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Artículos Originales
Esclerosis Mùltiple, Virus del Herpes Humano Tipo 6 y Chlamydophila Pneumoniae
Background and objectives: An increasing number of papers are showing a relationship between two infectious agents, human herpes virus 6 (HHV6) and Chlamydophila pneumoniae (Cp), and multiple sclerosis (MS), although these results remain controversial. The objectives was a meta-analysis of clinical series published in literature until now. Material and Methods: An electronic database search (Medline, Excerpta Medica and IME) was performed with MS relapsing remitting and the infectious agents as keywords. A strict selection criteria was applied. 16 studies were selected who complained with the methodological criteria. Results: After statistical analysis, we found that HHV6 was related with MS by detection of DNA in plasma and antibodies in serum and cerebrospinal fluid, but not with DNA in cerebrospinal fluid or peripheral blood white cells. Cp was related with MS by detection of DNA in cerebrospinal fluid, antibodies and the isolation of bacteria of cerebrospinal fluid, but not with serum antibodies. Conclusions: A study with enough number of patients and samples, prospective, controlled with healthy subjects and other neurological diseases, with multiple microbiological techniques in the same sample and patient, and correlated with clinical and paraclinical activity parameters, are needed.
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Estudio Puerta-a-Puerta de Enfermedades Neurológicas en Atahualpa, una Población Rural del Litoral Ecuatoriano — Metodología y Definiciones Operacionales
We describe the methods and operational definitions of an epidemiological door-to-door survey for the detection of neurological disorders in Atahualpa, a rural community of approximately 2,600 inhabitants, located in the coastal region of Ecuador. We will determine the prevalence of epilepsy; the prevalence and incidence of cerebrovascular disease; the prevalence of dementia; the relationship between smoking, alcohol ingestion, arterial hypertension, diabetes mellitus, and stroke; the relationship between cysticercosis and epilepsy; and the prevalence of Taenia solium infection among individuals who tested positive for anti-cysticercal antibodies in serum. We hope that improved epidemiological knowledge on some differences of expression that such diseases may present according to racial, cultural, and socio-economic factors, may improve the control and management of these conditions in Atahualpa.
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Palabras clave: Enfermedades Neurológicas,
estudio epidemiológico,
Keywords: epidemiological survey,
neurological disorders,
Síndrome Febril sin Causa Aparente en Lactantes Menores de 3 Meses: Utilidad de la Punción Lumbar
Febrile syndrome without apparent focus in children under 3 months old is a common problem in clinical practice. Here, we evaluate the role of lumbar puncture in this group of patients to assess the frequency of viral meningitis. We analyzed 253 medical records of patients hospitalized in the Seclusion Service of Roberto del Río Hospital from January 2001 to January 2003. The age ranged from 2 to 87 days; 55.7% of patients were younger that 28 days, and 86.6% were younger than 2 months. Most common manifestations were fever and poor appetite. Laboratory tests showed abnormal WBC in 28% of patients. CRP and ESR were impaired in 1.6% and 10.7% respectively. Blood cultures were positive in 3.2%, and urinalysis were abnormal in 30 patients. We performed lumbar puncture in 223 of 253 patients (88%). It yielded abnormal CSF findings in only 14 children. Viral meningitis was diagnosed in 10 patients and bacterial meningitis 4 patients.Pyelonephritis or occult bacteremia were confirmed in 11.8% and 4.7% respectively. Treatment was started in 125 patients, but only 62 completed it. We conclude that lumbar puncture is a diagnostic tool in febrile infants to rule out diseases having high morbidity and mortality rates, that must be receive prompt treatment. In febrile infants under 3 months of age with no apparent focus, bacterial disease must be suspected
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Relación Entre Patrones de Sueño y Ansiedad / Depresión
In recent years contradictory data as to relationship between the sleep patterns and psychological variables have appeared. This study analyses the relationships of depression and state-trait anxiety levels in subjects with different sleep patterns. From 583 subject sample, 25 long sleep pattern , 25 medium sleep and 25 short sleep pattern were selected. The results show that no relationships between psychological variables and sleep patterns.
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Improvement of Movement Disorders with Mirtazapine: A Preliminary Open Trial
We performed a non-controlled open trial in 22 patients who had movement disorders. Patients received 30 mg of Mirtazapine per day. Twenty patients (90.9%) had a favorable response and their scores on the severity and functional scale improved after treatment. The time needed to control abnormal movements was 30 days in almost 70% of the subjects. Further randomized controlled trials could determine the effectiveness of Mirtazapine for movement disorders.
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Hemorragias Cerebrales Lobares. Resultados Quirúrgicos
Stroke is the third cause of death in Cuba and in developed countries and intracerebral hemorrhage represent between 15-30% of all acute stroke. An observational descriptive study was conducted in 20 patients who had lobar spontaneous intracerebral hemorrhages and underwent surgery in our Service from January to December,2000. The patients were evaluated at admission by Kanaya system and the results by Glasgow outcome scale (GOS). arterial hypertension was the commonest risk factor (71.42 %). Computed axial tomography (95%) and carotid angiography (75%) were the diagnostic tests performed during the first 24 hours after receiving the patients in our emergency services. All the patients had lobar hemorrhages between 20-60 cm3. The etiology was unknown in 70% of cases,10% showed intracranial aneurysms, 10% brain tumours and 10% haematologic disturbance. Open surgical techniques were used in 80% of patients. Recombinant streptokinase was used twice during surgery to attain the total lysis of the clot . There were 4 deaths(20%) in the reported cases.
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Síndrome de Guillaín-Barré. Experiencia en el INNN. Búsqueda de Factores del Mal Pronóstico.
Objectives: This article describe the Guillaín-Barré syndrome in a Mexican population. Materials and Methods: We review the charts of 40 patients admitted to the National Institute of Neurology and Neurosurgery “Manuel Velásco Suárez” in México City, and we contact them by telephone in order to know their current outome. Results: We find pathological antecedents in 62% of patients. The clinical patern was classical in 62.5%. The functional grade at admission was II in 17.5%, III in 55% and IV in 27.5%. Electrophisiologic tests showed 72% of secundary axonal dammage, of them, 35% was severe. Twenty-two patients (55%) were admited to the Intensive Care Unite, with 70% of them requiring mechnical ventilation, and with a mean admission time of 17.8 days. 22.5% of patientes were treated with immunoglobulins, 7.5% underwent plasma exchange and 70% did not recive specific treatment. Average total hospitalization was 31.8 days. The twelve months outcome was good (Class A) in 77.5%, regular (Class B) in 15%, and bad (Class C) in 7.5%. Conclusions: The electrophysiologic pattern was directly related with the outcome. This was perhaps the same situation of the time of admition and later management with the outcome. The specific treatment and the outcome did not show any correlation. In the group of Class A patients, 50% were treated with IG vs 37.5% without treatment and 12.5% with plasma exchange. Thie study is limited by its retrospestive characteristic and by the lack of disponibility to specific treatment.
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Tratamiento Sistematizado de la Hemorragia Subaracnoidea
Hemorrhages account for 20% to 25% of stroke cases in our population, Among these patients, subarachnoid hemorrhage accounts for 7% to 10% of cases, and represent the main cause of stroke-related death. In the present study we present a model for systematic treatment of this condition with particular emphasis of early diagnosis and agressive therapeutic approach. We performed an observational study of 117 patients with subarachnoid hemorrhage admitted between January 1995 and August 1999 who were managed according to internationally accepted algorithms. Arterial hypertension and smoking were the most common risk factors. While angiography of intracranial vessels was performed in every patient, we could only find saccular aneurysms in 32 patients (27.36%). About 60% of those patients were operated on, with a mortality of less than 5%. Mortality was directly related to the clinical status of the patient on addmision, and aggessive therapy reduced the chance of death.
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Epidemiología de la enfermedad cerebrovascular hemorrágica en la región central de Cuba
Introduction. Cerebrovascular diseases are the third most important cause of death in Cuba. Among the programmes given priority by the Cuban Ministry of Public Health and the World Health Organization (WHO), hemorrhagic disorders are the most ‘lethal’. Objective. To determine the ‘behaviour’ of hemorrhagic cerebrovascular disease in the central region of Cuba. Patients and methods. An exploratory, descriptive, retrospective study in which 1,401 clinical histories were reviewed. The variables being investigated were then processed using the computer data processor EPINFO 6.0 to determine the mean, standard deviation and chi squared. Results. An annual incidence rate of 84.03 per 100,000 persons was seen for hemorrhagic cerebrovascular disease; 54.16 and 29.86 per 100,000 persons respectively for intracerebral hemorrhage and subarachnoid hemorrhage; and total mortality of 68.95%. The disorder was associated with possible meteorological factors and the highest percentage was due to intracerebral hemorrhage with 64.45%. Arterial hypertension was the most intensely studied risk marker (p< 0.01). Most cases were elderly (p< 0.001). Surgical treatment was given to 81 patients with subarachnoid hemorrhage, with a predominance of malformations of the middle and anterior cerebral arteries. Treatment was based on depletion using Manitol and calcium antagonists. A considerable number of patients required mechanical ventilation and vaso-active drug support. Most were attended in Intermediate Polyvalent Treatment Units and the main complication was sepsis. Conclusions. There is a high mortality from hemorrhagic cerebrovascular disease in the central region of Cuba, and once the diagnosis has been made the prognosis is usually poor. The patients included in the programme of attention for subarachnoid haemorrhage showed promising results.
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Pseudotumor cerebral: análisis de nuestra casuística y revisión de la literatura
Introduction. Pseudotumor cerebri (PC) is a complex syndrome characterized by increased intracranial pressure in the absence of any space occupying lesion, usually self-limiting, but often relapsing. Diagnosis is based on a record of intracranial pressure of over a limit of 250 mmH2O. Morbidity is basically due to possible loss of vision associated with atrophy of the optic nerve. When the aetiology is unknown this clinical condition is known as idiopathic intracranial hypertension. Patients and methods. We describe the principal characteristics of a series of patients who were admitted to our department with the diagnosis of PC and review the relevant literature. Results. Altogether 14 patients (12 women and 2 men) were admitted with the diagnosis of PC. In 12 patients the disorder presented with headache, with or without associated symptoms of disorders of vision. The main visual symptoms were transient darkening of vision, scotomas, photopsias and reduction in visual acuity. The headache was holocranial, continuous and well-tolerated or alternatively uni- or bilateral, pulsatile, moderate, with or without photophobia, and with or without nausea and vomiting. Bilateral papilloedema was seen in all patients. In one case there was also bilateral facial palsy and neck rigidity. In four cases visual field measurement were abnormal (inferoneasal scotoma, bilateral concentric reduction). Progress was poor in only one case. Conclusion. In spite of being theoretically benign, and there being many forms of treatment, PC may cause considerable morbidity of vision. Therefore, early diagnosis and close follow-up attention is essential.
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Palabras clave: presión intracraneal,
pseudotumor cerebral,
Keywords: intracranial pressure,
Pseudotumor cerebri,
Short course of albendazole therapy for neurocysticercosis: A prospective randomized trial comparing three days, eight days and the control group without albendazole
Antihelminthic therapy with albendazole for parenchymal cerebral cysticercosis, despite its widespread acceptance, is still the subject of controversy. In this prospective, randomized clinical trial, we compared the effectiveness of two regimens of albendazole therapy for neurocysticercosis against each other and against symptomatic therapy alone. A first group (27 patients) received albendazole for 3 days, a second group (27 patients) received albendazole for 8 days, and a third group (29 patients) received only symptomatic treatment. Effectiveness of albendazole was 85.8% with no difference between the 3 and 8-day groups of treatment. Improvement of the patients in the control group was 34.4%. Complete resolution of cysts was obtained in 77.7% of the patients who received albendazole. Two years after therapy, there was no difference in the number of patients free of seizures, when comparing the three groups of treatment. The ultra-short course of treatment with albendazole for 3 days was effective in our patients. Therapy with albendazole for 8 days did not provide additional benefits.
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Amnesia global transitoria y factores de riesgo vascular
Introduction. Transient global amnesia (TGA) is a clinical syndrome determined by an episode of less than 24 hours consisting of temporo-spatial disorientation with retrograde and anterograde amnesia followed by complete recovery. Objectives. To determine whether the presence or absence of vascular risk factors (VRF) in patients with TGA is associated with different clinical data and/or examination findings. Patients and methods. A retrospective study was made of two groups of 13 and 12 patients with TGA, who presented with and without VRF, respectively. The following variables were determined: VRF, age, a previous history of migraine, triggering factors, duration and repetition of the episodes, associated neurological symptoms and findings obtained by neuroimaging, eco-Doppler of the supra-aortic trunks and transcranial Doppler. The data were subjected to statistical analysis by univariate analysis with Fischer’s exact probability test. Results. The statistical studies showed no significant differences between the variables obtained in the two groups of patients. Conclusions. Transient global amnesia has been particularly related to migraine, epilepsy and cerebral vascular pathology, although its aetiology has not been fully determined. In this study we compare clinical data between the two groups of patients with and without VRF who have had TGA. The lack of significant differences between them tends to rule out a vascular aetiology as the sole cause of this syndrome. Recently Leao’s propagated depression has been suggested as the physiopathological mechanism involved. According to this theory, the vascular pathology might act as the trigger but probably not as the aetiological factor. The findings of our study may support this thesis.
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Características Clínicas del Temblor Esencial en México
We studied the clinical and genetic characteristics of 100 patients with definite diagnosis of essential tremor (ET), evaluated at the clinic of movement disorders of the National Institute of Neurology of Mexico. All patients hab laboratory (metabolic and endocrine tests), neurophysiologic studies, and neuroimaging studies to evaluate the presence of other potential causes of movement disorders. The study included 100 patients with definitive diagnosis of ET, 33 men and 67 women. The mean age at the time of diagnosis was 45,92 years (40.92 in men and 48.4 in women). Mean time from the onset of tremor to diagnosis was 10.60 years (13,71 in males and 9.07 in females). Family history of tremor was found in 56% of the patients. Patients with maternal inheritance had lower age of onset (35.61 years vs. 46.11 years, p<0.05). Five percent of the patients exhibited almost a total lack of capacity in writing and in fine and precise activities. This study showed that patients with ET inherited frim the mother exhibit a lower age of onset. A narrow relationship between the sex of the progenitor and ET probably exists, The torpid evolution of the tremor was noted in 5% of the cases, emphasizing the need for early therapy before deterioration becomes incapacitating.
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Manejo Electivo de los Aneurismas de Circulación Anterior Mediante Abordaje Pterional – Basal
During the last three years we employed a pteriono-basal approach to 26 aneurysms of anerior circulation. The approach consist of a pterional craniotomy removed in block with the orbitozygomatic complex, resection of the superolateral orbit and anterior clinoidectomy. Using this approach, multidireccional viewing is possible with minimal brain retraction. We recomend this approachfor most of anterior circulation aneurysm, especialy those situated in the paraclionid area.
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Palabras clave: Aneurismas Cerebrales,
vía pterional basal,
Keywords: Brain aneurysms,
pteriono-basal approach,
Cirugía en Hernias Discales Lumbares: Comparación de Técnicas
We studied 468 cases of lumbar disk hernias. They were surgically operated following standard clinical and radiological criteria. Of the 468 cases, 319 were operated using standard techniques and 149 cases were operated with microsurgery. Comparative study between these two techniques and results were evaluated. The results were excellent in 82.3% of cases when used standard techniques, and were excellent in 91.4% with microsurgery. We concluded, that microsurgery in lumbar disk hernias is a good option to decrease the risk of surgical trauma and to obtain a better postoperative prognosis.
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Neurocisticercosis en un Hospital General en San Luis Potosí, México
Cysticercosis is the most common parasitic disease of the CNS and the main cause of secondary epilepsy in developing countries. We present the number of patients with neurocysticercosis evaluated at a general hospital in San Luis Potosí, Mexico, on the basis of the files of the department of neuroimaging. The prevalence of neurocysticercosis that we found in this sample (28% of patients with secondary epilepsy) confirm that this parasitic disease is a common cause of secondary epilepsy and a major public health problem in our city.
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Anti-Human Herpes Virus 6 Type B Antibodies Make Up the Oligoclonal Bands in Multiple Sclerosis
Background: There is considerable Oepidemiological evidence that a latent or slow infection with human herpes virus 6 is associated with the etiology of multiple sclerosis. However, techniques for detecting anti-human herpes virus 6 antibodies in the cerebrospinal fluid had been lacking up to the time of this study. Preliminary results were presented at the Second International Conference on Human Herpesviruses 6, 7 and 8 (Italy, Pisa, May 8-11, 1997). Methods: We therefore adapted the enzyme-linked immunosorbent assay in order to make this determination.
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Palabras clave: anticuerpos,
virus herpes simple tipo 6,
Keywords: anti-human herpes virus 6,
antibodies,
Microcraniectomía Asterional: Una Opción Quirúrgica Para la Patología del Angulo Ponto-Cerebeloso.
Current tendency is towards minimally invasive surgical approaches that offer short-term recovery and short hospital stays, reducing the costs of treatment. In cranial neurosurgery, minimally invasive surgery is based on the Key-hole concept, that is, small surgical incision that allow an approach to the lesion using natural microsurgical corridors at the subarachnoid space. The technique that we present in this paper may be carried out with basic surgical equipment and instruments, and do not depend on sophisticated technology. In this article, we present our experience in 250 patients with the technique of key-hole surgery of the cerebelopontine angle. We had excellent results that were similar to those reported in the literature, since we had a low postoperative morbidity, fast recovery, fast recovery, reduced offers the advantage of reduced costs for both patients and institutions.
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Gliosarcomas Cerebrales: Aspectos Clínico-Quirúrgicos, Correlación con Estudios de Neuroimagen, Hallazgos inmunohistoquímicos y Pronóstico.
Gliosarcomas are maling, rare, and dimorphic neoplasms formed by glioblastoma associated with sarcomatous components that may develop from the malignant transformation of hyperplastic vascular elements. We report three patients with gliosarcoma to analyze the correlation between neuroimaging and surgical findings, and prognosis. Clinical manifestations had a sudden onset, in previously healthy patients, and was characterized by a syndrome of intracranial hypertension of acute onset related to the development of an intratumoral hemorrhage. In two of our patients the tumors were observed as intra-axial lesions having large areas of necrosis and peripheral enhancement of contrast material. This finding is similar to that observed in patients with glioblastomas. The other patient presented with a well-defined and homogeneous hyperdense lesion the resembled a meningioma. In our series the patients with the longest survival was the one who had a lesion resembling a meningioma, in whom the sarcomatous component of the lesion predominated.
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Epilepsias Mioclónicas
Objective: To analyze the frequency of myoclonic epilepsies (ME) according to the classification of the International League Epilepsy (ILAF) and workshop of the Comission on Pediatric Epilepsy (Royaumont-France 1997), considering the possibility to include or modifi myoclonic epileptic syndromes. Patients and Methods:Clinic histories of 113 patients (56 men and 57 women) with diagnostic of ME evaluated between January 1993 and July 1998 were reviewed. Early epileptic encephalopathy, progressive and photosensitive epilepsies, as well as other epilepsies presenting with myoclonic seizures during their evolutive course, were excluded. Results: We recognized the following syndromes: a) Idiophatic: 1) Bening ME of Infancy, 10 cases (8.8%), 2) Reflex ME of Infancy, 2 cases (1.8%), 3) Eyelid myoclinia with absence (EMA), 3 cases (2.6%), and 4) Juvenile ME, 29 cases (25.6%); b) Cryptogenic: 1) Myoclonic-Astatic Epilepsy (MAE) of favorable course, 21 cases (18.5%) and unfavorable course, 10 cases (8.8%), 2) Severe ME of infancy, 25 cases (22.1%), and 3) Myoclonic absence epilepsy, 2 cases (1.8%); and c) Symptomatic: 1) MAE, 2 cases (1.8%), 2) Severe ME of Infancy, 2 cases (1.8%), 3) Myoclonic Status in non-progressive encephalopathies (MSnPE), 4 cases (3.5%), and 4) others, 3 cases (2.6%). Conclusion: Cryptogenic (51.3%) and idiopathic (38.9%) seizures were the most common types of ME in our study. In the idiopathic group, the most frequent syndrome was juvenile ME, while in the cryptogenic group, was the Myoclonic-Astatic epilepsy. We consider that EMA should be included in the new classification of epilepsies as an idiopathic syndrome. We also suggest that Reflex ME of Infancy should be discussed as a new syndrome of ME or as a variant of benign ME of Infancy. Finally, whether MsnPE is a new syndrome or a peculiar evolution of symptomatic epilepsies needs further discussion.
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Aneurismas Intracraneales Grandes y Gigantes
Globular intracranial aneurysms are those that have a diameter between 15 and 25 mm, and giant aneurysms are those measuring more than 25 mm. The managing of these lesions in controversial. While mosto studies favor surgical exclusion of globular and giant intracranial aneurysms, several non-surgical options of management have been recently developed. In the present study, we report our experience with 15 operated globular and giant aneurysms over a 17 –year period. We analyze the time elapsed between bleeding and surgery, as well as the surgical technique and the outcome. We compare our results with other studies and consider that surgery is the therapeutic approach of choice for these lesions.
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Abnormal Involuntary Movements and Hydrocephalus
Background: Abnormal involuntary movements have been described in patients with hydrocephalus. However, the etiophatogenesis of this association has not been clarifed. We study the presence of dyskinesia, as weel as its clinical and demographic characteritics in patients with hydrocephalus. Design and patients: Series of cases studied during a 10 year period in a neurologic service of a third-level reference hospital. Nine subjects, 6 men and 3 women (mean age: 67 years) in whom hydrocephalus proced dyskinesia. Results: Hydrocephalus preced in 2.33 years the appearence of dyskinesia. Dyskinetic symptoms included tremor in 6 patients, parkinsonism in 1, and dystonia in 2. Five of these patients had family history of dyskinesia in parents or siblings. In 4 of them, the placement of a ventriculoperitoneal shunt improved the abdominal movements. Conclusion: Hydrocephalus may trigger dyskinesia (tremor, parkinsonism, and cranial-cervical dystonia) in a group of susceptible patients who are in their sixties and have a familiy history of movement disorders. It is possible that hydrocephalus due to mechanic distrotion or to alteration of blood flow to the basal ganglia or both, causes an unbalance between the central and the peripheral impulses for tremor and parkinsonism to appear; on the other hand, ti might unlock the control that basal ganglia exert on the motor-neurones of the trigeminal and facial motro nuclei thus triggering the cranial-cervical dystonia.
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Open label study of riluzole for the treatment of amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis (ALS) has a 5-years mortality of 80%. Several treatment modalities have been used to delay disease progression. The aim of the currrent study was to evaluate of riluzole on clinical progression as assessed by jablecki’s scale in Mexican patients with ALS. Fifty patients with a definitive diagnosis of ALS according to El Escorial criteria were selected. To measure the usefulness of riluzole therapy, disease progression was measured before and after treatment with jablecki’s scale. Patients received a daily oral dose of 100 mg of riluzole throughout the one-year study period. For the 50 patients initially enrolled, 31 (62%) completed the study. After the one-year, monthly progression decreased to 0.5682 points per month (p<0.05). In the 14 bulbar-onset patients with spinal-onset, initial progression was 0.6702 points per month, which decreased to 0.5551 (p<0.05). In 17 patients with spinal-onset, initial progression was 0.6702 points per month, which decreased to 0.5789 (p<0.05). There were no severe side effects related to therapy. Riluzole can delay disease progression and its use should be considered in ALS patients, after making it clear to them and their families that they will not be cured, and after taking into account cost-benefit issues.
