Neurologia Argentina最新文献

Introduction

The clinical presentation of Guillain-Barré syndrome can be heterogeneous due to its multiple variants, some defined and others that are part of the spectrum of the disease.

Clinical case

Thirty-five-year-old female who presented with multiple cranial neuropathy, with no other findings. Determination of antiganglioside antibodies in cerebrospinal fluid, positive for GD1b and GQ1b, was performed. Treatment with gamma globulin was performed with good response.

Conclusion

Multiple cranial neuropathy can occur in the context of Guillain-Barré variants, in relation to the case presented, the distribution of GD1b and GQ1b antibodies would explain the clinical presentation of the patient.

Giant cell arteritis is a vasculitis that affects medium and large-sized blood vessels. It is more common in women and individuals over 70 years of age. It is characterized by headache, visual symptoms, and constitutional symptoms. Painful ophthalmoplejía and inflammatory orbitopathy are uncommon. A rare presentation is reported in a 73-year-old male with headache associated with eyelid ptosis, proptosis, painful ophthalmoplegia, and unilateral visual acuity decrease. Brain magnetic resonance imaging showed optic neuritis with perineuritis, posterior scleritis, inflammation of the intraconal fat and extraocular muscles, as well as bilateral hypoechoic halo in temporal artery Doppler. The diagnosis was made using the new ACR/EULAR 2022 criteria. Giant cell arteritis should be considered among the possible etiological diagnoses for painful ophthalmoplegia and may be associated with inflammatory orbitopathy.

Sjogren's syndrome is an autoimmune disease characterized by cellular infiltration of the salivary and lacrimal glands, visceral organs, and the vascular system. Neurological manifestations may become rare. Therefore, its diagnosis requires meeting certain criteria. Appropriate treatment can improve the patient's clinic. We present a series of cases of manifestations of the peripheral and central nervous system from a national referral hospital.

Introduction

SARS-CoV-2 infection worldwide has affected about 232,075,351 people and caused at least 4,752,988 deaths according to WHO data. It has been considered that the organ of predilection for involvement by this infection is the lung, but according to the literature, 36.4% of patients have evidenced CNS involvement and 8.9% of the SNP.

Materials and methods

An intentional search of the literature was carried out in different medical databases such as Pubmed, Ovid, BMJ, Clinical Key, ScienceDirect, entering keywords such as COVID-19, brain, SARS-CoV-2 infection, PET/CT, PET/RM encephalopathy, accompanied by Boolean operators such as AND, OR and NOT.

Results

To date, numerous case reports, case series, and observational studies have been published using different PET/CT or PET/MRI radiotracers with different findings.

Conclusion

PET/CT or PET/MRI with 2-[¹⁸F]FDG or [¹⁸F]FDOPA has shown to be a useful tool to detect and understand the disease process in those patients with SARS-CoV-2 neuro-infection in cases of normal structural images.

Introduction

There are currently a significant number of options for disease-modifying therapies in multiple sclerosis (MS), which can be categorized as low, moderate, or highly effective based on their ability to control disease activity. As there are few comparative studies between high-efficacy therapies (HET), there is uncertainty about the best time to indicate or replace them.

Objective

To assist treating physicians in making decisions about the choice and use of highly effective therapies, in different scenarios regarding persistence of activity, progression of disability, presence of poor prognostic factors, or adverse effects under treatment.

Comments

A group of Argentine neurologists with experience in the management of patients with MS was convened to discuss and identify valid options for the strategy of indications and management of HETs (cladribine, ocrelizumab, ofatumumab, natalizumab, and alemtuzumab).

Conclusions

This work aims to serve as a guide for treating physicians in case of doubts about the management of SAD, according to what they would do in their office referring to the management of MS in Argentina.

Introduction

Adequate and timely treatment of acute manifestations of inflammatory-demyelinating diseases of the central nervous system including acute disseminated encephalomyelitis, isolated demyelinating syndromes (optic neuritis, acute myelitis), relapses of multiple sclerosis, neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated disease has implications for its prognosis. Each clinical scenario has its own particularity, and treatment has different degrees of evidence.

Objectives

To develop a clinical practice guideline on the acute treatment of inflammatory-demyelinating diseases of the central nervous system, based on the best available evidence.

Methods

A team to prepare the guidelines was formed among the members of the Working Group on Demyelinating Diseases of the Argentine Neurological Society. The methodology implemented was in accordance with the recommendations established by the Argentine Neurological Society, evidence-based, with its classification and elaboration of the recommendations according to the GRADE format.

Conclusions

We established 22 recommendations with different degrees and quality of evidence. High doses of intravenous corticosteroids are the first line of treatment in all cases, being able to use the oral route at equivalent doses in the relapses of multiple sclerosis and optic neuritis. It is recommended to use plasmapheresis in cases where there is insufficient response to steroids, mainly in neuromyelitis optica spectrum disorders, where indication should not be delayed and could be used as a first line treatment, although conclusive evidence is lacking. Other interventions generally lack sufficient evidence for their recommendation.

Introduction

COVID-19 seems to induce ischemic stroke by several potential mechanisms including promoting hypercoagulability, and worse functional outcomes have been reported in patients with stroke and the infection with SARS-CoV-2.

Objective

Determine the association between functional outcome and COVID-19 in patients with stroke.

Patients and methods

We performed a case control study comparing patients admitted to a neurological reference center in Peru with a diagnosis of stroke before (controls) and after (cases) the onset of the COVID-19 pandemic. There were 31 cases diagnosed with COVID-19 and 62 controls without COVID-19. Bivariate analysis and conditional fixed-effects Poisson regression analysis were used to evaluate the association between the functional outcome of the stroke and COVID-19.

Results

Cases had higher baseline serum glucose (133.5, IQR: 117.5-174 versus 117, IQR: 101-130, p = 0.033) than controls, higher neutrophil counts (7.91, IQR: 5.93-9.57 versus 5.96, IQR: 4.41-7.79, p = 0.008), lower lymphocyte counts (1.48, IQR: 1.04-1.8 versus 1.83, IQR: 1.26-2.32, p = 0.025), higher neutrophil/lymphocyte ratios (5.44, IQR: 4.0-8.1 versus 3.29, IQR: 2.25-6.02, p = 0.011), higher NIH stroke scale/score (NIHSS) (14, IQR: 9-18 versus 7 IQR: 5-11, p = 0.000), and higher modified Rankin scores at discharge (4, IQR: 4-5 versus 2, IQR: 1-4), p = 0.001). Seven (21.88%) participants died in the group of cases versus 1 (1.56%) in the controls (p = 0.014). The odds ratio of having a bad functional outcome at discharge was 1.344 (CI: 1.079-4.039; p = 0.029), adjusted by NIHSS at admission.

Conclusions

Our findings suggest that ischemic strokes associated with COVID-19 are more severe, have worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.

Introduction

Limited time to perform thrombolytic treatment in acute ischemic stroke, associated with initial normality in CT in the first hours, results in many cases in a difficult differentiation with “Stroke Mimic” (SM). The objective of this study was to determine the percentage of patients admitted to the San Bernardo Hospital in Salta Capital with an initial diagnosis of stroke, who were finally diagnosed as SM, as well as to describe their characteristics.

Material and methods

An observational, prospective, cross-sectional study was carried out for 16 months, including all hospitalized patients who had an initial diagnosis of acute ischemic stroke. Epidemiological data, history, data of the episode, FABS scale and a depression scale were collected. The final diagnosis was determined by neuroimaging or by ABCD2 score in case of transient ischemic attack. The necessary statistics were calculated to assess significant differences between both groups.

Results

155 cases were analyzed, of which 27 were SM. The SM group showed a higher percentage of women, a higher educational level and a lower percentage of hypertension. Regarding the FABS scale, most of its variables showed an association with the presence of SM (absence of facial paralysis, history of seizures, age under 50 years, systolic blood pressure at admission less than 150 mmHg and isolated sensory symptoms) We also could estimate that the higher the FABS scale score, the greater the possibility of having SM.

Conclusion

Knowing the variables that are most frequently associated with SM can facilitate the differential diagnosis and in this regard, we highlight the usefulness of the FABS scale for this purpose. Knowing local data can help improve diagnostic accuracy.

Sleep studies are non-invasive recordings in which signals from different physiological variables are recorded during sleep and wakefulness. The objective of this guide is to provide knowledge about polysomnography that will help in the daily practice of neurology. No technical details regarding sleep lab standards, protocols, instrumentation, or scoring and reporting specifics will be given.

Polysomnography (PSG) consists of the simultaneous recording of different biological signals. It is a tool in the evaluation of sleep disorders, it has specific indications and its results must be interpreted in the clinical context and the patient's usual medication.

It must be carried out at night or during the subject's usual sleep, with a record of no less than 6 hours and must include at least 3 hours of sleep.