38 research outputs found
Tratamiento m茅dico de la estenosis arterial intracraneal. 驴Es el mismo en prevenci贸n 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
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鈥檚 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
Neuroimagen estructural y funcional en las enfermedades pri贸nicas humanas
INTRODUCTION:
Prion diseases are neurodegenerative disorders resulting from the accumulation of a misfolded isoform of the cellular prion protein (PrPc). They can occur as acquired, sporadic or hereditary forms. Although prion diseases show a wide range of phenotypic variations, pathological features and clinical evolution, they are all characterised by a common unfavourable course and a fatal outcome.
REVIEW SUMMARY:
Some variants, such as kuru, have practically disappeared, while others, for example the variant Creutzfeldt-Jakob (vCJD) or those attributable to iatrogenic causes, are still in force and pose a challenge to current medicine. There are no definitive pre-mortem diagnostic tests, except for vCJD, where a tonsil biopsy detects 100% of the cases. For this reason, diagnostic criteria dependent on statistical probability have had to be created. These require complementary examinations, such as an electroencephalogram (EEG) or the detection of 14-3-3 protein in cerebrospinal fluid (CSF). Only the "pulvinar sign" in magnetic resonance imaging (MRI) has been included as a vCJD diagnostic criterion. The present review discusses neuroimaging findings for each type of prion disease in patients with a definitive histopathological diagnosis.
CONCLUSIONS:
The aim is to define the usefulness of these complementary examinations as a tool for the diagnosis of this family of neurodegenerative diseases
Determinaci贸n reciente de la colesterolemia en poblaci贸n adulta sana de Pamplona
RESUMEN: Objetivo: Los objetivos del estudio fueron estimar la proporci贸n de la poblaci贸n adulta sana de Pamplona que hab铆a determinado recientemente su colesterolemia e identificar los factores asociados a
esta determinaci贸n.
M茅todos: Estudio transversal con entrevista personal a 1066 habitantes de Pamplona seleccionados por muestreo de rutas aleatorias. Se estratific贸 la ciudad
en tres 谩reas urbanas seg煤n el nivel socioecon贸mico (alto, medio, bajo). La participaci贸n fue de un 91,8%.
Utilizando como variable dependiente la determinaci贸n del colesterol total en los 煤ltimos 5 a帽os, y como variables independientes la edad, el sexo, el
nivel socioecon贸mico y el h谩bito tab谩quico, se calcularon las odds ratios (OR) univariantes y se ajust贸 un modelo de regresi贸n log铆stica.
Resultados: El 71,2% de la muestra estudiada (IC 95%: 68,3-74,O) se hab铆a determinado el colesterol en los 煤ltimos cinco a帽os. Los no fumadores conoc铆an m谩s su colesterolemia que los fumadores con una OR ajustada de 1,38 (IC 95%: 1 ,O-1,9); los hombres lo conoc铆an m谩s que las mujeres (OR ajustada de 1,5; IC
95% 1,l-2,O). El conocimiento era menos frecuente en el grupo de edad 30 a帽os. La determinaci贸n de la colesterolemia se daba m谩s en los individuos de nivel socioecon贸mico medio y alto (OR ajustadas 3,2; IC 95% 2,2-4,7 y 1,6; IC 95% 1,l-2,3), respectivamente.
Conclusiones: La determinaci贸n reciente del
colesterol era m谩s frecuente en individuos de mayor edad y en varones. La determinaci贸n de la colesterolemia era menos frecuente en algunos grupos con peor perfil de riesgo coronario (menor nivel socioecon贸mico
y fumadores). Estos resultados sugieren la necesidad de intervenciones para mejorar el conocimientoy control de la colesterolemia en adultos sanos
A pilot study on the Spanish version of the Psychosocial Adjustment to Illness Scale (PAIS鈥怱R) with carers of people with Parkinson's disease
Aim: To report the cross-cultural adaptation and pilot study of the ongoing validation of the Spanish version of the Psychosocial Adjustment to Illness Scale with carers of people with Parkinson's disease.
Design: Cross-cultural adaptation and pilot study with a cross-sectional validation design of the Spanish version of the Psychosocial Adjustment to Illness Scale - Carers.
Methods: Twenty-one carers of people with Parkinson's disease from a Primary Care practice in Spain were recruited and completed the PAIS-Carers, the SF-36 Health Survey, the Brief COPE Inventory and an assessment form. SPSS 23.0 was used to determine viability/acceptability and preliminary aspects of internal consistency of the instrument.
Results: Five of the seven domains presented floor effect (71.42%), and only one presented ceiling effect (14.28%). The internal consistency of the scale and domains showed acceptable values (over 0.7). The content validity of the Spanish version seemed satisfactory with positive comments in general from participants
Experiencia cl铆nica del tratamiento con onabotulinumtoxin A en pacientes con migra帽a 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
18F-FDG-PET Imaging Patterns in Autoimmune Encephalitis: Impact of Image Analysis on the Results
Brain positron emission tomography imaging with 18Fluorine-fluorodeoxyglucose
(FDG-PET) has demonstrated utility in suspected autoimmune encephalitis. Visual and/or
assisted image reading is not well established to evaluate hypometabolism/hypermetabolism.
We retrospectively evaluated patients with autoimmune encephalitis between 2003 and 2018.
Patients underwent EEG, brain magnetic resonance imaging (MRI), cerebrospinal fluid (CSF)
sampling and autoantibodies testing. Individual FDG-PET images were evaluated by standard
visual reading and assisted by voxel-based analyses, compared to a normal database. For the
latter, three different methods were performed: two based on statistical surface projections (Siemens
syngo.via Database Comparison, and 3D-SSP Neurostat) and one based on statistical parametric
mapping (SPM12). Hypometabolic and hypermetabolic findings were grouped to identify specific
patterns. We found six cases with definite diagnosis of autoimmune encephalitis. Two cases had
anti-LGI1, one had anti-NMDA-R and two anti-CASPR2 antibodies, and one was seronegative.
18F-FDG-PET metabolic abnormalities were present in all cases, regardless of the method of analysis.
Medial鈥搕emporal and extra-limbic hypermetabolism were more clearly depicted by voxel-based
analyses. We found autoantibody-specific patterns in line with the literature. Statistical surface
projection (SSP) methods (Neurostat and syngo.via Database Comparison) were more sensitive
and localized larger hypermetabolic areas. As it may lead to comparable and accurate results,
visual analysis of FDG-PET studies for the diagnosis of autoimmune encephalitis benefits from
voxel-based analysis, beyond the approach based on MRI, CSF sample and EEG
Perfil neuropsicol贸gico de la degeneraci贸n lobar frontotemporal
La degeneraci贸n lobar frontotemporal engloba tres s铆ndromes diferentes, que comparten caracter铆sticas cl铆nicas y patol贸gicas comunes, dificultando as铆 su diagn贸stico en estadios iniciales. Se incluyen en este grupo las tres variantes de la demencia frontotemporal, el s铆ndrome corticobasal y el s铆ndrome de par谩lisis supranuclear progresiva. Se ha llevado a cabo una revisi贸n del perfil neuropsicol贸gico de cada uno de los s铆ndromes, que permita clarificar las caracter铆sticas fundamentales que los definen y ayudar a diferenciarlos de otras demencias. Se ha hecho una revisi贸n de los diferentes trabajos publicados en la literatura al respecto, describiendo las caracter铆sticas cl铆nicas, patol贸gicas y los hallazgos de imagen fundamentales de cada entidad para describir de manera exhaustiva los hallazgos en los diferentes dominios neuropsicol贸gicos y su progresi贸n. Aunque existe un solapamiento entre los s铆ndromes que conforman la degeneraci贸n lobar frontotemporal, la comparaci贸n del perfil neuropsicol贸gico de las mismas entre s铆 y frente a otras demencias permite establecer caracter铆sticas propias de su perfil neuropsicol贸gico para llevar a cabo un diagn贸stico diferencial.Frontotemporal lobar degeneration encompasses
three different syndromes, with clinical and pathologic commonalities, making diagnosis difficult in early
stages. Three subtypes are recognized: frontotemporal
dementia and its three variants, corticobasal syndrome
and supranuclear palsy syndrome. The objective of this
study is to review the neuropsychological features of
each syndrome in order to differentiate amongst subtypes as well as from other forms of dementia.
We review multiple studies from the literature,
highlighting the main clinical features, neuropathology
and changes in brain imaging of each syndrome. Subsequently, we describe the neuropsychological profile
compared to other dementias, and how it progresses
over time.
Although there is an overlap amongst the different
subtypes of frontotemporal lobar degeneration, neuropsychological profiles can help identify subtypes and
discriminate frontotemporal lobar degeneration from
other forms of dementia