Intracerebral hemorrhage after deep brain stimulation surgery guided with microelectrode recording: analysis of 297 procedures / Hemorragia intracerebral después de cirugía de estimulación cerebral profunda guiada por microrregistro: un análisis de 297 procedimientos

Objectives: Report the incidence of symptomatic and asymptomatic intracerebral hemorrhage (ICH) in patients submitted to deep brain stimulation (DBS) guided with microelectrode recording (MER) with further analysis of potential risk factors, both inherent to the patient and related to the pathology and surgical technique. Methods: We performed a retrospective observational study. 297 DBS procedures were concluded in 277 patients in a single hospital centre between January 2010 and December 2020. All surgeries were guided with MER. We analysed the incidence of symptomatic and asymptomatic ICH and its correlation to age, sex, diagnosis, hypertension and perioperative hypertension, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, and number of MER trajectories. Results: There were a total of 585 electrodes implanted in 277 patients. 16 ICH were observed, of which 6 were symptomatic and 10 asymptomatic, none of which incurred in permanent neurological deficit. The location of the hemorrhage varied between cortical and subcortical plans, always in relation with the trajectory or the final position of the electrode. The incidence of symptomatic ICH per lead-implantation was 1%, and the CT-scan demonstrated asymptomatic ICH in 1.7% more patients. Male patients or with hypertension are 2.7 and 2.2 times more likely to develop ICH, respectively. However, none of these characteristics has been shown to have a statistically significant association with the occurrence of ICH, as well as age, diagnosis, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, number of MER trajectories and perioperative hypertension. Conclusions: MER-guided DBS is a safe technique, with low incidence of ICH and no permanent deficits in our study. Hypertension and male sex seem to be risk factors for the development of ICH in this surgery. Nevertheless, no statistically significant factors were found for the occurrence of this complication.(AU)

Objetivos: Reportar la incidencia de hemorragia intracerebral (HIC) sintomática y asintomática en pacientes sometidos a estimulación cerebral profunda (ECP) guiada por microrregistro (MER), con el consecuente análisis de posibles factores de riesgo, tanto inherentes al paciente como relacionados con la patología y técnica quirúrgica. Métodos: Realizamos un estudio observacional retrospectivo. Se analizaron un total de 297 procedimientos de ECP realizados en 277 pacientes en un centro hospitalario entre enero de 2010 y diciembre de 2020. Todas las cirugías fueron guiadas con MER. Analizamos la incidencia de HIC, tanto sintomática como asintomática, y la correlación con edad, sexo, diagnóstico, hipertensión arterial e intraoperatoria, diabetes, dislipemia, medicación antiplaquetaria previa, diana anatómica y número de vías. Resultados: El número total de electrodos implantados fue de 585 en 277 pacientes. Se observaron 16 HIC, de las cuales 10 fueron asintomáticas y 6 sintomáticas y ninguna incurrió en déficit neurológico permanente. La localización de la hemorragia varió entre planos corticales y subcorticales, siempre en relación con el trayecto o posición final del electrodo. La incidencia de hemorragia sintomática fue de alrededor del 1 %, y la TC posoperatoria demostró hemorragia asintomática en un 1,7 % adicional de los pacientes. Los pacientes varones o los pacientes con hipertensión tienen 2,7 y 2,2 veces más probabilidades de desarrollar sangrado, respectivamente. Sin embargo, ninguna de estas características demostró una asociación estadísticamente significativa con la ocurrencia de hemorragia intracerebral, como la edad, el diagnóstico, la diabetes, la dislipidemia, la ingesta previa de medicamentos antiplaquetarios, el objetivo anatómico, el número de MER y las vías de HTA intraoperatorias. Conclusión: La ECP con MER es una técnica segura, con baja incidencia de HIC y sin déficits permanentes en nuestro estudio...(AU)

Radiomic-based nonlinear supervised learning classifiers on non-contrast CT to predict functional prognosis in patients with spontaneous intracerebral hematoma.

PURPOSE: To evaluate if nonlinear supervised learning classifiers based on non-contrast CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma. METHODS: Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE > 18 years and with TCCSC performed within the first 24 h of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS 0-2) and poor prognosis (mRS 3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30% respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. RESULTS: 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC 0.798, 0.752 and 0.742 respectively). The predictions of these models, in the validation cohort, had a sensitivity of 0.897 (0.778-1;95%CI), with a false-negative rate of 0% for predicting poor functional prognosis at discharge. CONCLUSION: The use of radiomics-based nonlinear supervised learning classifiers are a promising diagnostic tool for predicting functional outcome at discharge in HIE patients, with a low false negative rate, although larger and balanced samples are still needed to develop and improve their performance.

Clasificadores de aprendizaje supervisado no lineales basados en radiómica de la TC cerebral sin contraste para predecir el pronóstico funcional en pacientes con hematoma intracerebral espontáneo / Radiomic-based nonlinear supervised learning classifiers on non-contrast CT to predict functional prognosis in patients with spontaneous intracerebral hematoma

Objetivo: Evaluar si clasificadores de aprendizaje supervisado no lineales basados en radiómica de la TC cerebral sin contraste (TCCSC) pueden predecir el pronóstico funcional al alta en pacientes con hematoma intracerebral espontáneo (HIE). Material y método: Análisis observacional retrospectivo y unicéntrico de pacientes con diagnóstico de HIE confirmado por TCCSC entre enero de 2016 y abril de 2018. Se incluyeron pacientes con HIE >18años y con TCCSC realizado dentro de las primeras 24horas del inicio de los síntomas. Se excluyeron los HIE secundarios y en los que no se disponía de las variables de radiómica. Se recogieron datos clínicos, demográficos y variables al ingreso. Los pacientes se clasificaron según la Escala Modificada de Rankin (mRS) al alta en buen (mRS0-2) y mal pronóstico (mRS3-6). Tras la segmentación manual de la TCCSC de cada HIE se obtuvieron las variables de radiómica. La muestra se dividió en una cohorte de entrenamiento y prueba y otra cohorte de validación (70-30%, respectivamente). Se usaron diferentes métodos de selección de variables y reducción de dimensionalidad, así como diferentes algoritmos para la construcción del modelo. Se realizaron 10 iteraciones de validación cruzada estratificada en la cohorte de entrenamiento y prueba y se calculó la media de los valores de área bajo la curva (AUC). Una vez entrenados los modelos, se calculó la sensibilidad de cada uno para predecir el pronóstico funcional al alta en la cohorte de validación. Resultados: Se analizaron 105 pacientes con HIE. Se evaluaron 105 variables de radiómica de cada paciente. Los algoritmos P-SVM, KNN-E y RF-10, en combinación con el método de selección de variables ANOVA, fueron los clasificadores con mejor rendimiento en la cohorte de entrenamiento y prueba (AUC: 0,798, 0,752 y 0,742, respectivamente)...(AU)

Purpose: To evaluate if nonlinear supervised learning classifiers based on non-contrast cerebral CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma (HIE). Methods: Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE >18years and with non-contrast CT performed within the first 24hours of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS0-2) and poor prognosis (mRS3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30%, respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. Results: 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC: 0.798, 0.752 and 0.742, respectively)...(AU)

Intracerebral hemorrhage after deep brain stimulation surgery guided with microelectrode recording: analysis of 297 procedures.

OBJECTIVES: Report the incidence of symptomatic and asymptomatic intracerebral hemorrhage (ICH) in patients submitted to deep brain stimulation (DBS) guided with microelectrode recording (MER) with further analysis of potential risk factors, both inherent to the patient and related to the pathology and surgical technique. METHODS: We performed a retrospective observational study. 297 DBS procedures were concluded in 277 patients in a single hospital centre between January 2010 and December 2020. All surgeries were guided with MER. We analysed the incidence of symptomatic and asymptomatic ICH and its correlation to age, sex, diagnosis, hypertension and perioperative hypertension, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, and number of MER trajectories. RESULTS: There were a total of 585 electrodes implanted in 277 patients. 16 ICH were observed, of which 6 were symptomatic and 10 asymptomatic, none of which incurred in permanent neurological deficit. The location of the hemorrhage varied between cortical and subcortical plans, always in relation with the trajectory or the final position of the electrode. The incidence of symptomatic ICH per lead-implantation was 1%, and the CT-scan demonstrated asymptomatic ICH in 1.7% more patients. Male patients or with hypertension are 2.7 and 2.2 times more likely to develop ICH, respectively. However, none of these characteristics has been shown to have a statistically significant association with the occurrence of ICH, as well as age, diagnosis, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, number of MER trajectories and perioperative hypertension. CONCLUSIONS: MER-guided DBS is a safe technique, with low incidence of ICH and no permanent deficits in our study. Hypertension and male sex seem to be risk factors for the development of ICH in this surgery. Nevertheless, no statistically significant factors were found for the occurrence of this complication.

Hemorrhagic Cerebrovascular Disease: An Unusual Presentation of Hyperhomocysteinemia / Accidente cerebrovascular hemorrágico: una inusual presentación de hiperhomocisteinemia / Acidente vascular cerebral hemorrágico: uma apresentação incomum da hiper-homocisteinemia

Introduction: Stroke is a major cause of morbidity and mortality worldwide, with hemorrhagic stroke being the deadliest form of acute stroke. Therefore, the cause of the event should be determined to direct the associated therapy and take preventive measures. Hyperhomocysteinemia has been described as a rare etiology of stroke. Although hyperhomocysteinemia has been associated with venous thrombotic events, altered endothelial function, and procoagulant states, its clinical role in stroke remains controversial. Case description: We present a case of a 60-year-old male patient with primary autoimmune hypothyroidism who presented with dysarthria, facial paresis, and left upper-limb monoparesis after sexual intercourse. A simple skull computed tomography scan showed hyperintensity in the right basal ganglion, indicating an acute hemorrhagic event. Etiological studies were performed, including ambulatory blood pressure monitoring, cerebral angiography, and transthoracic echocardiogram, which ruled out underlying vascular pathology. During follow-up, vitamin B12 deficiency and hyperhomocysteinemia were detected, without other blood biochemical profile alterations. Supplementation was initiated, and homocysteine levels gradually decreased, without new neurological deficits observed during follow-up. Conclusion: Quantification of homocysteine should be considered in patients with a cerebrovascular disease without apparent cause, as documenting hyperhomocysteinemia and correcting its underlying etiology are essential not only for providing appropriate management but also for preventing future events.

Introducción: el accidente cerebrovascular es una causa importante de morbilidad y mortalidad en todo el mundo, y el accidente cerebrovascular hemorrágico es la forma más mortífera de accidente cerebro- vascular agudo. La determinación de la causa del evento es esencial para dirigir la terapia asociada y poder tomar medidas preventivas. La hiperhomocisteinemia se ha descrito como una etiología poco frecuente de accidente cerebrovascular. Aunque esta se ha asociado con eventos trombóticos venosos, disfunción endotelial alterada y estados procoagulantes, sigue siendo controvertido su papel clínico en el accidente cerebrovascular. Descripción del caso: se presenta el caso de un hombre de 60 años con hipotiroidismo autoinmune primario que presentó disartria, paresia facial y monoparesia del miembro superior izquierdo después de un encuentro sexual. Una simple tomografía computarizada de cráneo mostró hipointensidad en la región del ganglio basal derecho, que indicaba un evento hemorrágico agudo. Se realizaron estudios etiológicos, incluyendo monitorización ambulatoria de la presión arterial, angiografía cerebral y ecocardiograma transtorácico, que descartaron patología vascular subyacente. Durante el seguimiento, se detectó deficiencia de vitamina B12 e hiperhomocisteinemia, sin otras alteraciones en el perfil bioquímico sanguíneo. Se inició la suplementación y los niveles de homocisteína disminuyeron gradualmente, sin observar nuevos déficits neurológicos durante el seguimiento. Conclusión: la cuantificación de homocisteína debe ser considerada en casos de enfermedad cerebrovascular sin causa aparente, dado que documentar la hiperhomocisteinemia y corregir su etiología subyacente es esencial no solo para proporcionar un manejo adecuado, sino también para prevenir eventos futuros.

Introdução: o acidente vascular cerebral (AVC) é uma das principais causas de morbidade e mortalidade em todo o mundo, sendo o AVC hemorrágico a forma mais letal de AVC agudo. A determinação da causa do evento é essencial para direcionar a terapia associada e poder tomar medidas preventivas. A hiperhomocisteinemia tem sido descrita como uma etiologia rara de acidente vascular cerebral. Embora a hiper-homocisteinemia tenha sido associada a eventos trombóticos venosos, disfunção endotelial alterada e estados pró-coagulantes, seu papel clínico no AVC permanece controverso. Descrição do caso: apresentamos o caso de um homem de 60 anos com hipotireoidismo autoimune primário que apresentou disartria, paresia facial e monoparesia do membro superior esquerdo após relação sexual. A tomografia computadorizada de crânio mostrou hipointensidade na região do gânglio da base direito, indicando evento hemorrágico agudo. Foram realizados estudos etiológicos, incluindo monitorização ambulatorial da pressão arterial, angiografia cerebral e ecocardiograma transtorácico, que descartaram patologia vascular subjacente. Durante o acompanhamento, foram detectados deficiência de vitamina B12 e hiper-homocistei- nemia, sem outras alterações no perfil bioquímico sanguíneo. A suplementação foi iniciada e os níveis de homocisteína diminuíram gradualmente, sem novos déficits neurológicos observados durante o acompanhamento. Conclusão: a quantificação da homocisteína deve ser considerada em casos de doença vascular cerebral sem causa aparente, pois documentar a hiper-homocisteinemia e corrigir sua etiologia subjacente é essencial não apenas para fornecer manejo adequado, mas também para prevenir eventos futuros.

El síndrome de Terson diagnosticado por ecografía como indicador de extrema gravedad en pacientes neurocríticos / Ultrasound diagnosis of Terson syndrome as an indicator of extreme severity in neurocritical care patients

Introducción: Se denomina síndrome de Terson (ST) a cualquier tipo de hemorragia intraocular (HIO), identificada en pacientes con patología aguda intracraneal. El ST parece estar relacionado con la gravedad clínica en la hemorragia subaracnoidea (HSA), pero en pacientes con trauma craneoencefálico (TCE) y hemorragia intracerebral (HIC), su asociación está por definir. Diseñamos este estudio para evaluar el rendimiento de la ecografía ocular (EO) y su utilidad en la práctica clínica.Materiales y métodosRealizamos un estudio observacional prospectivo, unicéntrico en pacientes neurocríticos. Analizamos los casos con respecto a los controles, identificados con oftalmoscopia indirecta (OI), y por EO. Determinamos las características diagnósticas de la EO. Hicimos un análisis multivariante para determinar asociaciones clínicamente relevantes.ResultadosSe incluyeron 91 pacientes con diagnósticos de HIC (41,76%), HSA (29,67%) y TCE (28,57%). El ST fue identificado por EO en ocho pacientes (8,79%) y en 24 pacientes (24,37%) por OI. La mortalidad ajustada para los pacientes con ST tuvo una OR 4,15 con IC 95% (1,52 - 11,33). Todos los pacientes con ST identificados por EO presentaron una escala de coma de Glasgow < 9 y tuvieron un riesgo elevado de precisar craniectomía descompresiva, una OR 9,84 (1,64 - 59). La EO alcanzó una sensibilidad global de 30,43%, una especificidad del 98,53%, con una precisión diagnóstica de 81,32. Para la detección de la hemorragia vítrea, una sensibilidad y especificidad del 87,5 y 98,5%, respectivamente.ConclusionesEl ST diagnosticado por EO discrimina pacientes neurocríticos de extrema gravedad que pueden requerir el máximo escalón terapéutico y es un factor independiente de mortalidad intrahospitalaria. (AU)

Introduction: Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice.Material and methodsWe performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations.ResultsThe sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively.ConclusionsOU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality. (AU)

Ultrasound diagnosis of Terson syndrome as an indicator of extreme severity in neurocritical care patients.

INTRODUCTION: Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice. MATERIAL AND METHODS: We performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations. RESULTS: The sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively. CONCLUSIONS: OU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality.

Hematoma cerebral intraparenquimatoso e intraventricular por cocaína: reporte de un caso

Introducción: La cocaína es una de las sustancias psicoactivas más consumidas mundialmente. Es altamente adictiva y puede producir cuadros graves por su consumo, esporádico o habitual o, por su abstinencia, a nivel sistémico y neurológico. La exposición aguda a esta sustancia desencadena manifestaciones psiquiátricas inmediatas, como cambios en el afecto o conducta: sensación de irritabilidad, hiperactividad, ansiedad, desasosiego, euforia o psicosis. Esta sintomatología contrasta con inducción en ciertos casos de depresión, aislamiento o tristeza con la cronificación en su consumo. Además de los diversos efectos sensoperceptuales descritos, la sustancia puede generar daños neurológicos y/o cardiovasculares graves, como trastornos del ritmo cardíaco, arritmias malignas, emergencias hipertensivas, síndromes coronarios y enfermedades cerebrovasculares. Métodos: Presentamos el caso de un paciente quien ingresó al Hospital Universitario del Valle, en la ciudad de Santiago de Cali, departamento del Valle del Cauca, en Colombia, por un cuadro neurológico que permitía sospechar origen central. Este paciente no tenía factores de riesgo cardiovasculares, pero sí antecedentes de síndrome de Guillain Barré y de consumo de cocaína desde su adolescencia. Resultados: Al mencionado paciente se le realizaron múltiples estudios, destacándose los imagenológicos (tomografía, resonancia y angiorresonancia magnética de cerebro) y la estrategia invasiva de angiografía cerebral, en la cual logró documentarse que las manifestaciones neurológicas del paciente obedecían a una enfermedad cerebrovascular hemorrágica severa secundaria al consumo de cocaína. Conclusiones: Siempre indagar en pacientes con sangrados intraparenquimatosos el consumo de psicoactivos, en especial la cocaína, por su efecto lesivo sobre la vasculatura cerebral.

Introduction: Cocaine is one of the most widely consumed psychoactive substances worldwide. It is highly addictive and can produce serious systemic and neurological symptoms due to sporadic or habitual use or withdrawal. Acute exposure to this substance triggers immediate psychiatric manifestations such as changes in affect or behavior: feelings of irritability, hyperactivity, anxiety, restlessness, euphoria or psychosis; this symptomatology contrasts with induction in certain cases of depression, isolation or sadness with the chronification of its consumption. In addition to the various sensory-perceptual effects described, the substance can cause serious neurological and/or cardiovascular damage, such as heart rhythm disorders, malignant arrhythmias, hypertensive emergencies, coronary syndromes and cerebrovascular diseases. Methods: We present the case of a patient who was admitted to the Hospital Universitario del Valle, in the city of Santiago de Cali, department of Valle del Cauca, in Colombia, for a neurological condition that suggested a central origin. This patient had no cardiovascular risk factors, but had a history of Guillain Barré syndrome and cocaine use since adolescence. Results: The aforementioned patient underwent multiple studies, highlighting the imaging studies (CT, MRI and MRA of the brain) and the invasive strategy of cerebral angiography, in which it was possible to document that the patient's neurological manifestations were due to severe hemorrhagic cerebrovascular disease secondary to cocaine consumption. Conclusions: Always inquire in patients with intraparenchymal bleeds the consumption of psychoactives, especially cocaine, for its injurious effects on the cerebral vasculature.

Cerebral amyloid angiopathy in an octogenarian

Cerebral amyloid angiopathy presents with lobar intracerebral hemorrhage, dementia or tran sient neurological events. It occurs due to P-amyloid deposits in the media and adventitia of small arteries, leptomeningeal capillaries and the cerebral cortex. Its prevalence increases with age, and its association with cognitive impairment is well established. We present the case of an 80-year-old previously independent woman with no disabilities or cognitive impairment, and a history of well-controlled systemic arterial hypertension who consulted due to a de novo seizure and focal neurological deficits. On imaging follow up, two bilateral parietal-occipital macrohemorrhages were found, which occurred at two different times during the development of the clinical condition. These findings were attributed to cerebral amyloid angiopathy, and the patient ultimately died during this hospitalization. In this case presentation, we discuss the diagnostic criteria for considering the presence of cerebral amyloid angiopathy, its prognosis, and the reason it led to death. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2567).

La angiopatía amiloide cerebral se presenta con hemorragia intracerebral lobular, demencia o eventos neurológicos transitorios. Ocurre como resultado del depósito de (3-amiloide en la media y la adventicia de las arterias pequeñas, los capilares de las leptomeninges y la corteza cerebral. Su prevalencia aumenta con la edad y su asociación con deterioro cognitivo está bien establecido. Se presenta el caso de una mujer de 80 años, previamente independiente, sin discapacidad ni deterioro cognitivo, con antecedente de hipertensión arterial sistémica bien controlada, quien consultó por episodio convulsivo de novo y focalización neurológica. Durante el seguimiento imagenológico se documentó presencia de dos macrohemorragias parietooccipitales bilaterales, acontecidas en dos momentos diferentes durante la evolución del cuadro clínico, hallazgos que fueron atribuidos a la presencia de angiopatía amiloide cerebral, finalmente la paciente falleció durante dicha hospitaliza ción. En esta presentación de caso se discuten los criterios diagnósticos para considerar la presencia de angiopatía amiloide cerebral, el pronóstico y la razón que llevó a la muerte. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2567).

Recomendaciones en el abordaje del hematoma intracerebral espontáneo durante la internación / Recommendations for the management of spontaneous intracerebral hemorrhage during hospitalization

Resumen El accidente cerebrovascular (ACV) constituye la principal causa de discapacidad de origen neuro- lógico en los adultos mayores a 40 años y la cuarta causa de muerte en Argentina. En los últimos diez años las publicaciones indexadas relacionadas al tratamiento del ACV isquémico fueron más numerosas que las de ACV hemorrágico. El objetivo de este material es proporcionar recomendaciones locales y actualiza- das del abordaje de pacientes con hematoma intraparenquimatoso espontáneo durante la internación. Para la redacción de este manuscrito se convocó a especialistas en esta enfermedad que conformaron grupos de trabajo. Se plantearon 10 tópicos centrales expresados como epidemiologia, atención inicial, imágenes, tratamiento de la presión arterial, reversión de antitrombóticos, indicación de cirugía, profilaxis anticonvulsivante, pronóstico, prevención de complicaciones y reinicio de antitrombóticos. De cada tópico se plantearon mediante preguntas PICO los interrogantes más frecuentes de la práctica diaria. Luego de una revisión sistemática de la literatura, se generaron recomendaciones evaluadas mediante sistema GRADE y consensuadas entre autores y pacientes.

Abstract Stroke is the leading cause of neurological disability in people over 40 years of age and the fourth leading cause of death in Argentina. In the last ten years, the indexed publications related to the treatment of ischemic stroke were more numerous than those of hemorrhagic stroke. The objective of this material is to provide local and updated recommendations for the management of patients with spontaneous intracere- bral hemorrhage during hospitalization. For the writing of this manuscript, diferent specialists were convened to form working groups. Ten central topics expressed as epidemiology, initial care, imaging, blood pressure treatment, reversal of antithrombotics, indication for surgery, seizure prophylaxis, prognosis, prevention of complications and resumption of antithrombotics were raised. For each topic, the most frequent questions of daily practice were raised through PICO questions. After a systematic review of the literature, recommendations were generated, evaluated using the GRADE system and agreed between authors and patients.

Hemorragia intracerebral fatal asociada al síndrome de trombosis con trombocitopenia tras la vacuna ChAdOx1-S / Fatal intracerebral haemorrhage associated with thrombosis with thrombocytopenia syndrome after ChAdOx1-S vaccine

Introducción: La pandemia por COVID-19 ha tenido un impacto devastador en la salud, la sociedad y la economía en el mundo. Por ello, las vacunas contra el coronavirus del síndrome respiratorio agudo grave 2 (SARS-CoV-2) han surgido como medida importante para combatir la pandemia. ChAdOx1-S (Oxford-AstraZeneca) es una vacuna vectorizada por adenovirus que expresa la proteína de espiga del SARS-CoV-2. Se han notificado varios casos de trombosis y trombocitopenia inusuales tras la ChAdOx1-S que imitan la trombocitopenia autoinmune inducida por heparina. Esta situación se denomina síndrome de trombosis con trombocitopenia (STT), y se han descrito casos de hemorragia intracerebral secundaria. Caso clínico: Presentamos un caso de hemorragia intracerebral tras la vacunación con ChAdOx1-S. Una paciente de mediana edad sin antecedentes médicos de interés fue atendida en urgencias 16 días después de la primera dosis de ChAdOx1-S con una hemiplejía izquierda de inicio repentino y una cefalea opresiva holocraneal grave. No recibió heparina los 100 días anteriores. El análisis de sangre mostró trombocitopenia moderada y en la tomografía computarizada se observó una hemorragia lobar frontal derecha sin trombosis en la venografía por tomografía computarizada. Se confirmó la presencia de anticuerpos contra el factor 4 de las plaquetas en la sangre. La paciente presentó un síndrome de hipertensión intracraneal resistente al tratamiento y falleció tres semanas después. Conclusiones: El STT es un efecto adverso infrecuente de la vacuna ChAdOx1-S que se define por la presencia de trombosis en localizaciones infrecuentes. En nuestro caso, describimos una hemorragia intracerebral espontánea secundaria a la trombocitopenia desencadenada por el STT. Representa una presentación clínica poco frecuente del STT.(AU)

INTRODUCTION: The COVID-19 pandemic has had a devastating impact on health, society and economics worldwide. Therefore, vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recently emerged as an important measure to fight the pandemic. ChAdOx1-S (Oxford-AstraZeneca) is an adenovirus-vectored vaccine that expresses the SARS-CoV-2 spike protein. It shows an acceptable safety profile. Nevertheless, several cases of unusual thrombosis and thrombocytopenia have been reported after initial vaccination with ChAdOx1-S mimicking autoimmune heparin-induced thrombocytopenia. This condition has been called thrombosis with thrombocytopenia syndrome (TTS) and complications such as intracerebral haemorrhage have been described. CASE REPORT: We present a case of intracerebral haemorrhage after ChAdOx1-S vaccination. Middle-aged patient with no prior medical history was seen in the emergency room 16 days after the first dose of ChAdOx1-S vaccine with sudden onset left hemiplegia and severe holocranial oppressive headache. She did not receive heparin treatment in the previous 100 days. Blood test showed moderate thrombocytopenia and a right frontal lobar haemorrhage was seen on computed tomography scan, computed tomography venography was negative for thrombosis. The presence of antibodies against platelet factor 4 was confirmed. The patient’s neurological condition progressively worsened. She developed a treatment resistant intracranial hypertension syndrome and she died three weeks later. CONCLUSIONS: TTS is a rare adverse effect of ChAdOx1-S vaccine, defined by the presence of thrombosis in uncommon locations. In our case we report an spontaneous intracerebral haemorrhage probable due to the thrombocytopenia related to probable TTS. It represents a rare clinical presentation of TTS.(AU)

Mortalidad en pacientes con hemorragia intracerebral asociada a anticoagulación oral. Eficacia de un protocolo de reversión y seguimiento clínico (proyecto HIC-ACO) / Mortality in patients with intracerebral haemorrhage associated with oral anticoagulation. Efficacy of a reversal protocol and clinical follow-up (ICH-OAC project)

Introducción: La hemorragia intracerebral espontánea asociada a anticoagulantes orales (HIC-ACO) presenta una elevada mortalidad. La aparición de nuevos fármacos anticoagulantes y protocolos de reversión aumenta el interés por esta entidad. Objetivos: El objetivo principal es determinar la tasa de mortalidad en pacientes con HIC-ACO (precoz, hospitalaria, global) en nuestra área sanitaria y analizar las principales variables relacionadas. El objetivo secundario es determinar la eficacia de las terapias de reversión de la anticoagulación (TRA), reflejada por la expansión radiológica del hematoma y el pronóstico funcional. Pacientes y métodos: Estudio prospectivo observacional que introdujo un protocolo dirigido al manejo de pacientes con HIC-ACO. Incluyó medidas generales y neuromonitorización, administración individualizada de TRA, tomografía craneal y seguimiento durante seis meses. Se recogieron los fármacos prescritos en el área durante este período, mortalidad y pronóstico funcional. Se diseñó un estudio bivariante y regresión logística para investigar variables relacionadas con la mortalidad. Resultados: Se incluyó a 49 pacientes durante tres años; de ellos, un 71,4% recibió TRA. La mortalidad fue del 16,3% (primeras 24 horas), el 53,1% (ingreso) y el 61,2% (180 días). Se observó una menor supervivencia entre pacientes con puntuaciones basales mayores en la National Institutes of Healt Stroke Scale (NIHSS) (p < 0,0001), valor de creatinina (p = 0,02), índice internacional normalizado (p = 0,048), volumen hemorrágico (p = 0,008), hidrocefalia (p = 0,015) y toma de acenocumarol (p = 0,030). Los pacientes que no recibieron TRA tuvieron una mayor mortalidad precoz (p = 0,003). La única variable relacionada con la mortalidad global de forma independiente fue la puntuación en la NIHSS basal (odds ratio = 1,282; intervalo de confianza al 95%: 1,023-1,608; p = 0,031)...(AU)

Introduction: Spontaneous intracerebral haemorrhage associated with oral anticoagulants (ICH-OAC) has a high mortality rate. The emergence of new anticoagulant drugs and reversal protocols increases interest in this entity. Objectives: The main objective is to determine the mortality rate in patients with ICH-OAC (early, in-hospital, global) in our health area and to analyse the main variables related to it. The secondary objective is to determine the efficacy of anticoagulation reversal therapies (ART) as reflected by radiological expansion of the haematoma and the functional prognosis. Patients and methods: A prospective observational study that introduced a protocol aimed at the management of patients with ICH-OAC. It included general measures and neuromonitoring, individualised administration of ART, cranial tomography and a six-month follow-up. Data on the drugs prescribed in the area during this period, mortality and functional prognosis were collected. A bivariate and logistic regression study was designed to investigate mortality-related variables. Results: Forty-nine patients were included over three years; of these, 71.4% received ART. Mortality was 16.3% (first 24 hours), 53.1% (admission) and 61.2% (180 days). Lower survival was observed among patients with higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001), creatinine value (p = 0.02), International Normalised Index (p = 0.048), bleeding volume (p = 0.008), hydrocephalus (p = 0.015) and acenocoumarol intake (p = 0.030). Patients who did not receive ART had a greater rate of early mortality (p = 0.003). The only variable independently related to overall mortality was the baseline NIHSS score (odds ratio = 1.282; 95% confidence interval: 1.023-1.608; p = 0.031)...(AU)

Hemorragia talámica izquierda espontánea: caso ilustrativo / Spontaneous Left Talamic Hemorrhage: Illustrative Case

RESUMEN La hemorragia talámica pertenece al grupo de las hemorragias intracerebrales de etiología no traumática o quirúrgica. Es una entidad relativamente infrecuente y tiene una prevalencia de 6-15 % de los casos dentro de dicho grupo. El tálamo es una estructura anatómica donde convergen múltiples vías neuronales, por lo tanto, sus manifestaciones clínicas no están totalmente descritas. A pesar de ello, se conoce que su presentación clínica más frecuente está asociada al síndrome sensitivo de Déjerine-Roussy, caracterizado por intenso dolor neuropático, alodinia contralateral a la lesión, hemiparesia y hemiataxia. La hemorragia talámica también se puede presentar con alteraciones de la memoria, sueño, emociones y procesamiento de información sensitiva. Se presenta un caso de hemorragia talámica izquierda espontánea en un paciente de 71 años que debutó con cambios en su comportamiento, bradipsiquia y amnesia anterógrada, con posterior recuperación completa de su estado cognitivo y psicológico antes de los 8 días y con hallazgos normales en la panangiografía.

ABSTRACT Thalamic hemorrhage belongs to the group of intracerebral hemorrhages of non-traumatic or surgical etiology. It is relatively rare and has a prevalence of 6-15% of cases. The thalamus is an anatomical structure where multiple neural pathways converge; therefore, its clinical manifestations are not fully described. Despite this, it is known that its most frequent clinical presentation is associated with the Dejerine-Roussy sensory syndrome, characterized by intense neuropathic pain, allodynia contralateral to the lesion, hemiparesis and hemiataxia. Thalamic hemorrhage can also present with alterations in memory, sleep, emotions, and the processing of sensitive information. We present a case of spontaneous left thalamic hemorrhage in a 71-year-old patient who presented with changes in his behavior, bradypsy-chia, and anterograde amnesia, with subsequent complete recovery of his cognitive and psychological state before 8 days and with normal findings in the panangiography.

Ultrasound diagnosis of Terson syndrome as an indicator of extreme severity in neurocritical care patients. / El síndrome de Terson diagnosticado por ecografía como indicador de extrema gravedad en pacientes neurocríticos.

INTRODUCTION: Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice. MATERIAL AND METHODS: We performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations. RESULTS: The sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively. CONCLUSIONS: OU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality.

Factores en el pronóstico de mortalidad en pacientes con hemorragia intracerebral espontánea / Prognostic factors of mortality rate in patients with spontaneous intracerebral hemorrhage

RESUMEN Introducción: la hemorragia intracerebral espontánea se considera, entre todos los ictus, el efecto más devastador, la mortalidad mensual estimada, oscila entre el 35 y el 52 %. Objetivo: determinar los factores que influyen en la mortalidad, a los 30 días, en pacientes con hemorragia intracerebral espontánea. Métodos: se realizó un estudio observacional analítico transversal en el Hospital Dr. Carlos Juan Finlay, en un periodo de tres años. El universo lo constituyeron 75 pacientes. Se estudiaron variables demográficas, clínicas y tomográficas. Se aplicaron estadígrafos descriptivos: frecuencia absoluta y relativa, media y desviación típica; y estadígrafos inferenciales: regresión logística mediante el Odds Ratio con intervalo de confianza del 95 %, para una significación positiva al ser p<0,05. Resultados: el grupo etario de 48 a 75 años predominó con 45 pacientes (60 %), el sexo masculino con 44 pacientes (58,7 %) y 33 de la raza blanca (44 %). Predominó la hipertensión arterial como principal antecedente con 61 pacientes para un 81,3 %. Se obtuvieron resultados significativamente positivos para la edad mayor de 80 años (p=0,001); el estado grave según la escala de coma de Glasgow (p=0,005); la presencia de extensión ventricular (p=0,001) y el tratamiento con anticoagulantes orales (p=0,023). Conclusiones: la hemorragia intracerebral se presenta con valores considerables de mortalidad. Las personas mayores de 80 años, con tratamiento con anticoagulantes orales presentan mayor riesgo de mortalidad. La extensión ventricular y bajo puntaje en la escala de coma de Glasgow, empeoran el pronóstico.

ABSTRACT Introduction: spontaneous intracerebral hemorrhage (ICH) is considered, among all strokes, the one having the most devastating effect, the estimated mortality rate per month ranges between 35 and 52 %. Objective: to determine the factors that influence 30-day mortality rate in patients with Spontaneous Intracerebral Hemorrhage. Methods: a cross-sectional, analytical, observational study conducted at Dr. Carlos Juan Finlay Military Hospital over a period of 3 years (2017 to 2019). The target group comprised 75 patients. Demographic, clinical and tomographic variables were studied. Descriptive statistics was applied: absolute and relative frequency, arithmetic mean and standard deviation; along with inferential statistics: logistic regression using the Odds Ratio with a 95 % confidence interval, for a positive significance on p <0.05. Results: the age group from 48 to 75 years prevailed with 45 patients (60 %), male sex 44 patients (58. 7%), and white race 33 (44 %). Hypertension predominated as the main antecedent in 61 patients (81. 3 %). Significantly positive results were obtained for ages over 80 (p = 0,001); the severe state according to Glasgow Coma Scale (p = 0,005); the presence of ventricular extension (p = 0,001) and treatment with oral anticoagulants (p = 0.023). Conclusions: intracerebral hemorrhage is evidence for extensive mortality rates. People over 80 years old, treated with oral anticoagulants have a higher risk of death due to this entity. Ventricular extension and a low score on the Glasgow Coma Scale worsen the prognosis.

Hemorragia intracerebral temprana como presentación atípica de encefalitis por herpes virus simple tipo 1 / Early intracerebral hemorrhage as an atypical presentation of herpes simplex-1 virus encephalitis

RESUMEN La encefalitis por herpes virus simple es la causa más común de encefalitis esporádica letal en el mundo. Una complicación poco usual es la hemorragia intracerebral. Se describe el caso de un preescolar de tres años que ingresa con cuadro clínico de encefalitis aguda, con hallazgos de hemorragia intracerebral temprana en región occipital y estudio en líquido cefalorraquídeo positivo para herpes virus tipo 1, que recibe tratamiento con aciclovir; sin embargo, cursa con evolución tórpida, incremento de hemorragias intracerebrales y desenlace fatal.

ABSTRACT Herpes simplex encephalitis is the most common cause of sporadic lethal encephalitis in the world. Intracerebral hemorrhage is an uncommon complication. The case of a 3-year-old preschooler who was admitted with acute encephalitis clinical picture is described. The patient presents findings of early in tracerebral hemorrhage in the occipital region and a positive cerebrospinal fluid study for herpes virus type 1, which is treated with acyclovir; however, it presents a torpid evolution, increased intracerebral hemorrhages and fatal outcome.

Caracterización clínica de la hemorragia intracerebral en pacientes ingresados en Hospital Faustino Pérez. 2012-2013 / Clinical characterization of the intracerebral hemorrhage in patients admitted in the Hospital Faustino Perez. 2012-2013

RESUMEN Introducción: las enfermedades cerebrovasculares son un problema de salud mundial, constituyen la tercera causa de muerte, la primera de discapacidad en el adulto y la segunda de demencia en el planeta Objetivo: caracterizar la hemorragia intracerebral en estos pacientes en relación con edad y sexo, factores de riesgo, letalidad según localización y extensión de la hemorragia. Materiales y métodos: se realizó un estudio observacional retrospectivo en pacientes ingresados con hemorragia intracerebral en el Hospital Faustino Pérez en los años 2012 y 2013. El universo del estudio fue de 86 pacientes ingresados con hemorragia intracerebral. Resultados: predominó el sexo masculino y el grupo de edades de 70-79 años con 54,65% y 34,88% respectivamente, la raza negra con 40,7% y el factor de riesgo más frecuente fue la hipertensión arterial con 82,55% seguido de la diabetes mellitus con 23.25. La letalidad fue más elevada en los pacientes mayores de 80 años con 41,66%. Según la localización la subcortical fue más frecuente con 34,88% y la más letal el tallo encefálico con 100%. Según la extensión predominó la intraparenquimatosa pura con 69,76% y fue más letal intraventricular con 55%. Conclusión: la hemorragia intracerebral fue más frecuente en pacientes del sexo masculino, del grupo de edades de 70-79 años y de raza negra. El factor de riesgo más frecuente fue la hipertensión arterial, la localización más frecuente fue la subcortical y la extensión la intraparenquimatosa pura. La letalidad fue más alta en pacientes mayores de 80 años, con localización en tronco encefálico y extensión intraventricular (AU).

ABSTRACT Introduction: cerebrovascular diseases are a health problem around the world, being the third cause of death, the first one of disability in adults, and the second cause of dementia in the world. Objective: to characterize intracerebral hemorrhage in these patients in relation to age and sex, risk factors, lethality according to its location and hemorrhage extension. Materials and methods: an observational, retrospective study was carried out in patients admitted in the Hospital Faustino Perez with intracerebral hemorrhage in 2012 and 2013. The universe of the study was 86 patients admitted due to intracerebral hemorrhage. Results: male sex (54.65 %), 70-79-years-old age group (34.88 %) and black race (49.7 %) predominated. The most frequent risk factor was arterial hypertension (82.55 %), followed by diabetes mellitus (23.25 %). Lethality was higher in patients elder than 80 years old (41.66 %). According to location, the subcortical one was the most frequent (34.88 %), and the most lethal was the one of the brainstem (100 %). According for the extension, the pure intraparenchimatous one predominated (69.76 %), and the intraventricular one was the most lethal (55 %). Conclusion: the intracerebral hemorrhage was more frequent in male sex, 70-79-years-old age group and black race. The most frequent risk factor was arterial hypertension; the most frequent location was the subcortical one, and the one with larger extension was the pure intraparenchimatous one. Lethality was higher in patients aged more than 80 years, located in the brainstem and with intraventricular extension (AU).

Caracterización clínica de la hemorragia intracerebral en pacientes ingresados en Hospital Faustino Pérez. 2012-2013 / Clinical characterization of the intracerebral hemorrhage in patients admitted in the Hospital Faustino Perez. 2012-2013

RESUMEN Introducción: las enfermedades cerebrovasculares son un problema de salud mundial, constituyen la tercera causa de muerte, la primera de discapacidad en el adulto y la segunda de demencia en el planeta Objetivo: caracterizar la hemorragia intracerebral en estos pacientes en relación con edad y sexo, factores de riesgo, letalidad según localización y extensión de la hemorragia. Materiales y métodos: se realizó un estudio observacional retrospectivo en pacientes ingresados con hemorragia intracerebral en el Hospital Faustino Pérez en los años 2012 y 2013. El universo del estudio fue de 86 pacientes ingresados con hemorragia intracerebral. Resultados: predominó el sexo masculino y el grupo de edades de 70-79 años con 54,65% y 34,88% respectivamente, la raza negra con 40,7% y el factor de riesgo más frecuente fue la hipertensión arterial con 82,55% seguido de la diabetes mellitus con 23.25. La letalidad fue más elevada en los pacientes mayores de 80 años con 41,66%. Según la localización la subcortical fue más frecuente con 34,88% y la más letal el tallo encefálico con 100%. Según la extensión predominó la intraparenquimatosa pura con 69,76% y fue más letal intraventricular con 55%. Conclusión: la hemorragia intracerebral fue más frecuente en pacientes del sexo masculino, del grupo de edades de 70-79 años y de raza negra. El factor de riesgo más frecuente fue la hipertensión arterial, la localización más frecuente fue la subcortical y la extensión la intraparenquimatosa pura. La letalidad fue más alta en pacientes mayores de 80 años, con localización en tronco encefálico y extensión intraventricular.

ABSTRACT Introduction: cerebrovascular diseases are a health problem around the world, being the third cause of death, the first one of disability in adults, and the second cause of dementia in the world. Objective: to characterize intracerebral hemorrhage in these patients in relation to age and sex, risk factors, lethality according to its location and hemorrhage extension. Materials and methods: an observational, retrospective study was carried out in patients admitted in the Hospital Faustino Perez with intracerebral hemorrhage in 2012 and 2013. The universe of the study was 86 patients admitted due to intracerebral hemorrhage. Results: male sex (54.65 %), 70-79-years-old age group (34.88 %) and black race (49.7 %) predominated. The most frequent risk factor was arterial hypertension (82.55 %), followed by diabetes mellitus (23.25 %). Lethality was higher in patients elder than 80 years old (41.66 %). According to location, the subcortical one was the most frequent (34.88 %), and the most lethal was the one of the brainstem (100 %). According for the extension, the pure intraparenchimatous one predominated (69.76 %), and the intraventricular one was the most lethal (55 %). Conclusion: the intracerebral hemorrhage was more frequent in male sex, 70-79-years-old age group and black race. The most frequent risk factor was arterial hypertension; the most frequent location was the subcortical one, and the one with larger extension was the pure intraparenchimatous one. Lethality was higher in patients aged more than 80 years, located in the brainstem and with intraventricular extension.

Hematoma intraparenquimatoso del sistema nervioso central asociado con dasatinib en el tratamiento de leucemia mieloide crónica en fase acelerada. Presentación de dos casos y revisión de la literatura / Intraparenchymal haematoma of the central nervous system associated with Dasatinib in the treatment of chronic myeloid leukaemia in accelerated phase. Presentation of two cases and review of literature

Resumen Se presentan dos casos clínicos de pacientes con leucemia mieloide crónica en fase acelerada, hospitalizados para inicio de terapia dirigida con inhibidores de tirosina cinasa (dasatinib). Posteriormente se determina la presencia de sangrado intraparenquimatoso a sistema nervioso central. Para finalizar, se revisa la literatura disponible a cerca de eventos adversos tipo sangrado asociados a dasatinib y los posibles condicionantes de este desenlace.

Abstract Two clinical cases are presented on patients with chronic myeloid leukaemia in accelerated phase, who were admitted to hospital for initiation of targeted therapy with tyrosine kinase inhibitors (Dasatinib). Intraparenchymal bleeding in the central nervous system was subsequently observed. A review was also made on the available literature on bleeding-related adverse events associated with Dasatinib and the possible determining factors of this outcome.