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1.
An. Fac. Cienc. Méd. (Asunción) ; 53(1): 59-70, 20200401.
Article in Spanish | LILACS | ID: biblio-1095646

ABSTRACT

Introducción: La Hemorragia Subaracnoidea es el sangrado en el espacio subaracnoideo. La causa espontánea en la mayoría de las veces se debe a ruptura de un aneurisma cerebral. Objetivo: Describir la casuística, manejo y resultados de los aneurismas cerebrales en el Hospital de Clínicas. Pacientes y método: Estudio observacional, descriptivo, transversal, incluyendo pacientes operados de aneurismas cerebrales, mayores de 17 años, en el Hospital de Clínicas del 2011 al 2019. Las variables descriptas fueron: edad, sexo, motivo de consulta, estudios radiológicos, escala de Glasgow y Hunt y Hess, localización, segmento, cantidad, fase, clipado temporario, vasoespasmo e hidrocefalia. Resultados: Se incluyó 249 pacientes; 45% masculino, 65% femenino, con edad promedio de 47,5 años. El motivo de consulta más frecuente fue cefalea. Al ingreso tuvieron predominantemente Hunt y Hess 2, y, Glasgow 15. El 43,2% eran Fisher 4. El Glasgow de egreso fue mayor o igual a 14 en 82,1%. Se diagnosticó el 51,7% con arteriografía; el 50,9% de los aneurismas en la carótida interna y, fueron múltiples en 10,84%. Se operaron en fase aguda 28,3%, 65% en fase tardía y, el 6,7% de los aneurismas fue de hallazgo casual. En 36,44% de los casos se realizó clipado temporario y, en el 70,4% se perforó la lámina terminalis. La mortalidad fue de 4,2%. Presentaron vasoespasmo radiológico en un 46% y, vasoespasmo clínico en 24,5 %. El 11% fue sometido a craniectomía descompresiva y, 5,5% desarrolló hidrocefalia dependiente de VDVP. Conclusión: El clipado de los aneurismas cerebrales es una técnica con buenos resultados y la única accesible en el sector público.


Introduction: Subarachnoid hemorrhage is bleeding in the subarachnoid space. The spontaneous is caused most of the time by rupture of a cerebral aneurysm. Objective: Describe the casuistry, management and results of cerebral aneurysms at the Hospital de Clínicas. Patients and methods: Observational, descriptive, cross-sectional study including patients operated for cerebral aneurysms, older than 17 years, at the Hospital de Clínicas from 2011 to 2019. The variables described were: age, sex, reason for consultation, radiological studies, Glasgow and Hunt and Hess scale, location, segment, quantity, phase, temporary clipping, vasospasm and hydrocephalus. Results: 249 patients were included; 45% male, 65% female, average age 47.5 years. The most frequent reason for consultation was headache. At admission they had predominantly Hunt and Hess 2, and Glasgow 15. 43.2% were Fisher 4. The Glasgow of discharge was greater than or equal to 14 in 82.1%. 51.7% were diagnosed with arteriography; 50.9% internal carotid aneurysms, multiple 10.84%. 28.3% were operated in acute phase, 65% late phase, 6.7% were a casually found. In 36.44% of cases a temporary clipping was performed and in 70.4% the lamina terminalis was perforated. Mortality was 4.2%, radiological vasospasm 46%, clinical vasospasm 24.5%, 11% underwent decompressive craniectomy and 5.5% developed VDVP-dependent hydrocephalus. Conclusion: The clipping of cerebral aneurysms is a technique with good results and the only one in the public sector.


Subject(s)
Intracranial Aneurysm/epidemiology
2.
Clinics ; 75: e1973, 2020. tab
Article in English | LILACS | ID: biblio-1133348

ABSTRACT

OBJECTIVES: This study aimed to analyze the incidence and epidemiological, angiographic, and surgical aspects associated with incomplete clipping of brain aneurysms in a cohort of patients undergoing microsurgical treatment. METHODS: The medical record data of patients who underwent microsurgery for cerebral aneurysm treatment and postoperative digital subtraction angiography, treated at the same teaching hospital between 2014 and 2019, were retrospectively analyzed. The studied variables involved epidemiological and clinical data, as well as neurological status and findings on neuroimaging. The time elapsed between hemorrhage and microsurgical treatment, data on the neurosurgical procedure employed for aneurysm occlusion, and factors associated with the treated aneurysm, specifically location and size, were also evaluated. RESULTS: One hundred and seventeen patients were submitted to 139 neurosurgical procedures, in which 167 aneurysms were clipped. The overall rate of residual injury was 23%. Smoking (odds ratio [OR]: 3.38, 95% confidence interval [CI95%]: 1.372-8.300, p=0.008), lesion size >10 mm (OR: 5.136, CI95%: 2.240-11.779, p<0.001) and surgery duration >6 h (OR: 8.667, CI95%: 2.713-27.681, p<0.001) were found to significantly impact incomplete aneurysm occlusion in the univariate analyses. CONCLUSION: Incomplete microsurgical aneurysm occlusion is associated with aneurysm size, complexity, and current smoking status. Currently, there is no consensus on postoperative assessment of clipped aneurysms, hindering the correct assessment of treatment outcomes.


Subject(s)
Humans , Intracranial Aneurysm/surgery , Intracranial Aneurysm/epidemiology , Intracranial Aneurysm/diagnostic imaging , Aneurysm, Ruptured/surgery , Angiography, Digital Subtraction , Retrospective Studies , Treatment Outcome , Neurosurgical Procedures , Microsurgery
4.
Arq. bras. neurocir ; 34(1): 2-6, 2015. ilus
Article in Portuguese | LILACS | ID: biblio-20

ABSTRACT

Objetivo Avaliar o perfil epidemiológico, os resultados cirúrgicos e os casos de hemorragia subaracnóidea aneurismática ocorridos no Hospital de Ensino da Univasf. Métodos Estudo descritivo e analítico, com abordagem quantitativa, baseado no caráter não experimental, documental e retrospectivo, os prontuários dos pacientes com diagnóstico de hemorragia subaracnóidea aneurismática não traumática admitidos em um hospital de ensino de setembro de 2008 a setembro de 2012. esultados Verificou-se uma prevalência de hemorragia subaracnóidea aneurismá-tica em Petrolina de 1,8 para cada 10 mil habitantes. Dos 55 prontuários, o sexo feminino foi o mais acometido (61,81%), com faixa etária de 41 a 50 anos. Aneurismas múltiplos foram encontrados em 23,5%. Com relação às escalas de Hunt-Hess e Fisher, obtivemos respectivamente 40% com Hunt-Hess grau dois e 35,7% com Fisher grau três. Não apresentaram nenhum tipo de déficit neurológico desde a admissão até a alta hospitalar 54,8% dos pacientes, e somente 1,81% apresentaram déficit neurológico após o procedimento cirúrgico. A reabordagem cirúrgica foi necessária em 3,7% dos casos. A mortalidade cirúrgica foi de 3,5%. Conclusão Existe uma prevalência de hemorragia subaracnóidea aneurismática em Petrolina/PE de 1,8 por 10 mil habitantes.


Objective To evaluate the epidemiological profile, the surgical results and cases of Subarachnoid Hemorrhage Aneurysmal occurred in the UNIVASF Teaching Hospital. Methods A descriptive and analytical study with a quantitative approach based on non-experimental, documentary and retrospective study, the charts of patients with nontraumatic Subarachnoid Hemorrhage Aneurysmal admitted to a teaching hospital from September 2008 to September 2012. Results It has been found a prevalence of Subarachnoid Hemorrhage Aneurysmal in Petrolina 1.8 per 10 thousand inhabitants. Of the 55 records, females were more prevalent 61.81%, ranging in age from 41 to 50 years; 23.5% had multiple aneurysms. Regarding Hunt-Hess and Fisher scales, respectively obtained 40% with Hunt-Hess grade two and 35.7% with Fisher grade three. 54.8% did not experience any neurological deficit from admission to discharge, and only 1.81% had neurological deficits after surgery; 3.7% of cases needed to be surgically re-approached. Operative mortality was 3.5%. Conclusion There is a prevalence of Subarachnoid Hemorrhage Aneurysmal in Petrolina/PE 1.8 per 10,000 inhabitants.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/surgery , Intracranial Aneurysm/epidemiology , Intracranial Aneurysm/surgery
5.
Yonsei Medical Journal ; : 403-409, 2015.
Article in English | WPRIM | ID: wpr-141641

ABSTRACT

PURPOSE: The purpose was to evaluate the incidence and risk factors for rebleeding during cerebral angiography in ruptured intracranial aneurysms. MATERIALS AND METHODS: Among 1896 patients with ruptured intracranial aneurysms between September 2006 and December 2013, a total of 11 patients who experienced rebleeding of the ruptured aneurysms during digital subtraction angiography (DSA) were recruited in this study. RESULTS: There were 184 patients (9.7%) who had suffered rebleeding prior to the securing procedure. Among them, 11 patients experienced rebleeding during DSA and other 173 patients at a time other than DSA. Eight (72.7%) of the 11 patients experienced rebleeding during three-dimensional rotational angiography (3DRA). The incidence of rebleeding during DSA was 0.6% in patients with ruptured intracranial aneurysms. Multivariate logistic regression analysis showed that aneurysm location in anterior circulation [odds ratio=14.286; 95% confidence interval (CI), 1.877 to 250.0; p=0.048] and higher aspect ratio (odds ratio=3.040; 95% CI, 1.896 to 10.309; p=0.041) remained independent risk factors for rebleeding during DSA. CONCLUSION: Ruptured aneurysms located in anterior circulation with a high aspect ratio might have the risk of rebleeding during DSA, especially during 3DRA.


Subject(s)
Adult , Aged , Aneurysm, Ruptured , Angiography, Digital Subtraction/methods , Cerebral Angiography/methods , Female , Humans , Imaging, Three-Dimensional/methods , Incidence , Intracranial Aneurysm/epidemiology , Intracranial Hemorrhages/epidemiology , Male , Middle Aged , Recurrence , Risk Factors , Tomography, X-Ray Computed
6.
Yonsei Medical Journal ; : 403-409, 2015.
Article in English | WPRIM | ID: wpr-141640

ABSTRACT

PURPOSE: The purpose was to evaluate the incidence and risk factors for rebleeding during cerebral angiography in ruptured intracranial aneurysms. MATERIALS AND METHODS: Among 1896 patients with ruptured intracranial aneurysms between September 2006 and December 2013, a total of 11 patients who experienced rebleeding of the ruptured aneurysms during digital subtraction angiography (DSA) were recruited in this study. RESULTS: There were 184 patients (9.7%) who had suffered rebleeding prior to the securing procedure. Among them, 11 patients experienced rebleeding during DSA and other 173 patients at a time other than DSA. Eight (72.7%) of the 11 patients experienced rebleeding during three-dimensional rotational angiography (3DRA). The incidence of rebleeding during DSA was 0.6% in patients with ruptured intracranial aneurysms. Multivariate logistic regression analysis showed that aneurysm location in anterior circulation [odds ratio=14.286; 95% confidence interval (CI), 1.877 to 250.0; p=0.048] and higher aspect ratio (odds ratio=3.040; 95% CI, 1.896 to 10.309; p=0.041) remained independent risk factors for rebleeding during DSA. CONCLUSION: Ruptured aneurysms located in anterior circulation with a high aspect ratio might have the risk of rebleeding during DSA, especially during 3DRA.


Subject(s)
Adult , Aged , Aneurysm, Ruptured , Angiography, Digital Subtraction/methods , Cerebral Angiography/methods , Female , Humans , Imaging, Three-Dimensional/methods , Incidence , Intracranial Aneurysm/epidemiology , Intracranial Hemorrhages/epidemiology , Male , Middle Aged , Recurrence , Risk Factors , Tomography, X-Ray Computed
7.
Yonsei Medical Journal ; : 987-992, 2015.
Article in English | WPRIM | ID: wpr-150487

ABSTRACT

PURPOSE: The operative risk and natural history rupture risk for the treatment of unruptured intracranial aneurysms (UIAs) should be evaluated. The purpose of this study was to report our experience with treating UIAs and to outline clinical risk factors associated with procedure-related major neurological complications. MATERIALS AND METHODS: We treated 1158 UIAs in 998 patients over the last 14 years. All patients underwent operation performed by a single microvascular surgeon and two interventionists at a single institution. Patient factors, aneurysm factors, and clinical outcomes were analyzed in relation to procedure-related complications. RESULTS: The total complication rate was 22 (2.2%) out of 998 patients. Among them, complications developed in 14 (2.3%) out of 612 patients who underwent microsurgery and in 8 (2.1%) out of 386 patients who underwent endovascular procedures. One patient died due to intraoperative rupture during an endovascular procedure. The procedure-related complication was highly correlated with age (p=0.004), hypertension (p=0.002), and history of ischemic stroke (p<0.001) in univariate analysis. The multivariate analysis revealed previous history of ischemic stroke (p=0.001) to be strongly correlated with procedure-related complications. CONCLUSION: A history of ischemic stroke was strongly correlated with procedure-related major neurological complications when treating UIAs. Accordingly, patients with UIAs who have a previous history of ischemic stroke might be at risk of procedure-related major neurological complications.


Subject(s)
Aged , Aneurysm, Ruptured , Endovascular Procedures/methods , Female , Humans , Intracranial Aneurysm/epidemiology , Male , Microsurgery , Middle Aged , Nervous System Diseases , Neurosurgical Procedures , Postoperative Complications/epidemiology , Risk , Risk Assessment , Risk Factors , Treatment Outcome
8.
Arq. neuropsiquiatr ; 63(2b)jun. 2005. tab
Article in English | LILACS | ID: lil-404589

ABSTRACT

OBJETIVO: A associação das anormalidades do septo interatrial - forame oval patente (FOP) e aneurisma de septo interatrial (ASA) - com acidente vascular cerebral isquêmico (AVCI) ainda é questão de incerteza para muitos autores. No entanto, vários estudo mostram que em pacientes jovens tais anormalidades podem estar relacionadas à gênese de eventos isquêmicos. Nosso objetivo é descrever a prevalência do FOP e ASA em uma coorte de pacientes jovens (< 55 anos) com AVCI e acompanhar estes pacientes após fechamento cirúrgico ou por prótese endovascular. MÉTODO: Em 21 meses de estudo, identificamos todos os pacientes com menos de 55 anos de idade admitidos em nosso hospital por AVCI. Consideramos AVCI como criptogenético quando não havia uma causa provável para AVCI. Todos os pacientes foram submetidos ao ecocardiograma transesofágico. O fechamento por prótese endovascular foi o procedimento oferecido àqueles com alguma anormalidade do septo interatrial. Os pacientes foram acompanhados mensalmente e submetidos a antiagregação plaquetária com AAS ou clopidogrel. RESULTADOS: Foram admitidos 32 pacientes jovens com AVCI. Após ampla investigação, 29 receberam o diagnóstico de AVCI criptogênico. Destes, 12 (12/29 - 41,3%) apresentaram alguma anormalidade do septo interatrial; sendo que em 7 havia a associação de FOP e ASA. Dez pacientes foram submetidos a fechamento endovascular percutâneo e 2 foram submetidos a fechamento cirúrgico. Até o momento, nenhum paciente relatou recorrência do evento isquêmico e 2 pacientes relataram melhora das crises de enxaqueca (14 meses de seguimento). CONCLUSÃO: Nossa pequena série de casos está de acordo com outros estudos e sugere uma possível relação entre anormalidades do septo interatrial e AVCI em pacientes jovens. Maiores estudos são necessários para comprovar esta associação e para definir a melhor conduta terapêutica.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Brain Ischemia/etiology , Heart Septal Defects, Atrial/epidemiology , Intracranial Aneurysm/epidemiology , Brazil/epidemiology , Cohort Studies , Heart Septal Defects, Atrial/complications , Intracranial Aneurysm/complications , Prevalence , Prospective Studies , Stroke/etiology
9.
Rev. chil. neuro-psiquiatr ; 41(2): 11-116, abr.-jun. 2003. ilus, tab
Article in Spanish | LILACS | ID: lil-383461

ABSTRACT

Objetivo. Determinar las características clínicas y epidemiológicas de los Aneurismas cerebrales, a partir de los datos encontrados. Materiales y método. Se realizó un estudio retrospectivo descriptivo, en el cual se revisaron protocolos de seguimiento de pacientes portadores de Aneurismas Cerebrales en el Hospital Clínico Regional de Concepción, desde agosto del año 2000 hasta febrero del año 2002, tabulando y analizando los resultados. Resultados. De 38 protocolos revisados, encontramos 2 pacientes fallecidos. Predominó el sexo femenino con un 73,68 por ciento, la edad promedio fue 48,79 años (DE + 13.67) y el antecedente mórbido más encontrado fue la hipertensión arterial crónica en un 39,47 por ciento de los pacientes. Respecto al ingreso, el 69,69 por ciento tenía Score de Glasgow mayor o igual a 13 y el 54,83 por ciento tenía grado III de Hunt y Hess. Los signos clínicos más encontrados fueron los de irritación meníngea (60,52 por ciento) seguidos por el tercer par. El 100 por ciento de los aneurismas se ubicó en la circulación anterior. La media de días previos a la cirugía y de días de hospitalización de los pacientes fue de 14,95 (DE + 10,04) y 29,74 días (DE + 10,21) respectivamente. Finalmente el 50 por ciento de los pacientes presentó Karnofsky de egreso igual a 100. Conclusión. Los aneurismas cerebrales son una patología de gran importancia por las repercusiones que tiene tanto para el paciente como para la sociedad.


Subject(s)
Humans , Intracranial Aneurysm/epidemiology , Chile , Epidemiology, Descriptive , Retrospective Studies
10.
Neurol India ; 2003 Mar; 51(1): 22-6
Article in English | IMSEAR | ID: sea-120892

ABSTRACT

One thousand human brains of both sexes were examined. Aneurysms were found in 10 specimens (1%). The incidence of aneurysms was 1.6% in females and 0.8% in males. All the aneurysms were saccular. The aneurysms varied in size. In 5 specimens the aneurysms were minute bulbous dilatations. In the rest of the cases it varied from 0.2 to 2.5 cm. In 7 specimens the aneurysms were present at the junction of anterior cerebral artery with the anterior communicating artery, in 2 on the anterior communicating artery and in one specimen it was seen at the origin of posterior communicating artery. The youngest subject with saccular aneurysm was an 18-years-old male and the oldest was a 55-years-old male. No aneurysm was found in the brains of 94 children (1-17 years).


Subject(s)
Adolescent , Adult , Female , Humans , Incidence , India/epidemiology , Intracranial Aneurysm/epidemiology , Male , Middle Aged
11.
Rev. chil. neurocir ; 20: 40-43, 2003. tab
Article in Spanish | LILACS | ID: lil-390359

ABSTRACT

Se presentan una serie de 16 pacientes menores a 20 años portadores de aneurismas cerebrales intervenidos en el Hospital Carlos van Buren. En la muestra predominaron los pacientes de sexo femenino, los aneurismas de carótida interna y cerebral media fueron los más frecuentes. No hubo mortalidad y el estado de alta fue bueno en 15 de los 16 enfermos.


Subject(s)
Humans , Male , Adolescent , Female , Intracranial Aneurysm/classification , Intracranial Aneurysm/complications , Intracranial Aneurysm/epidemiology , Chile
12.
Arq. neuropsiquiatr ; 59(3B): 676-680, Sept. 2001. tab
Article in English | LILACS | ID: lil-295829

ABSTRACT

OBJECTIVE: Clinical and surgical outcome of patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm were assessed in comparison to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding. METHODS: We evaluated 100 consecutive patients with aneurysmal SAH. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and before surgery Hunt Hess scale, need for cerebro-spinal fluid shunt, presence of complications during the surgical procedure, Glasgow Outcome Scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. For statistical analysis, we applied the chi-squared test or Fisher's test using the pondered kappa coeficient. Kruskal-Wallis test was used for comparison of continue variables. Tendency of proportion was analyzed through Cochran-Armitage test. Significance level adopted was 5 percent. RESULTS: Patients studied were mainly white, female, without previous history of hypertension and non-smokers. Upon hospital admittance, grade 2 of Hunt-Hess scale was most frequently observed (34 percent), while grade 3 of Fisher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, between 12 and 24 mm. The most frequent Glasgow Outcome Scale observed was 5 (60 percent). Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome (p=0.00002 and p=0.001, respectively). Other variables were not significantly correlated to prognosis. Tendency of proportion was observed between Hunt-Hess scale and Fisher scale. CONCLUSION: Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms, the Hunt-Hess scale upon the moment of surgery and the presence of surgical adversities are statistically related to degree of disability


Subject(s)
Humans , Male , Female , Middle Aged , Subarachnoid Hemorrhage/surgery , Brazil/epidemiology , Glasgow Coma Scale , Intracranial Aneurysm/epidemiology , Intracranial Aneurysm/surgery , Postoperative Complications , Preoperative Care , Prospective Studies , Risk Factors , Statistics, Nonparametric , Subarachnoid Hemorrhage/epidemiology , Treatment Outcome
13.
Article in English | IMSEAR | ID: sea-43058

ABSTRACT

We retrospectively reviewed the 380 patients on whom surgery was performed for intracranial aneurysms between January 1987 and December 1997. The incidence of multiple intracranial aneurysms (MIA) in our hospital was 8.7 per cent (33/380 cases). The management outcome of 33 patients with MIA was assessed 6 months after SAH. The outcome was poorer for patients with MIA than for those with a single intracranialaneurysm (SIA). The mortality and morbidity in all grades were 24.2 per cent in patients with MIA and 16.7 per cent and 19.6 per cent respectively in those with SIA. Delayed neurological deficit and treatment outcome of poor grade patients had significant contribution to outcome in patients with MIA, more than in patients with SIA.


Subject(s)
Adult , Aged , Female , Humans , Incidence , Intracranial Aneurysm/epidemiology , Male , Middle Aged , Retrospective Studies , Thailand/epidemiology
14.
Article in English | IMSEAR | ID: sea-40715

ABSTRACT

119 patients with surgically treated intracranial aneurysm between December 18, 1984 and October 1997 were analyzed resulting in nine patients with intraoperative aneurysm rupture. These nine cases formed the basis of this study. The incidence of intraoperative aneurysm rupture was 7.6 per cent. The mortality was 33.3 per cent. In our institution, maneuvers used to control profuse hemorrhage include induced hypotension, suction dissection, and temporary clips at the parent vessels. Some controversies exist regarding the effect of timing of surgery on intraoperative aneurysm rupture and ischemic consequence from induced hypotension. The argument is whether early surgery, within 72 hours, increases the incidence of intraoperative aneurysm rupture.


Subject(s)
Aged , Aneurysm, Ruptured/epidemiology , Female , Humans , Incidence , Intracranial Aneurysm/epidemiology , Intraoperative Complications/epidemiology , Male , Middle Aged , Retrospective Studies , Thailand/epidemiology , Treatment Outcome
15.
Article in English | IMSEAR | ID: sea-44079

ABSTRACT

We retrospectively reviewed the 107 patients on whom direct surgery was performed for intracranial aneurysms between December 18, 1984 and July 25, 1996. The incidence of multiple intracranial aneurysms in our hospital is 6.5 per cent (7/107 cases). There were 16 aneurysms in 7 cases with multiple aneurysms. There were 2 and 5 patients with 3 and 2 aneurysms respectively. The most common site was at the junction of posterior communicating artery (PCoA) and internal carotid artery (ICA). The preoperative conditions of the patients were closely related to the operative results. We performed direct surgery on bilateral aneurysms by bifrontal approaches. There was no mortality.


Subject(s)
Adult , Age Distribution , Aged , Female , Hospitals , Humans , Incidence , Intracranial Aneurysm/epidemiology , Male , Middle Aged , Retrospective Studies , Risk Factors , Sex Distribution , Survival Rate , Thailand/epidemiology
16.
Med. UIS ; 11(4): 214-7, oct.-dic. 1997. ilus
Article in Spanish | LILACS | ID: lil-232013

ABSTRACT

La hemorragia subaracnoidea producida por la ruptura de un aneurisma cerebral es una entidad relativamente frecuente que afecta a una población activa y es capaz de generar altos grados de incapacidad y mortalidad. Se debe resaltar la importancia que el diagnóstico precoz tiene sobre el pronóstico. Los dos principales problemas que generan las mayores complicaciones son el resangrado y el vasoespasmo arterial. Un adecuado entendimiento de la fisiología es vital para obtener los mejores resultados terapéuticos, evitando aumentar la morbi-mortalidad que ya posee por si sola esta entidad


Subject(s)
Humans , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/drug therapy , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/mortality , Subarachnoid Hemorrhage/physiopathology , Subarachnoid Hemorrhage/rehabilitation , Subarachnoid Hemorrhage/surgery , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/epidemiology , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/rehabilitation , Intracranial Aneurysm/surgery
17.
Medicina (B.Aires) ; 55(1): 59-68, 1995. tab, ilus
Article in Spanish | LILACS | ID: lil-153963

ABSTRACT

Las dolicoectasias de las arterias intracraneanas es una entidad caracterizada por la dilatación y elongación de las arterias intracraneales, siendo la base del encéfalo el sitio más afectado. Su incidencia es menor del 0,05 por ciento y representan el 7 por ciento de los aneurismas intracraneanos. Predomina en el sexo masculino, habitualmente adultos de más de 40 años y con historia de hipertensión arterial. La presentación clínica es variada dependiendo del área vascular afectada. Si se afecta el territorio carotídeo predominan los cuadros isquémicos, mientras que cuando el afectado es el vertebrobasilar, los fenómenos compresivos sobre el tronco cerebral y/o pares craneales son más frecuentes. Es rara la ruptura de esta malformación ocasionando hemorragia intracraneana, así como también la producción de trastornos neurovegetativos. La anatomía patológica muestra engrosamiento de la pared arterial, degeneración hialina de la capa muscular, esclerosis de la íntima en parches y pérdida de la membrana elástica interna, esto último en forma casi constante. La metodología diagnóstica ha mejorado notablemente con la introducción de la tomografía computada, la resonancia magnética (RM) y la angiografía por RM. La angiografía convencional y por substracción digital dejó de ser necesaria, excepto en los casos en que se sospecha aneurisma sacular coexistente, evidencia de hemorragia subaracnoidea, o se decida tratamiento quirúrgico de la malformación vascular. El tratamiento quirúrgico endovascular consiste en la colocación de balón y espirales de platino. El tratamiento quirúrgico extravascular pasa por la oclusión arterial, y la envoltura de la malformación y clipado de refuerzo. El pronóstico es variable dependiendo de la edad del paciente, la precocidad en el diagnóstico y el manejo de los factores de riesgo, aunque en general presentan una evolución poco favorable


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Intracranial Aneurysm/diagnosis , Intracranial Arteriovenous Malformations/diagnosis , Cerebral Arteries/pathology , Intracranial Aneurysm/epidemiology , Intracranial Aneurysm/etiology , Intracranial Aneurysm/therapy , Intracranial Arteriovenous Malformations/complications , Intracranial Arteriovenous Malformations/epidemiology , Intracranial Arteriovenous Malformations/therapy , Risk Factors
18.
Rev. chil. neurocir ; 8(12): 43-50, 1994. tab
Article in Spanish | LILACS | ID: lil-173280

ABSTRACT

Se presenta una serie inédita de doce casos de aneurisma seculares en pacientes pediátricos bajo los 15 años de edad (promedio 12 años) observados en el Instituto de Neurocirugía Alfonso Asenjo durante un período de 10 años (1980-1990). La proporción entre hombres y mujeres fue de 1,4: 1 siendo la paciente más joven de sólo 6 años de edad. Se excluyó las lesiones aneurimáticas micóticas como también las hemorragias secundarias a la ruptura de malformaciones arteriovenosas y aquellas con clínica de hemorragias subaracnoideas, pero sin demostración angiográfica. El 91.6 porciento presentó sintomatología inicial típica de hemorragia subaracnoidea. Usando la clasificación de Hunt y Hess al ingreso de los pacientes se advirtió que el 41.7 porciento fue admitido en grado 1 y el 33 porciento en grado 2. Los aneurismas se localizan preferentemente en la circulación anterior con un 83,4 porciento encontrándose un 50 porciento del total ubicados en la bifurcación del sifón carotideo. Del total de doce casos estudiados 10 llegaron a la intervención quirúrgica falleciendo un niño por resangramiento pre-operatorio y otro por la hipertensión endocraneana inducida por un voluminoso hematoma intracerebral. La mortalidad operatoria fue del 10 porciento. Los resultados finales muestran a 8 niños (66 porciento) con una buena recuperación neurológica regresando a su vida escolar y sólo un caso con deterioro sico orgánico significativo. Se discuten aspectos clínicos quirúrgicos com tambien históricos y el desarrollo de la patología aneurismática en edad pediátrica comparando algunos resultados con otras series de la literatura y con la serie de adultos del mismo Instituto de Neurocirugía. Se plantean algunas diferencias locales con la experiencia internacional con respecto a tamaño y ubicación de los aneurismas y se plantean algunas conductas a seguir


Subject(s)
Humans , Male , Female , Adolescent , Intracranial Aneurysm/epidemiology , Angiography , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/pathology , Intracranial Aneurysm/surgery , Tomography, X-Ray Computed
19.
In. Universidad Nacional Autónoma de Honduras. Unidad de Investigación Científica. Memoria. Primera Jornada Cientifica Facultad de Ciencias Medicas Ecologia y Salud Humana. Tegucigalpa, Graficentro Editores, 1994. p.21.
Monography in Spanish | LILACS | ID: lil-136008
20.
Rev. bras. neurol ; 28(5): 143-5, set.-out. 1992. ilus
Article in Portuguese | LILACS | ID: lil-123023

ABSTRACT

O hospital de base é o centro de referência do Sistema Médico de Brasília e recebe pacientes admitidos nos Hospitais Regionais do DF, atendendo a uma populaçäo estimada na ocasiäo em torno de 1,5 milhöes de habitantes. Durante o ano de 1985, 159 pacientes foram admitidos com diagnóstico de acidente vascular cerebral hemorrágico. Desse total de pacientes, 60,58% tiveram como causa determinante a rotura de um aneurisma intracraniano. Levando-se em conta as características da organizaçao do Sistema de Saude de Brasília, esse número significa que aproximadamente 5,5 pacientes por 100.000 habitantes por ano säo admitidos com rotura de aneurisma intracraniano em Brasília


Subject(s)
Intracranial Aneurysm/epidemiology , Subarachnoid Hemorrhage , Cerebral Hemorrhage , Cerebrovascular Disorders/epidemiology , Health Systems
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