Search

Resumen La neuromielitis optica (NMO), tambien llamada espectro de la neuromielitis optica (neuromyelitis optica spectrum disorders) se reconoce como una enfermedad inflamatoria, autoinmune, desmielinizante del sistema nervioso central, mediada por autoanticuerpos contra el receptor de acuaporina 4 (AQP4-IgG) que afecta predominantemente a los nervios opticos y la medula espinal 1 , 2 , 3 . Es conocido que los pacientes con trastornos inmunitarios tienen mas probabilidades de presentar otras enfermedades autoinmunes; sin embargo, no esta completamente descrita la asociacion entre artritis idiopatica juvenil y NMO 5 . En este escrito se reporta el caso de una paciente que cursa con artritis idiopatica juvenil, inicio con compromiso neurologico rapidamente progresivo, y es tratada con medicamentos biologicos 1 , 2 , 3 , 4 .

Introduction Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. Methods A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. Results The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. Conclusions Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.

Resumen Introduccion La lobectomia temporal anterior (LTA) es un procedimiento quirurgico comunmente utilizado para el tratamiento de la epilepsia del lobulo temporal refractario al tratamiento medico, con altas tasas de exito en el control de las crisis. Sin embargo, se ha descrito una asociacion importante con enfermedades psiquiatricas que puede afectar al resultado posquirurgico en estos pacientes. Metodos Se exponen 2 casos representativos de pacientes que sufrieron complicaciones psiquiatricas en el posoperatorio de lobectomia temporal anterior, a pesar del control exitoso de las crisis. Resultados Un varon sin antecedentes de enfermedad mental que sufre un episodio depresivo mayor en el periodo posoperatorio mediato, y una mujer con psicosis previa que evidencia exacerbacion de su afeccion como complicacion quirurgica. Conclusiones La enfermedad psiquiatrica se puede presentar en pacientes posoperatorios de epilepsia de lobulo temporal tanto con antecedentes de enfermedad mental como sin ellos. Las alteraciones mas frecuentes reportadas son depresion, ansiedad, psicosis y trastornos de la personalidad. La inclusion de evaluaciones psiquiatricas en los protocolos prequirurgicos y posquirurgicos pueden llevar a una mejora en el pronostico de los resultados neurologicos y mentales de los pacientes sometidos a la intervencion.

Background: The COVID-19 pandemic has had a great impact on cognitive health in Latin American older adults, increasing the risk of cognitive impairment and dementia. Our objective was to analyze the prevalence of dementia and the associated factors in Latin American older adults during SARS-CoV-2 pandemic. Methods: A multicentric first phase cross-sectional observational study was conducted during the SARS-CoV-2 pandemic. Five thousand two hundred and forty-five Latin American adults over 60 years of age were studied in 10 countries: Argentina, Bolivia, Chile, Colombia, Ecuador, Guatemala, Mexico, Peru, the Dominican Republic, and Venezuela. We used the telephone version of Montreal Cognitive Assessment, the “Alzheimer Disease 8” scale for functional and cognitive changes, and the abbreviated version of the Yesavage depression scale. We also asked for sociodemographic and lockdown data. All the evaluation was made by telephone. Cross-tabulations and χ2 tests were used to determine the variability of the prevalence of impairment by sociodemographic characteristics and binary logistic regression to assess the association between dementia and sociodemographic factors. Results: We observed that the prevalence of dementia in Latin America is 15.6%, varying depending on the country (Argentine = 7.83 and Bolivia = 28.5%). The variables most associated with dementia were race and age. It does not seem to be associated with the pandemic but with social and socio-health factors. Conclusion: The prevalence of dementia shows a significant increase in Latin America, attributable to a constellation of ethnic, demographic, and socioeconomic factors.

Introduction. Melkersson–Rosenthal syndrome (MRS) is a neuromucocutaneous disorder characterized by the following classic symptom triad: peripheral facial paralysis, orofacial edema, and scrotal or fissured tongue. It is rare, and since most of the patients are oligo- or monosymptomatic, it makes it difficult to diagnose. Clinical Case. We present a 26-year-old male patient with a history of sickle cell trait, untreated snoring, and left peripheral facial paralysis when he was 11 years old. This was an overall 20-day clinical profile that started with left peripheral facial paralysis, which was accompanied by moderate-intensity occipital pulsatile headaches. Additionally, the patient experienced paresthesias in the tongue and feelings of labial edema. After one week, he manifested peripheral facial paralysis on the right side. Physical examination revealed bilateral peripheral facial paralysis, mild labial edema, and a scrotal or fissured tongue. The patient received corticosteroids, which resulted in improvement of the edema and facial paralysis. Discussion. MRS is a rare disorder that predominantly affects women, typically starting in their 20s or 30s. The etiology is unknown. However, a multifactorial origin that involves environmental factors and a genetic predisposition has been proposed, which causes a dysfunction of the local immune system and autonomic nervous system (ANS) and an appearance of granulomatous inflammation in the lips and tongue. Facial paralysis usually appears later on; however, it can occur from its clinical debut. There are no curative treatments. Therapy is focused on modulating the patient's immune response, and relapses are frequent.

Resumen Objetivos La hemisferectomia es considerada una opcion terapeutica en el tratamiento de ninos y adultos con epilepsia refractaria que presentan un dano unilateral y hemisferico importante. El objetivo de esta serie de casos es realizar una descripcion de la poblacion tratada con epilepsia refractaria en el FIRE entre los anos 1986 y 2014 a quienes se les practico una hemisferectomia. Metodos Se realizo un estudio retrospectivo de casos tomados de la base de datos de historias clinicas de los pacientes sometidos a hemisferectomia desde el ano 1986 hasta el ano 2014 de la institucion. Ademas se realizo una busqueda sistematica de la literatura en las bases de datos PubMed y SciELO. Resultados Se describen 53 sujetos sometidos a hemisferectomia, con edades comprendidas entre 0 y 43 anos en el momento de la cirugia. En la mayoria de los pacientes la causa de la epilepsia fue secundaria a malformaciones del desarrollo cortical (71,6%). En el momento de las valoraciones posquirurgicas, 29 pacientes se encontraron en la categoria i de Engel. Las complicaciones postoperatorias fueron pocas, siendo vasculares las mas frecuentes, con el 5,6% de los casos, seguidas de las infecciosas. Conclusiones La hemisferectomia es una tecnica confiable y efectiva para el manejo de pacientes pediatricos y adultos con epilepsia refractaria que presentan dano hemisferico cerebral. Los resultados postoperatorios demuestran una baja morbimortalidad en pacientes seleccionados. Nuestros datos evidencian efectos positivos en la evolucion postoperatoria en cuanto al control de las crisis epilepticas.

The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access.This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic.We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile.To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm.The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso.Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19.Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile.Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm.O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.

Aggression is a clinical manifestation that usually occurs in neurodevelopmental disorders. In intellectual disability, dysfunctional behavior and aggressive and maladaptive responses are common. These facts put at risk the patient’s safety and cause discomfort in family members and caregivers (Gouveia et al., 2019). In general, drug prescription and behavioral therapy have favorable results in these individuals. However, there is a subset of patients who do not respond adequately to pharmacological and psychological treatment due to the severity of clinical symptoms and associated brain dysfunction (Torres et al., 2013) responsible for aggressive behavior. For this limited population of individuals, surgical interventions targeting the amygdala or hypothalamus have been proposed.

Introducción La detección de síntomas de ansiedad entre el personal sanitario que atiende a pacientes contagiados de COVID-19 es una prioridad actual. Se requieren instrumentos rápidos y válidos para esta población. El objetivo es establecer la validez de constructo y la confiabilidad de la Escala de Ansiedad Generalizada (GAD-7) en médicos colombianos durante la cuarentena por la COVID-19. Métodos Estudio eSalud, en el que se recopilaron datos transversales en línea (n = 1.030) de 610 médicos de COVID y 420 no de COVID durante la cuarentena colombiana, entre el 20 de abril y el 10 de agosto de 2020. Se contactó con cada sujeto, que confirmó participación, identidad y función profesional. Resultados Se encontró una estructura factorial de 1 solo factor, conformado por los 7 ítems del instrumento, que logró explicar el 70% de la varianza. Los índices de bondad de ajuste (RMSEA = 0,080; CFI = 0,995; SRMR = 0,053; p 0,07. Por último, la consistencia interna del instrumento fue buena, con alfa de Cronbach = 0,920 (IC95%, 8,80-9,71). Conclusiones El GAD-7 es un instrumento que presenta indicadores adecuados de validez y confiabilidad. Es un excelente instrumento, confiable, fácil y rápido de usar para la detección de los síntomas de ansiedad generalizada en personal médico, atienda o no a pacientes contagiados de COVID-19.

Introduction Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains. Objective To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpatient consultation at a reference diagnostic center in Colombia and analyze and the influencing factors. Materials and methodology One-hundred and four patients during neurology outpatient consultation in the city of Cartagena, Colombia, were assessed with the (MoCA) test, i.e., 54 people who consulted for headache and have not been diagnosed with epilepsy (NEP) and 50 with a diagnosis of epilepsy (EPs) according to the diagnostic criteria of the International League Against Epilepsy (ILAE). Results Significant differences were found in the total mean scores of the (MoCA) between (EPs) and (NPE) groups (t = 4.72; p

La enfermedad de Moyamoya es una enfermedad neurovascular crónica caracterizada por una estenosis progresiva bilateral de las arterias carótidas internas, con la formación anormal de nuevos vasos sanguíneos, cuyo bloqueo en flujo sanguíneo ocasiona variadas manifestaciones clínicas y complicaciones asociadas a eventos cerebrovasculares (isquémicos o hemorrágicos) agudos que pueden llegar a ser incluso mortales. El presente artículo pretende realizar una aproximación acerca de esta entidad, su incidencia, prevalencia, formas de presentación y medidas terapéuticas y pronostico mediante el reporte de un caso clínico

In Latin America, the volume of care of infected patients, higher presence of comorbidities among older adults, and restricted access to clinical controls have become this age group into one with the highest risk (Dubey etal , 2020) [ ]a Consortium of universities, research centers, and clinical centers have joined forces to carry out research which seeks to know the emotional state of Latin American older adults during confinement by Coronavirus disease (COVID-19) The protocol we used includes a sociodemographic and clinical questionnaire, information on confinement, lifestyles, and the abbreviated version of the Yesavage Geriatric Depression Scale (Martinez de la Iglesia etal , 2020)

Introduction Since ancient Greece, cerebrovascular accidents have been described with no variation. Even today, they are still a catastrophic event in the lives of patients with a high risk of disabling sequelae. Methodology Case report of a 56-year male patient with thalamic ischemia. Results The intervention with integral strategies involving pharmacological management and cognitive interventions was decisive for the satisfactory evolution of the patient. Conclusions The management of patients with cerebrovascular accidents cannot be limited to the emergency room. Pharmacological advances in programs and cognitive intervention methods provide intervention tools from the very beginning of the stroke thus reducing the impact of long-term sequelae, and consequently enabling a better reintegration of the patient to his family.

Since ancient Greece, cerebrovascular accidents have been described with no variation. Even today, they are still a catastrophic event in the lives of patients with a high risk of disabling sequelae.Case report of a 56-year male patient with thalamic ischemia.The intervention with integral strategies involving pharmacological management and cognitive interventions was decisive for the satisfactory evolution of the patient.The management of patients with cerebrovascular accidents cannot be limited to the emergency room. Pharmacological advances in programs and cognitive intervention methods provide intervention tools from the very beginning of the stroke thus reducing the impact of long-term sequelae, and consequently enabling a better reintegration of the patient to his family.