[Basilar dolichoectasia and fusiform vertebral artery aneurysm: ischemic stroke of dual cause] / Dolicoectasia basilar y aneurisma fusiforme de arteria vertebral: accidente cerebrovascular isquémico de causa dual.

A 76-year-old woman arrived at the emergency department due to an ischemic stroke that affected the territory of the left anterior choroidal and basilar arteries. Imaging studies showed dolichoectasia basilar associated with a fusiform aneurysm with thrombi inside it in the left vertebral artery. Both anatomic abnormalities are associated with ischemic stroke.

Mujer de 76 años que acudió al servicio de urgencias por un accidente cerebro vascular isquémico que afectó el territorio de arteria coroidea anterior izquierda y basilar. Los estudios de imagen mostraron dolicoectasia basilar asociada a un aneurisma fusiforme con trombos en su interior en la arteria vertebral izquierda. Las dos anomalías anatómicas están asociadas a accidente cerebrovascular isquémico.

[ Delay time from diagnosis to surgery in drug-resistant epilepsy]. / Tiempo de retraso desde el diagnóstico hasta la cirugía en la epilepsia refractaria.

Drug-resistant epilepsy, in a good number of cases, can benefit from surgery. It is essential to make a timely referral for the pre-surgical study. We retrospectively reviewed the clinical records of our center from 2011 to 2019. The patients who underwent temporal lobectomy were selected. After performing the data analysis, an average waiting time of 23 years was observed, similar to that observed in other countries of the American continent. There is an evident need to provide strategies to reduce the waiting time for epilepsy surgery in patients who benefit from the intervention.

La epilepsia refractaria, en una buena parte de los casos, puede beneficiarse de cirugía. Es importante realizar una referencia oportuna para el estudio prequirúrgico. Se revisaron de forma retrospectiva los registros clínicos de nuestro centro desde el año 2011 al 2019 y se seleccionaron a los pacientes sometidos a lobectomía temporal. Tras realizar el análisis de los datos se objetivó un tiempo de espera medio de 23 años, similar a lo observado en otros países del continente americano. Existe una necesidad evidente de proporcionar estrategias para disminuir el tiempo de espera para la cirugía de epilepsia en los pacientes que se beneficien de la intervención.

Eficacia de la asociación de lacosamida en neuralgia del trigémino / Effectiveness of the association of lacosamide in trigeminal neuralgia

La neuralgia del trigémino es un motivo de consulta frecuente en neurología, es sumamente complejo e incapacitante. Su abordaje, además de un adecuado enfoque etiológico, precisa de un tratamiento sintomático eficaz. Presentamos dos pacientes con neuralgia del trigémino y buena respuesta al tratamiento con lacosamida. La lacosamida es un fármaco que muestra ser una alternativa segura y eficaz en el tratamiento del dolor neuropático

Trigeminal neuralgia is a frequent reason for consultation in neurology, it is highly complex and incapacitating. Its approach, in addition to an adequate etiological focusing, requires effective symptomatic treatment. We present two patients with trigeminal neuralgia and good response to treatment with lacosamide. Lacosamide is a drug that appears to be a safe and effective alternative in the treatment of neuropathic pain

[Typical visual aura without headache: a case report.] / Aura visual típica sin cefalea: a propósito de un caso.

Introduction: The typical aura without headache is a type of migraine with aura regularly assessed by ophthalmology. It is defined as at least two recurrent attacks, lasting from 5 to 60 minutes, of reversible, visual, sensorial and / or language unilateral neurological symptoms.Methods: We present a case report of a male with typical aura without headache. Results: Male with a history of migraine without aura in adolescence and without vascular risk factors. Referred from ophthalmology by biweekly episodes characterized by central teicopsia that progressively covers the entire visual field in 20 minutes, without being influenced by opening or closing eyes, which disappears after 40 minutes from the beginning. The episodes are not stereotyped, they are not followed by headache, nor do they associate other neurological symptoms. Neurological examination and complementary tests were normal. It is concluded in favor of typical aura without headache and after six months of starting treatment with Lamotrigine there were no recurrences. Final conclusion: The diagnosis of typical aura without headache begins with an adequate anamnesis. Due to the nature of its manifestations it is necessary to differentiate it from other etiologies such as transient ischemic attacks and focal seizures due to the diagnostic, therapeutic and prognostic implications. It may appear, as in this case, in patients with migraine without aura. Lamotrigine is an excellent therapeutic option in the typical aura without headache.

Introducción: El aura típica sin cefalea es un tipo de migraña con aura valorada al inicio regularmente por oftalmología. Se define como al menos dos ataques recurrentes, de 5 a 60 minutos de duración, de síntomas neurológicos unilaterales reversibles, visuales, sensoriales y/o lenguaje. Métodos: Presentamos el caso clínico de un varón con aura migrañosa sin cefalea. Resultados: Varón con antecedente de migraña sin aura en la adolescencia y sin factores de riesgo vascular. Remitido desde oftalmología por episodios bisemanales caracterizados por teicopsia central que progresivamente abarca todo el campo visual en 20 minutos, sin influenciarse con la apertura o cierre ocular, que desaparece tras 40 minutos desde el inicio. Los episodios no son estereotipados, no se siguen de cefalea, ni asocian otros síntomas neurológicos. La exploración neurológica y las pruebas complementarias fueron normales. Se concluye a favor de aura típica sin cefalea y tras seis meses de iniciar el tratamiento con Lamotrigina no existieron recurrencias. Conclusión final: El diagnóstico de aura típica sin cefalea inicia con una anamnesis adecuada. Por la naturaleza de sus manifestaciones se hace necesario diferenciarle de otras etiologías como accidentes isquémicos transitorios y crisis epilépticas focales por las implicaciones diagnósticas, terapéuticas y pronósticas. Puede aparecer, como en este caso, en pacientes con migraña sin aura. La lamotrigina es una excelente opción terapéutica en el aura típica sin cefalea.

Imitador De Ictus Debido A Trombosis Venosa Cerebral / Stroke Mimic Due To Cerebral Venous Thrombosis

RESUMEN Introducción: Un imitador de ictus es toda aquella patología no vascular que se presenta como un ictus isquémico agudo. La presentación clínica, factores epidemiológicos, el tiempo de inicio, la distribución vascular y la disponibilidad de pruebas de imagen, son factores que ayudan a diferenciarlos. Caso clínico: Presentamos un caso, de una mujer de la tercera edad que fue llevada a urgencias por hemiparesia izquierda de cinco horas de evolución. La evolución clínica y las pruebas complementarias permitieron excluir el diagnóstico de ictus isquémico agudo. La semiología fue explicada por una parálisis de Todd prolongada que se comportó como imitador de ictus en la fase aguda y las crisis epilépticas se produjeron en el contexto de una trombosis venosa cerebral. Comentarios: Los imitadores de ictus, al contrario del ictus isquémico agudo, ocurren en pacientes más jóvenes, tienen menos factores de riesgo vascular, menor puntuación de NIHSS, menos afasia y disfagia. Las principales causas son crisis epilépticas y síncopes. Deben considerarse también migrañas, neoplasias, alteraciones tóxicas o metabólicas, encefalopatías y trastornos funcionales. Realizar un estudio neurovascular completo y pruebas dirigidas nos permitirán el diagnóstico.

ABSTRACT Introduction: A stroke mimic is any non-vascular pathology that presents as an acute ischemic stroke. The clinical presentation, the epidemiological factors, the time to onset, vascular distribution and the availability of imaging tests are factors that help to differentiate them. Case report: We present a case, of a woman of the third age who was taken to the emergency department due to a five-hour history of left hemiparesis. The clinical evolution and the supplementary tests allowed to exclude the diagnosis of acute ischemic stroke. The semiology was explained by a prolonged Todd's palsy that behaved as a stroke mimic at the acute phase and the seizures occurred in the context of a cerebral venous thrombosis. Comments: Stroke mimics, in contrast to acute ischemic stroke, occur in younger patients, have fewer vascular risk factors, lower NIHSS score, less aphasia and dysphagia. The main causes are seizures and syncope. Migraines, neoplasms, toxic or metabolic alterations, encephalopathies and functional disorders should also be considered. To perform a complete neurovascular study and directed tests will allow us to make the diagnosis.

[Ocular ischemic syndrome: clinical manifestations, diagnosis and evolution after treatment.] / Síndrome de isquemia ocular: manifestaciones clínicas, diagnóstico y evolución tras el tratamiento.

Ocular ischemia syndrome is caused by ocular chronic hypoperfusion due to stenosis or occlusion of the ipsilateral common or internal carotid artery. We present the case of a 58-year-old male with recurrent unilateral amaurosis fugax, ophthalmological examination compatible with chronic ocular ischemia, and severe stenosis of ipsilateral internal carotid artery. After angioplasty and stenting of the carotid stenosis, the findings resolved.

El síndrome de isquemia ocular es causado por la hipoperfusión ocular crónica debido a estenosis u oclusión de arteria carótida común o interna ipsilateral. Presentamos el caso de un varón de 58 años con episodios de amaurosis fugax unilateral, exploración oftalmológica compatible con isquemia ocular crónica y estenosis severa de arteria carótida interna ipsilateral. Tras la angioplastia y stent de la zona de estenosis carotídea, los hallazgos resolvieron.

Medical Versus Surgical Approach to Initial Treatment in Septic Arthritis: A Single Spanish Center's 8-Year Experience.

OBJECTIVE: The aim of this study was to compare the functional results of 2 different procedure types, medical or surgical used in treating native joint septic arthritis. METHODS: In this cohort study, we reviewed the clinical registries of patients admitted to a single third-level hospital with the diagnosis of septic arthritis during the period of January 1, 2008, to January 31, 2016. RESULTS: A total of 63 cases of septic arthritis were identified in which the initial approach for 49 patients was medical (arthrocentesis), whereas the initial approach for 14 patients was surgical (arthroscopy or arthrotomy). Of the 49 patients who received initial medical treatment (IMT), 15 patients (30%) later required surgical treatment because of poor progress. The median age of the patients was 60 (SD, 18) years. The group who received IMT were older than those who received initial surgical treatment (median, 64 years [interquartile range {IQR}, 54-76 years], vs. 48 years [IQR, 30-60 years]). There was a larger percentage of male patients in the surgical group (78% vs. 42% [p = 0.018]). Thirty percent of the medical group had been receiving corticosteroid treatment (p = 0.018). Results of complete recovery of joint functionality showed no significant differences after 1 year (68% with MT vs. 67% with ST, p = 0.91). Both groups had similar symptom duration until diagnosis, duration of antibiotic therapy (median, 30 days [IQR, 28-49 days], vs. 29.5 days [IQR, 27-49] days), and mortality rate (3 in the medical group). CONCLUSIONS: The results of the study show that initial surgical treatment in patients with native joint septic arthritis is not superior to IMT. However, half of the patients with shoulder and hip infections treated with IMT eventually required surgical intervention, suggesting that perhaps this should be the preferred initial approach in these cases.

Anti-TNFα therapy and switching in severe uveitis related to Vogt-Koyanagi-Harada syndrome.

The study aimed to describe the effectiveness of switching the anti-TNFα agent when an acceptable clinical response has not been obtained with the first anti-TNFα agent in patients with uveitis in VKH syndrome. Patients diagnosed with VKH syndrome being evaluated from the uveitis unit of a single tertiary hospital from January 1, 2000, to October 30, 2015. Patients who presented uveitis with an inadequate response to a first anti-TNFα and required switching to a second anti-TNFα were selected. Complete clinical response was assumed in patients whose visual acuity was normal and those who showed absence of inflammatory findings (inflammatory cells in the anterior chamber and vitritis) or absence of macular thickening in upon OCT. A systematic review of the literature of anti-TNFα agents in VKH syndrome was performed. Five patients met the criteria of VKH syndrome. Two cases of VKH syndrome with uveitis and inadequate clinical response to an initial anti-TNFα (both IFX) were presented. After switching to Adalimumab (ADA), a satisfactory clinical response was noted in the first month. For the first time, we present two patients with severe uveitis due to VKH syndrome who after inadequately responding to the first anti-TNFα agent showed complete and maintained clinical improvement when switched to a second anti-TNFα agent.

Mieloma múltiple oligosecretor: presentación clínica inhabitual de una enfermedad poco frecuente / Oligosecretory multiple myeloma: unusual presentation of a rare clinical disease

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Deficiencia de mevalonato quinasa (síndrome de hiper-IgD) y solapamiento con mutación de fiebre mediterránea familiar / Mevalonate kinase deficiency (hyper-IgD syndrome) overlap mutation familial Mediterranean fever

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Sialodochitis fibrinosa (kussmaul disease) report of 3 cases and literature review.

BACKGROUND: Sialodochitis fibrinosa is a rare disease which is characterized by recurring episodes of pain and swelling of the salivary glands due to the formation of mucofibrinous plugs. Analytic studies ascertain elevated levels of eosinophils and immunoglobulin E (IgE). Imaging studies such as magnetic resonance imaging (MRI) and sialography reveal dilation of the main salivary duct (duct ectasia). Treatment is initially supportive, consisting of compressive massages, and use of antihistamines and/or corticosteroids. MATERIAL AND METHODS: In the following, 3 cases of sialodochitis fibrinosa are presented which were diagnosed in a third level hospital during the period of 2008 and 2016, as well as a literature review of all cases reported to our knowledge. RESULTS: Of the 41 cases found, including the 3 of this article, 66% were women with an average age of 45 years old. However, 75% of reported cases were of Japanese heritage. Involvement of the parotid glands was more frequent than the submandibular glands. In more than half of all cases treatment with compressive massages, antihistamines and/or corticosteroids was effective. CONCLUSION: Clinicians should consider sialodochitis fibrinosa as a diagnostic possibility when presented with cases of recurring parotid and submandibular gland tumescence.

Síndrome del mentón entumecido secundario a schwannoma solitario / Numb chin syndrome secondary to solitary schwannoma

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