Cavernomatosis familiar secundaria a una nueva mutación genética / Familial cavernous malformation secondary to a novel genetic mutation

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Doppler Resistivity and Cerebral Small Vessel Disease: Hemodynamic Structural Correlation and Usefulness for the Etiological Classification of Acute Ischemic Stroke.

INTRODUCTION AND GOAL: Lacunar stroke is defined as an <1.5 cm diameter infarct located in the territory of a perforating artery, that is not accessible for direct study using conventional imaging techniques. Diagnosis requires exclusion of other causes. It usually occurs in the context of chronic cerebral small vessel disease, which can be suspected during the neurosonography study in the form of high pulsatility [PI] or resistance index [RI]. Clinical research was performed to confirm that PI and RI correlate with cerebral small vessel lesion burden and to determine whether these parameters are useful for supporting a lacunar origin (LO) in acute stroke. MATERIAL AND METHODS: We prospectively recorded internal carotid artery resistivity and the Fazekas score for all patients with acute ischemic stroke who met inclusion but not exclusion criteria over a 6-month period. RESULTS: The study population comprised 74 patients. A correlation was observed between the Fazekas score and resistivity. Both parameters predicted a LO, with an area under the curve of .78 and .696, respectively. The optimal cut-offs were PI = .96/RI = .58 for screening (sensitivity, 96%) and PI = 1.46/RI = .83 for confirmation (specificity, 89%). CONCLUSIONS: Doppler ultrasound is a useful technique for determining the LO of acute stroke.

Validación transcultural al castellano del Actionable Bladder Symptoms Screening Tool / Transcultural validation in Spanish of the Actionable Bladder Symptoms Screening Tool

Introducción. Los trastornos del tracto urinario inferior son frecuentes en pacientes con esclerosis múltiple a lo largo del transcurso de la enfermedad y alcanzan prevalencias variables cercanas al 75%. Es primordial realizar un diagnóstico precoz en fases tempranas y un abordaje terapéutico óptimo. Burks et al elaboraron el Actionable Bladder Symptoms Screening Tool (ABSST) como herramienta de cribado útil de dichos trastornos. Posteriormente, Bates et al desarrollaron una versión corta del ABSST con el objetivo de minimizar el tiempo de realización y facilitar su manejo. Objetivo. Realizar la validación transcultural al castellano de la versión breve del ABSST. Pacientes y métodos. Se realizó la traducción al castellano del ABSST y una posterior retrotraducción al inglés que confirmaba su equivalencia semántica. Se llevó a cabo una prueba de campo en 40 pacientes con esclerosis múltiple, incluyendo dos preguntas finales para comprobar la comprensión y aceptabilidad de la herramienta y un último ítem que recogía el tiempo empleado para su realización. Resultados: Se seleccionaron 40 pacientes conforme a los criterios de inclusión y exclusión; el 67,5% eran mujeres y la media global de edad era de 46,2 años. La comprensión del test fue del 100%, y la aceptabilidad, del 97,5%. El 57,5% obtuvo puntuaciones >= 3, y se emplearon 5,33 minutos de media. Conclusiones. El ABSST como cuestionario de cribado breve de trastornos urinarios en la esclerosis múltiple es una herramienta útil para su detección temprana y queda validado para su uso en castellano (AU)

Introduction. Disorders of the lower urinary tract are frequent in patients with multiple sclerosis throughout the course of the disease and reach variable prevalences close to 75%. It is essential to obtain an early diagnosis in the initial phases and to implement an optimal therapeutic management. Burks et al developed the Actionable Bladder Symptoms Screening Tool (ABSST) as a useful screening test in such disorders. Later, Bates et al developed a short version of the ABSST with the objective of minimising the time required to complete it and making it easier to use. AIMS. To carry out the transcultural validation into Spanish of the short version of the ABSST. Patients and Methods: The ABSST was translated into Spanish and then back-translated into English, which confirmed the semantic equivalence. A field test was conducted on 40 patients with multiple sclerosis, with two extra questions being included at the end in order to check the comprehension and acceptability of the tool, together with a final item that asked for the time spent on completing it. Results: Forty patients were selected In accordance with the eligibility and exclusion criteria; 67.5% of them were females and the overall mean age was 46.2 years. The rate of comprehension of the test was 100%, and that of acceptability was 97.5%. Results showed that 57.5% obtained scores >= 3, and an average of 5.33 minutes were spent on completing it. Conclusions: As a brief screening questionnaire for urinary disorders in multiple sclerosis, the ABSST is a useful tool for detecting them at an early stage and has now been validated for use in Spanish (AU)

Síndrome de Brown bilateral adquirido / Bilateral acquired Brown syndrome

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Análisis de factores asociados al pronóstico a largo plazo en el ictus isquémico fibrinolisado / Factors associated with long-term prognosis after ischemic stroke treated with fibrinolytic agents

Objetivo: Analizar las variables que influyen en un mejor pronóstico funcional a los tres meses en un grupo de pacientes con ictus isquémico agudo fibrinolisado. Material y métodos: Se analizaron retrospectivamente 63 pacientes con características de código ictus y que recibieron fibrinólisis en un hospital de referencia de Málaga Oeste. Se determinó el tiempo de inicio de fibrinolisis (TIF), la gravedad del infarto mediante la puntuación NIHSS basal y a las 24 horas y el pronóstico funcional a los 3 meses mediante la escala Rankin modificada (mRS). Resultados: Se incluyeron 63 pacientes, edad media 65 (DE 11) años. El TIF fue de 151 (DE 42) minutos. Se obtuvo una puntuación media en la escala NIHSS basal de 15,5 (DE 4,8) y a las 24 horas de 9,1 (DE 7,13), y una diferencia media de NIHSS a las 24 horas de 6,3 (DE 5,8). Se realizó análisis de correlación entre mRS y NIHSS a las 24 horas(Rho = 0,73; p < 0,01); NIHSS a la llegada (Rho = 0,34; p = 0,01); edad (Rho = 0,41; p = 0,001); TIF (Rho = 0,21;p = 0,09); y diferencia de NIHSS a las 24 h (Rho = –0,61; p = 0,001). Conclusión: El pronóstico funcional de los pacientes con ictus agudo que reciben tratamiento fibrinolítico endovenoso depende de factores como la edad, el tiempo desde que se administra el tratamiento, la gravedad inicial del infarto y la situación del paciente a las 24 horas, siendo este último el factor el más relacionado con el pronóstico funcional (AU)

Objective: To analyze the variables associated with better functional outcome 3 months after ischemic stroke treated with fibrinolytic agents. Material and methods: The cases of 63 patients with characteristics leading to activation of a stroke code were analyzed retrospectively. The patients received fibrinolytic therapy in a referral hospital for the western district of Malaga, Spain. We recorded the time until start of fibrinolytic therapy, severity according to the National Institute of Health Stroke Scale (NIHSS) at baseline and at 24 hours, and functional outcome at 3 months according to the modified Rankin Scale. Results: Data for 63 patients with a mean (SD) age of 65 (11) years were included. The mean time until start of fibrinolytic therapy was 151 (42) minutes. The mean NIHSS scores were 15.5 (4.8) points at baseline and 9.1 (7.13) at 24hours. The mean change in score at 24 hours was 6.3 (5.8) points. The findings of correlation analysis between scores on the modified Rankin scale and other variables were as follows: NIHSS score at 24 hours, ρ = 0.73; P < .01; NIHSS at baseline, ρ = 0.34; P = .01); age, ρ = 0.41; P = .001); time until start of fibrinolysis, ρ = 0.21; P = .09); change in NIHSS score at 24 hours, ρ = –0.61; P = .001). Conclusions: The prognosis for the functional recovery of patients given intravenous fibrinolytic therapy after stroke depends on such factors as age, time treatment is started, severity, and the patient’s status at 24 hours. The last factor34-38 im/tab is the one that is most strongly related to prognosis (AU)

[Factors associated with long-term prognosis after ischemic stroke treated with fibrinolytic agents]. / Análisis de factores asociados al pronóstico a largo plazo en el ictus isquémico fibrinolisado.

OBJECTIVES: To analyze the variables associated with better functional outcome 3 months after ischemic stroke treated with fibrinolytic agents. MATERIAL AND METHODS: The cases of 63 patients with characteristics leading to activation of a stroke code were analyzed retrospectively. The patients received fibrinolytic therapy in a referral hospital for the western district of Malaga, Spain. We recorded the time until start of fibrinolytic therapy, severity according to the National Institute of Health Stroke Scale (NIHSS) at baseline and at 24 hours, and functional outcome at 3 months according to the modified Rankin Scale. RESULTS: Data for 63 patients with a mean (SD) age of 65 (11) years were included. The mean time until start of fibrinolytic therapy was 151 (42) minutes. The mean NIHSS scores were 15.5 (4.8) points at baseline and 9.1 (7.13) at 24 hours. The mean change in score at 24 hours was 6.3 (5.8) points. The findings of correlation analysis between scores on the modified Rankin scale and other variables were as follows: NIHSS score at 24 hours, ρ = 0.73; P < .01; NIHSS at baseline, ρ = 0.34; P = .01); age, ρ = 0.41; P = .001); time until start of fibrinolysis, ρ = 0.21; P = .09); change in NIHSS score at 24 hours, ρ = -0.61; P = .001). CONCLUSION: The prognosis for the functional recovery of patients given intravenous fibrinolytic therapy after stroke depends on such factors as age, time treatment is started, severity, and the patient's status at 24 hours. The last factor is the one that is most strongly related to prognosis.

OBJETIVO: Analizar las variables que influyen en un mejor pronóstico funcional a los tres meses en un grupo de pacientes con ictus isquémico agudo fibrinolisado. METODO: Se analizaron retrospectivamente 63 pacientes con características de código ictus y que recibieron fibrinolisis en un hospital de referencia de Málaga Oeste. Se determinó el tiempo de inicio de fibrinolisis (TIF), la gravedad del infarto mediante la puntuación NIHSS basal y a las 24 horas y el pronóstico funcional a los 3 meses mediante la escala Rankin modificada (mRS). RESULTADOS: Se incluyeron 63 pacientes, edad media 65 (DE 11) años. El TIF fue de 151 (DE 42) minutos. Se obtuvo una puntuación media en la escala NIHSS basal de 15,5 (DE 4,8) y a las 24 horas de 9,1 (DE 7,13), y una diferencia media de NIHSS a las 24 horas de 6,3 (DE 5,8). Se realizó análisis de correlación entre mRS y NIHSS a las 24 horas (Rho = 0,73; p < 0,01); NIHSS a la llegada (Rho = 0,34; p = 0,01); edad (Rho = 0,41; p = 0,001); TIF (Rho = 0,21; p = 0,09); y diferencia de NIHSS a las 24 h (Rho = ­0,61; p = 0,001). CONCLUSIONES: El pronóstico funcional de los pacientes con ictus agudo que reciben tratamiento fibrinolítico endovenoso depende de factores como la edad, el tiempo desde que se administra el tratamiento, la gravedad inicial del infarto y la situación del paciente a las 24 horas, siendo este último el factor el más relacionado con el pronóstico funcional.

Midriasis unilateral por contacto con floripondio o trompeta de ángel / No disponible

No disponible

Transient global amnesia associated with an acute infarction at the cingulate gyrus.

Background. Transient global amnesia (TGA) is a syndrome of sudden, unexplained isolated short-term memory loss. In the majority of TGA cases, no causes can be identified and neuroimaging, CSF studies and EEG are usually normal. We present a patient with TGA associated with a small acute infarct at the cingulate gyrus. Case Report. The patient, a 62 year-old man, developed two episodes of TGA. He had hypertension and hypercholesterolemia. He was found to have an acute ischemic stroke of small size (15 mm of maximal diameter) at the right cerebral cingulate gyrus diagnosed on brain magnetic resonance imaging. No lesions involving other limbic system structures such as thalamus, fornix, corpus callosum, or hippocampal structures were seen. The remainder of the examination was normal. Conclusion. Unilateral ischemic lesions of limbic system structures may result in TGA. We must bear in mind that TGA can be an associated clinical disorder of cingulate gyrus infarct.

Control de la epilepsia en pacientes adultos con esclerosis tuberosa / Control of epilepsy in adult patients with tuberous sclerosis

Introducción. La esclerosis tuberosa es una enfermedad genética cuyas manifestaciones principales son la formación de tumores neuroectodérmicos, que asocia epilepsia secundaria muy frecuentemente. Objetivo. Describir el perfil epiléptico, el control, la frecuencia de crisis y la efectividad del tratamiento en pacientes adultos con esclerosis tuberosa. Pacientes y métodos. Estudio descriptivo en el que se han incluido pacientes adultos (mayores de 14 años) con diagnóstico confirmado de esclerosis tuberosa. Se ha analizado la frecuencia y tipos de crisis. Se ha realizado un estudio y contabilización de los diferentes fármacos antiepilépticos en cada paciente, la frecuencia de uso de cada principio activo y un estudio comparativo entre control de crisis y tipo de terapia. Resultados. De 19 adultos estudiados, tuvieron crisis epilépticas 16 (84%). Presentaron control de crisis completo, crisis esporádicas y crisis frecuentes el 44%, 25% y 31%, respectivamente. Hubo frecuencia de crisis focales, generalizadas y ambas en el 38%, 6% y 25%, respectivamente. Estaban en tratamiento con fármacos antiepilépticos en monoterapia, biterapia y triterapia el 38%, 44% y 19%, respectivamente. El más consumido globalmente fue el levetiracetam, seguido de la carbamacepina y el ácido valproico. En monoterapia, el más frecuente fue la carbamacepina, con mayor proporción de control completo. Conclusiones. La epilepsia en la esclerosis tuberosa es relativamente benigna, y se consigue un aceptable control en la mayoría de casos con un número de antiepilépticos acorde con lo aconsejado en las guías de tratamiento. Se observa estabilidad de lesiones, y no hay malignización en nuestra serie. El bajo número de la muestra limita el estudio, pero se observan proporciones similares de efectividad del tratamiento respecto a otra serie publicada (AU)

Introduction. Tuberous sclerosis is a genetic disease, the main manifestations of which are the formation of neuroectodermal tumours, which are very often associated to secondary epilepsy. Aim. To describe the epileptic profile, control, frequency of seizures and effectiveness of treatment in adult patients with tuberous sclerosis. Patients and methods. The study was descriptive and included adult patients (over 14 years of age) with a confirmed diagnosis of tuberous sclerosis. Both the frequency and type of seizures were analysed. A study was conducted to analyse and record the number of different antiepileptic drugs in each patient and the frequency of use of each active ingredient, and the control of seizures and the type of therapy were also included in another comparative study. Results. Of a total of 19 adults who were studied, 16 of them (84%) had epileptic seizures. Results showed that 44%, 25% and 31% of them presented full control of seizures, sporadic seizures and frequent seizures, respectively. A certain frequency of focal, general and both types of seizures existed in 38%, 6% and 25%, respectively. Likewise, 38%, 44% and 19% of them were under treatment with antiepileptic drugs in monotherapy, bitherapy and tritherapy, respectively. Overall, the most commonly consumed drug was levetiracetam, followed by carbamazepine and valproic acid. In monotherapy the most common was carbamazepine, with a higher proportion of full control. Conclusions. Epilepsy in tuberous sclerosis is relatively benign and an acceptable degree of control is achieved in most cases with a number of the antiepileptic drugs recommended in the treatment guidelines. In our series, we observed stability of involvement and there was no progression to a malignant status. The small number of individuals in the sample limits the study, but the proportions of treatment effectiveness are seen to be similar to those observed in another series published in the literature (AU)

[Control of epilepsy in adult patients with tuberous sclerosis]. / Control de la epilepsia en pacientes adultos con esclerosis tuberosa.

INTRODUCTION: Tuberous sclerosis is a genetic disease, the main manifestations of which are the formation of neuroectodermal tumours, which are very often associated to secondary epilepsy. AIM: To describe the epileptic profile, control, frequency of seizures and effectiveness of treatment in adult patients with tuberous sclerosis. PATIENTS AND METHODS: The study was descriptive and included adult patients (over 14 years of age) with a confirmed diagnosis of tuberous sclerosis. Both the frequency and type of seizures were analysed. A study was conducted to analyse and record the number of different antiepileptic drugs in each patient and the frequency of use of each active ingredient, and the control of seizures and the type of therapy were also included in another comparative study. RESULTS: Of a total of 19 adults who were studied, 16 of them (84%) had epileptic seizures. Results showed that 44%, 25% and 31% of them presented full control of seizures, sporadic seizures and frequent seizures, respectively. A certain frequency of focal, general and both types of seizures existed in 38%, 6% and 25%, respectively. Likewise, 38%, 44% and 19% of them were under treatment with antiepileptic drugs in monotherapy, bitherapy and tritherapy, respectively. Overall, the most commonly consumed drug was levetiracetam, followed by carbamazepine and valproic acid. In monotherapy the most common was carbamazepine, with a higher proportion of full control. CONCLUSIONS: Epilepsy in tuberous sclerosis is relatively benign and an acceptable degree of control is achieved in most cases with a number of the antiepileptic drugs recommended in the treatment guidelines. In our series, we observed stability of involvement and there was no progression to a malignant status. The small number of individuals in the sample limits the study, but the proportions of treatment effectiveness are seen to be similar to those observed in another series published in the literature.

TITLE: Control de la epilepsia en pacientes adultos con esclerosis tuberosa.Introduccion. La esclerosis tuberosa es una enfermedad genetica cuyas manifestaciones principales son la formacion de tumores neuroectodermicos, que asocia epilepsia secundaria muy frecuentemente. Objetivo. Describir el perfil epileptico, el control, la frecuencia de crisis y la efectividad del tratamiento en pacientes adultos con esclerosis tuberosa. Pacientes y metodos. Estudio descriptivo en el que se han incluido pacientes adultos (mayores de 14 anos) con diagnostico confirmado de esclerosis tuberosa. Se ha analizado la frecuencia y tipos de crisis. Se ha realizado un estudio y contabilizacion de los diferentes farmacos antiepilepticos en cada paciente, la frecuencia de uso de cada principio activo y un estudio comparativo entre control de crisis y tipo de terapia. Resultados. De 19 adultos estudiados, tuvieron crisis epilepticas 16 (84%). Presentaron control de crisis completo, crisis esporadicas y crisis frecuentes el 44%, 25% y 31%, respectivamente. Hubo frecuencia de crisis focales, generalizadas y ambas en el 38%, 6% y 25%, respectivamente. Estaban en tratamiento con farmacos antiepilepticos en monoterapia, biterapia y triterapia el 38%, 44% y 19%, respectivamente. El mas consumido globalmente fue el levetiracetam, seguido de la carbamacepina y el acido valproico. En monoterapia, el mas frecuente fue la carbamacepina, con mayor proporcion de control completo. Conclusiones. La epilepsia en la esclerosis tuberosa es relativamente benigna, y se consigue un aceptable control en la mayoria de casos con un numero de antiepilepticos acorde con lo aconsejado en las guias de tratamiento. Se observa estabilidad de lesiones, y no hay malignizacion en nuestra serie. El bajo numero de la muestra limita el estudio, pero se observan proporciones similares de efectividad del tratamiento respecto a otra serie publicada.

Impact of 99mTc-HMPAO brain perfusion scan in the diagnosis of hemiplegic migraine.

Hemiplegic migraine (HM) is an unusual type of migraine, with few cases reported in the literature. Unlike other types of migraine, aura HM presents accompanying motor deficit manifestations that do not last more than 24 hours. We report a 27-year-old man referred to us from the emergency department to carry out a cerebral perfusion SPECT with (99m)Tc-HMPAO. He presented with intense headache and motor weakness. The brain perfusion scan was performed before and after intravenous infusion with nimodipine and showed a significant change of cerebral blood flow, allowing early and correct diagnosis.