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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Validación ecológica y de contenido del cuestionario de evaluación de las actividades de la vida diaria–escolar o AVD-E en el contexto colombiano. Ecological and content validation of the questionnaire for evaluating activities of daily living–school or ADL-E in the Colombian context.

Background: In Colombia there is little bibliography regarding the adaptation of instruments that assess the Activities of Daily Living in the population with neurodevelopmental disorders. On the other hand, existing research does not report processes of ecological validity or content adjusted to the Colombian contextual characteristics.

Objective: To carry out structural adaptations for the ecological and content validation of the questionnaire for the evaluation of activities of daily life – school or AVD-E, in the Colombian context.

Material and method: A divergent research methodology with a mixed approach and a DEXPLOS design was used, through three focus groups (10 professionals and 5 families), expert validation (8 professionals) and a pilot test (30 infants).

Results: In the qualitative stage, thirteen emerging categories were obtained that evidenced the need to make structural and linguistic changes. In the quantitative stage, content validity (RVC= 3.82), internal consistency (Cronbach’s Alpha= 0.76) and concurrent validity (Pearson= 0.58) were obtained.

Conclusions: In conclusion, the validated items make it possible to measure the variation of ADLs in the Colombian context, responding to the sociocultural particularities inherent to the ecological assessment of the construct.

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Palabras clave: AVD, evaluación neuropediátrica, Neurorrehabilitación, trastornos del neurodesarrollo, validez ecológica,

Keywords: AVD, ecological validity, neurodevelopmental disorders, neuropediatric evaluation, Neurorehabilitation,

The postural instability in hemiparkinsonian rats is ameliorated by intrastriatal implants of SiO2-DA. La inestabilidad postural en las ratas hemiparkinsonianas es reducida por implantes intraestriatales de SiO2-DA.

Parkinson’s disease (PD) is a chronic disease with loss of dopaminergic neurons of the substantia nigra pars compacta (SNpc) causing motor impairment.

The objective of this study was to evaluate the effect of the intrastriatal release of dopamine (DA) from SiO2 reservoirs on postural asymmetry in hemiparkinsonian animals.

This study compares groups of rats without an implant (L), with empty SiO2 implant (SiO2), and with SiO2 implant plus DA (SiO2-DA) to assess motor and clinical relevance during vertical exploration using the Steps Adjustment and the Cylinder tests.

All rats showed significant deterioration of up to 80% (p < 0.0001) in the execution of the steps with the contralateral forelimb (CF), without affectation of the ipsilateral forelimb (IF) and only the SiO2-DA group recovered 100% symmetry in the adjustment of steps between both forelimbs.

In the cylinder, only the SiO2-DA group significantly reduced (p < 0.0001) the deterioration in the use of CF during vertical exploration. No tolerance or dyskinesias were present at the time of the study.

These results showed that SiO2-DA reservoirs are safe and a promising therapeutic alternative against PD.

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Palabras clave: administración de fármacos, enfermedad de Parkinson, hemiparkinsonismo, Inestabilidad postural, reservorio de SiO2-DA,

Keywords: drug delivery, hemiparkinsonism, Parkinson’s disease, Postural instability, SiO2-DA reservoir,

Complicaciones intrahospitalarias del evento cerebrovascular isquémico de novo en centros hospitalarios de segundo nivel de atención. Inpatient complications of de novo ischemic stroke in second level care hospitals.

The ischemic stroke (IS) is one of the leading causes of mortality worldwide. approximately 90% of patients manifest complications that have been progressively increasing since the last decades. The objective of the study is to determine the inpatient complications of IS in second level hospitals during the period 2020-2022.

Methodology: A retrospective study was carried out in two second level hospitals in Guayaquil. Patients with age ≥ 40 years with de novo ischemic cerebrovascular disease were included. The Oxfordshire Community Stroke Project (OCSP) classification was used to categorize patients according to the affected circulation, with the neurologist being the professional responsible for carrying out said categorization. Descriptive statistics were applied to determine the most frequent neurological complications (NC) and extraneurological (ENC), using frequencies and percentages.

Results: In 320 patients with IS, 64% were men with a mean age of 70 years. In-hospital complications occurred in 72.8% of the patients. The average incidence of NC in the study population was 48.1% while ENC was 55.6%.

Conclusion: In-hospital complications of IS are frequent and their incidence varies depending on the affected circulation.

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Palabras clave: complicaciones intrahospitalarias, Enfermedad cerebrovascular isquémica, Mortalidad, Oxfordshire Community Stroke Project,

Keywords: in-hospital complications, ischemic stroke, Mortality, Oxfordshire Community Stroke Project,

Factores de riesgo cardiovascular y etiología del ictus en adultos jóvenes. Cardiovascular risk factors and stroke etiology in young adults.

Objectives: To describe the etiology of stroke and the frequency of cardiovascular risk factors in a group of patients under 50 years of age, hospitalized in the stroke unit of a public tertiary hospital in Ecuador.

Patients and methods: Descriptive and retrospective cross-sectional study of patients aged 50 and under, admitted between November 2016 and August 2019. Demographic data, cardiovascular risk factors, type of stroke, etiology door symptom time and the length of stay in the neurology department were analyzed. The results were compared between sexes.

Results: 45 patients were included. The mean age was 38 ± 10 years and there were no differences between the sexes. The 77.8% had some cardiovascular risk factors. Alcohol consumption predominated (33.3%), followed by smoking and dyslipidemia (22.2%). In general, and by sex, ischemic stroke (75.5%) was the most frequent. Intracerebral hemorrhage represented 24.4%. In the etiology of the ischemic stroke, an unusual cause predominated (35.3%), followed by cardioembolic stroke (26.8%) and that of undetermined etiology. For intracerebral hemorrhage, the most frequent etiology was hypertension (63.3%).

Conclusions: The high frequency of at least one modifiable cardiovascular risk factor, added to the delay in arrival at the hospital, constitute an alert to consider the need to insist on primary prevention and carry out information campaigns aimed to improve knowledge of the disease.

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Palabras clave: Adultos jóvenes, Ecuador, Etiología, Factores de riesgo, Ictus,

Keywords: Ecuador, Etiology, Risk factors, stroke, Young adults,

Tratamiento de migraña en embarazo. Treatment of migraine in pregnancy.

Introduction: Migraine is the most disabling primary headache. In pregnancy, its treatment is controversial due to possible side effects.

Objective: Conduct an updated literature search on migraine treatment during pregnancy.

Method: A search was carried out in PubMed, Scopus and Web of Science. Search terms were “pregnancy”, “migraine” and “treatment”. Search date ranged from 2018 to 2023. 315 articles were found; duplicates were eliminated with Rayyan QCRI (Rayyan Systems Inc ©) where selection was carried out by title and summaries, and full text. Finally, 21 articles were selected that included clinical trials, systematic reviews and narratives.

Development: Acute and preventive therapy exists for migraine during pregnancy; non-pharmacological treatment is the first choice in both. For acute treatment, paracetamol, non-steroidal anti-inflammatory drugs only in the second trimester, triptans, metoclopramide and nerve blocks can be used. If the intensity is moderate and is not controlled with acute treatment, prevention is carried out with propranolol; Other drugs do not show safe evidence for use during pregnancy

Conclusion: An appropriate choice of treatment, prioritizing non-pharmacological treatment and taking into account drug associations, is necessary in pregnant women whose migraine attacks do not subside.

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Palabras clave: embarazo, Migraña, paracetamol, Propranolol, Tratamiento,

Keywords: Migraine, paracetamol, pregnancy, propranolol, Treatment,

Neuropsychological and brain atrophy pattern characterization in patients with stroke related to COVID infection: A systematic review. Caracterización neuropsicológica y del patrón de atrofia cerebral en pacientes con ictus relacionado a COVID: Una revisión sistemática.

Introduction: The high mortality rates in patients with COVID infection have been the main focus of interest in clinical and research practice. COVID infection has also been characterized by its respiratory consequences; however, several studies have reported neurological manifestations in this clinical population (e.g., stroke). From a neurological perspective, patients with stroke related to COVID infection remain challenging as well. No systematic reviews have yet focused on neuropsychological and neuroanatomical correlate profiles.

Aim: To characterize the neuropsychological profile and the pattern of brain areas affected in adult and older adults with stroke related to COVID infection.

Methods: The present study followed the PRISMA guidelines and included studies from the PubMed, Scopus, and Web of Sciences databases, published between January 2020 and September 2022.

Results: 7 articles were included in this systematic review for critical analysis. Ischemic stroke was the most reported in patients. Results suggest that the most reported neuropsychological declines are orientation, attention, memory, executive function, visuoconstructive skills, and language. The pattern of brain areas also considers right lesions in cortical and subcortical regions.

Conclusion: In patients with COVID-related strokes, lesions in the left hemisphere or bilateral are common, together with the expression of aphasia. Likewise, our findings reflect only ischemic patients’ cognitive and brain features. Therefore, results must be interpreted carefully.

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Palabras clave: Atrofia Cerebral, Correlato neuroanatómico, COVID-19, diagnóstico, evaluación neuropsicológica, Ictus,

Keywords: Atrophy pattern, COVID-19, diagnosis, Neuroanatomical Correlate, Neuropsychological assessment, stroke,

Paraparesia flácida subaguda progresiva y meningitis carcinomatosa como forma de presentación de recaída tardía de leucemia linfoblástica aguda de estirpe linfoide B BCR-ABL/Phi+. Progressive subacute flaccid paraparesis flaccida and subclinical carcinomatous meningitis as a presentation of late relapse of BCR-ABL/Phi+ B-lymphoblastic acute lymphoblastic leukaemia.

Introduction: Acute lymphoblastic leukemia (ALL) is a malignant neoplasm characterized by the proliferation of abnormal lymphoid cells in bone marrow (BM) and/or extramedullary territories.

Case report: 20-year-old male with BCR-ABL B-ALL in childhood, presenting with subacute flaccid paraparesis (PFS) and paresthesias in the lower limbs. He presents with motor axonal polyneuropathy, leptomeningeal uptake in left occipito-parietal sulci and extramedullary intrathecal D11-S1 infiltration. Immunoblasts in peripheral blood and MO with BCR-ABLp190 mutation confirm late relapse of ALL.

Conclusions: We expose a rare case of PFS and carcinomatous meningitis as a form of presentation of late relapse of BCR-ABL ALL-B BCR-ABL.

Progressive subacute flaccid paraparesis flaccida and subclinical carcinomatous meningitis as a presentation of late relapse of BCR-ABL/Phi+ B-lymphoblastic acute lymphoblastic leukaemia.

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Palabras clave: Leucemia linfoblástica aguda, meningitis carcinomatosa, paraparesia flácida subaguda,

Keywords: Acute lymphoblastic leukaemia, carcinomatous meningitis, subacute flaccid paraparesis,

All that Restricts is Not Stroke: A Case Series of Brain imaging Findings in Infective Endocarditis. Todo lo que restringe no es enfermedad cerebrovascular: Una serie de casos de hallazgos de imágenes cerebrales en endocarditis infecciosa.

Infective endocarditis is a systemic illness characterized by infection and inflammation of the endocardium which produces symptoms due to local causes and embolization.

One of the sites of embolism is the central nervous system. Cerebral magnetic resonance imaging (MRI) exhibits greater sensitivity than computed tomography (CT) when detecting covert lesions like cerebral microbleeds and asymptomatic embolisms.

There are specific patterns on cerebral MRI that prompt the diagnosis of infective endocarditis. This is a retrospective case series with the collection of data from 3 patients, who were encountered in the emergency and intensive care departments.

All three patients had clinical features secondary to a shower of multiple emboli detected on MRI brain as multiple bi-hemispheric and multi-circulation foci of diffusion restriction.

They were presumed initially to be cardioembolic in origin, which after targeted investigation were found to be due to infective emboli from IE.

Bi-hemispheric scattered diffusion restricting foci can mislead the treating physician into evaluation for stroke secondary to cardioembolism including the hunt for an occult atrial fibrillation which can delay treatment required in IE.

Distinguishing between septic and other cardioembolic lesions will result in the optimum management of such cases.

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Palabras clave: Endocarditis infecciosa, Ictus, resonancia magnética en Endocarditis Infecciosa,

Keywords: Infective endocarditis, MRI in IE, stroke,

Encephalitis and rapidly progressive dementia due to probable Prion disease presenting with a non-convulsive status epilepticus. Case report and literature review. Encefalitis y demencia rápidamente progresiva por probable enfermedad priónica que se presenta con un estado epiléptico no convulsivo. Reporte de caso y revisión de la literatura.

Prion diseases are rare and rapidly progressive fatal neurological disorders characterized by abnormal folding of neuronal proteins.

The diagnosis is often challenging and relies on a high clinical suspicion, imagenological findings, electroencephalographic (EEG) patterns and cerebrospinal fluid (CSF) analysis.

We present a case of probable prion disease with an accelerated neurological decline and a non-convulsive status epilepticus (NCSE), which has only been described in a few cases worldwide, and seems to be associated with worse neurological outcomes and shorter survival time.

Clinical manifestations, treatment, and outcomes are shown below.

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Palabras clave: demencia, encefalitis, Enfermedad por priones, Estatus epileptico no convulsivo, Síndrome de Creutzfeldt-Jakob,

Keywords: Creutzfeldt-Jakob syndrome, dementia, encephalitis, Non convulsive status epilepticus, Prion Disease,

External capsule infarct related to occlusion of the middle cerebral artery. Infarto en la cápsula externa relacionado con oclusión de la arteria cerebral media.

The external capsule is a band of longitudinal fibers (white matter) limited by two deep gray matter structures, the putamen medially and the claustrum laterally (Figure 1).

This structure is mainly composed of axons that connect different areas of the cerebral cortex with the tegmentum (corticotegmental fibers).

Ischemic strokes confined to the external capsule are extremely rare, representing 0.3% of patients enrolled in a large hospital-based ischemic stroke registry.

External capsule infarcts may be related to different pathogenic mechanisms, including large artery disease, cardiogenic brain embolism, sporadic cerebral small vessel disease, or to a combination of them.

In addition, external capsule infarcts have been typically reported in a hereditary form of cerebral small vessel disease known as CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy).

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Palabras clave: Cápsula externa, déficits neurológicos focales, enfermedad de grandes arterias, oclusión de la arteria cerebral media,

Keywords: External capsule, focal neurological deficit, intracranial large vessel disease, Middle cerebral artery occlusion,

Mi breve recorrido por las encefalitis autoinmunes. My brief journey through autoimmune encephalitis.

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Setenta años desde la doble hélice, veinte años desde el Proyecto Genoma Humano: historia y avances de la neurogenética. Seventy years since the double helix, twenty years since the Human Genome Project: history and advances in neurogenetics.

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Palabras clave: ADN sintético, Doble Hélice, Edición del Genoma, Neurogenética, Postgenómica,

Keywords: Double Helix, Genome Editing, Neurogenetics, Postgenomics, Synthetic DNA,

Cisticercos calcificados en el parénquima cerebral y daño de hipocampos. Calcified cysticerci in the brain parenchyma and hippocampal damage.

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Palabras clave: atrofia de hipocampo, calcificaciones cerebrales, cisticercosis, esclerosis de hipocampo, neurocisticercosis,

Keywords: brain calcifications, Cysticercosis, hippocampal atrophy, hippocampal sclerosis, neurocysticercosis,

Epilepsia, hiperia y mística en Hildegarda de Bingen. Epilepsy, hyperia and mysticism in Hildegard of Bingen.

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Palabras clave: Delirio, depresión, Epilepsia, hiperia, misticismo,

Keywords: Delirium, depression, Epilepsy, hyperia, mysticism,

Discapacidad e inclusión educativa en la enseñanza superior de Honduras: Lecciones aprendidas. Disability and educational inclusion in higher education in Honduras: Lessons learned.

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Palabras clave: Discapacidad, educación superior, Honduras, inclusión educativa, lecciones aprendidas,

Keywords: Disability, educational inclusion, higher education, Honduras, lessons learned,

Desarrollo psicomotor y funciones ejecutivas en la primera infancia: Un enfoque interdisciplinario para la educación integral. Psychomotor development and executive functions in early childhood: An interdisciplinary approach to comprehensive education.

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Palabras clave: Desarrollo psicomotor, Educación Inicial, Educación Parvularia, Funciones Ejecutivas, Trabajo Pedagógico Interdisciplinario,

Keywords: early childhood, Early Childhood Education, Executive functions, Interdisciplinary Pedagogical Work, Psychomotor development,

Actividades básicas e instrumentales de la vida diaria en pacientes con demencia tipo Alzheimer. Basic and instrumental activities of daily living in patients with Alzheimer’s dementia.

Alzheimer’s dementia (AD) produces multiple alterations, both in the cognitive, behavioral and functional spheres. The basic activities of daily living (BADL) are affected in patients with AD, compared with subjects without cognitive impairment (SWCI). In this research, 50 patients with AD who met the diagnostic criteria established in the DSM-IV-TR and the NINCDSADRDA and 60 SWCI with similar sociodemographic characteristics were analyzed. The results show that the most affected BADL are the capacities of food, washing, dressing, arranging, transferring, walking, going up and down stairs and the least affected BADL were urination and the ability to go to the toilet, not being affected differentially in the deposition ability. These findings confirm the general hypothesis that patients with AD have involvement of the BADL compared with the SWCI.

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Palabras clave: actividades básicas de la vida diaria, demencia tipo alzheimer,

Keywords: Alzheimer dementia, Basic activities of daily living,

Disappointing agreement in the interpretation of neurological adverse events following immunization with SARS-CoV-2 vaccines. A case-series study. Pobre concordancia en la interpretación de eventos adversos neurológicos después de la inmunización con vacunas contra el SARS-CoV-2. Estudio de una serie de casos.

Background: A sizable proportion of the world’s population has been vaccinated to prevent SARS-CoV-2 infections. In clinical practice, however, almost any neurological manifestation occurring after vaccination has been attributed to the vaccine, generating doubts on their safety. In 2013, the WHO created the Adverse Event Following Immunization (AEFI) criteria to establish the relationship between a vaccine and side effects, but they seem not to dispel doubts regarding severity and causality of neurological events following SARS-CoV-2 vaccination. This study aims to analyze consistency of the AEFI to designate probable side effects of SARSCoV-2 vaccines among patients who develop neurological symptoms after vaccination.

Methods: We measured the level of agreement using the Fleiss kappa methodology. Seventeen observers (five neurologists, four infectious disease specialists, and eight internal medicine residents) independently rated 11 cases treated in our service presenting neurological symptoms within 21 days after SARS-CoV-2 vaccination according to the AEFI criteria.

Results: We found low concordance agreements among the 17 raters regarding severity (k=0.088) and causality (k=0.025). When analyzing by raters’ subgroups, agreement for severity was moderately higher among neurologists (k=0.383) and for causality among internal medicine residents (k=0.117).

Conclusions: AEFI criteria do not allow, by themselves, to establish the relationship between a vaccine and adverse neurological effects. Therefore, it is essential to create more useful tools that allow doctors and lay people to be more confident in this challenge.

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Palabras clave: COVID-19, Efectos adversos luego de inmunización, Estadísticas Kappa, SARS-CoV-2,

Keywords: Adverse Event Following Immunization, COVID-19, Kappa statistics, SARS-CoV-2, Vaccine,

Predictores de ansiedad durante la pandemia COVID-19 en estudiantes de medicina de Morelos, México. Predictors of anxiety during the COVID-19 pandemic in medical students from Morelos, Mexico.

Introduction: Medical students are a group of concern in the face of COVID-19, as social distancing measures may affect their anxiety and be vulnerable to the emotional impact, since the profession is part of the first line of care in the face of this pandemic.

Objective: To describe the prevalence and predictors of anxiety caused by the COVID-19 pandemic in university medical students from Morelos, Mexico.

Method: Cross-sectional descriptive observational study using an online questionnaire, with Sociodemographic Characterization, Generalized Anxiety Disorder-7 (GAD-7), Passion for Study, Self Compassion Scale (SCS), Connor-Davidson Resilience Scale (CDRISC), Life Satisfaction and Demoralization Scale (DS).

Results: In a sample of 292 medical students, women (62.8%), older than 21 years (66.9%), 72.7% reported anxiety and 65.5% sleep problems. The multiple regression model shows that dysphoria is the variable that reports the greatest predictive capacity of importance with 34.8%, followed by having trouble sleeping with 24.4%, discouragement 22.4%, over-identification 13.9% and concern about getting infected 4.5%.

Conclusions: Concern and uncertainty in the hospital environments where medical students are prepared and trained increase the risk of anxiety, due to the perception of adverse conditions and frustration as part of their profession.

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Palabras clave: ansiedad, COVID-19, desmoralización, estudiantes universitarios, malestar psicológico,

Keywords: anxiety, COVID-19, demoralization, psychological distress, university students,

Evaluación de la función cognitiva diaria del adulto y adulto mayor mediante el uso del ECog (everyday cognition). Evaluation of the daily cognitive function of adults and elderly adults through the use of ECog (everyday cognition).

Introduction: Older adulthood is the stage of life where significant biological changes occur, such as a decrease in cognitive function. The ECog is a valuable tool for detecting early changes in declining cognitive function and subjective cognitive impairment. It can be answered by an informant (relative) without needing the patient to be present. It can be applied to patients with a low educational level or some disability without this limitation.

Objective: To know the changes in the daily cognitive function of adults and older adults for decades. (50-59, 60-69, >70 years) using the ECog.

Methods: Descriptive, cross-sectional, randomized, survey-type study. Patients over 50 who attended a Family Medicine consultation for any reason other than dementia were included, patients who did not wish to participate were excluded, and incomplete surveys were eliminated. The n was 180 patients, 60 for each age group (group 1=50-59 years, group 2=60-69 years, and group 3=>70 years). The ECog was applied to the patients (answered by an informant). The means were calculated by age group, the variation between each group was calculated using a means comparison formula, the prevalence of Subjective Cognitive Impairment (cut-off point in ECog>1.36) was calculated by age group, and the most affected domains.

Results: The decrease in cognitive function measured by the ECog increased significantly with age in each group (Anova p value less than 0.001) and the prevalence of cases with Subjective Cognitive Impairment. The most affected functions were memory, attention and organization. The least affected domain was language.

Conclusion: A significant decline in cognitive function was observed with advancing age. The ECog is an excellent tool, easy
and straightforward to use for the Primary Care physician.

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Palabras clave: adulto mayor, deterioro cognitivo, ECog,

Keywords: cognitive impairment, ECog, older adult,

Correlación entre la calidad de sueño y actividad de la enfermedad en pacientes con Espondiloartritis. Correlation between sleep quality and disease activity in patients with Spondyloarthritis.

Objective: To evaluate the quality of sleep and its relationship with disease activity in patients with spondyloarthritis (SpA).

Methodology: Observational, cross-sectional study, in patients of 18 to 65 years of age with a diagnosis of SpA. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to measure sleep quality, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), Disease Activity in PSoriatic Arthritis (DAPSA) instruments were used to assess disease activity.

Results: 72 were evaluated with SpA. The overall median age was 42 (IQ 33.75 – 56.25), the mean sleep quality measured by PSQI was 9.15 ± 4.11. Scores 8 and 9 presenting more frequently with 10 subjects each, followed by score 10, present in 9 individuals. 59 patients with SpA were found to have a PSQI score>5 or poor sleep quality. A significant association was observed for sleep quality measured by PSQI, and disease activity assessed by BASDAI (r 0.530; P<0.001), ASDAS-CRP (r 0.533; P<0.001), DAPSA (r 0.368; P=0.002), VGP (r 0.478; P<0.001), VGM (r 0.382; P=0.001), VAS (r 0.522; P<0.001), SJC/66 (r 0.286; P=0.019), ESR (r -0.363; P =0.021). An association was observed between the use of antidepressants and gabapentinoids with sleep quality by PSQI, showing r 0.30; P=0.005, and r 0.25; P=0.029, respectively.

Conclusion: In patients with SpA, poor sleep quality is an independent factor of greater disease activity.

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Palabras clave: actividad de la enfermedad, calidad de sueño, espondiloartritis, PSQI,

Keywords: disease activity, PSQI, sleep quality, spondyloarthritis,

Enfermedad de Vogt-Koyanagi-Harada, revisión de literatura: Una entidad infrecuente con tratamiento efectivo. Literature review on Vogt-Koyanagi-Harada disease: An infrequent entity with effective treatment.

Introduction: Vogt-Koyanagi-Harada (VKH) disease is an uncommon systemic inflammatory disease of autoimmune etiology. It can present neurological, auditory, dermatological, and ophthalmological manifestations, it has a well-established natural clinical course with variations between different states, which constitutes a diagnostic challenge in clinical practice.

Development: A search of literature on Vogt-Koyanagi-Harada disease available until July 2023 in the databases PubMed and Scopus was carried out, including MeSH terms “Vogt-Koyanagi-Harada disease,” “Uveitis,” “Uveitis-Meningitis Syndrome,” “Aseptic meningitis.”

Conclusions: Vogt-Koyanagi-Harada disease is considered an infrequent and multifaceted condition, which constitutes a diagnostic challenge. There is evidence supporting a mechanism of autoimmunity mediated by T-lymphocytes against melanocyte antigens, the triggering factor is still uncertain. The diagnosis of this disease is clinical, associated with complementary imagenologic and laboratory exams, it is necessary to conform better diagnostic criteria to achieve an early diagnosis and treatment, oriented to obtain better clinic results for patients with this disease.

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Palabras clave: Enfermedad de Vogt-Koyanagi-Harada, Melanocitos, Meningitis aséptica, Trastorno autoinmune, Tratamiento inmunosupresor, Uveítis,

Keywords: Aseptic meningitis, Autoimmune disorder, Immunosuppressive treatment, Melanocytes, Uveitis, Vogt-Koyanagi-Harada disease,

Mielopatía en enfermedad por descompresión. Myelopathy in decompression sickness.

Decompression sickness (DCS) refers to the clinical manifestations caused by the formation of bubbles of an inert gas in
the tissues. It is associated with changes in environmental pressure during diving, and injuries to the central nervous system in the disease are not uncommon. We present a case of severe thoracic spinal cord injury in DCS in a diver.

We highlight the typical aspects of DCS in the case for easy recognition by non-specialist physicians. Prevention and prompt initiation of recompression therapy are the cornerstones of DCS management.

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Palabras clave: buceo, enfermedad por descompresión (ED), Mielopatía,

Keywords: decompression sickness, myelopathy, scuba diving,

Análisis neuropsicológico en un caso de Afasia Global. Neuropsychological analysis in a case of Global Aphasia.

Acquired brain damage generates a series of neuropsychological alterations, among which we can highlight aphasia. This syndrome is characterized by language impairment, with its main features being deficits in fluency, comprehension, repetition, naming, reading, writing and calculation. In this article we present the case of a patient suffering from global aphasia, who presents severe linguistic alterations. The state of the disease and its neuropsychological condition are analyzed. Finally, we close this analysis, highlighting the need for a correct neuropsychological approach at the level of diagnosis and rehabilitation which can help the patient.

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Palabras clave: afasia, Daño cerebral adquirido, estudio de caso, neuropsicología,

Keywords: Acquired brain injury, aphasia, case study, neuropsychology,

Encefalomielitis aguda diseminada tras infección por herpes virus. Acute disseminated encephalomyelitis after herpes virus infection.

Acute disseminated encephalomyelitis (ADEM) is a rapid inflammatory and demyelinating process of the central nervous
system, mainly affecting the white matter, but also the gray matter. It usually occurs after viral infections or vaccinations. The case of a 26-year-old patient with sensory symptoms and weakness in the left extremities is presented. Tests showed brain and cerebellar lesions with possible demyelination. ADEM is suspected due to a history of herpes zoster. Corticosteroids are administered with satisfactory evolution. ADEM is a serious process that can affect children and adolescents and presents MRI findings similar to Multiple Sclerosis. The diagnosis is exclusionary, the treatment is with corticosteroids, but it can leave sequelae.

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Palabras clave: Adulto, Encefalomielitis, Polirradiculoneuropatía,

Keywords: Adult, Encephalomyelitis, polyradiculoneuropathy,

Encefalopatía inducida por metanol. Methanol-induced encephalopathy.

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Palabras clave: Encefalopatía, ganglios de la base, Metanol,

Keywords: basal ganglia, Encephalopathy, Methanol,

Consideraciones sobre los posgrados de medicina en el Ecuador. Considerations about medical postgraduate education in Ecuador

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Palabras clave: editorial,

Keywords: editorial,

Neurociencias, cibernética e inteligencia artificial: Recordando a Humberto Maturana (1928-2021). Neurosciences, cybernetics and artificial intelligence: Remembering Humberto Maturana (1928-2021)

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Palabras clave: Autopoiesis, Cibernética, Inteligencia Artificial, neurociencia cognitiva,

Keywords: Artificial Intelligence, Autopoiesis, cognitive neuroscience, Cybernetics,

Calidad del sueño y contaminación visual nocturna. Sleep quality and nighttime visual pollution.

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Palabras clave: Calidad del sueño, Contaminación visual nocturna, Ecuador, Escala de Pittsburgh, Zonas rurales,

Keywords: Ecuador, Nighttime visual pollution, Pittsburgh scale, rural areas, sleep quality,

Validez y confiabilidad de la tarea experimental de Redes Atencionales para investigaciones de neuropsicología en el contexto ecuatoriano. Validity and reliability of the experimental task of Attentional Networks for neuropsychological research in the Ecuadorian context

The main experimental tasks in the area of neuroscience and psychology have been performed in industrialized populations, but they have not been developed and adapted in a Latin population. The aim of this study was to validate the attentional networks task in an Ecuadorian sample. For this purpose, a construct validity analysis was carried out through an analysis of variance and correlation between the networks; and a reliability analysis for the global components of the attentional networks.
The results showed main and interaction effects proving construct validity in the population. Likewise, for the interaction validity, a high significant correlation was found between all conditions of the attentional networks. For the reliability analysis, a moderate and high relationship was found for the orientation and cognitive control network, but not for the alertness network.
At the end, the importance of the validation of the experimental tasks in the Latin American population and the clinical relevance in the field of neuropsychology are discussed.

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Palabras clave: control cognitivo, orientación, redes atencionales, vigilancia,

Keywords: attentional networks, cognitive control, orientation, vigilance,
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