[Systematic review of the treatment of spasticity in acquired adult brain damage]. / Revisión sistemática del tratamiento de la espasticidad en el adulto con daño cerebral adquirido.

Spasticity is a motor disorder characterised by an increase in muscle tone that appears as a consequence of a central nervous system disorder, leading to deficit and disability and impairing quality of life. In acquired adult brain damage, spasticity is a severe and frequent problem, appearing in 20-30% of patients with stroke and in 13-20% of patients with moderate-severe traumatic brain injury. The main objective of this study was to perform a systematic review of the treatments used in spasticity in adult patients with acquired brain damage secondary to stroke and head trauma. A systematic search of randomised controlled trials, published between January 1, 2013 and June 30, 2017 in English and Spanish, was carried out in the PubMed, Cochrane plus Library and Ovid databases. We finally selected 17 studies, with methodological quality that was at least acceptable according to the Jadad scale. The most frequently investigated treatments are botulinum toxin, especially serotype A, together with rehabilitative measures. Clinical scales are the most frequently used to assess spasticity.

Primary somesthetic cortex involvement in fibromyalgia: review of neuroimage studies / Envolvimento do córtex somestésico primário na fibromialgia: revisão de estudos de neuroimagem

ABSTRACT BACKGROUND AND OBJECTIVES: The mechanisms underlying nociplastic pain, such as fibromyalgia (FM), are not fully understood, however, it is believed that altered sensory processing and pain modulation play prominent roles in the maintenance of nociplastic pain. The hypothesis is that changes in the primary somesthetic cortex (S1) contribute to the generalized pain character of FM. The objective of this study was to evaluate the involvement of the primary somesthetic cortex in humans with fibromyalgia, as well as to investigate possible associations between S1 changes and clinical signs and symptoms of FM. CONTENTS: For this integrative review, the following databases were used: Pubmed and Web of Science, including observational studies carried out in humans with FM. In total, 541 studies were identified and four were included. The majority of studies are case-control studies, published between 2016 and 2022. In total, data from 161 individuals were included in this review. It was identified that there are morphological changes, hyperactivation and increased functional connectivity between S1 and periaqueductal gray matter and between S1 and anterior cingulate cortex. CONCLUSION: Patients with FM present morphological changes and hyperactivation in S1, as well as increased functional connectivity between S1 and periaqueductal gray matter and S1 and limbic system. Furthermore, different bilateral somatotropic subregions (legs, chest, fingers, hands, face and back) showed reduced functional connectivity in patients with FM. These regions are often presented as "tender points" in FM.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os mecanismos subjacentes à dor nociplástica, como a fibromialgia (FM), não são totalmente compreendidos, contudo acredita-se que o processamento sensorial e a modulação da dor alterados desempenham papéis proeminentes para a manutenção da dor nociplástica. Com a hipótese de que alterações no córtex somestésico primário (S1) contribuam para o caráter de dor generalizada da FM, o objetivo deste estudo foi avaliar o envolvimento do córtex somestésico primário em humanos com FM, bem como investigar possíveis associações entre alterações de S1 com sinais e sintomas clínicos da FM. CONTEÚDO: Para esta revisão integrativa, foram utilizadas as seguintes bases de dados: Pubmed e Web of Science, incluindo estudos observacionais realizados em humanos com FM. No total, 541 estudos foram identificados e quatro foram incluídos. A maioria dos estudos são do tipo caso-controle, publicados entre 2016 e 2022. Ao todo, dados de 161 indivíduos foram incluídos. Foi identificado que há alterações morfológicas, hiperativação e aumento da conectividade funcional entre S1 e substância cinzenta periaquedutal e entre S1 e córtex cingulado anterior. CONCLUSÃO: Pacientes com FM apresentam alterações morfológicas e hiperativação em S1, bem como aumento da conectividade funcional entre S1 e substância cinzenta periaquedutal e S1 e sistema límbico. Ademais, diferentes sub-regiões somatotrópicas bilaterais (pernas, tórax, dedos, mãos, face e costas) apresentaram redução da conectividade funcional em pacientes com FM. Essas regiões são frequentemente apresentadas como "tender points" na FM.

Neurogenesis and pesticides: news of no new neurons / Neurogênese e pesticidas: a ausência de novos neurônios é a novidade

Abstract New hippocampal neurons are continuously generated in the adult human brain. Several studies have demonstrated that the proliferation of hippocampal cells is strongly influenced by a variety of stimuli, including pesticides exposure. These effects are particularly important because neurogenesis dysregulation could be associated with the decline of neuronal and cognitive functions and the possible development of neuropsychiatric disorders.

Resumo Novos neurônios hipocampais são gerados continuamente no cérebro humano adulto. Vários estudos têm demonstrado que a proliferação de células do hipocampo é influenciada por uma variedade de estímulos, incluindo a exposição a pesticidas. Estes efeitos são particularmente importantes porque a desregulação da neurogênese pode estar associada ao declínio das funções neuronais e cognitivas e ao possível desenvolvimento de doenças neuropsiquiátricas.

The uniqueness of the human brain: a review / A singularidade do cérebro humano: uma revisão

ABSTRACT The purpose of this review is to highlight the most important aspects of the anatomical and functional uniqueness of the human brain. For this, a comparison is made between our brains and those of our closest ancestors (chimpanzees and bonobos) and human ancestors. During human evolution, several changes occurred in the brain, such as an absolute increase in brain size and number of cortical neurons, in addition to a greater degree of functional lateralization and anatomical asymmetry. Also, the cortical cytoarchitecture became more diversified and there was an increase in the number of intracortical networks and networks extending from the cerebral cortex to subcortical structures, with more neural networks being invested in multisensory and sensory-motor-affective-cognitive integration. These changes permitted more complex, flexible and versatile cognitive abilities and social behavior, such as shared intentionality and symbolic articulated language, which, in turn, made possible the formation of larger social groups and cumulative cultural evolution that are characteristic of our species.

RESUMO Esta revisão se propõe a relatar os aspectos mais importantes da singularidade anatômica e funcional do cérebro humano. Para isso, faz-se uma comparação entre o nosso cérebro e os de nossos parentes evolutivos mais próximos (chimpanzés e bonobos) e os ancestrais humanos. Durante a evolução humana ocorreu aumento absoluto do tamanho do cérebro e do número de neurônios corticais cerebrais, maior grau de lateralização funcional e assimetria anatômica cerebral, citoarquitetura cortical mais diversificada e aumento das redes neurais intracorticais e do córtex cerebral para as estruturas subcorticais acompanhada de mudança em direção ao investimento de redes neurais na integração multissensorial e sensório-motora-afetiva-cognitiva. Essas mudanças possibilitaram capacidades cognitivas e comportamentos sociais complexos, flexíveis e versáteis, destacando-se a intencionalidade compartilhada e a linguagem articulada simbólica, que permitiram a formação de grupos sociais maiores e a evolução cultural cumulativa característica de nossa espécie.

Why did humans surpass all other primates? Are our brains so different? Part 1 / Por que os seres humanos superaram todos os outros primatas? Nossos cérebros são tão diferentes? Parte 1

ABSTRACT. This review is based on a conference presented in June 2023. Its main objective is to explain the cognitive differences between humans and non-human primates (NHPs) focusing on characteristics of their brains. It is based on the opinion of a clinical neurologist and does not intend to go beyond an overview of this complex topic. As language is the main characteristic differentiating humans from NHPs, this review is targeted at their brain networks related to language. NHPs have rudimentary forms of language, including primitive lexical/semantic signs. Humans have a much broader lexical/semantic repertory, but syntax is the most important characteristic, which is probably unique to Homo sapiens. Angular gyrus, Broca's area, temporopolar areas, and arcuate fascicle, are much more developed in humans. These differences may explain why NHPs did not develop a similar language to ours. Language had a profound influence on all other higher nervous activities.

RESUMO Esta revisão baseia-se numa conferência apresentada em junho de 2023. O seu principal objetivo é explicar as diferenças cognitivas entre humanos e primatas não humanos (PNH) com base nas características dos seus cérebros. Baseia se na opinião de um neurologista clínico e não pretende ir além de uma visão geral deste tema complexo. Como a linguagem é a principal característica que diferencia os humanos dos PNH, esta revisão concentra-se nas redes cerebrais relacionadas à linguagem. Os PNH têm formas rudimentares de linguagem, incluindo sinais lexicais/semânticos primitivos. Os humanos têm um repertório léxico/semântico muito mais amplo, mas a sintaxe é a característica mais importante e única do Homo sapiens. O giro angular, a área de Broca, as áreas temporopolares e o fascículo arqueado são muito mais desenvolvidos em humanos. Essas diferenças podem explicar por que os PNH não desenvolveram uma linguagem semelhante à nossa. A linguagem teve influência profunda em todas as outras atividades nervosas superiores.

Neurodengue, a narrative review of the literature / Neurodengue, uma revisão narrativa da literatura

Abstract Dengue fever (DF) is the most frequent arboviral disease globally. Deforestation, armed conflicts, and climate change have caused an unprecedented global spread of DF, raising concerns in healthcare systems worldwide. Systemic manifestations of the disease range from mild to severe and, in some cases, can lead to death. Although neurological complications have been reported over the last few decades, they are often neglected or underreported. The present narrative review aims to describe the most important central and peripheral nervous system complications and provide guidance to neurologists in terms of diagnosis and management.

Resumo A dengue é a arbovirose mais frequente no mundo. O desmatamento, os conflitos armados e as mudanças climáticas levaram a uma disseminação global e sem precedentes da dengue, o que gera preocupações na maioria dos sistemas de saúde em todo o mundo. As manifestações sistêmicas variam de leves a graves, incluindo morte. Complicações neurológicas têm sido descritas nas últimas décadas, mas geralmente são negligenciadas ou subnotificadas. O objetivo desta revisão narrativa é descrever as complicações neurológicas centrais e periféricas e auxiliar os neurologistas em seu diagnóstico e manejo.

Suprapiamadre: Análisis Etimológico y Propuesta Terminológica para la Cuarta Meninge en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica / Suprapiamadre: Etymological Analysis and Terminological Proposal for the Fourth Meninge in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica

A lo largo de la historia, el conocimiento sobre las meninges ha evolucionado desde los primeros registros en el papiro de Edwin Smith hasta la actualidad, donde se ha descrito SLYM, una cuarta meninge que separa el espacio subaracnoideo en un compartimiento superficial y otro profundo, a la que se le atribuyen funciones de barrera semipermeable y de nicho de células inmunes para la vigilancia y protección del sistema nerviosos central. La FIPAT contiene un grupo de terminologías que son mundialmente aceptadas para la descripción de las estructuras del cuerpo humano, sin embargo, en Terminologia Anatomica, Ter- minologia Neuroanatomica y Terminologia Histologica, aún no se encuentra incluido el término SLYM para representar una cuarta meninge, quizás porque sea un reciente descubrimiento. El objetivo de este estudio fue sugerir un nuevo término que concuerde con los lineamientos de la FIPAT y con las reglas de Terminología Anatómica Regular (RAT) en reemplazo de SLYM, además de proponer su inclusión en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica, previa revisión y aprobación por parte del comité respectivo de la FIPAT. Se revisó el acrónimo SLYM y los elementos que lo conforman (membrana subaracnoidea de tipo linfática), desde un enfoque etimológico, este análisis estuvo acompañado de una revisión a las reglas RAT aceptadas por la FIPAT, que fueron consideradas para examinar su cumplimiento por parte del acrónimo SLYM. Se encontró que SLYM, al igual que los términos que lo componen no cumplen totalmente con las reglas RAT. El acrónimo SLYM no proporciona una descripción adecuada de la estructura que representa, lo que contradice las reglas RAT. Se propone el término Suprapiamater como alternativa, para su inclusión en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica, basado en elementos latinos que describen su ubicación y función, mejorando la precisión y claridad en la comunicación científica.

SUMMARY: Throughout history, knowledge about the meninges has evolved from the first records in the Edwin Smith papyrus to the present, where SLYM, a fourth meninge that separates the subarachnoid space into a superficial compartment and another, has been described deep, to which semipermeable barrier and immune cell niche functions are attributed for the surveillance and protection of the central nervous system. The FIPAT contains a group of terminologies that are globally accepted for the description of the structures of the human body, however, in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, the term SLYM to represent a fourth meninge is not yet included, perhaps because be a recent discovery. The objective of this study was to suggest a new term that agrees with the FIPAT guidelines and with the Regular Anatomical Terminology (RAT) rules to replace SLYM, in addition to proposing its inclusion in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, previously review and approval by the respective FIPAT committee. The acronym SLYM and the elements that make it up (Subarachnoid Lymphatic-like Membrane) were reviewed from an etymological approach. This analysis was accompanied by a review of the RAT rules accepted by FIPAT, which were considered to examine their compliance by the acronym SLYM. It was found that SLYM, like the terms that compose it, do not fully comply with the RAT rules. The SLYM acronym does not provide an adequate description of the structure it represents, which contradicts the RAT rules. The term suprapiamater is proposed as an alternative, for inclusion in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, based on Latin elements that describe its location and function, improving precision and clarity in scientific communication.

Brain insulin resistance and Alzheimer's disease: a systematic review / Resistência insulínica cerebral e a doença de Alzheimer: uma revisão sistemática

ABSTRACT. The disability of cells to react to insulin, causing glucose intolerance and hyperglycemia, is referred to as insulin resistance. This clinical condition, which has been well-researched in organs such as adipose tissue, muscle, and liver, has been linked to neurodegenerative diseases like Alzheimer's disease (AD) when it occurs in the brain. Objective: The authors aimed to gather data from the current literature on brain insulin resistance (BIR) and its likely repercussions on neurodegenerative disorders, more specifically AD, through a systematic review. Methods: A comprehensive search was conducted in multiple medical databases, including the Cochrane Central Register of Controlled Trials, EMBASE, Medical Literature Analysis and Retrieval System Online (Medline), and PubMed®, employing the descriptors: "insulin resistance", "brain insulin resistance", "Alzheimer's disease", "neurodegeneration", and "cognition". The authors focused their search on English-language studies published between 2000 and 2023 that investigated the influence of BIR on neurodegenerative disorders or offered insights into BIR's underlying mechanisms. Seventeen studies that met the inclusion criteria were selected. Results: The results indicate that BIR is a phenomenon observed in a variety of neurodegenerative disorders, including AD. Studies suggest that impaired glucose utilization and uptake, reduced adenosine triphosphate (ATP) production, and synaptic plasticity changes caused by BIR are linked to cognitive problems. However, conflicting results were observed regarding the association between AD and BIR, with some studies suggesting no association. Conclusion: Based on the evaluated studies, it can be concluded that the association between AD and BIR remains inconclusive, and additional research is needed to elucidate this relationship.

RESUMO. A incapacidade das células de reagir à insulina, ocasionando intolerância à glicose e hiperglicemia, é chamada de resistência à insulina. Essa condição clínica, que tem sido bem pesquisada em órgãos como tecido adiposo, músculo e fígado, tem sido associada às doenças neurodegenerativas como a doença de Alzheimer (DA) quando ocorre no cérebro. Objetivo: O objetivo dos autores foi reunir os dados da literatura atual sobre a resistência insulínica cerebral (RIC) e sua provável repercussão em doenças neurodegenerativas, mais especificamente na DA, por meio de uma revisão sistemática da literatura. Métodos: Foi realizada uma pesquisa abrangente em vários bancos de dados médicos, incluindo o Cochrane Central Register of Controlled Trials, EMBASE, Medical Literature Analysis and Retrieval System Online (Medline) e PubMed, empregando os descritores: "resistência à insulina", "resistência insulínica cerebral", "doença de Alzheimer", "neurodegeneração" e "cognição". Os autores concentraram sua busca em estudos no idioma inglês publicados entre 2000 e 2023 que investigaram a influência da RIC em distúrbios neurodegenerativos ou ofereceram insights sobre os mecanismos subjacentes da RIC. Dezessete estudos que atenderam aos critérios de inclusão foram selecionados. Resultados: Os resultados demonstram que a RIC é um fenômeno observado em uma variedade de doenças neurodegenerativas, incluindo a DA. Estudos sugerem que a utilização e captação prejudicadas de glicose, a produção reduzida de trifosfato de adenosina (ATP) e as alterações na plasticidade sinápticas causadas pela RIC estão ligadas a problemas cognitivos. No entanto, foram observados resultados conflitantes com relação à associação entre DA e RIC, com alguns estudos sugerindo nenhuma associação. Conclusão: Com base nos estudos avaliados, pode-se concluir que a associação entre DA e RIC ainda é inconclusiva, e pesquisas adicionais são necessárias para elucidar essa relação.

Manejo neuroquirúrgico de absceso epidural post traumatismo craneoencefálico: a propósito de un caso / Neurosurgical management of epidural abscess after traumatic brain injury: a case report

RESUMEN El traumatismo craneoencefálico es un evento ocasionado por la fuerza sobre el continente que guarda al contenido cerebral, que hace que la inercia ocasione lesiones por aceleración y desaceleración produciendo hemorragias y/o fracturas Estas pueden generar una serie de complicaciones como el absceso epidural que al estar muy cerca al cerebro constituye una emergencia, siendo complejo su manejo y seguimiento. En esta oportunidad mostramos el caso de un paciente con absceso epidural ocasionado por traumatismo craneoencefálico y manejo neuroquirúrgico, con buena evolución clínica.

ABSTRACT Cranioencephalic trauma is an event caused by force on the container that holds the brain content, which causes inertia to cause acceleration and deceleration injuries, producing hemorrhages and/or fractures; These can generate a series of complications such as epidural abscess which, being very close to the brain, constitutes an emergency for its management and follow-up15. On this occasion we show the case of a patient with epidural abscess caused by cranioencephalic trauma and neurosurgical management.

Hallazgos en imágenes por resonancia magnética de pacientes con tuberculoma intracraneal en un centro privado de Lima, Perú / Magnetic resonance imaging findings of patients with intracranial tuberculoma in a private center in Lima, Peru

RESUMEN Una de las formas del cuadro inflamatorio-infeccioso de la tuberculosis, problema mayor de salud pública en América Latina, Asia y África y con potencial extensión mundial, es la forma parenquimal tumoral en el encéfalo, conocida como granuloma tuberculoso o tuberculoma. Este cuadro condiciona comúnmente efectos de masa y edema perilesional, los cuales suelen confundirse con manifestaciones radiológicas de otros granulomas y masas neoplásicas, en especial, las de alto grado. Son por ello necesarios estudios minuciosos de carácter clínico, epidemiológico, exámenes de laboratorio y, sobre todo, de imágenes por resonancia magnética. Se comparten en este artículo algunas observaciones de imágenes de casos comprobados de granuloma tuberculoso en el encéfalo, en pacientes examinados en un centro privado de diagnóstico radiológico por resonancia magnética en Lima. Los hallazgos podrían ayudar en el diagnóstico relativamente temprano de casos, previniéndose así el avance de la enfermedad y sus consecuencias, así como el empleo de métodos diagnóstico-terapéuticos invasivos.

ABSTRACT One of the forms of the inflammatory-infectious condition of tuberculosis, a major public health problem in Latin America, Asia and Africa with a potential worldwide spread, is the parenchymal tumor form in the brain, known as tuberculous granuloma or tuberculoma. This form commonly induces a mass effect and perilesional edema, which are often confused with the radiological manifestations of other granulomas and neoplastic masses, especially high-grade ones. Therefore, it is necessary to conduct careful clinical and epidemiological studies, laboratory tests and, above all, magnetic resonance imaging explorations. In this article, we share some MRI observations of proven cases of tuberculous granulomas in the brain, in patients seen at an MRI diagnostic radiological center. The findings could help in a relatively early diagnosis of cases, thus preventing the progression of the disease with its well-known consequences, and the use of invasive diagnostic/therapeutic methods.

Asociación entre el polimorfismo Val66Met del gen BDNF y el desarrollo de disfunción ejecutiva en pacientes con cáncer de mama

Introducción. La disfunción ejecutiva asociada a quimioterapia es un efecto adverso del tratamiento antineoplásico convencional y afecta a un porcentaje considerable de personas. Se ha reportado que la presencia de ciertos polimorfismos en genes relevantes puede causar mayor susceptibilidad a padecerlo. Objetivo. Determinar la relación entre el polimorfismo Val66Met (196 G>A) del gen BDNF y el desarrollo de disfunción ejecutiva en mujeres con cáncer de mama tratadas con quimioterapia. Métodos. Se evaluaron a 73 pacientes mujeres con cáncer de mama para determinar disfunción ejecutiva antes y después de la quimioterapia. La evaluación fue realizada con la prueba INECO Frontal Screening (IFS). Se determinó el genotipo (GG=Val/Val, GA=Val/Met y AA=Met/Met) por PCR y secuenciamiento del gen BDNF. El análisis de asociación se realizó mediante el cálculo del odds ratio (OR). Resultados. El 13,7% (n = 10) de pacientes presentó el alelo A (GA y AA), además obtuvieron puntajes significativamente menores de la prueba IFS comparado con las homocigotas GG (p A) del gen BDNF y el desarrollo de disfunción ejecutiva en pacientes con cáncer de mama tratadas con quimioterapia; sin embargo, las portadoras del alelo A (Met) presentaron puntajes menores en la evaluación cognitiva.

Introduction. Chemotherapy-associated executive dysfunction is an adverse effect of conventional antineoplastic treatment that affects many patients. It has been reported that the presence of specific polymorphisms in key genes can cause a greater susceptibility to develop this condition. Objective. To determine the relationship between the Val66Met polymorphism (196 G>A) of the BDNF gene and the development of executive dysfunction in female patients with breast cancer treated with chemotherapy. Methods. 73 female breast cancer patients were evaluated for executive dysfunction before and after chemotherapy. The evaluation was carried out with the INECO Frontal Screening test (IFS). The genotype (GG=Val/Val, GA=Val/Met and AA=Met/Met) was determined by PCR and sequencing of BDNF gene. Association analysis was performed by calculating the Odds Ratio (OR) and by quantitative comparison. Results. 13.7% (n = 10) of the sample presented the allele A (GA and AA), which obtained significantly lower scores in the IFS test compared to the homozygous GG (p A) polymorphism of the BDNF gene and the development of executive dysfunction in patients with breast cancer treated with chemotherapy. However, patients with the allele A (Met) presented significant lower scores in the cognitive assessment.

Brain-derived neurotrophic factor interplay with oxidative stress: neuropathology approach in potential biomarker of Alzheimer's disease / Interação do fator neurotrófico encefálico com o estresse oxidativo: abordagem neuropatológica a um potencial biomarcador da doença de Alzheimer

ABSTRACT The aging population poses a serious challenge concerning an increased prevalence of Alzheimer's disease (AD) and its impact on global burden, morbidity, and mortality. Oxidative stress, as a molecular hallmark that causes susceptibility in AD, interplays to other AD-related neuropathology cascades and decreases the expression of central and circulation brain-derived neurotrophic factor (BDNF), an essential neurotrophin that serves as nerve development and survival, and synaptic plasticity in AD. By its significant correlation with the molecular and clinical progression of AD, BDNF can potentially be used as an objectively accurate biomarker for AD diagnosis and progressivity follow-up in future clinical practice. This comprehensive review highlights the oxidative stress interplay with BDNF in AD neuropathology and its potential use as an AD biomarker.

RESUMO O envelhecimento da população representa um sério desafio no que diz respeito ao aumento da prevalência da doença de Alzheimer (DA) e o seu impacto na carga, morbidade e mortalidade globais. O estresse oxidativo, como uma marca molecular que causa suscetibilidade na DA, interage com outras cascatas de neuropatologia relacionadas à DA e diminui a expressão do fator neurotrófico encefálico (brain-derived neurotrophic factor - BDNF), uma neurotrofina essencial que serve como desenvolvimento e sobrevivência nervosa, e plasticidade sináptica na DA. Pela sua correlação significativa com a progressão molecular e clínica da DA, o BDNF pode potencialmente ser usado como um biomarcador objetivamente preciso para o diagnóstico da DA e acompanhamento da progressividade na prática clínica futura. Esta revisão abrangente destacou a interação do estresse oxidativo com o BDNF na neuropatologia da DA e seu uso potencial como biomarcador da DA.

Factores asociados al desarrollo de secuelas por trauma craneoencefálico en menores de 15 años: un estudio de cohorte retrospectiva en un hospital de Medellín, Colombia. 2010-2014 / Factors associated with the development of sequelae due to traumatic brain injury in children under 15 years old: a retrospective cohort study in a hospital in Medellín, Colombia. 2010-2014

Introducción: el trauma craneoencefálico es una de las principales causas de morbimortalidad infantil en Colombia, sus secuelas impactan gravemente la calidad de vida de los pacientes y la evidencia científica actual de los factores asociados al trauma es escasa. Objetivo: analizar los factores asociados al desarrollo de secuelas por trauma craneoencefálico en menores de 15 años que consultaron a un hospital de Medellín entre 2010 y 2014. Materiales y métodos: estudio de cohorte retrospectivo. Se incluyeron 812 pacientes en un periodo de 5 años, de los cuales 294 no cumplieron los criterios de inclusión. Se evaluaron variables sociodemográficas, clínicas y se estimó la incidencia de secuelas con el método estadístico de Wilson. El riesgo relativo se calculó mediante regresión log-binomial. Resultados: en total se analizaron 518 pacientes. La mediana de edad fue de 5 años, el 64,3 % eran hombres, el 75,4 % de los participantes tenía un trauma leve y el 5 % un trauma grave. Las caídas fueron la principal causa (64,2 %), seguidas de los accidentes de tránsito (25,3 %). La incidencia de secuelas fue del 7.3 % (IC: 5,4 % - 9,9 %). Conclusiones: la carga de enfermedad en el paciente posterior a TCE representa un problema de salud pública. La probabilidad de desarrollar una secuela en este estudio fue del 7,3 %, la cual se relaciona con los siguientes factores que se identifican en el servicio de urgencias: lesión difusa, una escala de Glasgow al ingreso moderada o grave y sufrir un accidente de tránsito.

Background: traumatic brain injury is one of the main causes of infant morbidity and mortality. The sequelae after trauma seriously impact the quality of life of patients and the scientific evidence of associated factors is scarce. Objective: to analyze the factors associated with the development of sequelae due to head trauma in children under 15 years old who went to the emergency room of a hospital in Medellín between 2010 and 2014. Materials and methods: retrospective cohort study. 812 patients were included in a period of 5 years, of which 294 did not meet the inclusion criteria. Sociodemographic and clinical variables were evaluated and the incidence of sequelae was estimated with 95 % confidence intervals using the Wilson statistical method. The relative risk was calculated using log-binomial regression. Results: a total of 518 patients were analyzed. The median age was 5 years, 64,23 % were male children, 75,4 % had mild trauma, and 5 % suffered severe trauma. Falls were the main cause (64,2 %), followed by traffic accidents (25,3 %). The incidence of sequelae was 7,3 % (CI: 5,4% - 9,9 %). Conclusions: the burden of disease in the patient after TCE represents a public health problem. The probability of developing a sequel in this study was 7,3 %, which is related to the following factors that identify in the emergency department: diffuse injury, a moderate or severe Glasgow scale on admission, and suffering a traffic accident.

Fístula nasal de líquido cefalorraquídeo post-traumática. Resultados de la implementación de un protocolo de trabajo / Post-traumatic cerebrospinal fluid nasal leak. Results of the implementation of a work protocol

Introducción: Los pacientes con fracturas de base de cráneo anterior post traumatismo encéfalo-craneano tienen alto riesgo de fístula de líquido céfalo-raquídeo por las fosas nasales. Es importante el manejo oportuno y apropiado, evitando así complicaciones; razón por la cual se desarrolló el "protocolo HP" para su tratamiento quirúrgico. Objetivo: Comunicar la utilidad del "protocolo HP" en el manejo de la fístula de líquido céfalo-raquídeo de la base de cráneo anterior. Materiales y métodos: Estudio transversal retrospectivo con pacientes ≥ 15 años con diagnóstico de fístula de líquido céfalo-raquídeo nasal post traumatismo encéfalo-craneano, desde 1/1/2016 hasta 31/8/2021 que ingresaron al hospital y requirieron cirugía de reparación, con 28 pacientes incluidos, el valor p ˂0,05 (estadísticamente significativo). Resultados: 96,4% hombres, mayoría adultos jóvenes con traumatismo encéfalo-craneano leve; 82,1% presentó fístula de líquido céfalo-raquídeo temprana. Todos requirieron reparación transcraneal frontal, en 67,9% fue bilateral. La reparación antes de los 7 días fue en el 39,3%, 7-21 días en 46,4% y después de 21 días en 14,3% de los casos. Uso de drenaje lumbar continuo: preoperatorio 10,7%, intraoperatorio 60,7%, postoperatorio 46,4%. En el 89,3% la ubicación de la fístula de líquido céfalo-raquídeo intra-quirúrgica fue congruente con la tomografía. Desde el 2020 se sistematizó el manejo de las fístula de líquido céfalo-raquídeo. La recurrencia fue de 10,7% antes del 2020 (posteriormente fue de 0%), asociándose con Glasgow bajo e inicio de fístula de líquido céfalo-raquídeo 7 días post traumatismo encéfalo-craneano (p˂0,05). Complicaciones encontradas: meningitis 28,6%, convulsión 25%, anosmia 14,3%, neumoencéfalo a tensión 7,1% y absceso 3,6%. Mortalidad por fístula de líquido céfalo-raquídeo: 3,6%. Curación 96,4%. Conclusiones: La aplicación del "Protocolo HP" tuvo resultados satisfactorios. La tasa de recurrencia postoperatoria de fístula de líquido céfalo-raquídeo nasal post traumatismo encéfalo-craneano fue 0%(AU)

Background: Patients with anterior skull base fractures after traumatic brain injury have a high risk of cerebrospinal fluid leak through the nostrils. Timely and appropriate management is important, avoiding complications. The "HP protocol" for surgical treatment was developed. Objectives: To communicate the utility of the "HP protocol" in the management of the anterior skull base cerebrospinal fluid leak. Methods: Retrospective cross-sectional study; patients ≥ 15 years old with a diagnosis of nasal cerebrospinal fluid leak after traumatic brain injury, who were admitted at the hospital from 1/1/2016 to 8/31/2021 and required surgery. Included 28 patients, p value ˂0.05 (statistically significant). Results: 96.4% men, mostly young adults with mild traumatic brain injury; 82.1% presented early cerebrospinal fluid leak. All required frontal transcranial repair, in 67.9% it was bilateral. Repair before 7 days was in 39.3%, 7-21 days in 46.4%, and after 21 days in 14.3%. Use of continuous lumbar drainage: preoperative 10.7%, intraoperative 60.7%, postoperative 46.4%. In 89.3%, the location of the intraoperative cerebrospinal fluid leak was consistent with the CT scan. Since 2020, the management of the cerebrospinal fluid leak was systematized. The recurrence was 10.7% before 2020; after it was 0% and associated with low Glasgow and onset of cerebrospinal fluid leak 7 days after traumatic brain injury (p<0.05). Complications: meningitis 28.6%, seizure 25%, anosmia 14.3%, high tension pneumocephalus 7.1% and abscess 3.6%. Cerebrospinal fluid leak mortality: 3.6%. Cure 96.4%. Conclusions: The application of the "HP Protocol" had satisfactory results. The post traumatic brain injury nasal cerebrospinal fluid leak recurrence rate was 0%

Producción científica sobre traumatismo craneoencefálico en revistas estudiantiles cubanas. Enero de 2015-junio de 2021

Introducción: los traumatismos craneoencefálicos son un reto para los servicios de salud. Recibir desde pregrado una formación en su atención constituye una necesidad. Objetivo: caracterizar la producción científica sobre traumatismo craneoencefálico, publicada en revistas estudiantiles cubanas entre enero de 2015 y junio de 2021. Materiales y métodos: se realizó un estudio bibliométrico, descriptivo y retrospectivo. El universo estuvo constituido por nueve artículos, de los que se analizó tipología, año de publicación, cantidad de autores, provincia y centro de procedencia de los mismos, cantidad de referencias, cantidad de artículos por revista y número de veces citados. Resultados: el 77,8 % de los artículos fueron originales, y 2020 fue el año más productivo (55,6 %). El 44,4 % de los artículos fue firmado por cinco autores; el 32,4 % de los autores pertenecían a la provincia de Pinar del Río. La media de referencias por artículos fue de 19,9; el Índice de Price se encontró entre 0,45 y 0,82, con una media de 0,75. El 55,6 % de las publicaciones aparecieron en la revista Universidad Médica Pinareña, cuyos artículos también fueron los más citados (85 %). Conclusiones: la producción científica estudiantil sobre trauma craneoencefálico es baja, y la influencia y visibilidad de los artículos disponibles, atendiendo a la cantidad de citas, es pequeña.

Introduction: crania-encephalic traumas are a challenge for health services. Receiving training on their care since undergraduate studies is a necessity. Objective: to characterize the scientific production on crania-encephalic trauma published in Cuban student journals between January 2015 and June 2021. Materials and methods: a bibliometric, descriptive and retrospective study was carried out. The universe was constituted by 9 articles, of which typology, year of publication, quantity of authors, province and centers of origin, quantity of references; quantity of articles per journal and number of times cited were analyzed. Results: 77.8% of the articles were originals, and 2020 was the most productive year (55.6%). 44% of the articles were signed by five authors; 32.4% of the authors belonged to the province of Pinar del Rio. The average number of references per articles was 19.9; the Price Index was found between 0.45 and 0.85, with an average of 0.75. 55.6% of the publications appeared in the journal Universidad Médica Pinareña, the articles of which were also the most cited ones (85%). Conclusions: the student scientific production on crania-encephalic trauma is low, and the influence and visibility of the available articles, taking into account the quantity of cites, is small.

Perfil neuropsicológico en pacientes con trauma craneoencefálico atendidos en un hospital de alta complejidad de Medellín, Colombia / Neuropsychological profile of patients with traumatic brain injury evaluated in a high complexity hospital in Medellin, Colombia

RESUMEN INTRODUCCIÓN: El trauma craneoencefálico (TCE) es una de las principales causas de daño cerebral y discapacidad en personas menores de 40 años. Según su severidad, se puede clasificar en leve, moderado o grave, en función de la escala de coma de Glasgow. Muchos pacientes quedan con secuelas neuropsicológicas y comportamentales que pueden afectar en mayor o menor grado su funcionalidad. El objetivo del estudio fue determinar las diferencias en el perfil neuropsicológico, las características clínicas y el compromiso funcional en pacientes con TCE según la clasificación de la severidad. METODOLOGÍA: Se realizó un estudio observacional, analítico, de corte transversal. Se revisaron las historias clínicas y los reportes neuropsicológicos de adultos con TCE evaluados por neuropsicología entre los años 2014 y 2019. Se compararon los resultados de pruebas neuropsicológicas, síndromes neuropsicológicos y funcionalidad según la severidad del TCE. RESULTADOS: Se estudiaron 48 pacientes, 38 de ellos hombres (73 %), con una mediana de edad de 35 años (RI: 25-51). En 14 casos el TCE fue leve, en 18 moderado y en 16 severo. El síndrome neuropsicológico más frente fue el amnésico (100 %), seguido del disejecutivo (79 %) y el compromiso en la atención (77 %). No se encontraron diferencias según severidad del TCE. Cuarenta y un pacientes (85 %) presentaron cambios comportamentales, 14 (29 %) experimentaron alteración en las actividades básicas de la vida diaria y 32 (68 %) en las actividades instrumentales. CONCLUSIONES: Las alteraciones neuropsicológicas, comportamentales y funcionales posteriores a un TCE son frecuentes, sin embargo, no se encontraron diferencias significativas según severidad del trauma.

ABSTRACT INTRODUCTION: Traumatic Brain Injury (TBI) is one of the main causes of brain damage and disability in people under 40 years of age. The severity of TBI can be classified as mild, moderate, or severe based on the Glasgow coma scale. Many patients are left with neuropsychological and behavioral sequelae that can affect functionality to a greater or lesser degree. The objective of the study was to determine the differences in the neuropsychological profile, clinical characteristics and functional impairment in patients with TBI according to severity. METHODOLOGY: An observational, analytical, cross-sectional study was carried out. The clinical records and neuropsychological reports of adults with TBI evaluated between 2014 and 2019 were reviewed. The results of neuropsychological tests, neuropsychological syndromes, and functionality according to severity of TBI were compared. RESULTS: 48 patients were studied, 35 were males (73 %), the median age was 35 years (IR: 25-51). In 14 TBI was mild, in 18 moderate and 16 severe. The most common neuropsychological syndrome was amnesic (100 %) followed by dysexecutive (79 %) and attentional commitment (77 %). No differences were found according to severity of TBI. 41 patients (85 %) presented behavioral changes, 14 (29 %) presented alteration in basic activities of daily life and 32 (68 %) in instrumental activities. CONCLUSIONS: Neuropsychological, behavioral and functional alterations are frequent after TBI; however, no significant differences were found according to the severity of the trauma.

Evaluación tomográfica de las cisternas basales

Introducción: Las características radiológicas de las cisternas de la base son de interés en el diagnóstico, evolución y pronóstico de los pacientes con lesiones traumáticas. En la actualidad el estado de las mismas es un factor predictivo importante en pacientes con trauma craneoencefálico severo. En la mayor parte se refieren solo a cisternas normales, comprimidas o ausentes. Objetivo: Determinar las dimensiones normales de las principales cisternas basales en la tomografía y su relación con la edad y el sexo. Métodos: Se realizó un estudio analítico, de corte transversal en un periodo de dos meses: marzo y abril de 2021, en labor conjunta de los servicios de Neurocirugía e Imagenología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey. El universo quedó formado por 101 pacientes mayores de 18 años con tomografías de cráneo sin alteraciones. El estudio incluyó la evaluación de las imágenes de TAC simples de cráneo de pacientes con sospecha de enfermedad cerebrovascular, estudio de epilepsia de debut tardío, síndrome confucional o de síndrome cefalálgico. Se evaluaron la cisterna crural, interpeduncular, ambiens y cuadrigeminal. Las mensuraciones fueron realizadas siempre por especialistas en Imagenología y Neurocirugía con años de experiencia. El criterio básico de selección fue que la tomografía fuera informada sin alteraciones, independiente de la edad y el sexo. Resultados: De los 101 pacientes, 53 fueron del sexo masculino y 48 correspondieron al sexo femenino. El promedio del diámetro de la cisterna interpeduncular fue de 5,5 mm, la cisterna crural promedió 2,3 mm, mientras que la cisterna ambiens y la cuadrigeminal promediaron 3,1 mm y 5 mm respectivamente. Los mayores de 60 años tuvieron las cisternas basales con mayor diámetro. Conclusiones: El diámetro de las cisternas basales varía con la edad, no así con el sexo. Esto está determinado por el envejecimiento fisiológico del cerebro.

Introduction: The radiological characteristics of the cisterns of the base are of interest in the diagnosis, evolution and prognosis of patients with traumatic injuries. Currently, their condition is an important predictive factor in patients with severe head trauma. For the most part they refer only to normal, compressed or absent cisterns. Objective: To determinate the normal measurements of the principal basal cisterns in a tomagraphy and their relation with age and sex. Methods: An analytical, cross-sectional study was carried out in a period of two months: March and April 2021, in joint work of the Neurosurgery and Imaging services of the Manuel Ascunce Domenech University Hospital in Camagüey province. The universe was made up of 101 patients over 18 years of age with skull tomographies without alterations. The study included the evaluation of simple CT images of the skull of patients with suspected cerebrovascular disease, study of late-onset epilepsy, confusional syndrome or cephalalgic syndrome. The crural, interpeduncular, ambiens and quadrigeminal cistern were evaluated. The measurements were always performed by specialists in Imaging and Neurosurgery with years of experience. The basic selection criterion was that the tomography was reported without alterations, regardless of age and sex. Results: The sample was 101 patients, 53 males and 48 females. The average width of the interpeduncular cistern was 5.5 mm, besides crural cistern averages 2.3 mm and the ambiens and cuadrigeminal cisterns average 3.1 mm and 5 mm respectively. The patients older than 60 years had major dimensions of the cranial cisterns. Conclusions: The width of basal cisterns could be change with age but not with sex. This is associated with brain physiological aging.

Una presentación inusual de fístula carótido-cavernosa secundaria a trauma craneoencefálico leve: reporte de caso / An unusual presentation of carotid-cavernosa fistula secondary to mild craneoenephalic trauma: a case report

Resumen La fístula carótido-cavernosa es cualquier comunicación anómala entre la arteria carótida y el seno cavernoso que genera un shunt arteriovenoso patológico, se manifiesta en forma anterógrada a la órbita, causa ceguera y oftalmoparesia. Su asociación con trauma craneoencefálico leve es escasa y poco reportada, por lo que se desconoce su prevalencia. Se reporta un paciente masculino de 54 años proveniente de Cali, Colombia, con antecedente de trauma craneoencefálico leve 2 meses antes del ingreso, quien presenta cuadro de cefalea holocraneal y alteraciones visuales. Al examen físico presentó oftalmoparesia, con ptosis palpebral bilateral asimétrica y proptosis pulsátil izquierda; se realizó resonancia magnética cerebral simple y angioresonancia, con hallazgos sugestivos de fístula carótido-cavernosa. El paciente fue llevado a arteriografía más embolización, logrando un resultado favorable. La presencia de cefalea con banderas rojas, alteraciones visuales, proptosis pulsátil y el antecedente de trauma craneoencefálico, sin importar su grado, pueden hacer sospechar la presencia de esta entidad.

Abstract The carotid-cavernous fistula is any abnormal communication between the carotid artery and the cavernous sinus, generating a pathological arteriovenous shunt manifesting anterograde to the orbit, causing blindness and ophthalmoparesis. Its association with mild head trauma is scarce and underreported, its prevalence being unknown. A 54-year-old male patient from Cali - Colombia is reported, with a history of mild cranioencephalic trauma 2 months ago, who consulted for a holocranial headache and visual disturbances. On physical examination he presented ophthalmoparesis, with bilateral asymmetric palpebral ptosis with left pulsatile proptosis. A simple brain magnetic resonance and angio-MRI was performed, with findings suggestive of a carotid-cavernous fistula. The patient was taken to arteriography plus embolization, achieving a favorable result. The presence of headache with red flags, visual disturbances, pulsatile proptosis, and a history of head trauma, regardless of its degree, can lead to suspect the presence of this entity.

Perspectiva histórica del trastorno del espectro del autismo / Historical perspective of autism spectrum disorder

RESUMEN INTRODUCCIÓN: El presente artículo incluye una mirada histórica de algunas teorías y clasificaciones del trastorno del espectro del autismo (TEA), incluyendo a los autores más reconocidos y las perspectivas semiológicas vigentes. Se pretende contribuir así a la unificación de criterios entre los profesionales, y propender por la reflexión acerca de las consecuencias de una conceptualización desacertada del trastorno. MATERIALES Y MÉTODO: Se trata de una revisión documental de artículos indexados en bases de datos, y otros documentos seleccionados intencionalmente. RESULTADOS: Tres categorías a saber fueron consideradas para la organización de la información: a) de la ficción a la ciencia: el paso de la sintomatología mítica a la clasificación nosológica; b) los pioneros austríacos: la dualidad inicial que se transformó en espectro; y c) trastorno del espectro del autismo: una trayectoria en la estructuración de sus criterios diagnósticos. DISCUSIÓN Y CONCLUSIONES: La variabilidad en las hipótesis etiológicas, así como en la manifestación de los síntomas nucleares del TEA, han impactado en su clasificación y abordaje terapéutico. Se requiere una actualización permanente de los profesionales por el avance de la genética y las neurociencias, siendo posible la futura generación de cambios en el rol de los profesionales que intervienen en su detección, evaluación e intervención.

ABSTRACT Introduction: This article involves a historical review of some theories and classifications of autism spectrum disorder (ASD), including the most recognized authors and current semiological perspectives. In this way, it is intended to contribute to the unification of criteria among professionals, and to encourage reflection on the consequences of an unwise conceptualization of the disorder. Materials and methods: It is a documentary review of articles indexed in databases, and other intentionally selected documents. Results: Three categories, namely, were considered for the organization of the information: a) from fiction to science: the transition from mythical symptomatology to nosological classification; b) the Austrian pioneers: the initial duality that became a spectrum; and c) autism spectrum disorder: a trajectory in the structuring of its diagnostic criteria. Discussion and conclusions: The variability in the etiological hypotheses, as well as in the manifestation of the core symptoms of ASD, have impacted its classification and therapeutic approach. A permanent update of professionals is required due to the advancement of genetics and neurosciences, making possible the future generation of changes in the role of professionals involved in its detection, evaluation and intervention.

Effect of providing purple sweet potato water extract on tumor necrosis factor-α levels, protein 53 expression, glial fibrillary acidic protein expression, brain-derived neurotrophic factor levels, and spatial working memory in rats with d-galactose induction / Efeito do extrato de água de batata doce roxo no fator de necrose tumoral níveis alfa, na expressão da proteína 53, na expressão de proteína ácida fibrilar glial, nos níveis de fator neurotrófico cerebral e na memória espacial em ratos com indução de d-galactose

ABSTRACT. Alzheimer's dementia (AD) is a neurodegenerative disease. The mechanism of oxidative stress in AD is due to amyloid beta (Aβ) protein that aggregates to form plaques, which further triggers chronic inflammation and neuronal apoptosis. Purple sweet potato extract with the main content of anthocyanins is a potential antioxidant with a direct target on the amyloid cascade hypothesis. Objective: The research objective was to determine the role of purple sweet potato water extract as an antioxidant and anti-inflammatory in preventing apoptosis in order to provide a neuroprotective effect in d-galactose-induced rats. Methods: A total of 100 male Wistar rats with randomized posttest-only control group design that met the eligibility criteria were included in this study. The treatment group was given 200 mg/kg BW/day of purple sweet potato water extract on days 1-70. d-galactose induction was administered in the treatment and control groups on days 15-70. Results: The independent t-test showed that the mean tumor necrosis factor-α (TNF-α) levels in the treatment group (735.36±139.74) was significantly lower than that in the control group (896.77±152.52). The p53 and glial fibrillary acidic protein (GFAP) expressions of astrocyte cells in the treatment group were significantly lower than that in the control group. The brain-derived neurotrophic factor (BDNF) levels in the treatment group (498.13±121.47) were higher than that in the control (391.93±140.28), and there was a significant increase in spatial working memory in the treatment group (72.01±10.22) than the control (59.77±11.87). Conclusions: The neuroprotective effect of purple sweet potato extract is due to d-galactose induction resulting from decrease in TNF-α levels, p53 expression, and GFAP expression and increase in BDNF levels and spatial working memory.

RESUMO. A doença de Alzheimer (DA) é uma doença neurodegenerativa. O mecanismo de estresse oxidativo na DA ocorre devido à proteína beta amilóide que se agrega para formar placas que desencadeiam inflamação crônica e apoptose neuronal. O extrato de batata-doce roxa composto principalmente por antocianinas é um potencial antioxidante com efeito direto sobre a hipótese da cascata amilóide. Objetivo: O objetivo da pesquisa foi determinar o papel do extrato aquoso de batata-doce roxa como antioxidante e anti-inflamatório na prevenção da apoptose, para proporcionar um efeito neuroprotetor em ratos induzidos por D-galactose. Métodos: Grupo controle randomizado pós-teste com 100 ratos Wistar machos que preencheram os critérios de elegibilidade. O grupo de tratamento recebeu 200mg/kg de peso corporal/dia de extrato aquoso de batata-doce roxa nos dias 1-70. A indução de D-galactose foi testada nos grupos de tratamento e controle nos dias 15-70. Resultados: O teste t independente mostrou que a média dos níveis de TNF-α no grupo de tratamento (735,36±139,74) foi significativamente menor do que no grupo controle (896,77±152,52). A expressão de p53 e a expressão de GFAP de células de astrócitos foram significativamente menores no grupo de tratamento do que no grupo controle. Os níveis de BDNF no grupo de tratamento (498,13±121,47) foram maiores que no grupo controle (391,93±140,28) e houve um aumento significativo da memória de trabalho espacial no grupo de tratamento (72,01±10,22) em relação ao controle (59,77±11,87). Conclusões: O efeito neuroprotetor do extrato de batata-doce roxa é devido à indução de D-galactose pela diminuição dos níveis de TNF-α, expressão de p53 e expressão de GFAP, aumentando assim os níveis de BDNF e memória espacial.