Archivos de Neurociencias

Clinical inertia in the management of patients with post-COVID 19 neurological syndrome: a problem without current evidence

Ivan David Lozada-Martinez — 2022-10-20

Not applicable

Meet the Editor: César Alvarez González

César Álvarez-González — 2022-10-15

Appreciation to Reviewers 2023

Editorial Council — 2024-01-05

José de Jesús González del Castillo Padilla (1874-1933) and his book Estudios de neurología published in 1922

Gabriela Castañeda López — 2024-06-29

Dr. José de Jesús González Padilla was born in Villa de Adobes, today Unión de San Antonio, Jalisco, on June 10^th 1874, and died in León, Guanajuato, on March 31^st 1933. He exercised his profession in León, was a member of important scientific associations, such as the National Academy of Medicine, won various awards, and wrote several books and numerous articles. His trajectory as an ophthalmologist is widely known and his works on school hygiene are well recognized. He also performed important labors in the area of neurology that could well place him among the pioneers in the field. This article analyzes his life and works as they relate to neurology, especially his book Estudios de neurología, published in 1922.

Bipolar disorder progression to dementia with frontal features. A scoping review protocol

Ramiro Ruiz-Garcia — 2023-06-19

Background: A subset of patients with bipolar disorder (BD) develop a midlife cognitive/behavioral decline that overlaps with the clinical features of behavioral variant Frontotemporal Dementia (bvFTD). Several case reports and case series have described different clinical features and outcomes of a frontal cognitive/behavioral decline in patients with history of BD. Given that this presentation is scarcely reported, a first step to better characterize this specific condition is to perform an evidence synthesis report. Objective: This scoping review protocol aims to describe and characterize the different patterns of frontal cognitive/behavioral decline in patients with history of BD. Information sources: Studies will be retrieved from MEDLINE (PubMed), PsychINFO, EMBASE and Google Scholar, no other sources will be considered. Inclusion criteria: Studies describing patients with an established diagnosis of BD preceding a later development of dementia with frontal cognitive/behavioral decline. Exclusion criteria: Studies written in languages different than Spanish or English or French that could not be appropriately translated, or whose full text files could not be retrieved, and studies describing manic or BD symptoms, but not an antecedent history consistent with bipolar disorder, as a clear prodrome of bvFTD diagnosis. Data will be extracted by two researchers and verified by agreement. This protocol complies with the PRISMA-P, PRISMA ScR and JBI manual for evidence synthesis scoping review guidelines.

SOMATOMEDIN C (IGF-1) IN BRAIN TRAUMA: POTENTIAL EFFECT ON NEUROPROTECTION

Luis Rafael Moscote Salazar — 2023-03-26

In recent years, through experimental studies, the effects of various neurotransmitters, as well as proteins, enzymes, and hormones involved in the inflammatory response during and after traumatic brain injury, have been investigated in depth, finding a substance called insulin-like growth factor type I (IGF-1), this protein, has shown to be important in processes of neuroprotection, synaptogenesis, myelination, and prevention of apoptosis, among others.

This article aims to clarify the role of Somatomedin C or type I insulin-like factor and its potential neuromodulatory function after head trauma. Factors such as age, sex, physical activity, diet, and the influence of other hormones have been related to the brain's levels and functioning of somatomedin C. IGF-1 receptors are found in higher concentration in some specific regions of the nervous system where neuronal tissue is more susceptible and have binding proteins that regulate the degradation of this substance, which in inflammatory conditions such as brain trauma has been shown to promote angiogenesis and attenuate the production of proinflammatory cytokines.

Implementation of Code Status Epilepticus in Mexico: Time is Brain

Elma Paredes-Aragon — 2023-07-17

Introduction: Status epilepticus is a neurological emergency. Its incidence is calculated in 61 cases/ 100,000 persons/year. Mortality has been estimated between 20-80%. This percentage is highly dependent of the efficacy and timing of treatment, determination of etiology and risk factors. Methods: In this narrative synthesis, the authors revised the actual scientific evidence and elaborated a proposal based on expert information for status epilepticus, with a tailored, practical approach specific to Mexico. Results and discussion: We synthesized recent data of medical evidence for status epilepticus, with a practical approach for the improvement of patients with status epilepticus. Conclusions: Patients with status epilepticus must be treated in a standarized manner to prevent morbi-mortality of the disease.

PEDIATRIC GUILLAIN-BARRÉ SYNDROME IN MÉXICO CLINICAL FEATURES BEFORE AND DURING SARS-COV-2 PANDEMIC

Fabiola Marycruz De la Fuente-Silva — 2023-09-18

Introduction: Guillain-Barré Syndrome is the most common cause of acute flaccid paralysis in childhood. It is a post infectious disease immune-mediated with a rapidly progressive course, usually without relapse. The main features are progressive weakness of more than one limb, areflexia or hyporeflexia, which gets progressively worst over days-to-weeks, to potentially life-threatening severity requiring mechanical ventilation.

Objective: We aimed to describe the clinical features of pediatric Guillain-Barré Syndrome in México before and during SARS-CoV-2 pandemic.

Methods: We performed an ambispective, observational, cross-sectional study in a Mexican reference hospital from January 2013 to December 2021. Data were obtained through records: demographic, clinical, laboratories, neurophysiological variants and treatment.

Results: Here we show that of the 96 patients, 55 were males with mean age of 9 years, 72% had history of infection; progressive weakness was present in 97%, areflexia/hyporeflexia 97%, progression of symptoms 99%, mean cells of 9/mm3 and mean proteins 88 mg/dL. Admission to Pediatric Intensive Care Unit was 20%. Acute Motor Axonal Neuropathy was the most frequent subtype. Nineteen patients required mechanical ventilation. Immunoglobulin was administered in 88%. Most frequent Disability Score at discharge was bedridden/wheelchair-bound. During 2020-2021 we found two SARS-CoV-2 cases and one associated with BNT162b2 vaccine.

Conclusions: Our results demonstrate that clinical features of pediatric Guillain-Barré Syndrome are similar before and during SARS-CoV-2 pandemic, nevertheless the number of cases associated with SARS-CoV-2 infection did not find increase.

Prospective analysis of a TRD cohort over a 1-year follow-up with standard of care in Mexico: results for depression severity, treatment response, disability and QoL from the multicenter, observational TRAL Study

Javier Zambrano — 2023-10-10

Introduction: Based on TRAL Mexico subsample, clinical outcomes and Patient-Reported Outcomes (PROs) are reported here. Methods: From 697 patients with MDD recruited from 14 Mexican sites, 140 patients with diagnosis of TRD under standard of care (SOC) were included in the 1-year follow-up. Patients with relevant psychiatric comorbidities or active participation in a clinical trial were excluded. Outcomes were obtained from PROs and clinical assessment scales. Results: Patients were mostly female (82.6%), with a mean age of 47.6 years. Only 44.3% of the patients achieved a clinical response, and remission was around 37% (measured through MADRS). Results from PHQ-9, EQ-5D and SDS show significant symptoms and disability for TRD patients in their everyday life after 1-year of follow-up with SOC. Discussion: TRD patients showed a significant burden of the disease, as current SOC fails to deliver clinically meaningful results for the majority of the patients. Response, remission and relapse are far from the desired outcomes Conclusion: Mexico has undertaken relevant and meaningful strategies to improve mental health resources availability, but some unmet needs are yet to be addressed. All involved stakeholders should consider public policies to enhance clinical outcomes and availability of resources.

Giant Invasive Prolactinoma

Amado Jiménez Ruiz — 2023-11-08

Guillan-Barre syndrome triggered by heat stroke: clinical case and literature review

Juan Carlos López-Hernández — 2023-08-03

Introduction: Guillain-Barre syndrome is triggered in 70% of cases by some infectious agent. Heat stroke favors a pro-inflammatory state and endotoxemia at the gastrointestinal level. Few clinical cases of GBS following heat stroke are reported.

Objective: to report a clinical case of a patient who presented GBS after heat stroke.

Material and methods: clinical case report

Result: a 31-year-old male patient in agricultural occupation, presented heat stroke due to exertion while working (temperature 40ºC, epileptic seizures and drowsiness), requiring invasive mechanical ventilation, control of hyperthermia with physical means; presents good evolution, recovering and being discharged at home. On the day of his discharge, he presented symptoms of distal paresthesia and weakness in the 4 extremities ascending until he could not ambulate. In the examination without involvement of skull nerves, areflexia, strength in extremities with MRC score 28 points. Lumbar puncture with protein-cytological dissociation, nerve conduction compatible with AMSAN variant. He was diagnosed with GBS (level 1 of diagnostic certainty by Brighton criteria) after heat stroke, received management with human immunoglobulin, at 3 months of follow-up he recovered his independent gait.

Conclusion: Heat stroke is a potentially fatal condition, triggering a systemic pro-inflammatory state and endotoxemia at the gastrointestinal level, conditions that can facilitate the presentation of autoimmune inflammatory diseases such as Guillaín-Barre syndrome. More studies are required to establish the pathophysiology of GBS after heat stroke.

Staged Neuroendoscopic Management of a Dandy Walker Malformation Case Presenting with Complex Hydrocephalus

Marios Theologou — 2023-06-22

Backgroud: Dandy-Walker malformation is a rare congenital condition characterized by alteration of posterior fossa anatomy. Hydrocephalus is a common finding in these patients. VP-shunt placement remains the treatment of choice. Endoscopic Third Ventriculostomy (ETV) is an acceptable alternative for older children. Other techniques have also been proposed.

Case presentation: A full-term infant presented with signs of hydrocephalus. An endoscopic foraminoplasty of the posterior fossa cyst was conducted as a first stage. The cyst’s volume was reduced, without any changes of the supratentorial ventricular dimensions. A month post-surgery signs of hydrocephalus reoccurred. An ETV was performed alongside a fenestration of the tentorium. The toddler was discharged in good condition with amelioration of her symptoms. One month later she presented with recurrent hydrocephalus and subdural hygromas. A shunt was placed in the posterior fossa under endoscopic guidance, and an additional one was introduced in the subdural space. The patient was followed-up for 18 months without any further need for treatment. VP-shunt placement is the treatment of choice.

Discussion: Lushka and Magendie foraminoplasty seems to be ineffective. ETV should be reserved for older children. The ventriculoscope can be employed for positioning the VP-shunt in a specific anatomical region. Subdural hygromas may present after neuroendoscopic treatment. A staged approach may be mandatory for complex hydrocephalus treatment.