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Cerebral angiography (CA) is considered as the gold standard in diagnosis of intracranial aneurysms; nevertheless, the magnetic resonance angiography (MR-angiography) is wide spread used in detection of unruptured aneurysm. For this reason, several authors had proposed that MR-angiography could replace CA in the diagnosis of ruptured aneurysms.To asses the efficacy of MR-angiography in diagnosis of ruptured intracranial aneurysms, and in addition to determine the safeness of its surgical management with MR-angiography alone.We studied prospectively 52 patients with subarachnoid haemorrhage admitted at Teodoro Maldonado Carbo and Alcívar Guayaquil hospitals of Guayaquil, Ecuador, in a 5 years period. We compared the results of MR-angiography with CA and surgical findings in the diagnosis and categorization of intracranial aneurysms.We made diagnosis of 100% of 54 aneurysms with MR-angiography, while 98% with CA. The surgical findings were similar to the characteristics showed by MR-angiography.MR-angiography is an excellent no invasive method in the diagnosis of ruptured intracranial aneurysms, and could replace CA in selected cases.

Many patients with multiple sclerosis (MS) develop tremors that may involve one or both lower and/or upper extremities, head and/or voice. In the last few years, chronic high frequency deep brain stimulation of the ventral intermedious (Vim) thalamic nucleus (Vim-DBS, deep brain stimulation) seems to be gradually replacing Vim-thalamotomy in surgical treatment of tremor. The thalamotomy is a destructive procedure of the whole neural components, whereas Vim-DBS has shown to be a selective neurophysiological procedure to block a specific group of neural components, in particular large, fast and low threshold ones. MS is a disease of uncertain etiology characterized by demyelinating plaques in central nervous system. The neurophysiological intraoperative targeting applied to this pathology identifies demyelinated plaques and the functional state of Vim, reduces pitfalls and increases accuracy. Methods included spontaneous and induced multiunit activity recording, semimicroelectrode and tetraelectrode thalamic evoked potentials recording and micro/macro stimulation techniques.

Introduccion. La angiografia cerebral (AC) es la tecnica de referencia en el diagnostico de aneurismas intracraneales; no obstante, la angiografia por resonancia magnetica (angio-RM) se utiliza con gran efectividad para la deteccion de aneurismas en pacientes que no han presentado hemorragia subaracnoidea (HSA). Por lo tanto, algunos autores han propuesto que la angio-RM puede suplantar a la AC, incluso en el tratamiento de aneurismas rotos. Objetivos. Valorar la utilidad de la angio-RM comparada con la AC y la observacion quirurgica en el diagnostico de aneurismas intracraneales rotos, ademas de determinar la seguridad del tratamiento quirurgico con angio-RM como unico metodo diagnostico. Pacientes y metodos. Se estudiaron prospectivamente 52 pacientes con HSA aguda por ruptura de aneurisma en los hospitales Teodoro Maldonado Carbo y Alcivar Guayaquil, de la ciudad de Guayaquil, Ecuador, en un periodo de 5 anos. Comparamos los resultados de la angio-RM con la AC y los hallazgos quirurgicos en el diagnostico y caracterizacion de aneurismas intracraneales. Resultados. Diagnosticamos el 100% de 54 aneurismas intracraneales con angio-RM, mientras que con la AC, el 98%. Los hallazgos quirurgicos fueron similares a lo mostrado en la angio-RM. Conclusiones. La angio-RM es un metodo no invasivo y libre de contraste nefrotoxico optimo en el diagnostico de aneurismas intracerebrales rotos y puede reemplazar a la AC en casos seleccionados.

Introduccion. La anartria progresiva se define como una entidad de origen degenerativo consistente en dificultad articulatoria progresiva con los aspectos gramaticales, semanticos y graficos del lenguaje conservados. Enmarcada en los procesos que afectan a areas cerebrales restringidas, su ubicacion nosologica no esta clara. Se comunican dos casos que evolucionaron clinicamente hacia demencia frontotemporal y degeneracion corticobasal, respectivamente. Casos clinicos. Caso 1: varon, que debuto a los 72 anos con dificultad en el habla, con comprension y lectoescritura conservadas; tres anos despues desarrollo apatia, bulimia, indiscreciones sexuales y agresividad, con memoria visual, capacidad visuoconstructiva y escritura elemental conservadas. Caso 2: varon, que debuta a los 70 anos con problemas en el habla, asociado dos anos despues a lentitud generalizada, con cuadro rigido acinetico en II de Hoehn y Yahr; dos anos mas tarde, desarrollo actitud distonica y apraxia melocinetica en el miembro superior izquierdo. Conclusiones. Ambos casos, compatibles inicialmente con anartria progresiva, evolucionaron clinicamente hacia demencia frontotemporal y degeneracion corticobasal, entidades incluidas en el ?complejo Pick?, concepto que pensamos que es util desde el punto de vista clinico, dada la variabilidad en la histologia de las entidades que se proponen como integrantes de dicho grupo sindromico, asi como la evolucion de los casos descritos en la literatura y los nuestros propios comunicados en este trabajo.

INTRODUCTION Many patients with multiple sclerosis (MS) develop tremors that may involve one or both lower and/or upper extremities, head and/or voice. In the last few years, chronic high frequency deep brain stimulation of the ventral intermedious (Vim) thalamic nucleus (Vim-DBS, deep brain stimulation) seems to be gradually replacing Vim-thalamotomy in surgical treatment of tremor. The thalamotomy is a destructive procedure of the whole neural components, whereas Vim-DBS has shown to be a selective neurophysiological procedure to block a specific group of neural components, in particular large, fast and low threshold ones. MS is a disease of uncertain etiology characterized by demyelinating plaques in central nervous system. The neurophysiological intraoperative targeting applied to this pathology identifies demyelinated plaques and the functional state of Vim, reduces pitfalls and increases accuracy. Methods included spontaneous and induced multiunit activity recording, semimicroelectrode and tetraelectrode thalamic evoked potentials recording and micro/macro stimulation techniques.