The New-Onset Refractory Status Epilepticus (NORSE) is a rare entity that is defined as a clinical presentation, in a patient without active epilepsy or other relevant neurological disorder, who presents a refractory status epilepticus (RSE) without an acute or active structural, toxic, or metabolic cause. NORSE constitutes a diagnostic challenge that implies high morbidity and mortality in the short and long term. Clinically, NORSE is characterized by a prodromal phase, an acute phase, where seizures with diverse semiology that evolve to an RSE occur, and a chronic phase, with neurological deterioration and drug-resistant epilepsy. After an extensive work-up, the cause of NORSE is identified in only half of the cases. The initial treatment is based on the use of conventional anti-seizure drugs, requiring most of patients the use of anesthetics and mechanical ventilation. Better results have been observed with immunotherapy, more recently with anti-cytokine drugs, such as tocilizumab and anakinra, consistent with the immunological/inflammatory mechanisms proposed for the pathophysiology of NORSE.
physiopathology
Actualización en Neuropatía Óptica Isquémica No Arterítica. Nonarteritic Ischemic Optic Neuropathy: An Updated Review
Introduction: Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic nerve injury is the second most common optic neuropathy after glaucoma.
Development: Patients are over the age of 50 years with vascular risk factors. This condition typically presents with acute, painless, monocular loss of vision associated with a variable visual field defect and optic disc edema. NAION is produced by inadequate perfusion of the optic nerved head, supposedly because of nocturnal hypotension and small cup/disk ratio. Diagnosis is mainly clinical and prognosis is generally guarded.
Conclusion: There is no treatment for this condition despite numerous medical and surgical attempts. This article reviews the literature and summarizes current data of proposed treatments.
