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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Deterioro Cognitivo y Demencias en Adultos con Trastorno del Espectro Autista. Cognitive Impairment and Dementia in Adults with Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) has been studied mainly in children. However, currently, 1/68 adults live with this neurodevelopmental disorder. ASD in adulthood shows suggestive symptoms of cognitive impairment, quickly compromising various cognitive functions. Cognitive impairment and behavioral disorders help to develop neurodegenerative diseases such as Frontotemporal dementia (FTD) and Alzheimer’s Disease (AD) in people with ASD during adulthood, which affects activities of daily living (ADL). The objective of this systematic review is to investigate the progression of ASD to cognitive impairment and dementia in adulthood. The methodology included the qualitative analysis of studies published in the years 2000 and 2020, exclusively in english. Results reveal that adults with ASD develop early cognitive impairment and dementia according to the general population, mainly affecting cognitive functions such as memory and executive functions. In conclusion, moderate to a profound degree of intellectual disability, as well as reductions in white matter, seems to be precursors for the development of cognitive impairment and dementia in adults with ASD.

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Palabras clave: Adultez, Demencias, deterioro cognitivo, Discapacidad Intelectual, Trastorno del Espectro Autista,

Keywords: Adulthood, Autism Spectrum Disorder, Cognitive Dysfunction, dementia, Intellectual Disability,

Ictus no comunicable en un adulto joven con parálisis cerebral portador del genotipo MTHFR variante C677T homocigótica. Noncommunicable stroke in a young adult with cerebral palsy carrying the homozygous variant MTHFR C677T genotype.

Cerebral palsy (CP) is a group of disorders that affect movement and muscle tone or posture. It is caused by damage that occurs in the immature brain as it develops, most often before birth.

Although there are few studies in the literature, it has been seen that the risk of stroke is increased in this type of patients. We present the case of a young adult with a recent stroke and CP carrying. The homozygous variant MTHFR C677T genotype, decreased folic acid and vitamin D were found. Stroke in CP context is a challenge for the clinician. Therefore, we think that the possibility of stroke should be considered in every patient with CP, suggesting primary prevention measures in every patient with CP.

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Palabras clave: Genotipo MTHFR variante C677T homocigótica, Ictus no comunicable, Índice de masa corporal, parálisis cerebral,

Keywords: Body mass index, cerebral palsy, Homozygous variant MTHFR C677T genotype, Noncommunicable stroke,

Mielopatía Espondilótica Cervical Como Un Imitador De Accidente Cerebrovascular. Cervical Spondylotic Myelopathy As A Stroke Mimic.

Cervical spondylotic myelopathy (CSM) is the most common nontraumatic spinal cord condition in people over 55 years of age. This disorder is due to compression of the spinal cord by a stenotic cervical canal. A 55-year-old hypertensive patient with a clinical picture that simulated a stroke is described, due to a sudden onset of a right brachiocrural motor deficit, with elevated blood pressure levels in the range of hypertensive crisis. Hours later the patient presented the same motor deficit contralaterally: Computed tomography and magnetic resonance imaging of the brain showed no abnormality. The finding of atrophy in the interosseous muscles was striking. Cervical magnetic resonance imaging was performed showing a narrow spinal canal, with spinal cord hyperintensity in T2 sequences at levels C2 to C6. The most frequent causes of stroke mimics are tumors and metabolic toxic disorders. Spinal disorders represent 1.7% of all cases, CSM being a rare cause.

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Palabras clave: Imitador de ictus, Mielitis, Mielopatía espondilótica cervical,

Keywords: Cervical spondylotic myelopathy, Spinal cord injury, Stroke mimic,

Presentación rara de síndrome antifosfolípido primario asociado a hiperhomocisteinemia como causa de enfermedad cerebrovascular isquémica recurrente en varón joven. Rare presentation of primary antiphospholipid syndrome associated with hyperhomocysteinemia as a cause of recurrent ischemic stroke in young male.

We present the case of a 38-year-old male patient with a history of recurrent ischemic cerebrovascular disease without determined etiology and venous thrombosis in lower limbs. Due to the aetiological diversity of cerebral infarction in a young adult, he underwent a series of clinical tests, which resulted in the diagnosis of a primary antiphospholipid syndrome associated with hyperhomocysteinemia.

Once the diagnosis was made, he was given therapy with anticoagulants and corticoid pulses; with posterior improvement. Antiphospholipid syndrome is part of the differential diagnosis in young women with cerebral infarction; most cases have been reported in its secondary form, but finding it in primary form and in a male patient is rare. Also, increased homocysteine values are related to the severity of the first cerebrovascular event, but not to recurrent events.

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Palabras clave: adulto joven, homocisteína, infarto cerebral, Síndrome antifosfolípido,

Keywords: Antiphospholipid syndrome, Cerebral infarction, homocysteine, young adult,

Enfermedad de Pompe de inicio tardío desencadenada por el embarazo, reporte de una variante clínica genómica descrita por primera vez en un adulto. Late onset Pompe’s disease in a woman triggered by pregnancy, a genomic clinical variant first time described in an adult.

Background: this is the first time in the world that the variant NM_000152 (GAA_V001):c.1555A˃G; p.(Met519Val), is a described in an adult woman, triggered by pregnancy. It is a substitution for a non-sense, homozygous, probably pathogenic mutation.

Case report: this is the case of a mestizo adult woman, born and resident in Ecuador, who during her breastfeeding period, after a pregnancy and cesarean delivery, it did debut with a musculoskeletal disorder. It hospitalized this patient at the Eugenio Espejo Hospital in Quito Ecuador; she has been re-admitted several times. Most relevant clinical findings were proximal muscle weakness, lower limb muscle weakness, difficulty in climbing stairs, respiratory insufficiency due to muscle weakness, edema of her lower limbs, impairment of activities of daily living, orthopnea, sleep disturbance, muscle weakness, elevated serum creatine kinase, abnormal enzyme/coenzyme activity, lumbar scoliosis, pulmonary arterial hypertension, with tricuspid regurgitation and mild mitral regurgitation, fatty replacement of skeletal muscle, pulmonary insufficiency, skeletal myopathy and myotonic discharges in EMG.

Conclusion: this is the first time worldwide that the variant NM_000152(GAA_V001):c.1555A˃G; p.(Met519Val), a substitution by a missense mutation, homozygous, likely pathogenic is describe in an adult. It is the first case triggered by pregnancy , first case of late onset described in Ecuador, and first case described in a mestizo woman from Ecuador.

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Palabras clave: complicaciones del embarazo, edad de inicio, enfermedad de almacenamiento de glucógeno tipo II, enfermedad de almacenamiento de glucógeno tipo IIb, variante genómica clínica,

Keywords: Age of Onset, clinical genomic variant, Glycogen Storage Disease Type II, Glycogen Storage Disease Type IIb, pregnancy complications,

Síndrome de Percherón. Ictus Talámico bilateral. Percheron syndrome. Bilateral thalamic stroke.

Percheron syndrome or synchronous bilateral thalamic infarction is a rare entity with a difficult clinical diagnosis. The complex structure of the thalamus in nuclei, as well as its peculiar irrigation and individual anatomical variability means that ischemic lesions can occur bilaterally in both thalamus due to the obstruction of a single artery, characterizing this picture. We present a case with acute ischemic lesions in both thalamus and anterior midbrain, compatible with the obstruction of the Percheron artery.

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Palabras clave: Arteria Percherón, Infarto talámico bilateral,

Keywords: Bilateral thalamic infraction, Percheron artery,

Adrenoleucodistrofia Ligada al Cromosoma X: Patrón de Desmielinización Mesencéfalo-Ponto-Cerebelosa. X-Linked Adrenoleukodystrophy: Mesencephalon-Pons.cerebellum Demyelinating Pattern.

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Palabras clave: Adrenoleucodistrofia,

Keywords: Adrenoleukodystrophy,

Infiltración dural metastásica. Metastatic dural infiltration.

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Palabras clave: Infiltración dural metastásica,

Bioética, Epidemias y Derechos Humanos. Bioethics, Epidemics and Human Rights

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Palabras clave: Bioética, Derechos Humanos, Epidemias,

Estudio COVID-EC: ¿Por Qué se Justifica Investigar Las Características Clínicas de Los Pacientes COVID-19 En Guayaquil, Ecuador? COVID-EC Study: Why Is It Justified To Research The Clinical Characteristics Of COVID-19 Patients In Guayaquil, Ecuador?

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Palabras clave: Coronavirus, COVID-19,

Recomendaciones Ecuatorianas Para Pacientes con Esclerosis Múltiple en Relación a Pandemia Por Coronavirus (COVID-19). Ecuadorian Recommendations For Patients With Multiple Sclerosis In Relation To A Coronavirus Pandemic (COVID-19)

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Palabras clave: esclerosis múltiple,

Enfermedad Por Coronavirus 2019 (COVID-19): Importancia de Sus Potenciales Efectos Neurológicos. Coronavirus Disease 2019 (COVID-19): The Importance Of Its Potencial Neurological Effects

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Palabras clave: Coronavirus, COVID-19,

Profilaxis en la Migraña: Descripción de la Prescripción en un Primer Nivel de Colombia. Migraine Prophylaxis: Description Of The Prescription In A First Level Of Colombia

Introduction: Migraine is a prevalent disease, crisis can be prevented with medication for not less than 6 months.

Objective: To identify the drugs used for the prophylactic treatment of migraine, inappropriate prescriptions and associated variables.

Materials and methods. Cross-sectional study, in patients of legal age, diagnosed with migraine and prescribed with prophylactic medications. Sociodemographic, comedication, comorbidities and drugs variables were included. Univariate, bivariate and binary logistic regression analysis was performed. Inappropriate prescription was defined by the formulation of drugs without evidence of effectiveness for prophylaxis or by the use of drugs at doses or subtherapeutic times.

Results: 241 patients were included, 87.1% were women. 87.6% of patients received effective drugs, 10.8% probably effective, 2.5% possibly effective and 10.4% drugs without evidence. Propranolol was the most commonly used drug for prophylaxis, on average for 69.1±57.2 days, followed by valproic acid (53.2±55.3 days) and amitriptyline (45.7±39.6 days). 99.6% of patients presented an inappropriate prescription.

Conclusions: A high inadequate prescription of medications for the prophylactic treatment of migraine was identified due to not complying with the recommended dose and duration, as well as an important use of drugs without evidence.

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Palabras clave: Cefalea, Farmacoepidemiología, Prescripciones de Medicamentos, Propranolol, Trastornos migrañosos,

Keywords: headache, Migraine Disorders, Pharmacoepidemiology, Prescription Drugs, Propranololr,

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,

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