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.
enfermedad cerebrovascular
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?.
Palabras clave: Daño cerebral adquirido,
disfunción ejecutiva,
enfermedad cerebrovascular,
neuropsicología,
Tálamo,
Multi-territorial posterior circulation ischemic stroke after cocaine intoxication. Infarto cerebral isquémico multi-territorial de circulación posterior luego de un episodio de intoxicación por cocaína.
A 35-year-old man presented to the emergency department with altered mental status and bilateral tonicclonic seizures. Due to a progressive decrease in consciousness, he was intubated for airway protection. The patient’s relatives reported that he had used cocaine, leading to an initial suspicion of acute cocaine intoxication. However, a head CT scan without contrast revealed a hyperdense basilar artery sign without other signs of infarction (figure 1).
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Calidad de vida en pacientes con enfermedad cerebrovascular evaluados en un hospital venezolano. Quality of life in patients with stroke evaluated in a Venezuelan hospital.
Objective: Determine the health related quality of life (HRQL) in patients with cerebrovascular disease (CVD) evaluated in the Internal Medicine outpatient service from the Hospital General Hospital del Sur “Dr. Pedro Iturbe” en Maracaibo, Venezuela.
Materials and Methods: A descriptive and cross-sectional study was conducted, with a non-experimental design. The sample was represented by the first 80 patients with a new onset episode of CVD evaluated in the outpatient service from this hospital; to assess HRQL, the Quality of Life Scale for Stroke 38 was used.
Results: Of the subjects evaluated, 53.8% were women, the overall age was 60.7±9.4 years. Ischemic stroke was the most frequent, while 67.5% of the subjects evaluated showed some degree of involvement in their HRQL, specially moderate (36.3%) and mild (27.5%) degree.
Conclusion: no differences in HRQL were evidenced according to stroke type, although in general evaluation the majority reported a mild to moderate HRQL affectation, the analysis by domain shows a greater involvement in social functions, basic activities and physical problems.
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Aplicación de Realidad Virtual Para Tratamiento de la Mano Espástica en la Hemiplejía. Revisión Sistemática. Virtual Reality For Spastic Hand In Stroke Patient. Systematic Review.
Introduction: The virtual reality is as a real-time computer technology system whose use in neurological patients is an innovative process at the service of motor function recovery.
Aim: To determine the effect of virtual reality on the motor function of the spastic hand of the adult with hemiparesis.
Materials and methods: A systematic review of the literature was performed in PubMeD, Science direct, EMBASSE, PeDro, OT Seeker, Cochrane databases; they were selected results and controlled clinical analyzes from an analytical perspective according to the quality standards established to report experimental studies using the CONSORT 2010 strategy, for the inclusion criteria and the methodological quality studies was analyzed using the PEDro scale.
Results: The virtual reality therapy showed effectiveness in the function of the spastic hand of the adult with hemiparesis in selective activities that involve dexterity and execution of daily life skills, as well as favors the recovery of spasticity
Conclusions: Virtual reality therapy is effective in the spastic hand function of the adult with hemiplegia as a cerebrovascular consequence disease in selective activities that involve the dexterity and activities living of daily execution, as well as the recovery of the spasticity.
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Palabras clave: enfermedad cerebrovascular,
Extremidad superior,
Hemiparesia,
Terapia de realidad virtual,
Globesidad y Enfermedad Cerebrovascular: Una Pandemia Originada en la Globalizacion. Globesity And Cerebrovascular Disease: A Globalization Pandemic.
Palabras clave: enfermedad cerebrovascular,
obesidad,
La Enfermedad Cerebrovascular en Ecuador. The cerebrovascular disease in Ecuador.
Palabras clave: editorial,
enfermedad cerebrovascular,
Retardo en la Llegada de Pacientes con Ictus Isquémico a un Hospital Terciario de Ecuador. Delay In The Arrival Of Ischemic Stroke Patients At A Tertiary Hospital In Ecuador.
Introduction. In an Stroke unit, the ischemic stroke treatment with a pharmacological thrombolysis is associated with a better recovery. The aim of this study is to identify the variables having a significant impact in the delay of the arrival of patients at a tertiary hospital. Methods. A prospective and longitudinal study was undertaken in patients with an ischemic stroke diagnosis, who were admitted to the Stroke Unit of Eugenio Espejo Hospital of Quito city in Ecuador in the time period from November 2016 to July 2017. Patients treated with r-Tpa were compared to those who arrived 4,5 hours later. Results. A total of 61 patients were analyzed: of those, 51 arrived 4,5 hours after first symptoms at the hospital, and 10 (16,4%) were thrombolysed in the period of therapeutic window. None of the social, demographic and clinical variables were related to the early arrival, except the history of an atrial fibrillation. In the group of patients who received r-Tpa, a significantly higher percent sought for medical care as a first option compared with those arriving after the 4,5 hours (90 vs 49%, p 0,0170). The greatest impact of the early referral and the thrombolysis concerned the difference of score between the initial medical evaluation and the hospital discharge in the NIHSS scale. Conclusions. The results of this study point out to the unawareness of the stroke and the behavior to follow. The r-Tpa treatment shows clear benefits to the patients in our environment.
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Tabaquismo y su Asociación con Mortalidad Intrahospitalaria en Pacientes con Ictus Hemorrágico. Cigarette Smoking And Its Association With In-Hospital Mortality In Hemorrhagic Stroke Patients.
Background: Smoking is a well-known reversible risk factor associated with acute ischemic stroke (AIS), however, some data showed that in-hospital mortality rates among smoker’s patients with hemorrhagic stroke is lower when compared with non-smokers patients. The objective of this analysis was to assess in-hospital patient mortality rate between smokers and non-smokers patients with confirmed diagnosis of hemorrhagic stroke. Methods and Results: We analyzed all the data from patients diagnosed with hemorrhagic stroke that were registered in the Florida Stroke database from 2008-2012. Among the 21,013 patients diagnosed with hemorrhagic stroke, 10.9% of patients were smokers. A Multivariable model was used to estimate the adjusted odds ratio of in-hospital mortality rate in smokers versus non-smokers. Smoking was associated with lower in-hospital mortality in hemorrhagic patients. (UOR= 0.71 vs. AOR= 0.75). Other risk factors like hypertension, BMI>40 and hyperlipidemia, remained significantly associated after modeling, and some others like gender, race, health insurance coverage, and diabetes became insignificant. The difference between unadjusted and adjusted odds ratios for smoking (0.71 versus 0.75) indicates no presence of substantial confounding by age and other control variables. Conclusions: Among patients hospitalized for hemorrhagic stroke, smoking is a risk factor for early age of onset, even among those with few vascular risk factors. The persistent association with lower in-hospital mortality after adjusted analyses probably represents other unmeasured confounding, although a biological effect of smoking cannot be excluded. Further clinical and prospective population-based studies are needed to explore variables that contribute to outcomes in these patients.
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El Proyecto Atahualpa, Protocolo, Definiciones Operacionales y Diseño Inicial. The Atahualpa Project: Protocol, Operational Definitions, And Initial Study Design
Non-communicable diseases are the new health epidemics in developing countries due to increased life expectancy, and changes in lifestyle and dietary habits of the population. The Atahualpa Project was designed as a multi-step population-based cohort study designed to reduce the increasing burden of these conditions in rural Ecuador. The first step of the study followed a 3-Phase design, aimed to get information on demographics and cardiovascular risk factors of Atahualpa residents aged ≥40 years, as well as to assess the prevalence of stroke and ischemic heart disease. During Phase I, participants were screened with standardized questionnaires to evaluate their cardiovascular health and to identify those with suspected stroke or ischemic heart disease. In Phase II, neurologists and cardiologists examined suspected cases of stroke or ischemic heart disease, as well as a random sample of matched negative individuals, to assess prevalence of these conditions. In Phase III, patients with diagnosis of stroke and ischemic heart disease underwent complementary tests for achieving more specific diagnosis. Implementation of public health strategies directed to improve the cardiovascular health status of a given population must be based on studies evaluating specific risk factors at regional levels. Epidemiologic surveys such as the Atahualpa Project may prove cost-effective for improving the cardiovascular health status of people living in Latin American rural villages by increasing the knowledge on the particular needs of these populations.
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Enfermedad Cerebrovascular en el Ecuador: Análisis de los Últimos 25 Años de Mortalidad, Realidad Actual y Recomendaciones
Background. Cerebrovascular disease is the second cause of death and occupies the third place as a factor causing disability worldwide. At present, despite the recognition of its importance, the available data about Ecuador is scarce and there are not published analysis of its behavior. Methods. Retrospective longitudinal analysis of available public data on cerebrovascular disease in Ecuador, from 1991 to 2015. Results Cerebrovascular disease was the leading cause of mortality by 77 897 (6.70%) deaths and it is the only one with a constant trend pattern in the last 25 years. Conclusions. Cerebrovascular disease is the number one cause of death in Ecuador and its mortality is steadily increasing. Government policies must be implemented to reduce their mortality.
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Prevalencia de Enfermedades Neurológicas no Transmisibles en una Población Rural del Estado de Chiapas, México: Protocolo y Resultados Basales. Estudio Pro-Mas (Proyecto Comunitario La Soledad)
Objective: We aimed to assess cardiovascular health and neurological status of community-dwelling adults living in “La Soledad,” Chiapas, México, to calculate prevalence and incidence of cerebrovascular diseases, epilepsy and cognitive decline. Among others, these conditions are currently considered as the new epidemics in rural.
Design: Following a protocol similar to that used for the Atahualpa Project, we conducted a two-phase epidemiological study. During phase I, La Soledad residents were interviewed with validated field instruments to assess cardiovascular health status and well as to detect suspected stroke, epilepsy and cognitive impairment patients. During phase II, trained physicians examined suspected individuals as well as a random sample of non-suspected individuals to assess prevalence of diseases of interest.
Comment: Public health strategies must be based on the study of region-specific risk factors. Studies such the Atahualpa Project were proven to be effective for the assessment of public health problems in a rural Ecuadorian village. PROMAS will likely be cost effective to increase current knowledge on these conditions in Mexican rural villages and to promote a better cardiovascular health status among their inhabitants.
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Código Ictus: Protocolo de Tratamiento del Ictus Cerebral Isquémico
Cardiovascular diseases are the leading causes of mortality worldwide and Ecuador is not an exception. One of the great issues about these phenomena is the impact on vital organs such as the brain. Several features of cerebrovascular diseases, such as the high rate of associated disability and radiological advances, have encouraged the different government health institutions to establish standardized procedures, which are executed in order to generate an early diagnosis and individually analyze following procedures in affected patients. This article reviews the literature about CODE STROKE, which is a standardized approach performed in spaniards hospitals.
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Cadena de supervivencia del Ictus: Un desafío de la medicina actual.
A quasi experimental study was carried out in patients with cerebrovascular disease, through the stroke survival chain at the Municipality Holguín, in order to characterize the access getting of these patients to the secondary care unit at the Hospital Provincial Docente V. I. Lenin, from May to October 2006. Neurological evaluation and cerebrovascular risk scales were applied, obtaining the following results: ages from 60 to 74 years were the more affected, predominantly in male. Atherotrombotic cerebral infarcts were the more frequent. Only 8 patients (23,5%) arrived to the hospital during the first three hours of the event. High blood pressure, history of cerebrovascular disease and cardiopathies were the more frequent risk factors. Glasgow coma scale above 11 points was observed in all the cases. We conclude that, in order to reestablish cerebral blood flow after stroke, it is necessary to participate in a whole performance survival chain.
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Síndrome de Moyamoya en un niño con Drepanocitosis.
Sickle cell disease is one of the main causes of ischemic stroke in the childhood, generally related with stenosis of the arteries of the anterior carotid circulation. We present the results of the studies carried out in a patient with sickle cell with no history of stroke, in treatment with hidroxyurea. Transcraneal Doppler and Magnetic Resonance Imaging demonstrated the existence of stenosis in medial cerebral arteries and a Moyamoya pattern in the cerebral circulation with hemodynamic ischemic lesions.
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Palabras clave: Doppler transcraneal,
Drepanocitosis,
enfermedad cerebrovascular,
Hematología,
Ictus,
Moyamoya,
Disfagia en el Paciente con Enfermedad Cerebrovascular.
Dysphagia in patients with cerebrovascular disease is a common problem that is associated with increased rates of pneumonia, malnutrition, hospital stay and mortality. A literature search was conducted in MEDLINE and Cochrane Library for recommendations for assessment and management of dysphagia in patients with stroke. Because the evidence is poor in quality, hence doubtful, there are no clear guidelines. Emerging data suggest that the implementation of a protocol for early screening and management of dysphagia improves the prognosis of these patients. Further studies are needed to provide reliable evidence to make valid recommendations.
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Epidemiología de la Enfermedad Cerebrovascular en Latinoamérica
Palabras clave: editorial,
enfermedad cerebrovascular,
epidemiología,
ictus vascular cerebral,
Latinoamérica,
Descripción y Fundamentos de la Tomografía Computada en el Diagnóstico de la Enfermedad Cerebrovascular
Palabras clave: enfermedad cerebrovascular,
Descripción y Fundamentos de la Resonancia Magnética en el Diagnóstico de la Enfermedad Cerebrovascular
Palabras clave: enfermedad cerebrovascular,
Descripción y Fundamentos de las Técnicas de Imagen Vasculares en el Diagnóstico de la Enfermedad Cerebrovascular
Palabras clave: enfermedad cerebrovascular,
Descripción y Fundamentos del SPECT y el PET en el Diagnóstico de la Enfermedad Cerebrovascular
Palabras clave: enfermedad cerebrovascular,
Enfermedad Vascular Cerebral en los Trópicos
Objectives. To review the clinical manifestations, diagnosis, and therapy of diseases causing cerebrovascular disease (CVD) in the tropics. Development. Most prevalent conditions causing CVD in the tropics include: sickle cell disease, Takayasu’s arteritis, cysticercosis, infective endocarditis, Chagas’ disease, viral hemorrhagic fevers, gnathostomiasis, leptospirosis, snake bites, cerebral malaria, puerperal venous thrombosis, and tuberculosis. These conditions may cause cerebral infarcts or hemorrhages, and in most instances are related to either vascular damage secondary to angiitis or hemorrhagic diathesis with bleeding in other organs. In some patients, the severity of the neurological picture makes impossible to identify an specific stroke syndrome and cerebrovascular complications are only recognized on neuroimaging studies or autopsy. Conclusions. There is a group of tropical infectious and non-infectious diseases that may cause cerebral infarcts or hemorrhages. Prompt diagnosis and therapy are needed to reduce the severity or brain damage and to avoid recurrent strokes.
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Epidemiología de la enfermedad cerebrovascular hemorrágica en la región central de Cuba
Introduction. Cerebrovascular diseases are the third most important cause of death in Cuba. Among the programmes given priority by the Cuban Ministry of Public Health and the World Health Organization (WHO), hemorrhagic disorders are the most ‘lethal’. Objective. To determine the ‘behaviour’ of hemorrhagic cerebrovascular disease in the central region of Cuba. Patients and methods. An exploratory, descriptive, retrospective study in which 1,401 clinical histories were reviewed. The variables being investigated were then processed using the computer data processor EPINFO 6.0 to determine the mean, standard deviation and chi squared. Results. An annual incidence rate of 84.03 per 100,000 persons was seen for hemorrhagic cerebrovascular disease; 54.16 and 29.86 per 100,000 persons respectively for intracerebral hemorrhage and subarachnoid hemorrhage; and total mortality of 68.95%. The disorder was associated with possible meteorological factors and the highest percentage was due to intracerebral hemorrhage with 64.45%. Arterial hypertension was the most intensely studied risk marker (p< 0.01). Most cases were elderly (p< 0.001). Surgical treatment was given to 81 patients with subarachnoid hemorrhage, with a predominance of malformations of the middle and anterior cerebral arteries. Treatment was based on depletion using Manitol and calcium antagonists. A considerable number of patients required mechanical ventilation and vaso-active drug support. Most were attended in Intermediate Polyvalent Treatment Units and the main complication was sepsis. Conclusions. There is a high mortality from hemorrhagic cerebrovascular disease in the central region of Cuba, and once the diagnosis has been made the prognosis is usually poor. The patients included in the programme of attention for subarachnoid haemorrhage showed promising results.
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Diagnóstico de la Enfermedad Cerebrovascular Aguda.
Palabras clave: conferencia,
enfermedad cerebrovascular,
