Absceso cerebral por Actinomyces israelii / Actinomyotic brain abscess

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[Cerebral dissecting aneurysms]. / Aneurismas disecantes cerebrales.

INTRODUCTION: Blood stream penetrates through the lacerations of the arterial layers determining dissecting aneurysms. Each intramural clot localization determines different clinical form. OBJECTIVE: We present the clinical observations carried out in two patients with vertebrobasilar dissecting aneurysms and we review the state of the art of this process to remark the early identification of these unusual lesions. CASE REPORTS: Two cases of vertebrobasilar dissecting aneurysms were described. They were young patients that debuted, one as posteroinferior artery brain steam infarction and the other one as a subarachnoid hemorrhage caused by a right posterior cerebral artery dissecting aneurysms. Lesions were confirmed by helicoidal cerebral angiotomographic and angiograms. This patient was operated on and we clipped the posterior communicating that irrigated dissecting segment. We carry out an anatomical and hemodynamic analysis of that lesion. Both patients had a satisfactory clinical evolution. CONCLUSIONS: Dissecting intramural hematomas of the vertebrobasilar territory are frequent cause of young people ictus. It has been suggested that the ictus may happen after minor head trauma and pain, main symptom, always precedes neurological dysfunction signs. Hemorrhagic presentation has a high incidence of rebleeding and elevated mortality. It always requires, as soon as possible, direct microsurgical treatment or endovascular methods (coils). Most useful microsurgical procedure, until today, is parent artery clipping. This technique has a low index of isquemic and neural postoperative damage.

Aneurismas disecantes cerebrales / Cerebral dissecting aneurysms

Introducción. Los aneurismas disecantes se forman porque el torrente sanguíneo penetra por los desgarros patológicos de la íntima y separa las capas arteriales. Cada localización intramural del coágulo determina una forma clínica distinta. Objetivo. Presentar dos pacientes con lesiones disecantes en el sistema vertebrobasilar, revisar la literatura y contribuir a la identificación temprana de estas lesiones. Casos clínicos. Se describen dos casos de aneurismas disecantes del territorio vertebrobasilar en dos pacientes jóvenes: uno debutó con un cuadro isquémico de la arteria cerebelosa posteroinferior, y el otro, con una hemorragia subaracnoidea por aneurismas disecantes de la arteria cerebral posterior derecha. Los diagnósticos se confirmaron mediante estudio angiotomográfico y por arteriografía. La segunda paciente se intervino quirúrgicamente y se realizó un pinzamiento de la arteria comunicante posterior derecha que nutría el segmento arterial disecado. Realizamos un análisis anatómico y hemodinámico de esa lesión. Ambos pacientes tuvieron una evolución clínica satisfactoria. Conclusión. Las disecciones de las arterias del territorio vertebrobasilar son una causa frecuente de ictus en pacientes jóvenes. La incidencia real no se conoce con exactitud. Se ha sugerido que el ictus puede ocurrir después de traumatismos, y el dolor, como síntoma fundamental, precede a los signos de disfunción neurológica. La forma clínica hemorrágica tiene una elevada incidencia de resangrado y de mortalidad. Estos pacientes requieren un tratamiento quirúrgico directo o endovascular (espirales). El procedimiento microquirúrgico más utilizado y con más bajo índice de complicaciones es el pinzamiento del vaso madre (AU)

Introduction. Blood stream penetrates through the lacerations of the arterial layers determining dissecting aneurysms. Each intramural clot localization determines different clinical form. Objective. We present the clinical observations carried out in two patients with vertebrobasilar dissecting aneurysms and we review the state of the art of this process to remark the early identification of these unusual lesions. Case reports. Two cases of vertebrobasilar dissecting aneurysms were described. They were young patients that debuted, one as posteroinferior artery brain steam infarction and the other one as a subarachnoid hemorrhage caused by a right posterior cerebral artery dissecting aneurysms. Lesions were confirmed by helicoidal cerebral angiotomographic and angiograms. This patient was operated on and we clipped the posterior communicating that irrigated dissecting segment. We carry out an anatomical and hemodynamic analysis of that lesion. Both patients had a satisfactory clinical evolution. Conclusions. Dissecting intramural hematomas of the vertebrobasilar territory are frequent cause of young people ictus. It has been suggested that the ictus may happen after minor head trauma and pain, main symptom, always precedes neurological dysfunction signs. Hemorrhagic presentation has a high incidence of rebleeding and elevated mortality. It always requires, as soon as possible, direct microsurgical treatment or endovascular methods (coils). Most useful microsurgical procedure, until today, is parent artery clipping. This technique has a low index of isquemic and neural postoperative damage (AU)

Hematoma intracerebral postoperatorio. Una complicación poco frecuente del hematoma subdural crónico / Postoperative intracraneal hematoma. An unusual complication of chronic subdural hematoma

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Absceso cerebral hiperdenso. A propósito de un caso / Hyperdense cerebral abscess. A case report

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