Hyperuricaemia as a prognostic factor for acute ischaemic stroke. / Uricemia como factor pronóstico del ictus isquémico agudo.

INTRODUCTION: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results. METHODS: We collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels. RESULTS: A total of 73% of patients had mRS scores ≤2; the mean uric acid level was 5.22mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis. CONCLUSIONS: Serum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect.

Trombólisis intravenosa con activador tisular del plasminógeno recombinante en los síndromes de alarma vascular / Intravenous thrombolysis with recombinant tissue plasminogen activator in vascular warning syndromes

Introducción: Los síndromes de alarma vascular constituyen una situación de urgencia neurológica, debido a su alto riesgo de ictus establecido. Actualmente no existe evidencia firme sobre cuál debe ser el tratamiento de elección en estos casos. El objetivo de este trabajo es describir el papel de la trombólisis con rTPA intravenosa en el tratamiento de los síndromes de alarma vascular. Material y métodos: Se revisaron los casos propios y los existentes en la literatura en los que se hubiese tratado con rTPA intravenoso a los pacientes con clínica neurológica fluctuante. Resultados: Se obtuvieron 3 casos propios y 19 recogidos de la literatura (15 varones y 7 mujeres). La edad media fue de 68,7 ± 9 años (rango: 52-84 años). La frecuencia media de episodios antes del tratamiento fue de 4 (rango: 2-15 episodios). La puntuación en la escala NIH (NIHSS) máxima estuvo en un rango entre 6-22 según cada caso. Se dispuso de la NIHSS a las 24 h del tratamiento en 8 de los casos: en 6 (75%) fue de 0, y en 2 (25%) de 12. La escala de Rankin modificada (ERm) a los 3 meses del tratamiento fue de 0-1 en 18 (81,8%) de los pacientes: 8/10 (80%) en los síndromes de alarma lacunar, 6/7 (85,7%) en los síndromes de alarma basilar y 4/5 (80%) en pacientes con fluctuaciones que no entraban dentro de estos 2 grupos. Conclusiones: El tratamiento con rTPA intravenoso podría suponer una alternativa terapéutica eficaz y segura en los pacientes con clínica neurovascular fluctuante, aunque se necesitan estudios bien diseñados que establezcan de forma clara cuál es el papel real de la trombólisis intravenosa con rTPA en los síndromes de alarma vascular

ntroduction: Vascular warning syndromes constitute a neurological emergency due to their associated high risk of established stroke. At present, there is no strong evidence indicating the best treatment for these patients. The aim of this paper is to describe the function of intravenous rt-PA thrombolysis in the treatment of vascular warning syndromes. Material and methods: We reviewed our hospital records and the literature to find patients with neurologically fluctuating profiles and who underwent intravenous rt-PA thrombolysis. Results: We retrieved 3 cases from our hospital records and 19 from the literature (15 males and 7 females). Mean age was 68.7±9 years (range: 52-84 years). The mean number of episodes before treatment was 4 (range: 2-15 episodes). The maximum NIHSS scores ranged from 6 to 22 in different patients. We obtained 24-hour post-treatment NIHSS scores in 8 cases; of these cases, 6 (75%) had a score of 0, and the other 2 (25%) had a score of 12. The Modified Rankin Score calculated at 3 months of treatment was 0 or 1 in 18 patients (81.8%); these 18 comprised 8 of the 10 patients with lacunar warning syndromes (80%), 6 of the 7 with basilar warning syndromes (85.7%), and 4 of the 5 with fluctuating non-lacunar, non-basilar warning syndromes (80%). Conclusions: Intravenous rt-PA treatment may constitute an effective and safe therapeutic alternative for patients with neurovascular fluctuations. However, well-designed studies are needed to determine the role of intravenous rt-PA thrombolysis in cases of vascular warning syndrome

Intravenous thrombolysis with recombinant tissue plasminogen activator in vascular warning syndromes.

INTRODUCTION: Vascular warning syndromes constitute a neurological emergency due to their associated high risk of established stroke. At present, there is no strong evidence indicating the best treatment for these patients. The aim of this paper is to describe the function of intravenous rt-PA thrombolysis in the treatment of vascular warning syndromes. MATERIAL AND METHODS: We reviewed our hospital records and the literature to find patients with neurologically fluctuating profiles and who underwent intravenous rt-PA thrombolysis. RESULTS: We retrieved 3 cases from our hospital records and 19 from the literature (15 males and 7 females). Mean age was 68.7±9 years (range: 52-84 years). The mean number of episodes before treatment was 4 (range: 2-15 episodes). The maximum NIHSS scores ranged from 6 to 22 in different patients. We obtained 24-hour post-treatment NIHSS scores in 8 cases; of these cases, 6 (75%) had a score of 0, and the other 2 (25%) had a score of 12. The Modified Rankin Score calculated at 3 months of treatment was 0 or 1 in 18 patients (81.8%); these 18 comprised 8 of the 10 patients with lacunar warning syndromes (80%), 6 of the 7 with basilar warning syndromes (85.7%), and 4 of the 5 with fluctuating non-lacunar, non-basilar warning syndromes (80%). CONCLUSIONS: Intravenous rt-PA treatment may constitute an effective and safe therapeutic alternative for patients with neurovascular fluctuations. However, well-designed studies are needed to determine the role of intravenous rt-PA thrombolysis in cases of vascular warning syndrome.

[Usefulness of electroencephalograms in evaluating transient global amnesia]. / Utilidad de la electroencefalografia en la valoracion de la amnesia global transitoria.

INTRODUCTION: Transient global amnesia (TGA) is a perfectly well defined clinical picture, but nevertheless even today its aetiology remains unknown. The three most widely accepted theories suggest it has a vascular origin, it is related with the pathophysiology of migraine or it is of an epileptiform nature. AIM: To analyse whether there is an electroencephalographic pattern that is consistently repeated in a series of electro-encephalograms (EEG) carried out on patients with TGA. PATIENTS AND METHODS: The study consists in a retrospective analysis of a sample of 345 patients referred to have an EEG after an episode of TGA. RESULTS: In almost 20% of the EEGs something that could be considered abnormal was found, although most of these findings (64%) were of little pathological significance. Of the remaining 26%, attention should be drawn to the cases of two patients with subclinical rhythmic electroencephalogram discharges of adults (a pattern with a meaning that is not altogether clear and which has previously been associated with TGA). CONCLUSIONS: A considerable percentage of patients have TGA and EEG alterations, although most of them are of scarce pathological significance or can be attributed to some other underlying condition. We have not succeeded in identifying any pattern that is consistently repeated. Our results suggest that the EEG is a test with low diagnostic effectiveness in this pathology and it is necessary to reconsider the need to systematically perform such tests in suspected cases of TGA.

Meningitis neoplásica. Revisión de una serie hospitalaria / Neoplastic meningitis. Review of a clinical series

Introducción: El progresivo envejecimiento de la población en las últimas décadas ha provocado un aumento en la frecuencia de aparición de las muchas complicaciones que se asocian al cáncer. Entre ellas destacan las neurológicas, que aparecen en un 10-30% de los pacientes con neoplasias sistémicas. La meningitis neoplásica aparece en un 4-15% de los pacientes con tumores sólidos y se asocia a un mal pronóstico. El objetivo de este trabajo es describir las características clínicas, licuorales, de imagen y pronósticas en una serie de meningitis neoplásica. Fuentes y desarrrollo: Se realizó una revisión retrospectiva de todos los pacientes ingresados en el Hospital Universitario de Gran Canaria Dr. Negrín con sospecha de meningitis neoplásica entre los años 1990 y 2008. Se seleccionaron 37 pacientes, con un rango de edad entre los 15 y los 75 años. De los 33 casos en los que se identificó un tumor primario, 27 (81,8%) estaban asociados a tumores sólidos (24,2% de mama y 24,2% de pulmón). La diplopia fue la manifestación de disfunción de nervios craneales más frecuente, observándose en 12 casos (32,4%). La supervivencia media tras el diagnóstico fue de 87,9 días (12,6 semanas). La citología del líquido cefalorraquídeo fue positiva en 12/26 casos (46,4%). Conclusión: La meningitis neoplásica es una complicación grave de los tumores tanto sólidos como hematológicos. Es necesario mantener un alto nivel de sospecha que permita establecer un diagnóstico precoz, puesto que la supervivencia media en los pacientes con meningitis neoplásica es baja (AU)

Introduction: The increase in the ageing population in the last decades has led to an increasedfrequency of cancer-associated complications. Among these, neurological disorders stand out,as they appear in 10-30% of patients with systemic neoplasia. Neoplastic meningitis accounts for 4-15% of patients with solid tumours and it has a poor prognosis. The objective of this paper is to describe the clinical, imaging and prognostic characteristics as well as cerebrospinal fluid findings in a series of neoplastic meningitis. Background and development: We performed a retrospective review of all patients admitted to the Hospital Universitario of Gran Canaria Dr. Negrín with clinical suspicion of neoplastic meningitis between 1990 and 2008. We selected 37 patients with an average age ranging from 15 to 75 years old. A total of 81.8%of the cases in which a primary tumour was found were associated with solid tumours (24.2%were located in the breast, and 24.2% in the lung). The most frequent sign of cranial nervedysfunction was dyplopia, which was observed in 32.4% of the cases. The average survival rateafter diagnosis was 87.9 days (12.6 weeks). The cerebrospinal fluid cytology was positive in46.4% of the cases. Conclusion: Neoplastic meningitis is a severe complication of both solid and haematological tumours. We stress the importance of maintaining a high level of suspicion to achieve early diagnosis, since the average survival probability for neoplastic meningitis patients is low (AU)

Neoplastic meningitis.Review of a clinical series.

INTRODUCTION: The increase in the ageing population in the last decades has led to an increased frequency of cancer-associated complications. Among these, neurological disorders stand out, as they appear in 10-30% of patients with systemic neoplasia. Neoplastic meningitis accounts for 4-15% of patients with solid tumours and it has a poor prognosis. The objective of this paper is to describe the clinical, imaging and prognostic characteristics as well as cerebrospinal fluid findings in a series of neoplastic meningitis. BACKGROUND AND DEVELOPMENT: We performed a retrospective review of all patients admitted to the Hospital Universitario of Gran Canaria Dr. Negrín with clinical suspicion of neoplastic meningitis between 1990 and 2008. We selected 37 patients with an average age ranging from 15 to 75 years old. A total of 81.8% of the cases in which a primary tumour was found were associated with solid tumours (24.2% were located in the breast, and 24.2% in the lung). The most frequent sign of cranial nerve dysfunction was dyplopia, which was observed in 32.4% of the cases. The average survival rate after diagnosis was 87.9 days (12.6 weeks). The cerebrospinal fluid cytology was positive in 46.4% of the cases. CONCLUSION: Neoplastic meningitis is a severe complication of both solid and haematological tumours. We stress the importance of maintaining a high level of suspicion to achieve early diagnosis, since the average survival probability for neoplastic meningitis patients is low.

Neuropatía vasculítica no sistémica / Non-systemic vasculitic neuropathy

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