[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.

[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.

[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.

[Syndromes involving rostral occlusion of the basilar artery: a preliminary study and proposal for a new clinical and neuro- radiological classification]. / Síndromes por oclusión rostral de la arteria basilar: estudio preliminar y propuesta de una nueva clasificación cliniconeurorradiológica.

Occlusion of the top of the basilar artery causes infarctions in supra- and infra-tentorial regions (thalamus, occipito-temporal lobes, rostral trunk and cerebellum) with characteristic clinical and radiological manifestations. We studied 17 patients with this syndrome whose clinical data and neurological images led us to classify them into four groups: type I (2 patients, 12%), showing mainly alterations in consciousness and ocular motricity, and bilateral thalamic infarction; type II (6 patients, 35%), with campimetric manifestations and uni- or bilateral ischemia of the occipito-temporal lobes; type III (5 patients, 29%), with associated corticospinal deficits and lacunar images in the rostral brainstem; and type IV (4 patients, 24%) with symptoms of and neuro-images revealing lesions in the cerebellum. The proposed classification is an attempt to facilitate diagnosis by neuro-imaging and to group patients according to prognosis.

[Benign evolution of a spontaneous vermian hematoma using conservative treatment]. / Evolución benigna de un hematoma vermiano espontáneo con tratamiento conservador.

Spontaneous intracerebellar haematomas are a relatively unusual cause of haemorrhagic stroke. The uncommon variety of vermian haematomas (5%) represents a serious diagnostic and treatment challenge and its outcome is generally poor, being the result of rapid elevation of intracranial pressure and brainstem compression. A rare case of spontaneous vermian haematoma with benign course without surgery is reported, including the results of neuroimaging tests.