Adaptación lingüística y cultural del Oxford Cognitive Screen (OCS) en población española / Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population

Introducción: En España el ictus es la sexta causa de discapacidad. Sus secuelas producen alteraciones motoras, sensoriales y cognitivas, que pueden minimizarse con una actuación terapéutica temprana. Por ello se necesitan instrumentos de evaluación rápida que detecten déficits en estas áreas. El Oxford Cognitive Screen Test (OCS) es un test breve diseñado para la valoración de funciones cognitivas en pacientes con ictus. Nuestro objetivo fue generar una versión española (OCS-E) realizando una adaptación lingüística y cultural.Material y métodosDiseño de validación lingüística con doble traducción y 10 reuniones de consenso del equipo investigador multidisciplinar. Tres estudios piloto administrando el test respectivamente a 5 usuarios potenciales, 23 personas sanas y 23 diagnosticadas de ictus isquémico (61%) o hemorrágico, con edades entre 31-88 años.ResultadosEl OCS-E mantiene las 10 tareas originales, la codificación de respuestas y el sistema de puntuación. Se modificaron y ampliaron las instrucciones de administración, lo que asegura la fiabilidad del contenido y de su aplicación. En 5 tareas se han modificado imágenes, números y frases. La tarea praxia se amplió para evaluar ambos miembros superiores. Los estudios piloto confirmaron que las personas de la población diana comprendían de forma adecuada las tareas, con independencia de la existencia de problemas cognitivos.ConclusionesLa adaptación cultural ha generado una versión lingüística y conceptualmente equivalente, permitiendo su estudio psicométrico y posterior aplicación en población española. El OCS-E puede ser un instrumento de cribado útil para evaluación rápida de funciones cognitivas postictus. (AU)

Introduction: Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S).Material and methodsThe linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years.ResultsThe OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems.ConclusionsThe OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke. (AU)

Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population.

INTRODUCTION: Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S). METHODS: The linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years. RESULTS: The OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems. CONCLUSION: The OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke.

[Alzemon: a prospective follow-up study of eslicarbazepine acetate monotherapy in patients with newly diagnosed epilepsy]. / Alzemon: estudio de seguimiento prospectivo del acetato de eslicarbacepina en monoterapia en pacientes con epilepsia de diagnóstico reciente.

INTRODUCTION: Eslicarbazepine acetate is a novel sodium channel blocker for use in the treatment of focal onset seizures. Prospective studies on its effectiveness in monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice are scarce. AIM: To evaluate the effectiveness of eslicarbazepine as initial monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice. PATIENTS AND METHODS: A prospective, multicentre, post-authorisation study. Patients with newly diagnosed partial epilepsy aged 18 years or older without previous treatment were included. The efficacy variables were: percentage of seizure-free patients, responders and reduction in monthly frequency of seizures. The safety variables analyse the 12-month retention rate and the occurrence of adverse effects. RESULTS: Fifty-three patients were included. The retention rate was 77.4%. At the end of the observation period, 83% of patients were seizure-free and 92.5% had reduced their baseline frequency by 50% or more. In addition, 68% of the patients reported some adverse effect and 7.5% of them dropped out of the study for this reason. The effectiveness analysis of the subgroup of patients aged 65 years or more showed no differences with respect to the overall population. CONCLUSION: Eslicarbazepine monotherapy in patients with newly diagnosed partial epilepsy, both in the general population and in the population over 65 years old, is effective and safe in routine clinical practice.

TITLE: Alzemon: estudio de seguimiento prospectivo del acetato de eslicarbacepina en monoterapia en pacientes con epilepsia de diagnóstico reciente.Introducción. El acetato de eslicarbacepina es un nuevo bloqueante de los canales de sodio en el tratamiento de las crisis de inicio focal. Los estudios prospectivos sobre su efectividad en monoterapia en pacientes con epilepsia parcial de reciente diagnóstico en la práctica clínica habitual son escasos. Objetivo. Evaluar la efectividad de la eslicarbacepina en monoterapia de inicio en pacientes con epilepsia parcial de reciente diagnóstico en la práctica clínica habitual. Pacientes y métodos. Estudio postautorización prospectivo y multicéntrico. Se incluyó a pacientes con epilepsia parcial de reciente diagnóstico de 18 años o más sin tratamiento previo. Las variables de eficacia fueron: porcentaje de pacientes libres de crisis, respondedores y reducción en la frecuencia mensual de crisis. Las variables de seguridad analizan la tasa de retención a los 12 meses y la aparición de efectos adversos. Resultados. Se incluyó a 53 pacientes. La tasa de retención fue del 77,4%. Al final del período de observación, el 83% de los pacientes se encontraba libre de crisis y el 92,5% había reducido en un 50% o más su frecuencia basal. El 68% de los pacientes notificó algún efecto adverso y el 7,5% de ellos abandonó el estudio por este motivo. El análisis de efectividad del subgrupo de 65 años o más no mostró diferencias respecto a la población global. Conclusión. La eslicarbacepina en monoterapia en pacientes con epilepsia parcial de reciente diagnóstico, tanto en la población general como en la población de más de 65 años, es eficaz y segura en la práctica clínica habitual.

Alzemon: estudio de seguimiento prospectivo del acetato de eslicarbacepina en monoterapia en pacientes con epilepsia de diagnóstico reciente / Alzemon: a prospective follow-up study of eslicarbazepine acetate monotherapy in patients with newly diagnosed epilepsy

Introducción: El acetato de eslicarbacepina es un nuevo bloqueante de los canales de sodio en el tratamiento de las crisis de inicio focal. Los estudios prospectivos sobre su efectividad en monoterapia en pacientes con epilepsia parcia l de reciente diagnóstico en la práctica clínica habitual son escasos.Objetivo: Evaluar la efectividad de la eslicarbacepina en monoterapia de inicio en pacientes con epilepsia parcial de reciente diagnóstico en la práctica clínica habitual.Pacientes y métodos: Estudio postautorización prospectivo y multicéntrico. Se incluyó a pacientes con epilepsia parcial de reciente diagnóstico de 18 años o más sin tratamiento previo. Las variables de eficacia fueron: porcentaje de pacientes libres de crisis, respondedores y reducción en la frecuencia mensual de crisis. Las variables de seguridad analizan la tasa de retención a los 12 meses y la aparición de efectos adversos.Resultados: Se incluyó a 53 pacientes. La tasa de retención fue del 77,4%. Al final del período de observación, el 83% de los pacientes se encontraba libre de crisis y el 92,5% había reducido en un 50% o más su frecuencia basal. El 68% de los pacientes notificó algún efecto adverso y el 7,5% de ellos abandonó el estudio por este motivo. El análisis de efectividad del subgrupo de 65 años o más no mostró diferencias respecto a la población global.Conclusión: La eslicarbacepina en monoterapia en pacientes con epilepsia parcial de reciente diagnóstico, tanto en la población general como en la población de más de 65 años, es eficaz y segura en la práctica clínica habitual.(AU)

Introduction: Eslicarbazepine acetate is a novel sodium channel blocker for use in the treatment of focal onset seizures. Prospective studies on its effectiveness in monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice are scarce. Aim: To evaluate the effectiveness of eslicarbazepine as initial monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice. Patients and methods: A prospective, multicentre, post-authorisation study. Patients with newly diagnosed partial epilepsy aged 18 years or older without previous treatment were included. The efficacy variables were: percentage of seizure-free patients, responders and reduction in monthly frequency of seizures. The safety variables analyse the 12-month retention rate and the occurrence of adverse effects. Results: Fifty-three patients were included. The retention rate was 77.4%. At the end of the observation period, 83% of patients were seizure-free and 92.5% had reduced their baseline frequency by 50% or more. In addition, 68% of the patients reported some adverse effect and 7.5% of them dropped out of the study for this reason. The effectiveness analysis of the subgroup of patients aged 65 years or more showed no differences with respect to the overall population. Conclusion: Eslicarbazepine monotherapy in patients with newly diagnosed partial epilepsy, both in the general population and in the population over 65 years old, is effective and safe in routine clinical practice.(AU)

Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population. / Adaptación lingüística y cultural del Oxford Cognitive Screen (OCS) en población española.

INTRODUCTION: Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S). MATERIAL AND METHODS: The linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years. RESULTS: The OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems. CONCLUSIONS: The OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke.

[Transcranial magnetic stimulation: contributions to the study of the visual pathway]. / Estimulación magnética transcraneal: aportaciones al estudio de la vía visual.

INTRODUCTION: Most of our impressions of the world and our memory are based on sight. Being able to look around us and recognise our surroundings involves the activity of several processing pathways in the brain that interact with each other and integrate information until it becomes conscious. Little is known about all these mechanisms today and therefore new tools must be developed and employed to enable us to further our understanding in this field. DEVELOPMENT: The visual system is one of the most complex sensory systems. An important part of what we do know about how it is organised derives from studies carried out in animals or from clinical findings in patients with visual problems caused by local lesions. In recent years, advances in neurophysiological recording and stimulation techniques have made it possible to study visual functioning in a far more direct manner. Transcranial magnetic stimulation (TMS) is one of these new techniques and can be used to assess the excitability of the occipital cortex, induce conscious visual perceptions, produce 'virtual lesions' and even carry out direct manipulation of several visuoperceptual tasks. In this work we present the main applications of TMS in the study of the visual pathway, its most significant technical aspects and its clinical usefulness from the diagnostic point of view and within the field of visual rehabilitation. CONCLUSIONS: TMS is a safe technique with important clinical and therapeutic implications, which offers valuable data about the mechanisms underlying the processing of visual information, and it is therefore becoming a very useful tool within the areas of neuroscience and clinical neurology.

Estimulación magnética transcraneal: aportaciones al estudio de la vía visual / Transcranial magnetic stimulation: contributions to the study of the visual pathway

La mayor parte de nuestras impresiones del mundo y de nuestra memoria se basan en la visión. Observarnuestro entorno y reconocer aquello que nos rodea implica la actividad de varias vías de procesamiento cerebral que interactúan entre sí e integran la información hasta hacerla consciente. Todos estos mecanismos todavía se conocen mal, de ahí la necesidad de desarrollar y utilizar nuevas herramientas que permitan avanzar en este campo. Desarrollo. El sistema visual es uno de los más complejos sistemas sensoriales. Gran parte de lo que sabemos acerca de su organización deriva de estudios de experimentación animal o de hallazgos clínicos en pacientes con problemas visuales provocados por lesiones locales. En los últimos años, los avances en las técnicas neurofisiológicas de registro y estimulación han permitido el estudio dela función visual de un modo mucho más directo. La estimulación magnética transcraneal (EMT) es una de estas nuevas técnicas y permite valorar la excitabilidad de la corteza occipital, inducir percepciones visuales conscientes, producir ‘lesiones virtuales’ e incluso manipular directamente diversas tareas visuoperceptivas. En este trabajo se presentan las principalesaplicaciones de la EMT en el estudio de la vía visual, sus aspectos técnicos más relevantes y su utilidad clínica desde el punto de vista diagnóstico y en el ámbito de la rehabilitación visual. Conclusiones. La EMT es una técnica segura, con importantesimplicaciones clínicas y terapéuticas, que ofrece datos valiosos sobre las mecanismos que subyacen en el procesamiento de la información visual, por lo que se está convirtiendo en una herramienta de gran utilidad en el ámbito de la neurociencia y la neurología clínica

Most of our impressions of the world and our memory are based on sight. Being able to look aroundus and recognise our surroundings involves the activity of several processing pathways in the brain that interact with each other and integrate information until it becomes conscious. Little is known about all these mechanisms today and therefore new tools must be developed and employed to enable us to further our understanding in this field. Development. The visualsystem is one of the most complex sensory systems. An important part of what we do know about how it is organised derives from studies carried out in animals or from clinical findings in patients with visual problems caused by local lesions. In recentyears, advances in neurophysiological recording and stimulation techniques have made it possible to study visual functioning in a far more direct manner. Transcranial magnetic stimulation (TMS) is one of these new techniques and can be used to assessthe excitability of the occipital cortex, induce conscious visual perceptions, produce ‘virtual lesions’ and even carry out direct manipulation of several visuoperceptual tasks. In this work we present the main applications of TMS in the study of the visualpathway, its most significant technical aspects and its clinical usefulness from the diagnostic point of view and within the field of visual rehabilitation. Conclusions. TMS is a safe technique with important clinical and therapeutic implications, whichoffers valuable data about the mechanisms underlying the processing of visual information, and it is therefore becoming a very useful tool within the areas of neuroscience and clinical neurology

[Preadmission statins treatment in stroke patients: opportunity to treat high vascular risk patients]. / Antecedente del uso de estatinas en el ictus: oportunidad de mejora en el paciente con alto riesgo vascular por aterotrombosis.

AIM: To describe the use of preadmission statins in patients with cerebrovascular accident and the possible predictive factors. PATIENTS AND METHODS: Cross-sectional observational study of 795 consecutive patients with acute cerebrovascular accident. We assessed the differences among patients who were on preadmission statins (161) and those who were not (634), regarding vascular risk factors and clinical and neurosonological atherothrombotic disease markers. For univariate analysis, we used squared chi test, and for multivariate analysis, logistic regression analysis. RESULTS: Preadmission statins were 20.3%. In high vascular risk patients defined based on National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), this reached 28% and it might be 72%. Predictive factors for preadmission statins use were, in a positive sense, the antecedent of hypercholesterolemia diagnosis (OR = 189; 95% CI = 58-615; p < or = 0.001) and stroke (OR = 2.1; 95% CI = 1.2-3.6; p < or = 0.01), and in a negative sense, smoking (OR = 0.38; 95% CI = 0.18-0.81; p = 0.012). CONCLUSIONS: In our population of patients with stroke, the predictive factors of preadmission statins did not adjust to the current therapeutic NCEP-ATP III recommendations; treatment with statins in high vascular risk population was way below the indications, it was 28% and it might be 72%.

Deterioro neurológico brusco 12 horas después de un traumatismo severo / Sudden neurological deterioration twelve hours after a severe trauma

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[Neuropathic pain as the reason for visiting Neurology: an analysis of its frequency]. / El dolor neuropático como motivo de consulta en Neurología: análisis de su frecuencia.

INTRODUCTION: Neuropathic pain (NP) is defined as pain that begins with or is caused by a primary injury or by a dysfunction in the nervous system. AIMS: Our aim was to evaluate how often patients visit Neurology as outpatients with NP as the main reason for referral. PATIENTS AND METHODS: A descriptive, cross sectional study was carried out on the use of the health care services; patients attended for the first time in a Neurology Screening visit were included consecutively. The variables studied were the following: the number of first visits and the total number of patients attended per visiting session, rate of patients with NP per visiting day, the topography and probable causation of the NP, and the rate of patients referred to the monographic NP clinic; the different quantitative variables are expressed in terms of their mean and standard deviation (SD), whereas the qualitative variables are given as their absolute value and the percentage. A total of 1,972 patients were attended, of whom 1,422 (72.1%) were first visits, with an average of 17.5 (SD: 2.5) new patients per visiting session. RESULTS: In all 113 patients clinically diagnosed with NP were identified, which represents a rate of 7.95% of the first visits. CONCLUSIONS: NP may be among the most frequent causes of the demand for neurological ambulatory care. The most common causes of NP were found to be trigeminal neuralgia, post-herpes neuralgia and diabetic polyneuropathy.

El dolor neuropático como motivo de consulta en Neurología: análisis de su frecuencia / Neuropathic pain as the reason for visiting neurology: an analysis of its frequency

Introducción. El dolor neuropático (DN) se define como aquel dolor iniciado o causado por una lesión primaria o por una disfunción en el sistema nervioso. Objetivo. Evaluar la frecuencia con la que los pacientes con DN como motivo principal de derivación se remiten a una consulta ambulatoria de Neurología. Pacientes y métodos. Se trata de un estudio descriptivo, transversal sobreutilización de los servicios sanitarios; se incluyeron consecutivamente los pacientes atendidos por primera vez en una consulta de Neurología de selección; variables estudiadas: número de primeras visitas y número total de pacientes atendidos por sesión de consulta, tasa de pacientes con DN por día de consulta, la topografía y probable etiología del DN, y la tasa de pacientes remitidos a la consulta monográfica de DN; las diferentes variables cuantitativas se expresarán con su media y desviación estándar (DE), mientras que en las variables cualitativas esto se hará con su valor absoluto y el porcentaje. Se atendieron 1.972 pacientes, de los cuales 1.422(72,1%) fueron primeras visitas, con una media de 17,5 (DE: 2,5) pacientes nuevos por sesión de consulta. Resultados. Se identificaron113 pacientes con diagnóstico clínico de DN, lo que supone una tasa del 7,95% de las primeras visitas. Conclusiones. El DN puede estar entre las causas más frecuentes de demanda de asistencia neurológica ambulatoria. Las causas más frecuentes de DN fueron la neuralgia del trigémino, la neuralgia posherpética y la polineuropatía diabética (AU)

Introduction. Neuropathic pain (NP) is defined as pain that begins with or is caused by a primary injury or by a dysfunction in the nervous system. Aims. Our aim was to evaluate how often patients visit Neurology as outpatients with NPas the main reason for referral. Patients and methods. A descriptive, cross sectional study was carried out on the use of the health care services; patients attended for the first time in a Neurology Screening visit were included consecutively. The variables studied were the following: the number of first visits and the total number of patients attended per visiting session, rate of patients with NP per visiting day, the topography and probable causation of the NP, and the rate of patients referred to the monographic NP clinic; the different quantitative variables are expressed in terms of their mean and standard deviation (SD), whereas the qualitative variables are given as their absolute value and the percentage. A total of 1,972patients were attended, of whom 1,422 (72.1%) were first visits, with an average of 17.5 (SD: 2.5) new patients per visiting session. Results. In all 113 patients clinically diagnosed with NP were identified, which represents a rate of 7.95% of the first visits. Conclusions. NP may be among the most frequent causes of the demand for neurological ambulatory care. The most common causes of NP were found to be trigeminal neuralgia, post-herpes neuralgia and diabetic polyneuropathy (AU)

[The value of orbit magnetic resonance imaging in the diagnosis of blindness caused by giant cell arteritis]. / Aportación de la resonancia magnética orbitaria al diagnóstico de la ceguera por arteritis de células gigantes.

INTRODUCTION: Giant cell arteritis (GCA) is a chronic vasculitis of middle-sized and large calibre vessels which occurs mainly in individuals aged over the age of 50. It chiefly affects the cranial branches of the arteries that originate in the aortic arch. Its most important characteristic symptoms include visual disorders, especially loss of sight; bilateral blindness, however, is infrequent. CASE REPORT: We describe the case of an 81-year-old female who visited because of sudden blindness and bilateral retroocular pain. The neurological exploration only revealed bilateral amaurosis, dilated pupils with the phenomenon of papillary escape, and no alterations to the ocular fundus. Laboratory tests showed a haemoglobin level of 12 mg/dL, ESR of 71 mm/hr and CRP of 2.3. Magnetic resonance imaging (MRI) and computerised tomography of the brain without intravenous contrast showed findings compatible with small vessel ischemic phenomena. Because a vasculitic process was suspected, orbit RMI was performed and revealed signal hyperintensity in the soft intraconal parts with respect to the extraocular muscles. A biopsy study of the left temporal artery was compatible with GCA. CONCLUSIONS: In cases of GCA with an atypical visual presentation, finding enhancement of the intraconal fat or of the optic nerve sheath in the RMI can support the suspicion of an arteritic process.

[Binocular diplopy as the presentation of a haematoma in the rectus inferior]. / Diplopía binocular como presentación de un hematoma del recto inferior.

INTRODUCTION: The presence of quick onset binocular diplopy makes it essential to carry out a comprehensive differential diagnosis. The most frequent causes in adults include vascular, post-traumatic, tumorous and myopathic pathologies. Yet, to perform a differential diagnosis we also have to take into account less common aetiologies such as demyelinating disease, carotid-cavernous fistulas and Tolosa Hunt syndrome, among others. We report the case of a patient who was admitted to our hospital because she presented an acute onset diplopy secondary to a spontaneous haematoma of the left rectus inferior. CASE REPORT: We describe the case of a 54-year-old female with a history of hypercholesterolemia, who was a smoker and allergic to iodine contrasts and who visited because of an acute onset diplopy accompanied by instability and pain in the left eye. The neurological examination revealed paresis of the extraocular muscles dependent on the left oculomotor nerve with left palpebral ptosis, paresis of the rectus inferior, with no involvement of the pupils. Other results of the exploration were within normal limits. A computerised axial tomography scan of the head showed a haemorrhage in the rectus inferior. Magnetic resonance images of the head revealed an increase in the volume of the left-side rectus inferior with signs of bleeding, and the rest of the complementary explorations were normal. The patient progressed favourably and the diplopy gradually disappeared. CONCLUSIONS: Spontaneous bleeding of the extraocular muscles, although infrequent, must be taken into account in the differential diagnosis of painful ophthalmoplegia with diplopy in patients with no underlying pathology, especially in the absence of other neurological disorders.

Aportación de la resonancia magnética orbitaria al diagnóstico de la ceguera por arteritis de células gigantes / The value of orbit magnetic resonance imaging in the diagnosis of blindness caused by giant cell arteritis

Introducción. La arteritis de células gigantes (ACG) es una vasculitis crónica de vasos de mediano y gran calibre, que ocurre fundamentalmente en individuos de más de 50 años y afecta primordialmente a las ramas craneales de las arterias que se originan en el cayado aórtico. Entre los síntomas característicos desta can las alteraciones visuales, especialmente la pérdida de visión; la ceguera bilateral es poco frecuente. Caso clínico. Presentamos el caso de una mujer de 81 años que acude por cuadro de ceguera súbita y dolor retroocular bilateral. En la exploración neurológica sólo se objetiva amaurosis bilateral, pupilas midriáticas con fenómeno de escape pupilar, con fondo de ojo sin alteraciones. Las pruebas de laboratorio muestran una hemoglobina de 12 mg/dL, VSG de 71 mm/h y PCR de 2,3. La resonancia magnética (RM) y la tomografía computarizada cerebral sin contraste intravenoso mostraron hallazgos compatibles con fenómenos isquémicos de pequeño vaso. Ante la sospecha de proceso vasculítico, se realizó una RM orbitaria, que mostró hiperintensidad de señal en partes blandas intraconales con respeto de la musculatura extraocular. La biopsia de la arteria temporal izquierda fue compatible con ACG. Conclusión. En casos de ACG con presentación visual atípica, encontrar un realce de la grasa intraconal o de la vaina del nervio óptico en la RM, puede apoyar la sospecha de un proceso arterítico (AU)

Introduction. Giant cell arteritis (GCA) is a chronic vasculitis of middle-sized and large calibre vessels which occurs mainly in individuals aged over the age of 50. It chiefly affects the cranial branches of the arteries that originate in the aortic arch. Its most important characteristic symptoms include visual disorders, especially loss of sight; bilateral blindness, however, is infrequent. Case report. We describe the case of an 81-year-old female who visited because of sudden blindness and bilateral retroocular pain. The neurological exploration only revealed bilateral amaurosis, dilated pupils with the phenomenon of papillary escape, and no alterations to the ocular fundus. Laboratory tests showed a haemoglobin level of 12 mg/dL, ESR of 71 mm/h and CRP of 2.3. Magnetic resonance imaging (MRI) and computerised tomography of the brain without intravenous contrast showed findings compatible with small vessel ischemic phenomena. Because a vasculitic process was suspected, orbit RMI was performed and revealed signal hyperintensity in the soft intraconal parts with respect to the extraocular muscles. A biopsy study of the left temporal artery was compatible with GCA. Conclusions. In cases of GCA with an atypical visual presentation, finding enhancement of the intraconal fat or of the optic nerve sheath in the RMI can support the suspicion of an arteritic process (AU)