[Early subdural haematoma as the first symptom of intracranial hypotension syndrome: results from magnetic resonance imaging]. / Hematoma subdural precoz como forma de inicio del sindrome de hipotensión intracraneal: hallazgos en resonancia magnética.

INTRODUCTION: Subdural haematoma associated to intracranial hypotension syndrome (IHS) is an infrequent complication. Its sudden early appearance in this female patient allowed us to diagnose and treat the syndrome at an early stage of development. CASE REPORT: We describe the case of a 29-year-old patient who had a caesarean with spinal anaesthesia and, 48 hours afterwards, presented IHS accompanied by focal neurological symptoms as a consequence of a subdural haematoma. Performing an emergency computerised tomography scan and magnetic resonance imaging (MRI) at 14 hours allowed early diagnosis and treatment to be established. CONCLUSIONS: MRI is essential to confirm the clinical suspicion of IHS and thus avoid the need to submit the patient to invasive tests. In this way, treatment for the IHS can be initiated at an early stage and the subdural haematoma can be resolved without the need for surgical drainage.

[Amaurosis fugax as the sole manifestation of a dural arteriovenous fistula]. / Amaurosis fugaz como única manifestación de una fístula arteriovenosa dural.

INTRODUCTION: Ophthalmologic disorders caused by arteriovenous malformations (AVM) are generally related with alterations in the cavernous sinus or papilloedema. However, the appearance of amaurosis fugax (AF) as the sole clinical manifestation of an AVM has very rarely been reported in the literature. CASE REPORT: We present the case of a 64 year old male patient who displayed recurring episodes of temporary monocular blindness (AF) as a consequence of the haemodynamic disorders triggered off in the course of a dural AVM. DISCUSSION: The arteriovenous fistula, located in the anterior fossa, gives rise to theft phenomena in the region of the arteries that nourish the retina and trigger episodes of AF of an essentially haemodynamic nature.

[Dilation of the ventriculus terminalis, an infrequent cause of lower back pain. Magnetic resonance findings]. / Dilatación del ventrículo terminal, causa infrecuente de lumbalgia. Hallazgos en resonancia magnética.

INTRODUCTION: Ventriculus terminalis is the name given to a congenital disorder that consists in the appearance of a small oval ependymal cystic cavity in the conus medullaris. It is formed during embryogenesis as a result of the differentiation between the canalisation and regression of the spinal cord. The aim of this study is to describe the findings obtained by magnetic resonance (MR) imaging concerning the dilation of the ventriculus terminalis in a symptomatic patient. CASE REPORT: A 41-year-old female with a three-year history of lower back pain and irradiated pain in the left leg, together with paresthesias. The physical exploration revealed hypoesthesia with a low level of sensitivity in D12, L1 and L2. MR images revealed the presence of a cystic lesion located in the conus medullaris, with a well defined outline, and which was not enhanced following contrast IV. CONCLUSION: The ventriculus terminalis is the ependymal cavity that lies in the conus medullaris. It may present an abnormal dilation and we need to know of its existence, where it is typically located and its signal characteristics in MR in order to be able to diagnose and differentiate it from cystic tumours situated in the same place, which can display a similar appearance in MR images. The therapeutic management of these patients will depend on their clinical progress. MR scanning is fundamental for diagnosing and monitoring symptomatic patients.

[Descriptive epidemiology of ambulatory neurological care in the Vega Baja (Alicante) area]. / Epidemiología descriptiva de la asistencia neurológica ambulatoria en el área Vega Baja (Alicante).

AIMS: The aim of our work is to analyse ambulatory neurological care in the area of Vega Baja, which is located in the province of Alicante (Spain), in order to find out: a) the demographic characteristics of the population that visits the neurologist; b) the motives that led to the visit; c) the diagnoses carried out. PATIENTS AND METHODS: A prospective two year study of patients over the age of 14 sent to the Neurology department. The reasons for the visit were classified into 15 categories and the diagnoses were given a code according to the criteria set out in the International Classification of Diseases 9th edition. RESULTS: A total of 2,227 patients were included in the study. The annual incidence of first visits was 10.6 per 1,000 people. 60% of the patients were women. The average age was 51.6 years old. Headache was the most frequent reason for the visiting the doctor. One out of every three patients visited because of headache and/or facial pain. The five most frequent diagnoses in the under 65 group were, in descending order of frequency: migraine, tension type headache, epilepsy, syncope and anxiety. The five most common diagnoses in the over 65 group were, in descending order of frequency: Alzheimer, Parkinson, transitory cerebral ischemia, cerebral thrombosis and epilepsy. CONCLUSIONS: The type of ambulatory neurological pathology depends on the age of the patients, and thus we find that headache is prevalent in the younger patients whereas neurodegenerative and vascular pathological conditions are more common in those over the age of 65.

[Cost effectiveness of the diagnostic study of dementia in an extra-hospital Neurology service]. / Rentabilidad del estudio diagnóstico de la demencia en una consulta extrahospitalaria de Neurología.

AIM: The purpose of this study was to analyse the cost effectiveness of the complementary tests in the diagnosis of reversible causes of dementia in an extra-hospital Neurology service. PATIENTS AND METHODS: Patients referred to the Neurology service from Primary Care with a diagnosis of dementia according to DSM-III-R criteria. The following routine complementary tests were performed: 1. Analyses, including blood count, biochemical study, vitamin B12 and folic levels, thyroid hormones, and syphilis serodiagnosis; 2. Neuroimaging study, consisting in computerised axial tomography or cranial magnetic resonance. RESULTS: A total of 269 consecutive patients diagnosed as suffering from dementia were included in the study. The mean age of the patients was 74.5 years (49-94 years) and 61% were females. The most frequent cause of dementia was Alzheimer's disease (79.9%). In all, 31 patients presented potentially reversible conditions (11.5%), but if we exclude depression, the dementia was only reversible in one patient (0.4%). CONCLUSIONS: The percentage of patients with reversible causes of dementia in the field of extra-hospital neurology is low. The diagnostic study must be individualised according to the clinical suspicion.