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

Prognosis

 

Limited value of blood pressure levels in predicting white matter hyperintensities progression among community dwelling older adults living in a rural setting. Utilidad limitada de los niveles de presión arterial como predictor de progresión de hiperintensidades de sustancia blanca en adultos mayores que viven en un entorno rural

Introduction: This study aims to assess the impact of blood pressure (BP) on progression of white matter hyperintensities (WMH) of presumed vascular origin in community-dwelling older adults living in rural Ecuador.

Methods: Atahualpa residents aged ≥60 years receiving baseline and follow-up brain MRIs after a median of 6.5 years were included. Multilevel logistic regression models, which accounted for WMH severity at baseline, were fitted to assess the risk of WMH progression according to BP levels and other covariates.

Results: Analysis included 263 participants. WMH progression increased 3.45 times (95% C.I.: 1.94 – 4.96) among non-hypertensive individuals but 6.15 times (95% C.I.: 3.18 – 9.12) among those with arterial hypertension. However, overlapping of confidence intervals make such difference non-significant. Likewise, no differences in WMH progression were noticed when steady and pulsatile components of BP were used as independent variables.

Conclusions: High BP is not an independent predictor of WMH progression in the study population. 

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Palabras clave: enfermedad cerebral de pequeño vaso, estudio poblacional, hiperintensidades de sustancia blanca, Hipertensión arterial, presión arterial, Pronóstico,

Keywords: Arterial hypertension, blood pressure, cerebral small vessel disease, population study, Prognosis, White matter hyperintensities,

Evaluación de la Utilidad de las Escalas Pronósticas del Status Epiléptico Convulsivo en el Status Epiléptico no Convulsivo. Usefulness Of Status Convulsive Score In Prognosis Of Non-Convulsive Status Epilepticus

Introduction: The Non-Convulsive Status Epilepticus (NCSE) is a rare clinical entity. As of today, a predictive mortality scale has not been developed. Moreover, the risk factors that contribute to the prognosis have not been clearly defined. The aim of this study was to evaluate the usefulness of the prognostic scores for status epilepticus (SE): the epileptic status severity score (STESS), the modified RANKIN scale STESS (mRSTESS) and the epileptic status mortality score based on epidemiology (EMSE-EACEG) applied in patients diagnosed with NCSE.

Results: The sample analyzed for this study consisted of 66 patients with an average age of 59 years (SD 18.5).

The STESS and mRSTESS were significantly associated with higher odds for poor prognosis at the time of discharge in patients with NCSE (p<0.05 and p<0.05, respectively). However, none of the three was associated with mortality.

Conclusion: Considering that the scores used to predict prognosis in patients with SE have not shown equal diagnostic accuracy in the NCSE, we believe that a validated predictive scale of morbidity and mortality would be of great help for these patients.

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Palabras clave: Mortalidad, Pronóstico, Status epiléptico no convulsivo,

Keywords: Mortality, Non convulsive status epilepticus, Prognosis,

Epilepsia Como Factor Pronóstico de Refractariedad y Funcionalidad en Estado Epiléptico en Pacientes Mexicanos. Epilepsy As Prognostic Factor Of Refractoriness And Functionality In Status Epilepticus In Mexican Patients.

Introduction: Status epilepticus is a medical condition which could lead to a great disability and be mortal. Background of epilepsy could prevent a progression to a refractory status epilepticus and predict a good functional prognosis. Nevertheless, in Mexican population there are no studies about that.

Materials and methods: An observational, analytic, retrospective, cohort study was performed with patients with status epilepticus in Specialities Hospital of “Siglo XXI” National Medical Center, in Mexico. It was evaluated the probability of presenting refractory status epilepticus and a good functional outcome in patients with a background of epilepsy, performing Pearson Chi-square.

Results: 40 patients with status epilepticus were included, 32 with refractory status epilepticus and 14 with a background of epilepsy. The probability of presenting a refractory status epilepticus with a background of epilepsy was OR 1.29 (p 0.53), and for a good functional outcome was OR 3.63 (p 0.10).

Conclusions: Background of epilepsy is not a protective factor for preventing the progression to a refractory status epilepticus, neither a factor for predicting a good functional outcome in our study with Mexican population. Nevertheless, further studies with a bigger sample are needed in order to prove these results.

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Palabras clave: Epilepsia, estado epiléptico, factor de riesgo, funcionalidad, Pronóstico, refractariedad,

Keywords: Epilepsy, functionality, Prognosis, refractoriness, risk factor, Status Epilepticus,

Magnetic Resonance Poor Prognostic Factors In Mexican Multiple Sclerosis Patients. Factores de Mal Pronóstico Por Resonancia Magnética en Pacientes Mexicanos Con Esclerosis Múltiple.

Introduction: Multiple sclerosis is one of the main causes of disability in young people. It has characteristic lesions in magnetic resonance images which are part of diagnosis criteria, and some of them could predict a long-term disability. In mexican population there is no description about multiple sclerosis imaging characteristics.

Materials and methods: We performed an observational, descriptive, cross-sectional, and retrolective study at the Neurology Service of Specialties Hospital of Siglo XXI National Medical Center of Mexican Social Security Institute, in Mexico, evaluating magnetic resonance images characteristics of patients with multiple sclerosis diagnosis between January 2017 and January 2020.

Results: 75 patients were included, 8% had 1-3 T2-weighted lesions, 18.6% had 4-9 T2-weighted lesions, and 73.3% had 10 or more T2-weighted lesions. 50.6% had infratentorial lesions and 61.3% had spinal cord lesions. Gadolinium enhancing lesions were found in 48%, with a median of lesions 2 (IQR 1,3).

Conclusions: Mexican patients with multiple sclerosis have a great incidence of magnetic resonance image poor prognosis factors, which should lead to a closer follow-up and influence treatment options.

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Palabras clave: Discapacidad, epidemiología, esclerosis múltiple, pacientes mexicanos, Pronóstico,

Keywords: Disability, epidemiology, magnetic resonance, mexican patients, multiple sclerosis, Prognosis,

Factores Clínicos y Radiológicos Relacionados Con la Progresión de la Discapacidad en Esclerosis Múltiple. Clinical And Radiological Factors Related To The Progression Of Disability In Multiple Sclerosis

Multiple Sclerosis is a chronic demyelinating disease of the central nervous system, of unknown cause, of variable prognosis with high cost treatment. It may include sensory, motor, cognitive and behavioral alterations, as well as fatigue, pain, sexual and sphincter dysfunction, it represents a common cause of severe physical disability in young adults. Different factors that contribute to the progression of disability have been described. This work aims to describe clinical and radiological factors related to the progression of disability in patients with multiple sclerosis. A narrative review about clinical and radiological factors related to disability progression was made in PubMed, Embase, Science Direct, Scopus, and Lilacs data bases. We found 217 articles, after removing duplicates and systematic reviews, meta-analysis and clinical trials, 20 articles were left. Some factors such as vitamin D levels, general symptoms, brain atrophy, gray matter lesions, among others, are related to disability progression in multiple sclerosis. Magnetic resonance is the most important test for diagnosis and follow-up of the disease. The most appropriate way to assess the progression of disability includes clinical evaluation, magnetic resonance imaging, and other diagnostic tests.

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Palabras clave: Biomarcadores, esclerosis múltiple, Imagen por Resonancia Magnética, Personas con Discapacidad, Pronóstico,

Keywords: Biomarkers, Disabled Persons, magnetic resonance imaging, multiple sclerosis, Prognosis,

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,

Validación de Diferentes Escalas en la Evaluación del Pronóstico de Pacientes con Hemorragia Subaracnoidea Espontánea en el Hospital Regional “Dr. Teodoro Maldonado Carbo” entre Mayo-2011 y Mayo-2014

Background: Subarachnoid Hemorrhage (SAH) is associated with a high mortality rate and functional consequences. Several scales have been created in order to assess prognosis after SAH, and even though they have been widely studied, neither has achieved universal acceptance.
Objective: Validate different scales assessing the prognosis of patients with spontaneous SAH in a local hospital population.
Methods: A retrospective, cross-sectional study was conducted on patients admitted to the “Dr. Teodoro Maldonado Carbo” Hospital, diagnosed with spontaneous SAH, between 18 and 75 years. Descriptive statistics and Spearman correlation coefficient were calculated in order to evaluate the association of the Hunt and Hess, WFNS and Fisher Scales with functional outcome.
Results: Hunt and Hess Scale had a higher correlation (60,3%; p=0,000) with the functional outcome at discharge or death, compared to 55,3% (p=0,000) obtained by the World Federation of Neurological Surgeons Scale and 50% (p=0,000) by Fisher Scale. In addition, the Glasgow Coma Scale score (-58,4%; p=0,000), altered pupillary response (54,7%; p=0,000) and the need for invasive mechanical ventilation (73,8%; p=0,000) were factors associated with functional score.
Conclusion: Hunt and Hess Scale revealed a good correlation with the Rankin functional scale at discharge or death, and is superior to the other scales in evaluating the prognosis of patients with spontaneous subarachnoid hemorrhage.

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Palabras clave: escala, evaluación., Hemorragia Subaracnoidea, Pronóstico,

Keywords: evaluation, Prognosis, scale, Subarachnoid Hemorrhage,

Descripción y Valoración Pronóstica de la Hemorragia Cerebelosa no Traumática.

Spontaneous cerebellar hematomas (CH) represent 5%–10% of intracranial hemorrhages The purpose of this study was to describe CH characteristics in patients admitted to the critical care unit, to determine the prevalence of risk factors, to describe the clinical presentation, the treatment and the clinical situation at discharge. Thirty four consecutive patients were included. The mean age was 67±15 years. In the univariant analysis, only Glasgow Coma Score was associated with high mortality. An hematoma diameter > 3 cm., intraventricular hemorrhage and hydrocephalus were associated with mortality, but without statistical significance.

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Palabras clave: Hemorragia cerebelosa espontánea, Pronóstico,

Keywords: Prognosis, Spontaneous cerebellar hematoma,

La Creatinfosfokinasa tiene utilidad en la Evaluación Pronóstica Temprana de Discapacidad en el Infarto Cerebral.

Introduction: Cerebral infarction is the third cause of morbidity and mortality in the occidental world. The diagnosis is usually based on clinical and imaging studies, like computerized axial tomography. However, the prognostic value is limited especially in the first 48 h after the event. Currently, creatinphosphokinase tests are not known as a prognostic tool.

Objective: To study the creatinphosphokinase serum levels in patients with cerebral infarction in the first hours after the event, to determinate prognosis and establish a relation with disability.

Patients and methods: Forty hospitalized patients with cerebral infarction were studied. Levels of creatinphosphokinase in serum were measured at 12, 24 and 48 hours after infarction and were associated with disability using the Rankin modified scale.

Results: The creatinphosphokinase concentration increased during the first 12 hours after infarction, was higher at 24 hours and, at 48 hours, it began to decrease. The levels of creatinphosphokinase are correlated with disability results in the Rankin scale.

Conclusions: The creatinphosphokinase can be a useful tool in the prognostic evaluation of disability in patients suffering brain infarction, in the first hours after the event takes place, and preceding tomographic alterations.

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Palabras clave: Creatinfosfokinasa, Discapacidad, infarto cerebral, Marcador biológico, Pronóstico, Rankin,

Keywords: Biological marker, Cerebral infarction, Creatinphosphokinase, Disability, Prognosis, Rankin,
 
 
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