Journal of the Neurological Sciences最新文献

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a commonly misdiagnosed condition. Driven by cost-consciousness and technological fluency, distinct generations may gravitate towards healthcare alternatives, including artificial intelligence (AI) models, such as ChatGPT (Generative Pre-trained Transformer). Our objective was to evaluate the speed and accuracy of ChatGPT-3.5 (GPT-3.5) in the diagnosis of people with NMOSD (PwNMOSD) initially misdiagnosed.

Methods: Misdiagnosed PwNMOSD were retrospectively identified with clinical symptoms and time line of medically related events processed through GPT-3.5. For each subject, seven digital derivatives representing different races, ethnicities, and sexes were created and processed identically to evaluate the impact of these variables on accuracy. Scoresheets were used to track diagnostic success and time to diagnosis. Diagnostic speed of GPT-3.5 was evaluated against physicians using a Cox proportional hazards model, clustered by subject. Logistical regression was used to estimate the diagnostic accuracy of GPT-3.5 compared with the estimated accuracy of physicians.

Results: Clinical time lines for 68 individuals (59 female, 42 Black/African American, 13 White, 11 Hispanic, 2 Asian; mean age at first symptoms 34.4 years (y) (standard deviation = 15.5y)) were analyzed and 476 digital simulations created, yielding 544 conversations for analysis. The instantaneous probability of correct diagnosis was 70.65% less for physicians relative to GPT-3.5 within 240 days of symptom onset (p < 0.0001). The estimated probability of correct diagnosis for GPT-3.5 was 80.88% [95% CI = (76.35%, 99.81%)].

Conclusion: GPT-3.5 may be of value in recognizing NMOSD. However, the manner in which medical information is conveyed, combined with the potential for inaccuracies may result in unnecessary psychological stress.

Cervical lower motor neuron (LMN) syndromes, also known as brachial paresis, are characterized by muscle atrophy, weakness, and decreased reflexes in the upper limbs, devoid of sensory symptoms. These syndromes can stem from various factors, including degenerative conditions, immune-mediated diseases, infections, toxic exposures, metabolic disorders, and vascular anomalies.¹ Clinical presentations vary, with motor neuron involvement potentially limited to the cervical area or extending to other regions, affecting prognosis. Misdiagnosis is a significant issue, particularly in lower motor neuron presentations, with an error rate nearing 20 %.² This review proposes a classification system based on magnetic resonance imaging (MRI) findings, the onset timing of symptoms (acute, subacute, or chronic), the symmetry and distribution of atrophy, and the etiology (sporadic or hereditary). Acute conditions may include spinal ischemia,³ whereas subacute or chronic forms can manifest as symmetric (e.g., cervical spondylogenic myelopathy)⁴ or asymmetric (e.g., Hirayama disease)⁵ presentations. Neurophysiological assessments and cervical MRI are crucial for accurate diagnosis, as they reveal patterns that provide lesion localization and additional clues to the underlying cause. A systematic diagnostic approach is essential for navigating the complexities of these syndromes.

Background: Fast treatment is crucial for ischemic stroke patients; the probability of good patient outcomes increases with faster treatment. Treatment times can be improved by making changes to the treatment process. However, it is challenging to identify the benefits of changes prior to implementation. Simulation modelling, which mimics the treatment process, can be used to evaluate changes without patient involvement. This study models the acute stroke treatment process using discrete event simulation (DES) and identifies improvement strategies to reduce treatment times.

Method: The model was developed for a comprehensive stroke center in Nova Scotia, using Python. All treatment pathways and sub-tasks were identified via an observational time and motion study conducted in the center. Nine process change scenarios were tested individually and in combinations. The primary outcome measures were door-to-CT time (DTCT), door-to-needle time (DNT), and door-to-groin puncture time (DGPT). The model simulated 500 patients 30 times.

Results: Collecting patient history on the way to the radiology department (rather than in ED) showed the highest reduction among individual scenarios for DTCT (14.2 vs 12.4 min, p < 0.001). Combining all scenarios in the door-to-CT process resulted in a reduction of the DTCT by approximately 28 %. Thrombolysing patients in the imaging department's waiting area resulted in the lowest DNT (39.4 vs 34.8 min, p < 0.001) among all individual scenarios. The highest reduction in DGPT, among all individual scenarios, was achieved by implementing Rapid angiosuite preparation (67.7 vs 51.4 min, p < 0.001). The combinations of all scenarios resulted in the lowest DTCT (14.2 vs 10.1 min, p < 0.001), DNT (39.4 vs 23.0 min, p < 0.001), and DGPT (67.9 vs 38.5 min, p < 0.001).

Conclusions: The study identified various improvement strategies in the acute stroke treatment process through a discrete-event simulation model. Combining all scenarios resulted in significant reductions for all outcome measures.

Objective: Rare neurologic diseases (RNDs) are difficult to diagnose and treat due to their low prevalence and complex nature. This survey evaluated awareness and current care status of RNDs among esteemed neurologists affiliated with the World Federation of Neurology (WFN).

Methods: A 34-question survey was distributed to renowned neurologists, including delegates from national neurology societies in the WFN Assembly, various WFN committees, and members of the Rare Neurologic Diseases Specialist group. Responses were stratified by geographical regions, including Africa, the Americas, Asia/Oceania, and Europe, and into four income groups based on the World Bank Indicator. Descriptive statistics summarized responses, stratified by geographical regions or income groups, and significant differences were assessed by Fisher's exact test.

Results: Of 190 invited neurologists, 64 responded (34 % response rate). Among respondents, 89 % agreed that RND patients should receive timely and effective care on par with more common neurological conditions. Additionally, 77 % of respondents overall thought most RNDs could be accurately diagnosed in their country. However, there were significant differences in the perceived ability of respondents' country of practice to diagnose RNDs by region, specifically in Africa (25 %), and by income of country of practice, specifically in the lower-income group (17 %).

Conclusions: This global survey highlights varying RND diagnosis and care by country socioeconomic status, suggesting potential disparities in resources and preparedness. To improve outcomes and quality-of-life for RND patients, efforts should focus on improving diagnostic capabilities, fostering collaboration among neurology centers, and promoting education on the unique challenges and treatment options of RNDs.

Introduction: Herpes encephalitis is known to affect patients undergoing brain radiotherapy, but early diagnosis and treatment, the foremost determinants of disease outcome, remain challenging in this patient population. This can be due to attribution of symptoms to the brain tumor and radiation side effects, as well as patients' atypical clinical presentation. Here we sought to highlight pearls and pitfalls in the clinical course and diagnostic workup which may facilitate timely diagnosis and improve disease outcome.

Methods: Six patients with post radiation herpes encephalitis were identified in a retrospective review of Hadassah Medical Center medical records of between 2007 and 2022. Their clinical course, brain imaging, labs and EEG findings were included in the study.

Results: All six patients presented with fever and a confusional state and four had seizures. Lumbar puncture showed mild CSF pleocytosis in two of five patients, and PCR was positive for HSV1 in four out of five. MRI showed typical findings in all patients, though they were misinterpreted in two of six as disease exacerbation. EEG showed non convulsive status epilepticus in three patients. Outcome was favorable in half of patients.

Discussion: In patients undergoing radiotherapy to the brain and neck, fever and confusional state accompanied by new onset seizures, seizure exacerbation, changes in seizure lateralization and status epilepticus should lead one to consider a diagnosis of herpes encephalitis. A high index of suspicion, a timely workup and empiric treatment in this patient population can alter disease outcome.