[Sagittal sinus thrombosis as a rare cause of postpartum headache: a case report]. / Trombosis del seno sagital cerebral: causa infrecuente de cefalea del postparto: a propósito de un caso.

Postpartum cerebral vein thrombosis is a very rare entity (3-4 cases per million). Clinical manifestations vary, though persistent headache is almost always reported, meaning that differential diagnosis should be performed to rule out other causes of postpartum headache. Recognized risk factors for this disease are the prothrombotic state of pregnancy (third trimester), excess weight, and thrombophilia Accidental dural puncture, protein C and S deficiencies, factor V Leiden mutation, antiphospholipid syndrome, and the use of oral contraceptives have also been implicated. The diagnostic test of choice is magnetic resonance imaging, as it is convenient and harmless, though transcranial Doppler ultrasound can also be used. Pulmonary angiography is the gold-standard test. The treatment of choice is anticoagulant therapy with heparin (a treatment that is controversial, however, due to the high risk of rebleeding), followed by long-term treatment with antivitamin K drugs. We report a case of thrombosis of the upper longitudinal sinus associated with persistent postpartum headache and a history of a failed attempt at epidural puncture for analgesia during labor. The case posed interesting diagnostic questions.

Trombosis del seno sagital cerebral: causa infrecuentede cefalea del postparto: a propósito de un caso / Sagittal sinus thrombosis as a rare cause of postpartum headache: a case report

Las trombosis venosas cerebrales del postparto sonuna entidad muy poco frecuente (3-4 casos por millón).Sus manifestaciones clínicas son variadas, siendo la cefaleapersistente casi una constante, lo que implica hacerun diagnóstico diferencial con otras causas de cefaleadurante el puerperio. Los factores predisponentes reconocidosde ésta patología son el estado protrombótico delembarazo (tercer trimestre), el sobrepeso y la existenciade trombofilias. Además se han implicado en su producciónla punción dural accidental, la existencia de deficienciasde proteína C y S, Factor V Leiden, el síndromeantifosfolípido e ingesta de anticonceptivos orales. Laprueba diagnóstica de elección es por su comodidad einocuidad la resonancia magnética, aunque puede utilizarsetambién la ecografía Doppler transcraneal. Laarteriografía es la prueba de referencia. El tratamientode elección es la anticoagulación con heparina (controvertidopor el riesgo elevado de nuevo sangrado), seguidade fármacos antivitamina K durante largos periodos.Describimos un caso de trombosis de seno longitudinalsuperior en el contexto de una cefalea persistente duranteel puerperio con el antecedente de intento fallido depunción epidural para analgesia de trabajo de parto quesupuso un interesante dilema diagnóstico (AU)

Postpartum cerebral vein thrombosis is a very rareentity (3-4 cases per million). Clinical manifestationsvary, though persistent headache is almost alwaysreported, meaning that differential diagnosis should beperformed to rule out other causes of postpartumheadache. Recognized risk factors for this disease are theprothrombotic state of pregnancy (third trimester),excess weight, and thrombophilia Accidental duralpuncture, protein C and S deficiencies, factor V Leidenmutation, antiphospholipid syndrome, and the use of oralcontraceptives have also been implicated. The diagnostictest of choice is magnetic resonance imaging, as it isconvenient and harmless, though transcranial Dopplerultrasound can also be used. Pulmonary angiography isthe gold-standard test. The treatment of choice isanticoagulant therapy with heparin (a treatment that iscontroversial, however, due to the high risk ofrebleeding), followed by long-term treatment withantivitamin K drugs. We report a case of thrombosis ofthe upper longitudinal sinus associated with persistentpostpartum headache and a history of a failed attempt atepidural puncture for analgesia during labor. The caseposed interesting diagnostic questions (AU)

[Ischemic rhabdomyolysis and acute renal failure]. / Rabdomiolisis isquémica y fracaso renal agudo.

Rhabdomyolysis is a clinical syndrome characterized by the breakdown and later necrosis of skeletal muscle, leading to the release of various intracellular components into the blood stream. The clinical expression of rhabdomyolysis ranges from asymptomatic to severe forms involving multiorgan failure with electrolyte imbalance, respiratory distress syndrome, acute renal failure and disseminated intravascular coagulation. Diagnosis is based on a finding of elevated serum levels of components that are normally found within the muscle cell, chiefly muscle enzymes and myoglobin. Acute kidney failure, one of the main consequences of rhabdomyolysis, occurs in 4% to 33% of cases. Treatment requires prompt volume replacement with crystalloids. In spite of successful resuscitation and prophylaxis against myoglobulin-induced renal failure, 1 out of every 3 patients develops kidney damage and requires continuous replacement therapy.

Rabdomiolisis isquémica y fracaso renal agudo / Ischemic rhabdomyolysis and acute renal failure

La rabdomiolisis es un síndrome clínico caracterizadopor la destrucción y posterior necrosis del músculoesquelético que produce un aumento de sus componentesintracelulares en la circulación sanguínea. Su expresiónclínica puede variar desde un cuadro asintomático, hastaun cuadro grave asociado a fracaso multiorgánico conalteraciones electrolíticas, síndrome de distrés respiratorioagudo, fallo renal agudo y coagulación intravasculardiseminada. El diagnóstico se basa en la detección en lacirculación general de los componentes normalmentecontenidos en la célula muscular, principalmente losenzimas musculares y la mioglobina. El fracaso renalagudo es una de las consecuencias más importantes de larabdomiolisis, presentándose en un 4%-33% de loscasos. El tratamiento se basa en una reposición enérgicade volumen con cristaloides. A pesar de una adecuadareanimación y profilaxis contra el fallo renal mioglobinúrico,uno de cada tres pacientes lo desarrollan, precisandoalguna terapia continua de reemplazo renal (AU)

Rhabdomyolysis is a clinical syndrome characterized by the breakdown and later necrosis of skeletal muscle, leading to the release of various intracellular components into the blood stream. The clinical expression of rhabdomyolysis ranges from asymptomatic to severe forms involving multiorgan failure with electrolyte imbalance, respiratory distress syndrome, acute renal failure and disseminated intravascular coagulation. Diagnosis is based on a finding of elevated serum levels of components that are normally found within the muscle cell, chiefly muscle enzymes and myoglobin. Acute kidney failure, one of the main consequences of rhabdomyolysis, occurs in 4% to 33% of cases. Treatment requires prompt volume replacement with crystalloids. In spite of successful resuscitation and prophylaxis against myoglobulin-induced renal failure, 1 out of every 3 patients develops kidney damage and requires continuous replacement therapy (AU)