Transcranial Doppler ultrasound measurements of cerebral hemodynamic parameters in healthy volunteers at 2850 meters altitude. / Parámetros hemodinámicos cerebrales, determinados mediante Doppler transcraneal, en un grupo de voluntarios sanos a 2.850 metros de altura.

BACKGROUND: Transcranial Doppler ultrasound (TDU) is useful in cerebrovascular patients. TDU findings are operator-dependent; they can also be influenced by anatomical and physiological variables as well as by the altitude at which the study is done. OBJECTIVE: To report the cerebral hemodynamic parameters measured by TDU in subjects who live in Quito, Ecuador (altitude 2850 meters). MATERIAL AND METHODS: We recruited 47 volunteers with no history or clinical evidence of stroke, hypertension, metabolic disorders, or hematologic disorders; 2 patients were excluded because they did not have a viable cranial window for TDU study. Thus, we recorded mean cerebral blood flow velocity, peak systolic flow velocity, end-diastolic flow velocity, and pulsatility indices in 45 patients (28 (62.2%) women; mean age, 35.9 years). We recorded patients' age, sex, and hematocrit. We analyzed cerebrovascular hemodynamic parameters by sex and age group. RESULTS: No significant differences between hemispheres were observed in mean flow velocities, except in the anterior cerebral arteries with right predominance. Flow velocities were higher in women and in the youngest age group. No significant differences in the pulsatility indices were found between sexes or between age groups. The flow velocities in this series are lower than those reported for other series. CONCLUSIONS: The hemodynamic parameters in this series are lower than in other series and are influenced by the altitude, age, and sex.

[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)

[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.

[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 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

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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[Clinical course of post-laminectomy cervical spondylitic myelopathy]. / Curso clínico de la mielopatía espondilótica cervical poslaminectomía.

INTRODUCTION AND OBJECTIVE: To study the postsurgical clinical course of spondylitic myelopathy. PATIENTS AND METHODS: We assessed 39 patients admitted to the Departments of Neurology and Neurosurgery of the Hospital Clinico Quirúrgico Hermanos Ameijeiras, Cuba, with a confirmed diagnosis of spondylitic myelopathy who had decompressing laminectomies during the period between January 1996 and December 1997. RESULTS: Of the predicted variables, there was predominance of an age under 60 years (51.3%); male sex (71.8%); a history of cervical trauma and habitual dangerous physical activity in 38.5% and 41% respectively. The duration of preoperative symptoms was less than one year in 46.2%. The vertebral level most often involved was C5-C6 (97.4%). In 51.3% three levels were affected: 100% of the patients had stenosis in the zone of maximum compression; 28.2% had congenital stenosis of the canal and 66.7% had partial block shown on myelography or magnetic resonance studies of the cervical spine. There was clinical improvement in 78.4% after one month, in 91.9% after 3 months and in 94.6% after 6 months; only 2 patients had not improved on completion of the study. Motor and sensory function of the legs improved more than motor function of the arms and sphincter. CONCLUSIONS: The variables which influenced the degree of improvement were: age, duration of the symptoms, number of vertebral levels affected, presence of blockage and functional state. After application of the multiple regression model, it was seen that the duration of preoperative symptoms is an important predictor of the postoperative clinical course.

[Some hemorheological factors in patients with cerebrovascular ischemia]. / Algunos factores hemorreológicos en pacientes con enfermedad cerebrovascular isquémica.

INTRODUCTION AND OBJECTIVE: To study hemorheological factors in patients with ischemic cerebrovascular disease (not secondary to embolic cardiopathy). PATIENTS AND METHODS: We assessed 40 patients with an average age of 64.5 years; 26 had cerebral infarcts due to alterations in major blood vessels and 14 had lacunar infarcts. Forty persons with no cerebrovascular disease acted as controls. The hematological studies were done between three weeks and six months after the initial ictus. RESULTS: Blood viscosity and plasma fibrinogen concentrations were significantly higher in the patients than in the controls. However, hematocrit values were similar in all three groups studied. With regard to the hematocrit, fibrinogen levels and blood viscosity, no differences were seen between the group with damage to the great vessels and those with lacunar infarcts.