[Epidemiological, clinical and prognostic aspects of subarachnoid hemorrhage in Segovia]. / Aspectos epidemiológicos, clínicos y pronósticos de la hemorragia subaracnoidea en Segovia.

INTRODUCTION: Subarachnoid hemorrhage is a disorder commonly seen as a neurological emergency, with an incidence of 11-19/100,000 persons; 12% of the patients die without seeking medical attention, 63% die during the first year and 72% during the first five years. OBJECTIVE: To describe the epidemiological, clinical and prognostic factors of subarachnoid hemorrhage. PATIENTS AND METHODS: We made a retrospective study of the cases of primary subarachnoid hemorrhage occurring in the province of Segovia between January 1993 and November 1997. The patients presented with a clinical history compatible with subarachnoid hemorrhage which was confirmed by cranial CT and/or lumbar puncture. Angiography of the supra-aortic trunks was done to detect vascular malformations. The patients were classified according to clinical grades on the criteria of Hunt and Hess. RESULTS: There were 54 primary subarachnoid hemorrhages (29 men and 25 women); the average age was 59 years. The average annual incidence was 7/100,000 persons; 59% were at Hunt and Hess stage I-II. Headache was the presenting symptom in 67% of the patients. The patients with normal CT scans (20%) were of lower clinical grade and consulted later; 4% had further bleeding and all these died. There were associated neurological complications in 46% and systemic complications in 28%. Of the 44 arteriographies done, in 14 there were positive findings, 11 aneurysms (five were embolized and five treated surgically), and three arteriovenous malformations (two treated surgically). On discharge 7% had severe neurological sequelae. Mortality during the acute phase was 13%. CONCLUSIONS: Subarachnoid hemorrhage is still a serious condition, with a high rate of mortality during the acute phase (13%) and of sequelae (20%). The clinical grade and cranial CT findings were the main factors in prognosis.

Stenotic and occlusive disease of the venous drainage system of deep brain AVM's.

Angiograms obtained prior to treatment in 53 cases of deep-seated cerebral arteriovenous malformations (AVM's) were retrospectively analyzed with particular attention to the topography of the AVM nidus and the venous drainage. The location of the lesion was determined by a combination of angiography and computerized tomography. Twenty-seven AVM's involved the basal ganglia and thalamus, 12 were located in the corpus callosum, six were intraventricular, and eight involved the mesencephalon and brain stem. Forty-one patients (77.3%) presented with intracranial hemorrhage. Vessel wall irregularities and/or stenosis of the system of the vein of Galen were observed in 14 cases, and occlusion of the deep venous system was present in seven cases. These AVM's showed numerous collateral venous pathways through enlarged medullary and cortical regional veins. There was dominant participation of the basal vein of Rosenthal in all cases. Unique local hemodynamic factors produced by the convergence of the draining veins of the AVM's into the vein of Galen and straight sinus may lead to a higher incidence of stenosis and/or occlusion of the venous drainage. The relatively high incidence of intracranial hemorrhage in these deep-seated AVM's may suggest a relationship between an increased incidence of intracranial bleeding and impaired venous outlets.

Bilateral optic nerve meningioma. Case report.

A case of bilateral optic nerve meningioma is reported. The onset of the clinical symptoms, at age 27, resembled unilateral optic neuritis with papilledema, leading to bilateral amaurosis with optic atrophy 4 years later. Skull X-ray revealed a "blistering' type of bone reaction. In the carotid angiogram, the ophthalmic artery appeared quite enlarged and displaced. The CT scan showed a fusiform enlargement of both optic nerves. Pathological diagnosis was based upon an optic nerve biopsy. Including the present case, only 12 instances of bilateral optic nerve meningioma have been reported.

Arachnoid cysts of the posterior fossa.

A series of 6 patients with arachnoid cysts of the posterior fossa who were treated surgically is presented. The diagnosis of the nature of the lesion and of the exact location within the posterior fossa could not be established on a clinical basis. CT scanning is the best method for diagnosing the lesion and for observing the postoperative evolution. Treatment consisted of removing the cyst walls, shunting the cyst to the peritoneum, or both. The differential diagnosis of arachnoid cysts of the posterior fossa from other cerebrospinal fluid collections, such as the megacisterna magna or the Dandy-Walker malformation, are discussed.

Computed tomography with craniopharyngiomas: a review.

A retrospective study of the computerized tomographic (CT) examinations of 20 children and 13 adults with craniopharyngiomas was undertaken, with special attention paid to the densitometric characteristics of the tumors (contrast enhancement and presence of cysts and calcifications). The aim was to quantify these characteristics and to assess their diagnostic reliability, both alone and together. In suprasellar tumors al three characteristics were present in 75% of the cases, with a diagnostic accuracy of 100%; two were present in 20.6%, with a diagnostic accuracy of 85%; and one was present in 3.4%, with a diagnostic accuracy of 50%. The unusual densitometric presentations of intrasellar tumors are discussed.

Intratumoral hemorrhage in posterior fossa tumors after ventricular drainage. Report of two cases.

Severe intratumoral hemorrhage in posterior fossa tumors is reported in two children, one with a Grade I astrocytoma, and the other with a medulloblastoma. Fatal bleeding occurred a few hours after insertion of ventricular drainage for preoperative management of obstructive hydrocephalus.

Subdural haematoma as a complication in the surgical removal of intracranial hydatidosis.

A patient with multiple cerebral hydatidosis was operated on through a left frontal craniotomy. The occurrence of a subdural haematoma over the right cerebral convexity, secondary to cerebral decompression during the operation, proved fatal. The authors wish to draw attention to the possibility of this type of complication in surgical procedures likely to produce cerebral collapse.