Sialoadenitis aguda por administración de contraste yodado / Acute sialadenitis by iodine contrast medium administration

La sialoadenitis aguda es una reacción adversa muypoco frecuente a la administración de contraste yodado,que causa una inflamación autolimitada de las glándulassalivales. Su patogenia no está bien establecida, aunque la insuficiencia renal puede ser un factor de riesgo.El diagnóstico es inicialmente clínico, y debe realizarsediagnóstico diferencial con angioedema, infecciones y litiasis. Ningún tratamiento o profilaxis ha demostrado beneficio hasta el momento. Aunque tiene buen pronóstico,en algunos casos se han descrito complicaciones.Presentamos el caso de un varón de 68 años que presentó inflamación de las glándulas salivales submandibulares tras la realización de una tomografía computariza-da abdominal con administración de contraste yodado.Dado el uso creciente de contrastes yodados en pruebasde imagen y técnicas intervencionistas, es importante conocer posibles reacciones adversas como esta entidad.(AU)

Acute iodide sialadenitis is a rare adverse reactionto iodinated contrast that causes self-limited salivarygland swelling. Its pathogenesis is still unclear, althoughkidney failure may be a risk factor. The diagnosis isinitially clinical but angioedema, infections and lithiasis should be included in the differential diagnosis. Notreatment or prophylaxis was proven to be beneficial.Although its prognosis is benign, associated complications have been reported.We report a case of 68-year-old man with swelling ofthe submandibular salivary glands after the administration of iodine-based contrast media during an abdomi-nal computed tomography examination. Because of thewidespread use of iodinated contrast enhanced imaging and interventional techniques, clinicians should beaware of this issue.(AU)

[Acute sialadenitis by iodine contrast medium administration].

Acute iodide sialadenitis is a rare adverse reaction to iodinated contrast that causes self-limited salivary gland swell-ing. Its pathogenesis is still unclear, although kidney failure may be a risk factor. The diagnosis is initially clinical but angioedema, infections and lithiasis should be included in the differential diagnosis. No treatment or prophylaxis was proven to be beneficial. Although its prognosis is benign, associated complications have been reported. We report a case of 68-year-old man with swelling of the submandibular salivary glands after the administration of iodine-based contrast media during an abdominal computed tomography examination. Because of the widespread use of iodinated contrast enhanced imaging and interventional techniques, clinicians should be aware of this issue.

Neumomediastino, cuando la crisis asmática no mejora / Pneumomediastinum: When asthma exacerbation does not improve

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Crisis epiléptica como primera manifestación de angiosarcoma cardíaco / Epileptic seizure as a fi rst sign of a cardiac angiosarcoma

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Hipernefroma sobre riñón en herradura / No disponible

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[Generalized tonic-clonic seizure in immigrant]. / Crisis generalizada tonicoclónica en inmigrante.

INTRODUCTION: Neurocysticercosis is a disease caused by infection of the central nervous system by the larva of Taenia solium whose main clinical manifestation is epileptic seizures. This disease, whose prevalence had decreased in Spain in previous decades, has been increasing in importance due to the increased migratory flows from endemic zones and international trips. A recent clinical case is presented to review the diagnostic criteria of this condition. CLINICAL CASE: 47 year old woman, native of Ecuador, with disease backgrounds of high blood pressure, who was admitted due to generalized tonic-clonic episodes. The neurological examination was consistent with normality. In the computed tomography (CT) scan images, several cystic lesions with scolex inside were observed. Positive results were obtained in the serology for Taenia solium in the cerebrospinal fluid. The CT scan lesion resolution was complete after completing cysticide treatment with albendazole. CONCLUSIONS: Neurocysticercosis should be considered as a diagnosis in all adult patients with epileptic seizures who have the epidemiological characteristics indicated.

Crisis generalizada tonicoclónica en inmigrante / Generalized tonic-clonic seizure in inmigrant

Introducción. La neurocisticercosis es una patología producida por la infestación del sistema nervioso central por las formas larvarias de la Taenia solium, cuya principal manifestación clínica son las crisis epilépticas. Esta patología, cuya prevalencia había disminuido en España en las décadas previas, va incrementando su importancia debido al aumento de los flujos migratorios desde zonas endémicas y los viajes internacionales. Se presenta un caso clínico reciente para revisar los criterios diagnósticos de este proceso. Caso clínico. Paciente mujer de 47 años, natural de Ecuador, con antecedentes patológicos de hipertensión arterial, que ingresa por crisis tonicoclónica generalizada. La exploración neurológica fue compatible con la normalidad. En las imágenes de la tomografía computarizada (TC) se objetivaron varias lesiones quísticas con escólex en su interior. Se obtuvieron resultados positivos en la serología para Taenia solium en el líquido cefalorraquídeo. La resolución de las lesiones de la TC fue completa tras completar tratamiento cisticida con albendazol. Conclusiones. La neurocisticercosis debe plantearse como diagnóstico en todo paciente adulto con crisis epilépticas que presente las características epidemiológicas indicadas

Introduction. Neurocysticercosis is a disease caused by infection of the central nervous system by the larva of Taenia solium whose main clinical manifestation is epileptic seizures. This disease, whose prevalence had decreased in Spain in previous decades, has been increasing in importance due to the increased migratory flows from endemic zones and international trips. A recent clinical case is presented to review the diagnostic criteria of this condition. Clinical case. 47 year old woman, native of Ecuador, with disease backgrounds of high blood pressure, who was admitted due to generalized tonic-clonic episodes. The neurological examination was consistent with normality. In the computed tomography (CT) scan images, several cystic lesions with scolex inside were observed. Positive results were obtained in the serology for Taenia solium in the cerebrospinal fluid. The CT scan lesion resolution was complete after completing cysticide treatment with albendazole. Conclusions. Neurocysticercosis should be considered as a diagnosis in all adult patients with epileptic seizures who have the epidemiological characteristics indicated

Debut de linfoma Hodgkin con clínica de compresión medular / Spinal involvement as first presentation of Hodgkin´s disease

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[Migraine with pleocytosis: a case of atypical progression]. / Migraña con pleocitosis: un caso de evolucion atipica.

AIMS: Migraine with cerebrospinal fluid pleocytosis is a clinical pattern consisting in intermittent headaches accompanied by episodes of transient neurological deficit and lymphocytic pleocytosis, which last for varying lengths of time and have a spontaneous resolution. We describe the case of migraine with pleocytosis (MP) with atypical progression that responded well to corticoids. CASE REPORT: A 27 year old male with no familial or personal history of migraine who began with bouts of intense headaches that were preceded by neurological deficit (dysphasia and hemiparesis of the right hand side) lasting varying amounts of time (including hours). The serial study of cerebrospinal fluid (CSF) revealed a notable degree of lymphocytosis (400/mm3) with increased intracranial pressure (ICP) (> 30 mmHg). The other explorations that were performed (microbiological study of CSF and blood, humoral and cellular immunity, MR angiography and thyroid hormones, among others) were all normal. The neurological exploration carried out in the following days revealed a mild paresis of the right lateral rectus muscle, which was attributed to the intracranial hypertension and which clearly disabled the patient. As a consequence of the recurrence of the seizures and the long lasting increase in ICP, therapy was begun with 1 mg/kg/day of prednisone, at a descending rate; clinical remission and normalisation of the CSF was achieved within a period of two months. DISCUSSION: We describe this case of MP because of how atypical the progression was (paresis of the right abducent nerve secondary to the increase in ICP) and the possibility of associating corticoids in cases in which the benignity of the entity is in doubt.

Migraña con pleocitosis: un caso de evolución atípica / Migraine with pleocytosis: a case of atypical progression

Introducción. La migraña con pleocitosis (MP) de llíquido cefalorraquídeo (LCR) es un cuadro clínico consistente en cefaleas intermitentes acompañadas de episodios deficitarios neurológicos transitorios y pleocitosis linfocitaria, que se suceden durante un período variable y con resolución espontánea. Presentamos un caso de MP de evolución atípica con buena respuesta a corticoides. Caso clínico. Se trata de un varón de 27 años, sin antecedentes familiares ni personales de migraña, que inicia con episodios de cefalea intensa, precedidos de déficit neurológico (disfasia y hemiparesia derecha) de duración variable (incluso horas). El estudio seriado del LCR reveló una marcada linfocitosis (400/mm3) con incremento de la presión intracraneal (PIC) (más de 30 mmHg). El resto de las exploraciones practicadas (estudio microbiológico de LCR y sangre, inmunidad humoral y celular, angiorresonancia magnética y hormonas tiroideas, entre otras) fueron normales. La exploración neurológica en los días posteriores reveló una leve paresia del recto externo derecho, que se atribuyó a su hipertensión intracraneal y que claramente incapacitó al paciente. Dada la recurrencia de las crisis y la persistente elevación de la PIC, se inicia un tratamiento con prednisona (1 mg/kg/día, en pauta descendente) y se consigue la remisión clínica y la normalización del LCR en el plazo de dos meses. Discusión. Aportamos la descripción de este paciente afectado de MP por la atipicidad de su evolución (paresia del VI par derecho secundaria al aumento de PIC) y la posibilidad de asociar corticoides en aquellos casos en que se cuestione la benignidad de dicha entidad (AU)

Aims. Migraine with cerebrospinal fluid pleocytosis is a clinical pattern consisting in intermittent headaches accompanied by episodes of transient neurological deficit and lymphocytic pleocytosis, which last for varying lengths of time and have a spontaneous resolution. We describe the case of migraine with pleocytosis (MP) with atypical progression that responded well to corticoids. Case report. A 27-year-old male with no familial or personal history of migraine who began with bouts of intense headaches that were preceded by neurological deficit (dysphasia and hemiparesis of the right-hand side) lasting varying amounts of time (including hours). The serial study of cerebrospinal fluid (CSF) revealed a notable degree of lymphocytosis (400/mm3 ) with increased intracranial pressure (ICP) (> 30 mmHg). The other explorations that were performed (microbiological study of CSF and blood, humoral and cellular immunity, MR angiography and thyroid hormones, among others) were all normal. The neurological exploration carried out in the following days revealed a mild paresis of the right lateral rectus muscle, which was attributed to the intracranial hypertension and which clearly disabled the patient. As a consequence of the recurrence of the seizures and the long-lasting increase in ICP, therapy was begun with 1 mg/kg/day of prednisone, at a descending rate; clinical remission and normalisation of the CSF was achieved within a period of two months. Discussion. We describe this case of MP because of how atypical the progression was (paresis of the right abducent nerve secondary to the increase in ICP) and the possibility of associating corticoids in cases in which the benignity of the entity is in doubt (AU)

. Aims. Migraine with cerebrospinal fluid pleocytosis is a clinical pattern consisting in intermittent headaches accompanied by episodes of transient neurological deficit and lymphocytic pleocytosis, which last for varying lengths of time and have a spontaneous resolution. We describe the case of migraine with pleocytosis (MP) with atypical progression that responded well to corticoids. Case report. A 27-year-old male with no familial or personal history of migraine who began with bouts of intense headaches that were preceded by neurological deficit (dysphasia and hemiparesis of the right-hand side) lasting varying amounts of time (including hours). The serial study of cerebrospinal fluid (CSF) revealed a notable degree of lymphocytosis (400/mm3 ) with increased intracranial pressure (ICP) (> 30 mmHg). The other explorations that were performed (microbiological study of CSF and blood, humoral and cellular immunity, MR angiography and thyroid hormones, among others) were all normal. The neurological exploration carried out in the following days revealed a mild paresis of the right lateral rectus muscle, which was attributed to the intracranial hypertension and which clearly disabled the patient. As a consequence of the recurrence of the seizures and the long-lasting increase in ICP, therapy was begun with 1 mg/kg/day of prednisone, at a descending rate; clinical remission and normalisation of the CSF was achieved within a period of two months. Discussion. We describe this case of MP because of how atypical the progression was (paresis of the right abducent nerve secondary to the increase in ICP) and the possibility of associating corticoids in cases in which the benignity of the entity is in doubt (AU)