Hematomas de cerebelo: un ictus con tratamiento quirúrgico / Hematomas of the cerebellum: a stroke with surgical treatment

Introducción. Los hematomas espontáneos de cerebelo (HEC) representan casi el 10 por ciento de las hemorragias intraparenquimatosas intracraneales. En los últimos años se han publicado varios algoritmos para el manejo de estos pacientes. Objetivos. Estudiar el tipo de tratamiento conservador o quirúrgico y los principales factores pronóstico. Pacientes y métodos. Presentamos un análisis retrospectivo de 52 casos de HEC diagnosticados en los últimos 10 años en el Hospital General de Galicia. Estudiamos los factores clínicos y radiológicos que más influyen en el pronóstico y que condicionan la actitud terapéutica. Resultados. Encontramos una relación varón/mujer de 2/3. El 90,3 por ciento de nuestros pacientes tenían más de 60 años. El 55,7 por ciento habían sido diagnosticados previamente de HTA. El cuadro clínico se caracterizó por su perfil ictal siendo los síntomas de presentación más frecuentes la cefalea (90,3 por ciento), vómitos (63,4 por ciento) y la disminución del nivel de conciencia (50 por ciento). Los factores pronósticos más importantes fueron el nivel de conciencia y el tamaño del hematoma. Ensombrecieron el pronóstico, la hidrocefalia, la hemorragia intraventricular (HIV) o la extensión de los hematomas hacia la línea media. No tuvieron valor pronóstico la edad, el sexo o el diagnóstico previo de hipertensión arterial (HTA). La mortalidad fue del 25 por ciento. Conclusiones. Los HEC afectan típicamente a pacientes mayores de 60 años, y debutar con cefalea y vómitos de instauración brusca. En nuestra serie, los factores pronósticos más importantes fueron el tamaño del hematoma y el nivel de conciencia en función de éstos, se estableció el tratamiento (AU)

Hematoma epidural cervicalespontáneo / Spontaneous cervical epidural haematoma

No disponible

[Dorsal medullary compression due to a primary vertebral chondrosarcoma]. / Compresión medular dorsal por condrosarcoma vertebral primario.

INTRODUCTION: Chondrosarcomas are the second commonest type of bony tumors, although they are not commonly found to be vertebral. They may originate in healthy bone or develop in a cartilaginous lesion with sarcomatous degeneration. CLINICAL CASE: A 62 year old woman complained of pain in the back and weakness of her legs. Following magnetic resonance studies a tumour at the level of the D6-D7 vertebrae was diagnosed. This was operated on and an extradural tumour, a grade 11 chondrosarcoma was removed. A local recurrence was removed two years later and three years afterwards she is still asymptomatic. CONCLUSIONS: A spinal chondrosarcoma is a tumour which usually presents with local pain and signs of spinal involvement. On magnetic resonance it is iso-intense on T1 and shows up with contrast. The treatment of choice is radical surgery since it does not respond well to oncological treatment.

[Spinal meningiomas]. / Meningiomas espinales.

OBJECTIVE: Meningiomas account for 15 to 45% of spinal cord tumors. They are more frequent in females and have low recurrence rate due both to their low tendency for regrowth and to their prevalence in the aged population. METHODS: We reviewed retrospectively the clinical records of 37 patients operated on for spinal meningioma in our Neurosurgical Service from 1982 to 1998. Duration and type of symptoms, radiological and surgical results are analyzed. RESULTS: Our spinal meningiomas account for about 26% of all spinal cord tumors operated on during a 19-year period. They accounted for 11% of all meningiomas operated during the same period. We observed a higher prevalence in females between 50 to 70 years of age. Weakness and localized pain were the most common presenting symptoms. The tumors were located in the thoracic region in 33 patients and only one case was found to be completely extradural. All the patients were operated on by laminectomy and total removal was achieved in all cases. CONCLUSIONS: The use magnetic resonance to make an early diagnosis and microsurgical techniques appeared as the most relevant factors for further improvement of the surgical results.

Compresión medular dorsal por condrosarcoma vertebral primario / Dorsal medullary compression due to a primary vertebral chondrosarcoma

Introducción. El condrosarcoma representa el segundo tipo de tumor óseo en cuanto a incidencia, si bien su localización vertebral es poco frecuente. Puede originarse sobre hueso sano o desarrollarse sobre una lesión cartilaginosa con degeneración sarcomatosa. Caso clínico. Mujer de 62 años que consulta por presentar dolor dorsal y pérdida de fuerza en miembros inferiores. Tras la realización de resonancia magnética se diagnosticó un tumor vertebral a nivel D6-D7 y fue intervenida quirúrgicamente extirpándose una tumoración extradural que correspondió a un condrosarcoma grado II. Tras presentar una recidiva local fue reintervenida dos años más tarde y tres años después continúa asintomática. Conclusiones. El condrosarcoma espinal es una tumoración que se presenta habitualmente con un cuadro de dolor local o datos de afectación medular. En la resonancia magnética se manifiestan como isointenso en T1 y se realza con contraste. El tratamiento de elección es la cirugía radical ya que no responde bien al tratamiento oncológico (AU)

Meningiomas espinales / Spinal meningiomas

Fundamentos: Los meningiomas espinales representan entre el 15 y el 45 por ciento de todos los tumores espinales, se caracterizan por su incidencia en mujeres de edad avanzada y tienen una escasa tendencia a recidivar por su escaso índice de crecimiento. Métodos: Revisión retrospectiva de 37 casos de meningiomas espinales operados entre 1982 y 1998, estudiando las formas de presentación clínica, características neurorradiológicas y resultados quirúrgicos. Resultados: La casuística revisada supone el 26 por ciento de los tumores espinales intervenidos a lo largo de 19 años. Se encontró un claro predominio del sexo femenino (32 casos) y una mayor incidencia entre la quinta y séptima décadas de la vida. La forma de presentación más habitual es el déficit motor en 26 casos. En la región dorsal se localizaron 33 meningiomas y solamente un meningioma era de localización extradural. Todos fueron intervenidos quirúrgicamente con extirpación macroscópicamente completa en todos los casos. Conclusiones: El empleo de la resonancia magnética para conseguir un diagnóstico precoz y el empleo de técnica microquirúrgica son los dos factores más importantes en el éxito de la cirugía. (AU)

[Cerebellar hematomas: a surgically treatable stroke]. / Hematomas de cerebelo: un ictus con tratamiento quirúrgico.

INTRODUCTION: Spontaneous cerebellar hematomas make up nearly 10% of the intracranial intraparenchymatous hemorrhages. In recent years several algorithms have been published for the management of these patients. OBJECTIVE: To study the type of treatment, conservative or operative, and the main prognostic factors. PATIENTS AND METHODS: We present a retrospective analysis of 52 cases of spontaneous cerebellar hematomas diagnosed over the past 10 years in the Hospital General de Galicia. We studied the clinical and radiological factors with the greatest effect on prognosis and the approach to treatment. RESULTS: We found a male/female ration of 2/3. The age of 90.3% of our patients was over 60 years. Arterial hypertension had previously been diagnosed in 55.7% of the cases. The clinical picture was characterized by the profile of a stroke with headache (90.3%), vomiting (63.4%) and impaired consciousness (50%) being the commonest presenting symptoms. The most important factors in prognosis were the level of consciousness and the size of the hematoma. The prognosis was worse in cases with hydrocephalus, intraventricular hemorrhage or extension of the hematoma towards the midline. Neither age, sex nor the previous diagnosis of arterial hypertension were of importance in prognosis. Mortality was 25%. CONCLUSIONS: The spontaneous cerebellar hematomas typically affect patients over the age of 60 years and present with headache and vomiting of sudden onset. In our series the major prognostic factors were the size of the hematoma and level of consciousness, and treatment was given in accordance with this.

[Primary lymphoma of the central nervous system. Review of etiological factors]. / Linfomas primarios del sistema nervioso central. Revisión de la casuística.

INTRODUCTION: The primary lymphoma of the central nervous system are between 1 to 2% of all the brain tumors. The most important risk factor for the development of this kind of lesions is both acquired and congenital immunologic deficiency. METHODS AND RESULTS: In this paper we'll try to study the 13 cases of primary lymphomas of the central nervous system from etiological, epidemiological, clinic, diagnostic, therapeutic and outcome point of view. CONCLUSION: Besides we will discuss the bibliography founded paying special attention to diagnostic and therapeutic features.

[Hypodense meningioma. A care report]. / Meningioma hipodenso. A propósito de un caso.

INTRODUCTION: Meningiomas are benign tumours which originate in the arachnoid layer and are characterized by being iso- or hyper-dense on computerized axial tomography (CAT). Hypodense meningiomas are relatively infrequent and normally behave thus because of their fat content. A hypomeningioma is almost entirely composed of adipose tissue. However, a meningiotheliomatous meningioma with fatty degeneration, which is the case being considered, is characterized by zones of meningiotheliomatous cells together with zones of adipocytes. CLINICAL CASE: We present the case of a 73 year old woman with a meningiotheliomatous meningioma with extensive fatty degeneration which on CAT scan showed as a hypodense lesion, with well-defined edges, which took up contrast heterogeneously and produced a hyperosfosant reaction. On magnetic resonance (RMN) it gave signals of heterogeneous intensities. Up to the present time, only four cases of pure lipomeningiomas have been described in the literature. CONCLUSIONS: However, meningiomas with fatty degeneration are much more frequent. In this paper we discuss aspects of the differential diagnosis of meningiomas which behave as hypodense lesions on CAT scans.

[Intraventricular arachnoid cyst in the adult]. / Quiste aracnoideo intraventricular en el adulto.

INTRODUCTION: Intracranial arachnoid cysts are benign, congenial cystic lesions found in infancy. The commonest sites are the lateral fissure and the posterior fossa. Exceptionally they may be found in the ventricular system. CLINICAL CASE: We describe a 69 year old patient with a clinical history of headache and tingling of the face for 24 hours. Diagnosis of a lateral ventricle arachnoid cyst was made on computerized tomography and magnetic resonance. Treatment was surgical with excision of the wall of the cyst and the communication with the ventricle. CONCLUSION: We review 14 cases previously described (9 adults and 5 children), analyzing their clinical and radiological features, type of treatment given and the different theories proposed as to pathogenesis.

[Cervical intramedullary neurofibroma]. / Neurofibroma intramedular cervical.

Spinal neurofibromas make up a third of all tumours of the medulla. They are usually found to be intradural and extramedullary. Exceptionally they may be intramedullar. We describe the case of a patient with signs of slowly progressive compression of the medulla, who was operated on surgically for an intramedullary neurofibroma, after imaging studies. We review the previously published cases and analyse the different histogenic theories concerning this tumour.