Neurocirugia
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Clinical Trial
[The usefulness of transcranial Doppler ultrasonography in the early phase of head injury].
1) To know the transcranial Doppler (TCD) patterns in the early phase of the severe and moderate head injury and its prognostic implications. 2) To ascertain the TCD measurements concordance among different operators. ⋯ Early TCD detects a cerebral hypoperfusion status in the severe and moderate head injury that may imply therapeutic considerations. This hypoperfusion strongly correlates with the severity of the injury, the incidence of HICP and the functional outcome at the ICU discharge. In experienced hands, TCD measurements are reliable when done by different operators.
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Subarachnoidal hemorrhage (SAH) is a medical emergency in all the patients. There are some known risk factors and, some complications associated to subarachnoid hemorrhage due to aneurysm rupture, being the rebleeding the main cause of mortality. ⋯ This study has been specially self-helpful in order to analyze our medical policy in front of this entity, and in this way, to elaborate a protocol of treatment taking account nowadays tendencies and our experience.
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We are presenting the case of a 58 year-old woman with an arteriovenous malformation (AVM) of the middle and posterior thirds of the corpus callosum which had produced two episodes of bleeding before admission to our Department, when the patient was neurologically intact. The nidus was fed by the anterior and posterior pericallosal arteries draining through the left medial atrial vein to the vein of Galen, by parasagittal cortical veins to the superior sagittal sinus and by right temporal veins to the sphenoparietal sinus. The patient underwent embolization of the anterior and posterior feeders in two sessions separated by a week interval, and then the AVM was removed through a left paramedial parietooccipital craniotomy in a single stage. The patient showed transient mild short term memory deficit, but the final outcome was excellent.