Melanocitoma meníngeo con comportamiento maligno / Meningeal melanocytoma with malignant behaviour

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Valor del reflejo cutáneo palmar en el diagnóstico del síndrome del túnel del carpo idiopático / Value of the cutaneous-plantar reflex in the diagnosis of idiopathic carpal tunnel syndrome

Introducción. El síndrome del túnel del carpo (STC) constituye la primera entidad entre las neuropatías focales. Su diagnóstico se basa en el estudio neurofisiológico de las fibras motoras y sensitivas de grueso calibre en pacientes con una clínica característica, aunque en ocasiones, en casos leves, dicho estudio puede no detectar anomalías. Se decide realizar la evaluación de las fibras simpáticas de pequeño calibre mediante el reflejo cutáneo palmar (RCP) en pacientes con diferente grado de STC idiopático. Sujetos y métodos. Se estudian 54 casos, 15 hombres y 39 mujeres con STC, y 15 controles voluntarios sanos. Los casos se distribuyen en tres grupos: sólo con clínica positiva, con clínica y alteración en la conducción sensitiva, y con clínica y alteración de la conducción sensitiva y motora y pérdida axonal. El RCP se obtiene según la técnica habitual, modificada por nosotros, mediante la estimulación del nervio mediano en la muñeca y registrando la respuesta en la mano contralateral. Se procesan dos respuestas sucesivas con un intervalo superior a un minuto. Se presta especial atención al control de la línea de base y sudoración. Se efectúa un análisis estadístico descriptivo de inferencia y de correlación. Resultados. Se observó una disminución de amplitud de la respuesta en los pacientes con STC, latencias más cortas en las mujeres y buena correlación entre las latencias de la primera y segunda respuesta. No se objetivaron diferencias significativas en los demás parámetros estudiados. Conclusión. El estudio del RCP puede aportar datos complementarios en la evaluación del STC (AU)

Introduction. Carpal tunnel syndrome (CTS) is the most common of all focal neuropathies. Its diagnosis is based on aneurophysiological study of the thick motor and sensory fibres in patients with a characteristic clinical picture, although sometimes, in mild cases, this study does not detect the abnormalities. The decision was made to evaluate the smallcalibre sympathetic fibres by means of cutaneous-plantar reflex (CPR) in patients with different degrees of idiopathic CTS. Subjects and methods. The study involved 54 cases –15 males and 39 females with CTS– and 15 healthy volunteer controls. The cases were divided into three groups: those with only positive clinical features; those with clinical features and alteration of sensory conduction; and those with clinical features, alteration of sensory and motor conduction, and axonal loss. The CPR was obtained by means of the usual technique (which we modified), involving stimulation of the median nerve in the wrist and recording the response in the contralateral hand. Two successive responses were processed with an interval of more than one minute between them. Special attention was paid to controlling the baseline and sweating. A descriptive statistical inference and correlation analysis was performed. Results. A decrease in amplitude of the response was observed in patients with CTS, with shorter latencies in women and a good correlation between the latencies of the first and the second response. No significant differences were observed in the other parameters that were studied. Conclusion. Studying the CPR can provide complementary data in the evaluation of CTS (AU)

[Clinical variability in neuromyelitis optica: three case reports]. / Variabilidad clinica en la neuromielitis optica: descripcion de tres casos.

INTRODUCTION: Three cases of neuromyelitis optica (NMO) admitted in our hospital with a heterogeneous clinical characteristics are presented. CASE REPORTS: Case 1: a middle-aged woman with five acute transverse myelitis episodes and a high latency of the P100 in the visual evoked potentials. The MRI and the NMO antibodies were both negatives. Case 2: a young lady with a two months duration episode of optic neuritis in one eye first, and both myelitis and optic neuritis on the other eye burst secondly, with a very good evolution and positive NMO antibodies. Case 3: a 72 years-old woman with three episodes of acute transverse myelitis. After three years she had two more acute myelitis bursts and finally one optic neuritis, with no lesions in the brain MRI and negative NMO antibodies. CONCLUSIONS: The concept of the NMO has changed from its original description. Today it is conceived as a clinical spectrum by a well definite diagnostic criteria, but very heterogeneous as for the clinical characteristics, the outbreak age, or the response to the treatment, since it remains reflected in this three cases.

Ataxia aguda y meningitis aséptica secundarias a quiste dermoide de fosa posterior / Acute ataxia and aseptic meningitis secondary to a posterior fossa dermoid cyst

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Presentación clínica atípica en un varón joven de la polirradiculopatía aguda axonal motora / Atypical clinical presentation of acute motor axonal polyradiculoneuropathy in a young male

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