Search

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.)

Objetivo: Avaliar o papel da via de administração oral ou sonda nasoenteral de Nimodipino no desfecho de vasoespasmo (em 7 e 21 dias) em pacientes internados com hemorragia subaracnóidea aneurismática (HSA), além de analisar a incidência de mortalidade nesta população. Métodos: O estudo tem delineamento de coorte retrospectiva, com dados coletados em um hospital universitário de alta complexidade de Porto Alegre. O período analisado foi janeiro de 2019 e janeiro de 2023. Foram incluídos pacientes maiores de 18 anos, com diagnóstico de HSA e que realizaram, no mínimo, 7 dias de tratamento com nimodipino internados. Resultados: Um total de 121 pacientes foram incluídos no estudo, divididos entre: 59 pacientes que utilizaram o medicamento via oral e 62 que utilizaram via sonda nasoenteral, foi identificado potencial impacto do uso da via de administração (sonda nasoenteral) no aumento da incidência corrigida de vasoespasmo em 7 dias (RR=2,35; IC 95%: 1,01 - 5,46), em 21 dias (RR=2,40; IC 95%: 1,05 - 5,46) e também como fator possível para aumento da mortalidade corrigida (RR=5,74; IC 95%: 2,10 - 15,65). Conclusões: Esse é primeiro estudo dessa natureza, no contexto brasileiro ou latinoamericano, em que se comprova com dados de desfechos clínicos o impacto da via de administração de nimodipino no desfecho de vasoespasmo e mortalidade em pacientes com HSA. Os achados indicam fatores a serem considerados na prática clínica para desfechos de pacientes e demonstram a necessidade de estudos que correlacionam farmacocinética e os desfechos para concluir a questão.

Background There is very few data regarding homocysteine's influence on the formation and rupture of intracranial aneurysms.

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. 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: Aneurysms of the middle cerebral artery are usually responsible for intracranial bleeding and constitute a frequent location of aneurysms. Its close arterial and venous relationship in the Silvian cistern is accompanied by high complexity. Surgical clipping is highly effective. Objective: To describe the surgical results of middle cerebral artery aneurysms operated using microsurgical clipping. Method: A descriptive, prospective study was carried out that included 50 patients from the Hermanos Ameijeiras Hospital operated on for cerebral aneurysm of the middle cerebral artery using microsurgical clipping. A pterional and minipterional craniotomy and clipping of the aneurysm were performed. The variables studied were: clinical, cerebral aneurysm and postoperative with greater importance related to complications and the Glasgow Coma Scale for results. For data analysis, absolute and relative frequencies were used as summary measures. Results: There was a predominance of unruptured aneurysms (66.0%) of large size (42.0%) and located in the bifurcation of the middle cerebral artery (94.0%). Minipterional craniotomy was used in 74.0%. In relation to the main complications, vasospasm (8.0%), hydrocephalus (6.0%) and cerebral infarction (4.0%) were reported. According to the Glasgow Coma Scale for results, there was a greater presence of grade 5 (78.0%). Conclusions: Microsurgical clipping in patients with middle cerebral artery aneurysms is accompanied by total clipping and few postoperative complications.

Objective The present study aims to assess and compare the prognostic value of these two scales for predicting mortality.

Introducción: El manejo de los aneurismas cerebrales ha ido evolucionando con el paso de los siglos. En esta revisión se hace un resumen de cómo se ha desarrollado el manejo médico, endovascular y quirúrgico en el abordaje de estas patologías que causan una gran morbi-mortalidad en la población. Objetivo: Evaluar el manejo médico, endovascular y quirúrgico de los aneurismas cerebrales rotos y no rotos a lo largo del tiempo, desde las primeras veces en que fueron tratados hasta las innovaciones que se están llevando a cabo. Métodos: Se realizó una revisión de artículos buscados en la base de datos de PubMed, buscando Mesh Terms con palabras seleccionadas relacionadas al tema. Diseño de estudio: Revisión. Métodos: Selección de estudios con palabras clave de PubMed, y según consenso de todos los autores. Extracción de datos en Rayyan. Palabras claves: hemorragia subaracnoidea, aneurisma, neurocirugia, procedimientos endovasculares.

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.)

Fundamento: la importancia sanitaria de la hemorragia subaracnoidea espontánea, como problema de salud, es un hecho reconocido.Objetivo: determinar el comportamiento de algunos indicadores relacionados con la asistencia médica a pacientes con hemorragia subaracnoidea espontánea, en el contexto provincial.Métodos: estudio observacional, descriptivo-correlacional y retrospectivo, de 96 pacientes con hemorragia subaracnoidea espontánea entre 2016 y 2021. Se analizó el comportamiento de indicadores seleccionados, en su relación con diversas variables. En el análisis estadístico se utilizó como estadígrafo el Odds Ratio y su intervalo de confianza.Resultados: el 22 % de los pacientes fue diagnosticado pasadas las primeras 48 horas del inicio de los síntomas, mientras que 13 enfermos (14 %) requirieron más de una asistencia para el diagnóstico. La ocurrencia de diagnóstico tardío cuando no se identificó el sangramiento en la primera consulta fue significativa (OR 21,8[5,1;91,8]). Doce pacientes fueron admitidos fuera de unidades especializadas; esta situación se observó más en pacientes menores de 60 años (21% vs 4 %; OR 5,7[1,1;27,9]), y en quienes el diagnóstico se realizó después de las 48 horas del inicio de las manifestaciones (29 % vs 8 %; OR 4,6[1,3;16,2]). De los 35 pacientes trasladados a otra institución para tratamiento neuroquirúrgico solo cuatro (12 %) fueron evacuados en las primeras 72 horas.Conclusiones: se identifican brechas en la atención al paciente con hemorragia subaracnoidea en el contexto provincial; se destacan el ingreso de enfermos fuera de unidades especializadas y el traslado tardío a instituciones con servicio de cirugía neurovascular.

Introduction Anterior communicating artery aneurysms (ACoAAs) are intracranial aneurysms whose treatment is still considered a challenging task.

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU 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: 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

La evaluación clínica e imagenológica de los pacientes con hemorragia subaracnoidea espontánea constituye un paso fundamental para el manejo y valoración pronóstica de estos enfermos. Esta investigación tuvo como objetivo determinar el comportamiento del estado neurológico inicial y la magnitud (imagenológica) del sangramiento en pacientes con hemorragia subaracnoidea espontánea. Se realizó un estudio observacional, descriptivo-correlacional y retrospectivo, que incluyó 96 pacientes con hemorragia subaracnoidea espontánea entre 2016 y 2021. Se determinó las frecuencias de las categorías de las escalas de Hunt y Hess (clínica) y de Fisher (imagenológica); se analizó la relación entre estas escalas y otras variables mediante análisis bivariado (Odds Ratio y su intervalo de confianza). Entre los resultados se encuentra que el 54% de los pacientes se ubicó en la categoría “grado II” de la escala de Hunt y Hess; solo tres pacientes (3%) presentaron grado V. Hubo asociación significativa entre la condición de ancianidad y la agrupación de los grados III-V de dicha escala (OR 2,6[1,1;6]). El 77% de los casos estuvo ubicado en los grados III y IV de la escala de Fisher, con predominio de esta última (46%); más de la mitad de los pacientes de 60 años o más fueron clasificados como grado IV (55%), a diferencia de lo observado en los menores de esa edad (37%). Se concluye que la serie estuvo caracterizada por el predominio del estado clínico favorable al ingreso, a pesar de grados elevados de sangramiento según la escala imagenológica de Fisher. En los adultos mayores en particular, se observó mayor deterioro clínico al ingreso, y mayor magnitud del sangramiento.

Background: Delayed cerebral ischemia is a common complication after aneurysmal subarachnoid hemorrhage, which accounts for high morbidity and mortality in these patients. Predictors for this complication's development are necessary to ensure the prevention and adequate management of this complication. We aim to assess radiological features and anatomic variations as predictors of delayed cerebral ischemia. Methods: We performed a retrospective cohort analysis of a sample with aneurysmal subarachnoid hemorrhage between 2015 and 2019. Patients were classified according to the presence of delayed cerebral ischemia, and our statistical analysis sought predictors of delayed cerebral ischemia and bad neurological outcome. Results: Eighty-two patients were included in our study. Delayed cerebral ischemia occurred in 30 patients (36.6%). Hydrocephalus at admission (odds ratio [OR], 7.84; 95% confidence interval [CI], 2.02–52.75), intracerebral hematoma on initial computed tomography scan (OR, 5.80; 95% CI, 1.48–46.61), global cerebral edema (odds ratio [OR], 5.78; 95% confidence interval [CI], 1.61–110.59), anatomic variations (odds ratio [OR], 8.28; 95% confidence interval [CI], 2.81–232.41), higher values of systolic blood pressure on admission (odds ratio [OR], 6.56; 95% confidence interval [CI], 1.01–1.06), and smoking history (OR, 5.14; 95% CI, 1.35–64.92) were significantly associated with the development of delayed cerebral ischemia. Both anatomical variations (P = .018) and hydrocephalus (P = .019) were statistically correlated with a bad neurological outcome. Conclusions: Patients with anatomic variations and radiological injuries on admission are more likely to develop delayed cerebral ischemia during the hospital stay. A larger infarct territory can explain a worse neurological outcome in patients with anatomic variations. Resumen: Antecedentes: La isquemia cerebral tardía es una complicación común después de la hemorragia subaracnoidea aneurismática, lo que explica la alta morbilidad y mortalidad en estos pacientes. Los predictores del desarrollo de esta complicación son necesarios para asegurar la prevención y el manejo adecuado de esta complicación. Nuestro objetivo es evaluar las características radiológicas y las variaciones anatómicas como predictores de isquemia cerebral tardía. Métodos: Realizamos un análisis de cohorte retrospectivo de una muestra con hemorragia subaracnoidea aneurismática entre 2015-2019. Los pacientes fueron clasificados según la presencia de isquemia cerebral tardía, y nuestro análisis estadístico buscó predictores de isquemia cerebral tardía y mala evolución neurológica. Resultados: Ochenta y dos pacientes fueron incluidos en nuestro estudio. La isquemia cerebral tardía ocurrió en treinta pacientes (36,6%). Hidrocefalia al ingreso (odds ratio [OR], 7,84; intervalo de confianza [IC] del 95 %, 2,02-52,75), hematoma intracerebral en la tomografía computarizada inicial (OR, 5,80; IC del 95 %, 1,48-46,61), edema cerebral global (odds ratio [OR], 5,78; intervalo de confianza [IC] del 95 %, 1,61-110,59), variaciones anatómicas (odds ratio [OR], 8,28; intervalo de confianza [IC] del 95 %, 2,81-232,41), valores más elevados de presión arterial sistólica presión al ingreso (odds ratio [OR], 6,56; intervalo de confianza [IC] del 95 %, 1,01-1,06) y los antecedentes de tabaquismo (OR, 5,14; IC del 95 %, 1,35-64,92) se asociaron significativamente con el desarrollo de retraso cerebral isquemia. Tanto las variaciones anatómicas (p=0,018) como la hidrocefalia (p=0,019) se correlacionaron estadísticamente con un mal resultado neurológico. Conclusiones: Los pacientes con variaciones anatómicas y lesiones radiológicas al ingreso tienen mayor probabilidad de desarrollar isquemia cerebral tardía durante la estancia hospitalaria. Un mayor territorio de infarto puede explicar un peor resultado neurológico en pacientes con variaciones anatómicas.

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]

La enfermedad de Call-Fleming es una entidad rara de etiología indeterminada que se caracteriza por cefalea, déficit neu- rológico y vasoespasmo cerebral reversible. Describimos una paciente, mujer de 51 años con antecedente de hipertensión arterial con cefalea súbita asociada a déficit focal neurológico y convulsiones, evidencia de hemorragia subaracnoidea y vasoespasmo cerebral multifocal. Recibió tratamiento con bloqueadores de canales de calcio y esteroides, con mejoría clínica y neurosonológica luego de 20 días de evolución. Esta entidad infrecuente debe ser considerada en el diagnóstico diferencial de pacientes con cefalea “tipo trueno” y hemo- rragia subaracnoidea.

Objetivo: Determinar los resultados clínicos y angiográficos en pacientes con aneurismas intracraneales múltiples tratados endovascularmente en una única sesión. Materiales y Métodos: Se incluyó a todos los pacientes mayores de 18 años con aneurismas múltiples (>2), rotos o no rotos, tratados con terapia endovascular en una única sesión entre 2019 y 2021. Se recolectaron los datos clínicos y angiográficos. Se determinó la tasa de oclusión inmediata y del seguimiento. La escala de Rankin modificado se usó para valorar el resultado clínico. Resultados: Se trataron 25 pacientes, de los cuales 14 se presentaron con hemorragia subaracnoidea. Se diagnosticaron un total de 78 aneurismas, de los cuales 59 aneurismas fueron tratados. La localización más frecuente fue el segmento oftálmico. La altura máxima promedio fue de 5.2mm, lo cual tuvo diferencia estadística significativa con el estado de ruptura (p ≤ 0.02). El principal tipo de tratamiento endovascular fue la técnica de remodeling en el 39% de casos. El Raymond Roy inmediato fue I en el 60% y IIIa en el 35% de casos. La tasa de complicaciones fue del 24% y de mortalidad fue del 8%. Conclusiones: El tratamiento endovascular en una única sesión es una opción efectiva y segura en casos de aneurismas intracraneales múltiples en nuestra institución con tasa de oclusión y complicaciones aceptable.

La angiopatía amiloide cerebral (AAC) consiste en el depósito de amiloide en la pared de los vasos sanguíneos intracraneales, y conlleva a la aparición de hemorragia, isquemia o leucoencefalopatía. Las manifestaciones clínicas de la AAC son muy variables, tales como alteraciones cognitivas, alteraciones comportamentales, déficit neurológico focal, cefalea o crisis epilépticas. Un subtipo de angiopatía amiloide cerebral con inflamación relacionada (AAC-IR), se ha reportado recientemente en la literatura mundial. Presentamos el caso de una paciente de 74 años de edad, con un cuadro de demencia rápidamente progresiva de aproximadamente tres meses de evolución, asociada a cefalea, meningismo, disminución de la fuerza en hemicuerpo derecho, múltiples lesiones hemorrágicas parenquimatosas, hemosiderosis difusa, edema cerebral focal y estudio histológico con evidencia de amiloide intracerebral. El diagnóstico de la AAC se basa en una historia clínica compatible; neuroimagenes que demuestren hemosiderosis o múltiples hemorragias de predominio en fosa posterior, y en algunos casos estudio histológico que confirme la presencia de amiloide en la microcirculación intracraneal. Los criterios de Boston modificados unifican los hallazgos para el diagnóstico de AAC con diferentes grados de certeza. En algunas ocasiones, como en el caso presentado, la AAC se asocia a un componente inflamatorio, y se manifiesta con una demencia rápidamente progresiva, constituyéndose en un verdadero reto diagnóstico.

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 Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. 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.)

The C-Reactive Protein/Albumin Ratio (CAR) is being studied as a potential predictor of severe outcomes in various diseases. Our study aimed to review current evidence on the prognostic value of CAR in patients with aneurysmal subarachnoid hemorrhage (aSAH). We conducted a systematic search in PubMed, Embase, Scopus, Web of Science, and Google Scholar up to April 2023 and assessed the risk of bias using the NewCastle-Ottawa tool. A narrative synthesis was performed, and the GRADE system was used to evaluate the certainty of the evidence. Out of 534 articles, 4 were selected. We found that a higher CAR level is moderately associated with a lower score on the Glasgow Outcome Scale at 3 months and a higher incidence of in-hospital mortality. However, no significant association was found with the modified Rankin scale or delayed cerebral ischemia. Although the evidence is limited, CAR could be a useful tool for predicting poor prognosis in aSAH patients, but more prospective studies are needed to determine optimal cut-off points and include CAR in long-term prognostic models., Competing Interests: Declaration of competing interest All authors of this review declare that they have no conflict of interest., (Copyright © 2024 Sociedad Española de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved.)

Los aneurismas cerebrales en edad pediátrica son una patología poco frecuente, es importante tomarla en cuenta al evaluar pacientes pediátricos con manifestaciones clínicas características. Suelen localizarse en la circulación anterior, en pacientes masculinos con una edad media de 14.5 años. Se presenta un caso de un aneurisma cerebral del complejo comunicante anterior en un paciente masculino de 10 años de edad con clínica indicativa dada por cefalea de inicio súbito, vómitos incoercibles y disminución del estado de consciencia. Se realizó tomografía computarizada (TC) de cráneo simple donde se evidencia la presencia de hemorragia sub aracnoidea (HSA) Fisher II, se practica angiografía por TC para determinar la etiología del sangrado. El estudio confirmó la presencia de un aneurisma en el complejo comunicante anterior. Se realizó clipaje del aneurisma mediante un abordaje pterional clásico, obteniendo excelentes resultados y una recuperación satisfactoria. Es importante considerar los beneficios de la intervención endovascular como opción de tratamiento en casos semejantes. Brain aneurysms in pediatric age are a rare pathology, it is important to take it into account when evaluating pediatric patients with characteristic clinical manifestations. They usually appear in the anterior circulation, in male patients with a mean age of 14.5 years. A case of a cerebral aneurysm of the anterior communicating complex is presented in a 10-year-old male patient with indicative symptoms as sudden onset headache, incoercible vomiting, and decreased state of consciousness. A simple skull computed tomography (CT) was performed where was evidenced the presence of a subarachnoid hemorrhage (SAH) Fisher II, and a CT angiography was also performed to determine the etiology of the bleeding. The study confirmed the presence of an aneurysm in the anterior communicating complex. Clipping of the aneurysm was performed using a classic pterional approach, obtaining great results and a satisfactory recovery. It is important to consider the benefits of endovascular intervention as a treatment option in similar cases.

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.

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.

Resumo Objetivo: Analisar internações para tratamento de aneurismas cerebrais rotos e não rotos com realização de embolização e de microcirurgia cerebral no Sistema Único de Saúde (SUS), Brasil, 2009-2018. Métodos: Estudo descritivo, utilizando dados do Sistema de Informações Hospitalares do SUS. Descreveu-se a frequência das internações, procedimentos, utilização de unidade de tratamento intensivo (UTI), letalidade e gastos. Resultados: Das 43.927 internações, 22.622 (51,5%) resultaram em microcirurgia. Embolização e microcirurgia foram mais frequentes no sexo feminino. A duração das internações com embolização foi de 7,7 dias (±9,0), e com microcirurgia, 16,2 (±14,2) dias, a frequência de admissão em UTI, 58,6% e 85,3%, e a letalidade, 5,9% e 10,9%, respectivamente. Do gasto total, US$ 240 milhões, 66,3% corresponderam às internações com embolização. Conclusão: As internações com embolização para tratamento de aneurismas cerebrais no SUS apresentaram menor duração, menor frequência de utilização de UTI e menor letalidade, porém maior gasto em relação à microcirurgia cerebral.

Introducción: Los aneurismas tipo blíster son aneurismas pequeños, complejos, menores de 3mm, con alta tasa de morbilidad y mortalidad, así como de resangrado y recurrencia. Son difíciles de tratar y se han propuesto técnicas microquirúrgicas y endovasculares, siendo estas últimas las de menor tasa de complicaciones. Caso Clínico: Mujer de 74 años, ingresa con 6 horas de evolución de trastorno de sensorio brusco. La tomografía muestra hemorragia subaracnoidea difusa a predominio izquierdo. Se le realiza una angiografía cerebral que evidencia un aneurisma blíster de la trifurcación de la arteria cerebral media izquierda. Se emboliza con técnica de remodeling y coils, logrando obliterar la totalidad del aneurisma. Conclusión: Los aneurismas tipo blíster son aneurismas complejos y raros, siendo la terapia endovascular una alternativa segura y eficaz con menor tasa de complicaciones.

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU 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: Introduction: subarachnoid hemorrhage (SAH) is a rare and life-threatening cerebrovascular disease. Mitigating the factors that compromise patient recovery during neurocritical care due to SAH is of clinical benefit. Objectives: to evaluate the nutritional risk of patients with aneurysmal subarachnoid hemorrhage using "The Modified Nutrition Risk in the Critically Ill" (mNUTRIC) score, and examine its association with outcomes such as mortality, time of mechanical ventilation, and functional status among survivors. Methods: we designed a cross-sectional study. Patients with SAH admitted to the neurointensive critical care unit (neuroICU) in a tertiary care public hospital were eligible. The inclusion criteria were a minimum stay in the intensive care unit (ICU) of 24 hrs for subarachnoid hemorrhage from a nontraumatic, spontaneously ruptured cerebral aneurysm, and hospital admission within 24 hrs after the onset of symptoms. Results: high nutritional risk as stratified by the mNUTRIC score was associated with discharge type (OR = 0.346; 95 % CI = 0.182-0.650; p = 0.001), acute hypertensive hydrocephalus (OR = 4.371; 95 % CI = 2.283-8.549; p < 0.001), and functional outcome (OR = 0.106; 95 % CI = 0.025-0.0388; p < 0.001). The mNUTRIC score was significantly different among median age (p < 0.001), length of stay in the neuroICU (p = 0.005), SOFA score (p < 0.001), and APACHE II score (p < 0.001) categories. Conclusions: this study demonstrated an association between nutritional risk assessment and outcomes such as length of stay in the neuroICU, type of discharge, functional status, and mortality prediction accuracy. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. 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.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. 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.)

La cefalea es una de las razones más comunes de consulta médica, y se divide en dos categorías: primarias, que se presentan sin causa subyacente estructural a la cual atribuir los síntomas, que incluyen migraña con y sin aura, migrañas crónicas, cefaleas tensionales, trigeminales autonómicas, primarias por tos, ejercicio, estímulo frío o sexual y cefalea thunderclap; y secundarias donde existe causa subyacente que puede amenazar la vida, y agrupa a las atribuibles a trauma de cabeza y cuello, lesión vascular, las causadas por patologías intracraneales no-vasculares y por desórdenes psiquiátricos. Debe evaluarse toda cefalea para excluir una secundaria. La hemorragia subaracnoidea, cuyo principal signo cardinal es cefalea intensa de inicio súbito, suele ser inicialmente mal diagnosticada como migraña o cefalea tensional, está asociada a alto riesgo de muerte o discapacidad severa, presenta síntomas asociados como vómitos, alteración de la conciencia, rigidez nucal y déficits neurológicos. La meningitis bacteriana tiene alto riesgo de complicaciones con potencial de provocar secuelas graves o la muerte, se presenta comúnmente con cefalea, rigidez nucal y fiebre, y menos frecuentemente, alteración del estado mental, crisis epilépticas y signos de focalización. La hipertensión intracraneal (elevación sostenida de la presión intracraneal >20 mmHg por >5-10 minutos) tiene un cuadro clínico inicial de cefalea holocraneal, papiledema, vómitos en proyectil y alteración del estado mental. Si bien todas estas patologías tienen la cefalea como síntoma en común, es necesario estudiarlas para orientar un mejor diagnóstico diferencial, ya que todas requieren un abordaje muy distinto, pero de inicio inmediato para evitar complicaciones.

RESUMO Objetivo: Revisar sistematicamente a evidência atual da eficácia de milrinona no tratamento do vasoespasmo cerebral após hemorragia subaracnóidea. Métodos: Triaram-se as bases de dados Pubmed®, Cochrane e Embase quanto a artigos publicados entre abril de 2001 e fevereiro de 2019. Dois revisores independentes realizaram uma triagem metodológica da qualidade e a extração dos dados dos estudos. Resultados: Encontraram-se 22 estudos considerados relevantes, sendo que apenas um deles era um ensaio randomizado controlado. Os estudos demonstraram acentuada heterogeneidade e debilidade de seus critérios metodológicos. A maioria dos pacientes apresentava vasoespasmo moderado a grave. O principal método para diagnóstico do vasoespasmo foi a angiografia. Em três estudos, realizou-se administração de milrinona por via intra-arterial; em nove estudos, a administração foi endovenosa, e, em seis estudos, utilizaram-se ambas as vias de administração. A via intratecal foi utilizada em dois estudos, em um estudo, a administração foi realizada via cisterna e, em um estudo, a via de administração foi a endovascular. Os efeitos colaterais de milrinona foram descritos em seis estudos. Vinte e um estudos indicaram a resolução do vasoespasmo. Conclusão: A evidência atual indica que o uso de milrinona teve um papel no tratamento do vasoespasmo após hemorragia subaracnóidea aneurismática. Contudo, só foi realizado um ensaio randomizado controlado, com baixo nível de qualidade. Nossos achados indicam a necessidade de futuros estudos randomizados controlados com desfechos centrados no paciente, com o fim de proporcionar recomendações definitivas.

Malignant peripheral nerve sheath tumors (MPNST) are uncommon aggressive neoplasms, frequently associated with type I neurofibromatosis. This is the first case of intradural lumbar spine MPNST with intraoperative findings of associated subarachnoid hemorrhage (SAH). A 72-year-old man presented to the emergency department with severe acute low back pain. Neurological examination was unremarkable. Gadolinium-enhanced MRI of the lumbar spine showed an irregularly shaped intradural lesion extending from L3 to L5. The lesion exhibited a medium signal both on T1 and T2-weighted imaging with peripheral enhancement. Through an L3-L5 laminectomy, a diffuse SAH, and a tumor tightly adherent to cauda equina nerve roots were found. Specimen examination revealed a fusocelular tumor with pleomorphic and hyperchromatic nuclei, positive for S100, and SOX10. On an 8-month follow-up, he had no neurological deficit, with a Karnofsky performance score of 90 points. Surgical evidence of SAH in lumbar spine intradural MPNST is a novel finding., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

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 Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. 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 Cirugía y Cirujanos is the property of Publicidad Permanyer SLU 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 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.)

Se presentó una paciente de 62 años, con antecedente de hipertensión arterial sistémica e infarto cerebral. Acudió al cuerpo de guardia porque 24 horas después de un esfuerzo físico intenso presentó cefalea y dolor cervical intenso, vómitos no precedidos de náuseas y pérdida de la conciencia y al despertar no podía mover las piernas. El examen físico reveló signos meníngeos, paraplejia flácida, perdida de la sensibilidad táctil, térmica y dolorosa hasta el nivel de la segunda costilla y del tono de los esfínteres vesical y anal. La tomografía axial computarizada de cráneo mostró la presencia de hemorragia subaracnoidea occipital bilateral Fisher 3 y la resonancia magnética de columna dorsal contrastada reveló una hemorragia intramedular subaguda tardía. Se pondera la relevancia de la anamnesis, el examen físico y de los medios diagnósticos, sobre todo de la resonancia magnética para el diagnóstico clínico de hemorragia intramedular.

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]