[Locked-in syndrome due to a vertebral dissection and therapeutic options with intraarterial fibrinolysis in acute phase]. / Disección vertebral como causa del síndrome de enclaustramiento y opciones terapéuticas con fibrinólisis intraarterial durante la fase aguda.

INTRODUCTION: Dissection of vertebral artery is an unusual pathology but sometimes is the cause of stroke in young patients. Since last years, and with the rise of some chiropractic technics, some authors have related these ones with the dissection of vertebral artery. CASE REPORT: We show a case of a 37 years old woman that after a chiropractic session began symptoms of posterior circulation dysfunction as decrease level of sense, tetraparesis and alteration of cranial nerves. The arteriography confirmed the existence of a vertebral dissection of V2 portion and thrombosis of basilar and contralateral vertebral arteries. Intraarterial fibrinolysis was performed with complete recanalization of the artery. Although this, the patient had parenchimal lesions in pons, cerebellum and territory of posterior cerebral artery that produced a locked-in syndrome. All the complementary exams were normal. DISCUSSION: We discuss the relationship between cervical manipulation as an aetiology of vertebral dissection, locked-in syndrome and therapeutic options in these patients

Disección vertebral como causa del síndrome de enclaustramiento y opciones terapéuticas con fibrinólisis intraarterial durante la fase aguda / Locked-in syndrome due to a vertebral dissection and therapeutic options with intraarterial fibrinolysis in acute phase

Introducción. La disección de la arteria vertebral es una patología poco frecuente, pero que en ocasiones se ha implicado en la etiología del ictus en pacientes jóvenes. Desde hace algunos años, se han relacionado determinadas técnicas quiroprácticas, que poseen un elevado grado de aceptación, con la aparición de este fenómeno. Caso clínico. Presentamos el caso de una paciente de 37 años que, después de una sesión de masaje cervical, presentó una clínica progresiva de disminución del nivel de conciencia, tetraparesia y alteración de los pares craneales compatible con trastornos de la circulación posterior. Una arteriografía confirmó la sospecha de la existencia de una disección de la arteria vertebral izquierda, segmento V2, con una trombosis basilar y vertebral contralateral secundarias. Se realizó una fibrinólisis intrarterial y se consiguió la lisis del trombo y la recanalización arterial. A pesar de ello, la paciente presentó múltiples lesiones parenquimatosas en el tronco, el cerebelo y el territorio de la arteria cerebral posterior, que configuraron un síndrome clínico de enclaustramiento. El estudio etiológico mostró una absoluta normalidad de todas las exploraciones practicadas. Discusión. Se discuten las posibles relaciones de la manipulación cervical como causa de disección vertebral, su implicación etiológica con el síndrome de enclaustramiento y las opciones terapéuticas en estos pacientes (AU)

Introduction. Dissection of vertebral artery is an unusual pathology but sometimes is the cause of stroke in young patients. Since last years, and with the rise of some chiropractic technics, some authors have related these ones with the dissection of vertebral artery. Case report. We show a case of a 37 years old woman that after a chiropractic session began symptoms of posterior circulation dysfunction as decrease level of sense, tetraparesis and alteration of cranial nerves. The arteriography confirmed the existence of a vertebral dissection of V2 portion and thrombosis of basilar and contralateral vertebral arteries. Intraarterial fibrinolysis was performed with complete recanalization of the artery. Although this, the patient had parenchimal lesions in pons, cerebellum and territory of posterior cerebral artery that produced a locked-in syndrome. All the complementary exams were normal. Discussion. We discuse the relationship between cervical manipulation as an aetiology of vertebral dissection, locked-in syndrome and therapeutic options in these patients (AU)

[Pneumoencephalos: etiology, pathologic significance and diagnosis. Apropos of 13 observations]. / Neumoencéfalos: etiología, significado patológico y diagnóstico. A propósito de 13 observaciones.

Thirteen cases of pneumoencephalos attended at our hospital in a four-year period are reported. All the cases were men; mean age was 47.2 years. The most frequent cause was injury (seven cases) followed by surgical procedures (five cases); in one case, pneumoencephalos was secondary to barotrauma. In the initial period, the most frequent clinical features were impairment of level of consciousness and psychomotor agitation (84%), whereas in the established period, deep coma (Glasgow scale less than or equal to 7) predominated in 69% of patients. Only 16% of patients complained of headache. The most frequent localization of gas was in subdural space (54% of cases) followed by subarachnoid space (23% of cases). Twenty-three percent of patients presented tension pneumoencephalos. With respect to distribution of gas, 53% of patients presented pneumatocele, 38% of patients had pneumoencephalos, and 15% presented a laminar distribution of the gas. Pneumoencephalos is usually associated to a high mortality rate; 53% of our patients died. In the postsurgical group, mortality rate was 60% and in the posttraumatic group, mortality rate was 43%.