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1.
Eur J Neurol ; 20(2): 338-43, 2013 Feb.
Article in English | MEDLINE | ID: mdl-22928874

ABSTRACT

BACKGROUND AND PURPOSE: Clinics for early management of transient ischaemic attacks (TIAs) have been developed in some stroke centres, resulting in reduced recurrence rates compared to appointment-based outpatient management, thus saving on hospitalization. We analysed the care process, recurrence rates and economic impact of the first year of work in our early-management TIA clinic and compared these with our previous in-hospital study protocols for low- and moderate-risk TIA patients. METHODS: This was a prospective evaluation of the management of low- to moderate-risk TIA patients, comparing a new TIA clinic model (2010) with a previous hospitalization model (2009). Demographic data, vascular risk factor profiles, diagnostic test performance, secondary prevention measures, final aetiological diagnoses and cerebrovascular recurrences at 7 and 90 days were compared between in-hospital and TIA clinic assessed patients. We also carried out an economic comparison of the costs of each model's process. RESULTS: Two hundred and eleven low- to moderate-risk TIA patients were included, of whom 40.8% were hospitalized. There were no differences between the TIA clinic assessed and in-hospital assessed patients in terms of risk factor diagnosis and secondary prevention measures. The stroke recurrence rate (2.4% vs. 1.2%; P = 0.65) was low and similar for both groups (CI 95%, 0.214-20.436; P = 0.52). Cost per patient was €393.28 for clinic versus €1931.18 for in-hospital management. Outpatient management resulted in a 77.8% reduction in hospitalizations. CONCLUSION: Transient ischaemic attacks clinics are efficient for the early management of low- to moderate-risk TIA patients compared to in-hospital assessment, with no higher recurrence rates and at almost one-fifth the cost.


Subject(s)
Ambulatory Care Facilities , Disease Management , Hospitalization , Ischemic Attack, Transient/prevention & control , Ischemic Attack, Transient/therapy , Stroke/prevention & control , Aged , Ambulatory Care Facilities/economics , Female , Health Care Costs/statistics & numerical data , Hospitalization/economics , Hospitalization/statistics & numerical data , Humans , Ischemic Attack, Transient/complications , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/economics , Male , Outcome and Process Assessment, Health Care/economics , Prospective Studies , Risk Factors , Secondary Prevention/economics , Secondary Prevention/statistics & numerical data , Stroke/complications , Stroke/economics , Stroke/therapy
2.
J Neurol ; 259(12): 2555-64, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22588254

ABSTRACT

Room tilt illusion (RTI) is a transient disorder of the environmental visuo-spatial perception consisting of paroxysmal tilts of the visual scene. It is attributed to an erroneous cortical mismatch of the visual and vestibular three-dimensional coordinate maps. Thirteen subjects were included in this retrospective case series. Clinical presentation was 180º rotation of the visual scene following the coronal plane in seven patients. The most common cause for RTI in our series was posterior circulation ischaemia (five cases). Cases of endolymphatic sac tumour, critical illness neuropathy, acute traumatic myelopathy and multiple system atrophy causing RTI are reported for the first time. No case of supratentorial focal lesion was found. In order to describe the clinical and imaging features of RTI, 135 cases previously reported in the literature were reviewed along with our series. There was a male predominance (60.2 %). Mean age was 51.2 ± 20.3 years. The most common location of the injury was the central nervous system (CNS) (61.4 %). Supratentorial and infratentorial structures accounted for the same frequency of lesions. The most common aetiology was cerebral ischaemia (infarction or transient ischaemic episode; 27.7 %). These patients were significantly older and their lesions commonly involved posterior fossa structures when compared to patients with non-vascular disorders. In summary, RTI is a manifestation of several CNS and vestibular disorders, and rarely of peripheral nervous system disorders, triggered by disruption of vestibular and sensory perception or integration. Cerebral ischaemic disorders are the most common aetiology for this rare syndrome.


Subject(s)
Functional Neuroimaging , Illusions/physiology , Illusions/psychology , Space Perception/physiology , Adult , Aged , Aged, 80 and over , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/psychology , Female , Functional Neuroimaging/methods , Humans , Male , Middle Aged , Retrospective Studies , Vestibular Diseases/diagnosis , Vestibular Diseases/psychology
3.
J Clin Neurosci ; 19(7): 1046-7, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22480682

ABSTRACT

Hemifacial spasm (HFS) is usually produced by compression of the facial nerve by tortuous blood vessels at the root exit zone, including vertebrobasilar dolichoectasia (VBD). Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder with a variety of symptoms, affecting mainly the skin and nervous system. Cerebrovascular abnormalities are becoming a recognized complication of the disease and the most constantly described lesions are stenosis and occlusions affecting the internal carotid artery. VBD has rarely been associated with NF1. We report a 38-year-old female patient with HFS produced by VBD with NF1 presenting with other cerebrovascular abnormalities associated with this disease. We discuss the possible association between these three entities, assuming that a causal relationship may be established and that VBD is part of the spectrum of vascular abnormalities caused by NF1 in this patient.


Subject(s)
Hemifacial Spasm/etiology , Neurofibromatosis 1/complications , Vertebrobasilar Insufficiency/complications , Adult , Female , Hemifacial Spasm/diagnosis , Humans , Magnetic Resonance Imaging
8.
Rev. neurol. (Ed. impr.) ; 49(4): 190-192, 16 ago., 2009. ilus
Article in Spanish | IBECS | ID: ibc-94812

ABSTRACT

Introducción. El síndrome de hipoestesia del mentón (numb chin syndrome) se produce por una mononeuropatía del nervio mentoniano o del nervio alveolar inferior. Las causas más frecuentes del síndrome son la traumática y la infecciosa, y siempre que no se encuentre un antecedente relevante debe investigarse la posibilidad de que la etiología sea neoplásica. Otras causas del síndrome son excepcionales. Caso clínico. Mujer de 73 años de edad con cáncer de mama en estadio diseminado y en tratamiento crónico con ácido zoledrónico, que consultó por hipoestesia y disestesias en el territorio de inervación del nervio mentoniano. Se realizó una tomografía computarizada mandibular que demostró una lesión osteolítica con secuestro óseo compatible con osteonecrosis inducida por bifosfonatos. Tras la suspensión del tratamiento, las alteraciones sensitivas y la lesión radiológica permanecieron estables. Conclusiones. La osteonecrosis mandibular por bifosfonatos es una patología relativamente reciente que ha sido descrita de forma excepcional como causa de un síndrome de hipoestesia mentoniana. En el futuro próximo, debe ser tenida en cuenta como parte del diagnóstico diferencial de este síndrome en pacientes oncológicos en tratamiento con bifosfonatos (AU)


Introduction. Numb chin syndrome is caused by a mental or inferior alveolar nerve neuropathy. Traumatic and infectious injuries are the most frequent causes of the syndrome but, if an evident cause does not exist, a neoplastic etiology must be investigated. Other causes of the numb chin syndrome are rare. Case report. A 73-year-old woman had had a diagnosis of metastatic breast cancer and was been treated with zoledronic acid. She attended because of hypoesthesia and dysesthesia of the chin congruent with mental nerve distribution. A computed tomography of the jaw showed an osteolytic lesion with central bone sequestration, so biphosphonate-induced osteonecrosis of the jaw was diagnosed. After zoledronic acid was withdrawn, clinical neuropathy and imaging findings remained stable. Conclusions. Biphosphonates-induced osteonecrosis of the jaw is a recently described condition. It has been rarely reported as a cause for numb chin syndrome. In the future, osteonecrosis of the jaw must be considered in the differential diagnosis of this syndrome in cancer patients treated with biphosphonates (AU)


Subject(s)
Humans , Female , Aged , Osteonecrosis/complications , Hypesthesia/etiology , Mandibular Diseases/etiology , Diphosphonates/adverse effects , Osteonecrosis/chemically induced , Chin/injuries , Diagnosis, Differential , Tomography, X-Ray Computed
9.
Rev Neurol ; 49(4): 190-2, 2009.
Article in Spanish | MEDLINE | ID: mdl-19621321

ABSTRACT

INTRODUCTION: Numb chin syndrome is caused by a mental or inferior alveolar nerve neuropathy. Traumatic and infectious injuries are the most frequent causes of the syndrome but, if an evident cause does not exist, a neoplastic etiology must be investigated. Other causes of the numb chin syndrome are rare. CASE REPORT: A 73-year-old woman had had a diagnosis of metastatic breast cancer and was been treated with zoledronic acid. She attended because of hypoesthesia and dysesthesia of the chin congruent with mental nerve distribution. A computed tomography of the jaw showed an osteolytic lesion with central bone sequestration, so biphosphonate-induced osteonecrosis of the jaw was diagnosed. After zoledronic acid was withdrawn, clinical neuropathy and imaging findings remained stable. CONCLUSIONS: Biphosphonates-induced osteonecrosis of the jaw is a recently described condition. It has been rarely reported as a cause for numb chin syndrome. In the future, osteonecrosis of the jaw must be considered in the differential diagnosis of this syndrome in cancer patients treated with biphosphonates.


Subject(s)
Bone Density Conservation Agents/adverse effects , Chin , Diphosphonates/adverse effects , Imidazoles/adverse effects , Jaw Diseases , Mandibular Nerve/pathology , Osteonecrosis , Aged , Bone Density Conservation Agents/therapeutic use , Breast Neoplasms/drug therapy , Chin/innervation , Chin/pathology , Diphosphonates/therapeutic use , Female , Humans , Imidazoles/therapeutic use , Jaw Diseases/chemically induced , Jaw Diseases/complications , Jaw Diseases/pathology , Osteonecrosis/chemically induced , Osteonecrosis/complications , Osteonecrosis/pathology , Syndrome , Zoledronic Acid
11.
Rev Neurol ; 46(12): 724-6, 2008.
Article in Spanish | MEDLINE | ID: mdl-18543198

ABSTRACT

INTRODUCTION: Reversal of vision metamorphopsia is a disorder affecting the visuospatial perception of objects, without any changes in their shape, size or colour. It generally involves a full 180 degrees rotation of the visual field in the coronal plane. Its chief causation is vertebrobasilar ischaemia, although the phenomenon has also been linked to many other conditions, such as multiple sclerosis, epilepsy, migraine or traumatic head and neck injuries. Some notable features of reversal of vision metamorphopsia are the wide topographic variety of the lesions responsible for the condition, the transient nature of the symptom and its improvement or resolution in the presence of certain stimuli. CASE REPORT: A 35-year-old male with a sudden episode of instability that prevented him from walking, together with vomiting and reversal of vision metamorphopsia that lasted for an hour. A magnetic resonance scan enabled us to identify an acute ischaemic cerebellar lesion as the cause of the condition. CONCLUSIONS: The variety of locations of the lesions that give rise to reversal of vision metamorphopsia would be mainly due to the multisensory nature of the neurons in the posterior parietal cortex, the area of the brain where the visuospatial integration of images is performed. These neurons receive visual, proprioceptive and vestibular afferences, which means that any lesions that occur in these three systems or in the central integrator itself could cause the phenomenon of reversal of vision metamorphopsia.


Subject(s)
Brain Infarction/complications , Cerebellum , Vision Disorders/etiology , Adult , Humans , Male
12.
Rev. neurol. (Ed. impr.) ; 46(12): 724-726, 16 jun., 2008. ilus
Article in Spanish | IBECS | ID: ibc-131818

ABSTRACT

Introducción. La metamorfopsia invertida es un trastorno de la percepción visuoespacial de los objetos, sin alteración de su forma, tamaño o color. Generalmente se trata de una rotación completa de 180° del campo visual en el plano coronal. Su principal etiología es la isquemia vertebrobasilar, aunque se han relacionado otras muchas entidades con este fenó- meno, como la esclerosis múltiple, la epilepsia, la migraña o los traumatismos craneocervicales. Algunas características destacables de la metamorfopsia invertida son la gran variedad topográfica de las lesiones responsables del fenómeno, el carácter transitorio del síntoma y su mejoría o resolución ante determinados estímulos. Caso clínico. Varón de 35 años con un episodio brusco de inestabilidad que le impedía la marcha, acompañado de vómitos y metamorfopsia invertida de una hora de duración. Mediante resonancia se identificó una lesión cerebelosa isquémica aguda como responsable del cuadro. Conclusiones. La variedad topográfica de las lesiones que ocasionan una metamorfopsia invertida se debería principalmente al carácter multisensorial de las neuronas de la corteza parietal posterior, el área del cerebro donde se realiza la integración visuoespacial de las imágenes. Estas neuronas reciben aferencias visuales, propioceptivas y vestibulares, por lo que cualquier lesión de estos tres sistemas o en la propia área de integración sería capaz de provocar el fenómeno de la metamorfopsia invertida (AU)


Introduction. Reversal of vision metamorphopsia is a disorder affecting the visuospatial perception of objects, without any changes in their shape, size or colour. It generally involves a full 180º rotation of the visual field in the coronal plane. Its chief causation is vertebrobasilar ischaemia, although the phenomenon has also been linked to many other conditions, such as multiple sclerosis, epilepsy, migraine or traumatic head and neck injuries. Some notable features of reversal of vision metamorphopsia are the wide topographic variety of the lesions responsible for the condition, the transient nature of the symptom and its improvement or resolution in the presence of certain stimuli. Case report. A 35-year-old male with a sudden episode of instability that prevented him from walking, together with vomiting and reversal of vision metamorphopsia that lasted for an hour. A magnetic resonance scan enabled us to identify an acute ischaemic cerebellar lesion as the cause of the condition. Conclusions. The variety of locations of the lesions that give rise to reversal of vision metamorphopsia would be mainly due to the multisensory nature of the neurons in the posterior parietal cortex, the area of the brain where the visuospatial integration of images is performed. These neurons receive visual, proprioceptive and vestibular afferences, which means that any lesions that occur in these three systems or in the central integrator itself could cause the phenomenon of reversal of vision metamorphopsia (AU)


Subject(s)
Humans , Male , Adult , Cerebral Infarction/complications , Cerebellum , Vision Disorders/etiology
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