Pure spinal epidural cavernous hemangioma.

BACKGROUND: Pure epidural cavernous hemangiomas without bony involvement are rare, representing 4% of all spinal epidural tumors. Most of these are case reports and are easily misdiagnosed. METHODS: Herein nine patients (male:female, 5:4, average age: 51 years) with symptomatic pure epidural spinal cavernous hemangioma between 2005 and 2011 were treated, and the clinical, radiological, and pathological records, treatment, and prognosis were discussed. RESULTS: All patients experienced a slowing progressive clinical course, except for one with intralesional hemorrhage. Clinical manifestations included back or radiating pain, sensorimotor deficits, and sphincters disturbance. Eight lesions were isointense on T1- and hyperintense on T2-weighted images with homogenously strongly enhancement and one was mixed signal with heterogeneous enhancement because of intratumoral hemorrhage. Hemilaminotomoy or laminotomy was performed and total resection was achieved. All patients experienced a gradual neurological improvement with no recurrence. CONCLUSIONS: Spinal epidural cavernous hemangioma is a benign vascular malformation that should be excluded in the diagnosis of epidural lesion. Total surgical resection is recommended and usually results in a good prognosis.

Epilepsies and epileptic syndromes starting in the neonatal period.

As seizures in the neonatal period have generally been identified only by direct clinical observation, there is frequently a lack of objectivity as to whether seizures are categorized as epilepsies or non-epilepsies. A major characteristic of neonatal seizures is electro-clinical dissociation and some electro-graphic seizures do not produce clinical symptoms. It is difficult to correctly identify real epilepsies or epileptic syndromes in the neonatal period without ictal electroencephalogram (EEG). Some epileptic syndromes starting in the neonatal period such as early myoclonic encephalopathy, Ohtahara syndrome, or migrating partial seizures in infancy are categorized as malignant epilepsies. A suppression-burst EEG pattern (SBP) is usually seen in neonates with serious brain damage, malignant epileptic syndromes or other neurological conditions. However SBP has not been consistently defined in the literature. We review malignant epilepsies and benign familial and non-familial neonatal seizures starting in the neonatal period and propose the characteristics of SBP in Ohtahara syndrome. Epileptic encephalopathies with SBP in the neonatal period are known to evolve into relatively few types of epileptic syndromes. We emphasize the importance of ictal EEG for diagnosis and treatment of malignant epilepsies and epileptic syndromes in the neonatal period.

Convulsiones neonatales / Neonatal convulsions

Las convulsiones neonatales son la evidencia más clara de una anormalidad en el funcionamiento cerebral, teniendo una incidencia variable entre 1 a 5 por 1000 RN vivos, asociándose más frecuentemente a una patología subyacente, a diferencia de las condiciones genéticas o idiopáticas que se observan en otras edades. La fisiopatología involucrada incluye una descarga hipersincrónica de un grupo finito de neuronas corticales, a través de diferentes mecanismos que conducen a una despolarización de las membranas neuronales. La clasificación utilizada se fundamenta en una observación cuidadosa de los fenómenos clínicos, siendo los hallazgos motores de tipo tónico, clónico, mioclónico y automatismos los de mayor relevancia, agregándose los datos aportados por el electroencefalograma (EEG) y video-EEG para complementar las apreciaciones clínicas. En el diagnóstico diferencial hay fenómenos motores como el mioclonus benigno del sueño, temblores, movimientos del despertar, reflejos fisiológicos, movimientos conductuales, movimientos extrapiramidales entre otros. Se debe además reconocer si estas forman parte de uno de los síndromes específicos que se inician en el período neonatal. El tratamiento adecuado incluye el de la etiología subyacente así como los fármacos anticonvulsivantes, dentro de los cuales el Fenobarbital, Lorazepam y Fenitoína aún tienen una participación relevante.