Correlación neurorradiológica de las afasias. Mapa cortico-subcortical del lenguaje / Neuroradiologic correlation with aphasias. Cortico-subcortical map of language

La afasia es una alteración adquirida del lenguaje debida a una lesión cerebral, que se caracteriza por errores en la producción, la denominación o la comprensión del lenguaje. Aunque la mayoría de las afasias suelen ser mixtas, desde un punto de vista práctico se clasifican en diferentes tipos según sus rasgos clínicos principales: afasia de Broca, afasia de Wernicke, afasia de conducción, afasia transcortical y alexia con o sin agrafia. Presentamos los hallazgos clínicos de los principales subtipos representándolos con casos radiológicos, y proporcionamos una revisión actualizada de la red del lenguaje con imágenes de resonancia funcional y de tractografía

Aphasia is an acquired language disorder due to a cerebral lesion; it is characterized by errors in production, denomination, or comprehension of language. Although most aphasias are mixed, from a practical point of view they are classified into different types according to their main clinical features: Broca's aphasia, Wernicke's aphasia, conduction aphasia, transcortical aphasia, and alexia with or without agraphia. We present the clinical findings for the main subtypes of aphasia, illustrating them with imaging cases, and we provide an up-to-date review of the language network with images from functional magnetic resonance imaging and tractography

Neuroradiologic correlation with aphasias. Cortico-subcortical map of language. / Correlación neurorradiológica de las afasias. Mapa cortico-subcortical del lenguaje.

Aphasia is an acquired language disorder due to a cerebral lesion; it is characterized by errors in production, denomination, or comprehension of language. Although most aphasias are mixed, from a practical point of view they are classified into different types according to their main clinical features: Broca's aphasia, Wernicke's aphasia, conduction aphasia, transcortical aphasia, and alexia with or without agraphia. We present the clinical findings for the main subtypes of aphasia, illustrating them with imaging cases, and we provide an up-to-date review of the language network with images from functional magnetic resonance imaging and tractography.

Neurobehçet disease: clinical and demographic characteristics.

BACKGROUND: Neurobehçet disease (NBD) is a rare complication of Behçet disease (BD) but with important burdens of morbidity and mortality. Little is known about this complication because there are no validated diagnostic criteria, and all the studies have small number of patients. The prevalence reported normally ranges between 5% and 15% and it is more frequent amongst men between 20 and 40 years old. The typical presentations include focal parenchymal lesions, vascular thrombosis, arterial vasculitis, and aseptic meningo-encephalitis. METHODS: We retrospectively studied medical histories of all patients admitted to the hospital and discharged from it with diagnosis of BD from January 1996 to September 2009. NBD was defined as having neurological and/or psychiatric symptoms with compatible abnormalities in MRI and/or cerebrospinal fluid and without another possible explanation for their symptoms. RESULTS: Behcet disease was diagnosed in 25 patients and seven from these patients fulfilled our criteria of Neurobehcet disease (28%). Patients with NBD were significantly younger at the onset of their symptoms and had a significantly longer evolution until diagnosis and treatment compared to patients with non-Neuobehçet disease. Six presented a relapsing-remitting pattern, with a good outcome with corticosteroids. CONCLUSIONS: As reported in previous studies, progressive course was less frequent, with only one case, and had a more aggressive disease. Brainstem involvement bears a poorer prognosis because it is linked with a progressive evolution. In our series, NBD complication was not that infrequent. It is very important to be highly suspicious of this possibility to start early a correct treatment.

Síntomas neurootológicos en pacientes con migraña / Neuro-otological symptoms in patients with migraine

Introducción: La frecuencia de los síntomas neurootológicos son frecuentes en los pacientes con migraña, habiéndose descrito la asociación de diversas entidades. Pacientes y métodos: Seleccionamos de la unidad de cefaleas a 70 pacientes con diagnóstico de migraña episódica con o sin aura y valoramos específicamente el diagnóstico de inestabilidad, mareo psicofisiológico, síntomas presincopales, vértigo posicional paroxístico benigno (VPPB), vértigo recurrente asociado a la migraña (VRAM) y la enfermedad de Meniere.Resultados: Un 44,3% presentó ortostatismo o síncopes, un 15,7% inestabilidad posiblemente por hipofunción vestibular bilateral, un 14,2% VRAM y un 8,6% VPPB. La presencia de VPPB la hemos observado en pacientes de mayor edad (40 años), mientras que el VRAM es una entidad de más jóvenes (35 años). Estos hallazgos nos llaman la atención y nos recuerdan cómo el vértigo benigno paroxístico es una entidad de la infancia y para el VPPB la edad es un factor de riesgo. Conclusiones: Los migrañosos presentan con frecuencia síntomas neurootológicos que podemos clasificar en síntomas interepisódicos y episódicos, y síntomas específicos e inespecíficos de la migraña. Esta aproximación tiene un evidente interés fisiopatológico dado que tanto el VRAM como la posible hipofunción vestibular de los migrañosos son síntomas que comparten aspectos fisiopatológicos con la migraña, mientras que los síntomas de ortostatismo y el VPPB son inespecíficos y se observan asociados a otras entidades (AU)

Introduction: Neurootological symptoms are common in patients with migraine, and have been reported to be associated with diverse conditions. Patients and methods: A total of 70 patients with a diagnosis of episodic migraine, with or without aura, attending our Migraine Unit were selected. The specific variables studied were the diagnosis of instability, psycho-physiological dizziness, presyncopal symptoms, benign paroxysmal positional vertigo (BPPV), migraine associated recurrent vertigo (MARV), and Meniere's disease. Results: A total of 44.3% of cases had orthostatism or syncope, 15.7% with instability (possibly due to bilateral vestibular hypofunction), 14.2% with MARV and 8.6% with BPPV. The presence of BPPV was observed in older patients (40 years), whilst MARV was a condition seen in younger ones (35 years). These findings are of interest and remind us that benign paroxysmal vertigo is a childhood condition and age is a risk for BPPV.Conclusions: Migraine patients often present with neuro-otological symptoms that can be classified as inter-episodic and episodic symptoms, and specific and non-specific migraine symptoms. This approach is of obvious pathophysiological interest, given that MARV and the possible vestibular hypofunction of migraine patients are symptoms that share physiological aspects with migraine, while the orthostatism symptoms and BPPV are non-specific and are seen to be associated with other conditions (AU)

Neuro-otological symptoms in patients with migraine.

INTRODUCTION: Neurootological symptoms are common in patients with migraine, and have been reported to be associated with diverse conditions. PATIENTS AND METHODS: A total of 70 patients with a diagnosis of episodic migraine, with or without aura, attending our Migraine Unit were selected. The specific variables studied were the diagnosis of instability, psycho-physiological dizziness, presyncopal symptoms, benign paroxysmal positional vertigo (BPPV), migraine associated recurrent vertigo (MARV), and Meniere's disease. RESULTS: A total of 44.3% of cases had orthostatism or syncope, 15.7% with instability (possibly due to bilateral vestibular hypofunction), 14.2% with MARV and 8.6% with BPPV. The presence of BPPV was observed in older patients (40 years), whilst MARV was a condition seen in younger ones (35 years). These findings are of interest and remind us that benign paroxysmal vertigo is a childhood condition and age is a risk for BPPV. CONCLUSIONS: Migraine patients often present with neuro-otological symptoms that can be classified as inter-episodic and episodic symptoms, and specific and non-specific migraine symptoms. This approach is of obvious pathophysiological interest, given that MARV and the possible vestibular hypofunction of migraine patients are symptoms that share physiological aspects with migraine, while the orthostatism symptoms and BPPV are non-specific and are seen to be associated with other conditions.

[Osmophobia analysis in primary headache]. / Análisis de la osmofobia en las cefaleas primarias.

INTRODUCTION: Osmophobia is often reported by migraine patients. This study evaluates osmophobia in connection with the diagnosis of episodic migraine with or without aura, chronic migraine and episodic and chronic tension-type headache. METHODS: We recruited from our Headache Unit 68 patients (59 female, 9 male; age 37+/-14.7 years), of whom 24 were migraine without aura (MoA), 11 migraine with aura (MA), 10 chronic migraine (CM) and 23 TTH (episodic-TTH). Patients with two or more forms of primary headache were excluded. RESULTS: Among migraine patients, 54% with MoA and 0% with MA, 40 %CM reported osmophobia during the attacks; none of the 23 TTH patients suffered this symptom. The crisis frequency was MoA and osmophobia 2.15 crisis per month; MoA without osmophobia 3,14. MC with osmophobia 22; MC without osmophobia 21.7. CONCLUSIONS: Osmophobia and taste abnormalities were demonstrated to be very specific in diagnosing migraine, but very insensitive. Osmophobia frequency does not depend on migraine frequency. Osmophobia seems to be more frequent in females than in males. The lack of osmophobia in MA patients could be explained by a different pathophysiological mechanism between MA and MoA.

Análisis de la osmofobia en las cefaleas primarias / Osmophobia analysis in primary headache

Introducción. La osmofobia es un síntoma que aparece en lospacientes con migraña; aunque su frecuencia no es alta, parece bastanteespecífico, siendo bastante infrecuente en otros tipos de cefaleas.Presentamos una serie de pacientes con migraña episódica, crónicay cefalea tipo tensión, analizando la presencia de osmofobia ysu relación con otros síntomas.Material y métodos. Se seleccionan 68 pacientes (59 mujeres y9 varones) remitidos a la unidad de cefaleas, 24 con migraña sin aura(MSA), 11 con migraña con aura (MA), 10 con migraña crónica (MC),23 con cefalea tipo tensión (CTT) (5 episódica y 18 crónica), segúncriterios de la IHS-II (tabla 1). Se analiza la presencia de osmo, foto,fonofobia, náuseas y vómitos y frecuencia de crisis.Resultados. La edad media de la serie es de 37 ± 14,7 años(MSA: 35,5, MA: 33,1, MC: 44,4, CTT: 36,4). La edad promedio de lospacientes con osmofobia es de 41,6 años, y sin osmofobia, 34,4. OsmofobiaMSA: 54%, MA: 0%, MC: 40%, CTT: 0%. Todos los pacientescon osmofobia presentan foto y fonofobia. El promediocrisis/mes para MSA con osmofobia: 2,15; MSA sin osmofobia: 3,14;MC con osmofobia: 22; MC sin osmofobia: 21,7. Ningún varón presentóosmofobia.Conclusiones. La osmofobia es un síntomas específico de la migrañafrente a la cefalea tipo tensión. La frecuencia de las crisis demigraña es independiente de la presencia o no de osmofobia. Ennuestra serie tampoco es frecuente en la MA, lo que puede ser la expresiónde una fisiopatología diferente (AU)

Introduction. Osmophobia is often reported by migraine patients.This study evaluates osmophobia in connection with thediagnosis of episodic migraine with or without aura, chronic migraineand episodic and chronic tension-type headache.Methods. We recruited from our Headache Unit 68 patients(59 female, 9 male; age 37 ± 14.7 years), of whom 24 were migrainewithout aura (MoA), 11 migraine with aura (MA), 10 chronicmigraine (CM) and 23 TTH (episodic-TTH). Patients with twoor more forms of primary headache were excluded.Results. Among migraine patients, 54 % with MoA and 0%with MA, 40 % CM reported osmophobia during the attacks; noneof the 23 TTH patients suffered this symptom. The crisis frequencywas MoA and osmophobia 2.15 crisis per month; MoAwithout osmophobia 3,14. MC with osmophobia 22; MC withoutosmophobia 21,7.Conclusions. Osmophobia and taste abnormalities were demonstratedto be very specific in diagnosing migraine, but veryinsensitive. Osmophobia frequency does not depend on migrainefrequency. Osmophobia seems to be more frequent in femalesthan in males. The lack of osmophobia in MA patients couldbe explained by a different pathophysiological mechanism betweenMA and MoA (AU)

Miositis viral aguda en el adulto / Acute viral myositis in the adult

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