Revista de neurologia
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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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The antiepileptic drug gabapentin has begun to be used successfully in some cases of neuropathic pain. Its mechanism of action is still unknown, but seems to be related to a positive effect on the synthesis and liberation of the neurotransmitter GABA. ⋯ Gabapentin should be borne in mind in the treatment of this type of pain, particularly when the usual treatment cannot be given or is insufficient to control pain, especially in elderly patients in whom there is often reduced tolerance of drugs.
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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.