Aumento de la confianza en la interpretación del PET con 18F-Florbetaben: “machine learning” basado en la aproximación cuantitativa / Increasing the confidence of 18F-florbetaben PET interpretations: Machine learning quantitative approximation

Objetivo: Determinar el valor a-adido de los parámetros semicuantitativos en el análisis visual y estudiar los patrones del depósito cerebral de 18F-Florbetaben. Material y métodos: Análisis retrospectivo de pacientes con deterioro cognitivo leve o demencia de origen incierto procedentes de un estudio multicentrico. Los PET con 18F-Florbetaben fueron interpretados de forma visual por dos observadores independientes, analizando las regiones “diana” con la finalidad de calcular el acuerdo interobservador. Se realizó análisis semicuantitativo de todas las regiones corticales con respecto a tres regiones de referencia para obtener índices de captación (SUVRs). Se analizó la capacidad de los SUVRs para predecir el resultado de la interpretación visual, la posibilidad de depósito preferencial del radiotrazador en algunas regiones “diana” así como las diferencias interhemisféricas. Resultados: Se evaluaron 135 pacientes. En la valoración visual, 72 estudios se clasificaron como positivos. El acuerdo interobservador fue excelente. Todos los SUVRs fueron significativamente superiores en pacientes con PET positivos con respecto a los negativos. Las regiones corticales correspondientes al área prefrontal y al cingulado posterior mostraron la mejor correlación con la evaluación visual, seguidas por la valoración integrada cortical. Usando análisis de ROC, los SUVRs obtenidos en las mismas regiones “diana” mostraron la mejor capacidad diagnóstica. Conclusiones: La información obtenida de las regiones “diana” parece ser de ayuda en la clasificación visual, basado en un depósito preferencial de amiloide, lo que permitiría el “machine learning”. El depósito de amiloide, aunque difuso en todas las regiones corticales, parece no ser uniforme ni simétrico (AU)

Aim: To assess the added value of semiquantitative parameters on the visual assessment and to study the patterns of 18F-Florbetaben brain deposition. Materials and methods: Retrospective analysis of multicenter study performed in patients with mild cognitive impairment or dementia of uncertain origin. 18F-Florbetaben PET scans were visually interpreted by two experienced observers, analyzing target regions in order to calculate the interobserver agreement. Semiquantification of all cortical regions with respect to three reference regions was performed to obtain standardized uptake value ratios (SUVRs). The ability of SUVRs to predict the visual evaluation, the possibility of preferential radiotracer deposition in some target regions and interhemisphere differenceswere analyzed. Results: 135 patients were evaluated. In the visual assessment, 72 were classified as positive. Interobserver agreement was excellent. All SUVRs were significantly higher in positive PET scans than in negative ones. Prefrontal area and posterior cingulate were the cortical regions with the best correlations with the visual evaluation, followed by the composite region. Using ROC analysis, the SUVRs obtained in same target locations showed the best diagnostic performance. Conclusions: The derived information from target regions seems to help the visual classification, based on a preferential amyloid deposit, allowing machine learning. The amyloid deposit, although diffuse in all cortical regions, seems not to be uniform and symmetric (AU)

Signo de la cruz (hot cross bun sign) en la atrofia multisistémica. A propósito de 3 casos / "Hot-cross bun sign" in multiple system atrophy: A presentation of 3 cases

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Oftalmoplejía completa secundaria a un infarto talámico paramediano bilateral / Complete ophthalmoplegia secondary to a bilateral paramedian thalamic infarct

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[Recurrent painful ophthalmoplegia secondary to polyostotic fibrous dysplasia of the maxillary sinuses with involvement of the superior orbital fissure]. / Oftalmoplejia dolorosa recurrente secundaria a displasia fibrosa poliostotica del seno maxilar con afectacion de la hendidura esfenoidal.

INTRODUCTION: Fibrous dysplasia is a bone disease that is usually accompanied by asymptomatic lesions but which may sometimes display neurological manifestations due to the involvement of the craniofacial bones. CASE REPORT: A 25-year-old female, with a history of migraines, who visited at the age of 18 due to pain in the right retro-ocular and maxillary region, although with characteristics that were unlike those of her usual migraines, and which was associated with ipsilateral ophthalmoparesis. The condition had a self-limiting course and responded well to corticoids, although it was recurring. Examination revealed intense pain on palpation of the right-hand maxillary sinus and incomplete paralysis of the ipsilateral oculomotor nerve with palpebral ptosis. Results of complementary studies were normal, except for magnetic resonance imaging of the head and computerised axial tomography of the face, which revealed an expansive lesion with involvement of the right superior maxillary sinus and the greater wing of the sphenoid bone, with probable compromise of the superior orbital fissure, consistent with the diagnosis of fibrous dysplasia, which was confirmed by means of a pathology study. CONCLUSIONS: Fibrous dysplasia is a benign bone disorder, of unknown causation, in which normal bone tissue is replaced by amorphous conjunctive tissue. There is sometimes craniofacial involvement and a hypertrophic bone mass is formed which can fill the paranasal sinuses and the orbit, resulting in exophthalmus and visual disorders. To date the scientific literature does not include any reports of this disease manifesting as bouts of recurrent painful ophthalmoparesis which responds to corticoids, as happened in the case of our patient.

[Neurological sequelae following electrocution. A case report and review of the literature]. / Secuelas neurológicas tras electrocución. Presentación de un caso y revisión de la bibliografía.

INTRODUCTION: Electrocution is the cause of a large number of accidents and, of these, a considerable percentage result in death. Several factors affect the severity and distribution of the injuries. It is known that for low voltages the characteristics of alternating current make it three times more dangerous than continuous current. The high percentage of neurological sequelae can be accounted for by the fact that nerves are the tissue with the lowest resistance in the body and electricity tends to follow the path that offers the least resistance. CASE REPORT: A 16-year-old male who was accidentally electrocuted by an electric guitar and later suffered a cardiorespiratory arrest; the patient required intubation. After withdrawing sedation, the patient was found to be blind in both eyes and could not remember what had happened. FLAIR MR imaging revealed oedema in both occipital lobes and, to a lesser extent, in the junction between the parietooccipital and temporooccipital lobes. Treatment with steroids was established for three days. After approximately one month, the patient had recovered his sight and the brain injuries had disappeared. CONCLUSIONS: The neurological manifestations secondary to accidents caused by electricity are usually divided into two types -immediate and delayed. Blindness has rarely been reported as a sequela in those who have survived fulguration due to a lightning strike. The patient's recovery after administering treatment with steroids and the reversibility of the oedema could lead us to think that the mechanism producing this sequela was the damage to the nervous system caused directly by the electricity, which is known as the 'phenomenon of electroporation'.

Secuelas neurológicas tras electrocución. Presentación de un caso y revisión de la bibliografía / Neurological sequelae following electrocution. A case report and review of the literature

Introducción. La electrocución genera un gran númerode accidentes y, de éstos, un porcentaje no desestimable termina enmuerte. Existen factores que influyen en la gravedad y la distribuciónde las lesiones. Se conoce que, debido a sus características, lacorriente alterna para voltajes bajos es tres veces más peligrosa quela continua. El alto porcentaje de secuelas neurológicas se explicadebido a que los nervios son el tejido que menor resistencia poseedentro del organismo y la electricidad tiende a escoger el camino demenor resistencia. Caso clínico. Varón de 16 años que sufrió unaelectrocución accidental por una guitarra eléctrica, con posteriorparada cardiorrespiratoria; precisó intubación. Tras la retirada dela sedación, el paciente presentaba una ceguera bilateral con amnesiade lo sucedido. La resonancia magnética mostró, en la secuenciaFLAIR, edema en ambos lóbulos occipitales y, en menor grado,en la unión parietooccipital y temporooccipital. Se instauró empíricamenteun tratamiento esteroideo durante tres días. Aproximadamenteal cabo de un mes, el paciente había recuperado totalmentela visión y habían desaparecido las lesiones cerebrales. Conclusiones.Las manifestaciones neurológicas secundarias a los accidentespor electricidad se suelen dividir en inmediatas y tardías. La ceguerase ha descrito raramente como secuela de los supervivientes a lafulguración por rayos. La recuperación tras la administración deltratamiento esteroideo y la reversibilidad del edema podrían hacerpensar que el mecanismo de producción de esta secuela fuera el dañodirecto de la electricidad en el sistema nervioso, conocido como ‘fenómenode electroporación

Introduction. Electrocution is the cause of a large number of accidents and, of these, a considerable percentage resultin death. Several factors affect the severity and distribution of the injuries. It is known that for low voltages the characteristicsof alternating current make it three times more dangerous than continuous current. The high percentage of neurologicalsequelae can be accounted for by the fact that nerves are the tissue with the lowest resistance in the body and electricity tendsto follow the path that offers the least resistance. Case report. A 16-year-old male who was accidentally electrocuted by anelectric guitar and later suffered a cardiorespiratory arrest; the patient required intubation. After withdrawing sedation, thepatient was found to be blind in both eyes and could not remember what had happened. FLAIR MR imaging revealed oedema inboth occipital lobes and, to a lesser extent, in the junction between the parietooccipital and temporooccipital lobes. Treatmentwith steroids was established for three days. After approximately one month, the patient had recovered his sight and the braininjuries had disappeared. Conclusions. The neurological manifestations secondary to accidents caused by electricity are usuallydivided into two types –immediate and delayed. Blindness has rarely been reported as a sequela in those who have survivedfulguration due to a lightning strike. The patient’s recovery after administering treatment with steroids and the reversibility ofthe oedema could lead us to think that the mechanism producing this sequela was the damage to the nervous system causeddirectly by the electricity, which is known as the ‘phenomenon of electroporation’

[Recurrent aseptic meningitis secondary to taking ibuprofen and ketorolac]. / Meningitis recurrente aséptica secundaria a toma de ibuprofeno y ketorolaco.

INTRODUCTION: Aseptic meningitis is a process that is characterised by an inflammatory reaction of the meninges that is not due to any infectious agent. Its aetiology is varied and is most frequently caused by rheumatologic and/or autoimmune processes, chemical or medication-induced meningitis, the most notable drugs involved being antibiotics and non-steroidal anti-inflammatory drugs (NSAI). CASE REPORT: We report the case of a 70-year-old male, with no relevant history, who was admitted to hospital five times over a period of 16 months because of acute meningitis with polymorphonuclear pleocytosis, high protein levels in cerebrospinal fluid and normal glucose in cerebrospinal fluid. No evidence of an infectious causation, chemical meningitis, carcinomatosis or autoimmune disease was found and the patient was diagnosed with recurrent aseptic meningitis. It was found that the patient had taken ibuprofen or ketorolac on several occasions, a few hours before the appearance of symptoms. These episodes were quickly resolved after withdrawal of this medication. CONCLUSIONS: A number of NSAI have been reported as inducers of aseptic meningitis, one of the most notable being ibuprofen. We report the case of a patient who, as a consequence of taking ibuprofen and ketorolac, presented episodes of recurrent aseptic meningitis. To our knowledge this side effect of ketorolac has not been reported before. Its clinical features are impossible to differentiate from those of infectious meningitis. Diagnosis is reached by exclusion and a careful pharmacological study, including over-the-counter drugs like some of the NSAI, must be performed in patients with this condition, since it is a problem that can easily be solved by withdrawing the drug that causes it.

Meningitis recurrente aséptica secundaria a toma de ibuprofeno y ketorolaco / Recurrent aseptic meningitis secondary to taking ibuprofen and ketorolac

Introducción. La meningitis aséptica es un proceso que se caracteriza por una reacción inflamatoria meníngea no causada por ningún agente infeccioso. Su etiología es variada, y la más frecuente es la secundaria a procesos reumatológicos y/o autoinmunes, meningitis química e inducida por fármacos, entre los que destacan los antibióticos y los antiinflamatorios no esteroideos (AINE). Caso clínico. Varón de 70 años de edad, sin antecedentes relevantes, que en el período de 16 meses ingresó en cinco ocasiones por meningitis aguda con pleocitosis polimorfonuclear, hiperproteinorraquia y glucosa normal en el líquido cefalorraquídeo, en las que se descartó una etiología infecciosa, meningitis química, carcinomatosis o enfermedad autoinmune y se le diagnosticó meningitis aséptica recurrente. Se comprobó la toma de ibuprofeno o ketorolaco en distintas ocasiones, unas pocas horas antes de la aparición de la clínica. Estos episodios se resolvieron rápidamente tras la retirada de dicha medicación. Conclusiones. Se han implicado varios AINE como inductores de meningitis aséptica, entre los que destaca el ibuprofeno. Presentamos un paciente que, como consecuencia de la toma de ibuprofeno y ketorolaco, sufrió episodios de meningitis recurrente aséptica. En nuestro conocimiento no se ha comunicado previamente este efecto secundario con el ketorolaco. Su clínica es indistinguible de la meningitis infecciosa; el diagnóstico se efectúa por exclusión, y debe realizarse una cuidadosa historia farmacológica, que incluya fármacos de libre dispensación como algunos AINE, en pacientes con esta patología, puesto que se trata de un problema fácilmente solucionable con la retirada de la medicación que lo causa (AU)

Introduction. Aseptic meningitis is a process that is characterised by an inflammatory reaction of the meninges that is not due to any infectious agent. Its aetiology is varied and is most frequently caused by rheumatologic and/or autoimmune processes, chemical or medication-induced meningitis, the most notable drugs involved being antibiotics and non-steroidal anti-inflammatory drugs (NSAI). Case report. We report the case of a 70-year-old male, with no relevant history, who was admitted to hospital five times over a period of 16 months because of acute meningitis with polymorphonuclear pleocytosis, high protein levels in cerebrospinal fluid and normal glucose in cerebrospinal fluid. No evidence of an infectious causation, chemical meningitis, carcinomatosis or autoimmune disease was found and the patient was diagnosed with recurrent aseptic meningitis. It was found that the patient had taken ibuprofen or ketorolac on several occasions, a few hours before the appearance of symptoms. These episodes were quickly resolved after withdrawal of this medication. Conclusions. A number of NSAI have been reported as inducers of aseptic meningitis, one of the most notable being ibuprofen. We report the case of a patient who, as a consequence of taking ibuprofen and ketorolac, presented episodes of recurrent aseptic meningitis. To our knowledge this side effect of ketorolac has not been reported before. Its clinical features are impossible to differentiate from those of infectious meningitis. Diagnosis is reached by exclusion and a careful pharmacological study, including over-thecounter drugs like some of the NSAI, must be performed in patients with this condition, since it is a problem that can easily be solved by withdrawing the drug that causes it (AU)