[Benign intracranial hypertension. History, clinical features and treatment in a series of 41 patients]. / Hipertensión intracraneal benigna. Antecedentes, clínica y tratamiento en una serie de 41 pacientes.

INTRODUCTION: Benign intracranial hypertension (BIH) is a syndrome characterized by the abnormal elevation of the intracranial pressure with a normal composition of the cerebrospinal fluid (CSF) and in absence of ventriculomegaly or some intracranial expansive lesion. AIM: The present work seeks, by means of the analysis of diagnosed BIH patients to evaluate its epidemic, clinical and therapeutic features. PATIENTS AND METHODS: 87 histories from intracranial hypertension diagnosed patients with normal cerebral CT were reviewed, between 1999 and 2002. 41 BIH patients were selected. RESULTS: The reached results allow us to draw the following profile, a woman (> 70%) of between 21 and 30 years (29%), smoker, obese (59%) with an recent increase of weight (37%) that consults after spending more than three months with headache (89%), alterations of the visual acuity (> 50%) and nauseas with some vomiting (> 40%). In the exploration, it presents with bilateral papilledema (100%), a CSF pressure bigger than 20 cmH2O (40,78 15,55 cmH2O) with normal composition, without alterations in the neuroradiological study results. CONCLUSION: The treatment with acetazolamide was favourable (51,2%), being definitive (70%) the lumbar peritoneal shunt when it is specified (30,7%), being improved these figures in those patients with a smaller pressure of the CSF in the moment of the diagnosis (p<0,035).

[The organization of health care for stroke. The stroke units make the difference]. / Organización asistencial en el cuidado agudo de ictus. Las unidades de ictus marcan la diferencia.

INTRODUCTION: The advantages of care in stroke units (UI) are known, as are those of being in neurology wards as compared with the general medical wards, although to date there are no studies which make a comparative evaluation of the stroke team (EI) as compared with the UI with regard to benefits in care obtained by the patients. PATIENTS AND METHODS: We made a sequential analysis from the stroke register comparing three groups of patients attended during the years 1994-1996. During 1994 the patients were attended in the neurology ward by the EI. In 1995 an acute UI was set up. The criteria for inclusion or exclusion, health staff and technical resources were similar. We analysed the average stay, complications, mortality, hospital costs, functional state and destination on discharge. RESULTS: We included 1,491 patients: 435 (1994), 529 (1995) and 527 (1996). Comparing UI with EI we observed a reduced average stay (29.5%; p<0.001), fewer complications (47.8%; p<0.001), better functional state on discharge (Rankin 1 +/- 2 against 2 +/- 2; p<0.0001), increased transference to rehabilitation units (78%; p<0.001) with less long-term hospitalisation (22%; VS) and a reduction in costs ( up to 14.2%). There was no difference in mortality. CONCLUSIONS: The UI is a better system of attendance than EI for the management of strokes, since it reduces the average stay, hospital complications and health costs, as well as permitting a better functional state on discharge. Therefore treatment in the UI makes the difference in prognosis for these patients and the institutional expenses.

[Cerebral arteriopathy with subcortical infarctions and leukoencephalopathy with dominant autosomal inheritance (CADASIL). Clinical and morphological study]. / Arteriopatía cerebral con infartos subcorticales y leucoencefalopatía con herencia autosómica dominante (CADASIL). Estudio clínico y morfológico.

OBJECTIVE: The cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is characterized by the recurrence of subcortical infarcts leading to dementia. It is known the genetic and neuroimaging findings, but there are few studies about its histopathology. Our objective had been to study the pathological findings in this arteriopathy. SUBJECTS AND METHODS: We studied two families spreading over four generations. We performed a detailed clinical history, laboratory investigations, neuroimaging study and genetic analysis. Two brain biopsies and one autopsy were done in patients from the two families. RESULTS: Eight affected members, with autosomal dominant inheritance. Age at onset was between 40 and 50 years. This was characterized clinically by recurrent ischemic attacks, headache and subcortical dementia without vascular risk factors. Histopathological findings showed an arteriopathy characterized by a slightly basophilic small arterial granular degeneration of the medial sheath associated with the presence of ballooned smooth muscle cells with clear cytoplasm. CONCLUSION: The histopathological findings of CADASIL show a characteristic arteriopathy that allow a better understanding of its pathogenesis and could contribute for its diagnosis.

[Multiple sclerosis lesions simulating an expansive process on CT]. / Lesiones de esclerosis múltiple que simulan un proceso expansivo en la TC.

Patients with multiple sclerosis may present clinical data suggestive of cerebral tumor. It has been accepted that multiple sclerosis failed to show expansive signs in the computerized tomography (CT). However, since 1979 a total number of 13 patients have been reported to have expansive images at the CT. We report 3 cases with clinical symptoms suggesting a cerebral tumor associated with expansive signs at the CT. The subsequent follow-up of these patients confirmed the diagnosis of clinically defined multiple sclerosis. The management of these patients is difficult. Those patients with previous history suggestive of multiple sclerosis should be probably treated with steroids and followed with serial CT. If a clear recovery was not achieved in a relatively short term, a cerebral biopsy is recommended to rule out a neoplasm. When the clinical presentation begins with signs suggestive of a neoplasm, the cerebral biopsy is recommended.

[Neurologic effects of alcoholism]. / Repercusiones neurológicas del alcoholismo.

The alcoholism is no hereditary but genetic factors can be involved and racial differences in alcohol susceptibility depend on break down rate of ethanol. The alcohol adaptation and tolerance and physical dependence appearance with symptoms and signs display after abstinence on people suffers with chronic intoxication, it would be related to changes caused by alcohol over molecules of neuronal membranes, especially proteins and receptors. An account is achieved about the various neurologic manifestations related to alcoholism, nutritional in origin or unknown pathogenesis. The results obtained looking over the admission along 1988 in Neurological Service ("La Paz" Hospital) allowed to take into account three groups of alcoholic patients (miscellaneous, abstinence syndrome-encephalopathy-dementia-neuropathy, and stroke). It is analysed the results and it is afforded some conclusions about.

Absence status following metrizamide myelography: management of nonresponders.

Acute confusional state following metrizamide myelography has been reported to occur in up to 2% of patients. These patients have been diagnosed as having toxic encephalopathy. Recently, various cases have been reported to have a nonconvulsive status (absence status or complex partial status) who responded well to diazepam or clonazepam therapy. However, some authors have described cases of nonresponders to anticonvulsive therapy. Failure of therapy can be dose-related. For this reason, our patient was closely monitored by EEG to determine if dose adjustment was warranted, thereby achieving good results.