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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se han analizado en este estudio los factores pron&#243;sticos de 48 pacientes en edad pedi&#225;trica&#44; consecutivos y no seleccionados&#44; afectos de una lesi&#243;n encef&#225;lica difusa a ra&#237;z de un traumatismo craneoencef&#225;lico grave&#44; en cuya producci&#243;n intervinieron mecanismos din&#225;micos de aceleraci&#243;n-desaceleraci&#243;n&#46; Todos los pacientes presentaron un estado de coma de impacto&#44; valorado con una puntuaci&#243;n inferior o igual a 8 en la escala de Glasgow y no se observ&#243; en la Tomograf&#237;a computerizada cerebral &#40;TC cerebral&#41; ninguna lesi&#243;n intracraneal traum&#225;tica aguda ocupante de espacio&#46; Se estableci&#243; un protocolo de estudio que inclu&#237;a&#58; los datos obtenidos de la exploraci&#243;n cl&#237;nica y neurol&#243;gica&#44; la radiolog&#237;a simple&#44; la tomograf&#237;a computerizada&#44; la monitorizaci&#243;n de la presi&#243;n intracraneal y los potenciales evocados auditivos del tronco del enc&#233;falo&#46; Los resultados fueron evaluados al alta y a los seis meses&#44; no pudiendo ser valorados dos pacientes supervivientes en este &#250;ltimo per&#237;odo&#46; Los pacientes sobrevivientes fueron 37 &#40;77&#46;1&#37;&#41; Y11 &#40;22&#46;9&#37;&#41; fallecieron&#46; De los que sobrevivieron&#44; s&#243;lo 35 pudieron ser evaluados a los seis meses presentando los siguientes resultados cl&#237;nicos&#58; 29 &#40;63&#46;1&#37;&#41; presentaron una buena recuperaci&#243;n y 6 &#40;13&#46;0&#37;&#41; una moderada incapacidad&#44; es decir que todos los pacientes presentaron un buen resultado a los seis meses&#46; Los datos cl&#237;nicos obtenidos con mayor capacidad pron&#243;stica fueron&#58; la puntuaci&#243;n inicial global de la escala de Glasgow&#59; la puntuaci&#243;n inicial aislada de la respuesta motora&#44; tambi&#233;n seg&#250;n la valoraci&#243;n de la escala de Glasgow&#59; la presencia de midriasis y anisocoria y la respuesta alterada de los reflejos fotomotor y corneal&#46; La ausencia de cisternas basales y&#47;o del III ventr&#237;culo y la observaci&#243;n de hemorragia subaracnoidea han sido los factores pron&#243;stico que ha proporcionado la TC cerebral inicial&#46; En los pacientes supervivientes&#44; la presencia de signos de atrofia cerebral ha sido un indicador de un menor grado de recuperaci&#243;n neurol&#243;gica en estos ni&#241;os&#46; La hipertensi&#243;n endocraneal ha conllevado tambi&#233;n un peor pron&#243;stico en estos pacientes&#46; Por &#250;ltimo&#44; se ha efectuado un an&#225;lisis multivariable de los factores comunes a toda la serie obteniendo una mayor capacidad predictiva la presencia de midriasis y la visualizaci&#243;n de las cisternas basales y&#47;o del III ventr&#237;culo&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A series of 48 consecutive&#44; non selected children &#40;below 15 years-of age&#41; with severe head injury &#40;initial Glasgow coma score &#60; 8&#41; and showing diffuse brain injury in the computerized tomography &#40;CT&#41; scan are studied and the prognostic factors analyzed&#46; Mechanisms of acceleration were implicated in all cases&#46; Clinical data&#44; CT signs and intracranial pressure have been analyzed&#46; Eleven patients &#40;23&#37;&#41; died and 37 survived&#46; After six months of head injury 29 &#40;63&#37;&#41; of the patients made a good recovery and 6 &#40;13&#37;&#41; presented moderate disability&#46; Two patients could not be evaluated&#46; Of the neurological data at admission&#44; the following prognostic factors were seen to have significant value&#58; the initial Glasgow coma score&#44; initial motor response&#44; mydriasis&#44; anisocoria&#44; and an abnormal pupillary and corneal reflex&#46; Our findings in the CT scan indicate that compression of basal cisterns and&#47;or the III ventricle and the presence of subarachnoid hemorrhage are strong predictors of mortality&#46; Increased ventricular size and enlarged cortical sulci associated with a poorer neurological recovery&#46; Increased intracranial pressure is also a strong predictor of death&#46; By using a multivariate statistical analysis&#44; we observed that mydriasis and compression of basal cisterns and&#47;or the III ventricle are the more significant predictors of poor outcome&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Bosch Blancafort&#44; J&#46;&#59; Rubio Garc&#237;a&#44; E&#46;&#59; Iglesias Berenguer&#44; J&#46;&#59; Poch Puig&#44; J&#46;M&#46;&#59; Nogu&#233;s Bara&#44; P&#46;&#58;Factores pron&#243;sticos en el coma postraum&#225;tico infantil secundario a lesi&#243;n encef&#225;lica difusa&#46; Neurocirug&#237;a 1994&#59; 5&#58; 211&#8211;220&#46;</p>"
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Vol. 5. Núm. 3.
Páginas 211-220 (enero 1993)
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Vol. 5. Núm. 3.
Páginas 211-220 (enero 1993)
Factores pronósticos en el coma postraumático infantil secundario a lesión encefálica difusa
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J. Bosch Blancafort, E. Rubio García, J.M. Poch Puig, P. Nogués Bara
Servicio de Neurocirugía. Hospital Universitario Materno-Infantil Vall d'Hebrón. Universidad Autónoma. Barcelona
J. Iglesias Berenguer*
* Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario Materno-Infantil Vall d'Hebrón. Universidad Autónoma. Barcelona
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Resumen

Se han analizado en este estudio los factores pronósticos de 48 pacientes en edad pediátrica, consecutivos y no seleccionados, afectos de una lesión encefálica difusa a raíz de un traumatismo craneoencefálico grave, en cuya producción intervinieron mecanismos dinámicos de aceleración-desaceleración. Todos los pacientes presentaron un estado de coma de impacto, valorado con una puntuación inferior o igual a 8 en la escala de Glasgow y no se observó en la Tomografía computerizada cerebral (TC cerebral) ninguna lesión intracraneal traumática aguda ocupante de espacio. Se estableció un protocolo de estudio que incluía: los datos obtenidos de la exploración clínica y neurológica, la radiología simple, la tomografía computerizada, la monitorización de la presión intracraneal y los potenciales evocados auditivos del tronco del encéfalo. Los resultados fueron evaluados al alta y a los seis meses, no pudiendo ser valorados dos pacientes supervivientes en este último período. Los pacientes sobrevivientes fueron 37 (77.1%) Y11 (22.9%) fallecieron. De los que sobrevivieron, sólo 35 pudieron ser evaluados a los seis meses presentando los siguientes resultados clínicos: 29 (63.1%) presentaron una buena recuperación y 6 (13.0%) una moderada incapacidad, es decir que todos los pacientes presentaron un buen resultado a los seis meses. Los datos clínicos obtenidos con mayor capacidad pronóstica fueron: la puntuación inicial global de la escala de Glasgow; la puntuación inicial aislada de la respuesta motora, también según la valoración de la escala de Glasgow; la presencia de midriasis y anisocoria y la respuesta alterada de los reflejos fotomotor y corneal. La ausencia de cisternas basales y/o del III ventrículo y la observación de hemorragia subaracnoidea han sido los factores pronóstico que ha proporcionado la TC cerebral inicial. En los pacientes supervivientes, la presencia de signos de atrofia cerebral ha sido un indicador de un menor grado de recuperación neurológica en estos niños. La hipertensión endocraneal ha conllevado también un peor pronóstico en estos pacientes. Por último, se ha efectuado un análisis multivariable de los factores comunes a toda la serie obteniendo una mayor capacidad predictiva la presencia de midriasis y la visualización de las cisternas basales y/o del III ventrículo.

Palabras clave:
Traumatismo craneoencefálico
Infancia
Lesión encefálica difusa
Presión intracraneal
Summary

A series of 48 consecutive, non selected children (below 15 years-of age) with severe head injury (initial Glasgow coma score < 8) and showing diffuse brain injury in the computerized tomography (CT) scan are studied and the prognostic factors analyzed. Mechanisms of acceleration were implicated in all cases. Clinical data, CT signs and intracranial pressure have been analyzed. Eleven patients (23%) died and 37 survived. After six months of head injury 29 (63%) of the patients made a good recovery and 6 (13%) presented moderate disability. Two patients could not be evaluated. Of the neurological data at admission, the following prognostic factors were seen to have significant value: the initial Glasgow coma score, initial motor response, mydriasis, anisocoria, and an abnormal pupillary and corneal reflex. Our findings in the CT scan indicate that compression of basal cisterns and/or the III ventricle and the presence of subarachnoid hemorrhage are strong predictors of mortality. Increased ventricular size and enlarged cortical sulci associated with a poorer neurological recovery. Increased intracranial pressure is also a strong predictor of death. By using a multivariate statistical analysis, we observed that mydriasis and compression of basal cisterns and/or the III ventricle are the more significant predictors of poor outcome.

Key words:
Head injury
Children
Diffuse brain injury
Intracranial pressure

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