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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Síndrome de Millard-Gubler en un paciente joven: diagnóstico y neurorrehabilitación temprana. Millard-Gubler syndrome in a young patient: diagnosis and early neurorehabilitation.

Introduction: Millard-Gubler syndrome (MGS) is a rare neurological entity that affects the brainstem by multiple etiologies. The diagnosis is clinical and requires confirmation by imaging studies such as CT or MRI. Treatment is generally non-surgical with a rehabilitative approach with functional goals.

Clinical findings: In this case we present a 44-year-old male patient from southwestern Colombia, with a history of arterial hypertension who was admitted to the emergency department of a national reference university hospital with a hypertensive emergency and white organ lesion, presenting a sudden loss of mobility of his left hemibody accompanied by involvement of the VI and VII cranial nerves.

Treatment and outcome: Interventions were initiated by a multidisciplinary team, including the rehabilitation service, making the diagnosis of crossed brainstem syndrome (Millard-Gubler) of hemorrhagic vascular etiology. He required monitoring in the NICU until stabilization of his clinical condition, after which early neurological rehabilitation interventions were performed (physical therapy, occupational therapy, speech therapy, orthotics, psychology and pain), achieving an improvement in symptoms and functionality of the motor and cognitive component before h ospital discharge.

Conclusions: This case reflects the importance of a multidisciplinary team with a physician specializing in physical medicine and rehabilitation to ensure the best possible functional outcome, in addition to reporting the interventions performed in a young patient with a rare neurovascular entity.

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Síndrome de Debilidad Crónica como Presentación del Síndrome Postpolio. Chronic Weakness Syndrome as a Presentation of Post-polio Syndrome.

Post-polio syndrome (PPS) is characterized by progressive weakness, muscle fatigue, joint pain, and an increase in disability, which occurs decades after an episode of poliomyelitis. The cause of progressive neurological deterioration is unknown; however, the main hypotheses suggest induction of autoimmunity. There are no pathognomonic findings or specific tests that diagnose PPS; therefore, the diagnosis is made based on the clinic and the history of a polio episode at least 15 years before the onset of new symptoms. We present a case of a man, with a history of poliomyelitis who approximately 40 years later presents a slow progression of weakness, areflexia, atrophy, and fasciculation. Although the frequency of PPS is low, symptoms are disabling, and they cause great impairment in the patient’s functionality. Since there is no specific treatment, the management of PPS is mainly symptomatic and supportive.

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Hemorragia en área dependiente de circulación cerebral posterior por síndrome de hiperperfusión tras stenting en arteria carótida interna. Hemorrhage on a dependent area of posterior cerebral circulation due to hyperperfusion syndrome after stenting in internal carotid artery.

Cerebral hyperperfusion syndrome (CHS) after stent placement has a low incidence, between 0.37- 1.9% (1,2). We present a case of CHS due to recanalization in right internal carotid artery (ICA) which, contrary to expectations, produces a hematoma on a dependent area of the posterior cerebral circulation. Through the clinical case, we proceed to delve into the CHS and the characteristics that give the patient a higher risk. In addition, we expose the potential usefulness of the neurosonological study of inter-individual variability for better perioperative management. In this way, we can ensure a good therapeutic approach that minimizes morbidity and mortality as much as possible.

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Trombosis venosa cerebral profunda e infarto venoso, secundario al uso prolongado de anticonceptivos hormonales. Deep Cerebral Vein Thrombosis and venous infarction, secondary to prolonged use of Hormonal Contraceptives.

Introduction: Cerebral venous thrombosis represents an infrequent cause of cerebrovascular disease, but can result in highly lethal complications such as venous infarction. It affects women of childbearing age more frequently, and the use of oral hormonal contraceptives has shown a causal relationship with this pathology.

Clinical case: We present a 28-year-old patient, with a history of using oral hormonal contraceptives for 5 consecutive years, who came to the emergency room complaining of oppressive holocephalic headache, vomiting and diplopia, of 6 days of evolution. Consciousness with a tendency to obtundation, hypobulia, bradylalia, bradypsychia, paresis of the sixth cranial nerve (left) and bilateral Babinski’s sign were appreciated. Funduscopic examination revealed bilateral developed papilledema. Non-contrast computed tomography of the skull shows direct and indirect signs of thrombosis of the deep cerebral venous system involving internal cerebral veins, vein of Galen, and straight sinus. Nuclear magnetic resonance with T2-FLAIR, Diffusion and vascular sequences confirmed the diagnosis, as well as the presence of infarction in the corresponding venous territory.. Anticoagulant therapy with low molecular weight heparin was performed for ten days and anticoagulation with warfarin was maintained for three months. The causative agent is discontinued. The patient evolved favorably and to date there have been no re currences of the thrombotic event.

Conclusions: Cerebral venous thrombosis shows a worse prognosis when it involves the deep venous system; Its evolution also depends on early diagnosis and timely treatment.

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Síndrome de Tolosa-Hunt con compromiso de tres ramas del nervio trigémino y nervio facial. Tolosa-Hunt Syndrome with involvement of three branches of the trigeminal nerve and facial nerve

Introduction: Tolosa-Hunt Syndrome consists of a sensory neuropathy of the trigeminal nerve associated with the paralysis of one or more ocular motor nerves, secondary to an idiopathic granulomatous inflammation of the cavernous sinus, the superior orbital fissure or the orbit.

Clinical case: 19-year-old patient with Tolosa-Hunt Syndrome accompanied by peripheral facial paralysis, with enhancement of the facial nerve.

Conclusions: Compromise of trigeminal nerve branches and facial nerve is a rare finding. Imaging studies contribute to the characterization of the etiology. Steroid treatment continues to be effective.

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Complicaciones neurológicas post-vacuna COVID. Neurological complications post-COVID vaccine.

Post-vaccine SARS-CoV-2 neurological complications are rare. However, due to the SARS-CoV-2 pandemic, massive vaccination has been carried out worldwide, which is why we have seen a greater report of post-vaccination neurological adverse effects.
We present 4 cases, which after receiving the SARS-CoV-2 vaccine presented 4 different neurological pathologies at the Hospital Comarcal de Vinaroz during the year 2021.
A relationship between vaccination and the onset of neurological symptoms is observed. Three patients presented clinical manifestations in relation to the BNT162b2 vaccine. The first patient after administration of the first dose of the BNT162b2 vaccine presented diplopia and palpebral ptosis, a condition compatible with ocular Myasthenia gravis. The second patient had symptoms of acute sensory motor axonal polyneuropathy after the third dose. The third patient, who after the third dose of BNT162b2 presented lethargic encephalopathy. The fourth patient presented symptoms compatible with aseptic meningitis after AZD1222 and mRNA-1273 vaccination.
Due to the worldwide mass vaccination campaign, reports of accidentally related or causally linked neurological complications are emerging. These are very varied; they could be related to immunological and/or toxic mechanisms. Physicians must be aware of these possible adverse effects and rule out other causes. Studies should be carried out that allow us to clarify the pathological mechanisms in relation to post-vaccination complic ations.

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Síndrome de Fahr e hipoparatiroidismo. Fahr syndrome and hypoparathyroidism.

Introduction: Fahr’s disease is a rare pathology characterized by brain calcinosis syndrome, usually found incidentally and late in individuals with neurological and psychiatric symptoms, with these manifestations from an early age. It is a genetic disorder of unclear etiology of autosomal dominant behavior and can be a ssociated with metabolic, hereditary, or acquired etiology.
Objective: To present the case of a patient with Fahr’s disease treated in a second-level regional hospital in a rural area of central Andean Colombia.
Clinical case: This is a 54-year-old woman who consulted for the first seizure episode, with a significant pathological history of schizophrenia and a family history of maternal Alzheimer’s. Simple cerebral computed tomography was performed, which reported multiple periventricular calcifications and symmetric calcifications at the level of the basal ganglia with hypocalcemia and hypoparathyroidism.
Conclusions: Fahr’s disease is a rare entity, however, it is important to suspect and know about it early; Diagnostic images are essential for detection, and the search for differential diagnoses or associated metabolic causes is important for treating these patients in a timely and adequate manner.

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Análisis neuropsicológico de un caso de daño talámico. ¿Por qué el paciente presenta una nueva holgazanería y una ingenuidad adquirida?. Neuropsychological analysis of a case of thalamic damage. Why does he present a new laziness and acquired naiveté?.

Acquired brain damage is a topic of central interest in neuropsychology, since it allows us to understand the relationship between cognition, behavior and emotion with pathological brain functioning. On this occasion, we present a case with a cerebrovascular disease that, as a result of damage at the thalamic level, presents executive, emotional, linguistic, and memory disorders. This is a 52-year-old patient who presents signs and symptoms such as personal insouciance, lack of motivation to seek employment, problems regulating his behavior, among others. We analyze the case regarding the role of the thalamus in global brain functioning and the need to carry out a correct follow-up with the patient.

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Accidente cerebrovascular en un paciente con meningitis por Streptococcus Constellatus. Stroke in a patient with Streptococcus Constellatus meningitis.

Streptococcus Constellatus ssp pharingi belongs to the group of Streptococcus Anginosus, it constitutes normal flora of th respiratory, gastrointestinal and genitourinary tracts, it infrequently produces localized or disseminated infections in patients with risk factors. The case of a 41-year-old male patient is reported, with a history of pituitary macroadenoma resection in 2003, undergoing treatment, who consulted the emergency department for 4 days with intense holocranial headache, fever, emesis, associated with temporospatial disorientation and weakness in lower limbs in the last 24 hours. He required management in the intensive care unit, mechanical ventilation, vasopressor support, and tracheostomy, due to respiratory and hemodynamic deterioration. In extension studies, meningitis due to Streptococcus Constellatus ssp pharingi was documented in the presence of sinusitis, cerebrospinal fluid fistula and multi-infarct cerebral vascular compromise, product of vasculitis of infectious origin, a severe manifestation of
bacterial meningitis, not previously reported by this microorganism.

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Circunferencia del cuello y aterosclerosis subclínica. Neck circumference and subclinical atherosclerosis.

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Multi-territorial posterior circulation ischemic stroke after cocaine intoxication. Infarto cerebral isquémico multi-territorial de circulación posterior luego de un episodio de intoxicación por cocaína.

A 35-year-old man presented to the emergency department with altered mental status and bilateral tonicclonic seizures. Due to a progressive decrease in consciousness, he was intubated for airway protection. The patient’s relatives reported that he had used cocaine, leading to an initial suspicion of acute cocaine intoxication. However, a head CT scan without contrast revealed a hyperdense basilar artery sign without other signs of infarction (figure 1).

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La donación de órganos y tejidos en Ecuador. Organ and tissue donation in Ecuador.

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Ralph L. Sacco, MD, MS.

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Parálisis del nervio facial: Complicación inusual en pacientes con mucormicosis post COVID-19. Facial nerve palsy: Unusual complication in patients with post COVID-19 mucormycosis

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Disección de las fibras de sustancia blanca cerebral usando el método de Klinger en neurociencias. Dissection of cerebral white matter fibers using the Klinger method in neuroscience

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White matter hyperintensities severity and progression are not related to earlobe crease presence. A cross-sectional and longitudinal prospective study in community-dwelling older adults. La severidad y progresión de hiperintensidades de la sustancia blanca no están relacionados con la presencia del pliegue del lóbulo de la oreja. Un estudio transversal y longitudinal prospectivo en una población de adultos mayores

Background: Earlobe crease (ELC) has been associated with coronary atherosclerosis. Recently, ELC has been associated with white matter hyperintensities (WMH) of presumed vascular origin. However, the results are heterogeneous among studies. We aimed to assess whether ELC is associated with WMH severity and progression in community-dwelling older adults.

Methods: Atahualpa Project Cohort participants received earlobe photographs and brain MRIs to assess the association between ELC and WMH severity, as well as the relationship between ELC and WMH progression using ordinal logistic and Poisson regression models, respectively.

Results: The cross-sectional component of the study included 359 individuals aged ≥60 years. ELC was present in 175 subjects. On MRI, 107 participants did not have WMH, 174 had mild, 56 had moderate, and 22 had severe WMH. A multivariate ordinal logistic regression model did not show a significant association between the main variables investigated (OR: 0.72; 95% C.I.: 0.48 – 1.06). The longitudinal component included 252 individuals, 126 of whom had ELC and 103 had WMH progression. A Poisson regression model showed no association between ELC and WMH progression (IRR: 1.02; 95% C.I.: 0.69 – 1.51).

Conclusions: ELC is not related to WMH severity and progression in the study population.

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Evaluación de la calidad de las guías de práctica clínica sobre enfermedad vascular cerebral aguda mediante la herramienta AGREE II. Quality assessment of clinical practice guidelines on stroke using the AGREE II tool

Objetive: Evaluate the quality assessment of the treatment guidelines for stroke between 2010 and 2021.

Methods: Evaluation by AGREE II instrument. Intraclass correlation was performed for two observers, and it was analyzed the consensus on blood pressure goals and the use of prehospital scales.

Results: 21 clinical practice guidelines were included. The consensus between observers was 0.88 (95% CI: 0.69-0.95). The highest score was for clarity of presentation, while the lowest was for applicability. Nine guidelines (42.9%) were “recommended,” seven were “not recommended” (33.3%) and five were “recommended, but with modifications.” There is consensus on the blood pressure goals in the initial phase. The Fast scale was the most recommended.

Conclusions: Less than half of the guidelines analyzed were recommended for clinical use. Since 2016, the guidelines have shown substantial improvements in their quality. Implementing and actively utilizing the guidelines demands strengthening the applicability and editorial independence.

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Escala de Conocimiento de la Enfermedad de Alzheimer: Adaptación y Análisis de las Propiedades Psicométricas en Estudiantes Universitarios Ecuatorianos. Alzheimer’s Disease Knowledge Scale: Adaptation and Analysis of Psychometric Properties in Ecuadorian University Students

The aim of this study was to develop a linguistic adaptation of the Alzheimer’s Disease Knowledge Scale (ADKS), and to provide evidence on the reliability and validity of the adapted test. The ADKS is a self-administered instrument that examines knowledge about risk factors, assessment and diagnosis, symptoms, course, impact on life, care and treatment and management of Alzheimer’s disease (AD).

Methods: An instrumental study was implemented. The ADKS items were adapted to the Ecuadorian use of the Spanish language through an iterative process of translation by experts. Next, a sample of 523 university students completed the adapted scale together with a set of other instruments to analyze the fiability and criterion validity of the scale.

Results: ADKS Ecuador showed good internal consistency (Cronbach’s α=.78), adequate test-retest reliability, p > .05, and convergent and discriminatory evidence of validity when related to other variables.

Conclusion: ADKS Ecuador is an adequate instrument to assess general knowledge about AD in young highlgy educated Ecuadorian population with low dom ain knowledge.

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Prevalencia de deterioro cognitivo leve en peruanos adultos mayores y de mediana edad. Cognitive impairment prevalence in peruvian middle-age and elderly adults

Appraisals of dementias worldwide envisage an unfavorable scenario, especially in developing countries. Since factors such as education, socioeconomic status and healthiness play an important role in the development of Alzheimer’s disease and other dementias. It is known that pathophysiological features begin up to 20 years before an Alzheimer’s diagnosis and that the disease transits through three stages that include normal aging, mild cognitive impairment, and Alzheimer’s disease. The objective of this study was to determine the prevalence of cognitive impairment in a sample of middle-aged and older adults in southern Peru. A discriminant cognitive evaluation is performed for the absence or presence of cognitive alteration, focused especially on memory, language, visuoperception/visuoconstruction and other cognitive domains. Mini-Mental State Examination, Clock´s Test, and Verbal Fluency test were used, obtaining prevalence data for cognitive impairment with adjusted cut-off points according to age ranges (50-98 years) sex and education. Parametric and non-parametric statistics, logistic regression, Pearson correlation and ANCOVA were performed. The most suitable cut points for our population were selected through the ROC curves and the Youden index. The percentage of global mild cognitive deterioration was 58.80%. It is necessary to generate more effective mental health policies, especially referring to the middle-aged and elderly population, that address the early detection of MCI and Alzheimer’s disease.

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Impacto de los trastornos motores del habla y deglución sobre la calidad de vida de personas con enfermedad de Parkinson: una revisión sistemática de la literatura. Impact of motor speech and swallowing disorders in quality of life of people with Parkinson’s disease: a systematic review of the literature

Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s-type dementia. It is known that these types of diseases cause a significant decline in the quality of life of the people who suffer from them and in their next of kin. Understanding the physical and psychosocial effects of neurodegenerative diseases contributes to clinical decisionmaking. It is for the above mentioned that the present study aims to examine the current evidence regarding the direct impact that phonoaaudiological disorders of motor origin generate on the quality of life in people with PD. A systematic review of the literature was carried out. The articles were searched in the following databases: PUBMED, SCIELO and WOS, during the months of June and July of the year 2020, constituting a sample of 12 works, with a maximum age of 10 years. The analysed publications mainly describe the aspects of quality of life that are affected in people with PD, who suffer dysphagia or dysarthria, all this through the application of different questionnaires which evaluate different aspects of this concept. The results of the review show the importance of considering within the intervention process the component of quality of life in people with E.P, since the scores obtained according to the instruments applied indicate a decrease of this component and even more with the progress of the disease, which translates into worse quality of life related to food and speech.

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Perfil de efectividad y seguridad de preparaciones orales de cannabis para el tratamiento de epilepsias refractarias en la población infantojuvenil. Una revisión de alcance. Effectiveness and safety profile of oral cannabis preparations for the treatment of refractory epilepsies in infant-young population: A Scoping Review

Introduction: Refractory epilepsies (RE) are a common neurological condition expressed in childhood and adulthood, highlighting the current use of cannabis as an alternative treatment. Oral Cannabis Preparations (OCP) have demonstrated effectiveness in the adult population; however, knowledge is limited in the infant-young population.

Aim: To synthesize the available evidence on the efficacy and safety of OCP for the treatment of refractory epilepsies in the infant-young population.

Methods: The present study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and included studies from January 2013 until December 2020 from electronic databases, including SciELO, ScienceDirect, PubMed, and Web of Science.

Results: 7 articles were included in this scoping review for critical analysis. The results indicate that pharmaceutical and artisanal origin OCP has 41.3% effectiveness in reducing seizures and low safety after administration (≤ 27.4%). Likewise, after administration, the most frequent adverse symptoms were somnolence/fatigue, weight loss/decreased appetite, and irritability/aggressiveness.

Conclusion: The low levels of effectiveness and safety of OCP suggest that they should be administered with caution and as a complementary treatment and not as the first choice for managing RE in the infant-young population.

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Hemorragia en área dependiente de circulación cerebral posterior por síndrome de hiperperfusión tras stenting en arteria carótida interna. Hemorrhage on a dependent area of posterior cerebral circulation due to hyperperfusion syndrome after stenting in internal carotid artery

Cerebral hyperperfusion syndrome (CHS) after stent placement has a low incidence, between 0.37- 1.9% (1,2). We present a case of CHS due to recanalization in right internal carotid artery (ICA) which, contrary to expectations, produces a hematoma on a dependent area of the posterior cerebral circulation. Through the clinical case, we proceed to delve into the CHS and the characteristics that give the patient a higher risk. In addition, we expose the potential usefulness of the neurosonological study of inter-individual variability for better perioperative management. In this way, we can ensure a good therapeutic approach that minimizes morbidity and mortality as much as possible.

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Neuropatía craneal múltiple: Posible asociación a infección por HTLV 1. Multiple cranial neuropathy: Possible association with HTLV 1 infection

Human lymphotropic virus type 1 (HTLV 1) is an oncoretrovirus that chronically and persistently infects T lymphocytes; which can cause serious neoplastic or inflammatory diseases, however, most are asymptomatic and only a small number of patients develop the disease. Although this virus particularly affects the hematological system in the form of T-cell leukemia or lymphoma, the nervous system is also an important target, both the central and peripheral components. In recent years, different associations have been found between this viral infection and multiple neuroinflammatory pathologies such as encephalitis, motor neuron diseases, polyneuropathies, cranial neuropathies and even myopathies, enriching the syndromic spectrum of this entity. On this occasion, the clinical particularities of a rare and possible association between HTLV 1 and multiple cranial neuropathy expressed in a patient managed in a tertiary care hospital in Cali, Colom bia will be described.

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Síndrome de cabeza caída en Miastenia gravis tras una infección por SARS-CoV2. Dropped head syndrome in Myasthenia gravis after a SARS‐CoV2 infection

Objective: To report a case with an unusual presentation of myasthenia gravis after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and literature review.

Method: We report a case of a patient with head drop and a postsynaptic myasthenic syndrome after a SARS-CoV-2 infection and a retrospective review of the literature of all the reported cases of myasthenia gravis de novo associated with SARS-CoV2 infection from march-2020 to september-2022. Written informed consent was obtained from the patient for publication of this case report and accompanying images or videos.

Conclusion: Myasthenia gravis could also be the result of an autoimmune re action triggered by SARS-CoV-2 infection.

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Rehabilitación neuropsicológica de la memoria de trabajo sobre la conducta ejecutiva y el rendimiento académico en un niño con trastorno específico del aprendizaje. Neuropsychological rehabilitation of working memory on executive behavior and academic performance in a child with specific learning disorder

Introduction: Learning disorders are a clinical condition that manifests itself at school age, affecting the cognitive, social and emotional functioning of the individuals who suffer from it. There are studies that show a positive effect of interventions on executive functioning, impacting the executive behaviors and ac ademic performance of children.

Objective: To assess the effect of a neuropsychological rehabilitation program for working memory on executive behavior and academic performance in a child with specific learning disor der.

Clinical case: An 11-year-old boy, diagnosed with a specific learning disorder according to the DSM-5, a working memory rehabilitation program was designed and applied and its impact on executive behaviors and academic performance was measured.

Results: The measurements of the treatment phase show a downward trend reflecting a positive impact. For the global index of executive function, the percentage of data that exceeds the median (PEM= 100%) indicates a very effective treatment and the non-overlapping of all pairs (NAP=89%) indicates a medium effect of the intervention.

Discussion: The results suggest a positive impact at the level of cognitive, behavioral and emotional functioning of the patient, reflected in executive behavior and academic performance.

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From hypokinesia to hyperkinesia: An 86-year-old-woman with abnormal movements. De hipocinesia a hipercinesia: Mujer de 86 años con movimientos anormales

An 86-year-old woman presented with an acute onset of confusion, garbled speech, and decreased left arm movement. On exam, she had a forced right gaze, left homonymous hemianopsia, left hemiparesis, and left face and arm hypoesthesia. Forty-eight hours after successful revascularization therapies, the patient started complaining of abnormal involuntary movements. This manuscript discusses the phenomenology of these involuntary movements, their neuroanatomical correlates, management, and evolution. Neurologists should be mindful of post-stroke movement disorders, their latency period after stroke, and the functional-anatomic networks involved.

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El valle del rift y los australopitecos. Rift valley and australopithecines.

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Neurociencias y quinta revolución industrial: El futuro ha llegado Neurosciences and fifth industrial revolution: The future has arrived

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Programas de control de cisticercosis y erradicación de epilepsia relacionada a neurocisticercosis, Cysticercosis control programs and neurocysticercosis-related epilepsy eradication

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Testing the reliability of the Downton Fall Risk Index for predicting incident falls in community-dwelling older adults. A prospective population-based study. Evaluación de la confiabilidad del “Índice Downton de riesgo de caídas” como predictor de caídas incidentes en adultos mayores que viven en la comunidad. Estudio poblacional prospectivo.

Background: Accidental falls are a major cause of disability and death in older adults. However, the reliability of instruments designed to estimate the risk of future falls has not been adequately established in community dwellers.

Methods: Departing from a previous cross-sectional study of older adults living in rural Ecuador that estimated the potential risk of future falls, we carried out a prospective longitudinal study to assess the reliability of the Downton Fall Risk Index (DFRI) as a predictor of incident falls during three years of follow-up.

Results: Of 254 individuals, 158 (62%) experienced incident falls. The mean score of the baseline DFRI was 1.6±1.3 points, with 54 (21%) individuals showing an increased risk for future falls (DFRI score ≥3 points). Forty-seven of the 54 individuals with a positive DFRI had incident falls as opposed to 111/200 individuals with a negative DFRI (p<0.001). An adjusted logistic regression model found that individuals with a positive DFRI have a fivefold increase in incident falls compared with those having a negative DFRI (OR: 4.91; 95% C.I.: 1.94 – 12.4). Receiver operator characteristics curve analysis showed an area under the curve (AUC) of 0.612 (95% C.I.: 0.568 – 0.657) for a positive DFRI to predict incident falls. However, the AUC for the predictive value of incident falls given a history of previous falls (as a single variable) was 0.908 (95% C.I.: 0.875 – 0.942).

Conclusions: The DFRI has only a moderate predictive value for the occurrence of incident falls that is surpassed by that of previous falls.

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