NEUROANATOMIA PARTE 1

ECV ISQUEMICO Y HEMORRGICO

MENINGITIS
TUMORES
ENCEFALITIS-ABSCESO
COMA
NEUROANATOMIA PARTE 2
NEUROPATIA PERIFERICA
PLACA MOTORA - ELA -EM
CEFALEAS
DEMENCIA
DISQUINESIAS
MEDICINA EPILEPSIAS

NEUROLOGA
Dr. Christiam Ochoa
1

DIRECTOR GRUPO QXMEDIC

MORFOFISIOLOGA: CIRCULACIN
MORFOFISIOLOGA: CORTEZA
3
 2017 UpToDate
ENFERMEDAD VASCULAR CEREBRAL
Stroke type Clinical course Risk factors
ASPECTOS GENERALES Risk factors include
hypertension, trauma, bleeding
diatheses, illicit drugs (eg,
Intracerebral Gradual progression
amphetamines, cocaine),
hemorrhage during minutes or hours
vascular malformations. More
common in blacks and Asians
than in whites.
Abrupt onset of sudden,
severe headache. Focal Risk factors include illicit drugs
Subarachnoid
brain dysfunction less (eg, amphetamines, cocaine),
hemorrhage
common than with other bleeding diatheses.
types.
Stuttering progression
with periods of Risk factors include
improvement. Lacunes atherosclerotic risk factors (age,
Ischemic develop over hours or at smoking, diabetes mellitus,
(thrombotic) most a few days; large etc.). Men affected more
artery ischemia may commonly than women. May
evolve over longer have history of TIA.
TIA Deficit neurologico focal de duracion <24horas periods.
40% tendran un ictus establecido a los 3meses Atherosclerotic risk factors as
Sudden onset with deficit
ETIOLOGIA listed above. Men affected more
Ischemic maximal at onset. Clinical
Embolos art-art (embolic) findings may improve
commonly than women. History
Embolos cardiacos of heart disease (valvular, atrial
quickly.
fibrillation, endocarditis).
CLINICA
AMAUROSIS FUGAZ HOMOLATERAL

4

SINDROMES ALTERNOS:
MESENCEFALO
WEBER: pednculo cerebra paralisis
III ipsi + hemipareseia contra
PARINAUD: lamina cuadrigmina
paralisis mirada hacia arriba + nistagmo
convergencia + retraccin palpebral +
pupila dilatada y disociacin de la luz
cercana.
PUENTE
FOVILLE: inferomedial VII +
hemiparesia contralateral
DISARTRIA MANO TORPO CONTRA
5
LATERAL.
Artery Syndrome 2017 UpToDate Pathop
Anterior Motor and/or sensory deficit (leg >> face, arm)
Emb >
cerebral Grasp, sucking reflexes
athero
artery Abulia, paratonic rigidity, gait apraxia
Dominant hemisphere: aphasia, motor and sensory
deficit (face, arm > leg > foot), complete hemiplegia
Middle if internal capsule involved, homonymous
Emb >
cerebral hemianopia
athero
artery Non-dominant hemisphere: neglect, anosognosia,
motor and sensory deficit (face, arm > leg > foot),
homonymous hemianopia
Homonymous hemianopia; alexia without agraphia
(dominant hemisphere); visual hallucinations, visual
Posterior
perseverations (calcarine cortex); sensory loss, Emb >
cerebral
choreoathetosis, spontaneous pain (thalamus); III athero
artery
nerve palsy, paresis of vertical eye movement, motor
deficit (cerebral peduncle, midbrain)
Pure motor hemiparesis (classic lacunar syndromes) Small
BULBO RAQUDEO Pure sensory deficit artery
Penetratin
WALLENBERG: lateral dorsal ataxia Pure sensory-motor deficit (lacuna
g vessels
ipsi + horner ipsi + IX y X ipsi + Hemiparesis, homolateral ataxia r)
hemianestesia cruzada (cara ipsi + Dysarthria/clumsy hand infarct
cuerpo contra).
Cranial nerve palsies - Crossed sensory deficits
DEJERINE: bulbar anterior paresia
contra con sd piramidal + paralisis de la Diplopia, dizziness, nausea, vomiting, dysarthria,
Vertebrob Emb =
mitad homolateral de lengua + perdida dysphagia, hiccup - Limb and gait ataxia
asilar athero
cinestesia y tacto epicritico contralateral. Motory dficit - Coma
Bilateral signs suggest basilar artery disease
Internal Progressive or stuttering onset of MCA syndrome,
Athero
carotid occasionally ACA syndrome as well if insufficient
DIAGNSTICO ECV artery collateral flow
> emb
 ENFERMEDAD VASCULAR CEREBRAL HSA RESUMEN
TRATAMIENTO ETIOLOGA CLNICA
ANEURISMA CEREBRAL CEFALEA SBITA
1. IDENTIFICAR STROKE LLAMAR EMG MALFORMACION INTENSA
2. ABC TIEMPO UNIDAD STROKE ARTERIOVENOSA
TRASTORNO DE
GLUCOSA CONCIENCIA
3. <10 MIN: ABC + O2 + va + glucosa + NIHSS + VOMITOS
TAC/MRI + ECG OFTALMOPARESIA
4. <25 MIN: REVISION STROKE TEAM (NIHSS) MENINGISMO
5. <45 MIN: TAC resultado hemorragia: CONVULSIONES
neurocirujano // isquemia: t-PA exclusiones y FOCALIZACIN
NIHSS
6. <60 MIN: no candidato t-PA solo recibe aspirina DX ESCALA FISHER UCI reposo, analgesia, vendaje
TTO
y pasa a especialista. Si es candidato pedir COMPLICA: acidosis, hiperglicemia, inestabilidad
consentimiento. No anticoagulantes por 24h. I Sin evidencia de sangrado hemodinmica.
Bajar PA <160 Labetalol, enalapril.
7. <3h: Empezar esquema post t-PA. II Sangre difusa <1mm en cisternas Nimodipino 60mg c/4h. Inicia al 4to dia y sigue
hasta el 21. No se sabe el mecanismo.
III Coagulo, >1mm en cisternas La QX debe ser precoz. Da hiponatremia por
IV Hematoma IC, hemorragia IV, +- SIADH. Mortalidad en 30d es 50% por

sangrado difuso. 2017 UpToDate

PL
Inclusion criteria:
Clinical diagnosis of ischemic stroke causing measurable
neurologic deficit with the onset of symptoms <4.5 hours
before beginning treatment; if the exact time of stroke
onset is not known, it is defined as the last time the patient
was known to be normal
Exclusion criteria
TAC S/C
 DIAGNSTICO
MENINGITIS
Glucose (mg/dL) Protein (mg/dL) LEU (cells/microL)
100 to 100 to
ASPECTOS GENERALES <10 10 to 40 50 to 300 >1000 5 to 100
500 1000
Table 4. Most Common Bacterial Pathogens on Basis of Age and Predisposing Risks MEDSCAPE Viral MEC BAC-
MEC AUTOR: Rodrigo Hasbun, MD, MPH Associate Professor of Medicine Lyme BAC-V- precoz
+FC BAC BAC BAC BAC
SPIROQ TB V
TB MEC SIF TB
SIF-
Mump
TB V (mumps Enceph Encephali
-FC s and
HG and alitis tis
LCMV
LCMV)

2017 UpToDate
TTO EMPRICO PROFX

FR: AUSENCIA ANTICUEPOS, ASPLENIA, DEFICIT COMPLEMENTO,

GLUCOCORTICOIDES, HIV, BACTEREMIA, TX BASE CRANEO.

CLNICA
FIEBRE CEFALEA
SIGNOS MENNGEOS
TTNO SENSORIO
7

PARESIA VI, III, VII

 MEC-PEDIATRA

CURSO DEXAMETASONA (AAP dice)

Tiene 2 patrones de presentacin: Para Hib; talvez para neumococo y meningococo
Patrn 1 Dar antes o con la 1 dosis de ATB (max 30min despus de la
Precede enfermedad febril 1ra dosis de ATB)
Desarrollo progresivo en uno o varios das Dexametasona 0.6mg/Kg/da en 4 dosis x 2-4 das
Patrn 2
TRATAMIENTO ANTIBIOTICO EMPIRICO
Agudo y fulminante como sepsis Pensando en las bacterias +fr y su resistencia.
Desarrollo rpido en horas Cefotaxima 200mg/Kg/da EV max 12g/da en 3-4 dosis Ceftriaxona
PRESENTACIN 100mg/kg/da EV max 4g/da en 1-2 dosis
La mayora tiene FIEBRE y sint/sig menngeos; a menudo +
precedidos por sint resp sup. Vancomicina 60mg/kg/da EV max4g/da en 4 dosis
Nios mayores: fiebre, letargo y/o irritabilidad. +
Si en hay Gram negativos en la tincin Gram
Bebes: fiebre, hipotermia, letargo, dificultad respiratoria, Gentamicina 7,5 mg/kg/da EV 3 dosis

8
ictericia, falta de apetito, vmitos, diarrea, convulsiones, Amikacina 15 a 22. 5 mg/kg/da EV max 1,5 g/da en 3 dosis
agitacin, irritabilidad y/o fontanela abombada
 2017 UpToDate
Empiric antibiotics

ENCEFALITIS Immediately begin empiric antibiotics following

stereotactic or open biopsy/aspiration to obtain
Aseptic
Time
meningitis
Viral encephalitis a specimen for Gram stain, culture, and
pathology.
Enteroviruses: West Nile virus
The antibiotic regimen is dependent on Gram stain results
Summe Coxsackie St Louis encephalitis virus
r/fall Echovirus Eastern equine encephalitis Origin of abscess Treatment regimen*
Poliovirus virus
Oral, otogenic, or sinus source
Metronidazole PLUS
Mumps Measles (streptococci,Bacteroides spp,Hae
Winter/ Either penicillin G for a
mophilus spp,Fusobacterium spp;
spring suspected oral focus OR
Mumps less commonly, P. aeruginosa and
Ceftriaxone or cefotaxime
Enterobacteriaceae)
Herpes
Any simplex virus Herpes simplex virus type 1
season type 2 HIV infection Hematogenous spread (S.
Vancomycin
HIV infection aureus,Strep. viridans, other St.)

Postoperative neurosurgical patientsVancomycin PLUS
(S. aureus, streptococci, Either ceftazidime or cefepim

enterococci, P. aeruginosa) e or meropenem

Vancomycin PLUS
Penetrating head trauma (S. Either ceftriaxone or cefotaxi
aureus, Enterobacterspp) me - If the paranasal are
involved, add metronidazole

Vancomycin PLUS Either ce
Unknown source ftriaxone or cefotaxime PLU
S Metronidazole
Glucocorticoids
Glucocorticoids should be used when substantial mass
effect can be demonstrated on imaging and the mental
status is significantly depressed.
9

TTO acyclovir (10 mg/kg IV Q8h) ABSCESO CEREBRAL Dexamethasone is administered at a loading dose of 10 mg IV,
followed by 4 mg every six hours.
 TUMORES SNC EPIDEMIOLOGA DE TUMORES Metastasis > Primarios
Grupo etreos

CLNICA DE TUMOR METSTASIS ASTROCITOMAS MENINGIOMA

HTEC..
ETIOLOGA HTEC 2017 UpToDate Sntomas deficitarios
Traumatic brain injury/intracranial hemorrhage Sntomas irritativos.
Subdural, epidural, or intraparenchymal hemorrhage
Ruptured aneurysm
Diffuse axonal injury
Arteriovenous malformation or other vascular
anomalies
Central nervous system infections
CRANEOFARIN NEURINOMA DEL OLIGODENDRO
Ischemic stroke
GIOMA ACSTICO GLIOMA
Neoplasm
Vasculitis
Hydrocephalus
Idiopathic intracranial hypertension (pseudotumor
cerebri)
Idiopathic

Ciruga: tto de eleccin.

HTEC:
TTO SD. NEUROLGICOS PARANEOPLSICO
Vlvula de derivacin. - Osmticos como el manitol al 20. Sd. Denny Brown. HU. OAT /// Cerebelosa: YO y Ri. Ovario.
Evitar la hipercapnia (hiperventilar) -Mantener cabeza elevada. Miastenia Gravis Sd. Lambert Eaton.

10
Dexametasona para edema vasognico. Polimiositis dermatomiositis.
 Lesin de SRAA. Mltiples causas.
COMA Lesin ambos hemisferios. Un
hemisferio que empuja al otro.
Herniacin tronco. Metablicas.
DEFINICIN PUPILAS Y REACTIVIDAD:
No responde , no despierta. reflejo fotomotor. Difereciar II del
No usar otros trminos. III par.
Emergencia. MOTOR OCULAR: Roving.
ROC.ROV. Bobbing. DCM.
REFLEJO CORNEAL.
RPTA. DOLOR: decorticado.
Descerebrado. Hipotonia.
Asimtrico.
RITMO RESPIRATORIO:
Cheyne Stokes, hiperventilacin
neurgena central, apneusica,
atxica. Bradipnea. 2017 UpToDate
11
 EVALUATION MANAGEMENT
TOXINDROMES MANEJO COMA Vital signs and general
examination
ABCs (politraumatizado)
Intubate if GCS 8
Neurologic examination
Stabilize CSpine
and GCS
TX C PUP Vital signs OTRO EJM Screening laboratories
Supplement O2
Hyperthermia, Cocaine, (CBC, glucose IV access
Diaphoresis,
SYM Hyperalert, MIDR tachycardia, amphetamines, selectrolyes, BUN, Glucose 50 percent IV 50 mL (after blood drawn,
tremors
hypertension, ephedrine, creatinine, PT, PTT, before results back)
drug screen)
Hyperthermia,
Dry, decreased
Thiamine 100 mg IV
ANTI- tachycardia, Antihistamines, ECG
Agitacion MIDR bowel sounds, Treat definite seizures with phenytoin or
COL hypertension, ADT. Belladona Head CT scan
tachypnea
urinary retention equivalent
Lumbar puncture:
EEG Consider empiric treatments: INFECCION,
Hypothermia,
CNS Hyporeflexia, Other laboratory tests: INTOXICACION, HTEC, STATUS NOCV
OPIO bradycardia,
depression, MIOS pulmonary edema, Opiates blood cultures, adrenal
D hypotension,
coma needle marks, ILEO and thyroid tests,
apnea, bradypnea
coagulation tests,
Hypothermia, carboxyhemoglobin,
BZP,
CNS bradycardia, specific drug
SED MIOS Hyporeflexia barbiturates,
depression hypotension, concentrations
alcohols.
apnea, bradypnea
Brain MRI with DWI, if
cause remains obscure
Salivation,
Bradycardia, incontinence, D,V,
hypertension diaphoresis, OF and CM, PRONSTICO
Confusion,
COL Miosis orhypotension, lacrimation, GI nerve agents,
coma Estado vegetativo:
tachypnea or cramps, physostigmine,
bradypnea bronchoconstrictio lesin axonal difusa.
n, fasciculations CV Muerte cerebral :
arreactiva + conocido +
Confusion,
Hyperthermia, Tremor, irreversible. NO
tachycardia, hyperreflexia, RESPUESTA + NO

12
SER agitation, MIDR SSRIs,
hypertension, diaphoresis, FLUJO SANGUNEO
coma
tachypnea flushing, diarrhea
 FISIOLOGA: SISTEMA MOTOR
13
 ASPECTOS LAMBERT EATON BOTULISMO

ETIOPATOGENIA Ac anticanales de calcio. Toxina de C. botulinum

EPIDEMIOLOGA 40. Varon = mujer Lactantes

Prox. de MMII. Extraoc. Precoz PC. Descendente
MSCULOS
70% simtrica.
Midriasis. Profundos bajos. Midriasis. Profundos
REFLEJOS
normales o bajos.
AUTONMICOS Boca seca, impotencia. Deficit parasimptico.
MEJORA Ejercicio, guanidina.
PLACA MOTORA Ca pulmonar avena Mala consevacin
ASOCIACIONES
alimentos.
Plasmafresis. +Guanidina Soporte ventilatorio.
TTO Inmunosupresores. Antitoxina.

14
 RESPUESTA A DX GENERALIZADA OCULAR
COLINRGICOS: edrofonio
MIATENIA GRAVIS EV. (30s 5min)
AChR antibodies 80 to 90 40 to 55
AC ANTI RECEPTORES MuSK antibodies (in
Nm: 90% de miastenia AChR Ab negative 40 to 50 <10
ETIOLOGA generalizada y 50% de patients)
80% ac antiR de Ach. limitada a musculatura Repetitive nerve
ocular. 75 <50
Timo anormal en 65%. stimulation
EMG: fatiga, reduccin del
Asociado a otras >=10% del 5to potencial Single fiber
92 to 99 80 to 95
autoinmunes. evocado. electromyography

EPIDEMIO: 66% mujeres (28), 33% varones (50). TRATAMIENTO INICIO MAX
Symptomatic therapy
CLNICA Pyridostigmine 10-15 m 2 h
Muy eficaz pero no tiene cura an. Chronic immunotherapies
Debilidad y fatigabilidad
1. FRMACOS ANTICOLINRGICOS:
muscular: extraoculares, Prednisone 2 to 3 s 5-6 m
primera lnea. Piridostigmina.
cara, bulbares, cuello,
2. INMUNOSUPRESOR Azathioprine ~12 m 1 to 2 a
cinturas escapular y plvica,
3. TIMECTOMA Mycophenolate
tronco. 6 -12 m 1 to 2 a
4. PLASMAFERESIS O IG mofetil
MEJORA: fro, reposo,
5. CRISIS:
edrofonio. Cyclosporine and
6. CONTRAINDICACIONES DE ~6 m ~12 m
EMPEORA: avance del da, tacrolimus
FRMACOS
ejercicio, infecciones, Rapid immunotherapies
gestacin, calor.
Plasmapheresis 1 to 7 d 1 to 3 s
OTROS: reflejo miotatico
normal, no alt. Sensibilidad, Intravenous
1 to 2 s 1 to 3 s
no alteracin autonmica. immune globulin
CRISIS MIASTENIA = IRA2 Surgery
15

o disfagia. Thymectomy 1 10a 1 - 10 a

 66% (2/3) INFECCION PREVIA: BACTERIA: C. jejuni // VIRALES: herpes, hepatitis, VIH.
NEUROPATA PERIFRICA 5-10% INTERVENCION Qx - OTROS: linfomas, LES, vacunas.
GUILLIAN BARR DESMIELINIZACIN SEGMENTARIA EN NERVIOS Y RACES.
ETIOLOGA

POLIRRADICULONEUROPATIA AGUDA
INFLAMATORIA ASCENDENTE -
PREDOMINIO MOTOR -AUTOINMUNITARIA

DIAGNSTICO
1. 1 Parestesias 2 debilidad simetrica ascendente 3 arreflexia
2. Dificultad respiratoria 10-30%
3. Disfuncin vegetativa. No pierde control esfinteriano
4. Completan cuadro 1-2sem 50%, 3sem 80% y 4 90%.
5. APOYO: sin fiebre, LCR, EMG desmielinizacin

VARIANTES: MOTORA
PURA. SENSITIVA PURA. SD.
MILLER FISHER: oftalmoparesia
+ ataxia + arreflexia.

TRATAMIENTO PRONSTICO
Inmunoglobulinas. 85% recuperacin / 10% dficit.
5% mueren. 10% recurren.
Plasmafresis.

16
Sostn de funciones vitales.
 OTRAS ETIOLOGIA DE LAS
Symptom % ESCLEROSIS MULTIPLE
Sensory in limbs 31
NEUROPATIAS PERIFERICAS Visual loss 16
Spinal cord lesions typical of MS in MRI:
Little or no cord swelling
Motor (subacute) 9 Unequivocal hyperintensity on T2-weighted sequences
Traumticas (mononeuropatas)
Diplopia 7 and visible in two planes.
Infecciosas: difteria, rabia , VIH. At least 3 mm but less than two vertebral segments.
Gait disturbance 5
Inmunoalergicas: Sindrome Guillain-Barre, polineuropatia Motor (acute) 4
Occupy only part of the cord in cross-section
inflamatoria desmielinizante crnica. Focal
Balance problems 3
Asociadas a enfermedades crnicas: DM, uremia,
distiroidismo, enfermedades hepticas , cncer, protenas Sensory in face 3
monoclonales, vasculitis y enfermedad del tejido conectivo , Lhermitte sign 2
alcohol y dficit vitamnicos, sarcoidosis y polineuropatia del Vertigo 2
enfermo critico. Bladder problems 1
Hereditarias: Porfiria , Enf de Fabry Limb ataxia 1
Asociadas a tumores nerviosos y frmacos o toxinas. Acute transverse
1
myelopathy
CIDP (poliradiculoneuripatia difusa inflamatoria crnica) Pain <1

ASOCIADAS A CIDP ESCLEROSIS LATERAL AMIOTRFICA

Diabetes mellitus - Monoclonal
gammopathy HIV infection - Lyme
disease -Chronic active hepatitis
Conectivopaties -Sarcoidosis
Thyroid disease
17

2017 UpToDate
Subarachnoid hemorrhage
Intracerebral hemorrhage
Acute ischemic stroke
Subdural and epidural hematomas
Pituitary apoplexy
Migraine
Adults: Unilateral in 60 to 70%.
Crescendo pattern; pulsating;
moderate or severe intensity;
aggravated by routine physical
activity
Patient prefers to rest in a dark,
quiet room
4 to 72 hours
Nausea, vomiting, photophobia,
phonophobia; may have aura.
CEFALEAS HORTON
Colloid cyst of the third ventricle
Acute expansion of mass lesion
in the posterior fossa
Hypertensive encephalopathy
Coital headache
Acute narrow angle glaucoma
Exertional headache
Tensional Cluster Cluster headache:
Bilateral Always unilateral, around the eye A. At least five attacks fulfilling criteria B through D
B. Severe or very severe unilateral orbital, supraorbital and/or temporal
Pain begins quickly, pain is deep,
pain lasting 15 to 180 minutes when untreated.
vincha continuous, excruciating, and
C. Either or both of the following:
explosive in quality
1. Minimo 1 ipsilateral: d) Forehead and facial sweating
a) Conjunctival injection or lacrimation e) Forehead and facial flushing
Patient remains active
b) Nasal congestion and/or rhinorrhea f) Sensation of fullness in the ear
30 min to 7d 15 minutes to 3 hours
c) Eyelid edema g) Miosis and/or ptosis
Ipsilateral lacrimation and
redness of the eye; stuffy nose; 2. A sense of restlessness or agitation
D. Attacks have a frequency between one every other day and eight per
None rhinorrhea; pallor; sweating;
18
Horner syndrome; restlessness or day for more than half of the time when the disorder is active
agitation; sensitivity to alcohol E. Not better accounted for by another ICHD-3 diagnosis

MIGRAA
Alcohol Chocolate Queso curado
glutamato aspartame mani - nitritos
19
10-30. 60% mujer. Hereda. 3 FASES. TRATAMIENTO
Rafe.- Contraccion. - Trigeminal.
Migraine without aura 2017 UpToDate
A. At least five attacks fulfilling criteria B through D
B. Headache attacks lasting 4 to 72 hours (untreated or
unsuccessfully treated)
C. Headache has at least two of the following characteristics:
Unilateral location
Pulsating quality
Moderate or severe pain intensity
Aggravation by or causing avoidance of routine physical activity
(eg, walking or climbing stairs)
D. During headache at least one of the following:
Nausea, vomiting, or both
Photophobia and phonophobia
E. Not better accounted for by another ICHD-3b diagnosis
DISQUINESIAS TTNOS. HIPERCINTICOS

TEMBLOR DISTONA - ATETOSIS

COREA - MIOCLONO TICS

20
 DISQUINESIAS 2017 UpToDate

TTNO HIPOCINTICOS:
PARKINSONISMOS
1. Temblor. 2 Rigidez 3- Bradicinesia
Idiopaticos:
EP, AMS, PSP, DCB, EH, EA, DCLewy,
otros.
Secundarios: Post enceflico, frmacos
(antiD2). Toxicos. Hidrocefalia
normotensiva.

Idioptica - edad. Espordico. Dficit del

complejo I mitocondrial. Gen de alfa
sinucleina y gen de parkina. Asociado a
aluminio, arsnico, Levodopa + inhibidor de la dopadecarboxilasa perifrica
Degenera neuronas de SNpc. Baja DA, (carbidopa o benseracida) es primera lnea.
sube ACH, baja NA, 5HT. Inhibodores de la COMT. Los agonistas dopaminergicos.
Los anticolinrgicos (trihexifenidil o biperideno). La
selegilina o inhibidor selectivo de MAO-B
Ttno quirugico. TRATAMIENTO
21
 Incapacidad. 2% 65 / 20% 80. Deterioro
DEMENCIAS cognitivo no adquirido y alerta. MEMORIA + 1

CORTICAL: Afasia, apraxia, agnosia, acalculia. AD SUBCORTICAL: Retardo PM, mov anormales,
(90%), Pick, CJ, MEC, O2, Vascular, Neo, OH disartria, depre. EH, EP, Wilson, VIH, vascular
(10%). (10%), Neo, post Tx.

2017 UpToDate
DSM-5 criteria for major neurocognitive B. The cognitive deficits interfere with
disorder (previously dementia) independence in everyday activities.
A. Evidence of significant cognitive decline from a C. NO delirium
previous level of performance in one or more D. NO another mental disorder (eg,
cognitive domains*: major depressive disorder,
- Learning and memory schizophrenia)
- Language
- Executive function Vascular dementia:
- Complex attention Focal neurological

22
- Perceptual-motor signs or laboratory
- Social cognition evidence of ECV
condition
 ALZHEIMER Dementia of the Alzheimer type:
PRIONES
Gradual onset and continuing
cognitive decline
Not identifiable medical,
psychiatric, or neurologic
condition
Central feature Progressive cognitive decline, dementia
Degeneracion neuronas SELECTIVO Core features (two features essential for diagnosis of probable DLB, one for
Baja la somatostatina, ach (Meynert, ACT 90%). possible DLB)
Fluctuating cognition 60-80
95% espontaneos - Alelo E4 de APO E (cr19). - Edad
>60, mujer, TEC previo. Recurrent well-formed, detailed visual hallucinations 50-75
Spontaneous features of parkinsonism
Protege: APOE2, AINES, E2, educacion.
Suggestive features
1. Preclinico: puntual. 5. Cognicin. REM sleep disorder 85
2. Memoria reciente. 6. Depre y paranoia Severe neuroleptic sensitivity 30-50
3. Altera aprendizaje. 7. Extrapiramidales. Low dopamine transporter uptake in basal ganglia on SPECT or PET
4. Final, remota. 8. Infecciones. Supportive features (common features with undetermined diagnostic LEWIS
specificity)
Repeated falls 33
Syncope or transient loss of consciousness
Severe autonomic dysfunction
Hallucinations in other modalities 20
Systematized delusions 55-75
Depression 30-40
Relative preservation of medial temporal lobe on MRI or
CT
23

Temporal sequence (feature which distinguishes DLB from Parkinson disease

dementia)
RIVASTIGMINA DONAPEZILO - MEMANTINA Dementia should occur before or concurrently with onset of parkinsonism
 Astatic: Sudden loss of muscle Aura (None)
EPILEPSIA Behavioral: Abrupt change in Tonic phase (10 to 20 seconds)
behavior Clonic phase (30 to 90 seconds)
ETIOLOGA CRISIS Clonic Postictal phase (Minutes to several hours)

EPILEPSIA: 0.5 1% /// CRISIS: 1/10 0-2: hipoxia, metablicos, MEC, crisis febril. Infantile spasms
Headache, mild confusion
2-12: idiopticas, febril. Tonic
Other features
SINDROME EPILPTICO: 12-18: idiopticas, traumticas. Fast heart rate
Versive: A forced and sustained
IDIOPTICOS - SINTOMTICOS - 18-35: traumticas, neurocisticercosis*
Elevated blood pressure
tonic deviation of the eyes, Respiratory and metabolic acidosis
CRIPTOGNICOS 35-55: tumoral head and rotation of the trunk. Dilated pupils
CRISIS EPILEPTICA Mayor 55: ECV, degenerativas, TEC, tumor. Unclassified Risk of vertebral fracture, pneumonia

2017 UpToDate DX EPILEPSIA - STATUS CRISIS EPILEPTICAS CONTINUAS

>30 (10)m o >3crisis SIN
CLNICO + EEG + NEUROIMAGEN RECUPERACION DE LA
DD: Sincope, metablicos, aura, CONCIENCIA DE FORMA
TIA, ttno sueo, ttno mov. COMPLETA

TRATAMIENTO CRISIS TRATAMIENTO EPILEPSIA

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