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RESUMEN La trombosis venosa cerebral (TVC) es una entidad poco frecuente y potencialmente devastadora que se presenta con mayor frecuencia en adultos jóvenes, especialmente en mujeres. La TVC representa el 0,5 % a 1 % de todos los ACV, su amplio espectro clínico la convierte en un desafío diagnóstico, especialmente en aquellos casos de mujeres jóvenes sin factores protrombóticos conocidos que debutan con cefalea como único síntoma. La TVC puede ocasionar isquemia o infartos talámicos y gangliobasales bilaterales con delirio y deterioro del estado de conciencia, en especial cuando hay compromiso del sistema venoso profundo. El diagnóstico se confirma con resonancia magnética cerebral (RM) y venografía por resonancia. La anticoagulación sigue siendo la piedra angular del tratamiento; sin embargo, los pacientes que no responden a terapia médica intensiva pueden beneficiarse de la trombectomía endovascular mecánica (TEM). A continuación presentamos el caso clínico de una paciente de 29 años con una isquemia talámica y gangliobasal bilateral secundaria a trombosis venosa cerebral que fue llevada a trombectomía endovascular mecánica.

SUMMARY Thrombosis of the dural sinus and/or cerebral veins (CVT) is a rare but potentially devastating type of stroke that tends to occur in young adults, especially women. CVT represents about 0.5% of all strokes and can be challenging to diagnose because headache, rather than focal neurologic symptoms, is the prominent feature. However, some patients (especially those with deep cerebral venous occlusion) may present with bilateral thalamic or basal infarction and often will have decreased level of consciousness and rapid neurologic deterioration. The diagnosis of CVT is confirmed with MRI and magnetic resonance venogram (MRV). The mainstay of acute management is anticoagulation. However, some patients do not respond to medical therapy and these might benefit from endovascular mechanical thrombectomy. We present the case of a 29 year old female patient with bilateral thalamic and gangliobasal ischemia secondary to CVT, who was treated with anticoagulation and endovascular mechanical thombectomy.

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Due to demographic changes, rising health expenditures, and the reimbursement mechanisms of insurers in the past 30 years, physicians and nurses have had to changethe way services are delivered. Concepts such as cost effectiveness and patient safetyhave also led to the emergence of case management. Case management, usually ledby nurses, is responsible for early recognition of patients at high risk for prolongedhospitalization, readmission, a high level of consumption of healthcare resources,and mobilizing strategies to discharge patients as soon as possible in a safe mannerwith appropriate medical follow-up. Additionally, the case management teams areresponsible for patient education in a systematic way, for proper codification ofdiagnoses, and for ensuring proper documentation at the moment of discharge. Casemanagement has proven to reduce the length of hospital stays and readmissions. Italso facilitates the care of patients who are overwhelmed by the increasingly complexhospital procedures that they must endure. This is an exhaustive review of the literature about hospital-based case management, its origins, characteristics, types, andhow it has produced a positive impact on patient safety and metrics within hospitals.

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Due to demographic changes, rising health expenditures, and the reimbursement mechanisms of insurers in the past 30 years, physicians and nurses have had to change the way services are delivered. Concepts such as cost effectiveness and patient safety have also led to the emergence of case management. Case management, usually led by nurses, is responsible for early recognition of patients at high risk for prolonged hospitalization, readmission, a high level of consumption of healthcare resources, and mobilizing strategies to discharge patients as soon as possible in a safe manner with appropriate medical follow-up. Additionally, the case management teams are responsible for patient education in a systematic way, for proper codification of diagnoses, and for ensuring proper documentation at the moment of discharge. Case management has proven to reduce the length of hospital stays and readmissions. It also facilitates the care of patients who are overwhelmed by the increasingly complex hospital procedures that they must endure. This is an exhaustive review of the literature about hospital-based case management, its origins, characteristics, types, and how it has produced a positive impact on patient safety and metrics within hospitals.

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