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Emergency neurology

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https://www.readbyqxmd.com/read/28433337/increased-resource-utilization-and-overall-morbidity-are-associated-with-general-versus-regional-anesthesia-for-carotid-endarterectomy-in-data-collected-by-the-michigan-surgical-quality-collaborative
#1
Ahmad S Hussain, Andrew Mullard, William F Oppat, Kevin D Nolan
OBJECTIVE: Advocates for performing carotid endarterectomy (CEA) under regional anesthesia (RA) cite reduction in hemodynamic instability and the ability for neurologic monitoring, but many still prefer general anesthesia (GA) as benefits of RA have not been clearly demonstrated, reliable RA may not be available in all centers, and a certain amount of movement by the patient during the procedure may not be uniformly tolerated. We evaluated the association of anesthesia type and perioperative morbidity and mortality as well as resource utilization in patients undergoing CEA using the Michigan Surgical Quality Collaborative (MSQC) database...
April 19, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28432975/vaccination-strategies-against-zika-virus
#2
REVIEW
Estefania Fernandez, Michael S Diamond
The epidemic emergence of Zika virus (ZIKV) in 2015-2016 has been associated with congenital malformations and neurological sequela. Current efforts to develop a ZIKV vaccine build on technologies that successfully reduced infection or disease burden against closely related flaviviruses or other RNA viruses. Subunit-based (DNA plasmid and modified mRNA), viral vectored (adeno- and measles viruses) and inactivated viral vaccines are already advancing to clinical trials in humans after successful mouse and non-human primate studies...
April 19, 2017: Current Opinion in Virology
https://www.readbyqxmd.com/read/28431906/transgenic-mice-with-increased-astrocyte-expression-of-ccl2-show-altered-behavioral-effects-of-alcohol
#3
Jennifer G Bray, Amanda J Roberts, Donna L Gruol
Emerging research provides strong evidence that activation of CNS glial cells occurs in neurological diseases and brain injury and results in elevated production of neuroimmune factors. These factors can contribute to pathophysiological processes that lead to altered CNS function. Recently, studies have also shown that both acute and chronic alcohol consumption can produce activation of CNS glial cells and the production of neuroimmune factors, particularly the chemokine CCL2. The consequences of alcohol-induced increases in CCL2 levels in the CNS have yet to be fully elucidated...
April 18, 2017: Neuroscience
https://www.readbyqxmd.com/read/28431590/delays-in-door-to-needle-time-for-acute-ischemic-stroke-in-the-emergency-department-a-comprehensive-stroke-center-experience
#4
Ashkan Mowla, Jordan Doyle, Navdeep S Lail, Hamidreza Rajabzadeh-Oghaz, Christopher Deline, Peyman Shirani, Marilou Ching, Annemarie Crumlish, Deborah A Steck, David Janicke, Elad I Levy, Robert N Sawyer
BACKGROUND: Current American Stroke Association guidelines recommend initiating intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) within 60min of patient arrival, given the benefits of IVT for AIS are time dependent. This study aimed to identify the delaying factors in door-to-needle time (DTN) in the emergency department of one of the largest comprehensive stroke centers in New York State. We also recommended measures to reduce the delays. METHODS: We retrospectively reviewed the medical charts of all AIS patients who received IVT in our emergency department patients between April 1, 2012 and December 31, 2015 to identify those with a DTN time of >60min...
May 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28431508/association-between-cardiopulmonary-resuscitation-duration-and-one-month-neurological-outcomes-for-out-of-hospital-cardiac-arrest-a-prospective-cohort-study
#5
Masahiro Kashiura, Yuichi Hamabe, Akiko Akashi, Atsushi Sakurai, Yoshio Tahara, Naohiro Yonemoto, Ken Nagao, Arino Yaguchi, Naoto Morimura
BACKGROUND: The duration of cardiopulmonary resuscitation (CPR) is an important factor associated with the outcomes for an out-of-hospital cardiac arrest. However, the appropriate CPR duration remains unclear considering pre- and in-hospital settings. The present study aimed to evaluate the relationship between the CPR duration (including both the pre- and in-hospital duration) and neurologically favorable outcomes 1-month after cardiac arrest. METHODS: Data were utilized from a prospective multi-center cohort study of out-of-hospital cardiac arrest patients transported to 67 emergency hospitals between January 2012 and March 2013 in the Kanto area of Japan...
April 21, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28430857/repurposed-drugs-targeting-eif2%C3%AE-p-mediated-translational-repression-prevent-neurodegeneration-in-mice
#6
Mark Halliday, Helois Radford, Karlijn A M Zents, Collin Molloy, Julie A Moreno, Nicholas C Verity, Ewan Smith, Catharine A Ortori, David A Barrett, Martin Bushell, Giovanna R Mallucci
Signalling through the PERK/eIF2α-P branch of the unfolded protein response plays a critical role in controlling protein synthesis rates in cells. This pathway is overactivated in brains of patients with Alzheimer's disease and related disorders and has recently emerged as a promising therapeutic target for these currently untreatable conditions. Thus, in mouse models of neurodegenerative disease, prolonged overactivation of PERK/eIF2α-P signalling causes sustained attenuation of protein synthesis, leading to memory impairment and neuronal loss...
April 19, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/28430850/trends-in-hospitalization-for-hypertensive-emergency-and-relationship-of-end-organ-damage-with-in-hospital-mortality
#7
Mahek Shah, Shantanu Patil, Brijesh Patel, Shilpkumar Arora, Nilay Patel, Lohit Garg, Sahil Agrawal, Larry Jacobs, Susan P Steigerwalt, Matthew W Martinez
BACKGROUND: There are no comprehensive guidelines on management of hypertensive emergency (HTNE) and complications. Despite advances in antihypertensive medications HTNE is accompanied with significant morbidity and mortality. METHODS: We queried the 2002-2012 nationwide inpatient sample database to identify patients with HTNE. Trends in incidence of HTNE and in-hospital mortality were analyzed. Logistic regression analysis was used to assess the relationship between end-organ complications and in-hospital mortality...
April 20, 2017: American Journal of Hypertension
https://www.readbyqxmd.com/read/28430097/zika-virus-update-more-on-an-emerging-arboviral-disease-in-the-western-hemisphere
#8
Kelly G Vest
Zika virus has captivated the world with its quick spread throughout the Western Hemisphere. Increased emphasis has been placed on the infection of pregnant women and subsequent adverse and severe effects in the developing fetus and newborn. This article supplements a previous article and provides updated information on new and evolving evidence that strengthens the association between Zika virus and unique congenital and neurologic diseases, updates what is known about the epidemiology of the disease, and provides new and updated material for primary care providers as they counsel patients who may be exposed or infected...
April 2017: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/28429801/the-dizzy-patient-don-t-forget-disorders-of-the-central-vestibular-system
#9
REVIEW
Thomas Brandt, Marianne Dieterich
Vertigo and dizziness are among the most common complaints in neurology clinics, and they account for about 13% of the patients entering emergency units. In this Review, we focus on central vestibular disorders, which are mostly attributable to acute unilateral lesions of the bilateral vestibular circuitry in the brain. In a tertiary interdisciplinary outpatient dizziness unit, central vestibular disorders, including vestibular migraine, comprise about 25% of the established diagnoses. The signs and symptoms of these disorders can mimic those of peripheral vestibular disorders with sustained rotational vertigo...
April 21, 2017: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/28427827/antiviral-screen-identifies-ev71-inhibitors-and-reveals-camptothecin-target-dna-topoisomerase-1-as-a-novel-ev71-host-factor
#10
Kan Xing Wu, Justin Jang-Hann Chu
Enterovirus 71 (EV71) is one of the causative agents of hand, foot and mouth disease (HFMD) associated with severe neurological disease. EV71's pathogenesis remains poorly understood and the lack of approved antiviral has led to its emergence as a clinically important neurotropic virus. The goals of this study were to: (i) identify novel anti-EV71 compounds that may serve as lead molecules for therapeutics; and (ii) investigate their targets in downstream studies. We screened a 502-compound library of highly purified natural products for anti-EV71 activities in a cell-based immunofluorescence assay that were then confirmed in viral plaque reduction assays...
April 17, 2017: Antiviral Research
https://www.readbyqxmd.com/read/28427784/prehospital-removal-improves-neurological-outcomes-in-elderly-patient-with-foreign-body-airway-obstruction
#11
Yutaka Igarashi, Shoji Yokobori, Yudai Yoshino, Tomohiko Masuno, Masato Miyauchi, Hiroyuki Yokota
OBJECTIVE: In Japan, the number of patients with foreign body airway obstruction by food is rapidly increasing with the increase in the population of the elderly and a leading cause of unexpected death. This study aimed to determine the factors that influence prognosis of these patients. METHODS: This is a retrospective single institutional study. A total of 155 patients were included. We collected the variables from the medical records and analyzed them to determine the factors associated with patient outcome...
April 10, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28425262/copeptin-levels-in-carbon-monoxide-poisoning
#12
Güler Irem, Yunsur Çevik, Ahmet Turgut Keskin, Emine Emektar, Osman Lütfi Demirci, Tuba Şafak, Gülşah Çikrikçi Işik, Kadir Okhan Akin
BACKGROUND/AIM: The aim of this study is to identify the copeptin levels in patients presenting with carbon monoxide (CO) poisoning to the emergency department and to investigate its correlation with the neurological effects. MATERIALS AND METHODS: The study group consisted of patients presenting with CO poisoning and carboxyhemoglobin levels >10%. Blood samples for copeptin levels were obtained twice, first at presentation then at the fourth hour of observation...
April 18, 2017: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/28424044/emergent-carotid-thromboendarterectomy-for-acute-symptomatic-occlusion-of-the-extracranial-internal-carotid-artery
#13
Igor Gunka, Dagmar Krajickova, Michal Lesko, Stanislav Jiska, Jan Raupach, Miroslav Lojik, Radovan Maly
BACKGROUND: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. METHODS: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015...
May 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28423044/the-long-term-outcome-of-micturition-defecation-and-sexual-function-after-spinal-surgery-for-cauda-equina-syndrome
#14
Nina S Korse, Anna B Veldman, Wilco C Peul, Carmen L A Vleggeert-Lankamp
BACKGROUND: Cauda equina syndrome (CES) is a rare neurologic complication of lumbar herniated disc for which emergency surgical decompression should be undertaken. Despite the common belief that the restoration of functions that are affected by CES can take several years postoperatively, follow up seldom exceeds the first year after surgery. Long term outcome of especially micturition, defecation and sexual function-which are by definition affected in CES-are unknown. The aim of this study is to evaluate 1) postoperative long term outcome of micturition, defecation and sexual function in CES patients 2) attitude of patients towards received hospital care with regard to (recovery of) these functions...
2017: PloS One
https://www.readbyqxmd.com/read/28421841/adolescent-with-prolonged-toxidrome
#15
Jami Johnson, Kristie Williams, William Banner
A 13-year-old female was presented to the emergency department following an intentional ingestion. The patient developed significant toxicity including multiple, discreet tonic-clonic seizures. Despite appropriate resuscitation and antidotal management, the patient's symptoms persisted for more than 36 hours post-ingestion. An upright abdominal radiograph was performed revealing a radiopacity suggesting a pharmacobezoar. An esophagogastroduodenoscopy was performed with successful removal of a tennis ball-sized pharmacobezoar...
June 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28418788/factors-associated-with-delayed-cooling-in-cardiac-arrest-patients
#16
David A Pearson, Katherine Mayer, Catherine M Wares, Michael S Runyon, Jonathan R Studnek, Shana L Ward, Kathi M Kraft, Alan C Heffner
Therapeutic hypothermia has been shown to improve neurologic outcome in medical cardiac arrest patients, yet little is known about factors that delay target temperature achievement. Our primary aim was to identify factors associated with not achieving our institutional "door-to-cool" (DTC) performance goal (emergency department [ED] arrival to temperature of 34°C) of ≤4 hours. Secondary aims included whether achievement of DTC goal was associated with timing of bolus neuromuscular blockade (NMB), survival, or functional outcome...
April 18, 2017: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/28417441/relationships-between-essential-manganese-biology-and-manganese-toxicity-in-neurological-disease
#17
REVIEW
Anna C Pfalzer, Aaron B Bowman
PURPOSE OF REVIEW: Manganese (Mn) is critical for neurodevelopment but also has been implicated in the pathophysiology of several neurological diseases. We discuss how Mn requirements intersect with Mn biology and toxicity, and how these requirements may be altered in neurological disease. Furthermore, we discuss the emerging evidence that the level of Mn associated with optimal overall efficiency for Mn biology does not necessarily coincide with optimal cognitive outcomes. RECENT FINDINGS: Studies have linked Mn exposures with urea cycle metabolism and autophagy, with evidence that exposures typically neurotoxic may be able to correct deficiencies in these processes at least short term...
April 17, 2017: Current Environmental Health Reports
https://www.readbyqxmd.com/read/28416395/the-early-history-of-manganese-and-the-recognition-of-its-neurotoxicity-1837-1936
#18
Paul D Blanc
The history of the biomedical recognition manganese-caused neurotoxicity mirrors changing technologies as much as it does the ontology of parkinsonism. The initial 1837 report of manganese-induced neurologic injury was made by John Couper, a university-based physician in Scotland. He made clear that the outbreak occurred among workers at the Charles Tennant bleach manufactory in the environs of Glasgow. The relatively new technology of chlorine generation using manganese accounted for the novel exposure involved...
April 14, 2017: Neurotoxicology
https://www.readbyqxmd.com/read/28415148/the-6-a-s-a-risk-manager-s-guide-to-emergency-cesarean-delivery
#19
Larry Veltman
The allegation of delay in performing an emergency cesarean delivery is common in litigation involving neurological injury to newborns. Analyzing the actual performance of an emergency cesarean involves multiple steps, individuals, and systemic processes that need coordination for appropriate action when necessary. This article gives risk managers a systematic way to evaluate a given perinatal unit's approach to the ability to perform an emergency cesarean through evaluating the 6 "A"s: Assess, Alert, Align, Assemble, Act, and Analyze...
April 2017: Journal of Healthcare Risk Management: the Journal of the American Society for Healthcare Risk Management
https://www.readbyqxmd.com/read/28414687/disseminated-cryptococcal-disease-with-diffuse-pulmonary-infiltrates-in-a-non-hiv-host
#20
M Hughes, K Trivedi, M Rudrappa
INTRODUCTION: We present a case of disseminated Cryptococcus in a non-HIV host, where the primary manifestation was pulmonary with diffuse pulmonary infiltrates. This patient was on high dose corticosteroids for autoimmune hemolytic anemia. CASE: A 79 year old Caucasian man with a history of autoimmune hemolytic anemia on 100 mg of prednisone daily, coronary artery disease s/p bypass surgery, ischemic cardiomyopathy, chronic obstructive pulmonary disease, sleep apnea, chronic kidney disease, and history of bilateral pulmonary emboli presented to Hematology/Oncology clinic with symptoms of productive cough, worsening shortness of breath, hemoptysis...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
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