Deformaciones craneales posicionales: estudio clínico-epidemiológico / Positional cranial deformations: a clinical-epidemiological study

Introducción: Las deformidades craneales, que han existido desde siempre, recientemente han suscitado un gran interés. Varios estudios muestran un aumento llamativo de consultas por plagiocefalia occipital. En este trabajo se analizan los factores clínico-epidemiológicos relativos a esta deformación. Pacientes y métodos: Se revisaron las historias de 158 niños atendidos en nuestro hospital para evaluación de deformación craneal. Se recogieron datos clínicos y de neuroimagen, tratamientos y resultados, analizando especialmente los factores de riesgo. Resultados: Durante el estudio se apreció un aumento de visitas por esta causa. La media de edad al consultar fue de 9 meses, existiendo un claro predominio (68%) de varones. El tipo de deformación fue: plagiocefalia occipital unilateral (89,2%), bilateral (7,6%) y dolicocefalia (3,2%). Aparte de la posición para dormir, se encontraron diversos factores de riesgo, como colecciones pericerebrales de líquido cefalorraquídeo (LCR) en el 50% de los niños valorados mediante estudios de neuroimagen. El tratamiento fue conservador (posicional y/o fisioterapia) en la mayoría de niños y con cascos en 12, apreciándose mejoría en 136 pacientes. Discusión y conclusiones: Estos hallazgos concuerdan con los de la bibliografía. Un resultado original del estudio fue la elevada incidencia de colecciones pericerebrales de LCR. El aumento de plagiocefalia posicional coincidió con las indicaciones de la Academia Americana de Pediatría sobre la posición para dormir, con el fin de evitar la muerte súbita del lactante. Se destaca el papel del pediatra en la detección y el manejo inicial de estos pacientes. La instauración de medidas de prevención se considera más importante que las indicadas para su tratamiento (AU)

Introduction: Cranial deformities have always existed, but it is only until recently that they provoked a greater interest. Several reports have demonstrated an increasing tendency for occipital plagiocephaly. This work presents an analysis of the clinical-epidemiological features of these deformities in our area. Patients and methods: The medical records and neuroimaging studies of 158 children seen a tour hospital due to a skull deformation were analyzed, paying special attention to risk factors. Results: During the study period, an increase in the number of consultations for skull deformation of children was noted. The mean age for the patients at consultation was 9 months.There was a predominance of boys (68%) over girls. The deformities were: unilateral- (89.2%) or bilateral-posterior plagiocephaly (7.6%), and dolicochephaly (3.2%). In addition to the supine position for sleeping, there were several risk factors, among them pericerebral collections of cerebrospinal fluid found in 50% of children subjected to neuroimaging studies. Most children were managed conservatively, while 12 patients were given helmets, which led to an improvement in 136 cases. Discussion and conclusions: The present findings agree with those in the current literature. Aunique result of this study was the high rate of pericerebral fluid collections found in children assessed with neuroimaging methods. The increase in positional plagiocephaly seems to parallel the application of the recommendations for supine sleeping position established by the American Academy of Pediatrics for preventing the sudden infant death syndrome. The role played by Pediatricians in the detection, initial management and referral of these children is highlighted. Prevention measures seem to be more important than those regarding treatment (AU)

[Positional cranial deformations: a clinical-epidemiological study]. / Deformaciones craneales posicionales: estudio clínico-epidemiológico.

INTRODUCTION: Cranial deformities have always existed, but it is only until recently that they provoked a greater interest. Several reports have demonstrated an increasing tendency for occipital plagiocephaly. This work presents an analysis of the clinical-epidemiological features of these deformities in our area. PATIENTS AND METHODS: The medical records and neuroimaging studies of 158 children seen at our hospital due to a skull deformation were analyzed, paying special attention to risk factors. RESULTS: During the study period, an increase in the number of consultations for skull deformation of children was noted. The mean age for the patients at consultation was 9 months. There was a predominance of boys (68%) over girls. The deformities were: unilateral- (89.2%) or bilateral-posterior plagiocephaly (7.6%), and dolicochephaly (3.2%). In addition to the supine position for sleeping, there were several risk factors, among them pericerebral collections of cerebrospinal fluid found in 50% of children subjected to neuroimaging studies. Most children were managed conservatively, while 12 patients were given helmets, which led to an improvement in 136 cases. DISCUSSION AND CONCLUSIONS: The present findings agree with those in the current literature. A unique result of this study was the high rate of pericerebral fluid collections found in children assessed with neuroimaging methods. The increase in positional plagiocephaly seems to parallel the application of the recommendations for supine sleeping position established by the American Academy of Pediatrics for preventing the sudden infant death syndrome. The role played by Pediatricians in the detection, initial management and referral of these children is highlighted. Prevention measures seem to be more important than those regarding treatment.

[Radiosurgery as adjuvant treatment of a recurrent adult medulloblastoma. Ultra-early response]. / Radiocirugía como tratamiento complementario del meduloblastoma recidivadodel adulto: respuesta ultratemprana.

The role of radiosurgery after multimodality treatment of recurrent desmoplastic adult medulloblastoma is analyzed. The ultra-early clinical and pathological response of this tumor to adjunctive radiosurgery is stressed.

Tuberculous meningitis: an ancient warrior becomes a clinical challenge for 21st century physicians

Objetivos: La meningitis tuberculosa (MT) ocasiona la muerte y causa secuelas graves en más de la mitad de los pacientes que sufren la infección. La infección tuberculosa del LCR representa un reto diagnóstico y terapéutico. La tuberculosis puede considerarse como una epidemia y una prioridad sanitaria a nivel mundial; este reto epidemiológico se ha visto favorecido por el SIDA, el aumento en el número de viajeros internacionales, los movimientos migratorios y el aumento en el número de casos producidos por cepas resistentes. Pacientes y métodos: presentamos 3 casos de MT y revisamos algunos aspectos recientes de esta “clásica” infección. Resultados: dos de los tres casos de meningitis tuberculosa (dos mujeres marroquíes y un hombre español) presentaban lesiones pulmonares compatibles con afectación miliar; el paciente que no presentaba afectación pulmonar presentaba absceso paravertebral y afectación neurológica focal; ninguno de los pacientes presentaba infección por cepas resistentes y todos sobrevivieron aunque dos de ellos con secuelas o complicaciones locales. Conclusiones: el diagnóstico de meningitis tuberculosa debe considerarse en todo paciente con cuadro meníngeo de curso subagudo o en pacientes con abscesos paravertebrales y afectación óseas; el diagnóstico y tratamiento precoz son necesarios para disminuir la morbimortalidad (AU)

Objective: Tuberculosis meningitis (TM) kills or disables more than half of affected patients.CSF infection is difficult to diagnose and treat. Tuberculosis epidemic is a global emergency and its spread has been fuelled by AIDS pandemic, international travel, migration and increasing drug resistance. Patients and Methods: we present 3 cases of TM and comment on new times for an olddisease. Results: two out of three cases (2 Moroccan women and 1 Spanish man) had a chest X ray which showed millet-seed-like lesions; the patient who did not had pulmonary infection had aparavertebral abscess and neurological stroke; none of isolated M. tuberculosis was resistant to usual drugs; all of the patients survived but 2 of them had sequelae or local complications. Conclusions: diagnosis of tuberculous meningitis remains a challenge and must be considered in patients with subacute meningitis or epidural abscess and vertebral osteomyelitis; early treatment is crucial as delay has very serious life-threatening consequences and increases sequelae (AU)

Normal ventricular-CSF may comfound the diagnosis of tuberculous meningitis hydrocephalus.

BACKGROUND: The standard procedure for the diagnosis of central nervous system (CNS) infections consists of cerebrospinal fluid (CSF) sampling, which is usually accomplished by a lumbar puncture. However, in some patients presenting with acute hydrocephalus submitted to immediate CSF drainage, the fluid is customarily obtained from the placed draining system. In addition, the CSF obtained from the ventricular and lumbar spaces in some cases may show unusual differences, both in physiological and pathological conditions. ILLUSTRATIVE CASES: We report two children who presented with confounding results in the initial studies of their ventricular and lumbar CSF who were subsequently diagnosed with tuberculous meningitis, causing delay in diagnosis and treatment. AIM. By reporting these cases, we wanted to alert the treating physician about the possibility of this discrepancy to avoid the delayed diagnosis and management of the affected patients. DISCUSSION: We comment on the possible pathophysiological mechanisms that may result in this dissociation in ventricular and lumbar CSF composition. CONCLUSIONS; Normal results in CSF studies, especially those of the ventricular fluid, do not always rule out the presence of tuberculous meningitis. We suggest obtaining a CSF sample from the lumbar subarachnoid space in doubtful, or suspicious, cases of CNS infection even in the presence of a normal ventricular CSF.

Normal ventricular-CSF may confound the diagnosis of tuberculous meningitishydrocephalus / LCR ventricular normal: un factor de confusión en el diagnóstico de hidrocefalia por meningitis tuberculosa

Background. The standard procedure for the diagnosisof central nervous system (CNS) infections consistsof cerebrospinal fluid (CSF) sampling, which isusually accomplished by a lumbar puncture. However,in some patients presenting with acute hydrocephalussubmitted to immediate CSF drainage, the fluid is customarilyobtained from the placed draining system.In addition, the CSF obtained from the ventricularand lumbar spaces in some cases may show unusualdifferences, both in physiological and pathologicalconditions.Illustrative cases. We report two children who presentedwith confounding results in the initial studiesof their ventricular and lumbar CSF who were subsequentlydiagnosed with tuberculous meningitis, causingdelay in diagnosis and treatment.Aim. By reporting these cases, we wanted to alert thetreating physician about the possibility of this discrepancyto avoid the delayed diagnosis and management (..) (AU)

Antecedentes. El procedimiento habitual para eldiagnóstico de infección del sistema nervioso central(CNS) consiste en el estudio del liquido cefalorraquídeo(LCR) mediante la realización de una punción lumbar.Sin embargo, en pacientes que debutan con un cuadrode hidrocefalia aguda que son tratados de urgenciamediante la inserción de un sistema de drenaje deLCR, el líquido es rutinariamente obtenido desde elsistema derivativo implantado. Pero, en ciertos casos,el LCR ventricular y lumbar analizados pueden mostrardiferencias significativas, tanto en condicionesfisiológicas como patológicas.Casos ilustrativos. Se describen los casos de dosniños que presentaron resultados dispares en losestudios iniciales del LCR ventricular y lumbar, enlos que se demostró posteriormente que padecíanuna hidrocefalia por meningitis tuberculosa, lo que (..) (AU)

[Coccygeal dermal sinus: Clinical relevance and management]. / Sinus dérmico sacrocoxígeo: importancia clínica y manejo.

INTRODUCTION: The presence of a dermal sinus on a child's back is a common cause for paediatric neurosurgical consultation. The relative frequency of these lesions and fears on their possible clinical consequences enhances the importance of early diagnosis and treatment. With this work we aimed to search for the most relevant clinical features that might indicate an intradural penetration of the lesions and that may advise performing neuroimaging studies and a paediatric neurosurgical consultation. PATIENTS AND METHODS: The records pertaining to children diagnosed with sacro-coccygeal pits seen at our institution during the years 2005-2009 were reviewed. A Pub Med search of the most relevant articles on the subject was also performed. RESULTS: Thirty-two children diagnosed with sacro-coccygeal pits were seen at our institution in the study period. Most cases had been sent for neurosurgical consultation by their paediatricians, paediatric surgeons or paediatricians of the emergency services in our region. Seventeen patients were submitted to some neuroimaging study and 15 were evaluated only by physical examination. In no patient was an intradural penetration of the lesion observed. The lack of reports on coccygeal sinuses probably reflects the unimportance given to these lesions in the absence of neurological involvement. CONCLUSIONS: A detailed physical examination can reduce the number of neuroimaging studies, an intergluteal localization of the sinus being the most important diagnostic clue. Doubtful cases of an intradural penetration of the lesion can be further evaluated by ultrasound as a preliminary screening tool and by magnetic resonance and neurosurgical consultation if deemed necessary.

[Reversible primary empty sella. Case report]. / Silla turca vacía primaria reversible. A propósito de un caso.

We report the case of a 13-year-old girl with an increased hypophysis that mimicked an adenoma, who developed a partial empty sella on MRI after an acute episode of hydrocephalus. After replacement of a CSF shunt, the intracranial pressure returned to normal and the hypophysis filled up again all the sellar fossa. We discuss the possibility of the involvement by an ischemic atrophy of the adenohypophysis in the development of a primary empty sella with idiopathic chronic raised intracranial pressure that prevents the recovery of the gland volume after restoring the intracranial pressure to normal values. Restitution of empty sella may be an indicator of normal intracranial pressure in these cases.

Silla turca vacía primaria reversible. A propósito de un caso / Reversible primary empty sella. Case report

Se presenta el caso de un niña de 13 años con un aumento del tamaño de la hipófisis sugerente de adenoma que, tras un episodio de hidrocefalia aguda, desarrolló en la RM una silla turca vacía parcial.Tras la colocación de una derivación de líquido cefalorraquídeo, se normalizó la presión intracraneal y la hipófisis volvió a ocupar todo el espacio de la fosa sellar. Se discute la posibilidad de que en la silla turca vacía primaria con hipertensión intracraneal crónica idiopática, esté implicada una atrofia isquémica de la adenohipófisis que impide la recuperación del volumen glandular tras la restauración de la PIC a los niveles normales. La reversión de la silla turca vacía es un indicador de la normalización de la PIC (AU)

We report the case of a 13-year-old girl with an increased hypophysis that mimicked an adenoma, who developed a partial empty sella on MRI after an acute episode of hydrocephalus. After replacement of a CSFshunt, the intracranial pressure returned to normal and the hypophysis filled up again all the sellar fossa. We discuss the possibility of the involvement by an ischemic atrophy of the adenohypophysis in the development of a primary empty sella with idiopathic chronic raised intracranial pressure that prevents the recovery of the gland volume after restoring the intracranial pressure to normal values. Restitution of empty sell a may bean indicator of normal intracranial pressure in these cases (AU)

Ameloblastoma desmoplásico / Desmoplastic ameloblastoma

Presentamos un caso de ameloblastoma desmoplásico en una mujer de 32 años que afectaa la región media del maxilar superior. Se describen las características específicas, tantohistológicas como clínicas, de esta variante de ameloblastoma, y se insiste en su imagenradiológica similar a la de una lesión fibroósea benigna. Se indica la misma conducta terapéuticaque para el resto de los ameloblastomas intraóseos sólidos(AU)

We report a case of desmoplastic ameloblastoma in a 32 year-old female patient affectingthe region half of the upper jaw. We describe the specific characteristics, both histologicaland clinical of this variant of ameloblastoma, insisting its radiological image similar to thatof a benign fibroosseous lession. We indicate the same therapeutic conduct for the rest ofthe solid intraosseous ameloblastomas(AU)

[Bone marrow stem cell transplantation in amyotrophic lateral sclerosis: technical aspects and preliminary results from a clinical trial]. / Terapia celular para la esclerosis lateral amiotrófica: aspectos técnicos y resultados preliminares del estudio CMN/ELA.

Patients with amyotrophic lateral sclerosis (ALS) experience progressive and irreversible paralysis as a result of the continued loss of motor neurons, which leads to death in less than five years. To date, there is no treatment that can change the progression of this disease. Bone marrow stem cells have shown neural regenerative and neural repairing properties. Specifically, our group showed in a murine model of the disease that these cells, when injected in the spinal cord, can rescue motor neurons through the secretion of GDNF. Based on these results, we designed a phase I/II clinical trial for the purpose of demonstrating the viability of the intraspinal injection of autologous bone marrow mononuclear cells in patients with bulbar onset ALS, with an evolution between 6 and 36 months, with a forced vital capacity (FVC) 50% and T90 29%. This article describes the technique for extracting 60 mL of bone marrow used for the intervention, processing it by density gradient, and the neurosurgical technique used for implanting it. After 6 months of follow-up, the few adverse events reported in the first seven patients included seem to show that the procedure is safe and viable. Most of these patients, including two with a rapid deterioration, have stabilized the progression of their FVC and the neurologic scales measured. The data obtained so for seem to justify the design of new trials more oriented toward the efficacy of the procedure.

[Usefulness of hyperbaric oxygen in the treatment of radionecrosis and symptomatic brain edema after LINAC radiosurgery]. / Eficacia del oxígeno hiperbárico en el tratamiento de la radionecrosis y el edemacerebral sintomáticos tras radiocirugía con acelerador lineal.

Radionecrosis with brain edema is a complication of radiosurgery. Three female patients harbouring a frontal pole, petrous and parasagital parietoocipital meningiomas respectively who had been treated with LINAC radiosurgery are presented. Those patients developed, between two and eight months later, a severe symptomatic radionecrosis with a huge brain edema resistant to the usual steroid therapy. Only after 40 sessions of hyperbaric oxygen, a good remission of the lesions was obtained. There are few cases reported in the literature with such a good outcome. Consequentely, this therapy must be taken into account to treat this type of radiosurgical complication before considering surgery.

[Bidimensional-ultrasound guided-craniotomy in the excision of supratentorial brain tumours]. / Craneotomía guiada por ultrasonografía bidimensional para exéresis de tumor cerebral supratentorial.

OBJECTIVES: With this 1-year retrospective study we aimed to analyze our experience on the utilization of real-time bidimensional (2-D) ultrasonography as an aid for the localization of deep-seated supratentorial brain tumours. MATERIAL AND METHODS: During the year 2006 we performed 2-D ultrasonographic localization studies in patients undergoing excision of subcortical supratentorial brain tumours whose nature was pathologically proven. The ultrasound machines utilized were 2410 A ultrasounds HP and Phillips HDI 3500 ATL. To check gross anatomical structures we used a 3 MHz probe and then a 5 MHz sound to define the brain tumour characteristics. Coronal and sagittal cuts were obtained during parietal or temporal craniotomies, and axial and sagittal slices in the case of frontal masses. After brain tumour removal and after a thorough irrigation with saline, new image acquisitions were performed to confirm the completeness of tumour excision. The amount of removed tumour was also verified by a post-contrast computerized tomography (CT) scan performed after the surgery. RESULTS: The study group was composed by 30 patients with ages comprised between 28 and 82 years. The time required for tumour localization was 17.5 (+/- 1.9) min. The lesions were approached though 8 temporal, 7 parieto-occipital, 8 parietal, 2 fronto-parietal and 5 temporo-parietal craniotomies. Mean depth of the lesions was 5.3 (+/- 1.6) cm. The histopathologic diagnosis was 17 high-grade gliomas, 3 low-grade astrocytomas, 8 metastatic lesions and 2 oligo-astrocytomas. High-grade gliomas were more echogenic than low-grade tumours and than oedema. No residual tumour was detected at the end of the surgery except in two cases in which a tumoral rest was left due to the proximity of the lesion to eloquent cerebral areas. Postoperative CT scans confirmed the completeness of tumour removal in the patients of the study as assessed by intraoperative ultrasounds. CONCLUSIONS: Real-time 2-D ultrasonography affords an adequate image quality for performing guided-craniotomy in supratentorial brain tumours, as it allows for a safe and accurate localization of the lesions. Its use is mainly indicated in the removal of tumours located in, or close to, important anatomical and functional brain areas and to depict the presence of tumour rests after surgical removal of cerebral neoplasms.

Comments to Esparza et al’s article "Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases"

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Craneotomía guiada por ultrasonografía bidimensional para exéresis de tumorcerebral supratentorial / Bidimensional-ultrasound guided-craniotomy in the excision of supratentorial brain tumours

Objetivos: El objetivo de este estudio descriptivo es presentar nuestra experiencia clínica durante un año sobre la utilización de la ultrasonografía bidimensional (2-D) en tiempo-real para la exéresis de tumor supratentorial de localización cerebral profunda. Material y métodos: Durante el año 2006 realizamos craneotomía guiada por ultrasonografía 2-D en pacientes sometidos a cirugía para exéresis de tumor supratentorial, confirmado por anatomía patológica y de localización subcortical. Para la realización de la ultrasonografía se utilizaron los modelos de ultrasonidos M 2410 A ultrasounds HP y Phillips HDI 3500 ATL. Se utilizó en primer lugar un transductor de 3Mhz para localizar estructuras anatómicas, seguido de un transductor de 5MHz para la identificación del tumor cerebral. Se consiguieron cortes en el plano sagital y coronal durante la craneotomía parietal o temporal y en el plano axial y sagital en la craneotomía frontal. Tras la exéresis del tumor, se realizó una nueva ultrasonografía tras irrigar la cavidad con suero salino para la visualización de remanentes tumorales. Se realizó una tomografía computarizada (TC) craneal postoperatoria para verificar la exéresis total del tumor. Resultados: Se incluyeron en el estudio 30 pacientes de edades comprendidas entre 28 y 82 años. El tiempo requerido para la localización de la lesión fue de 17,5 (±1,9) min. Se realizaron 8 craneotomías temporales, 7 parietooccipitales, 8 parietales, 2 frontoparietales y 5 parietotemporales. La lesión fue localizada a una profundidad media de 5,3 (±1,6) cm. El estudio histológico reveló 17 gliomas de alto grado, 3 gliomas de bajo grado, 8 lesiones metastásicas y 2 oligoastrocitomas. Los gliomas de alto grado mostraron mayor ecogenidad que los gliomas de bajo grado y el edema cerebral. No se detectaron restos del tumor al final de la cirugía, excepto en dos pacientes debido a la proximidad a áreas elocuentes del cerebro. La TC craneal postoperatoria confirmó la exéresis total del tumor en los pacientes incluidos en el estudio. Conclusiones: La ultrasonografía 2-D en tiempo-real proporciona una imagen de calidad aceptable para la realización de craneotomía guiada para exéresis de tumores supratentoriales, ya que permite su localización de manera fiable y segura, sobre todo de tumores localizados en zonas del cerebro con gran importancia anatómica y funcional, así como identificar restos de tumor una vez finalizada la cirugía (AU)

Objectives: With this 1-year retrospective study we aimed to analyze our experience on the utilization of real-time bidimensional (2-D) ultrasonography as an aid for the localization of deep-seated supratentorial brain tumours. Material and methods: During the year 2006 we performed 2-D ultrasonographic localization studies in patients undergoing excision of subcortical supratentorial brain tumours whose nature was pathologically proven. The ultrasound machines utilized were 2410 A ultrasounds HP and Phillips HDI 3500 ATL. To check gross anatomical structures we used a 3MHz probe and then a 5MHz sound to define the brain tumour characteristics. Coronal and sagittal cuts were obtained during parietal or temporal craniotomies, and axial and sagittal slices in the case of frontal masses. After brain tumour removal and after a thorough irrigation with saline, new image acquisitions were performed to confirm the completeness of tumour excision. The amount of removed tumour was also verified by a post-contrast computerized tomography (CT) scan performed after the surgery. Results: The study group was composed by 30 patients with ages comprised between 28 and 82 years. The time required for tumour localization was 17.5 (±1.9)min. The lesions were approached though 8 temporal, 7 parieto-occipital, 8 parietal, 2 fronto-parietal and 5 temporo-parietal craniotomies. Mean depth of the lesions was 5.3 (±1.6)cm. The histopathologic diagnosis was 17 high-grade gliomas, 3 low-grade astrocitomas, 8 metastatic lesions and 2 oligo-astrocytomas. Highgrade gliomas were more echogenic than low-grade tumours and than oedema. No residual tumour was detected at the end of the surgery except in two cases in which a tumoral rest was left due to the proximity of the lesion to eloquent cerebral areas. Postoperative CT scans confirmed the completeness of tumour removal in the patients of the study as assessed by intraoperative ultrasounds. Conclusions: Real-time 2-D ultrasonography affords an adequate image quality for performing guided-craniotomy in supratentorial brain tumours, as it allows for a safe and accurate localization of the lesions. Its use is mainly indicated in the removal of tumours located in, or close to, important anatomical and functional brain areas and to depict the presence of tumour rests after surgical removal of cerebral neoplasms (AU)

Abscesos cerebrales: análisis de factores pronóstico e influencia del tratamiento antibiótico protocolizado en su evolución / Brain abscess. Evaluation of prognostic factors: does the use of antibiotic prescribing protocols improve outcome?

Objetivos: Analizamos los factores pronósticos asociados a mortalidad en pacientes con absceso cerebral (AC) y la influencia del tratamiento antibiótico protocolizado (PA). Pacientes y Métodos: estudio observacional en un hospital universitario (1975-2005). El tratamiento antibiótico empírico se realizó sin PA (Periodo I -PI-, 1975-1983; n = 33) y de acuerdo a PA diseñado por los Servicios de MI-Infecciosas y Neurocirugía a partir de 1983 (Periodo II -PII-; n = 71); valoramos la influencia del Protocolo Terapéutico en la curación de los enfermos. Resultados: se evaluaron 104 pacientes (edad media 45 años; rango12-86); el origen del AC se identificó en 89% y en 76% hubo confirmación microbiológica. Mortalidad, 16,3% (17/104); se asociaron de forma estadísticamente significativa a mayor mortalidad: edad > 40 años, enfermedad de base últimamente fatal, situación clínica inicial crítica-mala, presencia de alteración del estado de conciencia y tratamiento empíricono adecuado. No hubo diferencias estadísticamente significativas en las características epidemiológicas, clínicas, radiológicas o microbiológicas de los pacientes correspondientes al PI y al PII, excepto en edad (> 40años, 36% en PI y 62% en PII); si hubo diferencias en curaciones, 60% vs 77% (p < 0,05); recidivas 21 vs. 7% (p < 0,05) y mortalidad 18 vs.15,4% (p > 0,05) en PI y PII, respectivamente. Conclusiones: La edad, enfermedad de base últimamente fatal, gravedad clínica inicial, presencia de alteración del nivel de conciencia y el tratamiento antibiótico empírico inadecuado son los principales factores pronósticos asociados a mayor mortalidad en pacientes con AC. La prescripción del tratamiento empírico de acuerdo con un PA consensuado se asoció con mayor porcentaje de curaciones y menor número de recidivas

Background: the aim of this study was to evaluate prognostic factors in brain abscess (AB) and influence of management with antibiotic prescribing protocols (APP). Patients and Methods: observational study of a cohort of non-paediatric patients with BA admitted at a 944-bed hospital (1976-2005). Data collection from clinical records has been done according to a standard protocol. We analysed epidemiological, clinical, radiological, microbiological and laboratory data associated with mortality. From1976 to 1983 (Period I), antibiotic treatment was not done according toany internal APP; from 1983 (Period II), antibiotic management was done according to a APP designed by infectious diseases specialists and neurosurgeons. Predictors of mortality were identified by univariate analysis. The influence of the use of APP in outcome was assessed. Results: 104 patients with BA were included (mean age 45 years;range 12-86); presumed primary pathogenic mechanism of BA was identified in 89%; microbiologic diagnosis was made in 76%. Overall mortality was 16.3%. Factors statistically associated with higher mortality were: age > 40 years, ultimately fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequate empirical treatment; 33 patients were treated in Period I and 71 in Period II; no statistically significant differences were found between epidemiological, clinical, radiological or microbiological characteristics of the groups except for mean age (> 40 years in 36% and 62% respectively in Period I and II). Rates of resolution of BA were 60 vs. 77.4% (p <0.05); relapses 21 vs. 7% (p < 0.05) and mortality 18 vs. 15.4% (p >0.05), in Period I and II respectively. Conclusions: main prognostic factors associated with mortality in patients with BA are age, rapidly fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequateempirical treatment. Empiric treatment according to APP was associated with greater resolution and lower relapse rates

Cavernomas in children with brain tumors: a late complication of radiotherapy.

BACKGROUND: Delayed complications of radiation therapy comprise cerebral atrophy, radionecrosis and induction of tumors. Recent reports indicate the possibility of the "de-novo" formation of intracranial cavernomas in patients submitted to radiation therapy to the brain. OBJECTIVES: To report three children, two with medulloblastomas and one with a pineal germinoma, treated with radiotherapy that developed intracerebral cavernous hemangiomas some years after treatment. With this work, we aim to draw attention to this occurrence in the neurosurgical community. RESULTS: The patients were two girls and one boy with ages comprised between 2.5 and 7 years (mean 5.2 years). The average interval from irradiation to the appearance of cavernoma was of 5.3 years (range 5-6 years). The lesions were found during the routine neuroimaging studies performed for the follow-up of their primary neoplasms. No patient showed signs or symptoms related to the cavernomas. However, the three children will need both clinical and neuroimaging surveillance to monitor the evolution of these incidentally discovered lesions. CONCLUSIONS: Intracranial cavernomas can occur years after cerebral radiation therapy. In spite of previous reports that show a high incidence of bleeding lesions, cavernomas may be found incidentally during the neuroimaging surveillance studies that are performed to children with brain tumors previously treated with radiotherapy. In these cases, a conservative attitude seems to be advisable, reserving surgery only for those lesions that grow or bleed.

[A descriptive study of neurocysticercosis in a tertiary care hospital]. / Estudio descriptivo de neurocisticercosis en un hospital terciario.

INTRODUCTION: Neurocysticercosis is the most frequent parasitic disease affecting the central nervous system. It is a disease that is endemic to certain countries in South America. The phenomenon of immigration, however, has increased its prevalence in developed regions due to the arrival of immigrants from endemic areas. AIM: To present the clinical and demographic characteristics of the cases of neurocysticercosis attended in a tertiary care hospital in the city of Murcia. PATIENTS AND METHODS: We conducted a descriptive, retrospective study by reviewing the medical records of patients with a hospital diagnosis of neurocysticercosis over a nine-year period (1997-2005). Demographic and clinical data on these patients were collected. RESULTS: Twenty-three patients (three under 12 years of age) were found. Mean age: 29.6 years. Countries of origin: Ecuador and Bolivia. The most frequently observed clinical manifestations were: epileptic seizures (73.9%), headache (39.1%) and neurological focus (26.1%). Albendazole was employed in 91.3% of cases and corticoids in 73.9%. The most frequently used drug in patients who received antiepileptic therapy was phenytoin. Four patients required surgical treatment. During the follow-up period, 52.8% of the patients were asymptomatic. CONCLUSIONS: Neurocysticercosis is a disease that is becoming increasingly more prevalent in Spain and we should suspect its presence in patients from endemic areas who visit because of clinical symptoms involving the central nervous system.

Estudio descriptivo de neurocisticercosis en un hospital terciario / A descriptive study of neurocysticercosis in a tertiary care hospital

La neurocisticercosis es la enfermedad parasitaria más frecuente del sistema nervioso central. Setrata de una enfermedad endémica de ciertos países de Sudamérica. Sin embargo, debido al fenómeno de la inmigración, ha aumentado su prevalencia en zonas desarrolladas debido a la llegada de inmigrantes procedentes de áreas endémicas. Objetivo.Presentar las características clínicas y demográficas de los casos de neurocisticercosis atendidos en un hospital terciario de la ciudad de Murcia. Pacientes y métodos. Estudio descriptivo, retrospectivo mediante revisión de historias clínicas de pacientes con diagnóstico hospitalario de neurocisticercosis en un período de nueve años (1997-2005). Se recogen los datosdemográficos y clínicos de estos pacientes. Resultados. Se estudiaron 23 pacientes (tres menores de 12 años). Edad media: 29,6 años. Países de origen: Ecuador y Bolivia. Las manifestaciones clínicas más frecuentes fueron: crisis epilépticas (73,9%),cefalea (39,1%) y focalidad neurológica (26,1%). Se utilizó albendazol en el 91,3% de los casos y corticoides en el 73,9%. De los pacientes que recibieron tratamiento antiepiléptico, el fármaco más utilizado fue la fenitoína. cuatro pacientes precisarontratamiento quirúrgico. En el período de seguimiento estaban asintomáticos el 52,8% de los pacientes. Conclusiones. La neurocisticercosis es una enfermedad cada vez más prevalente en España y que debemos sospechar en pacientes procedentes de zonasendémicas que consulten por clínica de afectación del sistema nervioso central

Neurocysticercosis is the most frequent parasitic disease affecting the central nervous system. It is adisease that is endemic to certain countries in South America. The phenomenon of immigration, however, has increased its prevalence in developed regions due to the arrival of immigrants from endemic areas. Aim. To present the clinical and demographic characteristics of the cases of neurocysticercosis attended in a tertiary care hospital in the city of Murcia.Patients and methods. We conducted a descriptive, retrospective study by reviewing the medical records of patients with a hospital diagnosis of neurocysticercosis over a nine-year period (1997-2005). Demographic and clinical data on these patients were collected. Results. Twenty-three patients (three under 12 years of age) were found. Mean age: 29.6 years. Countries of origin: Ecuador and Bolivia. The most frequently observed clinical manifestations were: epileptic seizures(73.9%), headache (39.1%) and neurological focus (26.1%). Albendazole was employed in 91.3% of cases and corticoids in 73.9%. The most frequently used drug in patients who received antiepileptic therapy was phenytoin. Four patients requiredsurgical treatment. During the follow-up period, 52.8% of the patients were asymptomatic. Conclusions. Neurocysticercosis is a disease that is becoming increasingly more prevalent in Spain and we should suspect its presence in patients from endemicareas who visit because of clinical symptoms involving the central nervous system