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1.
Artículo en Inglés, Español | MEDLINE | ID: mdl-28869176

RESUMEN

OBJECTIVE: Cortical cerebral amyloid disease, a hallmark of Alzheimer's disease, has also been observed in idiopathic normal pressure hydrocephalus (iNPH). The aim of this study was to compare the 11C-PIB PET/CT retention pattern in iNPH patients and healthy subjects. MATERIAL AND METHODS: A comparison was made of the 11C-PIB PET/CT retention pattern in 13 iNPH patients selected for surgical deviation, compared to a normal control population. Images were visually analyzed and scored for gray matter and white matter (WM) from 1 to 4 (slight to very high PIB retention). The scoring was analyzed in both groups separately for infra- and supra-tentorial regions. A comprehensive clinical report was presented in terms of positive, negative, or equivocal. RESULTS: 11C-PIB PET/CT scan were reported as negative in 8, positive in 3, and equivocal in 2. Five of 13 patients showed at least one cortical area with PIB retention with an intensity higher than that observed in the control group. Overall, white matter (WM) PIB retention of iNPH scored lower than in the control group, showing a statistically significant difference in the infratentorial WM (92/104 vs 54/56; p<.05) and a tendency to be lower in the supratentorial regions (70/84 vs 122/156, p=.327), in particular in the upper periventricular region (25/28 vs 40/52; p=.134). CONCLUSIONS: The PIB retention pattern seems to be different in NPH, compared to normal subjects. PIB retention in WM of NPH appears less intense than in healthy subjects, and they show a higher degree of PIB retention in cortical regions. This deserves to be taken it into account.


Asunto(s)
Compuestos de Anilina/farmacocinética , Radioisótopos de Carbono/farmacocinética , Corteza Cerebral/diagnóstico por imagen , Sustancia Gris/diagnóstico por imagen , Hidrocéfalo Normotenso/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos/farmacocinética , Tiazoles/farmacocinética , Sustancia Blanca/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Amiloide/análisis , Corteza Cerebral/química , Corteza Cerebral/patología , Femenino , Humanos , Hidrocéfalo Normotenso/patología , Masculino , Persona de Mediana Edad , Especificidad de Órganos
2.
Neurologia (Engl Ed) ; 33(7): 449-458, 2018 Sep.
Artículo en Inglés, Español | MEDLINE | ID: mdl-27296497

RESUMEN

INTRODUCTION: Since its description five decades ago, the pathophysiology of idiopathic chronic adult hydrocephalus (iCAH) has been traditionally related to the effect that ventricular dilatation exerts on the structures surrounding the ventricular system. However, altered cerebral blood flow, especially a reduction in the CSF turnover rate, are starting to be considered the main pathophysiological elements of this disease. DEVELOPMENT: Compression of the pyramidal tract, the frontostriatal and frontoreticular circuits, and the paraventricular fibres of the superior longitudinal fasciculus have all been reported in iCAH. At the level of the corpus callosum, gliosis replaces a number of commissural tracts. Cerebral blood flow is also altered, showing a periventricular watershed region limited by the subependymal arteries and the perforating branches of the major arteries of the anterior cerebral circulation. The CSF turnover rate is decreased by 75%, leading to the reduced clearance of neurotoxins and the interruption of neuroendocrine and paracrine signalling in the CSF. CONCLUSIONS: iCAH presents as a complex nosological entity, in which the effects of subcortical microangiopathy and reduced CSF turnover play a key role. According to its pathophysiology, it is simpler to think of iCAH more as a neurodegenerative disease, such as Alzheimer disease or Binswanger disease than as the classical concept of hydrocephalus.


Asunto(s)
Hidrocéfalo Normotenso/fisiopatología , Enfermedades Neurodegenerativas/fisiopatología , Adulto , Ventrículos Cerebrales/fisiopatología , Presión del Líquido Cefalorraquídeo/fisiología , Circulación Cerebrovascular/fisiología , Enfermedad Crónica , Humanos , Hidrocéfalo Normotenso/líquido cefalorraquídeo , Hidrocéfalo Normotenso/diagnóstico , Enfermedades Neurodegenerativas/líquido cefalorraquídeo , Enfermedades Neurodegenerativas/diagnóstico
3.
Acta Neurochir (Wien) ; 151(11): 1465-72, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19424656

RESUMEN

Acinetobacter baumannii has emerged as an important nosocomial pathogen that can cause a multitude of severe infections. In neurosurgical patients the usual presentation is ventriculitis associated with external ventricular drainage. Carbapenems have been considered the gold standard for the treatment of Acinetobacter baumannii ventriculitis, but resistant isolates are increasing worldwide, reducing the therapeutic options. In many cases polymyxins are the only possible alternative, but their poor blood-brain barrier penetration could require them to be directly administered intraventricularly and clinical experience with this route is limited. We review the literature concerning intraventricular use of colistin (polymyxin E) for A. baumannii ventriculitis and add three cases successfully treated with this method. Our experience suggests that intraventricular colistin is a potentially effective and safe therapy for the treatment of multidrug-resistant A. baumannii central nervous system infections.


Asunto(s)
Infecciones por Acinetobacter/tratamiento farmacológico , Acinetobacter baumannii/efectos de los fármacos , Colistina/administración & dosificación , Encefalitis/tratamiento farmacológico , Ventrículos Laterales/cirugía , Infecciones por Acinetobacter/patología , Infecciones por Acinetobacter/fisiopatología , Acinetobacter baumannii/fisiología , Adulto , Antibacterianos/administración & dosificación , Encéfalo/diagnóstico por imagen , Encéfalo/microbiología , Encéfalo/patología , Derivaciones del Líquido Cefalorraquídeo , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/prevención & control , Resistencia a Múltiples Medicamentos , Encefalitis/microbiología , Encefalitis/fisiopatología , Resultado Fatal , Femenino , Humanos , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/microbiología , Hidrocefalia/cirugía , Inyecciones Intraventriculares/métodos , Ventrículos Laterales/diagnóstico por imagen , Ventrículos Laterales/microbiología , Masculino , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/microbiología , Persona de Mediana Edad , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/microbiología , Hemorragia Subaracnoidea/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ventriculostomía/métodos
4.
Rev Neurol ; 46(6): 336-9, 2008.
Artículo en Español | MEDLINE | ID: mdl-18368676

RESUMEN

INTRODUCTION: Intracranial subdural empyema (ISE) is an infrequent infectious disorder of diverse etiology and difficult to diagnose because of its non-specific clinical features. PATIENTS AND METHODS: Retrospective study of patients diagnosed of ISE in a third-level university hospital in a 15-year period. RESULTS: Five men were included (mean age: 39.3 years). The most frequent primary source of infection was otic and sinusal (60%). The initial clinical manifestations were fever, headache, alteration of consciousness, and neurological focal symptoms. The mean time elapsed between onset of symptoms and diagnosis was 3.6 days. Diagnosis was performed by computed tomography in all patients. ISE was localized in the left hemisphere in 60% of cases mainly affecting the parietal lobe (80%). Anaerobic and streptococci germs were the most frequently isolated microorganisms. Therapy was based on antibiotics and surgical drainage in 100% of the cases. The surgical procedure used in the evacuation of empyema was craniotomy in all the patients. The mean time elapsed between diagnosis and surgery was 8.4 days. The mean Intensive Care Unit stay was 12.8 days, whereas the overall mean in-hospital stay was 45.2 days. Mortality was 40%. CONCLUSION: ISE, although infrequent, displays a high morbimortality that can be reduced with an early therapeutic approach which may include the surgical evacuation in all the cases.


Asunto(s)
Encefalopatías/microbiología , Empiema Subdural , Adulto , Anciano , Encefalopatías/diagnóstico , Encefalopatías/epidemiología , Encefalopatías/terapia , Empiema Subdural/diagnóstico , Empiema Subdural/epidemiología , Empiema Subdural/terapia , Hospitales , Humanos , Lactante , Masculino , Estudios Retrospectivos
5.
Neurologia ; 19(10): 738-60, 2004 Dec.
Artículo en Español | MEDLINE | ID: mdl-15568172

RESUMEN

Cervical spondylotic myelopathy is the most severe consequence of degenerative disease of cervical spine. In this article we perform a bibliographic review, addressing current controversies in its pathophysiology. Present work lines of most groups dedicated to the study of this condition are focused on improving surgical techniques designed for the treatment of this disease. Pathophysiological studies are scarce, and most of our pathophysiological knowledge of cervical spondylotic myelopathy is based in works done in 60s and 70s. Literature of the last decade lacks neurochemichal studies parallel to those existing for acute spinal injury. In the same way, only three prospective clinical trials comparing conservative and surgical treatment have been done, and none of them has demonstrated clear superiority of surgery. Given the high prevalence of this disease, the need for deep knowledge of its pathophysiologic, neurochemichal and molecular basis, and the optimization of surgical treatment is justified. This probably implies the need for prospective randomized trials to determine which patients are going to benefit from surgery.


Asunto(s)
Vértebras Cervicales , Enfermedades de la Médula Espinal/fisiopatología , Osteofitosis Vertebral/fisiopatología , Humanos , Enfermedades de la Médula Espinal/etiología , Osteofitosis Vertebral/complicaciones
6.
Neurocirugia (Astur) ; 13(4): 321-5, 2002 Aug.
Artículo en Español | MEDLINE | ID: mdl-12355656

RESUMEN

Spinal extradural angiolipomas are rare benign tumours, accounting for only 0.14-1.2% of all spinal neoplasms. They are usually localized within the thoracic extradural space of the spinal canal and their common clinical presentation is myelopathy, mainly in the way of a slowly progressive paraparesis and sometimes in an acute form. We report the case of a 85 year old man who complained of bilateral lower limb weakness with sphincter disturbance of acute instauration. The MRI showed a posterior extradural lesion at L1-L2 level that compressed conus medularis and cauda equina. He underwent urgent surgical treatment and we achieved total resection of the lesion via a L1-L2 laminectomy. The pathological examination confirmed the tumour as an angiolipoma.


Asunto(s)
Angiolipoma/patología , Neoplasias de la Médula Espinal/patología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Angiolipoma/complicaciones , Angiolipoma/cirugía , Diagnóstico Diferencial , Progresión de la Enfermedad , Electromiografía , Humanos , Laminectomía/métodos , Extremidad Inferior/fisiopatología , Región Lumbosacra/patología , Región Lumbosacra/cirugía , Imagen por Resonancia Magnética , Masculino , Paraparesia/etiología , Paraparesia/fisiopatología , Índice de Severidad de la Enfermedad , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/etiología , Neoplasias de la Médula Espinal/complicaciones , Neoplasias de la Médula Espinal/cirugía
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