[Crying epilepsy]. / Epilepsia dacrística.

Crying epilepsy, consisting of the appearance of tears as an epileptic phenomenon, is apparently somewhat infrequent. In most cases which it has been possible to record, electroencephalography (EEG) indicated a right temporal focus. These findings have lent weight to the theory of the existence of hemispheric emotion control. We present two cases in which tears were one of the clinical signs of epilepsy. In one of the cases EEG showed left temporal focus.

[Migrainous infarct in pregnancy]. / Infarto migrañoso durante el embarazo.

INTRODUCTION AND CLINICAL CASE: We present the case of a migrainous patient who had a cerebral infarct during a migrainous crisis. She was 26 weeks pregnant. The infarct, detected on MRI was in the right thalamic region. It presented as left hemiparesia and left hemi-hypo-estesia. Laboratory tests were normal. There was full recovery from the episode. CONCLUSIONS: Migraine is considered to be a risk factor per se for stroke, especially in young women. The association of migrainous ictus, which is a diagnosis by exclusion of other aetiologies, and pregnancy is rare, as is apparent on review of the subject. In the Western world, pregnancy is not considered to be a risk factor for ictus. The functional prognosis of migrainous stroke is good, with minimal risk of relapse.

[Clinico-radiological dissociation in cerebral hemorrhage caused by afibrinogenemia]. / Disociación clinicorradiológica en la hemorragia cerebral por afibrinogenemia.

INTRODUCTION: Congenital afibrinogenemia is a very rare hereditary anomaly of coagulation. Only 150 cases have been published. Clinical manifestation in the form of some type of bleeding is similar to that of other congenital coagulopathies, although the pattern of presentation is different. Spontaneous bleeding is rare, but slight injury, which may be unnoticed, may trigger it off. In spite of being a congenital condition, it may be of late onset, as in our patient, with bleeding episodes occurring in the second decade of life. CLINICAL CASE: We describe a woman who had several episodes of bleeding, two of which were intracerebral. The principal feature of this was dissociation between the clinical findings and their detection by neuro-imaging. Substitutive therapy led to the disappearance of symptoms. CONCLUSION: Cerebral haemorrhage in the presence of afibrinogenemia may fail to be detected early on CT. On clinical suspicion of bleeding, early substitutive treatment should be started.

[Subdural empyema: medical treatment]. / Empiema subdural: tratamiento médico.

A young man who initially presented right maxillary sinusopathy which was treated with antibiotics, developed meningeal syndrome in association with focal neurological signs followed by focal tonoclonic convulsions which subsequently became general. Computed tomography confirmed the presence of a left parasagittal and right frontal subdural empyema. Medical treatment with antibiotics, dexamethasone and anticonvulsants resulted in rapid clinical and radiologic improvement in both the sinuses and brain images. The diagnostic and therapeutic aspects are discussed and medical treatment recommended as the first step in the therapy of subdural empyema when there is no other critical neurological situation.

[Benign familial chorea. A not so benign entity]. / Corea familiar benigna. Una no tan benigna entidad.

A family is reported with five generations showing hereditary chorea. In the youngest generation, two members had so severe choreic hyperkinesis that gait was impaired in one of them and totally impeded in the other; they also had associated mental retardation, which was not present in other members with variable degrees of hyperkinesis. There was no therapeutic response to several drugs. The literature regarding genetical, clinical and therapeutic aspects of this condition is reviewed, and it is concluded that the most adequate denomination for the disease is familial nonprogressive chorea rather that the accepted one of benign familiar chorea.

[Myoclonus as a manifestation of respiratory encephalopathy]. / Mioclonías como manifestación de la encefalopatía respiratoria.

The triad of mental abnormalities, neurologic disorders and abnormal electroencephalogram is central to respiratory encephalopathy. The development of myoclonus has been considered as a sign heralding the development of generalized seizures and coma. A patient with chronic bronchitis is reported in whom myoclonus was the predominant symptom. Myoclonus was generalized, symmetrical and synchronic, and electroencephalographic correlation was shown, with diffuse polyspike-high potential wave discharges coincident with myoclonus. Remarkably, they promptly responded to low doses of diazepam, with disappearance of clinical neurologic and electrical findings. These have not subsequently relapsed although the patient is not receiving specific therapy. The risk of the administration of diazepam was weighted against other specific drugs (clonacepam, pyracetam) which are probably better tolerated. The interest in the quicker response of diazepam prevailed. We propose the inclusion of myoclonus secondary to respiratory encephalopathy in the classification of myoclonic disorders.