[Overview of head injury]. / Revisión del traumatismo craneoencefálico.

A systematic revision of the main practical aspects related with the head injury management has been made in this article on the basis of relevant literature. The paper has been developed in different sections consisting of epidemiological factors, prognosis and classification, neuropathology and pathophysiology, clinical evaluation and treatment. According to clinical guidelines, the connections between the pathophysiological features with higher evidence degree and the schemes of therapeutic approaches have been emphasized.

Pauta de actuación médico-quirúrgica en la meralgia parestésica / Medico-surgical approach to meralgia paresthetica

La meralgia parestésica es una entidad nosológica caracterizada por la presencia de parestesias, hipoestesia y disestesias en la región ántero-lateral del muslo. Su origen es la compresión del nervio fémorocutáneo lateral, bien en su trayecto intrapelviano, a su paso a través del ligamento inguinal, o bien por causas extrínsecas. Aunque la sintomatología puede considerarse banal y la causa en muchas ocasiones idiopática, es preciso protocolizar su diagnóstico y terapéutica, no sólo para descartar afecciones más graves sino para lograr un tratamiento eficaz. Presentamos una serie de 25 casos de meralgia parestésica y exponemos el protocolo diagnóstico y terapéutico. El diagnóstico se basa en la exploración clínica, la ecografía abdómino-pélvica y el estudio electrofisiológico. Este último consta de electromiografía, electroneurografía y potenciales evocados somatosensoriales. Se exponen los límites de normalidad de estas pruebas. El tratamiento comienza con la instauración de medidas higiénico-dietéticas (evitar prendas compresivas, reeducación postural, pérdida de peso), lo que logró la desaparición de los síntomas en el 40% de los casos. Si estas medidas no son eficaces se instaura tratamiento farmacológico, primero con anticomiciales y posteriormente con ansiolíticos o antidepresivos, lo que logró la curación del 52% de los pacientes. El 8% restante fue sometido a descompresión quirúrgica del nervio fémorocutáneo lateral al nivel del ligamento inguinal, que resolvió el cuadro de alteración de la sensibilidad. Concluímos que, la meralgia parestésica debe ser diagnosticada por neurofisiología y tratada secuencialmente mediante medidas higiénico-dietéticas, farmacológicas y neurolisis quirúrgica (AU)

The meralgia paresthetica is an entity characterized by the presence of parestesias, hipoestesia and disestesias in the ántero-lateral region of the thigh. It is caused by the compression of the lateral femorocutaneous nerve, well in its intrapelvic course, its passing through the inguinal ligament, or for extrinsic causes. Although the sintomatology can be considered banal and the ethiology in many occasions idiopatic, is necessary to protocolize its diagnosis and therapeutic, not only to discard more serious affections but to achieve an effective treatment. A series of 25 cases of meralgia paresthetica is presented and the diagnostic and therapeutic protocol is exposed. The diagnosis is based on the clinical exploration, abdomino-pelvic ecography and electrophisiologic study. This last one consists of electromiography, electroneurography and somatosensorial evoked potentials. The limits of normality of these tests are exposed. The treatment begins with the setting-up of hygienic-dietary measures (evitación of compresive garments, postural reeducation, loss of weight), with what the disappearance of the symptoms was achieved in 40% of the cases. If these measures are not effective pharmacological treatment is established, first with anticonvulsivants and later on with ansiolytic or antidepressants, with what the cure of 52% of the patients was achieved. The remaining 8% was subjected to surgical decompression of the nerve at the level of the inguinal ligament, with what were solved the sensibility disturbances. It is concluded that the meralgia paresthetica should be diagnosed by neurophysiologic study and treated sequentially by means of hygienicdietary, pharmacological measures and surgical neurolisis (AU)

[Radiation-induced intracerebral sarcoma]. / Sarcoma intracerebral radioinducido.

We report a case of radiation-induced sarcoma in a 50 year-old male patient who was treated with total resection and radiation for right temporal lobe PNET. He received a dose of 60-Gy. A sequential magnetic resonance image 32 months after the completion of radiation therapy and 34 months after surgery showed a mass in the right temporal cerebral convexity. The postoperative diagnosis was sarcoma. Two years later the patient was operated because of a new lesion with similar characteristics. The follow up from the PNET diagnosis is 5 years and 10 months and the survival from sarcoma diagnosis is now 3 years and there is no evidence of recurrence. The development of sarcoma subsequent to cranial irradiation is an infrequent event but it should be considered in the differential diagnosis of a lesion that progresses several years after radiation therapy or when a new lesion appear.

[Epidural lumbar hematoma, epidural anesthesia and low-molecular-weight heparins]. / Hematoma epidural lumbar, anestesia epidural y heparinas de bajo peso molecular.

Epidural hematoma is an uncommon but serious complication of epidural anaesthesia. The use of low molecular weight heparin (LMWH) as thromboprophylaxis has increased the occurrence of this pathology. We report the case of a 81-year-old man who underwent an arthroscopy of the knee, with epidural anaesthesia and administration of LMWH. The patient suffered an important pain due to a lumbar epidural haematoma which was diagnosed by magnetic resonance, after withdrawal of the epidural catheter. He improved after surgical evacuation, and no neurological deficit was present. We comment the association of LMWH, epidural anaesthesia and epidural haematoma.

Parosteal osteosarcoma of the skull.

Parosteal osteosarcoma of the skull is a distinct surface bone tumor, with a better prognosis than conventional osteosarcoma. The most common location is on the surface of the distal femur which accounts for 46-66% of the cases. The presentation in the skull is uncommon and there are few cases reported in the literature. We describe the case of a man who developed a parosteal osteosarcoma arising from the occipital bone with extension to the parietal bone. The patient was operated and had a complete tumor resection.

[Ischemic infarct, mitral valve prolapse and protein S deficiency]. / Infarto isquémico, prolapso de válvula mitral y déficit de proteína S.

Ischaemic stroke in young people, that is in those under 45 years of age, forms a distinct entity. Whereas in the case of older patients the main cause is arteriosclerosis, in the younger group a broad spectrum of etiologies can be found. It is for this reason that in these latter cases we must carry out a diagnostic study that is not only more exhaustive but also additionally is aimed at seeking out specific pathologies as for instance a possible association with vasculitis, infectious diseases, hematological abnormalities or unclear cardiopathology. Given the therapeutic transcendency that findings might have, in order to avoid new bouts in patients at the most productive moments in their lives, we believe it to be of great interest to carefully study these patients as exhaustively as need be. In the present work we present the case of a young patient with ischaemic infarct in the region of both upper cerebella which started out with a clinical picture of ataxia and dysarthria with benign course and total recovery. Possible etiologies are discussed in the light of findings made during complementary tests, as well as the unusual location of the lesions.

[Wilson disease: a new case treated with trientine]. / Enfermedad de Wilson: a propósito de un caso tratado con trientine.

Hepatolenticular degeneration, also known as Wilson's disease (WD), is an infrequent hereditary disorder which is transmitted in recessive autosomic fashion: its genetic defect is to be found in the long branch of chromosome 13 (13q14.3) and allows disorder to take place which has not been sufficiently clarified, in the bilious excretion of the copper (Cu) which is deposited in an anomalous manner on a level with different organic tissues, giving rise to characteristic clinical manifestations which are, basically, of a neurological, hepatic, psychiatric and ocular nature. We present the case of a young patient whose case began, four years ago, with depressive-type manifestations, with diagnosis only being made now. Our opinion on the early detection of asymptomatic patients is commented on, along with that concerning the effectiveness and safety of therapeutic alternatives to D-penicilamine.