Experiencia en monitorización metabólico-cerebral en pacientes críticos neurológicos / Cerebral metabolic monitoring in critical neurological patients

Background: Cerebral metabolic monitoring in critical neurological patients allows the assessment of neuronal tissue response to injury and to plan the best therapy to correct each critical brain situation. Aim: To evaluate the usefulness of cerebral metabolic monitoring in patients with acute cerebral injury. Patients and methods: A retrospective analysis of 29 patients with acute brain injury, in whom a catheter was located in the bulb of the jugular vein to perform a cerebral metabolic monitoring. These patients were compared with others that were not subjected to this monitoring. The evolution at six months of follow up was assessed using the Glasgow outcome score, considering a favorable evolution when this score was 4 or greater. Results: Patients with an hyperemic state on admission or after optimization of therapy did not have hospital mortality, and 73 per cent had Glasgow outcome score of 4 or greater at six months of follow up. On the other hand, 50 per cent of those with hypoperfusion or global ischemia died during hospitalization and 72 per cent had a Glasgow outcome score of 3 or less at six months. Patients not subjected to cerebral metabolic monitoring behave as those with hypoperfusion or global ischemia. Conclusions: Cerebral metabolic monitoring is an useful tool to optimize the management of patients with acute cerebral injury, and those patients with an hyperemic cerebral state have the best prognosis

Absceso epidural espinal: análisis de 10 casos y revisión / Spinal epidural abscess: analysis of 10 cases and review

La infección bacteriana supurada del espacio epidural espinal tiene una elevada morbilidad y mortalidad en las distintas series, cuya baja incidencia aún persiste. Su diagnóstico se ha facilitado con los modernos métodos de neuroimagen. Se analizan 10 casos considerando factores clínicos, diagnósticos, de terapia y evolución. Fiebre, dolor espinalñ, déficit sensitivo y motor fueron los síntomas más frecuentes. El diagnóstico topográfico fue corroborado por mielografía, TAC o RNM, se discute su oportunidad y eficacia. Se aisló germen en 7 casos. En todos los pacientes se realizó cirugía decompresiva seguida de terapia antibiótica, discutiendo su eficacia. La evolución fue satisfactoria en 5 casos, hubo un fallecido y otros cuatro pacientes mejoraron su condición de ingreso. Se pone énfasis en la intervención quirúrgica precoz y terapia antibiótica agresiva como condiciones que mejoran los resultados