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BACKGROUND: There is scarce information about ischemic stroke in young patients in Colombia. To get insights about this phenomenon, this study describes the etiologies and risk factors of ischemic stroke in young patients in a third level complexity referral hospital in Medellin, Colombia. METHODS: A retrospective observational cross-sectional study was carried out reviewing the medical records of patients between 18 to 49 years old admitted for the first time for ischemic stroke, from January 2009 to December 2019. The sociodemographic characteristics, risk factors, and etiological classification of ischemic stroke according to the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) were described. RESULTS: Two hundred thirty-seven cases were found. The most frequent risk factors were arterial hypertension (31.7%), smoking (29.5%) and alcohol intake (23.2%). There was a greater number of traditional cardiovascular risk factors at older ages. The TOAST classification was large-artery atherosclerosis (6.8%), cardioembolism (17.7%), small-vessel disease (7.6%), other determined etiology (25.7%) and undetermined (42.2%). Within cardioembolism, the most common high-risk source was valve replacement, and the most common moderate-risk source was patent foramen ovale. Craniocervical arterial dissection (11.4%) and substance abuse (2.9%) were the two most frequent sources within other determined etiologies. The most common compromised vascular territory was the anterior (55.7%). CONCLUSIONS: The high frequency of traditional risk factors in young patients highlights the need to optimize primary and secondary prevention plans. This study provides new insights about the relevance of illicit substance abuse in Colombia as a cause of stroke in young patients, unlike the previous one conducted in Bogotá. Infectious causes were other peculiarities found. It is necessary to investigate the reasons for the high proportion of undetermined causes.

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BACKGROUND: There are few epidemiological studies published in the world evaluating the prevalence of Neuromyelitis Optica Spectrum Disorder (NMOSD). The true prevalence of the disease is not known and the studies carried out are based on the diagnostic criteria used prior to 2015. OBJECTIVE: To determine the prevalence of NMOSD in Antioquia, from January 2016 to December 2018. METHODS: The prevalence of NMOSD in Antioquia was determined using the Capture-Recapture Method. Eight centers in the Department of Antioquia for the care of patients with neurological diseases were included. The data was collected between 2016 and 2018. RESULTS: A total of 221 consultation histories, 169 patients with a diagnosis of NMOSD were identified. The prevalence was 4.03 cases/100,000 inhabitants (95% confidence interval (CI) 3.3-4.8) of whom (87.5%), were women and the predominant race was Mestizo (81.6%). The most frequent initial presentation was optic neuritis (ON) (50.9%). Most of the patients had motor or visual disability (86.4%) and the treatment most used was Rituximab (47.9%). CONCLUSION: The prevalence of NMOSD in Antioquia is one of the highest reported in the world, except for the French Antilles. More studies are required to know the prevalence of this disease in the Colombian population.

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INTRODUCCIÓN: El ataque cerebrovascular (ACV) es la principal causa de discapacidad en el mundo. Su incidencia está en aumento, incluso en jóvenes. Por lo anterior, los factores de riesgo y etiologías diversas del ACV en jóvenes deben estudiarse para planear acciones preventivas. Por eso en Colombia es necesario conocer dichos factores y etiologías analizando los estudios sobre el tema. METODOLOGÍA: Se hizo búsqueda y análisis de artículos sobre causas y factores de riesgo de ACV isquémico en Colombia publicados en Pubmed, Lilacs, Scielo, Google Scholar. Luego de revisar títulos y resúmenes se excluyeron los que no se referían a jóvenes entre 18 y 49 años o ACV isquémico, revisiones de tema, duplicados. Finalmente se analizaron 20 artículos. RESULTADOS Y DISCUSIÓN: La mayor parte de los estudios eran reporte o series de casos, sumaron 60 personas. No hubo predominio de sexo, excepto en los casos de síndrome antifosfolípido (SAF) que fueron mujeres, a diferencia de la mayoría de las series mundiales. La mayor frecuencia fue 56% para otras causas determinadas como SAF y disección de vasos craneocervicales, superior a otros reportes. Hubo una frecuencia baja de enfermedad de gran vaso, similar a otros estudios. La enfermedad de pequeño vaso fue mayor a otros reportes en Latinoamérica. CONCLUSIONES: La mayor parte de la información provino de reportes y series de caso que podrían no reflejar la frecuencia real de causas y factores de riesgo. Merece atención la neurocisticercosis y sustancias psicoactivas como causas de ACV propias de la revisión en colombiana.

INTRODUCTION: Stroke is the leading cause of disability in the world. Its incidence is increasing, even in young people. Therefore, the risk factors and various etiologies of stroke in young people should be studied to plan preventive actions. That is why in Colombia it is necessary to know these factors and etiologies analyzing the studies on the subject. METHODS: Search and analysis of articles on causes and risk factors of ischemic stroke in Colombia published in Pubmed, Lilacs, Scielo, Google Scholar. After reviewing titles and abstracts, those that did not refer to young people between 18 and 49 years, reviews, did not refer to ischemic strokes, duplicates, were excluded. Finally, 20 articles were analyzed. RESULTS AND DISCUSSION: Most of the studies were report or case series, they added 60 people. There was no predominance of sex, except in the cases of antiphospholipid síndrome (APS) that were women, unlike most of the world series. The highest frequency was 56% for other determined causes such as APS and craniocervical vessel dissection, higher than other reports. There was a low frequency of large vessel disease, similar to other studies. Small vessel disease was higher than other reports in Latin America. CONCLUSIONS: Most of the information came from reports and case series that may not reflect the real frequency of causes and risk factors. Neurocysticercosis and psychoactive substances as causes of stroke proper of the review in Colombia deserve attention.

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La investigación relacionada con el pronóstico se puede clasificar así: fundamental, que revela diferencias en desenlaces de salud; de factores pronósticos, que identifica y caracteriza variables; de desarrollo, validación y utilidad de modelos predictivos; y finalmente, de medicina estratificada, donde se establecen grupos de riesgo que comparten un factor asociado con el desenlace de interés. El desenlace en salud, o la condición de enfermedad que tendrá un individuo se pueden predecir considerando ciertas características asociadas, con anterioridad o simultáneamente, con dicho desenlace. Lo anterior puede hacerse mediante modelos predictivos pronósticos o diagnósticos. El desarrollo de un modelo predictivo exige cuidado en la selección, definición, medición y categorización de las variables predictoras; en la exploración de interacciones; en el número de variables que se van a incluir; en el cálculo del tamaño de la muestra; en el manejo de los datos perdidos; en las pruebas estadísticas que se van a usar y en la forma de presentación del modelo. El modelo así desarrollado se debe validar en un grupo diferente de pacientes para establecer su calibración, discriminación y utilidad.

Research related to prognosis can be classified as follows: fundamental, which shows differences in health outcomes; prognostic factors, which identifies and characterizes variables;development, validation and impact of predictive models; and finally, stratified medicine, to establish groups that share a risk factor associated with the outcome of interest. The outcome of a person regarding health or disease status can be predicted considering certain characteristics associated, before or simultaneously, with that outcome. This can be done by means of prognostic or diagnostic predictive models. The development of a predictive model requires to be careful in the selection, definition, measurement and categorization of predictor variables; in the exploration of interactions; in the number of variables to be included; in the calculation of sample size; in the handling of lost data; in the statistical tests to be used, and in the presentation of the model. The model thus developed must be validated in a different group of patients to establish its calibration, discrimination and usefulness.

Pesquisa relacionada com o prognóstico pode ser classificada como: crítica, revelando diferenças nos resultados da saúde; fatores prognósticos, que identifica e caracteriza as variáveis; desenvolvimento, validação e utilização de modelos de previsão; e, finalmente, estratificada medicina, onde os grupos que compartilham um fator de risco associado com o resultado do conjunto de interesses. O resultado em saúde, a doença ou condição que terá um indivíduo pode ser previsto considerando certas características associadas, antes de ou em simultâneo com esse resultado. Isto pode ser feito por modelos preditivos de prognóstico ou de diagnóstico. O desenvolvimento de um modelo preditivo requer cuidadosa seleção, definição, medição e categorização de variáveis de previsão; em explorar as interações; do número de variáveis a serem incluídas; no cálculo do tamanho da amostra; no manuseio de dados perdidos; em testes estatísticos a serem utilizados e a apresentação do modelo. O modelo bem desenvolvida deve ser validado em um grupo diferente de pacientes para estabelecer a calibração, a discriminação e utilidade.

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BACKGROUND: There are few published epidemiological studies concerning dystonia. Its true prevalence has been difficult to establish. There is no data published in Latin America on this matter. METHODS: In this study the prevalence of dystonias in the Department of Antioquia (Colombia) was estimated using a capture-recapture methodology with log-linear modeling, including cases in 3 centers for neurological referrals that cover the Department of Antioquia from 2007 to 2012. RESULTS: The overall prevalence was 712 per 1,000,000 (95% CI 487-937). Of the total of 874 patients, 79% had primary dystonias, and 75.5% had focal dystonias. The delay in diagnosis was longer for primary dystonias, with a median of 1 year. CONCLUSION: We found a high prevalence of dystonias in Antioquia. The frequency of the different types of dystonias, as well as the demographic characteristics of our patients, is similar to data from other populations of the world.

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En algunos subtipos de migraña se ha demostrado la existencia de hiperexcitabilidad cortical y metabolismo energético cerebral anormal debido probablemente a disfunción mitocondrial. En estos pacientes es alta la sospecha sobre la existencia de mutaciones en el ADN mitocondrial implicadas como mecanismos fisiopatológicos en esta entidad. Objetivo. Identificar la mutación A3243G del ADN mitocondrial en pacientes con complicaciones de la migraña, y la migraña hemipléjica esporádica, basilar y retiniana. Material y métodos. Se realizó un estudio descriptivo-prospectivo en una serie de pacientes de consulta externa neurológica de la ciudad de Medellín, con diagnóstico de los diferentes subtipos de migraña, desde agosto de 2006 a diciembre de 2007. Resultados. Se incluyeron en el estudio 19 pacientes, 14 mujeres y 5 hombres, con edad promedio de 33,4 ± 13,5 años. De los diferentes subtipos la hemipléjica fue la más prevalente (11 pacientes), seguida de la migraña basilar (3 pacientes), el estado migrañoso (2 pacientes), la migraña retinal (2 pacientes) y el aura prolongada (1 paciente). La mutación A3243G en el ADN de leucocitos de sangre periférica, que fue la única evaluada en el estudio, no estuvo presente en ninguna de las muestras analizadas. Conclusiones. La mutación A3243G del ADN mitocondrial no está relacionada con la presentación de los diferentes subtipos en la población estudiada. Futuros estudios con mayor número de pacientes de cada sub-tipo de migraña permitirán ampliar el conocimiento sobre el papel de ésta y otras mutaciones mitocondriales en este trastorno.

Hyperexitability and abnormal brain metabolism due to mitochondrial dysfunction has been described in somespecific types of migraine. In these patients there are high suspicion of mutations in mitochondrial DNA thatare implicated as pathophysiologic mechanisms in this entity. Objective. To identify the A3243G mutation of mitochondrial DNA in patients with complications of migraine, sporadic hemiplegic migraine, basilar type migraine, retinal migraine. Materials and methods. A prospective descriptive study of a series of neurological patients in an outpatient of the city of Medellin, with a diagnosis of that subtypes, from August 2006 to December 2007. Results. This study included 19 patients, 14 women and 5 men with mean age 33.4 ± 13.54 years. Of the different subtypes hemiplegic was the most prevalent (11 patients), followed by basilar migraine (3 patients), migraine status (2 patients), retinal migraine (2 patients) and prolonged aura (1 patient). The A3243G mutation in the DNA of peripheral blood leukocytes, which was only evaluated in the study, was not found in any of the samples. Conclusions. The mitochondrial DNA A3243G mutation is not related to the presentation of different subtypes in the population studied. Future clinical trials, with a representative number of patients for each subtypes, may draw conclusions about whether the mitochondrial dysfunction caused by this and other mutations associated with the clinical presentation of this type of migraine.

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Introducción. El síndrome de Guillain Barré tiene una incidencia de 1,2 a 1,7 por 100.000 hab en Colombia. Además de la mortalidad, esta entidad cuenta con un alto impacto social y económico en razón a la probabilidad importante de generar discapacidad. Presentamos los datos correspondientes al grupo de pacientes diagnosticados en un hospital colombiano de cuarto nivel durante un periodo de cinco años, haciendo énfasis en las características clínicas y de pronóstico. Objetivo. Describir las características y la evolución con la inmunoterapia de los pacientes con síndrome de Guillain Barré que ingresaron al Hospital San Vicente de Paúl, de Medellín, entre 2001 y 2005. Materiales y métodos. Estudio observacional descriptivo entre enero de 2001 y diciembre de 2005. Resultados. Se obtuvo información en 46 pacientes, 54,3% mujeres, con edad promedio de 39,4 años (+17,6). Predominaron los pacientes con las formas ascendente y desmielinizante. Quienes tenían las formas axonales permanecieron más tiempo hospitalizados. Recibieron inmunoterapia 50%, plasmaféresis 47,8%, inmunoglobulina 52,2%. Requirieron ventilación mecánica 50% de quienes recibieron plasmaféresis y 75% de quienes recibieron inmunoglobulina; el puntaje de Hughes fue más alto para el grupo de inmunoglobulina. Fallecieron 3 pacientes. Se recolectó información al año de egreso en 67,4% de los pacientes, 23,3% de ellos tenían secuelas. Conclusiones. La principal complicación fue la neumonía. Las características clínicas difieren entre este grupo de pacientes y las publicadas en el mundo. Se requiere reforzar los conocimientos de los médicos generales para evitar retraso en la atención, y nuevos estudios para aclarar el comportamiento de esta enfermedad en nuestro medio.

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