Uricemia como factor pronóstico del ictus isquémico agudo / Hyperuricaemia as a prognostic factor for acute ischaemic stroke

Introducción: En el proceso de búsqueda de biomarcadores para el pronóstico del ictus agudo, en los últimos años los estudios realizados en torno al ácido úrico han mostrado resultados contradictorios.MétodosSe recogieron muestras analíticas de 600 pacientes ingresados de manera consecutiva en un hospital de tercer nivel y se analizó la relación entre los niveles de ácido úrico y el pronóstico funcional de los pacientes medido mediante la escala de Rankin modificada (mRS). Se excluyeron los pacientes que habían recibido terapias de reperfusión, ya que podría existir un efecto diferencial en los mismos respecto a los no tratados.ResultadosEl 73% de los pacientes tuvieron una mRS ≤ 2 y los niveles medios de ácido úrico fueron de 5,22 mg/dl. Se encontró una relación no lineal entre el pronóstico funcional al alta y los niveles de ácido úrico sérico en el momento del ingreso al excluir del análisis la medida de la National Institutes of Health Stroke Scale (NIHSS).ConclusionesLos valores séricos de ácido úrico en pacientes afectos de un ictus isquémico agudo se asocian significativamente con el pronóstico funcional en el momento de su alta, pero esta relación es no lineal. Se asocia un peor pronóstico a las concentraciones extremas, muy bajas o muy elevadas, de ácido úrico. Esto podría revelar un doble papel del ácido úrico en su relación con el ictus, como factor de riesgo asociado y/o como posible neuroprotector dado su papel antioxidante. (AU)

Introduction: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results.MethodsWe collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels.ResultsA total of 73% of patients had mRS scores ≤ 2; the mean uric acid level was 5.22 mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis.ConclusionsSerum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect. (AU)

Hyperuricaemia as a prognostic factor for acute ischaemic stroke. / Uricemia como factor pronóstico del ictus isquémico agudo.

INTRODUCTION: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results. METHODS: We collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels. RESULTS: A total of 73% of patients had mRS scores ≤2; the mean uric acid level was 5.22mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis. CONCLUSIONS: Serum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect.

Trombólisis intravenosa con activador tisular del plasminógeno recombinante en los síndromes de alarma vascular / Intravenous thrombolysis with recombinant tissue plasminogen activator in vascular warning syndromes

Introducción: Los síndromes de alarma vascular constituyen una situación de urgencia neurológica, debido a su alto riesgo de ictus establecido. Actualmente no existe evidencia firme sobre cuál debe ser el tratamiento de elección en estos casos. El objetivo de este trabajo es describir el papel de la trombólisis con rTPA intravenosa en el tratamiento de los síndromes de alarma vascular. Material y métodos: Se revisaron los casos propios y los existentes en la literatura en los que se hubiese tratado con rTPA intravenoso a los pacientes con clínica neurológica fluctuante. Resultados: Se obtuvieron 3 casos propios y 19 recogidos de la literatura (15 varones y 7 mujeres). La edad media fue de 68,7 ± 9 años (rango: 52-84 años). La frecuencia media de episodios antes del tratamiento fue de 4 (rango: 2-15 episodios). La puntuación en la escala NIH (NIHSS) máxima estuvo en un rango entre 6-22 según cada caso. Se dispuso de la NIHSS a las 24 h del tratamiento en 8 de los casos: en 6 (75%) fue de 0, y en 2 (25%) de 12. La escala de Rankin modificada (ERm) a los 3 meses del tratamiento fue de 0-1 en 18 (81,8%) de los pacientes: 8/10 (80%) en los síndromes de alarma lacunar, 6/7 (85,7%) en los síndromes de alarma basilar y 4/5 (80%) en pacientes con fluctuaciones que no entraban dentro de estos 2 grupos. Conclusiones: El tratamiento con rTPA intravenoso podría suponer una alternativa terapéutica eficaz y segura en los pacientes con clínica neurovascular fluctuante, aunque se necesitan estudios bien diseñados que establezcan de forma clara cuál es el papel real de la trombólisis intravenosa con rTPA en los síndromes de alarma vascular

ntroduction: Vascular warning syndromes constitute a neurological emergency due to their associated high risk of established stroke. At present, there is no strong evidence indicating the best treatment for these patients. The aim of this paper is to describe the function of intravenous rt-PA thrombolysis in the treatment of vascular warning syndromes. Material and methods: We reviewed our hospital records and the literature to find patients with neurologically fluctuating profiles and who underwent intravenous rt-PA thrombolysis. Results: We retrieved 3 cases from our hospital records and 19 from the literature (15 males and 7 females). Mean age was 68.7±9 years (range: 52-84 years). The mean number of episodes before treatment was 4 (range: 2-15 episodes). The maximum NIHSS scores ranged from 6 to 22 in different patients. We obtained 24-hour post-treatment NIHSS scores in 8 cases; of these cases, 6 (75%) had a score of 0, and the other 2 (25%) had a score of 12. The Modified Rankin Score calculated at 3 months of treatment was 0 or 1 in 18 patients (81.8%); these 18 comprised 8 of the 10 patients with lacunar warning syndromes (80%), 6 of the 7 with basilar warning syndromes (85.7%), and 4 of the 5 with fluctuating non-lacunar, non-basilar warning syndromes (80%). Conclusions: Intravenous rt-PA treatment may constitute an effective and safe therapeutic alternative for patients with neurovascular fluctuations. However, well-designed studies are needed to determine the role of intravenous rt-PA thrombolysis in cases of vascular warning syndrome

Intravenous thrombolysis with recombinant tissue plasminogen activator in vascular warning syndromes.

INTRODUCTION: Vascular warning syndromes constitute a neurological emergency due to their associated high risk of established stroke. At present, there is no strong evidence indicating the best treatment for these patients. The aim of this paper is to describe the function of intravenous rt-PA thrombolysis in the treatment of vascular warning syndromes. MATERIAL AND METHODS: We reviewed our hospital records and the literature to find patients with neurologically fluctuating profiles and who underwent intravenous rt-PA thrombolysis. RESULTS: We retrieved 3 cases from our hospital records and 19 from the literature (15 males and 7 females). Mean age was 68.7±9 years (range: 52-84 years). The mean number of episodes before treatment was 4 (range: 2-15 episodes). The maximum NIHSS scores ranged from 6 to 22 in different patients. We obtained 24-hour post-treatment NIHSS scores in 8 cases; of these cases, 6 (75%) had a score of 0, and the other 2 (25%) had a score of 12. The Modified Rankin Score calculated at 3 months of treatment was 0 or 1 in 18 patients (81.8%); these 18 comprised 8 of the 10 patients with lacunar warning syndromes (80%), 6 of the 7 with basilar warning syndromes (85.7%), and 4 of the 5 with fluctuating non-lacunar, non-basilar warning syndromes (80%). CONCLUSIONS: Intravenous rt-PA treatment may constitute an effective and safe therapeutic alternative for patients with neurovascular fluctuations. However, well-designed studies are needed to determine the role of intravenous rt-PA thrombolysis in cases of vascular warning syndrome.

Ictus cardioembólico por fibrilación auricular y nuevos criterios de anticoagulación: un reto terapéutico / Cardioembolic stroke in atrial fibrillation and new anticoagulation criteria: a therapeutic dare

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Meningitis neoplásica. Revisión de una serie hospitalaria / Neoplastic meningitis. Review of a clinical series

Introducción: El progresivo envejecimiento de la población en las últimas décadas ha provocado un aumento en la frecuencia de aparición de las muchas complicaciones que se asocian al cáncer. Entre ellas destacan las neurológicas, que aparecen en un 10-30% de los pacientes con neoplasias sistémicas. La meningitis neoplásica aparece en un 4-15% de los pacientes con tumores sólidos y se asocia a un mal pronóstico. El objetivo de este trabajo es describir las características clínicas, licuorales, de imagen y pronósticas en una serie de meningitis neoplásica. Fuentes y desarrrollo: Se realizó una revisión retrospectiva de todos los pacientes ingresados en el Hospital Universitario de Gran Canaria Dr. Negrín con sospecha de meningitis neoplásica entre los años 1990 y 2008. Se seleccionaron 37 pacientes, con un rango de edad entre los 15 y los 75 años. De los 33 casos en los que se identificó un tumor primario, 27 (81,8%) estaban asociados a tumores sólidos (24,2% de mama y 24,2% de pulmón). La diplopia fue la manifestación de disfunción de nervios craneales más frecuente, observándose en 12 casos (32,4%). La supervivencia media tras el diagnóstico fue de 87,9 días (12,6 semanas). La citología del líquido cefalorraquídeo fue positiva en 12/26 casos (46,4%). Conclusión: La meningitis neoplásica es una complicación grave de los tumores tanto sólidos como hematológicos. Es necesario mantener un alto nivel de sospecha que permita establecer un diagnóstico precoz, puesto que la supervivencia media en los pacientes con meningitis neoplásica es baja (AU)

Introduction: The increase in the ageing population in the last decades has led to an increasedfrequency of cancer-associated complications. Among these, neurological disorders stand out,as they appear in 10-30% of patients with systemic neoplasia. Neoplastic meningitis accounts for 4-15% of patients with solid tumours and it has a poor prognosis. The objective of this paper is to describe the clinical, imaging and prognostic characteristics as well as cerebrospinal fluid findings in a series of neoplastic meningitis. Background and development: We performed a retrospective review of all patients admitted to the Hospital Universitario of Gran Canaria Dr. Negrín with clinical suspicion of neoplastic meningitis between 1990 and 2008. We selected 37 patients with an average age ranging from 15 to 75 years old. A total of 81.8%of the cases in which a primary tumour was found were associated with solid tumours (24.2%were located in the breast, and 24.2% in the lung). The most frequent sign of cranial nervedysfunction was dyplopia, which was observed in 32.4% of the cases. The average survival rateafter diagnosis was 87.9 days (12.6 weeks). The cerebrospinal fluid cytology was positive in46.4% of the cases. Conclusion: Neoplastic meningitis is a severe complication of both solid and haematological tumours. We stress the importance of maintaining a high level of suspicion to achieve early diagnosis, since the average survival probability for neoplastic meningitis patients is low (AU)

Neoplastic meningitis.Review of a clinical series.

INTRODUCTION: The increase in the ageing population in the last decades has led to an increased frequency of cancer-associated complications. Among these, neurological disorders stand out, as they appear in 10-30% of patients with systemic neoplasia. Neoplastic meningitis accounts for 4-15% of patients with solid tumours and it has a poor prognosis. The objective of this paper is to describe the clinical, imaging and prognostic characteristics as well as cerebrospinal fluid findings in a series of neoplastic meningitis. BACKGROUND AND DEVELOPMENT: We performed a retrospective review of all patients admitted to the Hospital Universitario of Gran Canaria Dr. Negrín with clinical suspicion of neoplastic meningitis between 1990 and 2008. We selected 37 patients with an average age ranging from 15 to 75 years old. A total of 81.8% of the cases in which a primary tumour was found were associated with solid tumours (24.2% were located in the breast, and 24.2% in the lung). The most frequent sign of cranial nerve dysfunction was dyplopia, which was observed in 32.4% of the cases. The average survival rate after diagnosis was 87.9 days (12.6 weeks). The cerebrospinal fluid cytology was positive in 46.4% of the cases. CONCLUSION: Neoplastic meningitis is a severe complication of both solid and haematological tumours. We stress the importance of maintaining a high level of suspicion to achieve early diagnosis, since the average survival probability for neoplastic meningitis patients is low.

[Descartes' influence on the development of the anatomoclinical method]. / La influencia de Descartes en el desarrollo del método anatomoclínico.

The development of the anatomical-clinical method was a huge advance for modern medicine since it revealed a new approach to understanding diagnostic procedures. This change in medical thinking towards a more scientific basis has gradually evolved over several centuries, reaching its brilliant zenith with the contributions of the French school. There are certain similarities between the guidelines of the anatomical-clinical method and René Descartes' philosophical principles, so it is fair to consider him as one of the major precursors in this new line of thinking that definitely influenced the historical course of medicine.

La influencia de Descartes en el desarrollo del método anatomoclínico / Descartes’ influence on the development of the anatomoclinical method

El desarrollo del método anatomoclínico supuso un gran avance para la medicina moderna, ya que fue una nueva forma de entender el proceso diagnóstico. Este cambio de pensamiento hacia una forma más científica fue desarrollándose gradualmente durante varios siglos y culminó de forma brillante con las aportaciones de la escuela francesa. Hay ciertas similitudes entre el planteamiento del método anatomoclínico y el método filosófico propuesto por René Descartes, por lo que parece justo considerar a Descartes como uno de los precursores de una forma de pensar que cambió para siempre la medicina (AU)

The development of the anatomical-clinical method was a huge advance for modern medicine since it revealed a new approach to understanding diagnostic procedures. This change in medical thinking towards a more scientific basis has gradually evolved over several centuries, reaching its brilliant zenith with the contributions of the French school. There are certain similarities between the guidelines of the anatomical-clinical method and René Descartes’ philosophical principles, so it is fair to consider him as one of the major precursors in this new line of thinking that definitely influenced the historical course of medicine (AU)

Cefalea en la hipertensión intracraneal idiopática / Headache in idiopathic intracranial hypertension

Resumen. Introducción. La hipertensión intracraneal idiopática (HICI) se caracteriza por un aumento de la presión intracraneal, sin datos de patología intracraneal. Los criterios diagnósticos de cefalea asociada a HICI están recogidos en la Clasificación Internacional de las Cefaleas; sin embargo, en la práctica clínica la cefalea asociada a HICI puede ser muy heterogénea. Pacientes y métodos. Se revisaron de forma retrospectiva las historias clínicas de todos los pacientes ingresados por HICI en el Hospital Universitario de Gran Canaria Dr. Negrín entre 1990 y 2007. Resultados. Se incluyeron 55 pacientes, con una proporción entre mujeres y hombres de 8,1 a 1. En el 85,4% apareció cefalea. La cefalea fue continua en un 63,8% y holocraneal, en un 51%. Conclusión. La cefalea asociada a HICI es muy heterogénea, y en ocasiones se presenta con características propias de las cefaleas primarias, por lo que se precisa una atención adecuada con el objeto de no retrasar el diagnóstico (AU)

Summary. Introduction. Idiopathic intracranial hypertension (IICH) is characterized by a rising in intracranial hypertension without evidence of intracranial expansive disease. Diagnostic criteria of headache related to IICH are described in the International Classification of Headache Disorders. In clinical practice, however, headache related to IICH may be heterogeneous.Patients and methods. Clinical charts of patients with IICH admitted to the Hospital Universitario de Gran Canaria Dr. Negrín between 1990 and 2007 were retrospectively reviewed. Results. Fifty-five patients were included, with a ratio female/male of 8.1:1. Headache was present in 85.4%. The headache was continuous in 63.8% of patients, and diffuse in 51%. Conclusion. Headache related to IICH is heterogeneous, and may mimic primary headache, so a high level of suspicion is needed to avoid diagnostic delay (AU)

[Headache in idiopathic intracranial hypertension]. / Cefalea en la hipertensión intracraneal idiopática.

INTRODUCTION: Idiopathic intracranial hypertension (IICH) is characterized by a rising in intracranial hypertension without evidence of intracranial expansive disease. Diagnostic criteria of headache related to IICH are described in the International Classification of Headache Disorders. In clinical practice, however, headache related to IICH may be heterogeneous. PATIENTS AND METHODS: Clinical charts of patients with IICH admitted to the Hospital Universitario de Gran Canaria Dr. Negrin between 1990 and 2007 were retrospectively reviewed. RESULTS: Fifty-five patients were included, with a ratio female/male of 8.1:1. Headache was present in 85.4%. The headache was continuous in 63.8% of patients, and diffuse in 51%. CONCLUSION: Headache related to IICH is heterogeneous, and may mimic primary headache, so a high level of suspicion is needed to avoid diagnostic delay.

Neuropatía vasculítica no sistémica / Non-systemic vasculitic neuropathy

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Factores de riesgo, etiología y pronóstico en pacientes con ictus isquémico y diabetes mellitus / Risk factors, etiology and prognosis in patients with ischemic stroke and diabetes mellitus

Introducción. El objetivo de este trabajo esdescribir las diferencias clínicas, etiológicas ypronósticas entre pacientes diabéticos y nodiabéticos que presentan un ictus isquémico.Material y métodos. Se revisaron retrospectivamentelas historias de los pacientes ingresados por ictusisquémico en el Servicio de Neurología del HospitalUniversitario de Gran Canaria Dr. Negrín en elperiodo 2004-2006. Se recogieron variablesdemográficas, clínicas y pronósticas.Resultados. Se incluyeron 633 pacientes, 256(40,4%) diabéticos y 377 (59,6%) no diabéticos.En los diabéticos, la edad media fue de 69,2 ± 9,3años (65,4 ± 13,9 años en los no diabéticos). Un63,7% eran hombres y un 36,3%, mujeres(62,2% hombres y 37,8% mujeres en los nodiabéticos). Un 85,9% de los diabéticos presentabahipertensión arterial (62,9% en los no diabéticos);un 49,2%, dislipemia (31% en los nodiabéticos); un 22%, cardiopatía isquémica(12,7% en los no diabéticos), y un 8,6%,arteriopatía periférica (4,8% en los no diabéticos).En el grupo de diabéticos, un 25% fue de origenaterotrombótico (16,4% en los no diabéticos); un20,3%, cardioembólico (24,4% en los nodiabéticos); un 26,1%, lacunar (22% en losno diabéticos), y un 25,7%, indeterminado(27,2% en los no diabéticos). La Escala de Rankinmodificada al alta fue 2 en un 65,3% de losdiabéticos y en un 62,5% de los no diabéticos.Conclusiones. En nuestra serie los pacientescon diabetes asocian otros factores de riesgovascular convencionales con mayor frecuencia ypresentan más ictus aterotrombóticos. No hemosencontrado diferencias significativas en cuanto alpronóstico

Introduction. The objective of this work is to describe the clinical, etiological and prognostic differences in diabetic and non-diabetic patients presenting ischemic stroke. Materials and methods. We performed a retrospective review of all patients with ischemic stroke requiring admission to the Neurology Service at the University Hospital of Gran Canaria Dr. Negrín (Spain) during our study period (1 Jan, 2004 -31 Dec, 2006). We collected demographic, clinical and prognostic variables. Results. A total of 633 patients were included, 256 (40.4%) were diabetic and 377 (59.6%) were non diabetic. The group of diabetic patients presented a mean age of 69.2 9.3 years (65.4 13.9 years in non-diabetic). Mean made up 63.7% of the diabetic patients and women 36.3% (62.2% menand 37.8% women in non-diabetics).A total of 85.9% of diabetic patients presented arterial hypertension (62.9% in non-diabetics); 49.2%had previous hyperlipidemia (31% in non-diabetics); 22% had ischemic heart disease (12.7% in nondiabetics);and 8.6% had peripheral arteriopathy (4.8% in non-diabetics). In the group of diabetic patients, 25% presented atherothrombotic stroke (16.4% in non-diabetics); 20.3% were cardioembolic(24.4% in non-diabetics); 26.1% were lacunar (22%in non-diabetics); and 25.7% had undetermined origin(27.2% in non-diabetics). The modified Rankin Scaleat discharge was ± in 65.3% of diabetic patients and 62.5% in non-diabetics. Conclusions. In our series, diabetic patients frequently present other conventional vascular risk factors and show a tendency to more atherothrombotic strokes. We have found no significant differences in relation to prognosis

Factores de riesgo vascular en pacientes con ictus isquémico / Vascular risk factors in patients with ischaemic stroke

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Hipertiroidismo que simula una enfermedad de la neurona motora / Hyperthyroidism mimicking a motor neuron disease

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