Neurologia Argentina最新文献

Introduction

The development of new symptoms of weakness, pain and fatigue decades after having experienced poliomyelitis is known as post-polio syndrome (PPS). In Argentina, there is no data available on its prevalence.

Objectives

To determine the impact and sequelae of polio survivors in Argentina. To identify and characterize patients with PPS.

Methods

A descriptive cross-sectional study that included 698 patients from different provinces of Argentina with a history of poliomyelitis, between 2019 and 2022. Online and telephone surveys were conducted regarding socioeconomic variables, age of polio diagnosis, PPS symptoms, diagnostic studies, and treatment.

Results

Most patients experienced polio between 1 and 3 years of age (mean 1.48). PPS was observed in 61,8% of the patients. Common PPS symptoms reported were increased weakness (89%), muscle pain (77%), sleep disorders (76%), and fatigue (8%). The average age of symptom onset was 50 years. Most patients reported difficulties in receiving a proper diagnosis and treatment. The diagnosis of PPS was significantly more frequent in women (60,04%) compared to men (39,95%) (p = 0.000).

Conclusions

61,8% of polio survivors in Argentina have PPS. Recognizing PPS and its prevalence will help in planning public policies aimed at proper diagnosis and treatment.

Introduction

There has been a significant boom in the field of artificial intelligence in recent years, especially in terms of accessibility and its use in different areas. This study attempts to determine if an AI can diagnose neurology patients.

Objective

To evaluate the utility and accuracy of ChatGPT 3.5 as a tool for conducting patient history, diagnosis, and treatment in cases of neurological pathology.

Materials and methods

A descriptive qualitative observational study was conducted, without intervention in patients, focused on evaluating the utility and accuracy of ChatGPT 3.5 for taking patient history, diagnosis, and treatment in patients with neurological pathology. The information provided to the neurologist was entered into the language model. Subsequently, the questions determined by ChatGPT were asked, and the complete neurological examination was provided. ChatGPT's diagnosis was compared with that of two different neurologists. Recruitment took place from May 2022 to June 2023 in a neurology consultation at a medium-sized hospital in Spain.

Results

A total of 72 patients (median age 58.71 years and 55.6% female) were enrolled in this study. Complementary tests suggested by the AI were considered correct in 33.3% of cases. The accuracy of the AI's diagnosis was 44.4%, and treatment recommendations were correct in 37.5%. The diagnosis was checked by two different neurologists following the latest national and international Neurology guidelines. In most cases, the diagnosis between the two neurologists agreed, with a kappa coefficient of 0.94.

Conclusions

Although we are in an unprecedented era of advancement in the field of artificial intelligence, it does not seem that ChatGPT can currently replace the evaluation of a neurology specialist.

Introduction and objectives

Dementia (D) are presented with high prevalence in older adults with great personal and socioeconomic impact. The objective of this study was to determine in patients, from the real world, who consulted for cognitive behavioral disorders (CBD), the diagnostic conditions and the therapeutic measures before and after the evaluation.

Material and method

Naturalistic horizontal study that included patients who made their first consultation for CBD in a reference center in Mendoza, Argentina.

Results

A total of 135 patients were included, mean age 76 years. A definite CBD was diagnosed in 124 patients (92%). The 48% corresponded to Alzheimer's (AD), 23% Mild Neurocognitive Disorder, 12% D. Mixed, 8% D. Lewy (DL), 3% D. Frontotemporal (DFT) and 6% other impairments. 115 patients had one or more previous consultations for CBB (ULT), the rest did so for the first time (PV). In the ULT group, 74% were evaluated by primary care physicians (general or family). The presence of D/TCM is related to older age (76/69 years P=.009) and duration of symptoms (2.6/1.4 years P=.014). 29% of ULT patients had undergone routine laboratory and 56% neuroimaging. Vitamin B₁₂ (D-B₁₂) deficiency was detected in 21%. Regarding the previous diagnosis: 48% did not have a definite diagnosis, 26% reported diagnoses such as senility, Senile D, atherosclerosis, age-related D, etc. In the group of treatable D. 37% did not receive any type of medication, 16% received medications without any degree of recommendation for use, 40% were taking memantine (20% optimal doses), 23% an anticholinesterases drugs (10% optimal doses), 15% were on combination therapy and of them only 5% in effective doses. 20% of the total group had been indicated, mentioned and/or performed regular physical activity, 17% cognitive stimulation and 14% healthy diet.

Conclusions

It is imperative to implement energetic and sustained educational measures to disseminate diagnostic and therapeutic algorithms for the correct management of CBD. These should include the use of non-pharmacological therapies, also around prevention. This will optimize and homogenize the comprehensive management of these devastating diseases.

Multiple sclerosis is an autoimmune disease that damages the central nervous system, causing neurological impairment. Its impact on quality of life and medical costs is significant. Providing pharmacological treatment and promoting physical activity are essential to enhance well-being. However, in Colombia, barriers such as social inequalities and limited access to healthcare facilities hinder this. Implementing physical activity and rehabilitation programs via telemedicine could overcome these barriers and benefit patients. Addressing this need is crucial to improve the health of those suffering from multiple sclerosis in Colombia.

Introduction

Parkinson's disease is a neurodegenerative process of onset in adulthood, characterized by signs such as bradykinesia, resting tremor, rigidity, increased muscle tension, resistance to movement and postural instability with loss of balance. There are multiple factors that can be associated, among which age, sex, family inherited and exposure to some toxins stand out.

Objective

To establish the association between smoking and the appearance of Parkinson's disease in people.

Materials and methods

A systematic review of documents produced between 2015 and 2020 in databases was carried out. Analytical observational studies that evaluated tobacco consumption (smoking) and the consequent development of Parkinson's disease were included. Data extraction was carried out by three researchers belonging to the project. The quality and risk of bias of the studies were assessed using the Newcastle-Ottawa scale.

Results

In total, 9 cohort studies that met the inclusion criteria were included, including a total of 12,533,445 people. The articles reported that tobacco consumption in people behaved as a protective factor, both in ex-smokers and in current smokers.

Conclusions

Despite the fact that smoking is a toxin that has been involved in the appearance of many pathologies, it has been found to behave as a protective factor for the development of Parkinson's disease.

Hereditary hemorrhagic telangiectasia or Rendu Osler Weber syndrome is a rare autosomal dominant genetic vascular disease. We present the case of a young adult who was admitted due to acute neurological deficit characterized by right motor deficit and aphasia due to acute ischemic stroke. The patient presented a history of previous epistaxis, presence of telangiectasias in the oral cavity, anemia and clubbing. A transcranial Doppler ultrasound revealed a right-left shunt and a pulmonary AVM was identified as the extracardiac cause of the shunt. The diagnosis of hereditary hemorrhagic telangiectasia is concluded, embolization is performed and subsequent left lower lobectomy correcting the AVM. The patient was discharged after the etiological study was completed, genetic counseling and outpatient rehabilitation therapy were provided. It is important to carry out a comprehensive evaluation in all young patients with stroke without classic cardiovascular risk factors, since carrying out appropriate diagnostic studies in a timely manner increases the probability of identifying the etiology, preventing the recurrence of new cerebrovascular events and improving the prognosis by providing adequate therapy.

Introduction

A free-floating carotid thrombus is a rare entity usually detected in the etiological study of an acute neurovascular syndrome.

Clinical case

We describe the case of a patient with ischemic cerebrovascular disease in the territory of the right middle cerebral artery with an incidental finding of a floating thrombus in the left internal carotid successfully treated with heparin and antiplatelet agents.

Conclusions

Carotid thrombosis is a rare entity. It represents a real therapeutic challenge as there are no unified treatment guidelines; however, the strategy based on anticoagulation is safe in most cases.

Introduction

Craniocervical dystonia is a major cause of chronic pain, loss of quality of life and increased economic costs to health care systems.

Objectives

To determine the prevalence, characterize and define the factors associated with craniocervical dystonia in a center for movement disorders.

Methodology

Cross-sectional study that included patients with a diagnosis of craniocervical dystonia in the specialized clinic for movement disorders from January 1, 2011 to December 31, 2021 at the Institute of Neurology and Neurosurgery of Havana, Cuba.

Results

A total of 99 patients were included in the study and the prevalence was 15.23% in the movement disorders clinic. The median age was 66 years old (RIQ: 19) and 57.6% were female. The types of dystonia were distributed as follows: blepharospasm 48.48%, cervical dystonia 34.34%, multiple regions 9.09%, oromandibular dystonia 5.05% and spasmodic dysphonia 3.03%. The associated factors were: female sex OR: 2.521 [95% CI: 1.112-5.713] for blepharospasm, white race OR: 3.309 [95% CI: 1.146-9.558] and sensory trick OR: 9.960 [95% CI: 3.582-27.68] for cervical dystonia. Female sex OR: 0.075 [95% CI: 0.008-0.799], segmental onset form OR: 0.080 [95% CI: 0.008-0.799] and sensory trick OR: 0.081 [95% CI: 0.008-0.796] for oromandibular dystonia.

Conclusions

Craniocervical dystonia is frequent in clinics providing specialized care for patients with movement disorders, and the factors described were associated with specific types of dystonia.

The Percheron artery is a rare arterial variant that irrigates the thalamic region bilaterally. Infarction due to obstruction of the Percheron artery has been reported at a frequency between 0.1 to 2% and classically causes an alteration in the level of consciousness, neurocognitive disorder and vertical gaze palsy. We present a 70-year-old female patient with altered level of consciousness, involvement of vertical gaze palsy, ophthalmoparesis and bilateral ptosis. The patient progressed with partial improvement of symptoms: she persisted severe bilateral ptosis and paresis of vertical gaze with slight improvement of the alteration of horizontal gaze and bilateral internuclear ophthalmoplegia. In conclusion, we report the atypical case of an infarction of the artery of Percheron and describe the anatomical substrate for presenting these clinical signs. It is important to suspect a possible case in every patient with symptoms of compromised level of consciousness and alteration in ocular mobility since this will allow us to make a timely diagnosis and treatment.

Charcot-Marie-Tooth (CMT) disease is the most common hereditary neuropathy, having a prevalence of 28,2 cases per 100.000 inhabitants. It is one of the genetically most complex neurodegenerative syndromes in which 31 cloned pathogenic genes have been described. Demyelinating forms with autosomal recessive transmission represent 4% of the European population affected by CMT. In countries with high consanguinity risk, the percentage may be higher. In gypsy ethnic groups it must be considered that three founding mutations represent three variants: CMT4D Lom type (NDRG1 mutation), CMT4G Russe type (HK1 mutation) and CMT4C (SH3TC2 mutation) all of them described in Spain. In this article, three cases of demyelinating CMT AR heredity and HK1 mutations will be discussed for the same gypsy families.