Hematoma cerebral agudo en la evolución de una encefalitis por virus herpes simple tipo 1. Una complicación infrecuente / Acute cerebral haematoma in the course of herpes simplex 1 encephalitis. A rare complication

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Tratamiento endovascular de estenosis intracraneales sintomáticas: resultados a corto y largo plazo de un único centro / Endovascular treatment of symptomatic intracranial stenoses: short- and long-term results in a single center

Objetivos. Presentamos los resultados a corto y largo plazo de una serie de pacientes con estenosis arteriales intracraneales (EAIC) sintomáticas tratados en nuestro centro mediante angioplastia y endoprótesis. Material y métodos. Revisión de pacientes con estenosis intracraneales > 50% sintomáticas tratados en nuestro centro mediante angioplastia y/o colocación de endoprótesis. Se recogieron los datos demográficos y los factores de riesgo vascular (hipertensión, diabetes, dislipemia, cardiopatía isquémica). Todas las lesiones tratadas se caracterizaron por su localización, grado y longitud de la estenosis. El grado de estenosis se calificó como moderado (50-70%) o grave (> 70%). En el seguimiento se evaluaron los accidentes cerebrovasculares, episodios de cardiopatía isquémica o fallecimientos ocurridos durante los 30 primeros días y en el seguimiento posterior. Resultados. Entre 2006 y 2010 se trataron 26 pacientes (21 varones y 5 mujeres) con edades comprendidas entre 44 y 79 años (media: 63 años), con 29 lesiones intracraneales. El procedimiento endovascular se realizó con éxito (angioplastia + endoprótesis) en 23 casos (92,0%). En los 30 primeros días postintervención se produjeron tres (11,5%) efectos adversos de origen vascular: un ictus, una hemorragia y un fallecimiento por trombosis de la endoprótesis. El seguimiento a largo plazo se ha realizado sobre 25 pacientes (5-46 meses). No se han detectado recurrencias de la sintomatología. Conclusión. El tratamiento endovascular de las EAIC es técnicamente factible. Las complicaciones del procedimiento a corto plazo tienen una prevalencia alta. No se ha detectado recurrencia de la sintomatología a largo plazo(AU)

Objectives. We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting. Material and methods. We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up. Results. Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty + stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms. Conclusion. Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up(AU)

[Endovascular treatment of symptomatic intracranial stenoses: short- and long-term results in a single center]. / Tratamiento endovascular de estenosis intracraneales sintomáticas: resultados a corto y largo plazo de un único centro.

OBJECTIVES: We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting. MATERIAL AND METHODS: We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up. RESULTS: Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty+stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms. CONCLUSION: Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up.

[Horner syndrome as a manifestation of carotid artery dissection]. / Síndrome de Horner como manifestación de disección carotídea.

CLINICAL CASE: A 42-year-old man presented with ptosis and miosis in his left eye and a history of headache over the last 20 days. An angioresonance showed dissection of internal carotid artery. DISCUSSION: "Painful Horner's Syndrome" is considered to be a medical emergency due possible onset of an internal carotid artery dissection. We consider that awareness of neuro-ophthalmologic emergencies is very important in the clinical praxis of an ophthalmologist. Multidisciplinary treatment and follow-up of these patients is required.

Evolución a largo plazo de la estenosis carotídea tratada endovascularmente: estudio prospectivo en una unidad neurovascular / Long-term development of carotid stenosis treated by endovascular means: a prospective study in a neurovascular unit

Objetivo. Aun hoy, a diferencia de la endarterectomía, la evolución a largo plazo en la angioplastia carotídea no está bien definida. El objetivo es describir la evolución a corto y largo plazo y la tasa de reestenosis de una serie consecutiva de pacientes con estenosis de carótida sometidos a tratamiento endovascular en el Hospital Universitario La Fe, diferenciando entre pacientes con y sin síntomas. Pacientes y métodos. Desde 1999 hasta 2010 se incluyeron 426 pacientes a los que se les realizó angioplastia carotídea (el 25,5% eran pacientes asintomáticos). Se llevó a cabo seguimiento clínico a 374 pacientes. Fueron visitados anualmente, y cada año se les realizó estudio neurosonológico. Se recogieron las complicaciones durante los 30 primeros días y las complicaciones a largo plazo; se recogió la tasa de reestenosis en el seguimiento y se valoraron las posibles diferencias entre pacientes con y sin síntomas. Resultados. La morbimortalidad en el primer mes fue del 4,2% (4,4% en pacientes sintomáticos y 3,8% en pacientes asintomáticos). El seguimiento medio fue de 55 meses: un 8% de pacientes presentó ictus, un 11% sufrió un infarto de miocardio y un 24,3% falleció, sin diferencias significativas entre los pacientes con y sin síntomas. La tasa de reestenosis fue del 17,3% a los cinco años, un 7,5% igual o superior al 50%, y de ellas, en el 1,1% fueron sintomáticas. Cinco pacientes con reestenosis significativa fueron tratados con éxito con técnicas endovasculares. Conclusiones. La angioplastia carotídea es una técnica efectiva y segura en manos experimentadas; nuestros resultados son buenos, tanto a corto como a largo plazo, con una baja tasa de reestenosis. En caso de producirse esta última, el intervencionismo vascular es seguro y eficaz (AU)

Aims. Even today, unlike endarterectomy, long-term development in carotid angioplasty has still not been well defined. The aim of this study is to describe both the short- and long-term development and the rate of restenosis in a consecutive series of patients with carotid stenosis who underwent endovascular treatment at the Hospital Universitario La Fe; a distinction is made between patients with and without symptoms. Patients and methods. From 1999 to 2010, 426 patients were submitted to a carotid angioplasty (25.5% were asymptomatic patients). Clinical follow-ups were conducted in the case of 374 patients. They had annual check-ups and every year a neurosonological study was performed. The aim was to determine what complications occurred during the first 30 days, as well as the long-term complications, to establish the rate of restenosis and to evaluate possible differences between patients with and without symptoms. Results. The morbidity and mortality rate in the first month was 4.2% (4.4% in symptomatic patients and 3.8% in asymptomatic patients). The mean follow-up time was 55 months: 8% of patients presented strokes, 11% suffered from myocardial infarct and 24.3% died, with no significant differences between patients with or without symptoms. The rate of restenosis was 17.3% at five years, 7.5% equal to or above 50% and, of those, 1.1% were symptomatic. Five patients with significant restenosis were successfully treated with endovascular techniques. Conclusions. Carotid angioplasty is an effective, safe technique in the hands of an experienced professional; our findings are good, both in the short and the long term, with a low rate of restenosis. If this latter condition occurs, vascular intervention techniques are safe and efficient (AU)

Síndrome de Horner como manifestación de disección carotídea / Horner syndrome as a manifestation of carotid artery dissection

Caso Clínico: Un varón de 42 años se presenta con ptosisymiosis izquierda después de una historia de cefalea homolateral de 20 días de evolución, que empeora progresivamente durante los últimos días. Una angioresonancia revela disección de la arteria carótida interna. Discusión: El «síndrome de Horner doloroso» destaca como una urgencia médica por posible manifestación de una disección carotídea. Consideramos que el perfecto conocimiento de las urgencias neurooftalmológicas es de gran necesidad para el médico oftalmólogo y que estas requieren una atención multidisciplinaria para asegurar un seguimiento y tratamiento adecuado(AU)

Clinical Case: A 42-year-old man presented with ptosis and miosis in his left eye and a history of headache over the last 20 days. An angioresonance showed dissection of internal carotid artery. Discussion: “Painful Horner‘s Syndrome” is considered to be a medical emergency due possible on set of an internal carotid artery dissection. We consider that awareness of neuro-ophthalmologic emergencies is very important in the clinical praxis of an ophthalmologist. Multidisciplinary treatment and follow-up of these patients is required(AU)

Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunts in adults.

Abdominal cerebrospinal fluid pseudocyst is an uncommon complication of using ventriculoperitoneal shunt (VPS). Although many cases have been reported in children, abdominal pseudocysts are rare in adult patients. The purpose of this article is to describe and illustrate the findings for this condition on commonly used abdominal diagnostic imaging modalities. This is a retrospective review of the six adult patients diagnosed with abdominal pseudocyst as a consequence of VPS at our centre from 1995 to 2006. We reviewed patients' prior history, cerebral and abdominal clinical manifestations, imaging findings, treatment and evolution. All patients presented with pain and abdominal distension associated with the presence of a palpable mass. Plain-film radiography was carried out in one patient, ultrasound in three and CT in all six. A fluid collection close to or associated to the VPS catheter was observed in all cases. Visualization of the distal tip of the VPS within a homogeneous intraperitoneal collection is the principal diagnostic sign of an abdominal cerebrospinal fluid pseudocyst at ultrasound and CT.