RESUMO
Hydrocephalus is a common neurosurgical disease affecting approximately 40 per 100,000 people. Cerebrospinal fluid diversion devices are essential in the management of this pathology. These devices include internal shunts and external ventricular drains. Infection is the most significant complication resulting from the high frequency of appearance and the consequences it involves, since it is associated with increased morbidity and mortality. It also involves increased hospital costs (approximately 40,000 euro per episode). In the present report the authors make a comprehensive review of cerebrospinal fluid diversion devices and their most important complication: infection. The authors make special emphasis on the epidemiology, aetiology, pathogenesis, risk factors, symptoms and signs, diagnosis, treatment and prevention of infection.
Assuntos
Líquido Cefalorraquidiano/microbiologia , Doenças Transmissíveis/epidemiologia , Drenagem/efeitos adversos , Drenagem/métodos , Equipamentos e Provisões/microbiologia , Hidrocefalia/complicações , Hidrocefalia/cirurgia , Doenças Transmissíveis/etiologia , Doenças Transmissíveis/mortalidade , Humanos , Fatores de RiscoRESUMO
Trigeminal neuralgia continues to be an illness poorly known for many general practitioners and what is even worse, badly handled by many of the specialists in charge of cephalic neuralgias. In this paper I resume the main knowledge about trigeminal neuralgia reviewing the clinical, physiopathological, and therapeutical aspects of this condition.
Assuntos
Neuralgia do Trigêmeo , Diagnóstico Diferencial , Humanos , Neuralgia do Trigêmeo/patologia , Neuralgia do Trigêmeo/fisiopatologia , Neuralgia do Trigêmeo/terapiaRESUMO
La neuralgia del trigémino continúa siendo una enfermedad desconocida para muchos médicos generalesy lo que resulta aun peor, mal manejada por muchos de los especialistas encargados de la misma.En este trabajo se resumen las principales características anatomo-clínicas, fisiopatológicas y terapéuticas de esta entidad (AU)
Trigeminal neuralgia continues to be an illness poorly known for many general practitioners and what is even worse, badly handled by many of the specialists in charge of cephalic neuralgias. In this paper I resume the main knowledge about trigeminal neuralgia reviewing the clinical, physiopathological ,and therapeutical aspects of this condition (AU)
Assuntos
Humanos , Neuralgia do Trigêmeo/epidemiologia , Dor Facial/etiologia , Neuralgia do Trigêmeo/fisiopatologia , Distribuição por Idade e Sexo , Diagnóstico Diferencial , Analgesia/métodos , Rizotomia , Compressão NervosaRESUMO
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Humanos , Feminino , Adulto , Hematoma Subdural Intracraniano/diagnóstico , Neoplasias Encefálicas/diagnóstico , Transtornos da Cefaleia/etiologia , Tomografia Computadorizada por Raios X/métodosRESUMO
Hemangiopericytoma is an uncommon mesenchymal neoplasm arising from Zimmerman's pericytes, which usually locates in soft tissues. Meningeal hemangiopericytoma accounts for less than 1% of all intracranial tumours. Typically, it behaves aggressively, showing distinct tendency to recur locally or distantly along the neural axis and to present extraneural metastases. We describe a 74-year-old patient who presented unspecific symptoms and whose physical exam revealed a painless retroauricular mass which was adhered to skin. Neuroimaging studies showed a large posterior fossa tumour with intense enhancement after contrast infusion that caused striking occipital-mastoid osteolysis and which was exclusively fed by external carotid artery branches. The patient underwent gross total resection of the tumour, and once the histological diagnosis of hemangiopericytoma was confirmed, she underwent initial adjuvant radiotherapy. Sixteen months after surgery, the patient remains recurrence free. The treatment of choice of intracranial hemangiopericytoma is gross total resection, which must be attempted when technically feasible, followed by adjuvant radiotherapy providing total doses over 50 Gy. This combination has demonstrated increasing recurrence- free interval in these patients. Close and longterm follow-up is mandatory in order to achieve early diagnosis of recurrence or metastases in these patients, since they can appear several years, even decades, after initial proper treatment.
Assuntos
Hemangiopericitoma/diagnóstico , Hemangiopericitoma/patologia , Neoplasias Infratentoriais/diagnóstico , Neoplasias Infratentoriais/patologia , Idoso , Irradiação Craniana , Feminino , Hemangiopericitoma/radioterapia , Hemangiopericitoma/cirurgia , Humanos , Neoplasias Infratentoriais/radioterapia , Neoplasias Infratentoriais/cirurgia , Resultado do TratamentoRESUMO
El hemangiopericitoma es un tumor mesenquimalinfrecuente originado de los pericitos de Zimmerman,que habitualmente asienta en tejidos blandos. Suvariante meníngea supone menos del 1% de todos lostumores intracraneales. Característicamente presentaun comportamiento agresivo, con marcada tendencia arecurrir localmente y a lo largo del neuroeje, así como ametastatizar en localizaciones extraneurales.Presentamos el caso de una paciente de 74 años quedebutó con clínica inespecífica, observándose durantela exploración física una masa retroauricular no dolorosaa la palpación, adherida a la piel. El estudio deneuroimagen demostró una lesión de gran tamaño localizadaen la fosa posterior que realzaba intensamentetras la administración de contraste, asociada a llamativaosteolisis occípito-mastoidea y cuya vascularizaciónprovenía exclusivamente de ramas de la arteria carótidaexterna. La paciente se sometió a la resección quirúrgicacompleta de la lesión, administrándose radioterapia inicialadyuvante una vez confirmado histológicamenteel diagnóstico de hemangiopericitoma. Dieciséis mesesdespués de la intervención, la paciente se encuentralibre de enfermedad.El tratamiento de elección del hemangiopericitomaintracraneal es su resección quirúrgica completa, siempreque sea técnicamente posible, seguida de radioterapiaadyuvante con dosis superiores a los 50 Gy. Estacombinación ha demostrado aumentar el intervalo detiempo libre de recurrencia. Un estrecho seguimiento alargo plazo de estos pacientes es esencial para detectarrecurrencias o metástasis a distancia precozmente,pudiendo aparecer incluso décadas después del adecuadotratamiento inicial (AU)
Hemangiopericytoma is an uncommon mesenchymalneoplasm arising from Zimmermans pericytes, whichusually locates in soft tissues. Meningeal hemangiopericytomaaccounts for less than 1% of all intracranialtumours. Typically, it behaves aggressively, showingdistinct tendency to recur locally or distantly along theneural axis and to present extraneural metastases.We describe a 74-year-old patient who presentedunspecific symptoms and whose physical exam revealeda painless retroauricular mass which was adhered toskin. Neuroimaging studies showed a large posteriorfossa tumour with intense enhancement after contrastinfusion that caused striking occipital-mastoid osteolisisand which was exclusively fed by external carotid arterybranches. The patient underwent gross total resectionof the tumour, and once the histological diagnosis ofhemangiopericytoma was confirmed, she underwentinitial adjuvant radiotherapy. Sixteen months after surgery,the patient remains recurrence free.The treatment of choice of intracranial hemangiopericytomais gross total resection, which must beattempted when technically feasible, followed by adjuvantradiotherapy providing total doses over 50 Gy.This combination has demonstrated increasing recurrence-free interval in these patients. Close and longtermfollow-up is mandatory in order to achieve earlydiagnosis of recurrence or metastases in these patients,since they can appear several years, even decades, afterinitial proper treatment (AU)
Assuntos
Humanos , Feminino , Idoso , Hemangiopericitoma/diagnóstico , Neoplasias Encefálicas/diagnóstico , Hemangiopericitoma/cirurgia , Neoplasias Encefálicas/cirurgia , Fossa Craniana PosteriorRESUMO
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Feminino , Adulto , Humanos , Telangiectasia Hemorrágica Hereditária/complicações , Abscesso Encefálico/complicações , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgiaAssuntos
Abscesso Encefálico , Telangiectasia Hemorrágica Hereditária , Adulto , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/etiologia , Abscesso Encefálico/microbiologia , Abscesso Encefálico/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/diagnóstico , Telangiectasia Hemorrágica Hereditária/patologiaRESUMO
Severe head injury (SHI) is one of the most important health, social, and economic problems in industrialized countries. Most of the recent studies related to this entity still show pessimistic results, with percentages of mortality and unfavourable outcomes very similar than those reported in the last quarter of century. In order to make predictions for patients with SHI, different "prognostic formulas or models" reviewed in this manuscript, have been developed with the main objective of performing reliable predictions for patients with this pathology. These models are constructed by using a group of "prognostic indicators or factors" and different "prognostic scales" useful for measuring the final outcome. The different "statistical techniques or methods" necessary to develop these prognostic models are also analyzed in this paper.
Assuntos
Traumatismos Craniocerebrais/diagnóstico , Modelos Biológicos , Modelos Estatísticos , Teorema de Bayes , Erros de Diagnóstico , Humanos , Valor Preditivo dos Testes , Prognóstico , Resultado do TratamentoRESUMO
BACKGROUND: Severe head injury (SHI) is one of the most important health, social and economic problems in industrialised countries. Unfortunately, none of the neuroprotection trials for traumatic brain injury have shown efficacy. One of the reasons for this failure could be the inclusion of patients with high probability of early death. A population-based, retrospective study was conducted to develop a prognostic model for identification of these patients. METHODS: Between January 1987 and August 1999, a total of 895 patients (> or = 15 years of age) with non-missile SHI were studied, in whom a computed tomography scan was carried out within the first 6 h of injury. The association between early death (first 48 h after injury) and independent prognostic factors was determined by logistic regression analysis. A scoring system was also constructed. RESULTS: The early-death rate was 20%. Independent predictors of early mortality after SHI were non-evacuated mass (odds ratio (OR) 65, 95% confidence interval (CI) 11 to 379), diffuse injury IV (OR 25, 95% CI 5 to 112), diffuse injury III (OR 8, 95% CI 3 to 22), flaccidity (OR 7, 95% CI 3 to 15), non-reactive bilaterally mydriasis (OR 6, 95% CI 3 to 12), evacuated mass (OR 4, 95% CI 1 to 11), age > or = 65 years (OR 4, 95% CI 1 to 9), decerebration (OR 3, 95% CI 2 to 7) and shock (OR 3, 95% CI 2 to 6). The prognostic model correctly identified 93% of the patients. CONCLUSIONS: This prognostic model is based on simple clinical and radiological data readily available during the first 6 h after injury and is useful for identification of early death after SHI.
Assuntos
Traumatismos Craniocerebrais/mortalidade , Adolescente , Adulto , Idoso , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Prognóstico , Curva ROC , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
El traumatismo craneoencefálico grave (TCEG) es uno de los problemas sanitarios, sociales y económicos más importantes de los países industrializados. Muchos estudios recientes sobre esta entidad arrojan aún resultados pesimistas, presentando cifras de mortalidad y de pronósticos desfavorables muy similares a las publicadas en el último cuarto de siglo. A la hora de predecir el pronóstico de los pacientes con TCEG, se han diseñado diferentes "fórmulas o modelos pronósticos" que nosotros revisamos en este trabajo y cuyo objetivo primordial consiste en realizar predicciones fiables en futuros pacientes que sufran un TCEG. Estos modelos están formados de un lado, por un conjunto de "indicadores o factores pronósticos "y del otro, por unas "escalas pronosticas" que sirven para medir el pronóstico final de estos pacientes. Para la creación de estos modelos se utilizan diversas "técnicas o métodos estadísticos" que también serán analizadas en este artículo
Severe head injury (SHI) is one of the most important health, social, and economic problems in industrialized countries. Most of the recent studies related to this entity still show pessimistic results, with percentages of mortality and unfavourable outcomes very similar than those reported in the last quarter of century. In order to make predictions for patients with SHI, different "prognostic formulas or models" reviewed in this manuscript, have been developed with the main objective of performing reliable predictions for patients with this pathology. These models are constructed by using a group of "prognostic indicators or factors" and different "prognostic scales" useful for measuring the final outcome. The different "statistical techniques or methods "necessary to develop these prognostic models are also analyzed in this paper
Assuntos
Humanos , Traumatismos Craniocerebrais/diagnóstico , Modelos Biológicos , Modelos Estatísticos , Teorema de Bayes , Erros de Diagnóstico , Prognóstico , Apoio à Pesquisa como Assunto , Resultado do Tratamento , Valor Preditivo dos TestesRESUMO
Aneurysmal bone cyst is an uncommon lesion that occurs mainly in long bones and vertebrae, being the location in the sphenoid sinus extremely rare. Its origin is unknown, but it can be considered as a vascular phenomenon secondary to a primary lesion. Other primary diseases that may be associated to aneurysmal bone cyst are polyostotic fibrous dysplasia and giant-cell tumors. We report the case of a patient with an aneurysmal bone cyst in the sphenoid sinus causing vision dysfunction.
Assuntos
Cistos Ósseos Aneurismáticos/patologia , Doenças dos Seios Paranasais/patologia , Seio Esfenoidal/patologia , Adulto , Cistos Ósseos Aneurismáticos/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Doenças dos Seios Paranasais/cirurgia , Seio Esfenoidal/cirurgiaRESUMO
El quiste óseo aneurismático es una patología infrecuente que asienta generalmente en las metáfisis de huesos largos y vértebras. La afectación del seno esfenoidal es excepcional. Su origen se encuentra aún por definir, pero podemos considerarlos como un fenómeno vascular secundario a una lesión del hueso subyacente. Puede asociarse a otras enfermedades, presentes de forma metacrónica o sincrónica en distintas localizaciones de un mismo sujeto, como la displasia fibrosa poliostótica o los tumores de células gigantes. En este artículo se expone el caso de un paciente que presenta un quiste óseo aneurismático en el seno esfenoidal y alteración de la visión
Aneurysmal bone cyst is an uncommon lesion that occurs mainly in long bones and vertebrae, being the location in the sphenoid sinus extremely rare. Its origin is unknown, but it can be considered as a vascular phenomenon secondary to a primary lesion. Other primary diseases that may be associated to aneurysmal bone cyst are polyostotic fibrous dysplasia and giant-cell tumors. We report the case of a patient with an aneurysmal bone cyst in the sphenoid sinus causing vision dysfunction
