关键词： Epidemiology   Global neurosurgery   Nepal   Traumatic brain injury  

摘要： BACKGROUND: Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem worldwide. It represents the greatest contribution to death and disability among all trauma-related injuries globally. TBIs are a leading cause of death and disability in Nepal, despite improvements in safety regulations and implementation of strict drunk driving laws. We describe the epidemiology of patients with TBI following admission to our hospital. We discuss the implementation of specific strategies to reduce its incidence. METHODS: We conducted a retrospective cross-sectional study of patients presenting to Annapurna Neurological Institute & Allied Sciences (ANIAS), Kathmandu, with a TBI between September 2018 to September 2019. RESULTS: One-hundred and sixty-seven patients presented with a TBI. The most common age groups were younger than 15 years old and 15-25 years old, and the majority were male (73%). The commonest cause of TBI was road traffic accidents (RTA) (59%). Drivers riding motorcycles were the predominant mechanism of RTA (38%). Helmet use was seen in 57% of patients riding 2-wheelers. Alcohol consumption was reported in 22% of all patients. Skull fractures were the most common diagnosis. Most patients were managed conservatively (84%). CONCLUSIONS: TBI should be recognized as an important public health problem in Nepal. TBI is responsible for a considerable number of neurosurgical admissions to ANIAS. Our study showed patients most vulnerable to TBI are males younger than 25 years old. The implementation of stricter traffic rules and regulations, helmet law enforcement, and public education programs may be helpful in decreasing the number of TBI.

关键词： acquired brain injuries   electroencephalogram (EEG)   post-acute prognosis   prognosis   severe disorders of consciousness   standardized EEG classification  

摘要： Objective According to electroencephalogram (EEG) descriptors included in the American Clinical Neurophysiology Society (ACNS) terminology, we generated a score, and we compared it to the EEG scores previously proposed in order to identify the one with the best prognostic power for neurological outcome at post-acute stages in patients with severe disorders of consciousness (DoC). Materials and methods Patients included in the analysis were clinically evaluated with the Coma Recovery Scale-Revised (CRS-R). An EEG was performed within the first week after admission to Intensive Rehabilitation Unit (IRU). EEGs were classified according to the ACNS terminology and to the scores of Bagnato and Estraneo. Results A total of 260 patients admitted to the IRU were analysed. A total of 160 patients (61%) improved their consciousness level during IRU stay. EEG score based on the ANCS terminology showed higher overall performance (receiver-operating area under the curve = 0.79) and greater sensitivity (65%), at comparable specificities (80%), for clinical improvement as compared to both CRS-R admission score and other EEG scores. Combining our EEG score with CRS-R score at admission, the cumulative sensitivity increased to 76% when at least one good prognostic index test was present in the same patient, whereas specificity increased up to 93% if both the good prognostic patterns of clinical and instrumental parameters were simultaneously present. Conclusion The EEG scored according to the ACNS terminology is the best among those looked at for the prediction of short-term clinical improvement in patients with DoC and represents a useful instrumental test, complementary to clinical evaluation at admission, to be added in post-acute neurological prognostication methods.

关键词： Functional neurological symptoms   Functional movement disorder: conversion disorder: children: adolescents: treatment  

摘要： Aim: To develop a cognitive behavioural treatment (CBT) approach that included novel attention training components to support symptom management in children with a primary diagnosis of Functional Movement Disorder (FMD). Method: Eighteen children (9 male and 9 female) with a mean age of 13 years (sd = 2.46, range 10-18 years) were assessed and completed CBT with novel attention training components. Treatment outcomes were measured using the Child Global Assessment Scale (CGAS) which was administered at baseline and post-treatment. Results: Scores on the CGAS improved significantly post-treatment (p < 0.001) with all participants showing significant change in functioning on the basis of the Reliable Change Index (RCI), with clinically significant change across classification boundaries. Interpretation: This case series provides support for the use of CBT with attention training components for the management of FMD. Larger trials are necessary to identify which individual treatment components are most effective and to better understand and quantify response to treatment. Future clinical treatment studies would benefit from the inclusion of objective measures of interoception and attentional focus. Crown Copyright (c) 2020 Published by Elsevier Ltd on behalf of European Paediatric Neurology Society. All rights reserved.

关键词： Brain abscess   encephalitis   human immunodeficiency virus (HIV)   meningitis   meningoencephalitis   MRCP   tuberculosis  

摘要： Neuroinfection syndromes cause significant mortality and morbidity. Clinical syndromes include meningitis, encephalitis, mass lesion (abscess), myelitis, radiculitis, neuritis, myositis and neuromuscular junction dysfunction. Symptoms can develop rapidly (acute) or over weeks (subacute) or longer (chronic). Viruses, bacteria, fungi or protozoa can be causal. Timely diagnosis and initiation of treatment can reduce morbidity and mortality. This article briefly outlines the common acute neuroinfection syndromes. As some pathogens are more likely to be encountered in specific geographical areas, information regarding travel to, and immigration from, endemic areas must be carefully sought. Further, different populations have varied susceptibility to infection because of specific defects in the host defence as a result of co-morbidities or treatment;assessment of potential immunosuppression is mandatory in all patients presenting with neuroinfections. For more detailed discussion, UK-specific guidelines are referenced. © 2020

关键词： Coccidioidal meningitis   Non-HIV/AIDS   CNS   Neurological center   Mexico  

摘要： Background: Coccidioidal meningitis is a life-threatening condition and a diagnostic challenge in cases of chronic meningitis. It is associated to severe complications, like basal arachnoiditis, hydrocephalus, and secondary vasculitis. Objective: To present a 20-year retrospective clinical series of coccidioidal meningitis cases at a Mexican neurological referral center. Results: The clinical records of 11 patients, predominantly males, were retrieved. Weight loss and night sweats were observed in 64 % of cases. Neurological signs included intracranial hypertension in 91 % of cases, altered alertness and meningeal syndrome in 72 %, and neuropsychiatric symptoms in 64 %. Mean CSF glucose levels were 30 +/- 25 mg/dL, and pleocytosis ranged from 0 to 2218 cells/mm(3). The diagnosis was confirmed by coccidioidal antigen latex agglutination in 91 % of cases. Radiological findings were hepatomegaly in 55 % of cases and pneumonia in 45 %. Neuroimaging findings included leptomeningitis in 73 % of cases, pachymeningitis in 45 %, and vascular involvement in 91 %. Less common findings included spinal cord lesion and mycotic aneurism, found in 18 % of cases. A molecular coccidioidal DNA test confirmed the predominance of Coccidioides immitis, detected in 64 % of cases. With respect to the clinical outcome, 46 % of patients died. The survivors suffered from sequels like chronic headache, cognitive alterations, and depression. Conclusions: Coccidioidal meningitis is an entity with high mortality rates. More than one half of patients suffered disseminated disease. Although meningeal signs are not frequent in chronic meningitis, more than twothirds of our patients showed mild nuchal rigidity. In addition, cerebral and cerebellar volume loss, associated with cognitive impairment and depression, was often observed in surviving patients during the clinical-radiological follow-up.

关键词： Fibrillar aggregates   Metal ion toxicity   Neurodegeneration   Serum albumin  

摘要： Protein fibrillation is a leading cause of innumerable neurodegenerative diseases. The exact underlying mechanism associated with the formation of fibrils is yet to be known. Recently, the role of metal ions resulting into fibrillation of proteins has gained attention of the scientific community. In this piece of work, we have investigated the effect of the aluminum (Al) metal ion on the kinetics of aggregation of bovine serum albumin (BSA) protein under physiological conditions by employing several biophysical and microscopic techniques. Quenching of tryptophan fluorescence was observed along with 9 nm blue shift, demonstrating BSA becomes more hydrophobic during unfolding pathway of thermal denaturation. Moreover, ANS (8-Anilino-1-naphthalene sulfonic acid) binding shows quenching in fluorescence intensity with increasing time of incubation at 65 degrees C, suggesting unfolding leading to the disruption of hydrophobic patches in BSA. Besides, Thioflavin T intensity indicated a significant acceleration in BSA fibrillation at a ratio of 1:1 and 1:2 of BSA and Al (III) metal ion respectively. In addition, circular dichroism (CD) spectroscopy study revealed the transition of BSA from alpha-helical conformation to the beta-sheet rich structure. Molecular docking analysis demonstrated significant binding affinity (-1.2 kcal/mol) of Al (III) with BSA involving Phe501, Phe506, Val575, Thr578, Gln579, Leu531 residues. Transmission electron microscopy (TEM) reaffirm augmentation of thermal-induced BSA fibril formation in the presence of Al (III) metal ions. This study highlights the metal chelating potency as the possible therapeutic target for neurological diseases. (C) 2020 The Authors. Published by Elsevier B.V. on behalf of King Saud University.

关键词： Multiple sclerosis   Neurological disorders   SARS-CoV-2  

摘要： The coronavirus disease 2019 (COVID-19) pandemic is concerning for patients with neuroimmunological diseases who are receiving immunotherapy. Uncertainty remains about whether immunotherapies increase the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or increase the risk of severe disease and death upon infection. National and international societies have developed guidelines and statements, but consensus does not exist in several areas. In this Review, we attempt to clarify where consensus exists and where uncertainty remains to inform management approaches based on the first principles of neuroimmunology. We identified key questions that have been addressed in the literature and collated the recommendations to generate a consensus calculation in a Delphi-like approach to summarize the information. We summarize the international recommendations, discuss them in light of the first available data from patients with COVID-19 receiving immunotherapy and provide an overview of management approaches in the COVID-19 era. We stress the principles of medicine in general and neuroimmunology in particular because, although the risk of viral infection has become more relevant, most of the considerations apply to the general management of neurological immunotherapy. We also give special consideration to immunosuppressive treatment and cell-depleting therapies that might increase susceptibility to SARS-CoV-2 infection but reduce the risk of severe COVID-19. In this Review, the authors synthesize recommendations on the management of neuroimmunological disease in the context of the COVID-19 pandemic. They consider these recommendations alongside the first available data from patients, and provide an overview of management approaches in the COVID-19 era.

关键词： cardiac arrest   cardiopulmonary resuscitation (CPR)   neurological function   prediction model  

摘要： Background Cardiac arrest is still a global public health problem at present. The neurological outcome is the core indicator of the prognosis of cardiac arrest. However, there is no effective means or tools to predict the neurological outcome of patients with coma and survived 24 hours after successful cardiopulmonary resuscitation (CPR). Hypothesis Therefore, we expect to construct a prediction model to predict the neurological outcome for patients with coma and survived 24 hours after successful CPR. Methods A retrospective cohort study was used to construct a prediction model of the neurological function for patients with coma and survived 24 hours after successful CPR. From January 2007 to December 2015, a total of 262 patients met the inclusion and exclusion criteria. Results The predictive model was developed using preselected variables by a systematic review of the literature. Finally, we get five sets of models (three sets of construction models and two sets of internal verification models) which with similar predictive value. The stepwise model, which including seven variables (age, noncardiac etiology, nonshockable rhythm, bystander CPR, total epinephrine dose, APTT, and SOFA score), was the simplest model, so we choose it as our final predictive model. The area under the ROC curve (AUC), specificity, and sensitivity of the stepwise model were respectively 0.82 (0.77, 0.87), 0.72and 0.82. The AUC, specificity, and sensitivity of the bootstrap stepwise (BS stepwise) model were respectively 0.82 (0.77, 0.87), 0.71, and 0.82. Conclusion This new and validated predictive model may provide individualized estimates of neurological function for patients with coma and survived 24 hours after successful CPR using readily obtained clinical risk factors. External validation studies are required further to demonstrate the model's accuracy in diverse patient populations.

关键词： Probiotic supplementation   Inflammation   Oxidative stress   Neurological disorders   Meta-analysis  

摘要： Background and objective: The objective of meta-analysis of randomized controlled trials (RCTs) was to evaluate the effects of probiotic supplementation on metabolic status in patients with neurological disorders. Methods: The following databases were search up to April 2019: Pubmed, Scopus, Google scholar, Web of Science, and Cochrane Central Register of Controlled Trials. The quality of the relevant extracted data was assessed according to the Cochrane risk of bias tool. Data were pooled by the use of the inverse variance method and expressed as mean difference with 95 % Confidence Intervals (95 % CI). Results: Nine studies were included in this meta-analysis. The findings suggested that probiotic supplementation resulted in a significant reduction in C-reactive protein (CRP) [Weighted Mean Difference (WMD): -1.06;95 % CI: -1.80, -0.32] and malondialdehyde (MDA) levels (WMD: -0.32;95 % CI: -0.46, -0.18). Supplementation with probiotics also significantly reduced insulin (WMD: -3.02;95 % CI: -3.88, -2.15) and homeostatic model assessment for insulin resistance (HOMA-IR) (WMD: -0.71;95 % CI: -0.89, -0.52). Probiotics significantly reduced triglycerides (WMD: -18.38;95 % CI: -25.50, -11.26) and VLDL-cholesterol (WMD: -3.16;95 % CI: -4.53, -1.79), while they increased HDL-cholesterol levels (WMD: 1.52;95 % CI: 0.29, 2.75). Conclusion: This meta-analysis demonstrated that taking probiotic by patients with neurological disorders had beneficial effects on CRP, MDA, insulin, HOMA-IR, triglycerides, VLDL-cholesterol and HDL-cholesterol levels, but did not affect other metabolic parameters.