Treatment with hydrochlorothiazide and alendronate in patients with stones and bone mineral density loss. Evolution of bone metabolism and calciuria with medical treatment. / Tratamiento con hidroclorotiazida y alendronato en pacientes con litiasis y pérdida de densidad mineral ósea. Evolución de la calciuria y metabolismo óseo en el tratamiento médico.

OBJECTIVES: Treatment of calcium stones is based on diet and pharmacological measures such as the use of thiazides and other drugs. The aim of this study is to assess the effect of alendronate on hydrochlorothiazide on urinary calcium and bone mineral density in patients with calcium stones. METHODS: Prospective observational study involving 77 patients with relapsing calcium stones divided into 2 groups according to treatment received. Group 1: 36 patients treated with alendronate 70 mg/week; Group 2: 41 patients treated with hydrochlorothiazide 50 mg/day. All patients receive diet recommendations and fluid intake. Studied and analyzed among other variables were bone mineral density, bone turnover markers and calciuria before and after 2 years of treatment. Statistical study with SPSS 17.0, statistical significance p<0.05. RESULTS: No statistically significant differences in the distribution by sex or age of the patients between groups. In group 1 statistically a significant decrease was observed in the Β-crosslaps and improvement in bone mineral density, along with decreased urinary calcium after 2 years of treatment. In Group 2 statistically significant decrease in urinary calcium and fasting calcium/creatinine was seen, along with improvement in bone mineral density after 2 years of treatment. In group 1, there is a more obvious and significant improvement in bone mineral density compared to 2 and Β-crosslaps decrease. However, in group 2 the decrease in urinary calcium and calcium/creatinine was more significant than in group 1. CONCLUSION: Treatment with thiazide decrease calciuria and produces an improvement in bone mineral density, although not in the same range as treatment with alendronate.

Initial proximal obstruction of ventriculoperitoneal shunt in patients with preterm-related posthaemorrhagic hydrocephalus.

BACKGROUND/AIMS: Obstruction is the most common complication of ventriculoperitoneal shunts in patients with hydrocephalus. Despite technical advances, rates of obstruction have barely decreased and remain at over 40% of cases. Patients suffering from preterm-related posthaemorrhagic hydrocephalus are considered a group with a particularly high risk of obstruction. The aim of the present study was to review our series of patients with preterm-related posthaemorrhagic hydrocephalus and analyse the occurrence of the first ventricular shunt obstruction as well as the related clinical and radiological factors. METHODS: We conducted a retrospective review of 103 cases treated from 1982 to 2010. Descriptive analysis, raw and adjusted bivariate correlations and survival analysis were performed. RESULTS: Over the course of the follow-up, 42 patients presented at least one episode of obstruction that required proximal revision. Medium-opening pressure valves were associated with a higher rate of obstruction compared to low-opening pressure valves; however, in our series this association became statistically significant only in patients with a weight of over 2,000 g at the time of surgery (odds ratio 6.75). The occurrence of previous infection and the development of late slit ventricle syndrome were also significantly associated with obstruction of the ventricular catheter (odds ratios 3.35 and 4.27, respectively). CONCLUSIONS: Rates of shunt obstruction in preterm-related posthaemorrhagic hydrocephalus remain high but do not seem to be higher than in other groups of paediatric hydrocephalus. Prevention of infection and the use of the appropriate type of valve design can help to decrease the incidence of proximal shunt obstruction, which in turn could decrease the incidence of symptomatic slit ventricle syndromes.

La resonancia magnética en patología infantil del eje hipotálamo-hipofisario / No disponible

Se realiza una revisión de los aspectos de imagen del eje hipófisis-hipotálamo en la edad pediátrica, haciendo unas consideraciones de esta técnica de imagen en sus indicaciones actuales. Se describe las indicaciones más frecuentes que incluyen malformaciones congénitas, inflamaciones, procesos autoinmunes, tumorales y las indicaciones endocrinas más frecuentemente requeridas en pediatría. Finalmente se comentarán brevemente los riesgos, efectividad y comparación con otros métodos (AU)

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[Women in climacteric. Results of the implementation of a health program]. / La mujer en edad de climaterio. Resultados de la aplicación de un programa de salud.

Menopause is a very important period in the life of a woman due to the physiological and psychological changes which happen during this period. The authors apply an educational program providing integrated attention to women during this phase of their lives to evaluate possible improvements in the conflictive aspects which menopause generates. The authors carried out a longitudinal study with interventions before and after their study. The sample was a group of 28 women between the ages of 45 and 64. The educational intervention consisted of the application of a program providing integrated attention to women by the Generalitat Valenciana, the autonomous government in the Valencia Autonomous Region. This program had a positive influence on the knowledge and aptitudes of these women regarding this period of their lives. Their physical and psychological health improved, with a decrease in the most common symptoms caused by menopause and there were very significant differences found on the Kupperman test. The application of this program succeeded in relating the material taught to these women with a positive repercussion in their physical, psychological and social states during their climacteric years.

La mujer en edad de climaterio / Women during their climacteric age

El climaterio es un periodo de la vida de la mujer muy importante debido a los cambios fisiológicos y psicológicos que ocurren en él. Se aplica un programa de formación y atención integral a estas mujeres para valorar la posible mejoría en los aspectos conflictivos que genera el climaterio. Se realizó un estudio longitudinal con intervención antes-después. La muestra fue de 28 mujeres de edad comprendida entre 45-64 años. La intervención de carácter educativo consistió en la aplicación del programa de atención integral a la mujer de la Generalitat Valenciana. El programa influyó de forma positiva en los conocimientos y aptitudes de las mujeres frente a este periodo de sus vidas. Su estado de salud físico y psíquico mejoró, con disminución de la sintomatología más común en el climaterio y diferencias estadísticamente muy significativas encontradas en el test de Kupperman. La aplicación del programa consiguió relacionar la formación impartida a las mujeres con la repercusión positiva en el estado psíquico, físico y social de la mujer climatérica. (AU)

Tumores tectales en pediatría. Revisión de ocho pacientes / Tectal tumours in paediatrics. a review of eight patients

Introducción. Los tumores de la región tectal constituyen, dentro del apartado de los gliomas del tronco del encéfalo, un subgrupo de mejor pronóstico que requiere una estrategia terapéutica distinta. Objetivos. Revisión retrospectiva de los tumores tectales en niños perfilando la actitud terapéutica más idónea y el pronóstico esperable. Pacientes y métodos. Se revisan ocho pacientes pediátricos que en los últimos 11 años han desarrollado un tumor tectal diagnosticado mediante técnicas de neuroimagen. Se evalúan sus características clínicas y, especialmente, su evolución clinicorradiológica. Resultados. La media de edad al diagnóstico fue de 10 años. Todos los casos mostraron una presentación clínica de hipertensión intracraneal secundaria a la obstrucción del acueducto de Silvio. La RM resultó clave para objetivar la lesión tectal en todos los casos excepto en uno visualizada previamente en la TC. La actitud terapéutica inicial y exclusiva fue la derivación ventricular. El seguimiento clinicorradiológico medio en nuestra serie ha sido de 4 años, con buena evolución en todos los casos sin precisar otras medidas terapéuticas. Los controles de RM dieron evidencia de estabilidad tumoral en todos los casos excepto en uno con mínima expansión lesional sin repercusión clínica. Conclusiones. Los tumores tectales en los niños muestran, en la mayoría de los casos, un curso benigno. La derivación ventricular es habitualmente el único tratamiento requerido. No obstante, se debe realizar un seguimiento clínico y radiológico estrecho para descartar progresión tumoral que aconseje otras medidas terapéuticas. La RM es electiva en la valoración inicial y en el seguimiento de estos tumores (AU)

[The relation between the clinical symptoms and the findings on magnetic resonance in children with periventricular leukomalacia]. / Relación entre los síntomas clínicos y los hallazgos en resonancia magnética en niños con leucomalacia periventricular.

OBJECTIVES: To assess whether there is a relationship between the various clinical symptoms and imaging findings on MR in children with periventricular leukomalacia (PVLM). PATIENTS AND METHODS: We made a retrospective study of 41 consecutive paediatric patients, 19 boys and 22 girls, with an average age of 30.5+/-19 months (range 8 84 months) who had been diagnosed as having PVLM and studied using MR, recording imaging, clinical and epidemiological data. RESULTS: The MR images showed areas of gliosis in all the children (few foci in 68.3% and multiple foci in 31.7%), with cysts in 22%. The changes were seen mainly in the parietal and occipital regions, were bilateral and symmetrical in 80.5%, with ventricular dilatation in 75.6%, atrophy of the parenchyma in 48.8%, Wallerian degeneration in 7.3%, delay in myelination in 31.7%, lesions in the optic radiations in 9.8%, thalamus 12.2% and anomalous venous drainage in 2.4%. The overall degree of involvement on MR was severe in 43.9%, moderate in 31,7% and mild in 24.4%. There was a history of perinatal foetal distress in 56.8%, hyaline membrane disease in 40.5%, intracranial hemorrhage in 35.1%, psychomotor retardation in 58.5%, motor retardation in 29.3%, and squint in 22%. A significant relationship was found only between acute foetal distress and lateralization of the lesions (p= 0.038) and the presence of parenchymatous cysts (p= 0.024). CONCLUSION: The patients with a history of foetal distress had a greater tendency to symmetrical, bilateral involvement with cysts in the white matter of the brain. It was not possible to establish a model for classification of the overall involvement using MR and the data recorded. The imaging findings were not related overall to the patients symptoms.

Relación entre los síntomas clínicos y los hallazgos en resonancia magnética en niños con leucomalacia periventricular / The relation between the clinical symptoms and the findings on magnetic resonance in children with periventricular leukomalacia

Objetivos. Valorar si existe una relación entre los diversos síntomas clínicos y los hallazgos de imagen observados mediante resonancia magnética (RM) en niños con leucomalacia periventricular (LMPV). Pacientes y métodos. Estudio retrospectivo de 41 pacientes pediátricos consecutivos, 19 de sexo masculino y 22 femenino, con una edad media de 30,5ñ19 meses (intervalo, 8-84 meses), diagnosticados de LMPV y examinados con RM, y en el que se han recogido diversas variables de imagen, clínicas y epidemiológicas. Resultados. En las imágenes de RM se observaron áreas de gliosis en todos los niños (focos escasos en 68,3 por ciento y múltiples en 31,7 por ciento) con quistes en el 22 por ciento. La localización de estas alteraciones fue predominantemente parietal y occipital, bilateral y simétrica (80,5 por ciento), con dilatación ventricular (75,6 por ciento), atrofia parenquimatosa (48,8 por ciento), degeneración walleriana (7,3 por ciento), retraso en la mielinización (31,7 por ciento), lesiones en las radiaciones ópticas (9,8 por ciento) y tálamos (12,2 por ciento), y venas de drenaje anómalas (2,4 por ciento). El grado de afectación global en RM fue grave (43,9 por ciento), moderado (31,7 por ciento) y leve (24,4 por ciento). Hubo antecedentes de sufrimiento fetal perinatal (56,8 por ciento), enfermedad de la membrana hialina (40,5 por ciento) y hemorragia intracraneal (35,1 por ciento), presentándose con retraso psicomotor (58,5 por ciento) o motor (29,3 por ciento) y estrabismo (22 por ciento). Sólo se detectaron relaciones significativas entre el sufrimiento fetal agudo y la lateralización de las lesiones (p= 0,038) y presencia de quistes parenquimatosos (p= 0,024). Conclusiones. Los pacientes con sufrimiento fetal presentan una mayor tendencia a la afectación bilateral y simétrica, y a presentar quistes en la sustancia blanca. No se ha podido establecer un modelo de clasificación de la afectación global mediante RM y las variables clínicas recogidas. Los hallazgos de imagen no se relacionan globalmente con la sintomatología del paciente (AU)

[Acquired oculomotor paralysis in the adolescent]. / Parálisis oculomotora adquirida en el adolescente.

INTRODUCTION: Acquired oculomotor palsy in juvenile age are most commonly due to head trauma, tumors, migraine, vasculopathies and demyelinating diseases. CLINICAL CASES: We document three cases of paroxysmal oculomotor nerve palsy in childhood, illustrating the main clinical symptoms, neurological examination, MR images, diagnosis, treatment and evolution. Final diagnosis were: multiple sclerosis, pineoblastoma, and craniopharyngioma. CONCLUSIONS: Sudden oculomotor nerve palsy occurring in youth in the absence of head trauma, viral infection or migraine access, firmly suggests a serious intracranial disease, and neuroimage studies should be quickly obtained to have an early diagnosis.

Imagen pseudotumoraltroncoencefálica: manifestaciónatípica de esclerosis múltipleen la infancia / Pseudotumoral brain-stem image: An atypical feature of multiple sclerosis in childhood

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Parálisis oculomotora adquirida en el adolescente / Acquired oculomotor paralysis in adolescents

Introducción. La etiología más frecuente de la parálisis oculomotora adquirida en el adolescente suele ser el traumatismo craneoencefálico, la migraña, la anomalía vascular, la lesión ocupante de espacio y la enfermedad desmielinizante. Casos clínicos. Se exponen los casos de tres adolescentes cuyo motivo de consulta fue una parálisis oculomotora de comienzo brusco; indicamos su tiempo de evolución hasta el diagnóstico, su examen neuroftalmológico y exploraciones complementarias, el diagnóstico, tratamiento y evolución. El diagnóstico definitivo fue de esclerosis múltiple, pineoblastoma y craneofaringioma, respectivamente. Conclusión. Es importante recordar que todo adolescente que presente de forma repentina una parálisis oculomotora sin antecedente traumático, infeccioso o acompañamiento migrañoso, puede presentar una patología orgánica intracraneal no benigna, por lo que no debe posponerse en exceso la realización de técnicas de neuroimagen que aclaren el diagnóstico de sospecha (AU)

[Tectal tumours in paediatrics. A review of eight patients]. / Tumores tectales en pediatría. Revisión de ocho pacientes.

INTRODUCTION: Tumours of the tectal region form, within the group of gliomas of the brain stem, a sub group with better prognosis which require a different therapeutic strategy. OBJECTIVES: A retrospective review of tectal tumours in children to find the most suitable therapeutic approach and the prognosis to be expected. PATIENTS AND METHODS: We reviewed 8 paediatric patients who, during the past 11 years, had developed tectal tumours diagnosed by means of neuro imaging techniques. We evaluated their clinical features and especially their clinico radiological progress. RESULTS: The average age at the time of diagnosis was 10 years. All cases presented with the clinical features of raised intracranial pressure secondary to obstruction of the aqueduct of Sylvius. MR was the key to visualization of the tectal lesion in all cases but one, which had already been shown on CT. The initial and only treatment given was a ventricular shunt. The average clinico radiological follow up in our series was 4 years, with good progress in all cases so that no other therapeutic measures were required. MR follow up showed that the tumours were stable in all cases but one, which had increased slightly in size but without parallel clinical signs. CONCLUSION: In most cases tectal tumours in children follow a benign course. A ventricular shunt is usually the only treatment necessary. However, close clinical and radiological follow up should be carried out to rule out growth of the tumour which make other treatment also necessary. MR is the method of choice for initial evaluation and follow up of these tumours.

[Periventricular leukomalacia: neurological and radiological sequelae and long term neuropsychological repercussions]. / Leucomalacia periventricular: secuelas neurológicas, radiológicas y repercusiones neuropsicológicas a largo plazo.

INTRODUCTION: Periventricular leukomalacia is an anatomical diagnosis made by neuroimaging technics, of hypoxic-ischemic origin and a characteristic neurological syndrome consisting in cerebral palsy, visual impairment and/or mental retardation. Is more frequently seen in pre-term infant (5-10%) as a spastic diplegia or tetraplegia. Real prevalence in a-term infant is unknown and is presented as hemiplegia. The correlation between periventricular leukomalacia severity and clinical severity is not absolutely clarified. Is not still known if we can predict mental retardation in an infant with periventricular leukomalacia on magnetic resonance image. DEVELOPMENT: This paper revise the clinical and radiological diagnosis of periventricular leukomalacia and shows the results of a series of 31 patients diagnosed radiologically of periventricular leukomalacia. We correlate the degree of neurological and mental disabilities with the severity of periventricular leukomalacia. CONCLUSION: We reach a good correlation between the severity of periventricular leukomalacia and the severity of neurological disturbances and mental retardation.

Leucomalacia periventricular: secuelas neurológicas, radiológicas y repercusiones neuropsicológicas a largo plazo / Periventricular leukomalacia: neurological and radiological sequelas and long term neuropsychological repercussions

Introducción. La leucomalacia periventricular es un diagnóstico anatómico realizado por técnicas de neuroimagen, de etiología hipóxico-isquémica y de sintomatología neurológica residual, en la mayor parte de casos en forma de parálisis cerebral infantil, alteraciones visuales y/o retraso psicomotor. Afecta con más frecuencia al neonato prematuro y su incidencia se estima entre el 5 y 10 por ciento; provoca diplejía espástica o tetraplejía. En el recién nacido a término se desconoce la frecuencia real y suele presentarse como hemiplejía. La correlación entre la gravedad de las lesiones clínicas y las radiológicas no está del todo determinada, y se desconoce en qué medida se puede predecir un retraso psicomotor ante un diagnóstico de leucomalacia periventricular. Desarrollo. Este trabajo incluye una revisión sobre el diagnóstico clínico-radiológico de esta entidad y presenta los resultados de un estudio realizado sobre 31 niños con diagnóstico radiológico de leucomalacia periventricular. Se correlaciona el grado de lesión neurológica y de retraso psicomotor con la gravedad de las lesiones de leucomalacia periventricular. Conclusión. Se obtiene una buena correlación entre la gravedad de las lesiones de leucomalacia periventricular y el grado de afectación motora y neuropsicológica (AU)

Meningoencefalitis virales / Viral meningoencephalitis

Entre el 1§ de enero de 1983 y el 30 de septiembre de 1999 atendimos a 117 niños con diagnóstico de meningoencefalitis viral, en la Sección de Infectocontagiosos del Hospital Infantil Universitario "La Fe" (Valencia, España). En 27 casos fue posible averiguar el agente etiológico: 20 por herpesvirus (14 Herpes simplex, 4 Epstein-Barr y 2 citomegalovirus) y 7 por enterovirus, quedando los 90 restantes sin demostrar.Se comentan los aspectos clínicos, diagnósticos y terapéuticos. Ante la posibilidad, aún remota, de una etiología herpética, se recomienda iniciar el tratamiento con aciclovir, dada su eficacia y el mal pronóstico de esta meningoencefalitis.En general, la evolución de nuestros casos fue favorable, con pocas secuelas, sobre todo en forma de convulsiones controladas con tratamiento anticomicial. Sólo ha habido que lamentar un caso de muerte por meningoencefalitis herpética.

[Disseminated acute encephalomyelitis in children. A retrospective study of seven patients]. / Encefalomielitis aguda diseminada en la infancia. Estudio retrospectivo de siete pacientes.

INTRODUCTION AND OBJECTIVE: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system. This study is based on clinical symptoms and diagnostic tests employed. PATIENTS AND METHODS: We describe a seven children series indicating the initial neurologic abnormalities, diagnostic tests, treatments used and clinical-neuroradiological evolution. RESULTS: The mean presentation age was 4.1 years. Initial neurologic symptoms were mainly spastic hemi/paraparesis, cerebellous and pyramidal syndrome, consciousness changes, meningeal signs, seizures and cranial nerve palsies. The cerebrospinal fluid was abnormal in four patients with positive serologic tests in two of them (Coxsackie B). Electrophysiological studies were affected in 50%. MRI findings consisted of multifocal supratentorial white matter lesions. Clinical evolution revealed a progressive improvement with resolution after two months. Follow-up was made between six months and five years. The treatment was based on aciclovir and corticosteroids. CONCLUSIONS: ADEM runs a monophasic course of progressive neurologic abnormalities. Diagnosis is based on suggestive clinical and neuroimaging findings. Generally speaking, MRI showed resolution of multifocal lesions in conjunction with clinical improvement.

Tuberous sclerosis: differences between cerebral and cerebellar cortical tubers in a pediatric population.

BACKGROUND AND PURPOSE: Histologic evidence of cortical tubers is pathognomonic of tuberous sclerosis (TS) disease. Cerebellar tubers, however, are uncommonly found. Our objective was to evaluate the prevalence and characteristics of cerebellar tubers in a large series of pediatric patients with TS studied with MR imaging. In particular, their relationship with volume loss and age will be analyzed. METHODS: MR images of 34 children with TS and cortical tubers were reviewed. There were 17 female and 17 male patients. The mean age was 8.9+/-4.5 years (mean +/- SD), with a range from 2 to 14 years. The number and location (supratentorial, infratentorial) of tubers and volume loss of the underlying parenchyma were recorded. The relationship between tuber location, patient age, and number of tubers was studied using the Student's t test for independent samples. The relationship between tuber location and presence of volume loss was established using the Pearson chi2 test. RESULTS: The mean number of cortical tubers was 14.3+/-8.5. Fifteen (44.1%) patients had cerebellar tubers associated with cerebral lesions. Patients with cerebellar and cerebral tubers had significantly more global cortical lesions than did patients with isolated cerebral tubers (17.9+/-8.9 versus 11.4+/-7.2 tubers, P = .026). Patients with cerebellar tubers were significantly older than those with isolated supratentorial tubers (11.3+/-3.4 versus 7.1+/-4.4 years, P = .005). In only four (11.8%) patients were tubers associated with focal parenchymal volume loss. The tubers in all of these cases were located in the cerebellum-indicating a significant relationship with volume loss (Pearson chi2 test, P = .017). CONCLUSION: In this series, cerebellar tubers were frequent and were always present in association with cerebral cortical tubers. They were seen in older children with a larger total number of tubers. Cerebellar tubers may be associated with focal volume loss.

Safety and efficacy of Omniscan (gadodiamide injection) at 0.1 mmol/kg for MRI in infants younger than 6 months of age: phase III open multicenter study.

RATIONALE AND OBJECTIVES: To demonstrate that gadodiamide injection is a safe and efficient contrast agent for MRI in infants younger than 6 months of age. METHODS: The authors designed a phase III multicenter nonrandomized study using a control group. Gadodiamide injection at a dosage of 0.1 mmol/kg body weight was administered to 39 children; 20 received no contrast. The mean age was 10.6 weeks in the contrast group and 9.3 weeks in the control group. MR examinations, blood (serum creatinine, S-ASAT, S-ALAT, S-bilirubin, alkaline phosphatase) and urine (proteins, blood, others) sampling before sedation and after examination, heart rate (electrocardiography) and oxygen saturation (pulse oximetry) during examination, adverse events, and efficacy parameters were analyzed. RESULTS: In the contrast group, 18 (51.4%) children had 31 abnormal changes in one or more of the safety parameters and vital signs. In the control group there were 16 (80.0%) children with 19 abnormal changes. Gadodiamide injection had no negative influence on the safety parameters. No serious adverse events occurred, and only three clinically relevant adverse events (elevation of S-ALAT and S-ASAT, elevation of bilirubin) in two patients in the contrast group and one event (vomiting) in one patient in the control group were documented. The benefit of the contrast medium was clearly shown for all evaluated parameters. CONCLUSIONS: Gadodiamide injection is safe, well tolerated, and effective in infants younger than 6 months of age.

Encefalomielitis aguda diseminada en la infancia. Estudio retrospectivo de siete pacientes / Disseminated acute encephalomyelitis in childhood. A retrospective study of seven patients

Introducción y objetivo. La encefalomielitis aguda diseminada (EAD) es una enfermedad inflamatoria y desmielinizante del sistema nervioso central. Este estudio se centra en las formas clínicas de presentación y en las exploraciones complementarias que ayudan a su diagnóstico. Pacientes y métodos. Describimos siete pacientes e indicamos la clínica neurológica inicial, las pruebas diagnósticas, los tratamientos empleados y la evolución clínico-neurorradiológica. Resultados. La edad media de presentación fue de 4,1 años. La clínica neurológica al inicio evidenciaba hemi/paraparesia espástica, cuadro cerebeloso, piramidalismo, alteración de conciencia, signos meníngeos, crisis epilépticas, parálisis de pares craneales, etc. El líquido cefalorraquídeo fue patológico en cuatro casos, con estudio serológico positivo en sólo dos de ellos (Coxsackie B). Los estudios neurofisiológicos practicados estaban alterados en un 50 por ciento de los pacientes. La neurorradiología inicial mostraba predominio de afectación de la sustancia blanca supratentorial multifocal. La evolución clínica posterior evidenció mejoría progresiva y, en su mayoría, los pacientes se encontraban prácticamente asintomáticos al segundo mes de iniciado el cuadro, con un seguimiento posterior mínimo de seis meses y un máximo de cinco años. El tratamiento se centró en aciclovir y corticoterapia. Conclusiones. La EAD presenta un cuadro agudo y monofásico de anomalías neurológicas progresivas. El diagnóstico se basa en los datos clínicos y los hallazgos sugestivos de la neuroimagen. En general, los pacientes evolucionan de manera satisfactoria con resolución de las lesiones desmielinizantes multifocales de forma paralela al curso clínico (AU)