38 research outputs found
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 NeurologÃa
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
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 patologÃa neurológica más prevalente, y a pesar de su elevada frecuencia, la investigación en esta cefalea primaria es escasa, su fisiopatologÃa 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
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
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
Upper gastrointestinal bleeding related to migraine: the importance of education for migraine care
Physicians involved in care of migraine patients should make a considerable effort to educate themselves and their patients. It is fundamental that doctors, patients and their families understand the causes of migraine, and know the different treatment strategies available to improve migraine care. Mallory-Weiss tears are lacerations in the region of the cardioesophageal junction due to vomiting. We report a case of Mallory-Weiss tear secondary to migraine that could had been reasonably avoided had the patient been treated with triptans since the first attack, according to the stratified care strategy. This case illustrates that inadequate management can cause serious medical consequences. It also proves that it is necessary to improve education about migraine for both patients and doctors
Excess abdominal fat is associated with cutaneous allodynia in individuals with migraine: a prospective cohort study
Objective: To investigate the specific relationship between cutaneous allodynia (CA) and the percentages of body
fat (BF) and abdominal fat in migraineurs. Additionally, we compared serum levels of inflammatory biomarkers in
patients with and without CA.
Background: Excess abdominal fat might facilitate progressive changes in nociceptive thresholds causing central
sensitization, clinically reflected as CA, which could drive migraine progression.
Methods: This prospective cohort study included 80 patients with migraine (mean age 39 years, 81.2% female) and
39 non-migraine controls. We analysed each participant’s height, body weight, and body mass index (BMI). The
amount and distribution of BF was also assessed by air displacement plethysmography (ADP) and ViScan,
respectively. We analysed serum levels of markers of inflammation, during interictal periods.
Results: We studied 52 patients with episodic migraine (EM) and 28 with chronic migraine (CM). Of the 80 patients,
53 (53.8%) had CA. Migraineurs with CA had a higher proportion of abdominal fat values than patients without CA
(p = 0.04). The independent risk factors for CA were the use of migraine prophylaxis (OR 3.26, 95% CI [1.14 to 9.32];
p = 0.03), proportion of abdominal fat (OR 1.13, 95% CI [1.01 to 1.27]; p = 0.04), and presence of sleep disorders (OR
1.13, 95% CI [00.01 to 1.27]; p = 0.04). The concordance correlation coefficient between the ADP and BMI
measurements was 0.51 (0.3681 to 0.6247). CA was not correlated with the mean plasma levels of inflammatory
biomarkers.
Conclusions: There is a relation between excess abdominal fat and CA. Abdominal obesity might contribute to the
development of central sensitization in migraineurs, leading to migraine chronification