[Specific markers of myocardial injury in acute stroke]. / Determinacion de marcadores específicos de lesión miocárdica en la enfermedad cerebrovascular aguda.

INTRODUCTION: It is thought that any acute damage to the central nervous system and, more particularly, acute cerebrovascular disease (ACVD) can give rise to a myocardial lesion. Our aim is to apply the latest biochemical markers (troponin T, troponin I and myoglobin) to the study of this problem. PATIENTS AND METHODS: We conducted a retrospective study of 42 patients who were consecutively admitted to hospital with ACVD. The pathological antecedents and the clinical and electrocardiographic variables were considered in each case. A single determination of CK, CK MB, myoglobin, troponin T and troponin I was performed for each patient. RESULTS: The determination of the new biochemical markers was positive in a higher number of cases than CK and its MB fraction, or electrocardiographic alterations. This positivity, together with the troponin T and troponin I values correlate with mortality. CONCLUSIONS: We present the first research work to be published in Spanish that studies the new biochemical markers of myocardial damage in ACVD. We urge researchers to carry out further analyses on more extensive series in order to determine the influence myocardial damage has on mortality and to establish suitable therapeutic measures. This will also allow us to find out whether a certain location or size of the lesion can give rise to a higher predisposition to this kind of damage

[Carotidynia as a form of presentation of paraxysmal hemicrania]. / Carotidinia como forma de presentación de la hemicránea paroxística.

INTRODUCTION: Paroxysmal hemicrania is a well-defined clinical condition about which many articles have been published. Attempts have been made to explain the response of this illness to indomethacin, suggesting its possible cervical origin. In some patients it is set off by stimulation of certain trigger zones situated in this region. The exceptional radiation of the pain seen in our patient clearly supports this theory. CLINICAL CASE: A 34 year old man with a past history of a similar but briefer episode 5 years previously presented to us. He complained of repeated episodes of stabbing pain with no obvious cause. The pain started at the base of the neck and radiated along the right carotid vessels to the cheek, base of the nose and ipsilateral eye. This was accompanied by injection of the conjunctivae, tears, nasal congestion and nasal discharge. Each episode lasted 15 to 30 minutes and was repeated 20 to 25 times a day without any particular relation to the time of day. The neurological examination, MR and angio-MR were normal. Before being seen by us he had been treated with prednisone and verpamil without effect. Indomethacin at a dose of 100 mg/day controlled the problem completely. CONCLUSIONS: We report a case of paroxysmal hemicrania with a spontaneous description of pain starting at the base of the neck and radiating along the carotid vessels. We consider this clinical description to be of interest since it supports the theories of a cervicogenic origin of this type of headache.

[Isolated trigeminal neuropathy associated with a fatty tumor of Meckel's cavum]. / Neuropatía aislada del nervio trigémino asociada a tumor graso en el cavum de Meckel.

INTRODUCTION: In recent years there has been increasing interest in isolated trigeminal sensory neuropathy. We present a case with an unusual association of this neuropathy and a fatty tumour of Meckel's cavum. CLINICAL CASE: A 24 year old man consulted for occasional episodes (during the previous two months) of dysesthesia of the right maxillary region. These were self-limiting and lasted only a few minutes. There was no lacrimation, apparent trigger factor, conjunctival injection or reduction in level of consciousness. There were no abnormal findings either on general or on full neurological examination. On cranial CT there was no signal from the tip of the right petrous temporal bone, but no space-occupying lesion nor pathological uptake of contrast material. On cranial MR there was an extra-axial lesion in the superior part of the tip of the right petrous temporal bone of 2 x 2 cm, localized to Meckel's cavum and right cavernous sinus, with a small lobule in the right lateral part of the prepontine cisterna. CONCLUSIONS: Trigeminal sensory neuropathy has been described in association with different connective tissue disorders, infections of the central nervous system, vascular dilatations and very varied types of tumours, particularly meningioma. The commonest site for lesions related to this clinical condition is the posterior fossa. A tumour in Meckel's cavum is rarely found in relation to this diagnosis, and from our review of the literature, involvement of fatty tumours seems to be rare.