Perforating brain injury from a speargun. A case report.

A case of a perforating brain injury caused by a speargun in a suicide attempt is described. Although this kind of injuries has been previously reported, the present case is specially interesting because the patient showed no neurological deficit after surgery. Some advices about the medical and surgical management are proposed based on this case and our literature review. The use of antibiotics and antiepileptic drugs and the anterograde extraction of the harpoon aided by the performance of a craniotomy surrounding the exit point are recommended.

Perforating brain injury from a speargun. A case report

A case of a perforating brain injury caused by a speargun in a suicide attempt is described. Although this kind of injuries has been previously reported, the present case is specially interesting because the patient showed no neurological deficit after surgery. Some advices about the medical and surgical management are proposed based on this case and our literature review. The use of antibiotics and antiepileptic drugs and the anterograde extraction of the harpoon aided by the performance of a craniotomy surrounding the exit point are recommen­ded (AU)

Describimos un caso de traumatismo craneo-encefá­lico perforante causado por un arpón de pesca submarina tras intento de autolisis. Aunque traumatismos parecidos han sido publicados previamente, el presente caso es especialmente interesante dada la escasa repercusión neurológica que el paciente presentó tras la cirugia. Basándonos en esta experiencia y en nuestra revisión bibliográfica proponemos algunos consejos que pueden ser de utilidad en el manejo médico y quirúrgico. El uso de antibióticos y antiepilépticos así como la extracción anterógrada del arpón con la ayuda de una craneotomía rodeando su punto de salida son algunas de estas reco­mendaciones (AU)

[Influence of the atmospheric pressure and other variable weather on the incidence of the subarachnoid hemorrhage]. / Influencia de los cambios de presión atmosférica y otras variables meteorológicas en la incidencia de la hemorragia subaracnoidea.

UNLABELLED: Spontaneous subarachnoid hemorrhage is a pathology usually related to risk factors, such as arterial hypertension and/or nicotine poisoning. Nevertheless, other variables exist, like meteorological changes, that although the experience aims as possible responsible for an increase of the incidence, are still not established like such. OBJECTIVE: It is to investigate the influence of the meteorological changes, either seasonal variations or changes of atmospheric pressure, in the incidence of the subarachnoid hemorrhage. METHOD: All the cases of spontaneous subarachnoid hemorrhage are considered from the 1st of January from 1997 to the 31st of March of 2008, making a medical registry of demographic aspects (age, sex) and antecedents (arterial hypertension, diabetes mellitus, cerebral ischemia, nicotine poisoning), as well as numbers of atmospheric pressure (in hectopascales, hPa), daily temperature and relative humidity, throughout this period, with a calculation of the maximum, average and minimum values, as well as pressure differentials between consecutive days. RESULTS: The analysis of the 173 gathered cases showed a predominance of the subarachnoid hemorrhage in female, specially the aneurismal ones, being arterial hypertension, the main factor of related risk. Significant differences between the days with and without hemorrhage were not demonstrated, in relation to the variation of atmospheric pressure (p 0.463), pressure temperature (p 0.381) and relative humidity (p 0.595) throughout the day. CONCLUSION: In our element, the variations of atmospheric pressure are not related to an increase of incidence of the subarachnoid hemorrhage. Instead of this, cases of subarachnoid hemorrhage take place with changes of hardly 1.7 (1-3) hPa in the day, without observing a clear seasonal tendency.

Influencia de los cambios de presión atmosférica y otras variables meteorológicas enla incidencia de la hemorragia subaracnoidea / No disponible

La hemorragia subaracnoidea espontánea es unapatología que habitualmente se relaciona con factoresde riesgo, tales como la hipertensión arterial y/o eltabaquismo. Sin embargo, existen otras variables, comolos cambios meteorológicos, que aunque la experienciaapunta como posibles responsables de un aumento de laincidencia, todavía no están establecidas como tales.Objetivo. Investigar la influencia de los cambiosmeteorológicos, ya sean variaciones estacionales ocambios de presión atmosférica, en la incidencia de lahemorragia subaracnoidea.Método. Se consideran todos los casos de hemorragiasubaracnoidea espontánea desde el 1 de enero de 1997al 31 de marzo de 2008, realizando un registro de aspectosdemográficos (edad, sexo) y antecedentes médicos(hipertensión arterial, diabetes mellitus, patologíacerebrovascular, tabaquismo), así como de las cifrasde presión atmosférica (en hectopascales, hPa), temperaturay humedad relativa diarias, a lo largo de dichoperiodo, con un cálculo de los valores máximo, medioy mínimo, así como de las diferencias de presión entredías consecutivos.Resultados. El análisis de los 173 casos recogidosmostró un predominio de la hemorragia subaracnoideaen el sexo femenino, especialmente la de origenaneurismático, siendo la hipertensión arterial, el principalfactor de riesgo relacionado. No se demostrarondiferencias significativas entre los días con y sin hemorragia,en relación a la variación de presión atmosférica(p 0.463), temperatura (p 0.381), humedad relativa (p0.595) a lo largo del día.Conclusión. En nuestro medio las variaciones depresión atmosférica no se relacionan con un aumentode la incidencia de la hemorragia subaracnoidea, produciéndoseésta con cambios de apenas 1,7 (1-3) hPaen el día, sin que se observe una clara tendencia estacional (AU)

Spontaneous subarachnoid hemorrhage is a pathologyusually related to risk factors, such as arterialhypertension and/or nicotine poisoning. Nevertheless,other variables exist, like meteorological changes, thatalthough the experience aims as possible responsible foran increase of the incidence, are still not established likesuch.Objetive. It is to investigate the influence of themeteorological changes, either seasonal variations orchanges of atmospheric pressure, in the incidence of thesubarachnoid hemorrhage.Method. All the cases of spontaneous subarachnoidhemorrhage are considered from the 1th of Januaryfrom 1997 to the 31th of March of 2008, making amedical registry of demographic aspects (age, sex) andantecedents (arterial hypertension, diabetes mellitus,cerebral ischemia, nicotine poisoning), as well as numbersof atmospheric pressure (in hectopascales, hPa),daily temperature and relative humidity, throughoutthis period, with a calculation of the maximum, averageand minimum values, as well as pressure differentialsbetween consecutive days.Results. The analysis of the 173 gathered casesshowed a predominance of the subarachnoid hemorrhagein female, specially the aneurismal ones, beingarterial hypertension, the main factor of related risk.Significant differences between the days with andwithout hemorrhage were not demonstrated, in relationto the variation of atmospheric pressure (p 0,463),pressure temperature (p 0,381) and relative humidity (p0,595) throughout the day (..) (AU)

[The role of platybasia in trigeminal neuralgia]. / Influencia de la platibasia en la neuralgia del trigémino.

INTRODUCTION: The vascular compression of a nerve is known to be the most important cause of idiopathic trigeminal neuralgia (ITN) by most authors. However, several cases of skull base deformities in patients with ITN have been reported in our bibliographic review. AIM. To compare the existence of platybasia between a group of patients with ITN and a randomized control group. SUBJECTS AND METHODS: Twenty-five patients with ITN and twenty-five control subjects were X-rayed and their basal angles were measured and compared. RESULTS: The basal angle measured to investigate the existence of platybasia is significantly greater in the ITN group than in the control group. Platybasia was found in 10 patients with ITN. However, only two cases of platybasia were reported in the control group. Therefore in our study we have found that the incidence of platybasia in patients with ITN is significantly increased. CONCLUSION: Our data demonstrated that platybasia has an important role in the pathogenesis of the ITN by altering the normal anatomy of the nerves and vessels within the posterior fossa.

Influencia de la platibasia en la neuralgia del trigémino / The role of platybasia in trigeminal neuralgia

Resumen. Introducción. La gran mayoría de autores considera que la neuralgia del trigémino idiopática (NTI) está causada por la compresión de un vaso sobre el nervio. Sin embargo, en la bibliografía se recogen algunos casos de neuralgia del trigémino asociados a deformidades de la base del cráneo, entre las cuales se encuentra la platibasia. Objetivo. Investigar la influencia de un tipo de deformidad de la base del cráneo, la platibasia, en la etiopatogenia de la compresión vascular que se considera causante de la NTI. Sujetos y métodos. Se realizan radiografías laterales de cráneo a 25 pacientes con diagnóstico de NTI, así como a 25 controles sanos para medir el ángulo basal y compararlos. Resultados. El ángulo basal medido para investigar la existencia de platibasia fue significativamente mayor en el grupo con NTI, aunque la platibasia estaba presente en sólo 10 pacientes. Sólo dos controles mostraban dicha deformidad. Por tanto, la diferencia de incidencia en platibasia entre ambos grupos de pacientes fue estadísticamente significativa. Conclusión. Los datos obtenidos en nuestro trabajo apoyan la teoría de que la platibasia influye en la etiopatogenia de la NTI, probablemente al alterar la disposición habitual de las estructuras vasculonerviosas alojadas en la fosa posterior (AU)

Summary. Introduction. The vascular compression of a nerve is known to be the most important cause of idiopathic trigeminal neuralgia (ITN) by most authors. However, several cases of skull base deformities in patients with ITN have been reported in our bibliographic review. Aim. To compare the existence of platybasia between a group of patients with ITN and a randomized control group. Subjects and methods. Twenty-five patients with ITN and twenty-five control subjects were X-rayed and their basal angles were measured and compared. Results. The basal angle measured to investigate the existence of platybasia is significantly greater in the ITN group than in the control group. Platybasia was found in 10 patients with ITN. However, only two cases of platybasia were reported in the control group. Therefore in our study we have found that the incidence of platybasia in patients with ITN is significantly increased. Conclusion. Our data demonstrated that platybasia has an important role in the pathogenesis of the ITN by altering the normal anatomy of the nerves and vessels within the posterior fossa (AU)

[Two cases of brain haemorrhage secondary to developmental venous anomaly thrombosis. Bibliographic review]. / Hemorragia intracerebral secundaria a trombosis espontánea de una anomalíavenosa del desarrollo: 2 casos y revisión de la literatura.

We report two cases of intracraneal brain haemorrhage secondary to developmental venous anomaly trombosis recently treated at our Department. First patient was a 28-year old woman on oral contraceptive treatment for a month who was referred to our Department with sudden-onset conscious level deterioration after presenting 24 hours previously with headache, vomits and hemiparesis. Computed Tomography revealed a predominant hypodense area containing hyperdense foci causing mild mass effect and midline-shift in keeping with a haemorrhagic infarction occupying almost completely the right frontal lobe. On CT, magnetic resonance (MR) and magnetic resonance angiography (MRA) there was a prominent tubular structure adjacent to the hematoma in keeping with a partly thrombosed vessel. Urgent craniotomy and partial hematoma evacuation was performed. Digital subtraction angiography confirmed the presence of a filling defect within the draining vein of a typical caputmedusae pattern developmental venous anomaly (DVA). Systemic anticoagulation was started and four days after surgery sedation was reversed and the patient awoke with normal conscious level although mild (4/5) hemiparesis persisted. Second patient was a 38-year old male evaluated in the Emergency Department due to tonic-clonic seizures in the left side followed by altered sensation in the same distribution. Initial CT revealed an intracranial bleed. After contrast administration there was an anomalous vessel in the same location that was confirmed angiographically represented a partly thrombosed DVA. Conservative management was favoured and the patient was discharged from hospital without clinical neurological deficits.

Hemorragia intracerebral secundaria a trombosis espontánea de una anomalíavenosa del desarrollo: 2 casos y revisión de la literatura / Two cases of brain haemorrhage secondary to developmental venous anomaly trombosis. Bibliographic

Presentamos dos casos de hemorragia cerebral secundaria a la trombosis de una anomalía venosa del desarrollo (AVD) recientemente tratados en nuestro servicio. La primera paciente era una mujer de 28 años que tomaba anticonceptivos orales desde hacía un mes, que ingresó tras deterioro agudo del nivel de conciencia precedido de hemiparesia, cefalea y vómitos de 24 horas de evolución. La tomografía computarizada (TC) realizada al ingreso demostró una imagen hipodensa con áreas de hiperdensidad en su interior y que ejercía efecto masa con desviación de la línea media. La lesión era sugestiva de un infarto hemorrágico que ocupaba casi la totalidad del lóbulo frontal derecho. Tanto en la TC, la resonancia magnética (RM) y la angioRM destacaba la existencia de una estructura tubular en el interior del hematoma compatible con un vaso con un trombo en su interior. La paciente fue sometida a una craneotomía urgente con evacuación parcial del hematoma. La arteriografía confirmó la existencia de un drenaje venoso anómalo (DVA) con un defecto de replección en su interior en el que desembocaba un penacho de venas con el patrón típico de "Cabeza de Medusa" por lo que, ante la sospecha de trombosis venosa, se procedió a la anticoagulación sistémica de la paciente. A los 4 días de la intervención se procede a la retirada progresiva de la sedación y de la intubación presentando la paciente un GCS de 15 con leve hemiparesia izquierda 4/5. El segundo caso fue un varón de 38 años que ingresó por un cuadro de crisis comicial tónico-clónica en hemicuerpo izquierdo seguida por una sensación de disestesia en la misma localización. La TC inicial mostraba una imagen de hemorragia intracraneal en la cual, al inyectar contraste, se apreciaba una imagen de vaso anómalo dilatado que, en el estudio angiográfico, resultó corresponder a un anomalía del desarrollo venoso trombosada. Se adoptó una actitud expectante con seguimiento angiográfico periódico de la lesión. El paciente fue dado de alta sin déficits neurológicos (AU)

We report two cases of intracraneal brain haemorrhage secondary to developmental venous anomaly trombosis recently treated at our Department. First patient was a 28-year old woman on oral contraceptive treatment for a month who was referred to our Department with sudden-onset conscious level deterioration after presenting 24 hours previously with headache, vomits and hemiparesis. Computed Tomography revealed a predominant hypodense area containing hyperdense foci causing mild mass effect and midline-shift in keeping with a haemorrhagic infarction occupying almost completely the right frontal lobe. On CT, magnetic resonance (MR) and magnetic resonance angiography (MRA) there was a prominent tubular structure adjacent to the hematoma in keeping with a partly thrombosed vessel. Urgent craniotomy and partial hematoma evacuation was performed. Digital subtraction angiography confirmed the presence of a filling defect within the draining vein of a typical caputmedusae pattern developmental venous anomaly (DVA). Systemic anticoagulation was started and four days after surgery sedation was reversed and the patient awoke with normal conscious level although mild (4/5) hemiparesis persisted. Second patient was a 38-year old male evaluated in the Emergency Department due to tonic-clonic seizures in the left side followed by altered sensation in the same distribution. Initial CT revealed an intracranial bleed. After contrast administration there was an anomalous vessel in the same location that was confirmed angiographically represented a partly thrombosed DVA. Conservative management was favoured and the patient was discharged from hospital without clinical neurological deficits (AU)

Paquimeningitis crónica hipertrófica idiopática.Aportación de dos nuevos casos y revisiónde la literatura / Idiopathic hypertrophic chronic pachymeningitis. Contribution of two new cases and literature review

La paquimeningitis crónica hipertrófica idiopática (PCHI) es un raro desorden caracterizado por inflamación crónica de la duramadre que puede asociarse a déficits neurológicos resultantes de la compresión de estructuras subyacentes. La etiología del proceso es incierta y para su diagnóstico es preciso descartar patología infecciosa, enfermedades del sistema inmune y otros procesos, junto con la confirmación anatomopatológica de la existencia de un infiltrado inflamatorio crónico de la duramadre, estéril sin evidencia de fenómenos vasculíticos o malignidad. La PCHI es una entidad poco frecuente. Revisando Medline de los últimos 35 años hemos encontrado 58 casos de PCHI, de los cuales en 43 la afectación estaba localizada a nivel intracraneal, siendo ésta la localización más frecuente, seguida de 11 casos donde la afectación estaba localizada a nivel espinal y 4 a nivel craneoespinal. Presentamos dos casos clínicos de PCHI de localización espinal, uno a nivel dorsal y otro lumbar vistos en nuestro servicio. Revisamos las manifestaciones clínicas, métodos diagnósticos y actitud terapéutica de los casos encontrados en la literatura (AU)

[Idiopathic hypertrophic chronic pachymeningitis. Contribution of two new cases and literature review]. / Paquimeningitis crónica hipertrófica idiopática. Aportación de dos nuevos casos y revisión de la literatura.

The idiopathic hypertrophic chronic pachymeningitis (IHCP) is a rare disorder characterized by chronic inflammation of the dura mater that there can be associated with resulting neurological deficits from the compression of underlying structures. The etiology of the pathologic process is uncertain and for its diagnosis it is necessary to rule out infectious pathology, diseases of the immune system and other processes, together with the pathological confirmation of the existence of a steril and chronic inflammatory infiltrate of the dura mater, and without evidence of vasculitic sings or malignancy. The IHCP is an infrequent entity. Through Medline last 35 years review we have found 58 cases of IHCP, of which in 43 the affectation was located at intracranial level, being this the most frequent localization, followed by 11 cases where the affectation was located at spinal level and 4 at craniospinal level. We present two clinical cases of IHCP of spinal localization, one at dorsal level and another one at the lumbar level seen in our institution, and we review the clinical manifestations, diagnostic methods, and therapeutic attitude used in the cases found in the literature.