Traumatic rupture of the circle of Willis with closed head injury: Its pathology and possible pathogenesis.

Massive and fatal subarachnoid hemorrhage (SAH) with an injury on the circle of Willis may be caused by blunt force to the head; however, it is extremely rare, and the precise mechanism of arterial rupture remains unclear. We investigated the clinicopathologic appearance of four rare autopsy cases of massive SAH associated with the rupture of the circle of Willis. All four cases were men aged 17-75 years who presented with a loss of consciousness within a short interval after the injury. Autopsy revealed that the rupture site was located in the vertebral artery in two cases and in the anterior cerebral artery (ACA) in two cases. During our literature review, we found no previous report on traumatic ACA rupture. Based on the correlation of the autopsy findings and the circumstance of injury, we determined that the accidental excessive stretching of the selected artery by neck anteflexion or rotation after a blunt trauma to the posterior head might have caused this rare lethal injury. These cases demonstrated the diversity of the traumatic rupture site of the circle of Willis after a blunt head and/or neck injury. The topographical features of the circle of Willis, particularly in correlation with the surrounding tissue, might account for the occurrence and site of these rare injuries.

Terapia endovascular y hemorragia subaracnoidea: experiencia en el Hospital Central de Maracay / Endovascular therapy and subarachnoid hemorrhage: experience in the Hospital Central of Maracay

La ruptura aneurismática es la causa más frecuente de hemorragia subaracnoidea y la embolización endovascular es un procedimiento neuroradiológico eficiente que minimiza la posibilidad de una nueva ruptura y sangrado a corto y largo plazo. Investigación de casos, descriptiva, retrospectiva, sin experimentación, de 78 historias clínicas de pacientes con diagnóstico de hemorragia subaracnoidea tratados en el servicio de medicina interna del Hospital Central de Maracay en el período enero 2011 – junio 2012. Predominó el género femenino, provenientes en su mayoría del centro del país, la edad promedio fue de 49 años, el mayor porcentaje recibió tratamiento electivo, con una estancia hospitalaria menor de 3 días. Las arterias afectadas pertenecieron especialmente al circuito anterior del Polígono de Willis. No se reportaron complicaciones fatales. La embolización es un instrumento terapéutico altamente eficaz, con pocas complicaciones perioperatorias y estancia hospitalaria corta.

Aneurysmal rupture is the most common cause of subarachnoid hemorrhage. Embolization is an efficient neuroradiological procedure that minimizes the possibility of a new rupture and bleeding. This is a descriptive case review, retrospective, not experimental, of the medical records of 78 patients with non-traumatic subarachnoid hemorrhage treated at the department of internal medicine of the Hospital Central Maracay, Venezuela from January 2011 to June 2012. Female gender predominated, the average age was 49 years; the highest percentage received elective treatment, with a hospital stay of less than 3 days. The affected arteries were mostly from the anterior circuit of Willis poligon. There were no fatal complications. Embolization is a highly effective therapeutic instrument, with few complications and shorter hospital stay.

Variaciones morfológicas del círculo arterial en fallecidos con enfermedades cerebrovasculares Isquémicas / Morphological variations of the arterial circle in the deceased with ischemic cerebrovascular disease

Se realiza un estudio con el objetivo de describir variaciones morfológicas del encéfalo en fallecidos por enfermedades cerebrovasculares isquémicas (ECVI) en el Hospital General Docente Dr Agostinho Neto de Guantánamo, en el período enero-junio de 2010. El universo está constituido por el total de fallecidos en dicha entidad hasta 2010 y, la muestra, por 134 encéfalos de individuos que al morir presentaron diagnóstico de ECVI. La información primaria es tomada de controles estadísticos, historias clínicas, libro de necropsias del hospital y plasmada en una ficha de vaciamiento. Se seleccionan variables como: edad, sexo, configuración del polígono de Willis y variaciones arteriales. Predomina el sexo masculino y el grupo de edades de 80-89, color de piel mestizo, así como círculos arteriales con modificaciones no clásicos, que en la mayoría de los individuos está dada por el aspecto delgado de las arterias, afectando fundamentalmente a la ACoP derecha. Se recomienda relacionar los resultados obtenidos en encéfalos de fallecidos por enfermedades cerebrovasculares isquémicas con los de fallecidos por otras causas (AU)

A research is done at the Microbiology lab of the Provincial Center of Hygiene Epidemiology and Microbiology (CPHEM) from January to March 2009 with the aim to determine antimicrobial resistance in 73 strains of microorganisms isolated and identified from sputum samples of patients with lower respiratory infections. Determine the sensitivity and resistance to antimicrobials in vitro by the Kirby Bauer method. The results are expressed in two-dimensional table and the summary measure was used by percentage. The highest number of bacteria was identified gram-negative bacilli. The greatest resistance is shown by the Pseudomonas aeruginosa, Staphylococcus aureus, followed by Klebsiella pneumoniae. As a conclusion antimicrobial resistance is an emerging problem, which requires the proper selection and identification of the etiologic agent

Variaciones del sector anterior del polígono de Willis. Correlación anatomo-angiográfica y su implicancia en la cirugía de aneurismas intracraneanos (Arterias, ácigos cerebral anterior, mediana del cuerpo calloso y cerebral media accesoria) / Variants of the anterior circle of Willis, Anatomic and angiografic correlation and its implications in the surgery of itnracranial aneurysms

Es universalmente aceptado que el polígono de Willis presenta variantes en su anatomía habitual, hasta en el 60% de los casos. Algunas de éstas se asocian a malformaciones vasculares, como los aneurismas. El conocimiento de estas variantes anatómicas es de fundamental importancia con vistas al acto quirúrgico, con el fin de preservar arterias en topografía poco habituales y cuya lesión puede determinar secuelas invalidantes. Los autores, en revisión anatómica de 192 hemisferios cerebrales, encuentran tres variantes del sector anterior del Polígono de Willis: arteria ácigos cerebral anterior, arteria mediana del cuerpo calloso y arteria cerebral media accesoria. Se realiza la descripción anatómica de los hallazgos, la correlación con la angiografía y finalmente cómo influyeron estos cambios en el acto quirúrgico de aneurismas de las regiones implicadas (AU)

It is worlwide accepted that in almost 60% of cases, anatomical variants in the Circle of Willis can be found. Some of them are associated with vascular malfor¬mations such as aneurysms. The knowledge of these anatomical variants is of vital importance when facing surgery, being the aims to preserve arteries in unusual localisations, which when injured can determine invali¬dating sequelae. The authors have reviewed 192 cerebral hemis¬pheres, finding three variants in the anterior Circle of Willis: Azigos anterior cerebral artery; Median artery of the corpus callosum and accesory middle cerebral artery. The authors make an anatomical description of the findings, their angiographical correlation, and describe the influence of these changes during surgery of aneurysms in the involved regions (AU)

Traumatic intracranial aneurysms complicating anterior skull base surgery.

Traumatic cerebral aneurysm formation following closed head injury is uncommon, although well documented in the literature. Aneurysmal development following surgical procedures on the anterior skull base is extremely rare. This article reports successful neurosurgical management of 3 cases of anterior circulation aneurysms that developed following relatively straightforward rhinological procedures. These cases illustrate the vulnerability of the vessels of the anterior circle of Willis; they also document the sites of penetration of the anterior skull base. As reported in the literature, most such aneurysms occur following transsphenoidal surgery. The clinical procedures, radiological follow-up, and the surgical management are outlined; three cases are utilized to illustrate this complication. The causes of such iatrogenic injury are discussed, with emphasis on strategies for the avoidance of such injuries.