[Cerebellar hematomas. Description of a cohort and prognosis based on therapeutic attitude]. / Hematomas cerebelosos. Descripción de una cohorte y pronóstico en función de la actitud terapéutica.

OBJECTIVES: Spontaneous cerebellar hematomas (CH) represent 5%-10% of intracranial hemorrhaging. We describe the existing cardiovascular risk factors, clinical presentation of CH and its relationship with mortality and the association between the treatment type (conservative medical or neurosurgical treatment) and the subsequent course of the patients. DESIGN AND SCOPE: Observational study of patients diagnosed of CH admitted over three years in an Intensive Care Unit of a level III Hospital. PATIENTS: Fifty-six consecutive patients diagnosed of CH. VARIABLES OF PRINCIPAL INTEREST: We studied the cardiovascular risk factors, presentation form (with Glasgow Coma Scale- GCS), hematoma size and site, and morbidity-mortality of the patients (with the Glasgow Outcome Scale--GOS). RESULTS: Fisher's exact test, Chi squared, calculation of Spearman's coefficient between certain variables and logistic regression analysis were used. Hematoma size, GCS on admission and presence of hydrocephaly obtained statistical significance. Conservative medical treatment has greater mortality. CONCLUSIONS: Patients with GCS < or = 8 and hematoma size > or = 3 cm benefit from surgical treatment. Initial GCS and vermian site are mortality predictor factors. There is no more morbidity due to surgical treatment.

Hematomas cerebelosos. Descripción de una cohorte y pronóstico en función de la actitud terapéutica / Cerebellar hematomas. Description of one cohort and prognosis based on therapeutic attitude

Objetivos. Los hematomas cerebelosos espontáneos (HC) representan un 5%-10% de las hemorragias intracraneales. Describimos los factores de riesgo cardiovascular existentes, la presentación clínica de los HC y su relación con la mortalidad, así como la asociación entre el tipo de tratamiento (médico conservador o neuroquirúrgico) y la evolución posterior de los enfermos. Diseño y ámbito. Estudio observacional de los pacientes diagnosticados de HC ingresados durante tres años en una Unidad de Cuidados Intensivos de un Hospital de nivel III. Pacientes. Cincuenta y seis enfermos consecutivos diagnosticados de HC. Variables de interés principales. Estudiamos los factores de riesgo cardiovascular, la forma de presentación (con el Glasgow Coma Score [GCS]), el tamaño y localización del hematoma y la morbimortalidad de los pacientes (con la Glasgow Outcome Scale [GOS]). Resultados. Se emplean la prueba exacta de Fisher, Chi cuadrado, el cálculo del coeficiente de Spearman entre determinadas variables y análisis de regresión logística. Obtuvieron significación estadística el tamaño del hematoma, el GCS al ingreso y la presencia de hidrocefalia. El tratamiento médico conservador conlleva mayor mortalidad. Conclusiones. Los pacientes con GCS ≤ 8 y tamaño de hematoma ≥ 3 cm se benefician de tratamiento quirúrgico. Son factores predictores de mortalidad el GCS inicial y la localización vermiana. No hay más morbilidad por el tratamiento quirúrgico

Objectives. Spontaneous cerebellar hematomas (CH) represent 5%-10% of intracranial hemorrhaging. We describe the existing cardiovascular risk factors, clinical presentation of CH and its relationship with mortality and the association between the treatment type (conservative medical or neurosurgical treatment) and the subsequent course of the patients. Design and scope. Observational study of patients diagnosed of CH admitted over three years in an Intensive Care Unit of a level III Hospital. Patients. Fifty-six consecutive patients diagnosed of CH. Variables of principal interest. We studied the cardiovascular risk factors, presentation form (with Glasgow Coma Scale- GCS), hematoma size and site, and morbidity-mortality of the patients (with the Glasgow Outcome Scale - GOS). Results. Fisher's exact test, Chi squared, calculation of Spearman's coefficient between certain variables and logistic regression analysis were used. Hematoma size, GCS on admission and presence of hydrocephaly obtained statistical significance. Conservative medical treatment has greater mortality. Conclusions. Patients with GCS ≤ 8 and hematoma size ≥ 3 cm benefit from surgical treatment. Initial GCS and vermian site are mortality predictor factors. There is no more morbidity due to surgical treatment

[Therapeutic attitude, evolution and prognosis of the cerebral hemorrhages of patients in dicumarinic treatment, in function of their supra or infratentorial localization]. / Actitud terapéutica, evolución y pronóstico de la hemorragia cerebral, según la localización supra o infratentorial, de pacientes en tratamiento dicumarínico.

INTRODUCTION: The anticoagulants are drugs with possible serious secondary effects, being one of the most serious the appearance of intracraneal hemorrhages, being able to vary the clinical course as they were hemorrhages in the deep supratentorial compartment (ST) or in the infratentorial (IT). OBJECTIVES: Compare the therapeutic attitude, the evolution and the prognostic of the cerebral hemorrhages in patient with warfarin treatment, in function of their localization ST or IT. PATIENTS AND METHODS: Descriptive and retrospective analysis of 42 patients; in 28 of the cases (66,6%) the localization was ST, and in 14 of the patients (33,3%) the localization was IT. We study risk vascular factors, age and the sex of the patients, the volume of the hemorrhage, the initial clinical state of the patients, the therapeutic attitude, the average stay and the mortality. As statistical tools, the t of Student and the c2 test were used, demanding a confidence interval of 95%. RESULTS: The factors of cardiovascular risk of our serie were similar to the existent ones in other studies. The hemorrhages IT are more frequent in women, existing significant differences in the age among sexes in function of the localization. 100% of the hemorrhages IT exceeded the therapeutic INR, in front of 39% of the ST. A bigger half stay is also demonstrated in the ST hemorrhages so much in the surviving as in the exitus. Statistical significance was not reached in the rest of the studied parameters. CONCLUSIONS: The presence of a INR that surpasses the therapeutic is an indicator of hemorrhage risk IT, in patient dicumarinic drawees, and that in this same subgrup, the stays stockings are sensibly inferior, in all the subgrups (medical treatment and surgical treatment). Also the feminine sex has a bigger incidence of processes ST, with a smaller presentation age.

Actitud terapéutica, evolución y pronóstico de la hemorragia cerebral, según la localización supra o infratentorial, de pacientes en tratamiento dicumarínico / Therapeutic attitude, evolution and prognostic of the cerebral hemorrhages of patients in dicumarinic treatment, in function of their supra or infratentorial localization

Introducción. La hemorragia intracraneal es uno de los efectos secundarios más graves de los anticoagulantes; el curso clínico puede variar según se trate de hemorragias supratentoriales (ST) profundas o infratentoriales (IT). Objetivo. Comparar la actitud terapéutica, la evolución y el pronóstico de los pacientes con hemorragia cerebral y tratamiento dicumarínico según la localización sea ST o IT. Pacientes y métodos. Análisis descriptivo y retrospectivo de 42 pacientes con hemorragia cerebral, ST profunda en 28 casos (66,6 por ciento), IT en los restantes 14 (33,3 por ciento). Estudiamos los factores de riesgo vascular, la edad, el sexo, el volumen de la hemorragia, el estado clínico inicial, la actitud terapéutica, la estancia media y la mortalidad. Como herramientas estadísticas empleamos la t de Student y el test de c2, con un intervalo de confianza del 95 por ciento. Resultados. Los factores de riesgo cardiovascular de nuestra serie son similares a los que presentan otros estudios. La hemorragia IT es más frecuentes en mujeres; existe una diferencia significativa en la edad entre sexos en función de la localización. Todos los pacientes con hemorragia IT excedían el INR terapéutico mientras que sólo lo hacía el 39 por ciento de los casos con hemorragia ST. La estancia media fue más prolongada entre los pacientes con hemorragia ST, tanto en los pacientes que sobrevivieron como entre los que fallecieron. No se alcanzó significación estadística en el resto de los parámetros estudiados. Conclusiones. La presencia de un INR que sobrepase el terapéutico es un indicador de riesgo para la hemorragia IT en pacientes en tratamiento dicumarínico. La estancia media del grupo IT es más corta (tanto en el subgrupo de pacientes que recibió tratamiento médico como en el que recibió tratamiento quirúrgico) que la del grupo ST. El sexo femenino tiene una mayor incidencia de procesos ST y una menor edad de presentación (AU)

[Histological prediction of cerebral tumors using SPECT with 201T1]. / Predicción histológica de los tumores cerebrales mediante SPECT con 201T1.

INTRODUCTION AND OBJECTIVE: SPECT with 201Tl provides information regarding the degree of malignancy of cerebral tumours, their possible relapses, the differentiation of necrotic tissue in the tumours following chemotherapy or radiotherapy and permits differentiation into zones of various grades of histological malignancy. MATERIAL AND METHODS: We carried out a prospective analysis of the usefulness of SPECT with 201Tl for the histological prognosis of cerebral tumours. For one year 68 patients diagnosed (on CT and/or MR) as having an expansive cerebral lesion were studied. The early uptake (ICP) and retention (R) indices were calculated, and these results correlated with the morbid anatomy (AP) findings and the results obtained with surgery and stereotactic biopsy. Four patients were excluded due to lack of AP results. RESULTS: Significant differences were found between the ICP of grade I-II astrocytomas (1.34 +/- 0.52) and glioblastomas multiformes (2.56 +/- 0.57), between the ICP of meningiomas (4.53 +/- 1.68) and metastases (2.45 +/- 0.58) and between those of meningiomas and all glial tumours. With regard to IR, we saw significant differences between the figures for meningiomas (0.63 +/- 0.13) and meningiomas with malignant relapses (0.94 +/- 0.17) and between metastases (0.8 +/- 0.03) and all glial tumours. CONCLUSIONS: From our study, it may be concluded that rapid, high captation of 201Tl (high ICP) with a slow fall (high IR), is associated with a process showing malignancy on histological study (malignant relapse of meningioma, glioblastoma multiforme, metastasis), whilst high take-up (high ICP) with rapid elimination (low IR) corresponds to a benign hypervascularized tumour (meningioma).

[Epidemiological study of primary brain tumors in the Autonomous Community of Aragon]. / Estudio epidemiológico de los tumores primarios cerebrales en la Comunidad Autónoma de Aragón.

OBJECTIVES: a) To analyse diverse clinical features related to the symptomatology, location and anatomopathological diagnosis of primary tumours of the C.N.S. and b) to improve knowledge of the frequency of cerebral tumours in our field of study. DESIGN: A protocolized and retrospective study of those patients diagnosed as having a primary cerebral Neoplasia. SETTING: The Autonomous Community of Aragon during the decade from 1980 to 1990. PATIENTS AND OTHER PARTICIPANTS: Our total sample consisted of 759 tumours, 412 (54.28%) in men and 347 (45.72%) in women. Our criterion for inclusion was a diagnosis of primary cerebral Neoplasia, excluding Metastasis and vascular tumours. MEASUREMENTS AND MAIN RESULTS: The majority of the cerebral tumours were located in the cerebral hemispheres (56%): migraine was the most common symptom. We confirmed that the occurrence of cerebral tumours was higher in urban than in rural zones. However the age at which these neoplastic intracranial processes present is greater in rural zones. For 67% of patients 4.5 months had to pass before it was possible to establish the diagnosis of expansive intracranial process. CONCLUSIONS: a) Migraine is the most common clinical manifestation (20%), followed by a disturbance of the higher functions (15%). b) There is considerable delay in the time needed to establish the diagnosis of expansive intracranial process, due to the present health-care framework. c) The occurrence of cerebral tumours is higher in urban than in rural zones.