Neurología : publicación oficial de la Sociedad Española de Neurología
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High-altitude cerebral edema is a potentially fatal neurologic syndrome that develops in subjects exposed to high-altitude. It may appear associated to other forms of altitude illnesses as acute mountain sickness or high-altitude pulmonary edema. The exact pathophysiology of high-altitude cerebral edema is still unknown and there is not consensus about the primarily type of edema: vasogenic or cytotoxic. We present a patient who suffered high-altitude cerebral edema and the clinical, neuroimaging and ultrasonographic findings at first and during the follow up. ⋯ TCD-A in our patient show a diminished cerebral vasoreactivity related to high-altitude cerebral edema. These findings suggest that impairment of cerebral autoregulation might play a role in high-altitude cerebral edema pathogenesis. Reversible clinical and neuroimaging changes indicate a predominant vasogenic edema.
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Drug-induced aseptic meningitis (DIAM) is an uncommon adverse reaction secondary to the administration of numerous agents. It is diagnosed by exclusion, and its outcome is generally excellent with complete long term recovery. There are few reports of DIAM associated to intrathecal administration of bupivacaine in the literature. ⋯ To the best of our knowledge, we report a case of bupivacaine induced aseptic meningitis.
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The clinical criteria for brain death consist of the demonstration of the absence of any clinical sign of encephalic activity. Confirmatory testing is usually not required for the diagnosis of brain death, except in some special situations that the Spanish law details. In these situations demonstrating cerebral circulatory arrest (CCA) by cerebral flow studies is necessary to support the diagnosis of brain death. ⋯ TCD is a useful method detecting CCA and therefore can be used to confirm brain death in a clinically brain-dead patient. The presence of reverberating flow, systolic spikes or absence of flow in the basilar and both middle cerebral arteries observed in two examinations is highly specific for the prediction of CCA and brain death in all patients.