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Garcia-Garcia J, Díaz-Maroto I, Martínez-Martín A, Pardal-Fernández JM, Segura T. A series of patients with refractory myasthenia gravis. Neurologia 2023; 38:256-261. [PMID: 37031801 DOI: 10.1016/j.nrleng.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/26/2020] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION Advances in the treatment of myasthenia gravis (MG) have improved quality of life and prognosis for the majority of patients. However, 10%-20% of patients present refractory MG, with frequent relapses and significant functional limitations. PATIENTS AND METHODS Patients with refractory MG were selected from a cohort of patients diagnosed with MG between January 2008 and June 2019. Refractory MG was defined as lack of response to treatment with prednisone and at least 2 immunosuppressants, inability to withdraw treatment without relapse in the last 12 months, or intolerance to treatment with severe adverse reactions. RESULTS We identified 84 patients with MG, 11 of whom (13%) met criteria for refractory MG. Mean (standard deviation) age was 47 (18) years; 64% of patients with refractory MG had early-onset generalised myasthenia (as compared to 22% in the group of patients with MG; P < .01), with a higher proportion of women in this group (P < .01). Disease severity at diagnosis and at the time of data analysis was higher among patients with refractory MG, who presented more relapses during follow-up. Logistic regression analysis revealed an independent association between refractory MG and the number of severe relapses. CONCLUSIONS The percentage of patients with refractory MG in our series (13%) is similar to those reported in previous studies; these patients were often women and presented early onset, severe forms of onset, and repeated relapses requiring hospital admission during follow-up.
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Affiliation(s)
- J Garcia-Garcia
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
| | - I Díaz-Maroto
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - A Martínez-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - J M Pardal-Fernández
- Servicio de Neurofisiología Clínica, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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2
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Martínez-Martín Á, García-García J, Díaz-Maroto Cicuéndez I, Quintanilla-Mata M, Segura T. Aportando luz en la oscuridad: ataxia cerebelosa autosómica recesiva por mutación en el gen SEPSECS. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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3
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Gil-Núñez A, Masjuan J, Montaner J, Castellanos M, Segura T, Cardona P, Tembl JI, Purroy F, Arenillas J, Palacio E. Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. Neurologia 2022; 37:136-150. [PMID: 33358061 DOI: 10.1016/j.nrl.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels <20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.
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Affiliation(s)
- A Gil-Núñez
- Sección Neurología Vascular-Centro de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, España; Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Montaner
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, La Coruña, España
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J I Tembl
- Servicio de Neurología, Hospital La Fe, Valencia, España
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova, Lérida, España
| | - J Arenillas
- Servicio de Neurología, Hospital de Valladolid, Valladolid, España
| | - E Palacio
- Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, España
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4
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Palacio-Portilla EJ, Roquer J, Amaro S, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, Fuentes B, García-Pastor A, Gomis M, Gómez-Choco M, López-Cancio E, Martínez-Sánchez P, Morales A, Rodríguez-Yáñez M, Segura T, Serena J, Vivancos-Mora J, de Leciñana MA. Dyslipidemias and stroke prevention: recommendations of the Study Group of Cerebrovascular Diseases of the Spanish Society of Neurology. Neurologia 2022; 37:61-72. [PMID: 33160722 DOI: 10.1016/j.nrl.2020.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/19/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE We present an update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. DEVELOPMENT We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. CONCLUSIONS In primary prevention, the patient's vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value <55mg/dL is recommended; in non-atherothombotic ischaemic strokes, given the unclear relationship with dyslipidaemia, target value should be established according to the vascular risk group of each patient. In both primary and secondary prevention, statins are the drugs of first choice, and ezetimibe and/or PCSK9 inhibitors may be added in patients not achieving the target value.
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Affiliation(s)
- E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, España.
| | - J Roquer
- Servicio de Neurología, IMIM-Hospital del Mar, Barcelona, España.
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari; Departamento de Medicina, Universidad de Barcelona. Instituto de Investigación Biomédica Augut Pi i Sunyer (IDIBAPS), Barcelona, España
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, España
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario de Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, España
| | - B Fuentes
- Servicio de Neurología, Centro de ictus, Hospital Universitario La Paz. IdiPAZ. Universidad Autónoma de Madrid, Madrid, España
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón. Universidad Complutense de Madrid, Madrid, España
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, España
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España
| | - P Martínez-Sánchez
- Servicio de Neurología, Hospital Universitario Torrecárdenas, Almería, España
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - M A de Leciñana
- Servicio de Neurología, Centro de ictus, Hospital Universitario La Paz. IdiPAZ. Universidad Autónoma de Madrid, Madrid, España
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5
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Palacio-Portilla EJ, Roquer J, Amaro S, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, Fuentes B, García-Pastor A, Gomis M, Gómez-Choco M, López-Cancio E, Martínez-Sánchez P, Morales A, Rodríguez-Yáñez M, Segura T, Serena J, Vivancos-Mora J, de Leciñana MA. Dyslipidemias and stroke prevention: Recommendations of the Study Group of Cerebrovascular Diseases of the Spanish Society of Neurology. Neurologia 2022; 37:61-72. [PMID: 35074190 DOI: 10.1016/j.nrleng.2020.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/19/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We present an update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. DEVELOPMENT We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. CONCLUSIONS In primary prevention, the patient's vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value <55 mg/dL is recommended; in non-atherothombotic ischaemic strokes, given the unclear relationship with dyslipidaemia, target value should be established according to the vascular risk group of each patient. In both primary and secondary prevention, statins are the drugs of first choice, and ezetimibe and/or PCSK9 inhibitors may be added in patients not achieving the target value.
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Affiliation(s)
- E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
| | - J Roquer
- Servicio de Neurología, IMIM-Hospital del Mar, Barcelona, Spain.
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari, Departamento de Medicina, Universidad de Barcelona, Instituto de Investigación Biomédica Augut Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, Spain
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario de Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - B Fuentes
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - P Martínez-Sánchez
- Servicio de Neurología, Hospital Universitario Torrecárdenas, Almería, Spain
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, Spain
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - M A de Leciñana
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
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6
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Gil-Núñez A, Masjuan J, Montaner J, Castellanos M, Segura T, Cardona P, Tembl JI, Purroy F, Arenillas J, Palacio E. Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. Neurologia (Engl Ed) 2021; 37:136-150. [PMID: 34906541 DOI: 10.1016/j.nrleng.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels < 20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.
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Affiliation(s)
- A Gil-Núñez
- Sección Neurología Vascular-Centro de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Montaner
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, La Coruña, Spain
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, Spain
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J I Tembl
- Servicio de Neurología, Hospital La Fe, Valencia, Spain
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova, Lérida, Spain
| | - J Arenillas
- Servicio de Neurología, Hospital de Valladolid, Valladolid, Spain
| | - E Palacio
- Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, Spain
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Pardal-Fernández JM, Garcia-Garcia J, Segura T. Cranial polyneuritis related to varicella-zoster virus infection. A case report. Rev Neurol (Paris) 2021; 178:401-403. [PMID: 34688479 DOI: 10.1016/j.neurol.2021.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/23/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- J M Pardal-Fernández
- Department of Clinical Neurophysiology, General University Hospital, C/Hnos. Falcó s/n, 02006 Albacete, Spain.
| | - J Garcia-Garcia
- Department of Clinical Neurophysiology, General University Hospital, C/Hnos. Falcó s/n, 02006 Albacete, Spain
| | - T Segura
- Department of Clinical Neurophysiology, General University Hospital, C/Hnos. Falcó s/n, 02006 Albacete, Spain
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García Pastor A, López-Cancio Martínez E, Rodríguez-Yáñez M, Alonso de Leciñana M, Amaro S, Arenillas JF, Ayo-Martín O, Castellanos M, Fuentes B, Freijo MM, Gomis M, Gómez Choco M, Martínez Sánchez P, Morales A, Palacio-Portilla EJ, Segura T, Serena J, Vivancos-Mora J, Roquer J. Recommendations of the Spanish Society of Neurology for the prevention of stroke. Interventions on lifestyle and air pollution. Neurologia 2021; 36:377-387. [PMID: 34714236 DOI: 10.1016/j.nrleng.2020.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To update the recommendations of the Spanish Society of Neurology regarding lifestyle interventions for stroke prevention. DEVELOPMENT We reviewed the most recent studies related to lifestyle and stroke risk, including randomised clinical trials, population studies, and meta-analyses. The risk of stroke associated with such lifestyle habits as smoking, alcohol consumption, stress, diet, obesity, and sedentary lifestyles was analysed, and the potential benefits for stroke prevention of modifying these habits were reviewed. We also reviewed stroke risk associated with exposure to air pollution. Based on the results obtained, we drafted recommendations addressing each of the lifestyle habits analysed. CONCLUSIONS Lifestyle modification constitutes a cornerstone in the primary and secondary prevention of stroke. Abstinence or cessation of smoking, cessation of excessive alcohol consumption, avoidance of exposure to chronic stress, avoidance of overweight or obesity, a Mediterranean diet supplemented with olive oil and nuts, and regular exercise are essential measures in reducing the risk of stroke. We also recommend implementing policies to reduce air pollution.
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Affiliation(s)
- A García Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañon, Madrid, Spain; Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - E López-Cancio Martínez
- Servicio de Neurología, Hospital Universitario Gregorio Marañon, Madrid, Spain; Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, A Coruña, Spain
| | | | - S Amaro
- Servicio de Neurología, Hospital Clinic i Universitari, Barcelona, Spain
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, Spain
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario de Cruces, Baracaldo, Spain
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - M Gómez Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broogi, Barcelona, Spain
| | | | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Girona, Spain
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, Spain
| | - J Roquer
- Servicio de Neurología, IMIM-Hospital del Mar, Barcelona, Spain
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Fernández Díaz E, Sánchez-Larsen Á, Redondo-Peñas I, Segura T. Progressive cerebellar ataxia with falsely positive anti-Ma2 antibodies. Neurología (English Edition) 2021. [DOI: 10.1016/j.nrleng.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Fernández Díaz E, Sánchez-Larsen Á, Redondo-Peñas I, Segura T. Ataxia cerebelosa progresiva con anticuerpos anti-Ma2 falsamente positivos. Neurologia 2021; 36:334-336. [DOI: 10.1016/j.nrl.2020.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/12/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022] Open
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Fuentes B, Amaro S, Alonso de Leciñana M, Arenillas J, Ayo-Martín O, Castellanos M, Freijo M, García-Pastor, Gomis M, Gómez Choco M, López-Cancio E, Martínez Sánchez P, Morales A, Palacio-Portilla E, Rodríguez-Yáñez M, Roquer J, Segura T, Serena J, Vivancos-Mora J. Stroke prevention in patients with type 2 diabetes mellitus or prediabetes: recommendations of the Spanish Society of Neurology’s Stroke Study Group. Neurología (English Edition) 2021. [DOI: 10.1016/j.nrleng.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Rodríguez-Yañez M, Gómez-Choco M, López-Cancio E, Amaro S, Alonso de Leciñana M, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, García-Pastor A, Gomis M, Martínez Sánchez P, Morales A, Palacio-Portilla EJ, Roquer J, Segura T, Serena J, Vivancos-Mora J, Fuentes B. Stroke prevention in patients with arterial hypertension: Recommendations of the Spanish Society of Neurology's Stroke Study Group. Neurologia (Engl Ed) 2021; 36:462-471. [PMID: 34238528 DOI: 10.1016/j.nrleng.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension. DEVELOPMENT We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations. CONCLUSIONS In primary stroke prevention, antihypertensive treatment should be started in patients with BP levels > 140/90 mmHg, with a target BP of < 130/80 mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24 hours), with a target BP of < 130/80 mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable.
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Affiliation(s)
- M Rodríguez-Yañez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari; Departamento de Medicina, Universidad de Barcelona. Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Departamento de Medicina, Universidad Autónoma de Madrid, Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, Spain
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, Spain
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
| | | | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, Spain
| | - E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - J Roquer
- Servicio de Neurología, Hospital del Mar, Barcelona, Spain
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Departamento de Medicina, Universidad Autónoma de Madrid, Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, Spain
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Romero-Sánchez C, Ayo-Martín O, Tomás-Labat M, Segura T. Q fever meningoencephalitis as stroke mimic. Neurología (English Edition) 2021; 36:477-478. [DOI: 10.1016/j.nrleng.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/04/2020] [Indexed: 10/21/2022] Open
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Díaz-Maroto I, García-García J, Sánchez-Ayaso PA, Alcahut-Rodríguez C, González-Villar E, Pardal-Fernández JM, Segura T. Ocular myasthenia gravis and risk factors for developing a secondary generalisation: Description of a Spanish series. Neurologia 2020; 38:S0213-4853(20)30300-5. [PMID: 33208236 DOI: 10.1016/j.nrl.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Ocular myasthenia gravis (MG) is the most common phenotype of MG at onset. A variable percentage of these patients develop secondary generalisation; the risk factors for conversion and the protective effect of immunosuppressive treatment are currently controversial. PATIENTS AND METHODS We designed a retrospective single-centre study with the aim of describing the demographic, clinical, and laboratory characteristics of a Spanish cohort of patients with ocular MG from Hospital Universitario de Albacete from January 2008 to February 2020. RESULTS We selected 62 patients with ocular MG from a cohort of 91 patients with MG (68.1%). Median age at diagnosis was 68 (IQR, 52-75.3), and men accounted for 61.3% of the sample (n = 38). Most patients presented very late-onset ocular MG (n = 34, 54.8%). Binocular diplopia was the most frequent initial symptom (51.7%). The rate of progression to generalised MG was 50% (n = 31), with a median time of 6 months (IQR, 2-12.8). Female sex (OR: 5.46; 95% CI, 1.16-25-74; p = .03) and anti-acetylcholine receptor antibodies (OR: 8.86; 95% CI, 1.15-68.41; p = .04) were significantly associated with the risk of developing generalised MG. CONCLUSIONS The conversion rate observed in our series is relatively high. Generalisation of MG mainly occurs during the first 2 years of progression, and is strongly associated with female sex and especially with the presence of anti-acetylcholine receptor antibodies.
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Affiliation(s)
- I Díaz-Maroto
- Servicio de Neurología del Complejo Hospitalario Universitario de Albacete, Albacete, España.
| | - J García-García
- Servicio de Neurología del Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - P A Sánchez-Ayaso
- Servicio de Neurología del Hospital General Universitario Reina Sofía de Murcia, Murcia, España
| | - C Alcahut-Rodríguez
- Servicio de Neurología del Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - E González-Villar
- Servicio de Neurología del Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - J M Pardal-Fernández
- Neurofisiología Clínica del Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - T Segura
- Servicio de Neurología del Complejo Hospitalario Universitario de Albacete, Albacete, España
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Garcia-Garcia J, Díaz-Maroto I, Martínez-Martín A, Pardal-Fernández JM, Segura T. A series of patients with refractory myasthenia gravis. Neurologia 2020; 38:S0213-4853(20)30293-0. [PMID: 33172684 DOI: 10.1016/j.nrl.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/15/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Advances in the treatment of myasthenia gravis (MG) have improved quality of life and prognosis for the majority of patients. However, 10%-20% of patients present refractory MG, with frequent relapses and significant functional limitations. PATIENTS AND METHODS Patients with refractory MG were selected from a cohort of patients diagnosed with MG between January 2008 and June 2019. Refractory MG was defined as lack of response to treatment with prednisone and at least 2 immunosuppressants, inability to withdraw treatment without relapse in the last 12 months, or intolerance to treatment with severe adverse reactions. RESULTS We identified 84 patients with MG, 11 of whom (13%) met criteria for refractory MG. Mean (standard deviation) age was 47 (18) years; 64% of patients with refractory MG had early-onset generalised myasthenia (as compared to 22% in the group of patients with MG; P<.01), with a higher proportion of women in this group (P<.01). Disease severity at diagnosis and at the time of data analysis was higher among patients with refractory MG, who presented more relapses during follow-up. Logistic regression analysis revealed an independent association between refractory MG and the number of severe relapses. CONCLUSIONS The percentage of patients with refractory MG in our series (13%) is similar to those reported in previous studies; these patients were often women and presented early onset, severe forms of onset, and repeated relapses requiring hospital admission during follow-up.
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Affiliation(s)
- J Garcia-Garcia
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España.
| | - I Díaz-Maroto
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - A Martínez-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - J M Pardal-Fernández
- Servicio de Neurofisiología Clínica, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
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Del Valle Pérez J, Redondo Peñas I, Layos Romero A, Segura T. Paraneoplastic opsoclonus-myoclonus syndrome in a patient with oesophageal adenocarcinoma. Neurología (English Edition) 2020. [DOI: 10.1016/j.nrleng.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sanchez-Larsen A, Sopelana D, Layos-Romero A, Segura T. Acetato de eslicarbazepina en neuralgia del trigémino. Neurologia 2020; 35:669-670. [DOI: 10.1016/j.nrl.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/19/2019] [Indexed: 10/25/2022] Open
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Sanchez-Larsen A, Sopelana D, Layos-Romero A, Segura T. Eslicarbazepine acetate for trigeminal neuralgia. Neurología (English Edition) 2020. [DOI: 10.1016/j.nrleng.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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García Pastor A, López-Cancio Martínez E, Rodríguez-Yáñez M, Alonso de Leciñana M, Amaro S, Arenillas JF, Ayo-Martín O, Castellanos M, Fuentes B, Freijo MM, Gomis M, Gómez Choco M, Martínez Sánchez P, Morales A, Palacio-Portilla EJ, Segura T, Serena J, Vivancos-Mora J, Roquer J. Recommendations of the Spanish Society of Neurology for the prevention of stroke. Interventions on lifestyle and air pollution. Neurologia 2020. [PMID: 32917433 DOI: 10.1016/j.nrl.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To update the recommendations of the Spanish Society of Neurology regarding lifestyle interventions for stroke prevention. DEVELOPMENT We reviewed the most recent studies related to lifestyle and stroke risk, including randomised clinical trials, population studies, and meta-analyses. The risk of stroke associated with such lifestyle habits as smoking, alcohol consumption, stress, diet, obesity, and sedentary lifestyles was analysed, and the potential benefits for stroke prevention of modifying these habits were reviewed. We also reviewed stroke risk associated with exposure to air pollution. Based on the results obtained, we drafted recommendations addressing each of the lifestyle habits analysed. CONCLUSIONS Lifestyle modification constitutes a cornerstone in the primary and secondary prevention of stroke. Abstinence or cessation of smoking, cessation of excessive alcohol consumption, avoidance of exposure to chronic stress, avoidance of overweight or obesity, a Mediterranean diet supplemented with olive oil and nuts, and regular exercise are essential measures in reducing the risk of stroke. We also recommend implementing policies to reduce air pollution.
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Affiliation(s)
- A García Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañon, Madrid, España; Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España.
| | - E López-Cancio Martínez
- Servicio de Neurología, Hospital Universitario Gregorio Marañon, Madrid, España; Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España.
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, A Coruña, España
| | | | - S Amaro
- Servicio de Neurología, Hospital Clinic i Universitari, Barcelona, España
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, España
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario de Cruces, Baracaldo, España
| | - M Gomis
- Servicio de Neurología, Hospital Universitari Germans Trias i Pujol, Barcelona, España
| | - M Gómez Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broogi, Barcelona, España
| | | | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Girona, España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, España
| | - J Roquer
- Servicio de Neurología, IMIM-Hospital del Mar, Barcelona, España
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Rodríguez-Yañez M, Gómez-Choco M, López-Cancio E, Amaro S, Alonso de Leciñana M, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, García-Pastor A, Gomis M, Martínez Sánchez P, Morales A, Palacio-Portilla EJ, Roquer J, Segura T, Serena J, Vivancos-Mora J, Fuentes B. Stroke prevention in patients with arterial hypertension: Recommendations of the Spanish Society of Neurology's Stroke Study Group. Neurologia 2020. [PMID: 32893074 DOI: 10.1016/j.nrl.2020.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension. DEVELOPMENT We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations. CONCLUSIONS In primary stroke prevention, antihypertensive treatment should be started in patients with BP levels >140/90mmHg, with a target BP of <130/80mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24hours), with a target BP of <130/80mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable.
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Affiliation(s)
- M Rodríguez-Yañez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España.
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España.
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari; Departamento de Medicina, Universidad de Barcelona. Instituto de Investigación Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz; Departamento de Medicina, Universidad Autónoma de Madrid. Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, España
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña; Instituto de Investigación Biomédica A Coruña, A Coruña, España
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario Cruces. Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, España
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón; Universidad Complutense de Madrid, Madrid, España
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, España
| | | | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca; Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, España
| | - E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
| | - J Roquer
- Servicio de Neurología, Hospital del Mar, Barcelona, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - J Serena
- Servicio de Neurología; Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz; Departamento de Medicina, Universidad Autónoma de Madrid. Área de Neurociencias. Instituto de Investigación IdiPAZ, Madrid, España
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Palao M, Fernández-Díaz E, Gracia-Gil J, Romero-Sánchez CM, Díaz-Maroto I, Segura T. Multiple sclerosis following SARS-CoV-2 infection. Mult Scler Relat Disord 2020; 45:102377. [PMID: 32698095 PMCID: PMC7340057 DOI: 10.1016/j.msard.2020.102377] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 12/21/2022]
Abstract
The first case of multiple sclerosis (MS) shortly after COVID-19 is presented. Viral infections strongly relate to MS onset and its relapses. SARS-CoV-2 can play a role in the triggering of demyelinating diseases. Systemic immune response against SARS-CoV-2 could reach CNS leading to demyelination.
SARS-CoV-2 infection can produce neurological features. The most common are headache, anosmia and dysgeusia but patients may also develop other central nervous system (CNS) injuries. We present a patient affected by Covid-19 who initially consulted for decreased visual acuity. The MRI showed inflammation in the right optic nerve and demyelinating lesions in the CNS. We speculate that an immune mechanism induced by SARS-CoV-2, which can activate lymphocytes and an inflammatory response, plays a role in the clinical onset of the disease. This pathogen may be associated with either the triggering or the exacerbation of inflammatory/demyelinating disease.
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Affiliation(s)
- M Palao
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Castilla- La Mancha, Spain.
| | - E Fernández-Díaz
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Castilla- La Mancha, Spain
| | - J Gracia-Gil
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Castilla- La Mancha, Spain
| | - C M Romero-Sánchez
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Castilla- La Mancha, Spain
| | - I Díaz-Maroto
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Castilla- La Mancha, Spain
| | - T Segura
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Castilla- La Mancha, Spain
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Valente L, Begg L, Anderson A, Segura T, Rudisill A, Kurtzberg J, Filiano A. Developing a novel thymus organoid as a cell therapy to correct autoimmunities. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Matías-Guiu J, Matias-Guiu JA, Alvarez-Sabin J, Ramon Ara J, Arenillas J, Casado-Naranjo I, Castellanos M, Jimenez-Hernandez MD, Lainez-Andres JM, Moral E, Morales A, Rodriguez-Antigüedad A, Segura T, Serrano-Castro P, Diez-Tejedor E. Will neurological care change over the next 5 years due to the COVID-19 pandemic? Key informant consensus survey. Neurologia 2020; 35:252-257. [PMID: 32364126 PMCID: PMC7165283 DOI: 10.1016/j.nrl.2020.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable. MATERIAL AND METHODS A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic. RESULTS Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination. CONCLUSION The key informant survey identified the foreseeable changes in neurological care after the pandemic.
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Affiliation(s)
- J Matías-Guiu
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España.
| | - J A Matias-Guiu
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - J Alvarez-Sabin
- Servicio de Neurología, Hospital Universitario de Vall d'Hebron, Barcelona, España
| | - J Ramon Ara
- Servicio de Neurología, Hospital Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - J Arenillas
- Servicio de Neurología, Hospital Clínico de Valladolid, Valladolid, España
| | - I Casado-Naranjo
- Servicio de Neurología, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, España
| | | | - J M Lainez-Andres
- Servicio de Neurología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - E Moral
- Hospital Moisès Broggi y Hospital General de l'Hospitalet, Barcelona, España
| | - A Morales
- Servicio de Neurología, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | | | - T Segura
- Servicio de Neurología, Hospital General Universitario de Albacete, Albacete, España
| | - P Serrano-Castro
- Servicio de Neurología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - E Diez-Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, España
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Martínez-Martín A, Hernández-Fernández F, Molina-Nuevo JD, López-Martínez A, Segura T. [Recurrent stroke, acrocyanosis and livedo racemosa: is it always Sneddon's syndrome?]. Rev Neurol 2020; 70:231-232. [PMID: 32149383 DOI: 10.33588/rn.7006.2019505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - J D Molina-Nuevo
- Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | - T Segura
- Complejo Hospitalario Universitario de Albacete, Albacete, España
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Surkova E, Segura T, Dimopoulos K, Flick C, West C, Senior R, Gatzoulis M, Li W. P1292 Prevalence and mechanisms of mitral regurgitation and its association with advanced heart failure in patients with a systemic right ventricle. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although tricuspid regurgitation in patients with cardiac diseases is an established predictor of adverse outcomes, prevalence, mechanisms and clinical/prognostic value of non-systemic mitral regurgitation (MR) in patients with congenitally corrected transposition of great arteries (ccTGA) or simple transposition after Mustard or Senning procedures (TGA) are still poorly understood.
Purpose
To assess prevalence, mechanisms of MR and its association with severity of heart failure in patients with a systemic right ventricle (SRV).
Methods
From our digital echocardiographic database, we have identified all patients with a SRV who underwent echocardiography between 2014 and 2018. Severity of MR, size and function of SRV and subpulmonary LV were assessed from the latest echocardiographic studies.
Results
157 patients fulfilled inclusion criteria (89 post-Mustard/Senning, 68 ccTGA), median age 40.6 (33.1; 46.8) years, 57% male, median BNP 79.5 [38.3; 173.3] ng/l.
More than trivial MR was present in 44 (28.0%), further classified as mild, moderate and severe in 26 (16.6%), 15 (9.6%) and 3 (1.9%), respectively.
Principal mechanisms of MR included (i) device lead interference with the leaflet(s) in 26, (ii) organic pathology of mitral valve in 5 (2 prolapse, 2 cleft and 1 parachute mitral valve) and (iii) systolic leaflet(s) tethering ± annular dilatation in 4; no obvious cause of MR was identified in 10 patients.
Presence of more than trivial MR was significantly associated with NYHA class 3-4 (Chi-square 25.74, p < 0.0001). Patients with MR also had higher BNP levels, larger LV with poorer systolic function and were more likely to have pulmonary stenosis (Table).
MR was less common in patients post-Mustard/Senning procedures compared to ccTGA (p < 0.0001, Table); however, patients from the former group were more likely to have severe heart failure (Figure).
Conclusions
Non-systemic MR in patients with a SRV is relatively uncommon, but when present is associated with LV dilatation and systolic dysfunction, raised BNP levels, and heart failure symptoms. Predominant underlying mechanisms were device leads, organic pathology, and valve tethering. MR should be routinely assessed in SRV patients, particularly those with previous Mustard/Senning procedures, and be taken into account in decision making and timing interventions.
Characteristics of 157 patients with SRV Parameter No/trivial MR (N = 113) Mild-severe MR (N = 44) P value Age, years Mustard/Senning ccTGA Pulmonary stenosis NYHA class 3-4 ICD/Pacemaker lead 39.5 (33.1; 45.7) 75 (66%) 38 (34%) 13 (12%) 7 (6%) 31 (27%) 44.4 (32.7; 52) 14 (32%) 30 (68%) 12 (27%) 17 (39%) 32 (73%) 0.105 <0.0001 <0.0001 0.022 <0.0001 <0.0001 LV EDDi, cm/m2 LV FAC, % MAPSE, mm SRV EDAi, cm2/m² TAPSE, mm 2.11 (1.9; 2.45) 48 (42; 52.5) 18 (14; 22) 17.6 (15.0; 20.2) 12 (9; 15) 2.5 (2.0; 2.9) 40 (34; 48.8) 14.6 (11.5; 16.5) 17.5 (14.4; 22.2) 10.5 (9; 13) 0.0007 0.0011 0.0005 0.754 0.435 BNP 68 (35.3; 104.3) 177 (62.5; 345.3) <0.0001 Values are reported as median (25th; 75th percentile) or n(%)
Abstract P1292 Figure. SRV patients with more than trivial MR
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Affiliation(s)
- E Surkova
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - T Segura
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - K Dimopoulos
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Flick
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C West
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - R Senior
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Surkova E, Segura T, Dimopoulos K, Flick C, West C, Senior R, Gatzoulis M, Li W. P679 Subpulmonary left ventricular dysfunction is associated with severity of heart failure in patients with systemic right ventricle. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Dysfunction of systemic right ventricle (SRV) in patients with congenitally corrected transposition of great arteries (ccTGA) or simple transposition (TGA) is commonly associated with exercise intolerance, heart failure and death. However, the relevance of subpulmonary left ventricular (LV) function in these settings is unknown.
Purpose
To examine the relation between severity of heart failure and echocardiographic parameters of subpulmonary LV size and function in patients with SRV.
Methods
We identified all patients with SRV from our digital echocardiographic database between 2014 and 2018. The size and function of SRV and subpulmonary LV were assessed in the most recent examination. Clinical data were collected from electronic patient records.
Results
We included 157 patients with SRV, median age 40.6 [33.1; 46.8] years, 57% male. 133 (85%) patients had NYHA functional class 1-2 and 24 (15%) NYHA class 3-4.
Patients with NYHA class 3-4 were older, had larger SRV and subpulmonary LV with poorer function and higher BNP level (Table, Figure A).
LV fractional area change (FAC) had higher sensitivity and specificity in differentiation of patients with severe heart failure than SRV FAC (Figurel B) with LV FAC cut-off value <39.2% showing the highest accuracy in prediction of NYHA class 3-4 (Se 83% and Sp 88%) and 86% Sp in predicting BNP > 100 ng/l.
LV end-diastolic diameter and area, MAPSE and FAC significantly correlated with BNP level (p < 0.0001; p = 0.001; p = 0.007; and p = 0.0002, respectively).
In Multivariate Cox regression analysis LV FAC and RV FAC were the only independent associates of NYHA class 3-4 (HR 0.69 [95%CI 0.55-0.86], p = 0.001 and HR 0.71 [95%CI 0.55-0.93], p = 0.012, respectively), while age, degree of tricuspid regurgitation and BNP were not.
Conclusions
Subpulmonary LV dysfunction is strongly associated with NYHA class 3-4 heart failure in patients with SRV. LV FAC is more accurate than SRV FAC in predicting heart failure symptoms. Subpulmonary LV should be accurately assessed in all SRV patients and be taken into account in clinical decision making and timing for interventions.
Characteristics of 157 patients with SRV Parameter NYHA Class 1-2 (N = 133) NYHA Class 3-4 (N = 24) P value Age, years 39.1 (31.9; 45.7) 46.5 (43.9; 58.1) <0.0001 RV EDAi, cm2/m2 17.4 (15.2; 20.1) 21.8 (17.5; 25.6) 0.0002 RV FAC, % 29.5 (23; 35) 22 (20; 27) <0.0001 LV EDAi, cm2/m2 12.0 (10.1; 14.1) 16.4 (11.6; 19.1) 0.0008 Reduced LV function by eyeballing 3 (2%) 18 (75%) <0.0001 BNP, ng/l 66 (35; 109) 356 (196; 512) <0.0001 Data presented as median (25th; 75th percentiles)
Abstract P679 Figure.
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Affiliation(s)
- E Surkova
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - T Segura
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - K Dimopoulos
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Flick
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C West
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - R Senior
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Constantine AH, Segura T, Nicol E, Kempny AH, Rafiq I, Barradas Pires A, Barracano R, Gatzoulis MA, Rubens M, Semple T, Dimopoulos K. P3654Location of the coronary origins in transposition patients following anatomical repair: Implications for invasive coronary angiography and intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Surgical repair of transposition of the great arteries (TGA) is most commonly via the arterial switch operation (ASO). This involves translocation of the aorta and pulmonary trunk, typically with anastomosis of the branch pulmonary arteries anteriorly (LeCompte manoeuvre) and re-implantation of the coronary arteries onto the posterior neo-aorta. As such, the position of the coronary ostia may differ from their expected locations.
Purpose
To use ECG-gated CT angiography to describe the anatomic position of coronary ostia in post-switch TGA patients guiding potential catheter interventions in this population.
Methods
All post ASO patients who underwent CT imaging between 2008–2018 were identified. Patients with complex anatomy such as double outlet right ventricle were excluded. The positions of the coronary ostia were measured in degrees from vertical on a double-oblique reconstruction in the aortic valve plane. Ostium positions were compared to those of patients with no congenital heart disease via Watson's two-sample test of homogeneity for circular data. Angular dispersion was compared between groups via the Wallraff test. P<0.05 indicated statistical significance.
Results
Of 206 adult patients with TGA and ASO followed in our adult congenital heart disease centre, 38 (18.4%) had CT imaging available for analysis during the study period (mean age 24±6.8, 75% male).
The control group consisted of 15 patients investigated for chest pain (mean age 54±15.1, 73% male). In the control group, the right and left coronary ostia arose at a mean angle of −19 and +125 degrees from vertical (figure 1a). This was significantly different to the mean ASO coronary ostia clustered at mean angles of −70 and +29 degrees from vertical (Watson p<0.001) (figure 1b, with stenosis at the left coronary anastomosis).
There was no significant difference in spread of left ostia (Rho 0.9 vs 0.99, p=0.12), but right ostia were significantly more variable in ASO patients than controls (0.71 vs 0.96, p=0.003).
Figure 1
Conclusions
Coronary ostial positions in the neo-aorta of post-ASO patients differ significantly from those of normal controls, with considerable variability, especially in right coronary position. CT can demonstrate coronary ostia in 3D space and derive appropriate tube angles to guide catheterisation in post-operative congenital cardiac patients, optimise catheter selection, reduce catheterisation tome, radiation and contrast dose.
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Affiliation(s)
- A H Constantine
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - T Segura
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - E Nicol
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - A H Kempny
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - I Rafiq
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - A Barradas Pires
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - R Barracano
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - M A Gatzoulis
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - M Rubens
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - T Semple
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
| | - K Dimopoulos
- Royal Brompton Hospital, Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, London, United Kingdom
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de la Cruz Cosme C, Dawid Milner M, Ojeda Burgos G, Gallardo Tur A, Márquez Martínez M, Segura T. Validation of a basic neurosonology laboratory for detecting cervical carotid artery stenosis. Neurología (English Edition) 2019. [DOI: 10.1016/j.nrleng.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sánchez-Larsen Á, García-García J, Ayo-Martín O, Hernández-Fernández F, Díaz-Maroto I, Fernández-Díaz E, Monteagudo M, Segura T. Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases. Neurología (English Edition) 2018. [DOI: 10.1016/j.nrleng.2016.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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30
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Sanchez-Larsen A, Sopelana D, Diaz-Maroto I, Perona-Moratalla AB, Gracia-Gil J, García-Muñozguren S, Palazón-García E, Segura T. Assessment of efficacy and safety of eslicarbazepine acetate for the treatment of trigeminal neuralgia. Eur J Pain 2018; 22:1080-1087. [PMID: 29369456 DOI: 10.1002/ejp.1192] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Antiepileptic drugs are the first-line treatment for trigeminal neuralgia (TN). Carbamazepine and oxcarbazepine are the most studied with well-known efficacy. Eslicarbazepine acetate is a third-generation antiepileptic drug that has not previously been evaluated for the treatment of TN. We aim to assess the efficacy, tolerability and safety of eslicarbazepine for TN. DESIGN AND METHODS Retrospective, open-label, multicentric, intention-to-treat study. We included patients older than 18 years who met the ICHD-3 beta diagnostic criteria for TN. We evaluated the variation of intensity and frequency of pain paroxysms before and after treatment with eslicarbazepine. Secondary objectives assessed were tolerability and safety of eslicarbazepine. RESULTS Eighteen patients were included, 15 women, mean age 65.2 years old, mean follow-up 21.1 months. The mean number of drugs tested before eslicarbazepine was 2; 10 patients used eslicarbazepine as monotherapy. After the treatment with ESL, the median of pain intensity improved from 9.5 to 2.5 (p < 0.001) and the median of pain paroxysms frequency improved from 70 episodes per week to 0.37 (p < 0.001). Responder rate was 88.9%; 44.4% became asymptomatic after treatment. Sixty-one per cent of patients presented some adverse event; four patients discontinued eslicarbazepine for this reason. Despite this, 16 patients (88.9%) noticed a good subjective tolerance to eslicarbazepine. The retention rate at 6 months was 77.8% and at 12 months 61.1%. CONCLUSIONS Our study supports the hypothesis that eslicarbazepine acetate is an effective, safe and well-tolerated treatment for the treatment of TN. Further studies are warranted to corroborate these results. SIGNIFICANCE Eslicarbazepine acetate has shown to be an effective, safe and well-tolerated drug for TN. This is the first study that evaluated the efficacy of this drug on TN in humans.
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Affiliation(s)
- A Sanchez-Larsen
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Spain
| | - D Sopelana
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Spain
| | - I Diaz-Maroto
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Spain
| | | | - J Gracia-Gil
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Spain
| | | | - E Palazón-García
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Spain
| | - T Segura
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Spain
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Rojas-Bartolome L, Pardal-Fernandez JM, Garcia-Garcia J, Ayo-Martin O, Fernandez-Valiente M, Romero-Sanchez CM, Segura T. [Ultrasound study of the vagal nerve as a diagnostic tool in Guillain-Barre syndrome]. Rev Neurol 2018; 66:65-66. [PMID: 29323403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - J Garcia-Garcia
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
| | - O Ayo-Martin
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
| | | | | | - T Segura
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
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Pardal-Fernandez JM, Grande-Martin A, Godes-Medrano B, Segura T, Garcia-Garcia J. [Morphological study with ultrasound imaging in meralgia paraesthetica: in search of therapeutic efficiency]. Rev Neurol 2018; 66:34. [PMID: 29251342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | - A Grande-Martin
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
| | - B Godes-Medrano
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
| | - T Segura
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
| | - J Garcia-Garcia
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
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Sánchez-Larsen A, Feria-Vilar I, Collado R, Segura T. Collet–Sicard syndrome caused by metastasis. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2015.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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34
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Pardal-Fernandez JM, Godes-Medrano B, Grande A, Segura T. [Evaluation of the vagal nerve in a patient with hereditary motor sensory neuropathy type 1A]. Rev Neurol 2016; 63:422. [PMID: 27779303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - B Godes-Medrano
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
| | - A Grande
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
| | - T Segura
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
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Sánchez-Larsen Á, García-García J, Ayo-Martín O, Hernández-Fernández F, Díaz-Maroto I, Fernández-Díaz E, Monteagudo M, Segura T. Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases. Neurologia 2016; 33:S0213-4853(16)30168-2. [PMID: 27645775 DOI: 10.1016/j.nrl.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES We aimed to determine whether the aetiology of ischaemic stroke has changed in recent years and, if so, to ascertain the possible reasons for these changes. PATIENTS AND METHODS We analysed the epidemiological history and vascular risk factors of all patients diagnosed with ischaemic stroke at Complejo Hospitalario Universitario de Albacete (CHUA) from 2009 to 2014. Ischaemic stroke subtypes were established using the TOAST criteria. Our results were compared to data from the classic Stroke Data Bank (SDB); in addition, both series were compared to those of other hospital databases covering the period between the two. RESULTS We analysed 1664 patients (58% were men) with a mean age of 74 years. Stroke aetiology in both series (CHUA, SDB) was as follows: atherosclerosis (12%, 9%), small-vessel occlusion (13%, 25%), cardioembolism (32%, 19%), stroke of other determined aetiology (3%, 4%), and stroke of undetermined aetiology (40%, 44%). Sixty-three percent of the patients from the CHUA and 42% of the patients from the SDB were older than 70 years. Cardioembolic strokes were more prevalent in patients older than 70 years in both series. Untreated hypertension was more frequent in the SDB (SDB = 31% vs CHUA = 10%). The analysis of other databases shows that the prevalence of cardioembolic stroke is increasing worldwide. CONCLUSIONS Our data show that the prevalence of lacunar strokes is decreasing worldwide whereas cardioembolic strokes are increasingly more frequent in both our hospital and other series compared to the SDB. These differences may be explained by population ageing and the improvements in management of hypertension and detection of cardioembolic arrhythmias in stroke units.
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Affiliation(s)
- Á Sánchez-Larsen
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España.
| | - J García-García
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - O Ayo-Martín
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | | | - I Díaz-Maroto
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - E Fernández-Díaz
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - M Monteagudo
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
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Fernandez-Valiente M, Rojas-Bartolome L, Segura T, Garcia-Garcia J. [Halo sign in the facial artery. An aid in the diagnosis of giant-cell arteritis]. Rev Neurol 2016; 62:570-571. [PMID: 27270679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - T Segura
- Hospital General Universitario de Albacete, 02006 Albacete, Espana
| | - J Garcia-Garcia
- Hospital General Universitario de Albacete, 02006 Albacete, Espana
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Monteagudo M, Doménech C, Segura T. Terson syndrome and ocular ultrasound. Neurología (English Edition) 2015. [DOI: 10.1016/j.nrleng.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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38
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Vinas D, Serrano-Heras G, Perona-Morata AB, De Andres P, Fortes J, Segura T, De Campos JM. P01.06 * HIF-1 AND HIF-2 AS POSIBLE NEW TARGETS IN THE TREATMENT OF VON HIPPEL-LINDAU DISEASE HEMANGIOBLASTOMAS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Vivancos J, Gilo F, Frutos R, Maestre J, García-Pastor A, Quintana F, Roda J, Ximénez-Carrillo A, Díez Tejedor E, Fuentes B, Alonso de Leciñana M, Álvarez-Sabin J, Arenillas J, Calleja S, Casado I, Castellanos M, Castillo J, Dávalos A, Díaz-Otero F, Egido J, Fernández J, Freijo M, Gállego J, Gil-Núñez A, Irimia P, Lago A, Masjuan J, Martí-Fábregas J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Nombela F, Purroy F, Ribó M, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment. Neurología (English Edition) 2014. [DOI: 10.1016/j.nrleng.2012.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Purroy F, Jiménez Caballero PE, Gorospe A, Torres MJ, Alvarez-Sabin J, Martínez-Sánchez P, Cánovas D, Freijo M, Egido JA, Ramírez-Moreno JM, Alonso-Arias A, Rodríguez-Campello A, Casado-Naranjo I, Martí-Fàbregas J, Silva Y, Cardona P, Morales A, García-Pastor A, Arenillas JF, Segura T, Jiménez C, Masjuán J. How predictors and patterns of stroke recurrence after a TIA differ during the first year of follow-up. J Neurol 2014; 261:1614-21. [PMID: 24912470 DOI: 10.1007/s00415-014-7390-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/24/2014] [Accepted: 05/26/2014] [Indexed: 01/31/2023]
Abstract
The highest risk of subsequent stroke after a TIA occurs within the first week after the index event. However, the risk of stroke recurrence (SR) remains high during the first year of follow-up. We studied the temporal pattern and predictors of SR (at 7 days and from 7 days to 1-year follow-up). Between April 2008 and December 2009, we included 1,255 consecutive TIA patients from 30 Spanish stroke centers (PROMAPA study). We determined the short-term (at 7 days) and long-term (from 8 days to 1 year) risk of SR. Patients who underwent short-term recurrence and long-term recurrence were compared with regard to clinical findings, vascular territories, and etiology. Enough information (clinical variables and extracranial vascular imaging) was assessed in 1,137 (90.6 %) patients. The 7-day stroke risk was 2.6 %. 32 (3.0 %) patients had an SR after 7-day follow-up. Multiple TIA (HR 3.50, 1.67-7.35, p = 0.001) and large artery atherosclerosis (HR 2.51, 1.17-5.37, p = 0.018) were independent predictors of early SR, whereas previous stroke (HR 1.40, 1.03-1.92, p = 0.034) and coronary heart disease (2.65, 1.28-5.50, p = 0.009) were independent predictors of late SR. Notoriously, 80 % of SR happened in the same territory of the index TIA at 7-day follow-up, whereas only 38 % during the long-term follow-up (p < 0.001). Different predictors of SR were identified throughout the follow-up period. Moreover, the ischemic mechanism differed in early and late stroke recurrences.
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Affiliation(s)
- F Purroy
- Stroke Unit, Department of Neurology, IRBLLEIDA Research Institute, Hospital Universitari Arnau de Vilanova de Lleida, Universitat de Lleida, Avda Rovira Roure, 80, 25198, Lleida, Spain,
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Fuentes B, Gállego J, Gil-Nuñez A, Morales A, Purroy F, Roquer J, Segura T, Tejada J, Lago A, Díez-Tejedor E, Alonso de Leciñana M, Álvarez-Sabin J, Arenillas J, Calleja S, Casado I, Castellanos M, Castillo J, Dávalos A, Díaz-Otero F, Egido J, López-Fernández J, Freijo M, García Pastor A, Gilo F, Irimia P, Maestre J, Masjuan J, Martí-Fábregas J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Nombela F, Ribó M, Rodríguez-Yañez M, Rubio F, Serena J, Simal P, Vivancos J. Guía para el tratamiento preventivo del ictus isquémico y AIT (II). Recomendaciones según subtipo etiológico. Neurologia 2014; 29:168-83. [DOI: 10.1016/j.nrl.2011.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/29/2011] [Indexed: 11/28/2022] Open
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Alonso de Leciñana M, Egido J, Casado I, Ribó M, Dávalos A, Masjuan J, Caniego J, Martínez Vila E, Díez Tejedor E, Fuentes (Secretaría) B, Álvarez-Sabin J, Arenillas J, Calleja S, Castellanos M, Castillo J, Díaz-Otero F, López-Fernández J, Freijo M, Gállego J, García-Pastor A, Gil-Núñez A, Gilo F, Irimia P, Lago A, Maestre J, Martí-Fábregas J, Martínez-Sánchez P, Molina C, Morales A, Nombela F, Purroy F, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J, Vivancos J. Guidelines for the treatment of acute ischaemic stroke. Neurología (English Edition) 2014. [DOI: 10.1016/j.nrleng.2011.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Mar J, Álvarez-Sabín J, Oliva J, Becerra V, Casado M, Yébenes M, González-Rojas N, Arenillas J, Martínez-Zabaleta M, Rebollo M, Lago A, Segura T, Castillo J, Gállego J, Jiménez-Martínez C, López-Gastón J, Moniche F, Casado-Naranjo I, López-Fernández J, González-Rodríguez C, Escribano B, Masjuan J. Los costes del ictus en España según su etiología. El protocolo del estudio CONOCES. Neurologia 2013; 28:332-9. [DOI: 10.1016/j.nrl.2012.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/10/2012] [Accepted: 07/13/2012] [Indexed: 11/30/2022] Open
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Rodríguez-Yáñez M, Castellanos M, Freijo M, López Fernández J, Martí-Fàbregas J, Nombela F, Simal P, Castillo J, Díez-Tejedor E, Fuentes B, Alonso de Leciñana M, Álvarez-Sabin J, Arenillas J, Calleja S, Casado I, Dávalos A, Díaz-Otero F, Egido J, Gállego J, García Pastor A, Gil-Núñez A, Gilo F, Irimia P, Lago A, Maestre J, Masjuan J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Purroy F, Ribó M, Roquer J, Rubio F, Segura T, Serena J, Tejada J, Vivancos J. Clinical practice guidelines in intracerebral haemorrhage. Neurología (English Edition) 2013. [DOI: 10.1016/j.nrleng.2011.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Affiliation(s)
- M Monteagudo
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España.
| | - C Doménech
- Servicio de Neurología, Hospital General Universitario de Elche, Alicante, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
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Palazon-Garcia E, Segura T, Moreno A, Hernandez-Fernandez F. [Intravenous fibrinolysis in a 14-year-old male with cerebral infarction due to dissection of the internal carotid artery]. Rev Neurol 2012; 55:767-768. [PMID: 23233146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Vivancos J, Gilo F, Frutos R, Maestre J, García-Pastor A, Quintana F, Roda JM, Ximénez-Carrillo A, Díez Tejedor E, Fuentes B, Alonso de Leciñana M, Alvarez-Sabin J, Arenillas J, Calleja S, Casado I, Castellanos M, Castillo J, Dávalos A, Díaz-Otero F, Egido JA, Fernández JC, Freijo M, Gállego J, Gil-Núñez A, Irimia P, Lago A, Masjuan J, Martí-Fábregas J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Nombela F, Purroy F, Ribó M, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment. Neurologia 2012; 29:353-70. [PMID: 23044408 DOI: 10.1016/j.nrl.2012.07.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/11/2012] [Accepted: 07/13/2012] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment. MATERIAL AND METHODS A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed. RESULTS The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm. CONCLUSIONS SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes.
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Segura T, Sánchez-Ayaso P. Neuropatía óptica en un síndrome de Lewis-Sumner: ¿una asociación casual? Neurologia 2012; 27:315-6. [DOI: 10.1016/j.nrl.2011.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/20/2011] [Indexed: 11/24/2022] Open
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Segura T, Perona A, Coloma R, Zorita M. Hypnic Headache, a Sleep Related Respiratory Disorder? (S36.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s36.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sanchez-Ayaso P, Hernandez-Fernandez F, Ayo-Martin O, Collado R, Segura T. [Anterior circulation embolic stroke secondary to thrombotic occlusion of the brachiocephalic trunk: the usefulness of neurosonological studies]. Rev Neurol 2012; 54:284-288. [PMID: 22362477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION. Atherosclerotic occlusion of the brachiocephalic trunk (CBT) is a rare clinical entity and its presentation in the form of arterio-arterial embolism is uncommon. Early identification of patients with CBT occlusion may have important therapeutic implications. CASE REPORT. A man aged 49 presents with sudden onset symptoms involving the territory of the right middle cerebral artery. Emergent transcranial doppler evaluation showed a flow pattern of proximal right M1 occlusion. After intravenous recombinant tissue plasminogen activator administration, partial recanalization of the vessel was found and the patient improved clinically. Cervical and transcranial duplex sonography demonstrated an occlusion in CBT, which was later confirmed on CT angiography and digital angiography of supraaortic vessels. After aorto-innominate bypass, pathological analysis confirmed the atherosclerotic origin. CONCLUSIONS. The most common clinical presentation of CBT occlusion are transient ischemic symptoms related to steal phenomenon in the vertebro-basilar territory. Symptoms of carotid circulation stroke usually result from arterio-arterial embolic mechanism. Early recognition is important for its therapeutic implications, therefore thrombolytic therapy should be indicated. Neurosonologic study allows rapid and reliable examination on hemodynamic status and the presence of distal embolic phenomena.
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Affiliation(s)
- P Sanchez-Ayaso
- Complejo Hospital General Universitario de Albacete, Albacete, Espana.
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