Determinación de los factores de mal pronóstico de la hemorragia intracerebral espontánea / Determination of poor prognosis factors of spontaneous intracerebral hemorrhage

Introducción: Las enfermedades cerebrovasculares son un problema de salud mundial. Estas constituyen la tercera causa de muerte, la primera de discapacidad en el adulto y la segunda de demencia en el planeta. Dentro ella, la hemorragia intracerebral espontánea es la segunda causa más común de enfermedad cerebrovascular, y llega a ser la tercera causa de muerte en Cuba. Objetivos: Determinar los principales factores de mal pronóstico que influyen en la evolución de los pacientes con la hemorragia intraparenquimatosa espontánea. Métodos: Se realizó un estudio observacional, transversal de una muestra conformada por pacientes atendidos en el Servicio de Neurología provincial de Camagüey, con diagnóstico de hemorragia cerebral espontánea primaria, confirmada por tomografía axial. Resultados: En esta investigación se detectó el predominio de hombres mayores de 80 años, con afectación de leve a moderada del estado de conciencia, predominaron las lesiones supratentoriales, y pocos casos con evacuación ventricular y sí un elevado porcentaje de hemorragias superiores a los 30 mL, con predominio de hipertensión arterial. Conclusiones: La mortalidad al alta hospitalaria no fue elevada, muy relacionada con la escala ICH(AU)

Introduction: Cerebrovascular diseases are a global health problem. These constitute the third cause of death, the first of disability in adults and the second of dementia on the planet. Within it, spontaneous intracerebral hemorrhage is the second most common cause of cerebrovascular disease, and it becomes the third cause of death in Cuba. Objectives: To determine the main factors of poor prognosis that influence the evolution of patients with spontaneous intraparenchymal hemorrhage. Methods: An observational, cross-sectional study was carried out of a sample made up of patients treated at Camagüey provincial Neurology service, with a diagnosis of primary spontaneous cerebral hemorrhage, confirmed by axial tomography. Results: In this research, a predominance of men over 80 years of age was detected, with mild to moderate impairment of the state of consciousness, supratentorial lesions predominated, and few cases with ventricular evacuation and high percentage of hemorrhages greater than 30 cc , with predominance of arterial hypertension. Conclusions: Mortality at hospital discharge was not high, closely related to the ICH score(AU)

Simple intracranial hematoma caused by ruptured intracranial aneurysms: Clinical analysis and literature review / 中国脑血管病杂志

Objective To explore the clinical features of patients with ruptured intracranial aneurysm combined with simple intracranial hematoma. Methods A total of 410 continuous patients with ruptured intracranial aneurysms in the Neurosurgery of the Second Affiliated Hospital of University of South China from October 2012 to December 2018 was enrolled retrospectively. Eight cases of those combined with simple intracranial hematoma but without subarachnoid hemorrhage. The clinical data of these patients were collected, including cerebrovascular risk factors, Glasgow Coma Scale score, Hunt-Hess classification, Fisher classification, imaging signs, the characteristics of intracranial aneurysm, the type of surgical treatment, and the outcomes of follow-up. After 3 months of treatment, the prognosis was evaluated by modified Rankin scale (mRS) score. Results (1) The proportion of ruptured intracranial aneurysms with simple intracranial hematoma accounted for 2.0% (8/410). Five patients ignored the diagnosis of intracranial aneurysm at initial diagnosis: one case was diagnosed with acute traumatic subdural hematoma at the first time, and then diagnosed as posterior communicating artery aneurysm by CT angiography (CTA); one case was diagnosed with spontaneous basal ganglia hemorrhage at the first time, and then diagnosed as middle cerebral aneurysm by CTA; one case was diagnosed with spontaneous basal ganglia cerebral hemorrhage in the other hospital at the first time, and then diagnosed as middle cerebral artery bifurcation aneurysm during the craniotomy hematoma removal, and further diagnosed as anterior communicating artery aneurysm 2 weeks after surgery by DSA; one case was diagnosed with spontaneous frontal lobe hemorrhage due to headache in the other hospital at the first time, and then diagnosed as anterior cerebral aneurysm by CTA; one case was diagnosed with spontaneous basal ganglia hemorrhage at the first time, and then diagnosed as posterior cerebral aneurysm by CTA. (2) Imaging features: hematoma in the basal ganglia is immediately adjacent to the lateral fissure or temporal lobe, and some patients had a round-like slightly high-density shadow on the edge of the hematoma; simple lateral intraventricular hemorrhage showed that the temporal lobe hematoma invaded into the lateral ventricle temporal angle, and the subdural hematoma was without skull fracture. In addition, CTA demonstrated that the expansion direction of the aneurysm toward the brain lobe was easy to form cerebral intraparenchymal hematoma, and the direction toward the dura mater was easy to form spontaneous subdural hematoma. (3)2 cases had good prognosis (mRS score 0-2), 6 cases had poor prognosis (mRS score 3-6). Conclusions For patients who are initially diagnosed with spontaneous intracranial hematoma without subarachnoid hemorrhage, head CTA or DSA should be performed as soon as possible, especially the hematoma in the basal ganglia area near to the lateral fissure, the hematoma existing a slightly rounded high-density shadow on edge, and subdural hematoma without skull fracture. The study should pay more attention to these imaging signs to identify intracranial aneurysms.

Evolución de un cuadro de hemorragia intracraneal en lactante con trombocitopenia inmune primaria / Evolution of a case of intracraneal hemorrhage in infant with primary immune trombocytopenia

La trombocitopenia inmune primaria (TIP) es una enfermedad hematológica de causa inmunológica que presenta una plaquetopenia inferior a 100 000 plaquetas/mm3 y tiene una incidencia de 4 casos por cada 100 000 habitantes, siendo más prevalente entre los 2 a 6 años de edad. Esta entidad continúa siendo un desafío con respecto a la terapéutica y puede conllevar a complicaciones graves muy difíciles de resolver una vez establecidas.Se presenta el caso de un lactante menor de sexo masculino que curso con por un cuadro de palidez generalizada con aparición súbita de hematoma en mucosa oral, máculas equimóticas y hemorragias puntiformes en toda la superficie corporal. En los exámenes realizados se evidenciaron trombocitopenia y anemia grave, llegando al diagnóstico de trombocitopenia inmune primaria inicialmente manejada con transfusiones y posteriormente con corticoides. A pesar del manejo, el cuadro evolucionó con complicaciones de hemorragia intraparenquimatosa y declino neurológico.

Primary immune thrombocytopenia (PIT) is a hematological disease of immunological cause that has platelet count less than 100 000 platelets / mm3 and has an incidence of 4 cases per 100 000 inhabitants, being more prevalent between 2 and 6 years of age. This entity remains a challenge with regard to therapeutics and can lead to serious complications that are difficult to resolve once established. We report the case of a young male infant who has a generalized pallor with sudden onset of hematoma in the oral mucosa, equimotic macules and punctate hemorrhages throughout the body surface. In the examinations performed thrombocytopenia and severe anemia were evident, arriving at the diagnoses of idiopathic thrombocytopenic purpura initially managed with transfusions and later with corticoids. despite the treatment the case progress whith complications of intraparenchymal hemorrhage accompanied by neurological decline

Imaging of Intracranial Hemorrhage / 대한뇌졸중학회지

Intracranial hemorrhage is common and is caused by diverse pathology, including trauma, hypertension, cerebral amyloid angiopathy, hemorrhagic conversion of ischemic infarction, cerebral aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistula, vasculitis, and venous sinus thrombosis, among other causes. Neuroimaging is essential for the treating physician to identify the cause of hemorrhage and to understand the location and severity of hemorrhage, the risk of impending cerebral injury, and to guide often emergent patient treatment. We review CT and MRI evaluation of intracranial hemorrhage with the goal of providing a broad overview of the diverse causes and varied appearances of intracranial hemorrhage.

Muerte cerebral secundaria a intoxicación por metanol / Brain death secondary to methanol poisoning

Las intoxicaciones por alcohol metílico son raras, pueden ser secundarias a intentos suicidas, accidentes e incluso a envenenamientos endémicos, tienen consecuencias severas que incluyen la muerte, secundarias a productos de la degradación del alcohol metílico por la alcohol deshidrogenasa, a continuación, presentamos un caso de intoxicación por alcohol metílico que como secuelas presentó alteraciones neurológicas y muerte. (Acta Med Colomb 2012; 37: 211-214).

Methyl alcohol poisoning is rare and may be secondary to suicide attempts, accidents and is also caused by endemic poisonings. It has severe consequences including death secondary to degradation products of methyl alcohol by alcohol dehydrogenase. We present a case of methyl alcohol poisoning that presented neurological alterations and death. (Acta Med Colomb 2012; 37: 211-214).

Estudio de caso a una persona con alteración en la necesidad de oxigenación secundaria a hemorragia intraparenquimatosa basado en el modelo conceptual de Virginia Henderson / Case study of a patient with oxygen needs alterations secondary to a intraparenchymal hemorrhage, based on the Virginia Henderson conceptual model

El presente estudio de caso se realizó en un adulto en estado crítico con diagnóstico médico de Hemorragia Intraparenquimatosa, atendido en un Hospital de Alta especialidad. Se utilizó el Modelo de Virginia Henderson para la valoración de necesidades, y se complementó con la valoración neurológica. La metodología establecida fue con la NANDA en la emisión de diagnósticos y la Clasificación de los Resultados de Enfermería (NOC) y la Clasificación de las Intervenciones de Enfermería (NIC) para la planificación del cuidado. Se utilizó la red de razonamiento clínico para la resolución del caso, según el modelo AREA (Análisis de Resultados del Estado Actual), propuesto por Pesut. El razonamiento clínico permite analizar la relación que existe entre diagnósticos y la influencia que tienen unos con otros, lo que lleva a la enfermera a identificar el diagnóstico prioritario. A partir de lo anterior se desarrolló un plan de cuidados priorizando las necesidades más alteradas y las intervenciones especializadas. La red de razonamiento se representó a través de líneas que conectan a los diagnósticos entre sí, lo que explica cómo y porqué unos diagnósticos influyen en otros. Dentro del perfil del especialista en Enfermería del Adulto en Estado Crítico, el razonamiento clínico es la manera de estructurar el pensamiento crítico, como un proceso que fundamenta los cuidados especializados por medio del conocimiento científico, la toma de decisiones, la prontitud en la manera de pensar, actuar , y la intuición. Herramientas fundamentales de un especialista.

This study case is linked to an adult in critical status being attended in a high-specialty hospital with a medical diagnosis of intraparenchymal hemorrhage. The Virginia Henderson Model was used to address the patient's needs, and this was complemented with the corresponding neurological assessment. The established methodology followed the directives of NANDA for diagnoses, and NOC (Nursing Results) and NIC (Nursing Interventions) for care planning. The clinical reasoning net for case resolution, in agreement with the Pesuts proposed Actual Status Results Analysis model was used. This clinical reasoning allows the analysis of the diagnoses' relationships and thus helps the nurse identify the primary diagnosis-Considering this, a care plan was developed prioritizing the most important needs, and the specialized interventions. The reasoning net was represented through lines connecting the diagnoses clarifying their corresponding inter-influences. Within the profile of the specialist in Critical Status Adult, clinical reasoning is the way to structure specialized care through scientific knowledge, the decision taking process, the opportunity in the form of thinking and acting, and the intuition. All of these are fundamental tools of a specialist.

Repercusión de factores clinicoepidemiológicos sobre el pronóstico de las hemorragias intraparenquimatosas / Implications of clinical and epidemiological factors on the prognosis of intraparenchymal hemorrhage

Se realizó un estudio descriptivo, transversal y prospectivo en 49 pacientes con hemorragia intraparenquimatosa, ingresados en el Servicio de Enfermedades Cerebrovasculares del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, desde enero hasta diciembre del 2006, para identificar los factores que inciden en el pronóstico de esta enfermedad. El sexo masculino y el grupo etáreo entre 45 y 54 años predominaron en la serie. La hipertensión arterial y diabetes mellitus constituyeron las principales afecciones que implicaron un mal pronóstico y las complicaciones con mayor mortalidad fueron las bronconeumonías y arritmias respiratorias

A descriptive, prospective and cross-sectional study was carried out in 49 patients with intraparenchymal hemorrhage admitted to the Service of Cerebrovascular Diseases of Saturnino Lora Provincial Teaching Hospital in Santiago de Cuba, from January to December 2006 to identify the factors that impact on the prognosis of this disease. Male sex and the age group between 45 and 54 years prevailed in the series. Hypertension and diabetes mellitus were the main conditions that implied a poor prognosis; and the complications with a higher mortality were bronchopneumonias and respiratory arrhythmias

Contralateral Intraparenchymal Hemorrhage Following Aneurysmal Clipping

Post-clipping intraparenchymal hemorrhage of the contralateral hemisphere is a very unusual phenomenon in a patient with aneurysmal subarachnoid hemorrhage, unless there is an underlying condition. We report a complicated case of 47-year-old man, who underwent uneventful clipping of ruptured aneurysm and experienced vasospasm two weeks later. Vasospasm was treated by intra-arterial nimodipine and systemic hyperdynamic therapy. One week thereafter, he became unconscious due to intraparenchymal hemorrhage on the anterior border-zone of contalateral hemisphere, but intraoperative and pathologic findings failed to disclose any vascular anomaly. We suggest that the anti-spastic regimens cause local hemodynamic redistribution through the vasodilatory effect and in turn, resulted in such an unexpected bleeding.

Intracranial Hemorrhage Developed from Patient Who Had Been Preeclampsia at Five Days Postpartum

Intracranial hemorrhage due to preeclampsia in the postpartum woman is rarely documented. Generally, the incidence of stroke is increased during pregnancy and early postpartum. Preeclampsia is considered a main cause of both nonhemorrhagic and hemorrhagic stroke. We present a 32-year-old woman who had intracranial hemorrhage at 5 days postpartum. At admission, her consciousness was semicomatose with elevated blood pressure. Computerized tomography revealed intracranial hemorrhage on right frontal lobe. Additional angiography did not reveal abnormal vascular lesion. Emergency craniectomy with hematoma removal was done. However, the patient showed no recovery and died 2 weeks later. We conclude that postpartum care of preeclampsia is important to prevent intraparenchymal hemorrhage. Relative high risk of stroke during the postpartum period suggests a causal roles for the large decrease in blood volume or the rapid changes in hormonal status that follow a live birth or stillbirth, perhaps by means of hemodynamics, coagulative, or vessel wall changes.