[Remote cerebellar hemorrhage after lumbar spinal fluid drainage. Report of two cases and literature review]. / Hematomas de cerebelo como complicación de drenaje lumbar. Presentación de dos casos y revisión de la literatura.

Remote cerebellar hematoma, a cerebellar hematoma occurring after performing a surgical procedure in an anatomical distant area from the cerebellum, is a rare complication. It has been reported after supratentorial surgery and, less often, after spinal surgery with dural opening with important loss of cerebrospinal fluid. We report the occurrence of remote cerebellar hemorrhage after lumbar spinal fluid drainage in two patients with suspected normal pressure hydrocephalus. They were managed conservatively with good outcome. We review the pathologic mechanism, diagnostic procedures, management and prognosis of remote cerebellar hemorrhage.

Hematomas de cerebelo como complicación de drenaje lumbar. Presentación de doscasos y revisión de la literatura / Remote cerebellar hemorrhage after lumbar spinal fluid drainage. Report of two cases and literature review

Los hematomas de cerebelo a distancia (HCD) sonuna complicación rara, consistente en la aparición deun hematoma en el cerebelo tras intervenciones quirúrgicasen áreas que no guardan relación anatómicacon él. Esta complicación ha sido descrita tras cirugíasupratentorial y, menos frecuentemente, tras cirugíaraquídea con apertura dural con importante pérdidade líquido cefalorraquídeo (LCR).Presentamos dos pacientes con un hematoma decerebelo tras la colocación de un drenaje lumbarexterno (DLE) por sospecha diagnóstica de hidrocefaliacrónica del adulto (HCA). Ambos evolucionaronfavorablemente tras la retirada de los DLE. Así mismo,realizamos una revisión de la literatura sobre los mecanismosetiopatogénicos, diagnóstico, tratamiento y pronósticode los HCD (AU)

Remote cerebellar hematoma, a cerebellar hematomaoccurring after performing a surgical procedure in ananatomical distant area from the cerebellum, is a rarecomplication. It has been reported after supratentorialsurgery and, less often, after spinal surgery with duralopening with important loss of cerebrospinal fluid. Wereport the occurrence of remote cerebellar hemorrhageafter lumbar spinal fluid drainage in two patients withsuspected normal pressure hydrocephalus. They weremanaged conservatively with good outcome. We reviewthe pathologic mechanism, diagnostic procedures, management and prognosis of remote cerebellar hemorrhage (AU)

[Pyogenic brain abscesses: experience with 60 consecutive cases]. / Abscesos piógenos encefálicos. Nuestra experiencia en 60 casos consecutivos.

INTRODUCTION: Brain abscess is a focal suppurative process in the brain parenchyma that still carries high mortality rates. Outcome is closely related with a correct and early management. In order to evaluate this management we have reviewed the brain abscesses treated in our Department during the last 14 years. MATERIAL AND METHODS: The authors present a retrospective series of 60 consecutive patients with pyogenic brain abscess treated between January of 1990 and February of 2004 paying attention to the epidemiology, etiology, clinical data, microbiology, treatment modalities and outcome. RESULTS: The male to female rate was 5.6 to 1. The average age was 47 years. Hematogenous spread was most frequent, followed by contiguous spread. In 22% of the cases, the origin was unknown. Regarding the causative pathogens, Gram positive cocci are the most frequent (44%), with a 40% incidence of anaerobics. A mixed infection occurred in 39% of the abscesses. Three modalities of treatment were used: non surgical, catheter drainage-aspiration and surgical excision. Outcome was excellent in 52 patients (86.7%) and 4 patients (6.7%) died. Although outcome was similar in both surgical modalities, drainage-aspiration required a second procedure in 20% of the cases while this was necessary in only 10% of the patients with abscess excision. Length of admission was shorter in the drainage-aspiration group than in the excision group (13 and 26 days respectively). Mortality was higher in patients with low level of consciousness and age over 70 years. CONCLUSIONS: The shorter admission time associated with drainage-aspiration of brain abscesses together with its high efficacy and low morbidity suggests that drainage-aspiration should be used as the first mode of treatment.

Abscesos piógenos encefálicos. Nuestra experiencia en 60 casos consecutivos / Pyogenic brain abscesses: experience with 60 consecutive cases

Introducción. El absceso cerebral es un proceso supurativo focal en el parénquima cerebral que todavía presenta una elevada mortalidad. El resultado está altamente relacionado con un tratamiento precoz y adecuado. Para valorar dicho tratamiento revisamos los abscesos cerebral es tratados en nuestro Servicio en los últimos 14 años. Material y métodos. Presentamos una revisión de los60 pacientes con diagnóstico de absceso cerebral piógeno tratados en el Servicio de Neurocirugía del Hospital Infanta Cristina entre Enero de 1990 y Febrero de 2004, prestando atención a la epidemiología, clínica, etiología, microbiología, tratamiento y resultado final. Resultados. La relación hombre/mujer es 5.6/1, con una edad media de 47 años; el origen de la infección más frecuente es el hematógeno, seguido de las infecciones contiguas, con un 22% de abscesos de origen desconocido; los gérmenes más frecuentes son los cocos Gram positivos (44%), con una importante presencia de gérmenes anaerobios (40%); en un 39% de los casos las infecciones son mixtas; las modalidades de tratamiento fueron la punción de los abscesos para aspiración-drenaje, la cirugía abierta, con o sin resección capsular, y el tratamiento médico exclusivo. 52 pacientes (86.7 %)curaron sin secuelas y 4 (6,7 %) fallecieron. Aunque los resultados de ambos tipos de tratamiento quirúrgico son similares, el drenaje del absceso requirió en un 20%de los casos un segundo proceder quirúrgico, mientras que la craneotomía lo precisó sólo en el 10%; la estancia media en nuestro hospital fue mucho menor en los abscesos tratados mediante drenaje que en los tratados mediante cirugía abierta (13 vs 26 días); la mortalidad fue mayor en pacientes con bajo nivel de conciencia al ingreso y en mayores de 70 años. Conclusiones. Consideramos que la menor estancia media del drenaje del absceso, unido a su alta eficacia y su baja morbilidad, hacen aconsejable su uso como tratamiento de primera elección

Introduction. Brain abscess is a focal suppurative process in the brain parenchyma that still carries high mortality rates. Outcome is closely related with a correct and early management. In order to evaluate this management we have reviewed the brain abscesses treated in our Department during the last 14 years. Material and Methods. The authors present a retrospective series of 60 consecutive patients with pyogenic brain abscess treated between January of 1990 and February of 2004 paying attention to the epidemiology, etiology, clinical data, microbiology, treatment modalities and outcome Results. The male to female rate was 5.6 to 1. The average age was 47 years. Hematogenous spread was most frequent, followed by contiguous spread. In 22%of the cases, the origin was unknown. Regarding the causative pathogens, Gram positive cocci are the most frequent (44%), with a 40% incidence of an aerobics. A mixed infection occurred in 39% of the abscesses. Three modalities of treatment were used: non surgical,catheter drainage-aspiration and surgical excision. Outcome was excellent in 52 patients (86.7%) and 4patients (6.7%) died. Although outcome was similar in both surgical modalities, drainage-aspiration required a second procedure in 20% of the cases while this was necessary in only 10% of the patients with abscess excision. Length of admission was shorter in the drainage aspiration group than in the excision group (13 and 26 days respectively). Mortality was higher in patients with low level of consciousness and age over 70 years. Conclusions. The shorter admission time associated with drainage-aspiration of brain abscesses together with its high efficacy and low morbidity suggests that drainage aspiration should be used as the first mode of treatment