Aspectos particulares de las neurocomplicaciones del cáncer / Particular aspects of the neurocomplications of cancer

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[The risk of hemorrhage in long-term use of aspirin and triflusal]. / El riesgo hemorrágico en la toma prolongada de aspirina y triflusal.

INTRODUCTION: Different studies have shown that aspirin (AAS), in low doses, may lead to a considerable frequency of hemorrhagic complications when used in the long term. OBJECTIVE: We compare the long-term occurrence of hemorrhagic complications with low doses of AAS and high doses of triflusal. PATIENTS AND METHODS: Our series included 106 patients who took 900 mg triflusal per day (300 mg 3 times per day) and 111 who took AAS (330 mg/day once daily). The former were followed up for an average period of 48.3 months (20-94) and the latter for 46.3 months (2-84). The average follow-up period for the study was 47.3 months. The presence of hemorrhagic complications was evaluated, as was their frequency and follow-up curve. RESULTS: Compared with AAS, triflusal led to a 76% reduction in risk of hemorrhagic complications (2.8% against 10.8%; OR 0.24; IC 0.06-0.94). There was a slightly increased incidence of hemorrhages in the women's group. There were more hemorrhages than gastrointestinal hemorrhages (4.5% against 0.9%) and intracranial hemorrhages (1.8%-0.9%). The follow-up curve showed significant differences in the form of an increased risk of hemorrhagic complications with AAS. CONCLUSIONS: The risk of hemorrhage with AAS depended on the period of follow-up, in a similar manner to with oral anticoagulant agents, in patients with prophylaxis of cerebral infarct. On the other hand, this did not occur with triflusal, with which the risk was homogeneous and lower in the long term.

[Transient cerebral and bone marrow ischemia in patients with atrioseptal aneurysm]. / Isquemia cerebral y medular transitoria en pacientes con aneurisma atrioseptal.

The relationship between atrioseptal aneurysm and ischemic stroke has not been clearly demonstrated. We present three patients with transient cerebrovascular events and one patient with transient medullar ischemia related with the presence of atrioseptal aneurysm. Other causes of cerebrovascular disease have been excluded. Following anticoagulation treatment all the patients remain asymptomatic.

[Somatosensory focal seizures as an onset form in adult Moyamoya syndrome]. / Crisis parciales somatosensoriales como forma de presentación de un síndrome de Moya-Moya del adulto.

Moya-Moya disease is a chronic infrequent vasculopathy. Occasionally such abnormalities are found in association with one of many conditions, in these cases the angiographic abnormality should be termed Moya-Moya syndrome rather than Moya-Moya disease. Although in children the usual manifestations are ischemic events and seizures. This clinical presentation is infrequent in adults. We present a 42-years-old man with a 1-month history of recurrent right sided partial somatosensorial seizures, later he presented a left parietal infarction, the angiographic findings were compatible with moyamoya syndrome.

[Risk factors and prognostic variables in transient ischemic attacks and in infarctions with minimal sequelae. A multivariate comparative study]. / Factores de riesgo y variables pronósticas en los ataques isquémicos transitorios y en los infartos con residuo mínimo. Estudio comparativo multivariado.

BACKGROUND: There are no clinical differences accounting for a distinction between transient ischemic attack (TIA) and cerebral infarct with minimal sequelae (IMS). The aim of the present study was to evaluate whether there are diverse risk factors involving a different prognosis in these two groups. METHODS: 144 patients with TIA and 110 with IMS of atherothrombotic origin were prospectively controlled during a mean period of 21 months. Risk factors in both groups were compared with the calculation of the odds ratio (OR) and its 95% confidence intervals (95%CI). The prognosis of the series was evaluated with survival curves, considering as end points the development of recurrences or cardiovascular death. RESULTS: In the TIA group there was a higher rate of previous TIA (OR = 3.6; 95%Ci = 1.5-8.6) and a smaller prevalence of hypertension (OR = 0.45; 95%CI = 0.27-0.76). There were no significant differences between both groups regarding the probability of survival without TIA or cerebral infarction. Cox's proportional risk analysis selected the stenosis of supraaortic arterial trunks and hyperglycemia as the only factors with independent prognostic significance. CONCLUSIONS: These results do not support the classification of reversible ischemic attacks into TIA and IMS. Both groups have similar risk factors with a similar prognosis.

[Neurologic manifestations of dissecting aneurysms of the aorta]. / Manifestaciones neurológicas de los aneurismas disecantes de aorta.

Dissecting aneurysm of the aorta keeps on being nowadays a diagnostic problem, although it is a well known entity. Dissecting aneurysms may be classified into type A, dissection involving the ascending aorta, and type B, dissection involving descending aorta. The frequency of neurologic manifestations oscillates from 18 to 30%. From the 133 cases of dissecting aneurysm attended at our hospital, 30 (22.5%) presented neurologic manifestations. Nine patients (30%) had symptoms of ischemic neuropathy; 13 (43.3%) presented symptoms compatible with spinal ischemia and 14 (46.7%) presented manifestations of brain ischemia, with involvement of supraaortic trunks proven at autopsy in eight cases. The neurologic complications of type A and B dissecting aneurysms were similar (28 and 26%); in up to 30% of patients, it was the initial symptom. In type A dissecting aneurysm, the most frequent neurologic manifestation was brain ischemia (57.1%) whereas ischemic neuropathy and spinal ischemia predominated in type B dissecting aneurysm. The overall mortality rate reached 76.7% (85.7% for type A and 55.5% for type B). The modality of treatment had no clear influence on the survival. In the presence of brain complications, the mortality was 100%.