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Biomedical subjects

M J Velasco Jabalquinto

Publications and source records attributed to M J Velasco Jabalquinto.

12 recordsLinked to original sources
PubMed2003

[Fatal outcome after severe cerebellar infarction due to spontaneous dissection of the vertebral artery].

Cerebellar infarction due to vertebrobasilar ischemia in spontaneous vertebrobasilar dissection is infrequent in children and adolescents. The commonest pathogenic mechanism of cerebellar infarction is arterial occlusion. Although usually favorable, outcome can be fatal, as in the present case. A previously healthy 4-year-old girl was admitted to the emergency room with sensory failure and trembling. The previous week she had suffered from a transitory ischemic attack that resolved spontaneously. On admission to the emergency department, the Glasgow Coma Scale score was 10/15 and she presented irregular polypneic breathing, anisocoric reactive pupils, enhanced reflexes, lower limb clonus and bilateral pyramidal signs. Cranial computed tomography revealed marked hypodensity in both cerebellar hemispheres and white supratentorial substance with obliteration of the quadrigeminus cisterns. Cerebral angiography showed left vertebral artery dissection with distal pseudoaneurysm and marked basilar occlusion. Despite aggressive antiedemic treatment and early instauration of intravenous continuous sodium heparin infusion, the patient developed a bilateral cerebellar infarction and supratentorial hydrocephalus. Brain death was diagnosed after 48 hours. Postmortem pathologic examination revealed previous thrombus the in superior left cerebellar artery and basilar artery occlusion. We discuss the absence of predisposing factors and the transitory ischemic attack in this patient 1 week before she developed massive cerebellar infarction.

Cerebral Infarction↗
PubMed2000

[Acute bulbar palsy due to myelomeningocele and Chiari II malformation].

We describe a case of a 10-year-old girl with myelomeningocele and type II Chiari malformation. She presented with an acute bulbar palsy requiring mechanical ventilation. Surgical decompression of the brainstem was performed and, because of a phrenic nerve palsy, surgical plication of the right diaphragm was also required. The patient s evolution was favourable. We discuss the various forms of clinical presentation of this pathology as well as its management. The importance of early diagnosis and surgical correction are also stressed as a key factor for favourable evolution.

Acute Disease↗
PubMed2000

[Delayed postanoxic encephalopathy].

We report the case of a 9-year-old boy with delayed postanoxic encephalopathy. The patient improved after a period of coma and adult respiratory distress syndrome caused by benzodiazepine intoxication. Initial improvement appeared to be complete, but 9 days after discharge from the pediatric intensive care unit, extrapyramidal rigidity of the left arm became manifest. This event was followed by progressive neurologic impairment with involuntary, non-repetitive, but occasionally stereotyped movements, affecting distal, proximal and axial musculature in various combinations. On physical examination, passive movement of the left arm showed a plastic, lead-pipe rigidity with a ratchet-like cogwheel quality. Magnetic resonance imaging (MRI) was performed. Axial T 2 -weighted images of the brain showed characteristic signs of an ischemic area in the basal ganglia which were more evident in the right region, a finding consistent with anoxic-ischemic encephalopathy. Delayed postanoxic encephalopathy is a relatively uncommon and unexplained phenomenon which becomes manifest after an initial hypoxic-ischemic event that causes stupor or coma. The pathogenesis is unknown. Exceptionally, this syndrome can affect the basal ganglia more than the cerebral cortex and white matter. Initial improvement is followed after a variable period of time by relapse, progressing for weeks to months until the patient is left with permanent sequelae.

Child↗
PubMed1997

[Hypoxic-ischemic coma in children. Factors related to the prognosis].

OBJECTIVE: The purpose of this study was to analyze the etiology, evolution and predictive value of clinical variables and complementary explorations in children admitted to a PICU with hypoxic-ischemic coma. PATIENTS AND METHODS: A retrospective review (1991-1996) of 24 children with hypoxic-ischemic coma admitted to the pediatric ICU of a reference hospital was performed. Clinical data on admission and results of complementary explorations (EEG and neuroimaging techniques) were collected and the findings compared according to the evolution and underlying pathophysiological mechanism. RESULTS: Non-reactive and dilated pupils, existence of neurohypophyseal disorders and isoelectric EEGs were exclusively found in dead patients. A score of 3-4 on the Glasgow Coma Score was obtained more frequently in groups with the worse evolution (exitus and surviving with sequelae), as well as positive findings with neuroimaging techniques and the appearance of seizures, though without meaningful differences. More significant was the existence of associated problems, which was more frequent in groups with a negative evolution. The differences among the pathophysiological groups were not meaningful. Global mortality in the series studied was 41.6%, with 29.2% of the survivors having neurological sequelae and 29.2% being healthy. CONCLUSIONS: Hypoxic-ischemic coma in children has a high mortality and morbility. The prognosis for each patient is based on the clinical facts and complementary explorations. No isolated data allows the establishment of the final outcome with certainty.

Brain Ischemia↗
PubMed1989

[Brain death in the child. Review of 12 cases].

Twelve brain death diagnosed children have been retrospectively surveyed. Their age ranged between seven months and thirteen years (mean = 5.7 years old). Etiology was as follows: eight of cranial trauma, two of ground-trapped asphyxia, one of hypernatremic dehydration ans one of subglottic laryngitis. When a brain death diagnosis was suggested, neurodiagnosis complementary tests were carried out eight cases presented an isoelectric EEG since the first recording and their evoked potentials did no reflect any response. Among the eight children to whom brain angiogammography was made, five presented no flow in the first study. Brain circulation signs were detected in two other children, disappearing subsequently. When the EEG was isoelectric, positive responses were never obtained from the brainstem. However, flow was detected in two cases. We suggest that, in doubtful cases, absence of brain radioisotopic activity is the most specific way to assess brain death in children.

Adolescent↗
PubMed1989

[Study of oxygenation and ventilation in critically ill children by non-invasive methods].

Oxygenation and ventilation were studied by invasive and non-invasive methods in 31 critically ill children; the average age was 27.1 +/- 12.6 months (range from 1 to 144 months). All the patients were receiving mechanical ventilation and had arterial catheters. We correlated PtcO2, PtcCO2 and StcO2 with their respective arterial values, when FiO2 was 1.0, 0.6 and 0.4. There was a good correlation (p less than 0.001) in the three values of FiO2, but it was especially significant in 0.4 (r = 0.904 for PaO2 and PtcO2, r = 0.905 for PaCO2 and PtcCO2 and r = 1 for SaO2 and StcO2). We conclude that StcO2 is the most reliable transcutaneous parameter to evaluate oxygenation state in critically ill patients.

Child↗
PubMed1988

[Hospital infection and resistance to antibiotics at a pediatric intensive care unit].

A retrospective study of nosocomial infection and its aetiological agents antimicrobial sensitivity in a pediatric ICU during 65 months is reported. Using statistical analysis association was found between infection site and certain diagnostic-therapeutic procedures, such as urinary infection and urinary tract catheter, respiratory lower tract infection and respiratory assistance devices, bacteremia with intravenous catheters. Also found relationship between age and causal agents: Streptococcus faecalis is the main microorganism in newborns and Pseudomonas aeruginosa in older patients. Gram negative bacilli sensitivity increased significantly for some antimicrobial drugs: carbenicillin, cefotaxime, gentamicin, fosfomycin and tobramycin, whereas gram positive microorganisms sensitivity decreased to cephalothin, cefoxitin, trimethoprim-sulphamethoxazole and gentamicin.

Anti-Bacterial Agents↗