Indicadores clínico-radiológicos de valor pronóstico en la patología vascular cerebral

Abstract

Brain haemorrhagic stroke is a common cause of mortality and major functional disability in our population. Deepening our understanding of clinical course of these patients lets us offer realistic expectations to their families and a proper optimization of health resources. Furthermore, by knowing prognostic value indicators during the acute phase we are able to improve our treatment decision-making. In order to predict the outcome of these patients, this thesis by compendium of articles sets out to identify several clinical and neuroradiological prognostic variables that could be defined in cerebrovascular pathology. Our work is focused on the two most common diseases in which vascular neurosurgeons are involved: aneurysmal subarachnoid haemorrhage and cerebral arteriovenous malformations (AVM). This compendium is based on four published papers, three of which were written from a neurosurgical twenty-years database at Vall d'Hebron Hospital and the fourth in collaboration with the University of California SFO. Regarding subarachnoid haemorrhage, we considered several clinical and neuroradiological variables that could help us to predict functional outcome in a rheumatological disease such as systemic lupus erythematous. Secondly, we investigated outcomes of patients who concomitantly had a subdural hematoma. Moreover, our study into AVMs was focused on whether AVMs intraoperative rupture could be related to a negative final outcome. We also analysed variables that predispose patients to this complication. In the last article we evaluated the clinical course of patients who showed an unusual subtype of arteriovenous malformation such as those located anatomically in the cerebral posterior fossa. Results of our work describe three new clinical patterns in systemic lupus erythematous not previously reported in the literature. In addition, these patients show a worse clinical outcome compared with simple subarachnoid haemorrhage. Furthermore, the presence of a radiological predictor as a subdural hematoma in coma patients does not seem to correlate to a negative functional outcome. AVMs Intraoperative rupture negatively impacts patient’s prognosis; we claim three common causes for this severe complication. Finally, our reviews of malformations anatomically located in posterior fossa strongly confirm a higher risk of bleeding and hydrocephalus. We find that unless the high first day’s mortality ratio in posterior fossa AVMs, survivors achieve a reasonably good long-term outcome.

Date of Award	16 Oct 2015
Original language	Spanish
Supervisor	Joan Sahuquillo Barris (Director)