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Summary. Introduction. Cognitive deterioration is a frequent finding in patients who have had a cerebral infarct which affected their quality of life. The prognostic factors associated with this are still not completely clear. Objectives. To determine the frequency of cognitive deterioration following cerebral infarct and the prognostic factors associated with its appearance. Patients and methods. We made a study of a prospective pohort in the Hospital Clinico Quirurgico Hermanos Ameijeiras de Ciudad de La Habana, Cuba, in 401 patients with the confirmed diagnosis of cerebral infarct during the period March 1997-February 2000. A questionnaire was completed for all patients. This contained the possible variables for prognosis. The neuropsychological tests were done 3 and 6 months after the cerebral infarct occurred to determine the appearance of cognitive deterioration. Statistical analysis included the χ 2 test, relative risk estimation, and multiple logistic regression analysis. Results. The frequency of cognitive deterioration 3 and 6 months after the cerebral infarct occurred was 22.2% and 6.9% respectively. Multiple logistic regression analysis showed prognostic variables of cognitive deterioration to be arterial hypertension (p=0.001, RR:2.0) and the number of current cerebral infarcts shown on computerized axial tomography (p=0.000, RR:5.2). Conclusions. Cognitive deterioration was a frequent complication after a cerebral infarct and several prognostic factors were associated with its appearance. [REV NEUROL 2002; 34: 223-31]

INTRODUCTION: Diabetic neuropathy is a common neurological complication in patients with diabetes mellitus which affects their quality of life. The risk factors involved in this are not completely clear. OBJECTIVE: To determine the frequency of symmetrical distal diabetic neuropathy and the risk factors associated with its occurrence in the group studied. PATIENTS AND METHODS: A transversal study was made in the Hospital Clinico Quirurgico Hermanos Ameijeiras of Ciudad de la Habana (Cuba), in 200 patients diagnosed as having type 1 or type 2 diabetes mellitus, between January 1997 and December 1999. A clinical neurological examination and neurophysiological investigations were done on all patients to make a diagnosis of diabetic neuropathy. Subsequently, we compared those with diabetic neuropathy and those without in relation to the risk factors. Statistical analysis included the chi squared test and estimation of the relative risk. RESULTS. The frequency of symmetrical distal diabetic neuropathy was 30.0%. Related risk factors were: smoking (p= 0.00, RR= 2.59), raised serum cholesterol (p= 0.00, RR= 4.12), poor metabolic control of diabetes mellitus (p= 0.00, RR= 4.13), associated disorders (p= 0.00, RR= 5.31) including arterial hypertension (p= 0.03, RR= 1.90) and duration of diabetes mellitus (p= 0.00, RR= 2.01). CONCLUSIONS: In our study symmetrical distal diabetic neuropathy was a common complication of diabetes mellitus associated with various risk factors.

Introduction and objective To study the postsurgical clinical course of spondylitic myelopathy. Patients and methods We assessed 39 patients admitted to the Departments of Neurology and Neurosurgery of the Hospital Clinico Quirurgico Hermanos Ameijeiras, Cuba, with a confirmed diagnosis of spondylitic myelopathy who had decompressing laminectomies during the period between January 1996 and December 1997. Results Of the predicted variables, there was predominance of an age under 60 years (51.3%); male sex (71.8%); a history of cervical trauma and habitual dangerous physical activity in 38.5% and 41% respectively. The duration of preoperative symptoms was less than one year in 46.2%. The vertebral level most often involved was C5-C6 (97.4%). In 51.3% three levels were affected: 100% of the patients had stenosis in the zone of maximum compression; 28.2% had congenital stenosis of the canal and 66.7% had partial block shown on myelography or magnetic resonance studies of the cervical spine. There was clinical improvement in 78.4% after one month, in 91.9% after 3 months and in 94.6% after 6 months; only 2 patients had not improved on completion of the study. Motor and sensory function of the legs improved more than motor function of the arms and sphincter. Conclusions The variables which influenced the degree of improvement were: age, duration of the symptoms, number of vertebral levels affected, presence of blockage and functional state. After application of the multiple regression model, it was seen that the duration of preoperative symptoms is an important predictor of the postoperative clinical course.

INTRODUCTION The lymphomas are neoplasias which may affect the nervous system at any stage of development, and affect the quality of life and survival time of these patients. OBJECTIVES To identify the neurological complications of patients with lymphomas, determine the survival time and the cause of death in these patients. PATIENTS AND METHODS We made a prospective study in 270 patients with the diagnosis of lymphoma who were admitted to the Hospital Clinico Hermanos Ameijeiras Ciudad de la Habana (Cuba). The complications were classified as direct or indirect, the average survival time was determined according to the Kaplan-Meier curve and the cause of death was established with anatomopathological confirmation. RESULTS We found 26 patients to have neurological complications. Of 188 patients with non-Hodgkin lymphomas, 12.2% had neurological disorders and in these patients leptomeningeal infiltration was the main neurological complication. In the 82 patients with Hodgkin's disease, 3.6% had neurological disorders of which herpes zoster infection was the commonest. The average survival time following diagnosis and the neurological features was 9.7 months. The neurological complication was the cause of death in 57.1% of those who died. CONCLUSIONS The patients with lymphomas had direct and indirect complications, with an average survival time of less than one year, and most died of a nervous system complication.