Pub Date : 2020-06-05DOI: 10.36648/2471-8505.6.2.6
A. Vassallo, V. Patel, Gerald Ferencz, Lindsey Smith
A 43-year-old male with a history of hypertension, obesity, and alcoholism presented with respiratory failure secondary to COVID-19 and was subsequently intubated. The patient was placed on therapeutic enoxaparin to treat the prothrombotic state caused by SARS-CoV-2. After the patient was weaned from the ventilator a neurological examination had revealed an acute ischemic stroke despite being on therapeutic anti-coagulation. Prior to discharge, a right upper extremity ultrasound also revealed a cephalic vein thrombus. This was consistent with both arterial and venous thrombotic complications.
{"title":"COVID-19, Coagulopathy, and Neurovascular Complications: A Case Report","authors":"A. Vassallo, V. Patel, Gerald Ferencz, Lindsey Smith","doi":"10.36648/2471-8505.6.2.6","DOIUrl":"https://doi.org/10.36648/2471-8505.6.2.6","url":null,"abstract":"A 43-year-old male with a history of hypertension, obesity, and alcoholism presented with respiratory failure secondary to COVID-19 and was subsequently \u0000intubated. The patient was placed on therapeutic enoxaparin to treat the prothrombotic state caused by SARS-CoV-2. After the patient was weaned from the \u0000ventilator a neurological examination had revealed an acute ischemic stroke despite being on therapeutic anti-coagulation. Prior to discharge, a right upper \u0000extremity ultrasound also revealed a cephalic vein thrombus. This was consistent with both arterial and venous thrombotic complications.","PeriodicalId":237353,"journal":{"name":"Journal of Neurology and Neurocritical Care","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127036499","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}
Taylor Schwebke, M. McDowell, Lina Piech, Robert K Mokszycki, E. Omi
Title: Evaluation of Efficacy of Hypertonic Saline and Mannitol in Combination in Patients with a Traumatic Brain Injury Background: Traumatic Brain Injury (TBI) is a major cause of disability and death. In 2013, an estimated 2.5 million emergency department visits were related to TBI. In current practice, hyperosmolar therapy such as bolus doses of intravenous mannitol 20% and sodium chloride 3% are commonly used as single agents for the treatment of Cerebral Edema And Intracranial Pressure (ICP) reduction. The Brain Trauma Foundation guidelines do not recommend a preferred agent, nor do they comment on the use of these agents in combination. Currently, there are no published studies evaluating combination hyperosmolar therapy for ICP reduction. The primary objective of this study is to evaluate the efficacy of bolus doses of intravenous mannitol 20% and sodium chloride 3% utilized as monotherapy or in combination in patients with TBI. Methods: This single-center retrospective study identified cases using a medication usage report generated through the electronic medical record at Advocate Christ Medical Center. Subjects 14 years and older admitted to the trauma service following a diagnosis of TBI who received an intravenous bolus of mannitol 20% and/or sodium chloride 3% from August 1, 2013 through August 1, 2018 were included. Subjects without known trauma confirmed by radiographic imaging, those who received a sodium chloride 3% continuous infusion, pregnant patients, and those who expired within twentyfour hours of admission were excluded. The following data points were collected: age, weight, gender, race, serum creatinine, serum sodium, serum osmolality, mean arterial pressure, initial Glasgow Coma Score (GCS), diagnostic imaging, presence of cerebral edema and size of midline shift on computed tomography, dose and frequency of hyperosmolar agents, neurosurgical intervention, vasopressor requirements, intravenous fluids, Hospital And Intensive Care Unit (ICU) Length Of Stay (LOS). All data was recorded without patient identifiers, maintained confidentially, and was analyzed using descriptive and inferential statistics. Results: A total of 1000 patients were screened of which 176 met the inclusion/exclusion criteria. In-hospital mortality was experienced by 6 of 24 patients in the combination group compared to 18 of 152 patients in the monotherapy group (p=0.08). Statically significant reductions were seen in need for neurosurgical intervention (p=0.04), vasopressor utilization (p=0.03), and ICU LOS (p=0.02) demonstrating a benefit of monotherapy over combination. No difference was seen in laboratory values or vitals measurements. Conclusion: Combination therapy was associated with a trend towards increase mortality compared to monotherapy use.
背景:外伤性脑损伤(TBI)是致残和死亡的主要原因之一。2013年，估计有250万急诊就诊与TBI有关。在目前的实践中，高渗治疗如20%静脉甘露醇和3%氯化钠的大剂量是常用的单药治疗脑水肿和颅内压(ICP)降低。脑外伤基金会指南没有推荐首选药物，也没有评论这些药物的联合使用。目前，还没有发表的研究评价联合高渗治疗ICP降低。本研究的主要目的是评估20%静脉注射甘露醇和3%氯化钠作为单药或联合治疗TBI患者的疗效。方法:这项单中心回顾性研究通过基督医疗中心电子病历生成的药物使用报告确定病例。在2013年8月1日至2018年8月1日期间接受20%甘露醇和/或3%氯化钠静脉滴注的14岁及以上被诊断为TBI后入院的创伤服务部的受试者。排除经影像学证实无已知创伤的患者、接受3%氯化钠连续输注的患者、孕妇以及入院24小时内死亡的患者。收集以下数据点:年龄、体重、性别、种族、血清肌酐、血清钠、血清渗透压、平均动脉压、初始格拉斯哥昏迷评分(GCS)、诊断影像、脑水肿的存在和计算机断层扫描中线偏移的大小、高渗透性药物的剂量和频率、神经外科干预、血管加压剂需求、静脉输液、医院和重症监护病房(ICU)住院时间(LOS)。所有数据的记录都没有患者标识符，保密保存，并使用描述性和推断性统计进行分析。结果:共筛选了1000例患者，其中176例符合纳入/排除标准。联合治疗组24例患者中有6例住院死亡率，而单药治疗组152例患者中有18例住院死亡率(p=0.08)。神经外科干预需求(p=0.04)、血管加压素使用率(p=0.03)和ICU LOS (p=0.02)均有统计学意义上的显著降低，表明单药治疗优于联合治疗。在实验室值或生命体征测量中没有发现差异。结论:与单药治疗相比，联合治疗有增加死亡率的趋势。
{"title":"Evaluation of Efficacy of Hypertonic Saline and Mannitol in Combination in Patients with a Traumatic Brain Injury","authors":"Taylor Schwebke, M. McDowell, Lina Piech, Robert K Mokszycki, E. Omi","doi":"10.31038/jnnc.2019211","DOIUrl":"https://doi.org/10.31038/jnnc.2019211","url":null,"abstract":"Title: Evaluation of Efficacy of Hypertonic Saline and Mannitol in Combination in Patients with a Traumatic Brain Injury Background: Traumatic Brain Injury (TBI) is a major cause of disability and death. In 2013, an estimated 2.5 million emergency department visits were related to TBI. In current practice, hyperosmolar therapy such as bolus doses of intravenous mannitol 20% and sodium chloride 3% are commonly used as single agents for the treatment of Cerebral Edema And Intracranial Pressure (ICP) reduction. The Brain Trauma Foundation guidelines do not recommend a preferred agent, nor do they comment on the use of these agents in combination. Currently, there are no published studies evaluating combination hyperosmolar therapy for ICP reduction. The primary objective of this study is to evaluate the efficacy of bolus doses of intravenous mannitol 20% and sodium chloride 3% utilized as monotherapy or in combination in patients with TBI. Methods: This single-center retrospective study identified cases using a medication usage report generated through the electronic medical record at Advocate Christ Medical Center. Subjects 14 years and older admitted to the trauma service following a diagnosis of TBI who received an intravenous bolus of mannitol 20% and/or sodium chloride 3% from August 1, 2013 through August 1, 2018 were included. Subjects without known trauma confirmed by radiographic imaging, those who received a sodium chloride 3% continuous infusion, pregnant patients, and those who expired within twentyfour hours of admission were excluded. The following data points were collected: age, weight, gender, race, serum creatinine, serum sodium, serum osmolality, mean arterial pressure, initial Glasgow Coma Score (GCS), diagnostic imaging, presence of cerebral edema and size of midline shift on computed tomography, dose and frequency of hyperosmolar agents, neurosurgical intervention, vasopressor requirements, intravenous fluids, Hospital And Intensive Care Unit (ICU) Length Of Stay (LOS). All data was recorded without patient identifiers, maintained confidentially, and was analyzed using descriptive and inferential statistics. Results: A total of 1000 patients were screened of which 176 met the inclusion/exclusion criteria. In-hospital mortality was experienced by 6 of 24 patients in the combination group compared to 18 of 152 patients in the monotherapy group (p=0.08). Statically significant reductions were seen in need for neurosurgical intervention (p=0.04), vasopressor utilization (p=0.03), and ICU LOS (p=0.02) demonstrating a benefit of monotherapy over combination. No difference was seen in laboratory values or vitals measurements. Conclusion: Combination therapy was associated with a trend towards increase mortality compared to monotherapy use.","PeriodicalId":237353,"journal":{"name":"Journal of Neurology and Neurocritical Care","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134504948","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 Molecular Basis of Neural Memory. Part 10: The Sins and Redemption of Neurobiology","authors":"","doi":"10.31038/jnnc.2018121","DOIUrl":"https://doi.org/10.31038/jnnc.2018121","url":null,"abstract":"","PeriodicalId":237353,"journal":{"name":"Journal of Neurology and Neurocritical Care","volume":"436 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126117734","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}
Objective Malignant peripheral nerve sheath tumors are uncommon malignant spindle cell tumors that account for 5% to 10% of all soft tissue sarcomas. Localization of such tumors in the scalp is extremely rare. Diagnosing and treating these tumors is very challenging. Methods Case presentation and Literature review. Results We found 18 cases of malignant peripheral nerve sheath tumors including our case. The occipital region was the most common site of the tumor. Five patients had h intracranial invasion and two patients had distant metastasis. All the patients were treated surgically. Four patients had recurrence of their tumors and two of them died from the disease
{"title":"Malignant Schwannoma of the Scalp: A Case Report and Review of the Literature","authors":"Sami Tanbouzi, H. Khayat, Nawaf Jurdi","doi":"10.31038/jnnc.2018112","DOIUrl":"https://doi.org/10.31038/jnnc.2018112","url":null,"abstract":"Objective Malignant peripheral nerve sheath tumors are uncommon malignant spindle cell tumors that account for 5% to 10% of all soft tissue sarcomas. Localization of such tumors in the scalp is extremely rare. Diagnosing and treating these tumors is very challenging. Methods Case presentation and Literature review. Results We found 18 cases of malignant peripheral nerve sheath tumors including our case. The occipital region was the most common site of the tumor. Five patients had h intracranial invasion and two patients had distant metastasis. All the patients were treated surgically. Four patients had recurrence of their tumors and two of them died from the disease","PeriodicalId":237353,"journal":{"name":"Journal of Neurology and Neurocritical Care","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121120465","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}
1Albany College of Pharmacy and Health Sciences, Albany NY, USA 2University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Buffalo NY, USA 3New York State Office of Mental Health, Buffalo Psychiatric Center, Buffalo, NY, USA 4University at Buffalo, School of Medicine, Department of Psychiatry, Buffalo, NY, USA 5Long Island University Predoctoral Program in Clinical Psychology, Brooklyn, NY, USA
{"title":"Adjunctive Sarcosine and N-Acetylcysteine Use for Treatment-Resistant Schizophrenia","authors":"E. Leppien, C. Blum, T. Demler, L. Opler","doi":"10.31038/jnnc.2018114","DOIUrl":"https://doi.org/10.31038/jnnc.2018114","url":null,"abstract":"1Albany College of Pharmacy and Health Sciences, Albany NY, USA 2University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Buffalo NY, USA 3New York State Office of Mental Health, Buffalo Psychiatric Center, Buffalo, NY, USA 4University at Buffalo, School of Medicine, Department of Psychiatry, Buffalo, NY, USA 5Long Island University Predoctoral Program in Clinical Psychology, Brooklyn, NY, USA","PeriodicalId":237353,"journal":{"name":"Journal of Neurology and Neurocritical Care","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132813586","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}
Recent studies have revealed that autistic spectrum disorders (ASD) is associated with enhanced glycolysis (i.e. establishment of the Warburg effect) accompanied by increased formation of glycated proteins in sera and urine. Both carnosine and agmatine levels in sera of autistic individuals are reported to be lower than in control subjects. Carnosine and agmatine can influence cellular energy metabolism, in part via effects on mTOR, thereby decreasing glycolysis and enhancing mitochondrial activity and thus countering onset of Warburg-like metabolism: other mechanisms including suppressing methylglyoxal toxicity are also discussed. Dietary supplementation studies with carnosine and arginine (agmatine precursor) indicate ameliorative activity towards behaviour in ASD subjects. It is suggested that co-administration of carnosine and agmatine should be explored as a potential route for ASD amelioration.
{"title":"Energy Metabolism and Autism: The Ameliorative Potential of Carnosine and Agmatine","authors":"Hipkiss Ar","doi":"10.15761/NDT.1000135","DOIUrl":"https://doi.org/10.15761/NDT.1000135","url":null,"abstract":"Recent studies have revealed that autistic spectrum disorders (ASD) is associated with enhanced glycolysis (i.e. establishment of the Warburg effect) accompanied by increased formation of glycated proteins in sera and urine. Both carnosine and agmatine levels in sera of autistic individuals are reported to be lower than in control subjects. Carnosine and agmatine can influence cellular energy metabolism, in part via effects on mTOR, thereby decreasing glycolysis and enhancing mitochondrial activity and thus countering onset of Warburg-like metabolism: other mechanisms including suppressing methylglyoxal toxicity are also discussed. Dietary supplementation studies with carnosine and arginine (agmatine precursor) indicate ameliorative activity towards behaviour in ASD subjects. It is suggested that co-administration of carnosine and agmatine should be explored as a potential route for ASD amelioration.","PeriodicalId":237353,"journal":{"name":"Journal of Neurology and Neurocritical Care","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115929850","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}
Astronomical phenomena have been purported to impact human behavior throughout history. Though literature regarding the potential influence of lunar phases on emotional status exists, reputable evidence based information detailing the impact of solar eclipses on psychiatric conditions is lacking. Our case study evaluates the potential psychiatric impact on patients in a state psychiatric hospital in Buffalo, NY that occurred on August 21st, 2017. Our case study reports that although the lowest count of restraint and seclusion events, as measured by evaluation of previously collected, de-identified and analyzed routine facility performance improvement data, occured during the month of the solar eclipse which took place on August 21st 2017 when compared to any date within the previous 6 years, one patient experienced significant and unexpected psychiatric exacerbation. On April 28, 2024, another total solar eclipse will cross the United States. As Buffalo falls within the path of totality, this event would be an excellent opportunity for further analysis of these findings.
{"title":"Shedding Light on the Potential Implications of Solar Eclipse on Psychiatric Patients","authors":"M. Lysogorski, T. Demler","doi":"10.31038/jnnc.2018115","DOIUrl":"https://doi.org/10.31038/jnnc.2018115","url":null,"abstract":"Astronomical phenomena have been purported to impact human behavior throughout history. Though literature regarding the potential influence of lunar phases on emotional status exists, reputable evidence based information detailing the impact of solar eclipses on psychiatric conditions is lacking. Our case study evaluates the potential psychiatric impact on patients in a state psychiatric hospital in Buffalo, NY that occurred on August 21st, 2017. Our case study reports that although the lowest count of restraint and seclusion events, as measured by evaluation of previously collected, de-identified and analyzed routine facility performance improvement data, occured during the month of the solar eclipse which took place on August 21st 2017 when compared to any date within the previous 6 years, one patient experienced significant and unexpected psychiatric exacerbation. On April 28, 2024, another total solar eclipse will cross the United States. As Buffalo falls within the path of totality, this event would be an excellent opportunity for further analysis of these findings.","PeriodicalId":237353,"journal":{"name":"Journal of Neurology and Neurocritical Care","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125489220","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}
C. Maurice, K. Grant, Austin M. Pereira, Y. Abulhasan
Deep brain stimulator surgery represents an interesting option for medically resistant Parkinson’s disease patients, indisposed by “wearing-off” and motor fluctuations. Considering the neurodegenerative nature of PD, after approximately five years of natural disease evolution, one half to twothirds of patients develops this delayed complication. The occurrence of dyskinesia and motor fluctuations interferes with activities of the daily living, consequently impacting the quality of life. A high frequency chronic stimulation targeting the subthalamic nucleus, located ventral to the thalamus and involved in the basal ganglia system, generates the same outcome than an ablation of this structure. Despite the positive impact of DBS surgery on PD symptomatology, physicians should be mindful of the vulnerability of this particular population and promote thorough monitoring, especially during the perioperative phase. A thoughtful approach considering the pathophysiological mechanisms underlying PD is required in order to select an individual’s pharmacopoeia. We report the case of a 61 year-old male, known for seventeen year of evolving PD, who developed acutely a state of generalized symmetrical rigidity, with a predilection for axial and bulbar musculature. After a meticulous review of this patient’s pharmacologic profile, sufentanil was deemed the responsible agent.
{"title":"Vulnerability of Parkinson Patients to Iatrogenic Adverse Events: Emphasis on the Perioperative Period through a Case Report","authors":"C. Maurice, K. Grant, Austin M. Pereira, Y. Abulhasan","doi":"10.31038/jnnc.2018122","DOIUrl":"https://doi.org/10.31038/jnnc.2018122","url":null,"abstract":"Deep brain stimulator surgery represents an interesting option for medically resistant Parkinson’s disease patients, indisposed by “wearing-off” and motor fluctuations. Considering the neurodegenerative nature of PD, after approximately five years of natural disease evolution, one half to twothirds of patients develops this delayed complication. The occurrence of dyskinesia and motor fluctuations interferes with activities of the daily living, consequently impacting the quality of life. A high frequency chronic stimulation targeting the subthalamic nucleus, located ventral to the thalamus and involved in the basal ganglia system, generates the same outcome than an ablation of this structure. Despite the positive impact of DBS surgery on PD symptomatology, physicians should be mindful of the vulnerability of this particular population and promote thorough monitoring, especially during the perioperative phase. A thoughtful approach considering the pathophysiological mechanisms underlying PD is required in order to select an individual’s pharmacopoeia. We report the case of a 61 year-old male, known for seventeen year of evolving PD, who developed acutely a state of generalized symmetrical rigidity, with a predilection for axial and bulbar musculature. After a meticulous review of this patient’s pharmacologic profile, sufentanil was deemed the responsible agent.","PeriodicalId":237353,"journal":{"name":"Journal of Neurology and Neurocritical Care","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134017220","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":"Misinformation Concerning Face Masks and the Wuhan Lab Leak","authors":"","doi":"10.31038/jnnc.2021412","DOIUrl":"https://doi.org/10.31038/jnnc.2021412","url":null,"abstract":"","PeriodicalId":237353,"journal":{"name":"Journal of Neurology and Neurocritical Care","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133987290","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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