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IFMBE Proceedings
César A. González Díaz · Christian Chapa González · Eric Laciar Leber · Hugo A. Vélez ·
Norma P. Puente · Dora-Luz Flores · Adriano O. Andrade · Héctor A. Galván ·
Fabiola Martínez · Renato García · Citlalli J. Trujillo · Aldo R. Mejía (Eds.)

Volume 75

VIII Latin American

Conference on Biomedical
Engineering and XLII
National Conference on
Biomedical Engineering
Proceedings of CLAIB-CNIB ,
October –, , Cancún, México
IFMBE Proceedings

Volume 75

Series Editor
Ratko Magjarevic, Faculty of Electrical Engineering and Computing, ZESOI,
University of Zagreb, Zagreb, Croatia

Associate Editors
Piotr Ładyżyński, Warsaw, Poland
Fatimah Ibrahim, Department of Biomedical Engineering, Faculty of Engineering,
University of Malaya, Kuala Lumpur, Malaysia
Igor Lackovic, Faculty of Electrical Engineering and Computing,
University of Zagreb, Zagreb, Croatia
Emilio Sacristan Rock, Mexico DF, Mexico
The IFMBE Proceedings Book Series is an official publication of the International
Federation for Medical and Biological Engineering (IFMBE). The series gathers the
proceedings of various international conferences, which are either organized or
endorsed by the Federation. Books published in this series report on cutting-edge
findings and provide an informative survey on the most challenging topics and
advances in the fields of medicine, biology, clinical engineering, and biophysics.
The series aims at disseminating high quality scientific information, encouraging
both basic and applied research, and promoting world-wide collaboration between
researchers and practitioners in the field of Medical and Biological Engineering.
Topics include, but are not limited to:
• Diagnostic Imaging, Image Processing, Biomedical Signal Processing
• Modeling and Simulation, Biomechanics
• Biomaterials, Cellular and Tissue Engineering
• Information and Communication in Medicine, Telemedicine and e-Health
• Instrumentation and Clinical Engineering
• Surgery, Minimal Invasive Interventions, Endoscopy and Image Guided Therapy
• Audiology, Ophthalmology, Emergency and Dental Medicine Applications
• Radiology, Radiation Oncology and Biological Effects of Radiation
IFMBE proceedings are indexed by SCOPUS and EI Compendex. They are also
submitted for ISI proceedings indexing.
Proposals can be submitted by contacting the Springer responsible editor shown
on the series webpage (see “Contacts”), or by getting in touch with the series editor
Ratko Magjarevic.

More information about this series at http://www.springer.com/series/7403

César A. González Díaz •

Christian Chapa González •

Eric Laciar Leber Hugo A. Vélez

• •

Norma P. Puente Dora-Luz Flores

• •

Adriano O. Andrade Héctor A. Galván

• •

Fabiola Martínez Renato García

• •

Citlalli J. Trujillo Aldo R. Mejía

•

Editors

VIII Latin American Conference

on Biomedical Engineering and XLII
National Conference on Biomedical
Engineering
Proceedings of CLAIB-CNIB 2019,
October 2–5, 2019, Cancún, México

123
Editors
César A. González Díaz Christian Chapa González
Instituto Politécnico Nacional Departamento de Ingeniería
Mexico City, Mexico Electrica y Computación
Universidad Autónoma de Ciudad Juárez
Eric Laciar Leber Chihuahua, Mexico
Universidad Nacional de San Juan
San Juan, Argentina Hugo A. Vélez
Universidad de Guadalajara
Norma P. Puente Guadalajara, Mexico
Universidad Autónoma de Nuevo León
Nuevo León, Mexico Dora-Luz Flores
Universidad Autónoma de Baja California
Adriano O. Andrade Ensenada, Baja California, Mexico
Universidade Federal de Uberlândia
Uberlândia, Brazil Héctor A. Galván
Instituto Nacional de Cancerología
Fabiola Martínez Mexico City, Mexico
Universidad Autónoma Metropolitana
Mexico City, Mexico Renato García
Universidad Federal de Santa Catarina
Citlalli J. Trujillo Florianópolis, Brazil
Instituto Nacional de Rehabilitación
Mexico City, Mexico Aldo R. Mejía
Universidad Autónoma de San Luis Potos
San Luis, Mexico

ISSN 1680-0737 ISSN 1433-9277 (electronic)

IFMBE Proceedings
ISBN 978-3-030-30647-2 ISBN 978-3-030-30648-9 (eBook)
https://doi.org/10.1007/978-3-030-30648-9
© Springer Nature Switzerland AG 2020
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part
of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this
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the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
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Preface

The VIII Latin American Conference on Biomedical Engineering and the XLII
National Conference on Biomedical Engineering (CLAIB-CNIB 2019) were carried
out together by the Regional Council of Biomedical Engineering for Latin America
(CORAL) and the Mexican Biomedical Engineering Society (SOMIB) in October
2–5, 2019, in Cancún, México. We are proud to present in this book a selection of
papers from all over the world, reporting on the latest findings and technological
outcomes in the biomedical engineering field. The content is organized into fifteen
parts to reflect outstanding scientific research lines in biomedical engineering.
Innovative topics tissue and molecular engineering, as well as bioimpedance
sensors and micro-nano devices are discussed in this book. Content innovation and
academic quality have been warranted by a careful peer-reviewing, which was
coordinated by an expert Scientific Committee and involved academic reviewers
from all continents. With a final acceptance rate of 50%, this book is the result of a
great effort involving more than 1000 scientists, both professors and students,
participating as authors, reviewers, and scientific committee members. We are sure
that the contributions presented in this book will give you a deep overview of the
leading edge in your expertise and other areas. On behalf of Scientific and
Organizing Committees, we thank authors, academic reviewers as well as
sponsoring societies such as CORAL, SOMIB, and the National Council for
Science and Technology (CONACYT), México, for their contribution. Moreover,
we encourage readers to enjoy this amazing piece of scientific literature as a breadth
of knowledge in the biomedical engineering field.

Christian Chapa González

Co-chair Program CLAIB-CNIB 2019
César A. González Díaz
Chair Program CLAIB-CNIB 2019

v
Distinguished Lecturer Message

It is my great pleasure and honor to welcome you all in reading the IFMBE
proceedings of CLAIB-CNIB 2019. This international conference that was held in
Cancun, Mexico, gave a unique occasion for us, to host all our colleagues from all
over the world with an outstanding spectrum of over 200 research papers from
25 countries, to focus on the challenges of developing future technologies in
medicine and biology. The real purpose of conferences like this is the chance to
socialize with those share your interest and expertise, and the chance to pick up new
ideas or share the trending ideas on some critical aspects of health care. This is a
great opportunity that this conference represents a chance for you to not only keep
abreast of your own area of expertise, but also to find out what is the leading edge in
other areas. May be your specialty is other than medical and biological engineering,
but this compilation of works just might provide you with some nugget of infor-
mation that transforms your approach to a bigger challenge. I hope that all of you
had enjoyed the larger opportunity we had during CLAIB-CNIB 2019—a
tremendous experience and expertise throughout the length and breadth of wide
range of fields under one roof—generating a wave of motivation and diversity
spreading across the Americas to the world.

Ricardo L. Armentano
Distinguished Lecturer CLAIB-CNIB 2019

vii
Organization

CLAIB-CNIB 2019 is organized by the Regional Council of Biomedical

Engineering for Latin America (CORAL) and the Mexican Biomedical Engineering
Society (SOMIB) in cooperation with National Council for Science and
Technology (CONACYT), México.

Executive Committee
Conference Chair
Herberth Bravo Hernández President of the Mexican Biomedical
Engineering Society (SOMIB), México

Program Chair
César A. González Díaz Instituto Politécnico Nacional, México

Organizing Chair
Francisco Javier Aceves Aldrete Universidad de Guadalajara, México

Scientific Committee
Program Chair
César A. González Díaz Instituto Politécnico Nacional, Mexico

Program Co-chair
Christian Chapa González
Session Coordinators
Renato García
Universidad Autónoma de Ciudad Juárez,
Mexico
Universidad Federal de Santa Catarina,
Brazil

ix
x Organization
Eric Laciar Leber
Hugo A. Vélez
Norma P. Puente
Dora-Luz Flores
Adriano O. Andrade
Héctor A. Galván
Fabiola Martínez
Pedro Berthemes Filho
Alexander Golberg
Citlalli J. Trujillo
Aldo R. Mejía
Amanda Ortiz Zitle
Awards Committee
Student Competition
Citlalli J. Trujillo
Scientific Challenge
Aldo R. Mejía
Guadalupe Dorantes Méndez
Bersain Alexander Reyes
Innovahealth Challenge
Amanda Ortiz Zitle
Organizing Committee
Organizing Chair
Francisco Javier Aceves Aldrete
Organizing Co-chairs
Ana Luz Portillo Hernández
Dora-Luz Flores
International Guests
Elliot Vernet Saavedra
Universidad Nacional de San Juan,
Argentina
Universidad de Guadalajara, Mexico
Universidad Autónoma de Nuevo León,
Mexico
Universidad Autónoma de Baja California,
Mexico
Universidade Federal de Uberlândia, Brasil
Instituto Nacional de Cancerología, Mexico
Universidad Autónoma Metropolitana,
Mexico
Universidad de Santa Catarina, Brasil
University of Tel Aviv, Israel
Instituto Nacional de Rehabilitación,
Mexico
Universidad Autónoma de San Luis Potosí,
Mexico
Universidad Autónoma de Baja California,
Mexico
Instituto Nacional de Rehabilitación,
Mexico
Universidad Autónoma San Luis Potosí,
Mexico
Universidad Autónoma San Luis Potosí,
Mexico
Universidad Autónoma San Luis Potosí,
Mexico
Universidad Autónoma de Baja California,
Mexico
Organization xi

Workshops
Carlos Graniel Tamayo

Exposition Chair
Herberth Bravo Hernández

Exposition Co-chairs
Herberth Bravo Hernández
Ivette Patrón Villegas

Education Committee
Chair
Lilian Beatriz Paredes Cardenas

Co-chairs
Janetthe Mariana Tarín León
Gerardo Ames

Logistics Committee
Chair
Zaynic Inc. Mexico

Graphic Design
Judith González

Administrative Support
Alexa Ruano

Referees
Adriana Santos Martel
Adriano Alves Pereira
Adriano O. Andrade
Adson Ferreira da Rocha
Agustina Garcés
Alberto Cavazos Gonzalez
Alcimar Barbosa Soares
Universidad Autónoma de Ciudad Juárez,
Mexico
Universidade Federal de Uberlândia, Brazil
Universidade Federal de Uberlândia, Brazil
Universidade de Brasília, Brazil
Universidad Nacional de San Juan,
Argentina
Universidad Autonoma de Nuevo Leon,
Mexico
Universidade Federal de Uberlândia, Brazil
xii
Aldo R. Mejía
Alejandra López
Alejandro Galaviz
Alessandra Cavalcanti
de Albuquerque e Souza
Alexandra La Cruz
Alfredo Corniali
Alher Mauricio Hernandez
Alma Edith Martínez Licona
Alvaro Gabriel Pizá
Amanda Gomes Rabelo
Ana Beatriz Ramírez Silva
Ana Lía Albarracin
Ana Paula Bittar Britto Arantes
Ana Paula Perini
André Candido Porto
Andrés Antonio González Garrido
Anselmo Frizera Neto
Antonio Hernandez
Antonio Padilha Lanari Bo
Antonio Rienzo
Antonio Sanchez Uresti
Aurelio Horacio Heredia Jimenez
Aurora Espinoza Valdez
Beatriz Janeth Galeano Upegui
Bersaín Alexander Reyes
Carelia G. Gaxiola Pacheco
Carlos Dell’Aquila
Carlos Ferrer-Riesgo
Organization
Universidad Autónoma de San Luis Potosí,
Mexico
Universidad de Sonora, Mexico
Centro de investigacion Cientifica y
Educacion Superior de Ensenada,
Mexico
Universidade Federal do Triângulo
Mineiro, Brazil
Universidade de Brasília, Brazil
Diretoria de Vigilância Sanitária Secretaria
de Saúde do Estado da Bahia, Brazil
Universidad de Antioquia, Colombia
UAM Iztapalapa, Mexico
Universidad Nacional de Tucumán,
Argentina
Universidade Federal de Uberlândia, Brazil
Universidad Industrial de Santander,
Colombia
INSIBIO-CONICET, Argentina
University of New Brunswick, USA
Universidade Federal de Uberlândia, Brazil
Universidade Federal de São Carlos, Brazil
Universidad de Guadalajara, Mexico
Universidade Federal do Espírito Santo,
Brazil
American College of Clinical
Engineering—ACCE, USA
Universidade de Brasília, Brazil
Universidad de Valparaíso, Chile
Universidad Autonoma de Nuevo Leon,
Mexico
Universidad Popular Autónoma del Estado
de Puebla, Mexico
Universidad de Guadalajara, Mexico
Universidad Pontificia Bolivariana,
Colombia
Universidad Autónoma de San Luis Potosí,
Mexico
Universidad Autónoma de Baja California,
Mexico
Universidad Nacional de San Juan,
Argentina
Universidad Central “Marta Abreu”
de Las Villas, Cuba
Organization
Carolina Tabernig
César A. González Díaz
César Covantes Osuna
César Javier Ortiz Echeverri
Christian Chapa González
Citlalli J. Trujillo
Claudia Edith Bonell
Cornelio Posadas Castillo
Dania Gutierrez
Daniel Campos Delgado
David Cervantes Vásquez
Diego Sebastián Comas
Dora-Luz Flores
Edgar Román Arce Santana
Edgard Lamounier
Edgard Morya
Eduardo Gerardo Mendizabal Ruíz
Eduardo Lázaro Martins Naves
Eduardo Martinez Montes
Eduardo Rocon
Emilce Preisz
Enrique Mario Avila Perona
Eric Laciar Leber
Erick Eduardo Guzmán Quezada
Ernesto Suaste Gómez
Esmeralda S. Zúñiga
xiii
Universidad Nacional de Entre Ríos,
Argentina
Instituto Politécnico Nacional, Mexico
Universidad de Guadalajara, Mexico
Universidad Autónoma de Querétaro,
Mexico
Universidad Autónoma de Ciudad Juárez,
Mexico
Instituto Nacional de Rehabilitación,
Mexico
Universidad Nacional Entre Rios,
Argentina
Universidad Autonoma de Nuevo Leon,
Mexico
Instituto Politecnico Nacional, Mexico
Universidad Autónoma de San Luis Potosí,
Mexico
Universidad Autónoma de Baja California,
Mexico
Universidad Nacional de Mar del Plata,
Argentina
Universidad Autónoma de Baja California,
Mexico
Universidad Autónoma de San Luis Potosí,
Mexico
Universidade Federal de Uberlândia, Brazil
Instituto Santos Dumont, Brazil
Universidad de Guadalajara, Mexico
Universidade Federal de Uberlândia, Brazil
Centro de Neurociencias de Cuba, Cuba
Centro de Automática y Robótica
CSIC-UPM, Spain
Universidad Nacional de Entre Rios,
Argentina
Universidad Nacional de San Juan,
Argentina
Universidad Nacional de San Juan,
Argentina
Universidad Autónoma de Guadalajara,
Mexico
CINVESTAV Sección Biolectrónica,
Mexico
Universidad Autónoma de Ciudad Juárez,
Mexico
xiv
Eunice Vargas Viveros
Evelio González Dalmau
Everardo Gutiérrez López
Fabiola Martínez
Fabricio Brasil
Fernando Alarid
Fernando Daniel Farfán
Fernando Pérez Escamirosa
Flavio Enersto Trujillo Zamudio
Francisco Berumen Murillo
Francisco Javier Alvarado
Francisco Javier Alvarado
Rodríguez
Francisco Javier Buchelly Imbachí
Gabriel Alfredo Ruiz
Gabriel Cañadas
Gabriella Lelis Silva
Gilberto Ochoa Ruíz
Griselda Quiroz Compean
Guadalupe Dorantes Mendez
Gustavo Abraham
Gustavo Bizai
Gustavo Meschino
Héctor A. Galván
Hougelle Simplício
Hugo A. Vélez
Imelda Olivas Armendáriz
Isela Bonilla Gutiérrez
Isnardo Torres
Organization
Universidad Autónoma de Baja California,
Mexico
Centro de Ingeniería Genética
y Biotecnología, Cuba
Universidad Autónoma de Baja California,
Mexico
UAM Iztapalapa, Mexico
Instituto Santos Dumont, Brazil
CIDE- Aguascalientes, Mexico
Universidad Nacional de Tucumán,
Argentina
Universidad Nacional Autónoma
de Mexico, Mexico
Hospital Regional de Alta Especialidad
de Oaxaca, Mexico
Université Laval, Canada, Canada
Universidad de Guadalajara, Mexico
Universidad de Guadalajara, Mexico
Universidad Nacional de Mar del Plata,
Argentina
Universidad Nacional de Tucumán,
Argentina
Universidad Nacional de San Juan,
Argentina
Universidade Federal de Uberlândia, Brazil
Universidad Autónoma de Guadalajara,
Mexico
Universidad Autonoma de Nuevo Leon,
Mexico
Universidad Autónoma de San Luis Potosí,
Mexico
INTEMA (UNMdP-CONICET), Argentina
Universidad Nacional Entre Ríos,
Argentina
Universidad Nacional de Mar del Plata,
Argentina
Instituto Nacional de Cancerología, Mexico
Instituto Santos Dumont, Brazil
Universidad de Guadalajara, Mexico
Universidad de Sonora, Mexico
Universidad Autónoma de San Luis Potosí,
Mexico
ABIOIN, Colombia
Organization
Israel A. Flores
Izabela Lopes Mendes
Javier E. Camacho
Javier Fernando Adur
Jesus Emmanuel Gomez Correa
Joaquín Azpiroz Leehan
John Jairo Villarejo Mayor
Johnny Rodriguez Maldonado
José Manuel Ferrer Villena
Jose Maria Flores
José Mejía
Jose Ramon Rodriguez Cruz
Juan Angel Rodriguez Liñan
Juan Carlos Perfetto
Juan Manuel Fontana
Juan Manuel Olivera
Juan Pablo Graffigna
Juan Pastore
Juan Valentín Lorenzo Ginori
Julián Villamarin
Karen Yael Castrejón
Leandro Ariza Jimenez
Lidia H. Rascón
Lígia Reis Nóbrega
Lilibeth Ortega-Pineda
Lorena Correa
Lorena Orosco
xv
Universidad Autónoma de Nuevo León,
Mexico
Universidade do Vale do Paraíba, Brazil
Universidade EIA, Colombia
Universidad Nacional Entre Rios,
Argentina
Centro de investigacion Cientifica y
Educacion Superior de Ensenada,
Mexico
UAM Iztapalapa, Mexico
Universidade Federal do Paraná, Brazil
Universidad Autonoma de Nuevo Leon,
Mexico
Pontificia Universidad Católica del Perú,
Perú
Universidad Nacional de Entre Rios,
Argentina
Universidad Autónoma de Ciudad Juárez,
Mexico
Universidad Autonoma de Nuevo Leon,
Mexico
Universidad Autonoma de Nuevo Leon,
Mexico
Universidad de Buenos Aires, Argentina
Universidad Nacional de Río Cuarto,
Argentina
Universidad Nacional Tucumán, Argentina
Universidad Nacional de San Juan,
Argentina
Universidad Nacional de Mar del Plata,
Argentina
Universidad Central “Marta Abreu”
de Las Villas, Cuba
Universidad Antonio Nariño, Colombia
Universidad Autónoma de Ciudad Juárez,
Mexico
Universidad EAFIT, Colombia
Universidad Autónoma de Ciudad Juárez,
Mexico
Universidade Federal de Uberlândia, Brazil
Universidad EIA, Colombia
Universidad Nacional de San Juan,
Argentina
Universidad Nacional de San Juan,
Argentina
xvi
Luciane Aparecida Pascucci Sande
de Souza
Lucio Pereira Neves
Luis Alfredo Rocha
Luis Enrique Bergues Cabrales
Luis Felipe Devia Cru
Luis Fernando Mercado
Luis Harnán Danyau Izarnótegui
Luis Mercado
Luis Rocha
Luis Vilcahuaman
Luiza Maire David Luiz
Luz Maria Alonso Velardi
Marco Octavio Mendoza Gutiérrez
Marcus Fraga Vieira
María Agustina Bouchet
Maria Elizete Kunkel
Maria Isabel Veras Orselli
María Virginia Walz
Mariana Cardoso Melo
Mariela Azul Gonzalez
Martha Elena Londoño López
Martha Ortiz Posadas
Martín Oswaldo Méndez García
Mauricio Corredor Rodríguez
Mauro Conti Pereira
Maycon Crispim de Oliveira
Carvalho
Mayra Deyanira Flores
Miguel Cadena Méndez
Mónica Huerta
Organization
Universidade Federal do Triângulo
Mineiro, Brazil
Universidade Federal de Uberlândia, Brazil
Universidad Nacional de Tucumán,
Argentina
University of Oriente, Cuba
Centro de investigacion Cientifica y
Educacion Superior de Ensenada,
Mexico
Universidad Autonoma de Nuevo Leon,
Mexico
Universidad de Valparaiso, Chile
Universidad Autonoma de Nuevo Leon,
Mexico
Universidade Nacional de Tucuman,
Argentina
Pontificia Universidad Catolica del Peru,
Peru
Universidade Federal de Uberlândia, Brazil
Instituto Tecnologico de Estudios
Superiores de Monterrey, Mexico
Universidad Autónoma de San Luis Potosí,
Mexico
Universidade Federal de Goiás, Brazil
Universidad Nacional de Mar del Plata,
Argentina
Universidade Federal de São Paulo, Brazil
Universidade Franciscana, Brazil
Universidad Nacional Entre Ríos,
Argentina
Universidade Federal de São Paulo, Brazil
Universidad Nacional de Mar del Plata,
Argentina
Universidad EIA, Colombia, Colombia
UAM Iztapalapa, Mexico
Universidad Autónoma de San Luis Potosí,
Mexico
Universidad de Antioquia, Colombia
Universidade Católica Dom Bosco, Brazil
Universidade Anhembi Morumbi, Brazil
Universidad Autonoma de Nuevo Leon,
Mexico
Universidad Autonoma de Mexico, Mexico
Universidad Simón Bolíver, Venezuela
Organization
Myriam Cristina Herrera
Nelly Gordillo
Noemi Lizarraga Osuna
Norma Alicia Barboza Tello
Norma P. Puente
Nydia Paola Rondon Villarreal
Odín Ramírez
Omar Paredes
Oscar Eduardo Cervantes García
Pablo Daniel Cruces
Pablo Diez
Patricia Juárez Camacho
Paula Bonomini
Paulo Eduardo Ambrosio
Paulo Eigi Miyagi
Pedro Arini
Pedro Bertmes Filho
Percy Nohama
Priscila Sousa de Avelar
Rafael Torres Amarís
Raúl Correa
Raúl Molina Salazar
Raul Rangel Rojo
Raúl Romo Doña
Rebeca del Carmen Romo Vázquez
xvii
Universidad Nacional de Tucuman,
Argentina
Universidad Autónoma de Ciudad Juárez,
Mexico
Universidad Autonoma de Baja California,
Mexico
Universidad Autonoma de Baja California,
Mexico
Universidad Autonoma de Nuevo Leon,
Mexico
Universidad Industrial de Santander,
Colombia
Instituto Tecnológico de Tlalnepantla,
Mexico
Universidad de Guadalajara, Mexico
Universidad Autonoma de Nuevo Leon,
Mexico
Universidad de Buenos Aires, Argentina
Universidad Nacional de San Juan,
Argentina
Centro de Investigación Científica y
Educación Superior de Ensenada,
Mexico
Universidad de Buenos Aires, Argentina
Universidade Estadual de Santa Cruz,
Brazil
University of Sao Paulo, Brazil
Universidad de Buenos Aires, Argentina
Universidade do Estado de Santa Catarina,
Brazil
Pontifícia Universidade Católica do Paraná,
Brazil
IEB-UFSC, Brazil
Universidad Industrial de Santander,
Colombia
Universidad Nacional de San Juan,
Argentina
Universidad Autónoma
Metropolitana-Iztapalapa, Mexico
Centro de investigacion Cientifica y
Educacion Superior de Ensenada,
Mexico
Universidad Nacional de San Juan,
Argentina
Universidad de Guadalajara, Mexico
xviii Organization

Renan Moioli Instituto Santos Dumont, Brazil

Renato García IEB-UFSC, Brazil
Renato Zaniboni IEB-UFSC Brasil, Brazil
Ricardo Salido Ruiz Universidad de Guadalajara, Mexico
Ricardo Silva Penn State University, USA
Ricardo Taborda Universidad Nacional de Cordoba,
Argentina
Roberto Carrillo Universidad de Sonora, Mexico
Rocío Ortiz Pedroza UAM Iztapalapa, Mexico
Roger Clotet Universidad Simón Bolíver, Venezuela
Rosa María Weisz Universidad Nacional de Entre Rios,
Argentina
Rossana Rivas Tarazona Pontificia Universidad Catolica del Peru,
Peru
Ruben Acevedo Universidad Nacional de Entre Ríos,
Argentina
Rubiel Vargas Cañas Universidad del Cauca, Colombia
Said David Pertuz Arroyo Universidad Industrial de Santander,
Colombia
Selma Terezinha Milagre Universidade Federal de Uberlândia, Brazil
Sergio Muhlen Universidade Estadual de Campinas, Brazil
Sérgio Ricardo de Jesus Oliveira Universidade Federal de Uberlândia, Brazil
Teodiano Freire Bastos Filho Universidade Federal do Espírito Santo,
Brazil
Valdeci Dionisio Universidade Federal de Uberlândia, Brazil
Veronica Medina Universidad Autónoma
Metropolitana-Iztapalapa, Mexico
Victor Eduardo Martínez Abaunza Universidade Federal do Rio Grande
do Sul, Brazil
Victor Hugo Casco Universidad Nacional Entre Rios,
Argentina
Virginia Ballarin Universidad Nacional de Mar del Plata,
Argentina
Wisley Falco Sales Universidade Federal de Uberlândia, Brazil
Yolanda Torres Pérez Universidad San Thomas, Colombia
Organization xix

Sponsoring Institutions
Regional Council of Biomedical Engineering for Latin America (CORAL)
Mexican Biomedical Engineering Society (SOMIB)
National Council for Science and Technology (CONACYT), Mexico
Contents

Processing of Biomedical Signals

EEG-PML: A Software for Processing and Machine Learning
Analysis of EEG Signals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Lluvia Gwendolyn Alvarado-Robles, Carlos Miguel Munguia-Nava,
Israel Román-Godínez, Ricardo Antonio Salido-Ruiz,
and Sulema Torres-Ramos
Performance Evaluation of Average Methods
in the Time Domain Using Quality Measures
for Automatic Detection of Evoked Potentials . . . . . . . . . . . . . . . . . . . . 12
Idileisy Torres-Rodríguez, Carlos Ariel Ferrer-Riesgo,
Martha Madyuri Pérez de Morales Artiles, and Alberto Taboada-Crispi
Analysis of the Maternal Cardio-Electrohysterographic Coupling
During Labor by Bivariate Phase-Rectified Signal Averaging . . . . . . . . 21
Cinthia Gabriela Esquivel-Arizmendi, Claudia Ivette Ledesma-Ramírez,
Adriana Cristina Pliego-Carillo, Juan Carlos Echeverría,
Miguel Ángel Peña-Castillo, Gustavo Pacheco-López,
and José Javier Reyes-Lagos
Capture of the Voluntary Motor Intention
from the Electromyography Signal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Leandro Alexis Hidalgo Torres, Yanexy San Martín Reyes,
and Juan David Chailloux Peguero
Early Prediction of Weight at Birth Using Support
Vector Regression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Oliver Campos Trujillo, Jorge Perez-Gonzalez,
and Verónica Medina-Bañuelos

xxi
xxii Contents

Algorithm to Quantify Maximum Isometric Voluntary Contraction

in Subjects with Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Angel Gallegos Ledezma, Ivett Quiñones Uriostegui,
Virginia Bueyes-Roiz, and Rafael Zepeda Mora
Prediction of Breast Cancer Diagnosis by Blood Biomarkers Using
Artificial Neural Networks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Balam Benítez-Mata, Carlos Castro, Rubén Castañeda, Eunice Vargas,
and Dora-Luz Flores
Measuring Periodicity Perturbations in Pathological Voice:
General-Purpose Software vs. Custom-Tailored Methods . . . . . . . . . . . . 56
Reinier Rodríguez-Guillén and Carlos A. Ferrer-Riesgo
Estimation of Heart Rate and Respiratory Rate via Blind Estimation
from Smartphone-Based Contact Image Photoplethysmography . . . . . . 63
Rodrigo García-López, Javier Benítez-Benítez,
Daniel Ulises Campos-Delgado, and Bersaín A. Reyes
Characterization of Forearm Electromyographic Signals
for Automatic Classification of Wrist Movements . . . . . . . . . . . . . . . . . 71
Milagros G. Salazar-Medrano, Bersaín A. Reyes, Marco Mendoza,
and Isela Bonilla
Correlation of EEG Brain Waves in a Time Perception Task . . . . . . . . 79
Sergio Rivera-Tello, Rebeca Romo-Vázquez, and Julieta Ramos-Loyo
Estimation of Beta Burst Durations from Subthalamic Nucleus
Local Field Potentials in Parkinson’s Disease Through Hilbert
and Continuous Wavelets Transforms . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Arnaldo Fim Neto, Julia Baldi De Luccas, Bruno Leonardo Bianquenti,
Tiago Paggi Almeida, Maria Sheila Rocha, Takashi Yoneyama,
Fabio Luiz Franceschi Godinho, and Diogo Coutinho Soriano
A Comparative Study of Time and Frequency Features
for EEG Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Cesar Ortiz-Echeverri, Omar Paredes, J. Sebastian Salazar-Colores,
Juvenal Rodríguez-Reséndiz, and Rebeca Romo-Vázquez
Cortical Auditory Evoked Potentials Elicited by Spanish Words:
An Equivalent Current Dipoles Clustering Study . . . . . . . . . . . . . . . . . . 98
Norma Castañeda-Villa, Pilar Granados-Trejo,
and Juan Manuel Cornejo-Cruz
Contents xxiii

Classification of Heart Health by LPC and MFCC Coefficients

and Statistical Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Manuel A. Soto-Murillo, Karen E. Villagrana Bañuelos,
Julieta G. Rodriguez-Ruiz, Jared D. Salinas-González,
Carlos E. Galván-Tejada, Hamurabi Gamboa-Rosales,
and Jorge I. Galván-Tejada
Nonlinear, Time-Varying and Frequency-Selective Analysis During
the Orthostatic Challenge in Patients with Vasovagal Syncope . . . . . . . 113
Laura E. Méndez-Magdaleno, Guadalupe Dorantes-Méndez,
Sonia Charleston-Villalobos, and Tomás Aljama-Corrales
Feature Selection and Machine Learning Applied for Alzheimer’s
Disease Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Ana Gabriela Sánchez-Reyna, Carlos H. Espino-Salinas,
Pablo C. Rodríguez-Aguayo, Jared D. Salinas-Gonzalez,
Laura A. Zanella-Calzada, Elda Y. Martínez-Escobar,
José M. Celaya-Padilla, Jorge I. Galván-Tejada, Carlos E. Galván-Tejada,
and for the Alzheimer’s Disease Neuroimaging Initiative
Fuzzy Logic as a Control Strategy to Command a Deep Brain
Stimulator in Patients with Parkinson Disease . . . . . . . . . . . . . . . . . . . . 129
Gabriel Martín Bellino, Carlos Rodolfo Ramirez,
Alejandro Miguel Massafra, and Luciano Schiaffino
Cerebral Cortex Atlas of Emotional States Through
EEG Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Alejandro Gómez, O. Lucia Quintero, Natalia Lopez-Celani,
and Luisa Fernanda Villa
Estimation of the Very Low Frequency Components in Heart Rate
Variability During Hemodiafiltration . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Raul Martínez-Memije, Brayans Becerra-Luna, Raul Cartas-Rosado,
Oscar Infante-Vázquez, Claudia Lerma, Hector Pérez-Grovas,
and Jóse Manuel Rodríguez-Chagolla
NeuroMoTIC: An Smart Tool to Support Pediatric
Epilepsy Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Rubiel Vargas-Canas, Maria Eugenia Mino-Arango,
and Diego Mauricio Lopez-Gutierrez
Comparative Analysis of Alpha Power Spectral Density
in Real and Virtual Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Fabian O. Romero-Soto, David I. Ibarra-Zárate,
and Luz Maria Alonso-Valerdi
xxiv Contents

Analysis of Cardiorespiratory Variations During Sleep in Shift

Workers by Univariate and Multivariate Detrended
Fluctuation Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Raquel Delgado-Aranda, Guadalupe Dorantes-Méndez,
and Martín Oswaldo Méndez
Morphological and Temporal ECG Features for Myocardial
Infarction Detection Using Support Vector Machines . . . . . . . . . . . . . . . 172
Wilson J. Arenas, Silvia A. Sotelo, Martha L. Zequera, and Miguel Altuve
Window Functions Analysis in Filters for EEG Movement
Intention Signals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
C. Covantes-Osuna, O. Paredes, H. Vélez-Pérez, and R. Romo-Vázquez
Algorithm for Presumptive Diagnosis of Cardiac Murmurs over
Auscultated Heart Signals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Andrea García-Cedeño, Eduardo Pinos, and Mónica Huerta
Recurrence Analysis of EEG Power and HRV Time Series
for Asynchronous BCI Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Claudia Ivette Ledesma-Ramírez, Erik Bojorges-Valdez,
Oscar Yanez-Suarez, and Omar Piña-Ramírez
Joint Exploitation of Hemodynamic and Electrocardiographic Signals
by Hidden Markov Models for Heartbeat Detection . . . . . . . . . . . . . . . 208
Nelson F. Monroy and Miguel Altuve
Hand Movement Detection from Surface Electromyography Signals
by Machine Learning Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Jose Alejandro Amezquita-Garcia, Miguel Enrique Bravo-Zanoguera,
Felix Fernando González-Navarro, and Roberto Lopez-Avitia
Characterization of Intrinsic Mode Functions of the Electrical
Cochlear Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Norma Castañeda-Villa, Pilar Granados-Trejo,
and Juan Manuel Cornejo-Cruz
Remote Optical Estimation of Respiratory Rate Based on a Deep
Learning Human Pose Detector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Isaac René Aguilar Figueroa, Jesús Vladimir Martínez Nuño,
and Eduardo Gerardo Mendizabal-Ruiz
Respiratory Rate Estimation by a Non-invasive Optical Method Based
on Video Image Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
C. A. Hurtado-Otalora, J. D. Pulgarin-Giraldo, and A. M. Gonzalez-Vargas
Computer Vision-Based Estimation of Respiration Signals . . . . . . . . . . . 252
Maria Eugenia Paz Reyes, Jasiel Dorta_Palmero, Jessica Leon Diaz,
Efren Aragon, and Alberto Taboada-Crispi
Contents xxv

Processing of Biomedical Images

Computer-Aided Detection Systems for Digital Mammography . . . . . . . 265
Marlen Perez-Diaz, Ruben Orozco-Morales, Eduardo Suarez-Aday,
and Rosana Pirchio
Time Estimation of Topotecan Penetration in Retinoblastoma
Cells Through Image Sequence Analysis . . . . . . . . . . . . . . . . . . . . . . . . 272
Debora Chan, Ursula Winter, Paula Schaiquevich, Rodrigo Ramele,
and Juliana Gambini
A Comparative Study of Reinforcement Learning Algorithms Applied
to Medical Image Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Ramiro F. Isa-Jara, Gustavo J. Meschino, and Virginia L. Ballarin
Measurement of the Degradation Rate of Anodized AZ91 Magnesium
Temporary Implants Using Digital Image Processing Techniques . . . . . 290
Francisco Javier Buchelly, Martina Gomez, Silvia M. Cere,
Josefina Ballarre, Virginia L. Ballarin, and Juan I. Pastore
Development of Eclipse Scripting API for Automatic Delineation
of Femoral Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Bruno Assumpção Gomes da Silva, Rodrigo Souza Dias,
Antonio Cassio de Assis Pellizzon, Álvaro Luiz Fazenda,
and Fabiano Carlos Paixão
Comparative Evaluation of Anisotropic Filters Used to Reduce
Speckle in Ultrasound Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
Lucas Gonçalves Santos, Carlos Marcelo Gurjão de Godoy,
Leopoldo de Jesus Prates, and Regina Célia Coelho
A System for High-Speed Synchronized Acquisition of Video
Recording of Rodents During Locomotion . . . . . . . . . . . . . . . . . . . . . . . 309
Cesar Ascencio-Piña, Marco Pérez-Cisneros, Sergio Dueñaz-Jimenez,
and Gerardo Mendizabal-Ruiz
An Entropy-Based Graph Construction Method for Representing
and Clustering Biological Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Leandro Ariza-Jiménez, Nicolás Pinel, Luisa F. Villa,
and Olga Lucía Quintero
Automatic Lid Segmentation in Meibography Images . . . . . . . . . . . . . . 322
Luis DelaO-Arévalo, Erik Bojorges-Valdez,
Everardo Hernández-Quintela, Nallely Ramos-Betancourt,
and Jesus H. Davila-Alquisiras
xxvi Contents

Brain Tortuosity as Biomarker to Classify Mild Cognitive Impairment

and Control Subjects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Eduardo Barbará Morales, Karla C. Rojas Saavedra, Luis Jiménez Ángeles,
and Verónica Medina Bañuelos
Classification of Handwritten Drawings of People with Parkinson’s
Disease by Using Histograms of Oriented Gradients and the Random
Forest Classifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
João Paulo Folador, Adrian Rosebrock, Adriano Alves Pereira,
Marcus Fraga Vieira, and Adriano de Oliveira Andrade
Improving Myoelectric Pattern Recognition Robustness to Electrode
Shift Using Image Processing Techniques and HD-EMG . . . . . . . . . . . . 344
Roberto Díaz-Amador, Miguel Arturo Mendoza-Reyes,
and Carlos A. Ferrer-Riesgo
Classification of Plasmodium-Infected Erythrocytes Through Digital
Image Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Juan Valentín Lorenzo-Ginori, Lyanett Chinea-Valdés,
Yanela Izquierdo-Torres, Rubén Orozco-Morales,
Niurka Mollineda-Diogo, Sergio Sifontes-Rodríguez,
and Alfredo Meneses-Marcel
Noise Reduction in Phase-Contrast Mammography Images
with Synchrotron Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Yusely Ruiz-Gonzalez, Javier D. Brizuela-Cardoso,
and Marlen Pérez-Díaz
Interface for Contour Extraction and Determination
of Morphologic Parameters in Digital Images of Footprints
Based on Hernandez-Corvo Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
H. A. Miranda C., Luz Alejandra Flores Cu, Santiago Camacho López,
Horacio Rostro González, and Miroslava Cano Lara
Cervix Type Classification Using Convolutional Neural Networks . . . . . 377
Daniel A. Cruz, Carmen Villar-Patiño, Elizabeth Guevara,
and Marisol Martinez-Alanis
Comparative Analysis of Different Techniques to Determine Motility
Parameters in Video Sequences of Ram and Buck Sperm . . . . . . . . . . . 385
Francisco Javier Buchelly, Ramiro Fernando Isa Jara, Lucía Zalazar,
Andreina Cesari, Juan I. Pastore, and Virginia L. Ballarin
3D Kidney Reconstruction from 2D Ultrasound Images . . . . . . . . . . . . . 393
Mariana Teresa Alvarez-Gutiérrez, Aldo Rodrigo Mejía-Rodríguez,
Ines Alejandro Cruz-Guerrero, and Edgar Román Arce-Santana
Contents xxvii

Mask R-CNN to Classify Chemical Compounds

in Nanostructured Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
Carlos Cabrera, David Cervantes, Franklin Muñoz, Gustavo Hirata,
Patricia Juárez, and Dora-Luz Flores
Follow-up of Cutaneous Leishmaniasis by Three-Dimensional
Reconstruction Based on Photogrammetry: Proof of Concept . . . . . . . . 412
Caren Garzón-Márquez, Manuela Gómez-Ramírez, Javier D. Murillo,
Sara Robledo, A. Hernandez, Benjamín Castañeda,
and Sandra Pérez-Buitrago
Image-Based Analysis of Human Tissue Regeneration During
Therapy Based on Photobiostimulation and Natural Latex
Biomembranes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Mayla dos Santos Silva, Lorena de Sousa Moreira,
Franciéle de Matos da Silva, Wellington Rodrigues,
Breno Amadeus Sales Marinho de Sousa, Luiz José Lucas Barbosa,
Cristiano Jacques Miosso, and Suélia de Siqueira Rodrigues Fleury Rosa
Semantic Segmentation of Lung Tissues in HRCT Images
by Means of a U-Net Convolutional Network . . . . . . . . . . . . . . . . . . . . . 426
Sarahí Hernández-Juárez, Aldo R. Mejía-Rodríguez,
Edgar R. Arce-Santana, S. Charleston-Villalobos, A. T. Aljama-Corrales,
R. González-Camarena, and M. Mejía-Ávila
Fast Optic Disc Localization Using Viola-Jones Algorithm . . . . . . . . . . . 435
Yainet García García, Reinier Rodríguez Guillén, Y. García,
and Alberto Taboada-Crispi

Biosensors
Recording and Analysis of the Vestibulo-Ocular Reflex with Pendular
Movement in the Vertical Plane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Geovanny Palomino Roldán and Ernesto Suaste Gómez
Fabrication of PPy/PVC Electrodes for ECG Monitoring . . . . . . . . . . . 449
Ernesto Suaste-Gómez, Ilian Pérez-Solís, and Grissel Rodríguez-Roldán
Implementation of the NEURONIC INFANTIX Newborn Hearing
Screening System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
José Carlos Santos-Ceballos, Jorge German Pérez-Blanco,
Yosvani Pantoja-Gómez, Francisco Martín-González,
Alejandro Torres-Fortuny, Eduardo Eimil-Suarez,
and Ernesto Velarde-Reyes
Prototype Sensor with Optical Principle for Measuring Strength
of the Fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460
Jessica Ferreira, Catherine Moreno, A. Ramírez, and Ricardo Espinosa
xxviii Contents

A Rapid and Low-Cost Lung Function Testing Method

Based on an Optical Flow Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Markus Höglinger, Bianca Wiesmayr, Werner Baumgartner,
and Anna T. Stadler
A New Approach to Cardiovascular Screening in Newborn . . . . . . . . . . 478
Rene Gonzalez-Fernandez, Luis Reyes-Morales,
Alejandro Torres-Fortuny, and Hany Pazos-Espinosa
Graphene Nanosensor for NO Metabolites Detection . . . . . . . . . . . . . . . 486
Andrés Fuentes-Aranda, Carlos Maya-Escamilla,
Columba Rentería-Montoya, Mercedes Teresita Oropeza-Guzmán,
Oscar Vázquez-Mena, and Viviana Sarmiento

Bioinstrumentation and Micro-Nanotechnologies

Heart Rate Monitor for Athletes in Activity . . . . . . . . . . . . . . . . . . . . . . 497
Gisella Borja, Evert De Los Ríos, José Ledesma, and Glayder Viloria
Instrumented Footwear for Diabetic Foot Monitoring:
Foot Sole Temperature Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Sofía D. Rodríguez-Sáenz, Sarahí S. Franco-Pérez,
Aurora Espinoza-Valdez, Ricardo A. Salido-Ruiz,
and Fátima B. Curiel-López
Analysis of the Thermal Distribution Generated by a Thermal Patch
to Evaluate Its Feasibility to Treat Patient’s Pain Relief . . . . . . . . . . . . 508
Luis A. Castellanos-Rivera, Edgar A. Mandujano-García,
Antonio Ruiz-Morán, Melany Barrón-Salazar, Benjamín A. Morales-Ruiz,
and Citlalli J. Trujillo-Romero
Prototype of a Multivariable Measurement System . . . . . . . . . . . . . . . . 519
Israel Sánchez-Domínguez, Paul Erick Méndez Monroy,
and Ernesto Pérez-Rueda
Development and Pilot Testing of a New Electromyography Device . . . . 524
Douglas Crochi, Tiago R. S. Silva, André Silva, Marcello F. Santos,
Natasha H. Ota, Paulo Daudt, Silvia C. Martini, Silvia R. M. S. Boschi,
Terigi A. Scardovelli, and Alessandro P. Silva
Initial Approaches for Manipulation of Human Lens for Irradiation
in a Solar Simulator: A Study for Cataract . . . . . . . . . . . . . . . . . . . . . . 530
Fernanda Oliveira Duarte, Andre Fragalli, Mauro Masili,
Sidney Julio de Faria e Sousa, and Liliane Ventura
Wearable Spine Postural Monitoring Embedded System
for Occupational Health in Sitting Position . . . . . . . . . . . . . . . . . . . . . . 538
Edisson Pugo-Méndez, Juan Cabrera-Zeas, Luis Serpa-Andrade,
Eduardo Pinos-Vélez, and Freddy Bueno-Palomeque
Contents xxix

Non-invasive Ultrasonic Stimulator Applied in the Treatment

of Urinary Incontinence in Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543
Aurelio H. Heredia J., Karim Tapia Q., María del R. L. Cabrera L.,
Germán Barrientos C., Roberto C. Ambrosio L., and Mario Moreno M.
SpO2 Alarm: A Tool for Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . 548
Nancy Lisset Domínguez-Hernández, Lady María Murrieta-Brígido,
and Pablo Samuel Luna-Lozano
Development of a Device Based on Oscillometry
and Photoplethysmography for Measuring Blood Pressure . . . . . . . . . . 560
Haydeé Alicia Yáñez-Ocampo, Brayans Becerra-Luna,
Raúl Cartas-Rosado, Raúl Martínez-Memije, and Oscar Infante-Vázquez
Treatment of Abdominal Hypertension:
Development of an Original Non-invasive Device ABDOPRE . . . . . . . . 567
Alicia Schandy, Francisco Pracca, and Franco Simini
Portable Wireless Monitoring Center Designed in LabVIEW
and myRIO 1900 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
Héctor García-Estrada, Karen Jazmín Mendoza-Bautista,
María Guadalupe Ramírez-Sotelo, and Agustín Ignacio Cabrera-Llanos
Design of a Suitable NIR System for Monitoring Hemodynamic
Changes in the Brain Prefrontal Cortex . . . . . . . . . . . . . . . . . . . . . . . . . 582
Miguel Angel Santiago Gorostieta-Esperon and Luis Jiménez-Ángeles
A Prototype for Automatically Blood Pressure Measurement
with Wireless Communication to a Graphical User Interface
in MATLAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 588
Alicia Sofía Virueña-Vázquez, Haydeé Alicia Yáñez-Ocampo,
Sebastián Aguiñaga-González, Juan Pablo Matadamaz-Castro,
María del Carmen Arquer-Ruiz, María Guadalupe Flores-Sánchez,
and José Israel Hernández-Oropeza
Development of Auricular Transcutaneous Vagal Stimulation
Device Integrated with Signal Monitoring . . . . . . . . . . . . . . . . . . . . . . . 593
Eugênia Gonzales Lopes, Eleonora Tobaldini, Nicola Montano,
Karina Rabello Casali, and Henrique Alves de Amorim
Development of a Bimodal Electronic Resuscitator Prototype
for Adult Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601
Andrea Paola Pineda-Espinosa, Ana Paulina Barba-Muñoz,
Rodrigo Antonio Sánchez-Mateos, María del Carmen Arquer-Ruiz,
and José Israel Hernández-Oropeza
xxx Contents

System to Continuous Differential Acquisition of Arterial Blood

Pressure During Tilt Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 606
Carmenchu Regueiro-Busoch, Carmen Busoch-Morlán,
René Joaquín Díaz-Martínez, and Angel Regueiro-Gómez
Assessment of AMR-ACB System Using Maghemite Nanoparticles
in Theranostic Concentration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611
Leopoldo de Jesus Prates, Fabiano Carlos Paixão, Marli Leite de Moraes,
Regina Célia Coelho, Robson Rosa da Silva,
and Carlos Marcelo Gurjão de Godoy
Fabrication and Study of Organic Nanomaterials as Photosensitizers
for Photodynamic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616
Nelly Monjaraz-Carrillo, Alejandro Valdez-Calderón,
Yunuén D. Solorio-Cendejas, Gabriel Ramos-Ortiz, and Mario Rodríguez

Biomaterials, Molecular, Cellular and Tissue Engineering

Evaluation of Titanium-Niobium Alloy as a Possible Material
to Manufacture Endodontic Files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 627
Javier Nino-Barrera, Oscar Rodriguez-Montano,
and Carlos Cortes-Rodriguez
Formation of Tumor Spheroids by Spontaneous Cellular Aggregation
in Incubation: Effect of Agarose as a Compaction Agent . . . . . . . . . . . . 637
Christian Chapa-González, Marcos Bryan Valenzuela-Reyes,
Lizbeth Lucero Alemán-Miranda, Laura Elizabeth Valencia-Gómez,
Adeodato Israel Botello-Arredondo, and Esmeralda Saraí Zúñiga-Aguilar
Synthesis and Characterization of Hydrogels Cross-Linked
with Gamma Radiation for Use as Wound Dressings . . . . . . . . . . . . . . . 643
Paola Bustamante, Carolina Anessi, Natalia Santoro, Nazarena Ciavaro,
and Celina Horak
Morphology and Viability of Nerve Cells Cultured on Plasma
Polymerized Polypyrrole-Coated Scaffolds . . . . . . . . . . . . . . . . . . . . . . . 652
Diana Osorio-Londoño, J. Rafael Godínez-Fernández,
Ma. Cristina Acosta-García, Juan Morales-Corona,
and Roberto Olayo-González
Analysis and Quantification of Bone Tissue Around Anodized
Zirconium Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 656
Guillermo Abras, Maria Rosa Katunar, Josefina Ballarre,
Virginia L. Ballarin, and Juan Ignacio Pastore
Contents xxxi

In Situ Mechanical Characterization of Skin:

Participation in the Program Nodos Binacionales de Salud . . . . . . . . . . 663
Michelín Alvarez-Camacho, Ana Laura Pérez-Medina,
Paris Joaquín Velasco-Acosta, Andreas Schoetz,
and Citlalli Jessica Trujillo-Romero
Residual SDS Reducing Methods in the Process of Decellularization
of Muscle Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 670
Christian Chapa-González, Miguel Ángel Alfaro-Zapata, Joseph Kinsella,
Adeodato Israel Botello-Arredondo, and Esmeralda Saraí Zúñiga-Aguilar

Modeling and Simulation

Animation of Atrial and Ventricular External Walls of a Virtual 3D
Heart Based on Echocardiogram Images . . . . . . . . . . . . . . . . . . . . . . . . 681
Gabriela Colares Ali Ganem, Regina Célia Coelho,
and Carlos Marcelo Gurjão de Godoy
Mathematical Model of the Oculomotor System . . . . . . . . . . . . . . . . . . . 685
Jesica Talero, Karen Leiva, and Ricardo Espinosa
Route to Chaos in a Nonlinear Model of HIV Dynamics
with Antiretroviral Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 694
Lorena de Sousa Moreira, Rodrigo Andres Miranda Cerda,
and Ronni Geraldo Gomes de Amorim
Automatic Control Applied to Servosystems. Influence
of the State Transition Matrix in Functional Variables
of DC Motors Used in Myoelectric Prostheses . . . . . . . . . . . . . . . . . . . . 699
Carlos Alvarez Picaza, C. R. Ferrari, J. I. Veglia, and M. A. Ulibarrie
SCHSim: A Simulator of Elastic Arterial Vessels Using
Windkessel Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 709
Andrew Guimarães Silva, Daniel G. Goroso, and Robson Rodrigues Silva
Effects of Astaxanthin on Pulse Rate Variability of Mice Under
Chronic Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 718
Daniel Escutia-Reyes, Rigoberto Oros-Pantoja, José Javier Reyes-Lagos,
Adriana Cristina Pliego-Carrillo, Claudia Ivette Ledesma-Ramírez,
Daniela Rodríguez-Muñoz, and Eugenio Torres-García
Criticism of Baroreflex Estimation Methods in Time Domain . . . . . . . . 724
Juan Carlos Perfetto and Aurora Graciela Ruiz
Another random document with
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been no paralysis, and the hemorrhages were probably not the
immediate cause of death.

Durand-Fardel gives a table of supposed causes in 21 cases of

persons over fifty: 8 of these were connected with either habitual use
of liquor or a debauch; 9 had an attack immediately after a meal.

After naming all these causes, it must be said that in many cases it is
impossible to find any reason for the occurrence of the hemorrhage
at the particular moment it comes. A person may go to bed in
apparent health, and be found some hours afterward unconscious
and comatose, or unable to stir hand or foot on one side, or to
speak. Gendrin, as quoted by Aitken, states that of 176 cases, 97
were attacked during sleep. The attack may come on when the
patient is making no special muscular effort and under no special
excitement. It is simply the gradual progress of the lesion, which has
reached its limit.

SYMPTOMATOLOGY.—If we take as a point of departure the fully-

developed attack, such as most frequently is found with a large and
rapid hemorrhage into the cerebral hemispheres, pons, or
cerebellum, the symptoms are those usually spoken of as an
apoplectic attack, shock, or stroke, or, as the Germans say,
Hemorrhagische Insult. Trousseau quotes as a satisfactory definition
the words of Boerhaave: “Apoplexia dicitur adesse, quando repente
actio quinque sensuum externorum, tum internorum, omnesque
motus voluntarii abolentur, superstite pulsu plerumque forti, et
respiratione difficili, magna, stertente, una cum imagine profundi
perpetuique somni.”

Loss of consciousness, abolition of voluntary motion and sensation,

and usually stertor, the appearance of the patient being that of one in
deep sleep, are found in the extreme cases. In others the loss of
consciousness and sensation are not complete; the patient can be
aroused enough to utter a grunt or raise a hand to his face in order
to brush away a fly or the hand of the physician who is trying to raise
his eyelids, or can make a grimace to show that he is hurt, the face
returning to its indifferent expression as soon as the cause of
irritation is removed. Although the grade of action, both sensitive and
motor, seems to be a little above the purely reflex, it is but very
slightly so, and probably is not sufficient to remain an instant in the
memory.

The rapidity with which this condition comes on varies widely, from a
very few minutes, or even seconds, to some hours. It may even
diminish for a time and return. The cases in which unconsciousness
is most rapidly produced are apt to be meningeal and ventricular,
and presumably depend upon the rupture of vessels of considerable
size, although the location among the deeper ganglia, where the
conductors of a large number of nervous impulses are gathered into
a small space, will, of course, make the presence of a smaller clot
more widely felt. Even in these, however, the onset is not absolutely
instantaneous, and the very sudden attack is rather among the
exceptions. Trousseau denies having seen, during fifteen years of
hospital and consulting practice, a single case in which a patient was
suddenly attacked as if knocked down with a hammer, and that since
he had been giving lectures at the Hotel Dieu he had seen but two
men and one woman in whom cerebral hemorrhage presented itself
from the beginning with apoplectiform phenomena. In each of these
the hemorrhage had taken place largely into the ventricles.

Lidell gives the following case: A colored woman, aged forty-nine,

was engaged in rinsing clothes, and while in a stooping posture
suddenly fell down upon her left side as if she had been struck down
by a powerful blow. She was picked up insensible, and died in ten or
fifteen minutes. The hemorrhage was chiefly meningeal, and
especially abundant about her pons and medulla oblongata. The
fourth ventricle was full of blood, and there were clots in the lateral
ventricles.

A woman, aged about forty, had been hanging out clothes in an

August sun. She was observed to run out of the house screaming,
and fell to the ground unconscious. This was at 1 P.M., and she died
at 3.30 P.M. Her temperature just after death was 107.2°. The
neighborhood of the posterior surface of the pons Varolii was
occupied by a broken-down-looking mass, appearing like an
aggregation of small apoplexies (hemorrhages), involving and
breaking down the middle crura of the cerebellum. There was no
fatty degeneration nor any miliary aneurism. (I do not know upon
how thorough an examination this last statement rests.)

In a large number of cases it is difficult to say, in the absence of any

observation, intelligent or otherwise, exactly how rapid the onset of
the symptoms may have been, but in those which occur where the
patient is watched or is in the company of observant persons it is
almost invariable to meet with symptoms less than unconsciousness
which denote the actual beginning of the hemorrhage. From the
nature of the lesion it can rarely give rise to symptoms which justify
the epithet of fulminating in the sense of struck with a thunderbolt.
The unconsciousness, so far as can be known, does not depend on
the injury of any one special small point of the brain in which
consciousness resides, but upon the compression of a considerable
portion, which must necessarily take place gradually, but with a
rapidity proportioned to the size of the current which issues from the
ruptured vessel and the ease with which pressure can diffuse itself
over a large area. It is undoubtedly the greater facility offered to such
diffusion by the communication of the hemorrhage with the so-called
cavity of the arachnoid and the ventricles which gives to these forms
a peculiar severity. The difference between a hemorrhage spreading
through all the ventricles or over a large surface of the brain, and
one which is limited to a focus in the substance of one hemisphere,
being restrained by more or less firm tissue, may be illustrated by the
gain in power in the hydraulic press from the transfer of the stream of
water from a small cylinder to a larger one.

Vomiting is a symptom of some importance in diagnosis, being not

very common in cerebral hemorrhage, but very frequent in
cerebellar.

Whether of sudden, rapid, or slow development, the apoplectic

attack is, in its main features, described in the aphorism of
Boerhaave given above. The muscular relaxation of the face imparts
to it an expressionless, mask-like character; the limbs lie motionless
by the side, unless they can be excited to some slight movement by
some painful irritation or are agitated by convulsions, or in a
condition of rigid spasm; the face may be pale or flushed; the cheeks
flap nervelessly—le malade fume la pipe.

Swallowing, in the deepest coma, is not attempted. The fluid poured

into the mouth remains, and distributes itself according to the laws of
gravity without exciting reflex movements of the pharynx. When the
depression is less profound, it may excite coughing or be swallowed.
An attempt to swallow when the spoon touches the lips indicates a
considerably higher degree of nervous activity. Respiration may be
slow, but when the case is to terminate fatally rises with the pulse
and temperature. It is often stertorous and difficult, the obstruction
consisting partly in the gravitation backward of the soft palate and
tongue, and partly in the accumulation of fluids in the pharynx.
Hence stertor is in some cases only an accidental phenomenon,
depending upon the position of the patient on the back, and can be
relieved by turning him on his side and wiping out the mouth as far
back as can be reached. Cheyne-Stokes respiration occurs in severe
cases, though not confined to necessarily fatal ones.

The general temperature in cerebral hemorrhage has been studied

enough to make it of considerable value, especially in prognosis. In a
case which extends over a sufficiently long time several stages can
be distinguished which in shorter ones may be wanting. An initial
period of depression is described by Bourneville17 as occurring
immediately after an attack, in which the temperature falls a degree
or two below the normal, and, according to his view, continues
depressed if death takes place rapidly. He gives the case of a man
who died very shortly after an attack (his second one), where the
temperature, taken in the rectum at the moment of death, was 35.8°.
In cases which survive longer this initial fall passes either into a
stage where it oscillates within the neighborhood of the normal or
immediately begins to rise; the latter occurrence indicates an
impending fatal termination (unless, of course, something else can
be found to account for it). In the former condition we find patients
whose life may be indefinitely prolonged for days or weeks, when, if
a fatal termination is to result, the thermometer again indicates a
rise.
17 Études cliniques et thermométriques sur les Maladies du Système nerveux, 1872.

The initial fall of temperature is not so likely to be observed except in

institutions like the Salpêtrière, where large numbers of old persons
are collected and under close medical surveillance; and, indeed, it
may be doubted, even from Bourneville's own table, whether the rule
is one without exceptions. At any rate, the rise is a more important
phenomenon than the fall. When the rise of temperature is
interrupted by a fall, and then continues again, it is due, according to
the author already quoted, to a renewal of the hemorrhage.

These changes of temperature may be noted with various locations

of the lesion, but it seems probable that further study might make
them useful in diagnosis as well as prognosis. Hale White reports the
case of a boy aged six and a half years, who was found unconscious
with right hemiplegia, and who afterward had many and various
paralyses with hyperpyrexia, the highest temperature being 107°. He
lived long enough for secondary degeneration to extend down the
crura and into the anterior cornua. A small soft patch a quarter of an
inch in diameter existed at the anterior part of each corpus
striatum.18
18 Guy's Hosp. Rep., 1882.
 FIG. 37.

The chart W. H. (Fig. 37) is from a man aged fifty who fell in the
street while returning from work at noon, and whose axillary
temperature was taken at 5 P.M. and every two hours thereafter until
death. The hemiplegia was not very marked, but the hemorrhage
was extensive, involving the pons and left crus cerebri, the external
capsule, left crus cerebelli, and medulla, bursting through into the
fourth ventricle.

FIG. 38.
The chart M. M. (Fig. 38), as taken from Bourneville, represents the
course of the temperature in a rapid case: each perpendicular line
denotes an hour.

The difference in the temperature of the two sides has been

variously stated, and probably depends on a number of factors
besides the length of time that has elapsed since the first attack.
There is probably, however, a tendency to excess of heat on the
paralyzed side soon after the attack, owing to vaso-motor paralysis;
and this difference will be more marked in the hands than in the
axillæ. After a length of time which may be from days to months the
temperature becomes equalized, or more frequently the relation is
reversed, the paralyzed side being colder as atrophy takes place.
Lepine19 gives a case where the axillary temperatures of the two
sides continued the same within a small fraction of a degree for three
days, and then separated very slowly, until at death the paralyzed
side was six-tenths of a degree (Cent.) hotter than the other, in both
being inferior to the rectal (107° Cent.).20
19 Mémoires de Société de Biol., 1867.

20 The chart in the original, and as reproduced by Bourneville, is wrongly lettered. The
text says that the left side was the hotter.

FIG. 39.

The chart C. M. (Fig. 39) shows the excess of temperature in a case

of meningeal hemorrhage. The dotted line is from the paralyzed side.
The first observation was made two and a half hours after the attack.
A very interesting case is reported by Johnson21 of crossed
hemiplegia, where the temperature was about a degree higher on
the paralyzed side of the body, and, corresponding to this, the
sphygmograph showed a great diminution of tension; the lesion is
supposed to have been a hemorrhage in the pons. Johnson, in
commenting on the statement of Lorain that in all cases of
hemiplegia the pulse is more full on the paralyzed side, says that it is
incorrect for ordinary cases of hemorrhage into the corpus striatum,
though true in his own case.
21 Brit. Med. Journ., Jan. 6, 1877.

The most marked differences of temperature have been observed

where the lesion has been in the neighborhood of the pons, crus
cerebri, or medulla oblongata. In a case reported by Allbutt there
was a difference of 1.6°; the radial pulse was softer and fuller on the
paralyzed side, and the cheek upon that side was flushed.22 The
pulmonary hemorrhages which have been noticed by Brown-
Séquard and others in animals after cerebral lesions, and the
extravasation, congestion, subpleural ecchymoses noted by Ollivier23
in cerebral apoplexy, are probably to be referred to vaso-motor
disturbances.
22 Med. Times and Gaz., Dec. 4, 1869.

23 Archives générales, 1873, 167.

Much more attention has been paid to the pulse than to the
temperature, but it is less easy to lay down definite rules in regard to
it. It may vary in either direction. When the case is approaching a
fatal termination the pulse is apt to accompany the temperature in a
general way in its rise, though not necessarily following exactly, as is
seen in the chart in Fig. 38.

The throbbing or bounding of the arteries often described may

indicate increased activity of heart, but means at the same time
vaso-motor relaxation. The urine and feces are often passed
involuntarily.
In some rare cases symptoms closely resembling those produced in
animals by section of the sympathetic have been seen. These are
false ptosis, narrowing of the palpebral opening and sinking of the
globe of the eye into the orbit, diminution in the size of the pupil,
higher temperature on the paralyzed side of the face and the
corresponding ear, abnormal secretion of the eye, nose, and mouth
on the same side.24 They are supposed to indicate a paralysis of the
sympathetic.
24 Nothnagel, quoted by Grasset.

The condition of general relaxation may be so profound as to cover

up everything else, but in many cases true paralytic symptoms may
be discovered or provoked, which even at an early period give us
information as to the locality and nature of the lesion.

A greater degree of muscular relaxation may be manifest on one

side of the face than the other; the forehead may be a little smoother
on one side, the corner of the mouth drooping, the downward line
from the ala of the nose flattened, and the cheek flapping. There
may be a little greater resistance to passive motion of the limbs on
one side; one hand on being raised may drop helplessly back to the
bed, while the other is laid slowly down; the right hand when pinched
lies motionless and without power to escape the pain until the left
comes to its assistance. Irregularity of the pupils, if present, is an
important sign, but its absence signifies nothing.

One of the most significant signs is the conjugate deviation of the

eyes, both eyes and the head being turned strongly to one side or
the other. When the lesion is above the pons and is irritative, as in
the early stage of hemorrhage, the deviation is toward the side of the
body affected and away from the lesion; when paralysis is
established, away from the paralysis and toward the lesion. Below
the pons the rule is reversed. The spastic stage of conjugate
deviation may coincide with stiffness (early rigidity) of the paralyzed
limbs. This deviation must not be mistaken for an accidental position
of the head. The patient should be addressed from the side away
from which he is looking. Sometimes the eyes can be brought to the
median line, and not beyond. An attempt to turn the head forcibly
beyond the median line occasionally causes pain. The value of this
symptom in diagnosis has been denied, but a part at least of the
apparent contradictions have arisen from the neglect to notice
whether it were of a paralytic or spastic character.

As the condition of unconsciousness gradually passes off, the face

regaining, at least in part, its natural and more intelligent expression,
the eyes trying to follow the movements of surrounding persons, an
attempt being made, perhaps only by an unintelligible sound or by a
nod, to answer questions, the tongue being protruded, or at least an
attempt toward it made, and some motions being made with the
limbs,—the exact extent and intensity of the paralysis become more
apparent. Conjugate deviation, if it have existed, may disappear
before the other symptoms, or, if it has been of the rigid form
depending on an irritative lesion, it may become paralytic, and is
then in the opposite direction. The patient is then usually found to be
in a condition of hemiplegia, and at this point the history of
hemorrhagic apoplexy becomes identical with that of paralysis from
hemorrhage where no truly apoplectic condition has been present.

Lidell states that in more than one-third of all cases of cerebral

hemorrhage hemiplegia is developed without loss of consciousness
or coma. In some, the paralysis precedes unconsciousness, which
then slowly supervenes.

Hemiplegia (ἥμι, half, πληγη blow) is a paralysis or paresis of a part

of the voluntary muscles of one side of the body, and a few, in some
cases, on the other, and is undoubtedly to be referred to a lesion
interrupting the nervous communication between the cortical centres
of motion and the nuclei of the motor nerves, cerebral and spinal; the
conductors passing through the corpora striata, the internal capsule,
the peduncles, and crossing in great part to the other side above or
at the lower border of the medulla oblongata, and passing down the
crossed pyramidal tracts of the cord, to be finally connected with the
anterior gray columns of the cord. The portion which does not
decussate passes down the inner border of the anterior columns
under the name of columns of Türck. The amount of decussation
which takes place varies somewhat, and the suggestion has been
made, in order to explain certain cases of paralysis occurring on the
same side with the lesion, that possibly in some rare cases there
may be no decussation. It has never been shown, however, that this
condition, highly exceptional if even it ever occurs, is present in such
cases.

It may be said in a general way, although exceptions to the rule can

be found, that it is those muscles trained to separate, specialized, or
non-associated movements which are chiefly affected, while those
which are habitually associated in function with those of the other
side are less or not at all so. It would not, however, be in the least
correct to say that specialized or educated movements of any set of
muscles are alone paralyzed, since the fingers, which are trained to
the most independent movements, are often just as incapable of
making the slightest movement of simple flexion as of writing or
sewing.

We have in ordinary hemiplegia more or less paralysis of the upper

facial, the patient not being able to close his eye or to wink quite so
well as on the paralyzed side. The forehead may be smoother on the
paralyzed side. This condition is usually slight and of short duration,
but varies in different cases. Paralysis of the lower facial angle of the
mouth and cheek is usually better marked, but not absolute. The
corner of the mouth droops, perhaps permits the saliva to escape;
the naso-labial fold is less deep, and the glabella deviated away from
the paralyzed side. The cheek flaps with respiration. The difference
between this facial paralysis connected with hemiplegia and that
dependent upon a lesion of the trunk or distribution of the nerve
(Bell's), as in caries of the temporal bone or the so-called rheumatic
paralysis, is very striking, the latter being so much more complete,
and, by affecting the orbicularis palpebrarum so as to prevent
closure of the eye, giving a very peculiar expression to the
countenance. This distinction between the two portions of the facial
seems to make an exception to the rule stated above, since in most
persons the movements of the corner of the mouth and of the cheek
are quite as closely bilaterally associated as those of the eyelids.

Paralyses of the third, fourth, and sixth pairs upon one side of the
body are comparatively rare in hemiplegia, and when present are
usually referable to localized lesions in the pons. They are to be
looked upon as something superadded to the ordinary hemiplegia.
These nerves, however, are affected in the peculiar way already
spoken of as conjugate deviation, which phenomenon would seem to
denote that muscles accomplishing combined movements in either
lateral direction of both eyes, rather than all the muscles of each, are
innervated from opposite sides—i.e. that the right rectus externus
and the left rectus internus are innervated from the left motor
centres, and vice versâ. Exactly the same remark will apply to the
muscles of the neck which cause the rotation of the head seen
together with the deviation of the eyes. The muscles controlling
deviation to one side, although situated upon both sides of the
median line, are apparently innervated from the side of the brain
toward which the head is turned in paralysis.

The tongue is usually protruded with its point toward the paralyzed
side; and this is simply for the reason that it is pushed out instead of
pulled, and the stronger muscle thrusts the tongue away from it. The
motor portion of the fifth is, according to Broadbent, affected to a
certain extent, the bite upon the paralyzed side being less strong.

The hand and the foot are the parts most frequently and most
completely affected, but one or the other may be partially or wholly
spared, though the latter is rare. The muscles of the limbs nearer the
trunk may be less affected, so that the patient may make shoulder or
pelvis movements when asked to move hand or foot. In severe
cases even the scapular movements may be paralyzed. The
muscles of the trunk are but slightly affected, though Broadbent
states that a difference in the abdominal muscles on the two sides
may be perceived as the patient rises from a chair. The respiratory
movements are alike on the two sides. A woman in the hospital
service of the writer had a quite complete left hemiplegia at about the
seventh month of pregnancy. There was some return of motion at
the time of her confinement. None of the attendants could perceive
any difference in the action of the abdominal muscles of the two
sides, although, of course, the usual bracing of the hand and foot
upon the left side was wanting. The pains were, however, generally
inefficient, and she was delivered by turning. Muscular weakness
often exists, and in some cases the non-paralyzed side shows a
diminution of power.

The sphincters of the bladder and rectum frequently, and in severe

cases almost invariably, lose their activity for a time. It is possible,
however, that in some cases of alleged inability to retain urine and
feces the defect is really mental, and akin to the dirty habits of the
demented. The involuntary muscles probably take no part in
hemiplegia, with the very important exception of the muscular coats
of the arteries, which apparently share to a certain extent, and
sometimes the iris.

Speech may be attempted, and the words be correct, so far as they

can be understood, though the patient is apt to confine his remarks
to the shortest possible answering of questions. It is, however, thick
and indistinct, since the muscles of the tongue and lips are but
imperfectly under the control of the will. This condition may be
connected with paralysis of either side, and is to be sharply
distinguished from aphasia or mental inability to select the proper
word or to determine the necessary movements for its pronunciation.
Aphasia is almost invariably connected with paralysis of the right
side, and will be minutely spoken of hereafter. There is, of course,
nothing to prevent the coexistence of the two conditions, but aphasia
cannot well be shown to exist until we have reason to suppose, first,
that the patient has ideas to express, and secondly, that the
paralysis of the muscles of the lips and tongue has more or less
completely disappeared. The patient may indistinctly mumble a word
which, however, can be understood to be appropriate to the occasion
(defective articulation, glosso-labial paralysis), or, on the other hand,
pronounce with distinctness an entire wrong word or a number of
sounds without meaning (aphasia).
Sensibility—that is, ordinary cutaneous sensation—and, so far as we
can judge, the special senses, are not greatly affected after the deep
coma has passed off, but exceptions to this rule will be noted later.

Having described this most typical but not most common form of
cerebral hemorrhage—that is, the form in which both lesion and
symptoms are most distinct and can be most clearly connected—we
have a point of departure for conditions less clearly marked and less
easily explained.

It is probable that cerebral hemorrhage is much less likely than

cerebral embolism to take place without any disturbance of
consciousness or abnormal sensations; but there can also be little
doubt that a certain amount of paralysis is often accompanied by no
other symptoms, and post-mortem appearances often show the
remains of small hemorrhages which have passed unnoticed or are
lightly estimated. It is highly probable that small hemorrhages may
give rise to symptoms which pass for only a little accidental vertigo
or a slight feeling of faintness, until a later and more serious attack
gives a more definite explanation.

On the other hand, we have a set of cases in which all the symptoms
of cerebral hemorrhage may be present without the lesion. Many of
these are of course due to embolism, which will be considered later;
but besides this condition, recognized as softening for many years,
we find described under the head of simple, congestive, serous, and
nervous apoplexy cases where sudden or rapid loss of
consciousness occurs with general muscular relaxation, which, when
fatal, show nothing beyond changes in the circulation—i.e. in the
amount of blood in the cerebral vessels or of serum in the meshes of
the pia or at the base of the brain.

Besides these, there are cases of temporary unconsciousness with

complete recovery—the coup de sang of the French, or rush of blood
to the head, which are attributed to congestion of the brain—a theory
difficult to prove or disprove, but not in itself unreasonable.
Trousseau, without denying the possibility, or even probability, of
such a condition, says that which has been called apoplectiform
cerebral congestion is in the greater number of cases an epileptic or
eclamptic accident, sometimes a syncope. Simple epileptic
vertigoes, vertigoes connected with a bad condition of the stomach
or diseases of the ear, are wrongly considered as congestions of the
brain. He speaks of various conditions, such as violent attacks of
whooping cough, the expulsive efforts of women in labor, the
congested faces of laborers under heavy burdens, to show that
cerebral congestion does not give rise to an apoplectiform attack;
and it is undoubtedly true that, as a rule, no long-continued attack is
the result; but it must be within the personal experience of almost
every one that decided cerebral disturbance is produced for a few
moments by such efforts, as, for instance, blowing a fire with the
head down. Besides this, a laborer under a heavy load is
presumably healthy and accustomed to his work, so that his arteries
may be supposed capable of maintaining a due balance between
arterial and venous blood in the brain; and, again, although the
ordinary efforts of women in labor do not cause unconsciousness,
puerperal convulsions, involving a longer period of violent muscular
action, may do so, and even give rise to hemiplegia.

Whatever name we may adopt for the temporary cases which

recover, there are others, and fatal ones, which are not explained by
any change in nomenclature. Epilepsy may, it is true, occur under
such circumstances that no convulsion is observed, but, on the other
hand, convulsions may accompany not only an attack of
unconsciousness, but actual cerebral hemorrhage.

Cases of sudden death with no discoverable lesion furnish abundant

opportunity and temptation for conjecture, and it is well known that
too much dependence must not be placed upon the post-mortem
appearances as to the amount of blood in the brain before death,
and probably just as little upon the amount of serum, except as
indicating a condition of atrophy.

Syncope, either from over-stimulation of the pneumogastric or from

simple failure of the heart, may be put forward to explain some cases
of sudden death, but seems to have no advantage as a universal
theory over the older one, which meets with so little favor. Lidell
gives no less than seventeen cases which he classifies as
congestive or serous apoplexy. They are not all equally conclusive,
and were almost all of alcoholics. In some of these there were
absolutely no appearances which could account for death. The two
most characteristic of congestive apoplexy were, first, a young
negress who experienced a violent fit of passion, became
unconscious, with stertorous breathing, and died, having had some
tonic spasms. The brain contained a large amount of blood in the
vessels, but no effusion. Second, a semi-intoxicated woman, aged
thirty, became very angry, fell insensible, and expired almost
immediately. The brain contained an excess of blood, with no
effusion. In both these cases the patients were subject to fits under
the influence of strong excitement, but in both the author took pains
to inquire into and negative the probability of epilepsy of the ordinary
kind; and a change of name does not go far toward clearing up the
pathology.

Lidell's case (XXII.) was that of a man accustomed to alcohol, thin

and pale, who had an apoplectic fit with coma and hemiplegia. He
regained consciousness on the second day, and the hemiplegia
disappeared in a fortnight. This rapid and complete recovery,
exceptional to be sure, cannot be regarded as proof of the absence
of hemorrhage or embolism. In fact, the latter is highly probable. It is
possible that the clot may have been partially dislodged, so as to
allow some blood to pass by it, or that an exceptionally favorable
anastomosis allowed a better collateral circulation than usual to be
established.

The following case occurred in the service of the writer: An elderly

negress, who had extensive anasarca and signs of enfeebled action
of the heart without any valvular lesion being detected, after washing
her face was heard to groan, and found speechless and unable to
swallow, with complete right hemiplegia. There was a slight
improvement in a few hours, but she died two days later. The
autopsy disclosed some hypertrophy and dilatation of the heart
without valvular lesion. A careful search failed to discover any
change in the brain or obstruction in its vessels, although there was
chronic endarteritis.

The relations between epilepsy, apoplexy, and syncope are

interesting and important, but are certainly far from clear. Little is
gained by shifting obscure cases from one category to the other. If
sudden deaths be synonymous with apoplexy, we shall certainly
have to admit that apoplexy does not always demand for its cause
cerebral changes sufficiently marked to be recognizable after death.
If, on the other hand, we refer them to heart disease, we shall have
to admit that a heart without valvular disease or extensive changes
in its muscular substance may cease to beat under influences as yet
not well understood.

Since the paralysis arising from hemorrhage resembles so closely in

its progress that dependent upon occlusion of the cerebral vessels, a
further description will be deferred until the latter lesion has been
described; but this remark does not apply to the premonitory and
initiative symptoms, which may be of great importance, and which
are not always the same with the two or three sets of lesions. There
are many of them, but, unfortunately, no one among them taken
alone can be considered of high significance, unless we except what
are sometimes called premonitory attacks, which are in all probability
frequently genuine hemorrhages of so slight extent that they produce
no unconsciousness, and but slight paralysis easily overlooked. A
little indistinctness of speech or a forgetfulness of words, a droop of
one angle of the mouth, or heaviness in the movement of a foot or
hand, lasting but a few moments, may be real but slight attacks,
which may be followed either by a much more severe one, by others
of the same kind, or by nothing at all for a long time. They are
sufficient to awaken apprehension, and to show in what direction
danger lies, but they give little information as to the time of any future
attack.

Retinal hemorrhage is admitted by all modern authors to be

connected with disease of the vascular system, and hence also with
renal inflammation and cerebral lesions. The writer is greatly
indebted to Hasket Derby for the following facts: Out of 21 patients
who had retinal hemorrhage, and of whose subsequent career he
had information, 9 had some sort of apoplectic or paralytic attack; 1
had had such an attack before she was examined; 3 died of heart
disease, 1 suddenly, the cause being variously assigned to heart
disease or apoplexy; and 6 were alive when heard from, one of
these, a man of forty-eight, being alive and well fourteen years after.

Bull25 describes four cases of his own where retinal hemorrhage was
followed by cerebral hemorrhage, demonstrated or supposed in
three, while in the fourth other symptoms rendered a similar
termination by no means improbable. He quotes others of a similar
character. The total number of cases which were kept under
observation for some years is, unfortunately, not given. In a case
under the observation of the writer a female patient, aged fifty-seven,
who had irregularity of the pulse with some cardiac hypertrophy, was
found to have a retinal hemorrhage two and a half years before an
attack of hemiplegia. The hemorrhage was not accompanied by the
white spots which often accompany retinitis albuminuria.
25 Am. Journ. Med. Sci., July, 1879.

In a case reported by Amidon26 retinal and cerebral hemorrhages

seem to have been nearly simultaneous a few hours before death.
There was diffuse neuro-retinitis and old hemorrhages besides the
recent one.
26 N. Y. Med. Rec., 1878, xiv. 13.

The highly interesting observation has been made by Lionville27 that

when miliary aneurisms are present in the brain, they may often be
found in the retina also. In one case where they were very numerous
in the cerebrum, cerebellum, pons, and meninges, aneurismal
dilatations were found also in the pericardium, mesentery, cervical
region, and carotids (the latter not being more minutely described).
There was very general atheroma and numerous points of arteritis.
The retinal aneurisms varied in size from those requiring a power of
ten or twenty diameters to be examined up to the size of a pin's head
or a millet-seed. He thinks they might have been recognized by the
ophthalmoscope.
27 Comptes Rendus de l'Acad. des Sci., 1870.

The hemorrhages accompanying idiopathic anæmia and other

diseases with a similar tendency are not to be taken into this
account. Hemorrhage accompanying optic neuritis is likely to be due
to some disease of the brain other than the one under consideration.

Mental disturbances of various kinds have been considered as

significant, and Forbes Winslow gives a great many instances of
different forms, but they are to be looked upon rather as indicating
chronic cerebral changes which may result in various conditions, of
which hemorrhage may be one, than as furnishing any definite
indication of what is to be expected. Loss of memory should be
regarded in this way. Some acute or temporary conditions of
depression may affect the nutrition of the brain in such a way, without
having anything to do with hemorrhage actual or anticipated.

Aberrations of the special senses are often observed, such as noises

in the ears more or less definite, the sight of colors (red), or being
unable to see more than a portion of an object. The fact to which
these testify is probably a localized disturbance of the circulation
which may not precede rupture of the vessels.

Distinct hallucinations of hearing, followed by those of smell and

succeeding irritability, sleeplessness, were observed by Savage28 in
a case which terminated soon after in apoplexy.
28 Journ. Ment. Sci., 1883, xxix. 90.

There are few symptoms which are more likely to excite alarm and
apprehension of a stroke of paralysis than vertigo or attacks of
dizziness, but it is too common under a great variety of
circumstances to have much value, and is, as a matter of fact, rarely
a distant precursor of intracranial hemorrhage, although it frequently
appears among the almost initiatory symptoms, especially when the