Revista de neurologia
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Cerebral vasospasm is involved in the development of delayed ischemic lesions in patients with subarachnoid hemorrhage. We developed an integral theoretical model to explain the pathophysiology of cerebral vasospasm, in which endothelin-1 has a pivotal role in the development of both cerebral vasospasm and delayed ischemic neurological deficits (DIND). ⋯ Plasma endothelin-1 levels are increased in patients after subarachnoid hemorrhage and are associated with the development of cerebral vasospasm and DIND.
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Malaria is one of the main health problems in the Third World. Plasmodium falciparum infects as many as 300 million people, causing up to three million deaths each year, most of which occur in African children. Cerebral malaria is the most common lethal complication of P. falciparum infection in children and is defined by three criteria: disturbances of consciousness, presence of P. falciparum parasitaemia and absence of other causes of acute encephalopathy. Cerebral malaria is a medical emergency and parenteral quinine is the most recommended treatment because of the frequency of chloroquine-resistant strains. Mortality is as high as 50 per cent and residual disability is present in about 20 per cent of survivors. ⋯ We must know better about cerebral malaria because of an increasing incidence of imported malaria due to emigration from African countries and Spaniard tourism to areas of endemic paludism.
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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.