Revista de neurologia
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Revista de neurologia · Dec 1998
Case Reports[Intra-arterial fibrinolysis in acute thrombosis of the basilar artery].
Ischemia in the territory of the basilar artery presents with a variable clinical picture of hemiparesia-tetraplegia, progressive deterioration of level of consciousness, irregular respiration and apnea leading to irreversible coma and death in between 75% and 86% of cases. The usual treatment is supportive. ⋯ Emergency treatment with cerebral intra-arterial fibrinolysis within the first six hours, in a case of neurological deficit progressing in the basilar artery territory, with persistence of brain-stem functions and no signs of decerebration (provided there are no contra-indications to fibrinolysis and the initial cerebral CT scan shows no bulbar lesions) may save the patient's life, with total or partial recovery of brain-stem function.
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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 · Oct 1998
Case Reports[Right sensory-motor syndrome as the presentation of a spontaneous cervico-thoracic epidural hematoma].
A spontaneous cervical epidural hematoma is an infrequent cause of cord compression. The commonest clinical presentations are with paraparesia and tetraparesia. Transient hemiparesia is very rare and a sensory-motor syndrome is exceptional. ⋯ The sensory motor syndrome is an unusual form of presentation of a spontaneous cervico-thoracic epidural hematoma. Root pain is a symptom of great value for orientation of a syndrome which would otherwise seem to be of central origin. The explanation for this clinical findings may be compression of both lateral cord pathways due to their particular blood distribution. Regarding therapeutic approach, this should be conservative, with close observation to see whether it will resolve spontaneously in a short period of time.