ABSTRACT
Cerebrospinal fluid diversion has become the mainstay treatment in hydrocephalus for over 50 years. As the number of patients with ventricular shunt systems increases, neurointensivists are becoming the first-line physicians for many of these patients. When symptoms of a shunt malfunction are suspected and access to a neurosurgeon is limited or delayed, workup and temporizing measures must be initiated. The article highlights the functional nuances, complications, and management of current programmable shunt valves and their MRI sensitivity.
Subject(s)
Cerebrospinal Fluid Shunts/adverse effects , Cerebrospinal Fluid Shunts/instrumentation , Critical Care/methods , Equipment Failure , Hydrocephalus/surgery , Neurology/methods , Postoperative Complications/therapy , HumansABSTRACT
OBJECTIVE: To develop a model that assists in the classification of patients with vascular dementia in two of its most relevant subtypes: multi-infarct dementia (cortical involvement) and Binswanger's disease (subcortical involvement). PATIENTS AND METHODS: Retrospective analysis of 50 consecutive patients with Binswanger's disease and 50 patients with multi-infarct dementia studied throughout a 12-year period (1986-1998) in a tertiary university hospital. The statistical model was obtained by multivariant analysis (logit model) and its accuracy was estimated by means of ROC curve analysis. RESULTS: The variables included in the regression model were: arterial hypertension (p < 0.03), cardioembolic disease (p < 0.05), and presence of cortical (p < 0.01) and lacunar (p < 0.01) infarctions in CAT. The specificity of the model was 90%, the sensitivity near 60%, and the positive likelihood ratio 5.8. The area under the ROC curve was 0.80 (0.73-0.87). CONCLUSIONS: Despite the availability of consensus diagnostic criteria for vascular dementia, their use is very commonly restricted to the research field. We have developed a classification model for patients with vascular dementia in two relevant subgroups: multi-infarct dementia and Binswanger's disease. This model can contribute to make identification of these patients in the daily clinical practice easier.
Subject(s)
Dementia, Multi-Infarct/diagnosis , Dementia, Vascular/diagnosis , Diagnosis, Differential , Humans , Models, Statistical , Retrospective StudiesABSTRACT
Objetivo. Desarrollar un modelo que facilite la clasificación de los pacientes con demencia vascular en dos de sus subtipos más relevantes: demencia multiinfarto (afectación cortical) y enfermedad de Binswanger (afectación subcortical). Pacientes y métodos. Análisis retrospectivo de 50 pacientes consecutivos con enfermedad de Binswanger y 50 enfermos con demencia multiinfarto estudiados durante un período de doce años (1986-1998) en un hospital universitario de tercer nivel. El modelo estadístico se obtuvo mediante análisis multivariable (modelo logit) y se estimó su exactitud mediante análisis de curvas ROC. Resultados. Las variables que integraron el modelo de regresión fueron: hipertensión arterial (p < 0,03), enfermedad cardioembólica (p < 0,05) y presencia de infartos corticales (p < 0,01) y lacunares (p < 0,01) en la tomografía axial computarizada (TAC). La especificidad del modelo fue del 90 por ciento, la sensibilidad de cerca del 60 por ciento y la razón de verosimilitud positiva de 5,8. El área bajo la curva ROC fue de 0,80 (0,73-0,87).Conclusiones. A pesar de existir unos criterios diagnósticos de consenso de demencia vascular, su utilización muchas veces está circunscrita al área de investigación. Hemos desarrollado un modelo de clasificación de los pacientes con demencia vascular en dos subgrupos relevantes: demencia multiinfarto y enfermedad de Binswanger. Este modelo puede contribuir a facilitar la identificación de estos pacientes en la práctica clínica diaria (AU)
Subject(s)
Humans , Dementia, Vascular , Models, Statistical , Dementia, Multi-Infarct , Retrospective Studies , Diagnosis, DifferentialABSTRACT
OBJECTIVE: Although an increasing quantity of information concerning risk factors for stroke have been developed lately, the relationship between alcohol consumption and cerebral ischemic infarction, unlike at coronary sites, remains unclear. This review highlights the main pathogenic mechanisms of alcohol in the development of ischemic stroke, as it intends to be an update of this possible association. DEVELOPMENT: A critical literature review has been performed regarding this association to study its pathogenic mechanisms and the possible confounding factors present in the current design of epidemiological reports. CONCLUSIONS: There is an increasing evidence about the effect of light to moderate alcohol consumption and prevention of ischemic stroke. On the other hand it seems that heavy drinking, and particularly binge drinkers, are exposed to a higher risk for cardioembolic stroke. The growing incidence of acute heavy alcohol consumption highlights the necessity of considering a cardioembolic source when managing ischemic stroke, specially in young adults.
Subject(s)
Alcoholism/epidemiology , Stroke/epidemiology , Age Factors , Alcoholism/ethnology , Brain Injuries/epidemiology , Ethnicity , Female , Humans , Hyperhomocysteinemia/epidemiology , Hypertension/epidemiology , Hypertension/ethnology , Male , Sex Factors , Sleep Apnea Syndromes/epidemiology , Stroke/ethnology , Ventricular Fibrillation/epidemiologyABSTRACT
OBJECTIVE: This document intends to review the main features of Binswanger's disease and its differential diagnosis with other vascular pathologies of the white matter. DEVELOPMENT: Nowadays, the raise of the elderly group of population has led to a remarkable increase in dementia's prevalence, therefore it becomes necessary to study deeply vascular dementias, the second most common kind of dementia behind Alzheimer's disease. The detection of Binswanger's disease has increased due to the progress of neuroimaging techniques, that allow to identify ischemic lesions situated in the cerebral white matter and the existence of multiple lacunar infarcts. This clinical entity represents the most frequent type of subcortical dementia, although controversy still remains about its pathogeny, ethiology, and nosologic limits. CONCLUSIONS: The search for unified criteria is the first step in the microangiopathic subcortical dementia's field to achieve valuable treatment strategies.
Subject(s)
Dementia, Vascular/diagnosis , Aged , Cognition Disorders/diagnosis , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Risk FactorsABSTRACT
Introducción. El presente trabajo pretende ser una somera revisión de las principales características de la enfermedad de Binswanger, de su diagnóstico diferencial con diversos procesos vasculares que cursan con daño de la sustancia blanca y de sus posibles mecanismos patogénicos. Desarrollo. En una época como la actual, en la que el envejecimiento de la población ha provocado un incremento importante en la prevalencia de las demencias, resulta necesario profundizar en el estudio de las demencias vasculares, grupo que constituye la segunda causa de deterioro mental tras la enfermedad de Alzheimer y que ofrece un posible tratamiento preventivo. Dentro de este grupo se sitúa la llamada enfermedad de Binswanger o demencia vascular microangiopática tipo Binswanger, proceso cuya detección ha aumentado progresivamente con la constante mejora de los métodos de diagnóstico radiológico, que permiten identificar perfectamente el daño isquémico de la sustancia blanca hemisférica cerebral y la presencia de pequeños y múltiples infartos lacunares. Este cuadro de evolución fluctuante e inexorablemente progresiva representa la demencia vascular de tipo subcortical más frecuente pero, a pesar de ello, en la actualidad todavía existen controversias acerca de su patogenia, su etiología y sus límites nosológicos. Conclusiones. El espectro etiológico de las demencias microangiopáticas subcorticales es amplio, y todavía existe una importante confusión respecto a su terminología y definición conceptual; la clarificación y unificación de criterios es el primer paso necesario para intentar un tratamiento que pueda resultar eficaz (AU)
