Asunto(s)
Disfunción Cognitiva/etiología , Delirio de Parasitosis/etiología , Demencia Vascular/complicaciones , Anciano de 80 o más Años , Antipsicóticos/administración & dosificación , Antipsicóticos/uso terapéutico , Delirio de Parasitosis/tratamiento farmacológico , Demencia Vascular/diagnóstico , Femenino , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/dietoterapia , Leucoaraiosis/complicaciones , Leucoaraiosis/diagnóstico , Fumarato de Quetiapina/administración & dosificación , Fumarato de Quetiapina/uso terapéuticoAsunto(s)
Ecolalia/etiología , Parálisis Supranuclear Progresiva/complicaciones , Anciano , Atrofia , Cuerpo Estriado/diagnóstico por imagen , Ecolalia/patología , Ecolalia/fisiopatología , Función Ejecutiva , Femenino , Lóbulo Frontal/patología , Lóbulo Frontal/fisiopatología , Humanos , Imagen por Resonancia Magnética , Mesencéfalo/patología , Corteza Motora/patología , Corteza Motora/fisiopatología , Pruebas Neuropsicológicas , Cintigrafía , Parálisis Supranuclear Progresiva/diagnóstico por imagen , Parálisis Supranuclear Progresiva/fisiopatologíaRESUMEN
TITLE: Variante del signo de la cara del panda gigante.
Asunto(s)
Ganglios Basales/patología , Degeneración Hepatolenticular/diagnóstico , Imagen por Resonancia Magnética , Mesencéfalo/patología , Neuroimagen/métodos , Adulto , Ganglios Basales/química , Química Encefálica , Cobre/análisis , Cobre/orina , Degeneración Hepatolenticular/patología , Degeneración Hepatolenticular/orina , Humanos , Hierro/análisis , Masculino , Mesencéfalo/químicaRESUMEN
Deep brain stimulation (DBS) is an established surgical therapy for intractable movement disorders, such as Parkinson's disease, essential tremor and dystonia. As the number of treated patients has increased rapidly, new sets of problems about complications of DBS have arisen. Bowstringing is defined as abnormal tethering of leads between the pulse generators and stimulating electrode, associated with pain and contracture of the neck over the extension cable. We report the case of a 56-year-old woman with a history of advanced Parkinson's disease who had been treated by implantation of a bilateral, subthalamic nucleus, deep brain stimulator. A car accident caused the rupture of the right electrode, which was replaced. Six months after the replacement the patient presented disabling pain and tension in the neck where deep brain extension cables were located. A cervical incision was performed to excise scar tissue. Bowstringing is a rare complication of DBS and although patients sometimes report discomfort and tension in the cervical region, surgical procedures are not normally required.
Asunto(s)
Estimulación Encefálica Profunda/efectos adversos , Electrodos Implantados/efectos adversos , Migración de Cuerpo Extraño/etiología , Dolor de Cuello/etiología , Accidentes de Tránsito , Cicatriz/etiología , Remoción de Dispositivos , Falla de Equipo , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Movimientos de la Cabeza , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Imagen Multimodal , Dolor de Cuello/diagnóstico por imagen , Dolor de Cuello/cirugía , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Estrés Mecánico , Tomografía Computarizada por Rayos XRESUMEN
Continuous subcutaneous apomorphine infusion (CSAI) is, at present, an alternative option for advanced Parkinson's disease (PD) with motor fluctuations. We studied the evolution of patients with PD and severe motor fluctuations long-term treated with CSAI. We reviewed data from 82 patients with PD (mean age, 67 +/- 11.07; disease duration, 14.39 +/- 5.7 years) and severe motor fluctuations referred to 35 tertiary hospitals in Spain. These patients were long-term treated (for at least 3 months) with CSAI and tolerated the procedure without serious side effects. We compared the baseline data of these 82 patients (before CSAI) with those obtained from the last follow-up visit of each patient. The mean follow-up of CSAI was 19.93 +/- 16.3 months. Mean daily dose of CSAI was 72.00 +/- 21.38 mg run over 14.05 +/- 1.81 hours. We found a statistically significant reduction in off-hours, according to self-scoring diaries (6.64 +/- 3.09 vs. 1.36 +/- 1.42 hours/day, P < 0.0001), total and motor UPDRS scores (P < 0.0001), dyskinesia severity (P < 0.0006), and equivalent dose of antiparkinsonian therapy (1,405 +/- 536.7 vs. 800.1 +/- 472.9 mg of levodopa equivalent units P < 0.0001). CSAI is an effective option for patients with PD and severe fluctuations, poorly controlled by conventional oral drug treatment.