Caracterización clínica e imagenológica de una serie de pacientes con disección de arterias cervicales e intracraneales / Cervicocranial arterial dissection: experience in 57 patients

Background: Cervicocranial arterial dissection (CIAD) is an important cause of stroke. Aim: To describe the clinical and imaging characteristics of patients with CIAD. Material and Methods: An anonymous registry was made including all patients admitted to a private hospital with a diagnosis of CIAD. Patients were subdivided as having an anterior or posterior circulation dissection (ACD or PCD, respectively). Results: Fifty-seven patients aged 40 ± 8 years (60% women) were included in the study, 39 with PCD and 18 with ACD. Cervical pain was the most common symptom. CIAD was diagnosed with no clinical or imaging signs of stroke in 49% of patients. Fifty one percent of patients had focal neurological deficits and 72% had a NIH stroke score below five. No significant differences between patients with ACD or PCD were found. Fifty patients received antiplatelet therapy (simple or dual), seven patients were anticoagulated and 13 were subjected to stenting due to progression of stenosis with hemodynamic involvement or bilateral dissection with scarce collaterals. The lesion was located in V3 segment in 27 patients and cervical segment of the internal carotid in 16 cases. A favorable Modified Rankin Scale (0-2) was achieved in 85.9%, with a trend towards achieving better functional prognosis in PCD. Conclusions: Due to the greater availability of non-invasive imaging methods, 50% of these patients with CIAD did not have a stroke. Thus, an earlier and more timely management is feasible.

Miastenia gravis y su asociación con trastornos linfoproliferativos: casos clínicos / Myasthenia gravis and its association with lymphoproliferative disorders: a case series

Myasthenia gravis (MG) is a rare autoimmune disease of the neuromuscular junction. It is characterized by variable weakness and excessive fatigability of skeletal muscles. In the last few years, numerous reports have been published showing the association between autoimmune diseases, such as systemic erythematous lupus or rheumatoid arthritis, with lymphoid neoplasias. The association between MG and lymphoid neoplasia seems to be less frequent. To analyze this association we reviewed the MG patients in the Department of Neurology, Hospital Salvador of Santiago, Chile. During a three-year period we identified four patients who developed different lymphoproliferative disorders: two with B-cell lymphoma, one with chronic lymphocytic leukaemia and one plasmacytoma with an associated amyloidosis. The MG was generalized but mild, all cases classified as type IIa according to the definition proposed by the MG Foundation of America. The neoplasia appeared two to 36 years after the onset of MG. These cases provide additional evidence of the association between MG and lymphoproliferative disorders.

Poliomavirus en sistema nervioso central, una aproximación imagenológica / Polyomaviruses and central nervous system disease

The polyomavirus are a family of opportunistic virus, which belongs to the JC virus whose primary manifestation is the Progressive Multifocal Leukoencephalopathy and neuronopathy of granulosa cells. Recently given the use of PCR for BK virus in transplant patients have also been described CNS pathologies in relation to this, and most frequent encephalitis and leukoencephalopathy. Each entity has a compatible clinical and genetic testing have allowed a diagnosis of high specificity, however the RNM is the great diagnostic pillar in these pathologies, allowing differentiate the different entities, the progression of lesions and response to treatment, especially in cases where it is indicated antiretroviral therapy, as gadolinium enhancement and mass effect may suggest Syndrome Immune and worse prognosis.

Los Poliomavirus son una familia de virus oportunistas, al cual pertenece el virus JC cuya principal manifestación es la Leucoencefalopatía Multifocal Progresiva y la Neuronopatía de Células Granulosas. Recientemente, dada la utilización de PCR para virus BK en LCR en pacientes trasplantados, también se han descrito patologías de SNC en relación a éste, siendo lo más frecuente la Encefalitis y la Leucoencefalopatía. Cada entidad tiene un contexto clínico compatible y las pruebas genéticas han permitido un diagnóstico de alta especificidad, sin embargo, la RNM es el gran pilar diagnóstico en estas patologías, permitiendo diferenciar las distintas entidades, la progresión de las lesiones y la respuesta a tratamiento, especialmente en los casos en que está indicado la terapia antirretroviral, pues la captación de gadolinio y el efecto de masa pueden sugerir un Síndrome de Reconstitución Inmune y peor pronóstico.

Encefalopatía tóxica por isopropanol: sobre-exposición accidental a gas propano / Toxic encephalopathy caused by liquefied gas exposure: report of one case

Liquefied hydrocarbon gas, such as propane is considered safe. However there are reports that voluntary exposure to liquefied gas at least could originate hallucinatory states. We report a 20 years old woman who was found in a coma with extensor muscle hypertonia, brisk tendon reflexes and extensor plantar (Babinski) responses after being exposed to propane gas. The brain magnetic resonance imaging (MRI) showed lesions in both hippocampi and white matter in the oval center. The patient had a normal oxygen saturation of 98%, a carboxyhemoglobin of 1.6% and a metabolic acidosis with a pH of 7.01 with an anion gap of 16 mEq/l. This pattern suggested that it was a consequence of the intermediary metabolism of isopropanol. The recovery of the patient was slow and four months later she still had lesions on MRI and limitations in her cognitive sphere, memory and executive functions. Thus, liquefied gas exposure can cause a toxic encephalopathy with a persistent damage of the central nervous system.