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Masjuan J, Gállego J, Aguilera J, Arenillas J, Castellanos M, Díaz F, Portilla J, Purroy F. Use of cardiovascular polypills for the secondary prevention of cerebrovascular disease. Neurología (English Edition) 2021. [DOI: 10.1016/j.nrleng.2017.10.008] [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: 10/26/2022] Open
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Masjuan J, Gállego J, Aguilera JM, Arenillas JF, Castellanos M, Díaz F, Portilla JC, Purroy F. Use of cardiovascular polypills for the secondary prevention of cerebrovascular disease. Neurologia 2018; 36:1-8. [PMID: 29325730 DOI: 10.1016/j.nrl.2017.10.013] [Citation(s) in RCA: 2] [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: 06/08/2017] [Revised: 09/28/2017] [Accepted: 10/03/2017] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION There is little control of cardiovascular (CV) risk factors in secondary prevention after an ischaemic stroke, in part due to a lack of adherence to treatment. The CV polypill may contribute to proper treatment adherence, which is necessary for CV disease prevention. This study aimed to establish how and in what cases the CV polypill should be administered. METHODS A group of 8 neurologists drafted consensus recommendations using structured brainstorming and based on their experience and a literature review. RESULTS These recommendations are based on the opinion of the participating experts. The use of the CV polypill is beneficial for patients, healthcare professionals, and the health system. Its use is most appropriate for atherothrombotic stroke, lacunar stroke, stroke associated with cognitive impairment, cryptogenic stroke with CV risk factors, and silent cerebrovascular disease. It is the preferred treatment in cases of suspected poor adherence, polymedicated patients, elderly people, patients with polyvascular disease or severe atherothrombosis, young patients in active work, and patients who express a preference for the CV polypill. Administration options include switching from individual drugs to the CV polypill, starting treatment with the CV polypill in the acute phase in particular cases, use in patients receiving another statin or an angiotensin ii receptor antagonist, or de novo use if there is suspicion of poor adherence. Nevertheless, use of the CV polypill requires follow-up on the achievement of the therapeutic objectives to make dose adjustments. CONCLUSIONS This document is the first to establish recommendations for the use of the CV polypill in cerebrovascular disease, beyond its advantages in terms of treatment adherence.
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Affiliation(s)
- J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Invictus Plus, Red Nacional de Investigación en Ictus, Madrid, España.
| | - J Gállego
- Complejo Hospitalario de Navarra, Pamplona, España
| | - J M Aguilera
- Hospital Universitario de Nuestra Señora de Valme, Sevilla, España
| | - J F Arenillas
- Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Castellanos
- Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de Coruña INIBIC, La Coruña, España
| | - F Díaz
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J C Portilla
- Hospital Universitario San Pedro de Alcántara, Cáceres, España
| | - F Purroy
- Hospital Arnau de Vilanova, Lérida, España
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Mercadal S, Vidal N, López-Parra M, Ibañez M, Caldú R, Bobillo S, Barceló I, García E, Martinez P, Cacabelos P, Dlouhy I, Sancho J, Muntañola A, Gómez L, Erro E, Gállego J, Salar A, Caballero A, Solé M, Huertas N, Estela J, Baron M, Barbero N, González-Barca E, Graus F, Velasco R. Initial management of primary central nervous system lymphoma in Spain in the last decade. The experience of the GELTAMO and Spanish neuro-oncology groups. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_107] [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: 11/09/2022]
Affiliation(s)
- S. Mercadal
- Hematology; Catalan Institute of Oncology. Hospital Duran i Reynals., L'Hospitalet de Llobregat; Barcelona Spain
| | - N. Vidal
- Pathology; Hospital de Bellvitge, L'Hospitalet de Llobregat; Barcelona Spain
| | - M. López-Parra
- Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - M. Ibañez
- Neurology; Hospital Universitario i Politècnic La Fe; Valencia Spain
| | - R. Caldú
- Neurology; Hospital Universitario Miguel Servet; Zaragoza Spain
| | - S. Bobillo
- Hematology; Hospital Vall d'Hebrón; Barcelona Spain
| | - I. Barceló
- Neurology; Hospital Universitario Son Espases; Palma de Mallorca Spain
| | - E. García
- Neurology; Hospital Universitario Virgen de la Arrixaca; Murcia Spain
| | - P. Martinez
- Hematology; Hospital Universitario Doce de Octubre; Madrid Spain
| | - P. Cacabelos
- Neurology; Complejo hospitalario Santiago Compostela; Santiago Compostela Spain
| | - I. Dlouhy
- Hematology; Hospital Clínic; Barcelona Spain
| | - J. Sancho
- Hematology; ICO. Hospital Germans Trias i Pujol; Badalona Spain
| | - A. Muntañola
- Hematology; Hospital Mutua de Terrassa; Terrassa Spain
| | - L. Gómez
- Neurology; Hospital Quirón; Madrid Spain
| | - E. Erro
- Neurology; Hospital de Navarra; Pamplona Spain
| | - J. Gállego
- Neurology; Clínica Universitaria de Navarra; Pamplona Spain
| | - A. Salar
- Hematology; Hospital del Mar; Barcelona Spain
| | - A. Caballero
- Hematology; Hospital de Sant Pau; Barcelona Spain
| | - M. Solé
- Hematology; Hospital Virgen del Rocío; Sevilla Spain
| | - N. Huertas
- Neurology; Hospiatl Severo Ochoa; Leganés Spain
| | - J. Estela
- Neurology; Hospital Parc Taulí; Sabadell Spain
| | - M. Baron
- Neurology; Hospital Fundación Alcorcón; Alcorcón Spain
| | - N. Barbero
- Neurology; Hospital Rey Juan Carlos; Móstoles Spain
| | - E. González-Barca
- Hematology; Catalan Institute of Oncology. Hospital Duran i Reynals., L'Hospitalet de Llobregat; Barcelona Spain
| | - F. Graus
- Hematology; Hospital Clínic; Barcelona Spain
| | - R. Velasco
- Neurology; Hospital de Bellvitge, L'Hospitalet de Llobregat; Barcelona Spain
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Fortea F, Masjuan J, Arikán-Abello F, Rovira A, González A, Arenillas J, Fernández Alen J, Gállego J. Criterios para la formación y capacitación en Neurorradiología Intervencionista-Neurointervencionismo, acordados por el Grupo Español de Neurorradiología Intervencionista (GENI), la Sociedad Española de Neurorradiología (SENR), el Grupo de Estudio de Enfermedades Cerebrovasculares (GEECV) de la Sociedad Española de Neurología (SEN) y el grupo experto en enfermedades vasculares de la Sociedad Española de Neurocirugía (SENEC). Bases para la obtención de una Acreditación de Centros y Especialistas en Neurorradiología Intervencionista-Neurointervencionismo. Neurologia 2017; 32:106-112. [DOI: 10.1016/j.nrl.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/14/2016] [Indexed: 11/29/2022] Open
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5
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Fortea F, Masjuan J, Arikán-Abello F, Rovira A, González A, Arenillas J, Fernández Alen J, Gállego J. Criteria for training and accreditation in Interventional Neuroradiology-Neurointervention, approved by the Spanish Group of Interventional Neuroradiology (GENI), the Spanish Society of Neuroradiology (SENR), the Spanish Group of Cerebrovascular Diseases (GEECV), the Spanish Society of Neurology (SEN), and the vascular disease specialists in the Spanish Society of Neurosurgery (SENEC). Requirements for accreditation in Interventional Neuroradiology-Neurointervention for institutions and specialists. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2016.02.002] [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: 11/25/2022] Open
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Cayuela N, Majos C, Simó M, Ripollés P, Gállego J, Graus F, Gil F, Gil-Gil M, Vidal N, Bruna J. P07.07 Tumor location and seizure risk in glioblastoma population. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.118] [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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Šmíd J, Martínez G, Gebhart J, Aznar J, Gállego J, Göçmen B, De Pous P, Tamar K, Carranza S. Phylogeny of the genus Rhynchocalamus (Reptilia; Colubridae) with a first record from the Sultanate of Oman. Zootaxa 2015; 4033:380-92. [PMID: 26624412 DOI: 10.11646/zootaxa.4033.3.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Indexed: 11/04/2022]
Abstract
The genus Rhynchocalamus comprises three species distributed in Southwest Asia. Little is known about them, most probably because of their secretive fossorial lifestyle. The poor knowledge of the genus is even underscored by the fact that its phylogenetic affinities remained unclear until very recently. The least known of the species, Rhynchocalamus arabicus, is known only from the holotype collected in Aden, Yemen, and it has not been observed since its description in 1933. Here we provide a second record for this species, which represents the first record of this genus for Oman. This extends its range in southern Arabia by more than 1000 km. The observed specimen was determined as R. arabicus on the basis of its similarity in size, color, and scalation with the holotype. Furthermore, we sequenced three mitochondrial (12S, 16S, cytb) and one nuclear (cmos) genes for R. arabicus and for two individuals of R. melanocephalus and one R. satunini and inferred the phylogenetic relationships of all currently recognized species of the genus for the first time. The results of our phylogenetic analyses indicate that Rhynchocalamus is a member of the Western Palearctic clade of Colubrinae and is sister to Lytorhynchus, with which it forms a very well supported clade and shares some morphological characters. As our results show, R. satunini is the basal lineage of the genus and R. melanocephalus is sister to R. arabicus.
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Affiliation(s)
- Jiří Šmíd
- Department of Zoology, National Museum, Cirkusová 1740, Prague, Czech Republic; unknown
| | - Gabriel Martínez
- C/ Pedro Antonio de Alarcón nº 34, 5º A, 18002, Granada, Spain; unknown
| | | | - Javier Aznar
- C/ Uruguay nº16, 3ºA, 28016 Madrid, Spain; unknown
| | - Javier Gállego
- Carretera motores, 211, 04720 Aguadulce, Almeria, Spain; unknown
| | - Bayram Göçmen
- Department of Biology, Zoology Section, Faculty of Science, Ege University, TR 35100 Bornova-Izmir, Turkey; unknown
| | - Philip De Pous
- Faculty of Life Sciences and Engineering, Departament de Producció Animal (Fauna Silvestre), Universitat de Lleida, E-125198, Lleida, Spain Institute of Evolutionary Biology (CSIC-Universitat Pompeu Fabra), Passeig Maritim de la Barceloneta 37-49, 08003 Barcelona, Spain; unknown
| | - Karin Tamar
- Department of Zoology, Tel-Aviv University, Tel-Aviv 6997801, Israel; unknown
| | - Salvador Carranza
- Institute of Evolutionary Biology (CSIC-Universitat Pompeu Fabra), Passeig Maritim de la Barceloneta 37-49, 08003 Barcelona, Spain;
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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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9
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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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10
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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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11
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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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12
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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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13
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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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Muñoz R, Durán-Cantolla J, Martinez-Vila E, Gállego J, Rubio R, Aizpuru F, De La Torre G, Barbé F. Central sleep apnea is associated with increased risk of ischemic stroke in the elderly. Acta Neurol Scand 2012; 126:183-8. [PMID: 22150745 DOI: 10.1111/j.1600-0404.2011.01625.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Sleep apnea/hypopnea syndrome is a well-recognized independent risk factor for stroke in middle-aged population, but controversy remains in older subjects. We examined the possible association between different respiratory parameters and risk of stroke in a prospective population-based cohort of 394 stroke-free elderly subjects. MATERIAL AND METHODS Fully overnight polysomnography was performed at baseline. Over the 6 year follow-up period, 20 ischemic strokes occurred. Differences in stroke-free survival between subjects according to central apnea index (CAI) were assessed. RESULTS We just observed association with incident ischemic stroke on central sleep apnea (CSA) episodes. Obstructive sleep apnea, time passed under 90% oxygen saturation, or arousal index were not associated. The event-free survival was lowest in the highest CAI group. This association was independent of any other vascular risk factors. CONCLUSIONS CSA is the specific respiratory event associated with stroke in the elderly. Additionally, CSA could be a marker of silent brain ischemia, as a sign of disturbed regulation of central respiratory mechanisms, tentatively of ischemic origin.
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Affiliation(s)
- R Muñoz
- Complejo Hospitalario de Navarra, Pamplona, Spain.
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15
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Gállego J, Gil Alzueta M. Dabigatrán: una nueva alternativa terapéutica en la prevención del infarto cerebral. Neurologia 2012; 27 Suppl 1:39-45. [DOI: 10.1016/s0213-4853(12)70007-5] [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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16
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Vera R, Lago A, Fuentes B, Gállego J, Tejada J, Casado I, Purroy F, Delgado P, Simal P, Martí-Fábregas J, Vivancos J, Díaz-Otero F, Freijo M, Masjuan J. In-hospital stroke: a multi-centre prospective registry. Eur J Neurol 2011; 18:170-6. [PMID: 20550562 DOI: 10.1111/j.1468-1331.2010.03105.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND in-hospital strokes (IHS) are relatively frequent. Avoidable delays in neurological assessment have been demonstrated. We study the clinical characteristics, neurological care and mortality of IHS. METHODS multi-centre 1-year prospective study of IHS in 13 hospitals. Demographic and clinical characteristics, admission diagnosis, quality of care, thrombolytic therapy and mortality were recorded. RESULTS we included 273 IHS patients [156 men; 210 ischaemic strokes (IS), 37 transient ischaemic attacks (TIA) and 26 cerebral haemorrhages]. Mean age was 72 ± 12 years. Cardiac sources of embolism were present in 138 (50.5%), withdrawal of antithrombotic drugs in 77 (28%) and active cancers in 35 (12.8%). Cardioembolic stroke was the most common subtype of IS (50%). Reasons for admission were programmed or urgent surgery in 70 (25%), cardiac diseases in 50 (18%), TIA or stroke in 30 (11%) and other medical illnesses in 71 (26%). Fifty-two per cent of patients were evaluated by a neurologist within 3 h of stroke onset. Thirty-three patients received treatment with tPA (15.7%). Thirty-one patients (14.7%) could not be treated because of a delay in contacting the neurologist. During hospitalization, 50 patients (18.4%) died, 41 of them because of the stroke or its complications. CONCLUSIONS cardioembolic IS was the most frequent subtype of stroke. Cardiac sources of embolism, active cancers and withdrawal of antithrombotic drugs constituted special risk factors for IHS. A significant proportion of patients were treated with thrombolysis. However, delays in contacting the neurologist excluded a similar proportion of patients from treatment. IHS mortality was high, mostly because of stroke.
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Affiliation(s)
- R Vera
- Hospital Ramón y Cajal, Madrid Hospital La Fe, Valencia Hospital La Paz, Madrid, Spain
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17
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Alvarez-Sabín J, Masjuan J, Alonso de Leciñana M, Lago A, Gállego J, Arenillas J, López-Fernández JC, Calleja S, Quintana M. [Necessary components in the hospitals that attend patients with stroke: results of a survey of Spanish experts]. Neurologia 2009; 24:373-378. [PMID: 19798603] [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: 05/28/2023] Open
Abstract
INTRODUCTION The stroke network considers the presence of hospitals with stroke teams (STH), stroke units (SUH) and Comprehensive Stroke Centers (CSC). The aim of the current study is to identify, according to specialized vascular neurologists, the main components needed in different kind of stroke centers. METHODS A survey was carried out between February and March 2008 to know the opinion of 36 vascular neurologists. Questions were about the components needed in each hospital level treating stroke patients. RESULTS Neurologists considered that STH must have as indispensable requirements the following components: emergency department, laboratory and computerized tomography scan facilities with full time availability (24 hours a day/7 days a week), multidisciplinary team including physiotherapists, action plans and pre-established referral circuits to SUH and CSC. Experts considered indispensable for SUH the aforementioned components and specific beds with multiparametric vitals monitoring, expert vascular neurologists, specialized nursery, neurologist on call, intravenous thrombolysis (full time), intensive care unit (ICU), neurorehabilitation specialists, diagnosis neuroradiologists, social workers, echocardiography, full time available neurosurgery, stroke register and educational programmes for patients and relatives. CSC must have the same components as STH-SUH and neurosurgeons specialized in stroke surgery, vascular surgeons specialized in carotid surgery and doctors specialized in endovascular intervention with full time availability. CONCLUSIONS The results show the components or requirements that are considered necessary by specialized vascular neurologists, evaluated on the basis of different hospital levels treating stroke patients.
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Affiliation(s)
- José Alvarez-Sabín
- Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona.
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Navarro MC, Erro ME, Cabada T, Gállego J. [Recurrent paramedian pontine stroke secondary to saccular basilar trunk aneurysms]. Neurologia 2009; 24:77-78. [PMID: 19214823] [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: 05/27/2023] Open
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Mayor S, Erro ME, Zazpe I, Gállego J. [Pontine stroke due to vasospasm secondary to perimesencephalic subarachnoid hemorrhage]. Neurologia 2008; 23:256-258. [PMID: 18516747] [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: 05/26/2023] Open
Abstract
INTRODUCTION Spontaneous non-aneurysmal subarachnoid hemorrhages generally have a good short and long term outcome, especially those with a perimesencephalic location. Vasospasm is an uncommon complication of this type of subarachnoid hemorrhage, and ischemic cerebral lesions related to vasospasm are even less frequent. CASE REPORT A 46 year-old man was admitted with a perimesencephalic subarachnoid hemorrhage. Angiographic study performed on admission was normal. Two weeks later he developed dysarthria and right faciobrachial paresis. Transcranial doppler showed a diffuse and moderate increase of medium velocity flow at basilar artery level suggestive of moderate vasospasm. An angioresonance confirmed this finding and a paramedian pontine infarction was found on resonance images. The patient was treated with nimodipine and he was discharged from hospital with only mild residual deficit. CONCLUSION Cerebral infarction related to vasospasm as complication of subarachnoid perimesencephalic hemorrhage is exceptional. The factors that could have been involved in the development of this complication are discussed.
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Affiliation(s)
- S Mayor
- Servicio de Neurología, Hospital de Navarra, Pamplona, Navarra, Spain
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Herrera M, Gállego J, Muñoz R, Aymerich N, Zandio B. [Reperfusion in acute ischaemic stroke: present and future]. An Sist Sanit Navar 2008; 31 Suppl 1:31-46. [PMID: 18528442] [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: 05/26/2023]
Abstract
Cerebral ischaemia is a dynamic process triggered when an intracranial artery is acutely occluded, normally due to an embolism from the heart or from arteriolosclerotic lesions of more proximal arteries. Urgent rerouting of these arteries and early reperfusion of the cerebral tissue, neuroprotector therapies that intervene in the ischaemic cascade and prevention of recurrence are the therapeutic aims in the acute phase of ischaemic stroke. Thrombolytic treatment pursues the lysis of the dot occluding the intracranial artery. At present, the only approved thrombolytic treatment is the intravenous Recombinant Tissue Plasminogen Activator (rtPA). Its safety and efficacy within the first three hours of evolution of the ischaemic stroke have been demonstrated. Establishment of this treatment involves a profound change in the health structures and the training of the personnel responsible. The small therapeutic window and the limitations of this medicine in daily practice have led to the urgent exploration of new strategies: we review the reconsideration of exclusion criteria (especially in the elderly and in minor neurological deficits or those of rapid improvement), the widening of the therapeutic window beyond 3 hours with the selection of patients by multimodal image, the possibility of thrombolysis combined with antithrombotic drugs or with enhancement through ultrasound. We also review the new thrombolytics that are appearing and the intra-arterial thrombolysis approach and therapies of endovascular mechanical reperfusion.
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Affiliation(s)
- M Herrera
- Servicio de Neurología, Hospital de Navarra, Pamplona, Spain.
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Muñoz R, Gállego J, Herrera M. Nuevas perspectivas en el manejo de la hemorragia intracraneal. An Sist Sanit Navar 2008. [DOI: 10.4321/s1137-66272008000200005] [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: 11/11/2022]
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Gállego J, Herrera M, Jericó I, Muñoz R, Aymerich N, Martínez-Vila E. [Stroke in the XXI century. Emergency care]. An Sist Sanit Navar 2008; 31 Suppl 1:15-29. [PMID: 18528441] [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: 05/26/2023]
Abstract
Cerebrovascular diseases have reached epidemic proportions worldwide. They are the major cause of mortality in developed countries, accounting for over one-quarter of worldwide documented deaths, and the leading cause of severe disability in adults. Given that Spain will become one of the countries most affected by population ageing, an increase in the incidence of these diseases is expected in coming years. Several studies have reported that public levels of awareness of stroke warning signs, symptoms and risk factors are relatively low. Information campaigns aimed at increasing these levels of awareness and considering stroke as a neurological emergency are needed. The stroke code is a system which allows rapid identification, notification, and transfer of stroke patients to the emergency units. Technological advances in stroke diagnosis, and the development of effective therapeutic measures, such as thrombolytics, require a coordinated multidisciplinary approach. Treating patients in Stroke Units is the most effective and efficient approach in acute ischemic or hemorrhagic stroke management. In coming years research advances will provide new and better strategies in acute stroke treatment.
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Affiliation(s)
- J Gállego
- Servicio de Neumología, Hospital de Navarra, Pamplona, Spain.
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26
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Herrera M, Erro ME, Aymerich N, Gállego J. [Involuntary movements in brainstem ischemic lesions]. Neurologia 2007; 22:475-9. [PMID: 17853968] [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: 05/17/2023] Open
Abstract
INTRODUCTION The appearance of movement disorders in vascular disease of the brainstem has hardly been described in the literature. Its frequency is probably underestimated due to their briefness and that they are often misinterpreted as epileptic seizures. Their pathophysiological mechanism is uncertain. Several mechanisms, such as the existence of a seizure-generating brainstem center, capable of generating epileptic activity or the interruption of the corticospinal tracts due to ischemia, have been proposed. CLINICAL CASES We present three patients with disease of the basilar artery and extensive brainstem infarction who have the presentation of sudden, involuntary movements in limbs in the initial phase, in paroxysms of short duration and of varied semiology in common. We described this in all of them. An electroencephalographic functional study during these episodes was done in one of the cases. CONCLUSIONS Preservation of conscious level, its variability of presentation, the null response to antiepileptic drugs and normality of the electroencephalogram in one of them leads us to ratify the hypothesis of failure of the cortical inhibitory projections as subcortical centers in trunk or spinal cord as pathophysiological origin of these involuntary movements. We stress the importance of recognizing these clinical manifestations of appearance in the initial phases of the disease, that permit a rapid diagnosis with the help of the transcranial Doppler to establish an early and aggressive treatment of this disease having known seriousness and bad prognosis. Further prospective studies would be interesting to know what the real incidence of these movements is, and functional ones to clarify the pathophysiological nature of this phenomenon.
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Affiliation(s)
- M Herrera
- Sección de Neurología, Hospital de Navarra, Pamplona.
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27
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Iriarte J, Ayuso T, Echavarri C, Alegre M, Urrestarazu E, Lacruz F, Gállego J, Artieda J. AGRYPNIA EXCITATA IN FATAL FAMILIAL INSOMNIA. A VIDEO-POLYGRAPHIC STUDY. Neurology 2007; 69:607-8. [PMID: 17679681 DOI: 10.1212/01.wnl.0000266664.68223.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Iriarte
- Clinical Neurophysiology Section, Department of Neurology, Clínica Universitaria, University of Navarra, Pamplona, Navarra, Spain.
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28
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Herrera M, Erro ME, Gállego J. [Hyperdense posterior cerebral artery sign]. Neurologia 2007; 22:182-3. [PMID: 17364257] [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: 05/14/2023] Open
Affiliation(s)
- M Herrera
- Servicio de Neurología, Hospital de Navarra, Pamplona, Spain.
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29
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Alvarez Sabín J, Alonso de Leciñana M, Gállego J, Gil-Peralta A, Casado I, Castillo J, Díez Tejedor E, Gil A, Jiménez C, Lago A, Martínez-Vila E, Ortega A, Rebollo M, Rubio F. [Plan for stroke healthcare delivery]. Neurologia 2006; 21:717-26. [PMID: 17106825] [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: 05/12/2023] Open
Abstract
INTRODUCTION All stroke patients should receive the same degree of specialized healthcare attention according to the stage of their disease, independently of where they live, their age, gender or ethnicity. OBJECTIVE To create an organized healthcare system able to offer the needed care for each patient, optimizing the use of the existing resource. METHODS A committee of 14 neurologists specialized in neurovascular diseases representing different regions of Spain evaluated the available scientific evidence according to the published literature. RESULTS During the acute phase, all stroke patients must be evaluated in hospitals that offer access to specialized physicians (neurologists) and the indicated diagnostic and therapeutic procedures. Hospitals that deliver care to acute stroke patients must be prepared to attend these patients and need to arrange a predefined transferring circuit coordinated with the extrahospitalary emergency service. Since resources are limited, they should be structured into different care levels according to the target population. Thus, three types of hospitals will be defined for stroke care: reference stroke hospital, hospital with stroke unit, hospital with stroke team.
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Affiliation(s)
- J Alvarez Sabín
- Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona.
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Abstract
Although there are several clinico-topographical studies of pontine infarcts, few include vascular studies. To clarify the etiopathogenic mechanisms of pontine infarcts we analyzed the vascular findings and their association with MRI lesions. The clinical features and vascular findings on transcranial Doppler (TCD) or MR angiography (MRA) of 67 patients with acute infarcts involving the pons were studied. Functional outcome was assessed by modified Rankin Scale (mRS) scores on admission and 2 months later. Two groups of isolated pontine infarcts were found on the basis of lesion location on MRI, according to the extent or not to the anterior surface of the pons: paramedian pontine infarcts (PPI, n = 36) and lacunar pontine infarcts (LPI, n = 31). Hypertension was the most common vascular risk factor and pure motor syndrome was the most frequent clinical profile in both groups. Basilar artery stenosis found on TCD or MRA was significantly more frequent amongst the PPI group (P < 0.05). On admission and 2 months later, the mRS scores of the PPI group were significantly worse (P < 0.0001) than those of the LPI group. Patients with PPI have a significantly higher frequency of basilar artery stenosis and they have a worse prognosis than patients with LPI.
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Affiliation(s)
- M E Erro
- Unidad de Ictus, Servicio de Neurología, Hospital de Navarra, Pomplona, Spain.
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31
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Aymerich N, Lacruz F, Gállego J, Soriano G, Ayuso T, Villanueva JA. [Rhombencephalitis caused by Listeria: clinical-radiological correlation]. An Sist Sanit Navar 2004; 27:245-8. [PMID: 15381957 DOI: 10.4321/s1137-66272004000300010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rhombencephalitis due to Listeria is a serious and infrequent infection of the brainstem. It principally affects subjects who were previously healthy. It shows itself clinically in two phases: the first with unspecific symptoms, which could last one week, and the second with the appearance of focal neurologic signs at the level of the brainstem. We present the case of a patient with rhombencephalitis due to Listeria that began initially with headache, nauseas and fever and after ten days the patient showed an asymmetrical affection of cranial nerves, cerebellar signs and sensory deficits in the left hemibody. Subsequently this became complicated with acute respiratory insufficiency, requiring admission to the Intensive Care Unit, and with episodes of urinary retention that required exploration. The early magnetic resonance image showed hypertense patch lesions that were objectified in T2 sequences at the level of the bulb and the pons. Facing a clinical-radiological suspicion of rombencephalitis due to Listeria, treatment was begun with ampicillin and tombramycin. After some days a positive haemoculture for Listeria monocytogenes serotype 4B resistant to ampicilin was detected, therefore it was replaced with vancomycin. The patient survived and on discharge he had oculomotor disorder and micturition problems as sequels. We would like to emphasise the importance of early recognition of the clinical signs of the disease and the early permormance of magnetic resonance, with diagnostic support, to be able to start a suitable antibiotic treatment as quickly as possible.
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Affiliation(s)
- N Aymerich
- Servicio de Neurología, Hospital de Navarra, Pamplona
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32
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Ajuria I, Gállego J, Erro ME. [Obnubilation and vertical gaze paralysis secondary to bilateral thalamic infarction]. Neurologia 2004; 19:272. [PMID: 15150711] [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: 04/29/2023] Open
Affiliation(s)
- I Ajuria
- Servicio de Neurología, Hospital de Navarra, Pamplona, Navarra.
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Erro ME, Aymerich N, Gállego J. [Trigeminal neuralgia secondary to rare abnormality of vascular development]. Neurologia 2003; 18:463-4. [PMID: 14615949] [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: 04/27/2023] Open
Affiliation(s)
- M E Erro
- Servicio de Neurología, Hospital de Navarra, Pamplona.
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Erro ME, Aymerich N, Gállego J, Olier J, Ayuso T, Lacruz F. [Internal carotid stenosis and giant cell arteritis]. Neurologia 2003; 18:409-12. [PMID: 14505252] [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] Open
Abstract
We report on the case of a 69-year-old man admitted with a transient ischemic attack preceded by a two months history of severe headache. Giant cell arteritis was diagnosed by means of temporal artery biopsy. Angiography showed an intra- and extracranial stenosis of the left internal carotid artery. The possible relationship between this stenosis and vasculitis is discussed and stroke as a clinical manifestation of the giant cell arteritis is reviewed.
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Affiliation(s)
- M E Erro
- Servicio de Neurología, Hospital de Navarra, Pamplona.
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Erro Aguirre ME, Gállego J, Aymerich N, Herrera M, Lacruz F, Villanueva JA. Paramedian pontine infarct secondary to basilar artery dissection. Cerebrovasc Dis 2003; 16:178-9. [PMID: 12792179 DOI: 10.1159/000070601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
The case of a 65-year-old woman with polyneuropathy, organomegaly, skin changes and monoclonal gammopathy of IgG-lambda type is described. This patient developed an acute carotid obliteration during oral anticoagulation and despite absence of vascular risk factors. Macroangiopathy has been described as a rare systemic manifestation of POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal spike and skin changes), affecting the coronary and lower limbs arteries. To our knowledge, this is the second case of POEMS syndrome with a cerebrovascular manifestation.
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Affiliation(s)
- M E Erro
- Servicio de Neurología, Hospital de Navarra. Pamplona (Navarra), Spain.
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37
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Fisa R, Gállego M, Castillejo S, Aisa MJ, Serra T, Riera C, Carrió J, Gállego J, Portús M. Epidemiology of canine leishmaniosis in Catalonia (Spain) the example of the Priorat focus. Vet Parasitol 1999; 83:87-97. [PMID: 10392965 DOI: 10.1016/s0304-4017(99)00074-6] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An epidemiological survey of canine leishmaniosis was conducted in the Priorat, a rural region in the Northeast of Spain, for 10 years (1985-1994). Seroprevalence throughout the region, determined by dot-ELISA and IFI, was 10.2% (8-12%). Forty percent of the dogs studied had a low level of anti-Leishmania antibodies, whereas only 50% were seronegative. Only one-third of the seropositive dogs had evident symptoms of the disease. Annual incidence of the disease was 5.7% and the level of endemicity was stable during the study. Four Leishmania zymodemes (MON-1, MON-29, MON-77, MON-105) were present in the focus, and their distribution in the different hosts is discussed. Apart from dogs and foxes, no other reservoir host has been found in the region.
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Affiliation(s)
- R Fisa
- Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia, Universitat de Barcelona, Spain.
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Gurtubay IG, Morales G, Aréchaga O, Gállego J. Development of myasthenia gravis after interferon alpha therapy. Electromyogr Clin Neurophysiol 1999; 39:75-8. [PMID: 10207675] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Interferon (IFN) alpha is now used in the treatment of some malignant diseases and chronic viral hepatitis. There have been several reports of development of autoantibodies and autoimmune diseases or the deterioration of preexisting disorders in patients under treatment. We enclose a case of myasthenia gravis (MG) which developed after six weeks of treatment as fluctuating bilateral ptosis, intermittent diplopia, and mild weakness of limb and neck muscles. A test dose of edrophonium chloride was administered, resulting in improved muscle strength. Elevated anti acetylcholine receptor (AChR) antibody titer was found. Single fiber electromyography showed an increased jitter from extensor digitorum communis, frequently accompanied by transmission blocking. Repetitive electric 3 Hz stimulation of the abductor pollicis brevis muscle, revealed an abnormal decrement of 28% in compound motor action potential. Myasthenia gravis was diagnosed and the patient was given pyridostigmine, immunoglobulines and prednisone with benefit. Six months latter he developed an acute myasthenic crisis with severe respiratory failure and high anti AChR antibody titer. IFN-alpha can induce MG or simply manifests a preexisting subclinical disease, but otherwise its therapeutic efficacy in MG has been shown in experimental and clinical studies. Autoimmune mechanisms, as the release of different cytokines as IFN, by immunocompetent cells, may be involved in the pathogenesis of both MG and chronic active hepatitis. Autoantibody production against postsynaptic membrane structures by IFN-alpha could be the underlying pathophysiology.
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Affiliation(s)
- I G Gurtubay
- Clinical Neurophysiological Department, Virgen del Camino Hospital, Pamplona, Spain
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Gállego J, Soriano G, Tuñón T, Lacruz F, Delgado G, Villanueva JA. [Primary intraventricular hemorrhage secondary to postero-inferior cerebellar artery aneurysm]. Neurologia 1998; 13:409-10. [PMID: 9859678] [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: 02/09/2023] Open
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40
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Soriano G, Gállego J, Lacruz F, Villanueva JA. [Mandibular VII cranial nerve paralysis due to endarterectomy]. Neurologia 1998; 13:155-6. [PMID: 9608226] [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: 02/07/2023] Open
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41
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Gurtubay IG, Morales G, Gállego J, Martín E, Maraví E. [Tolerance to interferon beta-1b amongst patients with remittent recurrent multiple sclerosis after more than one year of treatment]. An Sist Sanit Navar 1998; 21:15-9. [PMID: 12891417 DOI: 10.23938/assn.0648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Interferon beta-1b modifies the natural history of the remittent recurrent forms of multiple sclerosis. An analysis was made of its efficiency, tolerance and adverse effects on patients with over one year of treatment. MATERIAL AND METHODS 16 patients were studied (10 women, 6 men) with ages between 19 and 51 years, incapacity scale (EDSS) 2.61 +/- 1.07 and an annual rate of outbreaks before treatment of 1.65 +/- 0.25, who received 4 MUI/48 h/s.c. of interferon beta-1b x 15 days, afterwards continuing with 8 MUI/48 h/s.c. Corticoids were associated in four cases. Biochemical controls and mass neurological evaluations were carried out as well as a watch being kept for clinical and analytical secondary effects. RESULTS The annual rate for outbreaks was 0.68 +/- 0.29. Amongst the most frequent adverse effects the pseudoflu syndrome was notable (87%), with an average duration of 10.46 +/- 1.4 weeks, well tolerated with paracetamol. The local reactions (87%) were light and not related to the zone of injection. The patients experienced a sensation of fatigue following the injection in 50% of the cases, although in only one case did this reach a moderate intensity. Analytical alterations were found to be 43.7%, always within the margins of grade 1 of the clinical toxicity scale. With one patient developed an acute depressive syndrome, during which treatment was interrupted, later restarted at half the maintenance dosage. CONCLUSIONS In our series, just as in other studies, pseudoflu syndrome and local reactions were the most frequent secondary effects. Both complications are light, of brief duration and well tolerated by the patients.
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Affiliation(s)
- I G Gurtubay
- Servicio de Neurofisiología Clínica, Hospital Virgen del Camino, 31008 Pamplona
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42
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Gállego J, Tuñón T, Soriano G, Delgado G, Lacruz F, Villanueva JA. Bilateral pallidostriatal necrosis caused by a wasp sting: a clinical and pathological study. J Neurol Neurosurg Psychiatry 1995; 58:474-6. [PMID: 7738559 PMCID: PMC1073438 DOI: 10.1136/jnnp.58.4.474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A previously healthy man developed an acute encephalopathy with coma after a single wasp sting on his chin. Brain CT showed bilateral pallidostriatal radio-lucencies. He died 72 hours after the sting with no evidence of primary cardiorespiratory failure or allergic reaction. Pathological findings were bilateral pallidostriatal necrosis and diffuse neuronal damage in the frontal, temporal, and parietal cortex. The neurotoxic effect of the poison, together with a hypersensitivity are the most likely explanations for this unusual encephalopathy.
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Affiliation(s)
- J Gállego
- Servicio de Neurología, Hospital de Navarra, Pamplona, Spain
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Gállego J, Gállego M, Castillejo S, Fisa R, Portús M. First cases of gynandromorphism in Phlebotomus perniciosus Newstead 1911 (Diptera, Psychodidae, Phlebotominae). Parasite 1994; 1:283-5. [PMID: 9140495 DOI: 10.1051/parasite/1994013283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Two gynandromorphic specimens of Phlebotomus perniciosus Newstead, 1911 are described and illustrated for the first time. The specimens were collected in the Northeast of the Iberian Peninsula (Spain).
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Affiliation(s)
- J Gállego
- Unidad de Parasitología, Facultad de Farmacia, Universidad de Barcelona, España
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44
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Gállego J, Beaucournu-Saguez F, Portús M, Gállego M. [Aggressiveness of Simulium of the ornatum complex (Diptera: Simuliidae) in Catalonia (Spain). First observation]. Parasite 1994; 1:288. [PMID: 9235203] [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: 02/04/2023] Open
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Abstract
Meningovascular neurosyphilis (MN) is an unusual cause of stroke in young adults. The clinical manifestations include prodromal symptoms weeks or months before definitive stroke. The diagnosis is based on clinical findings and examination of the serum and cerebrospinal fluid. We report a case of MN with basilar artery irregularities demonstrated by magnetic resonance angiography.
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Affiliation(s)
- J Gállego
- Servicio de Neurología, Hospital de Navarra, Pamplona, Spain
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Abstract
BACKGROUND AND PURPOSE Spontaneous dissection of the intracranial carotid artery or its main branches is an unusual condition. CASE DESCRIPTION A 72-year-old hypertensive woman after an intense nuchal rigidity showed a subarachnoid hemorrhage and an interhemispheric hematoma by computed tomography. The neuropathological study revealed a transmural dissection of the pericallosal artery. CONCLUSIONS The authors suggest that the dissection origin is an atheromatous plaque that bleeds, producing a dissection plane from the lumen to the adventitial artery.
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Affiliation(s)
- J Guridi
- Department of Neurosurgery, Hospital de Navarra, Pamplona, Spain
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47
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Soriano G, Bujanda M, Gállego J, Villanueva JA. [Muscular pseudohypertrophy caused by chronic radiculopathy]. Neurologia 1992; 7:123-4. [PMID: 1389294] [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: 12/26/2022] Open
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Gállego M, Gállego J, Marrugat O, Fisa R, Portús M, Riera MC. Gynandromorphism in a population of Sergentomyia minuta (Rondani, 1843) in the northeast of Spain. Parassitologia 1991; 33 Suppl:253-60. [PMID: 1841215] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A study carried out, from July 1990 until April 1991, in a small village situated in the northeast of Spain (Pradell de la Teixeta) has allowed the discovery of three sandflies species: Phlebotomus ariasi, P. perniciosus and Sergentomyia minuta. P. ariasi was present from the initial data of capture to the end of October, disappearing the two others at the first half of November. The population of S. minuta furnished gynandromorphic individuals (1.6%) being the female-like specimens most commonly found (37/45, 82.2%). The different degrees of development of the genital region are discussed.
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Affiliation(s)
- M Gállego
- Departamento de Microbiología y Parasitología Santia rias, Facultad de Farmacia, Universidad de Barcelona, España
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Tuñón T, Ferrer I, Gállego J, Delgado G, Villanueva JA, Martinez-Peñuela JM. Leucodystrophy with pigmented glial and scavenger cells (pigmentary type of orthochromatic leucodystrophy). Neuropathol Appl Neurobiol 1988; 14:337-44. [PMID: 3221979] [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: 01/04/2023]
Abstract
A 38-year-old man with progressive psychiatric disturbances, dysarthria, myoclonus, rigidity and terminal generalized seizures died 4 years after onset. At post-mortem, severe leucodystrophy of the centrum semi-ovale, corpus callosum and internal capsule was found. In the demyelinated areas, abundant mononuclear phagocytes were found filled with dark yellow or brown pigment granules, staining with PAS and Sudan black, autofluorescent in paraffin sections, and orthochromatic with toluidine blue in paraffin and frozen sections and positive with Fontana's silver method. Iron deposits were present in a few cells. Electron micrographs of a biopsy showed massive storage of lipofuscin and ceroid with fingerprint profiles in macrophages and, to a lesser degree, in astrocytes as well. Oligodendroglia were depleted in demyelinated areas but prominent in the subcortical regions and in small foci in the deep cerebral white matter; they contained intracytoplasmic inclusions with fingerprint profiles. From these morphological findings it is suggested that lipofuscin and ceroids are the lipopigments stored in the pigmentary type of orthochromatic leucodystrophy.
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Affiliation(s)
- T Tuñón
- Depto. Anatomía Patológica, Hospital Príncipes de España, Hospitalet de Llobregat
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Abstract
A 21 year old male, well-nourished and non-alcoholic, died after five weeks illness. He had suffered epileptic fits, bilateral internuclear ophthalmoplegia, bulbar and pontine paralysis, tetraparesia, ataxia and dystonia. A CT brain scan showed low density lesions of the striatum bilaterally. Post-mortem studies revealed pathological anomalies compatible with Leigh's disease, although the presence of haemorrhages and involvement of the mamillary bodies could also suggest Wernicke's encephalopathy.
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