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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Neuroeducación física: Efectos del ejercicio aeróbico en la atención alternante, planificación y memoria visuoconstructiva en estudiantes universitarios. Physical neuroeducation: Effects of aerobic exercise on alternating attention, planning and visuoconstructive memory in university students

Introduction: There are numerous reports of the positive effects of physical exercise on various cognitive variables such as attention, mental flexibility, memory, inhibitory control, etc. The aim of the present study was to determine the effects of an aerobic exercise session on alternating attention, planning and visual constructive memory in physical education students from a university in Santiago de Chile.

Methodology: Quantitative with a quasi-experimental design. The sample consisted of physical education pedagogy students, where 15 were the control group was 15, and 20 subjects were the experimental group. The instruments used were the symbols and digits test of Smith, Tower of Hanoi and Rey Complex Figure Test.

Results: There was significative improvement in the experimental group: alternating attention (p=0.018), at the time of the planning test (p=0.005), visuoconstructive memory (p=0.000).

Conclusions and Recommendations: Aerobic exercise improves attention, memory, and planning functions, which could promote the line of study of neurophysical education, so it is suggested within the projections to investigate with different intensities, age ranges and other cognitive variables.

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Palabras clave: atención alternante, ejercicio aeróbico, memoria visuoconstructiva, neuroeducación física, planificación,

Keywords: aerobic exercise, alternating attention, physical neuroeducation, Planning, visuoconstructive memory,

Insomnio y factores asociados entre los estudiantes de medicina que se recuperaron de la infección aguda por COVID-19. Insomnia and associated factors among medical students recovering from acute COVID-19 infection

Introduction: The SARS-CoV-2 pandemic significantly affected the mental health of a large portion of the population, with sleep disorders, including insomnia, being notable after COVID-19 infection. One of the populations most affected were university students in the healthcare field, which was the focus of our study.

Objective: To evaluate the relationship between factors associated with insomnia in medical students during the Long-Covid period.
Methods: Data was collected through a survey that included questions about sociodemographic aspects, health habits, sleep disturbances such as insomnia, and COVID-19 history. The severity of insomnia and subjective sleep quality were measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics, Spearman and Kendall correlations, one-way ANOVA, and odds ratios were evaluated.

Results: A total of 117 students were included in the study, with a mean age of 21.8 ± 1.96 years and 58.1% being female. It was found that 65% of medical students experienced some degree of insomnia, while 78.6% reported difficulty sleeping. The Kendall and Spearman correlation coefficients between PSQI and ISI were 0.49 and 0.55, respectively (p < 0.001). Significant correlations were found between self-reported physical health, emotional health, among others.
Discussion: The prevalence of subclinical insomnia (39.3%) and moderate sleep difficulty (47%) is noteworthy. Significant correlations were found between insomnia scales, sleep quality, and an inverse correlation with emotional health. Limitations of the study include the use of ordinal and nominal variables, as well as the number of participants. It is recommended to replicate the study with a larger sample size and utilize a longitudinal design to assess the evolution of insomnia and sleep difficulty over time.

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Palabras clave: calidad de sueño, COVID persistente, Insomnio, SARS-CoV-2, trastornos del sueño,

Keywords: Insomnia, Long COVIDs, SARS-CoV-2, sleep disorders, sleep quality,

Propiedades psicométricas de un Instrumento de Tamizaje para Autismo (ITEA) en niños y adolescentes del Ecuador. Psychometric properties of an Autism Screening Instrument (ITEA) in children and adolescents from Ecuador

This study explores factorial validity of the Autism Spectrum Screening Test (ITEA) for the identification of autism in schooled children and adolescents in Ecuador. The psychometric study analyzes the validity and reliability, as well as internal consistency of the elements of the scale. The sample consisted of 848 autistic people, and 350 non-autistic, of ages between 4 and 17 years old, who attended regular schools. The Confirmatory Factor Analysis shows that the ITEA adjustment model behaves adequately for the Ecuadorian population, corroborated by means of a model of four first-order factors and a second-order general agglutinating factor with 32 items, in fact, the absolute, relative, and non-centrality-based fit indicators confirm this. In addition, the scale is highly reliable in terms of internal consistency with ω= .92 [.91 – .93], since it allows obtaining greater precision in the evaluation of the studied construct. It can be concluded that evidence of factorial validity and reliability show that the ITEA, in its structural model, is adequately adjusted for the screening of autism in schooled children with ages between 4 to 17 years old
in Ecuador. According to Support Vector Machines (SVM), which allows information regarding the accuracy of each evaluated item, the set of 42 items reached 89.04% Analysis using the Request for Evidence test (RFE) showed that, in order to increase the accuracy level of ITEA, 31 items exceeded the global value. Regarding the 7 categories evaluated (language, communication, social skills, affectivity, information processing, inflexibility, and sensory perception), a value of 89.387% was obtained, according to the SVM algorithm with “rbf” kernel. The data shows the ability of ITEA to show specific characteristics to identify autism

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Palabras clave: Autismo, Ecuador, fiabilidad, población infantil y adolescente, tamizaje, validez,

Keywords: Autism, child and adolescent population, Ecuador, reliability, Screening, validity,

Trail Making Test TMT: Primera aproximación a las propiedades psicométricas en población ecuatoriana adulta. Trail Making Test TMT: First approach to the psychometric properties in the adult Ecuadorian population

Background: The Trail Making Test (TMT) is the most widely used test in Latin America to measure sustained attention (Part A) and executive function (Part B). However, the scales used show differences in the references averages between groups of populations.

Objective: To determine the referential averages of the TMT test, considering the effect of the sociodemographic factor, in order to provide normative data in Ecuadorian adult population, from 18 to 90 years of age.
Method: A quantitative method was developed, with a non-experimental design, based on psychometric techniques in a nonprobabilistic sample of a total of 1679 Ecuadorian participants . The TMT test, part A and B, was administered.

Results: 57.4% of the sample corresponded to female participants, while 42.6% consisted of male participants. The majority coming from the city of Quito (41.7%). The mean age was 34 years, and most reported higher education. The weightings of the referential averages in part A for the general sample were (M: 34.1; SD: 13.2), while in part B it was (M: 77.9; SD: 39.8). Comparing the scores obtained by gender and by age groups, no significant differences were observed; however, in the TMT-B part, the group with higher education (> 12 years) obtained a better performance, compared to the groups with fewer years of education (P=0,000).

Conclusions: the referential averages for the TMT test in the Ecuadorian population show dependence on the sociodemographic factor associated with schooling. In addition, those obtained were observed slightly below the scales provided in other Latino populations. Therefore, it suggests the construction of a referential scale for the TMT test, adapted to the Ecuadorian cultural context

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Palabras clave: atención sostenida, Flexibilidad cognitiva, función ejecutiva, Test TMT,

Keywords: Cognitive flexibility, Executive function, sustained attention., TMT Test,

Number of Neurologists and Neurology Training Programs available in the Public Health System of Ecuador: Analysis and Recommendations. Número de Neurólogos y Programas de Entrenamiento en Neurología disponibles en el Sistema de Salud Público del Ecuador: Análisis y Recomendaciones.

Introduction: In 2008, Ecuador’s neurologic healthcare profile displayed significant needs, a lack of neurologists, and neurology training accessibility. In that year, a new constitution introduced universal health care. No publication analyzes Ecuador’s neurological Public Healthcare capacity. Hence, an up-to-date analysis of the number of neurologists and neurology training programs is required.

Objective: Determine if Ecuador’s public healthcare meets the minimum ideal ratio recommended by the World Health Organization of 1 neurologist per 100,000 population and the numb er of neurology training programs in Ecuador.

Methods: Cross-sectional analysis of public data until November 2022 from Ecuador’s Public Health System (PHS) and the Council of Higher Education. Ratios were calculated using the N ational Institute of Statistics and Censuses’ information.

Results: The public health network had ninety-four neurologists. Most found in Pichincha (37/39.4%) and Guayas (24/25.5%). There was one per province in five provinces. No neurologists were available in eight provinces. Two provinces met the ideal ratio. Ecuador’s ratio was 0.54:100,000 neurologists per population. One neuro logy training program was found in Quito.

Conclusion: Ecuador’s PHS has a shortage of neurologists, unfulfilling the minimum ideal ratio, and a severe lack of neurology training. Decentralizing neurological services, primary care support, and governmental funding for neurology training are an urgent need.

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Palabras clave: Ecuador, Educación de Posgrado, neurología, salud pública,

Keywords: Ecuador, neurology, Postgraduate Education, public health,

Análisis Clínico y Evolutivo de Pacientes Con Estado Epiléptico Refractario Acorde el Esquema de Tratamiento de Tercera Línea Utilizado. Clinical And Outcome Analysis Of Patients With Refractory Status Epilepticus According To The Third-Line Treatment Scheme Used

Introduction: The evidence available in the treatment of refractory status epilepticus (RSE) is limited.
Objective: Evaluate the clinical and outcome factors in patients with refractory status epilepticus (RSE) according the third line treatment used (midazolam-MDL and/or propofol-PRO).

Methods: Retrospective cohort study included 34 patients treated by RSE during November 2015 to June 2018.Variables: Age, severity and etiology of RSE, pretreatment level of consciousness, anesthetic drugs (MDL-PRO), outcome at hospital discharge and 3 months according Rankin score.

Results: Mean of age of the patients was 51.21±22.3 years and 32.4% (11) had previous history of epilepsy. Super RSE (SSRE) was diagnosed in 35.3% (12) of sample. Mortality reached up 50% of patients and extended to 55.9% at 3 months. Patients treated with MDL had higher rate of vasopressor needs (71.4% vs 50.0%) and the group who received a scheme of combined treatment MDL-PRO included mainly a SSRE patients (p≤0.01), higher rate of tracheostomy (p=0.03), vasopressor drugs (p=0.01) and diminished dosage of anesthetic drugs (p=0.05). Surveillance analysis according Kaplan Meier curve did not found significant differences at 3 months in survival rate between groups. MDL vs PRO (Log Rank=0. 17), MDL vs MDL-PRO (Log Rank=0. 49) y PRO vs MDL-PRO (Log Rank=0. 48).

Conclusion: Patients with RSE had a high mortality, without evidence of increase of mortality in groups according anesthetic drugs used and schemed of treatment applied.

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Palabras clave: Coma terapéutico inducido, Estatus epiléptico, Estatus Epiléptico refractario, Midazolam, Propofol,

Keywords: Induced therapeutic coma, Midazolam, Propofol, Refractory status Epilepticus, Status Epilepticus,

Causas de Traumatismo Intracraneal en Pacientes Atendidos en el Servicio de Emergencias del Hospital de Especialidades Teodoro Maldonado Carbo de Guayaquil. Causes Of Traumatic Brain Injury In Patients Admitted To The Emergency Department Of A Specialty Hospital In Guayaquil

Introduction: Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. The most common causes of TBI are falls and traffic accidents, the latter being the most c ommon in low-income countries.

Methodology: A cross-sectional study was conducted in patients with a diagnosis of intracranial trauma in the emergency department of the Teodoro Maldonado Carbo Hospital from January 2017 to December 2020 with the aim of analyzing its causes, clinical and radiological characteristics.

Results: 324 patients were analyzed within the study, evidencing that the most common cause of TBI was traffic accident followed by falls. TBI is more common in men with a mean age of 40 years. Using Pearson’s chi-square and Kruskal-Wallis tests, a statistically significant association was found between cause with age and length of hospital stay (p<0.001). However, there were no significant associations between the specific cause of TBI with patient clinical variables or mortality (p>0.05).

Conclusion: The most prevalent cause of intracranial trauma was traffic accident. There is an association between the cause of TBI and length of hospital stay.

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Palabras clave: accidente de tránsito, caídas accidentales, determinantes de mortalidad, estancia hospitalaria, salud pública, Traumatismo intracraneal,

Keywords: accidental falls, hospital stay, mortality determinants, public health, traffic accident, traumatic brain injury,

Asociación entre Inflamación y Desempeño Cognitivo en Adultos: Revisión Sistemática en PubMed 2017-2022. Association Between Inflammation And Cognitive Performance In Adults: Systematic Review In Pubmed 2017-2022.

Introduction: The decline of cognitive functions is one of the main negative changes associated with aging. In recent years, interest has grown in determining whether inflammation affects cognitive decline and to what extent. The objective was to review the literature for studies that investigated the association between inflammation and performance in specific cognitive domains (example, memory, attention, or language), and in adults of all ages.

Methods: The PubMed database was consulted between 2017-2022. A systematic review was carried out according to the PRISMA statement and 27 scientific articles were selected.

Results: 26 out of 27 articles warned that greater inflammation is associated with poorer performance in attention, memory, executive functions, language, and processing speed, among the main cognitive domains. The evidence includes adults of various ages with and without a history of inflammatory or neuropsychiatric disease. Eight longitudinal studies indicated that inflammation is an important predictor of cognitive decline.

Conclusion: The reviewed studies suggest that a higher level of inflammation is associated with worse performance in specific cognitive domains, with evidence for adults of different ages, with and without a history of disease. Some methodological recommendations are offered to improve the comparability between studies.

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Palabras clave: Biomarcadores de inflamación, Funciones cognitivas, Neuroinmunología, neuropsicología, Psiconeuroinmunología,

Keywords: Cognitive Functions, Inflammatory biomarkers, Neuroimmunology, neuropsychology, Psychoneuroimmunology,

Intervenciones Cognitivas, Emocionales y Educativas Para Niños en Primera Infancia. Revisión Sistemática. Cognitive, Emotional And Educational Interventions For Children In Early Childhood. Systematic Review.

Introduction. It is essential to implement intervention processes during early childhood for the recognition and management of emotions. This stage of development is the foundation for learning and for acquisition of cognitive, behavioral, and social skills.

Objective. Evaluate the quality of the interventions from the cognitive, emotional and behavioral aspects in early childhood, which allow guiding educational programs for the development an d strengthening of emotional intelligence.

Method. A search was performed in digital databases: Scopus, ScienceDirect, APA PsycNET, ProQuest, Web of Science, and Pubmed between January 2013 and August 2022.

Results. 165 articles were identified in the aforementioned databases, resulting in 26 articles after using the different selection filters and inclusion criteria. Interventions focused on the family (14 interventions), the school (7 interventions) and the children (4 interventions) were identified.

Discussion. The interest in the development of intervention programs for children in early childhood with quality standards at the research level (clinical trials, large samples, bias control) and with positive results that reveal the importance of carrying out adequate accompaniment in said stage is highlighted development.

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Palabras clave: desarrollo cognitivo, intervención, Primera infancia, Revisión Sistemática,

Keywords: cognitive development, early childhood, intervention, Systematic Review,

Neurodegeneración con acumulación de hierro en el cerebro: Primer reporte de caso en Ecuador. Neurodegeneration with brain iron accumulation: First case report in Ecuador

Neurodegeneration with brain iron accumulation is a rare group of neurodegenerative diseases that present extrapyramidal symptoms, mood disorders, and cognitive impairment. A prevalence of 1 to 2 cases per million inhabitants is estimated. In Latin America, there is no estimated prevalence, although there are some reported cases with typical presentation. The first case report of this disease in Ecuador is presented, in an atypical presentation, under the ruling out of differentials and compliance with diagnostic criteria.

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Palabras clave: Acumulación cerebral de hierro, Neurodegeneración,

Keywords: Brain iron accumulation, Neurodegeneration,

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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Palabras clave: hemiplejía, Rehabilitación, vascular,

Keywords: hemiplegia, Rehabilitation, vascular,

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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Palabras clave: debilidad muscular progresiva, fatiga muscular, motoneurona inferior, poliomielitis, Síndrome Postpolio,

Keywords: lower motor neuron, muscle fatigue, poliomyelitis, Post-polio syndrome, progressive muscle weakness,

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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Palabras clave: Hemorragia intracerebral, Neurorradiología, Síndrome de hiperp erfusión cerebral, Stent, Tálamo,

Keywords: Cerebral hyperperfusion syndrome, Intracerebral hemorrhage, Neuroradiology, Stent, Thalamus,

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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Palabras clave: Anticonceptivos Hormonales, Infarto venoso, Seno recto, Trombosis del Sistema Venoso Cerebral Profundo, Vena de Galeno, Venas cerebrales internas,

Keywords: Galen vein, Hormonal Contraceptives, Internal cerebral veins, Straight sinus, Thrombosis of the Deep Cerebral Venous System, Venous infarction,

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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Palabras clave: Desórdenes motores oculares, Oftalmoplejía (Descriptores DeSC/MeSH), Parálisis facial, Síndrome de Tolosa-Hunt, Tejido de granulación,

Keywords: Facial paralysis, Granulation Tissue, Ocular Motility Disorders, Ophthalmoplegia (Medical Subject Headings DeSC/MeSH), Tolosa-Hunt syndrome,

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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Palabras clave: Encefalopatía, meningitis, miastenia, polineuropatía, SARS-CoV-2,

Keywords: Encephalopathy, meningitis, myasthenia, polyneuropathy, SARS-CoV-2,

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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Palabras clave: calcificaciones, Convulsiones, hipoparatiroidismo, reporte de caso, Síndrome de Fahr,

Keywords: calcifications, case report, Fahr's disease, hypoparathyroidism, Seizures,

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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Palabras clave: Daño cerebral adquirido, disfunción ejecutiva, enfermedad cerebrovascular, neuropsicología, Tálamo,

Keywords: Acquired brain injury, Cerebrovascular disease, executive dysfunction, neuropsychology, Thalamus,

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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Palabras clave: Accidente Cerebrovascular, Meningitis bacteriana, Streptococcus Constellatus, Vasculitis del sistema nervioso central,

Keywords: Bacterial meningitis, Central nervous system, Streptococcus constellatus, stroke, vasculitis,

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

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Palabras clave: aterosclerosis, Circunferencia del cuello, factores de riesgo cardiovascular, índices antropométricos,

Keywords: anthropometric indices, Atherosclerosis, cardiovascular risk factors, Neck circumference,

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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Palabras clave: cocaína, enfermedad cerebrovascular, Ictus isquémico,

Keywords: cerebrovascular disorder, cocaine, ischemic stroke,

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

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Palabras clave: donación de órgano, donación de tejido, editorial,

Keywords: editorial, organ donation, tissue donation,

Ralph L. Sacco, MD, MS.

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Palabras clave: Ralph L. Sacco,

Keywords: Ralph L. Sacco,

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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Palabras clave: COVID-19, mucormicosis, parálisis,

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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Palabras clave: método de Klinger, neurociencias,

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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Palabras clave: el signo de Frank, Estudio de cohorte prospectivo, Factores de riesgo, hiperintensidades de sustancia blanca, Pliegue del lóbulo de la oreja, Progresión,

Keywords: Earlobe crease, Frank’s sign, Progression, Prospective cohort study, Risk factors, White matter hyperintensities,

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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Palabras clave: calidad, enfermedad vascular cerebral aguda, Guía de Práctica Clínica,

Keywords: clinical practice guideline, quality, stroke,

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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Palabras clave: Conocimiento, Educación para la salud, Enfermedad de Alzheimer, evaluación., psicometría,

Keywords: Alzheimer’s Disease, assessment, Health educations, Knowledge, psychometrics,

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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Palabras clave: Adultos de mediana edad, Adultos Mayores, deterioro cognitivo, epidemiología, fluidez verbal, MMSE, Test del reloj,

Keywords: Clock's test, cognitive impairment, elderly adults, epidemiology, Middle-age adults, MMSE, verbal fluency,

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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Palabras clave: calidad de vida, disartria, Disfagia, enfermedad de Parkinson, Trastornos del Movimiento,

Keywords: dysarthria, Dysphagia, movement disorders, Parkinson’s disease, quality of life,
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