Tao Zheng, Nian-Hua Wang, Hai-Bin Leng, Si-Wei Que, None Meng Nie, None Hua Chen, Li-Xin Xu
Background: Postoperative seizures are serious neurological complications of chronic subdural hematomas (CSDH). The identification of risk factors of seizures after CSDH is needed to determine which patients require antiepileptic prophylaxis. Methods: We retrospectively collected data on patients diagnosed with CSDH from 2015 to 2018. Postoperative seizures are defined as those occurring within 30 days after surgery. Non-hemorrhagic subdural effusion and acute subdural hemorrhage after craniotomy were precluded in the study. We collected data from 221 patients who had burr hole surgery. We retrospectively recorded patient characteristics, hematoma characteristics, symptoms at admission, comorbid conditions, and other related parameters to evaluate the impact of these parameters on postoperative seizures. Results: Postoperative seizures occurred in 16 patients (7.24%). The univariate analysis showed that previous chronic kidney disease (31.25% vs. 5.37%, p= 0.001), age (60.44 vs. 66.54 y, p = 0.029), low Glasgow Coma Score (GCS) at admission (13.69 vs. 14.46, p = 0.015), and preoperative midline shift (9.79 vs. 8.57 mm, p = 0.021) were significantly correlated with postoperative seizures. The multivariate analysis revealed that previous chronic kidney disease (odds ratio [OR] = 27.103; 95% confidence interval [CI] = 4.887-150.296; p < 0.001), younger age (OR = 0.921; 95% CI = 0.866-0.979; p = 0.009) and preoperative midline shift (OR = 1.782; 95% CI = 1.175-2.702; p = 0.007) were independent risk factors of seizures. However, there was no significant difference in GCS at admission. Conclusions: The independent predictors of postoperative seizures in patients with CSDH were preoperative midline shift, chronic kidney disease, and younger age. For younger patients with chronic kidney disease and preoperative midline displacement, we recommend antiepileptic preventive measures during the perioperative period.
背景:术后癫痫发作是慢性硬膜下血肿(CSDH)的严重神经系统并发症。需要确定CSDH后癫痫发作的危险因素，以确定哪些患者需要抗癫痫预防。方法:回顾性收集2015年至2018年诊断为CSDH的患者资料。术后癫痫发作定义为术后30天内发生的癫痫发作。本研究排除了开颅术后非出血性硬膜下积液和急性硬膜下出血。我们收集了221例接受钻孔手术的患者的数据。我们回顾性记录患者特征、血肿特征、入院时症状、合并症和其他相关参数，以评估这些参数对术后癫痫发作的影响。结果:术后发生癫痫发作16例(7.24%)。单因素分析显示，既往慢性肾脏疾病(31.25% vs. 5.37%， p= 0.001)、年龄(60.44 vs. 66.54 y, p= 0.029)、入院时格拉斯哥昏迷评分(GCS)低(13.69 vs. 14.46, p= 0.015)、术前中线移位(9.79 vs. 8.57 mm, p= 0.021)与术后癫痫发作显著相关。多因素分析显示既往慢性肾脏疾病(优势比[OR] = 27.103;95%置信区间[CI] = 4.887-150.296;p & lt;0.001)，年龄越小(OR = 0.921;95% ci = 0.866-0.979;p = 0.009)和术前中线移位(OR = 1.782;95% ci = 1.175-2.702;P = 0.007)是癫痫发作的独立危险因素。然而，两组入院时GCS无显著差异。结论:CSDH患者术后癫痫发作的独立预测因素是术前中线移位、慢性肾脏疾病和年轻。对于患有慢性肾脏疾病和术前中线移位的年轻患者，我们建议围手术期采取抗癫痫预防措施。
{"title":"Chronic kidney disease is an independent risk factor of postoperative seizures after burr hole surgery for chronic subdural hematomas","authors":"Tao Zheng, Nian-Hua Wang, Hai-Bin Leng, Si-Wei Que, None Meng Nie, None Hua Chen, Li-Xin Xu","doi":"10.54029/2023pep","DOIUrl":"https://doi.org/10.54029/2023pep","url":null,"abstract":"Background: Postoperative seizures are serious neurological complications of chronic subdural hematomas (CSDH). The identification of risk factors of seizures after CSDH is needed to determine which patients require antiepileptic prophylaxis. Methods: We retrospectively collected data on patients diagnosed with CSDH from 2015 to 2018. Postoperative seizures are defined as those occurring within 30 days after surgery. Non-hemorrhagic subdural effusion and acute subdural hemorrhage after craniotomy were precluded in the study. We collected data from 221 patients who had burr hole surgery. We retrospectively recorded patient characteristics, hematoma characteristics, symptoms at admission, comorbid conditions, and other related parameters to evaluate the impact of these parameters on postoperative seizures. Results: Postoperative seizures occurred in 16 patients (7.24%). The univariate analysis showed that previous chronic kidney disease (31.25% vs. 5.37%, p= 0.001), age (60.44 vs. 66.54 y, p = 0.029), low Glasgow Coma Score (GCS) at admission (13.69 vs. 14.46, p = 0.015), and preoperative midline shift (9.79 vs. 8.57 mm, p = 0.021) were significantly correlated with postoperative seizures. The multivariate analysis revealed that previous chronic kidney disease (odds ratio [OR] = 27.103; 95% confidence interval [CI] = 4.887-150.296; p < 0.001), younger age (OR = 0.921; 95% CI = 0.866-0.979; p = 0.009) and preoperative midline shift (OR = 1.782; 95% CI = 1.175-2.702; p = 0.007) were independent risk factors of seizures. However, there was no significant difference in GCS at admission. Conclusions: The independent predictors of postoperative seizures in patients with CSDH were preoperative midline shift, chronic kidney disease, and younger age. For younger patients with chronic kidney disease and preoperative midline displacement, we recommend antiepileptic preventive measures during the perioperative period.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135637560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hemophagocytic lymphohistiocytosis(HLH) is known to have numerous causes, such as chronic inflammation, infection, malignancy, drug use, and primary or familial HLH. HLH triggered by valproate (VPA) has rarely been reported in the literature. Here we describe a pediatric patient with HLH induced by VPA. A 5-years-old girl presented to our center with recurrent fever accompanied by diffuse generalized rash after 2 weeks of taking oral VPA. Physical examination revealed hepatosplenomegaly; laboratory findings showed bicytopenia (hemoglobin and platelet), hemophagocytic cells on the bone marrow smear, hypofibrinogenaemia and hypertriglyceridaemia, and a high ferritin level. She was diagnosed to have HLH associated with VPA. She was treated with intravenous immunoglobulin, glucocorticoid and withdrawal of the sodium valproate, and she completely recovered. In conclusion, VPA can trigger HLH, a potentially fatal condition.
{"title":"Hemophagocytic lymphohistiocytosis associated with sodium valproate","authors":"Xiang-Dong Zeng, Ping Liu, Wen-Guang Hu","doi":"10.54029/2023rzw","DOIUrl":"https://doi.org/10.54029/2023rzw","url":null,"abstract":"Hemophagocytic lymphohistiocytosis(HLH) is known to have numerous causes, such as chronic inflammation, infection, malignancy, drug use, and primary or familial HLH. HLH triggered by valproate (VPA) has rarely been reported in the literature. Here we describe a pediatric patient with HLH induced by VPA. A 5-years-old girl presented to our center with recurrent fever accompanied by diffuse generalized rash after 2 weeks of taking oral VPA. Physical examination revealed hepatosplenomegaly; laboratory findings showed bicytopenia (hemoglobin and platelet), hemophagocytic cells on the bone marrow smear, hypofibrinogenaemia and hypertriglyceridaemia, and a high ferritin level. She was diagnosed to have HLH associated with VPA. She was treated with intravenous immunoglobulin, glucocorticoid and withdrawal of the sodium valproate, and she completely recovered. In conclusion, VPA can trigger HLH, a potentially fatal condition.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135637953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thromboembolic complications during stent-assisted coiling of ruptured intracranial aneurysms are major complications that can cause serious neurological deficits. Management strategies include medical thrombolysis, mechanical thrombectomy with suction aspiration or stent retrieval, and rescue stenting. The existing literature suggests that tissue plasminogen activator agents should be used cautiously because of the high risk of severe bleeding at the aneurysm. We present the case of a ruptured anterior communicating artery aneurysm. Acute in-stent thrombosis occurred during the stent-assisted coiling of the aneurysm. Rescue therapy with tirofiban, suction aspiration, and rescue stenting was attempted; however, these methods failed. Finally, tissue plasminogen activator infusion was performed, which successfully dissolved the thrombus and restored blood flow. Follow-up brain computed tomography revealed no increase in hemorrhage volume.
{"title":"Rescue treatment with tPA for refractory thromboembolism during stent-assisted coiling of a ruptured intracranial aneurysm: A case report","authors":"Sanghyeon Kim, Myongjin Kang","doi":"10.54029/2023pcj","DOIUrl":"https://doi.org/10.54029/2023pcj","url":null,"abstract":"Thromboembolic complications during stent-assisted coiling of ruptured intracranial aneurysms are major complications that can cause serious neurological deficits. Management strategies include medical thrombolysis, mechanical thrombectomy with suction aspiration or stent retrieval, and rescue stenting. The existing literature suggests that tissue plasminogen activator agents should be used cautiously because of the high risk of severe bleeding at the aneurysm. We present the case of a ruptured anterior communicating artery aneurysm. Acute in-stent thrombosis occurred during the stent-assisted coiling of the aneurysm. Rescue therapy with tirofiban, suction aspiration, and rescue stenting was attempted; however, these methods failed. Finally, tissue plasminogen activator infusion was performed, which successfully dissolved the thrombus and restored blood flow. Follow-up brain computed tomography revealed no increase in hemorrhage volume.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135638088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
None Gozde Baran, None Ezgi Vural, None Sema Nur Erdem, None Secil Irmak, None Sena Zeynep Cetin, Ipek Midi
Objective: This study aimed to compare the frequency of admission to hospital in patients with acute ischemic stroke before the COVID 19 pandemic, during the pre-vaccination period, and after the start of vaccination for COVID 19, and to evaluate the time window period between symptom onset to door time, door to CT scan time, door to needle time, and door to puncture time. In addition, it aimed to investigate the effects of the COVID-19 pandemic on the admission, evaluation, and initiation of acute treatment of patients with acute ischemic stroke. Methods: Patients presenting with acute ischemic stroke between March 2019 - December 2019 (pre-pandemic), March 2020 - December 2020 (pre- vaccination pandemic period), and March 2021 - December 2021 (post-vaccination pandemic period) were included in the study. NIHSS was calculated by accordance with the neurological examination findings of the patients, cranial CT for the exclusion of bleeding and CT angiography images for the large vessel occlusions were performed, and the vital signs of the patients were recorded. IV tPA treatment was applied within the first 4.5 hours, and mechanical thrombectomy (MT) was performed in patients with large vessel occlusion. Results: Three hundred nineteen patients were included in the study. The times from symptom onset to emergency admission and from symptom onset to CT scan were found to be similar in all periods. The time from symptom onset to examine by a neurologist was found to be significantly longer in the vaccination period compared to the pandemic period. It was observed that the time from the door to needle time and the time from examine by a neurology doctor to needle time was statistically significantly shorter during the pandemic period (p<0.05). Conclusion: In our study in a tertiary hospital in Turkey, it was determined that the number of patients who was admitted with acute stroke clinic during the pandemic period was similar to other years and there was no delay in the initiation of treatment during the pandemic period. Door to needle times, as well as the time taken by the neurologist to examine and initiate IV-tPA treatment, were found to be shorter in the pre-vaccination pandemic period than in the pre-pandemic and post-vaccination periods.
{"title":"Comparison of treatment durations before Covid-19 pandemic, pre- and post-vaccination periods in acute ischemic stroke patients in a Turkish tertiary hospital","authors":"None Gozde Baran, None Ezgi Vural, None Sema Nur Erdem, None Secil Irmak, None Sena Zeynep Cetin, Ipek Midi","doi":"10.54029/2023pxi","DOIUrl":"https://doi.org/10.54029/2023pxi","url":null,"abstract":"Objective: This study aimed to compare the frequency of admission to hospital in patients with acute ischemic stroke before the COVID 19 pandemic, during the pre-vaccination period, and after the start of vaccination for COVID 19, and to evaluate the time window period between symptom onset to door time, door to CT scan time, door to needle time, and door to puncture time. In addition, it aimed to investigate the effects of the COVID-19 pandemic on the admission, evaluation, and initiation of acute treatment of patients with acute ischemic stroke. Methods: Patients presenting with acute ischemic stroke between March 2019 - December 2019 (pre-pandemic), March 2020 - December 2020 (pre- vaccination pandemic period), and March 2021 - December 2021 (post-vaccination pandemic period) were included in the study. NIHSS was calculated by accordance with the neurological examination findings of the patients, cranial CT for the exclusion of bleeding and CT angiography images for the large vessel occlusions were performed, and the vital signs of the patients were recorded. IV tPA treatment was applied within the first 4.5 hours, and mechanical thrombectomy (MT) was performed in patients with large vessel occlusion. Results: Three hundred nineteen patients were included in the study. The times from symptom onset to emergency admission and from symptom onset to CT scan were found to be similar in all periods. The time from symptom onset to examine by a neurologist was found to be significantly longer in the vaccination period compared to the pandemic period. It was observed that the time from the door to needle time and the time from examine by a neurology doctor to needle time was statistically significantly shorter during the pandemic period (p<0.05). Conclusion: In our study in a tertiary hospital in Turkey, it was determined that the number of patients who was admitted with acute stroke clinic during the pandemic period was similar to other years and there was no delay in the initiation of treatment during the pandemic period. Door to needle times, as well as the time taken by the neurologist to examine and initiate IV-tPA treatment, were found to be shorter in the pre-vaccination pandemic period than in the pre-pandemic and post-vaccination periods.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135637556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: In multiple sclerosis (MS), where low vitamin D level is a risk factor, there is no previous study evaluating the level of free vitamin D by direct measurement, and there is little information about vitamin D binding protein (DBP). This study assessed free vitamin D and DBP in patients with MS. Methods: The study subjects consisted of 43 MS patients and 25 controls. Free vitamin D and DBP levels were measured through an enzyme-linked immunosorbent (ELISA) kit. Results: The patient group had a mean age of 36.58 ± 9.4 (19-60) and the control group had a mean age of 33.56 ± 9.65 (24-52) years (p=0.210). The patient had free vitamin D level of 21.51 ±9.72 pg/ml and the free vitamin D level of the control group was 26.02 ±9.29 pg/ml. Free vitamin D levels did not significantly differ across the groups (p=0.065). The patient group (34.78 ±18.24 ng/ml) had a significantly higher DBP level than the control group (15.36 ±10.64 ng/ml) (p<0.001). Conclusion: MS patients have higher DBP than healthy control, while the free vitamin D levels of the patients tend to be lower.
{"title":"Free vitamin D and vitamin D binding protein in multiple sclerosis patients","authors":"Recep Dönmez, Özlem Kayım Yıldız, Ümit Görgülü","doi":"10.54029/2023hhe","DOIUrl":"https://doi.org/10.54029/2023hhe","url":null,"abstract":"Objective: In multiple sclerosis (MS), where low vitamin D level is a risk factor, there is no previous study evaluating the level of free vitamin D by direct measurement, and there is little information about vitamin D binding protein (DBP). This study assessed free vitamin D and DBP in patients with MS. Methods: The study subjects consisted of 43 MS patients and 25 controls. Free vitamin D and DBP levels were measured through an enzyme-linked immunosorbent (ELISA) kit. Results: The patient group had a mean age of 36.58 ± 9.4 (19-60) and the control group had a mean age of 33.56 ± 9.65 (24-52) years (p=0.210). The patient had free vitamin D level of 21.51 ±9.72 pg/ml and the free vitamin D level of the control group was 26.02 ±9.29 pg/ml. Free vitamin D levels did not significantly differ across the groups (p=0.065). The patient group (34.78 ±18.24 ng/ml) had a significantly higher DBP level than the control group (15.36 ±10.64 ng/ml) (p<0.001). Conclusion: MS patients have higher DBP than healthy control, while the free vitamin D levels of the patients tend to be lower.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135637564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Özge DEDEOGLU, Bahadır KONUŞKAN, Murat CANSEVER, Özlem Yayici Köken
Background & Objective: Vitamin D plays an important role in musculoskeletal health and is also potentially involved in the pathogenesis of chronic diseases. In this study, we aimed to determine the vitamin D status of children aged 2-6 years with motor developmental delay and compare them with asthmatic children. Method: Serum 25-Hydroxy cholecalciferol 25 (OH) D vitamin levels of children were measured between June 2020 and September 2020. Vitamin D deficiency was defined as a serum 25 (OH) vitamin D level less than 20 ng/mL and insufficiency as levels between 20 and 30 ng/mL. The deficiency and insufficiency rates and mean 25 (OH) vitamin D levels between the two groups were compared. Results: The study population included 818 children (192 children with asthma, 368 children with motor development delay and 258 healthy controls). There was no statistically significant difference between groups in terms of age and gender (p=0.130 and p= 0.082, respectively). Vitamin D deficiency and insufficiency were detected in one thirds of children with motor developmental delay (33.7%; 35.6% respectively). The rate of vitamin D deficiency of children with motor development delay between 24 - 47 months of age was found to be significantly higher than control and asthma group (p=0.001 and p=0.034). Conclusions: Vitamin D deficiency and insufficiency were common between 2-6 years of age children with motor development delay. Acceleration of2 motor development between 24 - 47 months of age may be a cause of high incidence of D vitamin deficiency. Clinicians should check and optimize vitamin D status in children with motor development delay especially between 24 - 47 months of age.
{"title":"Comparison of vitamin D levels in children with motor development delay and asthma","authors":"Özge DEDEOGLU, Bahadır KONUŞKAN, Murat CANSEVER, Özlem Yayici Köken","doi":"10.54029/2023npa","DOIUrl":"https://doi.org/10.54029/2023npa","url":null,"abstract":"Background & Objective: Vitamin D plays an important role in musculoskeletal health and is also potentially involved in the pathogenesis of chronic diseases. In this study, we aimed to determine the vitamin D status of children aged 2-6 years with motor developmental delay and compare them with asthmatic children. Method: Serum 25-Hydroxy cholecalciferol 25 (OH) D vitamin levels of children were measured between June 2020 and September 2020. Vitamin D deficiency was defined as a serum 25 (OH) vitamin D level less than 20 ng/mL and insufficiency as levels between 20 and 30 ng/mL. The deficiency and insufficiency rates and mean 25 (OH) vitamin D levels between the two groups were compared. Results: The study population included 818 children (192 children with asthma, 368 children with motor development delay and 258 healthy controls). There was no statistically significant difference between groups in terms of age and gender (p=0.130 and p= 0.082, respectively). Vitamin D deficiency and insufficiency were detected in one thirds of children with motor developmental delay (33.7%; 35.6% respectively). The rate of vitamin D deficiency of children with motor development delay between 24 - 47 months of age was found to be significantly higher than control and asthma group (p=0.001 and p=0.034). Conclusions: Vitamin D deficiency and insufficiency were common between 2-6 years of age children with motor development delay. Acceleration of2 motor development between 24 - 47 months of age may be a cause of high incidence of D vitamin deficiency. Clinicians should check and optimize vitamin D status in children with motor development delay especially between 24 - 47 months of age.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135637952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background & Objective: Cerebrovascular atherosclerotic disease is the major cause of ischemic stroke and transient ischemia attack (TIA). Atherosclerosis commonly affects intracranial and extracranial carotid arteries simultaneously. Plaque characteristics are significantly associated with the severity of ischemic stroke. We studied the characteristics of atheromatous plaques in ischemic stroke patients and correlated characteristics of atheromatous plaques with the patient’s National Institute of Health Score (NIHSS) at the time of presentation with ischemic stroke. Methods: We conducted a cross-sectional analysis of 83 in-patient adults presenting with complaints of acute stroke within seven days of stroke. Those who consented were included in the study. The management, investigations and treatment of the cases were according to the hospital’s stroke protocol. An NIHSS score was calculated. MRI brain and MRA/HR-MRI (vessel wall imaging) were done as stroke protocol. The data was analyzed using SPSS 22.0 and R.3.2.0. Results: A total of 83 patients were enrolled, of which 59% were males and 41% were females, with a mean age of 52.8 ± 11.6 years and 54.5 ± 11 years, respectively. The mean NIHSS score, internal carotid artery stenosis, and lumen area of ICA (mm2) for all plaques were statistically significant (p< 0.001). Conclusion: We established a strong association between carotid atherosclerotic plaque characteristics and ischemic stroke severity. We found that a CT scan is better for diagnosing calcified plaques than HR-MRI.
{"title":"Association between plaque characteristics and severity of acute ischemic stroke","authors":"None Abhas Kumar, None Pushpendra Nath Renjen, None Harsh Rastogi, None Dinesh Mohan Chaudhari, None Priyal, None Arushee Bhatnagar, None Kamal Ahmad, None Anjali Mishra","doi":"10.54029/2023few","DOIUrl":"https://doi.org/10.54029/2023few","url":null,"abstract":"Background & Objective: Cerebrovascular atherosclerotic disease is the major cause of ischemic stroke and transient ischemia attack (TIA). Atherosclerosis commonly affects intracranial and extracranial carotid arteries simultaneously. Plaque characteristics are significantly associated with the severity of ischemic stroke. We studied the characteristics of atheromatous plaques in ischemic stroke patients and correlated characteristics of atheromatous plaques with the patient’s National Institute of Health Score (NIHSS) at the time of presentation with ischemic stroke. Methods: We conducted a cross-sectional analysis of 83 in-patient adults presenting with complaints of acute stroke within seven days of stroke. Those who consented were included in the study. The management, investigations and treatment of the cases were according to the hospital’s stroke protocol. An NIHSS score was calculated. MRI brain and MRA/HR-MRI (vessel wall imaging) were done as stroke protocol. The data was analyzed using SPSS 22.0 and R.3.2.0. Results: A total of 83 patients were enrolled, of which 59% were males and 41% were females, with a mean age of 52.8 ± 11.6 years and 54.5 ± 11 years, respectively. The mean NIHSS score, internal carotid artery stenosis, and lumen area of ICA (mm2) for all plaques were statistically significant (p< 0.001). Conclusion: We established a strong association between carotid atherosclerotic plaque characteristics and ischemic stroke severity. We found that a CT scan is better for diagnosing calcified plaques than HR-MRI.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"374 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135637961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Snoring, apnea, and arousal are commonly observed during sleep in patients with obstructive sleep apnea (OSA), and these nocturnal symptoms frequently disturb their bed partners. We aimed to evaluate the sleep disturbance and depressive tendency in the bed partners of patients with OSA. Methods: A cross-sectional, prospective study was conducted. A total of 136 patients with OSA and their bed partners were recruited. We analyzed the demographic data of both patients with OSA and bed partners and the polysomnography parameters of patients with OSA. The sleep quality of bed partners was assessed using the Chinese version of the Pittsburgh Sleep Quality Index (PSQI), and depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression Scale (CES-D). Results: The mean apnea–hypopnea index (AHI) was 43.5/h among all participants. Among bed partners, the mean PSQI score was 7.8 and the mean CES-D score was 15.4. The prevalence of chronic disease was significantly higher in bed partners with sleep disturbance (PSQI > 5) and depressive tendency (CES-D ≥ 16). The AHI and snore index of patients with OSA were not associated with bed partners’ sleep disturbance and depressive tendency respectively. The CES-D score was positively correlated with the PSQI score in the bed partners of patients with OSA (r = 0.426, p < 0.001). Conclusions: Bed partners tended to have sleep disturbance, which was unrelated to the severity of AHI and snoring in patients with OSA. Poor sleep quality may cause depressive tendency and chronic disease in the bed partners of patients with OSA.
背景:打鼾、呼吸暂停和觉醒在阻塞性睡眠呼吸暂停(OSA)患者睡眠中很常见，这些夜间症状经常打扰他们的床伴。我们的目的是评估睡眠障碍患者床伴的睡眠障碍和抑郁倾向。方法:采用横断面前瞻性研究。共招募了136名OSA患者及其床伴。我们分析了OSA患者和床伴的人口学数据以及OSA患者的多导睡眠图参数。采用中文版匹兹堡睡眠质量指数(PSQI)评估同床者的睡眠质量，采用流行病学研究中心抑郁量表(CES-D)评估抑郁症状。结果:所有参与者的平均呼吸暂停低通气指数(AHI)为43.5/h。伴床者PSQI平均为7.8分，ses - d平均为15.4分。伴眠者的慢性疾病患病率显著高于伴眠者(PSQI >5)、抑郁倾向(CES-D≥16)。OSA患者的AHI和打鼾指数分别与床伴睡眠障碍和抑郁倾向无关。ses - d评分与OSA患者伴床者PSQI评分呈正相关(r = 0.426, p <0.001)。结论:同床者易出现睡眠障碍，睡眠障碍与OSA患者AHI和打鼾的严重程度无关。睡眠质量差可能导致OSA患者伴床者出现抑郁倾向和慢性疾病。
{"title":"Sleep disturbance and depressive tendency in bed partners of patients with obstructive sleep apnea","authors":"Chih-Yu Huang, Shao-Yun Wu, Chung-Chieh Yu, Chien-Ming Chu","doi":"10.54029/2023xze","DOIUrl":"https://doi.org/10.54029/2023xze","url":null,"abstract":"Background: Snoring, apnea, and arousal are commonly observed during sleep in patients with obstructive sleep apnea (OSA), and these nocturnal symptoms frequently disturb their bed partners. We aimed to evaluate the sleep disturbance and depressive tendency in the bed partners of patients with OSA. Methods: A cross-sectional, prospective study was conducted. A total of 136 patients with OSA and their bed partners were recruited. We analyzed the demographic data of both patients with OSA and bed partners and the polysomnography parameters of patients with OSA. The sleep quality of bed partners was assessed using the Chinese version of the Pittsburgh Sleep Quality Index (PSQI), and depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression Scale (CES-D). Results: The mean apnea–hypopnea index (AHI) was 43.5/h among all participants. Among bed partners, the mean PSQI score was 7.8 and the mean CES-D score was 15.4. The prevalence of chronic disease was significantly higher in bed partners with sleep disturbance (PSQI > 5) and depressive tendency (CES-D ≥ 16). The AHI and snore index of patients with OSA were not associated with bed partners’ sleep disturbance and depressive tendency respectively. The CES-D score was positively correlated with the PSQI score in the bed partners of patients with OSA (r = 0.426, p < 0.001). Conclusions: Bed partners tended to have sleep disturbance, which was unrelated to the severity of AHI and snoring in patients with OSA. Poor sleep quality may cause depressive tendency and chronic disease in the bed partners of patients with OSA.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136250038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Perampanel (PER), approved as an antiseizure medication in 2012, is a selective non-competitive antagonist of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors. PER is used as an add-on medication to treat partial-onset and primary generalized tonic-clonic seizures. In addition, positive effects have been reported in some patients with epileptic myoclonic convulsions in idiopathic systemic and progressive myoclonic epilepsy. We treated a male patient with post-hypoxic nonepileptic myoclonus (Lance-Adams syndrome) by adding PER to classic antiseizure medications after 10 days of targeted therapeutic hypothermia. Myoclonus movement, which showed no improvement with other antiseizure medications (valproate, levetiracetam, and clonazepam) administered for 9 days, gradually improved after PER was started. In addition, myoclonus recurred when the drug was withheld due to patient’s dry mouth or pickled extremities. By reintroducing PER, myoclonus improved without other side effects. For this reason, we believe that the early introduction of PER in Lance-Adams syndrome after cardiac arrest is worth considering.
{"title":"Successful case of Lance-Adams syndrome treatment with early use of perampanel after targeted therapeutic hypothermia","authors":"Ji Ho Lee, Dong Hun Lee","doi":"10.54029/2023uax","DOIUrl":"https://doi.org/10.54029/2023uax","url":null,"abstract":"Perampanel (PER), approved as an antiseizure medication in 2012, is a selective non-competitive antagonist of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors. PER is used as an add-on medication to treat partial-onset and primary generalized tonic-clonic seizures. In addition, positive effects have been reported in some patients with epileptic myoclonic convulsions in idiopathic systemic and progressive myoclonic epilepsy. We treated a male patient with post-hypoxic nonepileptic myoclonus (Lance-Adams syndrome) by adding PER to classic antiseizure medications after 10 days of targeted therapeutic hypothermia. Myoclonus movement, which showed no improvement with other antiseizure medications (valproate, levetiracetam, and clonazepam) administered for 9 days, gradually improved after PER was started. In addition, myoclonus recurred when the drug was withheld due to patient’s dry mouth or pickled extremities. By reintroducing PER, myoclonus improved without other side effects. For this reason, we believe that the early introduction of PER in Lance-Adams syndrome after cardiac arrest is worth considering.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48749765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background & Objective: A need exists for prophylactic treatment options for chronic migraine. Our aim was to evaluate and compare the effect of greater occipital nerve (GON) and transnasal sphenopalatine ganglion (SPG) blockade on headache days, responder rate, attack severity, attack frequency, and medication overuse in patients with chronic migraine. Methods: This was a retrospective study. The GON blockade was performed at the proximal level under ultrasound guidance with 1.5 cc 0.5% bupivacaine, and the SPG blockade was performed transnasally with 0.5 cc 0.5% bupivacaine applied for 30 minutes with swab sticks. Patients who completed bilateral blocks applied in four weekly sessions were included in the analysis. Results: Seventy patients (GON=37, SPG=33) were included in the study. Both groups showed a significant improvement in the number of days with headache, severity of attacks, and frequency of attacks at the first- and third-month follow-up visits compared to the baseline (p<0.001). Responder rates were similar at the first- and third-month follow-up visits (r= 3.707, p=0.054; r=0.071, p=0.790, respectively). At the third-month follow-up, the prevalence of medication overuse decreased from 78% to 13% in the GON group and from 57% to 9% in the SPG group, and these differences were statistically significant (p<0.001 for both groups). No significant difference was noted in efficacy between the treatment groups (p=0.714). No significant adverse effects occurred in either group. Conclusion: Both proximal GON blockade and minimally invasive SPG blockade are effective and safe options for prophylaxis in patients with chronic migraine.
背景与目的：慢性偏头痛需要预防性治疗方案。我们的目的是评估和比较枕大神经（GON）和经鼻蝶腭神经节（SPG）阻断对慢性偏头痛患者头痛天数、反应率、发作严重程度、发作频率和药物过度使用的影响。方法：本研究为回顾性研究。在超声引导下，用1.5 cc 0.5%布比卡因在近端水平进行GON阻断，用0.5 cc 0.5%布哌卡因经鼻用棉签棒进行SPG阻断30分钟。在每周四次疗程中完成双侧阻断的患者被纳入分析。结果：70名患者（GON=37，SPG=33）被纳入研究。与基线相比，两组在第一个月和第三个月随访时头痛天数、发作严重程度和发作频率均有显著改善（p＜0.001）。第一个月随访和第三次随访的应答率相似（分别为r＝3.707，p＝0.054；r＝0.071，p＝0.790）。在第三个月的随访中，GON组药物过度使用的发生率从78%降至13%，SPG组从57%降至9%，这些差异具有统计学意义（两组均<0.001）。治疗组间疗效无显著差异（p=0.714）。两组均未出现显著不良反应。结论：近端GON阻断和微创SPG阻断是预防慢性偏头痛有效、安全的选择。
{"title":"Comparison of outcomes of transnasal sphenopalatine ganglion and ultrasound-guided proximal greater occipital nerve blockades in chronic migraine","authors":"Selin Balta, A. U. Uca, F. Odabaş, A. Demir","doi":"10.54029/2023dpf","DOIUrl":"https://doi.org/10.54029/2023dpf","url":null,"abstract":"Background & Objective: A need exists for prophylactic treatment options for chronic migraine. Our aim was to evaluate and compare the effect of greater occipital nerve (GON) and transnasal sphenopalatine ganglion (SPG) blockade on headache days, responder rate, attack severity, attack frequency, and medication overuse in patients with chronic migraine.\u0000Methods: This was a retrospective study. The GON blockade was performed at the proximal level under ultrasound guidance with 1.5 cc 0.5% bupivacaine, and the SPG blockade was performed transnasally with 0.5 cc 0.5% bupivacaine applied for 30 minutes with swab sticks. Patients who completed bilateral blocks applied in four weekly sessions were included in the analysis.\u0000Results: Seventy patients (GON=37, SPG=33) were included in the study. Both groups showed a significant improvement in the number of days with headache, severity of attacks, and frequency of attacks at the first- and third-month follow-up visits compared to the baseline (p<0.001). Responder rates were similar at the first- and third-month follow-up visits (r= 3.707, p=0.054; r=0.071, p=0.790, respectively). At the third-month follow-up, the prevalence of medication overuse decreased from 78% to 13% in the GON group and from 57% to 9% in the SPG group, and these differences were statistically significant (p<0.001 for both groups). No significant difference was noted in efficacy between the treatment groups (p=0.714). No significant adverse effects occurred in either group.\u0000Conclusion: Both proximal GON blockade and minimally invasive SPG blockade are effective and safe options for prophylaxis in patients with chronic migraine.","PeriodicalId":49757,"journal":{"name":"Neurology Asia","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41757081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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