Tuberculosis meningovascular: descripción de un caso con presentación atípica / Meningovascular tuberculosis: case study of an atypical presentation

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Hemorragia intracerebral recurrente en amiloidosis primaria / Recurrent intracereberal haemorrhage in primary amyloidosis

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Epicrania fugax: características clínicas de una serie de 18 pacientes / Epicrania fugax: the clinical characteristics of a series of 18 patients

Introducción. La epicrania fugax es una entidad de reciente descripción, consistente en breves paroxismos dolorosos iniciados en regiones cefálicas posteriores, con irradiación hacia ojo, nariz o sien ipsilaterales. Objetivo. Presentar 18 casos de epicrania fugax de una consulta monográfica de cefaleas de un hospital terciario y analizar sus características demográficas y clínicas, así como la indicación y respuesta al tratamiento profiláctico. Pacientes y métodos. Entre marzo de 2008, momento en el que se describe la epicrania fugax y marzo de 2011, 18 pacientes (12 mujeres y 6 hombres), de entre 1.210 atendidos en dicha consulta (1,48%), recibieron dicho diagnóstico. Seis de estos casos se habían publicado con anterioridad. Resultados. Edad media al inicio de 42,5 ± 17,7 años (rango: 23-82 años). Presentaban paroxismos dolorosos iniciados en la región occipital (n = 11; 61,1%), parietal (n = 6; 33,3%) o parietooccipital (n = 1; 5,6%), e irradiados hacia el ojo (n = 12; 66,6%) o la sien (n = 6; 33,3%) ipsilaterales; todo el proceso duraba menos de 15 segundos. La mayoría describía su dolor como lancinante o punzante. En 10 casos (55,5%) persistía un dolor en la zona de origen de los paroxismos, que en 6 (33,3%) estaba circunscrito a una zona circular bien delimitada y reunía criterios de cefalea numular. En 12 casos (66,6%) se utilizó tratamiento profiláctico, sobre todo lamotrigina y gabapentina con respuesta variable. Conclusión. Pretendemos reforzar la propuesta de la epicrania fugax como un nuevo síndrome con un espectro clínico bien caracterizado. No parece una entidad excepcional, y su conocimiento dará lugar probablemente a la descripción de nuevas series. Con frecuencia es necesario tratamiento y, aunque se requiere mayor experiencia, la gabapentina y la lamotrigina tienen un papel prometedor (AU)

Introduction. Epicrania fugax is a recently reported condition consisting in brief painful paroxysms that begin in the posterior regions of the brain and irradiate towards the ipsilateral eye, nose or temple. Aims. To present 18 cases of epicrania fugax from a monographic headache centre in a tertiary hospital and to analyse their demographic and clinical features, as well as the indication and response to prophylactic treatment. Patients and methods. Between March 2008, when epicrania fugax was first reported, and March 2011, of a total of 1210 patients who were attended in that service (1.48%), 18 (12 females and 6 males) were diagnosed as suffering from this condition. Six of these cases had been published earlier. Results. The mean age at onset was 42.5 ± 17.7 years (range: 23-82 years). They presented painful paroxysms that began in the occipital (n = 11; 61.1%), parietal (n = 6; 33.3%) or parieto-occipital (n = 1; 5.6%) regions and irradiated towards the ipsilateral eye (n = 12; 66.6%) or temple (n = 6; 33.3%); the whole process lasted less than 15 seconds. Most of them described the pain as lancinating or stabbing. In 10 cases (55.5%) a pain remained in the area where the paroxysms began, which in 6 cases (33.3%) was limited to a well-defined circular area and met the criteria for classification as nummular headache. In 12 cases (66.6%), prophylactic treatment was used, above all lamotrigine and gabapentin, with varying results. Conclusion. Our aim is to back the proposal of epicrania fugax as a new syndrome with a well-defined clinical spectrum. It does not appear to be an exceptional condition and further knowledge about it will probably give rise to the description of new series. Treatment is often necessary and, although further information and experience are needed, gabapentin and lamotrigine both play a promising role (AU)

[Nummular headache: clinical features and therapeutic experience in a series of 30 new cases]. / Cefalea numular: caracteristicas clinicas y experiencia terapeutica en una serie de 30 nuevos casos.

INTRODUCTION: Nummular headache (NH) is a mild or moderate pain, located in a small, well circumscribed, rounded or elliptical area. Temporal pattern is variable and pain exacerbations have been described. AIM. To analyze clinical characteristics and therapy requirement and response in a series of patients attended due to NH in a headache outpatient office. PATIENTS AND METHODS: 30 patients (18 females, 12 males) diagnosed as NH. We considered demographic and nosological characteristics, temporal pattern, presence and intensity of exacerbations, and requirement of symptomatic or preventive therapies. RESULTS: Age at onset 49.2 ± 18.1 years (range: 21-79 years). Two of the patients presented a bifocal NH and we analyzed 32 areas, 28 rounded and 4 elliptical. Diameter: 4.7 ± 1.1 cm. Regarding locations occipital (10 areas, 31.3%), parietal (9 areas, 28.1%) and frontal (6 areas, 18.8%). Pain intensity of 5.2 ± 1.8 on a ten-point visual analogical scale. Regarding temporal profile, in 18 areas (56.3%) was chronic, in 5 (15.6%) episodic and undefined due to a scarce time from onset in 9 (28.1%). In 16 areas (50%) pain exacerbations lasting from 3 seconds to 15 minutes occurred. Nine (30%) patients did not improve with symptomatic drugs, and at least one preventative was prescribed in 23 (76.6%) patients without consistent effectiveness. CONCLUSIONS: NH is not an uncommon diagnosis in an outpatient headache office. In our series, basal pain intensity is moderate and symptomatic drugs commonly provide no relief. So, patients frequently need a preventive therapy.

Encefalitis por anticuerpos contra el receptor NMDA. Descripción de una paciente sin tumor asociado y revisión de la bibliografía / Encephalitis due to antibodies against the NMDA receptor. A case report of a female patient with no associated tumour and a literature review

Introducción. Recientemente se ha descrito una forma grave de encefalitis aguda asociada a anticuerpos contra el receptor N-metil-D-aspartato (NMDA). Este cuadro ocurre en jóvenes, no siempre con un tumor subyacente y, pese a la gravedad inicial, su identificación y tratamiento precoz pueden llevar a recuperaciones sin secuelas. Presentamos un nuevo caso y revisamos los conocimientos disponibles acerca de esta nueva entidad. Caso clínico. Mujer de 22 años de edad que acudió a nuestro centro como consecuencia de un trastorno progresivo del comportamiento. Durante los días siguientes, un deterioro del nivel de conciencia hizo necesario el soporte respiratorio. Una resonancia magnética craneal mostró lesiones hiperintensas principalmente en regiones temporales profundas. El estudio de líquido cefalorraquídeo reveló pleocitosis con predominio linfocitario y anticuerpos contra el receptor NMDA. En el estudio complementario no se apreció tumor subyacente. El tratamiento con corticoesteroides e inmunoglobulinas dio lugar a una lenta pero continua mejoría. Al cabo de un año de seguimiento no ha presentado recidivas, no ha aparecido tumor alguno y la paciente se ha reintegrado a sus actividades habituales. Incluso una atrofia temporal llamativa desarrollada al inicio del cuadro se ha ido resolviendo en estudios de neuroimagen de control. Conclusión. La encefalitis por anticuerpos anti-NMDA es una enfermedad recientemente caracterizada, pero, de acuerdo con los datos disponibles hasta la fecha, relativamente frecuente. Clínicamente bien definida, la sospecha de esta entidad hará posible un diagnóstico definitivo y la instauración de un tratamiento precoz (AU)

Introduction. A severe form of acute encephalitis associated to antibodies against the N-methyl D-aspartate (NMDA) receptor has recently been reported. This clinical picture occurs in young people, not always with an underlying tumour and, despite the initial severity, if identified and treated at an early stage, complete recovery without any kind of sequelae can be achieved. We report on a new case and review the body of knowledge currently available on this recently identified condition. Case report. A 22-year-old female who visited our centre due to a progressive conduct disorder. Over the days that followed, deterioration in the level of consciousness made it necessary to put her on assisted respiration. Magnetic resonance imaging of the head showed hyperintense lesions mainly in deep temporal regions. A study of the cerebrospinal fluid revealed pleocytosis with a predominance of lymphocytes and antibodies against the NMDA receptor. In the complementary study no underlying tumour was observed. Treatment with corticosteroids and immunoglobulins brought about a slow but steady improvement. After a one-year follow-up there have been no recurrences, no tumours have appeared and the patient has gone back to her usual day-to-day activities. Even a significant temporal atrophy that developed at the beginning of the clinical picture has gradually been seen to resolve itself in neuroimaging studies performed as a control measure. Conclusion. Encephalitis due to anti-NMDA antibodies is a disease that has only recently been characterised, but which, according to currently available data, is relatively frequent. Clinically well defined, suspicion of this condition will make it possible to reach a definitive diagnosis and to establish early treatment (AU)

[Other non-motor disorders in Parkinson's disease]. / Otros trastornos no motores en la enfermedad de Parkinson.

INTRODUCTION: In addition to the classic triad (tremor, rigidity and akinesia), Parkinson's disease (PD) is also accompanied by several non-motor disorders. AIM: To carry out an updated review of these non-motor symptoms in terms of their pathophysiology, epidemiology, clinical features and treatment. DEVELOPMENT: Autonomic disorders such as seborrhoeic dermatitis and disorders involving sweating, fatigue, weight loss or respiratory problems (dyspnea, inspiratory stridor) are highly prevalent and very disabling symptoms. In addition, they may be the main problem in a particular phase of PD (fatigue, stridor) and condition the quality of life of patients with Parkinson. They are often neglected and remain undetected. Although they may respond to dopaminergic agents, they usually require a different therapeutic approach. Studies are needed to evaluate new therapeutic perspectives that act against the pathophysiological mechanisms of these disorders. CONCLUSIONS: PD affects systems other than the dopaminergic nigrostriatal. A better understanding of this pathology will make it possible to approach and optimise the treatment of the conditioning symptoms, thereby enhancing the welfare of patients with PD.

Neuralgia del nervio intermediario y parálisis facial con o sin herpes / Neuralgia of the intermediate nerve and facial palsy with or without herpes

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Alteración de la mirada vertical y retracción palpebral como únicos síntomas de infarto en el territorio de la comisura posterior / Paralysis of upward gaze and eyelid retraction as isolated symptoms of posterior commissure infarction

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Sexsomnia: descripción de un nuevo caso / Sexsomnia: a new case description

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