Neurologia Argentina最新文献

{"title":"Retraso diagnóstico de esclerosis múltiple y sus factores asociados en los pacientes del Hospital Córdoba. Desafíos en la identificación precoz de la enfermedad en un centro de referencia","authors":"Tomás Martín Cosacov ,&nbsp;Susana Liwacki","doi":"10.1016/j.neuarg.2025.05.006","DOIUrl":"10.1016/j.neuarg.2025.05.006","url":null,"abstract":"<div><div>Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system and the leading cause of non-traumatic neurological disability in young adults. An early diagnosis is crucial for initiating disease-modifying treatments and preventing the progression of disability. However, multiple factors can delay diagnosis and treatment initiation. The objective of this study was to identify these factors and their impact on time to diagnosis and treatment in a cohort of patients at Hospital Córdoba. The researchers conducted a cross-sectional observational study of 153 adult patients diagnosed with multiple sclerosis according to the 2017 McDonald criteria. Their clinical and demographic data were collected and analyzed using logistic regression to determine the factors associated with an early versus late diagnosis or early versus late treatment initiation. The median times to diagnosis and treatment initiation were 95 and 184 days, respectively. Factors such as clinical onset with optic neuritis, diplopia, or motor symptoms were associated with an early diagnosis. In contrast, lack of health insurance, delays in test authorization, and delays in medication dispensing were relevant factors in late treatment initiation, though not statistically significant. Delaying consultation with a specialist was a significant predictor of late treatment initiation. This study highlights the frequency of late diagnosis of multiple sclerosis at Hospital Córdoba, which impacts the progression of disability. Specific clinical factors can favor early diagnosis, while barriers to access and delays in care can complicate the timely initiation of treatment. Improving health education and access to diagnostic resources for vulnerable populations could reduce these delays and improve patient outcomes.</div></div>","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 3","pages":"Pages 181-189"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145021075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signo del cerebelo blanco: un indicador de daño cerebral extenso","authors":"Martina Scicchitano,&nbsp;Daiana Barrio,&nbsp;Agustina Babbicola,&nbsp;Emilia Sanchez Toledo,&nbsp;Macarena Bermejo,&nbsp;Florencia Sica,&nbsp;Alejandra Heriz,&nbsp;María Emilia Clément,&nbsp;Lucas Romano,&nbsp;Pablo Ioli","doi":"10.1016/j.neuarg.2025.06.002","DOIUrl":"10.1016/j.neuarg.2025.06.002","url":null,"abstract":"","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 3","pages":"Pages 209-210"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ictus isquémico en una paciente de 27 años con COVID-19 asintomático: informe de un caso","authors":"Edgar Castillo-Tamara ,&nbsp;Loida Camargo ,&nbsp;María Cecilia Díaz ,&nbsp;Nicole Caldichoury ,&nbsp;Jorge Herrera-Pino ,&nbsp;Juan-Carlos Coronado ,&nbsp;Yuliana Florez ,&nbsp;Daniela Ripoll-Córdoba ,&nbsp;Juan Camilo Benitez-Agudelo ,&nbsp;Norman López","doi":"10.1016/j.neuarg.2025.05.002","DOIUrl":"10.1016/j.neuarg.2025.05.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Currently, there is evidence of numerous neurological manifestations in patients with various complications associated with COVID-19, one of which is stroke.</div></div><div><h3>Clinical case</h3><div>We present a young patient with no prior comorbidities and asymptomatic COVID-19, who developed motor aphasia as a manifestation of ischemic stroke.</div></div><div><h3>Conclusion</h3><div>We aim to highlight the importance of testing for SARS-CoV-2 in patients with cerebral ischemia without any other probable cause, even if they do not present symptoms of COVID-19.</div></div>","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 3","pages":"Pages 197-202"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145021077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consenso Argentino de Diagnóstico y Tratamiento de Encefalitis Autoinmune en Adultos (CARENAI)","authors":"Andrés Barboza ,&nbsp;María Cecilia Fernández ,&nbsp;Javier Hryb ,&nbsp;Manuel Facundo Latini ,&nbsp;Carlos Alberto Mangone ,&nbsp;Analisa Manin ,&nbsp;Mariano Marrodan ,&nbsp;Nahuel Pereira de Silva ,&nbsp;Manuel Pérez Akly ,&nbsp;Galeno Rojas ,&nbsp;Lucas Romano ,&nbsp;Carlos Rugilo ,&nbsp;Marina Sánchez ,&nbsp;Martin Tourreilles ,&nbsp;Andrés Villa ,&nbsp;Florencia Yorio ,&nbsp;Daniel Zuin","doi":"10.1016/j.neuarg.2025.06.003","DOIUrl":"10.1016/j.neuarg.2025.06.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Autoimmune encephalitis (AE) is a rapidly evolving field in neurology, with improved recognition due to advances in antibody detection. Despite its growing incidence, diagnostic and therapeutic challenges persist, including clinical heterogeneity, risk of misdiagnosis, and lack of standardized protocols. The Argentine Consensus on Diagnosis and Treatment of Autoimmune Encephalitis in Adults (CARENAI), endorsed by the Argentine Neurological Society, aims to establish management guidelines for AE in Argentina.</div></div><div><h3>Methods</h3><div>Seventeen experts from various neurological subspecialties were convened, using the RAND/UCLA method to evaluate diagnostic and therapeutic strategies. A systematic literature review informed the recommendations, focusing on clinical suspicion, antibody testing (in CSF and serum), neuroimaging (MRI, PET-FDG), EEG interpretation, and immunotherapeutic approaches.</div></div><div><h3>Results</h3><div>Diagnostic criteria emphasize subacute cognitive/psychiatric symptoms, exclusion of differential diagnoses, and inflammatory findings in CSF/MRI. First-line treatment includes corticosteroids, intravenous immunoglobulins (IVIG), or plasmapheresis, while refractory cases may require rituximab or cyclophosphamide. CARENAI addresses phenotype-specific management and emphasizes early tumor screening in paraneoplastic cases. Prognostic factors and relapse prevention are discussed, highlighting the importance of interdisciplinary follow-up.</div></div><div><h3>Conclusion</h3><div>CARENAI provides a framework to reduce diagnostic delays, optimize treatments, and improve outcomes, while acknowledging evidence gaps. It advocates for improved access to specialized testing and promotes future research to refine AE management in Argentina.</div></div>","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 3","pages":"Pages 153-172"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El rol modulador de lesiones en sustancia blanca en la mediación entre IMC, lípidos, presión arterial y niveles de glucosa","authors":"Alberto Guevara Tirado","doi":"10.1016/j.neuarg.2025.06.005","DOIUrl":"10.1016/j.neuarg.2025.06.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiometabolic alterations affect glycemic control, but the modulatory role of cerebral white matter lesions in these associations is not yet fully understood.</div></div><div><h3>Objective</h3><div>To evaluate whether the presence of cerebral white matter lesions moderates the relationship between BMI and glucose through cardiometabolic markers.</div></div><div><h3>Materials and Methods</h3><div>Analytical secondary data study (n<!--> <!-->=<!--> <!-->1904) of patients undergoing clinical evaluations and brain MRI. The independent variable was BMI and fasting glucose the dependent variable; mediators included LDL, triglycerides (TG), and systolic blood pressure (SBP); and the moderator was the presence of cerebral white matter lesions. Hayes’ PROCESS model 59 was used to assess direct, indirect, and moderated effects. The causal model was visualized with a directed acyclic graph.</div></div><div><h3>Results</h3><div>The effect of BMI on LDL (β<!--> <!-->=<!--> <!-->1.47; p<!--> <!-->&lt;<!--> <!-->0.001), TG (β<!--> <!-->=<!--> <!-->10.13; p<!--> <!-->&lt;<!--> <!-->0.001), and SBP(β<!--> <!-->=<!--> <!-->1.45; p<!--> <!-->&lt;<!--> <!-->0.001) was attenuated in the presence of lesions, with significant negative interactions (LDL: β<!--> <!-->=<!--> <!-->−0.86; p<!--> <!-->=<!--> <!-->0.036; TG: β<!--> <!-->=<!--> <!-->−3.89; p<!--> <!-->=<!--> <!-->0.003; SBP: β<!--> <!-->=<!--> <!-->−0.81; p<!--> <!-->=<!--> <!-->0.001). In the glucose model, BMI (β<!--> <!-->=<!--> <!-->1.36; p<!--> <!-->&lt;<!--> <!-->0.001), TG (β<!--> <!-->=<!--> <!-->0.015; p<!--> <!-->=<!--> <!-->0.003), and SBP (β<!--> <!-->=<!--> <!-->0.11; p<!--> <!-->=<!--> <!-->0.004) showed positive associations. Lesions had no significant direct effect (β<!--> <!-->=<!--> <!-->11.58; p<!--> <!-->=<!--> <!-->0.12) but moderated the BMI-glucose (interaction: β<!--> <!-->=<!--> <!-->−0.49; p<!--> <!-->=<!--> <!-->0.048) and TG-glucose (interaction: β<!--> <!-->=<!--> <!-->0.058; p<!--> <!-->&lt;<!--> <!-->0.001) relationships. The indirect effect of BMI on glucose via triglycerides was greater in the presence of lesions (β<!--> <!-->=<!--> <!-->0.45; 95%<span>C</span>I: 0.25–0.75) than in their absence (β<!--> <!-->=<!--> <!-->0.15;95%CI: 0.01-0.40). Mediation through SBP was significant in both groups (no lesions: β<!--> <!-->=<!--> <!-->0.15; with lesions: β<!--> <!-->=<!--> <!-->0.07).</div></div><div><h3>Conclusions</h3><div>The indirect effects of BMI on glucose are modulated by the presence of cerebral white matter lesions, highlighting the modulatory role of brain damage in the pathways linking adiposity and glycemic control.</div></div>","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 3","pages":"Pages 173-180"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advancements in nanoparticle drug delivery systems to cure neurological disorders via the nasal route","authors":"Preeti Tiwari ,&nbsp;S.K. Prajapati ,&nbsp;Vihangesh Dixit ,&nbsp;Mohammad Adnan Raza ,&nbsp;Ajazuddin ,&nbsp;Sanjay Kumar Gupta ,&nbsp;Mukesh Sharma","doi":"10.1016/j.neuarg.2025.05.003","DOIUrl":"10.1016/j.neuarg.2025.05.003","url":null,"abstract":"<div><div>Neurological disorders present a significant global health challenge, with limited effective treatment options due to the complex and selective nature of the blood–brain barrier (BBB). Recent years have witnessed remarkable advancements in nanoparticle-based drug delivery systems designed to overcome these barriers and enhance the therapeutic outcomes of neurological disorder treatments. Among these innovations, nasal drug delivery has emerged as a promising non-invasive approach to bypass the BBB and directly target the central nervous system (CNS). This article provides an overview of the origin of nanotechnology and its intersection with biotechnology, leading to the emergence of nanobiotechnology. It highlights the role of nanotechnology in drug delivery and its potential to enhance the effectiveness of nanoscale structures in biomedical science. The article emphasizes the significance of the chemical composition of nanoparticles (NPs) in determining their physiochemical properties and drug-release behavior. The challenges posed by the BBB in delivering drugs to the CNS and the limited permeability of macromolecules to the barrier. The article emphasizes the role of the BBB as a diffusion barrier and explains the mechanisms by which molecules can cross the barrier. It mentions the presence of interendothelial junctions and receptors/transporters in endothelial cells that regulate the permeability of the BBB. Overall, the article provides an overview of the role of nanoparticles in drug delivery through the nasal route for the treatment of neurological disorders.</div></div>","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 3","pages":"Pages 143-152"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trombosis venosa cerebral: experiencia en un hospital de referencia nacional del Perú","authors":"Otto J. Hernández Fustes ,&nbsp;Carlos Arteaga Rodríguez","doi":"10.1016/j.neuarg.2025.05.001","DOIUrl":"10.1016/j.neuarg.2025.05.001","url":null,"abstract":"","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 3","pages":"Pages 211-212"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piomiositis y absceso epidural por SAMR en 2 pacientes inmunocompetentes","authors":"Martina Scicchitano,&nbsp;Ludmila Ortiz,&nbsp;Daiana Soledad Barrio,&nbsp;Agustina Belén Babbicola,&nbsp;Emilia Sánchez Toledo,&nbsp;Macarena Bermejo,&nbsp;Carla Costa,&nbsp;Florencia Sica,&nbsp;Alejandra Heriz,&nbsp;María Emilia Clément,&nbsp;Lucas Martín Romano,&nbsp;Pablo Leonardo Ioli","doi":"10.1016/j.neuarg.2025.05.005","DOIUrl":"10.1016/j.neuarg.2025.05.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Central nervous system (CNS) and musculoskeletal infections can be severe, especially in immunocompromised individuals. Epidural abscess and pyomyositis are caused by <em>Staphylococcus aureus (S. aureus)</em>, requiring early diagnosis and treatment to improve prognosis.</div></div><div><h3>Case report</h3><div>Two young patients without comorbidities developed severe infections caused by methicillin-resistant <em>S. aureus</em>. The first patient developed primary pyomyositis with sepsis and muscle collections, requiring drainage and intravenous antibiotics. The second patient presented with an epidural abscess causing spinal cord compression, requiring laminectomy and antibiotics. Both showed neurological improvement, although they had mild motor sequelae one month after discharge.</div></div><div><h3>Discussion</h3><div><em>S. aureus</em> is responsible for invasive infections such as pyomyositis and epidural abscess. These infections pose diagnostic challenges since their symptoms are nonspecific. Laboratory tests are helpful but insufficient, making magnetic resonance imaging crucial for identification. Treatment involves a combination of antibiotics and either drainage or surgery in advanced cases. Prognosis depends on early diagnosis and the neurological status prior to treatment.</div></div><div><h3>Conclusion</h3><div>Pyomyositis and epidural abscess are serious and uncommon infections, with diagnosis often delayed due to nonspecific symptoms. Magnetic resonance imaging is essential for detection. Timely treatment with antibiotics and drainage improves prognosis, although pre-treatment neurological status influences recovery.</div></div>","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 3","pages":"Pages 203-208"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145021078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factores pronósticos en el síndrome de Guillain-Barré: un estudio prospectivo en el sur de Uruguay","authors":"Rodrigo Décima ,&nbsp;Mercedes Chiesa ,&nbsp;Héctor Chiaparelli ,&nbsp;Cristina Vázquez","doi":"10.1016/j.neuarg.2025.06.006","DOIUrl":"10.1016/j.neuarg.2025.06.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>Guillain-Barré Syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system characterized by acute, symmetric muscle weakness. Understanding its regional epidemiology and prognostic factors is crucial for clinical management. This study analyzed the incidence and prognostic factors of GBS in Uruguay, focusing on identifying clinical variables associated with poor outcomes and the need for mechanical ventilation (MV).</div></div><div><h3>Methods</h3><div>A prospective study was conducted on 61 GBS patients over two years in Uruguay. Data collected included demographic and clinical characteristics, cerebrospinal fluid (CSF) protein levels, and serological tests. The primary outcome was to predict the need for MV. The secondary outcome was functional recovery at 6<!--> <!-->months, assessed with the Hughes scale. Bivariate analysis was used to evaluate associations between clinical variables, MV requirement, and outcomes.</div></div><div><h3>Results</h3><div>Among the 61 cases, 38 (62%) were men, with a median age of 56<!--> <!-->years. Autonomic dysfunction was observed in 39% of patients. Eighteen (29%) required MV, which was significantly associated with autonomic dysfunction, bulbar weakness, and the Medical Research Council (MRC) sum score. The MRC score and the Erasmus GBS Outcome Scale (mEGOS) at day<!--> <!-->7 were related to worse recovery at 6<!--> <!-->months. No significant associations were found between CSF protein levels and outcomes. <em>Campylobacter</em> infection was low (10%).</div></div><div><h3>Conclusions</h3><div>Regional variations in the epidemiology and prognostic factors of GBS necessitate tailored clinical management. Autonomic dysfunction and bulbar weakness are critical for predicting the need for MV. The MRC score provides a simple tool for prediction in the clinical setting. This study enhances the understanding of GBS and guides clinical decision-making in Uruguay and similar regions.</div></div>","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 3","pages":"Pages 190-196"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145021076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporte de caso: Mielitis transversa con anticuerpos anti-glicoproteína de la mielina del oligodendrocito en un paciente con debut de síndrome de Sjögren","authors":"María Emilia Sanchez Toledo,&nbsp;Maria Macarena Bermejo,&nbsp;María Emilia Clement,&nbsp;Pablo Ioli,&nbsp;Nicolás Pellice,&nbsp;Lucas Piedrafita,&nbsp;María Florencia Sica","doi":"10.1016/j.neuarg.2025.04.001","DOIUrl":"10.1016/j.neuarg.2025.04.001","url":null,"abstract":"<div><div>Transverse myelitis is an inflammatory disease that affects the spinal cord. Its etiology is multiple. A case of a 55-year-old patient with no history is shown, who presented paraplegia and acute anesthesia of the lower limbs, associated with urinary retention, with a diagnosis of transverse myelitis. Magnetic resonance imaging of the dorso-lumbar spine was performed, which showed a longitudinally extensive spinal cord lesion from vertebral segment dorsal<!--> <!-->6. Anti-Ro antibodies were present in high titers, salivary gland biopsy confirmed Sjogren's syndrome, and antibodies directed against myelin oligodendrocyte glycoprotein (Anti-MOG) were present. Secondary causes were ruled out.</div></div>","PeriodicalId":39051,"journal":{"name":"Neurologia Argentina","volume":"17 2","pages":"Pages 138-141"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}