Guía rápida de cefaleas. Consenso entre Neurología (SAN) y Atención Primaria (SEMERGEN Andalucía). Criterios de derivación / Rapid headache guidelines. Neurology consensus between Neurology (SAN) and Primary Care (SEMERGEN Andalucía). Referral criteria

La cefalea es uno de los motivos más frecuentes de consulta en nuestros centros de salud, algo que no nos debe extrañar si tenemos en cuenta que es uno de los síntomas que con más frecuencia padece la población. La mayor preocupación del médico de familia, y del médico de urgencias, es llegar a un diagnóstico correcto mediante una adecuada historia clínica y una exploración neurológica básica y adaptada al tiempo y los medios de que dispone. En caso de dudas diagnósticas o sospecha de una cefalea secundaria el médico de atención primaria o del servicio de urgencias tendrán que derivar al paciente para que sea estudiado y/o tratado en los servicios de Neurología correspondientes, dicha derivación se hará con mayor o menor urgencia en función de la presencia, o no, de los síntomas o los signos de alarma. Un grupo de trabajo constituido por neurólogos de la Sociedad Andaluza de Neurología (SAN) que prestan sus servicios en diferentes hospitales de Andalucía y por Médicos de Familia representantes de la Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFyC) y de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN Andalucía), han elaborado una «Guía rápida» de cefaleas, en la que se abordan los aspectos más prácticos, para el diagnóstico, tratamiento y seguimiento del paciente con cefalea. Presentamos en este artículo el capítulo que se ocupa de los criterios de alarma y derivación (AU)

A working group consisting of Neurologists of Sociedad Andaluza de Neurología (SAN) to provide services in different hospitals in Andalucía and Family Physicians representatives of the Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFyC) and the Sociedad Española de Médicos de Atención Primaria (SEMERGEN Andalucía), has developed a Quick Guide headache, which addresses the more practical aspects for the diagnosis, treatment and monitoring of patients with headache. We show you in this paper, the chapter that deals the alarm criteria and referral. Headache is one of the most frequent reasons for consultation in our health centers, something which should not be surprising if we consider that is one of the most common symptoms experienced by the population. The main concern of the family physician and emergency physician is to reach a correct diagnosis by clinical history and a basic neurological examination and adapted to the time and means at its disposal. In case of diagnostic doubts or suspected secondary headache, the primary care physician or emergency medical have to refer the patient to be studied and/or treated for Neurology services, such referral shall be made with varying degrees of urgency depending on the presence, or not, of symptoms or signs of alarm (AU)

[Rapid headache guidelines. Neurology consensus between Neurology (SAN) and Primary Care (SEMERGEN Andalucía). Referral criteria]. / Guía rápida de cefaleas. Consenso entre Neurología (SAN) y Atención Primaria (SEMERGEN Andalucía). Criterios de derivación.

Headache is one of the most frequent reasons for consultation in our health centers, something which should not be surprising if we consider that is one of the most common symptoms experienced by the population. The main concern of the family physician and emergency physician is to reach a correct diagnosis by clinical history and a basic neurological examination and adapted to the time and means at its disposal. In case of diagnostic doubts or suspected secondary headache, the primary care physician or emergency medical have to refer the patient to be studied and/or treated for Neurology services, such referral shall be made with varying degrees of urgency depending on the presence, or not, of symptoms or signs of alarm. A working group consisting of Neurologists of Sociedad Andaluza de Neurología (SAN) to provide services in different hospitals in Andalucía and Family Physicians representatives of the Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFyC) and the Sociedad Española de Médicos de Atención Primaria (SEMERGEN Andalucía), has developed a Quick Guide headache, which addresses the more practical aspects for the diagnosis, treatment and monitoring of patients with headache. We show you in this paper, the chapter that deals the alarm criteria and referral.

Síndrome de ClusterTic. A propósito de um caso / No disponible

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Vincristine-induced acute neurotoxicity versus Guillain-Barré syndrome: a diagnostic dilemma.

We report the case of a patient with acute lymphoblastic leukaemia who, after the initiation of treatment with vincristine (VCR), developed a fulminant motor polyradiculoneuropathy resembling an axonal variant of Guillain-Barré syndrome (GBS). This report shows that differentiating between axonal GBS and VCR-induced acute neurotoxicity may be a challenge for clinicians.

[Cerebral haemorrhage in Sneddon's syndrome: case report and literature review]. / Hemorragia cerebral en el síndrome de Sneddon: caso clínico y revisión de la bibliografía.

INTRODUCTION: Sneddon's syndrome is the association between livedo reticularis and stroke. Hemorrhagic strokes in Sneddon's syndrome are exceptional. CASE REPORT: A 39-year-old woman who had had a livedo reticularis for about 14 years attended the Emergency Unit complaining of sudden, severe headache and numbness and weakness in her left extremities. Physical examination revealed left supranuclear facial palsy and left crural hemiparesis and hemihypoalgesia. Cranial CT showed a right parieto-occipital lobar haemorrhage. Immunological studies, including antiphospholipid antibodies, were negative. A cerebral angiography showed anomalies in most distal branches of intracranial arteries. Biopsies of the skin and digital arteries yielded non conclusive results. CONCLUSION: The association between livedo reticularis and stroke, together with the angiographic findings led us to the diagnosis of Sneddon's syndrome. When comparing our case with similar ones, we must point out to its onset with a hemorrhagic stroke and to the lobar location of the bleeding.

Hemorragia cerebral en el síndrome de Sneddon: caso clínico y revisión de la bibliografía / Cerebral haemorrhage in sneddon's syndrome: case report and literature review

Introducción. El síndrome de Sneddon es la asociación de livedo reticularis e ictus. Estos son casi siempre de naturaleza isquémica y, excepcionalmente, hemorrágicos. Caso clínico. Se trata de una mujer de 39 años de edad con dos abortos, hipertensión arterial mal controlada, tabaquismo y obesidad como antecedentes. Desde hacía unos 14 años presentaba una livedo reticularis y un fenómeno de Raynaud. Acudió a nuestro Servicio de Urgencias por un cuadro de cefalea intensa, de inicio brusco, junto a entumecimiento y debilidad de los miembros izquierdos. En la exploración física se objetivó una livedo reticularis generalizada y una focalidad neurológica consistente en parálisis facial supranuclear izquierda, hemiparesia izquierda de predominio crural y hemihipoalgesia y hemihipoestesia izquierdas. La tomografía axial computarizada craneal mostró un hematoma lobar parietooccipital derecho. La resonancia magnética craneal descartó otras lesiones. El estudio inmunológico, incluidos los anticuerpos antifosfolípido, resultó negativo. La arteriografía cerebral demostró la existencia de irregularidades en las ramas más distales de las arterias intracraneales. Las biopsias de piel y de arteria interdigital dieron resultados inespecíficos. Conclusión. La asociación en nuestra paciente de livedo reticularis e ictus, junto a los hallazgos angiográficos, justifican el diagnóstico de síndrome de Sneddon. Respecto a otros casos comunicados, destaca el inicio con un ictus hemorrágico y la localización lobar del sangrado (AU)

Introduction. Sneddon’s syndrome is the association between livedo reticularis and stroke. Hemorrhagic strokes in Sneddon’s syndrome are exceptional. Case report. A 39-year-old woman who had had a livedo reticularis for about 14 years attended the Emergency Unit complaining of sudden, severe headache and numbness and weakness in her left extremities. Physical examination revealed left supranuclear facial palsy and left crural hemiparesis and hemihypoalgesia. Cranial CT showed a right parieto-occipital lobar haemorrhage. Immunological studies, including antiphospholipid antibodies, were negative. A cerebral angiography showed anomalies in most distal branches of intracranial arteries. Biopsies of the skin and digital arteries yielded non conclusive results. Conclusion. The association between livedo reticularis and stroke, together with the angiographic findings led us to the diagnosis of Sneddon’s syndrome. When comparing our case with similar ones, we must point out to its onset with a hemorrhagic stroke and to the lobar location of the bleeding (AU)

Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis. A report of 50 cases.

This is the first large series, comprising 50 patients who suffered a total of 164 episodes, of pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis (PMP syndrome). Onset of PMP was between the ages of 14 and 39 years and was most frequent in males (68%). Eight males (24%) and five females (31%) had a personal history of migraine. One-quarter had had a viral-like illness up to 3 weeks prior to the onset of the syndrome. The clinical picture consisted of one to 12 episodes of changing variable neurological deficits accompanied by moderate-to-severe headache and occasionally fever. The headaches were described as predominantly throbbing and bilateral with variable duration (mean, 19 h). The mean duration of the transient neurological deficits was 5 h. Sensory symptoms were most common (78% of episodes), followed by aphasic (66%) and motor (56%) symptoms. Visual symptoms appeared in only 12% of episodes. The most frequent combinations were motor aphasia plus sensory and motor right hemibody symptoms (19% of episodes), motor aphasia plus right sensory symptoms (10%) and isolated right (9%) or left (9%) sensory symptoms. All patients were asymptomatic between episodes and following the symptomatic period (maximum duration 49 days). Lymphocytic pleocytosis ranged from 10 to 760 lymphocytic cells/mm3 CSF (mean, 199). In CSF, protein was increased in 96% of patients, IgG was normal in 80% of cases and oligoclonal bands were not found. Adensoine deaminase values were slightly above normal in two out of 16 patients tested. Extensive microbiological determinations, including viral HIV and borrelia serologies, were negative. Brain CT and MRI were always within normal limits, while EEG frequently showed focal slowing. Conventional cranial angiography was performed on 12 patients. In only one were there abnormalities suggestive of localized vascular inflammation, coincident with the focal neurological symptoms. Two patients developed PMP symptoms immediately after angiography. SPECT, performed on only three patients in the symptomatic period, revealed focal areas of decreased uptake consistent with the clinical symptoms. PMP aetiology remains a mystery; chronic arachnoiditis, viral meningoencephalitis or migraine are not plausible aetiological explanations. Because a number of patients had had a prodromic viral-like illness, we hypothesize here that such a viral infection could activate the immune system, thereby producing antibodies that would induce an aseptic inflammation of the leptomeningeal vasculature, possibly accounting for this clinical picture.

[Migraine with pleocytosis. Characteristics and etiopathogenesis. The Spanish experience and review of the literature]. / Migraña con pleocitosis. Análisis de sus características y etiopatogenia. La experiencia española y revisión de la literatura.

Since its first description in 1980, pseudomigraine syndrome with transient neurologic deficits and lymphocytic pleocytosis, or migraine with pleocytosis, has given rise to conflicting opinions regarding its possible etiology and place in the classification of headache. We describe the clinical profile of migraine with pleocytosis and its possible etiopathogenesis, with a broad survey of both Spanish cases and those reported in the English literature.

Computed tomographic brain scan findings in Q fever encephalitis.

Neurological involvement in Q Fever is unusual. We present a case of encephalitis due to Coxiella Burnetii with neuroradiologic findings on CT not described previously, consisting in areas of decreased absorption coefficient in the subcortical white matter of both hemispheres, predominantly in the right. Differential diagnosis must be established from viral encephalitis, of similar clinical presentation, which may show similar CT lesions to those in this case.