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N López-Hernández

Publications and source records attributed to N López-Hernández.

9 recordsLinked to original sources
PubMedDate not supplied

[Peripheral and optical myeloneuropathy in a folic acid deficient alcoholic patient].

INTRODUCTION: In Western countries, neurological disorders secondary to toxic nutritional problems usually present as isolated cases that are generally associated to identifiable causes (alcoholism, eating disorders, absorption disorders, use of medicines) that reduce the availability of basic nutrients, especially B group vitamins, but also folic acid (FA). The optic nerves and the peripheral axons are frequent target organs in this type of pathology, but leukoencephalopathy and spinal cord involvement may also appear, often in combination. CASE REPORT: We describe the case of a 38-year-old female smoker with a heavy alcohol habit, who developed a subacute clinical pattern of, predominantly axonal, sensitive peripheral polyneuropathy, with vegetative fibre involvement. She also presented involvement of the posterior spinal cord, which gave rise to an ataxic disorder in the gait, as well as a severe bilateral retrobulbar optic neuropathy. Likewise, she presented macrocytosis (MCV: 118) due to megaloblastosis. She was also found to have a FA deficit but a normal vitamin B12 metabolism. With the help of supplementary vitamins, stopping drinking and the regularisation of her diet, the patient presented progressive clinical improvement, and was able to walk without support at 3 months and almost completely recovered her sight, which was corroborated by an improvement in the studies of both visual and somatosensorial evoked potentials. CONCLUSIONS: In our community, alcoholism is a frequent cause of nutritional deficiencies, which lead to neurological problems. FA is one of the nutrients that become deficient in alcoholics. More and more descriptions are being reported of peripheral polyneuropathy, retrobulbular optic neuropathy, myelopathy or leukoencephalopathy associated to FA deficiency, above all in patients with a history of alcoholism.

Adult↗
PubMedDate not supplied

[Lamotrigine in refractory epilepsy].

INTRODUCTION: Lamotrigine (LTG) is a new antiepileptic drug indicated in all kinds of partial and generalised clonic-tonic seizures, both in monotherapy and polytherapy. Between 20 and 30% of epileptic patients have poor control over their seizures despite adequate treatment. AIMS: We report on our experience regarding the long-term efficacy and tolerability of LTG in refractory seizures. PATIENTS AND METHODS: We conducted a consecutive 10-year study of patients who began LTG therapy following poor control of their seizures, in spite of being treated with two or more antiepileptic drugs in monotherapy or in combination. Both their epidemiological and clinical data were collected for study. We studied the efficacy of the treatment, differentiating between remission (absence of seizures), improvement (reduction>50% of the seizures), inefficacy (reduction<50%), exacerbation (increase in seizures) and its tolerability (side effects and dropout). RESULTS: In all, data was collected from 39 patients, 18 males (46.2%), mean age 30.9 +/- 13.7 years; mean follow up time: 27.6 +/- 23.4 months. 43.7% presented cryptogenic epilepsy, in 28.5% it was symptomatic and in the remaining 28.5% it was idiopathic. EEG readings and neuroimaging scans were pathological in 53.8% and 43.6%, respectively. After beginning therapy with LTG, 33% remained free of seizures, 43.6% improved, in 18.3% it was seen to be ineffective and 5.1% got worse. Dropout rate was 56.4%:23.1% due to insufficient control over the seizures, 17.9% owing to side effects and 15.4% because of non-compliance. CONCLUSION: Treatment with LTG offers a high degree of efficacy in the control of seizures in patients with refractory epilepsy, although it is limited by a high dropout rate.

Adolescent↗
PubMedDate not supplied

[Neurosonological findings in the carotid artery in a sample of patients with lacunar infarction].

INTRODUCTION: Carotid stenosis has been reported as being associated to lacunar infarcts (LI) with variable frequency, but the aetiopathogenic relation between them is still subject to some controversy. AIMS: Our aim was to describe the prevalence of carotid disorders in a neurosonological study of a sample of patients with LI. PATIENTS AND METHODS: We analysed the results of the neurosonological study conducted on patients with clinical-radiological criteria of LI who were admitted to our Stroke Unit during the period of study. RESULTS: We studied 140 patients, and results were normal in only 42% of the cases. Stenosis > 50% was found in 10% of the cases and plaque without stenosis in 40.3% of the patients. In patients without plaque there was an increase in the tunica intima-media thickness in 7.2% of the cases. CONCLUSION: In most of the patients with LI there were anomalies in the study of the carotid performed using ultrasound scanning.

Aged↗
PubMedDate not supplied

[Neurosonological studies in patients over 80 years old].

INTRODUCTION: The link between cardiovascular risk factors and carotid atheromatosis has been shown to be more important in middle aged subjects than in the elderly. AIMS: Our aim was to study the frequency of carotid and intracranial atheromatosis in a population over the age of 80 and to compare the presence of neurosonological anomalies depending on whether the patients have suffered a stroke or not. We also wished to compare the findings according to the sex of the patient. PATIENTS AND METHODS: Patients over the age of 80 were studied at our Neurosonology laboratory using carotid and transcranial Doppler ultrasonography. The patients were analysed according to whether they had suffered an ischemic stroke or not. With regard to the carotid, a distinction was made between normal, non-significant atheromatosis and significant atheromatosis (stenosis > 50%). Intracranially, both the middle cerebral artery (normal, stenosis, microangiopathy and post-stenosis) and the basilar artery (normal, stenosis, microangiopathy and hyperdynamics) were studied. RESULTS: We recorded data concerning 832 patients: 342 males (44.1%), mean age 83.63 +/- 3.25 years, and 527 (63.3%) with stroke. The carotid study was pathological, with a higher frequency in stroke patients (32.1% compared with 41.9%; p = 0.002). The presence of atheromatosis was significantly linked to a higher risk of suffering a stroke and more intensely to its being more severe. Carotid studies were pathological with a higher frequency among males (28.7% compared with 40%; p < 0.001). No significant differences were found intracranially in any of the parameters analysed. CONCLUSIONS: There is a high frequency of carotid atheromatosis in patients over 80 years of age. Regardless of the age, carotid atheromatosis appears even more frequently in patients who have suffered a stroke and in males, and is significantly associated to the risk of suffering a stroke. Intracranially, no differences were found.

Aged↗
PubMedDate not supplied

[Health care activity in a headache-specific clinic].

INTRODUCTION: It is reckoned that headaches affect, at least once a year, around 90% of the population. The socioeconomic repercussion occasioned by this malady justifies the appearance in recent years of headache units. AIM: To conduct a descriptive epidemiological and health care study of the activity carried out in a headache-specific clinic. PATIENTS AND METHODS: All the relevant points from the histories of patients who visited our surgery over a period of two years were collected prospectively and consecutively. The different types of headaches were classified according to the 1988 IHS criteria. Both the symptomatic and the preventive treatment were analysed. RESULTS: In all, a total of 866 patients were found; 691 (79.8%) were females and the mean age was 39.8 +/- 15.9 years (range: 6-90 years); 208 (24%) had a history of migraine in the family; 399 (49.9%) were diagnosed as suffering from migraine: 256 (64.2%) had migraine without aura, 152 (19%) were diagnosed as having tension-type headache, and 218 (27.3%) presented chronic daily headache (CDH). The most frequently used symptomatic treatments were NSAI drugs (36.7%) and triptanes (28.4%). Amitriptyline (47.7%), beta-blockers (14.5%) and calcium antagonists (11.3%) were the main drugs used as preventive treatment. DISCUSSION: After several years' operation of our Headache Unit, we thought there was a need to analyse the population seen in the visits. The fact that the majority of our patients were middle-aged females matched our expectations. Although most of the patients were diagnosed as suffering from M, we also want to highlight the high proportion of cases of CDH, above all associated with the abuse of analgesics.

Adolescent↗
PubMedDate not supplied

[Prevalence of neurosonographic disturbances in chronic instability].

INTRODUCTION: Dizziness is a common symptom at the outpatient clinic of family doctors. Its origin is usually multifactorial and its outcome is often benign. However, exists a tendency to relate the dizziness with a cerebrovascular disturbance. AIM. To determine if there are cerebrovascular disorders in patients with chronic dizziness using a non invasive technique. PATIENTS AND METHODS: A prospective study was conducted. It included 404 patients without limit of age. The patients were evaluated in a Neurology Outpatient Clinic, to select those patients with chronic instability. A neurosonographic exam was performed to all those selected patients. This exam included colour duplex of the cervical arteries and transcranial Doppler. RESULTS: Up to 54 % of the patients who were included in the study had a normal carotid study. For the rest of the patients, the thickness intima-media was the most prevalent finding. At the vertebrobasilar system the study of the vertebral arteries was completely normal in 81.7% followed by the presence of microangiopathy in 12.1%. The basilar system was also normal in a high figure (78%) followed by the microangiopathy (17.1%). CONCLUSIONS: The vascular disturbances in the vertebrobasilar system are an exceptional finding in patients with chronic instability.

Adult↗
PubMedDate not supplied

[Delays before and after arrival at the hospital in the treatment of strokes].

INTRODUCTION: Only a minority of patients with acute stroke are eligible for fibrinolysis, and the main reason for this is that time runs out and goes beyond the therapeutic window. The chief delay occurs prior to arrival at the hospital, but there is also a nosocomial delay, which has received far less attention. AIMS: The purpose of our study was to describe the data on delays occurring before and after arrival at the hospital in a sample of patients with acute stroke, and to analyse possible associated factors, including the overload on health care services in the Emergency department, an aspect that has not previously been evaluated. PATIENTS AND METHODS: Epidemiological data, times of delays before and after entering the hospital, means of transport used and the health care workload in the Emergency department of the day of admission were collected for all the stroke patients admitted to the Stroke Unit of the Hospital General Universitario de Alicante throughout the period under study. RESULTS: From an initial sample of 460 patients, 423 were finally included in the study, with a mean delay before and after admission to hospital of 3.99 and 2.36 hours, respectively. Use of an ambulance and the haemorrhagic and transient ischemic attack subtypes were linked to a shorter delay before reaching the hospital, and arrival during the night shift was the only factor associated to a longer delay once inside the hospital. CONCLUSIONS: In our environment, there is a need to establish strategies aimed at shortening the times stroke patients take to reach the hospital and the time that elapses before they are attended.

Aged↗
PubMedDate not supplied

[An analysis of avoidable admissions to a neurology service].

INTRODUCTION: Inappropriate admissions to a hospital service generate unnecessary costs for our health care service. Most admissions to a hospital service come from the emergency department. The presence of a neurologist to attend hospital emergencies would be an important factor allowing admission criteria to be streamlined. AIMS: To determine the number of avoidable admissions (AA) in a neurology service, and to define their characteristics. PATIENTS AND METHODS: We conducted a prospective, descriptive study of the admissions that took place in the Neurology Service of the Hospital General Universitario de Elche (Alicante) over a period of three months. The neurologist determines whether admission is indicated or not. We collected demographic data concerning the patient, the admission diagnosis, neurological diagnosis, the reason for appropriateness and the reason for AA. RESULTS: A total of 250 admissions were attended; 65 were considered to be AA (26%). The most frequent diagnoses in the cases of AA were non-neurological (32.3%), clinical findings (15.4%), neuropathies (10.8%) and epilepsy (10.8%). The reasons leading to AA were non-neurological and transfer to another service (30.8%), follow-up by neurology outpatient department (NOD) (29.2%), NOD study (21.5%), non-neurological and discharge (16.9%) and not specified (1.5%). The mean length of stay in the case of AA was 4.3 days. CONCLUSIONS: The number of AA in our service is higher than that found in other studies. On-duty neurologists, streamlining outpatient diagnostic testing and the design of flexible schedules for outpatient care would reduce the amount of resources that are used, while at the same time increasing the quality of the health service.

Adult↗