Se presenta un caso de quiste aracnoideo gigante paucisintomático, diagnosticado incidentalmente por Resonancia Magnética Nuclear (RMN) a los 5 años de edad, en el cual se evidenció una imagen hipodensa de gran tamaño ubicada en el lóbulo frontal derecho. El seguimiento, durante 17 años, no mostró ninguna alteración en las funciones cognitivas superiores dependientes del área afectada. Actualmente, la exploración neurológica del paciente es óptima. El paciente es un estudiante universitario brillante, lo que constituye un ejemplo contundente de plasticidad cerebral. Los quistes aracnoideos (QA) son tumoraciones benignas congénitas que forman una cavidad extracerebral, llena de líquido con características similares al líquido cefalorraquídeo (LCR), y recubierto por una membrana aracnoidea. La sintomatología por quistes aracnoideos dependen en gran manera del tamaño, y localización de la lesión. La clínica es variada incluyendo cefalea, deformidad craneana, déficit neurológico, convulsiones, entre otras manifestaciones, las cuales se presentan en más de la mitad de los casos. En ciertas lesiones intracraneales con efecto de masa se produce un fenómeno conocido como plasticidad cerebral que se define como la capacidad cerebral de evolucionar generando cambio estructurales y funcionales.   Palabras clave: plasticidad cerebral, quiste aracnoideo, resonancia magnética nuclear, neurología.   Abstract   This is a case of paucisymptomatic giant arachnoid cyst, incidentally diagnosed by Nuclear Magnetic Resonance (MRI) at 5 years of age, where a large hypodense image located in the right frontal lobe was evidenced, follow up for 17 years, did not show any alteration in the superior cognitive functions dependent on the affected area. Currently, the patient's neurological examination is optimal and he is a brilliant university student, which is a strong example of cerebral plasticity. The arcanoideos cysts (QA) are benign congenital tumors that form an ex-brain cavity, filled with liquid with characteristics similar to the cerebrospinal fluid (CSF), and covered by an arachnoid membrane. Symptoms due to arachnoid cysts depend greatly on the size, and localization of the lesion the clinic is varied including a headache, cranial deformity, neurological deficit, seizures, among other manifestations, which occur in more than half of the cases. In certain intracranial lesions with mass effect, a phenomenon known as cerebral plasticity is produced, is defined as the cerebral capacity to evolve, generating structural and functional changes.   Keywords: cerebral plasticity, arachnoid cyst, nuclear magnetic resonance, neurology.

Se presenta un caso de quiste aracnoideo gigante paucisintomático, diagnosticado incidentalmente por Resonancia Magnética Nuclear (RMN) a los 5 años de edad, en el cual se evidenció una imagen hipodensa de gran tamaño ubicada en el lóbulo frontal derecho. El seguimiento, durante 17 años, no mostró ninguna alteración en las funciones cognitivas superiores dependientes del área afectada. Actualmente, la exploración neurológica del paciente es óptima. El paciente es un estudiante universitario brillante, lo que constituye un ejemplo contundente de plasticidad cerebral. Los quistes aracnoideos (QA) son tumoraciones benignas congénitas que forman una cavidad extracerebral, llena de líquido con características similares al líquido cefalorraquídeo (LCR), y recubierto por una membrana aracnoidea. La sintomatología por quistes aracnoideos dependen en gran manera del tamaño, y localización de la lesión. La clínica es variada incluyendo cefalea, deformidad craneana, déficit neurológico, convulsiones, entre otras manifestaciones, las cuales se presentan en más de la mitad de los casos. En ciertas lesiones intracraneales con efecto de masa se produce un fenómeno conocido como plasticidad cerebral que se define como la capacidad cerebral de evolucionar generando cambio estructurales y funcionales.   Palabras clave: plasticidad cerebral, quiste aracnoideo, resonancia magnética nuclear, neurología.   Abstract   This is a case of paucisymptomatic giant arachnoid cyst, incidentally diagnosed by Nuclear Magnetic Resonance (MRI) at 5 years of age, where a large hypodense image located in the right frontal lobe was evidenced, follow up for 17 years, did not show any alteration in the superior cognitive functions dependent on the affected area. Currently, the patient's neurological examination is optimal and he is a brilliant university student, which is a strong example of cerebral plasticity. The arcanoideos cysts (QA) are benign congenital tumors that form an ex-brain cavity, filled with liquid with characteristics similar to the cerebrospinal fluid (CSF), and covered by an arachnoid membrane. Symptoms due to arachnoid cysts depend greatly on the size, and localization of the lesion the clinic is varied including a headache, cranial deformity, neurological deficit, seizures, among other manifestations, which occur in more than half of the cases. In certain intracranial lesions with mass effect, a phenomenon known as cerebral plasticity is produced, is defined as the cerebral capacity to evolve, generating structural and functional changes.   Keywords: cerebral plasticity, arachnoid cyst, nuclear magnetic resonance, neurology.

Minor ischemic stroke is the most frequent presentation of cerebral vascular disease and treatment with antiplatelet drugs can be used for the prevention of its recurrence. This systematic review and meta-analysis was aimed to assess non-inferiority criteria about the effect in the comparison of different antiplatelet schemes using aspirin as active control. Twelve randomized studies with a total of 52204 patients were chosen. All met the inclusion criteria with minor recurrent ischemic stroke as end point and any extracranial bleeding as safety event. The results showed a significant risk reduction of 22% [RR (95% CI) = 0.78 (0.72-0.84), p<0.0001, NNT: 67] in the recurrence of ischemic events with any antiplatelet drug (combined or not with aspirin) versus aspirin alone and there were no differences in the bleeding risk [RR (95% CI) = 1.02 (0.74- 1.41), p= 0.899, NNH: 500]. Dual antiplatelet therapy (DAPT) and cilostazol were more effective compared with aspirin alone (22% and 32% risk reduction respectively) but only cilostazol showed a higher reduction (52%) of bleeding events. In conclusion, although in some instances equivalence was demonstrated, a clinical superiority in the risk reduction for recurrent ischemic stroke of any antiplatelet treatment versus aspirin alone was observed. With the sole exception of the cilostazol trials there was an increase of the bleeding risk when the antiplatelet drugs treatments were compared with aspirin alone.