Neurologia最新文献

英文中文

Thrombosis with thrombocytopenia syndrome following adenovirus vector-based vaccines to prevent COVID-19: Epidemiology and clinical presentation in Spain. 接种基于腺病毒载体的疫苗以预防 COVID-19 后出现血栓形成伴血小板减少综合征：西班牙的流行病学和临床表现。

Neurologia

Pub Date : 2024-11-01 Epub Date: 2024-10-31 DOI: 10.1016/j.nrleng.2024.10.001

D García-Azorín, E Lázaro, D Ezpeleta, R Lecumberri, R de la Cámara, M Castellanos, C Iñiguez Martínez, L Quiroga-González, G Elizondo Rivas, A Sancho-López, P Rayón Iglesias, E Segovia, C Mejías, D Montero Corominas

Background: We describe the epidemiological and clinical characteristics of thrombosis with thrombocytopenia syndrome (TTS) cases reported in Spain.

Methods: We included all cases of venous or arterial thrombosis with thrombocytopenia following administration of adenoviral vector vaccines (AstraZeneca or Janssen) against COVID-19 disease between 1 February and 26 September 2021. We describe the crude rate and the standardised morbidity ratio. We assessed the predictors of mortality.

Results: Sixty-one cases were reported and 45 fulfilled eligibility criteria; 82% of patients were women. The crude TTS rate was 4 cases/1 000 000 doses, and 14-15 cases/1 000 000 doses among patients aged 30-49 years. The number of observed cases of cerebral venous thrombosis was 6-18 times higher than that expected in patients younger than 49 years. Symptoms started a median (quartiles 1 and 3 [Q₁-Q₃]) of 10 (7-14) days after vaccination. Eighty percent (95% confidence interval [CI]: 65%-90%) had thrombocytopenia at the time of the emergency department visit, and 65% (49%-78%) had D-dimer levels > 2000 ng/mL. Patients had thromboses affecting multiple locations in 36% of cases and fatal outcomea in 24%. Platelet nadir < 50 000/μL (odds ratio [OR]: 7.4; 95% CI: 1.2-47.5) and intracranial hemorrhage (OR: 7.9; 95% CI: 1.3-47.0) were associated with fatal outcomes.

Conclusion: TTS must be suspected in patients with symptoms 10 days after vaccination and thrombocytopenia and/or elevated D-dimer levels.

背景：我们描述了西班牙报告的血栓伴血小板减少综合征（TTS）病例的流行病学和临床特征：我们描述了西班牙报告的血栓伴血小板减少综合征（TTS）病例的流行病学和临床特征：我们纳入了 2021 年 2 月 1 日至 9 月 26 日期间接种腺病毒载体疫苗（阿斯利康或杨森）以预防 COVID-19 疾病的所有伴血小板减少的静脉或动脉血栓形成病例。我们描述了粗死亡率和标准化发病率。我们评估了死亡率的预测因素：共报告了 61 例病例，其中 45 例符合资格标准，82% 为女性。粗TTS率为4/1,000,000剂量，30-49岁为14-15/1,000,000剂量。在 49 岁以下的患者中，观察到的脑静脉血栓病例数比预期高出 6-18 例。症状开始于接种疫苗后 10 天（四分位距（IQR）：7-14 天）。80%（95% 置信区间 (CI)：65-90%）的患者在急诊就诊时血小板减少，65%（95% 置信区间 (CI)：49-78%）的患者 D-二聚体大于 2000 纳克/毫升。36%的患者有多处血栓形成，24%的患者有致命后果。血小板最低点接种疫苗 10 天后出现症状、血小板减少和/或 D-二聚体增加的患者必须怀疑 TTS。

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引用次数: 0

Sporadic fatal insomnia: a rapidly progressive phenotype resembling progressive supranuclear palsy. 零星致命性失眠：快速进展的 PSP 样表型。

Neurologia

Pub Date : 2024-11-01 Epub Date: 2024-02-20 DOI: 10.1016/j.nrleng.2024.02.005

J C Romero-Fábrega, R Lorenzo-López, E Rivas-Infante, F Escamilla-Sevilla, M Rashki, A Mínguez-Castellanos, A Carvajal-Hernández

引用次数: 0

Encephalitis after COVID-19 vaccination 接种 COVID-19 疫苗后出现脑炎。

Neurologia

Pub Date : 2024-10-01 DOI: 10.1016/j.nrleng.2024.02.002

引用次数: 0

Unilateral MRIgFUS thalamotomy: Long-term follow-up in fragile X-associated tremor/ataxia syndrome 单侧 MRIgFUS 丘脑切开术：脆性X相关震颤/共济失调综合征的长期随访

Neurologia

Pub Date : 2024-10-01 DOI: 10.1016/j.nrleng.2024.09.004

M. Campins-Romeu , R. Conde-Sardón , J.L. León-Guijarro , I. Sastre-Bataller

引用次数: 0

Ischemic encephalopathic debut of CADASIL, a case report: It is better to be safe than sorry CADASIL缺血性脑病首发病例报告：安全胜于遗憾

Neurologia

Pub Date : 2024-10-01 DOI: 10.1016/j.nrleng.2024.09.005

C. González-Mingot , A. Gil-Sánchez , R. Begué-Gómez , R. López-Ortega , B.R. Luis

引用次数: 0

Cerebral venous thrombosis in children an 18-year review of a Portuguese hospital 葡萄牙一家医院 18 年来的儿童脑静脉血栓病回顾

Neurologia

Pub Date : 2024-10-01 DOI: 10.1016/j.nrleng.2024.09.002

J. Tenente , S. Lopes , P. Bem , M. Vila-Real , D. Ferreira , A.F. Geraldo , F. Santos

Introduction

Cerebral venous thrombosis (CVT) is an uncommon and clinically heterogeneous cerebrovascular particularly in children, only a few published case series focused in the pediatric population.

Patients and methods

Retrospective single-center observational and analytical study of consecutive pediatric patients admitted in a level II Portuguese hospital with a confirmed diagnosis of CVT, from 2003 to 2021. Clinical presentation, neuroimaging findings, prothrombotic factors, treatment strategies, outcome and recanalization were documented.

Results

Twelve children were included (58% female). Mean age was 7.3 years. The most frequent symptoms were vomiting, headache and behavioral alterations. Infection was the triggering factor in 50% of the cases. The diagnosis of CVT was made based on imaging evidence of thrombosis through magnetic imaging resonance (MRI) with venography and/or computed tomography (CT) with venography. In 67% of cases there were multiples sinuses involved; the transverse sinus was the most affected, followed by the sigmoid sinus. In 83% of cases anticoagulant therapy was initiated with low molecular weight heparin (LMWH) and associated prothrombotic factors were investigated, with no major prothrombotic factors identified. No deaths occurred, but 30% had long-term neurological sequelae. One patient recurred 18 years later.

Conclusion

The results of this study are consistent with data from other published studies. MRI is the preferred imaging method for diagnosis in children by avoiding ionizing radiation and allowing identification of subjacent causes. Anticoagulation with LMWH is recommended and important to reduce mortality and sequelae. Infectious diseases are the most common trigger for CVT and can also be the cause for high morbidity and poor outcomes.

导言脑静脉血栓（CVT）是一种不常见的临床异质性脑血管病，尤其是在儿童中，只有少数发表的系列病例集中在儿科人群中。患者和方法对葡萄牙一家二级医院 2003 年至 2021 年连续收治的确诊为脑静脉血栓的儿科患者进行回顾性单中心观察和分析研究。研究记录了临床表现、神经影像学检查结果、血栓形成诱因、治疗策略、疗效和再通情况。平均年龄为 7.3 岁。最常见的症状是呕吐、头痛和行为改变。在50%的病例中，感染是诱发因素。CVT的诊断依据是通过磁共振成像（MRI）和静脉造影术和/或计算机断层扫描（CT）和静脉造影术获得的血栓形成影像学证据。67%的病例涉及多个静脉窦；横窦受影响最大，其次是乙状窦。83%的病例开始使用低分子量肝素（LMWH）进行抗凝治疗，并对相关的促血栓形成因素进行了调查，但未发现主要的促血栓形成因素。无死亡病例，但30%的患者有长期神经系统后遗症。结论本研究结果与其他已发表的研究数据一致。核磁共振成像可避免电离辐射，并能识别亚邻近病因，是诊断儿童疾病的首选成像方法。建议使用 LMWH 抗凝，这对降低死亡率和减少后遗症非常重要。感染性疾病是 CVT 最常见的诱因，也是导致高发病率和不良后果的原因。

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引用次数: 0

Psychometric properties of the Spanish version of the Frontal Assessment Battery (FAB-E) and normative values in a representative adult population sample 西班牙文版前额叶评估测验（FAB-E）的心理测量特性和具有代表性的成人样本的标准值。

Neurologia

Pub Date : 2024-10-01 DOI: 10.1016/j.nrleng.2022.09.004

Background

The Frontal Assessment Battery is a short bedside test used to assess executive functions (EF). The aims of the present study were, first, to evaluate the psychometric proprieties of the Spanish version of the FAB (FAB-E) in a representative sample, and second, to establish cut-off points for impairment in executive function according to age and education level.

Methods

A sample of 798 healthy Spanish adult subjects aged 19 to 91 participated in this study. Neuropsychological assessment of participants was conducted using the FAB-E, Mini-Mental State Examination (MMSE) and Trail Making Test (TMT). We examined internal consistency, intraclass correlation, test-retest reliability, and concurrent and divergent validity. In addition, we established a cut-off point for detecting executive function impairment based on the 5th percentile by age group and education level.

Results

The analysis of the psychometric properties of the FAB-E showed good internal consistency (Cronbach’s α = 0.60), intraclass correlation (0.72), test-retest reliability (0.70) and concurrent and divergent validity between the TMT (r = −0.523), MMSE (r = 0.426) and the FAB-E. The cut-off points for each age group were 16 points for the ≤ 29 group, 15 points for the 30-39 group, 14 points for the 40-49 and 50-59 groups, 12 points for the 60-69 group, and 10 points for the ≥ 70 age group.

Conclusions

The psychometric analysis showed that the FAB-E has good validity and reliability. Thus, FAB-E may be a helpful tool to evaluate EF in a healthy Spanish population. In addition, this study provides information on reference data that will be very valuable for clinicians and researchers.

背景介绍额叶评估测试（Frontal Assessment Battery）是一种用于评估执行功能（EF）的简短床边测试。本研究的目的首先是评估西班牙版前额叶评估测验（FAB-E）在代表性样本中的心理测量学特性，其次是根据年龄和教育水平确定执行功能受损的临界点：方法：798 名年龄在 19 至 91 岁之间的西班牙健康成年受试者参与了这项研究。我们使用 FAB-E、迷你精神状态检查（MMSE）和寻迹测验（TMT）对受试者进行了神经心理学评估。我们考察了内部一致性、类内相关性、重测可靠性、并发效度和发散效度。此外，我们还根据不同年龄组和教育程度的第 5 百分位数确定了检测执行功能障碍的临界点：FAB-E的心理测量学特性分析表明，TMT（r = -0.523）、MMSE（r = 0.426）和FAB-E之间具有良好的内部一致性（Cronbach's α = 0.60）、类内相关性（0.72）、测试-再测信度（0.70）以及并发和发散效度。各年龄组的分界点分别为：≤29 岁组 16 分，30-39 岁组 15 分，40-49 岁组和 50-59 岁组 14 分，60-69 岁组 12 分，≥70 岁组 10 分：心理测量分析表明，FAB-E 具有良好的有效性和可靠性。因此，FAB-E 可作为评估西班牙健康人群 EF 的有用工具。此外，这项研究还提供了参考数据信息，对临床医生和研究人员非常有价值。

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引用次数: 0

Kernohan-Woltman notch phenomenon: an exceptional neurological picture? 克诺汉-沃尔特曼缺口现象：一种特殊的神经症状？

Neurologia

Pub Date : 2024-10-01 DOI: 10.1016/j.nrleng.2022.09.010

Introduction

Ipsilateral hemiparesis (IH) can be defined as a paradoxical dysfunction of the first motor neuron involving the extremities on the opposite side to that expected, given the location of the triggering intracranial pathology. Compression of the corticospinal tract (CSt) along its course through the contralateral cerebral peduncle against the free edge of the tentorium, known as the Kernohan-Woltman notch phenomenon (KWNP), represents the main cause of IH.

Methods

This retrospective study analyses a series of 12 patients diagnosed with IH secondary to KWNP treated at our institution, including a descriptive study of epidemiological, clinical, radiological, neurophysiological, and prognostic variables.

Results

In 75% of the cases, symptoms had an acute or subacute onset. Initial imaging studies showed signs of significant mass effect in half of the patients, whereas magnetic resonance imaging (MRI) identified a structural lesion in the contralateral cerebral peduncle in two thirds of them. Impairment of the motor evoked potentials (MEP) was verified in 4 patients. During follow-up 7 patients experienced improvement in motor activity, and near half of the cases were classified in the first three categories of the modified Rankin scale.

Conclusions

In contrast to prior historical series, most of our patients developed a KWNP secondary to a traumatic mechanism. MRI represents the optimal method to identify both the classic cerebral peduncle notch and the underlying structural lesion of the CSt. The use of MEP can help to establish the diagnosis, especially in those cases lacking definite radiological findings.

导言：同侧偏瘫（IH）可定义为第一运动神经元的矛盾性功能障碍，根据颅内病变的诱发位置，该功能障碍累及与预期相反的一侧肢体。皮质脊髓束（CSt）在穿过对侧大脑脚的过程中受到触角游离缘的压迫，即克尔诺汉-沃尔特曼切迹现象（KWNP），是导致 IH 的主要原因：这项回顾性研究分析了在我院接受治疗的 12 例继发于 KWNP 的 IH 患者，包括对流行病学、临床、放射学、神经生理学和预后变量的描述性研究：在75%的病例中，症状均为急性或亚急性起病。最初的影像学检查显示，半数患者有明显的肿块效应，而磁共振成像（MRI）则发现其中三分之二的患者对侧大脑脚有结构性病变。经证实，4 名患者的运动诱发电位（MEP）受损。随访期间，7 名患者的运动活动有所改善，近半数病例被归入改良兰金量表的前三类：结论：与之前的历史研究相比，我们的大多数患者都是继发于创伤机制的 KWNP。磁共振成像是鉴别典型的脑干切迹和CSt潜在结构性病变的最佳方法。 MEP的使用有助于确诊，尤其是在缺乏明确放射学检查结果的病例中。

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引用次数: 0

Design and validation of a questionnaire for monitoring neurological dysphagia and respiratory deterioration in patients with amyotrophic lateral sclerosis (DEREDELA) 设计并验证用于监测肌萎缩性脊髓侧索硬化症患者神经性吞咽困难和呼吸恶化的调查问卷（DEREDELA）

Neurologia

Pub Date : 2024-10-01 DOI: 10.1016/j.nrleng.2024.09.003

S. Bermudo Fuenmayor , P.J. Serrano Castro , P. Quiroga Subirana , S. López Palmero , M.M. Requena Mullor , T. Parrón Carreño

Introduction

Amyotrophic lateral sclerosis (ALS) is a degenerative disease of unknown origin that affects the motor neurons. It has a rapid, fatal course.

Method

For this study, an initial questionnaire of eleven items was developed by experts in the field, who evaluated the suitability and relevance of the items.

Results

The questionnaire was then applied to a pilot group of 22 patients diagnosed with ALS. Confirmatory factor analysis, based on estimating maximum likelihood, confirmed the three domains detected in the exploratory factor analysis. The reliability of the scale was tested using Cronbach's α (0.801) and the Kaiser–Meyer–Olkin test (0.770) confirmed the construct validity.

Conclusions

The DEREDELA questionnaire is valid, in terms of its content, for monitoring the neurological dysphagia and respiratory deterioration suffered by patients diagnosed with ALS.

导言肌萎缩性脊髓侧索硬化症（ALS）是一种原因不明的退行性疾病，影响运动神经元。本研究由该领域的专家编制了一份包含 11 个项目的初始问卷，并由他们对这些项目的适用性和相关性进行了评估。基于最大似然估计的确认性因子分析证实了探索性因子分析中发现的三个领域。使用 Cronbach's α（0.801）检验了量表的可靠性，Kaiser-Meyer-Olkin 检验（0.770）证实了量表的建构效度。结论 DEREDELA 问卷的内容对于监测 ALS 患者的神经吞咽困难和呼吸衰竭是有效的。

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引用次数: 0

Cybersickness. A systematic literature review of adverse effects related to virtual reality 网络病。与虚拟现实有关的不良影响的系统文献综述

Neurologia

Pub Date : 2024-10-01 DOI: 10.1016/j.nrleng.2022.04.007

L. Simón-Vicente , S. Rodríguez-Cano , V. Delgado-Benito , V. Ausín-Villaverde , E. Cubo Delgado

Background

Virtual Reality (VR) uses computer technology to create a simulated environment. VR is a growing technology with promising extensive applications in different areas such as Medicine, entertainment, sports, gaming, and simulation. However, information about VR side effects is still limited. We aimed to identify the most frequent physical side effects caused by VR therapeutic applications.

Methodology

All available full-text articles evaluating VR as a therapeutic intervention and side effects using the Simulator Sickness Questionnaire (SSQ) between 2016 and 2021 were consulted across 4 electronic (Entrez Pubmed, Scopus, Science Direct, and Wiley databases). The methodological quality was assessed using the PEDro scale.

Results

Ten out of 55 reviewed articles (18%) met inclusion/exclusion criteria, including a sample of 416 patients, mean age of 24.54 (15–52.6) years old. According to the PEDro scale, two articles (20%) were considered good or excellent. Side effects were reported more frequently with head-mounted displays compared to desktop systems, especially disorientation, followed by nausea and oculomotor disturbances.

Conclusions

Although VR might have positive effects as a therapeutic tool, VR can also cause side events. As in any other therapeutic intervention, it is important to understand the effectiveness and safety before planning a VR intervention using a well-designed scientific methodology.

背景虚拟现实（VR）利用计算机技术创建模拟环境。VR 是一项不断发展的技术，有望在医学、娱乐、体育、游戏和模拟等不同领域得到广泛应用。然而，有关 VR 副作用的信息仍然有限。我们的目的是找出 VR 治疗应用最常见的身体副作用。研究方法通过 4 个电子数据库（Entrez Pubmed、Scopus、Science Direct 和 Wiley 数据库）查阅了 2016 年至 2021 年间所有使用模拟器疾病问卷（SSQ）评估 VR 作为治疗干预和副作用的全文文章。结果55篇综述文章中有10篇（18%）符合纳入/排除标准，包括416名患者样本，平均年龄为24.54（15-52.6）岁。根据 PEDro 评分标准，两篇文章（20%）被认为是良好或优秀。与桌面系统相比，头戴式显示器的副作用报告更为频繁，尤其是迷失方向，其次是恶心和眼球运动障碍。与其他任何治疗干预一样，在使用精心设计的科学方法规划 VR 干预之前，了解其有效性和安全性非常重要。

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