Revista de neurologia
-
Revista de neurologia · Nov 2001
Case Reports[Isolated posterior cord syndrome in Lyme s disease: a clinico neurophysiological study].
Lyme disease, caused by spirochete Borrelia burgdorferi, is a multisystemic infectious disorder with prominent neurologic involvement, affecting both the peripheral and the central nervous system. Meningitis, cranial neuritis and radiculoneuritis are the usual manifestations in the acute phase, and peripheral neuropathy in the chronic phase. Other less common manifestations have been also described. Here we report one case of Lyme disease confirmed by PCR, with a previously undescribed neurological manifestation, and the neurophysiological studies performed before and after treatment. ⋯ Our findings reveal that posterior column disfunction can be a neurological manifestation of Lyme disease. Furthermore the neurophysiological study shows that this manifestation is partially reversible following treatment. Our study emphasize the importance of the neurophysiological tests for the diagnosis and follow up of neurological manifestations of Lyme disease.
-
Revista de neurologia · Nov 2001
[Clinical diagnostic of brain death and transcranial Doppler, looking for middle cerebral arteries and intracranial vertebral arteries. Agreement with scintigraphic techniques].
The Real Ordinance 2070/1999 meant an important modification in the legislation, when including transcranial Doppler (TCD) in explorations to confirm the clinical diagnosis of brain death (BD). Habitually for their employment in the diagnosis of BD, we look for blood flow signal from the middle cerebral arteries (MCA) and the basilar artery (BA). ⋯ In our results the TCD obtains a reliability of 100% when confirming the absence of blood flow in the supratentorial compartment; nevertheless the false positive result obtained at the infratentorial level, warns us to be cautious in accepting the flow from the VA as a test of absence of flow at the infratentorial compartment, especially in those patients with hemodynamic instability.
-
Revista de neurologia · Nov 2001
Review[Ischemia of the vertebrobasilar territory: mechanisms and practical considerations].
We first review historic, anatomic, and epidemiological aspects involving the vertebrobasilar territory ischemia. We describe the development of ideas regarding the stroke mechanisms and treatment in the posterior circulation. Key authors and their contributions are also mentioned. ⋯ The prognosis in patients with vertebrobasilar ischemia depends on: a) the mechanism of the stroke, b) site of the vessel occlusion, c) thrombus propagation, d) collateral circulation, e) hemodynamic (hypertension, cardiac output, etc.), and hemorreologic factors (viscosity, hypercoagulable state, etc.), f) neurologic status, g) time to treatment. The accurate the diagnosis of the mechanism, the better the prognosis.
-
Revista de neurologia · Nov 2001
[Prognostic value of electrocorticography in temporal lobe epilepsy: patterns of relationing mesial and neocortical activity].
Electrocorticography (ECoG) monitoring in temporal lobe epilepsy (TLE) has been employed since the 40 s as a means to delineate surgical removal especially in lesional epilepsy, to reduce resection size and decrease cognitive sequelae (memory, naming). However in recent years, ECoG has been claimed to lack indications and prognostic value in cases of non lesional TLE. On the grounds of the pathophysiological relationship between mesial structures and neocortex (through propagation pathways) we have suggested a classification of ECoG activity patterns regarding the activities simultaneously recorded in mesial and neocortical grids. ⋯ ECoG reflects the state of pathological involvement of neocortex and mesial structures. An expertise approach, although brief in time (20-30 min), may either lead to preservation of relevant tissue (patterns I, II) and to establish a prognosis on the grounds of the initial epileptogenic activity.