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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(02): e198-e206
DOI: 10.1055/s-0041-1740619
Case Report

Surgical Treatment for Refractory Aggression after Bacterial Meningitis Complicated by Stroke: Case Report

Tratamento cirúrgico para agressividade refratária pós-meningite bacteriana complicada por acidente vascular encefálico: Relato de caso
Pietro Alessandro Vaccario 
1   School of Medicine, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
,
Alícia Carolina Rodrigues Rocha 
1   School of Medicine, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
,
Ledismar José da Silva 
1   School of Medicine, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
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Abstract

Bacterial meningitis remains a public health problem. One of the complications of this group of diseases is cerebral ischemia, an important indicator of severity and an independent predictor of poor prognosis. It is already known that, in many cases, pathological aggressiveness is the result of brain abnormalities in individuals with mental illnesses. The indication of neurosurgeries for psychiatric disorders (NPDs) relies on numerous studies based on scientific evidence that correlate psychiatric illnesses with the limbic system and the pathophysiology of emotions. The development of sophisticated stereotactic target localization techniques, brain atlases, and imaging methods made stereotaxis possible, a procedure that increased the precision of neurosurgery and reduced brain damage. Nowadays, multiple targets can be treated during NPD, according to the particular characteristics of the patient. Moreover, the combination of lesions leads to more significant improvements compared with isolated procedures. The present study aimed to report the rare case of a patient with a history of bacterial meningitis who developed stroke and chronic pathological aggressiveness refractory to clinical treatment and underwent ablation using the multitarget stereotactic technique.

Resumo

A meningite bacteriana continua sendo um problema de saúde pública. Uma das complicações deste grupo de doenças é a isquemia cerebral, um importante indicador de gravidade e um preditor independente de mau prognóstico. Já se sabe que, em muitos casos, a agressividade patológica é o resultado de anormalidades cerebrais em indivíduos com doença mental. A indicação das neurocirurgias para doenças psiquiátricas (NDPs) se fundamenta em inúmeros estudos com base em evidências científicas, os quais correlacionam as enfermidades psiquiátricas com o sistema límbico e a fisiopatologia das emoções. O desenvolvimento de técnicas sofisticadas de localização de alvos estereotáxicos, atlas cerebrais e métodos de imagem tornaram a estereotaxia possível, um procedimento que aumentou a precisão da neurocirurgia e reduziu os danos cerebrais. Atualmente, múltiplos alvos podem ser tratados durante a NDP, de acordo com as características individuais do paciente. Ademais, a combinação das lesões leva a melhorias mais significativas em comparação com os procedimentos isolados. O presente estudo teve como objetivo relatar o caso raro de uma paciente com histórico de meningite bacteriana que evoluiu para acidente vascular encefálico e agressividade patológica crônica refratária ao tratamento clínico e foi submetida a ablação utilizando a técnica estereotáxica de múltiplos alvos.

Keywords

bacterial meningitis - psychosurgery - neurosurgery for psychiatric disorders - limbic system - aggression

Palavras-chave

meningite bacteriana - psicocirurgia - neurocirurgia para doenças psiquiátricas - sistema límbico - agressão


Publication History

Received: 27 October 2020

Accepted: 06 September 2021

Article published online:
07 January 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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