Serum neuron-specific enolase and S100 calcium binding protein B biomarker levels do not improve diagnosis of acute stroke.

BACKGROUND: The high sensitivities and specificities reported for blood biomarkers as a supportive test in the diagnosis of acute stroke do not correspond with their performance for decision-making in emergency situations. METHODS: Seventy-two patients with suspected stroke were recruited: 44 with ischaemic stroke, 17 with haemorrhagic stroke and 11 stroke mimics, as well as a high-risk control group of 79 individuals. Serum neuron-specific enolase (NSE) and S100 calcium binding protein B (S100B) biomarker levels were determined on admission, using immunoassay kits. The sensitivities and specificities of NSE and S100B for distinguishing acute stroke from stroke mimics and high-risk controls were calculated. RESULTS: For cut-off values (NSE ≤ 14 micrograms per litre and S100B ≤130 nanograms per litre) the sensitivity was 53% and 55% respectively. Specificity was 64 for both versus the stroke mimic group. Specificity was higher (79% and 86% respectively) when calculated on the basis of the control group. CONCLUSIONS: This study supports the evidence indicating that serum levels of NSE and S100B do not improve the diagnosis of acute stroke.

Metamorfopsia invertida: un trastorno de la percepción visual infrecuente / Reversal of vision metamorphopsia: an infrequent disorder affecting visual perception

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[Unilateral neglect, transient cognitive impairment and intercritical activity in Rolandic epilepsy]. / Heminegligencia, déficit cognitivo transitorio y actividad intercrítica en la epilepsia rolándica.

INTRODUCTION: Benign focal epilepsy in infancy with centro-temporal paroxysms is a frequent form of epilepsy within this group of epilepsies. Despite its relative benignity, however, it may be accompanied by neuropsychological deficits and therefore constitutes a suitable in vivo model for studying how the brain functions when processing information. CASE REPORT: We report the case of a 7-year-old child who began with this type of epilepsy by manifesting focal seizures during the early stages of sleep and who, with the absence of any continuous spike-wave activity in non-REM sleep, presented transient unilateral neglect syndrome on the right-hand side related with electroencephalographic intercritical activity. CONCLUSIONS: The neuropsychological manifestations in this type of epilepsy can be due to intercritical paroxysmal activity. The clinical features depend on where the paroxysms are located and in which direction they spread. A dysfunction of the physiological neuronal synchrony among the neuronal networks that are necessary for thinking processes could be the cause of this disorder.

Heminegligencia, déficit cognitivo transitorio y actividad intercrítica en la epilepsia rolándica / Unilateral neglect, transient cognitive impairment and intercritical activity in rolandic epilepsy

Introducción. La epilepsia focal benigna de la infancia con paroxismos centrotemporales es una epilepsia frecuente dentro de estas epilepsias. Sin embargo, a pesar de su relativa benignidad, puede cursar con déficit neuropsicológicos, por lo que constituye un modelo in vivo adecuado para estudiar el funcionamiento cerebral para procesar la información. Caso clínico. Niño de 7 años de edad que comenzó con este tipo de epilepsia mediante la manifestación de crisis focales durante las etapas tempranas del sueño y que, sin tener actividad de puntas-ondas continuas en el sueño no REM, presentaba una heminegligencia derecha transitoria relacionada con la actividad intercrítica electroencefalográfica. Conclusiones. Las manifestaciones neuropsicológicas en este tipo de epilepsia pueden deberse a la actividad paroxística intercrítica. La clínica depende del lugar donde se asienten los paroxismos y hacia dónde difundan. Una disfunción de la sincronía neuronal fisiológica entre las redes neurales que son necesarias para los procesos del pensamiento podría ser la causa de este trastorno

Introduction. Benign focal epilepsy in infancy with centro-temporal paroxysms is a frequent form of epilepsy within this group of epilepsies. Despite its relative benignity, however, it may be accompanied by neuropsychological deficits and therefore constitutes a suitable in vivo model for studying how the brain functions when processing information. Case report. We report the case of a 7-year-old child who began with this type of epilepsy by manifesting focal seizures during the early stages of sleep and who, with the absence of any continuous spike-wave activity in non-REM sleep, presented transient unilateral neglect syndrome on the right-hand side related with electroencephalographic intercritical activity. Conclusions. The neuropsychological manifestations in this type of epilepsy can be due to intercritical paroxysmal activity. The clinical features depend on where the paroxysms are located and in which direction they spread. A dysfunction of the physiological neuronal synchrony among the neuronal networks that are necessary for thinking processes could be the cause of this disorder

Epilepsia refleja por cepillado de dientes / Tooth-brushing-induced epilepsy

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[A clinical and epidemiological description of a series of patients diagnosed as suffering from progressive supranuclear palsy]. / Descripción clínica y epidemiológica de una serie de pacientes con diagnóstico de parálisis supranuclear progresiva.

INTRODUCTION: Progressive supranuclear palsy is a disease that normally presents only sporadically in adults and courses in a progressive, chronic manner. It is characterised by the presence of supranuclear ophthalmoplegia, postural instability, a Parkinsonian syndrome, pseudobulbar affect, cervical dystonia and cognitive impairment. PATIENTS AND METHODS: We conducted a descriptive study of clinical and epidemiological features in a series of 18 patients who satisfied the mandatory NINDS-SPSP clinical eligibility criteria for the likely diagnosis of progressive supranuclear palsy, using the scale developed by Golbe et al. RESULTS AND CONCLUSIONS: The mean age of onset of the disease was 58.6 +/- 8.2 years, 55.5% of the patients were males, the average history of the disease at the time of diagnosis was 4.39 +/- 2.3 years, and there was a diagnostic subregister in the first 4 years of the disease. Gait disorders, falls and slowness were the most frequently observed presenting forms of the disease. During their first four years with the disease, 75% of the patients were totally independent when it came to carrying out activities of daily living, whereas after the fourth year there was a predominance of the need for aid and absolute dependence. Dysphagia was more frequent in the later stages of the disease. Ocular motility disorders and impaired cognitive functioning were obvious in the initial stages of the disease, and there was a strong correlation between the length of time the disease had been coursing and the severity of the ocular and cognitive disorders.

Descripción clínica y epidemiológica de una serie de pacientes con diagnóstico de parálisis supranuclear progresiva / A clinical and epidemiological description of a series of patients diagnosed as suffering from progressive supranuclear palsy

Introducción. La parálisis supranuclear progresiva es una enfermedad de curso crónico progresivo, de presentación fundamentalmente esporádica en el adulto, que se caracteriza por la presencia de oftalmoplejía supranuclear, inestabilidad postural, síndrome parkinsoniano, afectación seudobulbar, distonía cervical y deterioro cognitivo. Pacientes y métodos. Realizamos un estudio descriptivo sobre aspectos clínicos y epidemiológicos en una serie de 18 pacientes que cumplían los criterios clínicos mandatarios de inclusión (NINDS-SPSP) para el diagnóstico probable de parálisis supranuclear progresiva, utilizando la escala de Golbe et al. Resultados y conclusiones. La edad de inicio promedio de la enfermedad fue de 58,6 ñ 8,2 años, el 55,5 por ciento de los pacientes pertenecen son varones, el tiempo medio de evolución de la enfermedad hasta el momento del diagnóstico fue de 4,39 ñ 2,3 años, y existía un subregistro diagnóstico en los primeros cuatro años de la enfermedad. Los trastornos de la marcha, las caídas y la lentitud constituyeron las formas más frecuente de debut de la enfermedad. El 75 por ciento de los pacientes en los primeros cuatro años de evolución era totalmente independiente para realizar las actividades de la vida cotidiana, mientras que después de los cuatro años predominaba la necesidad de asistencia y la dependencia absoluta. La disfagia fue más frecuente en etapas tardías de la enfermedad. La afectación de la motilidad ocular y la función cognitiva fue evidente en las etapas iniciales de la enfermedad, y existió una alta correlación entre el tiempo de evolución de la enfermedad y la gravedad de la afectación ocular y cognitiva (AU)

y. Introduction. Progressive supranuclear palsy is a disease that normally presents only sporadically in adults and courses in a progressive, chronic manner. It is characterised by the presence of supranuclear ophthalmoplegia, postural instability, a Parkinsonian syndrome, pseudobulbar affect, cervical dystonia and cognitive impairment. Patients and methods. We conducted a descriptive study of clinical and epidemiological features in a series of 18 patients who satisfied the mandatory NINDS-SPSP clinical eligibility criteria for the likely diagnosis of progressive supranuclear palsy, using the scale developed by Golbe et al. Results and conclusions. The mean age of onset of the disease was 58.6 ± 8.2 years, 55.5% of the patients were males, the average history of the disease at the time of diagnosis was 4.39 ± 2.3 years, and there was a diagnostic subregister in the first 4 years of the disease. Gait disorders, falls and slowness were the most frequently observed presenting forms of the disease. During their first four years with the disease, 75% of the patients were totally independent when it came to carrying out activities of daily living, whereas after the fourth year there was a predominance of the need for aid and absolute dependence. Dysphagia was more frequent in the later stages of the disease. Ocular motility disorders and impaired cognitive functioning were obvious in the initial stages of the disease, and there was a strong correlation between the length of time the disease had been coursing and the severity of the ocular and cognitive disorders (AU)

Atrofia espinal distalde predominioen miembros superiores.Presentación de un caso / Distal spinal atrophy with predominance in the upper limbs. A case report

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