关键词： Lymphoma   Diagnosis   Sarcoidosis   Neurology   Burkitt lymphoma   Angiotensin Converting Enzyme   Vasculitis  

摘要： The title "great imitator" refers to conditions which can cause varied manifestations and mimic many diseases. Lymphoma is worthy of this title. We describe three cases of lymphoma in which lymphoma mimicked other diseases causing neurological dysfunction, specifically sarcoidosis, vasculitis and infection respectively. Case 1 was a 66-year-old man with subacute progressive diplopia and gait disturbance and investigations revealing a supratentorial para-falcine soft tissue lesion, mid-thoracic cord enhancement and right axillary mass and an elevated serum ACE. Right axillary mass core biopsy was diagnostic of Burkitt lymphoma. Case 2 was a 50-year-old man with several weeks of constitutional symptoms and development of lower limb weakness and numbness, urinary retention and confusion while in hospital. MRI brain demonstrated multi-territory cerebral infarcts. Intravascular lymphoma was diagnosed on random skin biopsy. Case 3 was a 65-year-old man with several weeks of headache and diplopia on a background of previously treated Burkitt lymphoma. CSF analysis showed a lymphocytic pleocytosis and markedly low glucose with cytologic analysis negative for malignancy. Investigations for an infective cause were negative. FDG-PET demonstrated marked, disseminated spinal and cranial leptomeningeal disease and a multi-focal, intra-dural relapse of Burkitt lymphoma was diagnosed. The varied manifestations in our cases demonstrate the ability for lymphoma to mimic infective, inflammatory, granulomatous (including sarcoidosis) and neoplastic aetiologies. An elevated serum ACE appears insufficiently diagnostic to confirm sarcoidosis and tissue for histological examination should be sought whenever possible. When the diagnosis is uncertain, the possibility of this great imitator should be considered, especially for multi-focal disease. (C) 2020 Elsevier Ltd. All rights reserved.

关键词： Pediatric neurology physiotherapy   Walking problem   Cerebral palsy  

摘要： Introduction: Cerebral palsy is one of the conditions that usually cause disability in children. One of its symptoms is the walking problem. The purpose of this study is to examine the effectivity of Pediatric Physiotherapy Run Technique (PPRT) in improving walking ability of children with cerebral palsy. Methods: This is a pre-experimental study with time-series design. Twenty participants were included in this study. The outcome measure used was motor gross function measure (MGFM) walking dimension, which measured at baseline and after three times and nine times of PPRT session. Data were analyzed using repeated measure ANOVA. Results: The results of this study showed that there is a significantly different (p< 0.05) between pre, three times and nine times. The nine times is significantly higher than the baseline. Conclusion: Children with cerebral palsy may benefit from the PPRT program to improve their walking capacity. (C) 2019 Elsevier Espana, S.L.U. All rights reserved.

摘要： In connection with the development of the journal and the increased complexity of the reviewing process, I am very happy to announce a change in the process of selecting articles. I have appointed associate editors for specific fields that are particularly represented in the current submissions, including cerebrovascular disease and stroke, abnormal movements and Parkinsonism, peripheral neurological disease, neuroimmunology, behavioral neurology, and epilepsy. [Extracted from the article]

关键词： Bariatric surgery   Weight loss   Drop foot   Neurological complications  

摘要： Background The relationship between rapid weight loss and peroneal nerve entrapment neuropathy (PNEN) was shown in various series following bariatric surgery. Thus, we aimed to determine the occurrence of PNEN in our patients who underwent laparoscopic sleeve gastrectomy (LSG) and to reveal the factors contributing to this complication. Methods We evaluated our series of 635 patients in terms of neurological symptoms following laparoscopic sleeve gastrectomy, retrospectively. We recorded the preoperative data, laboratory vitamin and nutrient levels, weight loss, electromyography (EMG) findings, and treatment modalities of these patients. Results Seven out of 635 patients developed foot drop as a result of PNEN after bariatric surgery. The mean total weight loss for these patients was 50.6 kg in 6 months, and 63 kg in 12 months. In the laboratory analyses, we did not detect any signs of vitamin deficiency. EMG findings confirmed the diagnosis. Conclusion We demonstrate that rapid weight loss is correlated with the risk of foot drop incidence as a result of PNEN.

关键词： Childhood cancer   Neurology   Chemotherapy   Immunotherapy  

摘要： Both the onset of various malignancies as well as the treatment of cancer can lead to neurologic symptoms which can be difficult to diagnose. In this review, we highlight the varied ways in which neurologic sequelae of cancer and its treatment manifest in children. Initial neurologic presentation may be secondary to mass effect or to immune-mediated paraneoplastic syndromes. Treatment effects on the nervous system may arise from surgery, chemotherapy, radiation, or bone marrow transplantation. In addition, the rapidly expanding field of immunotherapies for cancer has generated numerous new approaches to eradicating cancer including monoclonal antibodies, checkpoint inhibitors, and chimeric antigen receptor T cells (CAR-T cells), which have neurologic side effects mediated by immune responses that are also being recognized. Here we review common consult questions to the neurologist and our general approach to these scenarios including altered mental status, headaches, seizures, and sensorimotor complaints, considering the multifactorial nature of each.

关键词： Neurological diseases   Respiratory failure   Hypercapnia   Hypoxemia   Invasive mechanical ventilation   Noninvasive ventilation  

摘要： Many neurological diseases may cause acute respiratory failure (ARF) due to involvement of bulbar respiratory center, spinal cord, motoneurons, peripheral nerves, neuromuscular junction, or skeletal muscles. In this context, respiratory emergencies are often a challenge at home, in a neurology ward, or even in an intensive care unit, influencing morbidity and mortality. More commonly, patients develop primarily ventilatory impairment causing hypercapnia. Moreover, inadequate bulbar and expiratory muscle function may cause retained secretions, frequently complicated by pneumonia, atelectasis, and, ultimately, hypoxemic ARF. On the basis of the clinical onset, two main categories of ARF can be identified: (i) acute exacerbation of chronic respiratory failure, which is common in slowly progressive neurological diseases, such as movement disorders and most neuromuscular diseases, and (ii) sudden-onset respiratory failure which may develop in rapidly progressive neurological disorders including stroke, convulsive status epilepticus, traumatic brain injury, spinal cord injury, phrenic neuropathy, myasthenia gravis, and Guillain-Barre syndrome. A tailored assistance may include manual and mechanical cough assistance, noninvasive ventilation, endotracheal intubation, invasive mechanical ventilation, or tracheotomy. This review provides practical recommendations for prevention, recognition, management, and treatment of respiratory emergencies in neurological diseases, mostly in teenagers and adults, according to type and severity of baseline disease.

关键词： Palliative care   pediatric   patient-centered outcomes research   qualitative research   caregiver   family   parents  

摘要： Background: The interest in outcome measurement in pediatric palliative care is rising. To date, the majority of studies investigating relevant outcomes of pediatric palliative care focus on children with cancer. Insight is lacking, however, about relevant outcome domains for children with severe neurological impairment and their families. Aim: The aim of this study was to identify meaningful outcome domains of pediatric palliative care for children with severe neurological impairment and their families. Design: A qualitative research design following a constructivist research paradigm was employed. Guided interviews were conducted with parents of children with life-limiting conditions and severe neurological impairment and professional caregivers. The data were analyzed using qualitative content analysis. Setting: Overall, 10 cooperating pediatric palliative care institutions across Germany (outpatient and inpatient settings) aided in the recruitment of eligible parents and professional caregivers. A total of 11 interviews with 14 parents and 17 interviews with 20 professional caregivers were conducted. Results: Six core outcome domains of pediatric palliative care for children with severe neurological impairment and their families were identified, namely (1) symptom control, (2) respite and support, (3) normalcy, (4) security, (5) empowerment, and (6) coping with the disease, each consisting of 1 to 13 individual aspects. Conclusion: As for other diagnostic groups, symptom control is a relevant outcome domain for children with severe neurological impairment. However, other outcome domains which focus on the whole family and take into account the long disease trajectory, such as respite and support, security, empowerment, and coping with the disease, are also crucial.

关键词： Out-of-hospital cardiopulmonary arrest   Hypoxia-ischemia brain   Induced hypothermia   Phosphopyruvate hydratase   Prognosis   Survivors  

摘要： Introduction and objectives: Neuron-specific enolase (NSE) is a prognostic marker in out-of-hospital cardiopulmonary arrest (OHCA) survivors treated with mild therapeutic hypothermia (MTH). The objectives were to analyze the correlation between dynamic changes in NSE and outcomes and to determine the measurement timing that best predicts neurological status. Methods: Multicenter cohort study including patients admitted after shockable rhythm OHCA and treated with MTH. Serum NSE was sampled at 2 different times and Delta-NSE (%) was calculated as 100 x (NSE2-NSE1)/NSE1. In-hospital mortality and neurological outcome, as assessed by the Cerebral Performance Category (CPC) scale, were evaluated during admission and after a 6-month follow-up. Results: We included 166 patients admitted to 4 hospitals. In-hospital mortality was 31.9%. Almost 60% of patients had a good neurological recovery (CPC 1-2). On univariate and multivariate logistic regression analyses, an increase in NSE levels was associated with higher in-hospital mortality and worse CPC on discharge and after 6-months (P<.001). Positive Delta-NSE showed an OR = 9.28 (95% CI 4.40-19.57) for mortality, OR = 11.23 (95% CI 5.24-24.11) for CPC 3-5 at discharge and OR = 11.14 (95% CI 5.05-24.55) for CPC 3-5 after 6-months' follow-up (P<.001). The first NSE measurement, conducted at 18 to 24 hours, and the second measurement at 69 to 77 hours after OHCA showed a high area under the curve in predicting CPC at discharge (0.9389 and 0.9909, respectively;0.8096 for the whole cohort). Conclusions: Dynamic changes in NSE serum levels are good markers of hard clinical outcomes after an OHCA due to shockable rhythm in an MTH-treated cohort. NSE measurements at specific intervals after OHCA may predict events even more precisely. (C) 2019 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cardiologia.

关键词： Neuron theory   Cerebral cortex   Neuronal amoeboidism   Glial amoeboidism   Santiago Ram6n y Cajal (1852-1934)   Pedro Lopez-PelSez y Villegas (1863-1903)  

摘要： The purpose of this article is two-fold: first, to preserve, in updated English translations, two theoretical papers written by Santiago Ramon y Cajal (1852-1934) in 1895 and 1896 under the titles, "Conjectures on the anatomical mechanism of ideation, association and attention" and "Conjectural interpretations of certain points in neurological histophysiology";and second, to set some of the ideas proposed by Cajal in a modern perspective. In his "Conjectures," Cajal ventured to explain the mechanisms of perception, association and attention in cellular terms. He introduced the term "impression unit," which would propagate, leading to conscious act via an "avalanche of conduction." Additionally, he attributed mental repose and sleep to morphological variations of neuroglia;at times of relaxation, astrocytes would grow appendices that penetrated among nerve cell connections and blocked the conduction of the "nervous current";in energetic contraction, such glial "pseudopodia" would shrink, allowing neuronal processes to come into contact again. In the sequel to the "Conjectures," Cajal presented strong arguments defending the neuron theory against the reticular theory. Moreover, he discussed the functional differentiation of spinal motor neurons and cortical pyramidal cells, which respectively subserve movement and consciousness, despite their morphological similarity.

关键词： Myxoma   Stellate cells   Fusiform aneurysm   CRP   Radiotherapy  

摘要： Cardiac myxoma can embolize and cause early and delayed sequelae including stroke, growth into intracranial fusiform aneurysms and cerebral tumors with risk of hemorrhage and mass effect. Here, we report the rare coincidence of all these manifestations in a 63-year-old man who presented with cognitive and behavioral changes, and seizures 9 months after an embolic stroke from the heart tumor. C-reactive protein (CRP) was elevated at the time of stroke and cardiac myxoma diagnosis but was normal at late neurologic manifestation with isolated myxoma-related intracranial tumors and aneurysms. Low-dose whole-brain radiotherapy can be helpful to diminish cerebral myxoma tumors and fusiform aneurysms despite reported increased risk of aneurysm rupture.