A proposal for a new pial arteriovenous fistulas grading scale for neuroendovascular procedures and literature review

Pial arteriovenous fistulas are an unusual type of cerebrovascular lesion. The vascular supply of this type of injury comes from cortical and pial vessels which are not located in the dura leaflets. With the aim to make a grading scale for this type of injury, we conducted a literature search using the keywords "pial arteriovenous fistulas", "embolization" associated with "outcome". Angiographic and imagenological characteristics typically found in pial arteriovenous fistulas were taken and was developed a preliminary classification system that must be validated in future studies. Pial arteriovenous fistulas are associated with a poor natural history and the establishment of an individualized therapeutic strategy can provide a good prognosis. The endovascular management of these lesions is safe and effective

Odontogenic Pain as the Principal Presentation of Vertebral Artery Pseudoaneurysm; a Case Report

Dissection of the vertebral artery is an important but rare cause of cerebrovascular accidents. Here we report a 48-year-old man with toothache since 4 days before who presented to the emergency department with neck pain and final diagnosis of dissecting right vertebral artery pseudoaneurysm. To our knowledge, this maybe the first report of odontogenic pain as the first manifestation of vertebral artery pseudoaneurysm in the literatures

Glycemia in spontaneous intracerebral hemorrhage: Clinical implications

Spontaneous cerebral hemorrhage or intracranial hemorrhage accounts for 10-15% of all strokes. Intracranial hemorrhage is much less common than ischemic stroke, but has higher mortality and morbidity, one of the leading causes of severe disability. Various alterations, among these the endocrine were identified when an intracerebral hemorrhage, these stress-mediated mechanisms exacerbate secondary injury. Deep knowledge of the injuries which are directly involved alterations of glucose, offers insight as cytotoxicity, neuronal death and metabolic dysregulations alter the prognosis of patients with spontaneous intracerebral hemorrhage

Traumatic cerebral contusion: Pathobiology and critical aspects

Traumatic brain injury is a major cause of mortality in developed countries. Cerebral parenchymal injury is evidenced by a significant percentage of patients. The most important structural lesion of the brain is the cerebral contusion, which is a complex and dynamic area, a result of the primary lesion and which is associated with ischemic and inflammatory phenomena that need to be known by the neurosurgeon. We present a review of the most important aspects of brain contusion

Microglia: roles and rules in brain traumatic injury

Microglia are a special type of supporting cells in the nervous system. between the functions they perform are myelin production, structural support, regulation of extracellular fluid, glial scar formation among others. This cell type for its versatility, is also related to pathological events, where his multiple roles and the release of proinflammatory factors can contribute to understand especially in traumatic brain injury, as secondary injury and the healing process, important aspects the context of brain injury

Bilateral traumatic paralysis of abducent nerves and clivus fracture: Case Report

Clivus fractures are a rare pathology, frecuently associated tohigh power trauma. Such injuries may be associated with vascular and cranial nerves lesions. The abducens nerve is particularly vulnerable to traumatic injuries due to its long intracranial course, since their real origin until the lateral rectus muscle. The unilateral abducens nerve palsy of 1-2-7% occurs in patients with cranial trauma, bilateral paralysis is rare. We report a patient who presented bilateral abducens nerve palsy associated with a clivus fracture

Giant Subgaleal cerebrospinal fluid leakage: An unusual complication of chronic subdural hematoma surgery

We report a rare case of chronic subdural hematoma complicated with a Giant subgaleal cerebrospinal fluid leakage. Physical examination was performed with no alteration in mental status and no focal neurological disorder. The subdural hematoma was drained and two weeks later, patient was admitted to our hospital with a giant scalp swelling. Physical examination revealed a left parietal subcutaneous collection. The patient was reoperated with a correction in the fistula, he presented a satisfactory postoperative evolution. To our knowledge, this is the first report in literature of a chronic subdural hematoma with a complicated giant subgaleal cerebrospinal fluid leakage

Fluid therapy in neurotrauma: basic and clinical concepts

The patient with head trauma is a challenge for the emergency physician and for the neurosurgeon. Currently traumatic brain injury constitutes a public health problem. Knowledge of the various therapeutic strategies to provide support in the prehospital and perioperative are essential for optimal care. Rapid infusion of large volumes of crystalloids to restore blood volume and blood pressure quickly is now the standard treatment for patients with combined TBI and HS The fluid in patients with brain and especially in the carrier of brain injury is a critical topic; we present a review of the literature about the history, physiology of current fluid preparations, and a discussion regard the use of fluid therapy in traumatic brain injury and decompressive craniectomy

Reconstrucción de encefalocele frontoetmoidal con injerto de acetábulo

El encefalocele frontoetmoidal es un defecto congénito deltubo neural caracterizado por una herniación parcial delcerebro y las meninges, a través de un defecto craneal anteriorque genera deformidad facial. Se presenta el reporte de unniño de 10 años con un defecto facial en línea media quecorrespondió a un encefalocele frontoetmoidal. Se realizócorrección quirúrgica acompañado de colocación de injertode acetábulo, obteniéndose una mejoría estética y anatómicafavorable. Este parece ser el primer caso en la literatura en elque se utiliza el injerto de acetábulo para la reconstrucción deun encefalocele frontoetmoidal

Spontaneous chronic subdural hematoma in a young male patient: Case report

The chronic subdural hematoma is a common pathology in elderly patients. There is usually a history of head trauma. The diagnosis of chronic subdural hematomas in young patients is very rare and few cases have been reported in the literature. The authors present a case of a patient of 16 years old who presented headache of two months of evolution, which was conducted by tomography diagnosis of chronic subdural hematoma. The patient had no history of mild trauma. Surgical management was performed, showing a satisfactory evolution