Neurologic emergencies are highly complex scenarios that require rapid decision-making, effective interprofessional collaboration, and advanced communication skills. However, traditional neurology training is often fragmented, separating clinical aspects from ethical and communication domains. Simulation-based education emerges as a key tool to integrate these competencies in a safe environment. An innovative model combines neurologic emergency scenarios with training in difficult conversations to promote ethical reasoning, role clarity, and emotional awareness. This approach is particularly relevant in Ecuador, where existing simulation centers could strengthen graduate training in neurology.
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Violencia Escolar, Salud Mental y Estrés en Adolescentes Expuestos a Pantallas: Una Advertencia Desde la Perspectiva del Neurodesarrollo. School Violence, Mental Health And Stress In Adolescents Exposed To Screens: A Warning From A Neurodevelopmental Perspective
School violence (which is becoming increasingly extreme), chronic stress, and excessive exposure to digital media (via mobile phones and tablets) are not isolated phenomena but rather reinforcing pressures that affect the developing brain of children and adolescents. This letter highlights the combined impact of school violence, stress, and screen exposure on neurodevelopment and adolescent mental health, and underscores the need for biomedical and educational interventions based on early preventive measures.
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Palabras clave: Adolescencia,
ciberacoso,
estrés,
neurodesarrollo,
salud mental,
uso de pantallas,
violencia escolar,
Keywords: Adolescence,
cyberbullying,
mental health,
neurodevelopment,
school violence,
screen time,
stress,
Semilleros de Investigación en Neurociencias Como Espacios Académicos-Investigativos Para Superar los Neuromitos. Neuroscience Research Seedbeds As Academic-Research Spaces For Overcoming Neuromyths
The aim of this letter is to highlight the importance of neuroscience research incubators—academic and research-oriented spaces that are particularly valuable for addressing the persistence of neuromyths in education and the health sciences.
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Palabras clave: Alfabetización científica,
educación superior,
neurociencias,
neuromitos,
semilleros de investigación,
Volar Más Alto: Ciencia e Investigación Desde la Periferia. Flying Higher: Science And Research From The Periphery
In the history of medicine, the most significant advances have not always emerged from the most powerful academic centers. Often, innovation has originated in peripheral settings, where necessity and creativity become engines of discovery. In this regard, the metaphor of Jonathan Livingston Seagull—Richard Bach’s celebrated 1970 work—offers a valuable lesson for researchers in resource-limited countries: true scientific freedom lies in daring to fly higher, even when one’s surroundings seem to constrain the possibilities.
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Gaetano Donizetti: Correlatos Neuropsiquiátricos de la Neurosífilis en un Compositor del Siglo XIX. Gaetano Donizetti: Neuropsychiatric Correlates Of Neurosyphilis In A 19th-Century Composer
Music and neurology find a point of intersection in Gaetano Donizetti (1797–1848). This renowned Italian composer—creator of L’elisir d’amore (1832), Lucia di Lammermoor (1835), and more than seventy operas—presented a clinical picture consistent with neurosyphilis, a condition that shaped both his life and his creative output. This letter aims to analyze that clinical picture, highlighting its neuropsychiatric implications and its impact on musical creativity.
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El Diagnóstico Clínico Positivo de los Trastornos Neurológicos Funcionales: Una Oportunidad Para Reducir Costos y Estancias Innecesarias. The Positive Clinical Diagnosis Of Functional Neurological Disorders: An Opportunity To Reduce Costs And Unnecessary Hospital Stays
Functional neurological disorders (FND) represent the second most common reason for neurological consultations, with an estimated annual incidence of 4 to 12 cases per 100,000 people and an approximate prevalence of 50 per 100,000 inhabitants. Despite their frequency, diagnosis is often delayed by an average of seven years—a period during which patients undergo multiple tests, repeated hospitalizations, and inappropriate treatments that unnecessarily increase the burden on healthcare systems.
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Caracterización Clínica y Desenlaces Hospitalarios en Adultos Con Meningitis en un Hospital de Alta Complejidad en Colombia (2019–2021). Clinical Characteristics And In-Hospital Outcomes In Adults With Meningitis In A High-Complexity Hospital In Colombia (2019–2021)
Introduction: Bacterial meningitis in adults is a time-dependent medical emergency due to its rapid progression, risk of septic shock, and severe neurological complications. The objective was to characterize the clinical profile, cerebrospinal fluid (CSF) cytochemical findings, and in-hospital outcomes in adult patients with a clinical diagnosis of meningitis.
Methods: A single-center, retrospective observational cohort study was conducted at a high-complexity hospital in Tunja, Colombia, a regional referral center. Patients with a clinical diagnosis of meningitis who underwent diagnostic lumbar puncture between 2019 and 2021 were included.
Results: Thirty-two patients were included, with a median age of 52 years and a male predominance. The most frequent symptoms were headache and fever; 53.1% presented with altered mental status at admission. CSF analysis showed pleocytosis with predominance of polymorphonuclear cells, low glucose levels, and elevated protein concentrations. In-hospital mortality was 21.9%, 25.0% of patients required admission to the intensive care unit, and 84.4% developed at least one complication.
Conclusions: Patients exhibited a clinical and cytochemical profile consistent with bacterial etiology and a high frequency of adverse outcomes (mortality ~22% and 84% complications). These findings highlight the severity of the condition and the need for timely diagnosis and treatment.
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Palabras clave: complicaciones,
Infecciones,
líquido cefalorraquídeo,
Meninges,
meningitis,
Mortalidad,
Hemorragia Intratumoral en Metástasis Cerebrales de Tumores Sólidos en Pacientes con Cáncer Sistémico: Experiencia del Hospital Carlos Andrade Marín. Intratumoral Hemorrhage In Brain Metastases From Solid Tumors In Patients With Systemic Cancer: Experience From The Carlos Andrade Marín Hospital
Background: Intracranial hemorrhage in cancer patients constitutes a neuro-oncological emergency. Its timely detection is essential for management and prognosis, as it may be due to coagulopathy, drug treatment, or intratumoral hemorrhage.
Objectives: To identify tumors that cause brain metastases with intratumoral hemorrhage and determine their prevalence. To describe the clinical presentation, location, time of onset, prognosis, associated factors, and characteristic neuroimaging findings.
Methods: Descriptive observational study. Patients with intratumoral hemorrhage secondary to brain metastasis admitted to the Department of Neurology at Carlos Andrade Marín Hospital between February 2020 and January 2021 with a diagnosis of spontaneous intracerebral hemorrhage were included. Two patients were analyzed, as they met the inclusion criteria.
Results: The prevalence of intratumoral hemorrhage was 2.9%. The associated cancers were papillary thyroid carcinoma and metastatic immature teratoma. In both cases, the hemorrhage occurred approximately 10 months after the oncological diagnosis and presented with progressive focal neurological deficit, headache, and epileptic seizures. The diagnosis was established by neuroimaging and confirmed by histopathology.
Conclusion: Intratumoral hemorrhage in metastatic brain disease is rare, but its recognition is essential. Presentation with progressive focal symptoms, a history of active cancer, and atypical lobar hemorrhages should raise high suspicion.
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Neurocognitive Impairments in Adults with Chronic Migraine: An Exploratory Cross-Sectional Study. Deterioro Neurocognitivo en Adultos con Migraña Crónica: Un Estudio Transversal Exploratorio.
Background: Chronic migraine is a major cause of disability, often associated with cognitive impairments affecting memory, attention, and executive functions. While such alterations have been described internationally, evidence in Latin America is limited. This study aimed to exploratorily characterize characterize neurocognitive alterations in Colombian patients with chronic migraine.
Methods: A cross-sectional study including adults diagnosed with chronic migraine according to the International Classification of Headache Disorders (2019). Patients were consecutively recruited at the Primary Headache Centre of Excellence between July 2023 and December 2024. Sociodemographic data and cognitive performance were assessed using validated instruments, including the Visual Analogue Scale, migraine disability and headache impact measures, Beck Depression Inventory-II, State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, Montreal Cognitive Assessment, D2 Test of Attention, Rey Auditory Verbal Learning Test, Five Digits Test, Letter-Number Sequencing, Tower of Hanoi, Trail Making Test, and Rey–Osterrieth Complex Figure.
Results: Thirty-two participants were included (96.9% female; mean age 43.4 years). Most reported severe pain and high migraine-related disability, with 68.8% showing severe headache impact. Depressive symptoms were mild to moderate, and anxiety levels were elevated. Cognitive assessment revealed scores below the cutoff of 26 in the Montreal Cognitive Assessment, with moderate deficits in memory, attention, and executive functions, while recognition remained preserved. Pain intensity showed a positive correlation with the D2 Variation Index and negative correlations with verbal learning and executive function tasks.
Conclusion: Adults with chronic migraine present significant neurocognitive impairments, particularly in verbal learning and executive functions, with pain intensity playing a central role.
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MuSK Antibody-Positive Myasthenia Gravis With An Overlapping Systemic Lupus Erythematosus. Miastenia Gravis Positiva para Anticuerpos MuSK con Lupus Eritematoso Sistémico Superpuesto.
Since 1961, the overlap between myasthenia gravis (MG) and systemic lupus erythematosus (SLE) has been increasingly recognized, with MG patients facing up to 13 times the risk of developing SLE, especially after thymectomy, predominantly in young women. Thymic B cells may play a role in MG and SLE, as shown in animal models. MG often coexists with family histories of autoimmune diseases, sharing genetic risk factors with SLE, as supported by genome-wide studies. Patients with both conditions also experience higher rates of other autoimmune diseases, suggesting a potential for broader autoimmunity. Early-onset MuSK-MG strengthens this observed connection.
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Hypertrophic Olivary Degeneration. Degeneración Olivar Hipertrófica.
A 60‑year‑old hypertensive woman with a history of right hemiparesis presented with clicking sounds in the ear, progressive dysphagia, and gait disturbance. Neurological examination revealed palatal myoclonus and ataxia. MRI demonstrated white matter hyperintensities, a chronic small paraventricular infarct in the left cerebral hemisphere, and bilateral hyperintense lesions involving the bulbar olivary nuclei. The latter is consistent with hypertrophic olivary degeneration, a known sequelae of cerebral infarcts.
This case illustrates the delayed injury to the Guillain Mollaret triangle, manifesting as rhythmic palatal movements and impaired coordination. Recognition of this syndrome is essential for accurate diagnosis and for distinguishing it from other causes of dysphagia and movement disorders.
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A Rare Cause of Refractory Headache: Falcotentorial Meningioma. Una Causa Rara de Cefalea Refractaria: Meningioma Falcotentorial.
A 40-year-old woman presented with a 20-day history of severe holocranial headache, progressively worsening with physical effort and associated with nausea, vomiting, photophobia, and phonophobia. She reported multiple emergency department visits, where she received analgesic treatment without symptom relief. Past and family history were unremarkable. On admission, physical and neurological examinations were normal. Cranial computed tomography revealed a mass at the falcotentorial junction, compatible with a falcotentorial meningioma (FM). The patient was referred for surgical excision.
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Prevenir la Enfermedad de Alzheimer: De la Evidencia a la Acción Pública. Preventing Alzheimer’s Disease: From Evidence to Public Action
Preventing Alzheimer’s disease has ceased to be a theoretical aspiration and has become a scientific, clinical, and social obligation. For decades, Alzheimer’s has been viewed with a mixture of resignation and fatalism, as if its onset were an inexorable part of aging. However, this narrative is no longer compatible with current knowledge. Today we know that a significant proportion of the risk of cognitive decline and dementia is linked to modifiable factors, and that intervening on these factors can delay or prevent a significant number of cases. This reality takes on even greater urgency when we consider that the number of people with dementia worldwide could rise from 57.4 million in 2019 to more than 150 million in 2050.
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Interfase Neurona-material: Del Implante Rígido a la Bioelectrónica Blanda. Neuron-material Interface: From Rigid Implants to Soft Bioelectronics
Spinal cord injury continues to represent one of the greatest therapeutic challenges in neurology, not only due to the complexity of the initial damage but also because of persistent limitations in long-term functional recovery. Despite advances in rehabilitation, electrical stimulation, and pharmacological strategies, clinical outcomes remain modest. In this context, it is becoming increasingly clear that one of the main bottlenecks lies not solely in neuronal regeneration itself, but rather in the interface between neural tissue and the materials used for its repair or stimulation.
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Buddleja globosa (Matico) Como Fuente Potencial de Compuestos Fenólicos de Interés Neuroprotector en la Enfermedad de Alzheimer. Buddleja globosa (Matico) as a Potential Source of Phenolic Compounds of Neuroprotective Interest in Alzheimer’s Disease
The insightful review by Bonilla-Santos et al. highlights that neuroinflammation alterations in Alzheimer’s disease (AD) constitute a priority therapeutic target, especially in the early stages of mild cognitive impairment, when biological and behavioral markers precede anatomical damage. In this context, identifying plant-derived compounds with anti-inflammatory and antioxidant activity, capable of modulating relevant cell signaling pathways, is pertinent for future pharmacological development. This letter aims to emphasize the potential of Buddleja globosa (Matico) as a source of phenolic compounds of neuroprotective interest in AD.
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Tensiones Entre las Funciones Ejecutivas y su Correlación con el Enfoque de Género en las Infancias. Tensions Between Executive Functions and Gender Perspectives in Childhood
Regarding the article “Executive functions and gender: systematic review,” published in this journal in 2024 (volume 3), it is reinforced that both working memory and cognitive flexibility are central processes for self-regulation and social adaptation. According to the authors, “Executive functions constitute mechanisms of intermodal and intertemporal integration that allow cognitions and emotions to be projected from the past into the future in order to find the best solution to novel and complex situations.” This process, then, allows children to integrate past experiences with new situations. In this context, and from a gender perspective, we can consider the value of play, since it is through play that gender begins to be constructed socially. However, human groups tend to confuse biological sex and gender, which could generate interpretive tension in the correlations linked to executive functions.
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Caracterización Clínica de la Migraña Crónica Refractaria Tratada con Toxina Botulínica A en Panamá. Clinical Characterization of Refractory Chronic Migraine Treated With Botulinum Toxin A in Panama
Introduction: Chronic migraine limits the quality of life of patients. This condition requires rescue and prophylactic treatment. Many patients do not respond to first-line prophylactic treatment. Since 2015, botulinum toxin A has been used in Panama for patients who do not respond to first-line prophylactic therapy.
Objective: Determine the impact of Botulinum Toxin A as a prophylactic therapy in patients with chronic migraine in Panama.
Methodology: A retrospective, descriptive study. Sample was equal to universe: 29 participants in the PREEMPT 1 protocol. Data collection was based on reviewing medical records. The study evaluated demographic and clinical characteristics, including MIDAS and HIT-6 scales scores.
Results: Participants had an average age of 43 years; all were female. A total of 55.1% experienced 25 to 30 days of acute migraine crises per month. Therapy shows a crisis reduction of 89.66% and 93.10% at 3 and 6 months, respectively. No adverse effects were reported.
Conclusions: Panamanian patients with a diagnosis of chronic migraine resistant to first-line prophylactic therapy have responded positively to treatment with botulinum toxin A, with a significant improvement in their quality of life.
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The Effectiveness of Immersive Virtual Reality for Spatial Learning Tasks in Two Diverse Age Groups. Efectividad de la Realidad Virtual Inmersiva Para Tareas de Aprendizaje Espacial en Dos Grupos Diversos de Edad
Spatial learning is a critical function for our effective functioning in the world. Despite the importance of this function, its study has been limited to unrealistic contexts, hindering a deep understanding of its underlying mechanisms. Today’s technological advancements allow us to study this phenomenon in environments close to natural ones, with the potential to perform physiological measurements that help us understand its mechanisms in humans. In this work, we aimed to evaluate the box room task implemented in an Immersive Virtual Reality System (IVRS) for studying spatial learning in humans. The sample consisted of healthy children and older adults, without neurological or psychiatric alterations. All participants successfully completed the task without any problems associated with the use of IVRS. Although in different ways, both children and older adults showed improvements in the three established performance measures used to assess their performance over the course of the rounds: time, travel distance, and number of errors. Our results support the effectiveness of the box room task implemented in an IVRS for studying spatial learning and navigation in humans. The flexibility of the task positions it as a valuable tool for investigating spatial cognition in a variety of populations with diverse characteristics.
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Bases Neurofisiológicas y Neuropsicológicas Implicadas en las Conductas Delictivas: Una Revisión Sistemática. Neurophysiological and Neuropsychological Bases Implicated in Delinquent Behaviors: A Systematic Review
Neurophysiological and neuropsychological structures are factors that may be involved in the commission of criminal behavior, however, their evaluation in the forensic expert field is far from being considered as evidence or support in court cases in our context. The objective of this research was to identify the neurophysiological and neuropsychological bases involved in criminal behaviors through a quantitative systematic review. For this purpose, previous research housed in Scopus and Pubmed was taken into account. For this reason, a total of 15 articles were identified and analyzed through the application of inclusion and exclusion criteria. The results suggest that most of the neurophysiological structures involved in crimes come from areas linked to the frontal lobe and the limbic system or nearby. Likewise, it was identified that offenders present neuropsychological deficiencies related to decision-making, self-regulation, emotional recognition, aggressiveness, anticipation, planning, among others. In conclusion, it was possible to identify that those evaluated do indeed present neurophysiological and neuropsychological anomalies; however, the commission of criminal behaviors also depends on other biological and social factors. Finally, the systematic review opens the gap to the importance of including forensic neuropsychological evaluation for the clarification of crimes, thus generating one more piece of evidence in judicial processes.
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Refractory Infantile Spasm Syndrome Treatment: A Systematic Review. Tratamiento del Síndrome de Espasmos Infantiles Refractario: Una Revisión Sistemática
Introduction: Infantile spasm syndrome is an epileptic and neurodevelopmental encephalopathy whose first-line treatment includes vigabatrin and hormonal therapy. However, there are refractory cases.
Objective: To compare the efficacy of the available treatments for refractory infantile spasm syndrome (RISS).
Methods: We searched PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL Clinical Trials, International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov until March 2024 for randomized controlled trials (RCTs) comparing the efficacy of two of the following three treatment alternatives: antiepileptics, ketogenic diet and surgery. The primary outcome was electroclinical response. The GRADE methodology was used to appraise the certainty of the evidence. We generated a Summary of Findings table using the GRADEpro software.
Results: We did not find enough RCTs to do a meta-analysis. Only one trial was close to fulfill our inclusion criteria. This study involved 318 patients with RISS receiving antiepileptic drugs and compared the modified Atkins diet (MAD) versus normal diet. However, we found a high risk of bias.
Conclusion: High-quality RCTs comparing treatment modalities for patients with RISS are urgent due to the devastating nature of this condition.
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Palabras clave: Epilepsia,
Espasmos Infantiles,
Revisión Sistemática,
Síndromes Epilépticos,
Sistema nervioso central,
Síndrome de Guillain-Barré y su Variante Faringo Cervicobraquial: Presentación Inusual y Desafíos Clínicos. Guillain-Barré Syndrome and its Pharyngocervicobrachial Variant: Unusual Presentation and Clinical Challenges
Guillain-Barré syndrome (GBS) encompasses a variety of clinical manifestations, including the rare and easily underdiagnosed pharyngeal-cervical-brachial variant (PCB). Here, we present the case of a 57-year-old woman with no significant medical history who lives in an area endemic for vector-borne diseases. She presented to the emergency department with four days of cervicobrachial weakness and acute dysphagia. Although imaging was normal, lumbar puncture revealed albuminocytologic dissociation and neurophysiological tests demonstrated acute demyelinating polyradiculopathy, confirming the diagnosis of the CPB variant. First described in 1986, this variant has been reported following arbovirus infections, such as dengue and chikungunya. This case highlights the importance of considering this atypical form of GBS and suggests the need for future research on its possible association with vector -borne infection.
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Nuevas Posibles Mutaciones para Aceruloplasminemia. New Possible Mutations for Aceruloplasminemia
Aceruloplasminemia is an ultrarare ad late-onset entity within the group of neurodegeneration with brain iron accumulation (NBIA) diseases. There are new mutations to describe, such as the one in this clinical case.
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Presentación Atípica de la Enfermedad de Creutzfeldt-Jakob. Reporte de Caso en la Patagonia Chilena. Atypical Presentation of Creutzfeldt-Jakob Disease. A Case Report in Chilean Patagonia
Introduction: Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disease. Symptoms include rapidly progressive dementia, myoclonus and motor impairment. In Chile, there is a remarkably high incidence, which together with the lethality of it highlights the importance of early diagnosis.
Case report: A 64-year-old woman presented with vertigo, gait instability, dysarthria and diplopia. Physical examination revealed ataxia, dysmetria and dysdiadochokinesia. Magnetic resonance imaging and electroencephalogram were ordered, with findings suggestive of CJD. Patient’s condition deteriorated rapidly, developing dementia after 3 months and dying in the fourth month.
Discussion and conclusion: CJD variants may present without alteration of cognitive functions and nonspecific prodromes. Diagnosis requires a high index of suspicion, taking as essential tests the nuclear magnetic resonance and the measurement of 14-3-3 protein in cerebrospinal fluid. The increased incidence in Chile may be due to mutations and environmental factors, suggesting the need to thoroughly in vestigate the causes and develop appropriate treatments.
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Palabras clave: demencia,
Enfermedades por prión,
Síndrome de Creutzfeldt-Jako b,
Trastornos Neurocognitivos,
Encefalitis de Hashimoto. Hashimoto´s Encephalitis
Introduction: Hashimoto’s encephalitis (HD) is a clinical entity characterized by neurological alterations associated with the presence of positive antithyroid antibodies. This encephalopathy responds well to management with corticosteroids.
Objective: The objective of the manuscript is to present the case of a patient with Hashimoto’s encephalitis.
Clinical case: This is an 18-year-old woman with no significant history, who was admitted for a 5-day history that began with photopsias, recurrent generalized tonic-clonic seizure episodes, with recovery of consciousness between seizures. On admission she was tachycardic, disoriented, unresponsive during questioning, symmetrical pupils, with presence of vertical nystagmus, preferential gaze to the right, clonic facial and left upper limb movements. Paraclinical and imaging studies on admission were normal. On the third day of admission, the patient presented status epilepticus with ventilatory failure, so she decided to manage a barbiturate coma. Lumbar puncture showed hyperproteinorrachia as the only finding; extension studies ruled out autoimmune encephalitis; however, she had subclinical hypothyroidism with positive antiperoxidase antibodies (Anti-TPO). Given this, it was suspected that she had Hashimoto’s encephalitis, so treatment with corticosteroids (prednisolone 50 mg every day) was given, resulting in an adequate clinical evolution of the patient.
Conclusions: This is a low prevalence disease, with varied neurological and psychiatric symptoms, where one of the most important criteria for this pathological entity is the presence of positive antithyroid antibodies with a good response to management with corticosteroids.
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Enfermedad de Lafora: Primer Caso Clínico Diagnosticado en Ecuador Mediante Prueba Genética. Lafora Disease: First Genetically Confirmed Case in Ecuador
Lafora disease is an autosomal recessive progressive myoclonic epilepsy characterized by refractory generalized tonic-clonic seizures, persistent myoclonus, severe and progressive cognitive decline, and a fatal course. We present the first genetically confirmed case in Ecuador. A 17-year-old male developed generalized tonic-clonic seizures at age 13, refractory to combined pharmacological treatment. He exhibited severe and progressive cognitive decline, significant neuropsychological regression, and an IQ of 32. The electroencephalogram (EEG) showed generalized epileptiform activity compatible with progressive myoclonic epilepsy. Genetic testing confirmed a mutation in the NHLRC1 gene. A ketogenic diet was initiated as a complementary therapeutic approach. This case highlights the importance of early genetic diagnosis and a comprehensive multidisciplinary management strategy.
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Palabras clave: diagnós tico genético,
dieta cetogénica,
Enfermedad de Lafora,
epilepsia mioclónica progresiva,
Calcificaciones en Ganglios Basales Compatibles con Síndrome de Fahr en un Contexto Autoinmune. Basal Ganglia Calcifications Consistent with Fahr Syndrome in an Autoimmune Context
A 53-year-old woman with a long history of rheumatoid arthritis, treated with methotrexate and adalimumab, underwent a computed tomography scan of the head during the evaluation of persistent headache. The study revealed dense calcifications in the basal ganglia, predominantly on the left, associated with mild cortical atrophy, without other relevant intracranial abnormalities.
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Criptococosis con Vasculitis del Sistema Nervioso Central Mediada Inmunológicamente: Un Reto Diagnóstico. Cryptococcosis with Immune-Mediated Central Nervous System Vasculitis: A Diagnostic Challenge
We report the case of a 63-year-old man who initially presented with hearing loss and optic neuritis. He subsequently developed vertigo, and multiple multitopographic cerebral infarctions were documented, with negative vascular risk factor evaluation. Panangiography revealed findings suggestive of central nervous system vasculitis, and the initial lumbar puncture showed no evidence of infection; therefore, an immune-mediated vasculitis was considered. Following further neurological deterioration, central nervous system infection due to Cryptococcus neoformans was confirmed. This case highlights the diagnostic challenge and the limitations of initial microbiological testing in central nervous system cryptococcosis.
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Palabras clave: Criptococosis,
efecto prozona,
Síndrome de Cogan,
Vasculitis del sistema nervioso central,
Inteligencia Artificial en Neurología: Una Aliada Para Ser Utilizada como Herramienta en Nuestra Práctica Diaria. Artificial Intelligence in Neurology: An Ally to Be Used as a Tool in Our Daily Practice
Neurology has always been a complex discipline in which every consultation, every complementary study, and each patient challenges us to interpret the signs and symptoms of the physical examination, arrive at a diagnosis, and ultimately determine the appropriate treatment. In recent years, artificial intelligence (AI) has been added, and its presence continues to grow in our field, already becoming part of our daily practice. When used properly, these tools help neurologists shorten the time required to search for differential diagnoses while maintaining clinical depth.
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La Simulación Como Metodología de Aprendizaje Fundamental para la Enseñanza de la Neurología. Simulation as a Fundamental Learning Methodology for the Teaching of Neurology
Reading the article by Castellanos-Ruiz et al. on the application of virtual reality for the treatment of hemiplegia invites reflection on the relevance of simulation in healthcare. Accordingly, the aim of this letter is to highlight the importance of simulation in neurology training.
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Prevalence of Dehydration at Acute Ischemic Stroke Onset and the Impact of Dehydration Subtypes on Severity: A Prospective Observational Study. Prevalencia de la Deshidratación al Inicio del Ictus Isquémico Agudo y el Impacto de los Subtipos de Deshidratación en la Gravedad: Un Estudio Observacional Prospectivo
Background: Dehydration has been suggested to influence stroke severity and recovery through mechanisms like increased blood viscosity and thromboembolism risk. This study aims to estimate the prevalence of dehydration at acute ischemic stroke (AIS) onset and assess the impact of different dehydration subtypes on stroke severity.
Methods: This prospective observational study was conducted at a tertiary care center over a period of one year. Dehydration was assessed using specific biomarkers to check for intracellular dehydration (Group A using urine osmolarity, plasma osmolarity, urine/plasma osmolarity ratio >1.5) and mixed dehydration (Group B using BUN/creatinine ratio >0.20 ) parameters. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS).
Results: Out of 177 AIS admissions, 71 patients met the inclusion criteria (49 males, 22 females; average age: 61.1 years for males, 62.8 years for females). Dehydration was present in 65% of patients at stroke onset. Among dehydrated patients, 33.3% had abnormal Group A parameters, 30% had abnormal Group B parameters, and 36% had abnormalities in both groups. A significant correlation was found between the presence of multiple dehydration markers and increased stroke severity (p < 0.005).
Discussion: The high prevalence of dehydration in AIS patients at onset suggests it may be a potential trigger for stroke and exacerbates stroke severity. Dehydration subtypes, categorized into intracellular, mixed, and extracellular dehydration, have distinct physiological implications requiring specific management strategies. Further research into standardized protocols and innovative biomarkers for dehydration assessment is recommended to enhance patient outcomes.
