Fractura de base de cráneo en recién nacidos: caso clínico / Basal fracture of the skull in a newborn: case report and review of the literature

Introduction: Reported incidence of cranial lesions in childbirth is about 1.7 to 59 per 10,000 births. Among these, fracture of the base of the skull is rare but serious due to sequelae and mortality. Objective: Describe a case of a newborn with a fracture of the temporal bone, review diagnosis and management of skull fractures. Clinical Case: The patient was born with assistance, use of forceps, showed deviation of the buccal commisure and otorrhagia on the left side during puerperium. CT Sean detected fracture of the base of the cranium at the level of the temporal bone. Hemogram, cultures and spinal fluid studies were done. Prophylactic therapy was initiated. All blood studies were negative and follow up studies were normal. Discussion: Literature reviews support the diagnosis to be confirmed through a CT sean, and an active search for meningitis be started through hemocultures, hemogram, and Cerebrospinal Fluid. Management should be conservative, evaluating the need for an LR Evidence shows that antibiotic prophylaxis for meningitis has little indication in these cases.

Introducción: La incidencia de lesiones de cráneo en recién nacidos reportadas son del orden de 1,7 a 59 por 10 000 nacimientos. Dentro de estas, las fracturas de base de cráneo son eventos poco frecuentes, pero de consideración dado su potencial gravedad en cuanto a mortalidad y secuelas. Objetivo: Relatar el caso de un recién nacido con una fractura de peñasco y revisar el diagnóstico y manejo de las lesiones de cráneo. Caso Clínico: El paciente, tras parto instrumentalizado por fórceps, presentó desviación de comisura bucal y otorragia durante su estadía en puerperio. La TAC de cerebro con reconstrucción ósea fue compatible con una fractura de base de cráneo (peñasco izquierdo). Se tomaron hemocultivo, hemograma y PCR y se inició antibioticoterapia profiláctica para meningitis. Evolucionó favorablemente con hemocultivos negativos, hemograma y PCR normales, TAC de control sin cambios y examen neurológico normal. Discusión: La literatura recomienda que el diagnóstico de fractura de base de cráneo debe ser confirmado por medio de TAC de cerebro y que debe realizarse una búsqueda activa de meningitis por medio de hemocultivos, hemograma y PCR, evaluar la necesidad de punción lumbar y manejar en forma conservadora. La evidencia señala que la profilaxis antibiótica para meningitis en estos pacientes no tiene indicación.

A propósito de la muerte de Cano de Aponte y los accidentes ecuestres / On the death of Gabriel Cano de Aponte

Gabriel Cano de Aponte was Governor of Chile since 1717 and util his death in 1733, being 68 years old. As a soldier, he was an experimented horse rider. The sequence ofevents that caused his death three months after an equestrian accident are unclear. A systematic clinical analysis of the later is the main objective of this review. Historians have documented Cano de Aponte's "inclination for unbridled fun and equestrian exercises". During a holiday Cano de Aponte suffered a horse fall and subsequent crushing by the latter. It has been stated that a spinal lesion caused by the accident kept him bedridden for a period of three months, clear in reason and with intense pain, before his death. However, there is no evidence on historie data that conveys any typical sign associated to spinal injury following the accident. Therefore we suggest that Cano de Aponte suffered a complex pelvic ring fracture. The fact that he was prostrated, lucid, but suffered and intense pain best sustains the hypothesis of a pelvic fracture. After the initial period, one ofthe most common causes of death resulting from a pelvic fracture is deep venous thrombosis with secondary pulmonary thromboembolism. This must have been the sequence ofevents that most probably caused Cano de Aponte's death).