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Neuroemergencies in South America: How to Fill in the Gaps?

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Abstract

South America is a subcontinent with 393 million inhabitants with widely distinct countries and diverse ethnicities, cultures, political and societal organizations. The epidemiological transition that accompanied the technological and demographic evolution is happening in South America and leading to a rise in the incidence of neurodegenerative and cardiovascular diseases that now coexist with the still high burden of infectious diseases. South America is also quite heterogeneous regarding the existence of systems of care for the various neurological emergencies, with some countries having well-organized systems for some diseases, while others have no plan of action for the care of patients with acute neurological symptoms. In this article, we discuss the existing systems of care in different countries of South America for the treatment of neurological emergencies, mainly stroke, status epilepticus, and traumatic brain injury. We also will address existing gaps between the current systems and recommendations from the literature to improve the management of such emergencies, as well as strategies on how to solve these disparities.

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Acknowledgements

The Galapagos Neurocritical Care Summit was sponsored by the Universidad San Francisco de Quito, Ecuador and endorsed by the Neurocritical Care Society.

Funding

The Galapagos Neurocritical Care Summit was sponsored by the Universidad San Francisco de Quito, Ecuador and endorsed by the Neurocritical Care Society.

Author information

Authors and Affiliations

  1. Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP) and Albert Einstein Hospital, Albert Einstein Street, 627, Suite 218, São Paulo, SP, 05652-900, Brazil

    Gisele Sampaio Silva

  2. Universidad San Francisco de Quito, Quito, Ecuador

    Nelson J. Maldonado

  3. Fundacion Valle del Lili, Cali, Colombia

    Jorge H. Mejia-Mantilla

  4. University of Iowa, Iowa City, IA, USA

    Santiago Ortega-Gutierrez

  5. Columbia University, New York, NY, USA

    Jan Claassen

  6. Henry Ford Hospital, Detroit, MI, USA

    Panayiotis Varelas

  7. Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jose I. Suarez

Authors
  1. Gisele Sampaio Silva
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  2. Nelson J. Maldonado
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  3. Jorge H. Mejia-Mantilla
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  4. Santiago Ortega-Gutierrez
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  5. Jan Claassen
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  6. Panayiotis Varelas
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  7. Jose I. Suarez
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Consortia

The Galapagos Neurocritical Care Summit Investigators

  • Tamer Abdelhak
  • , Mary K Bader
  • , Gretchen Brophy
  • , Eusebia Calvillo
  • , Jan Claassen
  • , Airton Leonardo De Oliveira Manoel
  • , Jennifer Frontera
  • , Alexandros Georgiadis
  • , Diana Greene-Chandos
  • , Manuel Jijaba
  • , Christos Lazaridis
  • , Enrique Leira
  • , Chris Lewandowski
  • , Nelson J Maldonado
  • , Jorge Mejia-Mantilla
  • , Jose Ignacio Moretti
  • , Daniel Ontaneda
  • , Santiago Ortega-Gutierrez
  • , Edgar Samaniego
  • , Gisele Sampaio Silva
  • , Brian Silver
  • , Marianna Spanaki
  • , Jose I Suarez
  • , Michel Torbey
  • , Panayiotis Varelas
  • , Chethan P Venkatasubba Rao
  •  & Walter Videtta

Contributions

GSS and JIS designed, directed this review and drafted the manuscript; NJM, JHM, SOG, JC and PV participated in the conceptual framing of the study and revision of the manuscript.

Corresponding author

Correspondence to Gisele Sampaio Silva.

Ethics declarations

Conflict of interest

Dr. Silva reports personal fees from Boehringer Ingelheim, personal fees from BARD, personal fees from Pfizer, Grants from Brazilian Ministry of Health, outside the submitted work. Dr. Maldonado has nothing to disclose. Dr. Mejia-Mantilla has nothing to disclose. Dr. Ortega receives Grants from Siemens, Society of vascular and Interventional Neurology. He is the site PI for 3 endovascular stroke trial at the University of Iowa including TESLA, SEGA and SELECT 2. Dr. Claassen reports Grants from Charles A. Dana Foundation , Grants from James S. McDonnell Foundation, from NIH: The Stroke Hyperglycemia Insulin Network Effort (SHINE) Trial, Grants from NIH: I-SPOT, Grants from NIH: Established Status Epilepticus Treatment Trial (ESETT), Grants from Bard: Intrepid, Grants from NIH: Futility Study of Deferoxamine Mesylate in Intracerebral Hemorrhage (I-DEF), Grants from NIH / NLM: BIGDATA: Causal Inference in Large-Scale Time Series with Rare and Latent Events, Grants from NIH: Rhapsody (ZZ-3K3A-201), other from iCE Neurosystems, outside the submitted work. Dr. Varelas reports Grants from Marinus, outside the submitted work. Dr. Suarez reports non-financial support and other from Neurocritical Care Society (President of the Neurocritical Care Society), non-financial support and other from Stroke Journal (member of the Editorial Board of Stroke), non-financial support and other from BARD (Chair of the DSMB for the INTREPID Study), outside the submitted work.

Ethical Approval/Informed Consent

No ethical approval is required for this type of study.

Additional information

Publisher's Note

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See “Appendix” for a full listing of investigators.

Appendix

Appendix

The Galapagos Neurocritical Care Summit Investigators (in alphabetical order)

  • Abdelhak Tamer, MD, Spectrum Health, Grand Rapids, MI, USA

  • Bader Mary K, RN, Mission Hospital St Joe Health, Mission Viejo, CA, USA

  • Brophy Gretchen, PharmD, Virginia Commonwealth University, Richmond, VA, USA

  • Calvillo Eusebia, RN, The Johns Hopkins University, Baltimore, MD, USA

  • Claassen Jan, Columbia University, New York, NY, USA

  • De Oliveira Manoel Airton Leonardo, MD, Sao Paulo, Brazil

  • Frontera Jennifer, MD, NYU Langone Health, Brooklyn, NY, USA

  • Georgiadis Alexandros, MD, Baylor College of Medicine, Houston, TX, USA

  • Greene-Chandos Diana, MD, Ohio State University, Columbus, OH, USA

  • Jijaba Manuel, MD, Hospital Eugenio Espejo, Quito, Ecuador

  • Lazaridis Christos, MD, University of Chicago, Chicago, IL, USA

  • Leira Enrique, MD, MS, University of Iowa, Iowa City, IA, USA

  • Lewandowski Chris, MD, Henry Ford Hospital, Detroit, MI, USA

  • Maldonado Nelson J, MD, Universidad San Francisco de Quito, Quito, Ecuador

  • Mejia-Mantilla Jorge, MD, Fundacion Valle del Lili, Cali, Colombia

  • Moretti Jose Ignacio, MD, Clinical Bicentenario, Santiago de Chile, Chile

  • Ontaneda Daniel, MD, The Cleveland Clinic Foundation, Cleveland, OH, USA

  • Ortega-Gutierrez Santiago, MD, University of Iowa, Iowa City, IA, USA

  • Samaniego Edgar, MD, University of Iowa, Iowa City, IA, USA

  • Sampaio Silva Gisele, MD, PhD, Federal University of Sao Paulo, Sao Paulo, Brazil

  • Silver Brian, MD, University of Massachusetts, Worcester, MA, USA

  • Spanaki Marianna, MD, Henry Ford Hospital, Detroit, MI, USA

  • Suarez Jose I, MD, The Johns Hopkins University, Baltimore, MD, USA

  • Torbey Michel, MD, MPH, University of New Mexico, Albuquerque, NM, USA

  • Varelas Panayiotis, MD, PhD, Henry Ford Hospital, Detroit, MI, USA

  • Venkatasubba Rao Chethan P, Baylor College of Medicine, Houston, TX, USA

  • Videtta Walter, MD, Hospital Nacional Posadas, Buenos Aires, Argentina.

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Silva, G.S., Maldonado, N.J., Mejia-Mantilla, J.H. et al. Neuroemergencies in South America: How to Fill in the Gaps?. Neurocrit Care 31, 573–582 (2019). https://doi.org/10.1007/s12028-019-00775-8

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  • DOI: https://doi.org/10.1007/s12028-019-00775-8

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