Encefalopatía subaguda con respuesta a esteroides sin evidencia de enfermedad autoinmune tiroidea: un caso de meningoencefalitis autoinmune no vasculítica / Sub-acute encephalopathy that responds to sterorids without any evidence of autoinmune thyroid disease a case of non-vasculitic autoimmune nm

Aim. To report a case of sub-acute encephalopathy with all the extension study negative and with response to steroid therapy. Case report. The study involves a 22-year-old female with no relevant past history who presented symptoms of sub-acute encephalopathy consisting in behavioural disorders, generalised seizures and bradypsychia, which gradually progressed to a state of low-level consciousness. While she was in hospital all kinds of diagnostic tests were conducted, the results of which were either normal or negative; the electroencephalogram was repeatedly abnormal and detection of protein 14-3-3 in cerebrospinal fluid was positive. Empirical corticoid therapy was begun with clinical and electrophysiological improvements and the patient recovered completely without any sequelae. Conclusions. With no evidence of autoimmune thyroid disease, although non-specific autoimmunity was present, the patient was diagnosed as having non-vasculitic autoimmune meningoencephalitis (AU)

Objetivo. Presentar un caso de encefalopatía subaguda con todo el estudio de extensión negativo y con respuesta a terapia esteroidea. Caso clínico. Mujer de 22 años sin antecedentes de interés que presentó un cuadro de encefalopatía subaguda consistente en alteraciones del comportamiento, crisis generalizadas y bradipsiquia, que evolucionó progresivamente a un estado de bajo nivel de conciencia. Durante su ingreso se realizaron todo tipo de pruebas diagnósticas, que fueron normales o negativas; el electroencefalograma fue repetidamente anormal y se detectó positividad de la proteína 14-3-3 en el líquido cefalorraquídeo. Se inició corticoterapia empírica con mejoría clínica y electrofisiológica, y recuperación ad integrum sin secuelas. Conclusiones. Sin la evidencia de enfermedad autoinmune tiroidea, aunque con presencia de autoinmunidad no específica, se diagnosticó a la paciente meningoencefalitis autoinmune no vasculítica (AU)

[Sub-acute encephalopathy that responds to steroids without any evidence of autoimmune thyroid disease: a case of non-vasculitic autoimmune meningoencephalitis]. / Encefalopatía subaguda con respuesta a esteroides sin evidencia de enfermedad autoinmune tiroidea: un caso de meningoencefalitis autoinmune no vasculítica.

AIM: To report a case of sub-acute encephalopathy with all the extension study negative and with response to steroid therapy. CASE REPORT: The study involves a 22-year-old female with no relevant past history who presented symptoms of sub-acute encephalopathy consisting in behavioural disorders, generalised seizures and bradypsychia, which gradually progressed to a state of low-level consciousness. While she was in hospital all kinds of diagnostic tests were conducted, the results of which were either normal or negative; the electroencephalogram was repeatedly abnormal and detection of protein 14-3-3 in cerebrospinal fluid was positive. Empirical corticoid therapy was begun with clinical and electrophysiological improvements and the patient recovered completely without any sequelae. CONCLUSIONS: With no evidence of autoimmune thyroid disease, although non-specific autoimmunity was present, the patient was diagnosed as having non-vasculitic autoimmune meningoencephalitis.

[Reye's syndrome. Description of a case focused on the patient's epileptic seizures]. / Síndrome de Reye. Descripción de un caso con especial interés en sus crisis epilépticas.

INTRODUCTION: Reye's syndrome is an acute disease characterised by encephalopathy and fatty degeneration of the liver that occurs almost exclusively in children. It can cause the death of the patient in up to a third of all cases, generally due to severe cerebral oedema. The aetiopathogenesis of this condition is uncertain and is usually preceded by a viral infection, generally from the influenza or varicella virus. Some studies have shown a strong epidemiological association between the ingestion of acetylsalicylic acid (ASA) during the viral infection and development of Reye's syndrome. CASE REPORT: We describe the case of a 20-month-old female who developed Reye's syndrome within the context of a viral infection and the ingestion of ASA. A hepatic biopsy study is appropriate in this syndrome. The patient presented a non-convulsive status during the acute phase and at one year developed Lennox-Gastaut syndrome. She died from pneumonia at the age of 18 years. CONCLUSIONS: In all patients with clinical features that suggest Reye's syndrome, inborn errors of metabolism that can mimic it must be precluded. Although the incidence of this syndrome has gone down considerably in recent years, it is important to keep it in mind as an early and aggressive diagnosis and treatment of cerebral hypertension will reduce the mortality rate and the sequelae.

[Implication of the neuropeptides methionine enkephalin, neurotensin and somatostatin of the caudal trigeminal nucleus in the experimental migraine]. / Implicación de los neuropéptidos metionina-encefalina, neurotensina y somatostatina del núcleo caudal del trigémino en la migraña experimental.

INTRODUCTION: Primary peptidergic sensory neurons of the trigeminal ganglion that innervate the cerebral dura have been involved in the pathogenesis of headache, including the migraine. In addition, it is known that nociceptive central processes of the trigeminal neurons terminate in the caudal trigeminal nucleus. Moreover, the electrical stimulation of the trigeminal ganglion has been used as an experimental model in order to study the vascular headache, including the migraine. AIM: To study whether there is or not a decrease of the immunoreactivity for methionine enkephalin, somatostatin and neurotensin in the caudal trigeminal nucleus after electrical stimulation of the trigeminal ganglion. MATERIAL AND METHODS: The trigeminal ganglia of Wistar albino rats of both sexes were electrically stimulated (frequency, 5 Hz; duration, 5 ms; intensity, 0,8 1.4 mA) and unilaterally for five minutes. Sections of the medulla oblongata containing the caudal trigeminal nucleus were obtained and processed for immunocytochemistry, in which specific antibodies were used against methionine enkephalin, neurotensin and somatostatin 28. RESULTS: In stimulated animals, we observed a decrease in the immunoreactivity for the three neuropeptides studied in the stimulated (ipsilateral) side, in comparison with the not stimulated side (contralateral). In control animals (not stimulated) the degree of the immunoreactivity was the same on both sides. CONCLUSIONS: 1. The decrease of the immunoreactivity in the ipsilateral side (stimulated) suggests that methionine enkephalin, neurotensin and somatostatin 28 are released in the caudal trigeminal nucleus after electrical stimulation of the trigeminal ganglion; 2. Methionine enkephalin and somatostatin 28 could act in the caudal trigeminal nucleus as inhibitors (with antinociceptive action) of another released exciters neuropeptides (with nociceptive action); and 3. These data will allow in the future to try new therapeutic strategies (e.g., the inhibition of the receptors implicated.), in order to alleviate certain headaches.