Neurología : publicación oficial de la Sociedad Española de Neurología
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Surgical activity is one of the major causes of iatrogeny. All surgery carries an inherent risk of complications, whether in emergency surgery or in simpler elective procedures. Because of the progressive increase in life expectancy, surgical techniques are increasingly used in the elderly, with a consequent rise in the possibility of catastrophic complications. ⋯ The present article reviews the most frequent neurological complications of anesthetic techniques and the types of surgery most commonly associated with central or peripheral nervous system complications. Neurologists are well versed in the complications associated with neurosurgery and carotid artery surgery. Other types of surgery, such as cardiac surgery, liver transplantation, bariatric surgery or aortic aneurism surgery, are also potential sources of complications.
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Neurologists should anticipate and recognize the onset of respiratory failure in patients with neuromuscular diseases. Symptoms vary according to the speed of onset of respiratory muscle weakness. Catastrophic situations usually occur in three clinical scenarios: 1) incorrect management of acute respiratory failure of neuromuscular origin, autonomic dysfunction or during general anaesthesia of patients with neuromuscular diseases ; 2) incorrect prognosis and treatment due to the lack of a correct diagnosis. This situation is more common in ventilated patients with associated muscular weakness, acute neuropathies or motor neuron disease, and 3) inappropriate medical intervention in patients with neuromuscular disease with a definitive diagnosis but longstanding disease (amyotrophic lateral sclerosis, spinal muscular atrophy, myotonic dystrophy and other muscular dystrophies).
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Acute intracranial hypertension is a syndrome with multiple etiologies. Diagnosis and treatment must be performed urgently to save the patient's life and prevent the development of significant disabilities. The appearance of this syndrome is due to intracraincreased volumes and -in turn- the pressure of the intracranial contents, either through an increase in the physiological components (blood, cerebrospinal fluid and brain parenchyma), or through the appearance of a volume in the form of added mass. ⋯ Treatment depends on the etiology and will generally require medical and surgical care. Patient management is usually carried out in neurocritical units and involves intracranial pressure monitoring to guide treatment. Correction of all hemostasis disorders is also crucial to patient survival.
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Convulsive status epilepticus constitutes a medical emergency that requires a fast and aggressive management with the objective to prevent neuronal damage and systemic complications. The objective is to determine clinico-epidemiologic characteristics and risk factors associated with convulsive status epilepticus in adults attended in a National Hospital from Lima-Peru in a period of four years. ⋯ Aetiologies more frequent in the hospital studied from Lima-Peru are remote symptomatic secondary crisis to cranio encephalic trauma, neurocysticercosis and idiopathic. The irregular antiepilepticus treatment constitutes a risk factor to convulsive status epilepticus.