ABSTRACT
Objetivos: Estudiar la influencia de diversos factores en la calidad de vida relacionada con la salud (CVRS) de los pacientes tras un infarto cerebral (IC), con especial atención a los trastornos psicopatológicos (TP). Pacientes y métodos: Estudio observacional prospectivo sobre 45 pacientes ingresados por IC, evaluados a las 4, 12 y 26 semanas del evento agudo. Se recogieron antecedentes y datos sociodemográficos previos, se utilizó la escala SF-36 para la valoración de la CVRS, para la valoración psicopatológica, cognitiva, neurológica y funcional se utilizó el inventario neuropsiquiátrico (NPI), MMSE, escala de Canadá, escala de Rankin modificada y otras escalas. Para determinar los posibles factores predictivos de las puntuaciones del SF-36 a las 26 semanas se realizó un estudio de regresión lineal, introduciendo como variables independientes los antecedentes médicos y psiquiátricos, las características sociodemográficas y la evaluación funcional, neuropsicológica y psicopatológica a las 4 semanas. Resultados: Se obtuvieron modelos predictivos válidos para todos los índices del SF-36, en los que el antecedente de depresión, las puntuaciones más altas en el NPI y la escala de Rankin, y más baja en la escala canadiense fueron los principales indicadores predictivos de una peor CVRS a largo plazo. El distrés del cuidador asociado a la psicopatología del paciente (medido a través del NPI) tuvo una influencia negativa sobre el índice de función social. Conclusiones: Los TP y la situación funcional fueron los principales determinantes de la CVRS de los pacientes tras un IC (AU)
Objectives: To study the influence of various factors on the health related quality of life (HRQOL) of patients who have suffered a brain infarction (BI), with special attention to psychopathological disorders (PD). Patients and methods: Prospective observational study on 45 patients admitted due to a BI, evaluated at 4, 12 and 26 weeks of the acute event. Social and demographic data, and medical history were collected; the SF-36 scale was used for the assessment of HRQOL, and the Neuropsychiatric Inventory (NPI), MMSE, Canadian Neurological Scale, Modified Rankin Scale and other instruments for assessing psychopathological, cognitive, neurological and functional status. A linear regression analysis was performed to identify potential predictors of the SF-36 scores at 26 weeks, introducing, as independent variables, medical and psychiatric history, demographic characteristics and the functional, neuropsychological and psychopathological assessments at 4 weeks. Results: Valid predictive models for all the SF-36 domains were obtained, in which a history of pre-morbid depression, higher scores in the NPI and Rankin Scale, and lowest in the Canadian Neurological Scale were the main predictors of a worse HRQOL in the long term. Psychopathology related caregiver's distress (assessed with the NPI) was associated with a lower score in the social function index. Conclusions: PDs and functional status were the main determinants of HRQOL in patients with BI (AU)
Subject(s)
Humans , Cerebral Infarction/complications , Prospective Studies , Quality of Life , Depression/epidemiology , Statistics on Sequelae and Disability , Caregivers/psychologyABSTRACT
OBJECTIVES: To study the influence of various factors on the health related quality of life (HRQOL) of patients who have suffered a brain infarction (BI), with special attention to psychopathological disorders (PD). PATIENTS AND METHODS: Prospective observational study on 45 patients admitted due to a BI, evaluated at 4, 12 and 26 weeks of the acute event. Social and demographic data, and medical history were collected; the SF-36 scale was used for the assessment of HRQOL, and the Neuropsychiatric Inventory (NPI), MMSE, Canadian Neurological Scale, Modified Rankin Scale and other instruments for assessing psychopathological, cognitive, neurological and functional status. A linear regression analysis was performed to identify potential predictors of the SF-36 scores at 26 weeks, introducing, as independent variables, medical and psychiatric history, demographic characteristics and the functional, neuropsychological and psychopathological assessments at 4 weeks. RESULTS: Valid predictive models for all the SF-36 domains were obtained, in which a history of pre-morbid depression, higher scores in the NPI and Rankin Scale, and lowest in the Canadian Neurological Scale were the main predictors of a worse HRQOL in the long term. Psychopathology related caregiver's distress (assessed with the NPI) was associated with a lower score in the social function index. CONCLUSIONS: PDs and functional status were the main determinants of HRQOL in patients with BI.
Subject(s)
Anxiety/etiology , Cerebral Infarction/psychology , Depression/etiology , Quality of Life , Aged , Anxiety/epidemiology , Brain Ischemia/psychology , Caregivers/psychology , Depression/epidemiology , Female , Humans , Linear Models , Male , Middle Aged , Neuroimaging , Neuropsychological Tests , Predictive Value of Tests , Prospective Studies , Risk Factors , Severity of Illness Index , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Surveys and QuestionnairesABSTRACT
A 45-year-old woman, who had been diagnosed in our unit with episodic paroxysmal hemicrania, was seen 2 years later for ipsilateral hemicrania continua in remitting form. Both types of headache had a complete response to indomethacin and did not occur simultaneously. The patient had a previous history of episodic moderate headaches that met criteria for probable migraine without aura and also had a family history of headache. The clinical course in this case suggests a pathogenic relationship between both types of primary headache.
Subject(s)
Paroxysmal Hemicrania/classification , Paroxysmal Hemicrania/diagnosis , Adult , Disease Progression , Female , Humans , Indomethacin/therapeutic use , Paroxysmal Hemicrania/drug therapy , Treatment OutcomeABSTRACT
INTRODUCTION: Brucellosis is a form of anthropozoonosis that is found the world over. It has a particularly high incidence rate in Spain, above all in rural areas such as Extremadura, Castile and Leon, Castile-La Mancha and Aragon, largely due to the consumption of non-pasteurised milk and cheese. Neurobrucellosis can be defined as a set of either early or late neurological complications caused by Brucella. It is difficult to determine its frequency, although it oscillates between 2-18% of all cases of brucellosis. CASE REPORTS: We report the cases of four patients diagnosed as having neurobrucellosis. The different presenting clinical symptoms, the complementary explorations, treatment and duration are all described. CONCLUSIONS: The clinical features of neurobrucellosis vary greatly and, in general, tend to be chronic. Many of the laboratory procedures usually employed in the diagnosis of brucellosis frequently give negative results. For these reasons, and because it is a disease that is both treatable and curable, the degree of suspicion must be high, especially in endemic areas, so that an early diagnosis can be made to allow suitable treatment to be established.
Subject(s)
Brucellosis , Adolescent , Adult , Aged , Animals , Anti-Bacterial Agents/therapeutic use , Brucella , Brucellosis/diagnosis , Brucellosis/drug therapy , Brucellosis/physiopathology , Cattle , Diagnosis, Differential , Female , Humans , Male , Middle AgedABSTRACT
Introduction. Brucellosis is a form of anthropozoonosis that is found the world over. It has a particularly high incidence rate in Spain, above all in rural areas such as Extremadura, Castile and Leon, Castile-La Mancha and Aragon, largely due to the consumption of non-pasteurised milk and cheese. Neurobrucellosis can be defined as a set of either early or late neurological complications caused by Brucella. It is difficult to determine its frequency, although it oscillates between2-18% of all cases of brucellosis. Case reports. We report the cases of four patients diagnosed as having neurobrucellosis. The different presenting clinical symptoms, the complementary explorations, treatment and duration are all described. Conclusions. The clinical features of neurobrucellosis vary greatly and, in general, tend to be chronic. Many of the laboratory procedures usually employed in the diagnosis of brucellosis frequently give negative results. For these reasons, and because itis a disease that is both treatable and curable, the degree of suspicion must be high, especially in endemic areas, so that an early diagnosis can be made to allow suitable treatment to be established (AU)
Introducción. La brucelosis es una antropozoonosis dedistribución mundial. Su incidencia en España es muy alta, sobretodo en áreas rurales de Extremadura, Castilla y León, Castilla-La Mancha y Aragón, en buena parte debido al consumo de leche y quesos no pasteurizados. La neurobrucelosis puede definirse como el conjunto de complicaciones neurológicas precoces o tardías debidas a Brucella. Su frecuencia es difícil de establecer, aunque oscila en un 2-18% de todos los casos de brucelosis. Casos clínicos. Presentamos cuatro pacientes diagnosticados de neurobrucelosis. Se exponen las diferentes formas de presentación clínica, las exploraciones complementarias, el tratamiento y su duración. Conclusiones. Las manifestaciones clínicas de la neurobrucelosis varían mucho y, en general, son de carácter crónico. En muchas ocasiones las determinaciones de laboratorio habitualmente empleadas para el diagnóstico de la brucelosis son negativas. Por estas razones, y por ser una enfermedad tratable y curable, se debe tener un elevado índice de sospecha, sobre todo en áreas endémicas, para hacer un diagnóstico precoz que permita instaurar el tratamiento adecuado (AU)
Subject(s)
Male , Female , Adult , Aged , Adolescent , Middle Aged , Animals , Cattle , Humans , Brucellosis/diagnosis , Brucellosis/drug therapy , Brucellosis/physiopathology , Anti-Bacterial Agents/therapeutic use , Brucella , Diagnosis, DifferentialABSTRACT
INTRODUCTION: Listeria monocytogenes is a gram-positive bacillus which causes sporadic infections in immunocompromised humans, with a special propensity for the central nervous system, in the form of acute, subacute or chronic meningitis, rhombencephalitis or abscesses in the brain or spinal cord. The final diagnosis is established by germ culture in blood or in cerebrospinal fluid (CSF). Preferred treatment is ampicillin in association with aminoglycosides. CASE REPORT: We report the case of a 70-year-old male patient with a history of arterial hypertension and chronic lymphatic leukaemia with no specific treatment, who suffered meningoencephalitis and brain abscesses caused by L. monocytogenes. Symptoms were a 48-hour history of headache and a febrile condition. The CSF showed lymphocytic pleocytosis with hypoglycorrhachia. Magnetic resonance scans of the brain revealed areas of cerebritis and multiple brain abscesses in the right frontal lobe. Specific treatment was established with ampicillin for 13 weeks, associated with gentamicin and vancomycin during the first few weeks, until x-rays showed the lesions to be resolved. CONCLUSIONS: L. monocytogenes infections must be investigated in all patients with cellular immunosuppression who present febrile symptoms. The central nervous system may be the only area of the body infected. Moreover, this site will need studying in patients who present neurological focus data or an alteration in the state of consciousness and bacteraemia due to L. monocytogenes. Establishing suitable treatment as early as possible can improve the prognosis.
Subject(s)
Brain Abscess , Listeria monocytogenes , Listeriosis/diagnosis , Listeriosis/pathology , Aged , Anti-Bacterial Agents/therapeutic use , Brain Abscess/diagnosis , Brain Abscess/microbiology , Brain Abscess/pathology , Humans , Listeriosis/drug therapy , Magnetic Resonance Imaging , MaleABSTRACT
Introducción. La Listeria monocytogenes es un bacilo grampositivo que causa infecciones esporádicas en pacientes inmunodeprimidos, con especial predilección por el sistema nervioso central, en forma de meningitis aguda, subaguda o crónica, rombencefalitis o abscesos cerebrales o medulares. El diagnóstico definitivo se establece mediante el cultivo del germen en sangre o en líquido cefalorraquídeo (LCR). El tratamiento de elección es la ampicilina asociada a aminoglucósidos. Caso clínico. Presentamos el caso clínico de un paciente varón de 70 años con antecedentes de hipertensión arterial y leucemia linfática crónica sin tratamiento específico, que sufrió una meningoencefalitis y abscesos cerebrales por L. monocytogenes. Los síntomas fueron cefalea y fiebre de 48 horas de evolución. El LCR mostró una pleocitosis linfocitaria con hipoglucorraquia. El estudio con resonancia magnética cerebral mostró áreas de cerebritis y abscesos cerebrales múltiples en el lóbulo frontal derecho. Se realizó un tratamiento específico con ampicilina durante 13 semanas, asociada a gentamicina y vancomicina durante las semanas iniciales, hasta la resolución radiológica de las lesiones. Conclusiones. Las infecciones por L. monocytogenes se deben investigar en todo paciente con inmunosupresión celular que padezca un síndrome febril. El sistema nervioso central puede ser el único lugar de afectación. Además, esta localización deberá estudiarse en los pacientes que presenten datos de focalidad neurológica o alteración del nivel de conciencia y bacteriemia por L. monocytogenes. La instauración precoz de un tratamiento adecuado puede mejorar el pronóstico
Introduction. Listeria monocytogenes is a gram-positive bacillus which causes sporadic infections in immuno-compromised humans, with a special propensity for the central nervous system, in the form of acute, subacute or chronic meningitis, rhombencephalitis or abscesses in the brain or spinal cord. The final diagnosis is established by germ culture in blood or in cerebrospinal fluid (CSF). Preferred treatment is ampicillin in association with aminoglycosides. Case report. We report the case of a 70-year-old male patient with a history of arterial hypertension and chronic lymphatic leukaemia with no specific treatment, who suffered meningoencephalitis and brain abscesses caused by L. monocytogenes. Symptoms were a 48-hour history of headache and a febrile condition. The CSF showed lymphocytic pleocytosis with hypoglycorrhachia. Magnetic resonance scans of the brain revealed areas of cerebritis and multiple brain abscesses in the right frontal lobe. Specific treatment was established with ampicillin for 13 weeks, associated with gentamicin and vancomycin during the first few weeks, until x-rays showed the lesions to be resolved. Conclusions. L. monocytogenes infections must be investigated in all patients with cellular immunosuppression who present febrile symptoms. The central nervous system may be the only area of the body infected. Moreover, this site will need studying in patients who present neurological focus data or an alteration in the state of consciousness and bacteraemia due to L. monocytogenes. Establishing suitable treatment as early as possible can improve the prognosis
Subject(s)
Male , Adult , Aged , Humans , Listeria monocytogenes , Listeriosis , Cerebrovascular Disorders , Anti-Bacterial Agents/administration & dosage , Brain Abscess/diagnosis , Brain Abscess/mortality , Telencephalon/physiopathology , Central Nervous System Diseases , Central Nervous System/physiopathology , Bacteremia , Sepsis , Endocarditis, Bacterial , Endophthalmitis , Peritonitis , Meningitis, Bacterial , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Treatment Outcome , Anti-Bacterial Agents/therapeutic use , Immune ToleranceABSTRACT
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Subject(s)
Middle Aged , Male , Humans , POEMS Syndrome , Osteolysis , Muscle Hypotonia , Hypertrichosis , Gynecomastia , Denervation , Splenomegaly , Hepatomegaly , Phenotype , Diabetes Mellitus, Type 2ABSTRACT
Psychotic symptoms are infrequent in multiple sclerosis (MS) and their relationship to cerebral lesions has not been clearly documented. The case of a 58 year old woman with secondary progressive MS is presented. She had acute delirium with persecutory delusions associated to paresis of her left leg. Magnetic resonance imaging of the brain disclosed an active lesion in the left hippocampus. The patient was treated with risperidone and megadoses of methylprednisolone, with dramatic improvement. Clinical and radiological data in this patient suggest that psychotic disorders can be symptomatic of a relapse in MS and, therefore, susceptible to be treated with steroids.
Subject(s)
Delirium/diagnosis , Delirium/etiology , Multiple Sclerosis/complications , Multiple Sclerosis/pathology , Diagnosis, Differential , Female , Humans , Middle Aged , RecurrenceSubject(s)
Jugular Veins/surgery , Sinus Thrombosis, Intracranial/physiopathology , Adult , Female , Humans , Intracranial Hypertension , Jugular Veins/pathology , Ligation , Magnetic Resonance Angiography , Sinus Thrombosis, Intracranial/etiology , Sinus Thrombosis, Intracranial/genetics , Sinus Thrombosis, Intracranial/pathologyABSTRACT
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Subject(s)
Adult , Female , Humans , Smiling , Medicine in the Arts , Paintings , Portrait , Sinus Thrombosis, Intracranial , Magnetic Resonance Angiography , Intracranial Hypertension , Ligation , Jugular Veins , Famous PersonsABSTRACT
INTRODUCTION: Neurocystercicosis (NCC) is a disorder caused by the Taenia solium larva. It is the commonest parasitosis of the CNS. In Spain most patients are from countries where the condition is endemic. However, sporadic cases still occur amongst the non immigrant population of rural regions. We report a new case of NCC from the Valle del Jerte in rural Extremadura. CASE REPORT: A 51 year old man presented with intellectual impairment, motor aphasia, apraxia, right hemiparesia and sphincter incontinence for the past six months. On cranial CAT and MR hydorcephalia was seen together with a subarachnoid cyst in the left Sylvan fissure. Serology was positive for cysticercosis in both plasma and CSF. The patient was treated with albendazol after insertion of a ventriculo peritoneal shunt. Three months later there was both clinical and radiological improvement. CONCLUSION: NCC is still a condition which must be included in the differential diagnosis of patients in Spain who present with CNS involvement and cystic lesions on neuro imaging investigations, even when they are not from countries where the disease is endemic. Treatment with albendazol and steroids given after insertion of a ventriculo peritoneal shunt was effective in our patient.
Subject(s)
Brain Diseases/complications , Brain Diseases/parasitology , Cysts/complications , Cysts/parasitology , Hydrocephalus/diagnosis , Hydrocephalus/etiology , Neurocysticercosis/parasitology , Albendazole/therapeutic use , Anthelmintics/therapeutic use , Brain Diseases/diagnosis , Brain Diseases/drug therapy , Cysts/diagnosis , Cysts/drug therapy , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurocysticercosis/diagnosis , Neurocysticercosis/drug therapy , Rural Population , Subarachnoid Space/diagnostic imaging , Subarachnoid Space/parasitology , Subarachnoid Space/pathology , Taeniasis/parasitology , Tomography, X-Ray ComputedABSTRACT
Introducción. La neurocisticercosis (NCC), enfermedad producida por el estado larvario de la Taenia solium, es la parasitosis más frecuente del SNC. En España, actualmente afecta sobre todo a pacientes procedentes de países endémicos, aunque todavía se describen casos aislados entre la población no inmigrante del medio rural. Se presenta un nuevo caso de NCC observado en el valle del Jerte, una comarca rural de Extremadura. Caso clínico. Varón de 51 años con cuadro de deterioro cognitivo, afasia motora, apraxia, hemiparesia derecha e incontinencia de esfínteres de seis meses de evolución. En TAC y RM craneal se observó hicrocefalia y un quiste subaracnoideo en la cisura de Silvio izquierda. La serología frente a cisticerco fue positiva en suero y LCR. Se trató con albendazol tras la colocación de una derivación ventriculoperitoneal, y se apreció mejoría clínica y radiológica a los tres meses. Conclusión. La NCC continúa siendo una entidad que debe tenerse en cuenta en España en el diagnóstico diferencial de pacientes con afectación del SNC y lesiones quísticas en las pruebas de neuroimagen, aunque éstos no provengan de países endémicos de esta enfermedad. El tratamiento con albendazol y esteroides, previa colocación de una derivación ventriculoperitoneal, fue eficaz en nuestro paciente (AU)
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