Niveles ventriculares occipitales por depósito de agregados celulares neoplásicos de origen epitelial / Occipital ventricular levels due to a deposit of neoplastic cell aggregates of epithelial origin

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Tratamiento endovascular de aneurismas cerebrales: revisión de una experiencia a 10 años (Endovascular treatment of cerebral aneurysms: review of a ten year experience) / Endovascular treatment of cerebral aneurysms: review of a ten year experience

Introducción. Se analizan los resultados clínicos y angiográficos, inmediatos y a largo plazo, del tratamiento endovascular con Guglielmi datachable coiling de aneurismas cerebrales en nuestro medio. Método. Entre enero de 1996 y junio de 2005 fueron intervenidos endovascularmente 145 aneurismas en 137 pacientes. El seguimiento clínico se realizó durante la hospitalización y luego en consultas externas un mínimo de 1 año (media: 40 meses). Se analizaron los resultados del seguimiento angiográfico que completaron el 64,9% de los pacientes (media: 33 meses). Resultados. Se obtuvo inicialmente una oclusión completa en el 64,8% e incompleta (saco o cuello remanente) en el 22,1%. La técnica fracasó en 12 casos. La morbilidad permanente asociada al procedimiento fue del 8,1%. No hubo ningún caso de mortalidad directa. Hubo un único caso de resangrado postembolización. La tasa de oclusión completa definitiva fue del 78,6%. La de recanalización del 7,5%. La oclusión incompleta y la recanalización se relacionaron con la geometría (compleja) y la localización (posterior) del aneurisma. La edad, el estado clínico al ingreso (grado de Hunt-Hess III-V), el tiempo de embolización y la presencia de hemorragia intraventricular se relacionaron con una peor evolución clínica (Rankin III-IV) a los 90 días (p<0,05). Discusión. En nuestra experiencia la terapia endovascular es una técnica eficaz y segura. Los datos de morbilidad y un único caso de recanalización tardía apoyan la seguridad del procedimiento y la estabilidad de los resultados a medio-largo plazo. La experiencia de los radiólogos y la aplicación de nuevos avances técnicos nos permitieron mejorar los resultados, sobre todo durante los últimos años (AU)

Introduction. We analyze the immediate and long-term clinical and angiographic results of endovascular treatment of ruptured and unruptured aneurysms in our single-center experience. Method. Between January of 1996 and June of 2005, 145 aneurysms were treated endovascularly in 137 patients. The clinical follow-up was performed during hospitalization and then for at least one year (mean, 40 months) in the out-patient clinic. The results of the angiographic follow-up that was completed by 64.9% of the patients (mean: 33 months) were analyzed. Results. Initially, complete occlusion was obtained in 64.8% and partial (sac or neck remnant) in 22.1%. There were technique failures in 12 cases. Overall morbidity associated to the procedure was 8.1%. There was no case of direct mortality and only one case of post-embolization re-bleeding. Rate of complete final occlusion was 78.6 and recanalization 7.5%. Partial occlusion and recanalization rates correlated with aneurysm geometry (simple or complex), neck size and posterior localization. Age, clinical state at admission (Hunt-Hess grade III-V), time of treatment and the concomitant intraventricular hemorrhage correlated with worse clinical outcome (Rankin III-V) at day 90 (p<0.05). Discussion. In our experience, endovascular treatment is an effective and safe technique for cerebral aneurysms. Rate of morbidity and the only case of long recanalization demonstrate the procedure safety and stability of the middle-long term results. The large experience of our radiologists and the incorporation of new technical modalities have allowed us to improve the results, above all, in recent years (AU)

Microsangrados silentes en pacientes con enfermedad cerebrovascular sintomática / Silent microhemorrhages in patients with symptomatic cerebrovascular disease

Introducción. La secuencia T2* eco de gradiente en resonanciamagnética cerebral (RM-T2*) permite detectar microsangrados(MS) producidos de modo silente y cuyo significadoclínico es en gran medida desconocido.Objetivo. Establecer la frecuencia de MS en una muestrade pacientes consecutivos con enfermedad cerebrovascularsintomática (ECS), analizando su asociación con distintosfactores de riesgo vascular y su posible significación clínica.Método. Examinamos mediante RM-T2* a 198 pacientesconsecutivos ingresados por ECS. Se analiza la asociación entre lapresencia y número de MS con distintos factores de riesgo vascular(FRV), subtipo de ictus y toma de medicación antitrombótica.Resultados. El 52,5% de nuestros pacientes presentaronMS. La mayor frecuencia (72,2%) se encontró en pacientes conhemorragia intracraneal (HIC), siendo el accidente isquémicotransitorio el subtipo con la menor proporción (42,9 %). Enanálisis bivariante los factores asociados con la presencia deMS fueron edad avanzada (72,4±10,5 frente a 67,7±12,7 años;p 0,004), hipertensión arterial (HTA) (65,4 frente a 51,1%;p 0,041), diabetes (35,6 frente a 22,3%; p 0,041) y el tratamientoantitrombótico (45,2 frente a 28,7%; p 0,017). En análisismultivariante fueron predictores de la presencia de MS la edadavanzada (p 0,019; OR: 1,03 [1,01-1,06]), HTA (p 0,031; OR: 1,97[1,06-3,65]), tratamiento antitrombótico previo (p 0,038;OR: 1,95 [1,04-3,65]) y haber sufrido un ictus hemorrágico(p 0,028; OR: 3,63 [1,15-11,46]).Conclusiones. La presencia de MS es frecuente entrepacientes con ECS, siendo especialmente elevada entre pacientescon ictus hemorrágico. Se asocian a FRV clásicamenteasociados con enfermedad de pequeño vaso y a la tomade tratamiento antitrombótico previo (AU)

Introduction. T2*-weighted gradient echo MRI sequences(T2*-MRI) have made it possible to detect cerebralmicrohemorrhages (MH) that have been consideredas subclinical but whose clinical significance is largelyunknown.Objective. To establish the frequency of MH in asample of consecutive symptomatic cerebrovascular disease(SCD) patients, analyzing its associations with differentvascular risk factors (VRF) and its clinical significance.Methods. A total of 198 patients with SCD were consecutivelyexamined using T2*-MRI. Preferential locationof MH and associations between MH presence and MHnumber with VRF, previous antithrombotic treatment andSCD subtypes were analyzed.Results. A total of 52.5% of our patients had MH.The highest frequency of MH was found in hemorrhagicstrokes (72.2%), Transitoy ischemic attack (TIA) (42.9%)being the group with the lowest frequency. According tothe bivariate analysis, the factors associated with the presenceof MH were elderly age (72.4±10.5 vs 67.7±12.7;p 0.004), hypertension (65.4 vs 51.1%; p 0.041), diabetes(35.6 vs 22.3 %; p 0.041) and being under antithrombotictreatment (45.2 vs 28.7 %; p 0.017). According to the multivariateanalysis, elderly age (p 0.019; OR: 1.03 [1.01-1.06]), hypertension (p 0.032; OR: 1.97 [1.06-3.65]), use ofantithrombotic treatment (p 0.038; OR: 1.95 [1.04-3.65])and having a hemorrhagic stroke (p 0.028; OR: 3.63 [1.15-11.46]) were predictors of MH presence.Conclusions. The presence of MH is frequent amongpatients with SCD, this being especially elevated in patientswith hemorrhagic stroke. Cerebral MHs are classically associatedwith VRF classically related with small vessel diseaseand previously taking antithrombotic treatment(AU)

[Silent microhemorrhages in patients with symptomatic cerebrovascular disease]. / Microsangrados silentes en pacientes con enfermedad cerebrovascular sintomática.

INTRODUCTION: T2*-weighted gradient echo MRI sequences (T2*-MRI) have made it possible to detect cerebral microhemorrhages (MH) that have been considered as subclinical but whose clinical significance is largely unknown. OBJECTIVE: To establish the frequency of MH in a sample of consecutive symptomatic cerebrovascular disease (SCD) patients, analyzing its associations with different vascular risk factors (VRF) and its clinical significance. METHODS: A total of 198 patients with SCD were consecutively examined using T2*-MRI. Preferential location of MH and associations between MH presence and MH number with VRF, previous antithrombotic treatment and SCD subtypes were analyzed. RESULTS: A total of 52.5% of our patients had MH. The highest frequency of MH was found in hemorrhagic strokes (72.2%), Transitory ischemic attack (TIA) (42.9%) being the group with the lowest frequency. According to the bivariate analysis, the factors associated with the presence of MH were elderly age (72.4+/-10.5 vs 67.7+/-12.7; p 0.004), hypertension (65.4 vs 51.1%; p 0.041), diabetes (35.6 vs 22.3 %; p 0.041) and being under antithrombotic treatment (45.2 vs 28.7 %; p 0.017). According to the multivariate analysis, elderly age (p 0.019; OR: 1.03 [1.01- 1.06]), hypertension (p 0.032; OR: 1.97 [1.06-3.65]), use of antithrombotic treatment (p 0.038; OR: 1.95 [1.04-3.65]) and having a hemorrhagic stroke (p 0.028; OR: 3.63 [1.15- 11.46]) were predictors of MH presence. CONCLUSIONS: The presence of MH is frequent among patients with SCD, this being especially elevated in patients with hemorrhagic stroke. Cerebral MHs are classically associated with VRF classically related with small vessel disease and previously taking antithrombotic treatment.

Síndrome del seno carotídeo secundario a infiltración tumoral del espacio carotídeo cervical / Carotid sinus syndrome secondary to invasion of the cervical carotid space due to tumoral infiltration

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Topiramato y glaucoma agudo / Topiramate and acute glaucoma

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Placebo response in a patient with chronic migraine and ergotic overuse.

Facilitation of nociceptive systems has been implicated in Chronic-Migraine pathogenesis. Daily consumption of medication may be a contributing factor. The patient was male, aged 76 years, with history of migraine without aura. Six years ago, he presented with a mild-moderate daily pulsating headache. He was overusing analgesics and ergotamine. After withdrawing, the patient started a nonpulsating headache, diffuse and constant. During follow up, he was refractive to several symptomatic and prophylactic treatments. When we treated him with placebo capsules, the headache responded very well. At first, pain-relief occurred for 6 h and progressively, extended. Two years later, when our patient started to use transdermal patches of fentanyl for treatment of a complex regional pain syndrome type 1, his headache did not improve. Patient has maintained prolonged response to placebo. Actually, he is pain-free for 2-3 days with 1 placebo capsule. We discuss mechanisms of chronic-migraine, drug-overuse, drug-induced headache and placebo addiction. Powerful psychological mechanisms could determine response to placebo in this patient.

[Efficacy and safety of endovascular treatment of brain aneurysms: experience in our setting]. / Eficacia y seguridad del tratamiento endovascular de aneurismas cerebrales: experiencia en nuestro medio.

INTRODUCTION: The objective of our study is to know the efficacy and safety of endovascular treatment in our setting. PATIENTS AND METHODS: a) prospective evaluation of patients with aneurysmal subarachnoid hemorrhage (SAH) or incidental aneurysm (Dec 1999-Dec 2002), and b) neurological, angiographic and evolutive evaluation of the endovascularly operated patients. RESULTS: A total of 79 patients were evaluated: 75 with SAH, 4 with incidental aneurysm. Arteriographies were performed in 74 (93.6%), detecting 58 aneurysms in 52 patients, 15 of the anterior communicating artery (25%) and 14 of the posterior communicating artery (24%). Fifty-two aneurysms were treated with Guglielmi Detachable Coiling (GDC) (89.6 %). Total occlusion (100 %) was obtained in 48 (82.7%) and partial occlusion in 4. Technique failure occurred in six cases. The earlier complications, after endovascular procedure (< 24 h), were one rebleeding, four angiographic spasms and ischemia and one coil displacement. During the first month, there were other cases of rebleeding and two cases of spasm and ischemia. Morbidity rate was 11.5 %. Death rate was 5.7 %. Follow-up period ranges between 6 and 42 months. After endovascular treatment 40 patients had a favourable outcome (Ranking 1-2) and 9 suffered moderate-severe incapacity (Ranking 3-5). We prescribed angiographic controls one year after the hemorrhagic event and there was only one case of aneurysmal recurrence. DISCUSSION: In our experience endovascular treatment is useful to treat ruptured and unruptured aneurysms, with similar surgical occlusion, morbidity and death rates.

Cefalea por abuso de triptanes / Triptans overuse headache

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Cavernomatosis múltiple. Diagnóstico diferencial por eco-gradiente / Multiple cavernomatosis. Differential diagnosis by gradient-echo

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