Primer caso descrito de parálisis aislada, completa y fluctuante del III nervio craneal como forma de inicio de un mieloma múltiple / First case described of isolated, complete and fluctuating cranial nerve III palsy heralding multiple myeloma

Introducción. El mieloma múltiple es la neoplasia de células plasmáticas más frecuente. Al ser incurable, el tratamiento persigue obtener el mayor tiempo de supervivencia libre de clínica. Constituye una causa extremadamente rara de afectación de los nervios craneales y es producido habitualmente por un plasmocitoma intracraneal. Presentamos un caso de mieloma múltiple, que asociaba un plasmocitoma intracraneal y que comenzó clínicamente con parálisis aislada, completa y fluctuante del III nervio craneal. Caso clínico. Mujer de 63 años que acudió a urgencias por presentar un cuadro clínico oscilante, consistente en diplopía binocular horizontal y, posteriormente, cefalea. La exploración neurooftalmológica reveló una parálisis completa del III nervio craneal derecho. Se solicitó una tomografía axial computarizada craneal urgente, que reveló múltiples lesiones osteolíticas diploicas, asociando una de ellas componente de partes blandas en la hendidura esfenoidal derecha. La paciente fue ingresada, y se le diagnosticó posteriormente un mieloma múltiple IgA-k. Tras recibir inducción quimioterápica y ser sometida a un trasplante autólogo de progenitores hematopoyéticos, alcanzó la remisión completa. Conclusiones. El mieloma múltiple es un trastorno raro de los nervios craneales, una causa muy infrecuente de parálisis aislada y completa del III nervio craneal y menos aún fluctuante, y no se ha encontrado ningún caso publicado con este inicio clínico. Tener en cuenta las posibles manifestaciones neurooftalmológicas del mieloma múltiple puede contribuir a un diagnóstico precoz y a una incidencia positiva sobre el curso de esta enfermedad (AU)

Introduction. Multiple myeloma is the most common plasma-cell malignancy. To be incurable, treatment aims to obtain the longest non-clinical survival time. Cranial nerve palsy in multiple myeloma is extremely rare and is usually due to an intracranial plasmacytoma. We present a multiple myeloma case, with an intracranial plasmacytoma, which debuted clinically with isolated, complete and fluctuating cranial nerve III palsy. Case report. A 63-year-old woman presented an oscillating clinical picture, consisting of horizontal binocular diplopia and later, headache. The neuro-ophthalmologic examination revealed a complete cranial nerve III palsy of the right eye. An urgent cranial CT-scan was requested. It showed multiple diploic osteolytic lesions, associating soft-parts component in the right superior orbital fissure. The patient was admitted, being diagnosed subsequently of IgA-k multiple myeloma. After receiving induction-chemotherapy and undergoing autologous stem cell transplantation, she achieved full remission. Conclusions. Multiple myeloma is a rare cranial nerves disorder, very uncommon cause of cranial nerve III full isolated paralysis and even less fluctuating, not having found any case published with this clinical onset. Awareness of possible multiple myeloma neuro-ophthalmic manifestations may bring about an early diagnosis and a positive impact on the disease course (AU)

[First case described of isolated, complete and fluctuating cranial nerve III palsy heralding multiple myeloma]. / Primer caso descrito de parálisis aislada, completa y fluctuante del III nervio craneal como forma de inicio de un mieloma múltiple.

INTRODUCTION: Multiple myeloma is the most common plasma-cell malignancy. To be incurable, treatment aims to obtain the longest non-clinical survival time. Cranial nerve palsy in multiple myeloma is extremely rare and is usually due to an intracranial plasmacytoma. We present a multiple myeloma case, with an intracranial plasmacytoma, which debuted clinically with isolated, complete and fluctuating cranial nerve III palsy. CASE REPORT: A 63-year-old woman presented an oscillating clinical picture, consisting of horizontal binocular diplopia and later, headache. The neuro-ophthalmologic examination revealed a complete cranial nerve III palsy of the right eye. An urgent cranial CT-scan was requested. It showed multiple diploic osteolytic lesions, associating soft-parts component in the right superior orbital fissure. The patient was admitted, being diagnosed subsequently of IgA-kappa multiple myeloma. After receiving induction-chemotherapy and undergoing autologous stem cell transplantation, she achieved full remission. CONCLUSIONS: Multiple myeloma is a rare cranial nerves disorder, very uncommon cause of cranial nerve III full isolated paralysis and even less fluctuating, not having found any case published with this clinical onset. Awareness of possible multiple myeloma neuro-ophthalmic manifestations may bring about an early diagnosis and a positive impact on the disease course.

TITLE: Primer caso descrito de paralisis aislada, completa y fluctuante del III nervio craneal como forma de inicio de un mieloma multiple.Introduccion. El mieloma multiple es la neoplasia de celulas plasmaticas mas frecuente. Al ser incurable, el tratamiento persigue obtener el mayor tiempo de supervivencia libre de clinica. Constituye una causa extremadamente rara de afectacion de los nervios craneales y es producido habitualmente por un plasmocitoma intracraneal. Presentamos un caso de mieloma multiple, que asociaba un plasmocitoma intracraneal y que comenzo clinicamente con paralisis aislada, completa y fluctuante del III nervio craneal. Caso clinico. Mujer de 63 años que acudio a urgencias por presentar un cuadro clinico oscilante, consistente en diplopia binocular horizontal y, posteriormente, cefalea. La exploracion neurooftalmologica revelo una paralisis completa del III nervio craneal derecho. Se solicito una tomografia axial computarizada craneal urgente, que revelo multiples lesiones osteoliticas diploicas, asociando una de ellas componente de partes blandas en la hendidura esfenoidal derecha. La paciente fue ingresada, y se le diagnostico posteriormente un mieloma multiple IgA-kappa. Tras recibir induccion quimioterapica y ser sometida a un trasplante autologo de progenitores hematopoyeticos, alcanzo la remision completa. Conclusiones. El mieloma multiple es un trastorno raro de los nervios craneales, una causa muy infrecuente de paralisis aislada y completa del III nervio craneal y menos aun fluctuante, y no se ha encontrado ningun caso publicado con este inicio clinico. Tener en cuenta las posibles manifestaciones neurooftalmologicas del mieloma multiple puede contribuir a un diagnostico precoz y a una incidencia positiva sobre el curso de esta enfermedad.

[The worldwide expansion of the neurosciences: the 14th International Congress of Medicine (Madrid, 1903)]. / El auge mundial de las neurociencias: XIV Congreso Internacional de Medicina (Madrid, 1903).

INTRODUCTION: The neurosciences developed at a swift pace throughout the 19th century. In Spain, following the intellectual poverty of the absolutist rule of King Ferdinand, medicine took on a new flourishing lease of life in the last third of the century under the leadership of its most distinguished proponent, Santiago Ramon y Cajal. In April 1903, and in spite of the country's multiple political and social ups and downs, Madrid organised a great medical convention (14th International Congress of Medicine) that gathered together the foremost figures in the neurosciences. DEVELOPMENT: This work attempts to describe the situation in which neurology found itself at that time, as well as the socio-political context, and to highlight the most important contributions that were made in our specialty. CONCLUSIONS: A whole medical generation from around the world enthusiastically took part and 1681 communications and papers were presented, many of which dealt with neurological topics. Special mention should be made of the presentations by Cajal, who described the histological structure of the optic thalamus, and by Pavlov, who gave details of his theory of conditioned reflexes for the very first time.

El auge mundial de las neurociencias: XIV Congreso Internacional de Medicina (Madrid, 1903) / The worldwide expansion of the neurosciences: the 14th International Congress of Medicine (Madrid, 1903)

Introducción. Las neurociencias se desarrollan de forma acelerada a lo largo del siglo XIX. En España, tras la indigencia intelectual del absolutismo fernandino, la medicina ha emergido con fuerza en el último tercio del siglo, liderada por la magna figura de Santiago Ramón y Cajal. En abril de 1903, y a pesar de los múltiples avatares políticos y sociales del país, Madrid organiza un gran encuentro médico (XIV Congreso Internacional de Medicina) que congrega a las máximas figuras de las neurociencias.Desarrollo. Este trabajo intenta describir la coyuntura de la neurología en esas fechas, así como el contexto sociopolítico, y destacar las aportaciones más importantes en nuestra especialidad. Conclusiones. Con la participación entusiasta de toda una generación médica mundial, se presentaron 1.681 comunicaciones y memorias, con gran protagonismo de los temas neurológicos. Destaquemos las intervenciones de Cajal, que describe la estructura histológica del tálamo óptico, y de Pavlov, que expone por primera vez la teoría de los reflejos condicionados (AU)

Introduction. The neurosciences developed at a swift pace throughout the 19th century. In Spain, following the intellectual poverty of the absolutist rule of King Ferdinand, medicine took on a new flourishing lease of life in the last third of the century under the leadership of its most distinguished proponent, Santiago Ramón y Cajal. In April 1903, and in spite of the country’s multiple political and social ups and downs, Madrid organised a great medical convention (14th International Congress of Medicine) that gathered together the foremost figures in the neurosciences. Development. This work attempts to describe the situation in which neurology found itself at that time, as well as the socio-political context, and to highlight the most important contributions that were made in our specialty. Conclusions. A whole medical generation from around the world enthusiastically took part and 1681 communications and papers were presented, many of which dealt with neurological topics. Special mention should be made of the presentations by Cajal, who described the histological structure of the optic thalamus, and by Pavlov, who gave details of his theory of conditioned reflexes for the very first time (AU)