Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 346
Filter
1.
Biomédica (Bogotá) ; 41(2): 218-224, abr.-jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1339260

ABSTRACT

Resumen. La otitis media es una infección frecuente en la infancia, la cual puede producir complicaciones, incluidas las neurológicas graves, en cuatro de cada 100 niños en países en desarrollo. Se presenta el caso de una niña de nueve años sin antecedentes de enfermedad que consultó por otitis media derecha, otorrea, síndrome de hipertensión intracraneal y parálisis del VI nervio craneal contralateral a la lesión. La tomografía computarizada de cráneo y la resonancia magnética cerebral revelaron otomastoiditis crónica, apicitis petrosa, y trombosis de los senos transverso y sigmoide, el bulbo yugular y la vena yugular interna derecha. Recibió tratamiento antibiótico y quirúrgico. Este caso refleja el espectro de complicaciones intracraneales y extracraneales asociadas con la otitis media aguda en la era antibiótica. El examen físico permite la detección precoz de la hipertensión intracraneal, con signos como el papiledema y la parálisis del VI par contralateral como hallazgo inusual.


Abstract. Otitis media is a frequent infection during childhood. Complications may be present in up to 4 of 100 children including serious neurological complications, particularly in developing countries. We report the case of a 9-year-old girl with no disease history who presented with otitis media, otorrhea, intracranial hypertension syndrome, and paralysis of the VI cranial nerve contralateral to the lesion. A computed tomography scan of the skull and a brain magnetic resonance imaging revealed chronic otomastoiditis, petrous apicitis, and thrombosis of the transverse and sigmoid sinus, the jugular bulb, and the right internal jugular vein. She received antibiotics and surgical treatment. This case shows the spectrum of intra and extracranial complications associated with acute otitis media in the antibiotic era. The physical examination allows early identification of intracranial hypertension with signs such as papilledema and sixth contralateral nerve palsy as an unusual finding.


Subject(s)
Otitis Media , Sinus Thrombosis, Intracranial , Intracranial Hypertension , Abducens Nerve Diseases , Petrositis , Mastoiditis
2.
Article in English | WPRIM | ID: wpr-922607

ABSTRACT

OBJECTIVES@#Idiopathic intracranial hypertension (IIH) is a syndrome that excludes secondary causes such as intracranial space-occupying lesion, hydrocephalus, cerebrovascular disease, and hypoxic ischemic encephalopathy. If not be treated promptly and effectively, IIH can cause severe, permanent vision disability and intractable, disabling headache. This study aims to explore the clinical and image features for IIH, to help clinicians to understand this disease, increase the diagnose rate, and improve the outcomes of patients.@*METHODS@#We retrospectively analyzed 15 cases of IIH that were admitted to Xiangya Hospital, Central South University, during January 2015 to September 2020. The diagnosis of IIH was based on the updated modified Dandy criteria. We analyzed clinical data of patients and did statistical analysis, including age, gender, height, weight, medical history, physical examination, auxiliary examination, treatment and outcome.@*RESULTS@#There were 10 females and 5 males. Female patients were 22 to 42 years old with median age of 39.5. Male patients were 27 to 52 years old with the median age of 44.0. The BMI was 24.14-34.17 (28.71±2.97) kg/m@*CONCLUSIONS@#IIH primarily affects women of childbearing age who are overweight. The major hazard of IIH is the severe and permanent visual loss. Typical image signs have high specificity in IIH diagnosis. Prompt diagnosis and effective treatment are significantly important to improve the outcomes of patients.


Subject(s)
Adult , Anemia, Iron-Deficiency , Female , Humans , Intracranial Hypertension , Male , Middle Aged , Pseudotumor Cerebri/diagnostic imaging , Retrospective Studies , Ventriculoperitoneal Shunt , Young Adult
3.
Chinese Journal of Traumatology ; (6): 344-349, 2021.
Article in English | WPRIM | ID: wpr-922348

ABSTRACT

PURPOSE@#Hypertonic fluids such as mannitol and half-molar sodium lactate are given to treat intracranial hypertension in patients with severe traumatic brain injury (TBI). In this study, sodium lactate was compared to mannitol in patients with TBI to investigate the efficacy in reducing intracranial pressure (ICP).@*METHODS@#This study was a systematic review with literature research on articles published in any year in the databases of PubMed, ScienceDirect, Asian Journal of Neurosurgery, and Cochrane Central Register of Controlled Trials. The keywords were "half-molar sodium lactate", "mannitol", "cerebral edema or brain swelling", and "severe traumatic brain injury". The inclusion criteria were (1) studies published in English, (2) randomized control trials or retrospective/prospective studies on TBI patients, and (3) therapies including half-molar sodium lactate and mannitol and (4) sufficient data such as mean difference (MD) and risk ratio (RR). Data analysis was conducted using Review Manager 5.3.@*RESULTS@#From 1499 studies, a total of 8 studies were eligible. Mannitol group reduced ICP of 0.65 times (MD 0.65; p = 0.64) and improved cerebral perfusion pressure of 0.61 times (MD 0.61; p = 0.88), better than the half-molar group of sodium lactate. But the half-molar group of sodium lactate maintained the mean arterial pressure level of 0.86 times, better than the mannitol group (MD 0.86; p = 0.09).@*CONCLUSION@#Half-molar sodium lactate is as effective as mannitol in reducing ICP in the early phase of brain injury, superior over mannitol in an extended period. It is able to prevent intracranial hypertension and give better brain tissue perfusion as well as more stable hemodynamics. Blood osmolarity is a concern as it increases serum sodium.


Subject(s)
Brain Edema , Brain Injuries, Traumatic/drug therapy , Diuretics, Osmotic/therapeutic use , Humans , Intracranial Hypertension/etiology , Intracranial Pressure , Mannitol/therapeutic use , Prospective Studies , Retrospective Studies , Saline Solution, Hypertonic , Sodium Lactate
4.
Article in Chinese | WPRIM | ID: wpr-878734

ABSTRACT

Idiopathic intracranial hypertension,also known as pseudotumor cerebri,is a syndrome characterized by raised intracranial pressure of unknown cause.These patients present normal neuroimaging and cerebrospinal fluid analysis while increased intracranial pressure and associated symptoms and signs.Delay of treatment can cause severe visual impairment.There are some new understandings of this disease,and we will review the pathogenesis,diagnosis,and treatment of idiopathic intracranial hypertension.


Subject(s)
Humans , Intracranial Hypertension , Neuroimaging , Pseudotumor Cerebri/therapy
5.
Rev. méd. Urug ; 36(4): 156-184, dic. 2020. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1144756

ABSTRACT

Resumen: El drenaje lumbar externo es un procedimiento invasivo de extracción de líquido cefalorraquídeo del espacio espinal cuyo uso se ha incrementado en los últimos años en el contexto de la medicina neurocrítica. Si bien no es recomendado por las guías o consensos internacionales, tiene un lugar en el manejo de algunas situaciones clínicas específicas vinculadas a diferentes tipos de neuroinjuria grave. Se realiza una revisión no sistemática de la literatura, a lo que se suma la experiencia de los autores. Se plantean las principales indicaciones actuales, se detallan las características de su manejo en los distintos escenarios clínicos y se señalan las contraindicaciones y complicaciones del procedimiento.


Summary: The placement of an external lumbar drainage (ELD), an invasive procedure to extract cerebrospinal fluid (CSF) from the spinal space, has gradually increased in practice in recent years within the context of neurocritical medicine. Despite it not being recommended by international guidelines or consensus, it is used for the handling of a few specific clinical situations in connection with different types of severe brain injury. The study consists of a non-systematic review of the literature, along with the authors' experience, presenting the main current indications and details for its handling in the different clinical scenarios and describing side effects and complications of the procedure.


Resumo: A drenagem lombar externa é um procedimento invasivo para extração do líquido cefalorraquidiano do espaço espinhal, cujo uso tem aumentado nos últimos anos no contexto da medicina neurocrítica. Embora não seja recomendado por consensos ou diretrizes internacionais, tem lugar no manejo de algumas situações clínicas específicas ligadas a diferentes tipos de dano neurológico grave. Realiza-se uma revisão não sistemática da literatura, à qual se soma a experiência dos autores. Apresentam-se as principais indicações atuais, detalham-se as características de seu manejo nos diferentes cenários clínicos e apontam-se as contraindicações e complicações do procedimento.


Subject(s)
Subarachnoid Hemorrhage , Cerebrospinal Fluid , Drainage , Intracranial Hypertension
6.
Rev. cuba. med. gen. integr ; 36(2): e1123, abr.-jun. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1138969

ABSTRACT

Introducción: Los tumores cerebrales a veces tienen una presentación clínica compleja y atípica en sus inicios, en dependencia de su localización, lo que puede confundirse con trastornos de la esfera psiquiátrica. Objetivo: Describir un caso clínico interpretado como una psicosis por su sintomatología cuyo diagnóstico resultó un glioblastoma multiforme de alta malignidad. Caso clínico: Mujer de 35 años que comienza desde hace varios meses con trastornos de la conducta, síntomas depresivos, irritabilidad y conflictos en el hogar. Se instala un cuadro de depresión profunda que no mejora con tratamiento farmacológico impuesto por psiquiatría y se decide tratamiento electroconvulsivo, después del cual cae en estado de coma con elementos de hipertensión intracraneal y focalización neurológica. La tomografía de urgencia evidencia un tumor intracraneal, con áreas de necrosis, infiltración y desplazamiento de estructuras adyacentes y signos de hipertensión intracraneal. Al realizar intervención microquirúrgica fallece. La necropsia reveló glioblastoma multiforme de alta malignidad con focos de necrosis y de hemorragias. Conclusiones: La depresión y manifestaciones de trastornos mentales pueden tener causa orgánica, un hecho que debe considerarse en el contexto clínico. La historia clínica bien obtenida, la evaluación psicopatológica y las técnicas de imágenes en la actualidad son herramientas fundamentales en la precisión diagnóstica(AU)


Introduction: Brain tumors sometimes have a complex and atypical clinical presentation at the beginning, depending on their location, which can be mistaken for psychiatric disorders. Objective: To describe a clinical case interpreted as a psychosis for its symptoms and whose diagnosis was a highly malignant glioblastoma multiforme. Clinical case: This is the case of a 35-year-old woman who, several months ago, started to present behavioral disorders, depressive symptoms, irritability, and conflicts at home. Clinical signs of deep depression onset, which does not improve with pharmacological treatment prescribed by the psychiatry specialist; electroconvulsive treatment is decided, after which she falls into a coma with elements of intracranial hypertension and a neurological focus. The emergency tomography shows an intracranial tumor, with necrotic areas, infiltration, and displacement of adjacent structures, as well as signs of intracranial hypertension. When microsurgical intervention is performed, she died. The necropsy revealed highly malignant glioblastoma multiforme with necrosis focuses and hemorrhage. Conclusions: Depression and manifestations of mental disorders may have an organic cause, a fact that must be considered in the clinical setting. A well-obtained clinical history, psychopathological evaluation, and imaging techniques are currently essential tools for an accurate diagnosis(AU)


Subject(s)
Humans , Female , Bipolar Disorder/diagnosis , Tomography, X-Ray Computed/methods , Glioblastoma/diagnostic imaging , Intracranial Hypertension/diagnosis
7.
Rev. colomb. psiquiatr ; 49(2): 116-120, abr.-jun. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1115652

ABSTRACT

RESUMEN Introducción: El síndrome de Otelo, epónimo del personaje de Shakespeare, es un término diagnóstico transnosológico que designa un cuadro caracterizado por delirios de infidelidad respecto a la pareja que, por consiguiente, puede acarrear actitudes celotípicas y conductas violentas hacia ella. En su forma pura, corresponde al trastorno delirante de infidelidad, pero también puede ser secundario a organicidad cerebral y a consumo de drogas. Métodos: Reporte de caso y revisión no sistemática de la literatura relevante. Presentación del caso: Varón de 26 arios con antecedente de consumo de drogas y víctima de maltrato infantil, 3 años antes había sufrido crisis convulsivas tónico-clónicas e hipertensión intracraneal, por lo que se sometió a una craneotomía, en la que se halló un tuberculoma cerebral frontal derecho. Tras un lapso, comenzó con delirios de infidelidad y conductas violentas hacia su pareja. Revisión de la literatura: Los celos delirantes se asocian, como otros delirios, a lesiones del lóbulo frontal derecho. Pese a la elevada y creciente prevalencia mundial de tuberculosis, no se han publicado casos de síndrome de Otelo secundario a tuberculoma cerebral. Conclusiones: El síndrome de Otelo, aunque no es la principal causa de violencia doméstica, puede asociarse con manifestaciones particularmente violentas y ser secundario a tuberculoma cerebral. Este es el primer caso de tal índole que se publica.


ABSTRACT Introduction: Othello syndrome, an eponym of Shakespeare's character, is a transnosological diagnostic term that designates a clinical picture characterised by the presence of delusions of infidelity with respect to a partner and that, consequently, can lead to typical jealousy attitudes and violent behaviour towards the partner. In its pure form, it corresponds to delusional disorder of infidelity, but it may also be secondary to brain organicity and drug use. Methods: Case report and non-systematic review of the relevant literature. Case presentation: A 26-year-old man, with a history of drug abuse and a victim of domestic violence as a child, presented with tonic-clonic seizures and intracranial hypertension three years ago, for which he underwent a craniotomy with the finding of a right frontal cerebral tuberculoma. After a lapse, he developed a clinical picture of delusions of infidelity regarding his partner and violent behaviour towards her. Literature review: Delusional jealousy is associated, like other delusions, with lesions of the right frontal lobe. Despite the high and growing prevalence of tuberculosis worldwide, there are no reported cases of Othello syndrome secondary to cerebral tuberculoma in the literature. Conclusion: Othello syndrome, although not the main cause of domestic violence, can be associated with particularly violent manifestations and be secondary to cerebral tuberculoma. This is the first published case of its kind.


Subject(s)
Humans , Male , Adult , Syndrome , Substance-Related Disorders , Jealousy , Schizophrenia, Paranoid , Seizures , Attitude , Prevalence , Domestic Violence , Intracranial Hypertension , Craniotomy , Diagnosis , Eponyms , Frontal Lobe
8.
In. Verga, Federico; Burghi, Gastón. Encares de paciente crítico. Montevideo, Oficina del Libro FEFMUR, 2020. p.59-75.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1342637
10.
Rev. argent. neurocir ; 33(4): 214-219, dic. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1152291

ABSTRACT

Introducción: El neurocitoma central fue descripto por primera vez en 1982 por Hassoun et al. Se trata de una neoplasia rara, bien diferenciada del sistema nervioso central de origen neuroectodermico, ubicado más comúnmente a nivel del sistema ventricular, típicamente adyacente al foramen de Monro. Cursa generalmente con síntomas de hipertensión intracraneal secundaria a hidrocefalia no comunicante. Afecta generalmente a adultos jóvenes, con edad de presentación media de 29 años en las mayores series descriptas. Objetivos: Describir y presentar un caso de tumor cerebral específico, cuya importancia se da debido a su baja prevalencia y escasa casuística relatada en la literatura. Descripción del caso: En el presente artículo describimos un caso de una paciente de 35 años diagnosticada incidentalmente con una lesión ocupante de espacio a nivel del ventrículo lateral izquierdo redondeada, heterogénea, de bordes netos con dimensiones de 40x30x30 mm. La paciente fue intervenida quirúrgicamente para su resección. Se realizó abordaje interhemisférico transcalloso homolateral. Sin intercurrencias post-quirúrgicas fue dada de alta 4 días luego de la cirugía. El informe anatomo-patológico demostró tratarse de un Neurocitoma Central. Se comparó nuestro caso con lo descripto en la literatura. Conclusión: El neurocitoma central a pesar de no ser una patología prevalente, debe ser conocido en profundidad por los neurocirujanos, ya que su correcto manejo afecta directamente al pronóstico de los pacientes


Introduction: The central neurocytoma was first described in 1982 by Hassoun et al. It is a rare, well-differentiated neoplasm of the central nervous system of neuroectodermal origin, located most commonly at the level of the ventricular system, typically adjacent to the foramen of Monro. It usually presents with symptoms of intracranial hypertension secondary to non-communicating hydrocephalus. It generally affects young adults, with an average age of presentation of 29 years in the largest series described. Objetives: Describe and present one case of specific brain tumor, which is important due to its your low prevalence and scarce casuistic in the literature. Case presentation: In the present article, we describe a case of a female 35-year-old patient diagnosed incidentally with a heterogeneus rounded space-occupying lesion at the level of the left lateral ventricle, with net edges and dimensions of 40x30x30mm. The patient was surgically intervened for tumoral resection. We opteded to use a homolateral transcallosal interhemisferic approach. Without post-surgical complications, she was discharged 4 days after surgery. The anatomo-pathological report proved to be a Central Neurocytoma. We compared our case with the existing publications. Conclusion: Despite being an uncommon tumor, Central Neurocytoma must be well understood by every neurosurgeon, considering that its adequated management influences the patient ́s prognosis directly


Subject(s)
Humans , Female , Neurocytoma , General Surgery , Brain Neoplasms , Central Nervous System , Intracranial Hypertension , Hydrocephalus
11.
Rev. medica electron ; 41(6): 1457-1470, oct.-dic. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1094142

ABSTRACT

RESUMEN La hipertensión intracraneal influye negativamente en el pronóstico del traumatismo craneoencefálico grave y del infarto maligno de la arteria cerebral media. La craniectomía descompresiva constituye una opción de tratamiento. Con esta revisión se persigue valorar las controversias de la craniectomía descompresiva en el tratamiento de la hipertensión endocraneana. Para lo cual se realizó una exhaustiva revisión de la literatura donde se tuvieron en cuenta diversos estudios multicéntricos y multinacionales que plasmaron aspectos polémicos acerca de la utilización de este proceder neuroquirúrgico como terapia en el manejo de la hipertensión endocraneana refractaria a tratamiento conservador. Se concluye que la craniectomía descompresiva se considera beneficiosa en el infarto maligno de la arteria cerebral media, mientras que en el trauma craneoencefálico grave su utilidad es controvertida (AU).


SUMMARY Intracranial hypertension negatively influences the prognosis of severe craniaencephalic trauma and malignant infarction of the middle cerebral artery. Decompressive craniotomy is a treatment option. The aim of this review is to assess the controversies of decompressive craniotomy in the treatment of intracranial hypertension. For this purpose, an exhaustive review of the literature was carried out, taking into account several multicentric and multinational studies revealing controversial aspects on the use of this neurosurgical procedure as therapy in the management of intracranial hypertension refractory to conservative treatment. It is concluded that decompressive craniotomy is considered beneficial in the malignant infarction of the middle cerebral artery, while in the case of severe craniaencephalic trauma its utility is controversial (AU).


Subject(s)
Humans , Intracranial Hypertension/surgery , Decompressive Craniectomy/methods , Randomized Controlled Trials as Topic , Infarction, Middle Cerebral Artery/diagnosis , Infarction, Middle Cerebral Artery/therapy , Brain Injuries, Traumatic/surgery , Brain Injuries, Traumatic/therapy , Survivorship
12.
J. bras. nefrol ; 41(3): 436-439, July-Sept. 2019. graf
Article in English | LILACS | ID: biblio-1040244

ABSTRACT

Abstract Introduction: The posterior reversible encephalopathy (PRES) syndrome encompasses a set of clinical-radiological findings associated with severe systemic arterial hypertension. This case report proposes to discuss the identification, diagnosis, and management of PRES in the pediatric population. Case presentation: Female patient, 10 years old, admitted to the emergency room with complaint of oliguria and generalized edema. At the initial physical exam, the only alteration present was anasarca. The diagnostic investigation revealed nephrotic syndrome, and clinical treatment was started. She evolved on the 8th day of hospitalization with peak hypertension, sudden visual loss, reduced level of consciousness, nystagmus, and focal seizures requiring intubation. She was transferred to the Intensive Care Unit, with neurological improvement, after the established therapy. CT scan revealed a discrete hypodense area in the white matter of the occipital lobe and anteroposterior groove asymmetry, compatible with PRES. Discussion: PRES is due to vasogenic cerebral edema of acute or subacute installation. Symptoms include headache and altered consciousness, stupor, coma, neurological deficits, seizures and cortical blindness. Nephropathies are the main cause of PRES in pediatrics. Magnetic resonance imaging with diffusion of molecules is the gold standard for diagnosis. The initial treatment objectives are the reduction of blood pressure, antiepileptic therapy, correction of hydroelectrolytic and acid-base disorders and management of intracranial hypertension. Conclusion: PRES is associated with acute hypertension. Early diagnosis and proper management may determine a better prognosis and minimize the severity of the clinical course.


Resumo Introdução: A Síndrome de Encefalopatia Posterior Reversível (SEPR) engloba um conjunto de achados clínico-radiológicos, associados a hipertensão arterial sistêmica grave. Este relato de caso propõe discutir a identificação, o diagnóstico e o manejo de SEPR na população pediátrica. Apresentação do caso: Paciente do sexo feminino, 10 anos, admitida em pronto-atendimento com queixa de oligúria e edema generalizado. Ao exame físico inicial, a única alteração presente era anasarca. A investigação diagnóstica revelou síndrome nefrótica, iniciando-se tratamento clínico. Evoluiu no 8º dia de internação com pico hipertensivo, perda visual súbita, redução do nível de consciência, nistagmo e crises convulsivas focais, demandando intubação. Foi transferida para Unidade de Terapia Intensiva, com melhora neurológica, após a terapêutica instituída. Tomografia de crânio evidenciou área de hipodensidade discreta em substância branca do lobo occipital e assimetria anteroposterior de sulcos, compatível com SEPR. Discussão: A SEPR decorre de edema cerebral vasogênico de instalação aguda ou subaguda. Sintomas descritos incluem cefaleia e alteração de consciência, estupor, coma, déficits neurológicos, convulsões e cegueira cortical. As nefropatias constituem as principais causas de SEPR em pediatria. A ressonância magnética com difusão de moléculas é o padrão-ouro para o diagnóstico. Os objetivos iniciais são a redução dos níveis pressóricos, terapia antiepiléptica, correção de distúrbios hidroeletrolíticos e do equilíbrio ácido-básico, e manejo da hipertensão intracraniana. Conclusão: A SEPR ocorre associada à hipertensão aguda. O diagnóstico precoce e manejo adequado podem determinar melhor prognóstico e minimizar a gravidade do curso clínico.


Subject(s)
Humans , Female , Child , Intracranial Hypertension/complications , Posterior Leukoencephalopathy Syndrome/etiology , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Hypertension/complications , Nephrotic Syndrome/complications , Tomography, X-Ray Computed , Treatment Outcome , Intracranial Hypertension/therapy , Diffusion Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/drug therapy , Hypertension/drug therapy , Anticonvulsants/therapeutic use , Antihypertensive Agents/therapeutic use
13.
Rev. argent. neurocir ; 33(1): 39-46, mar. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1177889

ABSTRACT

Introducción : Los hemangioblastomas y los meningiomas son neoplasias intracraneales frecuentes en las cuales la resección quirúrgica total es el tratamiento indicado. En algunas situaciones, son lesiones altamente vascularizadas, por lo cual es de utilidad la embolización preoperatoria. Descripción de los casos : Caso 1: paciente mujer de 42 años de edad, que consultó por cuadro de hipertensión endocraneana y ataxia de tipo cerebeloso. Se realizó resonancia magnética, la cual mostró un proceso expansivo en la parte superior del vermis cerebeloso. La angiografía cerebral demostró un tumor muy vascularizado, a expensas de la arteria cerebelosa superior. Previo a la cirugía se realizó una embolización con Onyx. Dos días después del procedimiento endovascular, se realizó la exéresis completa del tumor. La anatomía patológica informó hemangioblastoma. Caso 2: paciente mujer de 34 años de edad, que consultó por cuadro de cefalea intensa. La resonancia magnética mostró un tumor tentorial izquierdo, con crecimiento hacia arriba. Se realizó angiografía cerebral, la cual mostró que la irrigación principal del tumor provenía de la arteria cerebelosa superior. Se realizó una embolización preoperatoria del tumor con Onyx. Tres días después del tratamiento endovascular, se realizó la exéresis completa de la lesión. La anatomía patológica informó meningioma transicional. Discusión: La recomendación de embolización preoperatoria sería en pacientes con hemangioblastomas sólidos, de gran tamaño, irrigados por vasos que no puedan ser manipulados inmediatamente durante la resección. Algo similar sucede con los meningiomas. Sin embargo, es necesario evaluar caso por caso, ya que la embolización per se implica un riesgo para el paciente. Conclusión: Cuando es necesario, se puede realizar en forma segura y efectiva la embolización con Onyx a través de la arteria cerebelosa superior, de un tumor cuya irrigación principal está dada por dicha arteria y su acceso en una etapa temprana de la cirugía es difícil.


Introduction: Hemangioblastomas and meningiomas are frequent intracranial neoplasms in which gross total resection is the indicated treatment. In some situations, they are highly vascularized lesions, and preoperative embolization is useful. Description of the cases : Case 1: a 42-year-old female patient who consulted due to intracranial hypertension and cerebellar ataxia. Magnetic resonance imaging was performed, which showed an expansive process in the upper part of the cerebellar vermis. Cerebral angiography showed a highly vascularized tumor, at the expense of the superior cerebellar artery. Prior to surgery, Onyx embolization was performed. Two days after the endovascular procedure, gross total resection of the tumor was performed. The pathology reported hemangioblastoma. Case 2: a 34-year-old female patient who consulted due to severe headache. Magnetic resonance imaging showed a left tentorial tumor, with upward growth. Cerebral angiography was performed, which showed that the main irrigation of the tumor came from the superior cerebellar artery. A preoperative embolization of the tumor with Onyx was performed. Three days after endovascular treatment, gross total resection of the tumor was performed. The pathology reported transitional meningioma. Discussion : The recommendation of preoperative embolization would be in patients with solid hemangioblastomas, irrigated by vessels that cannot be manipulated immediately during resection. Something similar happens with meningiomas. However, it is necessary to evaluate case by case, since embolization per se implies a risk for the patient. Conclusion : When necessary, embolization with Onyx, through the superior cerebellar artery, of a tumor whose main irrigation is given by that artery and tis access at an early stage of surgery is difficult, can be performed safely and effectively.


Subject(s)
Cerebellar Ataxia , Hemangioblastoma , Intracranial Hypertension , Embolization, Therapeutic , Headache , Meningioma
14.
Prensa méd. argent ; 105(1): 24-33, mar 2019. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1026329

ABSTRACT

La presión intracraneal elevada es una complicación devastadora de la lesión neurológica, que puede complicar el trauma, los tumores del sistema nervioso central, la hidrocefalia, la encefalopatía hepática y el flujo venoso del SNC alterado. El adecuado tratamiento consta de un rápido reconocimiento, utilizar material de monitoreo neurológico invasivo y su manejo para reducir la hipertensión intracraneal y sus múltiples causas subyacente. A continuación presentamos una revisión de sus principales características y principios de abordaje diagnóstico-terapéutico


Intracranial pressure is a devastating complication of neurological damage, which can complicate trauma, central nervous system disorders, hydrocephalus, hepatic encephalopathy, and altered CNS venous flow. The appropriate treatment consists of a rapid recognition, the use of an invasive neurological system and its management to reduce intracranial hypertension and its multiple underlying causes. Below we present a review of its main characteristics and principles of diagnostic-therapeutic approach.


Subject(s)
Humans , Perfusion , Intracranial Pressure , Cerebrovascular Circulation , Ultrasonography, Doppler/methods , Intracranial Hypertension/diagnosis , Intracranial Hypertension/prevention & control , Intracranial Hypertension/therapy , Craniotomy , Conservative Treatment
15.
Rev. pesqui. cuid. fundam. (Online) ; 11(1): 255-262, jan.-mar. 2019. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-968579

ABSTRACT

Objetivo: Identificar a través de la literatura las intervenciones de enfermería en el monitoreo de la presión intracraneal en pacientes neurocríticos. Método: Revisión de la literatura integradora con búsqueda de artículos, SciELO, LILACS y PUBMED. Los artículos seleccionados fueron publicados entre los años 2007 y 2017. Resultados: Se encontraron 94 artículos y excluidos 78 como criterios de inclusión. Hasta 16 artículos fueron utilizados en esta revisión. Estos datos sugieren que la monitorización neurológica puede realizarse en una invasiva y no invasiva. Entre los métodos invasivos es el monitoreo de la presión intracraneal y la enfermera, que era directamente responsable de este cuidado. Por lo tanto, el cuidado y la elevación de la cabeza, cuidado con aspiración traqueal, cuidado con hipoxemia, coordinación y gestión en enfermería entre otros debe ser parte de la atención de enfermería. Conclusión: Cuidados de enfermería es esencial para el paciente neurocrítico. Este cuidado contribuir tanto positivos como negativos en estos pacientes


Objective: To identify through literature the nursing interventions in the intracranial pressure monitoring in patients neurocríticos. Method: Integrative review of literature with search of articles in SciELO, LILACS, and PUBMED. The selected articles were published between the years 2007 and 2017. Results: We found 94 articles and excluded 78 as inclusion criteria. So 16 articles were used in this review. These suggest that the neurological monitoring can be performed in a invasive and non invasive. Among the invasive methods is the monitoring of intracranial pressure, and the nurse, who was directly responsible for this care. Thus, care and the elevation of the head, care with tracheal aspiration, care with hypoxemia, coordination and management in nursing care among others must be part of nursing care. Conclusion: Nursing care is essential for the patient neurocrítico. This care contribute to both positive developments as negative in these patients


Objetivo: Identificar por meio da literatura as intervenções de enfermagem na monitorização da pressão intracraniana em pacientes neurocríticos. Método:Revisão integrativa da literatura com busca dos artigos nas bases de dados SciELO, LILACS e PUBMED. Os artigos selecionados foram publicados entre os anos de 2007 e 2017. Resultados: Foram encontrados 94 artigos e excluídos 78 conforme critérios de inclusão. Assim, 16 artigos foram usados nesta revisão. Estes apontaram que a monitorização neurológica pode ser realizada de maneira invasiva e não invasiva. Entre os métodos invasivos, está a monitorização da pressão intracraniana, sendo o enfermeiro, responsável direto neste cuidado. Assim, cuidados como a elevação da cabeceira, cuidados com aspiração traqueal, cuidados com hipoxemia, coordenação e gerenciamento nos cuidados de enfermagem, entre outros, devem fazer parte da assistência de enfermagem. Conclusão: Os cuidados de enfermagem são indispensáveis para o paciente neurocrítico. Estes cuidados contribuem tanto para evolução positiva quanto negativa desses pacientes


Subject(s)
Humans , Male , Female , Intracranial Hypertension/nursing , Intracranial Hypertension/therapy , Intensive Care Units
16.
S. Afr. j. child health (Online) ; 13(1): 44-48, 2019. ilus
Article in English | AIM, AIM | ID: biblio-1270356

ABSTRACT

Background. Hypertension (HPT) is often underdiagnosed in children, although significant morbidity and mortality arises from hypertensive target organ damage and hypertensive crises.Objectives. To determine the prevalence, complications and causes of severe HPT in children ≤12 years old at a central hospital.Methods. Hospital records of children ≤12 years old with severe HPT (stage 2 and higher) from 2005 to 2014 were reviewed. Demographics,nutritional status, causes, HIV status, presence of target organ damage and treatment were analysed.Results. Of 821 children admitted to the paediatric nephrology unit, 152 (18.5%) children had severe HPT, with a mean age of 6.3 years; 86(57%) were boys. A total of 28 (19%) were HIV-positive, and 19 (68%) were treatment naive. Kidney disease accounted for 82% of cases,46 (30%) having steroid-resistant nephrotic syndrome, 22 (14%) HIV-associated nephropathy, 19 (13%) glomerulonephritis, 21 (14%)congenital urinary tract abnormalities and 17 (11%) other renal causes. Renovascular causes accounted for 12 (8%) cases. Of these 12, 7 (58%)had left ventricular hypertrophy (LVH), compared with 10/125 (8%) who had other forms of kidney disease (p<0.023). Hypertensive crises occurred in 28 (18%) patients, and were significantly more common in children with HPT secondary to renovascular causes than renal causes (p=0.001).Conclusion. Renal diseases were the most common cause of severe HPT in children. Hypertensive crises, retinopathy and LVH are common in renovascular HPT


Subject(s)
Child , Hospitals , Intracranial Hypertension , South Africa
17.
Rev. Hosp. Niños B.Aires ; 61(274): 146-154, 2019.
Article in Spanish | LILACS | ID: biblio-1102315

ABSTRACT

El trauma es la principal causa de muerte en niños de 1 a 14 años, siendo el Traumatismo de cráneo grave el 50% de las mismas. Además puede asociarse a elevada morbilidad con secuelas. La hipertensión intracraneal es una de las principales injurias secundarias que actúan sobre el cerebro. La incidencia de hipertensión intracraneal en estos pacientes es elevada, pese a ello no se han podido identificar marcadores que puedan determinar su presencia. La monitorización de la Presión intracraneal en forma invasiva debe realizarse en este grupo de pacientes, ya que el aumento de la misma se ha relacionado con resultados neurológicos negativos. El control protocolizado de la presión intracraneal puede generar mejoría de los mismos, lo cual es sostenido en la tercera edición de las Guías para el manejo del traumatismo de cráneo severo pediátrico publicadas por la Brain Trauma Foundation en el año 2019. En esta revisión se plasmarán los conceptos que avalan la utilización del monitoreo invasivo de la Presión Intracraneana


Trauma is the leading cause of death in children ages 1-14. Traumatic Brain Injury accounts for 50% of deaths and is associated with high morbidity and sequelae. Intracranial hypertension is one of the main secondary insults acting on the brain. The incidence of intracranial hypertension in these patients is high, but it has not been possible to identify markers that could determine its presence or absence. This supports that the monitoring of intracranial pressure in an invasive way should be done in this group of patients, since the increase of this, has been related to poor neurological outcomes and the protocolized management of intracranial hypertension can generates improvement in them. This is sustained in the third edition of the Guidelines for the management of Pediatric Severe Traumatic Brain Injury, published by the Brain Trauma Foundation in the year 2019. In this review, the concepts that support the use of invasive monitoring of Intracranial Pressure will be embodied


Subject(s)
Intracranial Pressure , Intracranial Hypertension , Craniocerebral Trauma
18.
Article in English | WPRIM | ID: wpr-759975

ABSTRACT

Subarachnoid hemorrhage (SAH) usually occurs due to aneurysmal rupture of intracranial arteries and its typical computed tomography (CT) findings are increased attenuation of cisterns and subarachnoid spaces. However, several CT findings mimicking SAH are feasible in diverse conditions. They are so-called as pseudo-SAH, and this report is a case of pseudo-SAH which is misdiagnosed as aneurysm rupture accompanied by bilateral chronic subdural hematoma (cSDH). A 42-year-old male with severe headache visited our institute. Non-contrast brain CT images showed increased attenuation on basal cistern, and cSDH on both fronto-temporo-parietal convexity with midline shifting. Trans-femoral cerebral angiography was done and we confirmed small aneurysm at right M1 portion of middle cerebral artery. Under diagnosis of SAH, we planned an operation in order to clip aneurysmal neck and remove cSDH. cSDH was removed as planned, however, there was no SAH and we also couldn't find the rupture point of aneurysm. Serial follow-up CT showed mild cumulative cSDH recurrence, but the patient was tolerant and had no neurologic deficit during hospitalization. We have checked the patient via out-patient department for 6 months, there are no significant changes in volume and density of cSDH and the patient also have no neurologic complications.


Subject(s)
Adult , Aneurysm , Arteries , Brain , Brain Edema , Cerebral Angiography , Diagnosis , Follow-Up Studies , Headache , Hematoma, Subdural, Chronic , Hemorrhage , Hospitalization , Humans , Intracranial Hypertension , Male , Middle Cerebral Artery , Neck , Neurologic Manifestations , Outpatients , Recurrence , Rupture , Subarachnoid Hemorrhage , Subarachnoid Space
19.
Article in English | WPRIM | ID: wpr-759570

ABSTRACT

Whole body ultrasound can be used to improve the speed and accuracy of evaluation of an increasing number of organ systems in the critically ill. Cardiac and abdominal ultrasound can be used to identify the mechanisms and etiology of hemodynamic instability. In hypoxemia or hypercarbia, lung ultrasound can rapidly identify the etiology of the condition with an accuracy that is equivalent to that of computed tomography. For encephalopathy, ocular ultrasound and transcranial Doppler can identify elevated intracranial pressure and midline shift. Renal and bladder ultrasound can identify the mechanisms and etiology of renal failure. Ultrasound can also improve the accuracy and safety of percutaneous procedures and should be currently used routinely for central vein catheterization and percutaneous tracheostomy.


Subject(s)
Hypoxia , Brain Diseases , Catheterization , Catheters , Critical Care , Critical Illness , Hemodynamics , Intensive Care Units , Intracranial Hypertension , Lung , Operating Rooms , Renal Insufficiency , Tracheostomy , Ultrasonography , Urinary Bladder , Veins
20.
Article in Korean | WPRIM | ID: wpr-766858

ABSTRACT

PURPOSE: We report two patients diagnosed with a sinus thrombosis with papillary edema. CASE SUMMARY: Case 1 was a 27-year-old male who presented with complaints of headache and vomiting for 2 months and blurred vision in both eyes. The best-corrected visual acuity (BCVA) was 1.0 in the right eye and 1.0 in the left eye. A visual field (VF) examination revealed a binocular peripheral VF defect and optical coherence tomography (OCT) and a fundus examination indicated optic disc swelling in both eyes. Brain magnetic resonance imaging (MRI) showed no specific finding but magnetic resonance venography revealed filling defect signs in the transverse sinus and a cerebrospinal fluid examination indicated elevated intracranial pressure (ICP). Case 2 was a 54-year-old female who came to our hospital with suspicion of bilateral optic disc swelling. The BCVA was 0.9 in the right eye and 1.0 in the left eye. A VF examination revealed an inferior-temporal VF defect and blind spot enlargement in the right eye. OCT and a fundus examination showed optic disc swelling in both eyes. Brain MRI showed no specific finding but magnetic resonance venography revealed a decrease in blood flow in the transverse sinus, sigmoid sinus. A cerebrospinal fluid examination indicated elevated ICP. CONCLUSIONS: In the case of optic disc swelling in both eyes, a secondary cause of ICP elevation and the possibility of optic disc swelling due to sinus thrombosis should be considered, and brain MRI and venography are needed to distinguish these possibilities.


Subject(s)
Adult , Brain , Cerebrospinal Fluid , Colon, Sigmoid , Edema , Female , Headache , Humans , Intracranial Hypertension , Magnetic Resonance Imaging , Male , Middle Aged , Optic Disk , Optic Nerve Diseases , Papilledema , Phlebography , Sinus Thrombosis, Intracranial , Telescopes , Tomography, Optical Coherence , Visual Acuity , Visual Fields , Vomiting
SELECTION OF CITATIONS
SEARCH DETAIL