Crisis focal motora sin alteración de conciencia secundaria a accidente cerebrovascular. Reporte de un caso y diagnóstico diferencial con Limb Shaking

Introducción: Si bien la primera causa de crisis epilépticas en la población adulta mayor es el accidente cerebrovascular, un importante diagnóstico diferencial corresponde al limb shaking syndrome, una manifestación clínica particular de un accidente isquémico transitorio. Caso clínico: Se describe entonces el caso de un hombre chileno de 62 años de edad que sufre una crisis focal motora sin alteración de conciencia con evidencia imagenológica de injuria isquémica de unos 10 días de antigüedad y de estenosis carotídea significativa, la cual es manejada quirúrgicamente. Discusión: Existen diferentes elementos que pueden distinguir una crisis epiléptica de un limb shaking sryndrome. La fisiopatología de la primera corresponde un fenómeno irritativo post isquémico con una clara manifestación electroencefalográfica, mientras que la segunda es producida por hipoperfusión relativa gatillada por ortostatismo en el contexto de una enfermedad carotídea oclusiva. El cuadro clínico del paciente se consideró más compatible con una crisis epiléptica que con un limb shaking syndrome.

Introduction: Although the leading cause of seizures in the older adult population is cerebrovascular accident, limb shaking syndrome is an important differential diagnosis, being a particular clinical manifestation of a transient ischemic attack. Clinical case: We thus describe a clinical case of a 62-year-old Chilean man who suffers a simple focal motor epileptic seizure, with imaging evidence of ischemic injury about 10 days old and significant carotid stenosis which is managed surgically. Discussion: There are different elements that can distinguish an epileptic seizure from a limb shaking syndrome. The pathophysiology of the first corresponds to a post-ischemic irritative phenomenon with a clear electroencephalographic manifestation, while the second is produced by relative hypoperfusion triggered by orthostatism in the context of carotid occlusive disease. The patient's clinical picture was considered more compatible with an epileptic seizure than with a limb shaking syndrome syndrome.

Nivel de funcionalidad de familias con niños de 3 a 6 años, habitantes de una localidad de Bogotá, 2013 / Performance level families with children from 3 to 6 years population of a town of Bogota, 2013 / Nível de funcionalidade de famílias com crianças de 3 a 6 anos, habitantes de uma cidade de Bogotá, 2013

El presente estudio cuantitativo con enfoque descriptivo y transversal muestra los resultados de la segunda etapa de la investiga\r\n-\r\nción Funcionalidad de familias con niños de 3 a 6 años estudiantes de colegios de Bogotá D.C. 2013, realizada con características \r\nsimilares a la primera etapa del estudio (1), con el fin de identificar la funcionalidad de familias con niños de 3 a 6 años estudiantes \r\nde la localidad de Usaquén. La investigación determinó el nivel de funcionalidad familiar de una muestra de 75 familias con \r\nniños de 3 a 6 años estudiantes de una entidad educativa de nivel preescolar y residentes de una localidad de Bogotá D.C. Esta \r\nclasificación se basa en la aplicación de la Escala de Efectividad de la Funcionalidad Familiar ASF-E, que hace parte de la teoría de \r\norganización sistémica de Marie Luise Friedemann.\r\nEn esta segunda etapa de la investigación se pudo establecer que el nivel de funcionalidad total alcanzado fue alto (65%), \r\ndato que coincide con el obtenido por las familias que participaron en la primera etapa. Se concluyó entonces que las fami\r\n-\r\nlias participantes en la investigación en ambas etapas del estudio presentan alta efectividad familiar, resultados que pueden \r\nestar relacionados con similitudes en aspectos como tipo de conformación, estructura, organización, dinámica, así como medio \r\ndonde habitan y se desarrollan.

This quantitative descriptive cross-sectional study shows the \r\nresults of the second stage of research of a functioning study of \r\nfamilies with children from 3 to 6 years old, inhabitants of a town \r\nof Bogotá in 2013, conducted with similar characteristics to the \r\nfirst stage of the study (1) in order to serve the population of \r\nfamilies near the area of influence of the University. The investi\r\n-\r\ngation determined the level of family functioning achieved by \r\na sample of 75 families with children at a preschool educational \r\nlevel and residents of a locality of Bogotá. This classification was \r\ndetermined by applying the Scale of Effectiveness of Family \r\nFunctionality (ASF-E), which is part of the theory of systemic \r\norganization by Marie Luise Friedemann.\r\nThis second stage of research could establish that the total level \r\nof performance achieved by families was high (65%), matching \r\nthe data of families who participated in the study in the first \r\nstage of work, who also got high family functioning. With the \r\nabove it was concluded that participating families in both \r\nstages of the study have a high level of family effectiveness, \r\nresults that may be related by similar features and characteris\r\n-\r\ntics of both groups of families, as well as the type of formation, \r\nstructure, organization, dynamics and environment where the \r\nfamilies live and develop.

O presente estudo quantitativo com foco descritivo e transversal \r\napresenta os resultados da segunda etapa da pesquisa "Funcio\r\n-\r\nnalidade de famílias com crianças de 3 a 6 anos, estudantes \r\nde escolas de Bogotá D.C., 2013", realizada com características \r\nsemelhantes às da primeira etapa do estudo (1), com a intenção \r\nde identificar a funcionalidade de famílias com crianças de 3 a \r\n6 anos, estudantes de Usaquén. A pesquisa determinou o nível \r\nde funcionalidade familiar de uma amostra de 75 famílias com \r\ncrianças de 3 a 6 anos, estudantes de uma entidade educativa \r\nde nível pré-escolar e residentes de uma cidade de Bogotá D.C. \r\nEsta classificação é baseada na aplicação da Escala de Efetivi\r\n-\r\ndade da Funcionalidade Familiar ASF-E, que faz parte da teoria \r\nde organização sistêmica de Marie Luise Friedemann.\r\nNesta segunda etapa da pesquisa, conseguiu-se estabe\r\n-\r\nlecer que o nível de funcionalidade total alcançado foi alto \r\n(65%), dado que coincide com o obtido pelas famílias que \r\nparticiparam da primeira etapa. Concluiu-se que as famílias \r\nparticipantes na pesquisa, em ambas as etapas do estudo, \r\napresentam alta efetividade familiar, resultados que podem \r\nestar relacionados com semelhanças em aspectos como tipo \r\nde formação, estrutura, organização, dinâmica, assim como \r\nmeio onde habitam e se desenvolvem

Adverse drug reactions in an emergency medical dispatching centre.

PURPOSE: The purpose of this study is to assess the incidence of adverse drug reactions (ADR) leading to call an emergency medical dispatching centre. METHODS: A prospective, observational, monocentric clinical study performed over a 2-year period (2011-2012) in a French prehospital emergency dispatching centre, the Service d'Aide Médicale Urgente (SAMU) covering 1,156,000 inhabitants. All adult patients (age≥18) who called for any cause were included. We created an electronic trigger 'iatrogenic event' implemented by the dispatching physician for each suspected case of ADR, then we completed the analyses of all the cases with a chief complain represented in more than 1% of the triggered cases. The primary outcome variable was the occurrence of any possible ADR. We then used the French method of causal relationship assessment. RESULTS: The SAMU dispatched 339,915 calls during the study. In total, 1,467 ADRs were identified, representing 0.95% (CI 95% 0.90-1.00%) of cases. ADRs were as serious (SADR) in 51.06% (CI 95% 48.45-53.67%) of cases. The major ADR observed was haemorrhage, (42.81% (CI 95% 40.62-45.00%), n=628) followed by allergy, hypoglycaemia, vomiting, dizziness and drowsiness. The class of drugs most frequently involved was antithrombotic (43.69% (CI 95% 41.45-45.93%), n=641), followed by insulin (17.98% (CI 95%:17.06-18.90%), n=264). CONCLUSIONS: Emergency calls concerning ADRs were estimated as 9/1,000, and one out of two is serious.

Funcionalidad familiar de familias con niños preescolares estudiantes de colegios de Bogotá D.C. 2011 / Family functioning in families with preschool children in schools in Bogotá D.C. 2011

[{"text": "El presente estudio descriptivo transversal de tipo cuantitativo, estableció mediante una muestra de 157 familias con preescolares en un colegio de Bogotá, el nivel de efectividad del funcionamiento familiar a través de la aplicación del instrumento Escala de efectividad de la funcionalidad familiar, basado en Teoría de organización sistémica de Marie Luise Friedemann. El trabajo determinó los niveles de efectividad alcanzado por estas familias mediante la valoración de las metas de crecimiento, espiritualidad, control y estabilidad, observándose en las dos primeras, niveles intermedios y en las dos restantes, niveles altos de efectividad familiar. Así mismo fue posible la estimación de las dimensiones de mantenimiento, cambio, coherencia e individuación que hacen parte del modelo, mostrando en las tres primeras un grado de efectividad de nivel intermedio, mientras que el último criterio de mantenimiento del sistema familiar, tuvo clasificación de alto con el 73%. Con todo lo anterior se pudo concluir que las familias participantes en el estudio mantienen en mayor porcentaje (66%) un nivel total de efectividad alto, como se puede apreciar en los resultados del trabajo.", "_i": "es"}, {"text": "This descriptive cross-sectional study of a quantitative nature, established by a sample size of 157 families with preschool children in a school in Bogotá, measured the level of effectiveness of family functioning through the application of the instrument Rating Scale Family Functionality, based on Organization Theory Systemic Marie Luise Friedemann. The work determined the levels of efficiency achieved by these families by assessing growth, spirituality, control, and stability goals, observed in the first two intermediate levels, and the two remaining high levels of relative effectiveness. It was also possible to estimate the dimensions of maintenance, change, consistency and individuation that are part of the model, showing the first three degrees of effectiveness of intermediate level, while the last criterion of maintaining the system was a high level rating of 73%. It was concluded that the families participating in the study maintained to a high degree (66%) a high overall level of effectiveness, as can be seen in the results of the work.", "_i": "en"}]

[State of the art. Publications of French emergency's teams since 5 years]. / Publications des équipes françaises de médecine d'urgence. Où en est-on depuis cinq ans ?

INTRODUCTION: The development of emergency medicine in France and its valuation can take place only through acknowledged scientific publications. The aim of our study was to analyze the publications of French teams in emergency medicine since 2006. MATERIAL AND METHODS: Observational, descriptive study, from January 1st, 2006 to December 31st, 2010 including, thanks to Medline, studies related to emergency medicine with, as keywords, "medicine d'urgences; urgences; emergency; emergency medicine; French; France" the names of heads of the emergency departments, of the urgent medical aid services (samu) and of anaesthetics services in mainland France. Data collection focused on the type of study, subject, place of conducting the study and grade of international quality. RESULTS: Three hundred and twenty-five publications were listed: 39% (n=126) of the studies were carried out in prehospital. We identified 28% of observational studies (n=92), 20% of randomized prospective (n=66), 19% of cohorts (n=62), 18% of case reports (n=59), 10% of clarifications (n=32) and 4% of general reviews (n=11). The most frequent theme was the cardiology (38% of cases). The most favourite journal was the Annales françaises d'anesthésie et de réanimation (Afar) (18%, n=57). CONCLUSION: The release of French studies in emergency medicine is increasing, with an improvement in the quality of the published studies. All these results demonstrate the progress made since five years in emergency medicine in France but also the work that remains to be done in our rising medical specialization.

Hidatidosis humana: Generalidades y situación epidemiológica en Chile según egresos hospitalarios y notificación obligatoria entre los años 2001 y 2005 / Human hydatidosis: General aspects and epidemiological situation in Chile according to hospital discharge and mandatory reporting from 2001 to 2005

La hidatidosis humana en Chile se describe a partir de fuentes de información secundarias (bases de datos de enfermedades de notificación obligatoria y egresos hospitalarios) entre los años 2001 y 2005. Para valorar la magnitud de la infección en humanos se calcularon las tasas de incidencia y egresos hospitalarios en el período y según región geográfica. La incidencia promedio del período según notificaciones fue de 2,2 por 100.000 habitantes, con mayores tasas en las regiones de Coquimbo, La Araucanía y Magallanes. La tasa promedio del período según egresos fue de 6 por 100.000 habitantes siendo La Araucanía, Aysén y Magallanes las más afectadas. El 58,8 por ciento de casos notificados fueron por Echinococcus granulosus, mientras que 43,6 por ciento se registraron como equinococosis no especificada. El sistema notificación obligatoria da una estimación real de la magnitud de esta enfermedad, al reportar casos con confirmación diagnóstica. Las tasas obtenidas de los egresos sobreestiman la magnitud. Se recomienda concentrar los esfuerzos en el sistema de notificación y en potenciar estudios de seroprevalencia.

Human hydatidosis in Chile is described using as a source of information the Disease Notification Systems and hospital discharges between 2001 and 2005. To assess the extent of human infection we calculated incidence rates and hospital discharges during this period by geographical region. Incidence rate for the period was 2.2 per 100,000 inhabitants with higher rates in the regions of Coquimbo, La Araucanía and Magallanes. The hospital discharge rate for the period was 6 per 100.000 inhabitants, being the most affected regions: La Araucanía, Aysén and Magallanes. 58.8 percent of cases reported are from Echinococcus granulosus, while 43.6 percent were registered as unspecified echinococcosis. The notification system provides a real estimate of the magnitude of this disease, reporting cases with diagnostic confirmation. The rates obtained from the discharge system overestimate the magnitude of this disease. The improvement of the notification system and seroprevalence studies are recommended.

Pressure pain sensitivity of the scalp in patients with nummular headache: a cartographic study.

Nummular headache (NH) is characterized by focal pain fixed within a small round or elliptical area of the head surface. Sensory dysfunction is apparently restricted to the symptomatic area, but a thorough analysis of cranial pain sensitivity has not been performed. Pressure pain sensitivity maps were constructed for 21 patients with NH and 21 matched healthy controls. In each subject pressure pain thresholds (PPT) were measured on 21 points distributed over the scalp. In each patient PPT were also measured in the symptomatic area and at a non-symptomatic symmetrical point. In both groups an anterior to posterior gradient was found on each side, with no significant differences of PPT measurements between sides or groups. In patients with NH, only the symptomatic area showed a local decrease of PPT (significant in comparison with the non-symptomatic symmetrical point, P < 0.001). These findings further support that NH is a non-generalized disorder with a peripheral source.

Etica e investigación en la historia de la malaria / Ethics and research in the history of malaria

La investigación científica en clínica es absolutamente necesaria para el desarrollo del saber médico. No obstante, no siempre el gran progreso alcanzado por la Medicina se ha obtenido respetando la persona humana. En particular, a partir de 1880, cuando Laveran constató por primera vez la naturaleza protozoaria de la malaria, el desarrollo del conocimiento sobre el paludismo ha sido muy notable, pero hasta la mitad del siglo XX estos logros fueron, en muchos casos, fruto de experimentos que hoy resultan en extremo discutibles desde el punto de vista ético, tanto los dedicados al estudio de la biología y de la fisiopatología, como especialmente los ensayos de carácter farmacológico efectuados en individuos sanos para probar moléculas con acción antimalárica real o presunta.

Ética e investigación en la historia de la malaria / Ethics and research in the history of malaria

Clinical research is absolutely necessary for the development of medical knowledge. However, progress of Medicine has not always been obtained respecting human rights. From 1880 onwards, after Laveran's discovery of the protozoan nature of malaria, the increase in knowledge on paludism has been remarkable. Much of the knowledge gained up to the middle of the twentieth century was based although on highly questionable experiments according to modern ethical standards in the fields of biology and phisiopathology, and specially in therapeutic clinical triáis with antimalarial drugs.

La investigación científica en clínica es absolutamente necesaria para el desarrollo del saber médico. No obstante, no siempre el gran progreso alcanzado por la Medicina se ha obtenido respetando la persona humana. En particular, a partir de 1880, cuando Laveran constató por primera vez la naturaleza protozoaria de la malaria, el desarrollo del conocimiento sobre el paludismo ha sido muy notable, pero hasta la mitad del siglo XX estos logros fueron, en muchos casos, fruto de experimentos que hoy resultan en extremo discutibles desde el punto de vista ético, tanto los dedicados al estudio de la biología y de la fisiopatología, como especialmente los ensayos de carácter farmacológico efectuados en individuos sanos para probar moléculas con acción antimalárica real o presunta.

Bifocal nummular headache: the first three cases.

Nummular headache (NH) has been defined as a focal head pain that is exclusively felt in a small area of the head surface. Here we describe three patients who presented with focal head pain in two separate areas. This finding seems to be consistent with bifocal NH and further enlarges the clinical diversity of this headache disorder. The pathogenic mechanisms of NH may be active in multiple cranial areas in some particular patients.

Cómo se transmite la neurocisticercosis / How is neurocysticercosis transmitted?

No disponible

Coronariografía no invasiva mediante tomografía axial computada multicorte / 16 detector computed tomagraphy for coronary angiography

Antecedentes: La tomografía axial computada de 16 detectores de las arterias coronarias (TAC Coronario) ha emergido recientemente como una alternativa diagnóstica a la coronariografía invasiva (CI). Objetivo: Estudiar la exactitud del TAC coronario de 16 detectores para pesquisar la presencia o ausencia de estenosis coronaria en distintos tipos de pacientes, mediante su comparación con la CI. Métodos: A un total de 55 pacientes (46 hombres, 9 mujeres, promedio 57 +/-12 años) en quienes se realizó una CI electiva, se les realizó un TAC coronario. Se analizó específicamente la presencia de lesiones 50 por ciento y se compararon estos resultados con los obtenidos mediante la CI cuantitativa. Resultados: Cincuenta pacientes requirieron beta bloqueo, obteniéndose una FC promedio de 57 lpm. En los segmentos principales se objetivaron 61 lesiones significativas por CI, de las cuales 52 (85,2 por ciento) fueron correctamente detectadas por el TAC coronario. La sensibilidad, especificidad, LH(+) y LH(-) del examen fueron 85 por ciento, 97 por ciento, 33 y 0.15, respectivamente. La presencia o ausencia de enfermedad coronaria significativa fue correctamente diagnosticada en 50 de los 55 pacientes (91 por ciento). Conclusión: El TAC coronario de 16 detectores es un examen sensible y específico para el diagnóstico de estenosis significativas de los segmentos principales del árbol coronario.

Background: Invasive coronary arteriography (ICA) is the gold standard to assess coronary artery stenosis. Sixteen detector computed tomography (Coronary CT) has recently been introduced as a less invasive diagnostic alternative. Aim: To assess the reliability of Coronary CT in detecting coronary stenosis among different types of patients by comparing the results with those obtained by ICA. Methods: 55 patients (age 57+/-12 years, 46 males) who underwent ICA had also a coronary CT. Beta blockade was used to obtain a heart rate < 65 beats per min. The presence of significant stenosis (•'3d50 percent of luminal diameter measured by quantitative angiography) was compared between methods.Results: Adequate coronary images were obtained in 53 of 55 patients with coronary CT; a total of 715 coronary segments were available for analysis. Fifty patients required beta blockade and the mean heart rate was 57 beats per min. Fifty-two out of 61 main segment stenosis were detected by coronary CT (85.2 percent). Sensitivity, specificity, LH+ and LH- of coronary CT were 85 percent, 97 percent, 33 and 0.15, respectively. The presence or absence of significant lesions was correctly diagnosed in 50 of the 55 patients (91 percent). Conclusion: 16 detector coronary CT is a sensitive and specific method to diagnose main segment significant coronary stenosis.

Diseño y desarrollo de una aplicación informática para la escala de incapacidad por dolor lumbar de Oswestry / Design and development of computer-aided application for the Oswestry Disability Index

No disponibleIntroducción: La escala de Oswestry es un cuestionario autoaplicadoque permite medir la repercusión funcional del dolor lumbar.El esfuerzo que representa calcular la puntuación e interpretar y registrarlos resultados limita su incorporación a la práctica diaria.Objetivo: Diseñar una aplicación informática, sobre la versiónen castellano de la escala, que permita: 1) calcular automáticamentela puntuación; 2) clasificar al paciente en una categoría delimitación funcional; 3) generar alertas clínicas; 4) facilitar al pacientenormas posturales personalizadas (adaptadas a sus limitacionesy a su edad y sexo); 5) crear gráficos para ver la evoluciónen el tiempo de las puntuaciones; y 6) escribir automáticamenteun informe del resultado.Resultados y Discusión: Se ha desarrollado una aplicación web,accesible a través de un navegador, con las funciones señaladas. Laestructura es flexible, escalable y está conectada a una base de datos(Access). El proceso de evaluación interna demostró una disminuciónsignificativa del tiempo empleado en puntuar la escala (se reduce aun 25% del requerido con el método manual). La evaluación externaindicó que la aplicación es percibida por los usuarios potenciales(médicos y fisioterapeutas) muy útil, fácil de manejar y atractiva yque consigue ampliamente los objetivos planteados

Introduction: The Oswestry scale is a self applied questionnairewhich allows to measure the functional consequences of the low backpain. The effort to calculate the score of the test and the interpretationof the results it is a real limit to be incorporate to the daily practice.Objective: To design a computer application, based on theSpanish version of the scale, which allows: 1) automatic calculationof the score; 2) patient classification based on the functionallimitation category; 3) to generate clinic alerts; 4) to provide to thepatient personalize postural norms (adapted to the own limitations,age and gender); 5) to generate graphic presentations to visualizethe time dependence of the score and 6) the automaticgeneration of the report with the results.Results and Discussion:We have developed a web application, accessiblefrom the navigator programme, with the above mentionedfunctions. The structure is flexible, easy to scale and connected to adata base (in Access). The internal validation process shows a clear decreasein the working time used to calculate the score of the scale (thefinal time is only a 25% of the time requested in the manual mode).The external evaluation shows that the application is considered bythe potential users (medicals and physiotherapists) as useful, easy touse and attractive, so that we clearly achieve the proposed objectives

Enfermedad periodontal en pacientes con síndrome coronario agudo / Periodontal disease among patients with acute coronary syndrome

Background: Epidemiological studies suggest an association between periodontal disease and coronary heart disease. It is possible that periodontal disease may contribute to plaque destabilization in patients with acute coronary syndrome. Aim: To assess the association between severity of periodontal disease, the number of acute plaques and extension of coronary artery disease in patients with acute coronary syndrome. Patients and methods: The severity of periodontal disease was assessed by skilled independent observers in patients with acute coronary syndrome subjected to coronary angiography. The periodental disease was classified as mild or severe. Acute plaques were defined on angiography as those with thrombi, ulcers or flow alterations. The extension of coronary disease was analyzed using the Sullivan score. Results: Forty three patients (35 males) aged 41 to 83 years, were studied. Mild and severe periodontal disease was present in 18 (42percent) and 25 (58percent) patients respectively. Seventy six percent of those with severe disease had two or more acute plaques, compared with 17percent of those with mild disease (p<0.001). Median Sullivan score was 80.6 and 57.2 in patients with severe or mild periodontal disease respectively (p=0.001). Conclusions: Severe periodontal disease was associated with a higher number of acute coronary plasques and a higher extension of coronary artery disease, in patients with acute coronary syndromes.

[The study of otoacoustic emissions in diabetes mellitus]. / Estudio con otoemisiones acústicas en la diabetes mellitus.

Cochlear activity was evaluated by means of otoacoustic emission in patients with normal hearing and insulin-dependent diabetes mellitus. Twenty diabetic subjects were studied by recording click evoked otoacoustic emissions (TEOAE) and distortion products otoacoustic emissions (DPOAE) 2fl-f2 and comparing the results with those obtained in a control group of non-diabetic with normal hearing. The results obtained in the diabetic group showed a statistically significant decrease in mean amplitude, in the amplitude of every click evoked otoacoustic emissions and in the mean amplitudes of various distortion products compared with the control group. These findings suggest the presence of cochlear disorders in diabetic patients, probably produced by impaired functional properties of the outer hair cells.

[Lateral sinus thrombosis in the first three months of pregnancy]. / Trombosis del seno lateral durante el primer trimestre del embarazo.

Thrombosis of the cerebral venous sinuses is characterized by clinical pleomorphism and variable pathogenesis. Although there is a relationship with pregnancy and especially with the puerperium, occurrence during the first trimester of pregnancy is unusual and this may effect the diagnosis and treatment. We describe the case of a 33 years-old patient with lateral sinus thrombosis in the first trimester of pregnancy. This was diagnosed and followed-up by magnetic resonance. Investigations as to its aetiology were inconclusive and it followed a benign course without anticoagulation. Thrombosis of the venous sinuses has been found empirically to be related to states of deficiency of S protein, hypercoagulability, anaemia and deshydration during pregnancy, to having previously taken contraceptive pills. Behçet's disease, other coagulopathies, central or systemic vasculitis, collagen disorders, septic and neoplastic disorders and a large number of cases of unknown aetiology. In our patient neurological deterioration secondary to a venous infarct or intraparenchymatous haemorrhage was not seen. There was full recovery and complete spontaneous canalization of the sinus, as shown on posterior cranial angiography. The controversial decision to use heparin in thrombosis of the cerebral venous sinuses should probably depend on the possible risks and benefits in each individual case, taking into account the clinical findings, aetiology and topography of the thrombosed sinus.