Aplicación clinicorradiológica del uso de la tomografía computarizada craneal de tecnología espectral en el manejo del ictus isquémico agudo tras trombectomía mecánica / Clinicoradiological application of the use of spectral cranial computed tomography in the management of acute ischemic stroke after mechanical thrombectomy

Introducción El ictus isquémico agudo es una de las principales causas globales de morbimortalidad. La trombectomía mecánica ha mejorado el pronóstico funcional de esta patología; sin embargo, la transformación hemorrágica es una complicación frecuente. La tomografía computarizada (TC) de tecnología espectral, como prueba de neuroimagen de control, diferencia la extravasación de contraste de la transformación hemorrágica gracias al diferente comportamiento de los materiales a la energía dual, y esta distinción es de utilidad en su manejo clinicoterapéutico. Material y métodos. Estudio unicéntrico, observacional y retrospectivo, en el cual se investigó, mediante el acceso a una base de datos disociada y a la historia clínica, la presencia de una serie de variables clínicas, radiológicas y terapéuticas en los pacientes con ictus isquémico agudo que fueron tratados con trombectomía mecánica en nuestro hospital entre julio de 2022 y marzo de 2023.ResultadosDe los 155 pacientes incluidos, se realizó una TC craneal espectral en 63 y convencional en 75. En el grupo de TC espectral se detectaron 21 imágenes hiperdensas y en el grupo de TC convencional fueron 28. En el 42,8% de los casos en los que se detectó una hiperdensidad en el grupo de TC convencional no se pudo distinguir entre extravasación de contraste y transformación hemorrágica, en comparación con el 4,8% del grupo de TC espectral (p < 0,001).ConclusionesLa TC espectral confiere una gran confianza diagnóstica al radiólogo para establecer el tipo de hiperdensidad detectada y, por ello, proporciona también una gran confianza terapéutica al neurólogo para reiniciar precozmente la anticoagulación. (AU)

Introduction. Acute ischemic stroke is one of the leading global causes of morbidity and mortality. Mechanical thrombectomy has improved the functional prognosis of this condition; however, hemorrhagic transformation is a common complication. Spectral computed tomography (CT) imaging, as a neuroimaging control test, distinguishes contrast extravasation from hemorrhagic transformation due to the differential behavior of materials at dual energy levels. This distinction is valuable in its clinical therapeutic management.Material and methods. A single-center, observational, retrospective study was conducted in which the presence of various clinical, radiological, and therapeutic variables in patients with acute ischemic stroke treated with mechanical thrombectomy at our hospital between July 2022 and March 2023 was investigated using access to a dissociated database and medical records.Results. Out of 155 included patients, spectral cranial CT was performed in 63, and conventional cranial CT in 75. In the spectral CT group, 21 hyperdense images were detected, compared to 28 in the conventional CT group. In 42.8% of cases where hyperdensity was detected in the conventional CT group, it was not possible to distinguish between contrast extravasation and hemorrhagic transformation, in contrast to the 4.8% in the spectral CT group (p < 0.001).Conclusions. Spectral CT provides high diagnostic confidence to the radiologist in identifying the type of detected hyperdensity, thereby offering significant therapeutic confidence to the neurologist in early resuming anticoagulation therapy. (AU)

Clinicoradiological application of the use of spectral cranial computed tomography in the management of acute ischemic stroke after mechanical thrombectomy. / Aplicación clinicorradiológica del uso de la tomografía computarizada craneal de tecnología espectral en el manejo del ictus isquémico agudo tras trombectomía mecánica.

INTRODUCTION: Acute ischemic stroke is one of the leading global causes of morbidity and mortality. Mechanical thrombectomy has improved the functional prognosis of this condition; however, hemorrhagic transformation is a common complication. Spectral computed tomography (CT) imaging, as a neuroimaging control test, distinguishes contrast extravasation from hemorrhagic transformation due to the differential behavior of materials at dual energy levels. This distinction is valuable in its clinical therapeutic management. MATERIAL AND METHODS: A single-center, observational, retrospective study was conducted in which the presence of various clinical, radiological, and therapeutic variables in patients with acute ischemic stroke treated with mechanical thrombectomy at our hospital between July 2022 and March 2023 was investigated using access to a dissociated database and medical records. RESULTS: Out of 155 included patients, spectral cranial CT was performed in 63, and conventional cranial CT in 75. In the spectral CT group, 21 hyperdense images were detected, compared to 28 in the conventional CT group. In 42.8% of cases where hyperdensity was detected in the conventional CT group, it was not possible to distinguish between contrast extravasation and hemorrhagic transformation, in contrast to the 4.8% in the spectral CT group (p < 0.001). CONCLUSIONS: Spectral CT provides high diagnostic confidence to the radiologist in identifying the type of detected hyperdensity, thereby offering significant therapeutic confidence to the neurologist in early resuming anticoagulation therapy.

TITLE: Aplicación clinicorradiológica del uso de la tomografía computarizada craneal de tecnología espectral en el manejo del ictus isquémico agudo tras trombectomía mecánica.Introducción. El ictus isquémico agudo es una de las principales causas globales de morbimortalidad. La trombectomía mecánica ha mejorado el pronóstico funcional de esta patología; sin embargo, la transformación hemorrágica es una complicación frecuente. La tomografía computarizada (TC) de tecnología espectral, como prueba de neuroimagen de control, diferencia la extravasación de contraste de la transformación hemorrágica gracias al diferente comportamiento de los materiales a la energía dual, y esta distinción es de utilidad en su manejo clinicoterapéutico. Material y métodos. Estudio unicéntrico, observacional y retrospectivo, en el cual se investigó, mediante el acceso a una base de datos disociada y a la historia clínica, la presencia de una serie de variables clínicas, radiológicas y terapéuticas en los pacientes con ictus isquémico agudo que fueron tratados con trombectomía mecánica en nuestro hospital entre julio de 2022 y marzo de 2023. Resultados. De los 155 pacientes incluidos, se realizó una TC craneal espectral en 63 y convencional en 75. En el grupo de TC espectral se detectaron 21 imágenes hiperdensas y en el grupo de TC convencional fueron 28. En el 42,8% de los casos en los que se detectó una hiperdensidad en el grupo de TC convencional no se pudo distinguir entre extravasación de contraste y transformación hemorrágica, en comparación con el 4,8% del grupo de TC espectral (p < 0,001). Conclusiones. La TC espectral confiere una gran confianza diagnóstica al radiólogo para establecer el tipo de hiperdensidad detectada y, por ello, proporciona también una gran confianza terapéutica al neurólogo para reiniciar precozmente la anticoagulación.

Pronóstico al año de la hemorragia subaracnoidea cortical no traumática: Serie prospectiva de 34 pacientes / One-year prognosis of non-traumatic cortical subarachnoid haemorrhage: A prospective series of 34 patients

Introducción: Las hemorragias subaracnoideas corticales (HSAc) tienen numerosas etiologías. No hay estudios prospectivos que indiquen su evolución a largo plazo. El objetivo de este trabajo es describir las características clínicas y etiológicas de los pacientes con HSAc y conocer su pronóstico.MétodosEstudio observacional, prospectivo y multicéntrico. Se recogieron variables clínicas y radiológicas, y se siguió la evolución al año, observando la mortalidad, dependencia, tasa de resangrado y aparición de demencia.ResultadosSe incluyeron 34 pacientes (edad media 68,3 años, rango 27-89). Los síntomas más frecuentes fueron el déficit neurológico focal, con frecuencia transitorio y de repetición, y la cefalea. El TAC fue patológico en 28 pacientes (85%). Se realizó RM cerebral en 30 pacientes (88%), con isquemia aguda en 10 (29%), sangrados antiguos en 7 (21%) y siderosis superficial en otros 2 (6%). Se encontró etiología en 26 pacientes (76,5%): angiopatía amiloide (n = 8), ictus isquémico (n = 5), vasculitis (n = 4), encefalopatía posterior reversible (n = 2), trombosis venosa (n = 2), síndrome de vasoconstricción cerebral reversible (n = 2), oclusión carotidea (n = 1), síndrome de Marfan (n = 1) y carcinomatosis meníngea (n = 1). Durante el seguimiento fallecieron 3 pacientes (en 2 de ellos relacionado con la causa de la HSAc). Tres pacientes desarrollaron una demencia, 3 presentaron un hematoma lobar y otro una nueva HSAc.ConclusionesEn nuestra serie las causas más frecuentes de HSAc fueron la angiopatía amiloide, el ictus isquémico y la vasculitis. La HSAc tiene peor pronóstico que otras HSA no aneurismáticas. Puede tener numerosas causas y su pronóstico depende de la etiología subyacente. En el anciano existe una frecuente asociación con hemorragia intracraneal y deterioro cognitivo. (AU)

Introduction: Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis.MethodsWe performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia.ResultsThe study included 34 patients (mean age, 68.3 years; range, 27-89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH.ConclusionsThe most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment. (AU)

One-year prognosis of non-traumatic cortical subarachnoid haemorrhage: A prospective series of 34 patients. / Pronóstico al año de la hemorragia subaracnoidea cortical no traumática: Serie prospectiva de 34 pacientes.

INTRODUCTION: Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis. METHODS: We performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia. RESULTS: The study included 34 patients (mean age, 68.3 years; range, 27-89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH. CONCLUSIONS: The most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment.

[Multifocal encephalitis as a neurological manifestation of COVID-19 infection]. / Encefalitis multifocal como manifestación neurológica de la infección por COVID-19.

TITLE: Encefalitis multifocal como manifestación neurológica de la infección por COVID-19.

[Cerebral venous thrombosis and SARS-CoV-2 infection]. / Trombosis venosa cerebral e infección por SARS-CoV-2.

TITLE: Trombosis venosa cerebral e infección por SARS-CoV-2.

Trombosis venosa cerebral e infección por SARS-CoV-2 / Cerebral venous thrombosis and SARS-CoV-2 infection

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Folletos de información educativa en migraña: satisfacción percibida en un grupo de pacientes / Migraine education brochures and patient-perceived satisfaction

Introducción: Los folletos informativos son una herramienta educativa habitual en la práctica neurológica diaria; mediante este mecanismo se pretende incrementar de primera mano los conocimientos que la población tiene sobre una enfermedad concreta, además de evitar fuentes de información erróneas. Las encuestas son el medio más empleado para conocer la satisfacción de los usuarios con los servicios recibidos. Objetivos: Evaluar la satisfacción percibida y establecer una retroalimentación informativa que valore la comprensión y la utilidad global de un folleto educativo sobre migraña. Material y métodos: Estudio abierto, prospectivo y multicéntrico sobre una población de pacientes diagnosticados de migraña en diversas consultas de neurología de la provincia de Alicante. En la visita basal se les entrega un folleto informativo de migraña confeccionado por el grupo de estudio para la cefalea de la Sociedad Valenciana de Neurología (CEFALIC). En la visita control se les solicita la cumplimentación de una encuesta personal y por escrito sobre la calidad global de la información incluida en el folleto. Resultados: Se incluye a un total de 257 pacientes diagnosticados de migraña (83% migraña episódica; 17% migraña crónica), con una edad media de 37,6 años. Confirmaron la lectura del folleto 207 paciente (80,5%) y no lo habían leído 50 pacientes (19,5%), bien por olvido bien por desinterés. Al 90% de los pacientes la lectura del folleto les pareció interesante y comprensible. El 76% de los encuestados opina que la lectura del folleto incrementa sus conocimientos sobre migraña. El 50% de los pacientes opina que el folleto resultó de utilidad para mejorar el control de su migraña. Conclusiones: La utilización de un folleto educativo sobre migraña resultó comprensible, además incrementó el conocimiento global de la enfermedad y en opinión de los pacientes resultó útil para mejorar el control de su migraña. La evaluación de la información educativa que prestamos a nuestros pacientes con migraña debe ser medida para descubrir las causas de descontento, determinar el nivel de calidad del servicio e investigar las posibilidades de mejora de calidad

Introduction: Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. Objectives: This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. Material and methods: Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. Results: We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. Conclusions: Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement

Valor de la evaluación combinada de olfación e hiperecogenicidad de sustancia negra en el diagnóstico de la enfermedad de Parkinson / Diagnostic value of combined assessment of olfaction and sustantia nigra hyperechogenicity for Parkinson's disease

Introducción: La hiposmia y la hiperecogenicidad de la sustancia negra (SN+) son marcadores característicos de la enfermedad de Parkinson (EP), aunque su valor diagnóstico de forma aislada puede ser limitado. Se evalúa la prevalencia combinada de ambos marcadores en pacientes diagnosticados de enfermedad de Parkinson (EP) y su rentabilidad diagnóstica frente a una muestra con temblor esencial (TE) y otra de sujetos sanos. Métodos: Se incluyó a pacientes con diagnóstico de EP y TE procedentes de nuestra consulta externa. La olfación se evaluó con el test de identificación de olores Sniffin Sticks test (SS-12) y la evaluación de la sustancia negra mediante dúplex transcraneal. Resultados: Se evaluó a 98 individuos, 30 con diagnóstico de EP, 21 con TE y 47 controles. Las prevalencias de hiposmia (SS-12 < 8) e hiperecogenicidad de SN (área > 0,24 cm2) fueron del 70 y el 83,3% en EP, el 33,3 y el 9,5% en TE y el 17 y el 10,6% en los controles, respectivamente. La combinación de ambos marcadores estaba presente en el 63% de los pacientes con EP y en ninguno de los pacientes con TE y solo en 2 de los controles. Conclusiones: La evaluación combinada de la evaluación olfativa mediante el SS-12 y de la sustancia negra mediante ecografía, 2 test rápidos, inocuos y accesibles, mejora la especificidad aislada que cada marcador tiene en el diagnóstico de la EP frente a pacientes con TE o controles. Dado que ambos marcadores se han descrito en fases muy precoces de la EP, su aplicación podría ayudarnos en su diagnóstico precoz

Introduction: Hyposmia and substantia nigra hyperechogenicity (SN+) are characteristic markers of Parkinson's disease (PD), although their diagnostic value in isolation may be limited. We evaluated the combined prevalence of both disorders in patients diagnosed with PD and assessed their diagnostic yield compared to a sample with essential tremor (ET) and another group of healthy subjects. Methods: Patients diagnosed with PD and ET and treated in our outpatient clinic were enrolled. Olfaction was assessed using the 'Sniffin Sticks' odour identification test (SS-12) and hyperechogenicity of the substantia nigra (SN+) was assessed by transcranial duplex ultrasound. Results: A total of 98 subjects were analysed, comprising 30 with PD, 21 with ET, and 47 controls. The respective prevalence rates of hyposmia (SS-12 < 8) and SN+ (area > .24 cm2) were 70% and 83.3% in PD, 33.3% and 9.5% in ET, and 17% and 10.6% in controls. Both markers were present in 63% of patients with PD, none of the patients with ET, and only 2 of the controls. Conclusions: Combined use of substantia nigra sonography and olfactory testing with SS-12, two rapid, safe, and accessible tests, was more specific than each isolated marker for distinguishing patients with PD from patients with ET and control subjects. Since both markers have been described in very early phases of PD, combined use may be helpful in providing early diagnosis of PD

Diagnostic value of combined assessment of olfaction and sustantia nigra hyperechogenicity for Parkinson's disease.

INTRODUCTION: Hyposmia and substantia nigra hyperechogenicity (SN+) are characteristic markers of Parkinson's disease (PD), although their diagnostic value in isolation may be limited. We evaluated the combined prevalence of both disorders in patients diagnosed with PD and assessed their diagnostic yield compared to a sample with essential tremor (ET) and another group of healthy subjects. METHODS: Patients diagnosed with PD and ET and treated in our outpatient clinic were enrolled. Olfaction was assessed using the "Sniffin' Sticks" odour identification test (SS-12) and hyperechogenicity of the substantia nigra (SN+) was assessed by transcranial duplex ultrasound. RESULTS: A total of 98 subjects were analysed, comprising 30 with PD, 21 with ET, and 47 controls. The respective prevalence rates of hyposmia (SS-12 < 8) and SN+ (area > .24cm(2)) were 70% and 83.3% in PD, 33.3% and 9.5% in ET, and 17% and 10.6% in controls. Both markers were present in 63% of patients with PD, none of the patients with ET, and only 2 of the controls. CONCLUSIONS: Combined use of substantia nigra sonography and olfactory testing with SS-12, two rapid, safe, and accessible tests, was more specific than each isolated marker for distinguishing patients with PD from patients with ET and control subjects. Since both markers have been described in very early phases of PD, combined use may be helpful in providing early diagnosis of PD.

Migraine education brochures and patient-perceived satisfaction.

INTRODUCTION: Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. OBJECTIVES: This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. MATERIAL AND METHODS: Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. RESULTS: We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. CONCLUSIONS: Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement.

[Prevention of migraine: a pharmacoepidemiological study]. / Prevención de la migraña: un estudio farmacoepidemiológico.

INTRODUCTION: This study aims to perform a descriptive analysis of the usage patterns of migraine prophylactic medications by various neurologists in our setting. MATERIAL AND METHODS: The first preventive treatment prescribed for migraine in patients not associated to other diagnoses of primary headache was recorded in three outpatient neurology clinics and one headache specific clinic. RESULTS: A total of 235 prophylactic treatments out of 669 patients were initiated. The patients were aged 37 +/- 12 years (mean +/- standard deviation) and 84.45% were women. Migraines with aura accounted for 18.9% of migraines. By order of frequency, the prophylactic treatments administered were topiramate (43%), beta-blockers (18%), flunaricine (17%), amitriptyline (14%), selective serotonin reputake inhibitors (6%) and others (2%). Beta-blockers and flunaricine were used much more frequently in men (29.7% and 27% versus 15.9% and 14.4%, respectively) and antidepressants were used more in women (21.87% versus 5.4%). The most frequently used antidepressant was amitriptyline, and its use increases with the age of the patient, it being the most frequently used treatment in over 60-year-old patient group. CONCLUSIONS: At present, topiramate has become the first preventive treatment option for migraine in our setting, especially in young women. There is greater variability in the choice of an alternative treatment. Amitriptyline is the first choice within the antidepressants and is almost exclusively prescribed in women with migraine and elderly age.

Prevención de la migraña: un estudio farmacoepidemiológico / Prevention of migraine: a pharamacoepidemiological study

Introducción. Se realiza un análisis descriptivo de los tratamientosprofilácticos empleados para el tratamiento de la migrañapor varios neurólogos de nuestro medio.Material y métodos. Se registró el primer tratamiento preventivopautado para migraña en pacientes que no asociaban otro diagnósticode cefalea primaria. Se reclutaron durante 1 año en tres consultasde neurología ambulatoria y una específica de cefalea de laprovincia de Alicante.Resultados. De 669 pacientes totales, se iniciaron 235 tratamientosprofilácticos, con una edad de los pacientes de 37±12años (media±desviación estándar) y un 84,45 % de mujeres. Un18,9% de migrañas eran con aura. Por orden de frecuencia, los profilácticosempleados fueron el topiramato (43 %), los betabloqueantes(18%), la flunaricina (17%), la amitriptilina (14 %), inhibidoresselectivos de la recaptación de serotonina (6 %) y otros(2 %). Los betabloqueantes y la flunaricina se emplearon muchomás en el hombre (29,7 y 27 % frente a 15,9 y 14,4%, respectivamente)y los antidepresivos en la mujer (21,87 frente a 5,4 %). Elantidepresivo más empleado fue la amitriptilina, y su empleo aumentacon la edad del paciente, siendo el tratamiento más frecuenteen el grupo de más de 60 años.Conclusiones. El topiramato en la actualidad y en nuestro medioes la primera opción en el tratamiento preventivo de la migraña,sobre todo en la mujer joven. La variabilidad es mayor en la eleccióndel tratamiento alternativo. La amitriptilina es la primera opcióndentro de los antidepresivos y se prescriben casi exclusivamente en lamujer con migraña y en edades avanzadas (AU)

Introduction. This study aims to perform a descriptiveanalysis of the usage patterns of migraine prophylactic medicationsby various neurologists in our setting.Material and methods. The first preventive treatment prescribedfor migraine in patients not associated to other diagnosesof primary headache was recorded in three outpatient neurologyclinics and one headache specific clinic.Results. A total of 235 prophylactic treatments out of 669patients were initiated. The patients were aged 37±12 years(mean±standard desviation) and 84.45% were women. Migraineswith aura accounted for 18.9% of migraines. By order of frequency,the prophylactic treatments administered were topiramate(43%), beta-blockers (18%), flunaricine (17%), amitriptyline(14%), selective serotonin reputake inhibitors (6 %) and others(2 %). Beta-blockers and flunaricine were used much more frequentlyin men (29.7% and 27% versus 15.9% and 14.4%, respectively)and antidepressants were used more in women(21.87% versus 5.4%). The most frequently used antidepressantwas amitriptyline, and its use increases with the age of the patient,it being the most frequently used treatment in over 60 yearold patient group.Conclusions. At present, topiramate has become the firstpreventive treatment option for migraine in our setting, especiallyin young women. There is greater variability in the choiceof an alternative treatment. Amitriptyline is the first choice withinthe antidepressants and is almost exclusively prescribed inwomen with migraine and elderly age (AU)

[Massive cerebral infarction secondary to apoplexy due to pituitary adenoma]. / Infarto cerebral masivo secundario a apoplejía de un adenoma hipofisario.

INTRODUCTION: Pituitary apoplexy is a rare clinical entity. It is a rare cause of stroke, whose pathogenic mechanism has not been fully understood. Compression in intracavernous carotid artery and vasospastic mechanism have been described. It may initially begin as a meningeal syndrome, in which neuroimaging techniques may be fundamental, above all resonance magnetic imaging for a correct diagnosis of the disease and its complications. CASE REPORT: We report the case of a 23 year-old male who suffered a massive stroke due to bilateral carotid compression in its intracavernous portion due to apoplexy of a previously unknown pituitary tumor. The diffusion sequences and acute angioresonance of the circle of Willis are presented. CONCLUSIONS: This is a rare entity with controversial management. An exhaustive review of cases and series of patients with pituitary apoplexy related stroke is also presented.

[Rendu-Osler-Weber disease as an infrequent cause of stroke]. / Enfermedad de Rendu-Osler-Weber como causa infrecuente de ictus.

INTRODUCTION: Hereditary haemorrhagic telangiectasia, or Rendu-Osler disease, is a congenital vascular disease that is associated with the presence of arteriovenous fistulas that cause paradoxical embolisms. CASE REPORT: An 83-year-old female with clinical signs and symptoms of convulsive attacks and multiple cerebral infarctions in the acute phase. She also presented a history of multiple haemorrhages and iron deficiency anaemia with no clear aetiological causation. A thorough examination of her medical history revealed a family history of haemorrhages and a sister who had been diagnosed with Rendu-Osler disease, which suggested the possible existence of a pulmonary arteriovenous fistula as the aetiological causation of her cerebrovascular disease. Neurovascular Doppler ultrasonography with bubble contrast test was positive, and the presence of the fistula was confirmed by a computerised axial tomographic angiography scan of the lungs. CONCLUSIONS: Rendu-Osler disease is a rare cause of stroke due to the fact that it is usually associated with arteriovenous fistulas that can cause paradoxical embolisms. Neurovascular Doppler ultrasound scanning is useful for detecting these pulmonary fistulas by means of the bubble contrast test, which is a non-invasive test that can be carried out easily by neurologists themselves.

Enfermedad de Rendu-Osler-Weber como causa infrecuente de ictus / Rendu-osler-weber disease as an infrequent cause of stroke

La telangiectasia hemorrágica hereditaria o enfermedad de Rendu-Osler es una enfermedad vascularcongénita que se asocia con la presencia de fístulas arteriovenosas que son causa de embolias paradójicas. Caso clínico. Mujer de 83 años que ingresa con clínica de crisis epilépticas y múltiples infartos cerebrales en fase aguda. Asocia historiaprevia de múltiples hemorragias y anemia ferropénica sin clara causa etiológica. Tras una exhaustiva anamnesis, se descubre historia familiar de hemorragias y una hermana diagnosticada de enfermedad de Rendu-Osler-Weber, lo que sugiere la posible existencia de una fístula arteriovenosa pulmonar como causa etiológica de su enfermedad cerebrovascular. Se realiza Doppler neurovascular con infusión de test de burbujas con resultado positivo, lo cual confirma la presencia de la fístula mediante angiotomografía axial computarizada pulmonar. Conclusión. La enfermedad de Rendu-Osler es una causa poco frecuente de ictus debido a que suele asociar fístulas arteriovenosas que pueden ser causa de embolias paradójicas. El Doppler neurovascular es útil para la detección de estas fístulas pulmonares mediante el test de infusión de burbujas; se trata de unaprueba no cruenta y de fácil realización por parte de los propios neurólogos

Hereditary haemorrhagic telangiectasia, or Rendu-Osler disease, is a congenital vascular diseasethat is associated with the presence of arteriovenous fistulas that cause paradoxical embolisms. Case report. An 83-year-old female with clinical signs and symptoms of convulsive attacks and multiple cerebral infarctions in the acute phase. She also presented a history of multiple haemorrhages and iron deficiency anaemia with no clear aetiological causation. A thoroughexamination of her medical history revealed a family history of haemorrhages and a sister who had been diagnosed with Rendu-Osler disease, which suggested the possible existence of a pulmonary arteriovenous fistula as the aetiological causation of her cerebrovascular disease. Neurovascular Doppler ultrasonography with bubble contrast test was positive, and the presence of the fistula was confirmed by a computerised axial tomographic angiography scan of the lungs. Conclusions. Rendu-Osler disease is a rare cause of stroke due to the fact that it is usually associated with arteriovenous fistulas that can cause paradoxical embolisms. Neurovascular Doppler ultrasound scanning is useful for detecting these pulmonary fistulas by means of the bubble contrast test, which is a non-invasive test that can be carried out easily by neurologists themselves

[The use of levetiracetam in monotherapy in post-stroke seizures in the elderly population]. / Uso del levetiracetam en monoterapia en crisis postictus de la población anciana.

INTRODUCTION: Strokes are the leading cause of epileptic seizures in adults and account for 50% of seizures in those over the age of 65. These patients present certain specific characteristics with respect to the remaining population, which makes it necessary to look for medication that are suited to their particular case. AIM: To describe the effectiveness and safety of levetiracetam (LEV) in monotherapy in elderly patients with post-stroke epileptic seizures. PATIENTS AND METHODS: A prospective evaluation was conducted of a series of cases consisting of patients over the age of 60 years who had suffered a stroke and had had at least one epileptic seizure in the late post-stroke phase (more than two weeks). Demographic data and the characteristics of the epilepsy and the stroke were collected. Patients began treatment with LEV in monotherapy, underwent check-ups at one and six months of treatment, and the effectiveness and safety of the drug were evaluated. RESULTS: The sample consisted of 25 patients with a mean age of 75.2 +/- 7.6 years. They presented an average of 3.2 +/- 5.6 post-stroke seizures and the time elapsed since the stroke was 38.3 +/- 81.8 months. After six months' follow-up, 76% of the patients were still receiving treatment with LEV. Of the patients under treatment, 89.5% were free from seizures. Side effects that could be attributed to LEV were noted by 28% of patients, but did not compel them to stop treatment. CONCLUSIONS: LEV in monotherapy can be a safe, effective therapeutic option for elderly patients who have presented epilepsy following a stroke.

Uso del levetiracetam en monoterapia en crisis postictus de la población anciana / The use of levetiracetam in monotherapy in post-stroke seizures in the elderly population

Los ictus son la primera causa de crisis epilépticas en adultos y los responsables del 50% de crisisen mayores de 65 años. Estos pacientes presentan unas características propias respecto al resto de la población, por lo que se hace necesario buscar fármacos que resulten apropiados. Objetivo. Describir la eficacia y tolerabilidad del levetiracetam(LEV) en monoterapia en pacientes ancianos con crisis epilépticas postictus. Pacientes y métodos. Se evaluó prospectivamente una serie de casos formada por pacientes mayores de 60 años que hubieran sufrido un ictus y presentaran, al menos, una crisis epiléptica en la fase tardía (más de dos semanas) postictus. Se recabaron datos demográficos, características de la epilepsia y del ictus. Los pacientes iniciaron tratamiento con LEV en monoterapia, fueron controlados al mes y a los seis meses de tratamiento, y se evaluó la eficacia y tolerabilidad del fármaco. Resultados. Se incluyeron 25 pacientes con edad media de75,2 ± 7,6 años. Presentaron una media de 3,2 ± 5,6 crisis postictus y un tiempo trascurrido desde el ictus de 38,3 ± 81,8 meses.Tras seis meses de seguimiento, el 76% de los enfermos continuaba tratamiento con LEV. De los pacientes con el tratamiento, el 89,5% se mantenía libre de crisis. El 28% había presentado algún efecto secundario atribuible al LEV que no obligó a la suspensión del tratamiento. Conclusión. El LEV en monoterapia puede ser una opción terapéutica eficaz y segura para aquellos pacientes ancianos que hubieran presentado epilepsia tras sufrir un ictus

Strokes are the leading cause of epileptic seizures in adults and account for 50% of seizures in thoseover the age of 65. These patients present certain specific characteristics with respect to the remaining population, which makes it necessary to look for medication that are suited to their particular case. Aim. To describe the effectiveness and safetyof levetiracetam (LEV) in monotherapy in elderly patients with post-stroke epileptic seizures. Patients and methods. A prospective evaluation was conducted of a series of cases consisting of patients over the age of 60 years who had suffered a stroke and had had at least one epileptic seizure in the late post-stroke phase (more than two weeks). Demographic data andthe characteristics of the epilepsy and the stroke were collected. Patients began treatment with LEV in monotherapy, underwent check-ups at one and six months of treatment, and the effectiveness and safety of the drug were evaluated. Results. The sample consisted of 25 patients with a mean age of 75.2 ± 7.6 years. They presented an average of 3.2 ± 5.6 post-strokeseizures and the time elapsed since the stroke was 38.3 ± 81.8 months. After six months’ follow-up, 76% of the patients were still receiving treatment with LEV. Of the patients under treatment, 89.5% were free from seizures. Side effects that could be attributed to LEV were noted by 28% of patients, but did not compel them to stop treatment. Conclusions. LEV in monotherapycan be a safe, effective therapeutic option for elderly patients who have presented epilepsy following a stroke

[Preadmission statins treatment in stroke patients: opportunity to treat high vascular risk patients]. / Antecedente del uso de estatinas en el ictus: oportunidad de mejora en el paciente con alto riesgo vascular por aterotrombosis.

AIM: To describe the use of preadmission statins in patients with cerebrovascular accident and the possible predictive factors. PATIENTS AND METHODS: Cross-sectional observational study of 795 consecutive patients with acute cerebrovascular accident. We assessed the differences among patients who were on preadmission statins (161) and those who were not (634), regarding vascular risk factors and clinical and neurosonological atherothrombotic disease markers. For univariate analysis, we used squared chi test, and for multivariate analysis, logistic regression analysis. RESULTS: Preadmission statins were 20.3%. In high vascular risk patients defined based on National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), this reached 28% and it might be 72%. Predictive factors for preadmission statins use were, in a positive sense, the antecedent of hypercholesterolemia diagnosis (OR = 189; 95% CI = 58-615; p < or = 0.001) and stroke (OR = 2.1; 95% CI = 1.2-3.6; p < or = 0.01), and in a negative sense, smoking (OR = 0.38; 95% CI = 0.18-0.81; p = 0.012). CONCLUSIONS: In our population of patients with stroke, the predictive factors of preadmission statins did not adjust to the current therapeutic NCEP-ATP III recommendations; treatment with statins in high vascular risk population was way below the indications, it was 28% and it might be 72%.

Estudio del diámetro del ventrículo III mediante dúplex transcraneal / Study of the diameter of the third ventricle with transcranial sonography

Introducción. La insonación transtemporal mediante sistemas de ultrasonidos dúplex transcraneal codificado en color (DTCC) con sondas de baja frecuencia (2-2,5 MHz) permite la evaluación no sólo de los vasos del polígono de Willis, sino también de estructuras parenquimatosas cerebrales. Un número reducido de estudios, ninguno en nuestro medio, ha evidenciando su utilidad para la evaluación del sistema ventricular en adultos. Objetivo. Evaluar la utilidad del dúplex transcraneal como técnica de medición del diámetro del ventrículo III en una muestra de pacientes con enfermedades neurológicas. Pacientes y métodos. Se seleccionaron pacientes de cualquier edad ingresados en nuestro servicio de neurología y a los que dentro del protocolo de estudio se solicitaba una resonancia magnética (RM) encefálica. El máximo diámetro del ventrículo III se medía mediante DTCC y RM en planos axiales. Se presentan los resultados obtenidos mediante cada técnica y la correlación lineal entre ambas mediciones. Resultados. Se han estudiado 30 pacientes con una edad media de 48,5 años y 66,6% de mujeres. El diámetro del ventrículo III (media±desviación estándar) fue de 3,97± 2,58 mm medido con el DTCC y de 3,70±2,27 mm con la RM. La correlación lineal entre los valores obtenidos por ambas técnicas fue elevada (r=0,85). Conclusiones. Con el dúplex transcraneal disponemos de una técnica económica, inocua y de fácil aplicación que obtiene resultados equiparables a la RM en la determinación del tamaño del ventrículo III

Introduction. Transtemporal insonation by means of transcranial color-coded duplex sonography (TCDS) with low frequency probes (2-2.5 MHz) makes it possible to not only evaluate the blood vessels of the circle of Willis but also of brain parenchymal structures. A reduced number of studies, none of them in our area, have reported its usefulness for the evaluation of the ventricular system in adults. Aim. To evaluate ability of the transcranial duplex to measure the third ventricle diameter in a sample of patients with different neurological illnesses. Patients and methods. Patients of all ages admitted to our neurology ward and whose diagnostic procedure included a brain magnetic resonance (MRI) were recruited. The largest third ventricle diameter was measured with both the TCDS and MRI in axial planes. We report the results observed with both techniques and the lineal correlation between both of them. Results. We included 30 patients with mean age 48.5 years and 66.6% females. The third ventricle diameter (average ± standard deviation) was 3.97 ± 2.58 mm as measured with TCDS and 3.70±2.27 mm on MRI. Linear correlation between the values observed was high (r=0.85). Conclusions. Transcranial duplex is a cheap, safe and easy to perform technique. It has similar results in comparison with those obtained with the MRI when the third ventricle size is measured