[Parkinsonism and Camptocormia with focal spinal myopathy: case report and responsiveness to treatment]. / Parkinsonismo y camptocormia con miopatia focal espinal: descripcion de un caso y respuesta al tratamiento.

INTRODUCTION: Camptocormia is characterised by extreme flexion of the thoracolumbar spine. It suffered an increase during walking and it is relieved in supine position. Camptocormia has been described in psychogenic disorders, but in other diseases, including Parkinson's disease as well. It has been recently described several cases with focal spinal myopathy, and we present a patient with this clinical association. CASE REPORT: This 82-year-old man had a 6-year history of parkinsonian symptoms, mostly of rigid-akinetic type. He was in stage 4 on Hoehn & Yahr scale, and he had reached 62 points on Unified Parkinson Disease Rating Scale. Over the past 6-8 months, he developed progressive forward flexion of the trunk with clinical features of camptocormia. He suffered flogotic symptoms and signs on her lower back, and there were no dystonic posture or clinical features. Lumbar computerised tomography showed fat replacement of the paravertebral L3 muscles. A surgical paravertebral muscle examination and biopsy were performed, showing diffuse fat replacement and only a marginal myopathic focus. It was made several therapeutic approaches, with levodopa dose increase, reduction, fractioning, and addition of dopa-agonists. All of these strategies failed. It was determined to try a steroid course, but there were no improvement, so physiotherapy and rehabilitation measures did. He finally was confined to wheelchair. CONCLUSIONS: Physiopathologic and therapeutic aspects of camptocormia in Parkinson's disease are unclear. Their relationship could be casual or causal. Patients with clear inflammatory myopathy could benefit from steroid therapy, but patients with end-stage myopathy probably do not so.

Parkinsonismo y camptocormia con miopatía focal espinal: descripción de un caso y respuesta al tratamiento / Parkinsonism and camptocormia with focal spinal myopathy: case report and responsiveness to treatment

Introducción. La camptocormia es un trastorno caracterizadopor una postura anormal en flexión pronunciada del tronco,que desaparece al tumbarse y empeora al caminar; es de etiologíadiversa. Desde las consideraciones iniciales como trastorno psicogénico,se reconoce ya como un trastorno postural característicode la enfermedad de Parkinson, y se han descrito algunos casos enrelación con miopatías focales lumbares. Presentamos un pacientecon esta asociación clínica. Caso clínico. Varón de 82 años conparkinsonismo rígido-acinético de seis años de evolución, en estadio4 de la escala de Hoehn y Yahr, y 62 puntos en la Unified ParkinsonDisease Rating Scale. En 6-8 meses, desarrolló progresivamenteuna camptocormia dolorosa, sin datos de distonía asociados,y con signos flogóticos dorsolumbares. La tomografía axialcomputarizada lumbar mostró atrofia de los músculos espinales ysustitución grasa. La biopsia de músculos paraespinales mostródegeneración grasa y algún foco miopático marginal. Tras modificacionesinfructuosas de su medicación dopaminérgica (incremento,disminución, fraccionamiento, agonistas dopaminérgicos), serealizó ciclo de tratamiento esteroideo por vía oral, sin observarsemejoría alguna. Tampoco mejoró con rehabilitación o fisioterapia,y quedó confinado a una silla de ruedas. Conclusiones. Los aspectosfisiopatológicos y terapéuticos en la camptocormia con miopatíafocal asociada a la enfermedad de Parkinson son poco claros, ypueden relacionarse de modo causal o casual. Los pacientes conclara miopatía inflamatoria podrían beneficiarse de terapia esteroideaprecozmente, pero no aquellos con estadios finales de miopatíafocal espinal

Introduction. Camptocormia is characterised by extreme flexion of the thoracolumbar spine. It suffered an increaseduring walking and it is relieved in supine position. Camptocormia has been described in psychogenic disorders, but in otherdiseases, including Parkinson’s disease as well. It has been recently described several cases with focal spinal myopathy, andwe present a patient with this clinical association. Case report. This 82-year-old man had a 6-year history of parkinsoniansymptoms, mostly of rigid-akinetic type. He was in stage 4 on Hoehn & Yahr scale, and he had reached 62 points on UnifiedParkinson Disease Rating Scale. Over the past 6-8 months, he developed progressive forward flexion of the trunk with clinicalfeatures of camptocormia. He suffered flogotic symptoms and signs on her lower back, and there were no dystonic posture orclinical features. Lumbar computerised tomography showed fat replacement of the paravertebral L3 muscles. A surgicalparavertebral muscle examination and biopsy were performed, showing diffuse fat replacement and only a marginalmyopathic focus. It was made several therapeutic approaches, with levodopa dose increase, reduction, fractioning, and additionof dopa-agonists. All of these strategies failed. It was determined to try a steroid course, but there were no improvement, sophysiotherapy and rehabilitation measures did. He finally was confined to wheelchair. Conclusions. Physiopathologic andtherapeutic aspects of camptocormia in Parkinson’s disease are unclear. Their relationship could be casual or causal. Patientswith clear inflammatory myopathy could benefit from steroid therapy, but patients with end-stage myopathy probably do not so

[Gradenigo syndrome as the form of presentation of nasopharyngeal carcinoma]. / Síndrome de Gradenigo como forma de presentación de carcinoma nasofaríngeo.

INTRODUCTION: Nasopharyngeal carcinoma is a condition which usually has an insidious onset and non-specific features in the initial stages, so it is difficult to make an early diagnosis. The most usual presenting features are otological (serous otitis media) and involvement of adjacent cranial nerves. We report a case of Gradeningo's syndrome due to the tumour spreading towards the base of the skull. We review the literature on the aetiology of this syndrome. CLINICAL CASE: A 53 year old patient required neurological assessment for a clinical condition which was compatible with Gradenigo's syndrome that involved both right V and VI cranial nerves. This study permitted diagnosis of a nasopharyngeal carcinoma which had been undetected because of its non-specific features, until this complication occurred. Otorhinolaryngological assessment proved the presence of a neoplasm in the cavum. Biopsy of the lesion showed it to be a well-differentiated squamous cell carcinoma. Cranial magnetic resonance imaging showed extension of the tumour to the base of the skull, adjacent to the right sinus cavernosus. The cerebrospinal fluid was normal. Treatment by radiotherapy was indicated. CONCLUSIONS: Diagnosis of nasopharyngeal carcinoma requires a high index of suspicion in view of its initial, sparse, non-specific symptoms. Although ideally the disease should be detected in its early stages, we believe that it is useful to recommend that in cases of Gradenigo's syndrome a full systematic otorhinolaryngological exploration be made so as to effectively rule out this disorder.