Browsing by Author "Mellado, P"

Now showing 1 - 6 of 6
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    Intra-arterial thrombolysis in locked-in syndrome. Report of two cases
    (SOC MEDICA SANTIAGO, 2004) Mellado, P; Sandoval, P; Tevah, J; Huete, I; Castillo, L
    Locked-in syndrome is a dramatic clinical condition, the patient is can listen. and breath, but is unable to move any muscle, conserving only The vertical eye movements. The most common cause of locked-in syndrome is the thrombosis of the basilar artery and commonly leads to death, frequently due to pneumonia. Intravenous and intra arterial thrombolysis have been used successfully in a selective group of patients with ischemic stroke. There is only one report of two patients with locked-in syndrome who were treated successfuly with intra arterial thrombolysis. Other authors, based in their experiences, do not recommended this treatment. We report two female patients aged 63 and 26 years, with Locked-in syndrome due to a basilar thrombosis who were treated successfully with intra arterial thrombolysis using ecombinant tissue plasminogen activator (r-TPA). The lapses between the onset of the symptoms and thrombolysis were 5 and 8 hours respectively. A complete recanalization was obtained in both patients during the thrombolysis. One year after, the first patient has only a moderate ataxia, walking with assistance and the other has a normal neurological examination (Rev Med Chile 2004; 132: 357-60).
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    Ischemic brain infarction after an air embolism. Case report
    (SOC MEDICA SANTIAGO, 2005) Mellado, P; Constanzo, F; Miquel, JF; Ibanez, P
    Ishemic stroke due to embolic air is uncommon. There are few reports of patients with air embolic stroke as a complication of endoscopic procedures. The temporal relationship between the stroke and this procedure is the most important clue for the diagnosis. CT scan and MRI of the brain are confirmatory tests. The morbidity and mortality is high. Patients should be hospitalizedin a critical care service and treated as soon as possible with oxygen in a pressure camera. We report a 52 years old woman with an ovarian cancer that, during an upper gastrointestinal endoscopy, had a severe alteration of consciousness that did not respond to the use of Flumazenil. A CT scan showed multiple areas of air embolism in the watershed are between anterior and middle right cerebral arteries. A conservative treatment was decided and the patients died 48 hours later.
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    Malignant middle cerebral artery territory infarct in one patient with bacterial meningitis
    (SOC MEDICA SANTIAGO, 2004) Lopez, M; Mellado, P; Huete, I
    The mortality of acute bacterial meningitis (BM) has remained stable in the last decades in spite of the use of new antibiotics, probably due to vascular complications. We report a 68-year-old woman with BM who had a malignant infarction of left middle cerebral artery territory 72 hours after admission to the hospital. The patient experienced a bad evolution and died four days after admission. The arterial involvement in patients with BM is explained by vasospasm of large arteries and vasculitis of small arteries. The medical treatment of a malignant middle cerebral artery infarct has a high mortality.
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    Reversible nitrous oxide myelopathy and a polymorphism in the gene encoding 5,10-methylenetetrahydrofolate reductase
    (2006) Lacassie, HJ; Nazar, C; Yonish, B; Sandoval, P; Muir, HA; Mellado, P
    We present a case of a patient who received nitrous oxide on two occasions within a period of 8 weeks and who subsequently developed a diffuse myelopathy, characterized by upper extremity paresis, lower extremity paraplegia and neurogenic bladder. Laboratory testing revealed hyper-homocysteinaemia and low levels of vitamin B-12. Because of this uncommon clinical presentation, we analysed the patient's DNA, and found a polymorphism in the MTHFR gene that is associated with the thermolabile isoform of the 5,10-methylenetetrahydrofolate reductase enzyme, which explained the myelopathy experienced by the patient after being exposed to nitrous oxide. Soon after initiating supplementary therapy with folic acid and vitamin B12, the neurological symptoms subsided.
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    Temporal crescent syndrome. Report of one case
    (SOC MEDICA SANTIAGO, 2004) Mery, V; Mellado, P; Valenzuela, R; Luco, C; Huete, I
    The temporal crescent syndrome or half-moon syndrome is a rare mono ocular retrochiasmatic visual field defect that cart be correlated to a lesion along the contralateral parieto-occipital sulcus. This field defect may be missed in automated perimetry. We report a 45 years old man, consulting for sudden loss of the peripheral temporal field in his right eye. The magnetic resonance imaging and the spectroscopy studies confirmed an ischemic lesion on the left anterior occipital cortex. Control imaging studies six months later did not show changes in the lesion.
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    Wernicke's encephalopathy after Roux-en-Y gastric bypass
    (2004) Escalona, A; Pérez, G; León, F; Volaric, C; Mellado, P; Ibáñez, L
    Complications of bariatric operations include the development of nutritional deficiencies. If protracted vomiting is added, severe vitamin depletion could arise such as thiamine deficiency, resulting in the development of Wernicke's encephalopathy (WE). This article describes the rapid onset of WE in a 6-week postoperative morbidly obese woman. Because the occurrence of micronutrient deficiencies is infrequent, although reports are increasing, symptoms may be misdiagnosed leading to possible irreversible effects on the central nervous system. The importance of a prompt diagnosis of this serious complication and of adequate therapy is emphasized.