-Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, although the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic), whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review.KEY WORDS: epidural haematoma, clivus fracture, pediatric trauma.Hematoma cervical epidural com fratura de clivus: relato de caso Hematoma cervical epidural com fratura de clivus: relato de caso Hematoma cervical epidural com fratura de clivus: relato de caso Hematoma cervical epidural com fratura de clivus: relato de caso Hematoma cervical epidural com fratura de clivus: relato de caso RESUMO -As fraturas de clivus são entidades raras e graves, usualmente associadas a lesões vasculares ou de nervos cranianos, sendo freqüentemente diagnosticadas postmortem. Hematomas epidurais cervicais podem ser traumáticos ou espontâneos, manifestos de forma aguda ou crônica, requerendo tratamento cirúrgico na maior parte das vezes, embora o tratamento conservador possa ser indicado a pacientes com déficits incompletos ou não progressivos. Os autores relatam o caso de uma paciente do sexo feminino, 8 anos, vítima de atropelamento em via pública por veículo automotor em alta velocidade, que foi admitida em glasgow 7, com anisocoria (pupila esquerda midriática). A investigação radiológica evidenciou fratura transversa de clivus, hematoma epidural cervical e lesão axonal difusa. A paciente foi submetida a monitorização da pressão intracraniana, sedação e tratamento conservador com corticoesteróides, com boa evolução. Os autores apresentam também uma revisão da literatura pertinente. PALAVRAS-CHAVE: hematoma epidural, fratura de clivus, trauma pediátrico.
Introduction: Vaccination against SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is crucial to controlling the pandemic. Although there are not yet enough data on the coronavirus disease 2019 (COVID-19) and the risk of patients develop Multiple Sxlerosis, it is likely that older patients with higher disability and associated complications have a higher risk of complications from COVID-19 infections. Multiple sclerosis is defined as an inflammatory demyelinating disease characterized by the presence of episodes of neurological dysfunction in at least two areas of the central nervous system (brain, spinal cord and optic nerves) separated in time and space. Case report: A 37-year-old male patient, took the first dose of the pfizer vaccine in July 2021, after three months in October 2021, he started symptoms of bilateral paresthesia in the lower limbs evolving with weakness and faecal incontinence, 21 days later he sought medical service and underwent magnetic resonance imaging of the skull with the finding of eight small oval foci (> 3 mm) of hypersignal in T2 and FLAIR (Fluid-Attenuated Inversion Recovery) in the white matter of the cerebral hemispheres, including periventricular regions. without signs of acute inflammation. cerebrospinal fluid puncture showed the presence of oligoclonal bands associated with an immunoglobulin G index of 1.006 mg/dL. Vaccinated patients can present a myriad of symptoms and autoimmune disorders have been correlated to it. Conclusion: There is no cure for multiple sclerosis, the focus is the fast recovery from acute attacks reducing new relapses and slow progression of disease as well as brain atrophy and disability accumulation. To accomplish this purpose there are several disease modifying therapies for relapsing-remitting multiple sclerosis. Interferon beta medications are the most prescribed medications, with the mechanism of reducing inflammation and increasing nerve growth. Patients taking interferons need blood tests to monitor liver enzymes and experience side effects.
In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belém do Pará Health System, Brazil. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of prednisolone, enoxaparin and macrolides associated and followed in outpatient facilities. Two hundred and eight patients had excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.
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