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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Exposición de Ondas de Radiofrecuencia en Relación con Alteraciones en la Salud. Radiofrequency Waves Exposure And Health Changes.

The cell phone is a device widely used by people of all ages and all over the world. Among the studies regarding the harmful effects of radiation on the human body there is no consensus. It is therefore necessary to analyze the theoretical references about the deleterious effects of radiation on humans and identify a set of actions to help reduce exposure to this radiation. The overall objective is to give information to the user about excessive exposure to radio frequency by the indiscriminate use of cell phone and to warn about the health problems that can occur and the consequences that could trigger in the future. Radiation can affect humans negatively, especially prolonged exposure. Various studies reviewed indicate that radiation is associated with the onset of health disorders and described that fundamental mechanism to produce damage in man are thermal, non-thermal and athermal effects, but it is required to extend studies, with emphasis on epidemiological, to analyze the generated hypotheses about this particular.

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Palabras clave: efectos salud, Exposición, radiofrecuencia,

Keywords: exposure, Health effects, radio frequency,

Hemorragia Talámica Bilateral. Bilateral Thalamic Hemorrhage.

Thalamic hemorrhages represent a small group of cerebrovascular diseases of which only 0.7-3% is manifested bilaterally, being chronic hypertension the key factor for its development. We report a case of a 45-year-old patient with 10-years history of arterial hypertension who presented with brachiocrural motor deterioration accompanied by dysarthria, dyspnea, vomiting in number of two, with increased basal blood pressure. Neurimaging demostrated a bilateral thalamic hematoma.

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Palabras clave: bilateral, Eventos cerebrovasculares, Hemorragia talámica, hipertensión arterial crónica,

Keywords: bilateral, Cerebrovascular diseases, chronic hypertension, thalamic hemorrhages,

Evolución Natural de la Siringomielia: Presentación de un Caso. Natural Evolution Of Syringomyelia: Case Report.

Syringomyelia is a chronic degenerative and progressive disease of the spinal cord characterized by a dissociated loss of brachial sensitivity and amyotrophy, with evidence of centromedullary cavitation.

We report the case of a 62-year-old female patient with syringomyelia associated with Arnold Chiari malformation (type 1) who spontaneously rejected any surgical intervention five years after her diagnosis, which has been followed up for 21 years. Magnetic resonance imaging demonstrates the natural evolution of syringomyelia from 1998 to the present.

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Palabras clave: malformación de Arnold-Chiari, siringobulbia, Siringomielia,

Keywords: Arnold-Chiari malformation, syringobulbia, Syringomyelia,

Síndrome de Encefalopatía Posterior Reversible (PRES). Posterior Reversible Encephalopathy Syndrome.

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Palabras clave: neurología, patologias neurologicas,

Fe de Erratas

Esta fe de erratas se refiere al autor que faltó mencionar y su afiliación académica.

ARTÍCULO ORIGINAL
Esclerosis Lateral Amiotrófica: Revisión de Evidencia Médica para Tratamiento.
Autor:
Miriam E. Bucheli, Mauricio Campos, Diana B. Bermudes, Jean P. Chuquimarca, Katherin Sambache, Jonathan F. Niato,
Priscila Villalba, Johana Montalvo, Andrés Andino, Cristian Calero, Pilar Guerrero
Rev. Ecuat. Neurol. VOL 22 N° 1-3, 2013
Esclerosis Lateral Amiotrófica: Revisión de Evidencia Médica para Tratamiento

Autores:
Miriam E. Bucheli Ph.D.,1 Mauricio Campos,2 Diana B. Bermudes,2 Jean P. Chuquimarca,2 Katherin Sambache,2 Jonathan F. Niato,2 Dayra Navarrete,6
Priscila Villalba, Johana Montalvo,3 Andrés Andino,3 Cristian Calero M.D.,4 Pilar Guerrero M.D.5
1University of Massachusetts Medical School, Department of Neuro logy, Worcester, Massachusetts, USA.

2Universidad Central del Ecuador, Quito, Ecuador.
3Universidad San Francisco de Quito, Quito, Ecuador.
4Departamento de Neurología, Hospital Carlos Andrade Marín. Quito, Ecuador.
5Departamento de Neurología, Hospital Nacional de Policía. Guaya quil, Ecuador.
6Universidad de las Americas. Quito, Ecuador.

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Adicciones Comportamentales e Interdicción por Disipación

La dinámica del mundo actual hace que la ansiedad cause estragos, disfrazándose de múltiples propuestas sintomáticas entre las cuales, las adicciones comportamentales
o conductuales están adquiriendo la mayor tasa de crecimiento con edades de inicio cada vez más tempranas.
En la psiquiatría moderna (DSM-5) estas se categorizan entre las patologías de los Trastornos Adictivos a sustancias y no relacionados con sustancias (adicciones) y el Trastorno Obsesivo Compulsivo y trastornos relacionados (conductas compulsivas), siendo conceptualmente actividades humanas diversas, a menudo placenteras y sin relación con la ingestión de sustancias químicas.

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Funcionamiento de los Comités de Ética de Investigación en Seres Humanos en Ecuador, 2015

Research Ethics Committees play an important role in securing the quality of interventional studies in humans; in Ecuador, they are in process of becoming stronger. The aim of this observational study was to describe the evolution of Ecuadorian legislation, training processes implemented by the health authority in the period of 2006-2015 and the performance of six committees (Quito and Guayaquil) during 2015. A self-assessment survey and a questionnaire to determine training needs were applied. Each committee was visited to evaluate its performance. The average member number was 10 and, although there was no gender equity, all members had the profile required for membership. The average response time was 26 days and the average quorum at meetings was of six members. Among the weaknesses are, little training in biostatistics and clinical research methodology and a poor follow-up of the studies; concerning strengths, we highlight the willingness of the members to improve the performance of the committees, and the willingness of Ministry of Public Health to support them. This study reports for the first time, the evolution of Ecuadorian legislation regarding ethics committee, its basic characteristics, weakness and strengths.

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Palabras clave: bioética en el Ecuador, comités de ética, investigación en seres humanos,

Enfermedad Cerebrovascular en el Ecuador: Análisis de los Últimos 25 Años de Mortalidad, Realidad Actual y Recomendaciones

Background. Cerebrovascular disease is the second cause of death and occupies the third place as a factor causing disability worldwide. At present, despite the recognition of its importance, the available data about Ecuador is scarce and there are not published analysis of its behavior. Methods. Retrospective longitudinal analysis of available public data on cerebrovascular disease in Ecuador, from 1991 to 2015. Results Cerebrovascular disease was the leading cause of mortality by 77 897 (6.70%) deaths and it is the only one with a constant trend pattern in the last 25 years. Conclusions. Cerebrovascular disease is the number one cause of death in Ecuador and its mortality is steadily increasing. Government policies must be implemented to reduce their mortality.

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Palabras clave: Ecuador, enfermedad cerebrovascular, Ictus, Mortalidad,

Keywords: Cerebrovascular diseases, Ecuador, Mortality, stroke,

Prevalencia de Enfermedades Neurológicas no Transmisibles en una Población Rural del Estado de Chiapas, México: Protocolo y Resultados Basales. Estudio Pro-Mas (Proyecto Comunitario La Soledad)

Objective: We aimed to assess cardiovascular health and neurological status of community-dwelling adults living in “La Soledad,” Chiapas, México, to calculate prevalence and incidence of cerebrovascular diseases, epilepsy and cognitive decline. Among others, these conditions are currently considered as the new epidemics in rural.
Design: Following a protocol similar to that used for the Atahualpa Project, we conducted a two-phase epidemiological study. During phase I, La Soledad residents were interviewed with validated field instruments to assess cardiovascular health status and well as to detect suspected stroke, epilepsy and cognitive impairment patients. During phase II, trained physicians examined suspected individuals as well as a random sample of non-suspected individuals to assess prevalence of diseases of interest.
Comment: Public health strategies must be based on the study of region-specific risk factors. Studies such the Atahualpa Project were proven to be effective for the assessment of public health problems in a rural Ecuadorian village. PROMAS will likely be cost effective to increase current knowledge on these conditions in Mexican rural villages and to promote a better cardiovascular health status among their inhabitants.

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Palabras clave: deterioro cognitivo, enfermedad cerebrovascular, Epilepsia, estudio poblacional, PROMAS, salud cardiovascular,

Keywords: cardiovascular health, Cerebrovascular disease, cognitive impairment, Epilepsy, population-based study, PROMAS,

Características Pre y Perinatales de Niños que Viven en Sectores de Alto Riesgo Ambiental por Exposición a Solventes Orgánicos en el Municipio de Sampués-Sucre

The purpose of this study is to characterize -through the Maternal and Perinatal Risk Questionnaire CMRP – the pre and perinatal aspects of children whose mothers had frequent exposure to organic solvents during pregnancy.
The results demonstrates that exposed mothers had a higher number of urinary infections both before and during pregnancy, pre term deliveries, motor decline and cesarean deliveries, which are potential causes of developmental disorders, cerebral palsy, decreased growth of the baby and impaired psychomotor development. A significant data was the number of children who suffered hypoxia and anoxia during delivery, with subsequent risk of brain damage, learning disabilities, reduced IQ and potential behavior problems.

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Palabras clave: características pre y perinatales, conducta, desarrollo cognitivo, desarrollo físico, neurotoxicidad, Solventes orgánicos,

Keywords: behavior, cognitive development, neurotoxicity, Organic solvents, physical development, pre and perinatal characteristics,

Sistemas de Atención Focalizada, Sostenida y Selectiva en Universitarios de Quito-Ecuador

Introduction. Attention is a neuropsychological function that has threads of targeting, selectivity, sustainability, division and alternation, which enable human beings identify a particular stimulus for cognitive and brain processing. Objective. To analyze the performance of college students in a focused, sustained and selective attention test, considering age group, gender and academic level comparing factors. Method. A quantitative, non experimental, transectional and based on the comparison group research design was used. The sample size was 246 college students (50.8% men and 49.2% women), within17 and 29 years (M = 21.01, SD = 2.35) Results. It was found that targeting attentional processes, sustainability and selectivity are similar between the different age groups, educational level and gender. Conclusions. The basic attentional processes are fully developed in college students. Data are discussed around previous research and theoretical postulates of cognitive neuroscience.

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Palabras clave: atención selectiva, atención sostenida, Ecuador, estudiantes universitarios, focalización, neuropsicología,

Keywords: college students, Ecuador, focusing, neuropsychology, selective attention, sustained attention.,

Uso del Electroencefalograma en un Hospital de Tercer Nivel

Objective: To describe the EEG indications in Baca Ortiz Children Hospital and how they are related to the EEG results. Materials and Methods: This is a descriptive study with a sample of 659 pediatric EEG records from March to June 2016. Data of variables related to EEG indications and EEG results were obtained, and it was done a descriptive statistics analysis. Results: Fifty-six percent of the patients were male. The mean age was 6.46 years. Seventy percent of EEG requests came from the Outpatient Area and 88.16% from Neurology as specialty. Fifty-six percent of indications were related to Epilepsy. Fifty-one percent of requests were inadequate, where Epilepsy had again the highest percentage, 24.13% of all indications or 47,04% or all inadequate indications. Eighty-one percent of the EEG results were abnormal. Conclusions: These results reflect that EEG was misused as a routine diagnostic method, even in Epilepsy.

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Palabras clave: Electrodiagnóstico, Electroencefalografía, Electrofisiología, neurofisiología, Técnicas de Diagnóstico Neurológico, Técnicas y Procedimientos Diagnósticos (DeCS),

Keywords: Diagnostic Techniques, Electrodiagnosis, Electroencephalography, Electrophysiology, Neurological Diagnostic Techniques and Procedures (MeSH), neurophysiology,

Miositis Esporádica por Cuerpos de Inclusión

Sporadic inclusion body myositis is a common acquired inflammatory myopathy in people over 50 years of age. It presents with slowly progressive asymmetric weakness that affects preferentially the quadriceps and deep finger flexors. The pathogenesis is poorly understood. The diagnosis is made with a combination of the clinical history, physical exam, electrodiagnostic tests, imaging, serology and histopathology. There is no treatment for this condition but multiple therapies are currently being investigated.

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Palabras clave: cuerpos de inclusión, inflamación, miopatía, patogénesis, patología,

Keywords: inclusion bodies., inflammation, myopathy, pathogenesis, pathology,

El Cerebro y la Música

Sound and music share a lot, but they are not totalitarian synonyms. Each one has some qualities or elements that define them even when they are equivocally seen as equals. Sound is a physical event, while music is an art that uses that event as material to develop itself. In our brain, music is processed through neural networks that involve areas of auditory and motor processing, in turn, their perception and execution involve various cognitive functions. Although current knowledge of the structures involved in hearing and the effect of music in our brain is still uncertain, a review of the most up-to-date literature on the subject is useful.

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Palabras clave: afasia, amusia, cerebro, frecuencia, Música, ritmo, tono,

Keywords: amusia, aphasia, brain, frequency, Music, rhythm, tone,

Manifestaciones Neurológicas Asociadas a Infección por Virus Zika

Zika virus is a flavivirus and it is part of the flaviviridae family. This virus is transmitted by Aedes mosquito bites and sexual intercourse. The virus was discovered in 1947 but it was almost unknown until it spread along America in 2015 and was associated with multiple neurological disorders. Due to this incidence, the World Health Organization declared an emergency status in 2016. In Ecuador, the first case of Guillain-Barre Syndrome associated with Zika virus infection was reported during
the same year.

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Palabras clave: Ecuador, Guayaquil, Manifestaciones neurológicas, Zika,

Keywords: Ecuador, Guayaquil, neurological disorders, Zika,

Tratamiento Neuropsicológico del TDAH en Preescolares: Entrenamiento de la Función Ejecutiva

Preschoolers who have symptoms of impulsivity, hyperactivity and attention deficit manifest alterations in the executive functions: inhibitory control, working memory, monitoring and self-directed speech. It is essential in the preschool classroom to identify children who have difficulty regulating their behavior. The importance of this early detection is the possibility of avoiding a picture of ADHD with greater complexity in the child’s future. Training of executive function in children who could present these symptoms has been described as a highly effective strategy. Researches affirm that training of executive function would decrease the likelihood that a child will have ADHD at school age if he had received early attention from preschool. From the clinical experience it has witnessed the evolution of cases of children identified preschool with symptoms of ADHD, and then do a training executive functions for periods of one to two years better, and even at the beginning of schooling have a less severe psychopathology, unlike children who have not received this early intervention. In this paper I will describe the clinical picture of ADHD in initial preschool, the relationship between this disorder and executive function and some strategies in the training of executive functions.

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Palabras clave: Funciones Ejecutivas, preescolar, trastorno por déficit de atención con hiperactividad,

Keywords: Attention deficit hyperactivity disorder, Executive functions, preschool,

Síndrome de Guillain-Barré: Un Caso Atípico

Guillain Barre Syndrome (GBS), is an acute inflammatory polyneuropathy, of autoimmune etiology that produces an inflammation in the peripheral nerves and its spinal roots. GBS generally presents as flaccid, symmetric, ascendent and areflexic palsy, along with a previous respiratory or gastrointestinal infection. It has been reported atypical forms of presentation. We describe the case of a 53 years old male patient, without previous infections in the last months, who is admitted to the emergency department presenting walking difficulties due to decreased muscle strength, pain and numbness in the lower limbs, deep tendon reflexes present, followed few days later by a right peripheral facial palsy. Examination of cerebrospinal fluid (CSF) revealed albumino-cytological dissociation, leading to diagnose GBS of atypical presentation, which was treated with intravenous immunoglobulin followed by a favorable outcome.

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Parkinsonismo y Mielinolisis Osmótica. Descripción de caso

Introduction: Osmotic demyelination syndrome is a rare medical condition in which parkinsonian signs are relatively non frequent. Objective: To report a case of a patient with hyponatremia rapidly corrected and treated with neuroleptics. The cranial MRI showed demyelinating lesions in pons and basal ganglia. The patient clinically developed parkinsonism, with no response to dopamine. Conclusion: The inadequate correction of hyponatremia causes demyelinating lesions. As we appreciate in this case, the prescription of neuroleptic drugs may negatively affect the response to dopaminergic therapy.

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Palabras clave: Hiponatremia, Mielinolisis osmótica, neurolépticos, parkinsonismo,

Keywords: Hyponatremia, Neuroleptics, Osmotic myelinolysis, parkinsonism,

Razonamiento Clínico: Hombre de 57 Años de Edad con Dolor y Debilidad Muscular Proximal

We present a case of a 57-year-old man with a two-month history of shoulder pain and proximal weakness. The history and physical examination are reviewed and a stepwise approach to the differential diagnosis is made to reach the final diagnosis.

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Palabras clave: debilidad proximal, Diabetes mellitus, diagnóstico diferencial,

Keywords: Diabetes Mellitus, diagnosis, proximal weakness,

Infarto Talámico Bilateral

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Palabras clave: infarto cerebral, lupus eritematoso,

Feasibility of Global Sleep Research in Rural Areas of Low-and-Middle-Income Countries. The Atahualpa Project Experience

Changes in lifestyle, including sedentarism, shift work and increased visual contamination, have modified sleep patterns and increased the prevalence of sleep-related disorders in remote rural areas of many low- and middle-income countries (LMIC). However, there is scarce information on the public health impact of sleep-related disorders in these regions and publications lack consistency in their design and use of research tools, which creates barriers for proper comparison of results across populations. Moreover, in the largest studies on sleep-related disorders conducted in LMIC, individuals were interviewed with only one or two questions, which might not reflect the actual magnitude of the problem. In our opinion, the goal should not be to interview tens of thousands of individuals but to study them well by selecting representative populations of different regions to evaluate them thoughtfully and uniformly.

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Keywords: atahualpa project, feasibility, global sleep, income, research, rural areas,

Trombectomía Mecánica: Técnica de Primera Elección en el Tratamiento del Ictus Isquémico Agudo. Análisis de Beneficios y Resultados

The main objective of this article is to portrait mechanical thrombectomy as the modality of choice for interventional stroke treatment.

Methods and materials: Nine patients with acute ischemic stroke were diagnosed. Mechanical thrombectomy was perfomed in all of them with a solitaire type device associated with intraarterial rTPA. Eight patients (89%) had anterior vascular occlusion and only one (11%) had posterior vascular compromise. Treatment efficacy was assesed using a modified Rankin scale (mRs).

Results: Five patients (55%) had complete recovery while three of them (33%) had partial recovery. Only one patient (11%) showed no recovery at all.

Discussion: Although more data is needed, mechanical thrombectomy prooved to be effective and shows promising outcomes in patients with acute ischemic stroke.

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Palabras clave: ictus isquémico agudo, trombectomía mecánica,

Keywords: acute ischemic stroke, mechanical thrombectomy,

Experiencia Quirúrgica de Dos Años en el Manejo de la Epilepsia Refractaria Multifocal

Objective: To describe the series of patients with multifocal refractory epilepsy who have undergone surgery in our center.

Methods: A prospective analysis of patients with multifocal refractory epilepsy treated in our hospital during the last two years was performed.

Results: In this period we studied 25 patients with multifocal refractory epilepsy who have completed > or =1 year postoperative follow-up after callosotomy. The ages of the patients were between 3.8 and 18.8 years (mean 11, SD 4.46). The most common cause of refractory epilepsy in our series was Lennox Gastaut syndrome (ten patients). We perform 14 callosotomy in 13 patients. Of these, 10 were of the above callosotomías 2/3 and four complete. Overall there was a 66.5% reduction in seizures; in the case of total callosotomías this reduction was 90%. We report two minor complications and death from a pneumonic process.

Conclusion: The surgical management of multifocal refractory epilepsy is a safe procedure that provides good results in controlling the crisis. The complete callosotomy is the most efficient procedure in this population.

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Palabras clave: Callosotomía, Cirugía de la epilepsia, Epilepsia refractaria, Neuronavegación, Planificación quirúrgica,

Keywords: Callosotomy, Epilepsy Surgery, Neuronavigation, Refractory epilepsy, Surgical planning,

Impacto del Aprendizaje del Inglés Sobre los Procesos Cognitivos en Adultos Mayores. Un Estudio Preliminar en Cuenca

A descriptive exploratory study, before and after a six-month english learning course for seniors is conducted to evaluate the cognitive effect of learning another language in this age group in the city of Cuenca.

Materials and Methods: 80 adults of average age 70.48 ± 4.9 years (31 men, 19 women) were included; who underwent neurological and neuropsychological evaluation at baseline, six and twelve months after the course; including tests for executive function (working memory and attention processes).

Results: Data show significant statistical association between impaired olfactory perception related to age. Neuropsychological tests show interesting data relating cognitive maintenance and even improvement in the Performance Testing Direct and inverse series (Wais III) and Symbol Digital Modality Test (SMDT) six and twelve months after initiating a learning course of English.

Conclusion: The study suggests that learning English, even without functional objective of a new language, may have protective effect on the executive functions and neuronal brain networks are claimed the first findings in patients with cognitive impairment. We suggest perform this follow up long term in time to find strongest evidence, related to international bibliography.

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Palabras clave: demencia, deterioro cognitivo, inglés, Neuroprotección,

Keywords: Cognitive decline, dementia, english, Neuroprotection,

Validación de la Escala de Impulsividad Bis 11-C para su Aplicación en Adolescentes Ecuatorianos

Barratt scale (BIS) is an assessment tool often used to evaluate impulsivity. In this study, an analysis of the psychometric properties of the BIS 11 c scale Ecuadorian adolescent students (N = 245) is performed. Internal consistency through Cronbach’s alpha coefficient and homogeneity of the items were evaluated. For assessing the construct validity we perform a confirmatory factor analysis. The results obtained were acceptable parameters of valid and reliability to use the BIS 11 c scale in Ecuadorian adolescents. Finally, a discriminant analysis in a clinical sample of 18 students with ADHD was conducted.

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Palabras clave: adolescentes, Déficit atencional, Escala BIS, Hiperactividad, impulsividad,

Keywords: adolescents, Attentional Deficit Hyperactivity Disorder, BIS Scale, impulsivity,

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,
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