Neuropsychological assessment is increasingly used as complementary diagnostic test for different brain pathologies, and Portugal is not an exception. Therefore urges that the instruments used for the evaluation present adequate psychometric criteria and normative data adjusted to the same population. Aging is a dynamic and progressive process, leading to greater vulnerability and incidence of pathological processes. Within these processes included neurodegenerative diseases, the most common, Alzheimer’s Disease.1 Executive functions seem to be the most involved in the overall functioning of the individual and the Stroop Test, is frequently used to evaluate these functions. We present a study of adaptation of this instrument in a Portuguese sample, trying to verify the importance of sociodemographic variables on test performance and whether there were significant differences between healthy subjects and with neuropathology. The results have allowed verifying the importance of adaptation of populations where tests are used. Thus, the Stroop Test seems a test to take into account when establishing a neuropsychological evaluation protocol, as well unlike the patterns of performance between normative and pathological aging.
Artículos Originales
Intervención Neurolingüística en la Respiración y la Voz en Pacientes con Lesiones Estáticas Encefálicas Portadores de Trastornos Disártricos.
Objective: To prove the effectiveness of the neurolinguistic rehabilitation program for dysarthric patients, applied at the Encephalic Static Lesions Adults Clinic, International Center of Neurologic Restoration, in voice and breathing areas. It is a single sample pre-experiment obtained from logopedic records, contrasting them with the results of the external diagnosis, application of therapy and final evaluation.
Results: Males were prevalent and encephalic trauma as clinical diagnosis, there was great dispersion in age and time of evolution. Of the 54 patients, 40 increased their spirometric index: 22 the inspiration puff; 39 phono-respiratory coordination: 36 modified intensity; 11 tone; 18 modified their stamp vowel. The results evidence efficient functional recovery after the program was applied.
Conclusions: It was confirmed that there is not such established recovery pattern: none of the different variables influences significantly, the dispersion of the results is overwhelming and it is only possible to talk about tendencies. The program is effective but it cannot be affirmed that this variant is the correct one: more emphasis should be given to vocal indicators, other respiratory dimensions that are used should be measured as they have functional connotation.
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Trastornos del Sueño: Conocimiento de Apnea Obstructiva del Sueño en Médicos no Neurólogos y su Manejo Perioperatorio.
Objective: Obstructive sleep apnea syndrome (OSA) is a common sleep-related disorder that has been associated with a higher perioperative risk. Our purpose is to determine the level of knowledge and attitudes towards OSA among surgeons and traumatologists, knowing their important role in the prevention of potential perioperative complications in these patients.
Material and Method: Crosssectional survey study, using the “Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire” (OSAKA), administered to 105 surgeons and traumatologists and 27 surgery residents to measure the level of knowledge and attitudes towards OSA.
Results: Knowledge scores ranged from 3 (14%) to 17 (81%). The mean value for surgeons and traumatologists was below 62% (p=0.04), and lower than 48% (p=0.02) for residents. There is a positive correlation between the level of knowledge and the importance of identifying patients with OSAS (r = 0.26), and the confidence in themselves to identify this patients (r = 0.38). There was a negative correlation between knowledge and years of practice (r= -0.23).
Conclusion: Obstructive Sleep Apnea Syndrome is widely unknown among Surgeons and Traumatologists from Guayaquil. We recommend educational interventions that improve the level of knowledge and promote the use of guidelines in the management of patients in the perioperative period to decrease the risk of complications.
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The Impact of Rheumatoid Arthritis in Neuropsychology, Depression and Anxiety. A Case-Control Study, with 90 Portuguese Female Subjects.
Objectives: The study of the impact of Rheumatoid Arthritis in cognitive functions has not been well documented in Portugal. So, with this original article we tried to clarify this reality in this particular country.
Methods: We assessed the results of 45 Rheumatoid Arthritis female patients (intervention group), comparing each patient in a case control paired strategy (years in school and age), with control subjects (n = 45, in a total of 90 subjects). All subjects were evaluated with Paced Auditory Selective Attention Test, Word List Generation Test, Luria Nebraska Neuropsychological Battery, a Portuguese depression screening test (IACLIDE), STAI (anxiety trace and trait test) and the Mini Mental state examination.
Results: The results show, for the first time in Portuguese patients, the presence of major deficits in terms of cognitive function and symptoms of depression and anxiety.
Conclusion: This article strengthens the argument of the necessity to pay attention in psycho-educational, psychotherapeutic and cognitive stimulation as well as neuropsychological intervention in these types of patients.
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The “8-foot Up and Go” Test as a Physical Performance Measurement in Parkinson’s Disease: A Pilot Study.
Blackground: Parkinson disease (PD), is a movement disorder, so physical assessment should be a key component in the diagnosis of individuals suffering from this disease. There is a neeed to assess the utility of some motor tests in PD, specially those which include assessment of straight line walking and turning.
Objective: This pilot study aimed to asses the utility of the “8-foot up and go” test as a physical performance measurement in PD, as well as the relationship between functional mobility and quality of life in this population.
Material and Methods: Twenty-four patients with a diagnosis of idiopathic Parkinson’s disease volunteered and finished the study. They performed the “8 foot up-and-go” test and answered the 9-item Parkinson’s Disease Questionnaire.
Results: The motor test’s total score correlated significantly with different sub-scales of the 9-item Parkinson’s Disease Questionnaire, especially with the mobility sub-scale and with the total score.
Conclusions: The “8 foot up-and-go” test is useful and easy to perform by Parkinson’s disease patients and it has turned out to be a clear indicator of the way the illness affects their quality of life.
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Efectos de la Subtalamotomía en la Inducción o Modificación de Disquinesias en Pacientes con Enfermedad de Parkinson Idiopática.
We performed a longitudinal, analytic and retrospective study in order to evaluate the effect of subthalamotomy in the induction or modification of dyskinesias in patients with Parkinson’s disease. Was study the motor behaviour, the cardinal features of Parkinson’s disease, the mean daily Levodopa dose and the dyskinesias induced by Levodopa or subthalamotomy in 50 patients with Parkinson’s disease that were operated between 1995 and 2005 in our center. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at least for one year. Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol. In our study the cardinal features of the disease improved in more than 50 %, it were evaluated through the Unified Parkinson’s Disease Rating Scale (UPDRS), as well as the mean daily Levodopa dose was reduced by 40% compared with baseline. The dyskinesias induced by Levodopa were reducing too, and we think that it’s not explainable only for the reduction of the Levodopa dose. Subthalamotomy induced contralateral dyskinesias in approximately 50% of our patients but were generally mild and short lasting. The risk of persistent and severe dyskinesias postoperative was smallest. This study indicates that the presence of severe preoperative dyskinesias and the dorsal location of the lesion are relevant for the development of chorea after subthalamotomy in patients with Parkinson’s disease. These find must to be confirm in a prospective randomized study.
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Morphological Changes Induced by Three Aminoglycosides on the Cochlear Stria Vascularis.
Aminoglycosides are efficient antimicrobials commonly used in clinical practice. Their effects on the cells of the organ of Corti and the spiral ganglion neurons have been extensively studied. However, there are only a few reports concerning aminoglycoside-induced morphological changes on the stria vascularis. The purpose of this study was to describe morphological and morphometrical changes on the rat stria vascularis after a profound sensorineural hearing loss induced by three aminoglycosides (kanamycin, gentamicin and amikacin) followed by furosemide. To analyze the stria vascularis area and the number of blood capillaries per stria vascularis, cochleae from fourteen rats sampled at eight weeks after deafness and from four control animals were processed. Serial semi thin cochlear sections from the apical, upper middle, lower middle and basal turns were examined under a light microscope. The cochlear damage degree depended on the aminoglycoside. Mean stria vascularis areas for both kanamycin and gentamicin groups were lower than controls. The mean number of blood capillaries per stria vascularis was reduced for the three aminoglycoside-deafened groups as compared to control animals. For both variables, the most severe damage was observed for gentamicin-deafened animals, followed by kanamycin and amikacin.
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Efectos del Tratamiento Rehabilitador y el “Treadmill” en Pacientes con Ataxia.
Ataxia is a syndrome related to gait disorders that makes necessary a wide range of possibilities in rehabilitation in order to improve the disorder. The treadmill can be useful because it combines motor learning and sensory tricks. This study included 15 patients with ataxia from CIREN clinic. Treatment including treadmill was applied in 30 sessions, one hour each one. Motor function was evaluated pre and post treatment using ICARS scale, velocity, number and width of paces and Hausser index. Comparing results before and after intervention showed statistically significative improvement in ICARS scale and LEIS (p<0.001 and p<0.041 respectively). Rehabilitation treatment including treadmill has favorable effects over gait disorders in patients with ataxia.
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Neurofobia entre los estudiantes de la Carrera de Medicina de sexto a décimo semestre en la Universidad Católica Santiago de Guayaquil.
Background: Neurophobia is defined as fear to neuroscience and clinical neurology. By the impact of neurological diseases worldwide, management of these disorders could be affected. No data exist of this phenomenon in Ecuador. Objectives: To evaluate the difficulty, knowledge, confidence and interest in neurology, neuroscience specialties, affinity factors for difficulty in neurology and neurological training among medical students.
Methods and Materials: A descriptive study was conducted at the Catholic University of Santiago de Guayaquil, surveying: difficulty, knowledge, confidence and interest among specialties; affinity to neuroscience as a specialty, factors contributing neurology´s perception as difficult, and neurological undergraduate training.
Results: The response rate was 78.32% (401/512). Neurology was the most difficult (3.01±0.048), the second with less clinical confidence (2.01±0.056), and third with less knowledge (1.96±0.058). The differences were significant (p <0.001). 70.82% did not plan to pursue a specialty related to neuroscience, 59.85% for absent personal affinity; 10.97% for poor teaching; Contrary, 29.18% want a related specialty in neuroscience, 19.95% by personal affinity and 9.23% for good teaching. Need to know basic neuroscience was the most important for the perception of difficulty (2.76±0.055) followed by poor teaching factor in neurological involvement (2.68±0.57). Training in Neurological Semiology the lowest (1.70±0.061) followed by Neuroanatomy (1.98±0.58) and Neurology (2.52±0.81). Neurologic semiology had the highest percentage of inadequate training (20.45%) compared to Neuroanatomy (9.47%) and Neurology (6.16%).
Conclusions: There is neurophobia among our students. Research and modifications in teaching must be developed to prevent neurophobia and contribute to “neurophilia.”
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Desarrollo Psicomotor y Variables Medioambientales en Dos Poblaciones del Ecuador.
Objective: To determine the influence of some environmental variables associated with psychomotor development in children from an indigenous community and mestizo community in Ecuador. Material and methods: For the observation and measurement of variables were used EEDP scale and a registration form of environmental factors. Data was analyzed using logistic regression test. The methods of observation and measurement of variables through the EEDP scale and a registry of environmental factors were used. Data was analyzed through a logistic binary regression. X2 omnibus test was applied; the same statistician was estimated by the Hosmer-Lemeshow test with global adjustment. Also, it was estimated -2 log likelihood (-2LL) in order to check the veracity of the results, the Cox and Snell R2, Nagelkerke R2 and Wald statistic. Results: The findings indicate that some of the independent variables were related to motor development and coordination in the populations studied. Furthermore, it was found that breastfeeding and type of housing have influence in the social and language development of both populations.
Conclusions: Only some of the studied variables exert influence on psychomotor development of two populations: breastfeeding, age and housing type.
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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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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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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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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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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.
