关键词： Aciclovir   Acute kidney injury   Crystal nephropathy   Viral encephalitis  

摘要： Background Patients with 'suspected viral encephalitis' are frequently empirically treated with intravenous aciclovir. Increasing urea and creatinine are 'common', but rapidly progressive renal failure is reported to be 'very rare'. Aims To describe the clinical course and outcome of cases of aciclovir-induced acute kidney injury (AKI) encountered by the Liaison Neurology Service at AMNCH and to highlight the importance of surveillance and urgent treatment of this iatrogenic complication. Methods Retrospectively and prospectively collected data from the Liaison Neurology Service at AMNCH on patients who received IV aciclovir for suspected viral encephalitis and developed AKI were analysed. Aciclovir-induced AKI was defined by a consultant nephrologist in all cases as a rise in serum creatinine of > 26 mu mol/L in 48 h or by >= 1.5 times the baseline value. Renal function, haematocrit, and fluid balance were monitored following AKI onset. Results Data from 10 patients were analysed. Median time to AKI onset was 3.5 days (range: 1-6 days). Aciclovir was stopped or the dose adjusted. All patients recovered with IV normal saline, aiming for a urine output > 100-150 ml/h. The interval between first rise in creatinine and return to normal levels varied between 5 and 19 days. Conclusions Liaison neurologists and general physicians need to be aware that aciclovir may cause AKI attributed to distal intra-tubular crystal nephropathy. Daily fluid balance and renal function monitoring are essential because AKI may arise even with intensive pre-hydration. Prognosis is good if identified early and actively treated.

摘要： AimTo study the prevalence of minor neurological dysfunction (MND) at 6years of age in a cohort of children born extremely preterm without cerebral palsy (CP) and to investigate associations with motor function, cognitive abilities, and behaviour. MethodThis study assessed 80 children born at less than 27weeks of gestation and 90 children born at term age between 2004 and 2007 at a mean age of 6years 6months. The assessments included a simplified version of the Touwen Infant Neurological Examination, the Movement Assessment Battery for Children, Second Edition (MABC-2), Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV), the Strengths and Difficulties Questionnaire (SDQ), and the parent version of the Five to Fifteen questionnaire. ResultsFifty-one of the children born preterm had normal neurology, 23 had simple MND, and six had complex MND compared with 88 who had normal neurology and two simple MND in the term-born group (p<0.001). There were significant differences between the children with normal neurology and MND in the preterm group in MABC-2-assessed motor function (p<0.001), general cognitive abilities with WISC-IV (p=0.005), and SDQ overall behavioural problems and peer problems reported by the parents (p=0.021 and p=0.003 respectively). SDQ teacher-reported overall behavioural and hyperactivity problems were significantly different between children with normal and simple MND (p=0.036 and p=0.019). InterpretationChildren born extremely preterm, in the absence of CP, are at risk of MND and this is associated with motor function, cognitive ability, and behaviour.

关键词： CTP   NIHSS   ischemic stroke   ischemic volume   neurological deficit  

摘要： Background: The National Institutes of Health Stroke Scale (NIHSS) is the most adopted stroke patients' evaluation tool in emergency settings to assess the severity of stroke and to determine the patients' eligibility for specific treatments. Computed tomography perfusion (CTP) is crucial to identify salvageable tissue that can benefit from the reperfusion treatment. The aim of this study is to identify the relation between the NIHSS scores and the hypoperfused volumes evaluated by CTP in patients with hyperacute ischemic stroke. Methods: This retrospective study was conducted on 105 patients with ischemic stroke who underwent NIHSS assessment and CTP in the hyperacute phase. Hypoperfused volume was evaluated by CTP maps processed with semi-automatic algorithm. An analysis was conducted to determine the degree of correlation between the NIHSS scores and the ischemic lesion volumes and to investigate the relation between the anterior and the posterior circulation strokes, as well as between the right and the left hemispheric strokes. Results: A significant correlation was found between ischemic volume and NIHSS score at baseline (r = .82;P < .0001) in the entire cohort. A high NIHSS-volume correlation was identified in the anterior circulation stroke (r = .76;P < .0001);whereas, it was nonsignificant in the posterior circulation stroke. NIHSS score and volume correlated for the left and the right hemispheric strokes (r = .83 and .81;P < .0001), showing a slightly higher slope in the left. Conclusion: This study showed a strong correlation between the baseline NIHSS score and the ischemic volume estimated by CTP. We confirmed that NIHSS is a reliable predictor of perfusion deficits in acute ischemic stroke. CTP allows fast imaging assessment in the hyperacute phase. The results highlight the importance of these diagnostic tools in the assessment of stroke severity and in acute decision-making.

关键词： bedside teaching   medical education   learning theory   adult learner  

摘要： The patient's bedside offers an ideal venue for teaching the art of clinical neurology and modeling humanism and professionalism. However, bedside teaching is underutilized in modern medical education, despite evidence that learners desire more. Logistical challenges and lack of teacher confidence are commonly cited reasons, but both can be mitigated with a deliberate approach and sufficient experience. Well-executed bedside teaching can provide lasting lessons for learners while enhancing the patient experience, without affecting the efficiency or quality care delivery. In this review, we discuss the theory and evidence to support the use of bedside teaching, and subsequently delineate a framework for designing and executing effective bedside teaching in neurology.

关键词： Criminal   Moral   Brain lesions   Neurology   Frontal lobe   Brain networks  

摘要： Criminal behavior occurs in previously law-abiding neurological patients, including patients with traumatic brain injury, focal brain lesions, and dementia. Neuroimaging abnormalities in these patients allow one to explore the potential neuroanatomical correlates of criminal behavior. However, this process has been challenging because (1) It is difficult to determine the temporal relationship between criminal behavior and neurological disease onset;(2) Abnormalities in several different brain regions have been associated with criminal behavior;and (3) It is difficult to quantify neuroimaging abnormalities in individual subjects. Recent studies have begun to address these concerns, showing that neuroimaging abnormalities in patients with criminal behavior localize to a common brain network, rather than a single specific brain region. New methods have been developed to identify atrophy patterns in individual patients, but have not yet been used in neurological patients with criminal behavior. Future advances will be important for making sure that neuroimaging data is used in a responsible manner in legal cases involving criminal behavior.

关键词： Epilepsy   Perampanel   Children   Adolescent   Efficacy   Tolerability  

摘要： Aim: This study investigated the efficacy and safety of perampanel (PER) adjunctive therapy in pediatric patients with epilepsy whose seizures are pharmacoresistant to existing antiepileptic drugs. Methods: A clinical retrospective study was conducted from 2016 to 2017 in the pediatric neurology clinic at a tertiary children's hospital. We reviewed the data obtained from 66 children whose seizures were pharmacoresistant to more than two antiepileptic drugs, and could be followed up for a minimum of 3 months after PER adjunctive therapy initiation. The efficacy was estimated by the PER response rate at 3-, 6-, and 12-month follow-up evaluations, and adverse events were also recorded. Results: The rate of seizure reduction of >50% was 30.3%, 37.5%, and 34.7% for all seizure types at 3, 6, and 12 months, in which 7.6%, 8.9%, and 14.3% of the patients became seizure-free at these time points, respectively. No significant differences were found between enzyme-inducing and nonenzyme-inducing antiepileptic drugs in combination with PER with regard to the responder rate. Five patients with Dravet syndrome were included in the study. Four of them (80%) exhibited 50% seizure reduction at the last visit, at which point, two patients (40.0%) were seizure-free. The retention rate was 51% at 12 months. Adverse events were documented in 25 patients (35.7%) and led to PER discontinuation in eight patients (12.1%). The most common adverse events comprised irritability, skin rash, dizziness, and somnolence;however, all were transient and successfully managed after PER dose reduction or discontinuation. Conclusion: The current data support the value of adjunctive PER in child and adolescent patients with pharmacoresistant epilepsy in daily clinical practice. Perampanel was efficacious and generally well-tolerated as an add-on treatment for epilepsy. (C) 2018 The Authors. Published by Elsevier Inc.

关键词： Soft neurological signs   Neurodevelopment   Neurological abnormalities   Motor coordination   Risk factors  

摘要： Objective: Neurological soft signs (NSS) are a group of minor non-localizable neurological abnormalities found more often in patients with schizophrenia and other mental disorders. The aim of the current study was to investigate their prevalence and correlates in healthy controls without family history of any mental disorder. Material and methods: The study sample included 122 normal subjects (66 males and 56 females;aged 32.89 +/- 9.91 years old). The assessment included the Neurological Evaluation Scale (NES), and a number of scales assessing the subthreshold symptoms (MADRS, STAI) and functioning (GAF). Data on a number of socio-demographic variables were also gathered. The statistical analysis included the development of basic statistics tables and the calculation of Pearson correlation coefficients. Results: The results of the current study suggest that more than half of the study sample manifested at least one NSS and approximately 5% more than four. Still, the reported prevalence and NES scores are lower form those reported in the literature probably because of the carefully selected study sample. There were no significant correlations between NSS and any socio-demographic or clinical variable. Discussion: The current study is the first to study NSS in subjects without family history of any mental disorder and reports the presence of frequent silent neurodevelopmental events in the general population, probably in the form of a neurodevelopmental variation and possibly a weak generic rather than specific risk factor.

关键词： Anatomy   Animal cells   Animals   Antibodies   Apicomplexa   Arachnida   Arthropoda   Babesia   Bacteria   Bacterial pathogens   Biochemistry   Biology and life sciences   Blood   Blood cells   Body fluids   Borrelia   Borrelia burgdorferi   Cell biology   Cellular types   Cerebrospinal fluid   Disease vectors   Eukaryota   Immune physiology   Immune system proteins   Immunology   Infectious diseases   Invertebrates   Ixodes   Medical microbiology   Medicine and health sciences   Microbial pathogens   Microbiology   Nervous system   Organisms   Parasite groups   Parasitic diseases   Parasitic protozoans   Parasitology   Pathogens   Pathology and laboratory medicine   Physiology   Proteins   Protozoans   Red blood cells   Species interactions   Symposium   Ticks  

摘要： The article presents a case study of a 55-year-old female patient who was admitted to the hospital for tick-borne diseases with complaints of dizziness, gait disturbance and headache. Topics discussed include the cerebrospinal fluid (CSF) tests performed on the patient; the administration of the doxycycline drug for the patient; and diagnosis of a tick-borne Colpodella species parasite infection in the patient.

关键词： CARDIAC arrest   ELECTROPHYSIOLOGY   COMA   HOSPITAL admission & discharge   CEREBRAL ischemia   TREATMENT effectiveness