Meningitis neoplásica en tumores sólidos: revisión actualizada de diagnóstico, pronóstico, manejo terapéutico y direcciones futuras / Neoplastic meningitis in solid tumours: Updated review of diagnosis, prognosis, therapeutic management, and future directions

La meningitis neoplásica (MN) es una complicación metastásica relativamente frecuente en pacientes con cáncer, con alta morbilidad neurológica y en general pobre pronóstico. La prevalencia está en torno al 5-15% de los tumores sólidos, y los más frecuentes son el cáncer de mama, el de pulmón y el melanoma. La clínica se produce por afectación de hemisferios cerebrales, nervios craneales, médula y raíces nerviosas, siendo en muchos casos multifocal, y presenta a menudo síntomas y signos de hipertensión intracraneal. Las principales herramientas diagnósticas son la exploración neurológica, la resonancia magnética cerebral y medular con contraste, y el análisis y la citología del líquido cefalorraquídeo (LCR), aunque recientemente se están investigando técnicas como la detección de células tumorales y ADN circulante en el LCR, que aumentan la sensibilidad diagnóstica. Con las terapias disponibles en la actualidad el objetivo del tratamiento no es curativo, sino retrasar y disminuir los síntomas y preservar la calidad de vida de los pacientes, e implica un enfoque multimodal que puede incluir radioterapia, quimioterapia intratecal y/o sistémica y cirugía. El tratamiento debe ser individualizado y se basa principalmente en guías y opiniones de expertos. Actualmente se están llevando a cabo ensayos clínicos prometedores de fármacos contra dianas moleculares e inmunoterápicos. Este artículo es una revisión actualizada de la MN, e incluye epidemiologia, presentación clínica, diagnóstico, pronóstico, manejo y opciones terapéuticas; se dirige al neurólogo general, y en particular al neurólogo que ejerce su práctica en centros con pacientes oncológicos. (AU)

Neoplastic meningitis (NM) is a relatively frequent metastatic complication of cancer associated with high levels of neurological morbidity and generally poor prognosis. It appears in 5%-15% of patients with solid tumours, the most frequent being breast and lung cancer and melanoma. Symptoms are caused by involvement of the cerebral hemispheres, cranial nerves, spinal cord, and nerve roots, and are often multifocal or present with signs and symptoms of intracranial hypertension. The main diagnostic tools are the neurological examination, brain and spinal cord contrast-enhanced magnetic resonance imaging, and cerebrospinal fluid analysis including cytology, although studies have recently been conducted into the detection of tumour cells and DNA in the cerebrospinal fluid, which increases diagnostic sensitivity. With the currently available therapies, treatment aims not to cure the disease, but to delay and ameliorate the symptoms and to preserve quality of life. Treatment of NM involves a multimodal approach that may include radiotherapy, intrathecal and/or systemic chemotherapy, and surgery. Treatment should be individualised, and is based mainly on clinical practice guidelines and expert opinion. Promising clinical trials are currently being conducted to evaluate drugs with molecular and immunotherapeutic targets. This article is an updated review of NM epidemiology, clinical presentation, diagnosis, prognosis, management, and treatment; it is aimed at general neurologists and particularly at neurologists practicing in hospital settings with oncological patients. (AU)

Neoplastic meningitis in solid tumours: updated review of diagnosis, prognosis, therapeutic management, and future directions.

Neoplastic meningitis (NM) is a relatively frequent metastatic complication of cancer associated with high levels of neurological morbidity and generally poor prognosis. It appears in 5%-15% of patients with solid tumours, the most frequent being breast and lung cancer and melanoma. Symptoms are caused by involvement of the cerebral hemispheres, cranial nerves, spinal cord, and nerve roots, and are often multifocal or present with signs and symptoms of intracranial hypertension. The main diagnostic tools are the neurological examination, brain and spinal cord contrast-enhanced magnetic resonance imaging, and cerebrospinal fluid analysis including cytology, although studies have recently been conducted into the detection of tumour cells and DNA in the cerebrospinal fluid, which increases diagnostic sensitivity. With the currently available therapies, treatment aims not to cure the disease, but to delay and ameliorate the symptoms and to preserve quality of life. Treatment of NM involves a multimodal approach that may include radiotherapy, intrathecal and/or systemic chemotherapy, and surgery. Treatment should be individualised, and is based mainly on clinical practice guidelines and expert opinion. Promising clinical trials are currently being conducted to evaluate drugs with molecular and immunotherapeutic targets. This article is an updated review of NM epidemiology, clinical presentation, diagnosis, prognosis, management, and treatment; it is aimed at general neurologists and particularly at neurologists practicing in hospital settings with oncological patients.

Neoplastic meningitis in solid tumours: Updated review of diagnosis, prognosis, therapeutic management, and future directions. / Meningitis neoplásica en tumores sólidos: revisión actualizada de diagnóstico, pronóstico, manejo terapéutico y direcciones futuras.

Neoplastic meningitis (NM) is a relatively frequent metastatic complication of cancer associated with high levels of neurological morbidity and generally poor prognosis. It appears in 5%-15% of patients with solid tumours, the most frequent being breast and lung cancer and melanoma. Symptoms are caused by involvement of the cerebral hemispheres, cranial nerves, spinal cord, and nerve roots, and are often multifocal or present with signs and symptoms of intracranial hypertension. The main diagnostic tools are the neurological examination, brain and spinal cord contrast-enhanced magnetic resonance imaging, and cerebrospinal fluid analysis including cytology, although studies have recently been conducted into the detection of tumour cells and DNA in the cerebrospinal fluid, which increases diagnostic sensitivity. With the currently available therapies, treatment aims not to cure the disease, but to delay and ameliorate the symptoms and to preserve quality of life. Treatment of NM involves a multimodal approach that may include radiotherapy, intrathecal and/or systemic chemotherapy, and surgery. Treatment should be individualised, and is based mainly on clinical practice guidelines and expert opinion. Promising clinical trials are currently being conducted to evaluate drugs with molecular and immunotherapeutic targets. This article is an updated review of NM epidemiology, clinical presentation, diagnosis, prognosis, management, and treatment; it is aimed at general neurologists and particularly at neurologists practicing in hospital settings with oncological patients.

Breast cancer and leptomeningeal disease (LMD): hormone receptor status influences time to development of LMD and survival from LMD diagnosis.

Leptomeningeal disease (LMD) occurs in 5 % of breast cancer patients. The aim of this study was to identify risk factors related to survival and time to development of LMD in breast cancer patients. A retrospective analysis of breast cancer patients with LMD, evaluated in MDACC between 1995 and 2011. 103 patients with diagnosis of breast cancer and LMD were identified (one male). The median age at LMD diagnosis was 49.2 years. 78.2 % had invasive ductal carcinoma. Hormone receptors (HRs) were positive in 55.3 % of patients, 47.4 % were human epidermal growth factor receptor 2-positive and 22.8 % were triple negative. 52 % of the patients were treated with WBRT, 19 % with spinal radiation, 36 % with systemic chemotherapy and 55 % with intrathecal chemotherapy. Estimated median overall survival from time of breast cancer diagnosis was 3.66 years. Median survival from time of LMD diagnosis was 4.2 months. Time from breast cancer diagnosis to LMD was 2.48 years. In multivariate analysis, HR status and stage at diagnosis were significantly associated with time to LMD diagnosis (p < 0.05). In triple negative patients, time to LMD was shorter. In patients who were HR positive, time to LMD was longer. Survival from LMD diagnosis was significantly associated with both treatment, as well as positive HR status (multivariate analysis p < 0.05). In conclusion LMD has dismal prognosis in breast cancer patients. HR status contributes to time to LMD diagnosis and survival from LMD diagnosis. The impact of treatment aimed at LMD cannot be ascertained in our retrospective study due to the inherent bias associated with the decision to treat.

Infartos cerebrales y carcinomatosis leptomeníngea / No disponible

No disponible

Neuralgia supraorbitaria: una alternativa intervencionista. Réplica / Supraorbital neuralgia: an interventionist alternative. Reply

No disponible

Neuralgia supraorbitaria postraumática: una entidad benigna / Post-traumatic supraorbital neuralgia: a benign condition

Introducción. La neuralgia supraorbitaria es una entidad de reciente descripción. La mayor parte de los pacientes publicados sufre neuralgias idiopáticas, crónicas, de difícil tratamiento, que en ocasiones requieren cirugía de liberación del nervio. Presentamos nuestra experiencia en pacientes con una variante de esta neuralgia de causa conocida, aparición frecuente y pronóstico benigno. Casos clínicos. Estudiamos cinco pacientes, cuatro mujeres y un varón de 55 años de edad media (rango: 29-69 años). Todos sufrieron un traumatismo directo banal sobre la región frontal, de causa diversa. Cuatro desarrollaron un dolor continuo, de tipo pinchazo o quemazón, tres un dolor paroxístico y uno prurito. No hubo manifestaciones autonómicas. Todos presentaron una exploración de la sensibilidad anómala en el territorio afectado, con hipoestesia tactil, hiperalgesia o alodinia y signo de Tinel positivo. Las pruebas de neuroimagen fueron normales. Dos recibieron tratamiento con gabapentina y amitriptilina. Uno fue tratado con un bloqueo anestésico, con una mejoría transitoria. Tres no recibieron tratamiento alguno. Tras un año de seguimiento, todos mejoraron y tres quedaron sin dolor, si bien en todos persistieron alteraciones sensitivas. Conclusiones. La neuralgia supraorbitaria postraumática es una entidad frecuente, aunque probablemente infradiagnosticada. Presenta características clínicas y evolutivas particulares que la diferencian de la neuralgia supraorbitaria idiopática. Suele tener una buena evolución y una respuesta favorable al tratamiento sintomático, si es que llega a requerir alguno

Introduction. Supraorbital neuralgia has only recently been described. Most of the cases reported involve patients suffering from chronic idiopathic neuralgias that are difficult to treat and sometimes require surgery to release the nerve. We present our experience in patients with a variant of this neuralgia which has a known causation, is commonly seen and has a benign prognosis. Case reports. We studied five patients, four females and one male, with a mean age of 55 years (range: 29-69 years). They had all suffered direct banal traumatic injury to the frontal region due to different causes. Four of them developed continuous, piercing or burning-type pain; three of them had paroxysmal pain and one had itching. There were no autonomic manifestations. All of them were found to be abnormally sensitive in the affected area, with tactile hypaesthesia, hyperalgesia or allodynia and a positive Tinel’s sign. Neuroimaging tests were normal. Two patients were treated with gabapentin and amitriptyline. One was treated with an anaesthetic blockade, which afforded temporary relief. Three of them received no treatment at all. After one year of follow-up, all of them had improved and three were no longer in pain, although sensory alterations persisted in all cases. Conclusions. Post-traumatic supraorbital neuralgia is a frequent condition, although it is probably underdiagnosed. It has its own characteristic clinical and developmental features that distinguish it from idiopathic supraorbital neuralgia. Progress is usually good and it responds favourably to symptomatic treatment, if needed

[Post-traumatic supraorbital neuralgia: a benign condition]. / Neuralgia supraorbitaria postraumática: una entidad benigna.

INTRODUCTION: Supraorbital neuralgia has only recently been described. Most of the cases reported involve patients suffering from chronic idiopathic neuralgias that are difficult to treat and sometimes require surgery to release the nerve. We present our experience in patients with a variant of this neuralgia which has a known causation, is commonly seen and has a benign prognosis. CASE REPORTS: We studied five patients, four females and one male, with a mean age of 55 years (range: 29-69 years). They had all suffered direct banal traumatic injury to the frontal region due to different causes. Four of them developed continuous, piercing or burning-type pain; three of them had paroxysmal pain and one had itching. There were no autonomic manifestations. All of them were found to be abnormally sensitive in the affected area, with tactile hypaesthesia, hyperalgesia or allodynia and a positive Tinel's sign. Neuroimaging tests were normal. Two patients were treated with gabapentin and amitriptyline. One was treated with an anaesthetic blockade, which afforded temporary relief. Three of them received no treatment at all. After one year of follow-up, all of them had improved and three were no longer in pain, although sensory alterations persisted in all cases. CONCLUSIONS: Post-traumatic supraorbital neuralgia is a frequent condition, although it is probably underdiagnosed. It has its own characteristic clinical and developmental features that distinguish it from idiopathic supraorbital neuralgia. Progress is usually good and it responds favourably to symptomatic treatment, if needed.

[Spinal epidural abscess in a patient with septicaemia]. / Absceso epidural vertebral en un paciente con septicemia.

INTRODUCTION: Spinal epidural abscess is a rare entity requiring early diagnosis and treatment. Sepsis is a factor with an unfavourable prognosis. CASE REPORT: We report the case of a 57 year old female with acute low back pain who was admitted to hospital suffering from a state of septic shock and multiple organ failure secondary to an infection disseminated by Staphylococcus aureus, which was treated early on with vancomycin. The probable source of infection was assumed to be necrotizing fasciitis of the left arm. Once the acute phase had been overcome, serious paraparesis became apparent and this led to magnetic resonance imaging of the spine being carried out, the results of which showed the existence of a lumbar spondylodiscitis with associated epidural abscess. CONCLUSION: In patients with sepsis and some previous symptom that arouses suspicion, it is important to consider this possible diagnosis, since treatment with antibiotics alone does not manage to prevent neurological complications in all cases.

Hematoma epidural espontáneo de localización espinal / Spontaneous spinal epidural hematoma

No disponible

Absceso epidural vertebral en un paciente con septicemia / Spinal epiural abscess in a patient with septicaemia

Introducción. El absceso epidural espinal es una entidad rara que requiere un diagnóstico y tratamiento precoz. La sepsis es un factor de mal pronóstico. Caso clínico. Mujer de 57 años con una lumbalgia aguda, que ingresó en estado de choque séptico y fracaso multiorgánico secundarios a una infección diseminada por Staphylococcus aureus, que se trató con vancomicina precozmente. Se asumió como probable fuente de infección una fascitis necrotizante del brazo izquierdo. Tras superar la fase aguda, se hizo evidente una paraparesia grave que llevó a la realización de una resonancia magnética dorsolumbar, y se demostró una espondilodiscitis lumbar con absceso epidural asociado. Conclusión. En pacientes con sepsis y algún síntoma de sospecha previo, es importante contemplar esta posibilidad diagnóstica, dado que el tratamiento antibiótico aislado no consigue evitar las complicaciones neurológicas en todos los casos (AU)

[Unilateral isolated paralysis of the soft palate: a case report and a review of the literature]. / Parálisis aislada unilateral del velo del paladar: presentación de un caso y revisión de la literatura.

INTRODUCTION: Unilateral isolated paralysis of the soft palate is a rare clinical entity. CASE REPORT: We describe the case of a 12 year old girl who presented acute dysphagia, a nasal voice and regurgitation of liquids into the nose. Exploration revealed right velopalatine insufficiency with normal gag reflex and pharyngeal sensitivity. All the complementary studies, including magnetic resonance, lumbar puncture and viral serology tests, were normal. There are 28 similar cases in the literature, with the following characteristics: acute onset, appearing in infancy (96%), predominance in males (79%), recent respiratory infection (35%) and an excellent prognosis for recovery (85%). CONCLUSION: This is probably a case of acute cranial mononeuropathy with a viral aetiology

Parálisis aislada unilateral del velo del paladar: presentación de un caso y revisión de la literatura / Unilateral isolated paralysis of the soft palate: a case report and a review of the literature

Caso clínico. Paciente con epilepsia causada por una encefalitis límbica no relacionada con un proceso tumoral. Resultados. A lo largo de la evolución, y de forma subaguda, la paciente mostró crisis parciales y áreas variables de afectación de los lóbulos temporales, no simultáneas, que abocaron a una atrofia de las estructuras límbicas y áreas adyacentes y que dieron lugar a un estado de déficit neuropsicológico permanente, fundamentalmente en la memoria reciente verbal y visual. Tras 6 años de evolución, no se ha podido demostrar la coexistencia con un proceso neoplásico (AU)

Introduction. Unilateral isolated paralysis of the soft palate is a rare clinical entity. Case report. We describe the case of a 12-year-old girl who presented acute dysphagia, a nasal voice and regurgitation of liquids into the nose. Exploration revealed right velopalatine insufficiency with normal gag reflex and pharyngeal sensitivity. All the complementary studies, including magnetic resonance, lumbar puncture and viral serology tests, were normal. There are 28 similar cases in the literature, with the following characteristics: acute onset, appearing in infancy (96%), predominance in males (79%), recent respiratory infection (35%) and an excellent prognosis for recovery (85%). Conclusion. This is probably a case of acute cranial mononeuropathy with a viral aetiology (AU)

[Gradenigo syndrome as the form of presentation of nasopharyngeal carcinoma]. / Síndrome de Gradenigo como forma de presentación de carcinoma nasofaríngeo.

INTRODUCTION: Nasopharyngeal carcinoma is a condition which usually has an insidious onset and non-specific features in the initial stages, so it is difficult to make an early diagnosis. The most usual presenting features are otological (serous otitis media) and involvement of adjacent cranial nerves. We report a case of Gradeningo's syndrome due to the tumour spreading towards the base of the skull. We review the literature on the aetiology of this syndrome. CLINICAL CASE: A 53 year old patient required neurological assessment for a clinical condition which was compatible with Gradenigo's syndrome that involved both right V and VI cranial nerves. This study permitted diagnosis of a nasopharyngeal carcinoma which had been undetected because of its non-specific features, until this complication occurred. Otorhinolaryngological assessment proved the presence of a neoplasm in the cavum. Biopsy of the lesion showed it to be a well-differentiated squamous cell carcinoma. Cranial magnetic resonance imaging showed extension of the tumour to the base of the skull, adjacent to the right sinus cavernosus. The cerebrospinal fluid was normal. Treatment by radiotherapy was indicated. CONCLUSIONS: Diagnosis of nasopharyngeal carcinoma requires a high index of suspicion in view of its initial, sparse, non-specific symptoms. Although ideally the disease should be detected in its early stages, we believe that it is useful to recommend that in cases of Gradenigo's syndrome a full systematic otorhinolaryngological exploration be made so as to effectively rule out this disorder.