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Background: Non-ergoline dopamine agonists (DA) are effective treatments for Parkinson's disease (PD). This review presents the pharmacology, evidence of efficacy and safety profile of pramipexole, ropinirole, and rotigotine, and practical recommendations are given regarding their use in clinical practice., Results: Extended-release formulations of pramipexole and ropinirole and transdermal continuous delivery rotigotine patches are currently available; these may contribute to stabilising of plasma levels. In early PD, the three drugs significantly improve disability scales, delay time to dyskinesia and allow a later introduction of levodopa. In late PD they reduced total 'off'-time, improved Unified Parkinson's Disease Rating Scale (UPDRS) in both 'on' and 'off' state and allowed a reduction in total levodopa dosage. A significant improvement in quality of life scales has also been demonstrated. Extended-release formulations have proved to be non-inferior to the immediate release formulations and are better tolerated (ropinirole). Despite a generally good safety profile, serious adverse events, such as impulse control disorder and sleep attacks, need to be routinely monitored. Although combination therapy has not been addressed in scientific literature, certain combinations, such as apomorphine and another DA, may be helpful. Switching from one DA to another is feasible and safe, although in the first days an overlap of dopaminergic side effects may occur. When treatment with DA is stopped abruptly, dopamine withdrawal syndrome may present. Suspending any DA, especially pramipexole, has been linked to onset of apathy, which may be severe., Conclusions: New non-ergotine DAs are a valuable option for the treatment of both early and late PD. Despite their good safety profile, serious adverse effects may appear; these effects may have a pathoplastic effect on the course of PD and need to be monitored., (Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Objective: Pseudotumor cerebri (PC) is a complex syndrome characterized by increased intracranial pressure in the absence of any space occupying lesion, usually self-limiting, but often relapsing In recent years, some authors had researched the relationship between venous sinus disease and PC and they have suggested that it must be ruled out by magnetic resonance venography (MRV) before diagnosing this condition as idiopathic. Our aim is to determine the frequency of venous sinus disease and the need for MRV in these patients., Methods: We have studied 14 patients admitted between 1998 and 2005 in the Neurology Department of the University Clinical Hospital <> (Zaragoza; Spain) who had been diagnosed of PC. We reviewed the epidemiological and clinical features. The MRVs were reviewed and their appearances rated for focal narrowing and signal gaps., Results: Six patients had strong signal in both lateral and transverse sinus and their image was considered as normal. The other eight patients showed filling defects on the transverse sinus (focal unilateral narrowing in four cases, one or more signal gaps in four cases)., Conclusions: The presence of signal gaps in the venous sinus (stenosis/hypoplasia or absence of signal) is a frequent finding in patients with PC. That is why we have concluded that this test is important in patients with PC in order to search for a possible etiology and treatment option.

Introduction: Currently used antiparkinsonian drugs neither stop nor slow-down the progressive nature of the disease. The final phase of PD is characterized by the presence of symptoms and signs resistant to dopaminergic agents, such as depression, dementia, freezing and falls. Therefore, it is urgent to develop therapies able to positively modify this outcome. Despite neuroprotection is a research priority in PD, no effective strategies have been found so far., Method: A key informants study was conducted. A group of experts in PD fulfilled a questionnaire of 10 questions to explore the most important topics related to neuroprotection. Afterwards a consensus about the current situation of neuroprotection in PD was established and future directions of development were suggested., Results: Most of the answers emphasized the need of new concepts, the limitations of animal models and the difficulties in the difficulties in demonstrating a neuroprotective effects in humans owing to a lack of biomarkers. Some of the experts believe that we are already exerting a disease modifying effect., Conclusions: The concept of neuroprotection should be widened. Animal models should be improved. A reliable biomarker to start neuroprotective therapies long before the appearance of motor symptoms and to evaluate the neuroprotective effect of any therapy should be urgently developed.

Defects of the mitochondrial respiratory chain are associated with a great variety of clinical disorders. In addition to the well recognized syndromes, a significant number of patients present non-specific encephalopathic disorders. In consequence these types of mitochondrial disorder are very difficult to diagnose on clinical features alone. In this paper, we describe the clinical and the magnetic resonance findings of 2 patients with a neurological syndrome indistinguishable from multiple sclerosis (Poser). Muscle biochemistry revealed defect of complex IV of the respiratory chain. We think that these patients have a mitochondrial encephalomyopathy. We suggest that in patients presenting as atypical multiple sclerosis it could be necessary investigating mitocondrial encephalopathy.

The Hallevorden-Spatz disease should be suspected in children or young people with motor, pyramidal or extrapyramidal symptomatology and deterioration of superior functions specially upon the existence of family history. Pathognomonic diagnosis may only be obtained by necropsy but magnetic resonance images, although not pathognomic, are sufficiently characteristics to strongly support the diagnosis. Four cases of Hallevorden-Spatz disease are presented with special emphasis on the MR images characteristic of this disease.

The authors describe 6 cases of giant aneurysm of the basilar artery diagnosed in the Neurology Department of the Hospital Clínico Universitario of Zaragoza over the last 8 years by cerebral CT, arteriography and NMR with the clinical, diagnostic, and evolutive features of the same being reported. In 2 cases the clinical manifestations initiated as subarachnoid hemorrhage, in another two as AIT, in the fifth case as cerebral infarction and in the sixth case with pseudotumoral clinical manifestations with a necropsy study being available in the latter case. Three of the 6 patients died and of the remaining three only one was, successfully operated on. Anatomopathologic, clinical, therapeutic and diagnostic aspects of giant aneurysms of the basilar trunk are also reviewed with NMR being recommended as the technique of choice in diagnosis.

Two cases of migraine complicated with ischemic cerebral infarct are reported. Both met the established criteria for the diagnosis: definite history of classical or common migraine, development of an ischemic infarct during the crisis, duration of deficit lasting more than 24 hours and absence of other causes of cerebrovascular disease. Several laboratory examinations were carried out: routine blood tests, coagulation study, immunological study, serological tests for syphilis, ECG, echocardiogram, cerebral CT, and nuclear magnetic resonance imaging and angiography. The most remarkable finding in these two patients were multiple cerebral infarcts in different vascular territories. This fact is exceptionally reported in the literature. The clinical outcome of the patients was characterized by the virtually complete reversal of neurological deficit.

The concept of meteoropathy implicates the atmospheric properties as determining or at least provoking causes of different disease conditions. Thus, we know that changes in temperature, atmospheric pressure and humidity rate are associated with a higher incidence of stroke presentation. Considered as a whole, these three atmospheric factors have been associated with the several clinical diagnoses of stroke. A higher presentation rate of stroke has been found when the three following facts concurred: a reduction of 10 degrees (C) in the temperature of the preceding day, an increase of the atmospheric humidity rate from 20% to 60% on the day of stroke, and an increase in atmospheric pressure of 6 mlbs from the preceding day (s = 0.0000). In addition, a higher rate of presentation of stroke was found when the difference in atmospheric pressure was 16 mlbs between the day of stroke and the preceding one (s = 0.049). Also, when the atmosphere humidity rate increased from 20% to 60%, the difference in mean temperature between the day of stroke and the preceding one was 3 degrees (C), and the atmospheric pressure increased in 6 mlbs, the incidence of stroke was higher (s = 0.007). We compare these findings with those from other authors.

The set-test evaluates the verbal fluency in 4 categories: colors, animals, fruits and cities. It has been proposed as a diagnostic aid in dementia in elderly patients. Therefore, we have evaluated its yield in a normative control reference group of 79 individuals and in 56 patients with possible dementia. It had a positive correlation of 73 with minimental test. The cut-off value was 29 in adults an 27 in elderly people. A lower score is indicative of dementia. Sensitivity was 79% and specificity 82%, with 20% of incorrectly classified patients. Considering the short duration of the test, we think that it is very useful for the evaluation of patients with dementia.