Prevalence of multiple sclerosis in Valladolid, northern Spain

Producción CientíficaThe aim of this study was to ascertain the prevalence of multiple sclerosis (MS) in a northern Spanish region and to compare it with that from the most recent epidemiological studies in the country. MS prevalence was studied for a period of 2 years using multiple sources of information in the province of Valladolid, with a sample comprising a total population of 92,632. Patients were classified according to the Poser criteria. The crude prevalence of definite and probable MS was 58.3 per 100,000 (95% confidence interval: 43.7–75.7). The same methods have been used in ascertaining similar prevalence rates in Vélez-Málaga, Osona, and Gijón and a slightly lower rate in Teruel. Our survey confirms Spain as a high-risk area for MS, with prevalence rates over 50 per 100,00

Retropharyngeal tendinitis, brachial plexopathy and Horner's syndrome from an anomalous cervical posture

[ES] Introducción y objetivo: Presentamos el caso clínico de un paciente que, a consecuencia de una mala postura cervical, manifiesta una sintomatología y exploración compatibles con tendinitis retrofaríngea, síndrome de Horner y plexopatía braquial del mismo lado. No habiendo encontrado en la literatura una descripción similar, analizamos las características y posible fisiopatología de esta rara asociación. Caso clínico: Tras consumir en exceso alcohol y drogas, un hombre joven se queda dormido, inmóvil durante horas, con la cabeza inclinada sobre el hombro izquierdo. Al despertar acude a urgencias por presentar un intenso dolor de nuca y pérdida de sensibilidad en el cuello y miembro superior derecho. Posteriormente refiere dolor de garganta. La exploración clínica, analítica y radiológica permite el diagnóstico de síndrome de Horner, plexopatía braquial y tendinitis retrofaríngea del lado derecho. Discusión: Son pocos los casos publicados en los que una mala postura desencadene una tendinitis retrofaríngea, una plexopatía braquial o un síndrome de Horner y el único conocido por nosotros donde la extensión cervical forzada sea la causa de esta triple asociación. Las alteraciones neurológicas se diagnosticaron a través de la exploración clínica y radiológica, pero la tendinitis retrofaríngea ofrece una sintomatología y una exploración que puede confundirse con otras patologías de mayor transcendencia. Conclusión: Creemos que la postura produjo un estiramiento del “músculo longus colli”, del plexo braquial y de las fibras cervicales simpáticas preganglionares, desencadenando este cuadro clínico, que nunca hemos visto anteriormente descrito en la literatura. [EN] Introduction and objective: We present a clinical case of a patient who, because of an incorrect cervical posture, displayed symptoms and examination compatible with retropharyngeal tendinitis, Horner's syndrome and brachial plexopathy all on the same side. We have not seen a similar case described in the literature. The characteristics and possible physiopathology of this rare association is analysed. Case report: After excessive alcohol and drug consumption, a young man fell asleep and lay immobile for hours with his head bent towards his left shoulder. Upon awakening, he went to emergency services due to severe pain in the nape of his neck and loss of feeling in his neck and upper right arm. He later reported severe throat pain. Physical examination, analytical tests and x-rays yielded the diagnosis of retropharyngeal tendinitis, Horner's syndrome and brachial plexopathy of the right side. Discussion: There are few published cases where poor posture triggers a tendinitis retropharyngeal, brachial plexopathy or Horner Syndrome and the only one we know, where forced cervical extension causes the association of the three pictures. Neurological alterations were quickly diagnosed through clinical and radiological examination, but the retropharyngeal tendinitis offers a symptomatology and exploration which can be confused with other pathologies of greater importance. Conclusions: We feel the patient's posture stretched the “longus colli muscle”, brachial plexus and preganglionic sympathetic fibres, triggering this associated condition, which we have not seen before in the literature