Visual Hallucinations in a Patient With Moyamoya Disease: A Review and Case Report.

Moyamoya disease (MMD) is characterized by the progressive development of stenosis in the distal carotid territory and an abnormal vascular network. It is a rare disease with a higher prevalence in Asian countries compared with other countries. The most common symptoms of MMD vary from stroke to epileptic seizure and headaches. However, individuals with MMD may also experience psychiatric symptoms such as depression, anxiety, and, in rare cases, psychosis. We report the case of a 34-year-old man with MMD who suffered from psychosis accompanied by visual hallucinations. The man was diagnosed with MMD and attends periodic follow-ups in our neurology outpatient clinic. After undergoing programmed neurosurgery, the man's immediate postoperative follow-up neuroimaging showed an extensive right frontotemporal acute ischemic lesion for which he was treated and released. Almost a year later, he presented to an outpatient psychiatric clinic where he complained of visual hallucinations and delusions. This time, there was no change in neuroimaging. Treatment with olanzapine was successful, and the man's symptoms were completely reversed. To our knowledge, this is the first reported case of visual hallucinations in an individual with MMD. This case is especially relevant because the visual hallucinations were not associated with an occipital ischemic lesion or with epileptic activity. We propose a topographic hypothesis to explain such findings.

Guillain-Barré syndrome following the 2009 pandemic monovalent and seasonal trivalent influenza vaccination campaigns in Spain from 2009 to 2011: outcomes from active surveillance by a neurologist network, and records from a country-wide hospital discharge database.

BACKGROUND: Studies have shown a slight excess risk in Guillain-Barré syndrome (GBS) incidence associated with A(H1N1)pdm09 vaccination campaign and seasonal trivalent influenza vaccine immunisations in 2009-2010. We aimed to assess the incidence of GBS as a potential adverse effect of A(H1N1)pdm09 vaccination. METHODS: A neurologist-led network, active at the neurology departments of ten general hospitals serving an adult population of 4.68 million, conducted GBS surveillance in Spain in 2009-2011. The network, established in 1996, carried out a retrospective and a prospective study to estimate monthly alarm thresholds in GBS incidence and tested them in 1998-1999 in a pilot study. Such incidence thresholds additionally to observation of GBS cases with immunisation antecedent in the 42 days prior to clinical onset were taken as alarm signals for 2009-2011, since November 2009 onwards. For purpose of surveillance, in 2009 we updated both the available centres and the populations served by the network. We also did a retrospective countrywide review of hospital-discharged patients having ICD-9-CM code 357.0 (acute infective polyneuritis) as their principal diagnosis from January 2009 to December 2011. RESULTS: Among 141 confirmed of 148 notified cases of GBS or Miller-Fisher syndrome, Brighton 1-2 criteria in 96 %, not a single patient was identified with clinical onset during the 42-day time interval following A(H1N1)pdm09 vaccination. In contrast, seven cases were seen during a similar period after seasonal campaigns. Monthly incidence figures did not, however, exceed the upper 95 % CI limit of expected incidence. A retrospective countrywide review of the registry of hospital-discharged patients having ICD-9-CM code 357.0 (acute infective polyneuritis) as their principal diagnosis did not suggest higher admission rates in critical months across the period December 2009-February 2010. CONCLUSIONS: Despite limited power and underlying reporting bias in 2010-2011, an increase in GBS incidence over background GBS, associated with A(H1N1)pdm09 monovalent or trivalent influenza immunisations, appears unlikely.

[Identification and review of health promotion at work programs in Spain.] / Identificación y revisión de los programas de promoción de la salud en el trabajo en España.

OBJECTIVE: Health promotion at work (HPW) is an essential component of social and economic policies. Objectives: 1) To determine which regions in Spain have a HPW program and 2) To review these programs according to health promotion and equity models. METHODS: Regional HPW programs were identified through occupational health committee. Their webs were reviewed, and we interviewed by videoconference the persons in charge of each program. We used a data collection notebook to collect descriptive as well as quality variables, according to health promotion and equity models. RESULTS: 6 regions have a HPW program: Andalucía, Aragón, Cataluña, Comunidad Valenciana, Extremadura and Galicia, developed by health administration or work administration, but only in 1 case by both. 4 programs have regulations and 3 have created a network. The participation of occupational risk prevention services is key, while participation of workers and management teams is variable. Only 2 regions have incorporated information and materials related to COVID-19. Measures to promote equality and work-life balance, but not to promote equity. CONCLUSIONS: HPW in Spain is a reality in 6 regions, with differences between them related to the requisites and what the administration offers to them.

OBJETIVO: La promoción de la salud en el trabajo (PSLT) es un componente esencial de la política social y económica. Los objetivos fueron: 1) Determinar en qué comunidades autónomas (CCAA) existe un programa de PSLT y 2) Revisar dichos programas de acuerdo con los modelos de promoción de la salud y equidad en salud. METODOS: Los programas se han identificado a través de la Ponencia de salud laboral. Se han revisado sus webs y se han entrevistado por videoconferencia las personas responsables de cada programa. Se ha utilizado un cuaderno de recogida de datos para recoger variables descriptivas y de calidad según los marcos de promoción de la salud y equidad. RESULTADOS: 6 CCAA tienen programa de PSLT: Andalucía, Aragón, Cataluña, Comunidad Valenciana, Extremadura y Galicia, desarrollados por la administración sanitaria, por la de trabajo o conjuntamente. 4 CCAA han desarrollado normativa para el programa y 3 han creado una red. La participación de los servicios de prevención de riesgos laborales es clave, mientras que la de las personas trabajadoras y equipos directivos es variable. Sólo 2 CCAA han incorporado información y materiales relacionados con la COVID-19. Se observan medidas para el fomento de la igualdad y conciliación laboral, pero no para fomentar la equidad. CONCLUSIONES: La PSLT en España es una realidad en 6 CCAA, con diferencias entre los programas, tanto en relación con los requisitos, como respecto a lo que les ofrece la administración.