[Study of neurovascular contact in essential hemifacial spasm: an example of CISS sequence and magnetic resonance angiography]. / Estudio por resonancia magnética del contacto neurovascular en el espasmo hemifacial esencial: empleo de secuencia CISS y angiografía por resonancia magnética.

BACKGROUND AND PURPOSE: The purpose of this article is to assess the validity of the magnetic resonance imaging (MRI) CISS 3D sequence associated with 3D time of flight (TOF) angiographic sequence in order to detect neurovascular contact (NVC) between the facial nerve and neighbouring arteries in patients with essential hemifacial spasm (HFS) and to determine the relationship between HFS symptoms and NVC and NVC image features (type, number and site). MATERIALS AND METHODS: We prospectively enrolled 120 cerebellopontine angle (CPA) MRI studies, 44 cases with HFS symptoms and 76 which were asymptomatic (controls), using axial T2-weighted (CISS) and axial 3D TOF series with associated Maximal intensity (MIP) reconstructions. Prior TOF angiographic studies were available for 56 cases without associated CISS images and the results obtained from that study were compared with the results of the current study. RESULTS: The diagnostic values obtained significantly favoured the protocol used in this study, which demonstrated a sensitivity of 77.27% and a specificity of 75%. There was a statistically significant relationship between the presence of NVC and HFS symptoms (p<0.0001). Only one statistically significant relationship was found between facial nerve displacement (in type of NVC) and HFS symptoms (p=0.019). CONCLUSIONS: The proposed MRI protocol is sensitive and valid for detecting NVC in patients with HFS. The results of our study support a relationship between NVC and HFS symptoms. It is not a simple relationship, however. It may be influenced by other factors, such as displacement of the facial nerve due to NVC.

Estudio por resonancia magnética del contacto neurovascular en el espasmo hemifacial esencial: empleo de secuencia CISS y angiografía por resonancia magnética / Study of neurovascular contact in essential hemifacial spasm: an example of CISS sequence and magnetic resonance angiography

Objetivos: Evaluar la validez de la secuencia CISS 3D de resonancia magnética (RM) en relación con secuencias angiográficas TOF 3D para la detección del contacto neurovascular (CNV) entre el nervio facial y las arterias vecinas en pacientes con espasmo hemifacial esencial (EHE) y determinar la asociación entre la presencia de síntomas de EHE y el CNV y las características de imagen del CNV (tipo, número y localización).Material y métodos: Se han estudiado prospectivamente 120 ángulos pontocerebelosos (APC), 44 con clínica de EHE y 76 asintomáticos (controles), mediante el empleo de una serie axial potenciada en T2 (CISS) y una serie axial con técnica angiográfica TOF 3D con reconstrucciones MIP; 56 de estos APC tenían un estudio angiográfico TOF previo y se compararon sus resultados con los del estudio actual.Resultados: Los valores diagnósticos obtenidos fueron significativos a favor del protocolo del presente trabajo que mostró una sensibilidad del 77,27% y una especificidad del 75%. Se demostró una asociación estadísticamente significativa entre la presencia de CNV y la clínica de EHE (p<0,0001). Entre las características del CNV estudiadas, únicamente se halló una asociación estadísticamente significativa entre el desplazamiento del nervio facial (dentro de tipo de CNV) y la clínica de EHE (p=0,019). Conclusiones: El protocolo de RM propuesto es sensible y válido para detectar CNV en pacientes con EHE. Los resultados de nuestro estudio apoyan la asociación entre el CNV y la clínica de EHE, si bien no se trata de una asociación simple, sino que puede estar influida por otros factores, como el desplazamiento del nervio facial producido por el CNV (AU)

Background and purpose: The purpose of this article is to assess the validity of the magnetic resonance imaging (MRI) CISS 3D sequence associated with 3D time of flight (TOF) angiographic sequence in order to detect neurovascular contact (NVC) between the facial nerve and neighbouring arteries in patients with essential hemifacial spasm (HFS) and to determine the relationship between HFS symptoms and NVC and NVC image features (type, number and site).Materials and methods: We prospectively enrolled 120 cerebellopontine angle (CPA) MRI studies, 44 cases with HFS symptoms and 76 which were asymptomatic (controls), using axial T2-weighted (CISS) and axial 3D TOF series with associated Maximal intensity (MIP) reconstructions. Prior TOF angiographic studies were available for 56 cases without associated CISS images and the results obtained from that study were compared with the results of the current study. Results: The diagnostic values obtained significantly favoured the protocol used in this study, which demonstrated a sensitivity of 77.27% and a specificity of 75%. There was a statistically significant relationship between the presence of NVC and HFS symptoms (p<0,0001). Only one statistically significant relationship was found between facial nerve displacement (in type of NVC) and HFS symptoms (p=0.019).Conclusions: The proposed MRI protocol is sensitive and valid for detecting NVC in patients with HFS. The results of our study support a relationship between NVC and HFS symptoms. It is not a simple relationship, however. It may be influenced by other factors, such as displacement of the facial nerve due to NVC (AU)

[Inflammatory mechanisms, arteriosclerosis and ischemic stroke: clinical data and perspectives]. / Mecanismos inflamatorios, arteriosclerosis e ictus isquémico: datos de interés clínico y perspectivas.

OBJECTIVE: The atherosclerosis is the most common cause of death and disability in developed countries by causing ischemic cardiopathic and stroke. The ischemic atherotrombotic stroke is the most frequent form of the last one. In this sense we review herein the mechanisms underlying the artherosclerotic process. DEVELOPMENT: It is understood as an inflammatory disease, by taking into account the widely accepted hypothesis by Ross: it was firstly stated in structural terms, as macrophages and T/B linfocities were present in the arterial wall from the first stages of the disease (fatty streak) to the last and complicated ones. The starting point is a functional endothelial damage, secondary to mechanical or vascular risk factors and called response to injury hypothesis . The next step is an inflammatory cascade that involves humoral (citokines, growth factors) and cellular (increased quimiotaxis, adherece and infiltration of inflamatory cells) mechanisms. They interact among them, outbalanced and in a progresssive way that leads to the final fibroproliferative response. Every stage has his own inflammatory components and interactive pathways. The following elements are outstanding in this process: 1) Adhesion molecules, including E selectin, ICAM 1 and VCAM 1, that are increased locally in the plaques and as circulating elements; plaquetary receptors of the type IIb/IIIa are integrins wich belong to the same family; 2) Citokines with either proinflammatory activity like IL 1, the TNF a and linfocitary ligands like the CD 40, or with antiinflammatory activity like the gamma interpheron; 3) Growth factors, with plaquetary (PDGF) and fibroblastic (FGF) variants as the cornerstone; 4) Markers of systemic inflammation, overall plasma C reactive protein and fibrinogen, that predict the risk of stroke and cardiovascular death; IL 6, complement, thrombin and heat shock proteins (HSP) would act in a similar but less conclusive way. CONCLUSIONS: The evidences of the pivotal role of the inflammation in the stroke allow to develop therapeutical strategies to prevent the disease: fostering natural antiinflamatory mechanisms, or inhibiting inflammatory elements by selective (monoclonal antibodies) or non selective (IIb/IIIa receptors, antiinflammatory drugs) pathways are distinctily glimpsed, ongoing or fully developed.

Mecanismos inflamatorios, arteriosclerosis e ictus isquémico: datos de interés clínico y perspectivas / Inflammatory mechanisms, arteriosclerosis and ischemic stroke: clinical data and perspectives

Objetivo. La arteriosclerosis es la causa más común de muerte y discapacidad en los países desarrollados, debido a su papel principal en la cardiopatía isquémica e ictus, del cual la forma aterotrombótica resulta la más frecuente. Revisamos aquí los mecanismos subyacentes a la enfermedad arteriosclerótica. Desarrollo. Consideramos ésta un proceso inflamatorio de acuerdo con la hipótesis de Ross, inicialmente descrita en términos estructurales, ya que macrófagos y linfocitos T/B están presentes en la pared arterial desde los primeros (fatty streak) hasta los últimos y complicados estadios de la enfermedad. El punto de inicio es un daño endotelial funcional, secundario a factores de riesgo vascular o mecánicos, definido como ` response-to-injury hypothesis'. El siguiente paso es una cascada inflamatoria que incluye factores humorales (citocinas y factores de crecimiento) y celulares (aumento de quimiotaxis, adherencia e infiltración de células inflamatorias), que interactúan entre ellos de manera progresiva, dando lugar a la respuesta fibroproliferativa. Cada estadio tiene sus propios componentes inflamatorios e interacciones. Los siguientes elementos destacan en este proceso: 1) Moléculas de adhesión, incluyendo la E-selectina, ICAM-1 y VCAM-1, que están aumentados localmente en las placas y en el plasma; los receptores plaquetarios del tipo IIb/IIIa son integrinas pertenecientes a la misma familia; 2) Citocinas con actividad proinflamatoria -tales como la IL-1 o el TNF-alfa- y ligandos inflamatorios -como el CD-40-, o con actividad antiinflamatoria, como interferón- gama; 3) Factores de crecimiento: las variantes plaquetarias (PDGP) y fibroblástica (FGF) serían los elementos claves; 4) Marcadores de inflamación sistémica, sobre todo la proteína C reactiva plasmática y el fibrinógeno, que predicen el riesgo de ictus y de muerte cardiovascular; la IL-6, complemento, trombina y proteinas de `golpe de calor' (HSP) actuarían de modo similar pero menos decisivo. Conclusiones. Las evidencias del papel fundamental de la inflamación en el ictus permiten desarrollar estrategias terapéuticas para prevenir la enfermedad, ya sea fomentando los mecanismos antiinflamatorios o inhibiendo los elementos inflamatorios por vías selectivas (anticuerpos monoclonales) o no selectivas (receptores IIb/IIIa, fármacos antiinflamatorios); se vislumbra su desarrollo completo en un futuro próximo (AU)

[Clinical and lesion-related bases of alcoholic brain damage]. / Fundamentos lesionales y clínicos del daño cerebral alcohólico.

Alcohol-induced brain damage is known since long, with classical descriptions of lesions. There is no constant correlation between them and any of the clinical presentations of chronic intoxication. New neuroimaging techniques, neuropsychology and basic investigation have supplied with new data. The so-called alcoholic dementia and its possible reversibility are major issues of this problem. This paper reviews radiological, pathological, vascular and neuropsychological studies related to this point.

[Familial hypertrophic neuropathies. Conceptual and critical outline. Report of a family with Dyck and Lambert's type IV disease (author's transl)]. / Neuropatías hipertróficas familiares. Delimitación conceptual y crítica. Aportación de un grupo familiar tipo IV de Dyck y Lambert.

The authors make a historical and critical summary of the clinical development of hypertrophic neuropathies up to the classification established by Dick and Lambert, based on its clinical, electrophysiological and genetic study. Until more light is shed on the etiology of these diseases by the metabolic studies already initiated, the use of such classification is recommended. Based on this point of view the clinical, electrophysiological and pathological study of five members of a peculiar family is presented. The affected members presented clinically with different stages of evolution of the uncommon form defined as type IV by Dick and Lambert.