Normal Pressure Hydrocephalus In The Spectrum Of Neurological Complications Of Systemic Lupus Erythematosus

Normal pressure hydrocephalus is an unusual manifestation of systemic lupus erythematosus and its pathogenesis is still unclear. We report the case of a 39-year-old white woman with systemic lupus erythematosus who developed magnetic gait, speech difficulties, progressive memory impairment, urinary incontinence and episodes of involuntary closure of the eyelids. Signs and symptoms, associated with ventriculomegaly and normal cerebrospinal fluid pressure, suggested normal pressure hydrocephalus, which as a complication of systemic lupus erythematosus believably develops due to the insidious inflammatory process that occurs in the meningeal tissues or to the vasculitis itself. Normal pressure hydrocephalus tends to develop secondary to trauma, infection or subarachnoid haemorrhage, but in 50 % of patients no aetiology is found. Shunt surgery is the only effective treatment, specifically for the gait disorder, which usually improves more than the cognitive symptoms. Since the tap-test showed a strongly positive result, a medium pressure ventriculoperitoneal shunt was inserted, further replaced by a high pressure one in view of the complications, with less than expected improvement. Subdural hematomas and empyemas developed, requiring surgery and antibiotic therapy. A new tap-test was positive, and the patient improved only after a programmable valve was finally placed. However, pressure regulation shall be continuously required, and shunt dysfunction might still develop in the long term. 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Efeitos de Beauveria bassiana (Bals) Vuill e Metarhizium anisopliae (Metsc) Sorok sobre fêmeas ingurgitadas de Amblyomma cajennense (Fabricius, 1787) em condições de laboratório Effects of Beauveria bassiana (Bals) Vuill and Metarhizium anisopliae (Metsc) Sorok on engorged females of Amblyomma cajennense (Fabricius, 1787) in laboratory conditions

<abstract language="eng">The in vitro susceptibility of Amblyomma cajennense engorged females to some isolated of the fungus Beauveria bassiana and Metarhizium anisopliae was verified and lethal concentrations (LC 50 and LC 90) were calculated. The females were dived in conidia suspensions for five minutes, and kept in climatically controlled chambers BOD under 27&deg; C and 80% relative humidity. Each bioassay had four treatments in concentrations of 10(5),10(6),10(7)e10(8) conidia/ml. A control group was also used. The following characteristics were evaluated: weight and period of oviposition, indexes of reproductive and nutritional efficiency and percentage of microbiological control. A dose dependent negative effect was observed in ticks treated with the suspension. All isolates tested cause a negative effect on in vitro tests of engorged females of A. cajennense, suggesting its potential for microbiological control of tick's species