Microsurgery of Cerebral Aneurysm: Epidemiological Profile

Objectives Intracranial aneurysm consists of localized dilatation of the vascular wall. Its importance includes the fearsome event of rupture and subarachnoid hemorrhage, which presents high morbimortality rates. The present study aimed to analyze the profile and clinical outcome of patients submitted to the microsurgical approach of cerebral aneurysm in the city of Criciúma, state of Santa Catarina, Brazil, from 2015 to 2018. Methods A retrospective observational study was performed, with secondary data collection and a quantitative approach of 47 charts. Results A predominance of females (74.5%) and amean age of 53 years old (53.53 9.64) was observed. The middle cerebral artery was the most affected vessel (36.2%), with the highest percentage of aneurysms being between 2.1mmand 7.0mm(65.9%). Therewas a correlation between consciousness level and classification on the Hunt-Hess (HH) scale. Patients with GlasgowComa Scale (GCS)> 7 points had a better prognostic score in the HH scale, and those with GCS 7 points had a worse prognostic score in the HH scale. Conclusions The present study observed the presence of important risk factors for cerebral aneurysm formation, such as gender, age, smoking, and systemic arterial hypertension. The present study can measure a correlation of the level of consciousness with the HH classification.

One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital / Um ano de seguimento da condição neurológica de pacientes pós-parada cardiorrespiratória atendidos no pronto-socorro de um hospital universitário

ABSTRACT Objective: To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up. Methods: A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were included. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation. Results: Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed. Conclusion: There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed. .

RESUMO Objetivo: Identificar a condição neurológica e os fatores associados de sobreviventes pós-parada cardiorrespiratória na alta hospitalar, após 6 e 12 meses de seguimento. Métodos: Estudo de coorte, prospectivo e descritivo, realizado em um pronto-socorro. Foram incluídos pacientes em parada cardiorrespiratória que sobreviveram à alta. A amostra foi consecutiva por um ano, sendo composta por 285 pacientes, e os sobreviventes (n=16) foram acompanhados por um ano após alta. O estado neurológico foi avaliado pela Categoria de Performance Cerebral antes da parada, na alta, 6 e 12 meses após alta. Foram investigados os seguintes fatores: comorbidades, presença de consciência na admissão, parada cardiorrespiratória prévia, parada cardiorrespiratória testemunhada, local, causa e ritmo inicial da parada, número de paradas, intervalo entre colapso e início da ressuscitação cardiopulmonar, e entre colapso e término da ressuscitação, e duração da ressuscitação. Resultados: Dos pacientes atendidos, 4,5% (n=13) sobreviveram após 6 e 12 meses de seguimento. Na alta, 50% dos pacientes permaneceram com Categoria de Performance Cerebral prévia à parada, e 50% tiveram piora da mesma. Após 6 meses, 53,8% permaneceram com mesma Categoria de Performance Cerebral, e 46,2% tiveram melhora em relação à alta. Após 12 meses, a totalidade dos pacientes permaneceu com mesma Categoria de Performance Cerebral em relação aos 6 meses anteriores. Não houve associação estatisticamente significativa entre evolução neurológica durante o seguimento e variáveis de interesse. Conclusão: Observou-se piora neurológica na alta, mas houve melhora ou estabilização no decorrer de 1 ano. Não foi encontrada associação entre Categoria de Performance Cerebral e variáveis de interesse. .

Avaliação de 76 casos de traumatismo crânio-encefálico por queda da própria altura atendidos na emergência de um hospital geral / Evaluation of 76 cases of traumatic brain injury from falling from standing height in an Emergency

Objetivo: O objetivo deste estudo foi elaborar um perfil epidemiológico de pacientes que sofreram traumatismo crânio-encefálico (TCE) por queda da própria altura (QPA). Métodos: Foram selecionados os pacientes com TCE atendidos na emergência de um hospital geral em Florianópolis (SC) durante um período de dois meses. Os pacientes que apresentaram TCE por QPA foram avaliados. As variáveis deste estudo incluíram: idade, sexo, presença de comorbidades e pontuação na Escala de Coma de Glasgow (ECG) no momento da admissão à emergência. Resultados: Setenta e seis pacientes (44 homens e 32 mulheres) preencheram os nossos critérios de inclusão. As idades dos pacientes à admissão variaram de 15 a 98 anos (média: 45,8 anos). Aproximadamente 63% dos pacientes utilizaram o carro privado como meio de transporte préhospitalar; 15% tinham história de ingestão alcoólica recente; 37% perderam a consciência imediatamente antes ou logo após o trauma e 37% tinham uma ou mais comorbidades conhecidas no momento do trauma. De acordo com a ECG, cerca de 90% dos pacientes sofreram TCE leve(ECG>12). Conclusões: A maioria dos pacientes atendidos na emergência devido a TCE por QPA são homens eindivíduos com idade superior a 40 anos. O sexo masculino está mais freqüentemente associado com uma história de ingestão alcoólica. O consumo de álcool está associado com a perda de consciência e maior gravidade do TCE. As análises demonstraram não haver relação da gravidade do TCE com osexo, a idade, a perda da consciência ou a presença de comorbidades associadas.

Objective: The aim of this study was to elaborate an epidemiological profile of patients who suffered traumatic brain injury (TBI) from falling from standing height. Methods: We selected the patients with TBI presented to the emergency room (ER) of a generalhospital in Florianopolis (Brazil) during a time period of two months. Patients who suffered TBI caused by falling from standing height were evaluated. The variables analyzed included: age, sex,presence of comorbidities and the Glasgow Coma Scale score (GCS) at the time of admission to the ER.Results: Seventy six patients (44 men and 32 women) fulfilled our inclusion criteria. Ages at admission ranged from 15 to 98 years (mean: 45.8 years). Approximately 63% of patients arrived at the hospital by private car, 15% had a history of recent alcohol consumption, 37% lost consciousness immediately before or right after the trauma, and 37% had one or more known comorbidities. According to the CGS, about 90% of patients had a mild TBI (GCS>12). Conclusions: Most patients admitted into ER with TBI from falling from standing height are men andpeople older than 40 years old. Male sex is more often associated with a history of alcohol intake. Alcohol consumption is associated with loss of consciousness and severity of TBI. The analysisdemonstrated no correlation between sex, age, loss of conscioussness or comorbidities and the severity of TBI.

Serum S100B and neuron-specific enolase as predictors of the neurologic disability status after traumatic brain injury

This study was designed to evaluate the correlation between serum levels of protein S100B and neuron-specific enolase [NSE] and the severity and outcome of traumatic brain injury [TBI] so as to be used as prognostic markers for cases admitted to Intensive care unit [ICU] after TBI. The study comprised 40 patients with head injury of varied severity and 10 volunteers [control group]. Inclusion criteria were head injury and presentation to the emergency department within 6 hours of injury. Initial injury severity was assessed using the Glasgow coma score [GCS] and all patients had cranial CT scans and lesions were evaluated with respect to lesion topography and territories of vascular supply. A venous blood sample was collected at admission for estimation of serum protein S100B and NSE levels. All patients received measures to decrease intracranial pressure [ICP] and phyntoin for posttraumatic seizures and underwent the appropriate neurosurgical procedure according to type of post-traumatic lesion. Follow-up was conducted monthly and the final outcome at six months was assessed using the Expanded Disability Status Scale [EDSS]. The mean initial GCS score was 11.1 +/- 3; 14 patients [35%] had mild, 17'patients [42.5%] had moderate and 9 patients [22.5%] had severe trauma. Normal CT was reported in 14 patients [35%]; however, CT scanning detected extradural hemorrhage in 5 patients [12.5%] fissure skull fracture in 5 patients [12.5%], fissure basal skull fracture in 3 patients [7.5%] and depressed skull fracture in 2 patients [5%]; while 3 patients [7.5%] had intracerebral hemorrhage and the other 8 patients had subdural hemorrhage, subdural hemorrhage with contusion, subdural hematoma and subarachnoid hemorrhage. Throughout follow-up, 18 patients [45%] had favorable outcome [EDSS<5]; while 22 patients had unfavorable outcome with EDSS >/= 5. Serum levels of S100B and NSE were significantly [P[1]<0.05] increased in patients compared to control levels, moreover, mean serum level of S100B was significantly [P[2]<0.05] and of NSE was non-significantly [P[2]>0.05] higher in patients with unfavorable outcome [EDSS >/=] compared to those with favorable outcome [EDSS<5] with a positive significant correlation between serum levels of S100B and NSE, [r = 0.485, p = 0.002]. Moreover, serum levels of both parameters showed a negative significant correlation with the initial GCS while showed a positive significant correlation with EDSS. However, there was a negative correlation between both parameters and the final outcome as favorable or unfavorable; such correlation was significant with S100B and non-significant with NSE. Using Logestic regression analysis serum S100B was the most significant predictor of the final outcome, [beta =-0.371, p = 0.018]. Receiver operator characteristics [ROC] curve analysis for serum levels of both S100B and NSE for prediction of favorable outcome found serum levels of S100B more specific with an area under curve [AUC] =0.379 than serum levels of NSE that found to be more sensitive with an AUC = 0.294. It could be concluded that estimation of serum S100B and NSE immediately after traumatic brain injury could define patients who will develop unfavorable outcome and posttraumatic disability with high sensitivity with NSE and specificity with S100 and must be used for the initial evaluation of TBI irrespective of the extent of severity of inflicted trauma

Traumatismo encefalocraneano (TEC): una puesta al día / Craniocerebral Trauma (TEC): a bring up to date

El traumatismo encéfalocraneano continúa siendo la primera causa de muerte y discapacidad en la población de menos de 45 años de edad. Los datos obtenidos del Traumatic Coma Data Bank (TCDB), señalan que las cifras de malos resultados asociadas al TEC grave (pacientes que fallecen, que quedan en estado vegetativo o gravemente incapacitados), se acercan al 60 por ciento de los casos en los inicios de la década de los noventa. Su elevado índice de mortalidad, las prolongadas hospitalizaciones y las graves secuelas resultantes, hacen que el TEC constituya uno de los problemas socioeconómicos más importantes del momento actual. En los últimos años se han producido avances muy significativos tanto en el conocimiento de los mecanismos básicos del TEC como en su fisiopatología. Los nuevos conocimientos fisiopatológicos han permitido individualizar y racionalizar las medidas terapéuticas y han contribuido a mejorar el resultado final de estos pacientes. Por su gran interés práctico, y dado que la gran mayoría de estos enfermos son inicialmente atendidos por médicos de urgencia, cirujanos generales o internistas; parece recomendable explicitar cómo realizar una correcta evaluación neurológica en todo paciente que ha presentado un TEC, así como también exponer los mecanismos etiopatogénicos básicos involucrados en la génesis y evolución de las lesiones neurotraumáticas; y presentar los diferentes tipos de lesiones cerebrales de acuerdo con sus características radiológicas (lesiones focales y difusas), para finalmente diferenciar entre lesiones primarias, secundarias y terciarias, lo que nos permitirá comprender los fenómenos que tienen lugar en el momento del traumatismo, los que se añaden posteriormente y los que resultan de la acción de toda una serie de cascadas metabólicas anómalas que se desencadenan en este tipo de pacientes neurocríticos. En una mirada breve y actualizada del manejo del TEC, todavía persisten algunas sombras por aclarar, aunque las revisiones si...

Neurotrauma en Camagüey / Situation of neurotrauma in Camagüey

Se reporta que la neurocirugía en Cuba ha considerado como esencial su papel en el manejo de los pacientes con traumatismos craneoencefálicos. Se reseña el manejo de los pacientes con traumatismos craneoencefálicos en el Hospital Manuel Ascunce Domenech y se describen los resultados generales obtenidos. En el período de enero de 1996 a enero de 2002 fueron ingresados un total de 1 646 enfermos con una puntuación de 14 o menos en la Escala de Coma de Glasgow. Desde octubre de 1995 este hospital dispone de una Unidad de Politraumatismos con cuidados especiales. Fueron admitidos en esta sala 1 630 (99 por ciento) pacientes con traumatismos craneoencefálicos. No ingresaron en esa dependencia hospitalaria 16 (1 por ciento) enfermos a causa del fallecimiento inmediato en los servicios de urgencias o en el salón de operaciones. La mortalidad por traumatismos craneoencefálicos graves descendió desde el 56 hasta el 38 por ciento. Hubo 1 226 pacientes (74 por ciento) con traumatismos craneoencefálicos moderados y menores. La mortalidad por traumatismos moderados descendió del 12 al 4 por ciento y la mortalidad por lesionados menores se redujo del 3 al 2 por ciento. El 97 por ciento de los traumatismos craneoencefálicos graves recibieron tratamiento neurointensivo y agresivo. Las lesiones de la cabeza constituyen una causa frecuente de muerte e invalidez en personas jóvenes. La integración de todos los niveles de salud, la adecuada organización de los servicios, los protocolos dinámicos de tratamiento, el neurointensivismo, el neuromonitoreo y el manejo quirúrgico precoz y agresivo desempeñan un papel esencial para mejorar los resultados(AU)

It is said that Cuban neurosurgery considers as its fundamental role the management of patients with brain traumas. This paper presents the management of patients with brain trauma in "Manuel Ascunce Domenech" hospital and describes the general results achieved so far. From January 1996 to January 2000, a total number of 1 646 patients were admitted to the hospital with a Glasgow Coma Scale score of 14 or less. Since October 1995, this hospital has a Special Multiple Trauma Care Unit installed. This ward accommodated 1 630 patients (99 percent) with brain trauma. Sixteen patients were not admitted to this ward because they died at once in the emergency service room or in the surgery room. Mortality rate from serious brain trauma decreased from 56 to 38 percent. There were 1 226 patients (74 percent) with moderate and minor brain traumas. Mortality rate from moderate brain trauma reduced from 12 to 4 percent and mortality from minor lesions lowered from 3 to 2 percent. 97 percent of serious brain trauma cases received neurointensive and aggressive therapy. Head injures were a frequent cause of death and disability in young persons. The integration of all the health levels, the adequate organization of services, the dynamic treatment protocols, neurointensive care, neuromonitoring and early and aggressive surgical management play an essential role in the improvement of the results(AU)