Baclofeno intratecal para el tratamiento de la espasticidad: revisión de los casos presentes tratados en nuestro servicio / Intrathecal baclofen as a treatment for spasticity: Review of the cases treated in our hospital

Introducción: La espasticidad representa un problema médico cuya incidencia está aumentando debido a enfermedades como parálisis cerebral, ictus, esclerosis múltiple, traumatismos o encefalopatías, afectando tanto a adultos como a niños. Los tratamientos incluyen rehabilitación, farmacoterapia y cirugía, entre las cuales destacamos las bombas de baclofeno intratecal. Material y métodos: Seleccionamos a los pacientes portadores de bomba de baclofeno intratecal implantada en el Hospital Clínico de Santiago de Compostela entre 2005-2018 y analizamos retrospectivamente los resultados mediante escalas de valoración de espasticidad, como la de Ashworth, así como las complicaciones observadas. Resultados: Se implantaron bombas de baclofeno a 17 pacientes, obteniendo una mejoría de 2 puntos en la escala de Ashworth en el 88,2% y de 1 punto en la escala de Penn en el 94%. Se observaron complicaciones en 3 pacientes. Conclusiones: El tratamiento con baclofeno intratecal es una técnica sencilla con resultados muy positivos para mejorar la calidad de vida de pacientes con espasticidad

Introduction: Spasticity represents a medical problem whose incidence is increasing during the last years due to pathologies such as cerebral palsy, stroke, multiple sclerosis, trauma or encephalopathy, affecting both adults and children. The treatments include rehabilitation, pharmacotherapy and surgery, among which we highlight intrathecal baclofen infusion devices. Material and methods: Intrathecal baclofen devices implanted patients in Clinical Hospital of Santiago de Compostela from 2005 to 2018 were selected for retrospective analysis using assessment of spasticity scales, such as Ashworth scale. Complications are described. Results: Surgery was performed in 17 patients for baclofen pump implant, achieving an improvement of 2 points on the Ashworth Scale in 88,2% of the patients and of 1 point on the Penn Scale in 94%. Complications were seen in 3 patients. Conclusions: Intrathecal baclofen is a simple technique with good results for improving the quality of life of patients with spasticity

Parálisis aislada del nervio hipogloso ocasionada por quistes occipitoatloideos / Isolated paralysis of the hypoglossal nerve due to atlanto-occipital joint cysts

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Intrathecal baclofen as a treatment for spasticity: Review of the cases treated in our hospital. / Baclofeno intratecal para el tratamiento de la espasticidad: revisión de los casos presentes tratados en nuestro servicio.

INTRODUCTION: Spasticity represents a medical problem whose incidence is increasing during the last years due to pathologies such as cerebral palsy, stroke, multiple sclerosis, trauma or encephalopathy, affecting both adults and children. The treatments include rehabilitation, pharmacotherapy and surgery, among which we highlight intrathecal baclofen infusion devices. MATERIAL AND METHODS: Intrathecal baclofen devices implanted patients in Clinical Hospital of Santiago de Compostela from 2005 to 2018 were selected for retrospective analysis using assessment of spasticity scales, such as Ashworth scale. Complications are described. RESULTS: Surgery was performed in 17 patients for baclofen pump implant, achieving an improvement of 2 points on the Ashworth Scale in 88,2% of the patients and of 1 point on the Penn Scale in 94%. Complications were seen in 3 patients. CONCLUSIONS: Intrathecal baclofen is a simple technique with good results for improving the quality of life of patients with spasticity.

Hemisferectomía funcional: seguimiento a largo plazo en una serie de cinco casos / Functional hemispherectomy: long-term follow-up in a series of five patients

Introducción. La hemisferectomía funcional es una de las técnicas quirúrgicas con intención paliativa que se pueden realizar en pacientes con epilepsia farmacorresistente y síndromes hemisféricos. Se basa en la desconexión neuronal del hemisferio afectado preservando el árbol vascular. Objetivo. Analizar el pronóstico y la seguridad a largo plazo de las hemisferectomías realizadas en nuestro centro. Pacientes y métodos. Revisión retrospectiva de los casos intervenidos, recogiendo las siguientes variables clínicas: edad, sexo, edad de inicio de la epilepsia, tipo de crisis, etiología de la epilepsia, edad de intervención, pronóstico posquirúrgico y posibles complicaciones. El seguimiento mínimo fue de cinco años. Resultados. Cinco pacientes (60% mujeres) fueron intervenidos entre 1999 y 2010. La edad de inicio de la epilepsia fue de 36 meses, y el tiempo de evolución hasta la cirugía, de 7 años. El tipo de crisis más habitual fueron las crisis parciales simples motoras con generalización secundaria (n = 5). Tres pacientes permanecieron libres de crisis tras la cirugía, y otro paciente mejoró más de un 90%. El tiempo medio de seguimiento fue de 13 años. Como complicaciones, una paciente sufrió una meningitis bacteriana sin secuelas posteriores. A los seis años de la cirugía, un paciente presentó una hidrocefalia que requirió la implantación de una válvula de derivación ventriculoperitoneal. Conclusiones. La hemisferectomía funcional constituye un procedimiento quirúrgico eficaz para el tratamiento de pacientes con epilepsia farmacorresistente, patología hemisférica extensa y crisis limitadas a ese hemisferio. Hay complicaciones que pueden aparecer tardíamente, por lo que se aconseja un seguimiento a largo plazo de estos pacientes (AU)

Introduction. Functional hemispherectomy consists in palliative epilepsy surgical procedure usually performed in patients with pharmaco-resistant epilepsy and hemispheric syndromes. It is based on the neural disconnection of the affected hemisphere with preservation of the vascular supply. Aim. To analyze long-term prognosis and safety of the hemispherectomies performed in our institution. Patients and methods. Retrospective analysis collecting the following variables: age, gender, age of epilepsy onset, type of seizures, etiology, age of epilepsy surgery, prognosis and potential surgical complications. All patients had a minimum of five years of follow up. Results. Five patients (60% females) underwent hemispherotomy between 1999 and 2010. Age of epilepsy onset was 36 months and time of evolution until surgery was 7 years. The most frequent type of seizures were simple motor seizures with secondary generalization (n = 5). Three patients remained seizure free persistently after surgery and another patient had a more than 90% improvement. Time of follow up was 13 years. One patient suffered a bacterial meningitis without sequelae. Six years after surgery a patient suffered hydrocephalous requiring ventriculoperitoneal shunt. Conclusions. Functional hemispherectomy constitutes an effective method to treat patients with pharmaco-resistant epilepsy, extensive unihemispheric pathology and seizures limited to that hemisphere. Late complications may occur thus long-term follow-up is needed (AU)

[Chronic calcified subdural haematoma: armoured brain]. / Hematoma subdural cronico calcificado: cerebro blindado.

TITLE: Hematoma subdural cronico calcificado: cerebro blindado.

Cordoma sacrococcígeo / No disponible

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Hematoma subdural crónico en pacientes jóvenes / Chronic subdural hematoma in young patients

Objetivos Analizar las características demográficas, clínicas, radiológicas y los resultados quirúrgicos de una serie de pacientes jóvenes con hematoma subdural crónico. Pacientes y métodos Estudio retrospectivo que incluye 42 pacientes con edad inferior a 40 años diagnosticados y tratados quirúrgicamente de un hematoma subdural crónico durante un período de 30 años (1982-2011).Resultados La serie consta de 32 varones y 10 mujeres con una edad media de 29,3±8,9 años (intervalo 4-39). El período transcurrido entre el traumatismo y el inicio de la sintomatología fue de 33,4±9,7 días (intervalo 19-95). Los principales síntomas de presentación fueron la cefalea (59,5%) y las crisis comiciales (21,4%), y los factores predisponentes más frecuentes fueron tener implantada una derivación ventrículo-peritoneal en 5 (11,9%) casos y los trastornos hematológicos en otros 5 (11,9%) pacientes. El hematoma fue derecho en 21 pacientes (50%), izquierdo en 19 (45,3%) y bilateral en los restantes 2 (4,7%). Se produjeron 2 complicaciones postoperatorias: un caso de recidiva y un hematoma subdural agudo sobre la cavidad del hematoma. No se produjeron muertes relacionadas con el tratamiento. Conclusiones El hematoma subdural crónico es una patología poco frecuente en las primeras décadas de la vida. Afecta con mayor frecuencia a los varones, y la forma de presentación más habitual es la cefalea. Los índices de recidiva y las complicaciones postoperatorias son significativamente inferiores que las presentes en otros rangos de mayor edad (AU)

Objective: The objective of this study was to analyse demographic, clinical and radiological findings and surgical results in a series of chronic subdural haematomas (CSDH) in young adult patients. Patients and methods: This retrospective study included 42 patients under 40 years of age who were diagnosed and surgically treated for a CSDH during a 30-year period (1982-2011).Results: Of the 42 cases analysed, 32 were males and 10 (..) (AU)

Síndrome de hipotensión intracraneal espontánea: presentación de dos casos / Spontaneous intracranial hypotension syndrome: two case reports

Introducción. La hipotensión intracraneal espontánea es un cuadro clínico originado por una fístula de líquido cefalorraquídeo en la zona espinal. Se caracteriza por la presencia de cefalea ortostática, a la que se puede asociar un conglomerado de síntomas indicativos de afectación de diferentes estructuras tanto craneales como espinales. Casos clínicos. Presentamos los casos de dos varones jóvenes que comenzaron con cefalea ortostática. En las pruebas de imagen se observaron, además, colecciones líquidas extraaxiales intracraneales con un realce paquimeníngeo intenso. En ambos casos se diagnosticó fístula de líquido cefalorraquídeo en la región dorsal y los pacientes fueron tratados satisfactoriamente mediante el empleo de un parche hemático. Conclusiones. La hipotensión intracraneal espontánea no es una patología infrecuente. Habitualmente presenta problemas diagnósticos debido a la diversidad sintomatológica que puede exhibir. La resonancia magnética es fundamental para el diagnóstico al mostrar un realce paquimeníngeo, y para evidenciar la fuga de líquido cefalorraquídeo son útiles la resonancia magnética espinal, la mielografía asistida por tomografía computarizada o la cisternogammagrafía. Si falla el tratamiento conservador, el parche hemático consigue buenos resultados. Se recurre a la cirugía como última opción (AU)

Introduction. Spontaneous intracranial hypotension is caused by spontaneous spinal cerebrospinal fluid leaks and is known for causing orthostatic headaches, and a wide variety of associated symptoms have been reported. Case reports. We described two cases with spontaneous intracranial hypotension, treated in a short period of time, who presented with orthostatic headache and the neuroimaging studies showed subdural collections. Both patients were diagnosed of spinal cerebrospinal fluid leaks and treated with blood patches. Conclusions. Although intracranial hypotension is not an uncommon pathology, it usually presents diagnostic problems due to the diversity of symptoms that can occur. MRI is essential for the diagnosis by showing enhancement of the pachymeninges following administration of gadolinium and to prove the cerebrospinal fluid leak are useful spinal MRI, the computerized tomography myelography and the radionuclide cisternography. If conservative treatment falls, the epidural blood patch is the initial treatment of choice, reserving surgery for patients with persistent symptoms (AU)

[Spontaneous intracranial hypotension syndrome: two case reports]. / Sindrome de hipotension intracraneal espontanea: presentacion de dos casos.

INTRODUCTION. Spontaneous intracranial hypotension is caused by spontaneous spinal cerebrospinal fluid leaks and is known for causing orthostatic headaches, and a wide variety of associated symptoms have been reported. CASE REPORTS. We described two cases with spontaneous intracranial hypotension, treated in a short period of time, who presented with orthostatic headache and the neuroimaging studies showed subdural collections. Both patients were diagnosed of spinal cerebrospinal fluid leaks and treated with blood patches. CONCLUSIONS. Although intracranial hypotension is not an uncommon pathology, it usually presents diagnostic problems due to the diversity of symptoms that can occur. MRI is essential for the diagnosis by showing enhancement of the pachymeninges following administration of gadolinium and to prove the cerebrospinal fluid leak are useful spinal MRI, the computerized tomography myelography and the radionuclide cisternography. If conservative treatment falls, the epidural blood patch is the initial treatment of choice, reserving surgery for patients with persistent symptoms.

[Paediatric neurocysticercosis: two case reports]. / Neurocisticercosis pediatrica: a proposito de dos casos.

INTRODUCTION: Neurocysticercosis, caused by the larvae of Taenia solium, is the most common parasitic infection of the central nervous system in humans. Considered an endemic parasitosis in developing countries including Latin America, Asia and Africa while in Europa, the cases of neurocysticercosis are anecdotal. CASE REPORTS: We report two cases of neurocysticercosis in children of non-Spanish origin who presented with seizures, with the initial diagnosis of brain tumors both were treated with surgery; later, to be the diagnosis of neurocisticercosis antiparasitic therapy was administered. CONCLUSIONS: Neurocysticercosis can be a potential cause of epilepsy even in non-endemic countries. Some cases may be difficult to diagnose and they can be confused with other intracranial lesions. Clinicians should be aware of this condition given increasing incidence in Spain and neurocysticercosis should be always be considered in the differential diagnosis particularly in patients from Latin America and Africa.

Neurocisticercosis pediátrica: a propósito de dos casos / Paediatric neurocysticercosis: two case reports

Introducción. La neurocisticercosis es la enfermedad parasitaria más frecuente del sistema nervioso central y está causada por una infestación por la larva de la Taenia solium. Se trata de una enfermedad endémica en los países en vías de desarrollo, principalmente de América Latina, Asia y África, mientras que su presencia en Europa es anecdótica. Casos clínicos. Presentamos los casos de dos niños de origen no español, que comenzaron con una crisis epiléptica y que fueron diagnosticados inicialmente como tumores cerebrales primarios. Ambos fueron intervenidos quirúrgicamente y al diagnosticarse la parasitosis, recibieron posteriormente tratamiento antiparasitario. Conclusiones. La neurocisticercosis es una causa potencial de epilepsia incluso en aquellos países en los que no endémica. Numerosos casos presentan dificultades en el diagnóstico y se pueden confundir con otras lesiones intracraneales. Los facultativos debemos estar alerta, ya que se trata de una patología con un cierto repunte en España y se debe tener en cuenta en los diagnósticos diferenciales cuando tratamos pacientes procedentes de América Latina o África (AU)

Introduction. Neurocysticercosis, caused by the larvae of Taenia solium, is the most common parasitic infection of the central nervous system in humans. Considered an endemic parasitosis in developing countries including Latin America, Asia and Africa while in Europa, the cases of neurocysticercosis are anecdotal. Case reports. We report two cases of neurocysticercosis in children of non-Spanish origin who presented with seizures, with the initial diagnosis of brain tumors both were treated with surgery; later, to be the diagnosis of neurocisticercosis antiparasitic therapy was administered. Conclusions. Neurocysticercosis can be a potential cause of epilepsy even in non-endemic countries. Some cases may be difficult to diagnose and they can be confused with other intracranial lesions. Clinicians should be aware of this condition given increasing incidence in Spain and neurocysticercosis should be always be considered in the differential diagnosis particularly in patients from Latin America and Africa (AU)

[Chronic subdural hematoma in young patients]. / Hematoma subdural crónico en pacientes jóvenes.

OBJECTIVE: The objective of this study was to analyse demographic, clinical and radiological findings and surgical results in a series of chronic subdural haematomas (CSDH) in young adult patients. PATIENTS AND METHODS: This retrospective study included 42 patients under 40 years of age who were diagnosed and surgically treated for a CSDH during a 30-year period (1982-2011). RESULTS: Of the 42 cases analysed, 32 were males and 10 were females, and the mean age at diagnosis was 29.3±8.9 years (range: 4 to 39 years). The mean interval from trauma to appearance of clinical symptoms was 33.4±9.7 days (range: 19 to 95 days). The main symptoms were headache (59.5%) and seizures (21.4%), and the most frequent predisposing factors were ventriculoperitoneal shunting in 5 (11.9%) patients and haematological disorders in another 5 (11.9%) cases. CSDH was right-sided in 21 cases (50%), left-sided in 19 cases (45.3%) and bilateral in the remaining 2 patients (4.7%). Postoperative complications occurred in 2 patients (1 recurrence and 1 acute subdural haematoma). CONCLUSIONS: CSDH is a rare pathology during the first decades of life. It mainly affects males and headache is usually the first symptom. Prognosis is good in young patients, since postoperative complications and recurrences are less frequent at this age than in older populations.

Resolución postraumática de un quiste aracnoideo intracraneal / No disponible

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