Verónica Bruno

Sequence of electrode implantation and outcome of deep brain stimulation for Parkinson's disease

Introduction The effect of the variability of electrode placement on outcomes after bilateral deep brain stimulation of subthalamic nucleus has not been sufficiently studied, especially with respect to the sequence of hemisphere implantation. Methodology We retrospectively analysed the clinical and radiographic data of all the consecutive patients with Parkinsons disease who underwent surgery at our centre and completed at least 1 year follow-up. The dispersion in electrode location was calculated by the square of deviation from population mean, and the direction of deviation was analysed by comparing the intended and final implantation coordinates. Linear regression analysis was performed to analyse the predictors of postoperative improvement of the motor condition, also controlling for the sequence of implanted hemisphere. Results 76 patients (mean age 58±7.2 years) were studied. Compared with the first side, the second side electrode tip had significantly higher dispersion as an overall effect (5.6±21.6 vs 2.2±4.9 mm2, p=0.04), or along the X-axis (4.1±15.6 vs 1.4±2.4 mm2, p=0.03) and Z-axis (4.9±11.5 vs 2.9±3.6 mm2, p=0.02); the second side stimulation was also associated with a lower threshold for side effects (contact 0, p<0.001 and contact 3, p=0.004). In the linear regression analysis, the significant predictors of outcome were baseline activities of daily living (p=0.010) and dispersion of electrode on the second side (p=0.005). Conclusions We observed a higher dispersion for the electrode on the second implanted side, which also resulted to be a significant predictor of motor outcome at 1 year.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) in Argentina.

CADASIL is the most common cause of hereditary stroke and vascular dementia. Published information about this disease in South America is scant. We describe clinical and demographic characteristics of 13 patients (10 families) with CADASIL from Argentina.Methods Medical records, diagnostic tests and family history of patients with CADASIL were reviewed.Results Thirteen patients with CADASIL (10 families) were included. All patients had European ancestry. Initial presentation was stroke in most patients (n = 11). Stroke patients later developed cognitive complaints (n = 9), migraine with aura (n = 1), apathy (n = 4) and depression (n = 6). External capsule and temporal lobe involvement on MRI were characteristic imaging findings. Two patients died after intracerebral hemorrhage.Conclusion This is the first report of non-related patients with CADASIL in South America addressing ancestry. Since European ancestry is not highly prevalent in all South American countries, there may be variable incidence of CADASIL within this region.

Cerebral varicella-zoster vasculopathy sine herpete Atypical Ramsay-Hunt syndrome in an immunocompetent patient

Vasculitides constitute a heterogeneous group of diseases characterized by inflammation and necrosis of the blood vessel wall. Varicella-zoster virus (VZV) can be reactivated, causing neurologic complications including CNS vasculitis. The incidence of VZV vasculopathy in adults is unknown. It is more common in immunocompromised individuals.1 The clinical presentation of this condition includes ischemic and hemorrhagic strokes, TIAs, aneurysms, carotid dissections, arterial ectasias, and subarachnoid hemorrhages. A history of recent zoster, varicella rash, and CSF pleocytosis is the classic presentation. However, 30% of cases present with no previous rash or without typical CSF pleocytosis.1,2

Medication Overuse Headache: In-Patient Drug Withdrawal. Experience of a Derivation Centre in Argentina (P03.236)

Objective: The aim of this study was to assess the usefulness of in-patient drug withdrawal treatment for medication overuse headache (MOH) analyzing medication overuse recurrence and its predisposing factors. Background MOH is a disabling entity of difficult management likely to occur in patients who develop cronic headache. Treatment options include out-patient and in-patient drug withdrawal. Design/Methods: We present a series of 41 consecutive patients admitted to our hospital for MOH (Medication overuse headache). Retrospective review of medical records of patients hospitalized for MOH drug withdrawal between 2005 and 2011, and telephonic follow up. Results: We studied 31 women and 10 men, aged 42.4 ± 9 years. 56.1% had a past medical history positive for headache for at least 10 years; migraine without aura was the most frequent type (73.2%). As a co-morbidity 58.5% had a psychiatric condition. Most frequent drugs of abuse were ergotamine, triptans and combinations (including NSAIDs and opioids). During hospitalization (mean 4.7 days) all patients received intravenous chlorpromazine and 92.7% initiated preventive treatment at discharge. No major adverse reactions were detected during hospitalization. All patients presented headache after discharge (51.2% daily chronic and 48.8% episodic headache). The average follow-up was 27 months. Medication overuse recurrence occurred in 53.7% of patients and it had a positive correlation with chronic headache recurrence (p: 0.00), prior use of ergotamine (p: 0.08) or combination analgesics (p: 0.042). Differences in gender, duration of headache or psychiatric history could not be linked to abuse recurrence rate. Less than 50% of cases attended follow-up consults on a regular basis. Patients with better follow-up programs showed less incidence of overuse recurrence. Conclusions: In-patient treatment for drug withdrawal in patients with MOH represents a safe and valid option but it must be accompanied by a regular follow-up in order to prevent medication overuse recurrence. Disclosure: Dr. Bruno has nothing to disclose. Dr. Negrotto has nothing to disclose. Dr. Arena has nothing to disclose. Dr. Gonzalez Otarula has nothing to disclose. Dr. Goicochea has nothing to disclose. Dr. Bonamico has nothing to disclose. Dr. Leston has nothing to disclose.

Ocular Myositis in a Patient with Crohn Disease and Autoimmune Thyroid Disease

Orbital myositis is defined as inflammation of the extraocular muscles often also involving the intraorbital soft tissues. There are a number of possible causes: differential diagnoses include thyroid ophthalmopathy, orbital myositis secondary to systemic autoimmune disease (including Crohn disease), or idiopathic orbital pseudotumor. Other causes such as orbital cellulitis, cavernous sinus thrombosis, arteriovenous fistulas, lymphoid tumours, lymphangiomatosis, sarcoidosis, and metastatic carcinomas should also be ruled out. The authors present the case of a patient with acute asymmetric painful orbitopathy with a history of both Crohn disease and autoimmune thyroid disease.