[Stroke in the very old. Care in neurology units versus others general medical ward]. / Ictus en pacientes muy mayores. Análisis comparativo entre una unidad de neurología y otros servicios de medicina.

INTRODUCTION: The aim of this study is to compare the diagnosis, management, clinical course and outcome of the very major patients with acute stroke in our sanitary area. METHOD: Retrospective collection of data from a hospital-based registry, between January 2002 and March 2004, 130 stroke patients aged 84 and older admitted consecutively. We compared the patients admitted to the neurology unit (NU) to those admitted to other services (GWs). Demographic analysis, risk factors, morbidity to hospital admission (dementia, cancer, previous stroke and laboratory variables), neurological deficit measured for Canadian Neurological Scale (CNS) score, diagnostic studies, length of stay, outcomes variables (in-hospital mortality, complications developed during hospitalization and Rankin scale at hospital discharge) and need for institutionalization were analyzed. RESULTS: from a total of 130 patients, 44 (34,1 %) admitted to NU and 85 (65,9 %) to GWs. No difference was seen in demographic analysis, risk factors, morbidity to hospital admission, neurological deficit and outcomes variables. Length of stay was 8,4 days; 5,5 in the NU and 12,87 days among patients in the GWs (p=0,0001). There are significant differences in diagnostic studies in favor to NU (p < 0,05). Among the patients admitted into GWs the percentage of institutionalization to the discharge was of 28,8 % opposite to 5,6 % in the NU (p=0,006). CONCLUSIONS: There are not evidences of age discrimination for access to neurological units for demographic, risk factors, morbidity or neurological deficit. The diagnostic process is more rigorous and less costly in the NU than in the GWs.

Fracaso renal agudo tras ingestión de setas: síndrome orellánico / Oliguric acute renal failure as a complication of treatment of an infrarenal aortic aneurysm by implantation of an aortic stent

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Ictus en pacientes muy mayores. Análisis comparativo entre una unidad de neurología y otros servicios de medicina / Stroke in the very old. Care in neurology units versus others general medical ward

Introducción. El ánimo de este estudio es comparar elproceso diagnóstico, manejo, curso clínico y pronóstico delos pacientes muy mayores ingresado con un ictus agudo ennuestra área sanitaria.Método. Análisis retrospectivo de los pacientes de 84 añoso más ingresados de forma consecutiva con un ictus agudo enla unidad de neurología (UN) frente a los ingresados en unidadesde medicina interna o geriatría (grupo MIG) entre enero 2002y marzo 2004. Se analizaron variables demográficas, factoresde riesgo, morbilidad en el momento del ingreso (demencia,cáncer, ictus previo y parámetros de laboratorio), déficit neurológicomedido por la Escala Canadiense (CNS), estudios diagnósticos,estancia media, pronóstico (mortalidad intrahospitalaria,complicaciones desarrolladas durante la hospitalizacióny escala de Rankin al alta) y necesidad de institucionalización.Resultados. De un total de 130 pacientes, 44 (34,1 %)ingresaron en la UN y 85 (65,9 %) en la MIG. No se observarondiferencias en el análisis demográfico, factores de riesgo,morbilidad previa al ictus, gravedad clínica o variablespronósticas. La estancia media fue de 8,4 días; 5,5 días en laUN y 12,87 días en los pacientes ingresados en MIG (p =0,0001). La realización de estudios diagnósticos es más exhaustivaen la UN (p<0,05). En los pacientes ingresados enel grupo MIG el porcentaje de institucionalización al altafue del 28,8 % frente a un 5,6% en la UN (p=0,006).Conclusiones. No hay evidencias de discriminación parael ingreso de los pacientes muy mayores con ictus en neurologíapor criterios demográficos, factores de riesgo, morbilidado gravedad al ingreso. El proceso diagnóstico es más rigurosoy menos costoso en la UN que en el grupo MIG (AU)

Introduction. The aim of this study is to comparethe diagnosis, management, clinical course and outcomeof the very major patients with acute stroke in our sanitaryarea.Method. Retrospective collection of data from a hospital-based registry, betwen January 2002 and March2004, 130 stroke patients aged 84 and older admittedconsecutively. We compared the patients admited to theneurology unit (NU) to those admitted to other services(GWs). Demographic analysis, risk factors, morbidity tohospital admission (dementia, cancer, previous strokeand laboratory variables), neurological deficit measuredfor Canadian Neurological Scale (CNS) score, diagnosticstudies, length of stay, outcomes variables (in-hospitalmortality, complications developed during hospitalizationand Rankin scale at hospital discharge) and need forinstitutionalization were analyzed.Results. from a total of 130 patients, 44 (34,1 %) admittedto NU and 85 (65,9 %) to GWs. No difference wasseen in demographic analysis, risk factors, morbidity tohospital admission, neurological deficit and outcomesvariables. Length of stay was 8,4 days; 5,5 in the NU and12,87 days among patients in the GWs (p=0,0001). Thereare significant differences in diagnostic studies in favorto NU (p < 0,05). Among the patients admitted intoGWs the percentage of institutionalization to the dischargewas of 28,8 % opposite to 5,6 % in the NU(p=0,006).Conclusions. There are not evidences of age discriminationfor access to neurological units for demographic,risk factors, morbidity or neurological deficit. Thediagnostic process is more rigorous and less costly in theNU than in the GWs (AU)

Neuralgia amiotrófica bilateral y simétrica que simula el síndrome del ‘hombre en el barril’ / Bilateral symmetrical amyotrophic neuralgia mimicking man-in-the-barrel syndrome

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[Herpes simplex encephalitis in Cáceres. An analysis of the last five years]. / Encefalitis herpética en Cáceres. Análisis de los últimos cinco años.

INTRODUCTION: Herpes simplex encephalitis (HSE) is a rare disease, although it is still the most common serious viral infection of the central nervous system. Little is currently known about its epidemiology and clinical features in our area. This paper presents a retrospective description of the clinical, diagnostic and progressive characteristics of patients diagnosed with HSE in Cáceres General Hospital, and confirmed by means of a polymerase chain reaction (PCR) study for the DNA of the herpes simplex virus over the last 5 years. CASE REPORTS: We found four patients who had been diagnosed with HSE in the last 5 years (3.3 cases/million inhabitants/year; CI at 95% of 2.42-4.18), two males and two females, with an age interval between 58 and 75 years. All the patients had high temperatures and three of them also presented neurological focus. A computerised axial tomography scan of the head performed on admission was interpreted as being normal in all cases, while magnetic resonance imaging of the head carried out in two patients showed lesions compatible with HSE in both cases. Electroencephalographic studies were carried out in two patients and revealed focusing in one of them and severe generalised involvement in the other. Analysis of the cerebrospinal fluid (CSF) disclosed lymphocytic meningitis in four cases, although in one of them the study was normal on admission. In two of the patients, viral meningoencephalitis was suspected from the moment the patient was admitted to hospital. For this reason, early treatment with IV acyclovir was established and the clinical progression was good in both patients, although one of them was left with mild neurological sequelae. The other two cases, who died, had a severe underlying pathology and alternative clinical diagnoses that were reasonable on admission (extensive pneumonia and delirium tremens in one of them, and hypercapnic encephalopathy with severe chronic obstructive pulmonary disease in the other), and the clinical suspicion of HSE and the establishment of treatment were late. CONCLUSIONS: The incidence of HSE in our environment is in the upper interval of that reported in the literature. PCR analysis for the herpes simplex virus in CSF seems to have replaced brain biopsy studies as the diagnostic technique. The underlying severe chronic pathology makes it more difficult to diagnose and worsens the prognosis. A multicentre epidemiological study should be conducted to confirm these findings.

Encefalitis herpética en Cáceres. Análisis de los últimos cinco años / Herpes simplex encephalitis in cáceres. an analysis of the last five years

Introducción. La encefalitis herpética (EH) es una enfermedad rara, aunque la más frecuente de las infecciones víricas humanas graves del sistema nervioso central. La epidemiología y las características clínicas en nuestra zona son actualmente poco conocidas. Se describen retrospectivamente las características clínicas, diagnósticas y evolutivas de los enfermos de EH diagnosticados en el Hospital General de Cáceres, confirmados por el estudio de la reacción en cadena de la polimerasa (PCR) para el ADN del virus del herpes simple en los últimos 5 años. Casos clínicos. Encontramos cuatro pacientes diagnosticados de EH en los últimos 5 años (3,3 casos/millón de habitantes/año; IC al 95%: 2,42-4,18), dos varones y dos mujeres, con un intervalo de edad entre 58 y 75 años. Todos los enfermos presentaron fiebre y tres de ellos, focalidad neurológica. El estudio de tomografía axial computarizada craneal en el momento de su ingreso se interpretó como normal en todos, mientras que la resonancia magnética nuclear craneal, que se realizó en dos pacientes, mostró lesiones compatibles con EH en ambos. En dos enfermos se practicó un estudio de electroencefalografía, que demostró focalidad en un paciente y afectación generalizada grave en otro. El análisis del líquido cefalorraquídeo (LCR) puso de manifiesto meningitis linfocitaria en los cuatro casos, aunque en uno de ellos el estudio fue normal cuando ingresó. En dos de los pacientes, la sospecha de meningoencefalitis vírica se produjo desde el momento del ingreso, por lo que se instauró precozmente un tratamiento con aciclovir IV, con evolución clínica favorable en ambos, aunque con ligeras secuelas neurológicas en uno de ellos. Los otros dos casos, que fallecieron, presentaban una patología grave de base y diagnósticos clínicos alternativos razonables en el momento del ingreso (neumonía extensa y delirium tremens uno de ellos y encefalopatía hipercápnica en paciente con enfermedad pulmonar obstructiva crónica grave el otro), y se retrasó la sospecha clínica de EH y el inicio del tratamiento. Conclusiones. La incidencia de EH en nuestro medio se encuentra en el intervalo alto de la descrita en la literatura. El análisis de PCR para el virus herpes simple en el LCR parece haber desplazado como técnica diagnóstica a la biopsia cerebral. La patología crónica grave subyacente dificulta su diagnóstico y ensombrece el pronóstico. Convendría realizar un estudio epidemiológico multicéntrico para confirmar estos hallazgos

Introduction. Herpes simplex encephalitis (HSE) is a rare disease, although it is still the most common serious viral infection of the central nervous system. Little is currently known about its epidemiology and clinical features in our area. This paper presents a retrospective description of the clinical, diagnostic and progressive characteristics of patients diagnosed with HSE in Cáceres General Hospital, and confirmed by means of a polymerase chain reaction (PCR) study for the DNA of the herpes simplex virus over the last 5 years. Case reports. We found four patients who had been diagnosed with HSE in the last 5 years (3.3 cases/million inhabitants/year; CI at 95% of 2.42-4.18), two males and two females, with an age interval between 58 and 75 years. All the patients had high temperatures and three of them also presented neurological focus. A computerised axial tomography scan of the head performed on admission was interpreted as being normal in all cases, while magnetic resonance imaging of the head carried out in two patients showed lesions compatible with HSE in both cases. Electroencephalographic studies were carried out in two patients and revealed focusing in one of them and severe generalised involvement in the other. Analysis of the cerebrospinal fluid (CSF) disclosed lymphocytic meningitis in four cases, although in one of them the study was normal on admission. In two of the patients, viral meningoencephalitis was suspected from the moment the patient was admitted to hospital. For this reason, early treatment with IV acyclovir was established and the clinical progression was good in both patients, although one of them was left with mild neurological sequelae. The other two cases, who died, had a severe underlying pathology and alternative clinical diagnoses that were reasonable on admission (extensive pneumonia and delirium tremens in one of them, and hypercapnic encephalopathy with severe chronic obstructive pulmonary disease in the other), and the clinical suspicion of HSE and the establishment of treatment were late. Conclusions. The incidence of HSE in our environment is in the upper interval of that reported in the literature. PCR analysis for the herpes simplex virus in CSF seems to have replaced brain biopsy studies as the diagnostic technique. The underlying severe chronic pathology makes it more difficult to diagnose and worsens the prognosis. A multicentre epidemiological study should be conducted to confirm these findings

[Eosinophilic gastroenteritis: two cases report]. / Gastroenteritis eosinofílica: a propósito de dos casos.

Eosinophilic gastroenteritis is a rare condition characterized by eosinophilic infiltration or the different layers of the intestinal wall. Clinical symptoms depend of the site of eosinophilic infiltration and the layers involved. Usually characterized by peripheral eosinophilia. Definitive diagnosis is based on histopathological findings. We report two cases with excellent response to steroid therapy.

Gastroenteritis eosinofílica: a propósito de dos casos / Eosinophilic gastroenteritis: two cases report

La gastroenteritis eosinofílica es una enfermedad poco frecuente, caracterizada por la presencia de un infiltrado eosinófilo que puede afectar a las distintas capas de la pared intestinal. Las manifestaciones clínicas son variables y los síntomas dependen del grado de infiltración y del número de capas afectadas. Se caracteriza por presentar, en la mayoría de los casos, eosinofília periférica. Su diagnóstico definitivo es anatomopatologico. Aportamos dos casos, ambos con excelente respuesta al tratamiento esteroideo (AU)