Internal carotid artery dissection (ICAD) is a rare entity that either results from traumatic injury or can be spontaneously preceded or not by a minor trauma such as sporting activities. It represents a major cause of stroke in young patients. The diagnosis should be suspected with the combination of Horner's syndrome, headache or neck pain, and retinal or cerebral ischaemia. The confirmation is frequently made with a magnetic resonance angiography (MRA). Although anticoagulation with heparin followed by vitamin-K-antagonists is the most common treatment, there is no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid dissection. We describe a patient with ICAD following deep sea scuba diving, who presented with Horner's syndrome and neck pain and was successfully treated with anticoagulants.
Low-impact rami fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of complications are described in this fractures with a high 1 year mortality. Early rehabilitation therapy with adequate analgesic therapy should be recommended.
<p><em></em><span style="text-decoration: underline;">Objetivo</span>: Analizar los pacientes tratados por fractura osteoporótica de ramas pélvicas en nuestro hospital. </p><p><span style="text-decoration: underline;">Métodos</span>: Analizamos retrospectivamente pacientes con fracturas de ramas pélvicas atendidos en el Servicio de Urgencias de nuestro hospital. Los parámetros analizados incluyen datos demográficos, diagnósticos, lesiones asociadas, comorbilidades, autonomía previa, complicaciones y mortalidad al año.</p><p><span style="text-decoration: underline;">Resultados</span>: 60 pacientes (51 mujeres) con una edad media de 83,5 años (rango, 65,1-99) presentaron fractura osteoporótica de ramas pélvicas. 6 pacientes presentaban antecedentes de fractura de ramas pélvicas y 23 de fractura osteoporótica de otra localización. En 27 casos se asociaban a lesiones en otras localizaciones de la pelvis. 3 pacientes asociaban fracturas extrapélvicas y 6 traumatismos craneoencefálicos. 41 pacientes experimentaron complicaciones de algún tipo. Se requirió ingreso hospitalario en 8 casos, con una estancia media de 18 días. La mortalidad al año fue de 13,3%.</p><p><span style="text-decoration: underline;">Conclusiones</span>: Las fracturas osteoporóticas de ramas pélvicas afectan predominantemente a mujeres con numerosas comorbilidades. Muchas son las complicaciones descritas en estos pacientes con una mortalidad anual elevada. Es remendable un adecuado tratamiento analgésico que permita una movilización precoz del paciente tras descartar lesiones asociadas en la pelvis.</p>
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