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Biomedical subjects

S Calleja

Publications and source records attributed to S Calleja.

18 recordsLinked to original sources
PubMed2006

[Light-induced amaurosis fugax].

INTRODUCTION: Internal carotid artery atherosclerotic disease may present with a wide variety of ipsilateral ocular symptoms and signs that can herald a devastating stroke. Asymptomatic retinal emboli, transient monocular visual loss (also known as amaurosis fugax) and central retinal artery occlusion are the most common. CLINICAL CASE: A 66-year-old man presented several spells of monocular light-induced amaurosis fugax related to a severe carotid occlusive disease. Ancillary tests showed an exhausted cerebrovascular reactivity and visual evoked potentials demonstrated an increased latency. Following a carotid endarterectomy the patient remained asymptomatic and ancillary tests normalized. DISCUSSION: Our report supports the theory that light-induced amaurosis fugax occurs on a hemodynamic basis. A prompt recognition of this symptom is critical since symptomatic severe carotid stenosis implies a high risk of ipsilateral stroke.

Aged↗
PubMed2005

[Bickerstaff's encephalitis].

INTRODUCTION: The clinical and radiological findings in a case of Bickerstaff encephalitis are described and the relationship with Miller Fisher and Guillain Barré syndromes are discussed. CLINICAL CASE: Subsequently to a respiratory infection,a 44-year-old male developed external ophthalmoplegia and cerebellar-like ataxia; his condition deteriorated and he suffered consciousness disturbances and absent tendon reflexes were noted. An MRI scan was performed showing a lesion affecting the brainstem. The cerebrospinal fluid (CSF) revealed albuminocytologic dissociation and the presence of oligoclonal bands. He received high doses of intravenous immunoglobulins and five months later, he had completely recovered. A follow up MRI scan demonstrated complete resolution of the lesion. CONCLUSIONS: The initial condition was diagnosed as Bickerstaff brainstem encephalitis (BBE) with overlapping peripheral nervous system semiology. The presence during the acute phase of oligoclonal bands in CSF, which decreased with the clinical improvement, supports the hypothesis than an autoimmune mechanism may function in its pathogenesis. Our case suggests that intravenous immunoglobulins therapy should be considered in patients with BBE.

Adult↗
PubMed2004

Heraldic seizure.

BACKGROUND: The term heraldic seizures indicates epileptic seizures caused by cerebrovascular disease, believed to be triggered by silent ischemia and occurring before a stroke. This fact widens the spectrum of possible interrelations between epilepsy and cerebrovascular disease outside the well known context of post-stroke epilepsy. METHODS: This is a case report of a healthy 67-year-old male who had a new onset epileptic seizure prior to a lobar intracerebral hemorrhage (ICH). This man began to suffer myoclonic jerks in his left arm which progressed to a generalized tonic-clonic seizure. At the emergency area the physical and neurological examination were unremarkable and a CT scan was normal. The next day the patient developed left hemiparesis, hemianopsia and confusion and a new CT scan showed right parietal-occipital ICH. CONCLUSIONS: This case report exemplifies the concept of heraldic seizures, showing a patient who had a focal seizure preceding an intracerebral hemorrhage. Our etiologic diagnostic work led us to a diagnosis of probable amyloid angiopathy. We suggest that cerebral amyloid angiopathy (CAA) may be the underlying cause, since it may be the origin of both the late event (ICH) and the heralding seizures, resulting from concurrent ischemia.

Aged↗
PubMed2004

[Ring chromosome 20: a distinctive syndrome identifiable by electroclinical diagnosis].

The ring chromosome 20 syndrome is characterized by treatment resistant non-convulsive status epilepticus, and slow waves intercalated by spikes/spike waves predominantly in the front-temporal regions. Here, we describe the case of an 18 year old patient, whose seizures began at the age of 10, these being resistant to treatment. Neurologic examination and cranial MRI were normal. Interictal EEG showed normal background activity with burst of 2-20 seconds with bilateral spike wave. Ictal EEG showed continuous paroxysmal activity with generalized spike waves discharges and slow delta waves, coinciding with nonconvulsive status epilepticus. After 1 mg of intravenous clonazepam, both clinical semiology and EEG abnormalities disappeared. A cytogenetic study showed ring chromosome 20 in 35 % of metaphases. The epilepsy associated with ring chromosome 20 constitutes a syndrome with its distinctive electroclinical characteristics.

Adolescent↗
PubMed2001

Evolution of juvenile myoclonic epilepsy treated from the outset with sodium valproate.

Sodium valproate (VPA) is considered the first choice drug in juvenile myoclonic epilepsy (JME). We have analysed the long-term evolution of 22 patients treated from the outset with VPA. The following inclusion criteria were applied: (1) unequivocal diagnosis of JME; (2) treatment should be initiated with VPA monotherapy; and (3) follow-up for more than 5 years. Twenty-two patients (15 females, seven males) were studied and their EEG recordings were analysed. Their mean age was 28 years (range: 20-40 years) and their mean follow-up was 7.7 years (range: 5-17 years). Four of them suffered persistent seizures despite optimal VPA dosage and needed the addition of a second drug (lamotrigine in three cases, clobazam in one case). All of our patients who continued their treatment are seizure-free. VPA effectively controlled all seizures in 80% of patients. The discontinuation of drug therapy lead to a very high rate of relapses. With accurate diagnosis and appropriate therapy, seizures in JME can be effectively controlled. VPA is a very effective antiepileptic drug in controlling the seizures of JME, but many patients relapse after VPA discontinuation. Thus, JME may require lifelong therapy.

Adolescent↗
PubMed2001

[Levetiracetam].

Levetiracetam is a new antiepileptic drug with a chemical structure similar to piracetam, but different pharmacological properties. The pharmacokinetic profile of levetiracetam closely approximates the ideal characteristics expected of an antiepileptic drug: good bioavailability, linear kinetics, rapid achievement of steady-state concentrations, minimal protein binding and minimal metabolism. It has been approved as add-on therapy for the treatment of partial-onset seizures in adults. Its efficacy has been proved through four pivotal double-blind, aleatorized, placebo-controlled trials. Levetiracetam is well-tolerated and the incidence of adverse events is similar to placebo. There is no evidence of any specific interactions between levetiracetam and digoxin, warfarin, probenecid or other antiepileptic drugs. Preclinical studies have shown potential efficacy against generalized seizures. Antidystonic and antimyoclonic effects have been also suggested. There are few data of its efficacy on monotherapy and pediatric population.

Adult↗
PubMed2000

[Reflex epilepsies].

INTRODUCTION: Reflex seizures are provoked by a specific sensory stimulus. Approximately 6% of all epileptic patients have reflex seizures. For identification of these seizures it is necessary to take a directed history and make an EEG study whilst the patient is being exposed to the stimulus, which will confirm the diagnosis. DEVELOPMENT: Many stimuli are effective in provoking reflex seizures, the commonest are visual. Amongst the various epileptic syndromes there are different types of epilepsies with reflex seizures which generally correspond to idiopathic generalized epilepsies. The physiopathogenic mechanisms are usually complex. The cerebral cortex corresponding to the function which induces the epileptic crisis is hyperexcitable, and is the cause of an identifiable lesion or dysfunction without an underlying lesion. CONCLUSION: The diagnostic importance of reflex seizures is that when some formerly drug-resistant patients can control the mechanism which triggers off their seizures they attain good control of them.

Brain↗
PubMed1999

[Rational choice of antiepileptic treatment].

The choice of the adequate antiepileptic treatment is based on the clinical experience more than rationality. During some decades, the combination of two antiepileptic drugs was considered the initial treatment but monotherapy showed more advantages (effectiveness, fewer adverse events, fewer teratogenic effects and better compliance). New antiepileptic drugs have increased our interest and knowledge of the epilepsies. They have changed some of our therapeutical schemes. Sodium valproate continues to be considered the choice treatment for all the idiopathic, cryptogenic and symptomatic generalized epilepsies. Lamotrigine and topiramate are two valid alternatives in these epileptic syndromes. In West's syndrome vigabatrin is considered the initial treatment. Carbamacepine, vigabatrine and tiagabine are not indicated in the treatment of generalized idiopathic epilepsies especially in patients with absence seizures. In focal epilepsies, both cryptogenic and symptomatic all the antiepileptic drugs have shown efficacy and the choice treatment is based on the adverse events and the teratogenic power. Prospective studies in patients with the same type of seizures and epileptic syndromes will allow us to determine the more adequate antiepileptic treatment.

Anticonvulsants↗
PubMed1998

Evaluation of ultrasonography and clinical diagnostic scoring in suspected appendicitis.

BACKGROUND: Several diagnostic aids have been developed to improve diagnosis in suspected appendicitis including ultrasonography and clinical diagnostic scoring. The aim of this study was to elaborate a new scoring system and to measure its accuracy in the preoperative diagnosis of appendicitis, comparing it with the available scoring systems. METHODS: The clinical, radiological and ultrasonographic data of 192 patients with suspected appendicitis were collected prospectively. RESULTS: Only six of the 12 variables analysed were shown to have prognostic significance. Using Bayesian methodology, a weight was given to each criterion and two overall scores were calculated (ultrasonographic and classical scores). A cut-off point was identified to separate patients who needed surgery and those for observation. The ultrasonographic score showed an 81 per cent sensitivity and a 96 per cent specificity, compared with 60 and 73 per cent respectively for the classical score. CONCLUSION: Ultrasonography increases the diagnostic accuracy in patients with suspected acute appendicitis.

Abdominal Pain↗
PubMedDate not supplied

[Myoclonic epilepsies in adolescent and adult patients].

We review the electroclinical characteristics of the main myoclonic epileptic syndromes occurring in adolescents and adults, excepting the progressive myoclonic epilepsies. In the discussion we include some epilepsies which are not currently classified as generalized, but which develop myoclonic crises such as the myoclonic variant of epilepsy when reading. We emphasize strict criteria for diagnosis of juvenile myoclonic epilepsy and discuss the syndromes related to it. Other myoclonic epilepsies, such as those which may occur in adults with Down's syndrome and in Alzheimer's disease, are considered.

Adolescent↗
PubMedDate not supplied

[Juvenile myoclonic epilepsy].

INTRODUCTION: In this paper we review the history of juvenile myoclonic epilepsy (JME) since the description by Herpin in 1852 and 1857 of the seizures of some epileptic patients which he called impulsions . Credit is due to Janz and Christian who in 1957 gave a detailed description of the condition which they called impulsive Petit mal and we know today as JME. Delgado-Escueta and his group in Los Angeles discovered the genetic basis of JME in some patients. DEVELOPMENT AND CONCLUSIONS: The homogeneity of the clinical and neurophysiological characteristics of series of patients with JME reported from many different parts of the work is striking. Diagnosis of JME is easy when the syndrome is known. However, in some patients a broad differential diagnosis should be considered as discussed in this article. The treatment of choice is still valproic acid as monotherapy. When this is not effective or side-effects occur, other useful drugs are available such as primadone. Of the other new antiepileptic drugs lamotrigine has been shown to be effective and good results have been obtained with topiramate, so both these drugs should be considered in some patients. Although response to treatment is excellent, a high incidence of relapse was seen in all studies when the patients stopped their treatment.

Anticonvulsants↗
PubMedDate not supplied

[Long lasting intracranial artery stenosis of embolic origin].

INTRODUCTION: The term evanescent, or vanishing, has been used to describe those intracranial stenoses that are consecutive to the partial recanalization of an embolic occlusion. In general terms it has been admitted that those stenoses quickly disappear in parallel to the complete recanalization of the artery. This behaviour allows their differentiation from the atherosclerotic stenoses. CASE REPORT: We present here a 61-year-old male who suffered a middle cerebral artery territory stroke secondary to an atrial fibrillation. In the acute phase, a stenotic flow was found in the proximal portion of his left middle cerebral artery. Although it was an embolic occlusion, one year passed before the stenosis disappeared. DISCUSSION: Findings like this contradict the protocols in use (which consider a stenosis as atherosclerotic if it remains for more than three months), and stress the need for new studies which clarify the natural history of the intracranial arterial occlusions.

Cerebral Arteries↗