关键词： Colloids   Epidural Blood Patch   Postdural Puncture Headache  

摘要： Objective. Epidural blood patch is the procedure of choice to relieve postdural puncture headache. Hydroxyethyl-starch (HES) has been proposed as a patch in some circumstances such as in the case of hematological disease due to the theoretical risk of neoplastic seeding to the central nervous system. Acute neurological HES toxicity has been excluded by a previous animal study, but the long-term neurological toxicity has not been evaluated. Methods. Rats were randomly assigned to one of three groups: no intrathecal injection, 20 mu L of intrathecal saline, or a 20-mu L intrathecal HES (6% hydroxyethyl starch 130/0.4) administered via a cervical puncture. Clinical daily rat activity was measured before and after dural puncture by actinometry. The rats were killed at day 28, and the spinal cord was surgically removed and stained with hematoxylin-phloxine-saffron for gross and microscopic examination. Results. Eleven rats underwent dural puncture without injection, 11 were injected with normal saline, and 12 received intrathecal HES. No clinical or actimetric changes (total distance traveled, number of direction changes, and number of rearings) were observed up to one month after injection. Nonspecific histopathological changes were equally observed in all groups. Conclusions. The results of the current study indicate that intrathecal injection of HES in rats does not induce any clinical or histopathological evidence of long-term neuronal toxicity. Further safety studies in animals are warranted before HES might be considered a safe alternative to the classic epidural blood patch.

关键词： African genomics   ancestry information   anthropological genetics   Bantu expansions   endophenotypes  

摘要： Information about patterns of expression of neurological soft signs (NSS) in schizophrenia among individuals belonging to the same genetic ancestry may provide new insight for the understanding of the disease's genetic functions. This study aimed to investigate whether patterns of NSS expression in first episode schizophrenia are comparable in populations with dissimilar genetic ancestry. A sample of 207 patients with first episode schizophrenia were examined using the Neurological Evaluation Scale before they were exposed to anti-psychotics. They were allocated to two African ancestry groups: Black (81 Yoruba Nigerians, and 18 Xhosa South Africans), and non-Black (98 Coloured, and 10 White South Africans). Assessments were carried out using validated measures of clinical characteristics of schizophrenia. We determined the frequency, severity, factor structure, and association of NSS with clinical characteristics. Factor derived categories were compared using the Pearson's (r) and Tucker's congruence methods. The associations between factor derived categories and clinical characteristics of schizophrenia were determined using Pearson's correlations and multiple regression analyses. Neurological soft signs were more frequent and more severe in the Black African ancestry group. Also, the factor structure and presentation of NSS in the two ancestry groups were significantly different. Neurological soft signs, especially motor sequencing and cognitive-perceptual abnormalities, were independently associated with disorganization psychopathologies in all the participant groups. Differences in the profile of NSS in Black compared with non-Black African ancestry patients with first episode schizophrenia may suggest differing patterns of expression of NSS in schizophrenia according to genetic ancestry.

关键词： Alzheimer   dementia   FDG-PET   frontotemporal dementia   Parkinson   recommendations  

摘要： Background and purposeRecommendations for using fluorodeoxyglucose positron emission tomography (FDG-PET) to support the diagnosis of dementing neurodegenerative disorders are sparse and poorly structured. MethodsTwenty-one questions on diagnostic issues and on semi-automated analysis to assist visual reading were defined. Literature was reviewed to assess study design, risk of bias, inconsistency, imprecision, indirectness and effect size. Critical outcomes were sensitivity, specificity, accuracy, positive/negative predictive value, area under the receiver operating characteristic curve, and positive/negative likelihood ratio of FDG-PET in detecting the target conditions. Using the Delphi method, an expert panel voted for/against the use of FDG-PET based on published evidence and expert opinion. ResultsOf the 1435 papers, 58 papers provided proper quantitative assessment of test performance. The panel agreed on recommending FDG-PET for 14 questions: diagnosing mild cognitive impairment due to Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD) or dementia with Lewy bodies (DLB);diagnosing atypical AD and pseudo-dementia;differentiating between AD and DLB, FTLD or vascular dementia, between DLB and FTLD, and between Parkinson's disease and progressive supranuclear palsy;suggesting underlying pathophysiology in corticobasal degeneration and progressive primary aphasia, and cortical dysfunction in Parkinson's disease;using semi-automated assessment to assist visual reading. Panellists did not support FDG-PET use for pre-clinical stages of neurodegenerative disorders, for amyotrophic lateral sclerosis and Huntington disease diagnoses, and for amyotrophic lateral sclerosis or Huntington-disease-related cognitive decline. ConclusionsDespite limited formal evidence, panellists deemed FDG-PET useful in the early and differential diagnosis of the main neurodegenerative disorders, and semi-automated assessment helpful to assist visual reading. These decisions

关键词： Cardiac arrest   Prognostication   Intracranial pressure   Serum albumin   Optic nerve sheath diameter  

摘要： Aim: The optimal time to measure serum albumin concentration (SAC) to predict prognosis in cardiac arrest (CA) survivors has not been elucidated. We aimed to compare the relationships between time-related SAC, optic nerve sheath diameter (ONSD), intracranial pressure (ICP), and neurological prognosis in CA survivors. Methods: We undertook a retrospective study examining CA patients treated with target temperature management (TTM). ICP was measured using cerebrospinal fluid (CSF) pressure and ONSD was obtained before TTM. SAC was measured repeatedly at 4-6 h intervals from the hospital arrival time. We analysed CSF pressure, ONSD, and minimum SAC (MSAC) separately, or in combination, to predict poor neurological outcome. Results: Of 83 patients enrolled, the good outcome group comprised 25 (34%) patients. MSAC at 24 h (MSAC24) had a higher area under the receiver operating characteristic curve (AUC) (0.687;95% confidence interval (CI), 0.668-0.926) than other time points. CSF pressure showed a higher AUC (0.973;95% CI, 0.911-0.996) than MSAC24 and ONSD (0.677;95% CI, 0.565-0.776). In contrast to using MSAC24 and ONSD separately, the combination of both modalities resulted in a better AUC, thus improving the prediction of the neurological outcome (0.734;95% CI, 0.626-0.825) and ICP (0.758;95% CI, 0.651-0.845) after return of spontaneous circulation (ROSC) from CA. Conclusion: A higher ICP was strongly associated with and seemed predictive of poor outcome. Furthermore, the MSAC24/ONSD combination may be a useful predictor of high ICP and poor neurological outcome. Prospective studies should be conducted to confirm these results.

关键词： Modified Atkins diet   epilepsy   malignant glioma   Alzheimer's disease   migraine headache  

摘要： The current review highlights the evidence supporting the use of ketogenic diet therapies in the management of a growing number of neurological disorders in adults. An overview of the scientific literature supporting posited mechanisms of therapeutic efficacy is presented including effects on neurotransmission, oxidative stress, and neuro-inflammation. The clinical evidence supporting ketogenic diet use in the management of adult epilepsy, malignant glioma, Alzheimer's disease, migraine headache, motor neuron disease, and other neurologic disorders is highlighted and reviewed. Lastly, common adverse effects of ketogenic therapy in adults, including gastrointestinal symptoms, weight loss, and transient dyslipidemia are discussed.

关键词： Zika virus   Alice in Woderland syndrome   Viral   Metamorphopsia  

摘要： Zika virus (ZIKV) is a flavivirus endemic in Africa and Southern Asian countries, which has recently emerged in unprecedented epidemic proportions around the world. Although ZIKV infection is often asymptomatic or distinguished by non-specific influenza-like symptoms, an increase in its pathogenicity and biological behavior has been the hallmark of the current pandemic. Increasing evidence suggests that neurotropic strains of ZIKV have evolved from less pathogenic strains of the virus. Neurological manifestations of ZIKV infection include a spectrum of congenital and non-congenital clinical entities, however visual somatosensory perceptual disorders have not been recorded to date. Herein, we report a case of a 15-year-old female who presented with a constellation of perceptual symptoms (metamorphopsia, telopsia, and pelopsia) following acute ZIKV infection. Although such symptoms may have originated from direct viral injury, a post-ZIKV autoimmune reaction to previously unexposed neuronal surface antigens or through molecular mimicry cannot be excluded. The development of Alice in Wonderland syndrome in our patient highlights the ever-increasing expanding spectrum of neurological symptoms associated to ZIKV infection.

关键词： Head trauma   Post-concussional syndrome   Post traumatic amnesia   Neurology   Diagnosis   Second World War  

摘要： The increase in road traffic accidents in twentieth-century Britain brought with it a rise in the number of patients admitted to hospital with blunt, non-penetrating head injuries. Patients who had suffered mild to moderate trauma typically complained of a variety of problems, including headaches, dizziness and giddiness. For the neurologists tasked with diagnosing and treating these patients, such symptoms proved difficult to assess and liable to obscure the clinical picture. This article focuses on why neurologists turned to time as a diagnostic-tool in helping to resolve these issues, specifically the measurement of post-traumatic amnesia (PTA). This article argues that PTA became so central to neurological diagnosis owing to a set of epistemic, professional and material factors in the decades prior to the Second World War. It concludes with a call for deeper appreciation of the range of issues that contribute to the shaping of medical theories of head trauma.

关键词： Drug discovery   Gene therapy   Neurological disorders  

摘要： Adeno-associated viral (AAV) vectors are a rapidly emerging gene therapy platform for the treatment of neurological diseases. In preclinical studies, transgenes encoding therapeutic proteins, microRNAs, antibodies or gene-editing machinery have been successfully delivered to the central nervous system with natural or engineered viral capsids via various routes of administration. Importantly, initial clinical studies have demonstrated encouraging safety and efficacy in diseases such as Parkinson disease and spinal muscular atrophy, as well as durability of transgene expression. Here, we discuss key considerations and challenges in the future design and development of therapeutic AAV vectors, highlighting the most promising targets and recent clinical advances.

关键词： Acute ischemic stroke   Early neurological improvement   Recombinant tissue plasminogen activator   Leukocyte  

摘要： Early neurological improvement (ENI) after thrombolysis in acute ischemic stroke is associated with a favorable long-term outcome. With the goal to evaluate ENI, we aimed to investigate whether ENI bears a relationship with routine blood tests before thrombolysis. A total of 240 patients with confirmed early ischemic stroke and intravenous recombinant tissue plasminogen activator (rtPA) treatment were enrolled from two teaching hospitals, between June 2010 and March 2016. The primary endpoint was ENI that was defined as a decrease of National Institutes of Health Stroke Scale (NIHSS) scores >= 4 points or complete recovery in 24 h after thrombolysis. Patients underwent NIHSS score evaluation and head CT scan before and after 24 h of IV rtPA treatment. Blood samples for routine blood tests were drawn at admission before IV rtPA administration. Multivariate regression analysis was used to explore the relationship between test results and ENI. Of the results of routine blood tests, leukocyte count before thrombolysis was found to associated independently with ENI (adjusted odds ratio[adjOR] = 0.894, P = 0.025, 95% CI = 0.810-0.986). Onset-to-treatment time (OTT;(adj)AOR = 0.993, P = 0.003, 95% CI = 0.988-0.997) and negative CT sign ((adj)AOR = 3.975, P < 0.001, 95% CI = 1.916-8.246) both were associated with ENI. The change of NIHSS score after 24 h of thrombolysis correlated with the leukocyte and neutrophil count, and neutrophil-to-lymphocyte ratio. A model that combined leukocyte count, positive CT sign, and OTT was generated to predict non-ENI (AUC = 0.717). Therefore, we determined that the leukocyte count was independently associated with ENI. Predicting non-ENI aid in selecting patients for mechanical thrombectomy after thrombolysis. (C) 2018 Elsevier Ltd. All rights reserved.

关键词： Somatic mutation   Mosaicism   Autism spectrum disorder   Cortical malformation   Mosaic fraction   Development