Neurocardiovascular pathology in pre-manifest and early-stage Huntington's disease.

BACKGROUND AND PURPOSE: Cardiovascular events are a major cause of early death in the Huntington's disease (HD) population. Dysautonomia as well as deterioration of circadian rhythms can be detected early in the disease progression and can have profound effects on cardiac health. The aim of the present study was to determine if patients with HD and pre-manifest mutation carriers present a higher risk of cardiovascular disease than non-mutation-carrying controls. METHODS: This was a prospective, cross-sectional, multicentre study of 38 HD mutation carriers (23 pre-manifest and 15 early-stage patients) compared with 38 age- and gender-matched healthy controls. Clinical and epidemiological variables, including the main haematological vascular risk factors, were recorded. Ambulatory blood-pressure monitoring and carotid intima-media thickness (CIMT) measurement were performed to assess autonomic function and as target-organ damage markers. RESULTS: Most (63.2%) patients with HD (86.7% and 47.8%, respectively, of the early-stage and pre-manifest patients) were non-dippers compared with 23.7% of controls (P = 0.001). CIMT values were in the 75th percentile in 46.7% and 43.5%, respectively, of the early-stage and pre-manifest patients, whereas none of the controls presented pathological values (P = 0.001 and P = 0.006, respectively). Nocturnal non-dipping was significantly associated with CIMT values in patients (P = 0.002) but not in controls. CONCLUSIONS: These results suggest that higher cardiovascular risks and target-organ damage are present even in pre-manifest patients. Although larger studies are needed to confirm these findings, clinicians should consider these results in the cardiovascular management of patients with HD.

Síndrome de parkinsonismo-hiperpirexia / Parkinsonism hyperpyrexia syndrome

No disponible

Temblor ortostático secundario al uso recreativo de disolventes / Orthostatic tremor secondary to recreational use of solvents

No disponible

Agonistas dopaminérgicos en la enfermedad de Parkinson / Dopaminergic agonists in Parkinson’s disease

Introducción: Los agonistas dopaminergicos no ergoticos (AD) son tratamientos útiles en la enfermedad de Parkinson (EP). Revisamos la farmacología, el grado de evidencia en cuanto a eficacia y tolerabilidad de pramipexol, ropinirol y rotigotina, y proponemos algunas recomendaciones para su uso en la practica clínica. Desarrollo: En el momento actual se dispone de formas de liberacion prolongada (LP) de pramipexol y ropinirol y de administración transdermica de rotigotina, que contribuyen a una mayor estabilidad plasmatica de los valores del fármaco. En la EP inicial los 3 fármacos mejoran de forma significativa las escalas de incapacidad de los pacientes, retrasan la aparición de discinesias y permiten retrasar la introducción de levodopa. En la EP avanzada reducen el tiempo off, mejoran la Unified Parkinson’s Disease Rating Scale (UPDRS) en on y en off y permiten reducir la dosis total de levodopa. Además, los 3 han sido capaces de inducir una mejora significativa en las escalas de la calidad de vida relacionada con la salud. Las formulas de LP han demostrado la no inferioridad frente a las de liberación inmediata, e incluso una mejor tolerabilidad (ropinirol). A pesar de su buen perfil de seguridad, entre los efectos adversos graves cabe destacar el trastorno de control de impulsos, cuya aparición puede ser precoz, y los accesos de sueño (sleep attacks). Aunque la terapia combinada no ha sido estudiada específicamente, algunas asociaciones (como la de apomorfina y otros AD) pueden ser beneficiosas. El cambio de un AD a otro es factible de un día para otro, aunque en los primeros días puede haber una sumación de efectos adversos dopaminergicos que debe tenerse en cuenta. La suspensión brusca del tratamiento con AD puede inducir un síndrome de deprivacion dopaminergica. La retirada de cualquier AD, en particular pramipexol, se ha asociado a aparición de apatía que puede ser grave. Conclusiones: Los nuevos AD no ergoticos constituyen una opción valida de tratamiento de la EP tanto inicial como avanzada. A pesar de su buen perfil de tolerabilidad, no están exentos de efectos adversos graves, que pueden tener un efecto atoplastico en la EP y que deben monitorizarse

Background: Non-ergoline dopamine agonists (DA) are effective treatments for Parkinson’s disease (PD). This review presents the pharmacology, evidence of efficacy and safety profile of pramipexole, ropinirole, and rotigotine, and practical recommendations are given regarding their use in clinical practice. Results: Extended-release formulations of pramipexole and ropinirole and transdermal continuous delivery rotigotine patches are currently available; these may contribute to stabilizing of plasma levels. In early PD, the three drugs significantly improve disability scales, delay time to dyskinesia and allow a later introduction of levodopa. In late PD they reduced total ’off’-time, improved Unified Parkinson’s Disease Rating Scale (UPDRS) in both ’on’ and ’off’ state and allowed a reduction in total levodopa dosage. A significant improvement in quality of life scales has also been demonstrated. Extended-release formulations have proved to be non-inferior to the immediate release formulations and are better tolerated (ropinirole). Despite a generally good safety profile, serious adverse events, such as impulse control disorder and sleep attacks, need to be routinely monitored. Although combination therapy has not been addressed in scientific literature, certain combinations, such as apomorphine and another DA, may be helpful. Switching from one DA to another is feasible and safe, although in the first days an overlap of dopaminergic side effects may occur. When treatment with DA is stopped abruptly, dopamine withdrawal syndrome may present. Suspending any DA, especially pramipexole, has been linked to onset of apathy, which may be severe. Conclusions: New non-ergotine DAs are a valuable option for the treatment of both early and late PD. Despite their good safety profile, serious adverse effects may appear; these effects may have a pathoplastic effect on the course of PD and need to be monitored

Dopaminergic agonists in Parkinson's disease.

BACKGROUND: Non-ergoline dopamine agonists (DA) are effective treatments for Parkinson's disease (PD). This review presents the pharmacology, evidence of efficacy and safety profile of pramipexole, ropinirole, and rotigotine, and practical recommendations are given regarding their use in clinical practice. RESULTS: Extended-release formulations of pramipexole and ropinirole and transdermal continuous delivery rotigotine patches are currently available; these may contribute to stabilising of plasma levels. In early PD, the three drugs significantly improve disability scales, delay time to dyskinesia and allow a later introduction of levodopa. In late PD they reduced total 'off'-time, improved Unified Parkinson's Disease Rating Scale (UPDRS) in both 'on' and 'off' state and allowed a reduction in total levodopa dosage. A significant improvement in quality of life scales has also been demonstrated. Extended-release formulations have proved to be non-inferior to the immediate release formulations and are better tolerated (ropinirole). Despite a generally good safety profile, serious adverse events, such as impulse control disorder and sleep attacks, need to be routinely monitored. Although combination therapy has not been addressed in scientific literature, certain combinations, such as apomorphine and another DA, may be helpful. Switching from one DA to another is feasible and safe, although in the first days an overlap of dopaminergic side effects may occur. When treatment with DA is stopped abruptly, dopamine withdrawal syndrome may present. Suspending any DA, especially pramipexole, has been linked to onset of apathy, which may be severe. CONCLUSIONS: New non-ergotine DAs are a valuable option for the treatment of both early and late PD. Despite their good safety profile, serious adverse effects may appear; these effects may have a pathoplastic effect on the course of PD and need to be monitored.

[Incidence of venous system disease in pseudotumor cerebri]. / Incidencia de alteraciones del sistema venoso en pseudotumor cerebri.

OBJECTIVE: Pseudotumor cerebri (PC) is a complex syndrome characterized by increased intracranial pressure in the absence of any space occupying lesion, usually self-limiting, but often relapsing In recent years, some authors had researched the relationship between venous sinus disease and PC and they have suggested that it must be ruled out by magnetic resonance venography (MRV) before diagnosing this condition as idiopathic. Our aim is to determine the frequency of venous sinus disease and the need for MRV in these patients. METHODS: We have studied 14 patients admitted between 1998 and 2005 in the Neurology Department of the University Clinical Hospital <> (Zaragoza; Spain) who had been diagnosed of PC. We reviewed the epidemiological and clinical features. The MRVs were reviewed and their appearances rated for focal narrowing and signal gaps. RESULTS: Six patients had strong signal in both lateral and transverse sinus and their image was considered as normal. The other eight patients showed filling defects on the transverse sinus (focal unilateral narrowing in four cases, one or more signal gaps in four cases). CONCLUSIONS: The presence of signal gaps in the venous sinus (stenosis/hypoplasia or absence of signal) is a frequent finding in patients with PC. That is why we have concluded that this test is important in patients with PC in order to search for a possible etiology and treatment option.

Incidencia de alteraciones del sistema venoso en pseudotumor cerebri / Incidence of venous system disease in pseudotumor cerebri

Objetivo. Pseudotumor cerebri (PC) es un complejo síndrome caracterizado por un incremento de la presión intracraneal en ausencia de lesión ocupante de espacio, generalmente autolimitado. En los últimos años algunos autores han señalado la relación existente entre PC y la patología del sistema venoso e indican la necesidad de realizar una angio-resonancia magnética (RM) venosa para descartarla antes de diagnosticar dicha entidad como idiopática. Nuestro objetivo es determinar la frecuencia de patología venosa, así como la necesidad de realización de angio-RM venosa en estos pacientes. Método. Se revisan 14 pacientes ingresados en el Servicio de Neurología del Hospital Clínico de Zaragoza entre los años 1998 y 2005 con el diagnóstico de PC. Se consideraron las características clínicas y epidemiológicas. Los hallazgos de la angio-RM se etiquetaron bien como estenosis/hipoplasia, bien como ausencia de señal. Resultados. En 6 pacientes, el estudio mediante angio-RM venosa fue normal. En los 8 pacientes restantes se objetivaron alteraciones de señal a nivel del seno transverso (estenosis/hipoplasia en 4 casos, ausencia de señal en 4 casos). Conclusión. La presencia de defectos de señal a nivel del seno venoso (estenosis/hipoplasia o ausencia de señal) es un hallazgo frecuente en pacientes con PC. Destacamos la importancia de esta exploración en pacientes con PC de cara a perfilar una posible etiología u opción terapéutica (AU)

Objective: Pseudotumor cerebri (PC) is a complex syndrome characterized by increased intracranial pressure in the absence of any space occupying lesion, usually self-limiting, but often relapsing In recent years, some authors had researched the relationship between venous sinus disease and PC and they have suggested that it must be ruled out by magnetic resonance venography (MRV) before diagnosing this condition as idiopathic. Our aim is to determine the frequency of venous sinus disease and the need for MRV in these patients.Methods: We have studied 14 patients admitted between 1998 and 2005 in the Neurology Department of the University Clinical Hospital <> (Zaragoza; Spain) who had been diagnosed of PC. We reviewed the epidemiological and clinical features. The MRVs were reviewed and their appearances rated for focal narrowing and signal gaps.Results: Six patients had strong signal in both lateral and transverse sinus and their image was considered as normal. The other eight patients showed filling defects on the transverse sinus (focal unilateral narrowing in four cases, one or more signal gaps in four cases).Conclusions: The presence of signal gaps in the venous sinus (stenosis/hypoplasia or absence of signal) is a frequent finding in patients with PC. That is why we have concluded that this test is important in patients with PC in order to search for a possible etiology and treatment option (AU)

[Neuroprotection in Parkinson's disease: analysis though group of experts' methodology]. / Neuroprotección en la enfermedad de Parkinson: análisis a través de la metodología de informadores clave.

INTRODUCTION: Currently used antiparkinsonian drugs neither stop nor slow-down the progressive nature of the disease. The final phase of PD is characterized by the presence of symptoms and signs resistant to dopaminergic agents, such as depression, dementia, freezing and falls. Therefore, it is urgent to develop therapies able to positively modify this outcome. Despite neuroprotection is a research priority in PD, no effective strategies have been found so far. METHOD: A key informants study was conducted. A group of experts in PD fulfilled a questionnaire of 10 questions to explore the most important topics related to neuroprotection. Afterwards a consensus about the current situation of neuroprotection in PD was established and future directions of development were suggested. RESULTS: Most of the answers emphasized the need of new concepts, the limitations of animal models and the difficulties in the difficulties in demonstrating a neuroprotective effects in humans owing to a lack of biomarkers. Some of the experts believe that we are already exerting a disease modifying effect. CONCLUSIONS: The concept of neuroprotection should be widened. Animal models should be improved. A reliable biomarker to start neuroprotective therapies long before the appearance of motor symptoms and to evaluate the neuroprotective effect of any therapy should be urgently developed.

Neuroprotección en la enfermedad de Parkinson: análisis a través de la metodología de informadores clave / Neuroprotection in Parkinson’s disease: analysis though group of expert’s methodology

Introducción. La terapia convencional basada en fármacos dopaminérgicosno frena ni ralentiza de modo significativo el cursoprogresivo de la enfermedad de Parkinson (EP). La fase final de la EPse caracteriza por la presencia de síntomas y signos resistentes a laterapia dopaminérgica (depresión, demencia, disartria, caídas, etc.).Es urgente desarrollar terapias que eviten llegar a estas fases deteniendoo retardando la progresión de la enfermedad. Sin embargo,no se dispone de estrategias neuroprotectoras efectivas.Método. Se realizó un estudio de informadores clave en el queexpertos en EP que cumplimentaron un cuestionario de 10 preguntassobre la problemática más importante en el área de la neuroprotecciónen la EP. Tras ello se estableció un consenso sobre la situaciónactual y se sugirieron nuevas direcciones de investigación.Resultados. La mayoría de respuestas coincidieron en la necesidadde nuevos conceptos, en las limitaciones de los actuales modelosanimales o las dificultades de demostrar un efecto protector en humanospor la falta de biomarcadores. Algunos participantes opinanque ya se está ejerciendo un cierto efecto modificador del curso dela enfermedad.Conclusiones. El concepto de neuroprotección debe ser ampliado,los modelos animales deben mejorarse y urge encontrar un biomarcadorfiable para planificar la terapia en fases más precoces ypara determinar el efecto neuroprotector (AU)

Introduction. Currently used antiparkinsonian drugs neitherstop nor slow-down the progressive nature of the disease. The finalphase of PD is characterized by the presence of symptomsand signs resistant to dopaminergic agents, such as depression,dementia, freezing and falls. Therefore, it is urgent to develop therapies able to positively modify this outcome. Despite neuroprotectionis a research priority in PD, no effective strategieshave been found so far.Method. A key informants study was conducted. A group ofexperts in PD fulfilled a questionnaire of 10 questions to explorethe most important topics related to neuroprotection. Afterwardsa consensus about the cur-rent situation of neuroprotection inPD was established and future directions of development weresuggested.Results. Most of the answers emphasized the need of newconcepts, the limitations of animal models and the difficulties inthe difficulties in demonstrating a neuroprotective effects in humansowing to a lack of biomarkers. Some of the experts believethat we are already exerting a disease modifying effect.Conclusions. The concept of neuroprotection should be widened.Animal models should be improved. A reliable biomarkerto start neuroprotective therapies long before the appearance ofmotor symptoms and to evaluate the neuroprotective effect ofany therapy should be urgently developed (AU)

Infarto cardioembólico:características clínicas y evolutivas / Cardioembolic infarct: clinical characteristics and course

Introducción. Aproximadamente un 20 por ciento de todos los ictus isquémicos son debidos a cardioembolismo y la frecuencia es mayor en pacientes jóvenes. Nuestro objetivo es determinar las características clínicas y evolutivas de los infartos cardioembólicos (ICCE) comparándolos con aquellos infartos de otras etiologías (ICNCE). Pacientes y métodos. Se ha realizado un estudio propectivo de 354 pacientes ingresados durante un año tras excluir la isquemia transitoria y las hemorragias parenquimatosa/subaracnoidea. Establecimos dos grupos: ICCE (29,4 por ciento) e ICNCE (70,6 por ciento) y comparamos edad, sexo, factores de riesgo y evolución. Se ha realizado un estudio posterior durante dos años para valorar el índice de recurrencia. Resultados. Los pacientes con ICCE son mayores (75,89 frente a 72,58; p= 0,004), con frecuencia conocen la hora de inicio de los síntomas (p= 0,015) e ingresan preferentemente en las primeras seis horas de evolución (p= 0,01). La presencia de cardiopatía isquémica o fibrilación auricular es significativamente mayor (p= 0,0052; p= 0,005); desarrollan más complicaciones (p= 0,000); su estancia es más prolongada (13,62 frente a 11,8 días; p= 0,035); puntúan más bajo en el IB semanal (p= 0,0023) y la mortalidad es mayor (p= 0,000). Del subgrupo de 70 pacientes valorados dos años después recurrieron 11 casos sin que encontráramos diferencias significativas entre el tratamiento anticoagulante y el antiagregante. Conclusión. El ICCE acontece en pacientes más mayores, cursa con mayor déficit neurológico, se caracteriza por un peor pronóstico a corto plazo, desarrollan más complicaciones y la mortalidad es significativamente mayor (AU)

[Acute transverse myelitis secondary to hepatitis B vaccination]. / Mielitis transversa aguda secundaria a la vacunación de la hepatitis B.

INTRODUCTION: Acute transverse myelitis is an inflammatory disorder. The pathogenesis is unclear, but the probable mechanism involves an autoimmune phenomenon. Possible causes included multiple sclerosis and parainfectious and postvaccinal events. Myelitis has rarely been reported secondary to vaccinations including hepatitis B. We present a case of acute myelitis, which seems secondary to the administration of the hepatitis B vaccine. CLINICAL CASE: A 15-years-old female presented with progressive numbness of the right arm and leg, with right leg weakness. Symptom began one week after receiving the first dose of the hepatitis B vaccine. Spinal cord magnetic resonance (MR) revealed a diffuse increased signal extending from C6 to D2. Cerebral MR and cerebrospinal fluid were normal. She was treated with high doses of methylprednisolone with a complete recovery of neurological functional. Repeat medullar cord MR was normal. There was no relapse during a four years follow up. CONCLUSIONS: Potential causal relationship between vaccination against hepatitis B and multiple sclerosis was brought to the attention and to public debate. However, no conclusive association could be made between vaccination and demyelination. In the clinical setting, the distinction between a first episode of multiple sclerosis or postvaccinal myelitis depends upon subsequent course.

Mielitis transversa aguda secundaria a la vacunación de la hepatitis B / Acute transverse myelitis secondary to hepatitis B vaccination

Introducción. La mielitis transversa aguda es un proceso inflamatorio de patogenia desconocida, aunque se sospecha una base autoinmune. La mayor parte de los casos aparecen en el contexto de la esclerosis múltiple o tras infecciones o vacunaciones. El desarrollo de una mielitis transversa aguda asociada a la vacunación de la hepatitis B es poco frecuente. Presentamos un caso de mielitis transversa aguda desencadenada tras la primera dosis de la vacuna de la hepatitis B. Después de cuatro años de seguimiento no ha aparecido ningún otro síntoma neurológico. Caso clínico. Mujer de 15 años de edad, que a la semana de recibir la primera dosis de la vacuna de la hepatitis B comenzó con parestesias en el hemicuerpo derecho y posteriormente paresia en miembro inferior derecho. En la RMN medular se objetivó una lesión hiperintensa entre C6 y D2.Tanto la RMN craneal como los estudios inmunológicos en suero y líquido cefalorraquídeo fueron negativos. Se trató con megadosis de corticosteroides. A los 6 meses la paciente estaba asintomática y la RMN cervical de control fue normal. Conclusiones. La relación entre la administración de la vacuna de la hepatitis B y el primer brote de esclerosis múltiple ha sido objeto de debate y de estudios epidemiológicos. Aunque no hay suficientes datos para relacionar ambos efectos, en la práctica la distinción entre un primer brote de esclerosis múltiple o una mielitis transversa aguda posvacunal sólo puede realizarse con el seguimiento en el tiempo (AU)

[Diabetes mellitus and stroke]. / Diabetes mellitus e ictus.

INTRODUCTION: Diabetes mellitus (DM) is an important risk factor in cerebral vascular disease since it causes endothelial proliferation and thickening of the plasmatic membrane in the small blood vessels. The pathogenic mechanism is thus different from that of athero-thrombosis or emboli. Our objective was to determine whether there are differences between strokes in diabetic patients and strokes secondary to other diseases. PATIENTS AND METHODS: We made a prospective study of 415 stroke patients admitted to hospital consecutively over one year. Transient ischaemia and subarachnoid hemorrhage were excluded. We analysed age, sex, risk factors, severity (Canadian scale), mortality and functional prognosis one week later. RESULTS: Of the 415 patients, 354 were diagnosed as having cerebral infarcts and 61 parenchymatous hemorrhage. The average age was 72.2 years. The commonest risk factor was arterial hypertension (n = 241). There were 95 patients with DM. Bivariate and multivariate analysis showed independent variables associated with DM to be the onset of cerebrovascular pathology at a younger age (p = 0.009), association with arterial hypertension (p = 0.002) and poor previous quality of life (p = 0.003). We did not find a higher incidence of lacunar infarcts amongst the diabetic patients. CONCLUSIONS: The diabetic patient is younger and often also has arterial hypertension. There was no difference in mortality or type of stroke (ischemic compared with hemorrhagic). No significant relationship was found with lacunar infarcts.

[Transient global amnesia: a review of 58 cases]. / Amnesia global transitoria: revisión de 58 casos.

INTRODUCTION: Transient global amnesia (TGA) is a clinical condition in which the etiopathogenesis is still not clear. The most generally accepted theory is of a vascular origin, although epilepsy or migraine have also been considered to possibly be the cause. OBJECTIVE: To make a retrospective review of the risk factors, etiopathogenesis and clinical characteristics of 58 patients with TGA. PATIENTS AND METHODS: The variables recorded were compared with those from two control groups: one of healthy individuals and one of patients with transient ischemic attacks (TIA). RESULTS: The average age of the patients with TGA was 66.01 years. The risk factors included: arterial hypertension (58.62%), dyslipemia (15.51%) and migraine (8.62%). In three patients the EEG showed weak bilateral frontotemporal interference. Cerebral CT scans were done in all cases and were found to be pathological in 23, with lacunar multinfarct the commonest abnormality. With regard to patients with TIA, these were older (66.01 vs 72.94), smoked more (1.72% vs 12.06%) and a previous stroke was more frequent (8.62% vs 31.03%). We did not find differences regarding dyslipemia, atrial fibrillation, arterial hypertension or cardiac ischemia. However, the prevalence of vascular risk factors was significantly higher in patients with TGA as compared to healthy controls. CONCLUSION: We suggest that the etiopathogenesis of TGA is probably a transient ischemic phenomenon triggered (or not) following an attack of migraine.

Diabetes mellitus e ictus / Diabetes mellitus and stroke

Introducción. La diabetes mellitus (DM) es un importante factor de riesgo de la enfermedad vascular cerebral ya que induce, a nivel de los pequeños vasos, la proliferación endotelial y el engrosamiento de la membrana plasmática. El mecanismo patogénico es por tanto distinto al aterotrombótico y embólico. Nuestro objetivo es determinar si existen diferencias entre el ictus del paciente diabético y el secundario a otras enfermedades. Pacientes y métodos. Se ha llevado a cabo un estudio prospectivo de 415 pacientes con ictus ingresados consecutivamente durante un año. Se han excluido la isquemia transitoria y la hemorragia subaracnoidea. Se analizó edad, sexo, factores de riesgo, gravedad (escala canadiense), mortalidad y pronóstico funcional a la semana. Resultados. De los 415 pacientes, 354 fueron diagnosticados de infarto cerebral y 61 de hemorragia parenquimatosa. La edad media fue de 72,2 años. El factor de riesgo más frecuente fue la hipertensión arterial (HTA) (n= 241). Padecían DM 95 pacientes. El análisis bi y multivariante determina como variables independientes asociadas a la DM el debut de la patología cerebrovascular en edades más jóvenes (p= 0,009), la asociación a HTA (p= 0,002) y la peor calidad de vida previa (p= 0,003). No encontramos una mayor frecuencia de infartos lacunares entre los pacientes diabéticos. Conclusiones. El paciente diabético es más joven y con frecuencia asocia HTA. No existen diferencias en cuanto a mortalidad y tipo de ictus (isquémico frente a hemorrágico). Tampoco encontramos una relación significativa con el infarto lacunar (AU)

Amnesia global transitoria: revisión de 58 casos / Transient global amnesia: a review of 58 cases

Introducción. La amnesia global transitoria (AGT) constituye una entidad clínica cuya etiopatogenia no está aún definida. La teoría más extendida es la vascular aunque también se considera un origen epiléptico o migrañoso. Objetivo. Revisar retrospectivamente factores de riesgo, etiopatogenia y características clínicas de 58 pacientes con AGT. Pacientes y métodos. Las variables recogidas se compararán con las registradas en dos grupos control: uno compuesto por individuos sanos y otro por pacientes con ataque isquémico transitorio (AIT). Resultados. La edad media de los pacientes con AGT fue de 66,01 años. Entre los factores de riesgo vascular destacan la hipertensión arterial (58,62 por ciento), dislipemia (15,51 por ciento) y migraña (8,62 por ciento). En tres pacientes el electroencefalograma mostraba débil interferencia frontotemporal bilateral. Se practicó una tomografía computarizada cerebral a todos los pacientes que en 23 casos fue patológica, siendo el hallazgo más frecuente el multinfarto lacunar. En relación con los pacientes con AIT, éstos son mayores (66,01 frente a 72,94), fuman más (1,72 por ciento frente a 12,06 por ciento) y es más frecuente el ictus previo (8,62 frente a 31,03 por ciento). En los pacientes con AGT destaca el antecedente migrañoso (8,62 frente a 1,72 por ciento). No encontramos diferencias en lo referente a dislipemia, fibrilación auricular, hipertensión arterial o cardiopatía isquémica. Sin embargo, la prevalencia de factores de riesgo vascular fue significativamente más alta en los pacientes con AGT respecto a los controles sanos. Conclusión. Sugerimos que la etiopatogenia de la AGT probablemente sea un fenómeno isquémico transitorio desencadenado o no tras una crisis migrañosa (AU)

[Cardioembolic infarction: clinical course and characteristics]. / Infarto cardioembólico: características clínicas y evolutivas.

INTRODUCTION: Approximately 20% of all ischemic strokes are due to cardioembolism and occur more frequently in the younger patients. Our objective was to determine the clinical characteristics and course of cardioembolic infarcts (ICCE) comparing them with infarcts due to other aetiologies (ICNCE). PATIENTS AND METHODS: We made a prospective study of 354 patients admitted to hospital over a period of one year, after excluding transient ischaemia and parenchymatous/subarachnoid hemorrhage. Two groups were established: ICCE (29.4%) and ICNCE (70.6%), comparing age, sex, risk factors and course of the illness. Subsequently a study lasing two years was done to assess the recurrence rate. RESULTS: The ICCE patients were older (75.89 compared with 72.58, p = 0.004), often know the exact time of onset of their symptoms (p = 0.015) and usually are admitted to hospital during the first six hours of their illness (p = 0.01). There was a significantly higher incidence of ischemic cardiopathy or auricular fibrillation (p = 0.0052); p = 0.005); more complications arose (p = 0.000); stay in hospital was longer (13.62 as compared to 11.8 days; p = 0.035), there was a lower weekly BI score (p = 0.0023) and higher mortality (p = 0.000). In the subgroup of 70 patients evaluated two years later 11 cases recurred, with no difference observed between the anticoagulant and anti-aggregant groups. CONCLUSION: The ICCE occurs in older patients, they develop worse neurological defects, have a worse short-term prognosis, develop more complications and have significantly greater mortality.

[Symptomatic epilepsy: review of 208 patients]. / Epilepsia sintomática: revisión de 208 pacientes.

OBJECTIVE: To determine the main etiological mechanisms of symptomatic epilepsy and its frequency according to age. PATIENTS AND METHODS: We made a retrospective analysis of 208 patients admitted during a period of four and a half years, studying the variables: age, sex and type of seizures: simple partial, secondarily generalized partial, complex partial, tonic-clonic, generalized tonic, and also EEG and neuroimaging. RESULTS: The main etiological mechanisms found were: vascular (31.25%), alcoholic (12.01%), intracranial disorders (9.61%), traumatic (5.28%), degenerative (5.28%), infectious (2.88%) and cryptogenic (33.65%). In the last group there was an outstandingly large proportion of patients with silent infarcts. When considering vascular epilepsy, those seizures occurring during the acute phase of the stroke (24/65) are differentiated from those of late onset (41/65). In the latter there was a marked predominance of ischemic etiology (48.78% corresponded to extensive infarcts in the territory of the middle cerebral artery; 36.58% were associated with partial infarcts) probably because of the greater frequency of ischemic stroke as compared with hemorrhagic stroke. After the acute phase, the latency was of 10.68 +/- 0.43 months and the most frequent seizures were tonic-clonic (48.78%). CONCLUSION: In persons under 30 years of age, etiology is multifactorial; between 30 and 50 years of age alcoholic epilepsy (39.53%) and traumatic epilepsy (11.62%) predominate; over the age of 50 years the cause was vascular in 43.5%. In the latter age group there was a high proportion of patients with heraldic seizures.