Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. Los autores mantienen los derechos sobre los artículos y por tanto son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra. “TRATAMIENTO QUIRÚRGIO DE HEMATOMA SUBDURAL CRÓNICO” DR. BOLAÑOS CHICAIZA DANNY
MD. del Hospital Abel Gilbert Pontón, Guayaquil-Ecuador
Publicado como artículo científico. Revista Facultad
de Ciencias Médicas, Vol. 3 Edición N°1 Periodicidad semestral Enero-Junio pp. 26-35 ISSN 2661–6726 RESUMEN
Se desarrollan en personas seniles después de traumatismos craneoencefálicos leves. Objetivos: Determinar futuras complicaciones posquirúrgico tras una craneotomía des- compresiva por medio de agujeros de trepano, asociar las comorbilidades, determinar fac- tores que determinaron un tratamiento quirúrgico y relacionar edad, sexo, manifestaciones clínicas y tiempo de evolución. Metodología: Fue investigación descriptiva, retrospectiva y de corte transversal, realizada del 2018-2020 en el Hospital Abel Gilbert Pontón, Guayaquil, Ecuador. Resultados: Grupo de edad predominante fue de 60 a 70 años. El sexo masculino fue el más afectado. El mecanismo principal de trauma fue desconocido. El síntoma de presentación inicial es la cefalea leve. El tiempo de inicio de síntomas suele ser después de 1 mes. La atrofia cerebral es la conmorbilidad más común. Según la esca- la de Glasgow, el TCE leve es más predominante. Conclusión: Es frecuente en pacientes de sexo masculino de edad avanzada entre 50 a 70 años, con un promedio de 60 años.
Palabras Claves: TRAUMATISMO CRANEOENCEFÁLICO, HEMATOMA SUBDURAL CRÓNICO.
ABSTRACT
They develop in senile people after minor head injuries. Objectives: To determine future postoperative complications after a decompressive craniotomy through trepan holes, to associate comorbidities, to determine factors that determined a surgical treatment and to relate age, sex, clinical manifestations and evolution time. Metho- dology: It was descriptive, retrospective and cross-sectional research, carried out from 2018-2020 at the Abel Gilbert Pontón Hospital, Guayaquil, Ecuador. Results: The predominant age group was 60 to 70 years. The male sex was the most affected. The main mechanism of trauma was unknown. The initial presenting symptom is mild headache. The time of onset of symptoms is usually after 1 month. Brain atrophy is the most common commotion. According to the Glasgow scale, mild TBI is more predominant. Conclusion: It is frequent in elderly male patients between 50 and 70 years old, with an average of 60 years.
Keywords: CRANEOENEPHALIC INJURY, CHRONIC SUBDURAL HEMATOMA,
Recibida 17 de septiembre del 2021, aprobado 27 de diciembre del 2021
REVISTA / FACULTAD DE CIENCIAS MÉDICAS
TRATAMIENTO QUIRURGIO DE HEMATOMA SUBDURAL CRÓNICO Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. Los autores mantienen los derechos sobre los artículos y por tanto son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra.
INTRODUCCIÓN
El hematoma subdural crónico es una de las patologías más comunes, que se ven a diario en el área de neurocirugía, definiéndose como una neoformación de sangre la cual se encuentra dentro de una capsula, ubicándose entre la duramadre y aracnoides. El primer registro de un caso clínico, que se asemeja a esta patología, fue descrito por Johannes Wepfer en el año 1657. Donde citó “quiste sangriento”, el cual fue descubierto luego del fallecimiento de un anciano, el cual presentó sintomatología de acorde con un ECV. (1) (2) (3)
Para que exista la formación del hematoma subdural crónico se han propuestos dos procesos fisiopatológicos. Siendo el primero descrito por Gardner en 1932, llamándolo teoría osmótica, indicando que la degradación de la sangre dentro del espacio subdural produce una presión osmótica eleva atrayendo LCR, causando aumento del tamaño del hematoma de forma progresiva. (4)
El segundo proceso refiere que ocurre la formación de membranas con vascularización, la cual al ocurrir el sangrado y degradarse el mismo, provoca la formación de una neomembrana interna o cortical y a su vez la formación de una neomebrana externa o dural. (5)
El hematoma subdural crónico (HSDc) podríamos definirlo como una colección de productos de degradación sanguíneos localizada en el espacio subdural específicamente (2); es decir, que anatómicamente lo ubicamos entre la superficie cerebral y la duramadre (1). Es hoy por hoy una de las patologías que con más frecuencia lo encontramos en la consulta externa como en emergencia, especialmente está vinculada a pacientes vulnerables como es la población anciana. (8) (1)
En la mayoría de los casos tras la exposición a un traumatismo craneoencefálico lo primero que suele manifestarse frecuentemente es un hematoma subdural agudo, esto se explica debido a que existe ruptura de alguna vena del puente o pequeñas venas dúrales (13). A cabo de un tiempo esto continua con la degradación de restos hemáticos lo que conlleva a la activación del proceso de degranulación plaquetaria y desencadenar de esta manera una respuesta inflamatoria en las meninges adyacentes, provocando simultáneamente la formación de neomembranas, una interna que es fina y poco vascularizada y otra externa que es gruesa y muy vascularizada. (14)
Fuente: Elaboración propia
Su principal causa es el sangrado ocurrido posterior a un traumatismo; actualmente se ha evidenciado ciertos factores que se le añaden y pueden ayudar a favorecer su aparición. En cuanto a su incidencia se estima que va de a 3 por cada 100.000 personas; se ha demostrado que la incidencia está incrementando porque nuestra población senil cada vez aumenta más, así como las conmorbilidades que se le asocian. (6)
Los factores que predisponen esta afectación puede ser la disminución fisiológica de la masa cerebral, vejez, sexo masculino, caídas,
![](data:image/jpeg;base64,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)
Ilustración 1 Hematoma subdural crónico drenado
REVISTA / FACULTAD DE CIENCIAS MÉDICAS
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. Los autores mantienen los derechos sobre los artículos y por tanto son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra. administración de medicamentos, consumo de alcohol y episodios de epilepsia. (1) (7) (6)La sintomatología inicial en algunos casos no produce ningún síntoma o puede cursar con una cefalea leve; incluso el paciente muchas veces no recuerda cuando fue el traumatismo. En cuanto a la sintomatología se hace evidente luego de 2 a 3 semanas donde puede cursar con deterioro cognitivo el cual progresa con el tiempo, cambios de la personalidad, disminución leve de la fuerza muscular o incluso convulsiones. (8)
El diagnostico gold standar se lo realiza mediante una tomografía computarizada sin contraste del área del encefalo, sabiendo que su formación tarda de 2 a 3 semanas se presenta una lesión en media luna de resolución isodensa o hipodensa, la cual deforma la superficie del cerebro. (9)
RESULTADOS
La técnica utilizada en este trabajo de investigación fue la recolección de datos de las historias clínicas, las cuales fueron proporcionadas por la institución ante la previa solicitud y así también facilitadas por el departamento de docencia del hospital Abel Gilbert Pontón, aplicando la ficha de recolección de datos en las historias clínicas de los pacientes diagnosticados con hematoma subdural crónico.
Tabla 1 Pacientes con hematoma subdural secundario a traumatismo craneoencefálico. Distribuidos según su tiempo de evolución tratados en el hospital Abel Gilbert Pontón del 2018– 2020
TOTAL DE PACIENTES CON HEMATOMA SUBDURAL
HEMATOMA SUBDURAL SUBAGUDO
HEMATOMA SUBDURAL CRONICO
Fuente: Elaboración propiaIlustración 2 Pacientes con hematoma subdural crónico secundario a TCE del total de pacientes con hematoma subdural en el HAGP del 2018-2020
Fuente: Elaboración propia
Tabla 2 Mecanismo de trauma más frecuente en hematoma subdural crónico secundario a un traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020
Fuente: Elaboración propia.
Ilustración 3 Mecanismo de trauma más frecuente en hematoma subdural crónico
![](data:image/png;base64,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)
MECANISMO DE TRAUMA MAS FRECUENTE
EN HEMATOMA SUB- DURAL CRÓNICO
CAÍDA DESDE SU PROPIA ALTURA
CAÍDA DE VEHÍCULO EN MOVIMIENTO
AGRESIÓN POR TERCERA PERSONA
REVISTA / FACULTAD DE CIENCIAS MÉDICAS
TRATAMIENTO QUIRURGIO DE HEMATOMA SUBDURAL CRÓNICO Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. Los autores mantienen los derechos sobre los artículos y por tanto son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra.
secundario a un traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020.Fuente: Elaboración propia
Se puede observar en estos gráficos que, en un total de 207 pacientes, 117 no recuerdan cuando fue el traumatismo, lo cual representa el 57%, seguido por las caídas de su propia altura con 82 casos los cuales representan el 40%, seguido de 5 pacientes representado por el 2% debido a caídas de un vehículo en movimiento y en un menor porcentaje 1% se encuentran las agresiones por terceras personas con un total de 3 casos.
Tabla 3 Grupo de edad más afectado con hematoma subdural crónico secundario a un traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020.
GRUPO DE EDAD MÁS AFECTADO CON HEMATOMA SUBDURAL CRÓNICO
Fuente: Elaboración propia
Ilustración 4 Mecanismo de trauma más frecuente en hematoma subdural crónico
secundario a un traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020.Fuente: Elaboración propia
Se puede observar en estos gráficos que, en un total de 207 pacientes, 117 no recuerdan cuando fue el traumatismo, lo cual representa el 57%, seguido por las caídas de su propia altura con 82 casos los cuales representan el 40%, seguido de 5 pacientes representado por el 2% debido a caídas de un vehículo en movimiento y en un menor porcentaje 1% se encuentran las agresiones por terceras personas con un total de 3 casos
Tabla 4 Grupo de edad más afectado con hematoma subdural crónico secundario a un traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020.
Fuente: Elaboración propia
Ilustración 5 Grupo de edad más afectado con hematoma subdural crónico secundario a un
![](data:image/png;base64,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)
![](data:image/png;base64,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)
GRUPO DE EDAD MÁS AFECTADO CON HEMATOMA SUBDURAL CRÓNICO
REVISTA / FACULTAD DE CIENCIAS MÉDICAS
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. Los autores mantienen los derechos sobre los artículos y por tanto son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra. traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020.En los siguientes gráficos podemos observar una división por grupo de edades, el cual indica que el hematoma subdural crónico no es común en pacientes menores de 50 años, ya que no se reportó ningún caso en este grupo de edad. Por el contrario, el grupo de edad más afectado son pacientes entre 60 y 70 años con un 50% de incidencia, seguido muy de cerca por pacientes de 50 a 60 años con un total de 42% y menos frecuente en pacientes mayores de 70 años con un porcentaje del 8%.
Tabla 5 Género más afectado con hematoma subdural crónico secundario a un traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020
GÉNERO MÁS AFECTADO CON HEMATOMA SUBDURAL CRÓNICO
Fuente: Elaboración propia
Ilustración 6 Género que más presento un hematoma subdural crónico secundario a un
traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020.Se logra apreciar el predominio de sexo masculino que tiene el hematoma subdural crónico, con un total de 207 pacientes se reportó 166 casos en el sexo masculino representando un total del 80% y en el sexo femenino se reportó un total de 41 casos representado por el 20%.
Tabla 6 Conmorbilidades asociadas a la presentación de hematoma subdural crónico secundario a un traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020
Fuente: Elaboración propia
![](data:image/png;base64,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)
CONMORBILIDADES ASOCIADAS ALA PRESENTACION DE HEMATOMA SUBDURAL CRÓNICO
REVISTA / FACULTAD DE CIENCIAS MÉDICAS
TRATAMIENTO QUIRURGIO DE HEMATOMA SUBDURAL CRÓNICO Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. Los autores mantienen los derechos sobre los artículos y por tanto son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra.
Ilustración 7 Conmorbilidades asociadas a la presentación de hematoma subdural crónico secundario a TCE en el HAGP del 2018-2020
Fuente: Elaboración propia
En los siguientes gráficos se pone en evidencia que la atrofia cerebral es la principal conmorbilidad para el hematoma subdural crónico, afectando a un total de 88 pacientes y representando el 43%, seguida con un total de 64 casos representado por el 31% a pacientes que padecen de hipertensión arterial + diabetes, en un 19% con un total de 39 pacientes presentaban solo hipertensión y con un 8% representado por 16 pacientes padecían diabetes.
Tabla 7 Puntuación en la escala de Glasgow al momento del ingreso en pacientes con hematoma subdural crónico secundario a un traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020.
PUNTUACION EN LA ESCALA DE GLASGOW AL INGRESO EN PA- CIENTES CON HEMATOMA SUBDURAL CRÓNICO
TCE MODERADO Glasgow (9-12)
Fuente: Elaboración propia
Ilustración 8 Puntuación en la escala de Glasgow al momento del ingreso en pacientes con hematoma subdural crónico secundario a TCE en el HAGP del 2018-2020
Fuente: Elaboración propia
Se observa en los gráficos que el mayor porcentaje de pacientes con hematoma subdural crónico cursó con un traumatismo craneoencefálico leve teniendo 188 casos de los 207 representando un 91%, en cuanto al traumatismo craneoencefálico moderado se reportaron 19 pacientes con un total del 9% y por último se registra un total de 0 casos con traumatismo craneoencefálico grave.
![](data:image/png;base64,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)
![](data:image/png;base64,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)
REVISTA / FACULTAD DE CIENCIAS MÉDICAS
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. Los autores mantienen los derechos sobre los artículos y por tanto son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra. Tabla 8 Síntoma de presentación más frecuente en hematoma subdural crónico
Fuente: Elaboración propia
Se observa en los siguientes gráficos que el síntoma más frecuente en pacientes con hematoma subdural crónico es la cefalea leve con un total de 110 casos de 207 representando el 53%, la somnolencia con un total de 53 pacientes representado por un 26%, la hemiparesia se presentó en25 pacientes representado por el 12% y por último los pacientes que no tuvieron ningún síntoma y fue un hallazgo incidental representan el 9% con 19 pacientes.
Ilustración 9 Síntoma de presentación más frecuente en pacientes con hematoma subdural
crónico secundario a TCE en el HAGP del 2018-2020Fuente: Elaboración propia
Tabla 9 Inicio de síntomas en pacientes con hematoma subdural crónico
Fuente: Elaboración propia
Ilustración 10 Inicio de síntomas posterior al traumatismo craneoencefálico en pacientes con
SÍNTOMA DE PRESENTACIÓN MÁS FRECUENTE EN HEMATOMA SUBDURAL CRÓNICO
ALTERACION DE LA CONCIENCIA
INICIO DE SÍNTOMAS EN PACIENTES CON HEMATOMA SUBDURAL CRÓNICO
REVISTA / FACULTAD DE CIENCIAS MÉDICAS
TRATAMIENTO QUIRURGIO DE HEMATOMA SUBDURAL CRÓNICO Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. Los autores mantienen los derechos sobre los artículos y por tanto son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra.
hematoma subdural crónico en el hospital Abel Gilbert Pontón del 2018 – 2020.Fuente: Elaboración propia
Se logra observar en los siguientes gráficos que 141 pacientes presentaron síntomas después de 1 mes de sufrir el traumatismo que equivale al 68%, seguido en un 30% con 63 casos que presentan síntomas de 2 a 4 semanas, muy infrecuente la presentación de síntomas < 2 semanas con 3 casos q representan el 1% y se registró que ningún paciente presentó síntomas al mismo momento del traumatismo con un 0.
Tabla 10 tratamiento de elección pacientes con hematoma sub- dural crónico
Ilustración 11 Tratamiento de elección ante un hematoma subdural crónico secundario a un traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020.
Se aprecia en los siguientes gráficos que en 157 pacientes se realizó una craneotomía con agujero de trepano siendo el tratamiento de elección con un porcentaje del 76%, seguido en un 12% por el tratamiento farmacológico con un total de 24 pacientes, en un tercer lugar con un 7% se encuentra la craneotomía abierta con 14 pacientes y por ultimo con un total de12 pacientes representado por un 6% se encuentran los pacientes que su tratamiento fue una craneotomía con taladro manual.
Tabla 11 Complicación postquirúrgica más frecuente en pacientes con hematoma subdural crónico secundario a un traumatismo craneoencefálico en el hospital Abel Gilbert Pontón del 2018 – 2020.
COMPLICACION POSTQUIRÚRGICA EN PACIENTES CON HEMATOMA SUBDURAL CRÓNICO
![](data:image/png;base64,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)
![](data:image/png;base64,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)
TRATAMIENTO DE ELECCIÓN PACIENTES CON HEMATOMA SUB- DURAL CRÓNICO
CRANEOTOMÍA CON AGUJERO DE TREPANO
CRANEOTOMÍA CON TALADRO MANUAL
REVISTA / FACULTAD DE CIENCIAS MÉDICAS
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. Los autores mantienen los derechos sobre los artículos y por tanto son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra. Fuente: Elaboración propia
Se aprecia que un total de 156 pacientes representando por un 75% no presenta ninguna complicación postquirúrgica, seguido en un 14% con un total de 30 pacientes los cuales presentaron un nuevo sangrado, las crisis epilépticas solo se presentaron en 12 pacientes con un porcentaje del 6%, así mismo la lesión cerebral focal solo se presentó en 7 pacientes con un 3% del total y por último la complicación menos frecuente con el 1% representado por 2 pacientes se encuentra la apoplejía.
CONCLUSIONES
El presente trabajo investigativo realizado en el en el Hospital de Especialidades Abel Gilbert Pontón en el año 2018 – 2020, nos permite apreciar que el hematoma subdural crónico es una enfermedad prevalente, frecuente como consecuencia de un traumatismo craneoencefálico ya sea como consecuencia de caídas de su propia altura (40%) o en muchos casos como se muestra en nuestro estudio que no recuerden el mecanismo del trauma (57%), hay que recalcar que el HSDc afecta a principalmente a pacientes de edad avanzada entre 60 y 70 años de edad (50%), y se espera que aumente su incidencia en las próximas décadas, la mayoría de los pacientes cursan con un traumatismo craneoencefálico leve (91%) y presenta síntomas como cefalea leve (53%) así como cursar con un síndrome demencial
(26%) hasta solo presentarse como un hallazgo incidental (9%), la mayoría de los pacientes que cursan con HSDc son masculinos (80%), y que la mayoría de ellos cursan con una atrofia cerebral previa (43%), esto sucede porque la mayoría tiene como antecedente el consumo de alcohol crónico (87%). Además, hemos concluido que la craneotomía por medio de agujero de trepano es la más utilizada en el Hospital Abel Gilbert pontón (90%) y sigue siendo la que menor tasa de recurrencia produce (3%), por ende, la amplia difusión de este procedimiento se justifica por su seguridad, y la satisfactoria recuperación de los pacientes posoperatorios.BIBLIOGRAFÍA
1.Auguello SL. HEMATOMA SUBDURAL CRONICO. CONTROVERSIAS NEUROQUIRURGICAS. Congreso Virtual de Ciencias Morfologicas. Cuba: Universidad de Ciencias Médicas de Holguín. Holguín, Cuba, Cuba.2.
2.Huang JM. Chronic Subdural Hematoma: Epidemiology and Natural History. sciencedirect. 2017; 28(205 - 210).
3.Xavier WA. Patogénesis y fisiopatología del hematoma. Revista mexicana de neurociencia. 2017; 17(4): p. 78 - 85.
4.ManuelGonzález-Darder J. Historia de la craneotomía. sciencedirect. 2016; 27(5): p. 245 - 257.
5.Cuéllar-Montoya Z. Hematomas Subdurales Crónicos Unilaterales, Fisiopatología. encolombia. 2016; 29(1): p. 76.
6.Vincent M. Vacca IA. Hematoma subdural crónico: una complicación frecuente. ELSEVIER. 2019; 36(1).
7.Duche TCF, González CAQ, Cahuasquí JPO. Hematoma
REVISTA / FACULTAD DE CIENCIAS MÉDICAS
TRATAMIENTO QUIRURGIO DE HEMATOMA SUBDURAL CRÓNICO Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. Los autores mantienen los derechos sobre los artículos y por tanto son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra.
subdural crónico: tratamiento. RECIMUNDO. 2020; 4(1): p. 184 - 198.
10.Marlin Rossana Puente Tinoco EORGSMGO. Recuperación de pacientes en postoperatorio de drenaje de hematoma subdural crónico asociado al uso de ácido tranexanico. Revista Chilena de Neurocirugía. 2016; 42(4): p. 45 - 51.10. Goldstone PD, Hopkins F, Malmin RE, Paul P. Sequence of subbarrier fission resonances in U236. Phys Rev Lett. 1975;35(17):1141–3.
11.Rodríguez Gacio N. Evacuación de hematoma subdural crónico: hemorragia de Duret. Rev. Fac. Med. UNNE. 2016; 39(4).
properties. Mol Simul. 2008;34(10–15):981–7.
13.Dr. George Chater Cure DDGM. TRAUMA DE CRANEO. NEUROCIENCIAS EN COLOMBIA. 2015; 17(4).
14.René Miguel Pérez Rodríguez GCSJLRM. Hematoma subdural crónico sin evidencia de trauma previo. SCIELO. 2018; 22(3).
15.Kevin T Huang WLB,MAEB,SCY,IJT,IFD,WBG. The Neurocritical and Neurosurgical Care of Subdural Hematomas. NATIONAL LIBRARY OF MEDICINE. 2016; 24(2): p. 294-307.R. La despersonalización y su incidencia en los procesos de desgaste laboral. 2013;1–10.
16.IA I. Current diagnosis and treatment of chronic subdural haematomas. NATIONAL LIBRARY OF MEDICINA. 2015; 8(3): p. 274 - 284.
17.Daipayan Guha SC,RLM. Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study. J Neurosurg. 2016; 124(3): p. 750 - 9.
18.Arán-Echabe E FDCPGA. Hematoma subdural crónico calcificado: cerebro blindado. revista de neurologia. 2015; 58(9).
19.Alexei Rafael Pérez García APHAGMWRB. Prognostic factors of death in patients with cranioencephalic trauma. Revista cubana de neruologia. 2015; 13(4): p. 16 – 23.
REVISTA / FACULTAD DE CIENCIAS MÉDICAS