Enfermedad de párkinson como inicio de hidrocefalia de presión normal. Presentación de un caso

La hidrocefalia de presión normal es un síndrome caracterizado por alteraciones de la marcha, deterioro cognitivo e incontinencia urinaria que está asociado a crecimiento del sistema ventricular en ausencia de elevación de la presión del líquido cefalorraquídeo. Se presenta el caso de un paciente de 43 años de edad que presentó evento convulsivo único, acompañado de alteraciones de la marcha, bradipsiquia, bradicinesia, temblor en reposo y trastorno esfinteriano urinario. Se le realizó tomografía axial computarizada multicorte donde se observó sistema ventricular con índice de Evans de 0.42, se le realizó el tap test y derivación ventrículo peritoneal con utilización de neuromonitoreo de la presión intracraneal transoperatorio. La hidrocefalia de presión normal es una patología poco frecuente en neurocirugía, a menudo es mal diagnosticada y se confunde con enfermedades frecuentes en el anciano. Se presenta el caso para describir las características clínicas, de neuromonitoreo y tratamiento quirúrgico de un paciente que presentó una hidrocefalia de presión normal secundaria a un síndrome parkinsoniano.

Normal pressure hydrocephalus is a syndrome characterized by gait abnormalities, cognitive impairment, urinary incontinence that is associated with enlargement of the ventricular system in the absence of elevated cerebrospinal fluid pressure. A 43-years-old patient who presented a single seizure event, accompanied by gait disturbances, bradypsychia, bradykinesia, tremor at rest, and urinary sphincter disorder is presented. A multi-slice computerized axial tomography was performed where the ventricular system was observed with an Evans index of 0.42, the tap test and peritoneal ventricular shunt were performed with the use of intraoperative intracranial pressure neuromonitoring. Normal pressure hydrocephalus is a rare pathology in neurosurgery; it is often misdiagnosed and confused with common diseases in the elderly. The case is presented to describe the clinical, neuromonitoring and surgical treatment characteristics of a patient presenting normal pressure hydrocephalus secondary to parkinsonian syndrome.

Endoscopic evacuation of spontaneous supratentorial intracerebral hemorrhage

Introduction: Spontaneous intracerebral hemorrhage (SICH) constitutes a major public health problem worldwide, despite active research it is still a leading cause of morbidity, disability, and death. In Cuba cerebrovascular disease represents the 3rd cause of death and in the last decade, the number of deaths for this cause has increased and the mortality rate is about 41/100,000/year. Method: We have carried out a descriptive study of 14 patients admitted in the intensive care unit of Moron General Hospital in Ciego de Avila, Cuba, with diagnosis of Spontaneous Supratentorial Intracerebral Hemorrhage (SSICH), who were treated with endoscopic surgical evacuation in the period from January of 2013 to December of 2014. Results: All patients underwent surgery within 12 hours of ictus and 10 (71.43 percent) underwent surgery within 6 hours. The mean time from SSICH onset to surgery was 7.6 hours. The mean operative time was 90 minutes. Endoscopy was successfully completed in all cases and the hematoma evacuation rate was 97 percent- 100 percent in all patients. The mortality rate was 5 patients (35.71 percent). Six months after clot endoscopic evacuation, six cases (42.86 percent) had poor results (Grade IV-VI) and 8 (57.14 percent) had goodrecovery (Grade 0-III). Conclusions: Early endoscope-assisted SSICH evacuation is safe, effective and feasible method in hematoma evacuation.

Tratamiento quirúrgico en las hemorragias intracerebrales lobares espontáneas supratentoriales sin extensión ventricular / Surgical treatment for supratentorial spontaneous lobarintracerebral hemorrhage without ventricular extension

Objetivo: Evaluar los resultados en el manejo de pacientes con hemorragias intracerebrales lobares espontaneas, supratentoriales y sin extensión ventricular a través de la comparación entre el tratamiento quirúrgico y el tratamiento médico. Material y Método: Se realizó un estudio de casos y controles en el Hospital General “Roberto Rodríguez Fernández” de Morón, Ciego de Ávila, Cuba, en el período comprendido entre enero de 2009 y diciembre de 2013. La muestra quedó conformada por aquellos que reunieron los siguientes criterios de inclusión: 1) Edad de 18-60 años; 2) 48 horas de inicio de las manifestaciones clínicas; 3) volumen de la hemorragia entre 20 y 60 cm3 ; 4) Escala de coma de Glasgow al ingreso superior a 4 puntos. Se constituyeron dos grupos, en el Grupo I fueron incluidos los enfermos que recibieron tratamiento quirúrgico y médico. En el Grupo II se incluyeron los que recibieron tratamiento médico solamente. La inclusión en uno de los dos grupos quedó sujeta al criterio del médico que recibió al paciente en el departamento de emergencias, no existió aleatorización en el proceso. Resultados: Se incluyeron en el estudio un total de 147 pacientes 54 (36,73 por ciento) en el Grupo I y 93 (63,27 por ciento) en el Grupo II. En el Grupo I la mortalidad a los seis meses del egreso fue de 16 pacientes (29,64 por ciento), mientras que en el grupo II murieron 33 (35,48 por ciento). Conclusiones: Se obtuvo un discreto pero relevante predominio de los resultados satisfactorios en el grupo de pacientes operados y la mortalidad fue también menor en este grupo.

The aim of this paper was to evaluate the surgical versus medical treatment in patients with supratentorial spontaneous intracerebral hemorrhage without ventricular extension. Methods: A case-control study was carried out in the “Roberto Rodríguez Fernández” general hospital in Moron, Ciego de Avila, Cuba, in the period between January 2009 and December 2013. The sample was conformed by those patients that gathered the following inclusion criteria: 1) Age of 18-60 years; 2) 48 hours of beginning of clinical manifestation; 3) Volume of the hemorrhage between 20-60 cm3; 4) GCS superior to 4 points. Two groups were constituted. In the group I the patients whom received medical and surgical treatment were included. In the group II were included patients whom received medical treatment only. The inclusion in one of the two groups was subject to the doctor´s criteria in the emergency department, randomization didn’t exist in the process. Results: They were included in the study a total of 147 patients, 54 (36,73 percent) in the Group I and 93 (63,27 percent) in the Group II. The mortality at 6 month of discharge was 29,64 percent in Group I and 35,48 percent in Group II. Conclusions: A discreet but outstanding of the satisfactory results was obtained in the group of operated patients and the mortality was also smaller in this group.