ABSTRACT
Aneurism of the vein of Galen is a rare congenital anomaly, where complex arteriovenous malformation are identified between multiple choroidal arteries and the median prosencephalic vein of Markowski, which is a precursor of the vein of Galen, with subsequent aneurysmal enlargement of the respective arteriovenous system. The congenital malformation develops during week 6 to 11 of fetal development. Infants often die from high-output congestive heart failure. We present a case of a 40 years old patient, presented the first time at hospital at 28 weeks of gestation for lower perception of fetal movements. The patient was referred to our Prenatal Diagnosis Unit for a suspected cardiac malformation. We diagnosed cardiomegaly along vein of Galen aneurysmal malformation (VGAM) with severe cardiac failure, ascites, and critical fetal distress. Fetal demise was noted 24 hours later, during the corticosteroid procedures for fetal maturation. A stillborn weighting 2000g with a severe hydropic aspect was born after labor induction. Autopsy was performed following injection of colored gelatin in carotid vessels. The aneurysmal defect was evident in the vein of Galen and straight sinus. We also found the transverse, sagittal and the occipital sinus seriously dilated. We could not highlight the communication with the middle cerebral artery, because of the degradation of the cerebral tissue, despite an optimal preparation.
ABSTRACT
Traumatic brain injury (TBI) represents a common cause of presentation in the emergency room and is considered a major health problem all over the world. Our study objective was to provide a regional perspective from a county hospital regarding epidemiologic aspect of TBI in a single year and to compare it with existing studies. 592 patients fulfilled the inclusions criteria and their characteristics were noted. We observed that the highest rate of TBI was among older people with an age over >60 years with 40.88%, which represented 242 of cases. Middle age adults (40 to 60 years) represented 34.29% whereas young adults were 16.72%. The remaining cases of 8.11% suffered mostly of concussions (80%) and were encountered in the <20 years group. While comparing with the local population of the Dolj County we obtained an incidence of 89.6 per 100.000 people. When discussing gender, we observed that most of the patients were male with a ratio of 2,3:1. Over one year, 132 deaths were cause of TBI, with most of them being related to older age 55.71%, followed by the middle age adults with 37.93%. Direct cost was also assessed with 894.110.523 which represents more than 200.000 euro. Medium cost per patient was 6.296.552 RON, 1414 euro, with most of the patients having a medium admission of 10 days. TBI represents a major problem and perhaps a better assessment and a national program will help enhance the treatment quality and might also help reduce the cost.
