Amidarone (AMD) is an antiarrhytmic drug with side effects on the nervous system. Cerebellum is seldom involved. We describe the case of a 56 years old male patient with a history of 4 month of cerebellar involvement characterized by gait unstadiness, ataxia, nistagmus and vertigo. He was on treatment with AMD because of ventricular arrythmia. The cerebellar syndrom progressively disappeared after drug whitdrawal and he was symptoms-free 4 months later. Similar symptoms appeared after another one month of automedication with the same drug. Structural lesions, metabolic, nutritional deficiencies or toxics were excluded. Mechanisms of cerebellar toxicity of AMD are yet unknown. The knowledge of the toxic effects of this drug, widely used in our country, would allow its early recognition.

La amiodarona (AMD) es una droga antiarritmica cuyos efectos adversos pueden comprometer el sistema nervioso central y periferico. La aparición de un síndrome cerebeloso es infrecuente. Se presenta un paciente masculino de 56 anos de edad que desarolla un síndrome pancerebeloso de 4 meses de evolución, que revierte luego de la suspension de la AMD. El cuadro reaparece meses mas tarde luego de un periodo de automedicacion con la droga. Los mecanismos tóxicos por los cuales la AMD afecta al cerebelo permanecen inciertos. Esta droga de amplia difusión en nuestro medio, como otros antiarritmicos, posee efectos sobre el sistema nervioso que deben ser tenidos en cuenta a fin de poder detectarlos precozmente.

Schwannomatosis is a rare disorder, still not quite well defined, seldom described in the literature. In this paper we report the case of male. Patient, 52 years old, who in the last 30 years developed five subcutaneous tumors within his limbs peripheral nerves, which histologically proved to be schwannomas. A brain computed tomography showed a partially calcified tumor in the left temporal lobe which most likely was a meningioma. A thorough clinical examination was unable to find signs of type I or type II neurofibromatosis. The present condition, probably a form of phacomatosis, has to be distinguished from neurofibromatosis and is considered as an independent clinical entity whose origin still awaits further detailed investigations.

Se describe un paciente de 52 años de edad que presentó 5 tumoraciones subcutaneas adheridas a diferentes nervios periféricos. La anatomía patológica de todas ellas, indicó que se trataba de schwannomas. Una TAC de cerebro demostró una tumoración en lóbulo temporal izquierdo con calcificaciones en su interior, compatible a meningioma. La ausencia de criterios diagnósticos para neurofibromatosis I y II y la característica particular del cuadro, schwannomas múltiples asociados a tumoración endocraneana, sugieren el diagnós tico de schwannomatosis.

Nine-hundred-eighty-nine patients with lymphoma were studied. Fifty-three cases (5.3%) had lymphomatous craniocerebral infiltration. The principal factors of risk for this complication were: advanced stage of the lymphoma (III or IV), diffuse histiocytic, diffuse poorly differentiated lymphocytic, or mixed cellularity lymphoma histological type, bone marrow involvement, and previous systemic chemotherapy. Thirty-two per cent of the cases of meningeal lymphomatous infiltration were asymptomatic and represented autopsy findings. CT-scan was an useful test to detect brain focal parenchymatous infiltration, as opposed to meningeal infiltration. Mean survival time in patients with lymphomatous meningeal infiltration was 4.3 months, following the combined use of systemic chemotherapy, radiation therapy and intrathecal methotrexate. Two cases had primary cerebral lymphoma, although without associated immunodeficiency Twenty patients (2%) had intracranial hemorrhage, in clear relationship with platelet alterations. Fifteen patients (1.5%) had CNS infection, caused by common bacteriae or opportunistic agents. In 7 cases, the diagnosis was made at autopsy. Thirty-six autopsies were performed. In 8 cases (22%), pathologic findings such as, demyelination, microcalcificat ons, coagulative necrosis, or gliosis, suggested complications from treatment.

Fueron estudiados 989 pacientes con linfoma. Tuvieron infiltración linfomatosa craneocerebral 53 casos (5.3%). Los principales factores de riesgo para esta complicación fueron: a. estado avanzado del linfoma (III o IV); b. las formas difusas histiocíticas, difusa pobremente diferenciada o celularidad mixta; c. el compromiso de la medula osea y de la quimioterapia sistêmica previa. En el 32% de los casos la infiltración meníngea linfomatosa fué asintomática y represento hallazgos de autópsia. La tomografía cerebral fué de utilidad para detectar infiltraciones parenquimatosas focales, no así para Ias infiltraciones meníngeas. El tiempo medio de sobrevida en pacientes con infiltración meníngea linfomatosa fué de 4.3 meses, siguientes al uso combinado de terapia radiante a craneo total, quimioterapia sistêmica y/o intratecal con methotrexate. Dos casos con linfoma cerebral primário no estuvieron asociados con inmunodeficiencia. Hemorragias intracraniales se observaron en 20 pacientes (2%), en relaciõn con alteraciones plaquetarias. En 15 casos hubo infección del SNC (1.5%), causada uor bactérias comunes o por agentes oportunistas. En 7 de esos casos el diagnóstico se hizo por autópsia. En 8 de 36 casos autopsiados (22%) se observaron desmielinización, microcalcificaciones, necrosis coagulativa o gliosis, sugestivas de complicaciones por los tratamientos efectuados.