[Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy]. / Influência da dose de propofol e dos componentes sanguíneos na duração das convulsões elétricas em eletroconvulsoterapia.

BACKGROUND AND OBJECTIVES: Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. METHODS: After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. RESULTS: 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081s for every mg.kg-1 of propofol; CI95%: -7906 to -0.255, p=0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. CONCLUSIONS: Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.

Cefalea pulsátil / Pulsatile headache

Presentamos el caso de una adolescente de 16 años de edad que, estando previamente asintomática y sin historia clínica de haber padecido ninguna migraña, presenta de manera progresiva, en el plazo de una semana, una cefalea holocraneal de características pulsátiles, que no mejoraba con analgésicos a dosis altas. Ante la persistencia del cuadro y los criterios de alarma que presentaba fue fundamental el uso de la Resonancia Magnética Nuclear (RMN) para su diagnóstico (AU)

We report the case of a 16-year-old female teenager, previously asymptomatic and without a medical record of migraine-like headaches, who progressively developed a pulsating holocraneal headache, which did not improve with high doses of painkillers. Given the persistence of the clinical picture and the alarm criteria, the use of Nuclear Magnetic Resonance (RMN) was fundamental for achieving an accurate diagnosis (AU)

Siesta poco reparadora / A not very restful nap

Presentamos el caso de una mujer de 74 años de edad que estando previamente bien presenta de manera súbita dolor interescapular acompañado de alteración de la sensibilidad y la fuerza en miembro superior izquierdo. Ante esta clínica se solicitó Resonancia Magnética Nuclear (RMN) que confirmó el diagnóstico de hematoma cervical epidural espontáneo (AU)

The present is the case of a 74 years old previously healthy woman who felt sudden interscapular pain along with strength and sensitivity impairment in her right arm. Facing these clinical symptoms, a Magnetic Resonance Imaging test (MRI) was performed which confirmed the diagnosis of spontaneous cervical epidural hematoma (AU)

Cefalea con signos de alarma / Headache with warning signs

La cefalea es uno de los motivos más frecuentes de consulta en Atención Primaria, constituyendo cerca del 25% de las consultas neurológicas atendidas por el médico de familia. Esta entidad clínica es generalmente un síntoma benigno y sólo ocasionalmente es manifestación de una enfermedad grave (tumor, hemorragia subaracnoidea, meningitis, etc). La etiología y las manifestaciones clínicas de esta entidad nosológica son muy variadas y es capital la detección de los criterios de alarma en cuanto a instauración, su progresión y los síntomas asociados para un correcto manejo de las mismas. Los procesos odontológicos también son atendidos con mucha frecuencia en el primer nivel asistencial sanitario y muy raramente tienen complicaciones graves. Presentamos el caso de un paciente con cefalea con signos de alarma provocada por una complicación de un proceso odontológico (AU)

Headache is one of the most frequent reasons for primary care consultations, making up around 25% of neurological consultations handled by the family doctor. This clinical condition is usually a benign symptom and is only occasionally a sign of serious illness (tumour, subarachnoid haemorrhage, meningitis etc.). The cause and clinical signs of this disease are very diverse and detection of warning signs concerning onset, progression and associated symptoms is of utmost importance in order to manage them correctly. Dental processes are also very frequently dealt with at the first level of healthcare and rarely have serious complications. We report the case of a patient with a headache and warning signs caused by a complication in a dental process (AU)

Absceso de Psoas / Psoas abscess

El absceso de psoas es una entidad infrecuente y suele estar relacionada con patología gastrointestinal. Las manifestaciones clínicas suelen ser inespecíficas por lo que el diagnóstico suele ser tardío y como consecuencia de ello el pronóstico malo. Es importante destacar que ante la presencia de un absceso o enfisema en el muslo se debe tener siempre en cuenta la posibilidad de un origen abdominal, ya que el drenaje quirúrgico urgente y agresivo es el único tratamiento eficaz en estas situaciones (AU)

Psoas abscess is a rare clinical entity often associated with gastrointestinal disease. Clinical manifestations are usually non-specific and therefore diagnosis is delayed leading to poor prognosis. It is important to emphasis that when a patient presents with an abscess or cutaneous emphysema in the muscle the possibility of abdominal origin should always be considered, because immediate, aggressive surgical drainage is the only effective treatment (AU)