[Non-aneurysmal subarachnoid haemorrhage secondary to panarteritis nodosa at paediatric age: a case report]. / Hemorragia subaracnoidea no aneurismatica secundaria a panarteritis nodosa en edad pediatrica: caso clinico.

INTRODUCTION: Polyarteritis nodosa is a necrotizing vasculitis that mainly affects small and medium-sized arteries in skin and internal organs. Neurological involvement is reported in around 25% of cases: ischemic stroke is relatively common, but haemorrhagic lesions are extremely rare. Subarachnoid haemorrhage in polyarteritis nodosa is an uncommon expression of this disease, mostly associated with aneurism rupture. To the best of the authors' knowledge, there is just one published case in pediatric age with polyarteritis nodosa and subarachnoid haemorrhage with no underlying aneurismal disease. CASE REPORT: A 7-year-old girl, who presented a non-aneurismal subarachnoid haemorrhage with intraparenchymal extension in the left basal ganglia. She was previously diagnosed with polyarteritis nodosa and prothrombotic condition, being under immunosuppressive and anti-platelet treatment at that moment. CONCLUSIONS: The clinical features of polyarteritis nodosa together with continued anti-platelet therapy to prevent thromboembolic disease in this patient could have predisposed to the haemorrhagic event in the process of cerebral vasculitis. Standard subarachnoid haemorrhage management is initially required in such cases as cerebral aneurysms are the most common cause of haemorrhage in the context of polyarteritis nodosa disease.

TITLE: Hemorragia subaracnoidea no aneurismatica secundaria a panarteritis nodosa en edad pediatrica: caso clinico.Introduccion. La panarteritis nodosa es una vasculitis necrotizante que afecta de manera predominante a arterias de pequeño y mediano calibre de la piel y los organos internos. La afectacion neurologica sucede en un 25% de casos: los ictus isquemicos son relativamente frecuentes, pero las lesiones hemorragicas resultan extremadamente raras. La hemorragia subaracnoidea es una expresion poco comun de la enfermedad, asociada la inmensa mayoria de las veces a patologia aneurismatica. En nuestro conocimiento, solo existe otro caso descrito de panarteritis nodosa con hemorragia subaracnoidea en la edad pediatrica sin patologia aneurismatica subyacente. Caso clinico. Niña de 7 años que presento una hemorragia subaracnoidea no aneurismatica con extension intraparenquimatosa a los ganglios basales izquierdos. Previamente se habia diagnosticado panarteritis nodosa y enfermedad protrombotica, en tratamiento con farmacos inmunodepresores y antiagregantes en ese momento. Conclusiones. Las caracteristicas clinicas de la panarteritis nodosa, junto con el tratamiento antiagregante para prevenir la enfermedad tromboembolica en nuestra paciente, podrian haber predispuesto al evento hemorragico en el proceso de la vasculitis cerebral. El manejo estandar de la hemorragia subaracnoidea es necesario en estos casos debido a que los aneurismas cerebrales son la causa mas comun de hemorragia subaracnoidea en un contexto de panarteritis nodosa.

[Complications related with implanted devices in patients with Parkinson's disease treated with deep brain stimulation. A study of a series of 124 patients over a period of 16 years]. / Complicaciones relacionadas con dispositivos implantados en pacientes con enfermedad de Parkinson tratados con estimulacion cerebral profunda. Estudio de una serie de 124 pacientes durante 16 años.

INTRODUCTION: Establishing protocols of the best candidates for deep brain stimulation in patients with Parkinson's disease and a greater knowledge of the technique have increased its safety profile. Yet, the complications related with implanted devices still occur with a far-from-negligible frequency and have both an economic and clinical impact. AIM: From a broad series of patients undergoing deep brain stimulation included consecutively for the treatment of their Parkinson's disease, data concerning the complications related with implanted devices were gathered and compared with those in the literature. PATIENTS AND METHODS: Altogether 124 patients with a total of 242 implanted electrodes and 252 generator replacements were included in the study. Mean follow-up time was 8.4 years (range: 3-16 years). Data on all the complications related with implanted devices were collected retrospectively. RESULTS: Findings showed that 23 implanted device-related complications occurred (17.7% of the patients): 12 (9.6%) had culture-positive ulcers, five (4%) had culture-negative ulcers, four (3.2%) were left with infections following generator replacement, one (0.8%) had a generator malfunction, and electrode migration took place in one (0.8%). Significant differences were observed as regards the effectiveness of the treatment involving surgical revision of the ulcers, which suggests that the culture-negative ulcers responded to the surgical revision better than the culture-positive ulcers (80% healing versus 16.6%; p = 0.028). CONCLUSIONS: The results observed in the series were comparable to those in the existing literature. The presence of culture-positivity in the ulcers is a factor forecasting surgical revision.

TITLE: Complicaciones relacionadas con dispositivos implantados en pacientes con enfermedad de Parkinson tratados con estimulacion cerebral profunda. Estudio de una serie de 124 pacientes durante 16 años.Introduccion. La protocolizacion de los mejores candidatos para la estimulacion cerebral profunda en pacientes con enfermedad de Parkinson y el mayor conocimiento de la tecnica han aumentado su perfil de seguridad. Sin embargo, las complicaciones relacionadas con los dispositivos implantados siguen teniendo una frecuencia no menospreciable y presentan un impacto tanto clinico como economico. Objetivo. En una serie amplia de pacientes con estimulacion cerebral profunda incluidos consecutivamente para el tratamiento de su enfermedad de Parkinson, se recogieron las complicaciones relacionas con los dispositivos implantados y se compararon con la bibliografia. Pacientes y metodos. Se incluyeron en el estudio 124 pacientes con un total de 242 electrodos implantados y 252 recambios de generador. Seguimiento medio de 8,4 años (rango: 3-16 años). Se recogieron de forma retrospectiva todas las complicaciones relacionadas con los dispositivos implantados. Resultados. Se produjeron 23 complicaciones relacionadas con los dispositivos implantados (el 17,7% de los pacientes): 12 (9,6%) ulceras con cultivo positivo, cinco (4%) ulceras con cultivo negativo, cuatro (3,2%) infecciones tras recambio de generador, una (0,8%) malfuncion de generador y una (0,8%) migracion del electrodo. Se observaron diferencias significativas respecto a la efectividad del tratamiento de la revision quirurgica de las ulceras, lo que indica que las ulceras con cultivo negativo respondieron mejor que las ulceras con cultivo positivo a la revision quirurgica (80% frente a 16,6% de curacion; p = 0,028). Conclusiones. Se observan en la serie unos resultados comparables a la bibliografia existente. La presencia de positividad en el cultivo de las ulceras constituye un factor pronostico a la revision quirurgica.

[Abducens nerve palsy due to postraumatic retroclival and spinal subdural hematoma: case report and literature review]. / Paresia VI par craneal por hematoma subdural retroclival y espinal postraumatico: presentacin de un caso y revision de la literatura.

INTRODUCTION: Retroclival posttraumatic hematomas are extremely rare and almost exclusive to childhood. Only one case of retroclival subdural hematoma has been reported in the literature to date. CASE REPORT: An 8-year-old boy suffered a severe head injury with cervical hyperextension as the result of a bicycle accident. On admission his initial Glasgow Coma Score was 13 and he had diplopia due to right palsy of the VI nerve. A retroclival subdural hematoma was observed by CT and MRI of the craneovertebral junction. Management was conservative and a rigid collar was placed. Palsy of VI nerve recovered spontaneously at 6 days and at discharge the patient had only cervical pain. Follow up at 3 months after the accident showed clinical and radiological resolution. CONCLUSION: Traumatic retroclival hematomas are mainly a pediatric entity due to immaturity of the cranio-cervical junction. Treatment consists of placement of a rigid collar although clinical progression may require surgical evacuation.

[Ureteral injury after posterior lumbar surgery. Case report]. / Lesión del uréter tras una cirugía lumbar posterior. Caso clínico.

INTRODUCTION: The percentage of complications in posterior lumbar spine surgery varies from 1,9 to 10,8%. Injury to retroperitoneal structures is a severe but unfrequent complication. Ureter injury is an extremely rare complication with only 24 documented cases up to date. CASE REPORT: 43 year old woman. A deep bleeding was observed while performing a L4-L5 microdiscectomy. It was controlled with firm pressure and hemostatic agents. 36 hours later the patient developed a distended and painful abdomen associated with anemia and an increase in white blood cell count. Abdominal CT and retrograde pyelography confirmed the diagnosis of ureter injury. An emergency laparotomy was perfomed and a total section of the left ureter was treated with a end to end anastomosis. DISCUSSION: Ureter injury in posterior lumbar spine surgery can happen due to its close anatomical relationship with the vertebral body and disc. L4-L5 is the level most often affected. Due to the fact the ureter is surrounded by retroperitoneal fat, injury is less likely to happen and thus the low number of documented cases. Although the initial symptomatology may be inespecific, an early diagnosis is essential in order to avoid further complications such as a sepsis or a kidney loss. There are several treatment options although the most often used is the end to end anastomosis specially if there is a complete ureter injury.

[Sinking skin flap syndrome]. / Sindrome del colgajo hundido.

INTRODUCTION: The sinking skin flap syndrome is a complication of decompressive craniectomies. It is of relevance not only due to its frequency, it is often underdiagnosed, but also because of the possibility of reversing the symptoms with the proper treatment. CASE REPORT: A 53-year-old female sustained a severe head injury. The initial Glasgow Coma Scale was 6T. The CT scan showed a severe traumatic injury in the left temporal lobe that required a decompressive craniectomy. After surgery the patient developed aphasia and right hemiparesis but progressively improved. Four months after surgery, however, she presented neurological worsening. An MRI showed skin retraction with a mass effect on the brain parenchyma at the craniectomy defect. A cranioplasty was performed and the patient progressively recovered neurologically. CONCLUSIONS: The symptoms of sinking skin flap are headache, dizziness, inappropriate behaviour, neurological functional impairment and/or seizures. The symptoms worsen with the Valsalva manoeuvres and with changes in position. Typically, symptoms 3 to 5 months to appear. Theories to explain these symptoms include a direct atmospheric pressure effect, brain blood flow changes, alteration in cerebrospinal fluid dynamics and metabolic disturbances. Diagnosis is performed through clinical observation but imaging studies are recommended to confirm the diagnosis. The treatment of choice is a cranioplasty. Prognosis is excellent and almost all patients recover completely.

[The effectiveness of gravitational valves in the prevention of over-drainage in adult patients with hydrocephalus]. / Efectividad de las válvulas gravitacionales en la prevención del hiperdrenaje en pacientes adultos con hidrocefalia.

AIM: To evaluate the effect of gravitational valves on over-drainage in hydrocephalus in adults. PATIENTS AND METHODS: We performed a retrospective study of the shunt systems placed in patients over the age of 18 years between 1998 and 2006. Patients were divided into two groups: non-GV group (without gravitational valve) and GV group (with a gravitational valve, Aesculap-Miethke 5/35). The complications that occurred during the first year following the placement of the shunt system were recorded. RESULTS: Of a total of 137 patients, 91 were from the non-GV group and 46 belonged to the GV group. Mean age: non-GV group, 62.1 years; and GV group, 64.2 years, without any significant differences. In 80 patients the aetiology was chronic adult hydrocephalus, 19 were due to expansive processes, 15 due to vascular causes, eight pseudo tumours, six post-traumatic injuries and nine were due to other causes. In the non-GV group, 9.89% presented over-drainage, whereas there were no cases in the GV group; the difference was statistically significant (p = 0.029). In the rest of the complications there were no significant differences between the two groups. The total complications in the non-GV group were 25.27% and in the GV group, 6.52%, and there were significant differences (p = 0.01), although, above all, at the expense of over-drainage, because if this complication was excluded, then the differences were no longer significant (p = 0.175). CONCLUSIONS: In our series, the use of gravitational valves in the prevention of over-drainage in adult hydrocephalus proved to be more effective than employing valves without the gravitational device.