7 research outputs found
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
Estado epiléptico no convulsivo en el siglo XXI: clínica, diagnóstico, tratamiento y pronóstico
Non-convulsive status epilepticus is a significant issue for a neurologist
because, despite its low prevalence, it mimics other pathologies, with
therapeutics and prognostic outcomes. Diagnosis is based on clinical features,
mainly mental status or impaired consciousness and electroencephalographic
changes, so electroencephalogram is the first exploration we must perform with
clinical suspicion. There are three clinical forms: generalized or absence
status, with diffuse epileptiform discharges; focal, with epileptic discharges
located in a specific brain area and may not affect consciousness; and subtle,
with diffuse or local epileptic activity after a tonic-clonic seizure or
convulsive status and limited or no motor activity. Treatment are benzodiazepines
and antiepileptic drugs; anesthetic drugs are only recommended for patients with
subtle status and in some with partial complex status. Prognosis is mainly
determined by etiology and associated brain damage
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
Infratentorial hygroma secondary to decompressive craniectomy after cerebellar infarction
We present a case of expansive CSF collection in the cerebellar convexity. The patient was a 74 years old lady who one month before had suffered a cerebellar infarct complicated with acute hydrocephalus. She had good evolution after decompressive craniectomy without shunting. Fifteen days after surgery, the patient started with new positional vertigo, nausea and vomiting and a wound CSF fistula that needed ventriculoperitoneal shunt (medium pressure) because conservative treatment failed. After shunting, the fistula closed, but the patient symptoms worsened. The MRI showed normal ventricular size with a cerebellar hygroma, extending to the posterior interhemispheric fissure. The collection had no blood signal and expanded during observation. A catheter was implanted in the collection and connected to the shunt. The patient became asymptomatic after surgery, and the hygromas had disappeared in control CT at one month. This case shows an infrequent problem of CSF circulation at posterior fossa that resulted in vertigo of central origin. A higroma-ventricle-peritoneal shunt solved the symptoms of the patient
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
Estado epiléptico no convulsivo en el siglo XXI: clínica, diagnóstico, tratamiento y pronóstico
Non-convulsive status epilepticus is a significant issue for a neurologist
because, despite its low prevalence, it mimics other pathologies, with
therapeutics and prognostic outcomes. Diagnosis is based on clinical features,
mainly mental status or impaired consciousness and electroencephalographic
changes, so electroencephalogram is the first exploration we must perform with
clinical suspicion. There are three clinical forms: generalized or absence
status, with diffuse epileptiform discharges; focal, with epileptic discharges
located in a specific brain area and may not affect consciousness; and subtle,
with diffuse or local epileptic activity after a tonic-clonic seizure or
convulsive status and limited or no motor activity. Treatment are benzodiazepines
and antiepileptic drugs; anesthetic drugs are only recommended for patients with
subtle status and in some with partial complex status. Prognosis is mainly
determined by etiology and associated brain damage