Linfoma primario del nervio ciático / Primary Linfoma of the sciatic nerve

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[Frontal cortical infarction and contralateral postural and international tremor]. / Infarto cortical frontal y temblor postural e intencional contralateral.

INTRODUCTION: Movement disorders, when caused by ischemic stroke, may appear as initial manifestation or after a variable interval of time. Among postictal movement disorders tremor is an uncommon manifestation. Holmes' tremor, which is a mixed tremor, is the most frequent type of tremor after stroke. It is associated to infarcts of various localizations like mesencephalon, pons, cerebellum, and thalamus. Cortical infarct is exceptional as a cause of tremor. CASE REPORT: A sixty-three-year-old woman, with hypertension, who, 2 weeks after a cortical infarct located in the precentral circunvolution of the left frontal lobe, presented with a postural and intention tremor of low frequency (4 Hz) and high amplitude at the right arm. Tremor is still present 2 years after stroke and it has improved partially after treatment with clonazepam. DISCUSSION: Frontal cortical infarcts may cause a contralateral postural and intentional tremor. It usually appears after a time interval. Tremor physiopathology may be related, in these cases, to interruption of the inhibitory fronto-subcortical motor circuit.

Infarto cortical frontal y temblor postural e intencional contralateral / Frontal cortical infarction and contralateral postural and international tremor

Introducción. El ictus isquémico es una causa infrecuente de trastornos del movimiento que pueden formar parte de la clínica inicial o presentarse de forma diferida. Entre los movimientos involuntarios postictales el temblor es excepcional. El temblor más frecuente tras un ictus es un temblor mixto, de reposo, postural e intencional, denominado temblor de Holmes, que puede presentarse con infartos de topografía muy diversa (mesencéfalo, protuberancia, cerebelo y tálamo). La aparición de temblor tras infartos corticales es excepcional. Caso clínico. Mujer de 63 años, hipertensa, que 2 semanas después de un infarto cortical en la circunvolución precentral del lóbulo frontal izquierdo comenzó con un temblor postural e intencional, de gran amplitud y baja frecuencia (4 Hz) en el miembro superior derecho. El temblor persistía 2 años después del ictus y mejoró discretamente con clonazepam. Discusión. Los infartos corticales frontales son una causa infrecuente de temblor postural e intencional contralateral que suele presentarse de forma diferida. En estos casos la fisiopatología del temblor podría estar relacionada con la interrupción del circuito motor inhibidor frontosubcortical

Introduction. Movement disorders, when caused by ischemic stroke, may appear as initial manifestation or after a variable interval of time. Among postictal movement disorders tremor is an uncommon manifestation. Holmes’ tremor, which is a mixed tremor, is the most frequent type of tremor after stroke. It is associated to infarcts of various localizations like mesencephalon, pons, cerebellum, and thalamus. Cortical infarct is exceptional as a cause of tremor. Case report. A sixty-three-year-old woman, with hypertension, who, 2 weeks after a cortical infarct located in the precentral circunvolution of the left frontal lobe, presented with a postural and intention tremor of low frequency (4 Hz) and high amplitude at the right arm. Tremor is still present 2 years after stroke and it has improved partially after treatment with clonazepam. Discussion. Frontal cortical infarcts may cause a contralateral postural and intentional tremor. It usually appears after a time interval. Tremor physiopathology may be related, in these cases, to interruption of the inhibitory fronto-subcortical motor circuit

[A descriptive analysis of the demand for ambulatory neurological care in the health district of Huelva]. / Análisis descriptivo de la demanda de asistencia neurológica ambulatoria en un área sanitaria de Huelva.

INTRODUCTION: In recent years the demand for ambulatory neurological care has risen. Studying this situation can help to improve health care planning and the quality of the referrals from primary care. AIM: To analyse a number of variables involved in the first visits referred from primary care to neurology services. PATIENTS AND METHODS: We conducted a prospective, descriptive study in which data was consecutively collected about 500 new patients from primary care who had appointments for a visit to general neurology services in the health district of the province of Huelva. Demographic features, the reason for referral, initial diagnoses and the case resolution index were analysed. RESULTS: Mean age was 51 years old, and patients were predominantly female (63.4%). The most frequent diagnoses were headaches (42.8%) and cognitive impairment (12%). In 8.2% of cases the referred patients had no neurological pathology. Data showed that 40.2% were discharged after the first visit. CONCLUSIONS: The demographic characteristics and reasons for the visit were similar to those previously published on other regions in Spain. The high percentage of direct discharges translates into a poor selection of the patients referred from primary care. Improving the quality of referrals would make it possible to enhance the efficiency of ambulatory neurological care.

Análisis descriptivo de la demanda de asistencia neurológica ambulatoria en un área sanitaria de Huelva / A descriptive analysis of the demand for ambulatory neurological care in the health district of Huelva

Introducción. En los últimos años se ha incrementado la demanda de asistencia neurológica ambulatoria. Su estudio puede contribuir a mejorar la planificación sanitaria y la calidad de las derivaciones desde atención primaria. Objetivo. Analizar diversas variables de las primeras visitas remitidas desde atención primaria a las consultas de neurología. Pacientes y métodos. Estudio prospectivo descriptivo en el que se recogieron de forma consecutiva los datos de 500 pacientes nuevos procedentes de atención primaria citados en una consulta de neurología general en el área sanitaria de la provincia de Huelva. Se analizaron las características demográficas, el motivo de derivación, los diagnósticos iniciales y el índice de resolución de los casos. Resultados. La media de edad fue de 51 años, con un predominio femenino (63,4%). Los diagnósticos más frecuentes fueron las cefaleas (42,8%) y el deterioro cognitivo (12%). El 8,2% de los pacientes remitidos no tenía ninguna patología neurológica. El 40,2% fue dado de alta tras la primera visita. Conclusiones. Las características demográficas y los motivos de consulta son similares a los publicados previamente en otras comunidades españolas. El elevado porcentaje de altas directas traduce una escasa selección de los pacientes remitidos desde atención primaria. La mejora en la calidad de las derivaciones permitiría mejorar la eficiencia de la asistencia neurológica ambulatoria

Introduction. In recent years the demand for ambulatory neurological care has risen. Studying this situation can help to improve health care planning and the quality of the referrals from primary care. Aim.To analyse a number of variables involved in the first visits referred from primary care to neurology services. Patients and methods. We conducted a prospective, descriptive study in which data was consecutively collected about 500 new patients from primary care who had appointments for a visit to general neurology services in the health district of the province of Huelva. Demographic features, the reason for referral, initial diagnoses and the case resolution index were analysed. Results. Mean age was 51 years old, and patients were predominantly female (63.4%). The most frequent diagnoses were headaches (42.8%) and cognitive impairment (12%). In 8.2% of cases the referred patients had no neurological pathology. Data showed that 40.2% were discharged after the first visit. Conclusions. The demographic characteristics and reasons for the visit were similar to those previously published on other regions in Spain. The high percentage of direct discharges translates into a poor selection of the patients referred from primary care. Improving the quality of referrals would make it possible to enhance the efficiency of ambulatory neurological care

[Room tilt illusion: a rare symptom of migraine aura]. / Ilusión de inversión de la imagen visual: una manifestación excepcional de aura migrañosa.

INTRODUCTION: Room tilt illusion is a distorted perception of the spatial distribution of objects due to complex rotations in different planes. This distortion usually occurs in the vertical plane and is usually associated to vertebrobasilar ischemia. The etiology of the phenomenon varies greatly and only rarely corresponds to migraine aura. CASE REPORT: Since youth, a sixty-year-old woman had frequent episodes of room tilt illusion in the horizontal plane. These lasted from 30 minutes to 2 hours and were always followed by frontal headache fulfilling criteria for migraine (computerized tomography and magnetic resonance imaging) were normal. Visual symptoms and headache disappeared following treatment with flunarizine. DISCUSSION: Room tilt illusion might be a rare symptom of migraine aura. In this setting a functional depression of neurons from the posterior parietal cortex may occur, possibly mediated by chemical factors.

Ilusión de inversión de la imagen visual: una manifestación excepcional de aura migrañosa / Room tilt illusion: a rare symptom of migraine aura

Introducción. La ilusión de inversión de la imagen visual consiste en una percepción alterada de la situación de los objetos que se produce por rotaciones completas en los distintos planos del espacio. Esta alteración es más frecuente en el plano vertical y se asocia sobre todo a isquemia vertebrobasilar. La etiología del fenómeno es muy diversa y sólo excepcionalmente corresponde a un aura migrañosa. Caso clínico. Mujer de 60 años que desde su juventud presenta episodios de inversión visual en el plano horizontal, de 30 min a 2 h de duración, que siempre se siguen de una cefalea bifrontal con criterios de migraña. Los estudios de neuroimagen (tomografía computarizada y resonancia magnética craneal) fueron normales. Tanto los síntomas visuales como la cefalea desaparecieron al instaurar tratamiento con flunarizina. Discusión. La ilusión de inversión de la imagen visual puede ser una manifestación infrecuente de aura migrañosa. El mecanismo fisiopatológico consiste en una depresión funcional neuronal transitoria de la corteza parietal posterior, posiblemente mediada por factores químicos

Introduction. Room tilt illusion is a distorted perception of the spatial distribution of objects due to complex rotations in different planes. This distortion usually occurs in the vertical plane and is usually associated to vertebrobasilar ischemia. The etiology of the phenomenon varies greatly and only rarely corresponds to migraine aura. Case report. Since youth, a sixty-year-old woman had frequent episodes of room tilt illusion in the horizontal plane. These lasted from 30 minutes to 2 hours and were always followed by frontal headache fulfilling criteria for migraine (computerized tomography and magnetic resonance imaging) were normal. Visual symptoms and headache disappeared following treatment with flunarizine. Discussion. Room tilt illusion might be a rare symptom of migraine aura. In this setting a functional depression of neurons from the posterior parietal cortex may occur, possibly mediated by chemical factors

Síndromes paraneoplásicos en otoneuroftalmología / Paraneoplastic syndromes in otoneurophthalmology

Introducción y objetivo. Llamamos síndromes neurológicos paraneoplásicos (SNP) a un grupo de enfermedades del sistema nervioso de etiología desconocida que aparecen casi exclusivamente en pacientes con cáncer. Repasaremos los principales SNP prestando especial atención a aquellos con manifestaciones oftalmológicas y otológicas. Desarrollo. Existe alteración visual en la retinopatía paraneoplásica y en la neuritis óptica de origen paraneoplásico. Ésta, a diferencia de la retinopatía, coexiste normalmente con afectación de otras estructuras del sistema nervioso. En el síndrome opsoclono-mioclono se afecta la función oclulomotora. La diplopía y/o oftalmoparesia pueden ser un síntoma predominante o inicial en pacientes con degeneración cerebelosa paraneoplásica o encefalitis de tronco. En el síndrome de Eaton-Lambert y en la encefalomielitis paraneoplásica (EMP) la afectación del sistema nervioso autónomo puede manifestarse como visión borrosa y alteraciones pupilares. También se ha descrito algún caso de uveítis paraneoplásica. La afectación otológica paraneoplásica es menos frecuente. Se han descrito pacientes con sordera neurosensorial en el contexto de una EMP. En los SNP el vértigo se produce por afectación cerebelosa o de tronco y no por lesión de órganos periféricos. El nistagmo que aparece en un SNP puede ser de varios tipos y se debe a la afectación de estructuras del tronco cerebral o del cerebelo.Conclusiones. El diagnóstico de SNP en pacientes sin cáncer conocido es importante porque puede llevarnos a la detección de un cáncer oculto, localizado o poco diseminado. Las manifestaciones del área otoneuroftalmológica pueden ser el primer o único síntoma de presentación de un SNP (AU)

[Paraneoplastic syndromes in otoneuro-ophthalmology]. / Síndromes paraneoplásicos en otoneuroftalmología.

INTRODUCTION AND OBJECTIVE: The so-called neurological paraneoplastic syndromes (NPNS) are a group of diseases of the central nervous system of unknown etiology which are seen almost exclusively in patients with cancer. We review the main NPNS paying particular attention to those with ophthalmological and otological features. DEVELOPMENT: Certain neuro-ophthalmological findings may constitute, at least partly, some paraneoplastic syndromes. There are alterations of vision in paraneoplastic retinopathy and in optic neuritis of paraneoplastic origin. The latter, unlike the retinopathy, usually coexists with involvement of other structures of the nervous system. Oculomotor function is affected in the opsoclonus-myoclonus syndrome. Diplopia and/or ophthalmoplegia may be a predominant or initial symptom, in patients with paraneoplastic neurological degeneration or brainstem encephalitis. In the Lambert-Eaton syndrome and in paraneoplastic encephalomyelitis, may have blurred vision and alterations of the pupil. Cases of paraneoplastic uveitis have also been described. Paraneoplastic otological involvement is less frequent. Patients with sensorineural deafness in the context of a paraneoplastic encephalomyelitis have been reported. In the NPNS vertigo is caused by cerebellar or brainstem lesions and not by lesions of peripheral organs. When nystagmus occurs in a NPNS it may be of various types and is due to involvement of structures in the brain stem or cerebellum. CONCLUSIONS: The diagnosis of NPNS in patients with no known cancer is important because it may lead to the detection of an occult cancer which is localized or scarcely extended, and therefore is still potentially treatable. Oto-neuro-ophthalmological manifestations may be the first or only symptom of presentation of a paraneoplastic neurological clinical picture.