La fatiga en el daño cerebral sobrevenido / Fatigue in patients with acquired brain damage

La fatiga es un síndrome multidimensional, complejo y frecuente en los pacientes con daño cerebral sobrevenido, influyendo negativamente en el proceso de neurorrehabilitación. Aparece desde etapas tempranas luego de la lesión y puede permanecer en el tiempo, recuperadas o no las secuelas del daño. La fatiga depende de circuitos neuronales superiores y se define como una percepción anómala de sobreesfuerzo. Tiene una prevalencia de 29% a 77% tras el ictus, 18% a 75% tras el traumatismo craneoencefálico (TCE) y 47% a 97% tras tumores cerebrales. La fatiga se asocia a factores como sexo femenino, edad avanzada, familia disfuncional, antecedentes patológicos específicos, estado funcional (p. ej. fatiga previa a la lesión), comorbilidades, estado anímico, discapacidad secundaria y uso de ciertos fármacos. Su estudio se realiza sobre todo a partir de escalas como la Escala de severidad de fatiga (Fatigue Severity Scale). Hoy en día existen avances en herramientas de imagen para su diagnóstico como la resonancia magnética funcional. En cuanto a su tratamiento, no existe aún terapia farmacológica definitiva, sin embargo, existen resultados positivos con terapias dentro de la neurorrehabilitación convencional, terapia lumínica y el uso del neurofeedback, estimulación eléctrica y magnética transcraneal. Esta revisión tiene como objetivo ayudar al profesional dedicado a la neurorrehabilitación a reconocer factores asociados modificables, así como terapias a su alcance para disminuir sus efectos nocivos en el paciente. (AU)

Fatigue is a complex, multidimensional syndrome that is prevalent in patients with acquired brain damage and has a negative impact on the neurorehabilitation process. It presents from early stages after the injury, and may persist over time, regardless of whether sequelae have resolved. Fatigue is conditioned by upper neuronal circuits, and is defined as an abnormal perception of overexertion. Its prevalence ranges from 29% to 77% after stroke, from 18% to 75% after traumatic brain injury, and from 47% to 97% after brain tumours. Fatigue is associated with factors including female sex, advanced age, dysfunctional families, history of specific health conditions, functional status (eg, fatigue prior to injury), comorbidities, mood, secondary disability, and the use of certain drugs. Assessment of fatigue is fundamentally based on such scales as the Fatigue Severity Scale (FSS). Advances have recently been made in imaging techniques for its diagnosis, such as in functional MRI. Regarding treatment, no specific pharmacological treatment currently exists; however, positive results have been reported for some conventional neurorehabilitation therapies, such as bright light therapy, neurofeedback, electrical stimulation, and transcranial magnetic stimulation. This review aims to assist neurorehabilitation professionals to recognise modifiable factors associated with fatigue and to describe the treatments available to reduce its negative effect on patients. (AU)

Long-term outcomes after new onset seizure in children living with HIV: A cohort study.

OBJECTIVE: To determine the long-term outcomes, including mortality and recurrent seizures, among children living with HIV (CLWH) who present with new onset seizure. METHODS: Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent seizures. Demographic data, clinical profiles, index seizure etiology, and 30-day mortality outcomes were previously reported. After discharge, children were followed quarterly to identify recurrent seizures and death. Given the high risk of early death, risk factors for recurrent seizure were evaluated using a model that adjusted for mortality. RESULTS: Among 73 children enrolled, 28 died (38%), 22 within 30-days of the index seizure. Median follow-up was 533 days (IQR 18-957) with 5% (4/73) lost to follow-up. Seizure recurrence was 19% among the entire cohort. Among children surviving at least 30-days after the index seizure, 27% had a recurrent seizure. Median time from index seizure to recurrent seizure was 161 days (IQR 86-269). Central nervous system opportunistic infection (CNS OI), as the cause for the index seizure was protective against recurrent seizures and higher functional status was a risk factor for seizure recurrence. SIGNIFICANCE: Among CLWH presenting with new onset seizure, mortality risks remain elevated beyond the acute illness period. Recurrent seizures are common and are more likely in children with higher level of functioning even after adjusting for the outcome of death. Newer antiseizure medications appropriate for co-usage with antiretroviral therapies are needed for the care of these children. CNS OI may represent a potentially reversible provocation for the index seizure, while seizures in high functioning CLWH without a CNS OI may be the result of a prior brain injury or susceptibility to seizures unrelated to HIV and thus represent an ongoing predisposition to seizures. PLAIN LANGUAGE SUMMARY: This study followed CLWH who experienced a new onset seizure to find out how many go on to have more seizures and identify any patient characteristics associated with having more seizures. The study found that mortality rates continue to be high beyond the acute clinical presentation with new onset seizure. Children with a CNS OI causing the new onset seizure had a lower risk of later seizures, possibly because the trigger for the seizure can be treated. In contrast, high functioning children without a CNS OI were at higher risk of future seizures.

Chronic brain damage in HIV-infected individuals under antiretroviral therapy is associated with viral reservoirs, sulfatide release, and compromised cell-to-cell communication.

HIV infection has become a chronic and manageable disease due to the effective use of antiretroviral therapies (ART); however, several chronic aging-related comorbidities, including cognitive impairment, remain a major public health issue. However, these mechanisms are unknown. Here, we identified that glial and myeloid viral reservoirs are associated with local myelin damage and the release of several myelin components, including the lipid sulfatide. Soluble sulfatide compromised gap junctional communication and calcium wave coordination, essential for proper cognition. We propose that soluble sulfatide could be a potential biomarker and contributor to white matter compromise observed in HIV-infected individuals even in the current ART era.

A Comprehensive and Advanced Mouse Model of Post-Traumatic Epilepsy with Robust Spontaneous Recurrent Seizures.

Traumatic brain injury (TBI) is a leading cause of epilepsy in military persons and civilians. Spontaneous recurrent seizures (SRSs) occur in the months or years following the injury, which is commonly referred to as post-traumatic epilepsy (PTE). Currently, there is no effective treatment or cure for PTE; therefore, there is a critical need to develop animal models to help further understand and assess mechanisms and interventions related to TBI-induced epilepsy. Despite many attempts to induce PTE in animals, success has been limited due to a lack of consistent SRSs after TBI. We present a comprehensive protocol to induce PTE after contusion brain injury in mice, which exhibit robust SRSs along with neurodegeneration and neuroinflammation. This article provides a complete set of protocols for injury, outcomes, troubleshooting, and data analysis. Our broad profiling of a TBI mouse reveals features of progressive, long-lasting epileptic activity, hippocampal sclerosis, and comorbid mood and memory deficits. Overall, the PTE mouse shows striking consistency in recapitulating major hallmark features of human PTE. This mouse model will be helpful in assessing mechanisms of and interventions for TBI-induced epileptogenesis, epilepsy, and neuropsychiatric dysfunction. © 2022 Wiley Periodicals LLC. Basic Protocol 1: Inducing controlled cortical impact injuries Support Protocol: Creating the custom domed camp Basic Protocol 2: Recording long-term video-EEG signals Basic Protocol 3: Analyzing video-EEG recordings.

Social and physical environmental factors in daily stepping activity in those with chronic stroke.

BACKGROUND, PURPOSE/OBJECTIVE: Walking behavior in the chronic stroke population is multi-factorial. Previous work focused on the role of physical and biopsychosocial factors in understanding daily stepping post stroke. However, qualitative evidence suggests that social and physical environmental factors also affect daily stepping in those with stroke. The purpose of this study was to understand the role of social and physical environmental factors in daily stepping after stroke. METHODS: A total of 249 individuals ≥6 months post stroke were included in this cross-sectional analysis (129 females, mean age 62.98 years, SD 11.94). The social environment included living situation, work status, and marital status. The physical environment included the Area Deprivation Index (ADI) and Walk Score. At least 3 days of stepping was collected using an accelerometry-based device. Predictors were entered sequentially into a regression model: demographic characteristics, social environmental factors, and physical environmental factors. RESULTS: After adjusting for demographic factors, social environmental factors explained 6.2% (p =.017) of the variance in post stroke daily stepping. The addition of physical environmental factors improved the model (ΔR2 =.029, p =.024). The final model explained 9.2% (p =.003) of the variance in daily stepping. Lower area deprivation (ADI ß = -0.178, p =.015) and working (working vs. retired ß = -0.187, p = .029 and working vs. unemployed ß = -0.227, p =.008) were associated with greater daily stepping. DISCUSSION/CONCLUSION: Social and physical environmental factors predicted daily stepping and should be considered when setting expectations relative to the effects of rehabilitation on daily stepping in individuals poststroke.

[Meta-Cognitive Ability and Brain Damage in Autoimmune Encephalitis: A Case Report]. / Otoimmün Ensefalitte Beyin Hasari ve Üst Bilissel Beceri: Bir Olgu Sunumu.

Autoimmune encephalitis is an important contributor to rapidly progressive cognitive and behavioral decline. The purpose of this work was to evaluate the effects of cognitive rehabilitation in a patient with autoimmune encephalitis. We also wanted to evaluate the effectiveness of rehabilitative treatment by monitoring the cognitive and metacognitive outcomes over a time interval. We reported a case of 22 year-old female patient with autoimmune encephalitis, cognitive behavioral impairments, and severe reduction in metarepresentational capacity. We performed an assessment of personality, neuropsychological, and meta-cognitive functions at the beginning of the rehabilitative training. The last evaluation was performed six months after the discharge from the rehabilitation unit. We applied a combination of remediation, psycho-educational treatment, and psychotherapy to improve the knowledge and the empathy of the patient, to promote the selfcontrol strategies, and to prompt better behavioral management. Our findings revealed an improvement in the performance of the individual tests after rehabilitative training.

Amnesia del desarrollo y daño cerebral temprano: neuropsicología y neuroimagen / Developmental amnesia and early brain damage: neuropsychology and neuroimaging

Objetivo. Contribuir a la descripción de la amnesia del desarrollo como síndrome específico en niños que sufrieron agresión temprana, pero no masiva, de ambos hipocampos. Sujetos y métodos. Muestra de 24 escolares de ambos sexos, de 6-16 años de edad. Se distribuye en tres grupos: pacientes afectos de encefalopatía hipóxico-isquémica perinatal, con parálisis cerebral espástica, inteligencia normal y fallos de memoria (n = 8); pacientes con similares características, pero sin quejas de memoria (n = 7); y escolares sanos sin antecedentes de riesgo (n = 9) como grupo control. Se aplican escalas y tests para comprobar la normalidad intelectual y atencional, y para medir el perfil de rendimiento en tareas de memoria. En todos los sujetos, mediante resonancia magnética, se estima la presencia y grado de atrofia hipocámpica con la escala de Scheltens, y se calcula el índice espectroscópico NAA/(Cho + Cr). Resultados. El perfil neuropsicológico de los ocho pacientes del primer grupo es claramente sugestivo de amnesia el desarrollo, que contrasta con la normalidad en los otros grupos. En siete escolares con amnesia se constata bilateralmente algún grado de atrofia bihipocámpica o disminución significativa del índice NAA/(Cho + Cr). Conclusiones. La amnesia del desarrollo se caracteriza por afectación de la memoria episódica con preservación del aprendizaje semántico y procedimental. Se explica por daño parcial bihipocámpico temprano. El correcto diagnóstico permite una intervención psicoeducativa específica. En el futuro cabría ensayar terapias farmacológicas asociadas a la intervención psicoeducativa (AU)

Aim. To contribute to neuropsychological profiling of developmental amnesia subsequent to bilateral damage to both hippocampi in early age. Subjects and methods. The total sample of 24 schoolchildren from both sexes is distributed in three groups: perinatal hypoxic-ischaemic encephalopathy and everyday complaints of memory in school age (n = 8); perinatal hypoxic-ischaemic encephalopathy without memory complaints (n = 7); and a group of typically developing (n = 9). All participants in every groups did have normal general intelligence and attention. Both clinical groups had, as another clinical consequence, spastic cerebral palsy (diplegia). Neuropsychological exam consisted on tests of general intelligence, attentional abilities, declarative memory and semantic knowledge. All participants had a brain magnetic resonance image and spectroscopy of hippocampi. Scheltens criteria were used for visual estimation of hippocampal atrophy. Parametric and non-parametric statistical contrasts were made. Results. Despite preservation of semantic and procedural learning, declarative-episodic memory is impaired in the first group versus the other two groups. A significant proportion of bilateral hippocampal atrophy is only present in the first group versus the other two non-amnesic groups using Scheltens estimation on MRI. Two cases without evident atrophy did have diminished NAA/(Cho + Cr) index in both hippocampi. Conclusions. Taken together, these results contribute to delineate developmental amnesia as an specific impairment due to early partial bihippocampal damage, in agreement with previous studies. After diagnosis of developmental amnesia, a specific sychoeducational intervention must be made; also this impairment could be candidate for pharmacological trials in the future (AU)

Anormalidad en la visión del color como única manifestación de hidrocefalia normotensiva / Colour vision abnormality as the only manifestation of normal pressure hydrocephalus

CASO CLÍNICO: Presentamos el caso de un paciente varón de 73 años que acudió refiriendo visión en blanco y negro. La tomografía computarizada demostró hidrocefalia normotensiva (HNT). No se llegó a realizar resonancia magnética porque el paciente renunció a ser sometido a nuevos exámenes. DISCUSIÓN: La acromatopsia puede ser la primera o la única clínica de HNT. Puede ser prudente preguntar a los pacientes con HNT con respecto a la visión de color

CLINICAL CASE: The case is presented of a 73-year-old male patient who referred to having black and white vision. Computed tomography showed normal pressure hydrocephalus (NPH). Magnetic resonance imaging was not performed because the patient refused to undergo further examinations. DISCUSSION: Achromatopsia may be the first or only NPH symptom. It may be prudent to ask patients with NPH regarding colour vision

Ausencias sintomáticas, la etiología menos conocida de las crisis de ausencia / Symptomatic absence seizures, the least known causation of absence seizures

Introducción. Las crisis de ausencia son el paradigma de las crisis generalizadas idiopáticas de la infancia según la clasificación de la Liga Internacional contra la Epilepsia de 1981. A pesar de que las ausencias son mayoritariamente de origen idiopático, existen ausencias sintomáticas, que suponen un 10% de los casos de ausencia. Se piensa que una patología estructural puede favorecer la aparición de ausencias en individuos genéticamente predispuestos. Casos clínicos. Se presentan dos pacientes con crisis de ausencia sintomáticas de inicio en la infancia. El primero muestra un daño talámico de origen perinatal, y el segundo, un déficit del transportador de glucosa cerebral. Conclusión. Existe un porcentaje de las crisis de ausencia en la infancia que presenta un origen sintomático. Este hecho ocurre con mayor frecuencia en niños que presentan otros tipos de epilepsia, daños cerebrales focales o difusos, y en las ausencias que comienzan de forma precoz (AU)

Introduction. According to the 1981 International League Against Epilepsy classification, absence seizures are the paradigm of idiopathic generalised seizures of childhood. Although absences are mainly of an idiopathic origin, there are also symptomatic absences, which account for 10% of all cases of absences. It is thought that a structural pathology can favour the appearance of absences in genetically predisposed individuals. Case reports. We report the cases of two patients with symptomatic absence seizures of childhood onset. The first presented thalamic damage of a perinatal origin and the second had glucose transporter deficiency in the brain. Conclusion. A percentage of absence seizures in childhood are of a symptomatic origin. This occurs more frequently in children who present other types of epilepsy, focal or diffuse brain damage, and in early-onset absences (AU)

Encefalopatía traumática crónica, definición, diagnóstico y prevención: revisión de la literatura / Chronic traumatic encephalopathy, definition, diagnosis and prevention: review of literature

La encefalopatía traumática crónica (ETC) es una enfermedad neurodegenerativa que se produce como consecuencia traumatismos cerebrales repetitivos; concusiones, que son un síndrome clínico que se caracteriza por una alteración de la función cerebral. Una concusión, bajo su estricta definición, no debiese causar cambios estructurales en el cerebro por lo que no sería visible a través de imágenes, sí existen cambios a nivel microscópicos, bioquímicos y biomecánicos. La mayoría de los pacientes tienen completa resolución de sus síntomas dentro de 10 días (90 por ciento), pero existe un pequeño porcentaje que persiste con estos, pudiendo presentarse como un síndrome postconcusional, síndrome de segundo impacto o una encefalopatía traumática crónica. La ETC se caracteriza por la acumulación de prot-tau hiperfosforilada en neuronas y astrocitos. Estas se van a presentar en forma de ovillos o hilos neurofibrilares. En etapas iniciales las encontraremos de forma focalizada en la corteza frontal y en las formas más severas su distribución será más generalizada, distribuyéndose en la mayoría de las regiones del cerebro. Su diagnóstico se realiza a través de histopatología, por lo que hasta el momento sólo se ha logrado post-mortem. Se está trabajando en nuevas tecnologías asociadas a biomarcadores y PET para lograr una diagnostico premortem. El mayor énfasis en el manejo de esta taupatía es la prevención y adecuado manejo de las concusiones.

Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease which is produced as a consequence of repeated brain trauma: concussions, which are a clinical syndrome characterized by an alteration in brain functions. A concussion, understrict definition, should not cause structural changes to the brain. Therefore, it would not be possible to see through images if there were changes at a microscopic, biochemical level. Most patients see their symptoms completely resolved within 10 days (90 percent), but there is a small percentage which persists, and these might cause a post-concussional syndrome, second impact syndrome of chronic traumatic encephalopathy. CTE is characterized by the accumulation of hyper-phosphorylated Tau protein in neurons and astrocytes. These appear in the form of neurofibrillary tangles. During the initial stages they are focalized in the frontal cortex and, in more severe cases, their distribution is more generalized, spreading through the majority of the regions in the brain. It is diagnosis is done through histopathology. Thus, it has only been possible to do post mortem. New technologies associated with bio-markers and PET are being worked on to achieve a pre-mortem diagnosis. The greatest emphasis in the handling of this tauopathy lies in the prevention and the adequate handling of concussions.

Should we add visual acuity ratios to referral criteria for potential cerebral visual impairment? / ¿Se deberían incorporar los ratios de agudeza visual a los criterios de derivación en los casos de discapacidad visual cerebral potencial?

Purpose: To determine whether the assessment of visual acuity ratios might improve the referral of children with (sub)normal visual acuity but at risk of cerebral visual impairment. Methods: In an exploratory study, we assessed visual acuity, crowding ratio and the ratios between grating acuity (Teller Acuity Cards-II) and optotype acuity (Cambridge Crowding Cards) in 60 typically developing school children (mean age 5y8m±1y1m), 21 children with ocular abnormalities only (5y7m±1y9m) and 26 children with (suspected) brain damage (5y7m±1y11m). Sensitivities and specificities were calculated for targets and controls from the perspective of different groups of diagnosticians: youth health care professionals (target: children with any visual abnormalities), ophthalmologists and low vision experts (target: children at risk of cerebral visual impairment). Results: For youth health care professionals subnormal visual acuity had the best sensitivity (76%) and specificity (70%). For ophthalmologists and low vision experts the crowding ratio had the best sensitivity (67%) and specificity (79 and 86%). Conclusion: Youth health care professionals best continue applying subnormal visual acuity for screening, whereas ophthalmologists and low vision experts best add the crowding ratio to their routine diagnostics, to distinguish children at risk of visual impairment in the context of brain damage from children with ocular pathology only (AU)

Objetivo: Determinar si la valoración de los ratios de agudeza visual en niños podría mejorar la derivación de niños con agudeza visual (sub)normal, pero con riesgo de discapacidad visual cerebral. Métodos: En un estudio exploratorio, valoramos la agudeza visual, el ratio de aglomeración y los ratios comprendidos entre la agudeza de difracción (Teller Acuity Cards-II) y la agudeza visual de optotipos (Cambridge Crowding Cards) en 60 escolares con desarrollo normal (edad media 5.8±1,1), 21 con anomalías oculares únicamente (5,7±1,9) y 26 niños con daño cerebral (sospechado) (5,7±1,1). Las sensibilidades y especificidades fueron calculados para los casos de estudio y controles desde la perspectiva de diferentes grupos de evaluadores: profesionales sanitarios para jóvenes (objetivo: niños con cualquier anomalía visual), oftalmólogos y expertos en baja visión (objetivo: niños con riesgo de discapacidad visual cerebral). Resultados: Para los profesionales sanitarios para jóvenes la agudeza visual obtuvo la mejor sensibilidad (76%) y especificidad (70%). Para los oftalmólogos y los expertos en baja visión el ratio de aglomeración obtuvo la mejor sensibilidad (67%) y especificidad (79 y 86%). Conclusión: Los profesionales sanitarios para jóvenes siguen aplicando la agudeza visual inferior a lo normal en los exámenes visuales, mientras que los oftalmólogos y los expertos en baja visión incorporan el ratio de aglomeración a sus diagnósticos rutinarios, para distinguir a los niños con riesgo de discapacidad visual en el contexto del daño cerebral, de los niños con patología ocular únicamente (AU)

Coma prolongado: a propósito de un caso con recuperación de la conciencia tras seis meses / Prolonged coma: report of a case with good recovery of consciousness after six months

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Percutaneous Needle Tenotomy for the Treatment of Muscle and Tendon Contractures in Adults With Brain Damage: Results and Complications.

OBJECTIVE: To study the results and complications of percutaneous needle tenotomy for superficial retracted tendons in patients with brain damage. DESIGN: Prospective observational study. SETTING: University hospital. PARTICIPANTS: Patients with severe brain damage (N=38; mean age, 60.7y; age range, 24-93y; 21 women) requiring surgical management of contractures and eligible for percutaneous needle tenotomy were enrolled between February 2015 and February 2016. INTERVENTIONS: The percutaneous needle tenotomy gesture was performed by a physical medicine and rehabilitation physician trained by an orthopedic surgeon, under local or locoregional anesthesia. Treated tendons varied among patients. MAIN OUTCOME MEASURES: All patients were evaluated at 1, 3, and 6 months to assess surgical outcomes (joint range of motion [ROM], pain, and functional improvement) while screening for complications. RESULTS: Improvements in ROM (37/38) and contractures-related pain (12/12) were satisfactory. Functional results were satisfactory (Goal Attainment Scale score ≥0) for most patients (37/38): nursing (n=12), putting shoes on (n=8), getting in bed or sitting on a chair (n=6), verticalization (n=7), transfers and gait (n=8), and grip (n=2). Five patients had complications related to the surgical gesture: cast-related complications (n=2), hand hematoma (n=2), and cutaneous necrosis of the Achilles tendon in a patient with previous obliterative arteriopathy of the lower limbs (n=1). CONCLUSIONS: Percutaneous needle tenotomy yields good results in the management of selected superficial muscle and tendon contractures. The complications rate is very low, and this treatment can be an alternative to conventional surgery in frail patients with neurologic diseases.

Tratamiento rehabilitador en el paciente infantouvenil con daño cerebral adquirido / Rehabilitation treatment in child and youth patients with acquired brain injury

El daño cerebral es una de las causas más frecuentes de muerte y discapacidad en la población infantojuvenil. La mejoría en la atención a los pacientes en el momento agudo y la evolución de la asistencia sanitaria han supuesto un aumento de la supervivencia de estos pacientes y también de las secuelas. Secuelas físicas, cognitivo-conductuales u orgánicas son frecuentes, y las segundas son unas de las más frecuentes y más limitantes en estos pacientes. El daño cerebral afecta al paciente, pero involucra a toda la familia por la discapacidad que implica y por la dependencia que conlleva. El equipo es multidisciplinar, y el médico rehabilitador hace las funciones de coordinación. La familia debe recibir asistencia desde el primer día y es parte importante en la evolución adecuada de los pacientes. El tratamiento debe ser individualizado y adaptado para cada paciente, y suele durar entre 6 y 18 meses (AU)

Brain injury is one of the most frequent causes of death and disability in the child and adolescent. The improvement in patient care in the acute moment and the evolution of health care has meant and increase in the survival of these patients and also of the sequelae. Physical, cognitive-behavioral or organic symptoms are usually. The second is being one of the most frequent and most limiting in these patients. The brain injury affects the patient but involves the whole family because of the disability and the dependence it entails. The team is multidisciplinary and the rehabilitation physician performs the coordination functions. The family should receive assistance from the first day and are an important part in the proper evolution of patients. The treatment must be individualized and adapted for each patient and usually last between 6 and 18 months (AU)

Palinacusia secundaria a daño cerebral por metotrexato / Palinacousis secondary to brain damage from methotrexate

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Impacto del daño cerebral adquirido en la integración comunitaria: reinserción laboral, discapacidad y dependencia dos años después de la lesión / Impact of acquired brain injury towards the community integration: employment outcome, disability and dependence two years after injury

Objetivos. Analizar el impacto del daño cerebral adquirido en la integración comunitaria (trayectoria laboral, discapacidad y dependencia) en una muestra de sujetos con daño cerebral adquirido de etiología vascular, traumática y tumoral, durante un período de dos años tras la lesión original, y examinar qué variables sociodemográficas, datos clínicos premórbidos y relacionados con la lesión predicen la integración en la comunidad. Pacientes y métodos. Muestra de 106 sujetos adultos con daño cerebral adquirido, atendidos en el Área de Neuropsicología y Neuropsiquiatría del Complejo Hospitalario de Navarra, con déficit de memoria como secuela principal. Las diferencias entre grupos se analizan con los tests t de Student, chi al cuadrado y U de Mann-Whitney. Resultados. De los participantes que antes de la lesión se encontraban activos laboralmente, el 19% y 29% recuperaron su estatus previo al año y a los dos años, respectivamente; a un 45% de la muestra total se le reconoció la discapacidad, y a un 17%, la dependencia. No se halló relación entre las variables sociodemográficas y clínicas y los parámetros funcionales contemplados. Conclusiones. La lesión cerebral adquirida impacta con intensidad en la trayectoria vital de los afectados, aunque no se han estudiado antes en España sus consecuencias en el ajuste sociolaboral en los dos años siguientes al daño a través de parámetros funcionales valorados con instrumentos oficiales estatales en una muestra de etiología vascular, traumática y tumoral (AU)

Aims. To analyze the impact of acquired brain injury towards the community integration (professional career, disability, and dependence) in a sample of people affected by vascular, traumatic and tumor etiology acquired brain damage, over a two year time period after the original injury, and also to examine what sociodemographic variables, premorbid and injury related clinical data can predict the level of the person’s integration into the community. Patients and methods. 106 adults sample suffering from acquired brain injury who were attended by the Neuropsychology and Neuropsychiatry Department at Hospital of Navarra (Spain) affected by memory deficit as their main sequel. Differences among groups have been analyzed by using t by Student, chi squared and U by Mann-Whitney tests. Results. 19% and 29% of the participants who were actively working before the injury got back their previous status within one and two years time respectively. 45% of the total sample were recognized disabled and 17% dependant. No relationship between sociodemographic and clinical variables and functional parameters observed were found. Conclusions. Acquired brain damage presents a high intensity impact on affected person’s life trajectory. Nevertheless, in Spain, its consequences at sociolaboral adjustment over the the two years following the damage through functional parameters analyzed with official governmental means over a vascular, traumatic and tumor etiology sample had never been studied before (AU)

Rara miasis maxilar por Cochliomyia hominivorax. Reporte de caso, actualidad y entomología / A rare maxillary myiasis due to Cochliomyia hominivorax. A case report, update and entomology

La miasis maxilar es un raro padecimiento tropical y endémico de varias zonas del mundo, propio de algunos mamíferos, y el hombre no es la excepción. A continuación presentamos el primer reporte de miasis de este tipo en Ecuador, caracterizamos una masiva invasión larvaria y analizamos casos similares reportados en la literatura médica (AU)

Maxillary myiasis is a rare tropical disease, it is endemic in several areas around the world, and common of some mammals, although humans are not excluded. The first case of maxillary myiasis in Ecuador is presented, as well as a description of the massive larval invasion. Similar cases reported in the medical literature are also reviewed (AU)

Increased attentional load moves the left to the right.

INTRODUCTION: Unilateral brain damage can heterogeneously alter spatial processing. Very often brain-lesioned patients fail to report (neglect) items appearing within the contralesional space. Much less often patients mislocalize items' spatial position. We investigated whether a top-down attentional load manipulation (dual-tasking), known to result in contralesional omissions even in apparently unimpaired cases, might also induce spatial mislocalizations. METHOD: Nine right-hemisphere-damaged patients performed three computer-based tasks encompassing different levels of attentional load. The side of appearance of visual targets had to be reported either in isolation or while processing additional information (visual or auditory dual task). Spatial mislocalizations (from the contralesional hemispace towards the ipsilesional unaffected one) were then contrasted with omissions both within and across tasks, at individual as well as at group level. RESULTS: The representation of ipsilesional targets was accurate and not affected by dual-tasking requirements. Contralesional targets were instead often omitted and, under dual-task conditions, also mislocalized by four patients. Three cases reported a significant number of left targets as appearing on the right (alloesthesia). Two of these patients perceived more targets (albeit to a wrong spatial location) under dual- than under single-task load. In a fourth patient, increased visual load resulted in synchiria, the (mis)perception of single, contralesional targets as being two (one on each side). CONCLUSIONS: When the neural circuitry subtending spatial processing is damaged, an increase in task load can lead to either a disregard or a bias in the processing of contralesional hemispace. The spatial bias subtending mislocalizations seems to index a more severe deficit than neglect, as if contralesional space would be completely erased rather than merely ignored.

Utilidad clínica y propiedades psicométricas del inventario de síntomas prefrontales (ISP) en el daño cerebral adquirido y las demencias degenerativas / Clinical utility and psychometric properties of Prefrontal Symptoms Inventory (PSI) in acquired brain injury and degenerative dementias

Introducción. Las alteraciones cognitivas, emocionales y comportamentales secundarias al daño cerebral adquirido y las demencias degenerativas pueden valorarse cuantitativa y cualitativamente mediante la administración de autoinformes que interroguen –a pacientes e informadores fiables– sobre las dificultades de los pacientes en la vida cotidiana. Sujetos y métodos. Se administró el inventario de síntomas prefrontales (ISP) y el cuestionario de fallos de memoria en la vida cotidiana modificado (MFE-30) a 174 participantes emparejados: 87 pacientes con daño cerebral o demencias degenerativas y sus 87 informadores fiables. Se exploró, junto con la bondad psicométrica de las pruebas, la utilidad clínica de la aplicación de estos cuestionarios a pacientes e informadores para obtener un índice de discrepancia de las puntuaciones como medida de la anosognosia. Resultados. Los resultados muestran cómo aplicar el ISP-20 (20 ítems) o el ISP (46 ítems), sean o no administrados conjuntamente con el MFE-30 (30 ítems), resulta un procedimiento muy útil para la valoración de la sintomatología en los individuos con daño cerebral adquirido o demencias degenerativas, al proporcionar una gran cantidad de información sobre las dificultades de los pacientes en la vida cotidiana. Conclusiones. Se recomienda, junto con la obligada evaluación neuropsicológica, la cumplimentación de cuestionarios o inventarios de síntomas como los propuestos, dado que presentan ventajas desde el punto de vista clínico, además de resultar eficaces, efectivos y eficientes en términos económicos (AU)

Introduction. The cognitive, emotional and behavioural alterations secondary to acquired brain injury and degenerative dementias can be quantitatively and quantitatively appraised by administering self-reports that ask both patients and reliable informants about the difficulties patients have in their everyday life. Subjects and methods. The Prefrontal Symptoms Inventory (PSI) and the Modified Memory Failures in Everyday Life Questionnaire (MFE-30) were administered to 174 paired participants: 87 patients with brain damage or degenerative dementias and their 87 reliable informants. In addition to the psychometric goodness of the tests, the study also explored the clinical usefulness of applying these questionnaires to patients and their informants in order to obtain a rate of discrepancy in the scores as a measure of anosognosia. Results. The results show how applying the PSI-20 (20 items) or the PSI (46 items), whether administered together with the MFE-30 (30 items) or not, is a very useful procedure for assessing the symptoms in individuals with acquired brain injury or degenerative dementias, since it yields a great deal of information about patients’ difficulties in their daily life. Conclusions. We recommend that, in addition to the compulsory neuropsychological assessment, questionnaires or inventories of symptoms like those proposed here should be carried out, due to the fact that they offer a number of advantages from the clinical point of view, as well as being efficacious and effective in economic terms (AU)

The Effects of Chronic Right Hemispheric Damage on the Allocation of Spatial Attention: Alterations of Accuracy and Reliability.

Right hemispheric damage (RHD) caused by strokes often induce attentional disorders such as hemispatial neglect. Most patients with neglect over time have a reduction in their ipsilesional spatial attentional bias. Despite this improvement in spatial bias, many patients remain disabled. The cause of this chronic disability is not fully known, but even in the absence of a directional spatial attentional bias, patients with RHD may have an impaired ability to accurately and precisely allocate their spatial attention. This inaccuracy and variable directional allocation of spatial attention may be revealed by repeated performance on a spatial attentional task, such as line bisection (LBT). Participants with strokes of their right versus left (LHD) hemisphere along with healthy controls (HC) performed 24 consecutive trials of 24 cm horizontal line bisections. A vector analysis of the magnitude and direction of deviations from midline, as well as their standard deviations (SD), were calculated. The results demonstrated no significant difference between the LHD, RHD and HC groups in overall spatial bias (mean bisection including magnitude and direction); however, the RHD group had a significantly larger variability of their spatial errors (SD), and made larger errors (from midline) than did the LHD and HC groups. There was a curvilinear relationship between the RHD participants' performance variability and their severity of their inaccuracy. Therefore, when compared to HC and LHD, the RHD subjects' performance on the LBT is more variable and inaccurate.