Caracterización de la mortalidad por infarto cerebral reciente en diabéticos / Characterization of recent stroke mortality in diabetic patients

Introducción: la enfermedad cerebrovascular es la tercera causa de muerte en Cuba. La relación epidemiológica entre la diabetes y la enfermedad cerebrovascular tienen un notable interés clínico debido a la elevada prevalencia poblacional de ambos procesos. Objetivo: caracterizar clínica y anatomopatológicamente a pacientes diabéticos fallecidos con diagnóstico de infarto cerebral reciente, a quienes se les realizó la autopsia entre el 2004 y 2010. Métodos: estudio observacional, descriptivo de corte transversal, en 77 pacientes diabéticos fallecidos en el Hospital Militar Central "Dr. Carlos J. Finlay". Los datos fueron introducidos y procesados en el paquete estadístico SPSS versión 11.5 para Windows. Resultados : predominó el sexo masculino; el rango de edad en que más fallecidos hubo fue entre 75 y 84 años para ambos sexos. Las principales manifestaciones clínicas observadas fueron el déficit motor, los trastornos del estado de conciencia y las crisis epilépticas. La principal causa directa de muerte resultó el edema cerebral. Predominaron los fallecidos con niveles elevados de glucemia, en los primeros 14 días; resultó estadísticamente significativa la asociación de la transformación hemorrágica con cifras elevadas de glucemia. Conclusión: la presencia de glucemia alta incidió en una mayor mortalidad, durante las primeras dos semanas y en la aparición de la transformación hemorrágica del infarto cerebral.

Introduction: the cerebrovascular disease is the thirst cause of death in Cuba. The epidemiological link between diabetes and cerebrovascular disease has a significant clinical interest due to the high population prevalence of both processes. Objective: to characterize clinically and pathologically deceased diabetic patients who were diagnosed with cerebral infarction and their autopsy was conducted from 2004 to 2010. Methods: transversal descriptive study in 77 diabetic patients who had died with recent cerebral infarct at "Dr. Carlos J. Finlay" Central Military Hospital. Data was introduced and processed in the statistic packet SPSS 11.5. Results: the male sex was predominant. The age range predominant was 75 to 84 years for both sexes. The main clinical manifestations observed were mobility deficits, disorders of consciousness, and seizures. The main direct cause of death was cerebral edema. Deceased with high levels of glucose in the first 14 days were in the majority; the association of hemorrhagic transformation with high blood glucose levels was statistically significant. Conclusion: the presence of high leves of glucose impacted in a bigger mortality, during the first two weeks and in the appearance of hemorrhagic transformation of cerebral infarction.

Edema agudo cerebral de altura / High altitude acute cerebral edema

La ciudad de La Paz - Bolivia, ubicadageográficamente en la cordillera de Los Andes, presentapropiedades ambientales propias, tales comodisminución de la presión parcial de oxígeno en el aireambiente, menor densidad del aire, mayor sequedaddel aire, variaciones significativas de la temperaturaambiental y radiaciones solares no ionizantes(radiaciones ultravioleta). La primera de estascaracterísticas es atribuida como factor desencadenante principal del edema cerebral de altura (EACA). Cuando una persona no aclimatada asciende rápidamente por encima de los 3.000 metros de altura sobre el nivel del mar (m.s.n.m), recibe en algún grado el impacto de la hipoxia hipobárica ambiental que puede producir innumerables efectos fisiológicos enel cuerpo humano, siendo los más importantes los percibidos sobre el rendimiento físico, desempeñomental y sueño

Bifrontal decompressive craniotomy for malignant brain edema

To review the outcome of bifrontal decompressive craniotomy used for the treatment of malignant brain edema due to different etiologies. The study was carried out at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia during the period from January 2000 to June 2005, and included all patients who had malignant brain edema due to different etiology and were treated with bifrontal decompressive craniotomy after failure of aggressive medical treatment. Ten patients were included in the study, 6 males and 4 females; the mean age was 24 years. Seven patients had severe head injury, 2 had aneurysmal subarachnoid hemorrhage, and one had large calcified olfactory groove meningioma. Clinically, all patients, except one, had Glasgow coma scores more than 3 before surgery, and operation was performed in all patients once clinical deterioration was observed and diagnosis confirmed by CT brain scan. The outcome of surgery was good in 70%, poor in 20%, and mortality was 10%. The mean hospital stay was 85 days. Bifrontal decompressive craniotomy offers immediate reduction of intracranial pressure to its normal levels, and improves the outcome of malignant brain edema whatever its cause, it should be performed once clinical deterioration is observed

Endocardite infecciosa, aneurisma(s) micótico(s), hemorragia subaracnóidea e outras lesöes neurológicas: estudo clínico e anatomopatológico / Infectious endocarditis, mycotic aneurisms(s) subarachinoid hemorrhage and other neurologic lesions: clinical and anatomopathologic study

Os autores apresentam e discutem 20 observaçöes (1983-1991) de endocardite infecciosa (E.i.) com manifestaçöes clínicas neurológicas conseqüentes, principalmente, a fenômenos tromboembólicos cerebrais, muitos deles com formaçäo de aneurisma(s), que se romperam ou näo. Hemorragia subaracnóidea, conseqüente ou näo à ruptura de aneurisma micótico, foi outro achado importante. Outras lesöes neurológicas foram assinaladas no estudo clínico e na correlaçäo clínicop-patológica desta série. Sobreviveram apenas sete destes 20, dentre os quais, os quatro operados de aneurisma micótico intracraniano (casos 1 a 4). de 13 pacientes que foram a óbito, oito foram necropsiados, possibilitando uma correlaçäo entre achados clínicos e anatomopatológicos. Nestes oito casos necropsiados, a ruptura de aneurisma micótico com hemorragia foi a causa mortis. cefaléia persistente, manifestaçöes maníngeas, meningite piogênica, "meningite asséptica", hemorragia subacnóidea micro-ou macroscópica, além de sinais neurológicos de localizaçäo, representaram os sinais clínicos mais importantes na denúncia da presença de aneurisma(s) micótico(s). Em vários casos (no. 6, 9, 10, 11, 14, 16 e 20), a formaçäo de aneurisma(s) micótico(s) foi precedida de fenômeno tromboembólico cerebral, evento que indica, sempre, o estudo angiográfico cerebral completo na E.i. Fenômenos tromboembólicos em outras áreas levam-nos à suspeita de aneurisma(s) micótico(s) intracranianos), mesmo que o paciente näo tenha queixa neurológica alguma; observaçäo referida na literatura e constatada no presente estudo (casos 5, 7 e 19). O potencial traiçoeirao, imprevísivel e de alta gravidade do(s) aneurisma(s) micótico(s) e da hemorragia subaracnóidea pode bem ser avaliado na revisäo clínica patológica. Estes fatos recebem bastante ênfase na literatura internacional,onde há controvérsias sobre os aspectos da prevalência das lesöes vasculares, da sua patologenia e até mesmo sobre qual a melhor abordagem terapêutica diante delas...