[Pharyngeal-cervical-brachial variant of Guillain-Barré syndrome: a well-defined clinical condition with a heterogeneous immunological profile]. / Variante faringocervicobraquial del síndrome de Guillain-Barré: una entidad clínica bien definida con un perfil inmunológico heterogéneo.

INTRODUCTION: The pharyngeal-cervical-brachial variant of Guillain-Barre syndrome (GBS) is rare. This variant has its own specific clinical aspects but a heterogeneous immunological profile. CASE REPORT: A 38-year-old male who presented progressive symptoms of dysphagia, dysphonia and weakness hindering movement of the upper limbs. Two weeks earlier, the patient had presented acute self-limiting diarrhoea. He displayed predominantly right-side bilateral peripheral facial paresis, and paresis of the 9th and 12th cranial nerves and upper limbs (proximal 0/5, distal 1/5), although strength in the lower limbs was not compromised; sensitivity was preserved and deep tendon reflexes were diminished (0 in the upper limbs and + in the lower extremities). At 24 hours after admission, he suffered severe respiratory distress and had to be moved to the Intensive Care Unit with invasive mechanical ventilation. An electronystagmography/electromyogram study revealed severe demyelinating damage that predominantly involved the brain, but also included a small axonal component. The most striking immunological finding was the presence of positive IgG anti-GQ1b, IgM anti-GMI and IgM anti-asialo GM1 titres. CONCLUSIONS: The pharyngeal-cervical-brachial variant is a clinical condition with its own clinical characteristics and well-established diagnostic criteria that allow it to be distinguished from the other variants of GBS. Our case highlights the wide clinical spectrum of acute inflammatory demyelinating polyradiculoneuropathies and the important degree of heterogeneity that exists as regards the immunological parameters.

Variante faringocervicobraquial del síndrome de Guillain-Barré: una entidad clínica bien definida con un perfil inmunológico heterogéneo / Pharyngel-cervical-brachial variant of guillain-barre syndrome: A well-defined clinical condition with a heterogeneous immunological profile

Introducción. Una variante poco frecuente del síndrome de Guillain-Barré (SGB) es la faringocervicobraquial. Dicha variante posee aspectos clínicos específicos, pero un perfil inmunológico heterogéneo. Caso clínico. Varón de 38 años de edad que presentó cuadro progresivo de disfagia, disfonía y debilidad para movilizar las extremidades superiores. Dos semanas antes, presentó un cuadro diarreico autolimitado. Mostraba paresia facial periférica bilateral de predominio derecho, y paresia de los IX y XII pares craneales y de miembros superiores (proximal 0/5, distal 1/5), sin afectación de la fuerza en miembros inferiores, sensibilidad conservada y reflejos osteotendinosos disminuidos (0 en miembros superiores y + en inferiores). A las 24 horas de ingreso sufrió deterioro respiratorio grave, que requirió traslado a la Unidad de Cuidados Intensivoscon ventilación mecánica invasiva. La electronis-tagmografía/electromiograma mostró un grave daño desmielinizante de predominio cefálico y cierto componente axonal. Inmunológicamente destacó la presencia de títulos positivos de IgG anti-GQ1b, IgM anti-GM1 e IgM anti-asialo GM1. Conclusiones. La variante faringocervicobraquial es una entidad clínica con características clínicas propias y criterios diagnósticos establecidos que permiten distinguirla de las otras variantes del SGB. Nuestro caso pone de relieve el amplio espectro clínico de las polirradiculoneuropatías desmielinizantes inflamatorias agudas y la gran heterogeneidad existente respecto a parámetros inmunológicos

Introduction. The pharyngeal-cervical-brachial variant of Guillain-Barré syndrome (GBS) is rare. This variant has its own specific clinical aspects but a heterogeneous immunological profile. Case report. A 38-year-old male who presented progressive symptoms of dysphagia, dysphonia and weakness hindering movement of the upper limbs. Two weeks earlier, the patient had presented acute self-limiting diarrhoea. He displayed predominantly right-side bilateral peripheral facial paresis, and paresis of the 9th and 12th cranial nerves and upper limbs (proximal 0/5, distal 1/5), although strength in the lower limbs was not compromised; sensitivity was preserved and deep tendon reflexes were diminished (0 in the upper limbs and + in thelower extremities). At 24 hours after admission, he suffered severe respiratory distress and had to be moved to the Intensive Care Unit with invasive mechanical ventilation. An electronystagmography/electromyogram study revealed severe demyelinating damage that predominantly involved the brain, but also included a small axonal component. The most striking immunologicalfinding was the presence of positive IgG anti-GQ1b, IgM anti-GMI and IgM anti-asialo GM1 titres. Conclusions. Thepharyngeal-cervical-brachial variant is a clinical condition with its own clinical characteristics and well-established diagnostic criteria that allow it to be distinguished from the other variants of GBS. Our case highlights the wide clinical spectrum of acute inflammatory demyelinating polyradiculoneuropathies and the important degree of heterogeneity that existsas regards the immunological parameters

[Experiences with the Eurotest in neuropsychological examinations. A screening test]. / Experiencia con el Eurotest en la exploración neuropsicológica. Un test de cribado.

INTRODUCTION: The increasing number of foreign patients being attended in our health centres makes it necessary to have tests that are compatible among different countries, especially in Europe. The objective of this study is to compare the Eurotest with other screening tests and to determine whether there are any differences between European (other than Spanish) and Spanish patients. PATIENTS AND METHODS: We included patients who were referred because of complaints that were compatible with cognitive impairment and they were asked to carry out a protocol of tests that included the global deterioration scale (GDS), Folstein's MMSE (Mini-Mental State Examination), the Clock Test (CT) and the Eurotest. Epidemiological data were collected. The sample used in the study included 45 patients, 21 males and 24 females, with a mean age of 69.76 years; 34 were born in Spain and 11 abroad. RESULTS: Diagnoses were 17 with mild cognitive impairment, 8 with Alzheimer's disease, 6 with age-associated impairment, 5 with vascular dementia, 5 with a psychiatric disorder, 1 with mixed dementia and 1 with dementia with Lewy bodies. The distribution according to the GDS was as follows: 10 with a GDS of 2, 18 with a GDS of 3, and 17 with a GDS of 4. All the patients with a GDS 2 completed the tests correctly, those with a GDS 3 scored below the cut-off point 5 for the Eurotest, 4 for the MMSE and 3 for CT, and in the GDS 4 they were 9, 7 and 6, respectively. Results did not vary between Spaniards and foreigners, the kappa index between MMSE and the Eurotest was 0.39 and the Pearson coefficient was 0.67. CONCLUSION: The Eurotest was slightly more useful in patients with a greater degree of impairment.

Experiencia con el Eurotest en la exploración neuropsicológica. Un test de cribado / Experiences with the eurotest in neuropsychological examinations. A screening test

Introducción. El incremento de pacientes extranjeros atendidos en nuestras consultas hace necesario disponer de tests compatibles entre múltiples países, especialmente del ámbito europeo. El objetivo del estudio es comparar el Eurotest con otros tests de cribado y comprobar si existen diferencias entre pacientes europeos (no españoles) y españoles. Pacientes y métodos. Incluimos pacientes remitidos por presentar quejas compatibles con deterioro cognitivo; se les realizó un protocolo de tests para su estudio, que incluyó la escala global de deterioro (GDS), el MMSE (Mini-Mental state examination) de Folstein, el test del reloj (TR) y el Eurotest. Recogimos datos epidemiológicos. Fueron 45 pacientes, 21 hombres y 24 mujeres, con una edad media de 69,76 años, 34 nacieron en España y 11 fuera. Resultados. Los diagnósticos fueron 17 con deterioro cognitivo leve, 8 con enfermedad de Alzheimer, 6 con deterioro asociado a la edad, 5 con demencia vascular, 5 con trastorno psiquiátrico, 1 con demencia mixta y 1 con demencia por cuerpos de Lewy. La distribución según GDS fueron: 10 con GDS de 2, 18 con GDS de 3, y 17 con GDS de 4. Todos los pacientes con GDS 2 realizaron los tests correctamente, con GDS 3 dieron por debajo del punto de corte 5 para Eurotest, 4 para MMSE y 3 para TR, y en GDS 4 fueron 9, 7 y 6, respectivamente. Los resultados no variaron entre españoles y extranjeros, el índice kappa entre MMSE y Eurotest fue de 0,39, y el coeficiente de Pearson, de 0,67. Conclusión. El Eurotest fue ligeramente más útil en pacientes más deteriorados (AU)

Introduction. The increasing number of foreign patients being attended in our health centres makes it necessary to have tests that are compatible among different countries, especially in Europe. The objective of this study is to compare the Eurotest with other screening tests and to determine whether there are any differences between European (other than Spanish) and Spanish patients. Patients and methods. We included patients who were referred because of complaints that were compatible with cognitive impairment and they were asked to carry out a protocol of tests that included the global deterioration scale (GDS), Folstein’s MMSE (Mini-Mental State Examination), the Clock Test (CT) and the Eurotest. Epidemiological data were collected. The sample used in the study included 45 patients, 21 males and 24 females, with a mean age of 69.76 years; 34 were born in Spain and 11 abroad. Results. Diagnoses were 17 with mild cognitive impairment, 8 with Alzheimer's disease, 6 with age-associated impairment, 5 with vascular dementia, 5 with a psychiatric disorder, 1 with mixed dementia and 1 with dementia with Lewy bodies. The distribution according to the GDS was as follows: 10 with a GDS of 2, 18 with a GDS of 3, and 17 with a GDS of 4. All the patients with a GDS 2 completed the tests correctly, those with a GDS 3 scored below the cutoff point 5 for the Eurotest, 4 for the MMSE and 3 for CT, and in the GDS 4 they were 9, 7 and 6, respectively. Results did not vary between Spaniards and foreigners, the kappa index between MMSE and the Eurotest was 0.39 and the Pearson coefficient was 0.67. Conclusion. The Eurotest was slightly more useful in patients with a greater degree of impairmen (AU)

Infarto migrañoso y citrato de clomifeno / Migrainous infarction and clomiphene citrate

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Trombosis venosa cerebral y enfermedad inflamatoria intestinal / Cerebral venous thrombosis and inflammatory bowel disease

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