关键词： Blast TBI   Fluid percussion injury   Blast plus injury   Neurodegeneration   Cognitive deficits   Motor deficits   Ventricular enlargement   Neuronal loss   RIP1  

摘要： Soldiers are often exposed to more than one traumatic brain injury (TBI) over the course of their service. In recent years, more attention has been drawn to the increased risk of neurological deficits caused by the 'blast plus' polytrauma, which typically is a blast trauma combined with other forms of TBI. In this study, we investigated the behavioral and neuronal deficits resulting from a blast plus injury involving a mild-moderate blast followed by a mild blunt trauma using the fluid percussion injury model. We identified that the blast injury predisposed the brain to increased cognitive deficits, chronic ventricular enlargement, increased neurodegeneration at acute time points and chronic neuronal loss. Interestingly, a single blast and single blunt injury differed in their onset and manifestation of cognitive and regional neuronal loss. We also identified the presence of cleaved RIP1 from caspase 8 mediated apoptosis in the blunt injury while the blast injury did not activate immediate apoptosis but led to decreased hilar neuronal survival over time.

关键词： Burst fracture   Thoracolumbar trauma   Neurological outcome   Spinal cord injury  

摘要： Purpose To identify specific morphological characteristics in thoracolumbar burst fractures associated with neurological outcome after severe traumatic spinal cord injury (TSCI). Methods We retrospectively analyzed the clinical and radiological (CT scan morphological characteristics) data of 25 consecutive patients admitted for TSCI secondary to a burst fracture at levels from T11 to L2 between 2010 and 2017 in single level-1 trauma center. We included severe TSCI, defined as American Spinal Injury Association Impairment Scale (AIS) grade A, B or C. Results Among the 25 patients with severe TSCI, 14 were AIS A, 5 were AIS B, and 6 were AIS C upon initial preoperative neurological evaluation. The AIS grade and the burden of associated injuries (Injury Severity Score, ISS) were the only clinical factors significantly associated with poor neurological recovery. The trauma level of energy was not associated with neurological outcome. Several fractures parameters were independently related to neurological recovery: the postero-inferior corner translation, presence of retropulsed fragment comminution and complete lamina fracture. The magnitude of sagittal kyphosis angle, vertebral kyphosis index and vertebral body comminution were not associated with the neurological outcome. Conclusions Morphological features of the bony structures involving the spinal canal in thoracolumbar burst fractures with severe TSCI are associated with the chronic neurological outcome and could provide more insight than the AIS clinical grading. The fracture pattern may better reflect the actual level of energy transferred to the spinal cord than distinguishing between low- and high-energy trauma.

关键词： COVID-19   Neurohospitalist   Neurology residency   Neurology administration   Stroke  

摘要： The COVID-19 pandemic dramatically affected the operations of New York City hospitals during March and April of 2020. This article describes the transformation of a neurology division at a 450-bed tertiary care hospital in a multi-ethnic community in Brooklyn during this initial wave of COVID-19. In lieu of a mass redeployment of staff to internal medicine teams, we report a novel method for a neurology division to participate in a hospital's expansion of care for patients with COVID-19 while maintaining existing team structures and their inherent supervisory and interpersonal support mechanisms.

关键词： Cardiac arrest   Coma   Prognosis   Clinical examination   Somatosensory-evoked potentials   Neuron-specific enolase   Computed tomography   Diffusion magnetic resonance imaging  

摘要： Purpose To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169)

关键词： brain   central nervous system   cerebrospinal fluid   coronavirus   COVID-19   neuroinvasive   neuron   neurotropic   olfactory   SARS-CoV-2   transcribrial  

摘要： Coronavirus disease-2019 (COVID-19) was declared a global pandemic on 11 March 2020. Scientists and clinicians must acknowledge that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential to attack the human body in multiple ways simultaneously and exploit any weaknesses of its host. A multipronged attack could potentially explain the severity and extensive variety of signs and symptoms observed in patients with COVID-19. Understanding the diverse tactics of this virus to infect the human body is both critical and incredibly complex. Although patients diagnosed with COVID-19 have primarily presented with pulmonary involvement, viral invasion, and injury to diverse end organs is also prevalent and well documented in these patients, but has been largely unheeded. Human organs known for angiotensin-converting enzyme 2 (ACE2) expression including the gastrointestinal tract, kidneys, heart, adrenals, brain, and testicles are examples of extra pulmonary tissues with confirmed invasion by SARS-CoV-2. Initial multiple organ involvement may present with vague signs and symptoms to alert health care professionals early in the course of COVID-19. Another example of an ongoing, yet neglected element of the syndromic features of COVID-19, are the reported findings of loss of smell, altered taste, ataxia, headache, dizziness, and loss of consciousness, which suggest a potential for neural involvement. In this review, we further deliberate on the neuroinvasive potential of SARS-CoV-2, the neurologic symptomology observed in COVID-19, the host-virus interaction, possible routes of SARS-CoV-2 to invade the central nervous system, other neurologic considerations for patients with COVID-19, and a collective call to action.

关键词： Graph super-resolution   Brain connectomes   Connectional brain template learning   Topology-based residual graph manifold learning   Neurological disorder diagnosis   Brain graph fusion  

摘要： Existing graph analysis techniques generally focus on decreasing the dimensionality of graph data (i.e., removing nodes, edges, or both) in diverse predictive learning tasks in pattern recognition, computer vision, and medical data analysis such as dimensionality reduction, filtering and embedding techniques. However, graph super-resolution is strikingly lacking, i.e., the concept of super-resolving low-resolution (LR) graphs with n r nodes into high-resolution graphs (HR) with n(r') > n(r) nodes. Particularly, learning how to automatically generate HR brain connectomes, without resorting to the computationally expensive MRI processing steps such as image registration and parcellation, remains unexplored. To fill this gap, we propose the first technique to super-resolve undirected fully connected graphs with application to brain connectomes. First, we root our brain graph super-resolution (BGSR) framework in learning how to estimate a centered LR population-based brain graph representation, coined as connectional brain template (CBT), acting as a proxy in the target BGSR task. Specifically, we hypothesize that the estimation of a wellrepresentative and centered CBT would help better capture the individuality of each LR brain graph via its residual distance from the population-based CBT. This will eventually allow an accurate identification of the most similar individual graphs to a new testing graph in the LR domain for the target prediction task. Second, we leverage the estimated LR CBT (i.e., population mean) to derive residual LR brain graphs, capturing the deviation of all subjects from the estimated CBT. Third, we learn multi-topology LR graph manifolds using different graph topological measurements (e.g., degree, closeness, betweenness) by estimating residual LR similarity matrices modeling the relationship between pairs of residual LR graphs. These are then fused so we can effectively identify for each testing LR subject its most K similar training LR graphs.

关键词： Traumatic brain injury   Cerebral perfusion   Norepinephrine   Vasopressor   Neurological outcomes  

摘要： Background and objective: Despite multiple interventions, mortality due to severe traumatic brain injury (sTBI) within mature Trauma Systems has remained unchanged over the last decade. During this time, the use of vasoactive infusions (commonly norepinephrine) to achieve a target blood pressure and cerebral perfusion pressure (CPP) has been a mainstay of sTBI management. However, evidence suggests that norepinephrine, whilst raising blood pressure, may reduce cerebral oxygenation. This study aimed to review the available evidence that links norepinephrine augmented CPP to clinical outcomes for these patients. Methods: A systematic review examining the evidence for norepinephrine augmented CPP in TBI patients was undertaken. Strict inclusion and exclusion criteria were developed for a dedicated literature search of multiple scientific databases. Two dedicated reviewers screened articles, whilst a third dedicated reviewer resolved conflicts. Results: The systematic review yielded 4,809 articles, of which 1,197 duplicate articles were removed. After abstract/title screening, 45 articles underwent full text review, resulting in the identification of two articles that investigated the effect of norepinephrine administration on clinical outcomes in patients following TBI when compared to other vasopressors. Neither study found a difference in neurological outcome between the vasopressor groups. No articles measured the effect of norepinephrine compared to no vasopressor use on the clinical outcome of patients with sTBI. Conclusions: Despite being a mainstay of pharmacological management for hypotension in patients following sTBI, there is minimal clinical evidence supporting the use of norepinephrine in targeting a CPP for either improving neurological outcomes or reducing mortality. Outcomes-based clinical trials exploring the role of brain tissue perfusion and oxygenation monitoring are required to validate any benefit. (C) 2020 The Author(s). Published by Elsevier Ltd

摘要： Clinical characteristics of the three patients Patient 1 Patient 2 Patient 3 Sex Female Male Female Weight (kg) 70 84 90 Medical history None Obesity Obesity, depression Anticoagulation and medication Prophylaxis only (enoxaparin) Prophylaxis only (enoxaparin) Yes (unfractionated heparin) COVID-19 onset symptoms Fever and flu syndrome Dyspnea Dyspnea Time between onset and intubation (days) 7 2 2 Time between onset and dialysis (days) 10 6 12 Time between onset and cerebral hemorrhage (days) 15 16 15 Outcome Death Death Death Patient 1 A 56-year-old woman presented with fever and flu syndrome on March 29th, prompting her to seek medical attention in the emergency department. The next day he acutely presented mydriasis and immediately underwent a brain CT scan, which revealed multiple sites of intracerebral hemorrhage (right frontal lobe, left thalamus, and left occipital lobe) and diffuse cerebral edema (Fig. 1b–d). On the seventh day in the ICU, she acutely presented anisocoric pupils without reaction to light and underwent a brain CT scan, which showed multiple sites of hemorrhage (right basal ganglia, left frontal, and left occipital lobes) and diffuse edema (Fig. 1c). When considering the high incidence of acute renal failure (25-28%) and the use of low molecular weight heparin with no anti-factor Xa monitoring, clinical management of full anticoagulation becomes even more complicated [5].