Fenómenos de despolarización cortical propagada en los pacientes con lesiones cerebrales traumáticas e isquémicas. Resultados de un estudio piloto / Cortical spreading depolarization phenomena in patients with traumatic and ischemic brain injuries. Results of a pilot study

OBJETIVOS: Determinar la frecuencia y duración de episodios de despolarización cortical propagada (CSD y CSD-like) en pacientes con lesiones por traumatismo craneoencefálico (TCE) e infartos malignos de la arteria cerebral media (IMACM) que requirieron craneotomía. DISEÑO: Estudio descriptivo-observacional desarrollado durante 19 meses. Ámbito: Pacientes neurocríticos. PACIENTES: Estudio realizado en 16 pacientes (9 IMACM y 7 TCE graves) que requirieron tratamiento quirúrgico. INTERVENCIONES: Colocación de una tira de 6 electrodos en el córtex perilesional para el registro continuo de electrocorticografía (ECoG). Variables de interés principales: En todos los casos se determinó la hora, el número y la duración de los episodios de CSD y CSD-like detectados. RESULTADOS: De los 16 registros de ECoG analizados, 9 presentaron fenómenos CSD y CSD-like, de duración y frecuencias muy variables. CONCLUSIONES: Los episodios de CSD y CSD-like se detectan con frecuencia en el córtex en las regiones de penumbra isquémica y/o traumática de pacientes con un IMACM que han requerido craniectomía descompresiva o afectos de un TCE con contusiones cerebrales

OBJECTIVES: To determine the frequency and duration of cortical spreading depolarization (CSD) and CSD-like episodes in patients with traumatic brain injury (TBI) and malignant middle cerebral artery infarction (MMCAI) requiring craniotomy. DESIGN: A descriptive observational study was carried out during 19 months. SETTING: Neurocritical patients. PATIENTS: Sixteen patients were included: 9 with MMCAI and 7 with moderate or severe TBI, requiring surgical treatment. Interventions A 6-electrode subdural electrocorticographic (ECoG) strip was placed onto the perilesional cortex. MAIN VARIABLES OF INTEREST: An analysis was made of the time profile and the number and duration of CSD and CSD-like episodes recorded from the ECoGs. RESULTS: Of the 16 patients enrolled, 9 presented episodes of CSD or CSD-like phenomena, of highly variable frequency and duration. CONCLUSIONS: Episodes of CSD and CSD-like phenomena are frequently detected in the ischemic penumbra and/or traumatic cortical regions of patients with MMCAI who require decompressive craniectomy or of patients with contusional TBI

[Cortical spreading depolarization phenomena in patients with traumatic and ischemic brain injuries. Results of a pilot study]. / Fenómenos de despolarización cortical propagada en los pacientes con lesiones cerebrales traumáticas e isquémicas. Resultados de un estudio piloto.

OBJECTIVES: To determine the frequency and duration of cortical spreading depolarization (CSD) and CSD-like episodes in patients with traumatic brain injury (TBI) and malignant middle cerebral artery infarction (MMCAI) requiring craniotomy. DESIGN: A descriptive observational study was carried out during 19 months. SETTING: Neurocritical patients. PATIENTS: Sixteen patients were included: 9 with MMCAI and 7 with moderate or severe TBI, requiring surgical treatment. INTERVENTIONS: A 6-electrode subdural electrocorticographic (ECoG) strip was placed onto the perilesional cortex. MAIN VARIABLES OF INTEREST: An analysis was made of the time profile and the number and duration of CSD and CSD-like episodes recorded from the ECoGs. RESULTS: Of the 16 patients enrolled, 9 presented episodes of CSD or CSD-like phenomena, of highly variable frequency and duration. CONCLUSIONS: Episodes of CSD and CSD-like phenomena are frequently detected in the ischemic penumbra and/or traumatic cortical regions of patients with MMCAI who require decompressive craniectomy or of patients with contusional TBI.

Fisiopatología de las tormentas eléctricas en el encéfalo del paciente con una lesión cerebral aguda. Resultados preliminares de un estudio piloto / Pathophysiology of electrical storms in the brain of patients with acute brain injury. Preliminary results of a pilot study

Los fenómenos de despolarización cortical propagada (CSD y CSD-like) son despolarizaciones celulares que se extienden en forma de onda y están implicados en la progresión de las lesiones en pacientes con ictus y traumatismo craneoencefálico (TCE). Son detectables en el registro de electrocorticografía (ECoG). Experimentalmente inducen hipoxia cerebral e incrementa la permeabilidad de la barrera hematoencefálica. Objetivos: Determinar la frecuencia y duración de estos episodios en pacientes con TCE o infarto maligno de la arteria cerebral media (IMACM) que requieran craniectomía. Material y métodos: 20 pacientes a los que se les colocó, en el córtex perilesional, una tira de seis electrodos. Análisis del número y la duración de los episodios de CSD registrados. Resultados: En cuatro, de los ocho registros de ECoG analizados, se identificaron episodios de CSD o CSD-like de duración y frecuencia variable. Conclusiones: Se detectan frecuentemente episodios de CSD y CSD-like en pacientes con IMACM y TCE (AU)

The phenomena of cortical spreading depolarization (CSD and CSD-like phenomena) are cellular depolarization waves involved in the progression of lesions in patients with stroke and traumatic brain injury (TBI). Which are detected by an electrocorticographic (ECoG) recording. Experimentally, CSD induces cerebral hypoxia and increases the permeability of the blood-brain barrier. Objectives: To determine the frequency and duration of CSD episodes in patients with TBI and malignant middle cerebral artery infarction (MMCAI) requiring craniectomy. Material and methods: 20 patients were included. A strip of 6 electrodes was placed in the perilesional cortex. Analysis of the number and duration of CSD episodes in the ECoG recording was performed. Results: In four, of the eight ECoG recordings that was fully analyzed, CSD or CSD-like phenomena were identified with a variable frequency and duration. Conclusions: Episodes of CSD and CSD-like phenomena are frequently detected in patients with MMCAI and TBI (AU)

«Doctor, siento debilidad en las piernas» / «Doctor, my legs feel weak»

Se trata de una mujer de 55 años sin hipertensión arterial conocida hasta ese momento ni otros antecedentes clínicos de interés. Tras un proceso agudo de neuropatía sensitivomotora comienza con una hipertensión arterial moderada; permanece ingresada en el hospital durante un mes, siendo diagnosticada de síndrome de Guillain-Barré. La paciente es dada de alta con dosis bajas de fármacos antihipertensivos (IECA). Transcurrido un año del proceso agudo se consigue controlar la tensión arterial sin necesidad de tratamiento, por lo que sospechamos que la hipertensión arterial fue secundaria al proceso neurológico

This is a 55 year old woman with no known arterial hypertension up to now or other clinical background of interest. After an acute sensory-motor neuropathy condition, she began with moderate arterial hypertension. She remained in the hospital for one month, being diagnosed of Guillain-Barre syndrome. The patient was discharged with low doses of antihypertensive drugs (ACEIs). After one year with the acute condition, it was possible to control the blood pressure without need for treatment so that we suspect that the arterial hypertension was secondary to the neurological condition

Hepatitis C e hipertensión / Hepatitis C and hypertension

No disponible

[Adrenal mass and adrenal insufficiency]. / Masa suprarrenal e insuficiencia suprarrenal.

Primary adrenal insufficiency is a non frequent disease, that is declared in young adults and in the most of the cases is produced from an autoimmune mechanism or a tuberculous disease. The incidence of these forms in the different geographic areas is dependent of degree of irradication of the tuberculosis. We report the case of a patient with latent chronic adrenal insufficiency of tuberculous origin who was affected for an addisonian crisis during an intercurrent infectious disease, which permitted the diagnosis of the addisonian crisis, and Mal of Pott was moreover detected. Evolution with corticosteroid and specific treatment was very favorable.

[Langerhans cell granulomatosis with unifocal bone disease and asymptomatic pulmonary infiltration]. / Granulomatosis de células de Langerhans con afectación ósea unifocal e infiltrado pulmonar asintomático.

Langerhans' cell granulomatosis is a usually benign disease, characterized by the proliferation of Langerhans' cell containing S-100 protein. Disease is related with the smoking habit and immunological alterations, and is able to affect any organ in isolated or multisystem form. Diagnosis is provided by biopsy of the lesion and bronchoalveolar lavage if the lung is injured. We present a case of a smoker man with lytic lesion in the skull, which biopsy was diagnostic, and with an asymptomatic interstitial infiltrates lungs, with a restrictive spirometry. Remission was achieved with prednisone (0.75 mg x kg) and stop smoking.

[Acute acalculous cholecystitis complicating the presentation of cardiac tamponade as the initial manifestation of a pulmonary carcinoma]. / Colecistitis aguda alitiásica complicando la presentación de un taponamiento cardiaco, como manifestación inicial de un carcinoma pulmonar.

The finding of a cardiac tamponade (CT) as initial manifestation of lung cancer is rare, being its most frequent manifestations dyspnea, cough and edemas. The presence of alithiasic acute cholecystitis (AAC) as early manifestation of CT is extremely rare, despite this having being described related to other situations of low cardiac output. We present the case of a patient who underwent emergency surgery due to AAC as a form of presentation of CT, this being the initial manifestation of a pulmonary adenocarcinoma. The histopathological study of the liver and the vesicle were compatible with signs of short evolution venous stasis, and the diagnosis was established through pericardium biopsy and thoracic CAT.

[Q fever and endocarditis. Apropos a new case]. / Fiebre Q y endocarditis. A propósito de un nuevo caso.

Endocarditis is the first manifestation of Q fever in its chronic form, generally affecting prosthetic cardiac valves or previously injured valves. Its clinical presentation is an endocarditis with negative culture and there is not agreement with regard to the most adequate antimicrobial treatment and its duration. Frequently, the valve has to be replaced. We present a case of a patient with double aortic lesion, in whom endocarditis by Q fever was diagnosed and treated with doxycycline, initially with success. However, she relapsed one year later, being then resistant to the medical treatment (doxycycline, ciprofloxacine plus rifampicine). It was not possible to replace the valve and the patient died two months later due to cardiac failure.