Hallazgos radiológicos de una pseudooclusión carotídea sintomática: signo del Guadiana / Radiological findings of a symptomatic carotid pseudocclusion:

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Sobre el origen del asta de Amón / On the origin of Ammon’s horn

Introducción: El culto a los dioses y su recreación artística en Grecia y Roma se remontan al Antiguo Egipto, según podemos comprobar al estudiar las monedas antiguas. Grandes efemérides como el asesinato de César o leyendas como la llegada de Asclepio transformado en serpiente para liberar a Roma de una plaga, alternan en la numismática grecorromana con invocaciones a deidades mayores como Apolo el médico (en épocas de grandes epidemias) o el egipcio Amón. Desarrollo: Caracterizado con las astas de un carnero, Amón fue asimilado como epíteto de Zeus en Grecia y de Júpiter en Roma, tal como reflejan los antiguos tetradracmas de Alejandro Magno y las medallas consulares de Claudio. Resulta emocionante sostener un denario de Marco Aurelio con La Salud personificada y pensar que acaso fue entregado a Galeno como pago por sus servicios. No obstante, apenas existen tributos numismáticos a personas alejadas del poder como el gran médico de Pérgamo. Los anatomistas ilustrados franceses (Garengeot en 1742 y Flurant en 1752), heredando la costumbre de la escuela renacentista de Padua de recuperar mitos y dioses de la Antigüedad Clásica, denominaron a la retorcida corteza temporal medial asta de Amón. Entre los estudiosos de esta primitiva estructura cerebral destacan Lorente de Nó y su maestro Cajal, cuya divinizada efigie domina en los billetes de 50 pesetas emitidos en 1935. Conclusiones: La numismática grecorromana, en tanto que asequible fuente arqueológica y artística de primer orden, nos informa acerca del origen de los mitos de la Antigüedad, los cuales continúan inspirando a las artes y las ciencias

Introduction: Greek and Roman worship of their gods and myths go back to Ancient Egyptian times. Images engraved in Greco-Roman coinage range from references to the assassination of Caesar and legendary stories like the arrival of a snake shaped demi-god Aesculapius to save the Romans from the plague, to invocations of major deities including Apollo the physician or Ammon the protector. Development: Depicted with the horns of a ram, Ammon was adopted by the Greeks as an epithet of Zeus and later incorporated by the Romans as Jupiter. References to the cult ofAmmon appear on tetradrachms minted for Alexander The Great and on provincial Roman coins struck under Claudius. It is thrilling to hold a coin depicting Marcus Aurelius with Salus on the reverse and think that it could have been handed to Galen in payment for his services. However, it is rare to find figures other than rulers on coins and the physician of Pergamum is no exception. Inspired by the Renaissance school of Padua, French anatomists in the Enlightenment (Garengeot in 1742 and Flurant in 1752) continued reviving ancient myths and named the curveshaped- inner portion of the temporal lobe Ammon’s horn. Outstanding scholars who studied this primitive structure of the brain included Lorente de Nó and his mentor Cajal, whose portrait appeared on fifty-pesetas notes issued in 1935. Conclusions: As primary sources of great archaeological and artistic value, Greco-Roman coins provide information about the origins of the myths and gods of classical antiquity and continue to inspire the arts and sciences to this day

La epilepsia en la gestación artística de Dostoievski / Epilepsy in the process of artistic creation of Dostoevsky

Introducción: Durante toda su carrera literaria, Fiódor M. Dostoievski (Moscú,1821-San Petersburgo, 1881) padeció epilepsia. En el presente artículo abordamos la enfermedad del escritor partiendo de su obra literaria, su correspondencia y los testimonios de sus contemporáneos, complementada con una revisión de la literatura médica relacionada. Desarrollo: Desde Murin y Ordínov (La patrona, 1847) hasta Smerdiákov (Los hermanos Karamazov, 1879-1880), Dostoievski atribuyó epilepsia a seis personajes a lo largo de su obra. La idea (vertebradora en su literatura) de que un instante de felicidad puede valer por una vida nace probablemente del aura epiléptica con que se iniciaban los ataques. Además de utilizar la enfermedad inteligentemente en sus novelas, la epilepsia le valió también para librarse de una condena vitalicia a servir en el ejército siberiano. En 1863 viajó a Europa Central con intención de consultar a los neurólogos Romberg y Trousseau. En el primer análisis retrospectivo acerca de la epilepsia en su literatura, Stephenson e Isotoff apuntaron la probable influencia de la Psique de Carus (1848) en la construcción de sus personajes, mientras que su epilepsia ha inspirado a sucesivas generaciones de epileptólogos. Conclusiones: La de Dostoievski es la historia natural de una epilepsia que en terminología científica contemporánea se clasificaría como criptogénica focal de probable origen temporal. Por encima de todo, el caso de Dostoievski muestra el buen uso de un trastorno neurológico ordinario por un genio literario extraordinario, que supo transformar la adversidad en oportunidad

Introduction: Fyodor M. Dostoevsky (Moscow, 1821-Saint Petersburg, 1881) suffered epilepsy throughout his full literary career. The aim here is to understand his condition in light of his novels, correspondence and his contemporaries' accounts as well as by later generations of neurologists. Development: From Murin and Ordynov (The landlady, 1847) to Smerdyakov (The brothers Karamazov, 1879-1880), Dostoevsky portrayed up to six characters with epilepsy in his literature. Apart from making an intelligent use of the disease by incorporating it into his novels, his seminal idea -that a moment of happiness is worth a lifetime- was probably inspired by his epileptic aura. Through epilepsy, Dostoevsky also found a way to freedom from perpetual military servitude. The first symptoms of the epilepsy presented in early adulthood (late 1830s to early 1840s), but he was only diagnosed a decade later. In 1863 he went abroad seeking expert advice from Romberg and Trousseau. In the first retrospective study of Dostoevsky's literary epilepsy, Stephenson and Isotoff noticed the influence of Carus’ Psyche (1848) in the preparation of his characters, whilst his epilepsy has inspired later generations of epileptologists. Conclusions: Dostoevsky offers an insight into the natural history of an epilepsy, which in contemporary scientific terms would be classified as cryptogenic localization-related of probable temporal lobe origin. Above all, Dostoevsky's case illustrates the good use of a common neurological disorder by a remarkable writer who transformed suffering into art and a disadvantage into an advantage

Neurology and literature 2

Introduction: Good literary fiction has the potential to move us, extend our sense of life, transform our prospective views and help us in the face of adversity. A neurological disorder is likely to be the most challenging experience a human being may have to confront in a lifetime. As such, literary recreations of illnesses have a doubly powerful effect. Objectives: Study the synergies between neurology and fictional literature with particular reference to narrative based medicine (NBM). Development: Doctors establish boundaries between the normal and the abnormal. Taking a clinical history is an act of interpretation in which the doctor integrates the science of objective signs and measurable quantities with the art of subjective clinical judgment. The more discrepancy there is between the patient’s experience with the illness and the doctor’s interpretation of that disease, the less likely the doctor-patient interaction is to succeed. NBM contributes to a better discernment of the meanings, thus considering disease as a biographical event rather than just a natural fact. Drawing from their own experience with disease, writers of fiction provide universal insights through their narratives, whilst neuroscientists, like Cajal, have occasionally devoted their scientific knowledge to literary narratives. Furthermore, neurologists from Alzheimer to Oliver Sacks remind us of the essential value of NBM in the clinic. Conclusions: Integrating NBM (the narrative of patients) and the classic holistic approach to patients with our current paradigm of evidence based medicine represents a challenge as relevant to neurologists as keeping up with technological and scientific advances

Introducción: La buena literatura de ficción tiene la capacidad de conmovernos, expandir nuestros sentidos, cambiar nuestras perspectivas futuras y ayudarnos a afrontar mejor la adversidad. Por otra parte, una enfermedad neurológica es uno de los mayores desafíos a los que puede enfrentarse una persona, lo cual dobla en valor las recreaciones literarias de trastornos neurológicos. Objetivos: Estudiar las sinergias entre neurología y literatura de ficción en relación con una medicina basada en la narrativa (MBN). Desarrollo: El médico establece las fronteras entre lo normal y lo anormal. La historia clínica es un acto de interpretación que consiste en integrar la ciencia de los signos objetivos con el arte de reconocer y valorar los síntomas subjetivos. Cuanta mayor discrepancia exista entre la vivencia de la enfermedad por parte del paciente y la interpretación de aquella por parte del médico, menor probabilidad tendrá de prosperar la relación médico-enfermo. En este sentido, la MBN sirve contribuye a discernir los significados que encierra el hecho de enfermar, considerando la enfermedad como un suceso biográfico más allá de un hecho natural. Escritores de ficción han dotado de sentido universal a las enfermedades; asimismo, neurocientíficos como Cajal han aplicado ocasionalmente sus descubrimientos en ficciones literarias, mientras gran- des neurólogos desde Alzheimer hasta Oliver Sacks nos recuerdan la importancia de la MBN en la consulta Conclusiones: Integrar una MBN (la narrativa del paciente) con el paradigma actual de la medicina basada en la evidencia plantea un reto a la neurología tan relevante como los avances científicos y tecnológico

On the origin of Ammon's horn.

INTRODUCTION: Greek and Roman worship of their gods and myths go back to Ancient Egyptian times. Images engraved in Greco-Roman coinage range from references to the assassination of Caesar and legendary stories like the arrival of a snake shaped demi-god Aesculapius to save the Romans from the plague, to invocations of major deities including Apollo the physician or Ammon the protector. DEVELOPMENT: Depicted with the horns of a ram, Ammon was adopted by the Greeks as an epithet of Zeus and later incorporated by the Romans as Jupiter. References to the cult of Ammon appear on tetradrachms minted for Alexander The Great and on provincial Roman coins struck under Claudius. It is thrilling to hold a coin depicting Marcus Aurelius with Salus on the reverse and think that it could have been handed to Galen in payment for his services. However, it is rare to find figures other than rulers on coins and the physician of Pergamum is no exception. Inspired by the Renaissance school of Padua, French anatomists in the Enlightenment (Garengeot in 1742 and Flurant in 1752) continued reviving ancient myths and named the curve-shaped-inner portion of the temporal lobe Ammon's horn. Outstanding scholars who studied this primitive structure of the brain included Lorente de Nó and his mentor Cajal, whose portrait appeared on fifty-pesetas notes issued in 1935. CONCLUSIONS: As primary sources of great archaeological and artistic value, Greco-Roman coins provide information about the origins of the myths and gods of classical antiquity and continue to inspire the arts and sciences to this day.

Epilepsy in the process of artistic creation of Dostoevsky.

INTRODUCTION: Fyodor M. Dostoevsky (Moscow, 1821-Saint Petersburg, 1881) suffered epilepsy throughout his full literary career. The aim here is to understand his condition in light of his novels, correspondence and his contemporaries' accounts as well as by later generations of neurologists. DEVELOPMENT: From Murin and Ordynov (The landlady, 1847) to Smerdyakov (The brothers Karamazov, 1879-1880), Dostoevsky portrayed up to six characters with epilepsy in his literature. Apart from making an intelligent use of the disease by incorporating it into his novels, his seminal idea -that a moment of happiness is worth a lifetime- was probably inspired by his epileptic aura. Through epilepsy, Dostoevsky also found a way to freedom from perpetual military servitude. The first symptoms of the epilepsy presented in early adulthood (late 1830s to early 1840s), but he was only diagnosed a decade later. In 1863 he went abroad seeking expert advice from Romberg and Trousseau. In the first retrospective study of Dostoevsky's literary epilepsy, Stephenson and Isotoff noticed the influence of Carus' Psyche (1848) in the preparation of his characters, whilst his epilepsy has inspired later generations of epileptologists. CONCLUSIONS: Dostoevsky offers an insight into the natural history of an epilepsy, which in contemporary scientific terms would be classified as cryptogenic localization-related of probable temporal lobe origin. Above all, Dostoevsky's case illustrates the good use of a common neurological disorder by a remarkable writer who transformed suffering into art and a disadvantage into an advantage.

Neurology and literature 2.

INTRODUCTION: Good literary fiction has the potential to move us, extend our sense of life, transform our prospective views and help us in the face of adversity. A neurological disorder is likely to be the most challenging experience a human being may have to confront in a lifetime. As such, literary recreations of illnesses have a doubly powerful effect. OBJECTIVES: Study the synergies between neurology and fictional literature with particular reference to narrative based medicine (NBM). DEVELOPMENT: Doctors establish boundaries between the normal and the abnormal. Taking a clinical history is an act of interpretation in which the doctor integrates the science of objective signs and measurable quantities with the art of subjective clinical judgment. The more discrepancy there is between the patient's experience with the illness and the doctor's interpretation of that disease, the less likely the doctor-patient interaction is to succeed. NBM contributes to a better discernment of the meanings, thus considering disease as a biographical event rather than just a natural fact. Drawing from their own experience with disease, writers of fiction provide universal insights through their narratives, whilst neuroscientists, like Cajal, have occasionally devoted their scientific knowledge to literary narratives. Furthermore, neurologists from Alzheimer to Oliver Sacks remind us of the essential value of NBM in the clinic. CONCLUSIONS: Integrating NBM (the narrative of patients) and the classic holistic approach to patients with our current paradigm of evidence based medicine represents a challenge as relevant to neurologists as keeping up with technological and scientific advances.

El síndrome de don Quijote / Don Quixote syndrome

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[Neurology and literature]. / Neurología y literatura.

INTRODUCTION: Literature complements medical literature in the academic and clinical development of neurologists. The present article explores the contributions of writers of fiction on neurology. SOURCES: Literary works of fiction with particular reference to neurology. DEVELOPMENT: A symbiosis between writers of fiction and doctors has been well recognised. From Shakespeare to Cervantes by way of Dickens and Cela to writer - physicians such as Anton Chekhov or António Lobo Antunes have contributed through their medically informed literature to the better understanding of neurology. Some writers like Dostoevsky, Machado de Assis and Margiad Evans have written about their own experiences with disease thus bringing new insights to medicine. Furthermore, some neurological disorders have been largely based on literary descriptions. For instance, Dostoevsky's epilepsy has been retrospectively analysed by famous neurologists including Freud, Alajouanine or Gastaut, whilst his writings and biography have prompted others like Waxman and Geschwind to describe typical behavioural changes in temporal lobe epilepsy, finding their source of inspiration in Dostoevsky. Likewise, Cirignotta et al have named an unusual type of seizure after the Russian novelist. Inspired by Lewis Carroll, Todd introduced the term Alice in Wonderland Syndrome to refer to visual distortions generally associated with migraine. CONCLUSIONS: Writers of fiction offer a humanised perception of disease by contributing new insights into the clinical history, informing about the subjective experience of the illness and helping to eradicate the stigma associated to neurological disorders.

Neurología y literatura / Neurology and literature

Introducción: La literatura de ficción complementa a la literatura médica en la formación continuada del neurólogo. En el presente artículo se analiza la influencia de los escritores de ficción sobre la neurología. Fuentes: Obras literarias de ficción relacionadas con la neurología. Desarrollo: Escritores de ficción y médicos han mantenido una relación de simbiosis a lo largo del tiempo. Grandes literatos desde Shakespeare a Cervantes hasta Dickens o Cela y escritores-médicos como Anton Chéjov o António Lobo Antunes, han contribuido con su literatura al conocimiento de las enfermedades neurológicas. Otros como Dostoyevski, Machado de Assis o Margiad Evans han sabido utilizar su enfermedad inteligentemente enriqueciendo su obra literaria y transformando así la adversidad en oportunidad. Grandes neurólogos como Freud, Alajouanine o Gastaut se han inspirado en la epilepsia de Dostoyevski para desarrollar sus ideas. Waxman y Geschwind, por su parte, describieron cambios en el comportamiento característicos de la epilepsia del lóbulo temporal basándose en la enfermedad Dostoyevski, mientras Cirignotta y colaboradores utilizaron el epónimo del novelista ruso para definir un tipo infrecuente de epilepsia del lóbulo temporal. Asimismo Todd se inspiró en Lewis Carroll para denominar las metamorfopsias generalmente asociadas a la migraña Síndrome de Alicia en el País de las Maravillas.Conclusiones: La literatura de ficción ofrece una perspectiva humanizada del relato patográfico, aportando la vivencia de la enfermedad, informando sobre aspectos no atendidos por la ciencia y contribuyendo a erradicar el estigma social asociado al paciente neurológico (AU)

Introduction: Literature complements medical literature in the academic and clinical development of neurologists. The present article explores the contributions of writers of fiction on neurology. Sources: Literary works of fiction with particular reference to neurology. Development: A symbiosis between writers of fiction and doctors has been well recognised. From Shakespeare to Cervantes by way of Dickens and Cela to writer – physicians such as Anton Chekhov or António Lobo Antunes have contributed through their medically informed literature to the better understanding of neurology. Some writers like Dostoevsky, Machado de Assis and Margiad Evans have written about their own experiences with disease thus bringing new insights to medicine. Furthermore, some neurological disorders have been largely based on literary descriptions. For instance, Dostoevsky's epilepsy has been retrospectively analysed by famous neurologists including Freud, Alajouanine or Gastaut, whilst his writings and biography have prompted others like Waxman and Geschwind to describe typical behavioural changes in temporal lobe epilepsy, finding their source of inspiration in Dostoevsky. Likewise, Cirignotta et al have named an unusual type of seizure after the Russian novelist. Inspired by Lewis Carroll, Todd introduced the term Alice in Wonderland Syndrome to refer to visual distortions generally associated with migraine.Conclusions:_ Writers of fiction offer a humanised perception of disease by contributing new insights into the clinical history, informing about the subjective experience of the illness and helping to eradicate the stigma associated to neurological disorders (AU)

Congenital gingival hyperplasia in a neonate with foetal valproate syndrome.

There are several causes of gingival hyperplasia and one of the most well-known is drug-induced gingival enlargement. Nevertheless, causes of congenital gingival enlargement include only hereditary and metabolic disorders. Only one case of drug-induced congenital gingival hyperplasia has been reported. We present the second neonate with gingival hyperplasia in the context of foetal valproate syndrome and review the literature.

Neuroferritinopathy: missense mutation in FTL causing early-onset bilateral pallidal involvement.

The authors identified a missense mutation in the FTL gene (474G>A; A96T) in a 19-year-old man with parkinsonism, ataxia, corticospinal signs, mild nonprogressive cognitive deficit, and episodic psychosis. This mutation was also present in his asymptomatic mother and younger brother, who had abnormally low levels of ferritin in the serum. The patient and his mother displayed bilateral involvement of the pallidum.

[The problem of accurate diagnosis of Parkinson disease]. / El problema del diagnóstico preciso de la enfermedad de Parkinson.

A definite diagnosis of Parkinson's disease cannot be made solely on clinical grounds. None of the cardinal signs (tremor, rigidity, or bradykinesia) is entirely specific, including asymmetric presentation. A favourable response to levodopa may be found in different degenerative parkinsonisms or there may be drug-induced dyskinesias and fluctuations. "Probable" or "possible" as diagnostic categories depend on the presence or one or more cardinal signs, absence of potential etiologic factors (exposure to antidopaminergic drugs, among others), and atypical clinical manifestations early in disease course as dementia, falls and instability, erectile and micturition disturbances and unilateral neglect. Preclinical detection (positron emission tomography and molecular genetics in some familial forms) is a desirable goal with a view to neuroprotection. We emphasise some prodromal and early complaints as well as clinical skills to detect cardinal signs during early.