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The works of Argentinian scholar Jorge Luis Borges (1899-1986) have captivated physicians. An assiduous reader, he was given, with magnificent irony, "books and the night". Borges suffered from chronic and irreversible blindness, which influenced much of his work and has been the subject of different literary and diagnostic analyses from the ophthalmological point of view. However, the characteristics of his visual impairment have escaped the neurological approach, which is why we reviewed his work looking for data suggesting a concomitant brain injury. On his autobiography, he recounts how, during an episode of septicemia, he suffered hallucinations and loss of speech; in addition, in some poems and essays he describes data that suggest "phantom chromatopsia", a lesion of cortical origin. After that accident, Borges survived with a radical change in literary style. Although a precise diagnosis is impossible, his literary work allows recognizing some elements in favor of concomitant brain involvement.

Neurotoxicity from intrathecally administered chemotherapeutic drugs is frequent, particularly with some agents like methotrexate, which are more prone to developing adverse effects. Myelopathy ranks among the most frequently reported neurological entities; with the diagnosis being straightforward, after ruling out infectious, metabolic, autoimmune or paraneoplastic causes. Scarcity of cases precludes evidence-based recommendations for the management of these complications. The most common therapeutic approach consists of the suspension of chemotherapy, exclusion of infectious and neoplastic causes, with prompt administration of high-dose steroids. We report a 21-year-old patient with acute lymphoblastic leukaemia, who developed acute transverse myelitis and bilateral sensorineural hearing loss, after five rounds of intrathecal methotrexate and cytarabine. Although neurotoxicity from both agents has been documented, this combination has not been previously reported.

Introduction Menopause is a time of adaptation and transition to a new biological situation that implies the loss of reproductive function. The onset of menopause coincides with the onset of other symptoms related to hypertension, weight gain, hormonal changes, osteoporosis, and vascular disease. These hormonal changes could be responsible for some sleep disorders. It is well documented that the prevalence of sleep disorders is higher in post-menopause, regardless of other factors such as aging. Methods As part of routine care for patients in a gynecology outpatient clinic, all patients with menopause were screened for sleep disorders using the following clinical tools: the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire (PHQ-9), the STOP-BANG Questionnaire, and the Epworth Scale.A full clinical history was also taken, focusing on sleep habits and risk factors that could contribute to sleep difficulties.Patients that presented with any sleep disorders were assessed and continued their treatment depending on these results. Results Between August 2021 and December 2021, a total of 60 patients going through menopause that attended the gynecology outpatient clinic for other reasons were screened for sleep disorders.Using the PSQI we identified 51 patients with low quality sleep (defined as a score of 5 or higher using this tool).Depression was also identified in a total of 43 patients, none of which were receiving treatment. All these patients also reported low-quality sleep and other problems such as hypersomnia, which in turn was identified in 15 patients using the Epworth Scale.Thirty-five patients were identified as having at least 3 risks factors for obstructive sleep apnea with the STOP-BANG questionnaire and were ordered a polysomnography. Conclusion Sleep disorders are highly prevalent in menopause. With this initiative, we present our experience and results incorporating routine screening for these disorders in a clinical setting outside of a sleep clinic.Integrating this information can be helpful for working in multidisciplinary teams aimed at reducing chronic diseases and mortality in these patients. This is a multidisciplinary approach that will continue in our institution. Support (If Any)

Background: Ischemic stroke is a leading cause of disability and death in Mexico. Poor ability to identify signs and symptoms of ischemic stroke leads to longer hospital arrival times and precludes prompt treatment. The knowledge of stroke risk factors and warning signs in rural population is scarce. Since 2010, Stroke Education Campaigns are performed with a community-based approach. The aim of this study was to assess and compare stroke knowledge in rural and urban communities. Methods: During World Stroke Campaign, a standardized questionnaire to assess knowledge of stroke risk factors and warning signs was applied in urban and non-urban communities of Nuevo Leon, Mexico. Results: A total of 4,144 surveys were collected. Mean age was 44.2 ± 16.1 and 75.9% were women. People from rural and semi-urban areas mentioned > 3 risk factors (p < 0.001) and warning signs (p < 0.001) compared to the urban area. After logistic regression analysis, having received previous information about stroke remained significant for the knowledge of > 3 stroke risk factors and warning signs (p < 0.001; 95% CI 1.997–2.727; p < 0.001; 95% CI 1.880–3.787) respectively. Conclusions: Rural and semi-urban regions performed better than the urban population. Receiving stroke information is a determinant factor for stroke knowledge. Stroke Educational Campaigns are a cost-effective method for raising stroke awareness, thus reducing stroke burden.

The works of Argentinian scholar Jorge Luis Borges (1899-1986) have captivated physicians. An assiduous reader, he was given, with magnificent irony, "books and the night". Borges suffered from chronic and irreversible blindness, which influenced much of his work and has been the subject of different literary and diagnostic analyses from the ophthalmological point of view. However, the characteristics of his visual impairment have escaped the neurological approach, which is why we reviewed his work looking for data suggesting a concomitant brain injury. On his autobiography, he recounts how, during an episode of septicemia, he suffered hallucinations and loss of speech; in addition, in some poems and essays he describes data that suggest "phantom chromatopsia", a lesion of cortical origin. After that accident, Borges survived with a radical change in literary style. Although a precise diagnosis is impossible, his literary work allows recognizing some elements in favor of concomitant brain involvement.La obra del erudito argentino Jorge Luis Borges (1899-1986) ha cautivado a los médicos. Asiduo lector con magnífica ironía, le fueron dados “los libros y la noche”. Borges padeció una ceguera crónica e irreversible que impulsó gran parte de su obra y ha sido objeto de distintos análisis literarios y diagnósticos desde el punto de vista oftalmológico. Sin embargo, las características de su ceguera han escapado al abordaje neurológico, por lo cual revisamos su obra en busca de datos que sugieran una lesión cerebral concomitante. En su autobiografía relata cómo durante un episodio de septicemia padeció alucinaciones y pérdida del habla; además, en algunos poemas y ensayos describe datos que sugieren “cromatopsia fantasma”, lesión de origen cortical. Tras dicho accidente, Borges sobrevivió con un cambio radical en su estilo literario. Aunque un diagnóstico preciso es imposible, su obra literaria nos permite reconocer algunos elementos que sugieren involucramiento cerebral concomitante.

Objectives Increase the percentage of etiological diagnosis of epilepsy (according to the classification by the 2010 ILAE) using a systematic quick guide for pediatric patients with suspected epilepsy. Methods Ambispective cohort study. Patients under 16 years old with suspected epilepsy were studied, and a systematic quick guide was applied to the prospective group, and later the two groups were compared. It was a convenience sample, with a study period of one year for both groups. Results The prospective group was 120 patients and the retrospective group 71 patients. Comparing the epileptic diagnosis by etiology groups, in the prospective group (only outpatient patients), 3.3% had epilepsy of an unknown cause, 55% had epilepsy of a genetic cause, 36.7% had epilepsy of a structural/metabolic cause, and 5% had conditions that are not epilepsy itself. Meanwhile in the retrospective group, 52.1% had epilepsy of an unknown cause, 11.3% had epilepsy of a genetic cause, and 36.6% had epilepsy of a structural/metabolic cause (p Conclusions Compared to other similar studies, the etiological percentages of epilepsy increased. Using the systematic quick guide proposed, the percentage of etiological definitions of epilepsy was increased in pediatric patients.

Introduccion. Recientemente, se ha incrementado la atencion hacia causas metabolicas de la perdida de celulas dopaminergicas en la enfermedad de Parkinson (EP), dada la intolerancia a la glucosa que pueden presentar estos pacientes. Un sindrome caracterizado por resistencia a la insulina es el sindrome metabolico. Objetivo. Determinar la prevalencia y las caracteristicas clinicas del sindrome metabolico y sus componentes en pacientes con EP. Pacientes y metodos. Se analizaron variables de 99 pacientes con EP. Se registraron escalas que evaluan las funciones motora, no motora y cognitiva, los trastornos del sueno y la calidad de vida. El sindrome metabolico se diagnostico segun los criterios de la Organizacion Mundial de la Salud. Resultados. La prevalencia de sindrome metabolico se notifico en un 8%. Al subdividir a los pacientes en funcion de los criterios positivos de sindrome metabolico, no se observaron diferencias significativas en las funciones motora y cognitiva, la calidad de vida ni los trastornos del sueno entre los grupos. No obstante, pacientes con sindrome metabolico mostraron peores puntuaciones en la escala de sintomas no motores en comparacion con pacientes sin el sindrome, especialmente en cuanto a tracto gastrointestinal, estado de animo/apatia, funcion sexual, problemas perceptivos y miscelaneos. No se observaron diferencias significativas en las caracteristicas clinicas al agrupar a los pacientes sobre la base del componente unico de sindrome metabolico presente. Conclusion. El sindrome metabolico podria tener un efecto sobre la sintomatologia no motora en la EP, ya que los pacientes con este sindrome mostraron peores puntuaciones en la escala de sintomas no motores.

With great interest, we read the article by Barichella et al.1 that presents evidence of a nutritional strategy—in addition to an intensive rehabilitation program—associated with better rehabilitation outcomes in patients with parkinsonism. Previous evidence in patients with Parkinson disease linking muscle mass loss to disease progression2 and worse scores across multiple disease-domains (motor, mood, and quality of life),3 emphasize the importance of nutritional strategies accompanying an exercise program.4 Furthermore, the inclusion of patients with atypical parkinsonism represents a major strength demonstrating that nutritional strategies are fundamental in the management of patients with parkinsonism whether typical, atypical, or atypically atypical.5 We wonder whether there were any differences between Parkinson disease (PD) and non-PD parkinsonisms—regardless of the small number of patients with the latter—given the scarcity of studies on the topic. This article represents evidence for the systematic inclusion of nutritional strategies as a standard of care in patients with parkinsonism and encourages research that will allow to improve current interventions while addressing risks of malnutrition, even in patients with advanced stages of the disease.

The eight-and-a-half syndrome (EHS)—defined by the combination of a seventh cranial nerve palsy and an ipsilateral one-and-a-half syndrome—is a rare brainstem syndrome, which localises to the caudal tegmental region of the pons. We present a case of the EHS secondary to an inflammatory lesion on a previously healthy 26-year-old woman, with a literature review emphasising the relevance of aetiological assessment.

The association between memory loss and Hodgkin's lymphoma has been given the eponym of Ophelia syndrome, in memory of Shakespeare's character in The Tragedy of Hamlet, Prince of Denmark. Nevertheless, there are differences between the disease and the character. Objective: To review the origins and uses of the eponym through an original article by pathologist Ian Carr, its relation to the character Ophelia, and the related autoantibodies. Methods: Historical narrative review. Results: Besides an eloquent description in the original article, Carr presaged the presence of autoantibodies, before they had been thoroughly researched. Since then, five different autoantibodies (mGluR5, Hu, NMDAR, SOX, PCA2) have been associated with Hodgkin's disease. It is interesting to note the divergent outcomes of Shakespeare's character and the patient in the original description by Carr, the latter recovering to lead a normal life, and the former deceased. Conclusions: Although there is little relationship between the fictional character and the syndrome, both imply the unintentional trigger of self-harm (suicide in one case, autoimmunity in the other), thus remaining associated. RESUMO El síndrome de Ofelia describe la asociación entre pérdida de memoria y enfermedad de Hodgkin, en memoria del personaje de La Tragedia de Hamlet, Príncipe de Dinamarca, de William Shakespeare. Sin embargo, existen diferencias entre ambos. Objetivo: Revisar los orígenes y usos del epónimo a través del artículo original, su relación con el personaje y los autoanticuerpos relacionados. Métodos: Revisión narrativa histórica. Resultados: Además de una descripción elocuente, el artículo original prefigura los autoanticuerpos, cuando no se buscaban de rutina. Desde entonces, cinco distintos (mGluR5, Hu, NMDAR, SOX, PCA2) han sido asociados. Cabe destacar, que el desenlace del personaje y del paciente fueron diametralmente opuestos, el primero falleció y el segundo se recuperó, llevando una vida normal. Conclusiones: A pesar de la poca relación entre el personaje y el síndrome, ambos implican el desencadenamiento no intencional de daño auto-inflingido (suicidio en un caso, autoinmunidad en el otro), manteniendo así la adecuacía.

A 64-year-old woman with history of migraine with aura, presented 11 hours after developing sudden-onset right hand weakness (noted as difficulty holding objects). On examination, there was moderate weakness of flexor of the third, fourth and fifth fingers with normal reflexes, the rest of the examination was normal. MR scan of brain showed an acute ischaemic injury of the ‘hand knob’ of the left precentral gyrus (figure …

Aim To describe the main physiopathological mechanisms of obstructive sleep apnea syndrome (OSAS) associated with the development of stroke. Development Sleep breathing disorders have a high prevalence in the healthy population, among them, the OSAS is the most recognized. This syndrome has been associated with vascular diseases such as stroke, hypertension, atrial fibrillation, among others. Stroke has a high global prevalence and is considered a catastrophic disease. The physiopathological mechanisms are of great importance to understand the relationship that exists between OSAS and stroke. Both diseases are associated with molecular, cellular, and autonomic nervous system changes, with systemic cardiovascular repercussions and in particular with the vascular health of the brain. Conclusions The relationship between OSAS and ischaemic stroke is evident. The advance in the identification of molecular markers and low-cost studies for the identification of OSAS will allow implementing strategies to reduce their consequences in cardiovascular diseases, mainly in ischaemic stroke.

Restless legs syndrome (RLS) is a frequent complication of hemodialysis that has been associated with poor quality of life and increased risk for complications. Nevertheless, few studies regarding this entity exist in resource-limited settings. Objectives: To determine the prevalence of RLS among Mexican patients on hemodialysis; and compare these patients with a control group of the same population. Methods: We recruited 105 hemodialysis patients. Restless legs syndrome was diagnosed according to the updated criteria set out by the International RLS Study Group. We selected patients who did not meet the criteria, as controls. Results: We found an RLS prevalence of 18%. The RLS patients had a significantly higher prevalence of iron deficiency anemia and uremic pruritus. None of the patients reported RLS symptoms prior to hemodialysis initiation. Conclusions: Restless legs syndrome is common among Mexican patients on hemodialysis. Larger studies are required to address the impact of RLS in hemodialysis patients. Keywords: Restless legs syndrome; renal dialysis; renal insufficiency. RESUMEN El sindrome de piernas inquietas (SPI) es una complicacion de la hemodialisis que se ha asociado con menor calidad de vida y riesgo aumentado de complicaciones. Sin embargo, existen pocos estudios acerca de esta entidad en escenarios de recursos limitados. Objetivos: Determinar la prevalencia de SPI en pacientes mexicanos en hemodialisis, y comparar las caracteristicas con un grupo control de la misma poblacion. Metodos: Reclutamos 105 pacientes en hemodialisis. El SPI se diagnostico de acuerdo con los criterios actualizados del grupo de estudio internacional del sindrome de piernas inquietas. Seleccionamos a los pacientes que no cumplieron dichos criterios como controles. Resultados: Encontramos una prevalencia de SPI del 18%. Los pacientes con SPI tenian una prevalencia mas alta de anemia ferropenica, y prurito uremico. Ninguno de los pacientes reporto sintomas de SPI previo a iniciar la hemodialisis. Conclusiones: El SPI es frecuente en pacientes mexicanos en hemodialisis; se requieren estudios mas grandes para evaluar el impacto del sindrome en esta poblacion. Palabras-clave: Sindrome de piernas inquietas; dialisis renal; insuficiencia renal.