Background-Essential thrombocythemia (ET) is a chronic myeloproliferative disorder with increased frequency of thrombotic events, including transient ischemic attacks (TIAs) and stroke. Moyamoya syndrome is a rare cerebrovascular disease characterized by progressive occlusion of intracerebral arteries with a typical "puff of smoke" angiographic pattern. We report the development of moyamoya syndrome in a patient with ET. Case Description-The patient is an 18-year-old female who presented at age 13 with recurrent TIAs. Persistent thrombocytosis was found, a diagnosis of ET was made, and treatment with anagrelide was started. Despite normal platelet counts, she experienced recurrent TIAs and stroke. Severe stenosis of the supraclinoid segment of the left internal carotid artery (LICA) and abnormal collateral vessels were found, and moyamoya syndrome was diagnosed on the basis of the characteristic angiographic appearance. An intracranial stent was placed in the LICA, and since then, she has had an uneventful outcome after a 46-month follow-up. Conclusion-To our knowledge, the development of moyamoya phenomenon has not been reported in ET, and the relationship between these 2 disorders remains unclear. Besides, this is the first intracranial carotid stent implanted successfully in a patient with moyamoya. (Stroke. 2005;36:e71-e73.)

Background: The role of patent foramen ovale is a field of debate and current publications have increasing controversies about the patients’ management in young undetermined stroke. Work up with echocardiography and transcranial Doppler (TCD) can aid the decision with better anatomical and functional characterization of right-to-left shunt (RLS). Medical and interventional strategy may benefit from this information. Summary: a group of experts from the Latin American participants of the Neurosonology Research Group (NSRG) of World Federation of Neurology created a task force to review literature and describe the better methodology of contrast TCD (c-TCD). All signatories of the present consensus statement have published at least one study on TCD as an author or co-author in an indexed journal. Two meetings were held while the consensus statement was being drafted, during which controversial issues were discussed and voted on by the statement signatories. The statement paper was reviewed and approved by the Executive Committee of the NSRG of the World Federation of Neurology. The main objective of this consensus statement is to establish a standardization of the c-TCD technique and its interpretation, in order to improve the informative quality of the method, resulting in expanding the application of TCD in the clinical setting. These recommendations optimize the comparison of different diagnostic methods and encourage the use of c-TCD for RLS screening and complementary diagnosis in multicenter studies.

I. RAVERA, ROBERTOEP. SICA RESUMEN -La amiodarona (AMD) es una droga antiarrítmica cuyos efectos adversos pueden comprometer el sistema nervioso central y periférico. 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 período 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 antiarrítmicos, posee efectos sobre el sistema nervioso que deben ser tenidos en cuenta a fin de poder detectarlos precozmente.PALABRAS-LLAVE: síndrome cerebeloso, amiodarona.Cerebellar syndrome by amiodarone SUMMARY -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.KEY WORDS: cerebellar syndrome, amiodarone.La amiodarona (AMD) es una droga de uso frecuente en nuestro medio para el tratamiento de arritmias ventriculares y supraventriculares 10 . Sus efectos adversos sistemicos mas comunes son: hipertiroidismo, hipotiroidismo, depósitos corneales, fibrosis pulmonar, fotosensibilidad y aumento de las enzimas hepáticas 1,4 . Según las diferentes series, entre 20 y 54% de los pacientes que reciben AMD pueden presentar efectos colaterales sobre el sistema nervioso central y periférico 1,4 . El mas frecuente de ellos es la aparición de temblor postural, menos frecuentemente se describen trastornos en la marcha, parkinsonismo, distaxia de miembros, neuropatía y nistagmus 1,3 . Presentamos un paciente de 56 anos de edad, que desarrollo un síndrome pancerebeloso en relación a la administración de AMD, que remitió luego de la suspensión del fármaco. CASOFG, paciente de 56 anos de edad, de sexo masculino que, a raíz de una arritmia ventricular, inicia tratamiento con AMD, en dosis de 600 mg/dia. Tres meses mas tarde comienza con vértigo e inestabilidad progresiva para

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