Breve historia de la neurorradiología española / A brief history of neuroradiology in Spain

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Results of the section of the filum terminale in 20 patients with syringomyelia, scoliosis and Chiari malformation.

BACKGROUND: Spinal cord traction caused by a tight filum terminale may be considered a pathogenic mechanism involved in the development of syringomyelia, the Chiari malformation (type I) and scoliosis. Section of the filum terminale is proposed as a useful surgical approach in these conditions. METHODS: Between April 1993 and July 2003, a total of 20 patients (8 men and 12 women) with a mean age of 33.5 years underwent section of the filum terminale with or without opening of the dural sac through a standard sacrectomy. Eight patients suffered from scoliosis, 5 from syringomyelia, 2 from Chiari malformation and 5 with a combination of these conditions. FINDING: After section of the filum terminale, patients with syringomyelia showed an early clinical improvement of dysaesthesia, thermo-anaesthesia, hypo-aesthesia and walking difficulties. Rising of the medullary conus was also observed. In patients with scoliosis, back pain improved dramatically and a curve reduction was noticed, although progression of the curve was observed in one case. In patients with Chiari malformation, headache, dysaesthesia and paraparesis disappeared. CONCLUSIONS: Section of the filum terminale is a useful strategy in the treatment of scoliosis, syringomyelia and the Chiari malformation, and offers a new aetiological basis for the understanding of these three disorders.

[Historical review of the most outstanding neurological institutions]. / Reseña histórica de las instituciones neurológicas más destacadas.

OBJECTIVE: To present a historical review of the main Institutions of Neurological Sciences which have existed from the mid XIX century to the present day. DEVELOPMENT: We remember the founders and collaborators of these Institutions who with dedication contributed to the maintenance of their prestige and the advance of the neurosciences. These names are no doubt well known to those of us who have worked in any of the branches of the neurosciences. Unfortunately, some of the Institutions described no longer exist. Others, although somewhat overlooked continue their scientific work while some still maintain the prestige which was always theirs. The description follows the chronological order of their foundation. We have given a more extensive description of those which we consider of greater importance due to their contribution to advances in the neurosciences, and which we have had the opportunity to visit and study their function and organization at first hand. We state the site of an institution of a given neurological speciality, independently of whether or not it forms part of a general hospital complex, but maintaining its own autonomy under the direction of a neuroscientist, contributing to establish closer collaboration with neurologists, neurosurgeons, neuropathologists etc., which undoubtedly helps to raise the level of teaching and investigation in the neurosciences.

Reseña histórica de las instituciones neurológicas más destacadas / Historical review of the most outstanding neurological institutions

Objetivo. Exponer una revisión histórica de las principales instituciones de Ciencias Neurológicas que han existido desde mediados del siglo XIX hasta nuestros días. Desarrollo. Se recuerda a los fundadores y colaboradores de estas Instituciones, que con su tesón contribuyeron a mantener su prestigio y al avance de las Neurociencias, nombres, sin duda, conocidos sobradamente por todos los que nos hemos dedicado a cualquiera de las ramas de las Ciencias Neurológicas. Desgraciadamente, algunas de estas Instituciones a las que nos referimos han desaparecido. Otras, aunque algo postergadas, continúan su labor científica, y quedan algunas que continúan manteniendo la `solera' que siempre las ha caracterizado. La descripción se realiza siguiendo un orden cronológico respecto a su fundación. Hemos descrito más extensamente las que consideramos de mayor relevancia por su contribución al avance de las Neurociencias, y cuyo funcionamiento y organización hemos tenido ocasión de visitar y conocer a fondo. Se hace constatar que la ubicación en una Institución de cualquier especialidad neurológica, independiente o que forma parte de un complejo hospitalario general, pero manteniendo su propia autonomía y bajo la dirección de un neurocientífico, contribuye a establecer una más íntima colaboración de neurólogos, neurocirujanos, neuropatólogos, etc., que indudablemente conlleva a elevar el nivel de la docencia e investigación de las Neurociencias (AU)

[Neuroradiology, a specialty among the neurosciences]. / La Neurorradiología, una especialidad de las Neurociencias.

Neuroradiology as a Neuroscience speciality has to keep undoubtedly a narrow relationship with the rest of the branches of Neurological Diagnostic, but mainly with Clinical Neurology, Neurosurgery and Neuropathology. It is specially remarked that cooperation with Neurosurgery has to be very narrow not only in diagnostic field as in evaluation of Neuroradiology operation techniques (endovascular therapy) as in the field of Stereotaxis and Radiosurgery.

[Pneumoencephalos: etiology, pathologic significance and diagnosis. Apropos of 13 observations]. / Neumoencéfalos: etiología, significado patológico y diagnóstico. A propósito de 13 observaciones.

Thirteen cases of pneumoencephalos attended at our hospital in a four-year period are reported. All the cases were men; mean age was 47.2 years. The most frequent cause was injury (seven cases) followed by surgical procedures (five cases); in one case, pneumoencephalos was secondary to barotrauma. In the initial period, the most frequent clinical features were impairment of level of consciousness and psychomotor agitation (84%), whereas in the established period, deep coma (Glasgow scale less than or equal to 7) predominated in 69% of patients. Only 16% of patients complained of headache. The most frequent localization of gas was in subdural space (54% of cases) followed by subarachnoid space (23% of cases). Twenty-three percent of patients presented tension pneumoencephalos. With respect to distribution of gas, 53% of patients presented pneumatocele, 38% of patients had pneumoencephalos, and 15% presented a laminar distribution of the gas. Pneumoencephalos is usually associated to a high mortality rate; 53% of our patients died. In the postsurgical group, mortality rate was 60% and in the posttraumatic group, mortality rate was 43%.

Craniopharyngioma of the third ventricle.

A woman, aged 33 years, presented with headache, drowsiness, and attacks of loss of consciousness with incontinence, during the eight months previous to admission. A CT scan showed a round cystic mass in the third ventricle which was interpreted as a colloid cyst. A myodil ventriculogramm showed the anterior part of the third ventricle completely occupied by tumour. Eleven months later, because of worsening of symptoms, a new scan was carried out, and the presence of an intraventricular tumour in the anterior part of the third ventricle was confirmed. The patient died four months later. The histological diagnosis of the previous biopsy, as well as the post mortem examination, showed a craniopharyngioma of the third ventricle. There was no macroscopic or histological involvement of the pituitary gland by the tumour.

Stroke due to fibromuscular hyperplasia of the internal carotid artery.

An 11-year-old girl developed an ischemic stroke syndrome a few minutes after she had been swimming in a swimming pool. The motor deficit of the extremities reversed within 24 hours. The patient was discharged on the 6th hospital week with a completely recuperated neurological function. The left internal carotid arteriogram showed typical "string of beads" appearance of segmental fibromuscular hyperplasia.

[Occlusions of the middle cerebral artery and its branches: Correlations between clinical and angiographic findings (author's transl)]. / Occlusions de l'artère cérébrale moyenne et de ses branches; corrélation clinique-angiographique.

The authors studied 60 patients with occlusions of the middle cerebral artery, of which 30 were partial occlusions and 30 complete. They discuss the etiology, age and sex distribution, clinical findings, the localization of the lesion, and the anastomotic collateral circulation that develops.

Angiographic diagnosis of cerebral oedema.

Cerebral oedema is usually associated with brain vascular lesions, such as infarction, neoplasms, angiitis, thrombophlebitis, etc. and we consider that angiographic examination is essential for the diagnosis. In this paper we analyse the angiographic signs of cerebral oedema and the differential diagnosis between oedema and any associated lesions. We also consider that it is very important to establish a diagnosis between primary oedema and hydrocephalus with a view to establishing the correct treatment in each case.