Forma focal y de larga evolución del síndrome de la persona rígida / Focal gradual-onset variant of stiff-person syndrome

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Frequency and mechanism of ischemic stroke associated with malignancy: a retrospective series.

BACKGROUND: Cerebrovascular disease is the second most common non-metastatic neurological disorder in oncological patients. The aims of this study were to determine the prevalence of cancer in stroke patients and to compare mechanisms of stroke between patients with and without malignancy. PATIENTS AND METHODS: This retrospective study involved patients with ischemic stroke admitted over 1 year to a Neurology Department. Demographic and clinical data, cardiovascular risk factors, and laboratory findings were recorded. The etiology was classified following the TOAST criteria. Participants were classified as stroke and cancer patients (diagnosis of malignancy before stroke or cancer diagnosed after admission) or as control stroke patients. RESULTS: Over 1 year, 291 stroke patients (268 ischemic) were admitted. Sixteen ischemic patients had a malignancy (5.9%), and in 12 patients, malignancy was the only cause found for the stroke; in 4 patients, malignancy was a coexisting condition. Coexistent stroke and cancer was significantly related to higher median levels of fibrinogen, D-dimers, and erythrocyte sedimentation rate (ESR). Logistic regression analysis showed that D-dimer and ESR levels were independently related to cancer, with odds ratios of 1.004 (95% CI 1.001-1.007, p=0.02) and 1.075 (95% CI 1.031-1.121, p=0.001), respectively. CONCLUSIONS: Almost 6% of ischemic stroke patients had a concomitant malignancy. In most of them, cancer was the only cause of stroke found. Patients with stroke and malignancy exhibited raised D-dimer, fibrinogen, and ESR levels, suggesting the prothrombotic state was a principal mechanism underlying stroke. D-dimer and ESR assessments may be useful in identifying underlying disorders in ischemic stroke.

[Top of the basilar artery syndrome: clinico-radiological aspects of 25 patients]. / Síndrome del 'top de la basilar': aspectos clinicorradiológicos de 25 pacientes.

UNLABELLED: INTRODUCTION, PATIENTS AND METHODS: We studied 25 patients, 16 women and 9 men (average age 64.8 years; SD 8.6; range from 36 to 79 years) admitted to our hospital with clinical findings compatible with obstruction at the level of the bifurcation of the basilar artery. The patients were selected on clinical and neuroradiological criteria. RESULTS AND CONCLUSIONS: All patients included in the study had presented with two or more infarcts in the vertebro-basilar territory, related to pathology of the rostral region of the basilar artery. Diagnosis was confirmed on CT and MRI. Infarcts were found in the thalamus, brain-stem, cerebellum and parieto-occipital lobe. Infarct of the thalamus associated with another infarct in a different region was the most frequent lesion. The CT-MRI findings in the 25 cases were: 14 patients had unilateral thalamic infarcts associated with another infarct. There were 4 patients with bilateral thalamic infarcts and 5 with bilateral occipital infarcts. In 11 patients the occipital infarct was associated with another infarct at a different level, and 6 patients each had a cerebellar infarct together with a brain-stem infarct. In 12 patients the lesions were localized to three or more areas. The commonest clinical manifestations were: motor deficit (68%), abnormal eye movements (48%), cerebellar dysfunction (40%), alteration of the level of consciousness (32%), visual field defects (20%), pupil anomalies (16%). The risk factors most frequently associated were: arterial hypertension (64%), a history of cerebrovascular accident (28%), smoking (28%), diabetes mellitus (24%) and atrial fibrillation (20%). Mortality was 8%. Unlike the classical descriptions, motor deficit was the most frequent symptom in our series.

[Basilar artery rostral occlusion syndrome. Clinico-radiological assessment of 56 patients]. / Síndrome por oclusión rostral de la arteria basilar. Valoración clinicorradiológica de 56 pacientes.

We studied 56 patients, 30 women and 26 men ranging from 30 to 79 years of age (average age 64.5 +/- 10.4), who were admitted to our hospital between 1982 and August 1995 with clinical features compatible with occlusion at the level of the bifurcation of the basilar artery. The patients were selected following clinical and neuro-radiological criteria. All patients included in the study had two or more recent infarcts in the vertebro-basilar territory, related to involvement of the rostral region of the basilar artery. The diagnosis was confirmed by CT or MR scanning. The infarcts were in the thalamus, brain-stem, cerebellum and parieto-occipital lobe. A thalamic infarct associated with an infarct in another region was the most frequent lesion. The CT-MR findings in the 56 cases were: 29 patients presented with a unilateral thalamic infarct associated with another infarct (23 occipital, 8 parietal, 6 brain-stem and 2 cerebellum). There were eight patients with bilateral thalamic infarcts and seven with bilateral occipital infarcts. In six patients the occipital infarct was associated with another infarct at a different level (parietal or cerebellar) and six patients had cerebellar infarcts together with an infarct of the mid-brain. In 22 of the patients, lesions were found in three or more areas. The commonest clinical findings were: Motor deficit (69.6%), abnormal eye movements (44.5%), cerebellar dysfunction (42.8%), altered level of consciousness (32.1%), visual field defects (28.5%), pupil anomalies (19.6%). The most frequently associated risk factors were: Arterial hypertension (58.9%), a history of ACV (32.1%) and atrial fibrillation (21.4%). Mortality was 5.7%. In contrast to the classical descriptions, motor defecit was the commonest symptom in our series.

[Multicenter transverse study of the neurological ambulatory care in the Spanish Health System in Aragon: overall results]. / Estudio transversal multicéntrico de las consultas externas de Neurología de la Seguridad Social en Aragón. Resultados globales. Grupo de Estudio de Neurólogos Aragoneses.

OBJECTIVE: To evaluate clinical, diagnostic and therapeutic aspects and how the Neurology Outpatient Departments of Aragon work in practice. MATERIAL AND METHODS: For three consecutive months all patients attending the Neurology Outpatient Departments of the Health Areas of the Health Service of Aragón for the first time were given a specially designed questionnaire. RESULTS: The majority of the patients were women (57%). The average age was 51.5 +/- 20.6 years. The family doctor referred 79.5% of the patients. The average waiting time for patients to be seen was 12.4 +/- 10.7 days. Further investigations were requested in 48.9% of the patients (cerebral CT in 18.1%, MR in 2.6%, EEG in 12% and ENG-EMG in 6.8%). The commonest diagnoses were headache (25.5%), cerebrovascular pathology (12.5%), extrapyramidal pathology (7.5%), syncope (6.5%), convulsions (6%), vertigo (5.9%), psychiatric disorders (5%), non-neurological disorders (4.4%). No treatment was given to 15.64% of the patients attending for the first time. The commonest drugs used were: calcium antagonists (32.5%), platelet antiaggregants (20.9%), antidepressives (17%), antiepileptic drugs (15.6%) and NSAIDS (5.3%). CONCLUSIONS: There is a considerable demand for neurological consultations and there are few neurologists in proportion to the population. Better selection of the patients sent for consultation and a better understanding by family doctors of the commoner neurological disorders would considerably reduce the number of patients sent to the Outpatient Department.

[Predictive value of serum ferritin in the prognosis of acute cerebrovascular accident]. / Valor predictivo de la ferritina sérica en el pronóstico del accidente cerebrovascular agudo.

INTRODUCTION: Recent studies show that a raised level of serum ferritin indicates a poor prognosis in CVA patients, as do the well-known hyperglycemia, dyslipemia and arterial hypertension. The evolution and prognosis of acute cerebrovascular accidents are determined by a series of factors, some of which can be modified. This leads to a search for factors which can be modified and therefore influence the course of the illness. OBJECTIVE: To determine the ferritin levels and other parameters during the course of the illness of patients with serious cerebral vascular pathology and evaluate their effect on prognosis. MATERIAL AND METHODS: A prospective study was carried out on patients diagnosed as having CVA, admitted to the Neurology Department of the Miguel Servet Hospital (Zaragoza) during 1994, and who were in neurological coma (Glasgow scale less than 7) during the first 24 hours, and unable to swallow. The levels of various plasma parameters were determined (glucose, cholesterol, ferritin, etc.) on admission and then every 10 days. CONCLUSIONS: Plasma ferritin levels higher than those considered normal by the laboratory, in the first few hours after CVA, are an independent predictive factor suggesting unfavourable evolution of the vascular condition. Equally, raised ferritinemia in the first weeks after CVA indicates a worse prognosis. This laboratory test may be carried out on patients with acute CVA to obtain more information on which to base the prognosis.

[Neurobrucellosis. A report of 13 cases]. / Neurobrucelosis. Aportación de 13 casos.

Thirteen patients with nervous system brucellosis are described. The clinical signs were heterogeneous: meningoencephalitis in 5 cases, meningoradiculitis in another 5, meningomyelitis with cranial neuropathy in 1 and of a vascular nature in 2 others. Neurologic signs appeared during the active phase in 5 patients and later in 8. Diagnosis was based on clinical manifestations, serum and cerebrospinal fluid (CSF) serology, quantitative changes in CSF and favorable response to treatment. Therapy consisted of a combination of 2 or 3 of the following drugs: rifampin, doxycycline, streptomycin and trimethoprim sulfamethoxazole. In spite of favorable evolution, 5 patients suffered sequelae. We suggest that brucellosis be investigated when neurologic deficit ensues with no known etiology, especially in endemic countries.