Unidades de cefalea en el ámbito de la neurología / Headache units in the field of neurology

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Encefalopatía posterior reversible: más allá de la descripción original / Posterior reversible encephalopathy: beyond the original description

Introducción. La encefalopatía posterior reversible (EPR) es una entidad clinicorradiológica caracterizada típicamente por cuadros de cefalea, alteraciones visuales y crisis epilépticas, asociada a edema vasógeno corticosubcortical reversible en la neuroimagen. Objetivo. Presentar una revisión de los aspectos fisiopatológicos de esta entidad y también de las asociaciones de la EPR descritas en la bibliografía. Desarrollo. Existe una serie de factores desencadenantes bien conocidos, como las crisis hipertensivas, la eclampsia o ciertos medicamentos. La descripción de cada vez más casos atípicos desde un punto de vista clínico y radiológico, así como de posibles nuevos factores desencadenantes, obliga a una redefinición de la entidad. Conclusiones. La EPR es un conjunto de manifestaciones clínicas y radiológicas que no se pueden enmarcar dentro la palabra ‘síndrome’. Aunque la EPR se ha comunicado como irreversible en ciertos casos, el concepto de reversibilidad debemantenerse en la definición de esta entidad, ya que, en la mayor parte de los casos, el rápido control de la condición desencadenante de la EPR permite la reversibilidad de las lesiones (AU)

Introduction. Posterior reversible encephalopathy (PRE) is a clinical and radiological entity that is typically characterized by headache, visual disturbances and seizures associated with cortical and subcortical reversible vasogenic edema in neuroimaging. Aim. To present a review of the pathophysiology of this entity, and also the associations of the PRE described in the literature. Development. Given its clinical presentation, often nonspecific and variable, magnetic resonance imaging is essential for diagnosis. There are a number of well-known triggers, such as hypertensive crisis, eclampsia or certain drugs. The description of increasingly atypical cases from clinical and radiological point of view, and possible new triggers, requires a redefinition of this entity. Conclusions. The PRE is a set of clinical and radiological manifestations that may not be framed within the word ‘syndrome’. lthough, the PRE has been reported in some cases irreversible, reversibility concept should be maintained in the definition of this entity, since in most cases the rapid control of the triggering condition allows reversibility of the lesions (AU)

Pericapillary arteriovenous malformations angiographically manifested as cerebral venous malformations.

Cerebral venous malformations have been diagnosed by angiographic features and are considered to be a benign anomaly. However, ample evidence indicates that stroke or similar symptomatology occurs in patients harboring a cerebral vascular malformation that was diagnosed angiographically as a venous malformation. The purpose of the study is to confirm the presence of a pericapillary arteriovenous malformation in these patients by analyzing the clinical history and surgical findings and correlating them with histological features. Thirteen patients were included in this study. Each patient fulfilled four criteria: 1. the patient was neurologically symptomatic; 2. the angiographic diagnosis was a venous malformation; 3. at operation, shunting arterioles (50-100 microns) were found to contribute to the malformation; and 4. histologically, a mixture of venous channels and arterioles with arterioles directly connected to venules was found. Based on the above findings, the malformation present in the 13 patients can be termed a 'pericapillary arteriovenous malformation'. Its angiographic distinction from the cerebral venous malformation requires technological advancement in the capability of magnifying images of arterioles and venules, along with improvement in image resolution.