[Correlation between demyelinating lesions and executive function decline in a sample of Mexican patients with multiple sclerosis]. / Correlación entre las lesiones desmielinizantes y el deterioro de las funciones ejecutivas en una muestra de pacientes Mexicanos con esclerosis múltiple.

BACKGROUND: Multiple Sclerosis (MS) is characterised by several neurological symptoms including cognitive impairment, which has recently been the subject of considerable study. At present, evidence pointing to a correlation between lesion characteristics and specific cognitive impairment is not conclusive. OBJECTIVE: To investigate the presence of a correlation between the characteristics of demyelinating lesions and performance of basic executive functions in a sample of MS patients. PATIENTS AND METHODS: We included 21 adult patients with scores of 0 to 5 on the Kurtzke scale and no exacerbations of the disease in at least 3 months prior to the evaluation date. They completed the Stroop test and the Wisconsin Card Sorting Test (WCST). The location of the lesions was determined using magnetic resonance imaging (MRI) performed by a blinded expert in neuroimaging. RESULTS: Demyelinating lesions were more frequently located in the frontal and occipital lobes. The Stroop test showed that as cognitive demand increased on each of the sections in the test, reaction time and number of errors increased. On the WCST, 33.33% of patients registered as having moderate cognitive impairment. No correlation could be found between demyelinating lesion characteristics (location, size, and number) and patients' scores on the tests. CONCLUSION: Explanations of the causes of cognitive impairment in MS should examine a variety of biological, psychological, and social factors instead of focusing solely on demyelinating lesions.

[Fluconazole in meningeal coccidioidomycosis]. / El fluconazol en la coccidioidomicosis meníngea.

We report our experience with ten virgin cases (5 children, 5 adults) with coccidioidal meningitis treated with fluconazole. The diagnosis was confirmed by a positive culture of the cerebrospinal fluid. Fluconazole at doses of 6/mg/kg/day for children and 400 mg/day for adults were given. All responded well, in five it was discontinued and four relapsed but responded well to fluconazole. We conclude that fluconazole is useful for coccidioidal meningitis.

[Activity of aryl sulfatase A enzyme in patients with schizophrenic disorders]. / Actividad de la enzima aril sulfatasa A en pacientes con desórdenes esquizofrénicos.

Metachromatic leukodystrophy (MLD) is a degenerative disease caused by the deficiency of aryl sulfatase (ASA). It can course with psychiatric symptoms. We determined the prevalence of ASA deficiency in a group of 23 patients with presumable schizophrenia. The median serum ASA was 53.2 nmol/mL/h (range 3.3-152.5). Six patients (26%) showed low ASA activity (< 27.5 nmol/mL/h which is the lowest value observed in 29 normal controls); five of them had clinical history of delusions of grandeur, auditive hallucinations, multiple hospitalizations, low response to neuroleptics, and abnormal evoked potentials. It is probable that the schizophrenic symptoms in these patients may be due to the enzyme deficiency. We conclude that the assay is useful in clinical practice as it may help to identify cases of MLD in patients with suspected schizophrenia.

[Relations between delayed diagnosis and forms of onset in Duchenne muscular dystrophy]. / Relación entre el retraso del diagnóstico y las formas de inicio de la distrofia muscular de Duchenne.

Duchenne Muscular Dystrophy (DMD) is usually diagnosed several years after the onset of symptoms. The relatives of the patients with DMD frequently consult family physicians when they notice the first symptom. The purpose of this study was to determine the cause that influence the delayed diagnosis of DMD. Twenty-two patients with confirmed diagnosis of DMD were interviewed at two Neurology Centers (Mexican Social Security Institute) in Monterrey, Nuevo León, México. Two forms of onset of DMD: Retarded development and locomotion problems were found, confirming other studies. The mean age of onset of symptoms for 22 patients was 2.4 years. The mean age for DMD diagnosis was 4.9 years. Retarded development occurred in 12 (54.4%) of all cases and the age of diagnosis was between 1 and 6 years of age. In 10 cases of the group with locomotion problems (45.4%) the diagnosis was made between 3 and 11 years of age. The serum Creatine Kinase was increased in all patients and in the early stages these levels were much higher than late stages. Family physicians have opportunities to make early diagnosis of DMD if they are aware of the two forms of onset of the disease: Retarded development and locomotion problems and of the changes in serum CK levels. The findings of this study confirm the importance of family physicians in that respect and also in making recommendations for routine determination of serum Creatine Kinase (CK) as early as possible in a child with symptoms suggestive of DMD.

[Differential diagnosis of Becker and Duchenne muscular dystrophy]. / Diagnóstico diferencial entre distrofia muscular de Becker y Duchenne.

The Becker's Muscular Dystrophy (BMD) is a disease with similar aspect and distribution to the Duchenne Muscular Dystrophy (DMD), although it is usually less severe. The main purpose of this investigation was to outline the most important clinical characteristics that can help in the differential diagnosis between these two diseases. Thirty eight patients were studied; 16 with BMD and 22 with DMD. Clinically both are very similar, and the best criteria for the differentiation of this two diseases is the inability to walk. The age of symptomatology onset was 10.5 +/- 7.2 years in BMD and 2.3 +/- 13 years in DMD showing an overlapping of 18.42% of DMD and DMB at the age of 4, this overlapping difficult the precise diagnosis between both diseases. The creatine kinase (CK) study was not relevant.

[Oculopharyngeal muscular dystrophy: 1st report in Mexico]. / Distrofia muscular oculofaríngea: primer informe en México.

We report a case of a woman of Mexican origin with oculopharyngeal muscular dystrophy (OMD). This is the first OMD reported in Mexico. She was healthy until the age of 30, when she noticed slowly progressive ptosis and dysphagia. She developed dermatitis and polyneuritis which we attribute to a deficiency of nutrients due to her dysphagia. In contrast to most previous reported cases this patient had also a distal myopathy. It is recommended in this type of patients a strict dietary control in order to avoid complications. It is also recommended to perform biopsies of several muscles to complete the diagnosis and prognosis.