Accidente isquémico y ¿transitorio? Resonancia magnética en el AIT: experiencia de 106 casos / Ischaemic or transient attack? Magnetic resonance imaging in transient ischaemic attack: a review of 106 cases

Introducción: El accidente isquémico transitorio (AIT) clásicamente se ha definido como un episodio de déficit focal neurológico autolimitado con duración máxima de 24 horas, sin evidencia en la neuroimagen de lesión isquémica aguda establecida. Sin embargo, la definición de esta entidad está variando y se está adaptando a los nuevos tiempos y técnicas diagnósticas, incluida la resonancia magnética (RM) con secuencias en difusión. Es importante un abordaje íntegro y precoz del AIT, con RM cerebral, para descartar ictus isquémicos establecidos recuperados clínicamente, y así optimizar el manejo diagnóstico y terapéutico de los pacientes. Pacientes y métodos: Se identificó a los pacientes ingresados en un período de seis meses como sospecha de AIT en nuestra unidad de ictus, y se estudió el diagnóstico definitivo y su abordaje basándose en las pruebas realizadas. Resultados: Se estudiaron 106 sospechas de AIT en las que se realizó una RM precoz. De ellas, 43 (40,57%) fueron ictus isquémicos clínicamente recuperados (IICR); 31 (29,24%), otras patologías (nueve trastornos funcionales, seis crisis epilépticas, cinco auras migrañosas, dos amyloid spells y nueve otras causas); 26 (24,52%), AIT; y seis (5,66%), ictus hemorrágicos. De 43 IICR, ocho (18,6%) fueron cardioembólicos; ocho (18,6%), aterotrombóticos; ocho (18,6%), ictus embólico de origen desconocido; seis (13,95%), lacunares; cinco (11,62%) de causa infrecuente; cuatro (9,3%) microangiopáticos y cuatro (9,3%), de causa indeterminada. Los IICR recibieron un manejo terapéutico significativamente más individualizado respecto a los pacientes con AIT. Conclusiones: El uso de RM precoz en la sospecha clínica de AIT permite evidenciar la existencia de IICR y optimizar el abordaje diagnóstico y terapéutico de los pacientes.(AU)

Introduction: Transient ischaemic attack (TIA) has classically been defined as an episode of self-limited focal neurological deficit lasting up to 24 hours, with no neuroimaging evidence of established acute ischaemic injury. However, the definition of this entity is changing, and is adapting to new times and new diagnostic techniques, including magnetic resonance imaging (MRI) with diffusion sequences. An early and comprehensive approach to TIA, including MRI, is important to rule out clinically recovered established ischaemic strokes, in order to optimise the diagnostic and therapeutic management of patients. Patients and methods: Patients admitted to our stroke unit over a six-month period with suspected TIA were identified, and the definitive diagnosis and approach was studied based on the tests performed.Results: A sample of 106 suspected cases of TIA were studied, in which early MRI was performed. Of these, 42 (39.62%) were clinically recovered ischaemic strokes (CRIS); 32 (30.18%), other pathologies (six epileptic seizures, five migraine auras, nine functional disorders, two amyloid spells and nine other causes, totalling 31); 26 (24.52%), TIAs; and six (5.66%), haemorrhagic stroke. Of 43 CRIS, eight (18.6%) were cardioembolic; eight (18.6%), atherothrombotic; eight (18.6%), embolic stroke of unknown origin; six (13.95%), lacunar stroke; five (11.62%) of infrequent cause; and four (9.3%), totalling 39, of undetermined cause. CRIS patients received significantly more individualised therapeutic management than TIA patients. Conclusions: The early use of MRI in the clinical suspicion of TIA makes it possible to gather evidence of CRIS and optimises the diagnostic and therapeutic approach for patients.(AU)

[Ischaemic or transient attack? Magnetic resonance imaging in transient ischaemic attack: a review of 106 cases]. / Accidente isquémico y ¿transitorio? Resonancia magnética en el AIT: experiencia de 106 casos.

INTRODUCTION: Transient ischaemic attack (TIA) has classically been defined as an episode of self-limited focal neurological deficit lasting up to 24 hours, with no neuroimaging evidence of established acute ischaemic injury. However, the definition of this entity is changing, and is adapting to new times and new diagnostic techniques, including magnetic resonance imaging (MRI) with diffusion sequences. An early and comprehensive approach to TIA, including MRI, is important to rule out clinically recovered established ischaemic strokes, in order to optimise the diagnostic and therapeutic management of patients. PATIENTS AND METHODS: Patients admitted to our stroke unit over a six-month period with suspected TIA were identified, and the definitive diagnosis and approach was studied based on the tests performed. RESULTS: A sample of 106 suspected cases of TIA were studied, in which early MRI was performed. Of these, 42 (39.62%) were clinically recovered ischaemic strokes (CRIS); 32 (30.18%), other pathologies (six epileptic seizures, five migraine auras, nine functional disorders, two amyloid spells and nine other causes, totalling 31); 26 (24.52%), TIAs; and six (5.66%), haemorrhagic stroke. Of 43 CRIS, eight (18.6%) were cardioembolic; eight (18.6%), atherothrombotic; eight (18.6%), embolic stroke of unknown origin; six (13.95%), lacunar stroke; five (11.62%) of infrequent cause; and four (9.3%), totalling 39, of undetermined cause. CRIS patients received significantly more individualised therapeutic management than TIA patients. CONCLUSIONS: The early use of MRI in the clinical suspicion of TIA makes it possible to gather evidence of CRIS and optimises the diagnostic and therapeutic approach for patients.

TITLE: Accidente isquémico y ¿transitorio? Resonancia magnética en el AIT: experiencia de 106 casos.Introducción. El accidente isquémico transitorio (AIT) clásicamente se ha definido como un episodio de déficit focal neurológico autolimitado con duración máxima de 24 horas, sin evidencia en la neuroimagen de lesión isquémica aguda establecida. Sin embargo, la definición de esta entidad está variando y se está adaptando a los nuevos tiempos y técnicas diagnósticas, incluida la resonancia magnética (RM) con secuencias en difusión. Es importante un abordaje íntegro y precoz del AIT, con RM cerebral, para descartar ictus isquémicos establecidos recuperados clínicamente, y así optimizar el manejo diagnóstico y terapéutico de los pacientes. Pacientes y métodos. Se identificó a los pacientes ingresados en un período de seis meses como sospecha de AIT en nuestra unidad de ictus, y se estudió el diagnóstico definitivo y su abordaje basándose en las pruebas realizadas. Resultados. Se estudiaron 106 sospechas de AIT en las que se realizó una RM precoz. De ellas, 43 (40,57%) fueron ictus isquémicos clínicamente recuperados (IICR); 31 (29,24%), otras patologías (nueve trastornos funcionales, seis crisis epilépticas, cinco auras migrañosas, dos amyloid spells y nueve otras causas); 26 (24,52%), AIT; y seis (5,66%), ictus hemorrágicos. De 43 IICR, ocho (18,6%) fueron cardioembólicos; ocho (18,6%), aterotrombóticos; ocho (18,6%), ictus embólico de origen desconocido; seis (13,95%), lacunares; cinco (11,62%) de causa infrecuente; cuatro (9,3%) microangiopáticos y cuatro (9,3%), de causa indeterminada. Los IICR recibieron un manejo terapéutico significativamente más individualizado respecto a los pacientes con AIT. Conclusiones. El uso de RM precoz en la sospecha clínica de AIT permite evidenciar la existencia de IICR y optimizar el abordaje diagnóstico y terapéutico de los pacientes.

Evolución del síndrome de Lennox-Gastaut en la edad adulta / Development of Lennox-Gastaut syndrome in adulthood

Introducción. El síndrome de Lennox-Gastaut (SLG) es una encefalopatía epiléptica de inicio en la infancia con mecanismo fisiopatológico desconocido. Los estudios sobre la evolución del SLG demuestran un mal pronóstico. Pacientes y métodos. Estudio retrospectivo de 1.629 pacientes con epilepsia. Se incluyó a los pacientes con edad de inicio en la infancia, crisis tónicas y ausencias atípicas (los cuales podían sufrir además otros tipos de crisis); electroencefalograma (EEG) con punta-onda lenta generalizada y actividad rápida generalizada; retraso mental y tiempo de seguimiento de al menos 10 años. Resultados. Muestra de 12 pacientes, 9 de ellos varones. Tiempo de seguimiento: 20 años. Inicio de las crisis: 3 años. SLG criptogénico: 67%; sintomático: 33%. Frecuencia de las crisis al inicio: diaria (83,3%) o semanal (16,7%). Tipos de crisis: tónicas y ausencias atípicas (100%); drop-attacks (83%); tonicoclónicas generalizadas (75%); mioclonías (41,7%); parciales (8,3%) y pseudoepilépticas (8,3%). EEG con actividad de fondo lenta, punta-onda lenta generalizada y actividad rápida generalizada: 100%. El 50% de los pacientes tuvo al menos un estado epiléptico. Usaron una media de 7,5 antiepilépticos distintos. Al final del seguimiento sufrían crisis diarias el 33%; semanales, el 17%, y mensuales, el 42%. El 8,3% estaba libre de crisis. Todos seguían politerapia: el 17% biterapia y el 83% con un promedio de 3,8 fármacos (rango: 3-5). El 92% padecía un retraso mental grave o muy grave. El 50% precisó neurolépticos por trastorno del comportamiento. Conclusión. A pesar de que el pronóstico del SLG es grave, observamos una disminución en el número de crisis al cabo de unos años de evolución, si bien la politerapia antiepiléptica es una constante. El retraso mental y los trastornos del comportamiento provocan un pronóstico funcional malo (AU)

Introduction. Lennox-Gastaut syndrome (LGS) is an epileptic encephalopathy that starts in childhood and has an unknown pathophysiological mechanism. Studies on the progress of LGS reveal a poor prognosis. Patients and methods. A retrospective study of 1629 patients with epilepsy was conducted. Patients included in the study were those with an age of onset during childhood, tonic seizures and atypical absences (who might also suffer from other types of seizures); electroencephalogram (EEG) showing generalised slow spike-wave and generalised fast activity; mental retardation and a follow-up time of at least 10 years. Results. The sample consisted of 12 patients, 9 of whom were males. Follow-up time: 20 years. Onset of seizures: 3 years. Cryptogenic LGS: 67%; symptomatic: 33%. Frequency of the seizures at onset: daily (83.3%) or weekly (16.7%). Types of seizures: tonic and atypical absences (100%); drop-attacks (83%); generalised tonic-clonic (75%); myoclonias (41.7%); partial (8.3%) and pseudo-epileptic (8.3%). EEG with slow background activity, generalised slow spike-wave and generalised fast activity: 100%. Fifty percent of the patients had at least one epileptic status. They used an average of 7.5 different antiepileptic drugs. At the end of the follow-up 33% were suffering from seizures on a daily basis; 17% were weekly and 42% monthly. A total of 8.3% were free from seizures. All of them were following combination therapy: 17% in bitherapy and 83% with an average of 3.8 drugs (range: 3-5). A total of 92% suffered from severe or very severe mental retardation. Fifty percent required neuroleptic drugs due to behavioural disorders. Conclusions. Despite the fact that the diagnosis of LGS is serious, we observed a decrease in the number of seizures after several years of development, although the antiepileptic combination therapy remains constant. The mental retardation and behavioural disorders lead to a poor functional prognosis (AU)

[Development of Lennox-Gastaut syndrome in adulthood]. / Evolucion del sindrome de Lennox-Gastaut en la edad adulta.

INTRODUCTION: Lennox-Gastaut syndrome (LGS) is an epileptic encephalopathy that starts in childhood and has an unknown pathophysiological mechanism. Studies on the progress of LGS reveal a poor prognosis. PATIENTS AND METHODS: A retrospective study of 1629 patients with epilepsy was conducted. Patients included in the study were those with an age of onset during childhood, tonic seizures and atypical absences (who might also suffer from other types of seizures); electroencephalogram (EEG) showing generalised slow spike-wave and generalised fast activity; mental retardation and a follow-up time of at least 10 years. RESULTS: The sample consisted of 12 patients, 9 of whom were males. Follow-up time: 20 years. Onset of seizures: 3 years. Cryptogenic LGS: 67%; symptomatic: 33%. Frequency of the seizures at onset: daily (83.3%) or weekly (16.7%). Types of seizures: tonic and atypical absences (100%); drop-attacks (83%); generalised tonic-clonic (75%); myoclonias (41.7%); partial (8.3%) and pseudo-epileptic (8.3%). EEG with slow background activity, generalised slow spike-wave and generalised fast activity: 100%. Fifty percent of the patients had at least one epileptic status. They used an average of 7.5 different antiepileptic drugs. At the end of the follow-up 33% were suffering from seizures on a daily basis; 17% were weekly and 42% monthly. A total of 8.3% were free from seizures. All of them were following combination therapy: 17% in bitherapy and 83% with an average of 3.8 drugs (range: 3-5). A total of 92% suffered from severe or very severe mental retardation. Fifty percent required neuroleptic drugs due to behavioural disorders. CONCLUSIONS: Despite the fact that the diagnosis of LGS is serious, we observed a decrease in the number of seizures after several years of development, although the antiepileptic combination therapy remains constant. The mental retardation and behavioural disorders lead to a poor functional prognosis.

Estudio observacional intercontinental de los resultados de salud en pacientes ambulatorios con esquizofrenia (IC-SOHO): hallazgos iniciales de 6 meses de la muestra en Latinoamérica / The intercontinental schizophrenia outpatient health outcomes study (IC-SOHO): initial 6 month findings of the sample in Latin America

El estudio IC-SOHO se diseñó para aportar información sobre los tratamientos antipsicóticos en la práctica clínica real mediante la evaluación de una población de muestra grande y diversa con esquizofrenia. Este documento describe los hallazgos de los primeros 6 meses del IC-SOHO en Latinoamérica. A la fecha éste es el estudio observacional más grande de su tipo en esta región. En este estudio observacional y prospectivo se ingresaron aquellos pacientes ambulatorios con esquizofrenia que requirieron un cambio o un inicio de medicación antipsicótica. La efectividad se evaluó utilizando la escala de Calificación de Impresión Clínica Global-Gravedad (CGI-S). La tolerabilidad se evaluó mediante cuestionarios de efectos adversos y mediciones de peso. Se presentan aquí las comparaciones entre olanzapina (monoterapia), risperidona (monoterapia) y antipsicóticos convencionales (monoterapia y terapia combinada). En conjunto, participaron 7.658 pacientes en el IC-SOHO; n=2.671 provenientes de 11 países de Latinoamérica se incluyeron en este informe. A los 6 meses la proporción de pacientes que respondieron a la olanzapina fue significativamente mayor que los que respondieron a la risperidona o los antipsicóticos convencionales (p < 0,001). Los pacientes del grupo de olanzapina tuvieron mejorías mayores en todos los dominios de síntomas, incluyendo los síntomas generales, positivos, negativos, depresivos y cognoscitivos, en comparación con la risperidona (p<0,05) o los antipsicóticos convencionales (p<0,001). Los síntomas extrapiramidales (SEP) y la discinesia tardía (DT) disminuyeron desde la línea basal en los grupos tratados con olanzapina y risperidona, pero aumentaron en el grupo convencional. Los efectos adversos relacionados con la función sexual fueron más prominentes en el grupo convencional. Se observó ganancia de peso en cada grupo de tratamiento, aunque los pacientes del grupo de olanzapina aumentaron más de peso, seguidos por los de risperidona y después por los de antipsicóticos convencionales. Nuestros hallazgos en esta población de muestra latinoamericana emulan los resultados de otros estudios en muestras diferentes, donde se encontró que la olanzapina fue más efectiva y mejor tolerada que la risperidona o los antipsicóticos convencionales

The IC-SOHO study was designed to supply information on antipsychotic treatments in the real clinical practice by assessment of a large and diverse sample population with schizophrenia. This document describes the findings of the first 6 months of IC-SOHO in Latin America. To date, this is the largest observational study of its type in this region. In this observational and prospective study, those out-patients with schizophrenia, who require a change or initiation of antipsychotic medication are hospitalized. Effectiveness was evaluated using the Clinical Global Impression- Seriousness (CGI-S) grading scale. Tolerability was assessed by questionnaires on adverse events and weight measurements. Herein, the comparisons between olanzapine (monotherapy), risperidone (monotherapy) and conventional antipsychotics (monotherapy and combined therapy) are presented. As a whole, 7,658 patients participated in the ICSOHO; n=2,671 from 11 countries of Latin America that were included in this report. At 6 months, the proportion of patients who responded to olanzapine was significantly greater than those who responded to risperidone or conventional antipsychotics (p<0.001). Patients from the olanzapine group had greater improvements in all the symptom domains, including general, positive, negative, depressive and cognitive symptoms in comparison with risperidone (p<0.05) or conventional antipsychotics (p < 0.001). Extrapyramidal symptoms (EPS) and tardive dyskinesia (TD) decreased from baseline in the groups treated with olanzapine and risperidone, but increased in the conventional group. The adverse events related with the sexual function were more prominent in the conventional group. Weight gain was observed in each treatment group, although the patients from the olanzapine group had greater weight grain followed by those of risperidone and then by those of conventional antipsychotics. Our findings in this population of the Latin American sample emulate the results of other studies in different samples, where it was found that olanzapine was more effective and better tolerated than risperidone or conventional antipsychotics

[Memory loss: a reason for consultation]. / Pérdida de memoria como motivo de consulta.

INTRODUCTION: Memory loss is an increasingly frequent reason for consultation in neurology. The aim of this work is to know the current frequency as well as the characteristics and disorders of the patients who come for this reason. METHODS: We studied 200 patients who came to general neurology consultation due to loss of memory. RESULTS: 18.47% of the patients who came for the first time to a general neurology consultation did so due to memory loss, this being subjective loss of memory (SLM) in 39% of the cases and referred loss of memory (RLM) in 61% of the cases. The diagnostic groups to which the patients belonged are, in diminishing order, the following: degenerative primary dementia type Alzheimer's disease, mild cognitive impairment, mixed dementia, pure vascular dementia, depressive pseudodementia, attributable to drugs, secondary to systemic disease, non-Alzheimer's type disease primary degenerative dementia, structural reasons, transitory global amnesia and epilepsy. No disease was found in 13% of them, and the generally came due to SLM. CONCLUSIONS: Frequency of memory loss as a reason for consultation continues to growing. Patients studied due to memory loss, in whom no disease is found, are generally those having SLM. In spite of this, SLM is a good predictor of cognitive deterioration. It is important to systematically study of every patient and consults for loss of memory and to investigate the possible use of drugs or toxics that could alter the memory.

Pérdida de memoria como motivo de consulta / Memory loss: a reason for consultation

Introducción. La pérdida de memoria es motivo de consulta de frecuencia creciente en neurologia; el objetivo de este trabajo es conocer la frecuencia actual, asi como las características y patologías de los pacientes que acuden por este motivo. Métodos. Se estudian 200 pacientes que acuden a una consulta de neurología general por pérdida de memoria. Resultados. El 18,47 % de los pacientes que acuden por primera vez a una consulta de neurología general lo hacen por pérdida de memoria, siendo pérdida subjetiva de memoria (PSM) en el 39 % de los casos y pérdida referida de memoria (PRM) en el 61 %. Los grupos diagnósticos a los que pertenecen los pacientes son por orden decreciente los siguientes: demencia degenerativa primaria tipo enfermedad de Alzheimer, deterioro cognitivo leve, demencia mixta, demencia vascular pura, seudodemencia depresiva, demencia degenerativa primaria no tipo enfermedad de Alzheimer, atribuible a fármacos y tóxicos, secundaria a enfermedad sistémica, causas estructurales, amnesia global transitoria y epilepsia. En el 13 % de ellos no se encuentra ningún tipo de patología y suelen acudir por PSM. Conclusiones. La frecuencia de la pérdida de memoria como motivo de consulta continúa creciendo. Los pacientes estudiados por pérdida de memoria en los que no se encuentra patología suelen ser aquellos que presentan PSM, a pesar de lo cual la PSM es un buen predictor de deterioro cognitivo. Es importante realizar un abordaje sistematizado de todo paciente que consulte por pérdida de memoria e investigar el posible uso de fármacos o tóxicos que puedan alterar la memoria

Introduction. Memory loss is an increasingly frequent reason for consultation in neurology. The aim of this work is to know the current frequency as well as the characteristics and disorders of the patients who come for this reason. Methods. We studied 200 patients who carne to general neurology consultation due to loss of memory. Results. 18.47 % of the patients who carne for the first time to a general neurology consultation did so due to memory loss, this being subjective loss of memory (SLM) in 39 % of the cases and referred loss of memory (RLM) in 61 % of the cases. The diagnostic groups to which the patients belonged are, in diminishing order, the following: degenerative primary dementia type Alzheimer's disease, mild cognitive impairment, mixed dementia, pure vascular dementia, depressive pseudodementia, attributable to drugs, secondary to systemic disease, non-Alzheimer's type disease primary degenerative dementia, structural reasons, transitory global amnesia and epilepsy. No disease was found in 13 % of them, and the generally carne due to SLM. Conclusions. Frequency of memory loss as a reason for consultation continues to growing. Patients studied due to memory loss, in whom no disease is found, are gene rally those having SLM. In spite of this, SLM is a good predictor of cognitive deterioration. It is important to systematically study of every patient and consults for loss of memory and to investigate the possible use of drugs or toxics that could alter the memory

[The chronopathology of prion encephalopathies]. / Cronopatología de las encefalopatías priónicas.

INTRODUCTION: Prion encephalopathies are a group of diseases with a hereditary or acquired origin which, after a long asymptomatic period, give rise to rapidly progressing neurological disorders. This progression can only be explained by an exponential growth of the pathogenic protein load, which allows to keep the load in low levels for many years and then to grow swiftly in a few months. DEVELOPMENT: Bearing in mind the knowledge currently available about the pathogenesis of prion diseases and patients' clinical progression, it becomes possible to distinguish several different periods of progression, the length of which can be estimated for each disease by reviewing the series of cases published to date. In general, the infectious prion diseases have a shorter period of latency than the hereditary ones and those caused by insertion of genetic material are associated to shorter latencies and to longer periods of illness than those caused by sporadic mutations. CONCLUSIONS: The rate of growth of the prion load depends essentially on how fast the pathogenic prion protein replicates; nevertheless, this growth is also modulated by other factors, many of which are polymorphisms in certain positions on the gene coding for prion protein or in other genes.