PubMed · 14786706
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J SIMARRO PUIG, J LLOBERAS CAMINO, F RIBAS CLOTET. 1950. [Functional anisocoria].. https://pubmed.ncbi.nlm.nih.gov/14786706/
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Hypertensive encephalopathy is a severe complication of hypertensive crisis or malignant hypertonia. We report a case with grave clinical and radiological features. The patient was comatose, with pupillary dysfunction, and initial CT suggested a local intracranial mass with edema. Cranial MRI showed almost completely hyperintensive supratentorial white matter, with edema and midline shift, and hypertensities in cerebellum and brainstem. The patient recovered, and the radiological findings improved after antihypertensive therapy. Hypertensive encephalopathy may be differentiated by MRI, manifests acutely, and is potentially reversible when adequate therapy is rapidly performed.
We carried out a 4-year study of 159 children (ages 1 month-14 years) with pneumococcal meningitis. The study was divided into two periods: the retrospective period (1998-2000: 107 patients), and the prospective period (2001-2002: 52 patients). About 2/3 of the children were under 2 years of age: 72 (45%) were under 1 year of age and 38 (24%) had meningitis during the second year of life. One-third of the patients had signs of otitis media; convulsions were more frequent in patients under 1 year compared with older patients (34.7 vs. 14.9%; P=0.004); 13/159 children (8.2%) died; 93/159 (58.5%) recovered completely, 12.6% had motor sequelae, 6.9% hydrocephalus, 29.8% sensorineural hearing loss; 140/159 (88%) were treated with third generation cephalosporins, yet only 8.7% of the pneumococci identified were completely penicillin-resistant (> or =1 microg/ml); 119/159 were treated with dexamethasone. Four patients had received an injection of heptavalent vaccine. Antibiotics for 1 week prior to admission, shock, abnormal pupils, leukocytes count <6,000 mm(3), and CSF glucose < or =8.5 mg/dl were significantly associated with poor outcome and/or death in the univariate analysis. No patient with leukocytosis >16,000/mm(3) died. Conclusion. Sequelae are very common in pneumococcal meningitis. Poor outcome was associated with pupillary abnormality and a leukocyte count <6,000/mm(3) on admission. Leukocytosis was protective against poor outcome.
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