ABSTRACT
El tratamiento de elección para la evacuación de hematoma subdural crónico es la evacuación mediante orificio de trépano. Las complicaciones más frecuentes son recurrencia, neumoencefalo, convulsiones, hemorragia intracraneal y en otros sitios. La hemorragia del tronco cerebral secundaria a la cirugía es extremadamente rara. Aquí presentamos un paciente masculino de 72 años, que ingresa con GSC 9/15, hemiparesia izquierda 2/5. Con HSD crónico bilateral con desplazamiento de línea media de 1.5 cm. hacia izq. Al cual se realiza evacuación de HSD derecho. Y en el POP se detecta GSC 12/15, lado izquierdo fuerza 5/5, con hemiparesia derecha a predominio braquial. TC control POP: adecuada evacuación de HSD y lesión hiperdensa protuberancial. Es externado al 6to día POP con GSC 14/15 sin déficit motor. Este reporte, además de abordar la bibliografía actual y fisiopatología; agrega otro caso para reafirmar la posibilidad de pronóstico favorable en ésta patología
ABSTRACT The treatment of choice for the evacuation of chronic subdural hematoma is evacuation through a trepan orifice. The most frequent complications are recurrence, re-accumulation of the hematoma, pneumoencephalus, seizures, intracranial hemorrhage and elsewhere. Brainstem hemorrhage secondary to surgery is extremely rare. Here we present a 72-year-old male patient, admitted with GSC 9/15, left hemiparesis 2/5. Without obeying orders. With bilateral chronic HSD with midline displacement of 1.5 cm. to left; to which evacuation of right HSD is performed. And in the POP GSC 12/15 is detected, left side force 5/5, with right hemiparesis to brachial predominance. POP control CT: adequate evacuation of HSD and hyperdense pontine lesion. It is extership to the 6th day POP with GSC 14/15 without motor deficit. This report, besides addressing the current bibliography and physiopathology; adds another case to reaffirm the possibility of favorable prognosis in this pathology
Subject(s)
Humans , Male , Aged , Cerebral Hemorrhage, Traumatic/diagnostic imaging , Hematoma, Subdural, Chronic/surgery , Hemorrhage/pathology , Seizures/complications , Brain Stem/pathology , Brain Stem Hemorrhage, Traumatic/diagnostic imaging , Intracranial Hemorrhages/complicationsABSTRACT
Objective: to present 3 cases of intracranial cystic meningiomas with histological confirmation; and to review this relatively uncommon finding. Description: cystic meningiomas account for about 2-4 por ciento of intracranial meningiomas and their clinical presentation is similar to that of noncystic meningiomas; but in some cases, quick neurological deterioration may occur, perhaps due to rapid intratumoral cyst expansion among other causes. These lesions have been mistaken for astrocytomas, hemangioblastomas, neuroblastomas and metastasis. A thorough radiographic examination allows us to make the diagnosis of meningiomas in a high percentage of cases; however, even with CAT scanning. MRI and cerebral arteriography, diagnosis of cystic meningiomas is difficult. Tumor cells may be present in the cyst wall, so that resection of the solid portion alone carries the chance of tumor recurrence. Because of that, a total cyst excision in some cases is the goal to prevent tumor recurrence. Intervention: in the last three years, we have operated three cases of cystic meningiomas, two females and one male patien among 35-43 years old, all of them went to gross total surgical removal (Simpson II) of the solid and cystic portion; the pathological examination revealed a "meningothelial type"in two of them and a "sincitial type" in the other. Conclusion: proper surgical management depends on early recognition so that curative excision is not replaced by palliative surgery