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O J Hernández-Fustes

Publications and source records attributed to O J Hernández-Fustes.

At least 19 recordsLinked to original sources
PubMed2001

[Fatal necro-hemorrhagic pancreatitis related to sodium valproate: case report].

Among the idiosyncratic reactions related to VPA, pancreatitis is the most rare and less remembered even though its potentially fatal course. We report the case of a 5 year-old boy with epilepsy treated with VPA 40 mg/kg/day associated with CBZ 20 mg/kg/day and PB 3 mg/kg/day, admitted for vomiting, abdominal pain, low grade fever, abdominal tension and amylasis of 288 UI. On evolution presented upper digestive hemorrhage, shock and amylasis of 564 UI. The patient was submitted to exploratory laparotomy with findings of hemorrhagic ascitis, retroperitoneal hematoma, increased volume of pancreas with edema and hemorrhage leading to diagnosis of necro-hemorrhagic pancreatitis and a fatal course. Pancreatic complications are well known complications related to VPA treatment and may vary between asymptomatic hyperamilasemy to fatal acute pancreatitis. The characteristics of our patient correlates with the data on literature: we found 7 similar cases reported, 4 of which died.

Acute Disease↗
PubMed2000

Orbital myositis and rheumatoid arthritis: case report.

Orbital myositis implies orbital inflammation confined to one or more of the extraocular muscles. The acute form responds well to high doses of oral corticosteroids tapered gradually, but it may recur or become chronic. We describe a 38 years old female who has been suffering from rheumatoid arthritis for six years. She developed diplopia as a result of a paralysis of the right and left rectus medialis muscle. MRI showed inflammatory process and thickness of the referred muscles. The patient had a total recovery with oral use of 80 mg methylprednisolone daily. Two months after the first episode she developed a bilateral ophthalmoplegy. The patient improved with oral use of steroids the second time, but a paresis of the left rectus lateralis muscle remained. From the 156 cases we reviewed only three have been related to rheumatic diseases and none has been previously related to rheumatoid arthritis.

Adult↗
PubMed2000

The Wada test with propofol in a patient with epilepsy.

The usual drug used in the Wada test is amobarbital, but it is not available in Brazil. Propofol was already used by Bazin et al. in 1998, and in their report the test resulted good in the absence of any adverse effect. We report the use of propofol as the anesthetic for the Wada test. The test was carried out in a 26 years old woman with temporal medial lobe epilepsy refractory to medical treatment. Language functions and memory were tested after injection in both hemispheres by three procedures (Seattle, Montreal and Interview procedures). Propofol showed to be good to carry on the Wada test.

Adult↗
PubMed1999

[Syndrome of Munchausen and pseudoparaplegia. Case report].

We present a 36 years old female, with a 8 years history of "paraplegia", who was admitted to our department to have "some needles withdrawn" from her back. She referred previous admittances to general and psychiatric hospitals in order to treat several episodes of renal failure, combined with other clinical conditions like pulmonary tuberculosis and esophagus, ovary and breast cancer. On the psychiatric evaluation, we found a patient who seemed to be indifferent to her disease, giving accurate and very elaborated description of her symptoms. She was always complaining about previous medical therapies. She moved her both legs simultaneously, without any impairment on reflexes and sensibility. We did not find evidence of tumor processes. The electromyography, cranial CT scan, abdominal ultrasound scan and chest X-ray were normal. Lumbosacral X-ray and CT scan showed 16 sewing needles widespread in the lumbosacral soft tissues. A diagnosis of Munchausen syndrome was formed. After a 15-day trial of anti depressive drug, physiotherapy and psychotherapy, her clinical status significantly improved, reverting its neurological picture after treatment.

Adult↗
PubMed1998

[Post-traumatic spasmodic torticollis].

Dystonia is a rare consequence of head trauma. We describe one case of post-traumatic spasmodic torticollis and review thirty-one cases reported in the literature. The time course among the head injury and the onset of dystonia ranged from two hours to nine years. Eleven cases had mild head injury and twenty had severe. On CT studies, the most frequent lesion was extradural, subdural and thalamic hemorrhagies; on MRI there were lesions in contralateral basal ganglia or thalamus. In our case, initial CT findings were bilateral hygroma and generalized brain edema. A follow-up CT sixt days after head injury showed cerebral atrophy and MRI scan (one year later) showed cerebral atrophy either. The pathophysiologic mechanisms related to the appearence of dystonia are poorly understood. However, there are evidences suggesting that some dysfunction of lenticulothalamic neuronal circuits plays an important role. The period of time between the head injury and the appearance of post-traumatic dystonia, seems to be related to aberrant central neurons.

Adolescent↗
PubMed1998

[Etiological factors of epilepsy].

INTRODUCTION: The epilepsies are one of the main reasons for consultation and hospital admission in neurology. They may be caused by multiple factors. OBJECTIVES: To determine the types of epilepsy, their aetiology and the value of a clinical history in diagnosis of their cause. PATIENTS AND METHODS: We studied 96 epileptic patients aged over 15 years in the epilepsy clinic of the Hospital Dr. Carlos J. Finlay in La Habana, Cuba. On a questionnaire we recorded: family history, pre-, peri- and postnatal histories, clinical features of the crises and physical exploration. All had inter-ictal electroencephalograms, 62 had cranial CTs, 36 had MR studies and 8 had both types of imaging studies. We excluded acute metabolic disorders and cerebral tumours. RESULTS: There was a predominance of persons aged between 26 and 35 (78%) and 59.37% were men. Symptomatic epilepsy was seen in 51.4%, in 38.54% this was cryptogenic and in 10.41% idiopathic. Perinatal damage was present in 20.8%, head injury in 11.4%, febrile convulsion in 10.4%, meningoencephalitis in 8.3% and cardiovascular disease in 4.1%. CONCLUSIONS: The international classification of epilepsy permits our patients to be divided into groups. In most of them aetiological factors were detected after an interview and medical exploration.

Adult↗
PubMed1995

[Temporal lobe epilepsy: report of an intact patient 26 years later without treatment].

We present the case of a 36 years old man with temporal lobe epilepsy since 10 years old without treatment, and daily complex partial seizures and weekly tonic-clonic seizures. The diagnosis was made by clinical aspects and electroencephalographic findings. CT scan was normal. Cognitive functions were tested and showed no alterations. The patient had normal clinic, neurologic and mental exam.

Adult↗
PubMedDate not supplied

[Epilepsy and arteriovenous malformations].

OBJECTIVE: To describe the characteristics of the patients with epilepsy, associated to arteriovenous malformation. PATIENTS AND METHODS: We introduced 11 patients assisted in 1997, at University Cajuru Hospital, with arteriovenous malformation associated to refractory epileptic seizures. RESULTS: Six men and five women, with age between 12 and 40 years old (27 years in mean), were interned with epileptic crises, 4 generalized tonic-clonic, 3 partial simple secondarily generalized, one with complex partial and one with simple partial that the complex developed with secondary generalization. CT showed temporal lesion in 3 patients, parietal in 3 patient, ventricular in 3, parietal fose and temporoparietal on one patient, respectively. MRI was accomplished in 5 patients presenting temporal lesion in 3 and temporo-parietal in 2. It was possible to accomplish the EEG in 8 patients, all with epileptiform activity. The arteriography showed arteriovenous malformations in all the patients, 3 of the which died. Eight patients were guided for surgical treatment evidencing cavernous angioma in 6 patient and hemangioma in 2. CONCLUSIONS: We observed that cortical and not cortical arteriovenous malformation associates to epileptic seizures and in the cases in which it is possible, the surgical treatment favors the control of the seizures.

Adolescent↗
PubMedDate not supplied

[The clinical relevance of serial determinations of plasma concentrations of carbamazepine and sodium valproate].

INTRODUCTION: Serum concentrations of valproate (VPA) and carbamazepine (CBZ) were monitored in 66 epileptic out patients to determine then pharmacokinetic profiles. PATIENTS AND METHODS: Thirty-eight patients were receiving monotherapy, 17 with CBZ and 28 with VPA, and 28 patients were receiving VPA and CBZ. All were receiving standard (not controlled-release) CBZ or VPA preparations. Blood samples were obtained 2, 4, and 6 hours after the last dose. Serum concentrations were determined by gas chromatography. RESULTS: Mean serum concentrations of patients receiving CBZ were 8.2, 7.3 and 6.4 micrograms/ml for the 2, 4 and 6 hours samples, respectively. Mean serum concentrations of CBZ in the group receiving CBZ + VAP were 7.8, 8.4 and 7.8 micrograms/ml, respectively. Patients receiving VPA had mean serum concentrations of 92.8, 97.8 micrograms/ml, respectively. Those receiving CBZ + VPA had serum concentrations of 69.1, 70.6 and 55.8 micrograms/ml, respectively. Mean variation in the CBZ serum concentrations was 45% (range 7-91%) in patients receiving monotherapy and 31% (range 8-93%) in patients receiving CBZ + VPA. Mean variation in VPA serum levels of the patients receiving CBZ + VPA (56%) was greater than those of patients receiving CPA alone (38%). Subtherapeutic serum levels of either drug were detected in 35% of the patients. CONCLUSIONS: The large inter- and intraindividual variability of serum concentrations showed that a single measurement does not reflect the reality or CBZ and VPA clinical kinetics. The results confirm that three samples collected at 2, 4, and 6 hours after the last dose determine a clinically useful kinetic profile.

Anticonvulsants↗
PubMedDate not supplied

[Epilepsy and cerebral tumor].

OBJECTIVE: To determine clinical and pathological features with seizures associated brain tumors. PATIENTS AND METHODS: This was a retrospective study through of an Epilepsy Program Protocol where we studied fifty patients admitted at Hospital Universitário Cajuru of Curitiba, Brazil, in 1996-1997. RESULTS: We studied 36 males and 14 females, aged 6 and 81 years old (mean 40.5). Twenty six patients had tonic-clonic seizures, 13 had simple partial secondarily generalized, 8 had simple partial, 2 complex partial and one with simple partial progressing to complex partial seizure. CT showed parietal expansive lesion on 14 cases, frontal expansive lesion on 14 cases, frontoparietal on 5; intraventricular tumor, sella turcica, temporal temporoparietal and fronto-temporo-parietal expansive lesion 2 on each case, and suprasellar lesion, centrum semiovale, cerebello-pontine angle, ventricular trigone, fronto-naso-etmoidal and brain stem 1 on each case. All patients were submitted to a biopsy and/or resection of the lesion. The principal brain tumors were meningioma in 30%, astrocytoma in 22%, glioblastoma multiform in 14%, oligodendroglioma in 4% and pituitary adenoma in 4%.

Adolescent↗
PubMedDate not supplied

[Work conditions of patients with controlled epileptic crises].

OBJECTIVES: To study the employment conditions in a group of patient epileptic adults with control of its seizures, assisted in the University Hospital of Cajuru. PATIENTS AND METHODS: We studied 70 patients that we applied the specific protocol, obtaining data of its origin, profession and job situation. RESULTS: We examined 46 men and 24 women, with mean age 34 years old, where 63 of urban origin and 7 rural. All the patients were in treatment with antiepileptic drugs and without seizures or less than three seizures in the last twelve months. The largest group of patients (35) they met unemployed: 14 retired, 11 of the motivated by the disease, 10 worked as autonomous, 3 only studied and 3 were public employees.

Adolescent↗
PubMedDate not supplied

[Miller-Fisher syndrome and cavernous angioma].

INTRODUCTION: The Miller-Fisher syndrome is considered a variant of acute inflammatory demyelinating polyradiculoneuropathy, generally is a benign disorder. CLINICAL CASE: We describe a patient who has had, acutely, ataxia, areflexia and ophthalmoplegia. It has been electrophysiologically diagnosed as Miller-Fisher syndrome. The symptoms appeared after an infectious disease, namely sinusitis. The evoked potential studies suggested lesions at the brain stem and we found a cavernous angioma at MRI. CONCLUSION: We prepared a review of the literature published so far, showing that there is still much controversy about the physiopathology of this syndrome and the importance of the immunologic diagnoses.

Adult↗
PubMedDate not supplied

[Neurocysticercosis and epilepsy in Cuba].

INTRODUCTION: Neurocysticercosis is one of the main causes of epilepsy in the tropics, particularly in Central and South America. OBJECTIVES: To report the only five patients diagnosed in a tertiary care institution as having neurocysticercosis and its relation to epilepsy. PATIENTS AND METHODS: We made a retrospective study, reviewing the clinical histories of patients admitted to the Instituto de Neurologia y Neurocirugia of La Habana, Cuba, over 25 years up to 1989, to determine those with neurocysticercosis. RESULTS: We found only five patients, representing a frequency of 0.01% of all admissions. We discuss the origin of these cases and their possible place of infection, showing that this is almost non-existent in Cuba since three of the cases were of foreigners and there was evidence that the two Cubans had acquired the disease abroad. The correlation between neurocysticercosis and epilepsy (4 of 5 cases) was assessed. The main symptoms were analyzed: the three most important, in order, were tonic-clonic convulsions, headache and motor deficit respectively. The epileptic seizures were classified as secondary generalized partial seizures (symptomatic partial epilepsy secondary to cysticercosis). The clinical form, when the site is considered, was inactive, with intraparenchymatous and meningeal (mixed) calcifications in one case. CONCLUSION: We assess the elements which permit diagnosis, the efficacy of anti-helminth treatment and the drugs used to treat epilepsy and cerebral oedema, the prognosis as a function of the diagnosis and the treatment.

Adult↗
PubMedDate not supplied

[Sturge-Weber syndrome: differential diagnosis of neurocysticercosis].

INTRODUCTION: The Sturge-Weber syndrome is characterized by facial cutaneous angioma associated with leptomeningeal and cerebral angioma, typically ipsilateral to the facial lesion, which is accompanied by convulsions, mental retardation, contralateral hemiparesia, hemiatrophy, homonymous hemianopsia and glaucoma. Most of the patients with radiographic evidence of intracranial angioma develop convulsive crises, but only half have severe mental retardation. The image of calcification on cranial tomography often leads to confusion in diagnosis, especially with neurocysticercosis, particularly in places where this is endemic and the patients present with minimal skin lesions or these are at atypical sites. CLINICAL CASE: We present the case of a 13 year-old boy hospitalized with status epilepticus who, since the age of 1 year and 3 months, had had convulsive seizures which were of generalized tonic-clonic type and partially complex with secondary generalization, treated with carbamazepine at a dose of 400 mg per day. Neurocysticercosis was diagnosed on a tomogram showing calcification of the left parieto-occipital gyrus. Following physical examination and complementary tests the diagnosis of Sturge-Weber syndrome was made. CONCLUSION: We emphasize the importance of the diagnosis of Sturge-Weber syndrome, its clinical picture and treatment.

Adolescent↗
PubMedDate not supplied

[The importance of postnatal risk factors in localized epilepsies].

INTRODUCTION: The risk factors for epilepsy are not sufficiently well known. OBJECTIVES: To determine the postnatal risk factors for epilepsy related to localization. PATIENTS AND METHODS: We studied 100 patients with localized epilepsy who were over 14 years old, randomly selected and consulted us between January 1996 and July 1997. Data was obtained using the specific protocol of an epileptology program. All patients had electroencephalograms and skull tomography. RESULTS: The average age was 29 years. There were more males than females (57 males) and simple partial crises with secondary generalization were the commonest (49 patients). Head injury was the main risk factor. CONCLUSIONS: Postnatal risk factors which could have been avoided, such as head injury and neurocysticercosis made up the main group of patients with factors identified. Alterations on skull tomography were associated with statistically significant postnatal risk factors.

Adolescent↗
PubMedDate not supplied

[Etiology of late-onset epilepsy].

INTRODUCTION: Late-onset epilepsy is considered the epilepsy that starts after 25 years old. PATIENTS AND METHODS: To determine the etiology and value of the clinical and paraclinical studies in the diagnosis, we evaluated 300 patients older than 25 years admitted in the Institute of Neurology and Neurosurgery of the city of La Havana between 1980 and 1990. Data about the illness, family and personal history and physical exploration were picked up. EEG, CT, MRI and carotid arteriography were performed. RESULTS: The main prevalence was 25 to 29 years (15.3%) and those older than 60 years (14.3%). We determined the diagnosis in 56% of the patients. Stroke was present in 19.3%, degenerative diseases in 16.6%, cerebral tumors in 9%, severe cranial trauma in 7.6% and infections, perinatal damage and toxic and metabolic causes in 3.3%. CONCLUSIONS: The symptomatic epilepsy is the most frequent type of late-onset epilepsy, the vascular and degenerative etiology are the most important in those older than 40 years old, these findings are similar to those of the developed countries.

Adult↗