Experiencia clínica de la aplicación del sistema de realidad TOyRA en la neuro-rehabilitación de pacientes con lesión medular / Clinical experience regarding the application of the TOyRA virtual reality system in neuro-rehabiliation of patients with spinal cord lesion

Introducción. Recientemente estamos asistiendo a la introducción de dispositivos basados en realidad virtual (RV) como una de las novedades más relevantes en la neuro-rehabilitación. Objetivo. El objetivo es analizar la eficacia de un nuevo sistema de RV denominado TOyRA como herramienta de tratamiento en neuro-rehabilitación para personas con tetraplejia por lesión medular (LM). Materiales y métodos. Se trata de un estudio prospectivo, controlado, en el que se incluyeron 10 pacientes con tetraplejia por LM cervical. El sistema TOyRA consiste en un dispositivo que captura el movimiento basado en sensores inerciales que permite la reproducción de los movimientos del paciente por parte de un avatar en un monitor. La intervención consistió en la aplicación de sesiones de actividades de la vida diaria (AVD) a los 5 pacientes del grupo intervención como complemento a la terapia tradicional frente a un grupo control de otros 5 pacientes en los que solo se realizó terapia convencional. Las variables analizadas fueron cinemáticas y funcionales. Resultados. Se encontraron mejorías en el grupo tratado con TOyRA en el uno de los subtest del Jebsen-Taylor Hand Function (p<0,05). Se sugieren mejorías tanto en los parámetros cinemáticos de flexión de hombro y pronación de antebrazo como en otras escalas funcionales. Conclusiones. El sistema de RV TOyRA se presenta como una herramienta terapéutica que puede ofrecer mejores resultados funcionales que la realización en solitario de los métodos tradicionales en el tratamiento de los déficits motores de los miembros superiores en lesionados medulares (AU)

Introduction. We have recently been witnessing the introduction of devices based on virtual reality (VR) as one of the most important changes in neuro-rehabilitation. Objective. The objective is to analyze the efficacy of a new system called TOyRA virtual reality as a treatment tool in neuro-rehabilitation for people with quadriplegia due to spinal cord injury (SCI). Materials and methods. This is a prospective, controlled study that included 10 patients with SCI induced cervical quadriplegia. The TOyRA system consists of a device capturing motion-based inertial sensors that allows the reproduction of the patient movement by an avatar on a monitor. The intervention consisted of implementing sessions of activities of daily living activities (ADL) to the 5 patients in the intervention group as a complement to traditional therapy versus a control group of 5 other patients in whom only conventional therapy was performed. The analyzed variables were kinematic and functional ones. Results. There were improvements in the TOyRA treated group in one of the subtests of the Jebsen-Taylor Hand Function (P<0.05). Improvements in both the kinematic parameters of shoulder flexion and forearm pronation as in other functional scales were suggested. Conclusions. The TOyRA system is presented as a therapeutic tool that can provide better functional outcomes than when the traditional procedure are performed alone in the treatment of upper limb motor deficits in spinal cord injuries (AU)

[Unilateral apraxia of eyelid closure in ischemic stroke: role of the right hemisphere in the emotional gesture communication]. / Apraxia unilateral del cierre palpebral tras un ictus isquémico: el papel del hemisferio derecho en la comunicacion gestual mocional.

INTRODUCTION: Apraxia of eyelid closure (AEC) is an infrequent disorder that is characterised by the inability to close the eyelids on command, although spontaneous blinking and reflex shutting of the eyes is preserved. Very few cases of unilateral AEC have been reported and no long-term follow-ups have been carried out. We report the case of a patient with unilateral AEC that was followed up over a 3-year period and also discuss the role played by the right hemisphere in this disorder. CASE REPORT" We examined the case of a 67-year-old right-handed male who was admitted because of a parietotemporal infarction with extension into the subcortex. A few days after the stroke the patient reported the inability to close his left eye on command, although he was still able to blink spontaneously and the blink and visual threat reflexes were preserved. This deficiency was associated to a dense hemiparesis on the left side and notable aprosodia affecting language. At 3 years' follow-up the AEC had not improved significantly. CONCLUSIONS: There are data to suggest that the right hemisphere is related to emotional perception and expressiveness, as well as the regulation of language prosody. Likewise, symbolic anthropology stresses the importance of winking as a gesture involved in non-verbal communication. These data suggest that AEC may be a consequence of a dysfunction of the role played by the right hemisphere in emotional expressiveness through gestures. The association with language aprosodia could support this hypothesis.

Apraxia unilateral del cierre palpebral tras un ictus isquémico: el papel del hemisferio derecho en la comunicación gestual emocional / Unilateral apraxia of eyelid closure in ischemic stroke: role of the right hemisphere in the emotional gesture communication

Introducción. La apraxia del cierre palpebral (ACP) es un trastorno infrecuente caracterizado por la incapacidad por el cierre voluntario de los párpados con preservación del parpadeo espontáneo y del cierre ocular reflejo. La ACP unilateral se ha descrito en muy pocos casos y no consta un seguimiento a largo plazo. Presentamos un paciente con ACP unilateral con seguimiento durante 3 años y discutimos el papel del hemisferio derecho en este trastorno. Caso clínico. Varón de 67 años, diestro, ingresado por infarto parietotemporal derecho con extensión subcortical. Desde los pocos días del ictus refiere incapacidad por el cierre voluntario del ojo izquierdo, con preservación del parpadeo espontáneo y de los reflejos corneal y de amenaza. Este déficit se asoció a densa hemiparesia izquierda e importante aprosodia del lenguaje. Tras tres años de seguimiento, la ACP no mejoró significativamente. Conclusiones. Hay datos que relacionan el hemisferio derecho con la percepción y expresividad emocional, así como en la regulación de la prosodia del lenguaje. Asimismo, la antropología simbólica subraya la importancia del guiño como elemento gestual de la comunicación no verbal. Estos datos sugieren que la ACP puede ser consecuencia de una disfunción del papel del hemisferio derecho en la expresividad gestual emocional. La asociación con la aprosodia del lenguaje podría apoyar esta hipótesis

Introduction. Apraxia of eyelid closure (AEC) is an infrequent disorder that is characterised by the inability to close the eyelids on command, although spontaneous blinking and reflex shutting of the eyes is preserved. Very few cases of unilateral AEC have been reported and no long-term follow-ups have been carried out. We report the case of a patient with unilateral AEC that was followed up over a 3-year period and also discuss the role played by the right hemisphere in this disorder. Case report. We examined the case of a 67-year-old right-handed male who was admitted because of a parietotemporal infarction with extension into the subcortex. A few days after the stroke the patient reported the inability to close his left eye on command, although he was still able to blink spontaneously and the blink and visual threat reflexes were preserved. This deficiency was associated to a dense hemiparesis on the left side and notable aprosodia affecting language. At 3 years’ follow-up the AEC had not improved significantly. Conclusions. There are data to suggest that the right hemisphere is related to emotional perception and expressiveness, as well as the regulation of language prosody. Likewise, symbolic anthropology stresses the importance of winking as a gesture involved in non-verbal communication. These data suggest that AEC may be a consequence of a dysfunction of the role played by the right hemisphere in emotional expressiveness through gestures. The association with language aprosodia could support this hypothesis

Síndrome koro / Koro syndrome

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[Differential diagnosis between Mesulam's aphasia and aphasia secondary to ischemic disorder by brain perfusion SPECT]. / Diagnóstico diferencial entre afasia de Mesulam y afasia secundaria a trastorno isquémico mediante SPECT cerebral de perfusión.

Two cases with aphasic dysfunction with similar clinical features and structural neuroimaging studies results are presented. In these cases, brain perfusion SPECT was the most useful complementary study in the differential diagnosis of two pathologies with different etiologies: primary progressive aphasia or Mesulam's aphasia and aphasia secondary to a stroke.

Diagnóstico diferencial entre afasia de Mesulam y afasia secundaria a trastorno isquémico mediante SPECT cerebral de perfusión / Differential diagnosis between Mesulam's aphasia and aphasia secondary to ischemic disorder by brain perfusion SPECT

Presentamos dos casos de trastorno afásico con presentación clínica y hallazgos en técnicas de imagen morfológicas similares. En ellos, la SPECT cerebral de perfusión resultó ser la prueba complementaria más útil en el diagnóstico diferencial de dos patologías con distinta etiología: afasia primaria progresiva (APP) o de Mesulam y afasia secundaria a accidente cerebrovascular isquémico

Two cases with aphasic dysfunction with similar clinical features and structural neuroimaging studies results are presented. In these cases, brain perfusion SPECT was the most useful complementary study in the differential diagnosis of two pathologies with different etiologies: primary progressive aphasia or Mesulam's aphasia and aphasia secondary to a strokeTwo cases with aphasic dysfunction with similar clinical features and structural neuroimaging studies results are presented. In these cases, brain perfusion SPECT was the most useful complementary study in the differential diagnosis of two pathologies with different etiologies: primary progressive aphasia or Mesulam's aphasia and aphasia secondary to a stroke

[Transient cerebral oedema associated to hypoglycaemia]. / Edema cerebral transitorio asociado a hipoglucemia.

INTRODUCTION: In the adult, hypoglycaemia is documented as a consequence of overdose of insulin or oral hypoglycaemic agents. Neonatal hypoglycaemia is common but rarely symptomatic due to protective mechanisms. Very few reports on hypoglycaemic injury are available in adults and most of them in patients with poor outcome. CASE REPORT: Woman, 45 years old. She is referred to emergency room due to insulin overdose and coma of unknown duration. Glucose level was 15 mg% without other metabolic anomalies. Computerized tomography revealed brain oedema most obvious in the parieto-occipital lobes. Therapy with manitol and glucose was started with total functional recovery. CONCLUSIONS: Brain imaging in neonatal hypoglycaemia shows similar findings. In the acute phase oedema in the parieto-occipital cortex and underlying white matter and atrophy or malacic cysts in the chronic phase have been described. Chronic changes are related to long-term sequelae that vary from development delay and epilepsy to persistent vegetative state. In adults lesions involve hippocampus and basal ganglia. The reasons of different sensitivity of these regions are not fully clear. Differences in regional blood flow autoregulation or in excitotoxins receptors of aspartate have been postulated. Hypoglycaemia may induce blood-brain-barrier permeability and subsequently brain oedema.

[The importance of neurological examinations in the age of the technological revolution]. / Importancia de la exploración neurológica en la era de la revolución tecnológica.

INTRODUCTION: Neurologic practice and care have been modified in many important ways during the past ten years, to adapt to the explosion of new information and new technology. Students, residents and practicing physicians have been continuing programs to a model that focuses almost exclusively on the applications to neurologic disorders of the new knowledge obtained from biomedical research. On the other hand high demand for outpatient neurologic care prevents adequate patient's evaluation. CASE REPORTS: Case 1: 65 years old female. Occipital headache diagnosed of tensional origin (normal computerized tomography). Two months later is re-evaluated due to intractable pain and hypoglossal lesion. An amplified computerized tomography revealed a occipital condyle metastasis. Case 2: 21 years old female. Clinical suspicion of demyelinating disease due to repeated facial paresis and sensitive disorder. General exploration and computerized tomography revealed temporo-mandibular joint. Case 3: 60 years old female. Valuation of anticoagulant therapy due to repeated transient ischemic attacks. She suffered from peripheral facial palsy related to auditory cholesteatoma. CONCLUSIONS: Neurologic education is nowadays orientated to new technologies. On the other hand, excessive demand prevents adequate valuation and a minute exploration is substituted by complementary evaluations. These situations generate diagnostic mistakes or iatrogenic. It would be important a consideration of the neurologic education profiles and fulfillment of consultations time recommendations for outpatients care.

Importancia de la exploración neurológica en la era de la revolución tecnológica / The importance of neurological examinations in the age of the technological revolution

Introducción. Durante la última década hemos asistido a una importante modificación de la neurología en la práctica clínica debido a la explosión de nueva información y nuevas tecnologías en el ámbito de las neurociencias. La formación de los estudiantes y los especialistas en formación, así como la enseñanza posgraduada, están orientadas a esas nuevas tecnologías, y dejan en segundo plano la medicina clínica tradicional. Por otro lado, la masificación de las consultas ambulatorias impide una adecuada evaluación de los pacientes. Casos clínicos. Caso 1: Mujer de 65 años con cefalea occipital diagnosticada de origen tensional (tomografía axial computarizada normal). Dos meses después se reevalúa por dolor intratable y afectación del XII nervio craneal. Se amplía el estudio por neuroimagen y se detecta metástasis en el cóndilo occipital. Caso 2: Mujer de 21 años, sospechosa de enfermedad desmielinizante por parálisis faciales de repetición y trastorno sensitivo facial. La exploración y la tomografía axial computarizada temporomandibular detectan una luxación mandibular. Caso 3: Mujer de 60 años remitida para una valoración de la anticoagulación por isquemias transitorias de repetición. Se descubre parálisis facial periférica asociada a un colesteatoma con invasión del canal facial. Conclusiones. La formación en neurología, en la actualidad, concede una gran importancia a las nuevas tecnologías. Por otra parte, la masificación de las consultas externas impide una adecuada valoración del enfermo y, en muchas ocasiones, se sustituyen una historia y una exploración clínicas minuciosas por pruebas complementarias. Esto conlleva la comisión de errores diagnósticos, tanto por exceso (falsos positivos) como por defecto (falsos negativos), o que se dé yatrogenia terapéutica. Sería importante la reevaluación de los programas docentes y el cumplimiento de las recomendaciones mínimas de tiempo de visita (AU)

Introduction. Neurologic practice and care have been modified in many important ways during the past ten years, to adapt to the explosion of new information and new technology. Students, residents and practicing physicians have been continuing programs to a model that focuses almost exclusively on the applications to neurologic disorders of the new knowledge obtained from biomedical research. On the other hand high demand for outpatient neurologic care prevents adequate patient’s evaluation. Case reports. Case 1: 65 years old female. Occipital headache diagnosed of tensional origin (normal computerized tomography). Two months later is re-evaluated due to intractable pain and hypoglossal lesion. An amplified computerized tomography revealed a occipital condyle metastasis. Case 2: 21 years old female. Clinical suspicion of demyelinating disease due to repeated facial paresis and sensitive disorder. General exploration and computerized tomography revealed temporo-mandibular joint. Case 3: 60 years old female. Valuation of anticoagulant therapy due to repeated transient ischemic attacks. She suffered from peripheral facial palsy related to auditory cholesteatoma. Conclusions. Neurologic education is nowadays orientated to new technologies. On the other hand, excessive demand prevents adequate valuation and a minute exploration is substituted by complementary evaluations. These situations generate diagnostic mistakes or iatrogeny. It would be important a consideration of the neurologic education profiles and fulfillment of consultations time recommendations for outpatients care (AU)

[Acute polyneuropathy and encephalopathy caused by arsenic poisoning]. / Encefalopatía y polineuropatía agudas causadas por arsénico.

INTRODUCTION: Acute arsenic toxicity is a multisystemic disease with pleural and pericardial effusions, gastrointestinal symptoms and pancytopenia. The most frequent neurological complication of inorganic arsenic intoxication is a distal symmetrical polyneuropathy. CASE REPORT: We report here a patient who developed a systemic illness followed with severe acute polyneuropathy. Electrophysiological findings suggested a Guillain-Barré syndrome (GBS). Finally an acute encephalopathy appeared which led to reconsideration of the diagnosis. A 24-hour heavy metal urine, nail and hair analysis was performed. A diagnosis of arsenic toxicity was made. Instead of chelating therapy patient died due to respiratory failure. CONCLUSIONS: A misdiagnosis of GBS in inorganic arsenic polyneuropathy is not infrequent. Atypical progression compels to rule out arsenic or heavy metal intoxication. In our case the appearance of the encephalopathy was the key to the diagnosis. It has been suggested that axonal degeneration and segmental demyelination might be equally prominent pathological features of the neuropathy, depending on the dosage and the length of time of exposure to arsenic. The exact pathophysiology of arsenic polyneuropathy remains unclear and a interference with pyruvate oxidation has been postulated.

Encefalopatía y polineuropatía agudas causadas por arsénico / Acute polyneuropathy and encephalopathy caused by arsenic poisoning

Introducción. La intoxicación por arsénico inorgánico es una enfermedad multisistémica con derrames pericárdico y pleural, síntomas gastrointestinales y pancitopenia. La complicación neurológica más frecuente es la aparición de una polineuropatía distal simétrica. Caso clínico. Se describe la evolución de un paciente con un cuadro sistémico de tres meses de evolución, consistente fundamentalmente en sintomatología abdominal, que desarrolló una tetraparesia rápidamente progresiva asociada a una polineuropatía aguda desmielinizante, atribuida en un primer momento a un síndrome de Guillain-Barré (SGB) postinfeccioso. La aparición de un cuadro encefalopático asociado hizo descartar otras posibilidades diagnósticas; entre ellas, la intoxicación por metales pesados, y se detectaron unos niveles elevados de arsénico en el pelo, las uñas y la orina. A pesar del tratamiento quelante, el paciente falleció por complicaciones respiratorias. Conclusiones. La confusión diagnóstica con un SGB en la polineuropatía por arsénico no es infrecuente. La progresión atípica obliga a descartar intoxicación por metales pesados, entre otras patologías. En nuestro caso, la aparición de un cuadro encefalopático fue clave para el diagnóstico. Las neuropatías por arsénico, tanto desde el punto de vista electrodiagnóstico como anatomopatológico, pueden ser de tipo axonal o desmielinizante, según la dosis y el tiempo de exposición al mismo. Se postula la interferencia con el ciclo de Krebs como mecanismo fisiopatológico (AU)

Introduction. Acute arsenic toxicity is a multisystemic disease with pleural and pericardial effusions, gastrointestinal symptoms and pancytopenia. The most frequent neurological complication of inorganic arsenic intoxication is a distal symmetrical polyneuropathy. Case report. We report here a patient who developed a systemic illness followed with severe acute polyneuropathy. Electrophysiological findings suggested a Guillain-Barré syndrome (GBS). Finally an acute encephalopathy appeared which led to reconsideration of the diagnosis. A 24-hour heavy metal urine, nail and hair analysis was performed. A diagnosis of arsenic toxicity was made. Instead of chelating therapy patient died due to respiratory failure. Conclusions. A misdiagnosis of GBS in inorganic arsenic polyneuropathy is not infrequent. Atypical progression compels to rule out arsenic or heavy metal intoxication. In our case the appearance of the encephalopathy was the key to the diagnosis. It has been suggested that axonal degeneration and segmental demyelination might be equally prominent pathological features of the neuropathy, depending on the dosage and the length of time of exposure to arsenic. The exact pathophysiology of arsenic polyneuropathy remains unclear and a interference with pyruvate oxidation has been postulated (AU)

[Validation of a clinical protocol for the detection of dementia in the population]. / Validacion de un protocolo clinico para la deteccion de demencia en ambito poblacional.

AIMS: To analyse the validity of a set of neuropsychological and functional tests, and to study their value in detecting and diagnosing dementia through a pilot study. PATIENTS AND METHODS: A total of 131 subjects (101 controls and 30 with dementia) were evaluated using a comprehensive neuropsychological and functional battery. Validity analyses were conducted using ROC curves in accordance with the definitions of diagnostic test validation. Finally, a discriminant analysis was performed with the tests that showed greater diagnostic validity in the study of the ROC curves. RESULTS: The case and control groups were not significantly different as regards age, sex and level of schooling. The ROC curves analyses showed the following to be the tests with the highest diagnostic validity: the MMSE, delayed recall of a short story, delayed recall of six pictures, the Spanish version of the S IQCODE (shortened) and Pfeffer s FAQ. The discriminant analysis evidenced the fact that the joint utilisation of all the foregoing tests, except delayed recall of six pictures, classified 96.55% of our sample correctly. CONCLUSIONS: By combining direct cognitive evaluation of the subject and functional performance evaluated by a trustworthy informer, the vast majority of participants in the pilot study were correctly classified into patients with and without dementia. The high diagnostic validity of four relatively short tests lends support to their use in broader clinical or population studies.

Validación de un protocolo clínico para la detección de demencia en ámbito poblacional / Validation of a clinical protocol for the detection of dementia in the population

Objetivo. Analizar la validez de un conjunto de pruebas neuropsicológicas y funcionales y estudiar su utilidad en la detección y diagnóstico de la demencia mediante un estudio piloto. Pacientes y métodos. Se evaluaron 131 sujetos (101 controles y 30 dementes) con una amplia batería neuropsicológica y funcional. Los análisis de validez se llevaron a cabo mediante la utilización de curvas ROC según las definiciones de validación de test diagnósticos. Finalmente, se realizó un análisis discriminante con las pruebas que mostraron mayor validez diagnóstica en el estudio de curvas ROC. Resultados. Los grupos de casos y controles no diferían significativamente en edad, sexo y nivel educativo. Los análisis de curvas ROC determinaron como pruebas con mayor validez diagnóstica las siguientes: MMSE, recuerdo diferido de una historia corta, recuerdo diferido de seis láminas, la versión española del S-IQCODE (reducida) y el FAQ de Pfeffer. El análisis discriminante reflejó que el empleo conjunto de las pruebas anteriores-todas, salvo el recuerdo diferido de seis láminas-, clasificaba al 96,55 por ciento de nuestra muestra correctamente. Conclusiones. La combinación de la evaluación cognitiva directa del sujeto y el rendimiento funcional evaluado por un informador fiable permite la clasificación correcta en dementes y no dementes de la gran mayoría de los participantes en el estudio piloto. La elevada validez diagnóstica de cuatro pruebas relativamente cortas sugiere su empleo en estudios más amplios, clínicos o poblacionales (AU)

[Antiepileptic drugs and neuropathic pain]. / Fármacos antiepilépticos y dolor neuropático.

INTRODUCTION: This article is a bibliographic review of the part currently played by antiepileptic drugs in the treatment of neuropathic pain, and knowledge of their specific actions according to the different physiopathogenic mechanisms suspected of being involved in this type of pain. DEVELOPMENT: Neuropathic pain, the result of neurological damage in part of the nerve transmission system for pain, is one of the commonest painful syndromes in clinical practice and is a challenge for both neurologists and pain specialists. In recent years there has been increasing interest in the antiepileptic drugs, which were already used in this context in the sixties. Interest has increased with new drugs and better understanding of the physiopathogenic mechanisms of pain. The poor, variable response of these conditions to different treatments and the complex relationship between aetiologies, mechanisms and symptoms make it advisable to modify the traditional approach to the treatment of these conditions, passing form the aetiology and topographical distribution to the probable mechanisms involved in each individual patient, adapting the treatment to the individual concerned. CONCLUSIONS: The antiepileptic drugs are one of the most promising approaches to the drug treatment of neuropathic pain. Their use as the sole treatment, or in combination with other treatment, in individual patients depends on better understanding of the mechanisms involved in the genesis and maintenance of neuropathic pain and how antiepileptic drugs act on these mechanisms.

Fármacos antiepilépticos y dolor neuropático / Antiepileptic drugs and neuropathic pain

Introducción. El presente artículo pretende ser una revisión bibliográfica del papel actual de los fármacos antiepilépticos en el tratamiento del dolor neuropático, y de los conocimientos sobre su acción específica según los diferentes mecanismos fisiopatogénicos que se sospechan están inmersos en este tipo de dolor. Desarrollo. El dolor neuropático, resultante del daño neurológico en una parte del sistema de transmisión nerviosa del dolor, es uno de los síndromes dolorosos más frecuentes de la práctica clínica y constituye un reto terapéutico para neurólogos y especialistas en dolor. En los últimos años el interés por los fármacos antiepilépticos, usados ya con esta finalidad desde los años sesenta, ha aumentado con la aparición de nuevos medicamentos y el mejor conocimiento de los mecanismos fisiopatogénicos causantes de este dolor. La pobre y variable respuesta de estos cuadros a los diversos tratamientos y la compleja relación entre etiologías, mecanismos y síntomas, aconsejan modificar el abordaje tradicional en el tratamiento de estas entidades, pasando de la etiología y la distribución topográfica a los probables mecanismos implicados en cada paciente, adaptando las terapias a estos últimos. Conclusiones. Los fármacos antiepilépticos son una de las líneas más prometedoras en el tratamiento farmacológico del dolor neuropático. Su utilización como terapia única o asociada en cada paciente dependerá del mayor conocimiento de los mecanismos involucrados en la génesis y mantenimiento del dolor neuropático y de cómo los fármacos antiepilépticos actúan sobre ellos (AU)

[Reversible posterior leukoencephalopathy in a patient with non-Hodgkin's lymphoma after treatment with CHOP]. / Leucoencefalopatía posterior reversible en un paciente con linfoma no-Hodgkin tras tratamiento con CHOP.

Reversible posterior leukoencephalopathy syndrome is a newly characterised and increasingly recognized clinico-radiologic syndrome. Underlying conditions that reportedly trigger this syndrome include hypertensive encephalopathy, eclampsia, renal failure, and immunosuppressive drug therapy with cyclosporine, tacrolimus and interferon alpha. We describe a 51-year-old woman with non-Hodgkin's lymphoma treated with conventional CHOP chemotherapy. Eight days after this treatment she developed severe headache, bilateral visual loss and focal seizures with secondary generalization. Neurologic examination showed confusion, cortical blindness, and left hemiparesis with hyperreflexia and sensory loss. A cranial T2-weighted magnetic resonance imaging revealed increased signal intensity in the occipital and frontal lobes in both hemispheres and right parietal lobe. A diagnosis of reversible posterior leukoencephalopathy was made. She presented a favourable outcome with conservative treatment with mannitol and phenytoin. A new cranial scanning showed nearly complete resolution of the abnormalities. To the best of our knowledge, this is the first case of reversible posterior leukoencephalopathy in a patient treated with standard-dose CHOP. In this patient, we confirm the theoretical pathophysiologic mechanisms suggested explaining how these drugs can cause the syndrome.