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Cyclin-dependent kinases (CDKs), in association with cyclins, control cell cycle progression by phosphorylating a large number of substrates. In animals, activation of CDKs regularly requires both the association with a cyclin and then phosphorylation of a highly conserved threonine residue in the CDK activation loop (the classical mechanism), mediated by a CDK-activating kinase (CAK). In addition to this typical mechanism of activation, some CDKs can also be activated by the association of a cyclin to a monomeric CDK previously phosphorylated by CAK although not all CDKs can be activated by this mechanism. In animals and yeast, cyclin, in addition to being required for CDK activation, provides substrate specificity to the cyclin/CDK complex; however, in plants both the mechanisms of CDKs activation and the relevance of the CDK-associated cyclin for substrate targeting have been poorly studied. In this work, by co-expressing proteins in E. coli, we studied maize CDKA2;1a and CDKB1;1, two of the main types of CDKs that control the cell cycle in plants. These kinases could be activated by the classical mechanism and by the association of CycD2;2a to a phosphorylated intermediate in its activation loop, a previously unproven mechanism for the activation of plant CDKs. Unlike CDKA2;1a, CDKB1;1 did not require CAK for its activation, since it autophosphorylated in its activation loop. Phosphorylation of CDKB1;1 and association of CycD2;2 was not enough for its full activation as association of maize CKS, a scaffolding protein, differentially stimulated substrate phosphorylation. Our results suggest that both CDKs participate in substrate recognition.

Resumen: Introducción: Las hemorragias subaracnoideas corticales (HSAc) tienen numerosas etiologías. No hay estudios prospectivos que indiquen su evolución a largo plazo. El objetivo de este trabajo es describir las características clínicas y etiológicas de los pacientes con HSAc y conocer su pronóstico. Métodos: Estudio observacional, prospectivo y multicéntrico. Se recogieron variables clínicas y radiológicas, y se siguió la evolución al año, observando la mortalidad, dependencia, tasa de resangrado y aparición de demencia. Resultados: Se incluyeron 34 pacientes (edad media 68,3 años, rango 27-89). Los síntomas más frecuentes fueron el déficit neurológico focal, con frecuencia transitorio y de repetición, y la cefalea. El TAC fue patológico en 28 pacientes (85%). Se realizó RM cerebral en 30 pacientes (88%), con isquemia aguda en 10 (29%), sangrados antiguos en 7 (21%) y siderosis superficial en otros 2 (6%). Se encontró etiología en 26 pacientes (76,5%): angiopatía amiloide (n = 8), ictus isquémico (n = 5), vasculitis (n = 4), encefalopatía posterior reversible (n = 2), trombosis venosa (n = 2), síndrome de vasoconstricción cerebral reversible (n = 2), oclusión carotidea (n = 1), síndrome de Marfan (n = 1) y carcinomatosis meníngea (n = 1). Durante el seguimiento fallecieron 3 pacientes (en 2 de ellos relacionado con la causa de la HSAc). Tres pacientes desarrollaron una demencia, 3 presentaron un hematoma lobar y otro una nueva HSAc. Conclusiones: En nuestra serie las causas más frecuentes de HSAc fueron la angiopatía amiloide, el ictus isquémico y la vasculitis. La HSAc tiene peor pronóstico que otras HSA no aneurismáticas. Puede tener numerosas causas y su pronóstico depende de la etiología subyacente. En el anciano existe una frecuente asociación con hemorragia intracraneal y deterioro cognitivo. Abstract: Introduction: Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis. Methods: We performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia. Results: The study included 34 patients (mean age, 68.3 years; range, 27-89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH. Conclusions: The most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment.

Trombosis venosa cerebral e infección por SARS-CoV-2.

Resumen: Introducción: Los folletos informativos son una herramienta educativa habitual en la práctica neurológica diaria; mediante este mecanismo se pretende incrementar de primera mano los conocimientos que la población tiene sobre una enfermedad concreta, además de evitar fuentes de información erróneas. Las encuestas son el medio más empleado para conocer la satisfacción de los usuarios con los servicios recibidos. Objetivos: Evaluar la satisfacción percibida y establecer una retroalimentación informativa que valore la comprensión y la utilidad global de un folleto educativo sobre migraña. Material y métodos: Estudio abierto, prospectivo y multicéntrico sobre una población de pacientes diagnosticados de migraña en diversas consultas de neurología de la provincia de Alicante. En la visita basal se les entrega un folleto informativo de migraña confeccionado por el grupo de estudio para la cefalea de la Sociedad Valenciana de Neurología (CEFALIC). En la visita control se les solicita la cumplimentación de una encuesta personal y por escrito sobre la calidad global de la información incluida en el folleto. Resultados: Se incluye a un total de 257 pacientes diagnosticados de migraña (83% migraña episódica; 17% migraña crónica), con una edad media de 37,6 años. Confirmaron la lectura del folleto 207 paciente (80,5%) y no lo habían leído 50 pacientes (19,5%), bien por olvido bien por desinterés. Al 90% de los pacientes la lectura del folleto les pareció interesante y comprensible. El 76% de los encuestados opina que la lectura del folleto incrementa sus conocimientos sobre migraña. El 50% de los pacientes opina que el folleto resultó de utilidad para mejorar el control de su migraña. Conclusiones: La utilización de un folleto educativo sobre migraña resultó comprensible, además incrementó el conocimiento global de la enfermedad y en opinión de los pacientes resultó útil para mejorar el control de su migraña. La evaluación de la información educativa que prestamos a nuestros pacientes con migraña debe ser medida para descubrir las causas de descontento, determinar el nivel de calidad del servicio e investigar las posibilidades de mejora de calidad. Abstract: Introduction: Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. Objectives: This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. Material and methods: Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. Results: We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. Conclusions: Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement. Palabras clave: Folletos educativos, Información en migraña, Migraña, Encuestas, Keywords: Educational brochure, Migraine information, Migraine, Surveys

Introduction: Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. Objectives: This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. Material and methods: Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. Results: We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. Conclusions: Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement. Resumen: Introducción: Los folletos informativos son una herramienta educativa habitual en la práctica neurológica diaria; mediante este mecanismo se pretende incrementar de primera mano los conocimientos que la población tiene sobre una enfermedad concreta, además de evitar fuentes de información erróneas. Las encuestas son el medio más empleado para conocer la satisfacción de los usuarios con los servicios recibidos. Objetivos: Evaluar la satisfacción percibida y establecer una retroalimentación informativa que valore la comprensión y la utilidad global de un folleto educativo sobre migraña. Material y métodos: Estudio abierto, prospectivo y multicéntrico sobre una población de pacientes diagnosticados de migraña en diversas consultas de neurología de la provincia de Alicante. En la visita basal se les entrega un folleto informativo de migraña confeccionado por el grupo de estudio para la cefalea de la Sociedad Valenciana de Neurología (CEFALIC). En la visita control se les solicita la cumplimentación de una encuesta personal y por escrito sobre la calidad global de la información incluida en el folleto. Resultados: Se incluye a un total de 257 pacientes diagnosticados de migraña (83% migraña episódica; 17% migraña crónica), con una edad media de 37,6 años. Confirmaron la lectura del folleto 207 paciente (80,5%) y no lo habían leído 50 pacientes (19,5%), bien por olvido bien por desinterés. Al 90% de los pacientes la lectura del folleto les pareció interesante y comprensible. El 76% de los encuestados opina que la lectura del folleto incrementa sus conocimientos sobre migraña. El 50% de los pacientes opina que el folleto resultó de utilidad para mejorar el control de su migraña. Conclusiones: La utilización de un folleto educativo sobre migraña resultó comprensible, además incrementó el conocimiento global de la enfermedad y en opinión de los pacientes resultó útil para mejorar el control de su migraña. La evaluación de la información educativa que prestamos a nuestros pacientes con migraña debe ser medida para descubrir las causas de descontento, determinar el nivel de calidad del servicio e investigar las posibilidades de mejora de calidad. Keywords: Educational brochure, Migraine information, Migraine, Surveys, Palabras clave: Folletos educativos, Información en migraña, Migraña, Encuestas

Introduction: Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis. Methods: We performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia. Results: The study included 34 patients (mean age, 68.3 years; range, 27–89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH. Conclusions: The most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment. Resumen: Introducción: Las hemorragias subaracnoideas corticales (HSAc) tienen numerosas etiologías. No hay estudios prospectivos que indiquen su evolución a largo plazo. El objetivo de este trabajo es describir las características clínicas y etiológicas de los pacientes con HSAc y conocer su pronóstico. Métodos: Estudio observacional, prospectivo y multicéntrico. Se recogieron variables clínicas y radiológicas, y se siguió la evolución al año, observando la mortalidad, dependencia, tasa de resangrado y aparición de demencia. Resultados: Se incluyeron 34 pacientes (edad media 68.3 años, rango 27–89). Los síntomas más frecuentes fueron el déficit neurológico focal, con frecuencia transitorio y de repetición, y la cefalea. El TAC fue patológico en 28 pacientes (85%). Se realizó RM cerebral en 30 pacientes (88%), con isquemia aguda en 10 (29%), sangrados antiguos en 7 (21%) y siderosis superficial en otros 2 (6%). Se encontró etiología en 26 pacientes (76.5%): angiopatía amiloide (n = 8), ictus isquémico (n = 5), vasculitis (n = 4), encefalopatía posterior reversible (n = 2), trombosis venosa (n = 2), síndrome de vasoconstricción cerebral reversible (n = 2), oclusión carotidea (n = 1), síndrome de Marfan (n = 1) y carcinomatosis meníngea (n = 1). Durante el seguimiento fallecieron tres pacientes (en dos de ellos relacionado con la causa de la HSAc). Tres pacientes desarrollaron una demencia, tres presentaron un hematoma lobar y otro una nueva HSAc. Conclusiones: En nuestra serie las causas más frecuentes de HSAc fueron la angiopatía amiloide, el ictus isquémico y la vasculitis. La HSAc tiene peor pronóstico que otras HSA no aneurismáticas. Puede tener numerosas causas y su pronóstico depende de la etiología subyacente. En el anciano existe una frecuente asociación con hemorragia intracraneal y deterioro cognitivo.

In this work, we describe the well-known methods of cutting and shaping for optical glass materials. These operations are very important in optical workshops and needs to be well defined at the beginning of the optical fabrication process. In this work we show the first steps to fabricate prism components for the MEGARA instrument that is being developed to work with the GRANTECAN. We present a review of the techniques used at INAOE´s Optical workshop for cutting blanks of optical glasses with an extensive use in optical fabrication; besides that, we present the process of shaping of these optical glasses just before they enter to the grinding and polishing processes. We present some results showing the described processes and some tips for the methods used in the optical workshop including the use of the necessary supplies, tools, and machinery.

Hyposmia and substantia nigra hyperechogenicity (SN+) are characteristic markers of Parkinson's disease (PD), although their diagnostic value in isolation may be limited. We evaluated the combined prevalence of both disorders in patients diagnosed with PD and assessed their diagnostic yield compared to a sample with essential tremor (ET) and another group of healthy subjects.Patients diagnosed with PD and ET and treated in our outpatient clinic were enrolled. Olfaction was assessed using the "Sniffin' Sticks" odour identification test (SS-12) and hyperechogenicity of the substantia nigra (SN+) was assessed by transcranial duplex ultrasound.A total of 98 subjects were analysed, comprising 30 with PD, 21 with ET, and 47 controls. The respective prevalence rates of hyposmia (SS-128) and SN+ (area.24cm(2)) were 70% and 83.3% in PD, 33.3% and 9.5% in ET, and 17% and 10.6% in controls. Both markers were present in 63% of patients with PD, none of the patients with ET, and only 2 of the controls.Combined use of substantia nigra sonography and olfactory testing with SS-12, two rapid, safe, and accessible tests, was more specific than each isolated marker for distinguishing patients with PD from patients with ET and control subjects. Since both markers have been described in very early phases of PD, combined use may be helpful in providing early diagnosis of PD.

This study aims to perform a descriptive analysis of the usage patterns of migraine prophylactic medications by various neurologists in our setting.The first preventive treatment prescribed for migraine in patients not associated to other diagnoses of primary headache was recorded in three outpatient neurology clinics and one headache specific clinic.A total of 235 prophylactic treatments out of 669 patients were initiated. The patients were aged 37 +/- 12 years (mean +/- standard deviation) and 84.45% were women. Migraines with aura accounted for 18.9% of migraines. By order of frequency, the prophylactic treatments administered were topiramate (43%), beta-blockers (18%), flunaricine (17%), amitriptyline (14%), selective serotonin reputake inhibitors (6%) and others (2%). Beta-blockers and flunaricine were used much more frequently in men (29.7% and 27% versus 15.9% and 14.4%, respectively) and antidepressants were used more in women (21.87% versus 5.4%). The most frequently used antidepressant was amitriptyline, and its use increases with the age of the patient, it being the most frequently used treatment in over 60-year-old patient group.At present, topiramate has become the first preventive treatment option for migraine in our setting, especially in young women. There is greater variability in the choice of an alternative treatment. Amitriptyline is the first choice within the antidepressants and is almost exclusively prescribed in women with migraine and elderly age.

Pituitary apoplexy is a rare clinical entity. It is a rare cause of stroke, whose pathogenic mechanism has not been fully understood. Compression in intracavernous carotid artery and vasospastic mechanism have been described. It may initially begin as a meningeal syndrome, in which neuroimaging techniques may be fundamental, above all resonance magnetic imaging for a correct diagnosis of the disease and its complications.We report the case of a 23 year-old male who suffered a massive stroke due to bilateral carotid compression in its intracavernous portion due to apoplexy of a previously unknown pituitary tumor. The diffusion sequences and acute angioresonance of the circle of Willis are presented.This is a rare entity with controversial management. An exhaustive review of cases and series of patients with pituitary apoplexy related stroke is also presented.

Strokes are the leading cause of epileptic seizures in adults and account for 50% of seizures in those over the age of 65. These patients present certain specific characteristics with respect to the remaining population, which makes it necessary to look for medication that are suited to their particular case.To describe the effectiveness and safety of levetiracetam (LEV) in monotherapy in elderly patients with post-stroke epileptic seizures.A prospective evaluation was conducted of a series of cases consisting of patients over the age of 60 years who had suffered a stroke and had had at least one epileptic seizure in the late post-stroke phase (more than two weeks). Demographic data and the characteristics of the epilepsy and the stroke were collected. Patients began treatment with LEV in monotherapy, underwent check-ups at one and six months of treatment, and the effectiveness and safety of the drug were evaluated.The sample consisted of 25 patients with a mean age of 75.2 +/- 7.6 years. They presented an average of 3.2 +/- 5.6 post-stroke seizures and the time elapsed since the stroke was 38.3 +/- 81.8 months. After six months' follow-up, 76% of the patients were still receiving treatment with LEV. Of the patients under treatment, 89.5% were free from seizures. Side effects that could be attributed to LEV were noted by 28% of patients, but did not compel them to stop treatment.LEV in monotherapy can be a safe, effective therapeutic option for elderly patients who have presented epilepsy following a stroke.

To describe the use of preadmission statins in patients with cerebrovascular accident and the possible predictive factors.Cross-sectional observational study of 795 consecutive patients with acute cerebrovascular accident. We assessed the differences among patients who were on preadmission statins (161) and those who were not (634), regarding vascular risk factors and clinical and neurosonological atherothrombotic disease markers. For univariate analysis, we used squared chi test, and for multivariate analysis, logistic regression analysis.Preadmission statins were 20.3%. In high vascular risk patients defined based on National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), this reached 28% and it might be 72%. Predictive factors for preadmission statins use were, in a positive sense, the antecedent of hypercholesterolemia diagnosis (OR = 189; 95% CI = 58-615; por = 0.001) and stroke (OR = 2.1; 95% CI = 1.2-3.6; por = 0.01), and in a negative sense, smoking (OR = 0.38; 95% CI = 0.18-0.81; p = 0.012).In our population of patients with stroke, the predictive factors of preadmission statins did not adjust to the current therapeutic NCEP-ATP III recommendations; treatment with statins in high vascular risk population was way below the indications, it was 28% and it might be 72%.

To conduct a descriptive study of the welfare work carried out during one year in visits to ambulatory outpatient neurology clinics in the health district of Elche.We carried out a prospective study of data from the first visits to two outpatient neurology clinics between 1st May 2005 and 30th April 2006.A total of 3229 first-time visits were attended, with a mean age of 56.8 years (SD: 21) and 62% were females. The incidence of first-time visits was 18.9 per 1000 inhabitants over the age of 14 years per year. In all, 18% missed their appointments. Results showed that 93.9% of the visits came from Primary Care, with a total mean delay of 30.6 days (16.1 days in the preferential cases and 35.8 in ordinary cases). The most frequent reasons for referral were: headaches (27.2%), cognitive disorders (15.9%), applications for visas or orthopaedic material (8.3%), impaired levels of consciousness/paroxysms with suspected epilepsy (7.3%), dizziness/instability/vertigo (6.8%) and tremor (5.9%). The most frequent diagnoses were headache (28% of the total number; 41.35% of the group less than 65 years old), cognitive impairment (12.24% of the total number; 28.9% of the group equal or more than 65 years old), cerebrovascular disease (8.7%) and epilepsy (5.1%). Patients with a non-neurological pathology accounted for 21.8% of the total number.In our environment, headache continues to be the leading reason behind referrals to the neurologist. One notable point is the high frequency with which patients without any kind of neurological disorder are referred; the same can be said for those referred for bureaucratic reasons (visas and prescriptions for orthopaedic materials).

Transtemporal insonation by means of transcranial color-coded duplex sonography (TCDS) with low frequency probes (2-2.5 MHz) makes it possible to not only evaluate the blood vessels of the circle of Willis but also of brain parenchymal structures. A reduced number of studies, none of them in our area, have reported its usefulness for the evaluation of the ventricular system in adults. Aim. To evaluate ability of the transcranial duplex to measure the third ventricle diameter in a sample of patients with different neurological illnesses.Patients of all ages admitted to our neurology ward and whose diagnostic procedure included a brain magnetic resonance (MRI) were recruited. The largest third ventricle diameter was measured with both the TCDS and MRI in axial planes. We report the results observed with both techniques and the lineal correlation between both of them.We included 30 patients with mean age 48.5 years and 66.6% females. The third ventricle diameter (average +/- standard deviation) was 3.97 +/- 2.58 mm as measured with TCDS and 3.70 +/- 2.27 mm on MRI. Linear correlation between the values observed was high (r=0.85).Transcranial duplex is a cheap, safe and easy to perform technique. It has similar results in comparison with those obtained with the MRI when the third ventricle size is measured.

Only a minority of patients with acute stroke are eligible for fibrinolysis, and the main reason for this is that time runs out and goes beyond the therapeutic window. The chief delay occurs prior to arrival at the hospital, but there is also a nosocomial delay, which has received far less attention.The purpose of our study was to describe the data on delays occurring before and after arrival at the hospital in a sample of patients with acute stroke, and to analyse possible associated factors, including the overload on health care services in the Emergency department, an aspect that has not previously been evaluated.Epidemiological data, times of delays before and after entering the hospital, means of transport used and the health care workload in the Emergency department of the day of admission were collected for all the stroke patients admitted to the Stroke Unit of the Hospital General Universitario de Alicante throughout the period under study.From an initial sample of 460 patients, 423 were finally included in the study, with a mean delay before and after admission to hospital of 3.99 and 2.36 hours, respectively. Use of an ambulance and the haemorrhagic and transient ischemic attack subtypes were linked to a shorter delay before reaching the hospital, and arrival during the night shift was the only factor associated to a longer delay once inside the hospital.In our environment, there is a need to establish strategies aimed at shortening the times stroke patients take to reach the hospital and the time that elapses before they are attended.

Dizziness is a common symptom at the outpatient clinic of family doctors. Its origin is usually multifactorial and its outcome is often benign. However, exists a tendency to relate the dizziness with a cerebrovascular disturbance. AIM. To determine if there are cerebrovascular disorders in patients with chronic dizziness using a non invasive technique.A prospective study was conducted. It included 404 patients without limit of age. The patients were evaluated in a Neurology Outpatient Clinic, to select those patients with chronic instability. A neurosonographic exam was performed to all those selected patients. This exam included colour duplex of the cervical arteries and transcranial Doppler.Up to 54 % of the patients who were included in the study had a normal carotid study. For the rest of the patients, the thickness intima-media was the most prevalent finding. At the vertebrobasilar system the study of the vertebral arteries was completely normal in 81.7% followed by the presence of microangiopathy in 12.1%. The basilar system was also normal in a high figure (78%) followed by the microangiopathy (17.1%).The vascular disturbances in the vertebrobasilar system are an exceptional finding in patients with chronic instability.

It is reckoned that headaches affect, at least once a year, around 90% of the population. The socioeconomic repercussion occasioned by this malady justifies the appearance in recent years of headache units.To conduct a descriptive epidemiological and health care study of the activity carried out in a headache-specific clinic.All the relevant points from the histories of patients who visited our surgery over a period of two years were collected prospectively and consecutively. The different types of headaches were classified according to the 1988 IHS criteria. Both the symptomatic and the preventive treatment were analysed.In all, a total of 866 patients were found; 691 (79.8%) were females and the mean age was 39.8 +/- 15.9 years (range: 6-90 years); 208 (24%) had a history of migraine in the family; 399 (49.9%) were diagnosed as suffering from migraine: 256 (64.2%) had migraine without aura, 152 (19%) were diagnosed as having tension-type headache, and 218 (27.3%) presented chronic daily headache (CDH). The most frequently used symptomatic treatments were NSAI drugs (36.7%) and triptanes (28.4%). Amitriptyline (47.7%), beta-blockers (14.5%) and calcium antagonists (11.3%) were the main drugs used as preventive treatment.After several years' operation of our Headache Unit, we thought there was a need to analyse the population seen in the visits. The fact that the majority of our patients were middle-aged females matched our expectations. Although most of the patients were diagnosed as suffering from M, we also want to highlight the high proportion of cases of CDH, above all associated with the abuse of analgesics.

The link between cardiovascular risk factors and carotid atheromatosis has been shown to be more important in middle aged subjects than in the elderly.Our aim was to study the frequency of carotid and intracranial atheromatosis in a population over the age of 80 and to compare the presence of neurosonological anomalies depending on whether the patients have suffered a stroke or not. We also wished to compare the findings according to the sex of the patient.Patients over the age of 80 were studied at our Neurosonology laboratory using carotid and transcranial Doppler ultrasonography. The patients were analysed according to whether they had suffered an ischemic stroke or not. With regard to the carotid, a distinction was made between normal, non-significant atheromatosis and significant atheromatosis (stenosis50%). Intracranially, both the middle cerebral artery (normal, stenosis, microangiopathy and post-stenosis) and the basilar artery (normal, stenosis, microangiopathy and hyperdynamics) were studied.We recorded data concerning 832 patients: 342 males (44.1%), mean age 83.63 +/- 3.25 years, and 527 (63.3%) with stroke. The carotid study was pathological, with a higher frequency in stroke patients (32.1% compared with 41.9%; p = 0.002). The presence of atheromatosis was significantly linked to a higher risk of suffering a stroke and more intensely to its being more severe. Carotid studies were pathological with a higher frequency among males (28.7% compared with 40%; p0.001). No significant differences were found intracranially in any of the parameters analysed.There is a high frequency of carotid atheromatosis in patients over 80 years of age. Regardless of the age, carotid atheromatosis appears even more frequently in patients who have suffered a stroke and in males, and is significantly associated to the risk of suffering a stroke. Intracranially, no differences were found.

Carotid stenosis has been reported as being associated to lacunar infarcts (LI) with variable frequency, but the aetiopathogenic relation between them is still subject to some controversy.Our aim was to describe the prevalence of carotid disorders in a neurosonological study of a sample of patients with LI.We analysed the results of the neurosonological study conducted on patients with clinical-radiological criteria of LI who were admitted to our Stroke Unit during the period of study.We studied 140 patients, and results were normal in only 42% of the cases. Stenosis50% was found in 10% of the cases and plaque without stenosis in 40.3% of the patients. In patients without plaque there was an increase in the tunica intima-media thickness in 7.2% of the cases.In most of the patients with LI there were anomalies in the study of the carotid performed using ultrasound scanning.

Partial olfactory seizures are infrequent. They are related to the presence of lesions in the uncinate area of the temporal lobe. Patients describe smells during the ictal phase that are generally unpleasant. We report the cases of two patients with olfactory disorders of a paroxysmal nature caused by a parasellar meningioma.Case 1: a 43 year old male who presented paroxysmal episodes in which he perceived a bitter smell, with dysphoria, linked to the presence of a left side parasellar meningioma. Case 2: a 45 year old female who presented paroxysmal episodes during which she could smell formaldehyde and this was linked to the presence of a left side parasellar meningioma.Olfactory seizures are related to structural alterations to the amygdala. The most frequent causes are associated to the presence of mesial temporal sclerosis and, above all, to tumours situated in the temporomesial structures that have diverse aetiologies.

Atrial fibrillation is present in 24% of the population over 60 and it increases the risk of stroke by 2,4% 3%/year. Antithrombotic treatment is considered as the treatment of choice for cardioembolic stroke prevention in this patients. As far as we know there are not relevant data about the influence of these treatments on the type of stroke that may develop in these patients.Analyze whether there are differences in the clinical profile and functional prognosis after stroke in patients with atrial fibrillation depending on the type of treatment they were on at the time of occurrence of the event.We identified 67 patients who were admitted consecutively to our stroke unit with a stroke and atrial fibrillation over a period of 2 years. Patients were classified according to the type of antithrombotic treatment they were on. Functional prognosis was estimated by Rankin score at discharge.Treated patient showed a non significant tendency to suffer less severe strokes and present a better functional situation at discharge than those who were not on prophylactic treatment. Treated patients had a significant higher prevalence of previous TIA (44,2% vs 9,1%; p= 0,0042) and HBP (81,4% vs 52%; p= 0,041) than non treated patients. Embolic strokes were more frequent in non treated patients.Antithrombotic treatment not only prevents strokes but may also contribute to the development of less severe strokes with a better functional prognosis in patients with AF and does not contribute to increase complications in these group of patients.

Lamotrigine (LTG) is a new antiepileptic drug indicated in all kinds of partial and generalised clonic-tonic seizures, both in monotherapy and polytherapy. Between 20 and 30% of epileptic patients have poor control over their seizures despite adequate treatment.We report on our experience regarding the long-term efficacy and tolerability of LTG in refractory seizures.We conducted a consecutive 10-year study of patients who began LTG therapy following poor control of their seizures, in spite of being treated with two or more antiepileptic drugs in monotherapy or in combination. Both their epidemiological and clinical data were collected for study. We studied the efficacy of the treatment, differentiating between remission (absence of seizures), improvement (reduction50% of the seizures), inefficacy (reduction50%), exacerbation (increase in seizures) and its tolerability (side effects and dropout).In all, data was collected from 39 patients, 18 males (46.2%), mean age 30.9 +/- 13.7 years; mean follow up time: 27.6 +/- 23.4 months. 43.7% presented cryptogenic epilepsy, in 28.5% it was symptomatic and in the remaining 28.5% it was idiopathic. EEG readings and neuroimaging scans were pathological in 53.8% and 43.6%, respectively. After beginning therapy with LTG, 33% remained free of seizures, 43.6% improved, in 18.3% it was seen to be ineffective and 5.1% got worse. Dropout rate was 56.4%:23.1% due to insufficient control over the seizures, 17.9% owing to side effects and 15.4% because of non-compliance.Treatment with LTG offers a high degree of efficacy in the control of seizures in patients with refractory epilepsy, although it is limited by a high dropout rate.

In Western countries, neurological disorders secondary to toxic nutritional problems usually present as isolated cases that are generally associated to identifiable causes (alcoholism, eating disorders, absorption disorders, use of medicines) that reduce the availability of basic nutrients, especially B group vitamins, but also folic acid (FA). The optic nerves and the peripheral axons are frequent target organs in this type of pathology, but leukoencephalopathy and spinal cord involvement may also appear, often in combination.We describe the case of a 38-year-old female smoker with a heavy alcohol habit, who developed a subacute clinical pattern of, predominantly axonal, sensitive peripheral polyneuropathy, with vegetative fibre involvement. She also presented involvement of the posterior spinal cord, which gave rise to an ataxic disorder in the gait, as well as a severe bilateral retrobulbar optic neuropathy. Likewise, she presented macrocytosis (MCV: 118) due to megaloblastosis. She was also found to have a FA deficit but a normal vitamin B12 metabolism. With the help of supplementary vitamins, stopping drinking and the regularisation of her diet, the patient presented progressive clinical improvement, and was able to walk without support at 3 months and almost completely recovered her sight, which was corroborated by an improvement in the studies of both visual and somatosensorial evoked potentials.In our community, alcoholism is a frequent cause of nutritional deficiencies, which lead to neurological problems. FA is one of the nutrients that become deficient in alcoholics. More and more descriptions are being reported of peripheral polyneuropathy, retrobulbular optic neuropathy, myelopathy or leukoencephalopathy associated to FA deficiency, above all in patients with a history of alcoholism.

A total number of 1,149 specimens of cord-blood were subjected to cellulose acetate gel electrophoresis in order to estimate the incidence of haemoglobinopathies in newborn infants (NBI). It was found that 4.37% of black NBI and 0.54% of white NBI were AS carriers. Those samples with HbS or HbC were verified by means of agar-citrate electrophoresis at pH 6.2. Haemoglobin Bart was commonest in black (3.1%) than in white (0.4%) NBI. A slow haemoglobin variant was found with an alpha-chain mutation. The concentration of gamma G was estimated by separation of gamma G and gamma A chains with polyacrylamide gel electrophoresis, and it ranged between 52% and 94%, which could be attributed to the fact that the shift from HbF to HbA is not simultaneous in all the red-cell population.

Introduccion. Los ictus son la primera causa de crisis epilepticas en adultos y los responsables del 50% de crisis en mayores de 65 anos. Estos pacientes presentan unas caracteristicas propias respecto al resto de la poblacion, por lo que se hace necesario buscar farmacos que resulten apropiados. Objetivo. Describir la eficacia y tolerabilidad del levetiracetam (LEV) en monoterapia en pacientes ancianos con crisis epilepticas postictus. Pacientes y metodos. Se evaluo prospectivamente una serie de casos formada por pacientes mayores de 60 anos que hubieran sufrido un ictus y presentaran, al menos, una crisis epileptica en la fase tardia (mas de dos semanas) postictus. Se recabaron datos demograficos, caracteristicas de la epilepsia y del ictus. Los pacientes iniciaron tratamiento con LEV en monoterapia, fueron controlados al mes y a los seis meses de tratamiento, y se evaluo la eficacia y tolerabilidad del farmaco. Resultados. Se incluyeron 25 pacientes con edad media de 75,2 ± 7,6 anos. Presentaron una media de 3,2 ± 5,6 crisis postictus y un tiempo trascurrido desde el ictus de 38,3 ± 81,8 meses. Tras seis meses de seguimiento, el 76% de los enfermos continuaba tratamiento con LEV. De los pacientes con el tratamiento, el 89,5% se mantenia libre de crisis. El 28% habia presentado algun efecto secundario atribuible al LEV que no obligo a la suspension del tratamiento. Conclusion. El LEV en monoterapia puede ser una opcion terapeutica eficaz y segura para aquellos pacientes ancianos que hubieran presentado epilepsia tras sufrir un ictus.

Introduccion. Solo una minoria de pacientes con ictus agudo es candidata a fibrinolisis, y el principal motivo es sobrepasar temporalmente la ventana terapeutica. El principal retraso se produce hasta la llegada al hospital, pero tambien existe, y ha sido menos estudiado, un retraso intrahospitalario. Objetivo. Describir los datos de retraso extrahospitalario e intrahospitalario en una muestra de pacientes con ictus agudo y analizar los posibles factores asociados, entre ellos la sobrecarga asistencial en el area de Urgencias, aspecto previamente no evaluado. Pacientes y metodos. Se recogieron de forma sistematica los datos epidemiologicos, los tiempos de retraso extrahospitalario e intrahospitalario, el medio de trasporte empleado y la carga asistencial en Urgencias en el dia del ingreso de todos los pacientes con ictus que ingresaron en la Unidad de Ictus del Hospital General Universitario de Alicante durante el periodo de estudio. Resultados. De una muestra inicial de 460 pacientes, se incluyeron en el estudio 423, con una mediana de retraso extrahospitalario e intrahospitalario de 3,99 y 2,36 horas, respectivamente. El uso de ambulancia y los subtipos hemorragico y accidente isquemico transitorio se asociaron a un menor retraso extrahospitalario, mientras que la llegada durante el turno de noche fue el unico factor asociado a un mayor retraso intrahospitalario. Conclusiones. Se evidencia la necesidad en nuestro medio de iniciar estrategias encaminadas a mejorar las latencias con la que los pacientes con enfermedad cerebrovascular acuden y se atienden en el ambito hospitalario.