Revista de neurologia
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Coeliac disease is a gastrointestinal disorder caused by intolerance to cereals due to an immunological mechanism. The intestinal mucosa is damaged, causing a severe malabsorption syndrome. The diagnosis is based on classical clinical features such as diarrhoea and weight loss. However, there is a broad spectrum of this disorder which includes disorders of other organs and systems. In this paper we review the main studies of involvement of the nervous system in coeliac disease. ⋯ Many of these processes have only relatively recently been recognized. The pathogenic mechanism of these disorders is not completely clear although biochemical factors such as a low plasma serotonin level may be a cause. Treatment is based on the early recognition of the disorder which is difficult to suspect when there are no gastrointestinal symptoms present and the use of various types of treatment, including a cereal free diet, which is the most effective.
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Continuous display four channels EEG monitoring and near infrared spectroscopy (NIRS) are relatively new and valuable techniques used for continuous brain monitoring in the neonatal period. Supporting the value of continuous display four channels EEG monitoring in the evaluation of neonates with paroxysmal motor events is a study recently conducted at Miami Children s Hospital. ⋯ 1. NIRS is the best method to monitor regional cerebral oxygen saturation; 2. Regional cerebral oxygen saturation values are primarily those of the venous circulation in the subcortical white matter below the sensor; 3. Values of regional oxygen saturation should be considered not independently but only relative as a change over time; 4. Decreased regional cerebral oxygen saturation may be a sign of impending or established hypoxemia or hypotension, increased cerebral metabolic demands, or a cerebral oxygenation or perfusion problem that involve only brain, and 5. NIRS should be used in conjunction with arterial oxygen saturation and pressure monitoring (to detect hypoxemia and hypotension), with EEG to detect increased cerebral metabolic demands (electroencephalographic seizures) and with anterior cerebral artery Doppler ultrasound to detect perfusion (decreased flow velocity) and oxygenation (constant flow velocity) problems that involve only the brain.
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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.
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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.
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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.