Manejo avanzado del infarto cerebral en un hospital público chileno: trombectomía mecánica en el Hospital Barros Luco Trudeau / Mechanical thrombectomy in a Chilean public hospital. Experience in 149 patients

BACKGROUND: Mechanical thrombectomy is the accepted treatment for acute ischemic stroke in Large Vessel Occlusion. The Barros Luco Trudeau hospital developed endovenous thrombolysis in 2010, and since 2012, implemented endovascular management, becoming the neurovascular center in the southern area of the metropolitan region. AIM: To describe endovascular management of acute ischemic stroke in a Chilean public hospital. Material and Methods: Analysis of patients with acute ischemic stroke that were treated with mechanical throm-bectomy from 2012 to 2019 in the Barros Luco Hospital. RESULTS: In the study period, a mechanical thrombectomy was carried out in 149 patients aged 61 ± 15 years (46% females). The average National institute of Health Stroke Scale (NIHSS) at presentation was 19 ± 4-5. Anterior or posterior circulation involvement was present in 89.9 and 10.1 % of patients. Twenty-five percent of patients were referred from other public centers. The mean lapse between onset of symptoms and thrombectomy was 266 ± 178 in. Ninety days after the procedure, 58% of patients had minimal or absent disability (Modified Ranson score of 0-2), and 19,2% died. CONCLUSIONS: Mechanical thrombectomy, according to this experience, has favorable clinical outcomes in patients with high NIHSS scores at entry.

[Mechanical thrombectomy in a Chilean public hospital. Experience in 149 patients]. / Manejo avanzado del infarto cerebral en un hospital público chileno: trombectomía mecánica en el Hospital Barros Luco Trudeau.

BACKGROUND: Mechanical thrombectomy is the accepted treatment for acute ischemic stroke in Large Vessel Occlusion. The Barros Luco Trudeau hospital developed endovenous thrombolysis in 2010, and since 2012, implemented endovascular management, becoming the neurovascular center in the southern area of the metropolitan region. AIM: To describe endovascular management of acute ischemic stroke in a Chilean public hospital. MATERIAL AND METHODS: Analysis of patients with acute ischemic stroke that were treated with mechanical throm-bectomy from 2012 to 2019 in the Barros Luco Hospital. RESULTS: In the study period, a mechanical thrombectomy was carried out in 149 patients aged 61 ± 15 years (46% females). The average National institute of Health Stroke Scale (NIHSS) at presentation was 19 ± 4-5. Anterior or posterior circulation involvement was present in 89.9 and 10.1 % of patients. Twenty-five percent of patients were referred from other public centers. The mean lapse between onset of symptoms and thrombectomy was 266 ± 178 in. Ninety days after the procedure, 58% of patients had minimal or absent disability (Modified Ranson score of 0-2), and 19,2% died. CONCLUSIONS: Mechanical thrombectomy, according to this experience, has favorable clinical outcomes in patients with high NIHSS scores at entry.

Neurosonografía y resonancia magnética en patología cerebral fetal severa / Ultrasound and magnetic resonance imaging in the prenatal evaluation of brain pathology

Abnormalities of the brain are among the most frequent congenital malformations and its incidence is probably higher than reported as many of the anomalies are only recognized postnatally. Fetal neurosonography performed transvaginally has become an important imaging technique based on its improved resolution and resulting better sensibility. Nevertheless, there are several maternal and fetal factors that can affect visualization rate and, therefore, it has been recommended that US should be complemented with 3D ultrasound and magnetic resonance imaging (MRI) in the prenatal evaluation of brain pathology. In the last years, the incorporation of ultrafast MRI has allowed to obtain high-quality images from the fetal lungs and brain. In this collaborative work from 2 public hospitals, we compare the diagnostic performance of fetal neurosonography and MRI in 17 cases of severe fetal brain abnormalities. MRI was able to confirm the diagnosis in 100 percent of the cases, adding important clinical information in 17 percent, although missed diagnoses were documented in 12 percent of them. These results are comparable to other published series, highlighting the diagnostic correlation between the 2 techniques. Nevertheless, ultrasound has the advantages of its wider availability and lower costs than MRI, which make it the prefered imaging modality when a fetal brain malformation is suspected.

Las malformaciones congénitas cerebrales son muy frecuentes y probablemente tengan una incidencia mayor aun a la descrita, pues muchas de ellas solo son reconocidas en la etapa postnatal. La neurosonografía fetal dirigida por vía transvaginal se ha incorporado los últimos años como el estándar de referencia en el diagnostico de estas malformaciones, especialmente por la mayor sensibilidad y una mejor resolución. Aun así, pueden existir condiciones maternas o fetales que obligan a complementar el estudio con otras tecnologías como el ultrasonido 3D y la resonancia magnética (RM). Con la incorporación de secuencias ultrarrápidas, la RM ha permitido obtener imágenes prenatales de calidad diagnostica donde destacan el estudio de malformaciones de tórax y del cerebro fetal. Este trabajo colaborativo de 2 centros públicos compara los resultados diagnósticos entre la neurosonografía y RM en 17 casos de patología neurológica fetal. La RM confirma el 100 por ciento de los diagnósticos, pero además entrega información adicional en un 17 por ciento pero omite información parcial en un 12 por ciento de los casos. Estos resultados son comparables a lo publicado en series extranjeras, destacando la alta correlación diagnostica entre los 2 métodos. Sin embargo, los beneficios que tiene el US en comparación con la RM, como la alta disponibilidad y el bajo costo, aconsejan su uso preferente en nuestro medio.

Síndrome del niño sacudido en Chile: una forma más de maltrato infantil / Shaken baby syndrome in Chile: another form of child abuse

Introduction: The shaken baby syndrome is the most common cause of death and severe neurological damage in abused children. Characterized by acute encephalopathy with sub dural and retinal hemorrhages, which occur in inappropriate situations or an inconsistent story The lesions are due to the increased size of the child's head, weak neck musculature and the abundance of non-myelinated brain tissue that allows excessive stretching of blood vessels associated with the mechanism of injury that involves application of rotational forces of acceleration slowdown. Our goal is to present the clinical features of children admitted to four hospitals in Chile in order to alert the clinician to the suspicion and search box. Methods: Clinical and imaging analysis of six patients with clinical criteria for shaken baby syndrome, as defined by the presence of intracranial or intraocular injury as a result of shocks, in the context of physical abuse in children under two years. Results: Six cases, four children, two girls. Ages 3 months to 16 months. The first symptom in one child was ophthalmoparesis, four with seizures, one of which was admitted in severe coma until he died. All had retinal hemorrhages. Brain Magnetic Resonance showed subdural collections in all of them with different data. The coagulation study was negative in all. Conclusion: The shaken baby syndrome is a reality in Chile and its high morbidity and mortality should place emphasis on prevention at all levels of health care.

Introducción: El síndrome del niño sacudido es la causa más común de muerte y daño neurológico severo en niños maltratados. Caracterizado por encefalopatía aguda con hemorragias subduralesy retinianas, que ocurren en un contexto inadecuado o en una historia inconsistente. Las lesiones se explican por el mayor tamaño de la cabeza del niño, la debilidad de la musculatura cervicaly la abundancia de tejido encefálico no mielinizado que permite un excesivo estiramiento de los vasos sanguíneos asociado al mecanismo de injuria que implica aplicación de fuerzas rotacionales de aceleración-desaceleración. Nuestro objetivo es presentar las características clínicas de niños ingresados a cuatro hospitales de Chile para así alertar al clínico hacia la sospecha y búsqueda del cuadro. Método: Análisis clínico e imagenológico de seis pacientes con criterios clínicos para síndrome del niño sacudido, definido por la presencia de lesiones intracraneales o intraoculares como resultado de sacudidas, en el contexto de maltrato físico, en niños menores de dos a±os. Resultados: Seis casos, cuatro niños, dos niñas. Edades entre 3 meses y 16 meses. Uno debutó con oftalmoparesia, cuatro con crisis convulsivas de los cuales uno ingresó en coma evolucionando grave hasta fallecer. Todos presentaban hemorragias retinianas. La Resonancia Magnética cerebral mostró en todos ellos colecciones subdurales de distinta data. El estudio de coagulopatías fue negativo en todos. Conclusión: El síndrome del niño sacudido es una realidad en Chile y por su alta morbimortalidad se debiera insistir en la prevención de éste a todo nivel de la atención en salud.