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J M Cabezudo

Publications and source records attributed to J M Cabezudo.

At least 19 recordsLinked to original sources
PubMed2006

[Pyogenic brain abscesses: experience with 60 consecutive cases].

INTRODUCTION: Brain abscess is a focal suppurative process in the brain parenchyma that still carries high mortality rates. Outcome is closely related with a correct and early management. In order to evaluate this management we have reviewed the brain abscesses treated in our Department during the last 14 years. MATERIAL AND METHODS: The authors present a retrospective series of 60 consecutive patients with pyogenic brain abscess treated between January of 1990 and February of 2004 paying attention to the epidemiology, etiology, clinical data, microbiology, treatment modalities and outcome. RESULTS: The male to female rate was 5.6 to 1. The average age was 47 years. Hematogenous spread was most frequent, followed by contiguous spread. In 22% of the cases, the origin was unknown. Regarding the causative pathogens, Gram positive cocci are the most frequent (44%), with a 40% incidence of anaerobics. A mixed infection occurred in 39% of the abscesses. Three modalities of treatment were used: non surgical, catheter drainage-aspiration and surgical excision. Outcome was excellent in 52 patients (86.7%) and 4 patients (6.7%) died. Although outcome was similar in both surgical modalities, drainage-aspiration required a second procedure in 20% of the cases while this was necessary in only 10% of the patients with abscess excision. Length of admission was shorter in the drainage-aspiration group than in the excision group (13 and 26 days respectively). Mortality was higher in patients with low level of consciousness and age over 70 years. CONCLUSIONS: The shorter admission time associated with drainage-aspiration of brain abscesses together with its high efficacy and low morbidity suggests that drainage-aspiration should be used as the first mode of treatment.

Adolescent↗
PubMed2006

[Bilateral pure T11-T12 facet dislocation without neurologic residual deficit].

Bilateral pure facets dislocation in the thoracic spine is rare, but when it does occur in almost every instance produces a severe spinal cord lesion. It is thought to be caused by a flexion distraction mechanisms in most of the cases. A case is presented of a male suffered a polytrauma with important thoracic, abdominal, and esqueletic injuries in a car accident. The patient was in a hospital during two weeks, and one month after the trauma a bilateral pure dislocation of T11-T12 facets was diagnosed. Diagnosis was made with radiographs and CT with sagittal reconstruction. After an open reduction and fixation, recovery was complete within the first postoperative week. Facet dislocation in the thoracic spine is associated in many cases with thoracic and abdominal injuries that worsen the clinical picture, and thus it may contribute to misdiagnosis of the facet dislocation, specially in the cases with no neurological symptoms, adding a risk of secondary spinal cord damage. High-resolution CT with sagittal reconstruction provides an adequate and rapid demonstration of the luxation and associated thoraco-abdominal damages. Facet dislocation are unstable injuries that require open reduction and fixation. Recovery of patients with incomplete lesions is frequent, however, recovery from complete lesions did not occur.

Humans↗
PubMed2006

[Calcified disc herniation in childhood].

Calcification of intervertebral discs is a rare occurrence in children. Although the etiology of the calcification remains uncertain, it is no related with degenerative diseases. The clinical picture is non specific with neck pain, muscle contractures and, sometimes, low-grade fever. These symptoms generally disappear spontaneously, and surgery rarely becomes necessary. In our review of the literature, we have found only seventeen cases requiring surgical management. Two of these children had been previously diagnosed with calcified intervertebral discs, but at the time no herniation had been ruled out with magnetic resonance imaging (MRI). We report the case of a girl who was diagnosed, when she was ten years old, with intervertebral idiopatic calcifications. Four years later she presented with radiculopathy caused by the posterolateral displacement of a calcified cervical disc, which required operative management. We think that this case supports the theory of Heinrich et al. that considers that the calcified hernia is a complication of a previous pathology, namely intervertebral calcification. Clinical and therapeutic aspects of this entity are discussed.

Adolescent↗
PubMed2005

Anterior cervical osteophyte causing dysphagia as a complication of laminectomy.

Asymptomatic osteophytes of the anterior margins of the cervical vertebral bodies (VB) may occur in 20 - 30% of the population. On rare occasions, dysphagia or dyspnoea may be caused by such cervical osteophytes. We present the case of a 27-year-old woman with progressive dysphagia caused by a voluminous osteophyte secondary to chronic cervical instability after a laminectomy performed 8 years before. Progressive growth of the osteophyte was observed in sequential roentgenograms. As far as we know, this complication of cervical laminectomy has never been reported before. After resection of the osteophyte and arthrodesis of the affected segment the patient was cured.

Adult↗
PubMed2005

Brucellar spinal epidural abscesses. Analysis of eleven cases.

Brucellar spinal epidural abscesses (BSEA) are rare and very few series of them have been reported. In order to evaluate the clinical characteristics, management and outcome of this entity, the clinical records and current status of a series of 11 patients have been retrospectively reviewed. A series of 11 patients treated for BSEA in our Service during a period of 12 years (1989-2000) have been retrospectively studied. Spinal epidural abscesses (SEA) were diagnosed by MRI, CT or at surgery. Brucellar aetiology of SEA was considered when seroagglutination tests were positive at a titre of 1/160 or higher, and/or Brucella spp. were isolated in the blood or sample cultures. Ten of the 11 cases were treated with rifampicin plus doxycycline and in the remaining patient streptomycin was added because of a poor initial response. Six patients underwent surgical decompression and debridement of the SEA. Outcome was excellent in nine cases and good in two. There was no mortality and only one patient recovered incompletely from preadmission neurological deficits. Although BSEA is considered to be an unusual complication of spondylitis, our findings show that in some cases it can follow direct haematogenous spread to the extradural space. Surgical treatment must be undertaken when major neurological deficits are present. If antibiotic treatment is chosen as the initial therapy, the possibility of sudden neurological deterioration must be taken into account. Contrary to the high morbi-mortality rates reported in pyogenic or tuberculous SEA, BSEA has a good prognosis with early diagnosis and appropriate management.

Adolescent↗
PubMed2004

[Anterior cervical interbody fusion with treathed cylindrical bone versus bak-cace: a comparative study].

The authors conducted a prospective and randomized study in 44 consecutive patients requiring cervical interbody fusion following anterior cervical discectomy to compare the efficacy of heterologous threaded cylindrical bone (Unilab Surgibone) versus titanium implant (Bak-C; Spine-Tech, Minneapolis ). The patients were evaluated between two and five years postoperatively and the objectives of the study were to assess the potential differences in implant shifting, interespace collapse, angulation, maintenance of cervical alignment and lordosis, and clinical and radiographic fusion success rates between the two fusion substrates. Clinical results were satisfactory with both types of implant. However the threaded cylindrical titanium implant was found to be superior to the heterologous threaded cylindrical bone as an interbody substrate after single -and multiple- level anterior cervical decompression procedures with respect to maintenance of cervical interspace height, interspace angulation and radiographic fusion success rates.

Adult↗
PubMed2004

Candida albicans spondylodiscitis.

Candida spondylodiscitis is a rare complication of a haematogenous dissemination of a candida infection, that usually affects immunocompromised patients. We present a case of a Candida albicans spondylodiscitis in a patient in whom a bacterial origin was suspected because of the antecedent of a Staphylococcus aureus bacteriaemia. After unfavourable evolution with initial antibiotic treatment, the correct diagnosis was reached after culture of the material obtained from surgical debridement. The clinical, diagnostic features, and the literature are reviewed.

Aged↗
PubMed2004

[Contralateral extradural hematoma during evacuation of a previous one].

The development of an extradural hematoma during the evacuation of a traumatic extracerebral hematoma is a very rare event. It occurs in patients with a severe head injury that present with both an extraaxial hematoma and a contralateral skull fracture. Recognition of the significance of a sudden increase in the cerebral tension after hematoma evacuation is the key for a pront diagnosis of the development of a contralateral lesion. We present the case of a patient with a severe head trauma and an extradural hematoma who developed a contralateral extradural hematoma during evacuation of the initial one. The development of a contralateral lesion was suspected by a sudden and unexpected increase in cerebral tension during evacuation of the first hematoma and confirmed by emergency CT scan. We think that the most important pathogenetic mechanisms involved in the development of a contralateral extradural hematoma are the rapid fall of intracranial pressure, the loss of tamponade effect achieved by the energetic use of antiedema measures and the evacuation of the ipsilateral hematoma.

Adult↗
PubMed2003

[Isolated oculomotor palsy. An unusual presentation of chronic subural hematoma].

Isolated oculomotor palsy is an unusual symptom in chronic subdural hematomas and it is very rare as initial manifestation. We report a patient with a chronic subdural hematoma that presented with a complete third nerve palsy and normal consciousness. Complete recovery was achieved after surgical evacuation. Rebleeding within the hematoma cavity, most possibly favored by antiaggregating agents, was considered responsible for this rare presentation. In these cases expeditious surgical evacuation is indicated.

Chronic Disease↗
PubMed2003

Solitary eosinophilic granuloma of the cervicothoracic junction causing neurological deficit.

We report a case of spinal eosinophilic granuloma with aggressive course. Initially, a conservative management was decided upon, but neurological deterioration of the patient prompted us to undertake a more aggressive attitude, with surgical excision and postoperative radiotherapy. The clinical and radiological features, and the different options of treatment are discussed, and the literature is reviewed.

Cervical Vertebrae↗
PubMed2002

[Rapid spontaneous resolution of acute subdural hematoma].

Acute subdural hematomas are usually neurosurgical emergencies, although a conservative therapy is indicated in selected cases. In some of these patients a progressive resolution is appreciated. However, rapid spontaneous resolution of an acute suddural hematoma is seldom reported. A patient with antecedent of chronic alcoholism and spontaneous resolution of acute subdural hematoma in less than 18 hours after the head injury is described. The possible mechanisms of this rapid resolution are discussed. A tear in the arachnoid with spilling of CSF into the subdural space and the effect of intracranial antihypertensive measures together with cerebral atrophy, are factors that possibly contribute to dilution and redistribution of blood with hematoma disappearing in CT scan.

Atrophy↗
PubMed2001

Delayed pneumocephalus in shunted patients. Report of three cases and review of the literature.

Delayed pneumocephalus is a very rare complication of CSF shunt systems with only 37 cases so far reported. We report three additional cases with different mechanisms of production, clinical presentations and managements. While the first patient was treated with closure of the site of air entrance and shunt externalization, in the second case, modification of the shunt was enough to solve the pneumocephalus, even when a skull base fistula was suspected. The third one died during treatment from complications. The literature is reviewed with respect to the aetiology, clinical presentation, radiological findings and management of this problem.

Adolescent↗
PubMed2001

Cord compression secondary to cervical disc herniation associated with calcification of the ligamentum flavum: case report.

OBJECTIVE AND IMPORTANCE: Calcification of the ligamentum flavum is a rare disease that occurs almost exclusively in elderly Japanese people. We report the case of a young Caucasian woman who presented with a C5-C6 disc herniation associated with a cervical calcified ligamentum flavum. CLINICAL PRESENTATION: The patient presented with a cord compression syndrome of 76 hours' evolution. At exploration, a Brown-Sequard syndrome at the C6 level was found. Magnetic resonance imaging and computed tomography led to a correct diagnosis and planning for decompression. INTERVENTION: We operated on the patient through a combined anterior and posterior approach. After the patient underwent anterior discectomy with intersomatic arthrodesis, we performed posterior decompression. During the operation, we observed that the dura mater could not be separated from the ligamentum, so an en bloc excision of both structures was performed. Microscopic examination indicated that the excised ligamentum had calcification, and total integration of the dura mater into the structure of the ligamentum was demonstrated. To our knowledge, this circumstance has never been described before. A posterior C3-C7 arthrodesis was performed to prevent postoperative kyphosis. Recovery was successful, with total recovery from neurological deficits 4 months later. CONCLUSION: Calcification of the ligamentum flavum is a progressive disease that starts early in life and becomes symptomatic later in life when spinal stenosis occurs. Magnetic resonance imaging and computed tomography provide adequate diagnosis and allow proper surgical planning for decompression. The presence of hyperintense areas within the spinal cord parenchyma, in the absence of a traumatic antecedent, does not preclude a complete recovery.

Adult↗
PubMed1999

Traumatic aneurysm of the superficial temporal artery as a complication of pin-type head-holder device. Case report.

BACKGROUND: Despite the widespread use of pin head-holder devices in neurosurgical procedures, associated complications are relatively infrequent and usually minor. Inadvertent puncture of a major scalp vessel is one of these complications. Usually it is not problematic but the injured vessel may develop a traumatic aneurysm with subsequent rupture. CASE DESCRIPTION: We report the case of a 51-year-old man who underwent a left pterional craniotomy for intracranial aneurysm surgery. The head was fixed with the Sugita pin head-holder. Three weeks after discharge, the patient returned to the hospital after an enlarging and pulsatile mass in his left temporal region in one of the pin puncture wounds ruptured and bled. The angiogram revealed a traumatic aneurysm of the superficial temporal artery, which was ligated and excised. CONCLUSION: The Sugita multipurpose head frame is one of the head-holders most frequently used in neurosurgical procedures. It provides some advantages over other pin head-holders, but its sharp point pins in addition to a rotational fixing mechanism instead of simple pressure might increase the risk of scalp vessel injury. A traumatic aneurysm should be suspected when a pulsating scalp mass develops in a patient who has recently undergone a surgical procedure with his head fixed in a pin head-holder device. Physicians must be aware of this possibility when considering the diagnosis of a temporal mass to avoid unexpected hemorrhage at the time of surgery.

Craniotomy↗
PubMed1993

Inadvertent intraspinal placement of a Foley catheter in severe craniofacial injury with associated atlanto-occipital dislocation: case report.

A case of fatal, inadvertent, intraspinal placement of a Foley urinary catheter is presented. The patient suffered a severe craniofacial injury with life-threatening epistaxis requiring emergent tamponade with two Foley catheters plus gauze packing. There was an associated atlanto-occipital dislocation. The mechanism of production is discussed, and guidelines to avoid this complication are outlined.

Adult↗
PubMed1992

Focal dystonia secondary to cavernous angioma of the basal ganglia: case report and review of the literature.

The case of a young woman with focal dystonia of the hand due to a cavernous angioma of the basal ganglia is presented. The lesion involved the anterior third of the lentiform nucleus and a large portion of white matter anterior to this nucleus and lateral to the head of the caudate, as shown by magnetic resonance imaging; it was completely removed through a computed tomography-assisted stereotactic craniotomy by microsurgical technique, resulting in the cure of the patient. These facts support the pathophysiological hypothesis of a disruption of the striatopallidothalamic projection to the premotor cortex as the cause of symptomatic dystonia. A review of the reported cases of cavernous angiomas of the deep cerebral gray nuclei shows that this is the first case of cavernous angioma associated with movement disorder.

Adult↗