Síndrome de nieve visual y su relación con la migraña / Visual snow syndrome and its relationship with migraine

Introducción El síndrome de nieve visual (SNV) es un trastorno del sistema nervioso central que implica la visión de forma constante de pequeños puntos blancos y negros en la totalidad del campo visual. Desarrollo El SNV puede presentarse desde la infancia hasta la tercera edad, siendo más frecuente en jóvenes y sin diferencia entre géneros. En sus criterios diagnósticos se incluye la presencia de nieve visual, pero también otros fenómenos visuales como palinopsia, fotofobia, nictalopía y otros fenómenos visuales persistentes. La fisiopatología del SNV es desconocida, pero se postulan como mecanismos la hiperexcitabilidad del córtex visual y una disfunción en el procesamiento visual de orden superior. La prevalencia de migraña en los pacientes con SNV es alta en comparación con la población general y cuando se presentan conjuntamente los síntomas son más severos. No se dispone de un tratamiento eficaz, pero el fármaco con mejores resultados es la lamotrigina, recomendándose únicamente en casos seleccionados con alta limitación funcional. Conclusiones El síndrome de nieve visual es una entidad poco conocida e infradiagnosticada, pero el creciente número de investigaciones durante los últimos años ha permitido definir unos criterios diagnósticos y acercarnos a su fisiopatología. Es una entidad íntimamente relacionada con la migraña, con solapamiento de síntomas y probablemente mecanismos fisiopatológicos comunes. (AU)

Introduction Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field. Development VSS can present from infancy to old age, with greater prevalence in the young population, and shows no difference between sexes. The diagnostic criteria include the presence of visual snow and such other visual phenomena as palinopsia, photophobia, nyctalopia, and other persistent visual phenomena. The pathophysiology of VSS is unknown, but hyperexcitability of the visual cortex and a dysfunction in higher-order visual processing are postulated as potential mechanisms. The prevalence of migraine among patients with VSS is high, compared to the general population, and symptoms are more severe in patients presenting both conditions. No effective treatment is available, but the drug with the best results is lamotrigine, which is recommended only in selected cases with severe functional limitation. Conclusions VSS is a little-known and underdiagnosed entity, but the increasing number of studies in recent years has made it possible to establish diagnostic criteria and begin studying its pathophysiology. This entity is closely related to migraine, with overlapping symptoms and probably shared pathophysiological mechanisms. (AU)

Visual snow syndrome and its relationship with migraine.

INTRODUCTION: Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field. DEVELOPMENT: VSS can present from infancy to old age, with greater prevalence in the young population, and shows no difference between sexes. The diagnostic criteria include the presence of visual snow and such other visual phenomena as palinopsia, photophobia, nyctalopia, and other persistent visual phenomena. The pathophysiology of VSS is unknown, but hyperexcitability of the visual cortex and a dysfunction in higher-order visual processing are postulated as potential mechanisms. The prevalence of migraine among patients with VSS is high, compared to the general population, and symptoms are more severe in patients presenting both conditions. No effective treatment is available, but the drug with the best results is lamotrigine, which is recommended only in selected cases with severe functional limitation. CONCLUSIONS: VSS is a little-known and underdiagnosed entity, but the increasing number of studies in recent years has made it possible to establish diagnostic criteria and begin studying its pathophysiology. This entity is closely related to migraine, with overlapping symptoms and probably shared pathophysiological mechanisms.

Visual snow syndrome and its relationship with migraine. / Síndrome de nieve visual y su relación con la migraña.

INTRODUCTION: Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field. DEVELOPMENT: VSS can present from infancy to old age, with greater prevalence in the young population, and shows no difference between sexes. The diagnostic criteria include the presence of visual snow and such other visual phenomena as palinopsia, photophobia, nyctalopia, and other persistent visual phenomena. The pathophysiology of VSS is unknown, but hyperexcitability of the visual cortex and a dysfunction in higher-order visual processing are postulated as potential mechanisms. The prevalence of migraine among patients with VSS is high, compared to the general population, and symptoms are more severe in patients presenting both conditions. No effective treatment is available, but the drug with the best results is lamotrigine, which is recommended only in selected cases with severe functional limitation. CONCLUSIONS: VSS is a little-known and underdiagnosed entity, but the increasing number of studies in recent years has made it possible to establish diagnostic criteria and begin studying its pathophysiology. This entity is closely related to migraine, with overlapping symptoms and probably shared pathophysiological mechanisms.

Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study.

PURPOSE: The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic characteristics of a cohort of patients with CNO. METHODS: A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)-confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR). RESULTS: One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (p < 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s, p < 0.001; 0.80 vs 1.00, p < 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%, p = 0.051). CONCLUSION: The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.

The risk of recurrent stroke at 24 months in patients with symptomatic carotid near-occlusion: results from CAOS, a multicentre registry study.

BACKGROUND AND PURPOSE: The risk of recurrent stroke amongst patients with symptomatic carotid near-occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim was to define the 24-month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO. METHODS: A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography-confirmed SCNO were included. The primary end-point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted. RESULTS: The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24-month cumulative incidence of the primary end-point was 11.1% (95% confidence interval 5.8-16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log-rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively. CONCLUSIONS: The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near-occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure.

Neuropatía del III par craneal secundaria a hemorragia subaracnoidea perimesencefálica no aneurismática / Neuropathy of the oculomotor nerve secondary to perimesencephalic non-aneurysmal subarachnoid haemorrhage

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Aneurismas supraclinoideos bilaterales asociados de déficit visual progresivo / Bilateral supraclinoid aneurysms associated with progressive visual impairment

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Tratamiento fibrinolítico con activador del plasminógeno tisular. Resultados en la práctica clínica con un modelo de actuación multidisciplinario / Fibrinolytic treatment with tissue plasminogen activator. Outcomes in clinical practice with a multidisciplinary model of intervention

Introducción y objetivo. El tratamiento del infarto cerebral agudo con activador del plasminógeno tisular (rt-PA) se ha aplicado hasta ahora de forma restrictiva en grandes centros con unidades de ictus de agudos. El objetivo de este estudio es determinar la seguridad y eficacia de este tratamiento en un centro sin experiencia previa siguiendo un modelo multidisciplinario. Pacientes y métodos. Estudio prospectivo y observacional que incluyó pacientes con ictus isquémico agudo de menos de 3 h de evolución tratados con rt-PA endovenoso desde enero de 2004 a diciembre de 2006. Se valoraron variables basales, complicaciones hemorrágicas, respuesta al tratamiento y evolución funcional mediante la escala de Rankin modificada a (mRS) los 3 meses. El tratamiento y control se aplicó siguiendo un protocolo multidisciplinario con una dirección compartida por los servicios de Medicina Intensiva y Neurología. Resultados. Se trataron 46 pacientes, con una edad media de 67 ± 12 años (63% hombres). NIH pretratamiento: 13,6 ± 4,7; mediana: 13,5; rango: 5-22. El tiempo entre el inicio de los síntomas y la llegada al hospital fue de 53 ± 27 min, y el tiempo puerta-aguja, de 69 ± 27 min. A las 24 h, un 48% de los pacientes había mejorado en la escala NIH > 4 puntos. Se observaron un total de 10 transformaciones hemorrágicas (21,7%), ninguna de ellas sintomática. A los tres meses, un 54,3% de los pacientes era independiente funcionalmente (mRS: 0-2). La mortalidad a los 90 días fue del 13,1%. Conclusión. La administración de rt-PA a pacientes con ictus isquémico agudo en la práctica asistencial siguiendo un protocolo multidisciplinario es segura y con una evolución neurológica comparable a ensayos y estudios clínicos

Introduction and aims. Until now treatment of acute cerebral infarction with tissue plasminogen activator (rt-PA) has been applied to a limited extent in large medical centres with acute stroke units. The aim of this study is to determine the safety and effectiveness of this treatment in a centre with no previous experience following a multidisciplinary model. Patients and methods. We conducted a prospective, observation-based study involving patients who were treated with intravenous rt-PA within 3 hours of suffering an acute ischaemic stroke between January 2004 and December 2006. Basal variables, haemorrhagic complications, response to treatment and functional progress were evaluated using the modified Rankin Scale (mRS) at 3 months. Treatment and control were applied following a multidisciplinary protocol implemented by the Intensive Medicine and Neurology services. Results. In all, 46 patients were treated, their mean age being 67 ± 12 years (63% males). NIH pre-treatment: 13.6 ± 4.7; median: 13.5; range: 5-22. Time elapsed between the onset of symptoms and arrival at the hospital was 53 ± 27 min, and door-to-needle time was 69 ± 27 min. At 24 hours, 48% of patients had improved their scores on the NIH scale > 4 points. A total of 10 haemorrhagic transformations (21.7%) were observed, none of which were symptomatic. At three months, 54.3% of patients were functionally independent (mRS: 0-2). Mortality rate at 90 days was 13.1%. Conclusions. Administration of rt-PA to patients with acute ischaemic stroke in health care practice following a multidisciplinary protocol is safe and has a neurological progression that is comparable to clinical trials and studies

[Fibrinolytic treatment with tissue plasminogen activator. Outcomes in clinical practice with a multidisciplinary model of intervention]. / Tratamiento fibrinolítico con activador del plasminógeno tisular. Resultados en la práctica clínica con un modelo de actuación multidisciplinario.

INTRODUCTION AND AIMS: Until now treatment of acute cerebral infarction with tissue plasminogen activator (rt-PA) has been applied to a limited extent in large medical centres with acute stroke units. The aim of this study is to determine the safety and effectiveness of this treatment in a centre with no previous experience following a multidisciplinary model. PATIENTS AND METHODS: We conducted a prospective, observation-based study involving patients who were treated with intravenous rt-PA within 3 hours of suffering an acute ischaemic stroke between January 2004 and December 2006. Basal variables, haemorrhagic complications, response to treatment and functional progress were evaluated using the modified Rankin Scale (mRS) at 3 months. Treatment and control were applied following a multidisciplinary protocol implemented by the Intensive Medicine and Neurology services. RESULTS: In all, 46 patients were treated, their mean age being 67 +/- 12 years (63% males). NIH pre-treatment: 13.6 +/- 4.7; median: 13.5; range: 5-22. Time elapsed between the onset of symptoms and arrival at the hospital was 53 +/- 27 min, and door-to-needle time was 69 +/- 27 min. At 24 hours, 48% of patients had improved their scores on the NIH scale > 4 points. A total of 10 haemorrhagic transformations (21.7%) were observed, none of which were symptomatic. At three months, 54.3% of patients were functionally independent (mRS: 0-2). Mortality rate at 90 days was 13.1%. CONCLUSIONS: Administration of rt-PA to patients with acute ischaemic stroke in health care practice following a multidisciplinary protocol is safe and has a neurological progression that is comparable to clinical trials and studies.

[Influence of the HIV (+) cases on the epidemiology of infantile tuberculosis in Barcelona]. / Influencia de los VIH (+) en la epidemiología de la tuberculosis infantil en Barcelona.

OBJECTIVE: To understand better the characteristics of tuberculosis (TBC) in children and to identify sources of infection. DESIGN: Crossover study. SITE. At the community level in the city of Barcelona. PATIENTS: Children under 15 with tuberculosis, who were diagnosed between Oct 1, 1989 and Sept 30, 1990 and were resident in Barcelona. MAIN MEASUREMENTS AND RESULTS: Among the 78 cases found, we identified the source of infection for 26 children (33.3%). 6 of these (23.1%) had been infected by three cases of HIV+. A relationship was posited between the economic level of the population and the incidence of TBC. This was confirmed by the economic level of the families (80% of the sources of infection identified belonged to professions requiring few or no qualifications) and where they lived, given that the specific rate for children under 15 in the most depressed social-economic area (Ciutat Vella) was 206 per 100,000, whereas in the wealthiest area (Sarrià-Sant Gervasi) the rate was 4.3 per 100,000. CONCLUSIONS: This study makes clear the importance of investigating the contacts of children with tuberculosis. It should be fundamental for the TBC control programmes to focus closely on those with HIV. They are much more likely to contract and spread TBC to the least protected groups of the population, especially to the children of poor families.