RESUMEN

Introducción: las enfermedades priónicas humanas constituyen una causa importante de demencia rápidamente progresiva e incurable, por lo que su diagnóstico diferencial con otras demencias tratables es fundamental. Actualmente se incluyen el EEG y la proteína 14-3-3 entre los criterios diagnósticos, pero estudios recientes destacan la sensibilidad y la especificidad de la RM cerebral. Nuestro objetivo es revisar una serie de pacientes con enfermedad de Creutzfeldt-Jakob esporádica (ECJe), analizando la importancia de la neuroimagen. Pacientes y métodos: estudio descriptivo y retrospectivo realizado en el Hospital General de Castellón en un período de 20 años (enero 1993-diciembre 2012), incluyendo pacientes con ECJe posible o probable. Resultados: 10 pacientes con ECJe (6 mujeres y 4 hombres), con una media de edad de 67 años (intervalo 54-82). El EEG fue útil en el 50 %, la proteína 14-3-3 positiva en el 100 % y la RM cerebral mostró alteraciones en la sustancia blanca cortical y en los ganglios basales en el 63%, cifra que aumentó hasta el 83% cuando se realizó secuencia DWI. Discusión: la RM cerebral en secuencia DWI y FLAIR es una técnica útil en el diagnóstico de la ECJ, superior al EEG, que permite detectar alteraciones incluso en estadios precoces de la enfermedad, por lo que creemos necesario incluirla entre los criterios diagnósticos (AU)

Introduction: human prion diseases are an important cause of rapidly progressive and incurable dementias, so its differential diagnosis from other treatable dementias is essential. Current criteria diagnosis includes EEG and 14-3-3 protein, however recent studies highlight the sensitivity and specificity of brain MRI. We aim to review a group of patients with sporadic Creutzfeldt-Jakob disease (sCJD), analyzing the importance of neuroimaging. Patients and methods: retrospective study performed in General Hospital of Castellón over a period of 20 years (January 1993 - December 2012), including patients with possible or probable sCJD. Results: 10 patients with sCJD (6 women, 4 men), mean age 67 years (54-82). The EEG was useful in 50%, 14-3-3 protein was positive in 100% and MRI showed abnormalities in cortical white matter and basal ganglia in 63%, increasing to 83% when performed DWI sequence. Discussion: DWI and FLAIR MRI is a useful technique in the diagnosis of CJD more than EEG, allowing us to detect abnormalities in early stages of the disease, thus it would be desirable considering the use of MRI in the diagnostic criteria (AU)

Asunto(s)

RESUMEN

Introducción. La trombólisis endovenosa en el infarto cerebral es el tratamiento de elección en las primeras horas y el retraso es la principal barrera para su empleo. El código ictus (CI) es un sistema que permite una rápida identificación y traslado del paciente con ictus al hospital adecuado para realizarla. Objetivo. Conocer el impacto de extender el CI intrahospitalario (CII) a CI provincial (CIP). Pacientes y métodos. Registro prospectivo de CI atendidos en un centro de ictus provincial. Se recogieron los infartos cerebrales ingresados de forma consecutiva el año previo y posterior al inicio del CIP (1 de noviembre de 2008). Resultados. En un año se atendieron 318 CI: el 61,2% fueron CI extrahospitalarios (CIE). Se trombolizaron 45 pacientes: el 14,2% de las activaciones y el 25,7% de los infartos cerebrales con código activado. La tasa bruta anual de trombólisis fue de 7,7 × 100.000 habitantes (intervalo de confianza del 95%, IC 95% = 5,7-10,4). Medicina primaria activó el 34% de los códigos. No hay diferencias significativas en el porcentaje de activaciones correctas y trombólisis entre CIE y CII. El retraso puerta-aguja es menor en los CIE (59,7 ± 24 frente a 74,4 ± 20 min; p = 0,012). La franja horaria de 22:00 a 08:00 h incluye el 23,6% de los CI y el 22,2% de los trombolizados. Del primer al segundo período, la activación del CI pasa del 11,1 al 37,9% de infartos cerebrales, y la trombólisis aumenta del 3,8 al 12,7% (p < 0,0001; odds ratio = 4,1; IC 95% = 1,9-8,6). Conclusión. El CIP permitió cuadruplicar la trombólisis del infarto cerebral, mejorar la cadena asistencial y extenderla a toda la provincia (AU)

Introduction. Endovenous thrombolysis is the preferred treatment in the early hours following cerebral infarction and delays are the main obstacle preventing it from being used on a more widespread basis. The stroke code (SC) is a system that allows stroke patients to be identified quickly and taken to the most suitable hospital for such treatment to be implemented. Aim. To determine the impact of extending the intra-hospital SC (ISC) to a provincial SC (PSC). Patients and methods. The system consists in a prospective register of cases of SC treated in a provincial stroke centre. Data on the cases of cerebral infarction admitted consecutively the year prior to and after beginning the PSC (1st November 2008) were collected. Results. In one year 318 SC were handled: 61.2% were extra-hospital SC (ESC). A total of 45 patients were thrombolysed: 14.2% of the activations and 25.7% of cerebral infarctions with the code activated. The gross annual rate of thrombolysis was 7.7/100,000 inhabitants (95% confidence interval, 95% CI = 5.7-10.4). Primary medicine activated 34% of the codes. There are no significant differences between ESC and ISC as regards the percentage of correct activations and thrombolysis. The door-to-needle delay is shorter in ESC (59.7 ± 24 versus 74.4 ± 20 minutes; p = 0.012). The time slot from 22 pm to 8 am covers 23.6% of the SC and 22.2% of cases of thrombolysed patients. From the first to the second period, SC activation rises from 11.1% to 37.9% of cerebral infarctions and thrombolysis increases from 3.8 to 12.7% (p < 0.0001; odds ratio = 4.1; 95% CI = 1.9-8.6). Conclusions. The PSC allowed thrombolysis of cerebral infarction to be carried out in four times as many cases, as well as improving the health care chain and extending it throughout the whole province (AU)

Asunto(s)

RESUMEN

INTRODUCTION: Endovenous thrombolysis is the preferred treatment in the early hours following cerebral infarction and delays are the main obstacle preventing it from being used on a more widespread basis. The stroke code (SC) is a system that allows stroke patients to be identified quickly and taken to the most suitable hospital for such treatment to be implemented. AIM. To determine the impact of extending the intra-hospital SC (ISC) to a provincial SC (PSC). PATIENTS AND METHODS: The system consists in a prospective register of cases of SC treated in a provincial stroke centre. Data on the cases of cerebral infarction admitted consecutively the year prior to and after beginning the PSC (1st November 2008) were collected. RESULTS: In one year 318 SC were handled: 61.2% were extra-hospital SC (ESC). A total of 45 patients were thrombolysed: 14.2% of the activations and 25.7% of cerebral infarctions with the code activated. The gross annual rate of thrombolysis was 7.7/100,000 inhabitants (95% confidence interval, 95% CI = 5.7-10.4). Primary medicine activated 34% of the codes. There are no significant differences between ESC and ISC as regards the percentage of correct activations and thrombolysis. The door-to-needle delay is shorter in ESC (59.7 ± 24 versus 74.4 ± 20 minutes; p = 0.012). The time slot from 22 pm to 8 am covers 23.6% of the SC and 22.2% of cases of thrombolysed patients. From the first to the second period, SC activation rises from 11.1% to 37.9% of cerebral infarctions and thrombolysis increases from 3.8 to 12.7% (p < 0.0001; odds ratio = 4.1; 95% CI = 1.9-8.6). CONCLUSIONS: The PSC allowed thrombolysis of cerebral infarction to be carried out in four times as many cases, as well as improving the health care chain and extending it throughout the whole province.

Asunto(s)