关键词： Urgent neurological consultation population  

摘要： In the province of Ferrara, Italy, the urgent neurological consultation (UNC) cases in the population correspond to the resident outpatients who undergo a UNC in the ER of the university hospital of Ferrara (UHFe). Thanks to this health organization a retrospective survey identified 612 UNC cases (range of age 7-102 years, median 67,5 years) in the study period giving a period prevalence rate of 173 per 100,000 (95% CI 159.3-187.3) which increased with age (chi(2) for trend = 178.4 p < 0.001). The daily UNC cases (range 0-14, mean = 7.3, 95% CI 7.1-7.5) followed the Poisson distribution (goodness-of-fit test: lambda = 7.3, chi(2) = 8082, 12 freedom degrees, p > 0.70). The prevalence rate decreased with the distance between the patients' residence and the UHFe (chi(2) for trend = 82.9, p < 0.001). The commonest clinical conditions requiring UNCs were acute cerebrovascular disorders (28%), headache (14%), and vertigo (9%). The hospital admission rate was 32.5% which increased with age (chi(2) for trend = 35.8, p < 0.001). The commonest discharge diagnoses of the admitted cases were ischemic stroke (57.3%), epilepsy (7%), TIA (6%), and intraparenchymal hemorrhage (5.5%). Acute cerebrovascular disease accounted for 69% of the discharge diagnoses. The survey showed that the UNCs' demand was higher than previous Italian data confirming that acute cerebrovascular disease is the most frequent acute neurological condition requiring attention in the ER. It also suggested that the UNCs could be poorly appropriate. These findings would require the healthcare administrators attention.

关键词： Atrioesophageal Fistula   Septic emboli   Stroke  

摘要： Atrioesophageal fistula (AEF) is a rare complication of cardiac ablation for atrial fibrillation. It can present in many ways, but neurological signs and symptoms are common initial signs sometimes resulting in neurosurgeons and neurologists first evaluating patients with the condition. We present a case report of at 68-year-old female who presented with acute stroke symptoms and multifocal hemorrhages on MRI who was worked up through our neurosurgery department and diagnosed with AEF. This case highlights three clues to alert neurological clinicians to AEF as a possible diagnosis;clinical worsening of neurological symptoms in correlation to episodes of emesis, septic emboli on CT/MRI, and bacteremia caused by a gram positive oral or GI flora. If neurological clinicians encounter these red flags, an immediate CT of the chest and abdomen and consultation with cardiothoracic surgery may be life-saving.

关键词： Antidepressants   Depression   Anxiety   Parkinson's disease   Side effects   Mechanisms of action  

摘要： Introduction: Although antidepressants are widely used in Parkinson's disease (PD), few well designed studies to support their efficacy have been conducted. Development: These clinical guidelines are based on a review of the literature and the results of an AMN movement disorder study group survey. Conclusions: Evidence suggests that nortriptyline, venlafaxine, paroxetine, and citalopram may be useful in treating depression in PD, although studies on paroxetine and citalopram yield conflicting results. In clinical practice, however, selective serotonin reuptake inhibitors are usually considered the treatment of choice. Duloxetine may be an alternative to venlafaxine, although the evidence for this is less, and venlafaxine plus mirtazapine may be useful in drug-resistant cases. Furthermore, citalopram may be indicated for the treatment of anxiety, atomoxetine for hypersomnia, trazodone and mirtazapine for insomnia and psychosis, and bupropion for apathy. In general, antidepressants are well tolerated in PD. However, clinicians should consider the anticholinergic effect of tricyclic antidepressants, the impact of serotonin-norepinephrine reuptake inhibitors on blood pressure, the extrapyramidal effects of antidepressants, and any potential interactions between monoamine oxidase B inhibitors and other antidepressants. (C) 2016 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U.

关键词： Outcomes research   Spinal cord diseases  

摘要： Study design Post hoc analysis of prospectively collected data. Objectives Assess the influence of surgical timing on neurological recovery using classification tree analysis in patients sustaining cervical traumatic spinal cord injury. Setting Hopital du Sacre-Coeur de Montreal Methods 42 patients sustaining cervical SCI were followed for at least 6 months post injury. Neurological status was assessed from the American Spinal Injury Association impairment scale (AIS) and neurological level of injury (NLI) at admission and at follow-up. Age, surgical timing, AIS grade at admission and energy of injury were the four input parameters. Neurological recovery was quantified by the occurrence of improvement by at least one AIS grade, at least 2 AIS grades and at least 2 NLI. Results Proportion of patients that improved at least one ASIA grade was higher in the group that received early surgery (75 vs. 41 %). The proportion of patients that improved two AIS grades was also higher in the group that received early surgery (67 vs. 38 %). Finally, 30 % of the patients that received early decompression improved two NLI as compared with 0% in the other group. Early surgery was also associated with a non-statistically significant improvement in functional recovery. Conclusions Neurological recovery of patients sustaining cervical traumatic spinal cord injury can be improved by early decompression surgery performed within 19 h post trauma.

关键词： alpha-Synuclein   Enteric nervous system   Gastrointestinal symptoms   Parkinson disease  

摘要： Background/Aims alpha-Synucleinopathy in the brain is the neuropathological hallmark of Parkinson's disease (PD). However, the functional impact of alpha-synucleinopathy in the enteric nervous system remains unknown. We aim to evaluate the association between gastrointestinal (GI) dysfunction and alpha-synuclein (alpha SYN) pathology in the stomach and colon of PD patients and controls, as well as to investigate the association between the alpha SYN pathology in GI tract and future PD risk. Methods A total of 35 PD patients and 52 neurologically intact subjects were enrolled in this study. Endoscopic biopsies were performed, and then immunohistochemical staining for alpha SYN was performed. All subjects completed the validated Rome III questionnaire for the assessment of GI symptoms. The association between GI symptoms and the alpha SYN pathology in GI mucosa was evaluated. Incident PD cases were assessed during a median follow-up of 46 months. Results The proportion of self-reported constipation and functional constipation through the Rome III questionnaire was significantly higher in PD patients than in controls (P < 0.001 and P = 0.015). However, no significant association was found between the alpha SYN pathology in the stomach and colon mucosa and constipation, as well as other GI symptoms including dyspepsia symptoms and abdominal discomfort or pain, regardless of the presence or absence of clinical PD (P > 0.05). No incident PD cases were diagnosed during study period. Conclusions Our present study suggests that the deposition of alpha SYN in the mucosal enteric nervous system may not be reflected by functional impairment of the affected segment of the gut.

关键词： 病案教学法   神经病学   教学应用  

摘要： 在神经病学教学中,运用病案教学法既可以激发学生的学习兴趣和动力,又可加深医学生对所学内容的理解和记忆,提高教学效率。病案教学法是神经病学临床教学中有效的教学方法之一,值得推广和完善。

关键词： 临床试验   注册   神经病学  

摘要： 临床试验是推动医学进步的重要科研手段,为医务工作者提供重要的决策支持。临床试验注册要求研究者将研究计划提前公布,及时上传原始数据及研究结果,实现数据共享,避免重复研究,使临床试验更加透明化、规范化。该文对临床试验注册的相关内容进行概述,并简介临床试验注册平台及注册过程中的常见问题,以其在神经病学领域的应用为例,探讨临床试验注册在具体临床研究中的应用现状、价值及不足,旨在提高临床研究者的注册意识,提升临床研究质量。

关键词： 翻转课堂教学法   SP教学法   神经病学   教学改革  

摘要： 应用翻转课堂结合SP病人教学法对神经病学脑血管疾病章节进行授课，并与传统教学组的笔试，SP病人问诊及查体考核成绩进行对比研究。实验组同学的考核成绩优于传统教学组，并且收集病史能力，体格检查能力，科学、系统的临床思维能力更强，显示该方法可以提高临床教学质量。

关键词： 神经病学与神经康复学杂志   证明文件   缩略词   投稿声明  

摘要： 《神经病学与神经康复学杂志》(CN:31-1927/R;ISSN:1672-7061)由上海市卫生和计划生育委员会主管,上海市中西医结合学会、上海交通大学医学院附属仁济医院主办,是国内外公开发行的神经病学与神经康复学领域的专业学术期刊,以神经科。

关键词： 虚拟仿真技术   神经病学   临床实习教学  

摘要： 目的:探究虚拟仿真技术在《神经病学》临床实习教学中的应用效果。方法:选取2014级临床专业进入神经内科实习的4个班级,将1、2班学生作为常规组,进行常规授课,将3、4班学生作为VR组,在常规授课基础上进行VR辅助教学,比较学生对授课方式的满意度,并在授课结束后对学生进行考核,比较其考核分数。结果:VR组学生在与患者沟通、临床思维、团队协作等方面对教学方法满意程度均显著高于常规组(P<0.05),且VR组学生在患者病史、体检、实验室检查、诊断等考核项目得分均显著高于常规组,且总分为(83.26±2.98分,显著高于常规组的68.69±2.74分(P<0.05)。结论:采用虚拟仿真技术在《神经病学》临床教学工作中进行辅助教学,能够有效提高学生对该课程的满意程度,同时提高学生对该课程相关内容的满意程度,对提高教学质量具有重要意义。