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O Fernández-Concepción

Publications and source records attributed to O Fernández-Concepción.

17 recordsLinked to original sources
PubMed1997

[Clinical-epidemiological characteristics of late onset multiple sclerosis].

INTRODUCTION: Multiple sclerosis (MS) is the most frequent demyelinating disorder of the central nervous system. It mainly affects young adults and it has been calculated that between 20% and 30% are of late onset (after the age of 40), presenting clinical features, a clinical course and prognosis which are specific to this disorder. MATERIAL AND METHODS: Between 1985 and 1994 we studied 297 cases of MS (diagnosed according to the criteria of Poser) and found that in 20.5% the illness had started when the patients were over the age the 40. RESULTS AND CONCLUSIONS: Certain aspects of the clinical features and course of the disorder were compared, taking the group of late onset cases and a randomized sample of 100 cases of early onset, showing that the symptoms and pyramidal signs were more frequent in the late onset group, whilst sensory and visual signs were commoner in the early onset group. In both groups there were more females. MS was defined according to Poser's criteria in 78.7% and 77% respectively. Chronic, primary and secondary progressive forms predominated in tire late onset group, whilst in the group with onset before the age of 40 there was a predominance of the exacerbating-remitting form.

Adolescent↗
PubMedDate not supplied

[The problem of epilepsy of late onset].

INTRODUCTION: We have reviewed and analyzed aspects of the concept of late onset epilepsy and its medical significance. DEVELOPMENT: Analysis of the historical progression of the concept and its aetiologies show variations depending on series, geographical region and historical period in which they were carried out. Thus in former times it was considered to be synonymous with a tumorous or traumatic aetiology and more recently there is a predominance of vascular causes. CONCLUSION: Use of the different means of diagnosis for establishing the aetiology of this patient's group is given further consideration.

Age Factors↗
PubMedDate not supplied

[Cerebral tumors as a cause of late onset epilepsy].

UNLABELLED: INTRODUCTION, PATIENTS AND METHODS: We made a study of 223 patients with epileptic seizures which started when the patient was aged over 25 years (late onset), who were admitted to the National Institute of Neurology and Neurosurgery of La Habana, Cuba, over a period of ten years. The patients were divided into three groups according to age: from 25 to 39, from 40 to 59 and over 60 years. They formed two etiological groups--tumour and non-tumour--to evaluate the possible relationship with clinical variables and the results of complementary tests. RESULTS: Of all the patients of groups 25 to 39 and 40 to 59 years. Over half the causes were of undefined cause. Of those in whom the cause was known, the most frequent cause of presentation was a tumour. Although vascular and degenerative causes were most frequent in the over 60 age group, cerebral tumours made up a significant percentage. We found that the presence of localizing signs on neurological examination or neuropsychological study and the occurrence of focal activity on the electroencephalogram were associated with the presence of a tumour, although their absence did not exclude this aetiology. There was no association with the type of seizures seen. CONCLUSION: Computerized axial tomography was very useful in the diagnosis of these tumours. However, a large percentage of patients required from two to four studies to establish the diagnosis.

Adult↗
PubMedDate not supplied

[Cryptococcosis of the central nervous system. A report of five cases].

INTRODUCTION: Since the 1980s, in relation to the spread of AIDS, there has been an enormous increase in cryptococcosis, a mycotic disorder which usually affects the central nervous system (CNS). This disease is caused by Cryptococcus neoformans, a microorganism acquired by inhalation of bird excrement. This germ produces a capsule which protects it from phagocytosis, can synthesize melanin which acts as an antioxidant of the cytotoxic lymphocytes and can reproduce at body temperature. Clinically it may show as chronic or subacute meningitis and/or encephalitis, as endocranial hypertension or as an intracranial space occupying lesion (crytococcoma). To establish the diagnosis, Chinese ink, culture and the latex agglutination test are useful. Treatment is with amphotericin B associated or not with fluocytokine and fluconazole, the protocol used depending on the clinical form. OBJECTIVE: To review the most up-to-date literature on cryptococcosis of the CNS to study the condition in relation to five cases. CLINICAL CASES: We report five patients with cryptococcosis of the CNS diagnosed and treated in the Instituto Nacional de Neurología y Neurocirugia de la Habana, Cuba, showing an increase in the frequency of the occurrence of cases not related to HIV infection, great variety of clinico-humoral presentation and the characteristics of the treatment given. CONCLUSION: Cryptococcosis can be cured completely when the condition is diagnosed early; without treatment it is invariably fatal.

Adult↗
PubMedDate not supplied

[The quality of life of patients with strokes: from the point of view of factors which may affect it].

OBJECTIVE: To evaluate the effect of clinical and psychosocial factors on the quality of life of patients with stroke. PATIENTS AND METHODS: A non-experimental transverse study was done on 39 patients with strokes seen in the cerebrovascular diseases clinic of the Institute de Neurología y Neurocirugía in La Havana (Cuba). We recorded data on clinical variables (age, sex, race, previous illnesses, type of stroke, vascular territory, classification of prognosis, etiopathogenesis and function on the Rankin scale) and on psychosocial variables (pattern of behavior, anxiety as a feature and state, depression, manner of coping and social support received). Correlations were established with the dependent variable Quality of life, evaluated on the Nottingham Health Profile. RESULTS: Of the clinical variables there was no correlation with age, female sex was related to greater isolation and the presence of diabetes mellitus with less energy. Greater isolation was seen to be correlated with increased score on the Rankin scale, but this association was not statistically significant. Similarly the clinical characteristic of anxiety was related to greater difficulty in sleeping, as also occurred in depression. The latter was also associated with less energy and greater social isolation. The characteristics of self-control, acceptance of responsibility and positive reevaluation had a positive relation with energy and physical mobility. The greater the social support, especially in the area of health, the better the quality of life in the realms of pain, sleep and social isolation. CONCLUSION: The psychosocial aspects had more influence on the quality of life of these patients than the clinical factors did.

Adult↗
PubMedDate not supplied

[Characterization of the patients with cerebral infarcts discharged from a hospital in La Havana in 1998].

OBJECTIVE: We made a study of the 79 patients who were discharged from the Instituto Nacional de Neurología (La Havana, Cuba) during 1998, with the diagnosis of cerebral infarct, with the objective of analysing their behavior. PATIENTS AND METHODS: In this analysis we considered: the previous clinical history of factors and illnesses of risk, the certainty of the diagnosis in the emergency room, presenting symptoms, clinical signs, vascular territory, etiopathogenic category and results of cranial computerized axial tomography (CAT). RESULTS AND CONCLUSIONS: Arterial hypertension, smoking, cerebrovascular disease and ischemic cardiopathy were the commonest clinical features seen. There was close agreement between the diagnosis made in the emergency room and the final diagnosis. The presenting symptoms and clinical signs found in these patients were related to the vascular territory and motor involvement was the most constant. There was predominance of the carotid territory, especially of the left side. We also found predominance of atherothrombotic etiopathogenesis, with fewer cardio-embolic or unknown causes. There were few abnormal cranial CAT findings in patients with lacunar infarcts or infarcts localized to the posterior territory.

Adult↗
PubMedDate not supplied

[Type A behaviour and life events as risk factors for cerebral infarct].

INTRODUCTION: The role of psychosocial factors in cerebral infarct has been little studied and is therefore still undefined. OBJECTIVE and methods. To evaluate the effect of a pattern of behaviour which predisposes to stress, and of life events, on the occurrence of cerebral infarct, we studied a group and control involving 88 patients with cerebral infarcts diagnosed clinically and on imaging studies, and a control group of 99 persons paired for age and sex who lived in our health district. To evaluate the behaviour pattern we used Jenkins abbreviated questionnaire and for life events the Holmes and Rahe questionnaire. RESULTS: The type A behaviour pattern had a highly statistically significant association with cerebral infarct, which was not associated with the effects of other variables. This relation was the greater the lower the age of the person. It was not seen after the age of 75 years. The behaviour pattern was not related to arterial hypertension or with the aetiopathological mechanisms of the patients. In relation to the life events questionnaire, the number of events was significantly associated in the group of patients, but not with the total score of the questionnaire. However, the latter was significantly related to hypertensive patients and persons with a type A behaviour pattern. The commonest life events in both groups were related to the death or health problems of family members, the previous illnesses of the person and to financial and work problems. CONCLUSION: The type A behaviour pattern is individually associated with cerebral infarct, whilst stressful life events were involved in the cerebral infarcts of hypertensive and type A behaviour patients.

Aged↗
PubMedDate not supplied

[Usefulness of P300 as a tool for diagnosing alterations in sustained attention in ischemic cerebrovascular disease].

INTRODUCTION: Event related potentials, and especially the component P300, can be used to achieve greater precision and sensitivity in the cognitive evaluation of patients. They also enable us to obtain more accurate information about deficiencies in sustained attention, which is a cognitive function associated with the generation of the above mentioned component. Furthermore, the study of disorders triggered off by cerebrovascular disease must be given priority because of the high incidence with which they occur. PATIENTS AND METHODS: We studied four groups of individuals divided according to the localization of the lesion and the etiopatogenic mechanism involved (10 patients with right parietal atherothrombotic infarction, 10 patients with left parietal atherothrombotic infarction, 10 patients with lacunar infarction, 10 paired healthy controls). They were administered a classic test for obtaining P300, which evaluates sustained attention. RESULTS: Patients with cerebral infarction in the right hemisphere presented alterations in the functions evaluated, since they showed more omissions, gave fewer correct answers, the values for latency were significantly increased in Fz derivation and amplitude values were reduced in Pz, as compared to healthy controls. Individuals with left cerebral infarction, however, showed no significant differences with regard to the controls. People with lacunar infarction made less mistakes and omissions, and scored more correct answers than those that had suffered right or left infarction. Their amplitude values were also higher than the values of the individuals with a right lesion in Pz derivation but showed no differences as regards the controls. CONCLUSIONS: These results provide new data on the cognitive mechanisms that are affected during a right parietal lesion and demonstrate the sensitivity of P300 in detecting alterations in sustained attention in individuals that differ as regards not only the localization of the lesion but also the type of etiopathogenic mechanism involved.

Adult↗
PubMedDate not supplied

[Use of event related potentials for the diagnosis and follow up of sub clinical disorders of sustained attention in ischemic cerebrovascular disease].

INTRODUCTION: Ischemic cerebrovascular disease causes cognitive disorders among survivors, which may range from vascular dementia to alterations of a sub clinical nature. These are not easily detected using conventional diagnostic tools. Some of the most frequent disorders after a cerebral infarction are those affecting sustained attention or vigilance. The event related potential (ERP) P300 or P3 could be a valuable diagnostic indicator of this type of disorder and its evolution. AIMS. The evaluation and diagnosis of sub clinical disorders of sustained attention in patients with cerebral infarction by using ERP as a method of diagnosis and follow up. PATIENTS AND METHODS: We studied 13 patients with cerebral infarction located in the left parietal lobe, 13 with infarction in the right parietal lobe and 26 healthy control subjects, who were paired by gender, age and educational level. All subjects were submitted to a computerized continuous performance test, associated with the recording of electrical brain activity. RESULTS: Patients with right parietal lesions made more mistakes due to omission, answered fewer questions correctly and had a lower attention index than the rest of the patients and healthy controls. Although there were no significant differences in the P3 amplitude values, patients with right lesion presented significantly increased latencies in the F7, Fz and Cz derivations. After five months there was a significant improvement in performance in the attentional test. The value of the latency in the Cz derivation, nine days after the occurrence of the cerebral infarction, was related with the number of mistakes made by the subjects five months later in the attention test. CONCLUSIONS: Patients with an ischemic lesion in the right parietal lobe presented disorders in sustained attention, which were only diagnosed adequately by use of computerized tests associated with ERP recordings. This shows that evoked potentials are valuable in cognitive diagnosis, and also demonstrates the relation that exists between the capacity to hold the attention on a stimulus over a period of time and the structures of the right parietal lobe. Five months later, these disorders of a sub clinical nature can disappear. The value of the latency in Cz, nine days after the occurrence of the event, acts as a predictor of this recovery. Cognitive rehabilitation plans could benefit from the use of these diagnostic tools.

Attention↗
PubMedDate not supplied

[The role of blood lipids in the different aetiologies of cerebral infarction].

INTRODUCTION: In order to determine the role lipids play in cerebral infarction (CI), the different aetiological subgroups of this disease should first be separated. AIMS AND METHOD: We conducted case control studies to identify whether there is a relation between blood lipid levels and the occurrence of cerebral infarction caused by atheromatosis (CIA). Our study involved a total of 98 patients with cerebral infarction of an atherothrombotic or lacunar aetiopathogenesis that were included in the CIA category. Two control groups were set up: one consisted of 23 patients with non atheromatous cerebral infarction (NACI), which included other aetiologies (cardioembolic, unusual and unspecified), and the other was made up of 101 healthy subjects who had not had a stroke. RESULTS: The group of patients with CIA presented higher average cholesterol rates than the group of subjects with NACI (p= 0.005). Nevertheless, compared to the control group they had higher average levels of cholesterol (p= 0.003), triglycerides (p= 0.011), VLDL (p= 0.028) and LDL (p= 0.000), as well as a higher average atherogenic index (p= 0.028). Furthermore, the average levels of LDL (p= 0.030) and the atherogenic index (p= 0.008) were seen to be statistically higher in the group of subjects with NACI than in the control group. Lastly, it must be pointed out that no differences in the average HDL levels were found between the three groups studied (p= 0.500). The presence of high blood pressure and a history of ischemic heart disease in patients with CI did not modify the variations that were observed in the lipids. CONCLUSIONS: Patients with CIA have a more atherogenic lipid profile than healthy individuals, while subjects with NACI are situated midway between the two groups

Arteriosclerosis↗
PubMedDate not supplied

[Disability and quality of life in patients with migraine: determining factors].

AIMS: The purpose of this paper is to describe the behaviour of disability and quality of life (QOL) in patients suffering from migraine and to identify the factors associated with these variables. PATIENTS AND METHODS: A non experimental study based on observation was conducted with 116 patients diagnosed as having migraine, who were consecutively admitted to the Casualty department at the Institute of Neurology and Neurosurgery. The chief variables used in the study were disability, QOL and the overall evaluation of their state of health. The remaining variables employed included demographic variables (age, sex, skin colour) and clinical variables involved in the bouts of migraine (with or without aura, pain location, type of pain, length of the bouts, presence of associated symptoms, presence of precipitating factors and their number, intensity of the bouts and the number of days with headache). The Migraine Disability Assessment questionnaire (MIDAS) was used to evaluate disability, while QOL was measured with the Headache Needs Assessment survey (HANA). RESULTS: The mean total score on the MIDAS was 40.8, and 58.6% of the patients were in grade IV disability. The mean number of days with headache over a three month period was 32.25 and the mean headache intensity was 8.50. The mean score on the HANA was 76.37. The factors associated with disability were the number of days with headache and comorbidity with high blood pressure, whereas their QOL was linked to the number of days with headache, the intensity of the pain and to the female sex.

Comorbidity↗
PubMedDate not supplied

[Cognitive diagnosis of cerebrovascular disease by event related potentials: anatomical sources that generate P300].

INTRODUCTION: Cerebrovascular disease causes different cognitive alterations. There is a need to develop tools that are capable of diagnosing them. One of them could be event related potentials. These provide an indicator of cognitive processing in real time. PATIENTS AND METHODS: A study was conducted of 10 patients with cerebral infarction in the frontal region and 10 paired healthy controls. Evaluation of the patients was performed a week after the stroke. A continuous performance test was applied to both groups together with the recording of the electrical activity in the brain in order to obtain the P300 component. The results were submitted to the non-parametric Student's t test, and the Bayesian model averaging method (BMAM) was employed to calculate the sources generating the electrical activity recorded on the electroencephalogram. RESULTS: Patients displayed significantly poorer performances compared to the healthy controls in the attention test. The BMAM showed that the P300 component was related to the right hand temporal structures in healthy controls, whereas the left temporoparietal regions were also involved in the patients. CONCLUSIONS: These findings indicate the existence of subclinical disorders affecting sustained attention and that they can only be detected by very sensitive tools; furthermore, they also have implications for the brain circuits regulating sustained attention and the P300 component.

Attention↗
PubMedDate not supplied

[The development of a scale to evaluate the quality of life in stroke survivors].

INTRODUCTION: The selection of a measure that can be used to evaluate the outcome of therapeutic interventions in stroke patients has had a conceptual problem in that there is a need to detect a wide range of deficiencies, disabilities and handicaps as part of a patient-based model. It has also suffered from a methodological problem due to the lack of systematic attention given to the development of standard instruments. AIMS: We conducted this study with the aim of getting over these limitations by developing a scale to evaluate the quality of life in stroke survivors. SUBJECTS AND METHODS: We followed a methodology that had previously been standardised by other authors based on using the opinion given by patients and caregivers in the generation of the items to be included. This has several stages that include individual interviews with patients, caregivers and experts, focal groups with patients and experts, quantitative and qualitative analyses of these interviews, two panels of experts to actually draw up the instrument, and a pilot test carried out in a sample of 50 patients to reduce and group the items. This reducing and grouping process was performed taking into account the following: 1. The percentage of responses left unanswered; 2. A factorial analysis of the main components; 3. Cronbach's alpha coefficient. RESULTS: We interviewed 20 patients and 12 experts; these results were later used to classify the above mentioned aspects in order of priority according to the frequency with which they appeared in the surveys. Then, we elaborated the questionnaire with four areas or subscales by including the questions or items in these categories: I. Physical status (17 items); II. Emotional status (13 items); III. Activities of daily living (13 items); IV. Social and familial functions (13 items). After the pilot study 38 items were reorganised into eight domains, according to the factorial analysis: 1. Physical problems; 2. Communication; 3. Cognition; 4. Emotions; 5. Feelings; 6. Activities of daily living; 7. Familial functions; 8. Social functions. They displayed high coefficients of internal consistency. CONCLUSIONS: We developed a new scale for evaluating the quality of life for stroke patients and it is now ready to undergo its validation process.

Activities of Daily Living↗
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

[Stroke-specific quality of life scale (ECVI-38): an evaluation of its acceptance, reliability and validity].

INTRODUCTION AND AIMS: Health-related quality of life (HRQL) is currently essential in the evaluation of stroke-related clinical trials. Existing stroke-specific scales were developed in English-speaking countries and most of them do not satisfy the necessary standards of validity. In consequence, the first Spanish-language scale for evaluating the quality of life (QL) of stroke survivors was developed (ECVI-38). In this work the psychometric properties of this summary measure were assessed. PATIENTS AND METHODS: A group of 63 stroke patients were studied, between 2 months and 2 years after the event, to evaluate the acceptability, reliability and validity of the ECVI-38, using standardised psychometric methods. RESULTS: The ECVI-38 proved to have an important degree of acceptability; only three elements showed a high percentage of data loss due to the age of the patients in the sample; the floor and ceiling effects were within the accepted limits. The scale displayed good internal consistency (Cronbach's alpha 0.79-0.97, correlations between elements 0.53-0.90) and good stability in the test-retest trial (intraclass correlation coefficients 0.89-0.98). As regards its construct validity (total correlations among correct domains, convergent r = 0.57-0.90, discriminating r = 0.19-0.39), the results were very good, as were the findings of the studies of validity vs. external criteria (difference between groups with a known neurological status, and convergence validity). CONCLUSIONS: The ECVI-38 is a measure that is acceptable, reliable and valid for evaluating QL in patients who have had a stroke. Further tests are needed to evaluate its sensitivity and to explore its value in both clinical and research practice.

Activities of Daily Living↗