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Purpose: To report visual, clinical and radiological outcomes of three patients with fibromuscular dysplasia (FMD) that presented different ocular ischemic events, supported by different multimodal imaging. Methods: A retrospective study including patients who attended a tertiary referral hospital from July 2016 to June 2019 referring acute visual loss and later diagnosed of FMD. Ophthalmological examination included best corrected visual acuity (BCVA), biomicroscopy, fundoscopy, fluorescein angiography (FA), and macular and retinal nerve fiber layer spectral domain optic coherence tomography (SD-OCT). Patients were admitted by the Neurology service, completing the study with blood and cerebrospinal fluid (CSF) test, serology and cultures, cerebral magnetic resonance angiography (angioMRI), and arteriography. Results: Three patients were included; one male and second females. All referred unilateral acute visual loss, with BCVA of counting fingers or hand-motion. Relative afferent pupilar defect was present in all patients. Two patients associated neurological focal signs and one had chronic hypertension. Fundoscopy revealed hemorrhages and exudates in all patients, and the typical sign of “string-of-beads” in one. FA showed dye filling delay and macular and peripheral hypofluorescence. SD-OCT revealed acute and chronic retinal ischemic signs. Blood and CSF tests, serologies and cultures resulted negative. All presented cerebral vascular involvement, objectified in the cerebral angioMRI or arteriography. Conclusions: FMD should be considered in cases with unilateral sudden visual loss associated to neurological focal deficits in young patients. The typical “string-of-beads” image is rare in small arteries such as the retinal vasculature. When suspected, a complete ophthalmological examination and cerebral vascular imaging is essential to confirm the diagnosis.

During this year, in relation to the health crisis triggered by COVID-19, a total of 532 people have been evaluated by the Teaching Staff Prevention Service of the Ministry of Education and Vocational Training of the Balearic Islands, most of them which were women, as is usually the case in the teaching community. After some time of reflection, there are some questions that we would like to answer, such as knowing the most frequent pathologies with vulnerability to COVID-19 in our service and the work adaptations made. To answer these questions, we carried out this descriptive study.This study was made with sample of 508 people from Prevention Service of teachers during the course 2020-2021. We studied differences between sex, age, job, developed actuation, pathology. Statistical calculations were performed with Libreoffice's numerical calculation processor.From the several pathologies included among the vulnerable groups to COVID-19 according to the Health Ministry, the one with more prevalence is chronic pulmonar disease (25.39%).The pulmonar disease is the most frequent in our study, but due to the presence of many workers with pluripathology, this datum should be keepen in mind with some caution.Durante este año, en relación a la crisis sanitaria desencadenada por la COVID-19, desde el Servicio de Prevención del Personal Docente de la Conselleria de Educación y Formación Profesional de las Islas Baleares se han evaluado un total de 532 personas, la mayoría de las cuales eran mujeres, como suele ser en el colectivo de la docencia. Existen ciertas cuestiones a las que intentamos dar respuesta, como es saber las patologías más frecuentes que han hecho reconocer una vulnerabilidad a COVID-19 en nuestro servicio y las consecuencias que han tenido en cuanto a las adaptaciones laborales establecidas. Para dar respuesta a estas cuestiones, realizamos este estudio descriptivo.El estudio se desarrolló con una muestra de 508 personas del Servicio de Prevención del Personal Docente de Palma durante el curso 2020-2021. Para lo cual evaluamos las diferencias según sexo, edad, puesto de trabajo, actuación llevada a cabo y patología. Los cálculos estadísticos se realizaron con el procesador de cálculo numérico de Libreoffice.Del desglose de las patologías incluidas dentro de los grupos vulnerables frente a COVID-19 según el Ministerio de Sanidad, la más prevalente fue la enfermedad pulmonar crónica (25,39%).La patología pulmonar fue la más frecuente de nuestro estudio, pero debido a la presencia de muchos trabajadores con pluripatología, este dato debe ser tenido en cuenta con cierta cautela.

Background and Objective: Oral anticoagulation (OAC) for secondary stroke prevention is recommended in atrial fibrillation (AF) and other sources of cardioembolic stroke. Our objectives were to explore the differences in ischemic and hemorrhagic events when using OAC for secondary stroke prevention according to the type of anticoagulant treatment and to analyze the number and reasons for OAC switches during long-term follow-up. Methods: Ischemic stroke (IS) patients who were discharged on OAC for secondary stroke prevention from January 2014 to October 2017 were recruited in a prospective, multicenter, hospital-based registry. Follow-up at 3 months was scheduled at the outpatient clinic with subsequent annual phone interviews for 3 years. Patients were classified into three study groups according to OAC at discharge: Vitamin K antagonist (VKA), Factor Xa inhibitor (FXa), or direct thrombin inhibitor (DTI). We compared stroke recurrences, intracranial hemorrhage, major bleeding, and all-cause mortality during the follow-up. We recorded any switches in OAC and the main reasons for the change. Results: A total of 241 patients were included. An anticoagulant was indicated in the presence of a source of cardioembolic stroke in 240 patients (99.6%) and lupus plus antiphospholipid syndrome in one patient. Up to 86 patients (35.6%) were on OAC before the index stroke; in 71 (82.5%) of them, this was VKA. At hospital discharge, 105 were treated with FXa (43.8%), 96 with VKA (39.6%), and 40 with DTI (16.6%). The cumulative incidences at 3 years were 17% for stroke recurrence, 1.6% for intracranial hemorrhage, 4.9% for major hemorrhage, and 22.8% for all-cause mortality, with no differences among the OAC groups in any outcomes. During the follow-up, 40 OAC switches were recorded (63% of them to FXa), mostly due to stroke recurrence. Conclusion: Long-term OAC in secondary stroke prevention is associated with a lower frequency of bleeding complications than stroke recurrences. No differences between anticoagulant drugs were found in any of the analyzed outcomes. The main cause for OAC switch during follow-up was stroke recurrence., This study was supported by grants from the Foundation for Biomedical Research of La Paz University Hospital (PI 1131)

Objetivos: Revisión del síndrome Marchiafava-Bignami como diagnóstico diferencial en paciente con consumo de alcohol y sintomatología neurológica. Material y Métodos: Paciente de 45 años, consumidor crónico de alcohol, que ingresa en Medicina Interna por cuadro de tres semanas de evolución de deterioro físico con rigidez, pérdida de fuerza, pérdida de apetito y caídas frecuentes secundarias a debilidad en miembros inferiores. Esta sintomatología se acompaña de alucinaciones visuales y alteraciones sensoperceptivas que describen los familiares como intentos de trepar por el techo como si fuera una araña. En este tiempo parece haber empeorado la coordinación de la marcha hasta imposibilitar la deambulación y se ha incrementado la inquietud y dificultades del sueño. A la exploración destaca temblor de reposo, inestabilidad de la marcha que finalmente imposibilitaba la bipedestación, discurso incoherente fluctuante con episodios de desorientación y memoria a corto plazo conservada, déficit de atención y afectación anímica de larga evolución. Resultados: Durante el ingreso sufrió crisis convulsiva así como varios episodios de agitación psicomotriz, realizándose analítica de sangre que mostraba alteraciones compatibles con consumo de alcohol, serología negativa, TAC de cráneo, tórax, abdomen y pelvis en el que solo se objetivaron varices esofágicas y EEG con lentificación de ondas. Finalmente se realizó RNM que mostró hiperintensidad en esplenio del cuerpo calloso compatible con el diagnóstico de Marchiafava-Bignami. Conclusiones: La enfermedad de Marchiafava-Bignami es una encefalopatía que consiste en la desmielinización y necrosis del cuerpo calloso poco frecuente e infradiagnosticada, ya que se solapa con múltiples patologías, siendo necesario un alto índice de sospecha y la realización de una RNM como herramienta diagnóstica. Dada la gravedad de esta patología, es importante conocer la enfermedad y sospecharla en todo paciente alcohólico con alteración neurológica grave con el fin de realizar un diagnóstico precoz, un abordaje adecuado y poder ofrecer cuidados de calidad.

Descripción precisa de los objetivos Presentamos el caso de un varón de 30 años, que ingresa en traumatología por fracturas óseas tras una precipitación motivada por interpretaciones delirantes de señales, es atendido por psiquiatría de interconsulta. Niega antecedentes psiquiátricos familiares y como personales únicamente destaca un episodio mixto ansioso depresivo en el contexto de cambio de vivienda. Durante el ingreso se diagnostica de episodio maníaco. Como posible desencadenante cuenta consumo de ayahuasca, cannabis y setas alucinógenas un mes antes durante un viaje a sudamérica. Material y métodos Se analiza el caso clínico previo y se revisa la literatura científica para conocer la psicopatología descrita producida por ayahuasca. Resultados y conclusiones La ayahuasca es una bebida tradicional sudamericana preparada a partir de una o dos plantas diferentes, según la región, que generan efectos psicotrópicos y que actualmente está generando turismo de consumo de esta sustancia. Se están estudiando efectos beneficiosos de esta sustancia en episodios depresivos, como prevención suicidio y mejoría en mindfulness(1–3), aunque otros estudios sugieren que puede inducir psicosis(4). Hay casos descritos de inducción de manía en pacientes diagnosticados previamente de trastorno bipolar(5,6), sin embargo, hasta el momento actual la bibliografía sobre psicopatología es escasa.

Atrial fibrillation (AF) causes a substantial proportion of embolic strokes of undeterminded source (ESUS). Effective detection of subclinical AF (SCAF) has important therapeutic implications. We conducted a prospective study to determine the prevalence of SCAF in patients with ESUS through of a 21-day Holter monitoring. In an early-monitoring group, Holter was initiated immediately after hospital discharge. The results were compared with a previous cohort of patients in whom the Holter was initiated at least 1 week after hospital discharge (late-monitoring group). We included 100 patients (50 each group; 69 ± 13 years, 56% male). Mean time from ESUS to Holter was 1.2 ± 1 day in the early-monitoring group and 30 ± 15 days in the late-monitoring group. SCAF was detected in 22% of patients in the early-monitoring and 6% in the late-monitoring group (p0.05). Patients with SCAF were older (77 ± 9 vs 67 ± 11 years, p0.05), with a higher rate of left atrial enlargement (50% vs 20%, p0.05), renal impairment (28% vs 5%; p0.01), and a slower mean heart rate (55 ± 6 vs 70 ± 6 beats/min; p0.001). On multivariate analysis, the presence of persistent bradycardia (≤60 beats/min) in the 21-day Holter was a powerful and significant risk factor for SCAF. In conclusion, the sooner 21-day Holter electrocardiogram monitoring is initiated after ESUS, the more likely SCAF can be detected. Sinus bradycardia is a powerful predictor of SCAF in patients with ESUS.

A 73-year-old woman presented with a history of recurrent self-limited stupor episodes. Metabolic, vascular, structural, epileptic, toxicologic (exogenous), and sleep disorders were excluded after the pertinent investigations. We present video-EEG results during one of the episodes (video 1).

BACKGROUND AND OBJECTIVES: The objective of this study is to evaluate the epidemiological and toxicological characteristics of chemical exposures requiring Emergency Department consultation. METHODOLOGY: Descriptive study of Hospital Emergency Department consultations between 2000 and 2008 derived from exposure to a chemical agent. RESULTS: A total of 992 patients were included; the mean age was 42.7+18 years and 58.1% were female. The main causes were domestic accidents (67.3%), occupational accidents (14.8%), attempted suicides (11.2%) and incidents of violence (3.2%). There was a significantly greater proportion of females involved in domestic accidents and males in occupational accidents (p Language: es

The objective of this study is to evaluate the epidemiological and toxicological characteristics of chemical exposures requiring Emergency Department consultation.Descriptive study of Hospital Emergency Department consultations between 2000 and 2008 derived from exposure to a chemical agent.A total of 992 patients were included; the mean age was 42.7+18 years and 58.1% were female. The main causes were domestic accidents (67.3%), occupational accidents (14.8%), attempted suicides (11.2%) and incidents of violence (3.2%). There was a significantly greater proportion of females involved in domestic accidents and males in occupational accidents (p0.05). The most-frequently involved products were caustic substances (39.9%), irritating gases (13.8%), detergents (12.3%), solvents (12%) and asphyxiating gases (9.5%). Hospital admission was necessary in 10.8% of patients and 10 deaths occurred (1%), with non-occupational accidents being more severe (p0.05).Exposures to chemical agents represent a high number of poisonings in Emergency Department. Domestic accidents, which mainly affect women and often involve caustic substances, are much more frequent than occupational accidents. The general prognosis is good and mortality is very low.