Síndromes neurológicos asociados al uso de medicamentos. Frecuencia y caracterización / Neurological syndromes associated with drug use. Frequency and characterisation

Introducción: La necesidad de una asistencia sanitaria segura en la que los cuidados y tratamientos no supongan daños diferentes a los derivados de la enfermedad de base, ha motivado este estudio. Nuestro objetivo ha sido determinar la frecuencia y describir los síndromes neurológicos atribuibles a fármacos, su evitabilidad y los niveles asistenciales implicados. Métodos: Estudio observacional. Cohorte prospectiva de todos los sujetos derivados desde atención primaria y especializada, en el período de diciembre de 2008 a enero de 2010, por síntomas neurológicos atribuibles a fármacos y enfermos neurológicos conocidos con clínica distinta o agravada de la enfermedad de base causada por fármacos. Las notificaciones quedaron reflejadas en un cuestionario. Se realizaron distribuciones de frecuencias, medidas de tendencia central, pruebas de la 2 o Fisher y pruebas no paramétricas correspondientes. Resultados: La prevalencia de efectos adversos neurológicos respecto a la muestra total fue 0,586%. De los 105 pacientes seleccionados, los principales efectos adversos fueron: 25,7% síndrome rígido-acinético; 18,1% discinético; 11,4% síntomas neuropsiquiátricos, y 10,5% síndrome confusional. Los grupos farmacológicos más registrados fueron, en orden decreciente: antiepilépticos, dopaminérgicos, antidepresivos, neurolépticos, antivertiginosos y procinéticos. Describimos la población más susceptible y las asociaciones estadísticamente significativas entre la presencia de determinados grupos farmacológicos y síndromes neurológicos concretos.Conclusiones: La baja prevalencia detectada puede deberse al diseño del estudio, aunque los efectos adversos neurológicos suponen el 2,84% de los ingresos en una unidad de neurología.Conocer la epidemiología permitirá identificar los abordajes más seguros, aplicarlos correctamente a la población de mayor riesgo y reducir necesidades asistenciales y recursos médicos (AU)

Introduction: The need for safe health care, in which the care and treatment of the patient does not cause any injuries in addition to those already arising from their baseline disease, hasled to the present study. Our objective has been to determine the frequency and describe the neurological syndromes attributable to drugs, their preventability and the levels of medical care involved. Methods: Observational study. Cohort of subjects referred from Primary and Specialized Care between December 2008 and January 2010 due to neurological symptoms attributable to drugs, and previously known neurology patients who began to have symptoms other than those of the baseline disease, also caused by drugs. The notifications were recorded in a questionnaire. Frequency distributions, central tendency measurements, X2 or Fisher tests and non-parametric tests were performed. Results: The prevalence of adverse neurological events was 0.586% of the total sample. Of the 105 patients selected, the most frequent adverse events were: 25.7%, akinetic-rigid syndrome, 18.1%, dyskinetic syndrome, 11.4% neuro-psychiatric symptoms, and 10.5% confusional syndrome. The most commonly recorded pharmacological groups were, in decreasing order: anti-epileptic, dopaminergic, antidepressant, neuroleptic, antivertiginous and prokinetic drugs. We describe the most susceptible population and the statistically significant relationships between the presence of certain pharmacological groups and neurological syndromes. Conclusions: The low prevalence detected may be due to the study design, although adverse neurological events accounted for 2.84% of the admissions to a Neurology Unit. Understanding the epidemiology should help to identify the safest approaches, apply them correctly to the population at a higher risk, and reduce healthcare needs and consumption of medical resources (AU)

Neurological syndromes associated with drug use. Frequency and characterisation.

INTRODUCTION: The need for safe health care, in which the care and treatment of the patient does not cause any injuries in addition to those already arising from their baseline disease, has led to the present study. Our objective has been to determine the frequency and describe the neurological syndromes attributable to drugs, their preventability and the levels of medical care involved. METHODS: Observational study. Cohort of subjects referred from Primary and Specialized Care between December 2008 and January 2010 due to neurological symptoms attributable to drugs, and previously known neurology patients who began to have symptoms other than those of the baseline disease, also caused by drugs. The notifications were recorded in a questionnaire. Frequency distributions, central tendency measurements, X(2) or Fisher tests and non-parametric tests were performed. RESULTS: The prevalence of adverse neurological events was 0.586% of the total sample. Of the 105 patients selected, the most frequent adverse events were: 25.7%, akinetic-rigid syndrome, 18.1%, dyskinetic syndrome, 11.4% neuro-psychiatric symptoms, and 10.5% confusional syndrome. The most commonly recorded pharmacological groups were, in decreasing order: anti-epileptic, dopaminergic, antidepressant, neuroleptic, antivertiginous and prokinetic drugs. We describe the most susceptible population and the statistically significant relationships between the presence of certain pharmacological groups and neurological syndromes. CONCLUSIONS: The low prevalence detected may be due to the study design, although adverse neurological events accounted for 2.84% of the admissions to a Neurology Unit. Understanding the epidemiology should help to identify the safest approaches, apply them correctly to the population at a higher risk, and reduce healthcare needs and consumption of medical resources.

Heterogeneidad clínica y terapéutica de la trombosis venosa cerebral: descripción de una serie de 20 casos / Clinical and therapeutic heterogeneity of cerebral venous thrombosis: A descripion of a series of 20 cases

Resumen. Introducción. El desarrollo de las técnicas neurorradiológicas ha permitido diagnosticar con mayor frecuencia la trombosis venosa cerebral (TVC) y conocer su gran heterogeneidad clínica. Objetivos. Revisar los casos diagnosticados de TVC en nuestro servicio en el período 1996-2008 y analizar sus características. Pacientes y métodos. Se describen 20 pacientes (14 mujeres y 6 varones), con edades de 22 a 75 años. Resultados. El síntoma más frecuente fue la cefalea, seguida del síndrome de hipertensión intracraneal, alteración de conciencia y déficit focal. Destacan como presentaciones inusuales el accidente isquémico transitorio y la neuropatía óptica progresiva. Las instauraciones subaguda y crónica fueron más frecuentes que la aguda. La etiología fue muy variada: puerperio, hipertiroidismo, enfermedad de Crohn, meningitis, anovulatorios, mutación del factor V de Leiden, mieloma múltiple, colitis ulcerosa, meningioma y anestesia epidural. En ocho casos no se encontró la causa. La resonancia magnética fue diagnóstica en todos. Los pacientes en fase aguda recibieron anticoagulación, y en el resto se optó por ésta o por un tratamiento más conservador según la situación individual. Sólo hubo secuelas leves en seis pacientes. Conclusiones. En nuestra serie, hemos encontrado una gran variedad de etiologías y formas de presentación de TVC. Destacamos la necesidad de sospechar TVC ante una cefalea subaguda también en el paciente ambulatorio. El subgrupo con cefalea aislada o hipertensión intracraneal y presentación no aguda podría tener mejor pronóstico y ser susceptible de terapia menos agresiva (AU)

Summary. Introduction. Current neuro-radiological techniques have led to a more frequent diagnosis of cerebral vein thrombosis (CVT), and revealed its greater clinical heterogeneity. Aim. To analize the characteristics of the cases with the diagnosis of CVT in our unit between 1996 and 2008. Patients and methods.We describe 20 cases of CVT (14 women and 6 men), with ages of 22to 75 years. Results. Headache was the most frequent symptom, followed by intracranial hypertension, disorders of consciousness and focal deficits. Unusual presentations included transitory ischemia and progressive optical neuropathy. Subacute and chronic courses were more frequent than acute. The etiology was diverse including puerperium, contraception, hyperthyroidism, meningitis, Leiden V factor mutation, multiple myeloma, Crohn, ulcerative colitis, meningioma and epidural anesthesia. No cause was found in 8 cases. Magnetic resonance imaging was always diagnostic. Patients were anticoagulated during the acute phase. In subacute or chronic presentations, a more conservative treatment was considered on individual basis. Only 6 patients had mild sequelae. Conclusions. We report a great variety of etiologies and patterns of presentation of CVT. CVT should be suspected in patients with subacute headache, even in outpatients. Nonacute presentation with isolated headache or intracranial hypertension could have better prognosis, requiring a less aggressive therapy (AU)

[Clinical and therapeutic heterogeneity of cerebral venous thrombosis: a description of a series of 20 cases]. / Heterogeneidad clínica y terapéutica de la trombosis venosa cerebral: descripción de una serie de 20 casos.

INTRODUCTION: Current neuro-radiological techniques have led to a more frequent diagnosis of cerebral vein thrombosis (CVT), and revealed its greater clinical heterogeneity. AIM: To analize the characteristics of the cases with the diagnosis of CVT in our unit between 1996 and 2008. PATIENTS AND METHODS: We describe 20 cases of CVT (14 women and 6 men), with ages of 22 to 75 years. RESULTS: Headache was the most frequent symptom, followed by intracranial hypertension, disorders of consciousness and focal deficits. Unusual presentations included transitory ischemia and progressive optical neuropathy. Subacute and chronic courses were more frequent than acute. The etiology was diverse including puerperium, contraception, hyperthyroidism, meningitis, Leiden V factor mutation, multiple myeloma, Crohn, ulcerative colitis, meningioma and epidural anesthesia. No cause was found in 8 cases. Magnetic resonance imaging was always diagnostic. Patients were anticoagulated during the acute phase. In subacute or chronic presentations, a more conservative treatment was considered on individual basis. Only 6 patients had mild sequelae. CONCLUSIONS: We report a great variety of etiologies and patterns of presentation of CVT. CVT should be suspected in patients with subacute headache, even in outpatients. Nonacute presentation with isolated headache or intracranial hypertension could have better prognosis, requiring a less aggressive therapy.

[Peduncular hallucinosis associated with a space occupying lesion of the brain stem]. / Alucinosis peduncular asociada a un proceso expansivo del tronco cerebral.

INTRODUCTION: Traditionally visual hallucinations have been divided into simple and complex. Complex hallucinations due to disorder of the brainstem have been described, and this process referred to as peduncular hallucinosis. CLINICAL CASE: A 74 year old woman with a history of endometrial carcinoma with metastases to bones and lungs, was admitted for progressive ataxia and paraesthesias of the left half of her body. During her admission to hospital she had complex visual hallucinations of cartoon animals, animals, people and geometrical figures. The patient herself realized that they were hallucinations. On cerebral computerized tomography there was a space occupying lesion in the pons-midbrain region of the brainstem. In the clinical context of this particular patient, it was considered to probably be a metastasis from the carcinoma of the endometrium. CONCLUSIONS: Apart from its theoretical interest, peduncular hallucinosis has well defined stereotyped characteristics, and recognition of these may be useful in topographical diagnosis of the lesion.

[Parkinsonism induced by sodium valproate]. / Síndrome parkinsoniano inducido por valproato sódico.

Parkinsonism is a rare side effect of treatment with sodium valproate. We report 2 elderly women who developed parkinsonian syndrome several years after starting valproate therapy, and in whom symptoms disappeared when treatment was withdrawn. These cases, along with others in the literature, may support experimental evidence for the importance of GABAergic modulation in motor control.