Catástrofes Neurológicas
Catástrofes derivadas de las técnicas complementarias de diagnóstico neurológico
Catastrophes caused by neurologic diagnostic procedures
M. Arias Gómez
Servicio de Neurología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
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"apellidos" => "Tabernero García" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485310700530?idApp=UINPBA00004N" "url" => "/02134853/00000025000000S1/v1_201305151047/S0213485310700530/v1_201305151047/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0213485310700517" "issn" => "02134853" "doi" => "10.1016/S0213-4853(10)70051-7" "estado" => "S300" "fechaPublicacion" => "2010-10-01" "aid" => "70051" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "sco" "cita" => "Neurologia. 2010;25 Supl 1:52-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3371 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 2017 "PDF" => 1304 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Catástrofes Neurológicas</span>" "titulo" => "Catástrofes neurológicas por desconocimiento y retraso diagnóstico" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "52" "paginaFinal" => "60" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Neurological catastrophes due to medical errors" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Alberca" "autores" => array:1 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Alberca" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485310700517?idApp=UINPBA00004N" "url" => "/02134853/00000025000000S1/v1_201305151047/S0213485310700517/v1_201305151047/es/main.assets" ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Catástrofes Neurológicas</span>" "titulo" => "Catástrofes derivadas de las técnicas complementarias de diagnóstico neurológico" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "61" "paginaFinal" => "67" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M. Arias Gómez" "autores" => array:1 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Arias Gómez" "email" => array:1 [ 0 => "manuel.arias@usc.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Catastrophes caused by neurologic diagnostic procedures" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec157351" "palabras" => array:7 [ 0 => "Complicaciones neurológicas" 1 => "Punción lumbar Edrofonio" 2 => "EMG" 3 => "Angiografía" 4 => "Vídeo-EEG" 5 => "Biopsia cerebral" 6 => "Pruebas genéticas" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec157350" "palabras" => array:8 [ 0 => "Neurologic complications" 1 => "Lumbar puncture" 2 => "Edrophonium" 3 => "EMG" 4 => "Angiography" 5 => "Video-EEG" 6 => "Cerebral biopsy" 7 => "Genetic testing" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las complicaciones graves (catástrofes) de las numerosas técnicas diagnósticas neurológicas pueden producirse tanto por indicación y omisión como por retraso, ejecución o interpretación erróneas. La cefalea por hipotensión del LCR es la complicación más frecuente de la punción lumbar; si es intensa, puede tratarse con parche hemático. Las herniaciones cerebrales son la complicación más grave; para evitarlas, siempre hay que realizar antes un estudio de TC o RM: el hallazgo de una lesión con evidente efecto masa contraindica la punción. La no indicación de punción lumbar ante una cefalea centinela puede pasar por alto una hemorragia subaracnoidea menor, que se transformará en catástrofe en caso de recidiva. La prueba del edrofonio (tensilón) puede complicarse con bradicardia y/o asistolia. Su omisión puede dar lugar a que no se diagnostiquen precozmente cuadros de miastenia grave, sobre todo en sujetos de edad avanzada. La electromiografía tiene escasas complicaciones (casos puntuales de hematomas paraespinales y neumotórax). Los ultrasonidos, la angio-TC y la angio-RM han reducido las indicaciones de angiografía cerebral, cuyas complicaciones principales, además de reacciones al contraste, sangrado e infecciones en el lugar de la inyección, son los déficits neurológicos por disección vascular o embolismo de material ateromatoso. En la evaluación prequirúrgica de la epilepsia se realizan determinadas técnicas como vídeo-EEG con supresión de la medicación, lo que puede precipitar la aparición de crisis repetidas con riesgo de lesiones y estatus epiléptico. Los registros mediante electrodos invasivos y las mantas de electrodos pueden complicarse con infecciones y hemorragia intracraneal. La biopsia cerebral se indica ante la sospecha de patología tratable, pero con potenciales efectos secundarios graves de los tratamientos (radioterapia, quimioterapia). Puede agravar déficits neurológicos previos o producir otros nuevos. Las pruebas genéticas no están indicadas en niños sanos en los que se sospeche una entidad sin tratamiento. En los adultos se realizan en casos seleccionados, previa información detallada, y teniendo en cuenta posibles reacciones emocionales graves.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Serious complications (catastrophes) resulting from diverse neurological diagnostic procedures can be caused by erroneous indication and omission, as well as by delay and erroneous execution or interpretation. Headache, caused by cerebrospinal fluid (CSF) hypotension, is a frequent complication of lumbar puncture; hematic patch is a therapeutic option for severe cases. The most serious complication is cerebral herniation and, for its prevention, computed tomography (CT) or cerebral magnetic resonance imaging (MRI) must always be performed before lumbar puncture: a lesion with evident mass effect is a contraindication. Some cases of minor subarachnoid hemorrhages can produce sentinel headache: when the findings of CT scans are normal, lumbar puncture must be performed for diagnosis and prevention of a catastrophic recurrence. Edrophonium testing can be complicated with bradycardia and/or asystole. The lack of indication of this procedure is a cause of under-diagnosis of myasthenia gravis, especially in older people. Electromyography produces few complications (rare cases of paraspinal hematomas and pneumothorax). Ultrasound, CT angiography and MR angiography examinations have decreased the indications for cerebral angiography, whose main complications —in addition to contrast reactions, hemorrhage and infection at the injection site— are neurological deficits caused by vascular dissection or atheromatous embolus. Video-electroencephalogram (EEG) recording with medication suppression can be used in the presurgical evaluation of epilepsy, which can precipitate repeated seizures with the risk of injuries and status epilepticus. The possible complications of studies performed with invasive electrodes are infections and intracranial hemorrhages. Cerebral biopsy is indicated when treatable disease is suspected but the therapeutic options (radiotherapy, chemotherapy) have potential serious adverse effects. Furthermore, cerebral biopsy can aggravate previous neurological deficits or produce new deficits. Genetic testing is not indicated in healthy children when an untreatable disease is suspected. 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| 2024 Septiembre | 15 | 75 | 90 |
| 2024 Agosto | 17 | 21 | 38 |
| 2024 Julio | 17 | 28 | 45 |
| 2024 Junio | 17 | 26 | 43 |
| 2024 Mayo | 15 | 37 | 52 |
| 2024 Abril | 11 | 17 | 28 |
| 2024 Marzo | 13 | 29 | 42 |
| 2024 Febrero | 9 | 22 | 31 |
| 2024 Enero | 12 | 29 | 41 |
| 2023 Diciembre | 13 | 20 | 33 |
| 2023 Noviembre | 9 | 44 | 53 |
| 2023 Octubre | 10 | 14 | 24 |
| 2023 Septiembre | 12 | 19 | 31 |
| 2023 Agosto | 6 | 16 | 22 |
| 2023 Julio | 7 | 13 | 20 |
| 2023 Junio | 10 | 4 | 14 |
| 2023 Mayo | 11 | 15 | 26 |
| 2023 Abril | 6 | 6 | 12 |
| 2023 Marzo | 8 | 2 | 10 |
| 2023 Febrero | 15 | 7 | 22 |
| 2023 Enero | 12 | 1 | 13 |
| 2022 Diciembre | 11 | 8 | 19 |
| 2022 Noviembre | 19 | 10 | 29 |
| 2022 Octubre | 12 | 12 | 24 |
| 2022 Septiembre | 9 | 17 | 26 |
| 2022 Agosto | 16 | 11 | 27 |
| 2022 Julio | 10 | 11 | 21 |
| 2022 Junio | 22 | 8 | 30 |
| 2022 Mayo | 34 | 8 | 42 |
| 2022 Abril | 24 | 21 | 45 |
| 2022 Marzo | 13 | 14 | 27 |
| 2022 Febrero | 19 | 6 | 25 |
| 2022 Enero | 37 | 15 | 52 |
| 2021 Diciembre | 61 | 13 | 74 |
| 2021 Noviembre | 46 | 14 | 60 |
| 2021 Octubre | 57 | 15 | 72 |
| 2021 Septiembre | 24 | 13 | 37 |
| 2021 Agosto | 22 | 7 | 29 |
| 2021 Julio | 16 | 12 | 28 |
| 2021 Junio | 11 | 6 | 17 |
| 2021 Mayo | 12 | 10 | 22 |
| 2021 Abril | 30 | 32 | 62 |
| 2021 Marzo | 16 | 24 | 40 |
| 2021 Febrero | 7 | 19 | 26 |
| 2021 Enero | 11 | 18 | 29 |
| 2020 Diciembre | 7 | 20 | 27 |
| 2020 Noviembre | 11 | 17 | 28 |
| 2020 Octubre | 7 | 14 | 21 |
| 2020 Septiembre | 7 | 15 | 22 |
| 2020 Agosto | 9 | 16 | 25 |
| 2020 Julio | 13 | 14 | 27 |
| 2020 Junio | 9 | 13 | 22 |
| 2020 Mayo | 15 | 13 | 28 |
| 2020 Abril | 11 | 4 | 15 |
| 2020 Marzo | 19 | 13 | 32 |
| 2020 Febrero | 11 | 10 | 21 |
| 2020 Enero | 9 | 13 | 22 |
| 2019 Diciembre | 11 | 14 | 25 |
| 2019 Noviembre | 17 | 9 | 26 |
| 2019 Octubre | 11 | 10 | 21 |
| 2019 Septiembre | 14 | 15 | 29 |
| 2019 Agosto | 12 | 12 | 24 |
| 2019 Julio | 25 | 15 | 40 |
| 2019 Junio | 44 | 53 | 97 |
| 2019 Mayo | 118 | 160 | 278 |
| 2019 Abril | 59 | 90 | 149 |
| 2019 Marzo | 17 | 34 | 51 |
| 2019 Febrero | 7 | 40 | 47 |
| 2019 Enero | 6 | 34 | 40 |
| 2018 Diciembre | 9 | 24 | 33 |
| 2018 Noviembre | 7 | 28 | 35 |
| 2018 Octubre | 10 | 26 | 36 |
| 2018 Septiembre | 7 | 32 | 39 |
| 2018 Agosto | 6 | 83 | 89 |
| 2018 Julio | 7 | 50 | 57 |
| 2018 Junio | 3 | 47 | 50 |
| 2018 Mayo | 7 | 33 | 40 |
| 2018 Abril | 5 | 39 | 44 |
| 2018 Marzo | 4 | 15 | 19 |
| 2018 Febrero | 3 | 23 | 26 |
| 2018 Enero | 10 | 22 | 32 |
| 2017 Diciembre | 8 | 12 | 20 |
| 2017 Noviembre | 5 | 25 | 30 |
| 2017 Octubre | 9 | 23 | 32 |
| 2017 Septiembre | 11 | 28 | 39 |
| 2017 Agosto | 7 | 22 | 29 |
| 2017 Julio | 10 | 17 | 27 |
| 2017 Junio | 18 | 30 | 48 |
| 2017 Mayo | 25 | 31 | 56 |
| 2017 Abril | 13 | 26 | 39 |
| 2017 Marzo | 9 | 40 | 49 |
| 2017 Febrero | 8 | 84 | 92 |
| 2017 Enero | 20 | 17 | 37 |
| 2016 Diciembre | 20 | 15 | 35 |
| 2016 Noviembre | 29 | 22 | 51 |
| 2016 Octubre | 44 | 27 | 71 |
| 2016 Septiembre | 40 | 25 | 65 |
| 2016 Agosto | 31 | 11 | 42 |
| 2016 Julio | 17 | 9 | 26 |
| 2016 Junio | 14 | 21 | 35 |
| 2016 Mayo | 20 | 14 | 34 |
| 2016 Abril | 18 | 16 | 34 |
| 2016 Marzo | 18 | 30 | 48 |
| 2016 Febrero | 12 | 30 | 42 |
| 2016 Enero | 11 | 24 | 35 |
| 2015 Diciembre | 8 | 21 | 29 |
| 2015 Noviembre | 19 | 16 | 35 |
| 2015 Octubre | 20 | 13 | 33 |
| 2015 Septiembre | 20 | 21 | 41 |
| 2015 Agosto | 26 | 12 | 38 |
| 2015 Julio | 16 | 15 | 31 |
| 2015 Junio | 10 | 8 | 18 |
| 2015 Mayo | 11 | 12 | 23 |
| 2015 Abril | 19 | 13 | 32 |
| 2015 Marzo | 25 | 11 | 36 |
| 2015 Febrero | 16 | 3 | 19 |
| 2015 Enero | 31 | 5 | 36 |
| 2014 Diciembre | 25 | 15 | 40 |
| 2014 Noviembre | 23 | 2 | 25 |
| 2014 Octubre | 31 | 7 | 38 |
| 2014 Septiembre | 38 | 7 | 45 |
| 2014 Agosto | 21 | 8 | 29 |
| 2014 Julio | 35 | 7 | 42 |
| 2014 Junio | 23 | 10 | 33 |
| 2014 Mayo | 29 | 9 | 38 |
| 2014 Abril | 19 | 5 | 24 |
| 2014 Marzo | 26 | 12 | 38 |
| 2014 Febrero | 29 | 4 | 33 |
| 2014 Enero | 25 | 12 | 37 |
| 2013 Diciembre | 25 | 6 | 31 |
| 2013 Noviembre | 30 | 19 | 49 |
| 2013 Octubre | 20 | 23 | 43 |
| 2013 Septiembre | 14 | 22 | 36 |
| 2013 Agosto | 32 | 20 | 52 |
| 2013 Julio | 19 | 9 | 28 |
| 2010 Septiembre | 565 | 0 | 565 |
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