Pleural effusion in a child with a correctly placed ventricle-peritoneal shunt.

Pleural effusions in children (PE) due to ventricle-peritoneal shunt (VPS) is very rare, with few cases reported. We present a new case of an infant with VPS who had a massive hydrothorax not associated with misplacement or migration of the distal catheter or with ascites. After the evacuation of the PE we managed the patient by adjusting the pressure of the adjustable valve (AV). Sequential thoracic ultrasounds showed a satisfactory outcome. We review the literature thoroughly and describe the possible pathophysiological mechanisms.

[Fluorescence-guided resection with 5-aminolevulinic acid of an intramedullary tumor]. / Resección de tumor intramedular guiada por fluorescencia con ácido aminolevulínico.

Fluorescence-guided resection with 5-aminolevulinic acid (5-ALA) has demonstrated its usefulness in the resection of malignant cerebral gliomas. It also seems useful for the treatment of other types of cerebral and intramedullary neoplasms. We present the case of a patient with an intramedullary tumor in who fluorescence- guided resection was useful for intraoperative localization, definition of small tumor nodules and in order to achieve a complete resection of the tumor.

[Neurological sequelae of child abuse. Literature review]. / Secuelas neurológicas del maltrato infantil. Revisión bibliográfica.

Child abuse is both socially and medically troublesome and many times produces permanent consequences. A review of the literature is done from a neurosurgical standpoint, and the lesions produced at the Central Nervous System are evaluated in detail, including their physiopathology, neurological sequels and implications for rehabilitation treatment and the child's future life.

[Hydrocepahlia and subarachnoid cyst due to neurocysticercosis. A new case from rural Extremadura]. / Hidrocefalia y quiste subaracnoideo por neurocisticercosis. Un nuevo caso en una zona rural de Extremadura.

INTRODUCTION: Neurocystercicosis (NCC) is a disorder caused by the Taenia solium larva. It is the commonest parasitosis of the CNS. In Spain most patients are from countries where the condition is endemic. However, sporadic cases still occur amongst the non immigrant population of rural regions. We report a new case of NCC from the Valle del Jerte in rural Extremadura. CASE REPORT: A 51 year old man presented with intellectual impairment, motor aphasia, apraxia, right hemiparesia and sphincter incontinence for the past six months. On cranial CAT and MR hydorcephalia was seen together with a subarachnoid cyst in the left Sylvan fissure. Serology was positive for cysticercosis in both plasma and CSF. The patient was treated with albendazol after insertion of a ventriculo peritoneal shunt. Three months later there was both clinical and radiological improvement. CONCLUSION: NCC is still a condition which must be included in the differential diagnosis of patients in Spain who present with CNS involvement and cystic lesions on neuro imaging investigations, even when they are not from countries where the disease is endemic. Treatment with albendazol and steroids given after insertion of a ventriculo peritoneal shunt was effective in our patient.

[Rapid spontaneous resolution of acute subdural hematoma]. / Resolución precoz espontánea de hematoma subdural agudo intracraneal.

Acute subdural hematomas are usually neurosurgical emergencies, although a conservative therapy is indicated in selected cases. In some of these patients a progressive resolution is appreciated. However, rapid spontaneous resolution of an acute suddural hematoma is seldom reported. A patient with antecedent of chronic alcoholism and spontaneous resolution of acute subdural hematoma in less than 18 hours after the head injury is described. The possible mechanisms of this rapid resolution are discussed. A tear in the arachnoid with spilling of CSF into the subdural space and the effect of intracranial antihypertensive measures together with cerebral atrophy, are factors that possibly contribute to dilution and redistribution of blood with hematoma disappearing in CT scan.

[Isolated oculomotor palsy. An unusual presentation of chronic subural hematoma]. / Parálisis completa del tercer par craneal como forma de presentación en hematoma subdural crónico.

Isolated oculomotor palsy is an unusual symptom in chronic subdural hematomas and it is very rare as initial manifestation. We report a patient with a chronic subdural hematoma that presented with a complete third nerve palsy and normal consciousness. Complete recovery was achieved after surgical evacuation. Rebleeding within the hematoma cavity, most possibly favored by antiaggregating agents, was considered responsible for this rare presentation. In these cases expeditious surgical evacuation is indicated.

[Contralateral mesencephalic injury due to tentorial uncal herniation. Magnetic resonance imaging of the Kernohan's notch]. / Lesión mesencefálica contralateral por hernia cerebral. Imagen en resonancia magnética de la hendidura de Kernohan (Kernohan's notch).

We report a case of a traumatic epidural hematoma with ipsilateral hemiparesis, due to the so-called Kernohan's notch. We document the injury with axial and coronal magnetic resonance imaging.

Tumoraciones quísticas intracraneales. A propósito de un caso / Intracranial cystic tumors. A case report

Los quistes aracnoideos son lesiones benignas, de origen congénito, formadas por una membrana aracnoidea, que contienen líquido cefalorraquídeo en su interior. Presentamos el caso de un niño de cinco años con una asimetría craneal con abombamiento frontoparietotemporal derecho. Refería vómitos ocasionales de un año de evolución y cefalea que no le despertaba por la noche desde hacía dos años, acompañada algunas veces de sonofobia y fotofobia. En las pruebas de imagen se visualizaba un gran quiste aracnoideo en la fosa craneal media derecha con desplazamiento de la línea media y colapso de las astas ventriculares adyacentes. Dado el tamaño del quiste y la clínica, se decidió tratamiento con cistocisternostomía endoscópica comunicando el quiste aracnoideo con las cisternas basales (AU)

Arachnoid cysts are benign, congenital malformations formed by an arachnoid membrane containing cerebrospinal fluid inside. We report the case of a 5 year old child with cranial asymmetry with right fronto-parieto-temporal bulging. Occasional vomiting a year of evolution and sometimes headache are refered, which did not wake him at night, accompanied by sonophobia and photophobia for two years. The imaging displays large arachnoid cyst in right middle cranial fossa with midline shift and collapse of adjacent ventricular horns. Because of the size of the cyst and the clinic, endoscopic treatment was selected, communicating arachnoid cyst and basal cisterns (AU)

Secuelas neurológicas del maltrato infantil. Revisión bibliográfica / Neurolical sequels of chlid abuse. Literature review

El maltrato infantil es un problema de gran importancia tanto social como médico, y sus consecuencias en muchas ocasiones son irreparables. Realizamos una revisión bibliográfica con enfoque neuroquirúrgico, y analizamos con detalle las lesiones que se producen en el sistema nervioso central, estudiando su fisiopatología, las secuelas neurológicas que producen y su implicación en el tratamiento rehabilitador y el futuro de los niños

Child abuse is both socially and medically troublesome and many times produces permanent consequences. A review of the literature is done from a neurosurgical standpoint, and the lesions produced at the Central Nervous System are evaluated in detail, including their physiopathology, neurological sequels and implications for rehabilitation treatment and the child's future life

Resección de tumor intramedular guiada por fluorescencia con ácido aminolevulínico / Fluorescence-guided resection with 5-aminolevulinic acid of an intramedullary tumor

La resección guiada por fluorescencia con ácidoaminolevulínico (5-ALA) se ha demostrado útil para el tratamiento quirúrgico de los gliomas cerebrales malignos.También parece útil en el tratamiento de otros tipos de tumores, tanto cerebrales como intramedulares. Presentamos el caso de un paciente con un tumor intramedular en el que la fluorescencia con 5-ALA fue de utilidad para la localización intraoperatoria de la lesión, para la identificación de pequeños nódulos en el parénquima medular y para lograr la exéresis completa del tumor (AU)

Fluorescence-guided resection with 5-aminolevulinicacid (5-ALA) has demonstrated its usefulness in the resection of malignant cerebral gliomas. It also seems useful for the treatment of other types of cerebral and intramedullary neoplasms. We present the case of a patient with an intramedullary tumor in who fluorescence-guided resection was useful for intraoperative localization, definition of small tumor nodules and in order to achieve a complete resection of the tumor (AU)

Resolución precoz espontánea de hematoma subdural agudo intracraneal / Rapid spontaneous resolution of acute subdural hematoma

Los hematomas subdurales agudos en general constituyen una urgencia neuroquirúrgica. En casos seleccionados, está indicado como primera alternativa el tratamiento conservador con estrecha vigilancia neurológica. En algunos de estos pacientes se aprecia la resolución progresiva del hematoma. Sin embargo, la resolución precoz espontánea de un hematoma subdural agudo es un fenómeno muy poco frecuente. Se describe el caso de un paciente con antecedentes de alcoholismo crónico que sufrió traumatismo craneoencefálico con hematoma subdural agudo, en el que se apreció resolución espontánea del hematoma en menos de 18h, acompañado de mejoría clínica. Se discute la fisiopatología de la resolución precoz del hematoma. El desgarro de la aracnoides con fuga de LCR al espacio subdural junto con el control de la presión intracraneal y la atrofia cerebral, condicionarían el efecto de lavado y redistribución del hematoma que provocan su desaparición en la TC cerebral (AU)

Parálisis completa del tercer par craneal como forma de presentación en hematoma subdural crónico / Isolated oculomotor palsy. An unusual presentation of chronic subural hematoma

La parálisis aislada del nervio motor ocular común es un síntoma raro en los hematomas subdurales crónicos (HSDC) y excepcional si lo consideramos como forma de presentación. Comunicamos el caso de un paciente con HSDC que presentó como comienzo una parálisis completa del tercer par craneal, con nivel de conciencia conservado y recuperación completa de su déficit tras la intervención quirúrgica. Consideramos que el resangrado en el interior de la cavidad del hematoma, favorecido por la toma de antiagregantes plaquetarios, pudo provocar esta sintomatología de herniación uncal. En estos casos está indicada la intervención quirúrgica urgente. (AU)