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INTRODUCTION: Primary headaches are one of the most prevalent conditions in neurology. Botulinum toxin type A (TBA) has been used for years as a prophylactic measure for chronic daily headache (CDH) with varying infiltration regimens and outcomes. AIM: To demonstrate the speed, convenience and safety of a subcutaneous regimen of TBA as a prophylactic for CDH, and also to determine how effective it is as a preventive therapy. PATIENTS AND METHODS: A total of 843 patients were infiltrated subcutaneously with 100 U of TBA (Botox) using a 'fixed dose-fixed site' technique in six pericranial points in periods of at least three months. We evaluated the reduction in the mean frequency of crises and days with headaches and the intake of analgesics, as well as the percentage of patients with a reduction of over 50% in the mean frequency of headache crises. RESULTS: Subcutaneous infiltration of TBA brought about a reduction of 78.91+/-6.81% in the frequency of monthly crises (p<0.001) and a reduction of 62.38+/-12.8% in the number of days per month with headache after three months' infiltration. Reports from patients indicated that 92.8% of them had reduced the number of days with headache per month by at least 50%. Mean frequency and total intake of analgesics decreased from 21.48+/-2.47 to 1.96+/-1.27 (p<0.001) and from 126.01+/-24.7 to 6.65+/-2.27 doses, respectively. There were few side effects, none of which were severe. CONCLUSION: Simplified subcutaneous infiltration of TBA is very effective, convenient, fast and safe as a means of preventing CDH.

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Las cefaleas primarias constituyen una de las afecciones más prevalentes en neurología. La toxinabotulínica tipo A (TBA) se utiliza desde hace años en la profilaxis de la cefalea crónica diaria (CCD) con pautas de infiltración y resultados variables. Objetivo. Determinar la eficacia preventiva y demostrar la rapidez, comodidad y tolerabilidad de una pauta subcutánea de TBA en la profilaxis de la CCD. Pacientes y métodos. 843 pacientes fueron infiltrados subcutáneamente con una técnica ‘dosis fija-sitio fijo’ de 100 U de TBA (Botox) en seis puntos pericraneales en períodos de al menos tres meses. Se valoró la reducción de la frecuencia media de crisis y días con cefalea, y del consumo de analgésicos y porcentaje de pacientes con reducción de más del 50% de la frecuencia media de crisis de cefalea. Resultados. La infiltración subcutáneade TBA produjo una reducción del 78,91 ± 6,81% en la frecuencia de crisis mensuales (p < 0,001) y una reducción del 62,38 ± 12,8% en los días mensuales con cefalea a los tres meses de la infiltración. El 92,8% de los pacientes refirió una reducción de al menos un 50% de los días con cefalea mensuales. La frecuencia media y el total de consumo de analgésicos se redujo de 21,48 ± 2,47 a 1,96 ± 1,27 (p < 0,001), y de 126,01 ± 24,7 a 6,65 ± 2,27 dosis, respectivamente. Hubo pocos efectosadversos, ninguno grave. Conclusión. La infiltración simplificada subcutánea de TBA es muy eficaz, cómoda, rápida y segura en la prevención de la CCD

Primary headaches are one of the most prevalent conditions in neurology. Botulinum toxin type A(TBA) has been used for years as a prophylactic measure for chronic daily headache (CDH) with varying infiltration regimens and outcomes. Aim. To demonstrate the speed, convenience and safety of a subcutaneous regimen of TBA as a prophylactic for CDH, and also to determine how effective it is as a preventive therapy. Patients and methods. A total of 843 patients wereinfiltrated subcutaneously with 100 U of TBA (Botox) using a ‘fixed dose-fixed site’ technique in six pericranial points in periods of at least three months. We evaluated the reduction in the mean frequency of crises and days with headaches and theintake of analgesics, as well as the percentage of patients with a reduction of over 50% in the mean frequency of headache crises. Results. Subcutaneous infiltration of TBA brought about a reduction of 78.91 ± 6.81% in the frequency of monthly crises (p < 0.001) and a reduction of 62.38 ± 12.8% in the number of days per month with headache after three months’ infiltration. Reports from patients indicated that 92.8% of them had reduced the number of days with headache per month byat least 50%. Mean frequency and total intake of analgesics decreased from 21.48 ± 2.47 to 1.96 ± 1.27 (p < 0.001) and from 126.01 ± 24.7 to 6.65 ± 2.27 doses, respectively. There were few side effects, none of which were severe. Conclusion. Simplified subcutaneous infiltration of TBA is very effective, convenient, fast and safe as a means of preventing CDH

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INTRODUCTION: In the 16th century, at the height of the Spanish Renaissance, Bachiller Miguel Sabuco revolutionised medical theories about brain physiology with the publication of his work Nueva Filosof a in 1587. This work, which is mysteriously attributed to his daughter Luisa Oliva, presents a surprisingly gynocentric ideology for its time and has been reprinted on numerous occasions since its first edition saw the light. Sabuco s ideas have been plagiarised by such renowned authors as Descartes, Willis and Glisson. DEVELOPMENT: In stark contrast to the Arabized galenism based on the criterion of authority that predominated the medical practice of his time, Nueva Filosof a empirically promoted a modern approach to neurophysiology. This becomes even more worthy of merit if we bear in mind that Sabuco was not trained as a doctor but instead worked as an apothecary in Alcaraz (Albacete, Spain). The Bachiller granted the brain a commanding role over the organisation of the body for the first time in the history of medicine. He not only developed the surprising theory of succo nervoso (the nervous sap, or original neurotransmitting substance), but also an elegant digression on human nature that puts forward solid arguments about the dualist relation between mind and brain. He examined the association between emotional and physical health and explained how the emotions can impair health and lead to early death, which means he was also a pioneer in the development of psychosomatic medicine. CONCLUSIONS: Besides constituting the most illustrious forerunner of modern day neurochemistry, Sabuco s work also encourages doctors to treat their patients in an integral manner, with equal attention being given to the body, mind and soul. It comes as no surprise, then, that many aspects of his work can still be compared to modern medical and philosophical thought.

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Introducción. En el sigloXVI, en pleno Renacimiento español, el bachiller Miguel Sabuco revolucionó las teorías galénicas de la fisiología cerebral con la publicación en 1587 del texto Nueva Filosofía.Misteriosamente atribuido a su hija Luisa Oliva, con una ideología sorprendentemente ginocéntrica para su época, el texto sabuceano ha tenido numerosas impresiones desde su edición princeps; sus ideas han sido plagiadas por autores tan relevantes como Descartes, Willis y Glisson.Desarrollo. Nueva Filosofía, en abierta oposición con el galenismo arabizado predominante en la medicina de su época, basada en el criterio de autoridad, promueve empíricamente una aproximación moderna a la neurofisiología, lo cual resulta más meritorio si tenemos en cuenta la falta de formación médica de Sabuco, que ejerció la profesión de boticario en Alcaraz (Albacete). El bachiller otorgó al cerebro el papel de órgano rector de la economía por primera vez en la historia de la medicina; desarrolló no sólo la sorprendente teoría del suco nerveo (sustancia neurotransmisora primigenia), sino también una elegante digresión sobre la naturaleza humana que aporta argumentos sólidos sobre la relación dualista entre mente y cerebro. Escrutó la relación entre la salud emocional y física, y explicó cómo las emociones menoscaban la salud y causan la muerte prematura, por lo que fue pionero en el desarrollo de la medicina psicosomática. Conclusiones. Además de constituir el más preclaro antecedente de la moderna neuroquímica, la obra sabuceana invita a los médicos a tratar a sus pacientes de un modo integral, y a atender al unísono cuerpo, mente y ánima, por lo que muchos aspectos de su obra siguen siendo compatibles con el pensamiento médico y filosófico modernos (AU)

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Until now Neurology has lacked a patron saint who, taking the most advantage of the rich cultural tradition inherited from our past and independently of the religious ideology of each one, can be helpful approach in the neurologist figure to different people. An Ad Hoc Committee from the Neurology History Study Group of the SEN has researched the medical hagiography with any kind of neurological relationship (neurohagiography), in order to make a hagiography study of every saint related to our speciality, with the added luck of proposing a patron for Neurology with hispanic origin. In this pioneer study of historiographic research different documents related with the medical hagiography have been studied, especially the Index ac Status Causarum, and information coming from different national ecclesiastic archives. A total of 342 saints share the patronage of 137 diseases, of which a 27,7% are related in some way to Neurology. Headache constitutes the prime cause of the invocations, with 20 saints. Another 11 saints plead for epilepsy; to these we also must add another six for so called possessed patients. Therefore, two of the three main causes of invocation (headache, fever and epilepsy) come up to chronic processes. Of all the saints with a hispanic origin candidates to the patronage of the neurologists San Lamberto Caesaraugustanus stands out, who died in the year 303 during Diocletian persecution. Belonging to the selected standing of "cephalophoric martyrs" (those beheahed who carry their own head in their hands), he was able to walk an important distance (about six kilometres) with his head split from the body, a fact only understood as a suprahuman phenomenon thanks to which he has becomes the brain transplant pioneer.

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La neurología carece hasta el momento del patronazgo de un santo que, aprovechando la rica tradición cultural heredada de nuestro pasado e independientemente de la ideología religiosa de cada uno, sirva para aproximar la figura del neurólogo a la población. Un comité Ad Hoc del Grupo de Estudio de Historia de la Neurología de la SEN ha investigado la hagiografía médica con relación neurológica (neurohagiografía), con el objeto de realizar un estudio historiográfico de los santos relacionados con nuestra especialidad, con la posibilidad añadida de proponer un patrono para la neurología que tenga un origen hispano. En este trabajo pionero de investigación historiográfica se han estudiado diversos documentos relacionados con la hagiografía médica, especialmente los Index ac Status Causarum, y datos procedentes de diversos archivos eclesiásticos nacionales. En total 342 santos se reparten el patronazgo frente a 137 enfermedades, de las cuales un 27,7 per cent tiene relación con la neurología. La cefalea constituye la primera causa del total de advocaciones, con un total de 20 santos. Otros 11 santos abogan contra la epilepsia, a los que hay que añadir otros seis para los pacientes denominados endemoniados. Así, dos de las tres causas principales de advocación (cefalea, fiebre y epilepsia) corresponden a procesos neurológicos crónicos. Entre los santos de origen hispano candidatos al patronazgo de los neurólogos destaca San Lamberto Caesaraugustanus, muerto en el año 303 durante la persecución de Diocleciano. Perteneciente a la selecta categoría de los mártires cefalóforos (decapitados que transportan la propia cabeza con las manos), fue capaz de caminar una distancia considerable (unos 6 km) con la cabeza separada del cuerpo, hecho únicamente explicable como un fenómeno suprahumano y que le convierte en pionero del trasplante cerebral. (AU)

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In this work we present a study of the different conceptual, physiopathological, anatomical and clinical aspects that cerebrovascular pathology has had throughout history, from the early pre scientific beginnings of religious medicine, through the Renaissance period up to the Modern and Contemporary Ages. In the second part we emphasise its social importance and economic cost, and new methodologies are proposed for use in its study and pursuit. We also highlight the need for the creation of stroke units.

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En el presente trabajo se realiza una búsqueda histórica de la patología cerebrovascular en sus diversos apartados conceptuales, fisiopatológicos, anatómicos y clínicos a través de la medicina histórica credencial religiosa en el Renacimiento, la Edad Moderna y la Edad Contemporánea. En su segunda parte, se hace hincapié en su trascendencia social y coste económico, y se proponen nuevas metodologías en su estudio y seguimiento, así como la necesidad de creación de unidades de ictus (AU)

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Introducción. Desde la aplicación de la medicina técnica por los griegos, la neurología moderna se basa en un cuerpo de conocimientos y en un bagaje cultural heredado desde la antigüedad. En este trabajo se repasa la contribución de Al Ándalus a la neurociencia durante el medioevo y su repercusión en la neurología moderna. Desarrollo. Tras la muerte de Mahoma, en el siglo VII d.C., el Islam tuvo uno de los más espectaculares períodos de expansión en la historia de la humanidad. La ocupación de las ciudades de Alejandría y Gundishapur puso en contacto a los árabes con manuscritos grecolatinos originales, los cuales fueron asimilados y divulgados por científicos islámicos tanto en los califatos medioorientales de Damasco y Bagdad como en los occidentales de Al Ándalus (España) y Kairwan (Túnez). Esta medicina clásica hipocrático-galénica se reformuló en el denominado galenismo arabizado, que influyó notoriamente en los escolásticos y en el mundo cultural del periodo bajomedieval, y constituyó la base de la medicina europea hasta bien entrado el Renacimiento. En Al Ándalus hubo un primer Renacimiento cultural español durante los siglos IX-XII, a raíz del cual la medicina europea tuvo un florecimiento desconocido hasta entonces en el medioevo. Los médicos andalusíes hicieron importantes contribuciones en el cuerpo de conocimientos de la neurociencia y desarrollaron conceptos filosóficos importantes para el entendimiento del intelecto humano. Así, Abulcasis (936-1013), el padre de la cirugía moderna, diseñó material y técnicas de neurocirugía aún utilizadas en la actualidad. Averroes insinuó el síndrome parkinsoniano y atribuyó el papel fotorreceptor a la retina. Avenzoar describió las meningitis, las tromboflebitis intracraneales y los tumores mediastínicos, e hizo contribuciones a la moderna neurofarmacología. Maimónides escribió sobre enfermedades neuropsiquiátricas y describió la rabia y la intoxicación por belladona. Conclusión. Independientemente de las diferencias políticas, religiosas y culturales que hubo entonces entre Al Ándalus y los reinos cristianos de la península Ibérica, el período histórico andalusí (711-1492) constituye una de las páginas más brillantes de la historia de la neurociencia española (AU)

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Se somete a revisión el concepto de pseudodemencia, y especialmente su forma más frecuente, la pseudodemencia depresiva. La pseudodemencia depresiva es un término controvertido que, sin embargo, sigue siendo empleado en la actualidad para referirse a aquellos cuadros en los que la disfunción cognitiva nos obliga a establecer el diagnóstico diferencial entre depresión y demencia (AU)

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A migranous cerebral infarct (ICM) has the appearance of an ischaemic cerebral lesion which occurs during a migraine crisis and is shown by neuroimaging techniques to be in the corresponding vascular area. Four young patients are described. They fulfilled the clinical and neuroimaging criteria for compatibility with ICM and the protocol for the aetiological study of stroke was normal. Angiography ruled out other causes of ischaemia (dissection, fibromuscular dysplasia, etc.) and showed segmental images of 'vasculitis appearance' similar to these described in Call's syndrome, in 'benign intracranial angiopathy' and in other intracranial vasculopathies or criteria of 'reversible segmental cerebral vasoconstriction'. The pathogenic significance, as with migraine, is still unknown.

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Thrombosis of the cerebral venous sinuses is characterized by clinical pleomorphism and variable pathogenesis. Although there is a relationship with pregnancy and especially with the puerperium, occurrence during the first trimester of pregnancy is unusual and this may effect the diagnosis and treatment. We describe the case of a 33 years-old patient with lateral sinus thrombosis in the first trimester of pregnancy. This was diagnosed and followed-up by magnetic resonance. Investigations as to its aetiology were inconclusive and it followed a benign course without anticoagulation. Thrombosis of the venous sinuses has been found empirically to be related to states of deficiency of S protein, hypercoagulability, anaemia and deshydration during pregnancy, to having previously taken contraceptive pills. Behçet's disease, other coagulopathies, central or systemic vasculitis, collagen disorders, septic and neoplastic disorders and a large number of cases of unknown aetiology. In our patient neurological deterioration secondary to a venous infarct or intraparenchymatous haemorrhage was not seen. There was full recovery and complete spontaneous canalization of the sinus, as shown on posterior cranial angiography. The controversial decision to use heparin in thrombosis of the cerebral venous sinuses should probably depend on the possible risks and benefits in each individual case, taking into account the clinical findings, aetiology and topography of the thrombosed sinus.

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INTRODUCTION: Atherosclerosis is a generalized vascular disorder which tends to be localized to specific arterial territories. At the bifurcation of the carotid artery there is a marked predisposition to form plaques of atheroma on the postero-external wall. This tendency is due to the kinematics of fluids and their particular morphological characteristics which are unique in the vascular system. The carotid tree is a physical, non-lineal or in 'non-equilibrium', dynamic system which depends on the fluctuating contribution of energy from the cardiac cycle. It has fractal geometry which follows the Law of Biology of maximum efficiency with a minimum of effort. DEVELOPMENT: The complexity of the relationship between the haemo-rheological and anatomical factors, and the periodic oscillation of flow does not permit use of simple models and classical determinist equations to describe idealized systems of continuous movement and Newtonian fluids. On the contrary, since we are considering a complex dissipative dynamic system. It has marked intrinsic operational freedom adapting its responses to external disturbances well, thus determining vasculo-cerebral autoregulation. The theories of Determinist Chaos and of the Science of Complexity imply the existence of emerging properties which exceed those of the individual elements in the dynamic systems in non-equilibrium, which tend to function in the 'frontier of chaos' at the critical points of phase transition. The carotid tree has non-linear properties, appearance of order and fractal 'sibisemejanza'. Pseudo-chaotic vortices appear--in regions of phase transition between laminar flow and turbulence--with the emergence of a 'strange attractor' near to the postero-external wall of the bulb. CONCLUSIONS: The anatomical and kinematic complexity of the system, together with the irreversibility of the second Law of Thermodynamics, lead to a long-term tendency towards the appearance of a region of stagnant flow with increased Entropy in the territory of the strange attractor which determines--as an inevitable long-term outcome--the tendency to the appearance of atherosclerosis at this particular point.

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This article wants to be a memory to the figure and neuro-pathologic work of D. Gonzalo Rodríguez-Lafora. The tediousness of its neurological work allows to divide it in its slopes neurophatologic, neurophysiologic, clinic and therapy. Also, it embraces other topics outside of the field of the neurology, centered fundamentally in the psychiatry. It is without a doubt the facet neuro-histopathologic the one that provides him bigger national and international prestige and it contributes to deepen in the histopathology of the senility, picking up in a definitive way in their work critical valuation of the discoveries histopathological in the senility (1952) their thought in this respect. Mention separated deserves its more important discovery: The inclusions amylaceous in cells ganglionars, in a certain type of epilepsy myoclonic that today takes its name. Other entities like the illness of Wernicke, the hemorrhages hipofisarias, the Parkinson (for scarce months he is not early to Levy in an important discovery), or the alterations of the malaria in the cerebral fabric plows object of their attention, of the work of Lafora highlights its anatomo-pathologics works next to figures as Kraepelin, Alzheimer, Vogt, Openheim or Brodmann. Professor Lafora's figure is known internationally as neuropathologist, recognizing its contribution, collection in the world literature, to the study of the myoclonic epilepsy: 'Lafora disease. A form of progressive myoclonus epilepsy.

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Hiccoughs (singultus) is a habitual physiological phenomenon, the persistence of which might indicate neurological and extraneurological multiple lesions. Its activation involves starting up numerous central and peripheral mechanisms which have yet to be clearly determined. Hiccoughs results from an intermittent myoclonus of the diaphragm, reflex in origin, with unknown authentic cause or physiological significance. It has been suggested that, more than just an abnormal reflex, it could be a type of myoclonus brought on by repeated activity of the 'solitary inspiratory nucleus', by releasing control of the inhibiting-activating upper nervous system activity. We present the case of a patient with uncontrollable hiccoughs lasting over six years as a result of paramedial bilateral thalamic ischaemia (rostral occlusion syndrome of the basilar artery type 1) of cardioembolic origin (auricular fibrillation) secondary to hyperthyroidism.

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Ischaemic stroke in young people, that is in those under 45 years of age, forms a distinct entity. Whereas in the case of older patients the main cause is arteriosclerosis, in the younger group a broad spectrum of etiologies can be found. It is for this reason that in these latter cases we must carry out a diagnostic study that is not only more exhaustive but also additionally is aimed at seeking out specific pathologies as for instance a possible association with vasculitis, infectious diseases, hematological abnormalities or unclear cardiopathology. Given the therapeutic transcendency that findings might have, in order to avoid new bouts in patients at the most productive moments in their lives, we believe it to be of great interest to carefully study these patients as exhaustively as need be. In the present work we present the case of a young patient with ischaemic infarct in the region of both upper cerebella which started out with a clinical picture of ataxia and dysarthria with benign course and total recovery. Possible etiologies are discussed in the light of findings made during complementary tests, as well as the unusual location of the lesions.

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