RESUMEN
BACKGROUND AND PURPOSE: The pathophysiology of IIH remains unknown. TS stenoses have been observed in a high proportion of these patients. Stent placement to remove this potential obstruction to venous outflow has been proposed as a treatment option for patients with IIH refractory to medical treatment. MATERIALS AND METHODS: The clinical presentation, treatment, and outcome of patients with refractory IIH evaluated for venous sinus stent placement at a tertiary care center was retrospectively reviewed. RESULTS: Thirteen female patients with IIH were evaluated for sinovenous stent placement. Moderate sinus stenoses with normal intrasinus pressures were found in 3 patients and therefore stent placement was not performed. Ten patients had elevated intrasinus pressures (pressure gradient across stenosis, 11-50 mm Hg), which decreased following unilateral TS stent placement. Headaches improved or resolved in all stented patients. Papilledema resolved completely or almost completely in 8 patients and significantly improved in 2 patients. One patient developed optic atrophy. There were no major periprocedural complications. CONCLUSIONS: In this small case series, restoring the patency of stenotic venous sinuses with a stent in patients with refractory IIH resulted in symptomatic improvement in all treated patients. The safety and efficacy of this procedure should be evaluated in a randomized controlled study to determine its role within the armamentarium of therapeutic options for patients with IIH.
Asunto(s)
Seudotumor Cerebral/terapia , Stents , Senos Transversos , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Angiografía Cerebral , Constricción Patológica/diagnóstico , Constricción Patológica/terapia , Femenino , Estudios de Seguimiento , Humanos , Presión Intracraneal , Imagen por Resonancia Magnética , Manometría , Persona de Mediana Edad , Examen Neurológico , Obesidad Mórbida/complicaciones , Atrofia Óptica/etiología , Seudotumor Cerebral/diagnóstico , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: The vascular structures in the central nervous system has a particular distribution in respect of other organs. This anatomic configuration and other conditions predispose this arteries and veins to bleed frequently in the subarachnoid space, resulting in a syndrome known as subarachnoid hemorrhage. DEVELOPMENT: We make a study of the bibliography published in the topic, beside our professional criteria concerning those themes, with regard to the elements that we have been able to evaluate in our daily practice. We carried out a wide review about etiology, physiopathology, clinical presentation, diagnosis and management of the commonest problems associated with that entity. Specially those aspects related with the clinical support and treatment of the cerebral vasoespasm, hydrocephalus and other complications of the subarachnoid hemorrhage. CONCLUSION: In this paper we expose the most important aspects related with the clinical manifestations of certain vascular malformations like saccular aneurysm and arteriovenous malformations, the principles of it diagnosis and management.
Asunto(s)
Hemorragia Subaracnoidea , Volumen Sanguíneo , Diabetes Insípida Neurogénica/etiología , Diagnóstico Diferencial , Humanos , Hidrocefalia/etiología , Punción Espinal , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/patología , Hemorragia Subaracnoidea/terapia , Factores de TiempoRESUMEN
INTRODUCTION: The characteristics of semirigid cavity confer to the skull and their content a special behavior, with regard to the other organs of the economy and they become the increases of pressure the interior in this space a threat against the appropriate evolution of the patients with intracranial pathologies of etiologies dissimilar. DEVELOPMENT: We make a study of the bibliography published on the topic, besides our personal approach with regard to the elements that we have been able to evaluate in our practices in clinic daily. We carried out a wide revision of the topic being exposed the physiopathological factors that intervene in to the maintenance of a homeostasis intracranial, the influence of the vital functions on this pressure and other aspects of importance. The clinical manifestations specify of this syndrome they are baskets after carrying out an analysis of their physiopathology. CONCLUSIONS: In this paper we exposes the methods for their menstruation as well as the importance of the use of these evidences in the establishment of an appropriate treatment. The modernized therapy of this entity, as well as the foundations of their application.