Resumen: El ataque cerebrovascular (ACV) agudo es la segunda causa de muerte en el mundo y genera costos elevados en su tratamiento y recuperación, así como un gran impacto socioeconómico, pues es la principal causa de discapacidad a largo plazo. Si bien la tomografía axial computarizada (TAC) cerebral simple sigue siendo la imagen recomendada por las guías internacionales para la evaluación inicial y toma de decisiones sobre el manejo del paciente con sospecha de ACV, en los últimos años ha habido extraordinarios avances en el diagnóstico oportuno y temprano del ACV con nuevas herramientas que van desde la estandarización de la angiotomografía cerebral como uno de los estudios principales en el enfoque inicial hasta el uso de técnicas de perfusión por tomografía y resonancia magnética (RM) cerebral, que permiten establecer el núcleo del infarto y el área circundante potencialmente salvable, por lo que es posible ofrecer terapias que brindan al paciente funcionalidad y calidad de vida a mediano y largo plazo. Teniendo en cuenta lo anterior, es vital actualizar los métodos diagnósticos actuales disponibles en el país y las distintas terapias disponibles, según sea el caso de cada paciente, para el ACV isquémico agudo, con un enfoque clínico práctico y aplicable al escenario actual de salud en Colombia.
Reversible cerebral vasoconstriction syndrome (RCVS) is characterised by severe thunderclap headaches (with or without the presence of acute neurological symptoms) and segmental vasoconstriction of cerebral arteries that resolves spontaneously in a period of three months. Cases have been described in the literature with producing and non-producing masses of metanephrines. Within these reports, associations with cavernous haemangioma, medulloblastoma, colon cancer, paraganglioma, pheochromocytoma, uterine fibroids, among others were found. However, no association with adrenal masses which do not produce metanephrines was found. In this context, we reported the case of a woman with this type of tumour associated with RCVS which provided a treatment challenge, as well as we reviewed the literature on cases of RCVS associated with masses.
RESUMENObjetivos: reportar el caso de un embarazo cervical (EC) que recibió manejo conservador exitoso y realizar una revisión de la literatura sobre el tratamiento médico y quirúrgico conservador. Materiales y métodos: se presenta el caso de una paciente con embarazo cervical, quien recibió manejo farmacológico con metotrexate (MTX) y posterior legrado con evolución clínica satisfactoria. Se realizó una búsqueda de artículos en Medline vía PubMed, LILACS, SciElo y Google académico con los términos: "cervical ectopic pregnancy", "conservative treatment", "curettage", "methotrexate", ABSTRACT Objectives: To report a case of cervical pregnancy (CP) treated successfully with a conservative approach, and to conduct a review of the literature regarding conservative medical and surgical treatment. Materials and Methods: Patient with cervical pregnancy treated pharmacologically with methotrexate (MTX) followed by dilation and curettage, with a satisfactory clinical course. A search of articles was conducted in Medline via PubMed, LILACS, SciElo and Google Scholar using the terms "cervical ectopic pregnancy," "conservative treatment," "curettage,» "methotrexate," "uterine artery embolization," "hysteroscopy." Reports and case series were selected of patients with cervical pregnancy diagnosed on ultrasound at any gestational age, subjected to conservative medical or surgical treatment. Results: A total of 22 studies were included; 95 patients with CP treated with MTX were identified, 93 of them successfully treated. The most frequent complication was bleeding in 12%; 26% required complementary surgical treatment. Increasingly, uterine artery embolization (UAE) is carried out preventatively (7 cases) before curettage or treatment with MTX. The hysteroscopy is another recent alternative (20 cases). Abdominal hysterectomy was required in two cases, one of which was a cervico-isthmic pregnancy. Conclusions:Treatment with MTX continues to be the most frequent strategy. Dilation and curettage with endocervical plugging may be an option to consider in the emergency management of EP in primary care institutions. In institutions equipped with high complexity technology, uterine artery embolization before the surgical procedure and histeroscopy are options to be considered. Considering that early diagnosis of EP is now possible, multi-center studies comparing different management options are needed for better assessment of their safety and effectiveness.
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