RESUMEN
Over the last 10 years, we have witnessed the introduction of different procedures for coordinating clinical care, often shown as new tools in the hospital administration setting. Clinical or critical pathways are among these standardization methods of health care. In this article, we describe the characteristics of the clinical pathways and review their potential uses in neurology, especially in common conditions like stroke. In the following, we describe a clinical pathway for treating acute episodes in patients with relapsing-remitting of secondarily progressive forms of multiple sclerosis which was developed in the Son Dureta Hospital, in Palma de Mallorca, Spain. We carry out a critical assessment of this and other standardization methods.
Asunto(s)
Vías Clínicas , Manejo de la Enfermedad , Neurología , Vías Clínicas/estadística & datos numéricos , Humanos , Esclerosis Múltiple Recurrente-Remitente/terapia , Estándares de Referencia , Accidente Cerebrovascular/terapia , Encuestas y CuestionariosRESUMEN
En los últimos años hemos asistido a la introducción de diferentes sistemas de estandarización en la práctica clínica hospitalaria, presentados como herramientas de ayuda propias de la nueva metodología de gestión de los hospitales públicos como entidades empresariales. Entre estos sistemas de estandarización de la actividad asistencial se encuentran las vías clínicas. En el presente artículo se lleva a cabo una descripción de las vías y se revisan sus posibles aplicaciones en el ámbito de la neurología, con mayor detalle en aquellos procesos más relevantes, como es el caso del ictus. A continuación, se presenta una vía clínica desarrollada en el Hospital Son Dureta de Palma de Mallorca para el tratamiento de los brotes agudos en pacientes con formas remitentes-recidivantes o secundariamente progresivas de esclerosis múltiple. Efectuamos una evaluación crítica de este y otros sistemas de estandarización (AU)
Asunto(s)
Humanos , Neurología , Vías Clínicas , Manejo de la Enfermedad , Vías Clínicas , Accidente Cerebrovascular , Esclerosis Múltiple Recurrente-Remitente , Encuestas y Cuestionarios , Estándares de Referencia , Accidente CerebrovascularRESUMEN
The incidence of permanent visual loss in Benign Intracranial Hypertension (BIH) was assessed. 17 out of 100 patients with BIH had permanent visual loss which was severe in only three cases. We tried to identify the risk factors in this group of patients. Statistical analysis showed that the following factors were related with a bad visual outcome: atrophy of the disc, visual loss and field defects (other than enlargement of the blind stop) present at the first exam; delay of treatment; BIH in patients older than 40 years and, overall, presence of systemic hypertension. The identification of this risk factors may help in planning the treatment of the disorder.
Asunto(s)
Ceguera/etiología , Seudotumor Cerebral/complicaciones , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pronóstico , Factores de RiesgoRESUMEN
A 57-year-old patient nonimmunosuppressed who had zoster ophthalmicus associated to contralateral hemiplegia is presented. We noticed on the CT scan an infarction of left caudate nucleus, as well as in the angiography signs of vasculitis. We comment on the clinical and diagnosis features and suggest possible benefit effects of the treatment with acyclovir.
Asunto(s)
Hemiplejía/etiología , Herpes Zóster Oftálmico/complicaciones , Aciclovir/uso terapéutico , Encéfalo/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/etiología , Hemiplejía/diagnóstico por imagen , Herpes Zóster Oftálmico/diagnóstico por imagen , Herpes Zóster Oftálmico/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
The concepts of serous meningitis, pseudotumour cerebri, hypertensive meningeal state and otitic hydrocephalus have not been considered historically as synonyms nor can they be superimposed on what is currently known as Benign Intracranial Hypertension (BIH). BIH is a syndrome of intracranial hypertension with no clinical, radiological or analytical evidence for the existence of focal or general neurological lesions or hydrocephalus, and which has a self-limiting "benign" development. At present, the diagnostic criteria usually accepted are: 1. Symptoms and signs of intracranial hypertension. 2. Absence of focal neurological symptoms and signs. 3. Absence of radiologically verified cerebral lesion. 4. C.S.F. of normal composition and high pressure. The requirement of other criteria for the diagnosis of BIH, such as angiography, to eliminate the possibility of thrombosis of venous sinuses, or continuous monitoring of C.S.F. pressure, is controversial.
Asunto(s)
Seudotumor Cerebral , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Seudotumor Cerebral/líquido cefalorraquídeo , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/diagnóstico por imagen , Seudotumor Cerebral/etiología , Seudotumor Cerebral/historia , Radiografía , Efusión SubduralRESUMEN
Chronic intracranial hypertension in the presence of hydrocephalus and/or arachnoiditis is a rare presentation of neurobrucellosis. The present case is exceptional because neither hydrocephalus nor arachnoiditis were present. Brucellosis was diagnosed by serological tests. The patient developed asthenia, anorexia, weight loss, violent headaches, explosive vomiting, bilateral papilloedema, diplopia with paralysis of the abducens nerves, left supranuclear facial paralysis and left hemiparesis. A skull radiograph showed destruction of the sella turcica. Rapid recovery was attained with the use of antibiotics. The pathogenesis of this intracranial hypertension syndrome with destruction of sella turcica is discussed.
