[Show abstract][Hide abstract] ABSTRACT: We report a 40year-old male presenting in the emergeney room with headache, vértigo and left hemiparesis. A magnetic resonante imaging reporten a left cerebellar infarction with occlusion of the basilar artery ana dissection ofthe right vertebral artery. Thepatient experienced a clinical deterioration with the appearance ofa right hemiparesis. Therefore a brain angiography wasperformed alongwith a mechanical thrombolysis using a Solitaire FR® revascularization device. A thrombus located in the distal third ofthe artery was eliminated obtaining a complete perfusión ofthe artery. Thepatient had a satisfactory evolution.
Revista medica de Chile 03/2013; 141(3):388-91. · 0.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The use of hypothermia after cardiac arrest caused by ventricular fibrillation is a standard clinical practice, however its use for neuroprotection has been extended to other conditions. We report a 23-year-old male with intracranial hypertension secondary to a parenchymal hematoma associated to acute hydrocephalus. An arterial malformation was found and embolized. Due to persistent intracranial hypertension, moderate hypothermia with a target temperature of 33°C was started. After 12 hours of hypothermia, intracranial pressure was controlled. After 13 days of hypothermia a definitive control of intracranial pressure was achieved. The patient was discharged 40 days after admission, remains with a mild hemiparesia and is reassuming his university studies.
Revista medica de Chile 02/2012; 140(2):219-24. · 0.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Behçet's disease (BD) is a systemic inflammatory vascular disease with several clinical manifestations and geographical differences in disease expression. In Middle Eastern countries it is one of the most common causes of cerebral venous thrombosis. We report a 29-year-old female admitted for acute headache and vomiting. A magnetic resonance image showed a large thrombosis of sagital and transverse sinuses. She developed oral and genital ulcers a week later. Ophthalmologic examination revealed left anterior uveitis and ipsilateral papilledema. Multiple studies ruled out a hypercoagulability syndrome. The patient used oral contraceptives. Anticoagulant therapy was prescribed. A biopsy of a genital ulcer demonstrated diffuse lymphocytic infiltration with vasculitis. After treatment with topical and systemic corticoids, her condition improved. Venous sinus thrombosis followed by oral and genital ulcers is an unusual presentation of Behçet's disease.
Revista medica de Chile 06/2010; 138(6):746-51. · 0.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Continuous EEG provides the unique possibility to monitor neuronal function non-invasively. In our pilot study, we evaluated EEG spectral power during spontaneous drops in cerebral perfusion pressure (CPP) in deeply sedated and mechanically ventilated patients with severe stroke. We aimed to identify parameters that may be used for continuous monitoring even in patients with a burst-suppression baseline EEG pattern.
Twenty ventilated and sedated patients with severe hemorrhagic or ischemic stroke underwent continuous EEG monitoring with synchronous CPP recording.
EEG monitoring duration was 83.9 hours on average per patient. Spectral power of EEG during drops of CPP was compared with epochs during normal CPP under the same levels of sedation. We found a significant decrease in faster EEG activity (3.5-20.7 Hz) during phases of low CPP (unaffected hemisphere P < 0.01, affected hemisphere P < 0.01, both P < 0.01).
Despite considerable changes in baseline activity due to deep sedation and severe brain injury, we found evidence for disturbed neuronal function during drops in CPP. Thus, continuous EEG monitoring may add clinically relevant information on neuronal function in the setting of multimodality brain monitoring. Further studies are needed to implement real-time data analysis in the ICU setting.
Neurocritical Care 08/2009; 11(2):210-6. · 2.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Limbic encephalitis (LE) can be associated to cancer, viral infection or be idiopathic. One form is associated to voltage dependent potassium channel (VKC) antibodies. The clinical presentation includes impairment of consciousness, amnesia and temporal lobe seizures; typical abnormalities are also found in brain magnetic resonance. We report a 68 year-old male who had LE associated to VKC antibodies. The patient was treated with steroids with a partial response. At the moment of the report he is asymptomatic and continues with prednisone treatment .
Revista medica de Chile 06/2009; 137(5):675-9. · 0.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute liver failure has a mortality rate in excess of 80%. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33 degrees C. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33 degrees C. The patient was discharged in good conditions after 69 days of hospitalization.
Revista medica de Chile 06/2009; 137(6):801-6. · 0.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cerebrotendinous xanthomatosis is an inherited autosomal recessive disease caused by a mutation in the gene for the sterol 27-hydroxylase enzyme, which determines the accumulation of plasmatic cholestanol in various tissues. The natural history of this disease is characterized by chronic diarrhea beginning in childhood, cataract in youth, tendinous xanthomas in adulthood and later progressive neurological dysfunction manifested as dementia, psychiatric disorders, cerebellar, pyramidal or extra pyramidal signs or seizures. We report a 39 year-old male with a history of diarrhea during childhood and bilateral cataracts requiring surgery at 20 years of age, who evolves later with psychiatric disorders and bilateral increased volume in Achules tendons. High levels of plasmatic cholestanol and magnetic resonance imaging confirmed the diagnosis of this disease.
Revista medica de Chile 06/2009; 137(6):815-20. · 0.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obstructive Sleep Apnea (OSA) is a prevalent disease that has emerged as a new cerebrovascular disease (CVD) risk factor, which is independent of its association to hypertension, age and other known conditions that increase CVD. The mechanisms involved in this relation are most likely induced by the periodic hypoxia/reoxygenation that characteristically occurs in OSA, which results in oxidative stress, endothelial dysfunction and activation of the inflammatory cascade, all of which favor atherogenesis. Numerous markers of these changes have been reported in OSA patients, including increased circulating free radicals, increased lipid peroxidation, decreased antioxidant capacity, elevation of tumor necrosis factor and interleukines, increased levels of proinflammatory nuclear transcription factor kappa B, decreased circulating nitric oxide, elevation of vascular adhesion molecules and vascular endothelial growth factor. In addition, several authors have described that Continuous Positive Airway Pressure, the standard OSA therapy, reverts these abnormalities. Further research is needed in order to better clarify the complex mechanisms that underlie the relation between OSA, atherogenesis and CVD which most likely will have significant clinical impact.
Current Molecular Medicine 04/2009; 9(2):203-9. · 3.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Limbic encephalitis associated to voltage dependent potassium channel antibodies. Report of one case Limbic encephalitis (LE) can be associated to cancer, viral infection or be idiopathic. One form is associated to voltage dependent potassium channel (VKC) antibodies. The clinical presentation includes impairment of consciousness, amnesia and temporal lobe seizures; typical abnormalities are also found in brain magnetic resonance. We report a 68 year-old male who had LE associated to VKC antibodies. The patient was treated with steroids with a partial response. At the moment of the report he is asymptomatic and continues with prednisone treatment (Rev Méd Chile 2009; 137: 675-9). (Key words: Autoantibodies; Limbic encephalitis; Potassium channels, voltage-gated) Recibido el 22 de agosto, 2008. Aceptado el 15 de diciembre, 2008. Departamento de Neurología, Escuela de Medicina, Pontificia Universidad Católica de Chile. L a encefalitis límbica (EL) fue descrita en 1960 por Brierley et al, los que comunicaron tres pacientes con encefalitis subaguda que afectaba principalmente la región límbica 1 . El año 1968 Corsellis et al acuñaron el nombre de EL y la caracterizaron como una enfermedad autoinmu-ne 2 . Actualmente se le reconoce como un síndro-me paraneoplásico, en el que el tumor provoca una respuesta inmunológica cruzada contra las estructuras límbicas. En la última década se han descrito dos nuevas etiologías de EL, la secundaria a infección herpética, que puede afectar tanto a inmunocompetentes (virus herpes simple 1) como inmunocomprometidos (virus herpes simple 2, 6 y 7) 3,4 , y la idiopática o autoinmune, variedad potencialmente reversible y probablemente me-diada por anticuerpos, entre los que destacan los anticanales de potasio dependientes de voltaje (anticuerpos anti-ckvd) 5 . La EL por virus herpes no debe ser confundida con la encefalitis herpéti-ca, la que tiene caracteres clínicos, radiológicos e histopatológicos distintos.
Revista medica de Chile 01/2009; 137(5). · 0.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Orthotopic liver transplantation (OLT) is the treatment of choice for multiple acute and chronic end-stage liver diseases as well as for selected cases of liver malignancy and liver-site metabolic disorders. Neurological impairment is a major source of morbidity and mortality following OLT.
To describe the incidence and the type of neurological complications occurring in the post-operative period of OLT in patients transplanted in our hospital.
Between March 1994 and August 2007, 76 adult patients underwent OLT. Data on incidence, time of onset, and outcome of central nervous system (CNS) complications have been obtained from our program data base and patient charts.
Twenty three patients (30.3%) had CNS complications following OLT. The leading complications were immunosuppressive drug-related neurological impairment in nine patients (39.1%), peripheral nerve damage in five patients (21.7%), central pontine myelinolysis in four patients (17.4%), cerebrovascular disease in three (13%) and CNS infection in three (13%). Most CNS events (90%) occurred in the first 2 weeks after OLT. Five patients with neurological complications died (22%).
CNS complications occurred in almost one fifth of the population studied, and they had a poor outcome, as previously reported).
Revista medica de Chile 11/2008; 136(10):1255-63. · 0.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this article is to report our experience with endovascular treatment of internal carotid artery (ICA) dissection with the use of stents.
Carotid dissection is an important cause of ischemic stroke in young and middle-aged patients. There are some patients in whom invasive management is recommended.
Twelve patients (eight females, four males), mean age of 50 years (range 35-80 years) with ICA dissection, were treated with the endovascular approach during a 24-month period. Patients included in this study underwent magnetic resonance (MR) and digital subtraction angiography (DSA) for diagnosis. Over this time period, 162 patients with ICA dissections were seen at our institution. Indications for endovascular treatment were: recurrent ischemic events despite adequate anticoagulant treatment in seven cases, contraindication to anticoagulation in four cases, and one case with significant mismatch between diffusion and perfusion weighted MR. Eleven dissections were spontaneous and one was traumatic. The follow-up was performed clinically with Doppler ultrasound (US) and MR at 6, 12, and 24 months.
Stent deployment was successful in all cases. Acute symptoms were resolved in 66.7% of patients. No patients deteriorated their neurological status. There were no new clinical events, stent stenosis or occlusion on 24 months follow-up.
Our results showed an excellent clinical outcome of the treated patients. This suggests promising results with the use of endovascular treatment in selected patients.
Catheterization and Cardiovascular Interventions 05/2008; 71(5):694-700. · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The TT genotype of a functional factor XII (FXII) C46T gene polymorphism was shown to be a risk factor for peripheral venous thrombosis. We tested whether this genetic variant also increases the risk for cerebral venous thrombosis (CVT).
We performed a case-control study including 78 consecutive patients with proven CVT and 201 healthy population controls from South Germany. The FXII C46T genotype was assessed using a PCR technique.
The TT genotype of the FXII C46T polymorphism was more common in patients (16.7%) than in controls (5.5%). A strong association of the TT genotype with CVT was found, which was independent of covariables (adjusted odds ratio 4.57; 95% CI 1.55 to 13.41; p = 0.006).
The TT genotype of the functional factor XII C46T gene polymorphism may be a new independent risk factor for cerebral venous thrombosis (CVT). Our finding warrants confirmation in an independent study before this genetic variant should be added to the panel of established risk factors for CVT.
[Show abstract][Hide abstract] ABSTRACT: We report a case of severe neuroleptic malignant syndrome with hyperthermia, rhabdomyolysis and hepatic failure where we applied endovascular cooling in order to reverse hyperthermia. After rapid normalization of core temperature at 37.5 degrees C, the patient's condition improved and CK levels dropped. However, upon withdrawl of endovascular temperature control there was a relapse. This is the first case where endovascular cooling was applied successfully in neuroleptic malignant syndrome.
Journal of the Neurological Sciences 02/2008; 264(1-2):163-5. · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a patient who was treated with intravenous thrombolysis, and subsequently developed a Locked-In Syndrome (LIS). After 2 days, magnetic resonance imaging showed a large bilateral pontomedullary infarction. However, in contrast to the patient's clinical situation, the follow-up T2-weighted MR images up to day 26 did not display the infarction. This phenomenon is known as the so-called fogging effect.
Neurocritical Care 02/2008; 8(1):57-9. · 2.60 Impact Factor