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

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The Effect Modification Of Gender On The Relationship Between Neck Circumference And Obstructive Sleep Apnea In Stroke-Free Older Adults. Efecto Modificador Del Género en la Relación Entre la Circunferencia Del Cuello y la Presencia de Apnea Obstructiva de Sueño en Individuos Añosos Libres de Ictus

Background: Objectives: Studies attempting to assess the association between the neck circumference (NC) and the apnea-hypopnea index (AHI) gave inconsistent results. We aimed to assess the effect modification of gender in the association between the NC and the AHI in stroke-free older adults living in Atahualpa (rural Ecuador).

Methods: The study included 190 stroke-free Atahualpa residents aged ≥60 years who underwent brain MRI, polysomnography, assessment of cardiovascular risk factors, the NC and nasal septum deflection.

Results: The mean age of the study population was 71.1±7.6 years, and 64% were women. The mean NC (37.4±2.6 versus 34±2.5 cm; p<0.001) as well as the mean AHI (14.4±14.5 versus 10.5±11.1 episodes per hour; p=0.039) were greater in men than in women. A fully-adjusted generalized linear model showed significant main effects for NC, gender, and a significant interaction between gender and NC over the AHI (dependent variable). Average AHI increased significantly as NC enlarged, but this change was different in men and women. Men started with lower AHI margins at the 10th percentile of the NC, and while both significantly increased, men had a much larger rate of change in the average AHI. Therefore, at the 90th percentile of NC, men had a larger average AHI than women.

Conclusions: This study shows a significant effect modification of gender in the association between NC and AHI. Differences in cervical fat tissue distribution between men and women probably accounted for such effect.

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Palabras clave: Circunferencia del cuello, género, Índice apnea-hipopnea, proyecto atahualpa,

Keywords: Apnea-hypopnea index, Gender, Neck circumference, The Atahualpa Project,

Asociación Entre Enfermedad Renal Crónica No Terminal y Deterioro Cognitivo en Adultos Entre 55 a 65 años de Edad. Association Between Chronic Non-Terminal Renal Disease And Cognitive Impairment In Adults Between 55 And 65 Years Old

Introduction: According to the Latin American Nephrology and Hypertension Society it is estimated that in Latin America exists around 300 patients with chronic renal failure per million inhabitants, while the American Academy of Neurology reports that patients with cognitive risk are investigated from 60 years old.

Objective: To demonstrate the existence of a relationship between levels of decreased glomerular filtration rate and the presence of cognitive impairment in patients with chronic kidney disease.

Methodology: A cross-sectional, observational, descriptive and analytical study was performed to relate glomerular filtration rate levels to the score obtained in the MoCA Test.

Results: The degree of association between the GFR and MoCA Test variables was evaluated. It was found that when the GFR decreases, the value of punctuation of the MoCA test also does, both variables are directly proportional with a p value of statistical significance of 0.000 (very significant) and a 76.55% strong force of association.

Conclusion: We propose that in medical consultations chronic renal ifailure patients must be evaluated integrally, especially their levels of cognition for avoiding the worsening of their quality of life and functional capacity. Our public health system should make more research about this topic

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Palabras clave: deterioro cognitivo, Enfermedad renal crónica, Nefrología, Tasa de Filtrado Glomerular,

Keywords: cognitive impairment, Glomerular Filtration Rate, Nephrology, Renal chronic disease,

Development And Validation Of A Brief Scale To Assess Attachment In Adults: Psychometric Analysis In Latin America. Desarrollo y Validación de Una Escala Breve Para Valorar el Apego en Adultos: Análisis Psicométrico en América Latina

Assessment of the adult attachment in the Latin American context as a research line is not yet solved. This study has the aim to present the results of the development and validation of a scale to assess the adult attachment. The sample was composed of 1563 participants aged between 17 and 33 years from Chile and Ecuador. This scale was formed by 14 items, which allowed the assessment of secure attachment, avoidant attachment, and ambivalent attachment. Results are as following: (a) the scale presented an adequate internal consistency for secure attachment α=.73 and ω=.82, avoidant α=.58 and ω=.70, and ambivalent α=.69 and ω=.73; (b) adequate convergent validity with sense of coherence (r=.34 and .43, p=< .001); (c) the exploratory factor analysis kept up the items’ organization developed KMO=.77, x2=4133.91, p=<.001; and, (d) the confirmatory factor analysis presented a good fit with three items for each attachment type x2(24)=136.28, p=<.001, CFI=.95, RMSEA=.05(.04–.06), SRMR=.03. Findings of psychometric properties are discussed, highlighting the contribution of this scale in the Latin American context and its relationship with previous research.

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Palabras clave: apego ambivalente, apego evitativo, apego seguro, propiedades psicométricas y escala de apego,

Keywords: ambivalent attachment, attachment scale, avoidant attachment, Psychometric properties, secure attachment,

The Role Of Inhibitory Control In The Ability To Solve Problems Of University Students. El Rol Del Control Inhibitorio en la Habilidad Para Resolver Problemas de Estudiantes Universitarios

The aim of the present study was to analyze the role of inhibitory control in the ability to solve problems of university students. The sample consisted of 90 young people with typical development (M_age= 20.58, SD= 1.27), 39 females (43.33%) and 51 males (56.7%). The Stroop and the Anillas’ Test tasks were applied as instruments. As results, it was found a directly proportional and predictive relationship between inhibitory control and problem-solving of university students (correlation between: r= .34 and .47, p= <.01; prediction: r2= .14, F(1,88)= 13.88, p= <.01). It concludes by reflecting on the contribution of conscious control to solve problems faced by the university student on a day-to-day basis in an efficient way and invites future research in order to train inhibitory control.

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Palabras clave: control inhibitorio, Funciones Ejecutivas, monitorización, planificación, resolución de problemas,

Keywords: Executive functions, inhibitory control, Monitoring, Planning, Problem-solving,

Niveles de Hemoglobina y Anemia en Niños: Implicancias Para el Desarrollo de Las Funciones Ejecutivas. Hemoglobin And Anemia Levels In Children: Implications For The Development Of Executive Functions

Introduction: Anemia is one of the most important health problems in the world. In developing countries; anemia coexists with malnutrition, lack of access to water, and sanitation. In Peru, more than 40% of children have anemia that affects their brain function and cognitive processes during their development, even to adult life.

Objective: This study sought (1) to know the levels of hemoglobin and the presence of anemia in children in rural and urban Arequipa, as well as other indicators of physical health, (2) compare the level of development of executive functions between both groups of children, and (3) analyzes of hemoglobin levels predict the cognitive profile.

Method: 49 subjects were evaluated (55% from rural area, 46% girls). Both groups begin regular basic education, different weight measurements were evaluated, including hemoglobin (HemoCuer®) and O2 saturation. The executive functions were assessed with the BANFE test.

Results: Disturbing levels of anemia have been found in the rural area of Arequipa, as well as obesity in children in the urban area. Different processes of executive functions, especially from dorsolateral area have been reduced in rural children; despite having a similar educational and socioeconomic level. Finally, we found that hemoglobin levels explained the 27% of the variance; corresponding to the dorsolateral prefrontal score.

Conclusion: Anemia affects the development of executive functions in children, generating tombs consequences in their neurodevelopment.

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Palabras clave: Anemia, BANFE, Cognición, función ejecutiva, Perú, población infantil,

Keywords: anemia, BANFE, child-population, Cognition, Executive function, Peru,

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,

Multiple Sclerosis: A Review Of The Clinical Practice Guidelines. Esclerosis Múltiple: Una Revisión de Las Guías de Práctica Clínica

Neurological disorders are considered as one of the serious issues worldwide. While, many of the disorders have cure, there are still neurological diseases that lacks of curative treatment. Multiple sclerosis is one of them. It doesn’t have any cure, and therefore the prognosis of the disease is not so good. For this reason, the attention of the healthcare providers is mostly on the clinical management of the patients suffering from multiple sclerosis. The available literature for the clinical guidelines is into various dimensions, with a central focus to care the patients according to the evidence-based recommendations and rationales. A narrative review methodology is used to identify, evaluate, and analyze the available clinical guidelines worldwide. In total, ten clinical guidelines were found out of which only two fulfilled the quality guideline criteria. A quality guideline is the one in which four components are present: systematic review, meta-analysis, expert feedback and levels of recommendations. 2/10 clinical guidelines is a very less number which clearly indicates that there are many loop holes that need to be fixed in order to have a good pool of clinically evident recommendations.

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Palabras clave: Enfoque GRADE, esclerosis múltiple, Guía de Práctica Clínica, Práctica Clínica Basada en la Evidencia,

Keywords: Evidence-Based Practice, GRADE Approach, multiple sclerosis, Practice Guideline,

The Utility Of Earlobe Crease For The Detection Of Sub-Clinical Atherosclerosis. La Utilidad Del Pliegue Del Lóbulo de la Oreja Para la Detección de Aterosclerosis Subclínica.

Traditionally a crease in the ear has been considered a visible marker of atherosclerosis. There is strong evidence of its association with coronary heart disease (CHD) revealed in several retrospective and prospective studies. However, the usefulness of the earlobe crease (ELC) as a marker of atherosclerotic diseases of other vascular beds, especially in the intracranial or extracranial carotid vasculature, is not clear. A non-systematic search of studies evaluating the association between ELC and atherosclerosis was performed. Observational studies that explored the association of ELC with atherosclerosis in many vascular beds were reviewed. Most studies presented methodological limitations, selection bias, and relatively small sample sizes. Discrepancies were found between studies, mainly due to the interaction of age in the association pathway. In a population cohort study, age was the main modifier of the effect of ELC with atherosclerosis in different vascular beds. The role of ELC as a marker of atherosclerosis remains unclear, at least for extra-coronary atherosclerosis.

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Palabras clave: aterosclerosis, enfermedades cardiovasculares, enfermedades cerebrovasculares, Pliegue de la oreja,

Keywords: Atherosclerosis, cardiovascular diseases, Cerebrovascular diseases, Earlobe crease,

Estimulación Eléctrica en Niños y Adolescentes Con Parálisis Cerebral: Una Revisión Sistemática. Electrical Stimulation In Children And Adolescents With Cerebral Palsy: A Systematic Review

Objectives: To analyze the most investigated age ranges in children with cerebral palsy. To identify the anatomical regions treated by electro stimulation. To determine the frequency and duration of the protocols used in the studies carried out between 2009 to 2019.

Methodology: A systematic review of the literature on the utilization of electro stimulation in children with cerebral palsy in the last 10 years was carried out. The search was considered in the Pub Med database. The observation technique was used to extract the information and the indicators were recorded in an evaluation form (type of study, sample, anatomical region treated, subjects investigated, frequency and duration of therapies).

Results: Most of the studies have developed the treatments with electro stimulation in the legs and extensors of the elbow and the wrist and one study -at the same time- in the face and legs. The ages investigated ranged between 1 and 16 years. The protocols have been used from 3 to 5 times per week and in a range of 2 to 12 weeks. The time of administration of the electro stimulation ranged between 20 to 60 minutes.

Conclusion: To obtain positive benefits it is necessary to develop programs from 3-5 times per week and each session in periods of 20 to 60 minutes. This systematization could contribute to an efficient organization in future intervention programs and in the stimulation of other anatomical regions less explored.

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Palabras clave: Estimulación eléctrica, intervenciones, niños y adolescentes, parálisis cerebral,

Keywords: cerebral palsy, children and adolescents, Electrical stimulation, interventions,

Desempeño en Funciones Ejecutivas de Adultos Mayores: Relación Con su Autonomía y Calidad de Vida. Executive Functions Performance In Old Adults: Relationship With Autonomy And Quality Of Life

Throughout the life cycle, the human being is able to consciously control his thoughts, emotions and behavior in a way that adjusts to the demands of the environment, which is lost with old age, affecting the independent and autonomous life of people, negatively impacting their quality of life. The purpose of this review is to determine the executive functions that are most impaired over the years. The narrative review method was used to collect articles that addressed the relationship between executive functions and quality of life in older adults without severe cognitive impairment. The results show that the executive functions that are most affected over the years are attention, working memory and verbal fluency, involved in the search and updating of information; cognitive flexibility, responsible for generating modifications in behavior, thinking and reasoning, fundamental in efficient cognitive functioning. In addition, a slowdown in reasoning, inhibitory deficit, transmission deficit and sensory-perceptive is reported. It is concluded that executive functions are sensitive to the aging process and progressively affect the autonomy and quality of life of older adults. It is considered relevant to generate a maintenance program for these cognitive functions, as a way to promote successful aging.

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Palabras clave: adulto mayor, autonomía en adultos mayores, calidad de vida, Funciones Ejecutivas,

Keywords: autonomy in older adults, Executive functions, older adults, quality of life,

Encefalopatía Hepática: Diagnóstico y Tratamiento en 2019. Hepatic Encephalopathy: Diagnosis And Treatment In 2019

Hepatic encephalopathy is a clinical syndrome of neuropsychiatric disturbances secondary to the variable combination of hepatocellular dysfunction and portal hypertension. It is an ominous entity, which marks a high risk of death in patients with cirrhosis, since its appearance occurs in advanced stages of it. The spectrum of manifestations ranges from subclinical EH, which is only diagnosed by alterations in neuro-psychometric tests, to coma. Currently, the treatment has ammonium as a therapeutic target, either inhibiting or decreasing its production or modifying its extraction and the two most important complications are rifaximin and lactulose, which have proven efficacy both in the management of the acute episode and in preventing recurrence. In 90% of patients, a precipitating factor can be identified and makes part of the entity’s management treat that factor. Despite its wide recommendation, there are recommendations that lack enough evidence to be implemented. As with other complications of portal hypertension, hepatic encephalopathy is an indication of liver transplantation.

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Palabras clave: cirrosis, Encefalopatía, lactulosa, rifaximina,

Keywords: cirrhosis, Encephalopathy, lactulose, rifaximin,

Neurologic Manifestations Associated With SARS-CoV-2 Infection: A Neuro-Review of COVID-19. Manifestaciones Neurológicas Asociadas a la Infección Por SARS-CoV-2: Una Neuro-Revisión de COVID-19

Background. In December 2019, multiple cases of pneumonia of unknown etiology surged in China. In January 2020, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was the identified cause. The World Health Organization (WHO) defined the condition as “Coronavirus 2019 Disease” (COVID-19). In February, its presence was confirmed in South America and Ecuador. On March 11th, the WHO declared COVID-19 as a pandemic. This condition mainly afflicts the respiratory system. However, reports of neurological manifestations in confirmed COVID-19 patients have recently emerged.

Methods. Multiple databases were reviewed, the information was extracted and analyzed independently by 3 authors.

Results. Neurological manifestations associated with COVID-19 were identified. Including: myalgia, headache, altered mental status, cerebrovascular events, dizziness, hypogeusia, hyposmia, neuropathic pain, visual impairment, ataxia, seizures, Central Hypoventilation Syndrome, encephalopathy, rhabdomyolysis, Acute Hemorrhagic Necrotizing Encephalopathy, Guillain Barre Syndrome (GBS), meningitis and encephalitis.

Conclusion. COVID-19 is associated with neurological involvement. It is most frequently observed in cases that are severe, atypical, and with comorbidities. Health care providers and neurologists alike, must remain alert and keep high suspicion of severity when these manifestations are present. Timely recognition might help initiate early treatment and isolation, preventing clinical decline and viral spread.

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Palabras clave: Coronavirus, COVID-19, neurología, Pandemia, SARS-CoV-2,

Keywords: Coronavirus, COVID-19, neurology, Pandemic, SARS-CoV-2,

Neurogénesis y Ejercicios Físicos: Una Actualización. Neurogenesis And Physical Exercise: An Update

Neurogenesis is a brain mechanism of structural plasticity that could be defined as a process of production of new neurons from neural stem cells or progenitor cells. Currently is accepted that neurogenesis occurs mainly in two different neurogenic niches of humans and rodents’ adult brain, the granular zone (ZSG) in the dentate gyrus (GD) of the hippocampus, and the subventricular zone (ZSV) in the lateral ventricles. It is a complex process that depends on various factors being finely regulated, takes four to six weeks to complete and could be regulated positively or negatively by intrinsic or extrinsic factors.

Among the main positive regulators of neurogenesis is the physical exercise. Several studies showed the importance of regular practice of physical exercise for general health and cognitive functions. In the hippocampus, it is able to increase the cellular proliferation, differentiation and neuronal survival. In addition, physical exercise acts in synapses remodeling and modifying neuronal properties, protecting cognitive deterioration due to diseases or the natural aging process.

Thus, the objective of this review is to bring information on neurogenesis and an update that seeks to elucidate the possible mechanisms by which physical exercise favors adult hippocampal neurogenesis.

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Palabras clave: Ejercicio físico, Giro Dentado, Neurogénesis, Neuroplasticidad hipocampal,

Keywords: Dentate Gyrus, Hippocampal neuroplasticity, Neurogenesis, Physical exercise,

Bacterias, Endotoxinas y Neuroinflamación Crónica: ¿Una Etiopatogenia Para las Enfermedad de Alzheimer? Bacteria, Endotoxins And Chronic Neuroinflammation: An Etiopathogenesis For Alzheimer’s Disease?

Alzheimer’s disease represents one of the main health problems in advanced countries. Actually, we do not have an effective therapy for disease and its cause remains unknown. For several decades, research has focused on amyloidogenesis as the primary cause of disease. However, clearly satisfactory results have not been obtained in this line of research. In recent years there has been growing evidence about the role of neuroinflammation in AD and other neurodegenerative diseases. The role of ß-Amyloid as an element of the innate immune response places it in a new position in the pathophysiology of the disease. Alterations of intestinal and oral microbiota could have a role in the generation of neuroinflammatory changes, either directly by pathogens or by bacterial endotoxins. Endotoxins are polysaccharides of gram-negative bacteria that produce a potent immune reaction. Recently, there is evidence that gingipains have a role in production of neurotoxicity and amyloidogenesis. Gingipains are endotoxins produced by a pathogen associated with chronic periodontitis, Porphyromonas gingivalis. Gingipains generate direct neurotoxicity and its effect could be reversed with various molecules that are currently under development.

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Palabras clave: Endotoxinas, Enfermedad de Alzheimer, Gingipaína, Liposacáridos, Microbiota, Neuroinflamación, Patogenia, Periodontitis, Porphyromonas gingivalis,

Keywords: Alzheimer’s Disease, Endotoxins, Gingipain, Liposaccharides, Microbiota, neuroinflammation, pathogenesis, Periodontitis, Porphyromonas gingivalis,

Parálisis Del III Par Craneal Con Disfunción Externa Completa y Preservación Pupilar Como Manifestación de Aneurisma. Reporte de Caso. Third Nerve Palsy With Complete External Dysfunction And Pupillary Preservation, As A Manifestation Of Aneurysm. Case Report.

Acquired paralysis of the oculomotor nerve in the adult population includes various etiologies and frequently those that produce compressive lesions, such as intracranial aneurysms, generate pupillary involvement.

Increasing reports have shown atypical clinical presentations in intracranial aneurysms and this report presents the case of a patient without internal dysfunction or with pupillary preservation in addition to complete external dysfunction, that is, paralysis of all extraocular muscles innervated by the third cranial nerve, due to an intracranial aneurysm, which has not been published in the literature so far. Considering the mortality that is implied by an aneurysmal rupture and the novel clinical presentations reported to date, it is of great importance to request diagnostic means quickly to all patients with third cranial nerve palsy, regardless of their clinical expression.

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Palabras clave: Aneurisma, Arteria Carótida interna, Blefaroptosis, Enfermedades del Nervio Oculomotor, Oftalmoplejía, Trastornos de la pupila,

Keywords: Aneurysm, Blepharoptosis, internal carotid artery, Oculomotor Nerve Diseases, Ophthalmoplegia, Pupil Disorders,

Enfermedad de Parkinson y Respuesta Autonómica al Dolor. Parkinson’s Disease And Autonomic Pain Response.

A clinical case of PD is provided in which we analyze the autonomic involvement in response to pain, using various neurophysiological parameters. After the neurophysiological examination of pain thresholds (hand grip), this patient with 13 years history of Parkinson’s disease, showed a peripheral decrease that made the measurement of blood pressure not very stable. Sympathetic activity and nociceptive sensitivity were diminished, expressing the postganglionar noradrenergic myocardial denervation as it is widely known in parkinsonian patients. It is important to have in mind the autonomic nervous system involvement in Parkinson’s disease.

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Palabras clave: Actividad simpática, dolor, enfermedad de Parkinson, Examen neurofisiológico, Sistema Nervioso Autónomo,

Keywords: Autonomic Nervous System, Neurophysiological examination, pain, Parkinson’s disease, Sympathetic activity,

Trombo Flotante en Arteria Carótida. Carotid Free-Floating Thrombus.

Carotid free-floating thrombus (FFT) is a rare cause of ischemic stroke, usually detected during etiologic vascular studies. There is no consensus regarding the management of carotid free-floating thrombi in those patients.

A 83-year-old male presented to the emergency department with right hemiparesis and dysarthria, consistent with finding of multiple left hemispheric brain infarcts on neuroimaging. Contrast CT showed a free-floating thrombus fixed to an atheroma plaque in left internal carotid artery (ICA). Holter monitorization registered a not previously noticed paroxystic atrial fibrillation. Due to findings, sodic heparinization was started and serial ecosonographic monitoring of the thrombus was performed. He was discharged home with a clot reduction >50% with oral anticoagulant therapy (rivaroxaban 20mg daily). At 2 months, ecographic control was realized without residual clot in left ICA.

Oral anticoagulation is currently the first therapeutic option that should be considered when a FFT is detected. In some reported case series, simple antiplatelet therapy was associated. Deferred surgical endarterectomy has a limited therapeutic gap in these patients when an ulcerated atheroma plaque or a significant stenosis carotid stenosis are detected. Surgical thrombectomy is reported only in few cases series. Endovascular therapies are steadily growing as an effective option when a FFT is detected, usually associated with distal protection devices to avoid distal embolization.

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Palabras clave: Arteria Carótida interna, Fibrilación auricular, Heparina sódica, Trombo flotante,

Keywords: atrial fibrillation, Free-floating thrombus, internal carotid artery, Sodic heparinization,

Síndrome de Arteria Espinal Anterior. Anterior Spinal Artery Syndrome.

Spinal cord infarction is not common to see during daily clinical practice, it is a much rarer condition than a cerebral infarction. However, it is still important, although sometimes it is a challenge, the recognition and correct early management of this pathology that can have a catastrophic prognosis. The meticulous neurological examination is the key to suspect this disease. The most frequent clinical presentation is the anterior spinal artery syndrome. Typically, this syndrome is composed of loss of motor function, pain and temperature sensitivity loss, relatively preserving the proprioceptive and vibratory sensitivity below the level of the lesion. The most important imaging study is magnetic resonance imaging. The treatment is aimed at the general support of the patient, looking for the cause and secondary prevention. We present the case of a 33-year-old male patient, admitted with weakness and paresthesias in the lower limbs, limitation for gait, in addition to 1/5 dysfunctional paraparesis, sensitive level in D5, abolished abdominal reflexes and distal socks type hypoesthesia. Magnetic resonance imaging of the lumbar spine with gadolinium revealed longitudinal hyperintensity in anterior spinal medullary T2 in sagittal sequences from T1 to T8.

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Palabras clave: Arteria espinal anterior, infarto médula espinal, sensibilidad propioceptiva,

Keywords: Anterior spinal artery, proprioceptive sensitivity, spinal cord infarction,

Encefalitis Límbica Autoinmune Asociada a Anticuerpos LGI1. Autoimmune Limbic Encephalitis Associated With LGI1 Antibodies.

Introduction: Leucine rich glioma inactivated protein 1 (LGI1) antibody encephalitis is a rare disease characterized by subacute memory impairment, behavioral disorders and epileptic seizures. Even most cases have a good outcome, residual cognitive deficits are common.

Case report. A 76 years old woman who started with acute onset generalized tonic – clonic seizures and subsequent impaired level of consciousness. Antiepileptic treatment was started with slight clinical improvement. In magnetic resonance imaging performed during admission left hippocampal hyperintensity was seen in T2 and T2-FLAIR sequences. As autoimmune limbic encephalitis was suspected, immunomodulatory treatment with intravenous corticosteroids and immunoglobulins was started with clinical improvement. Afterwards, anti–LGI1 antibodies were positive in cerebrospinal fluid testing.

Conclusions. Anti–LGI1 antibody related encephalitis can produce different neurological manifestations and diverse onset, even acute. Early immunomodulatory treatment is important to improve both clinical manifestations and long–term outcome.

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Palabras clave: anti LGI1, Encefalitis autoinmune, Encefalitis límbica,

Keywords: anti LGI1, Autoimmune encephalitis, Limbic encephalitis,

Encefalitis Autoinmune Anti-Receptor NMDA Reporte de Caso Clínico y Revisión de Literatura. Anti-NMDA Receptor Encephalitis Case Report And Review Of Literature

Anti-NMDA Antibody encephalitis is an autoimmune entity characterized by the presence of autoantibodies against NMDA receptors. It is important to have in mind this entity, because it can be misdiagnosed initially due to its symptoms erroneously attributed to a psychiatric disorder, and diagnosis and treatment may be delayed. In this case report we describe a young woman who entered with neurological – psychiatric symptoms that simulate an acute schizophrenia and finally was diagnosed of autoimmune encephalitis.

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Palabras clave: anti-NMDAr, anti-receptor NMDA, encefalitis, Encefalitis autoinmune, Psiquiatría, teratoma de ovario,

Keywords: anti NMDA receptor, anti-NMDAr, Autoimmune encephalitis, encephalitis, ovarian teratoma, Psychiatry,

Transient Global Amnesia Disclosing A Right Thalamic Dysembryoplasthic Neuroepithelial Tumor. Amnesia Global Transitoria Secundaria a un Tumor Neuroepitelial Disembrioplásico Localizado En El Tálamo Derecho

A 56-year-old, right-handed, previously healthy women, presented with transient global amnesia (TGA), characterized by the sudden onset of anterograde amnesia and confusion with a normal level of consciousness. During the episode, the patient recurrently asked what she was doing and what she had been told, but was able to recognize familiar faces. Mild-to-moderate right fronto-orbital headache was a companion symptom. The episode lasted about 10 hours.

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Palabras clave: amnesia global transitoria, Tumor Neuroepitelial Disembrioplásico,

Keywords: Dysembryoplasthic Neuroepithelial Tumor, Transient global amnesia,

Cefalea Numular: A Propósito de dos Casos. Nummular Headache: About Two Cases.

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Palabras clave: Cefalea Numular,

Keywords: Numular Headache,

Malformación Arteriovenosa y Epilepsia. Arteriovenous Malformation And Epilepsy.

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Palabras clave: Epilepsia, Malformación Arteriovenosa,

Keywords: Arteriovenous Malformation, Epilepsy,

¿Es Posible Regular Concursos de Jefaturas de Servicio? La Importancia del Cambio y la Diversidad. Is It Possible To Regulate The Service Chief Competition? The Importance Of Change And Diversity

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Palabras clave: editorial,

Desarrollo de las Publicaciones Sobre Neurología en Latinoamérica A Través del SCImago Journal And Country Rank. Development Of Publications On Neurology In Latin America Through The Scimago Journal And Country Rank

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Palabras clave: carta al editor,

La Formación de los Técnicos de Conducta en la Florida (RBT/TC) Training Of Behavior Technicians In Florida (RBT)

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Palabras clave: carta al editor,

The Wiwanitkit Affair. La Aventura de Wiwanitki

Dear Editor – I would like to call to your attention and that of the editors of other medical journals to an uncommon situation that may represent a case of scientific misconduct. During the past years, I have received several “letters to the editor” written by Dr. Viroj Wiwanitkit (Bangkok, Thailand), commenting on my publications on neurocysticercosis. While those letters were not hostile, they included useless comments and were clearly written by a person that is not familiar with this disease.

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Keywords: letter from the editor,

Revistas Indexadas en Scopus en Ecuador: La Asignatura Pendiente. Journals Indexed In Scopus In Ecuador: A Pending Topic

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Palabras clave: carta al editor,

Enfermedades Neuro-Psiquiátricas en Atención Primaria en una Zona Rural de la Sierra Ecuatoriana en el 2018. Neuro-Psychiatric Diseases In Primary Care In A Rural Area Of The Ecuadorian Highlands 2018

Aim: To provide epidemiological data of neuro-psychiatric diseases. Methods: The sample corresponds to a native population of the northern Ecuadorian highlands, the data was retrospectively collected obtained from daily records of the health center in 2018. Neurological and mental health pathologies codified in ICD-10 were considered. Results: Of the total registered medical consultations, 521 corresponded to neuro-psychiatric diagnoses (4.07%). The majority of patients were women 66.79%. The average age was 39.22 years old 95% CI 37.17-41.26. Ethnic self-identification was native in 90.79%. The most frequent neurological pathology observed was the spectrum of headaches including migraine, tension headache and headache with 240 cases; and the psychiatric mental and behavioral disorder with 18 cases. It was also found that older women are more predisposed to suffer from these diseases. Conclusions: The integration of neurological and psychiatric services in primary health care should be an important political objective in our country for the early diagnosis and treatment of these pathologies with great impact on health.

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Palabras clave: Atención Primaria, Ecuador, epidemiología, neurología, Psiquiatría,

Keywords: Ecuador, epidemiology, neurology, Primary Care, Psychiatry,

Midline Cava And Limbic System Dysfunction In Community-Dwelling Individuals Aged ≥20 Years Living In Rural Ecuador. A Case-Control Study Nested To A Population-Based Cohort. Cavum de Línea Media y Disfunción del Sistema Límbico en Individuos de 20 Años o Más Que Viven en Zonas Rurales Del Litoral Ecuatoriano. Estudio de Caso-Control Anidado en Una Cohorte Poblacional

Background: Persistence of cavum septum pellucidum (CSP) and cavum vergae (CV) into adulthood and their association with mood disorders is unknown. Objective: We aimed to assess persistence of these cava in Atahualpa cohort individuals, and their association with clinical depression (as a surrogate of limbic system dysfunction). Methods: Cases were defined as Atahualpa residents aged ≥20 years with CSP and/or CV and paired 1:1 to age- and sex-matched randomly-selected controls. A board-certified psychiatrist (blinded to case-control status) interviewed individuals with the aid of the Patient Health Questionnaire depression module (PHQ-9) to establish a diagnosis of clinical depression. The McNemar’s test and conditional logistic regression models were fitted to assess the independent association between persistence of CSP and/or CV and clinical depression (as the dependent variable). Results: Of 1,298 individuals undergoing a head CT, 51 (3.9%) had a CSP and/or CV. The selection process for the nested case-control study on the Atahualpa cohort (after excluding eight missing individuals with midline cava) generated 43 pairs. Nine of 43 case-patients (20.9%) and only two control subjects (4.7%) had moderate-to-severe scores on the PHQ-9 (cutoff ≥10 points). Clinical depression was significantly more frequent among case-patients than controls by the McNemar’s test (OR: 8; 95% C.I.: 1.1 – 354.9) and the conditional logistic regression model (OR: 8; 95% C.I.: 1.00 – 63.96). Conclusions: This study provides epidemiological evidence favoring the association between midline cava and clinical depression, supporting their relationship with limbic system dysfunction.

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Palabras clave: Cavum Septum Pellucidum, Cavum vergae, Depresión clínica, Módulo de depresión del cuestionario de salud del paciente,

Keywords: Cavum Septum Pellucidum, Cavum vergae, Clinical depression, Patient Health Questionnaire depression module,

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