Traumatismo craneal no accidental: a propósito de un caso / Abusive head trauma: Report of a case

El traumatismo craneal no accidental es una forma de maltrato infantil. Frecuentemente, se encuentran lesiones intracraneales, como el hematoma subdural y también las hemorragias retinianas, en general, sin otras lesiones externas. Por su complejidad, esta entidad requiere de un equipo médico multidisciplinario, donde el papel del especialista en imágenes es muy importante, ya que existen múltiples métodos diagnósticos que se complementan para arribar al correcto diagnóstico

The abusive head trauma is a form of child abuse. The most frequent injuries are intracranial lesions, such as subdural hematoma, as well as retinal hemorrhages, usually without other external injuries. Due to its complexity, this problem requires a multidisciplinary medical team, where the role of the radiologist is important, since there are multiple diagnostic methods that are complementary in order to arrive at the correct diagnosis

[Abusive head trauma: report of a case]. / Traumatismo craneal no accidental: a propósito de un caso.

The abusive head trauma is a form of child abuse. The most frequent injuries are intracranial lesions, such as subdural hematoma, as well as retinal hemorrhages, usually without other external injuries. Due to its complexity, this problem requires a multidisciplinary medical team, where the role of the radiologist is important, since there are multiple diagnostic methods that are complementary in order to arrive at the correct diagnosis.

Renovascular disease and hypertension in children with neurofibromatosis.

Neurofibromatosis type 1 (NF1) is associated with vascular lesions, such as renal artery stenosis, and secondary hypertension. The real prevalence is largely unknown, particularly in children. We observed 27 patients with NF1, mean age 12.8 years (range 4.2-24 years), for 2-10 years to assess the association of NF1 with vascular abnormalities and secondary hypertension. Patients were studied with angiography, 24-h blood pressure monitoring, a captopril test, and Doppler ultrasonography of aorta and renal arteries. The prevalence of hypertension was 18.5%; 61.5% of patients studied with angiography had vascular lesions, half of whom were apparently normotensive. However, they had abnormal 24-h blood pressure monitoring, which was a first sign of poor blood pressure control. Those patients with severe hypertension (11.1%) were successfully treated with percutaneous transluminal angioplasty (PTA); stenosis recurred in 2 of 3 patients after a 2-year follow-up period, and was responsive to drugs. We conclude that hypertension is a frequent complication of NF1 in pediatric patients, it is usually secondary to typical vascular lesions, and requires careful follow-up. Ambulatory blood pressure monitoring (24-h) is a sensitive method for detecting initial alterations of the blood pressure pattern. PTA may be an effective treatment in this condition.

Percutaneous transluminal renal angioplasty in neurofibromatosis.

A 9-year-old boy with hypertension was found to have neurofibromatosis associated with stenosis of the right renal artery. Percutaneous transluminal angioplasty (PTA) was performed. Immediately post angioplasty angiography showed that the stenosis persisted, but over the next few days his blood pressure rapidly decreased and remained well controlled even when treatment was discontinued. The captopril stimulation test, performed after PTA, confirmed the return of plasma renin activity to normal values. A digital subtraction aortogram, performed 2.5 years after PTA, was unchanged. His blood pressure remained persistently normal, without anti-hypertensive agents. Based on these results, PTA is suggested as the first step in correcting renal artery stenosis due to neurofibromatosis. A complete anatomical resolution of the stenosis is probably not required since slight improvements in the renal artery lumen may be accompanied by important functional improvement.

Two-year clinical follow-up of children and adolescents after percutaneous transluminal angioplasty for renovascular hypertension.

RATIONALE AND OBJECTIVES: Two percent of children have hypertension. For those younger than 10 years of age, there is a high probability that hypertension is secondary. The purpose of this study was to evaluate the merits of percutaneous transluminal angioplasty (PTA) in the treatment of childhood renovascular hypertension (RVH) in light of the results previously obtained by the authors and to evaluate their stability at 2-year follow-up. METHODS: The positive response of peripheral renin plasma levels to a single dose of captopril was used as a criterion for selecting 36 patients between 4 and 15 years of age with renovascular hypertension. All underwent angiography; in most patients, PTA was performed in the same session. A 2-year follow-up study was conducted. RESULTS: In the 36 patients considered for RVH screening, PTA was successful in 34 of 36 patients (94%). Four of these patients had neurofibromatosis. The high success rate was confirmed in the 2-year follow-up study: 34 patients continue to be normotensive. CONCLUSIONS: Percutaneous transluminal angioplasty treatment of pediatric patients with hypertension has proved to be an effective and valuable method when the cause of renal artery stenosis is fibromuscular dysplasia, and the long-term results were sufficient to suggest the use of this technique in patients with neurofibromatosis as well.

Role of low-osmolality contrast media in thromboembolic complications: scanning electron microscopy study.

Numerous in vitro studies have found that clot formation may occur when blood is mixed directly with nonionic low-osmolality contrast media during angiographic procedures because of activation of hemostasis in the catheter; ionic contrast media, on the other hand, inhibit clot formation. Thirty patients were injected with low-osmolality contrast media--15 with ioxaglate, an ionic dimer, and 15 with iopamidol, a nonionic monomer. The inner wall of the angiographic catheter was studied with electron microscopy after selective catheterization of supraaortic vessels. Clot formation of various extent was observed in nine (60%) of the patients administered iopamidol. No coagulation process was found in the catheters of the patients administered ioxaglate. Results indicate that nonionic, low-osmolality contrast media may play a role in the formation of thromboembolisms.