[Carcinomatous encephalitis or intracerebral miliary metastasis].
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Adenocarcinoma↗
Biomedical subjects
I Pereiro
Publications and source records attributed to I Pereiro.
[Inverted metamorphopsia: an alteration in the perception of a special situation of objects].
OBJECTIVES: This study describes the characteristics of six patients who consulted because of episodes of perceptive alteration of extrapersonal space consisting in an inversion of the situation of objects although without changes in shape or size (inverted metamorphopsia). PATIENTS: Six patients (4 males and 2 females) who presented episodes of inverted metamorphopsia were studied: 4 referred right-left inversion (axial plane), 1 upwards-downwards (saggital plane) and 1 inclination of environment (clockwise movement). None had any alteration in the perception of their own bodies during the episodes which lasted from 3 minutes to 1 hour, reporting from 1 to 40 episodes. The most notable antecedents were: traumatism and forced cervical posture (2), arterial hypertension (3), migraine (2), hyperlipemia (2) and protuberantial ischemia (1). RESULTS: Intercritical neurologic exploration was normal. MR study showed leukoaraiosis (4), protuberantial paramedian infarctions (1) and was normal in one case of basilar migraine. Study of vestibular function (performed in 4 cases) did not show alterations. Three patients received antiepileptic drugs (1 carbamazepine and 2 gabapentin) with favorable response. CONCLUSIONS: Inverted metamorphopsia is a paroxistic phenomenon which transduces a dysfunction of the posterior parietal cortex or its afferences (propioceptive, vestibular, retinian). The causes may be multiple (traumatism, migraine, ischemia). Antiepileptic drugs may have a therapeutic role in the cases with multiple episodes.
Adult↗
[Malignant prolactinoma with intra- and extracranial metastasis: clinico-radiologic study].
Malignant prolactinomas are very rare pituitary neoplasms which can be identified not from the hystopathologic nor neuroimaging aspects but only retrospectively from the presence of distant metastases. A 32-year-old male patient was diagnosed of a pituitary prolactinoma because of bitemporal hemianopsia on the basis of cranial MRI aspect and raised blood prolactin level. Visual signs improved under bromocriptine treatment but after surgical and X-ray therapies patient developed paralysis of V and XII left cranial nerves and suffered from medulocerebelous angle, vertebrae, spinal epidural space, lung, liver, suprarenal and femoral metastases. Patient died 3 years after the diagnosis time. Prolactin levels raised 2000 ng/ml. This is the first case of malignant prolactinoma described in the spanish literature and the more large one in number of metastatic localizations between the malignant prolactinomas from the literature. These kind of neoplasms can be partially ameliorated under X-ray and bromocriptine treatment but there is not, by the moment, a curative chemotherapy.
Adult↗
[Clinical pseudo-peripheral presentation of cerebral lesions].
Small size cerebral lesions, located strategically, can determine the presence of sensitive and motor signs limited to a part of an extremity, clinically suggesting peripheral nervous system affectation, determining erroneous diagnostic and therapeutic decisions. We present 5 patients initially diagnosed of peripheral nervous system pathology, which were finally diagnosed of cerebral lesions (2 lacunar infarcts, multiple sclerosis, progressive multifocal leucoencephalopaty, multicentric astrocytoma). In all, clinical examination disclosed incongruous distribution of the sensitive manifestations and myotatic reflexes were present. CT studies were normal in three patients whereas MRI showed lesions in all cases. Lesions were smaller than 1.5 cm in diameter (greater in the case of multicentric astrocytoma), and were subcortically located in the opposite cerebral hemisphere to the affected extremity. Sensitivomotor signs restricted to an extremity not concordant with a nervous or radicular distribution and with presentation of myotatic reflexes, make it necessary to look for a central nervous system lesion. Lesion will be located in the opposite cerebral hemisphere and MRI will be the elective complementary exam.
Adult↗
[The existing differences between adolescent girls served on a first visit in a family planning center in 2 time periods].
OBJECTIVE: To determine the changes in sexual, reproductive and contraceptive behaviour of adolescent girls attended for the first time at a family planning centre (FPC) over two time-periods. DESIGN: A descriptive, retrospective study with analytic components. SETTING AND PARTICIPANTS: All the adolescent girls attended on their first visit to the Massamagrell (Valencia) FPC during the 10 years from April 1, 1986 to March 31, 1996 (n = 728). INTERVENTIONS: Dividing the two five-year periods, there were educational activities in schools and institutional campaigns to stop unwanted pregnancies, sexually transmitted diseases (STD) and AIDS. MEASUREMENTS AND MAIN RESULTS: In the second period more adolescent girls made their first visit to the FPC, with a similar mean age, less pregnancies, deliveries and abortions, and a later start to sexual activity. There was less time between the start of sexual relations and their first visit to the FPC; they used habitually and from the start of their sexual relations more effective contraception. CONCLUSIONS: Adolescent girls attending a FPC for the first time showed a change in their sexual, reproductive and contraceptive behaviour, in that they were at less risk of pregnancy, STD and AIDS.
Adolescent↗
[Reasonable prescription of drugs].
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Drug Costs↗
[Ulegyria and epilepsy].
Ulegyria is a derangement of the architecture of the cerebral cortex characterised by the presence of multiple small cerebral convolutions. It is caused by hypoxic-ischaemic damage of these convolutions in the perinatal period. This differentiates it from polimcrogyria which is due to damage during the period of late neuronal migration or early postmigration. The clinical findings vary from cases with hardly any symptoms to more severe forms which show psychomotor retardation, convulsive crises and/or motor defects. We describe the case of a 21-year-old patient who suffered anoxia during delivery, with a very low Apgar score, who presented with epileptic crises in childhood (motor foci which became generalized) with good anticonvulsant control. On examination, there was a slight mental handicap. On magnetic resonance an uligyric area was seen in the occipital cortex. High resolution magnetic resonance allows the diagnosis of this type of change in the cerebral cortex in the living patient since the differences between grey and white matter can be distinguished better than with computerized tomography.
Adult↗
[Pseudotumor cerebri secondary to cerebral venous defects not identified by magnetic resonance].
Pseudotumour cerebri is the name of a syndrome characterized by headache and papilloedema, with normal cerebral CT/MR studies and CSF with a high pressure and normal laboratory findings. We describe four patients who fulfilled the diagnostic criteria of this condition (including normal 0.5T MR studies). They all had cerebral angiograms showing minor abnormalities localized to the level of the superior longitudinal sinus. All improved on treatment with anticoagulants and steroids. In view of these findings we consider that in cases of pseudotumour cerebri without a clear aetiological factor, an angio MR study should be done, or if this technique is not available, a cerebral angiogram should be done, to exclude cerebral venous drainage defects.
Adult↗
Acute respiratory failure as the first sign of Arnold-Chiari malformation associated with syringomyelia.
We report a rare case of acute respiratory failure in a previously asymptomatic patient showing clinical signs of inferior cranial nerve palsy together with weakness and muscular atrophy of the upper limbs. Magnetic resonance imaging revealed Arnold-Chiari malformation associated with platybasia, basilar impression, syringomyelia and Klippel-Feil syndrome. Episodes of apnoea required tracheostomy and recurred upon tentative closure of the tracheostome, but remitted upon decompression of the posterior fossa. This case involved both obstructive mechanisms and dysfunction of the respiratory centre. Patients with respiratory failure not explained by pulmonary pathology should be checked for underlying neurological disease.
Abnormalities, Multiple↗
[Disorders of neuronal migration: clinical and radiological signs in 21 patients].
We describe 21 patients affected by neuronal migration disorders. The main clinical manifestations were epilepsy, hemiparesis with hemiatrophy and psychomotor retardation. The neuronal migration disorders most frequently diagnosed were various forms of heterotopia and schizencephaly. Magnetic resonance imaging was more sensitive and specific that computed tomography in the diagnosis of these disorders. Schizencephaly correlates well with hemiparesis and hemiatrophy, as does nodular heterotopia with focal epilepsy and diffuse neuronal migration disorders with severe encephalopathies.
Adolescent↗
Multiple sclerosis and hypertrophic demyelinating neuropathy.
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Adult↗
[Hypertensive encephalopathy: contribution of magnetic resonance].
We report a patient with hypertensive encephalopathy and we analyze his clinical and neurological imaging peculiarities. Computed tomography showed hypodense corticosubcortical lesions, whereas magnetic resonance scan disclosed extensive, wholly reversible enhanced signal lesions due to cerebral edema.
Brain Diseases↗
Cavernomas of the central nervous system: clinical and neuroimaging manifestations in 47 patients.
Forty seven cases of central nervous system cavernous angioma (21 males and 26 females) are described. The main clinical signs were epilepsy and brainstem syndromes. Digital subtraction intra-arterial angiography, when used, failed to reveal cavernoma. CT detected many of the lesions, but the most successful supplementary diagnostic procedure was MRI which produces highly characteristic images of cavernous angioma. The diagnosis of cavernous angioma was confirmed in the 18 cases in which the tumour was removed surgically.
Adolescent↗
[Study of non-participation in the breast cancer screening program in the city of Valencia (Spain)].
AIM: To determine the reasons for non-participation of women in a breast cancer screening program. METHODS: We performed an observational, cross-sectional study in women who were invited to participate in the breast cancer screening program in the city of Valencia and who failed to attend. The women were interviewed in their homes through a questionnaire consisting of 25 questions grouped as follows: knowledge of the program, reasons for nonparticipation, attitudes or beliefs and characteristics of the interviewees (socioeconomic and educational variables and age). A descriptive analysis was performed. Differences in the characteristics of women were evaluated through bivariate analysis. Multivariate analysis was performed through logistic regression. RESULTS: A total of 783 addresses were used, 411 questionnaires were completed and 361 were analyzed. The 50 questionnaires used in the pilot study were excluded because, as a consequence of this study, the questionnaire had been modified. Most of the women (93.4%) (CI: 90.3-95.7) remembered having an appointment. The main reason for not attending was being screened in another health service in 48.8% (CI: 43.6-53.9), followed by various personal reasons in 16.1% (CI: 12.3-19.9) and inability to keep the appointment at the specified time in 15.5% (CI: 11.8-19.2). Comparison of women in the middle and upper social classes with those in the lower classes revealed important differences. Middle and upper class women had a higher probability of knowing about the program and of being on hormone replacement therapy (HRT) and the most frequent reason for non-attendance was attendance at another program run by another health service. In lower class women the reasons for non-attendance were fear, not believing the program to be important to health and inability to keep the appointment at the specified time. In the multivariate analysis, the variables that entered the model were HRT, social class and education. Thus, middle or upper class women undergoing HRT and with secondary or higher education had a higher probability of being screened. CONCLUSIONS: The profile of non-participating women belongs on the one hand to those in the middle or upper social classes, undergoing HRT and being screened by other health services and, on the other, to a group of women of low social class, whose reason for non-participation is fear and timetable difficulties.
Aged↗
[Isolated hemi-ataxia as a sign of mesencephalic lacunar infarction].
INTRODUCTION: Lesions of the dento-rubro-thalamo-cortical pathway may cause homolateral or contralateral hemiataxia, depending on whether they are found above or below the decussation which occurs at the level of the inferior colliculus. Most mesencephalic infarctions causing hemiataxia also show oculomotor involvement with nuclear or fascicular lesions of the third cranial nerves. This was not seen in the case we report. CLINICAL CASE: We describe the case of a diabetic patient with a permanent right appendicular hemiataxia, without oculomotor involvement, caused by a lacunar infarct shown on MR imaging which was situated in the antero-external part of the left superior mesencephalum. CONCLUSIONS: This case helps to clarify the topography of the thalamic radiations of the mesencephalic calotte, including the decussated superior dento-rubro-thalamic pathway to the red nucleus. Involvement of this, situated in the mesencephalic lateral vascular territory causes contralateral hemiataxia.
Aged↗
[Tuberculous myelomeningitis without vertebral involvement: diagnostic value of the MR study].
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Adult↗
[CT vs MRI in the diagnosis of acute stroke].
70 patients who had suffered an acute stroke (52 ischaemic and 18 haemorrhagic) were studied with CT and MR, performing both techniques during the first week of disease and correlating the findings with the clinical data. MR proved superior in the detection of ischaemic infarcts, specially those in the posterior territory and with a small size; it was also superior to CT in the detection of leukoaraiosis and the demonstration of vascular obstructions. CT failed to detect a small brain stem haemorrhage secondary to bleeding of a cavernoma, while its performance was similar to that of MR in the remaining cases. In all patients with intracerebral haemorrhages, including two who were examined on the first day, an area of increased density was evidenced in the T1 sequences. It is concluded that CT, due to its greater availability and easiness of performance, must be maintained as first choice in acute stroke in order to differentiate haemorrhage from ischaemia, while MR may provide additional information in selected cases.
Acute Disease↗
[Autoscopy and multiple sclerosis].
A female patient with clinically defined multiple sclerosis presented episodes of audiovisual hallucinations in the form of projections of her own body image speaking to her. EEG and EEG-Holter studies were normal. MRI revealed multiple areas of hypersignals in white matter, particularly in both temporal lobes. The episodes remitted with carbamazepine therapy. We postulate that this phenomenon of autoscopy, which is unusual in multiple sclerosis, may be related to a mechanism of ephaptic transmission in the temporal lobe that is inhibited by carbamazepine, or it may be related to seizure.
Adult↗