Tomografía de emisión de fotones cerebral. Valor del índice corticocerebeloso y patrones gammagráficos en la enfermedad de Alzheimer y otras afecciones

Brain single photon emission computed tomography (SPECT) with 99mTc-HMPAO is a diagnostic tool for evaluating regional cerebral blood flow. Recently, the diagnostic possibilities of the method are being investigated in some neurologic disorders, such as cerebrovascular accidents, seizures and dementia. This work has been carried out with 54 subjects, 9 healthy volunteers and 45 patients (31 dementia and 14 epileptics), in order to evaluate gammagraphic patterns and the utility of cortico/cerebellar activity indexes. An interesting diagnostic finding is a significant decrease (p less than 0.001) in perfusion of temporoparietal regions in the patients with Alzheimer's disease in relation with the healthy volunteers' group. We have not found significant changes in perfusion in the group of epileptic patients during the interictal phase. We conclude emphasizing the interest of the SPECT in the differential diagnosis of dementia

Afasias infantiles congénitas y adquiridas

El amplio capítulo de las "disfasias o afasias del desarrollo" y el síndrome de "afasia infantil adquirida y persistente con comicialidad", son ocasión de estudio de modelos clínicos neuro-lingüísticos en los cuales se alteran y recuperan las funciones de decoficiación y codificación verbal en el cerebro en desarrollo . Dos pacientes ejemplifican cada una de las situaciones cita- das

Correlaciones entre la SPECT cerebral y la evaluación neuropsicológica en los estadios leve y moderado de la enfermedad de Alzheimer

Se evaluaron 34 pacientes con enfermedad de Alzheimer (EA) probable (EA leve = 16; EA moderada = 18) y 12 controles mediante un estudio semicuantitativo de SPECT con 99mTc-HMPAO y la batería de tests neuropsicológicos CERAD. Resultados: La hipoperfusión temporal (p < 0,01) y los tests de memoria (p < 0,001) permitieron diferenciar los controles de los pacientes con EA leve. En estos pacientes se observaron también correlaciones significativas (p < 0,05) entre: test de recuerdo diferido-hipoperfusión temporal, test de aprendizaje-hipoperfusión temporoparietal y frontal y praxis visuoconstructiva-hipoperfusión temporal posterior. Los pacientes con EA moderada mostraron, respecto a la EA leve, una mayor hipoperfusión temporal (p < 0,01), parietal y frontal (p < 0,05), junto a un empeoramiento de la praxis (p < 0,001) y los test de memoria (p < 0,05). Conclusiones: La SPECT y la evaluación neuropsicológica permiten distinguir entre controles y pacientes con estadios leve y moderado de la EA, existiendo una estrecha correlación entre ambos métodos desde las etapas iniciales de la enfermedad

Placebo-controlled trial of nimodipine in the treatment of acute ischemic cerebral infarction

Nimodipine is a 1,4-dihydropyridine derivative that shows a preferential cerebrovascular activity in experimental animals. Clinical data suggest that nimodipine has a beneficial effect on the neurologic outcome of patients suffering an acute ischemic stroke. Our double-blind placebo-controlled multicenter trial was designed to assess the effects of oral nimodipine on the mortality rate and neurologic outcome of patients with an acute ischemic stroke. One hundred sixty-four patients were randomly allocated to receive either nimodipine tablets (30 mg q.i.d.) or identical placebo tablets for 28 days. Treatment was always started less than or equal to 48 hours after the acute event. The Mathew Scale, slightly modified by Gelmers et al, was used for neurologic assessment. Mortality rate and neurologic outcome after 28 days were used as evaluation criteria. We considered 123 patients to be valid for the analysis of efficacy. Mortality rates did not differ significantly between groups. Neurologic outcome after 28 days of therapy did not differ between groups. However, when only those patients most likely to benefit from any intervention (Mathew Scale sum score of less than or equal to 65 at baseline) were analyzed separately in post hoc-defined subgroups, the nimodipine-treated subgroups showed a significantly better neurologic outcome. This result suggests that some patients with acute ischemic stroke will benefit from treatment with nimodipine tablets

Correlaciones entre la SPECT cerebral y la evaluación neuropsicológica en los estadios leve y moderado de la enfermedad de Alzheimer

Se evaluaron 34 pacientes con enfermedad de Alzheimer (EA) probable (EA leve = 16; EA moderada = 18) y 12 controles mediante un estudio semicuantitativo de SPECT con 99mTc-HMPAO y la batería de tests neuropsicológicos CERAD. Resultados: La hipoperfusión temporal (p < 0,01) y los tests de memoria (p < 0,001) permitieron diferenciar los controles de los pacientes con EA leve. En estos pacientes se observaron también correlaciones significativas (p < 0,05) entre: test de recuerdo diferido-hipoperfusión temporal, test de aprendizaje-hipoperfusión temporoparietal y frontal y praxis visuoconstructiva-hipoperfusión temporal posterior. Los pacientes con EA moderada mostraron, respecto a la EA leve, una mayor hipoperfusión temporal (p < 0,01), parietal y frontal (p < 0,05), junto a un empeoramiento de la praxis (p < 0,001) y los test de memoria (p < 0,05). Conclusiones: La SPECT y la evaluación neuropsicológica permiten distinguir entre controles y pacientes con estadios leve y moderado de la EA, existiendo una estrecha correlación entre ambos métodos desde las etapas iniciales de la enfermedad

Tomografía de emisión de fotones cerebral. Valor del índice corticocerebeloso y patrones gammagráficos en la enfermedad de Alzheimer y otras afecciones

Brain single photon emission computed tomography (SPECT) with 99mTc-HMPAO is a diagnostic tool for evaluating regional cerebral blood flow. Recently, the diagnostic possibilities of the method are being investigated in some neurologic disorders, such as cerebrovascular accidents, seizures and dementia. This work has been carried out with 54 subjects, 9 healthy volunteers and 45 patients (31 dementia and 14 epileptics), in order to evaluate gammagraphic patterns and the utility of cortico/cerebellar activity indexes. An interesting diagnostic finding is a significant decrease (p less than 0.001) in perfusion of temporoparietal regions in the patients with Alzheimer's disease in relation with the healthy volunteers' group. We have not found significant changes in perfusion in the group of epileptic patients during the interictal phase. We conclude emphasizing the interest of the SPECT in the differential diagnosis of dementia

Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study) : Does nutrition really affect ICU mortality?

The importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients. Methods: This multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for ≥72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy (type and details for ≤14 days), and outcomes were registered in a database. Confounders such as disease severity, patient type (e.g., medical, surgical or trauma), and type and duration of nutritional therapy were also included in a multivariate analysis, and hazard ratios (HRs) and 95% confidence intervals (95%CIs) were reported. We included 639 patients among whom 448 (70.1%) and 191 (29.9%) received enteral and parenteral nutrition, respectively. Mortality was 25.6%, with non-survivors having the following characteristics: older age; more comorbidities; higher Sequential Organ Failure Assessment (SOFA) scores (6.6 ± 3.3 vs 8.4 ± 3.7; P < 0.001); greater nutritional risk (Nutrition Risk in the Critically Ill [NUTRIC] score: 3.8 ± 2.1 vs 5.2 ± 1.7; P < 0.001); more vasopressor requirements (70.4% vs 83.5%; P=0.001); and more renal replacement therapy (12.2% vs 23.2%; P=0.001). Multivariate analysis showed that older age (HR: 1.023; 95% CI: 1.008-1.038; P=0.003), higher SOFA score (HR: 1.096; 95% CI: 1.036-1.160; P=0.001), higher NUTRIC score (HR: 1.136; 95% CI: 1.025-1.259; P=0.015), requiring parenteral nutrition after starting enteral nutrition (HR: 2.368; 95% CI: 1.168-4.798; P=0.017), and a higher mean Kcal/Kg/day intake (HR: 1.057; 95% CI: 1.015-1.101; P=0.008) were associated with mortality. By contrast, a higher mean protein intake protected against mortality (HR: 0.507; 95% CI: 0.263-0.977; P=0.042). Old age, higher organ failure scores, and greater nutritional risk appear to be associated with higher mortality. Patients who need parenteral nutrition after starting enteral nutrition may represent a high-risk subgroup for mortality due to illness severity and problems receiving appropriate nutritional therapy. Mean calorie and protein delivery also appeared to influence outcomes. ClinicaTrials.gov NCT: 03634943