A 38-year-old woman with a history of migraine presented with two tonic-clonic seizures confined to the left size of the body, which occurred one hour apart. The second seizure was followed by severe headache and hemiplegia ipsilateral to the seizures, which persisted for 24 hours, reversing completely thereafter. Brain MRI and a 21-channel EEG were normal. A lumbar puncture revealed CSF under normal opening pressure, discrete lymphocyte pleocytosis, and normal glucose and protein levels. This patient meets the diagnostic criteria for HaNDL syndrome, a rare condition of unknown cause, whose prognosis is usually favorable, with complete reversal of symptoms within a few weeks. Its diagnosis must be taken into account to avoid the practice of invasive tests or complex treatments that are not devoid of adverse effects.
Reportes de Casos Clínicos
Crisis focales como síntoma de presentación del síndrome HaNDL (cefalea transitoria y déficits neurológicos con pleocitosis linfocitaria). Focal seizures revealing HaNDL syndrome (Transient headache and neurological deficits with lymphocytic pleocytosis).
Absceso cerebral: una entidad poco común en pediatría. Brain abscess: an uncommon entity in pediatrics.
Brain abscess rarely occurs in children. It is a neurosurgical emergency with a potentially catastrophic outcome, with a high risk of permanent neurological deficit. With the introduction of modern imaging, antibiotics, and stereotactic surgical techniques, mortality has decreased markedly. Symptoms are nonspecific and may vary depending on the child’s age, location, size, number, and stage of the abscess, and the primary source of infection. Despite the decline in mortality, brain abscess remains a serious disease that can lead to serious morbidity or even death if diagnosed late, incorrectly diagnosed, or inadequately treated.
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Parkinsonismo y deterioro cognitivo rápidamente progresivo en un paciente con lupus eritematoso sistémico y síndrome antifosfolípido triple positivo. Parkinsonism and rapidly progressive cognitive decline in a patient with systemic lupus erythematosus and triple-positive antiphospholipid syndrome.
Background: The association between parkinsonism and systemic lupus erythematosus is inadequately described, and to date, the underlying pathophysiological mechanisms are not fully established, ranging from vascular impairments to immunomediated phenomena. Literature analysis identified only 28 cases of parkinsonism in patients with systemic lupus erythematosus, underscoring the limited attention to these associations and their respective therapeutic approaches.
Case Report: We present a case of a patient with an atypical presentation of systemic lupus erythematosus and a diagnosis of triple-positive antiphospholipid syndrome. Despite the absence of lupus activity, the patient developed symptoms of parkinsonism and rapidly progressive cognitive decline. No other underlying causes or thrombotic events in brain imaging were found to explain the atypical clinical presentation. Simultaneous administration of immunosuppressive therapy and levodopa/carbidopa resulted in symptom improvement.
Conclusion: Insufficient research has been conducted on the correlation between systemic lupus erythematosus and parkinsonism, primarily due to its seemingly low incidence in the medical literature. Consequently, this case report offers additional insights into this association, potentially laying the groundwork for future structured and well-designed studies. The efficacy of levodopa and immunosuppressive therapy in treating these patients remains uncertain and necessitates further investigation.
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Síndrome de RETT: Abordaje desde la fisioterapia y terapia conductual. RETT syndrome: Approach from physiotherapy and behavioral therapy.
Purpose: Rett syndrome is considered a neurodevelopmental disorder with late regression, its main clinical manifestation is the progressive delay of already acquired motor and language skills, accompanied by rigidity and stereotyped hand movements. The aim of this case report was to identify the effects of a physiotherapeutic intervention combined with behavioral therapy in a patient with Rett syndrome.
Case presentation: We present the case of a 10-year-old girl with a medical diagnosis of Rett syndrome, stage III, or also called stabilization or pseudo-stationary stage. Physiotherapy and behavioral therapy were applied 3 times a week, with 45-minute sessions for a period of 12 months of treatment.
Results: Changes were achieved in gross motor function, balance reactions, straightening, in the ability to avoid obstacles and follow instructions; these skills were preserved for 6 weeks (at the end of treatment), and again, the regression of psychomotor functions is evidenced, which may be due to the characteristics of the syndrome.
Conclusion: the results obtained suggest that the combination of physiotherapy with behavioral therapy generates positive changes in gross motor function and behavior in girls with Rett syndrome.
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Mixoma de aurícula derecha como probable causa de migraña. Right atrial myxoma as a probable cause of migraine.
Introduction: Cardiac myxoma is a benign tumor known as the “great imitator” because it can manifest clinically in a very diverse manner and/or with nonspecific findings that create a lot of confusion and make diagnosis difficult. It is associated with neurological manifestations, typically secondary to embolic complications affecting the nervous system, such as ischemic strokes, which can cause dizziness, headaches, loss of consciousness, and/or vision and speech disturbances.
Clinical Case: A 16-year-old female patient with a six-month history of headaches and no other neurological history. She was hospitalized for diagnostic evaluation by the neurology department, where her condition was interpreted as primary migraine-type headaches without aura. Among the tests performed during her hospitalization, an intracardiac mass in the right atrium was detected, compatible with cardiac myxoma, confirmed by postoperative histopathological analysis. She evolved favorably without presenting neurological symptoms again.
Conclusion: The occurrence of migraines in patients with cardiac myxomas is rarely reported, and this condition has only been associated with myxomas located in the left heart chambers. Describing the different published pathophysiological mechanisms that can lead to this neurological condition, and due to the unusual nature of the case reported, given the location of the neoplasm in the right heart chambers, it is considered possible that the migraine may have originated from the synthesis and release of vasoactive intestinal polypeptide by the myxomatous tumor.
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Complicaciones neurológicas en la acondroplasia: Cuadriparesia post traumatica en estenosis cervicomedular. Neurological complications in achondroplasia: Post-traumatic quadriparesis in cervicomedullary stenosis.
Achondroplasia is a common skeletal dysplasia characterized by short stature and bone deformities, caused by a mutation in the FGFR3 gene. Patients with this condition are at risk of neurological compression, especially at the craniocervical junction. We present the case of a girl with achondroplasia who suffered a traumatic brain injury, revealing stenosis of the foramen magnum and spinal cord contusion on MRI. Surgical decompression was performed with favorable results.
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Evaluación neuropsicológica en un caso de síndrome de Rasmussen de inicio tardío. Neuropsychological evaluation in a case of late-onset Rasmussen syndrome.
Rasmussen syndrome (RS) is a rare encephalitis characterized by inflammation of one cerebral hemisphere that causes atrophy, neurological and cognitive impairment. We present a 42-year-old female patient, with no significant previous history and diagnosed with epilepsy since she was 24 years old, epileptic seizures are reported in different time windows with temporary cessation, but with constant reinstallations of acute and drug-resistant episodes. Neurological examination revealed hyperkinesia of the extremities, with persistent flexion and extension movements. The neuropsychological evaluation carried out with the MoCA test, Rey’s complex figure and Token test, shows severe cognitive impairment with psychiatric symptoms. In addition, electroencephalogram results show unilateral hemispheric slowing with unilateral focal onset and MRI evidence of generalized atrophy of the left hemisphere, elements supporting the diagnosis of late-onset RS. Finally, information is offered about the associated neuropsychological manifestations.
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Neuropatía autoinmune por anticuerpos antigangliósidos GD-1b asociada a Síndrome de Sjögren primario. Autoimmune neuropathy by anti-ganglioside GD-1b antibodies associated with primary Sjögren’s Syndrome.
The terms axonal or demyelinating, traditionally disseminated in the classification of polyneuropathies, are electrophysiological interpretations that guide us to determine the pathogenic locus where the neuropathic lesion originates; this is an objective contribution to the knowledge of the etiology of the corresponding neuropathy. However, in some circumstances, a bimodal interpretation initially does not allow determining the possibility of involvement at the axolemma level, as can be identified in some immune-mediated polyneuropathies that compromise the Ranvier node or its different domains; These neuropathies are of autoimmune origin and are characterized by the presence of anti-ganglioside antibodies directed against antigenic epitopes at this anatomical locus.
This is a case report of a 66-year-old male patient with progressive weakness in all four limbs leading to prostration over a few weeks; no prior systemic infections were reported. Initially diagnosed with Guillain-Barré Syndrome (GBS), he was evaluated with electrophysiological studies that confirmed the existence of a sensorimotor demyelinating polyneuropathy and treated with intravenous immunoglobulin (IVIg), with partial clinical improvement. Two weeks later, he was readmitted with a new episode of global muscle weakness, due to a fluctuating response of GBS to immunomodulatory treatment; therefore, he received two cycles of IVIg with little response. Complementary immunological studies confirmed a diagnosis of Sjögren’s syndrome and showed positive IgM anti-GD1b antibodies.
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Encefalopatía Epiléptica y del Neurodesarrollo por Mutación en SYNGAP1: Primer Caso Reportado en Ecuador. Developmental and Epileptic Encephalopathy due to SYNGAP1 Mutation: First Case Reported in Ecuador.
Developmental and epileptic encephalopathy related to mutations in the SYNGAP1 gene (EED-SYNGAP1) is characterized by psychomotor delay and early-onset epilepsy. We present the first documented case in Ecuador, describing the clinical, electroencephalographic, therapeutic, and evolutionary characteristics of the patient. Genetic diagnosis revealed a de novo nonsense mutation in SYNGAP1. Treatment with valproic acid showed good control of epileptic seizures, although reflex seizures persisted during feeding. This case highlights the importance of genetic studies in the diagnosis of epileptic and developmental encephalopathies.
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Paraparesia flácida subaguda progresiva y meningitis carcinomatosa como forma de presentación de recaída tardía de leucemia linfoblástica aguda de estirpe linfoide B BCR-ABL/Phi+. Progressive subacute flaccid paraparesis flaccida and subclinical carcinomatous meningitis as a presentation of late relapse of BCR-ABL/Phi+ B-lymphoblastic acute lymphoblastic leukaemia.
Introduction: Acute lymphoblastic leukemia (ALL) is a malignant neoplasm characterized by the proliferation of abnormal lymphoid cells in bone marrow (BM) and/or extramedullary territories.
Case report: 20-year-old male with BCR-ABL B-ALL in childhood, presenting with subacute flaccid paraparesis (PFS) and paresthesias in the lower limbs. He presents with motor axonal polyneuropathy, leptomeningeal uptake in left occipito-parietal sulci and extramedullary intrathecal D11-S1 infiltration. Immunoblasts in peripheral blood and MO with BCR-ABLp190 mutation confirm late relapse of ALL.
Conclusions: We expose a rare case of PFS and carcinomatous meningitis as a form of presentation of late relapse of BCR-ABL ALL-B BCR-ABL.
Progressive subacute flaccid paraparesis flaccida and subclinical carcinomatous meningitis as a presentation of late relapse of BCR-ABL/Phi+ B-lymphoblastic acute lymphoblastic leukaemia.
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All that Restricts is Not Stroke: A Case Series of Brain imaging Findings in Infective Endocarditis. Todo lo que restringe no es enfermedad cerebrovascular: Una serie de casos de hallazgos de imágenes cerebrales en endocarditis infecciosa.
Infective endocarditis is a systemic illness characterized by infection and inflammation of the endocardium which produces symptoms due to local causes and embolization.
One of the sites of embolism is the central nervous system. Cerebral magnetic resonance imaging (MRI) exhibits greater sensitivity than computed tomography (CT) when detecting covert lesions like cerebral microbleeds and asymptomatic embolisms.
There are specific patterns on cerebral MRI that prompt the diagnosis of infective endocarditis. This is a retrospective case series with the collection of data from 3 patients, who were encountered in the emergency and intensive care departments.
All three patients had clinical features secondary to a shower of multiple emboli detected on MRI brain as multiple bi-hemispheric and multi-circulation foci of diffusion restriction.
They were presumed initially to be cardioembolic in origin, which after targeted investigation were found to be due to infective emboli from IE.
Bi-hemispheric scattered diffusion restricting foci can mislead the treating physician into evaluation for stroke secondary to cardioembolism including the hunt for an occult atrial fibrillation which can delay treatment required in IE.
Distinguishing between septic and other cardioembolic lesions will result in the optimum management of such cases.
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Encephalitis and rapidly progressive dementia due to probable Prion disease presenting with a non-convulsive status epilepticus. Case report and literature review. Encefalitis y demencia rápidamente progresiva por probable enfermedad priónica que se presenta con un estado epiléptico no convulsivo. Reporte de caso y revisión de la literatura.
Prion diseases are rare and rapidly progressive fatal neurological disorders characterized by abnormal folding of neuronal proteins.
The diagnosis is often challenging and relies on a high clinical suspicion, imagenological findings, electroencephalographic (EEG) patterns and cerebrospinal fluid (CSF) analysis.
We present a case of probable prion disease with an accelerated neurological decline and a non-convulsive status epilepticus (NCSE), which has only been described in a few cases worldwide, and seems to be associated with worse neurological outcomes and shorter survival time.
Clinical manifestations, treatment, and outcomes are shown below.
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Mielopatía en enfermedad por descompresión. Myelopathy in decompression sickness.
Decompression sickness (DCS) refers to the clinical manifestations caused by the formation of bubbles of an inert gas in
the tissues. It is associated with changes in environmental pressure during diving, and injuries to the central nervous system in the disease are not uncommon. We present a case of severe thoracic spinal cord injury in DCS in a diver.
We highlight the typical aspects of DCS in the case for easy recognition by non-specialist physicians. Prevention and prompt initiation of recompression therapy are the cornerstones of DCS management.
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Análisis neuropsicológico en un caso de Afasia Global. Neuropsychological analysis in a case of Global Aphasia.
Acquired brain damage generates a series of neuropsychological alterations, among which we can highlight aphasia. This syndrome is characterized by language impairment, with its main features being deficits in fluency, comprehension, repetition, naming, reading, writing and calculation. In this article we present the case of a patient suffering from global aphasia, who presents severe linguistic alterations. The state of the disease and its neuropsychological condition are analyzed. Finally, we close this analysis, highlighting the need for a correct neuropsychological approach at the level of diagnosis and rehabilitation which can help the patient.
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Encefalomielitis aguda diseminada tras infección por herpes virus. Acute disseminated encephalomyelitis after herpes virus infection.
Acute disseminated encephalomyelitis (ADEM) is a rapid inflammatory and demyelinating process of the central nervous
system, mainly affecting the white matter, but also the gray matter. It usually occurs after viral infections or vaccinations. The case of a 26-year-old patient with sensory symptoms and weakness in the left extremities is presented. Tests showed brain and cerebellar lesions with possible demyelination. ADEM is suspected due to a history of herpes zoster. Corticosteroids are administered with satisfactory evolution. ADEM is a serious process that can affect children and adolescents and presents MRI findings similar to Multiple Sclerosis. The diagnosis is exclusionary, the treatment is with corticosteroids, but it can leave sequelae.
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Neurodegeneración con acumulación de hierro en el cerebro: Primer reporte de caso en Ecuador. Neurodegeneration with brain iron accumulation: First case report in Ecuador
Neurodegeneration with brain iron accumulation is a rare group of neurodegenerative diseases that present extrapyramidal symptoms, mood disorders, and cognitive impairment. A prevalence of 1 to 2 cases per million inhabitants is estimated. In Latin America, there is no estimated prevalence, although there are some reported cases with typical presentation. The first case report of this disease in Ecuador is presented, in an atypical presentation, under the ruling out of differentials and compliance with diagnostic criteria.
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Síndrome de Millard-Gubler en un paciente joven: diagnóstico y neurorrehabilitación temprana. Millard-Gubler syndrome in a young patient: diagnosis and early neurorehabilitation.
Introduction: Millard-Gubler syndrome (MGS) is a rare neurological entity that affects the brainstem by multiple etiologies. The diagnosis is clinical and requires confirmation by imaging studies such as CT or MRI. Treatment is generally non-surgical with a rehabilitative approach with functional goals.
Clinical findings: In this case we present a 44-year-old male patient from southwestern Colombia, with a history of arterial hypertension who was admitted to the emergency department of a national reference university hospital with a hypertensive emergency and white organ lesion, presenting a sudden loss of mobility of his left hemibody accompanied by involvement of the VI and VII cranial nerves.
Treatment and outcome: Interventions were initiated by a multidisciplinary team, including the rehabilitation service, making the diagnosis of crossed brainstem syndrome (Millard-Gubler) of hemorrhagic vascular etiology. He required monitoring in the NICU until stabilization of his clinical condition, after which early neurological rehabilitation interventions were performed (physical therapy, occupational therapy, speech therapy, orthotics, psychology and pain), achieving an improvement in symptoms and functionality of the motor and cognitive component before h ospital discharge.
Conclusions: This case reflects the importance of a multidisciplinary team with a physician specializing in physical medicine and rehabilitation to ensure the best possible functional outcome, in addition to reporting the interventions performed in a young patient with a rare neurovascular entity.
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Síndrome de Debilidad Crónica como Presentación del Síndrome Postpolio. Chronic Weakness Syndrome as a Presentation of Post-polio Syndrome.
Post-polio syndrome (PPS) is characterized by progressive weakness, muscle fatigue, joint pain, and an increase in disability, which occurs decades after an episode of poliomyelitis. The cause of progressive neurological deterioration is unknown; however, the main hypotheses suggest induction of autoimmunity. There are no pathognomonic findings or specific tests that diagnose PPS; therefore, the diagnosis is made based on the clinic and the history of a polio episode at least 15 years before the onset of new symptoms. We present a case of a man, with a history of poliomyelitis who approximately 40 years later presents a slow progression of weakness, areflexia, atrophy, and fasciculation. Although the frequency of PPS is low, symptoms are disabling, and they cause great impairment in the patient’s functionality. Since there is no specific treatment, the management of PPS is mainly symptomatic and supportive.
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Hemorragia en área dependiente de circulación cerebral posterior por síndrome de hiperperfusión tras stenting en arteria carótida interna. Hemorrhage on a dependent area of posterior cerebral circulation due to hyperperfusion syndrome after stenting in internal carotid artery.
Cerebral hyperperfusion syndrome (CHS) after stent placement has a low incidence, between 0.37- 1.9% (1,2). We present a case of CHS due to recanalization in right internal carotid artery (ICA) which, contrary to expectations, produces a hematoma on a dependent area of the posterior cerebral circulation. Through the clinical case, we proceed to delve into the CHS and the characteristics that give the patient a higher risk. In addition, we expose the potential usefulness of the neurosonological study of inter-individual variability for better perioperative management. In this way, we can ensure a good therapeutic approach that minimizes morbidity and mortality as much as possible.
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Trombosis venosa cerebral profunda e infarto venoso, secundario al uso prolongado de anticonceptivos hormonales. Deep Cerebral Vein Thrombosis and venous infarction, secondary to prolonged use of Hormonal Contraceptives.
Introduction: Cerebral venous thrombosis represents an infrequent cause of cerebrovascular disease, but can result in highly lethal complications such as venous infarction. It affects women of childbearing age more frequently, and the use of oral hormonal contraceptives has shown a causal relationship with this pathology.
Clinical case: We present a 28-year-old patient, with a history of using oral hormonal contraceptives for 5 consecutive years, who came to the emergency room complaining of oppressive holocephalic headache, vomiting and diplopia, of 6 days of evolution. Consciousness with a tendency to obtundation, hypobulia, bradylalia, bradypsychia, paresis of the sixth cranial nerve (left) and bilateral Babinski’s sign were appreciated. Funduscopic examination revealed bilateral developed papilledema. Non-contrast computed tomography of the skull shows direct and indirect signs of thrombosis of the deep cerebral venous system involving internal cerebral veins, vein of Galen, and straight sinus. Nuclear magnetic resonance with T2-FLAIR, Diffusion and vascular sequences confirmed the diagnosis, as well as the presence of infarction in the corresponding venous territory.. Anticoagulant therapy with low molecular weight heparin was performed for ten days and anticoagulation with warfarin was maintained for three months. The causative agent is discontinued. The patient evolved favorably and to date there have been no re currences of the thrombotic event.
Conclusions: Cerebral venous thrombosis shows a worse prognosis when it involves the deep venous system; Its evolution also depends on early diagnosis and timely treatment.
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Síndrome de Tolosa-Hunt con compromiso de tres ramas del nervio trigémino y nervio facial. Tolosa-Hunt Syndrome with involvement of three branches of the trigeminal nerve and facial nerve
Introduction: Tolosa-Hunt Syndrome consists of a sensory neuropathy of the trigeminal nerve associated with the paralysis of one or more ocular motor nerves, secondary to an idiopathic granulomatous inflammation of the cavernous sinus, the superior orbital fissure or the orbit.
Clinical case: 19-year-old patient with Tolosa-Hunt Syndrome accompanied by peripheral facial paralysis, with enhancement of the facial nerve.
Conclusions: Compromise of trigeminal nerve branches and facial nerve is a rare finding. Imaging studies contribute to the characterization of the etiology. Steroid treatment continues to be effective.
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Complicaciones neurológicas post-vacuna COVID. Neurological complications post-COVID vaccine.
Post-vaccine SARS-CoV-2 neurological complications are rare. However, due to the SARS-CoV-2 pandemic, massive vaccination has been carried out worldwide, which is why we have seen a greater report of post-vaccination neurological adverse effects.
We present 4 cases, which after receiving the SARS-CoV-2 vaccine presented 4 different neurological pathologies at the Hospital Comarcal de Vinaroz during the year 2021.
A relationship between vaccination and the onset of neurological symptoms is observed. Three patients presented clinical manifestations in relation to the BNT162b2 vaccine. The first patient after administration of the first dose of the BNT162b2 vaccine presented diplopia and palpebral ptosis, a condition compatible with ocular Myasthenia gravis. The second patient had symptoms of acute sensory motor axonal polyneuropathy after the third dose. The third patient, who after the third dose of BNT162b2 presented lethargic encephalopathy. The fourth patient presented symptoms compatible with aseptic meningitis after AZD1222 and mRNA-1273 vaccination.
Due to the worldwide mass vaccination campaign, reports of accidentally related or causally linked neurological complications are emerging. These are very varied; they could be related to immunological and/or toxic mechanisms. Physicians must be aware of these possible adverse effects and rule out other causes. Studies should be carried out that allow us to clarify the pathological mechanisms in relation to post-vaccination complic ations.
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Síndrome de Fahr e hipoparatiroidismo. Fahr syndrome and hypoparathyroidism.
Introduction: Fahr’s disease is a rare pathology characterized by brain calcinosis syndrome, usually found incidentally and late in individuals with neurological and psychiatric symptoms, with these manifestations from an early age. It is a genetic disorder of unclear etiology of autosomal dominant behavior and can be a ssociated with metabolic, hereditary, or acquired etiology.
Objective: To present the case of a patient with Fahr’s disease treated in a second-level regional hospital in a rural area of central Andean Colombia.
Clinical case: This is a 54-year-old woman who consulted for the first seizure episode, with a significant pathological history of schizophrenia and a family history of maternal Alzheimer’s. Simple cerebral computed tomography was performed, which reported multiple periventricular calcifications and symmetric calcifications at the level of the basal ganglia with hypocalcemia and hypoparathyroidism.
Conclusions: Fahr’s disease is a rare entity, however, it is important to suspect and know about it early; Diagnostic images are essential for detection, and the search for differential diagnoses or associated metabolic causes is important for treating these patients in a timely and adequate manner.
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Análisis neuropsicológico de un caso de daño talámico. ¿Por qué el paciente presenta una nueva holgazanería y una ingenuidad adquirida?. Neuropsychological analysis of a case of thalamic damage. Why does he present a new laziness and acquired naiveté?.
Acquired brain damage is a topic of central interest in neuropsychology, since it allows us to understand the relationship between cognition, behavior and emotion with pathological brain functioning. On this occasion, we present a case with a cerebrovascular disease that, as a result of damage at the thalamic level, presents executive, emotional, linguistic, and memory disorders. This is a 52-year-old patient who presents signs and symptoms such as personal insouciance, lack of motivation to seek employment, problems regulating his behavior, among others. We analyze the case regarding the role of the thalamus in global brain functioning and the need to carry out a correct follow-up with the patient.
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Accidente cerebrovascular en un paciente con meningitis por Streptococcus Constellatus. Stroke in a patient with Streptococcus Constellatus meningitis.
Streptococcus Constellatus ssp pharingi belongs to the group of Streptococcus Anginosus, it constitutes normal flora of th respiratory, gastrointestinal and genitourinary tracts, it infrequently produces localized or disseminated infections in patients with risk factors. The case of a 41-year-old male patient is reported, with a history of pituitary macroadenoma resection in 2003, undergoing treatment, who consulted the emergency department for 4 days with intense holocranial headache, fever, emesis, associated with temporospatial disorientation and weakness in lower limbs in the last 24 hours. He required management in the intensive care unit, mechanical ventilation, vasopressor support, and tracheostomy, due to respiratory and hemodynamic deterioration. In extension studies, meningitis due to Streptococcus Constellatus ssp pharingi was documented in the presence of sinusitis, cerebrospinal fluid fistula and multi-infarct cerebral vascular compromise, product of vasculitis of infectious origin, a severe manifestation of
bacterial meningitis, not previously reported by this microorganism.
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Hemorragia en área dependiente de circulación cerebral posterior por síndrome de hiperperfusión tras stenting en arteria carótida interna. Hemorrhage on a dependent area of posterior cerebral circulation due to hyperperfusion syndrome after stenting in internal carotid artery
Cerebral hyperperfusion syndrome (CHS) after stent placement has a low incidence, between 0.37- 1.9% (1,2). We present a case of CHS due to recanalization in right internal carotid artery (ICA) which, contrary to expectations, produces a hematoma on a dependent area of the posterior cerebral circulation. Through the clinical case, we proceed to delve into the CHS and the characteristics that give the patient a higher risk. In addition, we expose the potential usefulness of the neurosonological study of inter-individual variability for better perioperative management. In this way, we can ensure a good therapeutic approach that minimizes morbidity and mortality as much as possible.
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Neuropatía craneal múltiple: Posible asociación a infección por HTLV 1. Multiple cranial neuropathy: Possible association with HTLV 1 infection
Human lymphotropic virus type 1 (HTLV 1) is an oncoretrovirus that chronically and persistently infects T lymphocytes; which can cause serious neoplastic or inflammatory diseases, however, most are asymptomatic and only a small number of patients develop the disease. Although this virus particularly affects the hematological system in the form of T-cell leukemia or lymphoma, the nervous system is also an important target, both the central and peripheral components. In recent years, different associations have been found between this viral infection and multiple neuroinflammatory pathologies such as encephalitis, motor neuron diseases, polyneuropathies, cranial neuropathies and even myopathies, enriching the syndromic spectrum of this entity. On this occasion, the clinical particularities of a rare and possible association between HTLV 1 and multiple cranial neuropathy expressed in a patient managed in a tertiary care hospital in Cali, Colom bia will be described.
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Síndrome de cabeza caída en Miastenia gravis tras una infección por SARS-CoV2. Dropped head syndrome in Myasthenia gravis after a SARS‐CoV2 infection
Objective: To report a case with an unusual presentation of myasthenia gravis after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and literature review.
Method: We report a case of a patient with head drop and a postsynaptic myasthenic syndrome after a SARS-CoV-2 infection and a retrospective review of the literature of all the reported cases of myasthenia gravis de novo associated with SARS-CoV2 infection from march-2020 to september-2022. Written informed consent was obtained from the patient for publication of this case report and accompanying images or videos.
Conclusion: Myasthenia gravis could also be the result of an autoimmune re action triggered by SARS-CoV-2 infection.
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Rehabilitación neuropsicológica de la memoria de trabajo sobre la conducta ejecutiva y el rendimiento académico en un niño con trastorno específico del aprendizaje. Neuropsychological rehabilitation of working memory on executive behavior and academic performance in a child with specific learning disorder
Introduction: Learning disorders are a clinical condition that manifests itself at school age, affecting the cognitive, social and emotional functioning of the individuals who suffer from it. There are studies that show a positive effect of interventions on executive functioning, impacting the executive behaviors and ac ademic performance of children.
Objective: To assess the effect of a neuropsychological rehabilitation program for working memory on executive behavior and academic performance in a child with specific learning disor der.
Clinical case: An 11-year-old boy, diagnosed with a specific learning disorder according to the DSM-5, a working memory rehabilitation program was designed and applied and its impact on executive behaviors and academic performance was measured.
Results: The measurements of the treatment phase show a downward trend reflecting a positive impact. For the global index of executive function, the percentage of data that exceeds the median (PEM= 100%) indicates a very effective treatment and the non-overlapping of all pairs (NAP=89%) indicates a medium effect of the intervention.
Discussion: The results suggest a positive impact at the level of cognitive, behavioral and emotional functioning of the patient, reflected in executive behavior and academic performance.
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Embolismo gaseoso cerebral: a propósito de un caso de ictus masivo. Cerebral air embolism: about a case of massive stroke
Introduction: Cerebral air embolism is a rare but potentially fatal entity, that occurs due to the entry of air into the cerebral blood circulation and is caused by multiple causes, including t hose associated with medical procedures.
Clinical case: We present the case of an 81-year-old male patient who, after removal of the high-flow hemodialysis catheter, begins with a deterioration of the level of consciousness, which worsens progressively. Multiple hypodense lesions, compatible with gas embolism, are evidenced in the cerebral tomography. Due to his slow evolution, he was transferred to the intensive care unit and died a few hours later.
Conclusion: It is essential to know the preventive measures to avoid this complication and the general and specific measures to adopt when it occurs.
