[Neuroschistosomiasis: a challenging diagnosis]. / Neuroesquistosomiasis: un reto para el diagnóstico.

INTRODUCTION: Neuroschistosomiasis is an uncommon and under diagnosed disease in our country because of the no clinical suspicion. The most common neurological manifestations are epileptic seizures as central nervous system involvement or different types of myelopathies: transverse myelitis, myeloradiculopathy, cauda equina syndrome or Brown-Sequard syndrome. CASE REPORT: A 27 years-old male from an endemic area, with atypical neurological affectation as he presented myelopathy and multifocal neuritis. Diagnosis was based on the epidemiological exposure datums, the myelopathy, the positive serological studies for Schistosoma haematobium, no detection of other parasitic infections and the clinical and radiological improvement after treatment. Cervical and thoracic magnetic resonance showed areas of hyper signal in T2 as it was described in other cases. It was detected S. haematobium in the bladder, the rest of serological and microbiological studies were negative. Besides, eosinophils on the biopsy of sural nerve orientative to parasitic etiology. CONCLUSION: In patient with myelopathy or another unexplained neurological manifestation we have to suspect neuroschistosomiasis. In a world where migrations and travels are so frequent we have to think in this type of diseases.

Neuroesquistosomiasis: un reto para el diagnóstico / Neurochistosomiasis: a challenging diagnosis

Introducción. La neuroesquistosomiasis es una entidad poco frecuente e infradiagnosticada en nuestro medio por la falta de sospecha clínica. Las formas más habituales de presentación son afectación cerebral o distintas variantes de mielopatías: mielitis transversa, mielorradiculopatía, síndrome de cola de caballo, síndrome de Brown-Séquard. Caso clínico. Varón de 27 años oriundo de zona endémica, con afectación neurológica atípica, pues presenta sintomatología medular y neuropatía multifocal. Los datos epidemiológicos de exposición, la clínica de mielopatía, la serología positiva para Schistosoma haematobium, el descarte de otras posibles parasitosis y la mejoría tanto clínica como radiológica tras el tratamiento nos han permitido llegar al diagnóstico. Las imágenes cervicales y dorsales observadas en la resonancia magnética son similares a las descritas en otras ocasiones. En la investigación etiológica se detecta S. haematobium vesical, siendo el resto de serologías y análisis microbiológicos negativos. Además la presencia de eosinófilos en la biopsia del nervio sural orienta hacia el origen parasitario de dicha afectación. Conclusión. Ante un paciente con mielopatía u otra afectación neurológica no explicada debemos sospechar neuroesquistomiasis. En un mundo donde las migraciones y los viajes son tan frecuentes, cada día debemos pensar más en este tipo de enfermedades de origen tropical

Introduction. Neuroschistosomiasis is an uncommon and under diagnosed disease in our country because of the no clinical suspicion. The most common neurological manifestations are epileptic seizures as central nervous system involvement or different types of myelopathies: transverse myelitis, myeloradiculopathy, cauda equina syndrome or Brown-Séquard syndrome. Case report. A 27 years-old male from an endemic area, with atypical neurological affectation as he presented myelopathy and multifocal neuritis. Diagnosis was based on the epidemiological exposure datums, the myelopathy, the positive serological studies for Schistosoma haematobium, no detection of other parasitic infections and the clinical and radiological improvement after treatment. Cervical and thoracic magnetic resonance showed areas of hyper signal in T2 as it was described in other cases. It was detected S. haematobium in the bladder, the rest of serological and microbiological studies were negative. Besides, eosinophils on the biopsy of sural nerve orientative to parasitic etiology. Conclusion. In patient with myelopathy or another unexplained neurological manifestation we have to suspect neuroschistosomiasis. In a world where migrations and travels are so frequents we have to think in this type of diseases

Mitochondrial haplogroups in Basque multiple sclerosis patients.

Previous studies have suggested that mitochondrial metabolism and/or mitochondrial DNA (mtDNA) could be, in conjunction with other genetic or environmental factors, a risk factor for the development of multiple sclerosis (MS). One of these studies establishes that mitochondrial haplogroup JT is a risk factor for developing the disease, in particular the visual manifestations [optic neuritis (ON)]. Nevertheless, as distribution of these haplogroups varies between populations, the observed association may be due to a slanted sample with no physiopathological value. This hypothesis was checked with MS patients, originals from Basque country (this population has peculiar genetic characteristics) and from other Spanish regions. We concluded that such an association does not exist. By contrast, a decrease could be seen in the frequency of the JT haplogroup in the ON group and in the MS-Basque group. That trend could be a protective effect, which needs to be verified in further investigations.

Endocarditis por Actinobacillus actinomycetemcomitans / Endocarditis causes by actinobacillus actinomycetemcomitans

Las endocarditis del grupo HACEK son poco prevalentes en la población general. Suelen originar endocarditis subagudas con aparición de vegetaciones grandes, embolismos periféricos, desarrollo de insuficiencia cardiaca, necesitando con frecuencia el recambio valvular. Describimos un caso de endocarditis por Actinobacillus actinomycetemcomitans (AA), sin las características típicas de este grupo de endocarditis y que evolucionó favorablemente con tratamiento médico (AU)

[Endocarditis caused by Actinobacillus actinomycetemcomitans]. / Endocarditis por Actinobacillus actinomycetemcomitans.

The HACEK group endocarditis are infrequent in general population. They usually develop subacute endocarditis with large vegetations, peripheral emboli, heart failure, requiring frequent valvular replacement. We report a clinical case of endocarditis caused by Actinobacillus actinomycetemcomitans (AA), without the typical findings of the HACEK group endocarditis and with a successful evolution with medical treatment.

Tolosa-Hunt syndrome: focus on MRI diagnosis.

Experience with modern neuroimaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI) scans, in the diagnosis of Tolosa-Hunt syndrome (THS) is reviewed. Conventional CT scan remains normal in about two-thirds of these patients. In the reported 22 patients meeting the IHS criteria for a THS diagnosis on whom an MRI study was performed, MRI revealed a convex enlargement of the symptomatic cavernous sinus by an abnormal tissue isointense with gray matter on short TR/TE images and isohypointense on long TR/TE images. This abnormal tissue markedly increases in signal intensity after contrast injection. MRI seems also to be the ideal technique to follow progressive resolution of the abnormal tissue after steroids. Therefore, normal MRI would probably exclude THS, whereas in the appropriate clinical setting of steroid-responsive painful ophthalmoplegia, MRI showing the cavernous sinus abnormality described here suggests a diagnosis of THS. From these data, we propose that the fourth IHS criterion for THS diagnosis, "Exclusion of other causative lesions by neuroimaging and (not compulsory) carotid angiogram" should be changed to "Finding by MRI of specific cavernous sinus abnormalities (with the characteristics described herein) which slowly resolve with steroid treatment".

Isolated unilateral hypoglossal nerve palsy: nine cases.

We report nine patients with hypoglossal nerve palsy as the sole neurological manifestation, without simultaneous involvement of other cranial nerves or long-tract signs. In four patients, no cause was found and the outcome was excellent. The next common cause proved to be metastatic disease at the base of the skull in three patients. Two exceptional causes were Chiari malformation in one case and dural arteriovenous fistula of the transverse sinus in another. Although the aetiological importance and ominous prognosis of neoplasia has been emphasized by others, our study suggests that an isolated hypoglossal nerve palsy may be benign and idiopathic.