Limb shaking. descripción de un caso desde la perspectiva / Limb Shaking: description of a case from a nursing perspective

Introducción. El limb shaking, descrito por Miller Fisher en 1962, se caracteriza por movimientos involuntarios, irregulares y estereotipados de un hemicuerpo desencadenados por la hipoperfusión hemisférica contralateral. Se asocia a una oclusión o estenosis crítica de la arteria carótida interna (ACI) extracraneal contralateral a los movimientos y a una pobre circulación colateral. Esto causa una isquemia que da lugar a las manifestaciones clínicas típicas de un ictus y estos movimientos anormales. Objetivo. Describir el caso clínico de un paciente con limb shaking. Descripción del caso. Varón de 59 años, con factores de riesgo cardiovascular, que acude a Urgencias por un cuadro súbito de afasia motora y pérdida de fuerza en extremidades derechas de predominio braquial distal. Ingresa en la Unidad de Ictus para monitorización neurológica y hemodinámica, donde, coincidiendo con el inicio de la sedestación, presenta estos movimientos involuntarios. Resultados. Las pruebas diagnósticas confirman un ictus isquémico cortical frontal izquierdo. El electroencefalograma muestra una actividad bioeléctrica de fondo normal. Es en la angio-RMN y la arteriografía donde se halla una estenosis crítica de la ACI izquierda. Discusión. Se establece el diagnóstico de limb shaking de acuerdo con los hallazgos del examen clínico y las pruebas complementarias, que confirman la presencia de una pseudooclusión de la ACI izquierda y la refractariedad al tratamiento antiepiléptico. Conclusión. El limb shaking es un síndrome raro, que debe reconocerse y diferenciarse precozmente de otros procesos para tratarlo de forma adecuada. El tratamiento está destinado a restaurar el flujo sanguíneo cerebral, mediante la revascularización quirúrgica o endovascular del hemisferio isquémico (AU)

Introduction. Limb shaking, which was described by Miller Fisher in 1962, is characterized by involuntary, irregular, stereotyped a hemibody triggered by the contralateral hemisphere hypoperfusion. It is associated with an occlusion or stenosis preoclusive of the extracranial internal carotid artery (ICA) contralateral to the movements, and poor circulation contralateral. This causes ischemia resulting in typical clinical manifestations of stroke and these abnormal movements. Objective. To describe a case of limb shaking. Materials and methods. 59 years old man, with cardiovascular risk factors, who go to the Emergency room with symptoms and motor dysphasia and sudden loss of strength in right limbs, with distal brachial predominance. Admitted to Stroke Unit for neurological and hemodynamic monitoring, which coincides with the beginning of the sitting have an episode of these involuntary movements. Results. Diagnostic tests confirm a left frontal cortical ischemic stroke. The EEG shows a normal background bioelectric activity. The angio-MRI and angiography showed a left ICA pseudoocclusion Discussion. A diagnosis of limb shaking based in the clinical examination and additional tests, which confirm the finding of a left ICA pseudo-occlusion and refractory to antiepileptic treatment. Conclusion. The limb shaking is a rare syndrome, which must be recognized and differentiated early from other processes to treat it properly. Treatment is aimed at restoring cerebral blood flow through the ischemic hemisphere revascularization (AU)

[Impact on quality of life in caregivers of stroke survivors]. / Impacto en la calidad de vida en cuidadores de supervivientes de un ictus.

UNLABELLED: Stroke is the first cause of disability in adults. Often, the care falls on the family and can affect their quality of life. AIM: To determine the health-related quality of life and the level of caregiver burden of a patient after a stroke. METHOD: Descriptive and cross-sectional study. Caregivers, who had cared for a patient for more than six months and without pay, were included. This study had been approved by the Ethics Committee. Variables collected: sociodemographic, EuroQol-5D questionnaire, Zarit scale, mood and sleep problems. RESULTS: Forty-eight caregivers were included, with a mean age of 55.63 (SD: 13.48) and the majority were women (70.8%). The mean time of the care was 28.8 months (SD: 28.68), with 58% stated having a depressed mood, 31% had burden, and 89.6% had sleep problems. The dimensions that presented problems (moderate and severe) in the EQ-5D were pain-discomfort (66.7%) and anxiety-depression (68.8%). The score on the visual analog scale rating of quality of life was associated with a worse mood (75.5 vs. 32, p=0.0028), with the pain (81.94 vs. 38, p<0.001), and Zarit scale (r:<0.334, p=0.020). CONCLUSIONS: The role of caregivers of stroke patients often falls on women. To be a caregiver affects the quality of life, mainly in the pain-discomfort and anxiety-depression dimensions, regardless of the functional status of the patient. Nurses must identify the psychopathological needs and develop strategies on the prevention of the risk of burnout.

[LIMB SHAKING: DESCRIPTION OF A CASE FROM A NURSING PERSPECTIVE]. / Limb shaking: DESCRIPCIÓN DE UN CASO DESDE LA PERSPECTIVA ENFERMERA.

INTRODUCTION: Limb shaking, which was described by MillerFisher in 1962, is characterized by involuntary, irregular, stereotyped a hemibody triggered by the contralateral hemisphere hypoperfusion. It is associated with an occlusion or stenosis preoclusive of the extracranial internal carotid artery (ICA) contralateral to the movements, and poor circulation contralateral. This causes ischemia resulting in typical clinical manifestations of stroke and these abnormal movements. OBJECTIVE: To describe a case of limb shaking. MATERIALS AND METHODS: 59 years old man, with cardiovascular risk factors, who go to the Emergency room with symptoms and motor dysphasia and sudden loss of strength in right limbs, with distal brachial predominance. Admitted to Stroke Unit for neurological and hemodynamic monitoring, which coincides with the beginning of the sitting have an episode of these involuntary movements. RESULTS: Diagnostic tests confirm a left frontal cortical ischemic stroke. The EEG shows a normal background bioelectric activity. The angio-MRI and angiography showed a left ICA pseudoocclusion. DISCUSSON: A diagnosis of limb shaking based in the clinical examination and additional tests, which confirm the finding of a left ICA pseudo-occlusion and refractory to antiepileptic treatment. CONCLUSION: The limb shaking is a rare syndrome, which must be recognized and differentiated early from other processes to treat it properly. Treatment is aimed at restoring cerebral blood flow through the ischemic hemisphere revascularization.

[Rehabilitation in stroke]. / Rehabilitación en el ICTUS.

Stroke is one of the most common causes of death and disability in adults, it causes disability and participation restriction, depending on the location and size of the affected territory and cerebral vascular sequel, and the deficits will be different. Our objective is to improve the disability of patients to enable them to reintegrate fully into his personal life, work and social, and provide care and support to patients and their family. Therefore, it's important to establish a comprehensive care plan, individualized, and established early with a specific rehabilitation program continued, and with an intensity, duration and frequency adapted to the patient, to achieve functional goals raised. The rehabilitative treatment offers a variety of methods and approached from different points of view by the multidisciplinary team that deals with management. The patient and their caregivers are the most important piece of the equipment, so they should receive ongoing information, counseling and psychological support. On the other hand, the discharge should not result in an interruption of the rehabilitation program; we must adequately establish phases and areas for this healthcare. Patients who have suffered a stroke, as well as receiving the best care in the acute phase, should benefit from specific rehabilitation programs in chronic phase, we need to ensure continuity and appropriateness of care for patients and their caregivers, not in a situation of helplessness.

Rehabilitación en el ICTUS / Rehabilitation in stroke

El ictus representa una de las causas más frecuentes de muerte e invalidez en los adultos, produce discapacidad y restricción de la participación; dependiendo de la localización y tamaño del territorio vascular y cerebral afectado las secuelas y los déficits serán diferentes. Nuestro objetivo consistirá en mejorar la discapacidad de los pacientes para que puedan reintegrarse plenamente en su vida personal, laboral y social; y prestar atención y apoyo al paciente y su familia. Por ello, es importante establecer un plan de cuidados integral e individualizado e instaurar de forma precoz un programa específico de rehabilitación continuo, con una intensidad, duración y frecuencia adaptadas al propio paciente para conseguir los objetivos funcionales planteados. El tratamiento rehabilitador ofrece una gran diversidad de métodos y técnicas abordadas desde diferentes puntos de vista por el equipo multidisciplinar que se ocupa de su manejo. El propio paciente y sus cuidadores son la pieza más importante del equipo, por lo que deben recibir continua información, asesoramiento y apoyo psicológico. Por otro lado, el alta hospitalaria no debe suponer una interrupción del programa de rehabilitación, por lo que debemos establecer adecuadamente las fases y los ámbitos de esta asistencia sanitaria. Los pacientes que han sufrido un ictus, además de recibir la mejor atención en la fase aguda, deben beneficiarse de programas de rehabilitación específicos en su fase crónica, por lo que tenemos que asegurar la continuidad y adecuación de los cuidados, para que los pacientes y sus cuidadores no se encuentren en una situación de desamparo(AU)

Stroke is one of the most common causes of death and disability in adults, it causes disability and participation restriction, depending on the location and size of the affected territory and cerebral vascular sequel, and the deficits will be different. Our objective is to improve the disability of patients to enable them to reintegrate fully into his personal life, work and social, and provide care and support to patients and their family. Therefore, it’s important to establish a comprehensive care plan, individualized, and established early with a specific rehabilitation program continued, and with an intensity, duration and frequency adapted to the patient, to achieve functional goals raised. The rehabilitative treatment offers a variety of methods and approached from different points of view by the multidisciplinary team that deals with management. The patient and their caregivers are the most important piece of the equipment, so they should receive ongoing information, counseling and psychological support. On the other hand, the discharge should not result in an interruption of the rehabilitation program; we must adequately establish phases and areas for this healthcare. Patients who have suffered a stroke, as well as receiving the best care in the acute phase, should benefit from specific rehabilitation programs in chronic phase, we need to ensure continuity and appropriateness of care for patients and their caregivers, not in a situation of helplessness(AU)

Los fitoestrógenosy su afectaciónsobre la masa ósea / Phytoestrogens and their effect on bone mass

Los fitoestrógenos son unos compuestos con similitud estructural y funcionala los estrógenos. Se encuentran en multitud de plantas; las isoflavonasy sus derivados son los más estudiados. El interés creciente porestos productos se ha debido a los estudios que señalaban a las isoflavonascomo productos beneficiosos en los síntomas de la menopausia, enel sistema cardiovascular, la osteoporosis y los cánceres dependientes delos estrógenos. A pesar del gran número de estudios que aportan luz sobrelos beneficios de estos compuestos y que recomiendan el uso racionalde estos productos como primer eslabón de la cadena terapéutica, todavíaexisten muchos interrogantes y, sobre todo, mucha variabilidad enlos resultados, haciendo hincapié en la necesidad de más estudios, biendiseñados, con preparados normalizados, que muestren el papel que jueganlas isoflavonas en la prevención y el tratamiento de la osteoporosisposmenopáusica. El propósito de este trabajo fue conocer el estado de larelación entre climaterio, masa ósea y fitoestrógenos con el objetivo concretode descubrir si existen evidencias de que los fitoestrógenos puedenser una alternativa natural a la terapia hormonal. Se realizó una revisiónbibliográfica no sistemática de artículos publicados durante los últimosdiez años, en las principales bases de datos (Medline, CINAHL, Cochrane),introduciendo como palabras de búsqueda “isoflavones”, “phytoestrogens”y “osteoporosis postmenopausal”. A la vista de los resultadosla mayoría de los autores concluyeron que, en diversas situaciones, las isoflavonaspueden ser una alternativa terapéutica en el climaterio, dado quehay algunos datos sobre posibles efectos beneficiosos aunque, no obstante,se desconocen sus posibles efectos adversos y no hay suficienteevidencia científica para recomendar su uso generalizado (AU)

Phytoestrogens are compounds that are structurally and functionally similarto estrogens. They are found in many plants, isoflavones and theirderivatives being the most studied. The growing interest in these productshas been a result of studies indicating that isoflavones are beneficialfor symptoms of menopause, the cardiovascular system, osteoporosisand oestrogen-dependent cancers. Despite the large number ofstudies that shed light on the benefits of these compounds and recommendthe rational use of these products as a first step in the therapeutic chain,there are still many questions and, especially, significant variability inresults, highlighting the need for further well-designed studies with normalizedpreparations that demonstrate the role of isoflavones in the preventionand treatment of postmenopausal osteoporosis. The aim of thiswork was to ascertain the status of the relationship between menopause,bone mass and phytoestrogens with the specific objective of determiningif there is evidence indicating that phytoestrogens are a naturalalternative to hormone therapy. A non-systematic bibliographic reviewof articles published in the last ten years was conducted in the primarydatabases (Medline, CINAHL, Cochrane), using “isoflavones”, “phytoestrogens”and “postmenopausal osteoporosis” as search terms. In viewof the results, most authors concluded that, in several different situations,isoflavones can be a therapeutic alternative in menopause giventhat there are data on possible beneficial effects. However, their possibleside effects are yet unknown and there is insufficient scientific evidenceto recommend their generalized use (AU)