关键词： Acute disseminated encephalomyelitis   Post-malaria neurological syndrome   Plasmodium falciparum   Magnetic resonance imaging  

摘要： There are four neurological complications that can occur after malaria treatment at a time when the patient is aparasitaemic: delayed cerebellar ataxia, acute inflammatory demyelinating polyneuropathy, post-malaria neurological syndrome and acute disseminated encephalomyelitis (ADEM). The authors describe a case of a 54-year-old male who presented with encephalopathy and generalized seizures forty-three days after complete recovery from acute malaria by Plasmodium falciparum. Diagnosis of post-malaria ADEM was made based on the acute onset of the neurological symptoms, characteristic findings in magnetic resonance imaging of the brain and prompt response to steroid therapy. ADEM is an autoimmune demyelinating disease of the central nervous system that usually arises after an infection or vaccination. Its occurrence after malaria infection is relatively rare, and to the best of our knowledge there are only thirteen cases described in the literature.

摘要： Background: Cardiac arrest (CA) due to pulmonary embolism (PE) is associated with low survival rates and poor neurological outcomes. We examined whether Extracorporeal Cardiopulmonary Resuscitation (ECPR) improves the outcomes of patients who suffer from CA due to massive PE. Methods: We retrospectively included 39 CA patients with proven or strongly suspected PE in two hospitals in the Netherlands, in a 'before/after'design. 20 of these patients were treated with Conventional Cardiopulmonary Resuscitation (CCPR) and 19 patients with ECPR. Results: The main outcomes of this study were ICU survival and favourable neurological outcome, defined as Cerebral Performance Category (CPC) score 1-2. The ICU survival rate in CCPR patients was 5% compared to 26% in ECPR patients (p<0.01). Survival with favourable neurological outcome was present in 0/20 (0%) CCPR patients compared to 4/19 (21%) of the ECPR patients (p<0.05). Conclusion: ECPR seems a promising treatment for cardiac arrest patients due to (suspected) massive pulmonary embolism compared to conventional CPR, though outcomes remain poor.

摘要： This commentary is on the original article by Pinchefsky et al. on pages350-358 of this issue.

关键词： Functional neurological symptoms   Conversion disorder   Children   Adolescents   Treatment  

摘要： Aim: To describe a cognitive-behavioural treatment and clinical outcomes in a series of children with functional neurological symptoms (FNS). Method: Thirty-six children with FNS were assessed and of these twenty-two (13 male, 9 female) with a mean age 14.5 years (SD = 2.6, range 6-17 years) completed treatment with cognitive behaviour therapy embedded in routine child and adolescent clinical/systemic practice. Treatment outcomes were measured at baseline and post-intervention on the Child Global Assessment Scale (CGAS), Strengths and Difficulties Questionnaire (SDQ), Goal Based Outcomes (GBO) and Revised Child Anxiety and Depression Scale (RCADS). Results: Scores on the CGAS improved significantly post-intervention (p < 0.001) with 82% of participants showing reliable change. Individualised goals (GBO) also showed clinically meaningful gains. Standard measures of emotional and behavioural symptoms (SDQ and RCADS) did not correlate well with clinical diagnoses, were usually subthreshold at baseline, and did not show significant improvement post-intervention. Interpretation: The outcome of this pilot study suggests that CBT can be effective in the rehabilitation of young patients with FNS. Detection of common comorbid psychiatric disorders was not assisted by use of standardised measures, although most participants were clinically anxious or depressed. More research is needed to understand why children with FNS and their parents may not endorse mental health symptoms on questionnaires, and to further evaluate interventions within randomised controlled trials. (C) 2018 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

关键词： Autoimmune neurology   Multiple sclerosis   Neuromyelitis optica   Acute disseminated encephalomyelitis   Autoimmune encephalitis   Sarcoidosis  

摘要： Autoimmune disorders of the central nervous system are common and often affect people in the most productive years of their lives. Among primary autoimmune diseases of the central nervous system, multiple sclerosis is most prevalent in the United States. Many other autoantibody-mediated neurologic syndromes have been identified within the past 2 to 3 decades, including neuromyelitis optica and anti-N-methyl-D aspartate receptor encephalitis. Finally, the central nervous system can also be affected by systemic autoimmune diseases such as sarcoidosis. Many of these diseases are treatable when detected early.

关键词： meta-analysis   outcome assessment   spinal cord injuries   spinal fusion   surgical decompression  

摘要： In patients with traumatic spinal cord injury (tSCI) a distinction in surgical urgency is made on the basis of the severity of the initial neurological injury. The optimal timing of surgical decompression, as well as its impact on neurological recovery, is as of yet undetermined. This study addresses neurological improvement after early and late surgery for complete and incomplete cervical tSCI. A systematic search retrieved 15 publications of observational studies reporting outcome measurements after surgery in 1126 patients with cervical tSCI from PubMed and Embase databases. Surgery was considered early within 24h, and late thereafter. An improvement of at least two grades on the American Spinal Injury Association (ASIA) scale was considered clinically meaningful. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. Improvement rates were summarized using individual patient data in a Bayesian random effects model and compared for those with complete and incomplete tSCI after early and late surgery. In patients with complete cervical tSCI (n=422), improvement was more frequent after early surgery than after late surgery (respectively, 22.6%, 95% credibility interval [CI]: 16.6-28.7% and 10.4%, 95% CI: 5.6-15.8%;odds ratio [OR] 2.6 [95% CI: 1.4-5.1]). Whereas in patients with incomplete cervical tSCI (n=636), improvement was similar between early and late surgery (respectively 30.4%, 95% CI: 19.8-41.6% and 32.5%, 95% CI: 21.4-45.8%;OR 0.9 [95% CI: 0.4-1.9]). These data suggest a paradigm shift in the treatment of patients with complete cervical tSCI, as surgical decompression within 24h is more frequently associated with clinically meaningful improvement. In incomplete cervical tSCI, neurological outcome is similar between early and late surgery.

关键词： cell replacement   Neural stem cell   neuroprotection   regenerative medicine   stroke  

摘要： Introduction Neural stem cells (NSCs) have demonstrated multimodal therapeutic function for stroke, which is the leading cause of long-term disability and the second leading cause of death worldwide. In preclinical stroke models, NSCs have been shown to modulate inflammation, foster neuroplasticity and neural reorganization, promote angiogenesis, and act as a cellular replacement by differentiating into mature neural cell types. However, there are several key technical questions to address before NSC therapy can be applied to the clinical setting on a large scale. Purpose of Review In this review, we will discuss the various sources of NSCs, their therapeutic modes of action to enhance stroke recovery, and considerations for the clinical translation of NSC therapies. Understanding the key factors involved in NSC-mediated tissue recovery and addressing the current translational barriers may lead to clinical success of NSC therapy and a first-in-class restorative therapy for stroke patients.

关键词： coping mechanisms   emotions   identity theory   neurosociology   suppression  

摘要： In the past few decades, sociologists have called for the incorporation of biological ideas and methods into sociology as a means of improving our understanding of social behavior. In this vein, researchers have argued that bringing neuroscience into the study of self and identity processes will help sociologists refine and construct more accurate theories. The present study pursues this agenda by using neuroscience insights and methodology to empirically examine a poorly understood aspect of identity processes: persistent identity nonverification. We find that increasing the amount of nonverifying feedback increases emotional and neurological arousal but only to a point before leveling out. Furthermore, our findings suggest that healthy individuals may employ an immediate coping mechanism of "suppression" to deal with persistent identity threats. We discuss the implications of our findings for future research on self and identity.

关键词： acid ceramidase   ASAH1   Farber disease   hematopoietic stem cell transplant   lysosomal storage disorder   macrophage  

摘要： Farber disease (FD) is an inherited autosomal recessive disorder of lipid metabolism. The hallmark of the disease is systemic accumulation of ceramide due to lysosomal acid ceramidase deficiency. The involvement of the central nervous system is critical in this disorder leading to rapid deterioration and death within a few years after birth. Efforts to treat patients by hematopoietic stem cell transplant (HSCT) have resulted in favorable results in the absence of neurological manifestations. We report the outcomes of HSCT in two patients with FD who received early HSCT and had neurological deterioration posttransplant. We also present a new understanding of the limitations of HSCT in FD management based on our observations of the clinical course of the two patients after therapy. © 2019 The Authors. Journal of Inherited Metabolic Disease published by John Wiley & Sons Ltd on behalf of SSIEM.

关键词： activity   hospital   neurology   nurse   nursing work   observation   time and motion  

摘要： AimTo investigate nursing work patterns in a neurology department in a Chinese hospital. BackgroundKnowledge of nursing work patterns is important for nursing management and work design, and for the evaluation of organizational process change associated with the introduction of an innovation. MethodsA time-and-motion method was used to observe 14 registered nurses' (RNs') work patterns in a neurology department in a Chinese hospital. ResultsThere were 147hr of observation. Overall, the most time-consuming activities were verbal communication (28.5%) and documentation (28.3%), followed by indirect care (14.6%) and direct care (14%). Compared to support RNs, charge RNs spent 20% more time on documentation and 11% more time on verbal communication. Two-thirds of the observed activities had a duration of less than 40s. ConclusionsCommunication, in verbal and written forms, consumed more than half of the nursing time. Conversely, nurses only spent about a quarter of their worktime on preparation for care provision and direct care provision. This reflects the significant role and resource-consuming nature of communication to provide safe and quality care. Implications for Nursing ManagementCommunication methods need to be enhanced to improve nursing productivity. This may be achieved through the introduction of more effective nursing documentation methods.