[Abducens nerve palsy due to postraumatic retroclival and spinal subdural hematoma: case report and literature review]. / Paresia VI par craneal por hematoma subdural retroclival y espinal postraumatico: presentacin de un caso y revision de la literatura.

INTRODUCTION: Retroclival posttraumatic hematomas are extremely rare and almost exclusive to childhood. Only one case of retroclival subdural hematoma has been reported in the literature to date. CASE REPORT: An 8-year-old boy suffered a severe head injury with cervical hyperextension as the result of a bicycle accident. On admission his initial Glasgow Coma Score was 13 and he had diplopia due to right palsy of the VI nerve. A retroclival subdural hematoma was observed by CT and MRI of the craneovertebral junction. Management was conservative and a rigid collar was placed. Palsy of VI nerve recovered spontaneously at 6 days and at discharge the patient had only cervical pain. Follow up at 3 months after the accident showed clinical and radiological resolution. CONCLUSION: Traumatic retroclival hematomas are mainly a pediatric entity due to immaturity of the cranio-cervical junction. Treatment consists of placement of a rigid collar although clinical progression may require surgical evacuation.

Paresia VI par craneal por hematoma subdural retroclival y espinal postraumático: presentación de un caso y revisión de la literatura / Abducens nerve palsy due to postraumatic retroclival and spinal subdural hematoma: case report and litera­ture review

Introducción. Los hematomas retroclivales postrau-máticos son extremadamente infrecuentes y casi exclu­sivos de la edad pediátrica. Únicamente se ha documen­tado en la literatura un caso de hematoma subdural retroclival postraumático. Caso clínico. Varón de 8 años de edad que tras accidente de bicicleta sufre traumatismo cráneo-ence­fálico con hiperextensión cervical. A su ingreso presentó Glasgow inicial de 13 y diplopia por paresia del VI par derecho. En la TAC y RM cráneo-cervical se objetivó un hematoma subdural retroclival. Se realizó manejo conservador con colocación de collarín rígido. Se observó recuperación espontánea del VI par a los 6 días presentando únicamente cervicalgia al alta. Presentó resolución clínica y radiológica a los 3 meses del acci­dente. Conclusión. Las lesiones hemorrágicas retroclivales postraumáticas son típicas de la edad pediátrica por la inmadurez de la unión cráneo-cervical que presentan. El tratamiento de elección es la colocación de un colla­rín rígido aunque si existe progresión clínica puede ser necesaria la evacuación quirúrgica (AU)

Introduction. Retroclival posttraumatic hematomas are extremely rare and almost exclusive to child­hood. Only one case of retroclival subdural hema­toma has been reported in the literature to date. Case report. An 8-year-old boy suffered a severe head injury with cervical hyperextension as the result of a bicycle accident. On admission his initial Glasgow Coma Score was 13 and he had diplopia due to right palsy of the VI nerve. A retroclival subdural hematoma was observed by CT and MRI of the craneovertebral junction. Management was conservative and a rigid collar was placed. Palsy of VI nerve recovered sponta­neously at 6 days and at discharge the patient had only cervical pain. Follow up at 3 months after the accident showed clinical and radiological resolution. Conclusion. Traumatic retroclival hematomas are mainly a pediatric entity due to immaturity of the cranio-cervical junction. Treatment consists of place­ment of a rigid collar although clinical progression may require surgical evacuation (AU)

[The effectiveness of gravitational valves in the prevention of over-drainage in adult patients with hydrocephalus]. / Efectividad de las válvulas gravitacionales en la prevención del hiperdrenaje en pacientes adultos con hidrocefalia.

AIM: To evaluate the effect of gravitational valves on over-drainage in hydrocephalus in adults. PATIENTS AND METHODS: We performed a retrospective study of the shunt systems placed in patients over the age of 18 years between 1998 and 2006. Patients were divided into two groups: non-GV group (without gravitational valve) and GV group (with a gravitational valve, Aesculap-Miethke 5/35). The complications that occurred during the first year following the placement of the shunt system were recorded. RESULTS: Of a total of 137 patients, 91 were from the non-GV group and 46 belonged to the GV group. Mean age: non-GV group, 62.1 years; and GV group, 64.2 years, without any significant differences. In 80 patients the aetiology was chronic adult hydrocephalus, 19 were due to expansive processes, 15 due to vascular causes, eight pseudo tumours, six post-traumatic injuries and nine were due to other causes. In the non-GV group, 9.89% presented over-drainage, whereas there were no cases in the GV group; the difference was statistically significant (p = 0.029). In the rest of the complications there were no significant differences between the two groups. The total complications in the non-GV group were 25.27% and in the GV group, 6.52%, and there were significant differences (p = 0.01), although, above all, at the expense of over-drainage, because if this complication was excluded, then the differences were no longer significant (p = 0.175). CONCLUSIONS: In our series, the use of gravitational valves in the prevention of over-drainage in adult hydrocephalus proved to be more effective than employing valves without the gravitational device.

Efectividad de las válvulas gravitacionales en la prevención del hiperdrenaje en pacientes adultos con hidrocefalia / The effectiveness of gravitational valves in the prevention of over drainage in adult patients with hydrocephalus

Resumen. Objetivo. Evaluar el efecto de las válvulas gravitacionales sobre el hiperdrenaje en la hidrocefalia en el adulto. Pacientes y métodos. Estudio retrospectivo de los sistemas de derivación colocados en pacientes mayores de 18 años entre 1998 y 2006. Se dividió a los pacientes en dos grupos: grupo no VG (sin válvula gravitacional) y grupo VG (con válvula gravitacional, Aesculap-Miethke 5/35). Se contabilizaron las complicaciones producidas dentro del primer año tras la colocación del sistema de derivación. Resultados. Sobre un total de 137 pacientes, 91 fueron del grupo no VG y 46 del grupo VG. Edad media: grupo no VG, 62,1 años, y grupo VG, 64,2 años, sin que las diferencias fueran significativas. La etiología en 80 pacientes fue hidrocefalia crónica del adulto, 19 por procesos expansivos, 15 por causas vasculares, ocho pseudotumores, seis postraumáticos y nueve por otras causas. En el grupo no VG, un 9,89% presentó hiperdrenaje, mientras que en el grupo VG no hubo ningún caso; la diferencia fue estadísticamente significativa (p = 0,029). En el resto de las complicaciones no se obtuvieron diferencias significativas entre ambos grupos. Las complicaciones totales en el grupo no VG fueron del 25,27% y en el grupo VG del 6,52%, y hubo diferencias significativas (p = 0,01), aunque, sobre todo, a expensas del hiperdrenaje, ya que si se excluía esta complicación las diferencias no eran significativas (p = 0,175). Conclusión. En nuestra serie queda probada la eficacia de las válvulas gravitacionales en la prevención del hiperdrenaje en la hidrocefalia en el adulto comparado con las válvulas sin dispositivo gravitacional (AU)

Summary. Aim. To evaluate the effect of gravitational valves on over-drainage in hydrocephalus in adults. Patients and methods. We performed a retrospective study of the shunt systems placed in patients over the age of 18 years between 1998 and 2006. Patients were divided into two groups: non-GV group (without gravitational valve) and GV group (with a gravitational valve, Aesculap-Miethke 5/35). The complications that occurred during the first year following the placement of the shunt system were recorded. Results. Of a total of 137 patients, 91 were from the non-GV group and 46 belonged to the GV group. Mean age: non- GV group, 62.1 years; and GV group, 64.2 years, without any significant differences. In 80 patients the aetiology was chronic adult hydrocephalus, 19 were due to expansive processes, 15 due to vascular causes, eight pseudo tumours, six post-traumatic injuries and nine were due to other causes. In the non-GV group, 9.89% presented over-drainage, whereas there were no cases in the GV group; the difference was statistically significant (p = 0.029). In the rest of the complications there were no significant differences between the two groups. The total complications in the non-GV group were 25.27% and in the GV group, 6.52%, and there were significant differences (p = 0.01), although, above all, at the expense of over-drainage, because if this complication was excluded, then the differences were no longer significant (p = 0.175). Conclusions. In our series, the use of gravitational valves in the prevention of over-drainage in adult hydrocephalus proved to be more effective than employing valves without the gravitational device (AU)