关键词： intermittent rhythmic delta activity   intensive care   EEG   stroke   pathophysiology  

摘要： Introduction. Frontal intermittent rhythmic delta activity (FIRDA), a transient rhythmic slow wave pattern over the anterior EEG leads, has been reported in a wide variety of cerebral lesions and different metabolic disturbances. Few authors have analyzed the frequency and clinical significance of FIRDA in the critical care setting. We aimed to better understand these issues in our intensive care cohort and if possible, try to delineate its underlying mechanisms. Methods. Video-EEG reports of consecutive adult patients in the neurological intensive care unit (NICU) since 2009 were retrospectively reviewed to identify cases with FIRDA. Demographic, clinical, and laboratory data were obtained from EEG reports and patient charts. Age- and sex-matched patients with acute stroke, hospitalized in NICU and no FIRDA on video-EEG monitoring served as the control group. Results. Among 162 patients who underwent video-EEG monitoring, FIRDA was documented in 17%. Female prevalence was 50% and age ranged from 23 to 82 years. Twenty-three (82%) of patients with FIRDA had a diagnosis of stroke. Comparison of demographic characteristics, EEG findings, metabolic disturbances and prognoses revealed no differences between stroke cases with and without FIRDA, except for higher frequency of acute and chronic isolated posterior circulation infarcts in patients with FIRDA. Conclusion. FIRDA is more commonly encountered in the neurocritical care setting as compared with outpatient EEG clinics. Our findings in stroke patients indicate that involved vascular territories may be related to the generation of FIRDA.

关键词： IMPACT factor (Citation analysis)   NEUROSCIENCES   PERIODICAL articles   MEDICAL literature   PERIODICAL editors  

关键词： In-hospital cardiac arrest   Heart arrest   Cardiopulmonary resuscitation   Prognosis   Clinical decision-making   Medical futility  

摘要： Background: A do-not-attempt-resuscitation order is issued when it is against the wishes of the patient that cardiopulmonary resuscitation is performed, or when the chance of good quality survival is minimal. Therefore it is essential for physicians to make an objective prearrest prediction of the outcome after an in-hospital cardiac arrest (IHCA). Our aim was external validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in a population based setting. Methods: The study was based on a retrospective cohort of adult IHCAs in Stockholm County 2013-2014 identified through the Swedish Cardiopulmonary Resuscitation Registry. This registry provided patient and event characteristics and neurological outcome at discharge. Neurologically intact survival is defined as Cerebral Performance Category score (CPC) 1 at discharge. Data for the GO-FAR variables was obtained from manual review of electronic patient records. Model performance was evaluated by measure of discrimination with the area under the receiver operating curve (AUROC) and calibration with assessment of the calibration plot. Results: The cohort included 717 patients with neurologically intact survival at discharge of 22%. In complete case analysis (523 cases) AUROC was 0.82 (95% CI 0.78-0.86) indicating good discrimination. The calibration plot showed that the GO-FAR score systematically underestimates the probability of neurologically intact survival. Conclusion: The GO-FAR score has satisfactory discrimination, but assessment of the calibration shows that neurologically intact survival is systematically underestimated. Therefore, only with caution should it without model update be taken into clinical practice in settings similar to ours.

关键词： double-negative T cells   neuroblastoma   opsoclonus-myoclonus syndrome   paraneoplastic syndrome   paediatric neuroinflammation  

摘要： Studies of cerebrospinal fluid (CSF) T cells in children are limited, dueespecially to the lack of control data. In adults, gamma/delta T cells (TCR-) residing in the intrathecal space are sometimes involved in neuroinflammation. To evaluate the possible role of T cells in paediatric neuroinflammation, we immunophenotyped cerebrospinal fluid (CSF) and blood lymphocytes using flow cytometry in a case-control study of 100 children with non-inflammatory neurological disorders (NIND), 312 with opsoclonus-myoclonus (OMS) and 23 with other inflammatory neurological disorders (OIND). In NIND, the negative correlation between CSF T cell frequency and patient age was striking: median frequency of 27% in infants and 33% in teens. Interindividual variations were largest in the youngest. There was no gender effect. In all OMS, after correcting for age, only a small effect of OMS severity remained. Measurement of markers for T cell activation [human leucocyte antigen D-related (HLA-DR)], maturation (CD45RA, CD45RO) or intracellular cytokine staining [interleukin (IL)-4, interferon (IFN)-] failed to discriminate OMS and NIND groups. Of seven OMS immunotherapies/combinations, none altered the frequency of total CSF T cells or subsets significantly. In OIND, the CSF T cell frequency was <10% for single samples of other paraneoplastic disorders [anti-neuronal nuclear antibody (ANNA)-1, PCA-1, teratoma-associated syndrome], cerebellar ataxia (post-infectious, ataxia-telangiectasia), acute disseminated encephalomyelitis, neuroborreliosis and encephalitis. This study provides new insights into CSF T cells in the paediatric population. Although their role in CSF remains elusive, the negative age correlation, resistance to immunotherapy and our age cut-off references for NIND are important findings for the design of future paediatric studies.

关键词： Ossification of the posterior longitudinal ligament   Thoracic spine   Posterior surgery   Clinical outcome  

摘要： Highlights • There is currently no preoperative factor for prediction of neurological outcome. • Postoperative change of kyphosis had no significant impact on the neurological outcome. • Recovery of JOA score during the first 3 months can predict the final neurological outcome.

关键词： Tubercular dacryoadenitis   Intracranial extension   Acute tuberculosis  

摘要： We report a case of young adult female with swelling in the superolateral aspect of left orbit for two weeks which was diagnosed as tubercular dacryoadenitis with intracranial extension without any neurological features. Tubercular dacryoadenitis is very rare but still makes an important differential diagnosis of lacrimal gland swellings especially in endemic areas like India. Few cases of tubercular dacryoadenitis have been reported in the past;but not a single case with intracranial extension in young adults with short history and without neurological symptoms. Although radiological investigations are routinely done in orbital lesions, it is advisable do so even in acute cases to look for intracranial extension before the appearance of neurological features. Tubercular dacryoadenitis though rare, should be kept as a differential diagnosis of acute or chronic lacrimal gland swellings in endemic areas.

关键词： Partial Epilepsies   Epilepsy, Absence   neurology   seizure frequency   Automated External Defibrillators   perampanel   American   Epilepsy   monotherapy   Anticonvulsants  

摘要： Objective: To update the 2004 American Academy of Neurology (AAN) guideline for treating new-onset focal or generalized epilepsy (GE) with second- and third-generation antiepileptic drugs (AEDs). Methods: The 2004 AAN criteria was used to systematically review literature (January 2003 to November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength. Results: Several second-generation AEDs are effective for new-onset focal epilepsy. Data are lacking on efficacy in new-onset generalized tonic-clonic seizures, juvenile myoclonic epilepsy, or juvenile absence epilepsy, and on efficacy of third-generation AEDs in new-onset epilepsy. Recommendations: Lamotrigine (LTG) should (Level B) and levetiracetam (LEV) and zonisamide (ZNS) may (Level C) be considered in decreasing seizure frequency in adults with new-onset focal epilepsy. LTG should (Level B) and gabapentin (GBP) may (Level C) be considered in decreasing seizure frequency in patients >= 60 years with new-onset focal epilepsy. Unless there are compelling adverse-effect-related concerns, ethosuximide (ETS) or valproic acid (VPA) should be considered before LTG to decrease seizure frequency in treating absence seizures in childhood absence epilepsy (Level B). No high-quality studies suggest clobazam, eslicarbazepine, ezogabine, felbamate, GBP, lacosamide, LEV, LTG, oxcarbazepine, perampanel, pregabalin, rufinamide, tiagabine, topiramate, vigabatrin, or ZNS is effective in treating new-onset epilepsy because no high-quality studies exist in adults of various ages. A recent FDA strategy allows extrapolation of efficacy across populations;therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons >= 4 years old and perampanel as monotherapy received FDA approval.