[Cerebrovascular disease in young adults. A study of its course in 167 patients]. / Enfermedad vascular cerebral en el adulto joven. Estudio evolutivo en 167 pacientes.

INTRODUCTION: Few studies have been made of the prognosis of ictus in the young adult. The objective of this paper is to study the short term evolution of 167 patients, aged between 15 and 45 years, with cerebral vascular disease. MATERIAL AND METHODS: Since 1986 a protocolized study has been made of all patients aged between 15 and 45 who were admitted to the Neurology Department of the Hospital General Universitario in Valencia for a cerebral vascular incident. The results obtained up to 1993 have been recorded in a data base. In this paper the demographic data and information as to intrahospital evolution have been used with the Canadian, modified Rankin and Barthel Scales in the various ictus groups. RESULTS: 28.7% of the patients were AIT and 71.3% were diagnosed as established ictus, of whom 38.8% were haemorrhagic and 61.2% were ischaemic. 29.8% of the HIP, 33.3% of the embolic infarcts and 18.2% of the atherothrombotic infarcts were severely disabled on discharge from hospital. Mortality was 4.2% when AIT were excluded. DISCUSSION: Most studies are basically aetiopathological and much fewer include evaluation of prognosis. In our series, the patients had a satisfactory clinical course and low short-term mortality. As in the other series, the two groups with the worst prognosis were the HIP and the cardioembolic infarcts. Patients with HSA and HIV made outstandingly good progress.

[Hospital stay after cerebral hemorrhage]. / Estancia hospitalaria en hemorragias intracerebrales.

INTRODUCTION AND OBJECTIVES: Patients with intracerebral haemorrhage (ICH) make up 10-12% of the total number of patients admitted to hospital. In this paper we evaluate the period of time during which the maximum benefit is obtained by a patient with this type of ictus. DEVELOPMENT AND CONCLUSIONS: We therefore review the aetiology, physiopathological course and complications of HIC in order to better understand the circumstances which affect the average hospital stay and identify the factors which can be acted upon and when to do so. We conclude that the average hospital stay does not depend on the type of ictus, in the sense of whether it is ischaemic or haemorrhagic, but on its severity which mainly depends on the size of the lesion. We find no justification for a patient with ICH spending more time in hospital than one with an ischaemic ictus, except where it is suspected that a cerebral aneurysm is the cause of the haemorrhage.

[Cerebral hemorrhage after carotid endarterectomy in a young adult]. / Hemorragia cerebral tras endarterectomía carotídea en un adulto joven.

INTRODUCTION: Cerebral haemorrhage after carotid endarterectomy is a rare complication. It follows 0.5% to 20% of all endarterectomies, but should be borne in mind because of the morbidity and mortality seen in most cases. CLINICAL CASE: We describe the case of a 42 year old man in whom carotid endarterectomy had been done 7 days before to treat a stenosis of 80%. He complained of a sudden onset of weakness of the right half of his body and changes in his speech. Physical examination showed right inferior facial paresia, right hemiparesia and right extensor cutaneous plantar reflex. On admission to the Emergency Department, before treatment, blood pressure was 80/60. Carotid auscultation and palpation were normal. Cerebral TRC showed a left lenticular haematoma. The patient progressed satisfactorily. DISCUSSION/CONCLUSIONS: We review the literature on the subject as well as the factors which should be considered as possibly predisposing to bleeding after carotid endarterectomy, such as arterial hypertension and occlusion or severe stenosis of the contralateral carotid artery. The detection of patients with the risk of postendarterectomy bleeding by simple noninvasive investigations, such as the transcranial doppler and the acetazolamide test, and early diagnosis of a clinical picture compatible with a hyperperfusion syndrome may contribute to the relief and prevention of sequelae in these patients.

[Intake patterns of analgesics in patients with headache who came to the neurologist]. / Patrón de consumo de analgésicos en el paciente con cefalea que acude a la consulta de neurología.

We have analysed the pattern of analgesic use in a group of patients that came for the first time to the neurologist. We have examined the first intention analgesic use in patients with headache, before the therapeutic intervention of the neurologist. During a month, we have followed a group of 40 patients. 20 of them were admitted as ambulatory patients at a Headache Unit at a Hospital and the other 20 were attended as outpatients by a general neurologist. 'Over-the-counter' analgesics were the most commonly used (paracetamol, acetylsalicylic acid and combinations of them with other products such as caffeine). More than a half of the patients had consumed a combination of analgesics. At the time of the investigation, the mean of analgesic use were greater in the group attended at the Headache Unit than in the one attended by the general neurologist. This could depend on the fact that chronic daily headache was more frequent in the first group and that they were older than the other group. These findings could be in relation with a larger evolution of their headache.