Cisternografía radioisotópica con 99Tc-DTPA en el diagnóstico etiológico del síndrome de hipotensión intracraneal: reporte de caso / Cisternography radioisotope with 99Tc-DTPA in the etiological diagnosis of intracranial hypotension syndrome: a case report

Introducción: Las fístulas de líquido cefalorraquídeo (LCR) constituyen una complicación frecuente de la cirugía espinal. La cisternografíaradioisotópica es una herramienta diagnóstica que permite la confirmación y localización de las mismas.Caso clínico: Paciente masculino de 30 años, con antecedentes de hidrocefalia congénita y a quien se le retiró hace ocho años un sistema derivativo lumboperitoneal colocado por esa causa. Consultó por episodios de cefalea ortostática de aproximadamente seismeses de evolución y que se aliviaban con el decúbito. Al realizarle la punción lumbar, para el estudio del LCR, se comprobó una presión de apertura de 5 cm H2O y los estudios citoquímicos, bacteriológicos, micológicos y virológicos fueron negativos. Se le realizó una cisternografía radioisotópica con 99Tc-DTPA que mostró una fístula de LCR en el sitio donde fue retirado el catéter de derivación lumboperitoneal.Conclusión: La cisternografía radioisotópica es una opción práctica y eficaz para corroborar el diagnóstico de fístula de LCR como complicación de la cirugía espinal en pacientes con hipotensión intracraneal(AU)

Introduction: Cerebrospinal fluid (CSF) fistulas are a common complication of spinal surgery. The radioisotope cisternography is a diagnostic tool that allows confirmation and localization.Case report: Male patient of 30 years, with a history of congenital hydrocephalus and eight years ago was removed a derivative lumboperitoneal shunt system placed by that cause. Consulted by episodes of approximately six months of orthostatic headache with relief in decubitus. A lumbar puncture was done for the study of CSF, an opening pressure of 5 cm H2O, and cytochemical, bacteriological,mycological and virological studies were negative. A cisternography radioisotope 99Tc-DTPA was done and showed a CSF fistula on the site where the lumboperitoneal shunt catheter was removed.Conclusion: The radioisotope cisternography is a practical and effective option to confirm the diagnosis CSF fistula as a complication ofspinal surgery in patients with intracranial hypotension(AU)

Epidemiologic analysis of the laboratory-confirmed cases of influenza A(H1N1)v in Colombia.

From 2 May to 16 July 2009, a total of 183 laboratory-confirmed cases of influenza A(H1N1)v were reported in Colombia, 117 (63.9%) of these had travelled outside the country. Hospital admission was necessary in 26 (14.21%) cases and seven patients died (fatality-case ratio: 3.8%). The infection affected younger age-groups and the symptoms most frequently reported were cough, fever and sore throat. Our findings are consistent with recent reports from other countries.

[Clinical usefulness of transcranial Doppler ultrasound imaging in the diagnosis of cerebral vasospasm in subarachnoid haemorrhage. A validation study]. / Utilidad clinica del Doppler transcraneal en el diagnostico del vasoespasmo cerebral en la hemorragia subaracnoidea. Estudio de validacion.

INTRODUCTION: During the clinical course of aneurysmal subarachnoid haemorrhage, cerebral vasospasm is one of the most dreaded medical complications. AIM. To determine the usefulness of transcranial Doppler (TCD) ultrasound imaging in diagnosing vasospasm in patients with subarachnoid haemorrhage (SAH) who were attended in a Stroke Unit. PATIENTS AND METHODS: The study included 89 patients with SAH of a non-traumatic origin; these patients had been admitted to a Stroke Unit and were submitted to a contrast-enhanced neurovascular study and daily monitoring with TCD. Values were determined for the sensitivity, specificity, predictive power and overall precision of the TCD ultrasound imaging, together with the differences in mean flow rate and the coefficient of correlation between the gold standard test and the results of monitoring with TCD. RESULTS: Female patients under 50 years of age with favourable initial clinical degrees were predominant. Aneurysmal SAH was prevalent and the frequency of angiographic vasospasm was 40%, in the majority of cases located in the middle cerebral arteries. Most of the patients had mean cerebral blood flow rates of or below 120 cm/s. The peaks of mean blood flow rate were obtained between the fourth and the tenth day. Overall precision, sensitivity and the predictive negative value of TCD were good. Specificity was excellent for flow rates below 130 cm/s, and the predictive positive value was low. CONCLUSIONS: Monitoring with TCD proved to be useful for diagnosing cerebral vasospasm in patients with a good initial clinical status.

Utilidad clínica del Doppler transcraneal en el diagnóstico del vasoespasmo cerebral en la hemorragia subaracnoidea: estudio de validación / Clinical usefulness of transcranial Doppler ultrasound imaging in the diagnosis of cerebral vasospasm in subarachnoid haemorrhage: a validation study]

Introducción. Durante el curso clínico de hemorragia subaracnoidea aneurismática, el vasoespasmo cerebral es una de las complicaciones médicas más temibles. Objetivo. Comprobar la utilidad de la ecografía Doppler transcraneal (DTC) para diagnosticar el vasoespasmo en pacientes con hemorragia subaracnoidea (HSA) atendidos en una Unidad de Ictus. Pacientes y métodos. Estudio de 89 pacientes con HSA no traumática, ingresados en una Unidad de Ictus, a los cuales se realizó un estudio neurovascular contrastado y monitorización diaria con DTC. Se determinaron los valores de sensibilidad, especificidad, predictivos y de precisión global de la ecografía DTC, las diferencias de velocidad de flujo media y el coeficiente de correlación entre la prueba estándar de referencia y los resultados de la monitorización con DTC. Resultados. Predominaron los pacientes menores de 50 años del sexo femenino con grados clínicos iniciales favorables. Prevaleció la HSA aneurismática y la frecuencia de vasoespasmo angiográfico fue del 40 porciento, preferentemente localizado en las arterias cerebrales medias. La mayoría de los pacientes tenían velocidades medias del flujo sanguíneo cerebral iguales o inferiores a 120 cm/s. Los picos de velocidad de flujo media se obtuvieron entre el cuarto y el décimo día. La precisión global, la sensibilidad y el valor predictivo negativo del DTC fueron buenos. La especificidad fue excelente para velocidades de flujo inferiores a 130 cm/s, y el valor predictivo positivo, bajo. Conclusión. Se comprobó la utilidad de la monitorización con DTC para el diagnóstico del vasoespasmo cerebral en pacientes con buen estado clínico inicial(AU)

INTRODUCTION: During the clinical course of aneurysmal subarachnoid haemorrhage, cerebral vasospasm is one of the most dreaded medical complications. AIM. To determine the usefulness of transcranial Doppler (TCD) ultrasound imaging in diagnosing vasospasm in patients with subarachnoid haemorrhage (SAH) who were attended in a Stroke Unit. PATIENTS AND METHODS: The study included 89 patients with SAH of a non-traumatic origin; these patients had been admitted to a Stroke Unit and were submitted to a contrast-enhanced neurovascular study and daily monitoring with TCD. Values were determined for the sensitivity, specificity, predictive power and overall precision of the TCD ultrasound imaging, together with the differences in mean flow rate and the coefficient of correlation between the gold standard test and the results of monitoring with TCD. RESULTS: Female patients under 50 years of age with favourable initial clinical degrees were predominant. Aneurysmal SAH was prevalent and the frequency of angiographic vasospasm was 40 percent, in the majority of cases located in the middle cerebral arteries. Most of the patients had mean cerebral blood flow rates of or below 120 cm/s. The peaks of mean blood flow rate were obtained between the fourth and the tenth day. Overall precision, sensitivity and the predictive negative value of TCD were good. Specificity was excellent for flow rates below 130 cm/s, and the predictive positive value was low. CONCLUSIONS: Monitoring with TCD proved to be useful for diagnosing cerebral vasospasm in patients with a good initial clinical status(AU)

Utilidad clínica del Doppler transcraneal en el diagnóstico del vasoespasmo cerebral en la hemorragia subaracnoidea. Estudio de validación / Clinical usefulness of transcranial doppler ultrasound imaging in the diagnosis of cerebral vasospasm in subarachnoid haemorrhage. A validation study

Introducción. Durante el curso clínico de hemorragia subaracnoidea aneurismática, el vasoespasmo cerebral esuna de las complicaciones médicas más temibles. Objetivo. Comprobar la utilidad de la ecografía Doppler transcraneal (DTC) para diagnosticar el vasoespasmo en pacientes con hemorragia subaracnoidea (HSA) atendidos en una Unidad de Ictus.Pacientes y métodos. Estudio de 89 pacientes con HSA no traumática, ingresados en una Unidad de Ictus, a los cuales se realizó un estudio neurovascular contrastado y monitorización diaria con DTC. Se determinaron los valores de sensibilidad, especificidad, predictivos y de precisión global de la ecografía DTC, las diferencias de velocidad de flujo media y el coeficiente de correlación entre la prueba estándar de referencia y los resultados de la monitorización con DTC. Resultados. Predominaron los pacientes menores de 50 años del sexo femenino con grados clínicos iniciales favorables. Prevaleció la HSA aneurismática y la frecuencia de vasoespasmo angiográfico fue del 40%, preferentemente localizado en las arterias cerebrales medias. La mayoría de los pacientes tenían velocidades medias del flujo sanguíneo cerebral iguales o inferiores a 120 cm/s. Los picos de velocidad de flujo media se obtuvieron entre el cuarto y el décimo día. La precisión global, la sensibilidad y el valor predictivo negativo del DTC fueron buenos. La especificidad fue excelente para velocidades de flujo inferiores a 130 cm/s, yel valor predictivo positivo, bajo. Conclusión. Se comprobó la utilidad de la monitorización con DTC para el diagnóstico del vasoespasmo cerebral en pacientes con buen estado clínico inicial

Introduction. During the clinical course of aneurysmal subarachnoid haemorrhage, cerebral vasospasm is one ofthe most dreaded medical complications. Aim. To determine the usefulness of transcranial Doppler (TCD) ultrasound imaging in diagnosing vasospasm in patients with subarachnoid haemorrhage (SAH) who were attended in a Stroke Unit. Patients and methods. The study included 89 patients with SAH of a non-traumatic origin; these patients had been admitted to a Stroke Unit and were submitted to a contrast-enhanced neurovascular study and daily monitoring with TCD. Values were determined forthe sensitivity, specificity, predictive power and overall precision of the TCD ultrasound imaging, together with the differences in mean flow rate and the coefficient of correlation between the gold standard test and the results of monitoring with TCD.Results. Female patients under 50 years of age with favourable initial clinical degrees were predominant. Aneurysmal SAH was prevalent and the frequency of angiographic vasospasm was 40%, in the majority of cases located in the middle cerebral arteries. Most of the patients had mean cerebral blood flow rates of or below 120 cm/s. The peaks of mean blood flow ratewere obtained between the fourth and the tenth day. Overall precision, sensitivity and the predictive negative value of TCD were good. Specificity was excellent for flow rates below 130 cm/s, and the predictive positive value was low. Conclusions. Monitoring with TCD proved to be useful for diagnosing cerebral vasospasm in patients with a good initial clinical status