[Iodinated contrast-induced encephalopathy: a pathology that must be borne in mind when carrying out endovascular examinations]. / Encefalopatia por contraste iodado: una patologia que se debe tener en cuenta en el desarrollo de las exploraciones endovasculares.

INTRODUCTION: In recent years there has been an increase in the number of endovascular examinations in the study of both cardiovascular and cerebrovascular diseases. One very infrequent complication is neurotoxicity due to contrast, and it must be suspected within the context of a neurological deficit following such examinations in order to be able to diagnose it. CASE REPORT: A 61-year-old male who presented an epileptic attack and later deficit in the left hemisphere following diagnostic arteriography. After ruling out the possibility of an urgent vascular pathology, he was submitted to a magnetic resonance brain scan with the suspicion of this condition. The clinical signs and symptoms were limited to 72 hours with cortisone therapy. CONCLUSIONS: Contrast-induced encephalopathy covers a wide range of clinical features which, in the vast majority of cases, are self-limiting to 24-72 hours, and within the context of neuronal damage following contrast infusion. Its prognosis is excellent, and diagnostic suspicion is crucial in its treatment.

TITLE: Encefalopatia por contraste iodado: una patologia que se debe tener en cuenta en el desarrollo de las exploraciones endovasculares.Introduccion. En los ultimos años ha aumentado el numero de exploraciones endovasculares en el estudio de la patologia tanto cardiovascular como cerebrovascular. Una de las complicaciones poco frecuentes es la neurotoxicidad por contraste y su sospecha resulta imprescindible en el contexto de un deficit neurologico tras dichas exploraciones para llegar a su diagnostico. Caso clinico. Varon de 61 años que tras una arteriografia diagnostica en el estudio de una hemorragia subaracnoidea presento una crisis epileptica y posteriormente deficit hemisferico izquierdo. Tras descartar una patologia vascular urgente, se realizo una resonancia magnetica cerebral con sospecha de encefalopatia poscontraste. La clinica se limito en 72 horas con corticoterapia. Conclusiones. La encefalopatia por contraste abarca un amplio espectro clinico, en la inmensa mayoria de los casos autolimitado en 24-72 horas, y en el contexto del daño neuronal tras la infusion de contraste. Su pronostico es excelente y la sospecha diagnostica es vital en el tratamiento.

Exploración neurológica y atención primaria. Bloque II: motilidad voluntaria, funciones corticales superiores y movimientos anómalos / Neurological examination and primary care. Block II: voluntary motility. Higher cortical functions. Abnormal movements

La exploración neurológica es, junto con la anamnesis, la base del diagnóstico de la patología del sistema nervioso. El médico de Atención Primaria, con un acceso limitado a pruebas de alta resolución, debe de conocer los aspectos más importantes de dicha exploración, siendo importante que esta se realice de manera sistemática.En un primer bloque se abordó la exploración de los pares craneales, la sensibilidad, los signos meníngeos, el cerebelo y la coordinación, y en esta segunda parte se analizan la función motora, las funciones corticales superiores y los movimientos anómalos (AU)

The neurological examination is, along with the anamnesis, the basis of the diagnosis of nervous system disease. The Primary Care doctor, with limited access to high resolution tests, must know the most important aspects of this examination; the most important being that this is carried out systematically. In the first Block, the examination of the cranial pairs, sensitivity, meningeal signs, cerebellum and coordination were looked at. In this second Block, motor function, higher cortical functions and abnormal movements are analysed (AU)

Exploración neurológica y atención primaria. Bloque I: pares craneales, sensibilidad, signos meníngeos. Cerebelo y coordinación / Neurological examination and primary care. Part 1: cranial pairs, sensitivity, meningeal signs, cerebellum and coordination

La exploración neurológica es, junto con la anamnesis, la base del diagnóstico de la patología del sistema nervioso. El médico de atención primaria, con un acceso limitado a pruebas de alta resolución, debe de conocer los aspectos más importantes de dicha exploración, siendo importante que ésta se realice de manera sistemática. Para una mejor compresión se ha dividido los diferentes apartados de la exploración neurológica en dos bloques: un primer bloque en el que se abordan la exploración de los pares craneales, la sensibilidad, signos meníngeos, cerebelo y coordinación, y un segundo bloque en que se analizan la función motora, las funciones corticales superiores y los movimientos anómalos (AU)

The neurological examination is, along with the anamnesis, the diagnostic basis of diseases of the nervous system. The Primary Care physician, with limited access to high resolution tests, must know the most important aspects of this examination. It is important that this examination is performed systematically. For a better understanding, the different sections of the neurological examination has been divided into two parts: the first one looks at the examination of the cranial pairs, sensitivity, meningeal signs, cerebellum and coordination, and the second will analyse motor function, higher cortical functions, and abnormal movements (AU)

Endometriomas de la pared abdominal. Revisión de una serie de 17 casos / Abdominal wall endometriomas. Report of 17 cases

Introducción: La endometriosis se caracteriza por la presencia de tejido endometrial fuera del cuerpo uterino. Su frecuencia oscila del 3 al 15% de las mujeres en edad fértil. La localización más habitual es la intraabdominal, pero puede presentarse en forma de nódulos dolorosos en la pared abdominal, cicatrices de intervenciones previas, fundamentalmente ginecológicas u obstétricas, o como nódulos inguinales o umbilicales. El objetivo del presente trabajo es revisar su incidencia, localización, clínica y tratamiento. Pacientes y métodos: A partir de un nuevo caso de endometrioma, originado en una cicatriz de Pfannenstiel, se revisan 17 casos diagnosticados desde 1990, analizando su forma de presentación y características clínicas, así como las diferentes teorías etiopatogénicas. Resultados: Desde 1990 se han intervenido 17 casos de endometriomas de pared abdominal, 2 localizados a nivel umbilical, 4 en la región inguinal y 11 tumoraciones en cicatrices de intervenciones quirúrgicas previas, ginecológicas u obstétricas. En la mayoría de los casos se trató de un hallazgo casual dentro del acto quirúrgico y en 4 casos se realizó una tomografía computarizada (TC) abdominal previa al tratamiento quirúrgico. El tratamiento consistió en exéresis amplia de la lesión. Posteriormente todas las pacientes fueron derivadas al servicio de ginecología para completar su estudio y tratamiento. Conclusiones: A pesar de que la incidencia de endometriomas de pared abdominal es baja, ante cualquier nódulo de características anómalas en la región inguinal o umbilical, o tumoración sobre cicatriz ginecológica u obstétrica en una mujer de edad fértil, se ha de sospechar la presencia de un endometrioma. La TC abdominal y la punción-aspiración con aguja fina pueden ayudar al diagnóstico. El tratamiento es quirúrgico (AU)

Background: Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. This finding occurs in 3 to 15% of women of reproductive age, and is most frequently located in the abdominal cavity. Occasionally, endometriosis is present as a painful mass in the abdominal wall, near a surgical scar, or in the umbilical or inguinal area. The aim of the present study was to review the incidence, location, symptoms and treatment of abdominal wall endometriomas in our center. Patients and methods: Prompted by a new case of endometrioma arising from a Pfannenstiel scar, we reviewed 17 cases of abdominal wall endometrioma (AWE) diagnosed since 1990, Symptoms, location, clinical findings, and the various etiopathogenic theories were analyzed. Results: Since 1990, 17 patients with AWE underwent surgery. Two endometriomas were located in the umbilical area, 4 in the inguinal region, and 11 arose from surgical scar sites from prior gynecological or obstetric surgery. Most of the tumors were incidental findings during surgical procedures. Preoperative diagnosis with computed tomography (CT) scan was made in 4 patients. Treatment was wide surgical excision. All patients were subsequently referred to the gynecology service for follow-up and further treatment. Conclusions: Although AWE are uncommon, these tumors should be suspected in women of reproductive age with any mass in the inguinal or umbilical region, or near a gynecologic or obstetric scar. Abdominal CT scanning and fine-needle biopsy may confirm the diagnosis. Treatment consists of surgical excision (AU)

[Recurrent aseptic meningitis secondary to taking ibuprofen and ketorolac]. / Meningitis recurrente aséptica secundaria a toma de ibuprofeno y ketorolaco.

INTRODUCTION: Aseptic meningitis is a process that is characterised by an inflammatory reaction of the meninges that is not due to any infectious agent. Its aetiology is varied and is most frequently caused by rheumatologic and/or autoimmune processes, chemical or medication-induced meningitis, the most notable drugs involved being antibiotics and non-steroidal anti-inflammatory drugs (NSAI). CASE REPORT: We report the case of a 70-year-old male, with no relevant history, who was admitted to hospital five times over a period of 16 months because of acute meningitis with polymorphonuclear pleocytosis, high protein levels in cerebrospinal fluid and normal glucose in cerebrospinal fluid. No evidence of an infectious causation, chemical meningitis, carcinomatosis or autoimmune disease was found and the patient was diagnosed with recurrent aseptic meningitis. It was found that the patient had taken ibuprofen or ketorolac on several occasions, a few hours before the appearance of symptoms. These episodes were quickly resolved after withdrawal of this medication. CONCLUSIONS: A number of NSAI have been reported as inducers of aseptic meningitis, one of the most notable being ibuprofen. We report the case of a patient who, as a consequence of taking ibuprofen and ketorolac, presented episodes of recurrent aseptic meningitis. To our knowledge this side effect of ketorolac has not been reported before. Its clinical features are impossible to differentiate from those of infectious meningitis. Diagnosis is reached by exclusion and a careful pharmacological study, including over-the-counter drugs like some of the NSAI, must be performed in patients with this condition, since it is a problem that can easily be solved by withdrawing the drug that causes it.

Meningitis recurrente aséptica secundaria a toma de ibuprofeno y ketorolaco / Recurrent aseptic meningitis secondary to taking ibuprofen and ketorolac

Introducción. La meningitis aséptica es un proceso que se caracteriza por una reacción inflamatoria meníngea no causada por ningún agente infeccioso. Su etiología es variada, y la más frecuente es la secundaria a procesos reumatológicos y/o autoinmunes, meningitis química e inducida por fármacos, entre los que destacan los antibióticos y los antiinflamatorios no esteroideos (AINE). Caso clínico. Varón de 70 años de edad, sin antecedentes relevantes, que en el período de 16 meses ingresó en cinco ocasiones por meningitis aguda con pleocitosis polimorfonuclear, hiperproteinorraquia y glucosa normal en el líquido cefalorraquídeo, en las que se descartó una etiología infecciosa, meningitis química, carcinomatosis o enfermedad autoinmune y se le diagnosticó meningitis aséptica recurrente. Se comprobó la toma de ibuprofeno o ketorolaco en distintas ocasiones, unas pocas horas antes de la aparición de la clínica. Estos episodios se resolvieron rápidamente tras la retirada de dicha medicación. Conclusiones. Se han implicado varios AINE como inductores de meningitis aséptica, entre los que destaca el ibuprofeno. Presentamos un paciente que, como consecuencia de la toma de ibuprofeno y ketorolaco, sufrió episodios de meningitis recurrente aséptica. En nuestro conocimiento no se ha comunicado previamente este efecto secundario con el ketorolaco. Su clínica es indistinguible de la meningitis infecciosa; el diagnóstico se efectúa por exclusión, y debe realizarse una cuidadosa historia farmacológica, que incluya fármacos de libre dispensación como algunos AINE, en pacientes con esta patología, puesto que se trata de un problema fácilmente solucionable con la retirada de la medicación que lo causa (AU)

Introduction. Aseptic meningitis is a process that is characterised by an inflammatory reaction of the meninges that is not due to any infectious agent. Its aetiology is varied and is most frequently caused by rheumatologic and/or autoimmune processes, chemical or medication-induced meningitis, the most notable drugs involved being antibiotics and non-steroidal anti-inflammatory drugs (NSAI). Case report. We report the case of a 70-year-old male, with no relevant history, who was admitted to hospital five times over a period of 16 months because of acute meningitis with polymorphonuclear pleocytosis, high protein levels in cerebrospinal fluid and normal glucose in cerebrospinal fluid. No evidence of an infectious causation, chemical meningitis, carcinomatosis or autoimmune disease was found and the patient was diagnosed with recurrent aseptic meningitis. It was found that the patient had taken ibuprofen or ketorolac on several occasions, a few hours before the appearance of symptoms. These episodes were quickly resolved after withdrawal of this medication. Conclusions. A number of NSAI have been reported as inducers of aseptic meningitis, one of the most notable being ibuprofen. We report the case of a patient who, as a consequence of taking ibuprofen and ketorolac, presented episodes of recurrent aseptic meningitis. To our knowledge this side effect of ketorolac has not been reported before. Its clinical features are impossible to differentiate from those of infectious meningitis. Diagnosis is reached by exclusion and a careful pharmacological study, including over-thecounter drugs like some of the NSAI, must be performed in patients with this condition, since it is a problem that can easily be solved by withdrawing the drug that causes it (AU)

[Aphasia and parietal syndrome as the presenting symptoms of a demyelinating disease with pseudotumoral lesions]. / Afasia y síndrome parietal como forma de presentación de una enfermedad desmielinizante con lesión pseudotumoral.

INTRODUCTION: Multiple sclerosis (MS) often presents with sensory symptoms, which are usually due to spinothalamic or spinal cord disorders; parietal syndrome is, however, very rare as the initial symptom. Likewise, aphasia is also an infrequent symptom of MS; in the few cases that have been reported, it is usually linked to the existence of important pseudotumoral lesions. CASE REPORT: We describe the case of a 31-year-old female with a 48-hour history of a progressive clinical picture consisting in nominal aphasia and a sensory parietal syndrome. Magnetic resonance imaging showed a lesion 3.6 cm in diameter that was hyperintense in T2 with perilesional edema and minimal gadolinium uptake, along with other images that revealed increased signal intensity in the periventricular subcortical white matter on the right-hand side and in the left-hand frontal subcortical region. A spectroscopic analysis of the largest lesion revealed that this lesion showed evidence of inflammation, with cell destruction and replacement, although it was not possible to distinguish between a demyelinating disease and a high grade glioma. Hence, a brain biopsy was required in order to reach the final diagnosis of demyelinating pseudotumoral lesion. CONCLUSIONS: Giant pseudotumoral plaques are a rare form of presenting symptom in MS; use of the clinical features, simple images and spectroscopy is not a very reliable means of reaching a differential diagnosis with a tumour and this often makes it necessary to conduct a biopsy study of the lesion.

Afasia y síndrome parietal como forma de presentación de una enfermedad desmielinizante con lesión pseudotumoral / Aphasia and parietal syndrome as the presenting symptoms of a demyelinating disease with pseudotumoral lesions

Introducción. Las manifestaciones sensitivas son frecuentes como síntomas iniciales de la esclerosis múltiple (EM), generalmente por alteración espinotalámica o medular; pero es excepcional un síndrome parietal como forma de inicio. Igualmente, la afasia es una manifestación infrecuente en la EM; en los pocos casos descritos suele asociarse a la existencia de grandes lesiones pseudotumorales. Caso clínico. Mujer de 31 años con un cuadro progresivo de 48 horas de evolución, consistente en afasia nominal y un síndrome sensitivo parietal. En la resonancia magnética se observó una lesión de 3,6 cm de diámetro hiperintensa en T2 con edema perilesional y con mínima captación de gadolinio, además de otras imágenes de aumento de intensidad de señal en sustancia blanca subcortical periventricular derecha y en zona subcortical frontal izquierda. El análisis espectroscópico de la lesión de mayor tamaño reveló que dicha lesión presentaba datos de inflamación, con destrucción y recambio celular, sin poder distinguir entre enfermedad desmielinizante o glioma de alto grado; se precisó para ello la realización de una biopsia cerebral para alcanzar el diagnóstico final de lesión pseudotumoral desmielinizante. Conclusiones. Las placas gigantes pseudotumorales constituyen una forma infrecuente de inicio de la EM; su diagnóstico diferencial con un tumor por la clínica, la imagen simple y la espectroscopia son poco fiables, por lo que, con frecuencia, es preciso recurrir a la biopsia de la lesión

Introduction. Multiple sclerosis (MS) often presents with sensory symptoms, which are usually due to spinothalamic or spinal cord disorders; parietal syndrome is, however, very rare as the initial symptom. Likewise, aphasia is also an infrequent symptom of MS; in the few cases that have been reported, it is usually linked to the existence of important pseudotumoral lesions. Case report. We describe the case of a 31-year-old female with a 48-hour history of a progressive clinical picture consisting in nominal aphasia and a sensory parietal syndrome. Magnetic resonance imaging showed a lesion 3.6 cm in diameter that was hyperintense in T2 with perilesional edema and minimal gadolinium uptake, along with other images that revealed increased signal intensity in the periventricular subcortical white matter on the right-hand side and in the left-hand frontal subcortical region. A spectroscopic analysis of the largest lesion revealed that this lesion showed evidence of inflammation, with cell destruction and replacement, although it was not possible to distinguish between a demyelinating disease and a high grade glioma. Hence, a brain biopsy was required in order to reach the final diagnosis of demyelinating pseudotumoral lesion. Conclusions. Giant pseudotumoral plaques are a rare form of presenting symptom in MS; use of the clinical features, simple images and spectroscopy is not a very reliable means of reaching a differential diagnosis with a tumour and this often makes it necessary to conduct a biopsy study of the lesion

[Expert opinion on the basic surgical technique for laparoscopic ventral hernia repair]. / Técnica quirúrgica básica consensuada para el tratamiento por vía laparoscópica de las hernias ventrales.

Laparoscopic ventral hernia repair is currently the subject of intense debate, even though it provides a series of advantages over open surgery and is feasible and safe. Various studies have shown this technique to be as effective as open repair with a lower recurrence rate. Despite the excellent results of laparoscopic repair of ventral hernias, there are numerous controversies associated with this procedure. These controversies concern the indications and contraindications of the procedure, and technical aspects such as how to create the pneumoperitoneum, perform adhesiolysis, manage the hernia sac, and insert and fix the mesh to the anterior abdominal wall. Also controversial are outcome, complications related to postoperative seroma, and which type and size of mesh should be used. The present article aims primarily to address many of these issues, based on the experience of distinct surgeons with expertise in this approach, in order to provide data to establish a consensus on how laparoscopic ventral hernia repair should be performed.

Epilepsia como forma de presentación de esclerosis múltiple con lesión pseudotumoral / Epilepsy as the form of onset of multiple sclerosis with a pseudotumoral lesion

No disponible