Biochemical biomarkers for multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is the most frequent demyelinating disease of the central nervous system. Although there is currently no definite cure for MS, new therapies have recently been developed based on a continuous search for new biomarkers. DEVELOPMENT: MS diagnosis relies on the integration of clinical, imaging and laboratory findings as there is still no singlepathognomonicclinical feature or diagnostic laboratory biomarker. The most commonly laboratory test used is the presence of immunoglobulin G oligoclonal bands (OCB) in cerebrospinal fluid of MS patients. This test is now included in the 2017 McDonald criteria as a biomarker of dissemination in time. Nevertheless, there are other biomarkers currently in use such as kappa free light chain, which has shown higher sensitivity and specificity for MS diagnosis than OCB. In addition, other potential laboratory tests involved in neuronal damage, demyelination and/or inflammation could be used for detecting MS. CONCLUSIONS: CSF and serum biomarkers have been reviewed for their use in MS diagnosis and prognosis to stablish an accurate and prompt MS diagnosis, crucial to implement an adequate treatment and to optimize clinical outcomes over time.

Forma tumoral de neurocisticercosis en un paciente con carcinoma de próstata / Tumour form of neurocysticercosis in a patient with prostate carcinoma

INTRODUCCIÓN: La neurocisticercosis es una infección parasitaria del sistema nervioso central que se produce por contacto con los huevos del parásito Taenia solium, que posteriormente se acantona en el tejido cerebral y ocular. Se manifiesta en forma de lesiones quísticas dispersas por el parénquima cerebral que suelen ser de pequeño tamaño y, dependiendo del estadio evolutivo en el que se presenten, pueden aparecer con edema asociado o con calcificaciones en su interior. CASO CLÍNICO: Varón de 63 años que consulta por cuadro constitucional, dolores generalizados y confusión. En la tomografía axial computarizada (TAC) craneal se visualiza una lesión frontoparietal derecha de 4 cm de diámetro, de aspecto quístico y edema circundante, así como varias lesiones de menor tamaño con calcificaciones en su interior. Dado el aspecto pseudotumoral, se realiza un estudio de extensión y se detecta un adenocarcinoma prostático con metástasis óseas universales. Se comienza un tratamiento con antiparasitarios y dexametasona con buena respuesta inicial, y empeora posteriormente con la aparición de una hemiparesia izquierda. En la TAC de control se observa un aumento de la lesión frontoparietal derecha con mayor edema, en relación con la respuesta inflamatoria con el tratamiento. Tras un nuevo ciclo de antiparasitarios, mantiene una respuesta clínica sostenida y estable. CONCLUSIONES: Este caso tiene la peculiaridad de una forma de presentación poco frecuente de neurocisticercosis en forma de lesión pseudotumoral. Existen pocos casos descritos en la bibliografía, y es importante mantener un alto nivel de sospecha clínica y radiológica, ya que este tipo de lesiones puede ser más resistente a la penetración de antiparasitarios y precisar un tratamiento más prolongado e incluso quirúrgico

INTRODUCTION: Neurocysticercosis is a parasitic infection of the central nervous system caused by contact with the eggs of the parasite Taenia solium, which subsequently lodge in brain and eye tissue. It manifests itself in the form of cystic lesions scattered throughout the brain parenchyma that are usually small in size and, depending on their stage of development, may appear with associated oedema or with calcifications inside them. CASE REPORT: We report the case of a 63-year-old male visiting due to constitutional symptoms, generalised pain and confusion. A cranial computed axial tomography (CAT) scan showed a right frontoparietal lesion with a cyst-like appearance and surrounding oedema, as well as several smaller lesions with calcifications inside them. Given the pseudotumoural appearance, an extension study was performed and a prostatic adenocarcinoma with universal bone metastases was detected. Treatment with antiparasitic medication and dexamethasone was started, with a good initial response, which later worsened with the onset of left hemiparesis. In the follow-up CAT scan, an increase in the right frontoparietal lesion with increased oedema was observed, related to the inflammatory response to the treatment. After a new course of antiparasitic drugs, the patient maintained a sustained and stable clinical response. CONCLUSIONS: The unusual feature of this case was a rare presentation of neurocysticercosis in the form of a pseudotumoural lesion. Few cases have been reported in the literature, and it is important to maintain a high level of clinical and radiological suspicion, as this type of lesion may be more resistant to the penetration of antiparasitic drugs and require longer treatment and even surgery