ABSTRACT
Introducción: La hipotensión intracraneal espontánea es un síndrome causado por la disminución del volumen de líquido cefalorraquídeo consecuencia de su fuga al espacio extradural. Aunque la ICHD-3 proporciona un alto nivel de especificidad diagnóstica, esta enfermedad puede manifestarse de forma atípica. Hasta en un 30% no es posible establecer el punto de escape, pero con el refinamiento de los exámenes de imágenes este porcentaje se ha reducido a un 15%-20%. Actualmente, su manejo no se encuentra estandarizado y las recomendaciones se basan en evidencia de limitada calidad metodológica, además de la variabilidad de protocolos entre distintos centros. Desarrollo En esta revisión actualizamos los procedimientos diagnósticos y terapéuticos. Por un lado, analizamos el rol de la resonancia nuclear magnética de encéfalo y médula espinal completa como primer paso diagnóstico y, por otro lado, señalamos los exámenes destinados a determinar la fuga de líquido cefalorraquídeo. Tal es el caso de la mielo-resonancia, la mielo-tomografía computarizada, tanto estándar, dinámica y por sustracción digital, además de la cisternografía con 111-Indium-DPTA. Sin embargo, determinar cuál de estos exámenes es el óptimo es objeto de debate. Lo mismo ocurre con el tratamiento: reposo; parche sanguíneo epidural a ciegas, parche guiado por fluoroscopia o tomografía computarizada, parche de fibrina; o cirugía. Conclusiones Se requiere de una mayor investigación, especialmente con trabajos multicéntricos controlados, para una mejor comprensión de la fisiopatología, el diagnóstico por imágenes, los enfoques terapéuticos y evaluación objetiva de los resultados clínicos. Solo así se establecerán pautas diagnósticas y de tratamiento validadas.
Introducction: Spontaneous intracranial hypotension is a syndrome caused by decreased CSF volume secondary to its leakage into the extradural space Although ICHD-3 provides a high level of diagnostic specificity, manifestations may be atypical, making diagnosis challenging. The site of leakage may be undetermined in point Up to 30% of cases, although with recent refinement of imaging, this percentage has been reduced to 15-20%. Currently, management is not standardized and recommendations are based on inconclusive evidence, with variability of protocols between centres. Development. In this review, we update diagnostic and therapeutic procedures. We analyse the role of whole brain and spinal cord MRI as a first investigation and review tests aimed at determining cerebrospinal fluid leakage, such as MRI myelography, conventional CT myelography, dynamic CT myelography, and digital subtraction CT myelography, as well as 111-Indium-DPTA cisternography. Determining optimal use of these investigations remains a matter of debate. The same is true for treatment: rest, blind epidural blood patch, fluoroscopy or CT-guided epidural blood patch, fibrin patch and surgery are discussed. Conclusión: Further research, especially multicentre controlled studies, is required to improve understanding of pathophysiology, diagnostic imaging, therapeutic approaches and to objectively assess clinical outcomes. Only then will diagnostic and treatment guidelines be evidence-based.
ABSTRACT
Wording problems are common in medical literature. The essence of any scientific work is to be understandable. A correct writing technique allows to communicate with the reader in an easy and accessible way, without disregarding proper grammatical and orthographic rules. This work is an updated guideline for the proper writing of biomedical manuscripts in Spanish. It avoids cumbersome grammatical explanations, aiming to become a simple material available for quick consultation.
Subject(s)
Language , Manuscripts, Medical as Topic , Writing/standards , Biomedical Research , Humans , Scholarly CommunicationABSTRACT
Wording problems are common in medical literature. The essence of any scientific work is to be understandable. A correct writing technique allows to communicate with the reader in an easy and accessible way, without disregarding proper grammatical and orthographic rules. This work is an updated guideline for the proper writing of biomedical manuscripts in Spanish. It avoids cumbersome grammatical explanations, aiming to become a simple material available for quick consultation.
Subject(s)
Humans , Writing/standards , Language , Manuscripts, Medical as Topic , Biomedical Research , Scholarly CommunicationABSTRACT
Medical literature shows that the co-infection of syphilis and human immunodeficiency virus (HIV) is increasing dramatically worldwide. HIV infection and syphilis have a synergistic relationship. Syphilis increases the risk of HIV transmission and acquisition, while HIV affects the presentation, diagnosis, progression and response to syphilis treatment. The diagnosis of syphilis is made with a non-treponemal reactive test (VDRL or RPR) confirmed with a treponemal test (FTA-ABS or MHA-TP). The opportune diagnosis of neurosyphilis is essential, particularly in the asymptomatic stages, given the high risk of serious sequels and lethality. All patients co-infected with HIV and syphilis with neurological symptoms must be studied with PL and other complementary tests. There is controversy about when to perform a lumbar puncture in co-infected patients who do not have neurological symptoms. However, there is consensus that a CD4 count lower than 350/µl or RPR title greater than 1/32 has indication for the study of cerebrospinal fluid. Therapy with penicillin G in high doses is the treatment of choice, in addition to clinical and serological follow-up that must be done to these patients. (AU)
Subject(s)
Humans , Male , HIV Infections/diagnosis , Neurosyphilis/diagnosis , HIV Infections/complications , HIV Infections/therapy , Neurosyphilis/complications , Neurosyphilis/therapyABSTRACT
We report five male patients, aged 35 to 63 years who suffered from paretic neurosyphilis. The clinical course was that of a subacute dementia with a frontal syndrome, with more apathy than euphoria. All were HIV negative and four were heterosexual. In all, the cerebrospinal fluid had a mononuclear pleocytosis and a positive VDRL. EEG was abnormal in the 3 cases in whom it was performed. One patient in whom a brain angiography was performed, had images of vasculitis. Treatment with 18-24 million units of penicillin per day during two weeks or more, was partially effective.
Subject(s)
Dementia , Neurosyphilis , Adult , Dementia/complications , HIV Seronegativity , Humans , Male , Middle Aged , Neurosyphilis/complications , Neurosyphilis/diagnosis , Neurosyphilis/drug therapy , Penicillins/therapeutic useABSTRACT
We report five male patients, aged 35 to 63 years who suffered from paretic neurosyphilis. The clinical course was that of a subacute dementia with a frontal syndrome, with more apathy than euphoria. All were HIV negative and four were heterosexual. In all, the cerebrospinal fluid had a mononuclear pleocytosis and a positive VDRL. EEG was abnormal in the 3 cases in whom it was performed. One patient in whom a brain angiography was performed, had images of vasculitis. Treatment with 18-24 million units of penicillin per day during two weeks or more, was partially effective.
Subject(s)
Adult , Humans , Male , Middle Aged , Dementia , Neurosyphilis , Dementia/complications , HIV Seronegativity , Neurosyphilis/complications , Neurosyphilis/diagnosis , Neurosyphilis/drug therapy , Penicillins/therapeutic useABSTRACT
Headache is the most frequent symptom that makes patients to attend a neurologists office. Is a very common reason to attend general physician as well, so is very important to know how to do a correct diagnosis between primary and secondary headache and to treat the most frequent ones. This review includes migraine, tension type headache and others, from a clinical perspective, with special focuses on clinical clues that allow clinicians a more specific diagnosis and treatment. We want to emphasize how rational treatment should be prescribed and how to avoid rebound headache and others complications related to certain drugs, in particular ergotamines.
Subject(s)
Humans , Migraine Disorders/diagnosis , Migraine Disorders/therapy , Headache Disorders/diagnosis , Headache Disorders/therapy , Migraine Disorders/etiology , Migraine Disorders/physiopathology , Headache Disorders/etiology , Headache Disorders/physiopathologyABSTRACT
Charles Bonnet syndrome is characterized by the presence of visual hallucinations associated with loss of vision. We report three patients aged 74, 84 and 80 years (two women) with a severe loss of vision due to ocular diseases and silent visual hallucinations, that they recognized as unreal. Two patients felt that the hallucinations were ominous. Years later, two suffered a probable Alzheimer's disease (AD). One of them had a mild cognitive impairment when the syndrome appeared, that evolved into an AD with psychosis. This syndrome is not uncommon in older patients with loss of vision and it is probably underdiagnosed. Its pathogenesis is probably a cortical deafferentation. The content of the visual hallucinations (faces, landscaped, and so on) coincides with the activation of different areas of the visual association cortices.
Subject(s)
Hallucinations/diagnosis , Vision Disorders/diagnosis , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Hallucinations/psychology , Humans , Male , Psychotic Disorders/diagnosis , Syndrome , Vision Disorders/psychologyABSTRACT
Charles Bonnet syndrome is characterized by the presence of visual hallucinations associated with loss of vision. We report three patients aged 74, 84 and 80 years (two women) with a severe loss of vision due to ocular diseases and silent visual hallucinations, that they recognized as unreal. Two patients felt that the hallucinations were ominous. Years later, two suffered a probable Alzheimer's disease (AD). One of them had a mild cognitive impairment when the syndrome appeared, that evolved into an AD with psychosis. This syndrome is not uncommon in older patients with loss of vision and it is probably underdiagnosed. Its pathogenesis is probably a cortical deafferentation. The content of the visual hallucinations (faces, landscaped, and so on) coincides with the activation of different areas of the visual association cortices).
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Hallucinations/diagnosis , Vision Disorders/diagnosis , Diagnosis, Differential , Hallucinations/psychology , Psychotic Disorders/diagnosis , Syndrome , Vision Disorders/psychologyABSTRACT
Neurological manifestations, secondary to perfusion problems, vasogenic edema or small infarcts, are common in thrombotic purpura. Moreover, they are the first symptoms of the disease in 50% of patients. We report a 50 year-old woman who presented with focal intermittent neurological signs with aphasia and right hemiparesis, who then developed progressive impairment of consciousness with stupor and generalized tonic-clonic seizures. Despite the severe neurological impairment, first neuroimaging studies were normal. A second magnetic resonance imaging showed small cortical infarcts, that were visible only with the technique of diffusion weighted imaging. The standard electroencephalograms showed focal left temporal slowing and low voltage first and then diffuse slowing accordind to the clinical condition of the patients. She was treated with plasmapheresis and had a partial neurological recovery at the fifth day, but died at the twelfth day of therapy.
Subject(s)
Brain Infarction/etiology , Purpura, Thrombotic Thrombocytopenic/complications , Brain Infarction/diagnosis , Electroencephalography , Fatal Outcome , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/therapy , Tomography, X-Ray ComputedABSTRACT
Neurological manifestations, secondary to perfusion problems, vasogenic edema or small infarcts, are common in thrombotic purpura. Moreover, they are the first symptoms of the disease in 50% of patients. We report a 50 year-old woman who presented with focal intermittent neurological signs with aphasia and right hemiparesis, who then developed progressive impairment of consciousness with stupor and generalized tonic-clonic seizures. Despite the severe neurological impairment, first neuroimaging studies were normal. A second magnetic resonance imaging showed small cortical infarcts, that were visible only with the technique of diffusion weighted imaging. The standard electroencephalograms showed focal left temporal slowing and low voltage first and then diffuse slowing accordind to the clinical condition of the patients. She was treated with plasmapheresis and had a partial neurological recovery at the fifth day, but died at the twelfth day of therapy .
Subject(s)
Female , Humans , Middle Aged , Brain Infarction/etiology , Purpura, Thrombotic Thrombocytopenic/complications , Brain Infarction/diagnosis , Electroencephalography , Fatal Outcome , Magnetic Resonance Imaging , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/therapy , Tomography, X-Ray ComputedABSTRACT
Disulfiram is widely used for aversive treatment of alcoholism. Although it is well tolerated in most patients, one in 15,000 patients will develop peripheral neuropathy every year, which is frequently misdiagnosed as alcoholic neuropathy. Disulfiram neuropathy can be mild or severe, depending on diverse factors such as time of exposure and the dosage. Most patients will present with a motor-sensory neuropathy of the lower limbs, which tends to improve as disulfiram administration ceases, however some cases may remain with permanent sequelae. We report the clinical, laboratory and electrophysiological features of three patients who developed disulfiram neuropathy during treatment of alcoholism. Recovery was incomplete at 8 weeks after treatment cessation in all of them. No other findings justified the clinical features described in these patients. Considering the incidence of alcoholism and the wide use of disulfiram treatment in Chile, we suggest that disulfiram neuropathy is being underdiagnosed. We also stress the fact that disulfiram neuropathy could be avoided by using lower doses
Subject(s)
Humans , Male , Adult , Middle Aged , Disulfiram , Nervous System Diseases , Paresthesia , AlcoholismABSTRACT
La interacción entre carbamazepina y claritromicina ha sido recientemente reportada en la literatura. Reportamos el caso de un niño de 8 años, portador de epilepsia, quien presentó una intoxicación por carbamazepina luego de que se agregara claritromicina al tratamiento. Después de la segunda dosis del antibiótico el paciente se mostró somnoliento y con ataxia cerebelosa, demostrándose una importante elevación del nivel plasmático de carbamazepina. El paciente recobró su condición normal rápidamente, luego de que se suspendiera el antibiótico con la concomitante disminución del nivel plasmático del anticonvulsivante. Se discuten las características de esta interacción de fármacos haciendo resaltar las características del metabolismo de los niños que hace especialmente importante esta situación clínica
Subject(s)
Humans , Male , Child , Carbamazepine/adverse effects , Clarithromycin/adverse effects , Drug Interactions , Epilepsy/drug therapySubject(s)
Humans , Alzheimer Disease/diagnosis , Alzheimer Disease/therapy , Aging/physiology , Attitude to Death , Caregivers , Diagnosis, Differential , Diagnostic Errors , Hospitalization , Medication Errors , Parkinson Disease/diagnosis , Parkinson Disease/drug therapy , Psychic Symptoms , Self-Help GroupsABSTRACT
Chronic inflammatory demyelinating polyneuropathy is a heterogeneous disease characterized by symmetrical motor and sensitive alterations, absence of tendom reflexes and increased cerebrospinal fluid protein levels. We report 6 patients with the disease (3 males) aged 41 to 70 years old. Four had tha classical presentation and two had an asymmetrical paresis, that predominated in superior limbs. These patients had proximal block with scarce prolongation of distal nerve conduction velocity. In all patients, underlying illnesses were discarded with a full diagnostic work up. Subjects were followed from 2 to 14 months after the diagnosis. In all, treatment with steroids improved muscle strength and sensivity
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Demyelinating Diseases/diagnosis , Neuromuscular Diseases/diagnosis , Steroids/administration & dosage , Demyelinating Diseases/physiopathology , Diagnosis, Differential , Electrophysiology/methods , Chronic DiseaseABSTRACT
HIV infected population has a higher incidence of syphilis, being this an independent risk factor for HIV infection. We report 88 HIV infected patients seen during the last three years. Fourteen (16 percent) had reactive serum VDRL and FTA-ABS and neurosyphilis was diagnosed in six (6,8 percent). Three had a treponemal uveitis-retinitis, one a meningovascular syphilis and one a secondary syphilis with meningeal and otological involvement. Patients were treated with penicillin 20 million UI/day for 14 days with good clinical and laboratory response and CFS normalization in those subjected to a second lumbar puncture. It is concluded that neurosyphilis must be considered in the differential diagnosis of neurological complications of HIV infections
Subject(s)
Humans , Male , Adult , HIV Infections/complications , Neurosyphilis/complications , Penicillins/administration & dosage , Homosexuality , Risk Factors , Cerebrospinal Fluid/microbiology , Neurologic Manifestations , Neurosyphilis/cerebrospinal fluid , Neurosyphilis/drug therapySubject(s)
Adult , Humans , Female , Thrombosis , Cerebrovascular Disorders , Coronary Disease , Hypertension , Skin ManifestationsABSTRACT
Se presenta un trabajo descriptivo emn pacientes operados por patología varicosa en el Hospital Sanatorio de Valparaíso durante 1983, encontrándose que la mayor frecuencia corresponde a pacientes del sexo femenino (64,9%)y la edad más común al momento de la primera consulta, fluctúa entre 40 y 49 años en ambos sexos. En relación a las características propias del cuadro varicoso destaca que los signos y síntomas más frecuentes al momento de consulta son la dilatación venosa (69,3%) y el dolor (33,3%) respectivamente. El territorio venoso más afectado es el de la safena interna, comprometiendo con mayor frecuencia ambas extremidades en forma simultánea. El mayor número de pacientes operados presentan várices en etapa moderada o avanzada al momento de la consultaa. Con respecto a los factores de riesgo o etiopatogénicos se aprecia que un 62,6% de los pacientes tienen sobrepeso o algún grado de obesidad y un porcentaje alto de mujeres (27,7%) presenta obesidad severa. Otro factor analizado fué la paridad, detectándose a éste respecto que el 80,4% de las mujeres operadas eran multíparas y que sólo en el 14,4% las várices aparecieron durante algún embarazo. Finalmente debemos destacar la alta prevalencia del cuadro y la poca información disponible en la literatura nacional, lo que estimula la realización de mayores estudios tanto de orden descriptivo como analítico
