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Villagrán-Sancho D, Luque-Ambrosiani AC, Mayorga-Morón C, Gómez-Fernández FJ, Arzalluz-Luque J, Castela-Murillo A, Hernández-Ramos FJ, Jiménez-Hernández MD, Palomino-García A. [Cryptogenic new-onset super-refractory status epilepticus following SARS-CoV-2 vaccination. A case report]. Rev Neurol 2023; 76:399-402. [PMID: 37303102 PMCID: PMC10478125 DOI: 10.33588/rn.7612.2022374] [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: 03/03/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION New-onset super-refractory status epilepticus (NOSRSE) is a neurological emergency characterised by the development of status epilepticus in a patient without epilepsy or any known prior neurological disease and with no clear structural, toxic or metabolic cause, which recurs after 24 hours of induced coma. The most common identifiable cause is inflammatory-autoimmune. Consequently, we present a case of NOSRSE related to SARS-CoV-2 vaccination as an opportunity to investigate the dysimmune origin of this pathology. CASE REPORT We report the case of a 40-year-old male who presented at the emergency department with fever and headache with no clear source of infection. His personal history included bacterial meningitis in childhood without any sequelae and protein S deficiency without treatment at the time, as well as vaccination with ChAdOx1 nCoV-19 21 days earlier. He was initially diagnosed with a urinary tract infection and treated with cefuroxime. Two days later, he was taken back to the emergency department with confusional symptoms and tonic-clonic seizures. He did not respond to midazolam and finally required sedation and orotracheal intubation for refractory status epilepticus. While in hospital, he required a number of lines of antiepileptic drugs, ketamine, a ketogenic diet, immunotherapy and plasmapheresis in order to successfully limit NOSRSE. The aetiological study offered normal results for serology, antineuronal antibodies in serum and cerebrospinal fluid, transthoracic echocardiography, testicular ultrasound and computed tomographic angiography. Only the control MRI scan showed a diffuse and bilateral alteration of the right hemispheric cortex and thalamic pulvinar as the only finding. CONCLUSION It is crucial to report suspected adverse reactions associated with SARS-CoV-2 vaccination, thereby allowing continued monitoring of the risk/benefit ratio of vaccination.
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Castilla-Guerra L, Fernández-Moreno MC, González-Iglesias ML, Boceta-Osuna J, Gutiérrez-Gutiérrez B, Jiménez-Hernández MD. Pharmacological therapy in the secondary prevention of ischemic stroke in the oldest-old patients: has it improved in recent decades? Rev Clin Esp 2023; 223:202-208. [PMID: 36842658 DOI: 10.1016/j.rceng.2023.02.006] [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] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Population aging has caused an increase in strokes in very elderly patients (VEP). We assess how secondary prevention of ischemic stroke has changed in VEP in recent decades. METHOD Retrospective study of discharges due to ischemic stroke in the Virgen Macarena, Virgen del Rocio and Valme hospitals in Seville (Spain), during the periods 1999-2001, 2014-16 and 2019-2020. VEP were considered those with ≥80 years. RESULT We studied 1806 patients, 349 (19.3%) were VEP. Over the years, VEPs have doubled (13.5% vs. 25.9% and 28% p = 0.0001) and age has increased (83.3 ± 3 vs. 84.1 ± 3 vs. 85.2 ± 4 p = 0.001). Comparing the periods, the VEPs have more hypertension (69.9% vs. 84.8% vs. 84.6%; p = 0.0001) and dyslipidemia (12% vs. 41.7% vs. 52.3%; p = 0.0001) and have prescribed more antihypertensives (69.1% vs. 86.7% vs. 92.3%; p = 0.0001), statins (5.3% vs. 78% vs. 81.5%; p = 0.0001) and anticoagulants (16.5% vs. 19.4% vs. 53.1%; p = 0.001), increasing the number of antihypertensives (1 ± 0.9 vs. 1.6 ± 0, 9 vs. 1.9 ± 0.8 drugs p = 0.0001), and high-intensity statins (2.3% vs. 42.7 vs. 69.2% p = 0.0001). Comparing the VEPs with the younger ones, there were no differences in antihypertensive treatment in any period, there were differences in antithrombotic treatment in the first period, and with statins the differences were maintained until the end. CONCLUSIONS In the last 20 years the number of VEPs has doubled, exceeding a quarter of the discharges. Although there is improvement in secondary stroke prevention in VEPs, there is room for improvement.
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Affiliation(s)
- L Castilla-Guerra
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain.
| | - M C Fernández-Moreno
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - M L González-Iglesias
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J Boceta-Osuna
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - B Gutiérrez-Gutiérrez
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M D Jiménez-Hernández
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Serrano-Castro PJ, Estivill-Torrús G, Cabezudo-García P, Reyes-Bueno JA, Ciano Petersen N, Aguilar-Castillo MJ, Suárez-Pérez J, Jiménez-Hernández MD, Moya-Molina MÁ, Oliver-Martos B, Arrabal-Gómez C, Rodríguez de Fonseca F. Impact of SARS-CoV-2 infection on neurodegenerative and neuropsychiatric diseases: a delayed pandemic? Neurologia 2020; 35:245-251. [PMID: 32364119 PMCID: PMC7164900 DOI: 10.1016/j.nrl.2020.04.002] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION SARS-CoV-2 was first detected in December 2019 in the Chinese city of Wuhan and has since spread across the world. At present, the virus has infected over 1.7 million people and caused over 100 000 deaths worldwide. Research is currently focused on understanding the acute infection and developing effective treatment strategies. In view of the magnitude of the epidemic, we conducted a speculative review of possible medium- and long-term neurological consequences of SARS-CoV-2 infection, with particular emphasis on neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin, based on the available evidence on neurological symptoms of acute SARS-CoV-2 infection. DEVELOPMENT We systematically reviewed the available evidence about the pathogenic mechanisms of SARS-CoV-2 infection, the immediate and lasting effects of the cytokine storm on the central nervous system, and the consequences of neuroinflammation for the central nervous system. CONCLUSIONS SARS-CoV-2 is a neuroinvasive virus capable of triggering a cytokine storm, with persistent effects in specific populations. Although our hypothesis is highly speculative, the impact of SARS-CoV-2 infection on the onset and progression of neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin should be regarded as the potential cause of a delayed pandemic that may have a major public health impact in the medium to long term. Cognitive and neuropsychological function should be closely monitored in COVID-19 survivors.
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Affiliation(s)
- P J Serrano-Castro
- Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA).
| | - G Estivill-Torrús
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA)
| | - P Cabezudo-García
- Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA)
| | - J A Reyes-Bueno
- Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA)
| | - N Ciano Petersen
- Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA)
| | - M J Aguilar-Castillo
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA); Servicio de Análisis Clínicos, Hospital Regional Universitario de Málaga, Málaga, España
| | - J Suárez-Pérez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA)
| | - M D Jiménez-Hernández
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA); Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Á Moya-Molina
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA); Servicio de Neurología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - B Oliver-Martos
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA)
| | - C Arrabal-Gómez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA)
| | - F Rodríguez de Fonseca
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA)
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Montaner J, Jiménez-Hernández MD, López-Barneo J. How to unfasten the Spanish Stroke Belt? Andalusia chooses research. Int J Stroke 2014; 9:946-9. [PMID: 25042753 DOI: 10.1111/ijs.12332] [Citation(s) in RCA: 3] [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: 12/16/2013] [Accepted: 04/29/2014] [Indexed: 11/28/2022]
Abstract
Andalusia in southern Spain, one of the largest regions in the European Union, has made a profound economic and social transformation that has led to establishment of a modern universal public health care system. However, due to its high stroke mortality rates, Andalusia is still known as the 'Spanish Stroke Belt'. To fight these figures, successive initiatives culminated in the launch of the Andalusian Plan for Stroke Care, to be developed during the period of 2011 to 2014. In addition, involved professionals have hypothesized that clinical and experimental research may contribute to improving stroke care in our community. To that end, one of the leading institutes of biomedical research in Andalusia, the Institute of Biomedicine of Seville (IBiS), has selected stroke as a flagship project in the region. Moreover, Seville, the capital of Andalusia, is now conducting a fusion process of its two largest hospitals, with the potential to generate a stroke alliance that will make it one of the main stroke hospitals in Europe (>2000 cases per year). It is anticipated that this will be an excellent platform to facilitate acute-phase clinical trials and speed the translation process from basic research in IBiS laboratories to the clinical setting. Furthermore, the recently created Andalusian Neurovascular Group is ready to develop prospective, collaborative, multicenter research projects that will evaluate interventions in areas of stroke care uncertainty. If we succeed in forging a link between research and health care quality, we may succeed in lowering the incidence of stroke and related mortality in the region in a short period of time.
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Affiliation(s)
- J Montaner
- Stroke Program, Institute of Biomedicine of Seville, Hospital Universitario Virgen del Rocio, Seville, Spain
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Castilla-Guerra L, Fernández-Moreno MC, López-Chozas JM, Jiménez-Hernández MD. [Polypills in the secondary prevention of strokes]. Rev Neurol 2009; 48:330-331. [PMID: 19291660] [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: 05/27/2023]
Affiliation(s)
- L Castilla-Guerra
- Servicio de Medicina Interna, Hospital de la Merced, Osuna, Sevilla, Spain.
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Castilla-Guerra L, Fernández-Moreno MC, López-Chozas JM, Jiménez-Hernández MD. [Statins and cerebrovascular disease: new perspectives in stroke prevention]. Rev Neurol 2007; 44:95-100. [PMID: 17236149] [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: 05/13/2023]
Abstract
INTRODUCTION AND DEVELOPMENT The role played by statins in the prevention of strokes has been subject to controversy for a long time, especially because no clear correlation between levels of cholesterol in serum and strokes has yet been established. Nevertheless, a number of randomised trials with statins and several meta-analyses that were carried out later have proved that statins lower the incidence of all kinds of strokes, with a 21% reduction in the relative risk. It has also been shown that this effect is essentially due to the degree to which LDL cholesterol (cholesterol linked to low-density lipoproteins) is reduced, which has a lowering effect on lipid levels. It has also been shown that statins have others beneficial effects apart from reducing cholesterol levels and that these may be independent of the subject's basal lipid levels. We are referring to the so-called pleiotropic effects, which include stabilisation of the atherosclerotic plaque, an antiinflammatory effect, an antithrombotic effect and enhanced vasomotor reactivity. CONCLUSION The recent appearance of the results of the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) study and the guidelines published by the American Heart Association and the Spanish Neurology Society, which grant statins a leading role in stroke prevention, both open up new horizons for the use of statins in cerebrovascular pathologies.
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Fernández-Moreno MC, Castilla-Guerra L, Castella-Murillo A, Cueli-Rincón B, Fernández-Bolaños R, Gutiérrez-Tous R, Jiménez-Hernández MD. [Hyperhomocysteinemia-related cerebral venous thrombosis]. Rev Neurol 2003; 37:1040-3. [PMID: 14669145] [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: 04/27/2023]
Abstract
INTRODUCTION Moderate hyperhomocysteinemia is a causal risk factor for atherosclerosis and venous thromboembolism. Recent researches have tried to find out a causal relationship. However, only a small number of cases have been reported on hyperhomocysteinemia and cerebral venous thrombosis in the world medical literature. CASE REPORT We present the case of a 21 years old woman, and oral contraceptives taker, who consulted for a one week clinical picture of biparietal headache, nausea and vomiting. Examination revealed bilateral papilledema, and subsequent CT scan, MRI and MR angiography showed thrombosis of the left lateral sinus. Immunologic tests (antinuclear antibodies, antiphospholipid antibodies) were negative. Hypercoagulability studies showed persistent homocysteine high levels. The patient improved and was discharged after treatment with anticoagulants and therapeutic measures against brain edema. DISCUSSION The 70 percent of the patients with thrombosis of the cerebral venous sinuses present hypercoagulable states, including moderate hyperhomocysteinemia. Several mechanisms are proposed for venous thrombosis in hyperhomocysteinemia, homocysteine induced endothelial dysfunction between others. Otherwise, oral contraceptives can increase the risk of venous thrombosis in other prothrombotic conditions. Folic acid and vitamins supplementation therapy are commented.
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Affiliation(s)
- M C Fernández-Moreno
- Servicio de Neurología, Hospital Universitario Virgen de Valme, Sevilla, España.
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Jiménez-Hernández MD, Torrecillas Nárvaez MD, Friera Acebal G. [Effectiveness and safety of gabapentin in the preventive treatment of migraine]. Rev Neurol 2002; 35:603-6. [PMID: 12389143] [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: 02/26/2023]
Abstract
INTRODUCTION Migraine is a frequent and disabling pathological condition with important socioeconomic repercussions. Recent studies have explored the use of antiepileptic drugs in the prophylactic treatment of migraine. Preliminary studies have shown that gabapentin is a drug that is effective and well tolerated by patients. AIM. To evaluate the effectiveness and safety of gabapentin in the prophylactic treatment of migraine. PATIENTS AND METHODS A prospective, open, multicentre, random clinical study, carried out according to IHS criteria, which compares the effectiveness and safety of gabapentin in 1,200 mg/day and 2,000 mg/day doses as a preventive treatment for migraine over a 16 week period. RESULTS Significant differences were found in patients treated with gabapentin, as compared with their basal state, in the following: a lower number of attacks (reduction in weeks 4, 10 and 16: 2.4 2.8, 2.9 2.9 and 3.1 2.9 attacks/month on a basal rate of 5.3 3.5 attacks/month), lower intensity (on a scale of 0 3 of increasing pain intensity: basal rate: 2.7 0.4, week 4: 1.8 0.9, week 10: 1.7 0.9, week 16: 1.4 1.0) and how long the pain lasts (basal rate 390 hours/month, week 4: 180 hours/month, week 10: 180 hours/month, week 16: 120 hours/month). No statistically significant differences were found between doses of 1,200 or 2,000 mg/day. Mild adverse effects were seen in 62 patients (37.8%): drowsiness (22.6%), asthenia (7.9%), dizziness (4.9%), abdominal pain (3.7%) and dazedness (3.7%). No serious adverse events occurred. CONCLUSIONS Gabapentin can be considered an effective and safe drug in the preventive treatment of migraine.
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Romero-Blanco M, Sánchez-Caballero F, Jiménez-Hernández MD. [Epilepsy and coma as the presentation of vitamin B12 deficiency]. Rev Neurol 1999; 29:492. [PMID: 10584258] [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: 02/14/2023]
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