Hematoma cerebral agudo en la evolución de una encefalitis por virus herpes simple tipo 1. Una complicación infrecuente / Acute cerebral haematoma in the course of herpes simplex 1 encephalitis. A rare complication

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Ultrasound-guided lumbar puncture for nusinersen administration in spinal muscular atrophy patients.

BACKGROUND AND PURPOSE: The purpose was to report the results of ultrasound-guided lumbar puncture for the administration of nusinersen in spinal muscular atrophy (SMA) patients with complex spines. METHODS: Eighteen SMA patients (five children, five adolescents and eight adults) with either severe scoliosis or spondylodesis were evaluated for ultrasound-guided lumbar puncture. Ultrasound was performed with a 3.5 MHz transducer to guide a 22 gauge × 15 mm needle, which was placed in the posterior lumbar space following a parasagittal interlaminar approach. RESULTS: Twelve patients had undergone spinal instrumentation (nine growing rods and three spinal fusion) whilst the other six showed severe scoliosis. Success was achieved in 91/94 attempts (96.8%), in 14/18 patients (77.8%), including 100% of children and adolescents and 50% of adult patients. In two of the unsuccessfully treated patients, computed tomography and fluoroscopy-guided transforaminal lumbar punctures were also tried without success. After a median follow-up of 14 months, only few adverse events, mostly mild, were observed. CONCLUSION: The ultrasound-guided lumbar puncture, following an interlaminar parasagittal approach, is a safe and effective approach for intrathecal treatment with nusinersen in children, adolescents and carefully selected adult SMA patients with complex spines and could be considered the first option in them.

Fractura lineal de cráneo en el lactante con traumatismo craneoencefálico leve: influencia de la tomografía computarizada en su manejo / Linear skull fracture in infants after mild traumatic brain injury: influence of computed tomography in management

INTRODUCCIÓN: El traumatismo craneoencefálico (TCE) constituye un motivo frecuente de consulta en urgencias pediátricas. La necesidad de intervención quirúrgica en pacientes menores de 2 años con TCE leve es mínima, pero los hallazgos intracraneales pueden influir en el manejo del paciente. El objetivo de este trabajo es valorar el impacto de la TC en el manejo de los niños menores de 2 años con TCE leve que presentan una fractura lineal de cráneo en la radiografía convencional. MATERIAL Y MÉTODOS: Estudio descriptivo y retrospectivo en el que se analizan las radiografías de cráneo practicadas a pacientes menores de 2 años que fueron atendidos en el área de urgencias de nuestro hospital de nivel terciario por TCE leve en un período de 4 años. RESULTADOS: Se realizaron 88 exploraciones de tomografía computarizada (TC) realizadas por sospecha de fractura lineal de cráneo en radiografía. Se confirmó la fractura en 74 de ellos (16% de falsos positivos). De los 74 niños con diagnóstico confirmado de fractura, la TC fue normal en el 92% de los estudios y mostró hallazgos intracraneales en 6 casos (8% de los casos con fractura). Dos casos requirieron ingreso superior a 2 días (2,7% de todos los casos con fractura) y en los 4 casos restantes la estancia hospitalaria no superó las 48 horas. En ningún caso se requirió cirugía. CONCLUSIÓN: No parece justificada la realización de una TC craneal de forma sistemática en niños menores de 2 años con TCE y bajo/intermedio riesgo de lesión intracraneal, incluso con fractura lineal de cráneo. En ausencia de factores de riesgo, proponemos individualizar el estudio de imagen basándose en el criterio clínico

INTRODUCTION: Traumatic brain injury (TBI) is a common reason for pediatric emergency room visits. Surgical intervention for mild TBI is rarely necessary in children aged <2 years, but the intracranial findings can influence the management of the patient. This paper aims to evaluate the impact of computed tomography (CT) in the management of children aged <2 years with mild TBI and linear skull fractures on plain-film X-rays. MATERIAL AND METHODS: This retrospective descriptive study analyzed skull X-rays obtained in children <2 years old attended for mild TBI in the emergency room of our tertiary hospital over a 4-year period. RESULTS: A total of 88 CT studies were done for suspicion of linear skull fractures on plain-film X-rays. Fractures were confirmed in 74, representing a false-positive rate of 16%. Of the 74 infants with confirmed fractures, intracranial CT findings were normal in 68 (92%) and abnormal in 6 (8%). Two patients (2.7% of all patients with confirmed fractures) required hospital stays longer than 2 days; the other four patients with abnormal intracranial findings were discharged within 48hours of admission. None of the cases required surgery. CONCLUSION: Systematic CT studies do not seem justified for all children aged <2 years with TBI and low/intermediate risk of intracranial lesions, even when they have linear skull fractures. In the absence of risk factors, we propose individualizing the imaging study based on clinical criteria

Papel de la radiología en el síndrome de pseudotumor cerebral / Role of Imaging in pseudotumor cerebri syndrome

El síndrome de pseudotumor cerebral (SPTC) es una alteración caracterizada por el aumento de presión intracraneal que afecta predominantemente a mujeres jóvenes obesas. El objetivo del trabajo es definir los conceptos de SPTC primario, sin causa identificable y denominado también hipertensión intracraneal idiopática (HII), y de SPTC secundario, con etiología identificable. Se revisa el papel actual de las pruebas de imagen en su diagnóstico y los hallazgos por imagen típicos del SPTC, algunos de los cuales se incluyen entre los criterios diagnósticos propuestos en 2013. También se remarca el papel fundamental de la radiología intervencionista en el tratamiento, puesto que la colocación de stent en las estenosis de senos venosos constituye una alternativa terapéutica novedosa en pacientes resistentes al tratamiento clásico. Por último, se describen aquellos biomarcadores de imagen que han sido evaluados para aproximar el diagnóstico de la HII y predecir la respuesta al tratamiento

Pseudotumor cerebri is a disorder characterized by increased intracranial pressure that predominantly affects obese young women. This paper aims to define the concepts of primary pseudotumor cerebri, in which the cause cannot be identified (also known as idiopathic intracranial hypertension), and secondary pseudotumor cerebri, in which the cause can be identified. We review the current role of imaging techniques in diagnosing pseudotumor cerebri and describe and illustrate the most characteristic imaging findings of the disorder, some of which are included in the diagnostic criteria proposed in 2013. We also consider the fundamental role of interventional radiology in the treatment of pseudotumor cerebri because placing a stent in stenosed venous sinuses is a novel treatment option in patients who are refractory to classical treatment. Finally, we describe the imaging biomarkers that have been evaluated for diagnosing primary pseudotumor cerebri and predicting the response to treatment

Role of Imaging in pseudotumor cerebri syndrome. / Papel de la radiología en el síndrome de pseudotumor cerebral.

Pseudotumor cerebri is a disorder characterized by increased intracranial pressure that predominantly affects obese young women. This paper aims to define the concepts of primary pseudotumor cerebri, in which the cause cannot be identified (also known as idiopathic intracranial hypertension), and secondary pseudotumor cerebri, in which the cause can be identified. We review the current role of imaging techniques in diagnosing pseudotumor cerebri and describe and illustrate the most characteristic imaging findings of the disorder, some of which are included in the diagnostic criteria proposed in 2013. We also consider the fundamental role of interventional radiology in the treatment of pseudotumor cerebri because placing a stent in stenosed venous sinuses is a novel treatment option in patients who are refractory to classical treatment. Finally, we describe the imaging biomarkers that have been evaluated for diagnosing primary pseudotumor cerebri and predicting the response to treatment.

Linear skull fracture in infants after mild traumatic brain injury: influence of computed tomography in management. / Fractura lineal de cráneo en el lactante con traumatismo craneoencefálico leve: influencia de la tomografía computarizada en su manejo.

INTRODUCTION: Traumatic brain injury (TBI) is a common reason for pediatric emergency room visits. Surgical intervention for mild TBI is rarely necessary in children aged <2 years, but the intracranial findings can influence the management of the patient. This paper aims to evaluate the impact of computed tomography (CT) in the management of children aged <2 years with mild TBI and linear skull fractures on plain-film X-rays. MATERIAL AND METHODS: This retrospective descriptive study analyzed skull X-rays obtained in children <2 years old attended for mild TBI in the emergency room of our tertiary hospital over a 4-year period. RESULTS: A total of 88 CT studies were done for suspicion of linear skull fractures on plain-film X-rays. Fractures were confirmed in 74, representing a false-positive rate of 16%. Of the 74 infants with confirmed fractures, intracranial CT findings were normal in 68 (92%) and abnormal in 6 (8%). Two patients (2.7% of all patients with confirmed fractures) required hospital stays longer than 2 days; the other four patients with abnormal intracranial findings were discharged within 48hours of admission. None of the cases required surgery. CONCLUSION: Systematic CT studies do not seem justified for all children aged <2 years with TBI and low/intermediate risk of intracranial lesions, even when they have linear skull fractures. In the absence of risk factors, we propose individualizing the imaging study based on clinical criteria.