Carlos Silva R

Neuropatía por disulfiram: Comunicación de tres casos clínicos

Disulfiram is widely used for aversive treatment of alcoholism. Although it is well tolerated in most patients, one in 15,000 patients will develop peripheral neuropathy every year, which is frequently misdiagnosed as alcoholic neuropathy. Disulfiram neuropathy can be mild or severe, depending on diverse factors such as time of exposure and the dosage. Most patients will present with a motor-sensory neuropathy of the lower limbs, which tends to improve as disulfiram administration ceases, however some cases may remain with permanent sequelae. We report the clinical, laboratory and electrophysiological features of three patients who developed disulfiram neuropathy during treatment of alcoholism. Recovery was incomplete at 8 weeks after treatment cessation in all of them. No other findings justified the clinical features described in these patients. Considering the incidence of alcoholism and the wide use of disulfiram treatment in Chile, we suggest that disulfiram neuropathy is being underdiagnosed. We also stress the fact that disulfiram neuropathy could be avoided by using lower doses (Rev Med Chile 2002; 130: 1037-42).

Síndrome de Charles Bonnet: presentación de tres casos y revisión de la literatura

Charles Bonnet syndrome is characterized by the presence ofvisual hallucinations associated with loss of vision. We report three patients aged 74, 84 and 80years (two women) with a severe loss of vision due to ocular diseases and silent visualhallucinations, that they recognized as unreal. Two patients felt that the hallucinations wereominous. Years later, two suffered a probable Alzheimer’s disease (AD). One of them had a mildcognitive impairment when the syndrome appeared, that evolved into an AD with psychosis.This syndrome is not uncommon in older patients with loss of vision and it is probablyunderdiagnosed. Its pathogenesis is probably a cortical deafferentation. The content of thevisual hallucinations (faces, landscaped, and so on) coincides with the activation of differentareas of the visual association cortices) (Rev Med Chile 2007; 135: 1034-39).(

Aspectos neurológicos del púrpura trombótico trombocitopénico: Presentación de un caso

Neurological manifestations, secondary to perfusion problems, vasogenic edema or small infarcts, are common in thrombotic purpura. Moreover, they are the first symptoms of the disease in 50% of patients. We report a 50 year-old woman who presented with focal intermittent neurological signs with aphasia and right hemiparesis, who then developed progressive impairment of consciousness with stupor and generalized tonic-clonic seizures. Despite the severe neurological impairment, first neuroimaging studies were normal. A second magnetic resonance imaging showed small cortical infarcts, that were visible only with the technique of diffusion weighted imaging. The standard electroencephalograms showed focal left temporal slowing and low voltage first and then diffuse slowing accordind to the clinical condition of the patients. She was treated with plasmapheresis and had a partial neurological recovery at the fifth day, but died at the twelfth day of therapy (Rev Med Chile 2006; 134: 348-52). (Key words: Brain infarction; Magnetic resonance imaging; Purpura, thrombocytopenic)

Parálisis general sifilítica: presentación de 5 casos

We report five male patients, aged 35 to 63 years who suffered from paretic neurosyphilis. The clinical course was that of a subacute dementia with a frontal syndrome, with more apathy than euphoria. All were HIV negative and four were heterosexual. In all, the cerebrospinal fluid had a mononuclear pleocytosis and a positive VDRL. EEG was abnormal in the 3 cases in whom it was performed. One patient in whom a brain angiography was performed, had images of vasculitis. Treatment with 18-24 million units of penicillin per day during two weeks or more, was partially effective.We report five male patients, aged 35 to 63 years who suffered from paretic neurosyphilis. The clinical course was that of a subacute dementia with a frontal syndrome, with more apathy than euphoria. All were HIV negative and four were heterosexual. In all, the cerebrospinal fluid had a mononuclear pleocytosis and a positive VDRL. EEG was abnormal in the 3 cases in whom it was performed. One patient in whom a brain angiography was performed, had images of vasculitis. Treatment with 18-24 million units of penicillin per day during two weeks or more, was partially effective.

Intoxicación por carbamazepina con dos dosis de claritromicina: Reporte de un caso

La interaccion entre carbamazepina y claritromicina ha sido recientemente reportada en la literatura. Reportamos el caso de un nino de 8 anos, portador de epilepsia, quien presento una intoxicacion por carbamazepina luego de que se agregara claritromicina al tratamiento. Despues de la segunda dosis del antibiotico el paciente se mostro somnoliento y con ataxia cerebelosa, demostrandose una importante elevacion del nivel plasmatico de carbamazepira. El paciente recobro su condicion normal rapidamente, luego de que se suspendiera el antibiotico con la concomitante disminucion del nivel plasmatico del aticonvulsivante. Se discuten las caracteristicas de esta interaccion de farmacos haciendo resaltar las caracteristicas del metabolismo de los ninos que hace especialmente importante esta situacion clinica