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

Artículos Originales

 

Fractura de cadera y deterioro cognitivo: un estudio seccional-cruzado.

Cognitive impairment is a non modifiable risk factor for hip fracture.

Objective: To determine if patients older than 60 years old with hip fracture presented association with cognitive impairment.

Method: Cross-sectional study.

Patients. All patients older than 60 years admitted in the traumatology service of Enrique Garcés Hospital in Quito-Ecuador.

Data recollection. It was made by: clinical history, interview with the patient that included valoration of cognitive state by minimental test and the photograph test, interview with the relatives of the patients if they where during his or her hospital stay. The variables were analyzed in percentages and the data was utilized to evaluate if there was a mayor association between cognitive impairment and hip fracture.

Results. Of the 56 patients included 83,92% presented cognitive impairment, of this patients 85,10% presented dementia and 42,55% presented severe dementia. The association between the following variables was significant: patients older than 80 years old with severe dementia OR 8 (IC 1,75 – 41,18), analphabets with severe dementia OR 5,33 (IC 1,13 – 27,97), hip fracture with severe dementia OR 6,28 (IC 1,54 – 30,24), hip fracture with falling OR 19,09 (IC 3,36 – 187,38).

Conclusions: Severe dementia presented an association with age older or equal to 80 years and analphabetism, and hip fracture presented an association with severe dementia and falling.

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Estudio de 20 pacientes con epilepsia del lóbulo temporal medial con esclerosis del hipocampo.

In order to more precisely define temporomedial epilepsy with hippocampal sclerosis, we evaluated 20 patients with magnetic resonance imaging findings of it: 1. Abnormal high signal of the hippocampus on T2 and Flair, 2. Hippocampal atrophy and 3. Structural deformity in hippocampus. 6 patients (55%) had history of febrile seizures during early chilhood or infancy. 4 patients (36%) had head trauma and 1 patient (9%) had neonatal hypoxia. The mean age of seizure onset was 18 years. All patients had complex partial seizures at onset.15 patients (75%) had auras, with abnormal abdominal visceral sensation being the most common type (40%). 11 patients with identified risk factors had an interval between the presumed cerebral insult and the development of habitual seizures, with a mean seizure free interval of 11 years. All patients had oroalimentary automatisms, and 14 patients (70%) also had other automatisms. 9 patients (45%) had lateralizing signs, 6 patients had contralateral version of the head and eyes and 3 patients had dystonic posturing of the contralateral upper extremity. 15 patients (75%) had an abnormal electroencephalogram. 13 patients (87%) showed paroxysmal abnormalities that were localized in the anterior temporal region, over the side of the hippocampal sclerosis in 12 patients and over one temporal lobe in 1 patient with bilateral hippocampal sclerosis with paroxysmal activity. . 2 patients (13%) had interictal bilateral temporal slowing, these patients had bilateral hippocampal sclerosis.

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Parkinsonismo inducido por neurolépticos. Caracterización clínica.

Background: Neuroleptic-induced parkinsonism is the most common clinical form of extrapyramidal syndrome induced by drugs. The objective of this research was to characterize its clinical spectrum.

Materials and methods: We collected the results of clinical neurological evaluation of 28 patients with chronic psychosis and parkinsonism, in treatment with parenteral decanoate of flufenacine and other classical antipsychotic drugs. The parkinsonism was confirmed by a specialist in neurology and was completed with the implementation of the motor section of the unified scale for the assessment of Parkinson’s disease (UPDRS).

Results: The mean age was 45.6 years and the relationship male / female 0.86:1. The average time of treatment with decanoate of flufenacine was 5 years and the 60.7% of patients had other neuroleptic associated. The parkinsonism is associated with the triad of bradicinesia, stiffness and tremor. We found no significant asymmetries and the predominant involvement was in the upper limbs. Generally these are mild forms that do not produce severe disability.

Conclusions: The drug-induced parkinsonism is different from Parkinson’s disease for more bilateral involvement of dominance in the upper limbs. And it can coexist with others extrapyramidal manifestations.

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Gliomas en pediatría. Análisis anatomopatológico de 233 casos.

The purpose of this paper was to analyze the anatomopathologic characteristics (location, histopathologic classification and gradation) of 233 Central Nervous System gliomas registered in the National Pediatric Neurosurgery Reference Center (Cuba), and to compare these results with other series from the literature.

Results: Gliomas represented 49,6 % of the total nervous system tumors diagnosed while collecting this series. The histopathologic gradation of the gliomas was: Grade I: 71, Grade II: 84, grades III: 64 and grade IV: 6. The histopathologic classification was: 107 grade I-II Astrocytoma; 51 grade III-IV Astrocytoma; 37 grade I-II Ependymoma; 21 grade III Ependymoma ; 7 grade II Oligodendroglioma; 3 grade II Oligoastrocytoma and 1 grade III Oligoastrocytoma. The locations of the gliomas were: 222 intracranial (127 supratentorial y 95 infratentorial) and 11 in the spinal cord. Male to female ratio was1.3:1.

Conclusions: Supratentorial gliomas were more frequent, different from other reported series. Pilocytic Astrocytoma was the more frequent glioma in this study.

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Información epidemiológica sobre la morbilidad hospitalaria en el Instituto Nacional de Neurología y Neurocirugía de la ciudad de México durante el período 2002-2007.

Hospital morbidity provides information for the strategic planning and implementation of health actions and programmes.

Objective: To determine the main causes of hospital morbidity, its distribution and behavior during the period 2000-2007 at the National Institute of Neurology and Neurosurgery in Mexico City (INNN).

Materials and Methods: An observational, transversal retrolective study was carried out. Data was collected from discharge notes and from the hospital database from the Epidemiology Department. The different rates of morbidity were calculated and their tendencies were determined for a period of six years.

Results: The main causes of morbidity were malignant encephalic tumors and benign tumors from other endocrine glands. However, a tendency to the increment of subarachnoid hemorrhage (p=0.03), cerebrovascular diseases (p=0.04) and benign brain tumors and from other parts of the central nervous system (p=0.01) was found.

Conclusions: Even though this is not a population study, the information obtained from one of the main training institutes and centers of the world and the largest in Latin America, is of great importance. It can be seen how, even though cerebrovascular diseases showed a tendency to increase, benign encephalic tumors occupy the main rates regarding morbidity.

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Depression and Anxiety in Parkinson’s Disease, Metric Properties of the Beck´s Depression and Anxiety Inventories. A K2 Factorial Design.

Background: Study to investigate the concurrent validity of the Beck Depression Inventory and Beck Anxiety Inventory evaluation scales against the ICD-10.
Methods: A K2 factorial design for studying the metrics properties of the BDI and BAI in parkinsonian outpatients.
Results: 147 parkinsonian patients were included; 44 patients has anxiety and depression; only depression 19; only anxiety 31; finally 53 subjects don’t have depression or anxiety. The BDI AUC was [0.858]. The BAI AUC was of [0.907]. The cut score was of 14/15 for the BDI and 13/14 for the BAI. The factorial design resulted in the two factors (depression and anxiety) has the best functional correlation in the regression.
Conclusions: The results we present bear out this lack of dimensionality, since we found that the BDI AUC-measured discriminative ability for anxiety was [0.739]. With regard to the BAI, this is employed to discriminate the depressed, AUC values of [0.771].

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Características Neuropsicológicas del Proceso del Pensamiento en los Subtipos de Esclerosis Múltiple.

Introduction: The study of thinking has been a superior but forgotten psychological process in the neuropsychological investigation field. But it plays an important role in the human being auto regulation. Objective: to identify the neuropsychological characteristics of thinking process in patients with Multiple Sclerosis considering its expression in the different subtypes of the disease. Material and methods: It included a sample of 60 admitted patients in “Faustino Pérez Hernández” Rehabilitation Hospital in Sancti Spíritus province, Cuba. A neuropsychological battery of thinking was applied from Luria’s postulates, directed to explore its practical-constructive and logical-verbal expression with techniques of simple analogies, test of lineal syllogism, interpretation of proverbs, construction of cubes, test of prepositional structures, solving of arithmetic problems and Paced Auditory Serial Addition Test (PASAT-3). Results: Investigating the structure of thinking in its logical-verbal expression, difficulties were evident in the establishment of logical links, in simultaneous synthesis, andhypothesis contrast, while in their practical-constructive expression, moderate and partial difficulties were evidenced in space synthesis and in programming activities and behavioural planning. Conclusions: Deterioration was verified in the processes of practical-constructive and logical-verbal thinking. Greater deficiencies were found in progressive clinical forms, specifically the secondary progressive multiple sclerosis.

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Caracterización Clínico-Epidemiológica del Temblor Esencial en Familias de Holguín y Matanzas, Cuba.

Essential tremor (ET) is a bilateral mostly simmetric disorder, usually postural but kinetic and rest tremor can be present, it involves the arms and hands. A tranversal study was made to get an epidemiological, functional and fenomenological characterization of ET. Patients with clinical criteria of ET were selected from movement disorders clinic from two cuban provinces; the Fahn, Tolosa and Marín functional disability scale was applied to the sample. A total of 105 patients were evaluated, 64.7% female, 40.0% over 60 years, 80.9% were white, in 36.1% tremor began between 21 and 40 years, superior limbs were affected in 90.4%, 85.9% showed a beginning age anticipation, 87.7% were from Holguín, just 8 sporadic cases; in 53.8% associated diseases were found, an autosomal dominant inheritance was evident. Functions included in the scale’s part B showed a moderate disability (25-49%) and those which belong to part C had low disability (1-24%).

Conclusions. Most of the sample was from Holguín. Female, whites and older than 60 years were predominant, tremor mostly began between 21 and 40 years, superior limbs were the most affected body part, dominant autosomal inheritance was predominant, with anticipation in begining age. Association with some other diseases was frequent, many patients showed functional disability.

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Combinación de un Programa de Rehabilitación y Estímulo Eléctrico en Pie Equino para las Alteraciones de la Marcha en Niños con Parálisis Cerebral.

There are many factors that cause gait disorders as is the case of patients suffering encephalic lesions that cause brain palsy with hemiplegia as sequelae. One of the most important and interesting features of rehabilitation of the patient with hemiplegia is gait reeducation. Because of that, a therapeutic strategy was created with the application of electric stimulus and a program of exercises in order to preserve the maximum of functional capabilities. For this reason, a retrospective study was performed including a sample of 10 patients with cerebral spastic palsy hospitalized at CIREN’s Clinic of Child Neurology with clubfoot and gait disorder. Every child was submitted to a rehabilitation treatment for four to eight weeks -six times per week- assessing the effectiveness of the neuromuscular stimulation over gross motor function and gait, including frequency of steps in 10 meters and its amplitude. At the end of the treatment, improvement was observed in the treated cases.

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Tipificación del Trastorno Afectivo en Pacientes con Epilepsia del Lóbulo Temporal.

 

Introduction: Affective disorders in people with epilepsy seem to be different from patients with primary mood disorders.

Objective: to determine the clinical characteristics that typifies depression in patients with temporal Lobe Epilepsy.

Patients and methods: Forty patients with Temporal Lobe Epilepsy and depression were enrolled in the study. Thirty one patients with primary depressive disorder were recruited as control group. Depression was clinically evaluated in both groups. The discriminate analysis was used to determine the main clinical features of depression in patients with epilepsy. The differentiation between groups in total scores of Mood disorders through the International Psychiatry Interview was used to determine the atypical sign of depressive symptoms in patients with epilepsy. Logistic regression was utilized to analyze the possible relationship between neurobiological functioning and depressive symptoms in patients with epilepsy. Results: Sixty two percent of patients had a mood disorder not classified in CIE-10 and DSM-IV. Perictal anhedonia associated with insomnia, guilty thoughts, psychomotor slowness, inattention, restlessness, irritability, faintness  became the clinical profiles of depression in patients with epilepsy. Age of onset of epilepsy, family history of psychiatric disorders, number of seizures per month, left temporal Lobe Epilepsy, and bilateral hippocampal atrophy were the most important determinants of mood disorders in our study.

Conclusion: Brief perictal depressive symptoms associated with dysphoria, anxiety and phobias, typify the clinical profile of depressive syndrome in patients with Temporal Lobe Epilepsy.

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Asociación de Tumores Neuroepiteliales y Displasia Cortical Focal Microscópica en Pacientes con Epilepsia del Lóbulo Temporal Fármaco Resistente.

Introduction: There is controversy between the extension of the surgical resection of electrophysiologically monitored brain tumors and the postoperative clinical evolution of patients with pharmacoresistant temporal lobe epilepsy (TLE).

Objective: To evaluate the histopathological spectrum and the electroclinical and imagenologic characteristics, as well as the clinical evolution in patients with neuroepithelial tumors included in the program of epilepsy surgery at CIREN.

Patients and methods: Cases with tumors and pharmaco resistant epilepsy operated from 2002 – 2009 were selected from the database. The patients underwent temporal lobectomy adjusted by electrocorticography (ECoG). The histopathological pattern, ictal video-EEG and intraoperative EcoG are described here.

Results: Of the 25 analyzed patients, 5 presented MRI neocortical structural lesions. One of them was an arachnoid cyst, a reason for its exclusion from the study. The histopathologic exam evidenced a patient with pilocytic astrocytoma, two ganglioglioma (GG) and a dysembryoplastic neuroepithelial tumour (DNT); the last one associated to a focal cortical dysplasia (FCD) type IA and IB. The seizure – type in these patients previous to surgery was partial complex. All cases were free of seizure until the last clinical evaluation.

Conclusions: The association of glioneuronal tumors is evidenced (GG and TND) with microscopic FCD in TLE patients. The temporal lobectomy adjusted by ECoG allowed to achieve the condition of no seizure in TLE patients / tumors of the neuroepithelial tissue, even in cases associated to FDC.

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Epidemiología del Ictus entre los años 2007-2009 en el Hospital Regional Dr. Teodoro Maldonado Carbo.

Objective: Determine the prevalence of the different epidemiological features and risk factors of stroke patients of the Regional Hospital Dr. Teodoro Maldonado Carbo.

Methods:Cross-sectional study of 521 patients with diagnosis of stroke, admitted to the Neurology Service of the Social Security Hospital between the years 2007-2009. Data was recollected from the discharge notes and medical records. The measured variables were duration of hospital stay, diagnosis, mortality, non-modifiable risk factors, and modifiable risk factors. In case of hemorrhagic stroke variables that could represent its cause were also recollected.

Results: Most patients were males (70.5%), the most prevalent risk factors were hypertension (81.1%), diabetes mellitus (27%) and dyslipidemia (16.88%). The mean age was 67±13 years. There was an increased tendency of hypertension in males and of diabetes mellitus in females (p=0.45, p=0.17 respectively). There was a significant difference in the presence of coagulopathy (p=0.01), valvulopathy (p=0.04) and anticoagulant use (p=0.004) in females. Ischemic stroke represented the 80.9% and hemorrhagic stroke the 19.1% of cases.

Conclusions: These results are similar to those found in Latin American and North American publications. The correction of the most prevalent risk factors in our population would markedly decrease the incidence of this disabling disease.

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Carbamazepina y Valproato de Magnesio en el tratamiento de la Epilepsia del Lóbulo Temporal Mesial de debut.

Introduction: Mesial Temporal Lobe Epilepsy is the most frequent symptomatic focal epilepsy in adults. There are no prospective studies that compare the efficacy and effectiveness of carbamazepine and valproic acid in this group of patients.

Objective: to compare the efficacy, effectiveness and tolerability of Carbamazepine and Valproic Acid in patients with Mesial Temporal Lobe Epilepsy.

Methods: We conducted a prospective, controlled and randomized study of parallel groups in patients with Mesial Temporal Lobe Epilepsy at time of onset. The patients were followed-up for one year. Fifty six patients were recruited. Forty three patients participated in a crossover study and only thirty three concluded it. We evaluated the efficacy, effectiveness and tolerability of two antiepileptic drugs.

Results: After cross-over, the efficacy of Valproic Acid was superior to Carbamazepine reducing seizure frequency from 7,9 to 2,6 seizures per month (p = 0,02). None of antiepilpetic drugs were associated with an improvement in Hamilton scale. Treatment with valproic Acid improved the quality of life by 20 % after a year of treatment (p < 0,01) . The number of patients with side effects was not significant statistically, even though valproic acid produced a greater variety of adverse effects.

Conclusion: The effectiveness and efficacy of Valproic Acid in patients with mesial Temporal Lobe Epilpesy at onset is superior to carbamazepine althought it is less tolerated.

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Predictores de Ansiedad y Depresión en Cuidadores Primarios de Pacientes Neurológicos.

Objective: To describe predictors of depression and anxiety in caregivers of neurological patients.

Methods: To a sample of 145 caregivers, from the outpatient clinic of the National Institute of Neurology and Neurosurgery, sociodemographic variables were collected and the following questionnaires were applied: Ways of Coping with Stress of Lazarus and Folkman, Zarit Burden Scale, Hospital Anxiety and Depression Scale. Additionally, Activities of Daily Living were assessed in patients.

Results: 97% of caregivers were provided by the informal system, usually a woman (82%) with an average age of 47.7 ± 15.1, house-wife (60%) and close relative of the sick person (78% . They suffer from a current illness (48%) and 62% presented the condition after caregiving. The regression model for anxiety included: negative impact, cognitive distancing, patient age and caregiver education. The depression model included: negative impact, caregiver education and cognitive distancing. Both explained 37% of variance.

Conclusions: Anxiety and depression depend on the skills and resources of the caregiver, the burden and impact of the disease. These correlate with physical, mental and socioeconomic issues that affect social relationships, intimacy and freedom of the caregiver.

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Influencia de la Reserva Cognitiva en la Función Ejecutiva en Sujetos Sanos y con enfermedad tipo Alzheimer de Inicio Tardío en una Muestra Portuguesa.

The Cognitive Reserve concept, generally understood as the acquired protective effect, is considered by many authors as an active mechanism that is based on the application of previously learned resources, due to a good education, profession and/or premorbid intelligence. The Stroop Test has been used in the neuropsychological assessment of executive functions in aging-related disease, such as Alzheimer’s Disease.

Objectives: We intend to study the influence of cognitive reserve in executive functions in subjects with late onset Alzheimer´s disease, and in healthy subjects in a Portuguese sample.

Method: We used two samples, one consisting of 91 healthy subjects and a second sample of 32 subjects diagnosed with senile dementia of the Alzheimer type.

Results: The group of healthy subjects showed better performance on the test, than the pathologic group. Significative differences were found in the healthy group between high and low cognitive reserve subgroups.

Conclusions: The Stroop Test, shows a high sensitivity in determining alterations in executive functions and the influence of cognitive reserve in that function.

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Effect of cold irritation on peripheral white blood cell and ICAM-1, IL-1β expression of brain tissue in rat.

Background: Some studies have showed that hypothermia is a neuroprotective factor for cerebral ischemic injury. Inflammation reaction plays a very important role in pathomechanism of neuron degeneration disease induced by cerebral ischemia. However whether there is relationship between cold irritation and inflammation reaction is not well known.

Objective: To explore effect of cold irritation on peripheral white blood cell and ICAM-1, IL-1β expression of brain tissue in rat with cerebral ischemia.

Methods: Model rats were put into low temperature water (0º) for cold irritation for 5 minutes one time every day for 20 days. MCAO rats were subjected to middle cerebral artery occlusion (MCAO) using an intraluminal suture method with permanent ligation of the ipsilateral common carotid artery. We assessed count of the peripheral white blood cells.The brains of all rats were cut at 1, 3, and 5 days after cerebral ischemia and frozen brain tissues were continuously sliced and stained immunohistochemically with Intercellular Adhesion Molecule-1 (ICAM-1) or Interleukin-1(IL-1) antibody.

Results: Cold irritation model rats were associated with increased leukocyte at 1 and 3 days post-ischemia, increased ICAM-1-positive vessels at 1, 3, and 5 days, and increased interleukin-1(IL-1) at 3 and 5 days. Vascular pathology of the hippocampus at electron microscope levels showed that the blood vessel has inflammation infiltration at 1, 3 and 5 days. Conclusion: These data demonstrate that cold irritation significantly increased endothelial adhesion molecule expression, leukocyte infiltration, and vascular pathology of the hippocampus in rat. The mechanism of neuron injury may be related to the inflammation reaction induced by cold irritation.

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Estimulación Magnética Trascraneal en los Retrovirus Humanos: Una Revisión Sistematica Desde 1985 a 2009.

Pyramidal tract is affected in tropical spastic paraparesis (HAM/TSP) and AIDS; the best paraclinic tool so far known to evaluate such involvement, in humans, is transcranial magnetic stimulation. A thorough investigation was done in MEDLINE database for the period between 1985 and 2009, and in Scielo.org between 1996 and 2009 using the terms “HTLV-I, HTLV-II, HTLV-III, HIV; HIV1, HIV2, evoked potential, motor evoked potential, transcranial magnetic stimulation, magnetic stimulation, corticomotor physiology, motor tracts, pyramidal tract, corticospinal tract, myelopathy, acquired immunodeficiency syndrome, AIDS, SIDA, tropical spastic paraparesis, HTLV-I associated myelopathy, HAM, TSP, HAM/TSP”. Papers in English, Spanish, Portuguese, French and Japanese were reviewed. Thirteen manuscripts reporting motor evoked potentials obtained by transcranial magnetic stimulation were identified. In HAM/TSP the pyramidal tract involvement is mainly at low thoracic levels, following a centripetal pattern; in HIV, such involvement follows a centrifugal pattern  which is greater at brain level. These findings should allow to redirect neurohabilitation and neuromodulation measures hopefully before fatal outcome or disability take place in these retroviruses-associated neurodegenerative disorders.

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Patrones de Perfusión Cerebral en la Epilepsia Rolándica: Formas Típicas y Atípicas.

Introduction: Cerebral perfusion patterns in typical rolandic Epilepsy and its variants remain unknown.

Objective: To describe interictal cerebral perfusion patterns in this Epilepsy and in one of its variants.

Patients and methods: Twenty four children were followed-up for 6 years after their first seizure. Magnetic Resonance Imaging and Single Photon Emission Tomography were performed during follow-up. We investigated for perfusion asymmetries in different cerebral structures using statistical parametric map. The perfusion images were registered whether atypical evolution was diagnosed or if we found some cognitive deficits suggestive of focal cortical lesion.

Results: Seven patients with atypical Benign Partial Epilepsy and seventeen with typical Rolandic Epilepsy were recruited. The vast majorly of the patients showed a cortical hyperperfusion pattern associated with asymmetric hypoperfusion pattern in basal ganglia and thalamus. Patients with atypical Benign Partial Epilepsy showed a well defined different cerebral perfusion pattern characterized by symmetrical hypoperfusion at the level of basal ganglia including thalamus.

Conclusions: Different cerebral perfusion patterns were documented in different variants of Rolandic epilepsy.

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Activador del Plasminógeno tisular, realidad actual. Estudio transversal retrospectivo entre los años 2007-2009 en el Hospital Regional Dr. Teodoro Maldonado Carbo.

Objective: To determine the proportion in which the variables for the administration of tissue plasminogen inhibitor (tPA) are present in the population admitted to a hospital in Guayaquil-Ecuador.

Methods: Cross-sectional study with patients admitted to the Neurology service at the Regional Hospital Dr. Teodoro Maldonado Carbo between January 1, 2007 and December 31, 2009 with diagnosis of acute stroke. The inclusion and exclusion criteria were the same ones used on the guidelines for the use of tPA in patients with stroke during the first 3 hours and between the first 3-4.5 hours of onset.

Results: 550 patients were included in the analysis. 434 patients had ischemic stroke and 116 hemorrhagic stroke. 6 patients arrived to the hospital in the first 3 hours from onset and 13 patients arrived between the 3-4.5 hours from onset. In the first 3 hours, 4 out of 6 patients (66%) were candidates for the administration of tPA and between the first 3-4.5 hours, 6 out of 13 patients (59%) were candidates for tPA.

Conclusions: The majority of the patients that arrived to this hospital; did so after 4.5 hours from the onset of symptoms. If these patients would have arrived earlier, a great proportion could have received a treatment potentially beneficial that would produce a clinical improvement and a better prognosis if the treatment was available in the hospital.

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Esclerosis Multiple en un Hospital del Litoral Ecuatoriano.

Objective: An observational study was conducted in 45 patients with Multiple Sclerosis in a hospital in the Ecuadorian Coast, in order to characterize the disease in our environment.

Methods: During the period of 8 years (2002 – 2010), demographic and clinical characteristics, disability status using the modified Kurtzke, assessment of functional systems and response to immunomodulatory treatment are evaluated.

Results: Of the 45 patients studied 58% were women, the most common age group was between 30 – 39 years. The predominating type was relapsing remitting (RR) followed by secondary progressive (SP). It is determined that the nuclear magnetic resonance (RM) is the complementary method of choice for diagnosis and monitoring of patients and the relapse rate was low using immunomodulatory therapy.

Conclusions: The study suggests that the presentation of the disease in a hospital in the Ecuadorian coast is lower than in the inter-Andean region probably due to demographics or other factors yet to be determined, but that the clinical features, the subtypes of the disease and immunomodulatory treatment response is similar to the series found in countries of the same characteristics.

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Propuesta Pedagógica para la Compensación de la Memoria Viso-Espacial en Pacientes con Secuelas Neurológicas.

During the perception of an object, a complex system of temporary connections, which reflects the links and relationships between objects, their parts and properties in the brain, appears.

Objective: To determine how the designed pedagogical proposal influences in the compensation of the viso- space memory in people with neurological sequels.

Material and method: A pre pedagogical experiment in a group of 20 patients was carried out. A neuropsychological battery was used evaluating visual memory, viso-construction, perceptual and motor speed, care, executive functions and verbal intelligence (NEUROPSI) both initial and final to verify the memory deficit. Results were compared and the percentage is reported.

Results: The studied group age range was between 21 and 55 years. The main feature found was the inaccuracy in the reproduction of the model due to the latent attention deficit. The disorders of the mechanism to fixate memories were one of the greatest difficulties presented. An improvement in each variable was observed.

Conclusion: The designed pedagogical proposal influenced positively the visospace memory compensation in the group of patients under investigation.

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Diabetes Mellitus y Cognición. Estudio Transversal.

Diabetes Mellitus Type 2 is associated with greater impairment of cognitive ability, and abnormalities in brain imaging studies compared with people without diabetes.

Objective: To determine if there is a difference in the score of cognitive function tests Addenbrooke (ACE) and Cognitive Ability Screening Instrument (CASI) among patients with type 2 diabetes and non-diabetics.

Methods: Cross sectional study of patients with a history of more than 5 years of diabetes mellitus type 2, between 45 and 64 years of Outpatient of Endocrinology Department, Hospital Teodoro Maldonado Carbo Guayaquil between September 1 and December 31, 2008, who had the cognitive assessment test: ACE and CASI.

Results: There were a total of 68 patients, of which 60.3% had diabetes mellitus, with an average age of 60 years, of this group: 53.6% were men and 46.3% were women. Hypertension was present in 39%. 14.6% were treated with oral antidiabetic agents and 73.2% with insulin. Glycated haemoglobin (Hb1Ac) was abnormal in 33.8%. With regard to the tests of cognitive assessment: the average score of ACE in diabetic patients was 88. 8 and in non-diabetic patients 90.1 and in the CASI the average was 91.5 in diabetics and 92.5 in non-diabetics.

Conclusions: The score of cognitive function tests Addenbrooke and CASI was lower in diabetics compared to non-diabetics, although there was no significant difference.

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Riesgo de enfermedad cerebrovascular en la fibrilación auricular. Hospital Lenin Enero 2006 – Diciembre 2007.

A case-series was performed in the Emergency Service of the University Hospital V. I. Lenin. The universe of the study was 413 patients in Observation at the Emergency Service of Internal Medicine. Considered as an objective was to determine the behavior of the different clinical, epidemiological and therapeutic variables of the patients with atrial fibrillation and with risk to develop cerebrovascular disease. Of these patients, 165 were selected according to the inclusion criteria. The main results were that the most frequent clinical pattern of presentation was recent diagnosis followed by recurrent and permanent diagnosis and that after 60 years of age the highest risk to develop stroke was in patients with permanent clinical pattern which were not properly protected to prevent it. We concluded that if cerebrovascular disease is to be prevented, then it is necessary to give the patients the proper anticoagulants and antiplatelet medications. We recommend insisting in the application of the protocols of management.

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Sistema de actividades para la compensación de la memoria de trabajo en adultos con ataxia por trauma craneoencefálico.

Introduction: Working memory or operational memory is considered a distinct element of the executive function. Objective: To propose a system of activities that will contribute to the compensation of working memory in adults with Ataxia by craneoencephalic trauma assisted in CIREN.

Material and methods: A pre experiment with a single group was carried out, initial tests were applied to determine the cognitive deficits in the amnesic process, before implementing the strategy, and at the end of the intervention, the results were compared to quantify evolutionary development in the work of clearing of memory in these people with special educational needs.

Results: The results of the diagnostic analysis favored the interpretation of the need to implement corrective treatments – countervailing duties taking into account the allocation of the basic mechanisms of working memory to improve the prognosis of evolution of this amnesic skill.

Discussion: A system of activities is proposed as part of considering the diagnosis as an important element in the corrective compensatory work looking for restoration to the highest possible physical, psychological functioning and social adaptation of persons towards an optimal level of social integration.

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Alteraciones electroencefalográficas en niños con cardiopatías congénitas severas.

Introduction and objectives: Congenital cardiopathies (CC) are among the most common birth defects. Delays of neurodevelopment are among the most frequently observed diseases in school-age children presenting CC. The main objective of this study was to determine the possible impact of severe CC on central nervous system (CNS) development as determined after EEG recording.

Methods: Thirty children of ages between 15 days and 12 years presenting severe CC with hemodynamic consequences and/or chronic hypoxia were studied (21 acyanogenic and 19 cyanogenic). Conventional EEGs were performed on all cases.

Results: In the whole sample we found abnormal EEGs in 43.3% of cases, these mostly showing immature basal activity (slow for the age), and focal and multifocal paroxysmal activity characterised by sharp waves and spikes/slow waves complexes. Abnormal EEG activity was determined in 42.8% of non-cyanogenic CC and 44.4% of cyanogenic CC.

Conclusions: A high percentage of children carrying severe CC showed epiletiform EEG activity. It is possible that in afflicted children resulting from haemodynamic disturbances present from foetal stages onwards, these would favour the development of ectopic growth of grey matter leading to epileptiform activity.

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Violencia en la díada cuidador-paciente en la Enfermedad de Parkinson: Tres métodos de medición.

Background: Violence between caregivers and patients is common and little studied. Their identification and assessment is complex considering the various types available and how they are perceived and reported. The instruments vary in the number of items, level and frequency of acts that constitute a case.

Objective: To determine the prevalence of violence in the caregiver-patient dyad in the context of Parkinson’s disease through three measurement methods, describe the correlation between them and demonstrate the complexity of the assessment of violence.

Methods: Descriptive study, on 46 caregiver-patient dyads selected INNN. They were given a battery composed of: 1. National Survey of Violence against Women (ENVIM), 2. Scale of Abuse Older Adults (EMA). 3. Perception Questionnaire Exercise of Power in Dyads (PEPD).

Results: the average age of participant patients was 62 years, with 50% women. The average age of caregivers was 50 years, with 80% women. Violence prevalence of patients according to ENVIM is 43.5%, patient or caregiver (any) is 60.9%; EMA reports 71.7% and the PEPD 60.9%. Mutual violence is present in 26% of dyads according to ENVIM. Correlations were found between the scales ranging from 0.32 to 0.78.

Conclusions: Prevalence of violence is higher than what is reported in international literature and the ENVIM. Correlations between the instruments utilized in this study are sensitive and show that multiple question assessments avoid underreports.

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Tamaño de Muestra a Considerarse en un Estudio de Resonancia Magnética Funcional (RMF) con un Equipo de Resonancia Magnéticade 1.5 T.

This work presents an analysis of the necessary tools and special considerations to develop investigation in brain using fMRI with a magnetic resonator of 1.5 T field. This work presents the sample size and the necessary task time to use for showing results.

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Raíz Conjunta Lumbo Sacra Simulando Hernia Discal.

MRI examinations of lumbosacral region during eleven years were included to determine frequency of imaging similarity between an extruded discal fragment and a conjoint root. In 7,117 studies included in our casuistic we detected conjoint root in 175 (2.4 %), resembling an extruded discal fragment which is usually well shown by MRI but in our observations corresponded to a conjoint root. Bibliography related with conjoint root was reviewed. Our conclusion support that MRI is the method of choice to differentiate a conjoint root from an extruded discal fragment.

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Análisis Demográfico Comparativo de Pacientes Adultos con y sin Enfermedad Neurológica que Asisten a una Consulta Externa de Neurología en Guayaquil, Ecuador.

Background: Studies carried out in European countries suggest a high prevalence of patients consulting for non-neurological conditions among persons evaluated in outpatient neurologic clinics. However, there is no information on the prevalence of such patients in developing countries.

Objective: To describe the demographic profile of patients with and without neurologic symptoms evaluated at an outpatient neurologic clinic in Guayaquil. Methods: Cohort of 7,519 adults evaluated over a 20-year period. We evaluated data concerning age, gender, year of first evaluation, reason for consultation, diagnosis, complementary neurodiagnostic tests, and follow-up. Patients were classified into three groups according to their main complain: neurologic patients, psychiatric patients, and persons with non-specific clinical manifestations.

Results: Neurologic diseases were found in 6,764 (90%) patients, psychiatric disorders in 186 (2.5%) and non-specific complaints in 569 (7.5%). Non-neurologic patients were younger than those with neurologic diseases (p<0.0001). The smallest prevalence of women was found among persons with non-specific complaints (p=0.017). We noted a lower prevalence of nonneurologic patients during the years that our country experienced a economic crisis. About 50% of patients with psychiatric disorders, and 30% of persons with non-specific complains had one or more neurodiagnostic tests, which did not modify the therapeutic approach in any case. In most cases, those exams were requested by the patients themselves.

Conclusions: The prevalence of non-neurologic disorders in our series is smaller than that reported from European studies, and their demographic profile is somewhat different. There are some characteristics of patients in our population that may account for such differences.

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Sistema de Actividades para la Compensación del Déficit Motor de las Habilidades Manipulativas en Pacientes con Parálisis Cerebral Adulta.

Cerebral palsy is the commonest cause of motor disability. Under this term are grouped people with special educational needs, who have in common a persistent disorder of tone and movement due to a non-progressive brain injury. Although cerebral palsy affects muscle movement, it is not caused by problems in the muscles or the nerves, but by abnormalities in brain impairing its ability to control movement and posture. In order to assess the influence of activities for the prefunctional motor deficit of manual abilities in patients with cerebral palsy, a therapeutic intervention was applied to 15 patients (7 men and 8 women) who had motor disorders in upper limbs. A quasi experimental 60 days study, conceived by 2 hours daily treatment was carried out. Initial and final qualitative functional scales of hands were applied to compare results. This novel therapeutic system influenced positively in the recovery of lost abilities as was statistically demonstrated.

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