Factores de riesgo en la cefalea pospunción dural / Risk factors in post-dural puncture headache

Objetivos Este estudio tiene como objetivo la determinación de la incidencia de CPPD y la identificación de factores predisponentes en su aparición. Método Se lleva a cabo un estudio descriptivo, de carácter prospectivo en 57 pacientes a los que se les realiza una punción lumbar. Para ello, se han analizado variables relativas a factores de riesgo derivado del paciente, factores clínicos y del procedimiento con la presencia de CPPD. La incidencia de CPPD ha sido de 38,6% y entre los factores asociados a su aparición se ha identificado la edad joven y el antecedente de cefalea previa. Resultados La incidencia de CPPD ha sido mayor en mujeres, siendo de mayor intensidad en este grupo, si bien es necesaria la realización de estudios con mayor tamaño muestra. Conclusiones Debemos tener presente los factores asociados a la aparición de una CPPD como son: la edad joven, el antecedente de cefalea y la percepción de dificultad del proceso, para una mejor información a los pacientes y una optimización de la técnica empleada (AU)

Introduction Post-dural puncture headache (PDPH) is the most common complication following lumbar puncture. However, its incidence varies according to the series consulted. Different factors associated with its onset have been identified. Objectives The purpose of this study is to determine the incidence of PDPH and to identify predisposing factors for its appearance. Method Prospective, descriptive study in 57 patients who underwent lumbar puncture procedures. To this end, variables associated with patient-related risk factors, clinical and procedural factors with the presence of PDPH were analysed. The incidence of PDPH was 38.6% and factors associated with onset included young age and previous history of headache. Results The incidence of PDPH was higher in women and presented greater intensity in this group, though studies with a larger sample size would need to be conducted. Conclusions We must bear in mind the factors associated with the appearance of PDPH, which include: young age, history of headache, and the perception of procedural difficulty, to better inform patients and optimise the techniques used (AU)

Risk factors in post-dural puncture headache.

INTRODUCTION: Post-dural puncture headache (PDPH) is the most common complication following lumbar puncture. However, its incidence varies according to the series consulted. Different factors associated with its onset have been identified. OBJECTIVES: The purpose of this study is to determine the incidence of PDPH and to identify predisposing factors for its appearance. METHOD: Prospective, descriptive study in 57 patients who underwent lumbar puncture procedures. To this end, variables associated with patient-related risk factors, clinical and procedural factors with the presence of PDPH were analysed. The incidence of PDPH was 38.6% and factors associated with onset included young age and previous history of headache. RESULTS: The incidence of PDPH was higher in women and presented greater intensity in this group, though studies with a larger sample size would need to be conducted. CONCLUSIONS: We must bear in mind the factors associated with the appearance of PDPH, which include: young age, history of headache, and the perception of procedural difficulty, to better inform patients and optimise the techniques used.

Infección por SARS-CoV-2 y seroprevalencia en pacientes con esclerosis múltiple / SARS-CoV-2 infection and seroprevalence in patients with multiple sclerosis

Introducción: El efecto de la infección por SARS-CoV-2 en los pacientes con esclerosis múltiple (EM) y la influencia de los tratamientos modificadores de la enfermedad (TME) es desconocida. Hasta el momento no se ha observado que los pacientes con EM tengan mayor riesgo de infección por COVID-19, ni peor curso evolutivo de la misma.MétodosEstudio descriptivo de pacientes con EM e infección por SARS-CoV-2 diagnosticada mediante PCR. Hemos analizado variables demográficas, clínicas, de laboratorio y de tratamiento en nuestra muestra. Se ha determinado la presencia de anticuerpos frente a SARS-CoV-2 en estos pacientes.ResultadosLa forma de esclerosis múltiple remitente recurrente (EMRR) fue la más frecuente en lo pacientes con EM e infección por COVID-19. El 10,2% presentó una evolución desfavorable, relacionada con una mayor edad y una Expanded Disability Status Scale (EDSS) más elevada. La seroprevalencia de anticuerpos frente a SARS-CoV-2 en nuestro estudio ha sido del 83,3%. El desarrollo de anticuerpos no está relacionado con el TME, la presencia de linfopenia u otros factores analizados.ConclusionesLa incidencia de COVID-19 ha sido ligeramente inferior a la de la población general de nuestra provincia. La evolución desfavorable se ha relacionado con una mayor edad y una puntuación elevada en la EDSS. El TME y la linfopenia no se han relacionado con el curso de la infección por COVID-19. La seroprevalencia es similar a la encontrada en población general con PCR positiva, sin poder determinar la influencia de los distintos TME. (AU)

Introduction: The effect of SARS-CoV-2 infection in patients with multiple sclerosis (MS) and the influence of disease-modifying therapies (DMT) for MS on COVID-19 are unknown. To date, patients with MS have not been shown to present greater risk of COVID-19 or more severe progression of the disease.MethodsWe performed a descriptive study of patients with MS presenting SARS-CoV-2 infection diagnosed with PCR. We analysed demographic, clinical, laboratory, and treatment variables in our sample. Presence of antibodies against the virus was also determined.ResultsRelapsing-remitting MS (RRMS) was the most frequent form of MS in our sample. Prognosis was unfavourable in 10.2% of patients, and was associated with older age and higher scores on the Expanded Disability Status Scale (EDSS). Seroprevalence of antibodies against SARS-CoV-2 was 83.3% in our sample. Development of antibodies was not associated with DMT, lymphocytopaenia, or any of the other variables analysed.ConclusionsThe incidence of COVID-19 was slightly lower in our sample than in the general population in our province. Unfavourable prognosis was associated with older age and higher EDSS scores. DMT and lymphocytopaenia did not influence the clinical course of COVID-19. Seroprevalence of antibodies against the virus in our sample was similar to that reported for the general population with positive PCR results for the virus; the influence of specific DMTs could not be determined. (AU)

SARS-CoV-2 infection and seroprevalence in patients with multiple sclerosis.

INTRODUCTION: The effect of SARS-CoV-2 infection in patients with multiple sclerosis (MS) and the influence of disease-modifying therapies (DMT) for MS on COVID-19 are unknown. To date, patients with MS have not been shown to present greater risk of COVID-19 or more severe progression of the disease. METHODS: We performed a descriptive study of patients with MS presenting SARS-CoV-2 infection diagnosed with PCR. We analysed demographic, clinical, laboratory, and treatment variables in our sample. Presence of antibodies against the virus was also determined. RESULTS: Relapsing-remitting MS (RRMS) was the most frequent form of MS in our sample. Prognosis was unfavourable in 10.2% of patients, and was associated with older age and higher scores on the Expanded Disability Status Scale (EDSS). Seroprevalence of antibodies against SARS-CoV-2 was 83.3% in our sample. Development of antibodies was not associated with DMT, lymphocytopaenia, or any of the other variables analysed. CONCLUSIONS: The incidence of COVID-19 was slightly higher in our sample than in the general population in our province. Unfavourable prognosis was associated with older age and higher EDSS scores. DMT and lymphocytopaenia did not influence the clinical course of COVID-19. Seroprevalence of antibodies against the virus in our sample was similar to that reported for the general population with positive PCR results for the virus; the influence of specific DMTs could not be determined.

SARS-CoV-2 infection and seroprevalence in patients with multiple sclerosis. / Infección por SARS-CoV-2 y seroprevalencia en pacientes con esclerosis múltiple.

INTRODUCTION: The effect of SARS-CoV-2 infection in patients with multiple sclerosis (MS) and the influence of disease-modifying therapies (DMT) for MS on COVID-19 are unknown. To date, patients with MS have not been shown to present greater risk of COVID-19 or more severe progression of the disease. METHODS: We performed a descriptive study of patients with MS presenting SARS-CoV-2 infection diagnosed with PCR. We analysed demographic, clinical, laboratory, and treatment variables in our sample. Presence of antibodies against the virus was also determined. RESULTS: Relapsing-remitting MS (RRMS) was the most frequent form of MS in our sample. Prognosis was unfavourable in 10.2% of patients, and was associated with older age and higher scores on the Expanded Disability Status Scale (EDSS). Seroprevalence of antibodies against SARS-CoV-2 was 83.3% in our sample. Development of antibodies was not associated with DMT, lymphocytopaenia, or any of the other variables analysed. CONCLUSIONS: The incidence of COVID-19 was slightly lower in our sample than in the general population in our province. Unfavourable prognosis was associated with older age and higher EDSS scores. DMT and lymphocytopaenia did not influence the clinical course of COVID-19. Seroprevalence of antibodies against the virus in our sample was similar to that reported for the general population with positive PCR results for the virus; the influence of specific DMTs could not be determined.

Utility of transcranial sonography in the diagnosis of drug-induced parkinsonism: a prospective study.

BACKGROUND AND PURPOSE: Drug-induced parkinsonism usually resolves after discontinuation of the causative agent. However, it persists in some patients, who actually have subclinical neurodegenerative parkinsonism. Identification of this condition is important because these patients could benefit from therapeutic measures. The objective of this study was to prove whether transcranial sonography, a technique used in the diagnosis of neurodegenerative parkinsonism, can be used for the said identification. METHODS: In this prospective study, patients with drug-induced parkinsonism were followed for at least 6 months after discontinuation of the causative drug and performance of blinded transcranial sonography. Patients were categorized as having iatrogenic parkinsonism if the clinical presentation had resolved or subclinical drug-exacerbated parkinsonism if it persisted. Once the patient was classified into one of the two groups, an expert assessed the transcranial sonography findings and their agreement with the clinical diagnosis. RESULTS: Twenty patients composed the group for analysis of results. Assessing hyperechogenicity in the substantia nigra >20 mm2 and/or hyperechogenic lentiform nucleus, differences were detected between the iatrogenic parkinsonism and the subclinical drug-exacerbated parkinsonism groups, although they did not reach statistical significance (Fisher's exact test 0.09). Joint assessment of sonographic alterations in both structures had a negative predictive value of 85.7% for diagnosis of drug-induced parkinsonism, with a negative likelihood ratio of 0.3. CONCLUSIONS: Although in our study statistically significant differences were not found between the transcranial sonography characteristics of subclinical drug-exacerbated parkinsonism and iatrogenic parkinsonism patients, we believe that transcranial sonography is a valid technique for diagnosis of drug-induced parkinsonism.

Evaluación de la versión española del Memory Impairment Screen / Evaluation of the spanish version of the memory impairment screen

Introducción. Los tests de cribado para detectar demenciassuelen ser largos, en ocasiones difíciles de aplicar, y precisancierto instrucción previa. El Memory Impairment Screen (MIS) esun test de cribado de fácil aplicación y rápido (3-4 minutos) queevalúa la memoria verbal a corto plazo. Objetivo. Evaluar la utilidaddel MIS para el cribado de demencia en nuestra población.Sujetos y métodos. Evaluamos a 101 sujetos, divididos en 49 sujetoscon demencia según los criterios DMS-IV y 52 sujetos sin deteriorocognitivo. Se estudiaron variables demográficas (edad, sexo,escolaridad) y los resultados de la escala de deterioro global, eltest minimental (MMSE) de Folstein, el MIS, la fluidez verbalsemántica (FVS) y el test del reloj a la orden (TRO). Análisis estadístico:se compararon variables demográficas y los resultados delos tests entre los grupos con y sin demencia, y se determinaron losparámetros de utilidad diagnóstica y áreas bajo la curva ROC(aROC). Resultados. No hubo diferencias significativas entre lasvariables sociodemográficas excepto una edad media mayor en elgrupo con demencia. El MIS mostró una sensibilidad del 83,7%(IC 95%: 71-97,9), mayor que la FVS y TRO, y una especificidaddel 94,2% (IC 95%: 84,4-98), mayor que el MMSE y la FVS. ElaROC del MIS fue de 0,935 (IC 95%: 0,954-1,006). Conclusión.Estos resultados demuestran que el MIS es un buen test de cribadode demencia, que podría emplearse por su sencillez y aplicaciónrápida en nuestra población

Introduction. Screening tests for detecting dementias are usually long, sometimes difficult to apply, and require acertain amount of instruction prior to using them. The Memory Impairment Screen (MIS) is a fast (3-4 minutes), easy-to-applyscreening test that evaluates short-term verbal memory. Aim. To evaluate the value of the MIS for screening for dementia inour population. Subjects and methods. We evaluated 101 subjects who were divided into two groups, one consisting of 49individuals with dementia according to DMS-IV criteria and the other made up of 52 subjects with no cognitive impairment.Demographic variables (sex, age, schooling) were studied together with the results from the Global Deterioration Scale, theFolstein Mini-Mental State Examination (MMSE), the MIS, the Semantic Verbal Fluency (SVF) and the Command-ConditionClock Test (CCCT). Statistical analysis: demographic variables and the results from the tests for the two groups (with andwithout dementia) were compared, and the parameters for diagnostic usefulness and the areas under the ROC (aROC) weredetermined. Results. No significant differences were found between the sociodemographic variables except for a higher meanage in the group with dementia. The MIS showed a sensitivity of 83.7% (95% CI: 71-97.9), which was higher than the SVF andthe CCCT, and a specificity of 94.2% (95% CI: 84.4-98), which was higher than the MMSE and the SVF. The aROC of the MISwas 0.935 (95% CI: 0.954-1.006). Conclusions. These findings show that the MIS is a good test for screening for dementia,and its simplicity and quick application could make it suitable for use in our population

[Evaluation of the Spanish version of the Memory Impairment Screen]. / Evaluación de la versión española del Memory Impairment Screen.

INTRODUCTION: Screening tests for detecting dementias are usually long, sometimes difficult to apply, and require a certain amount of instruction prior to using them. The Memory Impairment Screen (MIS) is a fast (3-4 minutes), easy-to-apply screening test that evaluates short-term verbal memory. AIM: To evaluate the value of the MIS for screening for dementia in our population. SUBJECTS AND METHODS: We evaluated 101 subjects who were divided into two groups, one consisting of 49 individuals with dementia according to DMS-IV criteria and the other made up of 52 subjects with no cognitive impairment. Demographic variables (sex, age, schooling) were studied together with the results from the Global Deterioration Scale, the Folstein Mini-Mental State Examination (MMSE), the MIS, the Semantic Verbal Fluency (SVF) and the Command-Condition Clock Test (CCCT). STATISTICAL ANALYSIS: demographic variables and the results from the tests for the two groups (with and without dementia) were compared, and the parameters for diagnostic usefulness and the areas under the ROC (aROC) were determined. RESULTS: No significant differences were found between the sociodemographic variables except for a higher mean age in the group with dementia. The MIS showed a sensitivity of 83.7% (95% CI: 71-97.9), which was higher than the SVF and the CCCT, and a specificity of 94.2% (95% CI: 84.4-98), which was higher than the MMSE and the SVF. The aROC of the MIS was 0.935 (95% CI: 0.954-1.006). CONCLUSIONS: These findings show that the MIS is a good test for screening for dementia, and its simplicity and quick application could make it suitable for use in our population.

[A descriptive study of intrahospital neurology service consultations]. / Estudio descriptivo de las interconsultas intrahospitalarias a un servicio de Neurologia.

INTRODUCTION: Neurology consultations requested by other services are a part of hospital attention that has not been studied or valued enough. However, it is a health care activity that is carried out on a daily basis and which consumes considerable amounts of time and resources. AIMS. The aim of this study is to assess intrahospital consultations (IHC) requested from a Neurology service. PATIENTS AND METHODS: We conducted a retrospective study of the requests for consultations received in the Neurology Service at the Hospital Universitario San Cecilio in Granada throughout the year 2001. The following variables were analysed: number of consultations, specialities involved, urgency of the request, syndromic diagnosis, complementary tests requested, final resolution and referral of patients. RESULTS: The number of consultations amounted to 270. The most frequent syndromic diagnoses were stroke (24.3%), epilepsy (13.7%) and dementia (11.7%). Internal Medicine, Cardiology, Vascular surgery and Oncology were the specialities that requested most consultations from the Neurology service. The most common complementary test was a computerised axial tomography of the head. 38.74% of the consultations were referred to Neurology outpatients for follow up. 40.5% of the consultations received were lacking in the information needed to understand the actual problem the patient was suffering from. CONCLUSIONS: This study attempts to highlight the importance of IHC as part of the day to day activity within a Neurology service, with respect to the number of consultations, knowledge of the most prevalent neurological pathologies in other services and the resources used in this type of assistance. More studies are needed on this subject, since there are few references in the literature to reports that analyse this type of attention.

Estudio descriptivo de las interconsultas intrahospitalarias a un servicio de Neurología / A descriptive study of intrahospital neurology service consultations

Introducción. Las interconsultas (IC) a Neurología propuestas por otros servicios son una parte de la asistencia hospitalaria poco estudiada y valorada; sin embargo, es una actividad asistencial que se realiza diariamente y que consume tiempo y recursos. Objetivo. Evaluar la IC intrahospitalaria (IH) a un servicio de Neurología. Pacientes y métodos. Se ha realizado un estudio retrospectivo de las IC recibidas en el Servicio de Neurología del Hospital Universitario San Cecilio de Granada, durante el año 2001. Hemos analizado las siguientes variables: número de C, especialidades implicadas, urgencia de la petición, diagnóstico sindrómico, pruebas complementarias solicitadas, resolución final y derivación de los pacientes. Resultados. Se realizaron 270 IC. Los diagnósticos sindrómicos más frecuentes han sido: enfermedad cerebrovascular aguda (24,3 por ciento), epilepsia (13,7 por ciento) y demencia (11,7 por ciento). Medicina interna, Cardiología, Cirugía vascular y Oncología fueron los servicios que más IC solicitaron al de Neurología. La prueba complementaria más indicada fue la tomografía axial computarizada craneal. Un 38,74 por ciento de las IC se derivaron a consulta externa de Neurología, para seguimiento. El 40,5 por ciento de las IC recibidas adolecían de falta de información para entender el problema real del paciente. Conclusiones. Este trabajo pretende poner de manifiesto la importancia de la ICIH dentro de la actividad diaria de un servicio de Neurología, en relación con el número de IC, el conocimiento de la patología neurológica más prevalente en otros servicios y los recursos empleados para este tipo de asistencia. Se deben realizar más estudios, ya que existen escasas referencias bibliográficas que analicen este tipo de asistencia (AU)

[Recurrent meningitis as a manifestation of spinal dysraphism in a young adult]. / Meningitis recurrente como manifestación de un disrafismo espinal en un adulto joven.

INTRODUCTION: Dysraphias are a varied set of anomalies affecting neuroectodermic tissue caused by the alteration of the neural tube during embryogenesis. Neuroradiological classification is broad and clinical manifestations are numerous: they affect the skin, osteomuscular tissue and the vascular, urological and nervous systems. We describe the case of a young adult with infrequent spinal dysraphism, which appeared as recurrent meningitis, and we stress the importance of studies using neuroimaging to define dysraphias. CASE REPORT: Male aged 23 with a history of urinary sphincter dysfunction, spina bifida and meningitis in infancy. He was admitted for treatment for recurrent meningitis and neuroradiological exploration revealed a hidden spinal dysraphism associated with spina bifida, sacrococcygeal dermal sinus with a fistular duct and communication with the dural sac, epidural lipoma and anchored spinal cord. The patient was submitted to decompression laminectomy, the abovementioned sinus was cut and the lipoma was removed. CONCLUSIONS: When faced with a case of recurrent meningitis, one of the etiopathogenic mechanisms to be taken into account is the presence of different malformations that can act as a point of entry to the nervous system not only in the cranial area but also, as in our case, in the spinal region. Late diagnosis of the cases is infrequent, but the presence of spina bifida with skin and urological manifestations point to possible malformations of the neural tube. Early surgical treatment must be performed in order to prevent neurological complications, which are potentially serious and give rise to high morbidity and mortality rates.

[Epileptic seizures as a sign of abstinence from chronic consumption of zolpidem]. / Crisis epil pticas como manifestaci n en la abstinencia al consumo cr nico de zolpidem.

INTRODUCTION: Zolpidem is derived from imidazopiridine. In recent years it has been used as a non benzodiazepine hypnotic. It is a short acting inducer of sleep of similar efficacy to the benzodiazepines or zopiclone, but well tolerated and does not lead to drug abuse, rebound effects or abstinence syndromes. In this clinical note we wish to show that in spite of the descriptions in the medical literature, complications may follow long term use of zolpidem. CLINICAL CASE: We report the case of a 50 year old woman with no clinical history of interest apart from chronic insomnia and anxiety. She had been treated with zolpidem for the previous five years, at the usual dosage. However, since this seemed to be insufficient, the dose was progressively increased until in the months before she was seen by us she was taking a total of 450 mg per day in divided doses. She had drug tolerance, abuse and dependence. After a period of 12 hours without taking zolpidem she developed an abstinence syndrome, with generalized tonic clonic seizures and a prolonged post convulsion period which improved on symptomatic anticonvulsant treatment. CONCLUSIONS: In view of our case, and others described, we should be sceptical of the claim that zolpidem has no side effects, since it may give rise to tolerance, abuse and an abstinence syndrome. We consider that its indiscriminate use should be modified. Patients should be carefully followed up and medical prescription necessary to obtain zolpidem, as opposed to its current unrestricted availability.

Crisis epilépticas como manifestación en la abstinencia al consumo crónico de zolpidem / Epileptic seizures as a sign of abstinence from chronic consumption of zolpidem

Introducción. El zolpidem es un derivado de la imidazopiridina, empleado en los últimos años como hipnótico no benzodiacepínico; es un inductor del sueño de acción corta, con eficacia similar a otros, como las benzodiacepinas o zopiclona, pero con buena tolerancia, sin producir abuso, efecto rebote ni síntomas de abstinencia. Con esta nota clínica queremos manifestar que, pese a lo descrito en la literatura médica, existen complicaciones por consumo crónico de zolpidem. Caso clínico. Describimos el caso de una mujer de 50 años de edad, sin antecedentes de interés, salvo insomnio crónico y ansiedad, en tratamiento con zolpidem desde hace más de 5 años en dosis habituales; pero, ante la falta de eficacia, aumentó progresivamente la ingesta hasta que en los últimos meses consumía 450 mg/día en varias tomas, y presentó tolerancia, abuso y dependencia. Tras un período de 12 horas sin ingesta, presentó síndrome de abstinencia, con crisis generalizadas tonicoclónicas y período poscrítico prolongado, que revertieron con tratamiento sintomático anticomicial. Conclusiones. De acuerdo con nuestro caso, y otros descritos, deberíamos dudar de la falta de efectos secundarios al emplear zolpidem, por su tolerancia, potencial de abuso y síndrome de abstinencia. Pensamos que se debe moderar el empleo indiscriminado de esta sustancia y realizar un seguimiento estrecho de los pacientes en tratamiento, con la inclusión de la obligatoriedad de prescripción facultativa, ya que hasta ahora se puede adquirir sin necesidad de receta médica (AU)