Pub Date : 2020-08-01Epub Date: 2020-06-23DOI: 10.14740/jnr603
Amjad Elmashala, Saurav Chopra, Aayushi Garg
The coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has so far affected 216 countries and more than 5 million individuals worldwide. The infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While pulmonary manifestations are the most common, neurological features are increasingly being recognized as common manifestations of the COVID-19, especially in the cases of severe infection. These include acute cerebrovascular disease, encephalitis, and Guillain-Barre syndrome (GBS). Here, we review the neuropathogenesis of SARS-CoV-2 and the central and peripheral nervous system manifestations of COVID-19.
{"title":"The Neurologic Manifestations of Coronavirus Disease 2019.","authors":"Amjad Elmashala, Saurav Chopra, Aayushi Garg","doi":"10.14740/jnr603","DOIUrl":"10.14740/jnr603","url":null,"abstract":"<p><p>The coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has so far affected 216 countries and more than 5 million individuals worldwide. The infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While pulmonary manifestations are the most common, neurological features are increasingly being recognized as common manifestations of the COVID-19, especially in the cases of severe infection. These include acute cerebrovascular disease, encephalitis, and Guillain-Barre syndrome (GBS). Here, we review the neuropathogenesis of SARS-CoV-2 and the central and peripheral nervous system manifestations of COVID-19.</p>","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"10 4","pages":"107-112"},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d1/35/jnr-10-107.PMC8040454.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38977944","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}
D. Wampler, B. Eastridge, R. Summers, Preston Love, A. Dharia, A. Seifi
Background: Spinal protection during emergency medical service (EMS) transport after trauma has become a focus of debate. Historically, patients at risk for spine injury are transported in a rigid collar, long spineboard and headblocks. The cervical collar (c-collar) is hypothesized to provide stabilization for the cervical spine. However, little is known how the c-collar affects cervical blood flow. Methods: Cerebral blood flow was measured in multiple conditions using a non-invasive cerebral blood flow monitor to establish cerebral blood flow index (CBFI). The CBFI data were collected at: standing, sitting, 45°, 30°, 10° or 15°, and supine, with and without c-collar. Descriptive statistics were used for CBFI in each condition, and parametric statistical methods were utilized to determine the significance of changes in CBFI. Results: Five volunteers were recruited, and each tested in six positions with and without c-collar. Mean age was 49 (standard deviation (SD) 15) years and 60% were male. The CBFI mean of means was 71.0 with and 69.4 without the c-collar. Only one subject demonstrated a statistically significant difference in CBFI with c-collar. The CBFI mean of means for position was 72.6 for head of bed less than 30° and 68.1 for greater than 30°. All subjects demonstrated > 99% confidence for a statistically significant difference in CBFI when dichotomized using head of bed at 30°. Conclusions: Head of the bed position has greater influence on CBFI than the c-collar . Clinical significance in healthy volunteers is unknown but this change in cerebral blood flow may have clinical significance in traumatic brain injury or neurologic conditions that compromise autoregulation. J Neurol Res. 2020;10(5):177-182 doi: https://doi.org/10.14740/jnr611
{"title":"Impact of Cervical Collar and Patient Position on the Cerebral Blood Flow","authors":"D. Wampler, B. Eastridge, R. Summers, Preston Love, A. Dharia, A. Seifi","doi":"10.14740/jnr611","DOIUrl":"https://doi.org/10.14740/jnr611","url":null,"abstract":"Background: Spinal protection during emergency medical service (EMS) transport after trauma has become a focus of debate. Historically, patients at risk for spine injury are transported in a rigid collar, long spineboard and headblocks. The cervical collar (c-collar) is hypothesized to provide stabilization for the cervical spine. However, little is known how the c-collar affects cervical blood flow. Methods: Cerebral blood flow was measured in multiple conditions using a non-invasive cerebral blood flow monitor to establish cerebral blood flow index (CBFI). The CBFI data were collected at: standing, sitting, 45°, 30°, 10° or 15°, and supine, with and without c-collar. Descriptive statistics were used for CBFI in each condition, and parametric statistical methods were utilized to determine the significance of changes in CBFI. Results: Five volunteers were recruited, and each tested in six positions with and without c-collar. Mean age was 49 (standard deviation (SD) 15) years and 60% were male. The CBFI mean of means was 71.0 with and 69.4 without the c-collar. Only one subject demonstrated a statistically significant difference in CBFI with c-collar. The CBFI mean of means for position was 72.6 for head of bed less than 30° and 68.1 for greater than 30°. All subjects demonstrated > 99% confidence for a statistically significant difference in CBFI when dichotomized using head of bed at 30°. Conclusions: Head of the bed position has greater influence on CBFI than the c-collar . Clinical significance in healthy volunteers is unknown but this change in cerebral blood flow may have clinical significance in traumatic brain injury or neurologic conditions that compromise autoregulation. J Neurol Res. 2020;10(5):177-182 doi: https://doi.org/10.14740/jnr611","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"106 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79253538","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 : 2020-08-01Epub Date: 2020-06-30DOI: 10.14740/jnr602
Luiz Severo Bem Junior, Pedro Lukas do Rego Aquino, Nicollas Nunes Rabelo, Maria Amellia do Rego Aquino, Ana Cristina Veiga Silva, Rita de Cassia Ferreira Valenca Mota, Hildo Rocha Cirne de Azevedo Filho
Coronavirus (CoV) is a virus infectious disease with a considerable spectrum of clinical presentations. Symptoms ranged from asymptomatic infection to severe pneumonia that may lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and several clinical complications. Neurologic symptoms related to CoV have been described recently in the literature. The relationship between SARS-CoV-2 and the central nervous system (CNS) is still not clear. This review aimed to reveal the current knowledge regarding CNS manifestation in SARS-CoV-2. A systematic literature review was carried out to identify the particularities of coronavirus disease 2019 (COVID-19) in patients with CNS involvement, using the PubMed database between January 1, 2020 and April 30, 2020. Conference papers, reviews, published letters, editorials, studies in pregnant women and children, and studies only reporting on a specific factor were excluded. An initial search included as many as 83 articles. Out of the 83 screened articles, 32 were selected for full-text review. Sixteen studies were excluded because they did not analyze nervous system involvement in SARS-CoV-2 infection. Thus, 16 papers were included in this review. There were three retrospective studies and 13 case reports/series of cases. Data from the current literature reveal that patients who suffer from a severe illness have more CNS involvement, neurological symptoms (i.e., dizziness, headache) and an association with strokes. The severe patients had higher D-dimer and C-reactive protein levels than non-severe patients and presented multiple organ involvement, such as serious liver, kidney and muscle damage.
{"title":"SARS-CoV-2 and Nervous System - Neurological Manifestations in Patients With COVID-19: A Systematic Review.","authors":"Luiz Severo Bem Junior, Pedro Lukas do Rego Aquino, Nicollas Nunes Rabelo, Maria Amellia do Rego Aquino, Ana Cristina Veiga Silva, Rita de Cassia Ferreira Valenca Mota, Hildo Rocha Cirne de Azevedo Filho","doi":"10.14740/jnr602","DOIUrl":"10.14740/jnr602","url":null,"abstract":"<p><p>Coronavirus (CoV) is a virus infectious disease with a considerable spectrum of clinical presentations. Symptoms ranged from asymptomatic infection to severe pneumonia that may lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and several clinical complications. Neurologic symptoms related to CoV have been described recently in the literature. The relationship between SARS-CoV-2 and the central nervous system (CNS) is still not clear. This review aimed to reveal the current knowledge regarding CNS manifestation in SARS-CoV-2. A systematic literature review was carried out to identify the particularities of coronavirus disease 2019 (COVID-19) in patients with CNS involvement, using the PubMed database between January 1, 2020 and April 30, 2020. Conference papers, reviews, published letters, editorials, studies in pregnant women and children, and studies only reporting on a specific factor were excluded. An initial search included as many as 83 articles. Out of the 83 screened articles, 32 were selected for full-text review. Sixteen studies were excluded because they did not analyze nervous system involvement in SARS-CoV-2 infection. Thus, 16 papers were included in this review. There were three retrospective studies and 13 case reports/series of cases. Data from the current literature reveal that patients who suffer from a severe illness have more CNS involvement, neurological symptoms (i.e., dizziness, headache) and an association with strokes. The severe patients had higher D-dimer and C-reactive protein levels than non-severe patients and presented multiple organ involvement, such as serious liver, kidney and muscle damage.</p>","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"10 4","pages":"113-121"},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/63/37/jnr-10-113.PMC8040459.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38978483","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}
Reza Bavarsad Sahripour, A. Maleki, B. Krishnaiah, A. Alexandrov
Tuberous sclerosis (TS) is an autosomal dominant disease known for over a century and recognized by characteristic hamartomatous lesions involving any organ. In this report, we are presenting a patient with TS who presented with acute embolic stroke and received tissue plasminogen activator (tPA) and had a mechanical thrombectomy (MT). She had a dramatic response without any hemorrhagic complications. She is a 68-year-old Caucasian woman with the past medical history of TS since childhood who presented to the hospital with symptoms of left middle cerebral artery (MCA) syndrome (right-sided weakness, sensory loss, right facial droop, aphasia, hemianopia, and dysarthria). National Institute of Health Stroke Scale (NIHSS) score was 19. Head computed tomography (CT) was negative for any acute abnormality except cortical tubers, subependymal ventricular calcification. CT angiography of the head and neck showed proximal occlusion of the left internal carotid artery. After ruling out all exclusion criteria, the patient received tPA and had an MT with complete reperfusion (thrombolysis in cerebral infarction (TICI) 3). Brain magnetic resonance imaging (MRI) showed an acute stroke in the multivessel territories (bilateral parietal cortices, the left lentiform nucleus, medial left temporal lobe, left thalamus, and right occipital lobe) suggestive of an embolic phenomenon and did not show any hemorrhagic complication. TS patients are at increased risk of intracerebral hemorrhage either in the setting of vascular malformation or due to hemorrhage into the subependymal giant cell astrocytoma. The best explanation for the latter could be secondary to elevated venous pressure from increased intracranial pressure. Fortunately, our TS patient who presented with acute ischemic stroke was within the window and received tPA and MT. The patient not only did not have any hemorrhagic side effects afterward but also had a significant improvement in her neurologic symptoms. To our best knowledge, this is the only case report of tPA administration in a TS patient. Moreover, we need more case reports to evaluate the safety of tPA in these patients. J Neurol Res. 2020;10(4):140-143 doi: https://doi.org/10.14740/jnr595
{"title":"Recombinant Tissue Plasminogen Activator Use in an Acute Stroke Patient With Tuberous Sclerosis","authors":"Reza Bavarsad Sahripour, A. Maleki, B. Krishnaiah, A. Alexandrov","doi":"10.14740/jnr595","DOIUrl":"https://doi.org/10.14740/jnr595","url":null,"abstract":"Tuberous sclerosis (TS) is an autosomal dominant disease known for over a century and recognized by characteristic hamartomatous lesions involving any organ. In this report, we are presenting a patient with TS who presented with acute embolic stroke and received tissue plasminogen activator (tPA) and had a mechanical thrombectomy (MT). She had a dramatic response without any hemorrhagic complications. She is a 68-year-old Caucasian woman with the past medical history of TS since childhood who presented to the hospital with symptoms of left middle cerebral artery (MCA) syndrome (right-sided weakness, sensory loss, right facial droop, aphasia, hemianopia, and dysarthria). National Institute of Health Stroke Scale (NIHSS) score was 19. Head computed tomography (CT) was negative for any acute abnormality except cortical tubers, subependymal ventricular calcification. CT angiography of the head and neck showed proximal occlusion of the left internal carotid artery. After ruling out all exclusion criteria, the patient received tPA and had an MT with complete reperfusion (thrombolysis in cerebral infarction (TICI) 3). Brain magnetic resonance imaging (MRI) showed an acute stroke in the multivessel territories (bilateral parietal cortices, the left lentiform nucleus, medial left temporal lobe, left thalamus, and right occipital lobe) suggestive of an embolic phenomenon and did not show any hemorrhagic complication. TS patients are at increased risk of intracerebral hemorrhage either in the setting of vascular malformation or due to hemorrhage into the subependymal giant cell astrocytoma. The best explanation for the latter could be secondary to elevated venous pressure from increased intracranial pressure. Fortunately, our TS patient who presented with acute ischemic stroke was within the window and received tPA and MT. The patient not only did not have any hemorrhagic side effects afterward but also had a significant improvement in her neurologic symptoms. To our best knowledge, this is the only case report of tPA administration in a TS patient. Moreover, we need more case reports to evaluate the safety of tPA in these patients. J Neurol Res. 2020;10(4):140-143 doi: https://doi.org/10.14740/jnr595","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81549628","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}
Bilateral giant cerebral aneurysms are exceedingly rare. Giant aneurysms of the internal carotid artery (ICA) carry a poor prognosis if untreated. Flow diversion is an endovascular technique whereby a device is placed in the parent blood vessel to divert blood flow away from the aneurysm and is an available treatment for giant aneurysms. A 69-year-old woman presented with progressive diplopia and was found to have bilateral ICA aneurysms. She had stenting of the left ICA aneurysm with improvement of her symptoms and no complications. Five years post procedure, she presented with recurrent diplopia and was found to have enlargement of the previously seen right-sided cavernous ICA aneurysm, which was treated with another flow diversion stent with no complications. Endoluminal reconstruction/flow diversion with Pipeline™ Embolization Device (PED) has emerged as an alternative to traditional endosaccular coiling and parent artery occlusion. We report a case of bilateral cavernous carotid giant aneurysms treated with flow diversion and demonstrate that flow diversion stenting using the PED is a safe and reliable treatment for bilateral giant ICA aneurysms. We encourage interventionists to consider this technique in patients with giant intracranial aneurysms. J Neurol Res. 2020;10(4):136-139 doi: https://doi.org/10.14740/jnr593
{"title":"Endovascular Reconstruction Utilizing Flow Diversion Stenting in a Patient With Bilateral Giant Cavernous Internal Carotid Artery Aneurysms","authors":"K. Sivakumar, J. Johal, H. Yacoub, M. Leary","doi":"10.14740/jnr593","DOIUrl":"https://doi.org/10.14740/jnr593","url":null,"abstract":"Bilateral giant cerebral aneurysms are exceedingly rare. Giant aneurysms of the internal carotid artery (ICA) carry a poor prognosis if untreated. Flow diversion is an endovascular technique whereby a device is placed in the parent blood vessel to divert blood flow away from the aneurysm and is an available treatment for giant aneurysms. A 69-year-old woman presented with progressive diplopia and was found to have bilateral ICA aneurysms. She had stenting of the left ICA aneurysm with improvement of her symptoms and no complications. Five years post procedure, she presented with recurrent diplopia and was found to have enlargement of the previously seen right-sided cavernous ICA aneurysm, which was treated with another flow diversion stent with no complications. Endoluminal reconstruction/flow diversion with Pipeline™ Embolization Device (PED) has emerged as an alternative to traditional endosaccular coiling and parent artery occlusion. We report a case of bilateral cavernous carotid giant aneurysms treated with flow diversion and demonstrate that flow diversion stenting using the PED is a safe and reliable treatment for bilateral giant ICA aneurysms. We encourage interventionists to consider this technique in patients with giant intracranial aneurysms. J Neurol Res. 2020;10(4):136-139 doi: https://doi.org/10.14740/jnr593","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73782515","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}
Luiz Severo Bem Junior, Pedro Lukas do Rêgo Aquino, N. Rabelo, M. A. Aquino, Ana Cristina Veiga Silva, R. Mota, H. A. Filho
Coronavirus (CoV) is a virus infectious disease with a considerable spectrum of clinical presentations. Symptoms ranged from asymptomatic infection to severe pneumonia that may lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and several clinical complications. Neurologic symptoms related to CoV have been described recently in the literature. The relationship between SARS-CoV-2 and the central nervous system (CNS) is still not clear. This review aimed to reveal the current knowledge regarding CNS manifestation in SARS-CoV-2. A systematic literature review was carried out to identify the particularities of coronavirus disease 2019 (COVID-19) in patients with CNS involvement, using the PubMed database between January 1, 2020 and April 30, 2020. Conference papers, reviews, published letters, editorials, studies in pregnant women and children, and studies only reporting on a specific factor were excluded. An initial search included as many as 83 articles. Out of the 83 screened articles, 32 were selected for full-text review. Sixteen studies were excluded because they did not analyze nervous system involvement in SARS-CoV-2 infection. Thus, 16 papers were included in this review. There were three retrospective studies and 13 case reports/series of cases. Data from the current literature reveal that patients who suffer from a severe illness have more CNS involvement, neurological symptoms (i.e., dizziness, headache) and an association with strokes. The severe patients had higher D-dimer and C-reactive protein levels than non-severe patients and presented multiple organ involvement, such as serious liver, kidney and muscle damage. J Neurol Res. 2020;10(4):113-121 doi: https://doi.org/10.14740/jnr602
{"title":"SARS-CoV-2 and Nervous System - Neurological Manifestations in Patients With COVID-19: A Systematic Review","authors":"Luiz Severo Bem Junior, Pedro Lukas do Rêgo Aquino, N. Rabelo, M. A. Aquino, Ana Cristina Veiga Silva, R. Mota, H. A. Filho","doi":"10.14740/JNR.V0I0.602","DOIUrl":"https://doi.org/10.14740/JNR.V0I0.602","url":null,"abstract":"Coronavirus (CoV) is a virus infectious disease with a considerable spectrum of clinical presentations. Symptoms ranged from asymptomatic infection to severe pneumonia that may lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and several clinical complications. Neurologic symptoms related to CoV have been described recently in the literature. The relationship between SARS-CoV-2 and the central nervous system (CNS) is still not clear. This review aimed to reveal the current knowledge regarding CNS manifestation in SARS-CoV-2. A systematic literature review was carried out to identify the particularities of coronavirus disease 2019 (COVID-19) in patients with CNS involvement, using the PubMed database between January 1, 2020 and April 30, 2020. Conference papers, reviews, published letters, editorials, studies in pregnant women and children, and studies only reporting on a specific factor were excluded. An initial search included as many as 83 articles. Out of the 83 screened articles, 32 were selected for full-text review. Sixteen studies were excluded because they did not analyze nervous system involvement in SARS-CoV-2 infection. Thus, 16 papers were included in this review. There were three retrospective studies and 13 case reports/series of cases. Data from the current literature reveal that patients who suffer from a severe illness have more CNS involvement, neurological symptoms (i.e., dizziness, headache) and an association with strokes. The severe patients had higher D-dimer and C-reactive protein levels than non-severe patients and presented multiple organ involvement, such as serious liver, kidney and muscle damage. J Neurol Res. 2020;10(4):113-121 doi: https://doi.org/10.14740/jnr602","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"94 1","pages":"113-121"},"PeriodicalIF":0.0,"publicationDate":"2020-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80131077","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}
Acute ischemic stroke (AIS) is a worldwide health burden and the leading cause of disability in adults. The management of AIS is developing rapidly. Currently, the two Food and Drug Administration (FDA)-approved treatment options for AIS are intravenous thrombolysis (IVT) with alteplase within the first 4.5 h of the AIS symptom onset and endovascular treatment (EVT) in patients with an occlusive clot in one of the intracranial large vessels within the first 24 h of symptom onset depending on the salvageability of the brain tissue [1-10]. Some studies have shown the potential benefit of EVT during the first 16 to 24 h from the AIS symptom onset if there is a favorable penumbra without a large infarct core [11, 12]. Another study revealed that EVT within 6 to 16 h after onset of AIS symptom could decrease the length hospital stay and improve patient functional outcome [13]. Alteplase is an intravenous recombinant tissue plasminogen activator (rTPA) with a short half-life that needs continuous infusion for about 1 h [14]. Infusion of alteplase as a bridge prior to EVT is still a treatment option for eligible AIS patients with intracranial large vessel occlusions [15-17]. Thus far, alteplase is the only FDA-approved pharmacological treatment for AIS [1, 5, 18]; however, infusion of alteplase has a relatively low rate of recanalization and reperfusion of the large vessel occlusions prior to EVT; hence, it might not be the ideal treatment option [15, 19]. Tenecteplase is a modified form of alteplase with 14-fold more fibrin specificity and enhanced ability for thrombolysis. It also has a longer half-life and 80 times greater resistance to plasminogen activator inhibitor-1 compared to the alteplase; as such, it can be used as an intravenous bolus rather than a bolus followed by 1 h infusion as with alteplase [20]. Single bolus infusion of tenecteplase can give practical benefits to AIS patients who need transportation between hospitals to access EVT [15]. Single bolus infusion of tenecteplase can also reduce the time to receive EVT after the onset of stroke symptoms [16]. Furthermore, according to the information available on drugs.com, in the USA, tenecteplase would cost much less when compared with the alteplase [20]. To the best of our knowledge, at least five randomized clinical trials that compared alteplase with tenecteplase in the treatment of AIS have shown no significant differences in the mortality rate or in the chance of neurological recovery between these two options [15]. Parson et al [18], in a randomized clinical trial on AIS patients who received thrombolytic therapy, found that tenecteplase was superior to alteplase concerning the angiographic outcomes, rate of reperfusion, and also neurological improvement in 24 h. They also showed lower rate of severe disability at 90 days [18]. Campbell et al [15] studied tenecteplase 0.25 mg/kg versus the standard dose of alteplase for patients with AIS within 4.5 h of symptom onset prior to EVT. T
{"title":"Thrombolytic Therapy for Stroke: Intravenous Tenecteplase Era","authors":"M. Abdoli, Pegah Mohammadi, A. Mowla","doi":"10.14740/jnr604","DOIUrl":"https://doi.org/10.14740/jnr604","url":null,"abstract":"Acute ischemic stroke (AIS) is a worldwide health burden and the leading cause of disability in adults. The management of AIS is developing rapidly. Currently, the two Food and Drug Administration (FDA)-approved treatment options for AIS are intravenous thrombolysis (IVT) with alteplase within the first 4.5 h of the AIS symptom onset and endovascular treatment (EVT) in patients with an occlusive clot in one of the intracranial large vessels within the first 24 h of symptom onset depending on the salvageability of the brain tissue [1-10]. Some studies have shown the potential benefit of EVT during the first 16 to 24 h from the AIS symptom onset if there is a favorable penumbra without a large infarct core [11, 12]. Another study revealed that EVT within 6 to 16 h after onset of AIS symptom could decrease the length hospital stay and improve patient functional outcome [13]. Alteplase is an intravenous recombinant tissue plasminogen activator (rTPA) with a short half-life that needs continuous infusion for about 1 h [14]. Infusion of alteplase as a bridge prior to EVT is still a treatment option for eligible AIS patients with intracranial large vessel occlusions [15-17]. Thus far, alteplase is the only FDA-approved pharmacological treatment for AIS [1, 5, 18]; however, infusion of alteplase has a relatively low rate of recanalization and reperfusion of the large vessel occlusions prior to EVT; hence, it might not be the ideal treatment option [15, 19]. Tenecteplase is a modified form of alteplase with 14-fold more fibrin specificity and enhanced ability for thrombolysis. It also has a longer half-life and 80 times greater resistance to plasminogen activator inhibitor-1 compared to the alteplase; as such, it can be used as an intravenous bolus rather than a bolus followed by 1 h infusion as with alteplase [20]. Single bolus infusion of tenecteplase can give practical benefits to AIS patients who need transportation between hospitals to access EVT [15]. Single bolus infusion of tenecteplase can also reduce the time to receive EVT after the onset of stroke symptoms [16]. Furthermore, according to the information available on drugs.com, in the USA, tenecteplase would cost much less when compared with the alteplase [20]. To the best of our knowledge, at least five randomized clinical trials that compared alteplase with tenecteplase in the treatment of AIS have shown no significant differences in the mortality rate or in the chance of neurological recovery between these two options [15]. Parson et al [18], in a randomized clinical trial on AIS patients who received thrombolytic therapy, found that tenecteplase was superior to alteplase concerning the angiographic outcomes, rate of reperfusion, and also neurological improvement in 24 h. They also showed lower rate of severe disability at 90 days [18]. Campbell et al [15] studied tenecteplase 0.25 mg/kg versus the standard dose of alteplase for patients with AIS within 4.5 h of symptom onset prior to EVT. T","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85534636","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}
Cannabidiol (CBD) and other marijuana derivatives are being more widely used in the medical community by people in an attempt to alleviate a variety of symptoms. While these products have shown promise in their analgesic properties, little is known about the potential pharmacological interactions of these and other drugs. We present a case of a 57-year-old Caucasian woman who presented with altered mental status, ataxia, left-sided numbness, and slurred speech. An extensive workup was completed and found to be largely unremarkable, though a thorough history revealed that her symptoms were likely caused by concurrent use of CBD and non-steroidal anti-inflammatory drugs (NSAIDs) resulting in drug-induced aseptic meningitis. The benign nature of CBD makes it a promising avenue for pain relief. Physicians and patients should be informed about the potential drug-drug interactions of CBD and other medications. J Neurol Res. 2020;10(4):132-135 doi: https://doi.org/10.14740/jnr598
{"title":"Cannabidiol and Non-Steroidal Anti-Inflammatory Drug Interactions: A Case of Drug-Induced Aseptic Meningitis","authors":"M. Emig, Jafar Kafaie, Samantha K Ong, Xujian Li","doi":"10.14740/jnr598","DOIUrl":"https://doi.org/10.14740/jnr598","url":null,"abstract":"Cannabidiol (CBD) and other marijuana derivatives are being more widely used in the medical community by people in an attempt to alleviate a variety of symptoms. While these products have shown promise in their analgesic properties, little is known about the potential pharmacological interactions of these and other drugs. We present a case of a 57-year-old Caucasian woman who presented with altered mental status, ataxia, left-sided numbness, and slurred speech. An extensive workup was completed and found to be largely unremarkable, though a thorough history revealed that her symptoms were likely caused by concurrent use of CBD and non-steroidal anti-inflammatory drugs (NSAIDs) resulting in drug-induced aseptic meningitis. The benign nature of CBD makes it a promising avenue for pain relief. Physicians and patients should be informed about the potential drug-drug interactions of CBD and other medications. J Neurol Res. 2020;10(4):132-135 doi: https://doi.org/10.14740/jnr598","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84532788","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: This study aims to compare the outcomes of complicated seizure cases in teaching institutions as compared to non-teaching hospitals. Methods: A retrospective cohort study was conducted utilizing the Healthcare Cost and Utilization Project (HCUP) national database to analyze outcomes of seizures between 2012 and 2016 in the USA. Results: We evaluated 267,430 of seizure patients with major complication or comorbidity between 2012 and 2016. Of these, 6,980 in-hospital deaths were reported. There was a trend toward a significantly higher mortality in teaching compared with non-teaching hospitals (P = 0.07). The average length of stay (LOS) was 5.2 days, with LOS in 2014 and 2016, being longer in teaching hospitals (P < 0.05). Hospital charges were not significantly different among the two groups, but both types of hospitals did show a statistically significant charge increase from 2012 to 2016 (P < 0.001). Conclusions: Our data showed that there is a trend toward significantly higher mortality in teaching hospitals. LOS was also more reported in teaching hospitals, which could be inherent to the increased volume and coordination of care and more complexity of the cases in teaching hospitals. However, hospital charges were not different in teaching versus non-teaching hospitals. J Neurol Res. 2020;10(4):127-131 doi: https://doi.org/10.14740/jnr588
{"title":"Seizures With Major Comorbidity and Complications: Association of the Teaching Status of the Hospitals With the Outcomes","authors":"Aparna Yarram, A. Seifi, V. Eslami","doi":"10.14740/jnr588","DOIUrl":"https://doi.org/10.14740/jnr588","url":null,"abstract":"Background: This study aims to compare the outcomes of complicated seizure cases in teaching institutions as compared to non-teaching hospitals. Methods: A retrospective cohort study was conducted utilizing the Healthcare Cost and Utilization Project (HCUP) national database to analyze outcomes of seizures between 2012 and 2016 in the USA. Results: We evaluated 267,430 of seizure patients with major complication or comorbidity between 2012 and 2016. Of these, 6,980 in-hospital deaths were reported. There was a trend toward a significantly higher mortality in teaching compared with non-teaching hospitals (P = 0.07). The average length of stay (LOS) was 5.2 days, with LOS in 2014 and 2016, being longer in teaching hospitals (P < 0.05). Hospital charges were not significantly different among the two groups, but both types of hospitals did show a statistically significant charge increase from 2012 to 2016 (P < 0.001). Conclusions: Our data showed that there is a trend toward significantly higher mortality in teaching hospitals. LOS was also more reported in teaching hospitals, which could be inherent to the increased volume and coordination of care and more complexity of the cases in teaching hospitals. However, hospital charges were not different in teaching versus non-teaching hospitals. J Neurol Res. 2020;10(4):127-131 doi: https://doi.org/10.14740/jnr588","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74142970","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}
Ross-Jordon S. Elliott, Marwah A. Elsehety, A. Seifi
Background: The aim of the study was to define the association between federal payer insurance and neurosurgical economic trends and readmissions after extracranial ventricular shunts (EVS) procedures and investigate these trends from 2009 to 2013 in the United States. Methods: We identified the procedure of insertion, replacement, or removal of EVS by applying the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) Procedure Codes of 231-235, 239, 242 and 243. Data were extracted for years 2009 to 2013. Year-wise distributions of index stays, readmission, percent readmission, cost for index stays and cost for readmissions for patients requiring EVS procedures who possess Medicare insurance (ME-patients) and Medicaid insurance (MD-patients) were described. Z-test statistic was used to compare the two groups. Results: During the 5 years of study, we recorded 149,220 index stays and 29,655 readmissions within 30 days involving the procedures of insertion, replacement, or removal of an EVS. Throughout the study period, hospital readmissions involving patients requiring procedures involving EVS consistently demonstrated both the highest annual mean cost for readmissions and the highest percentage of patient readmissions in regard to all neurosurgical procedures. The differences between the annual index stays and readmissions for ME-patients versus MD-patients requiring EVS were extremely statistically significant throughout the entire study period (P < 0.0001, P < 0.0001). The mean cost of readmissions within 30 days for all patients varied significantly from $19,005 to $23,499, with an average cost of $21,279 for readmissions occurring annually during the study period (P = 0.0161). The differences between the mean cost for index stays and readmissions for ME-patients versus MD-patients requiring EVS were extremely statistically significant throughout the entire study period (P < 0.0001, P < 0.0001). Conclusions: Federal payer insurance has a significant association with neurosurgical economic and patient readmission trends after EVS procedures in hospitals in the US. Further study is needed to investigate the etiology of these differences between patients’ payer insurance and their impact on clinical outcomes after EVS procedures. J Neurol Res. 2020;10(4):122-126 doi: https://doi.org/10.14740/jnr600
背景:本研究的目的是确定联邦支付人保险与神经外科经济趋势和颅外心室分流(EVS)手术后再入院之间的关系，并调查2009年至2013年美国这些趋势。方法:采用国际疾病分类第九版临床修改(ICD-9-CM)程序代码231-235、239、242和243，确定EVS的插入、置换或取出程序。数据取自2009年至2013年。描述了需要EVS手术且拥有医疗保险(ME-patients)和医疗补助保险(MD-patients)的患者的指数住院、再入院率、再入院百分比、指数住院费用和再入院费用的年度分布。采用z检验统计量对两组进行比较。结果:在5年的研究中，我们记录了149,220次指数住院和29,655次30天内再入院，涉及EVS的插入，更换或取出。在整个研究期间，在所有神经外科手术中，涉及EVS手术的患者再入院的年平均费用最高，再入院的患者比例最高。在整个研究期间，me患者与md患者需要EVS的年度住院指数和再入院率之间的差异具有极显著的统计学意义(P < 0.0001, P < 0.0001)。所有患者30天内再入院的平均费用从19,005美元到23,499美元不等，研究期间每年再入院的平均费用为21,279美元(P = 0.0161)。在整个研究期间，me患者与md患者需要EVS的平均住院费用和再入院费用之间的差异具有极显著的统计学意义(P < 0.0001, P < 0.0001)。结论:联邦付款人保险与美国医院EVS手术后神经外科经济和患者再入院趋势有显著关联。需要进一步的研究来调查患者支付保险之间的这些差异的病因及其对EVS手术后临床结果的影响。中华神经科学杂志，2020;10(4):122-126 doi: https://doi.org/10.14740/jnr600
{"title":"Neurosurgical Economic and Readmission Trends After Extracranial Ventricular Shunts in the United States From 2009 to 2013","authors":"Ross-Jordon S. Elliott, Marwah A. Elsehety, A. Seifi","doi":"10.14740/jnr600","DOIUrl":"https://doi.org/10.14740/jnr600","url":null,"abstract":"Background: The aim of the study was to define the association between federal payer insurance and neurosurgical economic trends and readmissions after extracranial ventricular shunts (EVS) procedures and investigate these trends from 2009 to 2013 in the United States. Methods: We identified the procedure of insertion, replacement, or removal of EVS by applying the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) Procedure Codes of 231-235, 239, 242 and 243. Data were extracted for years 2009 to 2013. Year-wise distributions of index stays, readmission, percent readmission, cost for index stays and cost for readmissions for patients requiring EVS procedures who possess Medicare insurance (ME-patients) and Medicaid insurance (MD-patients) were described. Z-test statistic was used to compare the two groups. Results: During the 5 years of study, we recorded 149,220 index stays and 29,655 readmissions within 30 days involving the procedures of insertion, replacement, or removal of an EVS. Throughout the study period, hospital readmissions involving patients requiring procedures involving EVS consistently demonstrated both the highest annual mean cost for readmissions and the highest percentage of patient readmissions in regard to all neurosurgical procedures. The differences between the annual index stays and readmissions for ME-patients versus MD-patients requiring EVS were extremely statistically significant throughout the entire study period (P < 0.0001, P < 0.0001). The mean cost of readmissions within 30 days for all patients varied significantly from $19,005 to $23,499, with an average cost of $21,279 for readmissions occurring annually during the study period (P = 0.0161). The differences between the mean cost for index stays and readmissions for ME-patients versus MD-patients requiring EVS were extremely statistically significant throughout the entire study period (P < 0.0001, P < 0.0001). Conclusions: Federal payer insurance has a significant association with neurosurgical economic and patient readmission trends after EVS procedures in hospitals in the US. Further study is needed to investigate the etiology of these differences between patients’ payer insurance and their impact on clinical outcomes after EVS procedures. J Neurol Res. 2020;10(4):122-126 doi: https://doi.org/10.14740/jnr600","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83703179","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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