Pauline Luczynski, C. Laule, G. Hsiung, G. Moore, H. Tremlett
Individuals with multiple sclerosis (MS) are now living close to normal lifespans and will likely suffer from the same diseases of aging as the general population. However, the coexistence of MS with diseases of aging remains poorly understood. In particular, little information exists describing the coexistence of MS with Alzheimer’s disease (AD), the most common form of dementia. In this case series, we searched a post-mortem pathological (autopsy) report database of the Vancouver General Hospital, Vancouver Coastal Health Authority in British Columbia, Canada to identify individuals with neuropathological features of both MS and AD. To complement the data from the autopsy reports, we accessed the medical records of the patients identified. Our search identified four individuals with pathological features of both MS and AD: three females and one male. Two individuals had pre-mortem diagnoses of MS while two did not. None of the patients with AD pathology had pre-mortem diagnoses of AD. In summary, this case series adds to the sparse literature describing the coexistence of these two relatively common neurological conditions and advances our understanding of the clinical and pathological features individuals with both MS and AD may present with. J Neurol Res. 2021;11(3-4):60-67 doi: https://doi.org/10.14740/jnr666
{"title":"Coexistence of Multiple Sclerosis and Alzheimer Disease Pathology: A Case Series","authors":"Pauline Luczynski, C. Laule, G. Hsiung, G. Moore, H. Tremlett","doi":"10.14740/jnr666","DOIUrl":"https://doi.org/10.14740/jnr666","url":null,"abstract":"Individuals with multiple sclerosis (MS) are now living close to normal lifespans and will likely suffer from the same diseases of aging as the general population. However, the coexistence of MS with diseases of aging remains poorly understood. In particular, little information exists describing the coexistence of MS with Alzheimer’s disease (AD), the most common form of dementia. In this case series, we searched a post-mortem pathological (autopsy) report database of the Vancouver General Hospital, Vancouver Coastal Health Authority in British Columbia, Canada to identify individuals with neuropathological features of both MS and AD. To complement the data from the autopsy reports, we accessed the medical records of the patients identified. Our search identified four individuals with pathological features of both MS and AD: three females and one male. Two individuals had pre-mortem diagnoses of MS while two did not. None of the patients with AD pathology had pre-mortem diagnoses of AD. In summary, this case series adds to the sparse literature describing the coexistence of these two relatively common neurological conditions and advances our understanding of the clinical and pathological features individuals with both MS and AD may present with. J Neurol Res. 2021;11(3-4):60-67 doi: https://doi.org/10.14740/jnr666","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83136130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health equity understood as the ability to live a healthy life, to have a good life, is impacted by many social determinants and by the social marginalization of various groups. “Measures” that use indicators to cover social determinants of a good life are useful tools to audit the impact of neuro-advancements on health equity. In this scoping review, I covered over 50 neurotechnologies, neuroenhancement, artificial intelligence (AI) machine learning (ML), robotics, neuroethics, neuro-governance and neurotechnology governance and various “measures” that focus on the ability to have a good life to answer three research questions: 1) Are the “measures” engaged with in the academic literature covering health equity or the chosen technologies? 2) Does the academic literature focusing on the technologies covered, neuroethics, or neurotechnology governance engage with health equity? 3) To what extent does the academic literature focusing on the technologies covered engage with the different primary and secondary indicators of four of the “measures” (social determinants of health, Better Life Index, Canadian Index of Well-Being, and community-based rehabilitation matrix)? For the scoping review, I examined the academic literature present in SCOPUS, which includes all Medline articles, and the 70 databases accessible under EBSCO-HOST and I employed a quantitative hit count approach for the analysis. I found that the term “health equity” was only mentioned in conjunction with the terms “determinants of health” and “social determinants of health” in a substantial way. Three of the terms linked to the “measures” were each mentioned in less than 10 abstracts and 16 terms linked to the “measures” were not mentioned at all in conjunction with the term “health equity”. Health equity was also rarely to not at all mentioned in conjunction with the different technologies covered and not at all in conjunction with the terms “neuroethics”, “neurotechnology governance” or “neuro-governance”. Finally, there was uneven engagement with the primary and secondary indicators of the four chosen “measures” in conjunction with the technologies covered. The results reveal vast opportunities at the intersections of neuroethics and neuro-governance and science and technology governance in general, health equity, social justice, and wellbeing discourses. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr695
{"title":"Auditing the Impact of Neuro-Advancements on Health Equity","authors":"G. Wolbring","doi":"10.14740/JNR.V0I0.695","DOIUrl":"https://doi.org/10.14740/JNR.V0I0.695","url":null,"abstract":"Health equity understood as the ability to live a healthy life, to have a good life, is impacted by many social determinants and by the social marginalization of various groups. “Measures” that use indicators to cover social determinants of a good life are useful tools to audit the impact of neuro-advancements on health equity. In this scoping review, I covered over 50 neurotechnologies, neuroenhancement, artificial intelligence (AI) machine learning (ML), robotics, neuroethics, neuro-governance and neurotechnology governance and various “measures” that focus on the ability to have a good life to answer three research questions: 1) Are the “measures” engaged with in the academic literature covering health equity or the chosen technologies? 2) Does the academic literature focusing on the technologies covered, neuroethics, or neurotechnology governance engage with health equity? 3) To what extent does the academic literature focusing on the technologies covered engage with the different primary and secondary indicators of four of the “measures” (social determinants of health, Better Life Index, Canadian Index of Well-Being, and community-based rehabilitation matrix)? For the scoping review, I examined the academic literature present in SCOPUS, which includes all Medline articles, and the 70 databases accessible under EBSCO-HOST and I employed a quantitative hit count approach for the analysis. I found that the term “health equity” was only mentioned in conjunction with the terms “determinants of health” and “social determinants of health” in a substantial way. Three of the terms linked to the “measures” were each mentioned in less than 10 abstracts and 16 terms linked to the “measures” were not mentioned at all in conjunction with the term “health equity”. Health equity was also rarely to not at all mentioned in conjunction with the different technologies covered and not at all in conjunction with the terms “neuroethics”, “neurotechnology governance” or “neuro-governance”. Finally, there was uneven engagement with the primary and secondary indicators of the four chosen “measures” in conjunction with the technologies covered. The results reveal vast opportunities at the intersections of neuroethics and neuro-governance and science and technology governance in general, health equity, social justice, and wellbeing discourses. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr695","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"223 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87647888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Li, Meide Zhao, R. Kufahl, X. Du, A. Alaraj, Jianmin Li, S. Amin‐Hanjani, F. Charbel
Background: Some cerebral flow models have good accuracy in predicting patient outcome, but are too complicated to be readily duplicated by others. Others are simpler, but lack accuracy in utilizing patient-specific boundary conditions. Methods: A new patient-specific cerebral flow model aimed at both simplicity and accuracy was designed and applied to predict stump pressure (SP) during balloon test occlusion (BTO). The new model simulates both a baseline and an internal carotid artery (ICA) occlusion flow model. The former involves building a novel patient-specific cerebral flow model with regional flows, where the resistances of all inlet and internal vessels were obtained using a multi-objective optimization algorithm; regional blood flows were calculated using vessel flows measured from quantitative magnetic resonance angiography (QMRA). The ICA occlusion flow model computes the new blood flows and pressures of efferent, inlet and internal vessels with the simulated occlusion of the ICA, while keeping the resistances of the peripheral, inlet and internal vessels constant. Results: The model was applied to predict SPs of four patients undergoing BTO. When aortic pressures are used, the simulated SPs demonstrate -11% to 7% error when compared to actual clinical measurements. When cuff pressures are used to approximate aortic pressures, the errors of the corresponding SPs becomes -19% to 1%. Conclusions: The proposed model flow was validated with both clinically measured blood flows and SPs. Even when cuff pressures were used to approximate aortic pressures, the reliable predicted SPs were achieved. The model may be promising for clinical use. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr671
{"title":"Patient-Specific Cerebral Flow Model Using Regional Flows and Multi-Objective Optimization","authors":"Daniel Li, Meide Zhao, R. Kufahl, X. Du, A. Alaraj, Jianmin Li, S. Amin‐Hanjani, F. Charbel","doi":"10.14740/jnr671","DOIUrl":"https://doi.org/10.14740/jnr671","url":null,"abstract":"Background: Some cerebral flow models have good accuracy in predicting patient outcome, but are too complicated to be readily duplicated by others. Others are simpler, but lack accuracy in utilizing patient-specific boundary conditions. Methods: A new patient-specific cerebral flow model aimed at both simplicity and accuracy was designed and applied to predict stump pressure (SP) during balloon test occlusion (BTO). The new model simulates both a baseline and an internal carotid artery (ICA) occlusion flow model. The former involves building a novel patient-specific cerebral flow model with regional flows, where the resistances of all inlet and internal vessels were obtained using a multi-objective optimization algorithm; regional blood flows were calculated using vessel flows measured from quantitative magnetic resonance angiography (QMRA). The ICA occlusion flow model computes the new blood flows and pressures of efferent, inlet and internal vessels with the simulated occlusion of the ICA, while keeping the resistances of the peripheral, inlet and internal vessels constant. Results: The model was applied to predict SPs of four patients undergoing BTO. When aortic pressures are used, the simulated SPs demonstrate -11% to 7% error when compared to actual clinical measurements. When cuff pressures are used to approximate aortic pressures, the errors of the corresponding SPs becomes -19% to 1%. Conclusions: The proposed model flow was validated with both clinically measured blood flows and SPs. Even when cuff pressures were used to approximate aortic pressures, the reliable predicted SPs were achieved. The model may be promising for clinical use. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr671","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82330576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yufeng Wang, Nacima Chen, Jun Chen, Xiang Li, Li Sun, Yi Bao
Background: To observe and explore the clinical effect of motor imagery therapy (MIT) combined with low-frequency pulsed electrical stimulation therapy (LFPEST) on improving upper limb function in young stroke patients. Methods: Eighty-one young stroke patients with hemiplegia were divided into MIT group, LFPEST group and combined treatment group. Fugl-Meyer assessment (FMA), functional test hemiplegic upper extremity (FTHUE) and modified Barthel Index (MBI) were used to evaluate the upper limb function and activities of daily living before and 6 weeks after treatment. Results: After treatment, the FMA score, FTHUE grading and MBI score of the combined treatment group and the MIT group were significantly higher than those of the LFPEST group (P < 0.05), and the curative effect of the combined treatment group was significantly higher than that of the MIT group (P < 0.05). Conclusions: MIT combined with LFPEST has more obvious curative effect than LFPEST and MIT, which can significantly improve the upper limb function, hand function and daily living ability of young stroke patients with hemiplegia. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr661
{"title":"Preliminary Study on Effect of Motor Imagery Combined With Low-Frequency Pulsed Electrical Stimulation Therapy on Upper Limb Function of Young Stroke Patients","authors":"Yufeng Wang, Nacima Chen, Jun Chen, Xiang Li, Li Sun, Yi Bao","doi":"10.14740/jnr661","DOIUrl":"https://doi.org/10.14740/jnr661","url":null,"abstract":"Background: To observe and explore the clinical effect of motor imagery therapy (MIT) combined with low-frequency pulsed electrical stimulation therapy (LFPEST) on improving upper limb function in young stroke patients. Methods: Eighty-one young stroke patients with hemiplegia were divided into MIT group, LFPEST group and combined treatment group. Fugl-Meyer assessment (FMA), functional test hemiplegic upper extremity (FTHUE) and modified Barthel Index (MBI) were used to evaluate the upper limb function and activities of daily living before and 6 weeks after treatment. Results: After treatment, the FMA score, FTHUE grading and MBI score of the combined treatment group and the MIT group were significantly higher than those of the LFPEST group (P < 0.05), and the curative effect of the combined treatment group was significantly higher than that of the MIT group (P < 0.05). Conclusions: MIT combined with LFPEST has more obvious curative effect than LFPEST and MIT, which can significantly improve the upper limb function, hand function and daily living ability of young stroke patients with hemiplegia. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr661","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87528490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-23DOI: 10.14740/JNR.V11I1-2.653
Samir S. Al-Ghazawi, Khaled Al-Robaidi, A. Jadhav, Qasem Al Shaer, Nada Alrifai, P. Thirumala
Background: Perioperative stroke, which occurs within 30 days following surgery, can increase morbidity and mortality. The prior might reduce surgical interventions’ clinical effectiveness, carrying significant impact on patients, their families, and healthcare resources utilization. We examined the impact of perioperative stroke on morbidity and mortality in patients undergoing non-cardiovascular non-neurological surgeries. Methods: We performed a retrospective cohort study utilizing State Inpatient Database (SID) available from the Health Cost Utilization Project (HCUP) between 2008 and 2011. The databases above can distinguish between previous and new strokes by providing the “present on admission” variable. We used multivariable logistic regression to assess stroke as an independent predictor of morbidity and mortality after adjusting for other covariables. Results: From the SID, a total of 1,206,057 inpatient discharge records were identified. The incidence of perioperative stroke, in-hospital mortality, and morbidity was 0.14%, 0.54%, and 8.1%. Multivariate logistic regression showed that perioperative stroke is an independent predictor of morbidity (odds ratio (OR) = 5.06, 95% confidence interval (CI) = 4.54 - 5.64, P < 0.001) and in-hospital mortality (OR = 7.26, 95% CI = 6.26 - 8.41, P < 0.001). Other independent predictors were identified, but they showed a weaker association with in-hospital mortality than perioperative stroke, including cardiovascular complications (OR = 4.33, CI = 3.93 - 4.77, P < 0.001). Conclusions: Perioperative stroke is a significant independent risk factor for morbidity and in-hospital mortality following non-cardiovascular, non-neurological surgeries. Patients who developed perioperative stroke had a higher risk of death than perioperative cardiovascular and pulmonary complications. J Neurol Res. 2021;11(1-2):5-13 doi: https://doi.org/10.14740/jnr653
背景:围手术期卒中发生在手术后30天内，可增加发病率和死亡率。这可能会降低手术干预的临床效果，对患者、家属和医疗资源的利用产生重大影响。我们研究了围手术期卒中对非心血管非神经外科手术患者发病率和死亡率的影响。方法:利用2008年至2011年卫生成本利用项目(HCUP)提供的国家住院患者数据库(SID)进行回顾性队列研究。上述数据库可以通过提供“入院时存在”变量来区分以前的笔画和新的笔画。在调整其他协变量后，我们使用多变量逻辑回归来评估卒中作为发病率和死亡率的独立预测因子。结果:从SID中共识别出1206057例住院出院记录。围手术期卒中发生率、住院死亡率和发病率分别为0.14%、0.54%和8.1%。多因素logistic回归显示围手术期卒中是发病率(优势比(OR) = 5.06, 95%可信区间(CI) = 4.54 ~ 5.64, P < 0.001)和住院死亡率(OR = 7.26, 95% CI = 6.26 ~ 8.41, P < 0.001)的独立预测因子。其他独立预测因素也被确定，但与围手术期卒中相比，它们与住院死亡率的相关性较弱，包括心血管并发症(OR = 4.33, CI = 3.93 - 4.77, P < 0.001)。结论:围手术期卒中是非心血管、非神经外科手术后发病率和住院死亡率的重要独立危险因素。围手术期卒中患者的死亡风险高于围手术期心血管和肺部并发症。中华神经科杂志。2021;11(1-2):5-13 doi: https://doi.org/10.14740/jnr653
{"title":"Perioperative Stroke Impact on Morbidity and In-Hospital Mortality in Non-Cardiovascular Non-Neurological Surgeries: State Inpatient Database Study","authors":"Samir S. Al-Ghazawi, Khaled Al-Robaidi, A. Jadhav, Qasem Al Shaer, Nada Alrifai, P. Thirumala","doi":"10.14740/JNR.V11I1-2.653","DOIUrl":"https://doi.org/10.14740/JNR.V11I1-2.653","url":null,"abstract":"Background: Perioperative stroke, which occurs within 30 days following surgery, can increase morbidity and mortality. The prior might reduce surgical interventions’ clinical effectiveness, carrying significant impact on patients, their families, and healthcare resources utilization. We examined the impact of perioperative stroke on morbidity and mortality in patients undergoing non-cardiovascular non-neurological surgeries. Methods: We performed a retrospective cohort study utilizing State Inpatient Database (SID) available from the Health Cost Utilization Project (HCUP) between 2008 and 2011. The databases above can distinguish between previous and new strokes by providing the “present on admission” variable. We used multivariable logistic regression to assess stroke as an independent predictor of morbidity and mortality after adjusting for other covariables. Results: From the SID, a total of 1,206,057 inpatient discharge records were identified. The incidence of perioperative stroke, in-hospital mortality, and morbidity was 0.14%, 0.54%, and 8.1%. Multivariate logistic regression showed that perioperative stroke is an independent predictor of morbidity (odds ratio (OR) = 5.06, 95% confidence interval (CI) = 4.54 - 5.64, P < 0.001) and in-hospital mortality (OR = 7.26, 95% CI = 6.26 - 8.41, P < 0.001). Other independent predictors were identified, but they showed a weaker association with in-hospital mortality than perioperative stroke, including cardiovascular complications (OR = 4.33, CI = 3.93 - 4.77, P < 0.001). Conclusions: Perioperative stroke is a significant independent risk factor for morbidity and in-hospital mortality following non-cardiovascular, non-neurological surgeries. Patients who developed perioperative stroke had a higher risk of death than perioperative cardiovascular and pulmonary complications. J Neurol Res. 2021;11(1-2):5-13 doi: https://doi.org/10.14740/jnr653","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85707688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-23DOI: 10.14740/JNR.V11I1-2.656
Hosna S. Elshony, Lamyaa G. Al Hamrawy
Background: Diminished pain sensitivity has been reported in patients in the acute phase of psychosis, as well as in stable patients. The cause of hypoalgesia in those patients is unknown. The aim of this study was to investigate the sensory thresholds, pain modalities, or other factors contributing to the perception or expression of physical pain in patients with schizophrenia (SCZ). Methods: This case-control study was conducted on 24 patients with SCZ and 12 healthy controls. Patients with SCZ were assessed by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Positive and Negative Symptom Scale and Schizophrenia Cognition Rating Scale. All participants were subjected to full medical and neurological examination and nociceptive reflex. Results: There was no significant difference between cases and controls in nociceptive threshold, while it showed a significant difference at the subjective pain threshold as the case group needed a higher intensity of current to perceive as painful. There was a significant positive correlation between age, duration of SCZ and number of episodes and the nociceptive reflex. Also, there was a significant positive correlation between the negative symptoms of SCZ and cognitive impairment on one arm and the subjective pain threshold on the other arm. Conclusion: The pain insensitivity in patients with SCZ is not related to physiological changes in the nociceptive pathway, but rather may be related to change in the experience and expression of pain. Older age, longer duration of disease, more frequent episodes, negative symptoms, and cognitive impairment, but not antipsychotic medications, all are positively correlated with the increase in subjective pain threshold. J Neurol Res. 2021;11(1-2):20-26 doi: https://doi.org/10.14740/jnr656
{"title":"Nociceptive Reflex in Patients With Schizophrenia: A Case-Control Study","authors":"Hosna S. Elshony, Lamyaa G. Al Hamrawy","doi":"10.14740/JNR.V11I1-2.656","DOIUrl":"https://doi.org/10.14740/JNR.V11I1-2.656","url":null,"abstract":"Background: Diminished pain sensitivity has been reported in patients in the acute phase of psychosis, as well as in stable patients. The cause of hypoalgesia in those patients is unknown. The aim of this study was to investigate the sensory thresholds, pain modalities, or other factors contributing to the perception or expression of physical pain in patients with schizophrenia (SCZ). Methods: This case-control study was conducted on 24 patients with SCZ and 12 healthy controls. Patients with SCZ were assessed by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Positive and Negative Symptom Scale and Schizophrenia Cognition Rating Scale. All participants were subjected to full medical and neurological examination and nociceptive reflex. Results: There was no significant difference between cases and controls in nociceptive threshold, while it showed a significant difference at the subjective pain threshold as the case group needed a higher intensity of current to perceive as painful. There was a significant positive correlation between age, duration of SCZ and number of episodes and the nociceptive reflex. Also, there was a significant positive correlation between the negative symptoms of SCZ and cognitive impairment on one arm and the subjective pain threshold on the other arm. Conclusion: The pain insensitivity in patients with SCZ is not related to physiological changes in the nociceptive pathway, but rather may be related to change in the experience and expression of pain. Older age, longer duration of disease, more frequent episodes, negative symptoms, and cognitive impairment, but not antipsychotic medications, all are positively correlated with the increase in subjective pain threshold. J Neurol Res. 2021;11(1-2):20-26 doi: https://doi.org/10.14740/jnr656","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91333945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-23DOI: 10.14740/JNR.V11I1-2.650
A. Ravichandran, Katie Reming, K. Sivakumar, H. Yacoub
Neurosyphilis (NS) is a rarely reported disease, with neurological manifestations occurring in the late stages of the infection. The incidence of NS has steadily increased, particularly with increased cases of human immunodeficiency virus (HIV) infection among homosexual partners, and can occur at any stage of the disease. In this case report, we present a 53-year-old homosexual man with HIV who presented with a gradual onset of vertigo over a course of 2 weeks, followed by gradual onset of multiple cranial neuropathies. Magnetic resonance imaging of the brain revealed pathological enhancement of multiple cranial nerves. Laboratory workup revealed reactive Venereal Disease Research Laboratory dilutional titer in the cerebrospinal fluid, supporting the diagnoses of NS. He was treated with intravenous penicillin with gradual resolution of symptoms. Our case illustrates that NS can occur with no known prior evidence or manifestation of the infection. The diagnosis of NS should be entertained in individuals with a known history of HIV and unexplained multiple cranial neuropathies. J Neurol Res. 2021;11(1-2):27-31 doi: https://doi.org/10.14740/jnr650
{"title":"An Early Presentation of Neurosyphilis Manifesting as Cranial Polyneuropathies: A Case Report","authors":"A. Ravichandran, Katie Reming, K. Sivakumar, H. Yacoub","doi":"10.14740/JNR.V11I1-2.650","DOIUrl":"https://doi.org/10.14740/JNR.V11I1-2.650","url":null,"abstract":"Neurosyphilis (NS) is a rarely reported disease, with neurological manifestations occurring in the late stages of the infection. The incidence of NS has steadily increased, particularly with increased cases of human immunodeficiency virus (HIV) infection among homosexual partners, and can occur at any stage of the disease. In this case report, we present a 53-year-old homosexual man with HIV who presented with a gradual onset of vertigo over a course of 2 weeks, followed by gradual onset of multiple cranial neuropathies. Magnetic resonance imaging of the brain revealed pathological enhancement of multiple cranial nerves. Laboratory workup revealed reactive Venereal Disease Research Laboratory dilutional titer in the cerebrospinal fluid, supporting the diagnoses of NS. He was treated with intravenous penicillin with gradual resolution of symptoms. Our case illustrates that NS can occur with no known prior evidence or manifestation of the infection. The diagnosis of NS should be entertained in individuals with a known history of HIV and unexplained multiple cranial neuropathies. J Neurol Res. 2021;11(1-2):27-31 doi: https://doi.org/10.14740/jnr650","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82725076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Esmaeili, S. N. R. Alavi, Sevim Soleimani, M. Mojtahed, M. Panahi, Y. Nilipour, Bahram Haghi Ashtiani
Thymoma is a rare tumor that is commonly associated with autoimmune diseases. Of these, myasthenia gravis (MG) is widely considered as the most common paraneoplastic condition. On the other hand, dermatomyositis (DM) has been rarely reported as the first presentation of non-invasive thymoma. Hereby, we describe a patient with non-invasive thymoma who initially presented with painful symmetric proximal muscle weakness with no signs of ptosis or diplopia. The needle electromyography (EMG) revealed spontaneous/insertional activity in proximal muscles. The patient was finally diagnosed with DM by muscle biopsy. Spiral chest computed tomography (CT) scan coupled with pathological assessment confirmed a non-invasive thymoma with diffuse reaction for P63 and pancytokeratin (Panck). Corticosteroids pulse therapy was initiated and the patient was referred for thymectomy. A few months later, patient began to display other neurological symptoms such as ptosis and diplopia with fluctuating pattern. As coexistence of MG was presumed, nerve conduction study (NCS) study was performed and slow repetitive nerve stimulation in proximal muscles showed more than 10% decrement in compound muscle action potential (CMAP) amplitude in repetitive nerve stimulation (RNS). Further workup revealed a positive anti-acetylcholine receptor antibody with high titer. Thus, MG was confirmed. No more treatment options were planned. Low dose corticosteroids were continued and azathioprine and pyridostigmine were prescribed. During follow-ups, symptoms were fully controlled. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr625
{"title":"Thymic Neoplasm: A Rare Disease With Unusual Neurologic Manifestations","authors":"S. Esmaeili, S. N. R. Alavi, Sevim Soleimani, M. Mojtahed, M. Panahi, Y. Nilipour, Bahram Haghi Ashtiani","doi":"10.14740/JNR.V0I0.625","DOIUrl":"https://doi.org/10.14740/JNR.V0I0.625","url":null,"abstract":"Thymoma is a rare tumor that is commonly associated with autoimmune diseases. Of these, myasthenia gravis (MG) is widely considered as the most common paraneoplastic condition. On the other hand, dermatomyositis (DM) has been rarely reported as the first presentation of non-invasive thymoma. Hereby, we describe a patient with non-invasive thymoma who initially presented with painful symmetric proximal muscle weakness with no signs of ptosis or diplopia. The needle electromyography (EMG) revealed spontaneous/insertional activity in proximal muscles. The patient was finally diagnosed with DM by muscle biopsy. Spiral chest computed tomography (CT) scan coupled with pathological assessment confirmed a non-invasive thymoma with diffuse reaction for P63 and pancytokeratin (Panck). Corticosteroids pulse therapy was initiated and the patient was referred for thymectomy. A few months later, patient began to display other neurological symptoms such as ptosis and diplopia with fluctuating pattern. As coexistence of MG was presumed, nerve conduction study (NCS) study was performed and slow repetitive nerve stimulation in proximal muscles showed more than 10% decrement in compound muscle action potential (CMAP) amplitude in repetitive nerve stimulation (RNS). Further workup revealed a positive anti-acetylcholine receptor antibody with high titer. Thus, MG was confirmed. No more treatment options were planned. Low dose corticosteroids were continued and azathioprine and pyridostigmine were prescribed. During follow-ups, symptoms were fully controlled. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr625","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76196589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The pandemic illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the identification of numerous common neurologic complications, which may result directly or indirectly from infection [1]. The most well-known neurologic symptom is anosmia/dysgeusia (loss of sense of smell/taste) [2] whose uniqueness to SARS-CoV-2 has been debated [3]; involvement of skeletal muscles is also very common and fortunately mild in most cases (predominantly myalgias), although myositis and rhabdomyolysis are described [4, 5]. Rarely, more significant neurologic complications arise [6]. In the central nervous system, some of the described phenotypes include encephalopathy [7], neuroimmunological syndromes [8], and myoclonus/ataxia [9]. Ischemic stroke appears to have a more severe outcome in COVID-19 patients but was not more common in a recent large series [10]. Peripheral nervous system complications mainly relate to above-mentioned complications of skeletal muscle, as well as variants of Guillain-Barré syndrome [11-13]. Mononeuritis multiplex has been described with high prevalence in a series of critically ill patients with COVID-19 [14], which is a group of patients in whom neurologic impairments may be difficult to identify and may be misattributed to critical illness neuro/ myopathy. When present, neurologic syndromes have been associated with increased mortality in COVID-19 patients [15]. SARS-CoV-2 infects cells via angiotensin-converting enzyme 2 (ACE2), a protein found abundantly among numerous cell types including neurones of the central and peripheral nervous systems, and muscle [16-18]. Therefore, neurologic complications may occur as a direct consequence of viral infection, in addition to neurologic damage resulting from hypoxia, the inflammatory cascade, and other end-organ injuries. As a result, there is concern that patients with pre-existing neurological disorders may be at greater risk of neurological complications, or more severe outcomes in general from COVID-19 [19].
{"title":"COVID-19 Vaccine Priority for People With Neurologic and Rare Diseases","authors":"G. Pfeffer, S. Jacob, J. Preston","doi":"10.14740/jnr665","DOIUrl":"https://doi.org/10.14740/jnr665","url":null,"abstract":"The pandemic illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the identification of numerous common neurologic complications, which may result directly or indirectly from infection [1]. The most well-known neurologic symptom is anosmia/dysgeusia (loss of sense of smell/taste) [2] whose uniqueness to SARS-CoV-2 has been debated [3]; involvement of skeletal muscles is also very common and fortunately mild in most cases (predominantly myalgias), although myositis and rhabdomyolysis are described [4, 5]. Rarely, more significant neurologic complications arise [6]. In the central nervous system, some of the described phenotypes include encephalopathy [7], neuroimmunological syndromes [8], and myoclonus/ataxia [9]. Ischemic stroke appears to have a more severe outcome in COVID-19 patients but was not more common in a recent large series [10]. Peripheral nervous system complications mainly relate to above-mentioned complications of skeletal muscle, as well as variants of Guillain-Barré syndrome [11-13]. Mononeuritis multiplex has been described with high prevalence in a series of critically ill patients with COVID-19 [14], which is a group of patients in whom neurologic impairments may be difficult to identify and may be misattributed to critical illness neuro/ myopathy. When present, neurologic syndromes have been associated with increased mortality in COVID-19 patients [15]. SARS-CoV-2 infects cells via angiotensin-converting enzyme 2 (ACE2), a protein found abundantly among numerous cell types including neurones of the central and peripheral nervous systems, and muscle [16-18]. Therefore, neurologic complications may occur as a direct consequence of viral infection, in addition to neurologic damage resulting from hypoxia, the inflammatory cascade, and other end-organ injuries. As a result, there is concern that patients with pre-existing neurological disorders may be at greater risk of neurological complications, or more severe outcomes in general from COVID-19 [19].","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"114 1","pages":"1 - 4"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87621084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Talita Sansoni, Nicholas Nascimento, G. Franco, R. Moreno, A. Barros, V. Filho, H. Zambelli, Ana Paula Devite Cardoso Gasparotto, L. A. Sardinha, A. E. Falcão
Background: The apnea test, which is considered positive when no spontaneous breathing movements are observed following maximal hypercapnia (PaCO 2 > 55 mm Hg) respiratory center stimulation, was critically evaluated in this study by assessment of blood gas analyses performed during brain death protocols from 2010 to 2017, in the intensive care units of the Universidade Estadual de Campinas (UNICAMP). Methods: A retrospective cohort analysis based on the intensive care unit and Transplant Organ Search Organization data banks. Blood gas analyses before (pre-first and -second apnea tests) as after (after-first and -second apnea tests) were assessed. Descriptive statistical analyses of the numerical variables (such as pH, PaO 2 , PaCO 2 , HCO 3, SatO 2 ) with mean values and standard deviation, medians, and quartiles were performed. The Student’s t -test was used for pairwise group comparisons. A P < 0.05 level was adopted for significance. Results: Eighty-seven protocols were evaluated. The mean apnea test duration was 11 min. All of the patients were under vasoactive drugs. Only five apnea tests were interrupted before the end at 10 min due to rapid desaturation (SatO 2 < 90%), with no invalidated apnea test. Mean and standard deviation of blood gas tests assessed before the first apnea test were: pH 7.35(± 0.10), PaO 2 252.15 mm Hg (± 114.11), PaCO 2 42.78 mm Hg (± 10.84); after the first apnea test: pH 7.11(± 0.08), PaO 2 208.39 mm Hg (± 112), PaCO 2 82.43 mm Hg (± 16.91); before the second test: pH 7.33 (± 0.09), PaO 2 253.56 mm Hg (± 105.36), PaCO 2 43.76 mm Hg (± 9.67); following the second apnea test: pH 7.11 (± 0.10), PaO 2 200.1 mm Hg (± 116.45), PaCO 2 84.98 mm Hg (± 20.21). The pH, PaO 2 , and PaCO 2 values before and after the first and second apnea tests have shown statistically significant differences (P < 0.0001). Conclusions: The apnea test was safe, blood gas test results are similar to those described in the literature, severe hypoxemias were prevented by a quick reconnection to the mechanical ventilation; and marked hypercapnia and acidemia following the apnea test were found, but no test was invalidated. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr646
背景:当最大高碳酸血症(paco2 > 55 mm Hg)呼吸中枢刺激后未观察到自发呼吸运动时，呼吸暂停测试被认为是阳性，在本研究中，通过评估2010年至2017年在坎皮纳斯大学(UNICAMP)重症监护室进行的脑死亡协议期间的血气分析，对该测试进行了严格评估。方法:基于重症监护病房和移植器官检索组织数据库进行回顾性队列分析。评估血气分析前(第一次和第二次呼吸暂停测试前)和后(第一次和第二次呼吸暂停测试后)。对数值变量(如pH、pao2、paco2、hco3、SatO 2)的平均值、标准差、中位数和四分位数进行描述性统计分析。两两组比较采用学生t检验。以P < 0.05为显著性水平。结果:共评估了87个方案。呼吸暂停测试的平均持续时间为11分钟。所有患者均服用血管活性药物。只有5次呼吸暂停测试在结束前10分钟因快速去饱和而中断(SatO 2 < 90%)，没有无效的呼吸暂停测试。首次呼吸暂停试验前评估血气试验的平均值和标准差为:pH 7.35(±0.10)，PaO 2 252.15 mm Hg(±114.11)，PaCO 2 42.78 mm Hg(±10.84);第一次呼吸暂停试验后:pH 7.11(±0.08)，PaO 2 208.39 mm Hg(±112)，PaCO 2 82.43 mm Hg(±16.91);第二次试验前:pH 7.33(±0.09)，pao2 253.56 mm Hg(±105.36)，paco2 43.76 mm Hg(±9.67);第二次呼吸暂停测试后:pH 7.11(±0.10)，PaO 2 200.1 mm Hg(±116.45)，PaCO 2 84.98 mm Hg(±20.21)。第一次和第二次呼吸暂停试验前后的pH、pao2、paco2值差异有统计学意义(P < 0.0001)。结论:呼吸暂停测试是安全的，血气测试结果与文献中描述的相似，通过快速重新连接机械通气可预防严重低氧血症;呼吸暂停测试后发现明显的高碳酸血症和酸血症，但没有测试无效。J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr646
{"title":"Apnea Test Safety in Brain Death: A Single-Center Retrospective Cohort Analysis","authors":"Talita Sansoni, Nicholas Nascimento, G. Franco, R. Moreno, A. Barros, V. Filho, H. Zambelli, Ana Paula Devite Cardoso Gasparotto, L. A. Sardinha, A. E. Falcão","doi":"10.14740/JNR.V0I0.646","DOIUrl":"https://doi.org/10.14740/JNR.V0I0.646","url":null,"abstract":"Background: The apnea test, which is considered positive when no spontaneous breathing movements are observed following maximal hypercapnia (PaCO 2 > 55 mm Hg) respiratory center stimulation, was critically evaluated in this study by assessment of blood gas analyses performed during brain death protocols from 2010 to 2017, in the intensive care units of the Universidade Estadual de Campinas (UNICAMP). Methods: A retrospective cohort analysis based on the intensive care unit and Transplant Organ Search Organization data banks. Blood gas analyses before (pre-first and -second apnea tests) as after (after-first and -second apnea tests) were assessed. Descriptive statistical analyses of the numerical variables (such as pH, PaO 2 , PaCO 2 , HCO 3, SatO 2 ) with mean values and standard deviation, medians, and quartiles were performed. The Student’s t -test was used for pairwise group comparisons. A P < 0.05 level was adopted for significance. Results: Eighty-seven protocols were evaluated. The mean apnea test duration was 11 min. All of the patients were under vasoactive drugs. Only five apnea tests were interrupted before the end at 10 min due to rapid desaturation (SatO 2 < 90%), with no invalidated apnea test. Mean and standard deviation of blood gas tests assessed before the first apnea test were: pH 7.35(± 0.10), PaO 2 252.15 mm Hg (± 114.11), PaCO 2 42.78 mm Hg (± 10.84); after the first apnea test: pH 7.11(± 0.08), PaO 2 208.39 mm Hg (± 112), PaCO 2 82.43 mm Hg (± 16.91); before the second test: pH 7.33 (± 0.09), PaO 2 253.56 mm Hg (± 105.36), PaCO 2 43.76 mm Hg (± 9.67); following the second apnea test: pH 7.11 (± 0.10), PaO 2 200.1 mm Hg (± 116.45), PaCO 2 84.98 mm Hg (± 20.21). The pH, PaO 2 , and PaCO 2 values before and after the first and second apnea tests have shown statistically significant differences (P < 0.0001). Conclusions: The apnea test was safe, blood gas test results are similar to those described in the literature, severe hypoxemias were prevented by a quick reconnection to the mechanical ventilation; and marked hypercapnia and acidemia following the apnea test were found, but no test was invalidated. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr646","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79365967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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