Manifestaciones neurooftalmológicas como forma de presentación de la neurosífilis / Neuro-ophthalmological manifestations presenting as neurosyphilis

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Percepción de los neurólogos generales sobre la importancia e influencia del deterioro cognitivo y las alteraciones de conducta en la enfermedad de Parkinson / No disponible

Introducción. En los últimos años ha ido adquiriendo cada vez mayor importancia la influencia de los trastornos no motores en la enfermedad de Parkinson (TNMEP). Las alteraciones de conducta (AC) y el deterioro cognitivo (DC) forman parte del espectro de estos TNMEP. Actualmente, en nuestro entorno, un número considerable de pacientes con enfermedad de Parkinson (EP) es valorado inicialmente en las consultas de neurología general, por lo que resulta importante que los neurólogos no especialistas en trastornos del movimiento consideren los TNMEP en la evaluación inicial de sus pacientes con EP. El objetivo de este trabajo es conocer la percepción que el neurólogo general tiene sobre la importancia e influencia de las AC y el DC en los pacientes con EP. Material y métodos. Se diseñó una encuesta que fue enviada por correo electrónico a los neurólogos con ejercicio profesional en la Comunidad Autónoma de Canarias. Resultados. Se enviaron 73 encuestas, de las que se respondieron 40. Las AC y el DC fueron considerados relativamente frecuentes/muy frecuentes por un 78,6 % y un 86 % de los participantes, respectivamente; un 78,6 % y un 82,1 % consideró que las AC y el DC, respectivamente, tienen mucha influencia o tanta influencia como los trastornos motores en la percepción que los pacientes tienen de su enfermedad. Un 60,7 % y un 64,2 % de los encuestados consideró que las AC y el DC, respectivamente, aparecen cuando comienzan a surgir las complicaciones motoras de la enfermedad o en fases tardías de esta. Un 89,2% y un 82,1 % de los encuestados contestó que explora de forma específica siempre o prácticamente siempre las AC y el DC, respectivamente, en su valoración de los pacientes con EP. Un 78,5 % de los encuestados consideró que la levodopa y los agonistas dopaminérgicos no tienen ninguna eficacia o tienen una eficacia limitada en el tratamiento de las AC y el DC. Conclusión. La mayoría de los neurólogos generales en nuestra comunidad autónoma considera que las AC y el DC son problemas frecuentes e importantes en los pacientes con EP, e incluyen de forma específica la valoración de estas complicaciones en su práctica diaria, siendo, en general, consideradas complicaciones tardías(AU)

Introduction. The influence of non-motor disorders in Parkinson’s disease (NMDPD) has become increasingly more important in recent years. Behaviour changes (BC) and cognitive impairment (CI) are part of the spectrum of these NMDPD. Currently, a significant number of patients with Parkinson’s disease (PD) is initially evaluated by general neurologists in our sanitary area; it is therefore important that neurologists not specialized in movement disorders consider NMDPD in the initial assessment of patients with Parkinson's Disease. The aim of this study is to determine the perception that the general neurologist has about the importance and influence of the BC and CI in patients with PD. Materials and methods. We designed a survey that was e-mailed to neurologists with professional activity in the Canary Islands. Results. We sent by e-mail 73 surveys to general neurologists, and we received feedback from 40 of them. BC and CI were considered relatively frequent / very frequent for 78.6% and 86 % of participants, respectively; 78.6 % and 82.1 % considered that BC and CI, in this order, are more influent or are as influent as motor disturbances in the patient self-perception of their disease; 60.7 % and 64.2 % of general neurologists felt that BC and CI appear at the same time than motor complications of the disease, or in later stages of the disease; 89.2 % and 82.1 % answered that they always, or almost always, explore BC and CI in their assessment of patients with PD; 78.5 % thought that levodopa and dopamine agonists have no efficacy or have limited efficacy in the treatment of BC and CI. Conclusion. Most general neurologists in our region believe that BC and CI are frequent and important problems in PD patients, and they specifically include the evaluation of these complications in their daily practice. Both BC and CI are generally considered to appear at later stages of disease course(AU)

[Description of the follow-up protocol for idiopathic intracranial hypertension in the neuro-ophthalmological unit of a tertiary hospital]. / Descripcion del protocolo de seguimiento para la hipertension intracraneal idiopatica en una unidad de neurooftalmologia de un hospital terciario.

AIM: To review the results of implementing a protocol for following up patients with idiopathic intracranial hypertension (IICH) in a neuro-ophthalmological unit (NOU). PATIENTS AND METHODS: A review of the literature was conducted in order to determine the examinations that needed to be included in the follow-up protocol, as well as the optimum frequency of visits and the most adequate duration of the follow-up. Later, a prospective review was performed of the patients that have been included since the NOU was set up and they were compared with the patients included in the IICH register prior to the creation of the NOU. RESULTS: Since the protocol was implemented, visual acuity and the visual field have been evaluated in 100% of patients at three months, at six months and at one year after diagnosis. Moreover, the visual field was examined at three months, at six months and at one year after diagnosis in 91%, 72.8% and 100% of patients with IICH, respectively. Before our follow-up protocol was implemented, 190 had been carried out, which is roughly three per patient. Eleven lumbar punctures have been performed since the NOU was set up. CONCLUSIONS: The creation of a multidisciplinary NOU makes it possible to optimise resources and improve the care given to patients with IICH. This should result in an improvement in the functional prognosis of these patients.

TITLE: Descripcion del protocolo de seguimiento para la hipertension intracraneal idiopatica en una unidad de neurooftalmologia de un hospital terciario.Objetivo. Revisar los resultados de la implantacion de un protocolo de seguimiento de pacientes con hipertension intracraneal idiopatica (HICI) en una unidad de neurooftalmologia (UNO). Pacientes y metodos. Se realizo una revision bibliografica para determinar las exploraciones necesarias que debian incluirse en el protocolo de seguimiento, asi como la frecuencia optima de las visitas y la duracion adecuada del seguimiento. Posteriormente, se revisaron de forma prospectiva los pacientes incluidos desde la creacion de la UNO y se compararon con los pacientes incluidos en el registro de HICI previo a la creacion de la UNO. Resultados. Desde la implantacion del protocolo, en el 100% de los pacientes se ha valorado la agudeza visual y la campimetria visual a los tres meses, a los seis meses y al ano del diagnostico. Ademas, en un 91%, 72,8% y 100% de los pacientes con HICI se realizo una campimetria visual a los tres meses, a los seis meses y al ano del diagnostico, respectivamente. Antes de la implantacion de nuestro protocolo de seguimiento, se habian realizado 190, lo que corresponde a unas tres por paciente. El numero de punciones lumbares realizadas desde la creacion de la UNO es de 11. Conclusiones. La creacion de una UNO multidisciplinar permite optimizar los recursos y mejorar la asistencia a los pacientes con HICI. Esto deberia redundar en una mejoria del pronostico funcional de estos pacientes.

Descripción del protocolo de seguimiento para la hipertensión intracraneal idiopática en una unidad de neurooftalmología de un hospital terciario / Description of the follow-up protocol for idiopathic intracranial hypertension in the neuro-ophthalmological

Objetivo. Revisar los resultados de la implantación de un protocolo de seguimiento de pacientes con hipertensión intracraneal idiopática (HICI) en una unidad de neurooftalmología (UNO). Pacientes y métodos. Se realizó una revisión bibliográfica para determinar las exploraciones necesarias que debían incluirse en el protocolo de seguimiento, así como la frecuencia óptima de las visitas y la duración adecuada del seguimiento. Posteriormente, se revisaron de forma prospectiva los pacientes incluidos desde la creación de la UNO y se compararon con los pacientes incluidos en el registro de HICI previo a la creación de la UNO. Resultados. Desde la implantación del protocolo, en el 100% de los pacientes se ha valorado la agudeza visual y la campimetría visual a los tres meses, a los seis meses y al año del diagnóstico. Además, en un 91%, 72,8% y 100% de los pacientes con HICI se realizó una campimetría visual a los tres meses, a los seis meses y al año del diagnóstico, respectivamente. Antes de la implantación de nuestro protocolo de seguimiento, se habían realizado 190, lo que corresponde a unas tres por paciente. El número de punciones lumbares realizadas desde la creación de la UNO es de 11. Conclusiones. La creación de una UNO multidisciplinar permite optimizar los recursos y mejorar la asistencia a los pacientes con HICI. Esto debería redundar en una mejoría del pronóstico funcional de estos pacientes (AU)

Aim. To review the results of implementing a protocol for following up patients with idiopathic intracranial hypertension (IICH) in a neuro-ophthalmological unit (NOU). Patients and methods. A review of the literature was conducted in order to determine the examinations that needed to be included in the follow-up protocol, as well as the optimum frequency of visits and the most adequate duration of the follow-up. Later, a prospective review was performed of the patients that have been included since the NOU was set up and they were compared with the patients included in the IICH register prior to the creation of the NOU. Results. Since the protocol was implemented, visual acuity and the visual field have been evaluated in 100% of patients at three months, at six months and at one year after diagnosis. Moreover, the visual field was examined at three months, at six months and at one year after diagnosis in 91%, 72.8% and 100% of patients with IICH, respectively. Before our followup protocol was implemented, 190 had been carried out, which is roughly three per patient. Eleven lumbar punctures have been performed since the NOU was set up. Conclusions. The creation of a multidisciplinary NOU makes it possible to optimise resources and improve the care given to patients with IICH. This should result in an improvement in the functional prognosis of these patients (AU)

[Thrombosis of the cerebral venous sinuses in the differential diagnosis of idiopathic intracranial hypertension in young obese females: is it a real problem?]. / Trombosis de senos venosos cerebrales en el diagnostico diferencial de la hipertension intracraneal idiopatica en mujeres jovenes obesas: un problema real?

INTRODUCTION: Idiopathic intracranial hypertension (IICH) typically presents in young women with obesity or a recent weight increase. The differential diagnosis of IICH includes thrombosis of the cerebral venous sinuses (TCVS), which can also present as an isolated intracranial hypertension syndrome. We review the frequency with which patients with a typical IICH profile presented TCVS as their diagnosis. PATIENTS AND METHODS: The study consisted in a retrospective review of all the admissions due to intracranial hypertension syndromes in our centre between 2000 and 2011. The cases selected were those with a normal cerebrospinal fluid study and computerised axial tomography scan of the head that presented as an isolated intracranial hypertension syndrome; those who manifested a focal neurological picture, however, were excluded. From the patients that were included, a subgroup made up of females between 16 and 35 years of age with a body mass index of above 25 were selected. RESULTS: A total of 37 cases were obtained. Of these, 35 (94.6%) were cases of IICH and two (5.4%) were TCVS. The time elapsed between the onset of symptoms and diagnosis was less than seven days in both cases of TCVS (100%) and in two cases (5.4%) of IICH. CONCLUSIONS: Up to 5.4% of patients with a typical IICH profile that present with an intracranial hypertension syndrome can present TCVS. The presence of prothrombotic factors and a high D-dimer can suggest this possibility, although there is still a need for well-established parameters that allow decisions to be made in emergencies in the absence of any chance of performing an urgent MR phlebography scan.

Trombosis de senos venosos cerebrales en el diagnóstico diferencial de la hipertensión intracraneal idiopática en mujeres jóvenes obesas: ¿un problema real? / Thrombosis of the cerebral venous sinuses in the differential diagnosis of idiopathic intracranial hypertension in young obese females: is it a real problem?

Introducción. La hipertensión intracraneal idiopática (HICI) se presenta típicamente en mujeres jóvenes con obesidad o aumento de peso reciente. En el diagnóstico diferencial de la HICI se encuentra la trombosis de los senos venosos cerebrales (TSVC), que también puede presentarse como un síndrome de hipertensión intracraneal aislada. Revisamos la frecuencia con la que pacientes con un perfil típico de HICI presentaron como diagnóstico una TSVC. Pacientes y métodos. Se revisaron de forma retrospectiva todos los ingresos por síndromes de hipertensión intracraneal en nuestro centro entre 2000 y 2011. Se seleccionaron los casos con tomografía axial computarizada craneal y estudio de líquido cefalorraquídeo normal que se presentaron como un síndrome de hipertensión intracraneal aislado, excluyéndose los que manifestaron clínica neurológica focal. Entre los pacientes incluidos, se seleccionó el subgrupo de mujeres entre 16 y 35 años con un índice de masa corporal superior a 25. Resultados. Se obtuvieron 37 casos. De éstos, 35 (94,6%) fueron casos de HICI y dos (5,4%) de TSVC. El tiempo desde el inicio de los síntomas hasta el diagnóstico fue menor de siete días en los dos casos (100%) de TSVC y en dos (5,4%) de HICI. Conclusiones. Hasta un 5,4% de los pacientes con perfil típico de HICI que se presentan con un síndrome de hipertensión intracraneal pueden presentar una TSVC. La presencia de factores protrombóticos y un dímero D elevado pueden orientar hacia esta posibilidad, aunque se precisan todavía parámetros bien establecidos que permitan la toma de decisiones en urgencias en ausencia de la posibilidad de una fleborresonancia craneal urgente (AU)

Introduction. Idiopathic intracranial hypertension (IICH) typically presents in young women with obesity or a recent weight increase. The differential diagnosis of IICH includes thrombosis of the cerebral venous sinuses (TCVS), which can also present as an isolated intracranial hypertension syndrome. We review the frequency with which patients with a typical IICH profile presented TCVS as their diagnosis. Patients and methods. The study consisted in a retrospective review of all the admissions due to intracranial hypertension syndromes in our centre between 2000 and 2011. The cases selected were those with a normal cerebrospinal fluid study and computerised axial tomography scan of the head that presented as an isolated intracranial hypertension syndrome; those who manifested a focal neurological picture, however, were excluded. From the patients that were included, a subgroup made up of females between 16 and 35 years of age with a body mass index of above 25 were selected. Results. A total of 37 cases were obtained. Of these, 35 (94.6%) were cases of IICH and two (5.4%) were TCVS. The time elapsed between the onset of symptoms and diagnosis was less than seven days in both cases of TCVS (100%) and in two cases (5.4%) of IICH. Conclusions. Up to 5.4% of patients with a typical IICH profile that present with an intracranial hypertension syndrome can present TCVS. The presence of prothrombotic factors and a high D-dimer can suggest this possibility, although there is still a need for well-established parameters that allow decisions to be made in emergencies in the absence of any chance of performing an urgent MR phlebography scan (AU)

Plexopatía braquial secundaria a tumor maligno de la vaina del nervio periférico / Brachial plexopathy secondary a malignant tumor of the peripheral nerve sheath

Introducción: el plexo braquial puede verse afectado por patología neoplásica tanto primaria como secundaria. Los tumores primarios del plexo braquial son entidades poco frecuentes, aunque algunos, como el tumor maligno de la vaina del nervio periférico pueden tener un comportamiento agresivo. Caso clínico: se presenta una mujer de 31 años con disestesias y debilidad progresiva en el miembro superior izquierdo. El estudio neurofisiológico mostró afectación del plexo braquial izquierdo. En la resonancia magnética se observó una masa de tejido blando que invadía el plexo braquial. El estudio histológico fue compatible con un tumor maligno de la vaina del nervio periférico. Conclusiones: el tumor maligno de la vaina del nervio periférico es un tumor altamente agresivo que puede aparecer en pacientes sin datos clínicos de neurofibromatosis tipo 1. Debe mantenerse un elevado nivel de sospecha con el objetivo de no retrasar el diagnóstico para así poder realizar un tratamiento lo más conservador posible.

Introduction. Malignant peripheral nerve sheath tumor (MPNST) are sarcomas that are rarely located in the upper limb. Clinical case. We present a 31- year-old woman with progressive dysesthesia and weakness of the left upper limb. The neurophysiological study showed damage in the left brachial plexus. A soft tissue mass that was invading the plexus was observed in the magnetic resonance image. The anatomopathological study was compatible with MPNST diagnosis. Conclusions. Intrinsic tumors of the brachial plexus are uncommon. A MPNST is an extremely aggressive mesenchymal tumor that is seldom rooted in the brachial plexus.

Trombólisis intravenosa con activador tisular de plasminógeno en el síndrome de alarma basilar / Intravenous thrombolysis with tissue plasminogen activator in basilar warning syndrome

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Diparesia braquial como forma depresentación del síndrome de Guillain-Barre / Brachial diparesis as clinical ons et of Guillain-Barré syndrome

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[Risk factors, etiology and prognosis in patients older than 80 years old with ischemic stroke]. / Factores de riesgo, etiología y pronóstico en pacientes mayores de 80 años con accidente cerebrovascular.

INTRODUCTION: The aim of this study was to analyze differences between patients aged 80 years or less and those aged more than 80 years old a hospital series of ischemic stroke. MATERIAL AND METHODS: We performed a retrospective review of all patients with ischemic stroke or transient ischemic attack requiring admission to the Neurology Service of the Dr. Negrín University Hospital of Gran Canaria (Spain) between January 1, 2004 and December 31, 2006. Data were gathered on hypertension, diabetes mellitus (DM), hyperlipidemia, ischemic cardiopathy (IC), atrial fibrillation (AF), the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, as well as the National Institutes of Health (NIH) scale and the modified Rankin scale (mRS) at discharge. RESULTS: A total of 850 patients were included. Age was >80 years in 106 (12.4%) and was <80 years in 744 (87.6%). In the group aged>80 years, 43.4% were men and 56.6% were women (64.1% men and 35.9% women in the group aged<80 years). Hypertension was present in 81.1% of patients aged>80 years (68.1% in those aged<80 years); previous DM was found in 29.2% (39.3% in the group aged<80 years); hyperlipidemia was present in 26.4% (40.2% in the group aged<80); IC was found in 16.9% (15.8% in the group aged<80); AF was found in 40% (20.9% in the group aged<80 years). In the group of patients aged>80 years, 23.6% had atherothrombotic stroke (19.3% in those aged<80 years); 38.7% were cardioembolic (19.3% in the group aged<80 years); 10.4% were lacunar (22.6% in the group aged<80 years); and 24.5% was of undetermined origin (28.6% in the group aged<80 years). The mRS at discharge was 80 years. CONCLUSIONS: Ischemic stroke in patients over 80 years old leads to certain differences in relation to risk factors, stroke etiology and stroke severity.

Factores de riesgo, etiologia y pronostico en pacientes mayores de 80 anos con accidente cerebrovascular / Risk factors, etiology and prognosis in patients older than 80 years old with ischemic stroke

Objetivos: el objetivo de este trabajo es analizar las diferencias entre mayores y menores de 80 años en una serie hospitalaria de accidente cerebrovascular (ACV). Material y m¨¦todos: se revisaron retrospectivamente las historias de los pacientes ingresados en el Hospital Universitario de Gran Canaria Dr. Negr¨ªn, en el per¨ªodo 2004-2006 por ACV o AIT. Se recogi¨® la presencia de hipertensi¨®n arterial (HTA), diabetes mellitus (DM), dislipemia (DLP), cardiopat¨ªa isqu¨¦mica (CI), fibrilaci¨®n auricular (FA), la clasificaci¨®n Trial of Org 10172 in Acute Stroke Treatment (TOAST) y la NIH, y la escala modificada de Rankin al alta. Resultados: se incluy¨® a 850 pacientes, 106 (12,4%) > 80 años y 744 (87,6%) < 80 años. En los > 80 años, el 43,4% eran varones y el 56,6% mujeres (el 64,1% varones y el 35,9% mujeres en los < 80 años). Un 81,1% de los > 80 años presentaba HTA (68,1% en los < 80 años); un 29,2% DM (39,3% en los < 80 años); un 26,4% DLP (40,2% en los < 80 años); un 16,9% CI (15,8% en los < 80 años) y un 40% FA (20,9% en los < 80 años). En los pacientes mayores de 80 años, en un 23,6% el ACV fue de origen aterotromb¨®tico (19,3% en los < 80 años); un 38,7% cardioemb¨®lico (19,3% en los < 80 años); un 10,4% lacunar (22,6% en los < 80 años) y un 24,5% indeterminado (28,6% en los < 80 años). La puntuaci¨®n en la escala Rankin al alta fue 3 2 en un 73,8% de los < 80 años y en un 55,7% de los > 80 años. Conclusiones: el accidente cerebrovascular isqu¨¦mico en los mayores de 80 años determina algunas diferencias en cuanto a la presencia de factores de riesgo, etiolog¨ªa del ACV y gravedad de ¨¦ste

Introduction: the aim of this study was to analyze differences between patients aged 80 years or less and those aged more than 80 years old a hospital series of ischemic stroke. Material and methods: we performed a retrospective review of all patients with ischemic stroke or transient ischemic attack requiring admission to the Neurology Service of the Dr. Negr¨ªn UniversityHospital of Gran Canaria (Spain) between January 1, 2004and December 31, 2006. Data were gathered on hypertension, diabetes mellitus (DM), hyperlipidemia, ischemic cardiopathy (IC), atrial fibrillation (AF), the Trial of Org 10172 in Acute Stroke Treatment(TOAST) classification, as well as the National Institutes of Health (NIH) scale and the modified Rankin scale (mRS) at discharge. Results: A total of 850 patients were included. Age was >80 yearsin 106 (12.4%) and was <80 years in 744 (87.6%). In the group aged >80 years, 43.4% were men and 56.6% were women(64.1% men and 35.9% women in the group aged <80 years).Hypertension was present in 81.1% of patients aged >80 years (68.1% in those aged <80 years); previous DM was found in 29.2% (39.3% in the group aged <80 years); hyperlipidemia was present in 26.4% (40.2% in the group aged <80); IC was found in 16.9% (15.8% in the group aged <80); AF was found in 40% (20.9% in the group aged <80 years). In the group of patients aged >80 years, 23.6% had atherothrombotic stroke (19.3% inthose aged <80 years); 38.7% were cardioembolic (19.3% in the group aged <80 years); 10.4% were lacunar (22.6% in the group aged <80 years); and 24.5% was of undetermined origin (28.6% in the group aged <80 years). The mRS at discharge was ¡Ý 2 in 73.8% of patients aged <80 years and in 55.7% of those aged >80 years. Conclusions: ischemic stroke in patients over 80 years old leads to certain differences in relation to risk factors, stroke etiology and stroke severity (AU)