Hemiplejia y afasia transitorias no tromboembólicas: ¿neurotoxicidad por contraste angiográfico? / A case of temporary nonthrombotic hemiplegia and aphasia due to neurotoxicity from angiographic contrast material?

Se presenta el caso de una mujer de 75 años, que desarrolló hemiplejia, afasia y disminución del nivel de conciencia, súbitamente, 3h después de una embolización de aneurisma cerebral. La embolización transcurrió sin complicaciones, con control angiográfico final normal. La tomografía computarizada (TC) craneal postembolización mostró hiperdensidad cortical y de los surcos de la convexidad; hallazgos que desaparecieron en una nueva TC realizada 4h después. Una arteriografía cerebral 24h postembolización presentaba retraso del parenquimograma hemisférico izquierdo respecto del derecho, sin oclusiones vasculares. El déficit neurológico persistió 72h, y se resolvió después, tan súbitamente como se instauró, espontánea y completamente. Éste es uno de los pocos casos descritos de déficit neurológico transitorio en relación con la administración de contraste iodado, fuera de la circulación posterior (ceguera cortical). Cuando se producen síntomas neurológicos tras un tratamiento endovascular cerebral, es fundamental distinguir este excepcional cuadro, probablemente tóxico, de las posibles complicaciones isquémicas del procedimiento (AU)

We present the case of a 75-year-old woman who suddenly developed hemiplegia, aphasia, and reduced consciousness three hours after embolization of a cerebral aneurysm. No complications occurred during embolization and the findings at end-procedure angiography were normal. Cranial computed tomography (CT) after embolization showed hyperdensity of the cortex and sulci of the convexity; another CT examination performed four hours later showed these findings had disappeared. Cerebral arteriography 24h after embolization showed delayed blood flow to the parenchyma of the left hemisphere compared to the right but no vascular occlusion. The neurological deficit lasted 72h and resolved spontaneously and completely as suddenly as it developed. This is one of the few cases of temporary neurological deficit related to iodinated contrast administration to be reported outside the posterior circulation (cortical blindness). When neurological symptoms occur after endovascular procedures in the brain, it is fundamental to distinguish this rare clinical syndrome of probable toxic origin from possible ischemic complications of the procedure (AU)

[A case of temporary nonthrombotic hemiplegia and aphasia due to neurotoxicity from angiographic contrast material?]. / Hemiplejia y afasia transitorias no tromboembólicas: ¿neurotoxicidad por contraste angiográfico?

We present the case of a 75-year-old woman who suddenly developed hemiplegia, aphasia, and reduced consciousness three hours after embolization of a cerebral aneurysm. No complications occurred during embolization and the findings at end-procedure angiography were normal. Cranial computed tomography (CT) after embolization showed hyperdensity of the cortex and sulci of the convexity; another CT examination performed four hours later showed these findings had disappeared. Cerebral arteriography 24h after embolization showed delayed blood flow to the parenchyma of the left hemisphere compared to the right but no vascular occlusion. The neurological deficit lasted 72 h and resolved spontaneously and completely as suddenly as it developed. This is one of the few cases of temporary neurological deficit related to iodinated contrast administration to be reported outside the posterior circulation (cortical blindness). When neurological symptoms occur after endovascular procedures in the brain, it is fundamental to distinguish this rare clinical syndrome of probable toxic origin from possible ischemic complications of the procedure.

[Epidemiological analysis of the improving areas for blood pressure control at Primary Care practice]. / Análisis de las áreas de mejora del control de la hipertensión arterial en Atención Primaria.

BACKGROUND AND OBJECTIVES: Most hypertensive patients do not have their blood pressure (BP) under control. This study aims to evaluate Primary Care physicians' management of hypertension by analyzing the four main areas proposed by experts to improve BP control. MATERIAL AND METHODS: From February to May 2003 a questionnaire was completed by 195 Primary Care physicians from 33 Primary Care centers of Madrid, Spain. Four aspects of clinical practice were examined: a) knowledge of hypertension guidelines and objectives; b) diagnosis and follow-up of patients; c) hypertension treatment, and d) drug compliance. RESULTS: Guidelines were followed by 90.6% of the physicians. Twenty six percent of the physicians perceived that guideline objectives are too strict and only 32% identified systolic BP as the component that provides more risk. Only 14% used automatic devices to measure BP while 89% still use the mercury sphygmomanometer. Diuretics were included among the 3 most used antihypertensive drugs by 94% of the physicians, ACEI by 91%, beta blockers by 62% and combinations only by 24%. Eighty eight percent believed that more than 40% of their patients have their BP under control and 53% felt that less than 20% of their patients were non-compliant with antihypertensive treatment. CONCLUSIONS: Hypertension management among Primary Care physicians showed some deficiencies in the 4 analyzed areas. Thus, perception of excessively rigorous guideline objectives, underrating of systolic BP, underuse of automatic devices and drug associations, and the overestimation of BP control and therapeutic compliance are specific areas that should be modified to improve BP control.

Análisis de las áreas de mejora del control de la hipertensión arterial en Atención Primaria / Epidemiological analysis of the improving areas for blood pressure control at Primary Care practice

Fundamento y objetivo. La mayoría de los hipertensos no tienen sus cifras de presión arterial (PA) controladas. Este estudio pretende conocer el manejo de la hipertensión arterial (HTA) por médicos de Atención Primaria en su práctica diaria analizando las cuatro grandes áreas de mejora del control propuestas por los expertos. Material y métodos. Desde febrero a mayo de 2003 se administró una encuesta a 195 médicos de Atención Primaria procedentes de 33 Centros de Salud de la Comunidad de Madrid. El cuestionario estudia 4 aspectos de la práctica clínica: a) conocimiento de las guías de HTA y objetivos terapéuticos; b) diagnóstico y seguimiento de pacientes hipertensos; c) tratamiento de la HTA, y d) cumplimiento terapéutico. Resultados. El 90,6% de los médicos sigue alguna guía acreditada. Para el 26% los objetivos terapéuticos de las guías son demasiado rigurosos y sólo el 32% identificó la presión sistólica como la que mayor riesgo confiere. Sólo el 14% utiliza dispositivos automáticos de brazo para medir la PA y el 89% utiliza esfigmomanómetros de mercurio. Para el 94% los diuréticos están entre los 3 fármacos más utilizados, los inhibidores de la enzima conversora de la angiotensina (IECA) para el 91%, los bloqueadores beta para el 62% y las combinaciones sólo para el 24%. El 88% cree que más del 40% de sus pacientes tienen su PA controlada. El 53% opina que menos del 20% de sus pacientes incumple/abandona el tratamiento antihipertensivo. Conclusiones. Se han identificado deficiencias en el manejo de la HTA en las 4 áreas analizadas. Así, la percepción de un excesivo rigor en los objetivos de las guías, el menosprecio de la presión sistólica, la infrautilización de los tensiómetros automáticos y de las asociaciones farmacológicas y la sobreestimación del control y del cumplimiento terapéutico son aspectos a corregir para incrementar el control de la PA (AU)

Background and objectives. Most hypertensive patients do not have their blood pressure (BP) under control. This study aims to evaluate Primary Care physicians' management of hypertension by analyzing the four main areas proposed by experts to improve BP control. Material and methods. From February to May 2003 a questionnaire was completed by 195 Primary Care physicians from 33 Primary Care centers of Madrid, Spain. Four aspects of clinical practice were examined: a) knowledge of hypertension guidelines and objectives; b) diagnosis and follow-up of patients; c) hypertension treatment, and d) drug compliance. Results. Guidelines were followed by 90.6% of the physicians. Twenty six percent of the physicians perceived that guideline objectives are too strict and only 32% identified systolic BP as the component that provides more risk. Only 14% used automatic devices to measure BP while 89% still use the mercury sphygmomanometer. Diuretics were included among the 3 most used antihypertensive drugs by 94% of the physicians, ACEI by 91%, beta blockers by 62% and combinations only by 24%. Eighty eight percent believed that more than 40% of their patients have their BP under control and 53% felt that less than 20% of their patients were non-compliant with antihypertensive treatment. Conclusions. Hypertension management among Primary Care physicians showed some deficiencies in the 4 analyzed areas. Thus, perception of excessively rigorous guideline objectives, underrating of systolic BP, underuse of automatic devices and drug associations, and the overestimation of BP control and therapeutic compliance are specific areas that should be modified to improve BP control (AU)