Clinical and nerve conduction features in Guillain-Barré syndrome associated with Zika virus infection in Cúcuta, Colombia.

BACKGROUND AND PURPOSE: Zika virus (ZIKV) infection has been associated with an increased incidence of Guillain-Barré syndrome (GBS) but the relative frequency of acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and axonal GBS subtypes is controversial. METHODS: Twenty GBS patients diagnosed according to the Brighton criteria during the ZIKV outbreak in Cúcuta, Colombia, were evaluated clinically and electrophysiologically. The electrodiagnosis of GBS subtypes was made according to a recently described criteria set that demonstrated a high diagnostic accuracy on the basis of a single test. The electrophysiological features of 34 Italian AIDP patients were used as control. RESULTS: All patients had symptoms compatible with ZIKV infection before the onset of GBS and ZIKV infection was laboratory confirmed through a plaque reduction neutralization test (PRNT90 ) in 100% of patients. The median time from onset of ZIKV infection symptoms to GBS was 5 days (interquartile range 1-6 days). Cranial nerve palsy was present in 85% of patients (facial palsy in 75%, bulbar nerve involvement in 60%), autonomic dysfunction in 85%, and 50% of patients required invasive mechanical ventilation. AIDP was diagnosed in 70% of patients. 40% of nerves of AIDP patients showed a prevalent distal demyelinating involvement but this pattern was not different from the Italian AIDP patients without ZIKV infection. CONCLUSIONS: Guillain-Barré syndrome associated with ZIKV infection in Cúcuta is characterized by a high frequency of cranial nerve involvement, autonomic dysfunction and requirement of mechanical ventilation indicating an aggressive and severe course. AIDP is the most frequent electrophysiological subtype. Demyelination is prevalent distally but this pattern is not specific for ZIKV infection.

Meta-análisis neuroepidemiológico sobre síndromes agudos vasculares encefálicos (S.A.V.E.) del circuito posterior de un hospital general de la ciudad de Córdoba / Acute vasculoencephalic syndrome of the posterior circuit: neuroepidemiological metha-analysis in a General Hospital of Córdoba city

Este trabajo neuroepidemiológico se llevó a cabo en un grupo de pacientes diagnosticados en forma fehaciente como afecciones vasculares del encéfalo y del circuito Vértebro Basilar Cerebral Posterior. nuestro pacientes nos han permitido construir una visión ampliada del perfil clínico en relación a la topografía lesional y a los mecanismos fisiopatogénicos. Y no nos ajustamos sólo a lo prescripto en 1975 por el comité Ad Hoc. Nuestra propuesta ampliatoria se basa en considerar al circuito posterior sobre un eje que comprenda a las arterias Vertebral - Basilar - Cerebral posterior y bajo el concepto de las manifestaciones clínicas fundadas en las definiciones del Comité Ad Hoc para Stroke y los datos que se agregaron al integrar a la arteria Cerebral Posterior. La estrategia del Meta-análisis nos ha permitido desarrollar la idea de la importancia que poseen signos o síntomas CENTINELAS o de SOSPECHA en un grupo etareo de alto riesgo por ser gerontes y portadores de cardiopatías embolígenas, hipertensión arterial, dislipemias y/o diabetes. Descubrir a sospechosos con datos subclínicos o pausisintomáticos, dentro del perfil de sindromes vasculares agudos o crónicos y enmarcados en una filosofía que priorice el diagnóstico temprano para evitar la lesión estructural incapacitante, redundará en una más alta calidad de vida para el geronte y un mejor control sanitario para la tercera edad