Síntomas y signos de la hipofunción vestibular unilateral y bilateral / Symptoms and signs of unilateral and bilateral vestibular hypofunction

INTRODUCCIÓN Y OBJETIVO: La disfunción vestibular periférica implica a los órganos vestibulares o a los nervios vestibulares, produciendo una gran variedad de síntomas y signos clínicos. MÉTODO: Revisión narrativa. DISCUSIÓN: El otoneurólogo es el encargado de realizar una evaluación exhaustiva para llegar a identificar el trastorno que presenta el paciente que acude con vértigo o desequilibrio. La clave diagnóstica es la anamnesis profunda completada con un cuidadoso examen otoneurológico. Además, las nuevas tecnologías de estudio que han surgido en este campo permiten un cambio en la definición, caracterización y tratamiento de estas patologías. CONCLUSIONES: En la presente revisión narrativa se describirán los dos grandes grupos de deficiencia vestibular periférica: la vestibulopatía unilateral y bilateral

INTRODUCTION AND OBJECTIVE: Peripheral vestibular dysfunction involve the vestibular organs or the vestibular nerve producing a wide variety of symptoms and clinical signs. METHOD: Narrative revision. DISCUSSION: The otoneurologist is responsible for conducting an exhaustive evaluation to identify the pathology presented by the patient who has vertigo or imbalance. The key to the diagnosis is the deep history completed with a careful otoneurological examination. CONCLUSIONS: In the present narrative review, the two large groups of peripheral vestibular deficiency will be described: unilateral and bilateral vestibulopathy

Compensación vestibular / Vestibular compensation

INTRODUCCIÓN Y OBJETIVO: La compensación vestibular es el conjunto de procesos que se ponen en marcha cuando tiene lugar una lesión a nivel vestibular sea cual sea el origen y la magnitud de la misma. a vez establecida la lesión los mecanismos de compensación del daño son variados y se establecen diferentes líneas de actuación. Para conocer cómo mejorar el estado de nuestros pacientes es importante saber cómo funciona la compensación vestibular y a qué niveles podemos actuar para acelerar el proceso de recuperación. CONCLUSIONES: Es importante conocer los mecanismos de compensación vestibular para adecuar la terapia a cada paciente y así mejorar su calidad de vida

INTRODUCTION AND OBJECTIVE: Vestibular compensation is the term used to describe the mechanisms triggered when there is damage in the vestibular system regardless of its origin. When suffering from an injure in vestibular area there are a wide range of compensatory responses that will involve different approaches. In order to improve the quality of life for our patients and to correctly work with them to accelerate the restoration process it is important to become acquainted with how vestibular compensation works. CONCLUSIONS: Vestibular compensation mechanisms are important to adapt the therapy to each patient and thus improve their quality of life

Hamartoma respiratorio epitelial adenomatoso bilateral de comportamiento atípico / Bilateral respiratory epithelial adenomatoid hamartoma with atypical behaviour

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Aneurisma intraparotídeo de vena comunicante posterior / Intraparotid aneurysm of the posterior communicating vein

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[Tuberculous arthritis of the temporomandibular joint caused by Mycobacterium bovis. A diagnostic conundrum]. / Artritis temporomandibular por Mycobacterium bovis. Un problema diagnóstico.

Infrequent variants of extrapulmonary tuberculosis pose a challenging public health problem because of the delay in their diagnosis and treatment. Joint involvement is usually encountered in major joints (hip, elbow, knee and ankle). Tuberculous involvement of the temporomandibular joint is extremely uncommon but must be considered in patients with pain, inflammation or joint stiffness not resolved with conventional treatment.

Artritis temporomandibular por Mycobacterium bovis. Un problema diagnóstico / Tuberculous arthritis of the temporomandibular joint caused by Mycobacterium bovis. A diagnostic conundrum

Las variantes infrecuentes de tuberculosis extrapulmonar son un reto de salud pública por abocar a un retraso diagnóstico-terapéutico. Las formas articulares se localizan en las grandes articulaciones (cadera, rodilla, codo, tobillo). La afectación temporomandibular es extremadamente infrecuente, pero debe ser considerada ante todo dolor, inflamación o rigidez articular que no se resuelva con tratamientos convencionales y, por tanto, ser investigada (AU)

Infrequent variants of extrapulmonary tuberculosis pose a challenging public health problem because of the delay in their diagnosis and treatment. Joint involvement is usually encountered in major joints (hip, elbow, knee and ankle). Tuberculous involvement of the temporomandibular joint is extremely uncommon but must be considered in patients with pain, inflammation or joint stiffness not resolved with conventional treatment (AU)

[Clinical study on head and neck tulareamia]. / Estudio clínico de la tularemia en cabeza y cuello.

OBJECTIVE: To perform a clinical description of head and neck tularaemia, collating the therapeutic strategies used and the most significant variables that seem to influence its evolution. MATERIAL AND METHODS: A retrospective descriptive study was performed on the series diagnosed in 2007 with involvement of the head and neck areas. For the definition of clinical cases, the recommendations of the Spanish National Centre for Epidemiological Surveillance, the European Union Network for the Surveillance and Control of Communicable Diseases and the U.S. Center for Disease Control and Prevention were followed. Basic statistics, stage, treatment carried out and evolution were noted. A descriptive statistical study as well as an analysis of the influencing variables in the clinical course of the disease and possible management are provided. RESULTS AND CONCLUSIONS: 27 patients were studied. The clinical profile of the patient type is a middle-aged individual from rural areas, with a 1:1 male/female ratio, asymptomatic but affected by growing laterocervical lymphadenopathies, often appearing in summer, and notable on palpation, without any demonstrable entranceway. However, the profile is subject to variable patterns. The suspected diagnosis was confirmed on the basis of serological determinations (93 %). Two groups were observed: one formed by those with less evident clinical manifestations and an early ganglionar stage that mostly evolved well with specific antibiotic therapy, and another one with major clinical manifestations or advanced stage in which surgical procedures were required although subsequent evolution was good. In areas of high incidence, in summer, it is a disease to be considered in the differential diagnosis of lymphadenopathy syndromes.

Estudio clínico de la tularemia en cabeza y cuello / Clinical study on head and neck tulareamia

Objetivo. Realizar una descripción clínica de la tularemia en cabeza y cuello, recoger las estrategias terapéuticas empleadas y las variables más significativas que influyen en su evolución. Material y métodos. Se realizó un estudio retrospectivo y descriptivo de nuestra serie de 2007, en la que se demostró afectación de algún área definida como otorrinolaringológica. Para la definición de caso clínico, se siguieron las recomendaciones de la Red Nacional de Vigilancia Epidemiológica, la Red de Vigilancia Epidemiológica y Control de las Enfermedades Transmisibles de la Unión Europea y en el Centro para el Control de Enfermedades de Estados Unidos. Se recogieron las variables estadísticas básicas, el estadio de enfermedad y el tratamiento realizado, así como su evolución. Se realizó un estudio estadístico descriptivo de nuestra serie y de las variables que influyeron en el curso clínico de la enfermedad y su posible tratamiento. Resultados y conclusiones. Se estudió a 27 pacientes. El paciente tipo presenta una proporción de mujer: varón de 1:1, de edad media, procedente generalmente del ámbito rural, asintomático, pero afectado de adenopatías laterocervicales de crecimiento progresivo evolucionadas, de aparición estival y sensibles a la palpación, sin puerta de entrada evidente. No obstante, el perfil está sujeto a múltiples variaciones. El diagnóstico de sospecha se confirmó mediante estudio serológico (93 %). Se demostraron dos grupos: uno con manifestaciones clínicas menores y estadio temprano, que evolucionaron bien con tratamiento antibiótico específico, y otro con estadio más avanzado en el que fueron precisos gestos intervencionistas, aunque la evolución posterior fue buena. En áreas de alta incidencia, en verano, es una enfermedad a tener muy en cuenta en el diagnóstico diferencial de síndromes adenopáticos (AU)

Objective: To perform a clinical description of head and neck tularaemia, collating the therapeutic strategies used and the most significant variables that seem to influence its evolution. Material and methods: A retrospective descriptive study was performed on the series diagnosed in 2007 with involvement of the head and neck areas. For the definition of clinical cases, the recommendations of the Spanish National Centre for Epidemiological Surveillance, the European Union Network for the Surveillance and Control of Communicable Diseases and the U.S. Center for Disease Control and Prevention were followed. Basic statistics, stage, treatment carried out and evolution were noted. A descriptive statistical study as well as an analysis of the influencing variables in the clinical course of the disease and possible management are provided.Results and conclusions: 27 patients were studied. The clinical profile of the patient type is amiddle-aged individual from rural areas, with a 1:1 male/female ratio, asymptomatic but affected by growing laterocervical lymphadenopathies, often appearing in summer, and notable on palpation, without any demonstrable entranceway. However, the profile is subject to variable patterns. The suspected diagnosis was confirmed on the basis of serological determinations (93 %). Two groups were observed: one formed by those with less evident clinical manifestations and an early ganglionar stage that mostly evolved well with specific antibiotic therapy, and another one with major clinical manifestations or advanced stage in which surgical procedures were required although subsequent evolution was good. In areas of high incidence, in summer, it is a disease to be considered in the differential diagnosis of lymphadenopathy syndromes (AU)

Cuerpo extraño cervical de larga permanencia / Long-term extraneous body in the neck

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Quiste tirogloso basilingual: causa infrecuente de disfagia y disnea / Basilingual thyroglossal cyst: an infrequent cause of Dysphagia and dyspnoea

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[Fast-growing atypical cervical mass]. / Masa cervical atípica de rápido crecimiento.

Aneurysms of the jugular vein are an uncommon condition, typical of childhood and adolescence although they can appear at any age. Clinically, they normally constitute an asymptomatic cervical mass which increases when Valsalva's manoeuvre is applied. Doppler echography is the most effective diagnostic test, with CT or NMR for doubtful situations. Treatment is conservative except for complications or major aesthetic repercussions. We present here the case of a 65-year-old female patient, and review the literature regarding aneurysms of the jugular vein.

Masa cervical atípica de rápido crecimiento / Fast-growing atypical cervical mass

Los aneurismas de la yugular interna son una entidad poco frecuente, propia de la infancia y la adolescencia, aunque pueden aparecer a cualquier edad. Clínicamente se observa una masa cervical asintomática que aumenta al realizar maniobras de Valsalva. La prueba diagnóstica más eficaz es la ecografía Doppler y, en situaciones dudosas, la tomografía computarizada y la resonancia magnética. El tratamiento es fundamentalmente conservador salvo con complicaciones o repercusiones estéticas importantes. Presentamos el caso de una paciente de 65 años afecta de esta enfermedad y revisamos la literatura publicada al respecto

Aneurysms of the jugular vein are an uncommon condition, typical of childhood and adolescence although they can appear at any age. Clinically, they normally constitute an asymptomatic cervical mass which increases when Valsalva's manoeuvre is applied. Doppler echography is the most effective diagnostic test, with CT or NMR for doubtful situations. Treatment is conservative except for complications or major aesthetic repercussions. We present here the case of a 65-year-old female patient, and review the literature regarding aneurysms of the jugular vein

[Castleman's disease of the neck]. / Enfermedad de Castleman cervical.

Castleman's disease is an uncommon benign lymphoid disorder usually found in the mediastinum (70 %) which is thought to be due to antigenic hyperstimulation of unknown origin. Two histological subtypes may be found in relation to two different clinical patterns with clinical and therapeutic implications. Diagnosis is frequently accomplished only by histological analysis after surgery since no specific features have been found in imaging studies. Surgical excision is both diagnostic and curative in localized forms, whereas additional therapies are required in multicentric forms. This report is of Castleman's disease presenting as a neck mass, an infrequent occurrence, with an analysis of management controversies and a review of the literature.

Enfermedad de Castleman cervical / Castleman’s disease of the neck

La enfermedad de Castleman es un trastorno linfoproliferativo benigno muy poco frecuente que generalmente aparece en el mediastino (70 %) que se cree debido a una sobrestimulación antigénica de causa desconocida. Se han descrito dos diferentes subtipos histológicos con diferentes comportamientos clínicos e implicaciones terapéuticas. A menudo sólo se diagnostica esta enfermedad mediante el estudio histológico de la pieza tras su exéresis quirúrgica debido a la inexistencia de patrones de imagen específicos en las pruebas de radiodiagnóstico para esta enfermedad. El tratamiento quirúrgico es diagnóstico y a la vez curativo en las formas localizadas, mientras que son necesarios tratamientos complementarios en las formas multicéntricas. Describimos un caso de enfermedad de Castleman de presentación cervical, forma infrecuente de esta enfermedad, y realizamos una revisión de la literatura disponible incidiendo en las controversias que surgen en cuanto a su diagnóstico y tratamiento

Castleman’s disease is an uncommon benign lymphoid disorder usually found in the mediastinum (70 %) which is thought to be due to antigenic hyperstimulation of unknown origin. Two histological subtypes may be found in relation to two different clinical patterns with clinical and therapeutic implications. Diagnosis is frequently accomplished only by histological analysis after surgery since no specific features have been found in imaging studies. Surgical excision is both diagnostic and curative in localized forms, whereas additional therapies are required in multicentric forms. This report is of Castleman’s disease presenting as a neck mass, an infrequent occurrence, with an analysis of management controversies and a review of the literature

Sobre la expresividad clínica de las lesiones proliferativas del ángulo pontocerebeloso. Respuesta / On the clinical expressiveness of proliferative lesions of the cerebello-pontine angle. Reply

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[Clinical picture of 8th pair schwannoma. Is it expressive enough?]. / Caracterización clínica del schwannoma del VIII par. Son suficientemente expresivos sus síntomas?

OBJECTIVE: To describe the stage-related clinical features of 8th cranial nerve schwannoma. MATERIAL AND METHOD: Descriptive study of 71 patients whose diagnosis and/or treatment have been carried out at our centre between 1997-2003. Gender, age, and symptoms were considered, with special attention to gender. Determination of tumoral stage following Tos and Thomsen image criteria. RESULTS: The mean age was 64.6 (range, 20-87) with a marked incidence between 52 and 70 years (62 % of the whole), slightly higher in females and in the left ear. The main symptoms were those derived from involvement of the 7th and 8th cranial nerves, with other cranial nerves and cerebello-pontine structures being involved in larger tumours, although a high variability was noted in clinical patterns of same-stage cases and in the first symptom. Our study also found a high variability in hearing conservation and a marked frequency of vestibular or facial (motor and sensory) symptoms. There were also very infrequent forms of presentation that are highlighted. CONCLUSIONS: There is no typical clinical pattern and no typical first symptom in 8th cranial nerve schwannomas. Any audiovestibular or facial symptom, even the slightest, may be the first expression of 8th cranial nerve schwannoma. There is no stage-specific symptom except for those with involvement of the cerebello-pontine or cerebral structures.