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BACKGROUND: Currently available scores for predicting shunt dependency after aneurysmal spontaneous subarachnoid hemorrhage (aSAH) are limited and not widely accepted. The key purpose of this study was to validate a recently created score for shunt dependency in aSAH (SDASH) in an independent population of aSAH patients. We compared this new SDASH score based on a combination of the Hunt and Hess grade, Barrow Neurological Institute (BNI) score, and the presence or not of acute hydrocephalus with other published predictive scores. METHODS: The SDASH score, Hijdra score, BNI grading system, chronic hydrocephalus ensuing from SAH score (CHESS), Graeb score, and modified Graeb score (mGS) were calculated for a cohort of aSAH patients. Logistic regression analysis was used to determine the reliability of the SDASH score, and the area under the curve (AUC) of the receiver operating characteristics (ROC) curve was used to assess the discriminative ability of the model. RESULTS: In 214 patients with aSAH, 40 (18.7%) developed shunt-dependent hydrocephalus (SDHC). The AUC for the SDASH score was 0.816. The SDASH score reliably predicted SDHC in aSAH (odds ratio: 2.93, 95% CI: 1.99-4.31; p < 0.001) with no statistically significant differences being found between the SDASH score and the CHESS score (AUC: 0.816), radiological-based Graeb score (AUC: 0.742), or modified Graeb score (AUC: 0.741). However, the Hijdra score (AUC: 0.673) and BNI grading system (AUC: 0.616) showed lower predictive values than the SDASH score. CONCLUSIONS: Our findings support the ability of the SDASH score to predict shunt dependency after SAH in a population independent to that used to develop the score. The SDASH score may aid in the early management of hydrocephalus in aSAH, and it does not differ greatly from other predictive scores.
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Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Hidrocefalia/epidemiología , Aneurisma Intracraneal/cirugía , Complicaciones Posoperatorias/epidemiología , Hemorragia Subaracnoidea/cirugía , Adulto , Anciano , Femenino , Humanos , Hidrocefalia/patología , Aneurisma Intracraneal/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/patología , Pronóstico , Hemorragia Subaracnoidea/patologíaRESUMEN
Se presentan 2 casos de trombosis venosa cerebral (TVC) aguda tratados mediante trombectomía mecánica venosa (TMV) en los que la anticoagulación sistémica, considerada como la primera línea terapéutica, estaba contraindicada. El objetivo de la presente nota clínica es mostrar esta técnica como tratamiento alternativo en pacientes críticos en los que la anticoagulación supone un riesgo excesivamente elevado o está contraindicada (AU)
We report the use of mechanical venous thrombectomy in 2 cases of cerebral venous sinus thrombosis in which the usual first-choice treatment with systemic anticoagulants was contraindicated. Our aim is to present this treatment as an alternative to consider when anticoagulants therapy is too risky or is contraindicated in critically ill patients (AU)
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Humanos , Masculino , Adulto , Persona de Mediana Edad , Trombosis Intracraneal/cirugía , Trombectomía/métodos , Cuidados Críticos/métodos , Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/normasRESUMEN
EN: We report the use of mechanical venous thrombectomy in 2 cases of cerebral venous sinus thrombosis in which the usual first-choice treatment with systemic anticoagulants was contraindicated. Our aim is to present this treatment as an alternative to consider when anticoagulants therapy is too risky or is contraindicated in critically ill patients.
ES: Se presentan 2 casos de trombosis venosa cerebral (TVC) aguda tratados mediante trombectomía mecánica venosa (TMV) en los que la anticoagulación sistémica, considerada como la primera línea terapéutica, estaba contraindicada. El objetivo de la presente nota clínica es mostrar esta técnica como tratamiento alternativo en pacientes críticos en los que la anticoagulación supone un riesgo excesivamente elevado o está contraindicada.
Asunto(s)
Trombosis de los Senos Intracraneales/cirugía , Trombectomía/métodos , Adulto , Anticoagulantes/uso terapéutico , Lesiones Traumáticas del Encéfalo/complicaciones , Terapia Combinada , Angiografía por Tomografía Computarizada , Contraindicaciones de los Medicamentos , Humanos , Hipertensión Intracraneal/complicaciones , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Convulsiones/etiología , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Trombosis de los Senos Intracraneales/etiología , Fracturas Craneales/complicaciones , Hemorragia Subaracnoidea/complicaciones , Adulto JovenRESUMEN
Damage to the lateral geniculate body by diffuse axonal injury in brain trauma is uncommon. The authors present the clinical case and in vivo fibre tractography using diffusion tensor magnetic resonance imaging of this lesion in a patient presenting with homonymous sectoranopia after a traumatic head injury.
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Humanos , Masculino , Persona de Mediana Edad , Isquemia Encefálica , Arteria Basilar , Resultado Fatal , Enfermedad AgudaRESUMEN
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