[Neurocysticercosis, its clinical and tomographic correlation]. / Neurocisticercosis, correlación clínica y tomográfica.

TITLE: Neurocisticercosis, correlación clínica y tomográfica.

[Considerations about late-onset epilepsy]. / Consideraciones acerca de las epilepsias tardías.

OBJECTIVE: To make a revision of the general point of view on late-onset epilepsy, known as epilepsy that starts in the mature age after 25 years old; around 25% of the patients with epilepsy had their first crisis after that age, with an increase in the incidence in the course of the age. DEVELOPMENT: The main ethiologies are discussed, standing out: alcoholism (22%), stroke (18%), tumors (10%), metabolic imbalances (10%), infections of the CNS, trauma, atrophies and cisticercosis. For the diagnosis is required a complete clinical evaluation, cardiovascular examination, metabolic tests, EEG and neuroimage studies. CONCLUSIONS: Monotherapy with phenobarbital, carbamazepine and valproate, control 80% of cases and failure related to patients with wide spread cerebral damage.

Consideraciones acerca de las epilepsias tardías / Considerations about late-onset epilepsy

Objetivo. Realizar una revisión de las epilepsias de inicio tardío, conocida como la epilepsia que se inicia en la edad adulta después de los 25 años; constituye aproximadamente el 25 por ciento de los pacientes con esta patología, y presenta un incremento en la incidencia con el transcurso de la edad. Desarrollo. Se discuten las etiologías principales, destacando: alcoholismo (22 por ciento), accidente cerebrovascular (18 por ciento), tumores (10 por ciento), alteraciones metabólicas (10 por ciento) e infecciones del SNC, trauma, atrofias y cisticercosis, principalmente. Para el diagnóstico se requiere una historia clínica completa, examen cardiovascular, de función metabólica, electroencefalograma y estudios de neuroimagen. Conclusión. La monoterapia con fenobarbital, carbamacepina y valproato controla el 80 por ciento de los casos; se describe el fracaso en el manejo de los pacientes con amplio daño cerebral (AU)

[Etiology of late-onset epilepsy]. / Etiología de las epilepsias de comienzo tardío.

INTRODUCTION: Late-onset epilepsy is considered the epilepsy that starts after 25 years old. PATIENTS AND METHODS: To determine the etiology and value of the clinical and paraclinical studies in the diagnosis, we evaluated 300 patients older than 25 years admitted in the Institute of Neurology and Neurosurgery of the city of La Havana between 1980 and 1990. Data about the illness, family and personal history and physical exploration were picked up. EEG, CT, MRI and carotid arteriography were performed. RESULTS: The main prevalence was 25 to 29 years (15.3%) and those older than 60 years (14.3%). We determined the diagnosis in 56% of the patients. Stroke was present in 19.3%, degenerative diseases in 16.6%, cerebral tumors in 9%, severe cranial trauma in 7.6% and infections, perinatal damage and toxic and metabolic causes in 3.3%. CONCLUSIONS: The symptomatic epilepsy is the most frequent type of late-onset epilepsy, the vascular and degenerative etiology are the most important in those older than 40 years old, these findings are similar to those of the developed countries.

Epilepsias de comienzo tardío:estudio clínico / Late-onset epilepsy: clinical study

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Etiología de las epilepsias de comienzo tardío / Etiology of late-onset epilepsy

Introducción. Se considera epilepsia tardía a aquella que cursa después de los 25 años de edad. Pacientes y métodos. Para determinar su etiología y el valor de los estudios clínicos y paraclínicos en su diagnóstico, evaluamos a 300 pacientes mayores de 25 años admitidos en el Instituto de Neurología y Neurocirugía de la ciudad de La Habana (Cuba) entre los años 1980 y 1990. Se recogieron datos de la historia de la enfermedad, historia familiar y personal, así como exploración física. Se practicaron estudios de EEG, TAC, RM y arteriografía carotídea cuando se precisó. Resultados. Hubo predominio de pacientes de entre 25 y 29 años (15,3 por ciento) y mayores de 60 años (14,3 por ciento). Se pudo precisar el diagnóstico en el 56 por ciento de los casos. Se presentó accidente cerebrovascular en el 19,3 por ciento, enfermedad degenerativa en el 16,6 por ciento, tumores cerebrales en el 9 por ciento, trauma craneal grave en el 7,6 por ciento e infecciones, daño perinatal y causas tóxicas y metabólicas en el 3,3 por ciento. Conclusiones. La epilepsia sintomática es la más frecuente entre las epilepsias de inicio tardío. La etiología vascular y degenerativa son las más importantes, en particular en los mayores de 40 años, tal como se ha enfatizado en los países desarrollados (AU)

[The importance of postnatal risk factors in localized epilepsies]. / Importancia de los factores de riesgo posnatales en las epilepsias localizadas.

INTRODUCTION: The risk factors for epilepsy are not sufficiently well known. OBJECTIVES: To determine the postnatal risk factors for epilepsy related to localization. PATIENTS AND METHODS: We studied 100 patients with localized epilepsy who were over 14 years old, randomly selected and consulted us between January 1996 and July 1997. Data was obtained using the specific protocol of an epileptology program. All patients had electroencephalograms and skull tomography. RESULTS: The average age was 29 years. There were more males than females (57 males) and simple partial crises with secondary generalization were the commonest (49 patients). Head injury was the main risk factor. CONCLUSIONS: Postnatal risk factors which could have been avoided, such as head injury and neurocysticercosis made up the main group of patients with factors identified. Alterations on skull tomography were associated with statistically significant postnatal risk factors.

Importancia de los factores de riesgo posnatales en las epilepsias localizadas / The importance of postnatal risk factors in localized epilepsies

Introducción. Los factores de riesgo para padecer epilepsia son insuficientemente conocidos. Objetivos. Determinar los factores de riesgo posnatales para la epilepsia relacionada con la localización. Pacientes y métodos. Estudiamos 100 pacientes con epilepsia localizada, mayores de 14 años de edad, seleccionados aleatoriamente y atendidos en el período comprendido entre enero de 1996 y julio de 1997. Los datos se obtuvieron mediante la aplicación de un protocolo específico del programa de epileptología. A todos los pacientes se les realizó electroencefalograma y tomografía craneal. Resultados. La edad media fue de 29 años; predominó el sexo masculino con 57 pacientes y las crisis parciales simples secundariamente generalizadas fueron las más frecuentes con 49 pacientes. El traumatismo craneal fue el principal factor de riesgo. Conclusiones. Factores de riesgo posnatales potencialmente evitables, como el traumatismo craneoencefálico y la neurocisticercosis, constituyeron el principal grupo de pacientes con factores identificados. Las alteraciones en la tomografía craneal se asociaron, con significación estadística, a la presencia de factores de riesgo posnatales (AU)

Orbital myositis and rheumatoid arthritis: case report.

Orbital myositis implies orbital inflammation confined to one or more of the extraocular muscles. The acute form responds well to high doses of oral corticosteroids tapered gradually, but it may recur or become chronic. We describe a 38 years old female who has been suffering from rheumatoid arthritis for six years. She developed diplopia as a result of a paralysis of the right and left rectus medialis muscle. MRI showed inflammatory process and thickness of the referred muscles. The patient had a total recovery with oral use of 80 mg methylprednisolone daily. Two months after the first episode she developed a bilateral ophthalmoplegy. The patient improved with oral use of steroids the second time, but a paresis of the left rectus lateralis muscle remained. From the 156 cases we reviewed only three have been related to rheumatic diseases and none has been previously related to rheumatoid arthritis.

[Sturge-Weber syndrome: differential diagnosis of neurocysticercosis]. / Síndrome de Sturge-Weber. Diagnóstico diferencial de la neurocisticercosis.

INTRODUCTION: The Sturge-Weber syndrome is characterized by facial cutaneous angioma associated with leptomeningeal and cerebral angioma, typically ipsilateral to the facial lesion, which is accompanied by convulsions, mental retardation, contralateral hemiparesia, hemiatrophy, homonymous hemianopsia and glaucoma. Most of the patients with radiographic evidence of intracranial angioma develop convulsive crises, but only half have severe mental retardation. The image of calcification on cranial tomography often leads to confusion in diagnosis, especially with neurocysticercosis, particularly in places where this is endemic and the patients present with minimal skin lesions or these are at atypical sites. CLINICAL CASE: We present the case of a 13 year-old boy hospitalized with status epilepticus who, since the age of 1 year and 3 months, had had convulsive seizures which were of generalized tonic-clonic type and partially complex with secondary generalization, treated with carbamazepine at a dose of 400 mg per day. Neurocysticercosis was diagnosed on a tomogram showing calcification of the left parieto-occipital gyrus. Following physical examination and complementary tests the diagnosis of Sturge-Weber syndrome was made. CONCLUSION: We emphasize the importance of the diagnosis of Sturge-Weber syndrome, its clinical picture and treatment.

Síndrome de sturge-weber. Diagnóstico diferencial de la neurocisticercosis / Sturge-weber syndrome. Differential diagnosis of neurocysticercosis

Introducción. El síndrome de Sturge-Weber se caracteriza por presentar angioma cutáneo facial asociado a angioma leptomeníngeo y cerebral, típicamente ipsilateral a la lesión facial, que se acompaña de convulsiones, retraso mental, hemiparesia contralateral, hemiatrofia, hemianopsia homónima y glaucoma. La mayoría de los pacientes con evidencia radiográfica de angioma intracraneal desarrollan crisis convulsivas, pero solamente la mitad presentan retraso mental grave. La imagen de calcificación en la tomografía craneal muchas veces conlleva cierta confusión diagnóstica, principalmente con la neurocisticercosis en aquellos lugares donde ésta es endémica y los pacientes presentan nevos cutáneos mínimos o de localizaciones atípicas. Caso clínico. Describimos el caso de un paciente de 13 años internado en estado de mal epiléptico. Desde la edad de 1 año y 3 meses padecía crisis convulsivas de tipo tonicoclónico generalizadas y parciales complejas con generalización secundaria, que fueron tratadas con carbamacepina en dosis de 400 mg al día, con diagnóstico de neurocisticercosis y una tomografía que mostraba una calcificación en giro parietoccipital izquierda. Después de la exploración física y los exámenes complementarios fue diagnosticado de síndrome de Sturge-Weber. Conclusión. Resaltamos la importancia del diagnóstico del síndrome de Sturge Weber en el diagnóstico diferencial de la neurocisticercosis, así como su cuadro clínico y tratamiento (AU)

[Epilepsy and cerebral tumor]. / Epilepsia y tumor cerebral.

OBJECTIVE: To determine clinical and pathological features with seizures associated brain tumors. PATIENTS AND METHODS: This was a retrospective study through of an Epilepsy Program Protocol where we studied fifty patients admitted at Hospital Universitário Cajuru of Curitiba, Brazil, in 1996-1997. RESULTS: We studied 36 males and 14 females, aged 6 and 81 years old (mean 40.5). Twenty six patients had tonic-clonic seizures, 13 had simple partial secondarily generalized, 8 had simple partial, 2 complex partial and one with simple partial progressing to complex partial seizure. CT showed parietal expansive lesion on 14 cases, frontal expansive lesion on 14 cases, frontoparietal on 5; intraventricular tumor, sella turcica, temporal temporoparietal and fronto-temporo-parietal expansive lesion 2 on each case, and suprasellar lesion, centrum semiovale, cerebello-pontine angle, ventricular trigone, fronto-naso-etmoidal and brain stem 1 on each case. All patients were submitted to a biopsy and/or resection of the lesion. The principal brain tumors were meningioma in 30%, astrocytoma in 22%, glioblastoma multiform in 14%, oligodendroglioma in 4% and pituitary adenoma in 4%.

[Miller-Fisher syndrome and cavernous angioma]. / Síndrome de Miller-Fisher y angioma cavernoso.

INTRODUCTION: The Miller-Fisher syndrome is considered a variant of acute inflammatory demyelinating polyradiculoneuropathy, generally is a benign disorder. CLINICAL CASE: We describe a patient who has had, acutely, ataxia, areflexia and ophthalmoplegia. It has been electrophysiologically diagnosed as Miller-Fisher syndrome. The symptoms appeared after an infectious disease, namely sinusitis. The evoked potential studies suggested lesions at the brain stem and we found a cavernous angioma at MRI. CONCLUSION: We prepared a review of the literature published so far, showing that there is still much controversy about the physiopathology of this syndrome and the importance of the immunologic diagnoses.

[Epilepsy and arteriovenous malformations]. / Epilepsia asociada a malformación arteriovenosa.

OBJECTIVE: To describe the characteristics of the patients with epilepsy, associated to arteriovenous malformation. PATIENTS AND METHODS: We introduced 11 patients assisted in 1997, at University Cajuru Hospital, with arteriovenous malformation associated to refractory epileptic seizures. RESULTS: Six men and five women, with age between 12 and 40 years old (27 years in mean), were interned with epileptic crises, 4 generalized tonic-clonic, 3 partial simple secondarily generalized, one with complex partial and one with simple partial that the complex developed with secondary generalization. CT showed temporal lesion in 3 patients, parietal in 3 patient, ventricular in 3, parietal fose and temporoparietal on one patient, respectively. MRI was accomplished in 5 patients presenting temporal lesion in 3 and temporo-parietal in 2. It was possible to accomplish the EEG in 8 patients, all with epileptiform activity. The arteriography showed arteriovenous malformations in all the patients, 3 of the which died. Eight patients were guided for surgical treatment evidencing cavernous angioma in 6 patient and hemangioma in 2. CONCLUSIONS: We observed that cortical and not cortical arteriovenous malformation associates to epileptic seizures and in the cases in which it is possible, the surgical treatment favors the control of the seizures.

[Work conditions of patients with controlled epileptic crises]. / Situación laboral de pacientes con crisis epilépticas controladas.

OBJECTIVES: To study the employment conditions in a group of patient epileptic adults with control of its seizures, assisted in the University Hospital of Cajuru. PATIENTS AND METHODS: We studied 70 patients that we applied the specific protocol, obtaining data of its origin, profession and job situation. RESULTS: We examined 46 men and 24 women, with mean age 34 years old, where 63 of urban origin and 7 rural. All the patients were in treatment with antiepileptic drugs and without seizures or less than three seizures in the last twelve months. The largest group of patients (35) they met unemployed: 14 retired, 11 of the motivated by the disease, 10 worked as autonomous, 3 only studied and 3 were public employees.

[Neurocysticercosis and epilepsy in Cuba]. / Neurocisticercosis y epilepsia en Cuba.

INTRODUCTION: Neurocysticercosis is one of the main causes of epilepsy in the tropics, particularly in Central and South America. OBJECTIVES: To report the only five patients diagnosed in a tertiary care institution as having neurocysticercosis and its relation to epilepsy. PATIENTS AND METHODS: We made a retrospective study, reviewing the clinical histories of patients admitted to the Instituto de Neurologia y Neurocirugia of La Habana, Cuba, over 25 years up to 1989, to determine those with neurocysticercosis. RESULTS: We found only five patients, representing a frequency of 0.01% of all admissions. We discuss the origin of these cases and their possible place of infection, showing that this is almost non-existent in Cuba since three of the cases were of foreigners and there was evidence that the two Cubans had acquired the disease abroad. The correlation between neurocysticercosis and epilepsy (4 of 5 cases) was assessed. The main symptoms were analyzed: the three most important, in order, were tonic-clonic convulsions, headache and motor deficit respectively. The epileptic seizures were classified as secondary generalized partial seizures (symptomatic partial epilepsy secondary to cysticercosis). The clinical form, when the site is considered, was inactive, with intraparenchymatous and meningeal (mixed) calcifications in one case. CONCLUSION: We assess the elements which permit diagnosis, the efficacy of anti-helminth treatment and the drugs used to treat epilepsy and cerebral oedema, the prognosis as a function of the diagnosis and the treatment.