[Fundoscopy in the smartphone era. Current devices and comments on our brief experience]. / La oftalmoscopia en la era del teléfono inteligente. Dispositivos actuales y comentarios sobre nuestra breve experiencia.

TITLE: La oftalmoscopia en la era del teléfono inteligente. Dispositivos actuales y comentarios sobre nuestra breve experiencia.

[Minor stroke in a patient with thrombocytopenia]. / Ictus menor en una paciente con trombocitopenia.

TITLE: Ictus menor en una paciente con trombocitopenia.

[Stiff-person syndrome: a case report]. / Síndrome de la persona rígida: a propósito de un caso.

INTRODUCTION: Stiff-person (stiff-man) syndrome is characterised by symptoms of muscular rigidity and spasms, which are generally of an axial nature. Involuntary contractions of the agonist and antagonist muscles caused by activity of the motor units during rest are the main clinical and electrophysiological marker of the disease. The nature of the syndrome is considered to be autoimmune, with positive glutamic acid decarboxylase (anti-GAD) antibodies in most patients. These antibodies exert an influence over GABAergic transmission. CASE REPORT: A 29-year-old female who was admitted to hospital with a diagnosis of psychogenic mutism. While in hospital the patient developed a clinical picture consisting in generalised stiffness that was predominantly axial and proximal with hyperreflexia in the four limbs and strong contraction of the muscles of the abdomen. The most striking lab finding was the presence of anti-GAD, anti-parietal cells, anti-microsomal/TPO and antithyroglobulin antibodies, together with oligoclonal immunoglobulin G bands in the cerebrospinal fluid. Treatment was established with benzodiazepines, antispastic agents and corticosteroids, and the clinical symptoms progressively improved until they had partially remitted at two months. The lab findings and clinical features are compatible with stiff-person syndrome in a patient with associated psychiatric comorbidity. CONCLUSIONS: Anti-GAD antibodies are not exclusive to stiff-person syndrome and can also be found in a number of other autoimmune disorders. Other mechanisms which can also produce a dysfunction of the GABAergic system have also been suggested. The syndrome can be difficult to diagnose from the clinical point of view and it must therefore be borne in mind in patients who begin with unexplainable stiffness and spasms because it is a potentially treatable pathology.

Síndrome de la persona rígida: a propósito de un caso / Stiff-person syndrome: A case report

Introducción. El síndrome de la persona rígida (stiff-man) se caracteriza por un cuadro de rigidez muscular y espasmos, generalmente de carácter axial. Las contracciones involuntarias de los músculos agonistas y antagonistas causadas por la actividad de las unidades motoras durante el reposo son el principal marcador clínico y electrofisiológico de la enfermedad. La naturaleza del síndrome se considera autoinmune, con anticuerpos antidecarboxilasa glutámica ácida (anti-GAD)positivos en la mayoría de los pacientes. Estos anticuerpos influyen en la transmisión gabérgica. Caso clínico. Mujer de 29 años que ingresó con el diagnóstico de mutismo psicógeno. Durante su ingreso desarrolló un cuadro que consistía en una rigidez generalizada de predominio axial y proximal con hiperreflexia en las cuatro extremidades y una importante contracción de la musculatura abdominal. En los estudios analíticos destacó la presencia de anticuerpos anti-GAD, anticélulas parietales, antimicrosomales TPO y antitiroglobulina, junto con la presencia de bandas oligoclonales de inmunoglobulina G en el líquido cefalorraquídeo. Se instauró un tratamiento con benzodiacepinas, antiespásticos y corticosteroides, con una mejoría progresiva del cuadro, hasta remitir parcialmente a los dos meses. Los hallazgos de laboratorio y el cuadro clínico son compatibles con un síndrome de la persona rígida en una paciente con comorbilidad psiquiátrica asociada. Conclusiones. Los anticuerpos anti-GAD no son exclusivos del síndrome de la persona rígida y también se pueden encontrar en numerosos trastornos autoinmunes. También se han postulado otros mecanismos por los cuales se produce una disfunción del sistema gabérgico.El síndrome puede ser de difícil diagnóstico desde el punto de vista clínico, por lo que debemos tenerlo presente en pacientes que comiencen con rigidez y espasmos inexplicables, dado que se trata de una patología potencialmente tratable

Introduction. Stiff-person (stiff-man) syndrome is characterised by symptoms of muscular rigidity and spasms, which are generally of an axial nature. Involuntary contractions of the agonist and antagonist muscles caused by activity of the motor units during rest are the main clinical and electrophysiological marker of the disease. The nature of the syndrome isconsidered to be autoimmune, with positive glutamic acid decarboxylase (anti-GAD) antibodies in most patients. These antibodies exert an influence over GABAergic transmission. Case report. A 29-year-old female who was admitted to hospital with a diagnosis of psychogenic mutism. While in hospital the patient developed a clinical picture consisting in generalised stiffness that was predominantly axial and proximal with hyperreflexia in the four limbs and strong contraction of the musclesof the abdomen. The most striking lab finding was the presence of anti-GAD, anti-parietal cells, anti-microsomal/TPO and antithyroglobulin antibodies, together with oligoclonal immunoglobulin G bands in the cerebrospinal fluid. Treatment was established with benzodiazepines, antispastic agents and corticosteroids, and the clinical symptoms progressively improveduntil they had partially remitted at two months. The lab findings and clinical features are compatible with stiff-person syndrome in a patient with associated psychiatric comorbidity. Conclusions. Anti-GAD antibodies are not exclusive to stiffperson syndrome and can also be found in a number of other autoimmune disorders. Other mechanisms which can also produce a dysfunction of the GABAergic system have also been suggested. The syndrome can be difficult to diagnose from the clinical point of view and it must therefore be borne in mind in patients who begin with unexplainable stiffness and spasms because it is a potentially treatable pathology