Cerebral vasoconstriction syndrome from a subdural empiema. Case report and bibliographical review.

Solapas principales

Jaume A.1, Negrotto M.2, Romero M.1, Aramburu I.1, Bentancourt V.1, Algorta M.1, Costa G.1

 

ABSTRACT

            Subdural empyema accounts for 10-25% of all intracranial infections, with a mortality rate of approximately 10%. In turn, it can add venous complications such as thrombosis and infarcts, as well as less frequently cerebral vasoconstriction or vasospasm associated to inflammation.

First, a clinical case of a patient who was assisted at Pereira Rossell Hospital, where a subdural empyema is studied and operated on, having as a complication vasospasm, requiring endovascular treatment with intra-arterial nimodipine. From this illustrative clinical case an update was made on this pathology.

subdural empyema is a serious complication that has an incidence of 1-5.8 cases per million inhabitants. The clinic is non-specific. The diagnosis is imaging, with the RNM being the gold standart study. The treatment of choice is surgical, supplemented with an antibiotic plan. The arterial vascular complication is rare and may be due to: vasculitis, vasospasm, or hypercoagulable state with endothelial dysfunction. Vasospasm is a potentially preventable and treatable cause of cerebral ischemia. The gold standard study for this pathology is cerebral arteriography. The treatment of vasospasm is medical and endovascular, knowing that an effective and definitive treatment of this pathology has not yet been achieved.

Subdural empyema is a rare pathology but with high morbidity and mortality. It is important quick and timely diagnosis, to achieve effective treatment and prevent complications that result in disabling sequelae.

 

Key Words: Subdural empyema, vasospasm, hypoperfusion, nimodipine, surgery.

 


  1. Servicio de Neurocirugía, Hospital Pereira Rossell, ASSE, Uruguay
  1. Servicio de Imagenología Hospital de Clínicas, Montevideo. Universidad de la República. Uruguay

 

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