Insuficiencia venosa cerebroespinal crónica y esclerosis múltiple: revisión y actualización del tema

The aetiology of multiple sclerosis remains unknown at the present time, although the most likely explanation is that it has an autoimmune inflammatory origin. During the history of this disease a vascular pathophysiology was once proposed, and it has recently re-emerged as a result of the work by Paolo Zamboni with the name of 'chronic cerebrospinal venous insufficiency'. Following this hypothesis, Zamboni puts forward a curative treatment for multiple sclerosis by means of endovascular treatment of the internal jugular vein and the azygos vein. However, several teams have attempted to replicate his findings without success. In this review, we offer a chronological description of the studies carried out by Zamboni and the later attempts to replicate his work. Our main conclusion is that, given the results we currently have available, we should be cautious and, for the time being, it would be advisable not to recommend the systematic use of this treatment for our patients

Utilidad de las secuencias potenciadas en susceptibilidad paramagnética (SWI) para diferenciar crisis somestésicas de accidentes isquémicos transitorios en un paciente con angiopatía amiloide cerebral

Background. Cerebral amyloid angiopathy (CAA) is characterized by the deposit of β-amyloid on the walls of small and medium-sized arteries of the cerebral cortex and leptomeninges causing cerebral bleeding. Clinical presentations may include transient neurological events for which differential diagnosis can be difficult. Case report. We report a subject with a medical history of recent stroke who presented somesthetic seizures mimicking transient ischemic attacks owing to CAA microbleeding. Antiplatelet treatment was reduced and after lamotrigine was commenced the episodes disappeared. Susceptibility-weighted magnetic resonance imaging was very helpful for diagnosis (SWI-MRI). Conclusions. CAA microbleeding can be manifested in the form of seizures mimicking focal transient sensitive neurological deficits that can be erroneously attributed to cerebral ischemia. The present case report suggests that, despite the presence of a past medical history of strokes, neurologists should consider CAA microbleeding as a possible cause of pseudo-transient ischemic attacks. High-resolution neuroimaging including SWIMRI imaging can be helpful in identifying cortical microbleedings. In this way, the start or increase of antiplatelet treatment can be avoided, and the risk of potentially fatal complications minimize

Monitorización con vídeo-EEG y ECG simultáneo para el diagnóstico diferencial de trastornos de conciencia transitorios. A propósito de un caso

We present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic crises and treated with valproate for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EGG monitoring, where there was an episode that showed temporary right epileptiform activity, with a diagnosis established of focal epilepsy of unknown cause. At present, she remains asymptomatic with oxycarbazepine

Gray Matter Changes in Parkinson's and Alzheimer's Disease and Relation to Cognition

Purpose of Review We summarize structural (s)MRI findings of gray matter (GM) atrophy related to cognitive impairment in Alzheimer's disease (AD) and Parkinson's disease (PD) in light of new analytical approaches and recent longitudinal studies results. Recent Findings The hippocampus-to-cortex ratio seems to be the best sMRI biomarker to discriminate between various AD subtypes, following the spatial distribution of tau pathology, and predict rate of cognitive decline. PD is clinically far more variable than AD, with heterogeneous underlying brain pathology. Novel multivariate approaches have been used to describe patterns of early subcortical and cortical changes that relate to more malignant courses of PD. New emerging analytical approaches that combine structural MRI data with clinical and other biomarker outcomes hold promise for detecting specific GM changes in the early stages of PD and preclinical AD that may predict mild cognitive impairment and dementia conversion

Utilidad de las secuencias potenciadas en susceptibilidad paramagnética (SWI) para diferenciar crisis somestésicas de accidentes isquémicos transitorios en un paciente con angiopatía amiloide cerebral

Background. Cerebral amyloid angiopathy (CAA) is characterized by the deposit of β-amyloid on the walls of small and medium-sized arteries of the cerebral cortex and leptomeninges causing cerebral bleeding. Clinical presentations may include transient neurological events for which differential diagnosis can be difficult. Case report. We report a subject with a medical history of recent stroke who presented somesthetic seizures mimicking transient ischemic attacks owing to CAA microbleeding. Antiplatelet treatment was reduced and after lamotrigine was commenced the episodes disappeared. Susceptibility-weighted magnetic resonance imaging was very helpful for diagnosis (SWI-MRI). Conclusions. CAA microbleeding can be manifested in the form of seizures mimicking focal transient sensitive neurological deficits that can be erroneously attributed to cerebral ischemia. The present case report suggests that, despite the presence of a past medical history of strokes, neurologists should consider CAA microbleeding as a possible cause of pseudo-transient ischemic attacks. High-resolution neuroimaging including SWIMRI imaging can be helpful in identifying cortical microbleedings. In this way, the start or increase of antiplatelet treatment can be avoided, and the risk of potentially fatal complications minimize

ACTUALIZACIÓN EN LA ENFERMEDAD DE PARKINSON

La enfermedad de Parkinson es un trastorno neurodegenerativo complejo y de presentación heterogénea. Aunque aún no se dispone de ningún fármaco que enlentezca la progresión de la enfermedad, existe un arsenal terapéutico extenso y eficaz para el control sintomático en cada una de sus fases, por lo que es importante realizar un diagnóstico preciso así como un correcto manejo de fármacos que garantice un estado óptimo en los paciente que la sufren, lo que resultará en una mejora en su calidad de vida. Además, dado que es el trastorno neurodegenerativo más frecuente tras la enfermedad de Alzheimer y que su factor de riesgo principal es la edad, la enfermedad de Parkinson supone, cada vez más, un reto de salud pública en nuestras sociedades occidentales progresivamente envejecidas. Esta revisión pretende actualizar los aspectos clínicos y diagnósticos fundamentales de la enfermedad de Parkinson así como las principales estrategias terapéuticas disponibles