Síndrome de hiperperfusión cerebral postendarterectomía carotídea / Post-carotid endarterectomy cerebral hyperperfusion syndrome

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[Indicators of care activity]. / Indicadores de actividad asistencial.

Quality indicators are tools to measure and improve quality of care. These indicator may evaluate estructural process or outcome measures. Development of quality indicators is a important goal of the quality program in a clinical department.

[Primary antiphospholipid syndrome and cerebrovascular disease]. / Síndrome antifosfolípido primario y enfermedad cerebrovascular.

Primary antiphospholipid syndrome (PAS) is characterized by the isolated presence of antiphospholipid antibodies in the absence of other immunological changes. Its association with ischemic cerebrovascular disease is rarely reported. This study analyzes this association in 10 patients (8 women) first presenting with ischemic cerebrovascular accident (ICVA) that met the criteria for PAS. The average age of the patients was 50.4 years. Two patients had Sneddon's syndrome. Prolonged thromboplastin partial activation time was found in only three patients. Eight started aspirin therapy. The average time of follow-up was 17.2 months, during which there was one relapse. PAS should be included as a possible cause when examining individuals with ICVA, particularly when patients are young, when abortion has occurred or when no other cause is evident. Acetylsalicylic acid is effective for preventing relapse when other vascular risk factors are carefully controlled.

[Gelastic seizures, precocious puberty and hypothalamic hamartomas. A case report and the contributions of Single Photon Emission Computed Tomography (SPECT)]. / Síndrome de crisis gelásticas, pubertad precoz y hamartoma hipotalámico. Presentación de un caso y aportaciones del SPECT.

We present a patient with gelastic seizures, precocious puberty and a hypothalamic hamartoma. The diagnostic method of choice for hypothalamic hamartoma is new generation MRI. The characteristic MRI images along with lack of growth during the course of disease indicates a diagnosis of hamartoma firmly with no need for pathological studies. Although the physical nature of gelastic seizures in this syndrome is a subject of dispute, SPECT findings point to activity at a distance from nerve routes connecting the hypothalamus to the cortical regions (the temporal region in this case). Prognosis improves if the various components of the syndrome are treated early and when dysgenesis is less extensive.

[Neoplastic lumbosacral plexopathy and "hot foot"]. / Plexopatía lumbosacra neoplásica y "pie caliente".

Neoplastic lumbosacral plexopathy is a frequent and disabling complication in subjects with cancer. Its clinical presentation is characterized by pain, muscle weakness, sensory complaints in one or occasionally both limbs associated with the tumoral symptoms. The presence of autonomic symptoms is less frequent; one of these is the "hot and dry foot". We present two patients, one with prostatic cancer and the other with myxoid liposarcoma, who developed a lumbosacral plexopathy as a manifestation of the extension of the neoplastic process; in both cases there was in addition a clear difference in the temperature of the affected limb. Although infrequent, the "hot and dry foot" it constitutes an early sign of metastatic plexopathy which facilitates the differential diagnosis with preforaminal lumbosciatic radiculopathies.