RESUMEN
BACKGROUND: Stereotactic biopsy has been reported as a useful and safety procedure in pediatric patients. In adult patients exist more controversy because a greater number of diagnostic options. OBJECTIVE: To demonstrate its usefulness and safety in adult patients with posterior fossa pathology. METHOD: From 2006-2014, 23 patients were operated from posterior fossa. Variables: age, gender, state, pre- and postoperative diagnosis, stereotactic device, location and complications. RESULTS: 52.2% females and 47.8% males. The location was ponto-mesencephalic 43.5%, cerebellum 39.1%, bulbar 13% and pineal region 4.3%. The preoperative diagnosis was brainstem glioma 78.2%, lymphoma 8.7%, and meningioma, metastasis and abscess 4.3% each one. In 73.9% Zamorano-Dujovni device was used and in 26.1% the CRW. The definitive diagnosis was pilocytic astrocytoma 17.4%, diffuse astrocytoma 13%, inflammatory response 13%, anaplastic astrocytoma 8.7%, gliosis 8.7%, glioblastoma, neuroectodermic primitive tumor, germinoma, pineocytoma and cryptococcosis 4.3% each one. In 17.4% there was no diagnosis. The preoperative diagnosis was concordant in 43.5%. One transient deficit and one pin displacement 4.3% were present. 91.4% without complications. CONCLUSIONS: It is a useful, necessary and safety procedure in adult patients.
ANTECEDENTES: La biopsia por estereotaxia ha sido reportada como segura y útil en pediatría. En adultos es más controvertida debido a la mayor diversidad de opciones diagnósticas. OBJETIVO: Demostrar su utilidad y seguridad en pacientes adultos con patología de fosa posterior. MÉTODO: En 2006-2014 se operaron 23 pacientes de fosa posterior. Variables: edad, sexo, diagnóstico preoperatorio y posoperatorio, estereotáctico, localización y complicaciones. RESULTADOS: 52.2% mujeres y 47.8% hombres. La localización fue la región pontomesencefálica en el 43.5%, el cerebelo en el 39.1%, bulbar en el 13% y pineal en el 4.3%. El diagnóstico preoperatorio fue glioma de tallo en el 78.2%, linfoma en el 8.7% y meningioma, metástasis y absceso en el 4.3% cada uno. En el 73.9% se utilizó el sistema Zamorano-Dujovni y en el 26.1% el CRW. El diagnóstico definitivo fue astrocitoma pilocítico en el 17.4%, astrocitoma difuso en el 13%, respuesta inflamatoria en el 13%, astrocitoma anaplásico en el 8.7%, gliosis en el 8.7%, y glioblastoma, tumor neuroectodérmico primitivo, germinoma, pineoctioma y criptococosis en el 4.3% cada uno. En el 17.4% no hubo diagnóstico. El diagnóstico preoperatorio fue concordante en el 43.5%. Hubo un déficit transitorio y un desplazamiento de uno de los pinchos en el 4.3% de los casos. En el 91.4% no hubo complicaciones. CONCLUSIONES: Es un procedimiento útil, necesario y seguro en pacientes adultos.
Asunto(s)
Biopsia , Neoplasias Infratentoriales/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia/efectos adversos , Biopsia/métodos , Encefalopatías/patología , Femenino , Glioma/diagnóstico , Glioma/patología , Gliosis/diagnóstico , Gliosis/patología , Humanos , Neoplasias Infratentoriales/diagnóstico , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/patología , Masculino , Meningitis Criptocócica/patología , Persona de Mediana Edad , Estudios Retrospectivos , Técnicas Estereotáxicas/efectos adversos , Neoplasias Supratentoriales/diagnóstico , Neoplasias Supratentoriales/patología , Adulto JovenAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/patología , Encéfalo/diagnóstico por imagen , Seropositividad para VIH/diagnóstico , VIH-1/aislamiento & purificación , Hemorragias Intracraneales/patología , Toxoplasmosis Cerebral/complicaciones , Toxoplasmosis Cerebral/patología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Adulto , Encéfalo/patología , Seropositividad para VIH/complicaciones , VIH-1/genética , Humanos , Hemorragias Intracraneales/diagnóstico por imagen , Hemorragias Intracraneales/etiología , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X , Toxoplasmosis Cerebral/diagnóstico , Toxoplasmosis Cerebral/diagnóstico por imagenRESUMEN
RESUMO Relatamos o caso de um uma criança de 2 anos de idade que sobreviveu após um episódio agudo de hemorragia intracraniana espontânea grave com sinais clínicos e radiológicos de hipertensão intracraniana e herniação transtentorial. O paciente foi para cirurgia de urgência para drenagem do hematoma, sendo inserido um cateter para monitorar a pressão intracraniana. Na análise da tomografia de crânio inicial, antes da drenagem do hematoma, constatou-se um cisto cerebral contralateral ao hematoma que, segundo análise do neurocirurgião e do neuroradiologista, possivelmente evitou um desfecho pior, visto que o cisto serviu de acomodação para o cérebro após a hemorragia maciça. Após investigação, constatou-se tratar de um caso de hemofilia tipo A sem diagnóstico prévio. O paciente foi tratado em terapia intensiva com controle da pressão intracraniana, reposição de fator VIII e obteve alta sem sequelas neurológicas evidentes.
ABSTRACT We report the case of a 2-year-old child who survived an acute episode of severe spontaneous intracranial hemorrhage with clinical and radiological signs of intracranial hypertension and transtentorial herniation. The patient underwent emergency surgery to drain the hematoma, and a catheter was inserted to monitor intracranial pressure. In the initial computed tomography analysis performed prior to hematoma drainage, a brain cyst was evident contralateral to the hematoma, which, based on the analysis by the care team, possibly helped to avoid a worse outcome because the cyst accommodated the brain after the massive hemorrhage. After the investigation, the patient was determined to have previously undiagnosed hemophilia A. The patient underwent treatment in intensive care, which included the control of intracranial pressure, factor VIII replacement and discharge without signs of neurological impairment.
Asunto(s)
Humanos , Masculino , Preescolar , Hipertensión Intracraneal/etiología , Hemorragias Intracraneales/etiología , Hemofilia A/complicaciones , Encéfalo/patología , Factor VIII/administración & dosificación , Tomografía Computarizada por Rayos X , Hemorragias Intracraneales/cirugía , Hemorragias Intracraneales/patología , Quistes/etiología , Quistes/patología , Hematoma/etiología , Hematoma/patología , Hemofilia A/diagnóstico , Hemofilia A/tratamiento farmacológicoRESUMEN
We report the case of a 2-year-old child who survived an acute episode of severe spontaneous intracranial hemorrhage with clinical and radiological signs of intracranial hypertension and transtentorial herniation. The patient underwent emergency surgery to drain the hematoma, and a catheter was inserted to monitor intracranial pressure. In the initial computed tomography analysis performed prior to hematoma drainage, a brain cyst was evident contralateral to the hematoma, which, based on the analysis by the care team, possibly helped to avoid a worse outcome because the cyst accommodated the brain after the massive hemorrhage. After the investigation, the patient was determined to have previously undiagnosed hemophilia A. The patient underwent treatment in intensive care, which included the control of intracranial pressure, factor VIII replacement and discharge without signs of neurological impairment.
Asunto(s)
Hemofilia A/complicaciones , Hemorragias Intracraneales/etiología , Hipertensión Intracraneal/etiología , Encéfalo/patología , Preescolar , Quistes/etiología , Quistes/patología , Factor VIII/administración & dosificación , Hematoma/etiología , Hematoma/patología , Hemofilia A/diagnóstico , Hemofilia A/tratamiento farmacológico , Humanos , Hemorragias Intracraneales/patología , Hemorragias Intracraneales/cirugía , Masculino , Tomografía Computarizada por Rayos XRESUMEN
The goal of this study was to examine executive functioning outcomes in children with hemophilia who have suffered intracranial hemorrhage. We assessed 10 boys with hemophilia with intracranial hemorrhage; 6 boys with hemophilia without intracranial hemorrhage; and 10 healthy boys as controls. Intellectual functioning was assessed with subscales from the Wechsler Intelligence Scale for Children-Mexican Revision. Concept formation and reasoning, cognitive flexibility, and planning and organization domains from a neuropsychological assessment battery for Spanish-speaking children were employed for our analysis. Results indicated that children with intracranial hemorrhage demonstrated significant impairment on some measures of executive function compared with the control groups. All differences reflected poorer performance by the intracranial hemorrhage group. These results may reflect the impact of disruption to immature brain circuits and the deficiency of functional specificity within the immature brain. This is the only known study examining neuropsychological functioning in Mexican youth with hemophilia.
Asunto(s)
Función Ejecutiva/fisiología , Hemofilia A/complicaciones , Hemorragias Intracraneales/fisiopatología , Adolescente , Niño , Preescolar , Humanos , Inteligencia , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/patología , Imagen por Resonancia Magnética , Masculino , México , Escalas de WechslerRESUMEN
Stroke causes disability and mortality worldwide and is divided into ischemic and hemorrhagic subtypes. Although clinical trials suggest distinct recovery profiles for ischemic and hemorrhagic events, this is not conclusive due to stroke heterogeneity. The aim of this study was to produce similar brain damage, using experimental models of ischemic (IS) and hemorrhagic (HS) stroke and evaluate the motor spontaneous recovery profile. We used 31 Wistar rats divided into the following groups: Sham (n=7), ischemic (IS) (n=12) or hemorrhagic (HS) (n=12). Brain ischemia or hemorrhage was induced by endotelin-1 (ET-1) and collagenase type IV-S (collagenase) microinjections, respectively. All groups were evaluated in the open field, cylinder and ladder walk behavioral tests at distinct time points as from baseline to 30 days post-surgery (30 PS). Histological and morphometric analyses were used to assess the volume of lost tissue and lesion length. Present results reveal that both forms of experimental stroke had a comparable long-term pattern of damage, since no differences were found in volume of tissue lost or lesion size 30 days after surgery. However, behavioral data showed that hemorrhagic rats were less impaired at skilled walking than ischemic ones at 15 and 30 days post-surgery. We suggest that experimentally comparable stroke design is useful because it reduces heterogeneity and facilitates the assessment of neurobiological differences related to stroke subtypes; and that spontaneous skilled walking recovery differs between experimental ischemic and hemorrhagic insults.
Asunto(s)
Isquemia Encefálica/psicología , Encéfalo/patología , Hemorragias Intracraneales/psicología , Recuperación de la Función , Accidente Cerebrovascular/patología , Accidente Cerebrovascular/psicología , Animales , Isquemia Encefálica/inducido químicamente , Isquemia Encefálica/complicaciones , Isquemia Encefálica/patología , Colagenasas/administración & dosificación , Endotelina-1/administración & dosificación , Hemorragias Intracraneales/inducido químicamente , Hemorragias Intracraneales/complicaciones , Hemorragias Intracraneales/patología , Masculino , Microinyecciones , Actividad Motora/efectos de los fármacos , Destreza Motora/efectos de los fármacos , Ratas , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnósticoRESUMEN
BACKGROUND: To evaluate the presence of ischemic and hemorrhagic lesions in brain MRI of patients with Fabry disease (FD). METHODS: Brain MRI studies in 46 consecutive patients were evaluated using classic sequences as well as GRE-weighted images, for ischemic lesions and chronic microbleed detection. Of the 36 adult patients (15 males, mean age 31.2 years; 21 females, mean age 41.6 years). All had signs or symptoms of FD but lacked history of stroke or TIA. RESULTS: Ten patients under 20 years of age initially presented a normal MRI. One child developed a hyperintense occipital lesion on T2-weighted imaging during control MRI. Sixteen adult patients (44.4%) had brain MRI evidence of small vessel disease in the basal ganglia, corona radiata, thalamus or brainstem, as well as in the periventricular white matter. Patients with MRI abnormalities were older (45.6 vs 30.9 years, p=0.005), with more vascular risk factors (1.2 vs 0.6 p=0.043). Three women (mean age 59.5 years) presented deep chronic microbleeds identified by GRE. Moreover, Flair and T2-weighted images revealed white matter disease and deep gray matter involvement. CONCLUSION: 44.4% of adult patients with FD without clinical history of CVA or prior dialysis had evidence of small vessel disease on MRI and 11% showed cerebral microbleeds. FD is a treatable disorder that should be routinely included in the differential diagnosis of ischemic and microhemorrhagic lesions in young adults.
Asunto(s)
Isquemia Encefálica/patología , Enfermedad de Fabry/patología , Hemorragias Intracraneales/patología , Adolescente , Adulto , Anciano , Ganglios Basales/irrigación sanguínea , Ganglios Basales/patología , Isquemia Encefálica/complicaciones , Isquemia Encefálica/epidemiología , Tronco Encefálico/irrigación sanguínea , Tronco Encefálico/patología , Niño , Comorbilidad , Enfermedad de Fabry/complicaciones , Enfermedad de Fabry/epidemiología , Femenino , Humanos , Cápsula Interna/irrigación sanguínea , Cápsula Interna/patología , Hemorragias Intracraneales/complicaciones , Hemorragias Intracraneales/epidemiología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Tálamo/irrigación sanguínea , Tálamo/patología , Adulto JovenRESUMEN
OBJECTIVE: To hypothesize that detailed examination of early cerebellar volumes in time would distinguish differences in cerebellar growth associated with intraventricular hemorrhage (IVH) and white matter injury in preterm infants. STUDY DESIGN: Preterm newborns at the University of California San Francisco (n = 57) and the University of British Columbia (n = 115) were studied with serial magnetic resonance imaging scans near birth and again at near term-equivalent age. Interactive semi-automated tools were used to determine volumes of the cerebellar hemispheres. RESULTS: Adjusting for supratentorial brain injury, cerebellar hemorrhage, and study site, cerebellar volume increased 1.7 cm(3)/week postmenstrual age (95% CI, 1.6-1.7; P < .001). More severe supratentorial IVH was associated with slower growth of cerebellar volumes (P < .001). Volumes by 40 weeks were 1.4 cm(3) lower in premature infants with grade 1 to 2 IVH and 5.4 cm(3) lower in infants with grade 3 to 4 IVH. The same magnitude of decrease was found between ipsilateral and contralateral IVH. No association was found with severity of white matter injury (P = .3). CONCLUSIONS: Early effects of decreased cerebellar volume associated with supratentorial IVH in either hemisphere may be a result of concurrent cerebellar injury or direct effects of subarachnoid blood on cerebellar development.
Asunto(s)
Lesiones Encefálicas/patología , Cerebelo/crecimiento & desarrollo , Ventrículos Cerebrales , Recien Nacido Prematuro , Hemorragias Intracraneales/patología , Leucoencefalopatías/patología , Cerebelo/irrigación sanguínea , Cerebelo/lesiones , Femenino , Humanos , Imagenología Tridimensional , Recién Nacido , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Tamaño de los Órganos , Análisis de RegresiónRESUMEN
Pathological studies would aid in finding the real causes of death and in outlining adequate strategies for treatment regarding patients with poor clinical outcome of influenza A H1N1 swine flu. We describe the autopsy findings of six cases of influenza A H1N1 swine flu. The lungs in these cases had an alveolitis with hyaline membranes. Immunohistochemistry for influenza was positive only in lungs (in pneumocytes, in macrophages, in some multinucleate cells in alveoli, and in blood vessel walls) of two cases. Disseminated petechial brain hemorrhage was observed in four of the cases and focally in one case. Focal myocarditis was observed in one case. Coagulation infarcts (ischemic) were observed in the pancreas of two cases and in the spleen of two cases. Our results indicate that there was marked replication of the virus in alveoli in the more recently infected cases, which could explain the extensive diffuse alveolar damage. In our cases, there were important vascular phenomena that resulted in hemorrhage and thrombosis, but without marked decrease of platelet count and coagulation cascade disruptions. This would be attributed to hemodynamic disruption. However, it is possible that the hemorrhagic petechial lesions in the brain are due to vascular lesions or to an increase of endothelial permeability.
Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/patogenicidad , Gripe Humana/patología , Pulmón/patología , Adulto , Autopsia , Encéfalo/patología , Femenino , Humanos , Inmunohistoquímica , Infarto/patología , Infarto/virología , Gripe Humana/mortalidad , Gripe Humana/virología , Hemorragias Intracraneales/patología , Hemorragias Intracraneales/virología , Pulmón/irrigación sanguínea , Pulmón/virología , Masculino , Persona de Mediana Edad , Miocarditis/patología , Miocarditis/virología , Miocardio/patología , Páncreas/irrigación sanguínea , Páncreas/patología , Bazo/irrigación sanguínea , Bazo/patología , Adulto JovenRESUMEN
OBJECTIVE: To describe the CT scan findings of 21 thrombocytopenic patients with central nervous system (CNS) hemorrhage. METHOD: Retrospective study of the computed tomography (CT) of 21 platelet-depleted patients with CNS hemorrhage. One patient presented two episodes of hemorrhagic episode with different intervals. The clinical data were obtained by the review of the medical records. Two radiologists analyzed the films and reached the decisions by consensus. The following findings were studied: type of bleeding, number of lesions, topography, laterality, size and associated findings. RESULTS: Intraparenchymal hemorrhage (IPH) was the most common findings, found in 20 cases, being six of them associated with subarachnoid and intraventricular hemorrhages. The size of the lesions varied between 1.8 and 10.5 cm. The parietal lobes were more commonly affected (n=11, 50%), followed by the temporal (n=7, 31.8%), frontal (n=7, 31.8%) and occipital (n=2, 9.09%) lobes. In 15 cases (68.2%) there was a single area of hemorrhage and in the remaining cases there were multiple hemorrhages. Associated findings were found in 20 cases. The most prevalent were edema (n=17, 77.3%), hydrocephalus (10, 45.4%) and midline shift (n=9, 41%). CONCLUSION: The most frequent CT scan findings in thrombocytopenic patients with CNS hemorrhage are single IPH, located mostly in the parietal, temporal and frontal lobes, with varied sizes and associated with edema, hydrocephalus and midline shift.
Asunto(s)
Hemorragia Cerebral/diagnóstico por imagen , Trombocitopenia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Distribución por Edad , Hemorragia Cerebral/patología , Niño , Preescolar , Femenino , Lóbulo Frontal/diagnóstico por imagen , Lóbulo Frontal/patología , Humanos , Hemorragias Intracraneales/diagnóstico por imagen , Hemorragias Intracraneales/patología , Masculino , Persona de Mediana Edad , Lóbulo Parietal/diagnóstico por imagen , Lóbulo Parietal/patología , Estudios Retrospectivos , Distribución por Sexo , Hemorragia Subaracnoidea/diagnóstico por imagen , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patología , Trombocitopenia/patologíaRESUMEN
OBJETIVE: To describe the CT scan findings of 21 thrombocytopenic patients with central nervous system (CNS) hemorrhage. METHOD: Retrospective study of the computed tomography (CT) of 21 platelet-depleted patients with CNS hemorrhage. One patient presented two episodes of hemorrhagic episode with different intervals. The clinical data were obtained by the review of the medical records. Two radiologists analyzed the films and reached the decisions by consensus. The following findings were studied: type of bleeding, number of lesions, topography, laterality, size and associated findings. RESULTS: Intraparenchymal hemorrhage (IPH) was the most common findings, found in 20 cases, being six of them associated with subarachnoid and intraventricular hemorrhages. The size of the lesions varied between 1.8 and 10.5 cm. The parietal lobes were more commonly affected (n=11, 50 percent), followed by the temporal (n=7, 31.8 percent), frontal (n=7, 31.8 percent) and occipital (n=2, 9.09 percent) lobes. In 15 cases (68.2 percent) there was a single area of hemorrhage and in the remaining cases there were multiple hemorrhages. Associated findings were found in 20 cases. The most prevalent were edema (n=17, 77.3 percent), hydrocephalus (10, 45.4 percent) and midline shift (n=9, 41 percent). CONCLUSION: The most frequent CT scan findings in thrombocytopenic patients with CNS hemorrhage are single IPH, located mostly in the parietal, temporal and frontal lobes, with varied sizes and associated with edema, hydrocephalus and midline shift.
OBJETIVO: Descrever os achados tomográficos de 21 pacientes trombocitopênicos com hemorragia no sistema nervoso central (SNC). MÉTODO: Estudo retrospectivo das tomografias computadorizadas (TC) de 21 pacientes trombocitopênicos que apresentaram hemorragia no SNC. Um dos pacientes apresentou 2 episódios hemorrágicos em épocas diferentes. Os dados clínicos foram obtidos por revisão de prontuários médicos. Dois radiologistas analisaram os exames e estabeleceram os achados por consenso. Os seguintes achados foram estudados: tipo de sangramento, número de lesões, topografia, lateralidade, tamanho e achados associados. RESULTADOS: A hemorragia intraparenquimatosa foi o achado mais comum, observada em 20 casos, sendo que em seis deles apresentavam hemorragia subaracnóidea e intraventricular associadas. O tamanho das lesões variou entre 1,8 e 10,5 cm (mediana= 4,5 cm). Os lobos parietais foram mais acometidos (n=11, 50 por cento), seguidos pelos temporais (n=7, 31,8 por cento), frontais (n=7, 31,8 por cento) e occipitais (n=2, 9,09 por cento). Em 15 casos (68,2 por cento) houve uma única área de hemorragia, e nos demais múltiplas áreas foram observadas. Em 20 casos foram encontrados achados associados, sendo mais comum edema (n=17, 77,3 por cento), hidrocefalia (n=10, 45,4 por cento) e desvio da linha média (n=9, 41 por cento). CONCLUSÃO: Os achados tomográficos mais freqüentes em pacientes trombocitopênicos com hemorragia cerebral são lesões intraparenquimatosas únicas acometendo principalmente os lobos parietais, temporais e frontais, com tamanhos variados e associadas a edema, hidrocefalia e desvio da linha média.
Asunto(s)
Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Cerebral , Tomografía Computarizada por Rayos X , Trombocitopenia , Distribución por Edad , Hemorragia Cerebral/patología , Lóbulo Frontal/patología , Lóbulo Frontal , Hemorragias Intracraneales/patología , Hemorragias Intracraneales , Lóbulo Parietal/patología , Lóbulo Parietal , Estudios Retrospectivos , Distribución por Sexo , Hemorragia Subaracnoidea , Lóbulo Temporal/patología , Lóbulo Temporal , Trombocitopenia/patologíaRESUMEN
We report 2 patients who presented a brainstem hemorrhage and who, after 1 and 6 months, respectively, developed a 4-Hz postural and resting tremor consistent with Holmes tremor, which severely interfered with the activities of daily living. In both cases, levodopa dramatically improved the tremor. Pharmacological treatment of this condition is usually disappointing, and surgical procedures are commonly required for severe cases. Our patients, together with 13 others gleaned from the literature, suggest that in cases of Holmes tremor secondary to brainstem hemorrhage, levodopa can be a useful treatment, and it should be tested before considering invasive therapies.
Asunto(s)
Antiparkinsonianos/uso terapéutico , Hemorragias Intracraneales/complicaciones , Levodopa/uso terapéutico , Temblor/tratamiento farmacológico , Temblor/etiología , Adulto , Tronco Encefálico/patología , Electromiografía/métodos , Femenino , Humanos , Hemorragias Intracraneales/patología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Literatura de Revisión como Asunto , Factores de TiempoRESUMEN
Autopsy files of 180 patients were reviewed, who died after BMT between July 1987 and June 1998 and 58 (32.2%) cases, who had experienced intracranial hemorrhage (ICH) were selected. Age, sex, underlying disease, preparatory regimens, immunoprophylaxis, chronic and acute GVHD, survival of the patients and localization and size of hemorrhages were evaluated. There were 33 males and 25 females, with a mean age of 23.4 years. The main underlying disorders for which BMT was performed included SAA (n = 21), CML (n = 13) and AML (n = 10). Forty patients were found to have intraparenchymal hemorrhage, 35 had subarachnoid hemorrhage and eight patients had subdural hemorrhage. In 16 cases the CNS hemorrhage was so extensive that it was considered to be the main cause of death. There was no significant statistical difference concerning sex (P = 0.217), age (P = 0.296), underlying disease (P= 0.352), preparatory regimens (P = 0.07), immunoprophylaxis (P = 0.914), chronic and acute graft-versus-host disease (P = 0.107 and P = 0.631, respectively) and survival (P = 0.701) when comparing patients with or without ICH. However, the number of cases in which the CNS was defined as the main cause of death was higher among patients with ICH than in patients without ICH (n = 16 vs 15) (P = 0.011). We conclude that ICH is common and has a significant mortality rate following BMT.
Asunto(s)
Trasplante de Médula Ósea/efectos adversos , Hemorragias Intracraneales/etiología , Adolescente , Adulto , Autopsia , Brasil/epidemiología , Estudios de Casos y Controles , Causas de Muerte , Distribución de Chi-Cuadrado , Niño , Preescolar , Femenino , Enfermedad Injerto contra Huésped , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/mortalidad , Enfermedades Hematológicas/terapia , Humanos , Hemorragias Intracraneales/mortalidad , Hemorragias Intracraneales/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Tasa de SupervivenciaRESUMEN
The lesions of the central nervous system represent an important cause of morbid-mortality in the neonatal period. This is due to the vulnerability of the brain to several adverse conditions during gestation and after birth. This study analyses the prevalence and pattern of central nervous system lesions in neonates autopsied at Hospital de Clínicas - Curitiba. There were 5743 pediatric autopsies performed in the Sector of Anatomic Pathology from 1960 to 1995 with 2049 cases corresponding to death during neonatal period. These later autopsies were reviewed and all cases with central nervous system lesions were selected and classified according to sex, age and pattern of central nervous system lesion. The central nervous system was affected in 1616 (78,87%) of neonatal autopsies and there was predominance of intracerebral hemorrhages (73,39%), congenital malformations (4,27%) and infections (3,59%). The hypoxic hemorrhages are the most prevalent central nervous system lesions in the neonatal period, affecting mainly premature babies. There was predominance of central nervous system malformations in the female neonates.
Asunto(s)
Enfermedades del Sistema Nervioso Central/epidemiología , Distribución por Edad , Autopsia , Enfermedades del Sistema Nervioso Central/congénito , Enfermedades del Sistema Nervioso Central/patología , Infecciones del Sistema Nervioso Central/epidemiología , Infecciones del Sistema Nervioso Central/patología , Femenino , Humanos , Recién Nacido , Hemorragias Intracraneales/epidemiología , Hemorragias Intracraneales/patología , Masculino , Prevalencia , Estudios Retrospectivos , Distribución por SexoAsunto(s)
Hemorragias Intracraneales/patología , Fallo Renal Crónico/terapia , Diálisis Renal , Adulto , Enfermedad de Chagas/complicaciones , Resultado Fatal , Hematoma Subdural/complicaciones , Humanos , Hipertensión/complicaciones , Hemorragias Intracraneales/etiología , Masculino , Infecciones por Strongylida/complicacionesAsunto(s)
Humanos , Masculino , Adulto , Hemorragias Intracraneales/patología , Insuficiencia Renal/terapia , Diálisis Renal/efectos adversos , Resultado Fatal , Infecciones por Strongylida/complicaciones , Hematoma Subdural/complicaciones , Enfermedad de Chagas/complicaciones , Hipertensión/complicaciones , Hemorragias Intracraneales/etiologíaAsunto(s)
Humanos , Masculino , Adulto , Diálisis Renal/efectos adversos , Hemorragias Intracraneales/patología , Insuficiencia Renal/terapia , Enfermedad de Chagas/complicaciones , Resultado Fatal , Hematoma Subdural/complicaciones , Hipertensión/complicaciones , Hemorragias Intracraneales/etiología , Infecciones por Strongylida/complicacionesRESUMEN
A injúria hipóxico-isquêmica do sistema nervoso central em neomortos é entidade altamente prevalente, acometendo de 1 a 6 para cada 1000 nascidos vivos. Quando severa provoca o óbito de muitas crianças ou deixa sequelas neurológicas importantes. Relatamos 1028 casos consecutivos de injúria hipóxico-isquêmica de padrão hemorrágico em encéfalos de neomortos do Hospital de Clínicas da Universidade Federal do Paraná - Curitiba, no período compreendido entre 1960 e 1995. Pode-se demonstrar que a prevalência destas lesões nos encéfalos de recém-nascidos autopsiados é alta (49,73 por cento). Os principais tipos de hemorragia encontrados foram as micro-hemorragias intraparenquimatosas cerebrais, as hemorragias intraventriculares, as hemorragias periventriculares e as hemorragias subaracnóideas. Os resultados obtidos demonstram a propensão dos prematuros ao desenvolvimento de hemorragias encefálicas, indicando a necessidade de medidas preventivas que diminuam o risco de complicações neurológicas.
Asunto(s)
Recién Nacido , Humanos , Masculino , Femenino , Sistema Nervioso Central/patología , Hipoxia-Isquemia Encefálica/patología , Hemorragias Intracraneales/patología , Brasil , Recien Nacido Prematuro , Hemorragia Subaracnoidea/patologíaRESUMEN
Realizou-se análise morfológica, macro e microscópica, das lesões encefálicas de 120 vítimas fatais de acidente de trânsito. A explosão lobar foi observada em 12 pacientes (10,0 por cento). O lobo acometido foi o frontal em seis pacientes (50,0 por cento), o temporal em dois (16,7 por cento) e ambos em quatro (33,3 por cento). A fratura de crânio ocorreu em 8 (66,7 por cento) pacientes e a hipertensão intracraniana em metade dos casos de explosão lobar estavam associados a lesão axonal difusa, associação essa que explica a alteração grave de consciência observada à admissão dos pacientes.
Asunto(s)
Adulto , Humanos , Masculino , Femenino , Persona de Mediana Edad , Preescolar , Adolescente , Accidentes de Tránsito , Traumatismos Craneocerebrales/patología , Hemorragias Intracraneales/patología , Accidentes de Tránsito/mortalidad , Traumatismos Craneocerebrales/complicaciones , Hemorragias Intracraneales/complicaciones , Tasa de SupervivenciaRESUMEN
Hypoxic-ischaemic injury of the central nervous system (CNS) in newborns is a very prevalent entity affecting 1 to 6 children per 1000 births. This injury may induce severe neurological sequelae. We present the analysis of 1028 consecutive cases of hypoxic-ischaemic CNS injuries of haemorrhagic pattern detected in autopsies performed at the Division of Anatomic Pathology, Hospital de Clínicas, University of Paraná, Brazil, from 1960 to 1995. The prevalence of these lesions was high (49.73%) amongst all autopsied newborns. The main types of haemorrhage were microscopical intra-parenchymal haemorrhages, intraventricular and periventricular haemorrhages and subarachnoid foci of bleeding. Our results emphasize that premature children constitute a high risk group for CNS haemorrhage needing special preventive therapeutic procedures to avoid neurological complications.