Subject(s)
Carotid Artery, Internal, Dissection/complications , Hypoglossal Nerve Diseases/etiology , Adult , Carotid Artery, Internal, Dissection/diagnosis , Carotid Artery, Internal, Dissection/pathology , Humans , Hypoglossal Nerve Diseases/diagnosis , Hypoglossal Nerve Diseases/pathology , Male , RecurrenceSubject(s)
Carotid Artery Injuries/etiology , Carotid Artery, Internal, Dissection/etiology , Carotid Artery, Internal/physiopathology , Infarction, Middle Cerebral Artery/etiology , Swimming/injuries , Wounds and Injuries/etiology , Accidents , Biomechanical Phenomena , Brain Concussion/etiology , Brain Concussion/pathology , Brain Concussion/physiopathology , Carotid Artery Injuries/pathology , Carotid Artery Injuries/physiopathology , Carotid Artery, Internal/pathology , Carotid Artery, Internal, Dissection/pathology , Carotid Artery, Internal, Dissection/physiopathology , Dysarthria/etiology , Dysarthria/pathology , Dysarthria/physiopathology , Humans , Hypesthesia/etiology , Hypesthesia/pathology , Hypesthesia/physiopathology , Infarction, Middle Cerebral Artery/pathology , Infarction, Middle Cerebral Artery/physiopathology , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Middle Aged , Seawater/adverse effects , Wounds and Injuries/pathology , Wounds and Injuries/physiopathologyABSTRACT
OBJECTIVE: To analyze the experience in daily clinical practice of interferon-beta (IFN-beta) treatment in relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) in Galicia (Spain). PATIENTS AND METHODS: Patients with RR-MS and SP-MS treated with IFN-beta1a and 1b between 1995 and December/2000, analyzing demographic and clinical data. RESULTS: 313 patients were included, with a mean age of 38.2 years. A total of 296 patients (94.6%) were clinically defined MS and 17 (5.4%) were laboratory supported (Poser criteria); 84.6% of the patients were RR and 15.4% were SP. The mean duration of the disease prior to treatment was 7.06 years. Betaferon was used in 52.4% patients (115 RR-MS and 47 SP-MS), Avonex in 26% and Rebif in 21.6%. Relapse rate was reduced in 68.8% for the RR-MS for Betaferon-treated patients, 73.3% for Avonex treated and 35.7% for Rebif-treated patients. Betaferon reduced relapse rate in 50% for SP-MS. The global EDSS remained stable during IFN-beta treatment. During treatment, 33% of Betaferon, 60.5% of Avonex and 54.5% of Rebif-treated patients remained relapse-free. Treatment was suspended in 12.9% of Betaferon, 6.2% of Avonex, and 3% Rebif-treated patients. The most frequent causes of treatment suspension were increase in disability and in relapse count. CONCLUSIONS: The present study supports the benefits of IFN-beta treatment in RR MS and SP MS in daily clinical practice, with reduction in relapses count and incapacity, good over-all tolerance and low incidence of serious adverse side-effects.
Subject(s)
Adjuvants, Immunologic/therapeutic use , Interferon-beta/therapeutic use , Multiple Sclerosis/drug therapy , Adult , Female , Humans , Male , SpainSubject(s)
Arachnoid Cysts/diagnosis , Arachnoid Cysts/surgery , Cerebrospinal Fluid , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Spinal CanalSubject(s)
Cerebellum/pathology , Functional Laterality , Atrophy/pathology , Humans , Magnetic Resonance Imaging , Middle Aged , SyndromeABSTRACT
INTRODUCTION: Cervical myelopathy is a common disorder of the spinal cord. The most frequent symptoms are muscle weakness and spasticity starting in the legs. Occasionally the sensory levels are several spinal cord segments below the cervical lesion which makes diagnosis difficult. CLINICAL CASE: We present the case of a 31 year old man who presented (after exercise) with paresthesia and numbness below the left costal margin in the left hemiabdomen and the left leg. On physical examination there was painful superficial tactile thermic hypoaesthesia at the level of D10 on the left side, together with brisk myotatic reflexes of the legs and indifferent bilateral plantar reflexes. Blood and CSF studies were normal. On cervical MR there was a large hernia of the intervertebral disk at C5-C6 and marked involvement of the spinal cord. Progress after surgery was good. Two months after operation he was symptom free and neurological examination was normal. CONCLUSIONS: Diagnosis of cervical myelopathy may be difficult because of the varied symptoms. There may be a dorsal or lumbar sensory level acting as a false localizing sign. The physiopathological mechanism for this is not clear. Different hypotheses have been put forward based on anatomical distribution of the spino-thalamic tract and on indirect factors (vascular, demyelinization, etc.). In a patient with a dorsal sensory level and normal radiological findings at this level, it is important to study levels above this as well to avoid errors of diagnosis and treatment.
Subject(s)
Cervical Vertebrae/pathology , Intervertebral Disc Displacement/diagnosis , Muscle Spasticity/diagnosis , Perceptual Disorders/diagnosis , Adult , Cervical Vertebrae/surgery , Humans , Intervertebral Disc Displacement/complications , Intervertebral Disc Displacement/surgery , Magnetic Resonance Imaging , Male , Muscle Spasticity/complications , Perceptual Disorders/etiologyABSTRACT
INTRODUCTION: Spontaneous mesencephalic hemorrhages are very unusual, specially those located in the tectal region. Hypertension is a less important factor that in other classical locations. Other etiologies reported are arteriovenous malformations, coagulation disorder and trauma. We describe two patients with spontaneous hemorrhage of the quadrigeminal plate. CLINICAL CASE: Case 1: a non-hypertensive 30 year-old man who suddenly presented headache, nausea, diplopia and left hemisensory deficit. Twenty-four hours later he lost consciousness but was again alert within five hours. Examination revealed upward and downward gaze palsy and limited convergence. The patient recovered completely within six weeks. Case 2: a 38 year-old man without hypertension, who suddenly developed dizziness, occipital headache, nausea and diplopia. On examination, there was impaired upward and downward gaze, limitation of convergence and right arm hyposthesia. After eight weeks examination showed a mild limitation of upward voluntary gaze. CT and MR imaging studies revealed a small quadrigeminal hemorrhage in both cases. CONCLUSIONS: Hemorrhages located at mesencephalic tectal region are infrequent. They have a typical clinical presentation and outcome is usually favourable. Hypertension is less common than in hemorrhages of other locations. A significant proportion of cases can be attributed to occult vascular malformations.
Subject(s)
Cerebral Hemorrhage/diagnosis , Tectum Mesencephali , Adult , Humans , Magnetic Resonance Imaging , Male , Tectum Mesencephali/diagnostic imaging , Tectum Mesencephali/pathology , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Wallenberg's syndrome is one of the most common clinically recognized conditions due to brain stem infarct, which can nowadays be identified thanks to modern neuro-imaging techniques. We present a retrospective study of 25 cases admitted to our hospital in the past eight years, to evaluate epidemiological aspects and clinical findings and to correlate these with magnetic resonance topography. MATERIAL AND METHODS: Patients diagnosed in the Neurology Section of Hospital Xeral-Calde in Lugo between January 1989 and December 1997 as having Wallenberg's syndrome. RESULTS: There was a predominance of middle aged men presenting at 55.06 years of age (range 30- 78). Arterial hypertension was the main risk factor (52%). There was a progressive form of onset in most cases. The commonest symptom was dysphonia followed by dysphagia. The commonest finding on physical examination was ataxic gait (24 patients) MR was positive in 22 of the 23 cases in which this was done. There were different clinical findings depending on the site of the lesion, whether rostral, caudal or medial. This is considered in the discussion. In most cases the prognosis was good. The commonest sequel was ataxia. CONCLUSIONS: The results are similar to those in the literature. We emphasize the excellent correlation of clinical data and neuroimaging findings.
Subject(s)
Brain/pathology , Lateral Medullary Syndrome/diagnosis , Adult , Aged , Ataxia/complications , Ataxia/diagnosis , Brain/diagnostic imaging , Deglutition Disorders/complications , Deglutition Disorders/diagnosis , Female , Humans , Incidence , Lateral Medullary Syndrome/complications , Lateral Medullary Syndrome/epidemiology , Magnetic Resonance Imaging , Male , Middle Aged , Prognosis , Retrospective Studies , Tomography, X-Ray Computed , Voice Disorders/complications , Voice Disorders/diagnosisABSTRACT
Transient global amnesia (AGT) is a well-defined syndrome of unknown aetiology. It is generally believed to be of vascular origin. Other theories suggest epilepsy or migraine as the cause. We studied the clinical features and associated risk factors in 24 patients with AGT, comparing them with two control groups with 24 people in each group, paired for age and sex. The first control group contained healthy individuals (CN) and the second patients with transient ischaemic attacks (AIT). Of the patients with AGT, 70% were women and 30% men. Their average age was 60 (range 14-76). The attacks were abrupt in onset in 100%. In 8% there was a recognisable trigger factor (driving, physical exercise, etc). The average duration was 7 hours. On study of the cardiovascular risk factors, it was found that 36% were hypertensive, 24% had cardiopathy, 12% had diabetes mellitus, 8% were smokers, 4% had polycythaemia, 16% had hyperlipidaemia, 4% were alcoholics. There was a history of migraine in 29%. No patient had a past history of epilepsy. Further investigation showed ECG changes in 12%. In 24% there were non-specific changes in the EEG. On cerebral CT scan there were lesions compatible with ischaemia in 12.5% of the patients. Levels of arterial hypertension were significantly higher in the AGT group as compared to the normal control group (Odds ratio 7.86; CI. 1.29-11.38). A past history of migraine was seen to be a risk factor associated with AGT as compared with both groups of controls (AGT/CN Odds ratio 9.47; CI 1.01-444.92; AGT/AIT Odds ratio > 1.72).
Subject(s)
Amnesia/physiopathology , Brain/physiopathology , Adolescent , Adult , Aged , Amnesia/diagnosis , Amnesia/etiology , Female , Humans , Ischemic Attack, Transient/complications , Ischemic Attack, Transient/physiopathology , Male , Middle Aged , Migraine Disorders/complications , Retrospective Studies , Risk FactorsSubject(s)
Brain Diseases/diagnosis , Brain/pathology , Headache/diagnosis , Hematoma/pathology , Aged , Amitriptyline/therapeutic use , Brain Diseases/complications , Brain Diseases/diagnostic imaging , Functional Laterality , Headache/drug therapy , Headache/etiology , Hematoma/diagnostic imaging , Humans , Male , Tomography, X-Ray ComputedABSTRACT
Neurological symptoms (NS) of 33 patients diagnosed as suffering from polycythemia vera (PV) are described. 24 of them (73%) had NS at some point in their evolution, the most frequent being related to blood hyperviscosity (headache 51%, dizziness 36%, paresthesias 30%, sight alterations 21%). 5 patients had ictus (15%) and there were no bleeding symptoms in the nervous system. There were no significant differences (p greater than 0.05) in age, sex; hematocrit, platelet or volume of packed red cells, between patients with NS and those without NS. A complete remission of NS was obtained reducing the hematocrit, except in ictus patients. We did not find mortality, as a result of NS.