Algunos apuntes sobre la historia de la Neurología en Santiago de Cuba / Some notes on the history of Neurology in Santiago de Cuba

Los inicios de la Neurología en Cuba se remontan a principios del siglo XIX, pero su definición como especialidad independiente se debió fundamentalmente a la intensa labor asistencial, docente e investigativa del profesor José Rafael Estrada González. Un hito importante fue la creación en 1962 del Instituto de Neurología y Neurocirugía. En la provincia de Santiago de Cuba los primeros neurólogos comenzaron a trabajar en la década de los 70 y a partir de 1983 se inició la docencia de posgrado. En estos años transcurridos se ha consolidado el trabajo docente, asistencial e investigativo de la especialidad, plenamente integrada a todos los programas y tareas del sistema de salud en el país.

The onset of Neurology in Cuba go back to the beginning of the XIX century, but its definition as independent specialty was mainly due to the intense assistance, educational and investigative work of professor José Rafael Estrada González. An important landmark was the creation of the Neurology and Neurosurgery Institute in 1962. In the province of Santiago de Cuba the first neurologists began to work in the 70´s and since 1983 the postgrade teaching began. During those years the educational, assistance and investigative work of the specialty has consolidated, fully integrated to all programs and tasks of the health system in the country.

Síndrome de Guillain-Barré en la infancia / Guillain-Barré syndrome in the childhood

Se realizó un estudio descriptivo y prospectivo de 25 pacientes con síndrome de Guillain-Barré, atendidos en el Hospital Infantil Docente Sur de Santiago de Cuba, desde enero de 2006 hasta diciembre de 2012, con vistas a identificar sus características clinicoepidemiológicas y determinar la utilidad del tratamiento empleado. Predominaron los niños menores de 5 años (40,0 por ciento), el sexo masculino y la infección respiratoria alta previa (ambas con 60,0 por ciento), así como la debilidad muscular y arreflexia osteotendinosa (76,0 por ciento en cada caso). La polirradiculoneuropatía desmielinizante inflamatoria aguda fue la variante clínica más frecuente (72,0 por ciento). Tanto el tratamiento con inmunoglobulina humana intravenosa como la rehabilitación resultaron beneficiosos y la mortalidad baja (4,0 por ciento)(AU)

A descriptive and prospective study of 25 patients with Guillain-Barré syndrome, assisted in the Teaching Southern Children Hospital in Santiago de Cuba was carried out from January, 2006 to December, 2012, with the aim of identifying their clinical and epidemiological characteristics and to determine the usefulness of the treatment applied. Children younger than 5 years (40.0 percent), male sex and previous upper respiratory infection (both with 60.0 percent), as well as the muscular weakness and osteotendinous areflexia (76.0 percent in each case) prevailed. The inflammatory and acute desmyelinating polyrradiculoneuropathy was the most frequent clinical variant (72.0 percent). Either the treatment with intravenous human immunoglobulin as rehabilitation were beneficial and the mortality was low (4.0 percent)(AU)

Síndrome de Guillain-Barré en la infancia / Guillain-Barré syndrome in the childhood

Se realizó un estudio descriptivo y prospectivo de 25 pacientes con síndrome de Guillain-Barré, atendidos en el Hospital Infantil Docente Sur de Santiago de Cuba, desde enero de 2006 hasta diciembre de 2012, con vistas a identificar sus características clinicoepidemiológicas y determinar la utilidad del tratamiento empleado. Predominaron los niños menores de 5 años (40,0 %), el sexo masculino y la infección respiratoria alta previa (ambas con 60,0 %), así como la debilidad muscular y arreflexia osteotendinosa (76,0 % en cada caso). La polirradiculoneuropatía desmielinizante inflamatoria aguda fue la variante clínica más frecuente (72,0 %). Tanto el tratamiento con inmunoglobulina humana intravenosa como la rehabilitación resultaron beneficiosos y la mortalidad baja (4,0 %).

A descriptive and prospective study of 25 patients with Guillain-Barré syndrome, assisted in the Teaching Southern Children Hospital in Santiago de Cuba was carried out from January, 2006 to December, 2012, with the aim of identifying their clinical and epidemiological characteristics and to determine the usefulness of the treatment applied. Children younger than 5 years (40.0%), male sex and previous upper respiratory infection (both with 60.0%), as well as the muscular weakness and osteotendinous areflexia (76.0% in each case) prevailed. The inflammatory and acute desmyelinating polyrradiculoneuropathy was the most frequent clinical variant (72.0%). Either the treatment with intravenous human immunoglobulin as rehabilitation were beneficial and the mortality was low (4.0%).

Celulitis facial iatrogénica como consecuencia de una sepsis odontógena / Facial iatrogenic cellulitis as consequence of an odontogenic sepsis

Se describe el caso clínico de un paciente de 56 años de edad, quien perdiera la obturación del canino superior derecho y acudió al servicio estomatológico de la Clínica Estomatológica Provincial Docente "Mártires del Moncada" de Santiago de Cuba con intenso dolor y sepsis apical incipiente, ante lo cual pedía una nueva obturación para aliviar sus síntomas. La especialista detectó la infección en ciernes y le alertó sobre las posibles complicaciones, pero debido a la insistencia del afectado obturó nuevamente el diente; en consecuencia, a las pocas horas se desarrolló una aguda celulitis facial con afectación periorbitaria, que solo cedió al administrar antibióticos de amplio espectro por vía endovenosa.

The case report of a 56 year-old patient who lost the obturation of the superior right canine and visited the estomatological service of "Mártires del Moncada" Teaching Provincial Estomatological Clinic in Santiago de Cuba with intense pain and incipient apical sepsis, requesting a new obturation to relieve his symptoms is described. The specialist detected the newly found infection, and alerted him on the possible complications, but due to the insistence of the affected patient she filled the tooth once more; in consequence, few hours later an acute facial cellulitis was developed with periorbital compromise, which improved only when administering wide-spectrum intravenous antibiotics.

Prevalence, demographics and clinical characteristics of multiple sclerosis in Qatar.

No published epidemiologic data on multiple sclerosis (MS) in Qatar exist. Our objectives were to determine the prevalence, demographics and clinical characteristics of MS in the Middle Eastern country of Qatar. We analyzed data for Qatari MS patients fulfilling the McDonald diagnostic criteria. A total of 154 patients fulfilled the inclusion criteria. On 31 April 2010, the crude prevalence of MS in Qatar was 64.57 per 100,000 inhabitants (95% CI: 58.31-70.37). The female-to-male ratio was 1.33:1. A positive family history was found in 10.4% of included MS patients. We conclude that Qatar is now a medium-to-high risk area for MS, with some important differences in clinical characteristics as compared to other countries in the region.

Encefalomielitis aguda diseminada y malaria cerebral / No disponible

No disponible

Hypothalamic hamartoma presenting with gelastic seizures, generalized convulsions, and ictal psychosis

We report a case of hypothalamic hamartoma in an adult female who presented with gelastic seizures, generalized convulsions, and ictal aggressive psychotic behavior. Anticonvulsant treatment was ineffective in controlling the epileptic seizures. Surgical excision after accurate imaging diagnosis 3 decades after the onset of symptoms markedly ameliorated her condition. Delayed(AU)

Scleredema diabeticorum with unusual presentation and fatal outcome

We present a case of Scleredema Diabeticorum (SD) in a patient with diabetic neuropathy and restrictive respiratory disease with unusual skin lesion distribution. The onset of dermatologic symptoms heralded a progressive respiratory disease with constrictive component. Painful diabetic neuropathy was noteworthy and difficult to relieve. Predominantly, distribution of the skin lesions on the thighs makes the case exceptional. T2-weighted MRI showed abnormal hyperintensities along the muscles of the thighs in correspondence with the skin lesions. Gait and respiratory symptoms progressively worsened. After a transient remitting period, he developed sudden shortening of breath, arrested and expired at home.The atypical distribution of the skin lesions with further involvement of underlying muscles plus concomitant polyneuropathy and respiratory constrictive disease with sudden death is quite unusual and aggressive presentation of SD(AU)

Scleredema diabeticorum with unusual presentation and fatal outcome

We present a case of Scleredema Diabeticorum (SD) in a patient with diabetic neuropathy and restrictive respiratory disease with unusual skin lesion distribution. The onset of dermatologic symptoms heralded a progressive respiratory disease with constrictive component. Painful diabetic neuropathy was noteworthy and difficult to relieve. Predominantly, distribution of the skin lesions on the thighs makes the case exceptional. T2-weighted MRI showed abnormal hyperintensities along the muscles of the thighs in correspondence with the skin lesions. Gait and respiratory symptoms progressively worsened. After a transient remitting period, he developed sudden shortening of breath, arrested and expired at home.The atypical distribution of the skin lesions with further involvement of underlying muscles plus concomitant polyneuropathy and respiratory constrictive disease with sudden death is quite unusual and aggressive presentation of SD(AU)

Epidemiología de las epilepsias / Epidemiology of the epilepsy

El tema de la Epidemiología de las epilepsias requiere de una especial atención por la capacidad de criterios metodológicos a la hora de diseñar los estudios de utilizar la clasificación de la ILAE, un instrumento que a pesar de ser muy útil y universalmente aceptado, sufre de limitaciones por lo que debe de modificarse teniendo en cuenta los avances de los últimos años que han redundado en una mejor comprensión de su fisiopatología. Desgraciadamente, una proporción importante, de los 40 millones de epilépticos que existen en el mundo, no pueden siquiera acceder a un médico, por lo que el estudio y adecuado manejo de estos pacientes es una quimera para una gran cantidad de países, de aquí que muchas tasas de prevalencia no reflejen de manera fidedigna la realidad. La composición etiológica en el mundo subdesarrollado muestra la elevada proporción de enfermedades infecciosas y parasitarias que condicionan la mayoría de las epilepsias sintomáticas, siendo neurocisticercosis una de las predominantes. Ante esta situación no existe otra alternativa que un trabajo de consenso donde se modifique la actual clasificación de la ILAE sobre la base de una mejor correlación clínico-electroencefalográfica, la de incorporar los avances de la genética molecular, de las imágenes funcionales, entre otros avances y sobre todo la voluntad política de los países para enfrentar con éxito este reto(AU)

The epidemiology of epilepsies requires a special attention due to the disparity in is methodological approach while designing studies base don the ILAE classification, a worthy instrument that it accepted worldwide in spite of objective limitations to be corrected taking into consideration the recent advances which has implied a better understanding of its physiopathology. Unfortunately, and important part of the more than 40 millions of persons suffering from epilepsy has not even the chance to see a doctor, so that the proper management of the cases of these cases remains a chimera for most of those countries and its is obvious that prevalence rates are not reliable nor reflect accurately the reality. Etiological composition in the poor world shows a high rate of infections and parasitic conditions that are the predominant cause of symptomatic cases, being neurocysticercosis one of the most important. After these reflections there is not other choice than working together around the globe to achieve consensus to modify the actual ILAE classification on the basis of a better clinical electroencephalographic correlates, the breakthrough of molecular genetic and that of functional imaging among other advances, but above all, there must be a political will to face successfully this challenge(AU)