RESUMEN
A 57-year-old woman, with a history of deep venous thrombosis and medicated with warfarin, presented at the hospital with acute back pain with paraplegia, headache, high blood pressure and vomiting. Imaging of the spine showed an acute intradural extramedullary haemorrhage with blood clot formation. The patient underwent surgery and received intensive post-surgical physiotherapy but remains paraplegic. Non-traumatic spinal intradural extramedullary haematoma (SIEH) is a rare neurological emergency that can result in spinal cord compression. Physicians should always consider this clinical entity as a differential diagnosis, especially in a patient presenting with acute back pain on anticoagulant therapy. LEARNING POINTS: Non-traumatic spinal intradural extramedullary haematoma is extremely rare.Acute cases can lead to spinal cord compression.Physicians should consider this clinical entity in anticoagulated patients presenting with acute onset of back or radicular pain followed by paraplegia, intestinal and bladder dysfunction.
RESUMEN
Non-traumatic haematomyelia is a rare finding of acute onset, which in most cases is the result of arteriovenous malformations (AVM), tumours, coagulation disorders or autoimmune conditions, but may also be secondary to treatment with anticoagulants and radiotherapy. We present the case of a 58-year-old woman with sudden onset cervical pain, followed by asymmetric diminution of strength in the upper limbs with reduced pain sensitivity. The diagnosis of AVM at the C7 and D1 levels was made following cervico-dorsal magnetic resonance imaging and angiography. Treatment was embolization with immediate isolation of the AVM. LEARNING POINTS: Central nervous system lesions (including subarachnoid haemorrhage) can be located in the spine as well as the brain.Subarachnoid haemorrhage can be diagnosed through examination of the cerebrospinal fluid, especially when the CT scan is normal in patients with typical signs of this condition (acute neurological deficits with pain and signs of meningeal irritation like fever or neck rigidity).Non-traumatic haematomyelia is a rare finding.
RESUMEN
INTRODUCTION: The National Post Hospital Care Project was created to provide a continuity of care after hospitalization or to functionally dependent people. Currently there is a great difficulty in the integration of patients. The objective of this paper is to compare the impact of the referral to the Project versus being discharged home, in the length of stay of stroke patients between 2010 and 2011. MATERIAL AND METHODS: Retrospective study of patients admitted to the Neurology Infirmary A and Stroke Unit of Coimbra's University Hospital, in 2010 and 2011. The cases analyzed were 1 209, featuring demographic data, length of stay, Rankin Score (mRS) and destination after discharge. The data was analyzed comparing the two years concerning the length of stay of stroke patients referred to the Project and those discharged home, given the their Rankin Score. RESULTS: In 2011, the number patients referred to the National Post Hospital Care Project was higher, 23.5% compared to 21.4%. The length of stay for the same Rankin Score of the patients referred to National Post Hospital Care Project, remained higher than those discharged home: for a Rankin Score of 1: 11, versus 26 days for the Project; Rankin Score 2: 13, versus 29 days for the project; Rankin Score 3: 13, versus 23 days for the Project; Rankin Score 4: 17, to 33 days for the Project, Rankin Score 5: 27, versus 39 days to the Project. After comparison between the length of stay of patient discharged of and those referred to the National Post Hospital Care Project, it was estimated that the referral represented an hospitalization excess of 1 718 days in 2010 and 1 198 days in 2011. CONCLUSION: The National Post Hospital Care Project is unable to meet the actual needs although the waiting time has reduced, possibly due to the increased number of beds and the possibility of patients waiting at home.
Introdução: A Rede Nacional de Cuidados Continuados Integrados surgiu para proporcionar a continuação de cuidados após internamento ou para pessoas funcionalmente dependentes. Actualmente há uma grande dificuldade na integração dos doentes no domicílio ou em estruturas de retaguarda. Pretende-se comparar o impacto da referenciação para a Rede Nacional de Cuidados Continuados Integrados versus alta para domicílio, no tempo de internamento dos doentes com Acidente Vascular Cerebral, entre 2010 e 2011.Material e Métodos: Estudo retrospectivo envolvendo os doentes internados na Neurologia A e Unidade de Acidente Vascular Cerebral dos Hospitais da Universidade de Coimbra, naquele anos. Analisaram-se 1 209 processos, incluídos 819, caracterizados demograficamente, tempo de internamento, Score de Rankin modificado e destino pós-alta. Compararam-se os dados, relativamente ao tempo de internamento dos doentes com Acidente Vascular Cerebral, referenciados para a Rede Nacional de Cuidados Continuados Integrados e os com alta para domicílio, atendendo ao Score de Rankin final.Resultados: Em 2011, aumentaram os doentes referenciados para a Rede Nacional de Cuidados Continuados Integrados, 23,5% comparativamente 21,4%. Em 2011 o tempo de internamento, para um mesmo Score de Rankin, da população referenciada manteve-se superior: para um Rankin de 1: 11 dias para domicílio, 26 dias para os doentes referenciados; para um Rankin de 2: 13 dias para domicílio, 29 dias para a rede; para Rankin de 3: 13 dias para domicílio, 23 dias para referenciados; para um Rankin de 4: 17 dias para domicílio, 33 dias para Rede; e para um Rankin de 5: 27 dias para domicílio, 39 dias para Rede. Comparando com os tempos de internamento da população com alta para domicílio, estima-se que tenha representado mais 1 718 dias de internamento, em 2010 e1 198 dias, em 2011.Conclusão: A Rede Nacional de Cuidados Continuados Integrados é incapaz de responder às necessidades actuais, embora o tempo de espera tenha reduzido, devido ao aumento do número de camas e da possibilidade dos doentes aguardarem vaga no domicílio.
