Ventriculitis associated with extraventricular drainage: etiology, diagnosis and treatment focused on neurocritic care units.

Ventriculitis after extraventricular drainage is a very important neurosurgical complication in neurocritical care units. It is necessary to make an early diagnosis, given that the morbidity and mortality secondary to it can be variable, and complicate the evolution of neurocritical patients. Despite this, ventriculostomy continues to be an important pillar in monitoring and treatment. Given the urgency of ventriculitis associated with multiresistant germs, new antimicrobial drugs have emerged as part of the treatment, as intraventricular routes have been proposed within the new investigations. However, the foregoing does not yet have sufficient bases to be able to support it. The present review was carried out with the aim of contributing to an early diagnosis and treatment of ventriculitis associated with extra ventricular drainage in neurocritical patients, and in this way to contribute to improve survival and prevent fatal outcomes in these patients.

La ventriculitis posterior a un drenaje extraventicular constituye una complicación neuroquirúrgica muy importante en las unidades de cuidados neurocríticos. Se hace necesario realizar un diagnóstico precoz, dado que la morbimortalidad secundaria a esta puede ser variable y complicar la evolución de los pacientes neurocríticos. A pesar de esto, la ventriculostomía continúa siendo un pilar importante en el monitoreo y el tratamiento. Ante la urgencia de ventriculitis asociadas a gérmenes multirresistentes han surgido nuevos fármacos antimicrobianos como parte del tratamiento, al igual que se han propuesto vías intraventriculares dentro de las nuevas investigaciones. Sin embargo, lo anterior aún no tiene bases suficientes para poder ­sustentarlo. La presente revisión se realizó con el objetivo de contribuir a un diagnóstico precoz y al tratamiento de la ventriculitis asociada a drenaje extraventricular en pacientes neurocríticos, y de esta forma poder mejorar la sobrevida y prevenir desenlaces fatales en estos pacientes.

Neurosurgical Implications of Osteogenesis Imperfecta in a Child after Fall: Case Illustration.

Osteogenesis imperfecta (OI) is a group of hereditary genetic pathologies of connective tissue, which is characterized by bone fragility and fractures. It is classified into types I, II, III, IV, V, and VI. The disorder is caused by an autosomal-dominant mutation in one of the two genes that encode the alpha chains of type I collagen, COL1A1 and COL1A2. Several central nervous system abnormalities have been described in children with OI, however, it has been through various case reports. The neurological abnormalities that have been described are macrocephaly, ventriculomegaly, myelopathy, cranial neuropathy, basilar invagination, obstructive hydrocephalus, cranial fractures, and intracranial hemorrhage. In this report, we describe the clinical case of a child with parietal fracture; the main objective of this work being to show one of the several neurological implications that children with OI can present, and their implications for the pediatric neurosurgeons as neurosurgical complications are very frequent.

Síncope en Urgencias: Aproximación Clínica / Syncope in Emergency Room: Clinical Approach

Resumen El síncope es un síntoma definido como una perdida transitoria de la conciencia de inicio rápido, de corta duración y con recuperación completa y espontánea. Los picos de presentación son en la adolescencia y posterior a la 8va década de la vida. La incidencia de sincope representa del 1% al 3% de los ingresos hospitalarios y se asocia con comorbilidad cardiovascular y farmacoterapia cardiovascular siendo en los adultos mayores una causa importante de morbimortalidad. La incidencia acumulada de síncope en las mujeres es casi el doble que en los hombres. Su aparición está explicada por una disminución en el flujo sanguíneo cerebral producto del descenso del gasto cardiaco ya sea por una caída en la presión arterial sistólica por debajo de 60 mmHg o disminución en la resistencia periférica. El síncope de divide en 3 grupos: 1) Síncope reflejo, en el cual se produce un cambio repentino en la actividad del sistema nervioso autónomo que lleva a la caída en la presión arterial; 2) Síncope secundario a hipotensión ortostática, en donde la actividad simpática eferente no proporciona una suficiente vasoconstricción y 3) Síncope de causa cardiopulmonar, caracterizado por una disminución brusca y repentina del gasto cardiaco producto de arritmias o enfermedades cardiacas estructurales. Dependiendo de la causa del síncope se puede o no presentar pródromo, que más comúnmente se compone de diaforesis, calor y rubor. La verdadera pérdida de la conciencia por lo general dura menos de un minuto, aunque algunos pacientes pueden tardar varios minutos en recuperar plenamente la conciencia. Por ello el diagnóstico está basado en una buena historia clínica con un examen físico completo. El tratamiento depende de la causa y el mecanismo de los episodios sincopales. Adicionalmente se deben tener como objetivos el aliviar los síntomas y mejorar el pronóstico, lo cual implica evitar o reducir las recurrencias.

Abstract Syncope is a symptom defined as a transient loss of consciousness, of rapid onset, of short duration and with complete and spontaneous recovery. Peaks of presentation are in adolescence and after the 8th decade of life. The incidence of syncope represents 1% to 3% of hospital admissions and is associated with cardiovascular comorbidity and cardiovascular pharmacotherapy, being an important cause of morbidity and mortality in the elderly. The accumulative incidence of syncope in women is almost double than in men. Its onset is explained by a decrease in cerebral blood flow due to the decrease in cardiac output, whether due to a drop in systolic blood pressure below 60 mmHg or a decrease in peripheral resistance. The syncope is divides into 3 groups: 1) Reflex syncope, in which there is a sudden change in the autonomic nervous system activity that leads to a drop in blood pressure; 2) Syncope secondary to orthostatic hypotension, where sympathetic efferent activity does not provide sufficient vasoconstriction; and 3) Syncope of cardiopulmonary cause, characterized by an abrupt and sudden decrease in cardiac output due to arrhythmias or structural heart diseases. Depending on the cause of syncope it may or may not present prodrome, which is more commonly composed of diaphoresis, heat and flushing. True loss of consciousness usually lasts less than a minute, although some patients may take several minutes to fully regain consciousness. Therefore, the diagnosis is based on a good medical history with a complete physical examination. Treatment depends on the cause and mechanism of syncopal episodes. In addition, the goals should be to alleviate symptoms and improve prognosis, which means avoiding or reducing recurrences.