Spinal myoclonus: successful treatment with the combination of sodium valproate and L-5-hydroxytryptophan.

We describe a 37-year-old man with spinal segmental myoclonus characterized by symmetric, rhythmic contractions of the abdomen with a frequency ranging between 100 and 150/min. The combination of sodium valproate and L-5-hydroxytryptophan was useful to control the myoclonus. We comment on the possible role of the serotonergic system in this syndrome.

[Thromboangiitis obliterans associated with small-vessel vasculitis]. / Tromboangiitis obliterante asociada a vasculitis de pequeños vasos.

The existence of thromboangiitis obliterans has been questioned for some years. However, it is now accepted as a specific condition within the wide group of vasculitis. We report a patient with this condition, who, as usual, was a male smoker. The illness presented with thrombophlebitis migrans, which is an uncommon initial feature. The patient also had small vessel cutaneous vasculitis, which is an extremely uncommon association. We report the case and discuss some aspects of the etiology and pathogenesis of the disease.

[Etiology of late-onset epilepsy. A prospective study in an area of rural health care]. / Etiología de la epilepsia de comienzo tardío. Estudio prospectivo en un área de salud rural.

A prospective study of 3 years' duration on the etiology of late onset epilepsy was carried out in a rural health area with a population of 135,000. Eighty patients were included. History, neurological physical examination, electroencephalogram, cranial computed tomographic scan (CT) and general laboratory investigations were carried out. The cause of epilepsy was unknown in 51.3% of cases. The most commonly identified causes were cerebrovascular disease (20%), chronic alcohol abuse (10%), tumors of central nervous system (6.3%), neurocysticercosis (6.3%) and post-traumatic epilepsy (2.5%). Our data are compared with those from the previous literature, and the value of cranial CT in the investigation of this clinical condition is discussed.

[Parkinson's disease and epilepsy]. / Maladie de Parkinson et épilepsie.

We report the case of a woman suffering from complex partial seizures who developed Parkinson's disease at the age of 58. Parkinsonian symptoms improved transitorily after complex partial seizures. Although this has been reported after generalized seizures, this case is, to our knowledge, the first description of improvement of parkinsonian symptoms following a complex partial seizure.

[Chylothorax as presenting form of a gastric adenocarcinoma]. / Quilotórax como forma de presentación de un adenocarcinoma gástrico.

Malignancies other than lymphoma can in rare instances induce the development of chylothorax. A patient with this unusual type of pleural effusion is described herein. The need to rule out a gastric neoplasm when confronted with a case of chylothorax with no obvious cause is stressed.

"Premorbid" personality of patients with Parkinson's disease.

To elucidate the possible existence of a so called "premorbid parkinsonian personality" we studied 33 patients with Parkinson's disease (PD) and 66 controls who did not differ in age, sex, geographic origin, and cultural level, with the Spanish version of the Minnesota Multiphasic Personality Inventory (MMPI). Females of the PD group obtained significantly higher scores than females of the control group for the scales of hypochondria (p less than 0.01), depression (p less than 0.01), hysteria (p less than 0.05), and social introversion (p less than 0.01). The scores of the males with PD in all of the clinical scales of MMPI did not differ significantly from those of the male controls. These results, despite the difficulty of interpretation of a test done in a retrospective way, would agree with the hypothesis previously suggested of the possible existence of a "premorbid" parkinsonian personality, at least in females.

Blepharospasm associated with neurocysticercosis.

We report a case of a 48-year-old woman who had a 4 years history of bilateral blepharospasm. CT-scan showed multiple intracranial calcifications (two of them in the left thalamus) corresponding to neurocysticerosis, and a lacunar infarction in right internal capsule area. To our knowledge this case is the first one reported in the literature of blepharospasm associated with (and perhaps symptomatic of?) neurocysticercosis.

[Brucellosis: a clinico-serological study in a rural health area]. / Brucelosis: estudio clinicoserológico en un área de salud rural.

UNLABELLED: We analyze retrospectively 132 cases of brucellosis evaluating the performance of diagnostic procedures, complications and serological and clinical evolution. We compare the 74 patients treated with streptomycin plus tetracycline versus the 41 patients treated with doxycycline plus rifampicin. The more outstanding results we find: a) Great sensibility of the rose bengal test; b) Higher relapse rate in the more severe cases (p less than 0.01); c) Good evolution with scarce relapse rate in both treatment groups; agglutination titers were lower at one year in the group treated with doxycycline plus rifampicin (p less than 0.05). CONCLUSIONS: Both treatments showed good efficacy, controlled studies would be needed to determine the most adequate one.

Neurobrucellosis mimicking migraine.

Central nervous system involvement in systemic brucellosis is not frequent. Neurobrucellosis may involve several areas of the central nervous system and may be the cause of several clinical pictures. We report a case of brucellar meningitis that was clinically indistinguishable from a migrainous syndrome. The diagnosis of brucellar meningitis was confirmed by the isolation of Brucella sp. in the cerebrospinal fluid.

Manejo del paciente diabético hospitalizado / Management of diabetes hospitalized patients

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