Síndrome de encefalopatía posterior reversible causada por emergencia hipertensiva en paciente con lupus / Hypertensive-emergency induced posterior reversible encephalopathy syndrome in a patient with lupus

Antecedentes y objetivos La encefalopatía posterior reversible es una entidad clínicoradiológica caracterizada por cefalea, obnubilación y ceguera cortical asociada a edema cerebral en neuroimagen, cuyas causas clásicas son: eclampsia, encefalopatía hipertensiva y agentes inmunosupresores. Métodos Mujer de 33 años afecta de lupus eritematoso sistémico traída a urgencias por cefalea, agitación y amaurosis. Resultados A su llegada PA: 205/139mmHg. No signos meningeos ni focalidad motora. Examen cardiopulmonar y ECG normales. Analítica anodina excepto proteinuria. RMN craneal: lesiones simétricas córticosubcorticales bioccipitales, hiperintensas en T2. Estos hallazgos sugerían lesiones tipo encefalopatía posterior reversible. Se administró labetalol i.v. como tratamiento de la emergencia hipertensiva con evolución favorable, consiguiéndose cifras de normotensión en días posteriores con valsartan y lercanidipino. La paciente quedó asintomática en 24h, RM craneal de control a las 2 semanas: normal. Se instauró tratamiento con prednisona y azatioprina orientando el episodio como complicación de su lupus eritematoso sistémico. Conclusiones La encefalopatía posterior reversible no es una condición excepcional en pacientes con lupus eritematoso sistémico. La clínica debe diferenciarse de un neurolupus y de posibles causas infecciosas en relación con la inmunosupresión. La evolución clínica y radiológica de este síndrome es generalmente rápidamente favorable (AU)

Background and objects: Posterior reversible encephalopathy syndrome (PRES) is aclinical-radiological entity characterized by headache, clouding of consciousness and cortical visual blindness associated to cerebral edema on the neuro image. Its classical causes are: eclampsia, hypertensive encephalopathy and immunosuppressant drugs. Method: A 33-year old woman suffering from systemic lupus (SLE) who was brought to the Emergency Department due to headache, agitation and blindness. Results: On her arrival, her blood pressure was 205/139 mmHg, with no meningeal ormotor signs. Cardiopulmonary and ECG examination normal. Blood tests were normal except for proteinuria. Brain MRI showed symmetric cortico-subcortical occipital lesions,T2 hyperintensity. These findings were suggestive of PRES. IV labetalol was administered for the hypertensive emergency with favorable course, achieving normal blood pressure levels in the following days with valsartan and lercanidipine. The patient remained asymptomatic at 24 h. The control MRI at 2 weeks was normal. Treatment was established with prednisone and azathioprine, considering the episode as a complication of the patient’s SLE. Conclusions: PRES is not a rare condition in patients with SLE. The symptoms should be differentiated from a neurolupus and possible infectious causes related to immunosupression. The clinical and radiological evolution of this syndrome is generally rapidly favorable (AU)

[Use of extra-hospital emergency systems in the treatment of acute stroke in the region of Murcia. Possible repercussions on the urgent care of stroke patients]. / Utilización del sistema de emergencias extrahospitalario en el tratamiento del ictus agudo en la región de Murcia. Posible repercusión en la asistencia sanitaria urgente del ictus.

AIM: To examine the use of extra-hospital emergency systems in the urgent care of stroke patients in our region and their influence on the time required to reach hospital, the time needed to perform an urgent computerised axial tomography (CAT) scan and the delay in receiving attention from the specialist. PATIENTS AND METHODS: Samples were collected from 232 stroke patients out of the total number admitted to our hospitals. Data about the stroke were collected prospectively, and included the arrival time, the time required to perform the CAT scan and the time the specialist devoted to attending the patient. Data were also gathered about the different extra-hospital transport and emergency systems. A statistical analysis was performed to determine the effect of using the extra-hospital emergency procedures on the different variables. RESULTS: A total of 53.6% of patients arrived within the first three hours. 38.7% went straight to hospital, 25% visited extra-hospital Emergency Services first, and 18.5% made a prior visit to Primary Care. 51.5% found their own way to the hospital and 46.7% arrived by ambulance. Mean time taken to perform an urgent CAT scan: 190.4 minutes; mean time required for specialist attention: 25.65 hours. The only statistically significant relation was the use of extra-hospital emergency systems and health care transport according to the type of stroke: both were more likely to be used in cases of haemorrhagic stroke. CONCLUSIONS: In hospitals in the Murcia region, the use of the extra-hospital emergency system and the means of transport utilised do not affect the time stroke patients take to reach hospital or the time needed to perform an urgent CAT scan or the delay in receiving attention from a specialist; the aetiology of the stroke does, however, influence the use of such services.

Utilización del sistema de emergencias extrahospitalario en el tratamiento del ictus agudo en la región de Murcia. Posible repercusión en la asistencia sanitaria urgente del ictus / Use of extra-hospital emergency system in the treatment of acute stroke in the region of murcia. Possible repercussions on the urgent care of stroke patients

Objetivo. Utilización en nuestra región de los sistemas de urgencias extrahospitalarias en la atención urgente del ictus y su influencia en el tiempo de llegada al hospital, el de realización de la tomografía axial computarizada (TAC) urgente y demora de la atención por el especialista. Pacientes y métodos. Se recogieron muestras de 232 pacientes con ictus del total de los ingresados en nuestros hospitales. Prospectivamente se recogieron datos sobre el ictus, con inclusión de los tiempos de llegada, tiempo de realización de la TAC y tiempo de atención por el especialista. Se recogió el uso delos distintos sistemas de urgencias y transporte extrahospitalarios. Estadísticamente se analizó la influencia del uso de los dispositivos de urgencia extrahospitalarios en las distintas variables recogidas. Resultados. 53,6% de los pacientes llegaron en las tres primeras horas. 38,7% acudieron directamente al hospital, el 25% acude primero al Servicio de Urgencias extrahospitalarias y 18,5% consulta previamente con Asistencia Primaria. El 51,5% llegaron por sus propios medios y el 46,7% en ambulancia. Tiempo medio de TAC urgente: 190,4 minutos; tiempo medio de atención por el especialista:25,65 horas. La única relación estadísticamente significativa fue el uso del sistema de urgencias extrahospitalarias y transporte sanitario según el tipo de ictus, con más tendencia a utilizarlos en los ictus hemorrágicos. Conclusiones. En los hospitales de Murcia, el uso del sistema de urgencias extrahospitalarias y el medio de transporte empleado no influyen en el tiempo de llegada del ictus al hospital, en el tiempo de realización de TAC urgente ni en la demora de atención por el especialista, y sí influye en la utilización de dichos servicios la etiología del ictus (AU)

Aim. To examine the use of extra-hospital emergency systems in the urgent care of stroke patients in our region and their influence on the time required to reach hospital, the time needed to perform an urgent computerised axial tomography(CAT) scan and the delay in receiving attention from the specialist. Patients and methods. Samples were collected from 232stroke patients out of the total number admitted to our hospitals. Data about the stroke were collected prospectively, and included the arrival time, the time required to perform the CAT scan and the time the specialist devoted to attending the patient. Data were also gathered about the different extra-hospital transport and emergency systems. A statistical analysis was performed to determine the effect of using the extra-hospital emergency procedures on the different variables. Results. A total of 53.6% of patients arrived within the first three hours. 38.7% went straight to hospital, 25% visited extra-hospital Emergency Services first, and 18.5% made a prior visit to Primary Care. 51.5% found their own way to the hospital and 46.7% arrived by ambulance. Mean time taken to perform an urgent CAT scan: 190.4 minutes; mean time required for specialist attention: 25.65hours. The only statistically significant relation was the use of extra-hospital emergency systems and health care transport according to the type of stroke: both were more likely to be used in cases of haemorrhagic stroke. Conclusions. In hospitals in the Murcia region, the use of the extra-hospital emergency system and the means of transport utilised do not affect the time stroke patients take to reach hospital or the time needed to perform an urgent CAT scan or the delay in receiving attention from a specialist; the aetiology of the stroke does, however, influence the use of such services (AU)