[Cardiovascular disorders in Parkinson's disease]. / Trastornos cardiovasculares en la enfermedad de Parkinson.

INTRODUCTION: In Parkinson's disease (PD) there is a post-gangliar cardiac sympathetic denervation that is present from the pre-symptomatic phases of the disease onwards and which can be demonstrated by means of the Valsalva manoeuvre and cardiac scintigraphy with [123]I-meta-iodobenzylguanidine. AIM: To describe the techniques for studying the cardiac noradrenergic function and the main cardiovascular manifestations in patients with PD. DEVELOPMENT: Orthostatic hypotension is the most disabling autonomic dysfunction in patients with PD and is related with an increase in morbidity due to falls and traumatic injuries. Loss of neurones in the intermediolateral columns of the spinal cord, cardiac autonomic dysfunction and the presence of Lewy bodies in the vegetative plexuses have all been related with its origin. Affected patients can benefit from a series of dietetic and postural measures and, if necessary, can use medication, such fludrocortisone, midodrine and pyridostigmine. Supine hypertension is a potentially serious complication that can appear in patients being treated for orthostatic hypotension with fludrocortisone or midodrine. CONCLUSIONS: Suitable recognition and treatment of the cardiovascular complications of PD, especially orthostatic hypo-tension, can improve these patients' quality of life to a significant extent.

[Transient ischemic attacks: risk factors, duration and neuroimaging in a series of 173 patients]. / Ataques isquémicos transitorios: factores de riesgo, duración y neuroimagen en una serie de 173 pacientes.

INTRODUCTION: The appearance of transient ischemic attacks (TIA) is an important sign of vascular risk. The maximum time the deficit lasts has been set arbitrarily at 24 hours. It is assumed that TIA does not entail permanent vascular lesions. PATIENTS AND METHODS: A retrospective review of the clinical records of patients diagnosed as suffering from TIA in our centre between 1996 and 1997. Analysis of associated risk factors (RF), duration and findings in neuroimaging. RESULTS: The clinical records of 173 patients (106 males) were examined. The RF identified were similar to those described for ischemic strokes. 45.6% of patients with a history of vascular pathologies received no preventative treatment. 58% of the TIA were resolved within the first 30 minutes and 71% within the first hour. Cranial CT was normal in 69%, showed old lesions in 26% and lesions that were compatible with the clinical signs of TIA in 5% (in the latter case the duration of the episodes was greater). CONCLUSIONS: TIA shares the same RF and aetiopathogenic mechanisms as ischemic stroke and should, therefore, be considered as such. There is a need to revise the concept of TIA paying special attention to the findings of neuroimaging or to establish duration limits that are better matched to the practical reality. TIA maintains a practical interest since it provides a simple method of identifying patients with a high vascular risk.

Ataques isquémicos transitorios: factores de riesgo, duración y neuroimagen en una serie de 173 pacientes / Transient ischemic attacks: risk factors, duration and neuroimaging in a series of 173 patients

Introducción. El ataque isquémico transitorio (AIT) es un importante marcador de riesgo vascular. La duración máxima de los déficit se establece arbitrariamente en 24 horas. Se asume que el AIT no asocia lesiones vasculares permanentes. Pacientes y métodos. Revisión retrospectiva de las historias clínicas de pacientes diagnosticados de AIT en nuestro centro durante 1996-1997. Análisis de factores de riesgo (FR) asociados, duración y hallazgos de neuroimagen. Resultados. Se revisaron las historias clínicas de 173 pacientes (106 varones). Los FR identificados fueron similares a los descritos para los ictus isquémicos. Un 45,6 por ciento de pacientes con antecedentes de patología vascular no recibía tratamiento preventivo. Un 58 por ciento de los AIT se resolvieron en los primeros 30 minutos y un 71 por ciento en la primera hora. La TC craneal fue normal en el 69 por ciento, mostró lesiones antiguas en el 26 por ciento y lesiones compatibles con la clínica del AIT en el 5 por ciento (en estos últimos, la duración de los episodios fue mayor).Conclusiones. El AIT comparte los mismos FR y mecanismos etiopatogénicos que el ictus isquémico y, por tanto, debería considerarse como tal. Se necesita revisar el concepto de AIT con especial atención a los hallazgos de neuroimagen o establecer límites de duración más adecuados a la realidad. El AIT conserva un interés practico, ya que permite identificar de forma sencilla a pacientes con alto riesgo vascular (AU)