RESUMO
A encefalite límbica vem sendo descrita como um distúrbio neurológico raro, que afeta seletivamente as estruturas do sistema límbico. Clinicamente, é caracterizada como uma desordem neurológica debilitante, que se desenvolve como encefalopatia rapidamente progressiva, causada por inflamação encefálica. Objetivamos aqui relatar um caso de encefalite do sistema límbico de provável etiologia autoimune para melhor conhecimento da comunidade médica, bem como averiguar métodos diagnósticos deste quadro. Paciente do sexo masculino, 59 anos, admitido em nosso serviço com queixa de confusão mental. O exame clínico evidenciou desorientação, disartria, paresia e parestesia no hemicorpo esquerdo, dificuldade de marcha, desvio de rima e histórico de epilepsia há 2 anos. No estudo por ressonância magnética do crânio, foram observadas extensas lesões que acometiam a região mesial do lobo temporal direito, todo o hipocampo e giro para-hipocampal direito, estendendo-se pelo fórnix até a porção posterior do hipocampo esquerdo, substância branca do lobo frontal bilateral. Mediante os resultados da investigação complementar, o paciente foi tratado com pulsoterapia de metilpredinisolona por 5 dias, resultando na regressão parcial dos sintomas. Atualmente, o paciente se encontra em seguimento ambulatorial para acompanhamento. A encefalite límbica é uma doença rara, porém muito importante de ser investigada e diagnosticada precocemente, uma vez que a progressão da doença pode causar incapacidade e sequelas irreversíveis.
Limbic encephalitis has been described as a rare neurological disorder affecting the limbic system structures selectively. Clinically, it is characterized as a debilitating neurological syndrome that develops as a quickly progressive encephalopathy caused by brain inflammation. This paper reports a case of limbic encephalitis, probably of autoimmune etiology, aiming to improve the knowledge of the medical community, and to promote a debate on diagnosis methods for this pathology. The patient is male, 59 years old, and was admitted at our service complaining of mental confusion. The clinical examination showed disorientation, dysarthria, left hemiparesis and paresthesia, gait difficulties, light asymmetrical smile, and history of epilepsy 2 years ago. The magnetic resonance imaging of skull showed extensive lesions affecting the mesial region of the right temporal lobe, the entire hippocampus, and right parahippocampal gyrus, extending through the fornix to the posterior portion of the left hippocampus, white matter of bilateral frontal lobe. Based on the complementary investigation results, the patient was treated with intravenous methylprednisolone for five days. Currently, he is being followed in the outpatient's department. Although being rare, limbic encephalitis shall be investigated and diagnosed early because its progression can lead to disability and irreversible sequelae
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Autoimunidade , Encefalite Límbica/diagnóstico por imagem , Paresia/etiologia , Parestesia , Carbamazepina/uso terapêutico , Prednisona/uso terapêutico , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X , Confusão/etiologia , Encefalite Límbica/complicações , Encefalite Límbica/imunologia , Encefalite Límbica/líquido cefalorraquidiano , Encefalite Límbica/tratamento farmacológico , Encefalite Límbica/sangue , Encefalite Límbica/virologia , Disartria/etiologia , Eletroencefalografia , Epilepsia/tratamento farmacológico , Hiponatremia , Anti-Inflamatórios/uso terapêutico , Anticonvulsivantes/uso terapêutico , Exame NeurológicoRESUMO
TITLE: Linfoma B intravascular hipotalamico en una paciente inmunocompetente.
Assuntos
Hipotálamo/irrigação sanguínea , Linfoma de Células B/patologia , Neoplasias Vasculares/patologia , Idoso , Terapia Combinada , Confusão/etiologia , Irradiação Craniana , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hipotálamo/diagnóstico por imagem , Hipotálamo/patologia , Hipotireoidismo/etiologia , Imunocompetência , Linfoma de Células B/complicações , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/terapia , Invasividade Neoplásica , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Transtornos do Sono do Ritmo Circadiano/etiologia , Neoplasias Vasculares/complicações , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/terapia , Vasopressinas/deficiência , Redução de PesoRESUMO
Brandt, R, Bevilacqua, GG, Coimbra, DR, Pombo, LC, Miarka, B, and Lane, AM. Body weight and mood state modifications in mixed martial arts: An exploratory pilot. J Strength Cond Res 32(9): 2548-2554, 2018-Mixed martial arts (MMA) fighters typically use rapid weight loss (RWL) as a strategy to make competition weight. The aim of the present study was to compare body weight and mood changes in professional male MMA athletes who used strategies to rapidly lose weight (n = 9) and with MMA athletes who did not (n = 3). Body mass and mood states of anger, confusion, depression, fatigue, tension, and vigor and total mood disturbance were assessed (a) 30 days before competition, (b) at the official weigh-in 1 day before competition, (c) 10 minutes before competition, and (d) 10 minutes postcompetition. Results indicated that RWL associated with reporting higher confusion and greater total mood disturbance at each assessment point. Rapid weight loss also associated with high anger at the official weigh-in. However, in performance, RWL did not have deleterious effects on performance. The RWL group also reported greater total mood disturbance at all assessment points with a moderate difference effect size. Research supports the notion that RWL associates with potentially dysfunctional mood states.
Assuntos
Afeto/fisiologia , Artes Marciais/fisiologia , Artes Marciais/psicologia , Redução de Peso , Adolescente , Adulto , Desempenho Atlético/fisiologia , Desempenho Atlético/psicologia , Peso Corporal , Confusão/etiologia , Humanos , Estudos Longitudinais , Masculino , Projetos Piloto , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Brucellosis is a chronic bacterial disease caused by members of the genus Brucella. Among the classical species stands Brucella neotomae, until now, a pathogen limited to wood rats. However, we have identified two brucellosis human cases caused by B. neotomae, demonstrating that this species has zoonotic potential. CASES PRESENTATION: Within almost 4 years of each other, a 64-year-old Costa Rican white Hispanic man and a 51-year-old Costa Rican white Hispanic man required medical care at public hospitals of Costa Rica. Their hematological and biochemical parameters were within normal limits. No adenopathies or visceral abnormalities were found. Both patients showed intermittent fever, disorientation, and general malaise and a positive Rose Bengal test compatible with Brucella infection. Blood and cerebrospinal fluid cultures rendered Gram-negative coccobacilli identified by genomic analysis as B. neotomae. After antibiotic treatment, the patients recovered with normal mental activities. CONCLUSIONS: This is the first report describing in detail the clinical disease caused by B. neotomae in two unrelated patients. In spite of previous claims, this bacterium keeps zoonotic potential. Proposals to generate vaccines by using B. neotomae as an immunogen must be reexamined and countries housing the natural reservoir must consider the zoonotic risk.
Assuntos
Brucelose/diagnóstico , Infecções do Sistema Nervoso Central/diagnóstico , Brucella , Confusão/etiologia , Costa Rica , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Portosystemic shunts are rare vascularization disorders, and an uncommon cause of confusional states. We report an 87-year-old male with a previously normal cognitive status who was repeatedly admitted for sudden symptoms of disorientation and functional limitation. The patient had high ammonium levels which lead to the suspicion of the presence a portosystemic shunt, even in the absence of pre-existing liver disease. A contrast enhanced computed tomography of the abdomen confirmed the presence an abnormal communication of the right portal vein with the suprahepatic veins. The communication was embolized and the confusional states of the patient subsided.
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Veia Porta/anormalidades , Confusão/etiologia , Veia Porta/diagnóstico por imagem , Portografia/métodos , Tomografia Computadorizada por Raios X , Embolização Terapêutica/métodos , Compostos de Amônio/sangueRESUMO
Portosystemic shunts are rare vascularization disorders, and an uncommon cause of confusional states. We report an 87-year-old male with a previously normal cognitive status who was repeatedly admitted for sudden symptoms of disorientation and functional limitation. The patient had high ammonium levels which lead to the suspicion of the presence a portosystemic shunt, even in the absence of pre-existing liver disease. A contrast enhanced computed tomography of the abdomen confirmed the presence an abnormal communication of the right portal vein with the suprahepatic veins. The communication was embolized and the confusional states of the patient subsided.
Assuntos
Confusão/etiologia , Veia Porta/anormalidades , Idoso de 80 Anos ou mais , Compostos de Amônio/sangue , Embolização Terapêutica/métodos , Humanos , Masculino , Veia Porta/diagnóstico por imagem , Portografia/métodos , Tomografia Computadorizada por Raios XRESUMO
When the frontal lobe of the brain is affected important behavioral changes may occur mainly at the level of executive functioning, i.e., planning, decision-making, judgment and self-perception. However, the behavioral changes may be of different nature with marked indifference and apathy. We report a clinical case of an 81-year-old patient with sudden onset of behavioral changes that were initially interpreted as an acute confusional episode of infectious etiology, but actually they were due to an ischemic lesion in the frontal lobe.
O lobo frontal, quando afetado, pode provocar alterações importantes do comportamento, principalmente na função executiva: planejamento, tomada de decisões, juízo e autopercepção. Contudo, as alterações podem ser de outra natureza, caracterizando-se por marcada indiferença e apatia. É relatado aqui o caso de uma paciente de 81 anos, com alterações súbitas do comportamento, que foram interpretadas inicialmente como um quadro confusional agudo de natureza infecciosa, mas que se mostraram provocadas por uma lesão isquêmica na região frontal.
Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Isquemia Encefálica/complicações , Lobo Frontal/irrigação sanguínea , Transtornos de Início Tardio/etiologia , Transtornos Psicóticos/etiologia , Isquemia Encefálica , Confusão/etiologia , Transtornos do Humor/etiologia , SíndromeRESUMO
When the frontal lobe of the brain is affected important behavioral changes may occur mainly at the level of executive functioning, i.e., planning, decision-making, judgment and self-perception. However, the behavioral changes may be of different nature with marked indifference and apathy. We report a clinical case of an 81-year-old patient with sudden onset of behavioral changes that were initially interpreted as an acute confusional episode of infectious etiology, but actually they were due to an ischemic lesion in the frontal lobe.
Assuntos
Isquemia Encefálica/complicações , Lobo Frontal/irrigação sanguínea , Transtornos de Início Tardio/etiologia , Transtornos Psicóticos/etiologia , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Confusão/etiologia , Feminino , Humanos , Transtornos do Humor/etiologia , Radiografia , SíndromeRESUMO
The presence of a cerebral aneurysm in patients with pituitary adenoma is a rare event. Diagnostic suspicion may stem from magnetic resonance imaging, which should lead to complementary investigation. As for treatment, even in conditions in which there has been no previous bleeding, the simultaneous approach should be considered, prioritising the aneurysm most of the time. The present report describes the case of a patient with a history of pituitary macroadenoma, who had undergone a partial transsphenoidal resection ten years earlier. Admission to our service occurred after a sudden headache followed by mental confusion. A cranial computed tomography showed subarachnoid haemorrhage and expansive suprasellar lesion. Cerebral angiography showed a saccular aneurysm of the anterior communicating complex. The patient underwent a surgical procedure for microsurgical clipping of the aneurysm and partial resection of the pituitary tumour. We have also included a brief review of the literature on this subject.