Expressions of plasma cystatin C, D-dimer and hypersensitive C-reactive protein in patients with intracranial progressive hemorrhagic injury after craniocerebral injury, and their clinical significance.

OBJECTIVE: To investigate the expressions of plasma cystatin C (Cys-C), D-dimer (D-D) and hypersensitive C-reactive protein (hs-CRP) in patients with intracranial progressive hemorrhagic injury (IPHI) after craniocerebral injury, and their clinical significance. METHODS: Forty-two IPHI patients and 20 healthy participants (control) were enrolled. The severity and outcome of IPHI were determined according to the Glasgow Coma Scale and Glasgow Outcome Scale, and the plasma Cys-C, hs-CRP and D-D levels were measured. RESULTS: The plasma Cys-C, D-D and hs-CRP levels in the IPHI group were significantly higher than those in the control group (p < 0.01). There were significant differences of plasma Cys-C, D-D and hs-CRP levels among different IPHI patients according to the Glasgow Coma Scale and according to the Glasgow Outcome Scale (all p < 0.05). In the IPHI patients, the plasma Cys-C, D-D and hs-CRP levels were positively correlated with each other (p < 0.001). CONCLUSION: The increase of plasma Cys-C, D-D and hs-CRP levels may be involved in IPHI after craniocerebral injury. The early detection of these indexes may help to understand the severity and outcome of IPHI.

Expressions of plasma cystatin C, D-dimer and hypersensitive C-reactive protein in patients with intracranial progressive hemorrhagic injury after craniocerebral injury, and their clinical significance / Expressões da cistatina C plasmática, dímero D e proteína C reativa hipersensível em pacientes com lesão hemorrágica progressiva intracraniana após trauma crânio-encefálico e seus significados clínicos

ABSTRACT Objective To investigate the expressions of plasma cystatin C (Cys-C), D-dimer (D-D) and hypersensitive C-reactive protein (hs-CRP) in patients with intracranial progressive hemorrhagic injury (IPHI) after craniocerebral injury, and their clinical significance. Methods Forty-two IPHI patients and 20 healthy participants (control) were enrolled. The severity and outcome of IPHI were determined according to the Glasgow Coma Scale and Glasgow Outcome Scale, and the plasma Cys-C, hs-CRP and D-D levels were measured. Results The plasma Cys-C, D-D and hs-CRP levels in the IPHI group were significantly higher than those in the control group (p < 0.01). There were significant differences of plasma Cys-C, D-D and hs-CRP levels among different IPHI patients according to the Glasgow Coma Scale and according to the Glasgow Outcome Scale (all p < 0.05). In the IPHI patients, the plasma Cys-C, D-D and hs-CRP levels were positively correlated with each other (p < 0.001). Conclusion The increase of plasma Cys-C, D-D and hs-CRP levels may be involved in IPHI after craniocerebral injury. The early detection of these indexes may help to understand the severity and outcome of IPHI.

RESUMO Objetivo Investigar as expressões da cistatina C plasmática (Cys-C), dímero-D (D-D) e proteína C-reativa hipersensível (hs-CRP) em pacientes com lesão hemorrágica progressiva intracraniana (IPHI) após lesão craniocerebral e seus significados clínicos. Métodos Quarenta e dois pacientes com IPHI e 20 indivíduos saudáveis (controle) foram incluídos. A gravidade e o resultado do IPHI foram determinados de acordo com a Escala de Coma de Glasgow (GCS) e Escala de Resultados de Glasgow (GOS), e os níveis plasmáticos Cys-C, hs-CRP e D-D foram detectados. Resultados Os níveis plasmáticos de Cys-C, D-D e hs-CRP no grupo IPHI foram significativamente maiores do que no grupo controle (P <0,01). Houve diferença significativa entre os níveis plasmáticos de Cys-C, D-D e hs-CRP entre os diferentes pacientes com IPHI de acordo com a GCS e entre os diferentes pacientes com IPHI de acordo com o GOS, respectivamente (todos P <0,05). Em pacientes com IPHI, os níveis plasmáticos de Cys-C, D-D e hs-CRP foram positivamente correlacionados entre si (P <0,001). Conclusão O aumento dos níveis plasmáticos de Cys-C, D-D e hs-CRP pode estar envolvido no IPHI após trauma crânio-encefálico. A detecção precoce desses índices pode ajudar a entender a gravidade e o resultado do IPHI.

Hematomas intracraneanos traumáticos y el tipo de intervención quirúrgica efectuada para su tratamiento, en el Servicio de Neurocirugía del Hospital Nacional Dos de Mayo, Lima - Perú periodo 2008 - 2013 / Traumatic intracranial hematomas and the type of surgical intervention effected for its treatment, in the Neurosurgery Service of the National Hospital Dos de Mayo, Lima - Peru period 2008 - 2013

Introducción.- Los Hematomas Intracraneanos Traumáticos son la patología más frecuente del área de Neurotrauma en la especialidad de Neurocirugía, estos Hematomas son lesiones primarias que se producen como consecuencia directa del traumatismo craneoencefálico, sobre las que el médico no tiene ningún tipo de control, es decir son inevitables, su tratamiento es primordial para poder salvar la vida de los afectados. Las diferentes clases de hematomas requieren intervenciones quirúrgicas distintas; conocer el tipo de intervención quirúrgica permite estandarizar el manejo de estos casos y principalmente reducir la morbi-mortalidad de los pacientes. Método.- Estudio descriptivo, observacional, transversal y retrospectivo. Se revisaron las historias clínicas de 457 pacientes que fueron intervenidos quirúrgicamente con diagnóstico de Hematomas Intracraneanos Traumáticos en el Servicio de Neurocirugía del Hospital Nacional Dos de Mayo, en el periodo enero del 2008 a diciembre del 2013. A través de la ficha de recolección de datos se ha obtenido la información y fue procesada estadísticamente con ayuda de programas como SPSS versión 22.0. Objetivo General: Determinar las Clases de Hematomas Intracraneanos Traumáticos que se presentaron y el resultado de los diferentes tipos de intervenciones quirúrgicas efectuadas para su tratamiento en el periodo de estudio. Objetivos Específicos: Determinar la casuística de los Hematomas Epidurales, Subdurales (agudos, subagudos, crónicos), Contusiones Hemorrágicas, hematomas mixtos; y el resultado de las Intervenciones Quirúrgicas efectuadas para su tratamiento. Resultados.- Las Clases de Hematomas Intracraneanos Traumáticos encontrados son: Los Hematomas Subdurales Crónico en un 34 por ciento, Hematomas Epidurales 25.6 por ciento, Contusiones Intracerebrales un 12.3 por ciento, Hematomas Mixtos 11.6 por ciento, Hematomas Subdurales Subagudos con un 11.4 por ciento, y Hematomas Subdurales Agudos con un 5 por ciento de los casos...

Introduction: Traumatic Intracranial hematomas are the most common area of Neurotrauma Neurosurgery specializing in pathology, these bruises are primary lesions that occur as a direct result of head trauma, on which the doctor does not have any control, it is they say are inevitable, treatment is essential to save the lives of those affected. Different kinds of hematomas require different operations; know the type of surgery it allows standardize the management of these cases and mainly reduce the morbidity and mortality of patients. Method: Descriptive, observational, cross-sectional and retrospective study. The medical records of 457 patients who underwent surgery with diagnosis of Traumatic intracranial hematomas in the Neurosurgery Service at National Hospital Dos de Mayo, in the period January 2008 to December 2013. Through the data collection sheet were reviewed information has been obtained and was processed statistically using SPSS version 22.0 programs like. General Objective: To determine the Class of Traumatic intracranial hematomas that were presented and the results of the different types of surgery performed for treatment in the study period Specific. Objectives: To determine the casuistry of epidural hematoma, Subdural (acute, subacute, chronic), hemorrhagic contusions, mixed hematomas; and the outcome of surgical procedures performed for treatment. Results: Classes Traumatic intracranial hematomas are found: Chronic subdural hematomas 34 per cent, 25.6 per cent Epidural hematoma, intracerebral contusions 12.3 per cent, 11.6 per cent Mixed hematomas, Subacute subdural hematomas with 11.4 per cent, and Acute subdural hematomas 5 per cent of cases. We should mention the casuistry of Bilateral Traumatic intracranial hematomas in this study was 14.6 per cent of 457 cases. The type of surgery depended mainly on the type and location of hematoma, Epidural hematomas in craniotomy was performed primarily, chronic subdural hematomas in and subacute...

Late-onset social anxiety disorder following traumatic brain injury.

BACKGROUND: Neuropsychiatric sequelae are the predominant long-term disability after traumatic brain injury (TBI). This study reports a case of late-onset social anxiety disorder (SAD) following TBI. CASE REPORT: A patient that was spontaneous and extroverted up to 18-years-old started to exhibit significant social anxiety symptoms. These symptoms became progressively worse and he sought treatment at age 21. He had a previous history of traumatic brain injury (TBI) at age 17. Neuroimaging investigations (CT, SPECT and MRI) showed a bony protuberance on the left frontal bone, with mass effect on the left frontal lobe. He had no neurological signs or symptoms. The patient underwent neurosurgery with gross total resection of the lesion and the pathological examination was compatible with intradiploic haematoma. CONCLUSIONS: Psychiatric symptoms may be the only findings in the initial manifestation of slowly growing extra-axial space-occupying lesions that compress the frontal lobe from the outside. Focal neurological symptoms may occur only when the lesion becomes large. This case report underscores the need for careful exclusion of general medical conditions and TBI history in cases of late-onset SAD and may also contribute to the elucidation of the neurobiology of this disorder.

Factores que influyen en la evolución de los pacientes con contusiones cerebrales en el Hospital María Auxiliadora. Lima - Perú 2008 - 2009 / Factors that influence in the evolution of the patients with cerebral contusions at the Hospital Maria Auxiliadora. Lima - Peru 2008 - 2009

Objetivo: Identificar y evaluar variables clínicas, tomográficas y laboratoriales que influyen en el pronóstico de los pacientes con contusiones cerebrales. Métodos: Se realizó un estudio descriptivo, observacional, longitudinal y retrospectivo; donde se seleccionó una muestra de 45 pacientes que ingresaron por emergencia desde enero del 2008 a Abril del 2009. Se evaluaron factores clínicos, tomográficos y laboratoriales y para el pronóstico la condición al egreso de los pacientes con contusión cerebral. Se utilizó según las variables pruebas de Chi cuadrado, T de Student o varianza, pruebas no paramétricas; así como, análisis de regresión logística determinando factores asociados al pronóstico. Resultados: 71.1 por ciento son varones, entre las edades de 25 a 58 años con media de 40 años. La causa principal fue los accidentes de tránsito. Los 3 mejores predictores de que el paciente tenga una mala condición al egreso dentro de las variables tomográficas son 2: la desviación de la línea media y el incremento en el grado de severidad según la escala de Marshall y el tercer predictor es la condición de ingreso a UCI, es decir con mayor gravedad clínica. Conclusiones: El modelo reafirma la importancia de la valoración global, clínica, laboratorial y tomográfica de este tipo de pacientes categorizando las variables más importantes que se relacionan con una condición final mala; siendo la desviación de la línea media que multiplica esta probabilidad en 1.4 veces por cada milímetro de desviación, el incremento de un grado menor a uno mayor en la escala de Marshall multiplica la probabilidad en 2.2, y los pacientes que ingresaron a UCI que son los más graves, multiplicaron su probabilidad de peor pronóstico en 16.5 veces.

Value of repeat cranial computed tomography in pediatric patients sustaining moderate to severe traumatic brain injury.

BACKGROUND: Repeat head computed tomography (CT) is standard practice for traumatic brain injury (TBI) at many centers. The few studies available in children remain unclear over the value of repeat CT within 24 hours to 48 hours of lesion in such patients. The purpose of the present study was to assess the value of repeat cranial CT in children presenting moderate or severe TBI. METHODS: A retrospective study performed within a pediatric intensive care unit between January 2000 and December 2006. All patients with moderate and severe TBI who survived the first 24 hours after admission were included. Clinical data collected included age, lesion mechanism, time between first and second CTs, disease severity score at admission, and Glasgow Coma Scale (GCS) both at admission and day of repeat CT. RESULTS: A total of 63 children were assessed whose mean age was 72 months (48-112). The time between the first and the second CT scans averaged 25.78 hours +/- 13.75 hours (range, 6-48 hours). The reasons for ordering repeat CT scans were divided as follows: follow-up (78%), neurologic deterioration (20.4%), and increased intracranial pressure (1.6%). The change on the follow-up CT scan was compared with the GCS score. The GCS score was improved in 66.6% of patients, remained the same in 15.9%, and worsened in 17.5%. The appearance on the CT scans was better, the same or worse in 41.3%, 34.9%, and 23.8% of patients, respectively. There was a significant association between GCS and changes in findings on repeat CT (OR = 34.5, confidence interval [5.98-199.04], p = 0.000009). The positive and negative predictive values were 82% and 89%, respectively. One patient with a worsened GCS required surgical intervention based on the repeat CT scan. CONCLUSION: An unchanged or improving neurologic examination in children sustaining moderate or severe TBI who are appropriately monitored may be adequate to exclude the possibility of neurosurgical intervention and, hence, repeat head CT scan.

Tratamento das lesões focais intracranianas no traumatismo craniencefálico / Treatmento of focal intracranial lesions in cranioencephalic traumatism

O traumatismo craniencefálico pode resultar em lesões intracranianas difusas ou focais, representando afecções traumatoógicas graves, em parte necessitando de atendimento e conduta neurocirúrgica de emergência. As principais lesões focais de indicação cirúrgica são os hematomas epidurais, os hematomas subdurais agudos e as contusões cerebrais. Há ainda controvérsias sobre o tratamento em muitas situações. Os autores realizaram revisão da literatura descrevendo os princípios do tratamento cirúrgico de lesões focais secundárias ao trauma de crânio.

Head trauma presents in some cases, intracranial lesions, diffuse and focal. The more important lesions are acute epidural hematoma, subdural hematoma and brain contusions. There is controversy about the surgical treatment. In this study, the authors describe a critical review of literature about principles for surgical management for focal lesions by head trauma.