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Biomedical subjects

J J Zarranz

Publications and source records attributed to J J Zarranz.

At least 19 recordsLinked to original sources

[Biopathology of craniocerebral injuries: experimental models].

INTRODUCTION: In traumatic brain injury the secondary damage is responsible for the majority of the clinical and pathological sequels. This circumstance together with the difficulties of acquiring well preserved brain material for specialized neuropathological study impair the understanding of processes implied in their pathophysiology. DEVELOPMENT AND CONCLUSIONS: The development of experimental models has played an outstanding role for the better knowledge of these processes. For the development of standardized experimental models the biophysical and anatomical characteristics of brain and skull of the various utilized species have to be considered, but the physiological, neurochemical and molecular peculiarities must also be taken into account. Various in vivo models have been developed, inducing direct impact to the skull or to the brain, or mimicking lesions subsequent to craniocerebral trauma, such as subarachnoid hemorrhage, hematoma or necrosis. To analyze the molecular mechanisms of cellular response in vitro models have been developed. A great amount of cells in the contusional area die immediately following traumatic brain injury, but a still higher number of cells will undergo in the following hours. This second wave of neuronal death is induced by phenomena such as secondary axotomy and brain edema. In the pathogenesis of both the damage of cytoplasmic membrane is involved.

Animals

Autoantibodies to glutamic acid decarboxylase in three patients with cerebellar ataxia, late-onset insulin-dependent diabetes mellitus, and polyendocrine autoimmunity.

BACKGROUND: Glutamic acid decarboxylase (GAD) is the main target of humoral autoimmunity in stiff-man syndrome (SMS) and insulin-dependent diabetes mellitus (IDDM). GAD autoantibodies (GAD-Abs) are reported in a few patients with cerebellar ataxia, but their relevance is unclear. We describe three patients with cerebellar ataxia and GAD-Abs. METHODS: GAD-Abs were assayed by radioimmunoassay (RIA) and immunohistochemistry and confirmed by immunoblot of recombinant human GAD65. The GAD-Ab levels of the three patients with cerebellar ataxia were compared with those of five with SMS, 49 with IDDM, 64 with cerebellar ataxia of probable degenerative origin without associated autoimmune features, 14 non-IDDM islet cell antibody-positive first-degree relatives of IDDM patients, and 91 normal subjects. RESULTS: The three patients with ataxia and GAD-Abs were women (mean age, 63 years) with an isolated progressive cerebellar disorder, family history of IDDM, late-onset IDDM, and several positive serum organ-specific autoantibodies. Two patients had autoimmune thyroiditis, and one had pernicious anemia. CSF analysis demonstrated oligoclonal IgG bands and intrathecal synthesis of GAD-Abs. By RIA, GAD-Ab titers from the three patients were similar to those of SMS and significantly higher, without overlap, than the titers of IDDM patients. GAD-Abs were absent in the 64 patients with cerebellar ataxia and no evidence of autoimmune disorders. CONCLUSIONS: These findings suggest a link of GAD autoimmunity not only with SMS but also with cerebellar dysfunction. GAD-Abs should be sought in patients with cerebellar ataxia who have late-onset IDDM and other organ-specific autoimmune manifestations.

Adolescent

[Psychotic crisis symptomatic of an outbreak of multiple sclerosis].

Mental disorders (especially depression and dementia) are highly prevalent among multiple sclerosis (MS) patients. Schizophrenic-type psychosis has been reported only rarely most often in advanced cases and its possible pathophysiological and even causal relation to the demyelinating disease is disputed. We describe a woman with MS who experienced 2 episodes of acute psychosis after having had only one prior episode of focal neurological dysfunction. The coincidence of psychiatric symptoms and the appearance of new white matter lesions in both hemispheres was confirmed by CT and MRI during the second episode. We suggest that in this patient the psychotic symptoms do not depend on the strategic anatomical location of plates, but rather on the effect of nonspecific lesions in a patient previously predisposed to psychiatric disorder.

Adult

[Posterior cortical atrophy with progressive visual agnosia].

Interest in progressive focal cerebral syndromes associated with classical degenerative diseases has increased in recent years. Descriptions of posterior cortical atrophy with progressive visual agnosia are relatively rare. We present 5 patients (2 women) ranging in age between 57 and 72 years old. In all cases symptoms began and progressed with no known etiology. All cases were sporadic. The main clinical signs are difficulty in recognizing objects, colors, persons or places; topographical disorientation and visual memory alterations; alexia, simultagnosia, loss of ocular fixing and optic ataxia. Some patients presented other disturbances of praxis or memory and 2 progressed to global dementia. Language function was preserved and behavioral disturbances did not develop. The amplitude of the P100 visual evoked potential was low but latency was normal in 4 patients and prolonged in 1. Brain images showed atrophy and hypoperfusion in the parieto-occipital area. The neuropathology status of these patients is unknown.

Adult

[Generalized idiopathic epilepsy with refractory absence seizures in the adult].

The prognosis for generalized epilepsy with absence seizures starting in childhood and adolescence (GEA) must be given cautiously because of the possibility that seizures may persist into adulthood and occur along with tonic-clonic seizures. Such an unfavorable course may be due to factors that are intrinsic to the various epileptic syndromes involving absences and/or to individual patient characteristics. An additional factor of particular importance in GEA is inadequate treatment. We describe 15 adult patients with GEA whose mean age when examined was 41.3 years. All had experienced absence seizures since childhood and 12 had had convulsive seizures. Most were following haphazardly combined therapies. An average of 4 years was needed to modify treatment and achieve remission of seizures in 11 of the 13 cases followed for more than 1 year. We emphasize the efficacy of valproate (in 14 of 15 patients) and its combination with ethosuximide (4 patients). GEA should not be considered refractory until appropriate use of these drugs has been tried; rather it is a syndrome that may go into remission even after decades of persistent seizures.

Adult

[The practice of neurology by regional specialists in Vizcaya (Spain)].

We describe the practice of 3 regional specialists in neurology in 1993 and 1994 at Hospital de Cruces in Vizcaya. Each neurologist alternately spent 1 day working in the hospital ward and another day working in an external clinic in the region, thus allowing clinic patients to be seen consistently by the same neurologist, while responsibility for inpatients could be shared by 2 physicians. All clinic patients in the region and the majority of hospital patients were covered by these specialists. A yearly average of 683.05 new patients were seen; 177.72 (26.01%) as inpatients, 82 (12%) at the hospital-based outpatient clinic and 423.33 (61.98%) at other clinics in the region. The wait time for new patients in the regional clinics was 119.71 days; 21.97% of these patients were classified as having no neurological disease (with diagnoses of syncope and peripheral vertigo included in this group), 25.74% had headache and 40.12% had cerebrovascular, neuromuscular, degenerative disease or epilepsy. Hospitalized patients released with diagnoses of non-neurological disease or cephalea represented 12.91% of the total; 50.6% of hospital patients had cerebrovascular disease.

Cerebrovascular Disorders

[Spontaneous internal carotid artery dissection as a cause of unilateral lower cranial nerve palsies].

We present a 60-year-old man with a complete right IX-XII nerve palsy (Collet-Sicard syndrome) due to spontaneous right internal carotid artery (ICA) dissection. Magnetic resonance imaging (MRI) and MR angiography (MRA) showed signs of subadventitial dissection of the right ICA with a mural haematoma that expanded the circumference of the vessel at the level of the retrostyloid space, adjacent to the IX-XII nerves. No narrowing of the lumen or aneurysms was found. Clinical recovery was excellent after treatment with only antiplatelet drugs. Cervical internal carotid artery dissection should be included in the differential diagnosis of lower cranial nerve palsies. MRI and MRA are noninvasive, reliable methods for diagnosis and follow-up, especially in subadventitial dissections.

Bulbar Palsy, Progressive