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Emergency neurology

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https://www.readbyqxmd.com/read/28526917/do-we-know-the-outcome-predictors-for-cauda-equine-syndrome-ces-a-retrospective-single-center-analysis-of-60-patients-with-ces-with-a-suggestion-for-a-new-score-to-measure-severity-of-symptoms
#1
Alexander König, Lisa Amelung, Marco Danne, Ullrich Meier, Johannes Lemcke
OBJECTIVE: Despite the awareness and familiarity of almost every medical professional with the cauda equine compression syndrome (CES), risk factors for a poor prognosis of the disease remain elusive. Even the relationship between subsequent outcome and the time elapsed from the time of appearance of symptoms to surgery taking place remain obscure. The aim of our study, therefore, was to analyze a relatively large population of our own patients studied consecutively, to identify outcome predictors for CES and to propose a clinical score for CES symptoms (Berlin CES score)...
May 19, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28526435/the-bidirectional-gut-brain-microbiota-axis-as-a-potential-nexus-between-traumatic-brain-injury-inflammation-and-disease
#2
Mark H Sundman, Nan-Kuei Chen, Vignesh Subbian, Ying-Hui Chou
As head injuries and their sequelae have become an increasingly salient matter of public health, experts in the field have made great progress elucidating the biological processes occurring within the brain at the moment of injury and throughout the recovery thereafter. Given the extraordinary rate at which our collective knowledge of neurotrauma has grown, new insights may be revealed by examining the existing literature across disciplines with a new perspective. This article will aim to expand the scope of this rapidly evolving field of research beyond the confines of the central nervous system (CNS)...
May 16, 2017: Brain, Behavior, and Immunity
https://www.readbyqxmd.com/read/28523433/structural-and-functional-roles-of-ether-lipids
#3
REVIEW
John M Dean, Irfan J Lodhi
Ether lipids, such as plasmalogens, are peroxisome-derived glycerophospholipids in which the hydrocarbon chain at the sn-1 position of the glycerol backbone is attached by an ether bond, as opposed to an ester bond in the more common diacyl phospholipids. This seemingly simple biochemical change has profound structural and functional implications. Notably, the tendency of ether lipids to form non-lamellar inverted hexagonal structures in model membranes suggests that they have a role in facilitating membrane fusion processes...
May 18, 2017: Protein & Cell
https://www.readbyqxmd.com/read/28523230/targeting-resolution-of-neuroinflammation-after-ischemic-stroke-with-a-lipoxin-a4-analog-protective-mechanisms-and-long-term-effects-on-neurological-recovery
#4
Kimberly E Hawkins, Kelly M DeMars, Jon C Alexander, Lauren G de Leon, Sean C Pacheco, Christina Graves, Changjun Yang, Austin O McCrea, Jan C Frankowski, Timothy J Garrett, Marcelo Febo, Eduardo Candelario-Jalil
BACKGROUND: Resolution of inflammation is an emerging new strategy to reduce damage following ischemic stroke. Lipoxin A4 (LXA 4) is an anti-inflammatory, pro-resolution lipid mediator that reduces neuroinflammation in stroke. Since LXA 4 is rapidly inactivated, potent analogs have been synthesized, including BML-111. We hypothesized that post-ischemic, intravenous treatment with BML-111 for 1 week would provide neuroprotection and reduce neurobehavioral deficits at 4 weeks after ischemic stroke in rats...
May 2017: Brain and Behavior
https://www.readbyqxmd.com/read/28521593/use-of-high-frequency-percussive-ventilation-to-expand-organ-donor-pool
#5
Francis Benn, Ashwad Afzal, Berhane Worku, Felix Khusid, Bashar H Fahoum, Iosif Gulkarov
A 34-year-old woman was brought in to the emergency department after a motor vehicle accident. She had signs of traumatic head injury with Glasgow Coma Scale score of 3, and her neurological examination was consistent with brain death. She was persistently hypoxic on conventional mechanical ventilation and high-frequency percussive ventilation was initiated. The patient's oxygenation improved and was sustained long enough to provide time for organ procurement. This is the first case portraying high-frequency percussive ventilation as a bridge for donors failing on conventional mechanical ventilation...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28521343/tarlov-cyst-causing-sacral-insufficiency-fracture
#6
Ross C Puffer, Marcus J Gates, William Copeland, William E Krauss, Jeremy Fogelson
BACKGROUND AND IMPORTANCE: Tarlov cysts, also known as perineural cysts, have been described as meningeal dilations of the spinal nerve root sheath between the peri- and endoneurium at the dorsal root ganglion. Most often they are found in the sacrum involving the nerve roots. Normally asymptomatic, they have been reported to present with radiculopathy, paresthesias, and even urinary or bowel dysfunction. Sacral insufficiency has not been a well-documented presentation. CLINICAL PRESENTATION: The patient is a 38-year-old female who started to develop left low back pain and buttock pain that rapidly progressed into severe pain with some radiation down the posterior aspect of her left leg...
June 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28520614/incidence-of-neurological-disorders-among-hiv-infected-individuals-with-universal-health-care-in-taiwan-2000-through-2010
#7
Yi-Tseng Tsai, Yen-Chin Chen, Chen-Yang Hsieh, Wen-Chien Ko, Nai-Ying Ko
OBJECTIVE: To determine the incidence of and factors associated with neurological disorders in a large Taiwanese cohort of HIV-infected persons with free access to highly active antiretroviral therapy (HAART). DESIGN: A retrospective population-based cohort study was conducted using the National Health Insurance Research Database for the years 2000-2010. METHODS: We identified 13,316 HIV-positive persons from 2000 through 2010. We used direct standardization to calculate age- and sex-adjusted incidence rates based on the 2000 World Health Organization world standard population...
May 17, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/28516363/posterior-reversible-encephalopathy-syndrome-presenting-in-the-anterior-circulation-with-malignant-intracranial-hypertension-requiring-surgical-decompression-a-case-report-and-literature-review
#8
S Hernández-Durán, A Barrantes-Freer, V Rohde, C von der Brelie
Posterior reversible encephalopathy syndrome (PRES) is thought to result from endothelial dysfunction and breakdown of the blood-brain barrier with subsequent vasogenic edema. Abrupt hypertension has been identified as one of its risk factors. We present a rare case of PRES in the anterior circulation with sudden onset of left hemiparesis and rapid neurological deterioration on the basis of hypertensive crisis. Due to refractory intracranial hypertension, the patient required emergent right decompressive craniectomy...
May 17, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28515272/racial-disparities-in-neurologic-health-care-access-and-utilization-in-the-united-states
#9
Altaf Saadi, David U Himmelstein, Steffie Woolhandler, Nicte I Mejia
OBJECTIVE: To evaluate racial and ethnic differences in the utilization of neurologic care across a wide range of neurologic conditions in the United States. METHODS: We analyzed nationally representative data from the 2006-2013 Medical Expenditure Panel Survey (MEPS), including information on demographics, patient-reported health conditions, neurology visit rates, and costs. Using diagnostic codes, we identified persons with any self-identified neurologic disorder except back pain, as well as 5 subgroups (Parkinson disease, multiple sclerosis, headache, cerebrovascular disease, and epilepsy)...
May 17, 2017: Neurology
https://www.readbyqxmd.com/read/28514888/seeing-is-believing-healthcare-professionals-perceptions-of-a-complex-intervention-to-improve-care-towards-the-end-of-life-a-qualitative-interview-study
#10
Katherine Bristowe, Irene Carey, Adrian Hopper, Susanna Shouls, Wendy Prentice, Irene J Higginson, Jonathan Koffman
BACKGROUND: Methods to improve care, trust and communication are important in acute hospitals. Complex interventions aimed at improving care of patients approaching the end of life are increasingly common. While evaluating outcomes of complex interventions is essential, exploring healthcare professionals' perceptions is also required to understand how they are interpreted; this can inform training, education and implementation strategies to ensure fidelity and consistency in use. AIM: To explore healthcare professionals' perceptions of using a complex intervention (AMBER care bundle) to improve care for people approaching the end of life and their understandings of its purpose within clinical practice...
May 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28512444/longitudinal-quantification-of-eye-movement-impairments-after-pontine-hemorrhage
#11
Melis Suner, Glen T Prusky, Jason B Carmel, N Jeremy Hill
INTRODUCTION: We report a case of hypertrophic olivary degeneration due to pontine hemorrhage. A 59-year-old male with untreated hypertension suffered a primary pontine hemorrhage, which caused horizontal eye-movement limitation. Progressive neurological deterioration with involuntary eye and palatal movements began months after hemorrhage. This was accompanied by magnetic resonance imaging evidence of hypertrophic olivary degeneration at 4.5 months. BACKGROUND: Primary pontine hemorrhage often leads to impairment of eye movements and diplopia...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28512320/hyponatremia-upon-presentation-to-the-emergency-department-the-need-for-urgent-neuroimaging-studies
#12
Arne Bokemeyer, Rainer Dziewas, Heinz Wiendl, Wolfram Schwindt, Paul Bicsán, Philipp Kümpers, Hermann Pavenstädt
This study aims to evaluate the necessity of urgent neuroimaging for emergency admissions exhibiting symptomatology of profound hyponatremia. We retrospectively analyzed the medical records of all patients admitted to the emergency room of the University Hospital Münster from 2010 to 2014 with a serum sodium value < 125 mmol/L. From 52918 emergency admissions, 261 patients with profound hyponatremia were identified, of whom 140 (54%) had neurological symptoms. Unspecific weakness and confusion were the most prevalent of these symptoms (59%)...
May 16, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28511987/human-parechovirus-type-3-infection-an-emerging-infection-in-neonates-and-young-infants
#13
REVIEW
Yuta Aizawa, Ryohei Izumita, Akihiko Saitoh
Human parechoviruses (HPeVs) are RNA viruses that have characteristics similar to those of enteroviruses and usually cause mild respiratory or gastrointestinal symptoms. Human parechovirus type 3 (HPeV3), first reported in 2004, is exceptional because it can provoke sepsis and meningoencephalitis leading to neurological sequelae, and even death, in neonates and young infants. Pediatricians and researchers are increasingly aware that HPeV3 is responsible for serious disease in neonates and young infants. Retrospective studies and several reports of epidemics of HPeV3 infection have provided data on epidemiology, clinical symptoms and signs, laboratory findings, and outcomes...
May 13, 2017: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
https://www.readbyqxmd.com/read/28511475/colour-doppler-evaluation-of-extracranial-carotid-artery-in-patients-presenting-with-acute-ischemic-stroke-and-correlation-with-various-risk-factors
#14
Samrin Haq, Manoj Mathur, Jasvir Singh, Navkiran Kaur, Raminderpal Singh Sibia, Rajesh Badhan
INTRODUCTION: Stroke is defined as an abrupt onset of neurologic deficit due to vascular cause. It is one of the leading causes of mortality and morbidity all over the world making early diagnosis and treatment inevitable. Lesions of extra cranial carotid arteries are implicated in majority of cases of acute ischemic stroke. Carotid Doppler is a non-invasive imaging technique, with sensitivity approaching that of angiography. Computed Tomography (CT) plays a major role to assess the site and nature of the lesion in patients with acute ischemic stroke...
March 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28510745/neural-network-imaging-to-characterize-brain-injury-in-cardiac-procedures-the-emerging-utility-of-connectomics
#15
B Indja, J P Fanning, J J Maller, J F Fraser, P G Bannon, M Vallely, S M Grieve
Cognitive dysfunction is a poorly understood but potentially devastating complication of cardiac surgery. Clinically meaningful assessment of cognitive changes after surgery is problematic because of the absence of a means to obtain reproducible, objective, and quantitative measures of the neural disturbances that cause altered brain function. By using both structural and functional connectivity magnetic resonance imaging data to construct a map of the inter-regional connections within the brain, connectomics has the potential to increase the specificity and sensitivity of perioperative neurological assessment, permitting rational individualized assessment and improvement of surgical techniques...
May 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28508972/development-of-intracerebral-hemorrhage-in-the-short-term-clinical-course-of-a-patient-with-microscopic-polyangiitis-without-neurological-symptoms-at-diagnosis-an-autopsy-case
#16
Yoshia Miyawaki, Takayuki Katsuyama, Ken-Ei Sada, Kohei Taniguchi, Yuki Kakio, Jun Wada
A 77-year-old man with high-grade fever, progressive renal dysfunction, high serum level of C-reactive protein and positive serum myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) was diagnosed with microscopic polyangiitis with rapidly progressive glomerulonephritis, and remission induction treatment with glucocorticoids and intravenous cyclophosphamide was initiated. Although his general condition improved in a short time, intracerebral hemorrhage occurred 12 days after the initiation of treatment and emergent hematoma evacuation was performed...
November 2016: CEN Case Reports
https://www.readbyqxmd.com/read/28508288/repetitive-postoperative-extubation-failure-and-cardiac-arrest-due-to-laryngomalacia-after-general-anesthesia-in-an-elderly-patient-a-case-report
#17
Jun Takeshita, Kei Nishiyama, Masashi Fujii, Hiroyuki Tanaka, Satoru Beppu, Nozomu Sasahashi, Nobuaki Shime
The authors report a case involving an elderly patient who experienced repetitive perioperative cardiac arrest caused by laryngomalacia. The patient underwent surgery under general anesthesia; however, 2 h after initial extubation, he experienced cardiopulmonary arrest. Return of spontaneous circulation was achieved by immediate resuscitation. Four hours later, a second extubation was performed without any neurological complications. However, 2 h later, he experienced cardiopulmonary arrest again. Immediately after the third extubation, 12 h after the second cardiopulmonary arrest, fiberoptic laryngoscopy revealed laryngomalacia...
May 15, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28503386/mechanical-thrombectomy-for-acute-ischemic-stroke-after-cardiac-surgery
#18
Ali S Haider, Prabhat Garg, Ian T Watson, Dean Leonard, Umair Khan, Ahmed Haque, Phu Nguyen, Kennith F Layton
Ischemic stroke is a rare yet devastating complication that may occur following cardiothoracic surgery. Fibrinolytic treatment is contraindicated due to elevated risk for hemorrhage. Mechanical thrombectomy entails a catheterized approach wherein the thrombus is physically removed from the vessel without the use of fibrinolytics, minimizing the possibility of intracranial hemorrhage. Here, we present two original cases of mechanical thrombectomy as treatment for patients experiencing emergent large vessel occlusion following cardiothoracic surgery...
April 11, 2017: Curēus
https://www.readbyqxmd.com/read/28502562/grade-1-spetzler-and-martin-cerebral-ruptured-arteriovenous-malformations-treated-by-microsurgery-poor-functional-outcome-is-related-to-injury-from-haemorrhage
#19
R Aboukaïs, M Quidet, M Baroncini, P Bourgeois, X Leclerc, M Vinchon, J-P Lejeune
INTRODUCTION: Ruptured arteriovenous malformations (rAVM) are life-threatening diseases. OBJECTIVE: To evaluate the outcome of patients with grade 1 SPM rAVM after microsurgical treatment. MATERIALS AND METHOD: We retrospectively included 64 consecutive operated patients with a grade 1 SPM rAVM in our institution between 2002 and 2012. Complications related to the surgical procedure were recorded. All patients were re-evaluated 3months after treatment using the modified Rankin Scale score (mRS)...
May 11, 2017: Neuro-Chirurgie
https://www.readbyqxmd.com/read/28501386/atrioesophageal-fistula-after-ablation-for-atrial-fibrillation
#20
Trisha Mackle, Kevin Pistawka
BACKGROUND: Atrioesophageal fistula (AEF) is a rare and highly fatal complication of ablation procedures for atrial fibrillation. We report a diagnostically challenging case of AEF that highlights the unfortunate outcome that can be expected when this condition is not promptly diagnosed and managed accordingly. The varied clinical presentations are reviewed and recommended diagnostic and management approaches are presented. CASE REPORT: A 79-year-old female who was 5 weeks post-ablation presented to a community emergency department with chest pain and a transient episode of left-arm weakness...
May 10, 2017: Journal of Emergency Medicine
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