Hombro doloroso postictus: estudio epidemiológico y análisis asistencial en el área sanitaria de La Coruña / Post-stroke shoulder pain: Epidemiological study and healthcare analysis on La Coruña health area

Antecedentes y objetivo: El síndrome de hombro doloroso postictus (HDPI) es una de las complicaciones más comunes tras un accidente cerebrovascular. Un estudio español estableció su incidencia en torno el 53% en el año 2001; no hay estudios más recientes. El objetivo de este estudio fue obtener información epidemiológica actualizada del HDPI en España y, secundariamente, obtener información de interés sobre su atención clínica. Pacientes y métodos: Estudio observacional prospectivo sobre 1.000 pacientes. Los pacientes fueron seleccionados de todos los servicios responsables de la asistencia clínica de pacientes postictus de un área sanitaria completa y seguidos durante un año. Fueron analizadas variables sociodemográficas, características del HDPI y factores relacionados con la asistencia médica. Se realizó un análisis descriptivo de las variables, empleando la función de Kaplan Meier para analizar la incidencia acumulada del HDPI. Resultados: Constituyeron la muestra final 576 individuos, de los cuales 119 (21%) presentaron HDPI. El 58% de ellos fue derivado a rehabilitación con un periodo de espera medio de 31 días. El diagnóstico del HDPI se dio en la mayoría de los casos tras el alta hospitalaria. Los servicios de rehabilitación detectaron el 41% de los casos, mientras que los servicios de Atención Primaria detectaron el 26%. Conclusiones. El HDPI es una complicación frecuente. La implementación de una pronta atención rehabilitadora y la reducción del periodo de ingreso hospitalario, en aquellos casos que resulte posible, podrían facilitar su asistencia médica. Una mayor participación de los servicios de rehabilitación y ambulatorios en los protocolos de valoración podría igualmente mejorar el diagnóstico y seguimiento de estos pacientes.

Background and objective: Post-stroke shoulder pain (PSSP) syndrome is a common complication after stroke. The most recent reference (2001) established PSSP incidence in Spain is around 53%. The objective of the current study was to obtain PSSP epidemiological data in Spain at present, obtaining information of interest about its clinical care secondarily. Patients and methods: A prospective observational study was developed on 1,000 patients, which were selected from all levels responsible of stroke patients care of one health area and followed-up during one year. Sociodemographic data, PSSP characteristics and medical care parameters were collected. Descriptive analysis was performed, using modified Kaplan-Meier function to show PSSP cumulative incidence.Results: The final sample consisted of 576 individuals, of which 119 (21%) were diagnosed with PSSP; 58% of the PSSP group was transferred to rehabilitation departments, delaying for a mean of 31 days. Most of patients were diagnosed with PSSP after hospital discharge: rehabilitation departments detected 41% of PSSP cases, while the primary care department detected 26%. Conclusions: PSSP is a frequent complication. Implementing a prompt rehabilitation care and a reduced hospital stay, where possible, could improve the PSSP medical care. Increasing the participation of rehabilitation and primary care departments in the PSSP assessment could substantially improve the diagnosis and follow-up of these patients.

[Endovascular treatment of carotid disease in patients at high surgical risk]. / Tratamiento endovascular de la enfermedad carotídea en pacientes de alto riesgo.

AIMS: To analyse the perioperative morbi-mortality rates during the first 30 days following endovascular therapy in patients with carotid stenosis and important risk factors for surgery. We also sought to determine the survival rate, the percentage of patients that were stroke-free and the percentage of cases of restenosis during the follow-up period. PATIENTS AND METHODS: A retrospective study was conducted on a series of 100 patients with symptomatic > 50% and asymptomatic > 70% carotid stenosis, who underwent endovascular therapy between January 2000 and December 2006 because of the important risk factors they presented. Monitoring was clinical and was performed by means of carotid Doppler scanning. RESULTS: The mean age of the sample: 72.2 years (46-86). Perioperative morbi-mortality of the series: 6% (confidence interval, CI 95% = 0.8-11.2) and in the symptomatic stenosis group: 5.7% (CI 95% = 1.8-12.9). The mean follow-up time was 23.4 months (0-94). Total mortality of the series during the follow-up was 7% (CI 95% = 1.4-12.5). The probability of survival at 3 and 5 years is 93 and 89%, respectively. At one year, 98.9% of the patients remained stroke-free. Restenosis of the stent occurred in 5% (CI 95% = 1.6-11.2). The probability of restenosis not occurring was 96.75% at 6 months and 94% at 3 years. CONCLUSIONS: Stent angioplasty is an effective form of treatment in carotid stenosis in patients with important risk factors for surgery and it is therefore important to fulfil patient selection protocols and avoid perioperative complications.

Tratamiento endovascular de la enfermedad carotídea en pacientes de alto riesgo / Endovascular treatment of carotid disease in patients at high surgical risk

Analizar la morbimortalidad perioperatoria durante los primeros 30 días tras la terapia endovascularen pacientes con estenosis carotídea e importantes factores de riesgo para la cirugía, y determinar la supervivencia, el porcentaje de pacientes libres de ictus, así como el porcentaje de reestenosis durante el tiempo de seguimiento. Pacientes y métodos.Se ha realizado un estudio retrospectivo de una serie de 100 pacientes con estenosis carotídeas sintomáticas > 50% y asintomáticas > 70% a los que se realizó terapia endovascular entre enero de 2000 y diciembre de 2006 por presentar importantes factores de riesgo. El seguimiento ha sido clínico mediante Doppler carotídeo. Resultados. Media de edad de la muestra: 72,2 años (rango: 46-86 años). Morbimortalidad perioperatoria de la serie: 6% (IC 95% = 0,8-11,2) y en el grupo de estenosissintomática: 5,7% (IC 95% = 1,8-12,9). El tiempo medio de seguimiento fue de 23,4 meses (rango: 0-94 meses). Lamortalidad total de la serie durante el seguimiento fue del 7% (IC 95% = 1,4-12,5). La probabilidad de supervivencia a los 3 y 5 años es del 93% y 89%, respectivamente. El 98,9% ha permanecido libre de ictus al año. Se produjo reestenosis del stenten el 5% (IC 95% = 1,6-11,2). La probabilidad de que no se produzca reestenosis es del 96,75% a los 6 meses y del 94% a los 3 años. Conclusiones. La angioplastia con stent es un tratamiento efectivo en estenosis carotídea en pacientes con importantes factores de riesgo para la cirugía, de ahí la importancia de realizar protocolos de selección de pacientes y evitar las complicaciones periprocedimiento

To analyse the perioperative morbi-mortality rates during the first 30 days following endovascular therapyin patients with carotid stenosis and important risk factors for surgery. We also sought to determine the survival rate, the percentage of patients that were stroke-free and the percentage of cases of restenosis during the follow-up period. Patients andmethods. A retrospective study was conducted on a series of 100 patients with symptomatic > 50% and asymptomatic > 70% carotid stenosis, who underwent endovascular therapy between January 2000 and December 2006 because of the important risk factors they presented. Monitoring was clinical and was performed by means of carotid Doppler scanning. Results. The mean age of the sample: 72.2 years (46-86). Perioperative morbi-mortality of the series: 6% (confidence interval, CI 95% =0.8-11.2) and in the symptomatic stenosis group: 5.7% (CI 95% = 1.8-12.9). The mean follow-up time was 23.4 months (0-94). Total mortality of the series during the follow-up was 7% (CI 95% = 1.4-12.5). The probability of survival at 3 and 5 years is 93 and 89%, respectively. At one year, 98.9% of the patients remained stroke-free. Restenosis of the stent occurred in 5% (CI95% = 1.6-11.2). The probability of restenosis not occurring was 96.75% at 6 months and 94% at 3 years. Conclusions. Stent angioplasty is an effective form of treatment in carotid stenosis in patients with important risk factors for surgery and it istherefore important to fulfil patient selection protocols and avoid perioperative complications (AU)

Estudio observacional sobre seguridad, tolerabilidad y efectividad de la galantamina en pacientes con enfermedad de Alzheimer leve a moderadamente grave / Observational study on safety, tolerability and effectiveness of galantamine in patients with mild to moderately severe Alzheimer's disease

Introducción. Ensayos clínicos controlados han demostrado la seguridad, tolerabilidad y efectividad de la galantamina en pacientes con enfermedad de Alzheimer (EA). Se presenta un estudio realizado en España, de carácter observacional y multicéntrico, con galantamina en el tratamiento de la EA leve a moderadamente grave en condiciones asistenciales reales. Métodos. Se llevaron a cabo cinco visitas durante un período de observación de 6 meses. El tratamiento con galantamina fue iniciado según la pauta estándar. Se recogieron todos los acontecimientos adversos (AA) comunicados por los pacientes, con especial atención a los considerados graves. También se exploraron las áreas cognitiva, actividades de la vida diaria, los síntomas conductuales y la calidad del sueño. Resultados. De los 723 pacientes reclutados se excluyeron 74, quedando una muestra total de 649 (71% mujeres y 29% varones). El 56.3% completó todas las visitas. La puntuación basal media del Mini-Examen Cognoscitivo (MEC) fue de 19,4 (DE: 4,7). El 29,3% de los pacientes comunicaron un total de 400 AA. Los AA más frecuentes fueron: náuseas (9,7%), vómitos (7,1), mareo (4,6%) y diarrea (4,5%). La puntuación del MEC se estabilizó a lo largo del estudio y hubo diferencias significativas favorables en la valoración de la conducta y la calidad del sueño. Conclusiones. La galantamina es un tratamiento bien tolerado en pacientes con EA leve a moderadamente grave y ha mostrado efectividad cognitiva, funcional y conductual en la práctica clínica habitual (AU)

INTRODUCTION: Several controlled clinical trials have demonstrated safety, tolerability, and efficacy of galantamine in patients with Alzheimer's disease (AD). We present an observational and multicenter study carried out in Spain. Its main objective was the assessment of the safety and tolerability of galantamine in the treatment of mild to moderately severe dementia of the Alzheimer type under real clinical conditions. METHODS: The study had five visits over a 6-month period. Titration of galantamine was performed on a standard basis. All the adverse events (AE) reported were recorded. Serious AE were particularly considered. Effectiveness was also assessed covering cognitive, functional, behavioral and sleep domains. RESULTS: 723 patients were enrolled but 74 were excluded, a sample of 649 (71% women and 29% men) remaining. A total of 56.3% patients completed all visits. Baseline Mini-Mental mean score was 19,4 (SD: 4,7). Up to 400 AEs were collected from 29.3% of the patients. The commonest AEs were: nausea (9.7%), vomiting (7.1%), dizziness (4.6%), and diarrhea (4.5%). Mini-Mental scores were stable over time and favorable and significant differences in behavioral and sleep evaluations were observed. CONCLUSIONS: Galantamine is a safe and well-tolerated treatment, and provides cognitive, functional, and behavioral benefits in patients with mild to moderately severe AD (AU)

[Observational study on safety, tolerability and effectiveness of galantamine in patients with mild to moderately severe Alzheimer's disease]. / Estudio observacional sobre seguridad, tolerabilidad y efectividad de la galantamina en pacientes con enfermedad de Alzheimer leve a moderadamente grave.

INTRODUCTION: Several controlled clinical trials have demonstrated safety, tolerability, and efficacy of galantamine in patients with Alzheimer's disease (AD). We present an observational and multicenter study carried out in Spain. Its main objective was the assessment of the safety and tolerability of galantamine in the treatment of mild to moderately severe dementia of the Alzheimer type under real clinical conditions. METHODS: The study had five visits over a 6-month period. Titration of galantamine was performed on a standard basis. All the adverse events (AE) reported were recorded. Serious AE were particularly considered. Effectiveness was also assessed covering cognitive, functional, behavioral and sleep domains. RESULTS: 723 patients were enrolled but 74 were excluded, a sample of 649 (71% women and 29% men) remaining. A total of 56.3% patients completed all visits. Baseline Mini-Mental mean score was 19,4 (SD: 4,7). Up to 400 AEs were collected from 29.3% of the patients. The commonest AEs were: nausea (9.7%), vomiting (7.1%), dizziness (4.6%), and diarrhea (4.5%). Mini-Mental scores were stable over time and favorable and significant differences in behavioral and sleep evaluations were observed. CONCLUSIONS: Galantamine is a safe and well-tolerated treatment, and provides cognitive, functional, and behavioral benefits in patients with mild to moderately severe AD.

Colitis linfocitaria inducida por carbamacepina / Lymphocytic colitis induced for carbamazepine

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Secreción inadecuada de hormona antidiurética secundaria a paroxetina / Inappropriate secretion of antidiuretic hormone secondary to paroxetine

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Colitis linfocitaria inducida por carbamacepina / Lymphocityc colitis induced for carbamazepine

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Obstrucción traumática bilateral de la arteria carótida interna / Traumatic bilateral internal carotid artery obstruction

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[Opsoclonus-myoclonus syndrome in patient with ovarian cancer]. / Síndrome opsosclonus -mioclonus en paciente con cáncer de ovario.

The opsoclonus-myoclonus syndrome is a rare entity as a paraneoplastic disorder usually associated to neuroblastoma in children and breast cancer or oat-cell lung carcinoma in adults. The association of opsoclonus-myoclonus syndrome and ovarian carcinoma is very unusual, to our knowledge there is only two cases reported in the literature. In both of them the opsoclonus-myoclonus syndrome preceded the neoplasy, improving with its treatment. In our patient opsoclonus began after ovarian cancer diagnosis, after chemotherapy and radiotherapy, improving with corticoid and clonazepan therapy.

Síndrome opsoclonus-mioclonus en paciente con cáncer de ovario / Opsoclonus-myoclonus syndrome in patient with ovarian cancer

El síndrome opsoclonus-mioclonus (SOM) es un trastorno poco frecuente que ha sido descrito como manifestación paraneoplásica, fundamentalmente asociado al neuroblastoma en niños y a tumores de mama y pulmón en adultos. La asociación con cáncer de ovario es excepcional habiéndose descrito sólo dos casos en la literatura; en ambos el patrón clínico fue similar precediendo el SOM a la neoplasia y mejorando con el tratamiento de la misma. A diferencia de estos en el caso que presentamos, el SOM se manifestó posteriormente al diagnóstico de cáncer de ovario, después del tratamiento de quimioterapia y radioterapia, mejorando con corticoides y clonazepan (AU)

Paraparesia progresiva secundaria a fístula arterio venosa dural espinal / Progressive paraparesis secondary to spinal dural arteriovenous fistula

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Posterior alien hand syndrome after a right thalamic infarct.

The alien hand syndrome, as originally defined, should be reserved for cases in which the hand feels foreign "together with" observable involuntary motor activity. These involuntary movements are unusual during or after acute stroke. Three varieties of alien hand syndrome have been reported, involving lesions of the corpus callosum alone, the corpus callosum plus dominant medial frontal cortex, and posterior cortical and subcortical areas. A patient with posterior alien hand syndrome of vascular aetiology is reported. Imaging studies disclosed an isolated infarction of the right thalamus sparing other cerebral regions.

Hipersensibilidad a fármacos antiepilépticos / Hipersensitivity syndrome due to antiepileptic drug

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