[Minor stroke in a patient with thrombocytopenia]. / Ictus menor en una paciente con trombocitopenia.

TITLE: Ictus menor en una paciente con trombocitopenia.

Análisis de la marcha y fisioterapia Bobath en adultos con síndrome de Down / Gait analysis and Bobath physiotherapy in adults with Down syndrome

Introducción. El síndrome de Down (SD) es un trastorno cromosómico de expresión fenotípica variable, aunque con rasgos comunes en los distintos pacientes. Entre ellos, destaca la hipotonía, hiperlaxitud ligamentosa y el retraso en el desarrollo psicomotor. Estos rasgos mejoran con la terapia temprana, pero persisten en forma de inestabilidad de la marcha y compensaciones patológicas en el adulto. La marcha patológica en estos pacientes ha sido objeto de estudios previos, pero el tratamiento de los problemas motores no ha sido abordado desde un enfoque neurorrehabilitador, dirigido a la calidad del funcionamiento. Objetivos. El propósito del presente estudio es describir las alteraciones de la marcha en una muestra de pacientes con SD y evaluar los cambios después del tratamiento con fisioterapia Bobath. Material y métodos. Estudio prospectivo experimental de tipo ensayo no controlado. Diez personas adultas con SD (edad media: 28 años) fueron evaluadas en situación basal y después de 10 sesiones de fisioterapia Bobath. Se recogieron variables cuantitativas (como longitud del paso, velocidad de la marcha) y variables cualitativas (como calidad del braceo o inestabilidad) a través de un evaluador ciego al tratamiento fisioterápico. Resultados. Se encontraron claras desviaciones respecto a la marcha adulta normal y una tendencia a la mejoría después del tratamiento fisioterápico. Esta mejoría fue significativa en la corrección del ángulo y en la simetría del paso. Se pone de manifiesto el potencial beneficio de la fisioterapia en adultos con SD y alteraciones de la marcha, así como la necesidad de realizar más estudios en este sentido (AU)

Introduction. Down syndrome (DS) is a chromosomal disorder with variable phenotypic expression, although different patients share some common features. Among them, hypotonia, ligament laxity and delayed psychomotor development stand out. These traits can improve with early therapy, but remain as gait instability and pathologic compensatory strategies in adult patients. Pathological gait in DS patients has been studied previously, but the treatment of motor problems has not been approached from a neurological rehabilitation viewpoint, focused on quality of function. Objectives. The aim of this study was to describe the gait alterations in a sample of patients with DS and to assess changes after Bobath physiotherapy. Material and methods. An experimental prospective uncontrolled study was performed. Ten adults with DS (mean age: 28 years) were assessed at baseline and after 10 sessions of Bobath physiotherapy treatment. Quantitative data (such as step length or walking speed) and qualitative data (such as characteristics of arm movements and instability) were recorded by an evaluator blinded to the treatment received. Results. Clear deviations with respect to normal adult gait were found, and a trend towards improvement after physiotherapy treatment. The results were significant in the correction of pitch angle and its symmetry. The study has revealed the potential benefits of physiotherapy in adults with DS and the need to complete more studies in this sense (AU)

Tromboendarterectomía carotídea en el paciente anciano: características clínicas de los pacientes intervenidos y resultados a corto y medio plazo / Carotid thromboendarterectomy in the elderly patient: clinical characteristics in operated patients and short and middle term results

Introducción. La tromboendarterectomía (TEA) carotídeaes el procedimiento de elección para estenosis graves,especialmente si son sintomáticas, en pacientes menores de80 años. En poblaciones ancianas hay estudios que documentanla persistencia del beneficio del procedimiento; además,otros tratamientos no han demostrado tanta eficacia o sehan acompañado de frecuentes complicaciones. Este estudiodescribe las características clínicas, resultados quirúrgicosy evolución de los pacientes mayores de 75 y 80 añosintervenidos en nuestro centro en relación con los más jóvenes.Métodos. Durante los años 2000 a 2006 fueron intervenidos86 pacientes, 8 de ellos bilateralmente. Se realizaun estudio retrospectivo que describe datos relativos a lascaracterísticas clínicas y evolución de los pacientes endarterectomizados,así como comparativo entre los distintos gruposde edad.Resultados. Fueron intervenidos 26 pacientes mayoresde 75 años, de ellos 6 eran mayores de 80 años. En los pacientesmayores el factor de riesgo fundamental fue la hipertensiónarterial, hubo menor proporción de fumadores ymayor frecuencia de estenosis grave u oclusión contralateral.Las estenosis intervenidas fueron más graves y con característicasmás agresivas. No se detectó mayor comorbilidado riesgo anestésico que en los pacientes más jóvenes.Los resultados quirúrgicos, la tasa de complicaciones perioperatoriasy la evolución a corto y medio plazo fue similaren los distintos grupos de edad (morbilidad y mortalidad inmediatapor accidente isquémico transitorio, infarto cerebralo muerte: 0% en mayores de 75 años frente a 4,41%en menores de 75 años).Conclusiones. Nuestros resultados apoyan que la edadno debe considerarse una contraindicación para la realizaciónde una TEA carotídea si existe una indicación quirúrgicaclara y una morbilidad y riesgo anestésico aceptables, comoen otros grupos poblacionales (AU)

Introduction. Carotid thromboendarterectomy is thetechnique of choice for treating high-grade stenosis inpatients less than 80 years of age, especially if they aresymptomatic. Previous studies have also documented thepersistence of the benefit of the procedure in elderly populationsand, in addition, other treatments have notbeen demonstrated to be as effective or have been relatedto more frequent complications. This study describes theclinical characteristics, surgical results and outcome ofpatients older than 75 and 80 years old, treated by thromboendarterectomyin our center in comparison with ayounger population.Methods. Between the years 2000 to 2006, 86 patientswere treated by thromboendarterectomy, 8 of thembilaterally. A retrospective study that described the dataregarding clinical characteristics and outcome of the patientswho had undergone endarterectomy was conductedand the different age groups were compared.Results. Twenty-six patients older than 75 years old,6 of whom were older than 80, were operated on. In theelderly patients, the fundamental risk factor was highblood pressure, there was a lower proportion of smokersand a higher proportion of contralateral severe stenosisor occlusion. Stenosis treated by surgery was more severeand had more aggressive characteristics. Comorbidityand anesthetic risk were the same as in younger patients.Surgical results, perioperative complication rates andshort and long term outcome were similar in the differentage groups (immediate morbidity-mortality due totransitory ischemic accident, stroke or death: 0% in408 older than 75 vs. 4.41% in those under 75). Conclusions. Our results support that age should notbe considered a contraindication for the performance ofa carotid thromboendarterectomy if there is a clear indicationand acceptable morbidity and anesthetic risk, asin other population groups (AU)

[Carotid thromboendarterectomy in the elderly patient: clinical characteristics in operated patients and short and middle term results]. / Tromboendarterectomía carotídea en el paciente anciano: características clínicas de los pacientes intervenidos y resultados a corto y medio plazo.

INTRODUCTION: Carotid thromboendarterectomy is the technique of choice for treating highgrade stenosis in patients less than 80 years of age, especially if they are symptomatic. Previous studies have also documented the persistence of the benefit of the procedure in elderly populations and, in addition, other treatments have not been demonstrated to be as effective or have been related to more frequent complications. This study describes the clinical characteristics, surgical results and outcome of patients older than 75 and 80 years old, treated by thromboendarterectomy in our center in comparison with a younger population. METHODS: Between the years 2000 to 2006, 86 patients were treated by thromboendarterectomy, 8 of them bilaterally. A retrospective study that described the data regarding clinical characteristics and outcome of the patients who had undergone endarterectomy was conducted and the different age groups were compared. RESULTS: Twenty-six patients older than 75 years old, 6 of whom were older than 80, were operated on. In the elderly patients, the fundamental risk factor was high blood pressure, there was a lower proportion of smokers and a higher proportion of contralateral severe stenosis or occlusion. Stenosis treated by surgery was more severe and had more aggressive characteristics. Comorbidity and anesthetic risk were the same as in younger patients. Surgical results, perioperative complication rates and short and long term outcome were similar in the different age groups (immediate morbidity-mortality due to transitory ischemic accident, stroke or death: 0% in older than 75 vs. 4.41% in those under 75). CONCLUSIONS: Our results support that age should not be considered a contraindication for the performance of a carotid thromboendarterectomy if there is a clear indication and acceptable morbidity and anesthetic risk, as in other population groups.

Administración de hialuronidasa intratecal en una paciente con orientación diagnóstica de aracnoiditis adhesiva / No disponible

No disponible

[Clinical, functional and quality of life differences in patients of different gender with essential tremor]. / Diferencias clínicas, funcionales y de calidad de vida en pacientes con temblor esencial de ambos sexos.

INTRODUCTION: Essential tremor (ET) is a chronic disease with important variability in its clinical manifestation, discapacity and quality of life (QoL) affectation. As previous reports have described differences in clinical manifestations of ET according to gender, this study proposes to check its existence in the Spanish population and to detect the presence of discapacity or alterations in QoL between different gender. METHODS: Patients with ET attended in the neurology clinic of a sanitary area were evaluated in a prospective consecutive way. Their clinical characteristics were recorded and discapacity and QoL were assessed through the Fahn and Tolosa scale for ET and the SF-36 health questionnaire. Comparisons between groups of both genders have been established. RESULTS: 104 patients with ET were evaluated (46 males and 58 females). Clinically there were differences concerning the localization and type of tremor. Although the intensity and the presence of discapacity were similar in both genders, women showed a lower QoL compared to men in the "physical role" dimension. CONCLUSIONS: There are differences in the clinical expression and in the affectation of QoL in patients with ET of different gender. Women had a lower score in the "physical role" dimension of QoL in comparison to their reference population, meaning lesser satisfaction with their performance capacity of their usual activities. QoL, thus, does not appear in this study as something only related with the degree of discapacity, but rather as having other determinant factors.

Diferencias clínicas, funcionales y de calidad de vida en pacientes con temblor esencial de ambos sexos / Clinical, functional and quality of life differences in patients of different gender with essential tremor

Introducción. El temblor esencial (TE) es una enfermedad crónica con importante variabilidad respecto a sus manifestaciones clínicas, discapacidad y afectación de calidad de vida (CdV). Dado que estudios previos describen diferencias en las manifestaciones clínicas del TE según el sexo, se plantea este estudio para comprobar su existencia en población española y detectar la presencia de discapacidad o alteraciones en CdV en los diferentes sexos. Métodos. Se han evaluado de forma prospectiva consecutiva pacientes con TE atendidos en las consultas de neurología de un área sanitaria, registrándose sus características clínicas y valorando discapacidad y CdV mediante la escala de TE de Fahn y Tolosa y el cuestionario de salud SF-36. Se han establecido comparaciones entre ambos sexos. Resultados. Participaron 104 pacientes con TE (46 varones y 58 mujeres). Clínicamente hubo diferencias en cuanto a localización y tipo de temblor. Aunque la intensidad del temblor y la presencia de discapacidad fue similar en ambos sexos, las mujeres manifestaron menor CdV respecto a los hombres en la dimensión de «rol físico». Conclusiones. Existen diferencias en la expresión clínica y en la afectación de CdV de pacientes con TE de diferentes sexos. Las mujeres presentaron menos puntuación en la dimensión «rol físico» de CdV respecto a su población de referencia, indicando un menor grado de satisfacción con la capacidad de realización de sus actividades habituales. La CdV, por tanto, no aparece en este estudio como un aspecto relacionado solamente con el grado de discapacidad, sino que puede tener otros factores determinantes

Introduction. Essential tremor (ET) is a chronic disease with important variability in its clinical manifestation, discapacity and quality of life (QoL) affectation. As previous reports have described differences in clinical manifestations of ET according to gender, this study proposes to check its existence in the Spanish population and to detect the presence of discapacity or alterations in QoL between different gender. Methods. Patients with ET attended in the neurology clinic of a sanitary area were evaluated in a prospective consecutive way. Their clinical characteristics were recorded and discapacity and QoL were assessed through the Fahn and Tolosa scale for ET and the SF-36 health questionnaire. Comparisons between groups of both genders have been established. Results. 104 patients with ET were evaluated (46 males and 58 females). Clinically there were differences concerning the localization and type of tremor. Although the intensity and the presence of discapacity were similar in both genders, women showed a lower QoL compared to men in the «physical role» dimension. Conclusions. There are differences in the clinical expression and in the affectation of QoL in patients with ET of different gender. Women had a lower score in the «physical role» dimension of QoL in comparison to their reference population, meaning lesser satisfaction with their performance capacity of their usual activities. QoL, thus, does not appear in this study as something only related with the degree of discapacity, but rather as having other determinant factors

[Progressive myoclonic cerebellar ataxia as a manifestation of Creutzfeldt-Jakob disease]. / Ataxia cerebelosa mioclónica progresiva como manifestación de la enfermedad de Creutzfeldt-Jakob.

INTRODUCTION: Progressive myoclonic cerebellar ataxia is a clinical entity with an important spectrum of possible diagnoses that requires a complex and exhaustive differential diagnosis. CASE REPORT: A 53-year-old male patient with no relevant medical history who was admitted to hospital because of an unstable gait, together with mild bilateral dysymmetry and the progressive and insidious widening of the base of support. The patient's symptoms then became more pronounced and included myoclonus and a deterioration of the higher functions. The patient died four months after the onset of the symptoms. The explorations that were conducted included a pathological study of the brain, which confirmed the diagnosis of classical spongiform encephalopathy (Creutzfeldt-Jakob disease). CONCLUSIONS: Creutzfeldt-Jakob disease must be included in the differential diagnosis of progressive cerebellar ataxias.

Ataxia cerebelosa mioclónica progresiva como manifestación de la enfermedad de Creutzfeldt-Jakob / Progressive myoclonic cerebellar ataxia as a manifestation of Creutzfeldt-Jakob disease

Introducción. La ataxia cerebelosa mioclónica progresiva es una entidad clínica con un importante espectro de posibilidades diagnósticas que obligan a un diagnóstico diferencial complejo y exhaustivo. Caso clínico. Paciente varón de 53 años de edad, sin antecedentes de interés, que ingresa por presentar inestabilidad en la marcha, con una leve dismetría bilateral y ampliación de la base de sustentación de instauración insidiosa y progresiva. Posteriormente, la sintomatología del paciente se acentuó y se asoció a mioclonías y a un deterioro de las funciones superiores. Cuatro meses después del inicio de los síntomas, el paciente falleció. Las exploraciones que se realizaron incluyeron el estudio anatomopatológico cerebeloso, que confirmó el diagnóstico de encefalopatía espongiforme (enfermedad de Creutzfeldt-Jakob) en su forma clásica. Conclusión. La enfermedad de Creutzfeldt-Jakob debe incluirse en el diagnóstico diferencial de las ataxias cerebelosas progresivas (AU)

Introduction. Progressive myoclonic cerebellar ataxia is a clinical entity with an important spectrum of possible diagnoses that requires a complex and exhaustive differential diagnosis. Case report. A 53-year-old male patient with no relevant medical history who was admitted to hospital because of an unstable gait, together with mild bilateral dysmetry and the progressive and insidious widening of the base of support. The patient’s symptoms then became more pronounced and included myoclonus and a deterioration of the higher functions. The patient died four months after the onset of the symptoms. The explorations that were conducted included a pathological study of the brain, which confirmed the diagnosis of classical spongiform encephalopathy (Creutzfeldt-Jakob disease). Conclusions. Creutzfeldt-Jakob disease must be included in the differential diagnosis of progressive cerebellar ataxias (AU)

[Pharmacological treatment of Korsakoff's psychosis: a review of the literature and experience in two cases]. / Tratamiento farmacológico de la psicosis de Korsakoff: revisión de la bibliografía y experiencia en dos casos.

INTRODUCTION: Korsakoff s psychosis (KP) is a relatively frequent pathological condition in our community that has been infradiagnosed. The most common cause is chronic alcohol consumption, although it can be brought about by other aetiologies accompanied by vitamin deficiencies. The lack of thiamine entails an alteration in the synthesis of neurotransmitters, which provides the neurochemical foundation for the specific cognitive impairment that defines the syndrome. AIMS: To evaluate the application of pharmacological treatments, in accordance with the neurochemical disorders described in the literature, and report our experience in two cases treated with anticholinesterases. CASE REPORTS: 1) Female aged 47, with a history of addiction to alcohol. Following Wernicke s encephalopathy, which improved with parenteral thiamine, she presented a memory disorder compatible with KP. After two months treatment with donepezil, a cognitive improvement was observed in the neuropsychological tests. 2) Male aged 77, who presented KP a month after being diagnosed and treated for a post encephalitic vasculitis caused be varicella zoster virus. His cognitive and functional condition improved after 3 months treatment with donepezil. DISCUSSION AND CONCLUSIONS: There are not enough studies in the literature with representative samples that consider the effects of thiamine or of other forms of treatment on cognitive impairment in KP. Noradrenaline, serotonin, glutamate and acetylcholine have been proposed in the pathogeny of the syndrome. Based on experiences gained in cholinergic disorders, two cases responded to treatment with donepezil. Effective treatment must be based on a combination of aetiological and pharmacological treatment, and cognitive rehabilitation.

Tratamiento farmacológico de la psicosis de Korsakoff:revisión de la bibliografía y experiencia en dos casos / Pharmacological treatment of korsakoff's psychosis: a review of the literature and experience in two cases

Introducción. La psicosis de Korsakoff (PK) constituye una patología relativamente frecuente en nuestro medio y se ha infradiagnosticado. La causa más habitual es el consumo crónico de alcohol; pueden producirla otras etiologías que cursen con déficit vitamínicos. La carencia de tiamina conlleva una alteración en la síntesis de neurotransmisores, que constituye la base neuroquímica de los específicos déficit cognitivos que definen el síndrome. Objetivo. Evaluar la aplicación de tratamientos farmacológicos, según los trastornos neuroquímicos descritos en la literatura, y exponer nuestra experiencia en dos casos tratados con anticolinesterásicos. Casos clínicos. 1) Mujer de 47 años, con antecedentes de adicción al alcohol. Tras cuadro de encefalopatía de Wernicke, que mejora con tiamina parenteral, presenta trastorno de memoria compatible con PK. A los dos meses de tratamiento con donepecilo se observa mejoría cognitiva en los tests neuropsicológicos. 2) Varón de 77 años, que presenta PK al mes de haberse diagnosticado y tratado de una vasculitis postencefalitis por virus varicela zoster. Mejora su estado cognitivo y funcional a los tres meses de tratamiento con donepecilo. Discusión y conclusiones. No existen estudios suficientes en la literatura con muestras representativas de pacientes que valoren los efectos de la tiamina ni de otros tratamientos sobre los defectos cognitivos de la PK. Noradrenalina, serotonina, glutamato y acetilcolina se han postulado en la patogenia del síndrome. Sobre la base de los trastornos colinérgicos, dos casos han experimentado respuesta al tratamiento con donepecilo. La terapéutica se sustenta en la combinación de tratamiento etiológico, farmacológico y rehabilitación cognitiva (AU)