Neurocritical Care

, Volume 31, Issue 3, pp 573–582 | Cite as

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

  • Gisele Sampaio SilvaEmail author
  • Nelson J. Maldonado
  • Jorge H. Mejia-Mantilla
  • Santiago Ortega-Gutierrez
  • Jan Claassen
  • Panayiotis Varelas
  • Jose I. Suarez
  • The Galapagos Neurocritical Care Summit Investigators


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.


Neurocritical care Outcome Health policy South America Critical care Neurological emergency 



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

Authors’ Contribution

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.

Source of Support

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

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.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019

Authors and Affiliations

  • Gisele Sampaio Silva
    • 1
    Email author
  • Nelson J. Maldonado
    • 2
  • Jorge H. Mejia-Mantilla
    • 3
  • Santiago Ortega-Gutierrez
    • 4
  • Jan Claassen
    • 5
  • Panayiotis Varelas
    • 6
  • Jose I. Suarez
    • 7
  • The Galapagos Neurocritical Care Summit Investigators
  1. 1.Department of Neurology and NeurosurgeryFederal University of São Paulo (UNIFESP) and Albert Einstein HospitalSão PauloBrazil
  2. 2.Universidad San Francisco de QuitoQuitoEcuador
  3. 3.Fundacion Valle del LiliCaliColombia
  4. 4.University of IowaIowa CityUSA
  5. 5.Columbia UniversityNew YorkUSA
  6. 6.Henry Ford HospitalDetroitUSA
  7. 7.Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and NeurosurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA

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