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Devan A Keesling, Jordan Paige Parker, Jason Tait Sanchez
iChirp-evoked auditory brainstem responses (ABRs) yield a larger wave V amplitude at low intensity levels than traditional broadband click stimuli, providing a reliable estimation of hearing sensitivity. However, advantages of iChirp stimulation at high intensity levels are unknown. We tested to see if high-intensity (i.e., 85 dBnHL) iChirp stimulation results in larger and more reliable ABR waveforms than click. Using the commercially available Intelligent Hearing System SmartEP platform, we recorded ABRs from 43 normal hearing young adults...
February 1, 2017: Audiology Research
M McDermott, T Jacobs, L Morgenstern
Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics...
2017: Handbook of Clinical Neurology
K van der Marel, S Vedantham, I M J van der Bom, M Howk, T Narain, K Ty, A Karellas, M J Gounis, A S Puri, A K Wakhloo
BACKGROUND AND PURPOSE: Advancements in medical device and imaging technology as well as accruing clinical evidence have accelerated the growth of the endovascular treatment of cerebrovascular diseases. However, the augmented role of these procedures raises concerns about the radiation dose to patients and operators. We evaluated patient doses from an x-ray imaging platform with radiation dose-reduction technology, which combined image noise reduction, motion correction, and contrast-dependent temporal averaging with optimized x-ray exposure settings...
January 19, 2017: AJNR. American Journal of Neuroradiology
Stephanie L Merhar, Vann Chau
Hypoxic-ischemic encephalopathy is associated with a high risk of morbidity and mortality in the neonatal period. Long-term neurodevelopmental disability is also frequent in survivors. Conventional MRI defines typical patterns of injury that reflect specific pathophysiologic mechanisms. Advanced magnetic resonance techniques now provide unique perspectives on neonatal brain metabolism, microstructure, and connectivity. The application of these imaging techniques has revealed that brain injury commonly occurs at or near the time of birth and evolves over the first weeks of life...
September 2016: Clinics in Perinatology
Christopher D Smyser, Emily W Y Tam, Taeun Chang, Janet S Soul, Steven P Miller, Hannah C Glass
BACKGROUND: Neonatal neurocritical care is a growing and rapidly evolving medical subspecialty, with increasing numbers of dedicated multidisciplinary clinical, educational, and research programs established at academic institutions. The growth of these programs has provided trainees in neurology, neonatology, and pediatrics with increased exposure to the field, sparking interest in dedicated fellowship training in fetal-neonatal neurology. OBJECTIVES: To meet this rising demand, increasing numbers of training programs are being established to provide trainees with the requisite knowledge and skills to independently deliver care for infants with neurological injury or impairment from the fetal care center and neonatal intensive care unit to the outpatient clinic...
October 2016: Pediatric Neurology
Carlos Cabral, Lana Kambeitz-Ilankovic, Joseph Kambeitz, Vince D Calhoun, Dominic B Dwyer, Sebastian von Saldern, Maria F Urquijo, Peter Falkai, Nikolaos Koutsouleris
Previous studies have shown that structural brain changes are among the best-studied candidate markers for schizophrenia (SZ) along with functional connectivity (FC) alterations of resting-state (RS) patterns. This study aimed to investigate effects of clinical and sociodemographic variables on the classification by applying multivariate pattern analysis (MVPA) to both gray matter (GM) volume and FC measures in patients with SZ and healthy controls (HC). RS and structural magnetic resonance imaging data (sMRI) from 74 HC and 71 SZ patients were obtained from a Mind Research Network COBRE dataset available via COINS (http://coins...
July 2016: Schizophrenia Bulletin
Linda J Kelly, Vicki L Sexton
Anti-N-methyl-D-aspartate receptor encephalitis is a newly described disease process. Patients are generally young females who present with psychiatric symptoms and progress to have seizures, abnormal movements, and. autonomic instability. Diagnosis is made based on serum and cerebrospinal fluid results, However, a characteristic EEG pattern described as extreme delta brush has been associated with this disorder making it especially relevant to neurodiagnostic technologists in practice today. Our case presentations follow two patients through the course of their illness and recovery...
June 2016: Neurodiagnostic Journal
Andrey Mazarati, Raman Sankar
The importance of comorbidities in determining the quality of life of individuals with epilepsy and their families has received increasing attention in the past decade. Along with it has come a recognition that in some individuals, certain comorbidities may have preexisted, and may have contributed to their developing epilepsy. Many mechanisms are capable of interconnecting different dysfunctions that manifest as distinct disorders, often diagnosed and managed by different specialists. We review the human data from the perspective of epidemiology as well as insights gathered from neurodiagnostic and endocrine studies...
July 1, 2016: Cold Spring Harbor Perspectives in Medicine
Melissa P Wasserstein, Mary Andriola, Georgianne Arnold, Alan Aron, Patricia Duffner, Richard W Erbe, Maria L Escolar, Lissette Estrella, Patricia Galvin-Parton, Alejandro Iglesias, Denise M Kay, David F Kronn, Joanne Kurtzberg, Jennifer M Kwon, Thomas J Langan, Paul A Levy, Thomas P Naidich, Joseph J Orsini, Joan E Pellegrino, James M Provenzale, David A Wenger, Michele Caggana
BACKGROUND: Early infantile Krabbe disease is rapidly fatal, but hematopoietic stem cell transplantation (HSCT) may improve outcomes if performed soon after birth. New York State began screening all newborns for Krabbe disease in 2006. METHODS: Infants with abnormal newborn screen results for Krabbe disease were referred to specialty-care centers. Newborns found to be at high risk for Krabbe disease underwent a neurodiagnostic battery to determine the need for emergent HSCT...
December 2016: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Misun Hwang, Giulio Zuccoli, Ashok Panigrahy, David Rodriguez, Michele D Poe, Maria L Escolar
OBJECTIVES: Evaluation of Krabbe disease burden and eligibility for hematopoietic stem cell transplantation are often based on neuroimaging findings using the modified Loes scoring system, which encompasses central but not peripheral nervous system changes. We show that quantitative evaluation of thickened cauda equina nerve roots may improve the evaluation of Krabbe disease and therapeutic guidance. METHODS: Lumbar spine MRI scans of patients obtained between March 2013 and September 2013 were retrospectively evaluated and compared to those of controls...
October 2016: European Radiology
Brent L Fogel, Saty Satya-Murti, Bruce H Cohen
PURPOSE OF REVIEW: The landscape of genetic diagnostic testing has changed dramatically with the introduction of next-generation clinical exome sequencing (CES), which provides an unbiased analysis of all protein-coding sequences in the roughly 21,000 genes in the human genome. Use of this testing, however, is currently limited in clinical neurologic practice by the lack of a framework for appropriate use and payer coverage. RECENT FINDINGS: CES can be cost-effective due to its high diagnostic yield in comparison to other genetic tests in current use and should be utilized as a routine diagnostic test in patients with heterogeneous neurologic phenotypes facing a broad genetic differential diagnosis...
April 2016: Neurology. Clinical Practice
Jonathan Nakhla, Rani Nasser, Reza Yassari, David Pasquale, David Altschul
BACKGROUND: Subarachnoid hemorrhage (SAH) caused by a ruptured cervical anterior spinal artery aneurysm is extremely rare and in the setting of cervical spondylosis. This case presentation reviews the diagnosis, management, and treatment of such aneurysms. CASE PRESENTATION: An 88-year-old female presented with the worst headache of her life without focal deficits. She was found to have diffuse SAH in the basal cisterns extending inferiorly down the spinal canal...
2016: Surgical Neurology International
Joseph J Orsini, Denise M Kay, Carlos A Saavedra-Matiz, David A Wenger, Patricia K Duffner, Richard W Erbe, Chad Biski, Monica Martin, Lea M Krein, Matthew Nichols, Joanne Kurtzberg, Maria L Escolar, Darius J Adams, Georgianne L Arnold, Alejandro Iglesias, Patricia Galvin-Parton, David F Kronn, Jennifer M Kwon, Paul A Levy, Joan E Pellegrino, Natasha Shur, Melissa P Wasserstein, Michele Caggana
PURPOSE: Krabbe disease (KD) results from galactocerebrosidase (GALC) deficiency. Infantile KD symptoms include irritability, progressive stiffness, developmental delay, and death. The only potential treatment is hematopoietic stem cell transplantation. New York State (NYS) implemented newborn screening for KD in 2006. METHODS: Dried blood spots from newborns were assayed for GALC enzyme activity using mass spectrometry, followed by molecular analysis for those with low activity (≤12% of the daily mean)...
March 2016: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Susan D Agostini, Ann M Bonner
PURPOSE: To determine and describe the contribution of Neurodiagnostic (ND) technologists in achieving better patient outcomes. METHODS: An online survey was distributed to ND services leadership (administrators, laboratory managers, supervisors, team leads, service owners, and Medical Directors) in the United States (U.S.) to assess the impact of ND professionals and credentialing on improved patient care. The 9-question internet survey addressed three sections: 1) Participant demographics; 2) Quality improvement with credentialing; 3) Value in obtaining credentials...
December 2015: Neurodiagnostic Journal
Dara V Albert, Charles P Pluto, Amanda Weber, Jorge Vidaurre, Fatima Barbar-Smiley, Rabheh Abdul Aziz, Kyla Driest, Sharon Bout-Tabaku, Lynne Ruess, Jerome A Rusin, Bethanie Morgan-Followell
BACKGROUND: Autoimmune encephalitis is currently a clinical diagnosis without widely accepted diagnostic criteria, often leading to a delay in diagnosis. The utility of magnetic resonance imaging (MRI) and electroencephalography (EEG) in this disease is unknown. The objective of this study was to identify disease-specific patterns of neurodiagnostic studies (MRI and EEG) for autoimmune encephalitis in children. METHODS: We completed a retrospective chart review of encephalopathic patients seen at a large pediatric hospital over a four year interval...
February 2016: Pediatric Neurology
Chad Poage, Charles Roth, Brandon Scott
Peroneal nerve palsy is the most common entrapment neuropathy of the lower extremity. Numerous etiologies have been identified; however, compression remains the most common cause. Although injury to the nerve may occur anywhere along its course from the sciatic origin to the terminal branches in the foot and ankle, the most common site of compressive pathology is at the level of the fibular head. The most common presentation is acute complete or partial foot drop. Associated numbness in the foot or leg may be present, as well...
January 2016: Journal of the American Academy of Orthopaedic Surgeons
Rafal Janik, Lynsie A M Thomason, Andrew M Stanisz, Paul Forsythe, John Bienenstock, Greg J Stanisz
The gut microbiome has been shown to regulate the development and functions of the enteric and central nervous systems. Its involvement in the regulation of behavior has attracted particular attention because of its potential translational importance in clinical disorders, however little is known about the pathways involved. We previously have demonstrated that administration of Lactobacillus rhamnosus (JB-1) to healthy male BALB/c mice, promotes consistent changes in GABA-A and -B receptor sub-types in specific brain regions, accompanied by reductions in anxiety and depression-related behaviors...
January 15, 2016: NeuroImage
Carlos Minaya, Samuel R Atcherson
The purpose of this study was to revisit the two-channel, simultaneous click-evoked extratympanic electrocochleography and auditory brainstem response (ECoG/ABR) recording technique for clinical use in normal hearing participants. Recording the compound action potential (AP) of the ECoG simultaneously with ABR may be useful when Wave I of the ABR is small or diminished in patients with sensorineural or retrocochlear disorder and minimizes overall test time. In contrast to some previous studies that used the extratympanic electrode both as non-inverting electrode for the ECoG and inverting electrode for ABR, this study maintained separate recording channel montages unique to conventional click-evoked ECoG and ABR recordings...
January 21, 2015: Audiology Research
Hannah C McLane, Aaron L Berkowitz, Bryan N Patenaude, Erica D McKenzie, Emma Wolper, Sarah Wahlster, Günther Fink, Farrah J Mateen
OBJECTIVE: To determine the availability, accessibility, and affordability of EEG, EMG, CSF analysis, head CT, and brain MRI for neurologic disorders across countries. METHODS: An online, 60-question survey was distributed to neurology practitioners in 2014 to assess the presence, wait time, and cost of each test in private and public health sectors. Data were stratified by World Bank country income group. Affordability was calculated with reference to the World Health Organization's definition of catastrophic health expenditure as health-related out-of-pocket expenditure of >40% of disposable household income, and assessment of providers' perceptions of affordability to the patient...
November 3, 2015: Neurology
Babak Bakhshinejad, Marzieh Karimi, Mohammad Khalaj-Kondori
The blood brain barrier represents a formidable obstacle for the transport of most systematically administered neurodiagnostics and neurotherapeutics to the brain. Phage display is a high throughput screening strategy that can be used for the construction of nanomaterial peptide libraries. These libraries can be screened for finding brain targeting peptide ligands. Surface functionalization of a variety of nanocarriers with these brain homing peptides is a sophisticated way to develop nanobiotechnology-based drug delivery platforms that are able to cross the blood brain barrier...
June 2015: Neural Regeneration Research
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