Factores asociados a sobrevida a un año en pacientes postoperados de glioblastoma.

OBJECTIVE: To identify factors associated with one-year survival in postoperative glioblastoma patients at a hospital in northeastern Mexico. MATERIAL AND METHODS: Nested case-control study. Patients operated on for glioblastoma between 2016-2019 were included. Information about clinical and surgical factors was obtained, survival was calculated by Kaplan-Meier analysis. Descriptive analysis was performed with medians and ranges, and inferential analysis with χ2, Fisher and Student t test, odds ratio and 95% confidence interval. A value of p < 0.05 was considered significant. RESULTS: Sixty-two patients with glioblastoma were included, 27 (43.5%) women and 35 (56.5%) men, median age 56 years (range: 6-83). Median survival was 3.6 months (1-52), 45 (72.6%) survived less than 12 months. The factors associated with a higher survival were administration of adjuvant treatment (p < 0.001), better functional status (p = 0.001), and absence of post-surgical complications (p = 0.034). CONCLUSIONS: Most patients with glioblastoma survive less than 12 months and the factors most strongly associated with longer survival are administration of adjuvant treatment, better functional status of the patient and absence of post-surgical complications.

OBJETIVO: Identificar los factores asociados a la sobrevida a un año en pacientes postoperados de glioblastoma en un hospital del noreste de México. MATERIAL Y MÉTODOS: Estudio de casos y controles anidado en una cohorte. Se incluyeron pacientes operados de glioblastoma entre 2016 y 2019. Se obtuvo la información sobre factores clínicos y quirúrgicos, se calculó la sobrevida mediante análisis de Kaplan-Meier. El análisis descriptivo se realizó con medianas y rangos, y el inferencial con prueba de χ2, Fisher, t de Student, razón de momios e intervalo de confianza al 95%. Se consideró significativo un valor de p < 0.05. RESULTADOS: Se incluyeron 62 pacientes con glioblastoma, 27 (43.5%) mujeres y 35 (56.5%) hombres, mediana de edad de 56 años (rango: 6-83). La mediana de sobrevida fue de 3.6 meses (1-52), 45 (72.6%) sobrevivieron menos de 12 meses. Los factores asociados a mayor sobrevida fueron: administración de tratamiento adyuvante (p < 0.001), mejor estado funcional (p = 0.001) y ausencia de complicaciones posquirúrgicas (p = 0.034). CONCLUSIONES: La mayoría de los pacientes con glioblastoma sobreviven menos de 12 meses y los factores más fuertemente asociados a mayor sobrevida son administración de tratamiento adyuvante, mejor estado funcional del paciente y ausencia de complicaciones posquirúrgicas.

Grading scale for prediction of outcome in primary intracerebral hemorrhages.

BACKGROUND AND PURPOSE: This study aimed to independently derive an intracerebral hemorrhage grading scale (ICH-GS) for prediction of 3 outcome measures. METHODS: We evaluated 378 patients with primary ICH at hospital arrival and during the next 30 days. Independent predictors were identified by multivariate models of in-hospital and 30-day mortality. Points were allotted to each predictor based on its prognostic performance. ICH-GS was also evaluated to predict good 30-day functional status and ICH-GS was compared with the ICH score as the reference scoring system. RESULTS: Independent predictors were age, Glasgow Coma Scale, ICH location, ICH volume, and intraventricular extension, all components of the ICH score. Nevertheless, different cutoffs and scoring improved substantially the prognostic power of the predictors. Compared with the ICH score, ICH-GS explained more variance in the 3 outcome measures, had higher sensitivity in predicting in-hospital and 30-day mortality, and performed equally well in predicting good functional outcome at 30 days follow up. CONCLUSIONS: The derived ICH-GS is a simple yet robust scale in predicting in-hospital and 30-day mortality, as well as good 30-day functional status, with equivalent performance.

Choreoacanthocytosis in a Mexican family.

BACKGROUND: Choreoacanthocytosis (CHAC) (Online Mendelian Inheritance in Man accession No. 200150) is a hereditary neurodegenerative syndrome characterized by movement disorders, cognitive decline, myopathy, behavioral changes, and acanthocytosis and is caused by mutations in the VPS13A gene. OBJECTIVE: To describe the cases of 2 Mexican women with clinical and molecular characteristics compatible with CHAC. DESIGN: Case reports. Patients Choreoacanthocytosis was identified in 2 Mexican mestizo sisters with healthy consanguineous parents. Clinical manifestations began at different ages. RESULTS: The onset of signs and symptoms of CHAC in the proband was at age 32 years and was characterized by balancing problems followed by chorea, compulsive lip and tongue biting with buccolingual self-mutilation, dysarthria, dysphagia, and weight loss. The first clinical manifestations in the proband's sister occurred at age 45 years and included multiple motor and verbal tics, with coprolalia, followed by lip and tongue biting, self-mutilation, and chorea. The clinical findings in both sisters were remarkable for acanthocytosis that developed late, when neurologic changes were already evident. Mutation screening of the VPS13A gene revealed homozygosity for the frameshift mutation c.3556_3557dupAC in exon 33. Currently, the proband's sister, in whom neurologic defects developed 13 years after onset of CHAC in the proband, is the least affected. CONCLUSIONS: The same mutation of the VPS13A gene can be expressed differently in the same family. This observation confirms the notion that there is considerable heterogeneity in the clinical manifestation of CHAC.

Hypertensive intracerebral hemorrhage in young people: previously unnoticed age-related clinical differences.

BACKGROUND AND PURPOSE: Hypertensive intracerebral hemorrhage (ICH) in young people has been the object of only succinct analyses. Therefore, it is unclear whether extrapolation of the information obtained from older patients is also valid for the young. Here we describe young persons with hypertensive ICH and compare them with their older counterparts to determine whether age-related clinical differences exist. METHODS: From 1988 to 2004, we studied 35 consecutive young patients with ICH (60% men; mean age, 33 years; range, 15 to 40 years) for whom the etiology of the brain hemorrhage was hypertension. For clinical comparisons, sex-matched persons with hypertensive ICH, aged >40 years, were randomly selected by a factor of 3:1 (n=105). RESULTS: Essential hypertension was present in 26 (74%) young patients and secondary hypertension in 9 (26%), with renovascular hypertension being the most common cause (n=5, 55%). Compared with older patients, the young had higher blood pressures, smaller hemorrhage volumes, lower rates of ventricular extensions (for all, P<0.05), and different distribution pattern of ICHs (P=0.05), without cerebellar and lobar locations. Thirty-day mortality was markedly lower in the young than in older persons (P=0.001), nevertheless at the expense of more incapacitating disabilities. CONCLUSIONS: Young people presenting with hypertensive ICH differ in clinical characteristics and have a different prognosis when compared with their older counterparts. These findings suggest underlying age-related differences in disease pathogenesis.

Hypertensive intracerebral hemorrhage in the very elderly.

BACKGROUND: The number of persons reaching the age 80 years and over is increasing in most populations. Literature focusing on hypertensive intracerebral hemorrhage (ICH) in this age group is lacking. Therefore, we aimed to analyze the main clinical characteristics of ICH of the advanced old age, in the context of hypertension. METHODS: From 1999 to 2003 we studied 56 hypertensive very elderly patients presenting with ICH (50% women; age 80-99 years). As controls, 168 hypertensive gender-matched persons with ICH, aged <80 years, were randomly selected by a 3:1 factor for clinical comparisons. RESULTS: Compared with their younger counterparts, the very elderly patients had a trend for fewer cases of obesity (34 vs. 49%, p = 0.05) and diabetes mellitus (12 vs. 24%, p = 0.06), had lower systolic, diastolic and mean blood pressure measures (in all, p < 0.01) and more cases with hematoma extension into ventricles (p = 0.02). Thalamic hemorrhage was more frequent in the very elderly patients than in controls (43 vs. 28%, p = 0.04). In multivariate analysis, age, Glasgow coma scale score at hospital admission, ICH volume and infratentorial location were independent predictors of in-hospital mortality, in all persons combined. In the very elderly group exclusively, Glasgow coma scale score was the only factor independently associated with mortality. CONCLUSIONS: ICH occurring in hypertensive patients aged > or =80 years has several differences from that seen in younger people; however, these differences do not seem to impact on early outcome.