ABSTRACT
El diagnóstico de infarto cerebeloso en su presentación inicial puede ser difícil, su reconocimiento tardío puede asociarse a graves complicaciones. Aunque sólo representa 2 por ciento a 3 por ciento de los infartos encefálicos, afecta a un importante número de pacientes, muchos de los cuales son jóvenes. De todos los infartos de cerebelo sólo 10 por ciento evolucionará en forma maligna, siendo denominado infarto pseudotumoral de cerebelo. Las causas más habituales son la embolia, la disección de la arteria vertebral y la aterotrombosis. La arteria cerebelosa póstero-inferior es la más frecuentemente comprometida, y en un tercio de los casos se encuentra una fuente cardioembólica. Su rasgo distintivo es el efecto de masa, el mismo que ocasiona compresión de troncoencéfalo e hidrocefalia aguda, generando un deterioro cuantitativo de conciencia. Las neuroimágenes, tomografía computada y resonancia magnética de encéfalo, son de vital importancia para establecer la presencia de un infarto cerebeloso e identificar potenciales complicaciones. Es importante recordar que la tomografía computada es menos sensible que la resonancia magnética para establecer el diagnóstico. El manejo especializado multidisciplinario y la implementación de las medidas de soporte generales y específicas pueden mejorar las posibilidades de sobrevida y recuperación funcional. Ante la presencia de un deterioro de conciencia, un abordaje quirúrgico agresivo pareciera ser la mejor opción de tratamiento.
The diagnosis of cerebellar infarction at initial presentation can be difficult, delayed recognition can be associated with serious complications. Although representing only 2 percent to 3 percent of brain infarcts, affects a significant number of patients, many of whom are young. Only 10 percent of cerebellar infarcts evolve into malignant form, being named pseudotumoral cerebellar infarction. Common causes include embolism, vertebral artery dissection and atherothrombosis. The postero-inferior cerebellar artery is the most frequently committed, and one third of cases there is a cardioemboIic sourse. Its distinguishing feature is the mass effect, causing brain stem compression and acute hydrocephalus, and generating a quantitative impairment of consciousness. The brain imaging, computed tomography and magnetic resonance imaging of brain, are of vital importance to establish the presence of a cerebellar infarct and identify potential complications. It is important to remember that computed tomography is less sensitive than magnetic resonance for diagnosis. The multidisciplinary specialized management and implementation of measures of general and specific support can improve the chances of survival and functional recovery. In the presence of impaired consciousness, an aggressive surgical approach appears to be the best treatment option.
Subject(s)
Humans , Cerebellar Diseases/diagnosis , Cerebellar Diseases/therapy , Cerebral Infarction/diagnosis , Cerebral Infarction/therapy , Cerebellar Neoplasms/diagnosis , Cerebellar Neoplasms/therapy , Cerebellar Diseases/etiology , Cerebellar Diseases/physiopathology , Cerebral Infarction/etiology , Cerebral Infarction/physiopathology , Cerebellar Neoplasms/etiology , Cerebellar Neoplasms/physiopathology , PrognosisABSTRACT
Background: Stroke is the second specific cause of death in Chile, with a mortality rate of 48.6 per 100.000 inhabitans. It accounts for 6 percent of all hospitalizations among adults. Aim: To study the type of patients hospitalized at a Stroke Unit in a general hospital and the costs and benefits of such unit. Material and methods: A descriptive and retrospective study using a patient registry, developed in Access® that included separate sections for ischemic and hemorrhagic stroke. Established diagnostic criteria were used. The mean costs per patient and complications were also calculated. Results: During 2003, 425 stroke patients were admitted to our hospital and 105 (age range 30-89 years, 58 percent female) were hospitalized at the Stroke Unit. Eighty three percent had ischemic and 16 percent had hemorrhagic stroke. The most common etiologies were thrombosis in 41 percent, embolism in 36 percent, lacunar in 13 percent, arterial dissection in 5 percent and transient ischemic attack in 3 percent. Fifty eight percent of patients had partial anterior ischemic stroke (PACI), 73 percent had hypertension and 29.5 percent diabetes. Only 18 percent arrived to the Stroke Unit with less of 6 hours of evolution, 7 percent of patients were admitted within the 3 hours after the onset of symptoms and 18 percent, from 3 to 6 hours. The mean lenght of stay in the Stroke Unit was 6.6 days and at the hospital 9.9 days (p <0.01). The mean costs per patient at the Stroke Unit and at the hospital were US$ 5.550 and US$ 4.815, respectively (p =ns). Conclusions: The Stroke Unit decreases hospital stay days without raising costs importantly. The inclusion criteria for stroke patients admitted to the Unit were adequate and the stroke registry allowed a good assessment of the Unit operation.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Hospital Units/economics , Outcome and Process Assessment, Health Care , Stroke/therapy , Chile , Cost-Benefit Analysis , Hospital Mortality , Retrospective Studies , Risk Factors , Severity of Illness Index , Stroke/economics , Stroke/mortalityABSTRACT
We report a 15 year-old female presenting with behavioral disturbances, headache, left hemiparesis and paresis of the vertical gaze. CAT scan and magnetic resonance showed an involvement of right thalamus, third ventricle and medial temporal lobe suggesting an encephalitis or lymphoma. 201Thalium SPECT suggested a lymphoma. A stereotaxic biopsy showed a subacute demyelinizing lesion, compatible with an acute disseminated encephalomyelitis. The patient was treated with Methylprednisolone with resolution of symptoms. She remains in good condition after one year of follow-up.
Subject(s)
Adolescent , Female , Humans , Encephalomyelitis, Acute Disseminated/pathology , Anti-Inflammatory Agents/therapeutic use , Biopsy, Needle/methods , Encephalomyelitis, Acute Disseminated/drug therapy , Methylprednisolone/therapeutic use , Thallium Radioisotopes , Tomography, Emission-Computed, Single-PhotonABSTRACT
Se analiza retrospectivamente la evolución clínica de 26 pacientes con fractura del esternón (FE) atendidos en un período de cinco años, en el Hospital del Trabajador de Santiago. Ellos representan el 2,7 por ciento de 957 traumatismos torácicos atendidos en el período de 1993-1998. Se trata de 22 hombres y 4 mujeres, con edad promedio 44 años. El accidente vehicular fue la causa más frecuente y el 81,8 por ciento llevaba cinturón de seguridad. En 13 casos la FE fue una lesión aislada y en los restantes se asoció a otras fracturas o lesiones torácicas. El 92 por ciento de las fracturas se localizó en el cuerpo esternal y en la mitad de los casos no se observó desplazamiento. En dos pacientes (8,7 por ciento) se diagnosticó contusión miocárdica y no hubo lesión de grandes vasos. Ningún paciente requirió estabilización quirúrgica de la fractura. La evolución de los pacientes con fractura aislada fue benigna, con una hospitalización promedio de 3,2 días. En esta serie no hubo mortalidad