Isidro Huete L

Características de la enfermedad cerebrovascular en un Servicio de Cuidados Intermedios Neurológicos, en Chile. Análisis de 459 pacientes consecutivos

.La creacion de unidades de tratamiento delataque cerebrovascular (UTAC) y el advenimientode la trombolisis intravenosa han producido undramatico cambio en la terapeutica de la ECV.Distintos metaanalisis han mostrado que los pa-cientes hospitalizados en UTAC tienen menor mor-bimortalidad que los controles hospitalizados enservicios generales

Trombolisis intraarterial en trombosis de la arteria basilar: Recuperación de dos pacientes con síndrome de enclaustramiento

Locked-in syndrome is a dramatic clinical condition, the patient isawake, can listen and breath, but is unable to move any muscle, conserving only the vertical eyemovements. The most common cause of locked-in syndrome is the thrombosis of the basilar arteryand commonly leads to death, frequently due to pneumonia. Intravenous and intra arterialthrombolysis have been used successfully in a selective group of patients with ischemic stroke. Thereis only one report of two patients with locked-in syndrome who were treated successfully with intraarterial thrombolysis. Other authors, based in their experiences, do not recommend this treatment.We report two female patients aged 63 and 26 years, with Locked-in syndrome due to a basilarthrombosis who were treated successfully with intra arterial thrombolysis using ecombinant tissueplasminogen activator (r-TPA). The lapses between the onset of the symptoms and thrombolysis were5 and 8 hours respectively. A complete recanalization was obtained in both patients during thethrombolysis. One year after, the first patient has only a moderate ataxia, walking with assistanceand the other has a normal neurological examination (Rev Med Chile 2004; 132: 357-60 ).(Locked-in syndrome is a dramatic clinical condition, the patient is awake, can listen and breath, but is unable to move any muscle, conserving only the vertical eye movements. The most common cause of locked-in syndrome is the thrombosis of the basilar artery and commonly leads to death, frequently due to pneumonia. Intravenous and intra arterial thrombolysis have been used successfully in a selective group of patients with ischemic stroke. There is only one report of two patients with locked-in syndrome who were treated successfully with intra arterial thrombolysis. Other authors, based in their experiences, do not recommend this treatment. We report two female patients aged 63 and 26 years, with Locked-in syndrome due to a basilar thrombosis who were treated successfully with intra arterial thrombolysis using recombinant tissue plasminogen activator (r-TPA). The lapses between the onset of the symptoms and thrombolysis were 5 and 8 hours respectively. A complete recanalization was obtained in both patients during the thrombolysis. One year after, the first patient has only a moderate ataxia, walking with assistance and the other has a normal neurological examination.

Leucoencefalopatía reversible posterior: cuatro casos clínicos

Reversible posterior leukoencephalopathy syndrome (PLS) ischaracterized by headache, clouding of sensorium, visual disturbances and seizures. It isassociated to hypertension, renal disease or immunosuppressive therapy. We report three males,aged 9, 12 and 16 years and one female, aged 5 years wih PLS associated toimmunosuppressive therapy. All had seizures and three had headache and clouding ofsensorium. One case was associated to an hypertensive emergency, one to liver failure and oneto high tacrolimus levels. Magnetic resonance imaging showed lesions in the white matter intwo patients and in the gray matter in the other two. The lapse between the start ofimmunosuppressive treatment and neurological symptoms ranged from 4 days to 6 months. Allreceived antiepileptic drugs and immunosuppresive therapy was changed or decreased, withcomplete clinical recovery (Rev Med Chile 2008, 136: 93-8).(

Síndrome moyamoya en paciente con síndrome de Down y déficit de antitrombina III

Moyamoya disease is a unique chronic progressive cerebrovascular disease characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis with prominent arterial collateral circulation. It can be primary or secondary to genetic syndromes such as Down syndrome. We report a seven year-old girl with a Down syndrome that presented with a disturbance of consciousness, seizures and a right hemiparesia at the age of five. Magnetic resonance imaging showed old cortical ischemic lesions in both cerebral hemispheres and a recent infarction in the territory of the left middle cerebral artery. Brain angiography showed a proximal stenosis of both medial cerebral arteries and a net of collateral vessels, consistent with the diagnosis of moyamoya syndrome. The patient had also an antithrombin III deficiency. Aspirin was indicated and a surgical correction was recommended. However, prior to the procedure, the patient had a new infarction in the territory of the right middle cerebral artery, which caused a severe disability (Rev Med Chile 2009; 137: 1066-70). (Key words: Antithrombin III deficiency; Cerebrovascular Moyamoya disease; Down syndrome)

VERTEBROPLASTIA PERCUTANEA: NUEVA ALTERNATIVA EN EL TRATAMIENTO DEL DOLOR DE ORIGEN VERTEBRAL

Resumen: Con el aumento de la expectativa de vida y el avance en la terapia oncologica enfrentamos una poblacion que presenta una mayor frecuencia de dolor vertebral originado en fracturas osteoporoticas o lesiones vertebrales neoplasicas. En este escenario y en conjunto con el desarrollo de las terapias minimamente invasivas aparece la vertebroplastia percutanea, que ha demostrado ser una excelente alternativa en el tratamiento del dolor de origen vertebral. Presentamos nuestra experiencia con esta nueva tecnica, que incluye 32 procedimientos en 21 pacientes, con resultados satisfactorios, observandose un 15.6% de complicaciones menores sin significado clinico.

Trombosis venosa cortical aislada: Comunicación de dos pacientes

Isolated cortical vein thrombosis is an uncommon presentation of central venous thrombosis. We report two females, aged 29 and 40 years, with isolated cortical vein thrombosis. Both presented with a focal neurological deficit and focal seizures that became generalized. The diagnosis was made with magnetic resonance imaging. Both had a history of oral contraceptive use. Both had a rapid response to unfractionated heparin. One patient had an antiphospholipid syndrome as a possible etiology. The most common manifestations of this disease are a transient or recurrent neurological deficit, visual disturbances and focal or generalized seizures, usually without intracanial hypertension. Neuroimages show ischemic abnormalities that do not follow an arterial vascular territory, often with an early hemorrhagic component. There is a good clinical response to heparin

Hematoma talámico bilateral simultáneo: Reporte de dos casos y revisión de la literatura

Resumen es: Las hemorragias encefalicas que comprometan diferentes territorios en forma simultanea son infrecuentes y de mal pronostico. Sus factores de riesgo son m...

Infarto maligno de la arteria cerebral media en una paciente con meningitis bacteriana

The mortality of acute bacterial meningitis (BM) has remained stable in the last decades in spite of the use of new antibiotics, probably due to vascular complications. We report a 68-year-old woman with BM who had a malignant infarction of left middle cerebral artery territory 72 hours after admission to the hospital. The patient experienced a bad evolution and died four days after admission. The arterial involvement in patients with BM is explained by vasospasm of large arteries and vasculitis of small arteries. The medical treatment of a malignant middle cerebral artery infarct has a high mortality (Rev Med Chile 2004; 132: 1217-20).The mortality of acute bacterial meningitis (BM) has remained stable in the last decades in spite of the use of new antibiotics, probably due to vascular complications. We report a 68-year-old woman with BM who had a malignant infarction of left middle cerebral artery territory 72 hours after admission to the hospital. The patient experienced a bad evolution and died four days after admission. The arterial involvement in patients with BM is explained by vasospasm of large arteries and vasculitis of small arteries. The medical treatment of a malignant middle cerebral artery infarct has a high mortality.

Ultrasonografía en la disrafia espinal y la medula anclada: diagnosis of tethered cord

Spinal dysraphism is relatively common in children and includes a wide spectrum of congenital anomalies in the normal closure of the posterior elements of the spine. The prognosis will depend mostly on early diagnosis and treatment. Occult spinal dysraphism may present without external anomalies and the diagnosis could be suspected lately, when neurological symptoms are present and often irreversible. Occult spinal dysraphism is frequently associated to a tethered cord, most commonly secondary to the presence of a lipoma. Ultrasonography has been proven highly sensitive in the detection of intraspinal anomalies, especially in the diagnosis of tethered cord, in children under two years of age due to lack of ossification of the posterior elements of the spine. Today ultrasonography should be the examination of choice in all those patients in whom some kind of spinal dysraphism is suspected. We report our experience with three infants with occult spinal dysraphism in whom diagnosis was initially made by US and later on proved by either computed tomography, magnetic resonance or myelography. All of them had corrective surgery and neurological abnormalities were not detected afterwards.

Síndrome del creciente temporal: Reporte de un caso y revisión de la literatura

The temporal crescent syndrome or half-moon syndrome is a raremono ocular retrochiasmatic visual field defect that can be correlated to a lesion along the con-tralateral parieto-occipital sulcus. This field defect may be missed in automated perimetry. Wereport a 45 years old man, consulting for sudden loss of the peripheral temporal field in his righteye. The magnetic resonance imaging and the spectroscopy studies confirmed an ischemic le-sion on the left anterior occipital cortex. Control imaging studies six months later did not showchanges in the lesion (Rev Med Chile 2004; 132: 1523-6).(Key Words: Temporal crescent syndrome; Visual acuity; Visual fields)The temporal crescent syndrome or half-moon syndrome is a rare mono ocular retrochiasmatic visual field defect that can be correlated to a lesion along the contralateral parieto-occipital sulcus. This field defect may be missed in automated perimetry. We report a 45 year old man, consulting for sudden loss of the peripheral temporal field in his right eye. The magnetic resonance imaging and the spectroscopy studies confirmed an ischemic lesion on the left anterior occipital cortex. Control imaging studies six months later did not show changes in the lesion.