PubMed Health⌕ Search

Biomedical subjects

S Guelbenzu

Publications and source records attributed to S Guelbenzu.

18 recordsLinked to original sources
PubMed2002

[Selective ophthalmic artery fibrinolysis in acute central retinal artery occlusion].

PURPOSE: To evaluate efficacy and reliability of local intra-arterial fibrinolysis (LIF) in Retinal Central Artery Occlusion (RCAO). MATERIAL AND METHOD: We have studied 12 patients with RCAO. Seven patients (group I) were treated with conventional therapy and 5 patients (group II) underwent treatment with urokinase via transcutaneous femoral catheter into the ophthalmic artery. Thereafter patients received heparin sulfate for 3 days. RESULTS: Mean follow up was 14 months and mean time from onset of symptoms to the beginning of therapy was 11 hours. One patient in group I showed improvement of visual acuity (from counting fingers to 0.1). In all patients in group II there was angiographic evidence of improved perfusion of retinal arteries and 4 patients (80%) showed improvement in visual acuity. The best results were obtained when LIF was performed before 10 hours after onset of symptoms. No complications were observed after the fibrinolysis treatment. CONCLUSION: LIF in ophtalmic arteries for the treatment of RCAO reduces dosage of fibrinolytic agents and becomes a safe and useful treatment during the first hours post RCAO.

Aged↗
PubMed1999

Neurological impairment in alpha-mannosidosis: a longitudinal clinical and MRI study of a brother and sister.

Neurological development over a period of 25 years and MRI findings are reported in two members of the same family affected by mannosidosis type II. Progressive axial and appendicular cerebellar syndrome, moderate hearing loss and deterioration of gait were present in both patients. Neuropsychological deficiency was severe, but progression over the years was not observed except in the woman's speech capacity. Neither of the patients showed clinical improvement. A progressive corticosubcortical atrophy stands out in the brain neuroimaging studies, especially at the vermian cerebellar level. The osseous cranial deformities are very characteristic and include brachycephaly, thickening of the calvaria at the expense of the diploe, and poor pneumatization of the sphenoid. Neither of our cases showed an empty sella turcica.

Adult↗
PubMed1998

[Idiopathic hypophyseal hyperplasia: diagnosis by magnetic resonance].

INTRODUCTION: Hypophyseal hyperplasia is an uncommon disorder in which the gland increase in size due to excessive proliferation of strings of normal cells, which usually secrete prolactin. Different aetiologies may cause this disorder of the hypophyseal gland. However, in a small number of cases the hyperplasia is not due to any of these aetiologies and is therefore known as idiopathic hypophyseal hyperplasia. There are few references in the literature to idiopathic hypophyseal hyperplasia with hyperprolactinaemia. Usually diagnosis is reached after treatment for a hypophyseal adenoma, since the clinical features are similar. CLINICAL CASES: We present three cases seen in our department, in which hormone and endocrine studies were done to exclude known causes of hyperplasia, together with CT and MR scans. We analyzed the behaviour of hypophyseal hyperplasia by using imaging techniques, and the differential aspects with regard to hypophyseal adenomas. Firm diagnosis is only made on anatomopathological study of the hypophysis. However, we consider that sound knowledge of the characteristics of this condition may help to establish the correct diagnosis and thus avoid unnecessary surgery. CONCLUSIONS: We review the information published in the literature on this subject, emphasizing the importance of differential diagnosis by means of imaging techniques.

Adenoma↗
PubMed1998

[Spontaneous intracranial hypotension: findings of cerebral NMR].

INTRODUCTION: The intracranial hypotension syndrome is characterized by a cerebrospinal fluid (CSF) pressure of less than 60 mmH2O and presents as postural hypotension which is often accompanied by nausea, vomiting, cervicalgia and some degree of neck rigidity. It is considered to be spontaneous when there is no known precipitating factor. It is believed that there is a CSF leak across the subarachnoid space, although it is not always possible to detect this. In recent years several authors have described different pathological findings on magnetic resonance (MR) studies. CLINICAL CASE: We present the radiological studies of a patient with clinical evidence of headache which was worse on standing and improved when lying down. The outflow pressure of CSF was 6 mmH2O when lying down. On isotopic cisternography using Tc DTPA-99m there was no detectable CSF leak. On cerebral MR there was diffuse pachymeningeal thickening with increased signals in T1 sequences. This was more pronounced in T2 with lineal dural uptake of contrast at infra and supratentorial levels. The brain stem meninges were intact. In parallel with a favorable clinical course, following clinical resolution the radiological images were seen to have returned to normal. CONCLUSIONS: Radiological findings, together with a compatible clinical condition, help to establish the diagnosis of spontaneous intracranial hypotension and avoids the use of unnecessary clinical investigations.

Adult↗
PubMed1998

[Wegener's granulomatosis with meningeal involvement: clinic-radiological correlations].

INTRODUCTION: Wegener's granulomatosis is a systemic vasculitis which, in its classical form, is characterized by involvement of the superior and inferior respiratory tract and the kidneys. The vasculitis may be multisystemic. Ophthalmic and neurological involvement are common (22% and 54% of those affected respectively). When considering involvement of the nervous system, the commonest finding is peripheral neuropathy, particularly in the form of multiple mononeuritis. Meningeal involvement is exceptional. CLINICAL CASE AND CONCLUSIONS: We present a case of Wegener's granulomatosis with meningeal involvement, studied using CT and MR. The findings using imaging techniques are described, and conditions which should be considered in the differential diagnosis are discussed.

Adult↗
PubMed1997

[Epilepsy as the first sign of multiple sclerosis].

INTRODUCTION: Epileptic crises are uncommon in patients with multiple sclerosis. However, epilepsy is commoner in these patients than in the general population. An epileptic crisis as the presenting feature of multiple sclerosis is even rarer. The lesions involved in the pathogenesis of these crises are plaques of demyelinization which affect the cortical or subcortical areas. Other factors, some of which are still not clearly understood, such as the fibre, electrolytic changes, size of the plaque, reactive gliosis and the enzyme (Na(+)-K+)ATPase, seem also to play a part in the production mechanism. Magnetic resonance is a very sensitive technique used in the detection of demyelinating lesions during the acute phase. The sensitivity is further increased by the use of gadolinium. CLINICAL CASES AND CONCLUSIONS: We present two cases of multiple sclerosis which presented as epileptic crises. In one there were generalized tonic-clonic crises and in the other partial sensitive crises. We mention the EEG findings, CSF analysis and neuroimaging diagnostic techniques.

Adult↗
PubMed1996

[Neuroimaging, CT and MR brain findings in a case of McCune-Albright syndrome].

McCune-Albright syndrome is characterized by the triad of polyostotic fibrous dysplasia, precocious puberty, cutaneous pigmentation and cafe-au-lait spots. A 23-year-old woman with McCune-Albright is reported. Findings on CT scan and magnetic resonance imaging of the skull in an affected girl with McCune-Albright syndrome are shown, and also the histopathological study of the right temporal bone biopsy.

Adult↗
PubMed1996

[Carotid cavernous fistula: endovascular therapy].

Abnormal communications between the carotidal artery and the cavernous sinus are known as carotid-cavernous fistulas. We can however distinguish between these fistulas two different evolutive and etiological entities: on the one hand there are the direct types with high flux and normally related to hard traumatisms and on the other hand there are the indirect types lacking clear etiological factors, with slower flux and which correspond to dural malformations with different arterial nutrition. In the last two years in our service we have treated eight carotid-cavernous fistulas, four direct and four indirect, using endovascular techniques with differing emboligenic materials according to the nature of the fistula, flux volume and origin. Complete closure was obtained in all patients with direct fistulas and in two whose fistulas were indirect. Closure was almost (greater than 75%) complete in the remaining two cases. In all cases symptomatology prior to intervention diminished completely a few weeks later with no relapse up until now. We discuss the classification and clinico-pathological characteristics of each fistula type, the comparative usefulness of different diagnostic methods and we review therapeutic symptoms with special emphasis on neuroradiological endovascular techniques, analyzing the usefulness of each emboligenic material type. The recent development of intervention techniques in neuroradiology makes low risk correct closure of carotid-cavernous fistulas a possibility. Endovascular is accepted as the treatment of choice today.

Adult↗
PubMed1996

[Magnetic resonance imaging usefulness in the diagnosis of intratumor bleeding in hypophyseal adenomas].

Hypophyseal adenomas are the most frequent intrasella tumours. They are classified as macroadenomas or as microadenomas depending on whether their size is greater or less than 1 cm. Hypophyseal tumours may undergo ischaemic necrosis and haemorrhage when the blood supply is reduced. Intratumoural bleeding is found in varying percentages, between 9.9% and 26%. We review our series of 122 patients with hypophyseal adenomas in whom MR was done. Signs of bleeding were found in 12 patients (9%). In five cases, bleeding had presented as hypophyseal apoplexy, in five cases with subacute symptoms and in two cases was asymptomatic and diagnosis fortuitous. Of the adenomas with intratumoural bleeding, 9 were functioning tumours (4 secreted PRL, 4 ACTH and 1 GH) and 3 non-functioning. The risk factors considered in the pathogenesis of intratumoural bleeding are numerous. The increased incidence of bleeding in large and in invasisve adenomas, especially when treated with bromocriptin, is well established. MR is the ideal technique to detect intratumoural bleeding, T2 weighted sequences being very useful in the diagnosis of bleeding in the acute phase. In the subacute phase, focal areas of hyperintensity are seen in T1 and of hypo/hyperintensity in T2. In the chronic phase, areas of hypodensity are seen both in T1 and in T2. In our study we analyze the clinico-radiological correlation in patients with signs of intratumoural bleeding.

Adenoma↗
PubMed1996

[Neuroimaging and efficacy of treatment in advanced African trypanosomiasis].

INTRODUCTION: West African trypanosomiasis (WAT) is rare in Spain. Delay in its diagnosis and treatment leads to irreversible diffuse meningoencephalitis and finally death of the patients. CLINICAL CASE: We described a patient in whom the diagnosis of advance WAT had been delayed. He had headache, alteration of the level of consciousness and sleep pattern, psychiatric disorders, crises, extrapyramidal, sensitive and endocrinological clinical alterations. Biochemical investigation showed slight anemia with marked thrombocytopenia, and raised ESR and IgM. Initially serology was negative for trypanosomes, although examination of the CSF confirmed the diagnosis. MR showed extensive lesions of the basal nuclei, brainstem and white matter. Both the clinical abnormalities and the lesions shown on MR disappeared after treatment with intravenous difluoromethylornithine. The patient is now symptom-free and at work as usual. DISCUSSION: Find diagnosis of WAT requires isolation of the parasite from the blood, the bone marrow or CSF. When other complementary tests (such as serology) are negative, the diagnosis should not be ruled out. There are few neuroimaging studies of WAT, and only by CT. We have found no MR studies of patients with WAT, in the literature. We emphasize the close correlation between the clinical and radiological findings in this case, and the excellent result obtained after treatment.

Adult↗
PubMedDate not supplied

[Clinical and radiologic assessment of vertebroplasty].

INTRODUCTION: Percutaneous vertebroplasty consists of the injection of acrylic cement into weakened vertebral bodies to achieve pain relief and mechanical stability of the spine. OBJECTIVE: To evaluate the characteristics and effectiveness of the vertebroplasties performed at the Hospital Universitario Miguel Servet in Zaragoza. PATIENTS AND METHODS: This is a retrospective study of 147 vertebroplasties performed in 95 patients (60 women and 35 men; age range: 19 to 84 years). The oblique transpedicular approach, which achieves adequate cement injection with a single puncture, is currently used. A visual analogue scale (VAS) was used to evaluate pain before and after the procedure. RESULTS: The osseous lesion most often treated by vertebroplasty is fracture secondary to osteoporosis, accounting for 65% of the cases in this series, followed by hemangiomas (23%), and osteolytic metastases, traumatic fractures, lymphomas, and myelomas. Prior to vertebroplasty, the mean VAS score was 8.88 versus 2.78 after the treatment. Only 7.3% of the patients had symptomatic complications. CONCLUSION: Vertebroplasty is safe and efficacious; it is the treatment of choice for vertebral pain refractory to medication. It enables patients to return to their habitual lifestyle quickly and thus helps reduce hospital stays and costs.

Adult↗
PubMedDate not supplied

[Preoperative percutaneous++ vertebroplasty in hemangioma compression].

INTRODUCTION: Vertebroplasty is a new procedure used in interventional neuroradiology, involving percutaneous introduction of acrylic cement. CLINICAL CASE: We present the case of a D10 vertebral hemangioma, which had progressed so as to cause compression of the spinal cord. We used combined treatment. Vertebroplasty was done with acrylic cement, using transpedicular percutaneous puncture, with subsequent bilateral laminectomy to decompress the spinal cord. One year later the clinical condition is completely satisfactory. The signs of paraparesia and dorsalgia have disappeared. Posterior fixation was not necessary. CONCLUSIONS: Vertebroplasty is effective since the vertebral body is consolidated and pain avoided. We give details of the methodology, indications and possible complications of the technique of percutaneous vertebroplasty.

Acrylic Resins↗
PubMedDate not supplied

[The contribution of an intraarterial electroencephalographic study in patients with deep epileptogenic foci].

OBJECTIVES: To evaluate the diagnostic efficacy of an intra-arterial electroencephalographic recording and determine which patients obtain most benefit from this technique, to compare the results obtained using other recording techniques and to establish a standard for recording. PATIENTS AND METHODS: We made 64 intra-arterial recordings in 30 patients from one of three groups: persons with drug-resistant temporal epilepsy; patients with epileptic seizures of any type who required cerebral arteriography and patients whose illness required selective anteriography for any reason. We used a Seeker 10 guide-wire, the end of which acted as an electrode and a 2 minute recording was made. The position of the electrode varied depending on the site of the patients disorder. Activity was simultaneously measured with surface electrodes. Using the chi squared non-parametric test, we analysed the efficacy of the test. The paired t test was used to establish the concordance between observers. We compared the results obtained from the intra-arterial EEG with the simultaneous surface recording. RESULTS: We found three types of electroencephalographic patterns. The commonest was defined by the presence of high-voltage multi-spiked acute waves. The sensitivity of the test was 93.33%, the specificity was 80% and the overall value of the test was 86.66%. The chi squared test showed its reliability in the diagnosis of deep epileptogenic foci. There was high concordance between the observers in the study. No complications were seen in the patients in this study. CONCLUSION: The intra-arterial EEG recording is a semiinvasive test which may be useful in a selected group of patients and has high sensitivity and specificity.

Adolescent↗
PubMedDate not supplied

[A clinico radiological study of patients with cavernous angiomas of the spinal cord].

AIM: To define the spectrum of signs, symptoms and radiological features in patients with spinal intramedullary cavernous angioma. We analyze surgical management and clinical follow up in these patients. PATIENTS AND METHODS: 16 adult patients, 9 women and 7 men, were studied in our hospital each with one cavernous angioma of the spinal cord. All patients were diagnosed with magnetic resonance imaging. The lesion location was intramedullary in all patients, 6 patients cervical level and 10 thoracic level. RESULTS: In 12 patients surgical resection of the malformation was performed and histological results confirmed the spinal cavernous diagnostic. In 10 patients, the clinical outcome had improved in Frankel grade. In the four nonoperated cases, successive monitoring studies demonstrated no radiological progression and the clinical symptomatology has remained stable. CONCLUSION: Women in the fertile period appear to be predisposed to develop spinal cavernous angioma. The bleeding risk, in our study, didn t have any relation with CMA level. Magnetic resonance imaging features cannot predict the CMA evolution.

Adolescent↗
PubMedDate not supplied

[Progression following the embolisation of 100 intracranial arteriovenous malformations].

INTRODUCTION: We analysed the characteristics, progression and outcomes observed following the embolisation of 100 intracranial arteriovenous malformations (AVM) that were performed in order to achieve complete obliteration of the AVM, the elimination of associated vascular risk factors and also to reduce their size with a view to increasing the effectiveness of later treatments. PATIENTS AND METHODS: The demographic and anatomical characteristics of 110 patients with AVM were analysed over a period of 13 years, and embolisation was performed in 100 of them. In all, 203 embolisation sessions were carried out with an average of 3 embolisations per patient. Of the 100 AVM that were embolised, 36 were AVM which were treated by embolisation with no later therapy, 48 required radiosurgery after the embolisation and the other 16 were submitted to surgery following the embolisation. The type of materials used included liquid adhesive embolic agents (Hystoacryl, Glubran), non-adhesive embolic agents (Onyx) and polyvinyl alcohol particles. Patients were examined clinically and arteriographically. RESULTS: Of the 100 AVM that were embolised, complete eradication was accomplished with just embolisation in 27 cases of AVM (27%). Of the 48 AVM in which radiosurgery was carried out at a later date, the average rate of obliteration was 78% and of the 16 AVM in which surgery was carried out some time later, the average rate of obliteration was 70%. Of the 100 AVM that were embolised, some residue remained in 16 cases. Embolisation eliminated most of the associated vascular risk factors, as can be seen by the fact that associated risk factors disappeared in 28 (65%) out of the 43 AVM with such factors. The morbidity and mortality rates with embolisation were 8% and 2%, respectively. CONCLUSIONS: Embolisation eliminated most of the vascular risk factors, with complete obliteration in 27 cases and size was satisfactorily reduced for later treatment; at the same time, morbidity and mortality rates were acceptable.

Adolescent↗
PubMedDate not supplied

[Epilepsy with normal CT: the MR contribution].

We present a study of 165 patients with fits with normal brain computerized tomography (CT) scan or else who showed no evidence as to the etiology of such attacks. We analyzed the magnetic resonance (MR) results obtained. In 36.6% of cases MR was pathological, the most frequent finding in our series being cerebral atrophy (12.8%). We comment on the most important pathology groups, highlighting the contribution MR made in our patients.

Adolescent↗