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Introducción: La esclerosis múltiple afecta significativamente la calidad de vida de las personas que padecen la enfermedad. Objetivo: Evaluar la calidad de vida de personas con esclerosis múltiple y analizar la asociación con variables sociodemográficas clínicas y funcionales. Materiales y Métodos: Estudio observacional, transversal, descriptivo-correlacional y cuantitativo que utilizó una muestra no probabilística por conveniencia, compuesta por 70 pacientes con esclerosis múltiple, registrados en la Asociación de Esclerosis Múltiple de la Región Central de Portugal. El protocolo de recolección de datos contuvo preguntas sociodemográficas y clínicas, la Escala de Apgar familiar y el Índice de Barthel. En el procesamiento de los datos se utilizó estadística descriptiva e inferencial y la recolección se realizó entre abril y julio de 2021. Resultados: La mayoría de los participantes presentan una calidad de vida general moderada (M=51,78 ± 24,09), con puntuaciones más altas en las relaciones sociales y dominios ambientales y menores en el dominio físico. Una mejor calidad de vida se asoció con una edad inferior a 45 años, mayor nivel educativo, familias funcionales y mayor independencia funcional en las actividades de la vida diaria. Discusión: Las variables con asociación más robusta son las que influyen en el dominio físico y en el dominio social, que explican, en total, el 59,00% y el 53,00% de su variabilidad. Conclusiones: Estos resultados indican que las personas con esclerosis múltiple tienen una calidad de vida comprometida, fortaleciendo la necesidad de implementar nuevas estrategias de diagnóstico precoz e intervenciones preventivas efectivas, potenciando una mejor calidad de vida, en todos los ámbitos que la constituyen.

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Fundamento: Morfofisiología del sistema nervioso es uno de los contenidos de las ciencias básicas biomédicas de mayor dificultad cognitiva en el estudiantado de la carrera de Medicina. Objetivo: identificar el nivel de conocimientos sobre la morfofisiología del sistema nervioso en los estudiantes del cuarto año de la carrera de Medicina, en la Filial de Ciencias Médicas de Puerto Padre, en Las Tunas. Métodos: se realizó una investigación descriptiva con enfoque cuanticualitativo, en la Filial de Ciencias Médicas de Puerto Padre, provincia Las Tunas, en el curso escolar 2022-2023. Se utilizaron métodos teóricos: analítico-sintético e inductivo-deductivo; empíricos: cuestionario; y matemático-estadísticos para el análisis de los resultados obtenidos mediante el uso de los métodos teóricos y empíricos. Resultados: el nivel de conocimientos generales sobre la morfofisiología del sistema nervioso fue calificado de medio en el 81,6 % de los estudiantes. No existió asociación estadística con respecto al sexo. Conclusiones: se identificó el nivel de conocimientos sobre la morfofisiología del sistema nervioso de los estudiantes del cuarto año de la carrera de Medicina, lo que permite hacer énfasis en el logro de un aprendizaje significativo de estos contenidos.

OBJECTIVE: to determine the clinical and epidemiological profile of the pediatric population diagnosed with central nervous system tumors attended in a high complexity hospital in Medellin, Colombia. MATERIALS AND METHODS: an observational, descriptive and retrospective study was carried out between January 2015 and December 2020, which included pediatric patients aged 0 to 14 years with a diagnosis of central nervous system tumors. For the analysis of qualitative variables, relative and absolute frequencies were measured, and for quantitative variables, measures of central tendency and interquantile ranges were used as measures of dispersion. RESULTS: seventy patients with clinical and/or imaging diagnosis of central nervous system tumors were included, with a median age of 9 years (minimum 0 - maximum 14 years). Male sex predominated with 57.1% and 74.3% of the population had urban origin. Regarding the characteristics of the tumor, the most common location was in the posterior fossa with 24.2%, the malignant behavior of the tumor predominated with 62.9% and 55.7% of the tumors were found in the initial stage. 87.1% (61) of the tumors were primary, 5.7% (4) presented metastasis and 20% (14) of the patients had a fatal outcome. CONCLUSIONS: CNS tumors are a serious oncologic disease, which considerably affects the pediatric population, with a predominance in the male sex. This study has evidenced the clinical and epidemiological profile of 52 children with CNS tumors, where the main symptoms reported at diagnosis were nausea and/or vomiting, followed by motor signs and symptoms. The main histological variant identified was neurofibromatosis type I (non-malignant), followed by medulloblastoma, which is consistent with reports in the literature. These oncologic diseases continue to have a great impact on infant mortality, as shown in several studies and also as found in this research. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To analyze the patients who underwent surgery in two private clinics, from January 2023 to date, in Matamoros, Tamaulipas, Mexico, and to establish the possibility of having contracted fungal meningitis. MATERIALS AND METHODS: Observational, descriptive study using statistical analysis technique, including all patients who met any of the three predictions established of the entering protocol with a probability of fungal meningitis. A clinical record was kept for all cases and a database was created at the time of admission including: age, sex, age group, clinical data, characterization of fungal meningitis, type of surgery, date of surgery and type of anaesthesia. RESULTS: Of 405 patients identified, 50 were from Matamoros, Tamaulipas, and all of them were asked to undergo their medical check-up at the general hospital of this town; only 26 attended: 24 were female and 2 were male. Of them, 4/26 were PCR positive for Fusarium solani, with cosmetic surgery and epidural anesthesia being predominant factors. The clinical picture appeared within a period of 30 to 60 days, stiff neck was the main symptom in 3/26 patients. Tomography scans were reported to have no morphological alterations upon admission. CONCLUSIONS: In fungal infection of the central nervous system the cabinet images are very non-specific; thus the faster and more reliable diagnostic method is PCR in cerebrospinal fluid. The inoculation of the fungus with contaminated drugs, in healthy patients, is perhaps the most accepted cause in this research. [ABSTRACT FROM AUTHOR]

Foundation: biomarkers of oxidative stress in Huntington's disease could predict the course of the disease and evaluate new treatments, but their nonspecific nature seems to prevent the identification of any useful marker. Clarifying similarities and differences of this phenomenon and its behavior with clinical characteristics may be essential. Objective: compare biomarkers of oxidative stress between patients with Huntington's disease and other neurological disorders. Methods: an analytical, retrospective and case-control study was carried out (Huntington's disease, amyotrophic lateral sclerosis, spinocerebellar ataxia type 2 and ischemic stroke: acute and chronic stage). Demographic and clinical variables and markers of oxidative damage (malonildialdehyde, advanced protein oxidation products) and antioxidants (superoxide dismutase: catalase: glutathione peroxidase, plasma antioxidant capacity) were collected. Results: there were significant differences in malonyldialdehyde in Huntington's disease compared to the control (p=0.02), but not with the rest of the groups. The enzyme superoxide dismutase in Huntington's disease was statistically lower compared to amyotrophic lateral sclerosis, although for catalase it was higher in relation to the rest of the patients. FRAP in Huntington's disease was significantly lower versus amyotrophic lateral sclerosis and acute ischemic stroke. Advanced products of protein oxidation were directly correlated with the biological and onset ages of Huntington's disease. Motor activity in amyotrophic lateral sclerosis and neurological deficit in acute ischemic stroke were correlated with malonyldialdehyde and glutathione peroxidase, respectively. Conclusions: huntington's disease seems to show specific characteristics in its antioxidant system. Protein oxidation could be related to the accumulation of mutated huntingtin over time.

The case report of a 37-year-old patient with history of having received radiotherapy due to a tumor lesion in the right frontal region is presented, who attended to the Institute of Neurology and Neurosurgery in Cuba because of intense headache and left hemiparesis. After carrying out the necessary examinations, the clinical-imaging diagnosis of a radionecrosis lesion in the contralateral hemisphere was established, which was corroborated in the pathological examination once the tumor was removed; then, immunotherapy was indicated. The patient had a favorable clinical course because the control of the disease was achieved as well as the resolution of symptoms. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos de Ciências da Saúde da UNIPAR is the property of Associacao Paranaense de Ensino e Cultura and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Se presenta el caso clínico de un paciente de 37 años de edad con el antecedente de haber recibido radioterapia por una lesión tumoral en la región frontal derecha, el cual acudió a consulta en el Instituto de Neurología y Neurocirugía de Cuba por presentar cefalea intensa y hemiparesia izquierda. Luego de realizados los exámenes necesarios, se estableció el diagnóstico clínico-imagenológico de lesión por radionecrosis en el hemisferio contralateral, que fue corroborado en el estudio anatomopatológico una vez que se extirpó el tumor; seguidamente, se indicó inmunoterapia. La evolución del paciente fue satisfactoria, pues se logró el control de la enfermedad y la resolución de los síntomas.

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Ciências da Saúde da UNIPAR is the property of Associacao Paranaense de Ensino e Cultura and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La encefalitis autoinmune es un trastorno inmunomediado que compromete distintos territorios del parénquima cerebral, involucrando frecuentemente la materia gris profunda o la corteza, con o sin compromiso de la materia blanca, meninges o médula espinal. Se asocia frecuentemente con enfermedades autoinmunes o paraneoplásicas, y constituye un reto diagnóstico. Reportamos el caso de una mujer de 55 años con antecedentes de síndrome de Sjögren que consultó a Emergencias por cefalea y confusión. El líquido cefalorraquídeo (LCR) presentaba leucocitosis con neutrofilia. En la resonancia magnética nuclear (RMN) cerebral se evidenciaron múltiples imágenes de comportamiento restrictivo, de señal hiperintensa en T2 y FLAIR, a predominio córtico-subcortical a nivel occipital bilateral, hemisferio cerebeloso derecho y parietal derecho. Se descartaron infecciones y neoplasias. El panel de anticuerpos para encefalitis autoinmune aquaporina-4 y anti-MOG en LCR fue negativo. Recibió metilprednisolona endovenosa con mejoría progresiva de los síntomas.

Introduction: COVID-19, infection caused by SARS-CoV-2, causes damage to different organs and systems, such as the central nervous system. Among the neurological alterations, brain fog is described as a frequent neurocognitive manifestation in post-COVID-19 syndrome, with a negative impact on patients' quality of life. 104 articles published were reviewed from june 2020 to october 2022, in Pubmed, Medline, Lilacs and Cumed databases. Objective: To update knowledge on the neurocognitive manifestations of brain fog in post-COVID-19 syndrome. Development: Neurocognitive alterations of mental fog, attention, concentration and memory disorders, associated with other neurological symptoms, such as headache, insomnia, anosmia, ageusia, anxiety, depression, and other persistent symptoms, which characterize post-COVID-19 syndrome, are described. Reference is made to elements of the etiopathogenesis, highlighting the exaggerated systemic immune response, generated by the release of cytokines, aspects to keep in mind for the diagnostic and therapeutic conduct of post-COVID-19 patients. Conclusions: The neurocognitive symptoms of brain fog are frequent neurological alterations of post-COVID-19 syndrome, they are varied, with a combination of different symptoms in each patient, more frequent in women and in patients who presented severe disease.

Introduction. The present study was carried out due to the few previous studies on cognitive functioning in patients with chronic kidney disease (CKD), especially comparing transplant recipients with patients receiving hemodialysis treatment. Objective. To compare cognitive functioning in people with CKD under hemodialysis treatment, post-kidney transplantation, and healthy people. Method. The study applied standardized neuropsychological tests: MoCa Test, King Figure, and Token Test to assess cognitive functions. Results. Better cognitive performance occurred in the screening test and visual memory in the control and the transplanted groups than in the hemodialysis group. Discussion. The findings suggest that people with chronic kidney disease with transplant treatment improve cognitive performance significantly after 6 to 12 months after the intervention. [ABSTRACT FROM AUTHOR]

La paquimeningitis hipertrófica (PH) es una entidad clínico-imagenológica caracterizada por un engrosamiento de la duramadre que puede ser focal o difuso manifestada por una variedad de síndromes neurológicos. Etiológicamente se clasifica en infecciosa, neoplásica, autoinmune e idiopática. Se ha demostrado que muchos de estos casos, antes idiopáticos, caen en el espectro de la enfermedad relacionada con IgG4. Describir el caso de una paciente asistida en nuestro servicio por compromiso neurológico por PH con diagnóstico inicial de tumor miofibroblástico inflamatorio (TMI) y diagnóstico final de enfermedad relacionada con IgG4. Mujer de 25 años con cuadro neurológico de 3 años de evolución caracterizado inicialmente por hipoacusia derecha, que evoluciona con cefalea y diplopía. Se realiza resonancia magnética nuclear (RMN) de encéfalo donde se evidencia engrosamiento paquimeníngeo con compromiso de estructuras vasculonerviosas en la punta del peñasco, seno cavernoso, agujero rasgado y quiasma óptico. Se presenta a la consulta con resultado de biopsia incisional que informa de lesión proliferativa que combina elementos fibrosos, de disposición fascicular o arremolinada con bandas colagenizadas con infiltrado linfoplasmocitario denso y algunos macrófagos, con tinción negativa para ALK 1 y con diagnóstico de tumor miofibroblástico inflamatorio. Por sospecha de enfermedad relacionada con IgG4 (ER-IgG4) se envía pieza de biopsia a revisión y se solicitan estudios complementarios pertinentes. Revisión de biopsia: fibrosis de tipo no estoriforme, infiltrado con predominio linfoplasmocitario, en otros cortes se reconocen también histiocitos y polimorfonucleares, sin granulomas ni atipias. Tinción para gérmenes negativos. Inmunohistoquímica con 50-60 células IgG4+/HPF e intervalo del 15 al 20%, CD68+ en histiocitos, CD1a− y S100−. La paciente presenta deterioro de la agudeza visual por compromiso de nervios oftálmicos, por lo cual se inicia tratamiento glucocorticoideo en pulsos y rituximab con regresión de los síntomas y mejoría en resonancia magnética de las lesiones. La PH es un síndrome clínico imagenológico con síntomas y etiologías variables que plantea un desafío diagnóstico. En este caso el diagnóstico de inicio fue TMI que es una neoplasia de comportamiento variable, localmente agresiva y puede metastatizar; es uno de los principales diagnósticos diferenciales de la enfermedad relacionada con IgG4 debido a que comparten características anatomopatológicas, incluyendo la fibrosis de tipo estoriforme. La ER-IgG4 es una condición inmunomediada que puede tener afectación única o múltiple. Su diagnóstico es complejo cuando se presenta con compromiso monoorgánico o en órganos no típicos (SNC, meninges) en los cuales los datos son escasos, como el caso de nuestra paciente con compromiso monoorgánico del SNC. Si bien existen criterios de clasificación para orientar a los médicos no especialistas en el diagnóstico, la suma del cuadro clínico, las imágenes, el laboratorio, la anatomía patológica y la inmunohistoquímica serán siempre evaluadas en conjunto llevando al diagnóstico definitivo. Hypertrophic pachymeningitis (HP) is a clinico-radiological entity characterized by a thickening of the dura mater that may be focal or diffuse and manifested by a variety of neurological syndromes. Aetiologically, it is classified as infectious, neoplastic, autoimmune, and idiopathic. Many of these formerly idiopathic cases have been shown to fall into the spectrum of IgG4-related disease. To describe the case of a patient attended for neurological involvement due to hypertrophic pachymeningitis with initial diagnosis of inflammatory myofibroblastic tumour and final diagnosis of IgG4-related disease. A 25-year-old woman with neurological symptoms of 3 years' evolution characterized initially by right hypoacusis, evolving with headache and diplopia. Magnetic resonance imaging (MRI) of the encephalon showed pachymeningeal thickening with involvement of vasculo-nervous structures in the tip of the cerebellum, cavernous sinus, ragged foramen, and optic chiasm. The patient presented for consultation with the result of an incisional biopsy that reported a proliferative lesion combining fibrous elements of fascicular or swirling arrangement with collagenized streaks with dense, lymphoplasmacytic infiltrate and some macrophages, with negative staining for ALK 1, with a diagnosis of inflammatory myofibroblastic tumour. Due to suspicion of IgG4-related disease (IgG4-RD) the biopsy was sent for review and pertinent complementary studies were requested. Non storiform fibrosis, predominantly lymphoplasmacytic infiltrate, histiocytes, and polymorphonuclear infiltrate in sectors, without granulomas or atypia. Staining for germs negative. Immunohistochemistry with 50-60 IgG4+/HPF cells and range of 15% to 20%, CD68 + in histiocytes, CD1a -, S100 -. The patient presented deterioration of visual acuity due to ophthalmic nerve involvement, so glucocorticoid treatment was started in pulses and rituximab with regression of symptoms and imaging improvement of the lesions. PH is a clinical imaging syndrome with variable symptoms and aetiologies that poses a diagnostic challenge. In this case the initial diagnosis was inflammatory myofibroblastic tumour, which is a neoplasm of variable behaviour, locally aggressive, and can metastasize; it is one of the main differential diagnoses of IgG4-related disease because they share anatomopathological features, including storiform fibrosis. IgG4-RD is an immune-mediated condition that can have single or multiple involvement. Its diagnosis is complex when it presents with single organ involvement or in non-typical organs (CNS, meninges) in which data are scarce, as in the case of our patient with single organ involvement of the CNS. Although there are classification criteria to guide non-specialists in the diagnosis, the sum of the clinical picture, imaging, laboratory, pathological anatomy, and immunohistochemistry will always be evaluated together for a definitive diagnosis. [ABSTRACT FROM AUTHOR]

Background: COVID-19 is caused by the SARS-Cov-2 virus and presents a wide range of symptoms, both in its acute phase and in its chronic phase. Among the systems that it affects is the Nervous, due to its neurotropic mechanism. Objective: to determine the risk of neurological complications associated with the COVID-19 severity in adult patients. Methods: a descriptive and cross-sectional study was carried out, which included 143 positive patients for COVID-19 treated at the San Vicente de Paúl Hospital, in Ibarra, Ecuador, during 2021. Neurological complications and the severity of the COVID-19 disease were analyzed. As a measure of association for these variables, the Fisher Test was used (p = ≤ 0.05) and a bivariate analysis was performed. Results: 54% of the patients presented neurological complications of the Central Nervous System, while 46% were of the Peripheral Nervous System; and mild-moderate severity was the most frequent (41%), and hearing impairment had the highest statistical probability of occurring (OR= 74.968; CI: 95%). The case fatality rate in these patients was 7.1%; and in those with neurological complications, 8.4%. Conclusion: the neurological sequelae most likely to occur were hearing impairment and taste impairment, in patients with mild severity and serious severity, respectively; in addition to polyneuropathy in patients with critical severity, which also occurred in deceased patients. Keywords: Coronavirus infections; neurologic manifestations; central nervous system; peripheral nervous system; severity of illness index

Baller-Gerold syndrome is secondary to mutations in the RECQL4 gene (8q24.3). This gene belongs to the RecQhelicase family and is implicated in other diseases predisposing to cancer. Diagnosis is based on clinical criteria and due to the high number of differential diagnoses, finding a mutation in the gene can help to specify the diagnostic spectrum, genetic counseling and treatment. Around 30 cases have been described in the literature, although it is known that it has occurred in less than 200,000 people in the world, being considered a rare clinical condition. We present the case of a newborn, who at birth was found to have multiple musculoskeletal malformations: radial aplasia, aplastic thumbs, malformations of the rib cage, clinodactyly of all the fingers of the upper limbs, hypoplastic forearms, clinodactyly of the left lower limb. She was given parenteral feeding for several days, it was impossible to establish an adequate oral route due to the absence and/or incoordination of the sucking-swallowing reflexes as an expression of her malformations at the central nervous system level. The case is presented due to its low incidence and prevalence, which is why it is considered a rare disease.

Dandy-Walker syndrome is associated with cystic dilatation of the fourth ventricle, varying degrees of abnormality of the cerebellar vermix, and supratentorial hydrocephalus. It is mainly based on an abnormal development of the cerebrospinal fluid communication pathways. Genetic predisposition associated with malformations and chromosomal alterations has been suggested. The diagnosis can be carried out during the prenatal or postnatal stage, clinically and diagnostic imaging studies. We present the case of a newborn who was admitted to the Neonatal Intensive Care Unit due to hypotonic, tongue protrusion with sucking disorders. A transfontanellar ultrasound was performed, with dilation of the lateral ventricles. In addition to the dilation of the lateral ventricles, a cyst in the choroid plexus and signs of brain atrophy were observed. She was diagnosed with Dandy-Walker syndrome, without surgical criteria because she did not present signs of hydrocephalus. The case is presented because it is a rare malformation of the central nervous system.

A 22­year­old female patient, with no known morbid history, with a clinical picture of 1 year of evolution characterized by frontal headache, vomiting, lipotimia and bilateral blindness, was diagnosed with primary germinal tumor of the central nervous system, germinoma type. She underwent partial resection of the tumor and received adjuvant management with CDDP/VP16 based chemotherapy for 2 cycles and craniospinal radiotherapy, with complete response. [ABSTRACT FROM AUTHOR]

BACKGROUND: Electrocardiographic alterations are frequent in patients with central nervous system affection, mainly acute cerebrovascular diseases (more than 50%) and secondly, tumors of the brainstem (42%) and intracerebral tumors (56%), which are secondary to the irritative effect of the blood and intracranial compression, which causes an increase in sympathetic activity and excessive discharge of catecholamines (adrenaline and noradrenaline). The most frequent electrocardiographic alterations found are sinus tachycardia, ST elevation, inversion of the T wave, accumulated T waves, pathological Q waves, QT prolongation, among others. CLINICAL CASE: A 74-year-old male patient with a finding of meningioma of the right wing of the sphenoid, which presented electrocardiographic changes suggestive of acute coronary syndrome. CONCLUSIONS: This is the first reported case in which electrocardiographic changes are associated with a tumor lesion of the central nervous system such as meningioma. [ABSTRACT FROM AUTHOR]

Background: Acute hemorrhagic leukoencephalitis (AHLE) is an inflammatory disease of the brain, with a fulminant course that leads to a hemorrhagic demyelination of the central nervous system, having a poor prognosis and high mortality. Most of the times associated to crossed reactivity and molecular mimicry. Clinical case: We present a case report of a previously healthy young woman with an acute and multifocal clinical course, preceded by a viral respiratory tract infection, followed by a rapid disease progression and a delay in the diagnosis. The clinical, neuroimaging and cerebrospinal fluid featured suggested the diagnosis of AHLE, despite efforts and management with immunosuppression and intensive care, the response to treatment was poor leaving the patient with a severe neurological impairment. Conclusion: There is little evidence regarding the clinical course and treatment of this disease, and more studies are needed to better characterize it and to provide further information about its prognosis and management. This paper gives a systematic review of the literature. [ABSTRACT FROM AUTHOR]

Introducción. La histoplasmosis localizada del sistema nervioso en una forma rara de presentación de esta micosis sistémica. Se puede manifestar clínicamente como una meningitis crónica, lesiones focales encefálicas o de la médula espinal, ataques cerebrovasculares y encefalitis. Caso clínico. Se presenta el caso de un niño inmunocompentente con histoplasmosis localizada del sistema nervioso central. Su cuadro clínico neurológico fue de evolución crónica y presentó varios déficits neurológicos focales. Las imágenes diagnósticas evidenciaron múltiples masas del tallo cerebral y de la médula espinal cervical. Las pruebas inmunológicas demostraron anticuerpos anti Histoplasma. El paciente mejoró con el tratamiento secuencial de anfotericina B y fluconazol. Conclusiones. A pesar de su rareza, la histoplasmosis del sistema nervioso debe estar en el diagnóstico diferencial de las masas múltiples del encéfalo y médula espinal en un paciente residente en área endémica, las pruebas inmunológicas son útiles como herramienta diagnóstica y el tratamiento antimicótico puede llevar a la curación.

Los gangliogliomas (GG) se definen como tumores mixtos conformados por células de glía y neurona; son considerados como benignos, sin embargo hay reportes de GG que se diferencian por ser tumores de alto grado tipo glioblastoma; este cambio se observa más en el componente glial, pero el componente neuronal puede tenerlo. La patogénesis de los GG se conoce mejor, parte de esto esta representado por la identificación de cambios en los genes de p53 y la definición de marcadores de diferenciación tumoral como el Ki 67, ambos importantes para el pronóstico y las decisiones terapéuticas. El tratamiento se basa en una resección quirúrgica amplia considerando la morbilidad del paciente; la quimioterapia y la radioterapia son opciones que han mejorado la sobrevida de los pacientes con GG anaplásicos. Este manuscrito revisa los cambios en la clasificación histológica y los aportes hechos por la inmunohistoquímica, la genética y las opciones de tratamiento en los GG. Se presentan dos casos de pacientes, con diferentes edades, para ilustrar el GG benigno y el que se diferencia hacia un tumor de alto grado tipo glioblastoma multiforme, con una detallada revisión patológica.

Los síndromes linfoproliferativos postrasplante (PTLD, por sus siglas en inglés) constituyen una complicación relativamente frecuente entre los receptores de trasplante de órgano sólido o de médula ósea. Representan un amplio espectro de lesiones, que oscilan desde los cambios histológicos tempranos producidos por la infección del virus de Epstein-Barr hasta las neoplasias de alto grado con respuestas variables a las intervenciones terapéuticas. El compromiso del sistema nervioso central (SNC) se ha descrito hasta en 22% de los casos, 12% de ellos en forma primaria, asociados a un peor pronóstico; en general el abordaje diagnóstico y terapéutico no está estandarizado, en parte, debido a la limitación fisiológica que implica la barrera hematoencefálica. El tratamiento tiene opciones limitadas; se acepta el uso de metotrexate a altas dosis o de rituximab intravenoso o intratecal. A continuación, se presenta el caso de un hombre de 76 años, receptor de un trasplante hepático por hemocromatosis, quien a los 6 años postrasplante consulta por alteración de la marcha. Tras documentar una lesión intra-axial, la biopsia por estereotaxia documenta un PTLD tardío, primario con lesión única en SNC. Después de la reducción inicial de la inmunosupresión, el tratamiento con rituximab y metotrexate intravenosos a altas dosis durante cinco ciclos, se logró respuesta parcial en este paciente, con toxicidad renal leve.

Los síndromes paraneoplásicos neurológicos (SPN) comprometen el sistema nervioso (central periférico o neu-romuscular) de forma focal o difusa y se deben a una respuesta inmune de tipo humoral o celular sin que haya metástasis o extensión directa del tumor, su incidencia es baja. El SPN hace que el sistema inmune medie su respuesta a través de las células T principalmente cuando los antígenos son de localización intracelular, pero cuando los antígenos se localizan en la membrana celular se ha observado una mediación por anticuerpos. Los SPN pueden preceder la aparición de un tumor. Los anticuerpos onconeuronales permiten limitar su espectro diferencial y facilitan el diagnóstico y tratamiento tempranos. Los síndromes neurológicos no paraneoplásicos y sin un tumor subyacente son entidades importantes para el diagnóstico diferencial, en ellos hay una mediación por anticuerpos contra las proteínas sinápticas y de la superficie celular y comparten características clínicas con los SPN; afectan niños y adultos jóvenes y pueden responder a inmunoterapia. El objetivo de este artículo es explorar las características de los SPN y los mecanismos inmunológicos que los identifican, definir los anticuerpos mejor estudiados y presentar un plan de diagnóstico y tratamiento.

INTRODUCCIÓN: el linfoma primario del sistema nervioso central (LPSNC) corresponde a una causa de importante mortalidad dentro de los tumores primarios del sistema nervioso central, además existen pocos datos epidemiológicos actualmente, razón por la cual se decide hacer un reporte de casos en el grupo de neuropatología de la Universidad de Antioquia. OBJETIVO: describir el comportamiento de esta patología en un grupo de pacientes. MATERIALES Y MÉTODOS: se revisaros los estudios patológicos e historias clínicas de 12 pacientes con diagnóstico de LPSNC en el servicio de neuropatología de la Universidad de Antioquia 2004 el 2011. RESUTADOS: se encontraron 12 pacientes que cumplían el criterio de inclusión. De estos pacientes el 61.5% fueron hombres y el 38.5% mujeres. La edad promedio al momento del diagnóstico fue de 42.6 años (1- 77 años). El Linfoma B no hodking de células gigantes con patrón difuso fue el tumor más frecuente con un 83.3 %, 8.35% corresponde a linfoma de células T, 8.35% a Linfoma de Burkitt; 33.3 % corresponden a pacientes inmunode-ficientes. CONCLUSIÓN: en esta serie de pacientes con linfoma del sistema nervioso central se encontraron características clínicas similares a las encontradas en la literatura, quizás el único hallazgo disímil fue la mayor cantidad de pacientes sin aparente alteración en el sistema inmune.

Se revisó desde una perspectiva biológica y clínica el compromiso del olfato por déficit neurológico pos traumatismo encéfalo craneano (TEC), para concientizar a la comunidad científica sobre la importancia de la relación de este déficit y su impacto en la vida diaria. Se hizo una revisión narrativa de tema sobre las bases biológicas, fisiológicas y clínicas, y el impacto en la vida diaria del olfato. Se revisó la literatura sobre el estado del arte actual. El sistema olfativo es una parte esencial de la fisiología humana y juega un papel crítico en la salud y el comportamiento, por ello su alteración conlleva a la afectación en la calidad de vida de los pacientes, que implica consecuencias físicas y/o psicológicas. Las opciones de rehabilitación del olfato son escazas o nulas, y existe poca literatura a nivel clínico, derivado del subdiagnóstico; además, la complejidad biológica para la evaluación, diagnóstico y rehabilitación del olfato posterior a lesión neurológica y/o otorrinolaringológica dificulta las estrategias de manejo. Los procesos de rehabilitación neurológica del olfato son un tema de potencial desarrollo que requiere del trabajo conjunto entre las neurociencias básicas y clínicas.

La Enfermedad de Rosai-Dorfman es un trastorno infrecuente y de etiología desconocida. La presentación intracraneal es aún más rara y suele imitar la apariencia de un meningioma en las imágenes del encéfalo. Se presenta el caso de un paciente varón de 38 años que ingresa por una tumoración intracraneal, extra-axial y supratentorial asociada a déficit neurológico leve; con diagnostico presuntivo de meningioma de la convexidad. Después de la intervención quirúrgica, el diagnóstico histológico definitivo fue de Enfermedad de Rosai-Dorfman intracraneal. Se debe considerar la Enfermedad de Rosai-Dorfman intracraneal dentro del diagnóstico diferencial de una lesión intracraneal extra-axial sugestiva de un meningioma debido a la similitud en las neuroimágenes y la presentación clínica entre ambas patologías.

BACKGROUND: Glioblastoma is the most common primary central nervous system neoplasm in adult patients. Extracranial metastases are not frequent and are estimated at 0.5% of cases. The most frequently reported anatomical sites are lung, lymph node, bone, and liver. Until now, only one case of extracranial metastasis has been reported in Latin America. CLINICAL CASE: A 26-year-old male patient with extracranial metastasis of glioblastoma, with no significant history of the current condition, who began 5 months prior to hospitalization with generalized tonic-clonic seizures. Imaging studies revealed an intraaxial lesion in the right temporal cerebral parenchyma, which affected the superior, middle, and inferior temporal gyrus, from the middle third of the temporal pole, reaching the lateral face of the occipital lobe, with a medial limit in the ventricular atrium. The evolution was poor, with deterioration of health and acute renal failure KDIGO III; loss of strength in the lower extremities and sphincter tone was added, in addition to complete spinal cord syndrome. Six months after the primary diagnosis of glioblastoma he passed away. Immunohistochemistry reported positivity for neurofilament, glial fibrillary acidic protein, IDH, and SOX10. CONCLUSIONS: The patient in this study represents the second reported case of extracranial metastasis in Latin America. Due to the lack of understanding about the mechanism by which these tumors originate, the mandatory study and reporting is necessary, as well as considering it at the time of the histopathological analysis. [ABSTRACT FROM AUTHOR]

Introduction: Malformations of the central nervous system (CNS), the type of congenital defect second only to cardiac malformations, cause infant disability and mortality. Objective: The aim of the study was to evaluate the incidence of congenital malformations of the CNS in newborns treated at a regional public hospital in Southern Mexico and explore the associated factors. Methods: This descriptive study included 113 newborns with CNS malformations. A specific diagnosis was provided and information was obtained from the parents in relation to age, schooling, occupation, prenatal control, intake of folic acid, and exposure to pesticides. A database was created in the statistical program Epi Info version 3.4.3 to carry out univariate and bivariate analyses using the Chi-square test, with significance considered at p < 0.05. Results: The most frequent malformations were hydrocephalus (45.1%), Arnold-Chiari (32.7%), and encephalocele (8.0%). Of the 113 newborns herein examined, a greater percentage of congenital malformations was found when the first pregnancy took place in mothers 12-19 versus over 19 years of age (78.8% vs. 21.2%, respectively; p < 0.05). Furthermore, 40.2% of mothers were exposed to insecticides and 39.8% to herbicides and/or fungicides before or during pregnancy. Only 15.4% of the mothers consumed folic acid during the first trimester of pregnancy. Conclusion: The incidence of congenital abnormalities of the CNS in newborns is a serious problem, perhaps associated with exposure of the mother to pesticides and a deficient intake of folic acid. Therefore, it is necessary to strengthen prenatal care and health literacy to help reduce the occurrence of these disorders. [ABSTRACT FROM AUTHOR]

Background: COVID-19 is caused by the SARS-Cov-2 virus and presents a wide range of symptoms, both in its acute phase and in its chronic phase. Among the systems that it affects is the Nervous, due to its neurotropic mechanism. Objective: to determine the risk of neurological complications associated with the COVID-19 severity in adult patients. Methods: a descriptive and cross-sectional study was carried out, which included 143 positive patients for COVID-19 treated at the San Vicente de Paúl Hospital, in Ibarra, Ecuador, during 2021. Neurological complications and the severity of the COVID-19 disease were analyzed. As a measure of association for these variables, the Fisher Test was used (p = = 0.05) and a bivariate analysis was performed. Results: 54% of the patients presented neurological complications of the Central Nervous System, while 46% were of the Peripheral Nervous System; and mild-moderate severity was the most frequent (41%), and hearing impairment had the highest statistical probability of occurring (OR= 74.968; CI: 95%). The case fatality rate in these patients was 7.1%; and in those with neurological complications, 8.4%. Conclusion: the neurological sequelae most likely to occur were hearing impairment and taste impairment, in patients with mild severity and serious severity, respectively; in addition to polyneuropathy in patients with critical severity, which also occurred in deceased patients. Keywords: Coronavirus infections; neurologic manifestations; central nervous system; peripheral nervous system; severity of illness index. [ABSTRACT FROM AUTHOR]

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High dose methotrexate (HD-MTX) based chemoimmunotherapy is a central part of the standard approach to treatment of primary central nervous system lymphoma (PCNSL). Renal dysfunction leads to delayed MTX complete elimination and critical MTX concentration. Despite the recommendations, hemodialysis status should not exclude HD-MTX.We report the case of a 64 years old woman on chronic hemodialysis with PCNSL successfully treated with HD-MTX-based chemoimmunotherapy with an adjusted dose of 100 mg/m2, instead of the usual dose of 3500 mg/m2, and daily hemodialysis started 24 h later. The patient had no significant toxicity and was in complete remission at 1 year after the end of the treatment.We argue that ESRD is not an absolute pitfall to the use of HD-MTX for hematological malignancies. Experts should consider the use of adjusted dose at 100 mg/m2 as a viable therapeutic modality in ESRD patients. Resumen: La quimioinmunoterapia basada en una dosis elevada de metotrexato (HD-MTX) es una parte central del enfoque terapéutico estándar del linfoma primario del sistema nervioso central (PCNSL). La insuficiencia renal causa la demora de la eliminación completa de MTX, así como la concentración crítica del mismo. A pesar de las recomendaciones, el estatus de hemodiálisis no debería excluir la HD-MTX.Reportamos el caso de una mujer de 64 años con PCNSL y tratamiento de hemodiálisis crónica que fue exitosamente tratada con quimioinmunoterapia basada en HD-MTX con una dosis ajustada de 100 mg/m2, en lugar de la dosis habitual de 3.500 mg/m2, iniciándose la hemodiálisis diaria al cabo de 24 h. La paciente no reflejó toxicidad significativa y experimentó remisión completa al cabo de un año desde la finalización del tratamiento.Nosotros argumentamos que la enfermedad renal en etapa terminal (ESRD) no constituye un escollo en absoluto para utilizar la HD-MTX para neoplasias hematológicas. Los expertos deberían considerar el uso de una dosis ajustada a 100 mg/m2 como modalidad terapéutica viable en los pacientes de ESRD.

INTRODUCCIÓN: Los tumores cerebrales son lesiones de gran diversidad histológica y genética, de ellos los gliomas son el grupo más frecuente. Los avances imagenológicos enfocados en la resonancia magnética avanzada y funcional, así como la categorización genética han permitido mejorar el enfoque terapéutico de estos pacientes, pero sin cambios significativos en el pronóstico. OBJETIVO: Reconocer la capacidad de la Espectroscopía, Perfusión y Difusión para el diagnóstico preoperatorio sobre las características histopatológicas e inmunohistoquímicas de las lesiones ocupantes de espacio de origen glial. MATERIAL Y MÉTODO: Se aplicaron técnicas de resonancia magnética avanzada (Espectroscopia - Perfusión - Difusión) a los pacientes con lesiones ocupantes de espacio en SNC con diagnóstico histopatológico de gliomas. Se correlacionaron estos resultados con el análisis histopatológico e inmunohistoquímico de las piezas quirúrgicas. Se revisó la asociación de estos índices imagenológicos (Índice Cho/Cr-Cho/NAA-NAA/Cr-DWI-rCVB) con la histología y la inmunohistoquímica en relación al índice de replicación celular de estas lesiones (anticuerpo KI 67) RESULTADOS: Se evidenció una relación entre aumento de índices de espectroscopia (Cho/Cr y Cho/NAA) e índices de difusión (DWI) y su relación con KI67/MIB1 en tumores de alto grado. DISCUSIÓN: Si bien los resultados no pueden probarse de forma estadística debido al tamaño de la muestra se puede evidenciar asociación entre hallazgos imagenológicos preoperatorios con características genéticas tumorales de forma preoperatoria. CONCLUSION: Las técnicas imagenológicas han avanzado en forma significativa en las últimas décadas, pero poco se ha logrado influir en el pronóstico de pacientes con lesiones gliales del SNC. La posibilidad de conocer en una etapa preoperatoria de las características histológicas e inmunohistoquímicas de los tumores primarios del SNC podría ser de gran ayuda en el abordaje interdisciplinario de estas lesiones.

Introduction: neurocysticercosis is a preventable parasitic infection caused by larval cysts of Taenia solium (tapeworm), which can infect any part of the body, including the brain and is the most severe form of the disease, sometimes lead to seizures and even be fatal. Objective: to synthesize information concerning this pathology. Method: an updated bibliographic search was carried out in databases such as PubMed, Google Scholar, Medline, Web of Science, Cochrane Library and ClinicalKey, as well as in high impact journals like SciELO, and Scopus. The information gathered was complemented with the use of systematic reviews, randomized clinical studies and meta-analysis approaches, in which to facilitate the search process various key words were used: "neurocysticercosis", "pathophysiology", "etiology", "clinical manifestations", "prevalence", "morbimortality", "diagnosis", and "treatment". Development: the research allowed the researchers to recognize the arduous work required for the diagnosis of this disease, assuming as well how difficult is to typify it. The importance of neuroimaging studies as tools to qualify the severity of neurocysticercosis and, thus, to choose the appropriate treatment was highlighted. The following sections were developed: epidemiology, etiopathogenesis, life cycle, clinical manifestations, classification, and evolution of lesions, diagnosis, diagnostic criteria, and treatment. Conclusions: Ecuador is considered an endemic country for Taeniasolium. The implementation of preventive actions should be regarded as a fundamental task of the Ministry of Health due to the permanent surrounding risk factors, which have an influence for getting infection and the set of aspects associated with the precarious quality of life in many parts of the country.

El acto de tragar va más allá de un fenómeno mecánico. Es un proceso altamente complejo, elaborado y modelado por varios niveles del sistema nervioso. Su alteración es consecuencia directa o complicación asociada de varias patologías, donde sobresale la disfagia orofaríngea por etiología funcional de origen neurológico y neuromuscular. Esta revisión tiene como objetivo actualizar el conocimiento sobre los fundamentos y concepto de la disfagia orofaríngea neurogénica, y proveer información de utilidad clínica de sus principales causas. Los trastornos neurológicos son responsables de 70% a 80% de la etiología de la disfagia orofaríngea. Se produce principalmente por ictus, enfermedad de Parkinson, esclerosis múltiple, esclerosis lateral amiotrófica y traumatismo encéfalo craneano. Conclusiones: La disfagia orofaríngea neurogénica resulta de lesiones en cualquier parte de los circuitos y estructuras centrales entre la corteza cerebral y los componentes periféricos de la deglución; sus déficits fisiológicos son variados. La comprensión conceptual, fisiopatológica y de características clínicas de las principales causas de disfagia neurogénica orientan a los equipos asistenciales para realizar acciones de detección, diagnóstico, tratamiento y rehabilitación oportuna. [ABSTRACT FROM AUTHOR]

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El objetivo es describir la presentación de un tumor poco frecuente de sistema nervioso cen- tral en un paciente inmunocompetente. Paciente de 65 años inmunocompetente quien inicia con apraxia transitoria, se le diagnosticó una tumoración encefálica por estudios radiológi- cos y se le realiza una biopsia encefálica reportándose un linfoma no Hodgkin de células b. Se concluye que el linfoma primario del sistema nervioso central en pacientes aparentemen- te inmunocompetentes y sin enfermedad autoinmunitaria demostrable se presenta en un 0,3 % a 1,5 % de los tumores de cerebrales. El diagnostico mediante resonancia magnética es el método de elección para esta patología, con toma de biopsia guiada por estereotaxia y aplicación de inmunohistoquímica.

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Introducción: la demencia asociada con infección por VIH es la causa de demencia no traumática más frecuente en pacientes de todas las edades. Objetivo: describir el complejo demencia-sida como complicación del virus de inmunodeficiencia humana tipo 1. Método: se realizó una revisión bibliográfica entre el 25 de julio y el 9 de agosto de 2021. Considerándose los materiales en idioma inglés y español, en las bases de datos Scopus, SciELO, Dialnet, EBSCO, PubMed/Medline, fueron seleccionados 16 artículos, utilizando los descriptores: Complejo demencia-SIDA; Demencia; Infección; Síndrome de inmunodeficiencia adquirida; Sistema nervioso central; Virus de inmunodeficiencia humana, para el idioma español e inglés. Desarrollo: el complejo demencia-sida normalmente ocurre después de varios años de infección por el VIH y se asocia con un titulaje bajo de células T CD4+ y elevados niveles de carga viral en el plasma sanguíneo. Se caracteriza histológicamente, por la infiltración de monocitos y macrófagos en el sistema nervioso central. Estas afectaciones estructurales y funcionales están asociadas a manifestaciones neurológicas como alteraciones de la marcha, compromiso motor como bradicinesia, temblor e hiperreflexia y fallas en la coordinación. El diagnóstico es esencialmente clínico y se realiza por exclusión, el tratamiento se basa en el uso de antirretrovirales. Conclusiones: este trastorno neurológico es una entidad caracterizada por la tríada de compromiso cognitivo, síntomas conductuales y motores. La demencia solo existe cuando el deterioro neurocognitivo en el paciente es lo suficientemente grave como para interferir significativamente con las funciones del día a día del sujeto.