Neurofibrosarcoma con metástasis pulmonares en paciente con neurofibromatosis tipo I / Neurofibrosarcoma with pulmonary metastasis in patient with neurofibromatosis type I

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[Comorbidity in the migraine: depression, anxiety, stress and insomnia]. / Comorbilidad en la migraña: depresión, ansiedad, estrés y trastornos del sueño.

INTRODUCTION: Migraine is frequently associated to other pathologies or factors. AIM: To analyze the migraine's profile in a neurologic consultation and to determinate its comorbidity. PATIENTS AND METHODS: 155 patients (36 men and 119 women) were studied in a neurologic consultation of the University Hospital of Salamanca during the year 2005. Migraine was diagnosed according the International Headache Society criteria, and associated disorders were measured using the Goldberg's Anxiety and Depression Scale, the Perceived Stress Questionnaire and the Oviedo Sleep Questionnaire. RESULTS: 99 patients suffered from migraine without aura and 56 with aura; mean age was 36 years; age at onset 20.64 years. 43 migraneurs had depression, anxiety 34, insomnia 58, stress 79, none of these pathologies 62 (40%). Depression and dream upheavals were close to equal between the migraine subtypes (although depression was something more common in migraine without aura), while anxiety and stress were more frequent in migraine with aura (RR: 1.42; 95% CI: 0.92-2.2; and RR: 1.38; 95% CI: 0.9-2.12, respectively). Depression and insomnia were more likely among women with nonsignificant differences (RR: 1.3; 95% CI: 0.95-1.34; and RR: 1.13; 95% CI: 0.95-1.34, respectively), whereas anxiety and stress were similar in both genders. Another associations were found between: migraine's family-history and migraine with aura (OR: 1.31; 95% CI: 0.63-2.71); some dietary factors and migraine without aura (OR: 2.27; 95% CI: 0.57-9.07). CONCLUSIONS: 60% of our migraneurs had at least one of the following disorders: depression (27.74%), anxiety (21.94%), stress (50.97%) or insomnia (37.42%); can trigger or worsen migraine attacks.

Comorbilidad en la migraña: depresión, ansiedad, estrés y trastornos del sueño / Comorbidity in the migraine: depression, anxiety, stress and insomnia

La migraña se asocia frecuentemente a trastornos psicológicos y a otros factores considerados predisponentes.Objetivo. Analizar el perfil de las migrañas en una consulta neurológica y determinar su comorbilidad. Pacientes y métodos. Se estudiaron 155 pacientes (36 hombres y 119 mujeres) en una consulta neurológica del Hospital Universitario de Salamanca durante el 2005. Se utilizaron los criterios diagnósticos de la Sociedad Internacional de Cefaleas y, para los trastornosasociados, la escala de ansiedad y depresión de Goldberg, el cuestionario de estrés percibido y el cuestionario Oviedo de sueño. Resultados. 99 pacientes tenían migraña sin aura y 56 con aura, con una edad media de 36 años, y una edad de inicio de 20,64 años. 43 migrañosos asociaron depresión; 34, ansiedad; 58, insomnio; 79, estrés; y 62, ninguna de estas patologías(40%). La depresión y los trastornos del sueño estuvieron presentes en la migraña sin y con aura (la depresión fue algo más común en la migraña sin aura; la ansiedad y el estrés fueron más frecuentes en la migraña con aura) (RR: 1,42; IC 95%:0,92-2,2; y RR: 1,38; IC 95%: 0,9-2,12, respectivamente). La depresión y el insomnio se manifestaron más frecuentes en mujeres(RR: 1,3; IC 95%: 0,95-1,34; y RR: 1,13; IC 95%: 0,95-1,34, respectivamente), y la ansiedad y el estrés fueron semejantes en ambos sexos. Se encontraron otras asociaciones entre: antecedentes familiares de migraña (OR: 1,31; IC 95%: 0,63-2,71) y migraña con aura, y determinados alimentos (OR: 2,27; IC 95%: 0,57-9,07) con migraña sin aura. Conclusiones. El 60% delos migrañosos presentaba alguno de los siguientes trastornos: depresión (27,74%), ansiedad (21,94%), estrés (50,97%) o insomnio (37,42%); pueden desencadenar o empeorar los episodios de migraña

Migraine is frequently associated to other pathologies or factors. Aim. To analyze the migraine’sprofile in a neurologic consultation and to determinate its comorbidity. Patients and methods. 155 patients (36 men and 119 women) were studied in a neurologic consultation of the University Hospital of Salamanca during the year 2005. Migraine was diagnosed according the International Headache Society criteria, and associated disorders were measured using theGoldberg’s Anxiety and Depression Scale, the Perceived Stress Questionnaire and the Oviedo Sleep Questionnaire. Results. 99 patients suffered from migraine without aura and 56 with aura; mean age was 36 years; age at onset 20.64 years. 43 migraneurs had depression, anxiety 34, insomnia 58, stress 79, none of these pathologies 62 (40%). Depression and dream upheavals were close to equal between the migraine subtypes (although depression was something more common in migrainewithout aura), while anxiety and stress were more frequent in migraine with aura (RR: 1.42; 95% CI: 0.92-2.2; and RR: 1.38; 95% CI: 0.9-2.12, respectively). Depression and insomnia were more likely among women with nonsignificant differences (RR: 1.3; 95% CI: 0.95-1.34; and RR: 1.13; 95% CI: 0.95-1.34, respectively), whereas anxiety and stress were similar in bothgenders. Another associations were found between: migraine’s family-history and migraine with aura (OR: 1.31; 95% CI:0.63-2.71); some dietary factors and migraine without aura (OR: 2.27; 95% CI: 0.57-9.07). Conclusions. 60% of our migraneurs had at least one of the following disorders: depression (27.74%), anxiety (21.94%), stress (50.97%) or insomnia (37.42%);can trigger or worsen migraine attacks

[Atypical Guillain-Barré syndrome: multiple cranial neuropathy]. / Síndrome de Guillain-Barré atípico: neuropatía craneal múltiple.

INTRODUCTION: Multiple cranial neuropathy is a condition rarely seen in everyday clinical practice. It has many different causes, and in spite of careful clinical investigation many cases remain of unknown aetiology. It is also considered to be an atypical variant, topographically circumscribed, of the Guillan Barr syndrome (GBS). CASE REPORT: A 23 years old man developed a progressive illness over ten days. He complained of diplopia, facial diplegia and a nasal voice. Subsequently, he also developed weakness of the neck and tongue muscles, dysphagia, abolition of reflexes of the left arm and right triceps reflex but without involvement of the respiratory muscles or other limbs. CSF studies showed slightly raised protein with no cells. Neurophysiological studies showed a demyelinating disorder with secondary axonal damage. In spite of further studies, no aetiological agent was found. DISCUSSION AND CONCLUSION: These observations suggested this case is of a topographical variant of GBS. Such cases have also been classified as the Miller Fisher syndrome, pharyngo cervico brachial paralysis, are flexic paraparesia and bilateral lumbar polyradiculopathy. In view of the diversity of the clinical and biological characteristics of the cases reviewed, which may mean different aetiopathogeneses, we consider that a thorough search should be made for the aetiology before these conditions are labelled as atypical variants of GBS.

Síndrome de Guillain-Barré atípico: neuropatía craneal múltiple / Atypical Guillain-Barré syndrome: multiple cranial neuropathy

Introducción. La neuropatía craneal múltiple es una entidad rara en la práctica clínica diaria. Son muy diversas las causas que la pueden originar, aunque muchos casos permanecen sin filiar después de un minucioso proceso diagnóstico. Se considera también que constituye una variante atípica, topográficamente circunscrita, del síndrome de Guillain-Barré (SGB). Caso clínico. Varón de 23 años que desarrolló un cuadro progresivo a lo largo de diez días consistente en diplopía, diplejía facial y voz nasal. Posteriormente se añadió debilidad de musculatura cervical y lengua, disfagia, abolición de reflejos en extremidad superior izquierda y del tricipital en extremidad superior derecha, sin afectación de musculatura respiratoria ni de extremidades. Los estudios de líquido cefalorraquídeo mostraron leve hiperproteinorraquia sin celularidad y el examen neurofisiológico reveló una afectación de tipo desmielinizante con daño axonal secundario. Los estudios practicados para aclarar la etiología no descubrieron ningún agente etiológico demostrable. Discusión y conclusiones. Estas observaciones sugieren que el presente caso es una variante topográfica del SGB; se han definido también como tales el síndrome de Miller-Fisher, la parálisis faringocervicobraquial, la paraparesia arrefléxica y la polirradiculopatía lumbar bilateral. Dada la diversidad en las características clínicas y biológicas de los casos revisados, que pueden suponer etiopatogenias diferentes, consideramos necesaria una amplia búsqueda etiológica antes de considerar estos cuadros como variantes atípicas del SGB (AU)