Cognition in non-demented Parkinson's disease vs essential tremor: A population-based study.

OBJECTIVES: Patients with Parkinson's disease (PD) and essential tremor (ET) have a higher risk of cognitive impairment than age-matched controls. Only a few small studies (11-18 subjects per group) have directly compared the cognitive profile of these conditions. Our aim was to compare the cognitive profile of patients with these two conditions to each other and to healthy individuals in a population-based study of non-demented participants. MATERIALS AND METHODS: This investigation was part of the NEDICES study, a survey of the elderly in which 2438 dementia-free participants underwent a short neuropsychological battery. We used nonparametric techniques to evaluate whether there are differences and/or a gradient of impairment across the groups (PD, ET, and controls). Also, we performed a head-to-head comparison of ET and PD, adjusting for age and education. RESULTS: Patients with PD (N=46) and ET (N=180) had poorer cognition than controls (N=2212). An impaired gradient of performance was evident. PD scored lower than ET, and then each of these lower than controls, in memory (P<.05) and verbal fluency (P<.001) tasks. When we compared PD and ET, the former had lower scores in verbal fluency (P<.05), whereas the later had a poorer cognitive processing speed (P<.05). CONCLUSIONS: This large population-based study demonstrates that both conditions influence cognitive performance, that a continuum exists from normal controls to ET to PD (most severe), and that although deficits are in many of the same cognitive domains, the affected cognitive domains do not overlap completely.

Obesity and impaired cognitive functioning in the elderly: a population-based cross-sectional study (NEDICES).

BACKGROUND AND PURPOSE: Studies of high body mass index (BMI) and cognition in the elderly have shown conflicting results. While some studies have shown a detrimental effect of high BMI on cognitive function, others have observed beneficial effects on cognition. Our aim was to assess cognitive function in a large population-based sample of overweight (BMI 25-29.9 kg/m(2) ) and obese (BMI ≥ 30 kg/m(2) ) community-dwelling elderly participants compared with their counterparts with BMI < 25 kg/m(2) (i.e. controls) living in the same population. METHODS: One-thousand nine-hundred and forty-nine population-dwelling participants aged ≥ 65 years in central Spain [the Neurological Diseases in Central Spain study (NEDICES)] underwent a neuropsychological assessment, including tests of global cognitive performance [measured with a 37-item version of the Mini-Mental State Examination (37-MMSE)], psychomotor speed, verbal fluency, memory and pre-morbid intelligence. RESULTS: There were 507 with BMI < 25 kg/m(2) , 850 overweight and 592 obese participants. In regression analyses that adjusted for age, gender, educational category, intake of medications that potentially affect cognition function, diabetes mellitus, hypertension, dementia, ever smoker, ever drinker and waist circumference, we found that obese/overweight status was associated with the lowest quartiles of the 37-MMSE, Trail Making Test-A (number of errors; indeed more errors), verbal fluency, delayed free recall, immediate logical memory and pre-morbid intelligence. CONCLUSIONS: In this large population sample, overweight and obese participants performed poorer on formal neuropsychological tests than their counterparts with BMI < 25 kg/m(2) . These results support the hypothesis of a detrimental effect of high BMI on impaired cognition in the elderly.

Infiltrative cervical lesions causing symptomatic occipital neuralgia.

BACKGROUND: Occipital neuralgia is a well-recognized cause of posterior head and neck pain that may associate mild sensory changes in the cutaneous distribution of the occipital nerves, lacking a recognizable local structural aetiology in most cases. Atypical clinical features or an abnormal neurological examination are alerts for a potential underlying cause of pain, although cases of clinically typical occipital neuralgia as isolated manifestation of lesions of the cervical spinal cord, cervical roots, or occipital nerves have been increasingly reported. CASE REPORTS: We describe two cases (one with typical and another one with atypical clinical features) of occipital neuralgia secondary to paravertebral pyomyositis and vertebral relapse of multiple myeloma in patients with relevant medical history that aroused the possibility of an underlying structural lesion. DISCUSSION: We discuss the need for cranio-cervical magnetic resonance imaging in all patients with occipital neuralgia, even when typical clinical features are present and neurological examination is completely normal.

Neuropatía óptica isquémica posterior bilateral / Bilateral posterior ischaemic optic neuropathy

No disponible

Metamorfopsia invertida: un trastorno de la percepción visual infrecuente. Réplica / Reversal of vision metamorphopsia: an infrequent disorder affecting visual perception. Reply

No disponible

No disponible

[Reversal of vision metamorphopsia as a manifestation of cerebellar infarct]. / Metamorfopsia invertida como manifestación de un infarto cerebeloso.

INTRODUCTION: Reversal of vision metamorphopsia is a disorder affecting the visuospatial perception of objects, without any changes in their shape, size or colour. It generally involves a full 180 degrees rotation of the visual field in the coronal plane. Its chief causation is vertebrobasilar ischaemia, although the phenomenon has also been linked to many other conditions, such as multiple sclerosis, epilepsy, migraine or traumatic head and neck injuries. Some notable features of reversal of vision metamorphopsia are the wide topographic variety of the lesions responsible for the condition, the transient nature of the symptom and its improvement or resolution in the presence of certain stimuli. CASE REPORT: A 35-year-old male with a sudden episode of instability that prevented him from walking, together with vomiting and reversal of vision metamorphopsia that lasted for an hour. A magnetic resonance scan enabled us to identify an acute ischaemic cerebellar lesion as the cause of the condition. CONCLUSIONS: The variety of locations of the lesions that give rise to reversal of vision metamorphopsia would be mainly due to the multisensory nature of the neurons in the posterior parietal cortex, the area of the brain where the visuospatial integration of images is performed. These neurons receive visual, proprioceptive and vestibular afferences, which means that any lesions that occur in these three systems or in the central integrator itself could cause the phenomenon of reversal of vision metamorphopsia.

Metamorfopsia invertida como manifestación de un infarto cerebeloso / Reversal of visión metamorphpsia as a manifestation of cerebelalr infarct

Introducción. La metamorfopsia invertida es un trastorno de la percepción visuoespacial de los objetos, sin alteración de su forma, tamaño o color. Generalmente se trata de una rotación completa de 180° del campo visual en el plano coronal. Su principal etiología es la isquemia vertebrobasilar, aunque se han relacionado otras muchas entidades con este fenó- meno, como la esclerosis múltiple, la epilepsia, la migraña o los traumatismos craneocervicales. Algunas características destacables de la metamorfopsia invertida son la gran variedad topográfica de las lesiones responsables del fenómeno, el carácter transitorio del síntoma y su mejoría o resolución ante determinados estímulos. Caso clínico. Varón de 35 años con un episodio brusco de inestabilidad que le impedía la marcha, acompañado de vómitos y metamorfopsia invertida de una hora de duración. Mediante resonancia se identificó una lesión cerebelosa isquémica aguda como responsable del cuadro. Conclusiones. La variedad topográfica de las lesiones que ocasionan una metamorfopsia invertida se debería principalmente al carácter multisensorial de las neuronas de la corteza parietal posterior, el área del cerebro donde se realiza la integración visuoespacial de las imágenes. Estas neuronas reciben aferencias visuales, propioceptivas y vestibulares, por lo que cualquier lesión de estos tres sistemas o en la propia área de integración sería capaz de provocar el fenómeno de la metamorfopsia invertida (AU)

Introduction. Reversal of vision metamorphopsia is a disorder affecting the visuospatial perception of objects, without any changes in their shape, size or colour. It generally involves a full 180º rotation of the visual field in the coronal plane. Its chief causation is vertebrobasilar ischaemia, although the phenomenon has also been linked to many other conditions, such as multiple sclerosis, epilepsy, migraine or traumatic head and neck injuries. Some notable features of reversal of vision metamorphopsia are the wide topographic variety of the lesions responsible for the condition, the transient nature of the symptom and its improvement or resolution in the presence of certain stimuli. Case report. A 35-year-old male with a sudden episode of instability that prevented him from walking, together with vomiting and reversal of vision metamorphopsia that lasted for an hour. A magnetic resonance scan enabled us to identify an acute ischaemic cerebellar lesion as the cause of the condition. Conclusions. The variety of locations of the lesions that give rise to reversal of vision metamorphopsia would be mainly due to the multisensory nature of the neurons in the posterior parietal cortex, the area of the brain where the visuospatial integration of images is performed. These neurons receive visual, proprioceptive and vestibular afferences, which means that any lesions that occur in these three systems or in the central integrator itself could cause the phenomenon of reversal of vision metamorphopsia (AU)

[Sensory ganglionopathy as a manifestation of celiac disease]. / Ganglionopatia sensitiva como manifestacion de enfermedad celiaca.

INTRODUCTION: The neurological manifestations of celiac disease (CD) may be caused by the disease itself, by associated autoimmune diseases or by complications from the tumours that may develop in the long term. We report a case of sensory ganglionopathy associated to CD. CASE REPORT: A 59-year-old female with chronic diarrhoea and loss of weight, who visited because of a clinical picture of gait disorders that progressed to the point where she was barely able to walk. Having been diagnosed with CD, finding a sensory ganglionopathy with dysautonomia (an atypical manifestation of this disease) led to a diagnosis of associated Sjogren's syndrome (SS). CONCLUSIONS: The neurological manifestations of CD are very varied, but in the presence of a sensory ganglionopathy, a neurological picture that is atypical in this disease, it becomes necessary to suspect SS, which is an infrequent but well established association. Likewise, all patients with SS must be screened for CD, which (albeit subclinically) can be complicated in the long term by the development of tumours. The differential diagnosis of the neurological manifestations of CD and of sensory ganglionopathy, as well as the association between celiac disease and SS, is also discussed.

Ganglionopatía sensitiva como manifestación de enfermedad celiaca / Sensory ganglionopathy as a manifestation of celica disease

Introducción. Las manifestaciones neurológicas de la enfermedad celiaca (EC) pueden deberse a la propia enfermedad, a las enfermedades autoinmunes asociadas o a complicaciones de los tumores que pueden desarrollar a largo plazo. Presentamos un caso de ganglionopatía sensitiva asociada a una EC. Caso clínico. Mujer de 59 años con diarrea crónica y pérdida de peso, que acude por un cuadro de trastorno de la marcha, que progresa hasta llegar a impedirla. Diagnosticada como EC, el hallazgo de una ganglionopatía sensitiva con disautonomía, manifestación atípica para esta enfermedad, llevó al diagnóstico de un síndrome de Sjögren (SS) asociado. Conclusiones. Las manifestaciones neurológicas de la EC son muy variadas, pero ante la presencia de una ganglionopatía sensitiva, cuadro neurológico atípico en esta enfermedad, es obligado sospechar un SS, asociación infrecuente, pero bien establecida. De igual manera, en todo paciente con SS debe realizarse un cribado de EC, que, aunque subclínica, puede complicarse a largo plazo con el desarrollo de tumores. Discutimos el diagnóstico diferencial de las manifestaciones neurológicas de la EC y de la ganglionopatía sensitiva, así como la asociación entre la celiaquía y el SS

Introduction. The neurological manifestations of celiac disease (CD) may be caused by the disease itself, by associated autoimmune diseases or by complications from the tumours that may develop in the long term. We report a case of sensory ganglionopathy associated to CD. Case report. A 59-year-old female with chronic diarrhoea and loss of weight, who visited because of a clinical picture of gait disorders that progressed to the point where she was barely able to walk. Having been diagnosed with CD, finding a sensory ganglionopathy with dysautonomia (an atypical manifestation of this disease) led to a diagnosis of associated Sjogren’s syndrome (SS). Conclusions. The neurological manifestations of CD are very varied, but in the presence of a sensory ganglionopathy, a neurological picture that is atypical in this disease, it becomes necessary to suspect SS, which is an infrequent but well established association. Likewise, all patients with SS must be screened for CD, which (albeit subclinically) can be complicated in the long term by the development of tumours. The differential diagnosis of the neurological manifestations of CD and of sensory ganglionopathy, as well as the association between celiac disease and SS, is also discussed

[What should a medical student know about neurology? A review]. / Que conocimientos neurologicos deberia adquirir un estudiante de Medicina? Revision.

AIM: To analyze the neurologic knowledge and abilities that the medical student should acquire during the undergraduated learning. DEVELOPMENT: A review of the neurologic knowledge and abilities that the undergraduate medical student should acquire was undertaken by a search in Medline. Also, an analysis of neurological programmes in the 28 webs of the Spanish universities with medical degree was performed. According to the recommendations of the main international neurological societies, during the medicine undergraduate degree, the students must learn the clinical ability to perform a meaningful clinical and neurological examination, and acquire the clinical skills to initiate appropriate investigations and management of the most frequent, urgent or treatable neurological illnesses. Also the student must have the awareness in which is appropriate to request a neurological consultation with a specialist. The multiple learning strategies to acquire these capacities are discussed. The data obtained in the 28 webs shows inadequacies to international recommendations and supported the Spanish White Book on undergraduate medical education statement about the need of a reform of the undergraduate training in Spain. CONCLUSIONS: The neurological training of the medical student in Spain may have several transformations to be adapted to the international recommendations.

¿Qué conocimientos neurológicos debería adquirir un estudiante de Medicina? Revisión / What should a medical student know about neurology? A review

Objetivo. Analizar los conocimientos y habilidades neurológicas que el estudiante de medicina debería adquirirdurante el aprendizaje pregraduado. Desarrollo. Se ha realizado, mediante una búsqueda en Medline, la revisión de los conocimientosy habilidades neurológicas que el estudiante de medicina debería adquirir durante el aprendizaje pregraduado.También se ha efectuado el análisis de los programas neurológicos en las 28 webs de las universidades españolas con estudiosde grado médico. De acuerdo con las recomendaciones de las principales sociedades neurológicas internacionales, duranteel pregrado de medicina los estudiantes deben aprender las habilidades para realizar un adecuado examen clínico yneurológico, y para iniciar investigaciones y terapias apropiadas en las enfermedades neurológicas más frecuentes, urgentesy tratables. También el estudiante debe ser consciente de las situaciones en qué es apropiado solicitar una consulta neurológicacon un especialista. Se discuten las múltiples estrategias de aprendizaje para adquirir estas habilidades. La informaciónobtenida en las webs muestra diversas inadecuaciones a las recomendaciones internacionales y sustentan las afirmacionesdel Libro blanco sobre la educación médica pregraduada de la necesidad de una reforma de la enseñanza pregraduada enEspaña. Conclusiones. La enseñanza neurológica del estudiante de medicina en España debe transformarse para adaptarse alas recomendaciones internacionales

Aim. To analyze the neurologic knowledge and abilities that the medical student should acquire during the undergraduatedlearning. Development. A review of the neurologic knowledge and abilities that the undergraduate medical studentshould acquire was undertaken by a search in Medline. Also, an analysis of neurological programmes in the 28 webs of theSpanish universities with medical degree was performed. According to the recommendations of the main internationalneurological societies, during the medicine undergraduate degree, the students must learn the clinical ability to perform ameaningful clinical and neurological examination, and acquire the clinical skills to initiate appropriate investigations andmanagement of the most frequent, urgent or treatable neurological illnesses. Also the student must have the awareness inwhich is appropriate to request a neurological consultation with a specialist. The multiple learning strategies to acquire thesecapacities are discussed. The data obtained in the 28 webs shows inadequacies to international recommendations andsupported the Spanish White Book on undergraduate medical education statement about the need of a reform of the undergraduatetraining in Spain. Conclusions. The neurological training of the medical student in Spain may have several transformations tobe adapted to the international recommendations

Topiramate for patients with refractory migraine: an observational, multicenter study in Spain.

INTRODUCTION: The efficacy of current preventive migraine treatments is limited. In addition, tolerability problems are not infrequent. OBJECTIVES: To check our experience with topiramate in the treatment of patients with refractory migraine. PATIENTS AND METHODS: We offered treatment with topiramate to patients with the diagnosis of International Headache Society (IHS) migraine who had not responded to or tolerated beta-blockers, amitriptyline, flunarizine and/or valproate. This series is made up of 115 patients (88 women), between 16 and 81 years. Most of them (n=79) fulfilled the Silberstein et al. criteria for transformed migraine. The parameters analyzed were "response" (reduction in migraine frequency>50%), excellent response (>75%) and tolerability. RESULTS: After 3 months, the maintenance doses of topiramate ranged from 25 to 400 mg, though most patients took 100 mg. Twenty-four (21%) patients withdrew due to adverse events, mostly cognitive difficulties, that had already occurred with doses as low as 25-50 mg, while 26 (23%) found topiramate ineffective. The remaining 65 (56%) patients responded, 34 with excellent response. Sixteen patients (10 obese) lost weight (3-13 kg). CONCLUSIONS: Topiramate seems to be a good therapeutic option for about half of the patients with refractory migraine. In these patients response is usually excellent. Intolerance due to adverse events appears in one-fifth of the cases early and at low doses.

Topiramato para pacientes con migraña refractaria: estudio multicéntrico observacional en España / Topiramate for patients with refractory migraine: an observacional, multicenter study in Spain

Introducción: La eficacia de los tratamientos preventivos antimigraña es limitada. No son, además, infrecuentes los efectos adversos. Objetivos: Explorar nuestra experiencia en el tratamiento con topiramato de pacientes con migraña refractaria. acientes y métodos: Se ofreció tratamiento con topiramato a pacientes con el diagnóstico de migraña según la International Headache Society (IHS) que no hubieran respondido o tolerado beta-bloqueantes, amitriptilina, flunarizina y/o valproato. Esta serie comprende un total de 115 pacientes (88 mujeres), de entre 16 y 81 años de edad. La mayoría (n = 79) cumplían los criterios de Silberstein et al. para el diagnóstico de migraña transformada. Los parámetros evaluados fueron "respuesta" (reducción en frecuencia de las crisis > 50 por ciento), respuesta excelente (> 75 por ciento) y tolerabilidad. Resultados: Tras 3 meses de tratamiento las dosis de mantenimiento de topiramato oscilaron entre 25 y 400 mg, si bien la mayoría de los pacientes tomaban 100 mg. Un total de 24 pacientes (21 por ciento) hubo de abandonar el tratamiento por efectos adversos, en la mayoría de los casos cognitivos, ya desde el inicio del tratamiento y a dosis bajas, mientras que 26 (23 por ciento) no respondieron. Los 65 pacientes restantes (56 por ciento) respondieron, 34 de ellos con respuesta excelente. Un total de 16 pacientes (10 eran obesos) perdieron peso (3-13 kg). Conclusiones: El topiramato es una buena opción de tratamiento para aproximadamente la mitad de los pacientes con migraña refractaria. En estos pacientes, la respuesta suele ser excelente. La intolerancia por efectos adversos aparece en uno de cada 5 pacientes al inicio del tratamiento, ya con dosis bajas. (AU)

[Acute paraparesis associated with dorsal diastematomyelia in an adult]. / Paraparesia aguda asociada a diastematomelia dorsal en un adulto.

Diastematomelia presenting in adult life has long been considered a rare occurrence. With the development of modern imagining techniques, cases of adult are being discovered with increasing frequency, but their exact number remains unclear. It occurs most often in the lumbar region, is rarely located above the level of T3 and it present clinical features such as deformity of the food, peculiar posture, or gait disturbance. The symptoms and signs of diastematomelia usually are recognized in children. We are reporting the case of an adult patient who had a forme frustre of Sjögren's syndrome and thoracic diastematomelia presenting as a acute myelopathy. Although in most of patients, the pathogenesis of the neurological deficits could be attributed to lesions such as spondylosis, herniation of a disc, traction injury or the tethering effect derived from an osseous septum or a fibrous band, in our patients was absent. We suggested as contributory cause to damage of the spinal cord a vascular ischemic mechanism during flexion and extension of the spine, and we postulated the role that anti-Ro (SS-A) antibodies play in the immunopathogenesis (mediating or potentiating) vascular injury by altering vascular endothelial function or proliferation.

[Compensatory hyperhidrosis on one side in a patient with Ross syndrome]. / Hiperhidrosis hemicorporal compensatoria asociada a pupila de Adie (síndrome de Ross).

Ross syndrome involves three clinical signs: tonic pupil, hyporeflexia and segmental hypohidrosis. Sometimes the clinical picture also includes autonomic dysfunction. To our knowledge only 24 cases have been described in the literature, indicating that the syndrome is rare. We present a new case in which contralateral hemicorporal hyperhidrosis was, as usual, the key complementary feature leading to diagnosis.

[Recurrence of meningoencephalitis induced by cotrimoxazole]. / Meningoencefalitis recurrente inducida por cotrimoxazol.

Although infrequent, one of the etiological causes of aseptic meningoencephalitis is drug-induced. In our patient, two cases of meningocephalitis took place over a period of six years, together with a meningismus following consumption of trimetroprim-sulphametoxazol (cotrimoxazol). Features of the cases were mental confusion, fever, alterations in the CSF and a benign clinical course, with a high degree of doubt regarding diagnosis, given the similarity of anomalies in the CSF to those present in partially treated bacterian meningitis.