[Cerebrovascular disease in a tertiary care hospital. The current situation and points to be improved]. / Patología cerebrovascular en un hospital terciario. Situación actual y puntos de mejora.

INTRODUCTION: Caring for patients suffering from a cerebrovascular diseases requires a large quantity of resources which must be optimised. The aim of this study is to analyse the management of stroke in a tertiary care hospital. PATIENTS AND METHODS: All admissions with a diagnosis of stroke were analysed retrospectively for the year 2003. Length of stay, computed tomography in the Emergency Room, origin, previous admissions during the last year, presence of vascular risk factors, stroke subtype, complications and mortality during admission and destination when discharged from hospital, were all recorded. RESULTS: 936 patients were admitted to hospital with a diagnosis of stroke. 80.22% corresponded to acute ischaemic strokes (27.14% lacunar, 18.57% transient ischaemic attacks, 10.25% cardioembolic, 15.44% aterothrombotic, 8.44% infarct of undetermined cause, 0.24% unusual aetiology) and 19.78% corresponded to haemorrhagic strokes (13.99% intraparenchymatous hemorrhage, 5.79% subarachnoid hemorrhage). Intra-hospital mortality was 5.3%. 11% suffered from complications while in hospital, and average length of stay was 10.4 days, being much longer for those patients discharged to a medium-long stay centre (17.5 days). Compared to other series, the incidence of cardioembolic and aterothrombotic subtypes of stroke is low. However, because of the inclusion of neurosurgical patients, an increase of cerebral haemorrhages is observed. CONCLUSIONS: Intra-hospital morbidity and mortality and average length of stay in our series are consistent with those from other centres of similar characteristics. A better coordination with medium-long stay centres along with the presence of neurologists on call, would certainly improve these variables.

[Chronic subdural haematoma. Presentation and therapeutic attitudes]. / Hematoma subdural crónico. Presentación y actitudes terapéuticas.

INTRODUCTION: The chronic subdural haematoma (CSH) is a present pathology in the day by day of any Neurosurgical Department, and even in the beginning of the xxi century, the different therapeutic options are of current debate. OBJECTIVE: To compare retrospectively the results obtained by different types of surgical techniques, different modalities of drainage systems, and the application or not of perioperative intrathecal solutions. PATIENTS AND METHODS: The data have been obtained by the review of 109 clinical cases treated of CSH between 1996 and 2000 in the Department of Neurosurgery of the Hospital de Cruces (Bilbao). We have analysed the age, sex, background, presenting symptomatology, type of treatment, evolution and mean hospital stay. RESULTS: The report is centred in the analysis of the recurrence rate of the CSH, its principal feature, and so, according to the type of evacuation technique, a burr hole presents 17,2% recurrences, two burr holes 31%, a small craniotomy 50%, and an ordinary craniotomy 66%. According to the drainage system, the subgaleal shunt presents 33,3% recurrences, the subdural 24,5%, and the subdural subgaleal 15,4%. The intrathecal solutions present 37% recurrences. CONCLUSION: After studying all the data, we can conclude that for the treatment of the CSH, the choice of a burr hole and subdural subgaleal shunt and intrathecal solution, can result beneficial in relation to other techniques, although with a minimum difference over the subdural shunt.

Hematoma subdural crónico. Presentación y actitudes terapéuticas / Chronic subdural haematoma. Presentation and therapeutic attitudes

Introducción. El hematoma subdural crónico (HSC) es una entidad presente en el día a día de cualquier servicio de Neurocirugía, y, a inicios del siglo XXI, todavía son de actual debate las distintas opciones terapéuticas. Objetivo. Comparar retrospectivamente los resultados obtenidos a partir de la realización de diversos tipos de técnicas quirúrgicas, diferentes modalidades de sistemas de drenaje, y la aplicación o no de soluciones intratecales perioperatorias. Pacientes y métodos. Los datos se han obtenido mediante la revisión de 109 casos clínicos tratados de HSC, entre 1996 y 2000, en el Servicio de Neurocirugía del Hospital de Cruces (Bilbao). Se han analizado: la edad, el sexo, los antecedentes, la clínica de presentación, el tipo de tratamiento, la evolución y la estancia media hospitalaria. Resultados. El trabajo se ha centrado en el análisis de la tasa de recidiva del HSC, característica principal, y así, según el tipo de técnica evacuadora, un agujero de trépano presenta el 17,2 por ciento de reacúmulos, dos trépanos el 31 por ciento, una trefina el 50 por ciento, y una craneotomía el 66 por ciento. Según el sistema de drenaje, el subgaleal presenta el 33,3 por ciento de recidivas, el subdural un 24,5 por ciento, y el subdurosubgaleal el 15,4 por ciento. Las soluciones intratecales presentan un 37 por ciento de reacúmulos. Conclusión. Tras el estudio de todos los datos, se puede concluir que para el tratamiento del HSC, la elección de un agujero de trépano más drenaje subdurosubgaleal y solución intratecal, puede resultar beneficiosa respecto a otras técnicas, aunque con una mínima diferencia sobre el drenaje subdural (AU)