Assessment of efficacy and safety of eslicarbazepine acetate for the treatment of trigeminal neuralgia.

BACKGROUND: Antiepileptic drugs are the first-line treatment for trigeminal neuralgia (TN). Carbamazepine and oxcarbazepine are the most studied with well-known efficacy. Eslicarbazepine acetate is a third-generation antiepileptic drug that has not previously been evaluated for the treatment of TN. We aim to assess the efficacy, tolerability and safety of eslicarbazepine for TN. DESIGN AND METHODS: Retrospective, open-label, multicentric, intention-to-treat study. We included patients older than 18 years who met the ICHD-3 beta diagnostic criteria for TN. We evaluated the variation of intensity and frequency of pain paroxysms before and after treatment with eslicarbazepine. Secondary objectives assessed were tolerability and safety of eslicarbazepine. RESULTS: Eighteen patients were included, 15 women, mean age 65.2 years old, mean follow-up 21.1 months. The mean number of drugs tested before eslicarbazepine was 2; 10 patients used eslicarbazepine as monotherapy. After the treatment with ESL, the median of pain intensity improved from 9.5 to 2.5 (p < 0.001) and the median of pain paroxysms frequency improved from 70 episodes per week to 0.37 (p < 0.001). Responder rate was 88.9%; 44.4% became asymptomatic after treatment. Sixty-one per cent of patients presented some adverse event; four patients discontinued eslicarbazepine for this reason. Despite this, 16 patients (88.9%) noticed a good subjective tolerance to eslicarbazepine. The retention rate at 6 months was 77.8% and at 12 months 61.1%. CONCLUSIONS: Our study supports the hypothesis that eslicarbazepine acetate is an effective, safe and well-tolerated treatment for the treatment of TN. Further studies are warranted to corroborate these results. SIGNIFICANCE: Eslicarbazepine acetate has shown to be an effective, safe and well-tolerated drug for TN. This is the first study that evaluated the efficacy of this drug on TN in humans.

Miastenia ocular desenmascarada por risedronato / Ocular myasthenia revealed by risedronate

No disponible

Estimulación cerebral profunda en la enfermedad de Parkinson / Deep brain stimulation in Parkinson's disease

Introducción. Desde su aparición en la década de los noventa, la estimulación cerebral profunda se ha impuesto como una alternativa terapéutica segura y eficaz en la enfermedad de Parkinson, estando indicada cuando aparecen complicaciones motoras incontrolables con el tratamiento farmacológico. Objetivo. Realizar una revisión actualizada de la literatura médica sobre los aspectos más importantes de esta cirugía funcional. Desarrollo. Aunque su mecanismo de acción a día de hoy continúa siendo desconocido, se ha postulado que ejerce una acción inhibitoria sobre la actividad de los núcleos subtalámico y globo pálido interno, que se encuentra exaltada en enfermos parkinsonianos. La técnica quirúrgica de elección es la estimulación del núcleo subtalámico. Ha demostrado tener unos resultados favorables tanto desde el punto de vista motor, con una mejoría significativa de los síntomas cardinales de la enfermedad, como en la calidad de vida de estos pacientes. El éxito de la cirugía depende de tres pasos fundamentales: 1) La adecuada selección del candidato quirúrgico, teniendo en cuenta las recomendaciones de los principales grupos de estudio sobre factores pronóstico como son la edad, el tiempo de evolución y la presencia de síntomas resistentes a la levodopa. 2) La correcta posición del electrodo en la diana quirúrgica. 3) La programación del sistema de estimulación. Conclusión. La estimulación cerebral profunda del núcleo subtalámico es una opción terapéutica claramente establecida en la enfermedad de Parkinson avanzada, cuyo desarrollo en los últimos años, ha favorecido la obtención de unos resultados clínicos favorables cuando el tratamiento farmacológico fracasa (AU)

Introduction. Since its appearance in the nineties, deep brain stimulation has proved itself to be a safe, effective therapeutic alternative in Parkinson's disease, and is indicated when there are motor complications that pharmacological treatment fails to control. Aims. The purpose of this work is to conduct an updated review of the medical literature on the most important aspects of this functional surgery. Development. Although today its mechanism of action remains unknown, it has been suggested that it exerts an inhibitory action on the activity of the subthalamic nuclei and internal globus pallidus, which is found to be overexcited in patients with parkinsonism. The preferred surgical technique is subthalamic nucleus stimulation. This procedure has proved to yield favourable results both from the motor point of view, with a significant improvement in the cardinal symptoms of the disease, and as regards these patients’ quality of life. The success of the surgical procedure depends on three fundamental steps: 1) Selection of a suitable candidate for surgery, taking into account the recommendations of the main study groups on prognostic factors, such as age, time to progression and the presence of symptoms that are resistant to levodopa; 2) The correct position of the electrode on the surgical target; 3) The programming of the stimulation system. Conclusions. Deep brain stimulation of the subthalamic nucleus is a clearly established therapeutic option in advanced Parkinson's disease. Recent developments allow favourable clinical outcomes to be obtained when pharmacological treatment fails (AU)

Miscelánea: parkinsonismo en otras enfermedades degenerativas / Miscellany: Parkinsonism in other degenerative diseases

Introducción. El parkinsonismo en otras enfermedades neurodegenerativas es un tema amplio y variado. Describiremos las características diferenciadoras de algunas entidades bien definidas (enfermedad de Huntington, enfermedad de Wilson), así como de otras más raras. Desarrollo. Existen gran cantidad de trastornos neurodegenerativos que cursan con parkinsonismo en algún momento de su evolución. Es necesario reconocer marcadores clínicos diferenciadores (edad de inicio, corea, hepatopatía, parálisis supranuclear de la mirada, respuesta a levodopa...), así como patrones de herencia y de neuroimagen que nos permitan reconocer cuadros clínicos definidos. Conclusiones. Todo cuadro de parkinsonismo debe estudiarse cuidadosamente. Debemos identificar aquellos cuadros con especial importancia por su frecuencia (enfermedad de Huntington) o por ser potencialmente curables (enfermedad de Wilson), en especial en todos los pacientes con un inicio juvenil. Otras entidades infrecuentes (hemiatrofia-hemiparkinson, síndrome pálido-piramidal, enfermedades por depósito, neuroacantocitosis, etc), también deben ser consideradas en el diagnóstico diferencial (AU)

Introduction. Parkinsonism in other neurodegenerative diseases is a broad and varied topic. We report the differentiating features of some well-defined conditions (Huntington's disease, Wilson's disease), as well as some other rarer ones. Development. There are many neurodegenerative disorders that are accompanied by parkinsonism at some point in their development. It is necessary to recognise differentiating clinical markers (age at onset, chorea, liver disease, supranuclear gaze palsy, response to levodopa, and so on) as well as inheritance and neuroimaging patterns that enable us to recognise defined clinical pictures. Conclusions. very clinical picture suggestive of parkinsonism must be studied carefully. We must identify those clinical patterns that are especially important due to their frequency (Huntington's disease) or because they are potentially curable (Wilson's disease), particularly in all patients with onset prior to adulthood. Other infrequent conditions (hemiatrophyhemiparkinsonism, pallidal-pyramidal syndrome, diseases due to deposits, neuroacanthocytosis, etc.) should also be taken into account in the differential diagnosis (AU)

Neurogenesis in subclasses of vomeronasal sensory neurons in adult mice.

The vomeronasal sensory epithelium contains two distinct populations of vomeronasal sensory neurons. Apical neurons express G(i) (2) (α) -linked V1R vomeronasal receptors and project to the anterior portion of the accessory olfactory bulb, while basal neurons express G(o) (α) -linked V2R receptors and project to the posterior portion. Sensory neurons expressing V1R and V2R vomeronasal receptors are sensitive to different stimuli. Neurons in the vomeronasal system undergo continuous cell turnover during adulthood. To analyze over time neurogenesis of the different sensory cell populations, adult mice were injected with bromodeoxyuridine (BrdU) and sacrificed at postinjection days 1, 3, 5, 7, and 11. Newborn vomeronasal neurons were revealed by antibodies against BrdU while subclasses of vomeronasal neurons were identified using antibodies against G(o) (α) or G(i) (2) (α) proteins. To ascertain whether G proteins are early expressed during neurogenesis, multiple labeling experiments using PSA-NCAM and doublecortin were performed. Distribution of BrdU-labeled cells was analyzed in angular segments from the margin of the sensory epithelium. No sexual differences were found. Within survival groups, BrdU-G(o) (α) labeled cells were found more marginally when compared with BrdU-G(i) (2) (α) labeled cells. The number of BrdU-positive cells decreased from day 1 to day 3 to remain constant afterwards. The relative proportions of BrdU-G(i) (2) (α) and BrdU-G(o) (α) labeled cells remained similar and constant from postinjection day 1 onwards. This rate was also comparable with BrdU-positive cells starting day 3. These results indicate an early, constant, and similar rate of neurogenesis in the two major subclasses of vomeronasal neurons, which suggests that both cell populations maturate independently.

[Non-motor disorders in Parkinson's disease: introduction and general features]. / Trastornos no motores de la enfermedad de Parkinson: introducción y generalidades.

INTRODUCTION: Two hundred years ago James Parkinson accurately described the disease that bears his name today, focusing not only on motor aspects but also on non-motor symptoms suffered by these patients. DEVELOPMENT: Non-motor symptoms are prevalent and decrease the quality of life of the patients with Parkinson's disease. In recent years, some non-motor scales have been developed to avoid the problem of underdiagnosis. Moreover, some of them have been proposed as clinical predictors for Parkinson's disease and it is has been suggested that individuals with any of these non-motor symptoms and without motor manifestations of the disease could be the aim for neuroprotective therapies when they become available. CONCLUSIONS: Non-motor symptoms are prevalent and have a great impact in the quality of life of patients. Therefore, it is important to detect and treat them. Their role as predictors of the disease is unclear yet.

Somatostatin, tau, and beta-amyloid within the anterior olfactory nucleus in Alzheimer disease.

Impaired olfaction is an early symptom of Alzheimer disease (AD). This likely to reflect neurodegenerative processes taking place in basal telencephalic structures that mediate olfactory processing, including the anterior olfactory nucleus. Betaeta-amyloid (Abeta) accumulation in AD brain may relate to decline in somatostatin levels: somatostatin induces the expression of the Abeta-degrading enzyme neprilysin and somatostatin deficiency in AD may therefore reduce Abeta clearance. We have investigated the expression of somatostatin in the anterior olfactory nucleus of AD and control brain. We report that somatostatin levels were reduced by approximately 50% in AD brain. Furthermore, triple-immunofluorescence revealed co-localization of somatostatin expression with Abeta (65.43%) with Abeta and tau (19.75%) and with tau (2.47%). These data indicate that somatostatin decreases in AD and its expression may be linked with Abeta deposition.

Fate of marginal neuroblasts in the vomeronasal epithelium of adult mice.

Chemical stimuli are sensed through the olfactory and vomeronasal epithelia, and the sensory cells of both systems undergo neuronal turnover during adulthood. In the vomeronasal epithelium, stem cells adjacent to the basal lamina divide and migrate to replace two classes of sensory neurons: apical neurons that express G(i2alpha)-linked V1R vomeronasal receptors and project to the anterior accessory olfactory bulb, and basal neurons that express G(oalpha)-linked V2R receptors and project to the posterior accessory olfactory bulb. Most of the dividing cells are present in the margins of the epithelium and only migrate locally. Previous studies have suggested that these marginal cells may participate in growth, sensory cell replacement or become apoptotic before maturation; however, the exact fate of these cells have remained unclear. In this work we investigated the fate of these marginal cells by analyzing markers of neurogenesis (bromodeoxyuridine incorporation), apoptosis (caspase-3), and neuronal maturation (olfactory marker protein and Neurotrace Nissl stain). Our data reveal a pool of dividing cells in the epithelial margins that predominantly give rise to mature neurons and only rarely undergo apoptosis. Newly generated cells are several times more numerous than apoptotic cells. These marginal neuroblasts could therefore constitute a net neural addition zone during adulthood.

[Paroxysmal dyskinesias]. / Discinesias paroxísticas.

INTRODUCTION: Paroxysmal dyskinesias are uncommon movements disorders that consist on recurrent brief episodes characterized by attacks with any combination of dystonia, chorea, athetosis or ballismus. DEVELOPMENT AND CONCLUSIONS: The pathophysiology of paroxysmal dyskinesias is unclear at the present time. An epileptic mechanism and basal ganglia disorders have been proposed although channelopathy due to ion channel mutations have been recently suggested. These disorders were classified by Demirkiran and Jankovic into two main groups: paroxysmal kinesigenic dyskinesia if the attacks were induced by sudden movement and paroxysmal nonkinesigenic dyskinesia if they were not. In addition to these groups, two more types have been known, namely paroxysmal exercise-induced dyskinesia and hypnogenic paroxysmal dyskinesia. As well association between benign infantile familial convulsions and paroxysmal choreoathetosis, or rolandic epilepsy, episodes of exercise induced dystonia, and writers' cramp have been described. Also others paroxysmal movements disorders have been known, we mention below. Paroxysmal dyskinesias can further be divided into idiopathic (familiar in most of the cases) or secondary cases depending on underlying cause.

Discinesias paroxísticas / Paroxysmal Diskinesias

Resumen. Introducción. Las discinesias paroxísticas consisten en trastornos del movimiento infrecuentes, que ocurren de forma brusca y recurrente, manifestadas como posiciones distónicas, movimientos coreicos, atetósicos, balísticos o una combinación de éstos. Desarrollo y conclusiones. No conocemos con exactitud su fisiopatología. Se sugiere tanto un mecanismo epiléptico como una alteración de la modulación de los ganglios basales, aunque como alteración común se plantea que se trate de canalopatías por mutaciones en genes de canales iónicos. En función del precipitante de las discinesias podremos hablar de discinesias no cinesogénicas, cinesogénicas, inducidas por ejercicio o hipnogénicas, siguiendo la última clasificación propuesta por Demirkiran y Jankovic. Además, se han descrito asociaciones como el síndrome de convulsiones infantiles y coreoatetosis paroxística o la asociación de epilepsia rolándica, distonía paroxística inducida por el ejercicio y calambre del escribiente. También se han descrito otros trastornos del movimiento paroxísticos; aunque no entraremos en detalles, se nombrarán posteriormente. Las discinesias paroxísticas también se diferencian, dependiendo de su etiología, en idiopáticas (familiares en la mayoría de los casos) y secundarias (sintomáticas de una enfermedad subyacente (AU)

Summary. Introduction. Paroxysmal dyskinesias are uncommon movements disorders that consist on recurrent brief episodes characterized by attacks with any combination of dystonia, chorea, athetosis or ballismus. Development and conclusions. The pathophysiology of paroxysmal dyskinesias is unclear at the present time. An epileptic mechanism and basal ganglia disorders have been proposed although channelopathy due to ion channel mutations have been recently suggested. These disorders were classified by Demirkiran and Jankovic into two main groups: paroxysmal kinesigenic dyskinesia if the attacks were induced by sudden movement and paroxysmal nonkinesigenic dyskinesia if they were not. In addition to these groups, two more types have been known, namely paroxysmal exercise-induced dyskinesia and hypnogenic paroxysmal dyskinesia. As well association between benign infantile familial convulsions and paroxysmal choreoathetosis, or rolandic epilepsy, episodes of exercise induced dystonia, and writers’ cramp have been described. Also others paroxysmal movements disorders have been known, wemention below. Paroxysmal dyskinesias can further be divided into idiopathic (familiar in most of the cases) or secondary cases depending on underlying cause (AU)

[Leprosy and severe neuropathy in two native Spaniards]. / Lepra y neuropatía grave en dos nativos españoles.

INTRODUCTION: Leprosy is a widespread infectious disease in humans that is endemic to regions with poor sanitary conditions, especially in cases of overcrowding, malnutrition and bad hygiene. The disease is characterised by dermopathy, which is quite typical, but above all by neuropathy, which often becomes the most important element. In most cases, alterations to nerves are defined by sensory deficits that are predominantly distal and multiple neuritis in areas where nerve entrapment has taken place. CASE REPORTS: Two patients, both native Spaniards, presented largely overlapping clinical pictures, that is, a history of 'glove and stocking' type paresthesias and dysesthesias going back months or even years and functional impotence, which gave rise to a very pronounced gait disorder. In the two cases, the immunological situation was determined to be borderline lepromatous leprosy. The neurophysiological study revealed the presence of severe, diffuse sensory-motor axonal polyneuropathy that was predominantly distal, and several entrapped nerves. The dermatological illness was greatly improved by the treatment. The same was partially true, although to a satisfactory extent, of the neurological disease. CONCLUSION: We describe the cases of two Spaniards with borderline lepromatous leprosy with no past history of the disease, in whom neuropathy was the predominant symptom. We highlight the speed with which the neuropathies progressed, probably due to a change in 'polarity', and the severity of the neurological deficits in comparison with the dermopathy, in an unusual immunological situation. The growing number of native patients in the first world, even when there is no relevant history, suggests that we should not think of leprosy as something only occurring in immigrant patients from places where it is endemic, although the epidemiological relationship has still not been determined.

Lepra y neuropatía grave en dos nativos españoles / Leprosy and severe neuropathy in two native spaniards

La lepra es una infección humana extendida, endémica de regiones con malas condiciones sanitarias,en especial hacinamiento, malnutrición y mala higiene. La enfermedad se caracteriza por dermopatía, bastante típica; pero, sobre todo, neuropatía, que se convierte con mucha frecuencia en protagonista. La alteración del nervio viene definida en la mayor parte de casos por déficit sensitivos de predominio distal y multineuritis en lugares de atrapamiento nervioso. Casosclínicos. Dos pacientes, españoles indígenas, presentaron cuadros muy superponibles: parestesias y disestesias continuas en guante y calcetín de meses o incluso años de evolución, e impotencia funcional, en uno de los casos provocando un trastornode la marcha muy importante. En los dos se estableció la situación inmunológica como lepra borderline lepromatosa. El estudio neurofisiológico determinó la presencia de polineuropatía axonal sensitivomotora grave y difusa de predominio distal, y varios atrapamientos nerviosos. El tratamiento mejoró muy significativamente la enfermedad dermatológica y, de maneraparcial, aunque satisfactoria, la neurológica. Conclusión. Describimos dos españoles con lepra borderline lepromatosa sin antecedentes, en los que predominó sintomáticamente la neuropatía. Destacamos la rápida progresión de las neuropatías,probablemente por un cambio en la ‘polaridad’, la gravedad de los déficit neurológicos en contraste con la dermatopatía, en una situación inmunológica poco habitual. El número creciente de afectados indígenas del primer mundo, incluso sin antecedentesrelevantes, indica que no sólo debemos pensar en lepra en pacientes inmigrantes procedentes de lugares endémicos, aunque la relación epidemiológica está por determinar

Leprosy is a widespread infectious disease in humans that is endemic to regions with poor sanitaryconditions, especially in cases of overcrowding, malnutrition and bad hygiene. The disease is characterised by dermopathy, which is quite typical, but above all by neuropathy, which often becomes the most important element. In most cases, alterationsto nerves are defined by sensory deficits that are predominantly distal and multiple neuritis in areas where nerve entrapment has taken place. Case reports. Two patients, both native Spaniards, presented largely overlapping clinical pictures, that is, ahistory of ‘glove and stocking’ type paresthesias and dysesthesias going back months or even years and functional impotence, which gave rise to a very pronounced gait disorder. In the two cases, the immunological situation was determined to beborderline lepromatous leprosy. The neurophysiological study revealed the presence of severe, diffuse sensory-motor axonal polyneuropathy that was predominantly distal, and several entrapped nerves. The dermatological illness was greatly improved by the treatment. The same was partially true, although to a satisfactory extent, of the neurological disease. Conclusion. Wedescribe the cases of two Spaniards with borderline lepromatous leprosy with no past history of the disease, in whom neuropathy was the predominant symptom. We highlight the speed with which the neuropathies progressed, probably due to a change in ‘polarity’, and the severity of the neurological deficits in comparison with the dermopathy, in an unusualimmunological situation. The growing number of native patients in the first world, even when there is no relevant history, suggests that we should not think of leprosy as something only occurring in immigrant patients from places where it is endemic, although the epidemiological relationship has still not been determined

Beneficio de la instauración de guardias de neurología de presencia física en un hospital general / Benefit of the implementation of on-call neurology physicians in a general hospital

Introducción. En la mayoría de hospitales españoles no existe neurólogo de guardia (NG). Hemos realizado este trabajo para intentar demostrar el beneficio que aporta esta figura a la asistencia sanitaria. Métodos. Estudio prospectivo realizado en el Complejo Hospitalario Universitario de Albacete que recoge datos sobre el primer año de funcionamiento de las guardias de neurología (2004). Comparamos además el número de ingresos de patología cerebrovascular aguda (PCVA) de ese año con respecto a 2003. Resultados. El NG valoró a 2.745 pacientes (7,6 por día). El 73,1% de las llamadas provinieron de urgencias y en el rango horario de 15 a 22 h. La PCVA fue la patología más atendida y se recibieron 118 avisos para valorar trombólisis. Se realizaron 323 estudios de neurosonología de forma urgente. De los pacientes vistos en urgencias, el 45,7% fueron ingresados y el 30,1% remitidos a consultas de neurología. Se produjo una disminución significativa de ingresos de pacientes con infarto cerebral en 2004 respecto a 2003 (12,3% menos) pese a un aumento del número de pacientes con PCVA ingresados en neurología en detrimento de los que lo hicieron en otros servicios. La estancia hospitalaria media de los pacientes con PCVA fue menor en neurología que en medicina interna. Conclusiones. El NG aporta mayor calidad asistencial, reduce ingresos hospitalarios innecesarios y potencia el servicio de neurología. Es necesaria la instauración de guardias de neurología de presencia física durante 24 h en todos aquellos centros que presten atención a enfermos urgentes y dispongan de servicios de neurología

Introduction. Most Spanish hospitals have no oncall neurologist (OCN) for emergency patients. This study was designed to highlight the benefits in patient management when an OCN system is implemented. Methods. We conducted a prospective study in the University Hospital of Albacete during the first year of OCN implementation (2004). We also compared stroke patients admissions from emergency department (ED) in 2004 with respect to 2003. Findings. OCN attended 2,745 patients (7.6 per day), 73.1% of these calls coming from ED between 3 PM and 10 PM. Acute stroke was the most frequent consultation. A total of 118 calls were made to determine the need for thrombolytic therapy and 323 emergency neurosonologic examinations were performed by the OCN during the duty. A total of 44.8% of the attended patients were admitted and 30.1% were referred to outpatient clinics. Our hospital had a significant decrease (12.3%) in stroke patients admissions over 2004 compared with 2003 despite an actual increase of total admissions in the neurological ward. The mean hospital stay of stroke patients was shorter in the neurology department than in the internal medicine one. Conclusions. OCN improves the quality of attention to the neurological patient, reduces the number of unnecessary hospital admissions and increases the status of the neurological department. Implementation of on-call neurology physicians for 24 hours is necessary in all those sites that provide care to emergency patients and have neurology services

[Benefit of the implementation of on-call neurology physicians in a general hospital]. / Beneficio de la instauración de guardias de neurología de presencia física en un hospital general.

INTRODUCTION: Most Spanish hospitals have no oncall neurologist (OCN) for emergency patients. This study was designed to highlight the benefits in patient management when an OCN system is implemented. METHODS: We conducted a prospective study in the University Hospital of Albacete during the first year of OCN implementation (2004). We also compared stroke patients admissions from emergency department (ED) in 2004 with respect to 2003. FINDINGS: OCN attended 2,745 patients (7.6 per day), 73.1% of these calls coming from ED between 3 PM and 10 PM. Acute stroke was the most frequent consultation. A total of 118 calls were made to determine the need for thrombolytic therapy and 323 emergency neurosonologic examinations were performed by the OCN during the duty. A total of 44.8% of the attended patients were admitted and 30.1% were referred to outpatient clinics. Our hospital had a significant decrease (12.3%) in stroke patients admissions over 2004 compared with 2003 despite an actual increase of total admissions in the neurological ward. The mean hospital stay of stroke patients was shorter in the neurology department than in the internal medicine one. CONCLUSIONS: OCN improves the quality of attention to the neurological patient, reduces the number of unnecessary hospital admissions and increases the status of the neurological department. Implementation of on-call neurology physicians for 24 hours is necessary in all those sites that provide care to emergency patients and have neurology services.

Diagnóstico y tratamiento en un caso de mioclono respiratorio / Diagnosis and treatment in a case of respiratory myoclonus

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[Thrombolytic treatment in stroke in patients with intracardiac thrombus: presentation of one case]. / Tratamiento trombolítico en el ictus en pacientes con trombo intracardíaco: presentación de un caso.

Intravenous tissue plasminogen activator (t-PA) is a recent proven effective treatment for acute ischemic stroke patients. However, the use of t-PA in some special settings is controversial. One of these is the presence of a cardiac thrombus, given that the use of t-PA could potentially accelerate breakup of the thrombus and cause additional embolisms. The authors describe the case of a cardiological patient with a cardiac thrombus who was given IV t-PA for acute stroke treatment without complications. We discuss the necessity or not of a 24 hours delay before anticoagulants administration in these special patients.

Tratamiento trombolítico en el ictus en pacientes con trombo intracardíaco: presentación de un caso / Trombolytic treatment in stroke in patients with intracardiac trhombus: presentation of one case

La utilización de activador tisular del plasminógeno (t-PA) por vía intravenosa es una opción terapéutica reciente en el ictus isquémico. Por este motivo existe aún poca experiencia clínica con este fármaco en patología vascular cerebral y su utilización plantea dudas en determinadas circunstancias. Una de ellas es si se conoce la existencia de un trombo intracavitario cardíaco, ya que en estos casos el uso de t-PA podría condicionar fragmentación del trombo con embolización múltiple distal. Presentamos un paciente de estas características en el que el tratamiento se mostró seguro. Discutimos la posibilidad de no demorar 24 h la utilización de antitrombóticos tras la fibrinólisis en circunstancias muy seleccionadas

Intravenous tissue plasminogen activator (t-PA) is a recent proven effective treatment for acute ischemic stroke patients. However, the use of t-PA in some special settings is controversial. One of these is the presence of a cardiac thrombus, given that the use of t-PA could potentially accelerate breakup of the thrombus and cause additional embolisms. The authors describe the case of a cardiological patient with a cardiac thrombus who was given IV t-PA for acute stroke treatment without complications. We discuss the necessity or not of a 24 hours delay before anticoagulants administration in theses special patients