ABSTRACT
Intraoperative ultrasound navigation was initially introduced in the neurosurgical field for brain tumor surgery and was then extended to arteriovenous malformation surgery with good success. This tool provides real-time intraoperative images.1 Moreover, Doppler ultrasound permits early identification of feeding arteries and supplies the surgeon with a global impression of the flow dynamics.2 A further use of doppler is to check for residual nidus. Other advantages are the capacity to identify intracerebral hemorrhage.2 In this video, we demonstrate the case of a 15-yr-old patient who presented intracranial hemorrhage. Magnetic resonance imaging revealed the presence of left frontoparietal hematoma associated with an image suggestive of cerebral arteriovenous malformation (AVM). Arteriography confirmed the diagnosis of AVM fed by branches of the anterior cerebral and superficial drainage for the superior sagittal sinus. The patient was placed in dorsal decubitus with his head turned to the right and a left parietal-frontal craniotomy was performed. After the dura mater was opened, cortical mapping was performed to locate the motor and sensory cortex. After the mapping, ultrasound with doppler was performed to locate the AVM and the hematoma and determine its relation to the motor and sensory cortex. At the end of the surgery, doppler ultrasound was used again to ensure complete resection of the AVM. Intraoperative Ultrasound navigation with doppler is an inexpensive technology that can be used in the treatment of AVMs, especially in the subcortex, as it assists in locating the nidus and confirms its complete resection.
ABSTRACT
Cerebral aneurysms are rarely observed in patients with Takaysu's arteritis. To our knowledge, this report presents the first case described in Brazil. Hemodynamic stress caused by obstructions of the cervical vessels developes cerebral aneurysms in these patients and they have higher rates of multiple and posterior circulation aneurysms than general population. In the majority of cases, microsurgical treatment is indicated mainly due to changes in the cervical vessels that preclude an endovascular approach.
Aneurismas cerebrais são raramente observados em pacientes com arterite de Takayasu. Este é o primeiro caso desta associação descrito no Brasil. O estresse hemodinâmico causado pelas obstruções vasculares cervicais desenvolve os aneurismas cerebrais nestes pacientes e eles apresentam maiores taxas de aneurismas múltiplos e de acometimento da circulação cerebral posterior. Na maioria dos casos, o tratamento microcirúrgico está indicado pois as alterações anatômicas dos vasos cervicais dificultam a abordagem endovascular.
Subject(s)
Humans , Female , Intracranial Aneurysm , Takayasu Arteritis , Takayasu Arteritis/physiopathology , Takayasu Arteritis/pathologyABSTRACT
OBJETIVOS: Avaliar a associação entre comorbidades e risco de morte e reinternação em idosos após alta de enfermarias de clínica médica de um hospital universitário. MÉTODOS: Estudo de coorte de idosos que receberam alta do Hospital Universitário Lauro Wanderley. Foram utilizados o Índice de Comorbidade de Charlson (ICC) e o ICC associado à idade (ICIC). O desfecho primário foi mortalidade pós-hospitalização e o secundário, ocorrência de reinternações. RESULTADOS: Foram acompanhados 104 pacientes por 40,9±27,6 semanas; 31 (29,8%) morreram e 38 (36,5%) foram reinternados. A curva de sobrevida foi descendente com proporção acumulada de 50%. Óbito relacionou-se com idade (p=0,04), número de prescrições hospitalares (p=0,01), ICC (p=0,001) e ICIC (p=0,001). Não houve associação de ICC com reinternação. CONCLUSÕES: A gravidade das comorbidades em idosos relacionou-se com maior risco de morte pós-hospitalização. Salienta-se a necessidade de se disporem de dados de comorbidade para avaliar cuidados a essa clientela.
OBJECTIVES: To evaluate the association between comorbidities and risk of death and readmission after discharge of elderly after discharge from medical wards in a university hospital. METHODS: A cohort study of elderly patients discharged from University Hospital Lauro Wanderley. We used the Charlson Comorbidity Index (CCI) and the ICC associated with age (ICIC). The primary outcome was post-hospitalization mortality ; the secondary, readmissions. RESULTS: 104 patients were followed for 40.9±27.6 weeks; 31 (29.8%) died and 38 (36.5%) were readmitted. The survival curve was descending with cumulative proportion of 50%. Death was related to age (p = 0.04), number of hospital prescriptions (p=0.01), CHF (p=0.001) and ICIC (p=0.001). There was no association of ICC with rehospitalization. CONCLUSIONS: The severity of comorbidities in the elderly was related to increased risk of death after hospitalization. This emphasizes the need to dispose of comorbidity data to evaluate care for these patients.
