[Benign paroxysmal positional vertigo: provocation and freeing manoeuvres]. / Vértigo posicional paroxístico benigno: maniobras de provocación y liberación.

The benign paroxystic positional vertigo (BPPV) is defined by brief episodic vertigo attacks and accompanied by a rotary-linear nystagmus, triggered by head position changes and is always produced in that position. The theory that better explains the BPPV is canalithiasis: free-floating particles leave the utricular macula and enter one of the semicircular canals, producing an endolymphatic movement that stimulates the cupula and produces vertigo and nystagmus. The diagnosis is based on a typical clinical history, normal ear and neurological examination and provocation maneuvers, such as the Dix-Hallpike test, reproduce the vertigo attacks. The treatments are the liberatory maneuvers, such as the Epley maneuver which makes the vertigo disappear. We present two cases of vertigo with a compatible clinic history of BPPV, where the Dix-Hallpike maneuver confirmed the diagnosis. The treatment in both cases was the Epley maneuver.

[Priapism: diagnosis and treatment]. / Priapismo: diagnóstico y tratamiento.

Priapism, prolonged and painful erection, is an exceptional cause of consultation in the pediatric population. High- and low-flow priapism and recurrent prolonged erection must be differentiated, as the prognosis and treatment of these entities differ. Assessment of patients with priapism begins with a detailed history, physical examination, and complete blood cell count. The definitive diagnosis is given by penile Doppler ultrasonography, corpora cavernosa blood gas analysis, and pelvic arteriography. We present two patients who attended our emergency service in the last year and propose an algorithm for the diagnosis and treatment of this entity.

[Response to high dose corticosteroids in a girl with bilateral optic neuritis]. / Respuesta a altas dosis de corticosteroides en una niña con neuritis óptica bilateral.

INTRODUCTION: Optic neuritis is rare in childhood. Frequently (35-52% of all cases depending on the series) they have, during their clinical course, foci of demyelination leading to the clinical picture of multiple sclerosis (MS). Since 1993, the optic neuritis study group has recommended treatment with high doses of corticosteroids, since this seemed to stop progression, improve long-term results and delay the appearance of MS. The course of our patient was better than we expected. CLINICAL CASE: A 10 year old prepubertal girl complained of progressive loss of vision and slight pain in the right eye for 26 days before admission to hospital. On examination there was obvious papillitis of the right ocular fundus with total loss of the pupillary light reflex, together with consensual hyporeflexia of the left eye. Study of the visual evoked potentials (VEP) showed that there was marked delay of the P-100 wave, and a lower amplitude in the right eye. Magnetic resonance imaging did not show any demyelinated focus. Serological testing for neurotropic viruses was negative. CONCLUSIONS: After the initial phase of intravenous treatment (third day) there was subjective recovery of vision and the pupillary light reflex returned. VEP studies showed marked recovery. Thirty days after treatment was started there was almost complete subjective and VEP recovery. This rapid progress, as compared to that of other paediatric cases published, suggests a mechanism involving decompression of the optic nerve.

Vértigo posicional paroxístico benigno: maniobras de provocación y liberación / Benign paroxysmal positional vertigo: provocation and freeing manoeuvres

El vértigo posicional paroxístico benigno (VPPB) se define como la aparición de episodios bruscos de vértigo de breve duración, provocados por cambios de posición, acompañados de nistagmo y que se reproducen al adoptar la posición desencadenante. La teoría fisiopatológica que mejor explica las características clínicas y del nistagmo en las maniobras de provocación del VPPB es la canalitiasis: partículas otolíticas desprendidas de la mácula del utrículo penetrarían en el interior de un conducto semicircular; su desplazamiento al realizar determinados movimientos en el plano de ese conducto produce una corriente endolinfática que estimularía la cúpula originando la aparición de vértigo y nistagmo. El diagnóstico se basa en una historia clínica típica, una exploración otoneurológica normal y una reproducción de la crisis con las maniobras de provocación. El tratamiento a través de las maniobras de reposición permite la resolución del cuadro de forma rápida y sencilla. Presentamos dos casos de mareo vistos en nuestro servicio de urgencias. La sospecha clínica y la realización de la maniobra de Dix-Hallpike confirmaron el diagnóstico de VPPB. La maniobra de Epley resolvió el cuadro de manera rápida y definitiva

The benign paroxystic positional vertigo (BPPV) is defined by brief episodic vertigo attacks and accompanied by a rotary-linear nystagmus, triggered by head position changes and is always produced in that position. The theory that better explains the BPPV is canalithiasis: free-floating particles leave the utricular macula and enter one of the semicircular canals, producing an endolymphatic movement that stimulates the cupula and produces vertigo and nystagmus. The diagnosis is based on a typical clinical history, normal ear and neurological examination and provocation maneuvers, such as the Dix-Hallpike test, reproduce the vertigo attacks. The treatments are the liberatory maneuvers, such as the Epley maneuver which makes the vertigo disappear. We present two cases of vertigo with a compatible clinic history of BPPV, where the Dix-Hallpike maneuver confirmed the diagnosis. The treatment in both cases was the Epley maneuver

Forma atípica de enfermedad por arañazo de gato en escolar inmunocompetente / Atypical cat scratch disease in an immunocompetent school-aged child

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Priapismo: diagnóstico y tratamiento / Priapism: Diagnosis and treatment

El priapismo, erección prolongada y dolorosa, es un motivo excepcional de consulta pediátrica. La distinción entre el priapismo de alto y bajo flujo, así como la diferenciación de la erección prolongada recurrente, es esencial por su diferente tratamiento y pronóstico. La historia clínica, la exploración y el hemograma son el primer escalón diagnóstico. El eco-Doppler peneano, la gasometría de cuerpos cavernosos y la arteriografía de ilíacas permiten el diagnóstico definitivo. Presentamos 2 casos vistos en nuestra urgencia en el último año y realizamos una revisión de la literatura especializada estableciendo un algoritmo de diagnóstico y tratamiento

Priapism, prolonged and painful erection, is an exceptional cause of consultation in the pediatric population. High- and low-flow priapism and recurrent prolonged erection must be differentiated, as the prognosis and treatment of these entities differ. Assessment of patients with priapism begins with a detailed history, physical examination, and complete blood cell count. The definitive diagnosis is given by penile Doppler ultrasonography, corpora cavernosa blood gas analysis, and pelvic arteriography. We present two patients who attended our emergency service in the last year and propose an algorithm for the diagnosis and treatment of this entity