Subacute subdural hematomas are a poorly individualized nosological entity, often equated clinically to chronic subdural hematomas. Yet, their neurological deterioration which is usually rapid seems to distinguish them from chronic subdural hematomas. We wanted to show this dangerousness by establishing the clinically evolving profile of the three types of subdural hematomas. This was a prospective and retrospective study of 63 subdural hematoma (18 acute, 13 subacute, and 32 chronic) patients admitted between 2012 and 2014 in the neurosurgery unit of Lomé University Hospital. Hematomas were classified according to the elapsed time after head injury and blood density on CT. The main parameter studied was the evolution of the Glasgow Coma Score (GCS) in the 3 months following the trauma, enabling to establish an evolving profile of each type of hematoma. The average age of patients was 58.1 years for chronic subdural hematomas and 47.6 years for subacute subdural hematomas. Disease duration before admission was 13.1 days for chronic against 36.6 h for subacute hematoma. The clinical profile shows acute worsening within hours during the second week for patients with subacute hematoma, while it is progressive for patients with chronic hematoma. We noted two deaths, all victims of a subacute hematoma (one operated, one patient waiting for surgery). Iso-density hematoma on CT, especially in a young person, must be considered as a predictive factor of rapid neurological aggravation suggesting an urgent care or increased monitoring by paramedics.
L’objectif était de relever les aspects anesthésiologiques et les complications périopératoires des méningiomes intracrâniens opérés au CHU Sylvanus Olympio de Lomé (CHU SO). Il s’agissait d’une étude rétrospective sur dossiers de patients opérés de méningiomes intracrâniens durant la période de Décembre 2010 à décembre 2015 (5 ans) au CHU SO. 21 (45,6%) méningiomes recensés sur 46 tumeurs cérébrales opérées. Age moyen: 49 ± 20 ans; prédominance masculine (52,4%), ratio M/F: 1,1. Classification ASA: ASA II: 16 patients, ASA III: 4 patients, et ASA IV: 1 patient. L’anesthésie a été intraveineuse totale avec du Propofol (100%) comme hypnotique et du fentanyl (76,2%) comme morphinique le plus disponible. Complications peropératoires: saignement, pertes sanguines moyennes: 1750 ± 584 ml; hypotension avec Pression artérielle moyenne (PAM) < 60 mmHg: 10 (47,6%) patients; choc hémorragique 2 (9,5%) patients, arrêt cardiocirculatoire: 01(4,7%) patient réanimé avec succès. Complications postopératoires: convulsions 5 (23,8%) cas, hyperthermie 4 (19%) cas, choc hémorragique 2(9,5%) cas, décès: 2 (9,5%) cas. La morbidité et la mortalité périopératoire de la chirurgie du méningiome intracrânien au CHU SO de Lomé reste élevée. L’amélioration du plateau technique et une consultation précoce permettrait de réduire ces complications.
Introduction: Ocular melanoma develops at the expense of eyes' melanocytes which give to the eyes their color. It is the first primitive intraocular tumor in the White race. It is rare, as that of the skin in black people. The bilateral cases are exceptional even in the white race, estimated at 0.2%. We present the case of bilateral ocular melanoma with bad prognosis in a black patient. Patient and observation: A 56-year-old black male patient, who had benefited 4 years earlier from an enucleation of the right eye for ocular melanoma, and admitted for bilateral exophthalmos which evolved for three months in a context of bilateral blindness. The cerebral Scanning had allowed to objectify a bilateral lateral-conical mass which evoked an inflammatory pseudo tumor. The failure of the medical treatment led to the exeresis of a conical, juxta-orbital and mid-muscular blackish mass, to the later apex respecting the surrounding structures. The histological examination ends again in a melanoma. No additional therapy was undertaken. The evolution 2 years later was marked by a local recurrence, multiple hepatic metastases and patient death. Conclusion: Bilateral ocular melanoma is exceptional in Black people. The etiologic factors as well as bilateralism mechanisms are still hypothetic. Its most effective treatment is local and the prognosis, bad in case of metastases due to the absence of an effective chemotherapy.
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