[First episode non-traumatic subarachnoid haemorrhage. An epidemiological study of incidence and of arterial hypertension as a risk factor]. / Primer episodio de hemorragia subaracnoidea no traumática. Estudio epidemiológico de su incidencia y de la hipertensión arterial como un factor de riesgo.

AIMS: Our aim was to conduct an epidemiological study of the incidence of non-traumatic subarachnoid haemorrhage (NTSAH) and to evaluate a history of arterial hypertension (AHT) as a risk factor (RF). We also sought to determine the gross annual rate (GAR) and specific rates, by sex and age, of first episode non-traumatic subarachnoid haemorrhage (FENTSAH) adjusted to the Censo Nacional de Población de la Argentina (CNPA), and to carry out a population-based case-control study about the history of AHT as a RF in an Argentine community. PATIENTS AND METHODS: Our institution, the Hospital Privado de Comunidad de Mar del Plata, Argentina, attends a population of about 89,500 individuals exclusively and completely. There is a single filing system of case histories with all the diagnoses in a database. Patients who suffered a FENTSAH between the years 1992 and 1996 (n=62) were investigated to determine the specific GAR by sex and age and adjusted to the 1991 CNPA. The population was compared at random with two controls per case for the study of a history of AHT as a RF, and was then stratified according to sex and age. RESULTS: 1. GAR: 13.6/100,000 inhab./year; 2. Specific rate for males: 10.5/100,000 inhab./year; 3. Specific rate for females: 15.9/100,000 inhab./year; 4. CNPA adjusted rate: 7.3/100,000 inhab./year; 5. A significantly important number of patients with FENTSAH presented a history of hypertension as compared to controls subjects (odds ratio: 4.73; CI 95%: 2.39 9.34). CONCLUSIONS: Our rates are not substantially different from the rates found in other western countries and our findings indicate that a history of AHT is a RF for FENTSAH.

[Chronic acquired hepatocerebral degeneration. Two case reports]. / Degeneración hepatocerebral crónica adquirida. Presentación de dos casos.

INTRODUCTION: Chronic acquired hepatocerebral degeneration (CAHD) is a rare heterogeneous disorder that may occur in patients with chronic liver disease, initially described in 1914 by van Woerkom. The spectrum of clinical presentations may be neuropsychiatric, a movement disorder, parkinsonism, cerebellar symptoms and myelopathy. The pathogenesis of CAHD has not been well clarified and is probably multifactorial. Neuroradiological patterns show a specific magnetic resonance (MR) imaging appearance with a hyperintense T1 signal in the basal ganglia and substantia nigra. CASES REPORTS: We describe two cases with clinical features and MR imaging findings present in the CAHD. One had Budd-Chiari syndrome, myoclonus and T1 hyperintensity in pallidum and substantia nigra in MR. The other had focal dystonia of the fingers and T1 hyperintensity in pallidum in MR. CONCLUSION: These two case reports have clinical and neuroradiological findings present in CAHD.

[Bupivacaine induced aseptic meningitis]. / Meningitis aséptica inducida por bupivacaína.

INTRODUCTION: Drug-induced aseptic meningitis (DIAM) is an uncommon adverse reaction secondary to the administration of numerous agents. It is diagnosed by exclusion, and its outcome is generally excellent with complete long term recovery. There are few reports of DIAM associated to intrathecal administration of bupivacaine in the literature. CASE REPORT: We present a 16 year-old male patient who received spinal anaesthesia with 10 mg of bupivacaine prior to orthopedic surgery. A few hours later he complained of headache followed by confusion and stupor. A TC scan of the brain was normal. Diagnostic lumbar puncture revealed cloudy cerebrospinal fluid (CSF) with increased polymorphonuclear, increased protein and decreased glucose concentrations. Immediate treatment with antibiotics and corticosteroids was instituted and the patient rapidly recovered without sequelae. Blood and CSF cultures were negative, antibiotics were suspended and corticosteroids tapered. CONCLUSION: To the best of our knowledge, we report a case of bupivacaine induced aseptic meningitis.

Degeneración hepatocerebral crónica adquirida. Presentación de dos casos / Chronic acquired hepatocerebral degeneration. Two case reports

Introducción. La degeneración hepatocerebral crónica adquirida (DHCA) es un trastorno heterogéneo raro que puede ocurrir en pacientes con enfermedad hepática crónica, descrito por primera vez en 1914 por van Woerkom y con un amplio espectro de manifestaciones neurológicas. Éste comprende alteraciones neurocognitivas, movimientos anormales, parkinsonismo, síndrome cerebeloso y mielopatía. El mecanismo fisiopatológico del cuadro no está completamente definido y probablemente sea de origen multifactorial. El patrón radiológico característico muestra hiperintensidad en T1 a nivel de los ganglios basales en la resonancia magnética (RM) cerebral.Casos clínicos. Describimos dos pacientes con manifestaciones neurológicas y hallazgos radiológicos presentes en la DHCA. El primero con síndrome de Budd-Chiari, mioclonías e hiperintensidad en T1 a nivel del globo pálido y sustancia negra bilateral en la RM. El segundo con distonía focal de mano e hiperintensidad en T1 a nivel del globo pálido bilateral en la RM.Conclusión. Los casos descritos reúnen los hallazgos clínicos y radiológicos presentes en la DHCA

Introduction. Chronic acquired hepatocerebral degeneration (CAHD) is a rare heterogeneous disorder that may occur in patients with chronic liver disease, initially described in 1914 by van Woerkom. The spectrum of clinical presentations may be neuropsychiatric, a movement disorder, parkinsonism, cerebellar symptoms and myelopathy. The pathogenesis of CAHD has not been well clarified and is probably multifactorial. Neuroradiological patterns show a specific magnetic resonance (MR) imaging appearance with a hyperintense T1 signal in the basal ganglia and substantia nigra.Cases reports. We describe two cases with clinical features and MR imaging findings present in the CAHD. One had Budd-Chiari syndrome, myoclonus and T1 hyperintensity in pallidum and substantia nigra in MR. The other had focal dystonia of the fingers and T1 hyperintensity in pallidum in MR.Conclusion. These two case reports have clinical and neuroradiological findings present in CAHD

Meningitis aséptica inducida por bupivacaína / Bupivacaine induced aseptic meningitis

Introducción. La meningitis aséptica inducida por fármacos (MAIF) es una reacción adversa poco frecuente, secundaria a la administración de numerosos agentes. El diagnóstico se realiza por exclusión y el pronóstico es generalmente favorable sin secuelas a largo plazo. Hay escasos informes en la literatura médica de MAIF secundaria a la administración de bupivacaína intratecal. Caso clínico. Comunicamos un paciente de 16 años de sexo masculino que horas después de haber sido sometido a cirugía ortopédica previa anestesia intrarraquídea con bupivacaína presentó cefalea, confusión y letargia, sin hallazgos relevantes en estudios por neuroimagen. Se realizó punción lumbar, habiéndose obtenido líquido cefalorraquídeo turbio con pleocitosis polimorfonuclear, hiperproteinorraquia e hipoglucorraquia. Tratado inicialmente con antibióticos y corticoides endovenosos, evolucionó favorablemente sin secuelas neurológicas. La antibioticoterapia se suspendió una vez obtenido el resultado negativo de los cultivos, continuando con corticoides en descenso gradual. Conclusión. A nuestro saber, describimos un caso de meningitis aséptica inducida por bupivacaína

Introduction. Drug-induced aseptic meningitis (DIAM) is an uncommon adverse reaction secondary to the administration of numerous agents. It is diagnosed by exclusion, and its outcome is generally excellent with complete long term recovery. There are few reports of DIAM associated to intrathecal administration of bupivacaine in the literature. Case report. We present a 16 year-old male patient who received spinal anaesthesia with 10 mg of bupivacaine prior to orthopedic surgery. A few hours later he complained of headache followed by confusion and stupor. A TC scan of the brain was normal. Diagnostic lumbar puncture revealed cloudy cerebrospinal fluid (CSF) with increased polymorphonuclear, increased protein and decreased glucose concentrations. Immediate treatment with antibiotics and corticosteroids was instituted and the patient rapidly recovered without sequelae. Blood and CSF cultures were negative, antibiotics were suspended and corticosteroids tapered. Conclusion. To the best of our knowledge, we report a case of bupivacaine induced aseptic meningitis

Hipertensión arterial como factor de riesgo de espasmo hemifacial por compresión vascular / Arterial hypertension as a risk factor for hemifacial spasm due to vascular compression

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Primer episodio de hemorragia subaracnoidea no traumática. Estudio epidemiológico de su incidencia y de la hipertensión arterial como un factor de riesgo / First episode non-traumatic subarachnoid haemorrhage. An epidemiological study of incidence and of arterial hypertension as a risk factor

Objetivos. Realizar un estudio epidemiológico de la incidencia de hemorragia subaracnoidea no traumática (HSANT), valorar el antecedente de hipertensión arterial (HTA) como factor de riesgo (FR), determinar la tasa bruta anual (TBA) y las tasas espe cíficas por sexo y edad del primer episodio de hemorragia subaracnoidea no traumática (PEHSANT) ajustadas al Censo Nacional de Población de la Argentina (CNPA), y llevar a cabo un estudio de casos y controles basado en la población sobre el antecedente de HTA como un FR en una comunidad argentina. Pacientes y métodos. Nuestra institución, el Hospital Privado de Comunidad de Mar del Plata, Argentina, atiende a una población de 89.500 individuos de manera exclusiva y completa. Existe un sistema único de historias clínicas con todos los diagnósticos en un banco de datos. Los pacientes que han sufrido una PEHSANT entre los años 1992 y 1996 ( n = 62) se investigaron para determinar la TBA específica por sexo y edad y ajustadas al CNPA del año 1991. La población se comparó al azar con dos controles por caso para el estudio del antecedente de HTA como un FR, y se estratificó por sexo y edad. Resultados. a) TBA: 13,6/100.000 hab/año; b) Tasa específica en varones: 10,5/100.000 hab/año; c) Tasa específica mujeres: 15,9/100.000 hab/año; d) Tasa ajustada CNPA: 7,3/100.000 hab/año; e) Un número significativamente importante de pacientes con PEHSANT presentaron antecedentes de ser hipertensos comparados con los controles ( odds ratio: 4,73; IC 95 por ciento: 2,39-9,34). Conclusiones. Nuestras tasas no difieren sustancialmente de las de países occidentales, y nuestros hallazgos indican que el antecedente de HTA es un FR de PEHSANT (AU)

Aims. Our aim was to conduct an epidemiological study of the incidence of non-traumatic subarachnoid haemorrhage (NTSAH) and to evaluate a history of arterial hypertension (AHT) as a risk factor (RF). We also sought to determine the gross annual rate (GAR) and specific rates, by sex and age, of first episode non-traumatic subarachnoid haemorrhage (FENTSAH) adjusted to the Censo Nacional de Población de la Argentina (CNPA), and to carry out a population-based case-control study about the history of AHT as a RF in an Argentine community. Patients and methods. Our institution, the Hospital Privado de Comunidad de Mar del Plata, Argentina, attends a population of about 89,500 individuals exclusively and completely. There is a single filing system of case histories with all the diagnoses in a database. Patients who suffered a FENTSAH between the years 1992 and 1996 (n = 62) were investigated to determine the specific GAR by sex and age and adjusted to the 1991 CNPA. The population was compared at random with two controls per case for the study of a history of AHT as a RF, and was then stratified according to sex and age. Results. 1. GAR: 13.6/100,000 inhab./year; 2. Specific rate for males: 10.5/100,000 inhab./year; 3. Specific rate for females: 15.9/ 100,000 inhab./year; 4. CNPA adjusted rate: 7.3/100,000 inhab./year; 5. A significantly important number of patients with FENTSAH presented a history of hypertension as compared to controls subjects (odds ratio: 4.73; CI 95%: 2.39-9.34). Conclusions. Our rates are not substantially different from the rates found in other western countries and our findings indicate that a history of AHT is a RF for FENTSAH (AU)