Neurophysiological intraoperative monitoring during an optic nerve schwannoma removal.

This paper reports the case of a patient with optic nerve schwannoma and the first use of neurophysiological intraoperative monitoring of visual evoked potentials during the removal of such tumor with no postoperative visual damage. Schwannomas are benign neoplasms of the peripheral nervous system arising from the neural crest-derived Schwann cells, these tumors are rarely located in the optic nerve and the treatment consists on surgical removal leading to high risk of damage to the visual pathway. Case report of a thirty-year-old woman with an optic nerve schwannoma. The patient underwent surgery for tumor removal on the left optic nerve through a left orbitozygomatic approach with intraoperative monitoring of left II and III cranial nerves. We used Nicolet Endeavour CR IOM (Carefusion, Middleton WI, USA) to performed visual evoked potentials stimulating binocularly with LED flash goggles with the patient´s eyes closed and direct epidural optic nerve stimulation delivering rostral to the tumor a rectangular current pulse. At follow up examinations 7 months later, the left eye visual acuity was 20/60; Ishihara score was 8/8 in both eyes; the right eye photomotor reflex was normal and left eye was mydriatic and arreflectic; optokinetic reflex and ocular conjugate movements were normal. In this case, the epidural direct electrical stimulation of optic nerve provided stable waveforms during optic nerve schwannoma resection without visual loss.

Asociación entre elevación sérica de gamma-glutamil transpeptidasa y riesgo aumentado de evento vascular cerebral isquémico en población mexicana / Relation between serum elevation of gamma-glutamyl transpeptidase and increased risk of ischemic stroke in Mexican population

Resumen: ANTECEDENTES: Las concentraciones elevadas de gamma-glutamil transpeptidasa (GGT) se han asociado con el riesgo de enfermedad coronaria isquémica, diabetes mellitus tipo 2 y evento vascular cerebral. OBJETIVO: Determinar mediante métodos estadísticos estandarizados que la elevación sérica de gamma-glutamil transpeptidasa es predictor temprano de evento vascular cerebral en la población mexicana. MATERIAL Y MÉTODO: Estudio tipo casos y controles, con medición de GGT sérica en pacientes con enfermedades crónico-degenerativas en control y pacientes crónicos con un evento cardiovascular adverso, en este caso, un evento vascular cerebral de tipo isquémico (EVC), efectuado de mayo de 2016 a julio de 2017. RESULTADOS: Se incluyeron 74 pacientes; los pacientes con EVC tuvieron, en pro- medio, 17.81 U/L de GGT más que los controles ajustado por edad, con diferencia estadísticamente significativa (p = 0.038, IC95% 1.04-34.57). CONCLUSIONES: Las concentraciones de gamma-glutamil transpeptidasa se correlacionan de manera directamente proporcional con el riesgo cardiovascular, lo que tiene gran importancia debido a que se ha demostrado que sus concentraciones séricas pueden disminuirse con medidas como dieta y ejercicio, por lo que se abre un amplio panorama para posteriores estudios que puedan reafirmar la validez de éste y hacer otros con un enfoque preventivo.

Abstract: BACKGROUND: Elevated levels of gamma-glutamyl transpeptidase (GGT) have been associated with the risk of ischemic heart disease, diabetes mellitus and stroke. OBJECTIVE: To determine, by means of standardized statistical methods, that the serum elevation of GGT is an early predictor of ischemic stroke in the Mexican population. MATERIAL AND METHOD: A case-control study was conducted with measurement of serum GGT in patients with chronic-degenerative diseases without cardiovascular events and chronic patients with an adverse cardiovascular event, in this case, an ischemic stroke, done from May 2016 to June 2017. RESULTS: A total of 74 patients were analyzed; patients with ischemic stroke presented, on average, 17.81 U/L of GGT more than controls adjusted for age, with a statistically significant difference (p = 0.038, 95%CI 1.04- 34.57). CONCLUSIONS: GGT levels correlated directly with cardiovascular risk, which is of great importance, since it has been shown that serum levels can be reduced with measures such as diet and exercise, so that a broad panorama opens up for further studies that can reaffirm the validity of this study and do others with a preventive approach.

Índice leuco-glucémico asociado con complicaciones en isquemia cerebral aterotrombótica / Leuco-glycemic index associated to complications in atherothrombotic cerebral ischemia

Resumen: OBJETIVO: Evaluar el índice leuco-glucémico (ILG) como marcador pronóstico de mortalidad y complicaciones en pacientes con enfermedad vascular cerebral de tipo isquémico aterotrombótico. MATERIAL Y MÉTODO: Estudio prospectivo efectuado en pacientes con enfermedad vascular de tipo isquémico aterotrombótico durante la fase aguda del infarto, que ingresaron entre enero y diciembre de 2017 al servicio de Medicina Interna del Hospital General Ticomán. Se recolectaron datos clínicos y de laboratorio, incluyendo glucemia y leucograma al ingreso, a partir de los cuales se calculó el ILG y se evaluó su valor pronóstico, así como su relación con las escalas de NIHSS y Rankin y con la mortalidad a 21 días. RESULTADOS: Se incluyeron 72 pacientes. Los pacientes con mayor número de complicaciones durante la hospitalización tuvieron valores superiores de ILG (p = 0.02). Se obtuvo un valor ≥ 900 como punto de corte; los pacientes con valores superiores tuvieron tres veces mayor probabilidad de complicaciones durante la hospitalización (razón de momios = 3.02; IC95%: 1.03 a 9.9; p = 0.04), por lo que el índice leuco-glucémico constituyó un predictor significativo. CONCLUSIONES: El índice leuco-glucémico se relacionó con mayor severidad de enfermedad vascular cerebral en las escalas de NIHSS y Rankin, además, se asoció con complicaciones intrahospitalarias.

Abstract: BACKGROUND: The glycemia and the determination of serum leukocytes on admission have demonstrated prognostic importance in patients with ischemic cerebral vascular disease (CVD). The leuko-glycemic index (ILG) is recently studied as a prognostic marker, but knowledge about its value is lacking. OBJECTIVE: To evaluate the leuko-glycemic index (ILG) as a prognostic marker of mortality and complications in patients with atherothrombotic ischemic stroke. MATERIAL AND METHOD: A prospective study was conducted on patients with atherothrombotic ischemic vascular disease during the acute phase of the infarction, who were admitted to the Internal Medicine Department of the Ticoman General Hospital from January to December 2017. Clinical and laboratory data were collected, including glycemia and leukogram at admission, from which the ILG was calculated and its prognostic value was evaluated, as well as its relationship with the NIHSS and Rankin scales and/or with the 21-day mortality. RESULTS: There were included 72 patients. Patients with a higher number of complications during hospitalization had higher ILG values (p = 0.02). A value ≥ 900 was obtained as a cut-off point; patients with higher values presented a three times higher probability of complications during hospitalization (odds ratio: 3.02, CI95%: 1.03 to 9.9, p = 0.04), so the ILG was a significant predictor. CONCLUSIONS: Leuko-glycemic index was associated with greater severity of cerebral vascular disease in the NIHSS and Rankin scales, and was associated with intrahospital complications.