Alteraciones en el procesamiento visual de formas: clasificación clínica integradora / Visual form-processing deficits: a global clinical classification

Introducción: Los pacientes que presentan dificultades para el reconocimiento visual de formas estimulares son considerados habitualmente como pacientes con agnosia visual. No obstante, estudios recientes permiten identificar diferentes manifestaciones clínicas que podrían corresponderse con entidades diagnósticas que reflejan déficits diferenciados a lo largo del continuo del procesamiento visual cortical de las formas. Desarrollo: Revisamos diferentes casos clínicos publicados en la literatura científica así como propuestas de clasificación de este déficit con la finalidad de dar una visión integradora del mismo. Exponemos los principales hallazgos en cuanto a las bases neuroanatómicas del procesamiento visual de formas y discutimos acerca de los criterios para evaluar dicho procesamiento cuando pueda estar alterado. Asimismo, presentamos un esquema de los déficits de procesamiento visual de formas que pretende integrar los distintos casos clínicos descritos en la literatura científica. Finalmente, proponemos un árbol de decisión que puede ser útil para guiar el proceso diagnóstico de estos casos. Conclusiones: Existe un amplio consenso en cuanto a las áreas corticales y circuitos neuronales que participan en el procesamiento visual, aunque futuros estudios con las nuevas técnicas de neuroimagen funcional permitirán profundizar en este aspecto. Una evaluación estructurada y exhaustiva de las diferentes etapas del procesamiento visual realizada a partir de una visión integradora del déficit nos facilitara un diagnóstico más objetivo, lo que nos permitirá conocer mejor el pronóstico y será de utilidad para guiar el diseño de estrategias individualizadas de psicoestimulación o rehabilitación

Introduction: Patients who have difficulties recognising visual form stimuli are usually labelled as having visual agnosia. However, recent studies let us identify different clinical manifestations corresponding to discrete diagnostic entities which reflect a variety of deficits along the continuum of cortical visual processing. Development: We reviewed different clinical cases published in medical literature as well as proposals for classifying deficits in order to provide a global perspective of the subject. Here, we present the main findings on the neuroanatomical basis of visual form processing and discuss the criteria for evaluating processing which may be abnormal. We also include an inclusive diagram of visual form processing deficits which represents the different clinical cases described in the literature. Lastly, we propose a boosted decision tree to serve as a guide in the process of diagnosing such cases. Conclusions: Although the medical community largely agrees on which cortical areas and neuronal circuits are involved in visual processing, future studies making use of new functional neuroimaging techniques will provide more in-depth information. A well-structured and exhaustive assessment of the different stages of visual processing, designed with a global view of the deficit in mind, will give a better idea of the prognosis and serve as a basis for planning personalised psychostimulation and rehabilitation strategies

Visual form-processing deficits: a global clinical classification.

INTRODUCTION: Patients who have difficulties recognising visual form stimuli are usually labelled as having visual agnosia. However, recent studies let us identify different clinical manifestations corresponding to discrete diagnostic entities which reflect a variety of deficits along the continuum of cortical visual processing. DEVELOPMENT: We reviewed different clinical cases published in medical literature as well as proposals for classifying deficits in order to provide a global perspective of the subject. Here, we present the main findings on the neuroanatomical basis of visual form processing and discuss the criteria for evaluating processing which may be abnormal. We also include an inclusive diagram of visual form processing deficits which represents the different clinical cases described in the literature. Lastly, we propose a boosted decision tree to serve as a guide in the process of diagnosing such cases. CONCLUSIONS: Although the medical community largely agrees on which cortical areas and neuronal circuits are involved in visual processing, future studies making use of new functional neuroimaging techniques will provide more in-depth information. A well-structured and exhaustive assessment of the different stages of visual processing, designed with a global view of the deficit in mind, will give a better idea of the prognosis and serve as a basis for planning personalised psychostimulation and rehabilitation strategies.

[Cavernous sinus syndrome: an initial expression of a breast carcinoma]. / Síndrome del seno cavernoso como manifestación inicial de una neoplasia mamaria.

Cavernous sinus syndrome (CSS) may be caused by a wide range of pathological process among we include metastatic disease. A case of a woman whose breast neoplasm was initially expressed by a CSS is discussed in this article. We describe a 64-year-old woman with several weeks progressive course of pain and numbness in her left-side facies and occasional diplopia. Neurological examination showed left ptosis, limitation of elevation of left eye and abducens nerve palsy as well as hypoesthesia in the frontal and maxillary regions of her left-side facies. Brain magnetic resonance imaging (MRI) scan revealed the presence of a mass in the orbit and left cavernous sinus. General examination disclosed a sclerotic and retractile lesion in her left breast which involved the nipple suggesting breast carcinoma metastases. The patient underwent a breast fine-needle aspiration biopsy which established the presence of an infiltrating breast carcinoma. This case shows the importance role of the general physical examination to determine the etiology of the CSS. It is necessary and fundamental to perform it on each patient not only to orientate further investigations but also to avoid more invasive diagnostic procedures.

Síndrome del seno cavernoso como manifestación inicial de una neoplasia mamaria / Cavernous sinus syndrome: an initial expression of a breast carcinoma

El síndrome del seno cavernoso (SSC) puede ser causado por una gran variedad de procesos patológicos, entre los que se incluye la enfermedad metastásica. Discutimos aquí el caso de una mujer cuya neoplasia mamaria se inició con un SSC. Se trata de una mujer de 64 años que consultó por cuadro progresivo de dolor y parestesias en región facial izquierda y diplopía ocasional de varias semanas de evolución. En la exploración neurológica se objetivó ptosis palpebral izquierda, incapacidad para elevar y abducir el ojo izquierdo, así como hipoestesia tactoalgésica en el territorio frontal y maxilar superior de la hemicara izquierda. La tomografía computarizada y la resonancia magnética cerebrales detectaron la presencia de una masa localizada en la órbita y seno cavernoso izquierdos. La exploración general puso de manifiesto una lesión esclerosa, retráctil, en mama izquierda que englobaba el pezón, sugiriendo metástasis de una posible neoplasia mamaria. El estudio anatomopatológico de la muestra obtenida por punción aspiración con aguja fina reveló un carcinoma infiltrante de mama. Este caso ilustra la relevancia de la exploración física completa en el establecimiento de la etiología del SSC. Su realización de forma sistemática es necesaria y fundamental para, por una parte, orientar los posibles exámenes complementarios y, por otra, evitar procedimientos diagnósticos más invasivos

Cavernous sinus syndrome (CSS) may be caused by a wide range of pathological process among we include metastatic disease. A case of a woman whose breast neoplasm was initially expressed by a CSS is discussed in this article. We describe a 64-year-old woman with several weeks progressive course of pain and numbness in her left-side facies and occasional diplopia. Neurological examination showed left ptosis, limitation of elevation of left eye and abducens nerve palsy as well as hypoesthesia in the frontal and maxillary regions of her left-side facies. Brain magnetic resonance imaging (MRI) scan revealed the presence of a mass in the orbit and left cavernous sinus. General examination disclosed a sclerotic and retractile lesion in her left breast which involved the nipple suggesting breast carcinoma metastases. The patient underwent a breast fineneedle aspiration biopsy which established the presence of an infiltrating breast carcinoma. This case shows the importance role of the general physical examination to determine the etiology of the CSS. It is necessary and fundamental to perform it on each patient not only to orientate further investigations but also to avoid more invasive diagnostic procedures

Estudio del efecto priming verbal en la enfermedad de alzheimer / Study of the effects of verbal priming in Alzheimer's disease

Fundamento: El "paradigma de completar raíces de palabras" ha sido utilizado para evaluar el efecto priming verbal en diversos estudios clínico-experimentales de demencia. Algunos estudios que han utilizado dicho paradigma en enfermos con enfermedad de Alzheimer (EA) han obtenido resultados contradictorios. Objetivos: Estudiar cómo afecta la latencia y la autogeneración de estímulos en el paradigma de completar raíces de palabras en pacientes con EA y comparar sus resultados con los de un grupo control de sujetos sanos. Sujetos y métodos: Han participado 30 pacientes con diagnóstico clínico de probable EA (criterios DSM-IV y NINCDS-ADRA) y 30 sujetos controles sanos (SC). Se han aplicado dos condiciones de generación de estímulos: sin latencia (SL) y con una latencia de 5 min (CL 5') entre la generación de los estímulos y la fase de ''evocación facilitada''. Resultados: El efecto priming verbal en la condición SL se mantiene en ambos grupos (EA y SC), mientras que en la condición CL 5', los pacientes con EA presentan una disminución del mismo. Conclusiones: La latencia y la autogeneración de estímulos por el propio sujeto en el paradigma de completar raíces de palabras son dos factores de interés clínico para el estudio del efecto priming verbal en la EA (AU)

[The verbal priming effect in Alzheimer's disease] . / Estudio del efecto priming verbal en la enfermedad de Alzheimer.

BACKGROUND: "Word-stem completion paradigm" has been used in many experimental and clinical studies to evaluate the verbal priming effect inpatients with dementia. Different studies using this tests with Alzheimer disease (AD) patients produced contradictory findings. AIMS: To study the effect of latency in the presentation of stimuli in the word-stem completion paradigm in words self-generated by patients with AD and to compare these results with those of a healthy control group. SUBJECTS AND METHODS: The sample consisted of 30 AD patients (DSM-IV y NINCDS-ADRA criteria) and 30 healthy control subjects (CS). Two stimulus generation conditions were applied: without latency (NL) and with five minutes latency (5'L). RESULTS: The verbal priming effect in the NL conditions was maintained in both groups, whilst in the condition 5'L a reduction was observed in the AD patient group. CONCLUSION: A 5'L and self generation of stimuli are two factors of clinical interest in the study of the verbal priming effect in AD.

[Syringomyelic arthropathy]. / Artropatía siringomiélica.

8 cases of syringomyelic arthropathy which were detected in 6 patients of 13 afflicted of syringomyelia, are presented. The etiopathogenesis, clinical, radiological, and pathological data are commented on; and an eclectic mechanism which mixed the 3 theories admitted: neurotrophic, neurotraumatic, and neurovascular, is suggested. We found the incidence of arthropathy higher than that described in existing medical literature and concluded that it is necessary to perform wide administer the appropriate therapy.