关键词： nervous system disorders   neurologic impairment   low- and middle-income countries   children  

摘要： Neurologic disorders contribute significantly to both morbidity and mortality among children in resource-limited settings, but there are a few succinct studies summarizing the epidemiology of neurologic disorders in these settings. A review of available literature was performed to identify data on the prevalence, etiology, outcomes, and treatment of neurologic disorders in children in resource-limited settings. The burden of neurologic disorders in children is high in resource-limited settings. Barriers to optimal care include lack of trained personnel, limited access to diagnostic technology, and limited availability of drugs used to treat common conditions. Several solutions have been suggested to deal with these challenges including increased collaborations to train neurologists willing to practice in resource-limited settings and increased training of physician extenders or community health workers. Further studies are necessary to improve our understanding of the epidemiology of neurologic disorders in resource-limited settings. Future epidemiologic studies should incorporate multiple countries in resource-limited settings and utilize standardized definitions and methodologies to enable comparison across regions.

关键词： Neuropsychiatry   Behavioral disorder   Apathy   Aggressivity   Frontal syndrome   Temporal lobes   Frontal lobes  

摘要： Behavioral disorders occupy the crossroads between neurology and psychiatry, and emerging disorders, such as frontotemporal lobar degeneration of genetic origin and autoimmune encephalitis, can present with both neurological and psychiatric signs. Thus, the primary aim of this introductory article is to review frequently encountered behavioral clinical features, such as apathy and agitation, and their related syndromes, including frontal and anterior temporal syndromes. These behavioral states and their underlying etiologies are also here illustrated with clinical case reports. In addition, this review highlights the idea that in order to progress in the understanding and management of behavioral disorders, there needs to be a strong interest towards developing new forms of cooperation between neurologists, psychiatrists and neuroscientists, such as those who work at university-based hospital neuropsychiatric clinical units. (C) 2018 Elsevier Masson SAS. All rights reserved.

关键词： cardiac arrest   hyperoxia   hypothermia   induced   outcome   oxygen  

摘要： Objective: Hyperoxia could lead to a worse outcome after cardiac arrest. The aim of this study was to investigate the relationship between the cumulative partial pressure of arterial oxygen (Pao(2)) and neurological outcomes after cardiac arrest treated with targeted temperature management. Design: Retrospective analysis of a prospective cohort. Setting: An academic tertiary care hospital. Patients: A total of 187 consecutive patients treated with targeted temperature management after cardiac arrest. Interventions: None. Measurements and Main Results: The area under the curve of Pao(2) for different cutoff values of hyperoxia (>= 100, >= 150, >= 200, >= 250, and >= 300 mm Hg) with different time intervals (0-24, 0-6, and 6-24 hr after return of spontaneous circulation) was calculated for each patient using the trapezoidal method. The primary outcome was the neurologic outcome, as defined by the cerebral performance category, at 6 months after cardiac arrest. Of 187 subjects, 77 (41%) had a good neurologic outcome at 6 months after cardiac arrest. The median age was 54 (43-69) years, and 128 (68%) were male. The area under the curve of Pao(2) with cutoff values of greater than or equal to 200, greater than or equal to 250, and greater than or equal to 300 was higher in the poor outcome group at 0-6 and 0-24 hours. The adjusted odds ratios of area under the curve of Pao(2) greater than or equal to 200 mm Hg were 1.659 (95% CI, 1.194-2.305) for 0-24 hours after return of spontaneous circulation and 1.548 (95% CI, 1.086-2.208) for 0-6 hours after return of spontaneous circulation. With a higher cumulative exposure to oxygen tension, we found significant increasing trends in the adjusted odds ratio for poor neurologic outcomes. Conclusion: In a new method for Pao(2) analysis, cumulative exposure to hyperoxia was associated with neurologic outcomes in a dose-dependent manner. Greater attention to oxygen supply during the first 6 hours appears to be important for outcome a

关键词： Neurological soft signs   pediatric HIV infection   Physical and Neurological Examination of Soft Signs  

摘要： Background: Children and adolescents comprise a significant proportion of people living with HIV. The effects of HIV on the growing brain have generated interest among researchers in this field. Deficits arising during this crucial phase of neuromaturation due to HIV infection need to be assessed and addressed. Neurological soft signs ( NSSs) can act as a proxy marker for underlying neuropsychological deficits. The present study aims to study the NSSs in pediatric patients with HIV and compare with healthy controls ( HCs). Materials and Methods: Forty-eight children aged between 6 and 16 years diagnosed with HIV were selected by purposive sampling, and the Physical and Neurological Examination of Soft Signs ( PANESS) scale was applied. Fifty children matched by age and sex were recruited from a nearby school, and the PANESS scale was applied. Children were divided into age- and gender-specific groups. The outcome scores of cases and controls groups were compared. Results: Males and females aged 13- 16 years with HIV showed more soft signs as compared to HCs, with respect to gait errors, dysrhythmia, impersistence, speed of repetitive and sequenced movements, overflow with gaits, overflow with sequenced movements, total overflow, and overflow in excess of age. The differences in scores were less marked in younger age groups among both the genders. Conclusions: The persistence of NSSs in older age group in HIV-infected children may point toward the presence of HIV-associated neurological disorder.

关键词： Resuscitation   Prognostication   NIRS   CPC   Survival   ROSC   Clinical decision-making   Cutoff-values   Regional cerebral oxygen saturation  

摘要： Introduction: Regional cerebral oxygen saturation (rSO2) can be measured non-invasively even at no-or low-flow states. It thus allows assessment of brain oxygenation during CPR. Certain rSO2 values had been associated with return of spontaneous circulation (ROSC) and neurological outcome in the past. Clear-cut thresholds for the prediction of beneficial outcome, however, are still lacking. Methods: We conducted a database search to extract all available investigations on rSO2 measurement during CPR. Mean, median, and Delta rSO2 values were either taken from the studies or calculated. Thresholds for the outcome "ROSC" and "neurological outcome" were sought. Results: We retrieved 26 publications for the final review. The averaged mean rSO2 for patients achieving ROSC was 41 +/- 12% vs. 30 +/- 12% for non-ROSC (p =. 009). ROSC was not observed when mean rSO2 remained < 26%. In ROSC patients, Delta rSO2 was 22 +/- 16% vs. 7 +/- 10% in non-ROSC patients (p =. 009). A rSO2 threshold of 36% predicted ROSC with a sensitivity of 67% and specificity of 69% while Delta rSO2 of 7% showed a sensitivity of 100% and a specificity of 86% (AUC = 0.733 and 0.893, respectively). Mean rSO2 of 47 +/- 11% was associated with favourable and 38 +/- 12% with poor neurological outcome. There was, however, a great overlap between groups due to scarce data. Conclusion: Higher rSO2 consistently correlated with increased rates of ROSC. The discriminatory power of rSO2 to prognosticate favourable neurological outcome remains unclear. Measuring rSO2 during CPR could potentially facilitate clinical decision-making.

关键词： Moyamoya disease   Revascularization surgery   Transient neurological events   Subcortical low intensity   Fluid-attenuated inversion recovery   Cortical hyperintensity belt sign  

摘要： Objectives: Transient neurological events (TNEs) are frequently observed after revascularization surgery for moyamoya disease (MMD). Recently, two signs on fluid-attenuated inversion recovery magnetic resonance images, a cortical hyperintensity belt (CHB) sign possibly reflecting vasogenic edema and a transient subcortical low intensity (SCLI) sign possibly reflecting cytotoxic edema, were reported associated with TNEs. The purpose of this study was to create a SCLI score and to investigate the significance of the score in TNEs. Patients and methods: The authors retrospectively analyzed 18 cerebral hemispheres in 16 consecutive patients with revascularization surgery for MMD. The SCLI sign was defined as a transient SCLI in surgically treated hemispheres, and blindly graded as the SCLI score (0-4) based on the extent. The relationships among SCLI, CHB signs and TNEs were evaluated. Results: Postoperative TNEs, SCLI and CHB signs were detected in 8 (44.4%), 9 (50.0%) and 12 (66.7%) hemispheres, respectively. Patients with SCLI and CHB signs had a significantly higher THE occurrence rate than those without these signs (p = 0.015, and p = 0.013, respectively). Patients with TNEs showed significantly higher SCLI scores than those without TNEs (p = 0.009), while the difference of CHB scores did not reach significance between patients with and without TNEs. For the occurrence of postoperative TNEs, SCLI score with a cut-off value of 1.0 resulted in a specificity of 80.0% and a sensitivity of 87.5%. Conclusion: The novel SCLI score may be useful for diagnosing TNEs after revascularization surgery for MMD, although both vasogenic and cytotoxic edema may be involved in postoperative TNEs.

关键词： Jean-Martin Charcot   Jean-Baptiste Charcot   Neurology   Maritime explorer  

摘要： The authors review the relationship between Jean-Martin Charcot, the most celebrate Professor of Neurology of the XIX century, and his son, Jean-Baptiste Charcot, former a physician and neurologist and after Professor Charcot's death, a worldwide famous maritime explorer, the "Commander Charcot."

关键词： Chikungunya   Epidermal necrosis   Guillain-Barre syndrome   Meningoencephalitis  

摘要： Chikungunya fever (CHIK) is an arboviral disease which is transmitted by a mosquito bite (Aedes aegypti). Fever, polyarthralgia, and maculopapular rash are hallmark clinical manifestations of this disease. These manifestations are self-liming and complete recovery is seen in most of the cases. However, atypical and lethal complications such as myocarditis, hepatitis, Guillain-Barre syndrome (GBS), and meningoencephalitis have been reported in few cases of CHIK. We hereby report two cases of chikungunya infection where rare and atypical manifestations of CHIK, i.e., GBS with bilateral lower motor facial nerve palsy, and meningoencephalitis with epidermal necrosis were seen.

关键词： tuberculosis   meningitis   human immunodeficiency virus   drug resistance   global health  

摘要： Central nervous system (CNS) involvement of tuberculosis (TB) is the most severe manifestation of TB and accounts for approximately 5 to 10% of all extrapulmonary TB (EPTB) cases and approximately 1% of all TB cases. TB meningitis (TBM) is the most common form of CNS TB, though other forms occur, often in conjunction with TBM, including intracranial tuberculomas, tuberculous brain abscesses, and spinal tubercular arachnoiditis. CNS TB often presents with nonspecific clinical features that mimic symptoms of other neurological conditions, often making diagnosis difficult. Defining neuroimaging characteristics of TBM include thick basal meningeal enhancement, hydrocephalus, and parenchymal infarctions most commonly involving the basal ganglia and internal capsule. Traditional cerebrospinal fluid sample analysis frequently requires lengthy times-to-result and have low sensitivity. Given the pitfalls of conventional CNS TB diagnostic methods, various molecular-based methods, including immunoassays and polymerase chain reaction (PCR)-based assays have emerged as alternative diagnostic tools due to their rapidity, sensitivity, and specificity. Expert panels on TBM have recently emphasized the need for standard research procedures with updated case definitions and standardized study methods, which will hopefully pave the way for more robust multicenter international studies. In this article, we review the epidemiology, diagnosis, molecular factors associated with disease presentation and outcome, and treatment of CNS TB.

关键词： NATURAL immunity   NEUROLOGICAL disorders   TEMOZOLOMIDE   GLIOMAS   T cells