ABSTRACT
No disponible
Subject(s)
Middle Aged , Male , Humans , Paralysis , Heart Arrest , Eye Diseases , Ataxia , Syndrome , Hypoxia, BrainSubject(s)
Ataxia/etiology , Eye Diseases/etiology , Heart Arrest/complications , Hypoxia, Brain/etiology , Paralysis/etiology , Humans , Male , Middle Aged , SyndromeABSTRACT
INTRODUCTION: Neurology consultations requested by other services are a part of hospital attention that has not been studied or valued enough. However, it is a health care activity that is carried out on a daily basis and which consumes considerable amounts of time and resources. AIMS. The aim of this study is to assess intrahospital consultations (IHC) requested from a Neurology service. PATIENTS AND METHODS: We conducted a retrospective study of the requests for consultations received in the Neurology Service at the Hospital Universitario San Cecilio in Granada throughout the year 2001. The following variables were analysed: number of consultations, specialities involved, urgency of the request, syndromic diagnosis, complementary tests requested, final resolution and referral of patients. RESULTS: The number of consultations amounted to 270. The most frequent syndromic diagnoses were stroke (24.3%), epilepsy (13.7%) and dementia (11.7%). Internal Medicine, Cardiology, Vascular surgery and Oncology were the specialities that requested most consultations from the Neurology service. The most common complementary test was a computerised axial tomography of the head. 38.74% of the consultations were referred to Neurology outpatients for follow up. 40.5% of the consultations received were lacking in the information needed to understand the actual problem the patient was suffering from. CONCLUSIONS: This study attempts to highlight the importance of IHC as part of the day to day activity within a Neurology service, with respect to the number of consultations, knowledge of the most prevalent neurological pathologies in other services and the resources used in this type of assistance. More studies are needed on this subject, since there are few references in the literature to reports that analyse this type of attention.
Subject(s)
Hospital Departments , Neurology , Referral and Consultation , Humans , Nervous System Diseases/diagnosis , Neuropsychological Tests , Retrospective Studies , Spain , SyndromeABSTRACT
Introducción. Las interconsultas (IC) a Neurología propuestas por otros servicios son una parte de la asistencia hospitalaria poco estudiada y valorada; sin embargo, es una actividad asistencial que se realiza diariamente y que consume tiempo y recursos. Objetivo. Evaluar la IC intrahospitalaria (IH) a un servicio de Neurología. Pacientes y métodos. Se ha realizado un estudio retrospectivo de las IC recibidas en el Servicio de Neurología del Hospital Universitario San Cecilio de Granada, durante el año 2001. Hemos analizado las siguientes variables: número de C, especialidades implicadas, urgencia de la petición, diagnóstico sindrómico, pruebas complementarias solicitadas, resolución final y derivación de los pacientes. Resultados. Se realizaron 270 IC. Los diagnósticos sindrómicos más frecuentes han sido: enfermedad cerebrovascular aguda (24,3 por ciento), epilepsia (13,7 por ciento) y demencia (11,7 por ciento). Medicina interna, Cardiología, Cirugía vascular y Oncología fueron los servicios que más IC solicitaron al de Neurología. La prueba complementaria más indicada fue la tomografía axial computarizada craneal. Un 38,74 por ciento de las IC se derivaron a consulta externa de Neurología, para seguimiento. El 40,5 por ciento de las IC recibidas adolecían de falta de información para entender el problema real del paciente. Conclusiones. Este trabajo pretende poner de manifiesto la importancia de la ICIH dentro de la actividad diaria de un servicio de Neurología, en relación con el número de IC, el conocimiento de la patología neurológica más prevalente en otros servicios y los recursos empleados para este tipo de asistencia. Se deben realizar más estudios, ya que existen escasas referencias bibliográficas que analicen este tipo de asistencia (AU)
Subject(s)
Adult , Male , Female , Humans , Neurology , Referral and Consultation , Hospital Departments , Spain , Syndrome , Interferon-beta , Multiple Sclerosis , Nervous System Diseases , Retrospective Studies , Adjuvants, Immunologic , Neuropsychological TestsABSTRACT
INTRODUCTION: Zolpidem is derived from imidazopiridine. In recent years it has been used as a non benzodiazepine hypnotic. It is a short acting inducer of sleep of similar efficacy to the benzodiazepines or zopiclone, but well tolerated and does not lead to drug abuse, rebound effects or abstinence syndromes. In this clinical note we wish to show that in spite of the descriptions in the medical literature, complications may follow long term use of zolpidem. CLINICAL CASE: We report the case of a 50 year old woman with no clinical history of interest apart from chronic insomnia and anxiety. She had been treated with zolpidem for the previous five years, at the usual dosage. However, since this seemed to be insufficient, the dose was progressively increased until in the months before she was seen by us she was taking a total of 450 mg per day in divided doses. She had drug tolerance, abuse and dependence. After a period of 12 hours without taking zolpidem she developed an abstinence syndrome, with generalized tonic clonic seizures and a prolonged post convulsion period which improved on symptomatic anticonvulsant treatment. CONCLUSIONS: In view of our case, and others described, we should be sceptical of the claim that zolpidem has no side effects, since it may give rise to tolerance, abuse and an abstinence syndrome. We consider that its indiscriminate use should be modified. Patients should be carefully followed up and medical prescription necessary to obtain zolpidem, as opposed to its current unrestricted availability.
Subject(s)
Epilepsy/etiology , GABA Agonists/adverse effects , Pyridines/adverse effects , Substance Withdrawal Syndrome/etiology , Drug Administration Schedule , Electroencephalography , Epilepsy/diagnosis , Female , GABA Agonists/administration & dosage , Humans , Pyridines/administration & dosage , Severity of Illness Index , ZolpidemABSTRACT
Introducción. El zolpidem es un derivado de la imidazopiridina, empleado en los últimos años como hipnótico no benzodiacepínico; es un inductor del sueño de acción corta, con eficacia similar a otros, como las benzodiacepinas o zopiclona, pero con buena tolerancia, sin producir abuso, efecto rebote ni síntomas de abstinencia. Con esta nota clínica queremos manifestar que, pese a lo descrito en la literatura médica, existen complicaciones por consumo crónico de zolpidem. Caso clínico. Describimos el caso de una mujer de 50 años de edad, sin antecedentes de interés, salvo insomnio crónico y ansiedad, en tratamiento con zolpidem desde hace más de 5 años en dosis habituales; pero, ante la falta de eficacia, aumentó progresivamente la ingesta hasta que en los últimos meses consumía 450 mg/día en varias tomas, y presentó tolerancia, abuso y dependencia. Tras un período de 12 horas sin ingesta, presentó síndrome de abstinencia, con crisis generalizadas tonicoclónicas y período poscrítico prolongado, que revertieron con tratamiento sintomático anticomicial. Conclusiones. De acuerdo con nuestro caso, y otros descritos, deberíamos dudar de la falta de efectos secundarios al emplear zolpidem, por su tolerancia, potencial de abuso y síndrome de abstinencia. Pensamos que se debe moderar el empleo indiscriminado de esta sustancia y realizar un seguimiento estrecho de los pacientes en tratamiento, con la inclusión de la obligatoriedad de prescripción facultativa, ya que hasta ahora se puede adquirir sin necesidad de receta médica (AU)
Subject(s)
Female , Humans , Substance Withdrawal Syndrome , GABA Agonists , Pyridines , Drug Administration Schedule , Electroencephalography , Epilepsy , Severity of Illness IndexABSTRACT
INTRODUCTION: The Parry-Romberg syndrome is a clinical condition in which there is progressive facial hemiatrophy which may be associated with neurological, ocular, cutaneous and auto-immune disorders. It is of unknown aetiology, although many theories have been put forward. CLINICAL CASE: We present a case of left facial hemiatrophy associated with ipsilateral lingual hemiatrophy and signs of cortico-cerebellar dysfunction, the neuroimaging findings (NMR) and clinico-radiological follow-up covered a period of over 10 years. CONCLUSION: The data on the clinical course and neuroimaging, together with our review of the literature, suggest that the Parry-Romberg syndrome may be considered to be a dysgenetic process which may originate during the first stages of CNS embryogenesis.
