[Chilaiditi’'s sign and syndrome: rare conditions but diagnostically important in pediatrics. Clinical cases]. / Signo y síndrome de Chilaiditi: condiciones infrecuentes pero con importancia diagnóstica en pediatría. Casos clínicos.

Although infrequent, bowel interposition between diaphragm and liver, Chilaiditi’s sign or syndrome (without or with gastrointestinal symptoms), are a major clinical condition given the possibilities of differential diagnosis, such as pneumoperitoneum, diaphragmatic hernia and subphrenic abscess. OBJECTIVE: To report the cases of two preschool patients with Chilaiditi´s sign and syndrome, as well as to highlight the importance of this clinical condition. CLINICAL CASES: Case 1: A male preschooler evaluated by respiratory disease without abdominal symptoms. Thorax X-ray shows left retrocardiac infiltrates and air in right subdiaphragmatic region. Previous radiographies shows the same image. He was diagnosed with Chilaiditi sign associated with pneumonia, antibiotics were used before discharge. Case 2: A female preschooler, evaluated by abdominal distention and constipation. A previous thorax X-ray shows bowel interposition between diaphragm and liver. Barium enema confirmed the findings. Blood test were normal. A Chilaiditi's syndrome was diagnosed. She received medical treatment with favorable evolution. CONCLUSION: These cases highlight the importance of this clinical condition that, despite being infrequent, constitutes a diagnostic challenge in the emergency services.

Signo y síndrome de Chilaiditi: condiciones infrecuentes pero con importancia diagnóstica en pediatría: casos clínicos / Chilaiditi’s sign and syndrome: rare conditions but diagnostically important in pediatrics: clinical cases

Aunque poco frecuente, la interposición de intestino entre el diafragma y el hígado, signo o síndrome de Chilaiditi (en relación a la ausencia o presencia de síntomas gastrointestinales), constituye una condición clínica de importancia dadas las posibilidades de diagnóstico diferencial, tales como: neumoperitoneo, hernia diafragmática y absceso subfrénico. OBJETIVO: Presentar dos preescolares con signo y síndrome de Chilaiditi, así como resaltar la importancia de esta condición clínica. CASOS CLÍNICOS: Caso 1: Preescolar varón evaluado por cuadro respiratorio sin síntomas abdominales. La radiografía de tórax mostró infiltrados retrocardíacos izquierdos y presencia de aire en región subdiafragmática derecha. En radiografías previas se encontraba la misma imagen. Se concluyó que se trataba de un signo de Chilaiditi asociado a un cuadro de neumonía, se trató con antibioterapia y se dio de alta. Caso 2: Preescolar de sexo femenino, evaluada por distensión abdominal y constipación. Radiografía de tórax, solicitada previamente por cuadro respiratorio, con imagen de colon derecho situado entre el hemidiafragma y el hígado. Enema baritado de colon confirmó los hallazgos. Exámenes de laboratorio normales. Se concluyó síndrome de Chilaiditi, se indicó tratamiento médico, con buena evolución. CONCLUSIÓN: Se resalta la importancia de esta condición clínica que pese a ser infrecuente constituye un reto diagnóstico en los servicios de urgencia.

Although infrequent, bowel interposition between diaphragm and liver, Chilaiditi’s sign or syndrome (without or with gastrointestinal symptoms), are a major clinical condition given the possibilities of differential diagnosis, such as pneumoperitoneum, diaphragmatic hernia and subphrenic abscess. Objective: To report the cases of two preschool patients with Chilaiditi´s sign and syndrome, as well as to highlight the importance of this clinical condition. Clinical cases: Case 1: A male preschooler evaluated by respiratory disease without abdominal symptoms. Thorax X-ray shows left retrocardiac infiltrates and air in right subdiaphragmatic region. Previous radiographies shows the same image. He was diagnosed with Chilaiditi sign associated with pneumonia, antibiotics were used before discharge. Case 2: A female preschooler, evaluated by abdominal distention and constipation. A previous thorax X-ray shows bowel interposition between diaphragm and liver. Barium enema confirmed the findings. Blood test were normal. A Chilaiditi's syndrome was diagnosed. She received medical treatment with favorable evolution. Conclusion: These cases highlight the importance of this clinical condition that, despite being infrequent, constitutes a diagnostic challenge in the emergency services.

Treatment of aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms by neurosurgeons in Colombia: A survey.

BACKGROUND: Trends in management of aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms among neurosurgeons is very variable and had not been previously described in any Latin American country. This study was conducted to determine the preferences of Colombian neurosurgeons in pharmacologic, surgical, and endovascular management of patients with aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms. METHODS: A survey-based descriptive study was performed in a sample of members from the Colombian Association of Neurosurgery. Questions about pharmacologic, surgical, and endovascular management of aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysm were carried out. We calculated the mean and the standard deviation of the results obtained from the continuous variables. The results of the categorical variables are presented as percentages. RESULTS: The preference of medication with poor clinical evidence, such as magnesium sulfate, aspirin, statins, and anti-fibrinolytics was lower than 10%. The use of intravenous nimodipine and systemic glucocorticoids was as high as 31%. The availability of endovascular therapy was 69%. The indication for treatment of patients with unruptured intracranial aneurysms that required intervention was less than 13.8%. In patients with ruptured or unruptured intracranial aneurysms, coiling was the preferred method for exclusion. CONCLUSIONS: Reported compliance of evidence-based clinical guidelines was similar to that described in developed countries, and even better. However, there is little agreement in treating patients with unruptured intracranial aneurysms. For other issues, the conducts reported by Colombian neurosurgeons are in accordance with the current guidelines.

Apoplejía postoperatoria de un macroadenoma hipofisiario residual e infarto de la arteria cerebral media / Post-operative apoplexy of a residual pituitary macro-adenoma and middle cerebral artery infarction

La apoplejía postoperatoria de los adenomas hipofisiarios es una complicación rara vez reportada. La presión ejercida por el tumor residular edematoso puede comprometer estructuras nerviosas y vasculares adyacentes a la región selar. Describios el caso de un hombre de 69 años de edad con un tumor selar gigante a quien le fue realizada una resección incompleta a través de un acceso pterional. La cirugía fue detenida por inestabilidad hemodinámica. Cuarenta y ocho horas más tarde, desarrolla oftalmparesias y disminución bilateral de la agudeza visual, deterioro del estado de consciencia, poliuria y hemiparesia izquierda. Una tomografía cerebral simple de emergencia demostró incremento del volumen tumoral con hemorragia y un infarto en el territorio de la arteria cerebral media derecha. El paciente falleció siete días más tarde. Este caso ejemplifica esta rara y catastrófica complicación con alta morbilidad y mortalidad. En la revisión de la literatura, solo fueron encontrados dos casos de ictus isquémico debido a la compresión de arterias intracraneales mayores por apoplejía postoperatoria de macroadenomas residuales.

Postoperative apoplexy of residual pituitary adenomas is a rarely reported complication. Pressure from edematous residual tumor may affect vascular and nervous structures adjacent to sellar region. We described a 69 years old man with a giant sellar tumor who underwent to incomplete resection through pterional approach. Surgery was stopped by hemodynamic instability. Forty-eight hours later, he developed bilateral decreased of visual acuity, bilateral ophthalmoparesis, drowsiness, polyuria and left hemiparesis. An emergency computed tomography scan showed increase in tumor volume with hemorrhage and an infarct of right middle cerebral artery. The patient died seven days later. This case exemplifies this rare and catastrophic complication with high morbidity and mortality. On literature review, only two cases of ischemic strokes due to compression major intracranial arteries by postoperative tumor apoplexy were found.

Síndrome del muñeco cabeza de resorte por quiste aracnoideo selar en un adulto / Bobble-head doll syndrome by selar arachnoid cyst in an adult

El síndrome del muñeco cabeza de resorte es un raro trastorno usualmente descrito en la población pediátrica como resultado de lesiones selares y del tercer ventrículo, especialmente quistes coloides. Su fisiopatología no está bien esclarecida. Se ha planteado que los trastornos del funcionamiento de las aferencias y eferencias hacia el núcleo dorso-medial del tálamo originarían los movimientos y estos permanecerían en el tiempo gracias a fenómenos de aprendizaje. Presentamos un raro caso del síndrome del muñeco cabeza de resorte de una paciente adulta como consecuencia de un quiste aracnoideo selar con extensión paraselar a través de la fisura de Silvio. Se realizaron comunicaciones del quiste hacia las cisternas adyacentes con lo cual se logro control completo de los síntomas tras 48 horas del procedimiento.

Bobble head doll syndrome is a rare disorder usually described in the pediatric population as a result of sellar lesions and the third ventricle, especially colloid cysts. Its pathophysiology is not well understood. It has been suggested that functional disorders of the afferent and efferent system to the dorso-medial nucleus of the thalamus causes of the movement and these remain over time through learning phenomena. We present a rare case of bobble head doll syndrome in an adult patient caused by a sellar arachnoid cyst with parasellar extension through the Sylvian fissure. Communications were made from the cyst into adjacent cisterns thereby achieving complete control of symptoms after 48 hours of the procedure.