Terapia continua intra-arterial selectiva con nimodipino para el tratamiento del vasoespasmo refractario en hemorragia subaracnoidea aneurismática: caso clínico / Continuous intra arterial nimodipine for vasospasm secondary to subarachnoid hemorrhage: report of one case

We report a 39-year-old male with an aneurysmal subarachnoid hemorrhage without hydrocephalus, in whom a right choroidal aneurysm was early excluded by endovascular coil insertion. Intracranial pressure (PIC) and cerebral oxygenation (PtiO2) sensors for neuromonitoring were installed due to a persistent comatose state. From the 3rd day, neuromonitoring became altered. CT angiography and cerebral angiography showed severe proximal and distal vasospasm (VE) of the middle (ACM) and anterior (ACA) right cerebral arteries. VE was treated with angioplasty and intravenous nimodipine. Forty eight hours later, despite hemodynamic maximization, neuromonitoring became altered again, mainly explained by a decrease in PtiO2 below 15 mmHg. A severe VE in ACM and right ACA was confirmed by angiography. Given the presence of an early and recurrent VE, which was associated with a decrease in cerebral oxygenation, internal carotid micro-catheters for continuous nimodipine infusion were installed. This therapy maintained a normal neuromonitoring for 15 days. During this period, attempts were done to decrease or discontinue the infusion, but the patient presented parallel falls of cerebral oxygenation or decreased cerebral perfusion observed with perfusion CT, interpreted as persistent VE. Finally, the infusion was stopped at day 15 without significant complication. We conclude that intra-arterial nimodipine continuous infusion in refractory VE can be useful and safe in selected patients. Multimodal neuromonitoring is essential.

Seroepidemiología familiar de la toxocariasis / Familial seroepidemiology of toxocariasis

Se estudio prospectivamente 78 casos índices pediátricos, infectados por Toxocara sp. y su grupo familiar que dio un total de 356 personas, conjuntamente con 28 familias conformadas por 97 integrantes, libres de esta infeccion, siendo ambos grupos comparables. A cada familia se le aplicó el índice de Graffar modificado con el fin de evaluar el nivel socioeconómico y cultural de los hogares. Además a cada persona se le hizo una anamnesis, examen físico y ELISA para toxocariasis. Los hábitos como geofagia, juegos o manipulación de tierra, el inadecuado lavado de las manos en especial antes de ingerir alimentos, al igual que la edad de los perros, resultaron estadísticamente mas frecuentes en la familias infectadas. En los hogares con un paciente con toxocariasis, un promedio de 2,8 de sus integrantes tenía serología positiva para la parasitosis a títulos significativos. Se destaca la distribución intrafamiliar de esta infección y la importancia de su prevención primaria