Analysis of the prognostic value of emergency blood tests in ischaemic stroke.

OBJECTIVES: This study aims to evaluate the prognostic value of emergency blood test results in patients with acute ischaemic stroke. METHODS: We evaluated 592 prospectively patients with neuroimaging-confirmed ischaemic stroke admitted to our stroke unit between 2015 and 2018. We gathered emergency blood test results and calculated the neutrophil-to-lymphocyte ratio and the neutrophil-to-platelet ratio (neutrophils × 1.000/platelets). The association between blood test results and functional prognosis (as measured with the modified Rankin Scale) and such complications as haemorrhagic transformation was evaluated by logistic regression analysis. The additional predictive value of blood test parameters was assessed with receiver operating characteristic curves and the net reclassification index. RESULTS: An neutrophil-to-lymphocyte ratio ≥ 3 at admission was associated with a two-fold increase in the risk of functional dependence at 3 months (OR: 2.24; 95% CI: 1.35-3.71) and haemorrhagic transformation (OR: 2.11; 95% CI: 1.09-4.05), while an neutrophil-to-lymphocyte ratio ≥ 3.86 resulted in an increase of 2.4 times in the risk of mortality at 3 months (OR: 2.41; 95% CI: 1.37-4.26) after adjusting for the traditional predictors of poor outcomes. Patients with neutrophil-to-platelet ratio ≥ 32 presented 3 times more risk of haemorrhagic transformation (OR: 3.17; 95% CI: 1.70-5.92) and mortality at 3 months (OR: 3.07; 95% CI: 1.69-5.57). Adding these laboratory parameters to standard clinical-radiological models significantly improved discrimination and prognostic accuracy. CONCLUSIONS: Basic blood test parameters provide important prognostic information for stroke patients and should therefore be analysed in combination with standard clinical and radiological parameters to optimise ischaemic stroke management.

[Pathophysiological bases of the non-motor symptoms in Parkinson's disease]. / Bases fisiopatológicas de los síntomas no motores de la enfermedad de Parkinson.

INTRODUCTION: The neuro-anatomical and neurochemical substrates underlying most of the non-motor symptoms (NMS) of Parkinson's disease (PD) are not understood in depth. AIM: To review the current knowledge on the pathophysiology of the different NMS of PD based on recent studies. DEVELOPMENT: In most of the NMS the pathophysiological foundation is complex. In addition to the dopaminergic dysfunction, the degeneration of non-dopaminergic (i.e. noradrenergic, serotoninergic and cholinergic) cellular systems is thought to underlie the development of most of the NMS and can be applied in dementia, depression, sleep disorders and vegetative disorders. Dementia, moreover, is essentially caused by different alterations that take place with the cerebral cortex. Dysfunction of the ventral striatum and of the mesolimbic projections exerts a crucial influence in impulsive-compulsive spectrum disorder. Loss of the sense of smell appears to be due to the neuronal degeneration of the olfactory bulb and the pain has an extremely varied pathogenetic basis and may be musculoskeletal, dystonic, radicular or central. CONCLUSIONS: Despite the fact that a huge amount of progress has been made in research on the pathophysiology of the NMS of PD, further clinicopathological and pathobiochemical comparative studies are needed to explain the pathophysiological bases of PD and to provide a broader foundation for future therapeutic strategies to treat NMS.

[Inflammatory optic neuritis]. / Neuritis óptica inflamatoria.

Inflammatory Optic Neuritis (ON) is the most frequent cause of acute visual loss in young adults. Although the visual prognosis is excellent in the majority of cases, many patients develop pathology, such as multiple sclerosis, in its subsequent evolution. The natural history of ON has been studied in numerous works in recent years; one of the most important of which is Optic Neuritis Treatment Trial. Magnetic Resonance plays a fundamental role in the etiological diagnosis of ON and in predicting the risk of conversion into multiple sclerosis. New exploratory techniques have recently been incorporated, such as optical coherence tomography, useful for diagnosis and prognosis; serum biomarkers have been identified in the diagnosis of other pathologies with an autoimmune nature that produce ON. A better understanding of the clinical and exploratory data of typical ON will make a more rapid and accurate diagnostic study possible. Treatment of ON with steroids must be individualised bearing in mind that they do not alter the long-term prognosis and an immunomodulating therapy must be proposed for patients with a high risk of conversion into multiple sclerosis. This article reviews the existing data in the literature on its clinical manifestations, its etiological and differential diagnosis, and the treatment of inflammatory ON.

Neuritis óptica inflamatoria / Inflammatory optic neuritis

La neuritis óptica inflamatoria (NO) es la causa másfrecuente de pérdida visual aguda en adultos jóvenes.Aunque el pronóstico visual es excelente en la mayoríade los casos, muchos pacientes desarrollarán otra patologíacomo esclerosis múltiple en la evolución posterior.La historia natural de la NO ha sido estudiada enmúltiples trabajos en los últimos años; uno de los másimportantes es el Optic Neuritis Treatment Trial.La Resonancia Magnética tiene un papel fundamentalen el diagnóstico etiológico de la NO y en la prediccióndel riesgo de conversión a esclerosis múltiple.Recientemente se han incorporado nuevas técnicasexploratorias como la tomografia de coherenciaóptica, útil para el diagnóstico y pronóstico; se hanidentificado biomarcadores séricos que ayudan en eldiagnóstico de otras patologías de naturaleza autoinmuneque producen NO.Un mejor conocimiento de los datos clínicos y exploratoriosde la NO típica permitirá un estudio diagnósticomás rápido y certero. El tratamiento de la NOcon esteroides debe ser individualizado teniendo encuenta que no modifican el pronóstico a largo plazo yen pacientes con alto riesgo de conversión a esclerosismúltiple debe plantearse terapia inmunomoduladora.Este trabajo revisa los datos existentes en la literaturareferentes a las manifestaciones clínicas, el diagnósticoetiológico y diferencial y tratamiento de la NO inflamatoria(AU)

Inflammatory Optic Neuritis (ON) is the mostfrequent cause of acute visual loss in young adults.Although the visual prognosis is excellent in the majorityof cases, many patients develop pathology, such asmultiple sclerosis, in its subsequent evolution.The natural history of ON has been studied in numerousworks in recent years; one of the most importantof which is Optic Neuritis Treatment Trial.Magnetic Resonance plays a fundamental role inthe etiological diagnosis of ON and in predicting therisk of conversion into multiple sclerosis.New exploratory techniques have recently beenincorporated, such as optical coherence tomography,useful for diagnosis and prognosis; serum biomarkershave been identified in the diagnosis of other pathologieswith an autoimmune nature that produce ON.A better understanding of the clinical and exploratorydata of typical ON will make a more rapid and accuratediagnostic study possible. Treatment of ON withsteroids must be individualised bearing in mind thatthey do not alter the long-term prognosis and an immunomodulatingtherapy must be proposed for patientswith a high risk of conversion into multiple sclerosis.This article reviews the existing data in the literatureon its clinical manifestations, its etiological and differentialdiagnosis, and the treatment of inflammatory ON(AU)

[Reperfusion in acute ischaemic stroke: present and future]. / Reperfusión en el ictus isquémico agudo: estado actual y futuro.

Cerebral ischaemia is a dynamic process triggered when an intracranial artery is acutely occluded, normally due to an embolism from the heart or from arteriolosclerotic lesions of more proximal arteries. Urgent rerouting of these arteries and early reperfusion of the cerebral tissue, neuroprotector therapies that intervene in the ischaemic cascade and prevention of recurrence are the therapeutic aims in the acute phase of ischaemic stroke. Thrombolytic treatment pursues the lysis of the dot occluding the intracranial artery. At present, the only approved thrombolytic treatment is the intravenous Recombinant Tissue Plasminogen Activator (rtPA). Its safety and efficacy within the first three hours of evolution of the ischaemic stroke have been demonstrated. Establishment of this treatment involves a profound change in the health structures and the training of the personnel responsible. The small therapeutic window and the limitations of this medicine in daily practice have led to the urgent exploration of new strategies: we review the reconsideration of exclusion criteria (especially in the elderly and in minor neurological deficits or those of rapid improvement), the widening of the therapeutic window beyond 3 hours with the selection of patients by multimodal image, the possibility of thrombolysis combined with antithrombotic drugs or with enhancement through ultrasound. We also review the new thrombolytics that are appearing and the intra-arterial thrombolysis approach and therapies of endovascular mechanical reperfusion.

Reperfusión en el ictus isquémico agudo: estado actual y futuro / Reperfusion in acute ischaemic stroke: present and future

La isquemia cerebral es un proceso dinámico desencadenado al ocluirse una arteria intracraneal de forma aguda, habitualmente por un embolismo, desde el corazón o desde lesiones arterioescleróticas de arterias más proximales. La recanalización urgente de dichas arterias y reperfusión precoz del tejido cerebral, las terapias neuroprotectoras que intervengan en la cascada isquémica y la prevención de la recurrencia son los objetivos terapéuticos en la fase aguda del ictus isquémico. El tratamiento trombolítico persigue la lisis del coágulo que ocluye la arteria intracraneal. En la actualidad, el único aprobado es el activador tisular del plasminógeno (rtPA) por vía intravenosa. Se ha demostrado su seguridad y eficacia dentro de las tres primeras horas de evolución del ictus isquémico. La instauración de este tratamiento implica una profunda modificación de las estructuras sanitarias y entrenamiento del personal responsable. La pequeña ventana terapéutica y las limitaciones que este fármaco tiene en la práctica diaria han urgido a abrir caminos para explorar nuevas estrategias: se revisan la reconsideración de los criterios de exclusión (especialmente en ancianos y déficits neurológicos menores o de rápida mejoría), la expansión de la ventana terapéutica mas allá de las 3 horas con selección de pacientes por imagen multimodal, la posibilidad de trombolisis combinada con fármacos antitrombóticos o con potenciación por ultrasonidos. Se revisan asimismo nuevos trombolíticos que van surgiendo y el abordaje intraarterial trombolisis intraarterial y terapias de reperfusión endovascular mecánica (AU)

Cerebral ischaemia is a dynamic process triggered when an intracraneal artery is acutely occluded, normally due to an embolism from the heart or from arteriolosclerotic lesions of more proximal arteries. Urgent rerouting of these arteries and early reperfusion of the cerebral tissue, neuroprotector therapies that intervene in the ischaemic cascade and prevention of recurrence are the therapeutic aims in the acute phase of ischaemic stroke. Thrombolytic treatment pursues the lysis of the dot occluding the intracranial artery. At present, the only approved thrombolytic treatment is the intravenous Recombinant Tissue Plasminogen Activator (rtPA). Its safety and efficacy within the first three hours of evolution of the ischaemic stroke have been demonstrated. Establishment of this treatment involves a profound change in the health structures and the training of the personnel responsible. The small therapeutic window and the limitations of this medicine in daily practice have led to the urgent exploration of new strategies: we review the reconsideration of exclusion criteria (especially in the elderly and in minor neurological deficits or those of rapid improvement), the widening of the therapeutic window beyond 3 hours with the selection of patients by multimodal image, the possibility of thrombolysis combined with antithrombotic drugs or with enhancement through ultrasound. We also review the new thrombolytics that are appearing and the intra-arterial thrombolysis approach and therapies of endovascular mechanical reperfusion (AU)

[Hypersomnia: diagnosis, classification and treatment]. / Las hipersomnias: diagnóstico, clasificación y tratamiento.

Hypersomnia or excessive daytime sleepiness is common in neurological practice and may have different etiologies. Hypersomnia may be defined as sleepiness at an inappropriate time or in an inappropriate situation. It is important to consider that hypersomnia is at times referred to as tiredness or fatigue. A detailed clinical history is essential to reach an accurate diagnosis. A correct diagnosis is necessary to initiate the appropriate treatment considering the negative social and occupational consequences of hypersomnia. Excessive daytime sleepiness syndromes include primary sleep disorders like narcolepsy and hypersomnia secondary to several neurological and psychiatric disorders and also as an adverse effect of numerous drugs.

Las hipersomnias: diagnóstico, clasificación y tratamiento / Hypersomnia: diagnosis, classification and treatment

La hipersomnia o somnolencia diurna excesiva es una queja frecuente en la práctica neurológica y puede ser debida a múltiples trastornos. Puede definirse como la sensación subjetiva de sueño a una hora inapropiada. Hay que tener en cuenta que en ocasiones la hipersomnia no viene referida por el paciente como tal sino que lo que aqueja es cansancio o fatiga. Para abordar el diagnóstico de la hipersomnia es necesaria una historia clínica detallada. Un diagnóstico correcto permitirá un correcto abordaje terapéutico lo cual tiene una gran importancia dada la repercusión social y laboral de la hipersomnia. Dentro de los síndromes con somnolencia diurna excesiva podemos encontrar trastornos intrínsecos del sueño como la narcolepsia o hipersomnia secundaria a otras enfermedades o como efecto secundario de diversos fármacos

Hypersomnia or excessive daytime sleepiness is common in neurological practice and may have different etiologies. Hypersomnia may be defined as sleepiness at an inappropriate time or in an inappropriate situation. It is important to consider that hypersomnia is at times referred to as tiredness or fatigue. A detailed clinical history is essential to reach an accurate diagnosis. A correct diagnosis is necessary to initiate the appropriate treatment considering the negative social and occupational consequences of hypersomnia. Excessive daytime sleepiness syndromes include primary sleep disorders like narcolepsy and hypersomnia secondary to several neurological and psychiatric disorders and also as an adverse effect of numerous drugs