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Alfonso Lagares

Publications and source records attributed to Alfonso Lagares.

8 recordsLinked to original sources
PubMed2006

Early transcranial Doppler after subarachnoid hemorrhage: clinical and radiological correlations.

BACKGROUND: The initial decrease in the level of consciousness after subarachnoid hemorrhage (SAH) is commonly considered secondary to cerebral hypoperfusion and metabolic depression. Age, intracranial pressure, and the amount of cisternal blood are closely related to the clinical grade on admission after SAH. Transcranial Doppler (TCD) may partially and indirectly estimate cerebral blood flow through analysis of flow velocity in the middle cerebral artery (MCA). Besides, pulsatility index (PI) can also be considered an indirect estimator of cerebrovascular resistance. The objective of this study was to determine the TCD parameters in the early stage after SAH and to analyze their correlation with the main clinical and radiological variables on admission. METHODS: A series of 52 consecutive patients diagnosed with SAH, with an abnormal computed tomography (CT) scan on admission and a TCD performed in the first 24 hours from the onset of the hemorrhage, were retrospectively reviewed. Age, sex, clinical grade, presence of cisternal blood or hydrocephalus on initial CT scan, and parameters of TCD examination were recorded for every patient. The relationship between sonographic and clinical and radiological variables was evaluated by partial correlation test, Kruskal-Wallis, and Student t test for paired samples. RESULTS: There were no significant differences in blood flow velocities or PIs between the left and right sides. Lower velocities and higher PIs correlated with a worse clinical condition at admission. Lower velocities also correlated with larger amounts of cisternal blood on the initial CT scan. No significant correlation was observed between PI and the amount of blood in the initial CT scan. CONCLUSIONS: A global decrease in blood velocity in the MCA along with a rise in PI is present in the first 24 hours after SAH. These changes correlate with the clinical deterioration and partially with the amount of blood in the initial CT scan. These findings support the hypothesis that low cerebral perfusion caused by high intracranial pressure leads to diffuse ischemic changes in the early phase of SAH.

Adult↗
PubMed2005

Pannus resolution after occipitocervical fusion in a non-rheumatoid atlanto-axial instability.

Periodontoid pseudotumor or pannus is considered to be an inflammatory mass most frequently associated with rheumatoid arthritis. Transoral resection of the pannus has been the treatment of choice for patients with associated myelopathy, followed in many instances by posterior stabilization. However, some authors have reported resolution of pannus associated with rheumatoid arthritis and other forms of chronic atlanto-axial instability only after posterior stabilization. We report a case of a 69-year-old man who presented with a rapidly progressing myelopathy due to a retro-odontoid mass produced by chronic atlanto-axial instability associated with an occipital assimilation of C1 and tight posterior fossa. An urgent posterior fossa craniectomy followed by occipitocervical fixation was performed. After surgery, the patient's clinical condition improved and 1 year after surgery was asymptomatic, walked without any help and had normal strength. Control MR showed complete resolution of the retro-odontoid pannus.

Aged↗
PubMed2005

Neuron numbers in the sensory trigeminal nuclei of the rat: A GABA- and glycine-immunocytochemical and stereological analysis.

The volume, total neuron number, and number of GABA- and glycine-expressing neurons in the sensory trigeminal nuclei of the adult rat were estimated by stereological methods. The mean volume is 1.38+/-0.13 mm3 (mean+/-SD) for the principal nucleus (Vp), 1.59+/-0.06 for the n. oralis (Vo), 2.63+/-0.34 for the n. interpolaris (Vip), and 3.73+/-0.11 for the n. caudalis (Vc). The total neuron numbers are 31,900+/-2,200 (Vp), 21,100+/-3,300 (Vo), 61,600+/-8,300 (Vip), and 159,100+/-25,300 (Vc). Immunoreactive (-ir) neurons were classified as strongly stained or weakly stained, depending on qualitative criteria, cross-checked by a densitometric analysis. GABA-ir cells are most abundant in Vc, in an increasing rostrocaudal gradient within the nucleus. Lower densities are found in Vip and Vp. The mean total number of strongly labeled GABA-ir neurons ranges between 1,800 in Vp to 7,800 in Vip and 22,900 in Vc, and varies notably between subjects. Glycine-ir neurons are more numerous and display more homogeneous densities in all nuclei. Strongly labeled Gly-ir cells predominate in all nuclei, their total number ranging between 9,400 in Vp to 24,300 in Vip and 34,200 in Vc. A substantial fraction of immunolabeled neurons in all nuclei coexpress GABA and glycine. In general, all neurons strongly immunoreactive for GABA are small, while weakly GABA-ir cells which coexpress Gly are larger. In Vc, one-third of all neurons are immunoreactive: 16.6% of them are single-labeled for GABA and 31.6% are single-labeled for glycine. The remaining 51.8% express GABA and glycine in different combinations, with those showing strong double labeling accounting for 22.6%.

Animals↗
PubMed2005

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome treated with microvascular decompression of the trigeminal nerve: case report.

OBJECTIVE AND IMPORTANCE: Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome is a very rare disorder characterized by short-lasting neuralgiform unilateral pain affecting the orbital-periorbital area and associated with autonomic phenomena consisting mainly of conjunctival injection, tearing, and rhinorrhea. Treatment of this condition is difficult; many drugs and surgical procedures have been tried with variable results. In the literature, two cases have been described with short-term response to microvascular decompression of the trigeminal root. We present the case of a patient with short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome who remains asymptomatic 2 years after microvascular decompression. CLINICAL PRESENTATION: A 56-year-old woman was referred to our clinic because she had experienced pain in the distribution of the first left trigeminal branch during the previous 2 years. She experienced paroxysms lasting from a few seconds to 1 to 2 minutes superimposed over a dull sensation of pain involving the same territory. The paroxysms had no refractory period and were triggered by touching the eye or the left side of the face, chewing, yawning, washing her hair, and even by light. Although the paroxysms were triggered by light touch or chewing, she was able to talk or touch herself while having the paroxysm. During pain attacks, she experienced tearing and ipsilateral conjunctival injection, eyelid edema and rhinorrhea, as well as intense photophobia. A magnetic resonance imaging scan revealed a vascular structure distorting and compressing the trigeminal root. INTERVENTION: The patient underwent microvascular decompression of the trigeminal root. At surgery, there was clear compression of the trigeminal root by a superior cerebellar artery loop that was resolved by interposing a Teflon patch. The patient awoke from the operation without pain, and all the accompanying signs and symptoms, such as photophobia, disappeared. The postoperative course was uneventful, and 2 years after treatment, the patient remains asymptomatic. CONCLUSION: Microvascular decompression could be an alternative therapeutic approach to this rare syndrome.

Conjunctival Diseases↗
PubMed2003

Comparison between perimesencephalic nonaneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage caused by posterior circulation aneurysms.

OBJECT: Some authors have questioned the need to perform cerebral angiography in patients presenting with a benign clinical picture and a perimesencephalic pattern of subarachnoid hemorrhage (SAH) on initial computerized tomography (CT) scans, because the low probability of finding an aneurysm does not justify exposing patients to the risks of angiography. It has been stated, however, that ruptured posterior circulation aneurysms may present with a perimesencephalic SAH pattern in up to 10% of cases. The aim of the present study was twofold: to define the frequency of the perimesencephalic SAH pattern in the setting of ruptured posterior fossa aneurysms, and to determine whether this clinical syndrome and pattern of bleeding could be reliably and definitely distinguished from that of aneurysmal SAH. METHODS: Twenty-eight patients with ruptured posterior circulation aneurysms and 44 with nonaneurysmal perimesencephalic SAH were selected from a series of 408 consecutive patients with spontaneous SAH admitted to the authors' institution. The admission unenhanced CT scans were evaluated by a neuroradiologist in a blinded fashion and classified as revealing a perimesencephalic SAH or a nonperimesencephalic pattern of bleeding. Of the 28 patients with posterior circulation aneurysms, five whose grade was I according to the World Federation of Neurosurgical Societies scale were classified as having a perimesencephalic SAH pattern on the initial CT scan. The data show that the likelihood of finding an aneurysm on angiographic studies obtained in a patient with a perimesencephalic SAH pattern is 8.9%. Conversely, ruptured aneurysms of the posterior circulation present with an early perimesencephalic SAH pattern in 16.6% of cases. CONCLUSIONS: This study supports the impression that there is no completely sensitive and specific CT pattern for a nonaneurysmal SAH. In addition, the authors believe that there is no specific clinical syndrome that can differentiate patients who have a perimesencephalic SAH pattern caused by an aneurysm from those without aneurysms. Digital subtraction angiography continues to be the gold standard for the diagnosis of cerebral aneurysms and should be performed even in patients who have the characteristic perimesencephalic SAH pattern on admission CT scans.

Adult↗