[Seizures in the emergency service: the clinical and therapeutic characteristics of 122 patients]. / Crisis en urgencias: una vista a las características clínicas y terapéuticas a través de 122 pacientes.

INTRODUCTION: Epileptic seizures are a common cause of admission in emergency services at hospitals. Performing the correct diagnosis can be difficult, and deciding when and which anti-seizure medication (ASM) to prescribe is critical. Our objective is to detail the characteristics of patients treated in a medium-sized hospital for this reason. PATIENTS AND METHODS: A retrospective observational study was performed, including all the adult patients treated by the emergency service of the Lucus Augusti University Hospital between January 2022 and January 2023 with a diagnosis of epileptic seizure on discharge. The study recorded their demographic variables, history, whether it was their first seizure, the number of seizures, whether an anti-seizure medication was administered and which one, the diagnosis, the tests performed, and whether the patient was referred to the neurology service. RESULTS: A total of 122 patients were diagnosed with epileptic seizures in the emergency service. 50.8% of the patients were women. The mean age was 69.8 years. Neurological assessment was requested for 47.6%. 50.8% presented their first seizure. No diagnosis was performed in 46% of the cases, of which only 10 were evaluated by the neurology service. The most common etiology was vascular. An electroencephalogram was performed on 41.8%. Levetiracetam was practically the only drug administered when the neurology department was not consulted. CONCLUSIONS: Early evaluation of patients with their first seizure in the emergency service by a neurological specialist is crucial for the diagnosis of epilepsy. The same anti-seizure medication is almost always prescribed when no cross-consultation takes place.

TITLE: Crisis en urgencias: una vista a las características clínicas y terapéuticas a través de 122 pacientes.Introducción. Las crisis epilépticas son un motivo frecuente de consulta en los servicios de urgencias hospitalarias. Llegar al diagnóstico correcto puede ser complejo, y es fundamental decidir cuándo y qué medicamento anticrisis (MAC) pautar. Nuestro objetivo es detallar las características de los pacientes que consultaron por este motivo en un hospital mediano. Pacientes y métodos. Estudio observacional retrospectivo de todos los pacientes mayores de edad que consultaron en el servicio de urgencias del Hospital Universitario Lucus Augusti entre enero de 2022 y enero de 2023 con diagnóstico al alta de crisis epiléptica. Se registraron variables demográficas, los antecedentes, si era una primera crisis, el número de éstas, si se inició un MAC y cuál, el diagnóstico, qué pruebas se realizaron y si se interconsultó con la guardia de neurología. Resultados. Se diagnosticó a 122 pacientes de crisis epilépticas en urgencias. El 50,8% eran mujeres. La media de edad fue de 69,8 años. Se solicitó valoración por neurología en un 47,6%. El 50,8% presentó una primera crisis. No se llegó al diagnóstico en un 46% de los casos, de los cuales sólo 10 fueron valorados por neurología. La etiología más frecuente fue la vascular. Se realizó un electroencefalograma en un 41,8%. El levetiracetam fue prácticamente el único fármaco utilizado cuando no se consultó con neurología. Conclusiones. La valoración precoz de los pacientes con una primera crisis en urgencias por un especialista en neurología es determinante para el diagnóstico de epilepsia. Cuando no se interconsulta, casi siempre se pauta el mismo MAC.

Enfermedad de neurona motora secundaria a saturnismo / Motor neuron disease secondary to lead poisoning

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Embriopatía por fenilcetonuria materna: una causa de retraso mental / Embryopathy due to maternal phenylketonuria: a cause of mental retardation

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Síndrome de Beckwith-Wiedemann y epilepsia / Beckwith-Wiedemann syndrome and epilepsy

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Afectación aislada del nervio hipogloso y disección carotídea recurrente / Isolated disorder of the hypoglossal nerve and recurring carotid dissection

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Enfermedad cerebrovascular como presentación de arteritis de la temporal / Cerebrovascular disease as the presenting symptom of temporal arteritis

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[Primary intraventricular hemorrhage as a result of a bleeding arteriovenous malformation]. / Hemorragia intraventricular primaria tras sangrado de malformación arteriovenosa.

Primary intraventricular hemorrhage is very rare in adults and is even more infrequent in children. We present a 15-year-old girl who presented to the hospital because of sudden severe headache, vomiting and fever. Neurological examination only showed neck stiffness. A brain computed tomography showed blood in the ventricular system. Conventional angiography revealed an arteriovenous malformation originating in the right pericallosal artery branches. Gamma-knife radiosurgery was performed without relevant complications. A follow-up cerebral angiography showed disappearance of the arteriovenous malformation. When a primary intraventricular hemorrhage is detected in a young patient it is mandatory to rule out an underlying lesion such an arteriovenous malformation. Treatment options include surgery, interventional radiology and radiosurgery, alone or in combination.

Hemorragia intraventricular primaria tras sangrado de malformación arteriovenosa / Primary intraventricular hemorrhage as a results of arteriovenous malformation bleeding

La hemorragia intraventricular primaria es rara en pacientes adultos. En niños y adolescentes es todavía más infrecuente. Se presenta una paciente de 15 años de edad que acudió al hospital por cefalea intensa de inicio súbito, vómitos y febrícula. La exploración neurológica fue normal, salvo marcada rigidez de nuca. La TC cerebral mostró la presencia de sangre en el sistema ventricular. La angiografía cerebral evidenció una malformación arteriovenosa alimentada por ramas de la arteria pericallosa derecha. Se realizó radiocirugía de esta sin complicaciones relevantes. Una angiografía cerebral de control realizada 2 años después del episodio de hemorragia mostró desaparición de la malformación. La presencia de una hemorragia intraventricular primaria en pacientes jóvenes obliga a descartar la existencia de una lesión subyacente como una malformación arteriovenosa. Las opciones terapéuticas en estos casos son la cirugía, la embolización y la radiocirugía solas o en combinación

Primary intraventricular hemorrhage is very rare in adults and is even more infrequent in children. We present a 15-year-old girl who presented to the hospital because of sudden severe headache, vomiting and fever. Neurological examination only showed neck stiffness. A brain computed tomography showed blood in the ventricular system. Conventional angiography revealed an arteriovenous malformation originating in the right pericallosal artery branches. Gamma-knife radiosurgery was performed without relevant complications. A follow-up cerebral angiography showed disappearance of the arteriovenous malformation. When a primary intraventricular hemorrhage is detected in a young patient it is mandatory to rule out an underlying lesion such an arteriovenous malformation. Treatment options include surgery, interventional radiology and radiosurgery, alone or in combination

Distribution of ACTH immunoreactivity in the diencephalon and the brainstem of the dog.

The present work describes for the first time the anatomical distribution of adrenocorticotropic hormone (ACTH) in the diencephalon and the brainstem of the dog by means of the indirect immunoperoxidase technique. The distribution found in this species agrees well with the pattern found in other mammals and particularly confirms much of the findings reported in the cat. An exception to that concordance is the presence of ACTH perikarya in the nucleus of the solitary tract of the dog, a population that has been described in the rat but not in the cat, and in the ventral mesencephalon. This last population spread across the ventral tegmental area from the raphe to the cerebral peduncle and appeared to be a specific feature of the canine brain. On the other hand, we can not see ACTH fibers in the substantia nigra of the dog which could be a characteristic of the domestic carnivores, opposite to rodents, since these fibers appeared to be also lacking in the cat. Nevertheless, the widespread distribution of ACTH fibers in the brain of the dog included many other nuclei containing monoaminergic neurons which supported a possible role for ACTH in the regulation of these neurotransmitter systems.

Predictors of cerebrovascular accidents in giant cell arteritis in a defined population.

OBJECTIVE: To examine the frequency and predictors of cerebrovascular accidents (CVA) in giant cell arteritis (GCA) patients from a defined population. METHODS: Retrospective study of biopsy-proven GCA patients diagnosed from 1981 through 2001 at the single hospital for the population of Lugo (Northwest Spain). RESULTS: Thirty (14.3%) of the 210 biopsy-proven GCA patients had CVA, 5 of them (16.7%) involving the vertebrobasilar territory. Five patients (4 of them involving the carotid territory) had CVA within the 2 years prior to the onset of GCA symptoms. Four patients had CVA within the first month after the diagnosis of the disease. Of these, 3 involved the vertebrobasilar territory. Another 5 patients suffered carotid stroke between the 4th and the 12th month after the disease diagnosis. The remaining 16 GCA patients had CVA (all but one involving the carotid territory) at least 1 year after the diagnosis of vasculitis. No differences in the clinical and laboratory features at the time of diagnosis between patients who had CVA and the rest of the biopsy-proven GCA patients were observed. However, hypertension and hyperlipidemia at the time of diagnosis of GCA were associated with the development of CVA (p < 0.05 for both). Also, anemia at the time of diagnosis (hemoglobin < 12 g/dL) [hazard ratio = 0.34 (95% CI 0.12 - 1.00; p = 0.05)] was negatively associated with CVA within the first 10 years after the diagnosis of the disease. Mortality in GCA patients with CVA was not significantly higher than that in patients without CVA (hazard ratio = 1.53; p = 0.14). CONCLUSION: The present study confirms that CVA may occur in GCA. Vertebrobasilar accidents are more common than carotid accidents at the time of diagnosis of the disease. Vascular risk factors should be carefully controlled in the follow-up of GCA patients.

Quiste del velum interpositum / Cyst in the velum interpositum

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