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Case Report: The case is presented of an 11 year-old girl referring to a one year history of photophobia and continuously seeing white spots in both eyes. The patient had a visual acuity of unity in both eyes, and a normal eye examination, and was referred to the Neuro-ophthalmology Unit. Once complete laboratory and imaging tests ruled out the possibility of any neurological pathology, she was diagnosed with visual snow (VS)., Discussion: VS is an isolated symptom, possibly part of the migraine aura, that is referred by patients reporting numerous and constant white dots moving in the visual field of BE. It can significantly interfere with patient's daily activities by altering their quality of life, and ending up as a misdiagnosis. Paediatric patients also present a diagnostic challenge due to the complex interpretation that the presence of VS involves in them., (Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Case Report: The case is presented of a 12 year-old boy with congenital glaucoma and low visual acuity diagnosed with Charles Bonnet syndrome. This consisted of the acute onset of complex, repetitive, persistent, and with visual hallucinations (people, brooms and coffeemakers) of self-limited evolution without treatment. The patient was diagnosed with congenital glaucoma at 3 years of age, and subjected to a trabeculectomy in right eye, and trabeculectomy and keratoplasty in his left eye., Discussion: Charles Bonnet syndrome symptoms have been described in adults, but their presence in children is poorly reflected in literature, with unknown characteristics and prevalence., (Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Anaesthetic block, alone or in combination with other treatments, represents a therapeutic resource for treating different types of headaches. However, there is significant heterogeneity in patterns of use among different professionals., Development: This consensus document has been drafted after a thorough review and analysis of the existing literature and our own clinical experience. The aim of this document is to serve as guidelines for professionals applying anaesthetic blocks. Recommendations are based on the levels of evidence of published studies on migraine, trigeminal autonomic cephalalgias, cervicogenic headache, and pericranial neuralgias. We describe the main technical and formal considerations of the different procedures, the potential adverse reactions, and the recommended approach., Conclusion: Anaesthetic block in patients with headache should always be individualised and based on a thorough medical history, a complete neurological examination, and expert technical execution., (Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Burning mouth syndrome is defined as scorching sensation in the mouth in the absence of any local lesions or systemic disease that would explain that complaint. The condition responds poorly to commonly used treatments and it may become very disabling., Methods: We prospectively analysed the clinical and demographic characteristics and response to treatment in 6 cases of burning mouth syndrome, diagnosed at 2 tertiary hospital headache units., Results: Six female patients between the ages of 34 and 82 years reported symptoms compatible with burning mouth syndrome. In 5 of them, burning worsened at the end of the day; 4 reported symptom relief with tongue movements. Neurological examinations and laboratory findings were normal in all patients and their dental examinations revealed no buccal lesions. Each patient had previously received conventional treatments without amelioration. Pramipexol was initiated in doses between 0.36mg and 1.05mg per day, resulting in clear improvement of symptoms in all cases, a situation which continues after a 4-year follow up period., Conclusions: Burning mouth syndrome is a condition of unknown aetiology that shares certain clinical patterns and treatment responses with restless leg syndrome. Dopamine agonists should be regarded as first line treatment for this entity., (Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Neurodegeneration in Alzheimer disease (AD) begins decades before dementia and patients with mild cognitive impairment (MCI) already demonstrate significant lesion loads. Lack of information about the early pathophysiology in AD complicates the search for therapeutic strategies.Subjective cognitive impairment is the description given to subjects who have memory-related complaints without pathological results on neuropsychological tests. There is no consensus regarding this heterogeneous syndrome, but at least some of these patients may represent the earliest stage in AD., Method: We reviewed available literature in order to summarise current knowledge on subjective cognitive impairment., Results: Although they may not present detectable signs of disease, SCI patients as a group score lower on neuropsychological tests than the general population does, and they also have a higher incidence of future cognitive decline. Depression and psychiatric co-morbidity play a role but cannot account for all cognitive complaints. Magnetic resonance imaging studies in these patients reveal a pattern of hippocampal atrophy similar to that of amnestic mild cognitive impairment and functional MRI shows increased activation during cognitive tasks which might indicate compensation for loss of function. Prevalence of an AD-like pattern of beta-amyloid (Aβ42) and tau proteins in cerebrospinal fluid is higher in SCI patients than in the general population., Conclusions: Memory complaints are relevant symptoms and may predict AD. Interpatient variability and methodological differences between clinical studies make it difficult to assign a definition to this syndrome. In the future, having a standard definition and longitudinal studies with sufficient follow-up times and an emphasis on quantifiable variables may clarify aspects of early AD., (Copyright © 2012 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Case Report: Two clinical cases are presented of two family relatives newly diagnosed with Leber hereditary optic neuropathy (LHON) and G11778A mutation analysis by optical coherence tomography (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, California, USA) layer peripapillary fibers retina (RNFL) and ganglion cell and internal plexiform layers (GCL/IPL) using macular segmentation., Discussion: The analysis of the macula by OCT segmentation (version 6.0 Cirrus OCT) allows the GCL/IPL to be evaluated without the interindividual variability of peripapillary RNFL distribution or the presence of edema of the optic disc. When an analysis of the peripapillary RNFL, it does not provide information on this neuronal damage, which itself is evidence in the study of GCL/IPL., (Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Case Report: The case involves a 22-year-old woman who presented with headache and decreased vision. She showed asymmetric papilledema, and a 6-mm tonsillar descent was observed in the image tests. She was diagnosed with secondary intracranial hypertension coinciding with the symptoms of a Chiari malformation (MC)., Discussion: Chiari malformation type I is the most common in this group of malformations, and is characterized by a greater than 5mm descent of the tonsils, being able to cause increased intracranial pressure and papilledema by blocking the flow of the cerebrospinal fluid. In this case, the MC was not the responsible for triggering the secondary intracranial hypertension, but a mere coincidence of both processes., (Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Hallucinations are frequent in clinical practice, with an incidence of up to 38.7% in the general population. We aim to determine the prevalence of hallucinations among healthy young adults in our environment., Subjects and Methods: We designed an observational study, using as subjects 3rd to 6th year medical students at the Universidad Complutense de Madrid who complete clinical rotations in the Hospital Clínico San Carlos. After a screening questionnaire, an individual interview was conducted via telephone or e-mail to those students who reported hallucinations. We obtained clinical and epidemiological data through a semi-structured clinical interview performed by a third year neurology resident., Results: N=134 (average age was 22.1 years; 77.6% were women). 74 respondents answered affirmatively to one or more screening questions, and 54 completed the follow-up interview. 22.2% described visual phenomena and 64.8%, auditory. The majority reported sleep-related experiences and auditory perceptions related to hyper vigilance, such as hearing the telephone or the doorbell ring when in fact it had not (38.8%). All subjects had good insight into their experiences and none had psychotic symptoms. Two cases were associated with substance abuse., Conclusions: Hallucinations are frequent among the general population. Traditionally, auditory phenomena have been associated with psychotic pathology, and other studies show a low population incidence (0.6%). However, in our sample, short auditory perceptions with immediate analysis were frequent and not pathological., (Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Introduction: Neurootological symptoms are common in patients with migraine, and have been reported to be associated with diverse conditions., Patients and Methods: A total of 70 patients with a diagnosis of episodic migraine, with or without aura, attending our Migraine Unit were selected. The specific variables studied were the diagnosis of instability, psycho-physiological dizziness, presyncopal symptoms, benign paroxysmal positional vertigo (BPPV), migraine associated recurrent vertigo (MARV), and Meniere's disease., Results: A total of 44.3% of cases had orthostatism or syncope, 15.7% with instability (possibly due to bilateral vestibular hypofunction), 14.2% with MARV and 8.6% with BPPV. The presence of BPPV was observed in older patients (40 years), whilst MARV was a condition seen in younger ones (35 years). These findings are of interest and remind us that benign paroxysmal vertigo is a childhood condition and age is a risk for BPPV., Conclusions: Migraine patients often present with neuro-otological symptoms that can be classified as inter-episodic and episodic symptoms, and specific and non-specific migraine symptoms. This approach is of obvious pathophysiological interest, given that MARV and the possible vestibular hypofunction of migraine patients are symptoms that share physiological aspects with migraine, while the orthostatism symptoms and BPPV are non-specific and are seen to be associated with other conditions., (Copyright © 2010 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Introduction: Although giant cell or temporal arteritis represents 5-10% of ischaemic optic neuropathies and is the most common arteritis in people over 60 years old. Currently there is no established treatment with oral glucocorticoids available., Background: Glucocorticoid (GC) is still the treatment of choice but has to be started without delay in order to prevent neurological or systemic complications. However, we can resort to intravenous treatment in cases where there is loss of sight or other neurological symptoms. In cases refractory to GC or in those in whom we wish to decrease the dose due to adverse effects, individualised treatment with methotrexate or TNF blockers could be indicated. There is insufficient evidence to recommend other treatments, such as azathioprine, dapsone, cyclosporine, cyclophosphamide or imitinib. In patients with vascular risk factors, anti-platelet therapy with ASA should be assessed. Surgical treatment should be considered in selected cases with symptoms due to arterial stenosis., Conclusions: The corticoids continue to be the treatment of choice in temporal arteritis, however, given the clinical variability of the disease and the special characteristics of this group of patients, usually elderly and with systemic diseases, we believe that individualised treatment with coherent therapeutic guidelines are essential. Currently there is not only treatment with oral glucocorticoids available, although in our patients we can choose to use intravenous mega-doses, anti-platelet treatment, resort to methotrexate or TNF inhibitors in refractory cases, or even consider surgical approaches.

Introduction: the use of questionnaires is a tool for obtaining information on cases and the variables to analyse in migraine study populations., Methods: we have validated the questionnaire within the PALM study, based on IHS-II criteria and administered by telephone using computer assisted sampling (CATI). The questionnaire has been validated using 50 randomly selected subjects, who had been assessed blind by a neurologist expert in migraine., Results: of the 24 patients diagnosed with strict migraine with the CATI interview, only in 2 (8%) of them did the neurologist determine that they did not suffer from migraine. Furthermore, of the patients in whom the diagnostic questionnaire concluded that they did not suffer from migraine, the specialist did not establish that diagnosis in any of them either. The analysis showed a sensitivity of 81.5% (95% CI, 66.8%-96.1%) and a specificity of 91.3% (95% CI, 79.8%-100%). The positive predictive value was 91.7% and the negative was 80.8%., Conclusions: the PALM questionnaire administered by telephone with computer support is a valid tool for use in determining the prevalence of migraine in study populations., (Published by Elservier España, S.L. All rights reserved.)

Introduction: Osmophobia is often reported by migraine patients. This study evaluates osmophobia in connection with the diagnosis of episodic migraine with or without aura, chronic migraine and episodic and chronic tension-type headache., Methods: We recruited from our Headache Unit 68 patients (59 female, 9 male; age 37+/-14.7 years), of whom 24 were migraine without aura (MoA), 11 migraine with aura (MA), 10 chronic migraine (CM) and 23 TTH (episodic-TTH). Patients with two or more forms of primary headache were excluded., Results: Among migraine patients, 54% with MoA and 0% with MA, 40 %CM reported osmophobia during the attacks; none of the 23 TTH patients suffered this symptom. The crisis frequency was MoA and osmophobia 2.15 crisis per month; MoA without osmophobia 3,14. MC with osmophobia 22; MC without osmophobia 21.7., Conclusions: Osmophobia and taste abnormalities were demonstrated to be very specific in diagnosing migraine, but very insensitive. Osmophobia frequency does not depend on migraine frequency. Osmophobia seems to be more frequent in females than in males. The lack of osmophobia in MA patients could be explained by a different pathophysiological mechanism between MA and MoA.

Introduction: Central pontine myelinolysis (CPM) is a neurological condition with unknown pathogenesis. It is most often observed in patients suffering hydroelectrolyte disturbances. There is no specific treatment and it can have an unfortunate outcome. We present a case of CPM that responded well to immunoglobulins., Case Report: The case of a 31 year old female patient with bulimia, impulsive type personality, potomania and chronic alcoholism is presented. After admission to the intensive care unit due to severe hyponatremia (104 mEq/l) with correction in 7 days, she had a rapidly progressive picture of dysarthria and gait instability, tetraparesis and pyramidalism. Due to suspected CPM, emergency magnetic resonance imaging was requested, observing a hypertense lesion in central, bilateral and symmetric T2 of the pons. Treatment was initiated with dexamethasone with clinical progression so that i.v. immunoglobulin treatment was prescribed, with a spectacular improvement after the third day., Conclusions: Treatment with immunoglobulins may be a therapeutic option to consider in patients with CPM and clinical progression after the usual treatment. Furthermore, this response opens questions on a possible dysimmune mechanism in this disease.

Introduction: We analyse the demand for neurologic care reasons for consultation and diagnoses of the immigrant population in two extrahospitalary neurological outpatient clinics., Patients and Methods: A prospective one-year study of first visits of adult immigrant patients sent to the neurological outpatient clinic., Results: A total of 342 patients were included in the study. They represented 9.4% of total patients in one clinic and 4.1% in another. The average age was 32.9 years old. There was a predominance of women (62.2%). The average stay in our country was two years. Latin America (especially from Ecuador and Colombia), Morocco and East Europe were mainly the origin of the patients. The cause of consultation was headache in a half of the cases and neuromuscular pathology, epilepsy and psychiatric disorders were the next most frequent diagnoses in descending order. The most frequent diagnoses was tension-type headache, and in descending order of frequency: migraine and transformed migraine, epilepsy, carpal tunnel syndrome, idiopathic facial palsy, low back pain and sciatica and syncope. Tension-type headache and transformed migraine were in relation to their situation of immigrants (family, working, adaptive problems)., Conclusions: The neurologic care demands in immigrant population is the same as in spanish one. These are a young people that fundamentally consults by headache (in relation to adaptive problems), neuromuscular disorders, epilepsy and psychiatric disorders. The public health service have to take into account this population to health resources planning.

Objective: To determine the reasons for consultation to the neurology service in a cancer center., Methods: A retrospective examination of all neurology consultations over a 3-month period., Results: A total of 247 patients were examined. The most frequent symptoms included, pain (34%), motor weakness (25%) and altered mental status (22%). The most frequent diagnoses were spinal cord compression (18%), brain metastases (15%), metabolic and/or toxic encephalopathies (14%) and stroke (7%). Spinal cord compression was demonstrated in 50% of patients with back pain or radiculopathy. Pain and motor weakness resulted from metastatic complications in 75% and 69% of the cases, respectively; however, only 18% of the cases of altered mental functions resulted from metastatic complications. At the time of the neurology consultation, 41% of the patients were receiving corticosteroids and 43% suffered from one or more of its adverse effects. The diagnostic test most frequently requested by the neurologist was the MRI. In 101 patients the neurological symptoms were followed for at least 5 days; when the cause of the neurological deficit was a metastatic complication, the effect of the treatment was evaluated one month later. Overall, 64% of the patients with metastatic complications improved with treatment, 19% remained stable, and 17% worsened or died., Conclusions: In a cancer center, the three symptoms that most frequently resulted in neurologic consultation were pain, motor weakness, and altered mental status. These were most commonly due to brain or epidural metastases, toxic and/or metabolic encephalopathy, and stroke. The use of neuroimaging does not appear to replace the need for neurologic consultation. The neurologist assists in establishing the diagnosis and initiating the appropriate treatment. In this study, two out of three patients improved after treatment of the neurologic deficit.