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Patrones de Perfusión Cerebral en la Epilepsia Rolándica: Formas Típicas y Atípicas.
Introduction: Cerebral perfusion patterns in typical rolandic Epilepsy and its variants remain unknown.
Objective: To describe interictal cerebral perfusion patterns in this Epilepsy and in one of its variants.
Patients and methods: Twenty four children were followed-up for 6 years after their first seizure. Magnetic Resonance Imaging and Single Photon Emission Tomography were performed during follow-up. We investigated for perfusion asymmetries in different cerebral structures using statistical parametric map. The perfusion images were registered whether atypical evolution was diagnosed or if we found some cognitive deficits suggestive of focal cortical lesion.
Results: Seven patients with atypical Benign Partial Epilepsy and seventeen with typical Rolandic Epilepsy were recruited. The vast majorly of the patients showed a cortical hyperperfusion pattern associated with asymmetric hypoperfusion pattern in basal ganglia and thalamus. Patients with atypical Benign Partial Epilepsy showed a well defined different cerebral perfusion pattern characterized by symmetrical hypoperfusion at the level of basal ganglia including thalamus.
Conclusions: Different cerebral perfusion patterns were documented in different variants of Rolandic epilepsy.
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Activador del Plasminógeno tisular, realidad actual. Estudio transversal retrospectivo entre los años 2007-2009 en el Hospital Regional Dr. Teodoro Maldonado Carbo.
Objective: To determine the proportion in which the variables for the administration of tissue plasminogen inhibitor (tPA) are present in the population admitted to a hospital in Guayaquil-Ecuador.
Methods: Cross-sectional study with patients admitted to the Neurology service at the Regional Hospital Dr. Teodoro Maldonado Carbo between January 1, 2007 and December 31, 2009 with diagnosis of acute stroke. The inclusion and exclusion criteria were the same ones used on the guidelines for the use of tPA in patients with stroke during the first 3 hours and between the first 3-4.5 hours of onset.
Results: 550 patients were included in the analysis. 434 patients had ischemic stroke and 116 hemorrhagic stroke. 6 patients arrived to the hospital in the first 3 hours from onset and 13 patients arrived between the 3-4.5 hours from onset. In the first 3 hours, 4 out of 6 patients (66%) were candidates for the administration of tPA and between the first 3-4.5 hours, 6 out of 13 patients (59%) were candidates for tPA.
Conclusions: The majority of the patients that arrived to this hospital; did so after 4.5 hours from the onset of symptoms. If these patients would have arrived earlier, a great proportion could have received a treatment potentially beneficial that would produce a clinical improvement and a better prognosis if the treatment was available in the hospital.
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Esclerosis Multiple en un Hospital del Litoral Ecuatoriano.
Objective: An observational study was conducted in 45 patients with Multiple Sclerosis in a hospital in the Ecuadorian Coast, in order to characterize the disease in our environment.
Methods: During the period of 8 years (2002 – 2010), demographic and clinical characteristics, disability status using the modified Kurtzke, assessment of functional systems and response to immunomodulatory treatment are evaluated.
Results: Of the 45 patients studied 58% were women, the most common age group was between 30 – 39 years. The predominating type was relapsing remitting (RR) followed by secondary progressive (SP). It is determined that the nuclear magnetic resonance (RM) is the complementary method of choice for diagnosis and monitoring of patients and the relapse rate was low using immunomodulatory therapy.
Conclusions: The study suggests that the presentation of the disease in a hospital in the Ecuadorian coast is lower than in the inter-Andean region probably due to demographics or other factors yet to be determined, but that the clinical features, the subtypes of the disease and immunomodulatory treatment response is similar to the series found in countries of the same characteristics.
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Propuesta Pedagógica para la Compensación de la Memoria Viso-Espacial en Pacientes con Secuelas Neurológicas.
During the perception of an object, a complex system of temporary connections, which reflects the links and relationships between objects, their parts and properties in the brain, appears.
Objective: To determine how the designed pedagogical proposal influences in the compensation of the viso- space memory in people with neurological sequels.
Material and method: A pre pedagogical experiment in a group of 20 patients was carried out. A neuropsychological battery was used evaluating visual memory, viso-construction, perceptual and motor speed, care, executive functions and verbal intelligence (NEUROPSI) both initial and final to verify the memory deficit. Results were compared and the percentage is reported.
Results: The studied group age range was between 21 and 55 years. The main feature found was the inaccuracy in the reproduction of the model due to the latent attention deficit. The disorders of the mechanism to fixate memories were one of the greatest difficulties presented. An improvement in each variable was observed.
Conclusion: The designed pedagogical proposal influenced positively the visospace memory compensation in the group of patients under investigation.
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Diabetes Mellitus y Cognición. Estudio Transversal.
Diabetes Mellitus Type 2 is associated with greater impairment of cognitive ability, and abnormalities in brain imaging studies compared with people without diabetes.
Objective: To determine if there is a difference in the score of cognitive function tests Addenbrooke (ACE) and Cognitive Ability Screening Instrument (CASI) among patients with type 2 diabetes and non-diabetics.
Methods: Cross sectional study of patients with a history of more than 5 years of diabetes mellitus type 2, between 45 and 64 years of Outpatient of Endocrinology Department, Hospital Teodoro Maldonado Carbo Guayaquil between September 1 and December 31, 2008, who had the cognitive assessment test: ACE and CASI.
Results: There were a total of 68 patients, of which 60.3% had diabetes mellitus, with an average age of 60 years, of this group: 53.6% were men and 46.3% were women. Hypertension was present in 39%. 14.6% were treated with oral antidiabetic agents and 73.2% with insulin. Glycated haemoglobin (Hb1Ac) was abnormal in 33.8%. With regard to the tests of cognitive assessment: the average score of ACE in diabetic patients was 88. 8 and in non-diabetic patients 90.1 and in the CASI the average was 91.5 in diabetics and 92.5 in non-diabetics.
Conclusions: The score of cognitive function tests Addenbrooke and CASI was lower in diabetics compared to non-diabetics, although there was no significant difference.
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Palabras clave: Addenbrooke,
CASI,
Cognición,
Complicaciones de la Diabetes,
demencia,
Diabetes mellitus,
Riesgo de enfermedad cerebrovascular en la fibrilación auricular. Hospital Lenin Enero 2006 – Diciembre 2007.
A case-series was performed in the Emergency Service of the University Hospital V. I. Lenin. The universe of the study was 413 patients in Observation at the Emergency Service of Internal Medicine. Considered as an objective was to determine the behavior of the different clinical, epidemiological and therapeutic variables of the patients with atrial fibrillation and with risk to develop cerebrovascular disease. Of these patients, 165 were selected according to the inclusion criteria. The main results were that the most frequent clinical pattern of presentation was recent diagnosis followed by recurrent and permanent diagnosis and that after 60 years of age the highest risk to develop stroke was in patients with permanent clinical pattern which were not properly protected to prevent it. We concluded that if cerebrovascular disease is to be prevented, then it is necessary to give the patients the proper anticoagulants and antiplatelet medications. We recommend insisting in the application of the protocols of management.
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Sistema de actividades para la compensación de la memoria de trabajo en adultos con ataxia por trauma craneoencefálico.
Introduction: Working memory or operational memory is considered a distinct element of the executive function. Objective: To propose a system of activities that will contribute to the compensation of working memory in adults with Ataxia by craneoencephalic trauma assisted in CIREN.
Material and methods: A pre experiment with a single group was carried out, initial tests were applied to determine the cognitive deficits in the amnesic process, before implementing the strategy, and at the end of the intervention, the results were compared to quantify evolutionary development in the work of clearing of memory in these people with special educational needs.
Results: The results of the diagnostic analysis favored the interpretation of the need to implement corrective treatments – countervailing duties taking into account the allocation of the basic mechanisms of working memory to improve the prognosis of evolution of this amnesic skill.
Discussion: A system of activities is proposed as part of considering the diagnosis as an important element in the corrective compensatory work looking for restoration to the highest possible physical, psychological functioning and social adaptation of persons towards an optimal level of social integration.
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Palabras clave: Ataxia,
Compensación,
Memoria de Trabajo,
Sistema de Actividades,
Trauma Craneoencefálico,
Alteraciones electroencefalográficas en niños con cardiopatías congénitas severas.
Introduction and objectives: Congenital cardiopathies (CC) are among the most common birth defects. Delays of neurodevelopment are among the most frequently observed diseases in school-age children presenting CC. The main objective of this study was to determine the possible impact of severe CC on central nervous system (CNS) development as determined after EEG recording.
Methods: Thirty children of ages between 15 days and 12 years presenting severe CC with hemodynamic consequences and/or chronic hypoxia were studied (21 acyanogenic and 19 cyanogenic). Conventional EEGs were performed on all cases.
Results: In the whole sample we found abnormal EEGs in 43.3% of cases, these mostly showing immature basal activity (slow for the age), and focal and multifocal paroxysmal activity characterised by sharp waves and spikes/slow waves complexes. Abnormal EEG activity was determined in 42.8% of non-cyanogenic CC and 44.4% of cyanogenic CC.
Conclusions: A high percentage of children carrying severe CC showed epiletiform EEG activity. It is possible that in afflicted children resulting from haemodynamic disturbances present from foetal stages onwards, these would favour the development of ectopic growth of grey matter leading to epileptiform activity.
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Violencia en la díada cuidador-paciente en la Enfermedad de Parkinson: Tres métodos de medición.
Background: Violence between caregivers and patients is common and little studied. Their identification and assessment is complex considering the various types available and how they are perceived and reported. The instruments vary in the number of items, level and frequency of acts that constitute a case.
Objective: To determine the prevalence of violence in the caregiver-patient dyad in the context of Parkinson’s disease through three measurement methods, describe the correlation between them and demonstrate the complexity of the assessment of violence.
Methods: Descriptive study, on 46 caregiver-patient dyads selected INNN. They were given a battery composed of: 1. National Survey of Violence against Women (ENVIM), 2. Scale of Abuse Older Adults (EMA). 3. Perception Questionnaire Exercise of Power in Dyads (PEPD).
Results: the average age of participant patients was 62 years, with 50% women. The average age of caregivers was 50 years, with 80% women. Violence prevalence of patients according to ENVIM is 43.5%, patient or caregiver (any) is 60.9%; EMA reports 71.7% and the PEPD 60.9%. Mutual violence is present in 26% of dyads according to ENVIM. Correlations were found between the scales ranging from 0.32 to 0.78.
Conclusions: Prevalence of violence is higher than what is reported in international literature and the ENVIM. Correlations between the instruments utilized in this study are sensitive and show that multiple question assessments avoid underreports.
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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria. RESUMEN.
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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 1: Introducción.
Not Available.
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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 2: Valoración prequirúrgica.
Not Available.
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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 3: Cirugía de la Epilepsia Farmacorresistente.
Not Available.
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Cirugía De La Epilepsia Farmocorresistente. Revisión multidisciplinaria Parte 4: Unidades Multidisciplinares de Epilepsia y Cirugía de la Epilepsia.
Not Available.
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Miopatías asociadas al uso de estatinas: Un enfoque actual.
Statins are the drugs of choice for the treatment of hyperlipidemia, cardiovascular disease, and coronary disease, among others. Their safety and tolerance allows its use on multiple branches in medicine. However, its long- erm use is associated with adverse effects that affect the quality of life of patients, and therefore, their adherence to treatment. Among these, myopathies are described. They represent a variety of clinical presentations ranging from mild myalgia to fatal rhabdomyolysis. In this literature review, the safety of statin use is assessed objectively in order to determine what attitude should be taken regarding the therapy for muscle disorders.
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Utilidad del doppler transcraneal en la evaluación del stroke criptogénico.
Cryptogenic stroke accounts for 40% of patients with ischemic stroke and it is considered that in which after conducting a thorough investigation, a cause cannot be determined. For several years there has been a close association between cryptogenic stroke and paradoxical embolism through right-to-left shunt, which occurred specially in patients with patent foramen ovale (PFO), whose prevalence is significantly higher in patients with cryptogenic stroke than in patients with stroke of a definite cause. The study of this type of cardiac abnormalities has been strengthened today with the advent of new technologies including transesophageal echocardiography (TEE) which remains the gold standard in the diagnosis of PFO, however, there are increasing reports of the usefulness of transcraneal doppler in the evaluation of these patients in a way that makes its recommendation comparable to TEE. This review is intended to expand the knowledge available on this specific procedure according to the current existing evidence.
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La Contribución de la Evaluación Neuropsicológica a la Atención Médica Primaria.
The present review offers a revision of neuropsychological assessment and the contribution that it makes to the diagnosis, prognosis, and treatment of various medical, neurological and psychiatric disorders. Neuropsychological assessment provides the clinician with information regarding the interaction between the patients’ neurologic, psychological and behavioral functioning, which frequently determines clinical management and outcome. This revision presents a summary of the contribution of neuropsychological assessment as a useful clinical tool, with the goal of helping clinicians determine the utility of such an assessment for individual patients.
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Encefalomielitis Aguda Diseminada: Formas de Presentación y Espectro Clínico. Serie de Casos.
Acute disseminated encephalomyelitis is an inflammatory demyelinating disease of the central nervous system. Although it often follows an infection or immunization, there are some cases without previous history. It develops usually as a monophasic disease, however recurrent and multiphasic cases have been reported. Its diagnosis is suggested based on clinical features, magnetic resonance imaging and negative complementary test results. We report 5 cases of acute disseminated encephalomyelitis illustrating its wide clinical and prognostic variety. Both mild and significant cases are reported. A previous history of infection was present only in one case. No patient developed symptoms suggesting multiple sclerosis during an 18 to 48 months follow-up. Conclusions: Acute disseminated encephalomyelitis is an uncommon condition that presents with a variety of symptoms. The major differential diagnosis is MS; however other demyelinating and infectious processes must be included. Treatment options include intravenous corticoids, immunoglobulins or plasmapheresis. The patient’s response to treatment is proportional to the prognosis.
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Palabras clave: Encefalomielitis aguda diseminada,
esclerosis múltiple,
Síndrome de Moyamoya en un niño con Drepanocitosis.
Sickle cell disease is one of the main causes of ischemic stroke in the childhood, generally related with stenosis of the arteries of the anterior carotid circulation. We present the results of the studies carried out in a patient with sickle cell with no history of stroke, in treatment with hidroxyurea. Transcraneal Doppler and Magnetic Resonance Imaging demonstrated the existence of stenosis in medial cerebral arteries and a Moyamoya pattern in the cerebral circulation with hemodynamic ischemic lesions.
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Palabras clave: Doppler transcraneal,
Drepanocitosis,
enfermedad cerebrovascular,
Hematología,
Ictus,
Moyamoya,
Sindrome parkinsoniano “rígido-acinético” debido a mielinosis extrapontina y mielinosis pontina asintomática secundarios a corrección rápida de hiponatremia.
The osmotic demyelinating syndromes are not always restricted to the pons. The extrapontine myelinolysis is seen in 10% of patients with central pontine myelinolysis. We present a 62-year-old woman who developed hyponatremia due to repeated vomiting. An acute akinetic-rigid syndrome followed rapid correction of hyponatremia. Bilateral putaminal and caudate lesions were seen on MRI. There were no clinical features of pontine involvement even though a typical lesion was seen on MRI. She recovered well with only symptomatic treatment. Although the exact pathogenesis is unknown, the most widely accepted hypothesis is that cellular edema secondary to the fluctuating osmotic forces, with rapid correction of hyponatremia, results in fibre-tract compression and demyelination. In contrast to the generally expected poor outcome in this condition, patients do have good recovery with symptomatic treatment and good nursing care.
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Palabras clave: Enfermedades desmielinizantes,
Extrapontino,
Hiponatremia,
Mielinolisis,
parkinsonismo,
Puente,
Tamaño de Muestra a Considerarse en un Estudio de Resonancia Magnética Funcional (RMF) con un Equipo de Resonancia Magnéticade 1.5 T.
This work presents an analysis of the necessary tools and special considerations to develop investigation in brain using fMRI with a magnetic resonator of 1.5 T field. This work presents the sample size and the necessary task time to use for showing results.
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Raíz Conjunta Lumbo Sacra Simulando Hernia Discal.
MRI examinations of lumbosacral region during eleven years were included to determine frequency of imaging similarity between an extruded discal fragment and a conjoint root. In 7,117 studies included in our casuistic we detected conjoint root in 175 (2.4 %), resembling an extruded discal fragment which is usually well shown by MRI but in our observations corresponded to a conjoint root. Bibliography related with conjoint root was reviewed. Our conclusion support that MRI is the method of choice to differentiate a conjoint root from an extruded discal fragment.
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Análisis Demográfico Comparativo de Pacientes Adultos con y sin Enfermedad Neurológica que Asisten a una Consulta Externa de Neurología en Guayaquil, Ecuador.
Background: Studies carried out in European countries suggest a high prevalence of patients consulting for non-neurological conditions among persons evaluated in outpatient neurologic clinics. However, there is no information on the prevalence of such patients in developing countries.
Objective: To describe the demographic profile of patients with and without neurologic symptoms evaluated at an outpatient neurologic clinic in Guayaquil. Methods: Cohort of 7,519 adults evaluated over a 20-year period. We evaluated data concerning age, gender, year of first evaluation, reason for consultation, diagnosis, complementary neurodiagnostic tests, and follow-up. Patients were classified into three groups according to their main complain: neurologic patients, psychiatric patients, and persons with non-specific clinical manifestations.
Results: Neurologic diseases were found in 6,764 (90%) patients, psychiatric disorders in 186 (2.5%) and non-specific complaints in 569 (7.5%). Non-neurologic patients were younger than those with neurologic diseases (p<0.0001). The smallest prevalence of women was found among persons with non-specific complaints (p=0.017). We noted a lower prevalence of nonneurologic patients during the years that our country experienced a economic crisis. About 50% of patients with psychiatric disorders, and 30% of persons with non-specific complains had one or more neurodiagnostic tests, which did not modify the therapeutic approach in any case. In most cases, those exams were requested by the patients themselves.
Conclusions: The prevalence of non-neurologic disorders in our series is smaller than that reported from European studies, and their demographic profile is somewhat different. There are some characteristics of patients in our population that may account for such differences.
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Sistema de Actividades para la Compensación del Déficit Motor de las Habilidades Manipulativas en Pacientes con Parálisis Cerebral Adulta.
Cerebral palsy is the commonest cause of motor disability. Under this term are grouped people with special educational needs, who have in common a persistent disorder of tone and movement due to a non-progressive brain injury. Although cerebral palsy affects muscle movement, it is not caused by problems in the muscles or the nerves, but by abnormalities in brain impairing its ability to control movement and posture. In order to assess the influence of activities for the prefunctional motor deficit of manual abilities in patients with cerebral palsy, a therapeutic intervention was applied to 15 patients (7 men and 8 women) who had motor disorders in upper limbs. A quasi experimental 60 days study, conceived by 2 hours daily treatment was carried out. Initial and final qualitative functional scales of hands were applied to compare results. This novel therapeutic system influenced positively in the recovery of lost abilities as was statistically demonstrated.
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Adaptación del Test de Colores y Palabras de Stroop: Su Importancia en la Detección Precoz de los Déficits en las Funciones Ejecutivas.
Neuropsychological assessment is increasingly used as complementary diagnostic test for different brain pathologies, and Portugal is not an exception. Therefore urges that the instruments used for the evaluation present adequate psychometric criteria and normative data adjusted to the same population. Aging is a dynamic and progressive process, leading to greater vulnerability and incidence of pathological processes. Within these processes included neurodegenerative diseases, the most common, Alzheimer’s Disease.1 Executive functions seem to be the most involved in the overall functioning of the individual and the Stroop Test, is frequently used to evaluate these functions. We present a study of adaptation of this instrument in a Portuguese sample, trying to verify the importance of sociodemographic variables on test performance and whether there were significant differences between healthy subjects and with neuropathology. The results have allowed verifying the importance of adaptation of populations where tests are used. Thus, the Stroop Test seems a test to take into account when establishing a neuropsychological evaluation protocol, as well unlike the patterns of performance between normative and pathological aging.
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Intervención Neurolingüística en la Respiración y la Voz en Pacientes con Lesiones Estáticas Encefálicas Portadores de Trastornos Disártricos.
Objective: To prove the effectiveness of the neurolinguistic rehabilitation program for dysarthric patients, applied at the Encephalic Static Lesions Adults Clinic, International Center of Neurologic Restoration, in voice and breathing areas. It is a single sample pre-experiment obtained from logopedic records, contrasting them with the results of the external diagnosis, application of therapy and final evaluation.
Results: Males were prevalent and encephalic trauma as clinical diagnosis, there was great dispersion in age and time of evolution. Of the 54 patients, 40 increased their spirometric index: 22 the inspiration puff; 39 phono-respiratory coordination: 36 modified intensity; 11 tone; 18 modified their stamp vowel. The results evidence efficient functional recovery after the program was applied.
Conclusions: It was confirmed that there is not such established recovery pattern: none of the different variables influences significantly, the dispersion of the results is overwhelming and it is only possible to talk about tendencies. The program is effective but it cannot be affirmed that this variant is the correct one: more emphasis should be given to vocal indicators, other respiratory dimensions that are used should be measured as they have functional connotation.
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Trastornos del Sueño: Conocimiento de Apnea Obstructiva del Sueño en Médicos no Neurólogos y su Manejo Perioperatorio.
Objective: Obstructive sleep apnea syndrome (OSA) is a common sleep-related disorder that has been associated with a higher perioperative risk. Our purpose is to determine the level of knowledge and attitudes towards OSA among surgeons and traumatologists, knowing their important role in the prevention of potential perioperative complications in these patients.
Material and Method: Crosssectional survey study, using the “Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire” (OSAKA), administered to 105 surgeons and traumatologists and 27 surgery residents to measure the level of knowledge and attitudes towards OSA.
Results: Knowledge scores ranged from 3 (14%) to 17 (81%). The mean value for surgeons and traumatologists was below 62% (p=0.04), and lower than 48% (p=0.02) for residents. There is a positive correlation between the level of knowledge and the importance of identifying patients with OSAS (r = 0.26), and the confidence in themselves to identify this patients (r = 0.38). There was a negative correlation between knowledge and years of practice (r= -0.23).
Conclusion: Obstructive Sleep Apnea Syndrome is widely unknown among Surgeons and Traumatologists from Guayaquil. We recommend educational interventions that improve the level of knowledge and promote the use of guidelines in the management of patients in the perioperative period to decrease the risk of complications.
