Especialización en Neurologíahttps://repository.urosario.edu.co/handle/10336/12672024-03-29T04:37:13Z2024-03-29T04:37:13Z341Apparent false lateralization of seizure onset by scalp eeg in temporal lobe epilepsy associated with cerebral cavernous malformation: a case report and overviewGaviria Carrillo, Marianahttps://repository.urosario.edu.co/handle/10336/309832021-02-27T08:02:59Zdc.title: Apparent false lateralization of seizure onset by scalp eeg in temporal lobe epilepsy associated with cerebral cavernous malformation: a case report and overview
dc.description.abstract: False lateralization of ictal onset by scalp electroencephalogram (EEG) is an infrequent entity that has been reported in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (HS). In these cases, a tendency for rapid seizures that spread through the frontal-limbic system and hippocampal commissural pathways to the contralateral hemisphere has been proposed. Cerebral cavernous malformations (CCMs), which constitute a collection of abnormally configured small blood vessels with irregular structures, is a well-defined epilepsy-associated pathology. Their primary association with seizures might be explained either as a result of physiological changes affecting the cerebral cortex immediately surrounding the CCM (an epileptogenic mechanism that is relevant for both, temporal and extratemporal lesions) or as a result of promoting epileptogenicity in remote but anatomo-functionally connected brain regions, a mechanism that is particularly relevant for temporal lobe lesions. To date, there have been only two publications on falsely lateralizing ictal onsets by EEG in temporal cavernoma, but not in other regions. Here, we report a rare case of apparent false lateralization of ictal onset by scalp EEG in a patient with a left medial frontal gyrus cavernoma (supplementary motor area), and discuss some relevant pathophysiological mechanisms of false lateralization.
dc.description: La falsa lateralización del inicio ictal por electroencefalograma (EEG) del cuero cabelludo es una entidad poco frecuente que se ha descrito en pacientes con epilepsia del lóbulo temporal mesial asociada a esclerosis hipocampal (HS). En estos casos, se ha propuesto una tendencia a las convulsiones rápidas que se diseminan a través del sistema frontal-límbico y las vías comisurales del hipocampo hacia el hemisferio contralateral. Las malformaciones cavernosas cerebrales (CCM), que constituyen una colección de pequeños vasos sanguíneos configurados de forma anormal con estructuras irregulares, son una patología asociada a la epilepsia bien definida. Su asociación principal con las convulsiones podría explicarse como resultado de cambios fisiológicos que afectan a la corteza cerebral que rodea inmediatamente al CCM (un mecanismo epileptogénico que es relevante para ambos, lesiones temporales y extratemporales) o como resultado de promover la epileptogenicidad en regiones cerebrales remotas pero conectadas anatomofuncionalmente, un mecanismo que es particularmente relevante para las lesiones del lóbulo temporal. Hasta la fecha, sólo ha habido dos publicaciones sobre la lateralización falsa de los inicios ictales por EEG en el cavernoma temporal, pero no en otras regiones. Aquí, presentamos un caso raro de aparente falsa lateralización del inicio ictal por EEG del cuero cabelludo en un paciente con un cavernoma de la circunvolución frontal medial izquierda (área motora suplementaria), y discutimos algunos mecanismos fisiopatológicos relevantes de falsa lateralización. sólo ha habido dos publicaciones sobre la lateralización falsa de los inicios ictales por EEG en el cavernoma temporal, pero no en otras regiones. Aquí, presentamos un caso raro de aparente falsa lateralización del inicio ictal por EEG del cuero cabelludo en un paciente con un cavernoma de la circunvolución frontal medial izquierda (área motora suplementaria), y discutimos algunos mecanismos fisiopatológicos relevantes de falsa lateralización. sólo ha habido dos publicaciones sobre la lateralización falsa de los inicios ictales por EEG en el cavernoma temporal, pero no en otras regiones. Aquí, presentamos un caso raro de aparente falsa lateralización del inicio ictal por EEG del cuero cabelludo en un paciente con un cavernoma de la circunvolución frontal medial izquierda (área motora suplementaria), y discutimos algunos mecanismos fisiopatológicos relevantes de falsa lateralización.
Gaviria Carrillo, MarianaFalse lateralization of ictal onset by scalp electroencephalogram (EEG) is an infrequent entity that has been reported in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (HS). In these cases, a tendency for rapid seizures that spread through the frontal-limbic system and hippocampal commissural pathways to the contralateral hemisphere has been proposed. Cerebral cavernous malformations (CCMs), which constitute a collection of abnormally configured small blood vessels with irregular structures, is a well-defined epilepsy-associated pathology. Their primary association with seizures might be explained either as a result of physiological changes affecting the cerebral cortex immediately surrounding the CCM (an epileptogenic mechanism that is relevant for both, temporal and extratemporal lesions) or as a result of promoting epileptogenicity in remote but anatomo-functionally connected brain regions, a mechanism that is particularly relevant for temporal lobe lesions. To date, there have been only two publications on falsely lateralizing ictal onsets by EEG in temporal cavernoma, but not in other regions. Here, we report a rare case of apparent false lateralization of ictal onset by scalp EEG in a patient with a left medial frontal gyrus cavernoma (supplementary motor area), and discuss some relevant pathophysiological mechanisms of false lateralization.Ataxias heredodegenerativasAmaya Sarachaga, AdrianaPedraza Linares, Olga Lucíahttps://repository.urosario.edu.co/handle/10336/46062021-06-03T05:45:47Z2013-01-01T00:00:00Zdc.title: Ataxias heredodegenerativas
dc.description.abstract: NEURODEGENERATIVE DISEASES NAMED AS ATAXIA CONSTITUTES THE MOST COMMON PATHOLOGY INBETWEEN DEGENERATIVE DISEASES THAT AFFECT CEREBELLUM AND SPINE. THE PURPOSE OF THE SUBSEQUENT PAGES HAS TO BE WITH THE PATHOPHYSIOLOGY OF THIS WIDE GROUP OF ENTITIES AND THEIR PRESENTATION, THE LIMITATIONS OF DIAGNOSIS AND THE NARROW WAY OF TREATMENT
dc.description: Descripción de las ataxias heredodegenerativas con énfasis en la semiología general de este tipo de enfermedades y la fisiopatología de los grandes grupos de ataxias.
2013-01-01T00:00:00ZAmaya Sarachaga, AdrianaPedraza Linares, Olga LucíaNEURODEGENERATIVE DISEASES NAMED AS ATAXIA CONSTITUTES THE MOST COMMON PATHOLOGY INBETWEEN DEGENERATIVE DISEASES THAT AFFECT CEREBELLUM AND SPINE. THE PURPOSE OF THE SUBSEQUENT PAGES HAS TO BE WITH THE PATHOPHYSIOLOGY OF THIS WIDE GROUP OF ENTITIES AND THEIR PRESENTATION, THE LIMITATIONS OF DIAGNOSIS AND THE NARROW WAY OF TREATMENTCaracterización clínica de pacientes con trastornos del espectro de neuromielitis óptica en la ciudad de Bogotá - ColombiaCortés Bernal, GiovannyOrtiz Salas, Paola AndreaRoa W., Luis FernandoHernán Rodríguez, Jesúshttps://repository.urosario.edu.co/handle/10336/190242021-03-01T19:22:49Z2019-01-01T00:00:00Zdc.title: Caracterización clínica de pacientes con trastornos del espectro de neuromielitis óptica en la ciudad de Bogotá - Colombia
dc.description.abstract: Introduction: Neuromyelitis Optica is an inflammatory disease of the central nervous system characterized by attacks of optic neuritis and longitudinally extensive transverse myelitis. The discovery of the anti-aquaporin-4 antibody diagnostic biomarker and the magnetic resonance imaging findings in the brain have allowed the recognition of a broader and more detailed clinical phenotype entitled Neuromyelitis Optica Spectrum Disorder. Objective: To determine the demographic and clinical characteristics of patients diagnosed with NMO/NMOSD in two institutions of high level of complexity in Bogotá. Methods: A case series study was carried out. Patients >18 years of age with a diagnosis of NMO/NMOSD, assessed in the neurology service of two high level of complexity hospitals between 2013 and 2017, with the availability of imaging studies and serology results, were included. Demographic, clinical and imaging variables were evaluated, and an analysis of these variables was performed according to seropositivity of Ac-AQP4. Results: Twenty-six patients with NMO/NMOSD were included (18 women, median age of 53.5 years, P25-P75=40.5-58.0, all of them of mixed-race). The median age of onset was 46.5 years (P25-P75=34.2-54.0), most patients had clinical manifestations at sensory (n=22) and motor levels (n=20), in six patients (n=6) a concomitant autoimmune disease was identified and in seven (n=7) patients’ greater disability was identified. Seropositivity for Ac-AQP4 was found in sixteen patients (n= 16), no statistically significant differences were found in the distribution of the study variables according to the serology result. The most frequent imaging findings were optic nerve lesions (n=14) and spinal cord lesions (n=16). Conclusions: NMO/NMOSD is an inflammatory pathology mediated by antibodies, with preference for female patients with ages over 40 years and whose greatest commitment is manifested in the optic nerve and cord medullar. The seropositivity of Ac-AQP4 in patients with this pathology seems to be related to specific clinical, imaging and laboratory characteristics, which should be study more detailed and in broader populations.
dc.description: Introducción: La neuromielitis óptica es una enfermedad inflamatoria del sistema nervioso central caracterizada por ataques de neuritis óptica y mielitis transversa longitudinalmente extensa. El descubrimiento del biomarcador diagnóstico anticuerpo anti-acuaporina-4 y los hallazgos imagenológicos en resonancia magnética cerebral, han permitido el reconocimiento de un fenotipo clínico más amplio y detallado denominado espectro neuromielitis óptica. Objetivo: Determinar las características demográficas y clínicas de los pacientes diagnosticados con NMO/NMOSD en dos instituciones de cuarto nivel de complejidad en Bogotá. Métodos: Se realizó un estudio tipo serie de casos. Fueron incluidos aquellos pacientes >18 años con diagnóstico de NMO/NMOSD, valorados en el servicio de neurología de dos hospitales de alta complejidad entre los años 2013 y 2017, con disponibilidad de estudios imagenológicos y resultados de serología. Se evaluaron variables demográficas, clínicas e imagenológicas y se realizó un análisis de estas variables según seropositividad del Ac-AQP4. Resultados: Se incluyeron 26 pacientes con NMO/NMOSD (18 mujeres, mediana de edad de 53.5 años; P25-P75= 40.5-58.0, todos de raza mestiza). La mediana de edad de inicio fue de 46.5 años (P25-P75=34.2-54.0), la mayoría de los pacientes tuvo manifestaciones clínicas a nivel sensitivo (n=22) y motor (n=20), en seis (n=6) pacientes se identificó una enfermedad autoinmune concomitante y en siete (n=7) pacientes se identificó discapacidad mayor. Se registró seropositividad para Ac-AQP4 en dieciséis pacientes (n=16), no se encontraron diferencias estadísticamente significativas en la distribución de las variables de estudio según el resultado de la serología. Los hallazgos imagenológicos más frecuentes fueron lesiones del nervio óptico (n=14) y lesiones en cordón medular (n=16). Conclusiones: La NMO/NMOSD es una patología inflamatoria mediada por anticuerpos, con preferencia por pacientes del sexo femenino con edades superiores a los 40 años y cuyo mayor compromiso se manifiesta en el nervio óptico y el cordón medular. La seropositividad del Ac-AQP4 en pacientes con esta patología parece relacionarse con características clínicas, imagenológicas y de laboratorio particulares, que deben ser estudiadas de manera más detallada en poblaciones más amplias.
2019-01-01T00:00:00ZCortés Bernal, GiovannyOrtiz Salas, Paola AndreaRoa W., Luis FernandoHernán Rodríguez, JesúsIntroduction: Neuromyelitis Optica is an inflammatory disease of the central nervous system characterized by attacks of optic neuritis and longitudinally extensive transverse myelitis. The discovery of the anti-aquaporin-4 antibody diagnostic biomarker and the magnetic resonance imaging findings in the brain have allowed the recognition of a broader and more detailed clinical phenotype entitled Neuromyelitis Optica Spectrum Disorder. Objective: To determine the demographic and clinical characteristics of patients diagnosed with NMO/NMOSD in two institutions of high level of complexity in Bogotá. Methods: A case series study was carried out. Patients >18 years of age with a diagnosis of NMO/NMOSD, assessed in the neurology service of two high level of complexity hospitals between 2013 and 2017, with the availability of imaging studies and serology results, were included. Demographic, clinical and imaging variables were evaluated, and an analysis of these variables was performed according to seropositivity of Ac-AQP4. Results: Twenty-six patients with NMO/NMOSD were included (18 women, median age of 53.5 years, P25-P75=40.5-58.0, all of them of mixed-race). The median age of onset was 46.5 years (P25-P75=34.2-54.0), most patients had clinical manifestations at sensory (n=22) and motor levels (n=20), in six patients (n=6) a concomitant autoimmune disease was identified and in seven (n=7) patients’ greater disability was identified. Seropositivity for Ac-AQP4 was found in sixteen patients (n= 16), no statistically significant differences were found in the distribution of the study variables according to the serology result. The most frequent imaging findings were optic nerve lesions (n=14) and spinal cord lesions (n=16). Conclusions: NMO/NMOSD is an inflammatory pathology mediated by antibodies, with preference for female patients with ages over 40 years and whose greatest commitment is manifested in the optic nerve and cord medullar. The seropositivity of Ac-AQP4 in patients with this pathology seems to be related to specific clinical, imaging and laboratory characteristics, which should be study more detailed and in broader populations.Caracterización de la actividad lúpica en sistema nervioso central y periférico de pacientes con LES y enfermedad renal crónica en estadio finalBonilla Navarrete, Andres Mauriciohttps://repository.urosario.edu.co/handle/10336/321572021-11-06T06:01:01Zdc.title: Caracterización de la actividad lúpica en sistema nervioso central y periférico de pacientes con LES y enfermedad renal crónica en estadio final
dc.description.abstract: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown cause. Neuropsychiatric involvement is a relatively common complication during lupus activity and is characterized by focal neurological syndromes, diffuse psychiatric syndromes, and / or peripheral nervous system involvement. There is significant variability in the prevalence and incidence of these manifestations with a range of 4-91% for CNS involvement and 8-40% for the PNS. It usually occurs during the early course of the disease and can be the debut symptom in 39-50% of SLE patients. End-stage chronic kidney disease is a common complication of patients with SLE, and dialysis therapy has been associated with disease remission. However, some recent studies have found persistence of disease activity after the onset of kidney complications. Recent data show that more than 50% of patients with SLE will develop clinically relevant nephritis at some point during the course of their disease, while in 20% of these patients, kidney damage progresses to end-stage renal disease (CKD5D) . The divergence in the studies on lupus activity after the start of renal replacement therapy makes it necessary to carry out new studies that make it possible to elucidate the behavior of the disease before and after its onset. Therefore, the purpose of the present investigation is to describe the effect of dialysis on the lupus activity of the nervous system in patients with SLE and end-stage chronic kidney disease. In conclusion, we found that lupus activity in the nervous system is less frequent (3%) in patients with RRT vs (12%) in patients without RRT. Additionally, after 1 year of initiating RRT, it seems to decrease the risk of autoimmune activity.
dc.description: El lupus eritematoso sistémico (LES) es una enfermedad autoinmune y crónica de causa aún desconocida (1). El compromiso neuropsiquiátrico es una complicación relativamente frecuente durante la actividad lúpica y se caracteriza por síndromes neurológicos focales, síndromes psiquiátricos difusos y/o compromiso del sistema nervioso periférico. Existe una importante variabilidad en la prevalencia e incidencia de estas manifestaciones con un rango de 4-91% para el compromiso del SNC y 8-40% para el SNP (2). Usualmente ocurre durante el curso temprano de la enfermedad y puede ser el síntoma de debut en el 39-50% de los pacientes con LES (2). La enfermedad renal crónica en estadio final es una complicación frecuente de los pacientes con LES y la terapia dialítica se ha relacionado con remisión de la enfermedad (3). Sin embargo algunos estudios recientes han encontrado persistencia de la actividad de la enfermedad después del advenimiento de las complicaciones renales (4-8). Datos recientes muestran que más del 50% de los pacientes con LES desarrollarán una nefritis clínicamente relevante en algún momento durante el curso de su enfermedad, mientras en el 20% de estos pacientes, el daño renal progresa a enfermedad renal en estadio final (ERC5D) (9). La divergencia en los estudio sobre la actividad lúpica después del inicio de terapia de reemplazo renal obliga a realizar nuevos estudios que permitan dilucidar el comportamiento de la enfermedad antes y después de su inicio. Por lo tanto el propósito de la presente investigación es describir el efecto de la diálisis en la actividad lúpica del sistema nervioso en pacientes con LES y enfermedad renal crónica en estadio final. En conclusión, nosotros encontramos que la actividad lúpica en el sistema nervioso es menos frecuente (3%) en los pacientes con TRR vs (12%) en los pacientes sin TRR. Adicionalmente después de 1 año de iniciada la TRR parece disminuir el riesgo de actividad autoinmune.
Bonilla Navarrete, Andres MauricioSystemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown cause. Neuropsychiatric involvement is a relatively common complication during lupus activity and is characterized by focal neurological syndromes, diffuse psychiatric syndromes, and / or peripheral nervous system involvement. There is significant variability in the prevalence and incidence of these manifestations with a range of 4-91% for CNS involvement and 8-40% for the PNS. It usually occurs during the early course of the disease and can be the debut symptom in 39-50% of SLE patients. End-stage chronic kidney disease is a common complication of patients with SLE, and dialysis therapy has been associated with disease remission. However, some recent studies have found persistence of disease activity after the onset of kidney complications. Recent data show that more than 50% of patients with SLE will develop clinically relevant nephritis at some point during the course of their disease, while in 20% of these patients, kidney damage progresses to end-stage renal disease (CKD5D) . The divergence in the studies on lupus activity after the start of renal replacement therapy makes it necessary to carry out new studies that make it possible to elucidate the behavior of the disease before and after its onset. Therefore, the purpose of the present investigation is to describe the effect of dialysis on the lupus activity of the nervous system in patients with SLE and end-stage chronic kidney disease. In conclusion, we found that lupus activity in the nervous system is less frequent (3%) in patients with RRT vs (12%) in patients without RRT. Additionally, after 1 year of initiating RRT, it seems to decrease the risk of autoimmune activity.Caracterización de los pacientes con ataque cerebrovascular isquémico agudo en la Fundación CardioinfantilBeltran Echeverry, MarlynConcha Patiño, Marcelahttps://repository.urosario.edu.co/handle/10336/180232024-02-29T15:23:49Z2018-01-01T00:00:00Zdc.title: Caracterización de los pacientes con ataque cerebrovascular isquémico agudo en la Fundación Cardioinfantil
dc.description.abstract: Introduction: Currently treatment is available to prevent ischemic injury in patients with acute stroke. However, its use is limited to those who attend during the first 6 hours. The aim of this study is to describe the clinical behavior of patients with acute stroke in the Fundación Cardioinfantil. Materials and methods: observational, retrospective study, case series, of patients older than 18 years with acute stroke who attended the Fundación Cardioinfantil; between June 2016 and July 2017; demographic, clinical characteristics and timeliness of care were evaluated. The outcome and complications were evaluated in the patients who received treatment. Results: 84 patients consulted for acute stroke and 53.6% were women, with an average age of 71.5 years. The average window time was 233 minutes (SD = 259.4); the average hospitalization time was 11.1 days (SD = 11.8); with RANKIN at discharge ≥3 in 39 patients (46.4%). 41 (48.8%) patients entered the window for reperfusion therapy and 17 (41.5%) received treatment. The decrease in the NIHSS scale at 24 hours in the treated patients was ≥ 4 in 13 patients (76.47%) and the mortality related to CVA was presented in 11.76% (n = 2) of the treated population. Discussion: the percentage of patients with acute ischemic stroke who received treatment was low; the main reason is the admission outside the therapeutic window. Timely intervention evidenced a significant decrease in the NIHSS scale in the majority of patients, with considerable improvement in the RANKIN at discharge.
dc.description: Introducción: Actualmente se dispone de tratamiento para evitar la lesión isquémica en pacientes con ACV agudo; sin embargo, su uso es limitado a quienes acuden durante las primeras 6 horas. El objetivo de este estudio es describir el comportamiento clínico de los pacientes con ACV agudo en la Fundación Cardioinfantil. Materiales y métodos: estudio observacional, retrospectivo, serie de casos, de pacientes mayores de 18 años con ACV agudo, que acudieron, a la Fundación Cardioinfantil; entre junio de 2016 a julio de 2017; se evaluaron características demográficas, clínicas y oportunidad en la atención. En los pacientes intervenidos se evaluó el resultado y las complicaciones. Resultados: 84 pacientes consultaron por ACV agudo y el 53.6% fueron mujeres, con una edad media de 71,5 años. El tiempo de ventana promedio fue 233 minutos (DE=259.4); el tiempo promedio de hospitalización fue 11.1 días (DE=11,8); con RANKIN al egreso ≥3 en 39 pacientes (46,4%). 41 (48,8%) pacientes ingresaron en ventana para terapias de reperfusión y 17 (41,5%) fueron intervenidos. El descenso en la escala de NIHSS a las 24 horas en los pacientes intervenidos fue ≥ 4 en 13 pacientes (76,47%) y la mortalidad relacionada a ACV se presentó en 11,76%(n=2) de la población tratada. Discusión: el porcentaje de pacientes con ACV isquémico agudo intervenidos fue bajo; el principal motivo es el ingreso fuera de la ventana terapéutica. La intervención oportuna evidencio un descenso significativo en la escala de NIHSS en la mayoría de los pacientes, con mejoría considerable en el RANKIN al egreso.
2018-01-01T00:00:00ZBeltran Echeverry, MarlynConcha Patiño, MarcelaIntroduction: Currently treatment is available to prevent ischemic injury in patients with acute stroke. However, its use is limited to those who attend during the first 6 hours. The aim of this study is to describe the clinical behavior of patients with acute stroke in the Fundación Cardioinfantil. Materials and methods: observational, retrospective study, case series, of patients older than 18 years with acute stroke who attended the Fundación Cardioinfantil; between June 2016 and July 2017; demographic, clinical characteristics and timeliness of care were evaluated. The outcome and complications were evaluated in the patients who received treatment. Results: 84 patients consulted for acute stroke and 53.6% were women, with an average age of 71.5 years. The average window time was 233 minutes (SD = 259.4); the average hospitalization time was 11.1 days (SD = 11.8); with RANKIN at discharge ≥3 in 39 patients (46.4%). 41 (48.8%) patients entered the window for reperfusion therapy and 17 (41.5%) received treatment. The decrease in the NIHSS scale at 24 hours in the treated patients was ≥ 4 in 13 patients (76.47%) and the mortality related to CVA was presented in 11.76% (n = 2) of the treated population. Discussion: the percentage of patients with acute ischemic stroke who received treatment was low; the main reason is the admission outside the therapeutic window. Timely intervention evidenced a significant decrease in the NIHSS scale in the majority of patients, with considerable improvement in the RANKIN at discharge.Causas de no trombolisis en ataque cerebrovascularMeza Bejarano, Luis YilberAmaya Gonzalez, PabloRodriguez, Jesúshttps://repository.urosario.edu.co/handle/10336/41202021-06-03T05:47:25Z2013-01-01T00:00:00Zdc.title: Causas de no trombolisis en ataque cerebrovascular
dc.description.abstract: Introduction. Stroke ranks first in frequency among all adult neurological diseases, and it is the third most frequent cause of death. In order to have an acute management, it was approved therapy with recombinant tissue plasminogen activator (t-PA) in the first 4,5 hours after symptoms onset, showing a longer survival and lower level of disability. However only 5-10% of patients receive this management.
These are the reasons why it is necessary to know which factors are associated with non-therapeutic intervention. Objective: To describe factors associated with non-thrombolysis in patients with stroke in a level IV hospital in Bogota, Colombia. Methods: Cross-sectional analytical study at a level IV hospital in Bogota between January 2009 and January 2011.
Results: We found 178 patients at an average age of 65.9 years (± 10 years) with a male to female ratio 1:1, the leading cause of non-thrombolysis was greater than window 4.5 hours, 33.7% (n = 60), 26.4% by changes in diagnostic image, and 14% for mild or sever scores on the scale National Institute of Health Stroke Scale (NIHSS), surgical history 7.3% and laboratory 4.5%.
The average time of attention was 23 minutes (SD ± 21 min.) for the stroke code ACV activation, 39 minutes for evaluation of neurology (DE ± 25 min), 46 minutes (DE ± 19,1 min), for making paraclinical issues, 66 minutes for images shooting and 97 minutes for thrombolysis (SD ± 21 min, SD ± 17 min, respectively). Thrombolysis was performed in 17 patients, 9.6%.
No significant association between organizational culture with thrombolysis or service time with thrombolysis was found.
Conclusions. The main reason for not thrombolysis was the window increased to 4.5 hours, there was no relationship between institutional organizational culture with thrombolysis. The average time was 90 minutes thrombolysis. Measures should be in place to reduce the time of arrival at the hospital, and the times of emergency care. New assessments should be performed after stroke code improvement strategies.
dc.description: Introducción. El ataque cerebrovascular (ACV) ocupa el primer lugar en frecuencia entre todas las enfermedades neurológicas de la vida adulta, y el tercer lugar como causa más frecuente de muerte. Se aprobó para el manejo agudo, la terapia con activador del plasminógeno tisular recombinante (t-PA) en las primeras 4,5 horas después del inicio de los síntomas, demostrando mayor sobrevida y menos niveles de discapacidad. Sin embargo solo el 5-10% de pacientes reciben este manejo. Por estas razones es necesario conocer que factores se asocian con la no intervención terapéutica. Objetivo. Describir los factores asociados con la no trombolisis en pacientes con ataque cerebrovascular en un hospital de IV nivel en Bogotá, Colombia. Métodos. Estudio analítico de corte transversal, en un centro de cuarto nivel en Bogotá entre enero de 2009 y enero de 2011. Resultados. Se encontraron 178 pacientes en un promedio de edad de 65,9 años (DE± 10 años) con una relación hombre-mujer 1:1, la principal causa de no trombolisis fue la ventana mayor a 4.5 horas, 33,7% (n=60), 26,4% por cambios en imágenes diagnosticas, y 14% por puntajes leves o severos en las escala National Institute of Health Stroke Scale (NIHSS), historia quirúrgica 7.3% y laboratorios 4.5%. El tiempo promedio de atención fue 23 minutos (DE ± 21 min) para la activación del código de ACV, 39 minutos para valoración por neurología (DE ± 25 min), 46 minutos (DE ± 19,1 min) para toma de paraclínicos, 66 minutos para toma de imágenes y 97 minutos para trombolisis (DE ± 21min, DE ± 17 min, respectivamente). Se realizó trombolisis en 17 pacientes, 9,6%. No se encontró asociación significativa entre cultura de organización con trombolisis ni de tiempos de atención con trombolisis. Conclusiones. La principal razón de no trombolisis, fue la ventana mayor a 4.5 horas, no se encontró relación entre cultura de organización institucional con trombolisis. El tiempo promedio de trombolisis fue de 90 minutos. Deben instaurarse medidas para reducir el tiempo de llegada al hospital, y los tiempos de atención en urgencias. Deben realizarse nuevas evaluaciones del código ACV posterior a las estrategias de mejoría.
2013-01-01T00:00:00ZMeza Bejarano, Luis YilberAmaya Gonzalez, PabloRodriguez, JesúsIntroduction. Stroke ranks first in frequency among all adult neurological diseases, and it is the third most frequent cause of death. In order to have an acute management, it was approved therapy with recombinant tissue plasminogen activator (t-PA) in the first 4,5 hours after symptoms onset, showing a longer survival and lower level of disability. However only 5-10% of patients receive this management.
These are the reasons why it is necessary to know which factors are associated with non-therapeutic intervention. Objective: To describe factors associated with non-thrombolysis in patients with stroke in a level IV hospital in Bogota, Colombia. Methods: Cross-sectional analytical study at a level IV hospital in Bogota between January 2009 and January 2011.
Results: We found 178 patients at an average age of 65.9 years (± 10 years) with a male to female ratio 1:1, the leading cause of non-thrombolysis was greater than window 4.5 hours, 33.7% (n = 60), 26.4% by changes in diagnostic image, and 14% for mild or sever scores on the scale National Institute of Health Stroke Scale (NIHSS), surgical history 7.3% and laboratory 4.5%.
The average time of attention was 23 minutes (SD ± 21 min.) for the stroke code ACV activation, 39 minutes for evaluation of neurology (DE ± 25 min), 46 minutes (DE ± 19,1 min), for making paraclinical issues, 66 minutes for images shooting and 97 minutes for thrombolysis (SD ± 21 min, SD ± 17 min, respectively). Thrombolysis was performed in 17 patients, 9.6%.
No significant association between organizational culture with thrombolysis or service time with thrombolysis was found.
Conclusions. The main reason for not thrombolysis was the window increased to 4.5 hours, there was no relationship between institutional organizational culture with thrombolysis. The average time was 90 minutes thrombolysis. Measures should be in place to reduce the time of arrival at the hospital, and the times of emergency care. New assessments should be performed after stroke code improvement strategies.Cirugía de epilepsiaMoreno Castellanos, Julio Cesarhttps://repository.urosario.edu.co/handle/10336/45642021-06-03T05:46:06Z2013-01-01T00:00:00Zdc.title: Cirugía de epilepsia
dc.description.abstract: Epilepsy Surgery Chapter on decisions in neurology book in its second edition of publisher Universidad del Rosario. The chapter is intended to guide the reader in that moment patients with refractory epilepsy are good candidates for surgical management.
dc.description: Capítulo sobre Cirugía de Epilepsia del libro decisiones en neurología en su segunda edición de la editorial de la universidad del rosario. El capitulo pretende guiar al lector en que momentos los pacientes con epilepsia refractaria son buenos candidatos para manejo quirúrgico.
2013-01-01T00:00:00ZMoreno Castellanos, Julio CesarEpilepsy Surgery Chapter on decisions in neurology book in its second edition of publisher Universidad del Rosario. The chapter is intended to guide the reader in that moment patients with refractory epilepsy are good candidates for surgical management.Clasificación de la epilepsiaSuarez Burgos, Fabio Enriquehttps://repository.urosario.edu.co/handle/10336/46032021-06-03T05:45:47Z2013-01-01T00:00:00Zdc.title: Clasificación de la epilepsia
dc.description.abstract: Classification of Seizures and Epilepsy
dc.description: Clasificación de la epilepsia. Basada en la ILAE, descripción semiologica y hallazgos electroencefalograficos.
2013-01-01T00:00:00ZSuarez Burgos, Fabio EnriqueClassification of Seizures and EpilepsyClonazepam como primera línea de manejo en el estado epiléptico en adultosGutiérrez Alzate, Jhoan Sebastiánhttps://repository.urosario.edu.co/handle/10336/209272021-03-01T19:22:49Zdc.title: Clonazepam como primera línea de manejo en el estado epiléptico en adultos
dc.description.abstract: Background: Status epilepticus is a neurological emergency that implies high morbidity and mortality with high costs of attention. Despite international guidelines recommendations for its in-hospital management, there are no results related to the use of available benzodiazepines in Colombia. Objective: To describe results regarding the clinical termination of status epilepticus, understood as the clinical termination or control of epileptic seizures, in patients managed with clonazepam as a first-line treatment. Materials and methods: We conducted a case series study, based on the clonazepam controlled drug database, registered at Fundación Cardioinfantil-Instituto de Cardiología between 2010 and 2018. The results are presented as absolute and relative frequencies for qualitative variables and as medium and interquartile ranges for quantitative. They are also presented according to two analysis groups: clinical termination or progression to refractoriness. Results: We included 88 patients, 56.8% were men, with a median age of 59 years (IQR=31-74). 62.5% of the patients presented clinical termination and 42% progression to refractoriness. More events were resolved with a dose of 1mg of Clonazepam (64.1%), intravenous administration (98.3%) was more frequent. The overall mortality was 2.3%. Conclusion: Clonazepam as a first-line benzodiazepine in the management of status epilepticus, presented a high percentage of crisis termination for this case series.
dc.description: Antecedentes: El estado epiléptico como urgencia neurológica conlleva implicaciones de alta morbilidad y mortalidad, con un alto consumo de recursos económicos. A pesar de lineamientos internacionales en su manejo inicial intrahospitalario, en Colombia no se encuentran resultados del uso de las benzodiacepinas disponibles. Objetivo: Describir la respuesta clínica, entendida como la terminación clínica o control de crisis epilépticas, en pacientes con estado epiléptico en quienes se utilizó clonazepam como tratamiento de primera línea. Materiales y métodos: Se realizó un estudio tipo serie de casos, a partir de la base de datos del medicamento controlado clonazepam, registrada en la Fundación Cardioinfantil-Instituto de Cardiología entre 2010 y 2018. Los resultados se presentan como frecuencias absolutas y relativas para las variables cualitativas y como medianas y percentiles 25 y 75 para las cuantitativas. También se presentan según dos grupos de análisis: terminación clínica o progresión a refractariedad. Resultados: Se incluyeron 88 pacientes, 56.8% hombres, con una mediana de edad de 59 años (P25-P75=31-74). El 62.5% de los pacientes presentaron terminación clínica y el 42% progresión a refractariedad. Se resolvieron más eventos con dosis de 1mg de Clonazepam (64.1%), fue más frecuente la administración por vía endovenosa (98.3%). La mortalidad global fue de 2.3%. Conclusión: El Clonazepam como benzodiacepina de primera línea en el manejo del estado epiléptico, presento un alto porcentaje de terminación de crisis para esta serie de casos.
Gutiérrez Alzate, Jhoan SebastiánBackground: Status epilepticus is a neurological emergency that implies high morbidity and mortality with high costs of attention. Despite international guidelines recommendations for its in-hospital management, there are no results related to the use of available benzodiazepines in Colombia. Objective: To describe results regarding the clinical termination of status epilepticus, understood as the clinical termination or control of epileptic seizures, in patients managed with clonazepam as a first-line treatment. Materials and methods: We conducted a case series study, based on the clonazepam controlled drug database, registered at Fundación Cardioinfantil-Instituto de Cardiología between 2010 and 2018. The results are presented as absolute and relative frequencies for qualitative variables and as medium and interquartile ranges for quantitative. They are also presented according to two analysis groups: clinical termination or progression to refractoriness. Results: We included 88 patients, 56.8% were men, with a median age of 59 years (IQR=31-74). 62.5% of the patients presented clinical termination and 42% progression to refractoriness. More events were resolved with a dose of 1mg of Clonazepam (64.1%), intravenous administration (98.3%) was more frequent. The overall mortality was 2.3%. Conclusion: Clonazepam as a first-line benzodiazepine in the management of status epilepticus, presented a high percentage of crisis termination for this case series.Costos intrahospitalarios de pacientes con epilepsia que ingresan a urgencias por crisis epilépticaOsorio Restrepo, Andrea Carolinahttps://repository.urosario.edu.co/handle/10336/337372022-03-08T16:16:16Zdc.title: Costos intrahospitalarios de pacientes con epilepsia que ingresan a urgencias por crisis epiléptica
dc.description.abstract: Introduction: Epilepsy represents a significant social burden which also affects inpatient costs, mainly in those with uncontrolled epilepsy. Objective: To determine the inpatient costs of patients with a history of epilepsy who are admitted to the emergency room for epileptic seizures. Materials and methods: Patients with a diagnosis of epilepsy who were admitted to the emergency room for epileptic seizures were included. The sample size was calculated by detecting the impact of nonadherence, taking an expected proportion of 30%, with 5% precision and a 95% confidence level and power, for a sample size of 313 patients. Results: The total sample was made up of 313 patients with an epilepsy diagnosis who were admitted to the emergency room between January 2017 and April 2018 for epileptic seizures. Of these, 47.0% had controlled epilepsy and 51.0% had uncontrolled epilepsy. Twenty-two percent of all the patients were diagnosed with drug resistance. The total direct cost amounted to $1,574,746,247 COP. Within this total cost, the greatest increase was influenced by the lack of antiseizure medication delivery by the health insurance company and interrupted treatment (voluntary or forgetting to take the doses). Conclusion: According to the proposed model, patients with a history of uncontrolled epilepsy are associated with increased total direct inpatient costs
dc.description: Introducción: La epilepsia representa una carga social importante y que también afecta los costos derivados de hospitalización, principalmente en aquellos con epilepsia no controlada Objetivo: Determinar los costos de hospitalización en pacientes con antecedente de epilepsia quienes ingresan a servicio de urgencias por crisis epiléptica Materiales y métodos: Se incluyeron pacientes que ingresaron a urgencias por una crisis epiléptica y que tuvieran diagnóstico de epilepsia. El cálculo de la muestra se obtuvo mediante la detección del impacto de la no adherencia, tomando una proporción esperada de 30%, con una precisión del 5% así mismo una confiabilidad y poder del 95% para un tamaño de muestra de 313 pacientes Resultados: La muestra total estuvo conformada por 313 pacientes con diagnóstico de epilepsia, quienes ingresaron a urgencias desde enero 2017 hasta abril 2018 por crisis epiléptica. Los pacientes con epilepsia controlada representaron el 47,0% y los de epilepsia no controlada el 51,0%. Del total de pacientes, los que tenían diagnóstico de farmacorresistencia fue del 22,0%. El valor total de los costos directos fue de $1.574.746.247 COP. De este total de costos, el mayor incremento en los mismos estuvo influenciado por la no entrega del medicamento anticrisis por parte de EPS y la interrupción del tratamiento (voluntaria o por olvido en la toma de las dosis). Conclusión: Según el modelo propuesto, los pacientes con historia de epilepsia no controlada se asocian con un incremento en los costos hospitalarios totales directos.
Osorio Restrepo, Andrea CarolinaIntroduction: Epilepsy represents a significant social burden which also affects inpatient costs, mainly in those with uncontrolled epilepsy. Objective: To determine the inpatient costs of patients with a history of epilepsy who are admitted to the emergency room for epileptic seizures. Materials and methods: Patients with a diagnosis of epilepsy who were admitted to the emergency room for epileptic seizures were included. The sample size was calculated by detecting the impact of nonadherence, taking an expected proportion of 30%, with 5% precision and a 95% confidence level and power, for a sample size of 313 patients. Results: The total sample was made up of 313 patients with an epilepsy diagnosis who were admitted to the emergency room between January 2017 and April 2018 for epileptic seizures. Of these, 47.0% had controlled epilepsy and 51.0% had uncontrolled epilepsy. Twenty-two percent of all the patients were diagnosed with drug resistance. The total direct cost amounted to $1,574,746,247 COP. Within this total cost, the greatest increase was influenced by the lack of antiseizure medication delivery by the health insurance company and interrupted treatment (voluntary or forgetting to take the doses). Conclusion: According to the proposed model, patients with a history of uncontrolled epilepsy are associated with increased total direct inpatient costs