Neuralgia occipital y su manejo en Atención Primaria / Occipital neuralgia and its management in Primary Care

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Neuralgia occipital como primer síntoma de un hepatocarcinoma / Occipital neuralgia as the first symptom of a hepatocarcinoma

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Fibre types of human suboccipital muscles

Understanding the functional role of the cervical muscles is important for the effective diagnosis and treatment of cervical disorders. The suboccipital muscles are targets for treatment in whiplash and chronic headache, although their function remains unclear. There are no data on suboccipital muscle fiber type composition to facilitate an understanding of their function. Suboccipital muscles (n=95; rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis superior, obliquus capitis inferior) were dissected bilaterally from 12 cadavers (6 male; mean age 81 years). Immunohistochemistry was used to identify type I/II muscle fibers. Fibers were counted using stereology (random systematic sampling) and data analyzed (descriptive statistics, ANOVA, paired and independent t-tests) to examine differences between muscles, sex and laterality (p<0.05). Mean [SD] type I fiber proportion overall was 62.3% [10.9]; rectus capitis posterior minor had the smallest proportion of type I fibers (58.8% [9.5]), obliquus capitis inferior the largest (69.2% [10.5]). There were no significant differences overall between muscles or sides. There was a significant difference between sexes overall when data from the four muscles were pooled (p=0.027), but no difference when muscles were compared separately. Individual suboccipital muscles showed similar type I/II fiber type proportions, suggesting homogenous function for muscles in this group. Fiber type composition indicated high levels of both postural and phasic activity. Conservative management of cervical disorders involving the suboccipital muscles (e.g. exercise therapy) should consider the homogenous function of this muscle group, and include rehabilitation promoting both postural and phasic function

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Papel de la experiencia en la neurología de la expresión facial de las emociones / The role of experience in the neurology of facial expression of emotions

Introduction. Facial expression of emotion has an important social function that facilitates interaction between people. This process has a neurological basis, which is not isolated from the context, or the experience of the interaction between people in that context. Yet, to date, the impact that experience has on the perception of emotions is not completely understood. Aims. To discuss the role of experience in the recognition of facial expression of emotions and to analyze the biases towards emotional perception. Development. The maturation of the structures that support the ability to recognize emotion goes through a sensitive period during adolescence, where experience may have greater impact on emotional recognition. Experiences of abuse, neglect, war, and stress generate a bias towards expressions of anger and sadness. Similarly, positive experiences generate a bias towards the expression of happiness. Conclusions. Only when people are able to use the facial expression of emotions as a channel for understanding an expression, will they be able to interact appropriately with their environment. This environment, in turn, will lead to experiences that modulate this capacity. Therefore, it is a self-regulatory process that can be directed through the implementation of intervention programs on emotional aspects (AU)

Introducción. La expresión facial de las emociones tiene una función social importante que facilita la interacción entre las personas. Este proceso tiene una base neurológica, que no se aísla del contexto ni de la experiencia acumulada por la interacción entre las personas en dicho contexto. Sin embargo, hasta la fecha, no se conocen con claridad los efectos de la experiencia sobre la percepción de las emociones. Objetivos. Discutir qué función desempeña la experiencia en el reconocimiento de la expresión facial de las emociones y analizar los sesgos que las experiencias negativas y positivas podrían tener sobre la percepción emocional. Desarrollo. La maduración de las estructuras que soportan la capacidad para reconocer la emoción pasa por un período sensible durante la adolescencia, donde la experiencia adquirida puede tener mayor impacto sobre el reconocimiento emocional. Experiencias de abuso, maltrato, abandono, guerras o estrés generan un sesgo hacia las expresiones de ira y tristeza. De igual manera, las experiencias positivas dan lugar a un sesgo hacia la expresión de alegría. Conclusiones. Sólo cuando las personas son capaces de utilizar la expresión facial de las emociones como un canal de comprensión y expresión interaccionarán de manera adecuada con su entorno. Este entorno, a su vez, dará lugar a experiencias que modulan dicha capacidad. Por lo tanto, es un proceso autorregulatorio que puede ser dirigido a través de la implementación de programas de intervención sobre los aspectos emocionales (AU)

Neuralgia occipital secundaria a vasculitis de la arteria occipital. Diagnóstico mediante dúplex color / Occipital neuralgia secondary to vasculitis of the occipital artery. Diagnosis using colour duplex

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Superficial occipital artery: report of a rare case and literature review

We report a rare case of an aberrant occipital artery found during routine dissection of the right posterior neck and the occipital region of an embalmed 67-year-old Caucasian male cadaver. The right occipital artery, having considerable size (diameter 4 mm), arose from the postero-lateral side of the external carotid artery just above the posterior belly of the digastric muscle. Consequently, the aberrant occipital artery turned laterally around the posterior belly of the digastric and the stylohyoid muscles, reaching the subcutaneous layer as it passed transversely over the upper attachment of the sternocleidomastoid muscle. Distally, the artery showed typical branching pattern. Detailed knowledge about the basic anatomy of the occipital artery, as well as its variations, are highly important in preventing complications during extra-to-intracranial bypass surgery and therapeutic embolization via this vessel. A careful preoperative examination of the artery is necessary to reveal some of its rarest anatomical variation

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Estimulación táctil pasiva y su repercusión clínica y neurofisiológica (P300) en niños ciegos con sintomatología de trastorno por déficit de atención / Passive tactile stimulation and its clinical and neurophysiological repercussions (P300) in blind children with symptoms of attention deficit disorder

Introducción. La estimulación táctil es clave en la reorganización de la actividad cerebral y en los procesos de atención, pero todavía no está clara su eficacia en trastornos por déficit de atención (TDA) en niños ciegos. Sujetos y métodos. Para valorar la eficacia de la estimulación táctil realizamos un estudio en niños ciegos con TDA y sin TDA, consistente en un protocolo de estimulación táctil diaria en dos sesiones (mañana y tarde), de media hora por sesión, durante seis meses. Se midió la capacidad para detectar un estímulo táctil infrecuente, el tiempo de reacción, la latencia P300, las fuentes de actividad cerebral y la sintomatología del TDA, tanto al inicio como al final del entrenamiento. Resultados. La estimulación táctil en los niños ciegos con TDA mejora significativamente la sintomatología del TDA, especialmente la atención, la conducta y el autocontrol de los movimientos involuntarios y tics. Además, se observa que el entrenamiento táctil en niños ciegos con TDA cambia el patrón de actividad cerebral induciendo una mayor actividad en las áreas frontales y occipitales, que podrían estar asociadas a una compensación del déficit de atención. Conclusión. La estimulación táctil pasiva diaria mejora la sintomatología clínica y reorganiza la actividad cerebral en áreas frontooccipitales de niños ciegos con TDA (AU)

Introduction. Tactile stimulation is key for the posterior brain re-organization activity and attention processes, however the impact of tactile stimulation on attention deficit disorder (ADD) in blind children remains unexplored. Subjects and methods. We carried out a study with children having or not ADD (four per group). The subjects have been exposed during six months to tactile stimulation protocol consisting in two daily sessions (morning and afternoon sessions) of 30 minutes each. We have measured the ability to detect an infrequent tactile stimulus, reaction time, latency of P300, sources of brain activity, and ADD clinical symptoms, before and after tactile training. Results. Passive tactile stimulation significantly improves ADD clinical symptoms, particularly attention, behavior and selfcontrol of involuntary movements and tics. In addition, tactile stimulation changes the pattern of brain activity in ADD blind children inducing activity in frontal and occipital areas, which could be associated to a compensation of the attention deficit. Conclusion. Passive tactile stimulation training may improve ADD clinical symptoms and can reorganize the pattern of brain activity in blind ADD children (AU)

Higroma quístico - Diagnóstico pré-natal, prognóstico obstétrico e pediátrico / Cystic hygroma - Prenatal diagnosis, obstetric and pediatric outcome

Introdução: O higroma quístico (HQ) é uma malformação congénita diagnosticada durante a gravidez pela demonstração ecográfica de uma estrutura quística na região occipitocervical. Pode surgir isolado ou em associação a anomalias cromossómicas, malformações fetais ou síndromes genéticas, com prognóstico global reservado. O objetivo deste trabalho foi avaliar a conduta obstétrica e os resultados pediátricos dos sobreviventes com higroma quístico (HQ). Material e métodos: Estudo retrospetivo descritivo de 224 grávidas com HQ fetal, diagnosticadas ou referenciadas ao Centro de Diagnóstico Pré-Natal da nossa instituição, entre janeiro de 1991 e julho de 2011. Resultados: A idade gestacional média ao diagnóstico foi de 13 semanas, 77,7% dos casos diagnosticados no primeiro trimestre. Ecograficamente, 66 casos estavam associados a hidrópsia. O cariótipo fetal foi determinado em 206 casos, com deteção de 107 anomalias cromossómicas. O cariótipo foi normal em 99 casos, tendo sido detetados 12 casos de doenças genéticas e 18 de malformações estruturais fetais. A interrupção médica de gravidez foi a opção de 111 pacientes, registaram-se 39 casos de morte in utero e 61 nados-vivos. O tempo médio de seguimento dos sobreviventes foi de 75 meses, tendo-se verificado um desenvolvimento psicomotor adequado em 30 casos. Conclusão: Perante o diagnóstico de HQ, é essencial esclarecer a etiologia, de modo a definir o prognóstico e orientar corretamente a gravidez. Existe uma forte correlação entre o diagnóstico de HQ com aneuploidia fetal, conferindo-lhe pior prognóstico em comparação com os casos de HQ sem evidência de alterações cromossómicas ou malformações estruturais fetais, geralmente com bons resultados neonatais e pediátricos (AU)

Introduction: Fetal cystic hygroma (CH) is a congenital malformation prenatally diagnosed by the demonstration of a cystic structure in the occipitocervical region on ultrasound. It may appear isolated or in association with chromosomal abnormalities, fetal malformations or genetic syndromes, with a poor overall prognosis. The main purpose of this work was the evaluation of the obstetric management and paediatric outcome for the survivors of CH. Material and method: Retrospective analysis of 224 pregnant women with fetal CH, diagnosed or referred to our prenatal diagnosis centre, from January 1991 to July 2011. Results: The mean gestational age at diagnosis was 13 weeks and 77.7% of cases were diagnosed in the first trimester. On ultrasound, 66 cases were associated with hydrops. Fetal karyotype was obtained in 206 cases, and chromosomal abnormalities were found in 107. Fetal karyotype was normal in 99 cases, detected 12 cases of genetic diseases and 18 cases of fetal malformations. Elective pregnancy termination was undertaken by 111 patients. There were 39 cases of spontaneous fetal demise and 61 live births. The mean follow-up of survivors was 75 months, and normal paediatric outcome was confirmed in 30 cases. Conclusion: It is essential to clarify the underlying aetiology of CH in order to establish a prognosis and counselling. There is a strong association with fetal aneuploidy and significantly worse outcome in contrast in cases without evidence of chromosomal or structural abnormalities, most of them carrying good prognosis (AU)

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Neuralgia occipital: características clínicas y terapéuticas de una serie de 14 pacientes / Occipital neuralgia: clinical and therapeutic characteristics of a series of 14 patients

Introducción. La neuralgia occipital es un dolor en la distribución de los nervios occipitales, acompañado de hipersensibilidad al tacto en el territorio correspondiente. Objetivos. Presentamos la serie de neuralgia occipital de la consulta monográfica de cefaleas de un hospital terciario y analizamos sus características clínicas y su respuesta terapéutica. Pacientes y métodos. Se recogen variables de los casos de neuralgia occipital diagnosticados en dicha consulta entre enero de 2008 y abril de 2013. Resultados. Serie de 14 pacientes(10 mujeres, 4 varones) con neuralgia occipital sobre un total de 2.338 (0,59%). Edad al inicio del cuadro: 53,4 ± 20,3 años (rango: 17-81 años), y tiempo hasta el diagnóstico de 35,5 ± 58,8 meses (rango: 1-230 meses). Se descartó apropiadamente en cada caso patología intracraneal o cervical. En 13 de ellos (92,8%) se observó dolor basal de carácter generalmente opresivo e intensidad 5,3 ± 1,3 (4-8) en la escala analógica verbal. Once (78,5%) presentaban exacerbaciones, generalmente de carácter punzante, frecuencia variable (4,6 ± 7 al día) e intensidad 7,8 ± 1,7 (rango: 4-10) en la escala analógica verbal. En cuatro no se llevó a cabo bloqueo anestésico (dos por patrón remitente y dos por deseo del paciente); en los restantes, se realizó bloqueo con eficacia completa de duración entre dos y siete meses. Cuatro casos habían recibido anteriormente tratamiento preventivo (amitriptilina en tres y gabapentina en uno), sin respuesta. Conclusiones. En esta serie de una consulta monográfica de cefaleas, la neuralgia occipital es una entidad infrecuente y que afecta principalmente a pacientes mayores de 50 años. Ha de tenerse en cuenta, dada su respuesta escasa a preventivos, y completa y prolongada a bloqueos anestésicos (AU)

Introduction. Occipital neuralgia is a pain in the distribution of the occipital nerves, accompanied by hypersensitivity to touch in the corresponding territory. Aims. We present the occipital neuralgia series from the specialised headache unit at a tertiary hospital and analyse its clinical characteristics and its response to therapy. Patients and methods. Variables were collected from the cases of occipital neuralgia diagnosed in the above-mentioned headache unit between January 2008 and April 2013. Results. A series of 14 patients (10 females, 4 males) with occipital neuralgia was obtained out of a total of 2338 (0.59%). Age at onset of the clinical signs and symptoms: 53.4 ± 20.3 years (range: 17-81 years) and time elapsed to diagnosis was 35.5 ± 58.8 months (range: 1-230 months). An intracranial or cervical pathology was ruled out by suitable means in each case. Baseline pain of a generally oppressive nature and an intensity of 5.3 ± 1.3 (4-8) on the verbal analogue scale was observed in 13 of them (92.8%). Eleven (78.5%) presented exacerbations, generally stabbing pains, a variable frequency (4.6 ± 7 a day) and an intensity of 7.8 ± 1.7 (range: 4-10) on the verbal analogue scale. Anaesthetic blockade was not performed in four of them (two due to a remitting pattern and two following the patient’s wishes); in the others, blockade was carried out and was completely effective for between two and seven months. Four cases had previously received preventive treatment (amitriptyline in three and gabapentin in one), with no response. Conclusions. In this series from a specialised headache unit, occipital neuralgia is an infrequent condition that mainly affects patients over 50 years of age. Given its poor response to preventive treatment, the full prolonged response to anaesthetic blockades must be taken into account (AU)

Correlación de la morfometría por resonancia magnética con los hallazgos clínicos y electroencefalográficos de pacientes con diagnóstico de ulegiria y epilepsia / Correlation between the magnetic resonance imaging morphometry and the clinical and electroencephalographic findings in patients diagnosed with ulegyria and epilepsy

Introducción. La ulegiria es una lesión cortical propia de zonas vasculares limítrofe, que da a las circunvoluciones unaspecto de hongo. Es una causa importante de epilepsia occipital. Objetivo. Correlacionar clínica, eléctrica y morfométricamente a los pacientes con diagnóstico de ulegiria y epilepsia comparando el espesor cortical de las zonas ulegíricas con el espesor cortical normal comunicado en la bibliografía y el promediodel espesor cortical de sujetos sanos.Pacientes y métodos. Se incluyeron diez pacientes con ulegiria comprobada imaginológicamente con resonancia magnética,los cuales se sometieron a una entrevista clínica, un estudio electroencefalográfico y un análisis morfométrico cortical a partir de secuencias T1 volumétricas. Resultados. Encontramos un predominio del sexo masculino, retraso en el neurodesarrollo y epilepsia. La ulegiria fueen su mayoría parietooccipital, frecuentemente bilateral, con adelgazamiento del espesor cortical en el sitio de la lesiónsignificativamente estadístico y aumento del grosor de la corteza en las zonas periféricas a la lesión.Conclusión. Describimos una serie de pacientes con ulegiria con características similares a las existentes en la bibliografíay detectamos en morfometría un aumento en el espesor cortical que rodea las zonas ulegíricas. Estos hallazgos podrían indicar bien la presencia de neuroplasticidad adaptativa en las neuronas que rodean el tejido cicatricial o el resultado de cambios mecánicos del tejido normal en respuesta a la pérdida de volumen de la zona ulegírica, datos que se deben replicaren un estudio con un mayor número de pacientes (AU)

Introduction. Ulegyria is a cortical lesion affecting neighbouring vascular zones, which gives the convolutions a mushroomlikeappearance. It is an important cause of occipital epilepsy. Aim. To correlate patients diagnosed clinically, electrically and morphometrically with ulegyria and epilepsy by comparing the thickness of the cortex in the zones affected by ulegyria with the normal cortical thickness reported in the literatureand the average cortical thickness of healthy subjects. Patients and methods. Ten patients with ulegyria confirmed by magnetic resonance imaging were included in the study;all of them were submitted to a clinical interview, an electroencephalographic study and cortical morphometric analysisbased on volumetric T1 sequences.Results. Findings included a predominance in males, neurodevelopmental retardation and epilepsy. Ulegyria was mainlyparietooccipital, frequently bilateral, with statistically significant thinning of the cortical thickness in the site of the lesion and an increase in the thickness of the cortex in the areas surrounding the lesion. Conclusions. We report on a series of patients with ulegyria with characteristics similar to those existing in the literature and by means of morphometry we detected an increase in the thickness of the cortex around the areas affected byulegyria. These findings could point to the presence of adaptive neuroplasticity in the neurons that surround the scar tissue or they may be the result of mechanical changes of normal tissue in response to the loss of volume of the legyriaaffectedarea, although these data need to be replicated in a study with a greater number of patients (AU)

Estimulación del nervio occipital para la cefalea en racimos refractaria al tratamiento farmacológico / Stimulation of the occipital nerve in the treatment of drug-resistant cluster headache

Objetivo. Evaluar la utilidad de la estimulación del nervio occipital en el tratamiento de la cefalea en racimos crónica refractaria al tratamiento farmacológico. Pacientes y métodos. Serie prospectiva de cuatro pacientes, tres varones y una mujer. La edad media es de 42 años. Hay historia de cefalea en racimos de entre 1 y 16 años, con mal control de las crisis mediante tratamiento farmacológico. En todos los casos se han colocado percutáneamente electrodos octopolares en ambas regiones occipitales. Se ha realizado un seguimiento de seis meses. Resultados. A los seis meses se obtuvo una reducción de la frecuencia de las crisis del 56% (rango: 25-95%), una disminución en la intensidad del 48,8% (rango: 20-60%) y una disminución de la duración de un 63,8% (rango: 0-88,8%), sin observarse empeoramiento ni progresión de la enfermedad en ningún caso. La mejoría en la calidad de vida respecto a la prequirúrgica fue de un 15,4% (rango: 6-31,5%) en el cuestionario de salud SF-36. Excepto en un caso, se objetivó una reducción significativa en la cantidad y la dosis de fármacos requeridos respecto al tratamiento prequirúrgico. No se han detectado complicaciones postoperatorias. Todos los pacientes aconsejarían el procedimiento como opción terapéutica. Conclusiones. La estimulación del nervio occipital puede ser una alternativa terapéutica segura y efectiva en el tratamiento de la cefalea en racimos crónica refractaria al tratamiento farmacológico. Sin embargo, son necesarios más estudios para valorar la efectividad de la técnica en un mayor número de pacientes y los resultados a largo plazo (AU)

Aim. To evaluate the occipital nerve stimulation therapy in as a treatment for drug-resistant cluster headache. Patients and methods. Prospective study of four patients, three males and one female. Mean age of 42 years. Patients complained of a cluster headache lasting between one and 16 years, with suboptimal control of the attacks with medication. In all cases octopolar electrodes were placed percutaneously in the occipital region bilaterally. Follow-up of 6 months. Results. At 6 months, there was a 56% (range: 25-95%) reduction in the frequency, a 48.8% (range: 20-60%) decrease in the intensity and a 63.8% (range: 0-88.8%) reduction in the duration of the attacks. Worsening or progression of the illness was not observed in any case. All patients referred a 15.4% (range: 6-31.5%) improvement in their quality of life compared to their previous basal situation in SF-36. In all cases but one there was a significant reduction in the amount and dosage of medication required. Postoperative complications were not observed. All patients would recommend the procedure. Conclusions. Occipital nerve stimulation may be considered a safe and effective therapeutic option in the drug-resistant cluster headache. However, studies with more patients and a longer follow-up are required to evaluate the efficacy of the technique (AU)

Nena d’onze anys amb important tumefacció del cuir cabellut frontooccipital / No disponible

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Cefalea y visión borrosa en una mujer de 26 años / Headache and blurred vision in a 26 years old woman

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Síndrome de Panayiotopoulos de evolución parcialmente atípica: importancia de la correlación electroclínica / No disponible

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Neuroplasticidad cerebral en áreas occipitales en adolescentes ciegos / Brain neuroplasticity in occipital areas in blind teenagers

Introducción y desarrollo. La neuroplasticidad es un proceso mediante el cual las neuronas consiguen aumentar sus conexiones con otras neuronas y estabilizar dichas conexiones a consecuencia de la experiencia, el aprendizaje y la estimulación sensorial y cognitiva. Diferentes autores han documentado la existencia de un gran proceso de plasticidad cerebral hacia otras áreas sensoriales, principalmente auditivas y visuales, en sujetos ciegos. Desde el punto de vista anatómico, numerosos trabajos han encontrado diferencias significativas en el cerebro de los sujetos ciegos, principalmente en estructuras relacionadas con la visión, como consecuencia de la falta de actividad de dichas áreas, que trae consigo una menor plasticidad neuronal y consecuentemente un menor volumen estructural; también se han encontrado diferencias en el volumen de estructuras subcorticales relacionadas con la visión, como el esplenio y el istmo del cuerpo calloso. Metodología. Se estimuló táctil y pasivamente a un adolescente mediante un estimulador de 1.500 táxels. La estimulación se llevó a cabo diariamente, durante una hora, a lo largo de tres meses, y consistió en líneas verticales, horizontales y oblicuas. Los resultados obtenidos en un adolescente indican una progresión de la actividad electroencefalográfica desde áreas parietales de sensibilidad táctil hacia áreas occipitales visuales a medida que avanza la estimulación. Conclusión. Cabe plantearse si la repetición sistemática, ordenada y organizada de los estímulos táctiles en sujetos ciegos permite una mayor plasticidad cerebral, consiguiendo poco a poco colonizar otras áreas cerebrales como las occipitales, responsables de la visión humana (AU)

Introduction and development. Neuroplasticity is a process by which neurons increase their connectivity with other neurons in a stable fashion as a consequence of experience, learning and both sensitive and cognitive stimulation. Different authors have shown a huge process of brain plasticity in blind subjects towards other sensorial areas, mainly auditive and visual ones. From an anatomical standpoint many data show significant differences in blind subjects brains, mainly in visual pathways and structures as a result of lack of activity on those areas. This brings a lesser neuroplasticity and, therefore, a decrease in structural volumes. They have also found differences in subcortical structures volumes related to vision, such as splenium or corpus callosum istmus. Methodology. An adolescent was administered passive tactile stimulation with an 1,500 taxels stimulator. This was carried out daily for an hour, for three months, and stimulation consisted of vertical, horizontal and oblique lines. The results obtained in an adolescent indicate a clear progression of EEG activity from tactile sensory parietal areas to visual occipital ones as stimulation progresses. Conclusion. Therefore one can speculate if systematic and organized repetition of tactile stimuli in blind subjects leads to a greater neuroplasticity which expands towards occipital areas, largely responsible for human vision (AU)

Diagnóstico prenatal de un hemangioma occipital de rápida involución / Prenatal diagnosis of a occipital rapidly involuting hemangioma

El hemangioma occipital es, tras los linfangiomas, el tipode tumoración más frecuente en cabeza y cuello. Su diagnósticoecográfico suele establecerse en el tercer trimestre o finalesdel segundo trimestre siendo útil la resonancia magnética(RM) prenatal para la confirmación del mismo. Posnatalmente,la gran mayoría de los casos regresan espontáneamente si bienpueden persistir y complicarse requiriendo exéresis quirúrgica.Presentamos el caso del hemangioma fetal de involuciónrápida (RICH, Rapidly Involuting Congenital Hemangioma) anivel occipital diagnosticado por ecografía en el tercer trimestrede gestación así como una revisión de la literaturadestacando los puntos clave para su diagnóstico diferencial,manejo prenatal, conducta obstétrica y tratamiento posnatal(AU)

Occipital hemangioma is one of the most frequentfetal head and neck tumors, second only to lymphangiomas.Diagnose is usually established in the third or inthe late second trimester of pregnancy. Prenatal MRIallowsdiagnosis confirmation. Vast majority of fetal hemangiomasregress spontaneously in the first year afterdelivery. However, persistence is a possibility, and theymight present complications, such as bleeding or ulcerations,in which case surgical treatment is warranted.We report a case of rapidly involuting congenitalhemangioma (RICH) in the occipital region of fetal craniumdiagnosed on a routine third timester fetal ultrasoundscan. We also present a review of available literature,outlining the key points to differential diagnosis,prenatal, obstetric and postnatal management(AU)

Gamma Knife radiosurgery for occipital condyle metastasis

We present a 45 year old female with right occipital condylar metastases who was treated at William Beaumont Hospital in the Gamma Knife Unit. Clinical results at 17 months follow-up and MRI are expose (AU)

Síndrome de Panayiotopoulos: a propósito de dos casos en hermanos gemelos / Panayiotopoulos syndrome: a report of two cases in twin brothers

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