Eduardo Lamas

Observations on 82 patients with extradural hematoma

A consecutive, unselected series of 82 patients with epidural hematoma treated between 1973 and 1980 is presented. Forty-one patients were managed before the advent of computerized tomography (CT) and the other 41 after this neuroradiological method was available. Mortality and disability rates which were 29.2% and 31.7% during the pre-CT period decreased to 12.1% and 19.5%, respectively, with the aid of CT scanning. This technique allowed a more rapid and accurate diagnosis of the hematomas than angiography, and defined better the presence and the evolutional changes of the associated cerebral lesions. As a consequence, surgery has been more effectively planned and executed during the CT era.

Spinal Metastatic Disease: Analysis of Factors Determining Functional Prognosis and the Choice of Treatment

The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spinal metastases to determine the influence of factors such as tumor biology and topography, pretreatment neurological status, the presence of a myelographic block, the progression rate of symptoms, and the general medical condition of the patient on both the functional prognosis and the choice of treatment. Both life expectancy and the functional results after therapy are mainly dependent on tumor biology, which in turn determines radiosensitivity. The remaining factors seem to have only complementary predictive power. Because radiotherapy has been found to be as effective as operation plus radiotherapy in the management of the majority of patients with spinal metastases, it is very important to improve the selection of surgical candidates (less than 42% of the total cases) to prevent unnecessary surgery-related morbidity and mortality. Factors considered important in the selection of therapy are the location of the tumor within the spinal canal, the neurological status at the time of treatment, and the systemic condition of the patient.

Outcome in children with severe head injuries

We present a series of 56 children who suffered severe head injuries, with a Glasgow Coma Score (GCS) of less than 8. The cases were classified according to the type of morphologic lesion on computed tomography (CT) scan. Intracranial pressure (ICP) was monitored in all children in this series. A protocol that included artificial ventilation and other measures of treatment for intracranial hypertension was applied. Results were analyzed according to age, type of lesion, and ICP. The usefulness of the ICP recording and of obtaining a correct classification of lesions using the CT scan is emphasized.

Comparison of the Clinical Presentation of Symptomatic Arteriovenous Malformations (Angiographically Visualized) and Occult Vascular Malformations

The authors compared the clinical presentations of angiographically apparent arteriovenous malformations (AVMs) and angiographically occult vascular malformations (AOVMs) of the brain in 188 consecutive patients treated when computed tomography and magnetic resonance were available. There were 133 patients (70.7%) with AVMs and 55 patients (29.2%) with AOVMs. AOVMs tended to occur more frequently in male patients and in the posterior fossa and to present earlier clinically than AVMs, but differences were not significant. One distinctive feature was the greater size of AVMs, as compared with AOVMs. Presentation by hemorrhage occurred in 64.3% of the patients with AVMs and in 61.8% of those with AOVMs. Malformations of both types located in the posterior fossa presented with hemorrhage more frequently (84.2% of AVMs and 78.5% of AOVMs) than similar lesions lying above the tentorium (60.8% of AVMs and 56% of AOVMs). Bleeding was more severe in patients with AVMs than in those with AOVMs, as indicated by the higher mortality associated with hemorrhage (7.5 vs. 3.6% of the cases) and the more frequent and marked decrease in the level of consciousness observed at admission (34 vs. 16.2% of drowsy or comatose patients). Brain hematomas caused by AVMs were on average bigger than those caused by AOVMs (58.8 and 20% of large hematomas, respectively), and intraventricular and subarachnoid hemorrhages were also more common and profuse in patients with AVMs. However, AOVMs bled subsequently more times than AVMs (61.7 vs. 15.6%), before they were diagnosed and treated, leading to a higher nonoperative morbidity (16.3 vs. 13.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Epidural haematoma of the posterior fossa with delayed operation: Report of a “chronic” case

SummaryA case of chronic epidural haematoma of the posterior fossa is reported. The lesion was studied with cerebral angiography and computed tomography. The patient was under observation for two weeks before the extradural clot was. removed. The membrane surrounding the haematoma was examined histologically. The importance of computed tomography in the diagnosis of traumatic lesions of the posterior fossa is emphasized.

Extradural hemorrhage in the posterior fossa in neonates

The case of a neonate with an extradural hemorrhage in the left posterior fossa, the result of trauma at birth, is reported. The routine axial transverse CT scan did not detect the exact preoperative location of the clots in the extradural space of the posterior fossa. Good recovery was achieved following the operation.

Bilateral dural arteriovenous fistula in the region of the cavernous sinus

SummaryThe case of a patient with a fistula between the left internal carotid artery and the cavernous sinus, and another fistula between the right external carotid artery and the cavernous sinus, is reported. The clinical symptomatology, which was of spontaneous onset, was unilateral and consisted of exophthalmos and injection of the conjunctiva on the left side. Almost complete remission occurred after angiography.

Chronic adult hydrocephalus due to uncommon causes

SummaryThe authors report on four unusual cases of chronic adult hydrocephalus extracted from a large personal series of patients with hydrocephalic dementia. A syndrome resembling that of normal pressure hydrocephalus was due to the following aetiologies in these patients: Pagets disease of the skull, unruptured cerebral arteriovenous malformation, colloid cyst of the third ventricle, and cerebromeningeal cysticercosis. All these patients exhibited disturbances in cerebrospinal fluid dynamics at the time of study, and were considerably improved by CSF shunting. The value of the continuous CSF pressure monitoring and the constant infusion test in selecting patients with chronic hydrocephalus for shunt therapy is emphasized.

Hemorragia subaracnoidea aneurismática. Estudio de una serie clínica de 412 casos

Resumen Se analizan retrospectivamente 412 casos consecutivos de hemorragia subaracnoidea aneurismatica, tratados durante los anos 1974–1991. El 79% de los pacientes ingresaron en los tres primeros dias del sangrado. El 63% de los pacientes ingresaron en buen grado clinico (Botterell I y II). Se aprecio vasoespasmo angiografico en el 38% de los casos. Se intervinieron 336 pacientes (81,6%), la mayoria pasados siete dias. Del total de la serie fallecieron 132 pacientes (32%), 69 de estos (16,7%) despues de haber sido intervenidos. Las complicaciones que mas influyeron en la mortalidad fueron la isquemia cerebral y el resangrado. Apreciamos una estrecha correlacion entre el deposito de sangre cisternal, la aparicion de vasoespasmo angiografico y el desarrollo de isquemia cerebral, lo que apoya la teoria que imputa a la sangre, o a alguno de sus componentes o productos de degradacion un papel fundamental en la produccion de vasoespasmo. Es muy importante reconocer precozmente esta enfermedad con el fin de instaurar lo antes posible el tratamiento adecuado.

Hemorragia subaracnoidea idiopática. Estudio clínico de una serie de 258 casos

Resumen Se analizan retrospectivamente 258 casos consecutivos de hemorragia subaracnoidea idiopatica, tratados durante los anos 1974–1991; estos representan el 34% del total de hemorragias subaracnoideas diagnosticadas en el mismo periodo. Se discuten los datos clinicos y radiologicos de esta en entidad y se comparan con los de la hemorrragia subaracnoidea aneurismatica, comprobandose una menor incidencia de complicaciones neurologicas (isquemia 8% y resangrado 6%) y una mejor evolucion final (90,3% independientes y solo un 5,4% de mortalidad) que en los pacientes con aneurisma. Asimismo, se analiza la distribucion de sangre en las cisternas subaracnoideas, apreciandose una mayor afectacion de las cisternas peritruncales (interpeduncular y ambiens). Se desaconseja repetir el estudio angiografico si este es completo y de buena calidad, pudiendose repetir este si existe resangrado, si el grado clinico inicial es malo, si hubo vasoespasmo en el estudio angiografico, o si la TC al ingreso muestra una extensa distribucion de sangre por cisternas basales.