P A Gómez

Complutense University of Madrid, Madrid, Madrid, Spain

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Publications (115)133.27 Total impact

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    ABSTRACT: Object Traumatic brain injury (TBI) represents a large health and economic burden. Because of the inability of previous randomized controlled trials (RCTs) on TBI to demonstrate the expected benefit of reducing unfavorable outcomes, the IMPACT (International Mission on Prognosis and Analysis of Clinical Trials in TBI) and CRASH (Corticosteroid Randomisation After Significant Head Injury) studies provided new methods for performing prognostic studies of TBI. This study aimed to develop and externally validate a prognostic model for early death (within 48 hours). The secondary aim was to identify patients who were more likely to succumb to an early death to limit their inclusion in RCTs and to improve the efficiency of RCTs. Methods The derivation cohort was recruited at 1 center, Hospital 12 de Octubre, Madrid (1990-2003, 925 patients). The validation cohort was recruited in 2004-2006 from 7 study centers (374 patients). The eligible patients had suffered closed severe TBIs. The study outcome was early death (within 48 hours post-TBI). The predictors were selected using logistic regression modeling with bootstrapping techniques, and a penalized reduction was used. A risk score was developed based on the regression coefficients of the variables included in the final model. Results In the validation set, the final model showed a predictive ability of 50% (Nagelkerke R(2)), with an area under the receiver operating characteristic curve of 89% and an acceptable calibration (goodness-of-fit test, p = 0.32). The final model included 7 variables, and it was used to develop a risk score with a range from 0 to 20 points. Age provided 0, 1, 2, or 3 points depending on the age group; motor score provided 0 points, 2 (untestable), or 3 (no response); pupillary reactivity, 0, 2 (1 pupil reacted), or 6 (no pupil reacted); shock, 0 (no) or 2 (yes); subarachnoid hemorrhage, 0 or 1 (severe deposit); cisternal status, 0 or 3 (compressed/absent); and epidural hematoma, 0 (yes) or 2 (no). Based on the risk of early death estimated with the model, 4 risk of early death groups were established: low risk, sum score 0-3 (< 1% predicted mortality); moderate risk, sum score 4-8 (predicted mortality between 1% and 10%); high risk, sum score 9-12 (probability of early death between 10% and 50%); and very high risk, sum score 13-20 (early mortality probability > 50%). This score could be used for selecting patients for clinical studies. For example, if patients with very high risk scores were excluded from our study sample, the patients included (eligibility score < 13) would represent 80% of the original sample and only 23% of the patients who died early. Conclusions The combination of Glasgow Coma Scale score, CT scanning results, and secondary insult data into a prognostic score improved the prediction of early death and the classification of TBI patients.
    Journal of neurosurgery. 09/2014;
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    ABSTRACT: To describe the demographic and clinical profiles of a cohort of environmentally representative severe traumatic brain injury (TBI) cases collected for the past 25 years and to analyse the changes that occurred by dividing the analysis period into 3 equal time periods.
    Neurocirugia (Asturias, Spain) 07/2014; · 0.34 Impact Factor
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    ABSTRACT: Objetivo Describir el perfil demográfico y clínico de una cohorte de TCE grave recogida en los últimos 25 años, representativa de nuestro medio y analizar los cambios que han sucedido a lo largo de estos años, dividiéndolos en tres periodos de tiempo iguales. Material y métodos Estudio observacional de cohorte de TCE grave cerrado (puntuación en la escala de Glasgow GCS≤8) adultos (>14 años) ingresados consecutivamente en las primeras 48 horas del traumatismo, en Hospital 12 de Octubre entre 1987 y 2012. Se definen las variables epidemiológicas y clínicas que han demostrado ser las mas relevantes en la literatura y se comparan en 3 periodos de tiempo equivalentes, 1987-1995, 1996-2004 y 2005-2014. Resultados Existe una reducción de la frecuencia de TCE grave de un 13% entre el primer y último periodo de tiempo. Se aprecia un aumento de la edad media de 35 a 43 años, la frecuencia de TCE grave por sexo se iguala en las últimas décadas de la vida. Se aprecia un cambio en el mecanismo del trauma, el accidente de tráfico ha disminuido de un 76% a un 55%, sobre todo se ha reducido el accidente en vehículo-4 ruedas. Sin embargo, han aumentado notablemente las caídas, especialmente en mujeres de mayor edad, siendo la lesión estructural mas frecuente la contusión y el hematoma subdural. En el último periodo de tiempo no se pudo determinar con fiabilidad la puntuación motora, debido a la intubación precoz y el uso de drogas sedantes. Conclusiones La epidemiología del TCE ha cambiado en los países occidentales, esta tendencia también se observa en nuestro medio, con un aumento de la edad media que refleja el aumento de caídas en la población de pacientes de edad avanzada.
    Neurocirugía. 01/2014;
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    ABSTRACT: BACKGROUND AND PURPOSE:In patients with spinal cord injury after blunt trauma, several studies have observed a correlation between neurologic impairment and radiologic findings. Few studies have been performed to correlate spinal cord injury with ligamentous injury. The purpose of this study was to retrospectively evaluate whether ligamentous injury or disk disruption after spinal cord injury correlates with lesion length.MATERIALS AND METHODS:We retrospectively reviewed 108 patients diagnosed with traumatic spinal cord injury after cervical trauma between 1990-2011. Plain films, CT, and MR imaging were performed on patients and then reviewed for this study. MR imaging was performed within 96 hours after cervical trauma for all patients. Data regarding ligamentous injury, disk injury, and the extent of the spinal cord injury were collected from an adequate number of MR images. We evaluated anterior longitudinal ligaments, posterior longitudinal ligaments, and the ligamentum flavum. Length of lesion, disk disruption, and ligamentous injury association, as well as the extent of the spinal cord injury were statistically assessed by means of univariate analysis, with the use of nonparametric tests and multivariate analysis along with linear regression.RESULTS:There were significant differences in lesion length on T2-weighted images for anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum in the univariate analysis; however, when this was adjusted by age, level of injury, sex, and disruption of the soft tissue evaluated (disk, anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum) in a multivariable analysis, only ligamentum flavum showed a statistically significant association with lesion length. Furthermore, the number of ligaments affected had a positive correlation with the extension of the lesion.CONCLUSIONS:In cervical spine trauma, a specific pattern of ligamentous injury correlates with the length of the spinal cord lesion in MR imaging studies. Ligamentous injury detected by MR imaging is not a dynamic finding; thus it proved to be useful in predicting neurologic outcome in patients for whom the MR imaging examination was delayed.
    American Journal of Neuroradiology 12/2013; · 3.17 Impact Factor
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    ABSTRACT: Objective the embolization of brain arteriovenous malformations (AVMs) has shown to be a very effective adjuvant technique before surgical or radiosurgical therapy. The purpose of this work is to analyse the technique, effectiveness and complications of therapeutic embolization of brain AVMs in a series of patients who were subsequently treated by surgery or stereotactic radiosurgery. Materials and methods A series of 17 consecutive patients treated with endovascular embolization are considered. These were extracted from a series of 212 patients with brain AVMs admitted between 1975 and 1999. NBCA (hystoacryl) or PVA (polyvinyl-alcohol) were used as embolization materials. Pre and postembolization angiographic studies were done in order to assess the reduction of the nidus. Postembolization microsurgical technical difficulty was also compared against other similar cases operated without previous embolization. Results On average 1,4 arterial feeders were embolized per session in a total of 27 sessions, with an average of 2,2 feeders embolized per patient. Nidus size reduction ranged from 20 to 100% (average 74%). Embolization favoured the following surgical or radiosurgical treatment. Two patients suffered minor neurological deficits (11,7%) and one developed a major deficit after embolization. The majority of the patients presented made a good recovery. Conclusions Embolization of brain AVMs is an adjuvant therapeutic procedure that facilitates the posterior surgical or radiosurgical treatment of these lesions.
    Neurocirugía. 08/2013; 11(4):271–280.
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    ABSTRACT: The case of a 45 year-old woman with multiple intracranial aneurysms, one of hich was of “blister-like” type and an arteriovenous malformation (AVM) of the contralateral temporal lobe is presented. Clinical presentation was with subarachnoid hemorrhage. At the initial operation a carotid-posterior communicating artery aneurysm was clipped and a baby aneurysm of the anterior choridal artery was coagulated; the blister-like aneurysm located between the origin of the anterior choroidal artery and the carotid bifurcation was wrapped with muscle because it was deemed not suitable for clipping. Seventeen days after the operation, the patient suddendly became comatose and a control CT scan showed a big temporal hematoma which was evacuated. Postoperative control carotid angiography showed enlargement of the blister-like aneurysm. Occlusion of the internal carotid artery was planned after the contralateral AVM was embolized in order to decrease blood flow steal from the right cerebral hemisphere. Following occlusion of approximately 65% of the AVM nidus a reversal of flow from the left to the right hemisphere was observed. Ahigh flow bypass with saphenous graft between the external carotid artery and a M2 segment was performed and the internal carotid artery was ligated at cervical level. Thereafter the patient underwent radiosurgery of the AVM. The therapeutic problems posed by-blister-like aneurysms which are usually located at the anterior walI of the supraclinoidal carotid artery, have a thin wall and no neck and are rarely detected by angiography are commented. The most appropriate management usualIy consists in carotid occlusion with or without previous cerebral revascularization.
    Neurocirugía. 07/2013; 11(6):435–439.
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    ABSTRACT: Mild head injuries had attracted little interest since a few years ago. Those patients represent 80% of all head injuries. These high admission rates constitute a major public health problem in the occidental world. Besides, a substantial reduction in mortality as a whole can be achieved by addressing more attention to the large number of patients with an initial mild head injury. For a long time, there had not been a consensus in the definition, radiological test or uniform treatment of patients with mild head injury, which generated a great disagreement in the treatment of these patients. In the last ten years, along with a greater availability of CT scan, different guidelines for management have been published. The end point of these works is to diagnose a higher number of patients at risk to develop an intracranial haematoma after suffering an initial mild head injury, with the best cost- effectiveness. In our work we analyse the advances obtained in the last years of investigation.
    Neurocirugía. 07/2013; 11(5):351–363.
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    ABSTRACT: BACKGROUND AND PURPOSE:Traumatic brain injuries represent an important cause of death for young people. The main objectives of this work are to correlate brain stem injuries detected at MR imaging with outcome at 6 months in patients with severe TBI, and to determine which MR imaging findings could be related to a worse prognosis.MATERIALS AND METHODS:One hundred and eight patients with severe TBI were studied by MR imaging in the first 30 days after trauma. Brain stem injury was categorized as anterior or posterior, hemorrhagic or nonhemorrhagic, and unilateral or bilateral. Outcome measures were GOSE and Barthel Index 6 months postinjury. The relationship between MR imaging findings of brain stem injuries, outcome, and disability was explored by univariate analysis. Prognostic capability of MR imaging findings was also explored by calculation of sensitivity, specificity, and area under the ROC curve for poor and good outcome.RESULTS:Brain stem lesions were detected in 51 patients, of whom 66% showed a poor outcome, as expressed by the GOSE scale. Bilateral involvement was strongly associated with poor outcome (P < .05). Posterior location showed the best discriminatory capability in terms of outcome (OR 6.8, P < .05) and disability (OR 4.8, P < .01). The addition of nonhemorrhagic and anterior lesions or unilateral injuries showed the highest odds and best discriminatory capacity for good outcome.CONCLUSIONS:The prognosis worsens in direct relationship to the extent of traumatic injury. Posterior and bilateral brain stem injuries detected at MR imaging are poor prognostic signs. Nonhemorrhagic injuries showed the highest positive predictive value for good outcome.
    American Journal of Neuroradiology 05/2012; · 3.17 Impact Factor
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    ABSTRACT: An actualized revision of the most important aspects of aneurismal subarachnoid hemorrhage is presented from the guidelines previously published by the group of study of cerebrovascular pathology of the Spanish Society of Neurosurgery. The proposed recommendations should be considered as a general guide for the management of this pathological condition. However, they can be modified, even in a significant manner according to the circumstances relating each clinical case and the variations in the therapeutic and diagnostic procedures available in the center attending each patient.
    Neurocirugia (Asturias, Spain) 04/2011; 22(2):93-115. · 0.34 Impact Factor
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    ABSTRACT: An actualized revision of the most important aspects of aneurismal subarachnoid hemorrhage is presented from the guidelines previously published by the group of study of cerebrovascular pathology of the Spanish Society of Neurosurgery. The proposed recommendations should be considered as a general guide for the management of this pathological condition. However, they can be modified, even in a significant manner according to the circumstances relating each clinical case and the variations in the therapeutic and diagnostic procedures available in the center attending each patient.
    Neurocirugia (Asturias, Spain) 04/2011; 22(2):93–115. · 0.34 Impact Factor
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    ABSTRACT: The aim of this study was to determine the incidence of posttraumatic hydrocephalus in severely head-injured patients who required decompressive craniectomy (DC). Additional objectives were to determine the relationship between hydrocephalus and several clinical and radiological features, with special attention to subdural hygromas as a sign of distortion of the CSF circulation. The authors conducted a retrospective study of 73 patients with severe head injury who required DC. The patients were admitted to the authors' department between January 2000 and January 2006. Posttraumatic hydrocephalus was defined as: 1) modified frontal horn index greater than 33%, and 2) the presence of Gudeman CT criteria. Hygromas were diagnosed based on subdural fluid collection and classified according to location of the craniectomy. Hydrocephalus was diagnosed in 20 patients (27.4%). After uni- and multivariate analysis, the presence of interhemispheric hygromas (IHHs) was the only independent prognostic factor for development of posttraumatic hydrocephalus (p<0.0001). More than 80% of patients with IHHs developed hydrocephalus within the first 50 days of undergoing DC. In all cases the presence of hygromas preceded the diagnosis of hydrocephalus. The IHH predicts the development of hydrocephalus after DC with 94% sensitivity and 96% specificity. The presence of an IHH showed an area under the receiver-operator characteristic of 0.951 (95% CI 0.87-1.00; p<0.0001). Hydrocephalus was observed in 27.4% of the patients with severe traumatic brain injury who required DC. The presence of IHHs was a predictive radiological sign of hydrocephalus development within the first 6 months of DC in patients with severe head injury.
    Journal of Neurosurgery 12/2010; 113(6):1287-93. · 3.15 Impact Factor
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    ABSTRACT: The objective of this work is two-fold: to determine the role of MRI findings in establishing the prognosis of patients with moderate and severe traumatic brain injury (TBI) admitted to our centre, measured with different outcome scales; and to determine in which patients the information given by MR findings adds prognostic information to that from traditional prognostic factors. One hundred patients suffering moderate or severe head injury in whom MRI had been performed in the first 30 days after trauma were included. The MRI was evaluated by two neuroradiologists who were not aware of the initial CT results or the clinical situation of the patients. Outcome was determined 6 months after head injury by means of the extended version of the Glasgow Outcome Scale. The prognostic capacity of the different factors related to outcome was compared by the analysis of receiver operating characteristic (ROC) curves and the area under the curve (AUC) for each factor. There exists a clear relation between the depth of the traumatic lesions shown on MRI, and their classification by the proposed scale, and the outcome of patients suffering traumatic brain injury determined by different scales 6 months after injury. The anatomical substrate of TBI depicted by MRI could be a useful prognostic tool in patients suffering moderate and severe head injury. Patients with a score of 4 or less on the motor subscale of the GCS scale are those who could benefit most from the prognostic information provided by MRI.
    Acta Neurochirurgica 03/2009; 151(4):341-56. · 1.55 Impact Factor
  • P Miranda, P Gomez, R Alday
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    ABSTRACT: In patients with traumatic spinal cord injury, several studies correlate neurological impairment and radiological findings. However, little information is available about this correspondence in the particular group of acute traumatic central cord syndrome. The object of the present work was to describe the clinical and radiological features of a series of patients presenting with acute traumatic central cord syndrome and to analyze clinical and radiological correlations on admission and at last follow-up. Retrospective review of 15 patients diagnosed of acute traumatic central cord syndrome between 1995 and 2005. Global motor score and motor score in upper extremities were determined on admission and at last follow-up (6 months-4 years, mean 16 months). Plain films, cervical computed tomography and magnetic resonance (MR) were performed in every patient and retrieved for the study. In seven patients, serial MR studies were performed during follow-up. Clinical and radiological correlations were statistically analyzed with non-parametric tests. Cervical spondylosis appeared associated with older age, falls, and absence of fracture. Spinal cord edema was the most common finding in MR studies but hemorrhage was also observed. The length of spinal cord edema significantly correlated with initial motor score. The decrease in T2-weighted hyperintensity in serial MR studies correlated with the gain of motor power in upper limbs at last follow-up. Elderly patients with more degenerated cervical spines commonly develop acute traumatic central cord syndrome after incidental falls. Length of spinal cord edema correlates with neurological impairment on admission and may provide significant prognostic information.
    Journal of neurosurgical sciences 01/2009; 52(4):107-12; discussion 112. · 0.53 Impact Factor
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    ABSTRACT: It has been suggested that nitric oxide could be implicated in the neuronal degeneration of substantia nigra compacta in patients with Parkinson's disease. Recently, it has been reported decreased CSF nitrate levels (oxidation product that provides an indirect estimation of nitric oxide) in Parkinson's disease patients, assessed with a colorimetric method. We studied the CSF and plasma levels of nitrate with a kinetic cadmium-reduction method in 31 Parkinson's disease patients and 38 matched controls. The CSF and plasma nitrate levels were not correlated either in patient or in the control group, and they did not differ significantly between the two study groups. They were not influenced significantly by antiparkinsonian drugs in patients, although there was a trend for CSF nitrate levels to be higher in patients treated with levodopa or with dopamine agonists. CSF and plasma nitrate levels did not correlate with age at onset, duration, scores of the unified Parkinson's disease rating scales and Hoehn & Yahr staging in the patients group. These date suggest that CSF and plasma levels of nitrate are apparently unrelated with the risk for PD.
    Acta Neurologica Scandinavica 01/2009; 93(2-3):123-6. · 2.47 Impact Factor
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    ABSTRACT: Severe head injury (SHI) is a significant health, social and economic concern rendering a worldwide health problem. This retrospective study was designed to describe the features and outcomes of patients with SHI treated in a single neurosurgical unit (Hospital "12 de Octubre", Madrid, Spain) over a period approaching 13 years. The subjects enrolled were 895 patients (15 years or older) with non-missile SHI treated over the period January 1987 to August 1999, in whom a computerised tomography scan had been performed within the first 6 h of injury. We considered epidemiological, clinical, analytical, radiological and therapeutic data along with final patient outcomes. The overall mortality rate was 46.8% (419 patients). Of these 419 deaths, 177 (42.2%) occurred within the first 48 h of injury rendering an early death rate of 19.8% (177/895 patients). Despite overall mortality showing a clear decreasing trend by the end of the 1990s, proportions of early deaths (within the first 48 h of injury) dramatically rose in the last 3 years of the study. As a whole, an unfavourable outcome was recorded in 62.6% (560 patients). Despite continued efforts to improve the outcome of patients with SHI, the results of our study are pessimistic in that high mortality and unfavourable outcome rates were recorded in this large series of patients. Although overall mortality has diminished over the years, the number of early deaths has increased.
    Neurosurgical Review 11/2008; 32(3):343-53; discussion 353-4. · 1.97 Impact Factor
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    ABSTRACT: Surgery plays a mayor role in the management of some patients with cerebellar haematomas, although a universally accepted treatment guideline is lacking. The aim of this study was to review the existing evidence supporting surgical evacuation of the haematoma in this pathology. Without any clinical trial on this field, data derived from clinical series suggest that the level of consciousness, the size of the haematoma, the presence of hydrocephalus and the compression of the posterior fossa CSF containing spaces are the main criteria to decide management. Fourth ventricular compression seems to be the best indicator of the last parameter. Existing bibliography shows that haematomas greater than 4 cm or causing complete obliteration of the fourth ventricle or prepontine cistern need surgical evacuation irrespective of the level of consciousness, as they indicate a significant compression of the brainstem. On the other hand, it seems that haematomas of less than 3 cm and without fourth ventricular compression can be managed conservatively or by means of ventricular drainage if hydrocephalus exists and requires treatment. The management of intermediate sized haematomas is less clear although conservative approach could be adopted in presence of adequate neurological status, with EVD in the case of hydrocephalus with low consciousness level. If the level of consciousness is low despite the treatment of hydrocephalus, or in absence of this latter, haematoma evacuation is indicated. Finally, patients with flaccid tetraplejia and absent oculocephalic reflexes, and those whose age or basal condition precludes an adequate functional outcome are not suitable for aggressive treatment. Moreover, some studies have shown that comatose patients with CT scan evidence of severe brainstem compression present a reduced probability of good outcome. Anyway, management should be decided on an individual basis, as there is no enough evidence to support a strict treatment protocol.
    Neurocirugia (Asturias, Spain) 05/2008; 19(2):101-12. · 0.34 Impact Factor
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    ABSTRACT: El tratamiento quirúrgico juega un papel fundamental en el manejo de algunos pacientes con hematomas de cerebelo, y sin embargo, no existe una guía de tratamiento universalmente aceptada que permita seleccionar a este subgrupo de pacientes. El objetivo del presente trabajo fue revisar la base sobre la que se fundamentan las indicaciones del tratamiento quirúrgico en esta patología. En ausencia de ensayos clínicos que afronten este problema, las series clínicas muestran que los criterios más consistentes para la decisión terapéutica son el nivel de consciencia, el tamaño del hematoma, la presencia de hidrocefalia y los datos radiológicos de compresión de los espacios continentes de LCR en la fosa posterior. El parámetro mejor estudiado como reflejo de este último aspecto posiblemente sea la deformidad del IV ventrículo. La literatura sugiere que los hematomas de 4 o más cm de diámetro, o que causan una oclusión completa del IV ventrículo o de la cisterna prepontina deben ser intervenidos independientemente del nivel de consciencia, al presentar una compresión significativa del tronco del encéfalo (TDE). Por el contrario, es probable que hematomas de menos de 3 cm y que no deforman el IV ventrículo, no causen una compresión importante en la fosa posterior, y puedan ser manejados de forma conservadora o mediante el drenaje de la hidrocefalia si fuera preciso. Para hematomas de tamaño intermedio la decisión terapéutica está menos clara, pudiendo optarse por observación estricta en los pacientes con GCS 14-15 o con drenaje ventricular externo (DVE) aislado en aquellos con GCS<14 que presenten hidrocefalia. En presencia de un bajo nivel de consciencia a pesar del tratamiento de la hidrocefalia, o en ausencia de ésta, se debería realizar una evacuación del hematoma. Finalmente, no parece indicado el tratamiento de pacientes con GCS 3 y ausencia de reflejos de tronco, oaquéllos en los que por su edad avanzada o mala calidad de vida previa presenten un pronóstico funcional malo. Se ha encontrado además que los pacientes en coma y con signos radiológicos de grave compresión del TDE las posibilidades de una buena recuperación son muy escasas. A pesar de todo el tratamiento ha de ser individualizado en cada caso, ya que no existe la evidencia suficiente que permita elaborar una guía de aplicación estricta.
    Neurocirugia (Asturias, Spain) 01/2008; · 0.34 Impact Factor
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    ABSTRACT: The objective of this study was to describe clinical and radiological features of a series of patients presenting with Brown-Sequard syndrome after blunt spinal trauma and to determine whether a correlation exists between cervical plain films, CT, MRI and the clinical presentation and neurological outcome. A retrospective review was done of the medical records and analysis of clinical and radiological features of patients diagnosed of BSS after blunt cervical spine trauma and admitted to our hospital between 1995 and 2005. Ten patients were collected for study, three with upper- and seven with lower-cervical spine fracture. ASIA impairment scale and motor score were determined on admission and at last follow-up (6 months-9 years, mean 30 months). Patients with lower cervical spine fracture presented with laminar fracture ipsilateral to the side of cord injury in five out of six cases. T2-weighted hyperintensity was present in seven patients showing a close correlation with neurological deficit in terms of side and level but not with the severity of motor deficit. Patients with Brown-Sequard syndrome secondary to blunt cervical spine injury commonly presented T2-weighted hyperintensity in the clinically affected hemicord. A close correlation was observed between these signal changes in the MR studies and the neurologic level. Effacement of the anterior cervical subarachnoid space was present in all patients, standing as a highly sensitive but very nonspecific finding. In the present study, craniocaudal extent of T2-weighted hyperintensity of the cord failed to demonstrate a positive correlation with neurological impairment.
    European Spine Journal 08/2007; 16(8):1165-70. · 2.47 Impact Factor
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    ABSTRACT: Severe head injury (SHI) is one of the most important health, social and economic problems in industrialised countries. Unfortunately, none of the neuroprotection trials for traumatic brain injury have shown efficacy. One of the reasons for this failure could be the inclusion of patients with high probability of early death. A population-based, retrospective study was conducted to develop a prognostic model for identification of these patients. Between January 1987 and August 1999, a total of 895 patients (> or = 15 years of age) with non-missile SHI were studied, in whom a computed tomography scan was carried out within the first 6 h of injury. The association between early death (first 48 h after injury) and independent prognostic factors was determined by logistic regression analysis. A scoring system was also constructed. The early-death rate was 20%. Independent predictors of early mortality after SHI were non-evacuated mass (odds ratio (OR) 65, 95% confidence interval (CI) 11 to 379), diffuse injury IV (OR 25, 95% CI 5 to 112), diffuse injury III (OR 8, 95% CI 3 to 22), flaccidity (OR 7, 95% CI 3 to 15), non-reactive bilaterally mydriasis (OR 6, 95% CI 3 to 12), evacuated mass (OR 4, 95% CI 1 to 11), age > or = 65 years (OR 4, 95% CI 1 to 9), decerebration (OR 3, 95% CI 2 to 7) and shock (OR 3, 95% CI 2 to 6). The prognostic model correctly identified 93% of the patients. This prognostic model is based on simple clinical and radiological data readily available during the first 6 h after injury and is useful for identification of early death after SHI.
    Journal of neurology, neurosurgery, and psychiatry 09/2006; 77(9):1054-9. · 4.87 Impact Factor
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    ABSTRACT: Severe head injury (SHI) is one of the most important health, social, and economic problems in industrialized countries. Most of the recent studies related to this entity still show pessimistic results, with percentages of mortality and unfavourable outcomes very similar than those reported in the last quarter of century. In order to make predictions for patients with SHI, different "prognostic formulas or models" reviewed in this manuscript, have been developed with the main objective of performing reliable predictions for patients with this pathology. These models are constructed by using a group of "prognostic indicators or factors" and different "prognostic scales" useful for measuring the final outcome. The different "statistical techniques or methods" necessary to develop these prognostic models are also analyzed in this paper.
    Neurocirugia (Asturias, Spain) 07/2006; 17(3):215-25. · 0.34 Impact Factor

Publication Stats

1k Citations
133.27 Total Impact Points

Institutions

  • 1996–2014
    • Complutense University of Madrid
      • Facultad de Medicina
      Madrid, Madrid, Spain
  • 1989–2013
    • Hospital Universitario 12 de Octubre
      Madrid, Madrid, Spain
  • 1988–2012
    • Hospital 12 de Octubre
      • • Servicio de Bioquímica Clínica
      • • Servicio de Neurocirugía
      Madrid, Madrid, Spain
  • 2010
    • Hospital Universitario Virgen del Rocío
      • Department of Neurosurgery
      Hispalis, Andalusia, Spain
  • 2008
    • Hospital Clínico San Carlos
      Madrid, Madrid, Spain
  • 2000
    • University of Alcalá
      • Faculty of Pharmacy
      Cómpluto, Madrid, Spain
  • 1998
    • Hospital Universitario Principe de Asturias
      Cómpluto, Madrid, Spain