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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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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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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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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Malformación Arteriovenosa y Epilepsia. Arteriovenous Malformation And 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
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
La Formación de los Técnicos de Conducta en la Florida (RBT/TC) Training Of Behavior Technicians In Florida (RBT)
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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Revistas Indexadas en Scopus en Ecuador: La Asignatura Pendiente. Journals Indexed In Scopus In Ecuador: A Pending Topic
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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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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Coeficiente de Difusión Aparente en Tejido Encefálico: Valores de Normalidad en Población Colombiana Clínicamente Sana. Apparent Diffusion Coefficient In Brain Tissue: Values Of Normality In Clinically Healthy Colombian Population
Introduction: The diffusion sequences in magnetic resonance, including the apparent diffusion coefficient (ADC), represent a fundamental tool for the radiologist in the clinical diagnosis. However, there is no standardization for measurements between normal limits or a range of normal ADC values. Objective: To determine normal ADC values in the brain tissue for the clinical and radiologically healthy population. Methods: Cross-sectional study on retrospective data, ADC values were measured for 21 encephalic regions (frontal gray, parietal and temporal substance, frontal and parietal white matter, caudate nucleus, putamen, thalamus, internal capsule, cerebellar hemispheres bilaterally and bridge of the brainstem) in 90 clinically and radiologically healthy subjects, in two private clinics in Bogotá. Results: Normal ADC values, in a clinical and radiologically healthy population, in 21 encephalic territories, comparative analysis of the results according to the sex and age of the patients, and correlation between the measurements made by two researchers. Conclusions: The findings serve as a reference for the Colombian and normal Latin American population, establish a point of comparison for the evaluation of intracranial pathologies, and open the possibility to develop new research projects that seek to determine ADC values in sick population.
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Psychometric Properties Of ADHD Rating Scale In School Context. Propiedades Psicométricas de la Escala ADHD en el Contexto Escolar
Background: The ADHD Rating Scale IV (ADHD RS IV) is one of the most commonly used scales in attention deficit hyperactivity disorder (ADHD) assessment. Its psychometric properties have been studied in contexts including Europe and North America, however, in Latin America, there is shortage of empirical evidence about validity or reliability reported by teachers on a scholar context. The aim of the research was to analyze the psychometric properties of the ADHD RS IV based on the behavior of students reported by teachers. Material/methods: Three hundred and forty-five students voluntarily participated in this study (162 men and 183 women), aged between 5 and 15 years (Mage = 10.43, SD = 3.61). As instruments of measurement ADHD RS IV, Perception of Differences Test and Go / No-Go experiment were used. Cronbach’s alpha, Pearson correlation and confirmatory factor analysis were applied and analyzed. Results: In the results it was found that internal consistency coefficient of RS IV ADHD is between .93 and .97. There is a significant statistically correlation between the scale and the number of successes points in the Perception of Differences Test (r = -.55, p = < .001) and mistakes to stimuli no-go (r = .34, p = .002). The classic ADHD model of two factors had good indicators of goodness of fit x2(101) = 321.40, p < .001; CFI = .96; RMSEA = .08 (.07 to .09) and SRMR = .04. Conclusions: The article is finalized highlighting the ADHD RS IV has adequate psychometric properties in order to be applied in the school context.
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Inhibitory Control And Symptomatology Of Attention Deficit Hyperactivity Disorder El Control Inhibitorio y la Sintomatología Del Trastorno Por Déficit de Atención Con Hiperactividad
Background. Inhibitory control has been described as a factor causing difficulties in the regulation present in the ADHD. Objective. The aim was to analyze the relationship between inhibitory control and symptoms of ADHD in a sample of 81 subjects diagnosed with ADHD (Mage=10.05, SD=2.53). Methods. A quantitative, cross-sectional and correlational scope research was carried out. The instruments used were the ADHD RS IV and SIMON experiment. Correlation inferential statistical regression and regression processes were applied. Results. Three regression models were tested, where inhibitory control presents a significant prediction with the (a) attention deficit F(1,79)=20.69, p=<.001, R2=.21, (b) hyperactivity and impulsivity F(1,79)=5.90, p=.01, R2=.07 and (c) the combination of both (a+b) F(1,79)=13.25, p=< .01, R2=.14. Conclusions. The findings suggest that inhibitory control is one of the main executive functions that determines the degree of affectation of the symptomatology of the child population with ADHD.
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Índice Ventricular De Levene y Mensuración del Tercer Ventrículo en Neonatos Ecuatorianos Mediante Ecografía Cerebral. Levene Ventricular Index And Measurement Of The Third Ventricle In Ecuadorian Neonates By Means Of Cerebral Ultrasound.
Introduction: The application of ultrasound in the brain evaluation of the neonate allows the measurement of brain structures. Objective: To obtain the sizes of the third ventricle and the ventricular index of Levene in a group of Ecuadorian neonates without neurological alterations. To establish normal ranges that can be used in the daily work of the neonatology service. Methods: A group of neonates without neurological alterations was studied. Through the anterior fontanelle, the Levene index was determined. The third ventricle’s diameter was seized through the temporal cranial window. Results: Sixty-six patients of 37 weeks’ gestational age at birth (range 27-42 weeks), predominantly male and an average weight at birth of 2554 grams, were included. The third ventricle’s mean diameter was 1.5 mm (range: 0.5 mm – 3.8 mm). The average Lindergaard index was 12.7 mm (8.2-27 mm). Both, the diameter of the third ventricle and the ventricular index were affected by the birth weight of newborns. Regarding the moment of delivery, there was no significant difference in ventricular size. Conclusions: Compared with the results of other series, our study offers different parameters.
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Percepción de Los Padres de Niños Con Déficit Ejecutivos Que Presentan Dificultades en el Aprendizaje de Matemáticas. Parental Perception In Children With Executive Deficits Who Have Learning Difficulties In Mathemathics
The main objective of this research is to describe the executive deficits of children with learning difficulties in mathematics and their relationship with parental perceptions. A sample of 30 children with difficulties in mathematics at ages between 9 and 12 years was studied, they underwent Tower of London test, and to the parents the Children’s Inventory of Executive Functions (CHEXI) was studied. According to the applied tests, the results showed difficulties in working memory, planning, regulation and inhibition. The results showed no correlation between the executive deficits evidenced in children and the perception of parents. However, there is a positive relationship between the perception of parents in the area of working memory and poor academic performance. The results are discussed by the complexity of the evaluated construct and the multiple variables involved at the time of its clinical assessment.
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Perspectivas en el Abordaje Farmacológico de la Epilepsia: Una Revisión Extensa de la Farmacoterapia Perspectives On The Pharmacologic Management Of Epilepsy: A Comprehensive Review
Background. Epilepsy represents the third most common reported neurologic disorder, surpassed only by cerebrovascular accidents and Alzheimer’s disease. Iyt is believed that around 70% to 80% of all convulsive disorders can be successfully controlled with monotherapy alone and an additional 10% to 15% with combination therapy. Around 10% of cases never achieve remission through pharmacological therapy alone. Objectives. Through this comprehensive review of the literature describing the current available pharmacologic therapies for the management of epilepsy and their recognized indications, the authors intend to provide an educational tool that could assist the general practitioner to make decisions when selecting a suitable treatment strategy according to a specific clinical scenario (and as guided by their own professional judgment, circumstances and clinical reality). Methods. We used a wide variety of medical search engines, articles and abstracts for the purpose of data collection and interpretation. Conclusions. Through this review the authors managed to present all current and innovative approaches regarding the pharmacologic management of epilepsy encompassing the scope of current knowledge.
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Primera Crisis Epiléptica en Adultos: ¿Epilepsia o no? First Seizure In Adults: Epilepsy Or Not?
First epileptic seizure is a fact that impacts the life of who suffers and its environment as a relationship with the possibility of a manifestation of epilepsy. It is one of the main causes of consultation in the emergency service, so neurologists and general doctors must have a basic and global knowledge of this. However, there are factors (provoked or unprovoked seizures, risk of recurrence) that it will allow to diagnose of epilepsy with the aim of establishing a timely pharmacological treatment that reduces the possibilities of a new crisis also to resolve the doubts that patients have regarding this disease.
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Fundamentos Neurobiológicos del Sueño. Neurobiological Basis Of Sleep
Sleep is one of the most important behaviors for the cognition of the human being. It has between 4 to 6 cycles that are characterized by presenting different electromagnetic activity that causes a certain brain activity to occur in each of them. When the sleep pattern is affected, there are alterations in the daily life of the subject who suffers it, generating a negative impact on the activities carried out in the personal, family and social environment. In this article we report a theoretical review of the dream, its electrical activity during each of its phases, sleep disorders and the impact of sleep disorders on the individual’s life. It is concluded by emphasizing the role of maintaining a balance in the sleep pattern as a benefit for the daily life of the subject.
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Encefalopatía Posterior Reversible Asociada a Exacerbación de Enfermedad Pulmonar Obstructiva Crónica. Reporte de Caso y Revisión de la Literatura. Reversible Posterior Encephalopathy associated with Exacerbation of Chronic Obstructive Pulmonary Disease. Case Report and Review Of Literature
Posterior Reversible Encephalopathy Syndrome (PRES) is a reversible clinical and radiological entity. There are several entities that are associated with PRES. Chronic obstructive pulmonary disease (COPD) is a rare factor for the development of this condition. We present the case of a 71-years-old woman who was being treated for an acute exacerbation of COPD and developed sensory impairment and seizures. The findings of characteristic images, associated clinical symptoms and their medical history led to a diagnosis of PRES in our patient. Although the association of PRES and COPD is a rare entity, the diagnosis of PRES should be a differential if a patient develops encephalopathy or seizures in the exacerbation of COPD.
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Síndrome de Encefalopatía Posterior Reversible de Etiología Atípica. Posterior Reversible Encephalopathy Síndrome of Atypical Etiology
Posterior reversible encephalopathy syndrome is a clinical-radiological syndrome, characterized by images compatible with vasogenic edema, whose pathophysiology is not fully clarified. There are multiple described causes of this syndrome, mainly severe arterial hypertension, renal insufficiency, sepsis, preeclampsia or eclampsia, immunosuppressive therapy and others. We report a case of a 38-year-old man, renal post-transplant in treatment with mycophenolate and prednisone, with renal failure of the transplant and chronic anemia, hospitalized by urinary focus sepsis plus lymph node tuberculosis, who after receiving 1 concentrate of red blood cells presents seizures, Hb elevation of 3.1 g/dl and images compatible with vasogenic edema and almost complete resolution of them at 16 days.
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Parálisis Facial Secundaria a Arteritis de la Arteria Carótida Interna en Paciente Escolar. Facial Palsy Secondary To Arteritis Of The Internal Carotid Artery In A School Patient
Facial palsy can be secondary to multiple etiologies such as infectious, traumatic, neoplastic, metabolic and neurological; with resolution in most cases. It has an incidence of between 11.5 and 40.2 cases per 100,000 people/year including adult and pediatric patients. We present the case of a 9-year-old patient who consulted for facial paralysis in whom a diagnosis of stenosis of the internal carotid artery was made, with subsequent symptomatic improvement with specific treatment.
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Demencia Rápidamente Progresiva Como Manifestación de Recaída en Linfoma de Células Del Manto: Experiencia en Diagnóstico y Tratamiento. Rapidly Progressive Dementia As A Manifestation Of Relapse In Mantle Cell Lymphoma: Experience In Diagnosis And Treatment
Introduction: Rapidly progressive dementia is an entity that has a multiple and heterogeneous etiology. It is characterized by the alteration of two or more cognitive domains in a period of less than 1 to 2 years. The involvement of the central nervous system attributed to mantle cell lymphoma is rare with a poor prognosis and mainly debuts in the late stages of the disease as a relapse. Case Report: A 61-year-old male with a history of mantle cell lymphoma who presents a relapse of the central nervous system, given by a clinical course compatible with a rapidly progressive dementia and which is confirmed by flow cytometry studies in cerebrospinal fluid. It presents an adequate response to management with a tyrosine kinase inhibitor (Ibrutinib), resolving clinical symptoms and imaging findings. Discussion: The involvement of the central nervous system secondary to mantle cell lymphoma is a rare complication and debuts as a relapse with variable clinical manifestations that requires a timely intervention with the aim of improving patient survival. Therapy with a single agent such as Ibrutinib seems to be a good alternative in cases of refractoriness and neurological involvement.
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Schwannoma Con Una Localización Cervical Infrecuente en un Paciente Pediátrico: Reporte De Caso. Schwannoma With A Non-Frequent Location In Pediatric Patient. Case Report
Schwannomas are usually benign, slow-growing tumors, usually found in adults. They are very rare in the pediatric population and their diagnosis requires a high index of clinical suspicion. We present the case of a 9-year-old male patient with a history of an asymptomatic cervical mass, with no other relevant clinical history. Total excision of the mass was possible, and histopathology confirmed the diagnosis of schwannoma. The patient recovered completely, with excellent prognosis. It is necessary to keep in mind schwannomas in the differential diagnosis in cases of cervical masses in pediatric patients.
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Encefalitis Límbica Autoinmune Asociada a Anticuerpos LGI1: Presentación de un Caso y Revisión de la Bibliografía. Autoimmune Limbic Encephalitis Associated With LGI1 Antibodies: Case Report And Review Of The Literature
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: 76-year-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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Disfunción Mioneural Periférica Como Único Elemento Para el Diagnóstico de la Distrofia Miotónica Tipo I. Myoneural Disfunction For The Diagnosis Of Myotonic Dystrophy Type I
Myotonic dystrophy type 1, also known as Steinert’s disease, is a mulsystemic disorder that primarily affects the skeletal and smooth muscle, as well as the eye, heart, endocrine system and central nervous system. This pathology is uncommon and is characterized by generalized myotonia and multiorgan damage. Its clinical expression is variable, but in most cases, there is a variable degree of muscle weakness, cardiac arrhythmias and other conduction disorders, endocrine disorders, sleep disorders, cataracts and baldness. This is a hereditary disease with three recognizable phenotypes: mild, classic and congenital. Depending on the presentation, it may show poor prognosis and a usually rapid progression, which lacks of effective treatment. Case presentation: 54-year-old female patient who enters the Traumatology service of San Vicente de Paul Hospital in Ibarra, Ecuador for presenting a left femur fracture resulting from a fall of her own height. During hospitalization, the patient presented with type II respiratory failure without apparent cause, so she was admitted to the ICU for ventilatory support. The patient had difficulty achieving ventilatory weaning due to distal and proximal muscle weakness. Electromyography reveals a myopathic pattern compatible with the diagnosis of myotonic dystrophy type I. A tracheotomy was performed, and she was discharged for follow-up by the Internal Medicine service. The performance of a molecular diagnostic study was suggested. Conclusions: The molecular study is the diagnostic gold standard to determine with certainty the presence of myotonic dystrophy type I, besides allowing to determine its severity depending on the number of repeated. However, resource limitations in the present case forced evidence to be sought for diagnosis through electromyography. The treatment remains symptomatic. Because of its inheritance pattern being autosomal dominant, due to the expansion of trinucleotides, family members must be evaluated because they may have the diagnosis even though asymptomatic.
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Imitador de Ictus Debido a Trombosis Venosa Cerebral. Stroke Mimic Due To Cerebral Venous Thrombosis
Introduction: A stroke mimic is any non-vascular pathology that presents as an acute ischemic stroke. The clinical presentation, the epidemiological factors, the time to onset, vascular distribution and the availability of imaging tests are factors that help to differentiate them. Case report: We present a case, of a woman of the third age who was taken to the emergency department due to a five-hour history of left hemiparesis. The clinical evolution and the supplementary tests allowed to exclude the diagnosis of acute ischemic stroke. The semiology was explained by a prolonged Todd’s palsy that behaved as a stroke mimic at the acute phase and the seizures occurred in the context of a cerebral venous thrombosis. Comments: Stroke mimics, in contrast to acute ischemic stroke, occur in younger patients, have fewer vascular risk factors, lower NIHSS score, less aphasia and dysphagia. The main causes are seizures and syncope. Migraines, neoplasms, toxic or metabolic alterations, encephalopathies and functional disorders should also be considered. To perform a complete neurovascular study and directed tests will allow us to make the diagnosis.
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Síndrome de Embolia Grasa Postraumática, Síntomas Neurológicos Sin Clínica Respiratoria en Ausencia de Foramen Oval Permeable. Posttraumatic Fat Embolism Syndrome, Neurological Symptoms Without Respiratory Symptoms In The Absence Of Permeable Foramen Ovale.
Fat embolism syndrome is a potentially catastrophic complication of long-bone fractures. The classic triad of symptoms are petechial skin rashes, hypoxemia, and neurological abnormalities, which usually occur within 24 to 72 hours after the fracture. The respiratory component occurs in practically all of the reports. We present the case of a patient with post traumatic fat embolism with predominant neurological symptoms, without respiratory involvement in the absence of patent foramen ovale.
