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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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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Palabras clave: Neuronavegación, Planificación quirúrgica, Tumores de fosa posterior,

Keywords: Neuronavigation, Posterior fossa tumors, Surgical planning,

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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Palabras clave: demencia, Informe neurológico, Ley ecuatoriana,

Keywords: dementia, Ecuadorian Law, Neurological Report,

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,

Keywords: basal ganglia lesion, corea, parkinsonism, pathogenesis, tuberculous encephalitis,

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,

Keywords: Extrapontine myelinolysis, hiponatremia, osmotic demyelination syndrome, trismus,

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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Palabras clave: diplopía, hemiparesia contralateral, lesión mesencefálica, parálisis del tercer par, Síndrome de Weber, tallo cerebral,

Keywords: brainstem, contralateral hemiparesis, diplopia, midbrain injury, third nerve palsy, Weber’s syndrome,

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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Palabras clave: análisis, diagnóstico diferencial, neurología,

Keywords: analysis, differential diagnosis, neurology,

Unidades Multidisciplinares

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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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Palabras clave: demencia, deterioro cognitivo,

Keywords: cognitive deterioration, dementia,

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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Palabras clave: ancianos, Enfermedad de Alzheimer, test del reloj a la orden, validación,

Keywords: Alzheimer, Clock Test, elderly, validation,

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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Palabras clave: escala, evaluación., Hemorragia Subaracnoidea, Pronóstico,

Keywords: evaluation, Prognosis, scale, Subarachnoid Hemorrhage,

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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Palabras clave: demencia, deterioro cognitivo, Ecuador, epidemiología, escolaridad,

Keywords: cognitive impairment, dementia, Ecuador, education, epidemiology,

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,

Keywords: cervical spinal cord injury, electrotherapy, quadriplegia, respiratory function, Speech, speech therapy, voice,

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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Palabras clave: código ictus, Discapacidad, enfermedad cerebrovascular,

Keywords: Cerebrovascular disease, Disability, stroke protocol,

Quistes Aracnoideos Bilaterales de Ángulo Pontocerebeloso

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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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Palabras clave: arteriolopatia, infarto lacunar, microsangrado cerebral,

Keywords: arteriolopathy, cerebral microbleed, lacunar infarct, lipohyalinosis,

“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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Palabras clave: cisticercosis, neurocisticercosis, Virchow-Robin,

Keywords: Cysticercosis, neurocysticercosis, perivascular spaces, Virchow-Robin space,

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.

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Estudio de ochenta pacientes con Epilepsia Benigna de la Niñez con Espigas Centrotemporales.

The Benign Epilepsy of Childhood with centrotemporal Spikes (BECCTS) constitutes the most common form of idiopathic epilepsy in the paediatric population.
We present 80 cases with this diagnosis analyzing its clinical and electrophysiological characteristics, and particularly its atypical evolution. Results: 71% were male (relation 2.5:1), the partial motor seizures were the most frequent (40%) followed by the partial generalized secondarily (35%). 75% of the seizures appeared during sleep. The 66% of our patients were not medicated and a patient showed an electro-clinical picture of BECCTS and of Occipital Benign Epilepsy, Panayiotopoulos type, in concomitant form. 5% evolved in atypical form: a patient as atypical BECCTS with compromised language and hyperactivity, another developed a continuous point-wave syndrome of slow sleep and a patient debuted as focal epileptic state in hemi face with anarthria. Conclusions: The present study remarks its differential diagnosis and alerts about the phenomena of secondary bisynchronism that can appear in this type of epilepsy, the role that antiepileptic drugs play in its probable appearance and the proper and adequate changes to avoid future cognitive compromise. However, in 95% of our cases, the evolution of the BECCTS was favourable.

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Palabras clave: Epilepsia Benigna de la Niñez,

Keywords: Benign Epilepsy of Childhood,

Valor de la pulsioximetría nocturna en pacientes tetrapléjicos.

Sleep breathing disorders are common in quadriplegic patients and can be accompanied by significative oxygen desaturations. The purpose of this investigation was to evaluate the behavior of the oxygen saturation during sleep in 20 patients diagnosed as traumatic cervical tetraplegia admitted at the Julio Diaz National Rehabilitation Center, considering the intensity of the injury according to ASIA scale as well as the behavior of demographic, anthropometric, spiro metrical, oxymetrical variables and the muscle strength in both complete and incomplete injuries.

Ventilatory function and nocturnal oxygen saturation were studied, with findings of higher percent of incomplete injuries (70%) toward the complete ones (30%). There were not significant differences between both groups age, body mass index, neck circumference, neck length, time of injury, espiratory volume in the first second, forced vital capacity, espiratory volume in the first second/forced vital capacity index, vital capacity, maximal inspiratory pressure, and maximal espiratory pressure.

All patients showed a restrictive ventilatory disorder. Though significant oxyhemoglobin desaturations were not found in any case; complete injuries displayed a higher rate of desaturations after an hour sleep than the incomplete ones and they showed a significant negative correlation between the desaturation episode per hour of sleep index, and mean oxygen saturation.

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Palabras clave: Funcion ventilatoria,

Keywords: Ventilatory function,

Malformaciones vasculares de la médula espinal.

Congenital vascular malformations are largely known as rare entities. The prevalence of vascular malformations of the spinal cord is around 16%. Spinal arteriovenous malformations (AVM) are a heterogeneous group of lesions that may impair spinal cord function, and can be considered as a treatable cause of myelopathy.

According to localization they are classified as: dural, intradural, extradural, and complex, each one with a different arterial nutrition. According to the pathological anatomy it classifies in: cavernous angiomas, capillary hemangiomas and AV lesions.

The clinical manifestations of the spinal AVM are acute neurological deficits caused mainly by bleeding, or a subacute myelopathy, presenting as an insidious onset paraparesis associated with sensorial, intestinal, sexual and urinary dysfunction, based on the level (cervical to lumbar) of the lesion. The most common spinal vascular lesion in adults and elderly are dural arteriovenous fistulas prevalent in men and representing 56% of spinal vascular malformations.

After clinical suspicion, diagnosis is made by magnetic resonance imaging (IRM) which leads to selective medullary angiographies in order to determine type and subtype of medullary vascular malformation and, therefore, establish the most appropriate treatment.

Early rehabilitation permits acceptable functional recovery.

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Palabras clave: Hemangiomas, malformaciones vasculares espinales,

Keywords: Hemangioma, spinal vascular malformations,

Mioclonías benignas de la infancia temprana: Revisión de la literatura a propósito de dos casos clínicos.

Benign myoclonus of early infancy (BMEI) is a non epileptic paroxystic disorder unknown in our pediatric population. We analyze the clinical characteristics in two patients with BMEI, and emphasize their differential diagnosis in four groups: encephalopathies with a non epileptic myoclonus, myoclonus without encephalopathy and without epilepsy, epileptic encephalopathies with myoclonus seizures and myoclonic epilepsy without encephalopathy. We consider to the BMEI as an autolimited, age-dependent, non epileptic paroxystic disorder without encephalopathy with onset in the early infancy. This study could be useful in order to identify the BMEI and avoid the incorrect use of antiepileptic drugs in our patients.

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Palabras clave: Mioclonias Benignas,

Keywords: Benign myoclonus,

Epilepsia Benigna Occipital tipo Panayiotopoulos y Epilepsia Benigna con espigas centrotemporales concomitantemente en el mismo paciente.

The Panayiotopoulos type benign childhood occipital epilepsy, (PBCOE) and the benign childhood occipital epilepsy with centro-temporal spikes (BCECT) are two forms of focal idiopathic epilepsy recognized by the International League Against Epilepsy. Several authors have reported that some patients with PBCOE evolve later in life toward a BCECT, remarking the fact of the morphological similarities of their paroxysms and the spikes migration phenomena. However, few cases of patients with PBCOE have been described concomitantly clinical characteristics of a BCECT in the same evolving process. One clinical case with the mentioned concomitant manifestation is shown, analyzing its clinical characteristics, differential diagnosis and treatment. Finally it is postulated that the PBCOE could be an early form of the BCECT

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Palabras clave: Epilepsia, Tipo Panayiotopoulos,

Keywords: Epilepsy, Panayiotopoulus type,

Resolución clínica de un hematoma subdural crónico en un niño con quiste aracnoideo conocido.

Chronic subdural haematoma is a well-known and relatively frequent entity in the elderly. It is originated by a slight trauma which provokes subdural veins to rupture after suffering stretching due to cortical atrophy.
We report the case of a 11 year old patient with a previous known arachnoid cyst who was diagnosed as chronic subdural haematoma without association to cranial trauma and with slight neurological impairment. He responded successfully to pharmacological therapy. The following clinical case permits review pathophysiology of chronic subdural haematoma and considers subarachnoid cyst as a risk factor.

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Palabras clave: Hematoma subdural crónico, quiste aracnoideo, traumatismo craneoencefálico,

Keywords: arachnoid cyst, chronic subdural haematoma, Head injury,

Esclerosis Lateral Amiotrófica Secundaria a Infección por VIH.

Motor neuron diseases are not frequently associated to Human Immunodeficiency Virus (HIV) infection, although some reports have mentioned this relationship, suspecting a viral involvement in the pathogenesis of this disease. A 43-years-old male with HIV diagnosis is described, who started with progressive weakness of his legs, showing further worsening 6 months later, with upper extremity and bulbar involvement. Neurophysiological studies demonstrated upper and lower motor neuron compromise in all the extremities and bulbar muscles. Other causes were ruled out. Auto-antibodies against Human Herpes Virus type 8 were positive for IgG. There were no anomalies on image studies. A change in the antiviral scheme stopped temporarily the progression of the clinical features. However, posterior withdrawal of medications due to toxic hepatitis led to worsening of signs and symptoms. This case, among the previously reported worldwide, suggests that the association between motor neuron diseases and HIV is not coincidental, this must raise suspicion in every subject with risk factors for HIV and coexistent motor neuron disease.

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Palabras clave: Debilidad, Denervación, Enfermedad de Neurona Motora, Esclerosis Lateral Amiotrófica, Hiperreflexia, Virus de la Inmunodeficiencia Humana,

Keywords: Amyotrophic Lateral Sclerosis, Denervation, Human Immunodeficiency Virus, Hyperreflexia, Motor Neuron Disease, Weakness,

Algunos aspectos sobre la Hemorragia Intracerebral Espontánea en el Puerperio.

Primary hemorrhagic cerebrovascular accident in brain parenchyma is known as spontaneous intracerebral hemorrhage. It uncommonly occurs during pregnancy and puerperium. We briefly describe this clinical entity, although it is rare, is important to know its existence in order to give a good treatment.

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Palabras clave: Accidente cerebrovascular hemorrágico,

Keywords: Intracerebral hemorrhage,

Cavernomas: a propósito de dos casos.

Cavernomas are uncommon vascular lesions, with presenting symptoms after third decade of life. They are asymptomatic in 20% of cases, rising to 40% in familiar cases. Clinical picture is variable but seizure is the most common presenting feature. We report, briefly, two clinical cases and comment some data from the literature.

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Palabras clave: Cavernomas,

Keywords: Cavernomas,

Evolución histórica de la Neurología Ecuatoriana.

Not Available.

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Presidentes de la Sociedad Ecuatoriana de Neurología.

Not Available.

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Manifestaciones no motoras de la SEN.

Not Available.

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