Neurología : publicación oficial de la Sociedad Española de Neurología
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Streptococcus salivarius is a usual commensal of skin, gastrointestinal tract, genitourinary tract, oral cavity and paranasal sinuses. Although it is usually considered to have low virulence, S. salivarius may cause life-threatening infections, particularly endocarditis. On the other hand, bacterial meningitis after spinal anesthesia is very rare, there being some reported cases caused by S. salivarius, S. mitis, Staphylococcus aureus and Enterococcus faecalis. ⋯ Of the 28 cases, 18 occurred after lumbar puncture for diagnostic or for spinal anesthesia, 5 occurred following a bacteriemia for upper gastrointestinal endoscopy or intestinal neoplasia, and the other 5 in patients who had dural defects. We discuss the possible etiological causes of the meningitis due to S. salivarius cases reports. The early recognition of this entity and the aseptic precautions likely to reduce the incidence of infectious complications after lumbar puncture are stressed.
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Charles Bonnet's syndrome is characterized by the existence of visual hallucinations without psychiatric manifestations or cognitive disorder. Most patients are elderly people with severe visual problems. The objective of this paper is to describe the cases of three patients with this syndrome. ⋯ Treatment with neuroleptics or antiepileptics was effective only in one case. We conclude that it is important to know the syndrome and to differentiate it from psychiatric semiology. Deafferentation of the visual cortex could be the decisive factor in the occurrence of visual hallucinations.
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Diagnostic reasoning is a cognitive proccess that has various performance and results. There are several kinds of clinical reasoning, such as model or pattern recognizing, causal or physiopathologic reasoning, deterministic, exhaustive, and hypotetic-deductive ones. ⋯ It is necessary that the neurologist knows the principles of diagnostic reasoning and the more frequent errors and biases. These can be summarized as: errors associated with the proccess of taking history and clinical examination, mnesic and semantic components of clinical reasoning, failure of hipotetic- deductive reasoning, and inadequate use of probability theory in Medicine.
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Randomized clinical trials and mainly meta-analysis, have become the gold standard in the assessment of drug efficacy. A meta-analysis is a systematic review that uses statistical techniques to combine and summarize results of previous studies. ⋯ This type of meta-analysis avoids the partiality which may originate from the non-publication of nonsignificant studies. The future tendency would recommend that investigators, clinicians, reviewers, journal editors and sponsors agree on publication criteria other than positive p values such as clinical validity and clinical relevance.
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Cerebral venous thrombosis (CVT) is considered to be a relative unusual pathology, probably underdiagnosed. Many acquired and inherited hypercoagulability states (HS) have been described as cause of CVT. ⋯ Although this is a small series, we found a high incidence of hereditary (37.5%) and acquired (37.5%) thrombophilia in patients with CVT.