Factores asociados a una evolución desfavorable en la hemorragia subaracnoidea aneurismática. Serie de 334 pacientes / Factors associated with poor outcome for aneurysmal subarachnoid haemorrhage in a series of 334 patients

Objetivo: Evaluar los factores sociodemográficos, clínicos, imagenológicos y relacionados con la atención médica que influyen sobre el pronóstico de los pacientes con hemorragia subaracnoidea aneurismática al alta hospitalaria. Pacientes y método. Se realizó un estudio tipo cohorte, retrospectivo, con 334 pacientes atendidos en el Hospital Hermanos Ameijeiras en La Habana, Cuba, en el periodo comprendido entre octubre de 2005 y junio de 2014. Resultados: En el análisis multivariado se encontró que los factores asociados a una evolución desfavorable fueron la edad mayor a 65 años (OR 3,51, IC 95% 1,79-5,7, p = 0,031), el sexo femenino (OR 2,17, IC 95% 1,22-3,84, p = 0,0067), la HTA sistólica (OR 4,82, IC 95% 2,27-9,8, p = 0,0001), la hiperglucemia al ingreso (OR 3,93, IC 95% 2,10-7,53, p = 0,0003), las complicaciones como la sepsis respiratoria (OR 2,73, IC 95% 1,27-5,85, p = 0,0085), los trastornos hidroelectrolíticos (OR 3,33, IC 95% 1,33-8,28, p = 0,0073), la hidrocefalia (OR 2,21, IC 95% 1,05-4,63, p = 0,0039), el resangrado (OR 16,50, IC 95% 8,24-41,24, p = 0,0000), el vasoespasmo sintomático (OR 19,00, IC 95% 8,86-41,24, p = 0,0000), el infarto cerebral (OR 3,82, IC 95% 1,87-7,80, p = 0,0000), el resangrado múltiple (OR 6,69, IC 95% 1,35-36,39, p = 0,0019), así como los grados III y IV de las escalas de la Federación Mundial de Neurocirujanos (OR 2,09, IC 95% 1,12-3,91, p = 0,0021) y de Fisher (OR 5,18, IC 95% 2,65-10,29, p = 0,0008). Conclusiones: La evolución de la hemorragia subaracnoidea aneurismática está relacionada con la edad, el sexo, el estado clínico al arribo a la unidad de ictus, así como las características imagenológicas según la escala de Fisher, las cifras de tensión arterial y de glucemia, y las complicaciones como los trastornos hidroelectrolíticos, la hidrocefalia, el resangrado, el vasoespasmo y el resangrado múltiple

Objective: This study evaluates care-related sociodemographic, clinical, and imaging factors and influences associated with outcome at discharge in patients with aneurismal subarachnoid haemorrhage. Patients and method: Retrospective cohort study in 334 patients treated at Hospital Hermanos Ameijeiras in Havana, Cuba between October 2005 and June 2014. Results: Logistic regression analysis determined that the following factors were associated with higher risk of poor outcome: age older than 65 years (OR 3.51, 95% CI 1.79-5.7, P = .031), female sex (OR 2.17, 95% CI 1.22-3.84, P = .0067), systolic hypertension (OR 4.82, 95% CI 2.27-9.8, P=.0001), and hyperglycaemia at admission (OR 3.93, 95% CI 2.10-7.53, P = .0003). Certain complications were also associated with poor prognosis, including respiratory infection (OR 2.73, 95% CI 1.27-5.85, P = .0085), electrolyte disturbances (OR 3.33, 95% CI 1.33-8.28, P = .0073), hydrocephalus (OR 2.21, 95% CI 1.05-4.63, P = .0039), rebleeding (OR 16.50, 95% CI 8.24-41.24, P = .0000), symptomatic vasospasm (OR 19.00, 95% CI 8.86-41.24, P = .0000), cerebral ischaemia (OR 3.82, 95% CI 1.87-7.80, P = .000) and multiplex rebleeding (OR 6.69, 95% CI 1.35-36.39, P = .0019). Grades of III and IV on the World Federation of Neurological Surgeons (OR 2.09, 95% CI 1.12-3.91, P = .0021) and Fisher scales (OR 5.18, 95% CI 2.65-10.29, P = .0008) were also related to poor outcome. Conclusions: Outcome of aneurysmal subarachnoid haemorrhage was related to age, sex, clinical status at admission to the stroke unit, imaging findings according to the Fisher scale, blood pressure, glycaemia and such complications as electrolyte disturbances, hydrocephalus, rebleeding, and multiplex rebleeding

Factors associated with poor outcome for aneurysmal subarachnoid haemorrhage in a series of 334 patients. / Factores asociados a una evolución desfavorable en la hemorragia subaracnoidea aneurismática. Serie de 334 pacientes.

OBJECTIVE: This study evaluates care-related sociodemographic, clinical, and imaging factors and influences associated with outcome at discharge in patients with aneurismal subarachnoid haemorrhage. PATIENTS AND METHOD: Retrospective cohort study in 334 patients treated at Hospital Hermanos Ameijeiras in Havana, Cuba between October 2005 and June 2014. RESULTS: Logistic regression analysis determined that the following factors were associated with higher risk of poor outcome: age older than 65 years (OR 3.51, 95% CI 1.79-5.7, P=.031), female sex (OR 2.17, 95% CI 1.22-3.84, P=.0067), systolic hypertension (OR 4.82, 95% CI 2.27-9.8, P=.0001), and hyperglycaemia at admission (OR 3.93, 95% CI 2.10-7.53, P=.0003). Certain complications were also associated with poor prognosis, including respiratory infection (OR 2.73, 95% CI 1.27-5.85, P=.0085), electrolyte disturbances (OR 3.33, 95% CI 1.33-8.28, P=.0073), hydrocephalus (OR 2.21, 95% CI 1.05-4.63, P=.0039), rebleeding (OR 16.50, 95% CI 8.24-41.24, P=.0000), symptomatic vasospasm (OR 19.00, 95% CI 8.86-41.24, P=.0000), cerebral ischaemia (OR 3.82, 95% CI 1.87-7.80, P=.000) and multiplex rebleeding (OR 6.69, 95% CI 1.35-36.39, P=.0019). Grades of iii and iv on the World Federation of Neurological Surgeons (OR 2.09, 95% CI 1.12-3.91, P=.0021) and Fisher scales (OR 5.18, 95% CI 2.65-10.29, P=.0008) were also related to poor outcome. CONCLUSIONS: Outcome of aneurysmal subarachnoid haemorrhage was related to age, sex, clinical status at admission to the stroke unit, imaging findings according to the Fisher scale, blood pressure, glycaemia and such complications as electrolyte disturbances, hydrocephalus, rebleeding, and multiplex rebleeding.

[Symptomatic vasospasm. Clinical manifestations]. / Vasoepasmo sintomático. Caracterización clínica.

INTRODUCTION: Symptomatic vasospasm in the setting of a subarachnoid hemorrhage is a complication of difficult diagnosis in some clinical situations. Objectives. Describe the clinical characteristics of cerebral vasospasm demonstrated by neurovascular studies in patients with ruptured saccular aneurysm. PATIENTS AND METHODS: 19 consecutive patients with symptomatic vasospasm, evaluated with TCD and any variant of neurovascular study with contrast injection. All these cases were in degrees between 1 and 3 of the World Federation of Neurological Surgeons Scale. RESULTS: The cognitive and behavioral manifestations were the most frequent (53%), followed by neurological focal deficits (26%). Clinical vasospasm occurred most frequently between day 9 and 10. Vasospasm is predominant in the arteries of the anterior circulation. The high mortality (42%) and the antecedent of arterial hypertension characterized the group with symptomatic vasospasm. There was no statistical relationship between the result of the scale of Fisher and the symptomatic vasospasm. All the TCD parameters had statistical significance. CONCLUSIONS: The clinical manifestations more frequently associated with symptomatic vasospasm were cognitive and behavioral. This group of patients is characterized by a high mortality. The TCD is a test of great value to predict cerebral ischemia due to vasospasm.

Vasoespasmo sintomático. Caracterización clínica / Symptomatic Vasospasm. Clinical manifestations

Introducción. El vasoespasmo sintomático en la hemorragiasubaracnoidea es una complicación de difícildiagnóstico en algunas situaciones clínicas.Objetivos. Describir las características clínicas de ungrupo de pacientes con HSA aneurismática, que presentaronvasoespasmo sintomático demostrado en losestudios neurovasculares.Pacientes y métodos. Se estudiaron 19 enfermos convasoespasmo sintomático, evaluados con DTC y conalguna variante de estudio neurovascular con inyecciónde contraste. Todos los casos se encontraban en gradosentre I y III de la escala de la Federación Mundial deCirujanos Neurológicos.Resultados. Los síntomas y signos cognitivo conductualesfueron las manifestaciones más frecuentedel vasoespasmo (53%), seguido del déficit neurológicofocal (26%). Las manifestaciones clínicas ocurrieroncomo promedio entre el 9no y 10mo día de evolución. Elvasoespasmo predominó en las arterias de la circulaciónanterior. La mortalidad elevada (42%) y el antecedentede hipertensión arterial caracterizó el grupocon vasoespasmo sintomático. No se encontró relaciónestadística entre el resultado de la escala de Fishery la isquemia cerebral por vasoespasmo. Todos losparámetros del DTC evaluados tuvieron significaciónestadística.Conclusiones. Las manifestaciones clínicas más frecuentesen el vasoespasmo sintomático son de tipocognitivo conductuales. Este grupo de enfermos secaracteriza por una elevada mortalidad. El DTC esuna prueba de gran utilidad en el seguimiento de estospacientes (AU)

Introduction. Symptomatic vasospasm in the settingof a subarachnoid hemorrhage is a complication ofdifficult diagnosis in some clinical situations. Objectives.Describe the clinical characteristics of cerebralvasospasm demonstrated by neurovascular studies inpatients with ruptured saccular aneurysm.Patients and methods. 19 consecutive patients withsymptomatic vasospasm, evaluated with TCD and anyvariant of neurovascular study with contrast injection.All these cases were in degrees between 1 and 3 of theWorld Federation of Neurological Surgeons Scale.Results. The cognitive and behavioral manifestationswere the most frequent (53%), followed by neurologicalfocal deficits (26%). Clinical vasospasm occurred mostfrequently between day 9 and 10. Vasospasm is predominantin the arteries of the anterior circulation. Thehigh mortality (42%) and the antecedent of arterialhypertension characterized the group with symptomaticvasospasm. There was no statistical relationshipbetween the result of the scale of Fisher and the symptomaticvasospasm. All the TCD parameters had statisticalsignificance.Conclusions. The clinical manifestations more frequentlyassociated with symptomatic vasospasm werecognitive and behavioral. This group of patients ischaracterized by a high mortality. The TCD is a test ofgreat value to predict cerebral ischemia due to vasospasm (AU)

Disecciones arteriales craneocervicales en la edad pediátrica: ¿una patología emergente o infradiagnosticada?

Las disecciones craneocervicales constituyen una reconocida causa de ictus en la infancia y adolescencia, y son responsables del 0,4-20 por ciento del total de casos. Objetivo. Describir una población de niños con disecciones arteriales, analizando su presentación clínica, factores de riesgo, signos angiográficos, evolución y tratamiento. Se llevó a cabo un estudio descriptivo, retrospectivo y colaborativo (Hospital Sant Joan de Déu de Barcelona y Centro Hospitalario Pereira Rossell de Montevideo), durante los años 2000 a 2009, de niños entre 1 mes a 17 años, con disecciones arteriales craneocervicales. Resultados. Se identificaron 10 casos con diagnóstico de disección arterial, siete varones y tres niñas. Nueve presentaron traumatismo previo al inicio de los síntomas neurológicos. Del total de pacientes, cinco comenzaron con hemiparesia, tres con síndrome hemicerebeloso, uno con afectación del VI par, y uno con soplo craneal. De éstos, tres tuvieron convulsiones y seis cefaleas que precedieron al cuadro clínico. El deterioro de la circulación anterior tuvo lugar en cinco niños, y el de la posterior en los otros cinco. Cuatro pacientes presentaron afectación arterial intracraneal, y seis, extracraneal. Se realizó anticoagulación en cinco pacientes, antiagregación en tres y no se trataron los dos restantes. No hubo fallecimientos, complicaciones por la anticoagulación, ni recurrencias en el período de seguimiento clínico. Las disecciones craneocervicales son una causa frecuente de ictus en la infancia. La sospecha clínica debe ser alta ante todo paciente con sintomatología focal neurológica en relación con un traumatismo craneocervical(AU)

[Delays in the arrival of patients with subarachnoid haemorrhage at a tertiary hospital]. / Demora en la llegada de pacientes con hemorragia subaracnoidea a un hospital terciario.

INTRODUCTION: Patients with subarachnoid haemorrhage should be referred to a tertiary hospital as early as possible. The aim of this research was to study how long these patients take to reach a tertiary care centre in Havana. PATIENTS AND METHODS: We conducted a prospective study of patients with subarachnoid haemorrhage who were admitted to the Stroke Unit at the Hospital Hermanos Ameijeiras between January 2005 and December 2007. The time of arrival at the hospital was determined and a comparison was carried out between patients who arrived after 72 hours and those who reached the hospital sooner. RESULTS: The sample studied comprised 94 patients. Only 34 (36%) arrived during the first three days, whereas 13 (13.8%) reached the hospital within the first 24 hours. None of the sociodemographic and clinical variables that were studied was associated with early remission. The length of time spent in hospital by patients admitted during the first 72 hours was 14.9 days, while in the other cases it was 17.57 days (p = 0.248). The greatest impact on early remission to the tertiary centre was on the outcome at discharge on the Rankin scale, which was lower in those who arrived early compared to the rest of the cases (p = 0.05); the same was true of mortality, which was 5.9% in those who arrived within the first 72 hours versus 11.7% in the others (p = 0.04). CONCLUSIONS: Only a third of the cases reached hospital during the first 72 hours and this group had a more favourable course.

Demora en la llegada de pacientes con hemorragia subaracnoidea a un hospital terciario / Delays in the arrival of patients with subarachnoid haemorrhage at a tertiary hospital

Se recomienda que los pacientes con hemorragia subaracnoidea se remitan precozmente a un hospital terciario. Esta investigación tiene como objetivo estudiar la demora en la llegada de estos pacientes a un centro terciario de La Habana. Pacientes y métodos. Estudio prospectivo de pacientes con hemorragia subaracnoidea que ingresaron en la Unidad de Ictus del Hospital Hermanos Ameijeiras entre enero de 2005 y diciembre de 2007. Se determinó el momento de llegada al hospital, y se compararon los pacientes que llegaron después de las 72 horas con aquéllos que lo hicieron antes. Se estudiaron 94 pacientes. Sólo 34 (36 por ciento) llegaron en los primeros tres días, mientras que 13 (13,8 por ciento) lo hicieron en las primeras 24 horas. Ninguna de las variables sociodemográficas y clínicas evaluadas se asoció a la remisión temprana. La estancia hospitalaria de los pacientes recibidos en las primeras 72 horas fue de 14,9 días, mientras que en el resto fue de 17,57 días (p = 0,248). El impacto mayor de la remisión precoz al centro terciario fue sobre el resultado a la salida en la escala de Rankin, que fue inferior en los que llegaron temprano en relación con el resto de los casos (p = 0,05), al igual que la mortalidad, que fue del 5,9 por ciento en los que llegaron en las primeras 72 horas, frente al 11,7 por ciento en el resto (p = 0,04). Sólo un tercio de los casos se recibió en las primeras 72 horas, y este grupo tuvo una evolución más favorable(AU)

[Clinical usefulness of transcranial Doppler ultrasound imaging in the diagnosis of cerebral vasospasm in subarachnoid haemorrhage. A validation study]. / Utilidad clinica del Doppler transcraneal en el diagnostico del vasoespasmo cerebral en la hemorragia subaracnoidea. Estudio de validacion.

INTRODUCTION: During the clinical course of aneurysmal subarachnoid haemorrhage, cerebral vasospasm is one of the most dreaded medical complications. AIM. To determine the usefulness of transcranial Doppler (TCD) ultrasound imaging in diagnosing vasospasm in patients with subarachnoid haemorrhage (SAH) who were attended in a Stroke Unit. PATIENTS AND METHODS: The study included 89 patients with SAH of a non-traumatic origin; these patients had been admitted to a Stroke Unit and were submitted to a contrast-enhanced neurovascular study and daily monitoring with TCD. Values were determined for the sensitivity, specificity, predictive power and overall precision of the TCD ultrasound imaging, together with the differences in mean flow rate and the coefficient of correlation between the gold standard test and the results of monitoring with TCD. RESULTS: Female patients under 50 years of age with favourable initial clinical degrees were predominant. Aneurysmal SAH was prevalent and the frequency of angiographic vasospasm was 40%, in the majority of cases located in the middle cerebral arteries. Most of the patients had mean cerebral blood flow rates of or below 120 cm/s. The peaks of mean blood flow rate were obtained between the fourth and the tenth day. Overall precision, sensitivity and the predictive negative value of TCD were good. Specificity was excellent for flow rates below 130 cm/s, and the predictive positive value was low. CONCLUSIONS: Monitoring with TCD proved to be useful for diagnosing cerebral vasospasm in patients with a good initial clinical status.

Utilidad clínica del Doppler transcraneal en el diagnóstico del vasoespasmo cerebral en la hemorragia subaracnoidea: estudio de validación / Clinical usefulness of transcranial Doppler ultrasound imaging in the diagnosis of cerebral vasospasm in subarachnoid haemorrhage: a validation study]

Introducción. Durante el curso clínico de hemorragia subaracnoidea aneurismática, el vasoespasmo cerebral es una de las complicaciones médicas más temibles. Objetivo. Comprobar la utilidad de la ecografía Doppler transcraneal (DTC) para diagnosticar el vasoespasmo en pacientes con hemorragia subaracnoidea (HSA) atendidos en una Unidad de Ictus. Pacientes y métodos. Estudio de 89 pacientes con HSA no traumática, ingresados en una Unidad de Ictus, a los cuales se realizó un estudio neurovascular contrastado y monitorización diaria con DTC. Se determinaron los valores de sensibilidad, especificidad, predictivos y de precisión global de la ecografía DTC, las diferencias de velocidad de flujo media y el coeficiente de correlación entre la prueba estándar de referencia y los resultados de la monitorización con DTC. Resultados. Predominaron los pacientes menores de 50 años del sexo femenino con grados clínicos iniciales favorables. Prevaleció la HSA aneurismática y la frecuencia de vasoespasmo angiográfico fue del 40 porciento, preferentemente localizado en las arterias cerebrales medias. La mayoría de los pacientes tenían velocidades medias del flujo sanguíneo cerebral iguales o inferiores a 120 cm/s. Los picos de velocidad de flujo media se obtuvieron entre el cuarto y el décimo día. La precisión global, la sensibilidad y el valor predictivo negativo del DTC fueron buenos. La especificidad fue excelente para velocidades de flujo inferiores a 130 cm/s, y el valor predictivo positivo, bajo. Conclusión. Se comprobó la utilidad de la monitorización con DTC para el diagnóstico del vasoespasmo cerebral en pacientes con buen estado clínico inicial(AU)

INTRODUCTION: During the clinical course of aneurysmal subarachnoid haemorrhage, cerebral vasospasm is one of the most dreaded medical complications. AIM. To determine the usefulness of transcranial Doppler (TCD) ultrasound imaging in diagnosing vasospasm in patients with subarachnoid haemorrhage (SAH) who were attended in a Stroke Unit. PATIENTS AND METHODS: The study included 89 patients with SAH of a non-traumatic origin; these patients had been admitted to a Stroke Unit and were submitted to a contrast-enhanced neurovascular study and daily monitoring with TCD. Values were determined for the sensitivity, specificity, predictive power and overall precision of the TCD ultrasound imaging, together with the differences in mean flow rate and the coefficient of correlation between the gold standard test and the results of monitoring with TCD. RESULTS: Female patients under 50 years of age with favourable initial clinical degrees were predominant. Aneurysmal SAH was prevalent and the frequency of angiographic vasospasm was 40 percent, in the majority of cases located in the middle cerebral arteries. Most of the patients had mean cerebral blood flow rates of or below 120 cm/s. The peaks of mean blood flow rate were obtained between the fourth and the tenth day. Overall precision, sensitivity and the predictive negative value of TCD were good. Specificity was excellent for flow rates below 130 cm/s, and the predictive positive value was low. CONCLUSIONS: Monitoring with TCD proved to be useful for diagnosing cerebral vasospasm in patients with a good initial clinical status(AU)

Utilidad clínica del Doppler transcraneal en el diagnóstico del vasoespasmo cerebral en la hemorragia subaracnoidea. Estudio de validación / Clinical usefulness of transcranial doppler ultrasound imaging in the diagnosis of cerebral vasospasm in subarachnoid haemorrhage. A validation study

Introducción. Durante el curso clínico de hemorragia subaracnoidea aneurismática, el vasoespasmo cerebral esuna de las complicaciones médicas más temibles. Objetivo. Comprobar la utilidad de la ecografía Doppler transcraneal (DTC) para diagnosticar el vasoespasmo en pacientes con hemorragia subaracnoidea (HSA) atendidos en una Unidad de Ictus.Pacientes y métodos. Estudio de 89 pacientes con HSA no traumática, ingresados en una Unidad de Ictus, a los cuales se realizó un estudio neurovascular contrastado y monitorización diaria con DTC. Se determinaron los valores de sensibilidad, especificidad, predictivos y de precisión global de la ecografía DTC, las diferencias de velocidad de flujo media y el coeficiente de correlación entre la prueba estándar de referencia y los resultados de la monitorización con DTC. Resultados. Predominaron los pacientes menores de 50 años del sexo femenino con grados clínicos iniciales favorables. Prevaleció la HSA aneurismática y la frecuencia de vasoespasmo angiográfico fue del 40%, preferentemente localizado en las arterias cerebrales medias. La mayoría de los pacientes tenían velocidades medias del flujo sanguíneo cerebral iguales o inferiores a 120 cm/s. Los picos de velocidad de flujo media se obtuvieron entre el cuarto y el décimo día. La precisión global, la sensibilidad y el valor predictivo negativo del DTC fueron buenos. La especificidad fue excelente para velocidades de flujo inferiores a 130 cm/s, yel valor predictivo positivo, bajo. Conclusión. Se comprobó la utilidad de la monitorización con DTC para el diagnóstico del vasoespasmo cerebral en pacientes con buen estado clínico inicial

Introduction. During the clinical course of aneurysmal subarachnoid haemorrhage, cerebral vasospasm is one ofthe most dreaded medical complications. Aim. To determine the usefulness of transcranial Doppler (TCD) ultrasound imaging in diagnosing vasospasm in patients with subarachnoid haemorrhage (SAH) who were attended in a Stroke Unit. Patients and methods. The study included 89 patients with SAH of a non-traumatic origin; these patients had been admitted to a Stroke Unit and were submitted to a contrast-enhanced neurovascular study and daily monitoring with TCD. Values were determined forthe sensitivity, specificity, predictive power and overall precision of the TCD ultrasound imaging, together with the differences in mean flow rate and the coefficient of correlation between the gold standard test and the results of monitoring with TCD.Results. Female patients under 50 years of age with favourable initial clinical degrees were predominant. Aneurysmal SAH was prevalent and the frequency of angiographic vasospasm was 40%, in the majority of cases located in the middle cerebral arteries. Most of the patients had mean cerebral blood flow rates of or below 120 cm/s. The peaks of mean blood flow ratewere obtained between the fourth and the tenth day. Overall precision, sensitivity and the predictive negative value of TCD were good. Specificity was excellent for flow rates below 130 cm/s, and the predictive positive value was low. Conclusions. Monitoring with TCD proved to be useful for diagnosing cerebral vasospasm in patients with a good initial clinical status

[Hypernephroma associated motor neuron disease. Presentation of a case]. / Enfermedad de la motoneurona asociada a hipernefroma. Presentación de un caso.

INTRODUCTION: Paraneoplastic motor neuron disease are rare among patients with renal cell carcinoma. OBJECTIVE: Present the clinical and electrophysiological evolution of a patient with a motor neuron disease and hypernephrome. CASE REPORT: A 60 years old woman, affected only by high level pressure since 10 years ago. She noticed sudden palsy of the left leg and 10 months later an abdominal ultrasound showed a renal cell carcinoma, discovered without other symptoms than neurologic. After radical nephrectnomy, the patient was treated with recombinant interferon alpha 2b. The neurologic damage advanced and she has a flaccid weakness and muscle atrophy in the legs and brisk reflexes, also in wasted limbs. There is Babinski, fasciculations, light flaccid dysarthria and laryngospasm. Peripheral nerve conduction studies are within normal limits. The electromyogram show positive sharp waves in both legs and left hand. Recruitment patterns are decreased and there are fasciculations in the tongue, upper and lower limbs. The magnetic resonance of the brain and spinal cord is normal. There are not evidence of metastasis. The question of whether or not this is a paraneoplastic form of motor neuron disease remain unclear. CONCLUSION: This case suggest the need to consider a renal cell carcinoma in the course of a motor neuron disease.

[A comparative study of intravenous immunoglobulin and plasmapheresis preoperatively in myasthenia]. / Estudio comparativo entre inmunoglobulina intravenosa y plasmaféresis en el perioperatorio de la miastenia gravis.

INTRODUCTION: Thymectomy is a well established procedure in myasthenia gravis (MG). To reduce its morbidity, treatments which are effective in the short term, such as plasmapheresis and intravenous immunoglobulin (IGI) have been used. OBJECTIVE: To evaluate the efficacy and tolerability of the IGI, compared with plasmapheresis, in the preparation of myasthenic patients before thymectomy. PATIENTS AND METHODS: We compared a group of 33 prospective myasthenic patients treated with IGI with 38 clinical histories taken as controls treated by plasmapheresis during the peri operative period of thymectomy. RESULTS: The patients treated with IGI were in the intensive care unit and neurology ward for less time. The endotracheal tube was also removed sooner. However, these differences were not significant. The commonest complications of IGI were fever, shivering and phlebitis. The most frequent adverse reaction to plasmapheresis were cutaneous eruptions. One patient developed Hepatitis C after plasmapheresis. CONCLUSION: IGI is comparable in efficacy to plasmapheresis in the peri operative period of MG, but has a better profile of adverse reactions.

Asociación entre polineuropatíainflamatoria desmielinizantecrónica y diabetes mellitus.Presentación de un caso / Chronic demyelinizing polyneuropathy associated with diabetes mellitus. A case report

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Asociación entre neuropatía desmielinizante inflamatoria crónica de predominio en miembros superioresy pénfigo vulgar / Association between chronic inflammatory demyelinating neuropathy predominantly of the arms and penphigus vulgaris

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Estudio comparativo entre inmunoglobulina intravenosa y plasmaféresis en el perioperatorio de la miastenia gravis / A comparative study of intravenous immunoglobulin and plasmapheresis preoperatively in myasthenia

Introducción. La timectomía es un procedimiento establecido en la miastenia gravis (MG). Para reducir su morbilidad se han empleado tratamientos con efecto a corto plazo, como la plasmaféresis y la inmunoglobulina intravenosa (IgIV). Objetivo. Evaluar la eficacia y tolerancia de la IgIV, comparada con la plasmaféresis, en la preparación de pacientes miasténicos para la timectomía. Pacientes y métodos. Se compara un grupo de 33 pacientes miasténicos prospectivos tratados con IgIV con 38 controles históricos tratados con plasmaféresis, durante el perioperatorio de la timectomía. Resultados. Los pacientes tratados con IgIV estuvieron menos tiempo en la unidad de terapia intensiva y en la sala de neurología, así consiguieron una retirada más precoz del tubo endotraqueal; sin embargo, las diferencias encontradas no fueron significativas. Las complicaciones más frecuentes de la IgIV fueron fiebre, escalofríos y flebitis, mientras que las erupciones cutáneas constituyeron la reacción adversa más común de la plasmaféresis. Un paciente desarrolló hepatitis C secundaria a plasmaféresis. Conclusión. La IgIV es comparable en eficacia a la plasmaféresis en el perioperatorio de la MG, aunque tiene mejor perfil de reacciones adversas (AU)

Miastenia gravis familiar de comienzo tardío / Late onset familial myasthenia gravis

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