Intracranial subdural hematoma is an entity characterized by the rupture of the bridging veins that are found in the subdural space and promote the slow outflow of blood. A 23-year-old first-time pregnant patient presented with severe preeclampsia, for which an emergency cesarean section was performed using regional anesthesia. During the postpartum period, the patient presented a single generalized seizure episode with secondary headache. The imaging study reported the presence of a lamellar subdural hematoma. This type of injury is a rare complication of lumbar puncture, where factors such as the use of very large needles, large dural orifice, multiple punctures, pregnancy, dehydration, use of anticoagulants, coagulopathies, cerebral vascular anomalies and atrophy cerebral.
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Avances Recientes del Proyecto Atahualpa: Impacto en la Salud Pública Rural. Recent Advances Of The Atahualpa Project: Impact On Rural Public Health
The Atahualpa Project, since its inception, has made it possible to identify specific risk factors for the development of non-communicable diseases and to suggest public health strategies adapted to local needs.
Through detailed studies, it has been possible to gain a better understanding of the prevalence of these diseases and their impact on the community, which will undoubtedly translate into the implementation of more effective preventive measures. Recent findings have revealed risk patterns that were not previously considered relevant in these populations, such as the influence of dietary habits and the high social vulnerability of their inhabitants.
In addition, the project has demonstrated the importance of epidemiological studies in specific communities and has allowed the establishment of correlations between genetic and environmental factors. These data have opened new lines of research to better understand the interaction between genetics and epigenetics in the development of these pathologies.
Likewise, the Atahualpa Project has served as a model of how research can directly impact people’s quality of life, providing valuable information for the prevention of non-communicable diseases, which, according to the Pan American Health Organization, represent the new epidemics of Latin America.
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De la Trepanación al Abordaje Subfrontal: Saltos Temporales de una Evolución Histórica del Desarrollo de la Intervención Quirúrgica Frontocerebral en la Medicina Iberoamericana. From Trepanation To The Subfrontal Approach: Temporal Leaps In The Historical Evolution Of Frontocerebral Surgical Intervention In Ibero-American Medicine
Exactly 20 years ago, Dr. Boris Zurita-Cueva published in this journal an article entitled “The Subfrontal Approach: Is It Really Minimally Invasive?”, the reading of which prompted us to recall and write about how medicine has evolved in its surgical intervention techniques over the years.
Although Zurita-Cueva’s work¹ refers to Krause’s description from 1908, it is worth highlighting that the technique originated from trepanations—one of the oldest examples of surgical procedures—practiced since the Neolithic period in a large number of primitive cultures spread across five continents
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Periodontitis y Trastornos Neurológicos: Mirando al Cerebro, la Boca y el Sistema Digestivo. Periodontitis And Neurological Disorders: Looking At The Brain, The Mouth, And The Digestive System
Madam Editor,
I read with particular interest the publication by De la Cruz Rodríguez et al.¹, who mention that “…a wide range of neuropsychiatric disorders can be prevented through oral treatment and hygiene.”¹ It is relevant to highlight the interconnection between periodontitis and neurological disorders from a comprehensive perspective that encompasses not only the nervous system, but also its relationship with the oral and gastrointestinal microbiota.²
This letter emphasizes the connection between periodontitis and neurological disorders from a bidirectional perspective, where chronic periodontal inflammation not only impacts oral health, but also plays a crucial role in neurodegenerative and psychiatric diseases through neuroinflammation and dysbiosis of the oral and gastrointestinal microbiota.²,³
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La Teoría de las Catástrofes: Modelo y Aplicaciones en Salud Mental y Enfermedad. Catastrophe Theory: A Conceptual Model And Its Applications In Mental Health And Disease
Madam Editor:
Catastrophe Theory, formulated by René Thom (1923–2002), has influenced the biological and health sciences by proposing a non-linear approach to explain abrupt transitions in complex systems. During the COVID-19 pandemic, sudden clinical transitions in respiratory conditions became evident, which motivates renewed interest in this model and its biomedical adaptation conceived by Dr. Bruno Günther Schaffeld (1914–2009).
This letter aims to highlight its conceptual and clinical relevance in the field of mental health, in order to understand complex conditions such as psychiatric crises, neurological disorders, and decompensated cognitive processes. Günther—a Chilean physiologist trained in Buenos Aires under Nobel Laureate Bernardo Houssay—stood out for applying this theory to the transition between health and disease. He proposed the “cusp catastrophe” model to describe how physiological states can change gradually or suddenly. These transitions may be reversible or irreversible, and their rapid inversion defines the concept of “anastrophe.”
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Síndrome de Guillain-Barré como Complicación del Golpe de Calor. Guillain-Barré Syndrome As A Complication Of Heatstroke
Madam Editor:
Heatstroke (HS) is a medical emergency characterized by a body temperature above 40ºC and the development of neurological alterations such as delirium, seizures, or coma. HS may result from excessive exposure to environmental heat (classic HS) or from strenuous physical exertion.¹ Several factors have been identified that increase susceptibility to HS, including extreme ages of life, medical comorbidities (infections, fever, skin disorders, or cardiovascular insufficiency), the use of certain medications (diuretics, beta-blockers, antihistamines, and antidepressants), or alcohol consumption.
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Ketamina en el Tratamiento del Estado Epiléptico Refractario. Ketamine In The Treatment Of Refractory Status Epilepticus
Madam Editor:
In relation to the work of Rivero Rodríguez D, et al., we would like to expand on some aspects of the role of ketamine in the treatment of refractory status epilepticus. The third-line drugs most commonly used in refractory status epilepticus are midazolam, propofol, and thiopental. As a general rule, thiopental is considered slightly more effective in the short term, while midazolam and propofol are used as alternatives with a more favorable adverse effect profile, without a significant difference in long-term outcomes.
Ketamine, an anesthetic that acts by blocking N-methyl-D-aspartate (NMDA) glutamate receptors, is characterized by its short half-life and its ability not to compromise respiration, preserving airway protective reflexes. Among other theoretical benefits are the reduction of NMDA receptor-mediated excitotoxicity, which decreases neuronal metabolic demands, as well as a direct neuroprotective effect by blocking NMDA receptor-mediated apoptosis induction.
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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
Madam Editor:
We would like to complement the findings of the article “Daily Stress, Executive Functions, and Academic Performance in Primary School Children” by Armstrong-Gallegos and Troncoso-Díaz, published in the Revista Ecuatoriana de Neurología (Vol. 33, No. 1, 2024). In this regard, we propose adding the perspective of the first two years of life, understanding it as a critical stage in this process.
Brain development in early childhood is rapid and crucial, and nutrition plays a fundamental role during these first years of life. Nutrients such as iron, fatty acids like omega-3, and B-complex vitamins support key processes such as myelination and synaptogenesis. These processes, in turn, are essential for executive functions (EF) such as working memory, inhibitory control, and cognitive flexibility. Conversely, the lack of these nutrients may lead to long-term difficulties in self-regulation, affecting performance in social and educational environments.
Additionally, glucose, as the brain’s main source of energy, when blood levels fluctuate excessively, may hinder focus and impulse control, thereby affecting both performance and interactions with others.
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Estudio de la Vida Real del uso de Agentes Modificadores de la Enfermedad en Pacientes Ecuatorianos con Esclerosis Múltiple. Real-Life Study Of Disease-Modifying Agents In Ecuadorian Patients With Multiple Sclerosis
Introduction: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system and the leading cause of non-traumatic disability in young adults. Disease-modifying therapies (DMTs) have transformed its management, reducing relapses and delaying progression, with over fifteen options approved worldwide. However, access to DMTs in Ecuador began only in 2008, with limited data available on their impact on adherence and therapeutic persistence. This study aims to describe the experience with disease-modifying agents in a tertiary-level care unit.
Methods: A retrospective study was conducted involving 142 MS patients treated at a tertiary hospital in Ecuador who met the McDonald 2017 diagnostic criteria and received DMTs between 1995 and 2022. Patients who left the country or social security system were excluded. Demographic and clinical data (EDSS), disease chronology, therapeutic lines, and treatment changes were analyzed. Statistical analysis was performed using SPSS.
Results: The study population consisted of MS patients evaluated at a tertiary hospital in Quito, Ecuador. Among them, 30.3% were male an 69.7% female. The average time between diagnosis and treatment initiation showed a progressive decrease, from 59.3 months for Betaferon to 4.2 months for Rituximab, reflecting improvements in access to DMTs and an improvement in the diagnostic criteria. Regarding the first-line treatment, interferons predominated during earlier periods, while advanced therapies such as Fingolimod, Rituximab, Ocrelizumab and Cladribine gained relevance after 2016. A total of 59% of patients changed treatment, primarily due to therapeutic failure. In the second line, Fingolimod (28.92%) and Rituximab (17.9%) were the most frequently used, although 53.6% of patients required another change. In third- and fourth-line treatments, the use of high-efficacy therapies increased, with Rituximab and Ocrelizumab being prominent. Final treatment data showed that Rituximab (30.3%) was the most commonly used therapy, followed by Rebif (21.8%) and Fingolimod (17.6%). Overall, 41.5% of patients received high-efficacy therapies, while interferons accounted for 36% of treatments. These findings highlight a transition toward more effective and personalized therapies in the management of MS in Ecuador.
Conclusions: This study demonstrates the evolving use of DMTs in MS treatment un Ecuador. It was evident that prior to 2005, there was no access to DMTs. Throughout the study period, interferons were the most widely used drugs but also had the highest rates of therapeutic failure. Adherence and tolerability improved with the introduction of high-efficacy drugs such as Fingolimod, cladribine, Ocrelizumab and Rituximab. Treatment initiation times were notably shortened, primarily due to advancements in diagnostic criteria and improved meditation access.
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Investigating Lack Of Adherence To Medications Used For Primary Or Secondary Stroke Prevention In Rural Ecuador: Rationale And Protocol Of A Population-Based Study Investigación de la Falta de Adherencia a Medicamentos Utilizados para la Prevención Primaria y Secundaria de Ictus en Zonas Rurales del Ecuador: Fundamentación y Protocolo de un Estudio Poblacional
Background: Stroke is an emerging public health crisis in Latin America, particularly in rural areas of low- and middle-income countries (LMIC), where limited healthcare access exacerbates disease burden. Medication adherence plays a fundamental role in stroke prevention, yet information on this topic remains insufficiently known due to issues related to socioeconomic, educational, and infrastructural barriers.
Aims: This study introduces a protocol designed to assess adherence to primary and secondary stroke prevention medications in rural Ecuador. By identifying behavioral patterns and underlying barriers, this research aims to provide evidence-based recommendations for improving adherence and informing public health interventions.
Methods: The study will be conducted in Atahualpa, Ecuador, using a population-based design with an initial cross-sectional assessment followed by a 10-year longitudinal follow-up. Medication adherence will be evaluated through validated questionnaires, clinical examinations, and annual updates on vascular risk factors and social determinants of health. Statistical analyses will assess the relationship between adherence levels, demographic variables, and cerebrovascular outcomes.
Comment: This research provides essential insights into adherence behaviors in underserved populations, offering a foundation for targeted interventions. Findings will support healthcare accessibility, strengthen patient education, and improve adherence strategies to reduce stroke incidence and improve health outcomes in rural LMIC settings.
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Electroencefalografía Cuantitativa y Evaluación Neuropsicológica en el Diagnóstico del Deterioro Cognitivo en Adultos Mayores Ecuatorianos Quantitative Electroencephalography and Neuropsychological Assessment in the Diagnosis of Cognitive Impairment in Older Ecuadorian Adults
Objective: To evaluate the usefulness of quantitative electroencephalography (qEEG) and neuropsychological assessment in the diagnosis of cognitive impairment in Ecuadorian older adults.
Patients and method: Twelve older adults from the Cuenca canton with suspected cognitive impairment were selected. Neuropsychological tests (Neuropsi and Mini-Mental State Examination) were applied and EEG recordings were performed and analyzed using Persyst software. Average voltage amplitude values of brain waves (alpha, beta, theta and delta) and heat maps were obtained to identify specific patterns.
Results: Neuropsychological tests detected significant deficiencies in executive functions, memory and attention, with greater impairment in patients with Alzheimer’s. EEG analysis showed a generalized slowing of the basal rhythm, predominance of slow waves (theta and delta) and decreased alpha frequency (<8 Hz) in occipital and frontal regions. A significant correlation was found between cognitive deficits and EEG alterations.
Conclusions: The combination of qEEG and neuropsychological assessment offers a comprehensive tool for the early diagnosis of cognitive impairment, allowing for personalized therapeutic strategies. These findings reinforce the relevance of accessible and noninvasive methods in the care of older adults in resource-limited settings.
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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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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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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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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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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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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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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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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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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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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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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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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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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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Estado actual de la Esclerosis Múltiple en Ecuador. Current Status of Multiple Sclerosis in Ecuador.
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.
