The cross-sectional area of the median nerve: An independent prognostic biomarker in amyotrophic lateral sclerosis.

INTRODUCTION: Ultrasound changes in the cross-sectional area of the median nerve (CSAmn) could be of interest as biomarkers in patients with amyotrophic lateral sclerosis (ALS). METHODS: Eighty-four ALS patients (51 men [60.7%]; mean 62.0 [SD 11.46] years old) and forty-six controls (27 men [58.7%]; mean 59.9 [SD 8.08] years old) of two different cohorts were recruited between September 2013 and February 2018. The CSAmn was measured bilaterally in each cohort, by two different examiners with two different ultrasound machines (one in each cohort). Its association with clinical variables (disease duration, muscle strength, disability, progression rate and tracheostomy-free survival) was assessed. RESULTS: The CSAmn was smaller in patients than in controls, and the study cohort did not influence its values. A mild correlation between the strength of the wrist flexor and the CSAmn was found. In the multivariable analysis, the probability of this association being true was 90%. In the cox regression, both a faster progression rate and a larger CSAmn independently predicted poor survival (HR=4.29, [Cr.I95%: 2.71-6.80], p<0.001; and HR=1.14, [Cr.I95%: 1.03-1.25], p=0.01), after adjusting by age, body mass index, bulbar onset, and diagnostic delay. CONCLUSIONS: The CSAmn is an easy to assess biomarker that seems reliable and reproducible. Our data also suggest that it could act as a progression and prognostic biomarker in ALS patients. Longitudinal studies with repeated measures are warranted to confirm its usefulness in the clinical practice.

Tratamiento endovascular de estenosis intracraneales sintomáticas: resultados a corto y largo plazo de un único centro / Endovascular treatment of symptomatic intracranial stenoses: short- and long-term results in a single center

Objetivos. Presentamos los resultados a corto y largo plazo de una serie de pacientes con estenosis arteriales intracraneales (EAIC) sintomáticas tratados en nuestro centro mediante angioplastia y endoprótesis. Material y métodos. Revisión de pacientes con estenosis intracraneales > 50% sintomáticas tratados en nuestro centro mediante angioplastia y/o colocación de endoprótesis. Se recogieron los datos demográficos y los factores de riesgo vascular (hipertensión, diabetes, dislipemia, cardiopatía isquémica). Todas las lesiones tratadas se caracterizaron por su localización, grado y longitud de la estenosis. El grado de estenosis se calificó como moderado (50-70%) o grave (> 70%). En el seguimiento se evaluaron los accidentes cerebrovasculares, episodios de cardiopatía isquémica o fallecimientos ocurridos durante los 30 primeros días y en el seguimiento posterior. Resultados. Entre 2006 y 2010 se trataron 26 pacientes (21 varones y 5 mujeres) con edades comprendidas entre 44 y 79 años (media: 63 años), con 29 lesiones intracraneales. El procedimiento endovascular se realizó con éxito (angioplastia + endoprótesis) en 23 casos (92,0%). En los 30 primeros días postintervención se produjeron tres (11,5%) efectos adversos de origen vascular: un ictus, una hemorragia y un fallecimiento por trombosis de la endoprótesis. El seguimiento a largo plazo se ha realizado sobre 25 pacientes (5-46 meses). No se han detectado recurrencias de la sintomatología. Conclusión. El tratamiento endovascular de las EAIC es técnicamente factible. Las complicaciones del procedimiento a corto plazo tienen una prevalencia alta. No se ha detectado recurrencia de la sintomatología a largo plazo(AU)

Objectives. We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting. Material and methods. We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up. Results. Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty + stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms. Conclusion. Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up(AU)

[Endovascular treatment of symptomatic intracranial stenoses: short- and long-term results in a single center]. / Tratamiento endovascular de estenosis intracraneales sintomáticas: resultados a corto y largo plazo de un único centro.

OBJECTIVES: We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting. MATERIAL AND METHODS: We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up. RESULTS: Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty+stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms. CONCLUSION: Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up.

Estudio de la relación entre lesiones de sustancia blanca en la resonancia magnética y foramen oval permeable en pacientes con migraña / Study of the relationship between white matter lesions in the magnetic resonance imaging and patent foramen ovale

Introducción. Diversos estudios han demostrado unamayor prevalencia de lesiones de sustancia blanca (LSB) enresonancia magnética (RM) cerebral de pacientes con migraña.También se ha comunicado mayor frecuencia deshunt derecha-izquierda (SDI) en pacientes con migrañacon aura (MCA) que en población general. El objetivo denuestro estudio es explorar una eventual asociación entre laexistencia de LSB y la presencia o no de SDI en pacientescon migraña.Métodos. Se revisaron los pacientes con MCA o migrañasin aura (MSA) con estudio de RM, a los que se había determinadopreviamente SDI mediante doppler transcraneal(DTC). Se determinaron LSB (alteraciones de señal de sustanciablanca hiperintensas en secuencias ponderadas en T2y FLAIR sin alteración de señal en T1). Se relaciona la presenciade LSB con el tipo de migraña y presencia o no de SDImediante estadística univariante.Resultados. Cuarenta y cuatro pacientes con migraña(31 mujeres y 13 hombres); edad media: 39 años (23-66).Doce pacientes con MSA y 32 con MCA. Catorce pacientesmostraron LSB (31,8 %). Veintinueve pacientes (65,9 %) presentaronSDI. Los pacientes con LSB presentaron SDI tan sóloen un 26,7% y los pacientes con SDI presentaron LSB enun 34,5 %. No se apreciaron diferencias estadísticamentesignificativas (p=0,738).Conclusiones. No hemos podido demostrar una relaciónentre el SDI y la aparición de LSB en la RM cerebral ennuestra serie. Desconocemos la naturaleza de la asociaciónentre LSB y migraña, pero estos hallazgos sugieren que elmecanismo no sería el embolismo paradójico (AU)

Introduction. Previous studies have described a higherprevalence of white matter lesions (WML) in thebrain magnetic tesonance imaging (MRI) in patients withmigraine. A higher frequency of right-to-left shunt (RLS)in patients with migraine with aura (MA) than in generalpopulation has been reported. This study has aimed toinvestigate a possible association between the existenceof WML and the presence or non-presence of RLS in patientswith migraine.Methods. We have reviewed migraine patients sufferingMA or migraine without aura (MWA) with an MRIstudied in whom left-right shunt had been determinedpreviously by transcranial doppler (TCD). The presenceof WML was determined (white matter hyperintensitiesin T2-weighted MR images (T2WI) and FLAIR, withoutsignal alteration in T1WI). The presence of WML was relatedwith the type of migraine and presence or non-presenceof RLS by univariate statistics.Results. Forty four patients with migraine, 13 maleand 31 female, mean age 39 years (23-66) were studied.Twelve patients had MA and 32 MWA. Fourteen patientshad WML (31.8%), 29 patients (65.9%) RLS; 26.7% ofthe patients with WML also had RLS, and 34.5% of thepatients with RLS had WML. Non-statistically significantdifferences were observed (p=0.738).Conclusions. We could not demonstrate a relationshipbetween RLS and WML in the brain MRI of ourpatients. We do not know the nature of the associationbetween is the association between WML and migraine,but these findings suggest that the link would not be byparadoxical embolism (AU)

[Migraine with aura, right-to-left shunt and frequency of seizures]. / Migraña con aura, shunt derecha-izquierda y frecuencia de crisis.

INTRODUCTION: The high prevalence of patent foramen ovale in migraine with aura (MWA) seems to be well established; yet, the possible relation between the magnitude of the right-to-left shunt (RLS) and MWA is not so clear. As a hypothesis, if the RLS played a precipitating role, subjects with a larger degree of shunt might experience a higher number of seizures. We examine this possible relationship between the magnitude of the shunt and the incidence of seizures. PATIENTS AND METHODS: We examined a series of 72 patients with MWA to obtain the frequencies of seizures (dividing them into three groups of increasing frequency), history and precipitating factors. The presence and magnitude of the RLS were later determined by means of transcranial Doppler ultrasonography, following a method that had previously been validated. Univariate analysis was then used to evaluate the possible association between the magnitude of the shunt and the frequency of seizures. RESULTS: The mean age was 36 years. RLS appeared in 44 patients (61.1%) and followed a 'shower/curtain' pattern in 38% of cases. Frequency of seizures was low in 27%, medium in 45% and high in 27% of patients. Frequency was not associated with the magnitude of the shunt even when only high-frequency cases were considered. High frequency was associated, however, with certain precipitating factors. CONCLUSIONS: Our study confirms the existence of a high prevalence of RLS in patients with MWA, but no association was found between the magnitude of the shunt and the frequency of the seizures. As discussed here, these findings are partly at odds with a 'threshold' type of association or mechanism that precipitates seizures.

[Direct carotid-cavernous fistulas: endovascular treatment using a detachable balloon]. / Fístulas carotidocavernosas directas: tratamiento endovascular mediante balón desprendible.

INTRODUCTION: Carotid cavernous fistulas are abnormal communications between the cavernous sinus and the internal and/or external carotid artery. They may be spontaneous or acquired. Two basic types are distinguished as a function of the aetiology, clinical features and treatment. The direct type is usually due to trauma while the indirect is of varied aetiology. CLINICAL CASE: We present a series of seven cases of direct carotid-cavernous fistulas, four post-traumatic and three spontaneous, with initial symptoms of ocular involvement and ophthalmoparesia predominantly. All were treated, in our hospital, by embolization with a detachable balloon in the venous variant of the fistula in six cases and by carotid occlusion in one case. Only one severe complication due to distal embolization occurred. CONCLUSIONS: It is necessary to consider the diagnosis of carotid-cavernous fistulas in patients complaining of acute alterations of ocular motility, headache and/or other ocular symptoms, especially when there is a clinical history of head injury. There should be minimal delay between diagnosis and treatment since there is a high risk of hemorrhage and irreversible sequelae caused by alteration of the venous drainage when they are long-standing. The treatment of choice for direct fistulas is by detachable balloon, which has been shown to be superior to other techniques.