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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Evaluación de Estimulación Cognitiva en Pacientes con Deterioro Cognitivo Leve Mediante un Estudio Analítico, Aleatorizado y Doble Ciego Evaluation Of Cognitive Stimulation In Patients With Mild Cognitive Impairment In An Analytical, Randomized, And Double-Blind Study

Introduction: The aging of the population increases the scientific interest in identifying and treating the stages preceding dementia. The concept of mild cognitive impairment (MCI) includes patients with demonstrated cognitive deficits but who are able to maintain adequate functionality. There are no pharmacological measures capable of slowing the progression to dementia in a percentage of these patients, although cognitive stimulation (CS) may be a promising treatment.

Methodology: A double-blind randomized clinical trial was conducted including 38 MCI patients who were followed up using neuropsychological and functionality tests for one year. CS was provided to the intervention group.

Results: The statistical analysis showed significant differences in the quantitative results of the Montreal Cognitive Assessment (MoCA) test between intervention and control groups. Furthermore, we detected a non-significant positive trend in the neuropsychological evaluation but not in the functionality scores.

Conclusions: Dementia is expected to triple its prevalence by 2050, making the study of pre-dementia stages necessary. Despite not achieving significance, CS therapy may be a useful tool in this situation. The MoCA is a useful score for the diagnosis and monitorization of these patients.

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Palabras clave: Deterioro Cognitivo Leve, Entrenamiento cognitivo, Estimulación, neuropsicología, Test de Montreal, Tests neuropsicológicos,

Keywords: Cognitive training, Mild Cognitive Impairment, Montreal Cognitive Assessment, Neuropsychologic tests, neuropsychology, Stimulation,

Redes Atencionales como Predictores Cognitivos de la Comprensión Lectora de Niños en Edad Escolar. Attentional Networks As Cognitive Predictors Of Reading Comprehension In School-Age Children

The socio-affective stimuli received in childhood are essential to develop reading skills. The objective of this research is to investigate impact vectors of attentional networks developed in contexts of social vulnerability, as cognitive predictors of reading comprehension. The methodology contemplates a non-experimental design of a randomized group with two distributions applied to 30 children from 4th and 5th grade of basic education (N=60). The neuropsychological evaluation consisted of subtests of three instruments such as: WISC-V, TMT and ENI. The statistical analysis indicated that there are no significant differences (U >0.05) between the evaluated groups, while the modelling showed positive results in the multiple linear regression. Now, the divided attentional network (visual and verbal) has a significant correlation (r = 0.61 and r = 0.40) with the reading comprehension process.

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Palabras clave: comprensión lectora, edad escolar, predictores cognitivos, redes atencionales, vulnerabilidad social,

Keywords: attentional networks, cognitive predictors, reading comprehension, school age, social vulnerability,

Tiempo en Horas Desde el Inicio del Deterioro Neurológico en Pacientes con un Evento Cerebrovascular Isquémico hasta su Llegada a la Sala de Emergencia. Estudio Observacional Time In Hours From The Beginning Of Neurological Deterioration In Patients With Ischemic Stroke To Arrival At The Emergency Room. An Observational Study

Patients who present neurological symptoms compatible with an ischemic cerebrovascular event benefit from the use of alteplase (intravenous thrombolysis) as long as it is administered within 4.5 hours after the onset of symptoms.

Objective: Establish the time in hours that it takes our patients to arrive at the Emergency Department of the General Hospital Del Norte in Guayaquil Los Ceibos, Ecuador.

Methods: It is an observational, descriptive cross-sectional study that included 157 patients with a diagnosis of acute ischemic cerebrovascular event by computed tomography and/or magnetic resonance imaging and who attended the emergency room of our hospital between January and June, 2022 and from February to April 2023. Other variables such as percentage of thrombolyzed patients, sex, average age, age groups, blood pressure at admission and localization of the cerebral infarct were also studied.

Results: The average time in arrival hours was 34.7 hours, of which 18 (11.5 %) arrived up to 3.0 hours, 14 (8.9%) between > 3.0 to 4.5 hours and 125 subjects (79.6%) arrived after 4.5 hours from the onset of symptoms. Only 3.2 % of patients were thrombolyzed. Men were affected in 64.3% and women in 35.7%. The average age was 69 years old; by age groups, the vast majority ocurres after age 50 and only 8.3 % before that age. 72.6% were hypertensive and of these, 62.3% were male and 37.7% were female; by age groups, we see that 81.6% of hypertensive patients are between 60 and 89 years old. Regarding the location of the infarction, of all patients, the anterior territory is affected in 64.5% of cases and the posterior territory in 35.5%. Conclusions: Our patients arrive very late to the emergency room, well beyond the 4.5 hours that is the time during which they would benefit from thrombolytic treatment, the highest percentage of events ocurres after the age of 50, the majority are men, most arrive with hypertension and the anterior brain territory is more affected than the posterior.

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Palabras clave: circulación cerebrovascular, edad, hipertensión, imagen por resonancia magnética nuclear, infarto cerebral, sexo, tomografía computada,

Keywords: age, Cerebral infarction, cerebrovascular circulation, hypertension, magnetic resonance imaging, sex, tomography,

Perfil Clínico y Demográfico de Pacientes con Enfermedad de Parkinson: Experiencia en un Centro de Referencia de Perú. Clinical And Demographic Characteristics Of Patients With Parkinson’s Disease: Experience At A Referral Center In Peru

Objective: To describe the demographic and clinical characteristics of patients with Parkinson’s disease treated at a national reference hospital in Peru.

Methods: We conducted a retrospective cross-sectional study that included 35 adult patients (18 years and older) with Parkinson’s disease treated at the Neurology outpatient service of the Edgardo Rebagliati Martins National Hospital during 2020. We recorded the clinical and demographic information of the medical records. clinics. We performed bivariate analysis to compare the covariates of interest with the presence of complications and the Hoehn and Yahr stage.

Results: The average time of illness was more than 5 years from diagnosis and most presented motor complications, the treatment they received was almost entirely levodopa and 37% received treatment with deep brain stimulation. In the bivariate analysis according to the Hoehn and Yahr stages with the variants age, clinical variant, time of illness and being subjected to Deep Brain Stimulation, no significant differences were found. In the bivariate analysis according to the presence of complications, statistical differences were found between complications and tertiles of age (p=0.008) and the median time of illness (p=0.010).

Conclusion: We report a prolonged disease time in the included patients, most of them presented motor complications, their main treatment was levodopa and a high percentage of deep brain stimulation. It is important to propose multicenter studies in reference centers for Parkinson’s management that allow us to have a better overview of the clinical and demographic situation of these patients in our population.

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Palabras clave: enfermedad de Parkinson, Estimulación Encefálica Profunda, levodopa, Perú, Signos y Síntomas,

Keywords: Deep brain stimulation., levodopa, Parkinson’s disease, Peru, Signs and Symptoms,

Reactividad Vasomotora Cerebral en un Grupo de Voluntarios Sanos a Más De 2000 Metros de Altura. Estudio con Doppler Transcraneal Cerebral. Vasomotor Reactivity In A Group Of Healthy Volunteers At An Altitude Of More Than 2000 Meters. Transcranial Doppler Study

Introduction. Cerebral vasoreactivity (CVR) is the mechanism that maintains stable cerebral blood flow in response to cerebral metabolic variations or systemic blood pressure. The reference method for studying CVR is transcranial Doppler (TCD) using a vasodilator stimulus. A simple alternative to perform is the apnea test, but its results can be influenced by physiological variables and the height at which the subject is.

The objective of this study was to determine normal CVR values in a group of people residing in Quito.

Material and Methods. 48 people without a history of disease were examined. Flow parameters in the middle cerebral and basilar arteries were recorded. With the results of the apnea test, the percentage increase in flow velocity and the Breath Holding Index were calculated. This data was analyzed by sex and the age group.

Results. The average age was 34.8 years, with a predominance of those under 40 years of age and women (70.8%). Higher Vmf were recorded in women. CVR was significantly higher in the MCA (p 0.000) and lower in women. With age, flow parameters and apnea test results did not demonstrate significant differences.

Conclusions. In the cohort examined, the hemodynamic parameters recorded during the apnea test offer different results than those published in other series. The lower RVC appears to be influenced by altitude and sex.

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Palabras clave: altura, Doppler transcraneal, reactividad vasomotora cerebral, test apnea, ultrasonido,

Keywords: altitude, apnea test, cerebral vasoreactivity, Transcranial Doppler, ultrasound,

Síndrome de Desmielinización Osmótica tras Corrección de Hiponatremia Tratado con Inmunoglobulina Intravenosa y Plasmaféresis. Osmotic Demyelination Syndrome After Correction Of Hyponatremia Treated With Intravenous Immunoglobulin And Plasmapheresis

Introduction: Osmotic demyelination syndrome (ODS) is a non-inflammatory demyelination of neurons due to apoptosis of oligodendrocytes and the infiltration of macrophages that degrade myelin. It has a prevalence of about 0.06% in hospitalized patients, which can lead to severe disability or death. It can be precipitated by aggressive correction of a hyper or hypo osmolar condition.

Clinical Case: We present the case of a 52-year-old male patient with a history of hypertension, dyslipidemia, depression, neck pain and low back pain under treatment with desvenlafaxine, gabapentin, oxycodone-naloxone, dexketoprofen, metamizole, diazepam, ezetimibe-atorvastatin, enalapril who presented low level of consciousness and tonic-clonic seizures. In the initial examination he was in a post-critical state and scored 7 points on the Glasgow scale. In the analysis he presented hyponatremia. After correction, his neurological status progressively deteriorated, with a brain magnetic resonance imaging showing a hyperintense lesion in the pons and left temporal region compatible with ODS. Immunoglobulins were administered and subsequently, 7 plasmapheresis sessions were performed. No clinical improvement was evident with the administration of immunoglobulins. Neurological improvement was presented after 7 plasmapheresis sessions.

Conclusion: Osmotic demyelization syndrome constitutes a clinical challenge for its diagnosis, and should be suspected in patients who present new neurological symptoms after correction of serum sodium levels. There are currently no guidelines for optimal treatment. However, in some cases good results have been reported with the administration of immunoglobulins or plasmapheresis.

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Palabras clave: Hiponatremia, inmunoglobulinas intravenosas, mielinólisis extrapontina, Mielinólisis pontina central, neuroimagen, plasmaféresis,

Keywords: Central pontine myelinolysis, Extrapontine myelinolysis, hiponatremia, intravenous immunoglobulins, neuroimaging, plasmapheresis,

Ataxia Cerebelosa Aguda Secundaria a Intoxicación por Mercurio. Acute Cerebellar Ataxia Secundary To Mercury Intoxication

Cerebellar ataxia is a neurological disorder characterized by loss of coordination, particularly affecting gait and balance. It can be acquired or congenital. Among the acquired causes are infectious, metabolic, vascular, neoplastic processes, vitamin deficiencies, autoimmune diseases and toxic ones. Mercury poisoning can generate subacute or chronic neurological manifestations, with cerebellar ataxia being a rare manifestation. Cases of poisoning by this heavy metal still occur in people of underdeveloped countries, especially in fields such as illegal and low-scale mining, who still use it to extract gold. In this case, an atypical and acute presentation of mercury poisoning in an illegal mining worker patient with cerebellar ataxia will be described.

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Palabras clave: ataxia cerebelosa, intoxicación por mercurio, minería,

Keywords: cerebellar ataxia, mercury poisoning, mining,

Encefalopatía en el Paciente Hospitalizado: No Olvidar el Síndrome de Wernicke-Korsakoff. Encephalopathy In The Hospitalized Patient: Do Not Forget The Wernicke-Korsakoff Syndrome

Introduction: Wernicke-Korsakoff syndrome, a cause of encephalopathy, is frequently overlooked in the hospitalized patient.

Case report: a 52-year-old woman, who was hospitalized for a prolonged fever and liver-spleen problems, experienced progressive acute encephalopathy, which led to the exclusion of various possible diagnoses. A brain magnetic resonance imaging scan was conducted, revealing certain features of Wernicke-Korsakoff encephalopathy. Consequently, the patient was administered intravenous thiamine as empirical treatment, resulting in significant improvement.

Discussion: This case highlights the significance of considering Wernicke-Korsakoff syndrome as a potential cause of encephalopathy in hospitalized patients. It also emphasizes the atypical nature of its presentation, variable radiological findings, and the criticality of initiating early treatment.

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Palabras clave: Deficiencia de Tiamina, diagnóstico diferencial, Encefalopatía, Encefalopatía de Wernicke, Imagen por Resonancia Magnética,

Keywords: differential diagnosis, Encephalopathy, magnetic resonance imaging, Thiamine Deficiency, Wernicke Encephalopathy,

Meningitis por Enterococcus Casseliflavus Secundaria a Anestesia Raquídea: Primer Reporte de Caso en Las Américas. Enterococcus Casseliflavus Meningitis, Secondary To Spinal Anesthesia: First Case Report In The Americas

Neuraxial anesthesia (epidural and spinal) is a common regional anesthesia technique. Acute bacterial meningitis after spinal anesthesia is a rare event and rarely described enterococcal infection, usually occurring due to Enterococcus faecalis and Enterococcus faeciumm. We describe the first case in the Americas of meningitis caused by Enterococci casseliflavus in a young woman who received spinal anesthesia for osteosynthesis of the right ankle, who after three days developed headache, fever and disorientation. The cerebrospinal fluid (CSF) study and blood cultures confirmed the bacterial infection. The patient received antibiotic management with significant improvement. There are only two reported cases in the world of Central Nervous System involvement by Enterococci casseliflavus.

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Palabras clave: anestesia raquídea, Cefalea, Enterococcus casseliflavus, meningitis bacterianas, punción espinal,

Keywords: Bacterial meningitis, Enterococcus casseliflavus, headache, Spinal Anesthesia, Spinal Puncture,

Diffuse Neurofibroma In Neurofibromatosis Type 1: Case Series. Neurofibroma Difuso en Neurofibromatosis Tipo 1: Serie de Casos

Diffuse neurofibromas are poorly defined, benign tumors of the peripheral nerve sheath with an invasive growth pattern. They are not commonly associated with neurofibromatosis or other neurocutaneous disorders. This manuscript aims to document the occurrence of diffuse neurofibromas in patients with NF1, while providing a comprehensive review of this type of tumor. We present three cases highlighting diffuse neurofibromas’ clinical, radiological, or histological characteristics of diffuse neurofibromas in patients with a long-standing history of NF1. These rare tumors have a low prevalence but have defined and characteristic pathologic, imaging, and immunohistochemistry features for diagnosis. Treatment is challenging due to the lack of standardization in therapies and should be analyzed on a case-by-case basis. Diffuse neurofibromas should be included in the differential diagnosis in patients with NF1 and any associated cutaneous lesions. Further studies are needed to standardize an integral approach in these patients.

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Palabras clave: neurofibroma difuso, neurofibromatosis tipo 1, NF1, paraneurofibroma, serie de casos,

Keywords: Case series, diffuse neurofibroma, neurofibromatosis type 1, NF1, paraneurofibroma,

Diagnóstico de la Enfermedad de Alzheimer de Inicio Temprano Mediante el Uso de Biomarcadores en Líquido Cefalorraquídeo: Reporte de Caso. Diagnosis Of Early-Onset Alzheimer’s Disease Using Cerebrospinal Fluid Biomarkers: A Case Report

Alzheimer’s disease (AD) represents between 50% and 75% of dementia cases worldwide. It is classified into two types: Late-onset (LOAD), which is common in individuals over 65 years old, and Early-onset (EOAD), which affects 5-10% of individuals before the age of 65. Its manifestations vary considerably, ranging from typical amnestic presentation in LOAD to atypical forms such as non-fluent aphasia, executive, and visuoperceptive alterations in EOAD, which makes timely diagnosis difficult.

Currently, the diagnostic model goes beyond conventional, proposing the use of biomarkers in cerebrospinal fluid for early detection and management.

In the case presented, we describe a 57-year-old woman with EOAD, characterized by a two-year history of progressive and insidious memory loss accompanied by logopenic aphasia and behavioral changes. In her family history, the patient had a history of dementia in three generations on the maternal side. To confirm the diagnosis, complementary studies were performed such as conventional brain magnetic resonance imaging with perfusion sequences and the measurement of Tau protein and Beta-amyloid peptide biomarkers in cerebrospinal fluid. These analyses confirmed the presence of early-onset Alzheimer’s disease.

In this study, we discuss the diagnostic process of Alzheimer’s disease, emphasizing in the use of biomarkers in cerebrospinal fluid.

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Palabras clave: biomarcadores en líquido cefalorraquídeo, Demencia por Alzheimer, diagnóstico de la Enfermedad de Alzheimer, Enfermedad de Alzheimer de inicio temprano, péptidos beta-amiloide, proteínas de líquido cefalorraquídeo,

Keywords: Alzheimer's Dementia, Alzheimer's disease diagnosis, Alzheimer’s Disease, Amyloid beta-peptides, Biomarkers, cerebrospinal fluid, Cerebrospinal fluid proteins, Early-onset,

Infarto Cerebral que Simula una Encefalitis: A Propósito de Tres Casos. Cerebral Infarction Mimicking Encephalitis: Regarding Three Cases

The differential diagnosis between Stroke and Encephalitis from a clinical point of view in some cases can be complicated, making it necessary to resort to MRI diffusion sequences. Three men with acute ischemic stroke (AIS) are presented, all three with suspected encephalitis that were a diagnostic challenge for the clinician. The first case, an AIS in the territory of the right anterior cerebral artery (ACA) that was initially medicated with antibiotic therapy for community pneumonia, and the reappearance of fever and epileptic seizure made us think of a CNS infection. The second case was an infarction in the border territory of the left middle cerebral artery (MCA)/posterior cerebral artery (PCA) with onset of aphasia, fever and agitation accompanied in its evolution by extensive intestinal ischemia with a fatal outcome. The third case, an AIS of the posterior circulation with inaugural headache, vomiting, altered level of consciousness and speech with transient right motor deficit in which the cause of the stroke was a patent foramen ovale (PFO). The three cases correspond to cerebral infarcts that simulate encephalitis in the clinic and in cerebrospinal fluid (CSF): light pleocytosis, proteinorrachia, without identified microorganism. In the literature, there are no studies or clinical series, only exceptional clinical cases of this form of presentation whose pathogenic mechanism is unknown. In these cases, we must always exclude an embolic stroke of undetermined origin (ESUS).

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Palabras clave: encefalitis, infarto cerebral, Líquido cefalorraquídeo inflamatorio, Resonancia cerebral,

Keywords: Brain resonance, Cerebral infarction, encephalitis, Inflammatory cerebrospinal fluid,

Muerte Encefálica: Diagnóstico Apoyado por Doppler Transcraneal. Brain Death: Diagnosis Supported By Transcranial Doppler

Brain death is diagnosed through a clinical examination that requires a period of observation.  We present the case of a patient diagnosed with aneurysmal subarachnoid hemorrhage, in whom after presenting symptomatic vasospasm, brain death was diagnosed with the support of transcranial Doppler sonography.

Conclusion: Transcranial Doppler allows us to demonstrate the cerebral circulatory arrest that accompanies brain death and shortens the observation period.

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Palabras clave: Aneurisma, diagnóstico, Doppler transcraneal, Hemorragia Subaracnoidea, Muerte encefálica,

Keywords: Aneurysm, Brain death, diagnosis, Subarachnoid Hemorrhage, Transcranial Doppler,

Estado actual de la Esclerosis Múltiple en Ecuador. Current Status of Multiple Sclerosis in Ecuador.

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Estado funcional en la Enfermedad de Alzheimer: Más allá del deterioro cognitivo. Functional status in Alzheimer’s Disease: Beyond cognitive impairment.

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Palabras clave: actividades de la vida diaria, Enfermedad de Alzheimer, fragilidad, multimorbilidad, valoración geriátrica integral,

Keywords: activities of daily living, Alzheimer disease, comprehensive geriatric assessment, frailty, multimorbidity,

Neurociencia Ambiental y salud mental: Realidades invisibilizadas en las comunidades rurales. Environmental Neuroscience and mental health: Invisible realities in rural communities.

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Palabras clave: Cambio Climático, Comunidad Rural, Educación Ambiental, neurociencia, salud mental,

Keywords: Climate Change, Environmental Education, mental health, neuroscience, Rural Community,

Sobre el artículo “Modelos de Organización Cerebral”: La relevancia de la hipótesis organizacional-activacional. On the article “Brain Organization Models”: The relevance of the organizational-activational hypothesis.

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Palabras clave: conducta, desarrollo cerebral, diferenciación sexual, esteroides, mamíferos,

Keywords: Behaviour, brain development, mammals, sex differentiation, steroids,

Trastorno del desarrollo de la coordinación en la infancia: Interacción con la condición física y estado nutricional. Developmental coordination disorder in childhood: Interaction with physical condition and nutritional status.

Dear Editor:

Developmental coordination disorder (DCD), or dyspraxis, is a challenge of interest to both clinical researchers and education professionals, particularly pre-service teachers. This disorder, as described by Castelluci et al., is characterized by impaired motor performance and difficulties learning motor skills in childhood.

Recent evidence suggests that infants with greater motor impairment are at increased risk of developing health problems, given that decreased levels of physical activity and participation in sports activities could aggravate this condition. In this case, infants with probable DCD have demonstrated lower levels of muscle strength, aerobic fitness, and endurance compared to their peers without DCD.

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Mejorando la Atención del Evento Cerebrovascular en Ecuador a través de una Red Articulada de Atención Improving Cerebrovascular Event Care in Ecuador through an Articulated Care Network

In the era of “big data” in health and healthcare, the need for high-quality information on population health has never been more critical. In the context of cerebrovascular events (CVD) in Ecuador, the increasing burden of the disease, the inequity in the distribution of neurologists, and the recent enactment of the Universal Health Care Law underscore the urgency of establishing effective networks between primary care and hospitals prepared to treat CVD. This article reviews the existing literature and evidence highlighting the role of primary care providers (PCPs) and specialists in the different stages of CVD management, as well as care transitions and the use of telemedicine/teleneurology.

The experience in Ecuador with the “Act with Speed” campaign launched by the Vice Presidency of the Republic in coordination with the Global Angels initiative provides a valuable model. This campaign has certified hospitals as Stroke Ready Centers, trained thousands of professionals, and raised awareness among the population about the importance of a rapid response to a CVD. Implementing a CVD referral network between primary care and specialized hospitals could significantly improve patient outcomes, especially in underserved areas.

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Palabras clave: evento cerebrovascular,

Keywords: Cerebrovascular,

Ambientes Saludables en la Infancia Temprana. La clave para el desarrollo de Funciones Ejecutivas Healthy Environments in Early Childhood. The key to the development of Executive Functions.

We would like to complement the findings of the article “Daily Stress, Executive Functions, and Academic Performance in Elementary School Children” by Armstrong-Gallegos and Troncoso-Díaz, published in the Ecuadorian Journal of Neurology (Vol. 33, No. 1, 2024). Along these lines, we propose adding the perspective of the first two years of life, understanding that this is a critical stage in this process.

The brain development of children is rapid and crucial. Nutrition plays a fundamental role during these first years of life. Nutrients such as iron, omega-3 fatty acids, and B vitamins support important processes such as myelination and synaptogenesis. These processes, in turn, are key to executive function (EF) skills such as working memory, inhibitory control, and cognitive flexibility.1,2 Conversely, a lack of these nutrients can lead to long-term difficulties with self-regulation, impacting social and educational environments.3 Furthermore, glucose, as the brain’s primary energy source, when blood levels fluctuate too much, may make it harder for individuals to stay focused or control their impulses, which can affect their performance and interactions with others.

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Palabras clave: Funciones Ejecutivas, infancia temprana,

Keywords: early childhood, Executive function,

Características Clínicas de Pacientes Hipertensos hospitalizados con y sin Enfermedad Cerebrovascular de 60 a 90 años en Quito, Ecuador: Estudio de Casos y Controles. Clinical Characteristics of hospitalized Hypertensive Patients with and without Stroke aged 60 to 90 years in Quito, Ecuador: A Case-Control Study.

Background: Stroke is the world’s second leading cause of death from disease, and disability-adjusted life years. The investment in management of a hospitalized stroke patient generates a high healthcare cost. In Ecuador it is the third leading cause of death. Hypertension is one of the most important factors in the stroke development. Patients with high blood pressure and stroke have a higher risk of complications, mortality and poor prognosis.

Objective: The present study aimed to identify which variables differ between hypertensive patients with stroke versus hypertensive patients without stroke, hospitalized, during 2017- 2020.

Methods: In a population of 96 cases and 57 controls, a retrospective analytical cohort study between two groups of patients was conducted.

Results: The variable education (primary education) was the most affected among cases (χ²=13.298; p=0.039). Patients with atrial fibrillation were significantly higher in the case group (χ²=7.31 p=0.007). Other variables like: sex, age, provenance, years lived with hypertension, smoking, type 2 diabetes mellitus, heart failure, hypercholesterolemia and anticoagulant therapy, showed no significant difference between the two groups.

Conclusions: Patients with complete primary education and atrial fibrillation had significant presence in hypertensive patients with stroke.

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Palabras clave: comorbilidades, enfermedad cerebrovascular, enfermedades cardiovasculares, Factores de riesgo, Hipertensión arterial, síndrome metabólico,

Keywords: Arterial hypertension, cardiovascular diseases, Comorbidity, metabolic syndrome, Risk factors, stroke,

Factors related to swallowing prognosis in patients with acute ischemic stroke at a specialized institution in Medellín, Colombia. Factores asociados con el pronóstico deglutorio en pacientes con accidente cerebrovascular isquémico agudo en una institución especializada en Medellín, Colombia.

Objetive: To analyze the factors associated with swallowing prognosis among individuals with acute ischemic stroke who received treatment at a specialized neurology institution in Medellín, Colombia, in 2020.

Methods: This registry-based retrospective cohort study evaluated clinical factors influencing dysphagia, employing parametric survival models for interval-censored data.

Results: 270 patients were included, 52.2% female, with a mean age of 68.7 years (SD 14.4), with a mean follow-up of 4.91 days. The median survival time was 4.1 days (95% CI 3.7-4.6), with a cumulative seven-day survival rate of 22.72%. Main variables associated with dysphagia were TOAST small vessel occlusion (TR = 0.57, 95%CI 0.39-0.84) and large vessel atherosclerosis (TR=0.66, 95%CI 0.46-0.99), NIHSS severe (TR = 0.30, 95%CI 0.17-0.53), moderate (TR = 0.38, 95%CI 0.22-0.68), and mild to moderate scores (TR = 0.52, 95%CI 0.32-0.86), history of Parkinson’s disease (TR = 0.50, 95%CI 0.27-0.96) and older age (p = 0.043).

Conclusion: These findings have implications for developing a risk score to aid decision-making.

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Palabras clave: Accidente Cerebrovascular Isquémico, Deglución, Disfagia, Pronóstico,

Keywords: Dysphagia, ischemic stroke, Prognosis, Swallowing,

Estado de las normas de las pruebas neuropsicológicas para niño/as y adolescentes en Ecuador. Status of neuropsychological testing standards for children and teenagers in Ecuador.

Using neuropsychological tests that have normative data from the population in which they are being applied has positive effects on the accuracy and validity of the diagnoses, which can influence the effectiveness of the interventions derived from them. In addition, it provides greater precision in the studies that use such tests. In Ecuador, there are no studies on the use of standardized tests, which is why the objective of this study was to identify the neuropsychological tests for children and adolescents that have been adapted, standardized and/or validated in Ecuador. A systematic review was conducted using the PRISMA model. There are 10 tests with normative data for the Ecuadorian population: Wisconsin Card Sorting Test Modified Version, Trail Making Test, Color and Word Test: STROOP, Peabody Picture Vocabulary Test, Symbol and Digit Test SDMT, Rey Complex Figure – Osterrieth, Learning and Verbal Memory Test (TAMV-I), Concentration Endurance Test (d2), Verbal Fluency Test and Token Test. The instruments allow the evaluation of 17 cognitive functions. Based on the results, it is recommended that the country’s professionals choose to use these tests and their Ecuadorian scales.

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Palabras clave: baremación, Datos Normativos, evaluación neuropsicológica, psicometría, validez,

Keywords: Neuropsychological assessment, Normative Data, psychometrics, scale, validity,

Evaluación de la calidad de las guías de práctica clínica sobre encefalopatía hipóxico-isquémica en recién nacidos mediante la herramienta AGREE II: una revisión sistemática. Quality assessment of clinical practice guidelines on hypoxic-ischemic encephalopathy in newborns using the AGREE II tool: a systematic review.

Introduction: Hypoxic-ischemic encephalopathy (HIE) is a common cause of cerebral palsy and other severe neurological deficits in children. This study systematically evaluates the methodological quality of clinical practice guidelines (CPGs) on HIE using the AGREE II instrument.

Methodology: Ten CPGs were evaluated using the AGREE II instrument. Overall inter-rater agreement was calculated with the intraclass correlation coefficient (ICC).

Results: The “scope and purpose” domain received the highest score (78.33%, SD = 16.40, ICC 0.82), while the “applicability” domain received the lowest score (42.71%, SD = 38.86, ICC 0.85). Three guidelines were classified as “high quality” and seven as “low quality”. No significant differences were found in the quality of guidelines published between 2012-2017 and 2018-2023 (p = 0.20).

Conclusions: Most guidelines were rated as having low methodological quality, with the applicability domain receiving the lowest scores. Gaps were identified in the development of HIE guidelines between high-income and low/middle-income countries, and there was limited user involvement in formulating recommendations. 

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Palabras clave: asfixia neonatal, encefalopatía hipóxica-isquémica, guías de práctica clínica, neonatología, recién nacido,

Keywords: clinical practice guidelines, hypoxic-ischemic encephalopathy, neonatal asphyxia, neonatology, newborn,

Relación de las funciones ejecutivas y la conducta delictiva: Una revisión sistemática cuantitativa. Relationship of executive functions and criminal behavior: A quantitative systematic review.

Executive functions can be contextualized as the higher cognitive processes that allow a person to plan, make decisions, regulate behavior and solve problems, while criminal behaviors are actions or behaviors that violate the norms established in society. The aim of the article is to report the results of a quantitative systematic review that sought to analyze the relationship described in previous research between executive functions and criminal behavior. The databases reviewed for this work were Scopus and Pubmed. A total of 101 articles were identified and by applying inclusion and exclusion criteria, 11 eligible studies were selected. The research variables were examined in these studies. The results suggest that, impairments in executive functions are associated with an increased risk of engaging in delinquent behaviors.  These impairments may be caused by genetic factors, brain injury, exposure to addictive substances, or dysfunctional family environment. The results are discussed in relation to previous research, highlighting the importance of further progress in conducting studies that expand and strengthen the current understanding of executive functions in criminal behavior. 

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Palabras clave: conducta delictiva, criminalidad, Funciones Ejecutivas, psicología forense, toma de decisiones,

Keywords: criminal behavior, criminalitys, decision making, Executive functions, forensic psychology,

Funciones ejecutivas y género. Una revisión sistemática. Executive functions and gender. A systematic review.

Executive functions are a set of higher-order skills involved in the generation, regulation, and effective execution of behaviors to perform goal-directed activities. Given the importance of gender, it is essential to explore how executive functioning contributes to the adaptive behavior of women and men. Therefore, the aim of this study was to evaluate the existing evidence on executive functions in relation to gender. A systematic review of articles published in scientific journals was conducted using the PRISMA method. Selection criteria for the databases, inclusion and exclusion criteria for the studies, and search descriptors were established. Initially, 9277 records were identified, which, after being evaluated for eligibility, were reduced to 24 studies that were included for analysis. Four categories of analysis were established: women<men, women>men, women≠men, women=men. The analysis revealed that, although there is no consensus among the studies, the discrepancy decreases in those reporting that the brain areas and circuits activated in executive functioning differ between genders. The findings are discussed.

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Palabras clave: áreas cerebrales, desempeño, edad, estimulación formal e informal, Funciones Ejecutivas, género,

Keywords: age, brain areas, Executive functions, formal and informal stimulation, Gender, performance,

Encefalopatía Posterior Reversible asociada a hipercalcemia maligna: una presentación poco usual. Posterior Reversible Encephalopathy associated with malignant hypercalcemia: an unusual presentation

Posterior reversible encephalopathy syndrome (PRES) is a transient clinical condition associated with a loss of cerebral vascular regulation. We present the case of a patient diagnosed with abdominal diffuse large B-cell lymphoma who presented to the emergency department with visual impairment, headache, and seizures. A brain magnetic resonance imaging showed T2 bilateral occipital hyperintensity and on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) showed hyperintense signal, consistent with vasogenic edema compatible with PRES, with no additional findings on images or in cerebrospinal fluid. The only abnormal metabolic finding was hypercalcemia. Metastatic involvement of the central nervous system was ruled out. Medical management of the hypercalcemia was performed, achieving complete resolution of the patient’s symptoms with reversibility of the imaging alterations 6 weeks after the episode. 

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Palabras clave: hipercalcemia, leucoencefalopatía posterior reversible, Linfoma, Linfoma No Hodgkin, PRES,

Keywords: hypercalcemia, lymphoma, non Hodgkin lymphoma, Posterior Leukoencephalopathy Syndrome, PRES,

Epilepsia del lóbulo temporal de inicio tardío en etapa post-Covid. Post-Covid Late onset temporal lobe epilepsy.

Introduction: Temporal lobe epilepsy (TLE) of is the most frequent form of adult epilepsy, temporal mesial sclerosis (TMS) is a common abnormality associated. It could appear at the end of second decades in life.

Case report: We report a male patient, 67 years old, who suffered moderated Covid 19. Six months, he started with seizures which characterized by gastric disturbances, hand and oral automatisms, teeth snapping, upper extremities rigidity and change of hands coloration. EEG showed interictal paroxystic activity over left frontal and central-temporal regions and also abnormalities in quantitative measures. MRI described frontal, parietal, occipital and temporal mesial atrophy with hyperintensity on mesial and hippocampal areas. The volumetric value was diminished on middle frontal and temporal gyrus, pre-central gyrus, parietal lobe, insular cortex and operculum, the value of cortical thickness was diminished on pre-central gyrus.

Conclusions: This is a case with unusual beginning of TLE due to TME post-Covid.

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Palabras clave: COVID-19, EEG, Epilepsia del Lóbulo temporal, esclerosis temporal mesial, IRM, volumetría,

Keywords: COVID-19, EEG, MRI, Temporal lobe’s epilepsy, temporal mesial sclerosis, volumetry,

Síndrome de encefalopatía posterior reversible atípico en paciente gestante. Atypical posterior reversible encephalopathy syndrome in a pregnant patient.

Introduction: Posterior reversible encephalopathy syndrome (PRES) was first described by Hinchey in 1996, when he observed that some patients presented with an acute reversible picture comprising mental alterations, loss of vision and headache.

Objective: To present the clinical case of a patient with atypical posterior reversible encephalopathy syndrome.

Clinical case: A 19-year-old woman, 36.5 weeks of gestation, presented with a clinical picture of 4 hours of evolution with high intensity stabbing pain in the epigastrium associated with moderate intensity global headache, accompanied by a self-resolved convulsive episode. Magnetic resonance imaging (MRI) showed bilateral intensity changes in the frontoparietal cortico-subcortical regions, lenticular nuclei and brain stem region with restrictive pattern in some lesions, and diffusion was indicative of ischemic vascular involvement with diffuse edema, in addition, parietooccipital paramedial hemorrhagic foci were observed bilaterally, suggesting a possible PRES.

Conclusions: PRES should be considered as a diagnosis in a previously healthy pregnant woman who has sudden convulsive episodes during labor. The exact etiology of PRES during pregnancy is not entirely clear and remains controversial. Clinical presentation and MRI are used for diagnosis. Immediate treatment should be focused on controlling the underlying cause or pathology, the main one being hypertension. 

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Palabras clave: Convulsiones, Eclampsia, embarazo, Síndrome de encefalopatía posterior reversible atípico,

Keywords: atypical posterior reversible encephalopathy syndrome, Eclampsia, pregnancy, Seizures,

Síndrome de Guillain Barré asociado a infección por SARS-CoV-2. Guillain-Barré Syndrome Associated with SARS-CoV-2 infection.

Guillain-Barré Syndrome (GBS) is an uncommon but potentially serious clinical entity characterized by symmetric, rapidly progressive limb weakness, reduced or absent deep tendon reflexes, and paresthesias. This case report discusses a 23-year-old male with a history of SARS-CoV-2 infection, presenting with paresthesias, weakness in the thighs, and walking difficulty.

Physical examination exhibited asymmetric facial diplegia, right sixth cranial nerve palsy, flaccid quadriparesis with predominant crural involvement, and generalized areflexia.

Electrophysiological studies, practiced within the first week, revealed absent H reflex and delayed distal motor latencies. Additionally, concentric needle examination showed no abnormal activity at rest, with a pattern of poor recruitment of motor units with normal morphology. The cerebrospinal fluid analysis showed albumin-cytological dissociation. Intravenous immunoglobulin therapy was initiated, resulting in gradual neurological stabilization, and the patient was discharged with a Rankin score of 4/5.

Follow-up evaluations showed improvement in motor symptoms, and after six months, the patient fully reintegrated into normal life. This case emphasizes the association between GBS and prior COVID-19 infection, highlighting the importance of neurological monitoring during convalescence.

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Palabras clave: complicaciones neurológicas, COVID-19, inmunoglobulina intravenosa, Síndrome de Guillaín-Barré,

Keywords: COVID-19, Guillain Barre syndrome, intravenous immunoglobulin, neurological complications,
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