[Nonbacterial thrombotic endocarditis as initial event of lung cancer]. / Endocarditis trombótica no bacteriana como manifestación inicial de neoplasia pulmonar.

Nonbacterial thrombotic endocarditis (NBTE) is a rare cause of peripheral embolism. NBTE is usually associated with malignant diseases and hypercoagulability states. Echocardiography is a very useful technique for the diagnosis. However valvular lesions in NBTE are similar to valvular vegetations observed from infectious endocarditis (IE), so it s necessary to establish a differential diagnosis. The treatment of thrombotic endocarditis is controversial, but the literature coincides in the use of intravenous heparin. We describe the case of a 42 years old woman with stroke in which transesophageal echocardiography (TEE) was useful in establishing the diagnosis of NBTE. The infectious origin was excluded with the realization of a exhaustive microbiologic study. In the search of causes for NBTE a lung adenocarcinoma was detected. In the present case the diagnosis of endocarditis preceded the neoplastic disease diagnosis.

[Cerebellar degeneration associated with anti-Tr antibodies without Hodgkin's disease. Four years follow-up]. / Degeneración cerebelosa con anticuerpos anti-Tr positivos sin linfoma de Hodgkin asociado. Seguimiento durante 4 años.

The presence of antineuronal anti-Tr antibodies is associated to paraneoplastic cerebellar degeneration due to Hodgkin's disease. The anti-Tr can become negative after successful and early treatment of the tumor, and there could even be remission of the cerebellar symptoms in some patients. There are few cases in which no tumor is found when there are anti-Tr. We report the case of a 66 year old man with a severe cerebellar syndrome and anti-Tr in serum detected by immunohistochemistry. After a 4 year follow-up, no underlying tumor has been found. In addition, anti-Tr spontaneously disappeared. The cerebellar degeneration persists and is incapacitating. This case suggests that in a few instances the origin of anti-Tr is not a tumor but another unknown cause. Alternatively the anti-Tr mediated immune response could have eradicated the underlying lymphoma.

Endocarditis trombótica no bacteriana como manifestación inicial de neoplasia pulmonar / Nonbacterial thrombotic endocarditis as inital event of lung cancer

La endocarditis trombótica no bacteriana (ETNB) es una causa poco frecuente de embolismo sistémico cuya presencia suele asociarse a enfermedades malignas y estados de hipercoagulabilidad. La ecocardiografía constituye una técnica útil para el diagnóstico. Sin embargo las lesiones valvulares de la ETNB son ecográficamente indistinguibles de las vegetaciones observadas en la endocarditis infecciosa (EI), por lo cual es necesario establecer un diagnóstico diferencial con esta entidad. El tratamiento de la endocarditis trombótica es controvertido coincidiendo la literatura en el uso de heparina intravenosa. Presentamos el caso de una paciente de 42 años de edad con infartos isquémicos cerebrales múltiples, en la cual la realización una ecocardiografía transesofágica (ETE) ayudó a establecer el diagnóstico de ETNB. La etiología infecciosa fue descartada tras practicar un estudio microbiológico exhaustivo. En la búsqueda de patologías causantes o relacionadas con la ETNB se encontró la presencia de un adenocarcinoma pulmonar como enfermedad subyacente (AU)

[Alien hand syndrome in Creutzfeldt-Jakob disease]. / Síndrome de la mano alienígena en la enfermedad de Creutzfeldt-Jakob.

Alien hand syndrome is defined by uncontrolable actions of the arm and hand that seem to have a purpose. It is usually associated with acute focal lesions after a stroke or surgery of the corpus callosum. It has been described in chronic dementiating diseases such as cortico-basal degeneration, Alzheimer's disease, orthochromatic leukodystrophy and Marchiafava-Bignami disease. We now report a patient with Creutzfeldt-Jakob disease and alien hand syndrome, which appeared after the cognitive alterations and had characteristics of the frontal type of alien hand affecting the dominant upper limb. In the three cases described previously in the literature the alien hand affected the non-dominant hand and the abnormal movement appeared before dementia was clinically obvious. The non specific nature and poorly localising sign of alien hand is remarked. Alien hand should be added the list of features of Creutzfeldt-Jakob disease.

Síndrome de la mano alienígena en la enfermedad de Creutzfeldt-jakob / Alien hand syndrome in CreutzfeldtJakob disease

El síndrome de la mano alienígena se caracteriza por acciones incontroladas del brazo y la mano que parecen tener un propósito. La extrañeza que causa al sujeto esa extremidad y sus acciones define a este síndrome. Se asocia habitualmente a lesiones focales agudas tras ictus y a tumores o cirugía sobre el cuerpo calloso. También se ha descrito en enfermedades crónicas demenciantes como la degeneración corticobasal, la enfermedad de Alzheimer, la leucodistrofia ortocromática y la enfermedad de Marchiafava-Bignami. Describimos el caso de un paciente con enfermedad de Creutzfeldt-Jakob y síndrome de la mano alienígena que aparece con posterioridad a la alteración cognitiva y que reúne características de mano alienígena en su variante frontal con afección de mano dominante. En los tres casos previamente descritos en la bibliografía la afección fue de la mano no dominante y este movimiento anormal precedió al deterioro cognitivo. Se señala la inespecifidad de este síndrome en cuanto a etiología y valor localizador. Sugerimos que la mano alienígena debe considerarse como una de las posibles manifestaciones de la enfermedad de Creutzfeldt-Jakob (AU)

[Hemicrania continua]. / Hemicránea continua.

Hemicrania continua is a very rare headache and, as its name implies, is characterised by a continuous, unilateral headache of moderate severity. In most patients, attacks of more intense pain are superimposed. These last from minutes to several days and are sometimes associated with autonomic features. In this review, we shall try to clarify the clinical and pathophysiological features, the nosology, the differential diagnosis and the treatment of this entity.

[Chondrosarcoma of the thyroid cartilage. Presentation of a case and review of the literature]. / Condrosarcoma de cartílago tiroides. Presentación de un caso y revisión de la literatura.

We present a case of Thyroid cartilage Chondrosarcoma with growing out, without injury of intralaryngeal noble structures and whose symptom of presentation was a cervical tumour. We review the cases of thyroid cartilage Chondrosarcomas in the literature.

[Extracranial primary meningioma. Presentation of a case of nasoethmoid localization]. / Meningiomas primarios extracraneales. Presentación de un caso de localización nasoetmoidal.

A case is presented of primary meningioma situated in the right nasal ethmoid. Clinical and radiological studies, as well as histopathological and ultrastructural examinations of the piece to be operated upon confirm definite diagnosis. The word is concluded by a bibliographical revision of the subject.