Alfonso Pacheco-Hernandez

Antithrombotic Therapy in Chronic Subdural Hematoma: Solving the Dilemma

LETTER: We read with interest the article “Resumption of Antithrombotic Agents in Chronic Subdural Hematoma: Systematic Review and Meta-analysis” published recently in WORLD NEUROSURGERY. Chronic subdural hematoma (CSDH) is one of the most frequent neurologic pathologies with an incidence of 3.4 per 100,000 inhabitants younger than 65 years of age and 8e58 per 100,000 in adults older than 65 years old. Chronic subdural hematoma is more common in males; people at risk of falling; and those with a history of seizures, alcohol abuse, or coagulation disorders who take medications to treat such conditions. CSDH begins with the formation of acute hematomas, which can spontaneously resolve or increase in size and continue to grow, causing rupture of small veins as they expand, further increasing the amount of blood. Phan et al present a meta-analysis that evaluates the lack of information regarding restarting antithrombotic therapy after surgery for CSDH. Interestingly, they found no relationship between the initiation of antithrombotic therapy and the rate of hemorrhagic and thromboembolic complications.

Intradural spinal neurocysticercosis: case illustration

Abstract Introduction: Neurocysticercosis (NCC) is a common parasitic infection of the central nervous system caused by the larvae of the Taenia solium. Spinal cord involvement is very uncommon. Clinical case: A female patient with a history of NCC presented with chronic and recurrent headache associated with motor and sensory deficit, which develops tonic-clonic convulsion, with spatial disorientation. She also had intracranial hypertension syndrome, meningitis syndrome, and pyramidal sygns suggestive of spinal NCC. Conclusions: Neurocysticercosis usually occurs in developing countries and should be considered as a differential diagnosis of neurological diseases. Early diagnosis and treatment are mandatory, as well as education to the community to primary prevention.

Intracranial foreign body in a child

Abstract Intracranial foreign bodies are rare events that occur accidentally and depending on the extent and involvement of the brain parenchymal, generate focal neurological deficit, bleeding and even long-term complications. In present article we describe a case of 4 year child and discuss the approach, management and prognosis.

Management of subdural chronic hematoma in Colombia: national survey

Abstract 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.

Intracranial actinomycosis: case report and review of literature

Abstract Actinomycosis infection is a slow progressing disease, in which involvment of the central nervous system by Actinomyces israelii is uncommon (less than 5%). Clinical picture is non-specific and is often misdiagnosed with neoplasia; some clinical clues my arise suspicion. The case of a 59 year-old female is reported who presented headache and focal neurologic signs and in whom a out-of the hospital diagnosis of a neuroepitelial dysembryoplastic tumor was made; nonetheless after careful interview and physical exploration, a spectroscopy magnetic resonance of the brain and hystopathological description of the lesion was made and yielded the definitive diagnosis of intracranial actinomyces infection. Treatment and progression were uneventful.

Intradiploic pterional epidermoid tumor: A case report and review of literature

Intradiploic epidermoid cyst is an uncommonly occurring neoplasm, and only about 200 cases are reported in the form of isolated case report. It is presumed to occur due to ectodermal cells in inclusion in the bone tissue during embryonic life neural tube closure. It commonly remains asymptomatic or rarely presents as a bony lump in the skull bone. Authors report present an interesting case, which presented with swelling, and underwent successful surgical resection. Pertinent literature along with diagnosis and management is briefly reviewed. These lesions can erode the bone and involve the brain parenchyma due to their proximity to the brain. Radiological imaging is very helpful in accurate diagnosis of these lesions and in differentiating intradural from intradiploic varieties of epidermoid. We present an unusual case of this pathology.