Hemorràgies subaracnoïdals per ruptura d'aneurisma intracranial. Tractament quirúrgic de 100 aneurismes consecutius.

El reconocimiento de la HSA en los Servicios de Urgencias es el primer paso para mejorar los resultados globales de esta grave enfermedad. Deben dirigirse rápidamente a los servicios de neurocirugía y operarlos rápidamente, como mínimo a los enfermos de grado 1, 2 y 3, evitando el temible resangrado. En nuestra serie de 100 aneurismas consecutivos, la decisión de intervención precoz ha supuesto una mejora en los resultados globales, tanto en mortalidad como en morbilidad. En los grados 4 y 5 la decisión quirúrgica precoz o tardía queda abierta a la discusión. La hipertensión-hipervolemia, así como la administración de antagonistas del Ca (nimodipino) han reducido las secuelas producidas por el espasmo arterial. Los resultados obtenidos en el Hospital de Bellvitge, equiparables a otras series mundiales publicadas, muestran unos buenos resultados en el 71 % de los casos, con una mortalidad de un 12 % que se ha reducido a un 6,3 % en los últimos años. La reincorporación laboral ha sido de un 67 % al año de la intervención

Studies with the Golgi method in central gangliogliomas and dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease)

The rapid Golgi method, combined with current optical and electronmicroscopica1 techniques, was used in three central gangliogliomas and in one dysplastic gangliocytoma of the cerebellum to study the morphology of ganglionic cells. Gangliogliomas were composed of bipolar, fusiform and radiate cells with dense core and clear vesicles in the perikaryon and cellular processes, the number of each cellular type varying from one case to another. These features, together with the fact that isodendritic neurons are considered to be phylogenetically old neurons, suggest that these tumours are composed of 'primitive' neurons that are not homogeneous with regard to their morphology. In contrast, ganglionic cells in dysplastic gangliocytoma are huge cells with long, stereotyped neurites that establish unique asymmetric contacts with neighbouring perikarya and neurites by means of claw-shaped processes covered with synaptic buttons. These morphological characteristics are different from those of any other neuron of the CNS

Hemorràgies subaracnoïdals per ruptura d'aneurisma intracranial. Tractament quirúrgic de 100 aneurismes consecutius.

El reconocimiento de la HSA en los Servicios de Urgencias es el primer paso para mejorar los resultados globales de esta grave enfermedad. Deben dirigirse rápidamente a los servicios de neurocirugía y operarlos rápidamente, como mínimo a los enfermos de grado 1, 2 y 3, evitando el temible resangrado. En nuestra serie de 100 aneurismas consecutivos, la decisión de intervención precoz ha supuesto una mejora en los resultados globales, tanto en mortalidad como en morbilidad. En los grados 4 y 5 la decisión quirúrgica precoz o tardía queda abierta a la discusión. La hipertensión-hipervolemia, así como la administración de antagonistas del Ca (nimodipino) han reducido las secuelas producidas por el espasmo arterial. Los resultados obtenidos en el Hospital de Bellvitge, equiparables a otras series mundiales publicadas, muestran unos buenos resultados en el 71 % de los casos, con una mortalidad de un 12 % que se ha reducido a un 6,3 % en los últimos años. La reincorporación laboral ha sido de un 67 % al año de la intervención

Cysticercose of the central nervous system: II. Spinal cysticercose

The compromising of the spinal canal by cysticercus is considered infrequent, varying from 16 to 20% in relation to the brain involvement. In the spinal canal the cysticercus predominantly places in the subarachnoid space. Clinical signs in spinal cysticercosis can be caused by direct compression of the spinal cord/roots by cisticerci and by local or at distance inflammatory reactions (arachnoiditis). Another mechanism of lesion is degeneration of the spinal cord due to pachymeningitis or circulatory insufficiency. The most frequent clinical features are signs of spinal cord and/or cauda equina compression. The diagnosis of spinal cysticercosis is based on evidence of cerebral cysticercosis and on neuroradiological examinations (myelography and myelo-CT) that show signs of arachnoiditis and images of cysts in the subarachnoid space and sometimes, signs of intramedullary lesions, but the confirmation can only be made through immunological reactions in the CSF or during surgery. The clinical course of 10 patients with diagnosis of spinal cysticercosis observed among 182 patients submitted to surgical treatment due to this diasease are analyzed. The clinical pictures in all cases were signs of spinal cord or roots compression. All but two presented previously signs of brain cysticercosis. Neuroradiological examinations showed signs of arachnoiditis in 4 patients, images of cysts in the subarachnoid space in 5, and signs of arachnoiditis and images of cysts in one. The 6 patients that presented intraspinal cysts were submitted to exeresis of the cysts and 2 patients with total blockage of the spinal canal underwent surgery for diagnosis. The 2 remaining patients with arachnoiditis and blockge of the spinal canal were clinically treated. All of the six patients submitted to cyst exeresis had initial improvement but 4 of them later developed arachnoiditis and recurrence of the clinical signs and only 2 remained well for long-term. The 2 non operated patients had no improvement of their clinical signs. Two patients died later due to complications of cerebral cysticercosis. Based on the experience acquired in the management of these patients we indicate surgical treatment for patients that present free cyst in subarachnoid space. For those who present arachnoiditis, surgery is indicated only when there is doubt in the diagnosis. Intramedullary cysts should also be surgically treated