Enfermo con neurofibromatosis tipo 1 y tumoración supratentorial / Patient with neurofibromatosis type 1 and supratentorial tumor

Se presenta un paciente varón, de 24 años de edad, con antecedentes de neurofibromatosis tipo 1 que ingresó por cefalea, vómitos y disartria. Se demostró una tumoración supratentorial y se diagnosticó un tumor de estirpe glial de tipo astrocitoma difuso fibrilar grado IV. El informe de diversos tumores asociados a la enfermedad de Von Recklinghausen y las características imagenológicas y morfológicas descritas motivaron a revisar la clasificación de la Organización Mundial de la Salud para los tumores del sistema nervioso central y la clasificación de St Anne-Mayo para tumores hemisféricos y permitió su correcta ubicación y su diferenciación con otras neoplasias intracraneales que han sido descritas en pacientes afectos de la enfermedad. La sobrevida del enfermo, de 20 meses hasta la fecha, coincide con su ubicación como un tumor de crecimiento más lento que ha sufrido transformación anaplásica, en el que se describe un pronóstico relativamente mejor(AU)

Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients

Objective To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury. Design Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: basic model (demographic and clinical variables only) and CT model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately. Setting Medical Research Council (MRC) CRASH Trial. Subjects 10 008 patients with traumatic brain injury. Models externally validated in a cohort of 8509. Results The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration. Conclusion Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury(AU)

Effect of intravenous corticosteroids on death within 14 daysin 10008 adults with clinically significant head injury (MRCCRASH trial): randomised placebo-controlled trial

Background Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1–2 percent. The CRASH trial—a multicentre international collaboration—aimed to confirm or refute such an effect by recruiting 20 000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment(AU)