Spinal Taenia solium cysticercosis in Mexican and Indian patients: a comparison of 30-year experience in two neurological referral centers and review of literature.

OBJECTIVE: To present a retrospective study from patients with spinal cysticercosis (SC), diagnosed within the last 30 years in Mexican and Indian neurological referral centers. METHODS: This is a retrospective and comparative study of the clinical and radiological profile between Mexican and Indian patients with spinal neurocysticercosis during a 30-year period and a review of the literature during the same period. RESULTS: Twenty-seven SC patients were included: 19 from Mexico and 8 from India. SC presented predominantly with motor symptoms (21/27 patients): paraparesis and paraplegia were the most common signs; one-third of patients presented sphincter dysfunction. Imaging studies showed that parasites in vesicular stage were more frequent in patients from Mexico, while degenerative stages predominated in India. Association of subarachnoid cysticerci and hydrocephalus was observed only in Mexican patients. CONCLUSIONS: Despite the limitations of this study, the collected information supports the existence of differences in the clinical and radiological traits of SC patients between Asian and Latin-American hospitals. The possible biological factors that may underlie these differences are discussed.

Clinical and paraclinical profile of neuromyelitis optic spectrum disorder in a peruvian cohort.

BACKGROUND: Neuromyelitis Optica Spectrum Disorders (NMOSD) is an autoimmune, inflammatory disorder of the Central Nervous System that typically involves the spinal cord and the optic nerves. Recently, the clinical and radiological spectrum of NMOSD has been increasing in Latin America. In Peru, there have only been a few clinical reports on NMOSD published. For this reason, we aimed to assess the clinical and paraclinical characteristics of patients with NMOSD from a tertiary-level neurological center in Lima-Peru. METHODS: This is a descriptive study. We assessed medical reports of patients with NMOSD based on the 2015 diagnostic criteria attended in a goverment institute (Instituto Nacional de Ciencias Neurologicas) from Peru between 2013-2019. Those patients who met diagnostic criteria were selected and analyzed. We analyzed continuous data among groups (AQP4-IgG seropositive and AQP4-IgG seronegative/unknow). RESULTS: We identified 58 clinical records that met the selection criteria and were included in the study. The highest percentage of patients (53%) were born in the north of Peru (from parallel 0°01'48''S - 6°56'38''S). NMOSD were more prevalent in women (86%), the male:female ratio was 1:6, the mean age at diagnosis was 50 years. AQP4-IgG antibodies were tested in (63.8%), 62% of whom were seropositive and 38% seronegative. The frequency of EO-NMO and LO-NMO was 34.8% and 65.2% in AQP4-IgG seropositive patients, respectively. Unknown AQP4-IgG was found 21 patients. In LO-NMOSD group, AQP4-IgG seropositive was found in a higher percentage. Optic neuritis was the first clinical event at 40% . In the patients who presented myelitis as the first clinical event, 18.2% were AQP4-IgG seropositive, while only 4.8% was found in the rest of the patients. 17% had other associated autoimmune diseases and 16% had anti-nuclear antibodies. 79% of patients had low vitamin D-25(OH) levels (<30ng/ml). Orbit MRI showed unilateral optic neuritis in 46.6%. Spinal cord MRIs showed extensive longitudinal myelitis in 52% of patients and the thoracic segment was the most frequently affected (47%). CONCLUSIONS: In the present study of a peruvian NMOSD cohort, we found a higher frequency of unilateral optic neuritis cases, and a higher percentage of AQP4-IgG seropositive patients among those older than 50.

Clinical characteristics and plasma exchange response in Guillain-Barré patients. / Características clínicas y respuesta al recambio plasmático terapéutico en los pacientes con síndrome de Guillain Barré.

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.

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.

Brainstem syndrome at onset is related to an early MS diagnosis in Peru: A national referral center cohort.

BACKGROUND: MS is unpredictable regarding clinical symptoms; however, certain symptoms represent the preferred localization of white matter lesions such as brainstem, spinal cord; or optic nerve. OBJECTIVES: To investigate the epidemiological, clinical, and imaging characteristics of MS patients in a national referral center in Peru, and to evaluate whether the type of symptom at onset relates with the time to making an MS diagnosis. METHODS: Retrospective study of MS patients at the Instituto Nacional de Ciencias Neurológicas between January 2010 and December 2018. Four different syndromes were selected for analysis as symptom onset (optic neuritis, brainstem syndrome, myelitis, and others). RESULTS: we identified 268 patients for whom a diagnosis of MS had been given; after excluding misdiagnosed patients (33 Neuromyelitis optica), lost or incomplete records, 121 patients were included. The majority of patients (46.6%) were born in Lima. Female to male ratio was 1.37 to 1, mean age at diagnosis was 31 years. At onset, myelitis was present in 35% of RRMS patients, followed by brainstem syndrome (25%) and optic neuritis (18%). Brainstem syndrome was statistically significant predictor for earlier diagnosis (adjusted HR: 2.09; p = 0.015). CONCLUSION: Brainstem syndrome as an initial presentation of MS in Peru is related to an earlier diagnosis.

Autoimmune neurology: Co-occurrence of anti-NMDAR encephalitis and anti-MOG associated disease, report of a case.

We report the case of a patient with symptoms of anti-NMDAR encephalitis and anti-MOG associated disease simultaneously, in whom the identification of antibodies guided to a more aggressive treatment strategy, resulting in a good clinical outcome. MRI is an important tool to diagnose this kind of patients. The co-occurrence of both diseases in infrequent, but atypical symptoms should increase our awareness of the possibility of an overlap syndrome.

Knowledge and Attitudes for the Management of Behavioral Variant of Frontotemporal Dementia.

Background: The diagnosis of the behavioral variant of frontotemporal dementia (bvFTD) can be especially challenging and is relatively underdiagnosed. There is scarce information on training and attitudes from care providers facing bvFTD in settings with limited resources. We aim to describe clinical knowledge and attitudes facing bvFTD from neurologists, psychiatrists, and residents in Peru. Methods: Potential participants received invitations by email to complete an online questionnaire. In addition, we reviewed 21 curricula from undergraduate medical schools' programs offered by the main schools of medicine in Peru during 2020 and 2021. Results: A total of 145 participants completed the survey. The responders were neurologists (51%), psychiatrists (25%), and residents in neurology or psychiatry (24%). Only 26% of the respondents acknowledged receiving at least one class on bvFTD in undergraduate medical training, but 66.6% received at least some training during postgraduate study. Participants identified isolated supportive symptoms for bvFTD; however, only 25% identified the possible criteria and 18% the probable bvFTD criteria. They identified MoCA in 44% and Frontal Assessment Battery (39%) as the most frequently used screening test to assess bvFTD patients. Memantine and Acetylcholinesterase inhibitors were incorrectly indicated by 40.8% of participants. Seventy six percentage of participants indicated that they did not provide education and support to the caregiver. The dementia topic was available on 95.2%, but FTD in only 19%. Conclusion: Neuropsychiatry medical specialists in Peru receive limited training in FTD. Their clinical attitudes for treating bvFTD require appropriate training focused on diagnostic criteria, assessment tools, and pharmacological and non-pharmacological management.

Prevalence of stroke survival in rural communities living in northern Peru.

BACKGROUND AND PURPOSE: Stroke is the leading cause of neurological impairment in the South American Andean region. However, the epidemiology of stroke in the region has been poorly characterized. METHODS: We conducted a staged three-phase population-based study applying a validated eight-question neurological survey in 80 rural villages in Tumbes, northern Peru, then confirmed presence or absence of stroke through a neurologist's examination to estimate the prevalence of stroke. RESULTS: Our survey covered 90% of the population (22,278/24,854 individuals, mean age 30±21.28, 48.45% females), and prevalence of stroke was 7.05/1,000 inhabitants. After direct standardization to WHO's world standard population, adjusted prevalence of stroke was 6.94/1,000 inhabitants. Participants aged ≥85 years had higher stroke prevalence (>50/1000 inhabitants) compared to other stratified ages, and some unusual cases of stroke were found among individuals aged 25-34 years. The lowest age reported for a first stroke event was 16.8 years. High blood pressure (aPR 4.2 [2.7-6.4], p>0.001), and sedentary lifestyle (aPR 1.6 [1.0-2.6], p = 0.045) were more prevalent in people with stroke. CONCLUSIONS: The age-standardized prevalence of stroke in this rural coastal Peruvian population was slightly higher than previously reported in studies from surrounding rural South American settings, but lower than in rural African and Asian regions. The death rate from stroke was much higher than in industrialized and middle-income countries.

Neuromyelitis optica in patients with myasthenia gravis: Two case-reports.

Neuromyelitis optica spectrum disorders (NMOSD) and myasthenia gravis (MG) are disorders that affect the central nervous system and the neuromuscular junction respectively. Although both conditions are rare, reports of the coexistence of these two pathologies are increasing worldwide. Rarely, patients with MG develop aggressive forms of neuromyelitis optica (NMO) after thymectomy. Here, we describe two Peruvian patients with the association of MG and NMO.

Primer caso de esclerosis múltiple primaria progresiva tratada con ocrelizumab en el Perú / First case of Primary Progressive Multiple Sclerosis treated with Ocrelizumab in Peru

RESUMEN La esclerosis múltiple es una enfermedad crónica, inflamatoria, desmielinizante, de etiología autoinmune que afecta al sistema nervioso central. Es la causa más común de discapacidad neurológica no traumática en adultos jóvenes. El 10 % de pacientes con esta enfermedad son diagnosticados con la forma esclerosis múltiple primaria progresiva (EMPP) que, hasta la aparición del anticuerpo monoclonal anti-CD20 ocrelizumab, no tenía una terapia específica. Se presenta el primer caso de EMPP tratado con ocrelizumab en el sistema público peruano. El paciente presentó una tolerabilidad aceptable y una respuesta clínica adecuada, medida con la Escala Expandida del Estado de Discapacidad (EDSS). Se destaca que, en la legislación peruana, la esclerosis múltiple es considerada una enfermedad rara que requiere una evaluación ad hoc para la autorización de financiamiento público para terapias específicas.

ABSTRACT Multiple Sclerosis is a chronic, demyelinating, autoimmune, neuroinflammatory disease. Known as the most common cause of non-traumatic neurological disability in young adults. Ten per cent of patients with Multiple Sclerosis are diagnosed with the Primary Progressive form (PPMS) which, until the emergence of the anti-CD20 monoclonal antibody Ocrelizumab, had no specific therapy. The first case treated with Ocrelizumab in the Peruvian public healthcare system is reported. The patient presented an acceptable tolerability and an adequate clinical response, as measured by the EDSS scale. Of note, under Peruvian legislation, Multiple Sclerosis is considered a rare disease and, therefore, requires an ad hoc evaluation for the authorization of public funding for specific therapies.

Características clínicas y respuesta al recambio plasmático terapéutico en los pacientes con síndrome de Guillain Barré / Clinical characteristics and plasma exchange response in Guillain-Barré patients

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.

Características clínicas y respuesta al recambio plasmático terapéutico en los pacientes con síndrome de Guillain Barré / Clinical characteristics and plasma exchange response in Guillain-Barré patients

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.

Alteraciones atípicas del líquido cefalorraquídeo en el Síndrome de Guillain-Barré: Reporte de casos / Atypical Alterations of cerebrospinal fluid in Guillain Barré Syndrome: Cases Reports

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.

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.

Cost-of-illness study in a retrospective cohort of patients with dementia in Lima, Peru.

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.

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.

The Memory Alteration Test Discriminates between Cognitively Healthy Status, Mild Cognitive Impairment and Alzheimer's Disease.

BACKGROUND/AIMS: Dementia is a worldwide public health problem and there are several diagnostic tools for its assessment. The aim of this study was to evaluate the performance of the Memory Alteration Test (M@T) to discriminate between patients with early Alzheimer's disease (AD), patients with amnestic mild cognitive impairment (a-MCI), and subjects with a cognitively healthy status (CHS). METHODS: The discriminative validity was assessed in a sample of 90 patients with AD, 45 patients with a-MCI, and 180 subjects with CHS. Clinical, functional, and cognitive studies were independently performed in a blinded fashion and the gold standard diagnosis was established by consensus on the basis of these results. The test performance was assessed by means of a receiver operating characteristic curve analysis as area under the curve (AUC). RESULTS: M@T mean scores were 17.7 (SD = 5.7) in AD, 30.8 (SD = 2.3) in a-MCI, and 44.5 (SD = 3.1) in CHS. A cutoff score of 37 points had a sensitivity of 98.3% and a specificity of 97.8% to differentiate a-MCI from CHS (AUC = 0.999). A cutoff score of 27 points had a sensitivity of 100% and a specificity of 98.9% to differentiate mild AD from a-MCI and from CHS (AUC = 1.000). CONCLUSIONS: The M@T had a high performance in the discrimination between early AD, a-MCI and CHS.

Informal caregiver burden in middle-income countries: Results from Memory Centers in Lima - Peru.

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.

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.

Central nervous system immune reconstitution inflammatory syndrome in AIDS: experience of a Mexican neurological centre.

BACKGROUND: Highly active antiretroviral therapy (HAART) restores the inflammatory immune response in AIDS patients and it may unmask previous subclinical infections or paradoxically exacerbate symptoms of opportunistic infections. Up to 25% of patients receiving HAART develop immune reconstitution inflammatory syndrome (IRIS). We describe six patients with IRIS central nervous system (CNSIRIS) manifestations emphasizing the relevance of CSF cultures and neuroimaging in early diagnosis and management. METHODS: Patients with CNSIRIS were identified among hospitalized HIV-infected patients that started HAART from January 2002 through December 2007 at a referral neurological center in Mexico. RESULTS: One-hundred and forty-two HIV-infected patients with neurological signs were hospitalized, 64 of which had received HAART, and six (9.3%) developed CNSIRIS. Five patients were male. Two cases of tuberculosis, two of cryptococcosis, one of brain toxoplasmosis, and one possible PML case were found. IRIS onset occurred within 12 weeks of HAART in five patients. Anti-infective therapy was continued. In one case, HAART was temporarily suspended. In long-term follow-up the clinical condition improved in all patients. CONCLUSIONS: CNSIRIS associated to opportunistic infections appeared in 9% of patients receiving HAART. Interestingly, no cases of malignancy or neoplasm IRIS-related were found. Frequent clinical assessment and neuroimaging studies supported diagnosis and treatment. Risk factors were similar to those found in other series.

Subarachnoid hemorrhage in neurocysticercosis: a direct or serendipitous association?

INTRODUCTION: The cerebrovascular complications in neurocysticercosis (NC) are uncommon. However, their pathophysiology remains unknown, but may be likely related to chronic inflammatory processes in the subarachnoid space (basal meningitis). Alterations of inflammatory cytokines in cerebrospinal fluid and sera correlate with vasospasm in SAH; these inflammatory mediators in NC may induce aneurysm formation. CASE REPORTS: A 7-year retrospective study in a neurological referral center (Instituto Nacional de Neurología y Neurocirugía), showed 3 cases of subarachnoid hemorrhage (SAH) among the 267 NC patients admitted during the study period. The clinical status, cerebrospinal fluid parameters, and clinical outcome were retrieved to compare them with previous NC-related SAH reported patients. Six of 15 patients showed aneurysm. These aneurysms were found within foci of inflammation and fibrosis surrounding the parasites. CONCLUSIONS: We found that, in contrast with the ominous prognosis of SAH for ruptured congenital aneurysm, cases associated with NC may have a more benign course. However with limited clinical information provided by previous reports, we only propose a possible direct relationship between chronic inflammation and NC as an inference because of the limited evidence available.

Crisis epilépticas en la demencia de la enfermedad de Alzheimer / Seizures in the dementia of the Alzheimer disease

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.

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.