关键词： Magnetic resonance imaging   multiple sclerosis   restriction spectrum imaging   neurite density   neurological disability  

摘要： Background: Restriction spectrum imaging (RSI) is a recently introduced magnetic resonance imaging diffusion technique. The utility of RSI in multiple sclerosis (MS) is unknown. Objective: To investigate the association between RSI-derived parameters and neurological disability in MS. Methods: Seventy-seven relapsing-remitting MS patients were scanned with RSI on a 3-T scanner. RSI-derived parameters: fast and slow apparent diffusion coefficient (sADC), fractional anisotropy, restricted fractional anisotropy, neurite density (ND), cellularity, extracellular water fraction, and free water fraction, were obtained in white matter lesions (WML) and normal appearing white matter (NAWM). Patients were divided into three groups according to their expanded disability status scale (EDSS): with minimal, low, and substantial disability (<2.5, 2.5-3, and >3, respectively). Group comparisons and correlation analyses were performed. Results: All tested RSI-derived parameters differed between WML and NAWM (p < 0.001 for all pairwise comparisons). The sADC in WML showed largest difference across disability subgroups (analysis of variance (ANOVA): F = 5.1, eta(2) = 0.12, p = 0.008). ND in NAWM showed strongest correlation with disability (rho = -0.39, p < 0.001). Conclusion: The strongest correlation with EDSS of ND obtained in NAWM indicates that processes outside lesions are important for disability in MS. Our study suggests that RSI-derived parameters may help understand the "clinico-radiological paradox" and improve disease monitoring in MS.

关键词： Apnea challenge test   Death by neurological criteria   Brain death examination   Venous carbon dioxide   Arterial carbon dioxide  

摘要： Background: Compare the increase in partial pressure of carbon dioxide (P-CO2) from venous blood samples with that of arterial blood samples during apnea challenge test in determination of death by neurological criteria. Methods: Prospective nonrandomized cohort study in tertiary care pediatric intensive care unit. Patients older than 37 week's gestation admitted to PICU with irreversible brain injury at the time when attending physician will perform apnea challenge test as part of brain death examination from October 2015 till September 2017. Interventions: None. Results: The primary outcome was to measure and compare the increase in P-CO2 from venous blood samples with that from arterial blood samples during apnea challenge test. A total of nine apnea challenge tests from seven patients (ages five months to 17 years) were included in the study. P-CO2 in venous blood sample increased less than that in arterial blood samples (venous, 26.1 mm Hg;S.D., 10.1;95% confidence interval, 18 to 34 mm Hg;arterial, 33.9 mm Hg;S.D., 12.0;95% confidence interval, 24 to 43 mm Hg) (P = 0.02). Conclusion: Postapnea challenge test P-CO2 of 60 mm Hg along with increase of 20 mm Hg in venous blood sample correlated to P-CO2 greater than 60 mm Hg along with increase of greater than 20 mm Hg in arterial blood sample. Further studies are warranted to assess if current recommendations for determination of death by neurological criteria in children can be modified to allow for use of venous blood samples as an alternate to arterial blood samples. (C) 2018 Elsevier Inc. All rights reserved.

关键词： Osteoporosis   Vertebral fractures   Teriparatide   Spinal surgery  

摘要： Study Design: Retrospective case review. Purpose: To assess the incidence and effect of teriparatide (TP) on subsequent vertebral fractures following a long-instrumented fusion surgery for osteoporotic vertebral fractures (OVFs). Overview of Literature: TP treatment may be a useful strategy for patients with OVFs treated with a long-instrumented surgery. Methods: Overall, 47 patients who underwent long-instrumented fusion surgery (>= 3 levels) for OVFs with neurological deficits between 2010 and 2013 were enrolled. The mean age of the subjects was 76 years;the study population comprised 20 males and 27 females. The mean follow-up duration was 23 months. The average of fused vertebrae was 4.9. TP was used for 19 patients who comprised the TP group. The incidence of subsequent VFs was estimated with Kaplan-Meier analyses and compared between the TP and non-TP groups using the log-rank test. Risk factors were evaluated using a Cox proportional hazards model. Results: A total of 38% (18/47 cases) of the subjects were identified with subsequent VFs. There were no significant differences in the age, sex, fused levels, presence of prevalent fractures, and correction loss of the two groups. The occurrence of subsequent VFs was lower in the TP group than in the non-TP group (16% vs. 54%, p=0.014). The log-rank test revealed that the TP treatment significantly reduced the risk of subsequent VFs (p=0.048). A Cox proportional hazards model revealed that preoperative TP treatment is only a protective factor of subsequent VFs after instrumented fusion surgery for OVFs (hazard ratio, 0.281;p=0.047). Conclusions: In this retrospective study, pre- and postoperative TP treatment significantly reduced the incidence of subsequent VFs after instrumented fusion surgery for OVFs. A prospective randomized study is warranted to determine the efficacy of TP treatments.

关键词： Post-malaria neurological syndrome (PMNS)   Falciparum malaria  

摘要： BackgroundPost-malaria neurological syndrome (PMNS) is a rare self-limiting neurological complication that can occur after recovery from malaria, usually severe falciparum malaria. It is characterized by a myriad of neuropsychiatric manifestations including mild neurological deficit to severe encephalopathy. PMNS was first described in 1996 and since then there have been 48 cases reported in the English literature. We report another case of PMNS in a 24-year-old healthy male and present a review of the disease *** searched PMNS-related journal articles and case reports in the English literature, using PubMed and Google search engines. A total of forty-nine cases meeting the diagnostic criteria of PMNS were selected in this *** is a rare complication of severe malaria that might be underreported. It can develop up to 2 months after clearance of parasitemia. Clinical features can be variable. Most cases are self-limited, but more severe cases may benefit from steroid therapy.

关键词： Nervous System Diseases   MicroRNAs  

摘要： The article talks about how microRNA expression can be helpful in detecting the brains of neurodegenerative diseases. It is mentioned that these biomarkers helps in access to understanding of the central nervous system (CNS) and how the profiling of these miRNA expression can help in understanding various types of neurological diseases. The article also adds that these microRNA were extracted from the cerebrospinal fluid (CSF) of the patients.

关键词： Severe traumatic brain injury   Spontaneous hyperventilation   Hypocapnia   Respiratory alkalosis   Glasgow Outcome Scale  

摘要： BackgroundHypocapnia induces cerebral vasoconstriction leading to a decrease in cerebral blood flow, which might precipitate cerebral ischemia. Hypocapnia can be intentional to treat intracranial hypertension or unintentional due to a spontaneous hyperventilation (SHV). SHV is frequent after subarachnoid hemorrhage. However, it is understudied in patients with severe traumatic brain injury (TBI). The objective of this study was to describe the incidence and consequences on outcome of SHV after severe *** conducted a retrospective, observational study including all intubated TBI patients admitted in the trauma center and still comatose 24h after the withdrawal of sedation. SHV was defined by the presence of at least one arterial blood gas (ABG) with both PaCO2<35mmHg and pH>7.45. Patient characteristics and outcome were extracted from a prospective registry of all intubated TBI admitted in the intensive care unit. ABG results were retrieved from patient files. A multivariable logistic regression model was developed to determine factors independently associated with unfavorable outcome (defined as a Glasgow Outcome Scale between 1 and 3) at 6-month *** 7years, 110 patients fully respecting inclusion criteria were included. The overall incidence of SHV was 69.1% (95% CI [59.9-77]). Patients with SHV were more severely injured (median head AIS score (5 [4-5] vs. 4 [4-5];p=0.016)) and exhibited an elevated morbidity during their stay. The proportion of patients with an unfavorable functional neurologic outcome was significantly higher in patients with SHV: 40 (52.6%) versus 6 (17.6%), p=0.0006. After adjusting for confounders, SHV remains an independent factor associated with unfavorable outcome at the 6-month follow-up (OR 4.1;95% CI [1.2-14.4]).ConclusionsSHV is common in patients with a persistent coma after a severe TBI (overall rate: 69%) and was independently associated with unfavorable outcome at 6-month follow-up.

关键词： Surgical site infection   Metastatic spinal cord compression   Spinal metastases  

摘要： PurposeMost of the literature on infection after surgery for spinal metastases focuses on incidence and risk factors for surgical site infection (SSI). To the best of our knowledge, there is no report on the influence of infection on neurological outcome and survival in patients undergoing emergent surgery for metastatic spinal cord compression (MSCC).MethodsOur aim was to establish if SSIs adversely affected the neurological outcome and survival in patients with MSCC. We reviewed 318 consecutive patients admitted for surgical intervention for MSCC from October 2005 to October 2012. Morbidity (neurological outcome, length of hospital stay and additional procedures) and survival rates were *** this study period, the incidence of infection was 29/318 (9.1%). The median length of stay in hospital in the infected group was 25days compared to 13days in the non-infected group (p=0.001). Twenty out of the 29 (69%) infected patients underwent an additional procedure (29 procedures in total) compared to 9/289 (3%) non-infected patients (p=0.001). There was no statistical difference between the two groups with regard to neurological outcome (p=0.37) but the survival rate was statistically different between the two groups [infected group: median survival 131days (19-1558) vs. non-infected group: 258days (5-2696;p=0.03)].ConclusionSurgical site infection increased the morbidity with considerably longer hospital stay and requirement for additional procedures. Although there was no difference in neurological outcome, the infected group of patients had a significantly shorter survival. [GRAPHICS]

关键词： Lumbar disc   Motor deficit   Neurological deficit   Foot drop   Recovery   Review  

摘要： Neurodeficit due to lumbar disc herniation (LDH) is a serious complication and can range from sensory hypoesthesia in a single dermatome to a debilitating condition like cauda equina syndrome (CES). Many authors have described variable clinical and radiological risk factors for neurodeficit in LDH. Similarly the prognostic factors influencing recovery have been variable across the studies. This narrative review discusses the pathogenesis, most consistent factors associated with the occurrence of neurodeficit in LDH patients and also the factors which have a prognostic role in recovery. Pathological mechanisms like venous congestion, neuronal ischaemia and multiple root impairment act either individually or in combination to result in neurodeficit in LDH patients. Among the clinical risk factors, diabetes mellitus and acute onset of symptoms have been associated with neurodeficit while pre-existing spinal canal stenosis, non-contained discs (sequestrated/migrated) are potential radiological risk factors for developing neurodeficit. When considering prognostic factors for recovery, pre-operative muscle strength is the only significant factor. Knowledge about the causative and prognostic factors in neurodeficit following LDH would help in the successful management of this condition.

关键词： F-18-fluorodeoxyglucose positron emission tomography   stroke   CNS infection   epilepsia partialis continua   Creutzfeldt-Jakob disease  

摘要： A compilation of 6 distinctive F-18-fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT) findings in the acute setting of neurohospital care is presented. In case 1, PET/CT allowed the final diagnosis of circumscribed ischemic infarction by demonstrating a clear pattern of luxury perfusion. In case 2, diagnosis of thalamic abscess was made, whereby PET/CT demonstrated an empty zone. Hypermetabolic enlarged hilar lymph nodes and hypermetabolic spinal lumbar roots in PET/CT led to the diagnosis of neurosarcoidosis in case 3. In case 4, a hypermetabolic brain focus in PET/CT identified the seizure focus in epilepsia partialis continua. A cerebral hemispheric hypometabolism in PET/CT in case 5 supported the diagnosis of Creutzfeldt-Jakob disease, which initially mimicked acute stroke. In case 6, PET/CT detected infective endocarditis as a source of multiple cerebral ischemic lesions. In conclusion, PET/CT can contribute importantly to find the correct diagnosis in acute neurohospital patients.