Pub Date : 2020-10-01Epub Date: 2020-09-04DOI: 10.14740/jnr619
Leonardo Jardim Vaz de Mello, Emylle Guimaraes Silva, Gabriel Oliveira Correa Rabelo, Mariana Evaristo Leite, Nathalia Ramos Vieira, Maryam Bahadori, Ali Seifi, Daniel Agustin Godoy
Coronavirus disease 2019 (COVID-19) disease caused by a new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with many neurological symptoms. The purpose of this article is to describe the neurological manifestations so far reported and their probable pathogenesis. We conducted a literature review on EMBASE, MEDLINE and SCIELO databases using the terms "COVID-19", "COVID", "neurological", "neurologic", "manifestations", "implications", "Guillain-Barre syndrome", "encephalopathy". A total of 33 articles including clinical series, retrospective studies, and case reports were selected and thoroughly reviewed to describe neurological manifestations of COVID-19. There are several neurological manifestations of SARS-CoV-2 infection with different clinical presentations, severity, and prevalence. The most critical ones, such as cerebrovascular disease, encephalopathy, and Guillain-Barre syndrome, were less common and usually associated with previous medical history, known risk factors for cerebrovascular disease or advanced age. The main hypotheses for the spread of the virus are through the hematogenous route or the cribriform plate of the ethmoid bone or a disseminated severe immune response by a cytokine storm. The presence of neurological disturbances associated with laboratory tests alterations is an important clue for the physicians to promptly recognize neurological manifestations of SARS-CoV-2.
{"title":"Neurologic Compromise in COVID-19: A Literature Review.","authors":"Leonardo Jardim Vaz de Mello, Emylle Guimaraes Silva, Gabriel Oliveira Correa Rabelo, Mariana Evaristo Leite, Nathalia Ramos Vieira, Maryam Bahadori, Ali Seifi, Daniel Agustin Godoy","doi":"10.14740/jnr619","DOIUrl":"https://doi.org/10.14740/jnr619","url":null,"abstract":"<p><p>Coronavirus disease 2019 (COVID-19) disease caused by a new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with many neurological symptoms. The purpose of this article is to describe the neurological manifestations so far reported and their probable pathogenesis. We conducted a literature review on EMBASE, MEDLINE and SCIELO databases using the terms \"COVID-19\", \"COVID\", \"neurological\", \"neurologic\", \"manifestations\", \"implications\", \"Guillain-Barre syndrome\", \"encephalopathy\". A total of 33 articles including clinical series, retrospective studies, and case reports were selected and thoroughly reviewed to describe neurological manifestations of COVID-19. There are several neurological manifestations of SARS-CoV-2 infection with different clinical presentations, severity, and prevalence. The most critical ones, such as cerebrovascular disease, encephalopathy, and Guillain-Barre syndrome, were less common and usually associated with previous medical history, known risk factors for cerebrovascular disease or advanced age. The main hypotheses for the spread of the virus are through the hematogenous route or the cribriform plate of the ethmoid bone or a disseminated severe immune response by a cytokine storm. The presence of neurological disturbances associated with laboratory tests alterations is an important clue for the physicians to promptly recognize neurological manifestations of SARS-CoV-2.</p>","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"10 5","pages":"164-172"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/89/jnr-10-164.PMC8040461.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38977941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute ischemic stroke (AIS) has been reported as a serious neurological complication after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It was shown that occurrence of AIS in coronavirus disease -19 (COVID-19) was correlated with the severity of respiratory illness [1, 2]. Despite many reports of AIS and COVID-19 in older patients with established cardiovascular risk factors, there are several reports of AIS in young patients without any significant past medical history or cardiovascular risk factors [2, 3]. Such reports suggest hypercoagulability and/or endothelial dysfunction within the arteries of the COVID-19 patients. Furthermore, it has been shown that inflammation and hypercoagulable processes contribute to developing both venous and arterial thromboembolism following infection with SARS-CoV-2 [1, 4-7]. These potential mechanisms as well as the clinical and epidemiological differences in patients with COVID-19 compared to non-COVID-19 patients, raise the question of the optimal secondary stroke prevention antithrombotic regimen in young COVID-19-related AIS patients. To address such an important question, there is need for randomized clinical trials and high-quality prospective studies with reasonable duration of follow-up. However, given lack of such studies to date, we aimed to review the limited current literature to investigate the optimal antithrombotic regimen for secondary prevention strategy in this group of patients. We carried out a review in PubMed to find all articles evaluating secondary prevention of AIS following COVID-19 from December 1, 2019 to June 30, 2020. The keywords: “COVID-19” or “SARS-CoV-2 “or “coronavirus” and “stroke” or” cerebrovascular” and “treatment “or “secondary prevention” were used in different combinations. All pertinent case reports, case series and original research articles in English language were included. The literature search revealed 430 articles. After eliminating the duplications and non-relevant articles, seven articles were included in the study. We identified only the patients with COVID-19-related AIS who did not have any pertinent past medical history or cardiovascular risk factor and were 50 years old or younger. Data for secondary prevention antithrombotic regimen in 16 patients with above-mentioned inclusion criteria were available. Mean age of the patients was 39.5 years (range: 31 50). Anticoagulation was administered for 10 (62.5%), single antiplatelet for three (18.7%) and dual antiplatelet for three (18.7%) patients (Table 1) [2-4, 8-11]. Despite the fact that several studies have shown the possibility of hypercoagulable state in the young COVID-19 patients, so far, no consensus on the secondary prevention antithrombotic regimen exists. Furthermore, the optimal secondary prevention measures in this particular group of patients might differ from the usual secondary prevention strategies in AIS patients with established cardiovascular risk factors [12]. Ba
{"title":"COVID-19-Related Acute Ischemic Stroke in Young Adults: What Is the Optimal Antithrombotic Regimen for Secondary Prevention?","authors":"Fahimeh Vahabizad, Maryam Sharifian Dorche, Pegah Mohammadi, Kasra Khatibi, Ashkan Mowla","doi":"10.14740/jnr616","DOIUrl":"https://doi.org/10.14740/jnr616","url":null,"abstract":"Acute ischemic stroke (AIS) has been reported as a serious neurological complication after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It was shown that occurrence of AIS in coronavirus disease -19 (COVID-19) was correlated with the severity of respiratory illness [1, 2]. Despite many reports of AIS and COVID-19 in older patients with established cardiovascular risk factors, there are several reports of AIS in young patients without any significant past medical history or cardiovascular risk factors [2, 3]. Such reports suggest hypercoagulability and/or endothelial dysfunction within the arteries of the COVID-19 patients. Furthermore, it has been shown that inflammation and hypercoagulable processes contribute to developing both venous and arterial thromboembolism following infection with SARS-CoV-2 [1, 4-7]. These potential mechanisms as well as the clinical and epidemiological differences in patients with COVID-19 compared to non-COVID-19 patients, raise the question of the optimal secondary stroke prevention antithrombotic regimen in young COVID-19-related AIS patients. To address such an important question, there is need for randomized clinical trials and high-quality prospective studies with reasonable duration of follow-up. However, given lack of such studies to date, we aimed to review the limited current literature to investigate the optimal antithrombotic regimen for secondary prevention strategy in this group of patients. We carried out a review in PubMed to find all articles evaluating secondary prevention of AIS following COVID-19 from December 1, 2019 to June 30, 2020. The keywords: “COVID-19” or “SARS-CoV-2 “or “coronavirus” and “stroke” or” cerebrovascular” and “treatment “or “secondary prevention” were used in different combinations. All pertinent case reports, case series and original research articles in English language were included. The literature search revealed 430 articles. After eliminating the duplications and non-relevant articles, seven articles were included in the study. We identified only the patients with COVID-19-related AIS who did not have any pertinent past medical history or cardiovascular risk factor and were 50 years old or younger. Data for secondary prevention antithrombotic regimen in 16 patients with above-mentioned inclusion criteria were available. Mean age of the patients was 39.5 years (range: 31 50). Anticoagulation was administered for 10 (62.5%), single antiplatelet for three (18.7%) and dual antiplatelet for three (18.7%) patients (Table 1) [2-4, 8-11]. Despite the fact that several studies have shown the possibility of hypercoagulable state in the young COVID-19 patients, so far, no consensus on the secondary prevention antithrombotic regimen exists. Furthermore, the optimal secondary prevention measures in this particular group of patients might differ from the usual secondary prevention strategies in AIS patients with established cardiovascular risk factors [12]. Ba","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"10 5","pages":"203-206"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8b/cd/jnr-10-203.PMC8040460.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38977942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The goal of this review is to provide a guide to magnetic resonance imaging (MRI) reading for non-radiologists. A thorough literature search was conducted using the keywords “MRI”, “CT”, “Non-radiologist” and “MRI interpretation” to develop an approach to MRI reading for non-radiologists. Common indications for a brain MRI include workup of an intracranial tumor, chronic headache, seizure disorder, and confirmation of a stroke. When assessing for an intracranial tumor, MRI is the preferred diagnostic modality. Computed tomography (CT) has much lower resolution and is typically reserved for the emergency setting. T1 weighted images provide anatomically relevant images of the brain parenchyma that will be familiar to non-radiologists. In contrast to T1 weighted images, fluid is bright in T2 and white matter will appear darker than gray matter. Fluid attenuation inversion recovery (FLAIR) is most sensitive for edema and parenchymal abnormalities like a low-grade glioma. The main purpose of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) sequences are to visualize acute ischemic stroke. Although non-radiologists generally have a greater exposure to head CT images, the same foundational principles of CT head interpretation can apply to brain MRI reading. Benefits of brain imaging by MRI includes obtaining a multi-planar assessment of the brain, highly detailed images of the brain, and using different MRI sequences to assess for different pathology. J Neurol Res. 2020;10(5):173-176 doi: https://doi.org/10.14740/jnr628
{"title":"Approach to Brain Magnetic Resonance Imaging for Non-Radiologists","authors":"A. Taree, V. Eslami, S. Emamzadehfard","doi":"10.14740/jnr628","DOIUrl":"https://doi.org/10.14740/jnr628","url":null,"abstract":"The goal of this review is to provide a guide to magnetic resonance imaging (MRI) reading for non-radiologists. A thorough literature search was conducted using the keywords “MRI”, “CT”, “Non-radiologist” and “MRI interpretation” to develop an approach to MRI reading for non-radiologists. Common indications for a brain MRI include workup of an intracranial tumor, chronic headache, seizure disorder, and confirmation of a stroke. When assessing for an intracranial tumor, MRI is the preferred diagnostic modality. Computed tomography (CT) has much lower resolution and is typically reserved for the emergency setting. T1 weighted images provide anatomically relevant images of the brain parenchyma that will be familiar to non-radiologists. In contrast to T1 weighted images, fluid is bright in T2 and white matter will appear darker than gray matter. Fluid attenuation inversion recovery (FLAIR) is most sensitive for edema and parenchymal abnormalities like a low-grade glioma. The main purpose of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) sequences are to visualize acute ischemic stroke. Although non-radiologists generally have a greater exposure to head CT images, the same foundational principles of CT head interpretation can apply to brain MRI reading. Benefits of brain imaging by MRI includes obtaining a multi-planar assessment of the brain, highly detailed images of the brain, and using different MRI sequences to assess for different pathology. J Neurol Res. 2020;10(5):173-176 doi: https://doi.org/10.14740/jnr628","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89146845","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}
Background: After spinal cord injury (SCI), patients are seen in either trauma center emergency departments (EDs) or non-trauma center EDs, and then selectively admitted for hospitalization. The association between SCI and admission to designated trauma centers is currently unknown. In this study, we assess the trends in admission between designated trauma centers after SCI from a large multi-center nationwide registry. Methods: In this retrospective analysis of the Nationwide Emergency Department Sample (NEDS), we identified visits with SCI from 2006 to 2014. Z-test analyses were used to compare patients diagnosed with SCI at EDs with an associated trauma center designated hospital (TC-visits) against patients diagnosed with SCI at EDs without an associated trauma center designated hospital (NTC-visits). Results: A total of 516,716 reported visits were identified with SCI. The annual total ED visits with admission to the same hospital for patients diagnosed with SCI increased significantly from 39,129 to 50,127 from 2006 to 2014 (P < 0.001). From 2006 to 2014, the annual ED visits and admissions from TC-visits increased significantly from 27,781 to 43,926 and 23,445 to 35,635, respectively (P < 0.0001, P < 0.0001). However, the annual ED visits and admissions from NTC-visits did not change significantly from 23,938 to 22,107 and 15,683 to 14,493, respectively (P = 0.09 and P = 0.1). Throughout the entire study period, the annual total ED visits with admissions to the same hospital was significantly higher for TC-visits than NTC-visits diagnosed with SCI (P < 0.0001). The mean length of stay (14.1 days vs. 8.1 days), annual total in-hospital mortality (6.8% vs. 6.0%), and annual total discharges to another institution (53.8% vs. 46.8%) were significantly higher in TC-visits throughout the study period (P < 0.001). However, the annual total routine discharges (27.2% vs. 26.4%), annual total discharges to short-term hospital (12.4% vs. 7.2%), and annual total discharges to home health care (7.7% vs. 4.4%) were significantly higher in NTC-visits throughout the study period (P < 0.001). Conclusions: Of the population of patients with SCI who visit EDs, those seen at trauma centers have a significant parallel association with incidence and patient outcome compared against those seen at non-trauma centers. Prospective research is warranted to make recommendations for required healthcare infrastructures based on an institution’s trauma center designation. J Neurol Res. 2020;10(5):193-198 doi: https://doi.org/10.14740/jnr609
{"title":"Association Between Trauma Center Designation and Spinal Cord Injury Admission in the USA","authors":"Ross-Jordon S. Elliott, A. Dharia, A. Seifi","doi":"10.14740/jnr609","DOIUrl":"https://doi.org/10.14740/jnr609","url":null,"abstract":"Background: After spinal cord injury (SCI), patients are seen in either trauma center emergency departments (EDs) or non-trauma center EDs, and then selectively admitted for hospitalization. The association between SCI and admission to designated trauma centers is currently unknown. In this study, we assess the trends in admission between designated trauma centers after SCI from a large multi-center nationwide registry. Methods: In this retrospective analysis of the Nationwide Emergency Department Sample (NEDS), we identified visits with SCI from 2006 to 2014. Z-test analyses were used to compare patients diagnosed with SCI at EDs with an associated trauma center designated hospital (TC-visits) against patients diagnosed with SCI at EDs without an associated trauma center designated hospital (NTC-visits). Results: A total of 516,716 reported visits were identified with SCI. The annual total ED visits with admission to the same hospital for patients diagnosed with SCI increased significantly from 39,129 to 50,127 from 2006 to 2014 (P < 0.001). From 2006 to 2014, the annual ED visits and admissions from TC-visits increased significantly from 27,781 to 43,926 and 23,445 to 35,635, respectively (P < 0.0001, P < 0.0001). However, the annual ED visits and admissions from NTC-visits did not change significantly from 23,938 to 22,107 and 15,683 to 14,493, respectively (P = 0.09 and P = 0.1). Throughout the entire study period, the annual total ED visits with admissions to the same hospital was significantly higher for TC-visits than NTC-visits diagnosed with SCI (P < 0.0001). The mean length of stay (14.1 days vs. 8.1 days), annual total in-hospital mortality (6.8% vs. 6.0%), and annual total discharges to another institution (53.8% vs. 46.8%) were significantly higher in TC-visits throughout the study period (P < 0.001). However, the annual total routine discharges (27.2% vs. 26.4%), annual total discharges to short-term hospital (12.4% vs. 7.2%), and annual total discharges to home health care (7.7% vs. 4.4%) were significantly higher in NTC-visits throughout the study period (P < 0.001). Conclusions: Of the population of patients with SCI who visit EDs, those seen at trauma centers have a significant parallel association with incidence and patient outcome compared against those seen at non-trauma centers. Prospective research is warranted to make recommendations for required healthcare infrastructures based on an institution’s trauma center designation. J Neurol Res. 2020;10(5):193-198 doi: https://doi.org/10.14740/jnr609","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91515331","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, M. Abbasi, Ensieh Malekdar, M. Joghataei, M. Mehrpour
Background: Mild cognitive impairment (MCI) is defined as a progressive memory dysfunction. There are controversies with regards to whether repetitive transcranial magnetic stimulation (rTMS) could improve the condition. Methods: In a randomized, self-control, crossover clinical trial, effect of rTMS on cognitive performance in patients with MCI was assessed. Patients were randomized into two study groups (A and B) and received both rTMS procedure and sham therapy in sequence, with each lasting for 8 weeks. Montreal cognitive assessment (MoCA) test was performed as a cognition battery at baseline and 1 week after each 8-week period of interventions. Results: Sixteen patients were enrolled in the study. Baseline measures of MoCA were statistically equal between two groups (P value = 0.10). Mean MoCA score significantly increased in group A at nine-week follow-up compared to both group B (P value < 0.001) and its baseline (P value = 0.01). However, at 18-week follow-up, mean MoCA scores were increased in both groups compared to their baseline (both P values < 0.001) with no significant differences between study groups (P value = 0.87). No adverse effects were reported. Conclusions: The rTMS is suggested as an effective and safe therapeutic option for cognitive improvement in patients with MCI. J Neurol Res. 2020;000(000):000-000 doi: https://doi.org/10.14740/jnr622
{"title":"A Pilot Clinical Trial of Repetitive Transcranial Magnetic Stimulation in Mild Cognitive Impairment","authors":"S. Esmaeili, M. Abbasi, Ensieh Malekdar, M. Joghataei, M. Mehrpour","doi":"10.14740/jnr622","DOIUrl":"https://doi.org/10.14740/jnr622","url":null,"abstract":"Background: Mild cognitive impairment (MCI) is defined as a progressive memory dysfunction. There are controversies with regards to whether repetitive transcranial magnetic stimulation (rTMS) could improve the condition. Methods: In a randomized, self-control, crossover clinical trial, effect of rTMS on cognitive performance in patients with MCI was assessed. Patients were randomized into two study groups (A and B) and received both rTMS procedure and sham therapy in sequence, with each lasting for 8 weeks. Montreal cognitive assessment (MoCA) test was performed as a cognition battery at baseline and 1 week after each 8-week period of interventions. Results: Sixteen patients were enrolled in the study. Baseline measures of MoCA were statistically equal between two groups (P value = 0.10). Mean MoCA score significantly increased in group A at nine-week follow-up compared to both group B (P value < 0.001) and its baseline (P value = 0.01). However, at 18-week follow-up, mean MoCA scores were increased in both groups compared to their baseline (both P values < 0.001) with no significant differences between study groups (P value = 0.87). No adverse effects were reported. Conclusions: The rTMS is suggested as an effective and safe therapeutic option for cognitive improvement in patients with MCI. J Neurol Res. 2020;000(000):000-000 doi: https://doi.org/10.14740/jnr622","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84643831","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}
Brain abscesses are a relatively rare entity with an estimated incidence of 0.3 to 1.3 per 100,000 people per year. Brain abscesses arise from direct contiguous spread, hematogenous spread, neurosurgical procedures, open traumatic brain injuries, and cryptogenic sources. Early identification is pivotal, as delayed diagnosis and treatment lead to a very poor prognosis. Our case illustrates an elderly gentleman with a history of adenoid cystic carcinoma (ACC) of the oropharyngeal palate who presented to an outside hospital with severe headaches and was found to have a questionable metastatic lesion to his left temporal region. He was discharged with a course of steroids. Weeks later his headaches persisted, mentation further declined and repeat imaging revealed the same abnormal lesion. He subsequently underwent a craniotomy and was found to have a significant temporal abscess and empyema, which were evacuated. Post-operatively his course was complicated by status epilepticus requiring intubation and he was ultimately placed on hospice care. Our case illustrates the importance of early recognition and intervention for suspicious lesions, particularly when predisposing risk factors exist. J Neurol Res. 2020;000(000):000-000 doi: https://doi.org/10.14740/jnr620
{"title":"Brain Abscess in a Patient With Radiotherapy-Treated Adenoid Cystic Carcinoma: A Misdiagnosis Case Report and Review of the Literature","authors":"Christopher Macko, S. Ahmed, A. Seifi","doi":"10.14740/jnr620","DOIUrl":"https://doi.org/10.14740/jnr620","url":null,"abstract":"Brain abscesses are a relatively rare entity with an estimated incidence of 0.3 to 1.3 per 100,000 people per year. Brain abscesses arise from direct contiguous spread, hematogenous spread, neurosurgical procedures, open traumatic brain injuries, and cryptogenic sources. Early identification is pivotal, as delayed diagnosis and treatment lead to a very poor prognosis. Our case illustrates an elderly gentleman with a history of adenoid cystic carcinoma (ACC) of the oropharyngeal palate who presented to an outside hospital with severe headaches and was found to have a questionable metastatic lesion to his left temporal region. He was discharged with a course of steroids. Weeks later his headaches persisted, mentation further declined and repeat imaging revealed the same abnormal lesion. He subsequently underwent a craniotomy and was found to have a significant temporal abscess and empyema, which were evacuated. Post-operatively his course was complicated by status epilepticus requiring intubation and he was ultimately placed on hospice care. Our case illustrates the importance of early recognition and intervention for suspicious lesions, particularly when predisposing risk factors exist. J Neurol Res. 2020;000(000):000-000 doi: https://doi.org/10.14740/jnr620","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85774049","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}
Background: Our aim was to compare the efficacy of Na valproate with lithium in prolonging the time to mood episode recurrence in patients suffering from bipolar disorder (BD) type 1. Patients’ social and occupational functioning in the inter-episode interval was also compared. Methods: A total of 324 patients that were admitted in our psychiatry ward with diagnosis of BD, manic phase, were surveyed for their past psychiatry history. The patients entered the study if they had adhered to their mood stabilizing medications from their past mood episode till this current mood episode. A total of 169 patients were on lithium (mean dose: 785.7 mg) and 155 patients were on Na valproate (mean dose: 734.3 mg) while admitted. The time period the patients were in the inter-episode interval was compared between the two groups. The patients’ occupational and social functioning in the inter-episode interval was also compared. Results: The inter-episode interval was 28.7 months in the patients taking lithium and 29.4 months in the patients on Na valproate. There was no significant difference in this regard between the two groups (P = 0.564). Furthermore, rates of substance abuse (0.561), divorce (0.543), suicidal attempt (0.693) and unemployment (P = 0.453) in the inter-episode interval did not differ significantly between the lithium and valproate groups. Conclusions: Na valproate was demonstrated to be as effective as lithium in preventing mood episode recurrence in bipolar patients. Our patients also demonstrated comparable occupational and social status in the inter-episode interval. J Neurol Res. 2020;000(000):000-000 doi: https://doi.org/10.14740/jnr610
{"title":"Comparing Lithium With Valproate for Clinical and Social Status of Bipolar Disorder Patients in Inter-Episode Interval: A Retrospective Comparative Study","authors":"A. Mowla, Sanaz Boostani, Zahra Ehsaei","doi":"10.14740/JNR.V0I0.610","DOIUrl":"https://doi.org/10.14740/JNR.V0I0.610","url":null,"abstract":"Background: Our aim was to compare the efficacy of Na valproate with lithium in prolonging the time to mood episode recurrence in patients suffering from bipolar disorder (BD) type 1. Patients’ social and occupational functioning in the inter-episode interval was also compared. Methods: A total of 324 patients that were admitted in our psychiatry ward with diagnosis of BD, manic phase, were surveyed for their past psychiatry history. The patients entered the study if they had adhered to their mood stabilizing medications from their past mood episode till this current mood episode. A total of 169 patients were on lithium (mean dose: 785.7 mg) and 155 patients were on Na valproate (mean dose: 734.3 mg) while admitted. The time period the patients were in the inter-episode interval was compared between the two groups. The patients’ occupational and social functioning in the inter-episode interval was also compared. Results: The inter-episode interval was 28.7 months in the patients taking lithium and 29.4 months in the patients on Na valproate. There was no significant difference in this regard between the two groups (P = 0.564). Furthermore, rates of substance abuse (0.561), divorce (0.543), suicidal attempt (0.693) and unemployment (P = 0.453) in the inter-episode interval did not differ significantly between the lithium and valproate groups. Conclusions: Na valproate was demonstrated to be as effective as lithium in preventing mood episode recurrence in bipolar patients. Our patients also demonstrated comparable occupational and social status in the inter-episode interval. J Neurol Res. 2020;000(000):000-000 doi: https://doi.org/10.14740/jnr610","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73748667","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}
Amyotrophic lateral sclerosis (ALS), a neurodegenerative disease, is fatal within 3 years of symptom onset. Both upper motor neurons and lower motor neurons are targeted. It is hypothesized that: edaravone is effective at managing ALS. This review article used a combination of secondary and primary research articles to gain a plethora of information to help test this hypothesis. Using PubMed, research articles were studied to identify important information. For the Introduction, both secondary and primary articles were used without a limitation on publication date. For the Results section, only primary articles were used which had to have been published no earlier than 2006. The Results section of this review helped to support the hypothesis that edaravone is effective at managing ALS. The most pivotal efficacy endpoint, the change in the Amyotrophic Lateral Sclerosis Functional Rating Scale Revised score, was positively influenced by edaravone over the placebo. This was shown to be statistically significant by use of analysis of variance, amongst other statistical tests. Secondary endpoints such as forced vital capacity and pinch strength were also analyzed, showing similar favorable results. From the clinical trials analyzed in this review, it is concluded that edaravone is sufficient in treating ALS. Edaravone is limited to a target population which could prove to be a problem. Future studies should explore this issue in hopes of expanding the treatment population of edaravone. J Neurol Res. 2020;10(5):150-159 doi: https://doi.org/10.14740/jnr589
{"title":"The Effect of Edaravone on Amyotrophic Lateral Sclerosis","authors":"B. Nightingale","doi":"10.14740/jnr589","DOIUrl":"https://doi.org/10.14740/jnr589","url":null,"abstract":"Amyotrophic lateral sclerosis (ALS), a neurodegenerative disease, is fatal within 3 years of symptom onset. Both upper motor neurons and lower motor neurons are targeted. It is hypothesized that: edaravone is effective at managing ALS. This review article used a combination of secondary and primary research articles to gain a plethora of information to help test this hypothesis. Using PubMed, research articles were studied to identify important information. For the Introduction, both secondary and primary articles were used without a limitation on publication date. For the Results section, only primary articles were used which had to have been published no earlier than 2006. The Results section of this review helped to support the hypothesis that edaravone is effective at managing ALS. The most pivotal efficacy endpoint, the change in the Amyotrophic Lateral Sclerosis Functional Rating Scale Revised score, was positively influenced by edaravone over the placebo. This was shown to be statistically significant by use of analysis of variance, amongst other statistical tests. Secondary endpoints such as forced vital capacity and pinch strength were also analyzed, showing similar favorable results. From the clinical trials analyzed in this review, it is concluded that edaravone is sufficient in treating ALS. Edaravone is limited to a target population which could prove to be a problem. Future studies should explore this issue in hopes of expanding the treatment population of edaravone. J Neurol Res. 2020;10(5):150-159 doi: https://doi.org/10.14740/jnr589","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"2004 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89528611","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 year 2020 marks the silver jubilee of the landmark National Institute of Neurological Disorders and Stroke (NINDS) trial which made intravenous tissue plasminogen activator (IV tPA) the only Food and Drug Administration (FDA)-approved treatment for acute ischemic stroke (AIS) management thus far [1]. Over the years, the use of IV tPA has become safer and ubiquitous [2-8]. 2020 also marks the fifth anniversary of the five large randomized clinical trials (RCTs) which revolutionized acute stroke care by endorsing the benefits of concomitant use of IV tPA and endovascular treatment (EVT) with stent retrievers over IV tPA alone in large vessel strokes [9]. EVT with stent retrievers have demonstrated to improve the overall functional outcome and reduce mortality in large vessel strokes, with or without IV tPA [9]. While the efficacy of IV tPA in AIS has been well validated, recently and in the era of effective EVT, its use in AIS with large vessel occlusion (LVO) has been debated. We are at a critical juncture in the ever evolving and exciting field of AIS care, the question on every neurologist’s mind remains whether to bypass IV tPA for EVT in AIS with LVO. Is it the end of the road for IV tPA in AIS with LVO? It has been largely recognized that IV tPA has a low rate of recanalization in AIS with LVO. In a computed tomography (CT) angiogram-based retrospective study, only 21% of the AIS patients with LVO who received IV tPA within 4.5 h of symptom onset achieved complete recanalization [10]. The same study noted much lower rates of recanalization in the case of proximal internal carotid artery and basilar artery occlusions, approximately 4% [9]. Rai et al concluded that administration of IV tPA before EVT for large vessel strokes single handedly increased the total length of hospital stay and the health care costs [11]. It is well known that early recanalization of an occluded intracranial large vessel leads to better functional outcome. Combination therapy increases the door to groin puncture time of EVT that may lead to delayed recanalization time and subsequently worse functional outcomes [12]. Furthermore, the results of the recently published SKIP trial [13], comparing EVT with versus without IV tPA in AIS with internal carotid artery (ICA) and M1 occlusions, showed a lower rate of intracranial hemorrhage in the EVT only group (34% vs. 50%, P = 0.02). There is also a concern that IV tPA administration might fragment a blood clot targeted for extraction and potentially propagate the fragments downstream, making it non-amenable to EVT [14]. Kamal et al [15] also reported the possibility of recurrent AIS early after IV tPA administration due to disintegration of a pre-existing intracardiac, valvular or aortic thrombus and subsequent systemic embolization. Since health care providers usually think of intracranial hemorrhage as the cause of neurological deterioration during or shortly after IV thrombolysis (IVT), this might cause a delay in the
2020年是具有里程碑意义的美国国家神经疾病和中风研究所(NINDS)试验的50周年纪念，该试验使静脉注射组织型纤溶酶原激活剂(IV tPA)成为迄今为止唯一获得美国食品和药物管理局(FDA)批准的急性缺血性卒中(AIS)治疗方法[1]。多年来，静脉注射tPA已变得更加安全且普遍[2-8]。2020年也是五项大型随机临床试验(RCTs)的五周年纪念日，它们通过认可在大血管卒中中同时使用静脉tPA和血管内治疗(EVT)与支架回收器相比单独使用静脉tPA的益处，彻底改变了急性卒中的护理[9]。经证实，无论是否采用静脉tPA，采用支架置换器的EVT均可改善大血管卒中患者的整体功能结局并降低死亡率[9]。虽然静脉tPA在AIS中的疗效已经得到了很好的验证，但最近在有效EVT的时代，它在大血管闭塞(LVO)的AIS中的应用一直存在争议。我们正处于不断发展和令人兴奋的AIS护理领域的关键时刻，每个神经科医生心中的问题仍然是是否在患有LVO的AIS患者中绕过静脉tPA进行EVT。这是LVO AIS患者静脉tPA治疗的终点吗?人们普遍认为，静脉tPA在合并LVO的AIS中具有较低的再通率。在一项基于CT血管造影的回顾性研究中，在症状出现后4.5小时内接受静脉tPA治疗的伴有LVO的AIS患者中，只有21%的患者实现了完全再通[10]。同一项研究指出，近段颈内动脉和基底动脉闭塞的再通率要低得多，约为4%[9]。Rai等人得出结论，大血管卒中EVT前单独给予静脉注射tPA会增加总住院时间和医疗费用[11]。众所周知，颅内大血管闭塞的早期再通可以带来更好的功能结果。联合治疗增加了EVT到腹股沟穿刺的时间，可能导致再通时间延迟，从而导致更差的功能预后[12]。此外，最近发表的SKIP试验[13]的结果显示，在合并颈内动脉(ICA)和M1闭塞的AIS患者中，EVT组颅内出血发生率较低(34% vs. 50%， P = 0.02)。还有一种担忧是，静脉注射tPA可能会使用于提取的血凝块破碎，并可能将碎片向下游传播，使其不适合EVT[14]。Kamal等[15]也报道了静脉注射tPA后早期AIS复发的可能性，这是由于先前存在的心内、瓣膜或主动脉血栓的解体以及随后的全身栓塞。由于医疗保健提供者通常认为颅内出血是静脉溶栓(IVT)期间或之后不久神经功能恶化的原因，这可能会导致大血管卒中时复发性AIS和随后的EVT的及时诊断延迟。尽管在大血管卒中EVT前静脉注射tPA存在问题，但它仍然是标准的治疗方法。目前美国心脏协会/美国卒中协会(AHA/ASA)的指南反对在符合条件的患者中不给予静脉tPA治疗，无论LVO状态如何[16]。HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials)合作小组对5项具有里程碑意义的LVO卒中试验进行了汇总数据分析，结果显示，静脉注射tPA后接受EVT的患者具有更好的功能结局和更低的死亡率[9]。在一项前瞻性观察性研究中，Ferrigno等[17]表明，在前循环大血管卒中的病例中，静脉tPA + EVT组较单纯EVT组有更高的预后机会(35% vs 22%， P = 0.007)，且3个月死亡率较低(32% vs. 14%， P < 0.0001)。此外，一项包括381例患者的ASTER试验的事后分析[18]显示，静脉tPA加EVT组的90天死亡率低于单纯EVT组(完全调整风险比:0.59;95%置信区间(CI): 0.39 0.88)。这两项研究都显示了在脑梗死(TICI) 2b级中实现溶栓的更好机会的趋势。论文提交于2020年6月8日，接受于2020年6月15日
{"title":"Large Vessel Strokes: Is Bridging With Intravenous Thrombolysis Still Beneficial in the Era of Endovascular Treatment?","authors":"Harshit Shah, S. Dighe, A. Mowla","doi":"10.14740/jnr621","DOIUrl":"https://doi.org/10.14740/jnr621","url":null,"abstract":"The year 2020 marks the silver jubilee of the landmark National Institute of Neurological Disorders and Stroke (NINDS) trial which made intravenous tissue plasminogen activator (IV tPA) the only Food and Drug Administration (FDA)-approved treatment for acute ischemic stroke (AIS) management thus far [1]. Over the years, the use of IV tPA has become safer and ubiquitous [2-8]. 2020 also marks the fifth anniversary of the five large randomized clinical trials (RCTs) which revolutionized acute stroke care by endorsing the benefits of concomitant use of IV tPA and endovascular treatment (EVT) with stent retrievers over IV tPA alone in large vessel strokes [9]. EVT with stent retrievers have demonstrated to improve the overall functional outcome and reduce mortality in large vessel strokes, with or without IV tPA [9]. While the efficacy of IV tPA in AIS has been well validated, recently and in the era of effective EVT, its use in AIS with large vessel occlusion (LVO) has been debated. We are at a critical juncture in the ever evolving and exciting field of AIS care, the question on every neurologist’s mind remains whether to bypass IV tPA for EVT in AIS with LVO. Is it the end of the road for IV tPA in AIS with LVO? It has been largely recognized that IV tPA has a low rate of recanalization in AIS with LVO. In a computed tomography (CT) angiogram-based retrospective study, only 21% of the AIS patients with LVO who received IV tPA within 4.5 h of symptom onset achieved complete recanalization [10]. The same study noted much lower rates of recanalization in the case of proximal internal carotid artery and basilar artery occlusions, approximately 4% [9]. Rai et al concluded that administration of IV tPA before EVT for large vessel strokes single handedly increased the total length of hospital stay and the health care costs [11]. It is well known that early recanalization of an occluded intracranial large vessel leads to better functional outcome. Combination therapy increases the door to groin puncture time of EVT that may lead to delayed recanalization time and subsequently worse functional outcomes [12]. Furthermore, the results of the recently published SKIP trial [13], comparing EVT with versus without IV tPA in AIS with internal carotid artery (ICA) and M1 occlusions, showed a lower rate of intracranial hemorrhage in the EVT only group (34% vs. 50%, P = 0.02). There is also a concern that IV tPA administration might fragment a blood clot targeted for extraction and potentially propagate the fragments downstream, making it non-amenable to EVT [14]. Kamal et al [15] also reported the possibility of recurrent AIS early after IV tPA administration due to disintegration of a pre-existing intracardiac, valvular or aortic thrombus and subsequent systemic embolization. Since health care providers usually think of intracranial hemorrhage as the cause of neurological deterioration during or shortly after IV thrombolysis (IVT), this might cause a delay in the ","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87434181","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}
Background: Schizophrenia is a chronic illness, with the majority of patients experiencing multiple relapses. Our aim is to survey the risk factors and antipsychotic medications associated with more relapses in schizophrenia patients. Methods: The records of 251 schizophrenia patients who were adherent to their antipsychotic medications during the course of their illness were surveyed. The files were divided to two groups with regard to the number of admissions. The groups were compared regarding age, sex, education, marital status, place of living, family history, positive or negative symptom profile, substance abuse and the antipsychotic medications used. Results: The patients of the two groups did not show any differences regarding demographic factors. The dominant antipsychotic (the antipsychotic used more than 50% of time during the course of illness) used in the two groups was risperidone without significant difference (P = 0.486). Only substance abuse (P = 0.090) and electroconvulsive therapy (ECT) administration (P < 0.001) were shown to be different between the groups. Conclusions: Antipsychotics were not revealed to have preventive effects for relapse. Less substance abuse was demonstrated to lessen the risk of relapse. J Neurol Res. 2020;000(000):000-000 doi: https://doi.org/10.14740/jnr613
{"title":"What Antipsychotic Medications and Risk Factors Are Associated With More Relapses in Chronic Schizophrenia Patients","authors":"A. Mowla, Vahid Zarei, A. Pani","doi":"10.14740/JNR.V0I0.613","DOIUrl":"https://doi.org/10.14740/JNR.V0I0.613","url":null,"abstract":"Background: Schizophrenia is a chronic illness, with the majority of patients experiencing multiple relapses. Our aim is to survey the risk factors and antipsychotic medications associated with more relapses in schizophrenia patients. Methods: The records of 251 schizophrenia patients who were adherent to their antipsychotic medications during the course of their illness were surveyed. The files were divided to two groups with regard to the number of admissions. The groups were compared regarding age, sex, education, marital status, place of living, family history, positive or negative symptom profile, substance abuse and the antipsychotic medications used. Results: The patients of the two groups did not show any differences regarding demographic factors. The dominant antipsychotic (the antipsychotic used more than 50% of time during the course of illness) used in the two groups was risperidone without significant difference (P = 0.486). Only substance abuse (P = 0.090) and electroconvulsive therapy (ECT) administration (P < 0.001) were shown to be different between the groups. Conclusions: Antipsychotics were not revealed to have preventive effects for relapse. Less substance abuse was demonstrated to lessen the risk of relapse. J Neurol Res. 2020;000(000):000-000 doi: https://doi.org/10.14740/jnr613","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"128 1","pages":"183-187"},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84367812","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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