A 77-year-old man developed progressive slurry speech, action tremor in both upper limbs, generalized bradykinesia, and unsteady and shuffling gait several weeks after heavy binge-drinking followed by an unconsciousness state in which the patient did not respond to verbal commands or painful stimuli. MRI disclosed bilateral and symmetrical necrosis of globus pallidus as well as severe cortical and hippocampal atrophy. Damage of the globus pallidus was likely related to respiratory acidosis during the event. Pallidal Parkinsonism should be considered in the differential diagnosis of a progressive movement disorder after an acute toxic or hypoxic insult to the nervous system.
issue_article
Hemorragia intracerebral espontánea en pacientes con Covid-19 severa: Reporte de dos casos. Spontaneous Intracerebral Hemorrhage in severe Covid-19 patients: Report of two cases
The respiratory system is mainly affected by the SARS-CoV-2 infection, producing a severe acute respiratory syndrome known as COVID-19 (Coronavirus disease 2019), patients with severe disease usually develop multiorgan failure; among these we can focus on the nervous system, due to its potential neurotropism. Recent clinical data reveal that patients may manifest symptoms such as anosmia, dysgeusia, impaired consciousness, headache, seizures, and cerebrovascular disease (CVD). We describe two physically active male patients with complicated SARS-CoV-2 infection without significant comorbidities related to the development of intracranial hemorrhage, nor a history of head trauma or documented anatomic malformations. Both were admitted by the emergency department and during their stay in the ICU they developed intracranial hemorrhage diagnosed by computed tomography. The paraclinical findings in the two cases were compatible with a prothrombotic state as possible etiologies of bleeding in both.
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Alteración del estado de conciencia secundario a intoxicación por litio. Altered state of consciousness secondary to lithium intoxication
Introduction: Lithium is a pharmacological molecule that is commonly used in patients with bipolar affective disorder. Due to its chemical similarity to sodium, alterations in the latter have a direct effect on its plasma concentrations. Among the complications that can occur are nephrogenic diabetes insipidus, thyroid dysfunction, and some central nervous system defects such as nystagmus, ataxia, tremor, fasciculations, seizures, and coma.
Objective: To present the case of a patient with a syndrome of altered state of consciousness secondary to lithium poisoning coincide.
Clinical case: 61-year-old woman with a history of bipolar affective disorder who presented the syndrome of altered state of consciousness associated with lithium poisoning, for which reason the drug was withdrawn and hemodialysis sessions were carried out, obtaining an adequate response. with improvement of renal function and normalization of serum lithium values (0.76 mmol / L).
Conclusions: Lithium may involve alterations at the renal level that are associated with modifications in serum electrolytes. This can facilitate the appearance of neurological symptoms or symptoms, as evidence in the present case.
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Canalopatía de calcio CACNA1E: Nueva encefalopatía epiléptica en un paciente pediátrico. CACNA1E calcium channelopathy: New epileptic encephalopathy in a pediatric patient
Introduction: Epileptic and developmental encephalopathies, related to voltage-associated calcium channel mutations, are heterogeneous entities recently described in pediatric population.
Objective: To describe the case of pediatric patient with epileptic and developmental encephalopathy caused by a mutation in the CACNA1E gene that codes for a calcium channel.
Clinical case: Preschool male patient with refractory epilepsy starting at two months of life, associated with global developmental delay, behavioral disorder, hyperkinetic movements (dystonia) and hypotonia, with multifocal interictal activity and normal brain resonance, with pathogenic mutation in the gene CACNA1E.
Conclusion: Mutations in the CACNA1E gene cause functional alteration of the calcium channel CaV2.3, originating a clinical picture of a recently described phenotype.
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Aplasia unilateral del nervio vestibulococlear. Unilateral Vestibulocochlear nerve aplasia
Introduction: Vestibulo cochlear aplasia is an embryological defect in the formation of the inner ear that causes a sensorineural hearing loss. We report the case of an 8 year-old boy with left sided hearing loss, not previously detected. On neurological examination, a hearing loss in the left ear was found. Through imaging studies, the diagnosis is confirmed.
Conclusion: When hearing loss is suspected, imaging studies are the ideal method for detecting pathological findings in the inner ear.
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Drip and ship: Una práctica usual en el tratamiento de ictus isquémico por oclusión de arterias proximales en países de altos ingresos pero anecdótica en Colombia. Drip and ship: a prevalent practice in acute stroke with large vessel occlusion in high-income countries but anecdotal in Colombia
The Drip and Ship consists of giving intravenous thrombolysis in the primary center and referral for mechanical thrombectomy.
Objective: To describe the experience of Drip and Ship in acute ischemic stroke in two regions of Colombia.
Methods: We conducted a retrospective case series study of patients undergoing Drip and Ship from 2019 to first quartile of 2021. We compared times: door-to-image, door-to-needle, door-to-groin and clinical outcomes. Measures of central tendency and descriptive statistics were calculated.
Results: Six patients with ischemic stroke and large vessel occlusion were registered. Median of 60 minutes of the onset of symptoms, 75 minutes for door-to-needle, 167.5 minutes for door-in door-out time, and 91.5 minutes for travel time referred from another city. Five patients received mechanical thrombectomy with TICI 2c-3. 50% of patients with favorable modified Rankin scale at discharge and 84% at three months.
Conclusions: According to the RES-Q registry, between 2019 and the first quartile of 2021, there were 5954 cases of ischemic stroke cases in Colombia, and 20 patients received Drip and Ship strategy (0.33%). In agreement to international guidelines, door-to-needle and remission times were longer than recommended, especially in patients from other cities. It is necessary to structure care networks to improve treatment times and the number of patients treated.
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The association between pineal gland calcification and intracranial atherosclerotic disease in older adults. Asociación entre calcificaciones de la glándula pineal y enfermedad aterosclerótica intracraneal en adultos mayores
Background: This study assesses whether pineal gland calcification (PGC) – a surrogate for reduced endogenous melatonin production – is associated with significant stenosis of large intracranial arteries – a biomarker of intracranial atherosclerotic disease (ICAD).
Methods: Individuals aged ≥60 years enrolled in the Three Villages Study received head CT to assess PGC and MRA to estimate stenosis of large intracranial arteries. Multivariate logistic regression models were fitted to assess the association between PGC and ICAD, after adjusting for relevant confounders. Inverse probability of exposure weighting was used to estimate the effect of PGC on ICAD.
Results: A total of 581 individuals were enrolled. PGC and ICAD were associated in a fully-adjusted logistic regression model (p=0.032). Inverse probability of exposure weighting showed an estimate for the proportion of ICAD among those without PGC of 3.7% and the adjusted-effect coefficient was 5.7% higher among those with PGC (p=0.031).
Conclusions: PGC is associated with ICAD. Study results provide grounds for evaluating the role of melatonin deficiency in ICAD progression.
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Niveles altos de hemoglobina glicosilada se asocian a hemorragia intracerebral espontánea: Estudio de casos y controles. High levels of glycated hemoglobin are associated with spontaneous intracerebral hemorrhage: A case control study
Introduction: Evidence shows that glycosylated hemoglobin (HbA1C) is associated with spontaneous intracerebral hemorrhage (ICH). However, reports in Latin-American patients are scarce.
Objective: To determine if HbA1C is a risk factor for ICH.
Methods: A case-control study was carried out. Cases were hospitalized patients with ICH, whereas the controls were diabetic patients within the same age range. Logistics regression was calculated to identify risk factors associated with ICH.
Results: A total of 45 cases and 45 controls were included. HbA1C values were higher in the ICH group (median 6.8%, IQR=5.8– 7.5) compared to the control group (median 5.8%, IQR=5.5–6.2%; P<0.001). High HbA1C values were identified as a risk factor for ICH (OR=2.75, 95% CI=1.41-5.41). Among the ICH patients, barely 29% had a confirmed previous diagnosis of diabetes. The hospital mortality rate in the ICH patients was 37.8%, while mortality was 15% in the patients with diabetes and 46% in those without a previous diabetes diagnosis.
Conclusions: High HbA1C levels were associated with the development of ICH. It is paramount to improve public policies for early detection of diabetes due to the potential to reduce the impact of spontaneous intracerebral hemorrhage in the general population.
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Uso de la Escala de Inteligencia de Adultos de Wechsler-IV para la evaluación neuropsicológicas en Ecuador. The Wechsler Adult Intelligence Scale-IV for use in Neuropsychological Assessments in Ecuador
An important part of cognitive status evaluation is the determination of general cognitive ability. However, the most common tests are not standardized for use in Ecuador. This has limited the extent and accuracy of clinical neuropsychological assessments within the country. We used the 7-subtest Wechsler Adult Intelligence Scale-IV (WAIS-IV) with 155 mainly city-living Ecuadorian adults, recruited from a range of socioeconomic backgrounds around 4 different sites in Ecuador. The sample was matched to the Ecuadorian urban population for gender, education, and ethnicity. We show that this version of the WAIS-IV is a reliable and valid assessment for this context. In addition, we provide a method to adjust standard scores derived from the Spanish population, and used in the WAIS-IV manual, so that they are more appropriate for use in Ecuador. These can potentially be used to calculate full IQ scores. We also describe methods of comparing the Ecuador-adjusted standard scores so that they can be used in clinical neuropsychological evaluations of Ecuadorian adults.
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Palabras clave: CI,
evaluación cognitiva,
evaluación neuropsicológica,
inteligencia,
neuropsicología,
Cognición, afectividad y resiliencia en el perdón de una transgresión en la pareja. Cognition, affectivity and resilience in the forgiveness of a transgression in the couple
The transgression of the agreements between the couple is a current problem that generates discomfort on a personal, family and social level. In this article, an investigation is reported that analyzes a model that proposes the interaction between the variables positive cognition, positive affect and resilience as predictive factors that contribute to the understanding of the process of forgiveness of a transgression in the couple. 203 adults (103 women 60%, 88 men 40%) between 18 and 26 years of age participated in the research (Mage = 20.4, SD = 1.68). The hypothesized model was tested through the process of structural equations, finding adequate levels of goodness of fit x2 = 113.87, GL = 84, p = .02, SRMR = .05, RMSEA = .04 (.03 – .06), CFI = .97. The results found contribute to two essential levels in the line of investigation of the interaction between couples, firstly, at a theoretical level, it is provided with an innovative theory that allows us to understand the process of forgiveness in the couple and, secondly, to clinical level, for psychotherapeutic intervention in variables such as cognition and positive affect that would benefit a couple to overcome a conflict and reach a forgiveness.
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Estudio piloto sobre el funcionamiento sexual en mujeres con Esclerosis Múltiple en México. Pilot Study on Sexual Functioning in Women with Multiple Sclerosis in Mexico
Introduction: Sexual dysfunction in women with Multiple Sclerosis (MS) is frequent. The way it is approached by physicians and communication with patients has not been widely explored.
Objective: Describe the sexuality of women with MS, their satisfaction with their relationship and communication with doctors.
Material and Methods: Descriptive cross-sectional study, carried out in the MS Clinic in the main concentration center in Mexico, with self-administered questionnaires through an online survey, on mental health, couple relationships, doctor-patient interaction on the subject of health sexual and reproductive, female sexual functioning, intimacy and sexuality.
Results: 37 women participated, average age 35.0 ± 8.25 years. They have been with the disease for 4.3 ± 3.8 years and the main course is relapsing remitting MS (79.2%). 89.1% report sexual intercourse and 43.8% used contraceptives in their first relationship. Out of self-interest, 40% spoke to a doctor about sexuality. Women who are not in a relationship and have not spoken to a doctor about sexuality score low in the domains of sexual functioning.
Discussion and Conclusions: Communication about sexual health is fundamental and for this the doctor-patient relationship is central.
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Actualización y aproximación clínica a los modelos teóricos de la apraxia de extremidades. Approaching theorical models of limb apraxia: a clinical update
Apraxia is a common disorder in people who have suffered a left hemispheric stroke, with significant impact on their quality of life. Although several models have been proposed for its interpretation and approach, some aspects are still under study. The objective of this study is to review the current models of limb apraxia, to analyze the available evaluation tools and to make recommendations for clinical practice. The review shows that in the literature there is a greater interest in the conceptual system within the lexical-semantic route, without developing in detail the conceptual system within the visuomotor route. This article proposes a model of apraxia that overcomes these limitations and describes an assessment method focused on body knowledge within the visuomotor route. Finally, it is concluded that more studies are necessary to experimentally validate the proposed model and the associated evaluation methods.
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Estado Epiléptico Refractario de Aparición Reciente (NORSE): Revisión y actualización. New-Onset Refractory Status Epilepticus (NORSE): Review and Update
The New-Onset Refractory Status Epilepticus (NORSE) is a rare entity that is defined as a clinical presentation, in a patient without active epilepsy or other relevant neurological disorder, who presents a refractory status epilepticus (RSE) without an acute or active structural, toxic, or metabolic cause. NORSE constitutes a diagnostic challenge that implies high morbidity and mortality in the short and long term. Clinically, NORSE is characterized by a prodromal phase, an acute phase, where seizures with diverse semiology that evolve to an RSE occur, and a chronic phase, with neurological deterioration and drug-resistant epilepsy. After an extensive work-up, the cause of NORSE is identified in only half of the cases. The initial treatment is based on the use of conventional anti-seizure drugs, requiring most of patients the use of anesthetics and mechanical ventilation. Better results have been observed with immunotherapy, more recently with anti-cytokine drugs, such as tocilizumab and anakinra, consistent with the immunological/inflammatory mechanisms proposed for the pathophysiology of NORSE.
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Enfermedad de Creutzfeldt-Jakob. Creutzfeldt-Jakob disease
Palabras clave: (DeCS),
demencia,
difusión,
Enfermedad de Creutzfeldt-Jakob,
enfermedad priónica,
resonancia magnética,
Síndrome de Arlequín. Harlequin syndrome
We herein report the case of a 37-year-old woman who sought medical attention due to facial erythema on the right side of her face as well as diaphoresis following stressful events or exercise. Clinical examination was unremarkable. Blood tests and Thorax CT excluded any structural causes. Given this, she was diagnosed with Harlequin syndrome. Therapeutic options were explained, and follow-up provided.
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Asterixis and dysarthria-clumsy hand originated of lacunar infarction: A series of six cases. Asterixis y disartria-mano torpe originado a partir de los infartos lacunares: Una serie de seis casos
La asterixis y la disartria-mano torpe son signos neurológicos poco frecuentes que pertenecen a los trastornos del movimiento después de un accidente cerebrovascular. Clínicamente ellos son clasificados como parte del infarto lacunar y la mayoría de los casos se resuelven espontáneamente en un periodo entre 10 semanas y un mes. El objetivo de este estudio fue reportar seis casos de pacientes masculinos con infarto lacunar y describir los síntomas, localización y tamaño de las lesiones. Se describen casos de infarto lacunar y síntomas motores leves (disartria y asterixis) sin ningún indicio de demencia. En conclusión, nuestros casos presentan movimientos neurológicos anormales como asterixis y disartria-mano torpe en pacientes con hipertensión y / o diabetes mellitus tipo 2. Debido a la transitoriedad de esos movimientos, el diagnóstico en el tiempo adecuado es importante, a partir de eso los médicos pueden solicitar los exámenes de imagen, tratar al paciente y luego acompañarlo previniendo futuros ictus con consecuencias aún más graves. Así, estudios como el nuestro pueden contribuir al correcto diagnóstico de los infartos lacunares.
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Giant bilateral open-lip schizencephaly. Esquizencefalia bilateral gigante de labio abierto
La esquizencefalia es una malformación cerebral congénita caracterizada por hendiduras en la corteza cerebral, se clasifica en Tipo I (labio abierto) y tipo II (labio cerrado). Los pacientes con esquizencefalia presentan convulsiones, hidrocefalia, déficit motor y mental. La ecografía se utiliza para el diagnóstico intra útero y recién nacidos, y la resonancia magnética o tomografía computarizada en pacientes ya nacidos. El manejo de la esquizencefalia es conservador, con rehabilitacción de los déficits motores o mentales, medicación o cirugía para convulsiones y derivación en hidrocefalia con aumento de la presión intraacraneal. En la literatura, solo se han informado unos pocos casos bilaterales gigantes. Presentamos un caso de esquizencefalia gigante bilateral de labio abierto, en un paciente masculino de 10 días, que se presenta con hipotonía leve y sin convulsiones. Este caso es raro debido a las características relativamente beningnas en comparación con otros casos notificados.
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Palabras clave: esquizencefalia bilateral,
hendidura gigante,
malformación cerebral,
pediatría,
TAC,
Aplicación móvil de realidad virtual para el entrenamiento de la mano espástica. Virtual reality mobile application for spastic hand training
Background: The hand is a structure with a complex neuromuscular organization that in hemiparesis is compromised, affecting function.
Aim: To determine the changes in the motor function of the spastic hand of an adult with hemiparesis through the use of a mobile application for virtual reality.
Method: Case report of a 29-year-old adult with hemiparesis, evaluated with the Fugl Meyer upper extremity assessment (FMA-ES), the Trail Making test and the force dynamometry test. A therapeutic intervention was performed with exercises of the least affected hand for 12 sessions using special glasses for a total immersion 20 minutes using mobile application Mirror box Therapy VR®.
Results: The virtual reality therapy applied through the Mirror Box Therapy VR® mobile application, shows in a short time favorable changes in the motor and sensory hand function of the patient.
Discussion: Virtual reality provides a functional interaction, making it an effective tool to motivate patients during sessions.
Conclusion: An intervention through the use of virtual reality generates changes in the motor and sensory function of the hand of a patient with hemiparesis after 12 work sessions.
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Índice leucoglucémico alto como predictor de mortalidad intrahospitalaria en pacientes con ictus isquémico agudo. High leuko-glycemic index as an in-hospital mortality predictor in patients with acute ischemical ictus
Objective: To demonstrate that the high leuko-glycemic index was a predictor of in-hospital mortality in patients with acute ischemic stroke of the Neurology Department at Belen of Trujillo Hospital in the period from January 2014 to December 2018.
Material and method: Observational, analytical, cohort and retrospective research, conducted at Belen of Trujillo Hospital, with a census sample of patients hospitalized in the Neurology department with diagnosis of acute ischemic stroke in the period from January 2014 to December 2018 , who met the selection criteria.
Results: 281 medical records were analyzed, where 18 were of deceased patients, of which 56% died with a leuko-glycemic index greater than 1600, the association being statistically significant (RRa: 6.33, CI: 95% [1.35 – 29.64]; p = 0.019). In addition, in the multivariate analysis, age greater than or equal to 80 years, admission moderate awareness disorder and in-hospital pneumonia were also relevant.
Conclusion: The high leuko-glycemic index was a predictor of in-hospital mortality in patients with acute ischemic stroke of the Neurology Department at Belen of Trujillo Hospital in the period from January 2014 to December 2018.
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Prevalencia de neuromitos en académicos universitarios de Chile. Neuromyth prevalence in university academics in Chile
Introduction: A neuromyth is an interpretation error derived from a misunderstanding or mistaken belief about scientific findings, being frequent in educational contexts, but also in the area of neurology and other neurosciences. This research aimed to determine the prevalence of neuromyths among Chilean university scholars.
Methodology: Quantitative, non-experimental, cross-sectional study. The instrument used was the Neuromyth Prevalence Questionnaire, Spanish version. The sample considered 64 scholars from six Chilean universities.
Results: Among university teachers of education careers, four neuromyths had a prevalence higher than 70% in the items related to the relevance of the stimuli in the preschool stage and that individuals learn better when they receive information according to a learning style (visual, auditory or kinesthetic, VAK).
Conclusions and Recommendations: In conclusion, there is a high prevalence of neuromyths among the Chilean university scholars studied. As a challenge of scholar performance, they should adequately disseminate neuroscience research, as this impacts student training and their professional future. Furthermore, the awareness about neuromyths that prevail among them will allow us to address the dismissal of misconceptions that have lasted for a long time in the complex scenario of the interaction between educational sciences and neurosciences.
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Función cognitiva en adultos mayores con y sin dedos de Dawson relacionados con enfermedad de pequeño vaso cerebral. Cognitive performance in older adults with and without Dawson’s fingers-related cerebral small vessel disease
Background/objective: Dawson’s fingers have been traditionally associated with multiple sclerosis. However, this imaging biomarker has also been linked to white matter hyperintensities related to cerebral small vessel disease. In the latter, Dawson’s fingers could represent damage of small venules in subjects with severe small vessel disease and could theoretically be associated with cognitive decline. In this study, we aimed to assess the association between Dawson’s fingers and cognitive performance in a population of older adults.
Methods: Population-based study conducted in individuals aged 60 years or older, residing in three rural villages of coastal Ecuador (Atahualpa, El Tambo and Prosperidad). Of 712 older adults identified by means of a door-to-door survey, 590 underwent a brain MRI. Of them, 575 also had the Montreal Cognitive Assessment (MoCA). We selected the 157 individuals with moderate-to-severe white matter hyperintensities to assess the presence of Dawson’s fingers. The independent association between Dawson’s fingers and cognitive performance (as the dependent variable) was assessed by means of a linear regression model, after adjusting for demographics, cardiovascular risk factors, and the other biomarkers of cerebral small vessel disease.
Results: Of 157 individuals with moderate-to-severe White matter hyperintensities, 17 (11%) had Dawson’s fingers on MRI. The mean MoCA score in subjects with Dawson’s fingers was 14.5±6.4 points and that of those without this neuroimaging biomarker was 17.3±6.2 points. The association between Dawson’s fingers and the MoCA score was marginal in univariate models (p=0.082), but it completely vanished in a multivariate linear regression model adjusted for relevant covariates (β:-0.31; 95% C.I.: -3.23 – 2.60; p=0.833). A mediation model disclosed that 83.5% of the effect of Dawson’s finger on cognitive performance was mediated by age.
Conclusion: Dawson’s fingers are not independently associated with cognitive performance in individuals with cerebral small vessel disease. Most of the effect of this association is mediated by age.
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Síntomas de depresión, ansiedad y estrés en la población general ecuatoriana durante la pandemia por COVID-19. Depression, anxiety and stress symptoms experienced by the ecuadorian general population during the pandemic for COVID-19
Objective: To describe the mental health state of Ecuadorian adults during the COVID-19 pandemic from March to August 2020. Data from a larger study involving several Spanish-speaking countries were analyzed. This research was non-experimental, quantitative, and cross-sectional, conducted through an anonymous online survey used as the collection tool.
Results: A total of 766 people participated, 64.23% were women and the mean age was 32.35 (SD = 12.54). Around 8% of the participants declared having presented a diagnosis of COVID-19, and 12.9% having experienced associated symptoms. Most participants (77.4%) indicated not having had mental health problems in the past, and 87.6% did not have these problems during the pandemic. However, 41% acknowledged having experienced greater psychological distress. Participants presented low levels of symptoms of depression, anxiety, and stress. Women and young adults were the most affected groups by the assessed symptoms.
Conclusions: In pandemic and confinement situations, providing mental health care services for the general population is essential, especially for women and young adults.
