[Neuro-critical management of glycemia in spontaneous intracerebral hemorrhage: review of the literature]. / Manejo neurocrítico de la glicemia en la hemorragia intracerebral espontánea: revisión de la literatura.

Spontaneous cerebral hemorrhage or intracranial hemorrhage represents between 10 and 15% of all cerebrovascular events. Intracerebral hemorrhage is far less frequent than ischemic stroke, but leads to increased morbidity and mortality, one of the leading causes of severe disability. Several changes have been identified in the field of intracerebral hemorrhage, including endocrine. These stress-mediated mechanisms exacerbate secondary injury. Deep knowledge of the injuries that are directly involved in the alterations of glucose in the context of an intracerebral hemorrhage, offers a vision of how the cytotoxicity, neuronal death and metabolic disturbances alter the prognosis of patients with spontaneous intracerebral hemorrhage.

[CHRONIC SUBDURAL HEMATOMA: PHYSIOPATHOLOGY AND SURGICAL MANAGEMENT]. / HEMATOMA SUBDURAL CRONICO: FISIOPATOLOGIA Y MANEJO QUIRURGICO.

Chronic subdural hematoma is an encapsulated collection of blood underneath the Dura, essentially characterized by the presence of a membrane. It usually occurs in the elderly considered as a sentinel event. Simple brain computed tomography is the current imaging aid of choice for the diagnosis of this entity. It should be suspected especially in patients who present with dementia syndrome. Although less frequent, it should be investigated in patients with transient neurologic deficit. There is still no consensus regarding the ideal surgical modality of treatment. The procedure that seems most recommended is closed suction drainage through burr holes. It has been controversial whether intraoperative washing of such collection improves outcomes.

[Multimodal monitoring in severe craniocerebral trauma: state the art]. / Neuromonitoreo multimodal en trauma craneoencefalico severo: estado del arte.

Traumatic brain injury is a public health problem and leading cause of death. In the context of a severe head injury, monitoring strategies give us the option to analyze the posterior intracranial alterations to the primary lesion. Neuromonitoring allows us to identify the deterioration of neurological function and the presence of secondary brain injury that may benefit from a therapeutic intervention letting us know pathophysiological changes that occur in a patient with brain injury. Understanding the physiological data allow to individualize therapies and interpret variables that ultimately help us choice a better treatment.

[Sacrococcygeal teratoma: review of the literature]. / Teratoma sacrocoxigeo: revisión de la literatura.

Sacrococcygeal teratoma (SCT) is rare germ cell tumor composed of multiple types of cells derived from the three primitive germ cell layers. SCT is the most common tumor of germ cells. In recent years the routinely use of prenatal obstetric ultrasonography has led to increase in the prenatal diagnosis of type of malformation. Management should be multidisciplinary and integrated by pediatric neurosurgeons, pediatric surgeons, pediatricians and oncologists. The advent of fetal surgery to identify fetuses at risk has improve survival. We present a review of the literature aimed to enable better understanding of this pathology.

[Type I Chiari malformation associated with cerebellar atrophy. Case report]. / Malformación de Chiari Tipo I asociado a atrofia cerebelosa. Reporte de caso.

Chiari malformation is characterized by caudal displacement of the cerebellar tonsils that penetrate into the spinal canal through the foramen magnum, achieving reach the atlas or axis. trunk and any drop of the fourth ventricle is observed. Typically is seen in young adults. In some cases scoliosis and Syringomyelic cavities may occur. The authors present (as far as they know) the first case in the literature with long term follow-up, of a caucasian woman with an unusual form of cerebellar atrophy and Chiari Type I malformation, suffering from weakness in his upper and lower extremities with rapidly progression. The patient was successfully treated with suboccipital decompression and C1 laminectomy.

La malformación de Chiari se caracteriza por un desplazamiento caudal de las amígdalas cerebelosas que penetran hacia el canal raquídeo por el foramen mágnum, logrando llegar hasta el atlas o el axis. No hay descenso del tronco y tampoco del cuarto ventrículo. Típicamente se observa en adultos jóvenes. En algunos casos hay escoliosis y cavidades siringomiélicas. Los autores presentan lo que a su conocimiento es el primer caso de la literatura con seguimiento a largo plazo de una mujer de raza blanca con una forma inusual de atrofia cerebelosa y malformación de Chiari tipo I, que sufre de debilidad en sus extremidades superiores e inferiores rápida y progresivamente. La paciente fue tratada con éxito mediante descompresión suboccipital y laminectomia C1.

Sacroiliac Pain: A Clinical Approach for the Neurosurgeon.

Pain originating from sacroiliac joint may also cause pain in the lumbar and gluteal region in 15% of the population. The clinical manifestation represents a public health problem due to the great implications on the quality of life and health-related costs. However, this is a diagnosis that is usually ignored in the general clinical practice; probably because of the unknown etiology, making harder to rule out the potential etiologies of this pathology, or maybe because the clinical criteria that support this pathology are unknown. By describing several diagnostic techniques, many authors have studied the prevalence of this pathology, finding more positive data than expected; coming to the conclusion that even though there is no diagnostic gold standard yet, an important amount of cases might be detected by properly applying several tests at the physical examination. Thus, it is necessary to have knowledge of the physiopathology and clinical presentation so that diagnosis can be made to those patients that manifest this problem. We present a clinical approach for the neurosurgeon.

Intradiploic Pterional Epidermoid Tumor: A Case Report and Review of literature.

Intradiploic epidermoid cyst is an uncommonly occurring neoplasm, and only about 200 cases are reported in the form of isolated case report. It is presumed to occur due to ectodermal cells in inclusion in the bone tissue during embryonic life neural tube closure. It commonly remains asymptomatic or rarely presents as a bony lump in the skull bone. Authors report present an interesting case, which presented with swelling, and underwent successful surgical resection. Pertinent literature along with diagnosis and management is briefly reviewed. These lesions can erode the bone and involve the brain parenchyma due to their proximity to the brain. Radiological imaging is very helpful in accurate diagnosis of these lesions and in differentiating intradural from intradiploic varieties of epidermoid. We present an unusual case of this pathology.

Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring.

Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.

Symptomatic Chiari Malformation with Syringomyelia after Severe Traumatic Brain Injury: Case Report.

Chiari malformation Type I (CM-I) is a congenital disorder, which is basically a tonsillar herniation (≥ 5 mm) below the foramen magnum with or without syringomyelia. The real cause behind this malformation is still unknown. Patients may remain asymptomatic until they engender a deteriorating situation, such as cervical trauma. The objective of this case report is to give a broad perspective on CM-I from the clinical findings obtained in a patient with asymptomatic non-communicating syringomyelia associated with a CM-I exacerbated within 2 years of a TBI, and to discuss issues related to that condition.

Management of Craniocerebral Gunshot Injuries: A Review.

Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive.

Odontogenic Pain as the Principal Presentation of Vertebral Artery Pseudoaneurysm; a Case Report.

Dissection of the vertebral artery is an important but rare cause of cerebrovascular accidents. Here we report a 48-year-old man with toothache since 4 days before who presented to the emergency department with neck pain and final diagnosis of dissecting right vertebral artery pseudoaneurysm. To our knowledge, this maybe the first report of odontogenic pain as the first manifestation of vertebral artery pseudoaneurysm in the literatures.

Effects of sexed semen and interactive effects on commercial in vitro embryo production when oocytes are collected from cows of Bos indicus, and Bos taurus breeding and crossbred cows of these subspecies.

A large scale commercial in vitro embryo production and in vitro fertilization record is reported when there was use of oocytes from Bos taurus (BT), Bos indicus (BI), and Bos Taurus/indicus (BT/BI) crossbred subspecies fertilized with sexed (SS) and conventional (CS) semen. The aim of the study was to analyze the impacts of use SS in a commercial embryo production center in Colombia. Non-pregnant (n=800), healthy, and estrous cycling BT, BI, and BI/BT crossbred cows were selected to be used as oocyte donors. Viable oocytes from 733 ovum pick up sessions in cows of the BT (4663) and BI (7305), BT/BI (3605) groups were matured and fertilized with frozen thawed semen from commercial sires. Of all cultured oocytes (n=15,573), 52.3% of the embryos (n=8607) underwent cleavage while 3062 (19.7%) developed to the blastocyst stage. For cows of the BT, SS and CS groups, there were similar cleavage rates; however, use of SS decreased blastocyst formation (15.6% versus 18.9%). In the BI group, use of SS increased cleavage rates (59.1% versus 53%, respectively) although there was no effect on blastocyst rate development (22.9% versus 21.9). In the BI/BT groups, use of SS decreased cleavage (44.4% versus 57.1%, respectively) and blastocyst rate development compared with the CS group (15.3% versus 20.1%, respectively). Data from this study indicate embryos from cows of the BT purebred or BI/BT crossbred had less in vitro developmental capacity compared to embryos derived from oocytes of cows that were purebred BI in tropical-subtropical regions.

Intravenous Fluid Therapy in Traumatic Brain Injury and Decompressive Craniectomy.

The patient with head trauma is a challenge for the emergency physician and for the neurosurgeon. Currently traumatic brain injury constitutes a public health problem. Knowledge of the various supportive therapeutic strategies in the pre-hospital and pre-operative stages is essential for optimal care. The immediate rapid infusion of large volumes of crystalloids to restore blood volume and blood pressure is now the standard treatment of patients with combined traumatic brain injury (TBI) and hemorrhagic shock (HS). The fluid in patients with brain trauma and especially in patients with brain injur y is a critical issue. In this context we present a review of the literature about the history, physiology of current fluid preparations, and a discussion regarding the use of fluid therapy in traumatic brain injury and decompressive craniectomy.

Brain Infarction: Rare Neurological Presentation of African Bee Stings.

Bee stings are commonly encountered worldwide. Various manifestations after bee sting have been described including local reactions which are common, systemic responses such as anaphylaxis, diffuse intravascular coagulation and hemolysis. We report a case of a 74-year-old man who developed neurologic deficit 5 hours after bee stings, which was confirmed to be left frontal infarction on brain CT-scan. The case does not follow the reported  pattern  of hypovolemic or anaphylactic shock, hemolysis and/or  rhabdomyolysis, despite the potentially lethal amount of venom injected. Diverse mechanisms have been proposed to give an explanation to all the clinical manifestation of both toxic and allergic reactions secondary to bee stings. Currently, the most accepted one state that victims can develop severe syndrome characterized by the release of a large amount of cytokines.

Fatal Massive Cerebral Infarction in a Child after Mild Brain Trauma: A Case Report and Literature Review.

Traumatic brain injury is a common entity. However cerebral infarction in infants is a rare entity while the diagnosis of this pathology in the pediatric population is usually difficult. The mild head trauma is rarely accompanied by intracranial injury and even less, with cerebral infarction. We herein report the first case of cerebral infarction after a mild brain trauma in a 2-year-old Latin-American male patient, in which brain computed tomography (CT) scan was performed on the first day of the accident, showed right hemispheric cerebral ischemia compromising the fronto-parieto-occipital region. Conservative management was established. The patient died at day 5. So Brain CT scan may be beneficial to reveal any hemispheric infarction due to a probable mass effect.

[Endovascular management of skull base tumors. A practical review on literature]. / Manejo endovascular de tumores de la base del cráneo. Revisión práctica de la literatura.

Generally speaking, skull base tumors are very difficult-to-reach lesions. More or less, two thirds of those tumors correspond to meningiomas, which are highly vascular tumors. Tumors that are able to an embolization are juvenile nasopharyngeal angiofibromas, hemangiopericytomas, hemangioblastomas, meningiomas, metastatic lesions, paragangliomas, glomus tumors and other paragangliomas. Pre-operatory embolization of tumors arising in the skull base is a surgical strategy which allows to control probable hemorrhages secondary to the surgical resection of the tumor. The benefits of this sort of embolization have been partially demonstrated. However, there are concrete and objective results, as reduction in bleeding, time of surgery, post-operative hospital stay, and the use of blood transfusion; besides, another benefit reported is the lower morbimortality related to the surgical management of neural tissue and vascular structures. The aim of this article was to bring up to date the available information up to this moment, describe briefly the background of the pre-operative embolization of skull base tumors, and emphasize the knowledge related with the variables of this therapy, such as the types of hypervascular tumors, vascular anatomy related to this (according to type and position of the tumor), the types of embolization therapy in hypervascular tumors, as well as the materials that must be used.

Los tumores de la base del cráneo por lo general son lesiones a las que es difícil acceder. Un porcentaje que se aproxima a los dos tercios corresponde a meningiomas, los cuales son tumores altamente vasculares. Los tumores que pueden ser embolizados son los angiofibromas nasofaríngeos juveniles, los hemangiopericitomas, los hemangioblastomas, los meningiomas, las lesiones metastáticas, los paragangliomas, los tumores del glomus y demás paragangliomas. La embolización preoperatoria de tumores que aparecen en la base del cráneo es una estrategia quirúrgica que sirve para controlar probables hemorragias que son secundarias a la resección quirúrgica del tumor. Los beneficios de esto se han demostrado de manera parcial; sin embargo, hay resultados objetivos concretos, como la reducción del sangrado, del tiempo operatorio, de la estancia hospitalaria postoperatoria, y de la utilización de transfusiones sanguíneas, además de una menor morbimortalidad relacionada con la manipulación quirúrgica del tejido neural y las estructuras vasculares. El objetivo de esta revisión consistió en actualizar la información disponible hasta este momento, describir los antecedentes de la embolización preoperatoria de tumores de base de cráneo y enfatizar en el conocimiento de las variables relacionadas con esta terapia, tales como los tipos de tumores hipervasculares, la anatomía vascular relacionada (según el tipo y la localización del tumor), los tipos de terapia embolizante en tumores hipervasculares, así como los materiales que hay que utilizar.

Sacroiliac screw fixation: A mini review of surgical technique.

The sacral percutaneous fixation has many advantages but can be associated with a significant exposure to X-ray radiation. Currently, sacroiliac screw fixation represents the only minimally invasive technique to stabilize the posterior pelvic ring. It is a technique that should be used by experienced surgeons. We present a practical review of important aspects of this technique.

Bilateral Traumatic Basal Ganglia Hemorrhage Associated With Epidural Hematoma: Case Report and Literature Review.

Traumatic basal ganglia hematoma is a rare condition defined as presence of hemorrhagic lesions in basal ganglia or adjacent structures suchas internal capsule, putamen and thalamus. Bilateral basal ganglia hematoma are among the devastating and rare condition. We herein report a 28-year old man, a victim of car-car accident who was brought to our surgical emergency room by immediate loss of consciousness and was diagnosed to have hyperdense lesion in the basal ganglia bilaterally, with the presence of right parietal epidural hematoma. Craniotomy and epidural hematoma drainage were considered, associated to conservative management of gangliobasal traumatic contusions. On day 7 the patient had sudden neurologic deterioration, cardiac arrest unresponsive to resuscitation. Management of these lesions is similar to any other injury in moderate to severe traumatic injury. The use of intracranial pressure monitoring must be guaranteed.

Fluid therapy in neurotrauma: basic and clinical concepts.

The patient with head trauma is a challenge for the emergency physician and for the neurosurgeon. Currently traumatic brain injury constitutes a public health problem. Knowledge of the various therapeutic strategies to provide support in the prehospital and perioperative are essential for optimal care. Rapid infusion of large volumes of crystalloids to restore blood volume and blood pressure quickly is now the standard treatment for patients with combined TBI and HS The fluid in patients with brain and especially in the carrier of brain injury is a critical topic; we present a review of the literature about the history, physiology of current fluid preparations, and a discussion regard the use of fluid therapy in traumatic brain injury and decompressive craniectomy.

Effects of Glycemic Level on Outcome of Patients with Traumatic Brain Injury: A Retrospective Cohort Study.

OBJECTIVE: To determine the effects of glycemic level on outcome patients with traumatic brain injury. METHODS:  From September 2010 to December 2012, all medical records of adult patients with TBI admitted to the Emergency Room of Laura Daniela Clinic in Valledupar City, Colombia, South America were enrolled. Both genders between 18 and 85 years who referred during the first 48 hours after trauma, and their glucose level was determined in the first 24 hours of admission were included. Adults older than 85 years, with absence of Glasgow Coma Scale (GCS) score and a brain Computerized Tomography (CT) scans were excluded. The cut-off value was considered 200 mg/dL to define hyperglycemia. Final GCS, hospital admission duration and complications were compared between normoglycemic and hyperglycemic patients. RESULTS: Totally 217 patients were identified with TBI. Considering exclusion criteria, 89 patients remained for analysis. The mean age was 43.0±19.6 years, the mean time of remission was 5.9±9.4 hours, the mean GCS on admission was 10.5±3.6 and the mean blood glucose level in the first 24 hours was 138.1±59.4 mg/dL. Hyperglycemia was present in 13.5% of patients. The most common lesions presented by patients with TBI were fractures (22.5%), hematoma (18.3%), cerebral edema (18.3%) and cerebral contusion (16.2%). Most of patients without a high glucose level at admission were managed only medically, whereas surgical treatment was more frequent in patients with hyperglycemia (p=0.042). Hyperglycemia was associated with higher complication (p=0.019) and mortality rate (p=0.039). GCS was negatively associated with on admission glucose level (r=0.11; p=0.46). CONCLUSION: Hyperglycemia in the first 24-hours of TBI is associated with higher rate of surgical intervention, higher complication and mortality rates. So hyperglycemia handling is critical to the outcome of patients with traumatic brain injury.