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6.
An. med. interna (Madr., 1983) ; 17(8): 425-428, ago. 2000. ilus
Article in Es | IBECS | ID: ibc-208

ABSTRACT

La carcinomatosis meníngea ocurre en el 0,8-8 porciento de los tumores sólidos. Las neoplasias que con mayor frecuencia se han asociado a esta patología son el carcinoma de mama y de pulmón de células pequeñas. Las metástasis meníngeas por carcinoma de células transicionales de vejiga son raras y generalmente aparecen en fases avanzadas de la enfermedad. A continuación se presentan dos casos de carcinomatosis meníngea como primera manifestación tumoral de un carcinoma vesical. En el primer caso se presenta un varón de 46 años que debutó con signos de afectación medular, generalizándose posteriormente con afectación de base de cráneo y encéfalo. En el segundo caso un varón de 68 años se presentó con panhipopitituarismo y linfangitis pulmonar de primario desconocido, diagnosticándose posteriormente de tumor vesical y carcinomatosis meníngea tras desarrollar hidrocefalia obstructiva. Se destaca el polimorfismo de la presentación de la carcinomatosis meníngea y la necesidad de considerar la vejiga como localización del tumor primario (AU)


Subject(s)
Aged , Male , Middle Aged , Humans , Carcinoma, Transitional Cell , Urinary Bladder Neoplasms , Meningeal Neoplasms , Carcinoma, Transitional Cell/secondary , Urinary Bladder Neoplasms/pathology , Bone Neoplasms/secondary , Meningeal Neoplasms/secondary
7.
An Med Interna ; 17(8): 425-8, 2000 Aug.
Article in Spanish | MEDLINE | ID: mdl-11218991

ABSTRACT

Meningeal carcinomatosis may occur in 0.8-8% of patients with solid tumors. The most common tumors associated with that condition are breast and small cell lung cancer. Meningeal carcinomatosis from urothelial cancer is rare, and it appears described in advanced stages of disease, generally, after chemotherapy. Two cases of meningeal carcinomatosis as the first manifestation of bladder cancer were reported. In the first case, a 46-year-old man presented signs and symptoms indicative of involvement of the spinal roots, subsequently neurologic dysfunction of the brain and cranial nerves appeared. In the second case, a 68-year-old man was admitted to our hospital with a history compatible with panhypopituitarism and pulmonary lymphangitic carcinomatosis from cancer of unknown primary site. Follow-up revealed a transitional cell carcinoma of the bladder and hydrocephalus due to cerebrospinal fluid outflow obstruction. We emphasize in the polymorphic presentation of meningeal carcinomatosis and the necessity to consider the bladder as primary tumor localization.


Subject(s)
Bone Neoplasms/secondary , Carcinoma, Transitional Cell/secondary , Meningeal Neoplasms/secondary , Urinary Bladder Neoplasms/pathology , Aged , Humans , Male , Middle Aged
8.
Rev Neurol ; 29(7): 606-10, 1999.
Article in Spanish | MEDLINE | ID: mdl-10599106

ABSTRACT

INTRODUCTION: Dissection of the internal carotid artery is a condition with a broad clinical spectrum. In absence of the classical triad of cervical pain, oculosympathetic ipsilateral paralysis and ischemic cerebral symptoms a considerable index of clinical suspicion is necessary to make a diagnosis. It is therefore considered to be probably underdiagnosed. The development of new techniques for neurovascular investigation, particularly ultrasound and magnetic angioresonance have improved the possibilities of diagnosis. CLINICAL CASES: In this paper we describe two cases of dissection of the internal carotid artery representing different clinical findings in the same condition. One patient presented with unilateral paralysis of the XI, X and XII cranial nerves and the other with transient ischemic cerebral accidents. In both cases the provisional diagnosis was made in function of the duplex findings of the supra-aortic trunks and confirmed by magnetic angioresonance studies. Both patients made satisfactory progress with complete recanalization of the vessels and no recurrence of symptoms after several months of follow-up. CONCLUSION: We discuss the different clinical characteristics and findings of the neurovascular examinations.


Subject(s)
Carotid Artery, Internal, Dissection/diagnosis , Ischemic Attack, Transient/diagnosis , Brain/blood supply , Carotid Artery, Internal, Dissection/complications , Cranial Nerves/physiopathology , Diagnosis, Differential , Humans , Ischemic Attack, Transient/etiology , Magnetic Resonance Angiography , Male , Middle Aged , Paralysis/diagnosis , Paralysis/physiopathology , Voice Disorders/diagnosis , Voice Disorders/etiology
9.
Rev Neurol ; 28(8): 799-809, 1999.
Article in Spanish | MEDLINE | ID: mdl-10363326

ABSTRACT

INTRODUCTION: Motor complications of treatment with levodopa affect more than 50% of patients after several years' treatment. This has a marked effect on patients with Parkinson's disease since these side effects are undesirable, affect the natural course of the disorder and complicate treatment. DEVELOPMENT: In this review we describe the main epidemiological, physiopathological and therapeutic aspects of the motor complications of levodopa. According to most epidemiological studies, starting treatment at an early age and more severe degree of the disorder are the main risk factors. The physiopathology of motor complications is varied. It has been thought to be due to loss of the buffer effect of the brain on plasma levels of levodopa, alterations in the functional state of the postsynaptic receptors and chronic intermittent use of levodopa. Management includes division and/or reduction of the dose of levodopa, use of slow-release preparations and association of dopaminergic agonists with COMT inhibitors which are the latest drugs to be tried. Various surgical possibilities in specialist centres may also be considered for serious cases of motor complications which do not respond to medical treatment. CONCLUSIONS: Recent advances in understanding the physiopathology and in the medical and surgical treatment permit improved control of the motor complications of chronic treatment with levodopa.


Subject(s)
Antiparkinson Agents/adverse effects , Dyskinesia, Drug-Induced/etiology , Levodopa/adverse effects , Parkinson Disease/drug therapy , Aged , Dose-Response Relationship, Drug , Dyskinesia, Drug-Induced/diagnosis , Gait/drug effects , Humans , Middle Aged , Risk Factors
10.
Med Clin (Barc) ; 112(7): 245-50, 1999 Feb 27.
Article in Spanish | MEDLINE | ID: mdl-10220750

ABSTRACT

BACKGROUND: To identify which clinical factors can modify the probability of the appearance of the psychotic syndromes in patients with idiopathic Parkinson's disease treated with levodopa. PATIENTS AND METHODS: 214 patients were retrospectively studied to evaluate the appearance of hallucinosis, delusions or mental confusion, from the beginning of the treatment with levodopa to a transversal evaluation along the course of the disease. To determine which clinical factors were independent predictors of psychosis, a multivariate logistic regression model was obtained, using the variables for which the univariate studies showed p values under 0.25. RESULTS: The multivariate model showed that the probability of developing psychosis during levodopa treatment was higher for the patients with intermediate or advanced stages of the disease (Hoehn and Yarh scale), at the beginning of the treatment (OR: 4.5; 95% CI: 1.86-11.23), when amantadine was administrated as associated drug (OR: 3.31; 95% CI: 1.19-9.23) and for the patients who presented motor fluctuations (OR: 3.08; 95% CI: 1.32-7.16). Univariate studies showed a significant association between levodopa psychosis and dyskinesias (univariate OR: 2.44; 95% CI: 1.12-5.33). Patients who suffered from psychotic complications had received significantly higher mean levodopa daily dose (p = 0.016) and the punctuation reached in the Folstein's Mini-Mental Scale was significantly lower (p = 0.0001). CONCLUSIONS: Levodopa psychosis appears in a "bad prognostic" group of patients, characterized by a greater motor and cognitive impairment and by the occurrence of other levodopa central adverse effects, higher doses of levodopa and a more frequent administration of other antiparkinsonian drugs.


Subject(s)
Antiparkinson Agents/adverse effects , Levodopa/adverse effects , Parkinson Disease/complications , Psychoses, Substance-Induced/etiology , Aged , Antiparkinson Agents/administration & dosage , Dose-Response Relationship, Drug , Female , Humans , Levodopa/administration & dosage , Male , Middle Aged , Multivariate Analysis , Parkinson Disease/drug therapy , Parkinson Disease/psychology , Patient Selection , Psychoses, Substance-Induced/diagnosis , Psychoses, Substance-Induced/psychology , Retrospective Studies , Risk Factors
14.
Clin Neuropharmacol ; 17(3): 298-302, 1994 Jun.
Article in English | MEDLINE | ID: mdl-9316676

ABSTRACT

Severe neurologic complications following treatment with cyclosporine are uncommon. They tend to occur during the first month of treatment and disappear after withdrawal or reduction of the dose of the drug. We report the case of a man who underwent a liver transplantation and subsequently developed severe central nervous system toxicity. After two years receiving cyclosporine, he presented with a brachial monoparesis and a complex visual disturbance. Symptoms slowly worsened during four months. On admission, he had confusion and seizures. Multiple areas of T2 prolongation, located in cerebral white matter, were seen on magnetic resonance imaging (MRI). Symptoms partially improved after cyclosporine withdrawal, but brain lesions shown on MRI persisted in serial imaging studies after two years of follow-up. We discuss the mechanisms that have been proposed to explain this clinical picture. Severe cyclosporine-associated neurotoxicity can also occur after chronic administration, even with serum levels in therapeutic range.


Subject(s)
Brain Diseases/chemically induced , Cyclosporine/adverse effects , Immunosuppressive Agents/adverse effects , Brain Diseases/diagnosis , Humans , Liver Transplantation , Magnetic Resonance Imaging , Male , Middle Aged
17.
An Esp Pediatr ; 39(4): 331-4, 1993 Oct.
Article in Spanish | MEDLINE | ID: mdl-8256955

ABSTRACT

Four newborn patients with symptomatic Chiari II malformations were studied retrospectively. Clinical manifestations and surgical results are presented. All of these patients had hydrocephalus, which was symptomatic in two patients from the first day of life. Three of them had bradycardia and apnea spells. Two patients had lower cranial nerve palsies. Cranial sonography was the first neuroimaging procedure used and it played an important role during the follow-up period, especially for the study of the hydrocephalus. Two newborns could be studied with Magnetic Resonance Imaging (MRI). It defined the level of the decent of the fossa posterior structures and the associated malformations. All of the patients were treated with surgical repair of the spinal dysraphism, ventricular shunt and decompressive surgery. Two patients died before the age of three months. Two other patients showed better evolution after their two year and four year check-ups, respectively. Bradycardia and apnea spells are features that worsen the prognosis as compared with other manifestations.


Subject(s)
Central Nervous System/abnormalities , Meningomyelocele/diagnosis , Central Nervous System/surgery , Female , Humans , Hydrocephalus/diagnosis , Hydrocephalus/epidemiology , Hydrocephalus/surgery , Infant, Newborn , Male , Meningomyelocele/epidemiology , Meningomyelocele/surgery , Prognosis , Retrospective Studies , Syndrome
19.
Neurologia ; 8(4): 131-4, 1993 Apr.
Article in Spanish | MEDLINE | ID: mdl-8517960

ABSTRACT

Reports on supratentorial metastases of medulloblastoma are infrequent. Computed tomography has increased the possibilities of detecting then in a silent clinical phase. Five children with supratentorial metastasis of medulloblastoma were retrospectively reviewed. Diagnosis was established by cranial CT between three and sixty months following treatment of the tumor. Dissemination through the ventricular system was found in all the cases. Other lesions were found in the transition zone between the white and grey matter (2/5) and the left frontal lobe (1/5). The routes of dissemination are discussed. Early diagnosis of supratentorial metastasis of medulloblastoma require periodic cranial CT or magnetic resonance imaging (MRI), at least during the first years after diagnosis and treatment of the primary tumor.


Subject(s)
Medulloblastoma/pathology , Supratentorial Neoplasms/secondary , Cerebral Ventricles/pathology , Cerebral Ventriculography , Child , Female , Humans , Male , Medulloblastoma/diagnosis , Medulloblastoma/therapy , Neoplasm Metastasis , Neoplasm Recurrence, Local , Radiotherapy , Retrospective Studies , Supratentorial Neoplasms/diagnosis , Supratentorial Neoplasms/therapy , Tomography, X-Ray Computed
20.
Arch Neurobiol (Madr) ; 55(2): 75-8, 1992.
Article in Spanish | MEDLINE | ID: mdl-1352098

ABSTRACT

Neuroleptic malignant syndrome (NMS) is an adverse reaction of an idiosyncratic nature to drugs having antidopaminergic activity. Pathogenesis is largely disputed. An NMS case is presented which was triggered by flupentixol and was associated with severe hyponatremia (116 mmol/l upon admission). Both clinically and analytically, the hyponatraemia fulfills criteria to be considered secondary to an inappropriate secretion of antidiuretic hormone (SIADH). Other possible causes of hyponatraemia were ruled out. After early treatment with dopaminergic agonists and water restriction, both conditions improved in parallel. The different pathogenetic possibilities which may explain the temporal coexistence of both syndromes in the same patient are discussed. The association of these two conditions is in favour of a probable central pathogenetic cause for NMS. On the other hand, it is suggested that hyponatraemia may mask the diagnosis of NMS.


Subject(s)
Flupenthixol/adverse effects , Hyponatremia/etiology , Inappropriate ADH Syndrome/complications , Neuroleptic Malignant Syndrome/complications , Adjustment Disorders/drug therapy , Aged , Dopamine Agents/therapeutic use , Female , Humans , Hyponatremia/diagnosis , Inappropriate ADH Syndrome/diagnosis , Inappropriate ADH Syndrome/drug therapy , Models, Biological , Neuroleptic Malignant Syndrome/diagnosis , Neuroleptic Malignant Syndrome/drug therapy
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