关键词： ACNS nomenclature   Cardiac arrest   EEG   Neurological prognosis   Prognostication  

摘要： Background: Electroencephalography (EEG) patterns are predictive of neurological prognosis in comatose survivors from cardiac arrest but intensive care clinicians are dependent of neurophysiologist reports to identify specific patterns. We hypothesized that the proportion of correct assessment of neurological prognosis would be higher from short statements confirming specific EEG patterns compared with descriptive plain text reports. Methods: Volunteering intensive care clinicians at two university hospitals were asked to assess the neurological prognosis of a fictional patient with high neuron specific enolase. They were presented with 17 authentic plain text reports and three short statements, confirming whether a "highly malignant", "malignant" or "benign" EEG pattern was present. Primary outcome was the proportion of clinicians who correctly identified poor neurological prognosis from reports consistent with highly malignant EEG patterns. Secondary outcomes were how the prognosis was assessed from reports consistent with malignant and benign patterns. Results: Out of 57 participants, poor prognosis was correctly identified by 61% from plain text reports and by 93% from the short statement "highly malignant" EEG patterns. Unaffected prognosis was correctly identified by 28% from plain text reports and by 40% from the short statement "malignant" patterns. Good prognosis was correctly identified by 64% from plain text reports and by 93% from the short statement "benign" pattern. Conclusion: Standardized short statement, "highly malignant EEG pattern present", as compared to plain text EEG descriptions in neurophysiologist reports, is associated with more accurate identification of poor neurological prognosis in comatose survivors of cardiac arrest.

关键词： Transcranial magnetic stimulation   Transcranial direct current stimulation   Sleep initiation and maintenance disorders   Polysomnography   Sleep disorders   Circadian rhythm   Brain  

摘要： Sleep disturbances (e.g., difficulty to initiate or maintain sleep) and poor sleep quality are major health concerns that accompany several neurological and neuropsychiatric clinical conditions where different brain circuitries are affected (e.g., chronic pain, Parkinson's disease or depression), having a great impact in the individual's well-being, quality of life, and the socioeconomic system. Sleep disturbances in absence of breathing or neurological disorders are mainly treated with medications (e.g., benzodiazepines, hypnotics, etc.) and cognitive behavioral therapy, which are associated with side-effects and adherence issues, respectively. Moreover, these therapies do not seem to work effectively for some individuals. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are non-invasive stimulation techniques used to treat several conditions and symptoms. Results from this systematic review indicate that rTMS and tDCS are safe and have potential to improve insomnia symptoms and sleep disturbances across different types of neurological and neuropsychiatric diseases. However, uncontrolled and quasi experimental studies with high risk of bias were included. Thus, although these results can help developing the field, caution in interpreting them is advised. Additional research efforts are needed to reduce bias, improve quality, and characterize optimal brain stimulation parameters to promote their efficacy on sleep related outcomes. (C) 2020 Elsevier Ltd. All rights reserved.

关键词： Alzheimer&apos   s disease   narcolepsy   neurological disorders   orexin   hypocretin   Prader Willi syndrome   stroke  

摘要： Neuropeptides orexin A and B (OX-A/B, also called hypocretin 1 and 2) are released selectively by a population of neurons which projects widely into the entire central nervous system but is localized in a restricted area of the tuberal region of the hypothalamus, caudal to the paraventricular nucleus. The OX system prominently targets brain structures involved in the regulation of wake-sleep state switching, and also orchestrates multiple physiological functions. The degeneration and dysregulation of the OX system promotes narcoleptic phenotypes both in humans and animals. Hence, this review begins with the already proven involvement of OX in narcolepsy, but it mainly discusses the new pre-clinical and clinical insights of the role of OX in three major neurological disorders characterized by sleep impairment which have been recently associated with OX dysfunction, such as Alzheimer's disease, stroke and Prader Willi syndrome, and have been emerged over the past 10 years to be strongly associated with the OX dysfunction and should be more considered in the future. In the light of the impairment of the OX system in these neurological disorders, it is conceivable to speculate that the integrity of the OX system is necessary for a healthy functioning body.

摘要： Additional pleiotropic benefits of dexmedetomidine include neuronal protection by reducing neuroinflammation and cerebral blood flow and improving neurological outcomes in murine model of SAH [3,4]. Baseline characteristics Mean, before adjustment Standardized difference, before adjustment Mean, after adjustment Standardized difference, after adjustment Without dexmedetomidine (Control) With dexmedetomidine (Dex group) Without dexmedetomidine (Control) With dexmedetomidine (Dex group) Age 55.05 54.75 −0.023 54.85 55.58 0.055 Male 0.22 0.39 0.366 0.23 0.26 0.056 Hypertension 0.67 0.54 −0.281 0.67 0.76 0.178 Diabetes mellitus 0.14 0.07 −0.230 0.14 0.21 0.221 Anterior circulation aneurysm 0.62 0.64 0.042 0.65 0.52 −0.272 Aneurysm size 7.42 5.75 −0.364 7.08 6.45 −0.137 Surgical aneurysm treatment 0.30 0.54 0.495 0.37 0.43 0.134 Endovascular aneurysm treatment 0.70 0.39 −0.650 0.63 0.53 −0.214 Fisher grade 3.64 3.79 0.230 3.70 3.87 0.279 Hunt Hess grade 2.67 3.57 0.685 2.90 2.73 −0.127 GCS score 12.40 6.96 −1.272 11.36 10.54 −0.193 WFNS score 2.13 3.46 0.825 2.48 2.77 0.179 Table 1 Standardized difference of baseline characteristics between patients with and without exposure to dexmedetomidine. Propensity scores generated using logistic regression model, based on covariates: sex, hypertension, diabetes mellitus, aneurysm size, surgical aneurysm treatment, Fisher grade, Hunt Hess grade, GCS score, and WFNS score.

关键词： Ischemic stroke   NIHSS   Large vessel occlusion   COVID-19   Coronavirus  

摘要： Background: To evaluate overall ischemic stroke volumes and rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US. Methods: We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as;March May 2020 (COVID-19 period) and March-May 2019 (seasonal pre-COVID-19 period). Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0-7), moderate [8-14], and severe (>14). Secondary outcomes were volume of large vessel occlusions (LVOs), stroke etiology, IV-tPA rates, and discharge disposition. Results: Of the 7969 patients diagnosed with acute ischemic stroke during the study period, 933 (12 %) presented in the COVID-19 period while 1319 (17 %) presented in the seasonal pre-COVID-19 period. Significant decline was observed in the mean weekly volumes of newly diagnosed ischemic strokes (98 +/- 3 vs 50 +/- 20,p = 0.003), LVOs (16.5 +/- 3.8 vs 8.3 +/- 5.9,p = 0.008), and IV-tPA (10.9 +/- 3.4 vs 5.3 +/- 2.9,p = 0.0047), whereas the mean weekly proportion of LVOs (18 % +/- 5 vs 16 % +/- 7,p = 0.24) and IV-tPA (10.4 % +/- 4.5 vs. 9.9 % +/- 2.4,p = 0.66) remained the same, when compared to the seasonal pre-COVID-19 period. Additionally, an increased proportion of patients presented with a severe disease (NIHSS 14) during the COVID-19 period (29.7 % vs 24.5 %,p < 0.025). The odds of being discharged to home were 26 % greater in the COVID-19 period when compared to seasonal pre-COVID-19 period (OR:1.26, 95 % CI:1.07-1.49,p = 0.016). Conclusions: During COVID-19 period there was a decrease in volume of newly diagnosed ischemic stroke cases and IV-tPA administration. Patients admitted to the hospital had severe neurological clinical presentation and were more likely to discharge home.

关键词： Stress disorders   Post-traumatic   caregivers   quality of life   hospitalization   intensive care units   linear models  

摘要： Background The objective is to pilot test the feasibility of assessing severity of posttraumatic stress disorder (PTSD) symptoms, as well as specific lower-order PTSD symptoms, experienced during neurological intensive care unit (neuro-ICU) admission and their relationship with 3-month quality of life (QoL) scores in multiple domains (i.e., physical, psychological, social, and environmental) in both patients and caregivers. Methods Between 2015 and 2016, we enrolled neurologically intact patients and informal caregivers of patients who reported demographics and PTSD symptoms (PTSD Checklist-Specific;PCL-S) during neuro-ICU admission and completed a QoL assessment (World Health Organization Quality of Life;WHOQOL-BREF) 3 months later. Clinical data were extracted from medical records. We ran two bivariate correlation matrices among PTSD symptom dimensions in patients and caregivers. Then, we used multiple linear regression to examine the prospective association of total PCL-S scores with each QoL domain in both patients and caregivers after adjusting for clinically important variables. Next, we explored differential associations between the 4 PTSD symptom dimensions and each QoL domain in both patients and caregivers, adjusting for sex and age. Results A total of 70 patients (45.7% women, 84.3% white, mean age 52.08 years) and 64 caregivers (64.1% women, 90.6% white, mean age 53.12 years) were included. PTSD symptom dimensions were moderately strongly correlated among patients (r = 0.65-0.79, p < 0.001) and caregivers (r = 0.55-0.78, p < 0.001). For both patients and caregivers, greater PTSD symptom severity was prospectively associated with lower QoL in all domains (beta = - 0.289 to - 0.622;p < 0.05). Our exploratory analysis revealed that greater numbing symptoms were associated with lower psychological QoL in patients (beta: - 0.397, p = 0.038), and lower physical (beta: - 0.409, p = 0.014), psychological (beta: - 0.519, p = 0.001), and social QoL (beta: - 0.704,

关键词： Conversion disorder   DTI   functional movement disorder   psychogenic nonepileptic seizures   somatization  

摘要： Background Functional neurological disorder (FND) is a condition at the intersection of neurology and psychiatry. Individuals with FND exhibit corticolimbic abnormalities, yet little is known about the role of white matter tracts in the pathophysiology of FND. This study characterized between-group differences in microstructural integrity, and correlated fiber bundle integrity with symptom severity, physical disability, and illness duration. Methods A diffusion tensor imaging (DTI) study was performed in 32 patients with mixed FND compared to 36 healthy controls. Diffusion-weighted magnetic resonance images were collected along with patient-reported symptom severity, physical disability (Short Form Health Survey-36), and illness duration data. Weighted-degree and link-level graph theory and probabilistic tractography analyses characterized fractional anisotropy (FA) values across cortico-subcortical connections. Results were corrected for multiple comparisons. Results Compared to controls, FND patients showed reduced FA in the stria terminalis/fornix, medial forebrain bundle, extreme capsule, uncinate fasciculus, cingulum bundle, corpus callosum, and striatal-postcentral gyrus projections. Except for the stria terminalis/fornix, these differences remained significant adjusting for depression and anxiety. In within-group analyses, physical disability inversely correlated with stria terminalis/fornix and medial forebrain bundle FA values;illness duration negatively correlated with stria terminalis/fornix white matter integrity. A FND symptom severity composite score did not correlate with FA in patients. Conclusions In this first DTI study of mixed FND, microstructural differences were observed in limbic and associative tracts implicated in salience, defensive behaviors, and emotion regulation. These findings advance our understanding of neurocircuit pathways in the pathophysiology of FND.

摘要： Solomon Carter Fuller (1872-1953) is widely acknowledged as the first African-American psychiatrist but underappreciated as a pioneer of Alzheimer's disease. He immigrated to the United States from Liberia at age 17 and excelled in his medical career to become associate professor of both pathology and neurology at Boston University by 1921. He was one of five research assistants selected by Alois Alzheimer to work in his laboratory at the Royal Psychiatric Hospital in Munich, an experience that arguably paved the way for trailblazing research in Alzheimer's disease. Dr Fuller was the first to translate much of Alzheimer's pivotal work into English, including that of Auguste Deter, the first reported case of the disease. He published what is now recognized to be the first comprehensive review of Alzheimer's disease, in it reporting the ninth case ever described. His achievements, in a period when African-American physicians were under-represented, merit greater recognition.