[Combined anterior-posterior arthrodesis en patient with athetoid cerebral palsy who developed spondylotic cervical mielopathy. Case report and review of literature]. / Artrodesis combinada anterior y posterior en paciente con parálisis cerebral atetósica que desarrolla mielopatía cervical degenerativa. Caso clínico y revisión de la literatura.

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of cervical mielopathy in this subgroup of patients and a clinical case in which we decided to realize decompression and arthtrodesis by a combined anterior and posterior approach, with lateral-mass screw placement, using botulinium toxin injections in the postoperative period, achieving a good clinical outcome.

Artrodesis combinada anterior y posterior en paciente con parálisis cerebral atetósica que desarrolla mielopatía cervical degenerativa. Caso clínico y revisión de la literatura / Combined Anterior-Posterior arthrodesis en patient with athetoid cerebral palsy who developed spondylotic cervical mielopathy. Case Report and review of literature

La mielopatía cervical espondiloartrósica es una complicación frecuente en pacientes jóvenes afectados por parálisis cerebral infantil (PCI) que presentan un importante componente distónico y atetósico. Su tra- tamiento quirúrgico es problemático, caracterizado por tasas elevadas de fracaso precoz de la artrodesis, tanto en los abordajes anteriores como en los posteriores a la columna. Ofrecemos una revisión histórica del tratamiento de la mielopatía cervical en este subgrupo de pacientes, aportando un caso clínico en el que se ha decidido descomprimir y realizar artrodesis tanto por la vía anterior como por la vía cervical posterior, con fijación con tornillos a masas laterales, complementando el tratamiento quirúrgico con la inyección de toxina botulínica en el seguimiento postoperatorio, logrando un buen resultado clínico (AU)

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of cervical mielopathy in this subgroup of patients and a clinical case in which we decided to realize decompression and arthtrodesis by a combined anterior and posterior approach, with lateralmass screw placement, using botulinium toxin injections in the postoperative period, achieving a good clinical outcome (AU)

[Spinal pleomorphic xantoastrocytoma. Case report]. / Xantoastrocitoma pleomórfico espinal. Caso clínico.

INTRODUCTION: we report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma, an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature. CASE REPORT: a 60 years old woman consulted with doctor because she felt progressive clumsiness accompanied by occasional paresthesias on her left hand. Neurological examination showed up weakness and slight propioceptive disturbances. The differential imagine diagnosis was established between intramedullary astrocytoma and ependimoma. Patient underwent surgical gross total remove. Histopathological examination confirmed the diagnosis of pleomorfic xanthoastrocytoma. We performed MRI controls at 6, 12, 24 and 36 months that did not reveal recurrence. Nowadays, the patient has regained her previous quality of life. DISCUSSION AND CONCLUSION: comparing to published cases about intracranial pleomorphic xanthoastrocytomas, spinal pleomorphic xanthoastrocytomas (SPXA) present different epidemiological characteristics. The known SPXAs affected to cervical and/or high thoracic levels. The hypothesis about a more aggressive behaviour of PXA in spinal cord may be corroborated after literature review. Extension examination is mandatory since dissemination along the neuroaxis has been described. Removal extension is crucial in the prevention of tumour recurrence. Adyuvant radiotherapy should only be considered when there is postoperative residual tumour and/or anaplastic features. Randomized clinical trials or databases are necessary to know all the aspects of this pathological entity.

Xantoastrocitoma pleomórfico espinal. Caso clínico / Spinal pleomorphic xantoastrocytoma. Case report

Introducción. Presentamos los aspectos clinicopatológicos y radiológicos de uno de los escasos casos dexantoastrocitoma pleomórfico espinal publicado, una entidad neoplásica infrecuente en una realmente rara localización. Revisamos la breve literatura inglesa disponible y establecemos un apropiado manejo en función de ésta.Caso clínico. Mujer de 60 años de edad que consultó por acorchamiento progresivo de su mano izquierda, acompañado de ocasionales parestesias de dos meses de evolución. La exploración neurológica mostró debilidad y un leve trastorno de la sensibilidad propioceptiva de la extremidad superior derecha. El diagnóstico diferencial tras las pruebas de imagen se estableció entre astrocitoma y ependimoma. La paciente recibió tratamiento quirúrgico obteniéndose una resección completa y el diagnóstico de xantoastrocitoma pleomórfico. En los controles de imagen realizados a los 6, 12, 24 y 36 meses no seo bjetivó recidiva tumoral. Actualmente la paciente ha recuperado su calidad de vida previa.Discusión y conclusión. Comparando con los xantoastrocitomas pleomórficos intracraneales, aquellos con localización espinal (XAPE) presentan diferentes características epidemiológicas, con afectación predominante de niveles cervical y dorsal alto. La hipótesis de comportamiento más agresivo de los XAPE podría ser corroborada tras la revisión de la literatura. El estudio de extensión es fundamental para descartar la descrita diseminación a través del neuroeje. El grado de extensión de la resección quirúrgica es crucial en la prevención de la recurrencia tumoral. La radioterapia adyuvante debería únicamente considerarse cuando aparece tumor residual y/o anaplasia. Ensayos clínicos randomizados y bases de datos multicéntricas son necesariaspara conocer todos los aspectos de esta entidad neoplásica (AU)

Summary Introduction. We report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma,an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature.Case report. A 60 years old woman consulted with doctor because she felt progressive clumsiness accompanied by occasional paresthesias on her left hand.Neurological examination showed up weakness and slight propioceptive disturbances. The differential imagine diagnosis was established between intramedullary astrocytoma and ependimoma. Patient under went surgicalgross total remove. Histopathological examination confirmed the diagnosis of pleomorfic xanthoastrocytoma.We performed MRI controls at 6, 12, 24 and 36 months that did not reveal recurrence. Nowadays, the patient has regained her previous quality of life.Discussion and conclusion. Comparing to published cases about intracranial pleomorphic xanthoastrocytomas, spinal pleomorphic xanthoastrocytomas (SPXA)present different epidemiological characteristics. The known SPXAs affected to cervical and/or high thoraciclevels. The hypothesis about a more aggressive behaviour of PXA in spinal cord may be corroborated after literature review. Extension examination is mandatory since dissemination along the neuroaxis has been described.Removal extension is crucial in the prevention of tumour recurrence. Adyuvant radiotherapy should only be considered when there is postoperative residualtumour and/or anaplastic features. Randomized clinical trials or databases are necessary to know all the aspects of this pathological entity (AU)

Síndrome de Adie y nefropatía crónica / Adie syndrome and chronic nephropathy

No disponible

Papel de la cirugía descompresiva en el tratamiento de la compresión medular por metástasis / The role of decompressive surgery in the treatment of spinal cord compression due to metastasis

No disponible

No disponible

[Bilateral sixth nerve and left third nerve palsy after head trauma]. / Parálisis del VI par bilateral y III par izquierdo postraumático.

CASE REPORT: To describe a case of combined bilateral cranial nerve palsy of traumatic origin. To determine the lesions that produce the symptoms is useful to define the final prognosis and the best treatment. DISCUSSION: We report the case of a patient who developed a bilateral sixth nerve and left third nerve palsy after head trauma. The underlying lesion was a diffuse axonal injury. After an observation period during which no spontaneous improvement occurred, we administered botulinum toxin with a successful clinical result. Bilateral combined traumatic cranial nerve palsies are rare. When a diffuse axonal injury is present, the chance of spontaneous resolution is poor.

Parálisis del VI par bilateral y III para izquierdo postraumático / Bilateral sixth nerve and left third nerve palsy after nead trauma

Caso clínico: Describir un caso de parálisis bilateral combinada de origen traumático. Conocer las lesiones que ocasionan la clínica nos es útil para inferir el pronóstico final y tratamiento más adecuado.Discusión: Presentamos un paciente con una parálisis del III par izquierdo y VI par bilateral de origen traumático. El daño anatomofuncional era una lesión axonal difusa. Tras un período de observación sin presentar mejoría se realizó una inyección de toxina botulínica con la que mejoró clínicamente. Las lesiones de pares craneales combinadas y bilaterales traumáticas son infrecuentes. Si son por un daño axonal difuso las expectativas empeoran

Case report: To describe a case of combined bilateral cranial nerve palsy of traumatic origin. To determine the lesions that produce the symptoms is useful to define the final prognosis and the best treatment.Discussion: We report the case of a patient who developed a bilateral sixth nerve and left third nerve palsy after head trauma. The underlying lesion was a diffuse axonal injury. After an observation period during which no spontaneous improvement occurred, we administered botulinum toxin with a successful clinical result. Bilateral combined traumatic cranial nerve palsies are rare. When a diffuse axonal injury is present, the chance of spontaneous resolution is poor

[Neurochemical treatment of Parkinson's disease and essential tremor]. / Tratamiento neuroquirúrgico en la enfermedad de Parkinson y el temblor esencial.

INTRODUCTION: Recent technological advances along with new neuroimaging techniques and progress in neuro-monitoring have provided us with new therapeutical options from the neurosurgical point of view in the management of movement disorders. Deep brain stimulators become more and more frequently used in the last few years since they have reversible effects, are easily implantable and have shown good initial results. However, only now we start knowing the clinical effects in the middle run. AIM: To review the main neurosurgical options in Parkinson's disease and tremor. DEVELOPMENT: We reviewed the articles considering ablative or stimulating neurosurgical treatments in these diseases, and we grouped the results according to the technique performed and the time of follow-up. CONCLUSION: Clinical results are often similar despite the use of different techniques. However, the side-effects are critical in deciding which technique should be used once medical therapy has been considered insufficient.

[Guillain-Barre syndrome following resection of glioblastoma multiforme]. / Síndrome de Guillain-Barré tras resección de glioblastoma multiforme.

INTRODUCTION: Guillain-Barre syndrome (GBS) is an acute demyelinating polyneuropathy characterised by progressive muscular weakness and areflexia. Although the pathogenesis is uncertain, it is probably secondary to an aberrant immunological response to components of the peripheral nervous system. GBS has been linked to bacterial or viral infections, systemic diseases, neoplasias, pregnancy, traumatic injuries or organ transplant. An association with intracranial surgery has been reported, but this is exceptional. CASE REPORT: We report the case of a 67-year-old male submitted to surgical intervention due to a right-side occipital-parietal glioblastoma. The patient was well until ten days after the intervention, when he presented a rapidly progressive are flexive paraparesis with an ascending course. A spinal tap revealed cerebrospinal liquid with an elevated protein level and albuminocytologic dissociation. The electromyogram study and lumbar magnetic resonance with contrast confirmed the suspected diagnosis of GBS. After establishing treatment with immunoglobulins the patient progressed well and recovered quickly and completely from the paresis. CONCLUSIONS: GBS may appear after intracranial surgery and make it more difficult to reach a differential diagnosis with other entities. To optimise the prognosis, treatment must begin as early as possible. Intravenous immunomodulation with immunoglobulins or plasma exchange are effective in shortening the course of the disease.

Síndrome de Guillain-Barré tras resección de glioblastoma multiforme / Guillain-Barre síndrome following resection of gliobastoma multiforme

Introducción. El síndrome de Guillain-Barré (SGB) consiste en una polineuropatía desmielinizante aguda caracterizada por debilidad muscular y arreflexia progresivas. Aunque la patogénesis es incierta, probablemente es secundaria a una respuesta inmunológica aberrante frente a componentes del sistema nervioso periférico. El SGB se ha relacionado con infecciones bacterianas o virales, enfermedades sistémicas, neoplasias, embarazo, trauma o trasplante de órganos. Se ha descrito la asociación con cirugía intracraneal, pero es excepcional. Caso clínico. Se trata de un varón de 67 años intervenido de un glioblastoma parietooccipital derecho. Se encontraba previamente bien, pero diez días después de la cirugía presentó una paraparesia arrefléctica rápidamente progresiva y de curso ascendente. La punción lumbar mostró un líquido con aumento proteico y disociación albuminocitológica. El estudio de electromiografía y la resonancia magnética lumbar con contraste confirmaron la sospecha diagnóstica de SGB. Después de instaurar un tratamiento con inmunoglobulinas, el paciente experimentó una buena evolución, con rápida y completa recuperación de la paresia. Conclusiones. El SGB puede aparecer tras la cirugía intracraneal y dificultar el diagnóstico diferencial con otras entidades. Para optimizar el pronóstico, el tratamiento debe comenzar lo antes posible. La inmunomodulación intravenosa con inmunoglobulinas o recambio de plasma acorta el curso de la enfermedad de manera efectiva (AU)

Introduction. Guillain-Barre syndrome (GBS) is an acute demyelinating polyneuropathy characterised by progressive muscular weakness and areflexia. Although the pathogenesis is uncertain, it is probably secondary to an aberrant immunological response to components of the peripheral nervous system. GBS has been linked to bacterial or viral infections, systemic diseases, neoplasias, pregnancy, traumatic injuries or organ transplant. An association with intracranial surgery has been reported, but this is exceptional. Case report. We report the case of a 67-year-old male submitted to surgical intervention due to a right-side occipital-parietal glioblastoma. The patient was well until ten days after the intervention, when he presented a rapidly progressive areflexive paraparesis with an ascending course. A spinal tap revealed cerebrospinal liquid with an elevated protein level and albuminocytologic dissociation. The electromyogram study and lumbar magnetic resonance with contrast confirmed the suspected diagnosis of GBS. After establishing treatment with immunoglobulins the patient progressed well and recovered quickly and completely from the paresis. Conclusions. GBS may appear after intracranial surgery and make it more difficult to reach a differential diagnosis with other entities. To optimise the prognosis, treatment must begin as early as possible. Intravenous immunomodulation with immunoglobulins or plasma exchange are effective in shortening the course of the disease (AU)