关键词： coronavirus   COVID-19   neurological   survey  

摘要： Background and purpose Although the main clinical features of COVID-19 infection are pulmonary, several associated neurological signs, symptoms and diseases are emerging. The incidence and characteristics of neurological complications are unclear. For this reason, the European Academy of Neurology (EAN) core COVID-19 Task Force initiated a survey on neurological symptoms observed in patients with COVID-19 infection. Methods A 17-question online survey was made available on the EAN website and distributed to EAN members and other worldwide physicians starting on 9 April 2020. Results By 27 April 2020, proper data were collected from 2343 responders (out of 4199), of whom 82.0% were neurologists, mostly from Europe. Most responders (74.7%) consulted patients with COVID-19 mainly in emergency rooms and in COVID-19 units. The majority (67.0%) had evaluated fewer than 10 patients with neurological manifestations of COVID-19 (neuro COVID-19). The most frequently reported neurological findings were headache (61.9%), myalgia (50.4%), anosmia (49.2%), ageusia (39.8%), impaired consciousness (29.3%) and psychomotor agitation (26.7%). Encephalopathy and acute cerebrovascular disorders were reported at 21.0%. Neurological manifestations were generally interpreted as being possibly related to COVID-19;they were most commonly recognized in patients with multiple general symptoms and occurred at any time during infection. Conclusion Neurologists are currently and actively involved in the management of neurological issues related to the COVID-19 pandemic. This survey justifies setting up a prospective registry to better capture the prevalence of patients with neuro COVID-19, neurological disease characteristics and the contribution of neurological manifestations to outcome.

关键词： brain death   hemodynamics   tissue and organ procurement  

摘要： Purpose We performed a systematic review of the literature to identify the ideal blood pressure (BP) target in neurologically deceased organ donors to optimize outcomes of recipient organ function and survival, and organs transplanted per donor. Source We searched MEDLINE and EMBASE from inception to December 2018 for studies that evaluated BP targets in neurologically deceased organ donors. A two-step review process with three independent reviewers was employed. We assessed the risk of bias and applied Grading of Recommendations Assessment, Development, and Evaluation methodology to evaluate the certainty of the evidence by outcome. Principal findings Twelve cohort studies were included in our final analysis. Seven studies showed that hypotension was associated with worse post-transplant graft function or survival, while three studies found no association between hypotension and post-transplant graft function or survival. Two other studies showed no association between hypotension and organs transplanted per donor. Overall, six of the identified studies had serious risk of bias. Conclusion A systolic BP less 90 mmHg may be associated with graft dysfunction in kidney recipients, but this is based on very low certainty in evidence. Although an ideal and universal BP target in neurologically deceased organ donors is not clearly identifiable in the literature, this could reflect the complexity of donor hemodynamics and the need for individualized targets for different organs. Further prospective research is required to address these questions.

关键词： africa   coronavirus   neurology   neuro-COVID-19 Africa   SARS-CoV-2  

关键词： Spinal cord injury   Biomarkers   Syringomyelia   Cerebrospinal fluid   Tethering of the spinal cord (TSC)   Glial fibrillary acidic protein (GFAP)   Ubiquitin C-terminal hydrolase L1 (UCH-L1)   Neurofilament   Post-traumatic myelopathy  

摘要： Background Years after a traumatic spinal cord injury (SCI), a subset of patients may develop progressive clinical deterioration due to intradural scar formation and spinal cord tethering, with or without an associated syringomyelia. Meningitis, intradural hemorrhages, or intradural tumor surgery may also trigger glial scar formation and spinal cord tethering, leading to neurological worsening. Surgery is the treatment of choice in these chronic SCI patients. Objective We hypothesized that cerebrospinal fluid (CSF) and plasma biomarkers could track ongoing neuronal loss and scar formation in patients with spinal cord tethering and are associated with clinical symptoms. Methods We prospectively enrolled 12 patients with spinal cord tethering and measured glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and phosphorylated Neurofilament-heavy (pNF-H) in CSF and blood. Seven patients with benign lumbar intradural tumors and 7 patients with cervical radiculopathy without spinal cord involvement served as controls. Results All evaluated biomarker levels were markedly higher in CSF than in plasma, without any correlation between the two compartments. When compared with radiculopathy controls, CSF GFAP and pNF-H levels were higher in patients with spinal cord tethering (p <= 0.05). In contrast, CSF UCH-L1 levels were not altered in chronic SCI patients when compared with either control groups. Conclusions The present findings suggest that in patients with spinal cord tethering, CSF GFAP and pNF-H levels might reflect ongoing scar formation and neuronal injury potentially responsible for progressive neurological deterioration.

摘要： This letter comments on the letter by

关键词： clinical trials   Miro1   mitochondria   mitophagy   Parkinson's disease   precision  

摘要： Parkinson's disease (PD) is a debilitating movement disorder, significantly afflicting the aging population. Efforts to develop an effective treatment have been challenged by the lack of understanding of the pathological mechanisms underlying neurodegeneration. We have shown that Miro1, an outer mitochondrial membrane protein, situates at the intersection of the complex genetic and functional network of PD. Removing Miro1 from the surface of damaged mitochondria is a prerequisite for mitochondrial clearance via mitophagy. Parkinson's proteins PINK1, Parkin, and LRRK2 are the molecular helpers to remove Miro1 from dysfunctional mitochondria destined for mitophagy. We have found a delay in clearing Miro1 and initiating mitophagy in postmortem brains and induced pluripotent stem cell-derived neurons from PD patients harboring mutations inLRRK2,PINK1, orParkin, or from sporadic PD patients with no known mutations. In addition, we have shown that reducing Miro1 by both genetic and pharmacological approaches can correct this Miro1 phenotype and rescue Parkinson's-relevant phenotypes in human neurons and fly PD models. These results suggest that the Miro1 defect may be a common denominator for PD, and compounds that reduce Miro1 promise a new class of drugs to battle PD. We propose to couple this Miro1 phenotype with Miro1-based drug discovery in future therapeutic studies, which could significantly improve the success of clinical trials. (c) 2020 International Parkinson and Movement Disorder Society

关键词： COVID-19   Stroke   Rehabilitation  

摘要： The article reports on the neurological signs and symptoms associated with COVID-19 infection in a hospitalized population in Wuhan, China, the initial epicenter of the disease. It mentions that persistence of symptoms that affect the nervous system, such as headache and dizziness, can have a profound impact on function. It also mentions that neurological disease is recognized as a grave concern in a subset of patients with COVID-19.

关键词： COVID-19   Functional neurological disorders   Functional movement disorders   Psychogenic non-epileptic seizures   Conversion disorders  

关键词： Anoxic-ischemic encephalopathy   Cardiac arrest   Computed tomography   Neuroimaging   Cerebral networks   Prognostication  

摘要： Purpose: To quantitatively assess the severity of anoxic-ischemic brain injury early after cardiac arrest (CA) using a novel automated method applied to head computed tomography (HCT). Methods: Adult patients who were comatose and underwent HCT < 24 h after arrest were included in a retrospective analysis. Principal endpoint was unfavorable outcome (UO) defined as Cerebral Performance Category (CPC) of 3-5 at hospital discharge. We developed an automated processing algorithm for HCT images to be registered, atlas-segmented in 181 regions, and region-specific radiologic densities determined in Hounsfield Units. This approach was compared with an established manual method evaluating grey-white matter ratios (GWR). We tested univariable and multivariable prognostic models which integrated clinical and HCT features including densities in lobes and in nodes of cerebral networks linked to CA recovery. Results: Ninety-one patients were enrolled among whom 66 (73%) had an UO. HCTs were interpreted as normal or without acute abnormality by a neuroradiologist in 77 cases (85%). Compared to the favorable outcome group, UO patients had significantly lower densities in all lobes and in nodes of cerebral networks. A model combining clinical variables with the automated method applied to cerebral network nodes had the highest prognostic performance although not significantly different than the combined clinical-GWR method (AUC [95% CI] 0.94 [0.86-1.00] and 0.92 [0.83-1.00] respectively). Conclusion: In comatose survivors of CA, automated quantitative analysis of HCT revealed very early multifocal changes in brain tissue density which are mostly overlooked on conventional neuroradiologic interpretation and are associated with neurological outcome.