Brain insulin resistance and Alzheimer's disease: a systematic review / Resistência insulínica cerebral e a doença de Alzheimer: uma revisão sistemática

ABSTRACT. The disability of cells to react to insulin, causing glucose intolerance and hyperglycemia, is referred to as insulin resistance. This clinical condition, which has been well-researched in organs such as adipose tissue, muscle, and liver, has been linked to neurodegenerative diseases like Alzheimer's disease (AD) when it occurs in the brain. Objective: The authors aimed to gather data from the current literature on brain insulin resistance (BIR) and its likely repercussions on neurodegenerative disorders, more specifically AD, through a systematic review. Methods: A comprehensive search was conducted in multiple medical databases, including the Cochrane Central Register of Controlled Trials, EMBASE, Medical Literature Analysis and Retrieval System Online (Medline), and PubMed®, employing the descriptors: "insulin resistance", "brain insulin resistance", "Alzheimer's disease", "neurodegeneration", and "cognition". The authors focused their search on English-language studies published between 2000 and 2023 that investigated the influence of BIR on neurodegenerative disorders or offered insights into BIR's underlying mechanisms. Seventeen studies that met the inclusion criteria were selected. Results: The results indicate that BIR is a phenomenon observed in a variety of neurodegenerative disorders, including AD. Studies suggest that impaired glucose utilization and uptake, reduced adenosine triphosphate (ATP) production, and synaptic plasticity changes caused by BIR are linked to cognitive problems. However, conflicting results were observed regarding the association between AD and BIR, with some studies suggesting no association. Conclusion: Based on the evaluated studies, it can be concluded that the association between AD and BIR remains inconclusive, and additional research is needed to elucidate this relationship.

RESUMO. A incapacidade das células de reagir à insulina, ocasionando intolerância à glicose e hiperglicemia, é chamada de resistência à insulina. Essa condição clínica, que tem sido bem pesquisada em órgãos como tecido adiposo, músculo e fígado, tem sido associada às doenças neurodegenerativas como a doença de Alzheimer (DA) quando ocorre no cérebro. Objetivo: O objetivo dos autores foi reunir os dados da literatura atual sobre a resistência insulínica cerebral (RIC) e sua provável repercussão em doenças neurodegenerativas, mais especificamente na DA, por meio de uma revisão sistemática da literatura. Métodos: Foi realizada uma pesquisa abrangente em vários bancos de dados médicos, incluindo o Cochrane Central Register of Controlled Trials, EMBASE, Medical Literature Analysis and Retrieval System Online (Medline) e PubMed, empregando os descritores: "resistência à insulina", "resistência insulínica cerebral", "doença de Alzheimer", "neurodegeneração" e "cognição". Os autores concentraram sua busca em estudos no idioma inglês publicados entre 2000 e 2023 que investigaram a influência da RIC em distúrbios neurodegenerativos ou ofereceram insights sobre os mecanismos subjacentes da RIC. Dezessete estudos que atenderam aos critérios de inclusão foram selecionados. Resultados: Os resultados demonstram que a RIC é um fenômeno observado em uma variedade de doenças neurodegenerativas, incluindo a DA. Estudos sugerem que a utilização e captação prejudicadas de glicose, a produção reduzida de trifosfato de adenosina (ATP) e as alterações na plasticidade sinápticas causadas pela RIC estão ligadas a problemas cognitivos. No entanto, foram observados resultados conflitantes com relação à associação entre DA e RIC, com alguns estudos sugerindo nenhuma associação. Conclusão: Com base nos estudos avaliados, pode-se concluir que a associação entre DA e RIC ainda é inconclusiva, e pesquisas adicionais são necessárias para elucidar essa relação.

Primary somesthetic cortex involvement in fibromyalgia: review of neuroimage studies / Envolvimento do córtex somestésico primário na fibromialgia: revisão de estudos de neuroimagem

ABSTRACT BACKGROUND AND OBJECTIVES: The mechanisms underlying nociplastic pain, such as fibromyalgia (FM), are not fully understood, however, it is believed that altered sensory processing and pain modulation play prominent roles in the maintenance of nociplastic pain. The hypothesis is that changes in the primary somesthetic cortex (S1) contribute to the generalized pain character of FM. The objective of this study was to evaluate the involvement of the primary somesthetic cortex in humans with fibromyalgia, as well as to investigate possible associations between S1 changes and clinical signs and symptoms of FM. CONTENTS: For this integrative review, the following databases were used: Pubmed and Web of Science, including observational studies carried out in humans with FM. In total, 541 studies were identified and four were included. The majority of studies are case-control studies, published between 2016 and 2022. In total, data from 161 individuals were included in this review. It was identified that there are morphological changes, hyperactivation and increased functional connectivity between S1 and periaqueductal gray matter and between S1 and anterior cingulate cortex. CONCLUSION: Patients with FM present morphological changes and hyperactivation in S1, as well as increased functional connectivity between S1 and periaqueductal gray matter and S1 and limbic system. Furthermore, different bilateral somatotropic subregions (legs, chest, fingers, hands, face and back) showed reduced functional connectivity in patients with FM. These regions are often presented as "tender points" in FM.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os mecanismos subjacentes à dor nociplástica, como a fibromialgia (FM), não são totalmente compreendidos, contudo acredita-se que o processamento sensorial e a modulação da dor alterados desempenham papéis proeminentes para a manutenção da dor nociplástica. Com a hipótese de que alterações no córtex somestésico primário (S1) contribuam para o caráter de dor generalizada da FM, o objetivo deste estudo foi avaliar o envolvimento do córtex somestésico primário em humanos com FM, bem como investigar possíveis associações entre alterações de S1 com sinais e sintomas clínicos da FM. CONTEÚDO: Para esta revisão integrativa, foram utilizadas as seguintes bases de dados: Pubmed e Web of Science, incluindo estudos observacionais realizados em humanos com FM. No total, 541 estudos foram identificados e quatro foram incluídos. A maioria dos estudos são do tipo caso-controle, publicados entre 2016 e 2022. Ao todo, dados de 161 indivíduos foram incluídos. Foi identificado que há alterações morfológicas, hiperativação e aumento da conectividade funcional entre S1 e substância cinzenta periaquedutal e entre S1 e córtex cingulado anterior. CONCLUSÃO: Pacientes com FM apresentam alterações morfológicas e hiperativação em S1, bem como aumento da conectividade funcional entre S1 e substância cinzenta periaquedutal e S1 e sistema límbico. Ademais, diferentes sub-regiões somatotrópicas bilaterais (pernas, tórax, dedos, mãos, face e costas) apresentaram redução da conectividade funcional em pacientes com FM. Essas regiões são frequentemente apresentadas como "tender points" na FM.

Factores asociados al desarrollo de secuelas por trauma craneoencefálico en menores de 15 años: un estudio de cohorte retrospectiva en un hospital de Medellín, Colombia. 2010-2014

Introducción: el trauma craneoencefálico es una de las principales causas de morbimortalidad infantil en Colombia, sus secuelas impactan gravemente la calidad de vida de los pacientes y la evidencia científica actual de los factores asociados al trauma es escasa. Objetivo: analizar los factores asociados al desarrollo de secuelas por trauma craneoencefálico en menores de 15 años que consultaron a un hospital de Medellín entre 2010 y 2014. Materiales y métodos: estudio de cohorte retrospectivo. Se incluyeron 812 pacientes en un periodo de 5 años, de los cuales 294 no cumplieron los criterios de inclusión. Se evaluaron variables sociodemográficas, clínicas y se estimó la incidencia de secuelas con el método estadístico de Wilson. El riesgo relativo se calculó mediante regresión log-binomial. Resultados: en total se analizaron 518 pacientes. La mediana de edad fue de 5 años, el 64,3 % eran hombres, el 75,4 % de los participantes tenía un trauma leve y el 5 % un trauma grave. Las caídas fueron la principal causa (64,2 %), seguidas de los accidentes de tránsito (25,3 %). La incidencia de secuelas fue del 7.3 % (IC: 5,4 % - 9,9 %). Conclusiones: la carga de enfermedad en el paciente posterior a TCE representa un problema de salud pública. La probabilidad de desarrollar una secuela en este estudio fue del 7,3 %, la cual se relaciona con los siguientes factores que se identifican en el servicio de urgencias: lesión difusa, una escala de Glasgow al ingreso moderada o grave y sufrir un accidente de tránsito.

Background: traumatic brain injury is one of the main causes of infant morbidity and mortality. The sequelae after trauma seriously impact the quality of life of patients and the scientific evidence of associated factors is scarce. Objective: to analyze the factors associated with the development of sequelae due to head trauma in children under 15 years old who went to the emergency room of a hospital in Medellín between 2010 and 2014. Materials and methods: retrospective cohort study. 812 patients were included in a period of 5 years, of which 294 did not meet the inclusion criteria. Sociodemographic and clinical variables were evaluated and the incidence of sequelae was estimated with 95 % confidence intervals using the Wilson statistical method. The relative risk was calculated using log-binomial regression. Results: a total of 518 patients were analyzed. The median age was 5 years, 64,23 % were male children, 75,4 % had mild trauma, and 5 % suffered severe trauma. Falls were the main cause (64,2 %), followed by traffic accidents (25,3 %). The incidence of sequelae was 7,3 % (CI: 5,4% - 9,9 %). Conclusions: the burden of disease in the patient after TCE represents a public health problem. The probability of developing a sequel in this study was 7,3 %, which is related to the following factors that identify in the emergency department: diffuse injury, a moderate or severe Glasgow scale on admission, and suffering a traffic accident.

Asociación entre el polimorfismo Val66Met del gen BDNF y el desarrollo de disfunción ejecutiva en pacientes con cáncer de mama

Introducción. La disfunción ejecutiva asociada a quimioterapia es un efecto adverso del tratamiento antineoplásico convencional y afecta a un porcentaje considerable de personas. Se ha reportado que la presencia de ciertos polimorfismos en genes relevantes puede causar mayor susceptibilidad a padecerlo. Objetivo. Determinar la relación entre el polimorfismo Val66Met (196 G>A) del gen BDNF y el desarrollo de disfunción ejecutiva en mujeres con cáncer de mama tratadas con quimioterapia. Métodos. Se evaluaron a 73 pacientes mujeres con cáncer de mama para determinar disfunción ejecutiva antes y después de la quimioterapia. La evaluación fue realizada con la prueba INECO Frontal Screening (IFS). Se determinó el genotipo (GG=Val/Val, GA=Val/Met y AA=Met/Met) por PCR y secuenciamiento del gen BDNF. El análisis de asociación se realizó mediante el cálculo del odds ratio (OR). Resultados. El 13,7% (n = 10) de pacientes presentó el alelo A (GA y AA), además obtuvieron puntajes significativamente menores de la prueba IFS comparado con las homocigotas GG (p A) del gen BDNF y el desarrollo de disfunción ejecutiva en pacientes con cáncer de mama tratadas con quimioterapia; sin embargo, las portadoras del alelo A (Met) presentaron puntajes menores en la evaluación cognitiva.

Introduction. Chemotherapy-associated executive dysfunction is an adverse effect of conventional antineoplastic treatment that affects many patients. It has been reported that the presence of specific polymorphisms in key genes can cause a greater susceptibility to develop this condition. Objective. To determine the relationship between the Val66Met polymorphism (196 G>A) of the BDNF gene and the development of executive dysfunction in female patients with breast cancer treated with chemotherapy. Methods. 73 female breast cancer patients were evaluated for executive dysfunction before and after chemotherapy. The evaluation was carried out with the INECO Frontal Screening test (IFS). The genotype (GG=Val/Val, GA=Val/Met and AA=Met/Met) was determined by PCR and sequencing of BDNF gene. Association analysis was performed by calculating the Odds Ratio (OR) and by quantitative comparison. Results. 13.7% (n = 10) of the sample presented the allele A (GA and AA), which obtained significantly lower scores in the IFS test compared to the homozygous GG (p A) polymorphism of the BDNF gene and the development of executive dysfunction in patients with breast cancer treated with chemotherapy. However, patients with the allele A (Met) presented significant lower scores in the cognitive assessment.

Producción científica sobre traumatismo craneoencefálico en revistas estudiantiles cubanas. Enero de 2015-junio de 2021

Introducción: los traumatismos craneoencefálicos son un reto para los servicios de salud. Recibir desde pregrado una formación en su atención constituye una necesidad. Objetivo: caracterizar la producción científica sobre traumatismo craneoencefálico, publicada en revistas estudiantiles cubanas entre enero de 2015 y junio de 2021. Materiales y métodos: se realizó un estudio bibliométrico, descriptivo y retrospectivo. El universo estuvo constituido por nueve artículos, de los que se analizó tipología, año de publicación, cantidad de autores, provincia y centro de procedencia de los mismos, cantidad de referencias, cantidad de artículos por revista y número de veces citados. Resultados: el 77,8 % de los artículos fueron originales, y 2020 fue el año más productivo (55,6 %). El 44,4 % de los artículos fue firmado por cinco autores; el 32,4 % de los autores pertenecían a la provincia de Pinar del Río. La media de referencias por artículos fue de 19,9; el Índice de Price se encontró entre 0,45 y 0,82, con una media de 0,75. El 55,6 % de las publicaciones aparecieron en la revista Universidad Médica Pinareña, cuyos artículos también fueron los más citados (85 %). Conclusiones: la producción científica estudiantil sobre trauma craneoencefálico es baja, y la influencia y visibilidad de los artículos disponibles, atendiendo a la cantidad de citas, es pequeña.

Introduction: crania-encephalic traumas are a challenge for health services. Receiving training on their care since undergraduate studies is a necessity. Objective: to characterize the scientific production on crania-encephalic trauma published in Cuban student journals between January 2015 and June 2021. Materials and methods: a bibliometric, descriptive and retrospective study was carried out. The universe was constituted by 9 articles, of which typology, year of publication, quantity of authors, province and centers of origin, quantity of references; quantity of articles per journal and number of times cited were analyzed. Results: 77.8% of the articles were originals, and 2020 was the most productive year (55.6%). 44% of the articles were signed by five authors; 32.4% of the authors belonged to the province of Pinar del Rio. The average number of references per articles was 19.9; the Price Index was found between 0.45 and 0.85, with an average of 0.75. 55.6% of the publications appeared in the journal Universidad Médica Pinareña, the articles of which were also the most cited ones (85%). Conclusions: the student scientific production on crania-encephalic trauma is low, and the influence and visibility of the available articles, taking into account the quantity of cites, is small.

Brain-derived neurotrophic factor interplay with oxidative stress: neuropathology approach in potential biomarker of Alzheimer's disease / Interação do fator neurotrófico encefálico com o estresse oxidativo: abordagem neuropatológica a um potencial biomarcador da doença de Alzheimer

ABSTRACT The aging population poses a serious challenge concerning an increased prevalence of Alzheimer's disease (AD) and its impact on global burden, morbidity, and mortality. Oxidative stress, as a molecular hallmark that causes susceptibility in AD, interplays to other AD-related neuropathology cascades and decreases the expression of central and circulation brain-derived neurotrophic factor (BDNF), an essential neurotrophin that serves as nerve development and survival, and synaptic plasticity in AD. By its significant correlation with the molecular and clinical progression of AD, BDNF can potentially be used as an objectively accurate biomarker for AD diagnosis and progressivity follow-up in future clinical practice. This comprehensive review highlights the oxidative stress interplay with BDNF in AD neuropathology and its potential use as an AD biomarker.

RESUMO O envelhecimento da população representa um sério desafio no que diz respeito ao aumento da prevalência da doença de Alzheimer (DA) e o seu impacto na carga, morbidade e mortalidade globais. O estresse oxidativo, como uma marca molecular que causa suscetibilidade na DA, interage com outras cascatas de neuropatologia relacionadas à DA e diminui a expressão do fator neurotrófico encefálico (brain-derived neurotrophic factor - BDNF), uma neurotrofina essencial que serve como desenvolvimento e sobrevivência nervosa, e plasticidade sináptica na DA. Pela sua correlação significativa com a progressão molecular e clínica da DA, o BDNF pode potencialmente ser usado como um biomarcador objetivamente preciso para o diagnóstico da DA e acompanhamento da progressividade na prática clínica futura. Esta revisão abrangente destacou a interação do estresse oxidativo com o BDNF na neuropatologia da DA e seu uso potencial como biomarcador da DA.

Una presentación inusual de fístula carótido-cavernosa secundaria a trauma craneoencefálico leve: reporte de caso / An unusual presentation of carotid-cavernosa fistula secondary to mild craneoenephalic trauma: a case report

Resumen La fístula carótido-cavernosa es cualquier comunicación anómala entre la arteria carótida y el seno cavernoso que genera un shunt arteriovenoso patológico, se manifiesta en forma anterógrada a la órbita, causa ceguera y oftalmoparesia. Su asociación con trauma craneoencefálico leve es escasa y poco reportada, por lo que se desconoce su prevalencia. Se reporta un paciente masculino de 54 años proveniente de Cali, Colombia, con antecedente de trauma craneoencefálico leve 2 meses antes del ingreso, quien presenta cuadro de cefalea holocraneal y alteraciones visuales. Al examen físico presentó oftalmoparesia, con ptosis palpebral bilateral asimétrica y proptosis pulsátil izquierda; se realizó resonancia magnética cerebral simple y angioresonancia, con hallazgos sugestivos de fístula carótido-cavernosa. El paciente fue llevado a arteriografía más embolización, logrando un resultado favorable. La presencia de cefalea con banderas rojas, alteraciones visuales, proptosis pulsátil y el antecedente de trauma craneoencefálico, sin importar su grado, pueden hacer sospechar la presencia de esta entidad.

Abstract The carotid-cavernous fistula is any abnormal communication between the carotid artery and the cavernous sinus, generating a pathological arteriovenous shunt manifesting anterograde to the orbit, causing blindness and ophthalmoparesis. Its association with mild head trauma is scarce and underreported, its prevalence being unknown. A 54-year-old male patient from Cali - Colombia is reported, with a history of mild cranioencephalic trauma 2 months ago, who consulted for a holocranial headache and visual disturbances. On physical examination he presented ophthalmoparesis, with bilateral asymmetric palpebral ptosis with left pulsatile proptosis. A simple brain magnetic resonance and angio-MRI was performed, with findings suggestive of a carotid-cavernous fistula. The patient was taken to arteriography plus embolization, achieving a favorable result. The presence of headache with red flags, visual disturbances, pulsatile proptosis, and a history of head trauma, regardless of its degree, can lead to suspect the presence of this entity.

Effect of providing purple sweet potato water extract on tumor necrosis factor-α levels, protein 53 expression, glial fibrillary acidic protein expression, brain-derived neurotrophic factor levels, and spatial working memory in rats with d-galactose induction / Efeito do extrato de água de batata doce roxo no fator de necrose tumoral níveis alfa, na expressão da proteína 53, na expressão de proteína ácida fibrilar glial, nos níveis de fator neurotrófico cerebral e na memória espacial em ratos com indução de d-galactose

ABSTRACT. Alzheimer's dementia (AD) is a neurodegenerative disease. The mechanism of oxidative stress in AD is due to amyloid beta (Aβ) protein that aggregates to form plaques, which further triggers chronic inflammation and neuronal apoptosis. Purple sweet potato extract with the main content of anthocyanins is a potential antioxidant with a direct target on the amyloid cascade hypothesis. Objective: The research objective was to determine the role of purple sweet potato water extract as an antioxidant and anti-inflammatory in preventing apoptosis in order to provide a neuroprotective effect in d-galactose-induced rats. Methods: A total of 100 male Wistar rats with randomized posttest-only control group design that met the eligibility criteria were included in this study. The treatment group was given 200 mg/kg BW/day of purple sweet potato water extract on days 1-70. d-galactose induction was administered in the treatment and control groups on days 15-70. Results: The independent t-test showed that the mean tumor necrosis factor-α (TNF-α) levels in the treatment group (735.36±139.74) was significantly lower than that in the control group (896.77±152.52). The p53 and glial fibrillary acidic protein (GFAP) expressions of astrocyte cells in the treatment group were significantly lower than that in the control group. The brain-derived neurotrophic factor (BDNF) levels in the treatment group (498.13±121.47) were higher than that in the control (391.93±140.28), and there was a significant increase in spatial working memory in the treatment group (72.01±10.22) than the control (59.77±11.87). Conclusions: The neuroprotective effect of purple sweet potato extract is due to d-galactose induction resulting from decrease in TNF-α levels, p53 expression, and GFAP expression and increase in BDNF levels and spatial working memory.

RESUMO. A doença de Alzheimer (DA) é uma doença neurodegenerativa. O mecanismo de estresse oxidativo na DA ocorre devido à proteína beta amilóide que se agrega para formar placas que desencadeiam inflamação crônica e apoptose neuronal. O extrato de batata-doce roxa composto principalmente por antocianinas é um potencial antioxidante com efeito direto sobre a hipótese da cascata amilóide. Objetivo: O objetivo da pesquisa foi determinar o papel do extrato aquoso de batata-doce roxa como antioxidante e anti-inflamatório na prevenção da apoptose, para proporcionar um efeito neuroprotetor em ratos induzidos por D-galactose. Métodos: Grupo controle randomizado pós-teste com 100 ratos Wistar machos que preencheram os critérios de elegibilidade. O grupo de tratamento recebeu 200mg/kg de peso corporal/dia de extrato aquoso de batata-doce roxa nos dias 1-70. A indução de D-galactose foi testada nos grupos de tratamento e controle nos dias 15-70. Resultados: O teste t independente mostrou que a média dos níveis de TNF-α no grupo de tratamento (735,36±139,74) foi significativamente menor do que no grupo controle (896,77±152,52). A expressão de p53 e a expressão de GFAP de células de astrócitos foram significativamente menores no grupo de tratamento do que no grupo controle. Os níveis de BDNF no grupo de tratamento (498,13±121,47) foram maiores que no grupo controle (391,93±140,28) e houve um aumento significativo da memória de trabalho espacial no grupo de tratamento (72,01±10,22) em relação ao controle (59,77±11,87). Conclusões: O efeito neuroprotetor do extrato de batata-doce roxa é devido à indução de D-galactose pela diminuição dos níveis de TNF-α, expressão de p53 e expressão de GFAP, aumentando assim os níveis de BDNF e memória espacial.

Perspectiva histórica del trastorno del espectro del autismo / Historical perspective of autism spectrum disorder

RESUMEN INTRODUCCIÓN: El presente artículo incluye una mirada histórica de algunas teorías y clasificaciones del trastorno del espectro del autismo (TEA), incluyendo a los autores más reconocidos y las perspectivas semiológicas vigentes. Se pretende contribuir así a la unificación de criterios entre los profesionales, y propender por la reflexión acerca de las consecuencias de una conceptualización desacertada del trastorno. MATERIALES Y MÉTODO: Se trata de una revisión documental de artículos indexados en bases de datos, y otros documentos seleccionados intencionalmente. RESULTADOS: Tres categorías a saber fueron consideradas para la organización de la información: a) de la ficción a la ciencia: el paso de la sintomatología mítica a la clasificación nosológica; b) los pioneros austríacos: la dualidad inicial que se transformó en espectro; y c) trastorno del espectro del autismo: una trayectoria en la estructuración de sus criterios diagnósticos. DISCUSIÓN Y CONCLUSIONES: La variabilidad en las hipótesis etiológicas, así como en la manifestación de los síntomas nucleares del TEA, han impactado en su clasificación y abordaje terapéutico. Se requiere una actualización permanente de los profesionales por el avance de la genética y las neurociencias, siendo posible la futura generación de cambios en el rol de los profesionales que intervienen en su detección, evaluación e intervención.

ABSTRACT Introduction: This article involves a historical review of some theories and classifications of autism spectrum disorder (ASD), including the most recognized authors and current semiological perspectives. In this way, it is intended to contribute to the unification of criteria among professionals, and to encourage reflection on the consequences of an unwise conceptualization of the disorder. Materials and methods: It is a documentary review of articles indexed in databases, and other intentionally selected documents. Results: Three categories, namely, were considered for the organization of the information: a) from fiction to science: the transition from mythical symptomatology to nosological classification; b) the Austrian pioneers: the initial duality that became a spectrum; and c) autism spectrum disorder: a trajectory in the structuring of its diagnostic criteria. Discussion and conclusions: The variability in the etiological hypotheses, as well as in the manifestation of the core symptoms of ASD, have impacted its classification and therapeutic approach. A permanent update of professionals is required due to the advancement of genetics and neurosciences, making possible the future generation of changes in the role of professionals involved in its detection, evaluation and intervention.

Perfil neuropsicológico en pacientes con trauma craneoencefálico atendidos en un hospital de alta complejidad de Medellín, Colombia / Neuropsychological profile of patients with traumatic brain injury evaluated in a high complexity hospital in Medellin, Colombia

RESUMEN INTRODUCCIÓN: El trauma craneoencefálico (TCE) es una de las principales causas de daño cerebral y discapacidad en personas menores de 40 años. Según su severidad, se puede clasificar en leve, moderado o grave, en función de la escala de coma de Glasgow. Muchos pacientes quedan con secuelas neuropsicológicas y comportamentales que pueden afectar en mayor o menor grado su funcionalidad. El objetivo del estudio fue determinar las diferencias en el perfil neuropsicológico, las características clínicas y el compromiso funcional en pacientes con TCE según la clasificación de la severidad. METODOLOGÍA: Se realizó un estudio observacional, analítico, de corte transversal. Se revisaron las historias clínicas y los reportes neuropsicológicos de adultos con TCE evaluados por neuropsicología entre los años 2014 y 2019. Se compararon los resultados de pruebas neuropsicológicas, síndromes neuropsicológicos y funcionalidad según la severidad del TCE. RESULTADOS: Se estudiaron 48 pacientes, 38 de ellos hombres (73 %), con una mediana de edad de 35 años (RI: 25-51). En 14 casos el TCE fue leve, en 18 moderado y en 16 severo. El síndrome neuropsicológico más frente fue el amnésico (100 %), seguido del disejecutivo (79 %) y el compromiso en la atención (77 %). No se encontraron diferencias según severidad del TCE. Cuarenta y un pacientes (85 %) presentaron cambios comportamentales, 14 (29 %) experimentaron alteración en las actividades básicas de la vida diaria y 32 (68 %) en las actividades instrumentales. CONCLUSIONES: Las alteraciones neuropsicológicas, comportamentales y funcionales posteriores a un TCE son frecuentes, sin embargo, no se encontraron diferencias significativas según severidad del trauma.

ABSTRACT INTRODUCTION: Traumatic Brain Injury (TBI) is one of the main causes of brain damage and disability in people under 40 years of age. The severity of TBI can be classified as mild, moderate, or severe based on the Glasgow coma scale. Many patients are left with neuropsychological and behavioral sequelae that can affect functionality to a greater or lesser degree. The objective of the study was to determine the differences in the neuropsychological profile, clinical characteristics and functional impairment in patients with TBI according to severity. METHODOLOGY: An observational, analytical, cross-sectional study was carried out. The clinical records and neuropsychological reports of adults with TBI evaluated between 2014 and 2019 were reviewed. The results of neuropsychological tests, neuropsychological syndromes, and functionality according to severity of TBI were compared. RESULTS: 48 patients were studied, 35 were males (73 %), the median age was 35 years (IR: 25-51). In 14 TBI was mild, in 18 moderate and 16 severe. The most common neuropsychological syndrome was amnesic (100 %) followed by dysexecutive (79 %) and attentional commitment (77 %). No differences were found according to severity of TBI. 41 patients (85 %) presented behavioral changes, 14 (29 %) presented alteration in basic activities of daily life and 32 (68 %) in instrumental activities. CONCLUSIONS: Neuropsychological, behavioral and functional alterations are frequent after TBI; however, no significant differences were found according to the severity of the trauma.

Evaluación tomográfica de las cisternas basales

Introducción: Las características radiológicas de las cisternas de la base son de interés en el diagnóstico, evolución y pronóstico de los pacientes con lesiones traumáticas. En la actualidad el estado de las mismas es un factor predictivo importante en pacientes con trauma craneoencefálico severo. En la mayor parte se refieren solo a cisternas normales, comprimidas o ausentes. Objetivo: Determinar las dimensiones normales de las principales cisternas basales en la tomografía y su relación con la edad y el sexo. Métodos: Se realizó un estudio analítico, de corte transversal en un periodo de dos meses: marzo y abril de 2021, en labor conjunta de los servicios de Neurocirugía e Imagenología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey. El universo quedó formado por 101 pacientes mayores de 18 años con tomografías de cráneo sin alteraciones. El estudio incluyó la evaluación de las imágenes de TAC simples de cráneo de pacientes con sospecha de enfermedad cerebrovascular, estudio de epilepsia de debut tardío, síndrome confucional o de síndrome cefalálgico. Se evaluaron la cisterna crural, interpeduncular, ambiens y cuadrigeminal. Las mensuraciones fueron realizadas siempre por especialistas en Imagenología y Neurocirugía con años de experiencia. El criterio básico de selección fue que la tomografía fuera informada sin alteraciones, independiente de la edad y el sexo. Resultados: De los 101 pacientes, 53 fueron del sexo masculino y 48 correspondieron al sexo femenino. El promedio del diámetro de la cisterna interpeduncular fue de 5,5 mm, la cisterna crural promedió 2,3 mm, mientras que la cisterna ambiens y la cuadrigeminal promediaron 3,1 mm y 5 mm respectivamente. Los mayores de 60 años tuvieron las cisternas basales con mayor diámetro. Conclusiones: El diámetro de las cisternas basales varía con la edad, no así con el sexo. Esto está determinado por el envejecimiento fisiológico del cerebro.

Introduction: The radiological characteristics of the cisterns of the base are of interest in the diagnosis, evolution and prognosis of patients with traumatic injuries. Currently, their condition is an important predictive factor in patients with severe head trauma. For the most part they refer only to normal, compressed or absent cisterns. Objective: To determinate the normal measurements of the principal basal cisterns in a tomagraphy and their relation with age and sex. Methods: An analytical, cross-sectional study was carried out in a period of two months: March and April 2021, in joint work of the Neurosurgery and Imaging services of the Manuel Ascunce Domenech University Hospital in Camagüey province. The universe was made up of 101 patients over 18 years of age with skull tomographies without alterations. The study included the evaluation of simple CT images of the skull of patients with suspected cerebrovascular disease, study of late-onset epilepsy, confusional syndrome or cephalalgic syndrome. The crural, interpeduncular, ambiens and quadrigeminal cistern were evaluated. The measurements were always performed by specialists in Imaging and Neurosurgery with years of experience. The basic selection criterion was that the tomography was reported without alterations, regardless of age and sex. Results: The sample was 101 patients, 53 males and 48 females. The average width of the interpeduncular cistern was 5.5 mm, besides crural cistern averages 2.3 mm and the ambiens and cuadrigeminal cisterns average 3.1 mm and 5 mm respectively. The patients older than 60 years had major dimensions of the cranial cisterns. Conclusions: The width of basal cisterns could be change with age but not with sex. This is associated with brain physiological aging.

Patrones hemodinámicos cerebrales en pacientes con trauma craneoencefálico y su relación con la mortalidad

RESUMEN Fundamento: la mortalidad por traumatismo craneoencefálico grave es elevada y se debe a los disturbios hemodinámicos intracraneales que este provoca. Objetivo: determinar los patrones de flujo sanguíneo cerebral en el paciente con traumatismo craneoencefálico y su relación con la mortalidad. Métodos: estudio descriptivo, transversal realizado en las Unidades de Atención al Grave del Hospital Clínico-Quirúrgico Arnaldo Milían Castro, de Santa Clara, provincia Villa Clara, desde el año 2004 al 2007 y del 2018 al 2020. El ultrasonido Doppler transcraneal se le realizó a 82 pacientes, en las primeras 24 horas del ingreso, posterior a la estabilidad hemodinámica y respiratoria. Se determinaron las variables escala de coma de Glasgow, patrones de flujo sanguíneo cerebral y la mortalidad. La información fue procesada mediante el programa estadísticos SPSS/PC versión 15 para Windows, se aplicó un procesamiento estadístico con análisis univariado. Resultados: se estudiaron 82 pacientes, con una letalidad del 37,8 % del total; la mayor letalidad ocurrió entre los pacientes mayores de 65 años(60 %)(p=0,01). La escala de coma de Glasgow de 8 o menos puntos incluyó a 67 pacientes, con mortalidad del 43 % (p=0.00). El patrón isquémico cerebral fue el más diagnosticado (43,9 %) con una mortalidad del 74 %(p=0.03). Conclusiones: el patrón de flujo sanguíneo isquémico es el más frecuente y tiene una significativa relación con la mortalidad. La escala de coma de Glasgow tiene una relación significativa con la mortalidad del paciente con traumatismo craneoencefálico.

ABSTRACT Background: mortality from severe head trauma is high and is due to the intracranial hemodynamic disorders that it causes. Objective: to determine the patterns of cerebral blood flow in the patient with head trauma and its relationship with mortality. Methods: descriptive, cross-sectional study carried out in the Arnaldo Milían Castro Clinical-Surgical Hospital Serious Care Units, Santa Clara, Villa Clara province, from 2004 to 2007 and from 2018 to 2020. The transcranial Doppler ultrasound was performed in 82 patients, in the first 24 hours after admission, after hemodynamic and respiratory stability. The Glasgow coma scale variables, cerebral blood flow patterns and mortality were determined. The information was processed using the statistical program SPSS / PC version 15 for Windows, statistical processing with univariate analysis was applied. Results: 82 patients were studied, with mortality of 37.8% of the total; the highest fatality occurred among patients older than 65 years (60%) (p = 0.01). The Glasgow coma scale of 8 or less points included 67 patients, with a mortality of 43% (p = 0.00). The cerebral ischemic pattern was the most diagnosed (43.9%) with a mortality of 74% (p = 0.03). Conclusions: the ischemic blood flow pattern is the most frequent and has a significant relationship with mortality. The Glasgow coma scale has a significant relationship with the mortality of patients with head trauma.

Primeras experiencias de niños helitransportados en Uruguay / First experiences of helicopter transportation of children in Uruguay / Primeiras experiências de crianças transportadas de helicóptero no Uruguai

Se presentan los primeros tres pacientes pediátricos helitransportados con traumatismo encéfalo craneano (TEC) grave asistidos en nuestra institución. Se muestra el protocolo de asistencia utilizado en el hospital para la recepción, estabilización y oportuno traslado previa coordinación con sectores públicos y privados de asistencia médica. Se solicita consentimiento informado a los padres para el uso de los datos en actividades científicas y publicaciones.

We present the first three pediatric patients transported by helicopter with severe cranioencephalic trauma assisted at our institution. The assistance protocol used in our Hospital for the reception, stabilization and timely transfer is shown after coordination with public and private health providers. Informed consent was requested from the children's parents for the use of the data in scientific activities and publications.

Apresentamos os três primeiros pacientes pediátricos transportados de helicóptero com traumatismo cranioencefálico grave (TCE) atendidos em nossa instituição. Descrevemos o protocolo de atendimento utilizado em nosso Hospital para o acolhimento, estabilização e transferência oportuna prévia coordenação aos setores público e privado de assistência médica. Solicitamos consentimento informado aos pais para o uso dos dados em atividades e publicações científicas.

Dmitri Shostakovich: a work of virtuosity or a profitable misfortune? / Dmitri Shostakovich: ¿virtuosismo o infortunio provechoso?

Abstract Dmitri Shostakovich was one of the greatest composers of 20th century, famous for his piano and violin compositions. One of the compositions, the 5th symphony, is arguably his greatest work, which brought him back to the grace of the Soviet authorities in a moment of a political crisis in Russia. Among the experts, there is a theory which supports that Shostakovich's talent was due to a traumatic brain injury involving a shrapnel. Moreover, he might have suffered from a neurodegenerative process throughout his life. In this paper, we intend to discuss these viewpoints.

RESUMEN Dmitri Shostakovich fue uno de los más renombrados compositores del siglo XX, famoso por sus obras para violín y piano. Su Quinta Sinfonía, es para muchos su obra más importante. Esta pieza le trajo gran simpatía con las autoridades militares en un momento de crisis en la Unión Soviética. Entre opiniones de expertos, existe una teoría que postula que el talento de Shostakovich es secundario a un trauma craneoencefálico producido por herida de metralla. También se cree que pudo haber sufrido de un proceso neurodegenerativo. Nuestra intención en el presente artículo es discutir estos puntos de vista.

Absceso cerebral por Nocardia sp. En un paciente inmunocompetente en el Perú: reporte de caso / Brain abscess due to Nocardia sp. In an immunocompetent patient in Peru: a case report

RESUMEN La nocardiosis cerebral es una entidad rara que ha sido reportada principalmente en inmunosuprimidos, y en la actualidad no se dispone de guías clínicas que recomienden un tratamiento de primera línea. Presentamos el caso de un adulto mayor, inmunocompetente, con cuadro de encefalopatía y hemiparesia izquierda, asociado a lesiones compatibles con absceso cerebral múltiple y sugerente de etiología infecciosa. Recibió, inicialmente, tratamiento para la tuberculosis, absceso bacteriano y toxoplasmosis, sin respuesta clínica favorable. Se inició un tratamiento empírico para la nocardiosis con meropenem y trimetoprim/sulfametoxazol, y se logró mejoría clínica e imagenológica. La ocurrencia de eventos adversos obliga el uso temporal de medicamentos alternativos. Se resaltan algunos criterios a considerar para incluir la nocardiosis en el diagnóstico diferencial en los casos de absceso cerebral múltiple y se mencionan los métodos diagnósticos de laboratorio y los fármacos para iniciar un tratamiento empírico.

ABSTRACT Cerebral nocardia infections is a rare entity, which has been mainly reported in immunosuppressed patients. Currently, there are no clinical guidelines for first-line treatment. Our case refers to an older immunocompetent adult, with encephalopathy and left hemiparesis, associated with lesions compatible with multiple brain abscess and suggestive of infectious etiology. He initially received treatment for tuberculosis, bacterial abscess, and toxoplasmosis, without a favorable clinical response. An empirical treatment for nocardiosis started, by using meropenem and trimethoprim / sulfamethoxazole, and clinical and imaging improvement was achieved. The occurrence of adverse events forces the temporary use of alternative medications. We highlight some criteria for including nocardiosis in the differential diagnosis in cases of multiple brain abscess and mention laboratory diagnostic methods and drugs to initiate empirical treatment.

Effects of aerobic physical exercise on neuroplasticity after stroke: systematic review / Efeitos do exercício físico aeróbico na neuroplasticidade após o acidente vascular cerebral: revisão sistemática de literatura

ABSTRACT Background: Stroke is among the leading causes of death and disability worldwide. Interventions for stroke rehabilitation aim to minimize sequelae, promote individuals' independence and potentially recover functional damage. The role of aerobic exercise as a facilitator of post-stroke neuroplasticity in humans is still questionable. Objective: To investigate the impact of aerobic exercise on neuroplasticity in patients with stroke sequelae. Methods: A systematic review of randomized clinical trials and crossover studies was performed, with searches for human studies in the following databases: PUBMED, EMBASE, LILACS and PeDRO, only in English, following the PRISMA protocol. The keywords used for selecting articles were defined based on the PICO strategy. Results: This systematic review evaluated the impacts of aerobic exercise on neuroplasticity through assessment of neural networks and neuronal excitability, neurotrophic factors, or cognitive and functional assessment. Studies that evaluated the effects of aerobic exercise on neuroplasticity after stroke measured through functional resonance (fMRI) or cortical excitability have shown divergent results, but aerobic exercise potentially can modify the neural network, as measured through fMRI. Additionally, aerobic exercise combined with cognitive training improves certain cognitive domains linked to motor learning. Studies that involved analysis of neurotrophic factors to assess neuroplasticity had conflicting results. Conclusions: Physical exercise is a therapeutic intervention in rehabilitation programs that, beyond the known benefits relating to physical conditioning, functionality, mood and cardiovascular health, may also potentiate the neuroplasticity process. Neuroplasticity responses seem more robust in moderate to high-intensity exercise training programs, but dose-response heterogeneity and non-uniform neuroplasticity assessments limit generalizability.

RESUMO Antecedentes: O acidente vascular cerebral (AVC) é a segunda causa principal de morte no mundo. Intervenções para reabilitação dos pacientes com AVC visam minimizar sequelas, promover sua independência e potencialmente recuperar danos funcionais. O papel do exercício aeróbico como facilitador da neuroplasticidade pós-AVC em humanos ainda é questionável. Objetivo: Investigar o impacto do exercício aeróbico na neuroplasticidade em pacientes com sequelas de AVC. Métodos: Foi realizada revisão sistemática de literatura, pesquisando nas seguintes bases de dados: PUBMED, EMBASE, LILACS e PeDRO. Foram selecionados trabalhos em língua inglesa, realizados apenas com humanos, seguindo o protocolo PRISMA. As palavras-chave utilizadas para a seleção de artigos foram definidas com base na estratégia PICO. Resultados: Esta revisão sistemática avaliou os impactos do exercício aeróbico na neuroplasticidade através da avaliação das redes neurais e da excitabilidade neuronal, por meio de fatores neurotróficos, por meio da avaliação cognitiva e funcional. Estudos que avaliaram os efeitos do exercício aeróbico sobre neuroplasticidade após o AVC medido através de ressonância funcional ou excitabilidade cortical, são controversos, mas há dados sugerindo uma modificação da rede neural na ressonância funcional após o exercício aeróbico. Há evidências de que, associar exercício aeróbico com treinamento cognitivo melhora certos domínios cognitivos ligados à aprendizagem motora. Estudos que envolveram a análise de fatores neurotróficos, como avaliação da neuroplasticidade, tiveram resultados conflitantes. Conclusões: Exercício aeróbico é uma intervenção terapêutica em programas de reabilitação, pois, além de proporcionar os benefícios no condicionamento físico, funcionalidade, humor e saúde cardiovascular, pode potencializar a neuroplasticidade.

Evaluación de los pacientes con contusiones encefálicas en Camagüey / Assessment of patients with brain contusions in Camagüey

RESUMEN Fundamento: El trauma craneoencefálico es la primera causa de muerte en pacientes menores de 40 años y afecta a la población activa con una consecuente repercusión económica y secuelas incapacitantes. Objetivo: Evaluar las características de los pacientes con contusiones encefálicas mediante las escalas de Marshall y Rotterdam. Metodología: Se realizó un estudio descriptivo en adultos con contusiones encefálicas atendidos en el Hospital Universitario Manuel Ascunce de Camagüey desde 2016 al 2019. La muestra quedó constituida por 74 pacientes, a los que se les realizó una evaluación clínica e imagenológica mediante las escalas de Marshall y Rotterdam, lo que permitió efectuar una terapia médica o quirúrgica. Los datos estadísticos se calcularon con el paquete SSPS para determinar frecuencias absoluta y relativa. Resultados: Predominaron los lesionados masculinos (86.4 %) en el grupo de 18 y 39 años donde se ubicó el 40.5 % de la muestra. El 28.3 % no tenía lesiones asociadas. El 43.2 % tenía una gradación Marshall II y el 35.1 % un Rotterdam 1, se aplicó tratamiento médico al 62.1 %, el 43.2 % no presentó complicaciones y el 24.3 % requirió ventilación mecánica asistida. Conclusiones: Las contusiones cerebrales prevalecieron en adultos jóvenes con Marshall II y III, en el Rotterdam los lesionados obtuvieron hasta 3 puntos en la escala. La mayoría no requirió tratamiento quirúrgico, ni ventilación mecánica asistida y no hubo complicación alguna.

ABSTRACT Background: Cranioencephalic trauma is the first cause of death in patients under 40 years of age and affects the working population with subsequent economic repercussions and disabling implications. Objective: To assess the patient's individualities with brain contusions using the Marshall and Rotterdam scales. Methodology: A descriptive study was conducted in adults with brain contusions treated at Manuel Ascunce University Hospital of Camagüey from 2016 to 2019. The sample was constituted by 74 patients who underwent a clinical and imaging evaluation using the Marshall and Rotterdam scales which allowed medical or surgical therapy. Statistical data were calculated with the SSPS package to determine absolute and relative frequencies. Results: Male patients predominated (86.4 %) in the 18 and 39-year age group, where 40.5 % of the sample was located. 28.3 % had no injuries. The 28.3 % had no associated injuries. 43.2 % had a Marshall II grading and 35.1 % a Rotterdam 1, medical treatment was applied to 62.1 %, 43.2 % had no complications, 24.3 % required assisted mechanical ventilation. Conclusions: Brain contusions prevailed in young adults with Marshall II and III, in the Rotterdam the injured obtained up to 3 points on the scale. Most of them did not require surgical treatment or assisted mechanical ventilation and there were no complications.

Traumatismo encéfalo-craneano por caída libre en neonatos

Objetivo : Describir las características clínicas del traumatismo encéfalo craneano en neonatos. Materiales y métodos : Se realizó una serie de casos de neonatos con traumatismo encéfalo craneano, todos con diagnóstico clínico y tomográfico atendidos por el Servicio de Neuropediatría y Neonatología del Hospital Cayetano Heredia del 2014 al 2019. Resultados : Se incluyeron 12 neonatos, 67% (8/12) fueron varones, 33% (4/12) menores de cuatro días de edad y 25% (3/12) hijos de madres añosas. La caída libre fue el mecanismo de lesión en todos los casos y tres de ellos se cayeron de coches de paseo para bebés. El lugar más frecuente de la caída fue el hospital, tres neonatos se encontraban en alojamiento conjunto, dos en la sala de espera de la consulta externa y uno en hospitalización. El 83% (10/12) de los casos cayó de ≥ 0.5 m de altura y 33% (4/12) cayó de ≥ 1m. El 58% (7/12) fue sintomático a la caída, cuatro casos con letargia y uno con irritabilidad. Además, se reportaron vómitos y dificultad respiratoria. Cuatro presentaron hematoma epidural y tres de ellos fractura craneal, dos de gravedad por hipertensión endocraneana descompensada que requirieron evacuación quirúrgica de emergencia. Conclusión : El traumatismo encéfalo craneano en neonatos es un problema potencialmente grave. El hematoma epidural fue la lesión intracraneal más frecuente. La letargia e irritabilidad fueron los síntomas más frecuentes en los neonatos que cayeron de ≥ 0.5m de altura.

Objective : To describe clinical characteristics of head trauma in neonates. Material and methods : This is a case series of neonate patients with head trauma. All of them had a clinical diagnosis and computed tomography scans performed. They were taken care of in both Neuropediatrics and Neonatology services in Cayetano Heredia National Hospital in Lima, Peru from 2014 to 2019. Results : Twelve neonates were included, 67% (8/12) were male, 33% (4/12) were less than four days old, and 25% (3/12) were born to mature mothers. Free fall was the mechanism of lesion for all cases, and three of them fell down from baby trolleys. Places where these accidents occurred were at the hospital. Three neonates were in joint housing, two were in the waiting room of the outpatient clinic, and one fall occurred in the hospitalization ward. Eighty- three per cent (10/12) of all cases fell from ≥0.5- m height, and 33% (4/12) fell from 1- m height. Fifty-eight per cent (7/12) developed symptoms after the fall, four had lethargy and one had irritability. Also, vomits and respiratory distress were reported. Four neonates developed epidural hematoma and three had cranial fracture, two of these latter cases were severe because of decompensated cranial hypertension that required emergency surgical decompression. Conclusion : Head trauma in neonates is a potentially severe condition. Epidural hematoma was the most frequent intracranial lesion. Lethargy and irritability were most frequent symptoms in neonates who fell from ≥0.5- m height.

Magnetic resonance imaging of skull and brain parameters in fetuses with intrauterine growth restriction

Abstract Objective: To compare fetuses with intrauterine growth restriction (IUGR) and those with normal growth, in terms of skull and brain measurements obtained by magnetic resonance imaging (MRI). Materials and Methods: This was a prospective cohort study including 26 single fetuses (13 with IUGR and 13 with normal growth), evaluated from 26 to 38 weeks of gestation. Using MRI, we measured skull and brain biparietal diameters (BPDs); skull and brain occipitofrontal diameters (OFDs); corpus callosum length and area; transverse cerebellar diameter; extracerebral cerebrospinal fluid (eCSF); and right and left interopercular distances (IODs). Results: The following were significantly smaller in IUGR fetuses than in control fetuses: skull BPD (76.9 vs. 78.2 mm; p = 0.0029); brain BPD (67.8 vs. 71.6 mm; p = 0.0064); skull OFD (93.6 vs. 95 mm; p = 0.0010); eCSF (5.5 vs. 8.2 mm; p = 0.0003); right IOD (9.8 vs. 13.9 mm; p = 0.0023); and left IOD (11.8 vs. 16.3 mm; p = 0.0183). The skull BPD/eCSF, brain BPD/eCSF, skull OFD/eCSF, and brain OFD/eCSF ratios were also lower in IUGR fetuses. Conclusion: IUGR fetuses had smaller OFD and BPD, both skull and brain, and less eCSF when compared to normal growth fetuses.

Resumo Objetivo: Comparar medidas do crânio e encéfalo por meio da ressonância magnética (RM) de fetos com restrição do crescimento intrauterino (RCIU) e com crescimento adequado. Materiais e Métodos: Realizou-se um estudo de coorte prospectivo com 13 fetos com RCIU e 13 controles entre 26 e 38 semanas. Foram realizadas as seguintes medidas por RM: diâmetro biparietal (DBP) e diâmetro occipitofrontal (DOF) cerebral e ósseo, comprimento e área do corpo caloso (CPC), diâmetro transverso do cerebelo, líquido cerebroespinhal (LCE) extracerebral e distância interopercular (DIO) direita e esquerda. Resultados: Observaram-se diferenças significativas nas medidas do DBP ósseo (76,9 vs. 78,2 mm; p = 0,0029), DBP cerebral (67,8 vs. 71,6 mm; p = 0,0064) e DOF ósseo (93,6 vs. 95 mm; p = 0,0010) em fetos com RCIU em relação aos fetos com crescimento normal. Observaram-se, ainda, diferenças significativas nas médias do LCE extracerebral (5,5 vs. 8,2 mm; p = 0,0003) e DIO direita (9,8 vs. 13,9 mm; p = 0,0023) e esquerda (11,8 vs. 16,3 mm; p = 0,0183) em fetos com RCIU em relação aos controles. Fetos com RCIU e normais tiveram diferenças entre DBP ósseo/LCE, DBP cerebral/LCE, DOF/LEC, e DOF cerebral/LCE. Conclusão: Fetos com RCIU tiveram menores DBP e DOF, ambos crânio e encéfalo, e menor LCE extracerebral que fetos com crescimento adequado.

Validez del diámetro de la vaina del nervio óptico por ultrasonografía para el diagnóstico de hipertensión intracraneana en traumatismo craneoencefálico severo / Validity of the optical nerve sheath diameter by ultrasonography for the diagnosis of intracranean hypertension in severe craneoencephalic trauma

Objetivo: Determinar la validez del diámetro de la vaina del nervio óptico por ultrasonografía para el diagnóstico de hipertensión intracraneana en pacientes con traumatismo craneoencefálico severo. Material y métodos: Se Realizó un estudio de prueba diagnosticas que evaluó a 43 pacientes con sospecha de hipertensión intracraneana secundario a un traumatismo craneoencefálico severo, que cumplieron los criterios diagnósticos según la "Regla de Decisión Clínica" basado en hallazgos clínicos y tomográficos, luego se realizaron mediciones de la vaina del nervio óptico por ultrasonografía en el Hospital Regional Docente de Trujillo entre Mayo del 2019 -Enero del 2020. Resultados: De un total de 43 pacientes, al procesar los datos mediante la curva ROC, se obtuvo un punto de corte del diámetro de la vaina del nervio óptico de 6,05 mm equivalente a hipertensión intracraneana, con un área bajo la curva (AUC) de 0,776 (P=0,004); sensibilidad, especificidad, valor de predicción positiva y negativa de 82,76%, 57,14%, 80% y 61,54% respectivamente. No se encontraron diferencias significativas entre los 2 grupos en cuanto a sexo, edad, anisocoria e hipotensión arterial diastólica. Conclusiones: El diámetro de la vaina del nervio óptico medido por ultrasonografía tiene validez para el diagnóstico de hipertensión intracraneana secundario a un traumatismo craneoencefálico severo.

Objetive:To determine the validity of the diameter of the optic nerve sheath by ultrasound for the diagnosis of intracranial hypertension in patients with severe traumatic brain injury. Adiagnostic test study was carried Material and methods:out in 43 patients with suspected intracranial hypertension secondary to severe traumatic brain injury, who fulfilled the diagnostic criteria according to the "Clinical Decision Rule" based on clinical and tomographic findings, then were made measurements of the optic nerve sheath by ultrasound at the Regional Teaching Hospital of Trujillo between May 2019 -January 2020. : From a total of 43 Resultspatients, when processing the data using the ROC curve, a cut point of the diameter of the optic nerve sheath of 6.05 mm was obtained, equivalent to intracranial hypertension, with an area under the curve (AUC) of 0.776 (P= 0.004); sensitivity, specificity, positive and negative prediction value of 82.76%, 57.14%, 80% and 61.54% respectively. No significant differences were found between the 2 groups in terms of sex, age, anisocoria and diastolic arterial hypotension. The Conclusions:diameter of the optic nerve sheath measured by ultrasound is valid for the diagnosis of intracranial hypertension secondary to severe traumatic brain injury.