Revista de neurologia
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Revista de neurologia · Dec 1999
Review[Neurologic intensive care in patients with raised intracranial pressure].
Intracranial hypertension is associated with a high mortality in patients with various encephalo-cranial disorders, so that it is important to recognize and treat the condition without delay. ⋯ The main factors interacting to maintain normal intracranial pressure are the cerebral blood flow, arteriolar radius, cerebral perfusion pressure and plasma viscosity. Current treatment of raised intracranial pressure is aimed to restore these factors to normal, so as to maintain equilibrium between encephalic mass, cerebro-spinal fluid and blood volume. As well as traditional measures such as hyperventilation, administration of mannitol and barbiturates, today there are also new treatments available to the intensive care neurologist: hypertonic saline solutions, hypothermia, craniectomies and neuroprotective agents.
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Revista de neurologia · Dec 1999
Case Reports[Giant cell arteritis, bilateral anterior ischemic optic neuropathy and anticardiolipin antibodies].
We report a case of giant cell arteritis (GCA) that developed acute bilateral amaurosis secondary to anterior ischemic optic neuropathy (AION), without other symptoms and with a normal erythrocyte sedimentation rate (ESR). Physical examination revealed painless and pulseless temporal arteries, ophthalmoscopic findings were blurring of margins, hyperaemia and elevation of both optic discs. Visual acuity was limited to hand motion perception and light-darkness discrimination. Six months before of this syndrome, the patient was diagnosed of polymyalgia rheumatica and was maintained asymptomatic with 6 mg/day of deflazacort. Temporal artery biopsy was diagnostic. An elevated IgG type anticardiolipin antibodies (ACA) rate was detected in serum. The remaining laboratory studies were normal. ⋯ In old people with uni or bilateral acute visual loss, even with normal erythrocyte sedimentation rate and without other symptoms associated, it is necessary to have a high index of suspicion in order to detect giant cell arteritis. This can facilitate an early diagnosis and immediate initiation of treatment with high doses of corticosteroids. An elevated level of IgG type anticardiolipin antibodies may be a risk factor to thrombotic complications, as anterior ischemic optic neuropathy, in patients with giant cell arteritis.
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Revista de neurologia · Dec 1999
Clinical Trial[The effect of gabapentin in bucco-facial allodynia. Experimental correlation of the trigeminal nerve].
Trigeminal neuralgia is an unilateral alteration of the trigeminal nerve, characterized by recurrent paroxysms of pain in one or more of the nerve's branches. Trigger areas are described in points of the facial skin (allodynia). ⋯ Allodynia can be the result of a neuronal sensitization due to the increment on intracellular calcium facilitating the exocytosis. Changes in the mechano-receptors of low threshold establish communication with nociceptive neurons by a presynaptic mechanism, considering new synaptic and morphologic contacts associated with learning and memory. The major effectiveness in the combined treatment is the base of an association of the gabaergic mechanism of gabapentin and the blockade of sodium and potassium ionic channels by the carbamazepine.
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Revista de neurologia · Dec 1999
Letter Case Reports[Trigeminal neuralgia associated with Arnold Chiari malformation].