Meningioma parasagital y hematoma subdural crónico, una asociación inusual / Parasagittal meningioma and chronic subdural hematoma, unusual association

RESUMEN En muchas ocasiones, los pacientes con tumores cerebrales tienen una variedad de síntomas psiquiátricos inespecíficos. Algunos de estos pueden constituir la primera o única manifestación del tumor, sin la presencia de ningún síntoma o signo neurológico. El diagnóstico ha de basarse en la anamnesis completa y en la exploración neurológica; la neuroimagen confirmará el diagnóstico clínico. Con el presente trabajo se describió la asociación inusual de hematoma subdural crónico y meningioma parasagital en un caso presentado. Se trató de un paciente de 68 años con antecedentes de esquizofrenia. Acudió a consulta con una hemiparesia izquierda. Se le realizó una tomografía axial computarizada de cráneo y arrojó un hematoma subdural crónico y un meningioma parasagital derecho. Se le aplicó tratamiento quirúrgico en dos tiempos operatorios. Su evolución posquirúrgica transcurrió sin complicaciones (AU).

ABSTRACT In many cases, patients with brain tumors have a variety of nonspecific psychiatric symptoms. Some of them can be the first or the only manifestation of the tumor, without presenting any neurological signs or symptoms. The diagnosis must be based on the complete anamnesis and on the neurological examination. The neuroimaging will confirm the clinical diagnosis. The unusual association of a chronic subdural hematoma and a parasagittal meningioma was described in a case presented in the current work. It dealt with a patient, aged 68 years with antecedents of schizophrenia. He assisted the consultation with left hemiparesis. A skull computed tomography showed a chronic subdural hematoma and a right parasagittal meningioma. He underwent a two-steps surgery. His post-surgery evolution ran without complications (AU).

Meningeal Carcinomatosis for Prostate Adenocarcinoma Mimicking Chronic SubduralHematoma: Case Report and Literature Review

Introduction Cerebral metastases are the most common cancer of the central nervous system (CNS). Meningeal infiltration by neoplasms that did not originate in the CNS is a rare fact that is present in 0.02% of the autopsies. Epidemiologically, the radiological presentation mimicking a subdural hematoma is even more uncommon. We report a case of meningeal carcinomatosis by an adenocarcinoma of the prostate mimicking a chronic subdural hematoma. Case Report A 60-year-old male patient was diagnosed with prostate cancer in 2011. He underwent radical resection of the prostate, as well as adjuvant hormonal therapy and chemotherapy. Five years later, the patient presented peripheral facial paralysis that evolved with vomiting and mental confusion. Tomography and magnetic resonance imaging scans confirmed the subdural collection. At surgery, the dura was infiltrated by friable material of difficult hemostasis. The anatomicopathological examination showed atypical epithelial cells. The immunohistochemistry was positive for prostate-specific antigen (PSA) and other keymarkers, and it was conclusive for meningeal carcinomatosis by a prostate adenocarcinoma.

Kernohan-Woltman Notch Phenomenon ­ Case Report

The Kernohan-Woltman notch phenomenon is a paradoxical neurological manifestation consisting of a motor deficit ipsilateral to a primary brain injury. It has been observed in patients with brain tumors and with supratentorial hematomas. It is considered a false localizing neurological sign. Magnetic resonance imaging (MRI) scan has been the test of choice. The recognition of this phenomenon is important to prevent a surgical procedure on the opposite side of the lesion. The present case report describes a case of chronic subdural hematoma with a probable finding of the Kernohan-Woltman phenomenon, and it discusses its pathophysiology, imaging findings, treatment, and prognosis.

Tratamiento de hematoma subdural: comparación entre drenaje subdural a presión negativa contra otro tipo de drenajes / Treatment of subdural hematoma: comparative analysis between subdural drainage with negative pressure versus other drainages

La ultrasonografía es un método de evaluación rápido y eficaz en los departamentos de emergencias, siempre en manos entrenadas. La lesión vascular periférica es un cuadro que en lo que trauma se refiere, debe tener un veloz diagnóstico y tratamiento por los riesgos que significa: En lesiones abiertas, la hemorragia; y en lesiones cerradas se añade el síndrome compartimental. Lograr la evaluación de la indemnidad o no del árbol vascular en los miembros, se torna importante a la hora de prevenir eventos que requieran intervención quirúrgica (reparación y/o fasciotomía). El objetivo de este trabajo consiste en demostrar la utilidad del conocimiento del árbol vascular periférico y su evaluación mediante doppler para el manejo del trauma vascular periférico, mental (n=77) = 11 (14,78 %). Resolución: lesión vascular = 1 (1,3 %) síndrome compartimental= 1 (1,3 %) con resolución quirúrgica. La utilización de la ultrasonografía y del doppler para la evaluación vascular periférica es útil para el reconocimiento precoz del riesgo a desarrollar desde una lesión vascular simple hasta un síndrome compartimental. La utilización de listas de verificación durante la simulación para la generación del criterio, son útiles en la formación de residentes de cirugía

Report the recurrence rate ofnegative pressure subdural drainage (NPSD) versusto other kind of drains (OD). Design and Methods: Astudy was conducted cross-sectional and weretrospectively analyzed on the database of theneurosurgical service and we looked for all surgicalprocedures recorded from January 2006 to December2015. Procedures with preoperative diagnosis ofsubdural hematoma (SDH) were selected, with a to-tal of 364 interventions, were excluded patients withpostoperative diagnosis different from SDH andeliminated those who did not have complete data,recurrence was identified, a statistical analysis wasperformed describing frequency measurementspercentage and standard deviation, RM and chi-square was obtained by software EPIDAT 3.1. 277 surgeries were performed in 230 patients, Thepopulation was divided into two groups: the first thoseinterventions with negative pressure subduraldrainage versus a second group with other differentdrains, and finally we compared the recurrence ratein each group, 44 surgeries had recurrence of SDH.The proportion of recurrence was found 16 % of thesurgeries, 16 % (n=7) of these were performed withnegative pressure subdural drainage and theremaining 84 % (n=37) by other drainage. The reasonfor prevalence found was 0.36 (95 % CI , 0.15 to0.85), with statistically significant differences (p =0.0165). The chi-square was 5.75 for the SDH withNPSD. It was found that patients treated with NPSDhave a lower risk of recurrence compared with OD,which acts as a protective factor for patients treatedwith this type of drain, this is statistically significant.

Recuperación de pacientes en postoperatorio de drenaje de hematoma subdural crónico asociado al uso de ácidotranexámico / Recovery of patients operated with technical drain of chronic subdural hematome, associated to tranexamic acid

Con el objetivo de evaluar la recuperación de pacientes que recibieron ácido tranexámico luego del drenaje de hematoma subdural crónico (HSC), se seleccionan al azar 22 pacientes de ambos sexos en edades comprendidas de 32 a 87 años. A un grupo de 11 paciente intervenidos, se les continuó el tratamiento con la colocación de un sistema de drenaje externo tipo Jackson-Pratt (grupo A) y un segundo grupo de pacientes, se les continuó tratamiento con Ácido Tranexámico (grupo B). Ambos grupos fueron evaluados en aspectos clínicos y tomográficos una semana después de la intervención. La distribución obtenida por género representó 99,5 por ciento masculino. Del total de pacientes, la mitad presentó HSC en el lado derecho y los casos bilaterales representaron 31,8 por ciento. Los resultados funcionales postoperatorio fueron satisfactorios en el 59,1 por ciento comparado con los obtenidos en la escala Glasgow preoperatorio donde más del 50 por ciento de los casos no superaban el valor 13 de la escala. El síntoma más común fue hemiparesia izquierda (45,5 por ciento), seguido de hemiparesia derecha (22,7 por ciento). El tratamiento con Ácido Tranexámico obtuvo resultados satisfactorios en el 63,6 por ciento de los casos de manera inmediata y en el 27,3 por ciento a las 24 horas; caso contrario a los resultados obtenidos con el sistema de Jackson-Pratt, donde el 54,5 por ciento obtuvo mejoría a las 24 horas. Deigual manera la relación entre días de hospitalización y tratamiento fue significativa. Estos resultados permiten concluir que el tratamiento con Ácido Tranexámico ofrece una excelente tasa de recuperación, con menor número de complicaciones,...

The research presented as techniques to evaluate chronic subdural hematoma drainage associated with the use of tranexamic acid in the recovery of postoperative patients in IAHULA: Mérida, Venezuela. It is a descriptive, cross-sectional and retrospectivestudy. Randomly selected patients of both sexes aged 32 to 87 years old who had a diagnosis of Chronic SubduralHematoma, unilateral or bilateral. From a total of 22 patients, which will have surgery criteria: Drawing Subdural Hematoma. A group of 11 patients who underwent classic fashion, they continued the surgery with placement of an external drain JacksonPratt type. The other group of patients also underwent the classic way, they continued postoperative treatment with tranexamic acid. Both groups were evaluated clinically and tomographic week intervention. As a result it was found that most patients with surgical drainage of chronic subdural hematoma are the right area, in the group A (with A Jackson-Pratt) and group B (tranexamic acid). The present study showed male predominance (99.5 percent) and 50.0 percent of hematomas occurred on the right side, followed by bilateral cases (31.8 percent). The postoperative functional results were satisfactory in 59.1 percent compared with those obtained in the preoperative Glasgow where over 50 percent of cases did not exceed the value of the scale 13 scale. The most common symptom was left hemiparesis (45.5 percent), followed by right hemiparesis (22.7 percent). Treatment with Tranexamic Acid obtained satisfactory results in 63.6 percent of cases immediately and in 27.3 percent at 24 hours; Otherwise the results obtained with the system of Jackson-Pratt, where 54.5 percent improvement obtained by 24 hours. Similarly the relationship between days of hospitalization and treatment gave significant. These results suggest that treatment with tranexamic acid offers higher cure rate with fewer complications, mortality and sequelae, allowing also reduce hospitalization time,...

Chronic subdural hematoma: epidemiological and prognostic analysis of 176 cases / Hematoma subdural crônico: análise epidemiológica e prognóstica de 176 casos

Objective : To characterize patients with chronic subdural hematoma undergoing surgery and to identify prognostic indicators. Methods : We conducted a retrospective analysis of patients diagnosed with chronic subdural hematoma (CSDH) undergoing surgical treatment. We analyzed: age, period from trauma to diagnostic imaging, pre and postoperative Glasgow coma scale, type of surgery, associated comorbidities, use of postoperative drainage and outpatient treatment. Results : The sample consisted of 176 patients, 126 male and 50 female patients (ratio 2.5 : 1), ages ranged from six months to 97 years, with an average of 59.3 years. CSDH was caused by trauma in 52% of patients, with the time from trauma to imaging averaging 25.05 days; 37.7% were hypertensive patients and 20% had a neurological disease. Eighty-five (48.3%) patients were elderly and altered consciousness was present in 63% of cases. Of the 91 (51.7%) non-elderly patients, 44% presented with headache, altered consciousness occurred in 40% and motor abnormalities in 27.5%. The CSDH was located on the right in 41%, left in 43% and bilaterally in 16% of patients. Conclusion : the change of consciousness was the most common clinical alteration in the elderly and headache in non-elderly. The most associated comorbidity was the arterial hypertension and the most frequent cause, head trauma. The trepanation with two oriffices associated with a closed drainage system was the most used operating, with high efficacy and low complication rate.

Objetivo: caracterizar os pacientes com hematoma subdural crônico submetidos à intervenção cirúrgica e identificar os indicadores prognósticos. Métodos: análise retrospectiva de pacientes diagnosticados com hematoma subdural crônico (HSDC) submetidos a tratamento cirúrgico. Foram analisados: idade, período do trauma ao diagnóstico por imagem, escala de coma de Glasgow pré e pós-operatório, tipo de intervenção cirúrgica, comorbidades associadas, utilização de drenagem pós-operatória e acompanhamento ambulatorial. Resultados: a amostra consistiu em 176 pacientes, 126 do sexo masculino e 50 pacientes do sexo feminino (proporção de 2,5:1), a idade variou de seis meses a 97 anos, com uma média de 59,3 anos. O HSDC foi causado por trauma em 52% dos pacientes, com o intervalo do trauma ao diagnóstico por imagem, em média, de 25,05 dias. Eram hipertensos 37,7% dos pacientes e 20% possuíam alguma doença neurológica. Oitenta e cinco (48,3%) pacientes eram idosos e a alteração da consciência esteve presente em 63% dos casos. Não eram idosos 91 (51,7%)p pacientes, 44% aprresentaram cefaleia, alteração da consciência ocorreu em 40% dos pacientes e as alterações motoras, em 27,5%. O HSDC localizou-se à direita em 41%, à esquerda em 43% e, bilateral em 16% dos pacientes. Conclusão: a alteração de consciência foi a alteração clínica mais comum nos idosos e a cefaleia em não idosos. A comorbidade mais associada foi a HAS e a causa mais frequente, o traumatismo craniano. A trepanação com dois orifícios associada ao sistema de drenagem fechado foi a operação mais utilizada, com alta efetividade e baixo índice de complicações.

Hematoma subdural crônico em adultos jovens / Subdural Hematoma Chronic in Young Adults

Objetivo O hematoma subdural crônico em adultos jovens é relativamente frequente, sendo tipicamente encontrado em idosos. Os principais fatores relacionados ao hematoma subdural crônico em adultos jovens são: derivação ventriculoperitoneal, cisto aracnóideo, uso de droga anticoagulante, coagulopatias e esportes vigorosos. O prognóstico depende da idade do paciente, do estado neurológico na admissão, das doenças sistêmicas associadas, assim como do diagnóstico preciso e tratamento adequado. Métodos Foram incluídos pacientes de ambos os gêneros, da faixa etária de 20 a 45 anos de idade, com diagnóstico confirmado de hematoma subdural crônico. Resultados Foram analisados 34 pacientes no período de janeiro de 2005 a dezembro de 2013. O gênero masculino teve 25 e o feminino 9 casos. As causas foram: traumatismo cranioencefálico (20 pacientes), etilismo (7), crises convulsivas (3) e raquianestesia (2); as causas permaneceram desconhecidas em 2 pacientes. A tomografia computadorizada foi realizada em todos os pacientes e a ressonância magnética em 2 deles. Localização unilateral em 30 e bilateral em 4. Foram tratados cirurgicamente 28 pacientes e 6 receberam tratamento conservador. Tiveram boa evolução 27 pacientes, 4 apresentaram déficit neurológico focal, 2 apresentaram crise convulsiva e houve um óbito. Conclusões O hematoma subdural crônico é frequente em adultos jovens. O traumatismo cranioencefálico e etilismo crônico foram as principais causas de hematoma subdural crônico em jovens. Acomete mais o gênero masculino. O tratamento de escolha é cirúrgico. O prognóstico é bom.

Objective Chronic subdural hematoma in young adults is relatively common, typically found in the elderly. The main factors related to chronic subdural hematoma in young adults are: ventriculoperitoneal shunt, arachnoid cyst, anticoagulant drug, coagulopathies and vigorous sports. The prognosis depends on the patient's age, neurological status on admission, associated systemic diseases, as well as the accurate diagnosis and proper treatment. Methods Patients of both sexes were included with 20-45 years of age with a confirmed diagnosis of chronic subdural hematoma. Results 34 patients were analyzed from January 2005 to December 2013. Males reported 25 cases and 9 female. The causes were 20 traumatic brain injury, alcoholism 7, 3 seizures, spinal anesthesia 2 and unknown 2 patients. Computed tomography was performed in all patients and magnetic resonance imaging in 2 cases. Location unilateral in 30 and bilateral in 4. Surgically and 28 patients were treated conservative 6. Twenty-seven patients improved, four had focal neurological deficits, seizures two and one case died. Conclusions The chronic subdural hematoma is common in young adults. The craniocerebral trauma and chronic alcohol consumption were the main causes of chronic subdural hematoma in young. It affects more males. The treatment of choice is surgery. The prognosis is good.

Hematoma subdural crónico: análisis de 95 casos / Chronic subdural hematoma: analysis of 95 cases

El Hematoma Subdural crónico es una patología relativamente frecuente que predomina en adultos mayores. Es de inicio insidioso, su diagnóstico se basa en el cuadro clínico y estudios radiológicos como la tomografía computarizada (TAC), el manejo es predominante quirúrgico y su pronóstico es bueno. Se analiza en el presente estudio, una muestra de 95 expedientes clínicos de pacientes con dicho diagnóstico, síntomas iniciales, TAC pre y post diagnóstico, tratamiento y evolución...

Apresentaçao clínica e prognóstico dos pacientes com hematoma subdural crônico / Relation between clinical presentation and prognosis in chronic subdural hematoma patients

Introdução: O hematoma subdural crônico é considerado uma das lesões neurocirúrgicas que apresenta bom prognóstico. Os autores apresentam sua experiência sobre apresentação clínica e prognóstico. Pacientes e métodos: Foram analisados, retrospectivamente, 60 casos de hematoma subdural crônico entre janeiro de 2002 e junho de 2008. Os dados analisados foram características demográficas, quadro clínico, tratamento, complicações e prognóstico. Resultados: A idade variou entre 38 e 82 anos, com média de 58 anos. Houve predomínio do sexo masculino com relação masculino:feminino de 2,53:1. A localização foi unilateral em 49 casos e bilateral em 11 casos. Fatores predisponentes: traumatismo craniano (30), alcoolismo crônico (14), uso de anticoagulante oral (6), outras causas (6) e desconhecido (4). Apresentações clínicas foram: acidente vascular cerebral (16), hipertensão intracraniana (12), distúrbios psiquiátricos (11), síndrome piramidal (8), crises convulsivas (8), sintoma extrapiramidal (4) e hemorragia subaracnóidea (2). Tratamento cirúrgico foi realizado em 58 casos. Os casos de alcoolismo crônico associados à apresentação psiquiátrica tiveram péssimo prognóstico, seguidos dos casos de uso de anticoagulantes orais associados a hipertensão intracraniana. Os resultados foram ótimos em casos de hematoma subdural crônico associados a hipertensão intracraniana e nos casos com clínica piramidal e extrapiramidal. Cinco pacientes foram a óbito (dois por intercorrências cirúrgicas, dois por doenças sistêmicas e um por infecção hospitalar). Conclusão: O hematoma subdural crônico manifesta-se por formas clínicas variadas, seu prognóstico encontra-se diretamente relacionado à causa básica, apresentação clínica e tratamento.

Hematoma subdural crônico no idoso / Chronic subdural hematoma in elderly

Os distúrbios auditivos da terceira idade vêm recebendo crescente importância na medida em que a esperança de vida aumenta e, conseqüentemente, a idade da população. A presbiacusia, alteração mais freqüente, ao lado de outras doenças auditivas são discutidas, abordando-se suas principais características, diagnóstico e o tratamento.(au)