Brain-stem tuberculoma. An analysis of 11 patients.

The clinical and radiologic findings in 11 patients with brain-stem tuberculoma were reviewed. Clinical manifestations included various combinations of focal signs and symptoms of subacute onset, similar to those produced by other space-occupying lesions of the brain stem. Evidence of systemic tuberculosis was found in six cases (55%). Computed tomography (CT) usually showed an isodense or hyperdense brain-stem mass with abnormal contrast enhancement; associated supratentorial granulomas were found in four cases, and hydrocephalus was found in two cases. Magnetic resonance imaging showed irregular brain-stem lesions with long T1 and short T2 relaxation times. Cerebrospinal fluid findings were also nonspecific, as smears for acid-fast bacilli were most often negative. An incorrect diagnosis of pontine glioma was made in one patient. In contrast, proper integration of data from CT and magnetic resonance imaging findings, cerebrospinal fluid analysis, and x-ray films of the chest permitted an accurate diagnosis in ten cases. Prompt therapy with antituberculous drugs resulted in clinical improvement, documented by CT, in most patients. Brain-stem tuberculoma should be suspected in patients with space-occupying lesions of the brain stem who live in geographic areas where tuberculosis is endemic. Early diagnosis and prompt medical therapy are important in preventing mortality and reducing morbidity.

Peripheral motor neuropathy associated with autonomic dysfunction in two sisters: new hereditary syndrome?

We describe two sisters with distal, slowly progressive muscular weakness and hypotrophy since childhood, autonomic dysfunction characterized by profuse sweating, distal cyanosis related to cold weather, orthostatic hypotension, and esophageal achalasia. Nerve conduction velocity of several motor nerves was slow, and although no sensory abnormalities were present, sural nerve biopsy revealed severe nonspecific demyelination. No similar patients could be found in the literature and we therefore suggest the possibility that these individuals have a newly recognized hereditary syndrome.

[Systemic lupus erythematosus with affection to brainstem: report of three cases]. / Lupus erimatoso sistémico con afectación del tronco encefálico: presentación de tres casos.

INTRODUCTION: The frequency with which the central nervous system (CNS) is affected by systemic lupus erythematosus (SLE) varies, according to different series, between 13 and 59%, whereas the brain stem is affected in 5%. CASE REPORTS: Case 1: a 33 year old male who was submitted to a Nissen funduplicature as a treatment of (hypo)incoercible hiccups. The singultus persisted and some time after a paraplegia appeared. Magnetic resonance (MRI) showed images in the medulla oblongata, and in the cervical and thoracic spine. A biopsy was also performed to examine the cervical lesions and vasculitis was diagnosed. The patient began treatment with prednisone (1 mg/kg) and two months after symptoms had begun to improve he presented an episode of bilateral optic neuritis. Until this last event, the immunological studies had been positive. Case 2: female aged 19 who had had SLE for eight months. The illness began suddenly with bilateral paralysis of the sixth cranial nerve, vertical and horizontal nystagmus, dysdiadochokinesia, truncal ataxia, 4/5 muscular strength in the upper limbs and 3/5 in the lower limbs, and left flexor plantar response, but indifferent on the right hand side. MR showed T2 hyperintensities in the pons, medulla oblongata and the junction of medulla and upper spinal cord. Case 3: female aged 31 with sudden onset of the illness, characterised by diplopy and presence of internuclear ophthalmoplegia. Brain MR showed images of T1 hypointense and T2 hyperintense in the pontobulbar region. CONCLUSION: A brain stem disorder in patients suffering from SLE is one of the rarest manifestations of this pathological condition of the CNS and is probably caused by vasculitis

[Peripheral neuropathy during a second cycle of treatment with high doses of interferon-alpha in a patient with hepatitis C, and a review of the literature]. / Neuropatía periférica durante un segundo ciclo de tratamiento con dosis altas de interferón alfa en un paciente con hepatitis C y revisión de la bibliografía.

INTRODUCTION: Alpha interferons (IFN a) have been shown to be effective in patients with chronic active hepatitis C. IFN a treatment may be associated with neurologic complications, including peripheral neuropathy. CASE REPORT: We describe a patient with active hepatitis C treated with IFN a, who developed peripheral neuropathy after a second cicle of treatment with interferon. He received a first cicle of treatment with IFN a during 22 weeks (6 MU/day 3 times a week). Afther that he did not received treatment during one year and then he received the second cycle (6 MU/day 3 times a week). After 3 months of therapy the patient complained about paresthesias of both legs. CONCLUSIONS: IFN a related neuropathy is probably rare; however, some cases may be misdiagnosed. Diagnosis of IFN a related neuropathy should be considered by physicians, particularly in patients given longterm treatment and high IFN a dosage. In this case we think that the patient had an acumulative efectt of interferon though he did not received treatment with interferon during one year.

[Alexia without agraphia due to the lesion in the right occipital lobe in a right-handed man. Detection of hemispheric lateralization of handedness and language in a right-handed patient]. / Alexia sin agrafia por lesión occipital derecha en varón diestro. Segregación de la lateralización hemisférica manual y del lenguaje en un paciente diestro.

INTRODUCTION AND CLINICAL CASE: A 65 year-old man, right-handed, without any family history of left handiness, suddenly developed a left homonymous hemianopia and incapacity for reading. Neurological and neuropsychological examinations showed the presence of a profound alexia with preservation of writing to dictation and spontaneously. He was unable to read what he had written. He could spell the words letter by letter but he was unable to read the complete word. MRI showed an extensive infarct in the territory of the right posterior cerebral artery. The infarct extended anteriously to the right thalamus and to the medial temporal fifth or fusiform gyrus. The splenius was spared. Brain SPECT disclosed the area of the infarct and an extensive area of decreased cerebral perfusion over the right parietal and temporal areas. CONCLUSION: Alexia without agraphia has been reported in right-handed patients with left occipital lesions and in right occipital regions in left-handed patients but rarely if ever in right occipital lesions in right-handed patients.

[Painful neuropathies: their pathophysiology and treatment]. / Neuropatías dolorosas: fisiopatología y tratamiento.

OBJECTIVES: The purpose of this study is to review the different studies published in the literature concerning the different physiological mechanisms involved in the genesis of painful neuropathy, as well as the diagnostic options and the different pharmacological treatments currently available. DEVELOPMENT: Distinct pathologies usually condition painful neuropathy, one of the main ones being diabetes mellitus. The triggering phenomenon is often some kind of damage to the tissues that contain nervous pain receptors, which later gives rise to a release of proinflammatory molecules, and triggers a cascade of phenomena that result in disorders in the central and peripheral nervous system (peripheral and central sensitisation). These disorders usually produce clinical manifestations, such as allodynia, paresthesias, among others, and these are sometimes the sole manifestation of painful neuropathy. Diagnosis of this syndrome is at times complicated due to the involvement of thin fibres, which cannot be identified by the conventional methods used in neurophysiological studies. There is also a broad range of pharmaceuticals used in the treatment of painful neuropathy that range from tricyclic antidepressants, non-steroidal anti-inflammatory drugs, opioid analgesics, antiarrhythmics and even agents for topical use. CONCLUSIONS: Diagnosis of thin fibre neuropathy is usually performed by carrying out a Quantitative Sudomotor Axon Reflex Test, quantitative sensory tests and a skin biopsy. As regards the pharmacological treatment, the new generation of anticonvulsive drugs like gabapentin seems to have advantages over the traditional pharmaceuticals, although their widespread use is still largely restricted by their cost.

[Monitoring dermatomal somatosensory evoked potentials at the ERB point, the cervical spinal cord and the cerebral cortex in the diagnosis of cervical radiculopathy]. / Registro de potenciales evocados somatosensoriales dermatómicos en punto de Erb, médula cervical y corteza cerebral en el diagnóstico de la radiculopatía cervical.

INTRODUCTION: Recording at various levels of the somatosensory pathway is often used in somatosensory evoked potentials to mixed nerve stimulation (SEP), but not in dermatomal somatosensory evoked potentials (DSEP) in which only the cortical potential is usually recorded. The aim of our study was to compare the recordings of upper limb DSEP at Erb point, cervical cord, and subcortical and cortical levels with SEP recordings in healthy subjects and patients with cervical radiculopathy. PATIENTS AND METHODS: 17 patients with clinical history, MRI and electromyography consistent with cervical radiculopathy and 17 healthy subjects were included. Median and ulnar nerves were stimulated at the wrist; and C6, C7 and C8 dermatomes at the 1st, 3rd and 5th fingers respectively. All the potentials obtained with SEP and DSEP were compared between controls and patients by t test for independent samples. We also used Pearson s correlation for height/latencies, weight/amplitude and age/peripheral nerve conduction velocity (PNCV). RESULTS: DSEP potentials were of similar morphology of those observed in SEP but had longer latencies and smaller amplitudes. We found a positive correlation between height and latencies, and a negative association of weight with amplitude of peripheral potential, and age/PNCV. No difference between controls and the neurological intact segments of patients was found. 13 patient had DSEP altered while only 5 of them had altered SEP recorded. The most common finding was prolongation of the conduction time of the segment N9 N13 on DSEP recordings. CONCLUSION: We found that it is possible to record and to identify all the potentials in DSEP as observed in the SEP. On cervical radiculopathy, DSEP with the present technique increase the sensitivity and give some additional and useful information regarding the extension and localization of the pathology. Besides, DSEP recording is a non invasive technique, non traumatic and well tolerated for our patients.

[Myxoma of the mitral valve with embolization of the posterior circulation. A case report and review of the literature]. / Mixoma de la válvula mitral con embolización a circulación posterior. Descripción de un caso y revisión de la literatura.

INTRODUCTION: Although cardiac tumours are infrequent, over half are myxomas. Most are situated in the cavities of the heart and exceptionally on the valves. Embolism towards the arteries of the anterior circulation of the central nervous system is the commonest neurological finding, but rarely involves the posterior circulation. CLINICAL CASE: A 79 year old woman who one year before admission had had a right hemiparesia of the face and body, from which she had made a complete recovery. Three months later she had a sudden onset of unsteady gait which was deviated towards the right and vertigo. She attended our institution where magnetic resonance (MR) studies showed that there were infarcts in the territory of the right anterior and posterior inferior cerebellar arteries. Four months later she had a further episode of unsteady gait, vertigo and right hemiparesia of face and body for which she was admitted to hospital. On physical examination there was dysmetry, dysdiadokokinesia and involvement of the third cranial nerve. Further MR studies showed the previous lesions and also a new ischaemic lesion of the mesencephalum. A transoesophagic echocardiogram showed a tumour of approximately 18 x 20 mm, implanted in the mitral valve. Study of the resected tumour showed it to be a myxoma. Six months later the patient was asymptomatic and had not relapsed. CONCLUSION: Although the association of vascular events of the posterior circulation with myxomas of the mitral valve is rare, its clinical importance cannot be overlooked.

[Diagnostic tests in myasthenia gravis. Creation of a standard for diagnosis using a method of consensus]. / Pruebas diagnósticas en miastenia gravis. Conformación de un estándar diagnóstico mediante un método de consenso.

INTRODUCTION: Nowadays the best test for the diagnosis of myasthenia gravis (MG) is the single fiber electromyography (SFEMG). Due to the cost of the test it has not become routine in most part of the hospitals to confirm the diagnosis of MG. OBJECTIVE: To identify an acceptable gold standard for hospitals which do not have access to SFEMG, but have access to some other classical test through the use of a consensus methodology. SUBJECTS AND METHODS: The study was realized in three stages. The first two stages were done through a prolective survey and the third stage through a Delfos methodology. During the first stage 59 general neurologist were interviewed, applying an instrument in which they were asked which were the best test and the best group of tests to diagnose MG without using the SFEMG. During a second stage, a second collection instrument was applied to 15 experts in motoneuron diseases to identify the best isolated test and the best test scheme with and without using the SFEMG in four frequent clinical situations in clinical practice (typical clinical case of generalized MG, patient with ocular myasthenia, patient with generalized MG of medium and low probability). Finally four flowcharts were created of the four analyzed clinical situations and were approved through a Delfos methodology with 8 neurologist motoneuron disease. RESULTS: We identified an acceptable gold standard for hospitals which do not have access to SFEMG through the use of a consensus methodology. We have also completed four diagnostic flowcharts about the most frequent clinical situations that we have faced in the ordinary practice. CONCLUSIONS: We have found a series of important results for the diagnosis of MG available to general physicians, internists and neurologist that do not have all the test for the diagnosis of MG.

[A case of Hallervorden-Spatz disease with magnetic resonance imaging data]. / Un caso de enfermedad de Hallervorden-Spatz con hallazgos de resonancia magnética.

Hallervorden-Spatz disease (HSD) is an uncommon disorder, progressive and degenerative of the basal ganglia. It begins in the first or second decade of life and is characterized by a dominant extrapiramidal signs, dystonia and progressive dementia. It is autosomic recessive, although sporadic cases are seen in 15%. There is no biological marker for the disease. The post-mortem findings include iron deposits in the globus pallidum and pars reticulata of the substantia nigra. Magnetic resonance imaging (MRI) in T2 shows symmetric hypointense lesions in both globus pallidum with a hyperintense center: giving the "tiger's eye" sign. This is the first case reported in Mexico of sporadic HSD with typical clinical and MRI findings.

[The other genome: the clinical concept of mitochondrial cytopathies or disorders of pxidative phosphorylation]. / El otro genoma: el concepto clínico de las citopatías mitocondriales o enfermedades de la fosforilación oxidativa.

The investigations of mitochondrial DNA abnormalities and its relationship with derangements of oxidative phosphorylation and electron transport system, has yielded description a myriad of syndromes called mitochondrial diseases or cytopathies. The objective of this paper is to review the clinical relevant features of this heterogeneous group of diseases, to understand the board spectrum of signs and symptoms and suggest an algorithm for the diagnosis.

[Guillain-Barre syndrome. Experience in a third level hospital]. / Síndrome de Guillain-Barré. Experiencia en un hospital de tercer nivel.

INTRODUCTION: Acute peripheral neuropathy represents a medical emergency. The causes of it are diverse and plentiful. The most common cause of acute paralytic peripheral neuropathy is the Guillain-Barré syndrome (GBS). As many as 85% of those affected can be expected to make an excellent recovery. OBJECTIVE: To describe the principal risk factors associated, clinical manifestations, treatment, evolution and complications of 28 cases of Guillain-Barré syndrome (GBS) in the "Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán". METHODS: We search in our computer records all files under diagnostic of GBS, during the last ten years. We found 28 cases that were available to study. RESULTS: Mean age was 37 years old (SD 17.2). Fifteen patients were female (54%) and 13 were male (46%). Nine patients (32%) were preceded by a superior via infection, 5 (18%) by a diarrhea illness and 14 patients had not a predisposing factor. The duration of symptoms before diagnostic has a median of 7 days (2-15). Twenty-six patients (93%) had an ascending paralysis and 18 had paresthesias (64%). The most frequent subtype was acute inflammatory-demyelinating polyneuropathy (AIDP) in 18 patients (64%), acute motor-sensory axonal neuropathy (AMSAN) in 5 (18%), acute motor axonal neuropathy (AMAN) in 3 (11%) and 2 patients (7%) had the Fisher-Miller syndrome. Fifteen patients (54%) developed respiratory involvement requiring mechanical ventilation. Twenty-four patients (86%) had cerebrospinal fluid proteins elevated. Twenty patients (72%) had a total recovery, 6 (21%) had a partial recovery and 2 had not any response (7%). DISCUSSION: GBS is a particularly highstakes illness in that its onset is sudden and paralysis is frequently extreme (requiring assisted respiration), however, as many as 85% of those affected can be expected to make an excellent recovery. In our study the majority of patients (54%) develop respiratory involvement requiring mechanical ventilation but in this group the majority had a favorable outcome (71%).

[100 years of the Babinski sign]. / Los cien años del signo de Babinski.

In 1896 Joseph Francois Felix Babinski described for the first time the phenomenon of the toes. In his first paper he simply described extension of all toes with noxious stimulation of the sole of the foot. It was not until 1898 that he specifically described the extension of the hallux with stimulation of the lateral border of the sole. Babinski was probably not aware at the time that E. Remak, a German physician, had previously described the sign. In his third paper of 1903 Babinski concludes that if other authors had described the abnormal reflex before him, they found it fortuitously and did not realize its semiologic value. Babinski probably discovered it by a combination of chance, careful observation and intuition. He also had in mind practical applications of the sign particularly in the differential diagnosis with hysteria and in medico-legal areas. Several of his observations and the physiopathological mechanism proposed by him are still valid today. He realized since 1896 that the Babinski reflex was part of the flexor reflex synergy. He observed that several patients during the first hours of an acute cerebral or spinal insult had absent extensor reflexes. He realized that most patients with the abnormal reflex had weakness of the toes and ankles. He found a lack of correlation between hyperactive myotatic reflexes and the presence of an upgoing hallux. He discovered that not all patients with hemiplegia or paraplegia had the sign. He thought erroneously that some normal subjects could have an upgoing toe. His dream of a practical application of the sign has been fully achieved. The motto of Babinski was Observatio summa lex. Perhaps there is no better dictum in clinical neurology.

[Sodium benzoate in portal-systemic-encephalopathy-induced blood ammonia normalization and clinical improvement. Interim report of a double-blind multicenter trial]. / Derivación metabólica del amonio plasmático con benzoato de sodio, como método de tratamiento en pacientes con cirrosis y encefalopatía portosistémica. Informe interino de un estudio multicéntrico, doble ciego.

To investigate the therapeutic efficacy of sodium benzoate (SB) in a cirrotic population with chronic portal systemic encepalopathy (PSE), we performed a double blind, randomised, multicentric, clinical trial, comparing SB versus a standard therapy of lactitol (LA). To perform the study blind, syrups containing the two drugs were prepared. To date 27 patients have been studied. Of these, 12 received SB (5.6 g/day) and 15 received LA (29 g/day). Standard PSE parameters were assessed and hippurate urinary excretion was measured before and after the trial. For the SB group, basal and final PSE index were 0.39 +/- 0.16 and 0.17 +/- 0.1 respectively (p < 0.001). The Group on LA had a PSE index of 0.40 + 0.1 and 0.23 +/- 0.18 (basal and final respectively) (p < 0.001). The final hippurate excretion for SB group was 2498.9 mg/24 h. The hippurate excretion for the LA group suffer no changes (traces). No serious side effects were observed with either therapy. We suggested that SB is a safe, efficacious and comfortable alternate treatment for PSE.

[Significance of intracranial hypertension management in cryptococcal meningitis in patients with acquired immunodeficiency syndrome. Report of 2 cases]. / Importancia del manejo de la hipertensión endocraneana en meningitis criptocócica en pacientes con síndrome de inmunodeficiencia adquirida. Informe de dos casos.

Two cases of cryptococcal meningitis and increased intracranial pressure in patients with acquired immunodeficiency are described. Both patients presented high intracranial pressure that persisted despite optimal antifungal treatment (amphotericin B, 5-flucytosine initially, and fluconazole posteriorly). The elevated intracranial pressure produced headache, seizures, and reduced visual and auditory acuity. CAT scan demonstrated absence of ventricular dilatation or focal lesions. Both cases were treated with adequate antifungal therapy, as well as with repeated lumbar punctures and placement of a lumboperitoneal shunt due to the persistence of elevated intracranial pressure. One patient presented with unilateral loss of vision due to optic nerve atrophy. After one year of follow-up, one patient died due to progression of his disease, while the other is still alive and without evidence of neurological disease. Intracranial hypertension is a frequent clinical manifestation of cryptococcal meningitis in patients with acquired immunodeficiency syndrome (AIDS) that requires adequate diagnosis and management. Treatment should be directed towards the reduction of intracranial pressure though repeated lumbar punctures and, in some cases, with lumboperitoneal or ventricular-peritoneal shunts.

Horizontal appendicular dysmetria in four patients with a typical Wallenberg's syndrome.

During the acute stage of a Wallenberg's syndrome ipsilateral appendicular dysmetria is frequently seen. The dysmetria is more apparent in the ipsilateral upper extremity. These patients also have a peculiar type of dysmetric eye movements that are characterized by hypermetric saccades toward the side of the lesion and hypometric saccades to the opposite side. We examined four patients with acute Wallenberg's syndrome and found horizontal dysmetria of the affected extremity. Hypermetric arm and hand movements were present to the side of the lesion and hypometric movements toward the opposite side. This type of dysmetria is probably related to the same patophysiological mechanism that underlies dysmetric eye movements in the Wallenberg's syndrome. The dysmetria tends to disappear with time although it continues to be present in some patients six months after the ischemic damage.

[Central neurogenic hyperventilation associated with a pontine infarction]. / Hiperventilación central neurogénica en infarto pontino.

Central neurogenic hyperventilation in patients with a normal level of consciousness is uncommon. This condition occurs in bilateral pontine tegmental lesions, particularly tumors such as CNS lymphomas and glioma, as well as traumatic lesions. The physiopathological mechanisms are unknown and no there is no effective treatment for this entity. We report a case of central neurogenic hyperventilation associated to a unilateral basal pontine infarction.

[Klippel-Feil syndrome. Three-dimensional tomographic images]. / Síndrome de Klippel-Feil. Imágenes por tomografía en tercera dimensión.

Klippel-Feil syndrome (KPS) is characterized by congenital vertebral fusion believed to result from faulty segmentation along the embryo's developing axis. The hallmark phenotypic findings of low hairline, short neck, and limited range of motion of the neck are found as al triad in < 50% of patients. Congenital musculoskeletal and systemic anomalies are commonly found. These include, but are not limited to elevation of the scapula, scoliosis and renal and cardiac abnormalities. Here, we present the three-dimensional images by computed tomography of a 9-year-old boy with multiple fusion of the cervical vertebraes.

[Comparison of glycemic control in diabetic patients with and without metabolic syndrome]. / Comparación del control glucémico en pacientes diabéticos con y sin síndrome metabólico.

OBJECTIVE: To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS). METHODOLOGY: cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). RESULTS: 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6%). SM Criteria were : low HDL: 62.9%; hypertriglyceridemia: 56.3%; obesity abdominal (OA) 90.1%, hypertension (HBP): 62.5%. The prevalence of MS was 86.6% (95% CI 83% to 89%). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9% 2.3 vs 8.5% 2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95% in 1.010 to 1.016). CONCLUSIONS: We not found differences significant glycemic level in patients with and without MS.

Objetivo: Comparar el nivel glucémico en pacientes con diabetes tipo 2 (DM2) con y sin síndrome metabólico (SM). Metodología: Estudio transversal analítico. Se incluyeron aleatoriamente pacientes con DM2 corroborado en su expediente clínico. El SM se identificó en pacientes con al menos 3 de 5 criterios del ATP III (AdultTreatment Panel III). Se aplicó un cuestionario estructurado. Se determinó hemoglobina glucosilada (HbA1c), colesterol-HDL, triglicéridos, hipertensión arterial sistémica (HAS), índice de masa corporal (IMC), circunferencia de cintura (CCi) y cadera (CCa). Plan de análisis: prevalencia, prueba t de Student, correlación de Pearson y regresión logística. Resultados: Se incluyeron 283 pacientes. Edad promedio: 59.8±10.6 años. Predominó el sexo femenino (73.6%)Criterios cubiertos para SM: hipocolesterolemia-HDL: 62.9%; hipertrigliceridemia: 56.3%; obesidad abdominal (OA) 90.1%; hipertensión arterial sistémica (HAS): 62.5%. La prevalencia de SM fue 86.6% (IC95% 83% a 89%). No hubo diferencia significativa en el promedio de HbA1c en pacientes con y sin SM, HAS, OA, e hipocolesterolemia-HDL. En cambio, sujetos con hipertrigliceridemia tuvieron un promedio significativamente mayor de HbA1c que aquellos sin hipertrigliceridemia (8.9±2.3 vs 8.5±2.1, respectivamente; p=0.01). HbA1c correlacionó positivamente con trigliceridemia (r=0.24, p=0.001), y negativamente con el peso (r= -0.19, p=0.001), IMC (r= -0.172, p=0.004), CCi (r= -0.12, p=0.004) y CCa (r=-0.14, p=0.02). En el análisis multivariado ajustado, solamente la duración de la diabetes se asoció con el nivel glucémico (OR= 1.014, IC95% 1.010 a 1.016). Conclusiones: No encontramos diferencias significativas en el nivel glucémico en pacientes con y sin SM.

47 year-old man with HIV infection and hemiplegia.

CNS aspergillosis is often missed in the setting of advanced HIV infection, especially in the absence of presumed risk factors such as neutropenia or prior steroid treatment. We describe the postmortem evaluation of the brain of a patient with AIDS that developed progressive neurologic deterioration. Sequence brain MRIs, CSF analysis, and multiple presumed treatments failed to reveal the possible causes or improve his ongoing condition. His brain autopsy showed numerous abscesses with septated hyphae consistent with CNS angioinvasive aspergillosis.