Revista de neurologia
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Myasthenia gravis is an autoimmune disorder characterized by fluctuating muscle weakness and fatigue of different muscle groups. Myasthenia gravis may affect persons of all ages, but especially women aged 20 to 40 years. ⋯ The ocular, facial and bulbar muscles are most often involved in this disease. The muscle weakness of patients with myasthenia gravis becomes worse with intercurrent episodes of infection, fever and physical or emotional exhaustion. Respiratory infection (bacterial or viral) is the most frequent trigger factor. The presence of antibodies to acetylcholine receptors in a patient with the clinical features of myasthenia gravis, confirms the diagnosis. Treatment is controversial. Each patient therefore has to be treated individually, as no single treatment is suitable for all patients. Treatment may include anticholinesterase drugs, corticosteroids, plasmapheresis, immunoglobulin, immunosuppressive drugs and thymectomy.
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Although the neurological intensive care, seem have originated at the ends of 40s, during the epidemic of acute poliomyelitis that flogged Europe, it must be indicated that the growth and expansion of this subspecialty, has been a remarkable fact only in the course of the two last decades. Despite the fact that the neurological intensive care units (Neuro-ICU) are expensive; multiple have been the benefits derived from their creation; so much for patients, hospitals, as well for medical teaching. This is the current panorama of these units, mainly in developed countries, however, unfortunately this is not the situation in others, especially the underdeveloped ones. ⋯ Undoubtedly, the neurocritical patients results more benefitted, when receives attention from the neurointensivists; thus the medical care that it receives becomes defragmented. The creation of the Neuro-ICU in our countries should not be made in a generalized way, but strategically, in addition, would be very convenient the incorporation of neurointensivists in the polyvalent intensive care units or intermediate care units. For the future, it will have to keep in mind the fact, that certain novel procedures that today emerge for the management of certain neurocritical conditions, will have to be assimilated by neurointensivists, since they will be the personnel disposed to implement them in any moment, and what is more important, it is the competent personnel prepared to treat any complication that emerge upon applying these.
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Revista de neurologia · Jun 1998
Review[A new formulation of death: definition, criteria and diagnostic tests].
To present a new formulation of human death based on neurological considerations. ⋯ We present a new formulation of human death on a neurological basis which permits satisfactory integration of the three fundamental elements, definition, criteria and diagnostic tests, and so offers a suitable starting point from which man may start to understand death.
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Clinical and biochemical classifications of mitochondrial disorders have given way to an as yet incomplete genetic classification system based on alterations of the mitochondrial genome, the nuclear genome, or both. The first group includes mitochondrial disorders due to specific mutations of mitochondrial DNA such as the MELAS, MERRF or NARP encephalomyopathies, various conditions involving deafness (non-syndromic or associated with diabetes), Leber's optic neuropathy and a small group of cases of maternally transmitted Leigh's syndrome. All these diseases are transmitted through maternal line. conditions which are usually sporadic are due to deletion or duplication of mitochondrial DNA, and give rise to myopathies, with or without ophthalmoplegia, and to more complex disorders such as Kearns Sayre syndrome are also included. ⋯ This includes most cases of Leigh's syndrome, Alpers polydystrophies, the myoneurogastrointestinal syndrome, Barth's syndrome and Friedreich's disease. Amongst the disorders secondary to defects in communication between the nuclear and mitochondrial genomes is a progressive external ophthalmoplegic form with autosomal dominance which arises secondary to mutations on chromosomes 3 and 10. Further mitochondrial disorders due to faults in the relationship between the two genomes will probably be found in the near future.
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Revista de neurologia · Jan 1998
Review[Vertebrobasilar ischemia of thrombotic and embolic origin].
To analyze the mechanisms involved in the appearance of ischemia in vertebro-basilar territory, especially those of embolic or thrombotic characteristics. ⋯ The mechanism of vertebro-basilar ischemia is not homogeneous and can not be taken for granted in any patient in particular. For this reason it is necessary to carry out a full clinical study of patients with these symptoms, similar to that done for patients with carotid ischemia. This permits not only individualized, correct treatment of each patient but also a more complete knowledge of the mechanisms of ischemia in this territory.