RESUMEN
Eighty percent of people with stroke live in low- to middle-income nations, particularly in sub-Saharan Africa (SSA) where stroke has increased by more than 100% in the last decades. More than one-third of all epilepsy-related deaths occur in SSA. HIV infection is a risk factor for neurological disorders, including stroke and epilepsy. The vast majority of the 38 million people living with HIV/AIDS are in SSA, and the burden of neurological disorders in SSA parallels that of HIV/AIDS. Local healthcare systems are weak. Many standalone HIV health centres have become a platform with combined treatment for both HIV and noncommunicable diseases (NCDs), as advised by the United Nations. The COVID-19 pandemic is overwhelming the fragile health systems in SSA, and it is feared it will provoke an upsurge of excess deaths due to the disruption of care for chronic diseases such as HIV, TB, hypertension, diabetes, and cerebrovascular disorders. Disease Relief through Excellent and Advanced Means (DREAM) is a health programme active since 2002 to prevent and treat HIV/AIDS and related disorders in 10 SSA countries. DREAM is scaling up management of NCDs, including neurologic disorders such as stroke and epilepsy. We described challenges and solutions to address disruption and excess deaths from these diseases during the ongoing COVID-19 pandemic.
Asunto(s)
COVID-19 , Epilepsia , Infecciones por VIH , Accidente Cerebrovascular , África del Sur del Sahara/epidemiología , Epilepsia/epidemiología , Infecciones por VIH/epidemiología , Humanos , Pandemias , SARS-CoV-2 , Accidente Cerebrovascular/epidemiologíaRESUMEN
Two patients with post-coma reactivation deficiency who showed a "dramatic" response to rotigotine therapy are described. They had suffered from prolonged coma due to lesions in the mesencephalic ventral tegmental area. The authors believe that rotigotine effect in these cases could be due to restoration of dopaminergic transmission in medial frontal areas previously "de-afferented" from the lesions. Some comatous patients may experience a prolonged difficulty in recovering a normal state of consciousness. This phenomenon may be due to dysfunction of amynergic activating pathways connecting brainstem to the frontal cerebral cortex. In particular, dysfunction of dopaminergic pathways from the mesencephalon to the frontal cortical areas may be responsible for clinical pictures characterized by preserved alertness and total loss of interactions with the surrounding environment; the so called "waking coma" cases.
Asunto(s)
Mutismo Acinético/tratamiento farmacológico , Agonistas de Dopamina/uso terapéutico , Estado Vegetativo Persistente/tratamiento farmacológico , Tetrahidronaftalenos/uso terapéutico , Tiofenos/uso terapéutico , Administración Cutánea , Anciano , Hemorragia Cerebral/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la FunciónAsunto(s)
Infecciones por VIH/terapia , Telemedicina , Adolescente , Adulto , África del Sur del Sahara , Anciano , Niño , Preescolar , Femenino , Infecciones por VIH/psicología , Humanos , Lactante , Recién Nacido , Internet , Masculino , Persona de Mediana Edad , Neurólogos , Neurología/educación , Neurología/métodos , Cooperación del Paciente , Satisfacción del Paciente , Derivación y Consulta , Programas Informáticos , Telemedicina/métodos , Adulto JovenAsunto(s)
Apatía/efectos de los fármacos , Enfermedades Autoinmunes/tratamiento farmacológico , Enfermedades Autoinmunes/psicología , Agonistas de Dopamina/uso terapéutico , Encefalitis Límbica/tratamiento farmacológico , Encefalitis Límbica/psicología , Tetrahidronaftalenos/uso terapéutico , Tiofenos/uso terapéutico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Isolated behavioural disturbances can mimic psychiatric diseases and delay diagnosis of acute brain disease. We reported the case of a patient with carotid dissection manifesting only with apathetic syndrome that was initially considered as a possible postpartum depression, causing a threatening diagnostic delay.