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Objective To assess the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic near-occlusion with and without full collapse. Methods Included were consecutive patients eligible for revascularization, grouped into symptomatic conventional ≥ 50% carotid stenosis (n = 266), near-occlusion without full collapse (n = 57) and near-occlusion with full collapse (n = 42). The risk of preoperative recurrent ipsilateral ischemic stroke was analyzed, or, for cases not revascularized within 90 days, 90-day risk was analyzed. Results The risk of a preoperative recurrent ipsilateral ischemic stroke or ipsilateral retinal artery occlusion was 15% (95% CI 9–20%) for conventional ≥ 50% stenosis, 22% (95% CI 6–38%) among near-occlusion without full collapse and 30% (95% CI 16–44%) among near-occlusion with full collapse (p = 0.01, log rank test). In multivariate analysis, near-occlusion with full collapse had a higher risk of recurrent ipsilateral ischemic stroke (adjusted HR 2.6, 95% CI 1.3–5.3) and near-occlusion without full collapse tended to have a higher risk (adjusted HR 2.0, 95% CI 0.9–4.5) than conventional ≥ 50% stenosis. Only 24% of near-occlusion with full collapse underwent revascularization, common causes for abstaining were misdiagnosis as occlusion (31%), deemed surgically unfeasible (21%) and low perceived benefit (10%). Conclusions Symptomatic carotid near-occlusion has a high short-term risk of recurrent ipsilateral ischemic stroke, especially near-occlusion with full collapse.

Introduccion. La esclerosis multiple (EM) es una enfermedad desmielinizante del sistema nervioso central de origen desconocido, en cuya patogenesis el sistema inmunitario desempena un papel crucial. En los familiares de pacientes con EM se ha observado una elevada frecuencia de otras enfermedades autoinmunes (EA), por lo que se ha propuesto la existencia de genes de susceptibilidad comunes a este grupo de enfermedades. Objetivos. Estimar la prevalencia de EA en familiares de primer y segundo grado de pacientes con EM y determinar la coexistencia de otras EA en los pacientes de EM. Pacientes y metodos. Seleccionamos 251 pacientes con EM definida por los criterios de Poser e investigamos mediante una entrevista personal con el paciente y/o sus familiares las siguientes EA: EM, artritis reumatoide, lupus eritematoso sistemico, panarteritis nudosa, enfermedad tiroidea autoinmune (ETA), enfermedad inflamatoria intestinal, miastenia grave, diabetes mellitus tipo I (DMI) y psoriasis. Resultados. El 29,9% de los pacientes con EM tenia algun familiar de 1.r y/o 2.o grado con una EA. La prevalencia de las EA en los familiares de primer grado fue del 15,5%, del 30% en la EM familiar y del 40% si concurrian en el paciente EM y otra EA. Las EA mas frecuentes fueron EM (27%), psoriasis (18%), ETA (16%) y DMI (15%). Tenian EM y otra EA 15 pacientes: 6 con ETA, 3 con DMI, 4 con psoriasis, 1 con enfermedad inflamatoria intestinal y 1 con miastenia grave. Conclusiones. Estos hallazgos apoyan la presencia de genes de susceptibilidad comunes a las diferentes EA que actuarian como factores de riesgo.

Introduccion. La hipertension intracraneal grave debida al infarto de todo el territorio de la arteria cerebral media responde mal al tratamiento medico y, a menudo, le sigue una herniacion transtentorial y la muerte. Recientemente se han publicado buenos resultados tras la practica de una hemicraniectomia descompresiva en estos casos. Caso clinico. Comunicamos una paciente de 33 anos que sufrio un infarto masivo de la arteria cerebral media derecha, con herniacion transtentorial y dilatacion del ventriculo lateral izquierdo, que respondio bien a la realizacion de una ventriculostomia externa sin hemicraniectomia. Se monitorizo la presion parcial cerebral de oxigeno (PtiO2) en el lobulo frontal izquierdo y se observo una estrecha relacion con los eventos clinicos. Conclusiones. El drenaje ventricular externo sin craniectomia fue, aparentemente, una medida terapeutica util en nuestra paciente con un infarto ?maligno? hemisferico. Son necesarios mas estudios en este sentido. La monitorizacion de la PtiO2 en estos casos ayudaria a valorar y optimizar las decisiones terapeuticas

INTRODUCTION Although the association between benign neoplasias of the thymus and myasthenia gravis is well known, with greater predominance of squamous thymomas over other histological types, carcinoma of the thymus is only exceptionally associated with auto immune disorders. CASE REPORTS We present three patients with myasthenia gravis associated with carcinoma of the thymus. They were three men aged between 38 and 73 years. Clinical features of myasthenia were generalized in two cases and ocular only in the third. Antireceptor antibodies to acetylcholine and anti striped muscle antibodies were present in all three patients. Repetitive stimulation was abnormal in two of the three cases. On CAT of the thorax there was a tumour of the thymus with the radiological characteristics of a benign thymoma in two of the patients and data suggesting an invasive thymoma in the third. In all three cases the diagnosis of carcinoma of the thymus was made on the post operative histological findings. CONCLUSIONS The association of carcinoma of the thymus with myasthenia gravis in our series of cases was probably due to chance. We consider that this association is exceptional since the histological characteristics of carcinoma of the thymus do not favour the development of auto immunity.

INTRODUCTION The prevalence of epilepsy in multiple sclerosis (MS) is low and the occurrence of an epileptic seizure as a first sign of this illness is even more infrequent. The relationship between both these illnesses is not clear; as epilepsy is a common condition, a coincidental association only could exist between the two diseases. OBJECTIVE To establish a nexus of causality between epilepsy an MS. Clinical case. We present one case of epileptic seizures as the first manifestation of MS. The patient was a woman of 25 years old. The only result of the clinical examination was a right homonymous inferior cuadrantanopsy. The patient presented a high Tibbling index, lesions of demyelination in the subcortical occipital region and semioval centrum in the MRI and a pathological electroencephalogram; also, the visual and auditory evoked potential latency were delayed. CONCLUSIONS We related he results of the neuroimaging, the clinical examination and the complementary tests of the patient. The appears to be a causal association between epilepsy and MS.