Alteraciones cognitivas en pacientes operados de aneurismas cerebrales en el Hospital de Clínicas

Cognitive impairments in patients following clipping of ruptured aneurysms at Hospital de Clínicas

Autores/as

  • Gabriela Moguilner Servicio de Neurocirugía, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo - Paraguay
  • Fabrizio Frutos Servicio de Neurocirugía, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo - Paraguay
  • Ana Riquelme Servicio de Neurocirugía, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo - Paraguay
  • Kevin Arce Servicio de Neurocirugía, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo - Paraguay
  • Italo Flecha Servicio de Neurocirugía, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo - Paraguay
  • Dario Díaz Servicio de Neurocirugía, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo - Paraguay

Resumen

Introducción: la hemorragia subaracnoidea por sí misma puede dar lugar a un daño cerebral, por esto, en pacientes sin complicaciones los trastornos cognitivos pueden estar presentes. Objetivos: analizar las alteraciones neuropsicológicos en los pacientes operados de aneurismas cerebrales y los factores que se asocian a su desarrollo. Metodología: estudio analítico, observacional, ambispectivo, 2013 - 2020, que incluyó pacientes operados de aneurismas cerebrales rotos en el Hospital de Clínicas.  La evaluación cognitiva se realizó con el mini examen cognitivo de Lobo. Se consideró alterado cuando la puntuación fue menor a 27.  Se analizaron 12 variables asociando las mismas con el tema de estudio. Los datos fueron analizados con Epi-info 7.2. Resultados: La edad mayor a 60 años se asoció al déficit cognitivo de forma significativa, así como también la lateralidad a izquierda, el uso de clipado temporario durante la cirugía, la ruptura del aneurisma en el intraoperatorio, el vasoespasmo y la hidrocefalia. No se asoció significativamente con el desarrollo de un trastorno cognitivo; el sexo, el nivel de escolaridad, la cantidad de sangre cisternal, la localización del aneurisma, el Glasgow de ingreso ni la fase en la cual se realzó la cirugía. Discusión: en general los hallazgos coinciden con la literatura. Llamó la atención que la escala de Fisher en la muestra estudiada no demostró tener una asociación significativa con el trastorno cognitivo, sin embargo, hay datos en la literatura que sostienen que la cantidad de sangre cisternal al ingreso es un fuerte predictor del estado cognitivo del paciente al alta.

Palabras clave: aneurisma cerebral; trastornos cognitivos; hemorragia subaracnoidea.

ABSTRACT

Introduction: subarachnoid hemorrhage itself can lead to brain damage, so in uncomplicated patient’s cognitive disorders may be present. Objective: To analyze the cognitive impairments in patients following clipping of ruptured aneurysms and the factors that are associated with their development. Methodology: analytical, observational, ambispective study, 2013-2020, including patients operated for ruptured aneurysms at the Hospital de Clínicas. The cognitive evaluation was performed with the Lobo mini cognitive exam. It was considered altered when the score was less than 27. Twelve variables were analyzed associating them with the study topic. The data was analyzed with Epi-info 7.2. Results: Age over 60 years was significantly associated with cognitive deficit, as well as left laterality, the use of temporary clipping during surgery, intraoperative aneurysm rupture, vasospasm, and hydrocephalus. It was not significantly associated with the development of a cognitive disorder; sex, level of education, amount of cisternal blood, location of the aneurysm, admission Glasgow, and the timing in which the surgery was performed. Discussion: In general, the findings coincide with the literature. It was noteworthy that the Fisher scale in the studied sample did not show to have a significant association with cognitive disorder, however, there are data in the literature that maintain that the amount of cisternal blood on admission is a strong predictor of the patient's cognitive state at discharge.

Keywords: brain aneurysms; cognitive impairments; subarachnoid hemorrhage.

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Citas

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Publicado

2020-04-27

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