Características Clínicas y Terapéuticas de los Pacientes que Ingresan por Trauma Craneoencefálico en el Complejo Hospitalario Dr. Arnulfo Arias Madrid. 2022 - 2023

Introducción: El trauma craneoencefálico (TCE) se define como una patología caracterizada por la alteración cerebral secundaria a una lesión traumática en la región de la cabeza, con la presencia de alteración de la consciencia y/o amnesia debido al trauma, cambios neurológicos, neurofisiológicos, con posibles fracturas de cráneo o lesiones intra craneanas atribuibles al trauma. Metodología: Es un estudio observacional, descriptivo, prospectivo en pacientes que sufrieron TCE internados en el servicio de neurocirugía en el Complejo Hospitalario Dr. Arnulfo Arias Madrid durante el periodo de marzo de 2022 a febrero de 2023. Resultados: Los resultados de este estudio mostraron que predomina el sexo masculino (78%) sobre el femenino (22%) en pacientes con TCE. Las causas de lesión más comunes fueron caídas de sus pies (27%), caídas de altura (25%) y colisión de moto/automóvil (20%). Las presentaciones clínicas más comunes fueron pérdida de consciencia (49%), amnesia/desorientación (19%) y cefalea (10%). Conclusión: El seguimiento promedio de los pacientes con TCE fue de 16 días. El género masculino fue el más frecuente, con mayor proporción en la edad media y adulta mayor. La etiología principalmente fue por caídas, manifestándose comúnmente por perdida del estado de alerta, y teniendo hallazgos múltiples en la tomografía cerebral. La mayoría de los pacientes se les dio manejo conservador. (provisto por Infomedic International)

Introduction: Cranioencephalic trauma (TBI) is defined as a pathology characterized by cerebral alteration secondary to traumatic injury in the head region, with the presence of altered consciousness and/or amnesia due to trauma, neurological, neurophysiological changes, with possible skull fractures or intracranial lesions attributable to trauma. Methodology: This is an observational, descriptive, prospective study in patients who suffered TBI hospitalized in the neurosurgery service at the Complejo Hospitalario Dr. Arnulfo Arias Madrid during the period from March 2022 to February 2023. Results: The results of this study showed a predominance of male (78%) over female (22%) patients with TBI. The most common causes of injury were falls from their feet (27%), falls from height (25%) and motorcycle/automobile collision (20%). The most common clinical presentations were loss of consciousness (49%), amnesia/disorientation (19%) and headache (10%). Conclusion: The average follow-up of patients with TBI was 16 days. The male gender was the most frequent, with a higher proportion in middle age and older adults. The etiology was mainly due to falls, commonly manifested by loss of alertness, and multiple findings in brain tomography. Most patients were managed conservatively. (provided by Infomedic International)

Hematoma espontáneo en contexto de absceso periamigdalino, embolización y luego amigdalectomía. A propósito de un caso / Spontaneous hematoma in the context of a peritonsillar abscess, embolization and subsequent tonsillectomy. About a case

La hematoma amigdalino espontáneo, es un cuadro clínico raro con baja incidencia a nivel mundial, resultado de un proceso inflamatorio local secundario a la amigdalitis, donde el factor de riesgo más significativo es la amigdalitis a repetición. Desde el punto de vista clínico, su distinción del absceso periamigdalino, puede ser un desafío, lo cual es crucial debido a diferencias en el tratamiento y el pronóstico entre ambas. Al ser un cuadro de baja prevalencia es importante tener un alto nivel de sospecha diagnóstica para abordar adecuadamente esta entidad clínica y prevenir consecuencias potencialmente mortales.

Spontaneous tonsillar hematoma is a rare clinical condition with low incidence worldwide, resulting from a local inflammatory process secondary to tonsillitis, where the most significant risk factor is recurrent tonsillitis. From a clinical standpoint, its distinction from a peritonsillar abscess can be challenging, which is crucial due to differences in treatment and prognosis between the two. Given its low prevalence, maintaining a high level of diagnostic suspicion is important to address this clinical entity and prevent potentially life-threatening consequences appropriately.

Hepatectomía derecha de urgencia por necrosis hepática infectada secundaria a colangiografía endoscópica / Urgent right hepatectomy for infected hepatic necrosis secondary to endoscopic cholangiography

RESUMEN El hematoma subcapsular hepático es una complicación infrecuente pero potencialmente grave de la colangiografía retrógrada endoscópica. Por otra parte, las complicaciones derivadas del hematoma pueden ser su rotura, con el consiguiente sangrado masivo, y/o la trombosis portal por compresión que evolucione hacia la necrosis, la cual es susceptible de infecciones generalmente graves que requieren un manejo más enérgico. Presentamos el caso de una paciente a quien se le realizó una colangiografía endoscópica retrógrada por una colangitis aguda, y presentó en la evolución un hematoma subcapsular, que progresó a la necrosis hepática por compresión del pedículo portal, y una infección de esa necrosis, por lo que requirió una hepatectomía derecha de urgencia.

ABSTRACT Hepatic subcapsular hematoma is a rare but potentially lethal complication of endoscopic retrograde cholangiography. On the other hand, complications derived from the hematoma can be its rupture with the consequent massive bleeding, and/or portal thrombosis due to compression that evolves towards necrosis, which is susceptible to generally serious infections that require more aggressive management. We present the case of a patient treated in our department who underwent retrograde endoscopic cholangiography as treatment for her acute cholangitis, presenting in the evolution a subcapsular hematoma that progressed to hepatic necrosis due to compression of the portal pedicle and later an infection of that necrosis. requiring an emergency right hepatectomy as surgical treatment.

Application of transfrontal neuroendoscopic surgery in the treatment of chronic subdural hematoma / 中国内镜杂志

Objective To evaluate the efficacy of transfrontal neuroendoscopic surgery in the treatment of chronic subdural hematoma.Methods Analysis of clinical data of 80 cases of chronic subdural hematoma.According to the surgical method,40 cases were divided into traditional external drainage of parietaltuber,40 cases were divided into transfrontal neuroendoscopic small bone window hematoma removal.The treatment efficiency,hematoma recurrence rate,operation time and intraoperative blood loss were compared between the two groups.Results Treatment efficiency of neuroendoscopic group was 95.0%,significantly higher than drainage group 75.0%,hematoma recurrence rate one month after surgery of neuroendoscopic group was 5.0%,significantly lower than that in drainage group 25.0%,operation time of neuroendoscopic group was(54.1±7.5)min,longer than that of drainage group(40.7±9.4)min,the differences were statistically significant(P<0.05).The intraoperative blood loss of neuroendoscopic group was(30.1±4.5)mL,compared with(27.1±6.4)mL in the drainage group,the difference was not statistically significant(P>0.05).Conclusion Transfrontal neuroendoscopic surgery can significantly improve the efficacy of chronic subdural hematoma,and hematoma recurrence rate is extremely low.It is worthy of clinical application.

Analysis of risk factors of massive cerebral infarction after craniocerebral injury in children with acute subdural hematoma / 中国神经精神疾病杂志

Objective To analyze and compare the clinical manifestations and imaging features of children with secondary massive cerebral infarction after acute subdural hematoma(ASDH),and to evaluate its potential risk factors in order to provide evidence for the prevention,early diagnosis and early treatment of secondary massive cerebral infarction after ASDH.Methods The clinical data of children with ASDH aged 4～12 years were retrospectively studied.All the children received routine operation.The diagnosis of post-traumatic secondary massive cerebral infarction(MCI)was based on low-density areas on CT images and clinical signs.Clinical and radiographic findings related to patient outcomes were reviewed and statistically compared.Univariate and multifactor Cox regression analysis was used to evaluate the MCI after operation to obtain the factors affecting MCI.Results A total of 67 cases were included in the study,with 32 cases included in the MCI group and 35 cases included in the non-MCI group.There were significant differences between MCI and non-MCI groups in age(t=2.016,P= 0.048),body mass(t=2.389,P=0.020),multiple injuries(χ2=11.121,P=0.001),GCS(Z=-4.730,P＜0.001),hematoma volume(χ2=12.890,P=0.002),MLS(χ2=12.261,P=0.002)and perioperative shock(χ2= 14.417,P＜0.001).GCS(OR=0.322,P=0.002),perioperative shock(OR=10.992,P=0.007),multiple injury(OR= 6.547,P=0.046)and MLS score(OR= 46.974,P=0.025)were major risk factors for MCI in children with ASDH.Conclusion Perioperative shock,multiple injuries,low GCS and MLS greater than 10mm are risk factors for MCI.The incidence of MCI is significantly increased in children with multiple risk factors.

Advances in the diagnosis and treatment of chronic subdural hematoma / 中国神经精神疾病杂志

Chronic subdural hematoma is one of the common central nervous system diseases in middle-aged and elderly people,and the incidence is increasing year by year.Drill and drain surgery is recognized as one of the effective ways to treat chronic subdural hematoma.However,there still exists a non-negligible recurrence after surgery.In addition,with the aging of the population,senior patients may have many underlying diseases.Therefore,the risk of surgery is high and some patients even have contraindications to surgery due to the long-term use of anticoagulant or antiplatelet drugs.In recent years,some progress has been made in the treatment of chronic subdural hematoma,such as oral atorvastatin can promote the absorption of chronic subdural hematoma,small-dose dexamethasone is used in the treatment of chronic subdural hematoma,neuroendoscopy-assisted treatment of segregated chronic subdural hematoma,and middle meningeal artery embolization surgery to reduce the recurrence of chronic subdural hematoma patients.Meanwhile,with the development of imaging,Computed Tomography(CT)and Magnetic Resonance Imaging(MRI)have made some progress in the diagnosis of chronic subdural hematoma.

Value of TREM2 for early hematoma expansion in elderly patients with spontaneous cerebral hemorrhage / 中华老年心脑血管病杂志

Objective To explore the value of baseline plasma soluble type 2 myeloid cell trigger receptors(sTREM2)in evaluation for early hematoma enlargement in elderly patients with spontan-eous cerebral hemorrhage(SCH).Methods Clinical data of 240 patients with acute SCH admitted to our hospital from January 2020 to August 2022 were collected and analyzed retrospectively.According to the expansion of the hematoma volume,they were divided into non-expansion group(172 cases)and expanded group(68 cases).Baseline head CT scanning was performed in all patients within 24 h of onset,clinical and imaging data were analyzed,and the volume of cerebral hematoma was calculated.Blood samples were collected immediately after admission and sTREM2 and galectin-3 levels were measured.Results Compared with the non-expansion group,the ex-panded group had larger cerebral hematoma volume,and increased levels of sTREM2,galectin-3,hs-CRP and TNF-a at admission(P＜0.01).Pearson correlation analysis showed that the expres-sion levels of sTREM2 and galectin-3 were positively correlated with cerebral hematoma at ad-mission(r=0.784,P=0.012;r=0.815,P=0.004).ROC curve analysis indicated that the sensi-tivity of combined serum sTREM2 and galectin-3 levels was significantly higher than that of sin-gle detection(85.59％vs 73.73％and 64.41％,P＜0.05),and the AUC value was 0.896(95％CI:0.741-0.932).Conclusion The baseline plasma level of sTREM2 is significantly increased in eld-erly SCH patients after early hematoma expansion.So,sTREM2 can be used as a risk marker for early expansion of hematoma,and its combined detection with galectin-3 shows higher diagnostic value.

Diagnosis of fetal adrenal hematoma through prenatal ultrasound: a case report and literature review / 中华围产医学杂志

Objective:To investigate the ultrasonic characteristics and evolution pattern of fetal adrenal hematoma (AH).Methods:A retrospective analysis was conducted on the clinical data of one fetal AH diagnosed at the Affiliated Hospital of Jining Medical University. The study involved a comprehensive search of the relevant cases of fetal AH published from January 1, 1989, to December 31, 2022, in the Yiigle database, China National Knowledge Infrastructure Database, Wanfang Database, and PubMed Database. The clinical features, sonographic characteristics, interventions, and prognosis of fetal AH were summarized. Descriptive statistical analysis was used.Results:(1) Case: An ultrasound at 36 +3 weeks of pregnancy detected a mixed echogenic nodule at the fetal left adrenal region, with clear border and no obvious blood flow signal. Fetal AH was considered. Observations from the close ultrasound follow-up on the case before and after birth, and one year and eight months after birth presented a gradual transformation of the lesion from mixed echogenic to solid echogenic and a reduction following enlargement in lesion size. The lesion was ultimately liquefied and absorbed. (2) Literature review: A total of 12 cases of fetal AH that had clear diagnosis and ultrasound data were retrieved and added to the present case, for a total of 13 cases. Neither prenatal maternal nor postnatal typical clinical manifestations were observed in fetal AH cases. In cases with large hemorrhage and/or bilateral adrenal hemorrhage, mild jaundice and feeding difficulties may be present. Two cases were terminated, one live baby died of heart failure due to vein of Galen aneurysmal malformation, other ten had good prognosis. Fetal AH ultrasound image features demonstrated time-dependent changes, progressing in the sequence of anechoicity, solid echogenicity, mixed echogenicity, and complete absorption of the lesion, or residual hyperechogenicity. Conclusions:Fetal AH is a rare condition that exhibits characteristic transformations in ultrasound image features over time. Conducting close follow-up ultrasound examinations is the preferred and crucial approach to the diagnosis of fetal AH.

The curative effect of interventional embolization of middle meningeal artery for chronic subdural hematoma / 介入放射学杂志

Objective To evaluate the safety and efficacy of interventional embolization of middle meningeal artery(MMA)for the treatment of chronic subdural hematoma(CSDH).Methods The clinical data of 14 patients with CSDH(17 lesions in total),who were treated with simple embolization of MMA at the Yijishan Hospital of Wannan Medical College of China between July 2021 and July 2022,were retrospective analyzed.After superselective catheterization of MMA using a microcatheter was accomplished,Onyx-18 glue,a liquid embolization agent,was used to embolize the main trunk and the branches of MMA.Imaging follow-up was adopted at 30 days and 90 days after discharge from hospital to evaluate the absorption of hematoma,and the improvement of clinical symptoms was defined as the modified Rankin Scale score(mRS)being decreased≥1 point from the baseline value.Results Successful embolization of MMA was accomplished for all the 17 lesions in the 14 patients,and no procedure-related complications occurred.During the follow-up period,the clinical symptoms and signs were remarkably improved in all patients.The postoperative 90-day hematoma volume was reduced by more than 90%in 11 patients and by more than 40%in one patient,and in 2 patients the postoperative 30-day hematoma volume was reduced by more than 30%.Complete absorption of hematoma was seen in 11 patients,and partial absorption of hematoma was observed in 3 patients.Conclusion For the treatment of newly-developed or recurrent CSDH,interventional embolization of MMA is clinically safe and effective.(J Intervent Radiol,2024,32:12-16)

Rehabilitation with a Patient with Severe COVID-19 Who Presented with Acute Subdural Hematoma During Ventilator and Extracorporeal Membrane Ventilator Management：A case Report / The Japanese Journal of Rehabilitation Medicine

Introduction：Intracranial hemorrhage after severe coronavirus disease 2019 (COVID-19) is associated with increased mortality and unfavorable patient outcomes.Case：A man in his 60s with independent activities of daily living (ADL) was diagnosed with COVID-19, and placed on a ventilator on Day (D)-3 and VV-ECMO on D-5. On D-23, an emergency craniotomy was performed for a left acute subdural hematoma. The patient was weaned from VV-ECMO on D-27. On D-33, sitting was initiated. On D-36, the patient was weaned from the ventilator and began exercise therapy. The Glasgow coma score (GCS) was E2V1TM4. Basic movement as assessed by the Functional Status Score for ICU (FSS-ICU) and Barthel Index (BI), was 3 and 0 points, respectively. On D-40, wheelchair use commenced. He began standing with a long leg orthosis on D-50, and began walking on D-53.On D-67, the patient transferred to a convalescent hospital. His GCS was E4V4M6. Generalized cognitive decline and motor paralysis were noted. The right upper limb, hand, and lower limb were assessed as Brunnstrom recovery stage IV, V, and V, respectively. The patient's grip strength was 11.9 kg [right] and 18.3 kg [left]. His knee extensor strength was 0.13 kgf/kg [right] and 0.19 kgf/kg [left]. The FSS-ICU, walking speed, and BI were 21 points, 0.17 m/sec, and 40 points, respectively. The patient was discharged on D-240.Discussion：The Early Mobilization and Rehabilitation Expert Consensus reports that early mobilization and active exercise can improve ADL at discharge. Our patient was weaned from VV-ECMO as soon as possible and practiced standing and walking with a long leg orthosis, resulting in a better outcome.

Descending aortic intramural hematoma with pulmonary embolism: A case report / 中国胸心血管外科临床杂志

@#Aortic intramural hematoma and pulmonary embolism are two rapidly progressive and life-threatening diseases. A 65-year-old male patient with descending aortic intramural hematoma and pulmonary embolism underwent pulmonary embolectomy and descending aortic stent-graft placement, with good postoperative results.

Intracranial hematoma removal ICD coding and DRG group analysis / 现代医院

In the case of intracranial hemorrhage,coders tend to ignore the cause of intracranial hemorrhage in the cod-ing,whether it is spontaneous intracranial hemorrhage or intracranial hemorrhage caused by trauma,and the coding of the two is completely different in ICD-10.The former is classified as I60-I62 while the latter is classified as S06.Different etiology will also enter different DRG groups when DRG is included.When determining the cause,the site of intracranial hemorrhage should be determined whether it is subarachnoid hemorrhage,or epidural/subdural hemorrhage or cerebral parenchymal hemorrhage,be-cause different bleeding sites have different codes in ICD-9-CM-3 when performing blood removal in cranial swelling.The classifi-cation of epidural hematoma removal was on 01.24,subdural or subarachnoid hematoma removal was on 01.31,and intracerebral parenchymal hematoma removal was on 01.39.The removal of intracranial hematoma is usually divided into cone craniotomy,skull trepanation and drainage and traditional craniotomy according to different operation methods.The operation process of these three operations is obviously different,and coders need to understand the characteristics of the three operations to achieve accurate classification.In the DRG grouping,the disease code is different from the surgical code and the DRG group will be different.Through understanding the definition and etiology of intracranial hematoma removal,the coding ideas of intracranial hematoma re-moval were analyzed,so as to improve the professional ability of coders and ensure the accuracy of DRG data.

Role of thrombomodulin-thrombin-high mobility group box 1 pathway in chronic subdural hematoma / 中华神经医学杂志

Chronic subdural hematoma (CSDH) is a collection of blood, blood clots and their degradation products, encapsulated by membrane and located within dural border cell layer. Pathophysiological processes such as inflammatory responses within hematoma cavity, coagulation abnormalities, and abnormalities in neovascularization play significant roles in CSDH development. High mobility group box 1 (HMGB1) can mediate processes such as inflammation, angiogenesis, and hemostasis, while thrombomodulin (TM) can bind with HMGB1 and rely on thrombin to degrade HMGB1. Current research has confirmed that the expressions of TM, HMGB1, and their downstream related factors are abnormally increased in the hematoma fluid of CSDH; however, the role of TM-thrombin-HMGB1 pathway in CSDH development is not fully clear. This article reviews the role of TM-thrombin-HMGB1 pathway in CSDH development, aiming to provide some references for pathogenesis and new therapeutic targets of CSDH.

Factors of mortality in patients with cardiac implantable electronic device: 5-year experience

SUMMARY OBJECTIVE: The use of cardiac implantable electronic devices has increased in recent years. It has also brought some issues. Among these, the complications of cardiac implantable electronic devices infection and pocket hematoma are difficult to manage. It can be fatal with the contribution of patient-related risk factors. In this study, we aimed to find mortality rates in patients who developed cardiac implantable electronic devices infection and pocket hematoma over 5 years. We also investigated the risk factors affecting mortality in patients with cardiac implantable electronic devices. METHODS: A total of 288 cardiac implantable electronic devices patients were evaluated. Demographic details, history, and clinical data of all patients were recorded. Cardiac implantable electronic devices infection was defined according to the modified Duke criteria. The national registry was used to ascertain the mortality status of the patients. The patients were divided into two groups (exitus and survival groups). In addition, the pocket hematoma was defined as significant bleeding at the pocket site after cardiac implantable electronic devices placement. RESULTS: The cardiac implantable electronic devices infection was similar in both groups (p=0.919), and the pocket hematoma was higher in the exitus group (p=0.019). The exitus group had higher usage of P2Y12 inhibitors (p≤0.001) and novel oral anticoagulants (p=0.031). The Cox regression analysis, including mortality-related factors, revealed that renal failure is the most significant risk factor for mortality. Renal failure was linked to a 2.78-fold higher risk of death. CONCLUSION: No correlation was observed between cardiac implantable electronic devices infection and mortality, whereas pocket hematoma was associated with mortality. Furthermore, renal failure was the cause of the highest mortality rate in patients with cardiac implantable electronic devices.

Effect of subchorionic hematoma on first-trimester maternal serum free β-hCG and PAPP-A levels

Abstract Objective This study aimed to investigate the effects of the presence of subchorionic hematoma (SH) in early pregnancies with threatened miscarriage (TM) on levels of first-trimester maternal serum markers, pregnancy-associated plasma protein-A (PAPP-A), and free β-human chorionic gonadotropin (β-hCG) levels. Methods The data of TM cases with SH in the first trimester between 2015 and 2021 were evaluated retrospectively. The data of age and gestational age-matched TM cases without SH were also assessed to constitute a control group. Demographic characteristics, obstetric histories, ultrasonographic findings, and free β-hCG and PAPP-A levels of the groups were compared. Results There were 119 cases in the study group and 153 cases in the control group. The median vertical and longitudinal lengths of the SH were 31 mm and 16 mm. The median age of both groups was similar (p=0.422). The MoM value of PAPP-A was 0.088 (.93) in the study group and 0.9 (0.63) in the control group (p=0.519). Similarly, the MoM value of free β-hCG was 1.04 (0.78) in the study group and 0.99 (0.86) in the control group (p=0.66). No significant relationship was found in the multivariate analysis between free β-hCG MoM, PAPP-A MoM, age, gravida, and vertical and longitudinal lengths of the hematoma (p>0.05). Conclusion The level of PAPP-A and free β-hCG were not affected by the SH. Therefore, these markers can be used reliably in TM cases with SH for the first-trimester fetal aneuploidy screening test.

Ruptura de hematoma hepático secundario a terapia neural / Rupture of hepatic hematoma secondary to neural therapy

Objetivo: determinar si la terapia neural es una opción de tratamiento que pueda ser utilizada sin la aparición de efectos adversos. Presentación del caso: se presenta y analiza el caso de una paciente que ingresó a urgencias por dolor abdominal generalizado diagnosticándose hematoma hepático y realizándosele una revisión de la literatura científica. Resultados: se procedió a efectuar laparotomía con cirugía de control de daños, obteniendo resultados satisfactorios con egreso hospitalario sin complicaciones agregadas. Conclusiones: la terapia neural es un tratamiento del cual no se tiene suficiente evidencia científica que avale su seguridad en los pacientes

Objective: to determine whether neural therapy is a treatment option which can be used without the occurrence of adverse effects. Case report: we present and analyze the case of a female patient who was admitted to the emergency room for generalized abdominal pain. A hepatic hematoma was diagnosed, and a review of the scientific literature was conducted. Results: a laparotomy with damage control surgery was performed, obtaining satisfactory outcomes, with hospital discharge without any added complications. Conclusions: neural therapy is a treatment for which there is not enough scientific evidence to support its safety in patients

Surgical Treatment of Chronic Subdural Hematoma under Local Anesthesia: Case Report and Literature Review / Tratamento cirúrgico de Hematoma Subdural Crônico sob anestesia local: Relato de caso e revisão de literatura

Introduction Optimal surgical treatment for chronic subdural hematoma (CSDH) in the elderly has been controversial. Whenever possible, a less invasive technique should be used to avoid complications. Case Report The patient was 82-years-old, with JPS; with diagnosis of liver cirrhosis due to alcohol abuse and history of recent myocardial infarction. He was admitted to the emergency room with temporal-spatial disorientation. The Glasgow coma scale (GCS) value on admission was 9. Left hemiparesis and osteotendinous hyperreflexia in the left side of the body. Noncontrast-enhanced cranial computed tomography (CT) showed right frontoparietal hypodense lesion with mass effect. Due to the clinical conditions of the patient, drainage of the hematoma was indicated through local anesthesia and sedation with midazolam. He was discharged after 8 days with improvement in his mental and neurological condition. Conclusion Drainage of CSDH using local anesthesia in an elderly person with severe comorbidity can reach excellent results.

Introdução O tratamento cirúrgico ideal para hematoma subdural crônico (HSDC) em idosos tem sido controverso. Sempre que possível uma técnica menos invasiva deve ser utilizada para evitar complicações. Relato do Caso Paciente de 82 anos portadora de JPS; com diagnóstico de cirrose hepática por abuso de álcool e história de infarto do miocárdio recente. Foi admitido no pronto-socorro com desorientação espaço-temporal. O valor da escala de coma de Glasgow (ECG) na admissão era 9. Hemiparesia esquerda e hiperreflexia osteotendinosa no lado esquerdo do corpo. A tomografia computadorizada (TC) de crânio sem contraste mostrou lesão frontoparietal hipodensa direita com efeito de massa. Devido às condições clínicas do paciente foi indicada drenagem do hematoma através de anestesia local e sedação com midazolam. Teve alta após 8 dias com melhora do quadro mental e neurológico. Conclusão A drenagem do HDC com anestesia local em idoso com comorbidade grave pode alcançar excelentes resultados.

Hematoma subcapsular esplénico espontáneo y mononucleosis infecciosa: una asociación de interés para el cirujano

La rotura espontánea de bazo es una complicación infrecuente pero muy grave de la mononucleosis infecciosa. Dada la urgencia con la que suele presentarse tal situación, la esplenectomía suele ser la opción quirúrgica más utilizada. Presentamos el caso de un paciente en el que con el diagnóstico de rotura esplénica espontánea se somete a laparoscopia diagnóstica en la que se consigue la preservación del bazo con buena evolución clínica. A la luz de este paciente, consideramos que, en caso de estabilidad clínica y hematomas subcapsulares de bazo, la laparoscopia con preservación esplénica es una opción viable y con buenos resultados. (provisto por Infomedic International)

Spontaneous rupture of the spleen is a rare but very serious complication of infectious mononucleosis. Given the urgency with which such a situation usually presents, splenectomy is usually the most used surgical option. We present the case of a patient diagnosed with spontaneous splenic rupture who underwent diagnostic laparoscopy in which spleen preservation was achieved with good clinical evolution. In the light of this patient, we consider that, in the case of clinical stability and subcapsular haematomas of the spleen, laparoscopy with splenic preservation is a viable option with good results. (provided by Infomedic International)