Juan Idiaquez - Academia.edu (original) (raw)
Papers by Juan Idiaquez
Clinical Neurophysiology, 2021
Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upo... more Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis.
Revista chilena de neuro-psiquiatría, 2020
Introduction: Autonomic dysfunction occurs in patients with central and peripheral nervous system... more Introduction: Autonomic dysfunction occurs in patients with central and peripheral nervous system diseases. It is important to quantify the sympathetic and parasympathetic involvement for the diagnosis of the autonomic failure, for follow up and evaluate the response to a specific treatment. The most important studies are cardiovascular and sudomotor functional tests. There are other tests for the study of autonomic dysfunction in different organs, that are specific to respectively medical specialty. Development: we describe main symptoms, functional autonomic tests and other methods to study cardiovascular: sympathetic vasomotor (noradrenergic) and cardiovagal (cholinergic) and sudomotor: sympathetic (cholinergic) functions. We describe symptoms and tests for assessment pupillary, genitourinary and gastrointestinal autonomic dysfunction. The indications for autonomic function testing in the different clinical scenarios are reported. Conclusions: combined evaluation of clinical and tests of autonomic function results allow to obtain the level and severity of autonomic dysfunction based upon pathophysiological support.
Revista de Neurología, 2014
La miastenia grave es una enfermedad autoinmune que causa debilidad y fatiga musculoesqueletica m... more La miastenia grave es una enfermedad autoinmune que causa debilidad y fatiga musculoesqueletica mediada por anticuerpos que atacan directamente los receptores nicotinicos de acetilcolina en las uniones neuromusculares [1]. Cerca de la mitad de los pacientes con timoma tiene sintomas consistentes con miastenia grave [2,3]. Se recomienda una timomectomia en pacientes con miastenia grave, especialmente en aquellos con control inadecuado con inhibidores de la acetilcolinesterasa y en los menores de 55 anos. Cerca de un 75% se beneficia de la cirugia, y puede mejorar o estabilizar los sintomas incluso anos despues de esta [4-7]. La miastenia grave se clasifica clinicamente en cinco clases principales. La clase I corresponde a la miastenia grave ocular. Esta involucra cualquier grado de debilidad muscular ocular, y es la fuerza del resto de los musculos del cuerpo normal [8]. La disfuncion autonomica en asociacion con miastenia grave es rara; de hecho, hay pocos casos en la bibliografia [9-12]. Los sintomas de fallo autonomico descritos son variados y de diferente gravedad. Lo mas frecuente es la gastroparesia, seguida de afectacion cardiovascular y sindrome de Sicca, generalmente de curso subagudo en relacion con el inicio de los sintomas [9-15]. A continuacion se describe un nuevo caso de miastenia grave asociada a disautonomia grave despues de timomectomia.
Journal of Sleep Research
Evaluation and Management of Autonomic Disorders
Orthostatic hypotension management: non pharmacological: education, diet, physical methods. Pharm... more Orthostatic hypotension management: non pharmacological: education, diet, physical methods. Pharmacological: Midodrine, Pyridostigmine, Droxidopa (DOPS), Fludrocortisone, Erythropoietin, Desmopressin, Octreotride. Gastrointestinal: non pharmacological and drug therapy for constipation, gastroparesia and dysphagia. Therapy for sialorrhea. Bladder: non pharmacological and drug therapy for storage and voiding dysfunction. Erectile dysfunction management.
Currently, health disorders related to Blood Pressure (BP) fluctuations are within the most preva... more Currently, health disorders related to Blood Pressure (BP) fluctuations are within the most prevalent and of higher social and economic impact in the world. A continuous and routinary monitoring of the BP can contribute to the early identification of risk factors, and consequently, would help to prevent potential cardiovascular diseases. <br> <br> BP measurement methods based on the cuff are of widespread use today. The monitoring based on this technology is intrusive and cannot be made continuously, which is of fundamental importance to diagnose Hypertension accurately. Due to the discomfort, inconvenience and intrusiveness of the cuff-based measurements of BP most people undergo monitoring only when they present symptoms of cardiovascular problems and a high proportion of them do not complete the monitoring protocol. <br> <br> In order to provide a less intrusive technology for non-invasive and continuous BP monitoring, many researchers aimed to estimate th...
Evaluation and Management of Autonomic Disorders, 2018
A 64-year-old man in the last 4 years has noted a history of slowly progressive nocturnal paresth... more A 64-year-old man in the last 4 years has noted a history of slowly progressive nocturnal paresthesia with burning, prickling, and pain in both feet. At that time, a primary care consultation showed body mass index of 31 (obese range), glycemia, and hemoglobin A1c were normal. High serum triglyceride levels = 210 mg/dL, and impaired glucose tolerance test was found. He was advised to do a lifestyle modification (diet and exercise). The patient did not follow medical
Evaluation and Management of Autonomic Disorders, 2018
A 44-year-old man presented for evaluation due to progressive symptoms of orthostatic intolerance... more A 44-year-old man presented for evaluation due to progressive symptoms of orthostatic intolerance, including dizziness and lightheadedness on standing over the past 3 weeks. He had several episodes of syncope that rendered him unable to work. Concurrently, he noticed abdominal bloating, constipation, dry mouth, nycturia, erectile dysfunction, and intolerance to bright light. General examination was normal. Supine blood pressure was 130/67 mmHg; on standing blood pressure
Clinical case. Differential diagnosis: chronic variant of AAG, Synucleinopathies presenting with ... more Clinical case. Differential diagnosis: chronic variant of AAG, Synucleinopathies presenting with PAF phenotype. Diagnosis: Temporal profile of slowly progressive autonomic dysfunction without motor signs. Negative anti-ganglionic acetylcholine receptor antibodies (α3 nAChR). Main autonomic manifestations of PAF: orthostatic hypotension, sudomotor, erectile, bladder dysfunction and constipation. Symptoms management and prognosis.
Evaluation and Management of Autonomic Disorders, 2018
Clinical case. Differential diagnosis: GBS, Botulism, Porphyria, Lambert Eaton syndrome. Diagnosi... more Clinical case. Differential diagnosis: GBS, Botulism, Porphyria, Lambert Eaton syndrome. Diagnosis: presence of subacute peripheral polyneuropathy, nerve conduction studies. CSF analysis. Main autonomic manifestations of GBS neuropathy: blood pressure instability, arrhythmias, myocardial compromise, gastrointestinal, genitourinary and sudomotor dysfunction. Therapy: initial cardiac and hemodynamic monitoring, immunomodulation. Prognosis.
Clinical manifestations: Sympathetic autonomic failure: orthostatic hypotension, anhidrosis, Horn... more Clinical manifestations: Sympathetic autonomic failure: orthostatic hypotension, anhidrosis, Horner syndrome. Sympathetic hyperactivity: hypertension, arrhythmias, Takotsubo cardiomyopathy, hyperhidrosis, mydriasis. Parasympathetic autonomic failure: fixed tachycardia, Adie syndrome, urinary retention, impotence, sicca syndrome, gastrointestinal hypo function. Parasympathetic hyperactivity: bradycardia, urinary urgency sialorrhea, gastrointestinal dysmotility. Evaluation: general laboratory tests, evaluation of specific autonomic syndromes, special tests in specific circumstances, sympathetic and parasympathetic function tests.
Clinical case. Differential diagnosis: Synucleinopathies with parkinsonism (PD, MSA, DLB). Diagno... more Clinical case. Differential diagnosis: Synucleinopathies with parkinsonism (PD, MSA, DLB). Diagnosis: Temporal profile of motor and autonomic dysfunction, brain MRI, cardiac sympathetic imaging. Main autonomic manifestations of PD: orthostatic hypotension, gastrointestinal, bladder dysfunction and sudomotor dysfunction. Symptoms management and prognosis.
Journal of the Neurological Sciences, 2015
Objective: Report the case of central and peripheral location in a fatal paraneoplasic syndrome w... more Objective: Report the case of central and peripheral location in a fatal paraneoplasic syndrome with anti-Hu antibodies, revealing a bronchial tumor. Case report: We report the case of a 61 years old man patient, admited for a limbic encephalitis syndrome, complicated with an amyotrophic tetraparetic condition. MRI showed hippocampal lesions, and eletromyography showed an anterior horn syndrome. Further investigations discovered positive anti-Hu antibodies and a bronchial neoplasm. Conclusion: The association of multiple neurological paraneoplasic syndromes in the same patient is possible, but rare. The authors illustrate a documented case of an «encephalo-myelo-neuropathy» with anti-Hu antibodies that revealed a bronchial neoplasm.
Clinical Neurology and Neurosurgery, 2015
The version presented here may differ from the published version or from the version of the recor... more The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription.
Revista médica de Chile, 1992
Corticograms of the mesial structures of the temporal lobe may be obtained with the recently deve... more Corticograms of the mesial structures of the temporal lobe may be obtained with the recently developed foramen ovale electrodes. Since their installation is easy and of low risk, they will probably displace other invasive techniques routinely used up to the moment for the localization and lateralization of epileptic foci originated in the temporal lobe. For the first time in our country, we have used this technique in 7 patients with medically intractable complex partial epilepsy. In all the patients, the study allowed to clear doubts about the laterality of the start of ictal activity and to define irritative foci not found with conventional continuous superficial electroencephalographic recordings. The procedure was uneventful and the implanted electrodes were optimally tolerated. Foramen ovale electrodes are an effective diagnostic method for temporal lobe epilepsies and their features are specially appropriate for our milieu.
Revista médica de Chile, 1988
Revista médica de Chile, 2006
Renal failure secondary to effort rhabdomyolysis. Report of three cases Renal failure secondary t... more Renal failure secondary to effort rhabdomyolysis. Report of three cases Renal failure secondary to effort rhabdomyolysis is uncommon. We report three males age 28, 37 (military sportsmen) and 44 years (sedentary obese), with this condition. Episodes occurred after a training session to run a triathlon, during the course of a mini marathon and during a rescue attempt of a drowning person. All three subjects experienced intense muscle symptoms, hemoglubinuria, oliguria, rise of blood urea nitrogen and a significant rise in muscle enzymes. Creatinekinase reached a maximum of 41 times normal, aspartate aminotransferase a maximum 35 times normal and lactacte dehydrogenase a maximum of 11 times normal. There was a rapid elevation of serum creatinine, reaching values of 6.6 and 9.8 mg/dl on the third day after the physical effort. This parameter had a disproportionate elevation in relation to urea nitrogen, in two subjects. All subjects were managed with saline hydration, sodium bicarbonate and furosemide. Only one required hemodialysis for two days. All normalized their renal function 18 to 48 days after the physical exertion. No subject had other predisposing conditions for acute renal failure (Rev Méd Chile 2006; 134: 211-16).
Sleep and its Disorders Affect Society, 2014
Clinical Neurophysiology, 2021
Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upo... more Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis.
Revista chilena de neuro-psiquiatría, 2020
Introduction: Autonomic dysfunction occurs in patients with central and peripheral nervous system... more Introduction: Autonomic dysfunction occurs in patients with central and peripheral nervous system diseases. It is important to quantify the sympathetic and parasympathetic involvement for the diagnosis of the autonomic failure, for follow up and evaluate the response to a specific treatment. The most important studies are cardiovascular and sudomotor functional tests. There are other tests for the study of autonomic dysfunction in different organs, that are specific to respectively medical specialty. Development: we describe main symptoms, functional autonomic tests and other methods to study cardiovascular: sympathetic vasomotor (noradrenergic) and cardiovagal (cholinergic) and sudomotor: sympathetic (cholinergic) functions. We describe symptoms and tests for assessment pupillary, genitourinary and gastrointestinal autonomic dysfunction. The indications for autonomic function testing in the different clinical scenarios are reported. Conclusions: combined evaluation of clinical and tests of autonomic function results allow to obtain the level and severity of autonomic dysfunction based upon pathophysiological support.
Revista de Neurología, 2014
La miastenia grave es una enfermedad autoinmune que causa debilidad y fatiga musculoesqueletica m... more La miastenia grave es una enfermedad autoinmune que causa debilidad y fatiga musculoesqueletica mediada por anticuerpos que atacan directamente los receptores nicotinicos de acetilcolina en las uniones neuromusculares [1]. Cerca de la mitad de los pacientes con timoma tiene sintomas consistentes con miastenia grave [2,3]. Se recomienda una timomectomia en pacientes con miastenia grave, especialmente en aquellos con control inadecuado con inhibidores de la acetilcolinesterasa y en los menores de 55 anos. Cerca de un 75% se beneficia de la cirugia, y puede mejorar o estabilizar los sintomas incluso anos despues de esta [4-7]. La miastenia grave se clasifica clinicamente en cinco clases principales. La clase I corresponde a la miastenia grave ocular. Esta involucra cualquier grado de debilidad muscular ocular, y es la fuerza del resto de los musculos del cuerpo normal [8]. La disfuncion autonomica en asociacion con miastenia grave es rara; de hecho, hay pocos casos en la bibliografia [9-12]. Los sintomas de fallo autonomico descritos son variados y de diferente gravedad. Lo mas frecuente es la gastroparesia, seguida de afectacion cardiovascular y sindrome de Sicca, generalmente de curso subagudo en relacion con el inicio de los sintomas [9-15]. A continuacion se describe un nuevo caso de miastenia grave asociada a disautonomia grave despues de timomectomia.
Journal of Sleep Research
Evaluation and Management of Autonomic Disorders
Orthostatic hypotension management: non pharmacological: education, diet, physical methods. Pharm... more Orthostatic hypotension management: non pharmacological: education, diet, physical methods. Pharmacological: Midodrine, Pyridostigmine, Droxidopa (DOPS), Fludrocortisone, Erythropoietin, Desmopressin, Octreotride. Gastrointestinal: non pharmacological and drug therapy for constipation, gastroparesia and dysphagia. Therapy for sialorrhea. Bladder: non pharmacological and drug therapy for storage and voiding dysfunction. Erectile dysfunction management.
Currently, health disorders related to Blood Pressure (BP) fluctuations are within the most preva... more Currently, health disorders related to Blood Pressure (BP) fluctuations are within the most prevalent and of higher social and economic impact in the world. A continuous and routinary monitoring of the BP can contribute to the early identification of risk factors, and consequently, would help to prevent potential cardiovascular diseases. <br> <br> BP measurement methods based on the cuff are of widespread use today. The monitoring based on this technology is intrusive and cannot be made continuously, which is of fundamental importance to diagnose Hypertension accurately. Due to the discomfort, inconvenience and intrusiveness of the cuff-based measurements of BP most people undergo monitoring only when they present symptoms of cardiovascular problems and a high proportion of them do not complete the monitoring protocol. <br> <br> In order to provide a less intrusive technology for non-invasive and continuous BP monitoring, many researchers aimed to estimate th...
Evaluation and Management of Autonomic Disorders, 2018
A 64-year-old man in the last 4 years has noted a history of slowly progressive nocturnal paresth... more A 64-year-old man in the last 4 years has noted a history of slowly progressive nocturnal paresthesia with burning, prickling, and pain in both feet. At that time, a primary care consultation showed body mass index of 31 (obese range), glycemia, and hemoglobin A1c were normal. High serum triglyceride levels = 210 mg/dL, and impaired glucose tolerance test was found. He was advised to do a lifestyle modification (diet and exercise). The patient did not follow medical
Evaluation and Management of Autonomic Disorders, 2018
A 44-year-old man presented for evaluation due to progressive symptoms of orthostatic intolerance... more A 44-year-old man presented for evaluation due to progressive symptoms of orthostatic intolerance, including dizziness and lightheadedness on standing over the past 3 weeks. He had several episodes of syncope that rendered him unable to work. Concurrently, he noticed abdominal bloating, constipation, dry mouth, nycturia, erectile dysfunction, and intolerance to bright light. General examination was normal. Supine blood pressure was 130/67 mmHg; on standing blood pressure
Clinical case. Differential diagnosis: chronic variant of AAG, Synucleinopathies presenting with ... more Clinical case. Differential diagnosis: chronic variant of AAG, Synucleinopathies presenting with PAF phenotype. Diagnosis: Temporal profile of slowly progressive autonomic dysfunction without motor signs. Negative anti-ganglionic acetylcholine receptor antibodies (α3 nAChR). Main autonomic manifestations of PAF: orthostatic hypotension, sudomotor, erectile, bladder dysfunction and constipation. Symptoms management and prognosis.
Evaluation and Management of Autonomic Disorders, 2018
Clinical case. Differential diagnosis: GBS, Botulism, Porphyria, Lambert Eaton syndrome. Diagnosi... more Clinical case. Differential diagnosis: GBS, Botulism, Porphyria, Lambert Eaton syndrome. Diagnosis: presence of subacute peripheral polyneuropathy, nerve conduction studies. CSF analysis. Main autonomic manifestations of GBS neuropathy: blood pressure instability, arrhythmias, myocardial compromise, gastrointestinal, genitourinary and sudomotor dysfunction. Therapy: initial cardiac and hemodynamic monitoring, immunomodulation. Prognosis.
Clinical manifestations: Sympathetic autonomic failure: orthostatic hypotension, anhidrosis, Horn... more Clinical manifestations: Sympathetic autonomic failure: orthostatic hypotension, anhidrosis, Horner syndrome. Sympathetic hyperactivity: hypertension, arrhythmias, Takotsubo cardiomyopathy, hyperhidrosis, mydriasis. Parasympathetic autonomic failure: fixed tachycardia, Adie syndrome, urinary retention, impotence, sicca syndrome, gastrointestinal hypo function. Parasympathetic hyperactivity: bradycardia, urinary urgency sialorrhea, gastrointestinal dysmotility. Evaluation: general laboratory tests, evaluation of specific autonomic syndromes, special tests in specific circumstances, sympathetic and parasympathetic function tests.
Clinical case. Differential diagnosis: Synucleinopathies with parkinsonism (PD, MSA, DLB). Diagno... more Clinical case. Differential diagnosis: Synucleinopathies with parkinsonism (PD, MSA, DLB). Diagnosis: Temporal profile of motor and autonomic dysfunction, brain MRI, cardiac sympathetic imaging. Main autonomic manifestations of PD: orthostatic hypotension, gastrointestinal, bladder dysfunction and sudomotor dysfunction. Symptoms management and prognosis.
Journal of the Neurological Sciences, 2015
Objective: Report the case of central and peripheral location in a fatal paraneoplasic syndrome w... more Objective: Report the case of central and peripheral location in a fatal paraneoplasic syndrome with anti-Hu antibodies, revealing a bronchial tumor. Case report: We report the case of a 61 years old man patient, admited for a limbic encephalitis syndrome, complicated with an amyotrophic tetraparetic condition. MRI showed hippocampal lesions, and eletromyography showed an anterior horn syndrome. Further investigations discovered positive anti-Hu antibodies and a bronchial neoplasm. Conclusion: The association of multiple neurological paraneoplasic syndromes in the same patient is possible, but rare. The authors illustrate a documented case of an «encephalo-myelo-neuropathy» with anti-Hu antibodies that revealed a bronchial neoplasm.
Clinical Neurology and Neurosurgery, 2015
The version presented here may differ from the published version or from the version of the recor... more The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription.
Revista médica de Chile, 1992
Corticograms of the mesial structures of the temporal lobe may be obtained with the recently deve... more Corticograms of the mesial structures of the temporal lobe may be obtained with the recently developed foramen ovale electrodes. Since their installation is easy and of low risk, they will probably displace other invasive techniques routinely used up to the moment for the localization and lateralization of epileptic foci originated in the temporal lobe. For the first time in our country, we have used this technique in 7 patients with medically intractable complex partial epilepsy. In all the patients, the study allowed to clear doubts about the laterality of the start of ictal activity and to define irritative foci not found with conventional continuous superficial electroencephalographic recordings. The procedure was uneventful and the implanted electrodes were optimally tolerated. Foramen ovale electrodes are an effective diagnostic method for temporal lobe epilepsies and their features are specially appropriate for our milieu.
Revista médica de Chile, 1988
Revista médica de Chile, 2006
Renal failure secondary to effort rhabdomyolysis. Report of three cases Renal failure secondary t... more Renal failure secondary to effort rhabdomyolysis. Report of three cases Renal failure secondary to effort rhabdomyolysis is uncommon. We report three males age 28, 37 (military sportsmen) and 44 years (sedentary obese), with this condition. Episodes occurred after a training session to run a triathlon, during the course of a mini marathon and during a rescue attempt of a drowning person. All three subjects experienced intense muscle symptoms, hemoglubinuria, oliguria, rise of blood urea nitrogen and a significant rise in muscle enzymes. Creatinekinase reached a maximum of 41 times normal, aspartate aminotransferase a maximum 35 times normal and lactacte dehydrogenase a maximum of 11 times normal. There was a rapid elevation of serum creatinine, reaching values of 6.6 and 9.8 mg/dl on the third day after the physical effort. This parameter had a disproportionate elevation in relation to urea nitrogen, in two subjects. All subjects were managed with saline hydration, sodium bicarbonate and furosemide. Only one required hemodialysis for two days. All normalized their renal function 18 to 48 days after the physical exertion. No subject had other predisposing conditions for acute renal failure (Rev Méd Chile 2006; 134: 211-16).
Sleep and its Disorders Affect Society, 2014