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Biomedical subjects

J Alvarez-Sabín

Publications and source records attributed to J Alvarez-Sabín.

At least 55 records · Page 3Linked to original sources
PubMed1995

Asterixis associated with anatomic cerebral lesions: a study of 45 cases.

INTRODUCTION: Asterixis is an uncommon sign in structural central nervous system disorders. When asterixis is present, one cannot rule out the possibility of a focal lesion, but it is almost always due to a metabolic encephalopathy. PATIENTS AND METHODS: In the last five years all patients with uni- or bilateral neurologic asterixis attended in our hospital have been studied. Cerebral computed tomogram or magnetic resonance imaging was performed in all patients with uni or bilateral asterixis. RESULTS: We describe 45 patients with different forms of structural cerebral pathology who presented unilateral (37 patients) or bilateral (8 patients) asterixis not associated to either toxic or metabolic disorder. Central nervous system ischemic or hemorrhagic disorders were found to be the most frequent causes of asterixis (95.5%) and the thalamus the most frequent localization for unilateral asterixis to result (54%). CONCLUSIONS: Bilateral asterixis is not always associated with toxic or metabolic disorders and it may be a sign of some structural neurologic alterations. A good correlation was found between the presence of unilateral asterixis and structural intracranial disease.

Adult↗
PubMed1995

Delayed posttraumatic hemorrhage. "Spät-apoplexie".

BACKGROUND AND PURPOSE: Delayed posttraumatic hemorrhage (DPTH) is one of the causes of intracerebral hemorrhage (ICH). Most of the published series were reported before the advent of CT. Clinical characteristics and CT findings are described. METHODS: Ten cases of CT-proven DPTH from a series of 216 patients (age range, 15 to 50 years) with ICH were evaluated. Previous CT scans performed in the first 6 hours after head injury were normal in all patients. Cerebral angiography showed no evidence of vascular disorders in any patient. RESULTS: DPTH was the fourth most common cause of ICH in our series. The symptom-free interval after head injury ranged from 1 to 15 days. Most hematomas were located deep in the hemisphere and were of small or medium size. Clinical course was good in the majority of cases; none of the patients died, and there was no recurrence. CONCLUSIONS: DPTH is a relatively frequent cause of ICH in young adults. There is no relationship with intensity of the previous head injury. The more frequent location deep in the hemisphere may be related to the younger age of our patients compared with those of other published series. The good outcome in our patients may be related to their youth and the absence of complications such as skull fracture, need for neurosurgery, or coagulation disorders.

Adolescent↗
PubMedDate not supplied

[Intraventricular hemorrhage due to the rupture of atherosclerotic dissecting aneurysm of the middle cerebral artery].

INTRODUCTION: We present a case of fusiform intracranial aneurysm where, apart from the unusual site, we draw attention to the form of clinical presentation, namely intraventricular haemorrhage. Clinical case. A 68 year-old-man with a history of smoking, hyperuricemia with seizures of gout treated with colchicine and allopurinol, and hypertension treated with captopril. Nine years previously he had a right capsulothalamic haematoma and presented (as a sequela of this) a left sensomotor deficit, with a good functional level. In December 1998 he was admitted for sudden onset of headache and deterioration of consciousness. He had right limb movements which were typical of decerebration and made intubation and mechanical ventilation necessary. Cerebral CT, with angiographic sequences, showed blood in the lateral ventricles and III ventricle, with ventricular dilation and a fusiform aneurysm of the left middle cerebral artery. In view of the neurological state of the patient, treatment of the aneurysm was postponed. After initial improvement, which permitted extubation, tetraparesia (predominantly right) and a pseudobulbar syndrome were seen. The patient had repeated respiratory infections and died from sepsis caused by Pseudomona aeruginosa (of respiratory origin) three months after admission. CONCLUSIONS: Fusiform intracranial aneurysms form 9% of all aneurysms. Localization to the middle cerebral artery is infrequent, the basilar trunk and internal carotid artery are commoner sites. In our case angio-CT was a useful non-invasive neuro-radiological technique.

Aged↗
PubMedDate not supplied

[Vertebrobasilar abnormalities in patients with hemifacial spasm: MR-angiography findings].

INTRODUCTION: Hemifacial spasm (HFS) is a disorder characterized by a complex of symptoms with hyperactive motor dysfunction of the facial nerve. It is indicated that HFS in the majority of cases can be caused by a blood vessel compressing the nerve adjacent to the brainstem. PATIENTS AND METHODS: We studied and treated 44 patients with HFS. Magnetic resonance imaging (MR) and MR-angiography of the brain were performed in patients with HFS to asses the presence of an artery of the vertebrobasilar system compressing the root of the facial nerve. We evaluate the response to treatment with Botulinum toxin in these cases. 14 patients were excluded (6 patients presented HFS due to other lesions and in 8 patients the MR was not performed). The remaining 30 patients with idiopathic HFS underwent MR/MRA (3D-FISP) and it was also performed in 14 patients with synkineses after facial palsy to be used as controls. RESULTS: The MRA documented an abnormal position of the arteries surrounding the facial nerve (ipsilaterally to HFS) in 22 patients. The compressing artery was the PICA in 3 patients (10%), the AICA in 3 patients, the vertebral artery in 7 patients and the basilar artery in 8 patients, one patient showed a combined compression by AICA and PICA. The remaining 8 patients had a normal MRI. At the control group only one patient presented an abnormal AICA and the other had a normal MRI-MRA. Patients were followed-up for 22.4 months and after Botulinum toxin treatment patients kept 4.81 months free of symptoms. CONCLUSIONS: We recommend to perform MR studies in all HFS patients to rule out a secondary cause of the disease and MRA to evaluate the underlying vertebrobasilar abnormalities if surgery is planned. Botulinum toxin is a useful treatment in these patients and only after its failure, microvascular decompression will be considered.

Basilar Artery↗
PubMedDate not supplied

[Antiplatelet therapy of secondary stroke prevention after ESPS-2 and CAPRIE].

INTRODUCTION: Antiplatelet therapy is effective for secondary prevention of atherothrombotic stroke. Aspirin, the more frequently used antiplatelet drug, prevents 13 to 17% of ischemic events after stroke. New and more effective antiplatelet therapies are needed. DEVELOPMENT: Two large secondary stroke prevention trials have been recently published (CAPRIE and ESPS-2), including more than 25,000 patients. As well TACIP trial designed to assess the efficacy of triflusal, is close to end. The combination of ticlopidine and Aspirin has shown synergistic effect. CONCLUSIONS: Clopidogrel, like ticlopidine, increase 9% the relative risk reduction of stroke over Aspirin. Clopidogrel has a better safety profile than ticlopidine. Dipyridamole is an effective antiplatelet drug, but in combination with low doses of Aspirin is more effective. The possible efficacy of clopidogrel-Aspirin combination should be evaluated.

Clinical Trials as Topic↗
PubMedDate not supplied

[Determination of Doppler parameters in the study of basal cerebral veins: basal vein of Rosenthal and middle cerebral vein].

INTRODUCTION: To date, little attention has been paid to the study of the venous system by means of transcranial Doppler ultrasound. The objective of our study was to learn how to localize cerebral blood flow and find the normal values of different ultrasonographic parameters. PATIENTS AND METHODS: We studied 20 healthy persons in whom the arterial system of the circle of Willis had previously been shown to be normal. Transcranial Doppler scan was done with the person lying face upwards, using a transtemporal 2 MHz catheter. In the study we included persons in whom at least one of the two veins could be studied unilaterally. RESULTS: We studied twelve men and eight women aged between 25 and 78 years. The basal vein of Rosenthal, localized bilaterally in 70% of the cases, was identified as a wave of low pulsation between segments P1 and P2 of the posterior cerebral artery, going away from the catheter at a speed of about 11 cm/second. The middle cerebral vein was found bilaterally in only 35% of the cases as a wave near to the middle cerebral artery but in the opposite direction, at an average velocity of approximately 11.7 cm/second and of low pulsation. CONCLUSIONS: In spite of the technical problems, which can be solved using contrast agents, it is possible to study the cerebral venous system by means of transcranial Doppler. Our Unit is the first in Spain to show this. We therefore wish to promote the use of transcranial Doppler in cerebral venous disorders.

Adult↗
PubMedDate not supplied

[Acute pseudobulbar paralysis: the use of diffusion techniques with magnetic resonance].

INTRODUCTION: Acute pseudobulbar palsy produced by bilateral cerebral infarctions is a rare syndrome, which includes among its symptoms mutism, severe dysphagia and diverse sensory-motor signs. CLINICAL CASES: We report two middle-aged patients who suddenly developed a severe dysarthria and dysphagia, which impeded their ability to speak and to feed themselves, with spasmodic laughing and crying and slight motor deficit ('pure' pseudobulbar palsy). The acute lesions, using conventional and diffusion-weighted magnetic resonance imaging, corresponded partially to the anterior choroidal artery (case 1: acute lesion in the left periventricular white matter and a subacute one in the right semioval centrum; case 2: acute lesions in the right frontal subcortical white matter and in the periventricular white matter adjacent to the left lateral ventricle). The favorable evolution of these patients in contrast to previously described patients with acute pseudobulbar palsy could indicate that the motor deficit is a prognostic factor for this syndrome. CONCLUSIONS: Diffusion-Weighted magnetic resonance imaging permits differentiation with high precision of the acute lesions in patients who present old ones. Sometimes multiple acute lacunar infarctions (MALI) are found to be responsible of the syndrome. Hypertension and diabetes are the risk factors for the small vessel disease underlying these MALI.

Acute Disease↗
PubMedDate not supplied

[Treatment of the rise in arterial pressure during the acute phase of stroke. Recommendation of Catalan Societies of Arterial Hypertension and Neurology].

INTRODUCTION: Changes in arterial pressure (PA), especially arterial hypertension, are frequent during the acute phase of a stroke and the best therapeutic approach is controversial since although high blood pressure is associated with a poor prognosis, excessive or too rapid drop in blood pressure may also be associated with progression of the neurological deficit. OBJECTIVE: To reach agreement as to the correct therapeutic approach when the PA is high during the acute phase of a stroke, based on the published data and experience of a group of experts from the Catalan Societies of Neurology and Hypertension. METHODS: Review of the main recommendations published in the literature and discussion in joint study sessions. RESULTS: During the acute phase of a stroke moderate increases in blood pressure should not be treated. Antihypertensive treatment is recommended when the PA figures are of maintained levels of more than 220 mmHg of systolic or 120 mmHg of diastolic pressure in ischemic stroke, and over 180 mmHg of systolic or 105 mmHg of diastolic pressure in hemorrhagic stroke. CONCLUSIONS: Modifications of arterial pressure, especially of arterial hypertension, should be carefully treated during the acute phase of stroke, because of the risk of causing worsening of the neurological lesion. When treatment is indicated, it is best carried out in a Stroke Unite where this is possible.

Acute Disease↗
PubMedDate not supplied

[Lack of correlation between plasma homocysteine levels and cerebral microangiopathy in patients wtih transient ischemic attack].

OBJECTIVE: The aim of this study is to evaluate cerebral MRI findings in patients with atherothrombotic transient ischemic attacks (TIA) and its correlation with plasma homocysteine (Hcy) levels. PATIENTS AND METHODS: A total of 62 consecutive patients with the diagnosis of TIA of atherothrombotic origin were studied. MRI examinations were performed in all patients for the evaluation of the presence of infarct and/or white matter hyperintensities (WMHI). Plasma Hcy levels were determined according to the method described by Smolin and Schneider modified. RESULTS: Plasma Hcy levels were significantly (p < 0.036) higher in patients with MRI-detected infarcts (9.69 +/- 2.06 mumol/l) compared with patients without infarcts (8.65 +/- 1.7 mumol/l. There was no correlation (p < 0.33) between plasma Hcy levels and the presence or absence of WMHI seen on MRI. CONCLUSIONS: In TIA patients, plasma Hcy levels were significantly higher in patients with cerebral infarcts, but did not correlate with the presence of WMHI. Our results suggest that mild hyperhomocysteinemia would be associated with large-medium vessel rather than with small vessel disease.

Adult↗
PubMedDate not supplied

[Indications for carotid endarterectomy without arteriography. A validation study using eco-Doppler].

INTRODUCTION: The possibility of diagnosing carotid stenosis and carrying out surgery without arteriography has increased with the use of different diagnostic methods. The eco-Doppler has been shown to be a useful method, although it requires previous individualised validation. OBJECTIVE: We aim to validate our Vascular Diagnostic Laboratory in the diagnosis of stenosis of the carotid bifurcation using eco-Doppler as compared with angiography, and the therapeutic indication thus obtained. PATIENTS AND METHODS: We made a prospective study for one year of 62 consecutive patients diagnosed on eco-Doppler as having carotid stenosis of over 70% and subsequent carotid arteriography. The treatment indicated is given, without waiting for the result of the angiography, on clinical evaluation, computerized tomography or cranial magnetic resonance and eco-Doppler, and subsequently on angiography. The degree of correlation of both methods, both for the therapeutic indication and for the degree of stenosis was determined. RESULTS: In five cases there was discrepancy and the therapeutic indication was different. Three of these were related to the diagnosis of carotid occlusion and in the other two cases there were bilateral lesions of over 50% on eco-Doppler, which were classified as minor on angiographic study. In the group with stenosis of over 70% with < 50% contralateral stenosis, eco-Doppler showed sensitivity and specificity of 100%, with a kappa correlation index = 1. CONCLUSION: It is possible to indicate carotid endarterectomy in patients with unilateral stenosis greater than 70% and contralateral stenosis < 50%, based on the eco-Doppler studies done in our Vascular Diagnostic Laboratory.

Aged↗
PubMedDate not supplied

[The influence of the arterial pressure in the study of cerebrovascular reactivity in carotid obstructions].

INTRODUCTION: Cerebrovascular reactivity (CVR) is the capacity of the cerebral microcirculation to increase cerebral blood flow on vasodilator stimulation. This is reduced in patients with carotid obstruction. The changes in arterial pressure produced whilst carrying out different tests for estimation of the CVR may affect its measurement by transcranial Doppler. OBJECTIVES: To evaluate the concordance between the different methods for estimation of the CVR by transcranial Doppler in patients with carotid obstruction and to evaluate the importance of monitoring the arterial pressure during CVR tests. PATIENTS AND METHODS: We evaluated 17 patients with internal carotid artery obstruction confirmed on arteriography. The CVR was determined by three different methods: apnea test. Breath-Holding Index (BHI) and intravenous acetazolamide test. RESULTS: During the tests of RCV the arterial pressure was monitored. We found that there was a reduction in the average basal rate of flow and of the pulsatile index on the obstructed side, with a statistically significant association in relation to the contralateral side (p < 0.001). There was good concordance between the different tests of CVR, with reduced CVR seen on the obstructed side as compared to the contralateral side (p < 0.001) for the different tests. However, this correlation was not seen in stenosis < 70%. During the apnea test changes in blood pressure occurred, with a tendency to increase in the systolic pressure. However, there were no significant changes in blood pressure during the acetazolamide test. CONCLUSIONS: There is good concordance in the CVR between the apnea, BHI and acetazolamide tests in carotid obstruction. Changes in arterial pressure occurred during the apnea and BHI tests. However, the acetazolamide test caused no change in arterial pressure.

Acetazolamide↗