Diagnosis and treatment of disorders of intracranial pressure: consensus statement of the Spanish Society of Neurology's Headache Study Group.

Primary intracranial pressure disorders include idiopathic intracranial hypertension and spontaneous intracranial hypotension. Remarkable advances have been made in the diagnosis and treatment of these 2entities in recent years. Therefore, the Spanish Society of Neurology's Headache Study Group (GECSEN) deemed it necessary to prepare this consensus statement, including diagnostic and therapeutic algorithms to facilitate and improve the management of these disorders in clinical practice. This document was created by a committee of experts belonging to GECSEN, and is based on a systematic review of the literature, incorporating the experience of the participants, and establishes practical recommendations with levels of evidence and grades of recommendation.

Characteristics of informal caregivers of patients with dementia in Alicante province.

INTRODUCTION: Informal caregivers provide care to dementia patients, and this service prolongs their stay at home. OBJECTIVES: To describe characteristics of dementia patients in the province of Alicante, as well as the profiles and roles of caregivers who assist them. PATIENTS AND METHODS: Multi-centre prospective study carried out in 4 neurology departments in Alicante (June 2009 to January 2010). Dementia patients' relatives/caregivers were included in sequential order. The following variables were analysed: a) Demographic information pertaining to the patient and caregivers (age, sex, marital and employment status, educational level, relationship to patient); b) patient's family unit; c) motivating factor for primary caregiver (PC); d) secondary caregiver (SC) roles; e) country of citizenship of formal caregiver (FC) and source of remuneration (private/public); f) caregivers' knowledge of dementia. RESULTS: Most of our patients live at home (74.8%), and are female (69%) with Alzheimer's disease (78.4%) in a moderately severe stage (GDS level 4-5, 71.6%). PCs and SCs are mainly women (72.1% and 60.5% respectively), middle-aged and directly related to the patient (sons/daughters account for 64.3% of the PCs and 54.4% of the SCs); most are homemakers with a low educational level. Caregivers in the first category (PC) provide care due to moral obligation (75%), while those in the second (SC) involve patients in leisure or other stimulating activities (82.3%). Absent caregivers tend to be males (73.3%) residing long distances from the relative (52.4%). The FC tends to be female (91.7%), Spanish (81.8%) and privately remunerated. CONCLUSIONS: Women dominate the network of caregivers for dementia patients, whether as principal caregivers, supporting caregivers or formal caregivers (in all cases, they have only limited training in dementia management). Males are largely absent. Better knowledge of the care structure supporting dementia patients may be helpful in the overall management of these patients.

[Differences between Spanish ischemic stroke patients and those from Central and Northern Europe. A case-control study]. / Diferencias entre pacientes con ictus isquémico españoles frente a centro y nordeuropeos: un estudio de casos y controles.

INTRODUCTION: Studies conducted in the American population have revealed the existence of differences in cerebral vascular pathologies and in the prevalence of vascular risk factors between races. The few studies carried out in Hispanic populations have found a higher prevalence of diabetes mellitus, as well as a lower frequency of cardioembolic strokes and extracranial carotid atheromatosis, in comparison with whites of Anglo-Saxon extraction. PATIENTS AND METHODS: We performed a case-control study in which one case was paired with two controls, according to age and sex. The cases were people from Central and Northern Europe and the controls were Spaniards. All of them had been admitted to hospital because of ischemic stroke or TIA. We compared the frequency of conventional risk factors (RF), the subtype of ischemic stroke and the results from carotid duplex scans. The odds ratio and confidence intervals (CI) at 95% were calculated for paired data. RESULTS: Arterial hypertension (AHT) was less frequent in the cases, with an OR of 0.45 (CI 0.24-0.83). No statistically significant differences were found in the prevalence of diabetes, hypercholesterolemia, heart disease and atrial fibrillation. Fast recovery stroke and TIA were observed more frequently in the cases than in the controls (OR: 3.73; CI: 1.72-8.07), which we interpreted as being due to a bias in admissions. Carotid duplex scanning revealed stenosis > 70% in 21.9% of the cases and in 13% of the controls. CONCLUSIONS: This study did not reveal any differences between Spaniards and Northern Europeans in conventional RF, except for a higher prevalence of AHT in Spaniards. Severe carotid pathology seems to be less frequent in Spaniards. Future research should take into account other RFs (such as cholesterol subfractions, homocysteine, etc.), which are possibly race-linked and may account for the differences described.

[A control and case study of multiple sclerosis in the Alicante and Villajoyosa areas]. / Estudio de casos y controles sobre la esclerosis múltiple en las áreas de Alicante y Villajoyosa.

INTRODUCTION: Three studies have been carried out in the area of Alcoy (Spain) which show an association between contact with dogs and multiple sclerosis. We present a control and case study conducted in a different geographical area, the area of Alicante. AIMS. To examine environmental factors linked with multiple sclerosis in the health care district of Alicante, and to compare findings with those from the health care district of Alcoy. PATIENTS AND METHODS: A study of cases and controls was conducted with 47 patients, each of which was paired with four controls according to gender, age and place of residence. All the cases fulfilled criteria of defined multiple sclerosis. The controls were obtained from the Emergency and Casualty Services at different hospitals in the area. Each of the environmental factors studied was stratified by genders. RESULTS: A total of 47 patients and 188 controls were analysed. A statistically significant association was found between the disease and smoking, a low educational level, a social level 2 on the classification developed by Koch Henriksen, having had measles before the age of 15 and contact with dogs. The fact of being the third, or later, child in a family and a family history of cephalea were more frequent among controls than among cases. CONCLUSIONS: Multiple sclerosis in the Alicante area is related with contact with dogs, smoking, a low educational level, a high social level and measles before the age of 15. Since an association between contact with dogs and multiple sclerosis has been shown repeatedly in other previous studies conducted in the town of Alcoy, we are now in a position to state that this factor is indeed linked with the appearance of multiple sclerosis.

[The epidemiology of multiples sclerosis in Alcoi. Analytical data]. / Epidemiología de la esclerosis múltiple en Alcoi. Datos analíticos.

INTRODUCTION: The epidemiology of multiple sclerosis (ME) in the Alcoi area has been studied by our groups for many years. When studying the factors linked to ME in this area initially we observed that migration, contact with dogs and the textile industry were associated with the disorder. A later study, in which the migration factor was controlled, still showed a significant association with contact with dogs and the textile industry. OBJECTIVE: To make an analytical study avoiding the possible confusing effect of contact with the textile industry, since this may be associated with other factors. We also compared the results of previous studies. PATIENTS AND METHODS: We made a case control study in which each case was paired with four controls for age, sex and having worked or not worked in the textile industry. The cases fulfilled the criteria for diagnosis of ME. The control patients came from the Emergency and Trauma Departments of Alcoi hospital. RESULTS. We analyzed 37 patients and 148 controls. Significant values were obtained for smoking, low social class, chickenpox and measles infections when aged under 15 years, pneumonia when aged over 15 years and contact with dogs, sheep and dissolvents. CONCLUSIONS: Contact with dogs was associated with multiple sclerosis in all the studies carried out in the Alcoi area to date. This is therefore a risk factor for the disorder in the Alcoi population.

[Sporadic familial meningiomas]. / Meningiomas familiares esporádicos.

INTRODUCTION: Meningiomas are primary tumours of the central nervous system. Usually they are sporadic. The occurrence in more than one member of a family is unusual. Up till now this coincidence had been related with type 2 neurofibromatosis. In this paper we comment on two siblings who did not fulfil neurofibromatosis diagnostic criteria as an example of sporadic familial meningiomas. CLINICAL CASES: Two siblings (a 79 years old female and a 77 years old male) were diagnosed of a meningioma in an interval of two years, with surprising clinical and neuroimaging similarities. In sporadic meningiomas, abnormalities in the long arm of chromosome 22 have been found. Type 2 neurofibromatosis causative gene has also been found in this chromosome. Meningiomas are quite often found in this entity, and therefore, this gene was implicated as a main factor in the genesis of an important number of meningiomas. However, several studies have not found an association between these tumours and the locus for neurofibromatosis, leading to think that there may be other genes that may influence on meningiomas development.

[Cerebral venous thrombosis]. / Trombosis venosas intracraneales.

INTRODUCTION: Cerebral venous thrombosis (CVT) is a type of pathology which has many predisposing factors and forms of presentation, which make diagnosis and prognosis difficult. The objective of this paper is to review, and bring up to date, different aspects of knowledge concerning: aetiology, clinical features, diagnosis and treatment. MAIN FINDINGS: The proportion of cases of unknown aetiology is between 20-35% in spite of new causes being described. Magnetic resonance and recently, angiographic resonance are the diagnostic methods of choice, although conventional angiography is still necessary in some cases. The treatment of CVT is based on correction of the cause, control of symptoms and the use of anti-thrombotic drugs, mainly anticoagulants and more recently, fibrinolytic agents. The mortality of current series of patients is 10-15% and only 15-25% of the patients show sequelae. CONCLUSIONS: CVT is not rare and neuro-imaging techniques allow early diagnosis of more cases. In general prognosis is good. Antithrombotic treatment is still controversial and further study is necessary in this field.