Postraumatic pneumorrhachis: Report of three cases and classification proposal

The Pneumorrhachis is the presence of air at the level of the spinal canal. It can have several causes among which are: traumatic, iatrogenic among others. Clinical Cases: We present three cases of male patients handled by our neurosurgery service with traumatic pneumorrhachis patients, which were managed in a conservative manner, with control images. Conclusions: pneumorrhachis has traditionally been classified as internal if air is present in the subdural or subarachnoid space and external if the air is located at the epidural level. We propose a classification in degrees (Moscote-Agrawal-Padilla) which is more practical from the clinical and radiological point of view

Management of subdural chronic hematoma in Colombia: National survey

Chronic subdural hematoma is a growing neurological pathology, especially in older people. Thus, describing how this entity is approached in Colombia is of great importance because it allows to evaluate and contrast this approach with that of other countries, comparing the techniques used, therapeutic management and additional measures. In this study, this comparison was carried out using a self-administered survey with 16 multiple-choice items. The results were evaluated in Microsoft Excel, determining measures of central tendency accompanied by frequencies and percentages. As an initial management, 75.5% preferred to use 1Burr Hole and, in cases of recurrence, craniotomy is the choice in 50% of cases. Regarding the placement of drainage, its use was estimated to be 83.3%, especially the subdural system closed to external drainage, with a preference of 85.2%, and without use of corticosteroids as adjuvant therapy in 88.9 % of respondents. These data are consistent with the results of studies in other countries regarding the management of this pathology

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Cardiovascular complications associated with spinal cord injury

Spinal cord injury can lead to important functional, psychological and social sequelae. Despite the progress in medicine and greater understanding of the pathophysiological events associated with a traumatic spinal cord injury, spinal cord injury is still associated with a high morbidity and mortality. The involvement of the autonomic nervous system has implications in acute and chronic stages of the injured spinal cord patients. The most frequent cardiovascular complications in the acute phase of the traumatic spinal lesions are bradyarrhythmia, hypotension, increased vasovagal reflexes, ventricular and supraventricular ectopic beats, venous stasis, and vasodilation. In the chronic phase, we find orthostatic hypotension, alteration of the arterial pressure and the regulation of the body temperature as well as alteration of the blood volume. The knowledge of the cardiovascular alterations is of vital importance for the management and rehabilitation of the patients with spinal cord injury. In this article, we present a critical review of medical literature

Cranio-cervical bone hyperpneumatization: An overview and illustrative case

The pneumatization of regions such as the apex of the temporal crag, the mastoid cells and the perilaberytic region is considered physiological in adults. The process of craniocervical pneumatization in unhealthy adults derives from a dysfunction at the level of the eustachian tube, which provides a valve effect causing an increase in pressure at the level of the middle ear, forcing the entry of air into the dome of the skull through the opening of the occipitomastoidal suture. The process of standard pneumatization of the temporal bones, begins in the final weeks preceding birth, characterized by a decrease in the embryonic mesenchyme at the antrum level and progresses through childhood until adolescence, when the stone portion at the level of the rock is pneumatized; Normal variants have been reported, such as pneumatization that extends from the temporal scale to behind the sigmoid sinus. With regard to the process of hyperneumatization, several etiologies have been proposed that a congenital process versus an acquired process to develop this condition should be compared. The present illustrative case is a seventy-three years old male presented to the outpatient clinic with chronic recurrent occipital headache, already investigated by general practitioner for elevated blood pressure which was excluded. We had checked him to exclude the cervical spinal origin of the occipital headache which was then excluded too. This case scenario demonstrates the debate about how to deal with such cases and thus the review will bring the attention of those who take care of such radiological findings to keep in mind the possible causes and complications according to the reported cases till now. We concluded that the hyperpneumatization of the craniocervical junction is an uncommon radiological finding that is usually asymptomatic although it can entail serious complications in some instances, especially when it enlarges progressively, which may be due to an acquired process. Thus, craniocervical hyperpneumatization deserves highlighting for the managing team to gain fluent treatment and better patient outcome

Sacroiliac Pain: A Clinical Approach for the Neurosurgeon

Pain originating from sacroiliac joint may also cause pain in the lumbar and gluteal region in 15% of the population. The clinical manifestation represents a public health problem due to the great implications on the quality of life and health-related costs. However, this is a diagnosis that is usually ignored in the general clinical practice; probably because of the unknown etiology, making harder to rule out the potential etiologies of this pathology, or maybe because the clinical criteria that support this pathology are unknown. By describing several diagnostic techniques, many authors have studied the prevalence of this pathology, finding more positive data than expected; coming to the conclusion that even though there is no diagnostic gold standard yet, an important amount of cases might be detected by properly applying several tests at the physical examination. Thus, it is necessary to have knowledge of the physiopathology and clinical presentation so that diagnosis can be made to those patients that manifest this problem. We present a clinical approach for the neurosurgeon

Pharmacological potential of acetazolamide in traumatic intracranial hypertension

Traumatic brain injuries are an important cause of morbidity and mortality around the world. These types of lesions are often associated with increased intracranial pressure and cerebral edema, proper management of this can reduce tissue damage of the brain and improve brain perfusion. The use of acetazolamide is not indicated in guidelines for the management of intracranial hypertension, which is used to a great extent for the management of idiopathic intracranial hypertension. However, it is not yet known in the management of traumatic intracranial hypertension

Intracranial ricocheted-bullet injuries: An overview and illustrative case

The impact of a bullet by firearm is a mortal entity that in recent years has been on the rise due to the increase in crime, confrontations, among other acts of violence. Brain injuries by firearm account for 33.3% of all fatal injuries from this type of weapon. This resulted in a significant number of disabilities with its burden cost at a global level. The types of bullet injuries to the head include: penetrating (inlet without outlet), perforating (through and through), tangential (not enter the skull, causing coupe injury), ricochet (intracranial bouncing of bullet) and careening (rare, enter skull but not brain, runs in the subdural space). There are several situations that can occur once the bullet enters the body or into the intracranial cavity. Unmatched association of the bullet trajectory with the final position of the bullet within the body raise the suspicion for additional phenomena involvement, this can be explained by either internal bullet ricochet or internal bullet migration. The former usually represents an active movement and the latter is a passive movement. Intracranial ricocheting of bullets forms up to 25% of all penetrating bullet injuries to the skull. Such bullets types are commonly tumbling and have an unpredictable trajectory. The surgical management for intracranial bullet injury developed over decades from the time of Harvey Cushing and the World War I till the present. Now, the accepted intervention ranges from simple wound care to a proper surgery that includes hematoma evacuation, removal of only accessible bone fragments and foreign bodies, dural repair and wound debridement with or without decompressive craniectomy. Also, intracranial pressure monitoring is generally indicated. We reported a thirty-three years old male, victim of homicidal bullet injury to the head, presented with Glasgow Coma Scale score of 8 (best eye response: 2, best motor response: 4, best verbal response: 2), upon examination a right parietal (near vertex) inlet without outlet was found. The poor prognostic factors in this patient included bi-hemispheric involvement, associated acute subdural hematoma with interhemispheric extension, ricochet type of injury and effacement of sulci. Intracranial ricocheted-bullet injury is a special entity of bullet injury to the head with its particular ballistics and management that deserve highlighting by the trauma team to gain fluent treatment and better outcome

The prion-like properties of amyloid-beta peptide and tau: Is there any risk of transmitting alzheimer's disease during neurosurgical interventions?

Recent studies have recognized similarities between the peptides involved in the neuropathology of Alzheimer’s disease and prions. The Tau protein and the Amyloid β peptide represent the theoretical pillars of Alzheimer’s disease development. It is probable that there is a shared mechanism for the transmission of these substances and the prion diseases development; this presumption is based on the presentation of several cases of individuals without risk factors who developed dementia decades after a neurosurgical procedure. This article aims to present the role of Aβ and Tau, which underlie the pathophysiologic mechanisms involved in the AD and their similarities with the prion diseases infective mechanisms by means of the presentation of the available evidence at molecular (in-vitro), animal, and human levels that support the controversy on whether these diseases might be transmitted in neurosurgical interventions, which may constitute a wide public health issue