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Mortalidad y pronóstico funcional en pacientes con infarto cerebral en una ciudad a gran altitud (Cusco, 3300m) durante la pandemia por COVID-19. Mortality and functional prognosis in patients with ischemic stroke residing in a high-altitude city (Cusco, 3300 m) during the covid-19 pandemic.
Introduction: Information on stroke mortality in people residing at high altitudes is controversial, and during the coronavirus disease 2019 (COVID-19) pandemic, there was a decrease in in-person care. Our objective is to evaluate mortality and functional prognosis after 3 months in stroke patients residing at high altitude during the COVID-19 pandemic. Methods: An analytical longitudinal study was conducted from January 2020 to January 2022 in a hospital in Cusco (3300 m above sea level), including adult patients diagnosed with stroke but without COVID-19 diagnosis, who were followed up for 90 days, evaluating mortality and functional disability (modified Rankin scale ≥ 3). Clinical and laboratory risk factors were evaluated, obtaining crude and adjusted hazard ratios (HR) through Cox regression models with 95% confidence intervals (CI95%). Results: One hundred twenty-three stroke patients were evaluated. After 90 days of follow-up, 28 patients (22.7%) died and 80 patients (65.0%) were diagnosed with functional disability. In models adjusted for gender, age, Alberta stroke program early CT (ASPECTS) score, and hypertension background, the only variable with increased risk was National Institutes of Health Stroke Scale (NIHSS) score at admission, both for mortality (HR 1.14, CI95% 1.09–1.20) and functional disability (HR 1.07, CI95% 1.04–1.11). Conclusions: Regarding stroke patients cared for in a high-altitude city during the COVID-19 pandemic, NIHSS score at admission is the most important risk factor for determining the 90-day mortality or functional disability, with a risk increase of approximately 10% for both outcomes for each additional point on the scale.
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Demanda asistencial en consulta de neurología en la provincia de Sucumbíos, Ecuador. Care demand in neurology consultation in Sucumbios province, Ecuador.
Objective: To characterize the care activity in the neurology outpatient clinic of the Marcos Vinicio Iza Hospital in the province of Sucumbíos, Ecuador. Patients and methods: Cross-sectional descriptive observational study, which included patients seen in a first general neurology consultation, between the months of June to November 2022. The variables analyzed included demographic data, related to healthcare activity and clinics. Results were compared between sexes and are shown by age group. Results: 733 patients were included in the study; the mean age was 35 years (SD ± 25.27) with a predominance of males (p 0.008). Most of the patients were of Ecuadorian nationality, followed by Colombians. 84% patients were referred from the primary level of care by family physicians, followed by internal medicine (7%) and pediatrics (6%) from the hospital. The main diagnostic categories treated were epilepsy (24.8%), headache (22.2%) and neurodevelopmental disorders (21.1%). Conclusion: The population we assist has specific characteristics. In our case we function as a consultant to other specialties, mainly Family Medicine. The greater frequency of patients with epilepsy and neuropediatric diseases requires changes in the provision of human resources and diagnosis to demand from the health authorities.
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Consenso de expertos para el tratamiento de los pacientes con Esclerosis Múltiple en Ecuador. Experts recommendations on the management of Multiple Sclerosis patients in Ecuador.
During the last 25 years, multiple sclerosis (MS) has seen major changes with new diagnostic criteria, a better identification of disease, individualization of disease prognosis and the appearance of new therapeutic options. As a result, the management of MS patients has become more complex and challenging. The objective of these consensus recommendations was to review how the disease should be managed in Ecuador to improve short, mid and long-term outcomes in affected patients. Methods: A panel of experts in neurology from Ecuador, dedicated to the diagnosis and care of MS patients, gathered virtually during 2023 and 2024 to carry out consensus recommendations on the management of MS patients. To achieve consensus, the methodology of “formal consensus-RAND/UCLA method” was used. Results: Recommendations were established based on published evidence and expert opinion. Recommendations focused on diagnosis, disease prognosis and tailored treatment, treatment failure identification and the pharmacovigilance process. Conclusions: The recommendations of these consensus guidelines attempt to optimize the health care and management of patients with MS in Ecuador.
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Crisis focales como síntoma de presentación del síndrome HaNDL (cefalea transitoria y déficits neurológicos con pleocitosis linfocitaria). Focal seizures revealing HaNDL syndrome (Transient headache and neurological deficits with lymphocytic pleocytosis).
A 38-year-old woman with a history of migraine presented with two tonic-clonic seizures confined to the left size of the body, which occurred one hour apart. The second seizure was followed by severe headache and hemiplegia ipsilateral to the seizures, which persisted for 24 hours, reversing completely thereafter. Brain MRI and a 21-channel EEG were normal. A lumbar puncture revealed CSF under normal opening pressure, discrete lymphocyte pleocytosis, and normal glucose and protein levels. This patient meets the diagnostic criteria for HaNDL syndrome, a rare condition of unknown cause, whose prognosis is usually favorable, with complete reversal of symptoms within a few weeks. Its diagnosis must be taken into account to avoid the practice of invasive tests or complex treatments that are not devoid of adverse effects.
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Palabras clave: Cefalea,
crisis convulsivas,
hemiplejía transitoria,
pleocitosis linfocitaria,
Síndrome HaNDL,
Absceso cerebral: una entidad poco común en pediatría. Brain abscess: an uncommon entity in pediatrics.
Brain abscess rarely occurs in children. It is a neurosurgical emergency with a potentially catastrophic outcome, with a high risk of permanent neurological deficit. With the introduction of modern imaging, antibiotics, and stereotactic surgical techniques, mortality has decreased markedly. Symptoms are nonspecific and may vary depending on the child’s age, location, size, number, and stage of the abscess, and the primary source of infection. Despite the decline in mortality, brain abscess remains a serious disease that can lead to serious morbidity or even death if diagnosed late, incorrectly diagnosed, or inadequately treated.
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Parkinsonismo y deterioro cognitivo rápidamente progresivo en un paciente con lupus eritematoso sistémico y síndrome antifosfolípido triple positivo. Parkinsonism and rapidly progressive cognitive decline in a patient with systemic lupus erythematosus and triple-positive antiphospholipid syndrome.
Background: The association between parkinsonism and systemic lupus erythematosus is inadequately described, and to date, the underlying pathophysiological mechanisms are not fully established, ranging from vascular impairments to immunomediated phenomena. Literature analysis identified only 28 cases of parkinsonism in patients with systemic lupus erythematosus, underscoring the limited attention to these associations and their respective therapeutic approaches.
Case Report: We present a case of a patient with an atypical presentation of systemic lupus erythematosus and a diagnosis of triple-positive antiphospholipid syndrome. Despite the absence of lupus activity, the patient developed symptoms of parkinsonism and rapidly progressive cognitive decline. No other underlying causes or thrombotic events in brain imaging were found to explain the atypical clinical presentation. Simultaneous administration of immunosuppressive therapy and levodopa/carbidopa resulted in symptom improvement.
Conclusion: Insufficient research has been conducted on the correlation between systemic lupus erythematosus and parkinsonism, primarily due to its seemingly low incidence in the medical literature. Consequently, this case report offers additional insights into this association, potentially laying the groundwork for future structured and well-designed studies. The efficacy of levodopa and immunosuppressive therapy in treating these patients remains uncertain and necessitates further investigation.
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Palabras clave: autoinmunidad,
lupus eritematoso sistémico,
parkinsonismo,
Síndrome antifosfolípido,
Síndrome de RETT: Abordaje desde la fisioterapia y terapia conductual. RETT syndrome: Approach from physiotherapy and behavioral therapy.
Purpose: Rett syndrome is considered a neurodevelopmental disorder with late regression, its main clinical manifestation is the progressive delay of already acquired motor and language skills, accompanied by rigidity and stereotyped hand movements. The aim of this case report was to identify the effects of a physiotherapeutic intervention combined with behavioral therapy in a patient with Rett syndrome.
Case presentation: We present the case of a 10-year-old girl with a medical diagnosis of Rett syndrome, stage III, or also called stabilization or pseudo-stationary stage. Physiotherapy and behavioral therapy were applied 3 times a week, with 45-minute sessions for a period of 12 months of treatment.
Results: Changes were achieved in gross motor function, balance reactions, straightening, in the ability to avoid obstacles and follow instructions; these skills were preserved for 6 weeks (at the end of treatment), and again, the regression of psychomotor functions is evidenced, which may be due to the characteristics of the syndrome.
Conclusion: the results obtained suggest that the combination of physiotherapy with behavioral therapy generates positive changes in gross motor function and behavior in girls with Rett syndrome.
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Palabras clave: estudio de caso,
fisioterapia,
lenguaje infantil,
Sindrome de Rett,
terapias de la conducta cognitiva,
Mixoma de aurícula derecha como probable causa de migraña. Right atrial myxoma as a probable cause of migraine.
Introduction: Cardiac myxoma is a benign tumor known as the “great imitator” because it can manifest clinically in a very diverse manner and/or with nonspecific findings that create a lot of confusion and make diagnosis difficult. It is associated with neurological manifestations, typically secondary to embolic complications affecting the nervous system, such as ischemic strokes, which can cause dizziness, headaches, loss of consciousness, and/or vision and speech disturbances.
Clinical Case: A 16-year-old female patient with a six-month history of headaches and no other neurological history. She was hospitalized for diagnostic evaluation by the neurology department, where her condition was interpreted as primary migraine-type headaches without aura. Among the tests performed during her hospitalization, an intracardiac mass in the right atrium was detected, compatible with cardiac myxoma, confirmed by postoperative histopathological analysis. She evolved favorably without presenting neurological symptoms again.
Conclusion: The occurrence of migraines in patients with cardiac myxomas is rarely reported, and this condition has only been associated with myxomas located in the left heart chambers. Describing the different published pathophysiological mechanisms that can lead to this neurological condition, and due to the unusual nature of the case reported, given the location of the neoplasm in the right heart chambers, it is considered possible that the migraine may have originated from the synthesis and release of vasoactive intestinal polypeptide by the myxomatous tumor.
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Palabras clave: Cefalea,
Manifestaciones neurológicas,
mixoma,
neoplasias cardíacas,
Trastornos migrañosos,
Complicaciones neurológicas en la acondroplasia: Cuadriparesia post traumatica en estenosis cervicomedular. Neurological complications in achondroplasia: Post-traumatic quadriparesis in cervicomedullary stenosis.
Achondroplasia is a common skeletal dysplasia characterized by short stature and bone deformities, caused by a mutation in the FGFR3 gene. Patients with this condition are at risk of neurological compression, especially at the craniocervical junction. We present the case of a girl with achondroplasia who suffered a traumatic brain injury, revealing stenosis of the foramen magnum and spinal cord contusion on MRI. Surgical decompression was performed with favorable results.
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Evaluación neuropsicológica en un caso de síndrome de Rasmussen de inicio tardío. Neuropsychological evaluation in a case of late-onset Rasmussen syndrome.
Rasmussen syndrome (RS) is a rare encephalitis characterized by inflammation of one cerebral hemisphere that causes atrophy, neurological and cognitive impairment. We present a 42-year-old female patient, with no significant previous history and diagnosed with epilepsy since she was 24 years old, epileptic seizures are reported in different time windows with temporary cessation, but with constant reinstallations of acute and drug-resistant episodes. Neurological examination revealed hyperkinesia of the extremities, with persistent flexion and extension movements. The neuropsychological evaluation carried out with the MoCA test, Rey’s complex figure and Token test, shows severe cognitive impairment with psychiatric symptoms. In addition, electroencephalogram results show unilateral hemispheric slowing with unilateral focal onset and MRI evidence of generalized atrophy of the left hemisphere, elements supporting the diagnosis of late-onset RS. Finally, information is offered about the associated neuropsychological manifestations.
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Neuropatía autoinmune por anticuerpos antigangliósidos GD-1b asociada a Síndrome de Sjögren primario. Autoimmune neuropathy by anti-ganglioside GD-1b antibodies associated with primary Sjögren’s Syndrome.
The terms axonal or demyelinating, traditionally disseminated in the classification of polyneuropathies, are electrophysiological interpretations that guide us to determine the pathogenic locus where the neuropathic lesion originates; this is an objective contribution to the knowledge of the etiology of the corresponding neuropathy. However, in some circumstances, a bimodal interpretation initially does not allow determining the possibility of involvement at the axolemma level, as can be identified in some immune-mediated polyneuropathies that compromise the Ranvier node or its different domains; These neuropathies are of autoimmune origin and are characterized by the presence of anti-ganglioside antibodies directed against antigenic epitopes at this anatomical locus.
This is a case report of a 66-year-old male patient with progressive weakness in all four limbs leading to prostration over a few weeks; no prior systemic infections were reported. Initially diagnosed with Guillain-Barré Syndrome (GBS), he was evaluated with electrophysiological studies that confirmed the existence of a sensorimotor demyelinating polyneuropathy and treated with intravenous immunoglobulin (IVIg), with partial clinical improvement. Two weeks later, he was readmitted with a new episode of global muscle weakness, due to a fluctuating response of GBS to immunomodulatory treatment; therefore, he received two cycles of IVIg with little response. Complementary immunological studies confirmed a diagnosis of Sjögren’s syndrome and showed positive IgM anti-GD1b antibodies.
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Encefalopatía Epiléptica y del Neurodesarrollo por Mutación en SYNGAP1: Primer Caso Reportado en Ecuador. Developmental and Epileptic Encephalopathy due to SYNGAP1 Mutation: First Case Reported in Ecuador.
Developmental and epileptic encephalopathy related to mutations in the SYNGAP1 gene (EED-SYNGAP1) is characterized by psychomotor delay and early-onset epilepsy. We present the first documented case in Ecuador, describing the clinical, electroencephalographic, therapeutic, and evolutionary characteristics of the patient. Genetic diagnosis revealed a de novo nonsense mutation in SYNGAP1. Treatment with valproic acid showed good control of epileptic seizures, although reflex seizures persisted during feeding. This case highlights the importance of genetic studies in the diagnosis of epileptic and developmental encephalopathies.
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Palabras clave: Caso Clínico,
Encefalopatía epiléptica,
Epilepsia Refleja,
SYNGAP1,
Trastorno del Neurodesarrollo,
Parenchymal brain calcified cysticercus and progression of hippocampal atrophy. Cisticerco calcificado en el parénquima cerebral y progresión de atrofia de hipocampos.
A seizure-free 74-year-old woman had a single calcified cysticercus (Figure 1), and normal hippocampi (Figure 2, upper panel). Neuroimaging exams were practiced for a study aimed to assess the association between neurocysticercosis and hippocampal atrophy (HA).1 Seven years later, a control MRI showed bilateral HA (Figure 2, lower panel). The patient remained seizure-free during the observation period.
The association between calcified cysticercus and HA in seizure-free individuals has been recognized.2 It has been postulated that repetitive episodes of inflammation from antigens released to the brain parenchyma from calcifications are responsible for remote HA. However, HA progression in these patients has not been reported. This case underscores the need of early treatment with bisphosphonates to reverse the calcification process in the brain, reducing the risk of progressive HA.3
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Depression in adult day care centers in Ecuador: Prevalence and associated variables. Depresión en adultos que asisten a los centros de día en Ecuador: Prevalencia y variables asociadas.
Objectives: The present study aims to identify the prevalence and factors associated with depression in older adults attending day care centers in Quito, Ecuador.
Methods: This study is a correlational study with a non-experimental cross-sectional design. The study was applied in the 8 “Centros de Experiencia del Adulto Mayor” in the city of Quito, Ecuador. A total of 463 older adults with a mean age of 70.15 years were evaluated. All participants were administered a sociodemographic and health questionnaire, cognitive functioning, levels of depression, autonomy, and physical activity were measured.
Results: Using linear regressions, direct relationships were identified between depression scores with marital status (B=0.276, p=0.04) and renal impairment (B=1.257, p=0.007); and inverse relationships with educational level (B=-0. 537, p=0.002), sleep hours (B=-0.342, p<0.001), fish consumption (B=-0.318, p=0.021), physical activity (B=-0.454, p=0.002) and cognitive impairment (B=-0.091, p<0.001).
Conclusions: The results reflect the importance of considering a holistic approach in addressing depression in the older adult, including health, functional status and cognitive status together to prevent and or address depression in older adults. This study contributes to the implementation of public health policies related to the variables associated with depression in adults.
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Palabras clave: adulto mayor,
autonomía funcional,
centro de cuidado diurno,
depresión,
deterioro cognitivo,
Estrés Cotidiano, Funciones Ejecutivas y Rendimiento Académico en Escolares de Primaria. Daily Stress, Executive Functions, and Academic Performance in Elementary School Students.
The presence of stress has been linked to executive functions and academic performance; thus, the present research explored its relationship among primary students. The quantitative study included 62 participants between 8-12 years old, divided into late childhood and preadolescents groups.
A School Daily Stress scale was applied, with a report of academic averages and a battery of neuropsychological tests to measure executive functions and global cognitive capacity (CIT). The tests were the Trail making test, the colour and word Stroop test, and the Wechsler Intelligence Scale for Children. The main results showed a significant and negative correlation between daily stress, cognitive flexibility, working memory and inhibitory control (p<.05).
Regression analysis showed that both the CIT and the perception of daily stress predict academic performance (R2= .35). It is concluded that daily stress is relevant for the development of executive functions in primary school children and can have a negative impact on both academic performance and school trajectories.
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Alta viscosidad sanguínea en pacientes con Ictus Isquémico que residen a gran altitud. High blood viscosity in patients with ischemic stroke residing at high altitude.
Introduction: Risk factors for ischemic stroke have been extensively studied. However, few studies have been conducted in populations residing in high-altitude cities, where acclimatization processes cause elevations in blood viscosity. Our objective is to evaluate the association between blood viscosity and ischemic stroke in patients residing at altitude and to identify the most frequent subtype of ischemic stroke among these patients.
Methods: This case-control study was conducted in a hospital in Cusco, Peru (3,399 m) and included patients with and without ischemic stroke. Patients were included in the ischemic stroke group (cases) after having had up to three days of confirmed illness. The control group comprised patients hospitalized for other causes. Blood viscosity (in centipoise [cP]) was measured using a cone/plate viscometer. Viscosity data are reported as medians with interquartile ranges (IQR), and associations were evaluated using logistic regression with odds ratios (OR).
Results: A total of 386 patients were included, of which 141 (36.5%) had ischemic stroke. The median age was 67 years (IQR 52-80), and 165 (42.7%) patients were women. Blood viscosity was significantly higher in the ischemic stroke group (5.9 cP; IQR, 5.2–6.8) than in the control group (5.5 cP; IQR, 4.9–6.1; p<0.001). An increase in blood viscosity (in 1 cP increments) was associated with an increased risk of developing ischemic stroke (OR 1.40; 95% confidence interval, 1.16–1.69; p<0.001). Patients with the small-vessel occlusion subtype had the highest blood viscosity (6.1 cP; IQR, 5.8–6.3), which was significantly higher than in patients without stroke (p=0.002) or with other ischemic stroke subtypes (p=0.03).
Conclusions: Patients with ischemic stroke residing at high altitudes have higher blood viscosity than control patients regardless of ischemic stroke subtype, although the small-vessel occlusion subtype corresponded with the highest blood viscosity.
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Experiencia de aprendizaje autorregulado y su efecto en el rendimiento académico de universitarios de primer año. Self-regulated learning experience and its effect on the academic performance of first-year university students.
One of the relevant and predictive variables in explaining the academic performance of university students is self-regulation learning. This is why it becomes one of the necessary areas to develop and promote, especially in the first years of university life.
The aim of this study was to analyze the effect of learning experience on self-regulation of learning, self-efficacy for study regulation, willingness to study and academic performance in first-year university students.
The method has a quantitative approach with cross-sectional data in a sample composed of 115 university students of a career in the area of Engineering. Data processing was performed using the Partial Least Squares method.
The results show that learning experiences have a positive effect on the variables under study and specifically on academic performance.
This implies that the student’s experiences in the learning process, where teaching practices to promote self-regulation learning are especially relevant, have a direct effect on their academic performance
