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Emergencies in Movement Disorders
No full textMovement disorders is not an area of neurology known to have many clinical emergencies. However, their recognition is very important since urgent care can be needed in these cases. In this chapter we will review the more frequent and more severe emergencies in movement disorders, going from their cause to the diagnosis and treatment approach. For practical purposes, we will classify movement disorders emergencies in either hypokinetic or hyperkinetic. As it is the case for all movement disorders, careful history of the patient and physical examination is key to a correct identification of the problem and treatment strategy approach. For acute movement disorders presenting in the Emergency Department or in the hospital, a diligent review of medications taken by the patients is particularly necessary.Fil: Arena, Julieta E. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina
Heart Rate Variability and Mild Cognitive Impairment in Parkinson's Disease
No full textFil: Terroba Chambi, Cinthia. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Abulafia, Carolina. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Universidad Católica Argentina; Argentina.Fil: Vigo, Daniel Eduardo. Universidad Católica Argentina; Argentina. Katholieke Universiteit Leuven. Faculty of Psychology and Educational Sciences; Bélgica.Fil: Merello, Marcelo. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Universidad Católica Argentina; Argentina
Tratamiento quirúrgico de los cavernomas de tronco cerebral
No full textIntroducción
Los cavernomas del tronco cerebral (CTC) son malformaciones vasculares de
bajo flujo que pueden detactarse incidentalmente o presentarse con sangrado
y déficit neurológico. La resección quirúrgica continúa siendo el tratamiento
de elección. La íntima relación entre el cavernoma y las complejas estructuras
anatómicas adyacentes hacen que la cirugía sea un verdadero desafío.
Distintas zonas de entrada seguras (Safe Entry Zone, SEZ) al tronco cerebral
han sido recientemente descriptas para disminuir las probabilidades de daño
neurológico. Presentamos nuestra experiencia en el tratamiento quirúrgico
de los CTC.
Material y Método
Revisión retrospectiva de una serie de pacientes operados de CTC. Se incluyeron
pacientes mayores de 18 años de edad con diagnóstico de CTC que
habían sangrado.
Resultados
La serie incluyó 21 pacientes con CTC operados durante el período 2001-2019.
La edad promedio fue de 40 años y el seguimiento de 41 meses. El síntoma
más frecuente fue la cefalea súbita post-sangrado en el 66% de los casos y
el signo neurológico más común la hemiparesia en el 53% de los pacientes.
La localización más frecuente fue protuberencial en el 47% de los casos. Los
abordajes más utilizados fueron el telo-velo-tosilomedular y el retrosigmoideo.
Las SEZ al tronco cerebral más utilizadas fueron el triángulo suprafacial
del piso del IV ventrículo y el área peritrigeminal. El 38% de los pacientes se
operaron después del primer sangrado y el 57% post 2 sangrado. Se obtuvo
resección completa en el 95% de los casos. Al último seguimiento 71,4% de
los pacientes habían mejorado su condición clínico-neurológico respecto al
inicio, el 23,8% permanecieron sin cambios y solo el 4,7% habían empeorado.
Conclusión
La cirugía de los CTC sigue siendo el tratamiento de elección en pacientes candidatos a la misma. Lesiones sin expresión pial y oligosintomáticas podrían
controlarse clínico-radiológicamente. El detallado conocimiento de la anatomía
del tronco cerebral sumado a la utilización de monitoreo neurofisiológico
ayuda a disminuir las probabilidades de déficit neurológico postoperatorio.Fil: Cervio, Andrés. Fleni. Departamento de Neurocirugía; Argentina.Fil: Giovannini, Sebastián Juan María. Fleni. Departamento de Neurocirugía; Argentina.Fil: Caffaratti, Guido. Fleni. Departamento de Neurocirugía; Argentina.Fil: Villamil, Facundo. Fleni. Departamento de Neurocirugía; Argentina.Fil: Mormandi, Rubén. Fleni. Departamento de Neurocirugía; Argentina.Fil: Nuñez, Maximiliano. Hospital el Cruce. Departamento de Neurocirugía; Argentina.Fil: Grijalba Romero, Miguel. Hospital Garrahan. Departamento de Neurocirugía; Argentina
Traumatic vs Spontaneous Cerebrospinal Fluid Hypotension Headache: Our experience in a series of 137 cases
No full textObjectives: To analyze and compare differences between epidemiological and clinical aspects, as well as radiologic findings and treatment, in a series of adult patients with traumatic intracranial hypotension (TIH) and spontaneous intracranial hypotension (SIH) treated at our institution in order to identify predictors of recurrence.
Background: Cerebrospinal fluid hypotension headache (CSF-HH) is often caused by orthostasis and relieved by recumbency. Etiology can be either traumatic or spontaneous. Indirect signs of CSF hypotension are often observed on brain MRI. The most common therapeutic approach is conservative management and, when necessary, the use of an epidural blood patch.
Methods: Medical history and brain MRI of adult patients consulting our institution with a diagnosis of CSF-HH between January 2010 and March 2019, were retrospectively reviewed. Clinical criteria as per the International Classification of Headache Disorders, 3rd edition, were applied. Presence of typical MRI findings were assessed by two experienced neuroradiologists, previously informed of patients' clinical characteristics. Patients were divided into two different groups, namely: Group A: Spontaneous Intracranial Hypotension (SIH) and Group B: Traumatic Intracranial Hypotension (TIH). Recurrence was defined as return of symptoms after one month of remission. In order to find predictors of recurrent intracranial hypotension the patients were divided into three groups: Recurrent Orthostatic headache (ROH); (33 cases; 25%); Non-Recurrent Orthostatic headache (NROH) (84; 61%) and Patients missing follow-up (20; 15%). The latter were excluded from the regression analysis.
Results: 137 patients with CSF-HH were identified: 80 traumatic (54 women, age 33.8 ± 10.4 years) and 57 spontaneous (31 women, age 43.9 ± 15.2 years). Median follow-up was 35 months (range: 8 months-9 years). Compared with TIH, patients with SIH showed lower frequency of orthostatic headache and higher frequency of aural fullness. Also, in patients with SIH, brain MRI showed a higher frequency of pachymeningeal enhancement, ventricular collapse, cisternal obliteration, posterior fossa crowding, brainstem distortion, and a more likely presence of subdural collections. Patients with SIH required an epidural blood patch treatment more often, showed higher recurrence rates, and were more prone to develop subdural hematomas.
Recurrence: As more days elapsed between headache onset and clinical consultation, the presence of spontaneous intracranial hypotension, tinnitus, and thoraco-lumbo-sacral pain were all more common in patients with recurrence. Findings on brain MRI suggesting higher recurrence rates in patients included: ventricular collapse, brainstem distortion, and posterior fossa crowding. Patients treated with invasive therapy (epidural blood patch) presented a higher recurrence rate. In the multivariate regression analysis, the only independent predictor of recurrence after adjusting for age, sex and traumatic vs spontaneous cause of IH, was brainstem distortion diagnosed on MRI (OR 5.13, 95% CI: 1.2-21.7; p = 0.026).
Conclusions: SIH and TIH can no longer be likened, since there is considerable variability in clinical presentation, imaging findings, response to treatment and recurrence rates. Anatomical abnormalities underlying SIH leaks are often complex and not simply a disruption of normal structures as encountered in TIH, which could explain why treatment success is poor and recurrence rates remain high.Fil: Villamil, Facundo. Fleni. Departamento de Neurocirugía; Argentina.Fil: Ruella, Mauro E. Fleni. Departamento de Neurocirugía; Argentina.Fil: Pérez, Adriana. Fleni. Servicio de Anestesiología; Argentina.Fil: Millar Vernetti, Patricio. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.Fil: Paday Formenti, María Emilia. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Acosta, Julián Nicolás. Fleni. Departamento de Neurología; Argentina
Intravenous Chlorpromazine as Potentially Useful Treatment for Chronic Headache Disorders
No full textObjective: The aim of this study was to describe a group of patients with chronic headache disorders (CH) and medication overuse headache (MOH) treated with intravenous chlorpromazine (IVC). We hypothesized that IVC is an effective and safe addition to well-known treatment strategies for CH and MOH management.
Introduction: Up to 4% of the general population could experience CH. Most cases occur in women, in association with MOH. To date, evidence to support different treatment strategies is lacking. Although IVC is frequently used in the emergency room (ER), documentation on its use as supportive treatment for CH and for withdrawal management of MOH is poor.
Methods: A retrospective cohort of patients hospitalized to receive treatment for CH in a specialized neurological center in Argentina was analyzed.
Results: A total of 35 CH patients were included. Of the 35 patients, 33 (94%) patients also presented MOH. Patients reported only minor side effects to IVC administration (mainly drowsiness and symptomatic hypotension). Three months after inpatient treatment, the number of ER visits made by these patients decreased from an average of 2.8 in the 3 months prior to hospitalization to 0.7 after it (72%, P = .009). Headache frequency decreased in 20/34 (59%) patients during the same time period. Pain levels had dropped from a mean of 8 points at admission (in the scale of 1-10) to 2 points at discharge. In the first 3 months of follow-up, the average number of days per month in which patients experienced headache decreased from 28.9 to 15.4 days (53.3%, P < .0001).
Conclusion: In this particular group of inpatients, there were no significant safety issues with IVC administration and the study might suggest that the efficacy of IVC as an add-on treatment for CH and MOH.Fil: Ruiz Yanzi, María A. Fleni. Departamento de Neurología; Argentina.Fil: Goicochea, María Teresa. Fleni. Departamento de Neurología. Clínica del Dolor. Clínica de Cefaleas; Argentina.Fil: Yorio, Florencia. Fleni. Departamento de Neurología; Argentina.Fil: Alessandro, Lucas. Fleni. Departamento de Neurología; Argentina.Fil: Marrodán, Mariano. Fleni. Departamento de Neurología; Argentina.Fil: Farez, Mauricio Franco. Fleni. Centro de Epidemiología, Bioestadística y Salud Pública; Argentina
Comment on: The Geographic Diversity of Spinocerebellar Ataxias (SCAs) in the Americas
Get PDFResumen no disponibleFil: Rossi, Malco. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Guarnaschelli, Marlen. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.Fil: Zajd, Ana. GENDA; Argentina.Fil: RIgarreta, Pilar. GENDA; Argentina
Statin use and myopathy. Not always guilty.
Get PDFObjectives. Statins are the cornerstone of the treatment and prevention of cardiovascular disease but have been
associated with muscular side effects, among others. If patients are not properly evaluated, statin discontinuation
may take place, leaving patients’ symptoms unresolved and precluding an effective cardiovascular treatment. The
present study aims to describe the clinical characteristics, the diagnostic process and the final diagnosis of
selected patients with suspected statin-induced myopathy, with quite different alternative diagnoses.
Methods. Among the 86 patients referred to our unit for evaluation since 2012, 6 patients with suspected statininduced
myopathy that was finally ruled out were selected as examples because of their illustrative value. All
patients were evaluated in a Muscular Diseases Unit by myology experts, and additional testing was performed
according to clinical suspicion.
Results. Of the six selected patients with suspected statin-induced myopathy, three had a neurogenic aetiology,
two had vacuolar myopathies and one had severe hypothyroidism. Statins were permanently discontinued in two
cases, with the treatment of one of the latter patients being continued with a protein convertase subtilisin/kexin
type 9 (PCSK9) inhibitor.
Conclusion. Not all patients taking statins who develop muscle complaints have statin-related myopathy. A thorough
clinical evaluation and appropriate testing is warranted to avoid an unnecessary increase in cardiovascular
risk.Fil: Antoniol, María Noelia. Fleni. Departamento de Medicina Interna. Sección de Reumatología; Argentina.Fil: Moreno, Pedro J. Hospital Clínic de Barcelona. Internal Medicine Department. Muscle Research Unit; España. Universidad de Barcelona. Center for Biomedical Research on Rare Diseases; España.Fil: Milisenda, José C. Hospital Clínic de Barcelona. Internal Medicine Department. Muscle Research Unit; España. Universidad de Barcelona. Center for Biomedical Research on Rare Diseases; España.Fil: Selva O’Callaghan, Albert. Hospital Vall d'Hebron. Internal Medicine Department; España.Fil: Grau, Josep María. Hospital Clínic de Barcelona. Internal Medicine Department. Muscle Research Unit; España. Universidad de Barcelona. Center for Biomedical Research on Rare Diseases; España.Fil: Padrosa, Joan. Hospital Clínic de Barcelona. Internal Medicine Department. Muscle Research Unit; España. Universidad de Barcelona. Center for Biomedical Research on Rare Diseases; España
White cord syndrome in a pediatric patient: A case report and review
No full textWhite cord syndrome is a rare condition involving sudden neurological deterioration following a decompressive cervical spinal surgery and characterized by the appearance of hyperintensity on T2-weighted magnetic resonance imaging. We present a report of a pediatric male patient who presented with the condition. This case shows that white cord syndrome can also be present in pediatric patients. We provide a brief review of the literature highlighting the main radiologic findings.Fil: Carballo, Leandro. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Carnevale, Martín Diego. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Yáñez, Paulina. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.Fil: Sepulveda Hermosilla, Francisco. Department of Neuroradiology, Instituto de Neurocirugía Dr. Asenjo. Departamento de Neuroradiología; Chile
Recomendaciones actualizadas para la profilaxis de la enfermedad tromboembólica venosa en Argentina
Get PDFLa enfermedad tromboembólica venosa (ETV) en adultos hospitalizados posee elevada morbimortalidad, es origen de complicaciones crónicas y determina incrementos de costos para el sistema de salud.
Desde la publicación de recomendaciones de tromboprofilaxis en pacientes internados en 2013, han surgido nuevas alternativas y estrategias, que nos motivaron a actualizar nuestras recomendaciones. A pesar de que existen diferentes consensos y guías de práctica clínica la adherencia a las mismas es subóptima. Se han actualizado las diferentes alternativas terapéuticas para los adultos hospitalizados (clínicos no quirúrgicos, quirúrgicos no ortopédicos, con y sin cáncer, ortopédicos y embarazadas), poniendo particular atención en los fármacos disponibles en Argentina.Fil: Vazquez, Fernando F. Hospital Italiano de Buenos Aires. Servicio de Clínica Médica; Argentina.Fil: Korin, Jorge. Sanatorio Los Arcos. Argentina; Argentina.Fil: Baldessari, Enrique M. Fundación Favaloro. Departamento de Medicina Interna; Argentina.Fil: Capparelli, Federico Javier. Fleni. Departamento de Medicina Interna; Argentina.Fil: Gutierrez, Paula. Hospital Italiano de Buenos Aires. Servicio de Clínica Médica; Argentina.Fil: Pale, Carlos. Sanatorio Las Lomas. Clínica Médica; Argentina.Fil: Bocanegra, Florencia. Hospital Italiano de Buenos Aires. Clínica Médica; Argentina.Fil: Grand, Beatriz. Hospital Juan A. Fernández. Departamento Materno Infantil; Argentina.Fil: Vilaseca, Alicia. Clínica San Camilo. Hematología; Argentina.Fil: Penchasky, Diana. Hospital Italiano de Buenos Aires. Servicio de Clínica Médica. Sección Hematología; Argentina.Fil: González Alcantara, Maria Mónica. Hospital Juan A. Fernández. División Obstetricia; Argentina.Fil: Prémoli, María Sol. Hospital Español de Rosario; Argentina.Fil: Tabares, Aldo. Hospital Privado Universitario de Córdoba. Servicio de Medicina Vascular y Trombosis; Argentina.Fil: Wainsztein, Néstor Adrián. Fleni. Departamento de Medicina Interna; Argentina.Fil: Odetto, Diego. Hospital Italiano de Buenos Aires. Servicio de Ginecología. Sección de Oncología Ginecológica; Argentina.Fil: Vaccaro, Carlos. Hospital Italiano de Buenos Aires. Servicio de Cirugía General; Argentina.Fil: Martínez Aquino, Eleno. Sanatorio Franchin. Servicio de Clínica Médica; Argentina.Fil: Cumpian, Olga. Hospital Español de Mendoza. Servicio de Hematología; Argentina.Fil: Falabella, Verónica. Sanatorio Santa Isabel. Clínica Médica; Argentina.Fil: García, Santiago Antuel. Clínica 25 de Mayo. Hematología y Hemoterapia; Argentina.Fil: Saadi, José. Hospital Italiano de Buenos Aires. Servicio de Ginecología. Sección de Oncología Ginecológica; Argentina.Fil: Siccardi, Mariana. Hospital Español de Rosario; Argentina.Fil: Gándara, Esteban. Hospital Privado de la Comunidad. Servicio de Clínica Médica; Argentina
Culture shapes our understanding of others’ thoughts and emotions: An investigation across 12 countries
No full textHumans have developed specific abilities to interact efficiently with their conspecifics (social cognition). Despite abundant behavioral and neuroscientific research, the influence of cultural factors on these skills remains poorly understood. This issue is of particular importance as most cognitive tasks are developed in highly specific contexts, not representative of what is encountered by the world’s population. Through a large international and multi-site study, we assessed core social cognition aspects using current gold-standard tasks in 587 participants from 12 countries. Age, gender, and education were found to impact emotion recognition as well as the ability to infer mental states. After controlling for these factors, differences between countries accounted for more than 20% of the variance on both abilities. Importantly, it was possible to isolate cultural from linguistic impacts, which classically constitute a major limitation. We suggest important methodological shifts to better represent social cognition at the fundamental and the clinical levels.Fil: Allegri, Ricardo Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Crivelli, Lucía. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Calandri, Ismael Luis. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Clarens, María Florencia. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: Magrath Guimet, Nahuel. Fleni. Departamento de Neurología. Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría; Argentina.Fil: François, Quesque. Université de Lille; Francia.Fil: Coutrot, Antoine. Université de Nantes; Francia.Fil: Cox, Sharon. University College London. Institute of Epidemiology and Healthcare. Department of Behavioural Science and Health; Reino Unido.Fil: de Souza, Leonardo Cruz. University of Belo Horizonte; Brasil.Fil: Baez, Sandra. Universidad de los Andes; Colombia.Fil: Cardona, Juan Felipe. Universidad del Valle. Instituto de Psicología; Colombia.Fil: Mulet-Perreault, Hannah. Université Laval and CERVO Brain Research Centre; Canadá.Fil: Flanagan, Emma. University of East Anglia. Norwich Medical School; Reino Unido. University of Cambridge. Department of Clinical Neurosciences; Reino Unido.Fil: Neely-Prado, Alejandra. Adolfo Ibáñez University. Center for Social and Cognitive Neuroscience, School of Psychology; Chile.Fil: Cassimiro, Luciana. University of São Paulo. School of Arts, Sciences and Humanities; Brasil. University of São Paulo. Department of Neurology; Brasil.Fil: Musa, Gada. Universidad de Chile; Chile.Fil: Kemp, Jennifer. University of Strasbourg; Francia.Fil: Botzung, Anne. University of Strasbourg; Francia.Fil: Philippi, Nathalie. University of Strasbourg; Francia.Fil: Cosseddu, Maura. Spedali Civili Hospital. Neurology Unit; Italia.Fil: Trujillo, Catalina. Universidad del Valle. Instituto de Psicología; Colombia