Biomedical subjects
J R Ara
Publications and source records attributed to J R Ara.
[Urinary and sexual alterations in multiple sclerosis: population based study].
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[Fatigue and multiple sclerosis: a study in a health district in the province of Zaragoza].
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Neurologic complications of lumbar epidural analgesia: spinal and paraspinal abscess.
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[Multiple sclerosis as a cause of partial complex epilepsy].
INTRODUCTION: Although the epileptic seizures (ES) have been described on patients with multiple sclerosis (MS), the causal relationship is not clear. Seizure's prevalence in this illness is low and their apparition concerning the MS course is variable, but more common after MS diagnosis. The predominant crises are generalized or partial with secondary generalization; the partial complex seizures have rarely referred. CLINICAL CASES AND CONCLUSIONS: We presented two patients with ES in the MS course. In the first case is arrived to MS diagnosis upon appearing the crisis, having presented two previous cerebral lesions in another level. In both cases demyelinating lesion was located in the temporal lobe, agreeing with EEG anomaly and seizures type.
["Locked-in" syndrome due to hyperglycemia].
INTRODUCTION: Hypoglycemia can cause a diffuse brain malfunction and sometimes a focal neurological deficiency, that could lead to a mistaken diagnosis of cerebrovascular disease. CLINICAL CASE: We describe the case of a 67 year old man, with diabetes mellitus type II treated with glibenclamide, that was referred to our hospital due to worsening of his chronic obstructive pulmonary disease. On the fifth day following admission he developed acute weakness in the right extremities and experienced difficulty in talking: six hours later he was conscious, with normal eye movements, but there was an absence of spontaneous facial motility and to pain; he showed complete cuadraplegia and bilateral Babinski. A determination of glycemia was made with the result of 24 mg/dl; after immediate treatment with glucose solution intravenously the patient recovered in a few minutes. CONCLUSION: This clinical observation reminds us of the importance of determining blood glucose in the assessment of any acute neurological dysfunction.
[Determining factors in decisions regarding cardio-pulmonary resuscitation in patients with cerebral hemorrhage].
INTRODUCTION AND OBJECTIVE: Some medical factors related with cardiopulmonary resuscitation (CPR) outcome are known. Moreover, there are other factors, not strictly medical ones, as age, gender, race and socioeconomic status, that influence on decisions of CPR. The aim of this study was to analyse the influence of all this factors on in-hospital CPR of the patients with intracerebral hemorrhage. MATERIAL AND METHODS: This retrospective study comprised all the consecutive patients hospitalized with spontaneous intracerebral hemorrhage who died within 30 days of hospital admission in a public hospital during the period 1987-1994. We used stepwise logistic regression to identify variables that had a significant independent relation with decision of CPR. RESULTS: We identified 73 patients, 50 men and 23 women. Their mean age was 61 years. RCP was performed in 25 patients (34%). A logistic regression revealed that age (OR 0.8), Glasgow score on admission (OR 0.67) and time of death (OR 1.2) were significantly associated with CPR decision. CONCLUSIONS: CPR was less probable in aged even though they had better level of consciousness on admission. Moreover, CPR was less probable early in the morning.
[Myelitis and optic neuritis caused by varicella].
INTRODUCTION: Varicella mainly affects children between 1 and 14 years old. It is the initial infection caused by the Varicella-Zoster virus. It is characterized by a vesicular cutaneous eruption, fever and generally good prognosis. The neurological complications caused by the Varicella-Zoster virus are infrequent and include: meningitis, encephalitis, cerebellar ataxia, Reye's syndrome, myelitis, optic neuritis, mononeuropathy, polyneuropathy, necrosis of the retina and cerebral arteritis. CLINICAL CASE: We present the unusual case of a woman patient aged 18 who presented with myelitis 15 days after having a varicella rash. Analysis of the cerebrospinal fluid showed intrathecal production of antibodies against the Varicella-Zoster virus. Fourteen days after resolution of the myelitis, she presented with unilateral optic neuritis which remitted without sequelae, (as did the myelitis). Cerebral and medullary MR showed no alterations. CONCLUSIONS: The pathogenesis leading to involvement of the nervous system is still not well defined. Direct invasion by the virus has been postulated, particularly in Herpes-Zoster (reinfection by Varicella-Zoster), as immunological phenomena which may be more frequent with Varicella (initial infection by Varicella-Zoster virus). In our case there were two short episodes of neurological involvement: optic neuritis and myelitis, with a satisfactory clinical course after giving corticosteroids. This makes one think of immunological mechanisms rather than direct invasion of the central nervous system by the Varicella-Zoster virus.
[Primary intraventricular hemorrhage].
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[Sensory-motor polyneuropathy associated with lung tuberculosis: presentation of two new cases].
The association of active tuberculosis with changes in the peripheral nervous system is not well defined, although it is included amongst the neuro-muscular disorders of the peripheral nerve diseases due to infective agents. We describe the case of two patients with sensory-motor polyneuropathy and coexistant active pulmonary tuberculosis which was untreated prior to diagnosis of the peripheral nervous system disorder. In both cases the condition was sub-acute and did not improve until treatment was begun. Anti-tuberculosis treatment was followed by marked improvement of both the pulmonary tuberculosis and of the polyneuropathy. The close chronological relationship of both clinical pictures with the therapeutic response supports the hypothesis of the pathogenesis of the peripheral nervous system disorder being mediated by an anomolous immune response, initiated by the infection with Koch's bacillus.
[Phenotype variability in adrenoleukodystrophy. Presentation of three new cases and a review of literature].
INTRODUCTION: Adrenoleukodystrophy is a hereditary recessive sex-linked disorder with very variable phenotype expression, including classical infantil ALD, adrenomyeloneuropathy (AMN) in adults and sex-linked Addison's disease. Clinical observations. Three affected patients are presented. The first showed signs of myeloneuropathy from the age of 38 and diagnosis was made by showing raised serum and fibroblasts levels of very long chain fatty acids (C26:0). In the second case symptoms started at the age of 13 and cerebral and peripheral nervous system changes developed progressively. This patient's brother was the third case, showing symptoms when he was 21 and developing cerebral, medullary and peripheral nervous system involvement. In the latter two cases, diagnosis was made by showing intracytoplasmatic trilaminary inclusions in the nervous system. CONCLUSIONS: It is important to recognize the different varieties of this disease in view of the possibilities of genetic counselling and of the therapeutic implications which are currently being evaluated.
[Internuclear ophthalmoplegia in relation to lidocaine and pentothal].
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[Clinico-epidemiologic study of bacterial meningitis in Aragon].
BACKGROUND: The aim of the present study was to know the incidence, etiology, prognostic factors and rate of mortality of bacterial meningitis in Aragón (Spain). METHODS: The clinical records of all the patients with bacterial meningitis seen in the hospitals in Aragón (Spain), from 1985 to 1988 inclusive were reviewed. RESULTS: The mean of the annual rates of incidence for Aragón (Spain) was 7.52/100,000 inhabitants. In patients under the age of 15 years the most frequent etiologies were Neisseria meningitidis (59.0%), Haemophilus influenzae (13.7%) and Streptococcus pneumoniae (9.4%); the global rate of mortality was 3.5% similar to that of sequelae. In those over the age of 14 years, the most frequent etiologies were N. meningitidis (33%), S. pneumoniae (18.4%) and Staphylococcus spp. (13.6%); the rate of global mortality was 19.5% and that of sequelae 10.8% with resistance of S. pneumoniae to penicillin and/or ampicillin in 45.5% of the cases in children and in 26.3% in adults. No significant evolutive differences related with the existence of resistances or the administration of antibiotics prior to lumbar punction were observed in any of the age groups. CONCLUSIONS: N. meningitidis is the main etiologic agent in Aragón in both children and adults. The greatest rates of mortality and sequelae were observed in the youngest and oldest age groups with a similar relation being seen in infection by gramnegative bacilli and S. pneumoniae, thus making these patients to be considered as being at high risk.
[The validity of the system of obligatory disease declaration for the epidemiologic surveillance of meningococcal meningitis].
In Spain meningococcic meningitis is a disease of obligatory declaration which is declared under the name of "Meningococcic infection". In this section other process are also included with the declaration being made under suspicion, with no knowledge of the degree of fulfillment and the significance of the official data. To know this the clinical history of meningitis patients of all the hospitals in Aragon from January 1985 to December 1988 were reviewed comparing the results with those from the system of obligatory disease declaration. The degree of fulfillment for meningococcic meningitis was 90% with the annual rates of incidence of meningococcic meningitis being 1.11 to 2.13 fold higher, according to hospitalary data, higher than the rates of the obligatory disease declaration system.
[Discoid lupus erythematosus in a patient with Melkersson-Rosenthal syndrome].
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[Neuralgic amyotrophy of the shoulder associated with systemic brucellosis].
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[Neurophysiologic evaluation in patients with Behcet's disease].
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[Neuro-Behçet. Clinical study of 9 patients].
The authors evaluated the type of neurological involvement existing in patients with Behçet's syndrome over a 10 year period. Nine patients presenting several bouts with neurological symptomatology were studied with headache being clinically predominant followed in order of frequency by sensitive and/or motor ictal pictures. Suspected localization was both hemispheric and brain stem. No diagnostic test was able to clear up the origin of the lesions in the first stages of the disease, however the authors were able to observe, upon performing visual and/or brain stem evoked potentials and nuclear magnetic resonance at the time of the control, that several asymptomatic patients showed alterations in both tests. Thus, the value of the above mentioned tests must be emphasized in the follow up and control of neuro-Behçet's disease.