¿Existe relación entre las lesiones de la sustancia blanca asociadas a migraña y el foramen oval permeable? Análisis de una serie de pacientes con migraña crónica / Is there a relationship between white matter lesions associated with migraine and patent foramen ovale? Analysis of a series of patients with chronic migraine

INTRODUCCIÓN: Las lesiones de la sustancia blanca son más prevalentes en los pacientes migrañosos que en la población general, especialmente en los que tienen una alta frecuencia de ataques. El foramen oval permeable se ha descrito como posible nexo de unión entre la migraña y las lesiones de la sustancia blanca. OBJETIVO: Determinar la existencia de una posible relación entre el foramen oval permeable y las lesiones de la sustancia blanca en una serie de pacientes con migraña crónica. PACIENTES Y MÉTODOS: Estudio observacional, unicéntrico, de casos y controles. Se seleccionó a 89 mujeres con migraña crónica. La persistencia y las características del foramen oval permeable se evaluaron mediante un estudio Doppler transcraneal. El foramen oval permeable se clasificó como pequeño, moderado o masivo. Se consideraron permanentes los detectados en reposo, y latentes, el resto. El protocolo de resonancia magnética incluyó imágenes sagitales potenciadas en T1, axiales potenciadas en FLAIR-T2 y secuencia combinada de densidad protónica y T2-FSE. Las lesiones de la sustancia blanca se clasificaron como profundas, periventriculares o ambas. RESULTADOS: La prevalencia de foramen oval permeable (53,6% frente a 48,5%; p = 0,80) y la proporción de foramen oval permeable masivo y permanente fueron similares entre los pacientes con y sin lesiones de la sustancia blanca. Tampoco se encontraron diferencias en la prevalencia (55,6% frente a 52,6%; p = 1,00) o las características del foramen oval permeable en función de la distribución de las lesiones de la sustancia blanca. CONCLUSIÓN: Los resultados no sugieren la intervención del foramen oval permeable en la fisiopatología de las lesiones de la sustancia blanca observadas en pacientes migrañosos

INTRODUCTION. White matter lesions are more prevalent in migraine patients than in the general population, especially those with a high frequency of attacks. A patent foramen ovale has been described as a possible link between migraine and white matter lesions. AIM. To determine the existence of a possible relationship between a patent foramen ovale and white matter lesions in a series of patients with chronic migraine. PATIENTS AND METHODS. Observational, single-centre, case-control study. Eighty-nine women with chronic migraine were selected. The persistence and characteristics of the patent foramen ovale were assessed by means of a transcranial Doppler study. The patent foramen ovale was classified as small, moderate or massive. Those detected at rest were considered permanent, and the others were classified as latent. The MRI protocol included T1-enhanced sagittal images, FLAIR-T2-enhanced axial images, and a proton density and T2-FSE combined sequence. The white matter lesions were classified as deep, periventricular or both. RESULTS. The prevalence of patent foramen ovale (53.6% versus 48.5%; p = 0.80) and the proportion of massive, permanent patent foramen ovale were similar among patients with and without white matter lesions. Neither was there any difference in the prevalence (55.6% versus 52.6%; p = 1.00) or the characteristics of the patent foramen ovale as a function of the distribution of white matter lesions. CONCLUSION. The results do not suggest that a patent foramen ovale intervenes in the pathophysiology of the white matter lesions observed in patients with migraine

Réplica: Valoración de la atrofia cerebral en la esclerosis múltiple mediante el índice de cuerpo calloso / Reply: Appraisal of cerebral atrophy in multiple sclerosis by means of the corpus callosum index

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Valoración de la atrofia cerebral en la esclerosis múltiple mediante el índice de cuerpo calloso / Appraisal of cerebral atrophy in multiple sclerosis by means of the corpus callosum index

Introducción. La esclerosis múltiple se caracteriza en su evolución por el desarrollo de atrofia cerebral. Su monitorización resulta de interés para evaluar la respuesta al tratamiento, y son de elección los análisis volumétricos cerebrales, actualmente confinados al ámbito de la investigación. Objetivo. Analizar el índice de cuerpo calloso (ICC) como una posible alternativa a los métodos basados en la segmentación cerebral. Sujetos y métodos. Se reúne a 109 pacientes con enfermedades desmielinizantes de reciente diagnóstico (90 con esclerosis múltiple remitente recurrente, 7 con formas primarias progresivas y 12 con síndrome desmielinizante aislado) y se calcula el ICC en su primer estudio de resonancia magnética cerebral, así como en 101 controles sanos. Las secuencias de los pacientes se someten a análisis volumétrico mediante el programa MSmetrix. Resultados. El valor medio del ICC es de 0,377 en los pacientes y 0,411 en los controles, y la diferencia es estadísticamente significativa (p < 0,001). El ICC muestra una correlación estadísticamente significativa con el volumen encefálico (p < 0,001; r = 0,444) y con el volumen lesional en secuencia FLAIR (p < 0,001; r = -0,521), mientras que no se demuestra asociación con el volumen de la sustancia gris (p = 0,058). Conclusiones. El ICC se relaciona con el volumen encefálico global obtenido mediante técnicas volumétricas y puede reflejar la presencia de atrofia ya en los estadios iniciales de las enfermedades desmielinizantes, por lo que se presenta como una alternativa de rápido y sencillo cálculo

Introduction. The course of multiple sclerosis is characterised by the development of cerebral atrophy. It is of interest to monitor it in order to evaluate the treatment response, and the preferred technique consists in performing brain volume analyses, which are currently restricted to the field of research. Aim. To analyse the corpus callosum index (CCI) as a possible alternative to the methods based on brain segmentation. Subjects and methods. Our sample was made up of 109 patients with recently diagnosed demyelinating diseases (90 relapsing-remitting multiple sclerosis, 7 primary progressive forms and 12 isolated demyelinating syndromes), and the CCI was calculated in their first magnetic resonance brain scan, together with 101 healthy controls. The sequences of the patients were submitted to a volumetric analysis using the software package MSmetrix. Results. The mean value of the CCI was 0.377 in patients and 0.411 in the controls, and the difference was statistically significant (p < 0.001). The CCI also showed a statistically significant correlation with the brain volume (p < 0.001; r = 0.444) and with the lesional volume in the FLAIR sequence (p < 0.001; r = -0.521), while no association was observed with the volume of grey matter (p = 0.058). Conclusions. The CCI is related to the overall brain volume obtained by volumetric techniques and may reflect the presence of atrophy in the initial stages of demyelinating diseases, which makes it a fast and easy to calculate alternative

Anatomical results, rebleeding and factors that affect the degree of occlusion in ruptured cerebral aneurysms after endovascular therapy.

OBJECT: To present a series of ruptured cerebral aneurysms in consecutive non-selected patients treated with endovascular therapy, analyzing the initial degree of occlusion, its anatomical evolution mid-term and the variables that could statistically affect them. METHODS: 251 aneurysms were first treated with coiling (embolization). 203 patients were followed up with conventional angiography for 6-8 months after the initial treatment and 182 were followed up with three-dimensional time of flight MR angiography at 18-24 months. Postoperative and mid-term anatomical results were evaluated anonymously and independently using the modified Montreal Scale. RESULTS: The initial rate of complete occlusion was 70.9%, with rates of neck remnants and aneurysm remants of 18.3% and 10.7%, respectively. The recurrence rate was 13% after 6 months and 2% between 6 months and 2 years. The rate of retreatment was 11%. Statistically, the variables that were found to be related to the initial degree of occlusion were the use of a remodeling balloon technique (p=0.012), the size of the aneurysm neck (p=0.044) and the size of the aneurysm (p=0.004). The recanalization rate at mid-term depended on the size of the aneurysm. Although aneurysms with partial occlusion initially tended to evolve to a worse degree of closure than those with complete occlusion initially, the relationship was not statistically significant (p=0.110). CONCLUSIONS: Embolized aneurysms can develop a worse degree of closure even when the initial occlusion is complete. The degree of occlusion depends directly on morphological factors and the use of balloon-assisted techniques. The recanalization rate at mid-term depends on the size of the aneurysm and probably on the density of the packing achieved with the initial treatment.

Aneurisma cerebral roto tipo «blíster» / Ruptured cerebral artery blister aneurysm

Se presenta el caso clínico de un paciente joven con una hemorragia subaracnoidea bien tolerada clínicamente secundaria a la rotura de un aneurisma carotídeo tipo «blíster». Teniendo en cuenta que estos aneurismas son poco frecuentes, tienen paredes muy frágiles y sin un cuello definido, su tratamiento es controvertido. Inicialmente se planteó el abordaje endovascular mediante la implantación de una endoprótesis semicubierta redireccionadora de flujo, pero la evolución morfológica del aneurisma a los 10 días condicionó un cambio en el plan terapéutico. Finalmente se implantó una endoprótesis convencional cubriendo el cuello y se introdujeron 2 microcoils en el punto de rotura, con buen resultado morfológico. El paciente evolucionó de manera satisfactoria. En el seguimiento después de uno y 6 meses se demostró la estabilidad del tratamiento. Se realiza una breve introducción a esta patología y una pequeña discusión sobre las distintas opciones terapéuticas (AU)

We report the case of a young patient with subarachnoid haemorrhage secondary to a ruptured blister-like aneurysm. Since this kind of aneurysms have fragile walls without a well-defined neck, their treatment is difficult. We initially planned the deployment of a flow-diverter stent, but an angiogram obtained after 10 days revealed a morphological change of the aneurysm. Therefore, we finally deployed a conventional stent and introduced 2 micro coils into the point of rupture, obtaining a good morphological result without rebleeding. Follow-up at 1 and 6 months did not observe regrowth of the aneurysm. We offer a brief introduction and discussion of this pathology and its treatment (AU)

Síndrome de Grisel como secuela de una mastoiditis aguda complicada / Grisel’s syndrome as a sequela of a complicated acute mastoiditis

El síndrome de Grisel es una complicación infrecuente de las infecciones que afectan al área otorrinolaringológica. Consiste en una subluxación atloaxoidea no traumática, tras un proceso infeccioso. Su síntoma característico es la tortícolis, dolorosa y persistente, a pesar de haber solucionado la infección. El conocimiento de esta afección ayuda al diagnóstico y tratamiento precoz de la misma. Queremos, por lo tanto, presentar el caso de un paciente con un síndrome de Grisel como secuela de una mastoiditis aguda complicada con un absceso de Bezold, a fin de favorecer el conocimiento de este tipo de proceso (AU)

Grisel's syndrome is a rare complication of ENT area infections. It consists of a non-traumatic atlantoaxial subluxation after an infectious process. Its characteristic symptom is persistent torticollis despite a resolved infection. The knowledge of this condition helps early diagnosis and treatment. We therefore present the case of a patient with Grisel's syndrome as a sequela of an acute mastoiditis complicated by a Bezold's abscess (AU)

[Ruptured cerebral artery blister aneurysm]. / Aneurisma cerebral roto tipo «blíster¼

We report the case of a young patient with subarachnoid haemorrhage secondary to a ruptured blister-like aneurysm. Since this kind of aneurysms have fragile walls without a well-defined neck, their treatment is difficult. We initially planned the deployment of a flow-diverter stent, but an angiogram obtained after 10 days revealed a morphological change of the aneurysm. Therefore, we finally deployed a conventional stent and introduced 2 micro coils into the point of rupture, obtaining a good morphological result without rebleeding. Follow-up at 1 and 6 months did not observe regrowth of the aneurysm. We offer a brief introduction and discussion of this pathology and its treatment.

Arteria carótida interna paralela a la base del cráneo / Internal carotid artery parallel to the skull base

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Grisel's syndrome as a sequela of a complicated acute mastoiditis.

Grisel's syndrome is a rare complication of ENT area infections. It consists of a non-traumatic atlantoaxial subluxation after an infectious process. Its characteristic symptom is persistent torticollis despite a resolved infection. The knowledge of this condition helps early diagnosis and treatment. We therefore present the case of a patient with Grisel's syndrome as a sequela of an acute mastoiditis complicated by a Bezold's abscess.

Multiple involvement of the central nervous system in Rosai-Dorfman disease.

Rosai-Dorfman disease is a rare, benign, idiopathic histio-proliferative disorder. Only 5% of cases involve the central nervous system. We describe a 10-year-old girl with pain in her lower limbs and back. Spinal magnetic resonance imaging revealed an intradural extramedullary lesion at T9-T10. We decided on surgical treatment. An anatomic/pathologic examination revealed histiocytic-like cells and extensive fibrosis. Immunohistochemistry revealed positivity for CD68 protein and negativity for CD1a protein. Craniospinal magnetic resonance imaging demonstrated an extra-axial lesion in the right frontal region, a small nodule in the left middle cerebellar peduncle, and another small lesion in the right ventral pons. We performed a complete removal of the frontal lesion. The histologic examination produced results compatible with Rosai-Dorfman disease. Most lesions in intracranial Rosai-Dorfman disease mimic meningioma. The definitive diagnosis relies on pathologic and immunohistochemical characteristics. Surgical removal is generally regarded as the treatment of choice. Disease progression after surgical resection is uncommon. Surgical treatment is not recommended until clear disease progression is detected, or focal disease causes neurologic compression. This disease must be included in the differential diagnosis of lesions that mimic meningioma.

[Cerebral artery air embolism secondary to endoscopic retrograde cholangiopancreatography]. / Embolia aérea cerebral secundaria a colangiopancreatografía endoscópica retrógrada.

Stroke secondary to an air embolism is an uncommon complication of gastrointestinal endoscopy. We report the case of a patient who developed a cerebral artery air embolism during endoscopic retrograde cholangiopancreatography. Despite diagnosis and treatment, the patient died from severe ischemic brain damage. To date, cerebral artery air embolisms as a cause of stroke have only been reported anecdotally. The complications of endoscopic techniques are increasingly frequent and varied, due to the major increase in the use of these procedures in our hospitals. Greater knowledge of this infrequent complication would allow rapid diagnosis, which is essential to provide specific treatment and prevent fatal outcome.

Embolia aérea cerebral secundaria a colangiopancreatografía endoscópica retrógrada / Cerebral artery air embolism secondary to endoscopic retrograde cholangiopancreatography

El ictus cerebral secundario a embolias aéreas es una rara complicación de una endoscopia digestiva. Se presenta un caso de un paciente que desarrolló una embolia arterial cerebral durante la realización de una colangiopancreatografía retrógrada endoscópica. A pesar de su diagnóstico y tratamiento, el paciente falleció como consecuencia del grave daño cerebral isquémico. Las embolias aéreas cerebrales han representado, hasta ahora, una causa de ictus cerebral prácticamente anecdótica. Cada vez son más frecuentes y variadas las complicaciones secundarias a la realización de técnicas endoscópicas debido al gran aumento que este tipo de procedimientos ha experimentado en los hospitales españoles.El mejor conocimiento de esta rara complicación permite alcanzar un rápido diagnóstico, clave a la hora de aplicar su tratamiento específico y salvar la vida al paciente(AU)

Stroke secondary to an air embolism is an uncommon complication of gastrointestinal endoscopy. We report the case of a patient who developed a cerebral artery air embolism during endoscopic retrograde cholangiopancreatography. Despite diagnosis and treatment, the patient died from severe ischemic brain damage. To date, cerebral artery air embolisms as a cause of stroke have only been reported anecdotally. The complications of endoscopic techniques are increasingly frequent and varied, due to the major increase in the use of these procedures in our hospitals.Greater knowledge of this infrequent complication would allow rapid diagnosis, which is essential to provide specific treatment and prevent fatal outcome(AU)

Tuberculosis renoureteral en riñón trasplantado / Renoureteral tuberculosis in a transplanted kidney

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