Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

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Influencia del Estrés Crónico y de la Masticación Sobre el Dolor. Influence Of Chronic Stress And Chewing Over Pain.

Introduction: Chronic stress and mastication affect the response to pain; however, there is little knowledge about the relationship between these variables.

Objective: Determine the influence of chronic stress and mastication on the response to pain.

Methods: thirty-two 8-week-old male Balb/c mice were used. The sample was divided into 4 equal groups: Group N: normal mastication without stress; Group NE: Normal chewing + stress, Group D: deficient chewing without stress and Group DE: Poor chewing + stress. The response to the painful stimulus was evaluated through the tail withdrawal assay due to a thermal stimulus.

Results: By comparing the 4 experimental groups to the fourth and the eighth week through the ANOVA test yielded a value of p = 0.982 and p = 0.176; respectively. By applying the ‘t’ student, within each group, in comparison of the variation of the pain response between the fourth and eighth week, the values ​​of p = 0.52; p = 0.17; p = 0.84 and p = 0.069 were obtained for the group N, NE, D and DE respectively.

Conclusion: Chronic stress and mastication do not modify the response to pain in albino Balb/c mice.

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Palabras clave: dolor, Estrés crónico, masticación, neurociencias experimentales, respuesta dolorosa,

Keywords: Chronic stress, experimental neuroscience, hewing, pain, painful response,

Arterial Stiffness Is Not Independently Associated With Nighttime Sleep Duration In Community-Dwelling Older Adults. Results From The Atahualpa Project. La Rigidez Arterial no se Encuentra Asociada con la Duración del Sueño Nocturno en Adultos Añosos Que Viven en la Comunidad. Resultados del Proyecto Atahualpa.

Objectives: We aimed to assess the association between arterial stiffness and nighttime sleep duration in community-dwelling older adults living in rural Ecuador.

Methods: Aortic pulse wave velocity (PWV) determinations were used to assess arterial stiffness. Nighttime sleep duration was assessed by a single question. A generalized linear model—adjusted for demographics, cardiovascular risk factors and psychological distress—was fitted to assess the independent association between the aortic PWV and nighttime sleep duration (dependent variable).

Results: A total of 303 individuals were enrolled. Univariate analysis showed a significant association between the aortic PWV and long sleep duration (p=0.034), which vanished in a multivariate linear model (p=0.524). The single covariable remaining significant was anxiety (p=0.013).

Conclusion: Lack of independent association between arterial stiffness and nighttime sleep duration might be more likely related to lack of reliability of evaluation of sleep duration by means of a single question.

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Palabras clave: aterosclerosis, Duración del sueño, estudio poblacional, rigidez arterial, velocidad de onda de pulso aórtica,

Keywords: Aortic pulse wave velocity, Arterial stiffness, Atherosclerosis, population-based study, Self-reported sleep duration,

Escala Reducida Para Valorar el Sentido de Coherencia: SOC 15 Scale Reduced To Value The Sense Of Coherence: SOC 15

Introduction: The sense of coherence is a construct of health that allows the individual to face difficult situations of life. It is configured by three factors: meaning, understanding and management. As a method of assessment of this construct, has been proposed the SOC scale with 29 items in its original version.

Objective: The objective of this study is to propose a reduced SOC scale.

Methods: We worked with a sample of 445 healthy participants from Quito-Ecuador, 145 men (32.5%) and 300 women (67.4%).

Results: It was obtained that the reduced scale of 15 items presents an adequate internal consistency in its three factors: understanding α= .74, management α= .82 and meaning α= .82. In the confirmatory factor analysis, an acceptable adjustment of the reduced model was found (SOC-15) x2= 317.90, DF= 87, p= <. 001, CFI= .92, RMSEA= .07 (.06-.08) and SRMR= .04.

Conclusions: The data is discussed in relation to the benefits of counting with a reduced scale for its future application in the clinical and health scientific context.

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Palabras clave: Comprensión, psicometría, salutogénesis, sentido de coherencia, significado, SOC-15,

Keywords: meaning, psychometry, salutogenesis, sense of coherence, SOC-15, Understanding,

Meningitis Criptocócica. Diferentes Contextos Clínicos y Complicaciones. Serie de 7 Casos. Cryptococal Meningitis. Different Clinical Context And Complications. Seven Cases.

Introduction. Cryptococcal meningitis (CM) is a serious infection of the Central Nervous System. The diagnosis and treatment of these patients is often complex, due to the severity of the clinical manifestations and their complications. The aim of this study is to describe the different clinical contexts, the neuroradiological characteristics and the complications of patients with CM.

Patients. We performed a retrospective review of clinical and radiological factors of 7 patient’s diagnosis and treated with CM during the period October 2016 and September 2017, at the Eugenio Espejo Hospital.

Results. Male sex was predominant (6/7), with an average age of 31.6 years (Range 19-44). The average time for the diagnosis was 8.1 weeks. Immunosuppression causes were evidenced in 5 patients, two HIV positive, one case with Acute Lymphoblastic Leukemia, CD4 idiopathic lymphopenia and Primary Intestinal Linfagectasia respectively. Three patients developed complications as disseminated cryptococcosis, visual acuity and hearing loss, mortality rate reach 26.8% of patients. Hypoglycorrhachia was a relevant feature with average 12.7mmg / dl. In MRI, the most common lesion was dilatation of Virchow Robins spaces (5/7), followed by ischemic lesions.

Conclusions. CM is characterized for high morbidity and mortality, initial symptoms may be nonspecific and delays the diagnosis as well as initiation of antifungal agents. Several predisposing immunosuppressive conditions can be found and sometimes a diagnostic challenge.

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Palabras clave: comorbilidades, complicaciones, Criptococo Neoformans, meningitis, Meningitis Criptocócica, Mortalidad, resonancia magnética,

Keywords: comorbidities, complication, Cryptococcal meningitis, Cryptococcal Neoformans, Magnetic Resonance Image, meningitis, Mortality,

Factores Asociados a la Mortalidad de la Hemorragia Cerebral Intraparenquimatosa Espontánea en Pacientes Mayores de 50 Años de Edad que Acudieron al Hospital Teodoro Maldonado Carbo Durante el Año 2017. Factors Associated With Mortality Of Spontaneous Intraparenchymal Cerebral Hemorrhage In Patients Over 50 Years Old Who Attended The Teodoro Maldonado Carbo Hospital During 2017.

Objective. To determine the factors associated with the mortality of spontaneous intraparenchymal cerebral hemorrhage in patients over 50 years old who attended the Teodoro Maldonado Carbo Hospital during 2017.

Methods: A retrospective analytical observational study of 92 patients of diagnosis of spontaneous primary intraparenchymal hemorrhage, 30-day mortality was evaluated according to demographic characteristics, risk factors and poor prognostic factors. The Intracerebral Hemorrhage Grading Scale (ICH-GS) scale was applied in our population to evaluate the correlation of the scores obtained with the 30-day mortality.

Results: From 92 patients (mean age: 69 years, mean Glasgow Coma Scale [GCS] on admission: 10, mean supratentorial and infratentorial volume, respectively 36.63 and 13.92 ml, most common hematoma location: thalamus (21.74%). at 30 days it was [31.40%]). In a univariate analysis, GCS (odds ratio [OR] = 2.20, 95% confidence interval [CI] = 1.04- 4.65, p <0.04), infratentorial volume (OR) = 3.74 per ml, 95% CI = 1.25 to 11,120, p <0.02) and the ventricular extension was (OR = 5.43, 95% CI = 1.40-22.35, P = 0.02) were significant predictors for 30-day mortality The Pearson correlation showed correlations of 0.6556 between the IC-GS score and the 30-day mortality (P <0.001).

Conclusions: The GCS score at admission together with infratentorial volume and intraventricular extension are significant predictors of 30-day mortality in patients with primary spontaneous Intracerebral Hemorrhage (ICH) being useful for identifying high-risk patients in the short term.

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Palabras clave: escala de ICH-GS, Hemorragia cerebral; pronóstico; factores de riesgo,

Keywords: Cerebral haemorrhage, ICH-GS scale, Prognosis, Risk factors,

Ausencia de Asociación Entre la Posición de la Lengua Tipo IV de Friedman y Apnea Obstructiva de Sueño en Adultos Mayores con Ancestro Amerindio. Lack Of Association Between The Friedman’s Tongue Position Type IV And Obstructive Sleep Apnea In Older Adults Of Amerindian Ancestry.

Background: The burden of obstructive sleep apnea (OSA) in rural settings is unknown. In these regions, devices needed for OSA diagnosis are not available, and mass screening with field instruments may be complicated due to cross-cultural factors and illiteracy. The association between the Friedman’s tongue position (FTP) and OSA has been assessed in people from different ethnic groups but not in Amerindians.

Objective: We aimed to assess whether a FTP type IV is associated with OSA severity and with the apnea-hypopnea index (AHI) in community-dwelling older adults of Amerindian ancestry living in rural Ecuador.

Methods: A total of 201 Atahualpa residents aged ≥60 years, who underwent tongue position assessment, brain MRI, and polysomnography were included. After adjusting for relevant confounders, ordinal logistic regression models were fitted to assess the association between the presence of a FTP type IV and OSA categories (none, mild, and moderate-to-severe), and generalized linear models with a Gaussian link were fitted to assess the association between the presence of a FTP type IV and the continuous AHI.

Results: A FTP type IV was identified in 153 (76%) individuals, the mean AHI per hour was 11.9 ± 12.4, and 49 (24%) individuals had moderate-to-severe OSA, 88 (44%) had mild OSA, and the remaining 64 (32%) had no OSA. Fully-adjusted generalized linear models showed no independent association between the investigated exposure and the AHI (β: 0.09; 95% C.I.: -1.56 – 1.76; p=0.909). Likewise, ordinal logistic regression models showed no independent association between the investigated exposure and categories of OSA (β: 0.42; 95% C.I.: -0.47 – 1.31; p=0.357).

Conclusion: A FTP type IV is not associated with the AHI or the severity of OSA in this population of Amerindians. This lack of association could be related to phenotypic characteristics of people from this ethnic group (mostly their elliptic hard palate).

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Palabras clave: Apnea Obstructiva del Sueño, Índice apnea-hipopnea, posición de la lengua de acuerdo con Friedman,

Keywords: Amerindians, Apnea-hypopnea index, Friedman’s tongue position, Obstructive Sleep Apnea,

Adherencia al Tratamiento Antiepiléptico en Pacientes Pediátricos del Hospital Roberto Gilbert Elizalde en el Año 2014. Adherence To Antiepileptic Treatment In Pediatric Patients At Hospital Roberto Gilbert Elizalde During 2014.

Introduction: Epilepsy in the pediatric population is an entity that mostly affects underdeveloped countries. In Ecuador, hospital admissions due to poor control are increasing and the main cause is poor adherence to antiepileptic treatment.

Objective: To demonstrate the incidence of nonadherence to the antiepileptic regimen and determine the factors that contributes to it.

Materials and methods: A cross-sectional study was conducted in which 119 patients were included with ages between 6 months and 17 years. The parents or legal guardians were questioned regarding the degree of adherence to antiepileptic treatment using the Morisky questionnaire. A logistic regression model was used to measure the strength of association between variables.

Results: An incidence of non-adherence to antiepileptic treatment of 36.97% was found. The significantly associated variables were the mother’s schooling (x2=11.83, IC= 10.13 – 13.53, p=0.018), previous medical information (x2=9.35, IC= 7.95 – 10.75, p=0.02) and the failure to obtain medication due to lack of money (x2=5.98, IC= 5.29 – 6.67, p=0.01).

Conclusion: The incidence of nonadherence in this study was high; control over sociodemographic factors and related to treatment can have a great impact on these patients.

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Palabras clave: adherencia, Epilepsia, pediatría, Tratamiento,

Keywords: adherence, Epilepsy, pediatrics, Treatment,

Frecuencia de Casos Juveniles con Enfermedad de Huntington en Población Mexicana. Frequency Of Juvenile Huntington’s Disease In A Mexican Population.

Objective. The purpose of this study is to know the prevalence of juvenile cases in a sample of mexican subjects with confirmed Huntington Disease (HD).

Methods. Patients with clinical debut before 21 years of age were included who attended at movement disorders clinic of the National Institute of Neurology and Neurosurgery. The demographic and clinical information was obtained from the review of files.

Results. A total of 198 cases of patients diagnosed with HD were reviewed, of which 6.5% (n = .13) corresponded to juvenile forms. The mean age for the onset of symptoms was 17.8 ± 3.9 years. The mean score of the UHDRS-motor was 46.2 ± 17.4 points. The predominant motor symptom was chorea in (53.8%) of the cases. 84.6% of those affected presented at least one neuropsychiatric disorder.

Conclusion. It was detected that the dominant motor phenotype of these patients was chorea compared to the world reports until now, accordingly to that, our group of juvenile HD shows atypical motor clinical.

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Palabras clave: corea, enfermedad de Huntington, juvenil, México, Westphal,

Keywords: chorea, Huntington disease, juvenile, Mexico, Westphal.,

Fibrinólisis Farmacológica en el Ictus Isquémico Agudo. Experiencia en un Hospital Terciario del Ecuador. Pharmacological Thrombolysis In Ischemic Stroke. Experience In A Tertiary Hospital From Ecuador.

Introduction. Pharmacological thrombolysis in ischemic stroke is associated with a better recovery.

Objective. Describe the thrombolysis results after using r-Tpa applying an intrahospital stroke code, during one year.

Methods. A prospective, longitudinal study was performed in patients with cerebral infarction admitted to the stroke unit, with clinical follow-up up to 3 months after hospital discharge. The variables evaluated were compared in two groups of patients (only one group received the treatment).

Results. 107 patients were studied: 16 (14.9%) were thrombolyzed, 29 (27.1%) arrived in the therapeutic window period and 76 (71%) arrived after 4.5 hours. The average age was 68, 8 years and women predominated. The greatest impact of thrombolysis was on the difference in score between the initial assessment and the discharge on the NIHSS scale. At three months of evolution, the percentage of patients with mild disability (Rankin 0-2) was almost equal in the two groups. Mortality increased in patients with more severe disability (Rankin 3-5).

Conclusions. Treatment with r-Tpa shows benefits at hospital discharge. Further analysis is required with a greater number of cases.

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Palabras clave: Accidente Cerebrovascular, Ecuador, Fibrinólisis, infarto cerebral, Terapia Trombolítica,

Keywords: Cerebral infarction, Ecuador, fibrinolysis, stroke, Thrombolytic therapy,

Efectividad del Foto-Test Frente al MMSE, Para el Cribado del Deterioro Cognitivo en Población Peruana. Effectiveness Of The Photo-Test Front Of The MMSE, For The Screening Of Cognitive Deterioration In Peruvian Population.

The progressive increase of Alzheimer’s disease has generated interest in its early detection with cognitive screening tests being a useful tool, however, they need to be culturally adapted, objective and reliable. In Peru, this need is greater since the educational level of the elderly population is mostly low. The aim of the present study is to know the estimate sensitivity and specificity of FOTOTEST against MMSE for the screening/detection of cognitive impairment, analyzing the relationship of these cognitive tests with one of functional activity. 107 elderly people, aged 60-89 years, were evaluated. The Yesavage scale for geriatric depression was used, the functional activities questionnaire of Pfeffer, MMSE, and FOTOTEST. Pearson’s analysis showed a significant positive correlation between MMSE/FOTOTEST (Pearson 0.386, p <0.003), whereas only MMSE showed a significant negative correlation with PFAQ (Pearson -0.320, p <0.013). However, FOTOTEST did not show a significant correlation with PFAQ (Pearson -0.067, p <0.613). In addition, the percentage of effectiveness and specificity estimated for FOTOTEST was 100.00% and 92.68%, respectively, higher than the MMSE, with an estimated percentage of effectiveness being 83.33%, and specificity of 34.14%. We conclude that FOTOTEST would be a more useful test for the detection of cognitive impairment than MMSE.

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Palabras clave: Adultos Mayores, Cribado, Especificidad, Fototest, MMSE, Sensibilidad,

Keywords: elderly, MMSE, Phototest, Screening, Sensitivity, Specificity,

Salud Cardiovascular en Población Migrante Ecuatoriana en Madrid (España). ¿Debemos Preocuparnos?* Cardiovascular Health in an Ecuadorian Migrant Population to Madrid (Spain). Should we worry?

Background: The Ecuadorian community is the third largest foreign community in Spain. However, little is known about their cardiovascular (CV) health status and whether the effects of migration have caused a detriment in that state. Methods: With the aim of knowing the CV health in an Ecuadorian population of migrants in Madrid, a non-randomized, cross-sectional study was carried out, which included people of Ecuadorian nationality, older than 25 years, living in Madrid for a year or more. Surveys were conducted through the use of previously validated questionnaires, to determine the health status of the population, as well as the degree of neuro-physiological distress. Results: We included 165 participants (68.5% women), with an average age of 49 years. Of these, 86.1% presented poor cardiovascular health and 13.9% intermediate, without significant differences according to sex. There were no individuals that met the 7 variables consistent with and ideal CV status. Women had higher scores on the DASS-21 questionnaire compared to men (p <0.05). Conclusion: In the Ecuadorian migrant population living in Madrid, more than 85% had poor CV health, and none had an ideal CV health. Most prevalent risk factors in this population were poor physical activity, overweight/obesity and poor dietary habits. More studies are required to identify the real situation of CV risk in the Ecuadorian migrant population. Probably, in the medium-long term, it will be necessary to implement health policies especially addressed to migrants.

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Palabras clave: Ecuador, España, Madrid, Población migrante, salud cardiovascular,

Keywords: cardiovascular health, Ecuador, Madrid, Migrant population, Spain,

Intracranial Atherosclerosis And The Earlobe Crease (Frank’s Sign). A Population Study. Aterosclerosis Intracraneal y Pliegue Auricular (Signo De Frank). Estudio Poblacional.

Background: The earlobe crease (ELC) has been linked to coronary artery disease and other vascular conditions, but there is no information on its association with intracranial atherosclerosis. Objective: This study aimed to assess the association between high calcium content in the carotid siphons (as a surrogate of intracranial atherosclerosis) and ELC in communitydwelling adults living in rural Ecuador. Methods: Atahualpa residents aged ≥40 years underwent head CT to estimate calcium content in the carotid siphons, and visual inspection of both earlobes to evaluate the presence of ELC. The association between both variables was assessed by logistic regression models, after adjusting for demographics and cardiovascular risk factors. Results: Of 651 enrolled individuals (mean age: 59.7±12.8 years; 54% women), 225 (35%) had ELC, and 143 (22%) had high calcium content in the carotid siphons. Univariate logistic regression showed a borderline (non-significant) association between high calcium content in the carotid siphons and ELC presence (OR: 1.44; 95% C.I.: 0.99 – 2.12; p=0.057), which disappeared when age (OR: 0.98; 95% C.I.: 0.65 – 1.48; p=0.923) and other covariables (OR: 0.97; 95% C.I.: 0.63 – 1.49; p=0.890) were added to the model. Conclusion: This population study shows no association between high calcium content in the carotid siphons and ELC presence.

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Palabras clave: aterosclerosis intracraneal, calcificaciones de sifón carotídeo, estudio poblacional, Pliegue auricular, proyecto atahualpa,

Keywords: atahualpa project, carotid siphon calcifications, Earlobe crease, intracranial atherosclerosis, population-based study,

Rendimiento Diagnóstico de Minimental Frente Al DSM-5 en Trastorno Cognitivo: Experiencia de una Cohorte en Colombia. Diagnostic Performance Of Minimental Against DSM-5 In Cognitive Disorder. Experience Of A Cohort In Colombia.

Background: Cognitive screening tools are useful in the clinical and research setting. MiniMental (MMSE) is one of the most used instruments in Colombia, the objective of this work is to determine its performance against the new criteria for the diagnosis of cognitive disorder (DSM-5). Materials and methods: Diagnostic test study, assembled in a Colombian cohort, we evaluated a consecutive sample of 200 participants older than 50 years (66.5,+/-8.86) that represented the whole spectrum of the condition of interest, the index test (MMSE) was compared with the clinical reference standard (consensus diagnosis and classification by criteria DSM-5). Results: For mild cognitive impairment (MCI), the diagnostic performance of MMSE was: Sensitivity 45.3% (95% CI 33.7 to 57.4), specificity 96.9% (95% CI 91.4 to 99.0) and 76.9% accuracy (95% CI 69.5 to 82.4) at a cut-off point of 26 and, for major cognitive disorder (MCD) was: Sensitivity 76.32% (95% CI 60.8-87.0) and specificity 97.53% (95% CI 93.8-99.0) at the cut-off point of 24. Conclusions: MMSE is a valid alternative for the diagnosis of MCD, however it has limited validity for the detection of MCI, so new tools for the purpose of screening of MCI should be considered.

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Palabras clave: demencia, MiniMental, MMSE, prueba diagnóstica, Trastorno cognitivo, Trastorno cognitivo leve,

Keywords: Cognitive disorder, dementia, diagnostic test, Mild cognitive disorder, MiniMental, MMSE,

Tasa de Hospitalización Según Comorbilidades en Pacientes con Alzheimer en el Hospital Teodoro Maldonado Carbo. Hospitalization Rate According To Comorbidities In Alzheimer’s Patients At Hospital Teodoro Maldonado Carbo.

Introduction: According to World Health Organization (WHO) 2017 report there are 50 millions of people with dementia worldwide and 60% to 70% of cases belong to Alzheimer’s Disease. The WHO admit that dementia is a public health priority. Aims: Descriptive analysis of patients Alzheimer’s Disease in Guayaquil, Ecuador, focused hospitalization and mortality predictors. Methods: Cross-sectional study. Multivariate and univariate logistic regression analysis to indicate predictors of hospitalization by pneumonia and mortality. Results: 42.57% of the sample was men and the average age was 80.02 years. In a multivariate logistic regression analysis, the most associated comorbidity to increase the risk of pneumonia were Diabetes Mellitus combined with Arterial Hypertension (OR 5.62, 95% CI (1.17 – 26.96) p 0.031), statistically significant. Antipsychotic medication increase the pneumonia risk with a statistically significant meaning (OR 3.03, 95% CI (1.23 – 7.44) p 0.016). Conclusion: Future studies should focus on report the effect of medications and comorbidities on admissions in patients with Alzheimer. Guidelines to focus prevent common causes of hospitalization in these patients should be adapted.

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Palabras clave: Alzheimer; demencia, neumonía, readmisiones hospitalarias.,

Keywords: Alzheimer disease, dementia, patient readmission., pneumonia,

Evaluación de las Habilidades de la Corteza Prefrontal: La Escala Efeco II-VC y II-VR. Evaluation Of The Skills Of The Prefrontal Cortex: The Efeco II-VC And II-VR.

The pre-frontal cortex is the basis of the most complex mental abilities of human development. In its evaluation process, the EFECO scale provides an important contribution to assess its status. In previous investigations this scale has been studied with its configuration of 67 items, narrative focused on the deficit and evaluation of 8 executive functions. This research presents a new version of the scale, centered on its narrative in executive ability, proposed items to assess executive verification function and a summarized version of 42 items. The study included 118 healthy adults between 18 and 25 years of age (Mage = 20.72, SD = 1.65). In the results it was found that the EFECO II-VC scale (modified and complete version) obtained as internal consistency α = .96 and its sub-scales internal consistency between α = .64 and .81. The EFECO II-VR scale (modified and summarized version) obtained α = .94 and its sub-scales between α = .68 and .79. The internal consistency of the factors in which the executive functions are included were adequate: the supervisory system of cognition II-VC α = .93 and II-VR α = .70, while the supervisor system of behavior II- VC α = .93 and II-VR α = .81. The correlations between the executive functions assessed with both scales were between medium and large r = .36 and .94. The work is closed discussing the clinical and scientific contribution of the modification of the EFECO scale.

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Palabras clave: Corteza prefrontal, escala EFECO, evaluación neuropsicológica, Funciones Ejecutivas,

Keywords: EFECO scale, Executive functions, Neuropsychological Evaluation, Prefrontal cortex,

Conocimiento Acerca Del Ictus Isquémico En Ecuatorianos. Knowledge About Ischemic Stroke In Ecuadorian People.

Introduction. The arrival of patients with ischemic stroke to the hospital in the period of the therapeutic window, depends to a great extent on the identification of their clinical signs and the recognition that it is a medical emergency. Methods. A prospective, longitudinal, cross-sectional study was carried out, based on a structured interview with closed questions. The aim was to assess the degree of the population’s knowledge about the ischemic stroke. Results. A total of 135 subjects without a diagnosis of stroke were interviewed, randomly selected from the relatives of patients. The average age was 42.6 years, women predominated (92 / 68.1%), with an average level of education. 95.5% (129 subjects) admitted having little knowledge about stroke. Only 11.1% correctly indicated the clinical manifestations; The most recognized symptom was damping (59.3%) followed by speech disorders. 80.9% (109 respondents) identify stroke as a preventable condition. Less than half of the participants adequately named the risk factors (66 / 48.9%). 88.2% take a correct attitude to the symptoms. Conclusions. In the group of people interviewed there is a perception of risk regarding stroke, but knowledge about the manifestations and vascular risk factors is poor. It is necessary to carry out information campaigns aimed to improve knowledge of t he disease.

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Palabras clave: Conocimiento, Factores de riesgo, Ictus, infarto cerebral, Población.,

Keywords: ischemic stroke, Knowledge, Population., Risk factors, stroke,

Heterogeneidad Sintomatológica. Perfiles de Pacientes Diagnosticados con Demencia Tipo Alzheimer en Antioquia (Colombia) Symptomatology Heterogeneity. Profiles Of Patients Diagnosed With Alzheimer’s Type Dementia In Antioquia (Colombia).

Objective: To describe and contrast the symptomatic variability of cases with sporadic or non-sporadic Alzheimer’s dementia (DTA + E) with the data obtained from the cases with early familial Alzheimer’s dementia caused by the E280A of the Neurobank of the Neurosciences Group of Antioquia (GNA). Materials and Method: This study was of exploratory – descriptive and correlacional type, 83 donors’ cases were taken with DTA stored in the Neurobank. These cases were divided in two groups, i) a group defined genetically like E280A; and ii) another not carrying group of the mutation (DTA+E); the scoreboards and / or characteristics neuropsychiatric, neuropsychological, neurological and neuropathological of both groups were confirmed. Results: The symptom that showed higher differences between both groups was iteration iteration (DTAF E280A with 1.2% and 18.4% for the DTA+E group).  Other symptoms as depression or the time of appearance of progressive loss of memory did not show big differences among groups (DTAF E2080A=55.9%; DTA+E =53.1%) and (DTAF E2080A=55.9%; DTA+E =53.1%). The language disorders that were observed with major frequency among the donors were the loss of the language, mutism, anomia and aphasia. The sign with higher frequency in both groups was lost of sphincter control. The atrophy was with more intensity in the temporary lobes of the brains of the donors with DTA+E (83.3%). The weight of the brain and of the posterior fosse content, they have a moderate, directly proportional and highly significant relation from the statistical point of view. Conclusions: DTA +E has neuropathological differences with DTAF E280A that can be associated with the physiology hereditary from of DTAF E280A.

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Palabras clave: Alzheimer, demencia,

Keywords: Alzheimer, dementia,

Fístula Carótido Cavernosa. Utilidad del ultrasonido Doppler en el diagnóstico. Cavernous carotid fistula. Utility of Doppler ultrasound in diagnosis.

Introduction. Carotid cavernous fistulas are infrequent vascular malformations that generate a pathological arteriovenous shunt, which compromises ocular function. The definitive diagnosis is established by cerebral arteriography. However, its invasive nature limits its use in follow-up. The aim of this work is to illustrate the value of the study with transcranial doppler ultrasound for the diagnosis of cavernous carotid fistulas and to describe the flow parameters that could be modified. Patients. A retrospective review of the clinical histories of the patients treated with a diagnosis of cavernous carotid fistula was carried out in the stroke unit of the Hermanos Ameijeiras Hospital in Havana, between January 2005 and May 2014. Demographic and disease variables were collected, as well as the results of imaging and ultrasound studies. Results. We describe the clinical and imaging characteristics of three patients in whom carotid cavernous fistula was confirmed. In the two patients with direct communications, an increase of the mean flow velocity in the ophthalmic vein, arterialized, with decrease in pulsatility were registered; in addition to an increase in the diastolic peak velocity in the internal carotid artery ipsilateral to the fistula. In the patient with the indirect fistula the changes were less marked. Conclusion. The ultrasound study was useful in the diagnosis of carotid cavernous fistulas, showing differences in the flow parameters that can be used to classify the fistulas.

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Palabras clave: Doppler transcraneal, Fistula arteriovenosa dural, Fistula carótido cavernosa, Ictus, ultrasonido,

Keywords: Cavernous carotid fistula, dural arteriovenous fistula, Ictus, Transcranial Doppler, ultrasound,

Estatus Epiléptico. Factores Asociados a Una Evolución Desfavorable en un Centro Terciario. Status Epilepticus. Prognostic Variables For An Unfavorable Outcome In A Tertiary Center Of Care.

Introduction. Status Epilepticus (SE) is a frequent neurologic emergency. Little research has been done in South America to evaluate the prognostic variables of mortality and disability in patients with SE. Objective. To determine the variables associated to an unfavorable outcome at hospital discharge in the patients who were treated for SE. Methods. A retrospective study was performed during the period of January 2016–June 2017. A total of 26 patients were diagnosed of SE and its different variants. The effects of clinical, radiological, and electroencephalographic features on hospital outcome according Rankin scale were evaluated  Results. Twelve (46.2%) patients had an unfavorable outcome at hospital discharge, while the mortality rate reached 23.1%. There was a predominance of males with a 76.9% of all the patients. The independent variables associated with an unfavorable outcome were the number of comorbidities (p=0.01, OR: 4.27-95%CI1.33-13.6), structural lesions on the Magnetic Resonance Image (MRI) (p=0.04, OR: 3.92-95%CI1.05-14.61) and refractory SE (p=0.01, OR: 12.52-95%CI1.85-84.44). There was also a trend for age (p=0.07 OR: 1.03-95%CI0.99-1.07). While an initial good clinical condition, according to the Glasgow Scale represent a protective factor (p=0.00 OR: 0.49-IC95% 0.29-0.84) of an unfavorable outcome. Conclusions. The unfavorable outcome was marginally associated with patient age, clinical status at the onset of SE according to the Glasgow Coma Scale, as well as brain lesions on brain MRI. Refractory SE and more than 4 comorbidities are predictors of an unfavorable outcome at hospital discharge.

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Palabras clave: Discapacidad, Epilepsia, Estatus epiléptico, Estatus Epiléptico refractario, Mortalidad,

Keywords: Disability, Epilepsy, Mortality, outcome, Refractory status Epilepticus, Status Epilepticus,

Neuronavegación en la Planificación Prequirúrgica y en la Cirugía de la Epilepsia Refractaria. Neuronavigation In Pre Surgical Planning And Surgery Of Refractory Epilepsy.

Epilepsy is one of the more frequent neurologic disorders, with an incidence of 50/100,000/year and prevalence between 0.5 and 2% worldwide. A third of these patients suffer focal epilepsy due to epileptogenic lesions evident by neuroimaging new techniques. Epilepsy surgery is the only treatment that can cure refractory epilepsy. Its goal is to remove the epileptogenic lesion with preservation of eloquent areas, and in this case both surgical experience and neuroimaging technology play a pivotal role. Objective. To demonstrate utility of neuronavigation in presurgical planning and surgery of refractory epilepsy. Method. Descriptive, cross sectional and analytic study of 47 performed surgeries (12 resective, 12 palliative and 3 diagnostic) in patients with refractory epilepsy with an average age of 9.93 years (SD 4.1). In 27 patients (57.44%) neuronavigation was used. In patients operated with assistance of neuronavigation, surgical time diminished in 47.17 minutes  (p=0.022), hemorrhage in 111.41 ml (p=0.011) and days of hospitalization in 6.68 days (p=0.005) comparing with group without neuronavigation. Complications in the group with neuronavigation were 29.63% compared with 65% in the group without it. (P=0,034). Conclusions. In this study, using neuronavigation in planning and performing surgery in reducing the amount of blood loss, surgical time, days of hospitalization and post surgical complications.

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Palabras clave: Cirugía de epilepsia, Neuronavegación, planificación prequirúrgica,

Keywords: Epilepsy Surgery, Neuronavigation, presurgical planning,

El Posicionamiento Elevado de Cabeza y Cuerpo Podrían Afectar la Autorregulación Cerebral Dinámica en Pacientes con Enfermedad Silente de Pequeño Vaso Cerebral. Protocolo y Definiciones Operacionales. Head-Up And Body Positioning Might Impair Dynamic Cerebral Autoregulation In Patients With Silent Cerebral Small Vessel Disease. Protocol And Operational Definitions.

Background: Cerebral autoregulation (CA) is the ability of intracranial vessels to maintain a constant cerebral blood flow (CBF) during changes of cerebral perfusion pressure (CPP) related to fluctuations in blood pressure, postural changes or increased metabolic demands. It has been suggested that individuals with silent cerebral small vessel disease (SVD) may have impaired CA, but information is inconclusive. We describe the protocol of a study aimed to assess the association between white matter hyperintensities (WMH) of presumed vascular origin and poor dynamic CA, and to determine the effects of head-up and body positioning in patients with this condition. Methods: Using a case-control study design, we will assess the relationship between severity of WMH and dynamic CA, measured by continuous transcranial Doppler assessment of CBF velocities in the middle cerebral arteries (MCAs) combined with beat-to-beat blood pressure monitoring. Dynamic CA will be analyzed by calculating the mean flow index as the ratio of median arterial pressure and mean flow velocities of the MCAs. Participants will be categorized as case-patients if the MRI shows moderate-to-severe WMH. For every case-patient, an age- and sex-matched healthy individual with no neuroimaging evidence of SVD will be selected as a control. Comment: This study will assess whether head-up and body positioning impairs dynamic CA in the setting of diffuse subcortical damage related to SVD, providing further evidence on the importance of CPP in maintaining the CBF. If positive, the study will provide evidence favoring the stop of aggressive hypertensive therapy or interventions promoting orthostatic hypotension to reduce the risk of further ischemic brain damage in these cases.

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Palabras clave: autoregulación cerebral dinámica, Enfermedad de pequeño vaso, estudio poblacional, hiperintensidades de sustancia blanca,

Keywords: Dynamic cerebral autoregulation, population-based study, Small vessel disease, White matter hyperintensities,

Mortalidad por enfermedades cerebrovasculares en Ecuador 2001- 2015: Estudio de tendencias, aplicación del modelo de regresión joinpoint. Mortality due to cerebrovascular diseases in Ecuador 2001- 2015: a trend study, application of the joinpoint regression model.

Objective. To analyze the mortality trend for cerebrovascular diseases in Ecuador and to identify the presence of changes in the temporal trend using the joinpoint regression model.

Materials and Methods. A mixed ecological study was carried out. Standardized mortality rates for the last 15 years (2001 to 2015) in Ecuador were calculated and stratified by age, sex, and provinces. A joinpoint regression analysis was used for analysis of trends.

Results. From 2001 to 2015, there were 48,621 deaths from cerebrovascular diseases in Ecuador. In the joinpoint regression analysis, age-adjusted rates in men declined from 71.4 to 59.5 deaths per 100,000 population, with an annual decline of 1.51% (p <0.05) in females from 61.2 to 55.5 deaths per 100,000 population, with an annual decrease of 1.11% (p <0.05). In the analysis by provinces, Sucumbíos presented a growing trend of 3.17% per year (p <0.05).

Conclusions. Mortality from cerebrovascular disease has declined in Ecuador in the last 15 years. The downward trend was observed in almost all age demographics.

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Palabras clave: Accidente Cerebrovascular, Análisis de Regresión, Mortalidad,

Keywords: Cerebrovascular diseases, Mortality, Regression Analysis,

Riesgo Cardiovascular Entre Hispanos Residiendo en los Estados Unidos: El Sistema Conductual de Vigilancia de Factores de Riesgo 2013. Hispanic Ethnicity and the Risk of Cardiovascular Disease in the United States: The Behavioral Risk Factor Surveillance System 2013.

Background: Although the leading cause of death among Hispanics living in the United States (US) is cardiovascular disease (CVD), the association between Hispanic ethnicity and CVD has been scarcely explored. Objective: To examine whether being Hispanic is associated with an increased risk of CVD compared with the non-Hispanic US adult population in 2013. Methods: Secondary data analysis of a cross-sectional 2013 Behavioral Risk Factor Surveillance System survey in 2013 (n=486,905). The main exposure variable was Hispanic ethnicity (Mexican, Puerto Rican, Cuban or Spanish origin) and the main outcome variable was self-reported CVD (myocardial infarction/coronary artery disease/angina). The main covariates were sex, age, education, income, healthcare access, exercise, body mass index, current smoking, heavy drinking, diabetes, hypertension and hyperlipidemia. Unadjusted and adjusted logistic regressions were used to assess the effect between ethnicity and self-reported CVD. Odds ratios (OR) and 99% confidence intervals (CI) were calculated. Results: In total, 12% of the study participants were Hispanic (n=57,257). Approximately 24% of Hispanics were 25-34 y/o while (21%) of non-Hispanic were >65 y/o. After adjustment, Hispanics were 30% less likely to report CVD compared with non-Hispanics (OR=0.7; 99%; CI=0.6-0.8). Compared with men, women had a 40% decreased risk of having CVD (OR=0.60; 99% CI=0.5-0.6). Advanced age, lower educational attainment, income <$15,000/year, lack of exercise, smoking, non-heavy drinking, diabetes, hypertension and hyperlipidemia increased statistically significantly the likelihood of reporting CVD. Conclusion: The findings suggest that, in general, Hispanics residing in the US are significantly less likely to self-declare if they had a CVD compared with non-Hispanic Americans. These data suggest that although Hispanics are generally poorer and have less access to education and health services, their self-perceived health is better than in non-Hispanic residents of the US.

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Palabras clave: Accidente Cerebro Vascular, Enfermedad cardiovascular, hispano-americanos, Infarto de miocardio, paradoja hispana,

Keywords: Cardiovascular disease, Hispanic Paradox, Myocardial infarction, non-Hispanic Americans, stroke,

Evaluación Neuropsicológica de la Atención: Test de Símbolos y Dígitos. Neuropsychological Assessment of Attention: Symbols And Digits Test.

Introduction: The symbol digit modality test is a reactive which provides great support in neuropsychological evaluation. Its execution permits to evaluate brain functions such as visual perception, stimuli recognition, attention (focal, selective and sustained), task supervision, interference control among others. Object: The purpose of the current research study was to analyze the normative percentiles of the execution of the test, to identify the performance activity of the reactive according to age group and gender; applying the test in a sample of college students. Method: The sample included 250 university students,142 (56.8%) males and 108 (43.2%) females. The age range of the participants was between 18 and 34 years old (M=21.53, DE=2.25). A transversal, non-experimental, quantitative research model with a correlational scope was used. Results: The correct answer average for the test was 52.83 (DE=13,60) and for percentile P5 31,55 right answers were found; for percentile P75 60,00 right answers, P25 had 46,00 right answers, and for P95 74,45 right answers were found. No significant differences were found for the mean of errors in the test in terms of age group f(3, 246)=0,67, p=0,57 and gender t(248)=0,68, p=0,49 of the participants as comparison factor. Conclusions: Results were discussed based on prior research pointing out the importance of counting with a first statistical parameter of the test as ground for neuropsychological clinical practice in Ecuador.

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Palabras clave: Ecuador, neuropsicología, SDMT, test de símbolos y dígitos, universitarios,

Keywords: Ecuador, neuropsychology, SDMT, Symbol Digit Modality Test, university college students,

Factores de Riesgo Asociados a Parálisis Cerebral en una Poblacion de Niños y Jóvenes Mexicanos. Risk Factors Associated With Cerebral Palsy In A Population Of Mexican Children.

Objectives: To establish the risk factors associated with Cerebral Palsy in a population of Mexican children and compare the results with studies from other countries.Methods: Analytical, retrospective, randomized, observational study, through review of the file and a survey, comparison of proportions. Participants: 230 patients with Cerebral Palsy between 0 and 29 years of age and their biological mothers from a specialized institution in Mexico. Results: We studied 29 risk factors , range 0 to 9 in each patient. Prenatal 244 factors; Perinatal 378, Postnatal 319. Most frequent prenatal risk factors: urinary infection, 99 (43%), and transvaginal bleeding, 61 (27%). Perinatal: perinatal hypoxia, 131 (57%); and prematurity, 116, (50%). Postnatal: convulsive syndrome <2 Years old, 92 (42%); and jaundice, 84 (37%). Conclusions: The most common cerebral palsy associated risk factors were perinatal, which differs from that reported in countries such as Spain, USA and England, where the prenatal ones are. Sweden results are similar to Mexico. It is suggested to carry out prospective studies in this field.

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Palabras clave: Atención Primaria, Espasticidad Muscular, Factores de riesgo, parálisis cerebral, Prematuro,

Keywords: cerebral palsy, Muscle Spasticity, Premature, Primary Care, Risk factors,

Deterioro Cognitivo en Pacientes Diabéticos De 55 a 65 Años de Edad. Reporte Final de Estudio Observacional, Transversal en la Ciudad de Guayaquil. Cognitive Impairment In Diabetic Patients Between 55 And 65 Years Old. Final Report Of A Cross-Sectional, Observational Study In Guayaquil City.

Introduction: Diabetes mellitus is a frequent and systemic illness. Deleterious effects on cognition are one of its lesser known consequences. Diabetic individuals are at an increased risk for development of dementia in the future. Objective: To compare cognitive function in middle aged diabetic population with non-diabetic control group, in order to determine high risk population for developing cognitive decline or dementia in the future. Methodology: This is a cross-sectional, observational study conducted in Guayaquil. We studied 309 individuals between the ages of 55 and 65 years, of which 142 were diabetics and 167 were non-diabetic controls. A neuropsychological evaluation was performed to assess memory, attention, executive functioning and processing speed. Results: Group comparisons revealed significant differences between diabetics and non-diabetics in systolic blood pressure (p<.001), hyperlipidemia (p<.001) and cardiovascular risk (p < .001). Cognitive performance, after considering differences in scholarship, was lower in diabetic people (memory p values between .000 and .002; attention p values between .000 and .019; executive function p values between .000 and .001). Correlation between years of disease and cognitive decline was not significant (memory -.055; attention -.040; executive function .0169). Correlation between glycated hemoglobin and cognitive performance was significant for all evaluated functions (memory -.219; attention -.186; executive function -.269). Conclusion: Middle aged diabetic population has lower cognitive performance compared with non diabetics. The identification of individuals at risk for cognitive decline will contribute to the development and implementation of intervention strategies that will allow the slowing of cognitive decline in vulnerable individuals.

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Palabras clave: Alzheimer, Cognición, demencia, deterioro cognitivo, Diabetes mellitus, pruebas neuropsicológicas, salud cerebral,

Keywords: Alzheimer, brain health, Cognition, cognitive impairment, dementia, Diabetes Mellitus, neuropsychological tests,

Retardo en la Llegada de Pacientes con Ictus Isquémico a un Hospital Terciario de Ecuador. Delay In The Arrival Of Ischemic Stroke Patients At A Tertiary Hospital In Ecuador.

Introduction. In an Stroke unit, the ischemic stroke treatment with a pharmacological thrombolysis is associated with a better recovery. The aim of this study is to identify the variables having a significant impact in the delay of the arrival of patients at a tertiary hospital. Methods. A prospective and longitudinal study was undertaken in patients with an ischemic stroke diagnosis, who were admitted to the Stroke Unit of Eugenio Espejo Hospital of Quito city in Ecuador in the time period from November 2016 to July 2017. Patients treated with r-Tpa were compared to those who arrived 4,5 hours later. Results. A total of 61 patients were analyzed: of those, 51 arrived 4,5 hours after first symptoms at the hospital, and 10 (16,4%) were thrombolysed in the period of therapeutic window. None of the social, demographic and clinical variables were related to the early arrival, except the history of an atrial fibrillation. In the group of patients who received r-Tpa, a significantly higher percent sought for medical care as a first option compared with those arriving after the 4,5 hours (90 vs 49%, p 0,0170). The greatest impact of the early referral and the thrombolysis concerned the difference of score between the initial medical evaluation and the hospital discharge in the NIHSS scale. Conclusions. The results of this study point out to the unawareness of the stroke and the behavior to follow. The r-Tpa treatment shows clear benefits to the patients in our environment.

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Palabras clave: enfermedad cerebrovascular, Hospital terciario, Ictus isquémico, infarto cerebral, Llegada temprana, Trombolisis,

Keywords: Cerebral infarction, Cerebrovascular disease, Early arrival, ischemic stroke, Tertiary hospital, Thrombolysis,

Utilidad del Video EEG en un Hospital Pediátrico de Nivel Terciario Durante el Año 2015. Utility Of Video EEG In A Pediatric Tertiary Hospital During 2015.

The aim was to evaluate the V-EEG usefulness in the differential diagnosis of epilepsy in a Third Level Children’s Hospital during 2015. Materials and Methods: A descriptive study was performed over 90 patients in this unit during 2015. The data was obtained from variables related to indications and results of V-EEG, which were analyzed using descriptive statistics. Results: Fifty three percent of the patients were male. The mean age was 7.7 years (SD ± 4.7 years). The time measured between the first seizure and the V-EEG recording was 4,3 years. Seventy two patients (80%) had epileptic seizures, 12 patients (13,3%) had nonepileptic seizures, while six children (6.7%) had no seizures during the V-EEG monitoring. Ninety three percent of all recordings were successful. Conclusions: It was demonstrated the usefulness of V-EEG monitoring for the differential diagnosis of epilepsy.

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Palabras clave: crisis epilépticas, Electroencefalografía, epilepsia en pediatría, trastornos paroxísticos no epilépticos, Video-electroencefalografía,

Keywords: Children, Electroencephalography, Epilepsy, nonepileptic seizures, Seizures, Video-Electroencephalography,

Apnea Obstructiva del Sueño y Neumatización Aberrante de Huesos del Cráneo. Obstructive Sleep Apnea And Aberrant Pneumatization Of Skull Bones.

Objective: We aimed to assess the association between obstructive sleep apnea (OSA) and aberrant pneumatization of skull bones in Amerindians living in rural Ecuador.

Methods: A random sample of community-dwelling individuals aged ≥60 years enrolled in the Atahualpa Project, were invited to undergo a single diagnostic night polysomnography (PSG) at the sleep unit of the Atahualpa Project Community Center. Exams were performed with an Embletta® X100™ Comprehensive Portable PSG System. A board-certified sleep neurologist carried out analyses of sleep efficiency, architecture, arousal indexes, apnea/hypopnea index, oxygen saturation, heart rate and motor activity. CT readings were focused on the presence and distribution of pneumatization of intracranial bones, as assessed by CT with bone window settings.

Results: Thirty-eight participants were included. Mean age was 74.5 ± 6.8 years and 25 (66%) were women. The apnea/hypopnea index ranged from 0.2 to 56 (mean 15.7 ± 14.6) episodes per hour. Fifteen persons (39%) had ≥10 episodes per hour and were considered to have OSA. Abnormal pneumatization of skull bones was noticed in six persons, included five out of 15 (33%) with OSA and one out of 23 (4%) without (p=0.027). Air was found in the temporal squamas in five (bilateral in four), the occipital bones in one, and in both the temporal squamas and the occipital bones in the remaining person.

Conclusion: This study shows a significant association between OSA and aberrant pneumatization of skull bones. These findings are of potential clinical relevance, since these individuals could be at increased risk of painless fractures from minor trauma or may be prone to develop spontaneous cerebrospinal fluid leaks.

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Palabras clave: Amerindios, Apnea Obstructiva del Sueño, maniobra de Valsalva, neumatización de huesos del cráneo,

Keywords: Obstructive sleep apnea; pneumatization of skull bones; Valsalva maneuver; Amerindians,

Índice de Pulsatilidad Cerebral en Adultos Mayores con Infarto Lacunar Silente (Proyecto Atahualpa). Cerebral Pulsatility Index In Older Adults With Silent Lacunar Strokes (The Atahualpa Project).

Background: Diagnosis of silent lacunar infarcts is complicated in remote rural areas where MRI is not available. Hospital series have suggested an association between the pulsatility index of intracranial arteries –as assessed by transcranial Doppler –and some neuroimaging signatures of cerebral small vessel disease. We aimed to assess the reliability of cerebral pulsatility indices to identify candidates for MRI screening in population-based studies assessing prevalence of silent lacunar infarctions.

Methods: A random sample of stroke-free Atahualpa residents aged ≥60 years investigated with MRI underwent transcranial Doppler for calculating the pulsatility index (PI) of the middle cerebral artery (MCA). For each person, mean PI was obtained by averaging both MCAs. Using conditional logistic regression for matched pairs data, we evaluated whether the pulsatility index of both MCAs correlate with silent lacunar infarcts.

Results: Silent lacunar infarcts were noticed in 28 (12%) of 234 scanned persons. Six of them were excluded due to poor insonation through transtemporal windows. The remaining 22 participants were considered case-patients and were matched 1:1 with individuals free of infarcts (controls). Moderate-to-severe white matter hyperintensities were noticed in 12 (55%) case-patients and 7 (32%) controls (p=0.228). The mean MCA PI value in the 44 participants was 1.15 ± 0.21, with no difference found across case-patients and controls, after adjustment for white matter hyperintensities (β coefficient: 3.361, 95% C.I.: -0.693 to 7.417, p=0.104).

Conclusions: Cerebral PI should not be used to identify candidates for MRI screening in population-based studies assessing the burden of silent lacunar infarcts.

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Palabras clave: Doppler transcraneal, índice de pulsatilidad, infarto lacunar,

Keywords: Lacunar infarction, pulsatility index, Transcranial Doppler,
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