ABSTRACT The objective of the study was to describe the clinical characteristics, treatment response and possible associated factors of patients with Guillain-Barré syndrome at the National Institute of Neurological Sciences. A descriptive study on hospital discharges was conducted during the period 2017-2019. Treatment response was evaluated based on Hughes’ disability scale. From 31 patients 61.3% were males and the mean age was 50 years. At admission, 87.1% of patients were on grade 3 or 4 of Hughes scale, most of them with axonal compromise which was associated to disability. Only 22 patients received plasma exchange; 6 months thereafter, 90.9% of patients decreased by at least one degree in Hughes scale and 42.8% were left without disability. In conclusion, a male and axonal subtype predominance was found, been the latter associated to disability.

RESUMEN El objetivo del estudio fue describir las características clínicas, la respuesta al tratamiento y posibles factores asociados de los pacientes con síndrome de Guillain Barré en el Instituto Nacional de Ciencias Neurológicas. Se realizó un estudio descriptivo sobre egresos hospitalarios durante el periodo 2017-2019. La respuesta al tratamiento se evaluó mediante la escala de discapacidad de Hughes. De los 31 pacientes el 61,3% eran varones, y la edad promedio fue de 50 años. Al ingreso, el 87,1% de pacientes se encontraban en el grado 3 o 4 de la escala de Hughes, la mayoría con compromiso axonal, el cual estuvo asociado a discapacidad. Solo 22 pacientes recibieron recambio plasmático; luego de seis meses el 90,9% disminuyó al menos en un grado en la escala de Hughes y el 42,8% quedaron sin discapacidad. En conclusión, se encontró un predominio del sexo masculino y del compromiso axonal, este último asociado a discapacidad.

ABSTRACT The objective of the study was to describe the clinical characteristics, treatment response and possible associated factors of patients with Guillain-Barré syndrome at the National Institute of Neurological Sciences. A descriptive study on hospital discharges was conducted during the period 2017-2019. Treatment response was evaluated based on Hughes’ disability scale. From 31 patients 61.3% were males and the mean age was 50 years. At admission, 87.1% of patients were on grade 3 or 4 of Hughes scale, most of them with axonal compromise which was associated to disability. Only 22 patients received plasma exchange; 6 months thereafter, 90.9% of patients decreased by at least one degree in Hughes scale and 42.8% were left without disability. In conclusion, a male and axonal subtype predominance was found, been the latter associated to disability.

RESUMEN El objetivo del estudio fue describir las características clínicas, la respuesta al tratamiento y posibles factores asociados de los pacientes con síndrome de Guillain Barré en el Instituto Nacional de Ciencias Neurológicas. Se realizó un estudio descriptivo sobre egresos hospitalarios durante el periodo 2017-2019. La respuesta al tratamiento se evaluó mediante la escala de discapacidad de Hughes. De los 31 pacientes el 61,3% eran varones, y la edad promedio fue de 50 años. Al ingreso, el 87,1% de pacientes se encontraban en el grado 3 o 4 de la escala de Hughes, la mayoría con compromiso axonal, el cual estuvo asociado a discapacidad. Solo 22 pacientes recibieron recambio plasmático; luego de seis meses el 90,9% disminuyó al menos en un grado en la escala de Hughes y el 42,8% quedaron sin discapacidad. En conclusión, se encontró un predominio del sexo masculino y del compromiso axonal, este último asociado a discapacidad.

SUMMARY Guillain-Barré syndrome shows a cyto-albuminologic dissociation in most patients. Pleocytosis or hypoglycorrhachia may defer the diagnosis, a reason for which an infectious etiology must be ruled out. Three cases of Guillain-Barré are described, whose cerebrospinal fluid tests showed limphocytic pleocytosis and persistently elevated protein concentration, while one of the cases also showed hypoglycorrhachia, and the classic cyto-albuminologic dissociation was only demonstrated in subsequent analysis. The neurophysiologic evaluation revealed an axonal disruption in all the patients. The atypical alterations in the context of acute flaccid paralysis warrant a retesting of the cerebrospinal fluid in order to rule out other etiologies, but without postponing the start of treatment.

RESUMEN El síndrome de Guillain-Barré se caracteriza por presentar una disociación albúmino-citológica en la mayoría de pacientes. La presencia de pleocitosis o hipoglucorraquia puede alejar el diagnóstico, por lo que se recomienda descartar, principalmente, causas infecciosas. Se presentan tres casos cuyos estudios de líquido cefalorraquídeo mostraron pleocitosis linfocítica e hiperproteinorraquia persistente y uno de ellos, además, hipoglucorraquia; fue solamente en análisis posteriores que los tres pacientes presentaron la clásica disociación albuminocitológica. El estudio neurofisiológico en todos ellos demostró asimismo un compromiso axonal. Las alteraciones atípicas en el contexto de parálisis flácida aguda justificarían repetir el análisis de líquido cefalorraquídeo y descartar otras etiologías, pero sin posponer en modo alguno el tratamiento.

Alzheimer's disease and epilepsy not only share advanced age as a risk factor, also mechanisms underlying in their etiology. The seizures usually occur in late stages of Alzheimer's disease; however patients with familial Alzheimer's disease have even greater risk for seizures, which have been found in patients with mutations in PSEN1, PSEN2 or APP developing seizures even in early stages of the disease. Furthermore temporal lobe epilepsy per se could generate memory impairment and hippocampal sclerosis generatere organization of excitatory and inhibitory neural networks that would result in seizure activity. Is important to recognize patients with Alzheimer's disease and epilepsy for initiate early treatment and prevent further cognitive impairment and improve the quality of life of these patients.

La enfermedad de Alzheimer y la epilepsia no solo comparten la edad avanzada como un factor de riesgo, si no también compartirían mecanismos subyacentes en su etiología. Las crisis epilépticas generalmente fueron reportadas en estadios tardíos de la enfermedad de Alzheimer; sin embargo los pacientes con enfermedad de Alzheimer familiar con mutaciones en la PSEN1, PSEN2 y proteína precursora del amiloide tienen mayor riesgo de desarrollar crisis epilépticas aún en estadios tempranos de la enfermedad. Por otro lado la epilepsia del lóbulo temporal podría generar per sé compromiso de memoria y la esclerosis hipocampal generar reorganización de redes neuronales excitatorias e inhibitorias que daría como resultado una actividad epiléptica. Es importante reconocer e iniciar tratamiento temprano en pacientes con Enfermedad de Alzheimer y epilepsia para evitar mayor deterioro cognitivo y mejorar la calidad de vida de estos pacientes.

Demência é uma das principais causas de dependência e incapacidade entre idosos, e impõe enormes encargos econômicos. Apenas alguns estudos de custo-de-doença para a demência foram realizados em países de renda média e baixa. OBJETIVO: O objetivo deste estudo foi analisar os custos relacionados com demência em pacientes de uma clínica particular, em Lima, Peru. MÉTODOS: Foi realizado estudo retrospectivo de uma coorte durante três meses para extrair informações de prontuários de pacientes com demência para avaliar a utilização de recursos tanto de saúde como outros. Os custos totais da doença foram divididos em diretos (despesas de assistência médica e social) e indiretos (custos de cuidados informais). RESULTADOS: Em 136 pacientes ambulatoriais, observou-se que, enquanto metade dos pacientes não dementes teve custos totais de cuidados de menos de US$ 23 ao longo de três meses, os pacientes dementes tiveram custos de US$ 1500 ou mais (e mais de US$ 1.860 para a demência frontotemporal). Em nosso estudo, o custo mensal de um paciente demente (US$ 570) foi 2,5 vezes maior do que o salário mínimo (salário mínimo mensal no Peru em 2011: US$ 222,22). CONCLUSÃO: Demência constitui um problema socioeconômico, mesmo nos países em desenvolvimento, uma vez que os pacientes envolvem altos custos de saúde e não de saúde, com os custos sendo especialmente altos para a família do paciente.

Dementia is a major cause of dependency and disability among older persons, and imposes huge economic burdens. Only a few cost-of-illness studies for dementia have been carried out in middle and low-income countries. OBJECTIVE: The aim of this study was to analyze costs of dementia in demented patients of a private clinic in Lima, Peru. Methods. We performed a retrospective, cohort, 3-month study by extracting information from medical records of demented patients to assess the use of both healthcare and non-healthcare resources. The total costs of the disease were broken down into direct (medical and social care costs) and indirect costs (informal care costs). Results. In 136 outpatients, we observed that while half of non-demented patients had total care costs of less than US$ 23 over three months, demented patients had costs of US$ 1500 or over (and more than US$ 1860 for frontotemporal dementia). In our study, the monthly cost of a demented patient (US$ 570) was 2.5 times higher than the minimum wage (legal minimum monthly wage in Peru for 2011: US$ 222.22). Conclusion. Dementia constitutes a socioeconomic problem even in developing countries, since patients involve high healthcare and non-healthcare costs, with the costs being especially high for the patient's family.

OBJETIVO: Avaliar a sobrecarga do cuidador baseada na entrevista de Zarit (ZBI). MÉTODOS: Nós incluímos cuidadores com 18 anos ou mais de idade, língua espanhola como nativa, alfabetizados. Foram avaliadas características demográficas: idade, gênero, educação, relação com o paciente com demência, extensão do cuidado, outras fontes de ajuda para os cuidados, impacto na economia doméstica, suporte familiar e percepção do comprometimento de saúde; e dados clínicos de saúde dos pacientes: tipo de demência, tempo desde o diagnóstico, tratamento e escala de deterioração global (GDS); ZBI e BDI-II. RESULTADOS: Avaliamos 92 cuidadores informais. Os pacientes tinham 69 anos ou mais, 75% tinha pelo menos um ano do diagnóstico, 73,9% com doença de Alzheimer, 84,8% recebia algum tratamento, 75% tiveram GDS de 5 ou mais. Quanto aos cuidadores: 75% tinham 55 anos ou mais, mulheres (81,5%), casados (83,7%), cônjuge (60,9%), com pelo menos 10 anos de educação (75%) e um ano de cuidado (75%), tempo reduzido de entretenimento (90,2%) e autopercepção de comprometimento da saúde (83,7%). A mediana da ZBI foi 38 (mínimo: 3 e máximo: 74). O coeficiente de BDI foi 1,38 (p<0,001). CONCLUSÃO: Nossa amostra de cuidadores informais peruanos mostram valores consideráveis na ZBI. A autopercepção de piora de saúde, repercussão na economia familiar e tempo de cuidado foram os principais determinantes da ZBI, embora somente a BDI foi um preditor consistente de ZBI.

OBJECTIVE: The aim of this study was to evaluate caregiver burden based on Zarit Burden Interview (ZBI) and depression in caregivers on the Beck Depression Inventory-II (BDI-II). METHODS: Literate individuals, 18 years or older, who spoke Spanish as their native language were included. Demographic characteristics: Age, sex, education, relationship to person with dementia, length of time caregiving, other sources of help for caring, impact on the household economy, family support, and perception of impaired health; and Clinical data on care-recipients: type of dementia, time since diagnosis, treatment, and Global Deterioration Scale (GDS); the ZBI and BDI-II. Descriptive and analytical statistics were employed to assess caregiver burden and predictors of higher burden in caregivers. RESULTS: A total of 92 informal caregivers were evaluated. Regarding care-recipients, 75% were 69 years old or over, 75% had at least one year since diagnosis, 73.9% had Alzheimer's disease, 84.8% received treatment, 75% scored 5 or over on the GDS. For caregivers, 75% were 55.5 years old or over, predominantly female (81.5%), married (83.7%), the spouse of care-recipients (60.87%), had at least 10 years of education (75.0%) and one year of caregiving (75%), reduced entertainment time (90.2%) and self-perception of impaired health (83.7%). Median score on the ZBI was 37.5 (minimum value = 3; and maximum value = 74). The coefficient of BDI was 1.38 (p-value <0.001). CONCLUSION: This sample of Peruvian informal caregivers showed elevated ZBI values. Self-perception of worsened health, repercussion on the family economy and time caregiving were the main determinants of ZBI, although only BDI was a consistent predictor of ZBI.

Depression and dementia, in particular Alzheimer´s disease (AD) are critically important issues in the mental health of old age. Both conditions apparently reduce quality of life and increase the impairment of activities of daily living for elderly persons. AD usually shows poor prognosis owing to progressive neuronal degeneration, while depression is basically reversible. Longitudinal follow-up and case-control studies reported a strong association between late-onset depression and dementia, and therefore increased risk was observed in 2-5 times to develop dementia in patients with late-onset depression. Furthermore, early-onset depression have also consistenly demonstrated to be a risk factor for dementia and unlikely to be prodromal to dementia. The nature of this association (if depression is a prodrome or consequence of, or risk factor for dementia) remains unclear. Regardless of this, treatment strategies for depression could alter the risk of dementia

Depresión y demencia, sobre todo enfermedad de Alzheimer (EA) son entidades críticas en la salud mental de la tercera edad. Ambas condiciones disminuyen la calidad de vida e incrementan el deterioro de actividades de vida diaria de individuos de la tercera edad. EA tiene pobre pronóstico al ser una enfermedad neurodegenerativa; mientras que la depresión es básicamente reversible. Los estudios de seguimiento longitudinal y de caso-control reportan una estrecha asociación entre depresión de inicio tardío y deterioro cognitivo progresivo, pues se ha demostrado riesgo de incremento en 2 a 5 veces para desarrollar demencia en pacientes con depresión de inicio tardío. Por otro lado, la depresión de inicio precoz ha demostrado en forma consistente ser también un factor de riesgo para demencia, y escasas probabilidades de ser pródromo de demencia.La naturaleza de la asociación (si depresión es un pródromo o consecuencia de demencia, o un factor de riesgo para desarrollar demencia) permanece aún sin ser esclarecida. Independiente de ello, las estrategias para tratar depresión podrían alterar el riesgo de desarrollar demencia.

Objectives: Determine the adverse effects of intravenous metoclopramide in the acute treatment of migraine attacks. Patients and methods: Were evaluated patients with a confirmed diagnosis of migraine according to the criteria of the International Headache Society, they attended with migraine crisis to emergency or outpatient neurology. Demographic data were collected and pain intensity was determined by visual analog scale (VAS ) from 0 to 10. Each patient was given intravenous metoclopramide diluted. We determined the efficacy in reducing pain intensity and the side effects. Results: 76 patients were evaluated, of 18 to 56 years old, 77,6 % were women. The average baseline VAS was 8,6 , after receiving metoclopramide EV 80,2 % had a reduction in VAS ≥ 50 %. The 92,1 % of patients had any adverse effects, were the most frequent psychomotor restlessness, drowsiness, insomnia and dizziness. Conclusions: Intravenous metoclopramide is an effective treatment in controlling migraine attacks and produces very common side effects such as psychomotor restlessness, drowsiness, insomnia and dizziness; it should be noted prior to administration.

Objetivos: Determinar los efectos adversos de la metoclopramida endovenosa en el tratamiento agudo de las crisis de migraña. Pacientes y métodos: Se evaluaron pacientes con diagnóstico confirmado de migraña según los criterios de la International Headache Society, que acudieron refiriendo crisis de migraña por emergencia o consultorio externo de neurología. Se recogieron los datos demográficos y se determinó la intensidad del dolor mediante la escala visual análoga (EVA) de 0 a 10. A cada paciente se le administró metoclopramida diluida vía endovenosa. Se determinaron la eficacia en la disminución de la intensidad del dolor y los efectos adversos. Resultados: Se evaluaron 76 pacientes de 18 a 56 años de edad, 77,6% fueron mujeres. La EVA basal promedio de ingreso fue de 8,6, después de recibir metoclopramida EV 80,2% presentaron reducción en la EVA ≥ 50%. 92,1% de los pacientes mostraron algún efecto adverso siendo los más frecuentes inquietud psicomotora, somnolencia, insomnio y mareos. Conclusiones: La metoclopramida endovenosa es un tratamiento efectivo en el control de las crisis de migraña y produce muy frecuentes efectos adversos como inquietud psicomotora, somnolencia, insomnio y mareos; lo que debe advertirse antes de su administración.

Persistent trigeminal artery is a rare vascular disorder and represents the permanence of the communication between the carotid system and vertebrobasilar system after birth. This persistence has been associated with the existence of other alterations of brain vascular morphology and different clinical conditions. We report three cases of persistent trigeminal artery, two incidental findings in patients with transient symptoms and one in a patient with subarachnoid hemorrhage, identified by three-dimensional reconstruction of images obtained by angiotomography.

La persistencia de la arteria trigeminal es una alteración vascular infrecuente y representa la permanencia, después del nacimiento, de la comunicación entre el sistema carotideo y el sistema vertebro-basilar. Esta persistencia se ha asociado a la existencia de otras alteraciones de la morfología vascular cerebral y a condiciones clínicas variadas. Reportamos tres casos de persistencia de la arteria trigeminal, dos como hallazgo incidental en pacientes con sintomatología transitoria y uno en un cuadro de hemorragia subaracnoidea, identificados mediante reconstrucción tridimensional de imágenes obtenidas por angiotomografía.

Introduction: Cerebral venous thrombosis, rarely cerebrovascular disease, affects mainly children and women of childbearing age. Case report:. Female patient, 45 years of age, evaluated at another health center where she was diagnosed with typhoid fever, she went to emergency referring a time of illness 14 days, with frontal headache of moderate intensity, nausea and vomiting, she was hospitalized with a probable subarachnoid hemorrhage. On physical examination, she had stable vital functions and normal neurological examination, brain tomography showed diffuse cerebral edema, cerebral angiography and MRI of the brain showed thrombosis of the sagittal sinus, transverse and sigmoid. Blood tests were normal. Cerebral venous thrombosis was the diagnosis and she was treated with antiedema cerebral and started anticoagulation with low molecular weight heparin and then with warfarin, after was discharged without neurological impairment. Discussion: Cerebral venous thrombosis is a rare entity and presents inespecific symptoms, the most frequent is persistent headache refractory to treatment, some cases are of difficult diagnosis, the diagnostic method of choice is MRI in venous phase and the treatment is with anticoagulants.

Introducción: La trombosis venosa cerebral, una enfermedad cerebro vascular rara, afecta fundamentalmente niños y mujeres en edad fértil. Caso clínico: Paciente de sexo femenino, 45 años de edad, evaluada en otro establecimiento de salud donde le diagnosticaron fiebre tifoidea, acudió a emergencia refiriendo un tiempo de enfermedad de 14 días, con cefalea frontal de moderada intensidad, náuseas y vómitos, fue hospitalizada por una probable hemorragia subaracnoidea. Al examen físico tenía funciones vitales estables y examen neurológico normal; la tomografia cerebral mostró edema cerebral difuso, la angiotomografía cerebral y resonancia magnética de encéfalo evidenciaron trombosis del seno sagital superior, transverso y sigmoide derecha. Los exámenes de analítica sanguínea fueron normales. Se diagnosticó trombosis venosa cerebral y se inició tratamiento antiedema cerebral y anticoagulación con heparina de bajo peso molecular y después con warfarina, siendo dada de alta sin compromiso neurológico. Discusión: La Trombosis venosa cerebral es una entidad rara y presenta síntomas inespecíficos; siendo el más frecuente la cefalea recurrente, persistente y refractaria al tratamiento, algunos casos son de díficil diagnóstico, el método diagnóstico de elección es la resonancia magnética en fase venosa y su tratamiento se realiza con anticoagulantes.

HIV-associated neurocognitive disorder (HAND) is not a well recognized entity but has high prevalence and impact in individuals infected with HIV. The term HAND encompasses a spectrum of progressive central nervous system (CNS) involvement, ranging from asymptomatic neurocognitive impairment and minor neurocognitive disorder through to the most severe form of HIV-associated dementia (HAD). While the incidence of HAD has declined significantly with highly active antiretroviral treatment (HAART), the milder forms of HAND have increased. In this review, updated nomenclature and research case definitions to guide HAND diagnosis are described. Clinical manifestations, diagnosis and treatment recommendations are also outlined. Finally, while neurocognitive impairment is typically diagnosed with full neuropsychological evaluation, the interpretation of test results is based on comparing the patient’s performance to age and culturally adjusted population based normal values; thus, test results are valid only if adequate representative normative data exist for a given patient. Therefore, we propose a group of brief neuropsychological tests validated in Peruvian population that could be used to detect HAND opportunely not only by neurologists but also by a primary HIV-care provider or in resource-poor settings.

El trastorno neurocognitivo asociado a VIH (TNAV) es una complicación poco conocida pero de elevada prevalencia e impacto en los pacientes con VIH. El término TNAV agrupa un espectro de complicaciones progresivas del sistema nervioso central (SNC), desde un compromiso neurocognitivo asintomático y un trastorno neurocognitivo leve hasta una demencia asociada a VIH (DAV). Mientras que la incidencia de DAV ha disminuido significativamente con el tratamiento antirretroviral de gran actividad (TARGA), las formas más leves de TNAV se han incrementado. En esta revisión, describimos la nomenclatura actualizada y definiciones de caso para orientar el diagnóstico del TNAV. También, resumimos las manifestaciones clínicas, diagnóstico y recomendaciones para el tratamiento. Finalmente, mientras que el deterioro cognitivo es típicamente diagnosticado con una evaluación neuropsicológica completa, la interpretación de los resultados se basa en la comparación entre el rendimiento del paciente con valores normalizados en poblaciones ajustados culturalmente y según edad; así, los resultados de estas pruebas son válidos solo si existen datos representativos normalizados adecuadamente para un paciente. Por lo tanto, proponemos un grupo de pruebas neuropsicológicas breves validadas en nuestra población peruana, que pueden ser utilizadas para la detección temprana del TNAV no solo por los neurólogos sino también por el médico tratante del paciente con VIH o en centros de escasos recursos.

Background: Several studies have reported cognitive impairment in HIV-1 infected individuals even at early stages of the infection. Short-term memory, psychomotor speed, attention and executive functions are mainly affected. Objectives: To determine the cognitive profile in neurologically asymptomatic HIV-infected patients before starting highly active antiretroviral therapy (HAART), and possible associated factors. Design: Analytic and cross-sectional study. Setting: Hospital Regional de Huacho, Peru. Participants: HIV patients with criteria to start HAART. Interventions: Twenty-one asymptomatic HIV patients attended from April to July 2011 had a detailed clinical history and a battery of standardized neuropsychological tests. Main outcomes measures: Scores in psychomotor speed, executive function, immediate memory, attention, and visuospatial performance evaluations. Results: Significant cognitive impairment was determined in 47.6% of patients. Patients performed worse in psychomotor speed and executive function tests. All but one patient failed at least in one test. Age, level of instruction, time of disease, and depression were not statistically associated. Conclusions: In accordance with the literature, these findings suggest cognitive decline may occur in early asymptomatic stages of HIV infection.

Introducción: Diversos estudios han comunicado la presencia de deterioro cognitivo asociado al virus de inmunodeficiencia humana (VIH) tipo 1, aún en estadios tempranos de la infección. Las principales funciones comprometidas son la memoria a corto plazo, velocidad psicomotriz, atención y función ejecutiva. Objetivos: Describir el perfil cognitivo en pacientes con VIH neurológicamente asintomáticos, antes de iniciar terapia antirretroviral de gran actividad (TARGA), y determinar posibles factores asociados. Diseño: Estudio transversal-analítico. Lugar: Hospital Regional de Huacho. Participantes: Pacientes con VIH y con criterios para ingresar a TARGA. Intervenciones: Veintiún pacientes con VIH, que fueron atendidos desde de abril a julio de 2011, fueron evaluados clínicamente y se les administró una batería neuropsicológica estandarizada. Principales medidas de resultados: Puntajes alcanzados en las pruebas de velocidad psicomotriz, función ejecutiva, memoria inmediata, atención y habilidades visuoespaciales. Resultados: El 47,6% de pacientes presentó un deterioro cognitivo significativo. Los pacientes fallaron principalmente en las pruebas de velocidad psicomotriz y función ejecutiva. Con excepción de un paciente, todos fracasaron en al menos un test. La edad, tiempo de enfermedad, grado de instrucción y depresión no influyeron significativamente sobre el perfil cognitivo. Conclusiones: Estos hallazgos sugieren que el compromiso cognitivo en algún grado puede presentarse desde las fases tempranas y asintomáticas de la infección por el VIH; estos hallazgos coinciden con la literatura.