Derivación lumbo-peritoneal: análisis de 18 casos y revión bibliográfica / Lumbo-peritoneal derivatons: analysis of 18 cases and bibliographic review

Se analizan 18 casos de pacientes derivados con un sistema lumbo-periotoneal (DLP) entre junio de 1991 y junio del 2000 en nuestro servicio. Siete pacientes presentaron hidrocefalia comunicante (4 post-meningiticas y 3 post-HSA), 4 fistulas de liquido cefalorraquídeo (LCR), 4 pacientes hipertensión endocraneana benigna y 2 hidrocefalía normotensiva. Catorce de los 18 casos (83,3 por ciento) resolvieron su problema con la derivación, mientras que los restantes 4 no lo hicieron y requirieron de otro tipo de sistema o tratamiento. Las complicaciones mas frecuentemente observadas fueron dolor radicular y cefaléa a la sedestación. El sistema debió ser revisado en 5 pacientes. El análisis bibligráfico muestran cifras similares a las halladas en esta serie, respecto a indices de reexploraciones y éxitos terapéuticos. En conclusión, la DLP es un metodo de derivación de LCR en las hidrocefalías comunicantes de cualquier etiología, en fístulas de LCR abiertas o cerradas y en hipertensión endocraneana benigna. Presenta indice bajo de fracasos terapéuticos, pero como contralpartida genera una relativamente alta tasa de disfunsiones y complicaciones leves, que suelen requerir reexploraciones quirúrgicas frecuentes. (AU)

Derivación lumbo-peritoneal: análisis de 18 casos y revión bibliográfica / Lumbo-peritoneal derivatons: analysis of 18 cases and bibliographic review

Se analizan 18 casos de pacientes derivados con un sistema lumbo-periotoneal (DLP) entre junio de 1991 y junio del 2000 en nuestro servicio. Siete pacientes presentaron hidrocefalia comunicante (4 post-meningiticas y 3 post-HSA), 4 fistulas de liquido cefalorraquídeo (LCR), 4 pacientes hipertensión endocraneana benigna y 2 hidrocefalía normotensiva. Catorce de los 18 casos (83,3 por ciento) resolvieron su problema con la derivación, mientras que los restantes 4 no lo hicieron y requirieron de otro tipo de sistema o tratamiento. Las complicaciones mas frecuentemente observadas fueron dolor radicular y cefaléa a la sedestación. El sistema debió ser revisado en 5 pacientes. El análisis bibligráfico muestran cifras similares a las halladas en esta serie, respecto a indices de reexploraciones y éxitos terapéuticos. En conclusión, la DLP es un metodo de derivación de LCR en las hidrocefalías comunicantes de cualquier etiología, en fístulas de LCR abiertas o cerradas y en hipertensión endocraneana benigna. Presenta indice bajo de fracasos terapéuticos, pero como contralpartida genera una relativamente alta tasa de disfunsiones y complicaciones leves, que suelen requerir reexploraciones quirúrgicas frecuentes.

Intracranial hypotension: the nonspecific nature of MRI findings.

We present three patients who complained of postural headache related to different types of intracranial hypotension: spontaneous or primary, and secondary, but presenting the same findings on brain magnetic resonance imaging. Diffuse pachymeningeal gadolinium enhancement supports the belief that the enhancement is a nonspecific meningeal reaction to low pressure.

Plasma met-enkephalin and catecholamine changes during the menstrual cycle and pain episode in menstrual migraine.

In order to explore opioid, sympathetic and hormonal parameters, we evaluated plasma met-enkephalin (ME), catecholamines (CA), estradiol (E2) and progesterone (P) in different phases of the menstrual cycle and during menstrual crisis in women suffering from menstrual migraine (MM) and in controls. No differences in P and E2 were found between controls and patients. We observed an increase in plasma ME and a decrease in plasma free norepinephrine (NE) levels on day 22 in MM group and an increase in plasma ME, free NE and total epinephrine (E) during pain. Our data, although obtained in a small number of patients, show clear modifications in plasma ME and in the sympathoadrenal function, not only during pain but also in the mid luteal phase.

Plasma met-enkephalin levels: its relationship with age and type of headache.

The aim of the present study was to assess the peripheral proenkephalin-A system in order to determine if it is related in any way to age and/or the type of headache. Our results show no significant change in plasma met-enkephalin (ME) and neutrophil met-enkephalin-containing peptide (NMECP) with aging in controls. Plasma ME levels and NMECP in patients suffering from migraine without aura and tension-type headaches were found to be similar in both groups, younger and older than 60 years old. When ME plasma levels were compared among the three groups of subjects in the two age-groups, only chronic tension-type headache patients differed ( [Formula: see text] ) from both controls and migraine without aura subjects.

Opioid and sympathetic nervous system activity in cluster headache under verapamil or prednisone treatment.

This study was undertaken to evaluate the effect of treatment with prednisone or verapamil on plasma met-enkephalin (ME), neutrophil met-enkephalin containing peptides (NMECP) and free and conjugated plasma catecholamines (CA) in cluster headache (CH) patients. After obtaining a basal sample, patients were randomly selected to be treated with either verapamil (n = 5) or prednisone (n = 5). A second blood sample was obtained 10 days after starting treatment. At this time all patients were free of symptoms. ME (0.49 +/- 0.10 pmol/mL) and NMECP (35.1 +/- 2.4 pmol/mg protein) levels after prednisone treatment were significantly higher (P < 0.05) than in basal conditions (0.29 +/- 0.08 pmol/mL and 27.14 +/- 2.4 pmol/mg protein), while no differences were found in catecholamine levels. No differences in ME, NMECP or CA were found during verapamil treatment. Our results suggest that in CH the two drugs act through different mechanisms. The relief of the bout obtained with prednisone may be related to the opioid system stimulation observed in these patients.

Sympathetic adrenomedullary activity in cluster headache.

It is well known that autonomic phenomena, such as lacrimation, rhinorrhea, and Horner's syndrome, are associated with the pain attacks in episodic cluster headache. In order to elucidate the cause of these symptoms we studied plasma free and sulphoconjugated catecholamines in cluster headache patients during the pain attacks and in the following hours, as well as during the remission period. No change in these amine levels was found. We conclude that dysautonomic symptoms are not reflected in plasma catecholamine modification.

Changes in neutrophil met-enkephalin containing peptides in episodic cluster headache.

We have previously demonstrated an increase in plasma met-enkephalin levels during the pain attacks in episodic cluster headache. The present study was undertaken in order to clarify the source of the plasma met-enkephalin increase. Recent evidence has shown that peripheral blood polymorphonuclear cells contain peptides derived from the proenkephalin A system, which can be released by specific stimuli. We studied neutrophil met-enkephalin containing peptides (NMECP) in 27 episodic cluster headache patients: 24 in a cluster period (6 of them during a pain attack), and 3 in the remission period. Neutrophil met-enkephalin containing peptide levels (after sequential enzymatic digestion with trypsin and carboxypeptidase B) were determined by radioimmunoassay with specific antiserum. Neutrophil peptide concentration (pmol/mg prot) was lower (p less than 0.01) in patients during the pain attack (14.4 +/- 0.36) than after their pain had subsided (36.7 +/- 0.31) and lower than in the remission period patients (35.8 +/- 0.4). We conclude that neutrophil met-enkephalin containing peptides decrease during pain in episodic cluster headache, and that they may be involved in the concomitant plasma met-enkephalin increase.

Increase in plasma methionine-enkephalin levels during the pain attack in episodic cluster headache.

Since high levels of endogenous opioids (endorphins, enkephalins) were found in brain areas classically related to nociception, their peripheral levels in humans were studied in different pain syndromes yielding contradictory results. This study was undertaken to assess changes in plasma methionine-enkephalin (met-enkephalin) levels in patients with episodic cluster headache associated with the pain period. Twenty-nine patients, 24 in the cluster period (6 of them during an attack) and 3 in the remission period were studied. Two other patients were subjected to a longitudinal follow-up. Plasma met-enkephalin levels were determined by radioimmunoassay (RIA) with specific antibody. Plasma peptide concentration (pmol/ml) was higher (p less than 0.001) in patients during the pain attack (3.97 +/- 1.18) than in controls (0.25 +/- 0.03). When measured 4 and 48 h after the pain attack lower levels were found (0.46 +/- 0.06) which decreased to control values after 24 h. These results may suggest involvement of peripheral enkephalins in pain modulation in patients with episodic cluster headache.

Photosensitive epilepsy. Electrophysiological aspects.

Intermittent light stimulation (ILS) is more effective to trigger electroencephalographic paroxysms when the patient remains with his eyes closed. In order to evaluate the relative value of the different factors involved, 9 patients of matched age and sex were studied. EEG with ILS, electroretinogram and visual evoked potentials with a flash stimulus were performed under different conditions: open eyes with white, red and blue light, closed eyes and diffusing screen. Analysed in toto, results obtained in the different studies suggest that (a) the factor with greater capability to produce alterations in photosensitive epilepsy is the diffusion of light encompassing a bigger area of the stimulated retina and (b) not only the brain structures but also the retina itself would be involved in the mechanisms underlying the phenomenon of photosensitivity in these patients.

Photosensitive epilepsy: electrophysiological aspects

La estimulación luminosa intermitente (ELI) resulta más efectiva en desencadenar paroxismos electroencefalográficos cuando el paciente permanece con los párpados cerrados. Para evaluar el valor relativo de los distintos factores potencialmente involucrados en este hecho, se estudiaron 9 pacientes epilépticos fotosensibles (E.F.) y un grupo de controles normales con edades y sexo equiparable. Se practicó: EEG con ELI, electroretinograma y potenciales evocados visuales con estímulo flash en diferentes condiciones: ojos abiertos con luz blanca, roja y azula, párpados cerrados y pantalla difusora. Analizados en conjunto, los resultados obtenidos en los distintos estudios sugieren que (a) el factor de mayor capacidad para producir alteraciones en los E.F. es la difusión de la luz abarcando un área mayor de la retina estimulada y (b) no solo las estructuras cerebrales sino además la retina misma se encontraría en alguna medida involucrada en los mecanismos que subyacen el fenómeno de la fotosensibilidad en estos pacientes

Photosensitive epilepsy: electrophysiological aspects

La estimulación luminosa intermitente (ELI) resulta más efectiva en desencadenar paroxismos electroencefalográficos cuando el paciente permanece con los párpados cerrados. Para evaluar el valor relativo de los distintos factores potencialmente involucrados en este hecho, se estudiaron 9 pacientes epilépticos fotosensibles (E.F.) y un grupo de controles normales con edades y sexo equiparable. Se practicó: EEG con ELI, electroretinograma y potenciales evocados visuales con estímulo flash en diferentes condiciones: ojos abiertos con luz blanca, roja y azula, párpados cerrados y pantalla difusora. Analizados en conjunto, los resultados obtenidos en los distintos estudios sugieren que (a) el factor de mayor capacidad para producir alteraciones en los E.F. es la difusión de la luz abarcando un área mayor de la retina estimulada y (b) no solo las estructuras cerebrales sino además la retina misma se encontraría en alguna medida involucrada en los mecanismos que subyacen el fenómeno de la fotosensibilidad en estos pacientes (AU)

Photosensitive epilepsy. Electrophysiological aspects.

Intermittent light stimulation (ILS) is more effective to trigger electroencephalographic paroxysms when the patient remains with his eyes closed. In order to evaluate the relative value of the different factors involved, 9 patients of matched age and sex were studied. EEG with ILS, electroretinogram and visual evoked potentials with a flash stimulus were performed under different conditions: open eyes with white, red and blue light, closed eyes and diffusing screen. Analysed in toto, results obtained in the different studies suggest that (a) the factor with greater capability to produce alterations in photosensitive epilepsy is the diffusion of light encompassing a bigger area of the stimulated retina and (b) not only the brain structures but also the retina itself would be involved in the mechanisms underlying the phenomenon of photosensitivity in these patients.