[Infection of the central nervous system by Epstein-Barr virus: clinical manifestations and prognosis]. / Infección del sistema nervioso central por el virus de Epstein-Barr: manifestaciones clínicas y pronóstico.

INTRODUCTION: The role of Epstein-Barr virus (EBV) in central nervous system (CNS) infections is not fully resolved. We wanted to describe the clinical manifestations of patients with EBV infection in cerebrospinal fluid. PATIENTS AND METHODS: We reviewed the clinical records of all adult patients EBV PCR-positive in cerebrospinal fluid, without lymphoproliferative disease, during 2004 to 2020. RESULTS: We identified 27 patients, 22 (81.5%) were men, and median age was 54 years. Twenty-three (82.1%) patients were immunosuppressed, 16 HIV-positive. In 15 (55.6%) patients coinfection with another microorganism was diagnosed and in 12 (44.4%) patients it was detected as the only pathogen. Of the 12 patients, three (25%) was immunocompetent patients, one had Guillain Barre syndrome (GBS), another had disseminated multiphasic encephalitis, and another had lymphocytic meningitis; 9 (75%) immunosuppressed, 7 HIV-positive, 4 had encephalitis that resolved without sequelae and 4 had encephalopathy, two HIH-positive had moderate cognitive impairment as a sequela. CONCLUSIONS: In our study, EBV produced encephalitis, meningitis, polyradiculomyelitis and GBS, mainly in immunosuppressed patients. In more than half of the cases, it is associated with other pathogens where the role of EBV is unclear. In immunocompetent patient, the infection can be serious and leave sequelae and in HIV-positive patients with encephalopatic involvement without encephalitis, the neurological damage could be greater, so we consider it of interest to carry out studies to evaluate the prognosis as well as the role of antivirals in the evolucion of these clinical pictures.

TITLE: Infección del sistema nervioso central por el virus de Epstein-Barr: manifestaciones clínicas y pronóstico.Introducción. El papel del virus de Epstein-Barr (VEB) en las infecciones del sistema nervioso central no siempre está claro. Nuestro objetivo fue describir las manifestaciones clínicas y la evolución de los pacientes con detección del VEB en el líquido cefalorraquídeo (LCR). Pacientes y métodos. Se revisaron las historias clínicas de todos los pacientes adultos con detección del VEB en el LCR por reacción en cadena de la polimerasa diagnosticados desde 2004 hasta 2020 sin enfermedad linfoproliferativa. Resultados. Se diagnosticó a 27 pacientes, 22 (81,5%) hombres, con una mediana de 54 años; 23 (82,1%) pacientes eran inmunodeprimidos, 16 positivos para el virus de la inmunodeficiencia humana (VIH). En 15 (55,6%) pacientes, el VEB se detectó en coinfección con otro microorganismo, y en 12, como único patógeno. De los 12 pacientes, tres (25%) eran inmunocompetentes, uno presentó un síndrome de Guillain-Barré, otro una encefalitis diseminada multifásica y otro una meningitis linfocitaria; y nueve (75%) inmunodeprimidos, de los que cuatro presentaron encefalitis que se resolvieron sin secuelas, y cuatro encefalopatía, dos de ellos positivos para el VIH, que presentaron secuelas (deterioro cognitivo moderado). Conclusiones. En nuestro estudio, el VEB produjo cuadros de encefalitis, meningitis, polirradiculomielitis y SGB, principalmente en inmunodeprimidos. En más de la mitad de los casos se asocia a otros patógenos, en donde el papel del VEB no está claro. En inmunocompetentes, las infecciones pueden ser graves y dejar secuelas, y en pacientes con VIH con encefalopatía sin encefalitis, el daño neurológico podría ser mayor, por lo que consideramos de interés realizar estudios que evalúen el pronóstico y el papel de los antivirales en la evolución de estos cuadros clínicos.

Infección del sistema nervioso central por el virus de Epstein-Barr: manifestaciones clínicas y pronóstico / Infection of the central nervous system by Epstein-Barr virus: clinical manifestations and prognosis

Introducción: El papel del virus de Epstein-Barr (VEB) en las infecciones del sistema nervioso central no siempre está claro. Nuestro objetivo fue describir las manifestaciones clínicas y la evolución de los pacientes con detección del VEB en el líquido cefalorraquídeo (LCR). Pacientes y métodos: Se revisaron las historias clínicas de todos los pacientes adultos con detección del VEB en el LCR por reacción en cadena de la polimerasa diagnosticados desde 2004 hasta 2020 sin enfermedad linfoproliferativa. Resultados: Se diagnosticó a 27 pacientes, 22 (81,5%) hombres, con una mediana de 54 años; 23 (82,1%) pacientes eran inmunodeprimidos, 16 positivos para el virus de la inmunodeficiencia humana (VIH). En 15 (55,6%) pacientes, el VEB se detectó en coinfección con otro microorganismo, y en 12, como único patógeno. De los 12 pacientes, tres (25%) eran inmunocompetentes, uno presentó un síndrome de Guillain-Barré, otro una encefalitis diseminada multifásica y otro una meningitis linfocitaria; y nueve (75%) inmunodeprimidos, de los que cuatro presentaron encefalitis que se resolvieron sin secuelas, y cuatro encefalopatía, dos de ellos positivos para el VIH, que presentaron secuelas (deterioro cognitivo moderado). Conclusiones: En nuestro estudio, el VEB produjo cuadros de encefalitis, meningitis, polirradiculomielitis y SGB, principalmente en inmunodeprimidos. En más de la mitad de los casos se asocia a otros patógenos, en donde el papel del VEB no está claro. En inmunocompetentes, las infecciones pueden ser graves y dejar secuelas, y en pacientes con VIH con encefalopatía sin encefalitis, el daño neurológico podría ser mayor, por lo que consideramos de interés realizar estudios que evalúen el pronóstico y el papel de los antivirales en la evolución de estos cuadros clínicos.(AU)

Introduction: The role of Epstein-Barr virus (EBV) in central nervous system (CNS) infections is not fully resolved. We wanted to describe the clinical manifestations of patients with EBV infection in cerebrospinal fluid. Patients and methods: We reviewed the clinical records of all adult patients EBV PCR-positive in cerebrospinal fluid, without lymphoproliferative disease, during 2004 to 2020. Results. We identified 27 patients, 22 (81.5%) were men, and median age was 54 years. Twenty-three (82.1%) patients were immunosuppressed, 16 HIV-positive. In 15 (55.6%) patients coinfection with another microorganism was diagnosed and in 12 (44.4%) patients it was detected as the only pathogen. Of the 12 patients, three (25%) was immunocompetent patients, one had Guillain Barré syndrome (GBS), another had disseminated multiphasic encephalitis, and another had lymphocytic meningitis; 9 (75%) immunosuppressed, 7 HIV-positive, 4 had encephalitis that resolved without sequelae and 4 had encephalopathy, two HIH-positive had moderate cognitive impairment as a sequela. Conclusions: In our study, EBV produced encephalitis, meningitis, polyradiculomyelitis and GBS, mainly in immunosuppressed patients. In more than half of the cases, it is associated with other pathogens where the role of EBV is unclear. In immunocompetent patient, the infection can be serious and leave sequelae and in HIV-positive patients with encephalopatic involvement without encephalitis, the neurological damage could be greater, so we consider it of interest to carry out studies to evaluate the prognosis as well as the role of antivirals in the evolucion of these clinical pictures.(AU)

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.

Cefalea en la hipertensión intracraneal idiopática / Headache in idiopathic intracranial hypertension

Resumen. Introducción. La hipertensión intracraneal idiopática (HICI) se caracteriza por un aumento de la presión intracraneal, sin datos de patología intracraneal. Los criterios diagnósticos de cefalea asociada a HICI están recogidos en la Clasificación Internacional de las Cefaleas; sin embargo, en la práctica clínica la cefalea asociada a HICI puede ser muy heterogénea. Pacientes y métodos. Se revisaron de forma retrospectiva las historias clínicas de todos los pacientes ingresados por HICI en el Hospital Universitario de Gran Canaria Dr. Negrín entre 1990 y 2007. Resultados. Se incluyeron 55 pacientes, con una proporción entre mujeres y hombres de 8,1 a 1. En el 85,4% apareció cefalea. La cefalea fue continua en un 63,8% y holocraneal, en un 51%. Conclusión. La cefalea asociada a HICI es muy heterogénea, y en ocasiones se presenta con características propias de las cefaleas primarias, por lo que se precisa una atención adecuada con el objeto de no retrasar el diagnóstico (AU)

Summary. Introduction. Idiopathic intracranial hypertension (IICH) is characterized by a rising in intracranial hypertension without evidence of intracranial expansive disease. Diagnostic criteria of headache related to IICH are described in the International Classification of Headache Disorders. In clinical practice, however, headache related to IICH may be heterogeneous.Patients and methods. Clinical charts of patients with IICH admitted to the Hospital Universitario de Gran Canaria Dr. Negrín between 1990 and 2007 were retrospectively reviewed. Results. Fifty-five patients were included, with a ratio female/male of 8.1:1. Headache was present in 85.4%. The headache was continuous in 63.8% of patients, and diffuse in 51%. Conclusion. Headache related to IICH is heterogeneous, and may mimic primary headache, so a high level of suspicion is needed to avoid diagnostic delay (AU)

[Headache in idiopathic intracranial hypertension]. / Cefalea en la hipertensión intracraneal idiopática.

INTRODUCTION: Idiopathic intracranial hypertension (IICH) is characterized by a rising in intracranial hypertension without evidence of intracranial expansive disease. Diagnostic criteria of headache related to IICH are described in the International Classification of Headache Disorders. In clinical practice, however, headache related to IICH may be heterogeneous. PATIENTS AND METHODS: Clinical charts of patients with IICH admitted to the Hospital Universitario de Gran Canaria Dr. Negrin between 1990 and 2007 were retrospectively reviewed. RESULTS: Fifty-five patients were included, with a ratio female/male of 8.1:1. Headache was present in 85.4%. The headache was continuous in 63.8% of patients, and diffuse in 51%. CONCLUSION: Headache related to IICH is heterogeneous, and may mimic primary headache, so a high level of suspicion is needed to avoid diagnostic delay.

Neuropatía vasculítica no sistémica / Non-systemic vasculitic neuropathy

No disponible

No disponible

Plexopatía braquial bilateral aguda tras una cirugía abdominal que imita al síndrome del ‘hombre en el barril’ / Acute bilateral brachial plexopathy after abdominal surgery mimicking a man-in-the barrel syndrome

No disponible

Factores de riesgo, etiología y pronóstico en pacientes con ictus isquémico y diabetes mellitus / Risk factors, etiology and prognosis in patients with ischemic stroke and diabetes mellitus

Introducción. El objetivo de este trabajo esdescribir las diferencias clínicas, etiológicas ypronósticas entre pacientes diabéticos y nodiabéticos que presentan un ictus isquémico.Material y métodos. Se revisaron retrospectivamentelas historias de los pacientes ingresados por ictusisquémico en el Servicio de Neurología del HospitalUniversitario de Gran Canaria Dr. Negrín en elperiodo 2004-2006. Se recogieron variablesdemográficas, clínicas y pronósticas.Resultados. Se incluyeron 633 pacientes, 256(40,4%) diabéticos y 377 (59,6%) no diabéticos.En los diabéticos, la edad media fue de 69,2 ± 9,3años (65,4 ± 13,9 años en los no diabéticos). Un63,7% eran hombres y un 36,3%, mujeres(62,2% hombres y 37,8% mujeres en los nodiabéticos). Un 85,9% de los diabéticos presentabahipertensión arterial (62,9% en los no diabéticos);un 49,2%, dislipemia (31% en los nodiabéticos); un 22%, cardiopatía isquémica(12,7% en los no diabéticos), y un 8,6%,arteriopatía periférica (4,8% en los no diabéticos).En el grupo de diabéticos, un 25% fue de origenaterotrombótico (16,4% en los no diabéticos); un20,3%, cardioembólico (24,4% en los nodiabéticos); un 26,1%, lacunar (22% en losno diabéticos), y un 25,7%, indeterminado(27,2% en los no diabéticos). La Escala de Rankinmodificada al alta fue 2 en un 65,3% de losdiabéticos y en un 62,5% de los no diabéticos.Conclusiones. En nuestra serie los pacientescon diabetes asocian otros factores de riesgovascular convencionales con mayor frecuencia ypresentan más ictus aterotrombóticos. No hemosencontrado diferencias significativas en cuanto alpronóstico

Introduction. The objective of this work is to describe the clinical, etiological and prognostic differences in diabetic and non-diabetic patients presenting ischemic stroke. Materials and methods. We performed a retrospective review of all patients with ischemic stroke requiring admission to the Neurology Service at the University Hospital of Gran Canaria Dr. Negrín (Spain) during our study period (1 Jan, 2004 -31 Dec, 2006). We collected demographic, clinical and prognostic variables. Results. A total of 633 patients were included, 256 (40.4%) were diabetic and 377 (59.6%) were non diabetic. The group of diabetic patients presented a mean age of 69.2 9.3 years (65.4 13.9 years in non-diabetic). Mean made up 63.7% of the diabetic patients and women 36.3% (62.2% menand 37.8% women in non-diabetics).A total of 85.9% of diabetic patients presented arterial hypertension (62.9% in non-diabetics); 49.2%had previous hyperlipidemia (31% in non-diabetics); 22% had ischemic heart disease (12.7% in nondiabetics);and 8.6% had peripheral arteriopathy (4.8% in non-diabetics). In the group of diabetic patients, 25% presented atherothrombotic stroke (16.4% in non-diabetics); 20.3% were cardioembolic(24.4% in non-diabetics); 26.1% were lacunar (22%in non-diabetics); and 25.7% had undetermined origin(27.2% in non-diabetics). The modified Rankin Scaleat discharge was ± in 65.3% of diabetic patients and 62.5% in non-diabetics. Conclusions. In our series, diabetic patients frequently present other conventional vascular risk factors and show a tendency to more atherothrombotic strokes. We have found no significant differences in relation to prognosis

[Risk factors, etiology and prognosis in patients with ischemic stroke and diabetes mellitus]. / Factores de riesgo, etiología y pronóstico en pacientes con ictus isquémico y diabetes mellitus.

INTRODUCTION: The objective of this work is to describe the clinical, etiological and prognostic differences in diabetic and non-diabetic patients presenting ischemic stroke. MATERIALS AND METHODS: We performed a retrospective review of all patients with ischemic stroke requiring admission to the Neurology Service at the University Hospital of Gran Canaria Dr. Negrín (Spain) during our study period (1 Jan, 2004 -31 Dec, 2006). We collected demographic, clinical and prognostic variables. RESULTS: A total of 633 patients were included, 256 (40.4%) were diabetic and 377 (59.6%) were non-diabetic. The group of diabetic patients presented a mean age of 69.2 < or = 9.3 years (65.4 < or = 13.9 years in non-diabetic). Mean made up 63.7% of the diabetic patients and women 36.3% (62.2% men and 37.8% women in non-diabetics). A total of 85.9% of diabetic patients presented arterial hypertension (62.9% in non-diabetics); 49.2% had previous hyperlipidemia (31% in non-diabetics); 22% had ischemic heart disease (12.7% in nondiabetics); and 8.6% had peripheral arteriopathy (4.8% in non-diabetics). In the group of diabetic patients, 25% presented atherothrombotic stroke (16.4% in non-diabetics); 20.3% were cardioembolic (24.4% in non-diabetics); 26.1% were lacunar (22% in non-diabetics); and 25.7% had undetermined origin (27.2% in non-diabetics). The modified Rankin Scale at discharge was +/- in 65.3% of diabetic patients and 62.5% in non-diabetics. CONCLUSIONS: In our series, diabetic patients frequently present other conventional vascular risk factors and show a tendency to more atherothrombotic strokes. We have found no significant differences in relation to prognosis.