Hemorragia intracerebral lobular: análisis de una serie y características en pacientes antiagregados y anticoagulados / Lobar intracerebral haemorrhage: analysis of a series and characteristics of patients receiving anti-platelet or anticoagulation treatment

Introducción: La hemorragia intracerebral lobular (HIL) es una causa poco frecuente de ictus y representan cerca del 20% de las hemorragias intracerebrales primarias. La causa más frecuente son la angiopatía amiloidea cerebral (AAC), la hipertensión arterial (HTA) y otras como el tratamiento antiagregante o anticoagulante. Analizar una serie de pacientes con HIL y compararla con subgrupos de pacientes con HIL antiagregados o anticoagulados previamente. Determinar el volumen de la hemorragia y su valor predictivo de mortalidad.Pacientes y métodos: Se incluyó de forma consecutiva y retrospectiva a 162 pacientes diagnosticados de HIL y atendidos en el servicio de neurología del Hospital Meixoeiro de Vigo entre los años 1991 y 2009. Se recogieron características demográficas, factores de riesgo, etiologías y clínica, y se realizó un análisis comparativo entre la serie general y los subgrupos de paciente antiagregados y anticoagulados.Resultados: En la serie general la causa más frecuente fue la AAC posible o probable seguida de la HTA. En los subgrupos de pacientes antiagregados o anticoagulados no había diferencias en las variables estudiadas excepto en la frecuencia de cardiopatía. Sí existían diferencias en cuanto a la edad, la cardiopatía y la volumen de la hemorragia entre la serie general (sin los pacientes antiagregados o anticoagulados) cuando se compararon con los subgrupos de antiagregados y anticoagulados.Conclusiones: Aportamos algunas novedades respecto al comportamiento clínico de la HIL y sus diferencias en los pacientes antiagregados o anticoagulados. La mortalidad es superior en las HIL anticoaguladas. Son variables predictivas de defunción el sexo femenino y el volumen de la hemorragia (AU)

Introduction: Lobar intracerebral haemorrhage (LIH), is a rare cause of stroke which accounts for about 20% of primary intracerebral haemorrhages. The most common causes are cerebral amyloid angiopathy (CAA), high blood pressure and others, such as using anti-platelet or anticoagulation agents. We analysed a series of patients with LIH and compared it with subgroups of patients with LIH who were previously receiving anti-platelet or anticoagulation agents. We determined the volume of the bleeding and its predictive value for mortality. Patients and methods: We consecutively and retrospectively included 162 patients diagnosed with LIH and cared for in the Neurology Department of Hospital Meixoeiro in Vigo between 1991 and 2009. We collected demographic characteristics, risk factors, aetiologies and symptoms, and conducted a comparative analysis between the general series and the subgroups of patients receiving anticoagulation and anti-platelet agents. Results: In the general series, the most common cause was possible or probable CAA followed by hypertension. In the subgroup of patients receiving anti-platelet or anticoagulation agents there were no differences in the variables studied, except for the frequency of heart disease. Nonetheless, there were differences with respect to age, heart disease and bleeding volume between the general series (patients not treated with anti-platelet or anticoagulation agents) when compared with the subgroups of patients receiving anti-platelet and anticoagulation agents. Conclusions: We provide new information regarding the clinical behaviour of LIH and its differences in patients receiving anti-platelet or anticoagulation agents. Mortality is higher in cases of LIH on anticoagulants. LIH. Female sex and the volume of bleeding are predictors of mortality (AU)

Lobar intracerebral haemorrhage: analysis of a series and characteristics of patients receiving antiplatelet or anticoagulation treatment.

INTRODUCTION: Lobar intracerebral haemorrhage (LIH), is a rare cause of stroke which accounts for about 20% of primary intracerebral haemorrhages. The most common causes are cerebral amyloid angiopathy (CAA), high blood pressure and others, such as using anti-platelet or anticoagulation agents. We analysed a series of patients with LIH and compared it with subgroups of patients with LIH who were previously receiving anti-platelet or anticoagulation agents. We determined the volume of the bleeding and its predictive value for mortality. PATIENTS AND METHODS: We consecutively and retrospectively included 162 patients diagnosed with LIH and cared for in the Neurology Department of Hospital Meixoeiro in Vigo between 1991 and 2009. We collected demographic characteristics, risk factors, aetiologies and symptoms, and conducted a comparative analysis between the general series and the subgroups of patients receiving anticoagulation and anti-platelet agents. RESULTS: In the general series, the most common cause was possible or probable CAA followed by hypertension. In the subgroup of patients receiving anti-platelet or anticoagulation agents there were no differences in the variables studied, except for the frequency of heart disease. Nonetheless, there were differences with respect to age, heart disease and bleeding volume between the general series (patients not treated with anti-platelet or anticoagulation agents) when compared with the subgroups of patients receiving anti-platelet and anticoagulation agents. CONCLUSIONS: We provide new information regarding the clinical behaviour of LIH and its differences in patients receiving anti-platelet or anticoagulation agents. Mortality is higher in cases of LIH on anticoagulants. LIH. Female sex and the volume of bleeding are predictors of mortality.

[Lobar intracerebral haemorrhage and cerebral amyloid angiopathy: analysis of a series of 106 patients]. / Hemorragia intracerebral lobular y angiopatía amiloidea cerebral: análisis de una serie de 106 pacientes.

INTRODUCTION: Lobar intracerebral haemorrhage (LH) is an uncommon cause of stroke. Many LH are caused by cerebral amyloid angiopathy (CAA). The aim of the present study is to analyse the clinical signs, risk factors, lesion volume and development, of a consecutive series of patients suffering from LH and to compare the various characteristics between haemorrhages which comply with the Boston criteria for CAA and those which do not comply with these inclusion criteria. METHODS: A consecutive series of 106 patients suffering from LH and admitted to the neurological service in the Meixoeiro Hospital of Vigo between 1991 and 2005 is described. The Boston criteria were applied to all patients suffering from LH associated with possible, probable and confirmed CAA. The clinical signs, risk factors, haemorrhage sizes, evolution and complications of the patients complying with the CAA inclusion criteria were compared to those who did not comply with the inclusion criteria. RESULTS: The 106 patients from the series, represent 14.4% of intracerebral haemorrhages and 3.7% of all strokes. Fifty-four percent (54 %) of the patients were female and arterial hypertension was an important risk factor. Twenty point eight percent (20.8%) of the patients were admitted in coma and 60% with hemiparesis. Of these LH patients 28.3% died. The haemorrhage volume and the female gender were the only predictive factors for death. No significant variables were observed to differentiate the groups in the comparative analysis of the subgroups of patients with CAA inclusion criteria and those without. CONCLUSIONS: The series studied showed similar risk factors and clinical characteristics to other published series. No predictive clinical variables were found to differentiate between LH which complied with CAA inclusion criteria and those that did not comply.

Hemorragia intracerebral lobular y angiopatía amiloidea cerebral: análisis de una serie de 106 pacientes / Lobar intracerebral haemorrhage and cerebral amyloid: analysis of a series of 106 patients

Introducción. La hemorragia intracerebral lobular (HL) es una causa infrecuente de ictus. Muchas HL están causadas por angiopatía amiloidea cerebral (AAC). El objetivo del presente estudio es analizar la clínica, factores de riesgo, volumen de la lesión y evolución, de una serie consecutiva de pacientes con HL y comparar las distintas características entre las hemorragias que cumplían los criterios de Boston para AAC y aquellas que no reunían los criterios. Métodos. Se describe una serie consecutiva de 106 pacientes con HL ingresados en el Servicio de Neurología del Hospital Meixoeiro de Vigo entre los años 1991 y 2005. Se aplicaron a todos los pacientes los criterios de Boston para HL relacionadas con AAC posible, probable y definitiva. Se comparan las características clínicas, factores de riesgo, tamaño de la hemorragia, evolución y complicaciones del grupo de pacientes que reunían los criterios de AAC, con aquellos que no los cumplían. Resultados. Los 106 pacientes de la serie representan el 14,4% de las hemorragias intracerebrales y el 3,7% de todos los ictus estudiados en nuestro servicio. El 54% de los pacientes fueron mujeres y la hipertensión arterial fue el factor de riesgo más importante. Un 20,8% de los pacientes ingresaron en coma y el 60% con hemiparesia, falleciendo el 28,3% de las HL. El volumen de la hemorragia y el sexo femenino fueron los únicos factores predictivos de exitus. En el análisis comparativo de los subgrupos de pacientes con criterios de AAC y los no AAC, no se encontraron variables significativas que diferencien un grupo de otro. Conclusión. La serie estudiada presenta unos factores de riesgo y características clínicas similares a otras series publicadas. No encontramos variables clínicas predictivas que diferencien entre las HL que reúnen criterios de AAC, con las HL que no los cumplen (AU)

Introduction. Lobar intracerebral haemorrhage (LH) is an uncommon cause of stroke. Many LH are caused by cerebral amyloid angiopathy (CAA). The aim of the present study is to analyse the clinical signs, risk factors, lesion volume and development, of a consecutive series of patients suffering from LH and to compare the various characteristics between haemorrhages which comply with the Boston criteria for CAA and those which do not comply with these inclusion criteria. Methods. A consecutive series of 106 patients suffering from LH and admitted to the neurological service in the Meixoeiro Hospital of Vigo between 1991 and 2005 is described. The Boston criteria were applied to all patients suffering from LH associated with possible, probable and confirmed CAA. The clinical signs, risk factors, haemorrhage sizes, evolution and complications of the patients complying with the CAA inclusion criteria were compared to those who did not comply with the inclusion criteria. Results. The 106 patients from the series, represent 14.4% of intracerebral haemorrhages and 3.7% of all strokes. Fifty-four percent (54 %) of the patients were female and arterial hypertension was an important risk factor. Twenty point eight percent (20.8%) of the patients were admitted in coma and 60% with hemiparesis. Of these LH patients 28.3% died. The haemorrhage volume and the female gender were the only predictive factors for death. No significant variables were observed to differentiate the groups in the comparative analysis of the subgroups of patients with CAA inclusion criteria and those without. Conclusions. The series studied showed similar risk factors and clinical characteristics to other published series. No predictive clinical variables were found to differentiate between LH which complied with CAA inclusion criteria and those that did not comply (AU)

[Rapid-onset dystonia-parkinsonism: sporadic form]. / Distonía-parkinsonismo de inicio rápido: forma esporádica.

INTRODUCTION: The rapid-onset dystonia-parkinsonism is a movement disorder which associates dystonic symptoms, especially those affecting orofacial muscles, and parkinsonian symptoms. All these symptoms start suddenly and then they stabilize along the process. This disorder usually occurs to young adults and is an autosomal dominant trait with a reduced penetrance, although some sporadic cases have been reported. The genetic alteration is found on the chromosome 19q13, where the mutated gene ATP1A3 has been identified. This gene is linked to the regulation of the sodium-potassium pump. CASE REPORT: A 16-year-old woman developed a sudden onset of dystonic symptoms which affected her higher and lower limbs, bulbar muscles, together with severe dysarthria and dysphagia. The onset occurred over hours, but her symptoms have been stabilized for years. No movement or other neurological disorders are reported in her family history. CONCLUSIONS: This is probably a sporadic case of rapid-onset dystonia-parkinsonism, and it is the second one reported in Spain. Diagnostic criteria, differential diagnosis, etiopahogenesis and genetic alterations are also discussed.

Distonía-parkinsonismo de inicio rápido: forma esporádica / Rapid-onset dystonia-parkinsonism: sporadic form

Introducción. La distonía-parkinsonismo de inicio rápido es un trastorno del movimiento que asocia distonía, conespecial afectación de la musculatura orofacial, y síntomas parkinsonianos. Esta sintomatología se instaura de forma brusca y posteriormente permanece estable a lo largo de la enfermedad. Afecta sobre todo a personas jóvenes y tiene carácter hereditario autosómico dominante con escasa penetrancia, aunque se han descrito casos esporádicos. La alteración genética selocaliza en el cromosoma 19q13, donde se ha encontrado una mutación del gen ATP1A3 relacionado con la regulación de la bomba de sodio-potasio. Caso clínico. Mujer de 16 años con un cuadro brusco de distonía que afecta a los miembros superiores e inferiores y a la musculatura bulbar, con importante disartria y disfagia. El cuadro clínico se instauró en unas horas yha permanecido estable a lo largo de los años. No existen antecedentes familiares de trastornos del movimiento ni de otras enfermedades neurológicas. Conclusiones. La distonía-parkinsonismo de inicio rápido constituye una forma rara de parkinsonismo que puede aparecer de forma esporádica o familiar. Este caso representa probablemente una forma esporádica y es elsegundo caso de esta rara entidad comunicado en España. El diagnóstico diferencial es complejo y debe realizarse principalmente con el parkinsonismo juvenil, la distonía que responde a la levodopa y la distonía-parkinsonismo unido al cromosoma X. Se discuten los criterios diagnósticos, el diagnóstico diferencial, la etiopatogenia y las alteraciones genéticas

Introduction. The rapid-onset dystonia-parkinsonism is a movement disorder which associates dystonic symptoms,especially those affecting orofacial muscles, and parkinsonian symptoms. All these symptoms start suddenly and then they stabilize along the process. This disorder usually occurs to young adults and is an autosomal dominant trait with a reduced penetrance, although some sporadic cases have been reported. The genetic alteration is found on the chromosome 19q13,where the mutated geneATP1A3 has been identified. This gene is linked to the regulation of the sodium-potassium pump. Case report. A 16-year-old woman developed a sudden onset of dystonic symptoms which affected her higher and lower limbs, bulbar muscles, together with severe dysarthria and dysphagia. The onset occurred over hours, but her symptoms have been stabilized for years. No movement or other neurological disorders are reported in her family history. Conclusions. This isprobably a sporadic case of rapid-onset dystonia-parkinsonism, and it is the second one reported in Spain. Diagnostic criteria, differential diagnosis, etiopahogenesis and genetic alterations are also discussed

[Topiramate therapy in patients with refractory epilepsy]. / Tratamiento con topiramato en pacientes con epilepsia refractaria.

AIMS: The purpose of this study was to examine the result of administrating topiramate (TPM) to patients with epilepsy that is refractory to treatment with two or more antiepileptic agents. PATIENTS AND METHODS: A total of 50 patients were evaluated, 90% of which had partial seizures (simple partial, complex partial and partial with secondary generalisation) and the remaining 10% suffered from generalised seizures. The most frequent aetiology was that which corresponded to the symptoms (52% of the cases). 98% of the patients were treated with two or three drugs. TPM was added with a dosage interval between 75 and 550 mg and follow-up visits were carried out throughout a period of nine months. RESULTS: 12 patients remained seizure-free for at least the first three months of the study; in 20 patients the number of seizures decreased by 50% or more; in 14 patients no changes were observed, and in the other four there was an increase in the number of seizures. The best results were obtained in cases of seizures with an idiopathic aetiology, while complex partial seizures offered the worst results. We also analysed the factors that might exert an influence on the different degrees of response. CONCLUSIONS: TPM was effective in all kinds of seizures. 24% of the patients became seizure free, and the total percentage of respondents rose to 64%. No patients dropped out of the study because of intolerance to the drugs.

Tratamiento con topiramato en pacientes con epilepsia refractaria / Topiramate therapy in patients with refractory epilepsy

Objetivo. Estudiar el resultado de la administración de topiramato (TPM) a pacientes con epilepsia refractaria al tratamiento con dos o más fármacos antiepilépticos. Pacientes y métodos. Se evaluó un total de 50 pacientes. El 90 por ciento tenía crisis parciales (parciales simples, parciales complejas y parciales con generalización secundaria) y el 10 por ciento crisis generalizadas. La etiología más frecuente fue la sintomática (52 por ciento de los casos). El 98 por ciento de los pacientes se trataba con dos o tres fármacos. Se añadió TPM, con un intervalo de dosis entre 75 y 550 mg, y se hicieron visitas de seguimiento durante nueve meses. Resultados. 12 pacientes permanecieron libres de crisis, al menos durante los tres últimos meses del estudio; en 20 pacientes hubo una reducción del 50 por ciento o más en su número de crisis; en 14 pacientes no se observaron cambios, y en los cuatro restantes aumentó el número de crisis. Las crisis de etiología idiopática tienen mejor resultado, y las crisis parciales complejas, peor. Se analizan los factores que pudieron influir en los distintos grados de respuesta. Conclusiones. El TPM fue eficaz en todos los tipos de crisis. El 24 por ciento de los pacientes se libró de las crisis, y se elevó el porcentaje total de respondedores al 64 por ciento. Ningún paciente abandonó el estudio por intolerancia a la medicación (AU)

Aims. The purpose of this study was to examine the result of administrating topiramate (TPM) to patients with epilepsy that is refractory to treatment with two or more antiepileptic agents. Patients and methods. A total of 50 patients were evaluated, 90% of which had partial seizures (simple partial, complex partial and partial with secondary generalisation) and the remaining 10% suffered from generalised seizures. The most frequent aetiology was that which corresponded to the symptoms (52% of the cases). 98% of the patients were treated with two or three drugs. TPM was added with a dosage interval between 75 and 550 mg and follow-up visits were carried out throughout a period of nine months. Results. 12 patients remained seizure-free for at least the first three months of the study; in 20 patients the number of seizures decreased by 50% or more; in 14 patients no changes were observed, and in the other four there was an increase in the number of seizures. The best results were obtained in cases of seizures with an idiopathic aetiology, while complex partial seizures offered the worst results. We also analysed the factors that might exert an influence on the different degrees of response. Conclusions. TPM was effective in all kinds of seizures. 24% of the patients became seizure-free, and the total percentage of respondents rose to 64%. No patients dropped out of the study because of intolerance to the drugs (AU)

[Streptococcus bovis meningitis. An infrequent cause of bacterial meningitis in the adult patient]. / Meningitis por Streptococcus bovis: una causa poco frecuente de meningitis bacteriana en el paciente adulto.

INTRODUCTION: Bacterial meningitis in adult patients, produced by streptococci other than Streptococcus pneumoniae, is not common. CASE REPORT: We report the case of a 74 year old male patient with meningitis and endocarditis due to Streptococcus bovis (group D, not enterococcus), sensitive to penicillin (CMI< 0.1 mg/L), with no characteristic clinical or analytical discoveries. A gastrointestinal exploration revealed only diverticles in the colon and two lesions compatible with splenic infarction, observed by using computerised axial tomography of the abdomen. The patient responded favourably to a four week course of antibiotics; he remained asymptomatic, afebrile and culture negative after the therapy was stopped. CONCLUSIONS: In many previously reported cases, there is an association with gastrointestinal illness, endocarditis or oral lesions. Gram staining of the cerebrospinal fluid is usually negative and the neurological signs are often subtle. In the case of bacteraemia, endocarditis or S. bovis meningitis, the presence of an underlying pathology of the colon due to the frequent association between these processes must be ruled out. Treatment with penicillin G is usually sufficient.

Meningitis por Streptococcus bovis: una causa poco frecuente de meningitis bacteriana en el paciente adulto / Streptococcus bovis meningitis. An infrequent cause of bacterial meningitis in the adult patient

Introducción. La meningitis producida por estreptococos diferentes del S. pneumoniae es infrecuente en los pacientes adultos. Caso clínico. Paciente varón, de 74 años, que presentó meningitis y endocarditis debidas a Streptococcus bovis (grupo D, no enterococo), sensible a la penicilina (CMI< 0,1 mg/L), sin hallazgos clínicos ni analíticos característicos. En el estudio gastrointestinal sólo se observaron divertículos en el colon; mediante tomografía computarizada abdominal se observaron dos lesiones esplénicas compatibles con infarto. El paciente evolucionó favorablemente con el tratamiento antibiótico que recibió durante cuatro semanas, tras el cual permaneció asintomático, afebril y con hemocultivos negativos. Conclusiones. En muchos de los casos similares que se han comunicado coexiste una enfermedad gastrointestinal, endocarditis o lesiones orales. La tinción de Gram del líquido cefalorraquídeo suele ser negativa y los signos neurológicos son a menudo sutiles. En caso de bacteriemia, endocarditis o meningitis por S. bovis, es necesario descartar la presencia de patología colónica debido a la frecuente asociación entre estos procesos. El tratamiento con penicilina G es usualmente adecuado (AU)

[The association of Marchiafava-Bignami disease, cerebral pellagra and cerebellar degeneration in an alcoholic patient]. / Asociación de enfermedad de Marchiafava-Bignami, pelagra cerebral y degeneración cerebelosa en un paciente alcohólico.

INTRODUCTION: Marchiafava-Bignami disease, cerebral pellagra and alcoholic cerebellar degeneration are a group of diseases included in the alcoholic encephalopathies, although they may also be caused by metabolic or nutritional disorders. The isolated appearance of these diseases usually permits diagnosis during the life of the patient, based on the neuro-radiological findings. However, their combination leads to complex form, with variable neurological expression, which means that precise diagnosis may often be post mortem. CLINICAL CASE: We present a malnourished alcoholic patient with neurological features compatible with alcoholic encephalopathy. The post mortem findings showed lesions typical of alcoholic cerebellar degeneration, cerebral pellagra and Marchiafava-Bignami disease.