[Memory loss: a reason for consultation]. / Pérdida de memoria como motivo de consulta.

INTRODUCTION: Memory loss is an increasingly frequent reason for consultation in neurology. The aim of this work is to know the current frequency as well as the characteristics and disorders of the patients who come for this reason. METHODS: We studied 200 patients who came to general neurology consultation due to loss of memory. RESULTS: 18.47% of the patients who came for the first time to a general neurology consultation did so due to memory loss, this being subjective loss of memory (SLM) in 39% of the cases and referred loss of memory (RLM) in 61% of the cases. The diagnostic groups to which the patients belonged are, in diminishing order, the following: degenerative primary dementia type Alzheimer's disease, mild cognitive impairment, mixed dementia, pure vascular dementia, depressive pseudodementia, attributable to drugs, secondary to systemic disease, non-Alzheimer's type disease primary degenerative dementia, structural reasons, transitory global amnesia and epilepsy. No disease was found in 13% of them, and the generally came due to SLM. CONCLUSIONS: Frequency of memory loss as a reason for consultation continues to growing. Patients studied due to memory loss, in whom no disease is found, are generally those having SLM. In spite of this, SLM is a good predictor of cognitive deterioration. It is important to systematically study of every patient and consults for loss of memory and to investigate the possible use of drugs or toxics that could alter the memory.

Pérdida de memoria como motivo de consulta / Memory loss: a reason for consultation

Introducción. La pérdida de memoria es motivo de consulta de frecuencia creciente en neurologia; el objetivo de este trabajo es conocer la frecuencia actual, asi como las características y patologías de los pacientes que acuden por este motivo. Métodos. Se estudian 200 pacientes que acuden a una consulta de neurología general por pérdida de memoria. Resultados. El 18,47 % de los pacientes que acuden por primera vez a una consulta de neurología general lo hacen por pérdida de memoria, siendo pérdida subjetiva de memoria (PSM) en el 39 % de los casos y pérdida referida de memoria (PRM) en el 61 %. Los grupos diagnósticos a los que pertenecen los pacientes son por orden decreciente los siguientes: demencia degenerativa primaria tipo enfermedad de Alzheimer, deterioro cognitivo leve, demencia mixta, demencia vascular pura, seudodemencia depresiva, demencia degenerativa primaria no tipo enfermedad de Alzheimer, atribuible a fármacos y tóxicos, secundaria a enfermedad sistémica, causas estructurales, amnesia global transitoria y epilepsia. En el 13 % de ellos no se encuentra ningún tipo de patología y suelen acudir por PSM. Conclusiones. La frecuencia de la pérdida de memoria como motivo de consulta continúa creciendo. Los pacientes estudiados por pérdida de memoria en los que no se encuentra patología suelen ser aquellos que presentan PSM, a pesar de lo cual la PSM es un buen predictor de deterioro cognitivo. Es importante realizar un abordaje sistematizado de todo paciente que consulte por pérdida de memoria e investigar el posible uso de fármacos o tóxicos que puedan alterar la memoria

Introduction. Memory loss is an increasingly frequent reason for consultation in neurology. The aim of this work is to know the current frequency as well as the characteristics and disorders of the patients who come for this reason. Methods. We studied 200 patients who carne to general neurology consultation due to loss of memory. Results. 18.47 % of the patients who carne for the first time to a general neurology consultation did so due to memory loss, this being subjective loss of memory (SLM) in 39 % of the cases and referred loss of memory (RLM) in 61 % of the cases. The diagnostic groups to which the patients belonged are, in diminishing order, the following: degenerative primary dementia type Alzheimer's disease, mild cognitive impairment, mixed dementia, pure vascular dementia, depressive pseudodementia, attributable to drugs, secondary to systemic disease, non-Alzheimer's type disease primary degenerative dementia, structural reasons, transitory global amnesia and epilepsy. No disease was found in 13 % of them, and the generally carne due to SLM. Conclusions. Frequency of memory loss as a reason for consultation continues to growing. Patients studied due to memory loss, in whom no disease is found, are gene rally those having SLM. In spite of this, SLM is a good predictor of cognitive deterioration. It is important to systematically study of every patient and consults for loss of memory and to investigate the possible use of drugs or toxics that could alter the memory

APP processing and the APP-KPI domain involvement in the amyloid cascade.

Alternative APP mRNA splicing can generate isoforms of APP containing a Kunitz protease inhibitor (KPI) domain. KPI is one of the main serine protease inhibitors. Protein and mRNA KPI(+)APP levels are elevated in Alzheimer's disease (AD) brain and are associated with increased amyloid beta deposition. In the last years increasing evidence on multiple points in the amyloid cascade where KPI(+)APP is involved has been accumulated, admitting an outstanding position in the pathogenesis of AD to the KPI domain. This review focuses on the APP processing, the molecular activity of KPI and its physiological and pathological roles and the KPI involvement in the amyloid cascade through the nerve growth factor, the lipoprotein receptor-related protein, the tumor necrosis factor-alpha converting enzyme and the Notch1 protein.

[The chronopathology of prion encephalopathies]. / Cronopatología de las encefalopatías priónicas.

INTRODUCTION: Prion encephalopathies are a group of diseases with a hereditary or acquired origin which, after a long asymptomatic period, give rise to rapidly progressing neurological disorders. This progression can only be explained by an exponential growth of the pathogenic protein load, which allows to keep the load in low levels for many years and then to grow swiftly in a few months. DEVELOPMENT: Bearing in mind the knowledge currently available about the pathogenesis of prion diseases and patients' clinical progression, it becomes possible to distinguish several different periods of progression, the length of which can be estimated for each disease by reviewing the series of cases published to date. In general, the infectious prion diseases have a shorter period of latency than the hereditary ones and those caused by insertion of genetic material are associated to shorter latencies and to longer periods of illness than those caused by sporadic mutations. CONCLUSIONS: The rate of growth of the prion load depends essentially on how fast the pathogenic prion protein replicates; nevertheless, this growth is also modulated by other factors, many of which are polymorphisms in certain positions on the gene coding for prion protein or in other genes.

Cronopatología de las encefalopatías priónicas / The chronopathology of prion encephalopathies

Introducción. Las encefalopatías priónicas son un grupo de enfermedades de origen hereditario o adquirido que, tras un largo período asintomático, causan trastornos neurológicos rápidamente progresivos. Esta evolución sólo puede explicarse por un crecimiento de la carga proteica patógena de tipo exponencial, que permita mantener una carga baja durante muchos años y un crecimiento fugaz en meses. Desarrollo. Teniendo en cuenta los conocimientos actuales sobre la patogenia de las enfermedades priónicas y la evolución clínica de los pacientes, pueden distinguirse varios períodos evolutivos, cuya duración puede estimarse para cada enfermedad revisando las series de casos publicadas. En general, las enfermedades priónicas infecciosas tienen períodos de latencia más cortos que las hereditarias, y entre éstas, las causadas por inserción de material genético se asocian a latencias más cortas y períodos de enfermedad más prolongados que las causadas por mutaciones puntuales. Conclusión. La velocidad de crecimiento de la carga priónica depende fundamentalmente de la velocidad de replicación de la proteína priónica patógena; no obstante, este crecimiento también está modulado por otros factores, muchos de los cuales son polimorfismos en ciertas posiciones del propio gen codificador de la proteína priónica o en otros genes (AU)

[Wallenberg's syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation]. / Sindrome de Wallemberg secundario a disección de la arteria vertebral por manipulación quiropráctica.

INTRODUCTION: Chiropractic manipulations of the cervical region are techniques that are used more and more frequently to treat a number of osteomuscular pathologies, but can give rise to important complications, such as the dissection of the cervical arteries. Dissection of the vertebral artery generally presents as alternating syndromes, of which Wallenberg s syndrome, either complete or incomplete, is the most frequent. In this paper we review the literature published to date on the pathogenesis, risk factors, clinical features, chronopathology, diagnosis, treatment and prognosis of this complication. CASE REPORT: We describe the case of a young patient who suffered from incomplete Wallenberg s syndrome a few hours after a single session of cervical chiropractic manipulation, and we also show the resonance images that were used to support the diagnosis. CONCLUSIONS: The appearance of a pain in the neck and neurological symptoms in a patient who has undergone chiropractic manipulation in the last few hours or days must lead us to consider a possible dissection of the cervical arteries. Dissection of the vertebral artery usually gives rise to alternating syndromes, the most frequent of which is lateral bulbomedullary infarction or Wallenberg s syndrome due to proximal occlusion of the posteroinferior cerebellar artery. Magnetic resonance angiography of the supra aortic trunks and cranial magnetic resonance scanning are valid techniques for demonstrating the dissection of the artery and the associated ischemic lesion.

Síndrome de Wallemberg secundario a disección de la arteria vertebral por manipulación quiropráctica / Wallenberg´s syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation

Introducción. Las manipulaciones cervicales quiroprácticas son técnicas que se emplean cada vez con mayor frecuencia para el tratamiento de numerosas patologías osteomusculares, y pueden producir complicaciones importantes, como la disección de las arterias cervicales. La disección de la arteria vertebral se manifiesta generalmente por un síndrome alterno, de los cuales el síndrome de Wallemberg completo o incompleto es el más frecuente. En este artículo se revisa la bibliografía existente sobre la patogenia, factores de riesgo, clínica, cronopatología, diagnóstico, tratamiento y pronóstico de esta complicación. Caso clínico. Se expone el caso de un paciente joven que sufre un síndrome de Wallemberg incompleto, horas después de una única sesión quiropráctica cervical, y se muestran las imágenes de resonancia que se emplearon para apoyar el diagnóstico. Conclusiones. La aparición de cerviconucalgia y sintomatología neurológica en un paciente que se haya sometido a manipulación quiropráctica en las horas o días previos debe hacer pensar en la disección de las arterias cervicales. La disección de la arteria vertebral suele causar un síndrome alterno, de los que el infarto bulbomedular lateral o síndrome de Wallemberg por oclusión proximal de la arteria cerebelosa posteroinferior es el más frecuente. La angiorresonancia de los troncos supraaórticos y la resonancia magnética craneal son técnicas válidas para demostrar la disección arterial y la lesión isquémica asociada (AU)

Introduction. Chiropractic manipulations of the cervical region are techniques that are used more and more frequently to treat a number of osteomuscular pathologies, but can give rise to important complications, such as the dissection of the cervical arteries. Dissection of the vertebral artery generally presents as alternating syndromes, of which Wallenberg’s syndrome, either complete or incomplete, is the most frequent. In this paper we review the literature published to date on the pathogenesis, risk factors, clinical features, chronopathology, diagnosis, treatment and prognosis of this complication. Case report. We describe the case of a young patient who suffered from incomplete Wallenberg’s syndrome a few hours after a single session of cervical chiropractic manipulation, and we also show the resonance images that were used to support the diagnosis. Conclusions. The appearance of a pain in the neck and neurological symptoms in a patient who has undergone chiropractic manipulation in the last few hours or days must lead us to consider a possible dissection of the cervical arteries. Dissection of the vertebral artery usually gives rise to alternating syndromes, the most frequent of which is lateral bulbomedullary infarction or Wallenberg’s syndrome due to proximal occlusion of the posteroinferior cerebellar artery. Magnetic resonance angiography of the supra-aortic trunks and cranial magnetic resonance scanning are valid techniques for demonstrating the dissection of the artery and the associated ischemic lesion (AU)

Hallazgo simultáneo de schwanoma del nervio trigémino derecho y malformación arteriovenosa frontal izquierda en un mismo paciente / Simultaneous finding of right trigeminal nerve schwannomas and left frontal arteriovenous malformation

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Estimación de la prevalencia de la enfermedad de Parkinsonen Asturias (España). Estudio farmacoepidemiológicodel consumo de antiparkinsonianos / Estimation of the prevalence of parkinson's disease in Asturias (Spain). A pharmacoepidemiological study of the consumption of antiparkinson drugs

Introducción. Los estudios sobre la prevalencia de la enfermedad de Parkinson (EP) son escasos y realizados con diferentes metodologías. Por ello no es posible conocer su impacto en la salud pública de Asturias (España). Objetivo. Estimar la prevalencia de la EP en Asturias, a partir del consumo de fármacos antiparkinsonianos (Grupo terapéutico NO4A), en el período comprendido entre el 1 de enero de 1997 al 31 de diciembre de 1998. Material y métodos. Se calculó la dosis diaria definida por 100.000 habitantes para cada fármaco antiparkinsoniano prescrito en el período de estudio. Los registros de prescripción fueron facilitados por la Subdirección de Farmacia del Ministerio de Sanidad y Consumo con una cobertura del 100 por ciento de la población. Resultados. La determinación de la DDD por 100.000 habitantes para la prescripción de levodopa fue de 199,13 (IC95 por ciento: 172,4-228,6) casos por 100.000 habitantes, lo que supone 2.115 enfermos de Parkinson en Asturias (entre 1.827 y 2.423). Para el grupo de edad de menores de 65 años la prevalencia estimada es de 63,97 casos por 100.000 habitantes (IC95 por ciento: 49,4-81,7), y para el grupo de 65 y más años es de 668,19 casos por 100.000 habitantes (IC95 por ciento: 686,9794). Conclusiones. La prevalencia estimada de la EP en Asturias (España) puede calificarse de media-alta en relación con los países de nuestro entorno; sin embargo, los casos de EP en personas de 65 o mas años, serían más bajos que en su entorno. Las diferencias metodológicas existentes entre las diferentes investigaciones realizadas no permiten obtener conclusiones definitivas (AU)

[Estimation of the prevalence of Parkinson's disease in Asturia, Spain. A pharmacoepidemiological study of the consumption of antiparkinson drugs]. / Estimación de la prevalencia de la enfermedad de Parkinson en Asturias (España). Estudio farmacoepidemiológico del consumo de antiparkinsonianos.

INTRODUCTION: There are few studies of the prevalence of Parkinson's disease (PD) and they have been done using different methodologies. So it is impossible to know its impact on public health in Asturias (Spain). OBJECTIVE: To estimate the prevalence of PD in Asturias, from the consumption of antiparkinson drugs (Therapeutic Group N04A) in the period between January 1, 1997 and December 31, 1998. MATERIAL AND METHODS: We calculated the defined daily dose (DDD) per 100,000 inhabitants for each antiparkinson drug prescribed during the period studied. Records of prescriptions were obtained from the Pharmacy Sub-directorate of the Health and Consumption Ministry which covers 100% of the population. RESULTS: Determination of the DDD per 100,000 inhabitants for prescriptions of levodopa was 199.13 (95% CI: 172.4-228.6) cases per 100,000 inhabitants, which means 2,115 patients with Parkinson's disease in Asturias (between 1,827 and 2,423). In the group aged under 65 years the estimated prevalence is 63.97 cases per 100,000 inhabitants (95% CI: 49.4-81.7), and for the group aged 65 years or more is 668.19 cases per 100,000 inhabitants (95% CI: 686.9-794). CONCLUSIONS: The estimated prevalence of PD in Asturias (Spain) may be considered average-high as compared to neighboring countries. However, cases of PD in patients aged 65 years or more are fewer than in neighboring countries. The methodological differences between the different studies done prevents definite conclusions being drawn.