Pesquisa | SciELO

Resumen El accidente cerebrovascular (ACV) constituye la principal causa de discapacidad de origen neuro- lógico en los adultos mayores a 40 años y la cuarta causa de muerte en Argentina. En los últimos diez años las publicaciones indexadas relacionadas al tratamiento del ACV isquémico fueron más numerosas que las de ACV hemorrágico. El objetivo de este material es proporcionar recomendaciones locales y actualiza- das del abordaje de pacientes con hematoma intraparenquimatoso espontáneo durante la internación. Para la redacción de este manuscrito se convocó a especialistas en esta enfermedad que conformaron grupos de trabajo. Se plantearon 10 tópicos centrales expresados como epidemiologia, atención inicial, imágenes, tratamiento de la presión arterial, reversión de antitrombóticos, indicación de cirugía, profilaxis anticonvulsivante, pronóstico, prevención de complicaciones y reinicio de antitrombóticos. De cada tópico se plantearon mediante preguntas PICO los interrogantes más frecuentes de la práctica diaria. Luego de una revisión sistemática de la literatura, se generaron recomendaciones evaluadas mediante sistema GRADE y consensuadas entre autores y pacientes.

Abstract Stroke is the leading cause of neurological disability in people over 40 years of age and the fourth leading cause of death in Argentina. In the last ten years, the indexed publications related to the treatment of ischemic stroke were more numerous than those of hemorrhagic stroke. The objective of this material is to provide local and updated recommendations for the management of patients with spontaneous intracere- bral hemorrhage during hospitalization. For the writing of this manuscript, diferent specialists were convened to form working groups. Ten central topics expressed as epidemiology, initial care, imaging, blood pressure treatment, reversal of antithrombotics, indication for surgery, seizure prophylaxis, prognosis, prevention of complications and resumption of antithrombotics were raised. For each topic, the most frequent questions of daily practice were raised through PICO questions. After a systematic review of the literature, recommendations were generated, evaluated using the GRADE system and agreed between authors and patients.

Triphasic waves and brain atrophy in patients with acute encephalopathy
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Merchán del Hierro, Xavier

; Persi, Gabriel

; Rojas, Galeno

; Gatto, Emilia

; Pereira de Silva, Nahuel

Colombia Médica

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Jun 2022, Volume 53 Nº 2 elocation e2034500

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

Resumen Introducción: Las ondas trifásicas (OT) constituyen un patrón electroencefalográfico asociado con diversas encefalopatías. La atrofia cerebral podría predisponer a su aparición. Objetivo: Comparar el grado de atrofia cerebral y de lesión de sustancia blanca en pacientes con encefalopatía aguda con y sin OT. Métodos: Estudio observacional retrospectivo, incluyó pacientes adultos con encefalopatía aguda con y sin OT internados entre 2016 y 2019. El grado de atrofia cerebral y de lesión de sustancia blanca se definieron según las escalas Global Cortical Atrophy y Age Related White Matter Changes (ARWMC), respectivamente. Se compararon los puntajes entre grupos. Se registró la mortalidad. Resultados: Se identificaron 16 pacientes con OT y 30 sin OT pareados según edad y sexo. La edad promedio del grupo con OT fue 80 años. El 87.5% fueron mujeres. La encefalopatía multifactorial fue el diagnóstico más frecuente seguido de la encefalopatía metabólica. El grado de atrofia fue mayor en pacientes con OT (10.43 vs 6.9, p= 0.03). El puntaje ARWMC fue 9.43 ±6.5 y 8.5 ±7.89 en pacientes con y sin OT respectivamente (p= 0.5). La mortalidad fue mayor en el grupo con OT (31.25 vs 6.66% p= 0.02). Conclusiones: Pacientes con encefalopatía aguda y OT tuvieron mayor grado de atrofia cerebral. Dicha alteración estructural podría relacionarse con la aparición de OT. No hubo diferencias significativas en el grado de lesión de sustancia blanca. La mortalidad del grupo con OT fue elevada. Son necesarios estudios para determinar su valor pronóstico.

Abstract Introduction: Triphasic waves (TW) constitute an electroencephalographic pattern associated with certain kinds of encephalopathy. Brain atrophy may be a predisposing factor linked with TW. Objective: To compare the degree of brain atrophy and white matter disease between patients with acute encephalopathy with and without TW. Methods: A retrospective observational study including adult patients with encephalopathy, with and without TW, hospitalized between 2016 and 2017. The degree of brain atrophy and white matter lesion were defined using the Global Cortical Atrophy and Age Related White Matter Changes (ARWMC) scales, respectively. Scores were compared between groups. Mortality rates were registered. Results: Sixteen patients with TW were identified matched by age and sex with 30 patients without TW. The mean age was 80 years in the TW group. Women represented 87.5%. Multifactorial encephalopathy was the most frequent diagnosis followed by metabolic encephalopathy. Patients with TW had more brain atrophy (10.43 vs 6.9, p= 0.03). Mean ARWMC was 9.43±6.5 and 8.5 ±7.89 in patients with and without TW respectively (p= 0.5). Mortality rate was higher in the TW group (31.25 vs 6.66% p= 0.02). Conclusions: Patients with acute encephalopathy and TW had higher degree of cerebral atrophy. It is possible that this structural alteration predisposes to the appearance of TW. There was no significant difference in white matter lesion degree. The mortality of the TW group was high, so future studies are necessary to determine their prognostic value.

https://doi.org/10.25100/cm.v53i2.4500

Consenso de manejo del paciente con diabetes mellitus y patología cardiovascular. Sociedad Argentina de Cardiología (SAC)-Sociedad Argentina de Diabetes (SAD)
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Giorgi, Mariano Aníbal

; Litwak, León E.

; Sanabria, Hugo

; Lavalle Cobo, Augusto

; Musso, Carla

; Salmeri, Emiliano

; Álvarez, José

; Aranguren, Florencia

; Belcastro, Fernando

; Brites, Fernando

; Buso, Carlos

; Calvagno, Marta

; Caroli, Christian

; Celano, Leonardo

; Cohen Arazi, Hernán

; Comtesse, Daniel

; Corral, Pablo

; Costabel, Juan Pablo

; Elbert, Alicia

; Faingold, Cristina

; Fuente, Graciela

; García Merletti, Pablo

; Giorgi, Mariano Aníbal

; Giunta, Gustavo

; Gómez Santamaría, Héctor

; González Naya, Enrique

; Hadid, Claudio

; Kraselnik, Ariel

; Lavalle Cobo, Augusto

; Litwak, León

; Lobo, Martín

; Lozada, Alfredo

; Majul, Claudio

; Masson, Walter

; Musso, Carla

; Nogueira, Juan

; Persi, Gabriel

; Rodríguez, Martín

; Salmeri, Emiliano

; Sanabria, Hugo

; Schraier, Silvio

; Sinay, Isaac

; Siniawski, Daniel

; Thierer, Jorge

; Salzberg, Susana

; Suárez Cordo, Cristian

; Lerman, Jorge

; Sosa Liprandi, Álvaro

Revista de la Sociedad Argentina de Diabetes

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Mar 2021, Volume 55 Supl. 1 Páginas 3 - 70

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

resumen está disponible en el texto completo

Abstract This Consensus comes to light in the midst of one of the worst global health crises in the last 100 years. SARS-CoV-2 and its clinical manifestation, COVID-19, have caused a disruption in how doctors and patients interact. Although it is an infectious disease, one of the most notable characteristics is that its mortality increases in patients with chronic non-communicable diseases and, in particular, with a history of diabetes and cardiovascular disease. In this context, then, we believe that the recommendations made in this document, which aim to identify and protect these patients, become more relevant, while the implementation, beyond the statements, of specific cardiometabolic prevention policies becomes a priority. Methodology: this consensus is the result of the will of two Scientific Societies that have recognized the need to complement the focus on the same problem: that of patients with diabetes mellitus (DM) and cardiovascular disease (CVD), or who are at risk to suffer it. Both the Argentine Society of Cardiology (SAC) and the Argentine Society of Diabetes (SAD) have a recognized track record in the production of practice guidelines and consensus documents, although each has different work practices and cultures. Consequently, the first task that was faced was to agree, not only on the agenda and the approach to the different issues, but also on common working methods: general objective of the document, how to analyze and evalua-te the weight of the information, define the levels of evidence and determine the degrees of recommendation. It was agreed to adopt the modality used by the SAC in all the documents produced by the Consensus and Standards Area, set out in the following table: The experts who collaborated in the drafting of the Consensus were selected and invited to participate with the unanimous agreement of the group of Directors and Secretaries belonging to both Scientific Societies. Colleagues with recognized experience in the disciplines addressed were summoned to analyze the evidence and write the recommendations. All the methodological aspects and the final recommendations of this document were defined by agreement between the group of Directors and Consensus Secretaries.The information consolidation process was slow: from the decision of both companies until the writing of this document, the field of DM and CVD management underwent profound transformations that transcend the appearance of new therapeutic agents. What has been developed is a new approach model that is, in the words of Dr. Alicia Elbert, transdisciplinary. This has implied waiting and being able to understand and "process" all the information that has emerged in these years. This document, which aims to assist physicians in daily practice, has tried to adopt this new integrative perspective.

Consenso sobre accidente cerebrovascular isquémico agudo
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Pigretti, Santiago G

; Alet, Matías J

; Mamani, Carlos E

; Alonzo, Claudia

; Aguilar, Martín

; Álvarez, Héctor J

; Ameriso, Sebastián

; Andrade, María G

; Arcondo, Florencia

; Armenteros, Cristian

; Arroyo, José

; Beigelman, Ricardo

; Bonardo, Pablo

; Bres Bullrich, María

; Cabello, Cecilia

; Camargo, Gonzalo

; Camerlingo, Sebastián

; Cárdenas, Rolando

; Cháves, Hernán

; Ciardi, Celina

; Ciarrochi, Nicolas

; Cirio, Juan

; Claverie, Santiago

; Colla Machado, Pedro

; Costilla, Marcelo

; Díaz, María F

; Dossi, Daiana

; Estrella Gimenez, María

; Giber, Fabiana

; Gómez Schneider, Maia

; González, Leonardo

; Hlavnika, Alejandro

; Ioli, Pablo

; Isaac, Cristian F

; Izaguirre, Andrés

; Klein, Francisco

; Kuschner, Pablo

; Lerman, Damián

; López, Rossana

; Marquevich, Victoria

; Miranda, Juan C

; Murgieri, Margarita

; Odzak, Andrea

; Pahnke, Perla

; Persi, Gabriel

; Pizzorno, José

; Pollan, Javier

; Pujol Lereis, Virginia

; Requejo, Flavio

; Robledo, Laura

; Rosales, Julieta

; Rubin, Romina

; Sabio, Rodrigo

; Tejada Jacob, Virginia

; Tumino, Leandro

; Valdez, Pascual

; Videtta, Walter

; Vilela, Andrés

; Villaroel Saavedra, Víctor

; Winkel, Martín

; Zurrú, Maria C

Medicina (Buenos Aires)

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Mai 2019, Volume 79 Supl. 2 Páginas 1 - 46

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Stroke is the third cause of death and the first cause of disability in Argentina. Ischemic events constitute 80% of cases. It requires the implementation of systematized protocols that allow reducing the time of care, morbidity and mortality. Specialists from nine medical societies related to the care of patients with cerebrovascular disease participated in the consensus. A separate agenda was agreed upon in chapters and for the writing of them, work groups were formed with members of different medical specialties. The level of recommendation was discussed and agreed upon for each topic based on the best clinical evidence available for each of them. An adaptation to the local scope of the recommendations was made when it was considered necessary.The American Heart Association system was used to draft the recommendations and their level of evidence. The correction and editing were done by five external reviewers, who did not participate in the writing and with extensive experience in vascular pathology. Once the preliminary document was finalized, a general meeting was held with all the members of the working groups and the reviewers to reach final recommendations. The consensus covers the management of ischemic stroke in the pre-hospital phase, initial evaluation in the emergency center, recanalization therapies (thrombolysis and/ or mechanical thrombectomy), decompressive craniectomy, neuroimaging and clinical care in the hospital.

El accidente cerebrovascular es la tercera causa de muerte y la primera de discapacidad en la Argentina. Los eventos isquémicos constituyen el 80% de los casos. Los accidentes vasculares cerebrales requieren la implementación de protocolos sistematizados que permitan reducir los tiempos en la atención, la morbilidad y mortalidad. En el consenso participaron especialistas de nueve sociedades médicas relacionadas con la atención de pacientes con enfermedad cerebrovascular. Se consensuó un temario separado en capítulos y para la redacción de los mismos se conformaron grupos de trabajo con miembros de diferentes especialidades médicas. Se discutió y acordó para cada tema el nivel de recomendación en base a la mejor evidencia clínica disponible para cada tópico. Se realizó una adaptación al ámbito local de las recomendaciones cuando se consideró necesario. El sistema de la American Heart Association se utilizó para redactar las recomendaciones y su grado de evidencia. La corrección y edición fue realizada por cinco revisores externos, que no participaron en la redacción y con amplia experiencia en enfermedad vascular. Finalizado el documento preliminar, se organizó una reunión general con todos los integrantes de los grupos de trabajo y los revisores para redactar las recomendaciones definitivas. El consenso abarca la atención del paciente con accidente cerebrovascular isquémico en la fase pre-hospitalaria, evaluación inicial en la central de emergencias, terapias de recanalización (trombolisis y/o trombectomía mecánica), craniectomía descompresiva, neuroimágenes y cuidados clínicos en la internación.

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Juvenile Huntington disease in Argentina
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Gatto, Emilia Mabel

; Parisi, Virginia

; Etcheverry, José Luis

; Sanguinetti, Ana

; Cordi, Lorena

; Binelli, Adrian

; Persi, Gabriel

; Squitieri, Ferdinando

Arquivos de Neuro-Psiquiatria

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Jan 2016, Volume 74 Nº 1 Páginas 50 - 54

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Foram analisadas as características demográficas, clínicas e genéticas de doença de Huntington juvenil (JHD) e na freqüência em uma coorte argentino. A idade de início foi definida como a idade em que distúrbios comportamentais, cognitivos, psiquiátricos ou anormalidades motoras sugestivas de JHD foram relatada pela primeira vez. Os dados clínicos e genéticos foram semelhantes aos de outras séries internacionais, no entanto, neste contexto identificamos a maior freqüência de JHD relatados até agora (19,72%; 14/71). A idade de início de JHD é um desafio ainda em discussão. Nossos resultados reforçam a hipótese de que as manifestações clínicas, além do transtorno de movimento típico, pode antecipar a idade de início em muitos anos. As análises de coortes de JHD são obrigados a explorar frequências em populações com diferentes formações, para evitar uma subestimação deste fenótipo raro. Além disso, os dados de populações selecionadas podem abrir novos caminhos em abordagens terapêuticas e pode explicar novas correlações potenciais entre apresentações de HD e fatores ambientais ou biológicas

ABSTRACT We analyzed demographic, clinical and genetic characteristics of juvenile Huntington disease (JHD) and it frequency in an Argentinean cohort. Age at onset was defined as the age at which behavioral, cognitive, psychiatric or motor abnormalities suggestive of JHD were first reported. Clinical and genetic data were similar to other international series, however, in this context we identified the highest JHD frequency reported so far (19.72%; 14/71). Age at onset of JHD is challenging and still under discussion. Our findings reinforce the hypothesis that clinical manifestations, other than the typical movement disorder, may anticipate age at onset of even many years. Analyses of JHD cohorts are required to explore it frequency in populations with different backgrounds to avoid an underestimation of this rare phenotype. Moreover, data from selected populations may open new pathways in therapeutic approaches and may explain new potential correlations between HD presentations and environmental or biological factors.

https://doi.org/10.1590/0004-282X20150192 2396 downloads

Consenso de Diagnóstico y Tratamiento Agudo del Accidente Cerebrovascular Isquémico Consejo de Stroke: Sociedad Argentina de Cardiología
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Atallah, Ana María

; Zurrú, María Cristina

; Alonzo, Claudia

; Ameriso, Sebastián

; Atallah, Ana María

; Cirio, Juan José

; Zurrú, María Cristina

; García Dávila, Rafael

; Cárdenas, Rolando

; Alonzo, Claudia

; Atallah, Ana María

; Beigelman, Ricardo

; Bonardo, Pablo

; Brescacin, Laura

; Cirio, Juan

; Díaz, Fernanda

; Fustinoni, Osvaldo

; Gadda, Carlos

; Izaguirre, Andrés

; Ortega, Fabiana

; Orzuza, Gabriela

; Pedersoli, Martín

; Persi, Gabriel

; Romero, Ricardo

Revista argentina de cardiología

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Out 2012, Volume 80 Nº 5 Páginas 394 - 410

Resumo: Es | Texto: Es | PDF: Es

24623 downloads

Apatía en enfermedad de Parkinson: Impacto sobre la calidad de vida
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Bottini Bonfanti, Alejandro

; Etcheverry, José Luis

; Persi, Gabriel G

; Zezza, Héctor

; Starkstein, Sergio

; Gatto, Emilia M

Medicina (Buenos Aires)

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Abr 2009, Volume 69 Nº 2 Páginas 253 - 258

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Apathy is one of the most prominent non-motor symptoms in Parkinson Disease (PD). Its range of prevalence in PD has been estimated in 20 to 45%. The objective of this work is to assess the prevalence of apathy in PD patients, and its relation with depression and executive function impairment. Fifty seven PD patients (54% women), mean age of 68.7 years, and a disease duration of 7.5 years from diagnosis were included. We used the following scales: UPDRS, Hoehn & Yahr, Mini Mental State Examination, the 14-item Apathy Scale (AS), the Beck Depression Inventory, and Trail Making Test versions A and B (TMT), and Parkinson's Disease Quality of Life Questionnaire (PDQL). Apathy was identified in 31.6%; apathy without depression was present in 33.3% of patients. The TMT A and B were abnormal in 66.7% and 83.3% respectively of the apathetic patients vs. 46.2% and 61.5% in nonapathetic patients. Quality of life was impaired in apathetic patients. In our PD sample apathy is highly prevalent, has a great impact on quality of life and it may occur in the absence of depression. The alterations of TMT in apathetic patients contributes to suggest a positive relationship between apathy and the impairment of executive function secondary to the involvement of frontal-subcortical circuits.

La apatía es uno de los síntomas "no motores" más importantes de la Enfermedad de Parkinson (EP). Su prevalencia en EP oscila entre 20 y 45%. El objetivo de nuestro trabajo fue establecer la prevalencia de apatía en pacientes con EP y su relación con depresión y trastornos en las funciones ejecutivas. Se evaluaron 57 pacientes con EP (54% mujeres), con una edad promedio de 68.7 años y una duración promedio de enfermedad de 7.5 años. Se utilizaron las siguientes escalas: UPDRS, Hoehn & Yahr, Mini Mental State Examination, Escala de Apatía de 14 ítem (EA), Inventario de Depresión de Beck, Trail Making Test (TMT) A y B y Parkinson's Disease Quality of Life Questionnaire (PDQL). El 31.6% de los pacientes presentaban apatía; en el 33.3% de los apáticos este síntoma se presentó en ausencia de depresión. Alteraciones en el TMT A y B se observaron en 66.7% y 83.3% respectivamente de los pacientes apáticos contra el 46.2% y 61.5% de los no apáticos. La calidad de vida fue afectada en los pacientes apáticos. La apatía en EP es frecuente en esta población, ejerce un impacto negativo sobre la calidad de vida de los pacientes y puede ocurrir en ausencia de depresión. Las alteraciones del TMT en los pacientes apáticos sugerirían una posible relación entre apatía y las alteraciones de las funciones ejecutivas, probablemente por compromiso de circuitos fronto-subcorticales.

2019 downloads

Degeneración hepatocerebral adquirida
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Parisi, Virginia

; Persi, Gabriel

; Pariso, Gabriela

; Rugilo, Carlos A.

; Gatto, Emilia M.

Medicina (Buenos Aires)

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Fev 2007, Volume 67 Nº 1 Páginas 62 - 62

Resumo: Es | Texto: Es | PDF: Es

422 downloads

Pseudomigraña con pleocitosis linfocitaria
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Pariso, Gabriela S.

; Parisi, Virginia L.

; Persi, Gabriel G.

; Canto, Lucila

; Rugilo, Carlos A.

; Gatto, Emilia M.

Medicina (Buenos Aires)

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Ago 2006, Volume 66 Nº 4 Páginas 335 - 337

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis or pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis (HaNDL) is a syndrome consisting of recurrent headaches, reversible neurological deficit, lymphocytic pleocytosis in cerebrospinal fluid (CSF), variable duration over time and spontaneous resolution. Although several etiopathogenic mechanisms have been suggested (vascular, infectous, immunological and calcium channelopthy), its etiology remains unknown. We describe a 28 year old female, with recurrent migraine with pleocytosis, confusional syndrome and transient neurological deficit. The clinical remission was achieved within two months. Although its etiology remains unknown the differential diagnosis is discussed in order to keep in mind this syndrome.

El síndrome de cefalea y déficit neurológico transitorio con pleocitosis en el liquido cefalorraquídeo o pseudomigraña con síntomas neurológicos temporarios y pleocitosis linfocítica (HaNLD), es un cuadro de cefaleas recurrentes, déficit neurológico reversible y pleocitosis linfocitaria en el líquido cefalorraquídeo (LCR), de duración variable y resolución espontánea. Si bien se han propuesto múltiples mecanismos etiopatogénicos (vascular, infeccioso, inmunológico y alteración de los canales de calcio), su etiología es aún desconocida. Describimos el caso de una mujer de 28 años de edad, con episodios recurrentes de migraña con pleocitosis, síndrome confusional y déficit neurológico transitorio, con remisión clínica dentro de los dos meses. Si bien la etiología sigue siendo desconocida. Presentamos los diagnósticos diferenciales a tener en cuenta ante este síndrome.

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