Localización del punto de fuga de líquido cefalorraquídeo en un caso de hipotensión de líquido cefalorraquídeo / Locating the site of cerebrospinal fluid leak in a patient with low cerebrospinal fluid pressure

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Percheron artery syndrome: variability in presentation and differential diagnosis.

INTRODUCTION: Synchronous bilateral paramedian thalamic stroke (SBPTS), usually equated to Percheron artery infarction, is considered to be uncommon and difficult to diagnose clinically. Its characterization is based on the original description plus a few small series. AIM: To characterize SBPTS clinically by collecting cases and identifying the key difficulties for an early diagnosis. PATIENTS AND METHODS: Six cases at our centre plus another 115 located by systematic literature search and critical reading of articles fulfilled the criteria for SBPTS. An analysis was made of the variables age, gender, vascular risk factors, aetiology, alterations and fluctuations of consciousness, need for intubation, cognitive-behavioural disorders, pupillary changes, other neurological focal disorders and brainstem involvement on imaging studies. RESULTS: Of note in our series were disorders of consciousness (n=5), their fluctuations (n=3) and the diagnostic delay (seven days, with MRI in four patients). In only one case was a bilateral thalamic lesion seen on the initial CT. Joint analysis of all the cases showed a mean age of 61 years, a predominance of men (58%), the presence of vascular risk factors in 77%, a mainly cardioembolic aetiology (34% among those that were specified), sensory involvement in 75% (intubation in 7% and fluctuations in 16.5%), cognitive-behavioural disorders in 43%, oculomotor in 73%, pupillary in 31%, other in 67% and specified brainstem lesion in 37%. CONCLUSIONS: The SBPTS syndrome has a variable presentation with a low sensitivity on the initial CT, requiring brain MRI for typification. This explains the diagnostic difficulty and the fact that its frequency is probably underestimated.

Enfermedad de Creutzfeldt-Jacob: hiperseñal cortical y en ganglios basales en la resonancia magnética / Creutzfeldt-Jakob disease: hiperintense signal in cortex and basal ganglia in magnetic resonance imaging

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Infarto lacunar talámico con síndrome sensitivo puro como presentación de mixoma auricular / No disponible

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Espacio aortoentérico en pacientes sin patología aortoiliaca / Aortoenteric space in patients with no aortoiliac pathology

Introducción. La separación entre la aorta abdominal y el intestino adyacente es una relación anatómica utilizada en el seguimiento de intervenciones por cirugía protésica aortoiliaca y en estudios diagnósticos por sospecha de fístulas aortoentéricas; esta relación se valora frecuentemente por tomografía axial computarizada (TAC), pero no encontramos en la bibliografía medidas de referencia del espacio aortoentérico (EAE). Por ello, para establecer los parámetros de normalidad de este espacio, que sirvieran de comparación con pacientes a los que realizamos epiploplastia preventiva, que fue motivo de otro trabajo, evaluamos los estudios con TAC contrastados en un grupo de pacientes no intervenidos. Objetivo. Evaluar las medidas del EAE en enfermos no intervenidos. Pacientes y métodos. Estudio de 55 TAC en 55 pacientes consecutivos, con una edad media de 59 años (sexo: masculino 48 y femenino 7). Se recogieron: la edad, el sexo, la talla, el peso y la medida del EAE en tres niveles. Resultados. Las medidas del EAE dieron valores medios en el nivel A de 1,13, en B de 1,24 y en C de 1,33 mm. Al comparar los valores de los tres niveles, hubo diferencia significativa sólo entre A y C (p < 0,005). También, comparamos las medidas en los niveles A, B y C entre las clases de edad, talla y peso, y se encontró diferencia significativa entre ellas. Conclusión. El EAE estudiado por TAC contrastada en enfermos no intervenidos aumenta craneocaudalmente en la aorta infrarrenal y se relaciona con la edad y el peso

Introduction. The separation between the abdominal aorta and the adjacent intestine is an anatomical relation that is utilised in following up aortoiliac graft surgery and in diagnostic studies carried out due to suspected aortoenteric fistulae; this relation is frequently evaluated by computerised axial tomography (CAT) scans, but no reference measures for the aortoenteric space (AES) were found in the literature. Thus, to establish the parameters of normality for this space, which could be used in comparisons with patients who underwent preventive epiploplasty (which was the subject of a previous study), we evaluated the CAT scan studies that were contrasted in a group of patients who were not submitted to surgery. Aims. To evaluate the measurements of the AES in patients who had not undergone surgery. Patients and methods. We studied 55 CAT scans in 55 consecutive patients, with a mean age of 59 years (sex: 48 males and 7 females). Data collected: age, sex, height, weight and the size of the AES at three levels. Results. The mean values of the AES measurements at level A were 1.13, at level B they were 1.24 and at level C they were 1.33 mm. On comparing the values of the three levels, the only significant difference was found between A and C (p < 0.005). Furthermore, we compared the measurements at levels A, B and C between the age, height and weight classes, and significant differences were found between them. Conclusions. The AES studied by CAT contrasted in patients who had not undergone surgery increases craniocaudally in the infrarenal aorta and is related to the age and weigh

Absence of the inferior vena cava causing repeated deep venous thrombosis in an adult--a case report.

Agenesis of the inferior vena cava is an uncommon congenital vascular malformation. Although theoretically it may favor venous stasis, it is not normally associated with venous thrombosis. The authors found only three reports of the coexistence of both entities, and only one of these rules out the existence of associated hypercoagulability. They report the case of a patient with a history of repeated venous thrombosis. Magnetic resonance angiography and venography demonstrated complete agenesis of the inferior vena cava and persistence of a cardinal venous system with azygos and hemiazygos continuation, associated with right renal hypoplasia. Studies ruled out hypercoagulability syndrome, either primary or secondary to an occult neoplasm. The authors conclude that venous malformations, although rare, may cause thromboembolic disease, especially in young patients, and that magnetic resonance angiography is a useful diagnostic alternative to conventional phlebography.

[Obesity and distribution of body fat. Correlation between anthropometric and tomographic data on areas at the abdominal level]. / Obesidad y distribución de la grasa corporal. Relaciones entre antropometría y áreas tomográficas a nivel abdominal.

In a sample made up of 83 males and 68 females different parameters and external anthropometric indexes were compared (folds, perimeters and indexes of central fat distribution) with direct measurements of abdominal fat obtained by computerized tomography (visceral fat, subcutaneous fat and visceral/subcutaneous index). Anthropometric and tomographic differences between males and females were determined. Likewise, an analysis was made of variations in the fat pattern and subcutaneous and intra-abdominal visceral fat deposits, considering age and overweight. The results obtained in this study reveal different fat patterns for each sex, changes with age in body fat distribution, and different usefulness of external anthropometric measures in males and females to predict fat deposits and their distribution at the abdominal level.