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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Características Clínicas y Epidemiológicas de los Tumores de Fosa Posterior en Pacientes Pediátricos. Experiencia en un Centro de Referencia Nacional. Clinical And Epidemiological Features Of Posterior Fossa Tumors In Pediatric Patients. Experience Of A National Reference Center.

Objective: To perform a descriptive study of posterior fossa tumors from a sample of patients from a national reference center in Ecuador.

Materials and methods: a descriptive, retrospective, cross-sectional study was performed. Socio-demographic and clinical-epidemiological variables were established for 24 patients under the age of 14, whose clinical records reported a diagnosis of posterior fossa tumor, and who were hospitalized in Baca Ortiz Pediatric Hospital between 2014 and 2016.

Results: There was a 1:1 relationship between males and females, an age distribution of 20,8% of patients younger than 3 years, 33,3% between 3 and 6 years, and 45,8% of patients older than 6 years of age. The most frequent histopathological diagnosis was medulloblastoma with 45,8%, followed by ependymoma with 29,2%, and astrocytoma with 12,5%. 12,5% of patients did not have a biopsy performed. Intracranial hypertension was the most frequent clinical presentation syndrome with 87,5% followed by far less frequent symptoms in our sample.

Conclusions: Scientific evidence about posterior fossa tumors is limited in Ecuador. This study states the need to perform similar and more complete studies of this frequent pediatric brain tumor.

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Encefalopatía Traumática Crónica: Revisión de la Literatura. Chronic Traumatic Encephalopathy: Review Of Literature.

Repetitive exposure to cranial trauma is one of the hallmarks of chronic traumatic encephalopathy. Neuropathologically, hyperphosphorylated protein tau (p-tau) deposits are found. Initially it was described as pugilistic dementia, but it has been associated with other types of sports, explosive traumas among others. Symptoms of this disease include memory loss, cognitive impairment, mood swings and dementia. We present a review of the literature on this interesting disease.

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Características Neuroendocrinas del Trauma Temprano y su Relación con el Bullying. Neuroendocrine Characteristics Of Early Trauma And Its Relation To Bullying.

The aim of this article is to review the theoretical basis of neurobiological and neuroendocrine mechanisms that develop early trauma, which can be generators cognitive and emotional vulnerability in subjects exposed to environments with characteristics of child abuse; furthermore, it seeks to identify the relationship between early vulnerability cognitive expressed and affectively with relationships concerning profiles of child victims of bullying in early childhood and propose an explanatory framework for the development of profiles of vulnerability or resilience from the role that school as a protective factor for modifying the expression of genes in children and adolescents in vulnerable conditions.

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Síncope en Urgencias: Aproximación Clínica. Syncope In Emergency Room: Clinical Approach.

Syncope is a symptom defined as a transient loss of consciousness, of rapid onset, of short duration and with complete and spontaneous recovery. Peaks of presentation are in adolescence and after the 8th decade of life. The incidence of syncope represents 1% to 3% of hospital admissions and is associated with cardiovascular comorbidity and cardiovascular pharmacotherapy, being an important cause of morbidity and mortality in the elderly. The accumulative incidence of syncope in women is almost double than in men. Its onset is explained by a decrease in cerebral blood flow due to the decrease in cardiac output, whether due to a drop in systolic blood pressure below 60 mmHg or a decrease in peripheral resistance. The syncope is divides into 3 groups: 1) Reflex syncope, in which there is a sudden change in the autonomic nervous system activity that leads to a drop in blood pressure; 2) Syncope secondary to orthostatic hypotension, where sympathetic efferent activity does not provide sufficient vasoconstriction; and 3) Syncope of cardiopulmonary cause, characterized by an abrupt and sudden decrease in cardiac output due to arrhythmias or structural heart diseases. Depending on the cause of syncope it may or may not present prodrome, which is more commonly composed of diaphoresis, heat and flushing. True loss of consciousness usually lasts less than a minute, although some patients may take several minutes to fully regain consciousness. Therefore, the diagnosis is based on a good medical history with a complete physical examination. Treatment depends on the cause and mechanism of syncopal episodes. In addition, the goals should be to alleviate symptoms and improve prognosis, which means avoiding or reducing recurrences.

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Futbolistas Talentosos, el Gran Secreto Está en el Cerebro: La Gran Tragedia del Marshal y la Suerte de los Magos con un Sistema Nervioso Indemne. Talented Soccer Players, The Big Secret Is In The Brain: The Great Tragedy Of The Star Player And The Fate Of Magicians With A Preserved Nervous Systems.

In previous work, we have presented case studies from fascinating films for the eye of the neuropsychologist;1,2,3 continuing with this line of research, we describe here for your consideration a critical analysis of the role of brain functions in one of the most fascinating sports, soccer. In this analysis, we will look more closely at the brain damage suffered by the great footballer Salvador Cabañas and the role of the highly complex brain functions that allow the magical players to stand out in this sport. In the next pages, we present the case of Salvador Cabañas, both before and after his cerebral accident, and later we analyze the cerebral functions that are activated in brilliant players like Messi or Ronaldinho. We conclude this article by reflecting on the role of the brain in our normal human activities, and how catastrophic it becomes on a daily basis when our brain tissue is damaged so that as a result of this condition we can lose everything.

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Tumores de Sistema Nervioso Central en Pediatría: Presente y Futuro del Abordaje Diagnóstico. Central Nervous System Tumors In Pediatrics: Present And Future Of Diagnostic Approach.

Introduction: Central nervous system tumors are neoplasms with high frequency during childhood, with an incidence of 31,2 cases per million children, the most common being astrocytoma. These are the product of a combination of genetic and epigenetic factors that determine not only their appearance, but also their behavior and prognosis. The clinical presentation of these neoplasms ranges from the sudden and clear, to the gradual and ambiguous, which represents a barrier to carrying out an adequate approach and an early diagnosis. That is the reason to destinate many resources for evaluation and standarization of new diagnostic methods like tumor markers. Objective: To provide a clear review of central nervous system tumors and new perspectives in diagnosis. Methods: A search of the literature was carried out in databases using the descriptors central nervous system, neoplasms, astrocytoma. 25 articles were included in spanish and english. Conclusion: Central nervous system tumors have a significant relevance in the pediatric population. Their behavior and prognosis necessitate searching for new aids for an early diagnosis.

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Miastenia Gravis de Presentación Bulbar: Reporte de Caso y Revisión de Literatura. Myasthenia Gravis Of Bulbar Onset: Case Report And Review Of Literature.

Myasthenia gravis is a neuromuscular autoimmune disorder in which the predominant symptom is muscle weakness that fluctuates during the day and mainly affects the ocular and bulbar muscles. There is an intimate relationship between thymus abnormalities, the extirpation allows in many cases a better control of the disease and as long as they are resectable it must be part of the initial treatment. We present a case of a patient with myasthenia gravis and thymoma in whom the initial treatment was surgical.

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Síndrome de Parry Romberg y Epilepsia Refractaria al Tratamiento. Parry Romberg Syndrome And Pharmacoresistant Epilepsy.

Parry Romberg syndrome is an idiopathic disease, characterized by subcutaneous tissue atrophy. Its main clinical sign is progressive facial hemiatrophy including: skin, subcutaneous tissue, nerves, muscle and/or bone. Several theories have been mentioned, among them the possible hereditary and genetic origin of this disorder, as the manifestation of this disease sometimes is seen in members of the same family. We present a case: a patient with late presentation Parry Romberg, with right side face atrophy associated with refractory epilepsy and family history of a brother who presents right side face atrophy as well and a marked scleroderma in coup of saber.

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Desmielinización del Sistema Nervioso Central Asociado a Encefalomielitis Diseminada Aguda: Reporte de un Caso. Demyelination Of Central Nervous System Associated With Acute Disseminated Encephalomyelitis: Case Report.

Inflammatory demyelinating diseases comprise a series of autoimmune disorders affecting myelin at the level of the central nervous system (CNS) and peripheral nervous system. They can be monophasic, multiphasic, progressive, monofocal or multifocal, and their diagnosis is usually of exclusion. We report the case of a 15-year-old female patient with headache, ataxia, hemiparesis, ophthalmoplegia and altered consciousness. Magnetic resonance imaging showed lesions compatible with demyelinating disease. Acute disseminated encephalomyelitis was diagnosed. The patient responded to treatment with corticosteroids.

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Síndrome de Locked-In: Reporte de Caso y Revisión de Literatura. Locked-In Syndrome: Case Report And Review Of Literature.

Locked-In Syndrome, also known as Enclaustration, Deseferentization, or Enclosure Syndrome, was first defined in 1966 by Plum and Posner. Causes can be grouped into vascular and non-vascular, the former being the most frequent. Clinically this syndrome is characterized by consciousness and the state of watch conserved, but there is quadriplegia, anartria, dysphagia and difficulty to coordinate the ventilatory mechanics, representing pulmonary complications the main cause of death. In most cases, the patient retains vertical eye mobility, so the only method of communication is through eye blinking and vertical eye movements. Next, a case presentation and review of the literature with the most relevant pathophysiological, clinical, diagnostic and therapeutic aspects is done.

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Foramen Oval Permeable, un Diagnóstico Posible en Manos del Neurólogo. Descripción de Caso. Patent Foramen Ovale, A Possible Diagnosis From The Neurologist. Case Report.

Introduction: A high prevalence of atrial septal defects is reported in patients with cryptogenic ischemic stroke, also related to an increase of the risk of recurrence. Objective: To report case of a young patient with a history of diabetes mellitus and ischemic stroke without arterial changes proven. A transcraneal Doppler study with a bubble test helped to diagnose a patent foramen ovale. Conclusion: As part of the initial evaluation of this patient, a TCD study has helped to clarify the stroke etiology. The demonstration of a patent foramen ovale has implications fo r the secondary prevention of stroke.

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El Proyecto Atahualpa. The Atahualpa Project

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Atahualpa, Una Población Rural Ideal Para la Práctica de Estudios Epidemiológicos. Atahualpa, An Optimal Rural Setting For The Practice Of Epidemiological Studies

Atahualpa is a rural village located in coastal Ecuador that achieve a number of requisites to be considered as an optimal setting for the practice of epidemiological studies. Atahualpa is an isolated village with a very low index of migration rate. Inhabitants are fairly homogeneous regarding race, lifestyles and diet, which is rich in oily fish. From the racial point of view, inhabitants are Ecuadorian natives with little evidence of cross-breading. Most men are artisan carpenters and most women are homemakers. These coincidences reduce the risk of the presence of unexpected confounders at the time of data analyses. However, this may also cause that data obtained might not be extrapolated to other regions. The practice of studies in neighboring villages, using similar protocols, is needed to validate generality of data obtained in Atahualpa.

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El Proyecto Atahualpa, Protocolo, Definiciones Operacionales y Diseño Inicial. The Atahualpa Project: Protocol, Operational Definitions, And Initial Study Design

Non-communicable diseases are the new health epidemics in developing countries due to increased life expectancy, and changes in lifestyle and dietary habits of the population. The Atahualpa Project was designed as a multi-step population-based cohort study designed to reduce the increasing burden of these conditions in rural Ecuador. The first step of the study followed a 3-Phase design, aimed to get information on demographics and cardiovascular risk factors of Atahualpa residents aged ≥40 years, as well as to assess the prevalence of stroke and ischemic heart disease. During Phase I, participants were screened with standardized questionnaires to evaluate their cardiovascular health and to identify those with suspected stroke or ischemic heart disease. In Phase II, neurologists and cardiologists examined suspected cases of stroke or ischemic heart disease, as well as a random sample of matched negative individuals, to assess prevalence of these conditions. In Phase III, patients with diagnosis of stroke and ischemic heart disease underwent complementary tests for achieving more specific diagnosis. Implementation of public health strategies directed to improve the cardiovascular health status of a given population must be based on studies evaluating specific risk factors at regional levels. Epidemiologic surveys such as the Atahualpa Project may prove cost-effective for improving the cardiovascular health status of people living in Latin American rural villages by increasing the knowledge on the particular needs of these populations.

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Salud Cardiovascular en Habitantes de Atahualpa: Características y Correlatos. Cardiovascular Health Status In Atahualpa Residents: Characteristics And Correlates

Stroke and cardiovascular diseases will be the next epidemics in Latin America due to changes in lifestyle and increased life expectancy. Knowledge of cardiovascular health (CVH) status of the population is mandatory to implement cost-effective strategies directed to reduce the burden of vascular diseases in the region. In the Atahualpa Project, we assessed the CVH status of participants using the metrics proposed by the American Heart Association. The basal study included 616 subjects free of stroke and ischemic heart disease aged ≥40 years. Of these, 2.1% had ideal, 28.1% had intermediate and 69.8% had poor CVH status. Poorest metrics were blood pressure, fasting glucose, and BMI. The odds for having a poor CVH status were increased in persons aged ≥ 60 years and in those with only primary school education. Then, we compared our results with the Hispanic population of the Northern Manhattan Stroke Study (NOMAS), and found that Atahualpa residents had significantly better metrics than those enrolled in the NOMAS, with the exception of fasting glucose levels. Likewise, the odds for having 5 to 7 ideal metrics were also better in Atahualpa residents, irrespective of age. We also conducted a case-control study to assess the CVH status of Atahualpa residents according to their living arrangements, and found that social isolation was associated with a worse CVH status in this population. A couple of studies showed correlation between some sleep related disorders and poor CVH status. We have also started an ongoing program called “known your numbers”, which, together with community talks, is directed to improve the CVH status and to reduce the burden of vascular diseases in the region.

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Sub-estudio de Neuroimagen del Proyecto Atahualpa. Neuroimaging Substudy Of The Atahualpa Project

The Atahualpa Project includes a Neuroimaging sub-study, which consists in the practice of MRIs and MRAs to all participants aged ≥60 years, as well as those presenting with specific neurological complains. Likewise, all participants aged ≥20 years have been invited for the practice of a head CT. MRIs and MRAs have been performed with the use of a Philips Intera 1.5T MRI machine, and TCs with the use of a Philips Brilliance 64 CT scanner, following established protocols. All exams have been independently reviewed by a neurologist and a neuroradiologist, with adequate kappa coefficients for inter-rater agreement. MRIs studies have been focused on the evaluation of global cortical atrophy, posterior parietal atrophy, bicaudate index, Evans index, hippocampal atrophy, signatures of cerebral small vessel disease, and lesions consistent with ischemic or hemorrhagic strokes. By the use of MRI, we have assessed the prevalence of intracranial artery stenosis, intracranial dolichoectasia and variations in the configuration of the circle of Willis. Using CT, we have focused on the diagnosis of neurocysticercosis, pineal gland calcifications, as well as in variations and characteristics of skull bones, cerebellar atrophy, and severity of carotid siphon calcifications. In the present study, we focused on the description of basic protocols used for assessment of previously mentioned lesions of interest.

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Búsqueda de Substitutos Para Estudios de Neuroimagen con Propósitos de Investigación: Experiencia del Proyecto Atahualpa. The Search Of Surrogates For Neuroimaging Studies For Research Purposes: The Atahualpa Project Experience

Diagnosis of many non-communicable neurological diseases require the use of MRI, which is not readily available in remote rural populations. Efforts should be directed to find portable screening diagnostic tools that may help identify candidates for MRI screening. In the Atahualpa Project, all participants aged ≥60 years have been invited for the practice of MRI, and about 80% of them have underwent the procedure. Therefore, we have the unique opportunity to test the accuracy of non-invasive exams to be used as surrogates to MRI for identifying candidates for the practice of this exam. To date, we have assessed the value of the ankle-brachial index (ABI), the reliability of the neutrophil-to-lymphocyte ratio (NLR), the accuracy of hypertensive retinopathy, and the value of transcranial Doppler (TCD) to detect individuals with cerebral small vessel disease. Individuals with an abnormal ABI have 4 times de odds of having a silent lacunar infarct than those with a normal ABI. A high NLR has a poor sensitivity but is highly specific for detecting persons with at least one imaging signature of small vessel disease. Individuals with hypertensive retinopathy Grades 2-3 are almost four times more likely to have moderate-to-severe white matter hyperintensities than those with no- or only Grade 1 retinopathy. Finally, the correlation between the pulsatility indexes of major cerebral arteries with imaging markers of small vessel disease, as assessed by TCD, was poor. We are still in the search of some non-expensive and readily available biomarker that allow the identification of apparently healthy persons at risk of suffering a catastrophic cerebrovascular event.

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Trastornos de Sueño en Residentes de Atahualpa. Sleep Disorders In Atahualpa Residents.

Health problems related to sleep disorders are likely on the rise in rural areas of Latin America, partly related to changes in life style, shift work, and other factors. However, little is known on the burden of these conditions in remote rural settings. In the Atahualpa Project, we have investigated sleep disorders using standardized field instruments associated with sophisticated technology such as polysomnography. A poor sleep quality has been associated with frailty and with the presence of neuroimaging markers of cerebral small vessel disease and global cortical atrophy. On the contrary, dietary intake of oily fish was associated with a better sleep quality. We have also investigated the prevalence and some correlates of the restless legs syndrome (Willis-Ekbom disease), and found a prevalence relatively higher than that described in most other tropical regions, as well as the association of this condition with psychological stress. Finally, a preliminary report shows a high prevalence of moderate-to-severe obstructive sleep apnea in Atahualpa residents aged ≥60 years (27%) and its correlation with diffuse subcortical damage of vascular origin. Further studies are needed to better understand consequences of sleep-related symptoms in underserved populations.

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Alcohol: Consumo, Consecuencias y Complicaciones Neurológicas. Resultados del Proyecto Atahualpa. Alcohol: Intake, Consequences and Neurological Complications. Results From The Atahualpa Project.

Information about the burden and consequences of alcohol intake in rural communities of Latin America is scarce. This study aims to assess the magnitude of alcohol intake in Atahualpa as well as its consequences and prevalence of neurological complications. Male residents aged ≥40 years (n=277) were interviewed with a structured questionnaire designed to evaluate prevalence, drinking patterns and consequences of chronic alcohol intake. Most of them were current drinkers and 40% started drinking below the legal age (18 years). Weekly binge drinking were admitted by 81% individuals, 58% referred physical consequences related to alcohol intake, 59% had social consequences, and 51% recognized alcohol intake as a major economic burden. Individuals who started drinking below the legal age were more often involved in binge drinking and consumed more alcohol than those aged ≥18 years at first regular drink. The relationship between alcohol intake and alcoholic cerebellar degeneration was evaluated by the use of the BARS scale, with 14.6% of individuals having clinically relevant alcoholic cerebellar degeneration. Predictive models showed significant relationships between BARS score margins and years of drinking and the amount of alcohol intake. Our study also provided robust evidence favoring an independent and synergistic effect of age and years of drinking in the relationship between ACD and cognitive decline. This study shows a high prevalence of chronic alcohol intake in community-dwelling men living in Atahualpa.

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Enfermedad Cerebrovascular en Atahualpa: Prevalencia e Incidencia. Cerebrovascular Disease In Atahualpa: Prevalence And Incidence

Stroke burden is on the rise in rural regions of South America. We evaluated prevalence, pattern of subtypes and pathogenetic mechanisms underlying stroke in Atahualpa. In a three-phase epidemiologic study, suspected cases were detected by a door-to-door survey. Then, neurologists evaluated suspected cases and randomly selected negative persons, and confirmed patients underwent complementary exams. We found 20 stroke patients among 642 persons aged ≥ 40 years. Stroke prevalence was 31.15‰ that increased with age. Hypertensive arteriolopathy was the most likely mechanism underlying strokes (55% patients). Extracranial atherosclerotic lesions or cardiac sources of emboli were not found in any case. Comparison of our findings with a previous survey performed in the same village showed an alarming increase in stroke prevalence (from 14.08‰ in 2003 to 31.15‰ in 2012, p=0.03). Thereafter, we conducted an incidence study. For this, first-ever strokes occurring over four years were identified from yearly door-to-door surveys and other overlapping sources. Of 807 stroke-free individuals prospectively enrolled in the Atahualpa Project, follow-up was achieved in 718 (89%), contributing 2,499 years of follow-up (average 3.48±0.95 years). Stroke incidence rate was 2.97 per 100 person-years of follow-up (95% C.I.: 1.73–4.2), which increased to 4.77 (95% C.I.: 1.61–14.1) when only persons aged ≥57 years were considered. Poisson regression models, adjusted for relevant confounders, showed that high blood pressure (IRR: 5.24; 95% C.I.: 2.55–7.93) and severe edentulism (IRR: 5.06; 95% C.I.: 2.28–7.85) were the factors independently increasing stroke incidence. Stroke incidence in Atahualpa is comparable to that reported from the developed world. Besides age and high blood pressure, severe edentulism is a major factor independently predicting incident strokes.

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Deterioro Cognitivo: Prevalencia y Correlatos en una Comunidad Rural Ecuatoriana. Lecciones del Proyecto Atahualpa. Cognitive Decline: Prevalence And Correlates In A Rural Ecuadorian Community. Lessons From The Atahualpa Project.

Assessment of cognitive impairment in rural areas of developing countries is complicated by illiteracy and cross-cultural factors. The Montreal Cognitive Assessment (MoCA) was used to estimate cognitive performance in individuals enrolled in the Atahualpa Project. Some problems were noticed with the use of this test, including issues related to naming animals, as well as the need to adjust a different cutoff for diagnosing mild cognitive decline than that used in highly educated individuals living in developed countries. After correlating MoCA scores with neuroimaging signatures of cortical and subcortical atrophy, a cutoff of 19-20 points would better define cognitive impaired individuals in rural areas. We also noticed that severe edentulism as well as psychological distress were associated with poor cognitive performance in older adults living in Atahualpa. In contrast, our study showed a linear, and dose-dependent, direct relationship between dietary oily fish intake and cognitive performance. We also aimed to assess the independent contribution and the interaction of age, the stroke itself and diffuse subcortical damage in the poor cognitive performance observed in patients with stroke, and noticed that interaction of age and diffuse subcortical damage are major determinants for poor cognitive performance among stroke patients. The total cerebral small vessel disease score can be used as a reliable predictor of poor cognitive performance, although its predictive power is not better than that of isolated neuroimaging signatures of cerebral small vessel disease. Finally, we noticed an inverse relationship between calcium content in the carotid siphon – used as a surrogate of intracranial atherosclerosis – and cognitive performance in our population.

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Residencia y Subespecialidades Neurológicas en los Estados Unidos. Neurology Residency And Subspecialities In The United States.

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Estatus Epiléptico en Colombia: Análisis Descriptivo de Serie de Casos. Status Epilepticus In Colombia: A Case Series Descriptive Analysis.

Status Epilepticus (SE) is a neurological emergency that is by itself a syndrome defined according its clinical presentation and electroencephalographical manifestations, both highly variable. There aren’t any case series about this relatively common neurological emergency in Colombian indexed journals, for which a search for cases was performed in two neurological critical care institutions in the Colombian capital city in the period between 2011-2015. We describe demographical, diagnostic and therapeutic characteristics emphasizing in its clinical and paraclinical presentation, as the treatment applied according international guidelines. We found convulsive SE was three times more common that the non-convulsing time, 1.4 times more common in females that in males, more common in the pediatric group and less common in the geriatric group, the majority of this cases presented SE secondary to a congenital structural injury while adult and elder patients presented SE as a consequence of non-voluntary discontinuation of the therapy, and in 66% of the cases the SE described was not the first of its kind. The therapeutic regime applied corresponded to the stipulated in international guidelines in only 41.67%.

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Estudio Poblacional de Prevalencia de Cisticercosis Porcina en Atahualpa, Ecuador. Metodología y Definiciones Operacionales. Population-Based Study Of Porcine Cysticercosis Prevalence In Atahualpa, Ecuador. Methodology And Operational Definitions.

Objective: To assess sero-prevalence of porcine cysticercosis in Atahualpa, a rural Ecuadorian village endemic for human neurocysticercosis.

Design: We aim to collect at least 600 blood samples of local pigs, to quantify the number of positive bands in the EITB, and to estimate crude prevalence rates of porcine cysticercosis in the village. Sampling will only include pigs older than 2 months of age. Only healthy pigs will be sampled, to avoid risks inherent to manipulation of sick animals. There will be no risk for pigs as the result of the procedure. According to the estimated endemicity of human cysticercosis, we expect to find about 25% of infected pigs in this study. In the event of prevalence rates above or below the expected percentage, we will attempt to assess the causes of such discrepancies. All pig positive to 3 bands of more in the EITB will receive treatment with oxfendazole at a single dose of 30 mg/kg.

Comment: The importance of defining the prevalence of porcine cysticercosis in a village endemic for human neurocysticercosis is to confirm the existence of active transmission. If this is true, treatment of infected pigs will help to interrupt the life cycle of Taenia solium, thus reducing the prevalence of this disease in humans.

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Prevalencia de la Enfermedad de Parkinson: Estudio Puerta-Puerta en la Provincia de Manabí-Ecuador. Prevalence of Parkinson’s Disease: Door-to-door Study in Manabi-Ecuador.

Parkinson’s disease (PD) is one of the most frequent neurodegenerative disorders after dementias, with a worldwide prevalence of more than 1% in patients older than 65 years. In Ecuador, there are not direct statistical data on this disease. The aim of our research lies in establishing for the first time, the prevalence of Parkinson’s disease in the province of Manabi. For that, a door-to-door study was designed in two phases. They were selected 116,983 people, over forty years old. During the first phase, they were evaluated by survey, according to the London Brain Bank criteria for diagnosis. In the second phase, patients who met the criteria were referred to a neurologist for a definitive diagnosis. A total of 285 people (0.24%) were positive for Parkinson’s disease, predominating those aged over 61 years (33.33%), and with a slightly higher prevalence among males (56.14%) than in women (43.86%).

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Evaluación Neuropsicológica del Control Inhibitorio y el Control de la Interferencia: Validación de Tareas Experimentales en el Contexto Ecuatoriano. Neuropsychological Evaluation Of Inhibitory Control And Interference Control: Validation Of Experimental Tasks In The Ecuadorian Context.

In this article we report a study in which three experimental tasks (SIMON, Go / No-Go and Stroop Victoria) were adapted and validated to evaluate the inhibitory control and interference control in a sample of Ecuadorian students. The sample consisted of 100 students between 6 and 15 years old (M = 10.13 years, SD = 2.48) belonging to the public education system of Ecuador. The process followed in the adaptation and validation was through the linguistic translation of the experiments, followed by an expert judgment and a pilot study. In the results it was found that there are no statistically significant differences in the measures that assess the inhibitory control and the interference considering the sociodemographic variables of the participants as comparison factors. In the correlation analysis we found a statistically significant association between the measurements of the experiments. We conclude by analyzing the associations found and underlining the need to continue providing evidence in the research line of adaptation and validation of test for using in neuropsychological evaluation.

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Complicaciones Neurológicas de las Mordeduras de Arañas Neurological Complications of Spider Bites.

Spiders are venomous arthropods with worldwide distribution. Most spider bites are clinically insignificant, as the size of their chelicerae is too small to inject enough amount of venom to human beings. Despite this, there are hundreds of reported cases of human envenoming related to spider bites. While clinical manifestations related to spider-bite envenoming are pleomorphic, three main clinical syndromes could be recognized: latrodectism, loxoscelism, and funnel-web spider envenoming. Latrodectism is caused by the potent neurotoxin α-latrotoxin present in the venom of widow spiders (Latrodectus sp.). Most cases present with severe pain at the site of the bite, with arterial hypertension being the most frequent systemic manifestation. Neurological complications mostly consist of headache, lethargy, irritability, generalyzed myalgia, tremor, fasciculations, ataxia, or paresthesias. The latter manifestations are related to an exhaustive release of cholinergic neurotransmitters at the neuromuscular junction. Loxoscelism is caused by envenoming by spiders of the family Sicariidae, genera Loxosceles and Sicarius. It presents in two different forms, cutaneous (with changes restricted to the affected skin) area and viscerocutaneous. In the latter, a severe coagulopathy may occur, associated or not with acute renal failure, jaundice, fever, multi-organ failure and shock. The venom of fennel-web spiders have potent neurotoxins, called δ-atracotoxins, that stimulates neurotransmitter release from the presynaptic vesicle, causing hyperstimulation of post-synaptic receptors resulting in sensory disturbances and muscle paralysis. Also, sympathetic and parasympathetic manifestations, including diaphoresis, hypersalivation, arterial hypotension, and cardiac arrhythmias may occur.

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Hidrocefalia de Presión Normal. Normal Pressure Hydrocephalus.

Normal pressure hydrocephalus is a pathology causing dementia that is reversible. Despite the time elapsed since its discovery, its pathophysiology has not been clearly established and two theories have been proposed that try to explain the process, one based on changes in cerebrospinal fluid flow and the other on cerebral blood flow. In addition, the evaluation and diagnosis process is not determined, since there is no standard method and the symptoms are similar to other pathologies of the central nervous system, leading to the diagnosis as the summation of clinical symptoms and some findings in imaging which are not always constant.

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

Encephalitis caused by N-methyl-D-aspartate receptor antibodies is associated with auto antibodies against the heteromeric NR1/NR2 units of NMDA receptors. This type of encephalitis occurs more commonly in young adults, most of them women, and shows a good response to known treatments. Clinical features include neuropsychiatric manifestations, advancing through a series of stages up to a gradual recovery. This type of encephalitis can be associated with the presence, or lack thereof, lesions caused by tumors. It can easily be mistaken with infectious encephalitis, therefore is important to recognize its clinical features for an appropriate diagnosis and treatment in order to prevent higher morbidity and mortality. In this article, I describe a case study of autoimmune encephalitis caused by NMDA receptor antibodies in a twenty-two year old man, admitted to the Enrique Garcés Hospital in Quito-Ecuador, and I make a literature review on this pathology.

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Conceptos Fundamentales en la Teoría Neuropsicológica. Fundamental Concepts In The Neuropsychological Theory.

This article presents three concepts that are fundamental in the neuropsychological theoretical: (a) historical data in the study of the human brain, (b) neuropsychological evaluation of brain functions and (c) neuropsychological rehabilitation of brain functions. As relevant data in the theoretical development of the study of the human brain is a tour of the trepanation acts performed hundreds of years ago, the contributions of phrenology, the masterful findings of Broca and Wernicke, the heuristic contribution of Luria and the current revolution with the neuro-image. In the neuropsychological evaluation of brain functions, the role of specific, non-specific and delayed observation tests in the interpretation of the neuropsychological state of the human being is analyzed, which allow analyzing neuropsychological functions in the laboratory and in real lifeactivities. Finally, we analyze the process of neuropsychological rehabilitation of brain functions, where mention is made of the processes of restoration, compensation, substitution, activation-stimulation and integration, which are very useful when intervening in a brain that has suffered an acquired damage. It is concluded that the current accelerated pace has determined the advance of neuroscience, where technology and the forceful scientific contribution propose new techniques and theories to understand the processes of evaluation and rehabilitation of brain functioning.

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