Pub Date : 2023-11-01DOI: 10.1016/j.nrl.2021.04.006
A. Arauz , M.A. Barboza , L.C. Quintero , C. Cantu , E. Chiquete , F. Serrano
Introduction
Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC.
Materials and methods
Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed.
Results
Twenty-six patients were included (20 female, age 35.4 ± 12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction ± hemorrhagic lesion) > 6 cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization.
Conclusion
In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.
{"title":"Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy","authors":"A. Arauz , M.A. Barboza , L.C. Quintero , C. Cantu , E. Chiquete , F. Serrano","doi":"10.1016/j.nrl.2021.04.006","DOIUrl":"10.1016/j.nrl.2021.04.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC.</p></div><div><h3>Materials and methods</h3><p>Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed.</p></div><div><h3>Results</h3><p>Twenty-six patients were included (20 female, age 35.4<!--> <!-->±<!--> <!-->12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction<!--> <!-->±<!--> <!-->hemorrhagic lesion)<!--> <!-->><!--> <!-->6<!--> <!-->cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization.</p></div><div><h3>Conclusion</h3><p>In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"38 9","pages":"Pages 617-624"},"PeriodicalIF":3.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nrl.2021.04.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39179156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.nrl.2021.01.011
J. López-Gómez , B. Sacristán-Enciso , M.A. Caro-Miró , M.R. Querol Pascual
Introduction
In most cases, multiple sclerosis (MS) initially presents as clinically isolated syndrome (CIS). Differentiating CIS from other acute or subacute neurological diseases and estimating the risk of progression to clinically definite MS is essential since presenting a second episode in a short time is associated with poorer long-term prognosis.
Development
We conducted a literature review to evaluate the usefulness of different variables in improving diagnostic accuracy and predicting progression from CIS to MS, including magnetic resonance imaging (MRI) and such biofluid markers as oligoclonal IgG and IgM bands, lipid-specific oligoclonal IgM bands in the CSF, CSF kappa free light-chain (KFLC) index, neurofilament light chain (NfL) in the CSF and serum, and chitinase 3–like protein 1 (CHI3L1) in the CSF and serum.
Conclusions
Codetection of oligoclonal IgG bands and MRI lesions reduces diagnostic delays and suggests a high risk of CIS progression to MS. A KFLC index > 10.6 and CSF NfL concentrations > 1150 ng/L indicate that CIS is more likely to progress to MS within one year (40-50%); 90% of patients with CIS and serum CHI3L1 levels > 33 ng/mL and 100% of those with lipid-specific oligoclonal IgM bands present MS within one year of CIS onset.
{"title":"Síndrome clínico aislado: diagnóstico y riesgo de desarrollar esclerosis múltiple clínicamente definida","authors":"J. López-Gómez , B. Sacristán-Enciso , M.A. Caro-Miró , M.R. Querol Pascual","doi":"10.1016/j.nrl.2021.01.011","DOIUrl":"https://doi.org/10.1016/j.nrl.2021.01.011","url":null,"abstract":"<div><h3>Introduction</h3><p>In most cases, multiple sclerosis (MS) initially presents as clinically isolated syndrome (CIS). Differentiating CIS from other acute or subacute neurological diseases and estimating the risk of progression to clinically definite MS is essential since presenting a second episode in a short time is associated with poorer long-term prognosis.</p></div><div><h3>Development</h3><p>We conducted a literature review to evaluate the usefulness of different variables in improving diagnostic accuracy and predicting progression from CIS to MS, including magnetic resonance imaging (MRI) and such biofluid markers as oligoclonal IgG and IgM bands, lipid-specific oligoclonal IgM bands in the CSF, CSF kappa free light-chain (KFLC) index, neurofilament light chain (NfL) in the CSF and serum, and chitinase 3–like protein 1 (CHI3L1) in the CSF and serum.</p></div><div><h3>Conclusions</h3><p>Codetection of oligoclonal IgG bands and MRI lesions reduces diagnostic delays and suggests a high risk of CIS progression to MS. A KFLC index > 10.6 and CSF NfL concentrations > 1150 ng/L indicate that CIS is more likely to progress to MS within one year (40-50%); 90% of patients with CIS and serum CHI3L1 levels > 33 ng/mL and 100% of those with lipid-specific oligoclonal IgM bands present MS within one year of CIS onset.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"38 9","pages":"Pages 663-670"},"PeriodicalIF":3.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nrl.2021.01.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71835680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.nrl.2022.08.004
P. Irimia , R. Belvís , N. García González , J. García Ull , J.M. Laínez
{"title":"Inequidad de acceso a los nuevos tratamientos para la migraña","authors":"P. Irimia , R. Belvís , N. García González , J. García Ull , J.M. Laínez","doi":"10.1016/j.nrl.2022.08.004","DOIUrl":"10.1016/j.nrl.2022.08.004","url":null,"abstract":"","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"38 8","pages":"Pages 599-600"},"PeriodicalIF":3.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41960101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.nrl.2021.02.012
J.P. Sánchez Marín , P. Sienes Bailo , R. Lahoz Alonso , J.L. Capablo Liesa , J. Gazulla Abio , J.A. Giménez Muñoz , P.J. Modrego Pardo , B. Pardiñas Barón , S. Izquierdo Álvarez
Introduction
The incidence of myotonic dystrophy type 1 (DM1), a disease with great phenotypic variety, in our region is unknown. This study aims to estimate the incidence of DM1 at our hospital (a reference centre in Aragon, Spain) and to identify the characteristics of our population (genotype-phenotype correlation).
Methods
Retrospective, descriptive study of 459 patients classified according to the number of CTG repeats, as follows: normal (5-35), premutation (36-50), protomutation (51-80), small expansions (81-150), intermediate expansions (151-1000), and large expansions (> 1000). Furthermore, according to clinical phenotype, patients were categorised as unaffected (5-50 CTG repeats), mild form or asymptomatic (51-150), classical form (151-1000), and severe form (> 1000).
Results
The incidence of DM1 was 20.61 cases per million person-years (95% CI: 19.59-21.63). An inverse correlation was observed between the number of CTG repeats and the age at genetic diagnosis (ρ = −0.547; 95% CI: −0.610 to −0.375; P < .001). CTG5 was the most frequent polymorphic allele in healthy individuals. Of all patients with DM1, 28.3% presented the mild or asymptomatic form, 59.1% the classical form, and 12.6% the severe form. Inheritance was maternal in 35.1% of cases, paternal in 59.4%, and uncertain in 5.5%. In mild forms, frontal balding in men was the most prevalent phenotypic trait, as well as myotonia and cataracts, while in the classical form, ptosis, facial weakness, voice and pronunciation alterations, myotonia, and fatigue/sleepiness were most frequent.
Conclusions
The incidence of DM1 in Aragon is significant. Multidisciplinary study of the phenotype of patients with DM1 is key to early diagnosis and personalised management.
{"title":"Distrofia miotónica tipo 1: 13 años de experiencia en un hospital terciario. Estudio clínico y epidemiológico. Correlación genotipo-fenotipo","authors":"J.P. Sánchez Marín , P. Sienes Bailo , R. Lahoz Alonso , J.L. Capablo Liesa , J. Gazulla Abio , J.A. Giménez Muñoz , P.J. Modrego Pardo , B. Pardiñas Barón , S. Izquierdo Álvarez","doi":"10.1016/j.nrl.2021.02.012","DOIUrl":"https://doi.org/10.1016/j.nrl.2021.02.012","url":null,"abstract":"<div><h3>Introduction</h3><p>The incidence of myotonic dystrophy type<!--> <!-->1 (DM1), a disease with great phenotypic variety, in our region is unknown. This study aims to estimate the incidence of DM1 at our hospital (a reference centre in Aragon, Spain) and to identify the characteristics of our population (genotype-phenotype correlation).</p></div><div><h3>Methods</h3><p>Retrospective, descriptive study of 459 patients classified according to the number of CTG repeats, as follows: normal (5-35), premutation (36-50), protomutation (51-80), small expansions (81-150), intermediate expansions (151-1000), and large expansions (><!--> <!-->1000). Furthermore, according to clinical phenotype, patients were categorised as unaffected (5-50 CTG repeats), mild form or asymptomatic (51-150), classical form (151-1000), and severe form (><!--> <!-->1000).</p></div><div><h3>Results</h3><p>The incidence of DM1 was 20.61 cases per million person-years (95%<!--> <!-->CI: 19.59-21.63). An inverse correlation was observed between the number of CTG repeats and the age at genetic diagnosis (ρ<!--> <!-->=<!--> <!-->−0.547; 95%<!--> <!-->CI: −0.610 to −0.375; <em>P<!--> </em><<!--> <!-->.001). CTG<sub>5</sub> was the most frequent polymorphic allele in healthy individuals. Of all patients with DM1, 28.3% presented the mild or asymptomatic form, 59.1% the classical form, and 12.6% the severe form. Inheritance was maternal in 35.1% of cases, paternal in 59.4%, and uncertain in 5.5%. In mild forms, frontal balding in men was the most prevalent phenotypic trait, as well as myotonia and cataracts, while in the classical form, ptosis, facial weakness, voice and pronunciation alterations, myotonia, and fatigue/sleepiness were most frequent.</p></div><div><h3>Conclusions</h3><p>The incidence of DM1 in Aragon is significant. Multidisciplinary study of the phenotype of patients with DM1 is key to early diagnosis and personalised management.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"38 8","pages":"Pages 530-540"},"PeriodicalIF":3.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nrl.2021.02.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50190498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.nrl.2021.01.014
O. Sáez-Atxukarro , R. del Pino , J. Peña , D.J. Schretlen , N. Ibarretxe-Bilbao , N. Ojeda
Introduction
The UD Interference Test measures processing speed and attention, and is based on the concept of interference of the Stroop Test. The main purpose of the study is to provide an alternative version of the Stroop Test that overcomes some of the limitations of previous versions in assessing individuals with daltonism or age-related reading difficulties, and to obtain normative and standardised data for the Spanish population.
Methods
This study is part of the Normacog project. We evaluated 905 individuals (age range, 18-93 years) to analyse the test's reliability and concurrent and construct validity. We evaluated the effect of age, sex, and level of education on UD Interference Test performance and calculated percentiles and age- and education-adjusted scaled scores.
Results
The test has good reliability (α = 0.875) and concurrent (r = 0.443-0.725; p < .001) and construct validity (r = 0.472-0.737; p < .001). We observed age and educational level to have a significant effect on UD Interference Test scores, explaining 12-40% of variance. Sex only had a significant effect on the resistance to interference index.
Conclusions
We present an alternative version of the Stroop Color and Word Test with some advantages over previous versions. We provide standardised and normalised data for the Spanish population to correct the test according to the subject's age and level of education.
{"title":"Test UD Interferencia: Creación y validación de un nuevo instrumento de resistencia a la interferencia. Normalización y estandarización en población española","authors":"O. Sáez-Atxukarro , R. del Pino , J. Peña , D.J. Schretlen , N. Ibarretxe-Bilbao , N. Ojeda","doi":"10.1016/j.nrl.2021.01.014","DOIUrl":"https://doi.org/10.1016/j.nrl.2021.01.014","url":null,"abstract":"<div><h3>Introduction</h3><p>The UD Interference Test measures processing speed and attention, and is based on the concept of interference of the Stroop Test. The main purpose of the study is to provide an alternative version of the Stroop Test that overcomes some of the limitations of previous versions in assessing individuals with daltonism or age-related reading difficulties, and to obtain normative and standardised data for the Spanish population.</p></div><div><h3>Methods</h3><p>This study is part of the Normacog project. We evaluated 905 individuals (age range, 18-93 years) to analyse the test's reliability and concurrent and construct validity. We evaluated the effect of age, sex, and level of education on UD Interference Test performance and calculated percentiles and age- and education-adjusted scaled scores.</p></div><div><h3>Results</h3><p>The test has good reliability (α = 0.875) and concurrent (r = 0.443-0.725; p < .001) and construct validity (r = 0.472-0.737; p < .001). We observed age and educational level to have a significant effect on UD Interference Test scores, explaining 12-40% of variance. Sex only had a significant effect on the resistance to interference index.</p></div><div><h3>Conclusions</h3><p>We present an alternative version of the Stroop Color and Word Test with some advantages over previous versions. We provide standardised and normalised data for the Spanish population to correct the test according to the subject's age and level of education.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"38 8","pages":"Pages 566-576"},"PeriodicalIF":3.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nrl.2021.01.014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50190511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.nrl.2021.01.015
U. Díaz-Aristizabal, M. Valdés-Vilches, T.R. Fernández-Ferreras, E. Calero-Muñoz, E. Bienzobas-Allué, L. Aguilera-Ballester, J. Carnicer-Cáceres
Objectives
This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP).
Material and methods
We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox® or Xeomin®) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively.
Results
Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P = .004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P < .001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P < .001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P = .001).
Conclusions
BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.
{"title":"Efecto de la toxina botulínica tipo A en la funcionalidad, las sincinesias y la calidad de vida en secuelas de parálisis facial periférica","authors":"U. Díaz-Aristizabal, M. Valdés-Vilches, T.R. Fernández-Ferreras, E. Calero-Muñoz, E. Bienzobas-Allué, L. Aguilera-Ballester, J. Carnicer-Cáceres","doi":"10.1016/j.nrl.2021.01.015","DOIUrl":"https://doi.org/10.1016/j.nrl.2021.01.015","url":null,"abstract":"<div><h3>Objectives</h3><p>This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP).</p></div><div><h3>Material and methods</h3><p>We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox® or Xeomin®) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4<!--> <!-->weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively.</p></div><div><h3>Results</h3><p>Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (<em>P<!--> </em>=<!--> <!-->.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; <em>P</em> <!--><<!--> <!-->.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; <em>P</em> <!--><<!--> <!-->.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (<em>P<!--> </em>=<!--> <!-->.001).</p></div><div><h3>Conclusions</h3><p>BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"38 8","pages":"Pages 560-565"},"PeriodicalIF":3.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nrl.2021.01.015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50190510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1016/j.nrl.2020.12.008
P. Martín-Jiménez , M. Sánchez-Tornero , S. Llamas-Velasco , M.P. Guerrero-Molina , M. González-Sánchez , A. Herrero-San Martín , V. Blanco-Palmero , P. Calleja-Castaño , J. Francisco-Gonzalo , A. Hilario , A. Ramos , E. Salvador , Ó. Toldos , A. Hernández-Lain , D.A. Pérez-Martínez , A. Villarejo-Galende
Introduction
Cerebral amyloid angiopathy–related inflammation (CAA-ri) is an entity characterised by an inflammatory response to β-amyloid deposition in the walls of cerebral microvessels.
Methods
We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria.
Results
The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed.
Conclusions
Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.
{"title":"Inflamación relacionada con angiopatía amiloide: características clínicas y respuesta al tratamiento en una serie de casos","authors":"P. Martín-Jiménez , M. Sánchez-Tornero , S. Llamas-Velasco , M.P. Guerrero-Molina , M. González-Sánchez , A. Herrero-San Martín , V. Blanco-Palmero , P. Calleja-Castaño , J. Francisco-Gonzalo , A. Hilario , A. Ramos , E. Salvador , Ó. Toldos , A. Hernández-Lain , D.A. Pérez-Martínez , A. Villarejo-Galende","doi":"10.1016/j.nrl.2020.12.008","DOIUrl":"https://doi.org/10.1016/j.nrl.2020.12.008","url":null,"abstract":"<div><h3>Introduction</h3><p>Cerebral amyloid angiopathy–related inflammation (CAA-ri) is an entity characterised by an inflammatory response to β-amyloid deposition in the walls of cerebral microvessels.</p></div><div><h3>Methods</h3><p>We conducted a retrospective review of a series of patients with a diagnosis of CAA-ri according to histopathological study findings or clinical-radiological diagnostic criteria.</p></div><div><h3>Results</h3><p>The study included 7 patients (5 men) with a mean age of 79 years. Disease onset was acute or subacute in 6 patients. The most frequent symptoms were cognitive impairment (n = 6), behavioural alterations (n = 5), epileptic seizures (n = 5), focal neurological signs (n = 4), and headache (n = 2). Cerebrospinal fluid was abnormal in 3 patients (lymphocytic pleocytosis and high protein levels). The most frequent MRI findings were microbleeds (n = 7), subcortical white matter hyperintensities on T2-FLAIR sequences (n = 7), and leptomeningeal enhancement (n = 6). Lesions were bilateral in 3 patients and most frequently involved the parieto-occipital region (n = 5). Amyloid PET studies were performed in 2 patients, one of whom showed pathological findings. Two patients underwent brain biopsy, which confirmed diagnosis. All patients received immunosuppressive therapy. An initially favourable clinical-radiological response was observed in all cases, with 2 patients presenting radiological recurrence after treatment withdrawal, with a subsequent improvement after treatment was resumed.</p></div><div><h3>Conclusions</h3><p>Early diagnosis of CAA-ri is essential: early treatment has been shown to improve prognosis and reduce the risk of recurrence. Although a histopathological study is needed to confirm diagnosis, clinical-radiological criteria enable diagnosis without biopsy.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"38 8","pages":"Pages 550-559"},"PeriodicalIF":3.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nrl.2020.12.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50190509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The performance of the Low-Profile Visualized Intraluminal Support (LVIS) stent deployed following balloon angioplasty is unknown in treating intracranial atherosclerotic stenosis, and this study was to investigate the safety and efficacy of the LVIS stent in treating intracranial atherosclerotic stenosis in the middle cerebral artery M1 segment.
Methods
Thirty-five patients were enrolled with 35 atherosclerotic stenoses at the M1 segment. The stenosis was about 75% in 16 patients, 80% in 15, and 90% in the rest four. The LVIS stent was used to treat these patients.
Results
The success rate of stenting was 97.1%. The stenting procedure was failed in one patient because of intraprocedural dissection of the stenotic (75%) segment, resulting in a 30-day periprocedural complication rate of 2.9% (1/35). Before stenting, the stenosis rate ranged 75%–90% (mean 78.9% ± 4.7%), and after stenting, the diameter of the stented segment was significantly (P < 0.0001) increased to 1.5–3.4 mm (mean 2.1 ± 0.32 mm) ranging 68.2%–100% (mean 94.0% ± 5.8%) of the normal arterial diameter, with the residual stenosis ranging 0–31.8% (median 4.8%, IQR 2.4%–7.3%). Follow-up was performed at 6–20 months (mean 8.5) after stenting. One patient (2.9%) had occlusion of the stented M1 segment with no symptoms, and two patients (5.7%) had slight asymptomatic instent stenosis (40%) at the M1 segment, with the instent restenosis and occlusion rate of 8.6% (3/35).
Conclusion
The braided LVIS stent can be safely applied for treatment of intracranial atherosclerotic stenosis in the middle cerebral artery with good safety and efficacy immediately after stenting and at follow-up.
{"title":"Safety and efficacy of the Low-Profile Visualized Intraluminal Support stent in treating intracranial atherosclerotic stenosis","authors":"J.-W. Wang, X.-Y. Li, C.-H. Li, J.-F. Liu, H. Li, Y.-Y. Tian, B.-L. Gao","doi":"10.1016/j.nrl.2021.02.013","DOIUrl":"10.1016/j.nrl.2021.02.013","url":null,"abstract":"<div><h3>Purpose</h3><p>The performance of the Low-Profile Visualized Intraluminal Support (LVIS) stent deployed following balloon angioplasty is unknown in treating intracranial atherosclerotic stenosis, and this study was to investigate the safety and efficacy of the LVIS stent in treating intracranial atherosclerotic stenosis in the middle cerebral artery M1 segment.</p></div><div><h3>Methods</h3><p>Thirty-five patients were enrolled with 35 atherosclerotic stenoses at the M1 segment. The stenosis was about 75% in 16 patients, 80% in 15, and 90% in the rest four. The LVIS stent was used to treat these patients.</p></div><div><h3>Results</h3><p>The success rate of stenting was 97.1%. The stenting procedure was failed in one patient because of intraprocedural dissection of the stenotic (75%) segment, resulting in a 30-day periprocedural complication rate of 2.9% (1/35). Before stenting, the stenosis rate ranged 75%–90% (mean 78.9%<!--> <!-->±<!--> <!-->4.7%), and after stenting, the diameter of the stented segment was significantly (<em>P</em> <!--><<!--> <!-->0.0001) increased to 1.5–3.4<!--> <!-->mm (mean 2.1<!--> <!-->±<!--> <!-->0.32<!--> <!-->mm) ranging 68.2%–100% (mean 94.0%<!--> <!-->±<!--> <!-->5.8%) of the normal arterial diameter, with the residual stenosis ranging 0–31.8% (median 4.8%, IQR 2.4%–7.3%). Follow-up was performed at 6–20 months (mean 8.5) after stenting. One patient (2.9%) had occlusion of the stented M1 segment with no symptoms, and two patients (5.7%) had slight asymptomatic instent stenosis (40%) at the M1 segment, with the instent restenosis and occlusion rate of 8.6% (3/35).</p></div><div><h3>Conclusion</h3><p>The braided LVIS stent can be safely applied for treatment of intracranial atherosclerotic stenosis in the middle cerebral artery with good safety and efficacy immediately after stenting and at follow-up.</p></div>","PeriodicalId":19300,"journal":{"name":"Neurologia","volume":"38 8","pages":"Pages 521-529"},"PeriodicalIF":3.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nrl.2021.02.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38906922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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