Percepción de la validez del cuestionario Migraine Disability Assessment por una población de pacientes con migraña crónica / Perception of the validity of the Migraine Disability Assessment questionnaire in a population of patients with chronic migraine

Objetivos: El cuestionario Migraine Disability Assessment (MIDAS) es el instrumento más empleado para valorar el grado de discapacidad en los estudios de migraña. El objetivo del estudio es determinar el nivel de cumplimentación del cuestionario, valorar su facilidad de uso y conocer la percepción subjetiva del paciente sobre la capacidad del cuestionario para medir realmente su discapacidad.Material y métodosEstudio prospectivo sobre una población de 78 pacientes con migraña crónica. Se determina el nivel educativo y la situación laboral. En la visita basal se adiestra a los pacientes sobre la correcta cumplimentación del cuestionario. A los 3 meses se determina la puntuación total y el nivel de cumplimentación. Además los pacientes contestan una encuesta que mide: facilidad de uso y percepción del paciente sobre si la escala refleja su propia discapacidad.ResultadosSolo el 46% rellena completamente el cuestionario. El 69% de los pacientes indica que el cuestionario no les resulta fácil de cumplimentar (resultado no influido por el nivel educativo, pero sí por la situación laboral de los pacientes). El 62% de los encuestados opina que el cuestionario no refleja completamente su propia percepción de discapacidad.ConclusionesAunque está más que demostrada la validez y consistencia del cuestionario MIDAS, un porcentaje elevado de nuestra población reconoce que el cuestionario no es fácil de rellenar y además es percibido por muchos de nuestros pacientes como un cuestionario que no refleja adecuadamente su discapacidad. Conocer la opinión de los pacientes sobre la idoneidad de los cuestionarios administrados en las consultas es crucial para mejorar su cumplimentación. (AU)

Objectives: The Migraine Disability Assessment (MIDAS) questionnaire is the most frequently used instrument for assessing the level of disability in studies into migraine. This study aims to determine the level of completion of the questionnaire, assess the ease of use, and understand patients’ subjective perception of the questionnaire's actual ability to measure disability.Material and methodsWe performed a prospective study of a sample of 78 patients with chronic migraine, determining their level of education and employment status. In a baseline visit, patients were trained to properly complete the questionnaire. At 3 months, we determined the total score and level of completion. Patients also completed a survey measuring ease of use of the questionnaire and patients’ perception of whether the score accurately reflected their disability.ResultsOnly 46% of patients fully completed the questionnaire. Sixty-nine percent reported finding it difficult to complete (this was influenced by patient's employment status but not by educational level). Sixty-two percent of respondents believed that the questionnaire did not fully reflect their own perception of their disability.ConclusionsAlthough the validity and consistence of the MIDAS questionnaire are well documented, a high percentage of the study population reported finding it difficult to complete; many patients also considered that the questionnaire did not accurately reflect their disability. Understanding patients’ opinions of the suitability of questionnaires used in consultation is crucial to improving completion. (AU)

Perception of the validity of the Migraine Disability Assessment questionnaire in a population of patients with chronic migraine.

OBJECTIVES: The Migraine Disability Assessment (MIDAS) questionnaire is the most frequently used instrument for assessing the level of disability in studies into migraine. This study aims to determine the level of completion of the questionnaire, assess the ease of use, and understand patients' subjective perception of the questionnaire's actual ability to measure disability. MATERIAL AND METHODS: We performed a prospective study of a sample of 78 patients with chronic migraine, determining their level of education and employment status. In a baseline visit, patients were trained to properly complete the questionnaire. At 3 months, we determined the total score and level of completion. Patients also completed a survey measuring ease of use of the questionnaire and patients' perception of whether the score accurately reflected their disability. RESULTS: Only 46% of patients fully completed the questionnaire. Sixty-nine percent reported finding it difficult to complete (this was influenced by patient's employment status but not by educational level). Sixty-two percent of respondents believed that the questionnaire did not fully reflect their own perception of their disability. CONCLUSIONS: Although the validity and consistence of the MIDAS questionnaire are well documented, a high percentage of the study population reported finding it difficult to complete; many patients also considered that the questionnaire did not accurately reflect their disability. Understanding patients' opinions of the suitability of questionnaires used in consultation is crucial to improving completion.

Reversible Homonymous Inferior Quadrantanopia in a Nonketotic Hyperglycemic Patient.

Homonymous hemianopia is frequently associated with retrochiasmal lesions. Vascular etiology is the most common and usually evident on magnetic resonance imaging. When the results of neuroimaging are normal, there are other etiologies that we should consider, like nonketotic hyperglycemia (NKH). We report a 62-year-old female diabetic patient with headache, colour vision and sudden homonymous inferior quadrantanopia and elevated blood sugar levels with normal pH. The neuroimaging was normal and the visual lost improved after the correction of the hyperglycemia. NKH should be considered in patients with sudden and transient hemianopia and normal neuroimaging.

Perception of the validity of the Migraine Disability Assessment questionnaire in a population of patients with chronic migraine. / Percepción de la validez del cuestionario Migraine Disability Assessment por una población de pacientes con migraña crónica.

OBJECTIVES: The Migraine Disability Assessment (MIDAS) questionnaire is the most frequently used instrument for assessing the level of disability in studies into migraine. This study aims to determine the level of completion of the questionnaire, assess the ease of use, and understand patients' subjective perception of the questionnaire's actual ability to measure disability. MATERIAL AND METHODS: We performed a prospective study of a sample of 78 patients with chronic migraine, determining their level of education and employment status. In a baseline visit, patients were trained to properly complete the questionnaire. At 3 months, we determined the total score and level of completion. Patients also completed a survey measuring ease of use of the questionnaire and patients' perception of whether the score accurately reflected their disability. RESULTS: Only 46% of patients fully completed the questionnaire. Sixty-nine percent reported finding it difficult to complete (this was influenced by patient's employment status but not by educational level). Sixty-two percent of respondents believed that the questionnaire did not fully reflect their own perception of their disability. CONCLUSIONS: Although the validity and consistence of the MIDAS questionnaire are well documented, a high percentage of the study population reported finding it difficult to complete; many patients also considered that the questionnaire did not accurately reflect their disability. Understanding patients' opinions of the suitability of questionnaires used in consultation is crucial to improving completion.

Síndrome del canal de Alcock secundario a infiltración por endometriosis / Alcock canal syndrome secondary to endometrial infiltration

No disponible

Folletos de información educativa en migraña: satisfacción percibida en un grupo de pacientes / Migraine education brochures and patient-perceived satisfaction

Introducción: Los folletos informativos son una herramienta educativa habitual en la práctica neurológica diaria; mediante este mecanismo se pretende incrementar de primera mano los conocimientos que la población tiene sobre una enfermedad concreta, además de evitar fuentes de información erróneas. Las encuestas son el medio más empleado para conocer la satisfacción de los usuarios con los servicios recibidos. Objetivos: Evaluar la satisfacción percibida y establecer una retroalimentación informativa que valore la comprensión y la utilidad global de un folleto educativo sobre migraña. Material y métodos: Estudio abierto, prospectivo y multicéntrico sobre una población de pacientes diagnosticados de migraña en diversas consultas de neurología de la provincia de Alicante. En la visita basal se les entrega un folleto informativo de migraña confeccionado por el grupo de estudio para la cefalea de la Sociedad Valenciana de Neurología (CEFALIC). En la visita control se les solicita la cumplimentación de una encuesta personal y por escrito sobre la calidad global de la información incluida en el folleto. Resultados: Se incluye a un total de 257 pacientes diagnosticados de migraña (83% migraña episódica; 17% migraña crónica), con una edad media de 37,6 años. Confirmaron la lectura del folleto 207 paciente (80,5%) y no lo habían leído 50 pacientes (19,5%), bien por olvido bien por desinterés. Al 90% de los pacientes la lectura del folleto les pareció interesante y comprensible. El 76% de los encuestados opina que la lectura del folleto incrementa sus conocimientos sobre migraña. El 50% de los pacientes opina que el folleto resultó de utilidad para mejorar el control de su migraña. Conclusiones: La utilización de un folleto educativo sobre migraña resultó comprensible, además incrementó el conocimiento global de la enfermedad y en opinión de los pacientes resultó útil para mejorar el control de su migraña. La evaluación de la información educativa que prestamos a nuestros pacientes con migraña debe ser medida para descubrir las causas de descontento, determinar el nivel de calidad del servicio e investigar las posibilidades de mejora de calidad

Introduction: Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. Objectives: This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. Material and methods: Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. Results: We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. Conclusions: Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement

Eyelid myokymia in patients with migraine taking topiramate.

OBJECTIVE: Although ocular side effects of topiramate are common, neuroophthalmologic manifestations such as blepharospasm, myokymia and oculogyric crisis are scarcely reported. METHODS: We present a serie of 8 patients with migraine who developed eyelid myokymia after treatment with topiramate. We reviewed all patients with migraine treated with topiramate attending the headache outpatient clinic of our hospital from January 2008 to December 2012. RESULTS: During the study period, a total of 140 patients with migraine were treated with topiramate in our headache clinic. Eight presented eyelid myokymia after beginning treatment with topiramate (5,7%). Topiramate was stopped and myokymia disappeared in all patients, it was prescribed again and eyelid myokymia reappeared with their previous characteristics in all patients. CONCLUSIONS: Eyelid myokymia is an underreported side-effect of topiramate in patients with migraine, of unknown cause, so that in future, further studies are need to examine whether patients with migraine are predisposed or not to this adverse effect.

Réplica: Red de cuidadores informales de los pacientes con demencia en la provincia de Alicante, descripción de sus características / Reply to: "informal caregivers network of patients with dementia in Alicante province, characteristics description"

No disponible

Migraine education brochures and patient-perceived satisfaction.

INTRODUCTION: Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. OBJECTIVES: This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. MATERIAL AND METHODS: Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. RESULTS: We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. CONCLUSIONS: Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement.

Red de cuidadores informales de los pacientes con demencia en la provincia de Alicante, descripción de sus características / Characteristics of informal caregivers of patients with dementia in Alicante province

Introducción: Los cuidadores informales garantizan el cuidado de los pacientes con demencia, prolongando la estancia en su domicilio. Objetivos: Describir las características de los pacientes con demencia de la provincia de Alicante, así como los perfiles y roles de los cuidadores implicados en su manejo. Pacientes y métodos: Estudio prospectivo multicéntrico realizado en 4 consultas de neurología de la provincia de Alicante (junio del 2009-enero del 2010). Inclusión consecutiva de familiares/cuidadores de pacientes con demencia. Analizamos: a) datos demográficos del paciente y cuidadores (edad/sexo, estado civil/laboral, estudios, parentesco); b) unidad de convivencia del paciente; c) motivación para el cuidado del cuidador principal (CP); d) roles del cuidador secundario (CS); e) nacionalidad del cuidador formal (CF) y origen remuneración (privada/institucional), y f) formación en demencias de los cuidadores. Resultados: Nuestros pacientes residen en su domicilio (74,8%). Principalmente, son mujeres (69%) con enfermedad de Alzheimer (78,4%) moderadamente grave (GDS 4-5, 71,6%). CP y CS son mujeres (72,1% vs 60,5%), de edad media, parentesco directo (hijo/a 64,3% vs 54,4%), nivel cultural bajo y amas de casa. Las primeras garantizan el cuidado por obligación moral (75%), las segundas se ocupan del ocio/estimulación del paciente (82,3%). Los grandes ausentes son los varones (73,3%), quienes residen lejos del familiar (52,4%). El CF es una mujer (91,7%), espa˜nola (81,8%) con remuneración privada. Conclusiones: La mujer es el elemento principal en la red de cuidadores de pacientes con demencia: como CP, de apoyo o CF (todos con escasa formación en demencias), siendo el varón el gran ausente. Conocer la estructura de cuidados de estos pacientes facilitará su manejo (AU)

Introduction: Informal caregivers provide care to dementia patients, and this service prolongs their stay at home. Objectives: To describe characteristics of dementia patients in the province of Alicante, as well as the profiles and roles of caregivers who assist them. Patients and methods: Multi-centre prospective study carried out in 4 neurology departments in Alicante (June 2009 to January 2010). Dementia patients’ relatives/caregivers were included in sequential order. The following variables were analysed: a) Demographic information pertaining to the patient and caregivers (age, sex, marital and employment status, educational level, relationship to patient); b) patient’s family unit; c) motivating factor for primary caregiver (PC); d) secondary caregiver (SC) roles; e) country of citizenship of formal caregiver (FC) and source of remuneration (private/public); f) caregivers’ knowledge of dementia. Results: Most of our patients live at home (74.8%), and are female (69%) with Alzheimer’s disease (78.4%) in a moderately severe stage (GDS level 4-5, 71.6%). PCs and SCs are mainly women (72.1% and 60.5% respectively), middle-aged and directly related to the patient (sons/daughters account for 64.3% of the PCs and 54.4% of the SCs); most are homemakers with a low educational level. Caregivers in the first category (PC) provide care due to moral obligation (75%), while those in the second (SC) involve patients in leisure or other stimulating activities (82.3%). Absent caregivers tend to be males (73.3%) residing long distances from the relative (52.4%). The FC tends to be female (91.7%), Spanish (81.8%) and privately remunerated. Conclusions: Women dominate the network of caregivers for dementia patients, whether as principal caregivers, supporting caregivers or formal caregivers (in all cases, they have only limited training in dementia management). Males are largely absent. Better knowledge of the care structure supporting dementia patients may be helpful in the overall management of these patients (AU)

Characteristics of informal caregivers of patients with dementia in Alicante province.

INTRODUCTION: Informal caregivers provide care to dementia patients, and this service prolongs their stay at home. OBJECTIVES: To describe characteristics of dementia patients in the province of Alicante, as well as the profiles and roles of caregivers who assist them. PATIENTS AND METHODS: Multi-centre prospective study carried out in 4 neurology departments in Alicante (June 2009 to January 2010). Dementia patients' relatives/caregivers were included in sequential order. The following variables were analysed: a) Demographic information pertaining to the patient and caregivers (age, sex, marital and employment status, educational level, relationship to patient); b) patient's family unit; c) motivating factor for primary caregiver (PC); d) secondary caregiver (SC) roles; e) country of citizenship of formal caregiver (FC) and source of remuneration (private/public); f) caregivers' knowledge of dementia. RESULTS: Most of our patients live at home (74.8%), and are female (69%) with Alzheimer's disease (78.4%) in a moderately severe stage (GDS level 4-5, 71.6%). PCs and SCs are mainly women (72.1% and 60.5% respectively), middle-aged and directly related to the patient (sons/daughters account for 64.3% of the PCs and 54.4% of the SCs); most are homemakers with a low educational level. Caregivers in the first category (PC) provide care due to moral obligation (75%), while those in the second (SC) involve patients in leisure or other stimulating activities (82.3%). Absent caregivers tend to be males (73.3%) residing long distances from the relative (52.4%). The FC tends to be female (91.7%), Spanish (81.8%) and privately remunerated. CONCLUSIONS: Women dominate the network of caregivers for dementia patients, whether as principal caregivers, supporting caregivers or formal caregivers (in all cases, they have only limited training in dementia management). Males are largely absent. Better knowledge of the care structure supporting dementia patients may be helpful in the overall management of these patients.

[Prevention of migraine: a pharmacoepidemiological study]. / Prevención de la migraña: un estudio farmacoepidemiológico.

INTRODUCTION: This study aims to perform a descriptive analysis of the usage patterns of migraine prophylactic medications by various neurologists in our setting. MATERIAL AND METHODS: The first preventive treatment prescribed for migraine in patients not associated to other diagnoses of primary headache was recorded in three outpatient neurology clinics and one headache specific clinic. RESULTS: A total of 235 prophylactic treatments out of 669 patients were initiated. The patients were aged 37 +/- 12 years (mean +/- standard deviation) and 84.45% were women. Migraines with aura accounted for 18.9% of migraines. By order of frequency, the prophylactic treatments administered were topiramate (43%), beta-blockers (18%), flunaricine (17%), amitriptyline (14%), selective serotonin reputake inhibitors (6%) and others (2%). Beta-blockers and flunaricine were used much more frequently in men (29.7% and 27% versus 15.9% and 14.4%, respectively) and antidepressants were used more in women (21.87% versus 5.4%). The most frequently used antidepressant was amitriptyline, and its use increases with the age of the patient, it being the most frequently used treatment in over 60-year-old patient group. CONCLUSIONS: At present, topiramate has become the first preventive treatment option for migraine in our setting, especially in young women. There is greater variability in the choice of an alternative treatment. Amitriptyline is the first choice within the antidepressants and is almost exclusively prescribed in women with migraine and elderly age.

Prevención de la migraña: un estudio farmacoepidemiológico / Prevention of migraine: a pharamacoepidemiological study

Introducción. Se realiza un análisis descriptivo de los tratamientosprofilácticos empleados para el tratamiento de la migrañapor varios neurólogos de nuestro medio.Material y métodos. Se registró el primer tratamiento preventivopautado para migraña en pacientes que no asociaban otro diagnósticode cefalea primaria. Se reclutaron durante 1 año en tres consultasde neurología ambulatoria y una específica de cefalea de laprovincia de Alicante.Resultados. De 669 pacientes totales, se iniciaron 235 tratamientosprofilácticos, con una edad de los pacientes de 37±12años (media±desviación estándar) y un 84,45 % de mujeres. Un18,9% de migrañas eran con aura. Por orden de frecuencia, los profilácticosempleados fueron el topiramato (43 %), los betabloqueantes(18%), la flunaricina (17%), la amitriptilina (14 %), inhibidoresselectivos de la recaptación de serotonina (6 %) y otros(2 %). Los betabloqueantes y la flunaricina se emplearon muchomás en el hombre (29,7 y 27 % frente a 15,9 y 14,4%, respectivamente)y los antidepresivos en la mujer (21,87 frente a 5,4 %). Elantidepresivo más empleado fue la amitriptilina, y su empleo aumentacon la edad del paciente, siendo el tratamiento más frecuenteen el grupo de más de 60 años.Conclusiones. El topiramato en la actualidad y en nuestro medioes la primera opción en el tratamiento preventivo de la migraña,sobre todo en la mujer joven. La variabilidad es mayor en la eleccióndel tratamiento alternativo. La amitriptilina es la primera opcióndentro de los antidepresivos y se prescriben casi exclusivamente en lamujer con migraña y en edades avanzadas (AU)

Introduction. This study aims to perform a descriptiveanalysis of the usage patterns of migraine prophylactic medicationsby various neurologists in our setting.Material and methods. The first preventive treatment prescribedfor migraine in patients not associated to other diagnosesof primary headache was recorded in three outpatient neurologyclinics and one headache specific clinic.Results. A total of 235 prophylactic treatments out of 669patients were initiated. The patients were aged 37±12 years(mean±standard desviation) and 84.45% were women. Migraineswith aura accounted for 18.9% of migraines. By order of frequency,the prophylactic treatments administered were topiramate(43%), beta-blockers (18%), flunaricine (17%), amitriptyline(14%), selective serotonin reputake inhibitors (6 %) and others(2 %). Beta-blockers and flunaricine were used much more frequentlyin men (29.7% and 27% versus 15.9% and 14.4%, respectively)and antidepressants were used more in women(21.87% versus 5.4%). The most frequently used antidepressantwas amitriptyline, and its use increases with the age of the patient,it being the most frequently used treatment in over 60 yearold patient group.Conclusions. At present, topiramate has become the firstpreventive treatment option for migraine in our setting, especiallyin young women. There is greater variability in the choiceof an alternative treatment. Amitriptyline is the first choice withinthe antidepressants and is almost exclusively prescribed inwomen with migraine and elderly age (AU)

[Headache, does it cause a health care overload in primary health care? Urban area vs rural area medical visit]. / Cefalea, ¿una sobrecarga asistencial en atención primaria? Consulta urbana frente a consulta rural.

OBJECTIVES: Headache causes an overload and a problem to out-patient neurology. There are few studies that quantify the overload that the headache causes in a primary health care out-patient clinic visit. The aim of the present study is to identify and quantify the real load that this disease supposes in two primary health care consultations, one located in a rural area and another in an urban area. MATERIAL AND METHODS: A 6 month long observational and descritive study. The total number of patients seen, the number of patients seen for headache and their diagnostic classification were recorded. RESULTS: A total of 6,014 visits were counted. Only 46 patients consulted due to headache (0,76%). Tensional headache was the most frequently diagnosed headache (43.48%) followed by migraine (23.91%). CONCLUSIONS: Our study verifies that published by other authors and determines that, on the contrary to that which occurs in the neurology out-patient clinic, headache does not cause a daily work overload for the general practitioner. The scarce number of consultations for headache, with the diagnosis and management involved in this disease, makes it necessary to consider a multidisciplinary health care problem such as headache differently according to the health care level involved.

Angeítis aislada del sistema nervioso central / Isolated cerebral angiitis

Introducción. La angeítis granulomatosa aislada del sistema nervioso central se define histológicamente por la presencia de una inflamación granulomatosa que se distribuye desde los vasos meníngeos y se extiende hacia el parénquima a lo largo de venas y de arterias de calibre variable. Las alteraciones clínicas más frecuentes en estos pacientes son la cefalea y cuadros de encefalopatía. Caso clínico. Presentamos el caso clínico de una paciente que inicia crisis convulsivas de inicio parcial con generalización secundaria, diagnosticado mediante biopsia cerebral, con buena respuesta clínica al tratamiento inmunosupresor (corticoides y ciclofosfamida). Realizamos una actualización bibliográfica sobre esta patología. Conclusiones. La sintomatología tan heterogénea que presentan los pacientes con esta patología provoca en numerosas ocasiones confusión y retraso en el diagnóstico. La confirmación histológica mediante la realización de una biopsia cerebral y meníngea es el parámetro determinante para el diagnóstico de la angeítis granulomatosa del sistema nervioso central (AU)

Introduction: Isolated cerebral angiitis of the central nervous system is defined histologically by presence of granulomatous inflammation in the meningeal vessels, and parenchyma throughout veins and arteries of variable size. The most common clinical manifestations are headache and encephalopathy. Case Report: We present the clinical case of a patient with epileptic seizures of focal onset, secondary generalized, diagnosed by cerebral biopsy. Clinical response to immunosuppressive treatment (corticosteroid and cyclophosphamyde) was excellent. We make a bibliographic review and update. Conclusion: The heterogeneous clinical symptomatology of this disease leads to confusion and delay in diagnosis. Histological confirmation by cerebral and meningeal biopsy is the best parameter for diagnosis of isolated cerebral angiitis of the central nervous system (AU)

[Isolated cerebral angiitis]. / Angeítis aislada del sistema nervioso central.

INTRODUCTION: Isolated cerebral angiitis of the central nervous system is defined histologically by presence of granulomatous inflammation in the meningeal vessels, and parenchyma throughout veins and arteries of variable size. The most common clinical manifestations are headache and encephalopathy. CASE REPORT: We present the clinical case of a patient with epileptic seizures of focal onset, secondary generalized, diagnosed by cerebral biopsy. Clinical response to immunosuppressive treatment (corticosteroid and cyclophosphamyde) was excellent. We make a bibliographic review and update. CONCLUSION: The heterogeneous clinical symptomatology of this disease leads to confusion and delay in diagnosis. Histological confirmation by cerebral and meningeal biopsy is the best parameter for diagnosis of isolated cerebral angiitis of the central nervous system.

[Amaurosis fugax as the sole manifestation of a dural arteriovenous fistula]. / Amaurosis fugaz como única manifestación de una fístula arteriovenosa dural.

INTRODUCTION: Ophthalmologic disorders caused by arteriovenous malformations (AVM) are generally related with alterations in the cavernous sinus or papilloedema. However, the appearance of amaurosis fugax (AF) as the sole clinical manifestation of an AVM has very rarely been reported in the literature. CASE REPORT: We present the case of a 64 year old male patient who displayed recurring episodes of temporary monocular blindness (AF) as a consequence of the haemodynamic disorders triggered off in the course of a dural AVM. DISCUSSION: The arteriovenous fistula, located in the anterior fossa, gives rise to theft phenomena in the region of the arteries that nourish the retina and trigger episodes of AF of an essentially haemodynamic nature.

Amaurosis fugaz como única manifestación de una fístulaarteriovenosa dural / Amaurosis fugax as the sole manifestation of a dural arteriovenous fistula

Introducción. Las alteraciones oftalmológicas provocadas por malformaciones arteriovenosas (MAV) se relacionan generalmente con alteraciones en el seno cavernoso o papiledema. Sin embargo, la aparición de amaurosis fugaz (AF) como única manifestación clínica de una MAV, sólo se ha reflejado en la literatura de manera excepcional. Caso clínico. Presentamos el caso de un paciente de 64 años, que manifiesta episodios recurrentes de ceguera monocular transitoria (AF), como consecuencia de las alteraciones hemodinámicas desencadenadas en el seno de una MAV dural. Discusión. La fístula arteriovenosa, localizada en la fosa anterior, provoca fenómenos de robo en el territorio de las arterias que nutren la retina y desencadena episodios de AF de carácter fundamentalmente hemodinámico (AU)