[Complete remission of a migraine after treatment with cisplatin]. / Remisión completa de una migraña tras tratamiento con cisplatino.

TITLE: Remisión completa de una migraña tras tratamiento con cisplatino.

[Reversible cerebral vasoconstriction syndrome following smoking cessation and treatment with bupropion]. / Sindrome de vasoconstriccion cerebral reversible tras abandono de habito tabaquico y tratamiento con bupropion.

TITLE: Sindrome de vasoconstriccion cerebral reversible tras abandono de habito tabaquico y tratamiento con bupropion.

Clúster-tic como comienzo clínico de una fístula dural carótido cavernosa / Cluster-tic syndrome as the first clinical manifestation of a dural carotid-cavernous fistula

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Utility of transcranial sonography in the diagnosis of drug-induced parkinsonism: a prospective study.

BACKGROUND AND PURPOSE: Drug-induced parkinsonism usually resolves after discontinuation of the causative agent. However, it persists in some patients, who actually have subclinical neurodegenerative parkinsonism. Identification of this condition is important because these patients could benefit from therapeutic measures. The objective of this study was to prove whether transcranial sonography, a technique used in the diagnosis of neurodegenerative parkinsonism, can be used for the said identification. METHODS: In this prospective study, patients with drug-induced parkinsonism were followed for at least 6 months after discontinuation of the causative drug and performance of blinded transcranial sonography. Patients were categorized as having iatrogenic parkinsonism if the clinical presentation had resolved or subclinical drug-exacerbated parkinsonism if it persisted. Once the patient was classified into one of the two groups, an expert assessed the transcranial sonography findings and their agreement with the clinical diagnosis. RESULTS: Twenty patients composed the group for analysis of results. Assessing hyperechogenicity in the substantia nigra >20 mm2 and/or hyperechogenic lentiform nucleus, differences were detected between the iatrogenic parkinsonism and the subclinical drug-exacerbated parkinsonism groups, although they did not reach statistical significance (Fisher's exact test 0.09). Joint assessment of sonographic alterations in both structures had a negative predictive value of 85.7% for diagnosis of drug-induced parkinsonism, with a negative likelihood ratio of 0.3. CONCLUSIONS: Although in our study statistically significant differences were not found between the transcranial sonography characteristics of subclinical drug-exacerbated parkinsonism and iatrogenic parkinsonism patients, we believe that transcranial sonography is a valid technique for diagnosis of drug-induced parkinsonism.

Utilidad de la tomografía por emisión de fotón simple con 123Ioflupano en el diagnóstico del parkinsonismo relacionado con fármacos. Estudio prospectivo / Diagnostic accuracy of 123I-FP-CIT SPECT in diagnosing drug-induced parkinsonism: a prospective study

Introducción: El parkinsonismo relacionado con fármacos es una de las principales causas de parkinsonismo en nuestro entorno. La clínica suele desaparecer tras la retirada del fármaco, sin embargo puede persistir en un grupo de pacientes que presentan lo que se conoce como parkinsonismo subclínico exacerbado por fármacos y cuya identificación precoz es importante por las implicaciones pronósticas y terapéuticas. La prueba complementaria más utilizada para ello es la tomografía por emisión de fotón simple con 123Ioflupano, también conocida como SPECT [123I]FP-CIT. El objetivo de nuestro estudio es corroborar su utilidad para tal fin. Métodos: Se diseñó˜ un estudio prospectivo de pacientes con parkinsonismo relacionado con fármacos a los que, tras retirada del mismo y realización de SPECT [123I]FP-CIT, se les siguió durante un mínimo de 6 meses. Los pacientes se catalogaron como parkinsonismo iatrogénico si había desaparecido la clínica o parkinsonismo subclínico exacerbado por fármacos si la misma persistía. Finalmente se comprobó la concordancia entre el diagnóstico clínico y los resultados del SPECT [ 123I]FP-CIT. Resultados: La muestra quedó constituida por 19 pacientes. El grupo terapéutico mayoritario fueron los neurolépticos. Para el diagnóstico de ambos subgrupos el SPECT [ 123I]FP-CIT mostró una sensibilidad del 66,7%, una especificidad y un valor predictivo positivo del 100%, un valor predictivo negativo del 86,7% y una razón de verosimilitud negativa de 0,33. Conclusiones: Aunque es necesario comprobarlo con un número mayor de pacientes, el SPECT [123I]FP-CIT es una técnica útil en el diagnóstico de parkinsonismo relacionado con fármacos ya que identifica con gran precisión a los enfermos (AU)

Introduction: Drug-induced parkinsonism is a majortype of parkinsonism in our setting. Symptoms usually disappear after discontinuation ofthe drug. However,they may persistin patients with a variant known as subclinical drug-exacerbated parkinsonism; early identification of this entity has important prognostic and therapeutic implications. The most widely used complementary test in this diagnosis is single-photon emission computed tomography with ioflupane (123I), also known as 123I-FP-CIT SPECT. The aim of our study is to verify its diagnostic accuracy. Methods: We designed a prospective study of patients with drug-induced parkinsonism in which, after discontinuing the drug and undergoing a 123I-FP-CIT SPECT scan, patients would be monitored for at least 6 months. Patients were categorised as having iatrogenic parkinsonism if symptoms disappeared, or as having subclinical drug-exacerbated parkinsonism if they persisted. Lastly, we verified concordance between the clinical diagnosis and results from the 123IFP-CIT SPECT scan. Results: The sample included 19 patients. The most commonly prescribed drug class was neuroleptic agents. For the diagnosis of both subgroups, 123I-FP-CIT SPECT showed a sensitivity of 66.7%, specificity and positive predictive value of 100%, a negative predictive value of 86.7%, and a negative likelihood ratio of 0.33. Conclusions: Although the study needs to be repeated in a larger sample of patients, 123I-FPCIT SPECT is useful in the diagnosis of drug-induced parkinsonism since itis a very precise tool for identifying patients with that illness (AU)

Diagnostic accuracy of 123 I-FP-CIT SPECT in diagnosing drug-induced parkinsonism: a prospective study.

INTRODUCTION: Drug-induced parkinsonism is a major type of parkinsonism in our setting. Symptoms usually disappear after discontinuation of the drug. However, they may persist in patients with a variant known as subclinical drug-exacerbated parkinsonism; early identification of this entity has important prognostic and therapeutic implications. The most widely used complementary test in this diagnosis is single-photon emission computed tomography with ioflupane ((123)I), also known as (123)I-FP-CIT SPECT. The aim of our study is to verify its diagnostic accuracy. METHODS: We designed a prospective study of patients with drug-induced parkinsonism in which, after discontinuing the drug and undergoing a (123)I-FP-CIT SPECT scan, patients would be monitored for at least 6 months. Patients were categorised as having iatrogenic parkinsonism if symptoms disappeared, or as having subclinical drug-exacerbated parkinsonism if they persisted. Lastly, we verified concordance between the clinical diagnosis and results from the (123)I- FP-CIT SPECT scan. RESULTS: The sample included 19 patients. The most commonly prescribed drug class was neuroleptic agents. For the diagnosis of both subgroups, (123)I-FP-CIT SPECT showed a sensitivity of 66.7%, specificity and positive predictive value of 100%, a negative predictive value of 86.7%, and a negative likelihood ratio of 0.33. CONCLUSIONS: Although the study needs to be repeated in a larger sample of patients, (123)I-FP-CIT SPECT is useful in the diagnosis of drug-induced parkinsonism since it is a very precise tool for identifying patients with that illness.

Un caso de cefalea atípica con evolución de cefalea numular a epicrania fugax / Atypical migraine progressing from nummular headache to epicrania fugax

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Atención neurológica de la población inmigrante en Almería / Neurological attention to the immigrant population in Almería

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Possible case of peripheral osmotic demyelination syndrome.

Central pontine myelinolysis (CPM) is an uncommon neurological syndrome that is usually related to the rapid restoration of a previous hyponatraemia. Although the most frequent location of CPM injury is the pons, it is now designated osmotic demyelination syndrome (ODS) because, as well as in the brainstem, these injuries can be observed in other parts of the central nervous system (CNS)-for example, the thalamus, subthalamic nucleus, external geniculate body, putamen, globus pallidum, internal capsule, white matter of cerebellum and the deep layers of the brain cortex. However, an exhaustive search of the literature (MEDLINE 1967-2007) has revealed no case report of peripheral nervous system (PNS) demyelination secondary to severe hyponatraemia.

[Trigeminal-autonomic cephalalgias: International Headache Society diagnostic criteria does not allow for a correct classification]. / Cefaleas trigeminoautonómicas: los criterios diagnósticos de la International Headache Society no permiten su clasificación correctamente.

INTRODUCTION: The International Classification of Headache Disorders only recognizes the following as trigeminal- autonomic cephalalgias (TAC): cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome. Nevertheless, there are other types of TAC that still have not been incorporated into the International Classification of Headache Disorders although they have been before reported in the literature. We present the results of the analysis of a series of 94 cases of TAC. METHODS: We performed a retrospective study of 2,132 patient who attended a general neurology consultation due to headache between January 1997 and June 2006. Those patients with unilateral headache (orbital, supraorbital y/o temporal) accompanied of some ipsilateral autonomic sign were selected. We investigated the etiology of all cases and made a nosology classification according with two types of criteria: IHS (International Headache Society) strict criteria as well as other criteria (IHS plus) including migraine with ipsilateral autonomic signs and hemicrania continua, thus following Goabsby. RESULTS: A total of 94 cases of TAC (4.4% of all the headaches) were found, 89 of which had a primary etiology and 5 secondary etiology. Cluster headache was the most frequent TAC in our series (29%), independently of the criteria used. However, hemimigraine with ipsilateral autonomic signs had a similar frequency (28%) according to IHS plus criteria. CONCLUSIONS: a) In our series TAC have constituted an not very frequent entity, there being a subgroup of secondary cases among them, and b) the current International Classification of the Headache Disorders has some limitations as an instrument for the nosology classification of TAC.

Cefaleas trigeminoautonómicas: los criterios diagnósticos de la International Headache Society no permiten su clasificación correctamente / Trigeminal-autonomic cephalalgias: International Headache Society diagnostic criteria does not allow for a correct classification

Introducción. La Clasificación Internacional de las Cefaleasde la International Headache Society (IHS) sólo reconoce comocefaleas trigeminoautonómicas (CTA) la cefalea en racimos, lahemicránea paroxística y la cefalea SUNCT (short-lasting unilateralneuralgiform headache attacks with conjunctival injectionand tearing). No obstante, existen otras cefaleas hemicranealescon signos autonómicos ipsilaterales aún no incluidas a pesar dehaber sido ampliamente descritas en la literatura. Se presentanlos resultados del análisis de una serie de 94 casos de CTA.Métodos. Estudio retrospectivo de 2.132 pacientes queacudieron por cefalea a una consulta de neurología generalentre enero de 1997 y junio de 2006. Se seleccionaron aquellospacientes que sufrían una cefalea unilateral de localizaciónorbitaria, supraorbitaria y/o temporal acompañada de algúnsigno autonómico ipsilateral. Se realizó una clasificaciónetiológica de todas las CTA y una nosológica de las primarias.Esta última se llevó a cabo de acuerdo con dos tipos de criterios:IHS estricta e IHS plus (incluyendo migraña con signosautonómicos y criterios de Goabsby para hemicránea continua).Resultados. Encontramos 94 casos de CTA (4,4 % deltotal de cefaleas), 89 de etiología primaria y 5 secundaria.La cefalea en racimos fue la CTA más frecuente en nuestraserie (29 %), independientemente de los criterios utilizados,aunque la hemicránea continua y la migraña con signosautonómicos presentaron una frecuencia similar (28%) cuandose aplicaron los criterios IHS plus.Conclusiones. a) En nuestra serie las CTA han constituidouna entidad poco frecuente, existiendo entre ellas unsubgrupo de casos secundarios, y b) la actual ClasificaciónInternacional de las Cefaleas de la IHS tiene limitaciones paradistribuir nosológicamente las CTA (AU)

Introduction. The International Classification ofHeadache Disorders only recognizes the following as trigeminal-autonomic cephalalgias (TAC): cluster headache,paroxysmal hemicrania and short-lasting unilateralneuralgiform headache attacks with conjunctival injectionand tearing (SUNCT) syndrome. Nevertheless, thereare other types of TAC that still have not been incorporatedinto the International Classification of HeadacheDisorders although they have been before reported in theliterature. We present the results of the analysis of a seriesof 94 cases of TAC.Methods. We performed a retrospective study of2,132 patient who attended a general neurology consultationdue to headache between January 1997 and June2006. Those patients with unilateral headache (orbital,supraorbital y/o temporal) accompanied of some ipsilateralautonomic sign were selected. We investigated theetiology of all cases and made a nosology classificationaccording with two types of criteria: IHS (InternationalHeadache Society) strict criteria as well as other criteria(IHS plus) including migraine with ipsilateral autonomicsigns and hemicrania continua, thus following Goabsby.Results. A total of 94 cases of TAC (4.4 % of all theheadaches) were found, 89 of which had a primary etiologyand 5 secondary etiology. Cluster headache was themost frequent TAC in our series (29 %), independently ofthe criteria used. However, hemimigraine with ipsilateralautonomic signs had a similar frequency (28 %) accordingto IHS plus criteria.Conclusions. a) In our series TAC have constitutedan not very frequent entity, there being a subgroup ofsecondary cases among them, and b) the current InternationalClassification of the Headache Disorders has somelimitations as an instrument for the nosology classificationof TAC (AU)

[Vasomotor reactivity throught the voluntary apnea test can be measured without calculating the apnea index]. / La reactividad vasomotora mediante el test de la apnea voluntaria puede determinarse sin calcular el índice de apnea.

INTRODUCTION: Vasomotor reactivity (VR) is the capability of the cerebral arterioles to dilate and to constrict in response to determined stimuli. Using transcranial doppler (TCD), there are various test to evaluate it, including the breath holding test. With this test, VR can be calculated two ways: using the increment percentage of the mean velocity with respect to the basal velocity (PIV) or by quantifying the apnea time to obtain what is call the breath holding index (PIV/apnea seconds). The objective of our study is to study the linear correlation between the PIV and the breath holding index. METHODS: This was an observational study performed in a neurology ambulatory setting. A total of 128 subjects, age 16 to 50 years old, were included. We assessed VR using the breath holding test described by Markus and Harrison on the middle cerebral artery. The linear correlation between the two quantitative variables was analysed using Pearson's correlation coefficient. RESULTS: Pearson's correlation coefficient between the PIV and the breath holding index was 0.75 for a significance level of p < 0.0001. CONCLUSION: Given the good linear correlation between these two methods for calculating the VR using the breath holding test, we consider it is not necessary to calculate breath holding test time when using this test.

La reactividad vasomotora mediante el test de la apnea voluntaria puede determinarse sin calcular el índice de apnea / Vasomotor reactivity throught the voluntary apnea test can be measured without calculating the apnea index

Introducción. La reactividad vasomotora (RV) es la capacidad de las arteriolas cerebrales para dilatarse y contraerse ante determinados estímulos. Mediante ultrasonografía doppler transcraneal (OTC) existen diversos métodos para valorarla entre los que se incluye el test de la apnea voluntaria. Con este test la RV puede ser calculada de dos formas: mediante el porcentaje de incremento de la velocidad media con respecto a la basal (PIV) o cuantificando el tiempo de apnea para obtener el denominado índice de apnea voluntaria (PIV/segundos de apnea). El objetivo de nuestro estudio es estudiar la correlación lineal entre el PIV y el índice de apnea voluntaria. Métodos. Realizamos un estudio observacional mediante OTC en 128 sujetos de 16 a 50 años valorados en una consulta ambulatoria de neurología. Se estudió la RV con el método de la apnea voluntaria descrito por Markus y Harrison en la arteria cerebral media y se analizó la correlación lineal entre las dos variables cuantitativas mediante el coeficiente de correlación de Pearson. Resultados. El coeficiente de correlación de Pearson entre el PIV y el índice de apnea voluntaria fue de 0,75 para un nivel de significación de p < 0,000l. Conclusión. Dada la buena correlación lineal entre estos dos métodos de cálculo de la RV, creemos que no es imprescindible calcular el índice de apnea voluntaria

Introduction. Vasomotor reactivity (VR) is the capability of the cerebral arterioles to dilate and to constrict in response to determined stimuli. Using transcranial doppler (TCD), there are various test to evaluate it, including the breath holding test. With this test, VR can be calculated two ways: using the increment percentage of the mean velocity with respect to the basal velocity (PIV or by quantifying the apnea time to obtain what is call the breath holding index (PIV/apnea seconds). The objective of our study is to study the linear correlation between the PIV and the breath holding index. Methods. This was an observational study performed in a neurology ambulatory setting. A total of 128 subjects, age 16 to 50 years old, were included. We assessed VR using the breath holding test described by Markus and Harrison on the middle cerebral artery. The linear correlation between the two quantitative variables was analysed using Pearson's correlation coefficient. Results. Pearson's correlation coefficient between the PIV and the breath holding index was 0.75 for a significance level of p < 0.0001. Conclusion. Given the good linear correlation between these two methods for calculating the VR using the breath holding test, we consider it is not necessary to calculate breath holding test time when using this test

[Descriptive analysis of the e-mail list "Neurología-RedIRIS" (http://listserv.rediris.es/neurologia.html): an active, plural instrument having scientific quality at the reach of the Spanish speaking neurology sector]. / Análisis descriptivo de la lista de correo electrónica "Neurología-RedIRIS" http://listserv.rediris.es/neurologia.html): un instrumento activo, plural y de calidad científica al alcance de la neurología hispanohablante.

INTRODUCTION: In recent years, professional mailing-lists (PML) have experienced wide diffusion in the field of the medicine thanks to their educational and academic potential. In neurology and in Spanish, Neurología list belonging to RedIRIS has played the lead in the history of PML. Since the year 1997, it has maintained approximately 200 persons related with neurology in communication and has exceeded more of 7,300 messages. MATERIAL AND METHODS: We analyzed retrospectively the activity recorded in the Neurología PML between January and December 2003, recording variables related to the activity and scientific quality of the PML and to the origin and content of the messages. RESULTS: 758 messages were registered (2.07 messages/day; 3.73 messages/subscriber). 93 of 203 subscribers (45.81 %) participated on at least one occasion. 83 % of the messages came from Spain, there being an inverse relationship between the neurologists relative endowment and degree of participation in the PML. The most frequent messages referred to clinical cases followed by debate of topics of management and scientific consultations. The scientific quality of Neurología PML is comparable to other English language based PML analyzed based on the number of publications in Index Medicus and of the impact factor of its subscribers. CONCLUSION: Neurología PML has reached a level of maturity and enjoys a critical mass and a number of subscribers of high scientific level that assures its immediate future. Besides its educational and consultation functions, it may become an opinion forum for the Spanish neurologists without their losing their independence or Latin-American vocation.