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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Programa de Riesgo Vasculocerebral Multifactorial orientado a la Comunidad. Policlínica Buenaventura 2005.

Community-oriented multifactorial cerebrovascular risk program is a community health project for cerebrovascular risk factors control. Primary objective was to reduce morbimortality of this group of patients as risk was stratified.

Material and method: This intra-group controlled study included 101 patients, any gender, older than 45 years with a a past history of hypertension. A multidisciplinary group applied a Cerebrovascular Risk Evaluation Scale, which divided patients in low, moderate and high risk. Results were compared before and after intervention over modifiable risk factors. Statistical significance was considered at 95%.

Results: Modifiable risk factors control was beneficial in case of arterial hypertension. Lack of knowledge in the population stroke management was high. There was not good adherence to different treatments including diet, drug therapy and routine exercises. All these indicators were considered positive and were validated for the scale.

Conclusions: Clinical and administrative indicators in the evaluation of program effectiveness permitted to validate the applied instrument as an alternative in primary care assistance.

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Prevalencia y Tendencia de Trastornos Mentales en el Instituto Nacional de Neurología y Neurocirugía.

A mental disorder is the result of an imbalance between biological and social aspects that reflect an alteration of cerebral functions which intervene in the life and productiveness of each individual. In this study the prevalence and trend of mental disorders were estimated in the National Institute of Neurology and Neurosurgery in Mexico City. This was a transversal study. The information was obtained during 1995 to 2004 of clinical records of patients admitted by first time in the Institute with diagnosis of mental disorder according to ICD-10, and different epidemiological variables were identified.

One thousand four hundred eighty three cases were identified. 56% were woman. The more frequent group of age was 20-29 years. In first place was Schizophrenia (22%), followed by Depressive Episode (16.5%) and in third place Bipolar Affective Disorder (8.6%). The prevalence was higher in 1995. In general, a tendency to decrease of mental disorders was observed, although it was not statistically significant.

Previous reports affirm that the number or patients with neuropsychiatric disorders will increase around the world in next years. Because most patients are assisted in the beginning by general or alternative medicine, it is essential for cases to be promptly identified and be addressed to specialized institutions for their attention.

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Palabras clave: epidemiología, Prevalencia, Tendencia, Trastornos mentales,

Keywords: epidemiology, Mental disorders, Prevalence, Trend,

Predictores del nivel de somnolencia en pacientes con Apnea Obstructiva del Sueño.

Excessive daytime sleepiness (EDS) is the obstructive sleep apnea syndrome (OSAS) most frequent symptom. The relationship between the level of daytime sleepiness and standard polysomnographic variables (i.e., apnea/hypopnea index [AHI] and oxygen saturation SaO2) has been the subject of a number of studies. To date, the results have been inconsistent. The goal of this study is to assess the variables significantly related with daytime sleepiness severity. The variables chosen were: AHI, percentage of total time that the subject remains with arterial oxygen saturation level below 90% (SaO2<90%), minimum oxygen saturation (SaO2 m), body mass index (BMI), and age. The study sample was composed of 51 obstructive sleep apnea patients selected from a medical centre.

Subjects completed using the Epworth Sleepiness Scale (ESS) to determine daytime sleepiness. The OSAS was diagnosed by conventional polysomnography.

The results indicated significant correlations between level of daytime sleepiness and age (r=.302; p<.05), BMI (r=.339, p<.05), SaO2 m (r=-.393, p<.01) and SaO2 < 90% (r=.492, p<.01). Significant correlations were also found between AHI and SaO2<90% (r=.314, p<.05), BMI and SaO2<90% (r=.387; p<.05), and SaO2 m and SaO2<90% (r=- .746; p<. 01). No significant correlation was detected between AHI and level of daytime sleepiness. According to the results, the percentage of total time that the subject remains with arterial oxygen saturation level below 90% (SaO2< 90%) is the best predictor of daytime sleepiness severity.

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Palabras clave: Apnea, Índice de apnea-hipopnea, Índice de masa corporal, Saturación de oxígeno, Somnolencia,

Keywords: Apnea, Apnea-hypopnea index, Body mass index, Oxygen saturation, Sleepiness,

Síndrome de apnea obstructiva del sueño y accidentes de tráfico.

In recent years many studies have shown that Obstructive Sleep Apnea Syndrome is one of the biggest risk factors for drivers. The most severe patients report that they become sleepiness not only while driving on the highway or over long distances – during which the driver may stop the vehicle to sleep for a short time – but also during short distances around town. The interest raised by this problem has caused several studies to centre their objective on identifying the factors that are responsible for this increase in traffic accidents. Polysomnographic testing has verified that the sleep of these patients is fragmented which causes an excessive daily sleepiness and a sensation of tiredness and fatigue, which, up to a point can cause traffic accidents. Current work is revising some the studies which have been undertaken in order to evaluate the prevalence of traffic accidents in patients with Obstructive Sleep Apnea Syndrome according to the statistics. At present the nasal Continuous Positive Airway Pressure is the treatment of choice of this syndrome. For that reason and in relation to the problem that we are studying, the traffic accidents in patients with Obstructive Sleep Apnea Syndrome, we have recently revised some of the studies that have been undertaken to evaluate up to what point the therapy of Continuous Positive Airway Pressure diminishes the frequency of traffic accidents in patients with Obstructive Sleep Apnea Syndrome.

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Palabras clave: Accidentes de tráfico, Apnea del sueño, Presión Positiva Continua Nasal (nCPAP), Prevalencia, Simuladores de conducción, Somnolencia,

Keywords: Driving simulators, Nasal Continuous Positive Airway Pressure, Prevalence, Sleep apnea, Sleepiness, Traffic accidents,

La evaluación neuropsicológica en la Cirugía de Epilepsia.

Since the decade of the sixties objective systems of evaluation of the superior functions have been developed with the purpose of being able to establish the cognitive state from the patients candidates to epilepsy surgery, for that, the neuropsychological evaluation is made by means of the use of suitable instruments that allows to identify the cerebral dysfunction and taking into account the following aspects: a) to establish the global cognitive state, b) to guide in the lateralization of the cerebral dysfunction, c) to predict the risk of deterioration or cognitive improvement, with base in the preserved functions and in the altered functions, and d) after the surgery, to describe the patient’s cognitive state by means of periodic evaluations, with the purpose of having an evolutionary control of the neuropsychological functioning, providing in a precise and integrated way the effects that the surgical intervention produces in the cognitive functioning of the patients. The neuropsychological evaluation is an integrated process that requires of several hours to be completed, for that, it is important that this is carried out without the previous knowledge of the discoveries of image and/or electroencephalographic methods, since this could slant the exploration and the results, when it is not possible the identification of other possible cognitive alterations, or, one runs the risk of supposing the existence of cerebral pathology where there is not. In this article the theoretical-methodological aspects of the neuropsychological exploration are described in the area of epilepsy surgery.

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Palabras clave: Cirugía de epilepsia, evaluación neuropsicológica, Funciones cognoscitivas, Lateralización del foco epiléptico, Lenguaje,

Keywords: Cognitive Functions, Epilepsy Surgery, Language, Lateralization of the Epileptogenic Foci, Neuropsychological Evaluation,

Bases anatómicas y fisiológicas del sueño.

Sleep study has rarely been important until the past few years, although its pathology deserves special attention from the medical point of view. The present work intends, with update knowledge, to review in a summarized and practical way, the anatomical basis and mechanisms involved in sleep, its types, and the regulation sleep-wakefulness cycle. This will be helpful for a better understanding of its function and will permit an adequate management of its pathology.

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Palabras clave: mecanismo, Sueño, sueño-vigilia,

Keywords: mechanism, sleep, sleep-wakefulness cycle,

Epilepsia Occipital Benigna de la Niñez tipo Panayiotopoulos Presentación de cinco casos clínicos y revisión de la literatura.

Occipital Benign Epilepsy of Childhood, Panayiotopoulus Type (OBECP) is the more frecuent idiopathic epilepsy following the Benign Epilepsy Childhood with Centrotemporal Spikes. We present five cases with this diagnosis analyzing its clinical, electroencephalografics, therapeuthics and evolutives characteristics. This study remarks our low incidence, perhaps due to of poor knowledge and the most cases are underdiagnosted in the paediatric population. Our objetive is alert about this type of Epilepsy, its early diagnosis, adecuated treatment and the respective family assessment because this pathology had a favourable evolution.

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Palabras clave: diagnóstico, Epilepsia Occipital, Tipo Panayiotopoulos, Tratamiento,

Keywords: assessment, diagnosis, Occipital Epilepsy, Panayiotopoulus type, Treatment,

Síndrome de Guillain Barré imitando Muerte Encefálica.

Guillain Barré Syndrome is a neurological disease frequently admitted to the Intensive Care Unit, especially if there is associated hemodynamic or ventilatory compromise. Brain death is the irreversible cessation of all functions of Central Nervous System, and rarely, Guillain Barré Syndrome can mimick it, with subsequent recovery in the next few days or weeks. We report a case admitted to the Intensive Care Unit, with this type of evolution.

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Palabras clave: Doppler transcraneal, Guillain Barré, Muerte encefálica, polineuropatía,

Keywords: Brain death, Guillain Barre, polyneuropathy, Transcraneal Doppler,

Síndrome de Tolosa-Hunt: Hallazgos en Resonancia Magnética Cerebral antes y después del tratamiento con Terapia Corticoidal Sistémica.

Tolosa-Hunt syndrome is characterized by painful ophthalmoplegia due to a granulomatous inflammation in the cavernous sinus. Corticosteroid therapy dramatically resolves both clinical and radiological findings. We report a case of a patient 55 years old, initially managed as cavernous sinus thrombophlebitis, and by means of magnetic resonance imaging studies, was then diagnosed as Tolosa-Hunt syndrome. After receiving adequate therapy, clinical symptoms improved. We recommend serial magnetic resonance imaging studies when Tolosa-Hunt syndrome is suspected in order to differentiate it from other cavernous sinus lesions that can mimic it clinically and radiologically.

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Palabras clave: Corticoides, Oftamoplejía dolorosa, resonancia magnética, Seno cavernoso, Síndrome de Tolosa-Hunt,

Keywords: Cavernous sinus, Corticosteroid treatment, magnetic resonance imaging, Painful ophthalmoplegia, Tolosa-Hunt syndrome,

Una propuesta para la evaluación de la Prueba de Wada en pacientes analfabetos: Presentación de un caso.

In the preoperative neuropsychological evaluation of certain patients with epilepsy it is important to determine the hemispheric dominance; particularly in those of doubtful laterality, due to the high postoperative risks of affectation of the language and the memory. The test of Wada allows guiding the neurosurgeon about the possible impact of the surgical procedure in the hemispheric areas related to the language and the memory. Although it is well-known that the execution in diagnostic neuropsychological tests is under the influence of an important series of variables, as the culture and the educational level, until now there are not specific protocols for this kind of exploration in illiterate patients. In this study we describe the experience in the test of WADA of an illiterate patient with epilepsy diagnosis and cerebral congenital left hemiatrophy, of left-handed manual laterality. With base in the protocol of Trenerry and Loring the language tasks and memory were implemented according to the patient’s cultural context. It was found a right hemispheric representation for the language and the memory. These results confirm the effects of the cerebral plasticity in the reorganization and /or compensation of the cognitive functions, as the language and the memory in the cerebral hemisphere not affected.

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Palabras clave: Dominancia hemisférica, Epilepsia, Lenguaje, Memoria, Plasticidad cerebral, Prueba de Wada,

Keywords: Cerebral plasticity, Epilepsy, Hemispheric dominance, Language, Memory, Test of Wada,

Post-stroke hemiballismus and Contralateral tremor: Report of two cases.

Involuntary abnormal movements may occur as part of the symptomatology of acute stroke or may be delayed or progressive. We report two cases of post-stroke hemiballismus and contralateral tremor. Both patients presented acute hemiballismus. In one of the patients, the tremor started with acute symptomatology and the other was delayed. We discuss the possible pathogenic mechanisms for their movement disorders. To our knowledge, this is the first report of two cases with the unusual presentation of post-stroke hemiballismus and contralateral tremor.

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Palabras clave: Enfermedad vascular cerebral, Hemibalismo, Patofisiología, Temblor contralateral,

Keywords: Contralateral tremor, Hemiballismus, Pathophysiology, stroke,

James Parkinson (1755 – 1824) y su parálisis agitante.

Not Available.

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Las enfermedades neurológicas en el Ecuador: Un llamado a la acción.

Not Available.

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Descripción y Valoración Pronóstica de la Hemorragia Cerebelosa no Traumática.

Spontaneous cerebellar hematomas (CH) represent 5%–10% of intracranial hemorrhages The purpose of this study was to describe CH characteristics in patients admitted to the critical care unit, to determine the prevalence of risk factors, to describe the clinical presentation, the treatment and the clinical situation at discharge. Thirty four consecutive patients were included. The mean age was 67±15 years. In the univariant analysis, only Glasgow Coma Score was associated with high mortality. An hematoma diameter > 3 cm., intraventricular hemorrhage and hydrocephalus were associated with mortality, but without statistical significance.

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Palabras clave: Hemorragia cerebelosa espontánea, Pronóstico,

Keywords: Prognosis, Spontaneous cerebellar hematoma,

The incongruities of the NPI−Q score obtained by the caregiver versus that obtained directly from the non−demented patient with Parkinson’s disease.

Background: Neuropsychiatric symptomatology frequently accompanies Parkinson’s disease. Purpose: In this work (a one point time analytical study), we wished to explorer the Neuropsychiatric Inventory in its shorter format (NPI–Q) in seventy consecutive patients. To find out in what way information obtained from the caregiver (CG) is correlated with that which the patients provide. If this tool, designed to evaluate patients with dementia, can be applied to non-demented subjects with Parkinson’s disease (NDP).

Method: The study, the NPI–Q Spanish version was employed, first with the CG alone and subsequently, with the individual patient alone by a researcher with no knowledge of the previous result from the CG. The weighted kappa correlation coefficient was measured to evaluate the CG–NDP consistency rate (Test–retest reliability; obtained by judging the reproductibility or stability of a instrument over time; two or more observers; or two or more times); a value of 0.7 or higher was accepted as significant. Because the correlation results were found to be insignificant, a post–hoc analysis was performed. We study the convergent validity (Validity–Construct–related, include examining the logical relations that should exist with other measures, know too as convergent validity) analyzed using the Spearman rank correlation statistic values greater than (r <0.29 are weak correlations; r <0.3– .58 are moderate correlations and; r < 0.59 are high correlations the convergent validity).

Results: The consistency inter-rater (CG–NDP), were without any significant agreement; in the inter- tems correlations the best values were for the patients; and in the Spearman’s correlations (a measure of converging validity), the values obtained on the NDP were more significant.

Conclusions: We can assume that the patient’s NDP is the best source of information, and hence for these patients, we consider that the NPI–Q (reported by the CG) is not the best tool to evaluate the Neuropsychiatric symptomatology of NDP sufferers.

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Palabras clave: enfermedad de Parkinson, Inventario neuropsiquiátrico, Sintomatología neuropsiquiátrica, Validez convergente,

Keywords: Consistence inter–rater, Convergent validity, Neuropsichiatric Inventory short Format, Neuropsychiatric symptomatology, Parkinson’s disease,

Aneurismas intracraneales múltiples Presentación de un caso y revisión de la literatura.

Prior to review of literature, we present the case of a 51 year old woman, with arterial hypertension, who presented with a hemorrhagic stroke due to multiple intracranial aneurysms rupture (totally 4). Family history reported a sister died because of the same cause. The patient underwent aneurysms clipping, with a non-complicated after–surgery period. She was discharged in satisfactory general and neurological conditions. Nowadays, she undergoes a normal life, with no neurological deficit.

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Palabras clave: Aneurismas Intracraneales, Aneurismas Intracraneales Múltiples, Clipaje, Hemorragia Subaracnoidea,

Keywords: Clipping, Intracranial aneurysms, Multiple Intracranial Aneurysms, Subarachnoid Hemorrhage,

Migraña y anticonceptivos.

Migraine is a pathology predominant in women; being 2 to 3 times more prevalent than in men. It’s frequently associated with physiological changes in ovarian steroids levels, during the menstrual cycle and in menopause. Despite this strong association, few studies have examined the mechanism through the ovarian steroids influence the neural system in migraines. Clinical data demonstrate that high levels of estrogens increase the probability of having migraine. Paradoxically the sudden descent of estrogens during menstruation increases the probability of having a migraine attack.

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Palabras clave: Anticonceptivos orales, Migraña,

Keywords: Migraine, Oral anticonceptives,

Síndrome de Rett Revisión de la literatura y presentación de seis casos en el Hospital Pediátrico Dr. Roberto Gilbert E.

Rett syndrome is one of the most common causes of mental retardation in females. It is an X linked dominant inherited disorder characterized by regression of language and motor milestones, acquired microcephaly, severe mental retardation and loss of purposeful use of hands. Its hallmark is a repetitive “hand-washing” movement. In the majority of cases, defects on genes MECP2 and CDKL5 have been identified. On the following report we present our first experience involving Rett Syndrome patients, analyzing their main clinical and electroencephalographic features, progression of disease and its treatment. We also make an update of genetics and treatment options. We believe that this study will provide the necessary tools to make an early diagnosis in our environment, reach the most accurate treatment and the appropriate genetic counseling for the families.

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Palabras clave: asesoramiento genético, diagnóstico, herencia ligada al cromosoma X, Sindrome de Rett,

Keywords: diagnosis, genetic counseling, Rett syndrome, X linked inheritance,

Algunas Reflexiones sobre la Microcirugía de los Aneurismas Intracraneales.

A correlation between the authors´s surgical experience clipping brain aneurysms and current endovascular techniques is made.
The authors recommend early repair of aneurysms micro surgically or endo vascularly. Best results in microsurgical treatment are possible in young patients with small anterior circulation aneurysms operated in good clinical grade, without evidence of clinical or radiological vasospasm. The endovascular treatment is recommended in poor grade patients, elderly people, and as a complementary mean in the management of giant and complex aneurysms.

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Palabras clave: Aneurismas Cerebrales, Clipaje Microquirúrgico, Tratamiento Endovascular,

Keywords: Brain aneurysms, Endovascular Treatment, Surgical clipping,

Enfermedad de Lafora: Diagnóstico histopatológico de un caso por biopsia de piel.

Lafora disease constitutes one of the most common types of progressive myoclonic epilepsy in South Europe, especially in Spain. Its onset is between 10 and 18 years old, with myoclonus which can be segmentary, erratic, intentional and associated frequently with focal occipital seizures. There could also be primary or secondary generalized tonic-clonic seizures. A progressive dementia is evident as is the presence of intra citoplasmic inclusion bodies (Lafora bodies) in neurons and other glucose consuming body cells. The diagnosis can be done by identifying Lafora bodies in the sweat glands of the underarm skin. There are two genes fundamentally implicated in this disease: the EPM2A in 6q24 and the EPM2B in 6p22. We present, to our knowledge, the first documented case in Ecuador, diagnosed by histopathological material obtained by skin biopsy, and analyze its clinical, electroencephalographic and evolving characteristics. Patient’s family tree is analyzed in detail and an exhaustive literature update related with this disease is performed.

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Palabras clave: demencia, Enfermedad de Lafora, Epilepsia mioclónica,

Keywords: dementia, Lafora disease, Myoclonic Eplepsy,

Charcot: Superando el tiempo.

Not Available.

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Georges Gilles de la Tourette: El hombre y su tiempo.

Not Available.

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Verdaderos valores del ejercicio profesional.

Not Available.

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Valor del Potencial Evocado Auditivo de Latencia Media en el estudio de personas con Esclerosis Múltiple Forma Brote–Remisión.

A prospective study was carried out to establish the utility of Auditory Middle Latency Response (AMLR) in the evaluation of patients with relapsing- remitting multiple sclerosis. Twenty subjects were evaluated with the multimodal battery of auditory, visual and somatosensory evoked potentials, AMLR, and motor evoked potential by transcraneal magnetic stimulation. The results showed the following abnormalities: 60 % in the AMLR, (only 50 % of them with clinical symptoms), 25% in the auditory brainstem response, 85 % in the visual response and 90 % in somatosensorial and motor potentials. We found significant differences between the auditory tests and the rest of the electrophysiological techniques (rate comparison, p<.05). Those differences disappeared when auditory tests were considered together. There was a significant association between anatomical and functional tests in the evaluation of the auditory pathway, and a positive correlation between the absolute latency of Na, Pa, and Pb components and the temporal course of the disease. The results suggest the convenience of including AMLR in the battery of evoked potentials for the study of relapsing- remitting multiple sclerosis patients.

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Palabras clave: esclerosis múltiple, Estimulación magnética transcraneal, Potencial evocado auditivo de latencia media, Potencial evocado auditivo de tallo cerebral, Potencial evocado motor, Potencial evocado somatosensorial, Potencial evocado visual, Resonancia magnética nuclear,

Keywords: Auditory brainstem evoked potential, magnetic resonance imaging, Middle latency auditory evoked response, Motor evoked potential, multiple sclerosis, Somatosensory evoked potential, Transcraneal magnetic stimulation, Visual evoked potential,

Subtipos de Enfermedad Cerebrovascular: Análisis del registro de la Unidad de Ictus del Hospital Clínica Kennedy.

The main goal of this study was to determine the relative incidence of the different subtypes of stroke in a group of people from Guayaquil, considered of a relatively high socioeconomic stratus, to establish a relationship that was previously proposed as a probable cause of the etiologic stroke subtype variation found in our city. We conducted a retrospective study, in which were identified 100 consecutive patients with acute first-ever stroke admitted to the stroke unit of Hospital-Clínica Kennedy. The results were: male prevalence (57% vs 43%), mean age of onset 70 years for infarcts and 54 years for hemorrhages. Sixtythree patients had a cerebral infarction and 37 had an intracranial hemorrhage. As conclusion, we found that this relatively high prevalence of hemorrhages were related to rupture of intracranial aneurysms, and that most infarcts were related to hypertensive vasculopathy. We also found that the main risk factors were arterial hypertension and cardiopathies (p<0.05). Is important to resolve the controversies that were provoke in the last years about onset variability in types and subtypes of stroke, for which more studies and further are required.

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Palabras clave: hemorragia, Ictus, variación de subtipos, vasculopatía hipertensiva,

Keywords: hemorrhages, hypertensive vasculopathy, stroke, subtype variation,

Cadena de supervivencia del Ictus: Un desafío de la medicina actual.

A quasi experimental study was carried out in patients with cerebrovascular disease, through the stroke survival chain at the Municipality Holguín, in order to characterize the access getting of these patients to the secondary care unit at the Hospital Provincial Docente V. I. Lenin, from May to October 2006. Neurological evaluation and cerebrovascular risk scales were applied, obtaining the following results: ages from 60 to 74 years were the more affected, predominantly in male. Atherotrombotic cerebral infarcts were the more frequent. Only 8 patients (23,5%) arrived to the hospital during the first three hours of the event. High blood pressure, history of cerebrovascular disease and cardiopathies were the more frequent risk factors. Glasgow coma scale above 11 points was observed in all the cases. We conclude that, in order to reestablish cerebral blood flow after stroke, it is necessary to participate in a whole performance survival chain.

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Palabras clave: cadena de supervivencia, enfermedad cerebrovascular, infarto cerebral,

Keywords: Cerebrovascular disease, stroke, survival chain,

Efectos de la Terapia con Campos Magnéticos en los Niveles de Fatiga de las personas con Esclerosis Múltiple.

Introduction: Multiple Sclerosis (MS) is a demyelinating and neurodegenerative disease of the Central Nervous System. It is the major cause of neurological disability in the young adult. One of the most frequent and refractory symptoms to treatment is fatigue. Objective: To evaluate the efficacy of treatment with Magnetic Fields for fatigue produced by MS.

Material and Method: An almost experimental-type intervention study was performed in 14 patients evaluated at the Psychomotor Evaluation Lab and diagnosed with MS (Mc Donald et al) who presented fatigue. The Impact Fatigue Scale (IFS) was applied before and after the treatment with 1750-l magnetic bed was conducted for 4 weeks and 20 minutes, 50 Gauss. Statistics tests used were Spearman and ANOVA within the statistics program. The level of significance was p<0.05.

Results: The sample was composed by women (86%). The most frequent clinical form of MS was the Secondary Progressive (64.3%). Fatigue was found in 92.9% of cases, with an evolution period of 6 months or more. This is one of the symptoms that produced greater disability in these patients. After treatment with magnetic fields there was fatigue improvement in 92.9% of cases according to the evaluation of the fatigue impact scale. Tolerance to treatment was excellent.

Conclusion: Therapy with magnetic fields produced improvement of fatigue symptom in this group of patients with MS, especially in the progressive type.

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Palabras clave: Campos magnéticos de baja frecuencia, esclerosis múltiple, Fatiga,

Keywords: Fatigue, Low frequency magnetic fields, multiple sclerosis,

La Creatinfosfokinasa tiene utilidad en la Evaluación Pronóstica Temprana de Discapacidad en el Infarto Cerebral.

Introduction: Cerebral infarction is the third cause of morbidity and mortality in the occidental world. The diagnosis is usually based on clinical and imaging studies, like computerized axial tomography. However, the prognostic value is limited especially in the first 48 h after the event. Currently, creatinphosphokinase tests are not known as a prognostic tool.

Objective: To study the creatinphosphokinase serum levels in patients with cerebral infarction in the first hours after the event, to determinate prognosis and establish a relation with disability.

Patients and methods: Forty hospitalized patients with cerebral infarction were studied. Levels of creatinphosphokinase in serum were measured at 12, 24 and 48 hours after infarction and were associated with disability using the Rankin modified scale.

Results: The creatinphosphokinase concentration increased during the first 12 hours after infarction, was higher at 24 hours and, at 48 hours, it began to decrease. The levels of creatinphosphokinase are correlated with disability results in the Rankin scale.

Conclusions: The creatinphosphokinase can be a useful tool in the prognostic evaluation of disability in patients suffering brain infarction, in the first hours after the event takes place, and preceding tomographic alterations.

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Palabras clave: Creatinfosfokinasa, Discapacidad, infarto cerebral, Marcador biológico, Pronóstico, Rankin,

Keywords: Biological marker, Cerebral infarction, Creatinphosphokinase, Disability, Prognosis, Rankin,

Neuroprotección en la Isquemia Cerebral. Experiencias con la Eritropoyetina Humana Recombinante.

The current therapeutic strategies are oriented to reestablish the cerebral blood flow and to protect the nervous cells during cerebrovascular disease. Searching neuroprotective agents has been guided to block some of the molecular events that nervous cells suffer as a consequence of ischemia. Human recombinant erythropoietin constitutes a recent proposal, demonstrating to have neuroprotective mechanisms of action at more than one level, appearing to be a short term promising option. Its erythropoietic action can represent an convenience for chronic treatments or in secondary prevention. The use of an erythropoietin with low content of sialic acids –with neuroprotective activity but not erythropoietic– may be a good option. This molecule should be administered by a non systemic route as is the intranasal in order to prevent the hepatic degradation. Intranasal administration of human recombinant erythropoietin has shown to be quick and safe in accessing the brain, it does not stimulate erythropoiesis in acute treatments and it shows therapeutic effectiveness in several models of cerebral ischemia in rodents. This proposal can become a therapeutic option in cerebrovascular diseases.

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Palabras clave: Eritropoyetina, Intranasal, Isquemia Cerebral, Neuroprotección,

Keywords: Cerebral ischaemia, Erythropoietin, Intranasal route, Neuroprotection,

Aspectos Neuropsicológicos de la Resonancia Magnética Funcional.

Cognitive neuropsychology and functional magnetic resonance (RMf) have marked a particularly fertile period in the development of neurosciences. Their clinical value, although incipient, is unquestionable. Integration of these two disciplines allows the registration of cerebral images related to the neuronal activation of specific areas, providing structural and functional information of the human brain under normal and pathological conditions. The RMf has important clinical and research applications. For example, pointing the brain areas needed to be avoided during surgery, or observing the neurofunctional changes that take place with a pharmacological treatment or neuropsychological rehabilitation. It also permits increasing the knowledge of neurofunctional bases of different cerebral pathologies. It is of special interest and importance the selection and implementation of the activation paradigm on functions to be studied, condition that is required for the correct interpretation of the results. The procedure for RMf allows the study of a specific component in the cognitive process in response to a specific task. It doesn’t identify the function as a unique feature, but it identifies neurofunctional patterns. In this article, the basic theoretical-methodological neuropsychological aspects are described for the implementation of studies by RMf.

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Palabras clave: Entrevista, evaluación neuropsicológica, Neuropsicología cognitiva, Paradigma, Patrones neurofuncionales, resonancia magnética funcional,

Keywords: Cognitive neuropsychology, functional magnetic resonance, Interview, Neurofunctional pattern, Neuropsychological Evaluation, Paradigm,

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