[The contribution made by neurophysiological and ultrasound imaging studies to the diagnosis of carpal tunnel syndrome. Surgical correlation]. / Aportación de los estudios neurofisiológico y ecográfico al diagnóstico del síndrome del túnel carpiano. Correlación quirúrgica.

INTRODUCTION: Electrophysiological study has been for long time the elected approach for the diagnosis and clinical evaluation of carpal tunnel syndrome (CTS). More recently, echography and other imaging techniques have been introduced in current medicine for their potential in the anatomical evaluation of the neural compression. To asses the usefulness of both diagnostic procedures we have compared the findings obtained by electrophysiological and echographic approaches in a group of 60 CTS patients with different degrees of the disease. PATIENTS AND METHODS: In all patients the conduction velocity was evaluated in the median and cubital nerves using surface electrodes. For echography lineal transductors of 5-10 Hz and 5-12.5 MHz were employed. RESULTS: The patients were distributed for each test on a scale depending of the severity of the alterations detected by the corresponding technique and both files were subsequently compared by regression analysis, Pearson test and paired-test. No correlation was detected in any of the statistical test. CONCLUSIONS: The lack of correlation between the results of both proofs emphasizes the usefulness of the two diagnostic approaches in CTS. While electrophysiological study provides information about nerve function, ecography unravels the morphological alterations accounting for the syndrome, therefore being non-excluding complementary approaches.

Aportación de los estudios neurofisiológico y ecográfico al diagnóstico del síndrome del túnel carpiano. Correlación quirúrgica / The contribution made by neurophysiological and ultrasound imaging studies to the diagnosis of carpal tunnel syndrome. Surgical correlation

Introducción. El estudio neurofisiológico (ENF) como técnica de elección para el diagnóstico del síndrome del túnel carpiano (STC) ha demostrado repetidamente su utilidad y eficacia. Más recientemente se han incorporado técnicas de imagen como la ecografía (ECO), que aporta valiosos datos en cuanto a la morfología normal del nervio mediano en el canal carpiano y sus cambios patológicos. Nuestro objetivo ha sido comparar los resultados de ambos estudios, ENF y ECO, en un número reducido de pacientes de nuestra casuística con el fin de comprobar su diferente utilidad en el diagnóstico del síndrome. Pacientes y métodos. 60 pacientes diagnosticados de STC, en los que se estudió la conducción nerviosa de ambos nervios medianos y cubital mediante electrodos de superficie, así como estudio ecográfico de ambas muñecas mediante transductores lineales 5-10 Hz y 5-12,5 MHz. Resultados. Según el grado de afectación se utilizaron escalas de gravedad para ambas pruebas y los resultados se compararon estadísticamente mediante análisis de regresión, test de Pearson y test t pareado, que demostraron una ausencia de correlación entre ambas pruebas. Conclusión. La falta de correlación evidenciada entre ambas pruebas en los diferentes estudios estadísticos utilizados indica que ambas son herramientas útiles en el diagnóstico de STC. Los datos neurofisiológicos aportan información acerca de la funcionalidad del nervio y la ECO, por su parte, informa de sus alteraciones morfológicas en condiciones patológicas y las posibles lesiones o variantes anatómicas causantes del síndrome, por lo que consideramos que ambas pruebas no son excluyentes, sino complementarias

Introduction. Electrophysiological study has been for long time the elected approach for the diagnosis and clinical evaluation of carpal tunnel syndrome (CTS). More recently, echography and other imaging techniques have been introduced in current medicine for their potential in the anatomical evaluation of the neural compression. To asses the usefulness of both diagnostic procedures we have compared the findings obtained by electrophysiological and echographic approaches in a group of 60 CTS patients with different degrees of the disease. Patients and methods. In all patients the conduction velocity was evaluated in the median and cubital nerves using surface electrodes. For echography lineal transductors of 5-10 Hz and 5-12.5 MHz were employed. Results. The patients were distributed for each test on a scale depending of the severity of the alterations detected by the corresponding technique and both files were subsequently compared by regression analysis, Pearson test and paired-test. No correlation was detected in any of the statistical test. Conclusions. The lack of correlation between the results of both proofs emphasizes the usefulness of the two diagnostic approaches in CTS. While electrophysiological study provides information about nerve function, ecography unravels the morphological alterations accounting for the syndrome, therefore being non-excluding complementary approaches

[Non-convulsive status epilepticus]. / Estado epiléptico no convulsivo.

DEVELOPMENT: Non-convulsive status epilepticus (NCSE) is an epileptic condition lasting more than 30 minutes in which continuous or recurrent seizure activity on the electroencephalogram (EEG) is responsible for diverse clinical symptoms including alteration of mental state, abnormal behaviour, perception disturbances or consciousness impairment. Most authors recognize two types of NCSE depending on the ictal electroencephalographic changes: generalized (absence status epilepticus) and complex partial status epilepticus (CPSE). In addition, there is also a simple form of partial status which is likely underdiagnosed because of its frequent progression to CPSE, subtle and varied symptomatology and high proportion of normal electroencephalograms (EEG). Absence status epilepticus (ASE) may occur in different clinical situations including idiopathic generalized epilepsy (typical AS), symptomatic generalized epilepsy (atypical AS), and elderly subjects without antecedents of epilepsy on chronic treatment with psychotropic drugs (de novo AS of late onset). Furthermore, CPSE is more frequent than previously mentioned. Although initially was equated with temporal lobe status epilepticus, extratemporal cases of CPSE have been well-documented, and the electroclinical characteristics of two types (I and II) of frontal CPSE have been recently described. NCSE may occur in patients with diverse clinical diagnosis such as hypoxic-anoxic encephalopathy, cancer, drugs, autoimmune disorders, Creutzfeldt-Jakob disease, chromosomal alterations, peritoneal dialysis, infections, cerebral hamartomas or head trauma. CONCLUSION: The identification of NCSE may be particularly arduous and, therefore, a high level of suspicion is essential to obtain an early diagnosis. An urgent EEG with administration of intravenous benzodiazepines is considered as the method of choice in the diagnostic evaluation of NCSE.

Estado epiléptico no convulsivo / Non-convulsive status epilepticus

Objetivo. En este artículo se revisan aspectos generales relacionados con el estado epiléptico no convulsivo (EENC) y las dificultades prácticas y consideraciones clínicas y electrofisiológicas que fundamentan su diagnóstico. Desarrollo. El EENC es una condición epiléptica, de una duración superior a 30 minutos, en la cual existe actividad epileptiforme continua o recurrente en el electroencefalograma (EEG), que es responsable de síntomas clínicos diversos, como alteración del estado mental, comportamiento, afectividad, percepción sensorial o conciencia. La mayoría de los autores reconocen dos tipos de EENC, según los cambios electroencefalográficos ictales: generalizado -estado epiléptico de ausencia (EEA)- y estado epiléptico parcial complejo (EEPC). Además, existe una forma de estado epiléptico parcial simple (EEPS) que probablemente se infradiagnostica debido a la diversidad y sutileza de sus síntomas, su frecuente progresión hacia un EEPC y la elevada proporción de EEG normales.El EEA puede darse en diversas situaciones clínicas, incluida la epilepsia generalizada idiopática (EEA típico), la epilepsia generalizada sintomática (EEA atípico), y en ancianos sin antecedentes de epilepsia en tratamiento crónico con psicotrópicos (EEA de novo de presentación tardía). El EEPC es más frecuente que lo considerado previamente. Aunque inicialmente se equiparó a estado epiléptico del lóbulo temporal, se han documentado casos de EEPC extratemporal, y recientemente se han descrito las características clínicas de dos tipos (I y II) de EEPC frontal. El EENC puede presentarse en pacientes con diagnósticos clínicos diversos, como encefalopatía hipoxicoanóxica, cáncer, fármacos, trastornos autoinmunes, enfermedad de Creutzfeldt-Jakob, alteraciones cromosómicas, diálisis peritoneal, infecciones, hamartomas cerebrales o traumatismo craneal. Conclusiones. La identificación del EENC puede ser particularmente difícil; por ello, es esencial un alto nivel de sospecha para obtener un diagnóstico precoz. Un EEG urgente con administración de benzodiacepinas endovenosas se considera el método de elección en la evaluación diagnóstica del EENC (AU)

Development. Non-convulsive status epilepticus (NCSE) is an epileptic condition lasting more than 30 minutes in which continuous or recurrent seizure activity on the electroencephalogram (EEG) is responsible for diverse clinical symptoms including alteration of mental state, abnormal behaviour, perception disturbances or consciousness impairment. Most authors recognize two types of NCSE depending on the ictal electroencephalographic changes: generalized (absence status epilepticus) and complex partial status epilepticus (CPSE). In addition, there is also a simple form of partial status which is likely underdiagnosed because of its frequent progression to CPSE, subtle and varied symptomatology and high proportion of normal electroencephalograms (EEG). Absence status epilepticus (ASE) may occur in different clinical situations including idiopathic generalized epilepsy (typical AS), symptomatic generalized epilepsy (atypical AS), and elderly subjects without antecedents of epilepsy on chronic treatment with psychotropic drugs (de novo AS of late onset). Furthermore, CPSE is more frequent than previously mentioned. Although initially was equated with temporal lobe status epilepticus, extratemporal cases of CPSE have been well-documented, and the electroclinical characteristics of two types (I and II) of frontal CPSE have been recently described. NCSE may occur in patients with diverse clinical diagnosis such as hypoxic-anoxic encephalopathy, cancer, drugs, autoimmune disorders, Creutzfeldt-Jakob disease, chromosomal alterations, peritoneal dialysis, infections, cerebral hamartomas or head trauma. Conclusion. The identification of NCSE may be particularly arduous and, therefore, a high level of suspicion is essential to obtain an early diagnosis. An urgent EEG with administration of intravenous benzodiazepines is considered as the method of choice in the diagnostic evaluation of NCSE (AU)