[Influence of the caregiver on the cognitive and functional decline of people with dementia: A systematic review]. / Influencia del cuidador en el declive cognitivo y funcional de personas con demencia: revisión sistemática.

Dementia is a neurodegenerative disease that requires the accompaniment of a caregiver who is in charge of assisting and supervising basic and psychosocial needs. The objective of this article was to determine the influence of the caregiver on the cognitive and functional decline of patients with dementia. The method was a systematic review by searching the Scopus, Pubmed and Science Direct databases between the years 2010-2020. In conclusion, the informal caregiver condition was the most reported by the investigations, generally assumed by wives and children; Caregiver characteristics such as personality, subjective interpretations of the functional status of adults with dementia, and caregivers' coping strategies were associated with a decrease in the rate of cognitive and functional impairment of people with dementia.

Consensus of the Spanish society of laboratory medicine and the Spanish society of medical oncology on the methodology and criteria for evaluation of circulating tumour markers in breast cancer

The measurement of circulating tumour markers (TMs) for the diagnosis or monitoring of breast cancer has sometimes been considered of limited utility. In addition to the overinterpretation of irrelevant changes in marker levels, the characteristics of the patient, the disease or other pathologies that can modify them are often not considered in their evaluation. On the other hand, there are recent data on the relationship of TMs with molecular subtypes and on their prognostic value, the knowledge of which may improve their clinical utility. This consensus article arises from a collaboration between the Spanish Society of Laboratory Medicine (SEQCML) and the Spanish Society of Medical Oncology (SEOM). It aims to improve the use and interpretation of circulating TMs in breast cancer. The text summarizes the current knowledge and available evidence on the subject and proposes a series of recommendations mainly focussed on the indication, the frequency of testing and the factors that should be considered for correctly interpreting changes in the levels of TMs (AU)

Uricemia como factor pronóstico del ictus isquémico agudo / Hyperuricaemia as a prognostic factor for acute ischaemic stroke

Introducción: En el proceso de búsqueda de biomarcadores para el pronóstico del ictus agudo, en los últimos años los estudios realizados en torno al ácido úrico han mostrado resultados contradictorios.MétodosSe recogieron muestras analíticas de 600 pacientes ingresados de manera consecutiva en un hospital de tercer nivel y se analizó la relación entre los niveles de ácido úrico y el pronóstico funcional de los pacientes medido mediante la escala de Rankin modificada (mRS). Se excluyeron los pacientes que habían recibido terapias de reperfusión, ya que podría existir un efecto diferencial en los mismos respecto a los no tratados.ResultadosEl 73% de los pacientes tuvieron una mRS ≤ 2 y los niveles medios de ácido úrico fueron de 5,22 mg/dl. Se encontró una relación no lineal entre el pronóstico funcional al alta y los niveles de ácido úrico sérico en el momento del ingreso al excluir del análisis la medida de la National Institutes of Health Stroke Scale (NIHSS).ConclusionesLos valores séricos de ácido úrico en pacientes afectos de un ictus isquémico agudo se asocian significativamente con el pronóstico funcional en el momento de su alta, pero esta relación es no lineal. Se asocia un peor pronóstico a las concentraciones extremas, muy bajas o muy elevadas, de ácido úrico. Esto podría revelar un doble papel del ácido úrico en su relación con el ictus, como factor de riesgo asociado y/o como posible neuroprotector dado su papel antioxidante. (AU)

Introduction: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results.MethodsWe collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels.ResultsA total of 73% of patients had mRS scores ≤ 2; the mean uric acid level was 5.22 mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis.ConclusionsSerum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect. (AU)

Consensus of the Spanish society of laboratory medicine and the Spanish society of medical oncology on the methodology and criteria for evaluation of circulating tumour markers in breast cancer.

The measurement of circulating tumour markers (TMs) for the diagnosis or monitoring of breast cancer has sometimes been considered of limited utility. In addition to the overinterpretation of irrelevant changes in marker levels, the characteristics of the patient, the disease or other pathologies that can modify them are often not considered in their evaluation. On the other hand, there are recent data on the relationship of TMs with molecular subtypes and on their prognostic value, the knowledge of which may improve their clinical utility. This consensus article arises from a collaboration between the Spanish Society of Laboratory Medicine (SEQCML) and the Spanish Society of Medical Oncology (SEOM). It aims to improve the use and interpretation of circulating TMs in breast cancer. The text summarizes the current knowledge and available evidence on the subject and proposes a series of recommendations mainly focussed on the indication, the frequency of testing and the factors that should be considered for correctly interpreting changes in the levels of TMs.

Hyperuricaemia as a prognostic factor for acute ischaemic stroke. / Uricemia como factor pronóstico del ictus isquémico agudo.

INTRODUCTION: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results. METHODS: We collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels. RESULTS: A total of 73% of patients had mRS scores ≤2; the mean uric acid level was 5.22mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis. CONCLUSIONS: Serum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect.

Paresia idiopática del nervio hipogloso / Isolated hypoglossal nerve palsy

No disponible

Papiledema bilateral como forma de debut de un ependimoma espinal / Bilateral papilloedema as the initial manifestation of spinal ependymoma

No disponible

[Occipital intermittent rhythmic delta activity as the interictal pattern in an adult with focal epilepsy]. / Actividad delta ritmica intermitente occipital como patron intercritico en un adulto con epilepsia focal.

TITLE: Actividad delta ritmica intermitente occipital como patron intercritico en un adulto con epilepsia focal.

The role of peripheral vasopressin 1A and oxytocin receptors on the subcutaneous vasopressin antinociceptive effects.

BACKGROUND: Vasopressin (AVP) seems to play a role as an antinociceptive neurohormone, but little is known about the peripheral site of action of its antinociceptive effects. Moreover, AVP can produce motor impairment that could be confused with behavioural antinociception. Finally, it is not clear which receptor is involved in the peripheral antinociceptive AVP effects. METHODS: In anaesthetized rats with end-tidal CO2 monitoring, extracellular unitary recordings were performed, measuring the evoked activity mediated by Aß-, Aδ-, C-fibres and post-discharge. Behavioural nociception and motor impairment were evaluated under subcutaneous AVP (0.1-10 µg) using formalin and rotarod tests. Selective antagonists to vasopressin (V1A R) or oxytocin receptors (OTR) were used. Additionally, vasopressin and oxytocin receptors were explored immunohistochemically in skin tissues. RESULTS: Subcutaneous AVP (1 and 10 µg/paw) induced antinociception and a transitory reduction of the end-tidal CO2 . The neuronal activity associated with Aδ- and C-fibre activation was diminished, but no effect was observed on Aß-fibres. AVP also reduced paw flinches in the formalin test and a transitory locomotor impairment was also found. The AVP-induced antinociception was blocked by the selective antagonist to V1A R (SR49059) or OTR (L368,899). Immunohistochemical evidence of skin VP and OT receptors is given. CONCLUSIONS: Subcutaneous AVP produces antinociception and behavioural analgesia. Both V1a and OTR participate in those effects. Our findings suggest that antinociception could be produced in a local manner using a novel vasopressin receptor located in cutaneous sensorial fibres. Additionally, subcutaneous AVP also produces important systemic effects such as respiratory and locomotor impairment. SIGNIFICANCE: Our findings support that AVP produces peripheral antinociception and behavioural analgesia in a local manner; nevertheless, systemic effects are also presented. Additionally, this is the first detailed electrophysiological analysis of AVP antinociceptive action after subcutaneous administration. The results are reasonably explained by the demonstration of V1A R and OTR in cutaneous fibres.

Axons of Individual Dorsal Horn Neurons Bifurcated to Project in Both the Anterolateral and the Postsynaptic Dorsal Column Systems.

Sensory information stimulates receptors of somatosensory system neurons generating a signal that codifies the characteristics of peripheral stimulation. This information reaches the spinal cord and is relayed to supra-spinal structures through two main systems: the postsynaptic dorsal column-medial lemniscal (DC-ML) and the anterolateral (AL) systems. From the classical point of view, the DC-ML has an ipsilateral ascending pathway to the Gracilis (GRA) or Cuneate (CUN) nuclei and the AL has a contralateral ascending pathway to the ventral posterolateral (VPL) thalamic nucleus. These two systems have been the subject of multiple studies that established their independence and interactions. To analyze the ascending projections of L1-L5 spinal dorsal horn neurons in the rat, two retrograde neuronal tracers were injected into the GRA and the VPL. Additionally, an electrophysiological study was performed by applying electrical stimulation at the GRA or VPL and recording antidromic evoked activity in single unit spinal cord cells. Importantly, a subset of spinal dorsal horn neurons exhibited double staining, indicating that these neurons projected to both the GRA and the VPL. These double-stained neurons were located on both sides of the dorsal horn of the spinal cord. The spinal dorsal horn neurons exhibited antidromic and collision activities in response to both GRA and VPL electrical activation. These results show spinal cord neurons with bifurcated bilateral projections to both the DC-ML and AL systems. Based on these results, we named these neurons bilateral and bifurcated cells.

[Clinical profile and satisfaction with anticoagulated treatment in patients with non-valvular atrial fibrillation attended in Internal Medicine and Neurology departments of Spain]. / Perfil clinico y satisfaccion con el tratamiento anticoagulante en pacientes con fibrilacion auricular no valvular atendidos en consultas de medicina interna y neurologia de España.

AIM: To determine the clinical profile, management of anticoagulant treatment and satisfaction related to anticoagulation in outpatients with nonvalvular atrial fibrillation attended in Neurology or Internal Medicine departments of Spain. PATIENTS AND METHODS: Cross-sectional and multicenter study, in which 1,337 outpatients were included. Patients fulfilled ACTS, SAT-Q and EQ-5D questionnaires. RESULTS: 865 patients (64.7%) were recruited from Neurology department and 472 (35.3%) from Internal Medicine department. Those patients attended in Internal Medicine department were older and had more frequently hypertension, diabetes, heart failure, renal insufficiency and peripheral artery disease. Those patients attended in Neurology department had more commonly prior stroke. Overall, CHADS2 score was 3.2 ± 1.3, CHA2DS2-Vasc 4.8 ± 1.5 and HAS-BLED 2.0 ± 0.9. All scores were higher in those patients attended in Neurology department. Globally, 56.1% of patients were taking vitamin K antagonists, more commonly in Internal Medicine department. The adequate percent of time in therapeutic range was 47% (Rosendaal), without significant differences between groups. Satisfaction with oral anticoagulation was high in both groups, but higher in those attended in Neurology department, and higher in those individuals taking direct oral anticoagulants compared with vitamin K antagonists. CONCLUSIONS: Although there were some differences in the clinical profile of patients with atrial fibrillation attended in Neurology or Internal Medicine departments, all of them had many comorbidities and a high thromboembolic risk. Despite INR control was poor, the most common oral anticoagulant used were vitamin K antagonists. Satisfaction related to oral anticoagulation was high.

TITLE: Perfil clinico y satisfaccion con el tratamiento anticoagulante en pacientes con fibrilacion auricular no valvular atendidos en consultas de medicina interna y neurologia de España.Objetivo. Determinar el perfil clinico, el manejo del tratamiento anticoagulante y la satisfaccion relacionada con la anticoagulacion en pacientes con fibrilacion auricular no valvular atendidos en consultas de neurologia o medicina interna de España. Pacientes y metodos. Estudio prospectivo, transversal y multicentrico en el que se incluyo a 1.337 pacientes, que completaron los cuestionarios Anti-Clot Treatment Scale, Self-Assessment of Treatment Questionnaire y EuroQol-5 dimensions. Resultados. 865 pacientes (64,7%) provenian de consultas de neurologia, y 472 (35,3%), de medicina interna. Los atendidos en medicina interna eran mayores, tenian mas hipertension, diabetes, insuficiencia cardiaca, insuficiencia renal y arteriopatia periferica. Los pacientes atendidos en neurologia tenian mas antecedentes de ictus. Globalmente, la escala CHADS2 fue 3,2 ± 1,3; CHA2DS2Vasc, 4,8 ± 1,5, y HAS-BLED, 2,0 ± 0,9, y las puntuaciones mas altas fueron en neurologia. El 56,1% tomaba antagonistas de la vitamina K, lo que era mas comun en medicina interna. El porcentaje de tiempo en rango terapeutico adecuado fue del 47% (Rosendaal), sin diferencias entre los grupos. La satisfaccion con el tratamiento anticoagulante oral fue elevada en ambos grupos, aunque mayor en los sujetos atendidos en neurologia, y mayor con los anticoagulantes orales de accion directa que con los antagonistas de la vitamina K. Conclusiones. Aunque existieron ciertas diferencias en el perfil clinico de los pacientes con fibrilacion auricular atendidos en neurologia o medicina interna, todos presentaban multiples comorbilidades y un riesgo tromboembolico elevado. A pesar de que el control del indice internacional normalizado fue pobre, el anticoagulante oral mas empleado fueron los antagonistas de la vitamina K. La satisfaccion con el tratamiento anticoagulante oral fue alta.

Possible mechanisms involved in the vasorelaxant effect produced by clobenzorex in aortic segments of rats.

Clobenzorex is a metabolic precursor of amphetamine indicated for the treatment of obesity. Amphetamines have been involved with cardiovascular side effects such as hypertension and pulmonary arterial hypertension. The aim of the present study was to investigate whether the direct application of 10-9-10-5 M clobenzorex on isolated phenylephrine-precontracted rat aortic rings produces vascular effects, and if so, what mechanisms may be involved. Clobenzorex produced an immediate concentration-dependent vasorelaxant effect at the higher concentrations (10-7.5-10-5 M). The present outcome was not modified by 10-6 M atropine (an antagonist of muscarinic acetylcholine receptors), 3.1×10-7 M glibenclamide (an ATP-sensitive K+ channel blocker), 10-3 M 4-aminopyridine (4-AP; a voltage-activated K+ channel blocker), 10-5 M indomethacin (a prostaglandin synthesis inhibitor), 10-5 M clotrimazole (a cytochrome P450 inhibitor) or 10-5 M cycloheximide (a general protein synthesis inhibitor). Contrarily, the clobenzorex-induced vasorelaxation was significantly attenuated (P<0.05) by 10-5 M L-NAME (a direct inhibitor of nitric oxide synthase), 10-7 M ODQ (an inhibitor of nitric oxide-sensitive guanylyl cyclase), 10-6 M KT 5823 (an inhibitor of protein kinase G), 10-2 M TEA (a Ca2+-activated K+ channel blocker and non-specific voltage-activated K+ channel blocker) and 10-7 M apamin plus 10-7 M charybdotoxin (blockers of small- and large-conductance Ca2+-activated K+ channels, respectively), and was blocked by 8×10-2 M potassium (a high concentration) and removal of the vascular endothelium. These results suggest that the direct vasorelaxant effect by clobenzorex on phenylephrine-precontracted rat aortic rings involved stimulation of the NO/cGMP/PKG/Ca2+-activated K+ channel pathway.

Possible mechanisms involved in the vasorelaxant effect produced by clobenzorex in aortic segments of rats

Clobenzorex is a metabolic precursor of amphetamine indicated for the treatment of obesity. Amphetamines have been involved with cardiovascular side effects such as hypertension and pulmonary arterial hypertension. The aim of the present study was to investigate whether the direct application of 10-9-10-5 M clobenzorex on isolated phenylephrine-precontracted rat aortic rings produces vascular effects, and if so, what mechanisms may be involved. Clobenzorex produced an immediate concentration-dependent vasorelaxant effect at the higher concentrations (10-7.5-10-5 M). The present outcome was not modified by 10-6 M atropine (an antagonist of muscarinic acetylcholine receptors), 3.1×10-7 M glibenclamide (an ATP-sensitive K+ channel blocker), 10-3 M 4-aminopyridine (4-AP; a voltage-activated K+ channel blocker), 10-5 M indomethacin (a prostaglandin synthesis inhibitor), 10-5 M clotrimazole (a cytochrome P450 inhibitor) or 10-5 M cycloheximide (a general protein synthesis inhibitor). Contrarily, the clobenzorex-induced vasorelaxation was significantly attenuated (P<0.05) by 10-5 M L-NAME (a direct inhibitor of nitric oxide synthase), 10-7 M ODQ (an inhibitor of nitric oxide-sensitive guanylyl cyclase), 10-6 M KT 5823 (an inhibitor of protein kinase G), 10-2 M TEA (a Ca2+-activated K+ channel blocker and non-specific voltage-activated K+ channel blocker) and 10-7 M apamin plus 10-7 M charybdotoxin (blockers of small- and large-conductance Ca2+-activated K+ channels, respectively), and was blocked by 8×10-2 M potassium (a high concentration) and removal of the vascular endothelium. These results suggest that the direct vasorelaxant effect by clobenzorex on phenylephrine-precontracted rat aortic rings involved stimulation of the NO/cGMP/PKG/Ca2+-activated K+ channel pathway.

Midriasis benigna episódica. Experiencia en una consulta monográfica de neuro-oftalmología de un hospital terciario / Benign episodic mydriasis. Experience in a specialist neuro-ophthalmology clinic of a tertiary hospital

Introducción: Las anisocorias son un motivo de consulta relativamente frecuente en unidades de neuro-oftalmología (UNO). Suponen un reto diagnóstico por la variedad de procesos que pueden ocasionarla. En ausencia de síntomas acompañantes, suelen estar ocasionadas por procesos benignos. La midriasis benigna episódica (MBE) es una causa aislada de asimetría pupilar intermitente, de fisiopatología no esclarecida y predominio en mujeres jóvenes migrañosas. Sujetos, material y métodos: Describimos las características epidemiológicas y clínicas de los pacientes con MBE valorados en una UNO de un hospital terciario. Resultados: Un total de 7 pacientes fueron diagnosticadas de MBE. Todas eran mujeres, con edad media de 33 ± 10 años. Los motivos de consulta fueron asimetría pupilar (n = 5) y visión borrosa (n = 2) de presentación fundamentalmente unilateral (n = 6). La duración fue variable, desde minutos hasta 48 h. Cuatro pacientes (57%) presentaban como antecedente migraña sin aura. En estas, los episodios eran recidivantes (75%), de minutos de duración (75%) y asociaban visión borrosa (50%). Los estudios de neuroimagen (resonancia magnética cerebral) fueron normales. Discusión: La midriasis benigna episódica se presenta predominantemente en mujeres jóvenes. Se asocia al antecedente de migraña y hace plantear si se trata de un síntoma acompañante de la migraña, un aura migrañosa o de migraña oftalmopléjica. De predominio unilateral, puede sin embargo existir alternancia del ojo afectado o ser bilateral de forma simultánea, lo que nos hace cuestionarnos la idoneidad del término. En ausencia de síntomas acompañantes y en episodios de corta duración, no consideramos necesaria la realización de pruebas de imagen

Introduction: Anisocorias are a relatively frequent reason for consultation in neuro-ophthalmology units. They remain a diagnostic challenge for specialists as they may be due to several etiological factors. In the absence of other accompanying symptoms, anisocorias are usually due to benign processes. Benign episodic mydriasis (BEM) is an isolated cause of intermittent pupil asymmetry, in which the pathophysiology is still not fully understood, and is predominant in young women with migraine. Subjects, material and methods: We describe the epidemiological and clinical characteristics of patients with BEM, assessed in a neuro-ophthalmology unit in a tertiary hospital. Results: A total of 7 patients were diagnosed with BEM, all of them females, with a mean age of 33 ± 10 yrs. The patients presented with pupil asymmetry (n = 5) and blurred vision (n = 2), and 6 of the 7 patients had unilateral involvement. The duration of impairment varied from a few minutes to 48 hrs. Four patients (57%) had a clinical history of migraine without aura. The episodes in these 4 patients were recurrent (75%), often lasted for a few minutes (75%), and had associated blurred vision (50%). The neuroimaging studies were normal. Discussion: BEM appears predominantly in young women. It is frequently related to a previous history of migraine, and the specialist must consider if it is a concomitant symptom of common migraine, migraine with aura, or ophthalmoplegic migraine. Although BEM has unilateral predominance, there may be alternation of the affected eye or even bilateral impairment during the same episode, which makes us question the adequacy of the term to describe the process. Imaging tests are not recommended in the absence of other accompanying symptoms, or in short-term episodes

Benign episodic mydriasis. Experience in a specialist neuro-ophthalmology clinic of a tertiary hospital.

INTRODUCTION: Anisocorias are a relatively frequent reason for consultation in neuro-ophthalmology units. They remain a diagnostic challenge for specialists as they may be due to several etiological factors. In the absence of other accompanying symptoms, anisocorias are usually due to benign processes. Benign episodic mydriasis (BEM) is an isolated cause of intermittent pupil asymmetry, in which the pathophysiology is still not fully understood, and is predominant in young women with migraine. SUBJECTS, MATERIAL AND METHODS: We describe the epidemiological and clinical characteristics of patients with BEM, assessed in a neuro-ophthalmology unit in a tertiary hospital. RESULTS: A total of 7 patients were diagnosed with BEM, all of them females, with a mean age of 33 ± 10 yrs. The patients presented with pupil asymmetry (n = 5) and blurred vision (n = 2), and 6 of the 7 patients had unilateral involvement. The duration of impairment varied from a few minutes to 48 hrs. Four patients (57%) had a clinical history of migraine without aura. The episodes in these 4 patients were recurrent (75%), often lasted for a few minutes (75%), and had associated blurred vision (50%). The neuroimaging studies were normal. DISCUSSION: BEM appears predominantly in young women. It is frequently related to a previous history of migraine, and the specialist must consider if it is a concomitant symptom of common migraine, migraine with aura, or ophthalmoplegic migraine. Although BEM has unilateral predominance, there may be alternation of the affected eye or even bilateral impairment during the same episode, which makes us question the adequacy of the term to describe the process. Imaging tests are not recommended in the absence of other accompanying symptoms, or in short-term episodes.

Trombólisis intravenosa con activador tisular del plasminógeno recombinante en los síndromes de alarma vascular / Intravenous thrombolysis with recombinant tissue plasminogen activator in vascular warning syndromes

Introducción: Los síndromes de alarma vascular constituyen una situación de urgencia neurológica, debido a su alto riesgo de ictus establecido. Actualmente no existe evidencia firme sobre cuál debe ser el tratamiento de elección en estos casos. El objetivo de este trabajo es describir el papel de la trombólisis con rTPA intravenosa en el tratamiento de los síndromes de alarma vascular. Material y métodos: Se revisaron los casos propios y los existentes en la literatura en los que se hubiese tratado con rTPA intravenoso a los pacientes con clínica neurológica fluctuante. Resultados: Se obtuvieron 3 casos propios y 19 recogidos de la literatura (15 varones y 7 mujeres). La edad media fue de 68,7 ± 9 años (rango: 52-84 años). La frecuencia media de episodios antes del tratamiento fue de 4 (rango: 2-15 episodios). La puntuación en la escala NIH (NIHSS) máxima estuvo en un rango entre 6-22 según cada caso. Se dispuso de la NIHSS a las 24 h del tratamiento en 8 de los casos: en 6 (75%) fue de 0, y en 2 (25%) de 12. La escala de Rankin modificada (ERm) a los 3 meses del tratamiento fue de 0-1 en 18 (81,8%) de los pacientes: 8/10 (80%) en los síndromes de alarma lacunar, 6/7 (85,7%) en los síndromes de alarma basilar y 4/5 (80%) en pacientes con fluctuaciones que no entraban dentro de estos 2 grupos. Conclusiones: El tratamiento con rTPA intravenoso podría suponer una alternativa terapéutica eficaz y segura en los pacientes con clínica neurovascular fluctuante, aunque se necesitan estudios bien diseñados que establezcan de forma clara cuál es el papel real de la trombólisis intravenosa con rTPA en los síndromes de alarma vascular

ntroduction: Vascular warning syndromes constitute a neurological emergency due to their associated high risk of established stroke. At present, there is no strong evidence indicating the best treatment for these patients. The aim of this paper is to describe the function of intravenous rt-PA thrombolysis in the treatment of vascular warning syndromes. Material and methods: We reviewed our hospital records and the literature to find patients with neurologically fluctuating profiles and who underwent intravenous rt-PA thrombolysis. Results: We retrieved 3 cases from our hospital records and 19 from the literature (15 males and 7 females). Mean age was 68.7±9 years (range: 52-84 years). The mean number of episodes before treatment was 4 (range: 2-15 episodes). The maximum NIHSS scores ranged from 6 to 22 in different patients. We obtained 24-hour post-treatment NIHSS scores in 8 cases; of these cases, 6 (75%) had a score of 0, and the other 2 (25%) had a score of 12. The Modified Rankin Score calculated at 3 months of treatment was 0 or 1 in 18 patients (81.8%); these 18 comprised 8 of the 10 patients with lacunar warning syndromes (80%), 6 of the 7 with basilar warning syndromes (85.7%), and 4 of the 5 with fluctuating non-lacunar, non-basilar warning syndromes (80%). Conclusions: Intravenous rt-PA treatment may constitute an effective and safe therapeutic alternative for patients with neurovascular fluctuations. However, well-designed studies are needed to determine the role of intravenous rt-PA thrombolysis in cases of vascular warning syndrome