The first documented case of coronavirus disease 2019 (COVID-19) in the USA was reported in a 35-year-old man from Snohomish County, Washington on January 20, 2020. Since then, there have been almost 5,000,000 confirmed cases all around the world and more than 1,500,000 cases in the USA [1]. In spite of the unprecedented burden on healthcare infrastructure by this global pandemic, clinicians across the USA have made anecdotal observations in established health care trends. Specifically, the authors as well as other clinicians around the world have noted decreased hospital and emergency room visits and hospitalizations for acute stroke (AS) and acute myocardial infarction (AMI) at their institutions and the other hospitals around the world [2-9]. If this observation does indeed hold and is universal, reasons for it are manifold. Here, the authors present various theories for this observation, which is mostly based on the recently published opinions [2-9] and personal observation and communications with multiple clinicians who are involved in the care of AS and AMI patients. One theory is that the presentation of AS and AMI to hospitals is falsely low, and the patients do not go to the hospitals because of fear from the COVID-19 pandemic [2]. Recently the European Stroke Organization (ESO) published a statement and mentioned that among 426 stroke care providers from 55 countries, only one in five reported that stroke patients are currently receiving the usual acute and post-acute care at their hospital [2]. Similarly, a preliminary analysis during the early phase of the COVID-19 pandemic showed an estimated 38% reduction in the US cardiac catheterization for acute coronary syndrome (ACS), similar to the 40% reduction noticed in Spain [5, 6]. Fear and trepidation regarding exposure to the COVID-19 in clinical settings may compel many to avoid calling for help, and “ride the storm” at home instead. It is possible that patients, often those who are elderly and with multiple comorbidities, are deferring emergency services and are dying at home during this pandemic. A study in the UK reported a 25% decrease in emergency room admissions 1 week after initiation of the nationwide lockdown in March 2020 [10]. With the exceptions of admissions for pneumonia, which have increased, other morbidities such as myocardial ischemia and gastrointestinal abnormalities decreased [10]. Widespread stay-at-home mandates and city lockdowns have been adopted across the USA, and it could be another contributor to reduced emergency room visit rates for symptoms that are not typical of COVID-19. Some patients may even presume that hospitals and clinics are closed altogether, or doctors are too busy treating patients with COVID-19 to treat patients with stroke [2-4]. A study in 2019 found that individuals with intimate social networks consisting mainly of family members versus more robust social connections such as friends or co-workers were more likely to delay presentation f
{"title":"Fewer Hospital Visits for Acute Stroke and Acute Coronary Syndrome During the COVID-19 Pandemic: A Reality or a Myth?","authors":"Ali Seifi, Jared Alexander Stowers, Reza Behrouz","doi":"10.14740/jnr601","DOIUrl":"https://doi.org/10.14740/jnr601","url":null,"abstract":"The first documented case of coronavirus disease 2019 (COVID-19) in the USA was reported in a 35-year-old man from Snohomish County, Washington on January 20, 2020. Since then, there have been almost 5,000,000 confirmed cases all around the world and more than 1,500,000 cases in the USA [1]. In spite of the unprecedented burden on healthcare infrastructure by this global pandemic, clinicians across the USA have made anecdotal observations in established health care trends. Specifically, the authors as well as other clinicians around the world have noted decreased hospital and emergency room visits and hospitalizations for acute stroke (AS) and acute myocardial infarction (AMI) at their institutions and the other hospitals around the world [2-9]. If this observation does indeed hold and is universal, reasons for it are manifold. Here, the authors present various theories for this observation, which is mostly based on the recently published opinions [2-9] and personal observation and communications with multiple clinicians who are involved in the care of AS and AMI patients. One theory is that the presentation of AS and AMI to hospitals is falsely low, and the patients do not go to the hospitals because of fear from the COVID-19 pandemic [2]. Recently the European Stroke Organization (ESO) published a statement and mentioned that among 426 stroke care providers from 55 countries, only one in five reported that stroke patients are currently receiving the usual acute and post-acute care at their hospital [2]. Similarly, a preliminary analysis during the early phase of the COVID-19 pandemic showed an estimated 38% reduction in the US cardiac catheterization for acute coronary syndrome (ACS), similar to the 40% reduction noticed in Spain [5, 6]. Fear and trepidation regarding exposure to the COVID-19 in clinical settings may compel many to avoid calling for help, and “ride the storm” at home instead. It is possible that patients, often those who are elderly and with multiple comorbidities, are deferring emergency services and are dying at home during this pandemic. A study in the UK reported a 25% decrease in emergency room admissions 1 week after initiation of the nationwide lockdown in March 2020 [10]. With the exceptions of admissions for pneumonia, which have increased, other morbidities such as myocardial ischemia and gastrointestinal abnormalities decreased [10]. Widespread stay-at-home mandates and city lockdowns have been adopted across the USA, and it could be another contributor to reduced emergency room visit rates for symptoms that are not typical of COVID-19. Some patients may even presume that hospitals and clinics are closed altogether, or doctors are too busy treating patients with COVID-19 to treat patients with stroke [2-4]. A study in 2019 found that individuals with intimate social networks consisting mainly of family members versus more robust social connections such as friends or co-workers were more likely to delay presentation f","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"10 3","pages":"53-55"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0d/40/jnr-10-053.PMC8040453.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38978486","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}
A human immunodeficiency virus (HIV)-positive 29-year-old man presented with pre-syncope and acute left hemispheric infarction in multiple vascular territories. Thorax computed tomography (CT) with contrast showed bovine aortic arch and a left atrium large mass. On transthoracic echo, a 2.1 × 2.6 cm mass pointed to the heart as the embolic source. Successful surgical resection revealed cardiac myxoma. Although this presentation mimicked artery to artery embolization but having a bovine aortic arch can contribute to this stroke propensity to the left hemisphere. J Neurol Res. 2020;10(3):95-98 doi: https://doi.org/10.14740/jnr584
{"title":"Unilateral Cardioembolic Stroke in a Patient With Aortic Arch Anomaly","authors":"A. Maleki, R. Shahripour, A. Wilner","doi":"10.14740/jnr584","DOIUrl":"https://doi.org/10.14740/jnr584","url":null,"abstract":"A human immunodeficiency virus (HIV)-positive 29-year-old man presented with pre-syncope and acute left hemispheric infarction in multiple vascular territories. Thorax computed tomography (CT) with contrast showed bovine aortic arch and a left atrium large mass. On transthoracic echo, a 2.1 × 2.6 cm mass pointed to the heart as the embolic source. Successful surgical resection revealed cardiac myxoma. Although this presentation mimicked artery to artery embolization but having a bovine aortic arch can contribute to this stroke propensity to the left hemisphere. J Neurol Res. 2020;10(3):95-98 doi: https://doi.org/10.14740/jnr584","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75134648","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}
D. Wampler, Ronald M Stewart, R. Summers, R. Schaefer, L. Roakes, Craig Cooley, Mike Shown, T. Long, Chetan U. Kharod, B. Eastridge
Background: Recent evidence suggests that long spine board (LSB) may do little to manage spinal motion, and pose increased risk. This project sought to measure cervical and thoracolumbar motion during ambulance transport. The hypothesis was transport on a mattress with the head elevated without the LSB would allow less spinal movement than transport on an LSB. Methods: A randomized healthy volunteer crossover trial measured spinal motion using biometric sensors. Positions analyzed included 0 and 10° on LSB. Stretcher alone with head elevated to 10°, 30°, 45° and 60°, with and without head blocks. Simulated ambulance transport was on city streets at or below posted speed limits. Results: Nine subjects were included, with 66% being male. For cervical movement, there was no difference in axial, flexion/extension, or rotation (0.2 ± 0.1 mm vs. 0.2 ± 0.1 mm, 24 ± 12 mm vs. 22 ± 10 mm, and 5.1 ± 19° vs. 5.8 ± 20°, respectively). There were significant differences in lateral (3.7 ± 7 mm LSB vs. 2.0 ± 5 mm no LSB) movement and volumetric movement of the head (120 ± 172 mm 3 LSB vs. 77 ± 86 mm 3 no LSB). Positions allowing the lowest mean cervical volume of head movement were bed elevated to 30° and 45° with head blocks, (20 ± 22 mm 3 and 12 ± 6 mm 3 , respectively). For thoracolumbar movement, there was no statistical difference in three-dimensional volumetric movement of the thoracolumbar spine (2 ± 0.6 mm 3 LSB vs. 4.7 ± 5 mm 3 no LSB). Conclusion: Spinal motion was small in all groups. The stretcher mattress without LSB allowed less cervical motion than the LSB. Subjects secured to a stretcher mattress with head of the bed elevated to 30° had the least spinal movement. J Neurol Res. 2020;10(3):73-79 doi: https://doi.org/10.14740/jnr587
背景:最近的证据表明，长脊柱板(LSB)可能对控制脊柱运动没有什么作用，而且会增加风险。该项目旨在测量救护车运输过程中颈椎和胸腰椎的运动。假设是在床垫上运输，头部抬高，没有LSB，会比在LSB上运输允许更少的脊柱运动。方法:一项随机健康志愿者交叉试验，使用生物传感器测量脊柱运动。分析的位置包括LSB上的0°和10°。单独担架，头部升高到10°，30°，45°和60°，带和不带头部块。模拟救护车在城市街道上以或低于限速行驶。结果:纳入9名受试者，其中66%为男性。对于颈椎运动，轴向、屈伸或旋转均无差异(分别为0.2±0.1 mm vs. 0.2±0.1 mm, 24±12 mm vs. 22±10 mm, 5.1±19°vs. 5.8±20°)。侧移(3.7±7 mm LSB vs. 2.0±5 mm无LSB)和头部体积运动(120±172 mm 3 LSB vs. 77±86 mm 3无LSB)差异有统计学意义。允许最低平均头部运动颈椎容积的体位被抬高至30°和45°，并放置头块(分别为20±22 mm 3和12±6 mm 3)。在胸腰椎运动方面，胸腰椎三维体积运动无统计学差异(2±0.6 mm 3 LSB vs. 4.7±5 mm 3无LSB)。结论:两组患者脊柱运动均较小。没有LSB的担架床垫比LSB允许更少的颈椎运动。被固定在担架床垫上且床头抬高至30°的受试者脊柱运动最少。中华神经科学杂志，2020;10(3):73-79 doi: https://doi.org/10.14740/jnr587
{"title":"Biomechanical Motion Analysis of Cervical and Thoracolumbar Spine During Ambulance Transport: A Healthy Volunteer Study","authors":"D. Wampler, Ronald M Stewart, R. Summers, R. Schaefer, L. Roakes, Craig Cooley, Mike Shown, T. Long, Chetan U. Kharod, B. Eastridge","doi":"10.14740/jnr587","DOIUrl":"https://doi.org/10.14740/jnr587","url":null,"abstract":"Background: Recent evidence suggests that long spine board (LSB) may do little to manage spinal motion, and pose increased risk. This project sought to measure cervical and thoracolumbar motion during ambulance transport. The hypothesis was transport on a mattress with the head elevated without the LSB would allow less spinal movement than transport on an LSB. Methods: A randomized healthy volunteer crossover trial measured spinal motion using biometric sensors. Positions analyzed included 0 and 10° on LSB. Stretcher alone with head elevated to 10°, 30°, 45° and 60°, with and without head blocks. Simulated ambulance transport was on city streets at or below posted speed limits. Results: Nine subjects were included, with 66% being male. For cervical movement, there was no difference in axial, flexion/extension, or rotation (0.2 ± 0.1 mm vs. 0.2 ± 0.1 mm, 24 ± 12 mm vs. 22 ± 10 mm, and 5.1 ± 19° vs. 5.8 ± 20°, respectively). There were significant differences in lateral (3.7 ± 7 mm LSB vs. 2.0 ± 5 mm no LSB) movement and volumetric movement of the head (120 ± 172 mm 3 LSB vs. 77 ± 86 mm 3 no LSB). Positions allowing the lowest mean cervical volume of head movement were bed elevated to 30° and 45° with head blocks, (20 ± 22 mm 3 and 12 ± 6 mm 3 , respectively). For thoracolumbar movement, there was no statistical difference in three-dimensional volumetric movement of the thoracolumbar spine (2 ± 0.6 mm 3 LSB vs. 4.7 ± 5 mm 3 no LSB). Conclusion: Spinal motion was small in all groups. The stretcher mattress without LSB allowed less cervical motion than the LSB. Subjects secured to a stretcher mattress with head of the bed elevated to 30° had the least spinal movement. J Neurol Res. 2020;10(3):73-79 doi: https://doi.org/10.14740/jnr587","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76667169","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: Stroke is a public health problem in Romania, with important medical, social and financial implications, and sustained efforts are being made to improve post-stroke rehabilitation phase. A significant concern nowadays is the patient’s quality of life (QOL); a successful stroke recovery therapy implies the increasing of QOL index. However, there are very few studies evaluating patients’ QOL after stroke in Romania. In this context, the aim of this study was to evaluate the benefits that 1-year rehabilitation therapy brings to a patient with a history of ischemic stroke, highlighting the factors that influence the QOL index. Methods: A prospective study was conducted in which the QOL (calculated using the stroke-specific QOL (SSQOL) questionnaire) was measured in a group of 40 patients who had suffered an ischemic stroke in the left middle cerebral artery territory and benefited from rehabilitation therapy for 1 year. Patients admitted in our Neurology Department between January 2018 and June 2019 were divided into several subgroups according to age, gender, domicile, educational level, familial support and comorbidities. Statistical data were processed in SPSS v.20. Results: Among the individual factors studied, young age (under 60) showed a positive impact on QOL improvement after 1 year of stroke rehabilitation therapy (P = 0.005). This was explained by the young patient’s profile, with urban domicile (55% vs. 45%), higher educational level (60% vs. 40%) and family support. The best recovered functions as noted by the questionnaire were language (18.25 ± 4.95; P = 0.015), upper motor functions (21.50 ± 2.70; P = 0.039), personality (12 ± 0.81; P = 0.032) and family roles (11.53 ± 1.81; P = 0.007). On the other hand, patient’s gender (male 155.55 ± 31.21 vs. female 152.94 ± 28.14) did not influence the outcome of the therapy (P = 0.267). Conclusion: Stroke rehabilitation treatment is an essential component for improving the QOL of the patient after stroke; it has become topic of concern in the literature nowadays. This work complements the existing data on this topic for stroke patients in Romania. J Neurol Res. 2020;10(3):80-90 doi: https://doi.org/10.14740/jnr596
{"title":"The Influence of Neurological Rehabilitation on Patients’ Quality of Life After Ischemic Stroke: A Prospective Study in Romania","authors":"T. Schreiner","doi":"10.14740/jnr596","DOIUrl":"https://doi.org/10.14740/jnr596","url":null,"abstract":"Background: Stroke is a public health problem in Romania, with important medical, social and financial implications, and sustained efforts are being made to improve post-stroke rehabilitation phase. A significant concern nowadays is the patient’s quality of life (QOL); a successful stroke recovery therapy implies the increasing of QOL index. However, there are very few studies evaluating patients’ QOL after stroke in Romania. In this context, the aim of this study was to evaluate the benefits that 1-year rehabilitation therapy brings to a patient with a history of ischemic stroke, highlighting the factors that influence the QOL index. Methods: A prospective study was conducted in which the QOL (calculated using the stroke-specific QOL (SSQOL) questionnaire) was measured in a group of 40 patients who had suffered an ischemic stroke in the left middle cerebral artery territory and benefited from rehabilitation therapy for 1 year. Patients admitted in our Neurology Department between January 2018 and June 2019 were divided into several subgroups according to age, gender, domicile, educational level, familial support and comorbidities. Statistical data were processed in SPSS v.20. Results: Among the individual factors studied, young age (under 60) showed a positive impact on QOL improvement after 1 year of stroke rehabilitation therapy (P = 0.005). This was explained by the young patient’s profile, with urban domicile (55% vs. 45%), higher educational level (60% vs. 40%) and family support. The best recovered functions as noted by the questionnaire were language (18.25 ± 4.95; P = 0.015), upper motor functions (21.50 ± 2.70; P = 0.039), personality (12 ± 0.81; P = 0.032) and family roles (11.53 ± 1.81; P = 0.007). On the other hand, patient’s gender (male 155.55 ± 31.21 vs. female 152.94 ± 28.14) did not influence the outcome of the therapy (P = 0.267). Conclusion: Stroke rehabilitation treatment is an essential component for improving the QOL of the patient after stroke; it has become topic of concern in the literature nowadays. This work complements the existing data on this topic for stroke patients in Romania. J Neurol Res. 2020;10(3):80-90 doi: https://doi.org/10.14740/jnr596","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"109 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80688172","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}
V. Zvonarev, S. Mamtani, Sunita Yadav, Khadija Sharazi, Hussain Syed, A. Giri, Aaron Rodas, P. Tregubenko, D. Kotler
As minorities, African Americans (AAs) and Hispanic adults face enormous discrepancies across many dimensions, including race/ethnicity, socioeconomic status, legal status, gender, insurance status, or severity of conditions. There is a lot of evidence in the literature about the relationship between lifestyle and cognitive functioning in older adults. However, due to the infancy of research in this area, the relationship between diet, physical activity and cognitive decline in ethnic minorities remains unclear. We discussed the neurocognitive changes associated with physical activity and/or dietary aspects in Hispanic and AA adults, and explored various factors that affect physical activity and dietary changes in this population. Our analysis confirmed the convincing link between certain dietary patterns, physical inactivity and poor cognitive performance in AA and Hispanic adults. This report allowed us to draw necessary conclusions regarding the structure of Jacobi Frailty Initiative in the Bronx, NY, USA. J Neurol Res. 2020;10(3):56-68 doi: https://doi.org/10.14740/jnr594
{"title":"Neurocognitive Performance of African Americans and Hispanic Adults in Relation to Diet and Physical Activity: A Literature Review","authors":"V. Zvonarev, S. Mamtani, Sunita Yadav, Khadija Sharazi, Hussain Syed, A. Giri, Aaron Rodas, P. Tregubenko, D. Kotler","doi":"10.14740/jnr594","DOIUrl":"https://doi.org/10.14740/jnr594","url":null,"abstract":"As minorities, African Americans (AAs) and Hispanic adults face enormous discrepancies across many dimensions, including race/ethnicity, socioeconomic status, legal status, gender, insurance status, or severity of conditions. There is a lot of evidence in the literature about the relationship between lifestyle and cognitive functioning in older adults. However, due to the infancy of research in this area, the relationship between diet, physical activity and cognitive decline in ethnic minorities remains unclear. We discussed the neurocognitive changes associated with physical activity and/or dietary aspects in Hispanic and AA adults, and explored various factors that affect physical activity and dietary changes in this population. Our analysis confirmed the convincing link between certain dietary patterns, physical inactivity and poor cognitive performance in AA and Hispanic adults. This report allowed us to draw necessary conclusions regarding the structure of Jacobi Frailty Initiative in the Bronx, NY, USA. J Neurol Res. 2020;10(3):56-68 doi: https://doi.org/10.14740/jnr594","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75670777","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}
Paola Martinez, J. Donnelly, Humberto Leal-Bailey, K. Schreiber, A. Parker
In this manuscript, we highlight the importance of human immunodeficiency virus (HIV) testing in patients presenting with a clinical picture suggestive of amyotrophic lateral sclerosis (ALS), particularly when there are other findings not consistent with a primary motor neuron disease. J Neurol Res. 2020;10(3):91-94 doi: https://doi.org/10.14740/jnr582
{"title":"A Case of Unsteady Gait: An Amyotrophic Lateral Sclerosis Mimic Causing Reversible Weakness","authors":"Paola Martinez, J. Donnelly, Humberto Leal-Bailey, K. Schreiber, A. Parker","doi":"10.14740/jnr582","DOIUrl":"https://doi.org/10.14740/jnr582","url":null,"abstract":"In this manuscript, we highlight the importance of human immunodeficiency virus (HIV) testing in patients presenting with a clinical picture suggestive of amyotrophic lateral sclerosis (ALS), particularly when there are other findings not consistent with a primary motor neuron disease. J Neurol Res. 2020;10(3):91-94 doi: https://doi.org/10.14740/jnr582","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76970121","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}
Shaheryar Hafeez, Pegah Ghamasaee, Sharmin Amjad, Colleen A Barthol, R. Grandhi
Placement of carotid stents in the setting of large vessel occlusion (LVO) is sometimes necessary in patients with steno-occlusive disease of the extracranial internal carotid artery (ICA) or ICA dissection. Use of antiplatelet agents is required to prevent in-stent thrombosis; however, after an LVO, a decompressive hemicraniectomy may be necessary. After placement of a carotid stent, a fine balance must be obtained between preventing stent-related thromboembolic complications while also maintaining the possibility of quickly and safely performing a decompressive hemicraniectomy, if indicated. In this case, we discuss the novel use of continuous eptifibatide and cangrelor infusions after carotid stent placement to maintain stent patency, while preserving the option of emergent hemicraniectomy. A 55-year-old man presented with left hemispheric ischemic symptoms due to flow failure from a left ICA dissection. He underwent emergent angiography with angioplasty and stenting of the petrous and ascending cervical segments of the left ICA. The procedure was complicated by an embolization of thrombus to a left middle cerebral artery (MCA) M2 division branch, resulting in an occlusion, which could not be opened. The patient was placed on short acting intravenous antiplatelet agents (eptifibatide infusion for 60 h and cangrelor infusion for 24 h) for prevention of in-stent thrombosis while under close observation for potential neurologic decline and need for decompressive hemicraniectomy. After 84 h of observation, the patient did not experience a decline and the antiplatelet infusions were discontinued after he received aspirin and a loading dose of clopidogrel. Intravenous eptifibatide or cangrelor infusions are short-acting antiplatelet options that can be used in patients with acute ischemic stroke from LVO in the setting of ICA stent placement when there exists a potential for decompressive hemicraniectomy. J Neurol Res. 2020;10(3):99-103 doi: https://doi.org/10.14740/jnr591
{"title":"Use of Continuous Infusions of Eptifibatide and Cangrelor in Large Vessel Occlusion Acute Ischemic Stroke After Emergent Carotid Artery Stenting","authors":"Shaheryar Hafeez, Pegah Ghamasaee, Sharmin Amjad, Colleen A Barthol, R. Grandhi","doi":"10.14740/jnr591","DOIUrl":"https://doi.org/10.14740/jnr591","url":null,"abstract":"Placement of carotid stents in the setting of large vessel occlusion (LVO) is sometimes necessary in patients with steno-occlusive disease of the extracranial internal carotid artery (ICA) or ICA dissection. Use of antiplatelet agents is required to prevent in-stent thrombosis; however, after an LVO, a decompressive hemicraniectomy may be necessary. After placement of a carotid stent, a fine balance must be obtained between preventing stent-related thromboembolic complications while also maintaining the possibility of quickly and safely performing a decompressive hemicraniectomy, if indicated. In this case, we discuss the novel use of continuous eptifibatide and cangrelor infusions after carotid stent placement to maintain stent patency, while preserving the option of emergent hemicraniectomy. A 55-year-old man presented with left hemispheric ischemic symptoms due to flow failure from a left ICA dissection. He underwent emergent angiography with angioplasty and stenting of the petrous and ascending cervical segments of the left ICA. The procedure was complicated by an embolization of thrombus to a left middle cerebral artery (MCA) M2 division branch, resulting in an occlusion, which could not be opened. The patient was placed on short acting intravenous antiplatelet agents (eptifibatide infusion for 60 h and cangrelor infusion for 24 h) for prevention of in-stent thrombosis while under close observation for potential neurologic decline and need for decompressive hemicraniectomy. After 84 h of observation, the patient did not experience a decline and the antiplatelet infusions were discontinued after he received aspirin and a loading dose of clopidogrel. Intravenous eptifibatide or cangrelor infusions are short-acting antiplatelet options that can be used in patients with acute ischemic stroke from LVO in the setting of ICA stent placement when there exists a potential for decompressive hemicraniectomy. J Neurol Res. 2020;10(3):99-103 doi: https://doi.org/10.14740/jnr591","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74643662","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}
K. H. Nguyen, Hailey B. Gaskamp, Michael E. Walston, Regina Zamacona, J. Stowers, A. Seifi
Background: Ventriculoperitoneal shunts (VPS) have been used to treat hydrocephalus for many years. This procedure has saved many lives, but it does not come without its complications. Considering the invasiveness of the procedure, we sought to investigate the mortality rate of VPS in children in the USA. Methods: This retrospective cohort study used the Nationwide Inpatient Sample database to examine patients from the ages of 0 - 17 years who underwent the procedures involving the insertion, replacement, or removal of VPS from 1997 to 2012. Z-test was used to analyze the statistical significance. Results: During the study period, we recorded a total number of 165,484 cases of VPS with 54.5% occurring in males. The mean age was 5.25 years old, and the average mortality rate was 1.03%. The annual number of patients receiving VPS at all institutions during the study period decreased significantly from 13,075 in 1997 to 8,499 in 2012 (P = 0.001). The rate of patients receiving VPS per 100,000 discharges at all institutions during the study period also decreased significantly from 18.4 in 1997 to 11.5 in 2012 (P = 0.0001). The number of in-hospital deaths significantly decreased from 150 in 1997 to 50 in 2012 (P = 0.001), and the main decrease in the mortality happened after 2009 (P = 0.001). Conclusions: Utilization of pediatric VPS decreased in the USA between 1997 and 2012, and the number of in-hospital deaths significantly decreased as well. This may be related to better healthcare services in recent years, especially with more emphasis on the inpatient quality indicators (IQIs). Future research should determine the cause of the significant decrease and use the information to continue bringing the mortality rate down. J Neurol Res. 2020;10(3):69-72 doi: https://doi.org/10.14740/jnr573
{"title":"Trend of Death in Pediatric Ventriculo-Peritoneal Shunts in the United States","authors":"K. H. Nguyen, Hailey B. Gaskamp, Michael E. Walston, Regina Zamacona, J. Stowers, A. Seifi","doi":"10.14740/JNR.V0I0.573","DOIUrl":"https://doi.org/10.14740/JNR.V0I0.573","url":null,"abstract":"Background: Ventriculoperitoneal shunts (VPS) have been used to treat hydrocephalus for many years. This procedure has saved many lives, but it does not come without its complications. Considering the invasiveness of the procedure, we sought to investigate the mortality rate of VPS in children in the USA. Methods: This retrospective cohort study used the Nationwide Inpatient Sample database to examine patients from the ages of 0 - 17 years who underwent the procedures involving the insertion, replacement, or removal of VPS from 1997 to 2012. Z-test was used to analyze the statistical significance. Results: During the study period, we recorded a total number of 165,484 cases of VPS with 54.5% occurring in males. The mean age was 5.25 years old, and the average mortality rate was 1.03%. The annual number of patients receiving VPS at all institutions during the study period decreased significantly from 13,075 in 1997 to 8,499 in 2012 (P = 0.001). The rate of patients receiving VPS per 100,000 discharges at all institutions during the study period also decreased significantly from 18.4 in 1997 to 11.5 in 2012 (P = 0.0001). The number of in-hospital deaths significantly decreased from 150 in 1997 to 50 in 2012 (P = 0.001), and the main decrease in the mortality happened after 2009 (P = 0.001). Conclusions: Utilization of pediatric VPS decreased in the USA between 1997 and 2012, and the number of in-hospital deaths significantly decreased as well. This may be related to better healthcare services in recent years, especially with more emphasis on the inpatient quality indicators (IQIs). Future research should determine the cause of the significant decrease and use the information to continue bringing the mortality rate down. J Neurol Res. 2020;10(3):69-72 doi: https://doi.org/10.14740/jnr573","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"6 45","pages":"69-72"},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91509808","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}
Durvalumab is a monoclonal antibody that blocks the interaction of programmed cell death ligand 1 (PD-L1) with programmed cell death 1 (PD-1) molecules. It has shown significant survival benefits in various cancers as an immune checkpoint inhibitor. With increased usage of this therapy, there are several cases with a predilection for neurological immune-related adverse effects from checkpoint inhibitor neurotoxicity. We identified an index patient with lung cancer treated with durvalumab, who developed disabling ocular and bulbar symptoms and severe truncal ataxia, and found symptomatic benefit with plasmapheresis (PLEX). A 57-year-old African American woman presented with 3 months of oscillopsia, dizziness, scanning speech, and inability to stand and walk due to severe truncal ataxia. She was found to have stage IIIA lung adenocarcinoma. Brain magnetic resonance imaging (MRI) demonstrated abnormal T2-fluid-attenuated inversion recovery sequence (T2/FLAIR) signal in bilateral cerebellar hemispheres with lack of enhancement suggestive of paraneoplastic cerebellar involvement. No distinct paraneoplastic antibody was identified. She received combined pulse-dose steroids and intravenous immunoglobulin (IVIg) with no improvement of cerebellar syndrome. A month later, she started inpatient chemotherapy and concurrent radiation therapy with transient cancer regression. Because of subsequent metastatic spread, durvalumab was initiated. She completed four doses that were complicated by worsening cerebellar symptoms and autoimmune colitis. During durvalumab holiday, she received two courses of five PLEX treatments, 2 months apart, along with vigorous physical and speech therapy. Her neurologic symptoms and functional status improved considerably and continued to improve after treatment. At present time, the patient is largely independent for activities of daily living (ADLs) and uses a walker. Repeated brain MRI revealed resolution of previously seen abnormalities. Checkpoint inhibitors may worsen concomitant paraneoplastic neurologic syndromes that develop in association with malignancies potentially responsive to PD-L1 and PD-1 inhibitors. Meticulous coordination and timing of life-saving immune therapies for cancer with effective immune treatments for an underlying or associated neurological syndrome are essential for best outcomes. J Neurol Res. 2020;10(2):44-47 doi: https://doi.org/10.14740/jnr571
{"title":"Severe Cerebellar Syndrome Linked With Durvalumab","authors":"Connie G. Tang, G. Rakocevic","doi":"10.14740/jnr571","DOIUrl":"https://doi.org/10.14740/jnr571","url":null,"abstract":"Durvalumab is a monoclonal antibody that blocks the interaction of programmed cell death ligand 1 (PD-L1) with programmed cell death 1 (PD-1) molecules. It has shown significant survival benefits in various cancers as an immune checkpoint inhibitor. With increased usage of this therapy, there are several cases with a predilection for neurological immune-related adverse effects from checkpoint inhibitor neurotoxicity. We identified an index patient with lung cancer treated with durvalumab, who developed disabling ocular and bulbar symptoms and severe truncal ataxia, and found symptomatic benefit with plasmapheresis (PLEX). A 57-year-old African American woman presented with 3 months of oscillopsia, dizziness, scanning speech, and inability to stand and walk due to severe truncal ataxia. She was found to have stage IIIA lung adenocarcinoma. Brain magnetic resonance imaging (MRI) demonstrated abnormal T2-fluid-attenuated inversion recovery sequence (T2/FLAIR) signal in bilateral cerebellar hemispheres with lack of enhancement suggestive of paraneoplastic cerebellar involvement. No distinct paraneoplastic antibody was identified. She received combined pulse-dose steroids and intravenous immunoglobulin (IVIg) with no improvement of cerebellar syndrome. A month later, she started inpatient chemotherapy and concurrent radiation therapy with transient cancer regression. Because of subsequent metastatic spread, durvalumab was initiated. She completed four doses that were complicated by worsening cerebellar symptoms and autoimmune colitis. During durvalumab holiday, she received two courses of five PLEX treatments, 2 months apart, along with vigorous physical and speech therapy. Her neurologic symptoms and functional status improved considerably and continued to improve after treatment. At present time, the patient is largely independent for activities of daily living (ADLs) and uses a walker. Repeated brain MRI revealed resolution of previously seen abnormalities. Checkpoint inhibitors may worsen concomitant paraneoplastic neurologic syndromes that develop in association with malignancies potentially responsive to PD-L1 and PD-1 inhibitors. Meticulous coordination and timing of life-saving immune therapies for cancer with effective immune treatments for an underlying or associated neurological syndrome are essential for best outcomes. J Neurol Res. 2020;10(2):44-47 doi: https://doi.org/10.14740/jnr571","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91195899","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}
{"title":"The Evolving Role of Electroencephalography in the Neurocritically Ill Patient","authors":"A. Seifi, I. Perez","doi":"10.14740/jnr569","DOIUrl":"https://doi.org/10.14740/jnr569","url":null,"abstract":"","PeriodicalId":16489,"journal":{"name":"Journal of Neurology Research","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84410721","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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