[Diffusion tensor imaging of the corticospinal pathway and its association with the prognosis of acute cerebral infarction: experience with a cohort in Mexico]. / Imagen del tensor de difusión de la vía corticoespinal y su asociación con el pronóstico del infarto cerebral agudo: experiencia de una cohorte en México.

INTRODUCTION: Magnetic resonance diffusion tensor imaging through the fraction of anisotropy allows evaluation of the integrity of the motor pathways after cerebral infarction. AIMS: To correlate the fraction of anisotropy with the clinical scales and the prognosis of cerebral infarction. SUBJECTS AND METHODS: Prospective study of patients with cerebral infarction to compare the fraction of anisotropy in different regions of interest with functional evaluations and with controls free of infarction. A subgroup of subjects with rehabilitation underwent an initial MRI scan and another at three months, with clinical follow-up for six months. RESULTS: Thirty-eight consecutive patients with middle cerebral artery infarction were included. The fraction of anisotropy values were lower in the ipsilateral corticospinal pathway than the fraction of anisotropy of the corticospinal pathway of the controls. The values of the fraction of anisotropy in the ipsilateral corticospinal pathway were associated with the value of the functional scale on admission. Changes in the fraction of anisotropy values between the initial MRI and the scan performed at three months correlated with the score on the functional scale and the modified Rankin scale at three and six months. CONCLUSIONS: The value of the fraction of anisotropy in the ipsilateral internal capsule is associated with the presence of a lesion and with its presenting symptoms. Changes in the fraction of anisotropy at three months suggest long-term clinical recovery.

TITLE: Imagen del tensor de difusión de la vía corticoespinal y su asociación con el pronóstico del infarto cerebral agudo: experiencia de una cohorte en México.Introducción. La imagen del tensor de difusión por resonancia magnética a través de la fracción de anisotropía permite evaluar la integridad de las vías motoras después de un infarto cerebral. Objetivo. Correlacionar la fracción de anisotropía con las escalas clínicas y el pronóstico del infarto cerebral. Sujetos y métodos. Estudio prospectivo de pacientes con infarto cerebral para comparar la fracción de anisotropía en diferentes regiones de interés con evaluaciones funcionales y con controles sin infarto. En un subgrupo con rehabilitación, se realizó una resonancia magnética inicial y a los tres meses, con un seguimiento clínico durante seis meses. Resultados. Se incluyó a 38 pacientes consecutivos con infarto cerebral de la arteria cerebral media. Los valores de la fracción de anisotropía fueron menores en la vía corticoespinal ipsilateral que en la vía corticoespinal de los controles. Los valores de la fracción de anisotropía en la vía corticoespinal ipsilateral se asociaron con el valor de la escala funcional en el momento de su admisión. Los cambios en los valores de la fracción de anisotropía entre la resonancia magnética inicial y a los tres meses se correlacionaron con la puntuación en la escala funcional y en la escala de Rankin modificada a los tres y a los seis meses. Conclusiones. El valor de la fracción de anisotropía en la cápsula interna ipsilateral se asocia a la presencia de lesión y a su presentación clínica. Los cambios en la fracción de anisotropía a los tres meses sugieren la recuperación clínica a largo plazo.

The clinical spectrum of neurological manifestations in AIDS patients in Mexico.

BACKGROUND: Neurological complications may be present clinically in up to 39% of patients infected with HIV or AIDS. Some reports have shown different profiles of neurological illness related to geographic variations and the population studied. METHODS: This retrospective study describes the neurological manifestations of patients with AIDS seen between 1990 and 1998 at a single neurological referral hospital in Mexico City. RESULTS: One hundred forty-nine patients were included, 133 males (89%) and 16 females (10.7%). The average age was 33.8 years (9 to 75 years). Upon admission, only 50 patients (33.6%) were known to be seropositive to HIV-1. In 75 patients (50.3%), the neurological illness was definitory of AIDS and also was its first recognized clinical manifestation. The most common infection problems were brain toxoplasmosis (32.2%), meningeal cryptococcosis (21.5%), tuberculosis (8.7%), and AIDS-dementia complex (8.7%). There were eight (5.4%) cases of ischemic cerebrovascular disease and four (2. 7%) neoplasms. Two primary brain lymphomas and single cases of astrocytoma and oligodendroglioma, progressive multifocal leukoencephalopathy (PML), aseptic meningitis, acute encephalitis, transverse myelitis, myopathy, and cranial neuropathy were also seen. CONCLUSION: In comparison with other studies of neurological complications of AIDS, opportunistic infections amenable to treatment in our population were more common. A high case fatality rate was observed, as was a large proportion of patients in whom the neurological illness was the first manifestation of HIV infection or AIDS due to denied, unknown, or unrecognized risk factors for HIV infection.