Características Clínicas y Terapéuticas de los Pacientes que Ingresan por Trauma Craneoencefálico en el Complejo Hospitalario Dr. Arnulfo Arias Madrid. 2022 - 2023

Introducción: El trauma craneoencefálico (TCE) se define como una patología caracterizada por la alteración cerebral secundaria a una lesión traumática en la región de la cabeza, con la presencia de alteración de la consciencia y/o amnesia debido al trauma, cambios neurológicos, neurofisiológicos, con posibles fracturas de cráneo o lesiones intra craneanas atribuibles al trauma. Metodología: Es un estudio observacional, descriptivo, prospectivo en pacientes que sufrieron TCE internados en el servicio de neurocirugía en el Complejo Hospitalario Dr. Arnulfo Arias Madrid durante el periodo de marzo de 2022 a febrero de 2023. Resultados: Los resultados de este estudio mostraron que predomina el sexo masculino (78%) sobre el femenino (22%) en pacientes con TCE. Las causas de lesión más comunes fueron caídas de sus pies (27%), caídas de altura (25%) y colisión de moto/automóvil (20%). Las presentaciones clínicas más comunes fueron pérdida de consciencia (49%), amnesia/desorientación (19%) y cefalea (10%). Conclusión: El seguimiento promedio de los pacientes con TCE fue de 16 días. El género masculino fue el más frecuente, con mayor proporción en la edad media y adulta mayor. La etiología principalmente fue por caídas, manifestándose comúnmente por perdida del estado de alerta, y teniendo hallazgos múltiples en la tomografía cerebral. La mayoría de los pacientes se les dio manejo conservador. (provisto por Infomedic International)

Introduction: Cranioencephalic trauma (TBI) is defined as a pathology characterized by cerebral alteration secondary to traumatic injury in the head region, with the presence of altered consciousness and/or amnesia due to trauma, neurological, neurophysiological changes, with possible skull fractures or intracranial lesions attributable to trauma. Methodology: This is an observational, descriptive, prospective study in patients who suffered TBI hospitalized in the neurosurgery service at the Complejo Hospitalario Dr. Arnulfo Arias Madrid during the period from March 2022 to February 2023. Results: The results of this study showed a predominance of male (78%) over female (22%) patients with TBI. The most common causes of injury were falls from their feet (27%), falls from height (25%) and motorcycle/automobile collision (20%). The most common clinical presentations were loss of consciousness (49%), amnesia/disorientation (19%) and headache (10%). Conclusion: The average follow-up of patients with TBI was 16 days. The male gender was the most frequent, with a higher proportion in middle age and older adults. The etiology was mainly due to falls, commonly manifested by loss of alertness, and multiple findings in brain tomography. Most patients were managed conservatively. (provided by Infomedic International)

Neuropsychological alterations and neuroradiological findings in patients with post-traumatic concussion: Results of a pilot study. / Alteraciones neuropsicológicas y hallazgos neurorradiológicos en pacientes con conmoción cerebral postraumática. Resultados de un estudio piloto.

INTRODUCTION: Mild traumatic brain injury (mTBI) has traditionally been considered to cause no significant brain damage since symptoms spontaneously remit after a few days. However, this idea is facing increasing scrutiny. The purpose of this study is to demonstrate the presence of early cognitive alterations in a series of patients with mTBI and to link these findings to different markers of brain damage. METHODS: We conducted a prospective study of a consecutive series of patients with mTBI who were evaluated over a 12-month period. Forty-one (3.7%) of the 1144 included patients had experienced a concussion. Patients underwent a routine clinical evaluation and a brain computed tomography (CT) scan, and were also administered a standardised test for post-concussion symptoms within the first 24hours of mTBI and also 1 to 2 weeks later. The second assessment also included a neuropsychological test battery. The results of these studies were compared to those of a control group of 28 healthy volunteers with similar characteristics. Twenty patients underwent an MRI scan. RESULTS: Verbal memory and learning were the cognitive functions most affected by mTBI. Seven out of the 20 patients with normal CT findings displayed structural alterations on MR images, which were compatible with diffuse axonal injury in 2 cases. CONCLUSIONS: Results from this pilot study suggest that early cognitive alterations and structural brain lesions affect a considerable percentage of patients with post-concussion syndrome following mTBI.

[Magnetic resonance in traumatic brain injury: A comparative study of the different conventional magnetic resonance imaging sequences and their diagnostic value in diffuse axonal injury]. / Resonancia magnética en el traumatismo craneal grave: estudio comparativo de las diferentes secuencias de resonancia magnética convencional y su valor diagnóstico en la lesión axonal difusa.

OBJECTIVE: To compare the identification capability of traumatic axonal injury (TAI) by different sequences on conventional magnetic resonance (MR) studies in traumatic brain injury (TBI) patients. MATERIAL AND METHODS: We retropectevely analyzed 264 TBI patients to whom a MR had been performed in the first 60 days after trauma. All clinical variables related to prognosis were registered, as well as the data from the initial computed tomography. The MR imaging protocol consisted of a 3-plane localizer sequence T1-weighted and T2-weighted fast spin-echo, FLAIR and gradient-echo images (GRET2*). TAI lesions were classified according to Gentry and Firsching classifications. We calculated weighted kappa coefficients and the area under the ROC curve for each MR sequence. A multivariable analyses was performed to correlate MR findings in each sequence with the final outcome of the patients. RESULTS: TAI lesions were adequately visualized on T2, FLAIR and GRET2* sequences in more than 80% of the studies. Subcortical TAI lesions were well on FLAIR and GRET2* sequences visualized hemorrhagic TAI lesions. We saw that these MR sequences had a high inter-rater agreement for TAI diagnosis (0.8). T2 sequence presented the highest value on ROC curve in Gentry (0.68, 95%CI: 0.61-0.76, p<0.001, Nagerlkerke-R2 0.26) and Firsching classifications (0.64, 95%CI 0.57-0.72, p<0.001, Nagerlkerke-R2 0.19), followed by FLAIR and GRET2* sequences. Both classifications determined by each of these sequences were associated with poor outcome after performing a multivariable analyses adjusted for prognostic factors (p<0.02). CONCLUSIONS: We recommend to perform conventional MR study in subacute phase including T2, FLAIR and GRET2* sequences for visualize TAI lesions. These MR findings added prognostic information in TBI patients.

Caracterización de los pacientes con traumatismo craneoencefálico y lesión axonal traumática / Characterization of patients with head trauma and traumatic axonal injury

Fundamento: la lesión axonal traumática se caracteriza por lesiones multifocales, consecuencias del daño primario, secundario y terciario capaz de originar grados variables de discapacidad. Objetivo: caracterizar los pacientes con lesión axonal traumática. Métodos: se realizó un estudio analítico transversal desde enero de 2014 hasta diciembre de 2015. La población objetiva estuvo compuesta por 35 pacientes mayores de 18 años con diagnóstico de lesión axonal traumática tipo I a la IV de la clasificación tomográfica de Marshall. Con los datos recogidos de la revisión de historias clínicas y observación directa, se creó una base de datos en SPSS para su procesamiento mediante técnicas uni y multivariadas. Resultados: se encontró un predominio de los varones entre 18 y 30 años sin hábitos tóxicos. La mayor parte de los pacientes sobrevivieron y el fallecimiento se asoció a la presencia de lesión axonal traumática severa, clasificación tomográfica de Marshall grado III, aparición de complicaciones y presencia de traumatismos asociados en tórax, abdomen y columna cervical. Conclusiones: el diagnóstico de la lesión axonal traumática se basa en la correlación clínico radiológico apoyado en las imágenes de la tomografía y se confirma con la resonancia nuclear magnética. El estudio histológico evidencia lesiones que no son demostradas en los más avanzados estudios radiológicos. Su prevención es el pilar más importante en la atención médica seguida de la atención neurointensiva orientada por el neuromonitoreo.

Background: traumatic axonal injury is characterized by multifocal lesions, consequences of primary, secondary and tertiary damage which is able to cause varying degrees of disability. Objective: to characterize patients with traumatic axonal injury. Methods: a cross-sectional analytical study was conducted from January 2014 to December 2015. The target population was composed of 35 patients over age 18 whose diagnosis was traumatic axonal injury type I and IV of the Marshall computed tomographic (CT) classification. With the data collected from medical records revisions and direct observation, a database was created in SPSS for its processing through univariate and multivariate techniques. Results: male patients between 18 and 30 years old without bad habits prevailed. Most of the patients survived and death was associated with the presence of severe traumatic axonal injury, Marshall computed tomographic (CT) classification degree III, complications and presence of trauma in thorax, abdomen and cervical spine. Conclusions: diagnosis of traumatic axonal injury is based on the clinical radiological correlation based on images from tomography and it is confirmed by Magnetic resonance imaging (MRI). Histological study shows injuries that are not demonstrated in the most advanced radiological studies. Its prevention is the most fundamental base in medical assistance, followed by neurocritical attention oriented by neuromonitoring.

Fisiopatología del trauma craneoencefalico / Physiopathology of traumatic brain injury

Introducción: El trauma craneoencefalico (TCE) es un problema de salud mundial que produce incapacidades motoras, del comportamiento o en la esfera cognitiva. Objetivo: Hacer una revisión de la fisiopatología del TCE partiendo de unas bases epidemiológicas, anatómicas y fisiológicas. Discusión y conclusiones: La revisión de la fisiopatología del evento traumático servira para tener el contexto dentro del cual se intentara describir y conceptualizar de manera general los procesos fisiopatológicos mas importantes relacionados con el TCE. No es motivo de este artículo profundizar en los conceptos aquí expuestos porque generaría capítulos extensos de discusión tematica, sino por el contrario, dar una mirada panoramica del TCE para poder comprender las principales características y la definición como enfermedad del conjunto de manifestaciones clínicas y estructurales.

Introduction: Traumatic brain injury (TBI) is a global medical problem. After TBI patients may show motor, behavioral and cognitive disabilities. Objective: The intention of this paper is to develop the patho-physiology of the head injury, beginning with epidemiological, anatomical, and physiological bases. Discussion and conclusions: The knowledge of the pathophysiology of TBI will help us to have a context with in we will try to describe and conceptualize in general way the most important patho-physiological process related to the head injury. It is not pretense of this paper get in deep of the concepts exposed here, since it would generate huge chapters of thematic discussion. The pretense is to take a panoramic review of the head injury to understand the foremost characteristics and definition, as a whole of clinical and structural manifestation of this pathology.