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La Neurología en América Latina
Palabras clave: editorial,
neurología,
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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Demencia y el Vaso Sanguíneo
Palabras clave: demencia,
Enfermedad de Alzheimer,
Evaluación Pulmonar en la Esclerosis Lateral Amiotrófica
Palabras clave: Esclerosis Lateral Amiotrófica,
Aspectos Históricos del Tratamiento Farmacológico de la Epilepsia
In the present work, we make an historical revision on the different treatments that had been employed for epilepsy since ancient times through the present. This article reviews different periods such as: the believe between the Incas and the Aztecas that the cause of epilepsy was the action of malignant spirits and the basements of the treatments in magical and religious methods; the starting of pharmacological treatment in the XIX century with the use of bromides, the discovery of the antiepileptic drug phenobarbital by Alfred Hauptmann in 1912, phenytoin by H. Houston Merrit and Tracy Jackson Putnam in 1937, through the introduction of new antiepileptic drugs such as lamotrigine, tiagabine, vigabatrine, levetiracetam, etc. in the nineties.
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Aneurisma Gigante de la Bifurcación de la Arteria Cerebral Media: Reconstrucción con Clipaje y Microsutura
The key for the treatment of giant intracranial aneurysms is its exclusion from the circulation and restoration of the normal anatomy. This report describes the technique of the middle cerebral artery bifurcation reconstruction using microsuture aneurysmorraphy and clipping.
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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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Neuroprotección en isquemia cerebral aguda. Estado actual e importancia clínica de la cascada isquémica.
Knowledge of physiophatological mechanisms of cerebral ischemia permits understanding the mechanisms of action on which many aspects of treatment are based and the clinical and neuro-radiological changes. The only treatment with clinically demonstrated success is the use of thrombolytic to restore the cerebral circulation. A cellular and molecular mechanisms such as free radical production, lipid peroxidation, excitotoxicity and calcium ion overload constitute the important therapeutic targets of neuroprotection and it is now known that interventions such a delivering neuroprotective agents can participate to salvage a portentially reversible ischaemic region known as the ischaemic penumbra. We review the vascular and biochemistry that produce necrosis of neurons after a cerebrovascular occlusion and actual evidence of neuroprotective drugs.
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Enfermedad Vascular Cerebral en los Trópicos
Objectives. To review the clinical manifestations, diagnosis, and therapy of diseases causing cerebrovascular disease (CVD) in the tropics. Development. Most prevalent conditions causing CVD in the tropics include: sickle cell disease, Takayasu’s arteritis, cysticercosis, infective endocarditis, Chagas’ disease, viral hemorrhagic fevers, gnathostomiasis, leptospirosis, snake bites, cerebral malaria, puerperal venous thrombosis, and tuberculosis. These conditions may cause cerebral infarcts or hemorrhages, and in most instances are related to either vascular damage secondary to angiitis or hemorrhagic diathesis with bleeding in other organs. In some patients, the severity of the neurological picture makes impossible to identify an specific stroke syndrome and cerebrovascular complications are only recognized on neuroimaging studies or autopsy. Conclusions. There is a group of tropical infectious and non-infectious diseases that may cause cerebral infarcts or hemorrhages. Prompt diagnosis and therapy are needed to reduce the severity or brain damage and to avoid recurrent strokes.
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Rizotomía Prepontina para el Tratamiento de la Neuralgia Trigeminal Secundaria a Infarto de Tronco Cerebral
A 62-year-old woman presented with severe pain in the distribution of the second and third branches of the left trigeminal nerve. Pain was related to an infarct located in the brainstem at the entry of the trigeminal nerve. As pain was refractary to medical therapy, we performed a selective prepontine trigeminal rhizotomy. The procedure resulted in total relief of pain with preservation of sensation in the distribution of the trigeminal nerve.
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Palabras clave: nervio trigémino,
Rizotomía Prepontina,
Keywords: prepontine trigeminal rhizotomy,
trigeminal nerve,
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,
Aspectos Prácticos de las Infecciones Bacterianas del Sistema Nervioso Central
Palabras clave: meningitis piógena,
Estesioneuroblastoma: Presentación de un Caso y Revisión de la Literatura
A 34-year-old man presente wiith progressive anosmia, epistaxis, and intracranial hypertension related to a nasal tumor with intracranial extension. After surgical resection of the lesion, inmunohistochemical and electrical microscopy study of the biopsy material stablished the diagnosis of esthesioneuroblastoma or olfactory neuroblastoma. This is a rare embrionary tumor derived from neuroblasts of the olfactory sensorial system. That portion of the olfactory tract is located at the upper half of the nostrils, above the cribiform plate. Esthesioneuroblastoma shows a bimodal incidence with a first peak in the second decade, and a second and most important peak during the third and fifth decades of live. Individuals from both sexes are similarly affected. Pollipoid mass with epistaxis or nasal obstruction and chronic anosmia are the most common clinical manifestations of this tumor. It is invasive and frequently causes regional and distant metastasis; however, some tumors could stay without recognition until its intracranial growing through the cribiform plate causes neurologic symptoms.
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Palabras clave: estesioneuroblastoma,
neuroblastoma olfatorio,
Keywords: esthesioneuroblastoma,
olfactory neuroblastoma,
Tratamiento de la Paraparesia Espástica Tropical con Pentoxifilina: Estudio Piloto
Palabras clave: mielopatia crónica,
paraparesia espástica tropical,
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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Narcolepsia, Emoción, Conciencia y su Hipotética Relación
In this work a hipotetical relationship has settled down among emotion, Narcolepsy and Conscience. For it, two of the symptoms of this syndrome have been selected, day excessive drowsiness and cataplexy. This way, and after a detailed analysis of both symptoms, we coincide in pointing toward the importance that have the emotion, the anomalies of the dream REM found in subjects with narcolepsy and the conscious in the dysfunction that occupies us. For it, and to relate the narcolepsy with the conscience and the emotion, we have worked on the theory of the Emotion of Mandler, the theory of Activity of Search on the functions of the dream REM of Rottenberg and that of William James. The final result of this work has been a speculation of the processes that happen in the subjects with narcolepsy abiding to the previously noted theories.
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Perfil de la Epilepsia en el Ecuador
The point prevalence of active epilepsy in Ecuador is between 7/1000 and 12/1000, which is similar to that reported in developed countries; however, this finding does not necessarily indicate that the risk to develop epilepsy is the same in these two populations. The incidence of epilepsy in Ecuador is between 120/100,000 and 172/100,000, which is two to threefold higher than that reported in developed countries. These results should be confirmed by further studies. In Ecuador, the frequency of epilepsy is highest during adolescence and adulthood, probably due to the high prevalence of infectious and parasitic diseases in these age groups. Regarding the prognosis, seizures recur in 43% of patients with epilepsy. The risk of recurrence by the Kaplan-Meier actuarial analysis is 30% at 12 months, 51% at 24 months, and 79% at 45 months of follow-up. Statistically significant risk factors for recurrence are the etiology (52% recurrence risk in patients with symptomatic epilepsy) and the presence of an abnormal CT scan (51% recurrence risk in patients with abnormal CT scans). Mortality in patients with epilepsy is six-fold higher than in the general population of Ecuador (standardized mortality ratio SMR of 6.3). The SMR for sudden death in patients with epilepsy (3.9) is also higher than that reported in developed countries. These greater mortality ratios probably explain the relatively low prevalence rates in our country. In 1995, Ecuador spent 4.6% of the gross national product on the health system. The Ministry of Health, which funds the public health system, contributed only 1.5% of this amount. This government contribution is one of the lowest in South America. There are no government programs in Ecuador working to manage and prevent chronic diseases, such as epilepsy. There are also no laws to protect patients with epilepsy. This complex background obligates the health authorities, scientific community, and the society in general, to join together in the fight against epilepsy, as a bio-psycho- social problem.
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Progresive Dementia and Behavioral Changes: Pick’s Disease: A rare disease or an underdiagnosed disorder?
Pick’s disease is a nosological entity with frontal dementia, early cortical dementia with severe frontal lobe disturbances, absence of apraxia, and absence of gait disturbance at onset. This disorder is underdiagnosed in clinical practice. When specific criteria for the clinic, imaging and neuropathologic diagnosis including the presence of Pick bodies, are used, the diagnosis of Pick’s disease is achieved. However, taking into account that the definitive diagnosis of PD is achieved only with pathological study, in vivo diagnosis requires of the combination of neuroimaging techniques.
More than 100 years ago, Arnold Pick described several patients who presented with progressive behavioral changes (apragmatism, outbursts of rage, and later stages, mutism) and who, at autopsy, had characteristic frontal or temporal lobar atrophy [1]. Alloys Alzheimer histologically characterized the disorder when he described “argentophylic globes” in the cytoplasm of neurons and the presence of ballooned neurons and spongy cortical wasting in the absence of neurofibrillary tangles or plaques [2]. Pick’s disease is considered a relatively rare neurodegenerative disorder, affecting subjects in their 60s with the progressive development of frontal lobe type features (e.g., difficulty planning, reasoning, abnormal social behavior), language disturbances (decreased fluency followed by echolalia, mutism), later followed by memory and gait abnormalities and occasional parkinsonism [3]. In autopsy studies of progressive dementia, only about 5% are due to PD. The underlying cause is not know, but there does appear to be a hereditary component, with clear autosomal dominant transmission in some families. The disease usually progresses inexorably over 2 to 5 years to death. At the present time there is no specific treatment available [4]. We report our findings in a patient with the purpose of to attract attention about this entity with the aim to avoid unnecessary, expensive and dangerous treatment when this kind of patients received a wrong diagnosis.
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Keywords: dementia,
Pick’s disease,
Cirugía de Aneurismas Intracraneales
Palabras clave: Hemorragia Subaracnoidea,
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,
