Biomedical subjects

C Tejero-Juste

Publications and source records attributed to C Tejero-Juste.

12 recordsLinked to original sources

PubMedDate not supplied

[Epidemiology of various types of vascular epilepsy in adults].

From studies of the incidence of epilepsy, figures of between 40 and 70 per 100,000 inhabitants are obtained whilst in studies of prevalence, 5 to 7 cases per 1,000 are found. Cerebrovascular disease is the commonest cause of epileptic crises in the developed world, being more frequent in patients aged over 60, who make up 50% of all cases. Depending on the moment of presentation of crises in relation to the cerebrovascular disease, these may be classified as herald crises or precursors of vascular epilepsy, early crises if they occur during the first week and late crises if they occur after. Whilst early crises are usually due to metabolic or cytotoxic factors, the late crises occur in true vascular epilepsy. When these patients are assessed it is also important to consider increased hospital mortality in those with early crises and possible deterioration of neurological deficit as sequelae following late epileptic crises.

Adult↗

PubMedDate not supplied

[Peripheral facial paralysis: etiology, diagnosis and treatment].

OBJECTIVE: Peripheral facial paralysis is one of the commonest mononeuropathies. The frequency of idiopathic peripheral paralysis or Bell's palsy varies between 62% and 93% of all cases, with an incidence of between 14 and 25 cases per 100,000 inhabitants per year. However, in spite of its relative frequency in the population, there is still no definite unanimously agreed strategy currently used by neurologists. Although its course is relatively benign, up to 16% of the patients show moderate or severe sequelae according to follow-up data in 1,011 untreated patients. In this article we review the aetiology, diagnostic methods and therapeutical strategies at the present time. DEVELOPMENT: The topographic diagnosis of the lesion is based on the symptoms associated with the paralysis. The neurophysiological studies (trigeminofacial reflection and electroneurogram), usually done after the first week are prognoses that permit differentiation of the degree of the lesion (neuropraxis, axonotmesis or neurotmesis). In spite of recent trials with combined therapy (acyclovir and steroids) the most generally accepted treatment at present is still prednisose at a dose of 1 mg/kg/day. CONCLUSIONS: Peripheral facial paralysis is a common condition, usually with no apparent cause and an eminently clinical diagnosis. The electrophysiological studies determine the prognosis. Currently the standard treatment is still oral prednisone.

Acyclovir↗

PubMedDate not supplied

[Acute symptomatic epilepsies].

OBJECTIVES: To review the differentiating characteristics of symptomatic acute epilepsies, epidemiology, aetiology and controversies over treatment, and describe our experience with symptomatic acute epilepsy in cerebrovascular disorders. DEVELOPMENT AND CONCLUSIONS: The so-called symptomatic acute epilepsies show clearly differentiated characteristics with regard to true epileptic disorders: 1. A clearly identified causal association; 2. Generally tend not to recur; 3. Usually long-term anti-epileptic treatment is not necessary. Therefore the most suitable term for them is symptomatic acute seizures. They make up a large proportion of all newly-diagnosed epilepsies around 40%. The highest incidence occurs during the first year of life (probably because of the high incidence of seizures due to encephalopathies, metabolic disorders and infections) and in elderly patients (especially in relations to cerebrovascular disorders). The commonest causes are: cerebrovascular disorders, head injury, infections of the central nervous system, alcohol and drugs. The risk of subsequent epilepsy is increased in a subgroup of these patients, especially in cases with associated cerebrovascular disorders, head injuries and central nervous system infection. Long-term preventive treatment is rarely indicated in these patients.

Acute Disease↗

PubMedDate not supplied

[Visual field changes secondary to vigabatrin treatment].

INTRODUCTION: Vigabatrin is an effective antiepileptic drug for treatment of partial crises with or without generalization. It acts by increasing GABA levels by irreversible inhibition of the enzyme GABA-transaminase. In recent years there have been several reports published on the appearance of alterations of the visual fields of patients treated with this drug. OBJECTIVE: To study the prevalence and characteristics of the visual field changes associated with vigabatrin treatment in an adult epilepsy clinic. PATIENTS AND METHODS: Ophthalmological examination, consisting of questions about eye symptoms, study of the fundus oculi, Humphrey-type campimetry, protocol 30-2, visual evoked potentials and electroretinogram were done on a group of 10 patients on long-term vigabatrin treatment. RESULTS: Six of the ten patients (60%) had campimetric alterations, which were serious in two cases (20%). Only the two patients with severe field defects complained of sight changes when questioned and their complaints were mainly of repeatedly bumping into things. In two patients (20%) there was pallor of the optic nerve. In both cases, the patients with severe field defects showed alterations on the electroretinogram. Visual evoked potentials were normal in all cases. CONCLUSIONS: There is a very high prevalence of visual field defects in patients on long-term treatment with vigabatrin. Clinical ophthalmological signs are not usually seen until advanced stages. Pallor of the optic nerve was seen in a group of patients. It is very important that serial campimetric studies are done for early detection of such alterations.

4-Aminobutyrate Transaminase↗

PubMedDate not supplied

[Neuropsychological changes in epilepsy].

OBJECTIVE: The neuropsychological assessment of the epileptic patient is a very important aspect of diagnosis and treatment. It may be used to contribute to localization of the hemisphere involved in the seizures, differentiate situations of anxiety or depression or when planning treatment for rehabilitation. We review the different aspects of neuropsychological changes in patients with epilepsy. DEVELOPMENT: Firstly we review the different tests used in the neuropsychological assessment of epilepsy. Dodrill's neuropsychological battery of tests, in which the patients score less than the controls, is the most commonly used. We then evaluate and study the so-called 'transient cognitive disorder'. We also study memory problems in epilepsy. There may be episodes of seizures with amnesic features ('amnesic epileptic seizures'). Finally, the possibility of neuropsychological dysfunction secondary to antiepileptic drugs should always be considered. CONCLUSIONS: Epileptic patients have lower scores than persons taken as controls for the results of various neuropsychological tests, although there is less difference between the two groups when the patient group is made up of persons with a normal intelligence quotient. Transient cognitive involvement is common in epileptics and may cause underachievement at school or psychological problems. Memory disorders, particularly subjective, are common in epileptics, although neuropsychological tests other than those generally used may be necessary to evaluate this. It is possible that such memory disorders, if occurring as seizures, may be due to amnesic partial crises, which should always be differentiated from the diagnosis of transient global amnesia. Almost all antiepileptic drugs can cause negative neuropsychological effects, especially the benzodiazepines and barbiturates.

Acute Disease↗

PubMedDate not supplied

[Use of lamotrigine in the treatment of absence epilepsy crises].

OBJECTIVE: To review the current treatment and usefulness of lamotrigine in absence seizures. DEVELOPMENT: Absence seizures are classified amongst the generalized epilepsies. They are defined as a transient loss of consciousness of sudden onset and recovery characteristically associated with generalized spike-and-wave discharges on the EEG. In recent years, the epileptic syndromes associated with this type of seizure have been better defined, basically by means of video-EEG studies. The International League Against Epilepsy has recognized four epileptic syndromes with typical absences: absence-epilepsy of childhood, juvenile absence-epilepsy, juvenile myoclonic epilepsy and epilepsy with myoclonic absences. The classical treatment for this type of seizure was based on ethosuximide, or more often, sodium valproate. Sometimes both drugs together were necessary. Other useful drugs are the benzodiazepines such as clobazam. CONCLUSIONS: We review studies of the efficacy and tolerance of lamotrigine in the treatment of absence seizures, one of the groups of seizures in which this drug has been shown to be most effective. Although studies comparing lamotrigine, valproate and ethosuximide are necessary, we emphasize the possibility that lamotrigine may be a drug of choice in absence seizures.

Anticonvulsants↗

PubMedDate not supplied

[Morbi-mortality of medical and surgical treatments in the intracranial bleeding like complication of therapy with drugs that modifies normal coagulation].

INTRODUCTION: Antiaggregant and anticoagulant therapy has possible sever secondary effects, being the most serious intracranial bleeding. OBJECTIVES: Compare morbi-mortality between surgical and medical treatments in anticoagulated and/or antiaggregated patients with any kind of intracranial bleeding. Also risk factors and main indications of those treatments are studied. PATIENTS AND METHODS: Descriptive and retrospective study including 105 patients admitted in our Critical Care Unit, with intracranial bleeding, under anticoagulant or antiaggregant treatment. We study the type of bleeding (subarachnoid, epidural, subdural and intraparenchimal bleeding) and the relation between morbi-mortality and treatment applicated using relative risk like analytic tool. RESULTS: Major bleeding risk appears after the six first months from the beginning of the treatment. Thirty-four patients died with a relative risk of 1.55 in the surgical patients from the medical treatment patients. Relative risk between anticoagulated patients and antiaggregated ones was 1.16. Serious consequences happened on eight of the 49 patients under surgical treatment, and on 13 of the 52 patients under medical treatment. CONCLUSIONS: Surgical treatment has more morbi-mortality. Oral anticoagulation has only a little more relative risk than treatment with antiaggregants. Both groups had serious consequences.

Adult↗

PubMedDate not supplied

[Diagnose and predict utility of transcranial Doppler in the serious cerebral anoxia].

INTRODUCTION: In the clinical daily practice, exist multiple situations in which could produce phenomenons of serious hypoxia to encephalic level, normally with important repercussions for the patient. OBJECTIVES: Study if after the existence of a situation of serious encephalic hypoxia, any typical pattern in the exploration transcranial Doppler (TCD) exists, and the possible diagnostic and/or prognostic implications could bear. PATIENTS AND METHODS: We presented 10 patients admitted in our Unit of Intensive Care, for clinical situations in which a situation of encephalic hypoxia took place and to which was practiced a TCD like exploration of encephalic flow. We related the discoveries of the DTC, with the clinical situation, the images of the cerebral computed tomography in three of the patients, and the data of the electroencephalogram in the other seven. Like statistical tool, is used the test of square ji, demanding a confidence interval of the 95%. RESULTS: In all the patients, we found a patron TCD, of high speed mean with low Pulsatility Index. Nine patients died, surviving with serious sequels the last patient. CONCLUSIONS: In our series, we could conclude, that the existence of a patron TCD with high speed mean and with low Pulsatility Index, after an episode of brain hypoxia, its associated to a wrong presage, existing a high risk of death of the patient.

Adult↗

PubMedDate not supplied

[Evaluation of patients who do not visit neurology units].

AIMS: Our aim was to study the relation between non-attendance at neurology units and the delay that exists, as well as the demographic factors that may come to bear on non-attendance. PATIENTS AND METHODS: Data on neurology outpatients over the period between November and December 2002 were collected prospectively. Both patients who were referred for evaluation and those on their first programmed visit were included in the study. RESULTS: The total number of subjects was 1,035, with an average age of 55.31 +/- 19.84 (14-96). Of these, 605 were females and 430 were males, with no significant differences in the age of the two groups. 40% of the cases came from rural areas. 237 (22.9%) did not attend the visit. We found a statistically significant relation between age and non-attendance (t=2.67; p=0.008, Student's t). There was also a relation between not going to the visit and the delay that existed (t=5.84; p=0.000, Student's t). Patients who were referred from the Casualty department missed their visit more often those who were sent by their GP (Pi2=2.4; p=0.07, chi2). The date on which they received the appointment was also related to non-attendance (t=2.55; p=0.011, Student's t). CONCLUSIONS: Non-attendance was associated, above all, with the delay, with youth, being sent from casualty and with the length of time since they received notice of the visit.

Adolescent↗

PubMedDate not supplied

[Clinical, electrophysiological and immunological evaluation of the response to treatment with intravenous immunoglobulins in several immune-mediated neuropathies].

INTRODUCTION AND AIMS: Chronic immune-mediated neuropathies are characterised by their being predominantly demyelinating, by being associated to specific antibodies and by their response to immunotherapy. We evaluated the clinical, electrophysiological and immunological responses following treatment with intravenous immunoglobulins (IVIg) in different clinical forms. CASE REPORTS: We report on three patients with: 1. Multifocal motor neuropathy, 2. Multifocal sensory-motor neuropathy, and 3. Hypertrophic brachial plexopathy, who were evaluated before and 14 days after treatment with IVIg by means of clinical scales (MRC, Rankin), electrophysiological studies (ENG-EMG), and antibody (antiganglioside) determination. The three patients showed clinical improvement (> 20% MRC, > 1 Rankin) between the 4th and 7th day after the infusion, and this was maintained for 4-16 weeks. The ENG in cases 1 and 2 revealed conduction block (CB) in some nerves, lowered amplitude in others, and signs of demyelination. Following treatment, the CB disappeared in some nerves, while in others there was an improvement in the distal amplitude (distal block), but with no correlative improvement in the proximal amplitude, revealing new CBs that had previously gone undetected. The sum of post-treatment amplitudes improved in cases 1 and 2. In case 3, we were unable to demonstrate the existence of CBs, although we believe that they did exist proximally, and we found indirect signs of CB in EMG. The three cases had increased antiganglioside IgM antibodies levels, which did not undergo any significant variations. CONCLUSIONS: A 'consistent' clinical improvement was observed following treatment with IVIg. There was no correlation between the electrophysiological response (although apparent) and the degree of clinical response. CBs exist at different levels in the same nerve, which can be revealed after treatment. Following therapy, antiganglioside antibody levels remain high.

Adult↗

PubMedDate not supplied

[Amnesic stroke caused by hippocampal infarction].

INTRODUCTION: The term amnesic stroke is used to describe a condition in which the dominant symptom is a relatively persistent acute amnesia of a vascular origin. It may appear in cases of lesions in the posterior cerebral artery (PCA), thalamic arteries and anterior choroidal artery, and clinical reports describing this condition are scarce. CASE REPORT: We describe the case of a 77-year-old male with vascular risk factors who presented sudden onset mnemonic deficit that affected basic activities of daily living, and apathy. Examination of the patient revealed an anterograde episodic amnesia with an inability to retain new information and short-term memory was also clearly affected, although access to old memories remained relatively intact. There was no other sensory-motor focus. A CAT scan showed a right-side sylvian infarction and hypodense areas in both hippocampuses. The neuropsychological evaluation revealed global amnesia: CME (in Spanish, MEC) 17/30; working memory with CME 7/27; SVF (animals): 7; the 7-minute test (visual/verbal memory: free recall 2/16, facilitated 9/16); clock test: 3/9. Later progression was good, with recovery of short-term memory and the capacity to retain concepts, and the patient was again able to perform the activities he previously carried out. CONCLUSIONS: There are three amnesic stroke syndromes with different semiological characteristics, depending on the vascular territory, that is, the PCA, thalamic arteries and anterior choroidal artery. In this case, the most striking points are the more intense disorders affecting short-term memory and retention, with relative conservation of long-term memory, and the location of the stroke in the hippocampus. Its good outcome allows it to be distinguished from vascular dementia.

Aged↗

PubMedDate not supplied

[Language and cognitive impairment: a semiological study into visual naming].

INTRODUCTION: The presence of anomia and/or paraphasias in patients with cognitive impairment suggests an associated deterioration of their language. Visual naming makes it possible to examine these signs in a controlled manner as the target word is already known. AIM. To conduct a semiological study of naming in normal aging, cognitive impairment and language impairment conditions. SUBJECTS AND METHODS: The study consisted in an analysis of nine types of signs (correct response, increased latencies, circumlocutions, absence of response, semantic verbal paraphasias, verbal paraphasias with a similar form, unrelated verbal paraphasias, phonemic paraphasias and neologisms) in a visual naming task (6 items), in two groups with normal language--controls > 70 years and patients with Alzheimer's disease (AD) with onset of amnesia--and two groups with language impairment--vascular aphasia and anomic AD-. RESULTS: Patients failed to perform naming correctly in 4.2% of the responses in controls, 10% in patients with amnesic AD, 30% in patients with vascular aphasia and 50% in patients with anomic AD. Semantic paraphasias were observed in the two groups with normal language abilities (controls and amnesic AD), although frequencies were low. Signs that suggest difficulties in accessing/retrieving lexical items were more frequent in patients with AD and ran parallel to the degree of anomia. One notable finding was the absence of signs of phonological dysfunction in the two groups with AD, regardless of the degree of anomia. CONCLUSIONS: Semiological quantification makes it possible to distinguish differences in the degree of anomia and in the pattern of errors both in controls and in patients with amnesic onset AD and among patients with vascular aphasia and neurodegenerative anomia.

Aged↗