RESUMO
Brucellosis is a commonly diagnosed zoonosis and neurological involvement is rare. A 30-year-old woman presented with a pulsatile headache that was exacerbated by the Valsalva maneuver and refractory to analgesic therapy. The patient also had nausea, cough, and coryza that evolved over 7 days. The neurological examination was unremarkable. Thrombosis of the lateral and sigmoid sinus and ipsilateral internal jugular vein were diagnosed and anticoagulation therapy was started. Brucella spp was identified in a sample of cerebrospinal fluid (CSF); five months after treatment with rifampicin and doxycycline, CSF was sterile. Cerebral venous thrombosis is a very uncommon sign of brucellosis.
Assuntos
Brucelose/complicações , Trombose dos Seios Intracranianos/microbiologia , Adulto , Antibacterianos/uso terapêutico , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Doxiciclina/uso terapêutico , Feminino , Humanos , Rifampina/uso terapêutico , Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/tratamento farmacológicoRESUMO
Abstract: Brucellosis is a commonly diagnosed zoonosis and neurological involvement is rare. A 30-year-old woman presented with a pulsatile headache that was exacerbated by the Valsalva maneuver and refractory to analgesic therapy. The patient also had nausea, cough, and coryza that evolved over 7 days. The neurological examination was unremarkable. Thrombosis of the lateral and sigmoid sinus and ipsilateral internal jugular vein were diagnosed and anticoagulation therapy was started. Brucella spp was identified in a sample of cerebrospinal fluid (CSF); five months after treatment with rifampicin and doxycycline, CSF was sterile. Cerebral venous thrombosis is a very uncommon sign of brucellosis.
Assuntos
Humanos , Feminino , Adulto , Trombose dos Seios Intracranianos/microbiologia , Brucelose/complicações , Rifampina/uso terapêutico , Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/tratamento farmacológico , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Doxiciclina/uso terapêutico , Antibacterianos/uso terapêuticoRESUMO
INTRODUCTION: Thrombosis of the veins and venous sinuses is an uncommon condition. In 1947 it was described in adults by Garcin and Pestel. It is a potentially serious disorder, in which there is severe intracranial hypertension which may be fatal or cause serious neurological sequelae. Diagnosis is made, during life, on the clinical condition and neuro-imaging features. We consider that treatment of the underlying condition is essential to improve prognosis, although this is controversial. In Cuba there are no publications reporting series of patients with this condition. CLINICAL CASES: We present five patients, four of whom were women, with a neurological disorder involving focal neurological deficits, headache and severe intracranial hypertension, of subacute onset and with convulsions in 60%. The results of imaging studies were compatible with thrombosis of veins and/or venous sinuses. The diagnosis was conformed at necropsy in two patients. The commonest risk factor was the puerperium, occurring in four cases. The patients were treated symptomatically. Two patients died. The other patients made good progress. CONCLUSIONS: The puerperium is the commonest risk factor in thrombosis of the venous sinuses and the veins draining into them. Headache, neurological focal signs and level of consciousness are the main symptoms and signs. Coma, haemorrhagic infarct and convulsions are of bad prognosis and followed by unsatisfactory progress of the disorder.
Assuntos
Veias Cerebrais/microbiologia , Veias Cerebrais/patologia , Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/microbiologia , Trombose Venosa/diagnóstico , Trombose Venosa/microbiologia , Adolescente , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Imageamento por Ressonância Magnética , Masculino , Período Pós-Parto , Tomografia Computadorizada por Raios XRESUMO
The authors describe two cases of cutaneous nose infection that quickly spread and extended to the orbital venous complex. At first glance, the clinical presentation could be mistaken for a complicated sinusal infection; therefore, the evaluation of the sinuses, by means of physical examination and radiological investigation, was of great concern, showing that there was no important pathology in the sinuses. The CT scan and the color Doppler imaging (orbital ultrasound with Doppler) demonstrated, throughout the development of the disease, that the superior ophthalmic vein was affected in both patients and the cavernous sinus in one of them. On physical examination, chemosis of the conjunctiva, proptosis, and edema of the eyelids were prominent. Patients improved only after appropriate intravenous antibiotic therapy against staphylococcus (clindamycin) and corticosteroids, making one conclude that treatment of this disease should be initiated as soon as possible in order to decrease morbidity and mortality.
Assuntos
Bacteriemia/microbiologia , Doenças Nasais/microbiologia , Órbita/irrigação sanguínea , Infecções Cutâneas Estafilocócicas/complicações , Tromboflebite/microbiologia , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Bacteriemia/tratamento farmacológico , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/microbiologia , Celulite (Flegmão)/microbiologia , Clindamicina/administração & dosagem , Clindamicina/uso terapêutico , Doenças da Túnica Conjuntiva/microbiologia , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Diagnóstico Diferencial , Edema/microbiologia , Exoftalmia/microbiologia , Doenças Palpebrais/microbiologia , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Injeções Intravenosas , Pessoa de Meia-Idade , Órbita/diagnóstico por imagem , Doenças dos Seios Paranasais/microbiologia , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/tratamento farmacológico , Trombose dos Seios Intracranianos/microbiologia , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Tromboflebite/diagnóstico por imagem , Tromboflebite/tratamento farmacológico , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , VeiasRESUMO
We report two male adolescents who developed septic thrombosis of the cavernous sinuses after manipulation of a furuncle on the nasal dorsum. We noted in both patients, besides the clinical findings of a generalized infectious process, palpebral edema, proptosis, ptosis, altered pupillary reactivity and bilateral III, IV and VI nerve palsies, as well as dysfunction of the ophthalmic branch of the fifth cranial nerve. One of the patients also had bacterial meningitis. Their cerebral angiograms demonstrated narrowing of the intracavernous portion of both internal carotid arteries. They improved with the antimicrobial treatment, but were left with ptosis and ocular palsies as sequelae. The adequate management of facial furuncle to prevent such a serious complication is emphasized.