Estudio ultrasonográfico del nervio vago como herramienta diagnóstica en el síndrome de Guillain-Barré / Ultrasound study of the vagal nerve as a diagnostic tool in Guillain-Barré syndrome

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[Multiple abnormal innervation of the hand in one patient. Electrophysiological diagnosis]. / Inervacion anomala multiple de la mano en una paciente. Diagnostico electrofisiologico.

INTRODUCTION: Nerve anastomoses in the hand are deviations from the anatomical norm. They do not lead to illness, but still they are events related with electrodiagnostic difficulties and, due to their unexpected presentation, also with iatrogenesis in regional surgical interventions. CASE REPORT: We report the neurophysiological study conducted on a 45-year-old female who was found to have Riche-Cannieu-type motor anastomosis between the median and ulnar branches in the palm of the hand, complete innervation of the 4th finger by the ulnar nerve and complete innervation by the superficial radial of the back of the hand. CONCLUSIONS: Anatomical descriptions of abnormal innervations in the hand are frequent, especially of the sensory kind. They do not usually give rise to any problems, even when the communicating branch is injured, probably owing to the scant participation of axons that usually occurs in anastomosis. They are not difficult to recognise by means of electroneurography if we are aware of their different types and we have a good knowledge of the anatomical routes. This will enable us to develop accurate diagnostic protocols. Knowledge of these variants will prevent electrodiagnostic errors and surgical iatrogenic effects from occurring.

Mononeuritis múltiple en un paciente con síndrome de Churg-Strauss. Pseudobloqueos como expresión electroclínica temprana / Multiple mononeuritis in a patient with Churg-Strauss syndrome. Pseudo conduction block as an early electroclinical expression

Introducción. La mononeuritis múltiple es una de las manifestaciones más frecuentes del síndrome de Churg-Strauss. Caso clínico. En un varón de 53 años con síndrome de Churg-Strauss, se describe una mononeuritis múltiple aguda sensitivomotora de las cuatro extremidades. Mediante electrodiagnóstico en los primeros siete días se demostraron bloqueos de conducción en varios nervios. Los estudios posteriores objetivaron una polineuropatía axonal sensitivomotora difusa y bilateral con asimetrías, pero sin bloqueos. La electrofisiología y la histología, así como los estudios experimentales, indicaban que se trataba de una axonopatía secundaria a isquemia aguda. Conclusiones. Sólo en pocos casos, como en éste, y en estudios muy incipientes se han descrito bloqueos de conducción que, por su relación habitual con desmielinización, provocan confusión diagnóstica y pronóstica. La evolución suele demostrar una axonopatía por degeneración walleriana. Por tanto, en estos casos parece recomendable extremar la cautela y realizar estudios neurofisiológicos en las siguientes semanas para evitar inadecuados juicios diagnósticos y pronósticos (AU)

Introduction. Multiple mononeuritis is one of the most frequent manifestations of Churg-Strauss syndrome. Case report. We describe a case of acute sensory-motor multiple mononeuritis in all four limbs of a 53-year-old male with Churg-Strauss syndrome. Electrodiagnosis performed within the first seven days revealed conduction blocks in several nerves. Follow-up studies showed diffuse bilateral sensory-motor axonal polyneuropathy with symmetries, but without blocks. Electrophysiological and histological analyses, together with experimental studies, showed it to be an axonopathy secondary to acute ischaemia. Conclusions. In only a few cases, such as this one and in a small number of incipient studies, have there been reports of conduction blocks that, owing to the fact that they are commonly related with demyelination, give rise to confusion when it comes to diagnoses and prognoses. The condition usually displays axonopathy due to Wallerian degeneration. It therefore seems recommendable in these cases to proceed with caution and to perform neurophysiological studies in the following weeks in order to prevent inappropriate diagnostic and prognostic judgements from being formed (AU)

Periodic lateralized epileptiform discharges as manifestation of pneumococcal meningoencephalitis.

Periodic Lateralized Epileptiform Discharges (PLEDs) are usually seen in the context of destructive structural lesions of the cortex, more frequently in acute ischemic stroke and less common in tumours and meningoencephalitis, specially herpes simplex virus. Its origin and prognosis are uncertain but it is known that PLEDs are linked to epilectic seizures, including status epilepticus.We report on a 75-year old woman with pneumococcal meningoencephalitis who presented altered level of consciousness, acute focal deficits, convulsive seizures and PLEDs in left hemisphere. The finding of PLEDs on the electroencephalogram is related to focal lesions of heterogeneous origin, which up to date, have not been documented in pneumococcal infections of the central nervous system. Our case highlights the importance of identifying and addressing any modifiable etiologic factors of PLEDs.

[Multiple mononeuritis in a patient with Churg-Strauss syndrome. Pseudo conduction block as an early electroclinical expression]. / Mononeuritis múltiple en un paciente con síndrome de Churg-Strauss. Pseudobloqueos como expresión electroclínica temprana.

INTRODUCTION: Multiple mononeuritis is one of the most frequent manifestations of Churg-Strauss syndrome. CASE REPORT: We describe a case of acute sensory-motor multiple mononeuritis in all four limbs of a 53-year-old male with Churg-Strauss syndrome. Electrodiagnosis performed within the first seven days revealed conduction blocks in several nerves. Follow-up studies showed diffuse bilateral sensory-motor axonal polyneuropathy with symmetries, but without blocks. Electrophysiological and histological analyses, together with experimental studies, showed it to be an axonopathy secondary to acute ischaemia. CONCLUSIONS: In only a few cases, such as this one and in a small number of incipient studies, have there been reports of conduction blocks that, owing to the fact that they are commonly related with demyelination, give rise to confusion when it comes to diagnoses and prognoses. The condition usually displays axonopathy due to Wallerian degeneration. It therefore seems recommendable in these cases to proceed with caution and to perform neurophysiological studies in the following weeks in order to prevent inappropriate diagnostic and prognostic judgements from being formed.

[Metatarsalgia and neuropathies of the foot. Differential diagnosis]. / Metatarsalgias y neuropatías del pie. Diagnóstico diferencial.

INTRODUCTION: Metatarsalgia is the main symptom of a group of frequent ailments characterised by pain in the balls of the feet. Clinical knowledge and the availability of efficient complementary examinations are useful tools for the neurologist. AIM: To describe the range of processes related with metatarsalgia and a basic diagnostic schema that allows the aetiology to be differentiated. DEVELOPMENT: We perform an elementary review of the neurological anatomy of the foot and outline the different neuropathies affecting the region, as well as the extra neurological processes that could call for a differential diagnosis. CONCLUSIONS: Familiarity with the pathologies responsible for metatarsalgias, whether they are neurological or not, is an enriching element for the diagnosis and management of these patients, as well as for greater efficiency in the referral among the medical professionals involved.