Un caso de meningitis por virus Toscana en Murcia / A case of meningitis due to Toscana virus in Murcia

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[Paraneoplastic cerebellar degeneration as initial presentation of a pancreatic small-cell carcinoma]. / Degeneración cerebelosa paraneoplásica como inicio de un carcinoma indiferenciado de células pequeñas de páncreas.

INTRODUCTION: Oat (small) cell carcinoma is the type of tumour most frequently associated to neurologic paraneoplastic syndromes. It is usually located in the lungs although it has been described in some other locations. Cerebellar symptoms may appear alone, associated to anti Yo antibodies ( Breast and gynaecologic carcinomas), or as manifestation of a more generalized paraneoplastic encephalopathy, associated to signs and symptoms of some other neurologic systems affected. CASE REPORT: A 52 year old patient consulted due to a pancerebellar clinical picture, which started about two months before, and later associated to polineuropathy. Abdominal CT showed a 4 cm mass in the head of the pancreas. Pathologic evaluation demonstrated a poorly differentiated small cell pancreatic tumour. Anti Hu antibodies in high titres were found both in serum and cerebrospinal fluid. DISCUSSION: The association of anti Hu immunity and paraneoplastic encephalomyelitis has been observed in patients with neuroblastoma, seminomas, colorectal, breast and prostate carcinomas and some types of sarcoma. Only about 1% of pancreatic malignancies correspond to small cell type. We have not found any previous report about the association between a paraneoplastic syndrome and pancreatic poorly differentiated small cell carcinoma.

[Acute peritonitis and small bowel diverticula in a patient with mitochondrial neurogastrointestinal encephalomyopathy]. / Peritonitis agudas y divertículos del intestino delgado en una paciente con encefalomiopatía neurogastrointestinal mitocondrial.

INTRODUCTION: Jejunal and ileal diverticula are acquired lesions that are often associated with intestinal motility disturbances like those occurring in myopathies and neuropathies with visceral affection. Mitochondrial neurogastrointestinal encephalomyopathy is characterized by gastrointestinal dysmotility, cachexia, ptosis with external ophthalmoparesis, neuropathy, leukoencephalopathy and laboratory evidence of mitochondrial alteration. CLINICAL CASE: A female patient that since 9 months age presented digestive symptoms: diarrhea, nauseous, vomits, slow digestions and abdominal pain. She had myopia. At the age of 20, in a seven months period, she precised urgent abdominal surgical intervention in three occasions for acute diffuse peritonitis related to jejunal and ileal diverticula. She presented cachexia, mild palpebral ptosis, external ophthalmoparesis, hypertrophic major auricular nerves, scoliosis, pes cavus, distal weakness and hypoesthesia in extremities, bilateral neurosensorial hypoacusia and lactic acidosis. The electroneurographic study was compatible with severe chronic demyelinating sensitive motor polyneuropathy. In the cerebral MR leukoencephalopathy was detected. In muscular tissue it was seen alteration in all fibers type I with numerous lipid vacuoles and an increase of mitochondrial number in the form of thick grains and subsarcolemmal mitochondrial bags. There was no ragged red fibers nor ultrastructural mitochondrial alterations. There was chain respiratory complex III deficiency. CONCLUSIONS: In patients with intestinal dysmotility manifestations and jejunal and ileal diverticula neuropathies and myopathies with visceral affection must be suspected, among them MNGIE syndrome.

Peritonitis agudas y divertículos del intestino delgado en unapaciente con encefalomiopatía neurogastrointestinal mitocondrial / Acute peritonitis and small bowel diverticula in a patient with mitochondrial neurogastrointestinal encephalomyopathy

Introducción. Los divertículos del yeyuno y del íleon son lesiones adquiridas que se suelen asociar a trastornos de la motilidad intestinal, como las que ocurren en las miopatías y neuropatías con afectación visceral. La encefalomiopatía neurogastrointestinal mitocondrial (síndrome MNGIE) se caracteriza por dismotilidad gastrointestinal, caquexia, ptosis con oftalmoparesia externa, neuropatía, leucoencefalopatía y evidencia de laboratorio de alteración mitocondrial. Caso clínico. Mujer que desde los 9 meses de edad padecía síntomas digestivos: diarrea, náuseas, vómitos, digestiones lentas y dolor abdominal. Tenía miopía. A los 20 años de edad, en un periodo de siete meses, precisó cirugía abdominal urgente en tres ocasiones por peritonitis aguda difusa relacionada con divertículos en el yeyuno y el íleon. Tenía caquexia, ptosis parpebral ligera, oftalmoparesia externa, nervios auriculares mayores hipertróficos, escoliosis, pies cavos, debilidad e hipoestesia distales en extremidades, hipoacusia neurosensorial bilateral y acidosis láctica. El estudio electroneurográfico era compatible con una polineuropatía sensitivomotora desmielinizante crónica severa. En la RM cerebral se vio leucoencefalopatía. En el tejido muscular se apreció alteración de todas las fibras tipo I con abundantes vacuolas de lípidos y aumento del número de mitocondrias en forma de granos gruesos y de las bolsas mitocondriales subsarcolemales. No se observaron fibras rojo-rotas ni alteraciones ultraestructurales de las mitocondrias. Se detectó un déficit del complejo III de la cadena respiratoria. Conclusión. En pacientes con manifestaciones de dismotilidad intestinal y divertículos de yeyuno e íleon se debe sospechar de neuropatías y miopatías con afectación visceral, entre ellas el síndrome MNGIE (AU)

[Late onset epileptic crisis and cerebrovascular disease]. / Crisis epilépticas de comienzo tardío y enfermedad vascular cerebral.

INTRODUCTION: Stroke is the most frequent cause of epilepsy in adults, specially in those over 60 years old. Our aim was to analyze the etiologic relevance of stroke among the different etiologies of late onset seizures and to evaluate the clinical characteristics of the subgroup of patients with late onset seizures associated to stroke. PATIENTS AND METHODS: Patients aged over 20 who were admitted to the Neurology or Neurosurgery departments in our hospital for a first-ever seizure over a period of five years were identified retrospectively. The total number of patients included was 248. RESULTS: The most frequent etiologies were stroke (26.2%), tumors (26.2%), unknown (24.6%) and chronic alcohol intake (18.5%). Stroke was the most frequent etiology in patients over 60 (50%). Five of the 65 patients with stroke related seizures had suffered an intracranial hemorrhage and the rest had ischemic lesions. Seven patients had clinically silent infarctions. Seizures were generalized in 60% of the cases. Nearly in all the patients lesions were placed close to the cortex and mainly in carotid artery territory. CONCLUSIONS: Late onset seizures are due to a lesion in the brain in an important number of cases. Stroke is the most prevalent cause and this prevalence increases with age. A complete diagnostic procedures is warranted in this patients.

[Cerebrovascular disease in young women]. / Patología vascular cerebral en mujeres jóvenes.

INTRODUCTION: Cerebrovascular disease is an important cause of morbi-mortality. Although its incidence is maximal in older groups, its incidence in young people cannot be forgotten, even more if we consider the socioeconomic and personal consequences derived from it. There are several works on this subject but few of them analyze the specific problem of stroke in women. There is some degree of controversy in this subject, specially about the role of several factors which are more prevalent or either exclusive for women. OBJECTIVES: We wanted to analyze the risk factors and clinical characteristics in a group of women under 45 who suffered a stroke and also to compare these risk factors between women under 35 and those from 35 to 45. MATERIAL AND METHODS: We have carried out a descriptive study, including 61 women under 45 admitted to our centre consecutively between January 1989 and October 1996. RESULTS: Among the most prevalent factors we have found hypertension (27.8%), tobacco consumption (24.5%) and the presence of cardiac abnormalities (22.9%), specially associated to valvular pathology, as well as a higher incidence of contraceptives consumption in women under 35 (80%). CONCLUSIONS: These factors are similar to those found in studies on the general population of young people. Our data indicate that the relevance of the main factors for stroke is common for both sexes and is also significant in young patients.

[Neurological manifestations of Paget's disease: presentation of one case and review of the literature]. / Manifestaciones neurológicas en la enfermedad de Paget: presentación de un caso y revisión de la literatura.

INTRODUCTION: Paget's disease is a frequent metabolic disease. It is usually diagnosed as a accidental finding. Initial symptoms usually consist of generalized pain in bones. When it affects the Central Nervous System, symptoms usually appear in advanced cases and are due mainly to compression of the spinal cord. Neurological problems as the first manifestation of the disease are exceptionally found. CLINICAL CASE: We report the case of a woman affected by Paget's disease who presented as a triventricular obstructive hydrocephalus. The patient was 72 years old and consulted first to the emergency ward due to headache, gait disorders and cognitive abnormalities. COMMENTS: The most remarkable data about this patient are the indolent course of the disease which caused its debut as hydrocephalus associated to basilar impression, its favourable evolution after ventricular drainage and the almost absolute absence of previous similar cases reported in literature all over the last years.

[Stiff-man syndrome. Presentation of a new case]. / Síndrome de la persona rígida. Presentación de un nuevo caso.

INTRODUCTION: The stiff-man syndrome (SPR) is a rare neurological condition characterized by the presence of marked, involuntary rigidity of the axial muscles and limbs, together with intense painful muscle spasms which characteristically occur following external stimuli such as sudden noises, brusque movements or emotional stimuli. Symptoms are markedly improved by sleep and by diazepam. The aetiology is unknown, although it is associated with certain auto-immune disorders, particularly diabetes mellitus (DM) and others such as thyroid disease, vitiligo, pernicious anaemia, adrenal insufficiency, etc. The presence of high titres of glutamate-decarboxylase (GAD) antibodies seems to indicate an auto-immune aetiology. CLINICAL CASE: We describe a 59 year old woman who complained of an illness starting seven years previously with progressive pain and contractions of the dorso-lumbar muscles, which later spread to the cervical and abdominal muscles and to the upper limbs. From the time of onset, there were exacerbations of the condition following external stimuli. Also there was generalized vitiligo and whilst this progressed, DM developed (which finally required insulin to control it). On EMG there was continuous muscular activity and absence of muscle relaxation. The presence of high titres of anti-nuclear antibodies, gastric parietal cell antibodies and anti-GAD was very marked. There was a spectacular response to treatment with diazepam, with progressive improvement although ever increasing dosage was required. CONCLUSIONS: A new case of the 'stiff-man' syndrome is presented and aspects of aetiopathology and treatment are reviewed.

[Myopathy caused by inhibitors of hydroxymethylglutaryl-coenzyme A reductase]. / Miopatía producida por inhibidores de la hidroxi-metilglutaril-coenzima A reductasa.

INTRODUCTION: Hydroxymethylglutaryl-Coenzyme A (HMG-CoA) Reductase inhibitors are a group of drugs widely used for hypercholesterolemia. They are known to originate side-effects on muscles but with a very low incidence of myopathy. CLINICAL CASE: We present two cases of myopathy induced by HMG-CoA reductase inhibitors. They are two women, who were on 20 mg daily of lovastatin and 30 mg daily of simvastatin and consulted due to weakness, myalgia and a rise in blood levels of muscle enzymes. Both of them recovered completely a few weeks after withdrawal of the drugs. COMMENTS: Usage of this group of drugs is wide. Their side effects are rare but it is important to remember their capacity to induce a myopathy, usually reversible upon withdrawal of the drug.

[Pontine hemorrhage as a cause of peripheral facial paralysis]. / Hemorragia protuberancial como causa de parálisis facial periférica.

Bell's palsy is the most frequent type of peripheral facial nerve paralysis. Nevertheless there are other less frequent causes of peripheral facial palsy, among which, we can find lesions in the brain stem affecting the seventh cranial nerve nucleus or its fibers. These lesions of the pons which paralyze the muscles of the face are often accompanied by lesions to other structures in the vicinity of the nucleus. We present the case of peripheral facial nerve palsy caused by hemorrhage in the pons, seen both on brain CT-scan and MRI, which affected the nucleus of the seventh cranial nerve and was not accompanied by any other clinical manifestations due to lesions of structures placed in the vicinity of this nucleus.

[Meningiomas of the lateral ventricles: a case report]. / Meningiomas de los ventrículos laterales: a propósito de un caso.

We describe the case of a patient with an intraventricular meningioma, which initially manifested as transient mental impairment. Meningiomas are slowly growing, bening tumours, which usually remain asymptomatic or show only insidious clinical manifestations for long periods. In our case the distinct localization of the tumor gives rise to a peculiar clinical picture, with special reference to the episodic nature of symptoms. In this case we want to remark the role of both the clinical and neuroradiological data in the diagnosis of this pathology.

[Familial paroxysmal ataxia: a new case]. / Ataxia paroxística familiar: a propósito de un caso.

Over the last years several families affected of a clinical syndrome characterized by sudden ataxia, related to physical or mental stress, and lasting a few days have been described. Intercritical exploration is otherwise normal. We describe a new case which presents the clinical, laboratory and neuroradiological data characteristic of periodic familial ataxia. The patient is a 34 year old male who from his 23 has suffered three crisis of gait inestability, ataxia of trunk and limbs and spontaneous nystagmus in every direction, which increased in association with head movement. These episodes were always in relation with fatigue and stress and have decreased in severity. Mean duration of crisis has been 4 to 6 days. After starting treatment with acetazolamide there have no new crisis. In this case we have found no family history of the disease as it was the rule in previous description.

[Alcohol consumption among 7th grade students of EGB]. / Consumo de alcohol entre escolares de séptimo de EGB.

OBJECTIVES: To identify habits of alcohol consumption among school-children and analyse their ways of thinking about the question. DESIGN: A descriptive study of observation, using a crossover method, and carried out by means of a self-administered questionnaire. SETTING: Those EGB schools within the Molina de Segura (Murcia) Health Area which accepted the questionnaire. PARTICIPANTS: The 534 7th-year EGB students who attended class on the day of the field work. MEASUREMENTS AND RESULTS: We used the questionnaire elaborated by Torres Hernández to collect the data and that by Eysenck and Eysenck (EPI type A) to evaluate the replies' reliability. We analysed 478 of the 534 questionnaires which exceeded level 4 of the sincerity scale. We found that 83.3% had tried alcohol on some occasion, 2.5% drank it daily, 14.2% had consumed alcohol before the age of 10 and 19.5% had got drunk on some occasion. Cider and beer were the drinks preferred. We found no significant differences for gender. 91.6% thought that alcohol damaged health, 83.7% that it affected studies and 94.1% sport. 10.7% thought that it did not create dependence. CONCLUSIONS: We underline the high percentage of alcohol consumption in young people and their early starting-age, as well as the change in the patterns of traditional female behaviour in relation to alcohol consumption. We emphasise the need for Health Education among schoolchildren.

[The revision of the organization of consultation for long-term treatment]. / Revisión de la organización de la consulta de largo tratamiento.

The growing drug dependency of developed societies has meant the uncontrolled use of drugs with the consequent medical risks and important economic repercussions. Primary health care in our country is characterized by high demand bureaucratization of clinics. Because of this, we consider it useful to rely on a prescription system for long term treatment, this being understood as a mechanism which allows the obtaining of prescriptions easily both for the patient and the doctor, control and monitoring of established chronic treatments, periodical therapy evaluations, which rely on the participation of other members of the primary health care team. In this report the model of the repeat prescription system in our health area is shown, from which the prescription can be obtained in a maximum time limit of 8 hours, the medication taken for chronic illness can be easily recognized and to make note of the date of the prescription.