[Unusual thalamo-mesencephalic infarction: clinico-radiological correlations]. / Infarto tálamo-mesencefálico inusual: correlaciones clinicorradiológicas.

INTRODUCTION: Mesencephalic infarcts usually produce clinical features that allow the lesion to be located with precision, although they do not always match the patterns included in the classical syndromes reported in the literature, as occurs in the case we describe here. CASE REPORT: We report the case of a 73-year-old female with no cardiovascular risk factors, who presented a sudden clinical picture of instability, diplopia, palpebral ptosis and mild hypersomnia. On examining the patient the following manifestations were observed: compromise of the right common oculomotor nerve, up and down vertical gaze palsy, dysmetry of the right limbs and mild long tract signs in the left limbs. Magnetic resonance imaging of the brain revealed right thalamo-mesencephalic infarction in the paramedian territory, which became bilateral in the upper mesencephalon. The aetiological study showed only a carotid atheromatosis. CONCLUSIONS: Cerebellar compromise ipsilateral to a lesion in the common oculomotor nerve in mesencephalic infarcts is a very uncommon clinical variant. The pathogenetic heterogeneity of infarctions involving the mesencephalon makes it necessary to carry out an extensive aetiological study. Magnetic resonance imaging of the brain is an essential tool for understanding the clinical picture and the anatomical structures involved in cases of infrequent cerebral infarction.

Infarto tálamo-mesencefálico inusual: correlaciones clinicorradiológicas / Unusual thalamo-mesencephalic infarction: clinico-radiological correlations

Los infartos mesencefálicos suelen producir cuadros clínicos que permiten una localización precisade la lesión, aunque no siempre se ajustan a los patrones recogidos en los síndromes clásicos de la bibliografía, tal como ocurre en el caso que se presenta. Caso clínico. Mujer de 73 años sin factores de riesgo cardiovascular, que presentó un cuadrobrusco de inestabilidad, diplopía, ptosis palpebral e hipersomnia leve. En la exploración se observó la afectación del nervio oculomotor común derecho, la parálisis de la mirada vertical hacia arriba y hacia abajo, la dismetría de las extremidades derechasy la afectación piramidal leve de las extremidades izquierdas. En la resonancia magnética cerebral se objetivó un infarto tálamo-mesencefálico derecho en el territorio paramediano, que en el mesencéfalo superior se hacía bilateral. El estudio etiológico mostró únicamente una ateromatosis carotídea. Conclusiones. La afectación cerebelosa ipsilateral a la lesióndel nervio oculomotor común en los infartos mesencefálicos constituye una variante clínica muy infrecuente. La heterogeneidad patogénica de los infartos que afectan al mesencéfalo obliga a un estudio etiológico extenso. La resonancia magnética cerebral constituye una herramienta indispensable para comprender la clínica y las estructuras anatómicas implicadas en losinfartos cerebrales infrecuentes

Mesencephalic infarcts usually produce clinical features that allow the lesion to be located withprecision, although they do not always match the patterns included in the classical syndromes reported in the literature, as occurs in the case we describe here. Case report. We report the case of a 73-year-old female with no cardiovascular risk factors, who presented a sudden clinical picture of instability, diplopia, palpebral ptosis and mild hypersomnia. On examiningthe patient the following manifestations were observed: compromise of the right common oculomotor nerve, up and down vertical gaze palsy, dysmetry of the right limbs and mild long tract signs in the left limbs. Magnetic resonance imaging of the brain revealed right thalamo-mesencephalic infarction in the paramedian territory, which became bilateral in the uppermesencephalon. The aetiological study showed only a carotid atheromatosis. Conclusions. Cerebellar compromise ipsilateral to a lesion in the common oculomotor nerve in mesencephalic infarcts is a very uncommon clinical variant. The pathogeneticheterogeneity of infarctions involving the mesencephalon makes it necessary to carry out an extensive aetiological study. Magnetic resonance imaging of the brain is an essential tool for understanding the clinical picture and the anatomical structures involved in cases of infrequent cerebral infarction

[Nutrition, bone disease and alcoholic cirrhosis]. / Nutrición, enfermedad ósea y cirrosis alcohólica.

OBJECTIVES: To know the prevalence of osteopenia and osteoporosis in alcoholic cirrhotic males from 45 to 65 years old. To prove if the nutritional state is involved in the loss of bone mass in the hepatic disease. STUDY POPULATION: 52 alcoholic cirrhotic males from 45 to 65 years old, with normal kidney function, non-sedentary and with no treatment that could alterate the study. Design and variables: transversal descriptive study finished in 2 years. The nutritional state was evaluated by means of classic anthropometric parameters (weight, height, perimeter of the arm and skin folds) and total body densitometry (DPX plus LUNAR-DEXA with dual energy X-ray absorptiometry. STATISTICAL ANALYSIS: Mc Intosh computer (Filemaker PRO program). T Student was used to compare groups and p was significant if alpha alpha < or = 0.05. Clinical severity of cirrhosis: Child-Turcotte classification. RESULTS: Osteopenia was diagnosed if bone mineral density (BMD) was higher than 1 standard deviation (SD) but lower than 3 SD below T score (mean values for adult women) and osteoporosis (OP) if BMD was higher than 3 SD or vertebral compression fractures appeared in simple radiographies. The prevalence of bone disease was 58%. The percentages of fat obtained by means of anthropometric and densitometric measures were higher in non-osteopenic patients. DISCUSSION: The prevalence of bone disease was higher than another studies. The total body densitometry is a more exact method to measure the percentage of body fat. The percentages of fat obtained with both methods were not related to the loss of bone mass. The nutritional state as an isolated factor does not lead to bone disease in these patients.

[Bone metabolism and bone mass loss in eating disorders]. / Metabolismo óseo y pérdida de masa ósea en los trastornos de la alimentación.

Eating disorders (anorexia and bulimia nervosa) are present in 1-3% of young female women. A later beginning, prolonged amenorrhea and low body mass index are risk factors of osteopenia in bulimic patients. Bone demineralization in anorexia nervosa is due to a greater resorption than bone formation leading to osteopenia, secondary osteoporosis and increased risk of pathologic fractures. Pathophysiology of bone disease includes factors as long duration of amenorrhea, deficient absorption of calcium, extreme physical exercise, 1.25 vitamin D deficiency, low creatinine clearance, increased blood and urinary cortisol and high levels of GH. Proposed treatments are nutritional improvement and weight gain (the most important), calcium supplementation, moderate exercise, estrogens, antidepressive drugs, fluoride in selected cases, byphosphonates and recombinant human IGF-1. An adequate questionnaire is essential in women with slightly decreased weight and menstrual disorders.

Metabolismo óseo y pérdida de masa ósea en los trastornos de la alimentación / Bone metabolism and loss of bone mass in eating disordes

Los trastornos de la alimentación (anorexia y bulimia nerviosa)afectan al 1-3 por ciento de las mujeres jóvenes adultas. Edad tardía de inicio, duración de amenorrea e índice bajo de masa corporal son factores de riesgo de osteopenia en pacientes bulímicas. Se produce desmineralización cuando la reabsorción sobrepasa a la formación ósea en la AN, lo que lleva al desarrollo de osteopenia, osteoporosis secundaria y mayor riesgo de fracturas patológicas. La patofisiología de la desmineralización se atribuye a diversos factores como duración de la amenorrea, deficiente absorción de calcio, ejercicio físico extremo, déficit de 1,25 (OH) vit D, bajo aclaramiento de creatinina, exceso de cortisol sérico y urinario y niveles altos de GH. Los tratamientos recomendados son rehabilitación nutricional (el más importante), suplementos de calcio, ejercicio moderado, terapia estrogénica cuando esté indicada, tratamiento antidepresivo, flúor en casos seleccionados, bifosfonatos e IGF-1 recombinante humano. Un interrogatorio preciso es esencial en mujeres con peso ligeramente descendido y con trastornos menstruales. (AU)

Meningitis por staphylococcus aureus / Meningitis due to Staphylococcus aureus

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