Images in Intensive Medicine
Zika virus encephalitis
Encefalitis por virus Zika
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The lesion presents well defined margins, with an internal echolucency corresponding to CDMV. The image at right (longitudinal plane of the short axis of the left ventricle) shows the described lesion to be limited to the posterior leaflet of the valve (arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Arroyo Diez, M. Montero Baladía, A. Zabalegui Pérez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Arroyo Diez" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Montero Baladía" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Zabalegui Pérez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569118300391" "doi" => "10.1016/j.medin.2018.01.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118300391?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718302005?idApp=WMIE" "url" => "/21735727/0000004300000001/v1_201901260634/S2173572718302005/v1_201901260634/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173572718302066" "issn" => "21735727" "doi" => "10.1016/j.medine.2018.10.006" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1144" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2019;43:58" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 917 "formatos" => array:3 [ "EPUB" => 151 "HTML" => 536 "PDF" => 230 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Intensive Medicine</span>" "titulo" => "Complete rupture of the pancreas due to blunt abdominal trauma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "58" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rotura pancreática completa secundaria a traumatismo abdominal cerrado" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 481 "Ancho" => 850 "Tamanyo" => 38510 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI. The arrows show the location of the rupture.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Moya-Espinosa, M. Mateos-Rodriguez, J. Pérez-Vacas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Moya-Espinosa" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Mateos-Rodriguez" ] 2 => array:2 [ "nombre" => "J." 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"apellidos" => "Jáuregui Solórzano" "email" => array:1 [ 0 => "jmjauregui25@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Medicina Crítica, Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Terapia Intensiva, Hospital Luis Vernaza, Guayaquil, Ecuador" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Encefalitis por virus Zika" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figures 2 C and D" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 501 "Ancho" => 950 "Tamanyo" => 51951 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Progression of the lesions to cerebral peduncles and basal ganglia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Twenty-three-year old male with a clinical history of biliary pancreatitis one month ago and one cholecystectomy one week ago who now shows clinical manifestations of fever, dizziness, confusion, and significant muscle weakness in lower limbs of two-day duration leading to his admission in the internal medicine unit. The physical examination showed signs of dehydration and postoperative complications were ruled out. Normal brain and abdominal CT scans. The next day, the patient develops drowsiness, quadriplegia, hyporeflexia followed by stupor and hemodynamical instability that leads to the patient's admission to the Intensive Therapy Unit; empirical treatment was started with meropenem and vancomycin. One brain MRI was conducted that confirmed the presence of one hyperintense lesion in the brainstem, fornix, and bilateral thalamus (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1 A and B</a>, white arrows) without midline shift. The differential diagnosis included vasculitis, herpes, tuberculosis and toxoplasmosis. The biochemical and cytological analysis of the cerebrospinal fluid was nonspecific, and the molecular biology study conducted using the PCR method confirmed the presence of Zika virus ARN. Immunomodulating therapy was initiated with human immunoglobulin (IgG) and five (5) days later a new MRI was conducted that showed the progression of the lesions to cerebral peduncles and basal ganglia (<a class="elsevierStyleCrossRef" href="#fig0010">Figs. 2 <span class="elsevierStyleSmallCaps">C</span> and D</a>, white arrows) followed by multiple organ dysfunction and death.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors confirm no funding whatsoever.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vergara Centeno JL, González Zambrano L, Jáuregui Solórzano JM. Encefalitis por virus Zika. Med Intensiva. 2019;43:59.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figures 1 A and B" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 493 "Ancho" => 950 "Tamanyo" => 52661 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hyperintense lesions in brain-stem, fornix and bilateral thalamus.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figures 2 C and D" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 501 "Ancho" => 950 "Tamanyo" => 51951 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Progression of the lesions to cerebral peduncles and basal ganglia.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004300000001/v1_201901260634/S2173572718302054/v1_201901260634/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000001/v1_201901260634/S2173572718302054/v1_201901260634/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718302054?idApp=WMIE" ]
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