Experiencia con cuatro casos clínicos, ¿puede la encefalopatía traumática crónica estar asociada a un traumatismo craneoencefálico único? / Experience with 4 clinical cases. Traumatic encephalopathy may be associated with a single traumatic brain injury?

La encefalopatía traumática crónica (ETC) es una enfermedad neurodegenerativa que afecta a personas que han padecido traumatismos craneales repetitivos. No obstante, también durante el seguimiento de los pacientes con traumatismo craneoencefálico (TCE) único se pueden observar cambios respecto de su situación previa. Presentamos cuatro casos clínicos de pacientes visitados en la consulta externa del Instituto Guttmann entre 2017 y 2019, afectos de secuelas leves de TCE grave y único que han desarrollado posteriormente una enfermedad neurodegenerativa sin un diagnóstico concreto y que pudiesen cumplir criterios clínicos de síndrome de encefalopatía traumática crónica. Los médicos rehabilitadores son los profesionales con mayor posibilidad de identificar estos pacientes, indicando las exploraciones complementarias necesarias y estableciendo nuevos objetivos de rehabilitación.(AU)

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that affects people who had repetitive head trauma. Also, in single traumatic brain injury (TBI), changes may be found during the follow-up visits.We present four clinical cases of patients visited at the Institut Guttmann clinic between 2017 and 2019. They were affected by mild sequelae of severe and unique TBI who have subsequently developed a neurodegenerative disease without a specific diagnosis, and who could meet clinical criteria for chronic traumatic encephalopathy syndrome. Rehabilitation doctors are the professionals with the greatest possibility of identifying a suggestive clinic of this pathology, they can order the appropriate studies and indicate the new rehabilitation goals according to the new neurological situation.(AU)

[Experience with 4 clinical cases. Traumatic encephalopathy may be associated with a single traumatic brain injury?] / Experiencia con cuatro casos clínicos, ¿puede la encefalopatía traumática crónica estar asociada a un traumatismo craneoencefálico único?

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that affects people who had repetitive head trauma. Also, in single traumatic brain injury (TBI), changes may be found during the follow-up visits. We present four clinical cases of patients visited at the Institut Guttmann clinic between 2017 and 2019. They were affected by mild sequelae of severe and unique TBI who have subsequently developed a neurodegenerative disease without a specific diagnosis, and who could meet clinical criteria for chronic traumatic encephalopathy syndrome. Rehabilitation doctors are the professionals with the greatest possibility of identifying a suggestive clinic of this pathology, they can order the appropriate studies and indicate the new rehabilitation goals according to the new neurological situation.

[Transcranial direct current stimulation for the treatment of fibromyalgia: a systematic review]. / Estimulacion transcraneal por corriente directa en la fibromialgia: revision sistematica.

INTRODUCTION: Fibromyalgia is a multisymptomatic diffuse chronic musculoskeletal pain syndrome with evidence of central nervous system dysfunction. Accordingly, non-invasive brain stimulation techniques such as transcranial direct current stimulation (tDCS) may be a complementary therapeutic resource to reduce pain perception. AIMS: To review the potential effectiveness of tDCS to reduce pain in fibromyalgia, to identify the most effective neurostimulation parameters and to delimit its safety. PATIENTS AND METHODS: Systematic review of prospective studies reported in PubMed and Cochrane reviews. RESULTS: The anodal tDCS of the left primary motor cortex, at 2mA for 20 minutes with 35 cm2 electrodes on five consecutive days, provides better results in reducing pain (14-59%), and improving sleep quality, with greater accentuation on the fifth day. The clinical improvement persists up to a minimum of 60 days (11-20% reduction of pain). Adverse effects are well tolerated and few. CONCLUSIONS: The experience with tDCS in fibromyalgia is still limited. However, the anodal tDCS in the left primary motor cortex can be recommended with level B (probable therapeutic efficacy) and appears to act through the modification of the sensorial processing of the pain of thalamic inhibitory circuitry.

TITLE: Estimulacion transcraneal por corriente directa en la fibromialgia: revision sistematica.Introduccion. La fibromialgia es un sindrome de dolor cronico difuso musculoesqueletico multisintomatico, con evidencias de una disfuncion del sistema nervioso central. Consecuentemente, tecnicas de estimulacion cerebral no invasiva, como la estimulacion transcraneal con corriente directa (tDCS), pueden ser un recurso terapeutico complementario para reducir la percepcion de dolor. Objetivos. Revisar la potencial efectividad de la tDCS para reducir el dolor en la fibromialgia, identificar los parametros mas efectivos de neuroestimulacion y delimitar su seguridad. Pacientes y metodos. Revision sistematica de estudios prospectivos registrados en PubMed y revisiones Cochrane. Resultados. La tDCS anodica de la corteza motora primaria izquierda, a 2 mA durante 20 minutos con electrodos de 35 cm2 durante cinco dias consecutivos, es la que proporciona mejores resultados en la reduccion del dolor (14-59%) y mejora de la calidad del sueño, con mayor acentuacion en el quinto dia. La mejora clinica persiste hasta un minimo de 60 dias (11-20% de reduccion del dolor). Se tolera bien y tiene escasos efectos adversos. Conclusiones. La experiencia con la tDCS en fibromialgia es todavia limitada. No obstante, la tDCS anodica en la corteza motora primaria izquierda puede recomendarse con un nivel B (probable eficacia terapeutica) y podria actuar mediante la modificacion del procesamiento sensorial del dolor de circuitos inhibitorios talamicos.

Multiple sclerosis following a spinal cord injury: a rare and unfortunate case.

This is a case report and review of literature with the objective report of the case of a young man with physical disability following a traumatic spinal cord injury (SCI) who was later newly diagnosed with multiple sclerosis (MS) in an inpatient SCI rehabilitation center. (Barcelona, Spain). A 24-year-old male sustained a traumatic spinal cord lesion (T9 AIS A) as the result of a motorcycle accident. He completed his rehabilitation process without complications and returned to the community having adjusted to his new disability. Two and a half years after his initial injury, he attended the clinic after experiencing 2 months of paresthesias in his left hand, progressing to his right upper limb, and difficulty with fine hand movements. An magnetic resonance imaging (MRI) was arranged and although post-traumatic syringomyelia was ruled out, demyelinating areas in the cervical spinal cord were found. A brain MRI revealed multiple demyelinating lesions suggestive of MS. The diagnosis of MS was confirmed by a neurologist and treatment was started with daily doses of glatiramer acetate. At this time the patient was still independent in transfers, activities of daily living and wheelchair management. In young patients with SCI, adequate follow-up is important to detect subsequent complications that may lead to clinical and functional deterioration with a view to uncommon causes such as MS.

[Reversible segmental cerebral vasoconstriction: the value of duplex transcranial Doppler in its diagnosis and follow up]. / Vasoconstriccion segmentaria cerebral reversible: utilidad del duplex transcraneal en el diagnostico y seguimiento.

INTRODUCTION: Reversible segmental cerebral vasoconstriction, also known as Call Fleming syndrome, is a clinical entity that consists of segmental vasoconstriction of the arteries in the brain, which can course with focal neurological deficits and which is characteristically reversible. Diagnosis and follow up of reversible segmental cerebral vasoconstriction is performed using cerebral arteriography, but no previous evaluation has been conducted of the role that duplex transcranial Doppler can play in this syndrome. CASE REPORT: Here we describe the case of a 57 year old female patient who began suffering from sudden bouts of headaches with no other accompanying clinical features. After ruling out the possibility of a subarachnoid haemorrhage by means of a spinal tap, a suspicion diagnosis of reversible segmental cerebral vasoconstriction was made through duplex transcranial Doppler and this was later confirmed by arteriography, which revealed a segmental stenosis in the upper branch of the left middle cerebral artery. Following treatment with nimodipine, the patient presented a clear clinical improvement and the reversibility of the cerebral vasoconstriction was confirmed by duplex transcranial Doppler. CONCLUSION: Contrast enhanced duplex transcranial Doppler would enable us to obtain an early diagnostic approximation in patients in whom segmental vasoconstriction is suspected; it could also constitute the choice non invasive follow up method in these patients.

Vasoconstricción segmentaria cerebral reversible: utilidad del dúplex transcraneal en el diagnóstico y seguimiento / Reversible segmental cerebral vasoconstriction: the value of duplex transcranial doppler in its diagnosis and follow-up

Introducción. La vasoconstricción segmentaria cerebral reversible, también conocida como síndrome de Call-Fleming, es una entidad clínica consistente en una vasoconstricción segmentaria de las arterias cerebrales. Puede cursar con déficit neurológicos focales y es característicamente reversible. El diagnóstico y seguimiento de la vasoconstricción segmentaria cerebral reversible se realiza mediante arteriografía cerebral, pero el papel del estudio dúplex transcraneal en dicho síndrome no se ha valorado previamente. Caso clínico. Presentamos el caso de una paciente de 57 años que debuta con una cefalea de inicio súbito sin otra clínica acompañante. Tras descartar mediante punción lumbar una hemorragia subaracnoidea, se realiza el diagnóstico de sospecha de vasoconstricción segmentaria cerebral reversible mediante un estudio dúplex transcraneal, confirmada posteriormente por arteriografía al objetivar una estenosis segmentaria en la rama superior de la arteria cerebral media izquierda. Tras iniciar el tratamiento con nimodipino, la paciente presenta una clara mejoría clínica y se confirma mediante el estudio dúplex transcraneal la reversibilidad de la vasoconstricción cerebral. Conclusión. El dúplex transcraneal potenciado con contraste permitiría una primera aproximación diagnóstica en los pacientes con sospecha de vasoconstricción segmentaria, y podría constituir el método de seguimiento no invasivo de elección en estos pacientes (AU)

Introduction. Reversible segmental cerebral vasoconstriction, also known as Call-Fleming syndrome, is a clinical entity that consists of segmental vasoconstriction of the arteries in the brain, which can course with focal neurological deficits and which is characteristically reversible. Diagnosis and follow-up of reversible segmental cerebral vasoconstriction is performed using cerebral arteriography, but no previous evaluation has been conducted of the role that duplex transcranial Doppler can play in this syndrome. Case report. Here we describe the case of a 57-year-old female patient who began suffering from sudden bouts of headaches with no other accompanying clinical features. After ruling out the possibility of a subarachnoid haemorrhage by means of a spinal tap, a suspicion diagnosis of reversible segmental cerebral vasoconstriction was made through duplex transcranial Doppler and this was later confirmed by arteriography, which revealed a segmental stenosis in the upper branch of the left middle cerebral artery. Following treatment with nimodipine, the patient presented a clear clinical improvement and the reversibility of the cerebral vasoconstriction was confirmed by duplex transcranial Doppler. Conclusion. Contrast-enhanced duplex transcranial Doppler would enable us to obtain an early diagnostic approximation in patients in whom segmental vasoconstriction is suspected; it could also constitute the choice non-invasive follow-up method in these patients (AU)