Association between myasthenia gravis and Alzheimer's disease. / Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio.

INTRODUCTION: Myasthenia gravis (MG) and Alzheimer's disease (AD) are two of the most important diseases where the dysregulation of acetylcholine activity plays a crucial role. In the first, this dysregulation happens at the level of the neu-romuscular junction and in the second, in the central nervous system (CNS). AIM: To analyze the possible relationship between these two pathologies, analyzing the prevalence and the odds ratio of AD within patients previously diagnosed with MG. We will compare these data with respect to the prevalence of AD in the general population. PATIENTS AND METHODS: We examined the data obtained by the electronic medical records of patients in the health care system of Castilla La Mancha using the Natural Language Process provided by a clinical platform of artificial intelligence known as the Savana Manager?. RESULTS: We identified 970,503 patients over the age of 60 years, of which 1,028 were diagnosed with MG. The proportion of the patients diagnosed with AD within this group (4.28%) was greater than the rest of the population (2.82%) (p = 0,0047) with an odds ratio of 1.54 (confidence interval at 95% 1.13-2.08; p = 0.0051) without finding significant differences in the bivariate analysis for the rest of the most important actual known risk factors for AD. CONCLUSION: Our results suggest that there might be an increase in the prevalence of AD in patients previously diagnosed with MG.

TITLE: Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio.Introducción. La miastenia gravis (MG) y la enfermedad de Alzheimer (EA) son dos de las enfermedades neurológicas en cuya fisiopatología interviene la acetilcolina en distintos niveles. En la primera, la alteración de este neurotransmisor se produce en la unión neuromuscular, y en la segunda, en el sistema nervioso central. Objetivo. Analizar la posible relación entre dichas patologías estudiando la prevalencia y la odds ratio de la EA dentro de los pacientes diagnosticados de MG con respecto a la prevalencia de EA en la población general. Pacientes y métodos. Se han examinado datos de las historias clínicas electrónicas del sistema de salud de Castilla-La Mancha utilizando el procesamiento de lenguaje natural a través de la plataforma clínica de inteligencia artificial Savana Manager?. Resultados. Se ha identificado a 970.503 pacientes mayores de 60 años, de los que 1.028 tenían diagnóstico de MG. La proporción de pacientes con diagnóstico de EA dentro de este grupo (4,28%) es mayor que en el resto de la población (2,82%; p = 0,0047), con una odds ratio de 1,54 (intervalo de confianza al 95%: 1,13-2,08; p = 0,0051), sin que se encuentren diferencias significativas en el análisis bivariante del resto de los factores de riesgo para EA más importantes conocidos hasta ahora. Conclusiones. Nuestros resultados sugieren que podría existir un aumento de la prevalencia de EA en pacientes con MG.

[Acute transverse myelitis after obstetric epidural anesthesia]. / Mielitis transversa aguda tras anestesia epidural obstétrica.

INTRODUCTION: Acute transverse myelitis is an acute or subacute disorder of the spinal cord resulting in motor, sensory and sphincter dysfunction secondary to various causes. CASE REPORT: We present a 32 year-old female patient with an acute episode of bladder dysfunction and fever, followed by motor and sensory dysfunction in legs with sensory spinal level at D2-D3, two weeks after an eutocic delivery with uncomplicated epidural anesthesia. The cerebrospinal fluid (CSF) showed mild lymphocytic pleocytosis, high protein levels with normal glucose concentration, absence of oligoclonal bands and negative serum and CSF virology screening. The cervicodorsal magnetic resonance imaging showed widening of the spinal cord with diffuse patchy hyperintensity on the C6-D1 and D2-D5 levels without contrast enhancement. The patient was treated with intravenous high doses of methylprednisolone with favorable outcome and complete recovery within one year and no relapses two years after the episode. DISCUSSION: The main etiologies of non-compressive acute myelopathy as multiple sclerosis, systemic diseases, spinal cord infarct and direct infections have been ruled out with the complementary examinations. We consider that our patient had a parainfectious acute transverse myelitis and epidural anesthesia could be an incidental but possible contributing factor.

[Relapsing meningoencephalitis as onset of Behçet's disease]. / Meningoencefalitis recurrente como inicio de enfermedad de Behçet.

INTRODUCTION: Behçet's disease is a systemic, chronic, relapsing inflammatory disease of unknown etiology characterized by recurrent oral aphthae, genital ulcerations and uveitis. The main pathological mechanism is leukocytoclastic vasculitis. CLINICAL CASE: We present the case of a patient with Behçet's disease that presented as a relapsing meningoencephalitis with lymphocytic pleocytosis and high protein levels in cerebrospinal fluid. The MRI revealed a lesion in the brain stem and part of diencephalon. CONCLUSIONS: The central nervous system is involved in up to 5%-20% of patients with Behçet's disease, this being the first manifestation in 3% of the cases. Clinical course includes: patients with an isolated episode with complete or incomplete recovery, relapsing and remitting forms, progressive forms or asymptomatic neurological involvement. The most frequent presentation is relapsing meningoencephalitis, with progressive course localized in the brain stem. Prognosis varies according to the type of neurologic process. The worse outcome is in the parenchymal forms with brain stem and spinal cord involvement. It also depends on the pathological findings in the cerebrospinal fluid, and the number of total events or recurrences after tapering the glucocorticoids. Mortality rate is high, up to 20% of cases after 7 years in patients with neurological involvement.

[Neurological sequelae following electrocution. A case report and review of the literature]. / Secuelas neurológicas tras electrocución. Presentación de un caso y revisión de la bibliografía.

INTRODUCTION: Electrocution is the cause of a large number of accidents and, of these, a considerable percentage result in death. Several factors affect the severity and distribution of the injuries. It is known that for low voltages the characteristics of alternating current make it three times more dangerous than continuous current. The high percentage of neurological sequelae can be accounted for by the fact that nerves are the tissue with the lowest resistance in the body and electricity tends to follow the path that offers the least resistance. CASE REPORT: A 16-year-old male who was accidentally electrocuted by an electric guitar and later suffered a cardiorespiratory arrest; the patient required intubation. After withdrawing sedation, the patient was found to be blind in both eyes and could not remember what had happened. FLAIR MR imaging revealed oedema in both occipital lobes and, to a lesser extent, in the junction between the parietooccipital and temporooccipital lobes. Treatment with steroids was established for three days. After approximately one month, the patient had recovered his sight and the brain injuries had disappeared. CONCLUSIONS: The neurological manifestations secondary to accidents caused by electricity are usually divided into two types -immediate and delayed. Blindness has rarely been reported as a sequela in those who have survived fulguration due to a lightning strike. The patient's recovery after administering treatment with steroids and the reversibility of the oedema could lead us to think that the mechanism producing this sequela was the damage to the nervous system caused directly by the electricity, which is known as the 'phenomenon of electroporation'.

[Recurrent aseptic meningitis secondary to taking ibuprofen and ketorolac]. / Meningitis recurrente aséptica secundaria a toma de ibuprofeno y ketorolaco.

INTRODUCTION: Aseptic meningitis is a process that is characterised by an inflammatory reaction of the meninges that is not due to any infectious agent. Its aetiology is varied and is most frequently caused by rheumatologic and/or autoimmune processes, chemical or medication-induced meningitis, the most notable drugs involved being antibiotics and non-steroidal anti-inflammatory drugs (NSAI). CASE REPORT: We report the case of a 70-year-old male, with no relevant history, who was admitted to hospital five times over a period of 16 months because of acute meningitis with polymorphonuclear pleocytosis, high protein levels in cerebrospinal fluid and normal glucose in cerebrospinal fluid. No evidence of an infectious causation, chemical meningitis, carcinomatosis or autoimmune disease was found and the patient was diagnosed with recurrent aseptic meningitis. It was found that the patient had taken ibuprofen or ketorolac on several occasions, a few hours before the appearance of symptoms. These episodes were quickly resolved after withdrawal of this medication. CONCLUSIONS: A number of NSAI have been reported as inducers of aseptic meningitis, one of the most notable being ibuprofen. We report the case of a patient who, as a consequence of taking ibuprofen and ketorolac, presented episodes of recurrent aseptic meningitis. To our knowledge this side effect of ketorolac has not been reported before. Its clinical features are impossible to differentiate from those of infectious meningitis. Diagnosis is reached by exclusion and a careful pharmacological study, including over-the-counter drugs like some of the NSAI, must be performed in patients with this condition, since it is a problem that can easily be solved by withdrawing the drug that causes it.

[Aphasia and parietal syndrome as the presenting symptoms of a demyelinating disease with pseudotumoral lesions]. / Afasia y síndrome parietal como forma de presentación de una enfermedad desmielinizante con lesión pseudotumoral.

INTRODUCTION: Multiple sclerosis (MS) often presents with sensory symptoms, which are usually due to spinothalamic or spinal cord disorders; parietal syndrome is, however, very rare as the initial symptom. Likewise, aphasia is also an infrequent symptom of MS; in the few cases that have been reported, it is usually linked to the existence of important pseudotumoral lesions. CASE REPORT: We describe the case of a 31-year-old female with a 48-hour history of a progressive clinical picture consisting in nominal aphasia and a sensory parietal syndrome. Magnetic resonance imaging showed a lesion 3.6 cm in diameter that was hyperintense in T2 with perilesional edema and minimal gadolinium uptake, along with other images that revealed increased signal intensity in the periventricular subcortical white matter on the right-hand side and in the left-hand frontal subcortical region. A spectroscopic analysis of the largest lesion revealed that this lesion showed evidence of inflammation, with cell destruction and replacement, although it was not possible to distinguish between a demyelinating disease and a high grade glioma. Hence, a brain biopsy was required in order to reach the final diagnosis of demyelinating pseudotumoral lesion. CONCLUSIONS: Giant pseudotumoral plaques are a rare form of presenting symptom in MS; use of the clinical features, simple images and spectroscopy is not a very reliable means of reaching a differential diagnosis with a tumour and this often makes it necessary to conduct a biopsy study of the lesion.

[Mumps meningitis: a case mix in a Neurology Department]. / Meningitis urliana: casuística en un servicio de Neurología.

INTRODUCTION: Parotiditis is a viral infection that produces a non-suppurative inflammation of the parotid glands, although it may affect other salivary glands, the testicles, meninges and the pancreas. Clinical meningitis appears in 1-10% of cases, normally between the 4th and the 10th day after infection of the parotid glands. In this study, we analyse the clinical and analytic characteristics of the patients admitted to our Neurology Department over the last 12 years. CASE REPORTS: A retrospective study was conducted by analysing the hospital discharge reports. The eligibility criterion was the existence of an acute meningeal syndrome linked to the presence of positive IgM titres for the parotiditis virus. In all, 13 cases were found, with a mean age of 16.5 years, and most of them were males (92.3%). Parotiditis preceded meningitis in all our patients with an average of 8.3 days, while orchiepididymitis, when it occurred, appeared at the same time or after meningitis. Analysis of the cerebrospinal fluid showed a lymphocyte profile with glycorrhachia above 40%, except in two cases that showed a non-persistent neutrophilic profile. There was a transient 30.7% reduction in prothrombin time in the patients. No sequelae were observed. CONCLUSIONS: Vaccination campaigns have drastically reduced the number of cases of meningitis due to this germ since the second half of the 90s. This virus must be borne in mind in cases of meningitis in young males who come from underdeveloped countries.