摘要： Access to neuropathology is now becoming more and more difficult for clinical neurologists in Japan mainly because the numbers of autopsies and neuropathology laboratories to evaluate the brain are in catastrophic decline. Although clinical diagnoses for CBD/PSP are quite difficult, they demonstrated how neuropathology is powerful and useful to unmask the underlying processes. We will be very happy if this crosstalk between neuropathology and clinical neurology is enjoyable and helpful in activating neurology practice, education and research. [Extracted from the article]

关键词： Cardiac arrest   Targeted temperature management   Therapeutic hypothermia   Pupillary light reflex   Prognostication  

摘要： Background The absence of the pupillary light reflex (PLR) 3 days after cardiac arrest predicts poor outcome, but quantitative PLR assessment with pupillometry early after recovery of spontaneous circulation (ROSC) and throughout targeted temperature management (TTM) has rarely been evaluated. Methods Fifty-five adult patients treated with TTM with available pupillometry data from the NeurOptics NPi-200 were studied. Discharge outcome was classified good if the cerebral performance category score was 1-2, poor if 3-5. Pupil size, PLR percent constriction (%PLR), and constriction velocity (CV) were determined at TTM start and 6 (+/- 2)-h post-ROSC ("early"), and throughout TTM using data from the worst eye at each assessment. The Neurological Pupil index (NPi) was also determined at each pupil assessment;the NPi is scored from 0 (nonreactive) to 5 (brisk) with values < 3 considered sluggish or abnormal. Prognostic performance to predict poor outcome was assessed with receiver operator characteristic curves. Results All nine patients with >= 1 nonreactive pupil (NPi = 0) within 6 (+/- 2) h after ROSC died, and 12/14 (86%) with sluggish pupils (0 < NPi < 3) had poor outcomes. 15/29 (52%) patients with normal pupil reactivity (NPi >= 3) had poor outcomes, four survived with cerebral performance category = 3, three died of cardiac causes, and eight died of neurologic causes. During TTM, 20/21 (95%) patients with nonreactive pupils had poor outcomes, 9/14 (64%) of patients with sluggish pupils had poor outcomes, and 9/20 (45%) with normal pupil reactivity had poor outcomes. Pupil size did not predict outcome, but NPi (AUC = 0.72 [0.59-0.86], p < 0.001), %PLR (AUC = 0.75 [0.62-0.88], p < 0.001) and CV (AUC = 0.78 [0.66-0.91], p < 0.001) at 6 h predicted poor outcome. When nonreactive pupils were first detected, 75% were < 5 mm. Conclusions Very early after resuscitation from cardiac arrest, abnormal Neurological Pupil index and pupillary light reflex measurements by pupill

关键词： encephalitis   febrile seizure   epilepsy   neurodevelopment   pediatric   status epilepticus  

摘要： Purpose: Human herpesvirus 6 (HHV-6) can infect the central nervous system in immunocompromised individuals. Less is known, however, about HHV-6 infection in immunocompetent patients. This study evaluated the neurologic features and prognosis of HHV-6 infection in immunocompetent patients. Methods: The medical records of patients aged 1 month to 18 years who underwent cerebrospinal fluid examinations and were tested for 6 viruses, including HHV-6, by multiplex polymerase chain reaction were evaluated retrospectively. Results: During the study period, 252 children were included. None had underlying disease and all were immunocompetent. Their mean age at diagnosis was 40.98 +/- 47.65 months. Of these 252 patients, 144 (57.1%) were diagnosed with meningitis, 84 (33.3%) with febrile seizure not induced by meningitis, and 24 (9.5%) with encephalitis. Of the 9 patients positive for HHV-6, 3 (33.3%) had encephalitis, 3 (33.3%) had meningitis, 1 (11.1%) had complex febrile seizure, and the other 2 patients had fever alone. Outcomes were worse in the seizure group (Fisher exact test, P = .048), especially in patients with status epilepticus (Fisher exact test, P = .012), than in the other groups. Encephalitis patients with and without HHV-6 differed significantly in age (24.0 +/- 10.8 vs 63.4 +/- 47.7 months, t-test P < .05), with status epilepticus being more frequent in those with HHV-6 (Fisher exact test, P = .010). All 3 encephalitis patients positive for HHV-6 had neurologic sequelae;2 who had mild sequelae were treated with antiviral agents and intravenous immunoglobulin. Conclusions: HHV-6 may not be completely benign in immunocompetent children. It can be associated with encephalitis and poor prognosis.

关键词： Aneurysm   SSEP monitoring   Duration of SSEP deterioration   Intraoperative monitoring   Postoperative neurological deficit  

摘要： Although the application of somatosensory evoked potential (SSEP) in intracranial aneurysm surgery has been well demonstrated, the relationship between the duration of SSEP deterioration and postoperative neurological deficits (PNDs) is still not clear. The objectives of this study were (1) to detect the relationship between the SSEP deterioration duration and PND;and (2) detect the relationship between SSEP deterioration duration and postoperative computed tomography (CT) findings. Data from 587 patients were reviewed and 40 patients with SSEP deterioration were enrolled. Four patients presented irreversible disappearance and 36 patients presented reversible deterioration (including 9 [25%] patients with reversible reduction and 27 [75%] patients with reversible disappearance). In the patients with reversible SSEP deterioration, 17 patients had PNDs, and the SSEP deterioration duration was 42 +/- 46 min, ranging from 5 to 180 min. Nineteen patients did not have PNDs, and their duration of SSEP deterioration was 11 +/- 9 min (range 2-40 min). The SSEP deterioration duration significantly differed between patients with or without PND (P < 0.01). Eleven minutes is the optimal cut-off value of motor evoked potential change duration avoiding PND (area under the curve = 0.84). Patients with a SSEP deteriorating duration > 11 min had a significant higher incidence rate of abnormal CT finding postoperatively (p < 0.05). According to these results, we conclude that the duration of SSEP deterioration is extremely important to postoperative neurological function, and in order to avoid PND, the SSEP deterioration duration must not exceed 10 min. The SSEP deterioration duration is also associated with postoperative CT findings.

关键词： Cardiovascular diseases   Risk factors  

摘要： Objective Obesity without metabolic disorder [Ob(+)MD(-)] is a unique subcategory of obesity where individuals are protected from the obesity-related complications. Although conflicting clinical outcomes have been reported, there has been no study of the effects of Ob(+)MD(-) on cerebrovascular disease. In this study, we evaluated the association between the Ob(+)MD(-) phenotype and silent brain infarcts (SBI) in a neurologically healthy population. Subjects/methods We evaluated a consecutive series of healthy volunteers recruited between January 2006 and December 2013. MD(-) status was assessed using five clinical markers: blood pressure, triglycerides, high-density lipoprotein, fasting plasma glucose, and waist circumference. Obesity was defined when body mass index >= 25 kg/m(2). SBI was defined as asymptomatic, well-defined lesions with a diameter >= 3 mm with the same signal characteristics as the cerebrospinal fluid on T1- or T2-weighted images. Results A total of 3165 subjects were assessed, and 262 (8%) SBI cases were identified. In multivariate analyses, non-obesity with metabolic disorder [Ob(-)MD(+)] (adjusted odds ratio [aOR] = 1.65, 95% confidence interval [CI] = 1.07-2.56, P = 0.025) and obesity with metabolic disorder [Ob(+)MD(+)] (aOR = 1.75, 95% CI = 1.12-2.75, P = 0.014) were closely associated with SBI after adjustment for confounders. Meanwhile, Ob(+)MD(-) did not show any significant association with SBI (aOR = 0.85, 95% CI = 0.20-3.72, P = 0.832). These findings may indicate that metabolic abnormality, irrespective of obesity status, is a main risk factor of SBI. When we compared SBI burdens between the four metabolic phenotypes, the Ob(+)MD(+) and Ob(-)MD(+) groups had higher rates of multiple lesions than the Ob(+)MD(-) and non-obesity without metabolic disorder groups. Conclusions The presence of metabolic abnormality, and not obesity per se, is independently associated with the prevalence of SBI in a healthy population.

关键词： blood pressure   blood pressure variability   early neurological deterioration   minor stroke   transient ischemic attack  

摘要： It is generally known that acute minor stroke and transient ischemic attack (TIA) seem to be benign. However, their occurrence in patients with steno-occlusive arterial disease may result in early neurological deterioration (END). We aimed to elucidate the effect of blood pressure variability (BPV) on the development of END. Consecutive acute minor stroke and TIA patients within 24 hours of onset were prospectively recruited from the Affiliated Hospital of Yangzhou University between Aug 2015 and Feb 2019. END was defined as an NIHSS score increased >= 1 during the first 72 hours compared with the initial NIHSS score. During this period, the mean, maximum (max), the difference between the maximum and minimum (max-min), the SD, and coefficient of variation of BP (BPCV) were calculated. Of the 160 total patients enrolled in the study (mean age, 68.01 +/- 9.33 years;50.6% female), 52 (32.5%) patients occurred END during the first 72h after admission. To express the BPV as a categorical variable, we classified the subjects into one of four groups, representing four quartiles of BPV. In the multivariable analyses, the lowest quartiles were considered as reference groups. The results showed that patients who fell in the fourth quartile (SBPmax-min:OR = 3.289, 95% CI 1.147-9.430;SBPSD:OR = 3.313, 95% CI 1.041-10.547;SBPCV:OR = 3.425, 95% CI 1.164-10.077;DBPSD:OR = 3.124, 95% CI 1.065-9.158) had a significantly higher risk of END after adjusting the variables (age, female, diabetes mellitus, atrial fibrillation, and CRP with P values <.1 in univariate analyses). Our study demonstrated that the acute in-hospital BPV was associated with the development of END in acute minor stroke and TIA with steno-occlusive arterial disease.

关键词： epidemiology   disease burden   disability adjusted life years  

摘要： The author comments on a research about the burden of mental, neurological, substance use disorders and self-harm in North America. The author discusses the researchers' concern about the Global Burden of Disease (GBD) Project, particularly its implications for mental health. The author tackles the mortality and morbidity related to mental health classified by the GBD, as well as the behavioral and cognitive presentations of neurological disorders, issues of stigma and disease epidemiology.

关键词： Parkinson disease   Handwriting analysis   Neurodegenerative disorder  

摘要： Parkinson's disease (PD), a multi-system neurodegenerative disorder which affects the brain slowly, is characterized by symptoms such as muscle stiffness, tremor in the limbs and impaired balance, all of which tend to worsen with the passage of time. Available treatments target its symptoms, aiming to improve the quality of life. However, automatic diagnosis at early stages is still a challenging medicine-related task to date, since a patient may have an identical behavior to that of a healthy individual at the very early stage of the disease. Parkinson's disease detection through handwriting data is a significant classification problem for identification of PD at the infancy stage. In this paper, a PD identification is realized with help of handwriting images that help as one of the earliest indicators for PD. For this purpose, we proposed a deep convolutional neural network classifier with transfer learning and data augmentation techniques to improve the identification. Two approaches like freeze and fine-tuning of transfer learning are investigated using ImageNet and MNIST dataset as source task independently. A trained network achieved 98.28% accuracy using fine-tuning-based approach using ImageNet and PaHaW dataset. Experimental results on benchmark dataset reveal that the proposed approach provides better detection of Parkinson's disease as compared to state-of-the-art work.

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