Prevalence of Cognitive Impairments in Patients with Good Functional Outcome in Late Phase Subarachnoid Hemorrhage / Prevalência de alterações cognitivas em pacientes com bom desfecho funcional na fase tardia da hemorragia subaracnóidea

Prior studies have shown high prevalence of neuropsychological deficits after aneurysmal subarachnoid hemorrhage; however, few studies detect cognitive impairments in patients with good functional outcome, measured whith Rankin Modified Scale, in the late phase of subarachnoid hemorrhage. We confirmed a high prevalence of alterations in neuropsychological tests in 44 patients with Rankin Modified 2.We proposed the application of simple and fast tests that allowed us to detect impairments with precision similar to that of complex cognitive batteries used in previous studies. We also attempt to confirm statistical association between factors that could be related to poor cognitive outcome, like Hunt-Hess scale classification, bleeding intensity measured with Fisher scale, therapeutic type (microsurgery ou embolization), and aneurysm localization; however, there was no significance.

Estudos anteriores mostraram que a prevalência de déficits neuropsicológicos após hemorragia subaracnóide aneurismática é alto,mas poucos estudos detectaram alterações cognitiva sem pacientes com bom desfecho funcional,medido através da escada de Rankin Modificada, na fase tardia da hemorragia subaracnóide. O estudo confirmou em 44 pacientes com RankiN Modificado 2 a alta prevalência de alterações em testes neuropsicológicos. Propusemos a aplicação de testes simples e rápidos, capazes de detectar alterações, com precisão semelhante a baterias cognitivas complexas utilizadas em estudos anteriores.Nós também avaliamos a associação estatística entre alguns fatores como a escala de Hunt-Hess (HH), a intensidade do sangramento pela escala de Fisher, tipo de tratamento (microcirurgia ou embolização) e localização do aneurisma, ao pior desempenho cognitivo, no entanto não houve significância.

Indices of agreement between neurosurgeons and a radiologist in interpreting tomography scans in an emergency department / Índice de concordância entre neurocirurgiões e radiologistas na interpretação de tomografias de crânio na emergência

The power of interpretation in the analysis of cranial computed tomography (CCT) among neurosurgeons and radiologists has rarely been studied. This study aimed to assess the rate of agreement in the interpretation of CCTs between neurosurgeons and a radiologist in an emergency department. Method 227 CCT were independently analyzed by two neurosurgeons (NS1 and NS2) and a radiologist (RAD). The level of agreement in interpreting the examination was studied. Results The Kappa values obtained between NS1 and NS2 and RAD were considered nearly perfect and substantial agreement. The highest levels of agreement when evaluating abnormalities were observed in the identification of tumors, hydrocephalus and intracranial hematomas. The worst levels of agreement were observed for leukoaraiosis and reduced brain volume. Conclusions For diseases in which the emergency room procedure must be determined, agreement in the interpretation of CCTs between the radiologist and neurosurgeons was satisfactory. .

O poder de interpretação na análise de tomografias de crânio (TCC) entre neurocirurgiões e radiologistas tem sido pouco estudada. O objetivo deste estudo é avaliar as taxas de concordância na interpretação de TCCs entre neurocirugiões e radiologista em um departamento de emergência. Método 227 TCCs foram independentemente analizadas por 2 neurocirugiões (NC1 e NC2) e um radiologista(RAD). O índice de concordância nas análises foi estudada posteriormente. Resultados O valor de Kappa obtido entre os NC1 e NC 2 e entre estes e RAD foram quase perfeitos e substancial respectivamente. O maiores índices de concordância quando avaliadas anormalidades foram observados na identificação de tumores, hidrocefalia e hematomas intracranianos. O piores índices foram observados com relação a leucaraiose e redução volumétrica. Conclusão Para doenças apresentadas em um departamento emergência que demandam tratamento mais agressivo o índice de concordância na interpretação de TCCs entre RAD e NC foi satisfatório. .

Pituitary deficiency after aneurysmal subarachnoid hemorrhage

OBJECTIVE: Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome. METHODS: Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor. RESULTS: The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ≤13 (t test, p = 0.008), Hunt-Hess grade ≥4 (t test, p<0.001), or Fisher grade 4 (t test, p = 0.039). Hormone deficiency was not significantly associated (p>0.05) with increased hospitalization or clinical outcome. CONCLUSION: Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome. .

Brainstem biopsies in adults: Review of 80 consecutive cases / Biópsia estereotáxica das lesões do tronco cerebral. Estudo de 80 casos consecutivos

Objective: To retrospectively review the morbidity and mortality rates associated with stereotactic brainstem lesion biopsy, the success rate and the impact on treatment. Material and methods: Eighty consecutive stereotactic biopsies and literature review were performed to analyze clinical, radiographic and histopathological data. Results: Stereotactic biopsy of brainstem lesions conducted to the diagnosis in 96.3%. One death (1.3% of cases) occurred and 10% morbidity was associated with the procedure. Pathology showed that 65% of the adult brainstem intrinsic lesions were gliomas, 11.3% were metastasis, 8.7% were lymphomas and the remaining tumoral lesions were ganglioglioma, ependymoma and craniopharyngeoma. Non-tumoral lesions were the diagnosis in 11 cases. Conclusion: Empiric treatment of adult brainstem lesions is not prudent, because a wide spectrum of pathologies occur in this location. Stereotactic biopsy is a safe and effective method for determining the diagnostic of these lesions.

Objetivo: Analisar retrospectivamente as taxas de morbidade e mortalidade associadas ao procedimento de biópsia estereotáxica das lesões do tronco encefálico, assim como sua taxa de sucesso e impacto no tratamento. Material e métodos: Foram analisados retrospectivamente 80 casos consecutivos de biópsia estereotáxica de lesões do tronco encefálico e confrontados seus dados clínicos, imagiológicos e histopatológicos com dados da literatura atual. Resultados: A biópsia estereotáxica das lesões do tronco encefálico obteve diagnóstico em 96,3% dos casos. A taxa de mortalidade foi de 1,3% e de morbidade de 10%. Estudo histopatológico evidenciou que 65% das lesões intrínsecas do tronco encefálico do adulto eram gliomas, 11,3% eram metástases, 8,7%, linfomas, e o restante das lesões tumorais eram gangliogliomas, ependimomas e craniofaringeomas. Foram diagnosticadas lesões não tumorais em 11 casos. Conclusão: Tratamento empírico das lesões do tronco encefálico do adulto não é prudente em virtude do amplo espectro de patologias que podem acometer esta região. Concluímos que a biópsia estereotáxica é método seguro e efetivo para determinar o diagnóstico de tais lesões.