Spontaneous intracranial hypotension syndrome treated with a double epidural blood patch.

Spontaneous intracranial hypotension (SIH) is considered to be a very rare disease. It is characterised by an orthostatic headache in the absence of a past history of a trauma or a dural puncture. SIH is caused by a spontaneous spinal cerebrospinal fluid (CSF) leakage demonstrated by neuroradiological studies in most of the patients. Conservative treatment usually includes bed rest, hydration and administration of caffeine or steroids. However, when the patient is refractory to the conservative treatment, an epidural blood patch (EBP) is performed. We report a 34-year-old woman with SIH and no neuroradiologically demonstrable clear point of CSF leakage, who was treated with a double EBP at two different levels (lumbar and thoracic) in the same procedure. The patient was successfully managed, and she was still asymptomatic at the 18 months follow-up. After review of literature, we observed that execution of a double EBP at the same time is not a common procedure for treatment of SIH. We consider that simultaneous use of two EBP could be useful as a novel treatment in those cases of SIH without demonstration of CSF leakage.

Impairment of rapid repetitive finger movements and visual reaction time in patients with essential tremor.

BACKGROUND AND PURPOSE: The question whether patients with essential tremor (ET) have slowed movements as part of their clinical manifestations is still a matter of controversy. We analyzed basic motor function in patients with ET and in healthy matched controls. METHODS: We studied 61 patients with ET and 122 age- and sex-matched controls. Evaluation included four timed tests (pronation-supination, finger tapping and movement between two points, all with both hands, and walking test); and three tests performed on a personal computer (speed for pressing repetitively a key - frequency, visual reaction time and movement time, all with both hands). RESULTS: Essential tremor patients showed higher mean values for right and left finger tapping, left movement between two points; and with right and left frequency and reaction time. In the logistic regression study, ET patients showed significantly higher values than controls for right and left finger tapping; mean, SD, maximum and rank values of right and left frequency; and mean, SD, minimum, maximum and rank values of right and left visual reaction time. Tremor severity was not correlated with the altered values. CONCLUSIONS: Patients with ET showed impaired motor performance, at least in some tasks, such as rapid repetitive finger movements (finger tapping and frequency) and visual reaction time (impairment was not related with tremor severity). This probably means that patients with ET have some degree of bradykinesia.

[Historical study of delirium tremens in Spain in the second half of the 19th century]. / Estudio histórico del delirium tremens en España durante la segunda mitad del siglo XIX.

The authors, after a brief historical introduction, review the clinical contributions about Delirium Tremens during the second half of the XIXth century in 9 Saniard authors: J. Santamaría del Alba (1952), Inocente Escudero (1857), R. Sanfrutos (1858), Tomás Santero y Moreno (1867), Candela (1871), Robert (1871), José Armesto (1877), J. M. Castañeda (1879-1880), R. B. de la Roche (1881). It is appropriate to underline their tidying up and clinical interest, medical-pathological and general, their interest in the evolutionary course, their therapeutical empiricism and a certain indifference in framing this nosological entity in a doctrinal corpus more specific, except for Robert, who use the chloral hydrate only two after its introduction in medicine by Liebreich and De la Roche, who complains about absence of a monographic study and explains it according to the anatomic-clinical model of the General Pathology of his epoch, in a appropriate bibliographical context. Included are 12 tables and 27 bibliographical references.

[Historical study of seven cases of delirium tremens in Spain in the first half of the XIX century]. / Estudio histórico de siete casos de Delirium tremens en España durante la primera mitad del siglo XIX.

The authors in the introduction provide an schematic historical scope of reference about the spaniard and european psychiatry from the XVIIIe to the XIXe century. They described the first seven clinical cases of Delirium found by them and published by spaniard physicians in the first half of the XIXe century. They revised mainly the clinical sintomatology, course and evolution, and went into deep detail in the hygienic-dietetical and pharmacological therapeutics used in this period, specially several galenic preparations of opium, tartarus emeticus, cremor, etc. Serapio Escolar y Morales (1808-1874) described the first clinical case of Delirium Tremens in 1839 in a 28 year old man, raising the differential diagnosis between intermittent fever, epilepsy and meningitis, and proposed a useless antiflogistic treatment (bleeding, leeches, poultice) and opium. The second case was described by an anonymous author (J.M.S.Z.) in 1845 in a 42 year old man. Francisco Castellvi y Pallares (1812-1879), in 1845, published another case in a 34 year old male, with an adequate description of the natural history of the disease, healing in 19 days with high doses of watery opium extract. The fourth clinical case was described by R.C.B. in 1846 in a 60 year old man with "alcoholic chorea", "ataxis fever" being the only one with a mortal outcome, treated also with opiates which he did not agree with. The fifth and sixth cases were published by Uliberry in 1847 in two males, 38 and 36 years old respectively. The seventh and last case was described in 1848 by F. Paula Barea, having to highlight the nosological, nosographical and evolutive perspectives in 3 clinical periods and a fourth of convalescence, the treatment differences and the etiopathogenical considerations. Included are 9 tables, 2 graphics and 29 bibliographical references.