关键词： Prediction score   hematoma expansion   neurological deterioration   spontaneous intracerebral hemorrhage  

摘要： Objective: To ensure hematoma expansion and neurological deterioration in the management of acute spontaneous intracerebral hemorrhage, accurate prediction is crucial for initial assessment on admission. We conducted this study to develop a new clinical prediction score using only noncontrast computed tomography image and simply measurable variables. Methods: This study was a retrospective cohort analysis. The study took place in a single academic medical center in Japan. Development of the prediction score was conducted based on patients who presented between October 2010 and June 2015, using univariate and multivariate logistic regression. We then validated the results in a second cohort between July 2015 and April 2017. The primary outcome was hematoma expansion and the secondary outcome was neurological deterioration up to 14 days after onset. Results: In total, 622 patients were included in the analysis after excluding unsuitable cases. Of these, 457 patients were included in the development cohort and 165 were included in the validation cohort, with 10.8% meeting the criteria for hematoma expansion and 8.8% showing neurological deterioration. In the multivariate analysis, predictors of expansion or deterioration were as hematoma heterogeneity on computed tomography, niveau formation, peripheral edema, hematoma volume of more than 30 mL, and anticoagulant use. We then created the HEAVN score based on the univariate regression coefficients. The C-statistics for the hematoma expansion scores were .81 and .80 in the development and validation cohorts, respectively. Similar results were obtained for neurological deterioration. Conclusions: The HEAVN score is simple and useful for predicting hematoma expansion and neurological deterioration based on imaging and background data.

关键词： Glasgow Outcome Scale   head injury   serum magnesium  

摘要： Hypomagnesemia is postulated as one of the important determinants of outcome following traumatic brain injury (TBI) through its effect on secondary injuries to *** and Objective:The aim of this study was to determine the relationship between serum magnesium level and neurological outcome in patients admitted with severe head *** and Methods:In this prospective study, patients admitted with severe TBI were recruited and dichotomized into low serum magnesium group and normal serum magnesium group based on the initial serum magnesium level. Data were collected regarding age, sex, and Glasgow Coma Scale at admission. Neurological outcome of the patients in these groups was assessed using Glasgow Outcome Scale at 6 ***:Seventy-two patients (male = 50, female = 22) with a mean (±standard deviation) age of 42.5 (±12.7) years were studied. Forty-two (58%) patients had low serum magnesium level (<1.3 mEq/L) at admissions. At 6-month follow-up, 81% of patients with poor neurological outcome had low serum magnesium as compared to 19% of patients with good outcome (P = 0.01). Hypomagnesemia was associated with poor neurological outcome (odds ratio = 2.1, P = 0.04, 95% confidence interval = 1.0-8.8) on regression ***:Hypomagnesemia appears to be an independent prognostic marker in patients with severe TBI.

摘要： The above letter to the editor written by “Lars Andersson” (stated to be affiliated with Department of Physiology and Pharmacology, Karolinska Institutet), published in print and online in the Journal of Internal Medicine in Wiley Online Library https://***) on the date given above, has been retracted by agreement between the journal’s Editor‐in‐Chief Ulf de Faire, the Association for Publication of the Journal of Internal Medicine and John Wiley & Sons Limited. The retraction has been agreed due to the author’s use of what appears to be a false name and affiliation. Reference Andersson L. Response on the author’s reply to the Letter to the Editor: contradictory data on type 1 diabetes in a recently published article: risks of neurological and immune‐related diseases, including narcolepsy, after vaccination with Pandemrix. J Intern Med 2015; 277: 272-3.

关键词： bibliometrics   European Academy of Neurology   gross domestic product   population  

摘要： Background and purpose: Bibliometric searches may provide an indirect assessment of research in a field or country. The European Academy of Neurology decided to investigate how article production was developing in European countries, as an indicator of neurological vitality. Methods: We searched two databases, Scopus and PubMed, for articles published by authors belonging to neurological institutions in all European countries, the USA, Brazil, China and Japan. The search assessed production in the period between 2000 and 2015. We calculated four indicators, i. e. gross neurological product (GNP) (which includes all articles published in any indexed journal), production in top neurological journals, GNP per inhabitant and GNP per gross domestic product. Results: All indicators greatly increased over time. The European GNP paralleled that of the USA and was higher than those of the other countries. Restricting the search to top neurological journals showed that, since 2012, European production grew faster than that of the USA. Germany had the highest production within Europe, Switzerland had the best ratio between GNP and inhabitants, and The Netherlands had the best ratio between GNP and gross domestic product. Conclusions: Although this search had several limitations, the results were so straightforward that we can conclude that European neurology is highly active in the world. Future analyses should compare neurology with other main medical disciplines.

关键词： AAN   American Academy of Neurology   CI   confidence interval   DoC   disorders of consciousness   eMCS   emergence from minimally conscious state   LEP   laser-evoked potential   LR   likelihood ratio   MCS   minimally conscious state   MSTF   Multi-Society Task Force   OR   odds ratio   PVS   persistent vegetative state   UWS   unresponsive wakefulness syndrome   VS   vegetative state  

摘要： Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition for the minimally conscious state (MCS) by reviewing the literature on the diagnosis, natural history, prognosis, and treatment of disorders of consciousness lasting at least 28 days. Methods: Articles were classified per the AAN evidence-based classification system. Evidence synthesis occurred through a modified Grading of Recommendations Assessment, Development and Evaluation process. Recommendations were based on evidence, related evidence, care principles, and inferences according to the AAN 2011 process manual, as amended. Results: No diagnostic assessment procedure had moderate or strong evidence for use. It is possible that a positive EMG response to command, EEG reactivity to sensory stimuli, laser-evoked potentials, and the Perturbational Complexity Index can distinguish MCS from vegetative state/unresponsive wakefulness syndrome (VS/UWS). The natural history of recovery from prolonged VS/UWS is better in traumatic than non-traumatic cases. MCS is generally associated with a better prognosis than VS (conclusions of low to moderate confidence in adult populations), and traumatic injury is generally associated with a better prognosis than nontraumatic injury (conclusions of low to moderate confidence in adult and pediatric populations). Findings concerning other prognostic features are stratified by etiology of injury (traumatic vs nontraumatic) and diagnosis (VS/UWS vs MCS) with low to moderate degrees of confidence. Therapeutic evidence is sparse. Amantadine probably hastens functional recovery in patients with MCS or VS/UWS secondary to severe traumatic brain injury over 4 weeks of treatment. Recommendations are presented separately. Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine

关键词： Meningitis   encephalitis   Escherichia coli   coma   near-death experience  

摘要： A 54-year-old otherwise healthy man presented with altered mental status. On admission, the patient was confused and agitated, with a Glasgow Coma Scale (GCS) score of 11, suggesting moderate brain injury. He was sedated, placed on a ventilator, and started on tobramycin and ceftazidime for presumed bacterial meningitis, but switched to ceftriaxone once cultures returned as Escherichia coli. During his 8-day hospitalization, his mental status fluctuated from confused to nonresponsive, with GCS scores between 6 and 11. Although E. coli meningitis has a high rate of neurological complications and death, this patient recovered completely without any deficits, and recalled an elaborate near-death experience that occurred during his coma. This case highlights the importance of studying near-death experiences occurring during compromised brain function to further our understanding of the brain and consciousness.

关键词： Acute ischemic stroke   Glycemic variability   Early neurological deterioration  

摘要： The association between glycemic variability and early neurological deterioration (END) in acute ischemic stroke remains unclear. This study attempted to explore whether initial glycemic variability increases END in diabetic patients with acute ischemic stroke. We enrolled type 2 diabetic patients undergoing acute ischemic stroke from November 2015 to November 2016. A total of 336 patients within 72 h from stroke onset were included. The serum glucose levels were checked four times per day during the initial 3 hospital days. The standard deviation of blood glucose (SDBG) values and the mean amplitude of glycemic excursions (MAGE) were calculated for glycemic variability. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ae 2 points between hospital days 0 and 5. The frequencies of END and HbA1c were significantly different in subjects grouped according to tertiles of MAGE (9.09, 12.07 and 50.00%, p < 0.001 for END;7.36 +/- 1.91, 7.83 +/- 1.93 and 8.56 +/- 1.79, p < 0.001 for HbA1c). Compared to patients without END, patients with END had significantly higher HbA1c levels (8.30 +/- 1.92 vs 7.80 +/- 1.93, p = 0.043), increased SDBG (3.42 +/- 1.14 vs 2.60 +/- 0.96, p < 0.001), and increased MAGE (6.46 +/- 2.09 vs 4.59 +/- 1.91, p < 0.001). In a multivariable logistic regression, stroke etiology (OR 0.675;95% CI 0.485-0.940, p = 0.020), baseline NIHSS (OR 1.086;95% CI 1.004-1.175, p = 0.040), and MAGE (OR 1.479;95% CI 1.162-1.882, p = 0.001) were significantly associated with END. Initial glycemic variability is associated with END in diabetic patients with acute ischemic stroke.

关键词： Nervous system diseases   Tai Ji   Tai Chi   accidental falls   meta-analysis  

摘要： Objective: To evaluate the effect of Tai Chi on balance and reducing falls incidence in neurological disorders. Data sources: AMED, Embase, Web of Science, SCOPUS, EBSCO and Medline from inception until February 2018. Review method: Randomized controlled trials of Tai Chi compared with active or no treatment control, measuring balance with the Berg Balance Scale or the Timed Up and Go Test and number of falls in neurological disorders were included. Methodological quality was assessed using PEDro and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results: A total of 10 studies involving 720 participants were reviewed. Seven studies were in Parkinson's disease and three in stroke. Seven studies were of high methodological quality and three were low. Meta-analyses of balance measured with the Timed Up and Go Test in Parkinson's disease revealed a statistically significant effect of Tai Chi compared to no treatment (weighted mean difference (WMD), -2.13;95% confidence interval (CI), -3.26 to -1.00;P<0.001) and was insignificant (WMD, -0.19;95% CI, -1.74 to 1.35;P=0.81) when compared with active treatment. Tai Chi significantly reduced falls incidence in Parkinson's disease (odds ratio (OR), 0.47;95% CI, 0.29 to 0.77;P=0.003) and stroke (OR, 0.21;95% CI, 0.09 to 0.48;P<0.001). Balance measured with the Timed Up and Go Test comparing Tai Chi and active treatment was insignificant (WMD, 0.45;95% CI, -3.43 to 2.54;P=0.77) in stroke. Conclusion: Tai Chi is effective in reducing falls incidence in Parkinson's disease and stroke. This systematic review did not find high-quality studies among other neurological disorders.

关键词： Traumatic brain injury   Neuroinflammation   NLRP3 inflammasome   Interleukin-1 beta   Microglia   MCC950  

摘要： The nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domain containing 3 (NLRP3) inflammasome-mediated inflammatory response has emerged as a prominent contributor to the pathophysiological processes of traumatic brain injury (TBI). Recently, a potent, selective, small-molecule NLRP3 inflammasome inhibitor, MCC950, was described. Here, we investigated the effect of MCC950 on inflammatory brain injury and long-term neurological outcomes in a mouse model of TBI. Male C57/BL6 mice were subjected to TBI using the controlled cortical impact injury (CCI) system. Western blotting, flow cytometry, and immunofluorescence assays were utilized to analyze post-traumatic NLRP3 inflammasome expression and determine its cellular source. We found that NLRP3 inflammasome expression was significantly increased in the peri-contusional cortex and that microglia were the primary source of this expression. The effects of MCC950 on mice with TBI were then determined using post-assessments including analyses of neurological deficits, brain water content, traumatic lesion volume, neuroinflammation, blood-brain barrier (BBB) integrity, and cell death. MCC950 treatment resulted in a better neurological outcome after TBI by alleviating brain edema, reducing lesion volume, and improving long-term motor and cognitive functions. The therapeutic window for MCC950 against TBI was as long as 6 h. Furthermore, the neuroprotective effect of MCC950 was associated with reduced microglial activation, leukocyte recruitment, and pro-inflammatory cytokine production. In addition, MCC950 preserved BBB integrity, alleviated TBI-induced loss of tight junction proteins, and attenuated cell death. Notably, the efficacy of MCC950 was abolished in microglia-depleted mice. These results indicate that microglia-derived NLRP3 inflammasome may be primarily involved in the inflammatory response to TBI, and specific NLRP3 inflammasome inhibition using MCC950 may be a promising therapeutic appro

摘要： The clinical phenotype of leucine-rich glioma-inactivated protein 1 (LGI1) and contactin-associated proteinlike 2 (CASPR2) autoimmunity is well defined in adults. Data for children are limited (<10 cases). Among 13,319 pediatric patients serologically tested for autoimmune neurological disorders (2010-2017), 264 were seropositive for voltage-gated potassium channel-complex-IgG (radioimmunoprecipitation). Only 13 (4.9%) were positive by transfected cell-binding assay for LGI1-IgG (n=7), CASPR2-IgG (n=3), or both (n=3). This is significantly less than in adults. Encephalopathy, seizures, and peripheral nerve hyperexcitability were common, as was coexisting autoimmunity. No faciobrachial dystonic seizures or cancers were identified. Functional neurologic disorders were frequently the initial diagnosis, and immunotherapy appeared beneficial. Ann Neurol 2018;84:473-480