Association between myasthenia gravis and Alzheimer's disease. / Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio.

INTRODUCTION: Myasthenia gravis (MG) and Alzheimer's disease (AD) are two of the most important diseases where the dysregulation of acetylcholine activity plays a crucial role. In the first, this dysregulation happens at the level of the neu-romuscular junction and in the second, in the central nervous system (CNS). AIM: To analyze the possible relationship between these two pathologies, analyzing the prevalence and the odds ratio of AD within patients previously diagnosed with MG. We will compare these data with respect to the prevalence of AD in the general population. PATIENTS AND METHODS: We examined the data obtained by the electronic medical records of patients in the health care system of Castilla La Mancha using the Natural Language Process provided by a clinical platform of artificial intelligence known as the Savana Manager?. RESULTS: We identified 970,503 patients over the age of 60 years, of which 1,028 were diagnosed with MG. The proportion of the patients diagnosed with AD within this group (4.28%) was greater than the rest of the population (2.82%) (p = 0,0047) with an odds ratio of 1.54 (confidence interval at 95% 1.13-2.08; p = 0.0051) without finding significant differences in the bivariate analysis for the rest of the most important actual known risk factors for AD. CONCLUSION: Our results suggest that there might be an increase in the prevalence of AD in patients previously diagnosed with MG.

TITLE: Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio.Introducción. La miastenia gravis (MG) y la enfermedad de Alzheimer (EA) son dos de las enfermedades neurológicas en cuya fisiopatología interviene la acetilcolina en distintos niveles. En la primera, la alteración de este neurotransmisor se produce en la unión neuromuscular, y en la segunda, en el sistema nervioso central. Objetivo. Analizar la posible relación entre dichas patologías estudiando la prevalencia y la odds ratio de la EA dentro de los pacientes diagnosticados de MG con respecto a la prevalencia de EA en la población general. Pacientes y métodos. Se han examinado datos de las historias clínicas electrónicas del sistema de salud de Castilla-La Mancha utilizando el procesamiento de lenguaje natural a través de la plataforma clínica de inteligencia artificial Savana Manager?. Resultados. Se ha identificado a 970.503 pacientes mayores de 60 años, de los que 1.028 tenían diagnóstico de MG. La proporción de pacientes con diagnóstico de EA dentro de este grupo (4,28%) es mayor que en el resto de la población (2,82%; p = 0,0047), con una odds ratio de 1,54 (intervalo de confianza al 95%: 1,13-2,08; p = 0,0051), sin que se encuentren diferencias significativas en el análisis bivariante del resto de los factores de riesgo para EA más importantes conocidos hasta ahora. Conclusiones. Nuestros resultados sugieren que podría existir un aumento de la prevalencia de EA en pacientes con MG.

Aumento de la confianza en la interpretación del PET con 18F-Florbetaben: “machine learning” basado en la aproximación cuantitativa / Increasing the confidence of 18F-florbetaben PET interpretations: Machine learning quantitative approximation

Objetivo: Determinar el valor a-adido de los parámetros semicuantitativos en el análisis visual y estudiar los patrones del depósito cerebral de 18F-Florbetaben. Material y métodos: Análisis retrospectivo de pacientes con deterioro cognitivo leve o demencia de origen incierto procedentes de un estudio multicentrico. Los PET con 18F-Florbetaben fueron interpretados de forma visual por dos observadores independientes, analizando las regiones “diana” con la finalidad de calcular el acuerdo interobservador. Se realizó análisis semicuantitativo de todas las regiones corticales con respecto a tres regiones de referencia para obtener índices de captación (SUVRs). Se analizó la capacidad de los SUVRs para predecir el resultado de la interpretación visual, la posibilidad de depósito preferencial del radiotrazador en algunas regiones “diana” así como las diferencias interhemisféricas. Resultados: Se evaluaron 135 pacientes. En la valoración visual, 72 estudios se clasificaron como positivos. El acuerdo interobservador fue excelente. Todos los SUVRs fueron significativamente superiores en pacientes con PET positivos con respecto a los negativos. Las regiones corticales correspondientes al área prefrontal y al cingulado posterior mostraron la mejor correlación con la evaluación visual, seguidas por la valoración integrada cortical. Usando análisis de ROC, los SUVRs obtenidos en las mismas regiones “diana” mostraron la mejor capacidad diagnóstica. Conclusiones: La información obtenida de las regiones “diana” parece ser de ayuda en la clasificación visual, basado en un depósito preferencial de amiloide, lo que permitiría el “machine learning”. El depósito de amiloide, aunque difuso en todas las regiones corticales, parece no ser uniforme ni simétrico (AU)

Aim: To assess the added value of semiquantitative parameters on the visual assessment and to study the patterns of 18F-Florbetaben brain deposition. Materials and methods: Retrospective analysis of multicenter study performed in patients with mild cognitive impairment or dementia of uncertain origin. 18F-Florbetaben PET scans were visually interpreted by two experienced observers, analyzing target regions in order to calculate the interobserver agreement. Semiquantification of all cortical regions with respect to three reference regions was performed to obtain standardized uptake value ratios (SUVRs). The ability of SUVRs to predict the visual evaluation, the possibility of preferential radiotracer deposition in some target regions and interhemisphere differenceswere analyzed. Results: 135 patients were evaluated. In the visual assessment, 72 were classified as positive. Interobserver agreement was excellent. All SUVRs were significantly higher in positive PET scans than in negative ones. Prefrontal area and posterior cingulate were the cortical regions with the best correlations with the visual evaluation, followed by the composite region. Using ROC analysis, the SUVRs obtained in same target locations showed the best diagnostic performance. Conclusions: The derived information from target regions seems to help the visual classification, based on a preferential amyloid deposit, allowing machine learning. The amyloid deposit, although diffuse in all cortical regions, seems not to be uniform and symmetric (AU)

Mielitis transversa aguda tras anestesia epidural obstétrica / Acute transverse myelitis after obstetric epidural anesthesia

Introducción. La mielitis transversa aguda es una disfunciónmedular aguda o subaguda con afectación motora,sensitiva y/o esfinteriana secundaria que puede deberse amúltiples causas. Caso clínico. Presentamos a una paciente de 32 años concuadro agudo de disfunción vesical y fiebre, seguido de pérdidade fuerza y alteración sensitiva en miembros inferiores, con nivelsensitivo medular dorsal D2-D3 a las 2 semanas de un partoeutócico a término con anestesia epidural no complicada. El líquidocefalorraquídeo (LCR) mostraba pleocitosis linfocitarialeve, hiperproteinorraquia con glucorraquia normal, ausenciade bandas oligoclonales y estudios virológicos en suero y LCRnegativos. La resonancia magnética cervicodorsal mostraba ensanchamientodel cordón medular con hiperintensidad difusa anivel C6-D1 y D2-D5 sin captación de contraste. Tras tratamientocon metilprednisolona, la evolución fue favorable, estandocompletamente asintomática al año y sin nuevos episodiosde disfunción neurológica tras 2 años de seguimiento. Discusión. Tras descartar con los estudios complementarioslas causas más frecuentes de mielopatía aguda nocompresiva, como esclerosis múltiple, enfermedades sistémicas,infarto medular o infecciones, se considera que lapaciente ha presentado una mielitis transversa aguda parainfecciosaen la que la anestesia epidural sería incidental,pero posiblemente un factor contribuyente

Introduction. Acute transverse myelitis is an acuteor subacute disorder of the spinal cord resulting in motor, sensory and sphincter dysfunction secondary to variouscauses.Case report. We present a 32 year-old female patientwith an acute episode of bladder dysfunction andfever, followed by motor and sensory dysfunction in legswith sensory spinal level at D2-D3, two weeks after aneutocic delivery with uncomplicated epidural anesthesia.The cerebrospinal fluid (CSF) showed mild lymphocyticpleocytosis, high protein levels with normal glucose concentration,absence of oligoclonal bands and negativeserum and CSF virology screening. The cervicodorsalmagnetic resonance imaging showed widening of thespinal cord with diffuse patchy hyperintensity on theC6-D1 and D2-D5 levels without contrast enhancement.The patient was treated with intravenous high doses ofmethylprednisolone with favorable outcome and completerecovery within one year and no relapses two yearsafter the episode.Discussion. The main etiologies of non-compressiveacute myelopathy as multiple sclerosis, systemic diseases,spinal cord infarct and direct infections have beenruled out with the complementary examinations. Weconsider that our patient had a parainfectious acutetransverse myelitis and epidural anesthesia could be anincidental but possible contributing factor

[Acute transverse myelitis after obstetric epidural anesthesia]. / Mielitis transversa aguda tras anestesia epidural obstétrica.

INTRODUCTION: Acute transverse myelitis is an acute or subacute disorder of the spinal cord resulting in motor, sensory and sphincter dysfunction secondary to various causes. CASE REPORT: We present a 32 year-old female patient with an acute episode of bladder dysfunction and fever, followed by motor and sensory dysfunction in legs with sensory spinal level at D2-D3, two weeks after an eutocic delivery with uncomplicated epidural anesthesia. The cerebrospinal fluid (CSF) showed mild lymphocytic pleocytosis, high protein levels with normal glucose concentration, absence of oligoclonal bands and negative serum and CSF virology screening. The cervicodorsal magnetic resonance imaging showed widening of the spinal cord with diffuse patchy hyperintensity on the C6-D1 and D2-D5 levels without contrast enhancement. The patient was treated with intravenous high doses of methylprednisolone with favorable outcome and complete recovery within one year and no relapses two years after the episode. DISCUSSION: The main etiologies of non-compressive acute myelopathy as multiple sclerosis, systemic diseases, spinal cord infarct and direct infections have been ruled out with the complementary examinations. We consider that our patient had a parainfectious acute transverse myelitis and epidural anesthesia could be an incidental but possible contributing factor.

Meningoencefalitis recurrente como inicio de enfermedad de Behçet / Relapsing meningoencephalitis as onset of Behçet's disease

Introducción. La enfermedad de Behçet es una enfermedad inflamatoria, multisistémica, crónica y recidivante de etiopatogenia desconocida. Se caracteriza por úlceras aftosas orales recidivantes, úlceras genitales y uveítis. El sustrato patológico principal es una vasculitis leucocitoclástica. Caso clínico. Presentamos a una paciente con enfermedad de Behçet que se inició como una meningoencefalitis recurrente, con pleocitosis linfocitaria y proteinorraquia en el líquido cefalorraquídeo. La resonancia magnética cerebral mostró una lesión predominante del tronco del encéfalo. Conclusiones. Entre un 5-20% de los pacientes con enfermedad de Behçet tienen afectación neurológica, siendo la manifestación inicial en el 3% de los casos. Puede presentarse como: un único ataque con remisión completa o incompleta, como una forma remitente-recidivante, una forma progresiva o presentar únicamente afectación neurológica silente. La afectación neurológica más frecuente es una meningoencefalitis recurrente, a menudo con curso progresivo, que afecta más frecuentemente al troncoencéfalo. El pronóstico de la enfermedad va a depender de su forma de presentación, con peor porvenir en las formas parenquimatosas, sobre todo con afectación de tronco y medular, de las anomalías encontradas en el líquido cefalorraquídeo y del número de episodios o de las recaídas tras la disminución del tratamiento con esteroides. Tiene una mortalidad alta, llegando a comunicarse hasta un 20% de mortalidad a los 7 años en casos con afectación neurológica

Introduction. Behçet's disease is a systemic, chronic, relapsing inflammatory disease of unknown etiology characterized by recurrent oral aphthae, genital ulcerations and uveitis. The main pathological mechanism is leukocytoclastic vasculitis. Clinical case. We present the case of a patient with Behçet's disease that presented as a relapsing meningoencephalitis with lymphocytic pleocytosis and high protein levels in cerebrospinal fluid. The MRI revealed a lesion in the brain stem and part of diencephalon. Conclusions. The central nervous system is involved in up to 5%-20% of patients with Behçet's disease, this being the first manifestation in 3% of the cases. Clinical course includes: patients with an isolated episode with complete or incomplete recovery, relapsing and remitting forms, progressive forms or asymptomatic neurological involvement. The most frequent presentation is relapsing meningoencephalitis, with progressive course localized in the brain stem. Prognosis varies according to the type of neurologic process. The worse outcome is in the parenchymal forms with brain stem and spinal cord involvement. It also depends on the pathological findings in the cerebrospinal fluid, and the number of total events or recurrences after tapering the glucocorticoids. Mortality rate is high, up to 20 % of cases after 7 years in patients with neurological involvement

[Relapsing meningoencephalitis as onset of Behçet's disease]. / Meningoencefalitis recurrente como inicio de enfermedad de Behçet.

INTRODUCTION: Behçet's disease is a systemic, chronic, relapsing inflammatory disease of unknown etiology characterized by recurrent oral aphthae, genital ulcerations and uveitis. The main pathological mechanism is leukocytoclastic vasculitis. CLINICAL CASE: We present the case of a patient with Behçet's disease that presented as a relapsing meningoencephalitis with lymphocytic pleocytosis and high protein levels in cerebrospinal fluid. The MRI revealed a lesion in the brain stem and part of diencephalon. CONCLUSIONS: The central nervous system is involved in up to 5%-20% of patients with Behçet's disease, this being the first manifestation in 3% of the cases. Clinical course includes: patients with an isolated episode with complete or incomplete recovery, relapsing and remitting forms, progressive forms or asymptomatic neurological involvement. The most frequent presentation is relapsing meningoencephalitis, with progressive course localized in the brain stem. Prognosis varies according to the type of neurologic process. The worse outcome is in the parenchymal forms with brain stem and spinal cord involvement. It also depends on the pathological findings in the cerebrospinal fluid, and the number of total events or recurrences after tapering the glucocorticoids. Mortality rate is high, up to 20% of cases after 7 years in patients with neurological involvement.

[Neurological sequelae following electrocution. A case report and review of the literature]. / Secuelas neurológicas tras electrocución. Presentación de un caso y revisión de la bibliografía.

INTRODUCTION: Electrocution is the cause of a large number of accidents and, of these, a considerable percentage result in death. Several factors affect the severity and distribution of the injuries. It is known that for low voltages the characteristics of alternating current make it three times more dangerous than continuous current. The high percentage of neurological sequelae can be accounted for by the fact that nerves are the tissue with the lowest resistance in the body and electricity tends to follow the path that offers the least resistance. CASE REPORT: A 16-year-old male who was accidentally electrocuted by an electric guitar and later suffered a cardiorespiratory arrest; the patient required intubation. After withdrawing sedation, the patient was found to be blind in both eyes and could not remember what had happened. FLAIR MR imaging revealed oedema in both occipital lobes and, to a lesser extent, in the junction between the parietooccipital and temporooccipital lobes. Treatment with steroids was established for three days. After approximately one month, the patient had recovered his sight and the brain injuries had disappeared. CONCLUSIONS: The neurological manifestations secondary to accidents caused by electricity are usually divided into two types -immediate and delayed. Blindness has rarely been reported as a sequela in those who have survived fulguration due to a lightning strike. The patient's recovery after administering treatment with steroids and the reversibility of the oedema could lead us to think that the mechanism producing this sequela was the damage to the nervous system caused directly by the electricity, which is known as the 'phenomenon of electroporation'.

Secuelas neurológicas tras electrocución. Presentación de un caso y revisión de la bibliografía / Neurological sequelae following electrocution. A case report and review of the literature

Introducción. La electrocución genera un gran númerode accidentes y, de éstos, un porcentaje no desestimable termina enmuerte. Existen factores que influyen en la gravedad y la distribuciónde las lesiones. Se conoce que, debido a sus características, lacorriente alterna para voltajes bajos es tres veces más peligrosa quela continua. El alto porcentaje de secuelas neurológicas se explicadebido a que los nervios son el tejido que menor resistencia poseedentro del organismo y la electricidad tiende a escoger el camino demenor resistencia. Caso clínico. Varón de 16 años que sufrió unaelectrocución accidental por una guitarra eléctrica, con posteriorparada cardiorrespiratoria; precisó intubación. Tras la retirada dela sedación, el paciente presentaba una ceguera bilateral con amnesiade lo sucedido. La resonancia magnética mostró, en la secuenciaFLAIR, edema en ambos lóbulos occipitales y, en menor grado,en la unión parietooccipital y temporooccipital. Se instauró empíricamenteun tratamiento esteroideo durante tres días. Aproximadamenteal cabo de un mes, el paciente había recuperado totalmentela visión y habían desaparecido las lesiones cerebrales. Conclusiones.Las manifestaciones neurológicas secundarias a los accidentespor electricidad se suelen dividir en inmediatas y tardías. La ceguerase ha descrito raramente como secuela de los supervivientes a lafulguración por rayos. La recuperación tras la administración deltratamiento esteroideo y la reversibilidad del edema podrían hacerpensar que el mecanismo de producción de esta secuela fuera el dañodirecto de la electricidad en el sistema nervioso, conocido como ‘fenómenode electroporación

Introduction. Electrocution is the cause of a large number of accidents and, of these, a considerable percentage resultin death. Several factors affect the severity and distribution of the injuries. It is known that for low voltages the characteristicsof alternating current make it three times more dangerous than continuous current. The high percentage of neurologicalsequelae can be accounted for by the fact that nerves are the tissue with the lowest resistance in the body and electricity tendsto follow the path that offers the least resistance. Case report. A 16-year-old male who was accidentally electrocuted by anelectric guitar and later suffered a cardiorespiratory arrest; the patient required intubation. After withdrawing sedation, thepatient was found to be blind in both eyes and could not remember what had happened. FLAIR MR imaging revealed oedema inboth occipital lobes and, to a lesser extent, in the junction between the parietooccipital and temporooccipital lobes. Treatmentwith steroids was established for three days. After approximately one month, the patient had recovered his sight and the braininjuries had disappeared. Conclusions. The neurological manifestations secondary to accidents caused by electricity are usuallydivided into two types –immediate and delayed. Blindness has rarely been reported as a sequela in those who have survivedfulguration due to a lightning strike. The patient’s recovery after administering treatment with steroids and the reversibility ofthe oedema could lead us to think that the mechanism producing this sequela was the damage to the nervous system causeddirectly by the electricity, which is known as the ‘phenomenon of electroporation’

[Recurrent aseptic meningitis secondary to taking ibuprofen and ketorolac]. / Meningitis recurrente aséptica secundaria a toma de ibuprofeno y ketorolaco.

INTRODUCTION: Aseptic meningitis is a process that is characterised by an inflammatory reaction of the meninges that is not due to any infectious agent. Its aetiology is varied and is most frequently caused by rheumatologic and/or autoimmune processes, chemical or medication-induced meningitis, the most notable drugs involved being antibiotics and non-steroidal anti-inflammatory drugs (NSAI). CASE REPORT: We report the case of a 70-year-old male, with no relevant history, who was admitted to hospital five times over a period of 16 months because of acute meningitis with polymorphonuclear pleocytosis, high protein levels in cerebrospinal fluid and normal glucose in cerebrospinal fluid. No evidence of an infectious causation, chemical meningitis, carcinomatosis or autoimmune disease was found and the patient was diagnosed with recurrent aseptic meningitis. It was found that the patient had taken ibuprofen or ketorolac on several occasions, a few hours before the appearance of symptoms. These episodes were quickly resolved after withdrawal of this medication. CONCLUSIONS: A number of NSAI have been reported as inducers of aseptic meningitis, one of the most notable being ibuprofen. We report the case of a patient who, as a consequence of taking ibuprofen and ketorolac, presented episodes of recurrent aseptic meningitis. To our knowledge this side effect of ketorolac has not been reported before. Its clinical features are impossible to differentiate from those of infectious meningitis. Diagnosis is reached by exclusion and a careful pharmacological study, including over-the-counter drugs like some of the NSAI, must be performed in patients with this condition, since it is a problem that can easily be solved by withdrawing the drug that causes it.

Meningitis recurrente aséptica secundaria a toma de ibuprofeno y ketorolaco / Recurrent aseptic meningitis secondary to taking ibuprofen and ketorolac

Introducción. La meningitis aséptica es un proceso que se caracteriza por una reacción inflamatoria meníngea no causada por ningún agente infeccioso. Su etiología es variada, y la más frecuente es la secundaria a procesos reumatológicos y/o autoinmunes, meningitis química e inducida por fármacos, entre los que destacan los antibióticos y los antiinflamatorios no esteroideos (AINE). Caso clínico. Varón de 70 años de edad, sin antecedentes relevantes, que en el período de 16 meses ingresó en cinco ocasiones por meningitis aguda con pleocitosis polimorfonuclear, hiperproteinorraquia y glucosa normal en el líquido cefalorraquídeo, en las que se descartó una etiología infecciosa, meningitis química, carcinomatosis o enfermedad autoinmune y se le diagnosticó meningitis aséptica recurrente. Se comprobó la toma de ibuprofeno o ketorolaco en distintas ocasiones, unas pocas horas antes de la aparición de la clínica. Estos episodios se resolvieron rápidamente tras la retirada de dicha medicación. Conclusiones. Se han implicado varios AINE como inductores de meningitis aséptica, entre los que destaca el ibuprofeno. Presentamos un paciente que, como consecuencia de la toma de ibuprofeno y ketorolaco, sufrió episodios de meningitis recurrente aséptica. En nuestro conocimiento no se ha comunicado previamente este efecto secundario con el ketorolaco. Su clínica es indistinguible de la meningitis infecciosa; el diagnóstico se efectúa por exclusión, y debe realizarse una cuidadosa historia farmacológica, que incluya fármacos de libre dispensación como algunos AINE, en pacientes con esta patología, puesto que se trata de un problema fácilmente solucionable con la retirada de la medicación que lo causa (AU)

Introduction. Aseptic meningitis is a process that is characterised by an inflammatory reaction of the meninges that is not due to any infectious agent. Its aetiology is varied and is most frequently caused by rheumatologic and/or autoimmune processes, chemical or medication-induced meningitis, the most notable drugs involved being antibiotics and non-steroidal anti-inflammatory drugs (NSAI). Case report. We report the case of a 70-year-old male, with no relevant history, who was admitted to hospital five times over a period of 16 months because of acute meningitis with polymorphonuclear pleocytosis, high protein levels in cerebrospinal fluid and normal glucose in cerebrospinal fluid. No evidence of an infectious causation, chemical meningitis, carcinomatosis or autoimmune disease was found and the patient was diagnosed with recurrent aseptic meningitis. It was found that the patient had taken ibuprofen or ketorolac on several occasions, a few hours before the appearance of symptoms. These episodes were quickly resolved after withdrawal of this medication. Conclusions. A number of NSAI have been reported as inducers of aseptic meningitis, one of the most notable being ibuprofen. We report the case of a patient who, as a consequence of taking ibuprofen and ketorolac, presented episodes of recurrent aseptic meningitis. To our knowledge this side effect of ketorolac has not been reported before. Its clinical features are impossible to differentiate from those of infectious meningitis. Diagnosis is reached by exclusion and a careful pharmacological study, including over-thecounter drugs like some of the NSAI, must be performed in patients with this condition, since it is a problem that can easily be solved by withdrawing the drug that causes it (AU)

[Aphasia and parietal syndrome as the presenting symptoms of a demyelinating disease with pseudotumoral lesions]. / Afasia y síndrome parietal como forma de presentación de una enfermedad desmielinizante con lesión pseudotumoral.

INTRODUCTION: Multiple sclerosis (MS) often presents with sensory symptoms, which are usually due to spinothalamic or spinal cord disorders; parietal syndrome is, however, very rare as the initial symptom. Likewise, aphasia is also an infrequent symptom of MS; in the few cases that have been reported, it is usually linked to the existence of important pseudotumoral lesions. CASE REPORT: We describe the case of a 31-year-old female with a 48-hour history of a progressive clinical picture consisting in nominal aphasia and a sensory parietal syndrome. Magnetic resonance imaging showed a lesion 3.6 cm in diameter that was hyperintense in T2 with perilesional edema and minimal gadolinium uptake, along with other images that revealed increased signal intensity in the periventricular subcortical white matter on the right-hand side and in the left-hand frontal subcortical region. A spectroscopic analysis of the largest lesion revealed that this lesion showed evidence of inflammation, with cell destruction and replacement, although it was not possible to distinguish between a demyelinating disease and a high grade glioma. Hence, a brain biopsy was required in order to reach the final diagnosis of demyelinating pseudotumoral lesion. CONCLUSIONS: Giant pseudotumoral plaques are a rare form of presenting symptom in MS; use of the clinical features, simple images and spectroscopy is not a very reliable means of reaching a differential diagnosis with a tumour and this often makes it necessary to conduct a biopsy study of the lesion.

Afasia y síndrome parietal como forma de presentación de una enfermedad desmielinizante con lesión pseudotumoral / Aphasia and parietal syndrome as the presenting symptoms of a demyelinating disease with pseudotumoral lesions

Introducción. Las manifestaciones sensitivas son frecuentes como síntomas iniciales de la esclerosis múltiple (EM), generalmente por alteración espinotalámica o medular; pero es excepcional un síndrome parietal como forma de inicio. Igualmente, la afasia es una manifestación infrecuente en la EM; en los pocos casos descritos suele asociarse a la existencia de grandes lesiones pseudotumorales. Caso clínico. Mujer de 31 años con un cuadro progresivo de 48 horas de evolución, consistente en afasia nominal y un síndrome sensitivo parietal. En la resonancia magnética se observó una lesión de 3,6 cm de diámetro hiperintensa en T2 con edema perilesional y con mínima captación de gadolinio, además de otras imágenes de aumento de intensidad de señal en sustancia blanca subcortical periventricular derecha y en zona subcortical frontal izquierda. El análisis espectroscópico de la lesión de mayor tamaño reveló que dicha lesión presentaba datos de inflamación, con destrucción y recambio celular, sin poder distinguir entre enfermedad desmielinizante o glioma de alto grado; se precisó para ello la realización de una biopsia cerebral para alcanzar el diagnóstico final de lesión pseudotumoral desmielinizante. Conclusiones. Las placas gigantes pseudotumorales constituyen una forma infrecuente de inicio de la EM; su diagnóstico diferencial con un tumor por la clínica, la imagen simple y la espectroscopia son poco fiables, por lo que, con frecuencia, es preciso recurrir a la biopsia de la lesión

Introduction. Multiple sclerosis (MS) often presents with sensory symptoms, which are usually due to spinothalamic or spinal cord disorders; parietal syndrome is, however, very rare as the initial symptom. Likewise, aphasia is also an infrequent symptom of MS; in the few cases that have been reported, it is usually linked to the existence of important pseudotumoral lesions. Case report. We describe the case of a 31-year-old female with a 48-hour history of a progressive clinical picture consisting in nominal aphasia and a sensory parietal syndrome. Magnetic resonance imaging showed a lesion 3.6 cm in diameter that was hyperintense in T2 with perilesional edema and minimal gadolinium uptake, along with other images that revealed increased signal intensity in the periventricular subcortical white matter on the right-hand side and in the left-hand frontal subcortical region. A spectroscopic analysis of the largest lesion revealed that this lesion showed evidence of inflammation, with cell destruction and replacement, although it was not possible to distinguish between a demyelinating disease and a high grade glioma. Hence, a brain biopsy was required in order to reach the final diagnosis of demyelinating pseudotumoral lesion. Conclusions. Giant pseudotumoral plaques are a rare form of presenting symptom in MS; use of the clinical features, simple images and spectroscopy is not a very reliable means of reaching a differential diagnosis with a tumour and this often makes it necessary to conduct a biopsy study of the lesion

[Mumps meningitis: a case mix in a Neurology Department]. / Meningitis urliana: casuística en un servicio de Neurología.

INTRODUCTION: Parotiditis is a viral infection that produces a non-suppurative inflammation of the parotid glands, although it may affect other salivary glands, the testicles, meninges and the pancreas. Clinical meningitis appears in 1-10% of cases, normally between the 4th and the 10th day after infection of the parotid glands. In this study, we analyse the clinical and analytic characteristics of the patients admitted to our Neurology Department over the last 12 years. CASE REPORTS: A retrospective study was conducted by analysing the hospital discharge reports. The eligibility criterion was the existence of an acute meningeal syndrome linked to the presence of positive IgM titres for the parotiditis virus. In all, 13 cases were found, with a mean age of 16.5 years, and most of them were males (92.3%). Parotiditis preceded meningitis in all our patients with an average of 8.3 days, while orchiepididymitis, when it occurred, appeared at the same time or after meningitis. Analysis of the cerebrospinal fluid showed a lymphocyte profile with glycorrhachia above 40%, except in two cases that showed a non-persistent neutrophilic profile. There was a transient 30.7% reduction in prothrombin time in the patients. No sequelae were observed. CONCLUSIONS: Vaccination campaigns have drastically reduced the number of cases of meningitis due to this germ since the second half of the 90s. This virus must be borne in mind in cases of meningitis in young males who come from underdeveloped countries.

Meningitis urliana: casuística en un servicio de Neurología / Mumps meningitis: a case mix in a neurology department

Introducción. La parotiditis es una infección vírica que produce inflamación no supurada de las parótidas, aunque puede afectar a otras glándulas salivares, los testículos, las meninges y el páncreas. La meningitis clínica aparece en el 1-10% de los casos, normalmente entre el 4.º y el 10.º día de la inflamación parotídea. Se analizan las características clínicas y analíticas de los pacientes con esta meningitis ingresados en nuestro Servicio de Neurología en los últimos 12 años. Casos clínicos. Se ha realizado un estudio retrospectivo analizando los informes de alta. El criterio de inclusión es la existencia de un síndrome meníngeo agudo asociado a la presencia de una valoración positiva IgM frente al virus de la parotiditis. Se han encontrado 13 casos con una media de edad de 16,5 años; la mayoría son varones (92,3%). La parotiditis precede a la meningitis en todos nuestros pacientes en 8,3 días de media, mientras que la orquiepididimitis, cuando aparece, lo hace a la vez que la meningitis o después. El análisis del líquido cefalorraquídeo muestra un perfil linfocitario con glucorraquia por encima del 40%, excepto en dos casos que presentan un perfil neutrofílico no persistente. Existe un descenso transitorio del tiempo de protrombina en el 30,7% de los pacientes. No hemos encontrado secuelas. Conclusiones. Las campañas de vacunación han producido una drástica reducción de las meningitis por este germen a partir de la segunda mitad de los años 90. Se debe tener en cuenta este virus en los casos de meningitis en varones jóvenes procedentes de países subdesarrollados

Introduction. Parotiditis is a viral infection that produces a non-suppurative inflammation of the parotid glands, although it may affect other salivary glands, the testicles, meninges and the pancreas. Clinical meningitis appears in 1-10% of cases, normally between the 4th and the 10th day after infection of the parotid glands. In this study, we analyse the clinical and analytic characteristics of the patients admitted to our Neurology Department over the last 12 years. Case reports. A retrospective study was conducted by analysing the hospital discharge reports. The eligibility criterion was the existence of an acute meningeal syndrome linked to the presence of positive IgM titres for the parotiditis virus. In all, 13 cases were found, with a mean age of 16.5 years, and most of them were males (92.3%). Parotiditis preceded meningitis in all our patients with an average of 8.3 days, while orchiepididymitis, when it occurred, appeared at the same time or after meningitis. Analysis of the cerebrospinal fluid showed a lymphocyte profile with glycorrhachia above 40%, except in two cases that showed a non-persistent neutrophilic profile. There was a transient 30.7% reduction in prothrombin time in the patients. No sequelae were observed. Conclusions. Vaccination campaigns have drastically reduced the number of cases of meningitis due to this germ since the second half of the 90s. This virus must be borne in mind in cases of meningitis in young males who come from underdeveloped countries