Tratamiento médico de la estenosis arterial intracraneal. ¿Es el mismo en prevención primaria que en secundaria?

In this study we review the risk factors associated with the formation and progression of an atheroma plaque, the mechanism involved in cerebral ischemia secondary to intracranial atheromatosis and possible medical treatment in primary and secondary prevention. DEVELOPMENT: Medical treatment of intracranial stenoses (ICS) is aimed at stopping the progression of the atheroma plaque and at preventing recurrences in the case of symptomatic stenoses. It is based on the control of vascular risk factors, the use of statins and antithrombotic therapy (antiplatelet or anticoagulation drugs). Although antiplatelet agents have not proved to be beneficial in the primary prevention of stroke, they are recommended in patients with ICS in order to lower the risk of heart attack associated with this pathology. The use of antiplatelet drugs in the secondary prevention of ischemic stroke secondary to an ICS is based on clinical trials which have shown that antiaggregation prevents non-cardioembolic strokes. Nevertheless, several retrospective studies have observed that oral anticoagulation is better than antiaggregation with aspirin. Two prospective clinical trials are currently being conducted which will, in the next few years, help to determine what the first choice medical treatment is for this group of patients. CONCLUSIONS: Medical treatment of ICS patients must include the control of vascular risk factors and the use of statins. New studies are needed to be able to establish the first choice antithrombotic drug in secondary prevention

Urgencias neurológicas y guardias de Neurología

In recent years different studies have highlighted a progressive increase in the demand for neurological care in emergency departments. To analyze the convenience of specific neurology shifts or the role that the neurologist should play in the emergency department, it is necessary to answer questions such as: What is the demand for emergency neurological care? What are the most frequent neurological emergencies? Who should attend to neurological emergencies and why? Are specific neurology shifts necessary? Neurological emergencies account for between 2.6% and 14% of medical emergencies. Stroke represents a third of all neurological emergencies, while the diagnoses of acute cerebrovascular disease, epilepsy and cephalea constitute 50% of all neurological care in the emergency department. On the basis of quality of care criteria and professional competence, the best care for patients with a neurological emergency is provided by a specialist in neurology. The implementation of specific neurology shifts, with a 24 hour physical presence, is associated with greater quality of care, better diagnostic and therapeutic orientation from the moment the patient arrives in emergency department, reduces unnecessary admissions, reduces costs and strengthens the neurology service

La visión parkinsoniana de la figura compleja de Rey-Osterrieth

Visuospatial impairment has been frequently reported in Parkinson’s disease (PD). We present the progressive distorsioned performance of the Rey-Osterrieth complex figure in parkinsonian patients at different stages of the disease (PD de novo, PD on long-term treatment, PD with phychosis and PD with dementia

Cefalea en urgencias

Headache is among the most frequent neurological symptoms in the Emergency department. Although most of the patients suffer from primary headaches (migraine), an acute headache might be the only symptom of a serious disease, such as subarachnoid haemorrhage. The physician’s task is to make the diagnosis, carry out an appropriate selection of the patients who require further diagnostic evaluation and relieve the pain. An accurate history will identify most of the patients with secondary headaches. Clinicians should suspect secondary causes in sudden onset headache, headache in patients aged over 50 years, and also in those patients with abnormalities on neurological examination

Fisioterapia en cefalea tensional. ¿Debe recomendarse a nuestros pacientes?

La cefalea tensional es la patología neurológica más prevalente, y a pesar de su elevada frecuencia, la investigación en esta cefalea primaria es escasa, su fisiopatología es desconocida y el número de tratamientos médicos disponibles es muy limitado. Por ello, resulta muy gratificante encontrar publicaciones de grupos españoles abordando el tratamiento de la cefalea tensional desde el punto de vista de la atención fisioterápica

Endothelium-dependent relaxation of human saphenous veins in response to vasopressin and desmopressin

Purpose:The goal of this study was to determine the effects of vasopressin and the selective V2-receptor agonist desmopressin on human saphenous veins, with special emphasis on endothelium-mediated responses.Methods:Human saphenous vein segments were obtained from 35 patients undergoing coronary bypass surgery. Paired segments, one normal and the other deendothelized by gentle rubbing, were mounted for isometric recording of tension in organ baths. Concentration-response curves to vasopressin and desmopressin were determined in the presence and in the absence of either the V,-receptor antagonist d(CH2)5Tyr(Me)AVP (10−6 mol/L), the V1-V2 receptor antagonist desGly-d(CH2)5D-Tyr(Et)ValAVP (10−6 mol/L), indomethacin (10−6 mol/L), or NG-nitro-L-arginine methyl ester hydrochloride (L-NAME, 10−4 mol/L).Results:In vein rings under resting tension, vasopressin produced concentration-dependent, endothelium-independent contractions with a concentration of vasopressin producing-half-maximal contractions (EC50) of 3.44 × 10−8 mol/L. The vasopressin V1-receptor antagonist (10−6 mol/L) displaced the control curve to vasopressin 9.86-fold to the right in a parallel manner. In precontracted vein rings previously treated with the V1-antagonist (10−6 mol/L), vasopressin caused endothelium-dependent relaxations. This relaxation was reduced significantly by indomethacin (10−6 mol/L) and unaffected by the V1-V2-receptor antagonist (10−6 mol/L) or by L-NAME (10−4 mol/L). Desmopressin caused endothelium-dependent relaxations in precontracted vein rings that were inhibited by the mixed V1-V2-receptor antagonist and by indomethacin, but not by the V1-antagonist or by pretreatment with L-NAME.Conclusions:These observations indicate that vasopressin exerts contractile effects on human saphenous vein by V1-receptor stimulation. Vasopressin causes dilatation of human saphenous vein only if V1-receptor blockade is present. This relaxation appears to be mediated by the release of relaxant Prostaglandins, probably derived from endothelial cells, and is independent of V2-receptor stimulation or release of nitric oxide. Desmopressin elicits relaxation that is largely dependent on V2-receptor stimulation, which may bring about the release of dilating Prostaglandins from the endothelial cells

Trastornos neuropsiquiátricos en la enfermedad de Parkinson

This paper reviews the main neuropsychiatric disorders associated with Parkinson’s disease (PD) and describes the neuropathological hypothesis proposed to explain these symptoms. Development. This disease is usually associated with neuropsychiatric complications such as depression, anxiety and apathy. Besides, psychiatric symptoms are one of the most common side effects of antiparkinsonian drug-therapy. Conclusions. Depression is the most frequent emotional disorder reported in patients with PD. Up to 20% of parkinsonian patients meet DSM-IV criteria for major depressive episode and another 20% for dysthymia, while the prevalence of depression in normal aged population is about 2-8%. The relationship between PD and depression has not been fully established. Some investigators have suggested that depressive symptoms in PD are causally related to the underlying neuropathological process, affecting predominantly serotoninergic and dopaminergic pathways. Alternatively, depression in PD may represent a normal reaction to the progressive physical impairment induced by the disease. Otherwise, up to 20% of parkinsonian patients present levodopa-induced psychiatric complications. Visual hallucinations are the commonest, but delusions, confusional states, sexual disorders and sleep disorders have also been described. Serotonine and dopamine have been implicated in the neuropathological basis of these disorders

Simulation and experimental testbed for adaptive video streaming in ad hoc networks

[EN] This paper presents a performance evaluation of the scalable video streaming over mobile ad hoc networks. In particular, we focus on the rate-adaptive method for streaming scalable video (H.264/SVC). For effective adaptation a new cross-layer routing protocol is introduced. This protocol provides an efficient algorithm for available bandwidth estimation. With this information, the video source adjusts its bit rate during the video transmission according to the network state. We also propose a free simulation framework that supports evaluation studies for scalable video streaming. The simulation experiments performed in this study involve the transmission of SVC streams with Medium Grain Scalability (MGS) as well as temporal scalability over different network scenarios. The results reveal that the rate-adaptive strategy helps avoid or reduce the congestion in MANETs obtaining a better quality in the received videos. Additionally, an actual ad hoc network was implemented using embedded devices (Raspberry Pi) in order to assess the performance of the proposed adaptive transmission mechanism in a real environment. Additional experiments were carried out prior to the implementation with the aim of characterizing the wireless medium and packet loss profile. Finally, the proposed approach shows an important reduction in energy consumption, as the study revealed.This paper was performed with the support of the National Secretary of Higher Education, Science, Technology and Innovation (SENESCYT)–Ecuador Government (scholarship 195-2012) and the Multimedia Communications Group (COMM) belong to the Institute of Telecommunications and Multimedia Applications (iTEAM)-Universitat Politècnica de València.Gonzalez-Martinez, SR.; Castellanos Hernández, WE.; Guzmán Castillo, PF.; Arce Vila, P.; Guerri Cebollada, JC. (2016). Simulation and experimental testbed for adaptive video streaming in ad hoc networks. Ad Hoc Networks. 52:89-105. https://doi.org/10.1016/j.adhoc.2016.07.007S891055

Reversible cerebral vasoconstriction syndrome induced by adrenaline

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute severe thunderclap headaches and evidence of multifocal, segmental, reversible vasoconstrictions of the cerebral arteries. Several precipitating factors have been identified and reported, including the use of recreational substances or sympathomimetic drugs and the postpartum state. Case description: Here we present the case of a woman who developed RCVS after the administration of adrenaline (epinephrine) in the setting of an anaphylactic reaction during antibiotic allergy testing. Discussion: To our knowledge, this is the first reported case of RCVS following the administration of exogenous adrenaline. This case contributes to the understanding of the physiopathological mechanisms underlying reversible cerebral vasoconstrictio