摘要： Hypoxic-ischaemic insults occurring during or after birth can cause both acute and long-term neurological impairment. The duration of the insult is a critical factor, but most published reports of duration have important limitations. After the onset of a persistent bradycardia in 125 term born infants, abnormal outcomes occurred in two by 10 minutes, in 12 out of 47 (26%) delivered between 11 and 20 minutes, and in 55 out of 65 (85%) delivered after 20 minutes. Series with unspecified gestation or including infants born preterm give comparable results in over 500 additional cases. Before 20 minutes there was little correlation with severity, while after 20 minutes most were severely impaired. Limited neuroimaging data suggest that damage restricted to the basal ganglia and thalamus may begin to occur after 10 minutes, associated Rolandic damage after 15 minutes, and other cortical involvement after 20 minutes. Associated white matter damage can occur after any duration. There were little data for other patterns of damage. What this paper adds Some term born infants can withstand 20 minutes of fetal bradycardia without acute or chronic damage. Durations in humans are not the same as in animal models.

关键词： neurology  

关键词： Cyclic vomiting   Mimics   Neurological disease   Pediatrics   Migraine   Abdominal migraine  

摘要： Cyclic vomiting syndrome is an idiopathic chronic periodic disorder of childhood which may persist into the adult years. Although cyclic vomiting syndrome is considered a central nervous system disorder, it is often managed by a pediatric gastroenterologist. The practitioner should not assume a gastrointestinal or non-neurological cause of symptoms especially if there are coexisting neurological symptoms and signs or if vomiting does not bring relief;this suggests a possible central nervous system cause, which may necessitate a pediatric neurology consultation. Examples of central nervous system causes of cyclic vomiting syndrome that can have subjective and objective neurological findings include abdominal migraine, certain types of epilepsy, structural lesions (tumors, Chiari malformation, demyelinating disease), mitochondrial disease, autonomic disorders, fatty acid/organic acid disorders, urea cycle defects, and cannabinoid hyperemesis syndrome. Improved familiarity with cyclic vomiting syndrome and its mimics may improve the time to appropriate diagnosis and may reduce morbidity related to cyclic vomiting syndrome. (C) 2019 Elsevier Inc. All rights reserved.

关键词： electromyography   lumbosacral   magnetic resonance image   nerve root compressions   radiculopathy   upper lumbar spinal stenosis  

摘要： Background Radiculopathies caused by spinal stenosis in the upper lumbar spinal canal (L1/2, L2/3, L3/4) have not been comprehensively investigated. Methods This retrospective study reviewed 14 patients from a tertiary hospital outpatient clinic. The inclusion criteria were upper lumbar stenosis seen on MRI and radiculopathies with active denervation confirmed on electromyography. Patients with any other conditions that could explain the clinical or electrophysiological manifestations were excluded. Results Neurogenic findings were predominantly observed in L5 or S1 myotomes on electromyography. Abnormal spontaneous activity was observed in distal muscles in all patients and in proximal muscles in eight patients. Axonal involvement was bilateral in 10 patients and unilaterally in 4 patients. MRI showed redundant nerve roots in 13 patients with chronic reinnervation on electromyography. Conclusions Upper lumbar spinal stenosis usually causes L5 or S1 radiculopathies with diverse patterns. This discrepancy may cause diagnostic confusion.

关键词： 临床医学  

ISBN: (纸本)9787030650191

摘要： 本书改编自第二版Current Diagnosis & Treatment：Neurology。为了便于推广应用，较大程度地缩减了原版教材的篇幅，删除了“中枢神经系统肿瘤”、“创伤”、“脑脊液动力学紊乱”、“酒精中毒”、“药物依赖”等超出国内神经病学教学大纲的章节。在疾病概论中适当补充了国内的流行病学资料，并根据国内医疗现状对神经系统疾病诊断和治疗部分进行了修订。考虑到教材的特殊性，本书内容以延续经典为主，同时将神经病学最新进展穿插其中，汇集了作者们宝贵的临床经验，语言纯正、图文并茂。

摘要： Brain oedema can create a ‘vicious cycle’ of increased intracranial pressure (ICP) and worsening oedema, which, if uninterrupted, can lead to brain herniation and death. Decompressive craniectomy (DC), a surgical procedure in which part of the skull is removed and the dura opened, is an effective strategy for controlling ICP [1].

关键词： Multiple sclerosis   Speech   Disease disability   Disease duration   Rehabilitation  

摘要： Purpose. In this study, we attempted to assess the phonation and articulation subsystem changes in patients with multiple sclerosis compared to healthy individuals using Dysphonia Severity Index and Formant Centralization Ratio with the aim of evaluating the correlation between these two indexes with neurological status. Materials and Methods. A sample of 47 patients with multiple sclerosis and 20 healthy speakers were evaluated. Patients' disease duration and disability were monitored by a neurologist. Dysphonia Severity Index and Formant Centralization Ratio scores were computed for each individual. Acoustic analysis was performed by Praat software;the statistical analysis was run using SPSS 21. To compare multiple sclerosis patients with the control group, Mann-Whitney U test was used for non-normal data and independent-samples t test for normal data. Also a logistic regression was used to compare the data. Correlation between acoustic characteristics and neurological status was verified using Spearman correlation coefficient and linear regression was performed to evaluate the simultaneous effects of neurological data. Results. Statistical analysis revealed that a significant difference existed between multiple sclerosis and healthy participants. Formant Centralization Ratio had a significant correlation with disease severity. Conclusion. Multiple sclerosis patients would be differentiated from healthy individuals by their phonation and articulatory features. Scores of these two indexes can be considered as appropriate criteria for onset of the speech problems in multiple sclerosis. Also, articulation subsystem changes might be useful signs for the progression of the disease.

关键词： Targeted surgical prevention   RRSO   RRESDO   Ovarian cancer   BRCA   Acceptability  

摘要： Primary surgical prevention in the form of risk-reducing salpingo-oophorectomy (RRSO) is the most effective option and the gold standard for ovarian cancer (OC) risk-reduction, particularly given the absence of an effective national OC screening programme. However, premenopausal RRSO leads to premature surgical menopause with detrimental long-term health sequelae particularly in women who do not/are unable to take hormone replacement therapy (HRT). HRT uptake in women undergoing premenopausal oophorectomy appears low and is dependent on informed counselling, the safety of HRT and efficacy in mitigating the health sequelae of premature menopause. Acceptance of a central role for the fallopian tube in OC etiopathogenesis, coupled with the detrimental consequences of premature menopause, has led to the attractive proposal of early-salpingectomy with delayed oophorectomy as an alternative OC surgical prevention strategy in premenopausal women who have completed childbearing but decline or wish to delay RRSO. The successful implementation of risk reducing surgery for OC prevention depends on the acceptability of surgery to both, recipients (e.g. BRCA1/BRCA2 carriers) and intervention deliverers (healthcare professionals/researchers). Acceptability is also informed by an understanding of health outcomes following risk reducing surgery and the safety of HRT. It is therefore vital to understand the effects of surgery on important health outcomes such as cardiovascular health, neurological function and bone health. We present a comprehensive review of acceptability, the selected health outcomes mentioned above and HRT safety following risk reducing surgery. (C) 2020 Published by Elsevier Ltd.

关键词： Conversion disorder   Stroke mimic   Functional neurological disorder  

摘要： Objective The prognosis of motor functional neurological disorder (FND) is considered poor;however, all data come from chronic cohorts collected by specialists. The aim of this study was to determine the clinical outcome of acute FND, captured as 'stroke-mimics'. Methods A meta-analysis of studies with outcome data on functional stroke mimics. Authors were contacted to provide more information on their FND mimics, including baseline, discharge and follow-up stroke scales. A random effects meta-analysis of proportion of 'good outcome' was the primary measure of interest, with additional descriptive and statistical analysis. 'Good outcome' employed the usual conventions of modified Rankin Score (mRS) or National Institutes of Health Stroke Scale (NIHSS) <= 1. Results Eight studies with 79 patients were identified and analysed, all of cohorts undergoing thrombolysis. The mean age at presentation was 49.7 years with a 62% female preponderance, and median NIHSS score of 4. The proportion of patients with mRS or NIHSS <= 1 changed significantly from admission to discharge or follow up [from 24 (30%) to 50 (63%), p < 0.001]. Meta-analysis of the synthesized data showed the pooled standardized mean change (SMC) was statistically significant (SMC = - 1.28, [95% CI = -2.25, - 0.30], p = 0.010) indicating good symptomatic outcome for acute FND patients presenting as stroke-mimics. Heterogeneity was large. Conclusion Patients presenting with acute motor FND have good outcome of their presenting symptoms by discharge and at follow-up, following thrombolysis for presumed stroke, in contrast to specialist cohorts. Demographic differences, in addition to the thrombolysis, are possible explanations for these more favourable results.

关键词： Phthalate   Quinolinic acid (QA)   Kynurenine Pathway (KP)   Neurologic disorder   Reproductive  

摘要： Background: Quinolinic acid (QA), a neuroactive metabolite produced during tryptophan degradation, is implicated in the pathogenesis of several neurological disorders. Phthalates are structurally similar to QA, and exposure to phthalates has demonstrated increased QA production and excretion in rodent studies. We recently showed that very high exposure to dibutyl phthalate was associated with higher concentrations of urinary QA in men. However, no human studies examined the associations between background (low) phthalate exposures and QA. Objectives: To examine the associations of urinary concentrations of phthalate metabolites with QA. Methods: Female participants (N = 126) who participated in a prospective cohort study at the Massachusetts General Hospital Fertility Center provided 758 urine samples (273 during pregnancy and 485 during nonpregnancy). Concentrations of 11 phthalate metabolites and QA in urine were measured. We used multivariable linear mixed effect models to estimate the percent change in urinary QA concentrations associated with a doubling (100%) of urinary phthalate metabolite concentration, and evaluated whether there was effect modification by pregnancy status. Results: Women's mean (standard deviation) age was 34.2 (4.0) years with a body mass index of 23.5 (3.7) kg/m(2). The women were primarily Caucasian (92%), had at least a college degree (98%), and none were current smokers. Pairwise Spearman correlations between concentrations for phthalate metabolites and QA measured in the same urine samples ranged from 0.36 for MEHP to 0.68 for dibutyl phthalate (DBP) metabolites. In multivariable-adjusted models, the percent change in urinary QA concentrations was significantly higher for each doubling of several urinary phthalate metabolite concentrations. For example, each doubling of DBP metabolites was associated with a 13.7% (95%CI: 10.6, 16.9)% higher QA. Associations between the low molecular weight phthalate metabolites and QA were stronger a