Patrones estacionales de nacimiento en esclerosis múltiple / Seasonal birth patterns in multiple sclerosis

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Hematomas cerebrales espontáneos múltiples. Descripción de una serie y revisión de la bibliografía / Multiple spontaneous cerebral haemorrahges. Descriptión of a series and review of the literature

Resumen. Introducción. La aparición simultánea de hemorragias cerebrales en diferentes territorios arteriales ocurre en el 2-3% de los accidentes cerebrovasculares. Diversos factores de riesgo se han asociado con la presentación de múltiples hemorragias cerebrales, pero ninguno ha sido confirmado. Presentamos los síntomas clínicos, las manifestaciones radiológicas y la evolución clínica de siete casos admitidos en nuestro centro durante los últimos nueve años, así como los distintos factores etiológicos. Pacientes y métodos. Se revisaron retrospectivamente los pacientes con un episodio de accidente cerebrovascular agudo ingresados en nuestro servicio durante el período comprendido entre enero de 1998 y febrero de 2007. Se excluyó a los pacientes con historia de traumatismo cerebral o infartos hemorrágicos. Se analizaron la edad, los factores de riesgo, la presentación clínica, el número y localización de los hematomas y su evolución. Resultados. Presentamos 7 casos (5 hombres y 2 mujeres). La edad media fue de 78 años. Las manifestaciones clínicas más frecuentes fueron la disminución del nivel de conciencia y la pérdida de fuerza. El total de hematomas fue de 20, de los cuales 19 (95%) eran supratentoriales, y 15 (75%), lobares. En un paciente la hemorragia se extendió al sistema ventricular. Tres pacientes (43%) tuvieron historia de hipertensión, un caso se asoció con la toma de anticoagulación oral (14%) y otro con discrasias sanguíneas (14%). Tres pacientes fallecieron (43%). Conclusión. Nuestra serie de pacientes con múltiples hemorragias cerebrales, respecto a los síntomas, los hallazgos radiológicos y la evolución es similar a otras previamente descritas, pero nuestros pacientes son mayores. La avanzada edad y la localización de los hematomas sugieren que la angiopatía amiloidea puede ser un importante factor de riesgo para presentar hemorragias cerebrales múltiples (AU)

Summary. Introduction. The simultaneous occurrence of intracerebral haemorraghes in different arterial territories is an clinical event that develops in 2% to 3% of hemorrhagic strokes. Multiple risk factors have been associated with multiple intracerebral haemorraghes, but none of them are clearly defined. We reported clinical features, radiological findings, and outcome of 7 patients admitted to our department during last nine years and the diverse etiologic factors are discussed. Patients and methods.We retrospectively reviewed all patients with acute stroke admitted to our department during the period January 1998-February 2007. Patients with a history of traumatic brain injury or suspected hemorrhagic infarctions were excluded. We collected data concerning age, risk factors, clinical features, number and location of haematomas and outcome. Results. We studied 7 patients (5 males and 2 females) Mean age was 78. The most common clinical manifestations were decreased alertness and weakness. Total number of haematomas was 20, 19 (95%) supratentorial and 15 (75%) in lobar area. One patient haemorrhage extended into the ventricular system. Three patients (43%) had hipertensive history, and in only one case was associated with oral anticoagulant (14%) and one blood dyscrasia (14%). Three patients died (43%). Conclusion. In our series of patients with multiple intracerebral haemorraghes, clinical and radiological findings and outcome were comparable to others previously described, but our patients were older. The advanced age and lobar localization suggest amyloid angiopathy is an important risk factor to multiple intracerebral haemorraghes (AU)

[Multiple spontaneous cerebral haemorrhages. Description of a series and review of the literature]. / Hematomas cerebrales espontáneos múltiples. Descripción de una serie y revisión de la bibliografía.

INTRODUCTION: The simultaneous occurrence of intracerebral haemorraghes in different arterial territories is an clinical event that develops in 2% to 3% of hemorrhagic strokes. Multiple risk factors have been associated with multiple intracerebral haemorraghes, but none of them are clearly defined. We reported clinical features, radiological findings, and outcome of 7 patients admitted to our department during last nine years and the diverse etiologic factors are discussed. PATIENTS AND METHODS: We retrospectively reviewed all patients with acute stroke admitted to our department during the period January 1998-February 2007. Patients with a history of traumatic brain injury or suspected hemorrhagic infarctions were excluded. We collected data concerning age, risk factors, clinical features, number and location of haematomas and outcome. RESULTS: We studied 7 patients (5 males and 2 females) Mean age was 78. The most common clinical manifestations were decreased alertness and weakness. Total number of haematomas was 20, 19 (95%) supratentorial and 15 (75%) in lobar area. One patient haemorrhage extended into the ventricular system. Three patients (43%) had hipertensive history, and in only one case was associated with oral anticoagulant (14%) and one blood dyscrasia (14%). Three patients died (43%). CONCLUSION: In our series of patients with multiple intracerebral haemorraghes, clinical and radiological findings and outcome were comparable to others previously described, but our patients were older. The advanced age and lobar localization suggest amyloid angiopathy is an important risk factor to multiple intracerebral haemorraghes.

Afectación trigeminal en el SUNCT / Trigeminal involvement in SUNCT syndrome

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[Vascular malformations of the central nervous system in children]. / Malformaciones vasculares del sistema nervioso central en niños.

OBJECTIVE: To present the experience of vascular malformations (VM) of the central nervous system (CNS) in children obtained in our centre. Since these lesions do not often present clinically in childhood, there are few series described in the literature. PATIENTS AND METHODS: We made a retrospective review of the clinical histories of patients with VM of the CNS shown on MR, angiography and/or morbid anatomy, who were aged 15 years or under. Patients with Sturge-Weber or Von Hippel-Lindau syndromes were excluded. RESULTS: We describe 32 patients with VM of the CNS. Twenty four had arteriovenous malformations (AVM), 5 had cavernous malformations (CM), 2 had malformations of Galeno's vein (MGV) and one patient had a congenital fusiform arterial aneurysm. Twenty two children (68%) presented clinically with hemorrhages. This was the form of presentation in 20 patients with AVM. In 4 of the 5 patients with CM the first sign was epileptic crisis. The two patients with MGV presented with macrocephaly, in one neonate it was associated with heart failure and in on older baby with hydrocephaly. The patient with a congenital arterial aneurysm presented with paroxystic episodes of facial pain. CONCLUSIONS: The AVM are the VM which most frequently cause symptoms in childhood.