la migraña. Aunque suele ser autolimitada puede dejar secuelas. Los autores comunican los casos de cuatro pacientes: tres niños con parálisis del tercer nervio craneal: una de ellas, desarrolló en el tiempo una regeneración aberrante secundaria, situación excepcional descrita en la literatura internacional en menos de diez pacientes. El último, un adulto con dos episodios de parálisis del sexto nervio craneal y una del tercer nervio. Se discuten sus manifestaciones clínicas y neurorradiológicas.

Ophthalmoplegic migraine in childhood is a painful migraine or headache complicated by an isolated III, IV or VI oculo-motor nerve palsy followed by total resolution without sequelae. The pathogenesis is unclear, however, more recently an hypothesis of trigeminovascular system activation have been proposed. The authors reported four patients with ophthalmoplegic migraine: three children with third cranial nerve palsy; one of them developed secondary aberrant regeneration of the third nerve. It is an exceptional case, because in the international literature less than ten patients had been reported. One case was an adult patient with recurrent nerve palsy (two episodes of sixth cranial nerve palsy and one event of third nerve palsy). Clinical and neuroradiological manifestations are discussed.

Assuntos