[Psychiatric and neuropsychological legal assessment of traumatic brain damage and Law 30/95]. / La peritación psiquiátrica y neuropsicológica del daño cerebral traumático y la Ley 30/95.

Medico-legal assessment of people who have suffered injuries in road traffic accidents must use Law 30/95 as a reference frame. Psychiatric and neuropsychological syndromes secondary to traumatic brain injury (TBI) are no exception and pose demanding challenges to physicians and psychologists. This paper analyzes descriptive and nosological difficulties face by psychiatrists and psychologists; their expert contribution includes translation of official diagnostic entities into categories published in the annex of Law 30/95. Our psychopathological repertoire was created in the 19th century and has hardly been revised since. The wide and varied types of neuropsychological impairments encountered in TBI have to be diagnosed within a very narrow range of DSM-IV and ICD-10 categories. The most common conflicts encountered in the medicolegal arena are revised: the differential diagnosis between dementia and combinations of organic personality disorder with cognitive impairment; differential diagnosis between spontaneous psychiatric illness (bipolar disorder, schizophrenia) and psychiatric syndromes secondary to brain injury (posttraumatic psychosis, organic bipolar disorder); differential diagnosis between concussional syndrome and organic personality disorder, cognitive impairment or organic affective disorder. Specific diagnostic guidelines are suggested for each of these clinical situations. Actas Esp Psiquiatr 2003;31(6):353-360

[Pustulosis of Sneddon Wilkinson disease and multiple myeloma]. / Pustulosis de Sneddon Wilkinson y mieloma múltiple.

A case of subcorneal pustular dermatosis is described, this disease is not very common. Its origin remains unknown, there are some data that indicate an immunological basis because of its associations to hematological disorders and others autoimmune diseases. The diagnosis is based on clinic suspects and the histopathological analysis. The differentiation among other dermatosis like pustular psoriasis, due to its therapeutic implication and evolution. This patient developed an IgA-K myeloma after nine years of evolution, a very common finding in this disease. It has not definitive treatment, being corticosteroids and sulfonamides more effective. The prognosis depends on the appearance of complications and associated processes.