RESUMO
Se describe una experiencia clínico-formativa en el ámbito hospitalario, donde destacan los aportes de la neuropsicología en la atención multidisciplinaria a pacientes con tumores cerebrales. Se ejemplifican cuatro casos atendidos en el Servicio de Neurocirugía del Hospital México en Costa Rica, a quienes se les realizó una valoración neuropsicológica como parte del protocolo de atención en cirugía de resección tumoral. Se documenta una leve pero consistente tendencia a la mejoría en los rendimientos tras la intervención neuroquirúrgica de los casos reportados, evidenciando, también, las secuelas neurocognitivas y emocionales que permanecen e impactan directamente la calidad de vida. Se discute sobre los retos asociados a la expectativa sanitaria de prolongación de la vida pero preservando su calidad y funcionalidad.
The systematization of a clinical and educational experience in a hospital setting shows evidence of the neuropsychological contributions to the multidisciplinary care for patients with brain tumors. Four cases of people diagnosed with brain tumors are exemplified. The patients were treated at the Neurosurgical Unit at the Hospital Mexico, Costa Rica. Each patient underwent neuropsychological evaluations as part of the established protocol for neurosurgical interventions. Results showed a slight yet consistent trend of cognitive performance improvement after each surgery, and identified residual neurocognitive consequences that would have a direct impact on the patients quality of life. This paper discusses the challenges associated with health expectancy of prolonging life while preserving its quality and functionality.
RESUMO
Determine the variants of the cerebrospinal fluid in patients post-trauma and post-surgery without sepsis, to differentiate them from th variations in patients with meningitis. It's a prospective study in which we made lumbar puncture to 50 patients that were admitted in the neurosurgery service with the diagnosis of moderate or severe head trauma, or were operated for different reasons. All the patients had red blood cells in the cerebrospinal fluid. In 30 patientsthe white blood cells were >10 the relation of glucose in CSF/blood was less than 60 por ciento in 31 patients, and proteins were >45 mg/dl in 39 cases. Twenty-six patients had a relations red blood cell/white blood cell altered. All the cultures were negative. There was no correlation between fever, leukocytosis and number of white blood cells in CSF. Twelve patients had proteins elevated, glucose diminished and a low relation red blood cell/white blood cell. In all of them the culture was negative. Trauma and surgery procedure a subarachnoid hemorrhage that originates an inflamatory not infectious response, and this is the cause of the alterations of the cerebrospinal fluid. We recomended don't use antibiotics in post-trauma and post-surgery patients with fever and alterations of CSF, but without signs of meningitis, in wich the diagnosis in not confirmed with a culture of CSF
Assuntos
Pressão do Líquido Cefalorraquidiano , Cirurgia Geral , Diagnóstico , Diagnóstico Diferencial , Meningite , Neurocirurgia , Complicações Pós-Operatórias , Período Pós-Operatório , Ferimentos e Lesões , Costa RicaRESUMO
Se analiza un caso, de una paciente de 71 años de edad, femenina, con antecedente de lobectomía pulmonar derecha superior en 1987 por tumor carcinoide pulmonar, en 1993 consulta por vértigo, cefalea occipital y cervicalgia. La tomografía computada demuestra lesión hiperdensa en hemisferio cerebeloso derecho. Es llevada a cirugía y se realiza craneotomía suboccipital y resección de la lesión tumoral. El resultado de la biopsia revela tumor carcinoide metastásico a cerebelo. Se analiza el tema sobre la patología a fondo y sobre la metástasis de tumor carcinoide al sistema nervioso central, como los estudios para su diagnóstico.