Evaluación de la asistencia telefónica a demanda en cuidadores de pacientes con enfermedad de Alzheimer / An assessesment of telephone assistance systems for caregivers of patients with Alzheimer's disease

Introducción: La asistencia telefónica a demanda (ATAD) es una práctica habitual en las consultas de Neurología; no obstante, los estudios que valoran dicha modalidad de asistencia sanitaria son escasos. Hemos evaluado la ATAD en cuidadores de pacientes con enfermedad de Alzheimer (EA) desde el punto de vista económico y de la satisfacción percibida por el cuidador principal. Pacientes y métodos: Se seleccionó a 97 pacientes con diagnóstico de EA según criterios NINCDS-ADRDA y sus respectivos 97 cuidadores principales. Estudiamos los gastos diferenciales entre las modalidades asistenciales presencial y a demanda a lo largo de 12 meses. A los 12 meses se valoró la satisfacción de los cuidadores principales mediante un cuestionario autoadministrado. Resultados: El ahorro que supuso la ATAD frente la asistencia presencial fue de 80,05 ± 27,07 euros por usuario. Al 73,6% de los cuidadores que usaron la ATAD les parece mejor o mucho mejor esta que la asistencia presencial, mientras que al 2,6% de los cuidadores les parece peor o mucho peor. Conclusiones: La ATAD supone un servicio de salud eficiente en el seguimiento de los usuarios con EA en las consultas de Neurología y la satisfacción de los usuarios fue alta, por lo que consideramos que debería incluirse en la cartera de servicios del sistema sanitario (AU)

Introduction: Telephone assistance is a common practice in neurology, although there are only a few studies about this type of healthcare. We have evaluated a Telephone Assistance System (TAS) for caregivers of patients with Alzheimer's disease (AD) from 2 points of view: financially and according to the level of satisfaction of the caregiver. Patients and methods: 97 patients with a diagnosis of AD according to NINCDS-ADRDA criteria and their 97 informal caregivers were selected. We studied cost differences between on-site assistance and telephone assistance (TAS) for 12 months. We used a self-administered questionnaire to assess the level of satisfaction of caregivers at the end of the study period. Results: TAS savings amounted to 80.05 ± 27.07 euros per user. 73.6% of the caregivers consider TAS a better or much better system than on-site assistance, while only 2.6% of the caregivers considered TAS a worse or much worse system than on-site assistance. Conclusions: Telephone assistance systems are an efficient healthcare resource for monitoring patients with AD in neurology departments. Furthermore, the level of user satisfaction was high. We therefore consider that telephone assistance service should be offered by healthcare services (AU)

An assessesment of telephone assistance systems for caregivers of patients with Alzheimer's disease. / Evaluación de la asistencia telefónica a demanda en cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: Telephone assistance is a common practice in neurology, although there are only a few studies about this type of healthcare. We have evaluated a Telephone Assistance System (TAS) for caregivers of patients with Alzheimer's disease (AD) from 2 points of view: financially and according to the level of satisfaction of the caregiver. PATIENTS AND METHODS: 97 patients with a diagnosis of AD according to NINCDS-ADRDA criteria and their 97 informal caregivers were selected. We studied cost differences between on-site assistance and telephone assistance (TAS) for 12 months. We used a self-administered questionnaire to assess the level of satisfaction of caregivers at the end of the study period. RESULTS: TAS savings amounted to 80.05 ± 27.07 euros per user. 73.6% of the caregivers consider TAS a better or much better system than on-site assistance, while only 2.6% of the caregivers considered TAS a worse or much worse system than on-site assistance. CONCLUSIONS: Telephone assistance systems are an efficient healthcare resource for monitoring patients with AD in neurology departments. Furthermore, the level of user satisfaction was high. We therefore consider that telephone assistance service should be offered by healthcare services.

[Miller Fisher syndrome as the presenting symptom of Wernicke's encephalopathy]. / Síndrome de Miller Fisher como presentación de una encefalopatía de Wernicke.

INTRODUCTION: Wernicke's encephalopathy is an acute neuropsychiatric syndrome resulting from a thiamine deficit, which is defined by the characteristic triad of confusion, ophthalmoparesis and ataxia, although rare presentations have been reported that delay its diagnosis. Miller Fisher syndrome is characterised by the triad ophthalmoparesis, ataxia and areflexia and is considered to be a variant of Guillain-Barré syndrome; its differential diagnosis includes Wernicke's encephalopathy. CASE REPORT: A 75-year-old female with chronic digestive disorders, who developed an acute picture of bilateral internuclear ophthalmoplegia, ataxia and areflexia, with proteinocytologic dissociation in cerebrospinal fluid; accordingly, an initial diagnosis of Miller Fisher syndrome was proposed. Results of the neurophysiological studies were normal; anti-GQ1b antibodies were negative; and magnetic resonance imaging of the brain suggested Wernicke's encephalopathy. The response to thiamine was spectacular. CONCLUSIONS: The similarities in the distribution of the lesions of the two conditions, in the signs and symptoms and the lab findings, as well as the influence of certain misleading factors (hyponatremia, advanced age), went to make up a typical syndrome that favoured a wrong presumptive aetiological diagnosis. This was corrected at an early stage, however, in light of the results of certain diagnostic tests and after observing the therapeutic response. In addition to being an atypical presentation for Wernicke's encephalopathy, this case highlights the fact that for there to be an agreement between the syndromic and aetiological diagnoses it is necessary to carry out a correct differential diagnosis based on details from the patient's history, on appropriate complementary tests and on the follow-up study of how the patients progress, even when we come across typical syndromes that are usually related to a predominant aetiopathogenesis.

Síndrome de Miller Fisher como presentación de una encefalopatía de Wernicke / Miller fisher syndrome as the presenting symptom of wernicke’s encephalopathy

La encefalopatía de Wernicke es un síndrome neuropsiquiátrico agudo secundario a un déficit de tiamina, definido por la tríada característica de confusión, oftalmoparesia y ataxia, aunque se han descrito presentaciones raras que retrasan el diagnóstico. El síndrome de Miller Fisher se caracteriza por la tríada de oftalmoparesia, ataxia y arreflexia,y se considera una variante del síndrome de Guillain-Barré; su diagnóstico diferencial incluye la encefalopatía de Wernicke. Caso clínico. Mujer de 75 años con trastorno digestivo crónico, que desarrolla un cuadro agudo de oftalmoplejía internuclearbilateral, ataxia y arreflexia, con disociación proteinocitológica en el líquido cefalorraquídeo, por lo que se propuso el diagnóstico inicial de síndrome de Miller Fisher. Los estudios neurofisiológicos fueron normales, los anticuerpos anti-GQ1b,negativos, y la resonancia magnética cerebral sugirió una encefalopatía de Wernicke; la respuesta a la tiamina fue espectacular. Conclusiones. Las similitudes en la distribución lesional de ambas entidades, en la semiología y los resultados analíticos, así como la influencia de ciertos factores de confusión (hiponatremia, edad avanzada), conformaron un síndrome típico que favoreció un diagnóstico de sospecha etiológico erróneo, que pudo modificarse precozmente a la luz de ciertas pruebas diagnósticasy después de la respuesta terapéutica. Además de tratarse de una presentación atípica para una encefalopatía de Wernicke, este caso recuerda que la conjunción del diagnóstico sindrómico con el etiológico pasa por realizar un correcto diagnóstico diferencial apoyándonos en detalles de la anamnesis, en las pruebas complementarias necesarias y en el seguimientoevolutivo de los pacientes, incluso cuando nos encontramos ante síndromes típicos habitualmente relacionados con una etiopatogenia predominante

Wernicke’s encephalopathy is an acute neuropsychiatric syndrome resulting from a thiamine deficit,which is defined by the characteristic triad of confusion, ophthalmoparesis and ataxia, although rare presentations have been reported that delay its diagnosis. Miller Fisher syndrome is characterised by the triad ophthalmoparesis, ataxia and areflexiaand is considered to be a variant of Guillain-Barré syndrome; its differential diagnosis includes Wernicke’s encephalopathy. Case report. A 75-year-old female with chronic digestive disorders, who developed an acute picture of bilateral internuclear ophthalmoplegia, ataxia and areflexia, with proteinocytologic dissociation in cerebrospinal fluid; accordingly, an initial diagnosis of Miller Fisher syndrome was proposed. Results of the neurophysiological studies were normal; anti-GQ1b antibodies were negative; and magnetic resonance imaging of the brain suggested Wernicke’s encephalopathy. The response to thiamine was spectacular. Conclusions. The similarities in the distribution of the lesions of the two conditions, in the signs and symptoms and the lab findings, as well as the influence of certain misleading factors (hyponatremia, advanced age), wentto make up a typical syndrome that favoured a wrong presumptive aetiological diagnosis. This was corrected at an early stage, however, in light of the results of certain diagnostic tests and after observing the therapeutic response. In addition to being anatypical presentation for Wernicke’s encephalopathy, this case highlights the fact that for there to be an agreement between the syndromic and aetiological diagnoses it is necessary to carry out a correct differential diagnosis based on details from thepatient’s history, on appropriate complementary tests and on the follow-up study of how the patients progress, even when we come across typical syndromes that are usually related to a predominant aetiopathogenesis

Leucoencefalopatía posterior reversible: la lista de culpables aumenta. Respuesta / Reversible posterior leukoencephalopathy: the guilty list is increasing. Response

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Malformación arteriovenosa asociada a síndrome de Klippel-Trenaunay-Weber / No disponible

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Cambio de permeabilidad de la barrera hematoencefálica tras isquemia cerebral / Change of hematoencephalic barrier patency after cerebral ischemia

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Leucoencefalopatía posterior reversible: ¿debe ser la localización un factor definitorio? / Reversible posterior leukoencephalopathy: should the area involved be in the name of the syndrome?

Introducción. La leucoencefalopatía posterior reversible constituye un síndrome clinicorradiológico caracterizado por cefalea, vómitos y signos de focalidad neurológica coincidentes con lesiones en sustancia blanca de predominio posterior y generalmente reversible. Caso clínico. Presentamos un paciente pluripatológico que presentó un cuadro compatible con dicho síndrome. Se inició con crisis comiciales generalizadas durante un ingreso hospitalario. Entre sus antecedentes figuraban varios de los factores que hoy día se consideran involucrados en la etiopatogenia del mismo. Destacan la insuficiencia renal, la hipertensión arterial y los inmunosupresores. En la resonancia magnética aparecían lesiones compatibles pero que afectaban a varios territorios vasculares. Se confirmó la sospecha diagnóstica tras la resolución clínica y radiológica del proceso, sin que el paciente volviera a presentar nuevas crisis tras la normalización de la neuroimagen. Conclusiones. Planteamos una revisión de la etiopatogenia. Cuestionamos la idoneidad de la denominación del síndrome dada la extensión de las lesiones en la neuroimagen

Introduction. Reversible posterior leukoencephalopathy (RPL) is a syndrome of headache, vomiting and focal neurologic deficits with reversible lesions in posterior areas of the brain at the same time. Case report. We describe the case of a patient with a background of multiple diseases presenting a syndrome compatible with reversible posterior leukoencephalopathy. He presented seizures during a hospital stay. Among his background, he had several factors that are presently considered to be involved in its etiopathogeny. The most important ones are renal failure, hypertension and immunosuppressive agents. Magnetic resonance (MR) showed radiological typical changes of RPL syndrome but not only affecting the posterior regions of the brain. We confirmed the diagnostic suspicion after complete clinical and radiological recovery of the condition, and the patient did not have new episodes after the normalization of the neuroimage. Conclusions. We made a review of the etiopathogeny. We question the adequacy of the name of the syndrome, given the extension of the lesions in the neuroimage

[Reversible posterior leukoencephalopathy: should the area involved be in the name of the syndrome?]. / Leucoencefalopatía posterior reversible: debe ser la localización un factor definitorio?

INTRODUCTION: Reversible posterior leukoencephalopathy (RPL) is a syndrome of headache, vomiting and focal neurologic deficits with reversible lesions in posterior areas of the brain at the same time. CASE REPORT: We describe the case of a patient with a background of multiple diseases presenting a syndrome compatible with reversible posterior leukoencephalopathy. He presented seizures during a hospital stay. Among his background, he had several factors that are presently considered to be involved in its etiopathogeny. The most important ones are renal failure, hypertension and immunosuppressive agents. Magnetic resonance (MR) showed radiological typical changes of RPL syndrome but not only affecting the posterior regions of the brain. We confirmed the diagnostic suspicion after complete clinical and radiological recovery of the condition, and the patient did not have new episodes after the normalization of the neuroimage. CONCLUSIONS: We made a review of the etiopathogeny. We question the adequacy of the name of the syndrome, given the extension of the lesions in the neuroimage.

[Cardiac disease in intracerebral hematomas]. / Enfermedad cardíaca en los hematomas intracerebrales.

INTRODUCTION AND OBJECTIVE: The Central Nervous System (CNS) plays an essential role in the regulation of the cardiac function. There is strong evidence that many CNS lesions, mainly those of hemorrhagic origin, may induce repolarization abnormalities and enlargement of the QT interval (ECG changes) and several types of arrhythmias. In some cases these changes have been related to sudden death. The imbalance between the sympathetic and parasympathetic systems, favoring the former, seems to be the etiopathogenic factor. MATERIAL AND METHODS: We have carried out a study on thirty-two in-patients suffering from non-severe intracerebral hemorrhage, by means of a Holter ECG examination within the first 72 hours and a second record after two months. We have assessed any significative differences on the ECG findings in relation to the location of the hematoma (left or right hemispheres) and the presence of a personal history of arterial hypertension and/or heart disease. RESULTS: One or more ECG changes were present in 69.2% of the patients and 73% showed one or more rhythm abnormalities. There was a higher incidence of supraventricular arrhythmias associated with the right hemisphere hematomas, with an statistical significance for the atrial extrasystolia. No differences were found between the group with a previous history of hypertension and/or heart disease and the one without these conditions. There were two cases of sudden death, both with left hemisphere hematomas, and in one of them the previous rhythm abnormalities were recorded. CONCLUSIONS: This study corroborates the hypothesis that right hemispheric hematomas induce supraventricular arrhythmias more frequently. The possible association between severe ventricular arrhythmias and sudden death with left-hemisferic hematomas should be studied in a higher number of patients. We recommend monitoring every acute case of intracerebral hematoma when possible.

[Vascular risk factors in patients with infratentorial vertebrobasilar ischemia]. / Factores de riesgo vascular en pacientes con isquemia en el territorio vertebrobasilar infratentorial.

INTRODUCTION: Arteriosclerosis is the commonest aetiology of vertebro-basilar ischemia (VBI). In the literature few studies mention the risk profile of cerebrovascular accidents at this site. MATERIAL AND METHODS: In order to establish whether this profile has specific characteristics, we carried out a transversal study of 70 patients with VBI of artherothrombotic origin situated in the brain stem or cerebellum, determining the prevalence of the main risk factors (RF). The results were compared with a control group of individuals who had no cerebral vascular pathology and also with another group who had arteriosclerotic obstructive lesions of the carotid artery as an example of involvement of another vascular territory. RESULTS: In the the group of patients with VBI we found greater prevalence of hypertension, smoking, ischaemic cardiopathy, peripheral vascular disease and excessive alcohol consumption together with raised levels of arterial hypertension, haematocrit, haemoglobin and total cholesterol as compared with the control group and within a similar range to the group of patients with ischemia of the carotid territory. We underline the high prevalence of diabetes in patients with VBI (45.7%), considerably greater than that of the control group (12.5%), than those with carotid pathology (20.4%) and that described in the literature (17-25%). CONCLUSIONS: According to our results, the prevalence of RF in VBI and in carotid pathology is similar, except in the case of diabetes. This may play a more decisive role in territory such as the vertebro-basilar, where vascularization is basically by small calibre vessels.

[A cholesterol embolism during heparin treatment]. / Embolismo de colesterol durante el tratamiento con heparina.

The cholesterol embolization is a rare complication of atherosclerosis. A direct implication of the treatment with anticoagulants in the etiology of the disease has been questioned, and now such therapy is considered more as an adjuvant factor with angiographic procedures than as a cause. A 60-year-old patient with an ischemic cardiomyopathy presented cholesterol embolization syndrome, confirmed by cutaneous biopsy histologic examination during treatment with heparin. Spontaneous evolution was favourable and only limited amputation of the lower limbs were required. The authors think that cholesterol emboli have a direct relationship to the treatment with heparin in this case, there being no other causes to justify its appearance.