Jaqueca asociada a trastorno de conversión (jaqueca de Babinski). Análisis de una serie de 43 casos / Migraine associated with conversion symptoms (Babinski's migraine): evaluation of a series of 43 cases

Introducción: En 1890 el neurólogo francés Babinski describió como migraine ophthalmique hystérique o jaqueca oftálmica histérica, cuatro casos de cefalea asociada a síntomas visuales y trastornos histéricos. Desde entonces esta asociación ha sido raramente descrita, aunque la frecuencia, posiblemente elevada de acuerdo con descripciones anteriores, está por establecer. Este trabajo recupera la descripción de Babinski e intenta rehabilitar el síndrome descubierto por el semiólogo francés en la relativamente alta frecuencia de este tipo de pacientes observada en un hospital público. Asimismo, se especula sobre los motivos del olvido de esta descripción. Método: El estudio presenta una serie de 43 casos de jaqueca, la gran mayoría compatibles con jaqueca de tipo basilar de acuerdo con los criterios IHS, asociados a síntomas de conversión. El diagnóstico de trastorno de conversión (histeria) se basa en los criterios establecidos por el DSM-IV. Resultados: Todos los pacientes mostraron una o más manifestaciones de histeria durante las crisis de jaqueca, y algunos en los intervalos. Se discuten los detalles de las cefaleas, de los síntomas asociados y de las manifestaciones histéricas. La mayoría de los pacientes mejoró con medicación antijaquecosa. La alteración de la conciencia pudo haber contribuido al desencadenamiento de los síntomas histéricos. Conclusiones: La jaqueca basilar asociada a trastorno de conversión descrita de forma sistematizada por Babinski no es una entidad rara. Cuadros similares se han descrito a lo largo de la historia de la medicina. El silencio durante el último siglo sobre la entidad se debe posiblemente a la dificultad histórica en definir de forma apropiada los trastornos de conversión. La jaqueca de Babinski es una entidad bien establecida y debe ser recuperada para el clínico (AU)

Background: In 1890 four cases of headache associated with visual symptoms and hysterical disorder were described by the French neurologist Babinski as migraine ophthalmique hystérique, or hysterical ophthalmic migraine. Since that time this association has seldom been described, and the possibly high frequency previously reported still remains to be established. This paper has reused Babinski's description and it tries to rehabilitate the syndrome described by the French semiologist across the relatively frequent experience of this type of patients in a public hospital. Also it analyzes the reason of the oblivion of his description.Method: This study presents a series of 43 cases of headache of the migraine type associated with other symptoms, most consistent with basilar-type migraine according to IHS criteria. Diagnosis of conversion disorder (hysteria) was grounded in the criteria set forth in the DSM-IV. Results: All patients exhibited one or more manifestations of hysteria (conversion symptoms) during migraine attacks, and some did in the intervals between attacks as well. Details of the headaches, associated symptoms, and hysterical manifestations are discussed. Most patients improved with antimigraine medication. Altered consciousness may have contributed to the onset of hysterical symptoms. Conclusions: The basilar type migraine associated with conversion symptoms described of systematized form by Babinski, it is not a rare entity. Similar pictures have been described along the history of the medicine. The later silence possibly is due to the historical difficulty in defining accurately the conversión disorders. The Babinski's migraine is a certain well entity and must be recovered for the clinic (AU)

[Migraine associated with conversion symptoms (Babinski's migraine): evaluation of a series of 43 cases]. / Jaqueca asociada a trastorno de conversión (jaqueca de Babinski). Análisis de una serie de 43 casos.

BACKGROUND: In 1890 four cases of headache associated with visual symptoms and hysterical disorder were described by the French neurologist Babinski as migraine ophthalmique hystérique, or hysterical ophthalmic migraine. Since that time this association has seldom been described, and the possibly high frequency previously reported still remains to be established. This paper has reused Babinski's description and it tries to rehabilitate the syndrome described by the French semiologist across the relatively frequent experience of this type of patients in a public hospital. Also it analyzes the reason of the oblivion of his description. METHOD: This study presents a series of 43 cases of headache of the migraine type associated with other symptoms, most consistent with basilar-type migraine according to IHS criteria. Diagnosis of conversion disorder (hysteria) was grounded in the criteria set forth in the DSM-IV. RESULTS: All patients exhibited one or more manifestations of hysteria (conversion symptoms) during migraine attacks, and some did in the intervals between attacks as well. Details of the headaches, associated symptoms, and hysterical manifestations are discussed. Most patients improved with antimigraine medication. Altered consciousness may have contributed to the onset of hysterical symptoms. CONCLUSIONS: The basilar type migraine associated with conversion symptoms described of systematized form by Babinski, it is not a rare entity. Similar pictures have been described along the history of the medicine. The later silence possibly is due to the historical difficulty in defining accurately the conversión disorders. The Babinskís migraine is a certain well entity and must be recovered for the clinic.

Tratamiento biológico del trastorno límite de la personalidad / Psychopharmacological treatment in borderline personality disorder

El trastorno límite de la personalidad es un trastorno con importantes repercusiones clínicas y sociales y del que hasta el momento se ha realizado un abordaje principalmente psicoterapéutico. En los últimos años el análisis sindrómico del trastorno ha posibilitado identificar diferentes síntomas susceptibles de ser tratados psicofarmacológicamente. Así, la compleja clínica del trastorno límite de la personalidad se podría englobar en cuatro dimensiones básicas: impulsivo-agresiva, inestabilidad afectiva, cognitiva-perceptiva y ansiedad inhibición. Tanto los antidepresivos como los eutimizantes, los antipsicóticos, los ansiolíticos o, más recientemente, los ácidos grasos omega 3 han demostrado eficacia en el tratamiento de las dimensiones sintomáticas de este cuadro. Se plantea realizar una revisión bibliográfica sobre los artículos científicos (revisiones, ensayos clínicos o guías clínicas, etc.) publicados en los últimos 10 años y proponer algoritmos terapéuticos de actuación en el manejo psicofarmacológico de estos pacientes (AU)

Borderline personality disorder is a disorder with important social and clinical repercussions, which has been treated mainly by psychotherapy. In recent years, the syndromic analysis of this disorder has allowed us to identify different symptoms capable of being improved with psychopharmacology treatment. Thus, its complex symptomatology could be included in four clinical dimensions: impulsive-aggressive, affective instability, cognitive-perceptive and anxiety-inhibition. Antidepressants, mood stabilizers, antipsychotics, anxiolytics, or more recentlyomega-3 fatty acids have shown efficacy in the treatment of symptomatic dimensions of this disease. We have reviewed scientific articles (reviews, clinical trials or clinical guidelines) published over the last ten years and have proposed therapeutic algorithms for psychopharmacology management in these patients (AU)

Síndrome de Horner secundario a herpes zoster torácico / Horner’s syndrome secondary to thoracic herpes zoster

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[Wilder G. Penfield at the Residencia de Estudiantes (madrid, 1924)]. / Wilder G. Penfield en la Residencia de Estudiantes (Madrid, 1924).

INTRODUCTION: Wilder Graves Penfield (1891-1976) is considered to be one of the 20th century's most gifted and brilliant neuroscientists. He made crucial contributions in the field of epileptology or in brain mapping. He was the founder and director of the advanced Montreal Neurological Institute, regarded as being one of the most prestigious neurological and neurosurgical centres in the world. DEVELOPMENT: His wish to further basic neuroscientific knowledge as much as possible led him to Europe. In the spring of 1924 he arrived in Madrid with his wife and two children on an 'exciting adventure' to improve his knowledge of the histology of the nervous system. Inside the walls of the Residencia de Estudiantes (1910-1936) could be found an enlightening generation of artists and scientists who represented the beginning of the modernization of the country. The building had some humble but very active laboratories, where the scholars elaborated their scientific projects in order to opt for grants allowing them to travel to foreign centres. The North American scientist spent four and a half months participating enthusiastically in what was at that time an avant-garde subject: the discovery and characterisation of glial cells, which would be developed in a number of publications. He was also 'fascinated' by the 'cultural renaissance' that was taking place in Spain.

Wilder G. Penfield en la Residencia de Estudiantes (Madrid, 1924) / Wilder g. Penfield at the residencia de estudiantes (madrid, 1924)

Introducción. Wilder Graves Penfield (1891-1976) está considerado como uno de los neurocientíficos más capacitados y brillantes del siglo XX. Sus aportaciones en epileptología o en la cartografía cerebral han sido cruciales. Fue el fundador y director del avanzado Montreal Neurological Institute, considerado uno de los centros neurológicos y neuroquirúrgicos más prestigiosos del mundo. Desarrollo. Su deseo en ampliar al máximo los conocimientos neurocientíficos básicos le dirigió a Europa. En la primavera de 1924 llega a Madrid con su mujer y sus dos hijos en una `aventura emocionante' para mejorar sus conocimientos de histología del sistema nervioso. La Residencia de Estudiantes (1910-1936) reunía entre sus paredes una luminosa generación de artistas y científicos que ha representado la avanzadilla en la modernización del país. El edificio disponía de unos modestos pero muy activos laboratorios donde los becarios elaboraban sus proyectos científicos para optar a ayudas para viajar a los centros extranjeros. El norteamericano participará con entusiasmo durante cuatro meses y medio en el tema de vanguardia en esos momentos, el descubrimiento y caracterización de la glía, que materializará en varias publicaciones. También quedó `fascinado' por el `renacimiento cultural' que se vivía en España (AU)

Introduction. Wilder Graves Penfield (1891-1976) is considered to be one of the 20th century’s most gifted and brilliant neuroscientists. He made crucial contributions in the field of epileptology or in brain mapping. He was the founder and director of the advanced Montreal Neurological Institute, regarded as being one of the most prestigious neurological and neurosurgical centres in the world. Development. His wish to further basic neuroscientific knowledge as much as possible led him to Europe. In the spring of 1924 he arrived in Madrid with his wife and two children on an ‘exciting adventure’to improve his knowledge of the histology of the nervous system. Inside the walls of the Residencia de Estudiantes (1910-1936) could be found an enlightening generation of artists and scientists who represented the beginning of the modernisation of the country. The building had some humble but very active laboratories, where the scholars elaborated their scientific projects in order to opt for grants allowing them to travel to foreign centres. The North American scientist spent four and a half months participating enthusiastically in what was at that time an avant-garde subject: the discovery and characterisation of glial cells, which would be developed in a number of publications. He was also ‘fascinated’ by the ‘cultural renaissance’ that was taking place in Spain (AU)

[Neurology in the works of Lope de Vega]. / Neurología en la obra de Lope de Vega.

The Madrilenian Félix Lope de Vega Carpio (1562 1635) was the first Spanish playwright. As a privileged witness to his time and with an exquisite knowledge of the human soul, he managed to portray all the social and human reality of the Golden Age in his more than 700 plays. Illnesses and those who suffer them are to be found throughout his works. Many neurological diseases, such as apoplexy, melancholy, headaches or epilepsy, appear quite often in his plays. His descriptions are accurate and the ideas about each disease reflect the knowledge that existed during his time (galenic, medieval or renaissance).

[The ecstatic epilepsy of Teresa of Jesus]. / La epilepsia extática de Teresa de Jesús.

AIMS: Our aim is to define the ecstasies (raptures) of Teresa de Ahumada (Teresa of Jesus) and to link them with ecstasies recently identified as convulsive seizures (Dostoevsky s epilepsy, Saint Paul s disease, ecstatic epilepsy). DEVELOPMENT AND CONCLUSIONS: We review the Carmelite nun's pathography, with special attention given to the excellent detailed descriptions of her ecstasies. The stereotypic movements and comparison with similar cases leads us to consider them as being epileptic, possibly secondary to neurocysticercosis.

The Spanish school of neurology and the first American cases of Alzheimer's disease.

The object of this review is to recapitulate historical events tied to the discovery of Alzheimer's disease and to narrate the contribution by two graduates of the Spanish School of Neurology, N. Achúcarro and G. Lafora, who went on to describe the first cases in North America. Both Achúcarro and Lafora had studied with Alois Alzheimer at his Nervenklinik in Munich, Germany. Subsequently, their scientific skills were put to work at the neuropathology laboratory at the Government Hospital for the Insane in Washington, D.C. Achúcarro described the first American case of this disease in a 77-year-old patients in 1910. All the descriptions were accompanied by new findings, such as granular degeneration. This was the sixth case recorded in the literature worldwide. One year later, in 1911, Lafora presented a third case, a 62-year-old Civil War veteran, and subsequently a fifth case, a 50-year-old woman, in 1914. In this case Lafora observed histological structures similar to Lewy bodies. These original contributions have not been sufficiently mentioned in writings dealing with the history of Alzheimer's disease.

[Bilateral hand dystonia secondary to a bilateral opercular syndrome or Foix-Chavany-Marie syndrome]. / Mano distónica bilateral secundaria a síndrome biopercular o síndrome de Foix-Chavany-Marie.

INTRODUCTION: The main clinical feature of the opercular syndrome (Foix Chavany Marie) is the automatic voluntary dissociation of the facio glosso pharyngeal movements (that is, the alteration of voluntary motility with preservation of authomatic movements). Less frequently, it is presented with movement disorders as dystonia. CASE REPORT: We report a male patient aged 40 years who developed a biopercular syndrome of vascular etiology (confirmed by neuroimaging), in the context or a clinical picture of global hipoxemia, for which the most outstanding clinical manifestation was the presence of dystonic posturing. CONCLUSION: Although dystonia is usually related with damage or dysfunction of the basal ganglia or thalamus, in some case it can be caused by lesions in other locations, such as in some patients with biopercular syndrome as in the present case

Aniversario de Cajal / The aniversary of Cajal

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Mano distónica bilateral secundaria a síndrome biopercularo síndrome de Foix-Chavany-Marie / Bilateral hand dystonia secondary to a bilateral opercular syndrome or Foix-Chavany-Marie syndrome

Introducción. La principal característica clínica del síndrome opercular (Foix-Chavany-Marie) es la `disociación automática voluntaria' de los movimientos faciogloso-faríngeos (alteración de la motilidad voluntaria con preservación de los movimientos automáticos). Raramente cursa con trastornos del movimiento, como la distonía. Caso clínico. Presentamos un varón de 40 años que desarrolló un síndrome biopercular de etiología isquémica (que se confirmó con pruebas de neuroimagen), en el contexto de un cuadro de hipoxemia global, cuya manifestación clínica más llamativa era la presencia de posturas distónicas. Conclusión. Aunque la distonía suele relacionarse con la lesión o la disfunción de los ganglios basales o del tálamo, en algunos casos puede producirse por lesiones en otras localizaciones, como en algunos pacientes con síndrome biopercular, como el que presentamos (AU)

[Luis Simarro: precursor of Spanish Neurology and Grand Master of the freemasons]. / Luis Simarro: precursor de la Neurología española y Gran Maestre de la masonería.

Luis Simarro is considered to be the great precursor of Spanish Neurology, Neurohistology and Psychology. Together with Cajal he was one of the most outstanding figures of the Spanish freemasons in the field of medicine, where he reached the highest rank: Grand Master of the Spanish Great Orient. These historical notes summarize the scientific contribution of Simarro and his extensive work in the field of politics where he was influential in the modernization of Spain.

Luis Simarro:precursor de la Neurología española y Gran Maestre de la masonería / Luis Simarro: precursor of Spanish Neurology and grand master of the freemasons

Luis Simarro es considerado el gran precursor de la Neurología, Neurohistología y Psicología española. Junto con Cajal representa lo más sobresaliente de la masonería española en el campo de la medicina, donde alcanzó su máximo rango: Gran Maestre del Grande Oriente Español. Este apunte histórico sumariza la labor científica de Simarro y su extensa labor en el campo de la política donde contribuyó de manera influyente en la modernidad de España. (AU)

[Spanish national neurology (psychiatry). The work of Vallejo Nájera and López Ibor]. / La neurología (psiquiatría) nacional española. La obra neurológica de Vallejo Nájera y López Ibor.

After the Civil War, Spanish science underwent a profound crisis. The promising neurology of Madrid, which went hand in hand with psychiatry, collapsed since its leading figures were on the Republican side. The new leaders, Vallejo Nájera and López Ibor, gradually abandoned the neurological aspect so that this disappeared, and from a psychiatric point of view tried to support the new dominating ideas based on German national-socialism (German national psychiatry). Their 'pure' neurological work is limited, although of interest, since it represents the scant output of our specialty during those years.