AAN abstracts

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Author Listing for "Alvarez-Palazuelos" Return to Authors
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[P04.118] Prediction of Mortality after Aneurysmal Subarachnoid Hemorrhage: The Importance of the
Admittance Blood Glucose
Authors: Jose Luis Ruiz Sandoval, Erwin Chiquete, Miguel Angel Andrade Ramos, Lucia Elizabeth Alvarez
Palazuelos, Carmen Ruiz Sandoval, Guadalajara, Jalisco, Mexico
Session Info: Poster Sessions IV: Predictors of Stroke Risk and Outcome (7:00 AM-10:00 AM)
Presentation Time: Wednesday, April 16, 2008, 7:00 am
P04.118] Prediction of Mortality after Aneurysmal Subarachnoid Hemorrhage: The Importance of
the Admittance Blood Glucose
Jose Luis Ruiz Sandoval, Erwin Chiquete, Miguel Angel Andrade Ramos, Lucia Elizabeth Alvarez
Palazuelos, Carmen Ruiz Sandoval, Guadalajara, Jalisco, Mexico
OBJECTIVE: To identify clinical characteristics assessed at hospital presentation that can independently
predict in-hospital mortality after subarachnoid hemorrhage (SAH), in Mexican patients included in a
nationwide multicenter registry. BACKGROUND: The admittance blood glucose has been recognized as
an independent predictor of short-term poor outcome after SAH; however, it remains poorly characterized
in multivariate models of representative population samples with aneurysmal hemorrhage.
DESIGN/METHODS: Consecutive patients with SAH due to ruptured intracranial aneurysms were
registered from November 2002 to October 2004 in 25 tertiary referral centers from 14 states of Mexico.
Age- and gender-matched controls without a known neurological disease were randomly selected by a 1:1
factor, in order to identify variables potentially associated with the risk of aneurysmal SAH. Multivariate
analyses were modeled to find independent predictors of in-hospital mortality, with adjustment for relevant
confounders. RESULTS: A total of 231 patients were studied (66% women; mean age 52 years, range 16
to 90 years). More cases of hypertension and fewer of diabetes mellitus and hyperlipidemia were
observed among cases than in controls (for all, p<0.05). Duration of the hospital stay had a median of 23
days (range 2 to 98 days). In-hospital mortality occurred in 20% of cases, in 54% due to a neurological
cause. Survival analyses and Kaplan-Meier curves showed a higher probability of in-hospital death with
an admittance blood glucose levels in the higher quartile of the sample (glycemia >150 mg/dl) (p<0.001).
After a binary logistic regression model controlled for clinical and laboratory variables identified at hospital
presentation, predictors of in-hospital mortality were Hunt-Hess score >2 (OR: 3.79, 95% CI: 1.43-10.06)
and glycemia in the higher quartile (OR: 2.98, 95% CI: 1.12-7.96). The admittance blood pressure was not
associated with death. CONCLUSIONS/RELEVANCE: Among several variables estimated at hospital
admittance, plasma glucose concentration is the most important factor associated with in-hospital
mortality after aneurysmal SAH.
Category - Cerebrovascular Disease
SubCategory - Hemorrhagic Stroke
Wednesday, April 16, 2008 7:00 AM
Poster Sessions IV: Predictors of Stroke Risk and Outcome (7:00 AM-10:00 AM)
[P04.118] Prediction of Mortality after Aneurysmal Subarachnoid Hemorrhage: The Importance of
the Admittance Blood Glucose
Jose Luis Ruiz Sandoval, Erwin Chiquete, Miguel Angel Andrade Ramos, Lucia Elizabeth Alvarez
Palazuelos, Carmen Ruiz Sandoval, Guadalajara, Jalisco, Mexico

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OBJECTIVE: To identify clinical characteristics assessed at hospital presentation that can independently
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predict in-hospital mortality after subarachnoid hemorrhage (SAH), in Mexican patients included in a
nationwide multicenter registry. BACKGROUND: The admittance blood glucose has been recognized as
an independent predictor of short-term poor outcome after SAH; however, it remains poorly characterized
in multivariate models of representative population samples with aneurysmal hemorrhage.
DESIGN/METHODS: Consecutive patients with SAH due to ruptured intracranial aneurysms were
registered from November 2002 to October 2004 in 25 tertiary referral centers from 14 states of Mexico.
Age- and gender-matched controls without a known neurological disease were randomly selected by a 1:1
factor, in order to identify variables potentially associated with the risk of aneurysmal SAH. Multivariate
analyses were modeled to find independent prdictors of in-hospital mortality, with adjustment for relevant
confounders. RESULTS: A total of 231 patients were studied (66% women; mean age 52 years, range 16
to 90 years). More cases of hypertension and fewer of diabetes mellitus and hyperlipidemia were
observed among cases than in controls (for all, p<0.05). Duration of the hospital stay had a median of 23
days (range 2 to 98 days). In-hospital mortality occurred in 20% of cases, in 54% due to a neurological
cause. Survival analyses and Kaplan-Meier curves showed a higher probability of in-hospital death with
an admittance blood glucose levels in the higher quartile of the sample (glycemia >150 mg/dl) (p<0.001).
After a binary logistic regression model controlled for clinical and laboratory variables identified at hospital
presentation, predictors of in-hospital mortality were Hunt-Hess score >2 (OR: 3.79, 95% CI: 1.43-10.06)
and glycemia in the higher quartile (OR: 2.98, 95% CI: 1.12-7.96). The admittance blood pressure was not
associated with death. CONCLUSIONS/RELEVANCE: Among several variables estimated at hospital
admittance, plasma glucose concentration is the most important factor associated with in-hospital
mortality after aneurysmal SAH.
Category Cerebrovascular Disease
SubCategory - Hemorrhagic Stroke
Wednesday, April 16, 2008 7:00 AM
Poster Sessions IV: Predictors of Stroke Risk and Outcome (7:00 AM-10:00 AM)
[P07.096] Guillain-Barré Syndrome in a Referral Center of Mexico: High Frequency of Hand-Weakness
Onset, Axonal and Motor Variants
Authors: Lucia Elizabeth Alvarez Palazuelos, Jose Luis Ruiz Sandoval, Chiquete Erwin, Miguel Angel Andrade
Ramos, Lima Ojeda Juan Manuel Valentin, Guadalajara, Jalisco, Mexico
Session Info: Poster Sessions VII: Peripheral Nerve: Inflammatory: GBS and CIDP (11:30 AM-2:30 PM)
Presentation Time: Thursday, April 17, 2008, 11:30 am
[P07.096] Guillain-Barr Syndrome in a Referral Center of Mexico: High Frequency of Hand-Weakness
Onset, Axonal and Motor Variants
Lucia Elizabeth Alvarez Palazuelos, Jose Luis Ruiz Sandoval, Chiquete Erwin, Miguel Angel Andrade
Ramos, Lima Ojeda Juan Manuel Valentino, Guadalajara, Jalisco, Mexico
OBJECTIVE: To identify clinical characteristics and outcome of the various forms of Guillain-Barr syndrome
(GBS) in Mexicans. BACKGROUND: Information regarding the clinical presentation and outcome of the Guillain-
Barr Syndrome (GBS) in adults from Latin America is very limited. DESIGN/METHODS: We reviewed the
clinical and electrophysiological data of consecutive patients with confirmed Guillain-Barr syndrome who
presented to a tertiary referral hospital, from January 1999 to December 2006. A retrospective phase included
cases from 1999 to 2001. After a high frequency of axonal and hand-onset variants was identified, we designed
a prospective phase to include new cases from 2002 to 2007, in order to confirm our observations and review
every electrophysiological report by one investigator blinded to the patients clinical information. RESULTS: The
rate of confirmed cases with GBS was 1.13 per month; however, the annual rates showed the higher frequency
for the year 2001 (35 cases); which coincided with an outbreak of acute infectious diarrhea in the local
population. In the prospective phase 58 patients were registered (71% men, mean age 44 years, range 15 to 84
years): 25 (44%) AIDP, 14 (25%) AMAN, 19 (18%) AMSAN, 4 (7%) Miller Fisher syndrome, and 4 (7%) with a
non-conclusive electrophysiological pattern. The classical ascendant paralysis was observed in 35 (60%) cases,
and a hand-onset clinical variant was observed in 18 (31%). A preceding diarrhea had a higher frequency among
AMAN variant than in other forms (53% versus 22%, respectively; p=0.02). Eight (14%) patients died, 5 of them

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(62.5%) had an axonal variant. CONCLUSIONS/RELEVANCE: GBS in Mexico showed a distinct clinical pattern,
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as compared with previous series. Axonal forms are much more often seen than the demyelinating pattern, a
finding that is in agreement with previous reports of Latin America and Asia, which suggest there is a
participation of a common genetic and environmental background.
Category - Peripheral Nerve
SubCategory - Clinical
Thursday, April 17, 2008 11:30 AM
Poster Sessions VII: Peripheral Nerve: Inflammatory: GBS and CIDP (11:30 AM-2:30 PM)
. [P03.112] Thalamic Hemorrhage: Analyses on Causes and Short-Term Outcome
Authors: Lucia E. Alvarez-Palazuelos, Erwin Chiquete, Miguel A. Andrade-Ramos, , Carmen Ruiz-Sandoval,
Jose L. Ruiz-Sandoval, Guadalajara, Mexico
Date/Time: Tuesday, April 15, 2008 - 4:00 PM
Session Info: Poster Sessions III: Intracranial Hemorrhage (4:00 PM-7:30 PM)
[P03.112] Thalamic Hemorrhage: Analyses on Causes and Short-Term Outcome
Lucia E. Alvarez-Palazuelos, Erwin Chiquete, Miguel A. Andrade-Ramos, Carmen Ruiz-Sandoval, Jose L.
Ruiz-Sandoval, Guadalajara, Mexico
OBJECTIVE: To identify the main risk factors and to define the clinical impact of the thalamic hemorrhage.
BACKGROUND: Some studies suggest that thalamic hemorrhage differ in causes and consequences from
those that occurred in other brain areas. However, it is still unknown much of the etiologic factors and prognostic
determinants of this particular brain hemorrhage. DESIGN/METHODS: Consecutive patients presenting to a
tertiary referral hospital with neuroimaging-confirmed brain hemorrhage from 1999 to 2003 were analyzed.
Clinical characteristics at hospital presentation and in-hospital clinical evolution were registered. Binary logistic
regression models were performed to identify predicting factors of in-hospital mortality. RESULTS: A total of 100
cases were studied (52 men, mean age 68.4 years, range 27 to 91 years). Mean hemorrhage volume was 15.6
ml (range 2 to 124 ml), without significant difference according to age or gender. Irruption into the ventricular
system occurred in 78 cases. In 97 patients the hemorrhage was associated with hypertension (85 patients with
a medical history of the disease). In-hospital mortality rate for a mean hospital stay of 13.5 days (range 1 to 82
days) was 41%. A modified Rankin score of <2 at hospital discharge was observed in only 11 patients. The
mean Glasgow coma scale (GCS) score at hospital admittance was higher in women than in men (11.6 vs. 10.4,
respectively; p=0.04); however, in-hospital death occurred with a lower frequency in the female gender than in
males (27% vs. 54%, respectively; p=0.007). After multivariate analysis controlled for potential confounders,
factors associated with in-hospital mortality were the male gender (OR: 2.66, 95% CI: 1.05-6.72) and a GCS of
<8 points (OR: 16.25, 95% CI: 3.40-77.65). CONCLUSIONS/RELEVANCE: Thalamic ICH is mainly of
hypertensive etiology with relatively small hemorrhage volumes, but with a higher frequency of irruption into
ventricles. Predicting factors of in-hospital mortality differ from that of ICH in other locations.
Category - Cerebrovascular Disease
SubCategory - Hemorrhagic Stroke
Tuesday, April 15, 2008 4:00 PM
Poster Sessions III: Intracranial Hemorrhage (4:00 PM-7:30 PM)
. [P05.158] Palatal Myoclonus: Three Key Points That Alert to Its Diagnosis
Authors: Jose L. Ruiz-Sandoval, Lucia E. Alvarez-Palazuelos, Guadalajara, Jalisco, Mexico, Erwin Chiquete,
Carmen Ruiz-Sandoval, Miguel Andrade-Ramos, Guadalajara, Jalisco, Mexico
Date/Time: Wednesday, April 16, 2008 - 4:00 PM
Session Info: Poster Sessions V: Movement Disorders: Botulinum Toxin (4:00 PM-7:00 PM)

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[P05.158] Palatal Myoclonus: Three Key Points That Alert to Its Diagnosis
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OBJECTIVE: To describe patients with palatal myoclonus (PM) by using a simple clinical rule composed of three
clinical characteristics. BACKGROUND: PM, or palatal tremor is defined by the presence of persistent
rhythmic contractions of the palatal musculature. It has been referred for years as a rare entity, and in the clinical
wards as a medical curiosity with no more than 10 patients seen in a neurologist s professional life. However, it
is possible that its supposed oddness can be due to a low level of suspicion. DESIGN/METHODS: Seventeen
patients (10 men, mean age 45 years, range 19 to 89 years) with PM, who presented to two tertiary referral
hospitals from 1998 to 2006, were evaluated by the same neurologist, sensitized to the PM diagnosis.
RESULTS: The main cause of PM was cerebrovascular disease in 15 cases (88%): 9 brainstem or cerebellar
infarcts and six secondary to posterior fossa hemorrhages. One case was attributed to neurocysticercosis of the
fourth ventricle, and another to progressive degenerative ataxia. Five patients (4 hemorrhages, and the case
with neurocysticercosis) also had surgical intervention in the posterior fossa. The mean time from the insult to
the PM diagnosis was 17 months (range 5 to 48 months). Olivary hypertrophy was observed in 7 of 9 (78%)
patients in whom MRI was performed. The three clinical items favored diagnosis of PM in all patients: (1) history
of posterior fossa damage; (2) presence of severe rhombencephalic symptoms at neurological exploration; and
(3) severe spastic dysarthria. No patient responded to any medication administered.
CONCLUSIONS/RELEVANCE: PM might be more common than previously suggested, and therefore,
underdiagnosed. Three clinical key points may warn in its diagnosis.
Category - Movement Disorders
SubCategory - Hyperkinetic Disorders
Wednesday, April 16, 2008 4:00 PM
Poster Sessions V: Movement Disorders: Botulinum Toxin (4:00 PM-7:00 PM)
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