关键词： dog bites   injury   trauma  

摘要： In most cases of dog bites, there are low-risk injuries. However, more serious injuries may occur in rare cases which may include cerebral involvement due to skull fracture. The present case report aims to describe the medical care, clinical evolution, and impacts of lesions of a case of dog bite in a University Hospital. A 2-month-old female infant was in the baby-safe sleeper under supervision of the caregiver when she was attacked by a family dog. The infant showed uncontrollable vomiting, decreased level of consciousness, hypoactivity, fixed and pinpoint pupils, and hypovolemic shock. Owing to the severity of the fracture with scalping of the right temporal bone with exposed fracture and active bleeding, high-resolution computed tomography of the cranial region was indicated. The infant was referred to the surgical center to perform exploratory craniotomy. Plastic surgery was performed to allow debridement of devitalized tissues, revision of hemostasis and suture of scalp in a single continuous plane, and cartilage in the right ear. Owing to the severity of the lesions, the wounds evolved with mouth corner deviation to the left, and the infant had eyelid myoclonia and clonic seizures in the right upper limb. The patient remained in the ICU for 12 days with seizures controlled by anticonvulsants and received anti-biotic therapy. The infant attended the outpatient clinic for follow-up treatment in these areas: pediatric neurology, neurosurgery, plastic surgery, and motor physical therapy and visual rehabilitation. Nevertheless, the infant showed sequelae including left hemiparesis, hypertonia, hyperreflexia, and structural epilepsy. In pediatrics, the evaluation of dog bite victims requires systematization of medical care and quick hemodynamic and ventilatory support to reduce and prevent more severe sequelae, such as the neurological impairment of the present case. In addition, public health policies should emphasize the risks associated with dog bite incidents,

摘要： Chronic neurological diseases are the leading cause of disability globally. Yet, our health-care systems are not designed to meet the needs of many patients with chronic neurological conditions. Care is fragmented with poor interdisciplinary collaboration and lack of timely access to services and therapies. Furthermore, care is typically reactive, and complex problems are managed inadequately because of a scarcity of disease-specific expertise and insufficient use of non-pharmacological interventions. Treatment plans tend to focus on the disease rather than the individual living with it, and patients are often not involved in clinical decision making. By use of Parkinson's disease as a model condition, we show an integrated care concept with a patient-centred perspective that includes evidence-based solutions to improve healthcare delivery for people with chronic neurological conditions. We anticipate that this integrated care model will improve the quality of life for patients, create a positive working environment for health-care professionals, and be affordable.

摘要： [...]said Sir William Osler, a man who knew about the sea through his upbringing in a naval family and who learned medicine in many eminent institutions across the globe. [...]that Osler drew together two spheres of experience to make the central metaphor in that quote, the authors of Case studies in neurological infections of adults and children seek to combine the academic and experiential learning so central to the competent practice of medicine. Carmelo Serrano The book covers a broad range of pathologies both in terms of causative agent—bacterial, viral, parasitic, fungal, prion, and even autoimmune—as well as taking us right across the neuraxis from encephalitis to peripheral neuropathy.

关键词： granulomatous conditions   leprosy   sarcoidosis  

摘要： Sarcoidosis is a granulomatous condition with diverse clinical presentations, including neurological findings. It was previously hypothesized that perineural sarcoidal granulomas in the skin may be an explanation of small-fiber neuropathy. Herein, we present a case of a 55 year old female with anesthetic cutaneous lesions mimicking leprosy clinically and histopathologically and discuss the importance of this differential diagnosis.

关键词： Guillain-Barre syndrome   microcephaly   Zika virus   health-related quality of life   systematic review  

摘要： Objectives: In this systematic review, we synthesize the current evidence on health-related quality of life (HRQoL) for the two of the most relevant outcomes of Zika virus infection in humans, microcephaly and Guillain-Barre Syndrome (GBS). Methods: We searched the following databases: MEDLINE, Embase, CINAHL, LILACS, WHO's ICTRP clinical trials registries database and PROSPERO. Search terms included quality of life, microcephaly, and Guillain-Barre Syndrome. We included primary studies where HRQoL was quantitatively assessed for microcephaly and GBS using validated instruments. We used the Joanna Briggs Institute Critical Appraisal Tools to assess the risk of bias of individual studies. Results: From a total of 1,657 abstracts screened and 66 full texts reviewed, 21 studies met the eligibility criteria;one study for microcephaly and 20 for GBS. Adjusted disutilities for microcephaly compared to a normative childhood utility ranged from 20.745 to 20.820. For GBS, time traded-off the expected lifetime ranged from 16 days to 3 years. HRQoL follows the clinical course of GBS, with lower scores in the first months, recovery within the first year post onset, and stabilization after one year. Conclusions: Included studies reported a wide range of HRQoL for GBS, due in part to a high level of heterogeneity in methods, inclusion criteria, follow-up and reporting of results. Opportunities exist for primary studies assessing the longitudinal HRQoL over the entire course of the diseases to inform clinical practice, economic evaluations and health policy.

关键词： chronic migraine   medication   medication overuse   medication-overuse headache   migraine   prevention   primary headache   tension-type headache   therapy   treatment  

摘要： Background The frequent use of medication to treat migraine attacks can lead to an increase in migraine frequency and is called medication-overuse headache (MOH). Methods Based on the available literature in this guideline, the first step in patient management is education and counselling. Results Patients with MOH should be managed by a multidisciplinary team of neurologists or pain specialists and behavioral psychologists. Patients in whom education is not effective should be withdrawn from overused drugs and should receive preventive treatment with drugs of proven efficacy. Patients with MOH in whom preventive treatment is not effective should undergo drug withdrawal. Drug intake can be abruptly terminated or restricted in patients overusing simple analgesics, ergots or triptan medication. In patients with long-lasting abuse of opioids, barbiturates or tranquilizers, slow tapering of these drugs is recommended. Withdrawal can be performed on an outpatient basis or in a daycare or inpatient setting.

摘要： With this issue we begin print publishing the responses received in our call for Medical Education Adaptations: Lessons learned from educators' experiences rapidly transforming practice on account of COVID‐19 related disruption.

关键词： brain injury   cerebral organoids   functional recovery   neural repair   transplantation  

摘要： Background and Purpose Cerebral organoids (COs) have been used for studying brain development, neural disorders, and species-specific drug pharmacology and toxicology, but the potential of COs transplantation therapy for brain injury remains to be answered. Methods With preparation of traumatic brain injury (TBI) model of motor dysfunction, COs at 55 and 85 days (55 and 85 d-CO) were transplanted into damaged motor cortex separately to identify better transplantation donor for brain injury. Further, the feasibility, effectiveness, and underlying mechanism of COs transplantation therapy for brain injury were explored. Results 55 d-CO was demonstrated as better transplantation donor than 85 d-CO, evidenced by more neurogenesis and higher cell survival rate without aggravating apoptosis and inflammation after transplantation into damaged motor cortex. Cells from transplanted COs had the potential of multilinage differentiation to mimic in-vivo brain cortical development, support region-specific reconstruction of damaged motor cortex, form neurotransmitter-related neurons, and migrate into different brain regions along corpus callosum. Moreover, COs transplantation upregulated hippocampal neural connection proteins and neurotrophic factors. Notably, COs transplantation improved neurological motor function and reduced brain damage. Conclusions This study revealed 55 d-CO as better transplantation donor and demonstrated the feasibility and efficacy of COs transplantation in TBI, hoping to provide first-hand preclinical evidence of COs transplantation for brain injury.

关键词： Centers for Aging Medicine   Neurogeriatric assessment   Interdisciplinarity   Multidisciplinary team   Neurology   Cognitive decline   Movement disorder  

摘要： Geriatric medicine is a rapidly evolving field that addresses diagnostic, therapeutic and care aspects of older adults. Some disabilities and disorders affecting cognition (e.g. dementia), motor function (e.g. stroke, Parkinson's disease, neuropathies), mood (e.g. depression), behavior (e.g. delirium) and chronic pain disorders are particularly frequent in old subjects. As knowledge about these age-associated conditions and disabilities is steadily increasing, the integral implementation of neurogeriatric knowledge in geriatric medicine and specific neurogeriatric research is essential to develop the field. This article discusses how neurological know-how could be integrated in academic geriatric medicine to improve care of neurogeriatric patients, to foster neurogeriatric research and training concepts and to provide innovative care concepts for geriatric patients with predominant neurological conditions and disabilities.

关键词： HLA   Glutamic acid decarboxylase   Limbic encephalitis   Cerebellar ataxia   Stiff person syndrome  

摘要： The primary cause of neurological syndromes with antibodies against glutamic acid decarboxylase 65 (GAD65-Ab) is unknown, but genetic predisposition may exist as it is suggested by the co-occurrence in patients and their relatives of other organ-specific autoimmune diseases, notably type 1 diabetes mellitus (T1DM), and by the reports of a few familial cases. We analyzed the human leukocyte antigen (HLA) in 32 unrelated patients and compared them to an ethnically matched sample of 137 healthy controls. Four-digit resolution HLA alleles were imputed from available Genome Wide Association data, and full HLA next-generation sequencing-based typing was also performed. HLA DQA1*05:01-DQB1*02:01-DRB1*03:01 was the most frequent class II haplotype in patients (13/32, 41%). DQB1*02:01 was the only allele found to be significantly more common in patients than in controls (20/137, 15%, correctedp = 0.03, OR 3.96, 95% CI [1.54-10.09]). There was also a trend towards more frequent DQA1*05:01 among patients compared to controls (22/137, 16%;correctedp = 0.05, OR 3.54, 95% CI [1.40-8.91]) and towards a protective effect of DQB1*03:01 (2/32, 6% in patients vs. 42/137, 31% in control group;correctedp = 0.05, OR 0.15, 95% CI [0.02-0.65]). There was no significant demographic or clinical difference between DQ2 and non-DQ2 carriers (p > 0.05). Taken together, these findings suggest a primary DQ effect on GAD65-Ab neurological diseases, partially shared with other systemic organ-specific autoimmune diseases such as T1DM. However, it is likely that other non-HLA loci are involved in the genetic predisposition of GAD65-Ab neurological syndromes.