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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Revisión Sistemática de Literatura sobre Evaluación Neuropsicológica Infantil en Ecuador. Systematic Review Of The Literature On Child Neuropsychological Evaluation In Ecuador.

The objective of this study is to identify the cognitive functions evaluated and the tests used in child neurocognitive screening. Through a systematic review of the literature, the academic databases Pubmed, Scopus, ScienceDirect, Redalyc, Scielo and APA Psycnet were examined between the years 2014 and 2019. The results show that the functions considered for the evaluation are: language, memory, visual perception, attention, executive functions and learning abilities. In addition, the studies identify cognitive profiles based on the Wechsler, Kaufman Batteries and Infant Neuropsychological Assessment (ENI) scales.

In Ecuador, the Ministry of Public Health has not developed an instrument to carry out neurocognitive screening for children, so postgraduate thesis investigations were identified with the use of tests for specific situations such as violence, attention deficit, learning prob-lems and screening Infant highlights the use of the BREV Rapid Neurocognitive Function Assessment Battery model as a recommendation for a child neurocogitive screening instrument.

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Palabras clave: Evaluación Neuropsicológica Infantil, Perfil Neuropsicológico,

Keywords: Infant Neuropsychological Evaluation, Neuropsychological Profile, Neuropsychological test in childhood, Neuropsycholological evaluation and childhood,

Aterosclerosis Carotidea: Una Causa Frecuente Pero Prevenible de Ictus Isquémico. Carotid Atherosclerosis: A Common But Preventable Cause Of Ischemic Stroke

Carotid atherosclerosis is responsible for 10-20% of all ischemic strokes and is characterized by a high risk of stroke recurrence, as well as by its preventable nature through the control of vascular risk factors, intensive medical management, and surgical revascularization in cases of severe stenosis. Pivotal studies in the 90’s showed significant benefit of carotid endarterectomy in patients with severe symptomatic carotid stenosis (>70%), whereas the benefit in patients with moderate stenosis (50-69%) and those with asymptomatic disease was modest. Active areas of research in the field include the identification of novel non-traditional risk factors directed to the early diagnosis and primary prevention of carotid atherosclerosis, the efficacy of intensive medical management to decrease to the risk of stroke among patients with asymptomatic disease, and the development of new surgical revascularization techniques with lower complication rates. Through this revision manuscript we aim to summarize the current knowledge on carotid atherosclerosis and expose a practical approach for its diagnosis and treatment.

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Palabras clave: aterosclerosis carotidea, endarterectomía, estenosis carotídea, Ictus isquémico,

Keywords: carotid atherosclerosis, carotid stenosis, endarterectomy, ischemic stroke,

Temporal Squama Pneumatization: An Under-Recognized Limitation Of Transcranial Doppler. Pneumatización de las Escamas Temporales: Una Limitación Poco Reconocida Del Doppler Transcraneal

Transcranial Doppler (TCD) is a non-invasive procedure that is increasingly used for diagnostic and prognostic purposes in patients with an acute stroke. In addition, TCD enhances the effect of thrombolysis by exposing thrombi surfaces to circulating rTPA. However, insonation problems through acoustic windows limit the diagnostic efficiency of TCD.

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Keywords: pneumatization, Transcranial Doppler,

Encefalopatía Hipóxico-Isquémica Por Anfetaminas. Hypoxic-Ischemic Encephalopathy Due To Amphetamines

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Palabras clave: anfetaminas, Encefalopatía,

El Uso de Programas Computarizados y su Efectividad en la Rehabilitación de Funciones Ejecutivas en Daño Cerebral Adquirido. The Use Of Computer Programs And Their Effectiveness In The Rehabilitation Of Executive Functions In Acquired Brain Damage.

Given the increase in the offer of computerized programs for the neuropsychological rehabilitation of patients with acquired brain damage, it is important to know their efficacy and the advantages of their application on different processes. This article reviews the use of these programs in the neuropsychological rehabilitation of executive functions in patients with acquired brain damage.

The search was carried out in sources such as PUBMED, internet searches and some lists of bibliographic references. Controlled, randomized articles were reviewed, and due to the characteristics of the topic, quasi-experimental studies and a case study, adults, were also included, excluding only articles that included adults patients with acquired brain damage and who had executive function failure without specify one in particular and that they have received cognitive rehabilitation through computer programs. The results reflect weaknesses in the matching of the control groups, the size of their samples, and in the use of instruments for measuring executive functions to objectify efficacy. In general, the programs reviewed do not prove to be more effective than those of traditional pencil and paper interventions.

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Palabras clave: Daño cerebral adquirido, Funciones Ejecutivas, ordenador, rehabilitación neuropsicológica,

Keywords: Acquired brain damage, computer, Executive functions, neuropsychological rehabilitation,

Calcificaciones en Ganglios de la Base en un Caso de Hipoparatiroidismo Primario. Basal Ganglia Calcification In A Case Of Primary Hypoparathyroidism

Hypoparathyroidism is characterized by an insufficient production of parathyroid hormone, resulting in hypocalcemia and hyperphosphatemia, that without proper treatment can lead to multiple complications in different organs. We present the case of a patient with primary hypoparathyroidism, with basal ganglia calcifications as a complication of the disease and the therapeutic challenge it presents to improve the symptoms and quality of life.

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Palabras clave: calcificaciones, hipocalcemia, hipoparatiroidismo,

Keywords: calcifications, hypocalcemia, hypoparathyroidism,

Síndrome Lumbocostovertebral Asociado a Mielomeningocele. Lumbo-Costovertebral Syndrome Associated With Myelomeningocele

Lumbo-costo-vertebral syndrome is a rare anomaly that affects the vertebral bodies, the ribs and the muscles of the abdo- minal wall, and multiple additional congenital abnormalities requiring multidisciplinary management and early surgical inter- vention to avoid complications. Case presentation: A 10-day-old male infant presents with two right lumbar tumors, one that increased in size with crying consistent with a lumbar hernia, and the other a myelomeningocele. In complementary studies, it was found that the patient had fusion of the 1st and 2nd, 3rd and 4th and 11th and 12th ribs on the right, a 13th accessory rib on the right, and a 13th and 14th accessory rib on the left in addition to multiple defects in the fusion of the lumbar and sacral vertebral bodies, and a 1cm defect in the abdominal wall with protrusion of abdominal contents. The patient was diagnosed with LCVS with an associated myelomeningocele and underwent a simple closure and repair of the abdominal defect with a bovine pericardial patch, and plasty of the myelomeningocele without complications. We present this case due to the rarity with which it is reported in the literature. Conclusions: LCVS is a rare entity that merits early surgical resolution to avoid complications, in addition to multidisciplinary management.

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Palabras clave: hemivértebra, hernia lumbar, lumbo-costo-vertebral, Meningomielocele,

Keywords: hemivertebrae, lumbar hernia, lumbo-costo-vertebral, Meningomyelocele,

Carcinoma de Células de Merkel en Paciente con Esclerosis Múltiple en Tratamiento con Fingolimod. Merkel Cell Carcinoma In A Patient With Multiple Sclerosis Treated With Fingolimod

Fingolimod is a disease-modifying therapy widely used in Relapsing-Remittent Multiple Sclerosis. It blocks the capacity of lymphocytes to leave the lymph nodes, causing lymphopenia. This increases the risk of infections, but also non-melanocytic skin tumours. We report a case of Merkel cell carcinoma in a patient treated with fingolimod and a review of the literature, which helps to understand the relation between immunosuppression, opportunistic infections and cancer.

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Palabras clave: Cáncer, Carcinoma de células de Merkel, Efectos adversos, esclerosis múltiple, Fingolimod, Inmunosupresión,

Keywords: Adverse effect, Cancer, Fingolimod, Immunosuppression, Merkel Cell Carcinoma, multiple sclerosis,

Diferencias en la Corteza Visual Primaria Entre la Ceguera Congénita, Temprana y Tardía. Una Revisión Sistemática Differences In The Primary Visual Cortex Between Congenital, Early And Late Blindness. A Systematic Review

The loss of a sense, such as sight, promotes research on brain plasticity and the activity of the visual cortex, either with task or at resting-state. However, the activity of the primary visual area, its role in perception through cortical signals, once blindness has developed, is still being investigated. There is evidence of the differences between the changes associated with the different types of blindness, however, it is difficult to define how the anatomical and functional changes are interrelated and how they depend on, when vision is lost. That is why the main objective of this review is the clarification and definition of said modifications.

Important differences have been found in terms of the thickness and volume of the visual area, and how its decrease implies a greater activity detected by overload of neurons. Therefore, it explains a greater activity in congenital and early blindness compared to late blindness. Similarly, there is greater connectivity between the ventral and dorsal pathways in congenital blindness, as well as a lesser decrease in fractional anisotropy of the white matter (FA), compared to the other two types of blindness.

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Palabras clave: área visual primaria, Ceguera congénita, ceguera tardía, resting-state, RM, V1,

Keywords: Congenitally blind, late blind, primary visual area, resting-state, RM, V1,

Etiología del Daño Cerebral: Un Aporte Neuropsicológico en su Construcción Teórica (Primera Parte). Etiology Of Brain Damage: A Neuropsychological Contribution In Its Theoretical Construction (First Part)

The brain is the organ responsible for all the brilliant activities that human beings perform, such as thinking, acting, speaking, solving problems, making decisions, regulating emotions and other fascinating mental abilities. Any of these brain functions can be damaged at the least expected moment, generating cognitive and behavioral problems in the patient who suffers from acquired brain damage. This article proposes a theoretical review of various etiological factors of brain damage: (a) the most frequent of them, traumatic brain injury (TBI), a condition that causes a range of cognitive and behavioral deficiencies, in addition to being the main cause of prolonged dysfunction in industrialized countries; (b) brain tumors are also an important etiological factor, since any area of the Central Nervous System (CNS) can be affected and the effects are very varied according to the location of the tumor, its level of severity, its nature and whether or not surgery was performed; (c) thirdly, epilepsy is presented as a neurological disease present in 50 million people around the world and whose consequences on the CNS are related to seizures and anti-seizure drugs; finally, (d) the neurobiology of child abuse is exposed, which can generate alterations in the brain configuration of a minor. In each of these factors, its definition, classification, associated risk factors and, finally, what is its effect on the brain and the nature of the damage will be presented.

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Palabras clave: Daño cerebral adquirido, Epilepsia, maltrato infantil, traumatismo craneoencefálico, tumores cerebrales,

Keywords: Acquired brain damage, brain tumors, child abuse, Epilepsy, head trauma,

Trombosis Venosa Cerebral: Consideraciones Actuales. Brain Venous Thrombosis: Current Considerations

Introduction: Cerebral venous thrombosis (CVT) is an uncommon cause of cerebrovascular disease that mainly affects children and young adults, mostly in fertile-age-women.

Objectives: A contemporary review of the epidemiological, anatomical, pathophysiological, diagnostic and treatment characteristics of CVT.

Materials and methods: A bibliographic research was performed in the PubMed / MEDLINE database and including studies published in the period 2015-2020.

Development: The estimated-annual-incidence has been increasing in last years. Its diagnosis is established by clinical studies and neuroimaging, and laboratory studies. Although, the diagnosis is generally late due to a highly variable and nonspecific clinical presentation. Treatment target is preventing potential mortal complications, followed by anticoagulant therapy. In some cases, surgical thrombolytic procedures are indicated.

Conclusions: The diagnosis is based on a combination of MRI or CT studies. The current gold-standard treatment is low molecular weight heparin and warfarin.

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Palabras clave: resonancia magnética, tomografía computarizada, trombosis cerebral, Trombosis venosa,

Keywords: brain thrombosis, computed tomography, magnetic resonance, Venous thrombosis,

Síndrome de Persona Rígida de Causa Paraneoplásica. Claves Diagnósticas en una Entidad Rara. Stiff Person Syndrome Of Paraneoplastic Cause. Diagnostic Keys In A Rare Entity

Introduction: Paraneoplastic disorders exert their effect through immunological mechanisms and not by direct invasion of the tumor; in this way tumors located outside the nervous system induce the production of antibodies against antigens: on the neu- ronal surface, intracellular or synaptic and affect distant sites from its location to either the central or peripheral nervous system, thus producing various clinical manifestations. One of these syndromes is the Stiff Person syndrome, which, apart from being a rare entity, occurs as a paraneoplastic syndrome in only 5% of cases.

Clinical Case: A 72-year-old male patient, a 2-month evolution that began with painful muscle spasms in the dorsal and lumbar region, evolved to rigidity with posture in axial and appendicular hyperextension, pseudospastic gait, hyperekplexia; due to the suspicion of Stiff Person syndrome a diagnostic work-up was begun finding high levels of Ab anti GAD65 and later a Non- Hodgkin’s Lymphoma. The patient received immunotherapy and cancer treatment.

Conclusion: Paraneoplastic syndromes must be identified according to the clinical phenotype and the determination of an- tineuronal antibodies. High suspicion and rapid diagnosis are necessary to achieve timely treatment and avoid permanent injury.

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Palabras clave: Anticuerpos antineuronales, desórdenes paraneoplásicos, Linfoma No Hodgkin, síndrome de Persona Rígida,

Keywords: Antineuronal antibodies, non Hodgkin lymphoma, paraneoplastic disorders, stiff-person syndrome,

Síndrome de Joubert Asociado a Apnea Central del Sueño en un Adulto de Colombia. Joubert Syndrome Associated With Central Sleep Apnea In An Adult From Colombia

Introduction: The Joubert syndrome is an autosomal recessive disorder, classified as a ciliopathy. The primary cilia have a role in neuronal proliferation and axonal migration in the cerebellum and brainstem. Marie Joubert and colleagues in 1969 pu- blished four cases with partial or total agenesis of the cerebellar vermis and apnea-hyperpnea neonatal episodic disorder. From an early age the principal manifestations are: abnormal breathing pattern, nystagmus, swallowing alterations, hypotonia, ataxia and intellectual disability. Classically, the neonatal breathing disorder improve with age.

Clinical case: A 39 years old, with intellectual disability and a history of a movement disorder involving a lower extremity, snoring, episodes of central apnea, hypotonia and nystagmus. He was the second child, with an uncomplicated, full-term gestation. In the clinical exam was found dysarthria, short term and semanticmemory loss, Epworth scale: 9/24. Brain magnetic resonance imaging (MRI) showed cerebellar vermis hypoplasia and elongation of the hemispheres as the “molar tooth sign.” Moreover, a polysomnography study found a central sleep apnea disorder.

Discussion: It is fundamental to recognize this syndrome to establish a prenatal or an early age diagnosis, for a multidisciplinary approach and an early genetic counseling. The treatment of the sleep disorder in these patients is crucial for a better quality of life.

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Palabras clave: apnea central del sueño, Ciliopatías, Colombia, Signo del molar, Síndrome de Joubert, vermis cerebeloso,

Keywords: cerebellar vermis, Ciliopathy, Colombia, Joubert Syndrome, Molar tooth sign, sleep apnea central,

Cómo Reconocer el Meningioma Intraóseo: Etiología y Hallazgos por Imagen. How To Recognize Intraosseous Meningioma: Etiology And Imaging Findings

Meningiomas are the most common primary brain tumors. Primary intraosseous meningioma is a rare extradural meningioma subtype. They are usually asymptomatic but may cause proptosis or neurological symptoms depending on size and location. The most common finding in imaging tests is hyperostosis although a lytic or even mixed pattern can also be observed, so it should be considered in the differential diagnosis of cranial sclerotic bone tumors. Although most are benign, they are more likely to develop malignancy than intradural meningiomas. Imaging techniques (CT and MRI) are very useful in preoperative diagnosis and evaluation of adjacent anatomical structures. Surgical resection followed by cranial reconstruction is the treatment of choice.

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Palabras clave: cráneo, extradural, intraóseo, meningioma, osteolítico, tumor óseo,

Keywords: bone tumor, extradural, intraosseous, meningioma, osteolytic, skull,

Razonamiento Clínico: Mujer de 38 Años de Edad en Puerperio Alejado con Debilidad Muscular en Hemicara Derecha. Clinical Reasoning: 38-Year-Old Woman In Remote Puerperium With Weakness In Right Side Of The Face

A case of 38-year-old woman is presented with muscular weakness in right side of the face during her remote puerperium. We reviewed the history, physical examination, and analyze the differential diagnosis, etiology and the final diagnosis.

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Palabras clave: debilidad muscular, diagnóstico diferencial, Puerperio,

Keywords: differential diagnosis, Muscular Weakness, Puerperium,

Tuberculosis Meníngea en un Paciente Pediátrico: Reporte de un Caso Clínico. Meningeal Tuberculosis In A Pediatric Patient: A Case Report

Tuberculosis is a global public health problem. In pediatric ages it represents between 3% and 40% of the total disea- se. In countries with high incidence, such as Ecuador, the presence of cases of childhood tuberculosis always indicates the circulation of Mycobacterium tuberculosis or contact with an untreated patient or undiagnosed. In our country there is a high percentage of underdiagnosis of childhood tuberculosis and a lower burden than expected, mainly in children under 5 years of age. Meningeal tuberculosis is the most serious form of presentation of infection by M. tuberculosis in pediatric age since it causes many deaths and disability. The diagnosis of tuberculous meningitis is achieved considering epidemiological criteria, laboratory studies in blood, cerebrospinal fluid, and neuroimaging. Early treatment improves the prognosis, but the problem lies in making an early diagnosis, since it has different forms of clinical presentation ranging from nonspecific symptoms to severe neurological involvement.

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Palabras clave: Mycobacterium tuberculosis, Sistema nervioso central, tuberculosis infantil, tuberculosis meníngea,

Keywords: Central nervous system, childhood tuberculosis, meningeal tuberculosis, Mycobacterium tuberculosis,

Telemedicina y Neurología. Telemedicine and Neurology.

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Palabras clave: editorial, neurología, Telemedicina,

Keywords: editorial, neurology, telemedicine,

Funcionamiento Ejecutivo en Adolescentes Embarazadas Del Departamento de Sucre-Colombia: Una Respuesta Desde la Cognición. Executive Functioning In Pregnant Adolescents In The Department Of Sucre-Colombia: A Response From Cognition.

Introduction: Teen pregnancy changes the way of life of girls and their families, sometimes they can be the product of poor decision-making when having sex.

Objective: To describe the executive functioning of adolescents in a state of pregnancy in the department of Sucre.

Method: Quantitative, observational, descriptive level and cross-sectional approach; a sample of 72 adolescents, 36 of them pregnant in the department of Sucre, Colombia. Sample: selection and rejection method, applying a simple analysis of variance, using the R-Studio program. Instruments: a test protocol was applied containing: Controlled word association test, Wisconsin classification test (WCST), Stroop test, Trail Making Test (TMT).

Results: Adolescent girls in pregnancy presented greater difficulty in making decisions, failures in problem solving, organization and planning of information, as well as poor self-monitoring, slow learning, and low speed of information processing.

Conclusion: The maturation of brain areas with changes occurred in adolescence is consistent with the difficulties found in this executive functioning and the appearance of risk behaviors resulting in possible pregnancies during adolescence.

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Palabras clave: adolescentes, conductas de riesgo, embarazo temprano, función ejecutiva,

Keywords: adolescents, early pregnancy, Executive function, risk behavior,

Puntaje Global de Potenciales Evocados Multimodales Sensoriales en el Estudio de Pacientes Con Esclerosis Múltiple. Global Score Of Sensory Multimodal Evoked Potentials In The Study Of Patients With Multiple Sclerosis.

Introduction: Multiple sclerosis (MS) is a demyelinating, inflammatory and degenerative disease of the central nervous system. Multimodal sensory evoked potentials (MSEP) have been used to evaluate the integrity of sensory pathways but have not been globally considered as a tool to MS diagnose.

Objective: to evaluate the relationship between the global score of MSEP with the degree of disability and the presence of structural lesions in MS patients.

Methods: Thirty-five patients with relapsing-remitting MS were studied in the International Center for Neurological Restoration. The score of the MSEP was correlated to the disability scale of Kurtzke and the degree of lesions evidenced in magnetic resonance images.

Results: A significant correlation was found between the global score and disability scale (R=0.33, p<0.05) and between the global score and the number of lesion levels detected in the resonance images (R=0.42, p< 0.05).

Conclusion: The relationship between the global score of the MSEP and the structural lesions and degree of disability confirms its utility to study MS patients, even though they aren’t part of the diagnostic criteria.

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Palabras clave: escala de discapacidad, esclerosis múltiple, imágenes de resonancia magnética, potenciales evocados, puntaje global,

Keywords: disability scale, evoked potentials, global score, magnetic resonance imaging, multiple sclerosis,

Exámenes no Costo-Efectivos En Pacientes Con Lumbalgia Inespecífica en un Hospital Referencial. Non-Cost-Effective Tests In Patients With Unspecified Lumbalgia In A Referential Hospital.

Introduction: Low back pain has become a serious health problem due to its high frequency and social, labor and economic impact. 90% of them correspond to non-specific low back pain, and in them routine examinations have proved to be non-cost-effective.

Objective: To identify the frequency of the use of non-cost-effective tests in patients with a diagnosis of non-specific low back pain treated at The Almanzor Aguinaga Asenjo National Hospital, in 2014-2015.

Material and methods: Cross-sectional descriptive study in patients aged 18 to 49 years with a diagnosis of non-specific low back pain (ICD-10 M54.5) attended by an outpatient clinic at The Almanzor Aguinaga Asenjo National Hospital in 2014-2015. Census sampling was used, including a clinical history of patients without a serious or specific underlying condition or who did not show any signs of alarm to suspect them. Excluded psychiatric comorbidities or fibromyalgia, obtaining 177 patients. A collection form validated by experts was used. The data was analyzed with SPSS v.22.

Results: A frequency of non-cost-effective exams of 53,11% was found. The occupations with the highest physical load (60,64%) and the clinical services (47,87%) were the most frequent. The radiodiagnosis exams represent approximately 75% of the exams requested. A total unnecessary expense of s / .32125,21 equivalent to USD 9 818.32 was obtained.

Conclusions: There is a high frequency of the use of non-cost-effective tests in patients with non-specific low back pain, with radiodiagnosis being the most prescribed.

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Palabras clave: diagnóstico por imagen, Evaluación de costo-efectividad, Lumbalgia, Procedimientos Innecesarios, Uso Excesivo de los Servicios de Salud,

Keywords: cost-effectiveness Evaluation, diagnostic imaging, low back pain, Medical Overuse, Unnecessary Procedures,

Propiedades Psicométricas del Inventario CABI Para la Determinación del TDAH. Psychometric Properties Of The Cabi Inventory In The Determination Of ADHD.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most frequent mental health issues among children and adolescents

worldwide. Current literature shows that ADHD could affect both academic and work performances of those who present it. The aim of the present study was to analyze the psychometric properties of the Child and Adolescence Behavior Inventory (CABI) through an exploratory study, based on the report of 350 Chilean parents. Results indicated a three-dimensional model (sluggish cognitive tempo, inattention and hyperactivity) with adequate fit of the data (RMSEA=0.065; CFI= 0.954; TLI=0.941; PL=207) that explained 61.76% of the total variance with an Alpha of 0.961. Results show that the subscales analyzed have acceptable psychometric properties, an adequate internal consistency and that their indicators have a correct discriminatory power.

Therefore, according to these preliminary results, CABI can be considered a useful assessment tool for the diagnosis of ADHD. Implications for practice, policy and future research are discussed.

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Palabras clave: confiabilidad, evaluación., propiedades psicométricas, síntomas, trastorno por déficit de atención,

Keywords: assessment, Attention deficit disorder, Psychometric properties, reliability, symptoms,

Propuesta De Una Escala De Valoración De Las Funciones Ejecutivas En Universitarios. Proposal For An Evaluation Scale Of Executive Functions In University Students.

Introduction. The executive functions constitute a set of cognitive, affective and motivational processes, which allow the conscious control of thought, development of highly complex tasks, that is going to facilitate the adaptation to new situations, it is therefore necessary the contribution of new evaluation methodologies of executive functions centered on the university population, this is going to facilitate the access to check the cognitive processes of the pre-frontal cortex.

Objective. Evaluate executive functions in university students between 18 and 25 years of age using a self-report scale.

Subjects and method. 752 university students from Quito-Ecuador participated, aged between 18 and 25 years old, of whom 498 (66.2%) were female and 254 (33.8%) were male. As measuring reagent, the scale used to evaluate the executive functions in self-report was proposed in the project: Neuropsychological Systems for Supervision of Cognition and Behavior for the Benefit of Managing the Learning of Higher Education Students.

Results. Exploratory factor analysis reported an organization of 8 executive functions that explain 57% of the variance of the construct (p = <.001). An adequate level of reliability was obtained between α = .70 and .86, a factor was eliminated since its level of reliability was very low and did not improve under any statistical procedure. The correlation between the proposed factors was adequate at a median magnitude r = .67 and .39.

Conclusion. The results show that the proposed scale is based on situations in the student’s daily life, this scale design allows identifying both pathological situations and conditions that affect the quality of life and development in the university environment. Furthermore, psychometric indicators provide evidence in favor of their reliable use in the university context.

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Palabras clave: Escala de Auto reporte, estudiantes universitarios, Funciones Ejecutivas,

Keywords: Executive functions, Self-report Scale, university students,

Relación Entre Uricemia y El Estado Funcional Neurológico En El Ictus Isquémico Agudo – Estudio Multicéntrico. Relationship Between Uricemia And The Neurological Functional State In Acute Ischemic Stroke – Multicenter Study

INTRODUCTION: Various biomarkers are studied as a prognostic factor in ischemic stroke, the results obtained about uric acid are controversial.

OBJETIVE: To determine if there is a relationship between uricemia and the neurological functional state in acute ischemic stroke.

MATERIAL AND METHODS: A study was carried out that included 151 patients diagnosed with acute isquemic stroke from the neurology department of the Victor Lazarte Echegaray Hospital and Alta Complejidad Virgen de la Puerta Hospital that met the selection criteria, the relationship between uricemia and neurological functional prognosis using the modified Rankin Scale (mRS), using the Eta statics.

RESULTS: 55.6% of the patients had a poor neurological functional prognosis (mRS>2) reporting acid uric levels with a mean of 4.13 mg/dl. An Eta coefficient of 0.940 was obtained.

CONCLUSION: There is a direct relationship between uricemia and neurological functional state in patients with acute ischemic stroke, associating more extreme values with the worst functional prognosis at hospital discharge.

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Palabras clave: Accidente Cerebrovascular, Ácido úrico, pronóstico funcional,

Keywords: functional prognosis, stroke, Uric Acid,

Diseño y validación de un paradigma para evaluar la atención selectiva, utilizando el software de código abierto “PsychoPy”, aplicable a la Resonancia Magnética Funcional. Design and validation of a paradigm to evaluate selective attention, using the open source software “PsychoPy”, applicable to Functional Magnetic Resonance.

Introduction: Selective attention is a neuropsychological function involved in carrying out activities, from the simplest to the most complex, guiding us towards the search for relevant elements for the achievement of proposed tasks and inhibiting other responses.

Objective: Design and validation of the paradigm to evaluate selective attention.

Methodology: Quantitative study, exploratory-descriptive, experimental. The instrument was designed in three stages: 1) elaboration of the paradigm, 2) validation of the construct and content, 3) Field test and data analysis applied to 18 healthy adults, selected in a non-probabilistic way, between 18 and 30 years old. The paradigm was developed virtually in “PsychoPy”, based on the d2 test and adapted for the Magnetic Resonator.

Results: High scores were found in the evaluation of selective attention and the average time of correct answers is adequate in relation to the amount of work. When analyzing the influence of age and sex with the frequency of correct answers, no statistically significant differences were found.

Conclusions: The selective attention paradigm is a complementary prognostic tool, useful to assess this function, because it has construct and content validity; being a safe, free and easy-to-apply instrument.

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Palabras clave: Adultos, atención selectiva, Ecuador, neuropsicología, Paradigma, RMf,

Keywords: Adults, Ecuador, fMRI, neuropsychology, Paradigm, selective attention,

Actualización en Neuropatía Óptica Isquémica No Arterítica. Nonarteritic Ischemic Optic Neuropathy: An Updated Review

Introduction: Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic nerve injury is the second most common optic neuropathy after glaucoma.

Development: Patients are over the age of 50 years with vascular risk factors. This condition typically presents with acute, painless, monocular loss of vision associated with a variable visual field defect and optic disc edema. NAION is produced by inadequate perfusion of the optic nerved head, supposedly because of nocturnal hypotension and small cup/disk ratio. Diagnosis is mainly clinical and prognosis is generally guarded.

Conclusion: There is no treatment for this condition despite numerous medical and surgical attempts. This article reviews the literature and summarizes current data of proposed treatments.

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Palabras clave: fisiopatología, neuropatía óptica isquémica anterior no arterítica, Tratamiento,

Keywords: nonarteritic anterior ischemic optic neuropathy, physiopathology, Treatment,

Modelos de Organización Cerebral: un recorrido neuropsicológico. Brain Organization Models: a neuropsychological journey

There has always been an interest in understanding how the human brain functions in relation to behavior and cognition. An approach that seeks to solve this intrigue lies in the proposal of models of brain organization that try to explain how the work of the brain mass is. In this sense, this article proposes a theoretical review of the main models. Jackson proposes a theory where three levels of brain structure are considered: lower or medullary level, middle level, and higher level. McLean postulates the existence of three brains: reptile, paloemamiferous / limbic and neocortex. The Wernicke-Geswind model manifests the interaction of language structures in favor of brain function. Luria’s model of brain organization highlights the interactive role of three functional units: first, in charge of regulating tone and wakefulness; second, it receives, processes and stores the information; and the third, plans, monitors and verifies mental and behavioral activity. This review highlights the high complexity involved in the work of the human brain. This article closes highlighting the need to carry out research that can generate empirical evidence in favor of understanding the efficacy of each of the models described in this work.

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Palabras clave: Jackson, Luria, MacLean, modelos de organización cerebral, neuropsicología,

Keywords: brain organization models, Jackson, Luria, MacLean, neuropsychology,

Principios del aprendizaje motor: Una revisión sobre sus aplicaciones en la rehabilitación del accidente cerebrovascular. Motor learning principles: A review of their applications in stroke rehabilitation

Stroke is one of the leading causes of disability worldwide. Despite the functional consequences, a recovery process can occur in these patients thanks to the neuroplasticity mechanisms preserved after brain damage. Recovery of movement patterns after stroke has been suggested to be based on a learning process. Motor learning is an approach that has recently generated a great deal of attention in the field of neurorehabilitation. Thanks to its association with neuroplastic mechanisms, the implementation of motor learning principles has shown positive results during motor skills learning in stroke patients. The present study offers a review of the fundamentals of motor learning and its various strategies to promote the learning of a motor skill. This article provides a concise overview of the implications of motor learning in stroke rehabilitation, describing the strategies, therapeutic approaches, and assessment parameters used respectively to promote and evaluate motor learning in stroke patients.

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Palabras clave: Accidente Cerebrovascular, Aprendizaje motor, Desempeño motor, Habilidad motora, Rehabilitación,

Keywords: Motor learning, Motor performance, Motor skill, Rehabilitation, stroke,

Parálisis Periódica Hipopotasémica Tirotóxica, Una Emergencia Neuroendocrina: Artículo de Revisión. Thyrotoxic Hypokalemic Periodic Paralysis A Neuroendocrine Emergency: Review Article

Thyrotoxic Periodic Paralysis (TPP) is a neuroendocrine emergency and although rare should be part of the differential diagnosis of weakness in a patient presenting with hyperthyroidism. It is usually triggered by high carbohydrate diet, trauma, exposure to cold or strenuous exercise. Most of the cases occur in 20 – 30 year-old Asian males. Diagnosis is clinical with the triad of flaccid paralysis, signs of thyrotoxicosis and hypokalemia. Treatment consist on electrolyte repletion, thionamides and beta blockers. The importance of recognizing the association between hyperthyroidism and hypokalemic paralysis is vital as with successful treatment of hyperthyroidism paralysis resolves.

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Palabras clave: hipertiroidismo; Parálisis hipopotasémica, Parálisis periódica tirotóxica,

Keywords: hyperthyroidism, Hypokalemic paralysis, Thyrotoxic periodic paralysis,

Parálisis periódica hipocalémica: reporte de caso. Hypokalemic periodic paralysis: case report

Hypokalemic periodic paralysis is a disease included in the skeletal muscle channelopathies, characterized by attacks of muscle weakness secondary to dysfunction of Cav1.1 calcium or Nav1.4 sodium channels. We report a case of a patient with a diagnosis of episodic hypokalemic paralysis confirmed by genetic study, and a brief discussion regarding the importance of genetic analysis, its clinical and therapeutic implications.

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Palabras clave: canales de calcio dependientes de voltaje, canales de sodio dependientes de voltaje, canalopatías, debilidad muscular, excitabilidad muscular, parálisis periódica hipocalémica,

Keywords: channelopathies, hypokalemic periodic paralysis, muscle excitability, muscle weakness, voltage-dependent calcium channels, voltage-gated sodium channels,

Hallazgos histológicos en epilepsia temporal familiar en una familia de ascendencia Maya. Histological findings in familial temporal epilepsy in a Mayan descent family

Familial temporal lobe epilepsy is a heterogeneous genetic syndrome, initially recognized in studies with twins. In this condition, many members of a family are affected by psychic or autonomic auras and focal seizures with altered consciousness. We describe two brothers, children of non-blood parents, with different phenotypes of familial temporal lobe epilepsy and drug resistance who were referred to our center for epilepsy and functional neurosurgery. The family, of Mayan descent, has a history of epilepsy in other relatives. Epilepsy surgery was performed on the two brothers while remaining seizure-free today. The histological findings in both cases were consistent with cortical focal dysplasia IIIa. It is the first Latin American report of siblings with evidence of a correlation between familial temporal lobe epilepsy and histological changes suggestive of cortical focal dysplasia IIIa.

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Palabras clave: displasia focal cortical, Epilepsia familiar del lóbulo temporal, farmacorresistencia,

Keywords: cortical focal dysplasia, drug resistance, Familial temporal lobe epilepsy,

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