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e6 FMC. 2016;23(1):e6
Lo que hay detrás de una convulsión
Antonio V. Bazo Fariñas, Lorena E. Cano Lucas y Guadalupe Alcántara López-Sela
Centro de Salud Valdepasillas. Badajoz. España.
*Correo electrónico: abazofar@gmail.com
Mujer de 48 años con antecedentes de colecistectomía, y
en tratamiento antidepresivo por duelo patológico,
consulta por episodio de disartria y desviación de la comisu-
ra oral hacia la izquierda acompañado posteriormente de
síncope con pérdida de conocimiento, sin relajación de es-
fínteres y con recuperación espontánea a los pocos minutos.
Ya en consulta sufre una crisis convulsiva generalizada que
se controla bien con 10 mg de diazepam IV y Guedel. Una
vez estabilizada objetivamos hemiparesia del miembro supe-
rior derecho residual, por lo que decidimos continuar el es-
tudio con tomografía computarizada craneal.
En la tomografía computarizada de cráneo (figs. 1 y 2) se
observa una lesión extraaxial parasagital frontal izquierda
con bordes bien definidos de 44 = 42 = 29 mm con realce in-
tenso y homogéneo del contraste, compatible con un menin-
gioma1,2. También presenta edema preilesional con colapso
parcial del asta frontal del ventrículo lateral ipsilateral y des-
plazamiento de 5 mm de la línea media.
Bibliografía
1. Whittle IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet.
2004;363:1535.
2. Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin
GP, et al. Incidental findings on brain MRI in the general population. N
Engl J Med. 2007;357:1821-8.
Figura 2. Proyección axial de la lesión donde se aprecia edema pe-
rilesional (plano axial).
Figura 1. Masa con realce intenso y homogéneo del contraste (pla-
no coronal).
Document downloaded from http://www.elsevier.es, day 27/01/2018. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.Document downloaded from http://www.elsevier.es, day 27/01/2018. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.
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Article
Full-text available
Magnetic resonance imaging (MRI) of the brain is increasingly used both in research and in clinical medicine, and scanner hardware and MRI sequences are continually being improved. These advances are likely to result in the detection of unexpected, asymptomatic brain abnormalities, such as brain tumors, aneurysms, and subclinical vascular pathologic changes. We conducted a study to determine the prevalence of such incidental brain findings in the general population. The subjects were 2000 persons (mean age, 63.3 years; range, 45.7 to 96.7) from the population-based Rotterdam Study in whom high-resolution, structural brain MRI (1.5 T) was performed according to a standardized protocol. Two trained reviewers recorded all brain abnormalities, including asymptomatic brain infarcts. The volume of white-matter lesions was quantified in milliliters with the use of automated postprocessing techniques. Two experienced neuroradiologists reviewed all incidental findings. All diagnoses were based on MRI findings, and additional histologic confirmation was not obtained. Asymptomatic brain infarcts were present in 145 persons (7.2%). Among findings other than infarcts, cerebral aneurysms (1.8%) and benign primary tumors (1.6%), mainly meningiomas, were the most frequent. The prevalence of asymptomatic brain infarcts and meningiomas increased with age, as did the volume of white-matter lesions, whereas aneurysms showed no age-related increase in prevalence. Incidental brain findings on MRI, including subclinical vascular pathologic changes, are common in the general population. The most frequent are brain infarcts, followed by cerebral aneurysms and benign primary tumors. Information on the natural course of these lesions is needed to inform clinical management.
Article
Meningiomas are by far the most common tumours arising from the meninges. Progressive enlargement of the tumour leads to focal or generalised seizure disorders or neurological deficits caused by compression of adjacent neural tissue. Surgery remains the primary treatment of choice, although the use of fractionated radiotherapy or stereotactic single-dose radiosurgery is increasing for meningiomas that are incompletely excised, surgically inaccessible, or recurrent and either atypical or anaplastic. Although most meningiomas have good long-term prognosis after treatment, there are still controversies over management in a proportion of cases. We review various features of meningioma biology, diagnosis, and treatment and provide an overview of the current rationale and evidence base for the various therapeutic approaches.
  • Ir Whittle
  • C Smith
  • P Navoo
Whittle IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet. 2004;363:1535.
  • I R Whittle
  • C Smith
  • P Navoo
  • Collie D Meningiomas
Whittle IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet. 2004;363:1535.