[Delay in the diagnosis of Parkinson's disease in a Chilean public hospital]. / Latencia diagnóstica en la enfermedad de Parkinson: Estudio en 200 pacientes de novo en un hospital público de Chile.

BACKGROUND: Early diagnosis is fundamental in patients with Parkinson's disease (PD) to improve their quality of life. AIM: To determine the latency in the diagnosis of Parkinson's disease (PD) after the onset of motor symptoms. PATIENTS AND METHODS: Prospective study carried out during 16 months in a public hospital. Two hundred newly diagnosed patients aged 41 to 90 years (50% women), were included and analyzed. RESULTS: The lapse between the first symptom -more commonly tremor- and the diagnosis made by a neurologist ranged from 1 to 84 months (19.1 ± 13.8). In 39% of patients, it was done in the first year, in 26% during the second year and in 35% of patients, it took more than two years. The referral by a general practitioner had a delay ranging from 1 to 36 months. Sixty nine and 95% of patients were evaluated within the first 6 months after referral if they came from primary care or the same hospital, respectively. Twenty six percent of patients were classified in stages III to V of Hoehn & Yahr's staging and the Parkinson's Disease Rating Scale motor examination ranged from 5 to 81 points, mean 24 (± 12.8). CONCLUSIONS: The diagnosis of PD has a delay in a public hospital that could be influenced by the referral system.

Latencia diagnóstica en la enfermedad de Parkinson: Estudio en 200 pacientes de novo en un hospital público de Chile / Delay in the diagnosis of Parkinson’s disease in a Chilean public hospital

Background: Early diagnosis is fundamental in patients with Parkinson’s disease (PD) to improve their quality of life. Aim: To determine the latency in the diagnosis of Parkinson’s disease (PD) after the onset of motor symptoms. Patients and Methods: Prospective study carried out during 16 months in a public hospital. Two hundred newly diagnosed patients aged 41 to 90 years (50% women), were included and analyzed. Results: The lapse between the first symptom -more commonly tremor- and the diagnosis made by a neurologist ranged from 1 to 84 months (19.1 ± 13.8). In 39% of patients, it was done in the first year, in 26% during the second year and in 35% of patients, it took more than two years. The referral by a general practitioner had a delay ranging from 1 to 36 months. Sixty nine and 95% of patients were evaluated within the first 6 months after referral if they came from primary care or the same hospital, respectively. Twenty six percent of patients were classified in stages III to V of Hoehn & Yahr’s staging and the Parkinson’s Disease Rating Scale motor examination ranged from 5 to 81 points, mean 24 (± 12.8). Conclusions: The diagnosis of PD has a delay in a public hospital that could be influenced by the referral system.

Ginevra de Benci's portrait: had the lady a myopathic face?

The portrait of Ginevra de Benci was painted by Leonardo da Vinci around 1474. This painting is less famous and less known than Mona Lisa but it is extremely captivating and interesting due to its own characteristics. The overall picture gives to the viewer the impression of being in front of an enigmatic, hermetic and introspective woman. However, some details of her facial expression, especially the gaze direction, the upper eyelids' heaviness, the flat mouth and the absence of any defined emotion, give her the appearance of a patient with a muscular disease.

[Subacute combined degeneration of the spinal cord caused by vitamin B12 deficiency. Report of 11 cases]. / Mielopatía por déficit de vitamina B12: caracterización clínica de 11 casos.

BACKGROUND: Subacute combined degeneration is a clinical manifestation of vitamin B12 deficiency, that we observe with unusual frequency. AIM: To report a series of eleven patients with subacute combined degeneration. PATIENTS AND METHODS: Retrospective analysis of 11 patients hospitalized in a public hospital in Santiago, between March 2001 and February 2003. All had a myelopathy of more than three weeks of evolution with serum vitamin B12 levels of less than 200 pg/ml. RESULTS: A risk factor was identified in 10 cases and the most common was an age over 60 years old. The main presenting symptom was the presence of paresthesias. On admission, sphincter dysfunction, posterior column and pyramidal syndromes coexisted in nine patients. A level of sensitive deficit was detected in six. Ten patients had macrocytosis and eight were anemic. Serum vitamin B12 was measured in ten and in nine, it was below 200 pg/ml. The mean lapse between onset of symptoms and treatment was eight months. All received intramuscular vitamin B12 in doses on 1,000 to 10,000 IU/day. Sphincter dysfunction and propioception were the first symptoms to improve. CONCLUSIONS: Subacute combined degeneration must be suspected in patients older than 60 years with a subacute myelopathic syndrome and low serum vitamin B12 levels.

Crisis convulsiva inducida por estímulo laberíntico espontáneo: relación entre epilepsia y sistema vestibular / Convulsive seizure induced by spontaneous labirynthine stimulation: relation between epilepsy and vestibular system

La inducción refleja de crisis mediante estimulación laberíntica es un hecho raramente informado en la literatura. Presentamos el caso de un paciente varón de 24 años, sin historia previa de epilepsia, que en transcurso de un severo ataque de vértigo presentó una crisis convulsiva generalizada tónico-clónica. El examen otoneurológico demostró una paresia vestibular izquierda. E.E.G. basal reveló actividad irritativa temporal bilateral. Se realizó un estudio poligráfico con activación del E.E.G. mediante es estimulación calórica vestibular con agua a 30 y 44 grados. Durante este examen se apreció la aparición de actividad epileptiforme en el E.E.G. en región temporal derecha cuando se estimuló el laberinto sano. En nuestra opinión este caso traduce una forma de epilepsia vestibular latente que es muy sensible al estímulo laberíntico