[Cranial lesions due to forceps delivery]. / Lesiones craneales secundarias a parto asistido con forceps.

Deliveries with forceps or vacuum-extraction increase the incidence of perinatal craneoencephalic lesions, for which reason cesarean sections are performed more frequently. We report 3 cases of cranial lesions due to forceps deliveries, 2 with depressed skull fractures and 1 with a depressed fracture and an associated epidural hematoma. Diagnosis is made on clinical and radiological founds with CT scan or MRI. Treatment is surgical and consists of elevation of the depressed fracture and evacuation of the hematoma. The correct use of forceps is very important to avoid this kind of lesions in the newborn, especially in cases of difficult delivery.

Lesiones craneales secundarias a parto asistido con forceps / Cranial lesions due to forceps delivery

Los partos asistidos con forceps o vacuum aumentanla incidencia de lesiones craneoencefálicas fetales,siendo la tendencia actual a realizar cesáreas en partosque se prevén difíciles.Presentamos una serie de tres casos de lesionescraneales secundarias a parto asistido con forceps, doscasos de fracturas deprimidas y una fractura deprimidacon hematoma epidural subyacente. El diagnóstico serealiza con la clínica y técnicas de imagen como TACo IRM. El tratamiento es quirúrgico en la mayoría decasos, con elevación de la fractura y evacuación delhematoma.La forma correcta de aplicar los forceps resultaesencial para prevenir lesiones craneales fetales, especialmenteen partos difíciles (AU)

Deliveries with forceps or vacuum-extractionincrease the incidence of perinatal craneoencephaliclesions, for which reason cesarean sections are performedmore frequently. We report 3 cases of craniallesions due to forceps deliveries, 2 with depressedskull fractures and 1 with a depressed fracture and anassociated epidural hematoma. Diagnosis is made onclinical and radiological founds with CT scan or MRI.Treatment is surgical and consists of elevation of thedepressed fracture and evacuation of the hematoma.The correct use of forceps is very important to avoidthis kind of lesions in the newborn, especially in cases ofdifficult delivery (AU)

Paragangliomas de la cauda equina, a propósito de dos casos / Paragangliomas of the cauda equina: report of two cases

Los paragangliomas extraadrenales que afectan a la médula espinal no son frecuentes y suelen manifestarse como una compresión intradural de la cauda equina. Presentamos dos casos de paraganglioma de la cauda equina de características y comportamiento distintos, y revisamos los aspectos clínicos e histopatológicos de este tumor, así como el diagnóstico, tratamiento y pronós¬tico. Existen casos con una elevadísima vascularización tumoral que impide la extirpación completa de la lesión, lo cual es el tratamiento de elección de estos tumores. La realización de laminotomía osteoplástica y ecografía intraoperatoria son de gran utilidad en el abordaje de lesiones intradurales como el paraganglioma (AU)

Extraadrenal paragangliomas involving the spinal cord are not common and usually take the compres-sion of the cauda equine. Two cases of paraganglioma of the cauda equina with a different presentation are reported, and the clinical and histopathology findings of this tumor, as well as diagnosis, treatment and prognosis are review. We stress the importance of the high tumor vascularization form of intradural that can make impossible achieve a complete resection. Laminotomy and intraoperatory echography are very useful in the approach to intradural tumors, such as paraganglioma (AU)

Cervical epidural hematoma without fracture in a patient with ankylosing spondylitis. A case report.

Ankylosing spondylitis (AS) is an inflammatory disease involving the axial spine. Alterations in vertebral biomechanics leave the spine sensitive to traumas which, though minimal, may cause serious neurological lesions, particularly in long term AS patients with a completely ankylosed spine, who are more prone to suffer spine fractures. A 62-year-old man with a long-term AS suffered a minor trauma resulting in a cervical epidural hematoma from C2 to C7, leading to paraplegia. On the diagnosis of hematoma, he underwent C3-C7 left hemilaminectomies, to remove the hematoma. We could find no cause for the hematoma. The patient's condition improved, and he was eventually able to perform all his activities independently. Even though traumatic spinal epidural hematoma (SHE) of the ankylosed spine may occur in the absence of fracture, it is commonly associated with traumatic fracture or dislocation of the spine, particularly the cervical spine. In all the published series of SEH in AS, we could only find one more case of this pathology at the cervical spine without a fracture. Neurologic recovery can be successful if decompression is performed early. SHE must be considered after trauma to an ankylosed spine when there is neurological deterioration despite the absence of fracture. A good outcome depends on the early diagnosis and surgery.

[Paragangliomas of the cauda equina: report of two cases]. / Paragangliomas de la cauda equina: a propósito de dos casos.

Extraadrenal paragangliomas involving the spinal cord are not common and usually take the compression of the cauda equine. Two cases of paraganglioma of the cauda equina with a different presentation are reported, and the clinical and histopathology findings of this tumor, as well as diagnosis, treatment and prognosis are review. We stress the importance of the high tumor vascularization form of intradural that can make impossible achieve a complete resection. Laminotomy and intraoperatory echography are very useful in the approach to intradural tumors, such as paraganglioma.

[Brain aneurysms: an infrequent cause of transient ischemic stroke]. / Aneurismas cerebrales: una causa infrecuente de accidente isquémico transitorio.

INTRODUCTION: Ischemic symptomatology related to the presence of saccular brain aneurysms is infrequent, and this makes it difficult to reach a widespread agreement about the most suitable treatment. CASE REPORT: A 17-year-old male with symptoms of little stroke produced by distal embolisation of an aneurysm in the middle cerebral artery. The patient was treated by endovascular aneurysm exclusion. CONCLUSIONS: In patients with no other identifiable cause of ischemic attacks, the possible presence of a brain aneurysm must be taken into account. First choice treatment is the obliteration of the aneurysm using endovascular techniques. If the approach to the aneurysm (either endovascular or surgical) entails a high risk for the patient, another possibility is to use antiplatelet drugs.

Aneurismas cerebrales: una causa infrecuente de accidente isquémico transitorio / Brain Aneurysms: an infrequent cause of Little stroke

Introducción. La sintomatología isquémica en relación con la presencia de aneurismas cerebrales saculares es infrecuente, lo que dificulta el consenso en cuanto al tratamiento más adecuado. Caso clínico. Varón de 17 años con sintomatología isquémica transitoria producida por embolización distal de un aneurisma de la arteria cerebral media. Se trató mediante exclusión aneurismática por vía endovascular. Conclusiones. En pacientes sin otra causa identificable de accidentes isquémicos, debe considerarse la presencia de un aneurisma cerebral. El tratamiento de elección es la obliteración aneurismática mediante técnicas endovasculares. Se puede optar por emplear antiagregantes plaquetarios si el abordaje al aneurisma (endovascular o quirúrgico) supone un elevado riesgo para el Paciente (AU)

Introduction. Ischemic symptomatology related to the presence of saccular brain aneurysms is infrequent, and this makes it difficult to reach a widespread agreement about the most suitable treatment. Case report. A 17-year-old male with symptoms of little stroke produced by distal embolisation of an aneurysm in the middle cerebral artery. The patient was treated by endovascular aneurysm exclusion. Conclusions. In patients with no other identifiable cause of ischemic attacks, the possible presence of a brain aneurysm must be taken into account. First choice treatment is the obliteration of the aneurysm using endovascular techniques. If the approach to the aneurysm (either endovascular or surgical) entails a high risk for the patient, another possibility is to use antiplatelet drugs (AU)

Réplica. Cavernomatosis múltiple. Diagnóstico diferencial por eco-gradiente / Reply. Multiple cavernomatosis. Differential diagnosis by gradient-echo

No disponible

No disponible

[Management of multiple cerebral cavernomatosis]. / Tratamiento de la cavernomatosis cerebral multiple.

INTRODUCTION: Cavernous angiomas are angiographically occult vascular malformations that are present in 0.4% of people, and represent 5 13% of all cerebrovascular malformations. They can be alone or multiple, and sporadic or familial. The presence of multiple lesions is more frequent in familial cavernomatosis. OBJECTIVES: Improve our knowledge of the natural history of multiple cavernomatosis in order to improve our diagnostic and therapeutic management of this entity. PATIENTS AND METHODS: We have retrospectively reviewed 18 cases of multiple cerebral cavernomatosis; 4 of them belonged to the same family and 2 belonged to another family. Number, size, characteristics and evolution of the lesions, symptoms, treatment and clinical outcome have been analysed during a follow up period longer than 5 years. RESULTS: 31.5% of the cavernous angiomas reviewed by our department were multiple (at least three lesions). During the 5 year follow up period only four (4/18) patients underwent surgical treatment. 50% of patients suffered at least one hemorrhagic event with clinical impairment, and the most frequent manifestations were headache, focal deficit and seizures. The hemorrhagic rate per lesion per year was under 1%, for the more than 200 lesions and the low frequency of hemorrhagic events with clinical impairment in the time. CONCLUSIONS: Surgical treatment must be considered in patients with accessible lesions that have produced symptoms several or progressive symptoms. The non surgical patients should be followed with yearly MRI. When more than one first degree relative has a cavernous malformation or familial antecedent with cerebral hemorrhage or epilepsy, serial follow up monitoring consisting of physical examinations and MRI should be suggested to family members.

Tratamiento de la cavernomatosis cerebral múltiple / Management of the multiple cerebral cavernomatosis

Introducción. Los angiomas cavernosos son malformaciones vasculares angiográficamente ocultas, presentes en el 0,4 por ciento de los individuos, y que suponen el 5-13 por ciento de las malformaciones vasculares. Pueden ser únicos o múltiples, y esporádicos o familiares. El carácter múltiple de las lesiones es más frecuente en las formas familiares. Objetivos. Un mayor conocimiento de la historia natural de la cavernomatosis múltiple, que nos permita realizar un correcto manejo diagnóstico y terapéutico de esta patología. Pacientes y métodos. Hemos revisado retrospectivamente 18 casos de cavernomatosis cerebral múltiple, cuatro de los cuales pertenecían a una misma familia y dos a otra. Se ha analizado el número, tamaño, características y evolución de las lesiones, sintomatología del paciente, período de seguimiento, tratamiento realizado y evolución clínica a lo largo del tiempo. Resultados. Según los datos de nuestro servicio, en el 31,5 por ciento de los casos de cavernomas, éstos presentan un carácter múltiple (al menos tres lesiones). El seguimiento se ha efectuado durante un período medio de cinco años, durante el cual sólo cuatro pacientes se sometieron a tratamiento quirúrgico. El 50 por ciento de los pacientes presentaron al menos un episodio hemorrágico con repercusión clínica, y las manifestaciones más frecuentes fueron cefalea, focalidad neurológica y crisis comiciales. La incidencia de hemorragia por lesión por año es inferior al 1 por ciento, dado el elevado número de lesiones (más de 200 en total) y la escasa frecuencia de hemorragia con repercusión clínica a lo largo del tiempo. Conclusiones. El tratamiento quirúrgico debe plantearse en casos de lesiones de localización accesible que hayan producido síntomas en repetidas ocasiones o de forma progresiva. En el resto de casos se debe realizar un seguimiento con resonancia magnética (RM) anual. Cuando más de un familiar de primer grado tiene algún cavernoma o existen antecedentes familiares de hemorragias cerebrales o crisis comiciales, se debe ofrecer la posibilidad de seguimiento clínico y radiológico con RM a los miembros de la familia (AU)