Paroxysmal dystonia and pathological laughter as a first manifestation of multiple sclerosis.

Paroxysmal dystonia is an uncommon but well-established feature of multiple sclerosis (MS). Attacks can occur in established MS and may even occasionally be the initial symptom of this disorder. Pathological laughter is usually seen as a pseudobulbar palsy in some diffuse neurological diseases, but cases have been described, mostly in ischaemic attacks or tumours, where it is presented as bursts of laughter of variable duration. The pathogenesis of neither of the two phenomena has been fully established but both have been reported as being positive phenomena resulting from ectopic activation with ephaptic spread. We describe the first reported case of a paroxysmal hemidystonia together with bursts of pathological laughter as the first manifestation of MS.

[Diagnosis of isolated pulmonary arterio-venous fístula using contrast transcranial Doppler]. / Doppler transcraneal como herramienta diagnóstica de la fístula arteriovenosa pulmonar aislada.

We report the case of a young patient with an ischemic stroke due to a paradoxical embolism through a giant isolated pulmonary arterio-venous fistula and review the literature of similar cases. We argue that the use of contrast transcranial Doppler (c-TCD) may well help in redressing the likely situation of underdiagnosis of this condition. C-TCD is reliable and sensitive in the diagnosis of right-to-left shunt and allows us to suspect pulmonary arterio-venous fistula as the underlying mechanism. Furthermore, the qualities of non-invasiveness, ease of use, precision, reliability and inexpensiveness of c-TCD make it the ideal tool for checking the success of surgical or endovascular treatment and subsequent follow-ups.

Doppler transcraneal como herramienta diagnóstica de la fístula arteriovenosa pulmonar aislada / Diagnosis of isolated pulmonary arterio-venous fístula using contrast transcranial doppler

Presentamos el caso de un paciente con ictus isquémico producido por una embolia paradójica por una fístula arteriovenosa pulmonar (FAVP) gigante. La revisión de la literatura sugiere que la FAVP como causa de ictus es una patología infradiagnosticada. El doppler transcraneal con contraste salino es una técnica sensible y fiable para la detección de una comunicación derecha-izquierda producida por una FAVP. Dado que es una técnica inocua, sencilla y eficaz no sólo es útil para el diagnóstico, sino también para su control evolutivo postratamiento

We report the case of a young patient with an ischemic stroke due to a paradoxical embolism through a giant isolated pulmonary arterio-venous fistula and review the literature of similar cases. We argue that the use of contrast transeranial doppler (c-TCD) may well help in redressing the likely situation of underdiagnosis of this condition. C-TCD is reliable and sensitive in the diagnosis of right-to-left shunt and allows us to suspect pulmonary arterio-venous fistula as the underlying mechanism. Furthermore, the qualities of non-invasiveness, case of use, precision, reliability and inexpensiveness of c-TCD make it the ideal tool for cheeking the success of surgical or endovascular treatment and subsequent follow-ups