[Prophylaxis of chronic daily headache with a simplified regimen of subcutaneous administration of botulinum toxin type A]. / Profilaxis de la cefalea crónica diaria con una pauta simplificada de administración subcutánea de toxina botulínica tipo A.

INTRODUCTION: Primary headaches are one of the most prevalent conditions in neurology. Botulinum toxin type A (TBA) has been used for years as a prophylactic measure for chronic daily headache (CDH) with varying infiltration regimens and outcomes. AIM: To demonstrate the speed, convenience and safety of a subcutaneous regimen of TBA as a prophylactic for CDH, and also to determine how effective it is as a preventive therapy. PATIENTS AND METHODS: A total of 843 patients were infiltrated subcutaneously with 100 U of TBA (Botox) using a 'fixed dose-fixed site' technique in six pericranial points in periods of at least three months. We evaluated the reduction in the mean frequency of crises and days with headaches and the intake of analgesics, as well as the percentage of patients with a reduction of over 50% in the mean frequency of headache crises. RESULTS: Subcutaneous infiltration of TBA brought about a reduction of 78.91+/-6.81% in the frequency of monthly crises (p<0.001) and a reduction of 62.38+/-12.8% in the number of days per month with headache after three months' infiltration. Reports from patients indicated that 92.8% of them had reduced the number of days with headache per month by at least 50%. Mean frequency and total intake of analgesics decreased from 21.48+/-2.47 to 1.96+/-1.27 (p<0.001) and from 126.01+/-24.7 to 6.65+/-2.27 doses, respectively. There were few side effects, none of which were severe. CONCLUSION: Simplified subcutaneous infiltration of TBA is very effective, convenient, fast and safe as a means of preventing CDH.

[Monomelic segmental amyotrophy: a Spanish case involving the leg]. / Amyotrophie spinale partielle monomélique. Un cas espagnol affectant un membre inférieur.

A 65-year old male presented with selective amyotrophy of the right lower limb which, after a progressive course of some months, had stabilized 12 years previously. Physical examination showed amyotrophy involving the gastrocnemius and the quadriceps extensor femoris without sensory impairment. EMG suggested motor neuron disease. This case meets Hirayama and Serratrice's criteria for benign chronic monomelic amyotrophy. We support the hypothesis of a casual vascular factor, as proposed by Hirayama.

[The examination of men's wits by Juan Huarte de San Juan, and the dawn of the neurobiology of intelligence in the Spanish renaissance]. / Examen de ingenios, de Juan Huarte de San Juan, y los albores de la Neurobiología de la inteligencia en el Renacimiento español.

INTRODUCTION: The Spanish renaissance doctor Juan Huarte de San Juan (1529-1588) was the author of a unique and immortal work, The Examination of Men's Wits, the edition princeps of which was printed in Baeza in 1575. Since then it has been reprinted at least 80 times and translated into seven languages, which makes it the most influential Spanish contribution to medicine ever published. DEVELOPMENT: In this paper we review the unjustly little-known figure of Huarte as the founder of Neuropsychology, and we also analyse his works from a historical and neuroscientific point of view. Huarte's writings deal with the problem of the organic relations between the brain and understanding, and accept the possible influences exerted by temper on the will within the field of the Neurobiology of Intelligence. Thus, over four centuries ago Huarte became the founder of Differential or Physiological Psychology, Neuropsychology, Eugenics and Career Guidance. CONCLUSIONS: Huarte's work not only played a fundamental role in the history and development of the body of neuroscientific knowledge, but has also been a clear (although not always cited) influence on scientists, philosophers and men of letters such as Alarcón, Bacon, Cabanis, Cervantes (whose Don Quixote was inspired by him), Charron, Chomsky, Gall, Goethe, Hume, Kant, Kretchmer, Lessing, Lope de Vega, Montaigne, Montesquieu, Nietzsche, Quevedo, Rousseau, Schopenhauer, Thomasius, Tirso de Molina and Ziegler. In the middle of the 16th century, Huarte and his Examination of Men's Wits, together with the works of the naturalist philosophers Gómez Pereira (Antoniana Margarita, 1554) and Miguel Sabuco (New Philosophy, 1587), constituted the prestigious triumvirate of Spanish Renaissance scholars who, for the first time in history, contemplated the workings of the brain from a point of view that had more to do with science than the supernatural.

[Santiago Ramón y Cajal: his activity as a military doctor (1873-1875)]. / Santiago Ramón y Cajal: su actividad como médico militar (1873-1875).

Santiago Ram n y Cajal entered the Medical Corps after graduating in Medicine in 1873. His marked Spanish nationalist character and his excellent physical condition led him to serve in the third Carlist war as a medical lieutenant and later in the Cuban War as a captain. His stay in Cuba, however, was marked by hardship and illness. The decline of Spain s colonialist policy, the war that was fought in a hostile climate and atmosphere, and the corruption of the military officers led to Santiago being posted to the frontlines on a fixed logistics system of trails. All this was to end in military failure and the subsequent loss of the colony. Disillusioned and seriously ill from malaria, which nearly killed him, he returned to Spain after being discharged for illness. Shortly afterwards, thanks to Dr. Jenaro Casas, he became a university lecturer, which put an end to his military career

[Treatment of chronic tension type headache with mirtazapine and amitriptyline]. / Tratamiento de la cefalea tipo tensión crónica con mirtazapina y amitriptilina.

INTRODUCTION: The mechanisms at play in the production of tension type headaches (TTH) are partially unknown. Some of the aspects that have been discussed in connection with this issue include genetic, vascular and biochemical factors and even a predisposition of certain personalities to suffer from this kind of pain. Yet, the relation between neurotransmitters like noradrenalin (NAd) and serotonin (5 HT) and chronic TTH (CTTH) seems to be quite clear and hence the use of antidepressants that act on these substances in the pharmacological treatment of CTTH. In this study, the qualitative and quantitative efficiency of amitriptyline is compared with that of mirtazapine (two antidepressants that act on NAd and 5 HT) in the prophylaxis of CTTH. PATIENTS AND METHODS: A sample of 60 patients with CTTH criteria was divided into two groups, and subjects were administered one of the drugs at 50% random for six months. Group I was administered 25 mg of amitriptyline and group II received 30 mg of mirtazapine, both given in a single night time oral dose. Later, the two groups were compared before and after treatment, taking into account the following aspects: objective and subjective improvements, depression criteria according to the Hamilton 17 coefficient, reduction in the amount of pain killers taken, and the side effects produced by the two drugs. RESULTS: Both groups of patients presented depression criteria, which improved after taking the drugs, without any objective differences between the two forms of therapy, although the subjective feeling of improvement was greater with mirtazapine. In both groups there was a significant reduction in the usual consumption of analgesics after the prophylaxis. Side effects with both antidepressants were relatively frequent, but well tolerated, and the most common were a dry mouth and drowsiness. There were significantly fewer in the group of patients treated with mirtazapine than in those who received amitriptyline. CONCLUSIONS: First, depression and CTTH clearly coexist and that there is a certain dysphoric component associated to suffering chronic headache. Second, mirtazapine has proved to be as efficient in the treatment of CTTH as amitriptyline, but has significantly fewer side effects, probably because it acts more selectively on the brain receptors. It could, therefore, be a drug worth considering for use in the prophylaxis of chronic TTH.

[Sabuco's suco nerveo and the origins of neurochemistry in the Spanish Renaissance]. / El suco nerveo sabuceano y los orígenes de la neuroquímica en el Renacimiento español.

INTRODUCTION: In the 16th century, at the height of the Spanish Renaissance, Bachiller Miguel Sabuco revolutionised medical theories about brain physiology with the publication of his work Nueva Filosof a in 1587. This work, which is mysteriously attributed to his daughter Luisa Oliva, presents a surprisingly gynocentric ideology for its time and has been reprinted on numerous occasions since its first edition saw the light. Sabuco s ideas have been plagiarised by such renowned authors as Descartes, Willis and Glisson. DEVELOPMENT: In stark contrast to the Arabized galenism based on the criterion of authority that predominated the medical practice of his time, Nueva Filosof a empirically promoted a modern approach to neurophysiology. This becomes even more worthy of merit if we bear in mind that Sabuco was not trained as a doctor but instead worked as an apothecary in Alcaraz (Albacete, Spain). The Bachiller granted the brain a commanding role over the organisation of the body for the first time in the history of medicine. He not only developed the surprising theory of succo nervoso (the nervous sap, or original neurotransmitting substance), but also an elegant digression on human nature that puts forward solid arguments about the dualist relation between mind and brain. He examined the association between emotional and physical health and explained how the emotions can impair health and lead to early death, which means he was also a pioneer in the development of psychosomatic medicine. CONCLUSIONS: Besides constituting the most illustrious forerunner of modern day neurochemistry, Sabuco s work also encourages doctors to treat their patients in an integral manner, with equal attention being given to the body, mind and soul. It comes as no surprise, then, that many aspects of his work can still be compared to modern medical and philosophical thought.

[Neuroscience in ancient Egypt and in the school of Alexandria]. / Neurociencia en el Egipto faraónico y en la escuela de Alejandría.

INTRODUCTION: About five thousand years ago, one of the most ancient, important and enduring civilisations in the history of Mankind flourished on the banks of the Nile. In Egypt, all the branches of human knowledge attained a high degree of development and today it is considered the mother of medicine. Despite the marked religious component that affected all its activities, the medicine of the Pharaohs was practised in a rational and deductive manner, and the Egyptians were the inventors of clinical observation. METHOD: The desert climate of the Nile Valley has preserved monuments, mummies and papyruses which have enabled us to get a certain idea of the degree of development reached in medical matters. The aim of this work is to analyse them from a neuroscientific point of view. The anatomical discoveries of the Egyptians originated in the inspection of wounds and the practice of embalming. They came to know a large number of diagnoses and were able to prescribe many different forms of treatment. They also attained a certain proficiency in dealing with neurotraumatological patients. They practised anamnesis, prognostics and a regulated surgery that infrequently included trephination. Their conservatism meant that, after the Macedonian domination, the traditional Egyptian medicine was replaced the Greek medicinal arts, which reached their maximum period of splendour in the School of Alexandria, where Herophilus and Erasistratus, pioneers in the study of anatomy and brain circulation, were especially renowned. CONCLUSIONS: From the point of view of the neurosciences, the Egyptians were the first to describe the brain, migraine, epilepsy, strokes, tetanus, Bell s palsy and the sequelae of head injuries and of spinal transection. Their artwork sometimes shows neurological patients and, according to Herodotus, there were doctors who were specialised in head diseases and could therefore be considered the precursors of our present day neurologists.

[Neuroscience in Al Andalus and its influence on medieval scholastic medicine]. / La neurociencia en Al Andalus y su influencia en la medicina escolástica medieval.

INTRODUCTION: Since the application of technical medicine by the Greeks, modern neurology has been based on a body of knowledge and cultural heritage from ancient times. In this paper we review the contribution made by Al Andalus to neuroscience during the Middle Ages and its repercussions on modern neurology. DEVELOPMENT: Following the death of Mohammed in the vii century AD, Islam enjoyed one of the most spectacular periods of expansion in the history of mankind. Occupation of the cities of Alexandria and Gundishapur put the Arabs into contact with original Greco Latin manuscripts, which were assimilated and divulged by Islamic scientists in the middle eastern caliphates of Damascus and Bagdad as well as the western caliphates of Al Andalus (Spain) and Kairwan (Tunis). This classical hippocratico galenico medicine was refashioned into the so called arabized galenism, which markedly influenced the Scholastics and the cultured world of the lower Middle Ages and became the basis of European medicine until well into the Renaissance period. There was a first Spanish cultural Renaissance in Al Andalus during the ix xii centuries, which led to a flowering unheard of in the Middle Ages before then. Andalusian doctors made major contributions to the body of knowledge about neuroscience and developed major philosophical concepts of human understanding. Thus, Abulcasis (936 1013), the father of modern surgery, developed material and technical designs which are still used in neurosurgery. Averroes suggested the existence of Parkinson s syndrome and attributed photoreceptor properties to the retina. Avenzoar described meningitis, intracranial thrombophlebitis, mediastinal tumours and made contributions to modern neuropharmacology. Maimonides wrote about neuropsychiatric disorders and described rabies and belladonna intoxication. CONCLUSION: Aside from the political, religious and cultural differences between Al Andalus and the Christian kingdoms of the Iberian peninsula, the historical Andalusian period (711 1492) forms one of the most brilliant periods of Spanish neuroscience.

[The neuroanatomy of Juan Valverde de Amusco and medicine at the time of the Spanish renaissance]. / La Neuroanatomía de Juan Valverde de Amusco y la Medicina renacentista Española.

Juan Valverde de Amusco (c. 1525-c. 1564) is considered to have been the most important Spanish anatomist of the XVI century. A follower of Vesalius, he increased and divulged knowledge of anatomy during the Renaissance and his book The history of the composition of the human body was printed in Rome in 1556. The objective of this paper is to study the neuroanatomy in this book and present unpublished biographical data and describe the main contributions of this Castilian doctor to the neurosciences, in the context of Spanish medicine during the Renaissance period. He was born in the town of Hamusco (today Amusco) in the province of Palencia, which belonged to the Crown of Castile. Juan Valverde emigrated to Italy to improve his scientific knowledge. He carried out anatomical studies using the then revolutionary method of direct observation, as opposed to the Galenic criteria of authority inherited from the Medieval period. He trained in Padua under Realdo Colombo and lived in Rome where he practiced medicine until his death, becoming deservedly famous. He did not return to Spain since in the Spanish universities of the time there was a mentality which was reactionary to modern anatomy. His works, published in Italy but in the Spanish language, give an idea of the power of the Crown of Castile in the Europe of that period. The book is profusely illustrated with the first illustrations ever published in the history of printing, drawn by Nicolas Beatrizet. The book was sold widely and was translated and reedited on many occasions, until well into the XVIII century. For the first time Valverde made precise references to the minor circulation. He was the first anatomist to describe the muscles for movement of the eye correctly and the intracranial course of the carotid arteries. In his work he made the first drawing of the stapes, described by the Valencian Luis Collado. Vesalius and Valverde contributed decisively to the beginnings of modern neuroanatomy. Thanks to them, the brain is no longer an organ unknown to science.

[Ischemic infarct, mitral valve prolapse and protein S deficiency]. / Infarto isquémico, prolapso de válvula mitral y déficit de proteína S.

Ischaemic stroke in young people, that is in those under 45 years of age, forms a distinct entity. Whereas in the case of older patients the main cause is arteriosclerosis, in the younger group a broad spectrum of etiologies can be found. It is for this reason that in these latter cases we must carry out a diagnostic study that is not only more exhaustive but also additionally is aimed at seeking out specific pathologies as for instance a possible association with vasculitis, infectious diseases, hematological abnormalities or unclear cardiopathology. Given the therapeutic transcendency that findings might have, in order to avoid new bouts in patients at the most productive moments in their lives, we believe it to be of great interest to carefully study these patients as exhaustively as need be. In the present work we present the case of a young patient with ischaemic infarct in the region of both upper cerebella which started out with a clinical picture of ataxia and dysarthria with benign course and total recovery. Possible etiologies are discussed in the light of findings made during complementary tests, as well as the unusual location of the lesions.

[Untreatable hiccup as un unusual sign in a rostral occlusion syndrome of the basilar artery]. / Hipo intratable como manifestación inusual de un síndrome de oclusión rostral de la arteria basilar.

Hiccoughs (singultus) is a habitual physiological phenomenon, the persistence of which might indicate neurological and extraneurological multiple lesions. Its activation involves starting up numerous central and peripheral mechanisms which have yet to be clearly determined. Hiccoughs results from an intermittent myoclonus of the diaphragm, reflex in origin, with unknown authentic cause or physiological significance. It has been suggested that, more than just an abnormal reflex, it could be a type of myoclonus brought on by repeated activity of the 'solitary inspiratory nucleus', by releasing control of the inhibiting-activating upper nervous system activity. We present the case of a patient with uncontrollable hiccoughs lasting over six years as a result of paramedial bilateral thalamic ischaemia (rostral occlusion syndrome of the basilar artery type 1) of cardioembolic origin (auricular fibrillation) secondary to hyperthyroidism.

[The spectrum of prion pathology broadens: fatal familial insomnia]. / El espectro de la patología prion se amplía: el insomnio familiar fatal.

INTRODUCTION: The small group of prion diseases, caused by accumulation in the brain of an abnormal protein characterized by its aggregation and relative resistance to proteases (the PrPSc) in man is comprised of Creutzfeldt-Jacob disease (CJE), the Gerstmann-Straussler-Scheinker syndrome, kuru and the newest addition which is fatal familial insomnia (FFI). DEVELOPMENT: FFI is a hereditary condition with dominant autosomal transmission, characterized clinically by progressive insomnia, dysautonomy, changes in the circadian rhythm of hormone secretion, motor signs and slight to moderate deterioration of cognition. The usual age of onset is between 40 and 60 years, and the course of the illness lasts between 7 and 18 months. The histopathological changes, involving neurone loss and reactive gliosis, particularly affect the anteroventral and dorsomedial thalamic nuclei. These lesions lead to insomnia and to autonomic and endocrine disorders. To a lesser extent and degree, lesions are seen in other thalamic nuclei, the cerebral cortex, inferior olives and the cerebellum. FFI and some families with CJE have the same mutation of the codon 178 of the protein prion gene (gene PRNP) with substitution of aspartic acid by asparagine. Polymorphism of codon 129, which codifies methionine or valine determines the development of the clinical and neuropathological phenotype of FFI or CJE respectively. CONCLUSIONS: The description of FFI and the detection of PrPSe in familial cases of diffuse subcortical gliosis has indicated the possibility that there may be other familial or non-familial neurodegenerative diseases caused by prions.

[Kinematic deterministic chaos of fluids and fractal geometry in the carotid system]. / Caos determinista, cinemática de fluidos y geometría fractal en el sistema carotídeo.

INTRODUCTION: Atherosclerosis is a generalized vascular disorder which tends to be localized to specific arterial territories. At the bifurcation of the carotid artery there is a marked predisposition to form plaques of atheroma on the postero-external wall. This tendency is due to the kinematics of fluids and their particular morphological characteristics which are unique in the vascular system. The carotid tree is a physical, non-lineal or in 'non-equilibrium', dynamic system which depends on the fluctuating contribution of energy from the cardiac cycle. It has fractal geometry which follows the Law of Biology of maximum efficiency with a minimum of effort. DEVELOPMENT: The complexity of the relationship between the haemo-rheological and anatomical factors, and the periodic oscillation of flow does not permit use of simple models and classical determinist equations to describe idealized systems of continuous movement and Newtonian fluids. On the contrary, since we are considering a complex dissipative dynamic system. It has marked intrinsic operational freedom adapting its responses to external disturbances well, thus determining vasculo-cerebral autoregulation. The theories of Determinist Chaos and of the Science of Complexity imply the existence of emerging properties which exceed those of the individual elements in the dynamic systems in non-equilibrium, which tend to function in the 'frontier of chaos' at the critical points of phase transition. The carotid tree has non-linear properties, appearance of order and fractal 'sibisemejanza'. Pseudo-chaotic vortices appear--in regions of phase transition between laminar flow and turbulence--with the emergence of a 'strange attractor' near to the postero-external wall of the bulb. CONCLUSIONS: The anatomical and kinematic complexity of the system, together with the irreversibility of the second Law of Thermodynamics, lead to a long-term tendency towards the appearance of a region of stagnant flow with increased Entropy in the territory of the strange attractor which determines--as an inevitable long-term outcome--the tendency to the appearance of atherosclerosis at this particular point.

[Wilson disease: a new case treated with trientine]. / Enfermedad de Wilson: a propósito de un caso tratado con trientine.

Hepatolenticular degeneration, also known as Wilson's disease (WD), is an infrequent hereditary disorder which is transmitted in recessive autosomic fashion: its genetic defect is to be found in the long branch of chromosome 13 (13q14.3) and allows disorder to take place which has not been sufficiently clarified, in the bilious excretion of the copper (Cu) which is deposited in an anomalous manner on a level with different organic tissues, giving rise to characteristic clinical manifestations which are, basically, of a neurological, hepatic, psychiatric and ocular nature. We present the case of a young patient whose case began, four years ago, with depressive-type manifestations, with diagnosis only being made now. Our opinion on the early detection of asymptomatic patients is commented on, along with that concerning the effectiveness and safety of therapeutic alternatives to D-penicilamine.

[Segmental arteriographic anomalies in migranous cerebral infarct]. / Anomalías arteriográficas segmentarias en el infarto cerebral migrañoso.

A migranous cerebral infarct (ICM) has the appearance of an ischaemic cerebral lesion which occurs during a migraine crisis and is shown by neuroimaging techniques to be in the corresponding vascular area. Four young patients are described. They fulfilled the clinical and neuroimaging criteria for compatibility with ICM and the protocol for the aetiological study of stroke was normal. Angiography ruled out other causes of ischaemia (dissection, fibromuscular dysplasia, etc.) and showed segmental images of 'vasculitis appearance' similar to these described in Call's syndrome, in 'benign intracranial angiopathy' and in other intracranial vasculopathies or criteria of 'reversible segmental cerebral vasoconstriction'. The pathogenic significance, as with migraine, is still unknown.

[Lateral sinus thrombosis in the first three months of pregnancy]. / Trombosis del seno lateral durante el primer trimestre del embarazo.

Thrombosis of the cerebral venous sinuses is characterized by clinical pleomorphism and variable pathogenesis. Although there is a relationship with pregnancy and especially with the puerperium, occurrence during the first trimester of pregnancy is unusual and this may effect the diagnosis and treatment. We describe the case of a 33 years-old patient with lateral sinus thrombosis in the first trimester of pregnancy. This was diagnosed and followed-up by magnetic resonance. Investigations as to its aetiology were inconclusive and it followed a benign course without anticoagulation. Thrombosis of the venous sinuses has been found empirically to be related to states of deficiency of S protein, hypercoagulability, anaemia and deshydration during pregnancy, to having previously taken contraceptive pills. Behçet's disease, other coagulopathies, central or systemic vasculitis, collagen disorders, septic and neoplastic disorders and a large number of cases of unknown aetiology. In our patient neurological deterioration secondary to a venous infarct or intraparenchymatous haemorrhage was not seen. There was full recovery and complete spontaneous canalization of the sinus, as shown on posterior cranial angiography. The controversial decision to use heparin in thrombosis of the cerebral venous sinuses should probably depend on the possible risks and benefits in each individual case, taking into account the clinical findings, aetiology and topography of the thrombosed sinus.

[Antoniana Margarita: Gómez Pereira, Francisco Lobato and the antecedents of cerebral mechanicism during the Spanish renaissance]. / Antoniana Margarita: Gómez Pereira, Francisco Lobato y los antecedentes del mecanicismo cerebral en el Renacimiento español.

The year 2000 is the fifth century of the birth, in Medina del Campo (Vallodolid, Spain) of licenciado Perea (Gomez Perea or Pereira). A man of the Renaissance, he was an outstanding doctor, humanist, theologist, nominalist philosopher, naturalist and practical engineer. He developed the first modern theory of behavior, based purely on mechanicistic principles, describing his ideas in a text known by the curious title of Antoniana Margarita. The objective of this paper is to pay him homage on the fifth centenary of his birth, making a historiographic study of Gomez Perea and his works, with particular emphasis on the ideological basis and its relationship with Renaissance hydraulic engineering, collaborating with his colleague Francisco Lobato, author of one of the only two pretechnological codices of sixteenth century Spain. The book Antoniana Margarita is written in Renaissance Latin and was published in Medina del Campo in 1554. It represents the first truly modern approach to brain function which excludes the providencialist concepts of Galen involving the soul and the spirit, in vogue until then, transmitted through the Arab and Scholastic tradition. Analyzing his theory of the automatism of animals Perea made the first description ever of the reflex arc and the conditioned reflex. He also established a topographical model of the brain in which he sketched the functioning of the prefrontal cortex and neurophysiology of memory. Perea was the immediate forerunner of Neuropsychology and of the methodology and organicist thought which predominates in modern Neurobiology. He was also a visionary of the Evolution of Darwin and of modern aetiology.

[Pseudomeningocele after laminectomy]. / Pseudomeningocele postlaminectomía.

Pseudo-meningocele post-laminectomy is a non-frequent complication of this surgical technique. It is usually diagnosed by myelography; the CT scan has helped to detect more cases. We present a case studied by CT and RMN and there are no existing previous publications on the case confirmed by RMN. The relation between the findings and the clinic as well as the therapy still on discussion.

[Charcot-Marie-Tooth: a family case report]. / Charcot-Marie-Tooth: aportación de una familia.

Three cases in a Spanish family are presented, showing diagnosis criteria of hereditary motor-sensitive neuropathy (Charcot-Marie-Tooth disease) type I: suggestive symptoms, neurological and anatomopathological findings. The current classification of this pathology.

[Unusual neurologic manifestation of Graves-Basedow disease]. / Manifestación neurológica inusual en la enfermedad de Graves-Basedow.

A 74 year old, male patient had an acute, painful bilateral exophtalmos, ptosis, ophtalmopathy and vision impairment. The CT-scan showed a thickness of the extrinsic ocular muscles which oriented the diagnosis of Graves-Basedow disease, later confirmed by the laboratory test. We highlight the rarity of the acute onset contrary to the slowly progressive ophtalmopathy frequently seen in this type of thyrotoxicosis, as well as the importance of the orbital CT-scan for an early diagnosis. We review the pathogenic theories of the process with its important immunologic back-ground, taking part the humoral and the cellular immunity associated with the HLA-B35 haplotype commenting on the good response to high dosage of steroids, later combined with bromocriptine.