Ignacio Casas Parera

Flunarizine- and cinnarizine-induced extrapyramidal reactions.

Cinnarizine and flunarizine are selective calcium blockers that have been used to treat and prevent vertigo. We studied 15 patients who had extrapyrqmidal syndromes after taking these drugs. Eleven patients had parkinsonism, one with persistent akathisia as well; one had an orofacial tremor; one, acute akathisia alone; and one an acute dystonic reaction. All but one improved when the drug therapy was discontinued. Seven patients were also depressed during treatment. Cinnarizine and flunarizine must therefore be added to the list of potentially risky drugs known to induce extrapyramidal reactions and depression.

Bruxism secondary to chronic antidopaminergic drug exposure

Eight cases of diurnal bruxism (DB) secondary to long-term antidopaminergic drug exposure are reported. Five exhibited a grinding pattern, one a clenching form, and two a mixed type. An odontological etiology was absent throughout. EMG recordings disclosed two distinct patterns of muscle activity, one with brief rhythmic, forceful contractions and the other featuring sustained prolonged contractions. Surface EMG and EEG monitoring during a 24-h period confirmed the absence of bruxism during sleep. Several drug trials failed to provide relief. Our findings support DB as a focal tardive dystonia syndrome.

Familial bulbospinal neuronopathy with optic atrophy : a distinct entity

A 61 year old woman and her 58 year old brother presented with the clinical picture of late onset progressive bulbar and spinal muscular atrophy with family history of involvement in successive generations. The sister also had optic neuropathy and the brother developed diabetes mellitus and sex hormone abnormalities. Neurophysiological and histopathological studies showed a pattern of motor and sensory neuronopathy. There was no abnormal expansion of CAG repeats in the androgen receptor gene. This family seems to have a previously unrecognised entity with the bulbospinal neuronopathy phenotype.

Arm chorea secondary to an unruptured giant aneurysm.

We describe the case of a 20‐year‐old male who developed right‐arm choreic movements secondary to a giant unruptured aneurysm impinging upon the left thalamus, putamen, globus pallidus, cerebral peduncle, midbrain, and subthalamic nucleus. The aneurysm was treated successfully with coils and a supraclinoid balloon. Abnormal movements initially failed to ameliorate, but within a few months, it was possible to discontinue symptomatic haloperidol therapy, with only mild residual abnormal movements.

Unusual Manifestations of Basilar Artery Ectasia

Three patients with unusual presentations of basilar artery ectasia are described: subarachnoid hemorrhage was manifest in one and autonomic dysfunction developed in the other two. Aneurysmal rupture was the cause in the first patient, while compression of the brainstem and/or of the baroreceptor afferences of the IXth and Xth cranial nerves is postulated to be responsible for the symptoms found in the other two. Basilar artery aneurysms should be considered in cases with subarachnoid hemorrhage or autonomic dysfunction, particularly when diagnostic procedures fail to disclose other possible etiologies.

Estudio de una cohorte de pacientes adultos con tumores primarios de sistema nervioso central de la serie glial

Resumen Introduccion En los ultimos anos se sucedieron cambios en la neurooncologia que mejoraron la calidad de vida y sobrevida de pacientes con tumores primarios (TP) del SNC. Objetivos Presentar las caracteristicas clinicas de una cohorte de pacientes con TP de SNC de la serie glial. Material y metodos Entre los anos 2002-2009 se realizo el seguimiento de 148 pacientes con TP de SNC. Se analizaron solo los tumores de la serie glial intracraneanos. Este es un estudio descriptivo. Resultados Setenta y nueve pacientes (52 varones y 27 mujeres) presentaron tumores de la serie glial. El mayor numero de casos se presentaron en la cuarta decada. Segun la histopatologia: 34 glioblastomas multiformes (GBM), 6 astrocitomas GIII, 9 astrocitomas GII, 5 astrocitomas GI, 3 gliomas de tronco, 1 glioma cordoide, 16 oligodendrogliomas GII y 5 oligodendrogliomas GIII. La localizacion mas frecuente fue en el lobulo frontal. Los sintomas de inicio, en orden de frecuencia, fueron: crisis comiciales, cefalea, afasias, deficits cognitivos, motores o sensitivos, patologia de pares y sindrome de hipertension endocraneana. En 27 pacientes el tratamiento fue quirurgico/radioterapia/quimioterapia (Qx/Rt/Qt), 20 Rt/Qt, 6 Qx, 6 Qt, 5 Rt, 5 Qx/Qt, 4 Qx/Rt, y 6 pacientes no realizaron tratamiento. El 51% de los pacientes tuvieron reseccion parcial o completa del tumor. Las crisis epilepticas (parciales [62%] y generalizadas [38%]) fueron controladas completamente en el 66% de los casos con monoterapia. Conclusiones El GBM fue el tumor mas frecuente y el lobulo frontal el mas comprometido. El sintoma prevalente fueron las crisis epilepticas. Obtuvimos un porcentaje bajo de pacientes con reseccion parcial o completa del tumor.