Context: Septic Cavernous Sinus Thrombosis (CST) is a rare and potentially lethal illness that clinicians still occasionally see. We describe the evolution of a 6 months old infant patient who had a history of delayed vaccination and acquired a Pneumococcal Meningitis, leading to septic CTS. Case report: The patient was admitted with the complaint of constant crying and vomiting. The physical exam noticed: bulging of the bregmatic fontanelle, Glasgow Coma Score = 11, and bad general state. The clinical picture had begun one week before the hospitalization, but the fever had started just three days before. The vaccine neglection plus some pathological signs of meningeal infection guided the clinical thinking to meningitis, later confirmed by the lumbar puncture. Some days later, the patient presented paralysis of the third pair of cranial nerves, conducing to the inability to open the eyes, mydriatic non-photo reagent pupils, and bilateral swelling. A magnetic resonance confirmed thrombosis of traverse sinus along with the transition to the sigmoid one. Bilateral ptosis and exotropia were noticed. Antibiotic therapy resulted in progressive eye-opening and recurrence of photo reagent reflexes. The prognosis was great, pointed by the normotension and normal amplitude of the bregmatic fontanelle. Conclusion: The elimination of the meningeal infection focus was extremely important, since the pathophysiology of CST came from phlebitis of the cavernous sinuses, with consequent thrombus formation from the endothelial lesion. In addition, it is worth mentioning the omission of vaccination, which was concessive to the case.
A alergia alimentar é uma resposta de hipersensibilidade desencadeada pela ingestão e/ou contato com alimentos. Os mecanismos fisiopatológicos envolvidos podem ser mediados ou não mediados por IgE, variando assim a clínica de acordo com cada mecanismo. No geral, a sintomatologia ocorre por manifestações cutâneas, gastrointestinais e respiratórias. Em alguns casos reações de maior gravidade acometem os pacientes ocasionando nos quadros de anafilaxia. A alergia alimentar é frequentemente diagnosticada sem a presença de um médico, pois as consequências surgem geralmente após o consumo de um determinado alimento. Existem muitos exames para o diagnóstico, principalmente quando a alergia é mediada por IgE, são eles: exames laboratoriais, teste cutâneo, RAST, teste de provocação, etc. O principal tratamento é baseado na dieta de exclusão, sendo muito importante a orientação de um profissional da saúde para a educação do paciente e também dos seus familiares.
Background: Traumatic Brain Injury (TBI) is defined as any traumatic injury causing an anatomical lesion or functional impairment of the scalp, skull, meninges, brain or its vessels. Hospitalization of this patient, depending on the severity, can result in irreversible sequelae or death. Objective: To report the morbidity and mortality rates of patients suffering from TBI hospitalized in Brazilian hospitals between 2010 and 2020. Methods: Descriptive ecological study of the data collected at the Informatics Department of the Unified Health System (DATASUS). Results: There were 1,143,187 admissions due to TBI. There was a predominance of males with 871,999 (76.28%) cases and the age group between 20 and 29 years old 199,857 (17.48%). Brown patients were the ones with the highest hospitalization rate: 370,639 (32.42%). The mortality rate in the period was 9.52/100 hospitalizations, with the Southeast region occupying the first place (10.44 per 100 hospitalizations). In total, 108,853 deaths were recorded, of which 50,013 occurred in the Southeast, the region with the highest rate. Although the number of deaths was higher in people between 20 and 29 years old (16,687), the age group with the highest mortality rate was over 80 years old (19.84 per 100 hospitalizations). Conclusion: In the last 10 years, TBI has caused 1,143,187 hospitalizations in Brazil, with a predominance of males and the age group between 20 and 29 years. Brown patients had the highest rate of hospitalization. The region with the highest mortality was the Southeast and the smallest was the South.
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