Insuficiencia respiratoria aguda y embarazo: revisión de la literatura.

Introducción: La insuficiencia respiratoria aguda durante el embarazo no es una causa frecuente de ingreso a la unidad de cuidados intensivos, pero sí puede generar alta mortalidad. Las adaptaciones que sufre el organismo en muchos de sus sistemas biológicos durante el embarazo, condicionan cambios en el diagnóstico y tratamiento de este trastorno en comparación con la población general. Objetivo: Realizar una revisión bibliográfica sobre el tema y resumir los principales aspectos fisiológicos a tener en cuenta por el personal de salud en contacto con esta población, con el fin de realizar un adecuado abordaje de los casos. Fuente de datos: se realizó una búsqueda bibliográfica sistemática en la base de datos PubMed, SciELO y Google Académico desde el año 1998 hasta el año 2019. Conclusiones: El diagnóstico y tratamiento temprano de insuficiencia respiratoria aguda en la paciente embarazada es fundamental, debido a los cambios fisiológicos propios de la gestación, los cuales sumados a esta patología pueden concluir en un escenario catastrófico.

Plasmodium vivax and Neisseria meningitidis co-infection in a newborn.

Invasive infections due to Neisseria meningitidis in Colombia are unusual in newborns, in contrast to infections due to Plasmodium vivax which is one of the main pathogens related to the presentation of fever in this age group, especially in the indigenous population. We report a case of co-infection of these two microorganisms in a child.

[Pregnant woman with spontaneous coronary dissection successfully resurrected: case report]. / Embarazada con disección coronaria espontánea resucitada de manera exitosa: reporte de caso.

Background: Spontaneous coronary dissection is a disruption of the arterial wall, with clinical manifestations ranging from unstable angina to sudden cardiac death. It is presented a case of an obstetric patient who is successfully resuscitated after a spontaneous coronary dissection. Clinical case: 37-year-old female patient with a 33-week pregnancy and a history of preeclampsia in the previous pregnancy. She consulted for a 30-min chest pain. After her admission, the patient presented loss of consciousness and cardiorespiratory arrest. Basic and advanced life supports were given and then she was transferred to the intensive care unit where a dissection of the right coronary artery was diagnosed. After 14 days, the patient was discharged from the hospital without neurological sequelae. Conclusions: Spontaneous coronary dissection in the obstetric patient corresponds to a medical emergency, in which pharmacological and surgical measures must be implemented early in order to promote the fetal maternal well-being.

Introducción: La disección coronaria espontánea consiste en la disrupción de la pared arterial, con manifestaciones clínicas que van desde la angina inestable hasta la muerte súbita cardiaca. Se presenta el caso de una paciente obstétrica resucitada exitosamente tras una disección coronaria espontánea. Caso clínico: Mujer de 37 años con embarazo de 33 semanas y antecedente de preeclampsia en el embarazo anterior, quien consultó por dolor torácico de 30 minutos. Posterior a su ingreso presentó pérdida de la consciencia y paro cardiorrespiratorio. Se realizaron maniobras básicas y avanzadas de resucitación, y se trasladó a la unidad de cuidados intensivos donde se diagnosticó disección de arteria coronaria derecha. A los 14 días se dio alta hospitalaria, sin secuelas neurológicas. Conclusiones: La disección coronaria espontánea en la paciente obstétrica corresponde a una urgencia médica, en la cual deben implementarse medidas farmacológicas y quirúrgicas tempranamente con el fin de promover el bienestar del binomio madre-feto.

Considerations for the management of critical patients with thyroid disease. / Consideraciones para el manejo de los pacientes críticos con enfermedad tiroidea.

The role of the endocrine system in the homeostasis of all the body is essential, and has an impact on quality of life, prognosis and survival of patients. Although all the organs of this system are important, the thyroid gland is sizeable due to its easily accessible anatomical location and the variety of symptoms and signs that occur after it is affected. In the intensive care unit, knowledge of thyroid physiology and pathology is essential, due to the critical condition of patients and their multisystemic compromise, which is why this knowledge becomes an essential tool in the diagnostic arsenal to give a timely and effective management of these disorders. The objective of this review is to transmit in a timely and updated manner the necessary considerations for the optimal approach to patients with thyroid disease in the intensive care unit.

El papel que desempeña el sistema endocrino en la homeostasis de toda la economía corporal es fundamental, y su integridad o su alteración impactan en la calidad de vida, el pronóstico y la sobrevida de los pacientes en diferentes escenarios. Si bien todos los órganos que conforman este sistema son importantes, cobra especial importancia la glándula tiroides por su localización anatómica fácilmente abordable y la amalgama de síntomas y signos que se producen por su afectación. En la unidad de cuidados intensivos es fundamental el conocimiento de la fisiología y de la patología tiroidea, debido a la condición crítica de los pacientes y su compromiso multisistémico, por lo que este conocimiento se convierte en una herramienta imprescindible en el arsenal diagnóstico médico para un manejo oportuno y efectivo de dichas patologías. Esta revisión tiene el objetivo de transmitir de manera concreta y actualizada las consideraciones necesarias para el óptimo abordaje de los pacientes con enfermedad tiroidea en la unidad de cuidados intensivos.

[Influence of armed conflict on mortality due to traumatic brain injury in children and adolescents]. / Influencia del conflicto armado en la mortalidad por trauma craneoencefálico en niños y adolescentes.

BACKGROUND: In the presence an armed conflagration, the mortality behavior of a country is expected to be affected. The aim of this investigation was to assess, in a country with internal warfare, the trend of mortality associated with traumatic brain injury in children and adolescents, which even under social peace conditions, is one of the most common causes of death and disability in this population groups. METHODS: A retrospective, population-based study was conducted, where the trend of mortality due to traumatic brain injury during the 1999 to 2008 period was assessed. A linear regression was performed to establish its correlation with mortality associated with warfare events of the armed conflict. RESULTS: Global mortality rate was 12.7 per 100 000 inhabitants. The temporary analysis showed a -9.67% annual decrease throughout the entire period of study (95 % CI = -9.25 % to -10.1 %; p < 0.001). The mortality rate was increased by 0.28 and 0.62 for each incremental unit in the armed conflict-related violent death rate and in civilian population, respectively. CONCLUSIONS: In an armed conflict scenario, mortality behavior varies according to the intensity of warfare actions. Mortality due to traumatic brain injury in children and adolescents can be used as an indicator of the impact of war on civilian population not involved with the armed conflict.

INTRODUCCIÓN: ante un conflicto bélico es de esperar que el comportamiento de la mortalidad de un país se vea afectado. El objetivo de esta investigación fue evaluar en un país en guerra interna, la tendencia de la mortalidad por trauma craneoencefálico en niños y adolescentes, que aún en condiciones de paz social constituye una de las causas más frecuentes de muerte y discapacidad en esos grupos poblacionales. MÉTODOS: se llevó a cabo un estudio poblacional y retrospectivo en el que se evaluó la tendencia de la mortalidad por trauma craneoencefálico durante el periodo de 1999 a 2008. Se realizó una regresión lineal para determinar su correlación con la mortalidad relacionada con los eventos bélicos del conflicto armado. RESULTADOS: la tasa de mortalidad global fue de 12.7 por 100 000 habitantes. El análisis temporal demostró una disminución anual de ­9.67 % durante todo el periodo de estudio (IC 95 % = ­9.25 % a ­10.1 %, p < 0.001]. La tasa de mortalidad se incrementó 0.28 y 0.62 por cada unidad de incremento en la tasa de muertes violentas relacionadas con el conflicto armado y en población civil, respectivamente. CONCLUSIONES: en un escenario de conflicto armado, el comportamiento de la mortalidad varía en función de la intensidad de las acciones bélicas. La mortalidad por trauma craneoencefálico en niños y adolescentes puede utilizarse como un indicador del impacto de la guerra sobre la población civil ajena al conflicto armado.

[Multimodal monitoring in severe craniocerebral trauma: state the art]. / Neuromonitoreo multimodal en trauma craneoencefalico severo: estado del arte.

Traumatic brain injury is a public health problem and leading cause of death. In the context of a severe head injury, monitoring strategies give us the option to analyze the posterior intracranial alterations to the primary lesion. Neuromonitoring allows us to identify the deterioration of neurological function and the presence of secondary brain injury that may benefit from a therapeutic intervention letting us know pathophysiological changes that occur in a patient with brain injury. Understanding the physiological data allow to individualize therapies and interpret variables that ultimately help us choice a better treatment.

Posicionamiento postoperatorio de la cabecera tras drenaje de hematomas subdurales crónicos por trepanación: Revisión sistemática y metaanálisis de estudios controlados aleatorizados / Postoperative bed header position after burr-hole drainage of chronic subdural haematoma: Systematic review and meta-analysis of randomised controlled trials

INTRODUCCIÓN: Algunos estudios han señalado la posible influencia del posicionamiento postoperatorio de la cabecera sobre el riesgo de recurrencias y complicaciones médicas en los pacientes intervenidos por hematomas subdurales crónicos; sin embargo, esta hipótesis aún no se ha evaluado mediante un metaanálisis. MÉTODOS: Se incluyeron todos los estudios prospectivos controlados aleatorizados que analizaron la frecuencia de recurrencias sintomáticas en los pacientes operados por hematomas subdurales crónicos mediante trepanación, con relación al posicionamiento postoperatorio de la cabecera. El desenlace primario fueron las recurrencias sintomáticas y los secundarios, las reintervenciones y las complicaciones médicas postoperatorias. Los resultados se presentaron en riesgos relativos combinados, con sus intervalos de confianza del 95%. RESULTADOS: Fueron incluidos un total de 4 estudios controlados aleatorizados. Los riesgos relativos combinados fueron: recurrencias sintomáticas, 0,51 ([IC 95%: 0,22-1,16]; p = 0,11); reintervenciones, 1,07 ([IC 95%: 0,42-2,69]; p = 0,89) y complicaciones, 1,15 ([IC 95%: 0,7-1,91]; p = 0,58). No se encontró heterogeneidad estadísticamente significativa en ninguno de los análisis. CONCLUSIÓN: No se encontraron diferencias en el riesgo de recurrencias sintomáticas, reintervenciones ni complicaciones médicas en los pacientes que fueron mantenidos con la cabecera plana, en comparación con aquellos en quienes fue elevada en el postoperatorio. Aunque los resultados fueron consistentes entre los estudios incluidos, existe un potencial riesgo de sesgos, lo que proscribe emitir recomendaciones definitivas antes de contarse con estudios de mayor calidad metodológica

INTRODUCTION: Several studies have suggested the possible influence of postoperative bed header position on the risk of symptomatic recurrences and medical complications in patients who have been intervened due chronic subdural haematomas. Nevertheless, this hypothesis has not been assessed by a meta-analysis. METHODS: All randomised controlled trials analysing symptomatic recurrence rates in patients who underwent burr-hole drainage of chronic subdural haematomas, describing postoperative bed header positioning, were included. The primary outcome was risk of recurrence and the secondary outcome were the risks of reoperation and medical complications. Results were presented as pooled relative risks, with 95% confidence intervals. RESULTS: A total of 4 controlled studies were included. Pooled relative risks were: symptomatic recurrences 0.51 ([95% CI: 0.22-1.16]; P = .11), reoperations, 1.07 ([95% CI: 0.42-2.69]; P = .89) and medical complications, 1.15 ([95% CI: 0.7-1.91]; P = .58). No statistically significant heterogeneity was found in any of the analyses. CONCLUSION: There were no differences regarding frequency of symptomatic recurrences, reoperations or medical complications in patients who were maintained in a flat position compared with those whose bed header was elevated during the postoperative course. Despite there being consistency between the results, there is a potential risk of bias; thus proscribing definitive recommendations until studies with higher methodological quality are available

[Postoperative bed header position after burr-hole drainage of chronic subdural haematoma: systematic review and meta-analysis of randomised controlled trials]. / Posicionamiento postoperatorio de la cabecera tras drenaje de hematomas subdurales crónicos por trepanación: Revisión sistemática y metaanálisis de estudios controlados aleatorizados.

INTRODUCTION: Several studies have suggested the possible influence of postoperative bed header position on the risk of symptomatic recurrences and medical complications in patients who have been intervened due chronic subdural haematomas. Nevertheless, this hypothesis has not been assessed by a meta-analysis. METHODS: All randomised controlled trials analysing symptomatic recurrence rates in patients who underwent burr-hole drainage of chronic subdural haematomas, describing postoperative bed header positioning, were included. The primary outcome was risk of recurrence and the secondary outcome were the risks of reoperation and medical complications. Results were presented as pooled relative risks, with 95% confidence intervals. RESULTS: A total of 4 controlled studies were included. Pooled relative risks were: symptomatic recurrences 0.51 ([95% CI: 0.22-1.16]; P=.11), reoperations, 1.07 ([95% CI: 0.42-2.69]; P=.89) and medical complications, 1.15 ([95% CI: 0.7-1.91]; P=.58). No statistically significant heterogeneity was found in any of the analyses. CONCLUSION: There were no differences regarding frequency of symptomatic recurrences, reoperations or medical complications in patients who were maintained in a flat position compared with those whose bed header was elevated during the postoperative course. Despite there being consistency between the results, there is a potential risk of bias; thus proscribing definitive recommendations until studies with higher methodological quality are available.

[Cerebral artery infarction presented as an unusual complication of acute middle otitis]. / Infarto arterial cerebral: una rara complicación de la otitis media aguda.

BACKGROUND: acute otitis media is a frequent disease in the pediatric age. About 2 % of all cases develop intracranial complications such as meningitis. The cerebral infarction originates meningitis and usually occurs in the venous system. The presence of a cerebral artery infarction secondary to acute otitis media is a rare cause described in the literature. CLINICAL CASE: a girl of 12 months who presented a febrile syndrome due to acute otitis media and mental confusion. On physical examination, she appeared sleepy with anisocoria, mydriasis in the right eye and left hemiparesis. The computed tomography examination showed extensive cerebral artery infarction. The patient's parents refused the proposed surgical treatment and the girl died 48 hours later. CONCLUSIONS: regardless of the current technological advances, the clinical prognosis of cerebral infarction associated with acute otitis media is bad. The focused neurological signs and progressive clinical deterioration should raise suspicion that antimicrobial therapy is not effective.

Introducción: la otitis media aguda es una inflamación del oído medio frecuente en la edad pediátrica. Aproximadamente 2 % de todos los casos desarrolla complicaciones intracraneales, más específicamente meningitis; por lo general, los infartos cerebrales originados por esta última son venosos. Rara vez se ha descrito la ocurrencia de un infarto arterial cerebral como complicación directa de la otitis media aguda. Caso clínico: niña de 12 meses de edad quien fue llevada a un servicio de urgencias por síndrome febril secundario a otitis media aguda y alteración del estado de conciencia. A la exploración física se identificó que estaba somnolienta, con anisocoria, midriasis en el ojo derecho y hemiparesia izquierda. Con la tomografía axial computarizada de cerebro se apreció un infarto arterial cerebral extenso. Los padres no autorizaron la craniectomía descompresiva y la paciente falleció a las 48 horas de su ingreso hospitalario. Conclusiones: a pesar de los recursos tecnológicos con los que se dispone actualmente, el infarto cerebral relacionado con la otitis media aguda tiene una evolución tórpida. Los signos neurológicos focalizadores y el deterioro progresivo deben apuntar a la ineficacia del tratamiento antimicrobiano instaurado.

Control de las crisis epilépticas con la hemisferectomía cerebral en adultos: revisión sistemática y metaanálisis con datos de pacientes individuales / No disponible

OBJETIVO: Determinar la tasa de éxito de la hemisferectomía cerebral para controlar las crisis epilépticas de pacientes adultos con epilepsia resistente a los fármacos. MATERIALES Y MÉTODOS: Se realizó una revisión sistemática y metaanálisis con datos de pacientes individuales. La búsqueda de la literatura se llevó a cabo mediante 7bases de datos internacionales y actas de reuniones científicas. Los datos de pacientes individuales fueron analizados para establecer potenciales factores asociados con control de crisis epilépticas en el postoperatorio. RESULTADOS: Se identificaron un total de 8artículos que cumplieron los criterios de selección preestablecidos. Tras una mediana de seguimiento de 70 meses (rango intercuartílico, 29-175,5), el 79,4% de los pacientes permanecieron libres de crisis. No se encontraron diferencias estadísticamente significativas en la edad al inicio de la epilepsia, tiempo de evolución de la epilepsia, edad en el momento de la cirugía, tiempo de seguimiento postoperatorio, sexo, lateralidad, etiología, ni en las anormalidades electroencefalográficas ictales, entre los pacientes libres de crisis y los que presentaron recurrencias. CONCLUSIONES: En los pacientes adultos con epilepsia resistente a los fármacos la hemisferectomía cerebral tiene una alta tasa de control de crisis epilépticas. Ninguna de las variables analizadas en el presente estudio se asoció con el éxito de la cirugía

OBJECTIVE: The objective of our study was to determine the seizure control rate of cerebral hemispherectomies in adult patients with drug-resistant epilepsy. MATERIALS AND METHODS: A systematic review and individual patient data meta-analysis was carried out. Seven international databases and scientific meeting proceedings were reviewed. Individual patient data were analysed to establish potential factors associated with postoperative seizure control. RESULTS: Eight articles that satisfied the pre-established selection criteria were identified. After a median follow-up of 70 months (interquartile range, 29-175.5), 79.4% of patients remained seizure-free. There were no statistically significant differences in age at onset of epilepsy, duration of epilepsy, age at surgery, time of follow-up, gender, surgical-laterality, aetiology and ictal EEG abnormalities between seizure-free patients and those with recurrences. CONCLUSIONS: Cerebral hemispherectomy has a high seizure control rate in adult patients with drug-resistant epilepsy. None of the variables analysed in the present study were associated with surgical success

[Seizure outcomes of cerebral hemispherectomy in adults: A systematic review and individual patient data meta-analysis]. / Control de las crisis epilépticas con la hemisferectomía cerebral en adultos: revisión sistemática y metaanálisis con datos de pacientes individuales.

OBJECTIVE: The objective of our study was to determine the seizure control rate of cerebral hemispherectomies in adult patients with drug-resistant epilepsy. MATERIALS AND METHODS: A systematic review and individual patient data meta-analysis was carried out. Seven international databases and scientific meeting proceedings were reviewed. Individual patient data were analysed to establish potential factors associated with postoperative seizure control. RESULTS: Eight articles that satisfied the pre-established selection criteria were identified. After a median follow-up of 70 months (interquartile range, 29-175.5), 79.4% of patients remained seizure-free. There were no statistically significant differences in age at onset of epilepsy, duration of epilepsy, age at surgery, time of follow-up, gender, surgical-laterality, aetiology and ictal EEG abnormalities between seizure-free patients and those with recurrences. CONCLUSIONS: Cerebral hemispherectomy has a high seizure control rate in adult patients with drug-resistant epilepsy. None of the variables analysed in the present study were associated with surgical success.

[Congenital agenesis of cranial bones associated with hydrocephalus: a case report]. / Agenesia congénita de huesos craneales asociada a hidrocefalia: reporte de caso.

The absence of the cranial bones is a rare entity usually incompatible with life. Agenesis of parietal bones has been rarely reported in the literature. A case of a neonate with bilateral parietal agenesis associated hydrocephalus is reported. The cranial defect was managed conservatively. To our knowledge we present the first case of congenital agenesis of the parietal bone associated with hydrocephalus.

[The influence of climate on the onset of intracranial hemorrhages]. / Variaciones climáticas y hemorragias intracraneales.

BACKGROUND: there are not studies exploring the potential role of weather conditions in the incidence of intracranial hemorrhages in Latin America. METHODS: a descriptive study was carried out in an emergency room from Cartagena de Indias (Colombia). Data for all adult patients with intracranial hemorrhage and meteorological variables of the days when intracranial hemorrhages occurred were recorded and compared to with those where not a single case. RESULTS: the differences between the average temperature, maximum and minimum temperatures, barometric pressure, relative humidity and wind speed were non statistically significant. However, when comparing the temperature differences day of the event over the previous days, those met the pre-established criteria of statistical significance. Furthermore, differences in barometric pressure, relative humidity, maximum and minimum temperature over the previous day, also reached this criterion. CONCLUSIONS: the results of this study suggest the existence of a climatic profile associated with the onset of intracranial hemorrhages.

[Transvaginal penetrating fetal head injury]. / Traumatismo encefalocraneano fetal por vía penetrante transvaginal.

In utero head traumas are extremely rare and are usually caused by penetrating injuries in the thoracic or abdominal wall that affect the uterine cavity. Transvaginal fetal head injuries have been reported in exceptional cases. This is a case-report of a fetus affected by penetrating head trauma with skull fracture and intra-ventricular hemorrhage after his mother's self-insertion of a blunt object, violently through the vagina. Trauma disrupted the integrity of intrauterine membranes and precipitated preterm labor. After birth, there was a debridement of the scalp and surgical management of the fracture was performed; nevertheless, the patient died four weeks later, due to neonatal sepsis. Management of these wounds must not only be focused on repairing the primary wound, but on preventing the infectious complications.

Traumatismo encefalocraneano fetal por vía penetrante transvaginal / Transvaginal penetrating fetal head injury

Los traumatismos encefalocraneanos in útero son extremadamente raros y suelen ser consecuencia de lesiones penetrantes a través de la pared torácica o abdominal, que alcanzan la cavidad uterina. Los originados a través de la vagina se han comunicado excepcionalmente. Se presenta el caso de un feto que padeció traumatismo encefalocraneano penetrante, con fractura de la bóveda craneal y hemorragia intraventricular tras la introducción violenta de un objeto contundente a través de la vagina por parte de su madre. La ruptura traumática de las membranas ovulares desencadenó el trabajo de parto pretérmino. Tras el nacimiento, se realizó tratamiento quirúrgico de la fractura deprimida y desbridamiento de la herida; sin embargo, el paciente falleció cuatro semanas más tarde a causa de sepsis neonatal. El tratamiento de estos casos no solo deber ser dirigido a la corrección de las lesiones traumáticas primarias sino también a la prevención de las complicaciones infecciosas.

In utero head traumas are extremely rare and are usually caused by penetrating injuries in the thoracic or abdominal wall that affect the uterine cavity. Transvaginal fetal head injuries have been reported in exceptional cases. This is a case-report of a fetus affected by penetrating head trauma with skull fracture and intra-ventricular hemorrhage after his mother's self-insertion of a blunt object, violently through the vagina. Trauma disrupted the integrity of intrauterine membranes and precipitated preterm labor. After birth, there was a debridement of the scalp and surgical management of the fracture was performed; nevertheless, the patient died four weeks later, due to neonatal sepsis. Management of these wounds must not only be focused on repairing the primary wound, but on preventing the infectious complications.

Traumatismo encefalocraneano fetal por vía penetrante transvaginal / Transvaginal penetrating fetal head injury

Los traumatismos encefalocraneanos in útero son extremadamente raros y suelen ser consecuencia de lesiones penetrantes a través de la pared torácica o abdominal, que alcanzan la cavidad uterina. Los originados a través de la vagina se han comunicado excepcionalmente. Se presenta el caso de un feto que padeció traumatismo encefalocraneano penetrante, con fractura de la bóveda craneal y hemorragia intraventricular tras la introducción violenta de un objeto contundente a través de la vagina por parte de su madre. La ruptura traumática de las membranas ovulares desencadenó el trabajo de parto pretérmino. Tras el nacimiento, se realizó tratamiento quirúrgico de la fractura deprimida y desbridamiento de la herida; sin embargo, el paciente falleció cuatro semanas más tarde a causa de sepsis neonatal. El tratamiento de estos casos no solo deber ser dirigido a la corrección de las lesiones traumáticas primarias sino también a la prevención de las complicaciones infecciosas.(AU)

In utero head traumas are extremely rare and are usually caused by penetrating injuries in the thoracic or abdominal wall that affect the uterine cavity. Transvaginal fetal head injuries have been reported in exceptional cases. This is a case-report of a fetus affected by penetrating head trauma with skull fracture and intra-ventricular hemorrhage after his mothers self-insertion of a blunt object, violently through the vagina. Trauma disrupted the integrity of intrauterine membranes and precipitated preterm labor. After birth, there was a debridement of the scalp and surgical management of the fracture was performed; nevertheless, the patient died four weeks later, due to neonatal sepsis. Management of these wounds must not only be focused on repairing the primary wound, but on preventing the infectious complications.(AU)

[Intracerebral hemorrhages following drainage of chronic subdural hematomas]. / Hemorragia intracerebral posterior a drenado de hematomas subdurales crónicos.

BACKGROUND: postoperative intracerebral hemorrhage after drainage of chronic subdural hematoma is a rarely reported complication; however, its incidence, according to different series may be underestimated. CASE REPORT: this report presents a 77 year old male patient who, after the drainage of bilateral chronic subdural hematomas, developed an extensive hemorrhage in the thalami, basal ganglia, midbrain and pons, with extension into the ventricles and obstructive hydrocephalus. CONCLUSIONS: compression by extra-axial collection decreases cerebral blood flow on the affected hemisphere and alters its vascular self-adjustment. The rapid increase in cerebral blood flow in brain areas with altered vascular self-adjustment appears to be the precipitating mechanism of intracerebral hemorrhage after surgical evacuation of chronic subdural hematomas.

Apoplejía postoperatoria de un macroadenoma hipofisiario residual e infarto de la arteria cerebral media / Post-operative apoplexy of a residual pituitary macro-adenoma and middle cerebral artery infarction

La apoplejía postoperatoria de los adenomas hipofisiarios es una complicación rara vez reportada. La presión ejercida por el tumor residular edematoso puede comprometer estructuras nerviosas y vasculares adyacentes a la región selar. Describios el caso de un hombre de 69 años de edad con un tumor selar gigante a quien le fue realizada una resección incompleta a través de un acceso pterional. La cirugía fue detenida por inestabilidad hemodinámica. Cuarenta y ocho horas más tarde, desarrolla oftalmparesias y disminución bilateral de la agudeza visual, deterioro del estado de consciencia, poliuria y hemiparesia izquierda. Una tomografía cerebral simple de emergencia demostró incremento del volumen tumoral con hemorragia y un infarto en el territorio de la arteria cerebral media derecha. El paciente falleció siete días más tarde. Este caso ejemplifica esta rara y catastrófica complicación con alta morbilidad y mortalidad. En la revisión de la literatura, solo fueron encontrados dos casos de ictus isquémico debido a la compresión de arterias intracraneales mayores por apoplejía postoperatoria de macroadenomas residuales.

Postoperative apoplexy of residual pituitary adenomas is a rarely reported complication. Pressure from edematous residual tumor may affect vascular and nervous structures adjacent to sellar region. We described a 69 years old man with a giant sellar tumor who underwent to incomplete resection through pterional approach. Surgery was stopped by hemodynamic instability. Forty-eight hours later, he developed bilateral decreased of visual acuity, bilateral ophthalmoparesis, drowsiness, polyuria and left hemiparesis. An emergency computed tomography scan showed increase in tumor volume with hemorrhage and an infarct of right middle cerebral artery. The patient died seven days later. This case exemplifies this rare and catastrophic complication with high morbidity and mortality. On literature review, only two cases of ischemic strokes due to compression major intracranial arteries by postoperative tumor apoplexy were found.

Síndrome del muñeco cabeza de resorte por quiste aracnoideo selar en un adulto / Bobble-head doll syndrome by selar arachnoid cyst in an adult

El síndrome del muñeco cabeza de resorte es un raro trastorno usualmente descrito en la población pediátrica como resultado de lesiones selares y del tercer ventrículo, especialmente quistes coloides. Su fisiopatología no está bien esclarecida. Se ha planteado que los trastornos del funcionamiento de las aferencias y eferencias hacia el núcleo dorso-medial del tálamo originarían los movimientos y estos permanecerían en el tiempo gracias a fenómenos de aprendizaje. Presentamos un raro caso del síndrome del muñeco cabeza de resorte de una paciente adulta como consecuencia de un quiste aracnoideo selar con extensión paraselar a través de la fisura de Silvio. Se realizaron comunicaciones del quiste hacia las cisternas adyacentes con lo cual se logro control completo de los síntomas tras 48 horas del procedimiento.

Bobble head doll syndrome is a rare disorder usually described in the pediatric population as a result of sellar lesions and the third ventricle, especially colloid cysts. Its pathophysiology is not well understood. It has been suggested that functional disorders of the afferent and efferent system to the dorso-medial nucleus of the thalamus causes of the movement and these remain over time through learning phenomena. We present a rare case of bobble head doll syndrome in an adult patient caused by a sellar arachnoid cyst with parasellar extension through the Sylvian fissure. Communications were made from the cyst into adjacent cisterns thereby achieving complete control of symptoms after 48 hours of the procedure.

[Brain stem compression preceded by trigeminal neuralgia in a patient with vertebro-basilar and bilateral carotid dolichoectasia]. / Compresión tronco-encefálica precedida por neuralgia del trigémino en un paciente con dolicoectasia vertebro-basilar y carotidea bilateral.

We described a patient who had left trigeminal neuralgia by vertebro-basilar dolichoectasia, who underwent microvascular decompression separating the basilar artery of the trigeminal nerve by interposing a vascular graft piece. Symptoms resolved completely after surgery. Nine years later, he has a recurrence of facial pain associated with rapidly progressive brainstem compressive symptoms. The brain MRI showed the vertebro-basilar dolichoectasia exerting compression on the ventral-lateral aspect of the pons and the medulla. In cerebral angiography confirmed the presence of dilated tortuous vertebral arteries, basilar, and of both internal carotid. To our knowledge this is the first case of brain stem compression syndrome preceded by NT in patients with vertebro-basilar dolichoectasia and one of the few cases with coexistence of vertebro-basilar and bilateral carotid dolichoectasia.