[Anesthesia paresthetica: contribution of a new case and evolutive study using magnetic resonance]. / Anestesia parestésica: aportación de un nuevo caso y estudio evolutivo por resonancia magnética.

Patients with subclinical cobalamin deficiency may develop a subacute myeloneuropathy after nitrous oxide anesthesia. Frequently they have hematologic manifestations, however there is only a few reports of spinal lesions shown on MR and particularly of the effects of cobalamin replacement therapy on these lesions. We describe a patient with unsuspected cobalamin deficiency who developed subacute combined degeneration of the spinal cord after nitrous oxide anesthesia. MR showed high intensity in dorsal columns on T2-weighted image, and posterior resolution of abnormalities after therapy. We discuss the importance of preoperative hematologic manifestations for select high risk patients and prevent this complication. On the other hand, we consider MR as a useful tool to improve our knowledge in the pathophysiology of the neurologic manifestations of the process.

Detection of Legionella pneumophila in wastewater by nested polymerase chain reaction.

The study of Legionella in treated wastewater acquires special importance when this water is used in irrigation by spray, as Legionella is transmitted via the inhalation of aerosols and may consequently represent a health risk. In this study, we applied polymerase chain reaction (PCR) amplification as an alternative method to plate culture for detecting L. pneumophila in twelve heavily biocontaminated samples from a wastewater treatment plant. Moreover, we studied the efficiency of rapid gel filtration methods and filtration through chelating ion exchange resin in the elimination of PCR inhibitors from wastewater samples. When Legionella was investigated by PCR without any previous treatment, no amplification occurred, and when we used chromatographic methods to eliminate PCR inhibitors, nine out of twelve samples became positive. These results indicate the abundant presence of Legionella in wastewater, and although the methods used to eliminate PCR inhibitors are effective in the preparation of clean samples, the possible presence of different metal-organic matter compounds, which are not eliminated, may produce false-negative results.

[Primary intraventricular hemorrhage in a patient with unilateral moyamoya disease]. / Hemorragia intraventricular primaria en un paciente afectado de una enfermedad de moyamoya unilateral.

According to the diagnostic criteria currently in use, the so-called "unilateral" forms of the moyamoya disease, or rather those in which the disorders of the disease itself--such as occlusion of the internal supraclinoid carotid artery or its terminal branches and development of abnormal collateral circulation in the region of the basal ganglia--are only found in one hemisphere and should be considered as "probable" forms of the disease with a much lower incidence than the bilateral or "defined" forms of the same. One patient with a primary intraventricular hemorrhage (PIVH) in whom an occlusion of the right internal carotid artery was angiographically demonstrated and in whom collateral type moyamoya circulation was found as was the presence of an aneurysm in the right coroid territory is presented. The association of PIVH, unilateral moyamoya disease and aneurysm is infrequent in the literature, with the origin of the bleeding, in some cases, having been attributed to rupture of the aneurysm. Since angiographic control was not available in the patient presented it cannot be excluded that the aneurysm was really a pseudoaneurysm therefore being a consequence, rather than a cause, of the arterial rupture. Thus one of the other mechanisms proposed must be invoked to explain the pathogenesis of the PIVH: rupture of a perforating artery or of a microaneurysm located in the subependimary periventricular region. The treatment recommended for these case of PIVH associated to aneurysm is chirurgical if persistence is demonstrated in successive arteriographies.

[Neuralgiform paroxysmal migraine]. / Hemicrania paroxística neuralgiforme.

A 23-year-old woman presented with episodic, strictly unilateral, left-sided headaches of excruciating severity. Pain was referred to the eye, lasted from seconds to a minute and was accompanied by homolateral ptosis, redness of the eye, increased lacrimation and nasal discharge. The attacks of pain repeated up to seven times over 24 hours and clustered around ovulation for seven days a month. After she became pregnant, the attacks increased in frequency and appeared every five to ten minutes during night and day. Different medical treatments including indomethacin, were without effect. Two months later pregnancy was interrupted and the pain immediately subsided. After carotid angiography the pain reappeared for two months, but it finally disappeared and she has been free of pain without treatment for the last nine months. This syndrome can be related to episodic paroxysmal hemicrania.