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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Medical Therapy for Cysticercosis: Indications, Risk, and Benefits
Neurocysticercosis is a pleomorphic disease that causes serveral neurological syndromes and pathological lesions. Therefore, a unique therapeutic shceme can not be useful in every patient. A proper characterizcion of the disease in terms of viability of cysts, degree of the host’s immune response to the parasites, and location of the lesions is of major importance for a rational therapy. Therapy include a combination of symptomatic drugs, cysticidal drugs, surgical resection of lesions, ana placement of ventricular shunts.
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Keywords: neurocysticercosis,
Indicaciones y manejo de la toxina botulínica
Botulinus toxin (BTX) is the most potent biological toxin yet known. It is produced by Clostridium botulinium, a Gram positive bacteria. Type A Botulinus toxin is the most widely used in human drug trials. It has become the treatment of choice for blepharospasm, hemifacial spasm, cervical dystonia and laryngeal dystonia. It may also be used in the treatment of patients with oromandibular dystonia and limb dystonia, specially writer’s cramp, and has been used successfully in the treatment of spasticity and cerebral paralysis. There are many benefits from this treatment, including improved walking, improved posture of wheelchair patients, improvement of patients with spasms and easier extension of their arms and knees. The toxin also alleviates pain and may be used in therapeutic trials for prediction of the response to surgical elongation.
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Miastenia gravis: Diagnóstico y Tratamiento
Myasthenia gravis is an autoimmune disorder characterized by fluctuating muscle weakness and fatigue of different muscle groups. Myasthenia gravis may affect persons of all ages, but especially women aged 20 to 40 years. The ocular, facial and bulbar muscles are most often involved in this disease. The muscle weakness of patients with myasthenia gravis becomes worse with intercurrent episodes of infection, fever and physical or emotional exhaustion. Respiratory infection (bacterial or viral) is the most frequent trigger factor. The presence of antibodies to acetycholine receptors in a patient with the clinical features of myasthenia gravis, confirms the diagnosis. Treatment is controversial. Each patient therefore has to be treated individually, as no single treatment is suitable for all patients. Treatment may include anticholinesterase drugs, corticosteroids, plasmapheresis, immunoglobin, immunosuppressive drugs and thymectomy.
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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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Pseudotumor cerebral: el lado maligno del espectro clínico
Introduction. The pseudotumor cerebri syndrome (PTC) is a clinical entity of unknown etiology affecting mainly young, obese women. The major morbidity factor in this condition is the possibility of vision loss, initially considered to be low, but now known to affect a significant proportion of patients. Clinical case. We describe a case of PTC in a young, obese black women who presented with headache, transient visual blurring and diplopia. Besides obesity, there where no other relevant clinical findings, namely other pathologies and history of medication use. An extensive analytical workup was negative and the CSF showed no abnormalities, aside from increased pressure. Brain MRI was also normal. The clinical course was progressively worse, consisting of rapid vision loss associated with an intracranial pressure of over 850 mmH2 O, despite treatment with diuretics (acetazolamide, furosemide and spironolactone) in therapeutic dosage. Eventually, the patient needed the rapid implantation of a lumboperitoneal shunt to prevent blindness, and went on to make a nearly full recovery. Conclusions. In all major series of PTC, loss of vision has been reported to occur in a significant percentage of patients, and cases have been described in which a catastrophic course with rapid progression to near blindness has led to the introduction of the designation of ‘malignant’ pseudotumor cerebri. We believe that such cases, although rare, need to be recognized as the malignant end of the spectrum of PTC, and that their management constitutes a neurological emergency.
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Diagnóstico de la Enfermedad Cerebrovascular Aguda.
Palabras clave: conferencia,
enfermedad cerebrovascular,
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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Respiratory Dysfunction Associated with Acute Cerebrovascular Events
Cerebrovascular events (CDVE) are a major cause of morbidity and mortality worldwide. Most patients with CVE do not develop significant respiratory problems but when present, they may be a marker of severe neurologic derangement. In one study (1), only 8% of patients presenting with acute carotid territory stroke were electively intubated and mechanically ventilated due to neurologic deterioration. “Good” outcome in terms of survival and neurological status of patients with hemispheric strokes who required mechanical ventilation have been reported in approximately 20% of cases (2). Respiratory disturbances associates with strokes can result from discrete or difuse lesions to key componets of the respiratory controller. The clinical spectrum of respiratory disordes in stroke include abnormal breathing patterns, hypoxemic and hypercapnic respiratory failure, aspiration pneumonia due to an inability to protect the airways and clear the airway by coughing, and acute pulmonary emblism due to prolonged inmobilization. There is a veriety of altered respiratory patterns associated with strokes. There is a variety of altered respiratory patterns associated with strokes (3-5). These changes are not only important in determining the location of the neuroanatomic lesion, but they havealso been regarded as outcome predictors in CVE. This paper reviews the evaluation, management, and effect of respiratory care interventions, management, and effect of respiratory care interventions on a variety of respiratory system problems in patients with CVE.
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Keywords: Cerebrovascular,
Respiratory Dysfunction,
Problemas en el Diagnóstico de la Demencia Vascular
Palabras clave: demencia vascular,
Enfermedad vascular cerebral,
Sleep Patterns and their Relation to Psychological Traits in Women
The number of hours of sleep, approximately 8, is an average that varies little from one culture to another. However, there are individual differences for this variable, which has permitted the establishment of certain sleep patterns. Many studies have focused on the relationship between psychological variables and sleep patterns, which have produced contradictory results. The purpose of the present investigation is to evaluate the extent of dimensions of extraverted and neurotic personalities and state-trait anxiety levels in women with different sleep patterns. In a sample of 300 young healthy adults, 34 women were selected, 17 women showed a long sleep pattern, 9 showed an intermediate sleep pattern and 8 showed a short sleep pattern (age X = 20.29 SD = 1.55). The results indicate that there are no significant statistical differences between psychological variables and sleep patterns, which concludes that there exists no relation between sleep duration and personality and anxiety factors.
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Palabras clave: patrones de sueño,
variables psicológicas,
Keywords: Psychological Traits,
sleep patterns,
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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Transtorno de la Atención con Hiperactividad
Attention deficit hyperactivity disorder (ADHD), is one of the four syndromes of minimal brain dysfunction, recongnized by the last classification of the Diagnostic and Statistical Manual of Mental Disorder (DSM IV). It is mainly characterized by attention deficit, hyperactivity, a low-level frustration, impulsivity, and emotional labilit. Although there are no doubts about its organic naure, the presence of this syndrome does not mean a demonstrable cerebral or irreversible lesion, but an alteration in high cerebral function, particulary in the area of behaviour. ADHD can be associated with language, learning, and motor disabilities. Diagnosis should be made on the basis of behaviour. ADHD can be associated with language, learning, and motor disabilities. Neuroimaging and neurophysiological studies are required only to exclude another phatoogies. Stimulants are the first choice in the treatment of ADHD, mainly methylphenidate, because it is well tolerated and improves not only the attention level and hyperactivity, but also learning and writing abilites. Prognosis varies acording to the severity of the clinical picture, early diagnosis and the familial interaction on the social context of child. Approximately 5% of infantile schoool pupulation have ADHD; therefore, this diagnostic possiblity should be considered by neuropediatricians and pediatricians for early diagnosis and treatment.
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Palabras clave: déficit de la atención con hiperactividad,
Keywords: Attention deficit hyperactivity disorder,
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.
