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表现为脑静脉血栓形成的新型隐球菌性脑膜脑炎

Cryptococcal meningoencephalitis presenting as cerebral venous thrombosis.

作者信息

Equiza Jon, Fernandez-Eulate Gorka, Rodriguez-Antigüedad Jon, Campo-Caballero David, Muñoz-Lopetegi Amaia, Goenaga Sanchez Miguel-Angel, Larrea Jose Angel, de Arce Borda Ana

机构信息

Neurology Department, University Hospital Donostia, San Sebastian, Spain.

Infectious Diseases Department, University Hospital Donostia, San Sebastian, Spain.

出版信息

J Neurovirol. 2020 Apr;26(2):289-291. doi: 10.1007/s13365-019-00813-3. Epub 2019 Dec 20.

Abstract

Cerebral venous thrombosis (CVT) is characterized by its variety of neurological manifestations and difficulty in diagnosis. In subacute cases, the main symptoms are secondary to increased intracranial pressure. This condition is associated with an extensive range of medical disorders, but only 2% are caused by a CNS infection in recent series. We report a 45-year-old patient, with no previous medical history, who developed a syndrome of increased intracranial pressure as the presentation of a cryptococcal meningoencephalitis (CM) complicated with a CVT. The patient was first diagnosed of a CVT, and later on, the VIH infection and the CM diagnosis were made. Despite being treated with anticoagulation, liposomal amphotericin B, and a therapeutic lumbar puncture, the patient continued to deteriorate and suffered a respiratory arrest secondary to the increased intracranial pressure, with subsequent brain death. Cryptococcus is an infrequent cause of CNS infection in developed countries, despite being the most frequent cause of meningits in adults in several countries with high rates of HIV infection. CVT is a very rare complication of CM which can contribute to worsen the increased intracranial pressure and in consequence, its prognosis and outcome. A high level of suspicion is needed for diagnosing CM as the underlying cause of CVT and the subsequent increased intracranial pressure should be managed exhaustively.

摘要

脑静脉血栓形成(CVT)的特点是具有多种神经学表现且诊断困难。在亚急性病例中,主要症状继发于颅内压升高。这种情况与多种医学病症相关,但在最近的系列研究中,仅有2%是由中枢神经系统感染引起的。我们报告一名45岁既往无病史的患者,其以颅内压升高综合征为表现,诊断为新型隐球菌性脑膜脑炎(CM)合并CVT。该患者最初被诊断为CVT,随后确诊为艾滋病毒感染及CM。尽管接受了抗凝、脂质体两性霉素B治疗及治疗性腰椎穿刺,但患者病情仍持续恶化,继发于颅内压升高出现呼吸骤停,随后脑死亡。在发达国家,隐球菌是中枢神经系统感染的罕见病因,尽管在一些艾滋病毒感染率高的国家,它是成人脑膜炎最常见的病因。CVT是CM一种非常罕见的并发症,可导致颅内压升高恶化,进而影响其预后和结局。对于将CM诊断为CVT的潜在病因需要高度怀疑,并且应全面处理随后出现的颅内压升高。

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