Sound and music share a lot, but they are not totalitarian synonyms. Each one has some qualities or elements that define them even when they are equivocally seen as equals. Sound is a physical event, while music is an art that uses that event as material to develop itself. In our brain, music is processed through neural networks that involve areas of auditory and motor processing, in turn, their perception and execution involve various cognitive functions. Although current knowledge of the structures involved in hearing and the effect of music in our brain is still uncertain, a review of the most up-to-date literature on the subject is useful.
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Manifestaciones Neurológicas Asociadas a Infección por Virus Zika
Zika virus is a flavivirus and it is part of the flaviviridae family. This virus is transmitted by Aedes mosquito bites and sexual intercourse. The virus was discovered in 1947 but it was almost unknown until it spread along America in 2015 and was associated with multiple neurological disorders. Due to this incidence, the World Health Organization declared an emergency status in 2016. In Ecuador, the first case of Guillain-Barre Syndrome associated with Zika virus infection was reported during
the same year.
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Tratamiento Neuropsicológico del TDAH en Preescolares: Entrenamiento de la Función Ejecutiva
Preschoolers who have symptoms of impulsivity, hyperactivity and attention deficit manifest alterations in the executive functions: inhibitory control, working memory, monitoring and self-directed speech. It is essential in the preschool classroom to identify children who have difficulty regulating their behavior. The importance of this early detection is the possibility of avoiding a picture of ADHD with greater complexity in the child’s future. Training of executive function in children who could present these symptoms has been described as a highly effective strategy. Researches affirm that training of executive function would decrease the likelihood that a child will have ADHD at school age if he had received early attention from preschool. From the clinical experience it has witnessed the evolution of cases of children identified preschool with symptoms of ADHD, and then do a training executive functions for periods of one to two years better, and even at the beginning of schooling have a less severe psychopathology, unlike children who have not received this early intervention. In this paper I will describe the clinical picture of ADHD in initial preschool, the relationship between this disorder and executive function and some strategies in the training of executive functions.
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Síndrome de Guillain-Barré: Un Caso Atípico
Guillain Barre Syndrome (GBS), is an acute inflammatory polyneuropathy, of autoimmune etiology that produces an inflammation in the peripheral nerves and its spinal roots. GBS generally presents as flaccid, symmetric, ascendent and areflexic palsy, along with a previous respiratory or gastrointestinal infection. It has been reported atypical forms of presentation. We describe the case of a 53 years old male patient, without previous infections in the last months, who is admitted to the emergency department presenting walking difficulties due to decreased muscle strength, pain and numbness in the lower limbs, deep tendon reflexes present, followed few days later by a right peripheral facial palsy. Examination of cerebrospinal fluid (CSF) revealed albumino-cytological dissociation, leading to diagnose GBS of atypical presentation, which was treated with intravenous immunoglobulin followed by a favorable outcome.
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Parkinsonismo y Mielinolisis Osmótica. Descripción de caso
Introduction: Osmotic demyelination syndrome is a rare medical condition in which parkinsonian signs are relatively non frequent. Objective: To report a case of a patient with hyponatremia rapidly corrected and treated with neuroleptics. The cranial MRI showed demyelinating lesions in pons and basal ganglia. The patient clinically developed parkinsonism, with no response to dopamine. Conclusion: The inadequate correction of hyponatremia causes demyelinating lesions. As we appreciate in this case, the prescription of neuroleptic drugs may negatively affect the response to dopaminergic therapy.
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Razonamiento Clínico: Hombre de 57 Años de Edad con Dolor y Debilidad Muscular Proximal
We present a case of a 57-year-old man with a two-month history of shoulder pain and proximal weakness. The history and physical examination are reviewed and a stepwise approach to the differential diagnosis is made to reach the final diagnosis.
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Infarto Talámico Bilateral
Palabras clave: infarto cerebral,
lupus eritematoso,
Feasibility of Global Sleep Research in Rural Areas of Low-and-Middle-Income Countries. The Atahualpa Project Experience
Changes in lifestyle, including sedentarism, shift work and increased visual contamination, have modified sleep patterns and increased the prevalence of sleep-related disorders in remote rural areas of many low- and middle-income countries (LMIC). However, there is scarce information on the public health impact of sleep-related disorders in these regions and publications lack consistency in their design and use of research tools, which creates barriers for proper comparison of results across populations. Moreover, in the largest studies on sleep-related disorders conducted in LMIC, individuals were interviewed with only one or two questions, which might not reflect the actual magnitude of the problem. In our opinion, the goal should not be to interview tens of thousands of individuals but to study them well by selecting representative populations of different regions to evaluate them thoughtfully and uniformly.
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Trombectomía Mecánica: Técnica de Primera Elección en el Tratamiento del Ictus Isquémico Agudo. Análisis de Beneficios y Resultados
The main objective of this article is to portrait mechanical thrombectomy as the modality of choice for interventional stroke treatment.
Methods and materials: Nine patients with acute ischemic stroke were diagnosed. Mechanical thrombectomy was perfomed in all of them with a solitaire type device associated with intraarterial rTPA. Eight patients (89%) had anterior vascular occlusion and only one (11%) had posterior vascular compromise. Treatment efficacy was assesed using a modified Rankin scale (mRs).
Results: Five patients (55%) had complete recovery while three of them (33%) had partial recovery. Only one patient (11%) showed no recovery at all.
Discussion: Although more data is needed, mechanical thrombectomy prooved to be effective and shows promising outcomes in patients with acute ischemic stroke.
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Palabras clave: ictus isquémico agudo,
trombectomía mecánica,
Keywords: acute ischemic stroke,
mechanical thrombectomy,
Experiencia Quirúrgica de Dos Años en el Manejo de la Epilepsia Refractaria Multifocal
Objective: To describe the series of patients with multifocal refractory epilepsy who have undergone surgery in our center.
Methods: A prospective analysis of patients with multifocal refractory epilepsy treated in our hospital during the last two years was performed.
Results: In this period we studied 25 patients with multifocal refractory epilepsy who have completed > or =1 year postoperative follow-up after callosotomy. The ages of the patients were between 3.8 and 18.8 years (mean 11, SD 4.46). The most common cause of refractory epilepsy in our series was Lennox Gastaut syndrome (ten patients). We perform 14 callosotomy in 13 patients. Of these, 10 were of the above callosotomías 2/3 and four complete. Overall there was a 66.5% reduction in seizures; in the case of total callosotomías this reduction was 90%. We report two minor complications and death from a pneumonic process.
Conclusion: The surgical management of multifocal refractory epilepsy is a safe procedure that provides good results in controlling the crisis. The complete callosotomy is the most efficient procedure in this population.
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Palabras clave: Callosotomía,
Cirugía de la epilepsia,
Epilepsia refractaria,
Neuronavegación,
Planificación quirúrgica,
Impacto del Aprendizaje del Inglés Sobre los Procesos Cognitivos en Adultos Mayores. Un Estudio Preliminar en Cuenca
A descriptive exploratory study, before and after a six-month english learning course for seniors is conducted to evaluate the cognitive effect of learning another language in this age group in the city of Cuenca.
Materials and Methods: 80 adults of average age 70.48 ± 4.9 years (31 men, 19 women) were included; who underwent neurological and neuropsychological evaluation at baseline, six and twelve months after the course; including tests for executive function (working memory and attention processes).
Results: Data show significant statistical association between impaired olfactory perception related to age. Neuropsychological tests show interesting data relating cognitive maintenance and even improvement in the Performance Testing Direct and inverse series (Wais III) and Symbol Digital Modality Test (SMDT) six and twelve months after initiating a learning course of English.
Conclusion: The study suggests that learning English, even without functional objective of a new language, may have protective effect on the executive functions and neuronal brain networks are claimed the first findings in patients with cognitive impairment. We suggest perform this follow up long term in time to find strongest evidence, related to international bibliography.
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Validación de la Escala de Impulsividad Bis 11-C para su Aplicación en Adolescentes Ecuatorianos
Barratt scale (BIS) is an assessment tool often used to evaluate impulsivity. In this study, an analysis of the psychometric properties of the BIS 11 c scale Ecuadorian adolescent students (N = 245) is performed. Internal consistency through Cronbach’s alpha coefficient and homogeneity of the items were evaluated. For assessing the construct validity we perform a confirmatory factor analysis. The results obtained were acceptable parameters of valid and reliability to use the BIS 11 c scale in Ecuadorian adolescents. Finally, a discriminant analysis in a clinical sample of 18 students with ADHD was conducted.
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Neuronavegación en Tumores de Fosa Posterior en Pediatría
Introduction. Primary tumors of the central nervous system represent about 2% of the total of the neoplasms in adults and 20% of total neoplasms in children. Posterior fossa tumors represent 48% of pediatric population and are the first cause of malignancy of solid organs in the pediatric age. In our environment, the use of neuronavigation in the excision of posterior fossa tumors in pediatric population has not yet been adequately standardized.
Materials and methods. A retrospective observational study from january 2014 to may 2016 of patients diagnosed with posterior fossa tumors is reviewed. We included 20 patients with diagnosis of space-occupying lesion in posterior fossa.
Results. The relationship man: woman was 1:1. The average age was 4 years and 4 months. The degree of precision of the intraoperative neuronavigation prior to craniotomy had an average error margin less than 1.5 millimeters, varying from 1 to 3 millimeters.
Conclusions. Neuronavigation is useful in performing a precise surgery, reducing risks associated with the intervention and shortening the surgical times. Because of greater tumor resecting, neuronavigation is usefel in increasing survival of oncologic pediatric patients.
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Demencia y Ley. El Papel Jurídico del Neurólogo
Dementia has several legal effects under ecuadorian law. These effects are produced once dementia has been judicially established. The judge decides that a person suffers dementia based on a neurological report. When a neurologist elaborates such report, he has to take into account that legal concept of dementia resembles the medical concept of dementia.
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Tuberculous Encephalitis Associated With Basal Ganglia Lesions And Movement Disorders
An increasing number of autoimmune disorders with predominant involvement of the basal ganglia which result in movement disorders and psychiatric symptoms have been described. We report a 26 year old patient who, three weeks after initiation of treatment for tuberculous meningitis, presented with acute right hemichorea-ballism and confusion One week later the patient presented acute left hemiparkinsonism. The CSF showed oligoclonal bands. The MRI showed bilateral lesions in the basal ganglia in the T1W and FLAIR sequences. Antituberculous therapy with concomitant steroids and L dopa treatment ,resulted in clinical improvement .To our knowledge this is the first report of tuberculous encephalopathy associated with involvement of the basal ganglia and movement disorders.This case suggests involvement of the basal ganglia through an immune mediated pathogenesis.
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Palabras clave: corea,
encefalitis tuberculosa,
lesión de ganglios basales,
parkinsonismo,
patogénesis,
Mielinólisis Extrapontina Secundaria a Hiponatremia por Crisis Adrenal
Introduction: Extrapontine myelinolysis is an acute unusual process, included in demyelinating syndromes of metabolic etiology, which differentiate from central pontine myelinolysis, by affecting other brain areas with clinical manifestation such as dystonia, catatonia, postural tremor, myoclonic spasm, parkinsonism or pyramidal sings.
Objective: Present clinical, electrolytic, hormonal and neuroradiologic findings with emphasis in the unusual location of this disease.
Conclusion: Unlike central pontine myelinolysis, extrapontine has a lower incidence. Trismus, manifested in this patient is an unusual sign. The treatment is only supportive, with a high probability of mortality.
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Palabras clave: Hiponatremia,
mielinólisis extrapontina,
síndrome de desmielinización osmótica,
trismo,
Síndrome de Weber, Etiología Infrecuente y Resolución Espontánea
Weber’s syndrome is characterized by a third nerve palsy associated with contralateral hemiparesis because of a damage to the cerebral peduncle, due to multiple etiologies.
We report the case of a 40 years old man with no history of diabetes mellitus or hypertension who suddenly presented with diplopia and left hemiparesis. The MRI scan showed an angioma in the midbrain. Its relevance lies in the rare etiology of this syndrome and its spontaneous resolution.
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Razonamiento Clínico: Mujer de 63 Años de Edad Presenta Trastornos del Habla, Trastornos del Lenguaje y Debilidad del Lado Derecho
A case of a 63-year-old woman with one week history of speech and language abnormalities as well as right-sided weakness is presented. The history and physical examination are reviewed and a stepwise approach to the differential diagnosis is made to reach the final diagnosis and treatment.
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Unidades Multidisciplinares
Palabras clave: editorial,
unidades multidisciplinares,
Deterioro Cognitivo y Riesgo de Demencia, una Realidad para el Ecuador. Estudio de Factores de Riesgo en un Grupo de Pacientes Jubilados del IESS en Cuenca en el año 2013
According to WHO in 2050, 110 million people will be affected by dementia. Ecuador will see among the diseases related to underdevelopment, those related to increased life expectancy. We conducted a cross-sectional study in a health facility IESS in Cuenca. 391 peopled signed an informed consent and answered a form to define the demographics and identify potential risk factors associated to dementia. The mental state was studied using the Minimental-test (MMSE) tool and comorbidity of depression by Yesabage screening test. Data was analyzed using SPSS 15 for Windows. The average age was 70 years, 84% were women and 97% of them live as urban residents in Cuenca. By applying the MMSE, 17.1% showed cognitive impairment with RR of 3.81 for ages 65 and older and female condition. Chronic diseases such as diabetes and arthrosis were the most frequent comorbidities with statistical association for risk; hypertension, COPD, etc., showed no statistical association. 40.9% of the sample group where possitive for depression showing serious nature in 37.5%.
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Capacidad Diagnóstica y Validación Preliminar del Test del Reloj, Versión de Cacho a la Orden, para Enfermedad de Alzheimer de Grado Leve en Población Chilena
Background: To perform a study with discriminant power and validity using the Clock drawing Test by instruction (CDTI) in patients with mild Alzheimer’s disease (MAD).
Materials and Methods: Phase I diagnostic test study. We included a healthy control arm of 58 elderly people and 40 cases with mild Alzheimer’s disease. All participants were examined and diagnosed by clinical consensus. The MMSE, CDTI and clinical record were obtained.
Results: There were significant differences between the study groups regarding cognitive tests’ performance when comparing age and education, but no differences were found when comparing gender. ANCOVA test showed no significant effect exerted by the demographic variables on cognitive performance in any group. The sensitivity (CTO=84% vs MMSE=79,3%), specificity (92,5% vs
82,5%) and diagnostic utility of the CDTO were higher than one’s resulting form the MMSE (=0,90, p=0,000). The combined use of both
instruments increased diagnostic capacity. The best cutoff point for the diagnosis of mild dementia was ≤6 points in CDTO and ≤23 in
MMSE. Both instruments correlated statistically.
Conclusions: The CTO is a useful test and can discriminate between cognitively healthy subjects and patients with EAL when appliying the “to order” criteria from Cacho’s version.
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Validación de Diferentes Escalas en la Evaluación del Pronóstico de Pacientes con Hemorragia Subaracnoidea Espontánea en el Hospital Regional “Dr. Teodoro Maldonado Carbo” entre Mayo-2011 y Mayo-2014
Background: Subarachnoid Hemorrhage (SAH) is associated with a high mortality rate and functional consequences. Several scales have been created in order to assess prognosis after SAH, and even though they have been widely studied, neither has achieved universal acceptance.
Objective: Validate different scales assessing the prognosis of patients with spontaneous SAH in a local hospital population.
Methods: A retrospective, cross-sectional study was conducted on patients admitted to the “Dr. Teodoro Maldonado Carbo” Hospital, diagnosed with spontaneous SAH, between 18 and 75 years. Descriptive statistics and Spearman correlation coefficient were calculated in order to evaluate the association of the Hunt and Hess, WFNS and Fisher Scales with functional outcome.
Results: Hunt and Hess Scale had a higher correlation (60,3%; p=0,000) with the functional outcome at discharge or death, compared to 55,3% (p=0,000) obtained by the World Federation of Neurological Surgeons Scale and 50% (p=0,000) by Fisher Scale. In addition, the Glasgow Coma Scale score (-58,4%; p=0,000), altered pupillary response (54,7%; p=0,000) and the need for invasive mechanical ventilation (73,8%; p=0,000) were factors associated with functional score.
Conclusion: Hunt and Hess Scale revealed a good correlation with the Rankin functional scale at discharge or death, and is superior to the other scales in evaluating the prognosis of patients with spontaneous subarachnoid hemorrhage.
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Concepto de la Demencia como Enfermedad en un Grupo Poblacional de la Ciudad de Guayaquil
Background: Dementia is a clinical condition that causes progressive cognitive impairment, and early diagnosis may have a significant impact on the quality of life. So far, no studies have been conducted to evaluate the conception of the general population about this disease.
Methods: Cross-sectional, descriptive and analytical study, which surveyed individuals between 55 and 65 years old without neurocognitive pathology about the concept of the term “dementia”. The educational level of each respondent was also collected. The responses were assigned to one of 6 possible response groups for analysis, depending on which group better matched each individual response. The percentage of each type of response was calculated, and chi-square was used to observe the relationship between level of education and the type of answers given.
Results: a total of 274 individuals were surveyed, 35.8% were male and 64.2% female. Most patients (36.5%) had only elementary education. 11.7% did not know what dementia means. 45.5% defined it as memory loss and 23% incorrectly identified it as a psychiatric illness. A very small percentage of individuals correctly defined it as a type of cognitive impairment. We found a statistically significant relationship between the level of education and the type of answers obtained (p <0.001).
Discussion: more than half of respondents gave an acceptably correct answer about the concept of dementia, but there is still a significant percentage of people who do not know its meaning, or confuse it with psychiatric illness. It is imperative to carry out health campaigns to alert people about this disease and how to delay it’s onset by lowering risk factors, and to train as well primary care physicians to provide better information to their patients in order to improve the prevention of dementia and lessen its impact on quality of life.
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Electroestimulación En Músculos Rectos Abdominales Para el Aumento de la Capacidad Respiratoria Proporcional Para el Habla en Personas con Lesiones Medulares Cervicales.
Cervical spine injuries present with dysfunctions of the respiratory system characterized by: a reduction in forced vital capacity, ineffective cough, decreased peak expiratory and speech problems. Speech therapy intervention using an exercise program improves the intensity of the voice and fluency, the objective of this study was to determine the effect of electrotherapy in abdominal muscles on respiratory capacity proportional to speak in cervical injuries. We studied 60 people with chronic traumatic cervical spinal cord injury and restrictive breathing; they were divided in two groups: experimental (n=30) and control (n=30). Control group received speech therapy exercises and the experimental group received speech therapy and electrotherapy in abdominal muscles prior to the workout. Patients were assessed before and after application of the treatment with the following variables: forced vital capacity, peak expiratory flow, maximum phonation time, reading the words of two syllabes, vocal intensity and rate of speech disabilities. Two groups showed significant improvement in speech therapy variables evaluated after treatment (p ≤0.05). However, the use of electrical stimulation significantly increased the recovery of variables: vocal intensity (p =0.0485) and peak expiratory flow (p =0.0000) and both variables showed positive correlation [F (1, 28)=7.5478, p <0.01]. Conclusions: electrotherapy in abdominal muscles is beneficial for the improvement of peak expiratory flow and vocal intensity. Peak expiratory flow demonstrated to be a predictor of vocal in tensity.
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Palabras clave: electroestimulación,
función respiratoria,
Habla,
lesión medular cervical,
terapia logopédica,
tetraplejia,
voz,
Código Ictus: Protocolo de Tratamiento del Ictus Cerebral Isquémico
Cardiovascular diseases are the leading causes of mortality worldwide and Ecuador is not an exception. One of the great issues about these phenomena is the impact on vital organs such as the brain. Several features of cerebrovascular diseases, such as the high rate of associated disability and radiological advances, have encouraged the different government health institutions to establish standardized procedures, which are executed in order to generate an early diagnosis and individually analyze following procedures in affected patients. This article reviews the literature about CODE STROKE, which is a standardized approach performed in spaniards hospitals.
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Quistes Aracnoideos Bilaterales de Ángulo Pontocerebeloso
Palabras clave: lesion intracraneal,
quistes aracnoideos,
Disappearing Cerebral Microbleed After A Lacunar Infarct
Both, lacunar infarcts and deep cerebral microbleeds are recognized markers of cerebral small vessel disease. However, the “de novo” appearance of an infarct at the site of a previously documented microbleeds has not been described. Here, we report a patient who suffered a lacunar infarct at the site of a microbleed, associated with its disappearing on MRI. This case illustrate a previously unrecognized progression of a cerebral microbleed, which may help to elucidate pathogenetic mechanisms involved in this uncommon evolution.
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“Brain Holes.” A Diagnostic Challenge In Cysticercosis-Endemic Areas.
The introduction of modern neuroimaging and immunologic techniques has increased the diagnostic accuracy for neurocysticercosis.
However, there are some conditions that mimic neurocysticercosis by the time of the initial evaluation of the patient. We present six patients with a single abnormally dilated perivascular Virchow-Robin space mimicking a cysticercus.
In such cases, administration of repeated trials of cysticidal drugs together with long-term follow-up observation, excluded the diagnosis of neurocysticercosis. Physicians working in cysticercosis-endemic areas must keep in mind the possible occurrence of a single dilated perivascular space, to avoid the practice of unnecessary invasive procedures in patients with “cysticerci-like” lesions that do not change after several courses of cysticidal drug therapy.
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MENSAJE DE LA EDITORA: Nueva presentación de la Revista Ecuatoriana de Neurología.
Not Available.
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Entre el médico y el paciente: Una relación fundamentalmente humana.
Not Available.
