1,619 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
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
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
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
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
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
Experiencia clÃnica del tratamiento con onabotulinumtoxin A en pacientes con migraña refractaria
To analyse our experience in the treatment of refractory chronic migraine,
episodic frequent refractory migraine (>= 10 days/month), with onabotulinumtoxin
A (OnabotA). PATIENTS AND METHODS. Retrospective analysis of patients with
refractory migraine who underwent, at least two sessions of OnabotA pericranial
injections following the PREEMPT protocol between 2008 and 2012. The efficacy of
OnabotA was evaluated comparing the basal situation with 12-16 weeks after the
second session. We analysed the subjective improvement of the patients, number of
days with headache, preventive and abortive drugs consumption, and adverse
effects. RESULTS. Forty-one patients (37 women, 4 male) were identified. 65.8%
patients experienced subjective improvement after OnabotA treatment. 36.58%
responded (reduction of > 50% in headache days). Differences between days with
headache before the first session (24.5 +/- 7.3), and 12-16 weeks after the
second session (17.4 +/- 11.6), as well as the differences between the number of
abortive drugs taken before the first session (26.8 +/- 23.1) and 12-16 weeks
after the second session (16.7 +/- 19.3), were statistically significant (p <
0.001). Subgroups analysis showed that all differences were significant, except
for the reduction of the number of days with headache in patients with episodic
frequent refractory migraine. CONCLUSION. Our work shows that treatment with
OnabotA is safe and useful in patients with episodic and chronic refractory
migraine, including those patients with medication overuse headache
Study of vascular risk in Navarre: objectives and design. Prevalence of metabolic syndrome and of vascular risk factors
BACKGROUND: To determine in a representative sample of the population the prevalence of risk factors and metabolic syndrome; their association with sub-clinical atherosclerotic lesions and their impact on cardiocerebrovascular disease 10 years after.
MATERIAL AND METHODS: (Phase 1) Cross sectional survey of a random sample stratified by age and sex of the population of Navarre aged between 35 and 84. Antecedents, risk factors, physical and analytical exploration. (Phase II) Ten year follow-up cohort study, in 500 exposed to MS and 500 not exposed persons, aged between 45 and 74 years; with an 82.25% power to detect a risk ratio of 2; with analytical and image markers of sub-clinical atherosclerosis. (Phase III) Follow up of vascular events at ten years.
RESULTS: The subjects recruited were 6,553; excluded or not found 871; the final sample was 5,682 (2,644 men and 3,038 women); 4,168 (73,4%) took part in the study. The prevalence of MS was 22.1% (95%CI 20.5 - 23.7) for men and 17,2% (95%CI 15.8 - 18.5) for women. The main cardiovascular RF were high compared to other geographical areas except for HDL cholesterol. The rate was 8.5% (95%CI 7.4 - 9.6) for men and 1.7% (95%CI 1.3 - 2.2)
CONCLUSIONS: There are important differences in risk between sex, being worst for men. The high figures for HDL cholesterol and the low prevalence of MS might mean a lower risk of vascular events in Navarra
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