关键词： Early neurological deterioration   Blood pressure   Intravenous thrombolysis   Oxidative stress   Blood-brain barrier   MMP-9   AQP4  

摘要： Objective: To study association between blood pressure (BP) and development of early neurological deterioration (END) in acute ischemic stroke patients with intra-venous rt-PA thrombolysis and its possible mechanism. Methods: We prospectively collected data of acute ischemic stroke patients with intravenous rt-PA thromboly-sis from March 2015 to June 2019. The collected data include general, clinical data and laboratory test. Moreover, serum levels or activity of malondialdehyde (MDA), superoxide dismutase (SOD), matrix metalloproteinase-9 (MMP-9), occludin (OCLN), ZO-1 and aquaporin 4(AQP-4) were determined. Results: A total of 357 acute ischemic stroke patients received intravenous rt-PA thrombolysis and 16 cases were eventually excluded. Finally, 341 patients were eligible in this study and 65 patients (19.06%) experienced END. Mean systolic blood pressure (SBP) within 24 h, serum levels or activity of MDA, SOD, MMP-9, ZO-1, OCLN, AQP-4 at 24 h after thrombolysis were the independent predictors for END in the total and hyper-tension population using multivariate logistic regression analysis, and mean SBP within 24 h was the best predictor for END. Receiver operating characteristic (ROC) analysis found that cutoff mean SBP for END was 148.16 mmHg, and sensitivity was 85.6%. The best target SBP level is 140@149 mmHg. Further, spearman correla-tion tests indicated that BP levels were directly proportional to serum levels or activity of MDA, MMP-9, ZO-1, OCLN, AQP-4 at 24 h after thrombolysis and neu-rological deterioration severity. Conclusions: END frequently occurs after thrombol-ysis, and the best predictor of END is SBP which may be mediated through oxidative stress induced blood-brain barrier disruption and AQP4 upregulation.

摘要： Measuring the outcomes of pediatric stroke is a challenge, and hitting the target has been difficult. There has been an explosion of research in pediatric stroke as clinicians and researchers have directed attention to what was once considered a rare disorder. Earlier investigators knew that systematic measurement of outcomes is essential but that measurement in pediatric stroke has been inconsistent in the literature. Only one stroke outcome measure is validated in children, the Pediatric Stroke Outcome Measure (PSOM). The PSOM has been used in a number of observational1 and descriptive studies.2,3 Over the years, investigators noted that the PSOM scored some patients as having more severe deficits than seemed clinically warranted. Accordingly, there was realization that the PSOM needed to be refined, but as one can imagine any attempt to modify or re-interpret a measure as important as the PSOM creates worries about how those modifications might affect the measure.

摘要： There has been significant media attention and a New York City Health Alert [1] surrounding “Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19.” As of May 18, 2020, there were 145 suspected cases of this syndrome in New York City [2]. While this disease has been outlined as having components shock and similarities to Kawasaki disease, associated neurologic manifestations have not been described (https://***/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%***). We have encountered several children with this condition and highlight two with major neurological complications.

关键词： Hypoxic-ischemic encephalopathy   Magnetic resonance imaging   Diffusion magnetic resonance imaging   Prognosis   Regression analysis  

摘要： Objective: To investigate the value of a model based on brain magnetic resonance imaging (MRI) performed in the subacute phase (between the 1st and 30th day) in predicting long-term neurological outcomes of adult hypoxic-ischemic encephalopathy (HIE) patients. Methods: Ninety-six adult HIE patients who underwent conventional MRI and diffusion-weighted imaging (DWI) during the subacute phase were retrospectively analyzed. Favorable (Cerebral Performance Categories (CPC) 1-2) and unfavorable outcome (CPC 3-5) groups were created based on patient neuro-logical status approximately three months after the onset of hypoxic-ischemic events. A multivariate stepwise regression model was applied after univariate analysis of MRI findings, and then the overall MRI score, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), Bilateral ASPECTS (Bi-ASPECTS), modified ASPECTS (mASPECTS) and Bi- ASPECTS combined with posterior circulation ASPECTS (PC-ASPECTS) were calculated based on MRI findings. Receiver operating characteristic (ROC) curves were used to assess prognostic accuracy. Results: Both univariate and multivariate analyses showed the cerebral cortex and cerebellum, neostriatum, hippocampus, brainstem and postanoxic leukoencephalopathy were independent prognostic factors for unfavorable outcomes. The multivariate regression analysis resulted in an overall classification accuracy of 84.4%, a sensitivity of 84.2% (95% CI, 71.6-92.1%), and a specificity of 92.3% (95% CI, 78.0-98.0%) for unfavorable outcomes. The model had an areas under the ROC curves (AUC) of 0.944 (95% CI, 0.901-0.987);the MRI overall scores were 0.918 (95% CI, 0.866, 0.971), ASPECTS 0.839 (95% CI, 0.755, 0.923), Bi-ASPECTS 0.837 (95% CI, 0.753, 0.922), mASPECTS 0.851(95% CI, 0.771, 0.931) and Bi-ASPECTS+PC-ASPECTS 0.876 (95% CI, 0.806, 0.946). Conclusions: The multivariate model based on conventional MRI combined with DWI performed in the subacute phase could help predict the prognosis of adult

关键词： melatonin   neurogenesis   neural stem cell   neurogenesis impairment   neurological disorder   molecular mechanism   review  

摘要： Neurogenesis is the process by which functional new neurons are generated from the neural stem cells (NSCs) or neural progenitor cells (NPCs). Increasing lines of evidence show that neurogenesis impairment is involved in different neurological illnesses, including mood disorders, neurogenerative diseases, and central nervous system (CNS) injuries. Since reversing neurogenesis impairment was found to improve neurological outcomes in the pathological conditions, it is speculated that modulating neurogenesis is a potential therapeutic strategy for neurological diseases. Among different modulators of neurogenesis, melatonin is a particularly interesting one. In traditional understanding, melatonin controls the circadian rhythm and sleep-wake cycle, although it is not directly involved in the proliferation and survival of neurons. In the last decade, it was reported that melatonin plays an important role in the regulation of neurogenesis, and thus it may be a potential treatment for neurogenesis-related disorders. The present review aims to summarize and discuss the recent findings regarding the protective effects of melatonin on the neurogenesis impairment in different neurological conditions. We also address the molecular mechanisms involved in the actions of melatonin in neurogenesis modulation.

关键词： consanguineous marriages   homozygous variant   lower limbs weakness   missense variants   NKX6-2 gene   progressive spastic ataxia  

摘要： Background Progressive spastic ataxia is a heterogeneous disorder characterized by cerebellar ataxia and limb spasticity associated with other severe neurological complications. Spastic ataxia is classified into pure and complex types, inherited in both an autosomal recessive and autosomal dominant manner. It is caused by pathogenic variants in at least eight different genes, including NKX6-2 (MIM 607063) located on chromosome 10q26.3. The present study aimed to identify the genetic variant(s) underlying progressive spastic ataxia and to establish the genotype-phenotype correlation. Methods We collected a large consanguineous family having four affected individuals segregating progressive spastic ataxia in an autosomal recessive manner. To investigate the molecular cause of the disease, genomic DNA of three affected individuals underwent whole exome sequencing. Results All of the affected individuals showed progressive clinical features such as spastic ataxia, lower limb weakness and other mild neurological abnormalities. Whole exome sequencing data were analyzed using different filters. Filtering of rare and shared homozygous variants revealed a novel homozygous missense variant (c.545C>T;***182Val) in a highly conserved homeobox domain of the NKX6-2 protein. Conclusions The findings of the present study add a novel variant to the NKX6-2 mutation spectrum and provide evidence that homozygous variants in the NKX6-2 cause progressive spastic ataxia associated with other abnormalities.

关键词： COVID-19   Pandemic   Education   Neurology training  

摘要： Throughout this pandemic, neurology resident education and service has, and will continue to be, affected during this unprecedented time. Balancing the safety of our residents as well as the anticipated inpatient service demands, we have, and continue to, make changes to meet the needs of our community. Education certainly has been affected but we have made great effort to maintain normalcy. We are leveraging web-based technologies to continue formal didactics. The American Academy of Neurology has provided program directors with various tools to share to provide high-yield academic education. AAN Synapse, distance learning modules, and podcasts are a few examples. Each residency training program will likely face different challenges depending on location and community structure. We have an obligation to help all of our colleagues in the hospital in providing quality and compassionate care during this time of need. Our training and education will only benefit from this experience teaching us lessons on adaptability, the importance of teamwork, and self-sacrifice. (C) 2020 Elsevier Ltd. All rights reserved.

关键词： Burst fracture   Thoracolumbar spine   Spinal fracture   Posterior approach   Young patients   Neurological deficits  

摘要： Introduction: Surgical management of thoracolumbar burst fractures is controversial. While the goals of surgical treatment are well accepted (i.e., fracture reduction and stabilization, neural elements decompression, and segmental angular deformity correction), the choice of the best surgical approach (i.e., posterior vs. anterior vs. combined approach) remains controversial. Several studies have debated the advantages of each surgical approach but there is no definitive evidence available to date, particularly in young adult patients. The aim of this study was to assess whether posterior approach alone can be a valid surgical treatment for patient under the age of 40 affected by thoracolumbar burst fractures and incomplete neurological deficits. Material and Methods: A total of 10 consecutive patients affected by thoracolumbar burst fractures associated with incomplete neurological deficits treated at our institution from January 2015 to February 2017 were included in our study. All patients were under the age of 40 at the time of injury and underwent decompression and stabilization using the posterior surgical approach alone. Demographics, clinical, and radiographic parameters were recorded preoperatively, postoperatively and at the latest available follow-up. The minimum follow-up was set at 2 years post-operatively. Results: The mean operative time was 303.6 min (range, 138-486). Average blood loss was 756 mL (range, 440-2100). Nine out of ten patients returned to a normal neurological status after surgery while 1 patient showed some improvement but did not recover completely. Segmental kyphotic deformity improved from a mean of 21.8 degrees before surgery to 14.8 degrees at the time of the last follow-up. The anterior and posterior wall height of the fractured vertebra was restored with an average of 4 mm. The Visual Analogue Scale score reported an improvement from the mean preoperative value of 7.92 to 1.24 at the last follow-up;8 out of 10 patients resumed p