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.

Neurocysticercosis as a cause of epilepsy and seizures in two community-based studies in a cysticercosis-endemic region in Peru.

BACKGROUND: The prevalence of epilepsy added to inadequate treatment results in chronic morbidity and considerable mortality in poor populations. Neurocysticercosis (NCC), a helminthic disease of the central nervous system, is a leading cause of seizures and epilepsy in most of the world. METHODS: Taking advantage of a cysticercosis elimination program, we performed two community-based cross-sectional studies between 2006 and 2007 in 58 rural communities (population 20,610) to assess the prevalence and characteristics of epilepsy and epileptic seizures in this endemic region. Serological and computed tomography (CT) data in individuals with epilepsy were compared to previous surveys in general population from the same region. PRINCIPAL FINDINGS: In two surveys, 17,450 individuals were evaluated. Lifetime prevalence of epilepsy was 17.25/1000, and prevalence of active epilepsy was 10.8/1000 inhabitants. The prevalence of epilepsy increased after age 25 years and dropped after age 45. Only 24% (45/188) of patients with active epilepsy were taking antiepileptic drugs, all at sub-therapeutic doses. Antibodies to cysticercosis were found in approximately 40% of individuals with epilepsy in both studies. In one survey only individuals presenting strong antibody reactions were significantly associated with having epilepsy (OR 5.74; p<0.001). In the second, the seroprevalence as well as the proportion presenting strong antibody reactions were both significantly higher in individuals with epilepsy (OR 2.2 and 4.33, respectively). Brain CT showed NCC-compatible images in 109/282 individuals with epilepsy (39%). All individuals with viable parasites on CT were seropositive. CONCLUSION: The prevalence of epilepsy in this cysticercosis endemic region is high and NCC is an important contributor to it.

Las encefalomiopatías mitocondriales: a propósito de 3 casos con oftalmoplejia / The mitochondrials encephalomiopaties to purpose of three cases with ophtalmoplejia

Se describe a las encefalomiopatías mitocondriales como un grupo de enfermedades con determinante genético ligado a un defecto en la fosforilación oxidativa. Se describe el cuadro clínico de tres casos con oftalmoplejia. Se discute los casos a la luz de información reciente acerca de las enfermedades descritas y se concluye que no es posible aún demostrar y explicar la razón del fenotipo variable.

La paraparesia espástica tropical: a propósito de un caso / The tropical spastic paraparesis: apropos of a case

Se describe el caso de una paciente con una paraparesia espástica tropical, causada por el vírus HTLV-1. Se trata de una señorita de 26 años de edad que ha presentado dos cuadros diferentes: uno en relación con una cisticercosis cerebral, que comenzó en 1975 y el otro que es motivo de este trabajo. En 1979, comenzó a presentar una paraparesia pura de evolución muy lenta. Recientemente se ha podido demostrar, en la sangre y en el LCR, la presencia del virus humano T linfotropo tipo I. A propósito de la paciente se describe la enfermedad, los hallazgos paraclínicos más importantes. Los autores desean llamar la atención sobre esta patología que puede ser frecuente en nuestro medio

Degeneración hepato lenticular: enfermedad de Wilson / Hepatolenticular degeneration: Wilson's disease

Estudio de un caso de Degeneración Hepato Lenticular (Enfermedad de Wilson) en un paciente joven. Se analizan los criterios clínicos y de laboratorio empleados en el diagnóstico, lo mismo que la actualización en el abordaje terapéutico de esta dolencia

Nuevos conceptos en el tratamiento de la neurosifilis: a propósito de dos casos / New concepts in the treatment of neurosyphilis: apropos of 2 cases

La sífilis del sistema nervioso ha aumentado en los últimos años en frecuencia. Se ha comprobado, por otro lado, la ineficacia de los tratamientos con penicilina de acción retardada y de corta duración. A propósito de dos casos recientemente estudiados, los autores hacen una revisión de la clínica de la neurolúes y proponen un esquema terapéutico de larga duración y utilizando penecilina cristalina