Base de dados : MEDLINE
Pesquisa : derivação and ventriculoperitoneal [Palavras]
Referências encontradas : 3586 [refinar]
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[PMID]:29390310
[Au] Autor:Jang SH; Chang CH; Jung YJ; Lee HD
[Ad] Endereço:Department of Physical Medicine and Rehabilitation.
[Ti] Título:Recovery of akinetic mutism and injured prefronto-caudate tract following shunt operation for hydrocephalus and rehabilitation: A case report.
[So] Source:Medicine (Baltimore);96(50):e9117, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: A 76-year-old female patient was diagnosed with an aneurysmal subarachnoid hemorrhage following rupture of a right posterior communicating artery aneurysm. PATIENT CONCERNS: She was treated surgically with clipping of the aneurysmal neck. Six months after onset, when starting rehabilitation at our hospital, she showed no spontaneous movement or speech. DIAGNOSES:: aneurysmal subarachnoid hemorrhage following rupture of a right posterior communicating artery aneurysm. INTERVENTIONS: During 2 months' rehabilitation, her AM did not improve significantly. As there was no apparent change, she underwent a ventriculo-peritoneal shunt operation for hydrocephalus 8 months after her stroke. After the surgery, she remained in the AM state, but participated in a comprehensive rehabilitative management program similar to that before shunt operation. During 1 month's intensive rehabilitation, her AM gradually improved. At 9 months after onset, she became able to perform some daily activities by herself including eating, washing, and dressing. In addition, she could speak with some fluency. OUTCOMES: On 6-month DTT, the neural connectivity of the caudate nucleus (CN) to the medial prefrontal cortex (PFC, Broadmann area [BA]: 10 and 12) and orbito-frontal cortex (BA 11 and 13) was low in both hemispheres. However, the neural connectivity of the CN to the medial PFC increased on both sides on 9-month DTT. The integrity of the arcuate fasciculus (AF) was preserved in both hemispheres on both 6- and 9-month DTTs. LESSONS: Recovery of AM and injured PCTs was observed in a stroke patient.
[Mh] Termos MeSH primário: Afasia Acinética/etiologia
Afasia Acinética/reabilitação
Núcleo Caudado/lesões
Hidrocefalia/etiologia
Hidrocefalia/cirurgia
Córtex Pré-Frontal/lesões
Hemorragia Subaracnóidea/complicações
Hemorragia Subaracnóidea/cirurgia
Derivação Ventriculoperitoneal
[Mh] Termos MeSH secundário: Atividades Cotidianas
Idoso
Feminino
Seres Humanos
Recuperação de Função Fisiológica
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009117


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[PMID]:29369173
[Au] Autor:Jang SH; Chang CH; Jung YJ; Seo YS
[Ad] Endereço:Department of Physical Medicine and Rehabilitation.
[Ti] Título:Restoration of the corticoreticular pathway following shunt operation for hydrocephalus in a stroke patient.
[So] Source:Medicine (Baltimore);97(4):e9512, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: We report on a stroke patient who showed restoration of discontinued corticoreticular pathways (CRPs) on serial diffusion tensor tractography (DTT) concurrent with recovery of gait disturbance following shunt operation for hydrocephalus. PATIENT CONCERNS: A 67-year-old female patient underwent stereotactic drainage for management of intraventricular hemorrhage due to a rupture of the left posterior communicating artery. DIAGNOSES: After 4 weeks from onset, the patient exhibited quadriparesis with more severe weakness in the proximal muscles and could not even stand or walk. She underwent comprehensive rehabilitation for 3 weeks. Her quadriparesis, as a result of hydrocephalus, did not improve significantly. INTERVENTIONS: On the pre-op DTT, discontinuations (the right CRP: at subcortical white matter level, and the left CRP: at the midbrain level) of the CRP fibers from the premotor cortex were observed in both hemispheres. OUTCOMES: She underwent a ventriculo-peritoneal shunt operation and her quadriparesis improved, especially the proximal muscles. Consequently, she could walk with mild assistance on an even floor at 5 days and walk on stairs at 4 weeks after the shunt operation. On the post-op DTT, the discontinued CRP fibers were elongated to the premotor cortex in both hemispheres. LESSONS: Restoration of discontinued CRPs concurrent with recovery of gait disturbance following shunt operation for hydrocephalus was demonstrated in a stroke patient.
[Mh] Termos MeSH primário: Hidrocefalia/cirurgia
Quadriplegia/cirurgia
Formação Reticular/cirurgia
Acidente Vascular Cerebral/complicações
Derivação Ventriculoperitoneal/métodos
[Mh] Termos MeSH secundário: Idoso
Hemorragia Cerebral/etiologia
Hemorragia Cerebral/cirurgia
Drenagem/métodos
Feminino
Seres Humanos
Hidrocefalia/etiologia
Quadriplegia/etiologia
Recuperação de Função Fisiológica
Formação Reticular/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009512


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Registro de Ensaios Clínicos
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[PMID]:29262276
[Au] Autor:Kulkarni AV; Schiff SJ; Mbabazi-Kabachelor E; Mugamba J; Ssenyonga P; Donnelly R; Levenbach J; Monga V; Peterson M; MacDonald M; Cherukuri V; Warf BC
[Ad] Endereço:From the University of Toronto (A.V.K.) and the Hospital for Sick Children (A.V.K., R.D., J.L.), Toronto; Pennsylvania State University, University Park (S.J.S., V.M., M.P., M.M., V.C.); CURE Children's Hospital of Uganda, Mbale (E.M.-K., J.M., P.S., B.C.W.); and Harvard Medical School and Boston Ch
[Ti] Título:Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda.
[So] Source:N Engl J Med;377(25):2456-2464, 2017 12 21.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Postinfectious hydrocephalus in infants is a major health problem in sub-Saharan Africa. The conventional treatment is ventriculoperitoneal shunting, but surgeons are usually not immediately available to revise shunts when they fail. Endoscopic third ventriculostomy with choroid plexus cauterization (ETV-CPC) is an alternative treatment that is less subject to late failure but is also less likely than shunting to result in a reduction in ventricular size that might facilitate better brain growth and cognitive outcomes. METHODS: We conducted a randomized trial to evaluate cognitive outcomes after ETV-CPC versus ventriculoperitoneal shunting in Ugandan infants with postinfectious hydrocephalus. The primary outcome was the Bayley Scales of Infant Development, Third Edition (BSID-3), cognitive scaled score 12 months after surgery (scores range from 1 to 19, with higher scores indicating better performance). The secondary outcomes were BSID-3 motor and language scores, treatment failure (defined as treatment-related death or the need for repeat surgery), and brain volume measured on computed tomography. RESULTS: A total of 100 infants were enrolled; 51 were randomly assigned to undergo ETV-CPC, and 49 were assigned to undergo ventriculoperitoneal shunting. The median BSID-3 cognitive scores at 12 months did not differ significantly between the treatment groups (a score of 4 for ETV-CPC and 2 for ventriculoperitoneal shunting; Hodges-Lehmann estimated difference, 0; 95% confidence interval [CI], -2 to 0; P=0.35). There was no significant difference between the ETV-CPC group and the ventriculoperitoneal-shunt group in BSID-3 motor or language scores, rates of treatment failure (35% and 24%, respectively; hazard ratio, 0.7; 95% CI, 0.3 to 1.5; P=0.24), or brain volume (z score, -2.4 and -2.1, respectively; estimated difference, 0.3; 95% CI, -0.3 to 1.0; P=0.12). CONCLUSIONS: This single-center study involving Ugandan infants with postinfectious hydrocephalus showed no significant difference between endoscopic ETV-CPC and ventriculoperitoneal shunting with regard to cognitive outcomes at 12 months. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01936272 .).
[Mh] Termos MeSH primário: Cauterização
Desenvolvimento Infantil
Plexo Corióideo/cirurgia
Hidrocefalia/cirurgia
Derivação Ventriculoperitoneal
Ventriculostomia
[Mh] Termos MeSH secundário: Linguagem Infantil
Cognição
Feminino
Seres Humanos
Lactente
Masculino
Destreza Motora
Testes Neuropsicológicos
Uganda
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171221
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1707568


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[PMID]:28744710
[Au] Autor:Vishnu Bhat B; Mondal N
[Ad] Endereço:Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India. drvishnubhat@yahoo.com.
[Ti] Título:Outcome of Extreme Preterm Babies Treated with Ventriculo-Peritoneal Shunt for Post Hemorrhagic Hydrocephalus.
[So] Source:Indian J Pediatr;84(9):653-654, 2017 09.
[Is] ISSN:0973-7693
[Cp] País de publicação:India
[La] Idioma:eng
[Mh] Termos MeSH primário: Hidrocefalia/cirurgia
Derivação Ventriculoperitoneal
[Mh] Termos MeSH secundário: Seres Humanos
Lactente
Recém-Nascido
Doenças do Recém-Nascido
Doenças do Prematuro
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1007/s12098-017-2427-9


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[PMID]:29281574
[Au] Autor:AbdelRazek MA; Venna N
[Ad] Endereço:Harvard University, Cambridge, MA razek2@hotmail.com.
[Ti] Título:Ventriculoperitoneal-Shunt Placement for Normal-Pressure Hydrocephalus.
[So] Source:N Engl J Med;377(26):e35, 2017 12 28.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hidrocefalia de Pressão Normal/cirurgia
Derivação Ventriculoperitoneal
[Mh] Termos MeSH secundário: Idoso
Encéfalo/diagnóstico por imagem
Feminino
Transtornos Neurológicos da Marcha/etiologia
Seres Humanos
Hidrocefalia de Pressão Normal/complicações
Hidrocefalia de Pressão Normal/diagnóstico por imagem
Imagem por Ressonância Magnética
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMicm1701226


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[PMID]:29232818
[Au] Autor:Gupta R; Ascanio LC; Enriquez-Marulanda A; Griessenauer CJ; Chinnadurai A; Jhun R; Alturki A; Ogilvy CS; Thomas AJ; Moore JM
[Ad] Endereço:Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
[Ti] Título:In Reply to the Letter to the Editor "Validation of Predictive Scoring System for Ventriculoperitoneal Shunt Insertion After Aneurysmal Subarachnoid Hemorrhage: Statistical and Methodologic Issues".
[So] Source:World Neurosurg;109:511, 2018 01.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hemorragia Subaracnóidea/cirurgia
Derivação Ventriculoperitoneal
[Mh] Termos MeSH secundário: Derivações do Líquido Cefalorraquidiano
Seres Humanos
Hidrocefalia/cirurgia
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29232817
[Au] Autor:Safiri S; Ashrafi-Asgarabad A
[Ad] Endereço:Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
[Ti] Título:Validation of Predictive Scoring System for Ventriculoperitoneal Shunt Insertion After Aneurysmal Subarachnoid Hemorrhage: Statistical and Methodologic Issues.
[So] Source:World Neurosurg;109:510, 2018 01.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hemorragia Subaracnóidea/cirurgia
Derivação Ventriculoperitoneal
[Mh] Termos MeSH secundário: Seres Humanos
Hidrocefalia/cirurgia
Estudos Retrospectivos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:28953678
[Au] Autor:Serarslan Y; Yilmaz A; Çakir M; Güzel E; Akakin A; Güzel A; Urfali B; Aras M; Kaya ME; Yilmaz N
[Ad] Endereço:aNeurosurgery Department, Mustafa Kemal University, Hatay bNeurosurgery Department, Ataturk University, Erzurum cRadiology Department, Gaziantep Medical Park Hospital, Gaziantep dNeurosurgery Department, Bahcesehir University, Istanbul eNeurosurgery Department, Gaziantep Medical Park Hospital, Bahcesehir University, Gaziantep fNeurosurgery Department, Eryaman Hospital, Ankara, Turkey.
[Ti] Título:Use of programmable versus nonprogrammable shunts in the management of normal pressure hydrocephalus: A multicenter retrospective study with cost-benefit analysis in Turkey.
[So] Source:Medicine (Baltimore);96(39):e8185, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Ventriculoperitoneal shunt systems that are used in the treatment of normal pressure hydrocephalus are often associated with drainage problems. Adjustable shunt systems can prevent or treat these problems, but they may be expensive. The aim of our study is to compare the complications and total cost of several shunt systems.Patients with normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between 2011 and 2016 were included in the study. The study involves patient consent and the informed consent was given. Complications and the average cost per person were compared between patients with adjustable and nonadjustable shunts. Shunt prices, surgical complications, and revision costs were taken into account to calculate the average cost.Of the 110 patients who were evaluated, 80 had a nonadjustable shunt and 30 had an adjustable shunt. In the group with adjustable shunts, the rates of subdural effusion and hematoma were 19.73% and 3.29%, respectively. In the group with nonadjustable shunts, these rates were 22.75% and 13.75%, respectively. One patient in the adjustable group underwent surgery for subdural hematoma, while 8 patients in the nonadjustable group underwent the same surgery. Ten patients required surgical intervention for subdural effusion and existing shunt systems in these patients were replaced by an adjustable shunt system. When these additional costs were factored into the analysis, the difference in cost between the shunt systems was reduced from 600 United States dollars (USD) to 111 USD.When the complications and additional costs that arise during surgical treatment of normal pressure hydrocephalus were considered, the price difference between adjustable and nonadjustable shunt systems was estimated to be much lower.
[Mh] Termos MeSH primário: Hidrocefalia de Pressão Normal/cirurgia
Complicações Pós-Operatórias
Ajuste de Prótese/métodos
Derivação Ventriculoperitoneal
[Mh] Termos MeSH secundário: Adulto
Idoso
Custos e Análise de Custo
Análise de Falha de Equipamento
Feminino
Seres Humanos
Hidrocefalia de Pressão Normal/epidemiologia
Masculino
Meia-Idade
Avaliação de Processos e Resultados (Cuidados de Saúde)
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/economia
Complicações Pós-Operatórias/etiologia
Complicações Pós-Operatórias/prevenção & controle
Reoperação/economia
Reoperação/métodos
Reoperação/estatística & dados numéricos
Turquia/epidemiologia
Derivação Ventriculoperitoneal/efeitos adversos
Derivação Ventriculoperitoneal/classificação
Derivação Ventriculoperitoneal/economia
Derivação Ventriculoperitoneal/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008185


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[PMID]:28885096
[Au] Autor:Santos MM; Rubagumya DK; Dominic I; Brighton A; Colombe S; O'Donnell P; Zubkov MR; Härtl R
[Ad] Endereço:Department of Neurological Surgery, Weill Cornell Brain and Spine Center, and.
[Ti] Título:Infant hydrocephalus in sub-Saharan Africa: the reality on the Tanzanian side of the lake.
[So] Source:J Neurosurg Pediatr;20(5):423-431, 2017 Nov.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Infant hydrocephalus is estimated to affect more than 100,000 new infants each year in sub-Saharan Africa (SSA). Bugando Medical Centre (BMC), a government-funded and patient cost-shared referral center, serves over 13 million people in the Lake and Western regions of Tanzania. The goals of this study were to characterize the infant population affected by hydrocephalus who presented to BMC and were treated with a ventriculoperitoneal shunt (VPS) to determine the rate of early complications associated with this surgical procedure and to assess its potential risk factors. METHODS Data were prospectively collected from all patients less than 1 year of age who, over a period of 7 months, were diagnosed with hydrocephalus and admitted to BMC for insertion of a primary VPS. Demographic data, maternal history, preoperative studies, surgical procedure, and surgical complications developing by the time of the first follow-up visit were analyzed. Risk factors associated with the surgical complications were determined. RESULTS During the 7-month study period, 125 infants eligible for the study were included in the analysis. Overall, 75% were younger than 6 months of age, and 56% were males. Only 7% of mothers had a gestational ultrasound, 98% did not receive preconception folic acid, and 25% delivered their child at home. In most patients with hydrocephalus the etiology was uncertain (56%), and other patients had postinfectious (22.4%) or myelomeningocele-associated (16%) hydrocephalus. Patients' mean head circumference on admission was 51.4 ± 6.3 cm. Their median age at shunt surgery was 137 days, and 22.4% of the patients were operated on without having undergone radiological assessment. The majority of shunts were placed in a right parietooccipital location. Thirteen patients had undergone a previous intraventricular endoscopic procedure. Overall, at least one surgical complication was found in 33.6% of patients up to the first follow-up assessment (median follow-up time of 70 days); shunt infection was the most common complication. The postoperative mortality rate was 9%. The risk factors associated with early surgical complications were tumor-related etiology, larger head circumference, and postoperative hospital stays of greater duration. CONCLUSIONS In a region of the continent where most infant hydrocephalus cases had an uncertain etiology, most patients presented to the hospital in a late stage, with no prenatal diagnosis and with large head circumferences. Standard preoperative investigations were not uniformly performed, and the surgical complications, led by VPS infection, were disturbingly high. Younger patient age, previous endoscopic procedure, surgeon involved, and cranial location of the VPS had no statistical relation to the surgical complications. This study shows that the positive results previously reported by SSA mission hospitals, subspecialized in pediatric neurosurgery, are still not generalizable to every hospital in East Africa. To improve maternal and neonatal care in the Lake region of Tanzania, the development of a fluxogram to determine hydrocephalus etiology, a strict perioperative protocol for VPS insertion, and an increase in the number of endoscopic procedures are recommended to BMC.
[Mh] Termos MeSH primário: Hidrocefalia/epidemiologia
Hidrocefalia/cirurgia
[Mh] Termos MeSH secundário: Suplementos Nutricionais
Feminino
Ácido Fólico/administração & dosagem
Seguimentos
Seres Humanos
Hidrocefalia/diagnóstico por imagem
Hidrocefalia/etiologia
Lactente
Recém-Nascido
Masculino
Neuroendoscopia
Complicações Pós-Operatórias/epidemiologia
Estudos Prospectivos
Tanzânia
Ultrassonografia Pré-Natal
Derivação Ventriculoperitoneal
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
935E97BOY8 (Folic Acid)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.3171/2017.5.PEDS1755


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[PMID]:28813220
[Au] Autor:LaCasce AS; Flores EJ; Goldstein RH; Sohani AR
[Ad] Endereço:From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.S.L.), the Departments of Radiology (E.J.F.), Medicine (R.H.G.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Medicine (A.S.L., R.H.G.), Radiology (E.J.F.), and Pathology (A.R.S.), Harvard Medi
[Ti] Título:Case 25-2017.
[So] Source:N Engl J Med;377(7):677-688, 2017 Aug 17.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Infecções por Vírus Epstein-Barr/diagnóstico
Linfonodos/patologia
Linfadenopatia/etiologia
[Mh] Termos MeSH secundário: Diagnóstico Diferencial
Infecções por Vírus Epstein-Barr/complicações
Infecções por Vírus Epstein-Barr/patologia
Febre/etiologia
Cefaleia/etiologia
Herpesvirus Humano 4/imunologia
Herpesvirus Humano 4/isolamento & purificação
Seres Humanos
Hidrocefalia/complicações
Linfoma/diagnóstico
Masculino
Meia-Idade
Radiografia Torácica
Tomografia Computadorizada por Raios X
Derivação Ventriculoperitoneal
[Pt] Tipo de publicação:CASE REPORTS; CLINICAL CONFERENCE; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170830
[Lr] Data última revisão:
170830
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170817
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMcpc1706099



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