RESUMO
Introducción. El Real Decreto 2070/1999 supuso una importante modificación en la legislación, al incluir al Doppler transcraneal (DTC) dentro de las exploraciones para confirmar el diagnóstico clínico de muerte encefálica (ME). Habitualmente, para su empleo en el diagnóstico de ME se ecografían las arterias cerebrales medias (ACM) y la arteria basilar (AB). Objetivos. Comprobar la eficacia del DTC como prueba confirmatoria de ME, ecografiando ambas ACM y ambas arterias vertebrales en su porción intracraneal (AV) en lugar de la AB, tomando como patrón de oro la gammagrafía de perfusión cerebral. Pacientes y métodos. Presentamos 25 pacientes diagnosticados clínicamente de ME a los que se realizó DTC como prueba confirmatoria de dicho diagnóstico, ecografiando ambas ACM y ambas AV. Posteriormente, se procedió a realizar gammagrafía de perfusión cerebral (GPC) en todos los casos, como prueba confirmatoria final. Se usa como herramienta estadística el test de ji cuadrado, demandando un intervalo de confianza del 95 por ciento. Resultados. En 24 de los 25 el DTC fue eficaz a la hora de confirmar el diagnóstico de ME. En el paciente restante, se obtuvo un falso positivo, dado que el DTC no reveló flujo en fosa posterior, comprobándose mediante la GPC la presencia de flujo residual a dicho nivel, flujo que desapareció en 36 horas. Dicho paciente estaba hemodinámicamente inestable en el momento de realizar el DTC. Conclusiones. El DTC obtiene una fiabilidad del 100 por ciento a la hora de confirmar la ausencia de perfusión en la fosa anterior; no obstante el falso positivo obtenido en fosa posterior nos obliga a ser cautos a la hora de aceptar la ecografía de las AV, sobre todo en sujetos con tendencia a la inestabilidad hemodinámica, como prueba confirmatoria de ausencia de perfusión en la fosa posterior (AU)
Assuntos
Pessoa de Meia-Idade , Adulto , Adolescente , Idoso , Masculino , Feminino , Humanos , Artéria Vertebral , Reprodutibilidade dos Testes , Ultrassonografia Doppler Transcraniana , Artéria Cerebral Média , Ecoencefalografia , Morte Encefálica , TelencéfaloRESUMO
INTRODUCTION: The Real Ordinance 2070/1999 meant an important modification in the legislation, when including transcranial Doppler (TCD) in explorations to confirm the clinical diagnosis of brain death (BD). Habitually for their employment in the diagnosis of BD, we look for blood flow signal from the middle cerebral arteries (MCA) and the basilar artery (BA). OBJECTIVES: To check the effectiveness of the TCD like test of BD, looking for both middle cerebral arteries (MCA) and both intracranial vertebral arteries (VA), instead of the BA, and taking as Gold Standard cerebral scintigraphic techniques. PATIENTS AND METHODS: . We present 25 patients diagnosed clinically with BD; on these TCD was carried out to confirm BD. Later on we proceeded to carry out cerebral scintigraphic techniques in all these cases. As statistical tool the test of c2 is used with confidence interval of 95%. RESULTS: In 24 of the 25 cases, the TCD was effective in confirming the diagnosis of BD. In the remaining patient, a false positive result was obtained, since the TCD didn't reveal flow in the infratentorial compartment, as contrary to the cerebral scintigraphic techniques which showed the presence of residual flow at this level; this residual flow disappeared in 36 hours. This patient was hemodynamically unstable during TCD exploration. CONCLUSIONS: In our results the TCD obtains a reliability of 100% when confirming the absence of blood flow in the supratentorial compartment; nevertheless the false positive result obtained at the infratentorial level, warns us to be cautious in accepting the flow from the VA as a test of absence of flow at the infratentorial compartment, especially in those patients with hemodynamic instability.
Assuntos
Morte Encefálica/diagnóstico por imagem , Encéfalo/irrigação sanguínea , Artéria Cerebral Média/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Artéria Vertebral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Ecoencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
INTRODUCTION: The subarachnoid haemorrhage non traumatic assumes between the 6-8% of all acute cerebrovascular, besides is more frequent in young persons. The mortility and mortality is high and the predictive factors of the worse prognostic in unknown. MATERIAL AND METHODS: In the present work, we realized a study of the patients admitted to our intensive care unite (UCI) a cause of the subarachnoid haemorrhage during the last ten years. In the same time of admitted to the UCI we applied Glasgow coma scale. Apache II and Hunt-Hess scale. The clinic dates analyzed were sex, age, glycemia, rate heart, middle arterial pressure, intraventricular haemorrhage and arrhythmias. The number of patients was the 100 the 68% were female and the 32% were male. The middle age was 48,98 +/- 21,82 years-old. RESULTS: We obtained a worse prognostic in the 58%, versus in the 42% of the patients and the prognostic factors were Glasgow coma scales. Hunt-Hess scale, rate heart, middle arterial pressure, glycemia, intraventricular haemorrhage and arrhythmias.
Assuntos
Hemorragia Subaracnóidea/fisiopatologia , Adulto , Idoso , Encéfalo/fisiopatologia , Feminino , Escala de Coma de Glasgow , Humanos , Hiperglicemia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Hemorragia Subaracnóidea/diagnóstico , TaquicardiaRESUMO
We realized a retrospective study of all the patients who developed a nosocomial meningitis after to admitted to the Intensive Care Unit of our hospital, during the last five years. Nosocomial meningitis was found in 3.29% of the neurologic patients. The most frequent causes of the meningitis was the external ventricular drainage (14.8%), post-neurosurgical (0.8%) and head injury (0.0007%). The causative bacterias were stafilococo, S. pneumoniae, K. pneunomiae and P. aeruginosa. The mortality was of the 39.06%.
