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BACKGROUND: Reversible cerebral vasoconstriction syndrome is a disease whose incidence is unknown, in which segmental and reversible vasoconstriction of the cerebral arteries occurs, and is characterized by severe thunderclap headache, which may or may not be accompanied by neurological deficit. CLINICAL CASE: A 52-year-old female patient, with a history of 2 pregnancies and 2 deliveries and recent onset of climacteric, with dysregulation of the menstrual cycle and obesity. She presented a headache of 4 days of evolution, of severe intensity, palpitations, photophobia, sweating, nausea and vomiting. The neurological examination did not reveal any neurological deficit. Brain CT showed right fronto-parietal subarachnoid hemorrhage. The arteriography revealed multiple segmental stenosis in all vascular territories. During her admission, nimodipine was administered, and controls were performed with transcranial echo-Doppler, showing favorable clinical evolution. CONCLUSIONS: Reversible cerebral vasoconstriction syndrome constitutes a diagnostic challenge, given the different forms of presentation and the different causes and factors that can trigger it. The mechanisms involved in its production are partly unknown; however, within the reported associations it has been suggested that sex hormones play an important role in its pathogenesis, but more scientific evidence is needed to clarify this association. [ABSTRACT FROM AUTHOR]

Copyright of INSPILIP. Revista Ecuatoriana de Ciencia, Tecnología e Innovacion en Salud Pública is the property of Instituto Nacional de Investigacion en Salud Publica (INSPI) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Neurológica Colombiana is the property of Colombian Association of Neurology / Asociacion Colombiana de Neurologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: the spontaneous subarachnoid hemorrhage’s health importance, it’s recognized as a health problem. Objective: to determine the behavior of some indicators related to medical care for patients with spontaneous subarachnoid hemorrhage, in the provincial context. Methods: Observational, descriptive-correlational and retrospective study of 96 patients with spontaneous subarachnoid hemorrhage between 2016 and 2021. The behavior of selected indicators was analyzed in relation to various variables. In the statistical analysis, the Odds Ratio and its confidence interval were used as statisticians. Results: 22% of the patients were diagnosed after the first 48 hours after the onset of symptoms, while 13 patients (14%) required more than one assistance for diagnosis. The occurrence of late diagnosis when bleeding was not identified at the first visit was significant (OR 21.8[5.1;91.8]). Twelve patients were admitted outside of specialized units; this situation was observed more in patients under 60 years of age (21% vs 4%; OR 5.7[1.1;27.9]), and in whom the diagnosis was made 48 hours after the onset of manifestations (29% vs 8%; OR 4.6[1.3;16.2]). Of the 35 patients transferred to another institution for neurosurgical treatment, only four (12%) were evacuated in the first 72 hours. Conclusions: gaps are identified in the patients’ care with subarachnoid hemorrhage in the provincial context; The admission of patients outside specialized units and the late transfer to institutions with neurovascular surgery service stand out. [ABSTRACT FROM AUTHOR]

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: the spontaneous subarachnoid hemorrhage is the extravasation of blood into the subarachnoid spaces, its most frequent cause is the rupture of an intracranial aneurysm. Objective: to characterize clinically and epidemiologically and anatomopathologically the spontaneous subarachnoid hemorrhage in the "Arnaldo Milián Castro" Hospital during 2018. Methods: a descriptive observational study was carried out, of retrospective longitudinal cut, in the period from January to December 2018. The sample to be studied consisted of 32 patients. Results: the most affected sex was female (19, 59.4%), the predominant cause was aneurysmal (17, 53.1%), followed by arterial hypertension (18.8%), vasospasm (34.4%) and endocranial hypertension (21.9%). Conclusions: the most affected sex was female and, in relation to age, the 60 to 69 years age group was more predominant. The predominance of aneurysmal causes was determined, followed by those secondary to arterial hypertension, and the most frequently affected arteries were the middle cerebral and posterior communicating arteries. The most frequent complications were rebleeding and endocranial hypertension. The majority of patients had a fatal outcome and the aneurysmal cause predominated according to the anatomopathological report. [ABSTRACT FROM AUTHOR]

Objective: To determine the associated factors with the appearance of electrocardiographic alterations in patients with aneurysmal subarachnoid hemorrhage. Methods: An observational, descriptive and retrospective study was carried out with 89 patients admitted to the Stroke Unit, at "Hermanos Ameijeiras" Clinical- Surgical Hospital. They were diagnosed with aneurysmal subarachnoid hemorrhage and electrocardiographic abnormalities. The study period was from January 2013 to January 2018. The variables analyzed were age, sex, skin color, personal medical history, score according to the Glasgow Coma Scale and graduation according to the World Federation of Neurological Surgeons scale, plasma sodium levels and potassium, the location of the bleeding and intensity according to the Fisher scale, the location and size of the aneurysm, the presence or absence of neurological complications, the type of electrocardiographic alteration and clinical repercussion. For the analysis of the data, the calculation of absolute and relative frequencies was carried out, measures of central tendency (mean) and dispersion (range) were applied. Results: The most significant variable, from all those analyzed, were the type of electrocardiographic alteration and the clinical repercussion of these electrocardiographic alterations. The most frequent electrocardiographic alterations were QT interval prolongation (18.0%), sinus bradycardia (15.7%) and sinus tachycardia (14.6%), and the electrical changes in any of the patients showed clinical repercussion. The factors with statistical association to the appearance of electrocardiographic alterations were electrolyte imbalance (natremia p= 0.040; potassium p= 0.002), the behavior of bleeding according to the Fisher scale (p= 0.006), rebleeding (p= 0.032), and personal medical history of atrial fibrillation (p= 0.002) or ischemic heart disease (p= 0.034). Conclusions: Electrolyte imbalance, behavior of bleeding according to the Fisher scale, rebleeding and personal pathological history of atrial fibrillation and ischemic heart disease were the factors associated with the appearance of cardiac electrical changes in our series of patients. [ABSTRACT FROM AUTHOR]

Copyright of Universidad Médica Pinareña is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To determine the incidence of stroke, overall and by sub-types, in Peru between 2017 and 2018. Materials and Methods: Analysis of hospital morbidity data obtained from SUSALUD (open data). Using the ICD-10 codes, the following were studied: subarachnoid hemorrhage (I60), atraumatic intracerebral hemorrhage (I61), cerebral infarction (I63), and unspecified stroke (I64). The crude and age-standardized incidence was calculated according to the population of the World Health Organization and using the national projected population number of people according to year, age and sex as the denominator. Results: In 2017, a total of 10,570 stroke cases were recorded, whereas, in 2018, there were 12,835 cases. Ischemic events were more frequent in both years. Regardless of stroke subtype and year, men were more affected than women. In the 35+ year-old population, an increase in the crude incidence of total stroke was observed between 2017 and 2018, from 80.9 to 96.7 per 100,000 person-years. The age-standardized incidence showed the same trend, but in a greater magnitude: from 93.9 to 109.8 per 100,000 person-years. Ischemic stroke was the one that increased the most, with an age-standardized rate in people aged 35+ years of 35.2 in 2017 and 46.3 per 100,000 person-years in 2018. Conclusions: The incidence of stroke is high in Peru. Ischemic cases are the most frequent and they disproportionately affect men. Our results suggest the need for a surveillance system to robustly quantify the incidence of these cases and understand their determinants. [ABSTRACT FROM AUTHOR]

Antecedentes: La hemorragia subaracnoidea aneurismática (HSAa) representa el 5% de las enfermedades cerebrovasculares con un elevado índice de mortalidad y discapacidad. Aún no existen biomarcadores estandarizados que apoyen al neurocirujano a definir el mejor manejo con base en el pronóstico. Respecto a parámetros hormonales se ha reportado hipopituitarismo dependiente de hormona del crecimiento (GH) posterior al ictus, pero no queda dilucidada una asociación con el desenlace de la HSAa. Objetivo: Evaluar la relación de la concentración sérica de hormonas con el desenlace clínico de la HSAa. Métodos: Análisis secundario del protocolo 42/19. Estudio prospectivo, observacional y analítico. Todo paciente ingresado al Servicio de Urgencias del Instituto Nacional de Neurología y Neurocirugía con diagnóstico de HSAa fue incluido, tomando una muestra de sangre a su llegada para medir hormonas séricas. El desenlace clínico fue evaluado utilizando la escala Glasgow Outcome Scale (GOS) a su egreso, clasificándolo en desfavorable (puntuación 1 - 2) o favorable (puntuación 3 - 5). También se registraron la incidencia del vasoespasmo cerebral tardío, datos demográficos, escalas clínico-radiológicas y laboratorios prequirúrgicos. Se realizaron pruebas de estadística descriptiva, normalidad y un análisis bivariado con SPSS 25. Resultados: Se incluyeron 58 pacientes. La edad media fue de 53.84 años, con predominio del sexo femenino. La mayoría de los pacientes fueron clasificados como Hunt-Hess III, Fisher IV, WFNS I. Se encontró vasoespasmo en 34% de los casos y de estos, el 40% fue severo. La principal ubicación de los aneurismas fue en la ACM. El 76% de los pacientes tuvo un desenlace favorable. El tiempo transcurrido hasta la cirugía fue mayor en el grupo con desenlace favorable. Aquellos que tuvieron un desenlace desfavorable reportaron comparativamente menores niveles séricos de GH y linfocitos, pero mayor conteo de leucocitos totales, neutrófilos e índice neutrófilos/linfocitos (INL). El resto de hormonas analizadas no reportaron una diferencia significativa entre ambos grupos. Los resultados se resumen en la Tabla 1. Conclusiones: La GH sérica, el INL y el conteo de linfocitos y neutrófilos al ingreso hospitalario podrían ser biomarcadores útiles para predecir el desenlace de la HSAa en nuestra población. No obstante, es necesario ampliar el tamaño de la muestra para poder aplicar un análisis multivariado y determinar los predictores independientes del desenlace. [ABSTRACT FROM AUTHOR]

Copyright of Surgical Neurology International is the property of Scientific Scholar LLC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of CES Medicina is the property of Universidad CES and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Intracranial aneurysms are cerebral vascular anomalies with an approximate global prevalence of 2 to 3% and are the main cause of non-traumatic subarachnoid hemorrhage. Diagnosis and preventive treatment of this entity can considerably reduce morbidity and mortality. With the advent of new devices for cerebral endovascular therapy such as flow diverters, the patient now has the option of choosing a less invasive procedure, which does not require conventional surgery. This represents a significant reduction in the number of days of in hospital stay and recovery. The procedure has showed a high degree of security. The endovascular treatment for intracranial aneurysms has evolved substantially in the last two decades, and has become the treatment of choice. Case report: Case 1: A 62-year-old male was admitted in the hospital after a moderate cranioencephalic trauma with transient loss of conscious and a holocranial headache. A cerebral angiography was performed to rule out subarachnoid hemorrhage. The angiography showed an intracranial aneurysm. It was localized in left internal carotid-posterior communicating artery. The measures were of 4mm X 3mm with a 3mm neck. The treatment was performed with a pipeline flow-diverting device, as well as an angiographic control 3 months after the treatment with a satisfactory evolution. Case 2: A 59-year-old female patient with facial hemiparesis and ipsilateral arm, that showed a gradual increase in intensity and duration. A magnetic resonance study protocol was initiated and an intracranial aneurysm was observed in the communicating segment of the right internal carotid artery. The diameter of the aneurysmal sac was of 15 mm and also, a contralateral of 8 mm. Placement of a flow-diverting device was programmed. Conclusion: The use of flow-diverting devices is an excellent alternative for the treatment of incidental intracranial aneurysms, with important cost-effectiveness advantages, surgical time, hospital stay and recovery reduction. In addition to having a recovery percentage of 95% in 5 years. [ABSTRACT FROM AUTHOR]

Objective: To describe the diagnosis and management of a case of subarachnoid haemorrhage secondary to arterial cerebral aneurysm during the first half of gestation. Materials and methods: A 26-year-old woman during a second pregnancy, with no prior miscarriages, and one previous cesarean section seen at a maternal and perinatal care referral centre located in Quito, Ecuador, with a diagnosis of subarachnoid haemorrhage at seventeen weeks of pregnancy. Cerebral pan-angiography showed a wide-neck cerebral aneurysm of the anterior temporal artery with bleeding. Results: Treatment was performed using endovascular stenting and coiling. Later, the patient required dual anti-platelet therapy with clopidogrel and acetylsalicylic acid, maintained up to a week before delivery. Elective cesarean section was performed and the patient was delivered of a healthy baby at 37.2 weeks of gestation. Conclusion: Endovascular treatment with the use of micro-coils, associated with anti-platelet aggregation therapy is an option to consider in pregnant women during the first half of gestation. Further clinical studies are needed in order to identify more fundamental therapeutic approaches for the management of these cases. [ABSTRACT FROM AUTHOR]

Background: Paraclinoid aneurysms arise from C5 clinoid segment and C6 ophthalmic segment, within the internal carotid artery. Brain aneurysms have a frequency ranging from 5 to 11 %. A successful surgery requires knowledge of the anatomic region and the aneurysm. The objective was to show the surgical management of paraclinoid aneurysms. Methods: From January 2009 to January 2015, we carried out a retrospective study in the Neurosurgery Department at Centro Médico Nacional Siglo XXI. We included 66 patients with the diagnosis of paraclinoid aneurysm. We obtained the clinical characteristics, evolution, complications, and outcomes from the clinical and radiological records. Results: 61 patients (92.4 %) were female; 65 underwent neurosurgical clipping, and one underwent cerebral bypass surgery with exclusion of the aneurysm. Forty six patients presented subarachnoid hemorrhage due to aneurysmal rupture. By reason of their location, 35 paraclinoid aneurysms (53 %) were superior, 20 medial (30.3 %) and 4 inferior (6 %). Thirty three patients had small aneurysms, 23 large aneurysms, and 10 patients presented giant aneurysms. After surgery, 51 patients had good results, since they scored 4 and 5 in the Glasgow Outcome Score. Three patients presented amaurosis as a surgery-related complication. Conclusion: Microsurgical management is still the best treatment for these aneurysms, due to its ability to exclude them entirely; besides, is the best method to decompress the optic nerve. [ABSTRACT FROM AUTHOR]

Objective: To determine poor prognosis factors in patients with spontaneous subarachnoid hemorrhage admitted to the Hospital Manuel Ascunce Domenech during the period January 2014 to July 2015. Methods: A prospective observational study was conducted. The universe was composed of 35 patients diagnosed with subarachnoid hemorrhage delimited by the inclusion and exclusion criteria. The sample was consistent with the universe. For statistical analysis were used: number and percentage, univariate and multivariate strategies. Results: Female sex, ages between 44 and 56 years, patients with initial grade II clinical status (Hunt and Hess Scale) and grade II according to Fisher scale of tomographic predominate. Aneurysm was the most frequent cause. It was detected a prevalence of nosocomial bronchopneumonia, phlebitis, rebleeding and cerebral vasospasm. 18 patients have favorable outcome and 17 suffered unfavorable evolution. Conclusions: Poor prognostic were factors clinical status at admission grade III-IV-V according to Hunt and Hess scale and rebleeding. Determination of prognostic factor are limited due simple heterogeneity, regional variations in management, statistic bias, and different point of views about assessment and prognosis scales. [ABSTRACT FROM AUTHOR]

Subarachnoid haemorrhage (SAH) is one of the greatest injuries that can suffer any individual. It is defined as the occupation or invasion by blood of the subarachnoid space, in which normally circulates cerebrospinal fluid (CSF), or an intracranial haemorrhage that extends into this space. This review is aimed to summarize the current knowledge on this entity. [ABSTRACT FROM AUTHOR]

The subarachnoid space, located between the pia mater and the arachnoid membrane, is divided by trabeculae which in turn form cisterns, containing vascular and nervous structures; when they are damaged, as in the case of an aneurysmatic rupture, the hematic content is distributed in the cisterns peripheral to the affected arterial territory. The study of such cisterns was first described in 1875 by Key and Retzius, and one hundred years later was adapted and confirmed in microsurgery by Yasargil. Objective: Prove that anatomical knowledge of the circle of Willis and basal cisterns, associated with an emergency single-phase computed tomography, helps to identify the probable site of lesion. Material and methods: Twenty-eight clinical and radiological files of patients with subarachnoid hemorrhage who underwent single-phase tomography and then digital subtraction pan-angiography to identify the site of lesion (in the period from March 2013 through May 2015) were examined. Three patients in whom the site of lesion could not be defined were excluded. Results: Fischer grade 2 hemorrhage was found in 5 cases, and grades 3 and 4 in 10 patients. The most extensively affected basal cisterns were the Sylvian cisterns, which suggests that the affected vascular territory was in the terminal segments of the internal carotid artery. Other anatomical sites corresponding to the anterior cerebral artery affected the straight gyrus recto and the adjacent interhemispheric subarachnoid space. The affected perimesencephalic cisterns corresponded to the posterior circulation. This localization was achieved by digital subtraction angiography. Discussion: In subarachnoid hemorrhage it is important to know the system of cisterns and their communication because it helps to identify the affected vascular region, in an emergency single-phase tomography, to ensure correct evaluation and appropriate treatment. [ABSTRACT FROM AUTHOR]

Introduction: The rupture of an intracranial aneurysm is a vital emergency. Both surgical and endovascular approach are valid therapeutic options in this situation. Objective: To evaluate the outcomes of endovascular approach of ruptured and unruptured intracranial aneurysms in ten years of experience. Methods: We analyzed all patients diagnosed and treated intracranial aneurysm using an endovascular approach in our center for ten years, from 2003 to 2012. Results: A total of 45 unruptured cerebral aneurysms in 38 patients and 106 ruptured aneurysms were embolized; a total of 151 cerebral aneurysms in 144 patients. In all, 89 were women (61.5%) and 55 men (38.5%). The mean age of the patients was 55.5±4.4 years. In patients treated of ruptured aneurysms the time of stay in ICU was significantly higher than in patients treated of unruptured aneurysm (10.4 vs 1.6 days; p<0.001). Complications occurred in the first 24 hours since the procedure were dominant in the group of patients treated of ruptured aneurysms (2.2% vs 35.8%; p <0.001). In all, 97.8% of patients treated of unruptured aneurysm and 72.6% of those treated of ruptured aneurysm were independent for basic activities of daily living one year after the procedure. Conclusions: Patients with unruptured cerebral aneurysms treated by endovascular approach presented few complications and an early recovery. Patients with ruptured as well as unruptured cerebral aneurysms achieved a high proportion of independence for daily living activities after one year. [ABSTRACT FROM AUTHOR]

Objective: To assess basal characteristics and surgical outcome in patients with aneurismatic subarachnoid hemorrhage managed with one dynamic protocol based mostly on transcranial Doppler ultrasound. Methods: A descriptive longitudinal study was carried out in 233 patients with aneurismatic subarachnoid hemorrhages, who received neurosurgical clipping in the years 2006Â-2010 and were followed during one year. Results: Mean age was 49.19 years. Female were 66%. At the admission, 58.4% of cases were in grade 1 according to the modified scale of World Federation of Neurosurgical Societies (WFNS). Preoperatively 69.5% of patients become grade 1. Patients were mostly Fisher 3 according to CT scan results, and this was statistically associated with vasospasm. Angiographic vasospasm was present in 28.8% of the cases, but increased to 49.4% by using transcranial Doppler. In 25.8% of cases vasospasm was symptomatic, and 15.9% develop delayed ischemic deficit. Single aneurysms on the anterior Willis circle were most relevant statistically and accounted for 73.4% of the cases. Aneurysms were mostly of relatively small size, and in 79.4% of the patients they ranged between 4 and 10 mm. Outcome was favorable in 93%, and mortality was 4.29%. Outcome was significant associated with: neurological status at the admission, Fisher scale, numbers of aneurysms, vasospasm, and reÂ-bleeding. Most frequents surgical and medical complications were vasospasm, reÂ-bleeding, cerebral infarct urinary infection, hydrocephalus and intraoperative rupture. Conclusions: Compared with several series from specialized literature, outcome in this series was good. These suggest the utility of one dynamic protocol based on transcranial Doppler in patients with aneurismatic subarachnoid hemorrhage. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medicina is the property of Revista Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To review the recent aspects about epidemiology, related factors, physiopathology and treatment in rebleeding associated with aneurismatic subarachnoid haemorrhage. Development: Rebleeding is the most important cause of morbidity and mortality in patients with aneurismatic subarachnoid haemorrhage. There are factors associated with increase of this complication in many studies: systolic hypertension (more than 160 mm Hg), poor clinical condition at symptoms onset, intracerebral hematoma, size of the aneurism and sentinel headache. The main physiopathology mechanisms related are transmural pressure, fibrinolysis and coagulation system disorders. The administration of antifibrinolitic treatment in the first three days of subaracnoidea haemorrhage had been show decrease of rebleeding rate, also associated with the early surgery (conventional or endovascular). Conclusions: Some factors are related with rebleeding, but are not clear the causal effect of them. The early surgery and short antifibrinolitic therapy had been the most useful treatment to prevent aneurismatic rebleeding. [ABSTRACT FROM AUTHOR]

Objective: To evaluate clinical and outcome characteristics of patients with rebleeding after aneurismatic subarachnoid hemorrhage. Methods: An observational, retrospective cohort study was made, in patients treated by subarachnoid hemorrhage at the Hermanos Ameijeiras s Hospital, in Havana City, Cuba, since October 2005 until December 2012. Results: The more frequent location of the aneurism was the posterior communicant artery, followed by the anterior communicant. There was a significant association in patients with history of arterial hypertension (p=0.011), with an increase of the mortality (Rankin 6, p=0.000). In patients with subarachnoid rebleeding most aneurism were located in anterior circulation arteries (52/88.1 % of 59), mainly in anterior communicant artery (25/42.4 %) followed by posterior communicant artery (16/27.1 %). In non-rebleeding group the aneurisms were located mainly in carotid sector (96.5 %) and more frequent in posterior communicant artery (84/36.7 %) followed by anterior communicant artery (67/29.2 %). The surgical treatment was delayed in patients with rebleeding (16.6 days), compare with the other group of patients (12.2 days), but the difference was not significant (p=0.085). Conclusions: Patients with rebleeding after aneurismatic subarachnoid hemorrhage was characterized by arterial hypertension s history, higher mortality, disability and assistance in intensive unit service. [ABSTRACT FROM AUTHOR]

Objective: To asses surgical results in patients with anterior circulation intracranial aneurysms treated by two different approaches, the supraorbital keyhole and pterional craniotomy. Methods: A non-randomized surgical trial was carried out in which the patients was assigned to KHSO group if the approach selected was supraorbital Keyhole or CPT group if the approach was pterional craniotomy. Results: 125 cases were studied, 77 (61.60 %) in KHSO group and 48 (38.40 %) in CPT group. 153 aneurysmal sacs were treated, 93 in KHSO group and 60 in CPT group, 119 rupture (77.77 %) and 34 without rupture (22.23 %). Conclusions: There were no significant differences between the two groups. The supraorbital Keyhole is an alternative option in surgical treatment of anterior circulation intracranial aneurysms. [ABSTRACT FROM AUTHOR]

Objective. To determine the correlation of the findings of the three-dimensional angiography with post operative diagnosis in patients with cerebral aneurysm attending emergency of the Hospital Obrero #2 in the period from January 2 010 to December 2 013. Metodos: do a study retrospective, tranverse, descriptive type with a quantitative approach, counting with a universe of 100 patients of whom 30 patients who met the inclusion and exclusion criteria were chosen with a intentional non-probability sampling. Results: in those 30 cases the age group that showed higher frequency of aneurysmal rupture was 50-59 years old representing 33%, with 58years old as high peak. The most affected was the female gender with 73% (n = 22). According to clinical evaluation with scale Hund and Hess the most representative of the study was the Grade II level with a percentage of 40% (n = 12) .The Scale of Fisher found in greater proportion was Grade II with 40 % (n = 12) .The Angiotomograffas characteristics of aneurysms most frequently found are: aneurysm sac size 10 -25 mm (n = 23) of the aneurysm neck size: more than 4 mm: 77% (n = 23 ) Relationship neck / sac 1/3 -1 (n = 22); Saccular sac morphology: 97% (n = 29); Aneurysm location: supraclinoid carotid segment 33% (n = 10); A good correlation of 30 patients between the tomographic diagnosis in size, shape and post operative findings was found, however only one variant was found in terms of location: it was described on CT which was located in Segment clinoid C5 and postoperative communicating segment C in July. Conclusions: In this study, a good correlation between the diagnosis and postoperative angiotomography. was found to be diagnosed 100% of our patients, with only one variation, regarding the location. We believe that allowed carrying out timely surgical treatment in patients with SAH admitted to our hospital. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medicina is the property of Revista Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 55-yr-old woman was taken to the hospital after recovering from a presyncopal episode. The electrocardiogram showed sinus bradycardia with QTc interval of 840 msec. Few minutes later, the patient developed a polymorphic ventricular tachycardia and subsequent cardiac arrest requiring cardiopulmonary resuscitation. A week later she presented with severe headache, seizures and decerebrate movements. Cranial computed tomography scan showed subarachnoid hemorrhage with intracranial hypertension requiring decompressive craniectomy. On the follow- up the electrocardiograms always showed prolonged QTc interval, without any new arrhythmic event. The patient's clinical course was unfavorable and required maximum dose of vasoactive drugs. She died 13 days after admission. [ABSTRACT FROM AUTHOR]

Copyright of Revista Médica de Risaralda is the property of Universidad Tecnologica de Pereira and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Transcranial Doppler (TCD) is an essential test for vasospasm monitoring in Subarachnoid hemorrhage (SAH). Objective: To describe the results of TCD examination in a cohort of good grades SAH patients managed in Stroke Unit. Methods: From a total of 204 patients with spontaneous SAH admitted to Stroke Unit, 155 were selected for the study, because they had a contrasted neurovascular investigation, as well as TCD follow-up examination. Disease severity was evaluated with Fisher's scale and World Federation of Neurological Surgeon scale. Results: The men age was 48.4 years, there was a female predominance and the majority of patients had aneurismal etiology. Angiographic vasospasm was present in 21.9% of cases, anterior cerebral arteries was the most affected vessel. Temporal windows were not useful in 14.8% of cases. The highest values of mean flow velocity were detected between the days nine and ten. There was an inverse relationship between flow velocity and age. Symptomatic vasospasm occurred in patients with the highest velocities on TCD examination and vasospasm was detected on the contrasted neurovascular investigation. Conclusions: The absence of temporal window limits the utility of TCD examination. TCD match with neurovascular investigations in more than 60% of cases. In patients with cerebral infarcts secondary to symptomatic vasospasm the mean flow velocity was above 150 cm/s in middle cerebral artery and above 90 cm/s in anterior cerebral artery. [ABSTRACT FROM AUTHOR]

Cerebrovascular Disease (CVD) is a public health problem. According to World Health Organization, stroke is the second leading cause of overall death (9.7%), of which 4.95 million occur in countries with low and middle income. The rate of recurrence at two years, ranges from10 to 22%, but it can be reduced by up to 80%, with the modification of risk factors. In the absence of appropriate preventive interventions, it is estimated that by 2030, its incidence will increase up to 44%.4 Data from the ministry of health of Mexico show that in our country stroke mortality rate has increased from the year 2000, particularly in adults younger than 65. In 2007 the total number of discharges in public hospitals 1% was attributed to stroke, while in 2008 the mortality rate was 28.3/100,000. The present review addresses the most relevant aspects of the main types of stroke, ischemia, intracerebral hemorrhage and subarachnoid hemorrhage. [ABSTRACT FROM AUTHOR]

Introduction: Transcranial Doppler (TCD) is an essential test for vasospasm monitoring in Subarachnoid hemorrhage (SAH). Objective: To describe the results of TCD examination in a cohort of good grades SAH patients managed in Stroke Unit. Methods: From a total of 204 patients with spontaneous SAH admitted to Stroke Unit, 155 were selected for the study, because they had a contrasted neurovascular investigation, as well as TCD follow-up examination. Disease severity was evaluated with Fisher's scale and World Federation of Neurological Surgeon scale. Results: The men age was 48.4 years, there was a female predominance and the majority of patients had aneurismal etiology. Angiographic vasospasm was present in 21.9% of cases, anterior cerebral arteries was the most affected vessel. Temporal windows were not useful in 14.8% of cases. The highest values of mean flow velocity were detected between the days nine and ten. There was an inverse relationship between flow velocity and age. Symptomatic vasospasm occurred in patients with the highest velocities on TCD examination and vasospasm was detected on the contrasted neurovascular investigation. Conclusions: The absence of temporal window limits the utility of TCD examination. TCD match with neurovascular investigations in more than 60% of cases. In patients with cerebral infarcts secondary to symptomatic vasospasm the mean flow velocity was above 150 cm/s in middle cerebral artery and above 90 cm/s in anterior cerebral artery. [ABSTRACT FROM AUTHOR]

Objective: A literature review was carried out about the mainly and effective strategies stated for prevention and control of cerebrovascular diseases, and especially about stroke. Development: An assessment of the following strategies related with a greater impact in specific management of cerebrovascular diseases was conducted: 1) Stroke education, 2) Medical prevention, 3) Prehospital medical management system and stroke code, 4) Early diagnosis with brain and vascular imaging, 5) Stroke units, 6) Management by neurologist of stroke patients, 7) Intravenous thrombolysis in ischemic stroke, and 8) Specialization and regionalization of subarachnoid hemorrhage management. Also it was consider the need for potentiation of neurovascular clinical research and especially some possible clinical trials in stroke patients (Intravenous streptokinase for the treatment of ischemic stroke and recombinant human erythropoietin as a neuroprotective therapy in brain ischemia). Finally, is delineated the importance of statistical data vigilance of acute and chronic cerebrovascular disease: consequences, risk factors and repercussions of public health interventions. Conclusions: There is comprehensive information for assignation of more resources and implementation of sustainable strategies with effective impact in cerebrovascular diseases. Also is necessary one updated and approved national program or plan for prevention and control of cerebrovascular diseases. This organized healthcare system must be able to offer the needed care for each patient and optimizing the use of all resources. [ABSTRACT FROM AUTHOR]

Background and objectives: In spite that stroke has become a public health problem in Mexico, there are few information regarding several issues on stroke epidemiology. The main objectives of the present study were to determine, by means of a multicentric stroke registry, the prevalence of the stroke types, their vascular risk factors and the short-term outcome. Patients and methods: Prospective observational study of consecutive cases of stroke recruited in 25 hospitals (in 14 states of Mexico). The following information was obtained: demographic data, vascular risk factors, mechanisms and causes of stroke types, and clinical outcome. Descriptive statistical analysis (frequencies and medians) using χ² y Kruskal-Wallis for contrasting differences among stroke types. Resulted: We studied 2000 patients: women 55%, men 45% (p < 0.001) with median age of 64 years (IQR 49-75). Stroke types: tranient ischemic attack 5%, cerebral infarction 52%, intracerebral hemorrhage (ICH) 28%, subarachnoid hemorrhage (SAH) 12.0%, and cerebral venous thrombosis (CVT) 3.0%. Causes of cerebral infarct: atherosclerosis 14.7%, cardioembolism 24.7%, small vessel disease 19.4%, other 4.6%, undetermined 36.6%. Causes of ICH: hypertensive 67%, vascular malformations 7.8%, amiloid angiopaty 4%, hematologic disorders 4%, other 8%, undetermined 10%. Causes of SAH: aneurysm 86%, perimesencephalic 6%, other 2%, undetermined 6%. Causes CVT: puerperium/ pregnancy 47%, contraceptives agents 13%, other 17%, undetermined 23%. Short-term clinical outcome (30 days): Excellent recovery (Rankin 0/1) 41%; mild and moderate disability (R 2/3) 18%; severe disability (R 4/5) 20% and death 21%. Conclusions: Main mechanisms and causes of stroke in Mexico are described, revealing a higher frequency of ICH and CVT in Mexico than occidental countries. More than half of patients had poor outcome because they died or had some grade of disability. [ABSTRACT FROM AUTHOR]

Objective: A literature review was carried out of more relevant and refined elements about Subarachnoid hemorrhage (SAH) epidemiology, etiology, physiopathology and diagnosis. Development: SAH is a diagnostic challenge and includes complex, sophisticated, multidisciplinary, and rarely routinely procedures. The clinical suspicion of SAH is based in a sudden onset of very severe headache that peaks within minutes and lasts more than an hour. This patient must be urgently remitted for a hospital with at least CT scan equipment, neurosurgery service and dedicated intensive care unit. The first neurological study to make is CT scan without contrast enhancement, but negative results are not criteria for exclusion of SAH. When CT scan is negative we recommend that cases should be consulted with neurologist or neurosurgery specialist for lumbar puncture execution and results assessments. In this diagnostic protocol is essential an algorithm for urgently execution of standard angiography and/or CT angiography based in patient context and accessibility. Conclusions: The essentials points about incidence, risk factors, causes, physiopathology and diagnostic management of SAH was considered. The recommendations are a summary of best available evidence for diagnostic management of this stroke type. Nevertheless, some topics need more investigations because are controversial or received poor attention. [ABSTRACT FROM AUTHOR]

Objective: To identify the frequency of congenital anomalies located in Middle Cerebral Artery (MCA) in patients with aneurism in this vessel. Methods: The investigation was based on the evaluation of angiographic studies of 156 patients with Subarachnoid Hemorrhage admitted to Stroke Unit, in Hermanos Ameijeiras Hospital, between January 2006 and December 2008. Cerebral aneurysms were present in 118 patients, 31 aneurysms were localized in MCA in 27 patients. A total of 312 MCA were examined in 156 patients searching for the following MCA anomalies: duplication, hypoplasia or aplasia, accessory artery, fenestration, isolated branch and cuadrifurcation. Results: There were two cases with MCA anomalies in 31 MCA with aneurysms (6.5%), whereas the anomalies considered were not present in 281 non aneurysmal MCA examined. The abnormalities detected were duplication of MCA and fenestration of segment M1, both cases have a giant aneurysm of the affected MCA. Conclusions: Anomalies of MCA are very unusual, although can be associated with an aneurysm of the involved vessel. [ABSTRACT FROM AUTHOR]

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Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We report a female 40 years-old with familiar history; father death with cerebral hemorrhage at 42 year-old. Seven brother with blood hypertension, one sister with renal transplantation. She presented preeclampsia in last pregnant. 13 year before she was been treated of blood hypertensions. She presented nauseas, vomiting and intense cephalea and loss of alerting state until coma and died. Clip of the aneurysm was performed. The CT-scan showed subdural hemorrhage and multiple aneurysm. Abdominal CT-scan showed multiple renal cyst, renal calculi and hepatic cyst. We considerate the bloodhypertension was the cause of the aneurysm rupture. The association of polycystic kidney disease and cerebral aneurysms is rare, the subdural hemorrhage is cause of death in the majors of the cases. We report a rare case with these rare association. [ABSTRACT FROM AUTHOR]

Introduction: A comprehension of the normal anatomy of meninges and intracraneal spaces is crucial for neurosurgeons, neurologists and neuroradiologists dealing with diagnosis and treatment of a wide range of pathologies of the central nervous system. Material and method: For example, the distribution of blood within the cranial spaces (extradural, subdural or subarachnoidal hemorrhages) is highly dependent on the normal or pathologic anatomy of the three meningeal sheaths. Discusion and conclusions: In this report, the authors made an actualized interpretation of intracranial spaces, based in a literature review and the study of blocks of brain and meninges and chronic subdural hematoma capsules obtained at surgery. [ABSTRACT FROM AUTHOR]

Electrocardiographic abnormalities in patients with subarachnoid hemorrhage secondary to aneurysm rupture appear in 50% to 100% of cases. The most frequent electrocardiographic abnormalities are T wave deep positive, flat or inverted, T waves inverted associated with lengthening of the QT interval; positive or negative ST segment levels, prominent U waves, PR segment enlargement, acuminated P waves, pathologic Q waves and J wave. Other cardiac alterations include enzymatic elevation and ventricular arrhythmias. This paper addresses one case report and reviews current literature. [ABSTRACT FROM AUTHOR]

Non-traumatic subarachnoid hemorrhage (SAH) secondary to rupture of a cerebral aneurysm is an event associated with high mortality and morbidity. 85% of this SAH are due to intracranial aneurysm rupture, so early identification and localization is important to decrease the possibilities of vasospasm and rebleeding, with better management planning and execution. This is a descriptive study, analyzing radiological archives from September 2004 to July 2005 of a series of 9 patients with SAH .The accuracy of Angio CT was compared to an Angio DSA in patients with non-traumatic SAH. Results: When comparing Angio CT using Angio DSA as reference, the following data was obtained: Sensitivity: 80,0% CI (69,7-90,2%), Specificity: 66,6% CI (49,6-83,6%), PPV: 80% CI (69,7-90,2%, and a NPV: 66,6 CI (49,6-83,6%). Conclusions: Angio CT is a useful diagnostic method to diagnose cerebral aneurysms in our institution. [ABSTRACT FROM AUTHOR]