[Respiratory dyskinesia induced by veralipride]. / Discinesia respiratoria inducida por veralipride.

We describe the case of a patient whose menopause syndrome was treated with veralipride. After four months of this treatment she started to have bucco-lingual movements and marked dyspnea which caused difficult, irregular breathing and severe thoracic discomfort. After the drug was stopped there was progressive improvement and disappearance of the symptoms described. When the patient was taking a neuroleptic drug (veralipride) she developed bucco-lingual dyskinesia, considered to be the commonest late dyskinesia, together with marked respiratory dyskinesia. The latter is a type of dyskinesia seldom described, probably because it is only detected when it is severe enough to cause functional effects. It may pass unnoticed when the disorder is only slight or moderate. In the literature there are few references to disorders of movement induced by this drug, especially when compared with other benzamides which are frequently involved. However, in its mode of action there is a beneficial antigonadotropin activity together with an antidopaminergic effect which explains why they may cause such a reaction.

[Spontaneous intracranial hypotension: findings of cerebral NMR]. / Hipotensión intracraneal espontánea: hallazgos en RMN cerebral.

INTRODUCTION: The intracranial hypotension syndrome is characterized by a cerebrospinal fluid (CSF) pressure of less than 60 mmH2O and presents as postural hypotension which is often accompanied by nausea, vomiting, cervicalgia and some degree of neck rigidity. It is considered to be spontaneous when there is no known precipitating factor. It is believed that there is a CSF leak across the subarachnoid space, although it is not always possible to detect this. In recent years several authors have described different pathological findings on magnetic resonance (MR) studies. CLINICAL CASE: We present the radiological studies of a patient with clinical evidence of headache which was worse on standing and improved when lying down. The outflow pressure of CSF was 6 mmH2O when lying down. On isotopic cisternography using Tc DTPA-99m there was no detectable CSF leak. On cerebral MR there was diffuse pachymeningeal thickening with increased signals in T1 sequences. This was more pronounced in T2 with lineal dural uptake of contrast at infra and supratentorial levels. The brain stem meninges were intact. In parallel with a favorable clinical course, following clinical resolution the radiological images were seen to have returned to normal. CONCLUSIONS: Radiological findings, together with a compatible clinical condition, help to establish the diagnosis of spontaneous intracranial hypotension and avoids the use of unnecessary clinical investigations.

[Cerebrovascular accident: study of risk factors and development in 154 cases]. / Accidente cerebrovascular: estudio de los factores de riesgo y evolución en 154 casos.

A retrospective study of 194 patients is carried out. Patients were divided into two groups: 154 patients with acute cerebrovascular accident (ACA) and 40 patients without vascular pathology, hospitalized for other causes. A descriptive analysis of these patients is made with respect to age, sex, type of ACA, previous ACA and potential relationship between the type of this first ACA and the one motivating current hospitalization. In addition, ACA is related to risk factors (hypertension, dyslipemia, diabetes, cardiopathy). In our series, variables that can be considered as risk factors, with significant differences between both groups, are: HTA, tobacco consumption, cardiopathy, dyslipemia (hypercholesterolemia and hypertriglycemia, hyperuricemia and diabetes. Alcoholism, anticoagulation, antiaggregation or polyglobulia were not risk factors. In 33.2% of patients with current ACAs, there were antecedent of clinically documented cerebrovascular pathology; one thing of them were transitory cerebral ischemias and more than half of them, cerebral infarcts. In conclusion, we stressed the role of primary and secondary prevention acting against risk factors, given the recurrence of this pathology and the irreversibility of the injuries once happened.

[Rare manifestations of diabetic neuropathy]. / Manifestaciones poco frecuentes de la neuropatía diabética.

Up to 50% of diabetic patients develop neuropathies during their lives. Distal symmetric polyneuropathy is the most frequent variety, but there are other forms that are not exceptional and must be considered for the differential diagnosis of these patients. In this paper, the authors present three clinical cases of rare types of diabetic neuropathy: oculomotor cranial neuropathy (Case 1), diabetic amyotrophia (Case 2) and mixoide type with proximal asymmetrical locomotor neuropathy and distal polyneuropathy (Case 3). Their most relevant clinical characteristics are described, along with their differential diagnosis, evolution and therapeutical alternatives, in order to contribute to a better management of these patients.

[Myasthenia gravis and non-Hodgkin's lymphoma]. / Miastenia grave y linfoma no hodgkiniano.

We describe 2 patients with myasthenia gravis and non-Hodgkin's lymphoma outside the thymus gland, in whom the two diseases progressed at different rates. Diagnosis of myasthenia gravis was based on clinical signs and compatible neurophysiologic studies, specifically by high acetylcholine antireceptor titers in the first patient and a positive Tensilon test in the second. In the first patient the clinical and serological signs of the two diseases progressed similarly. The association of these two diseases may have been the result of an underlying immunological disorder favoring their appearance, or of an immune response, caused by the lymphoma involving postsynaptic nicotinic acetylcholine receptors.