Spontaneous Intracranial Hemorrhage Associated With an Intracranial Meningioma.

Spontaneous intracranial hemorrhage associated with an intracranial meningioma is rare, with a reported incidence of below 2.4% of all meningiomas. Such cases are described with a cause subdural with intratumoral hemorrhage, which is a challenge for patients and healthcare professionals because it can occur spontaneously without other pathological antecedents. We describe the case of a 55-year-old woman with subdural hemorrhage over the frontoparietal region of the right hemisphere associated with a meningioma, generating a mass effect and shifting the third ventricle and lateral ventricle. Therefore, urgent surgical treatment was decided. A tumor lesion was found with apoplexy, soft consistency, and violaceous color with abundant vascularity in the lesion's center, suggesting a probable angiomatous meningioma. The histopathological evaluation confirmed meningothelial hemorrhagic meningioma grade I, according to the World Health Organization grading. This article discusses the causes, risk factors, diagnosis, and surgical treatment for hemorrhage associated with intracranial meningioma.

[Relation of red cell distribution width and mean platelet volume with the severity of preeclampsia]. / Severidad de la preeclampsia y su relacion con volumen plaquetario y ancho de distribucion eritrocitaria.

BACKGROUND: It has been established a strong association between the red cell distribution width (RDW) and mean platelet volume (MPV) with hypertension in non-pregnant patients. However, few studies have been performed in patients with preeclampsia, yielding inconsistent results. Our aim is to evaluate the relationship between RDW and MPV with the severity of preeclampsia. METHODS: Analytic cross-sectional study. We include 64 patients with preeclampsia (26 mild, 38 severe) and 70 patients with normotensive pregnancy. Clinical data, sociodemographic characteristics and laboratory measures, including RDW and MPV, were recorded for each patient. RESULTS: Hemoglobin and platelet count measures were similar between groups. Preeclamptic patients had levels of RDW (14.7 ± 1.4 vs. 13.4 ± 0.7, p = 0.0001) and MPV (11.8 ± 2.4 vs. 11.0 ± 1.4, p = 0.03) more elevated than control group. Moreover, severe preeclamptic subgroup had more elevated levels of RDW (15.0 ± 1.6 vs. 14.0 ± 0.6, p = 0.001) and MPV (12.7 ± 2.8 vs. 10.8 ± 1.8, p = 0.01) in comparison with mild preeclamptic patients. CONCLUSIONS: We demonstrate that RDW and MPV are accessible and inexpensive measures associated with the severity of preeclampsia.

Introducción: se ha establecido fuertemente la asociación entre el ancho de distribución eritrocitario (ADE) y el volumen plaquetario medio (VPM) con la hipertensión arterial sistémica. Sin embargo, se han realizado pocos estudios en pacientes con preeclampsia, obteniéndose resultados inconsistentes. Nuestro objetivo es evaluar la relación entre el ADE y el VPM con la severidad de la preeclampsia. Métodos: incluimos 64 pacientes con preeclampsia (26 leve, 38 severa) y 70 pacientes con embarazo normotenso. Los datos clínicos, características sociodemográficas y valores de laboratorio, incluyendo ADE y VPM, fueron registrados en cada paciente. Resultados: las medidas de hemoglobina y conteo plaquetario fueron similares entre ambos grupos. Las pacientes con preeclampsia tuvieron niveles de ADE (14.7 ± 1.4 frente a 13.4 ± 0.7, p = 0.0001) y VPM (11.8 ± 2.4 frente a 11.0 ± 1.4, p = 0.03) más elevados que el grupo control. El subgrupo de preeclampsia severa tuvo niveles más elevados de ADE (15.0 ± 1.6 frente a 14.0 ± 0.6, p = 0.001) y VPM (12.7 ± 2.8 frente a 10.8 ± 1.8, p = 0.01) que las pacientes con preeclampsia leve. Conclusiones: se demuestra que el ADE y el VPM son medidas accesibles asociadas a la severidad de la preeclampsia.

Transcranial Direct Current Stimulation in Mesial Temporal Lobe Epilepsy and Hippocampal Sclerosis.

BACKGROUND: Transcranial direct current stimulation (tDCS) has been evaluated in medication refractory epilepsy patients. The results have been inconclusive and protocols have varied between studies. OBJECTIVE: To evaluate the safety and efficacy of two protocols of tDCS in adult patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS). METHODS: This is a randomized placebo-controlled, double-blinded clinical trial, with 3 arms, 3 sessions, 5 sessions and placebo stimulation. Frequency of seizures (SZs), interictal epileptiform discharges (IEDs) and adverse effects (AEs) were registered before and after treatment, and at 30 and 60 days follow-up. Descriptive statistics, k-related samples, Friedman's test, and relative risk (RR) estimation were used for analysis. RESULTS: We included twenty-eight subjects (3d n = 12, 5d n = 8, placebo n = 8), 16/28 (57%) men, age 37.8(±10.9) years old. There was a significant reduction of the frequency of SZs at one (p = 0.001) and two (p = 0.0001) months following cathodal tDCS compared to baseline in the 3 arms (p = 0.0001). The mean reduction of SZ frequency at two months in both active groups was significantly higher than placebo (-48% vs. -6.25%, p < 0.008). At 3 days (-43.4% vs. -6.25%, p < 0.007) and 5 days (-54.6% vs. -6.25%, p < 0.010) individual groups showed a greater reduction of SZs. A significant IED reduction effect was found between baseline and immediately after interventions (p = 0.041) in all groups. Side effects were minor. CONCLUSIONS: Cathodal tDCS technique of 3 and 5 sessions decreased the frequency of SZs and IEDs (between baseline and immediately post-tDCS) in adult patients with MTLE-HS compared to placebo tDCS.