Lesión del nervio mediano por cuerpo extraño metálico en un adulto joven / Lesion of the median nerve due to metallic strange body in a young adult

Se describe el caso clínico de un paciente de 36 años de edad, quien acudió a la consulta de Ortopedia y Traumatología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, con un alambrón oxidado, encarnado en la cara palmar de la muñeca derecha, con parestesias en la zona de inervación del nervio mediano. La radiografía reveló que dentro de las estructuras de la muñeca había 10 cm del alambrón, con la porción distal doblada en forma de gancho, por lo cual se le realizó intervención quirúrgica de urgencia. Se utilizó anestesia regional, sedación e isquemia y se extrajo el cuerpo extraño en sentido contrario a la curvatura que presentaba. Luego de pasar el efecto anestésico persistían las parestesias en el pulpejo del índice, que desaparecieron completamente a los 4 meses del accidente. Se incorporó a sus labores habituales a los 2 meses de operado.

The case report of a 36 years patient is described. He went to the Orthopedics and Traumatology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, with a rusty big wire, ingrowing in the right wrist palmar face, with paresthesias in the innervation area of the median nerve. The x-ray revealed that inside the wrist structures there was 10 cm of the big wire, with the distal portion bent in hook form, reason why an emergency surgical intervention was carried out. Regional anesthesia, sedation and ischemia were used and the strange body was removed in sense contrary to the bend that presented. After the anesthetic effect eased the paresthesias of the index finger tip persisted that disappeared completely 4 months after the accident. He went back to his usual works 2 months after the operation.

Parestesia dos nervos alveolar inferior e lingual pós cirurgia de terceiros molares / Paresthesia of lingual and inferior alveolar nerve after third molars surgery

A remoção cirúrgica dos terceiros molares vem se tornando cada vez mais freqüente nos dias de hoje. Quando se trata dos dentes inferiores, é importante atentar-se para a ocorrência das parestesias dos nervos lingual e alveolar inferior, cujas incidências são de 0-23% e 0,4-8,4%, respectivamente. O quadro poderá resolver-se espontaneamente, mas quando isso não ocorrer, as modalidades terapêuticas disponíveis apresentam resultados limitados a determinados casos, confirmando que o melhor é a prevenção. Esse estudo se propôs a realizar uma revisão de literatura sobre parestesia dos nervos lingual e alveolar inferior, em relação a sua etiologia, sintomatologia, condutas preventivas e terapêuticas.

Risk factors for unpleasant paresthesiae induced by paresthesiae-producing deep brain stimulation

Paresthesiae-producing deep brain stimulation (stimulation of ventrocaudal nucleus - VC, medial lemniscus - ML or internal capsule - IC) is one of the few procedures to treat the steady element of neural injury pain (NIP) currently available. Reviewing the first 60 patients with NIP submitted to deep brain stimulation (DBS) from 1978 to 1991 at the Division of Neurosurgery, Toronto Hospital, University of Toronto, we observed that 6 patients complained of unpleasant paresthesiae with paresthesiae-producing DBS, preventing permanent electrode implantation in all of them. Such patients accounted for 15 per cent of the failures (6 out of 40 failures) in our series. In an attempt to improve patient selection, we reviewed our patients considering a number of parameters in order to determine risk factors for unpleasant paresthesiae elicited by paresthesiae-producing DBS. The results showed that this response happenned only in patients with brain central pain complaining of evoked pain, secondary to a supratentorial lesion. Age, sex, duration of pain, quality of the steady pain, size of the causative lesion and site (VC,ML,IC) and type (micro or macroelectrode) of surgical exploration were not important factors. Unpleasant paresthesiae in response to dorsal column stimulation, restricted thalamic lesion on computed tomography and the occurrence of associated intermittent pain were considered major risk factors in this subset of patients and the presence of cold allodynia or hyperpathia in isolation and the absence of sensory loss were considered minor risk factors. It is our hope that the criteria here established will improve patient selection and so, the overall results of DBS.

Complicaciones neurológicas en pacientes sometidos a cirugía cardiovascular / Neurological complications following cardiac surgery

Las complicaciones neurologícas ocupan un lugar importante en cirugía cardiovascular dado que los trastornos orgánicos, sociales y económicos que originan influyen en el ámbito médico familiar. A pesar del avance en la tecnología aplicada a aparatos y sistemas médicos empleados durante la misma, no ha sido posible abolirlas, influyendo en esto el factor humano y técnico, así como la presencia previa de patología orgánica; pudiendo precipitar la incidencia de éstas al romperse el equilibrio fisiologíco cerebral, manifestado clínicamente por una gran variedad de signos y síntomas que el médico anestesiólogo debe identificar oportunamente, para instalar el tratamiento adecuado inicial apoyado por otros servicios médicos especializados necesarios y así disminuir la morbimortalidad y secuelas de estas complicaciones.