[Head injury in Buenos Aires city: a prospective, population based, epidemiologic study]. / Traumatismo craneoencefálico el la ciudad de Buenos Aires: estudio epidemiológico prospectivo de base poblacional.

OBJECTIVE: The aim of the study is to present head injury (HI) epidemiology in a population of Buenos Aires that represents almost all socioeconomic sectors. MATERIAL AND METHOD: Prospective, population based study, approved by the Ethic, Education and Research Committees as part of a neurotrauma program. RESULTS: HI incidence was 322/100,000 inhabitants, of them mild HI accounted for 93%, moderate HI 4% and severe HI 3%. Average age was greater in women than in men (49 vs. 38 yo, p 0.01). Taking into account population under and over 40 years we found several differences: the relative risk (RR) for any kind of HI was 1.97 (CI 95% 1.77-2.19, p < 0.01, and the RR for motor vehicle (MV) related HI was 2.53 (CI 95% 2.03-3.17, p < 0.01). Male drivers had a higher RR (16.76 CI 95% 5.35-52.50, p < 0.01) regardless age. Assaults were also significantly higher in people under 40 yo (RR 2.11 IC 95% 1.46-3.03, p < 0.01) increased in young males. Self altitude falls were more frequent in population over 40 yo (RR 4.35 CI 95% 2.61-4.16, p < 0.01) and in women at any age (RR 3.15 CI 95% 2.57-3.87, p < 0.01). Pedestrian accidents were also more common in population over 40 yo (RR 1.84 CI 95% 1.41-2.41 p < 0.01). We did not find any other differences concerning the remaining trauma mechanisms. CONCLUSIONS: HI incidence in Buenos Aires is similar to other printed series, but moderate and severe HI and mortality rates are below that ones. Motor vehicle accidents are the leading HI cause, especially in the young male population, while self altitude fall and pedestrian accidents are prevalent in women and people over 40 yo.

[Ultrasonography in diagnosis and monitoring the progress of dissection of cervicocerebral arteries]. / La ecografía en el diagnóstico y control evolutivo de las disecciones de arterias cervicocerebrales.

INTRODUCTION: Ultrasonography has become part of the arsenal of diagnostic methods available for examining the dissection of cerebral blood vessels (DCV). AIMS: To analyse the value of ultrasonography in the diagnosis and monitoring of DCV. PATIENTS AND METHODS: We conducted a consecutive study of 67 patients with a history and clinical picture compatible with DCV; all of them had been given confirmation of their diagnosis by another reference method (digital angiography or MR angiography) during the 48 hours prior to or following the ultrasound study. The ultrasonography was carried out on the neck and skull as per the usual system using continuous Doppler, neck duplex and transcranial Doppler ultrasonography. Diagnosis of the dissection was based on direct and indirect signs, in the absence of an atheroma plaque. The following were considered to be direct signs: haematoma in the wall of the vessel, flap, local increase in the flow velocity and echograms with split systole. Indirect signs were: haemodynamic alterations proximal to the dissection, a pattern of slow flow and high resistance. The transcranial Doppler showed the findings lying distal to the dissection to be a lowered mean velocity and pulsatility. RESULTS: The ultrasonography of the series revealed direct signs in 46 patients (69%) and indirect signs in 21 (31%). Ultrasonography was used as the primary diagnostic method in 29 (43%) patients; in the other 38 (57%) it was employed to verify the diagnosis or for the follow up. All the ultrasound diagnoses were confirmed using digital angiography (21 cases) or magnetic resonance angiography (46 cases). CONCLUSIONS: Due to its harmlessness, ultrasonography should be the first examination used to establish a probable diagnosis of DCV.