关键词： Intracerebral hemorrhage   ICH volume   Pupillometry   Neurological pupil index   Midline shift  

摘要： Objectives: There is growing interest in the ability of automated infrared pupillometry to assess severity of neurological illness. We studied the correlation between computed tomography (CT) indicators of intracerebral hemorrhage (ICH) severity with objective measures of the pupillary light reflex (PLR), and hypothesized that hemorrhage volume would predict the Neurological Pupil index (TM) (NPi (TM)), an indicator of pupillary reactivity. Methods: This study examined data from patients with supratentorial ICH who underwent serial pupillometer evaluations. CT images were examined to determine the location and laterality of the hemorrhage, along with hematoma volume (using the simplified ABC/2 method), midline shift, hydrocephalus score, and modified Graeb score (indicating interventricular hemorrhage). Demographics were examined with standard measures of central tendency, hypotheses with logistic regression, categorical data with Fisher's Exact X2, and multivariate modeling with constructed MAX-R models. Results: Data were gathered from 44 subjects. ICH volume exhibited the strongest correlation with NPi (ipsilateral [r(2) = 0.48, p < 0.0001, contralateral [(r(2) = 0.39, p < 0.0001]). Horizontal midline shift of the septum pellucidum also correlated with NPi (ipsilateral [r(2) = 0.25, p = 0.0006], contralateral [r(2) = 0.15, p = 0.0106]), as did shift of the pineal gland (ipsilateral [r(2) = 0.21, p = 0.0017], contralateral[r(2) = 0.11, p = 0.0328]). ICH volume was the most predictive of abnormal NPi (AUC = 0.85 for ipsilateral and 0.88 for contralateral NPi), and multivariate modeling identified additional independent predictors of NPi. Conclusion: ICH volume and shift of midline structures correlate with NPi, and abnormalities in NPi can be predicted by hematoma volume and other CT indicators of ICH severity. Future studies should explore the role of NPi in detecting early hematoma expansion and worsening midline shift.

关键词： endovascular recanalization   revascularization   stroke   thrombectomy  

摘要： Background and purpose Mechanical thrombectomy (MT) is the standard of care for patients with anterior circulation large vessel occlusion. Early neurological improvement (ENI), defined as a reduction of >= 8 on the National Institutes of Health Stroke Scale (NIHSS) compared with baseline score, or an NIHSS score of 0 or 1 at 24 h after MT, is a strong predictor of 3-month favorable outcome in such patients. The impact of ENI after MT in stroke patients with basilar artery occlusion (BAO) on 3-month outcome is not clear. We aimed to study the effects of ENI in patients with BAO. Methods We performed a retrospective analysis of a multicenter prospective cohort of all consecutive stroke patients with BAO who underwent MT. We compared clinical outcomes between BAO patient groups according to ENI status. Multivariate analyses were performed to determine the impact of ENI on favorable 90-day outcome (modified Rankin scale score 0-3) and to report factors contributing to ENI. Results A total of 237 patients were included. ENI was observed in 70 patients (30%). Outcomes were significantly better in ENI-positive patients, with 84% achieving favorable outcome (mRS score 0-3) at 3 months versus 30% for ENI-negative patients (P < 0.0001). In multivariate analysis, ENI was an independent predictive factor associated with higher rates of favorable outcome {odds ratio (OR) 18.12 [95% confidence interval (CI) 3.95-83.10];P = 0.0001}. Higher number of passes [OR 0.62 (95% CI 0.43-0.89);P = 0.010] and need for stenting [OR 0.27 (95% CI 0.07-0.95);P = 0.041] were negatively associated with ENI. Conclusion Early neurological improvement on day 1 following MT for BAO is a strong independent predictor of a favorable 3-month clinical outcome.

关键词： genomics   preferences   personal utility   neurodevelopmental disorders   children  

摘要： Purpose To estimate the value of genomic sequencing for complex pediatric neurological disorders of suspected genetic origin. Methods A discrete choice experiment (DCE) was undertaken to elicit societal preferences and values. A Bayesian D-efficient and explicit partial profile design was used. The design included 72 choice tasks, split across six blocks, with eight attributes (three overlapping per choice task) and three alternatives. Choice data were analyzed using a panel error component mixed logit model and a latent class model. Preference heterogeneity according to personal socioeconomic, demographic, and attitudinal characteristics was explored using linear and fractional logistic regressions. Results In total, 820 members of the Australian public were recruited. Statistically significant preferences were identified across all eight DCE attributes. We estimated that society on average would be willing to pay AU$5650 more (95% confidence interval [CI]: AU$5500 to $5800) (US$3955 [95% CI: US$3850 to $4060]) for genomic sequencing relative to standard care. Preference heterogeneity was identified for some personal characteristics. Conclusion On average, society highly values all diagnostic, process, clinical, and nonclinical components of personal utility. To ensure fair prioritization of genomics, decision makers need to consider the wide range of risks and benefits associated with genomic information.

关键词： Active compression-decompression CPR   Cardiac arrest   Cardiopulmonary resuscitation   Cerebral perfusion   Head Up CPR   Head and thorax elevation   Controlled sequential elevation   Impedance threshold device   Mechanical CPR  

摘要： Aim of the study: Controlled sequential elevation of the head and thorax (CSE) during active compression decompression (ACD) cardiopulmonary resuscitation (CPR) with an impedance threshold device (ITD) has been shown to increase cerebral perfusion pressure and cerebral blood flow in previous animal studies as compared to the traditional supine position. The potential for this novel bundled treatment strategy to improve survival with intact neurological function is unknown. Methods: Female farm pigs were sedated, intubated, and anesthetized. Central arterial and venous access were continuously monitored. Regional brain tissue perfusion (CerO2) was also measured transcutaneous. Ventricular fibrillation (VF) was induced and untreated for 10 min. Pigs were randomized to (1) Conventional CPR (C-CPR) flat or (2) ACD + ITD CSE CPR that included 2 min of ACD + ITD with the head and heart first elevated 10 and 8 cm, and then gradual elevation over 2 min to 22 and 9 cm, respectively. After 19 min of CPR, pigs were defibrillated and recovered. A veterinarian blinded to the intervention assessed cerebral performance category (CPC) at 24 h. A neurologically intact outcome was defined as a CPC score of 1 or 2. Categorical outcomes were analyzed by Fisher's exact test and continuous outcomes with an unpaired student's t-test. Results: In 16 animals, return of spontaneous circulation rate was 8/8 (100%) with ACD + ITD CSE and 3/8 (25%) for C-CPR (p = 0.026). For the primary outcome of neurologically intact survival, 6/8 (75%) pigs had a CPC score 1 or 2 with ACD + ITD CSE versus 1/8 (12.5%) with C-CPR (p = 0.04). Coronary perfusion pressure (mmHg, mean +/- SD) was higher with CSE at 18 min (41 +/- 24 versus 10 +/- 5, p = 0.004). rSO2 (%, mean +/- SD) and ETCO2 (mmHg, mean +/- SD) values were higher at 18 min with CSE (32 +/- 9 versus 17 +/- 2, p = 0.01, and 55 mmHg +/- 10 versus 21 mmHg +/- 4, p < 0.001), respectively. Conclusions: The novel bundled resuscitation approach of CSE wi

关键词： Brain ischaemia/enzymology   Out-of-hospital cardiac arrest/complications   Out-of-hospital cardiac arrest/mortality   Biomarkers/blood   Hypothermia   Induced   Multicentre study   Prospective studies  

摘要： Purpose: Prognostication of hypoxic-ischaemic brain injury after resuscitation from cardiac arrest is based on a multimodal approach including biomarker assays. Our goal was to assess whether plasma NSE helps to predict day-90 death or poor neurological outcome in patients resuscitated from cardiac arrest in non-shockable rhythm. Methods: All included patients participated in the randomised multicentre HYPERION trial. Serum blood samples were taken 24, 48, and 72 h after randomisation;pre-treated, aliquoted, and frozen at -80 degrees C at the study sites;and shipped to a central biology laboratory, where the NSE assays were performed. Primary outcome was neurological status at day 90 assessed by Cerebral Performance Category (1 or 2 versus. 3, 4 or 5). Results: NSE was assayed in 235 assessable blood samples from 101 patients. In patients with good versus poor outcomes, median NSE values at 24, 48, and 72 h were 22.6 [95%CI, 14.6;27.3] ng/mL versus 33.6 [20.5;90.0] ng/mL (p < 0.04), 18.1 [11.7;29.7] ng/mL versus 76.8 [21.5;206.6] ng/mL (p < 0.0029), and 9 [6.1;18.6] ng/mL versus 80.5 [22.9;236.1] ng/mL (p < 0.001), respectively. NSE at 48 and 72 h predicted the neurological outcome with areas under the receiver-operating curve of 0.79 [95%CI, 0.69;0.96] and 0.9 [0.81;0.96], respectively. NSE levels did not differ significantly between the groups managed at 33 degrees C and 37 degrees C (p = 0.59). Conclusions: Data from a multicentre trial on cardiac arrest with a non-shockable rhythm due to any cause confirm that NSE values at 72 h are associated with 90-day outcome. NSE levels did not differ significantly according to the targeted temperature. Registration Identifier: ClinicalTrial NCT02722473.

关键词： COVID-19   Neurological disorder   Neurology   Epilepsy   Systematic   Review  

摘要： Background: Patients with chronic diseases likely develop severe 2019 coronavirus disease (COVID-19). However, little is known about the effects of COVID-19 on patients with neurological disorders. We conducted a systematic review to evaluate the severity of COVID-19 and its effect on neurological symptoms in patients with preexisting neurological disorder and COVID-19. Methods: We searched the MEDLINE (PubMed) and medRxiv databases for reports of patients with both preexisting neurological disorders and COVID-19. Studies reporting data on changes in the symptoms of preexisting neurological disorders and/or the severity of COVID-19 were included. Results: Twenty-six articles with 2278 patients with preexisting neurological disorder and COVID-19 were identified. Of 232 patients, 74 (31.9 %) showed exacerbation of preexisting neurological symptoms of dementia (55/92;59.5 %), Parkinson's disease (10/17;58.8 %), epilepsy (1/1;100 %), and unspecified neurological disorders (8/106;7.5 %). Of 2168 patients, 478 (22.0 %) showed severe COVID-19 course. These included patients with cerebrovascular disease (86/445;19.3 %), dementia (70/316;22.2 %), Parkinson's disease (25/ 214;11.7 %), multiple sclerosis (28/71;39.4 %), spinal cord injury (5/7;71.4 %), epilepsy (10/98;10.2 %) and unspecified neurological disorders (254/1011;25 %). Conclusions: Patients with preexisting neurological disorders and COVID-19 may develop exacerbation of neurological symptoms and severe COVID-19. Clinicians should be aware of the risk of symptom exacerbation and severe COVID-19 in patients with preexisting neurological disease and should focus on the prevention and early care of COVID-19.

关键词： Brain   Low- and middle-income countries   Neonatal neurology   Sub-Saharan Africa  

摘要： Objective: To describe gestational age-specific distribution of scores for the Hammersmith Neonatal Neurological Examination (HNNE) up to 48 h after birth in a low-risk, term-born, single-center sample in Ghana. Study design: This is a nested substudy of a larger prospective study (IMPRINT: Impact of Malaria in Pregnancy on Infant Neurodevelopment) comprising 140 low-risk, term-born neonates at Korle Bu Teaching Hospital in Accra, Ghana, between November 2018 and February 2019. The sample was stratified into three gestational age groups: early-term (37 + 0-38 + 6, weeks + days;n = 61), full-term (39 + 0-40 + 6, weeks + days;n = 52), and late/post-term (41 + 0-42 + 6, weeks + days;n = 27). Neonates were administered the 34-item HNNE by trained physicians. As per the original British scoring system, raw scores for the Ghanaian sample were plotted and scores 10th centile were assigned a score of 1, 5th-10th centile 0.5, and < 5th centile 0. Results: The range of raw scores for 16/34 HNNE items varied with gestational age. Specifically, 100% (7/7), 50% (5/10), 33% (1/3), 33% (1/3), 20% (1/5), and 14% (1/7) of items within the orientation and behavior, tone, abnormal signs/patterns, movements, tone patterns, and reflexes subdomain, respectively showed a different distribution of scores above the 10th centile across the three gestational age groups. Conclusion: Differences in gestational age-specific results within our sample in comparison to the original British sample could be, albeit unlikely, due to misclassification of gestational age, unmeasured maternal or fetal morbidity, or perhaps more likely, variation in testing or test conditions, or some combination of these. Genetic variation in neurological development is also a possibility. Further research is warranted to determine the reasons for differences. Our findings highlight the need to determine the accuracy and reliability of standardized neurologic assessments in predicting neurodevelopmental risk for infants

关键词： Go-sha-jinki-Gan   inflammation   multiple sclerosis   1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine   tumornecrosis factor-alpha   p38  

摘要： Go-sha-jinki-Gan (GJG) is a traditional Japanese herbal medicine. In clinical practice, GJG is effective against neuropathic pain and hypersensitivity induced by chemotherapy or diabetes. In our previous study using a chronic constriction injury mouse model, we showed that GJG inhibited microglia activation by suppressing the expression of tumor necrosis factor-alpha (TNF-alpha) and p38 mitogen-activated protein kinase (p38 MAPK) in the peripheral nervous system. To investigate whether GJG can suppress inflammation in the central nervous system (CNS) in the context of neurological disorders, we examined the effect of GJG on the activation of resident glial cells and on p38-TNF signaling in two mouse models of neurological disorders: the experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis and the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) model of Parkinson's disease. GJG administration relieved the severity of clinical EAE symptoms and MPTP-induced inflammation by decreasing the number of microglia and the production of TNF-alpha in the spinal cord of EAE mice and the substantia nigra of MPTP-treated mice. Accordingly, GJG suppressed the phosphorylation of p38 in glial cells of these two mouse models. We conclude that GJG attenuates inflammation of the CNS by suppressing glial cell activation, followed by a decrease in the production of TNF-alpha via p38-TNF signaling.

关键词： Functional neurological disorder   Conversion disorder   Dissociative neurological symptom disorder   Psychosomatic medicine  

关键词： Neurological improvement   Acute ischemic stroke   Survivors   Propensity score matching analysis   Prognosis   Short-term outcome   NIHSS   Improvement  

摘要： Objectives: Stroke has become a national concern in China. Early prediction of stroke benefits patients and aids medical professionals in clinical decision making and rehabilitation plans to improve successful outcomes. To identify prediction factors influencing short-term outcomes in patients with acute ischemic stroke (AIS). Materials and Methods: This was a hospital-based prospective observational study. Recovery of neurological improvement was represented by a percent reduction in the National Institutes of Health Stroke Scale (NIHSS) at discharge. We performed propensity score matching (PSM) to balance the NIHSS at admission and compared NIHSS scores before and after matching with PSM criteria. Finally, we assessed the prognosis of neurological improvement and patient-related variables. Results: In the matched cohort, 92 pairs were matched by NIHSS admission after PSM. Modified Barthel Index, modified Rankin scale, NIHSS on admission, hypertension, sleep time, and Montreal Cognitive Assessment (MoCA) were statistically different between the two groups (P < 0.05) before matching. Multivariable analysis identified two factors independently associated with neurological improvement: diabetes (P = 0.030;adjusted odds ratio, 2.129;95% confidence interval [CI] 1.078-4.026) and MoCA (P < 0.001;adjusted odds ratio, 5.385;95% CI 2.278-12.730). Conclusion: Consistent with previous studies, diabetes affected the short-term outcomes of AIS, while cognitive impairment had a negative effect on long-term AIS *** and early cognitive impairment have adverse effects on short-term prognosis after AIS.