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Impact of the Stroke Law in Neuquén. First Experience in Argentina 内乌肯省中风法的影响。阿根廷的首次经验
Pub Date : 2024-07-17 DOI: 10.58624/svoane.2024.05.0146
Vicente Miriam, Parada Gabriela, Hasdeu Santiago, Castro César, Orbea Lisandro, Albornoz Florencia
This study examines the impact of Neuque n's pioneering Stroke Law in Argentina, focusing on its enactment and implementation. Neuque n, facing a high stroke incidence, established the first Argentinean legislation for stroke management, including prevention, acute treatment, and rehabilitation. The law led to the creation of the Provincial Stroke Network and inclusion of alteplase in the Neuque n Therapeutic Formulary. Results demonstrate advancements in healthcare delivery, with significant implications for public health policy and stroke management in Argentina. The study highlights challenges, particularly during the COVID-19 pandemic, and suggests future directions for comprehensive stroke care.
本研究探讨了 Neuque n 率先制定的《中风法》在阿根廷的影响,重点关注其颁布和实施情况。面对中风的高发病率,Neuque n 制定了阿根廷第一部有关中风管理的法律,包括预防、急性期治疗和康复。该法促成了省级中风网络的建立,并将阿替普酶纳入了 Neuque n 的治疗处方集。研究结果表明了医疗服务的进步,对阿根廷的公共卫生政策和中风管理具有重要意义。该研究强调了面临的挑战,尤其是在 COVID-19 大流行期间,并提出了全面中风治疗的未来方向。
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引用次数: 0
Early Childhood Onset Vanishing White Matter Disease with Multiple Cranial Nerve Enhancement: A New Consensus Criteria? 儿童早期发病的消失性白质病伴有多发性颅神经增强:新的共识标准?
Pub Date : 2024-07-17 DOI: 10.58624/svoane.2024.05.0145
Fahad Albassam, Muneer Almutairi, Saleh Ahmed Alzaid
Vanishing White Matter Disease (VWM), also known as Childhood Ataxia with Central Nervous System Hypomyelination (CACH), although a rare neurological condition, is a prevalent hereditary leukoencephalopathy with a characteristic phenotype of gradual neurologic deterioration with ataxia being a prominent feature. It is characterized by a wide range of onset, from antenatal and infantile periods to early childhood and later adulthood periods. The early childhood form is considered the prevailing form, characterized by a preceding phase of normal development until the second or 3rd year of life, followed by progressive neurologic deterioration, accentuated by certain stressors, such as infections or minor trauma. Diagnosis is achieved based on the clinical pretext combined with distinctive MRI brain features, confirmed by DNA analysis detection of elf2B mutation. Our case is a healthy 18-month-old male who after a preceding upper respiratory tract infection, developed an ataxic gait, encephalopathy, and recurrent generalized seizures. Physical assessment revealed signs of generalized spasticity and hyperreflexia. Neuroimaging revealed diffuse symmetric supratentorial and infratentorial diffuse white matter hypomyelination. Interestingly, there was notable enhancement of the 3rd and 5th cranial nerves. Differential diagnosis included acute demyelinating leukoencephalopathies; and neuromatobolic disorders with acute presentations (including leukodystrophies, hypomyelinating disorders, and mitochondrial encephalopathies). In the early course of his management, he received immunomodulatory therapy in the form of pulse steroids, intravenous immunoglobulins, and oral tapering course of steroids. He had limited response to these interventions. Whole exome sequencing yielded a homozygous mutation in EIF2B3, confirming the diagnosis of VWMD/CACH. The presence of enhancing cranial neuropathies represent an atypical phenotype reported in other case reports and should alert the physician to avoid unnecessary intervention with immunosuppressive therapies.
消失的白质病(VWM),又称儿童共济失调伴中枢神经系统髓鞘减少症(CACH),虽然是一种罕见的神经系统疾病,但却是一种流行的遗传性白质脑病,其特征性表型是神经系统功能逐渐衰退,共济失调是其显著特征。该病的发病范围很广,从产前和婴儿期到幼儿期和成年后期。幼儿期被认为是发病率最高的时期,其特点是在出生后的第二或第三年之前的阶段发育正常,随后神经系统逐渐恶化,某些应激因素(如感染或轻微外伤)会加重病情。诊断的依据是临床表现和明显的磁共振成像脑部特征,并通过 DNA 分析检测出 elf2B 基因突变。我们的病例是一名 18 个月大的健康男性,在上呼吸道感染后出现共济失调步态、脑病和反复全身抽搐。体格检查发现他有全身痉挛和反射亢进的症状。神经影像学检查发现,弥漫性对称性幕上和幕下弥漫性白质骨髓抑制。有趣的是,第 3 和第 5 颅神经明显增强。鉴别诊断包括急性脱髓鞘性白质脑病;以及急性表现的神经瘤变性疾病(包括白质营养不良症、髓鞘功能减退症和线粒体脑病)。在早期治疗过程中,他接受了脉冲类固醇、静脉注射免疫球蛋白和口服减量类固醇等形式的免疫调节治疗。他对这些干预措施的反应有限。全外显子组测序发现 EIF2B3 基因发生了同源突变,确诊为 VWMD/CACH。增强型颅神经病是其他病例报告中出现的非典型表型,应提醒医生避免使用不必要的免疫抑制疗法。
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引用次数: 0
Literature Review on Effective Use of Modern Modalities in Management of Intra-Axial Brain Lesions 关于有效利用现代方法治疗轴内脑损伤的文献综述
Pub Date : 2024-07-17 DOI: 10.58624/svoane.2024.05.0144
O. Uzoma, Havryliv Taras, Aigbogun Julia, Smolanka Andriy
The significant health burden caused by intra-axial brain lesions and the difficulties associated with their diagnosis and treatment have prompted a large number of researchers and practitioners to investigate various diagnostic and treatment modalities for their effectiveness and safety. This study focuses on evaluating different pre-, intra- and postoperative techniques and analyzes their advantages and limitations to ultimately improve the management of this type of brain lesion. Through a critical analysis of various scientific sources, this research aimed to synthesize existing knowledge on the topic. Magnetic resonance imaging plays a crucial role in diagnosing and managing brain tumors. Functional MRI identifies functional brain areas, but tumor-induced blood flow changes can affect its reliability. Connectome analysis provides information on functional localization and brain networks, which became possible using diffusion tensor imaging, that visualizes white matter pathways, aiding in tumor boundary delineation and surgical planning. Studies suggest this method can predict tumor histology and prognosis. Intraoperative MRI improves the extent of tumor resection and potentially patient survival. But due to its limitations it has alternative intraoperative techniques, like intraoperative ultrasound, fluorescence-guided surgery, direct electrical stimulation, deep brain stimulation, but evidence for most of these methods is limited for most brain tumors. Only ultrasound showed real-time tumor visualization and residual disease analysis offering high accuracy and is relatively inexpensive compared to ioMRI. This study can be useful to neurosurgeons, neuro-oncologists, neurologists, neuro-radiologists, and will demonstrate prospects for further research.
轴内脑损伤造成的巨大健康负担及其诊断和治疗方面的困难促使大量研究人员和从业人员研究各种诊断和治疗方法的有效性和安全性。本研究重点评估不同的术前、术中和术后技术,并分析其优势和局限性,以最终改善此类脑部病变的治疗。通过对各种科学资料的批判性分析,本研究旨在综合现有的相关知识。磁共振成像在诊断和管理脑肿瘤方面发挥着至关重要的作用。功能磁共振成像可识别大脑功能区域,但肿瘤引起的血流变化会影响其可靠性。扩散张量成像可将白质通路可视化,有助于肿瘤边界的划分和手术规划。研究表明,这种方法可以预测肿瘤组织学和预后。术中磁共振成像可改善肿瘤切除范围,并可能提高患者生存率。但由于其局限性,术中磁共振成像还有其他替代技术,如术中超声、荧光引导手术、直接电刺激、脑深部刺激等,但对于大多数脑肿瘤来说,这些方法的证据都很有限。只有超声显示了肿瘤的实时可视化和残余疾病分析,具有较高的准确性,而且与 ioMRI 相比价格相对便宜。这项研究对神经外科医生、神经肿瘤学家、神经病学家、神经放射学家很有帮助,并将展示进一步研究的前景。
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引用次数: 0
Contralateral Hyperhidrosis After Large Acute Left MCA Territory Infarction: A Case Report 急性左侧 MCA 大面积梗死后的对侧多汗症:病例报告
Pub Date : 2024-07-11 DOI: 10.58624/svoane.2024.05.0143
Ibrahim Kaleel, Ayoub Hambli, Abdel Salam Kaleel
A 51-year-old female presented with sudden onset of right-sided hemiparesis and aphasia. Imaging confirmed a left middle cerebral artery (MCA) territory infarct affecting the insular cortex. During her recovery, she developed excessive sweating exclusively on the right side of her body, leading to a diagnosis of contralateral hyperhidrosis. This case highlights the unusual presentation of hyperhidrosis following an MCA stroke and underscores the role of the insular cortex in autonomic regulation.
一名 51 岁的女性突然出现右侧偏瘫和失语。影像学检查确诊为左侧大脑中动脉(MCA)区域梗塞,影响到岛叶皮层。在康复期间,她出现了身体右侧多汗的症状,因此被诊断为对侧多汗症。该病例突出了多汗症在 MCA 中风后的不寻常表现,并强调了岛叶皮质在自主神经调节中的作用。
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引用次数: 0
Atypical Congenital Meduloblastoma: Case Report 非典型先天性髓母细胞瘤:病例报告
Pub Date : 2024-05-10 DOI: 10.58624/svoane.2024.05.0138
Sabina Oblitas López, Edgar Pinto Garcia, Mauro Toledo Aguirre
Medulloblastomas are WHO grade 4 embryonal neuroepithelial tumors that typically occur in the posterior fossa in the pediatric population. They represent 68% of embryonal tumors. The study of congenital cases is scarce due to the rarity of reported patients. There is also no specific bibliography, however histologically and molecularly they can be classified. On the other hand, due to the young age of these patients, they are difficult to manage and have a higher risk of complications in the treatment. In addition to this, patients are born with alterations in the development of the central nervous system due to chronic intracranial hypertension caused by said tumor and have little functional development. The objective of this study is to teach us to recognize the diagnosis early, the evolution of the disease to lead to better treatment for these patients in the future.
髓母细胞瘤是世卫组织 4 级胚胎性神经上皮肿瘤,通常发生在儿童后窝。它们占胚胎性肿瘤的 68%。由于报告的患者很少,对先天性病例的研究也很少。也没有专门的参考书目,但可以从组织学和分子学上对其进行分类。另一方面,由于这些患者年龄较小,因此难以管理,治疗过程中出现并发症的风险也较高。此外,由于上述肿瘤导致的慢性颅内高压,患者出生时中枢神经系统的发育就已发生改变,功能发育不完善。这项研究的目的是让我们学会早期识别诊断,了解疾病的演变过程,以便将来更好地治疗这些患者。
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引用次数: 0
Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) Mimicking Posterior Circulation Infarction 慢性淋巴细胞炎症伴对类固醇敏感的桥脑血管周围增强(CLIPPERS)模拟后循环梗死
Pub Date : 2024-05-02 DOI: 10.58624/svoane.2024.05.0136
A. Kanodia, Aqeel Alameer, Riccardo Zannoni, Vilte Balcaityte, Jonathan O'Riordan
CLIPPERS is a rare inflammatory condition of the central nervous system. It is pathologically characterised by white matter perivascular lymphohistiocytic infiltrate with or without parenchymal extension. A male patient in mid sixties presented with dysarthria and facial numbness underwent an MRI brain which supported a diagnosis of a subacute posterior circulation infarct. The patient re-presented with worsening of symptoms and a repeat MRI revealed changes atypical for ischaemia and consistent with CLIPPERS. Our case represents a common presentation of a very rare condition.
CLIPPERS 是一种罕见的中枢神经系统炎症。其病理特征是白质血管周围淋巴组织细胞浸润,伴有或不伴有实质扩展。一名 60 多岁的男性患者因构音障碍和面部麻木接受了脑部核磁共振成像检查,结果支持亚急性后循环梗死的诊断。患者再次就诊时症状加重,再次进行核磁共振成像检查发现,患者的症状变化与缺血症状不典型,与 CLIPPERS 一致。我们的病例是一种非常罕见疾病的常见表现。
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引用次数: 0
Frequency of Different Types of Artifacts in Electroencephalography of the Brain of Hospitalized and Outpatient Patients Referred to the Clinics of Al-Zahra Hospital and Khorshid Hospital in Isfahan 伊斯法罕扎赫拉医院和霍尔希德医院转诊的住院病人和门诊病人脑电图中不同类型伪影的频率
Pub Date : 2024-04-04 DOI: 10.58624/svoane.2024.05.0133
Noushin Mehrbod
Background: Artifact is a common error in patient’s electroencephalogram that if not addressed, it can lead to reduced quality and ultimately misdiagnosis. The aim of this study was to determine the frequency of different types of artifacts in electroencephalography of the brain of hospitalized and outpatient patients referred to the clinics of Al-Zahra Hospital and Khorshid Hospital in Isfahan. Methods: In this cross-sectional study that was performed in Al-Zahra and Noor hospitals in Isfahan in 1399, 256 patients were studied by electroencephalography and examined for their electroencephalography, the presence of physiological and non-physiological artifacts and the source of artifacts in them. Results: Out of 256 patients studied, in 237 cases (92.6%) the artifacts were physiological and 19 (7.4%) were non-physiological. The type of physiological artifacts included 217 cases (91.6%) ocular, 1 case (0.4%) cardiac, 5 cases (2.1%) sweating and 14 cases (5.9%) motor. Among non-physiological artifacts, 11 (57.9%) were electrode and 8 (42.1%) were external artifacts. There was no significant difference in the type of artifacts performed according to the age and sex of the patients. Conclusion: The findings of the present study show that the presence of artifacts in patient’s electroencephalogram is very common, and among them, physiological ocular artifacts and non-physiological electrode artifacts are the most common errors in patients’ electroencephalogram and therefore it is necessary to Investigate the possibility of different types of artifacts and take the necessary strategies to reduce them.
背景:伪影是患者脑电图中常见的错误,如果不加以解决,可能会导致质量下降,最终导致误诊。本研究旨在确定转诊至伊斯法罕扎赫拉医院和霍尔希德医院门诊的住院和门诊病人脑电图中不同类型伪影的频率。研究方法这项横断面研究于 1399 年在伊斯法罕的扎赫拉医院和努尔医院进行,共对 256 名患者进行了脑电图研究,并检查了他们的脑电图、是否存在生理和非生理伪影以及伪影的来源。研究结果在所研究的 256 例患者中,237 例(92.6%)为生理性伪像,19 例(7.4%)为非生理性伪像。生理伪影包括 217 例(91.6%)眼部伪影、1 例(0.4%)心脏伪影、5 例(2.1%)出汗伪影和 14 例(5.9%)运动伪影。在非生理伪影中,11 例(57.9%)为电极伪影,8 例(42.1%)为外部伪影。患者的年龄和性别在假象类型上没有明显差异。结论本研究结果表明,患者脑电图中出现伪像的情况非常普遍,其中生理性眼部伪像和非生理性电极伪像是患者脑电图中最常见的错误,因此有必要调查不同类型伪像的可能性,并采取必要的策略减少伪像。
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引用次数: 0
Adjacent Segment Degeneration and Adjacent Segment Disease: Implications following Spinal Fusion Surgery 相邻节段退化和相邻节段疾病:脊柱融合手术后的影响
Pub Date : 2024-03-06 DOI: 10.58624/svoane.2024.05.0130
Neda Kamandi
Spinal fusion is a common and effective option for patients with symptomatic degenerative disc disorders. However, concerns have raised over the probability of adjacent segment degeneration (ASDe) and adjacent segment disease (ASDi) following spinal instrumentation. Current study sought to document evidence on the incidence of ASDe and ASDi after lumbar fusion surgery and the risk factors precipitating adjacent pathologies. Given the benefits of spinal fusion surgery, it remains unclear whether adjacent pathologies are attributed to the natural degeneration or the adjacent fusion.
对于有症状的椎间盘退行性病变患者来说,脊柱融合术是一种常见且有效的选择。然而,人们对脊柱器械植入术后邻近节段退变(ASDe)和邻近节段疾病(ASDi)的发生概率表示担忧。本研究旨在记录腰椎融合手术后邻近节段变性(ASDe)和邻近节段病变(ASDi)的发生率以及诱发邻近节段病变的风险因素。鉴于脊柱融合手术的益处,目前仍不清楚邻近病变是由于自然退变还是邻近融合所致。
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引用次数: 0
Spinal Infarction: Anterior Spinal Artery Syndrome. Presentation of a Clinical Case 脊髓梗塞脊髓前动脉综合征。临床病例介绍
Pub Date : 2024-02-16 DOI: 10.58624/svoane.2024.05.0129
Maikel Germán Correa Sánchez
Diseases of the nervous system are sometimes confined to the spinal cord, and there they give rise to peculiar syndromes that depend on the special physiological and anatomical characteristics of that organ. On the other hand, spinal arteries do not tend to show atherosclerosis and emboli rarely lodge in them, giving rise to vascular diseases (1%) where infarctions occur with some regularity at this level. The most common clinical presentation is anterior spinal artery syndrome, a sudden-onset pathology with neurological involvement and devastating and disabling consequences for the affected patient. Its manifestations vary depending on the level of occlusion in the affected area. We present the case of a 74-year-old female patient, who was admitted due to sudden loss of muscle strength in both lower limbs, with a timely diagnosis achieved through clinical and magnetic resonance imaging of the dorsolumbar spine.
神经系统的疾病有时仅限于脊髓,在脊髓上会产生特殊的综合症,这取决于该器官的特殊生理和解剖特征。另一方面,脊髓动脉不会出现动脉粥样硬化,栓子也很少在其中停留,这就导致了血管疾病(1%),在这一水平经常发生梗塞。最常见的临床表现是脊髓前动脉综合征,这是一种突发性病变,会累及神经系统,对患者造成毁灭性的致残后果。其表现因受影响区域的闭塞程度而异。我们介绍了一例 74 岁女性患者的病例,她因双下肢突然失去肌力而入院,通过临床和背腰椎磁共振成像检查及时确诊。
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引用次数: 0
A 22-Year-Old Woman with NMDA Receptor Antibody Encephalitis Possibly Triggered by SARS-CoV-2 Infection 一名 22 岁女性可能因感染 SARS-CoV-2 而引发 NMDA 受体抗体脑炎
Pub Date : 2024-01-30 DOI: 10.58624/svoane.2024.05.0128
Charles Ce Wang
A 22-year-old woman presented to the emergency department (ED) on two occasions with seizures, altered mental status, psychoses, and behavioral changes. Analysis of both serum and cerebrospinal fluid revealed positive anti-NMDA receptor (NMDAR) antibodies, confirming the diagnosis of NMDAR antibody encephalitis. Interestingly, 5-6 weeks before her ED visits, she had experienced a SARS-CoV-2 infection, potentially serving as a triggering factor for her autoimmune encephalitis. This case adds to the limited instances documented in the literature, highlighting the potential link between SARS-CoV-2 infection and the onset of autoimmune encephalitis
一名 22 岁女性因癫痫发作、精神状态改变、精神病和行为改变两次到急诊科就诊。血清和脑脊液分析均显示抗 NMDA 受体(NMDAR)抗体阳性,确诊为 NMDAR 抗体脑炎。有趣的是,在她去急诊室就诊的 5-6 周前,她曾感染过 SARS-CoV-2,这可能是她患自身免疫性脑炎的诱发因素。本病例补充了文献中记载的有限病例,强调了 SARS-CoV-2 感染与自身免疫性脑炎发病之间的潜在联系。
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引用次数: 0
期刊
SVOA neurology
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