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Neurologia (Barcelona, Spain) 01/2004; 18(10):754; author reply 754-5. · 0.79 Impact Factor
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ABSTRACT: An aggressive case of lymphocytic hypophysitis is described which was successfully treated with azathioprine after failure of corticosteroids. The patient, aged 53, had frontal headache, diplopia, and diabetes insipidus. Cranial magnetic resonance imaging (MRI) showed an intrasellar and suprasellar contrast enhancing mass with involvement of the left cavernous sinus and an enlarged pituitary stalk. A putative diagnosis of lymphocytic hypophysitis was made and prednisone was prescribed. Symptoms improved but recurred after the dose was reduced. Trans-sphenoidal surgery was attempted but the suprasellar portion of the mass could not be pulled through the pituitary fossa. Histological examination confirmed the diagnosis of lymphocytic hypophysitis. Two months later he developed aseptic meningoencephalitis which was treated with high dose methylprednisolone pulse therapy. MRI revealed a progression of suprasellar mass. At this stage azathioprine treatment was begun. Four weeks later MRI shown no evidence of residual lesion and no pituitary stalk enlargement. After follow up of 18 months without azathioprine there was no clinical or radiological evidence of the disease. This is the first evidence of the efficacy of azathioprine treatment in a patient with lymphocytic hypophysitis.
Journal of Neurology Neurosurgery & Psychiatry 12/2003; 74(11):1581-3. · 4.76 Impact Factor
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ABSTRACT: Stroke is a frequent cause of epileptic seizures (ES) in adults. The authors evaluated the long-term efficacy and tolerability of gabapentin (900 to 1,800 mg/day) in 71 patients with a first poststroke late ES during a mean follow-up time of 30 months. ES recurred in 18.3% of the patients and side effects were noted in 27 cases (38%), but only two (2.8%) required discontinuation or early withdrawal. Gabapentin monotherapy was useful and safe for late poststroke ES.
Neurology 01/2003; 59(12):1991-3. · 8.31 Impact Factor
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ABSTRACT: An aggressive case of lymphocytic hypophysitis is described
which was successfully treated with azathioprine after failure
of corticosteroids. The patient, aged 53, had frontal headache,
diplopia, and diabetes insipidus. Cranial magnetic
resonance imaging (MRI) showed an intrasellar and suprasellar
contrast enhancing mass with involvement of the left
cavernous sinus and an enlarged pituitary stalk. A putative
diagnosis of lymphocytic hypophysitis was made and
prednisone was prescribed. Symptoms improved but
recurred after the dose was reduced. Trans-sphenoidal
surgery was attempted but the suprasellar portion of the
mass could not be pulled through the pituitary fossa.
Histological examination confirmed the diagnosis of lymphocytic
hypophysitis. Two months later he developed aseptic
meningoencephalitis which was treated with high dose
methylprednisolone pulse therapy. MRI revealed a progression
of suprasellar mass. At this stage azathioprine treatment
was begun. Four weeks later MRI shown no evidence of
residual lesion and no pituitary stalk enlargement. After
follow up of 18 months without azathioprine there was no
clinical or radiological evidence of the disease. This is the first
evidence of the efficacy of azathioprine treatment in a patient
with lymphocytic hypophysitis.
Journal of neurology, neurosurgery, and psychiatry 01/2003; J Neurol Neurosurg Psychiatry(74). · 4.87 Impact Factor
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ABSTRACT: Nonbacterial thrombotic endocarditis (NBTE) has been described as an important complication in patients affected by different kind of illnesses, above all underlying malignancies. Fifty % of the patients affected by NBTE will have embolic events in different organs. The poverty of specific symptomatology appears to difficult seriously its diagnosis. In fact, systemic embolic infarctions are usually asymptomatic, except when central nervous system is involved. We present a patient affected by NBTE with an asymptomatic cervical spinal cord infarction, which diagnosis was made by pathologic study. The difficulty to explore typical sings of spinal lesion and the absence of previous reported cases of NBTE with posterior spinal artery infarction, make this one fairly interesting. We think that fibrinoplatelet embolism from NBTE should be included in the etiology of the posterior spinal artery infarction.
Neurologia (Barcelona, Spain) 03/2002; 17(2):117-20. · 0.79 Impact Factor
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Neurologia (Barcelona, Spain) 06/2001; 16(5):237-9. · 0.79 Impact Factor
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Neurologia (Barcelona, Spain) 05/2001; 16(4):171. · 0.79 Impact Factor
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ABSTRACT: To evaluate differences in the temporal profile of acute phase response (APR) between ischemic stroke (IS) and intracerebral hemorrhage (ICH).
We studied APR parameters (< 24 h and 3-5 day) in 88 consecutive patients (43 ICH and 45 IS). The increase/decrease of the parameters between both dates was analyzed.
Leukocyte increase (LI) and fibrinogen increase (FI) is significantly higher in ICH than in IS (p = 0.047 and p = 0.035).
APR temporal profile is different for ICH and IS.
Medicina Clínica 02/2001; 116(2):54-5. · 1.38 Impact Factor
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ABSTRACT: Cardiac myxomas may present clinically with many different features. Since highly effective treatments exist, it is important that they are diagnosed quickly in order to avoid further complications. Our aim was to determine the influence of neurological presentation in diagnosis and prognosis of cardiac myxomas.
We have reviewed the clinical charts of 28 patients diagnosed with cardiac myxomas seen at our centre in the last 20 years.
Mean age at diagnosis in patients with neurological events was 49.22 years and 60.84 years in those without neurological manifestations (p = 0.0325). Most frequent presentations were: cardiac manifestations (92.8%), general manifestations (71.4%) and embolic events (39.3%). Nine patients (32.1%) presented with cerebral embolism; 7 of whom presented with transient ischaemic attacks (TIA), which was the first manifestation in 6 of them; 3 of them later suffered complete cerebral infarction with sequelae. Echocardiography confirmed diagnosis in 26 out of 27 patients in which it was performed. None of the patients presented neurological symptoms after surgery.
The most frequent initial neurological manifestation in our series was TIA. Nevertheless, none of the patients were diagnosed after the first neurological symptom. Although the contribution of cardiac myxomas to the total amount of TIA is low, since surgery is highly effective and of low risk, and patients with neurological manifestations are younger, it is vital to consider the possibility of cardiac myxoma after a TIA of unknown origin.
European Neurology 02/2001; 45(3):165-70. · 1.81 Impact Factor
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ABSTRACT: The rate and risk factors for early ischemic recurrence in patients with internal carotid artery dissection (ICAD) are largely unknown. Serial transcranial Doppler (TCD) monitoring of microembolic signals (MES) was performed in 28 consecutive patients with acute ICAD. MES were identified in 13 patients, and early ischemic recurrence occurred in 7. Six of 13 patients with MES and 1 of 15 without MES experienced early ischemic recurrence (p = 0.029). MES detection on serial TCD monitoring may be associated with an increased risk of early ischemic recurrence in patients with acute ICAD.
Neurology 01/2001; 55(11):1738-40. · 8.31 Impact Factor
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Journal of Neurology 10/2000; 247(9):718-9. · 3.47 Impact Factor
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ABSTRACT: Papillary fibroelastoma (PFE) is a rare benign tumour that attaches to the endocardial surface, mostly on cardiac valves. Though usually asymptomatic, it can be the source of several complications. To date, 49 cases have been reported of embolic stroke with a PFE as the probable origin. Case reports: (i) a 39-year-old male presented with ischemic embolic stroke; the presence of a PFE was assessed by means of transoesophageal echocardiography and confirmed by pathological findings; (ii) a 32-year-old woman presented with sudden onset of left hemiparesis; a cardiogenic embolic stroke was suspected, and a diagnosis of PFE was made based on echocardiographic and pathological findings. In both cases, surgical excision of the tumours was performed with no recurrences at follow-up. Two mechanisms can explain the formation of emboli in PFE: dislodgement of the tumour leaves or fibrin-platelet aggregation on the endocardial surface of these leaves. Transthoracic echocardiography may lead to the suspicion of a PFE, but transoesophageal echocardiography is required for confirmation. Prompt surgical excision is indicated in most cases. Anticoagulation is only recommended in situations of high surgical risk and during the wait for surgery.
European Journal of Neurology 08/2000; 7(4):449-53. · 3.69 Impact Factor
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ABSTRACT: Hashimoto's encephalopathy is a severe and rather infrequent clinical condition initially described in patients suffering from chronic lymphocytic thyroiditis. Its origin is still controversial but it can be agreed to have an autoimmune etiology. In fact, its most characteristic finding is the high titre of antithyroid antibodies, especially antimicrosomal. We describe three cases of Hashimoto's encephalopathy and establish a relationship between the clinical status, the antithyroid antibody levels and its response to corticosteroid treatment. There was an excellent response to corticosteroid treatment in all three cases. Interestingly, one case was associated with Graves' disease. Given this, and after the review of the literature, we believe that the term 'encephalopathy associated to autoimmune thyroid disease' could be more appropriate to define this entity. Finally, we suggest that autoimmune thyroid encephalopathy must be suspected in the face of unaccounted acute or subacute encephalopathy with high levels of antithyroid antibodies.
Journal of the Neurological Sciences 06/2000; 176(1):65-9. · 2.35 Impact Factor
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Neurologia (Barcelona, Spain) 04/2000; 15(3):143-5. · 0.79 Impact Factor
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ABSTRACT: Although the most frequent cause of intracranial neoplasms are metastases, they very rarely calcify; classic histopathological series have shown the incidence to be approximately 1%. We have found 54 reported cases of intracranial calcified metastasis, the most frequent primary tumour reported being pulmonary adenocarcinoma (13 cases) and adenocarcinoma of gastrointestinal tract and adenocarcinoma of breast (8 cases each). Some reports have shown a longer survival in patients with this kind of image on cerebral scans. We present two patients with intracranial calcified metastasis due to dissemination in both cases of pulmonary adenocarcinomas. The survival under treatment in both patients was similar to that of patients with no calcified metastasis on brain scans. So, facing calcified intracranial lesions, metastatic origin should be considered in the differential diagnosis, pulmonary tumours being the first to be ruled out.
Neurologia (Barcelona, Spain) 04/2000; 15(3):136-9. · 0.79 Impact Factor
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ABSTRACT: A transient hemiparesis may be ocassionally present at an early stage of the thrombosis of the basilar artery (herald hemiparesis). We report on one of these cases and the valuable role of transcranial Doppler ultrasound (TCD) to the early detection of the stroke-in-evolution. TCD in the emergency room is a good tool to assess a basilar occlusion, searching for direct (absence of signal at the basilar artery) and indirect (reversal flow of the pre-communicating segment the of posterior cerebral artery through the posterior communicating artery) signs. Early recognition and treatment of this condition could avoid the development of the full syndrome of the basilar artery thrombosis.
European Journal of Neurology 02/2000; 7(1):91-3. · 3.69 Impact Factor
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Medicina Clínica 02/2000; 114(1):38. · 1.38 Impact Factor
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ABSTRACT: Functional assessment of small arteries and arterioles could provide valuable information regarding the extent of diffuse arteriolosclerosis in patients with small-vessel disease. Therefore we attempted to clarify the role of cerebrovascular reactivity (CVR) as a risk marker for first-ever symptomatic lacunar infarction.
Forty-six patients with lacunar infarction and 46 sex- and age-matched control subjects were prospectively evaluated. Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. CVR was examined by calculating the percent increase in mean flow velocity occurring after 15 mg/kg acetazolamide administration (Diamox test).
CVR was significantly (P<0.0001, Student's t test) lower in cases (50.0+/-12. 7%) as compared with control subjects (65.2+/-12.4%). A multiple logistic regression analysis identified male sex (odds ratio [OR] 2. 3, P=0.02), age (OR 3.6, P<0.005), and the presence of lacunar infarction on magnetic resonance imaging (OR 5.3, P<0.001) as significant and independent factors associated with a reduction of CVR. Moreover, a cut-point of 55.6% (sensitivity 67%, specificity 82%) was established as the threshold value for distinguishing between pathological and normal CVR. CVR was significantly (P=0.02) lower in patients with multiple (46.38+/-12.6%) than with single (54. 83+/-11.58%) lacunar infarction. In addition, a trend of negative correlation was found between CVR and the number of lacunar infarctions (r=-0.26, P=0.08). In the multiple logistic model, history of hypertension (OR 7.24; 95% confidence interval 2.95 to 17. 79) and CVR (OR 0.8; 95% confidence interval 0.81 to 0.93) emerge as significant and independent predictors of first-ever lacunar infarction.
These data suggest that impaired CVR is a risk marker for first-ever lacunar infarction.
Stroke 11/1999; 30(11):2296-301. · 5.73 Impact Factor
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ABSTRACT: To evaluate plasma homocysteine (Hcy) levels in patients with atherotrombotic transient ischemic attacks (TIA), its temporal profile and response to folic acid (FA) treatment.
Hcy was determined in 62 patients and in 69 controls.
There were no differences (p < 0.87) of baseline Hcy in TIA patients vs controls. Hcy levels were higher 4-6 weeks after TIA (p = 0.02). FA treatment decreases the Hcy levels (p < 0.00001).
Hyperhomocisteinemia is a possible risk factor for atherothrombotic TIA and should be measured between 4-6 weeks after TIA. Treatment with FA normalizes Hcy levels.
Medicina Clínica 10/1999; 113(14):531-2. · 1.38 Impact Factor
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Neurologia (Barcelona, Spain) 04/1999; 14(3):136-7. · 0.79 Impact Factor
