Meningitis neutrofílica persistente / Persistent neutrophilic meningitis

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[Prevalence of neurosonographic disturbances in chronic instability]. / Prevalencia de alteraciones neurosonológicas en la inestabilidad crónica.

INTRODUCTION: Dizziness is a common symptom at the outpatient clinic of family doctors. Its origin is usually multifactorial and its outcome is often benign. However, exists a tendency to relate the dizziness with a cerebrovascular disturbance. AIM. To determine if there are cerebrovascular disorders in patients with chronic dizziness using a non invasive technique. PATIENTS AND METHODS: A prospective study was conducted. It included 404 patients without limit of age. The patients were evaluated in a Neurology Outpatient Clinic, to select those patients with chronic instability. A neurosonographic exam was performed to all those selected patients. This exam included colour duplex of the cervical arteries and transcranial Doppler. RESULTS: Up to 54 % of the patients who were included in the study had a normal carotid study. For the rest of the patients, the thickness intima-media was the most prevalent finding. At the vertebrobasilar system the study of the vertebral arteries was completely normal in 81.7% followed by the presence of microangiopathy in 12.1%. The basilar system was also normal in a high figure (78%) followed by the microangiopathy (17.1%). CONCLUSIONS: The vascular disturbances in the vertebrobasilar system are an exceptional finding in patients with chronic instability.

Prevalencia de alteraciones neurosonológicas en la inestabilidad crónica / Prevalence of neurosonographic disturbances in chronic instability

Introducción. El mareo es un síntoma muy frecuente en las consultas de atención primaria. Su origen es generalmente multifactorial y tiene un curso benigno. Existe, sin embargo, una tendencia a relacionar el mareo con una alteración vascular cerebral. Objetivo. Determinar si existen alteraciones cerebrovasculares en los pacientes con mareo crónico utilizando una técnica no invasiva. Pacientes y métodos. Se realizó un estudio prospectivo que incluía a 404 pacientes sin restricción de edad. Se evaluó a los pacientes en la consulta de neurología, con el objetivo de seleccionar los que tenían inestabilidad crónica. A los pacientes incluidos se les realizó un estudio neurosonológico con ecografía Doppler con color de las arterias cervicales y Doppler transcraneal. Resultados. En el 54 % de los pacientes, el estudio neurosonológico carotídeo fue rigurosamente normal. En el resto de los pacientes, el hallazgo más prevalente fue la ateromatosis carotídea no estenosante. En el sistema vertebrobasilar, el estudio de las arterias vertebrales fue completamente normal en el 81,7%, seguido de la presencia de microangiopatía en un 12,1%. El estudio de la arteria basilar fue también normal en una alta proporción de pacientes (78%), seguido de la presencia de microangiopatía en un 17,1%. Conclusiones. Las alteraciones vasculares vertebrobasilares son un hallazgo excepcional en pacientes con inestabilidad crónica

Introduction. Dizziness is a common symptom at the outpatient clinic of family doctors. Its origin is usually multifactorial and its outcome is often benign. However, exists a tendency to relate the dizziness with a cerebrovascular disturbance. Aim. To determine if there are cerebrovascular disorders in patients with chronic dizziness using a non invasive technique. Patients and methods. A prospective study was conducted. It included 404 patients without limit of age. The patients were evaluated in a Neurology Outpatient Clinic, to select those patients with chronic instability. A neurosonographic exam was performed to all those selected patients. This exam included colour duplex of the cervical arteries and transcranial Doppler. Results. Up to 54 % of the patients who were included in the study had a normal carotid study. For the rest of the patients, the thickness intima-media was the most prevalent finding. At the vertebrobasilar system the study of the vertebral arteries was completely normal in 81.7% followed by the presence of microangiopathy in 12.1%. The basilar system was also normal in a high figure (78%) followed by the microangiopathy (17.1%). Conclusions. The vascular disturbances in the vertebrobasilar system are an exceptional finding in patients with chronic instability

[Neurosonological studies in patients over 80 years old]. / Estudio neuroecográfico en mayores de 80 años.

INTRODUCTION: The link between cardiovascular risk factors and carotid atheromatosis has been shown to be more important in middle aged subjects than in the elderly. AIMS: Our aim was to study the frequency of carotid and intracranial atheromatosis in a population over the age of 80 and to compare the presence of neurosonological anomalies depending on whether the patients have suffered a stroke or not. We also wished to compare the findings according to the sex of the patient. PATIENTS AND METHODS: Patients over the age of 80 were studied at our Neurosonology laboratory using carotid and transcranial Doppler ultrasonography. The patients were analysed according to whether they had suffered an ischemic stroke or not. With regard to the carotid, a distinction was made between normal, non-significant atheromatosis and significant atheromatosis (stenosis > 50%). Intracranially, both the middle cerebral artery (normal, stenosis, microangiopathy and post-stenosis) and the basilar artery (normal, stenosis, microangiopathy and hyperdynamics) were studied. RESULTS: We recorded data concerning 832 patients: 342 males (44.1%), mean age 83.63 +/- 3.25 years, and 527 (63.3%) with stroke. The carotid study was pathological, with a higher frequency in stroke patients (32.1% compared with 41.9%; p = 0.002). The presence of atheromatosis was significantly linked to a higher risk of suffering a stroke and more intensely to its being more severe. Carotid studies were pathological with a higher frequency among males (28.7% compared with 40%; p < 0.001). No significant differences were found intracranially in any of the parameters analysed. CONCLUSIONS: There is a high frequency of carotid atheromatosis in patients over 80 years of age. Regardless of the age, carotid atheromatosis appears even more frequently in patients who have suffered a stroke and in males, and is significantly associated to the risk of suffering a stroke. Intracranially, no differences were found.

[Neurosonological findings in the carotid artery in a sample of patients with lacunar infarction]. / Hallazgos neurosonológicos carotídeos en una muestra de pacientes con infarto lacunar.

INTRODUCTION: Carotid stenosis has been reported as being associated to lacunar infarcts (LI) with variable frequency, but the aetiopathogenic relation between them is still subject to some controversy. AIMS: Our aim was to describe the prevalence of carotid disorders in a neurosonological study of a sample of patients with LI. PATIENTS AND METHODS: We analysed the results of the neurosonological study conducted on patients with clinical-radiological criteria of LI who were admitted to our Stroke Unit during the period of study. RESULTS: We studied 140 patients, and results were normal in only 42% of the cases. Stenosis > 50% was found in 10% of the cases and plaque without stenosis in 40.3% of the patients. In patients without plaque there was an increase in the tunica intima-media thickness in 7.2% of the cases. CONCLUSION: In most of the patients with LI there were anomalies in the study of the carotid performed using ultrasound scanning.

[Modification of clinical profile of stroke in atrial fibrillation patients. Effect of antithrombotic treatment]. / Modificacion del perfil clinico de los ictus en enfermos con fibrilacion auricular. Efecto del tratamiento antitrombotico.

BACKGROUND: Atrial fibrillation is present in 24% of the population over 60 and it increases the risk of stroke by 2,4% 3%/year. Antithrombotic treatment is considered as the treatment of choice for cardioembolic stroke prevention in this patients. As far as we know there are not relevant data about the influence of these treatments on the type of stroke that may develop in these patients. AIM: Analyze whether there are differences in the clinical profile and functional prognosis after stroke in patients with atrial fibrillation depending on the type of treatment they were on at the time of occurrence of the event. PATIENTS AND METHODS: We identified 67 patients who were admitted consecutively to our stroke unit with a stroke and atrial fibrillation over a period of 2 years. Patients were classified according to the type of antithrombotic treatment they were on. Functional prognosis was estimated by Rankin score at discharge. RESULTS: Treated patient showed a non significant tendency to suffer less severe strokes and present a better functional situation at discharge than those who were not on prophylactic treatment. Treated patients had a significant higher prevalence of previous TIA (44,2% vs 9,1%; p= 0,0042) and HBP (81,4% vs 52%; p= 0,041) than non treated patients. Embolic strokes were more frequent in non treated patients. CONCLUSION: Antithrombotic treatment not only prevents strokes but may also contribute to the development of less severe strokes with a better functional prognosis in patients with AF and does not contribute to increase complications in these group of patients.

Modificación del perfil clínico de los ictus en enfermos con fibrilación auricular. Efecto del tratamiento antitrombótico / Modification of clinical profile of stroke in atrial fibrillation patients. Effect of antithrombotic treatment

Background. Atrial fibrillation is present in 2-4% of the population over 60 and it increases the risk of stroke by 2,4-3% per year. Antithrombotic treatment is considered as the treatment of choice for cardioembolic stroke prevention in this patients. As far as we know there are not relevant data about the influence of these treatments on the type of stroke that may develop in these patients. Aim. Analyze whether there are differences in the clinical profile and functional prognosis after stroke in patients with atrial fibrillation depending on the type of treatment they were on at the time of occurrence of the event. Patients and methods. We identified 67 patients who were admitted consecutively to our stroke unit with a stroke and atrial fibrillation over a period of 2 years. Patients were classified according to the type of antithrombotic treatment they were on. The clinical picture was evaluated by the Canadian scale. Functional prognosis was estimated by Rankin score at discharge. Results. Treated patient showed a non-significant tendency to suffer less serious strokes and present a better functional situation at discharge than those who were not on prophylactic treatment. Treated patients had a significant higher prevalence of previous TIA (44,2% vs 9,1%; p = 0,0042) and HBP (81,4% vs 52%; p = 0,041) than non-treated patients. Embolic strokes were more frequent in non-treated patients. Conclusion. Antithrombotic treatment not only prevents strokes but may also contribute to the development of less serious strokes with a better functional prognosis in patients with AF and does not contribute to increase complications in these group of patients (AU)

Introducción. La fibrilación auricular (FA) aparece en el 2-4 por ciento de la población mayor de 60 años y hace aumentar el riego de ictus en un 2,4-3 por ciento por año. El tratamiento antitrombótico es el tratamiento de elección para prevenir los ictus de origen embólico. No existen datos relevantes sobre la influencia de estos tratamientos en el tipo de ictus que aparece en estos pacientes. Objetivo. Analizar si existen diferencias en la clínica y el pronóstico funcional entre pacientes con ictus y FA según se traten o no. Pacientes y métodos. Hemos incluido a 67 pacientes que ingresaron consecutivamente en nuestra Unidad de Ictus con FA asociada al ictus durante un período de 2 años. Hemos clasificado a los pacientes de acuerdo con el tipo de tratamiento profiláctico que recibían. Estimamos la clínica inicial mediante la escala canadiense, y la situación funcional al alta, mediante la escala de Rankin. Resultados. Encontramos una tendencia estadísticamente no significativa a una clínica menos grave al ingreso y un mejor estado funcional al alta a favor de los tratados respecto los no tratados. También encontramos diferencias significativas a favor de los tratados en cuanto a los antecedentes de accidente isquémico transitorio (44,2 por ciento frente a 9,1 por ciento; p = 0,0042) y a HTA (81,4 por ciento frente a 52 por ciento; p = 0,041), así como una mayor proporción de ictus embólicos en los no tratados. Conclusión. El tratamiento antitrombótico adecuado en un paciente con FA podría asociarse, en caso de aparecer un ictus, a una clínica inicial menos grave y un mejor estado funcional final respecto los no tratados sin aumentar el número de complicaciones (AU)

[Evaluation of hemodynamic parameters by transcranial Doppler in patients with leukoaraiosis]. / Estudio de los parámetros hemodinámicos en pacientes con leucoaraiosis mediante Doppler transcraneal.

INTRODUCTION: Leukoaraiosis is commonly found in neuroimaging in ancient people. The pathogenic theory that most suitably explains its origin is the vascular one, mainly linked to cerebral hemodynamic abnormalities. The techniques most frequently used in cerebral hemodynamic evaluation (PET and SPECT) are expensive and not widespread. Transcranial Doppler instead is cheaper and much more widespread. OBJECTIVE: Our aim has been to show whether transcranial Doppler is a useful tool for cerebral hemodynamic evaluation in leukoaraiosis. PATIENTS AND METHODS: We have prospectively included 116 patients aged 60-90 who came to the Neurology department with unspecific complaints such as dizziness or mild headache. Patients with recent history of stroke or moderate to severe cognitive impairment were excluded. RESULTS: Mean age was 74.4 +/- 6.3 years old. The prevalence of leukoaraiosis was 68.7%. Leukoaraiosis was significantly correlated with older age, lacunar infarctions, past history of stroke, cognitive impairment and to lower systolic and diastolic velocities in middle cerebral artery (MCA) and higher pulsatility index. Multivariate analysis only retained the lower diastolic velocity in MCA in the model. CONCLUSIONS: Transcranial Doppler can detect hemodynamic abnormalities in patients with leukoaraiosis and is therefore a very useful technique for the evaluation of this entity.

Estudio de los parámetros hemodinámicos en pacientes con leucoaraiosis mediante Doppler transcraneal / Evaluation of hemodynamic parameters by transcranial dopler in patients with leukoaraiosis

Introducción. La leucoaraiosis es un hallazgo frecuente en la neuroimagen de individuos ancianos. La teoría patogénica más defendida para explicar su origen es la hipótesis vascular, principalmente las alteraciones de la hemodinámica sanguínea cerebral. Las técnicas empleadas para el estudio hemodinámico (PET y SPECT) presentan un alto coste y escasa accesibilidad. Frente a ellas, el Doppler transcraneal (DTC) es una técnica más barata y accesible. Objetivos. Demostrar la utilidad del DTC como técnica válida para estudiar las alteraciones hemodinámicas en la leucoaraiosis. Pacientes y métodos. Se han estudiado prospectivamente 116 pacientes de entre 60 y 90 años, seleccionados en la consulta de Neurología del Hospital General Universitario de Alicante por mostrar una clínica inespecífica, como sensación de inestabilidad o cefalea. Excluimos a los pacientes con antecedentes recientes de ictus o déficit cognitivo moderado a grave. Resultados. La edad media fue de 74,4 ñ 6,3 años. La prevalencia de leucoaraiosis fue de un 68,7 por ciento. La leucoaraiosis se asociaba significativamente a mayor edad, infartos lacunares, antecedentes de ictus, deterioro cognitivo, menor velocidad sistólica (VS) y diastólica (VD) en la arteria cerebral media (ACM) e índices de pulsatilidad más altos. Los pacientes con leucoaraiosis tenían significativamente menor VD en la ACM, independientemente de los otros factores mencionados en el análisis multivariable. Conclusiones. El DTC es capaz de detectar las alteraciones hemodinámicas que aparecen en los pacientes con leucoaraiosis. Esto lo convierte en una herramienta muy útil en el estudio de esta entidad (AU)

Introduction. Leukoaraiosis is commonly found in neuroimaging in ancient people. The pathogenic theory that most suitably explains its origin is the vascular one, mainly linked to cerebral hemodynamic abnormalities. The techniques most frequently used in cerebral hemodynamic evaluation (PET and SPECT) are expensive and not widespread. Transcranial Doppler instead is cheaper and much more widespread. Objective. Our aim has been to show whether transcranial Doppler is a useful tool for cerebral hemodynamic evaluation in leukoaraiosis. Patients and methods. We have prospectively included 116 patients aged 60-90 who CAME to the Neurology department with unspecific complaints such as dizziness or mild headache. Patients with recent history of stroke or moderate to severe cognitive impairment were excluded. Results. Mean age was 74.4±6.3 years-old. The prevalence of leukoaraiosis was 68.7%. Leukoaraiosis was significantly correlated with older age, lacunar infarctions, past history off stroke, cognitive impairment and to lower systolic and diastolic velocities in middle cerebral artery (MCA) and higher pulsatility index. Multuvariant analysis only retained the lower diastolic velocity in MCA in the model. Conclusions. Transcranial Doppler can detect hemodynamic abnormalities in patients with leukoaraiosis and is therefore a very useful technique for the evaluation of this entity (AU)

[Gabapentin in 50 patients with epilepsy]. / Gabapentina en 50 pacientes con epilepsia.

OBJECTIVE: To evaluate monotherapy treatment with the anticonvulsant drug gabapentin, its efficacy and tolerability when used in patients with partial and secondary generalized partial epileptic seizures of recent onset who had not received treatment or who, in spite of treatment with other antiepileptic drugs failed to attain control over their seizures. PATIENTS AND METHODS: We made an open prospective study of 50 patients diagnosed as having partial and secondarily generalized partial epileptic seizures. The patients were given treatment at their first visit and them regularly followed up for two years. Treatment was given progressively until a maintenance dose of 1.200 mg/day was reached, and the dose them adjusted individually. RESULTS: We included 50 patients in the study; 78% were treated with gabapentin. Ten percent stopped this treatment because it was ineffective. All the patients who continued their treatment with gabapentin had their seizures reduced by over 50%. This reduction in the number of seizures is statistically significant (p < 0.05) for patients with partial and secondarily generalized partial seizures. Twelve percent of the group of patients stopped their treatment because of side-effects. CONCLUSIONS: When the results of our study are evaluated and compared with those published in the literature, it may be seen that gabapentin is a safe, effective drug which is well tolerated when used as monotherapy for the treatment of patients with partial seizures.

Relación entre alteraciones ultrasonográficas carotídeasy seropositividad frente a Chlamydia pneumoniaeen pacientes con ictus agudo / The relation between carotid ultrasound changes and seropositivity to Chlamydia pneumoniae in patients with acute stroke

Introducción. Varios agentes infecciosos han sido implicados con la aterogénesis en la última década. La Chlamydia pneumoniae es uno de los agentes más frecuentemente relacionados. En nuestro estudio hemos analizado la posible relación entre valores elevados de anticuerpos frente a Chlamydia, y la presencia de alteraciones ultrasonográficas carotídeas en pacientes que han sufrido un ictus. Pacientes y métodos. Se han estudiado 230 pacientes consecutivos ingresados en la Unidad de Ictus de nuestro hospital, con el diagnóstico de ictus. A todos los pacientes incluidos se les ha practicado estudio ultrasonográfico mediante dúplex carotídeo para evaluar el grado de estenosis. También se ha realizado a todos los pacientes un estudio serológico mediante microinmunofluorescencia para la detección de anticuerpos frente a Chlamydia pneumoniae. Resultados. Sólo en 35 pacientes se detecta la presencia de seropositividad frente a Chlamydia pneumoniae. El grado de ateromatosis fue similar en los pacientes que presentaban valores elevados de IgG frente a Chlamydia pneumoniae y aquellos en los que la serología fue negativa. No se detectó una relación estadísticamente significativa entre cualquier grado de estenosis y la seropositividad frente a Chlamydias. Conclusiones. Nuestros datos sugieren que en una población no seleccionada de pacientes con ictus no existe relación entre la ateromatosis carotídea y la presencia de seropositividad frente a Chlamydia pneumoniae. Si existe una relación entre Chlamydia pneumoniae y la ateromatosis carotídea, no parece que la serología sea la técnica adecuada para valorar dicha relación (AU)

[The relation between carotid ultrasound changes and seropositivity to Chlamydia pneumoniae in patients with acute stroke]. / Relación entre alteraciones ultrasonográficas carotídeas y seropositividad frente a Chlamydia pneumoniae en pacientes con ictus agudo.

INTRODUCTION: Several infectious agents have been found to be involved in atherogenesis over the past decade. Chlamydia pneumoniae is one of the commonest associated agents. In this study we have analysed the possible relationship between a high level of antibodies to Chlamydia, and the presence of carotid ultrasound changes in patients who have had strokes. PATIENTS AND METHODS: We studied 230 patients admitted consecutively to the Stroke Unit in our hospital, with the diagnosis of stroke. All the patients in the group had carotid duplex ultrasound studies to assess the degree of stenosis. All these patients also had serological studies using micro-immunofluorescence to detect antibodies to Chlamydia pneumoniae. RESULTS: Only 35 patients were found to have positive Chlamydia pneumoniae serology. The degree of atheromatosis was similar in the patients with high levels of IgG for Chlamydia pneumoniae and in those with normal serology. There was no statistically significant relation between the degree of stenosis and being seropositive for Chlamydiae. CONCLUSIONS: Our findings suggest that in an unselected population of stroke patients there is no relations between carotid atheromatosis and positive serology findings to Chlamydia pneumoniae. If there is any relationship between Chlamydia pneumoniae and carotid atheromatosis, serology does not seem to be a technique which is suitable for its assessment.