Insuficiencia respiratoria aguda como manifestación inicial de esclerosis lateral amiotrófica / Acute respiratory failure as initial manifestation of amyotrophic lateral sclerosis

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[Intracranial venous thrombosis: a study of 16 cases and a review of the literature]. / Trombosis venosa intracraneal: estudio de 16 casos y revisión de la bibliografía.

INTRODUCTION: The clinical picture and aetiology of intracranial venous thrombosis are highly variable. Early descriptions reported it as a rare disease with a poor prognosis but the advent of neuroimaging techniques, and a deeper knowledge of the clinical picture, have shown it to have a higher frequency and a better prognosis. OBJECTIVE: To report the clinical and neuroimaging findings in patients diagnosed as having intracranial venous thrombosis in our department and review the state of the literature. PATIENTS AND METHODS: We reviewed all discharge reports from patients admitted to the neurology department of the Juan Canalejo Hospital between 1975 and 2000. Of these, we reviewed the medical records of those patients diagnosed as having intracranial venous thrombosis in order to obtain data relating to the clinical manifestations, complementary tests, etiological and topographical diagnosis, treatment and outcome. RESULTS: Diagnosis of intracranial venous thrombosis was made in 16 patients. The most common symptom was headache. The superior sagittal was the most frequently affected sinus. In almost all patients CT results led to the suspicion, and in some cases the confirmation, of the diagnosis. The most frequently found aetiology was oral contraceptive consumption. Outcome was generally good both with anticoagulation and symptomatic treatments. CONCLUSIONS: The most important difference between the present study and earlier reports is in the frequency of the different aetiologies. Our findings provide further evidence that intracranial venous thrombosis is not an infrequent disease and that the prognosis is generally good.

[Endovascular treatment of dural arteriovenous fistulas with medullary venous drainage. Experience with 18 patients]. / Tratamiento endovascular de fístulas arteriovenosas durales con drenaje venoso medular. Experiencia en 18 pacientes.

INTRODUCTION AND OBJECTIVE: The authors report a series of 18 patients with myelopathy who were diagnosed of dural arteriovenous fistulas with venous medullary drainage (DFVMd). Purpose was to assess the effectiveness, initial and long term, of embolization, as the initial treatment, using polyvinyl alcohol particles (PVA) and liquid adhesives. N-butyl-cyanoacrylate (NBCA). MATERIAL AND METHODS: Magnetic resonance images were obtained in all patients showing spinal cord tissue changes consistent with an isquemic process secondary to venous hypertension. All 18 patients showed initially an improvement in clinical symptoms, demonstrating previous MR images resolution. RESULTS: The neurological status of 8 patients subsequently deteriorated with angiographically proven recurrences of their DFVMd. These patients underwent a second successful embolization procedure using NBVA. PVA embolization is long term ineffective and is not without risk. Endovascular treatment is less invasive than surgery, its morbidity is less, and it ensures earlier recovery for the patients. If embolization has failed, surgery can still be done. CONCLUSIONS: We recommend that NBVA embolization be the initial treatment of choice for DFVMd if referring the patient to an experienced interventional Neuroradiology unit is available. Careful clinical and neurologic examination is necessary to establish the diagnosis of DFVMd. Finally, we strongly recommend that patients be followed closely and aggressively. Periodic clinical and radiologic assessments, including MR and spinal angiography, are essential to achieve complete cure.

[Eight cases of extracranial vertebral artery dissection]. / Disección de la arteria vertebral extracraneal: ocho casos.

We present eight cases of extracranial vertebral artery dissection. One of these had traumatic antecedents at the neck level while undergoing massage treatment. Of the rest, in four cases there was only a history of commonplace traumatism at neck level, consisting of twisting or stretching. Most presented pain at this level both before and during symptoms. Five had symptoms compatible with lateral bulbar infarct, two with cerebral infarct and one at the protuberance level. Angiography showed irregular stenosis of the spine on the affected side in five cases, occlusion in three cases. Nuclear magnetic resonance (NMR) was performed on five, with findings compatible with dissection. Six received anticoagulant treatment and two received platelet antiagregants with good recovery except in one patient who died twelve months later without any indication of the existence of dissection. We also carried out a review of the literature with special emphasis on the etiology of spontaneous cases, on clinical and neuroimaging findings and on treatment.