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Sample records for neurologically impaired patients

  1. HBV and neurological impairment in HIV-infected patients

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    L Manolescu

    2012-11-01

    Full Text Available Objective: HIV can affect CNS in early stages of disease and determine neurological impairment. HBV DNA was found in CSF of HIV co-infected patients, but little is known about the neurotropic character of this virus. Here we assessed the degree of association between HBV infection and neurological impairment in a large cohort of long-term survivors, HIV-infected patients that experienced multiple therapeutic schemes over time. Methods: A total of 462 HIV-1-infected patients were retrospectively followed up for 10 years for HBV infection and neurological impairment. The patients were tested for immune (flow cytometry and virological parameters of HIV infection (Roche Amplicor, version 1.5/ COBAS AmpliPrep/COBAS TaqMan HIV-1 test and for HBV infection markers (HBsAg, anti HBc: Murex Biotech ELISA tests. Many of these patients have experienced between one and six regimens such as: 2 NRTIs, 3 NRTIs, 2 NRTIs+1 NNRTI, 1 NRTI+1 NNRTI+1 PI, 2 NRTIs+2 PIs. Results: After 10 years 29.87% of the patients presented neurological impairment. Out of them 56.52% were HBV-infected. The prevalence of HIV encephalopathy (HE in our studied cohort was 22.7% and 50.4% of these patients were HBV-infected. The median HIV diagnosis age was 7 and the median age of HE diagnosis was 10. In order to establish a possible correlation between HBV infection and HE we first reviewed and excluded the main risk factors associated with HE at the moment of diagnosis: low weight, anemia, constitutional symptoms, low CD4+count, high plasma HIV-RNA load. No patient was infected with HCV. The groups of patients that presented HE and HBsAg and HE without HBsAg were balanced regarding sex, number of deceased patients, number of class C3 patients, but the patients in first group presented lower CD4 values at HE diagnosis vs patients from second group 2: 44.5 vs 95 cells/µL, p=0.3; lower nadir CD4 count: 38 vs 51 cell/µL, p=0.1; and slightly higher HIV viral load: 5.2 vs 5 log10 copies

  2. Burn injury in patients with early-onset neurological impairments: 2002 ABA paper.

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    Alden, N E; Rabbitts, A; Rolls, J A; Bessey, P Q; Yurt, R W

    2004-01-01

    Many patients suffer from sensorimotor deficits that may contribute to burn injury. This retrospective study examines burn injuries in the subgroup of patients that suffer from the early onset neurological impairments of mental retardation, cerebral palsy, spina bifida, autism, and attention deficit-hyperactivity disorder. Fifty-one patients who suffered from the above-mentioned early-onset neurological impairments were admitted to our burn center during a 4-year period. The average TBSA burned was 8.9% yet resulted in prolonged hospitalizations. This study describes our burn center's experience in treating patients admitted with early-onset neurological impairments.

  3. Clinical and Neurological Status in Patients with Mild Cognitive Impairment due to Chronic Cerebral Ischemia

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    Yokudhon N. Madjidova

    2014-09-01

    Full Text Available The aim of our work was to study the neurological status and cognitive function in patients with stage I and II CCI, depending on its nature. Material and Methods: The study included 302 patients (mean age - 61.3±0.3 years; 165/54.6% men and 137/45.4% women with stage I and II CCI. Clinical and neurological examination, study of cognitive function, and MRI were performed in all patients. The degree of cognitive defect was determined by the MMSE (Mini-Mental State Exam test and the Bourdon test (visual perception and vigilance. All the subjects were categorized into two groups. Group 1 consisted of 133 patients with the amnestic type of MCI (AT-MCI; Group 2 consisted of 169 patients with the multifunction type of MCI (MT-MCI. Results: The highest frequency of complaints of a cerebral nature was observed in Group 2 patients with MT-MCI compared to Group 1 patients with AT-MCI. It should be noted that memory impairment occurred in all patients in Group 1. The clinical-neurological examination revealed that the subjective complaints of a cerebral nature occurred significantly more frequently in Group 2 patients compared with Group 1 patients, except for the memory disorders, which prevailed in Group 1 patients with AT-MCI. With regard to the objective symptoms, the focal neurological symptoms occurred with equal frequency in both groups. It should be noted that the symptoms of the carotid region were more frequent in Group 2 patients and the symptoms of the vertebrobasilar region in Group 1 patients. The parameters of the cognitive function related to the concentration and stability of attention were less disturbed in patients with AT-MCI compared with the patients having the MT-MCI, and those parameters correlated with the parameters of the neurological focal symptoms.

  4. Anaerobic Infections in Children with Neurological Impairments.

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    Brook, Itzhak

    1995-01-01

    Children with neurological impairments are prone to develop serious infection with anaerobic bacteria. The most common anaerobic infections are decubitus ulcers; gastrostomy site wound infections; pulmonary infections (aspiration pneumonia, lung abscesses, and tracheitis); and chronic suppurative otitis media. The unique microbiology of each of…

  5. Neurological disorders in hypertensive patients

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    N. V. Vakhnina

    2015-01-01

    Full Text Available Hypertension is one of the most common vascular diseases. The brain as target organs in hypertension is damaged more often and earlier. Neurological complications due to hypertension are frequently hyperdiagnosed in Russian neurological practice. Thus, headache, dizziness, impaired recall of recent events, nocturnal sleep disorders, and many other complaints in a hypertensive patient are usually regarded as a manifestation of dyscirculatory encephalopathy. At the same time headaches (tension headache and migraine in hypertensive patients are predominantly primary; headache associated with dramatic marked elevations in blood pressure is encountered in only a small number of patients. The role of cerebrovascular diseases in the development of dizziness in hypertensive patients is also overestimated. The vast majority of cases, patients with this complaint are in fact identified to have benign paroxysmal postural vertigo, Mеniеre’s disease, vestibular neuronitis, or vestibular migraine. Psychogenic disorders or multisensory insufficiency are generally responsible for non-systemic vertigo in hypertensive patients. Chronic cerebral circulatory insufficiency may cause non-systemic vertigo as a subjective equivalent of postural instability.Cognitive impairments (CIs are the most common and earliest manifestation of cerebrovascular lesion in hypertension. In most cases, CIs in hypertension were vascular and associated with cerebrovascular lesion due to lacunar infarcts and leukoaraiosis. However, mixed CIs frequently occur when hypertensive patients are also found to have signs of a degenerative disease, most commonly in Alzheimer’s disease.

  6. Esophageal adenocarcinoma and Barrett esophagus in a neurologically impaired teenager.

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    Hwang, Jae-Yeon; Lee, Yeoun Joo; Chun, Peter; Shin, Dong Hoon; Park, Jae Hong

    2016-11-01

    Esophageal adenocarcinoma (EAC) accompanied by Barrett esophagus (BE) is rare in patients younger than 20 years old. EAC in the upper esophagus is also rare. We report a rare case of EAC with BE that developed in the upper esophagus after chronic, untreated gastroesophageal reflux disease in a neurologically impaired teenager. A 19-year-old neurologically impaired man underwent endoscopy for evaluation of dysphagia and vomiting, and was diagnosed with EAC with BE. He underwent transthoracic esophagectomy, extensive lymph node dissection, and cervical esophagogastric anastomosis, but the prognosis was poor. Pathology indicated poorly differentiated adenocarcinoma with BE. © 2016 Japan Pediatric Society.

  7. Alterations in the brain adenosine metabolism cause behavioral and neurological impairment in ADA-deficient mice and patients

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    Sauer, Aisha V.; Hernandez, Raisa Jofra; Fumagalli, Francesca; Bianchi, Veronica; Poliani, Pietro L.; Dallatomasina, Chiara; Riboni, Elisa; Politi, Letterio S.; Tabucchi, Antonella; Carlucci, Filippo; Casiraghi, Miriam; Carriglio, Nicola; Cominelli, Manuela; Forcellini, Carlo Alberto; Barzaghi, Federica; Ferrua, Francesca; Minicucci, Fabio; Medaglini, Stefania; Leocani, Letizia; la Marca, Giancarlo; Notarangelo, Lucia D.; Azzari, Chiara; Comi, Giancarlo; Baldoli, Cristina; Canale, Sabrina; Sessa, Maria; D’Adamo, Patrizia; Aiuti, Alessandro

    2017-01-01

    Adenosine Deaminase (ADA) deficiency is an autosomal recessive variant of severe combined immunodeficiency (SCID) caused by systemic accumulation of ADA substrates. Neurological and behavioral abnormalities observed in ADA-SCID patients surviving after stem cell transplantation or gene therapy represent an unresolved enigma in the field. We found significant neurological and cognitive alterations in untreated ADA-SCID patients as well as in two groups of patients after short- and long-term enzyme replacement therapy with PEG-ADA. These included motor dysfunction, EEG alterations, sensorineural hypoacusia, white matter and ventricular alterations in MRI as well as a low mental development index or IQ. Ada-deficient mice were significantly less active and showed anxiety-like behavior. Molecular and metabolic analyses showed that this phenotype coincides with metabolic alterations and aberrant adenosine receptor signaling. PEG-ADA treatment corrected metabolic adenosine-based alterations, but not cellular and signaling defects, indicating an intrinsic nature of the neurological and behavioral phenotype in ADA deficiency. PMID:28074903

  8. Validation of a new neurological score (FOUR Score) in the assessment of neurosurgical patients with severely impaired consciousness.

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    Chen, Bixia; Grothe, Christoph; Schaller, Karl

    2013-11-01

    The Glasgow coma scale (GCS) was introduced as a scoring system for patients with impaired consciousness after traumatic brain injury (TBI). Since, it has become the worldwide standard in TBI assessment. The GCS has repeatedly been criticized for its several failures to reflect verbal reaction in intubated patients, and to test brain stem reflexes. Recently, the full outline of unresponsiveness (FOUR) score was introduced, which is composed of four clinically distinct categories of evaluation: eye reaction, motor function, brainstem reflexes and respiratory pattern. This study aims to validate the FOUR score in neurosurgical patients. FOUR score and GCS were assessed in a consecutive series of neurosurgical patients with severely impaired consciousness (GCS consciousness. There was no relevant difference in predicting poor and good outcome.

  9. Speech and neurology-chemical impairment correlates

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    Hayre, Harb S.

    2002-05-01

    Speech correlates of alcohol/drug impairment and its neurological basis is presented with suggestion for further research in impairment from poly drug/medicine/inhalent/chew use/abuse, and prediagnosis of many neuro- and endocrin-related disorders. Nerve cells all over the body detect chemical entry by smoking, injection, drinking, chewing, or skin absorption, and transmit neurosignals to their corresponding cerebral subsystems, which in turn affect speech centers-Broca's and Wernick's area, and motor cortex. For instance, gustatory cells in the mouth, cranial and spinal nerve cells in the skin, and cilia/olfactory neurons in the nose are the intake sensing nerve cells. Alcohol depression, and brain cell damage were detected from telephone speech using IMPAIRLYZER-TM, and the results of these studies were presented at 1996 ASA meeting in Indianapolis, and 2001 German Acoustical Society-DEGA conference in Hamburg, Germany respectively. Speech based chemical Impairment measure results were presented at the 2001 meeting of ASA in Chicago. New data on neurotolerance based chemical impairment for alcohol, drugs, and medicine shall be presented, and shown not to fully support NIDA-SAMSHA drug and alcohol threshold used in drug testing domain.

  10. Self-reported gait unsteadiness in mildly impaired neurological patients: an objective assessment through statistical gait analysis

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    Benedetti Maria

    2012-08-01

    Full Text Available Abstract Background Self-reported gait unsteadiness is often a problem in neurological patients without any clinical evidence of ataxia, because it leads to reduced activity and limitations in function. However, in the literature there are only a few papers that address this disorder. The aim of this study is to identify objectively subclinical abnormal gait strategies in these patients. Methods Eleven patients affected by self-reported unsteadiness during gait (4 TBI and 7 MS and ten healthy subjects underwent gait analysis while walking back and forth on a 15-m long corridor. Time-distance parameters, ankle sagittal motion, and muscular activity during gait were acquired by a wearable gait analysis system (Step32, DemItalia, Italy on a high number of successive strides in the same walk and statistically processed. Both self-selected gait speed and high speed were tested under relatively unconstrained conditions. Non-parametric statistical analysis (Mann–Whitney, Wilcoxon tests was carried out on the means of the data of the two examined groups. Results The main findings, with data adjusted for velocity of progression, show that increased double support and reduced velocity of progression are the main parameters to discriminate patients with self-reported unsteadiness from healthy controls. Muscular intervals of activation showed a significant increase in the activity duration of the Rectus Femoris and Tibialis Anterior in patients with respect to the control group at high speed. Conclusions Patients with a subjective sensation of instability, not clinically documented, walk with altered strategies, especially at high gait speed. This is thought to depend on the mechanisms of postural control and coordination. The gait anomalies detected might explain the symptoms reported by the patients and allow for a more focused treatment design. The wearable gait analysis system used for long distance statistical walking assessment was able to detect

  11. Elaboration of a clinical and paraclinical score to estimate the probability of herpes simplex virus encephalitis in patients with febrile, acute neurologic impairment.

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    Gennai, S; Rallo, A; Keil, D; Seigneurin, A; Germi, R; Epaulard, O

    2016-06-01

    Herpes simplex virus (HSV) encephalitis is associated with a high risk of mortality and sequelae, and early diagnosis and treatment in the emergency department are necessary. However, most patients present with non-specific febrile, acute neurologic impairment; this may lead clinicians to overlook the diagnosis of HSV encephalitis. We aimed to identify which data collected in the first hours in a medical setting were associated with the diagnosis of HSV encephalitis. We conducted a multicenter retrospective case-control study in four French public hospitals from 2007 to 2013. The cases were the adult patients who received a confirmed diagnosis of HSV encephalitis. The controls were all the patients who attended the emergency department of Grenoble hospital with a febrile acute neurologic impairment, without HSV detection by polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF), in 2012 and 2013. A multivariable logistic model was elaborated to estimate factors significantly associated with HSV encephalitis. Finally, an HSV probability score was derived from the logistic model. We identified 36 cases and 103 controls. Factors independently associated with HSV encephalitis were the absence of past neurological history (odds ratio [OR] 6.25 [95 % confidence interval (CI): 2.22-16.7]), the occurrence of seizure (OR 8.09 [95 % CI: 2.73-23.94]), a systolic blood pressure ≥140 mmHg (OR 5.11 [95 % CI: 1.77-14.77]), and a C-reactive protein <10 mg/L (OR 9.27 [95 % CI: 2.98-28.88]). An HSV probability score was calculated summing the value attributed to each independent factor. HSV encephalitis diagnosis may benefit from the use of this score based upon some easily accessible data. However, diagnostic evocation and probabilistic treatment must remain the rule.

  12. [Airway obstruction after tracheostomy in a neurologically impaired child].

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    Kawase, Mizuho; Arakura, Kumiko; Kawase, Soichiro; Shiozawa, Riyo; Inoue, Yasuro

    2008-03-01

    A 14-year-old boy neurologically impaired was scheduled for tracheostomy under general anesthesia because of the prolonged tracheal intubation. He had twice received artificial respiration under tracheal intubation for aspiration pneumonia. During emergence from anesthesia, bucking occurred and suddenly the patient's lungs could not be ventilated. Neither anesthetic circuit nor tracheostomy tube were not functioning well, and airway obstruction was not relieved by manual and positive pressure ventilation within 40 mmHg. SpO2 gradually decreased to 48%, resulting in bradicardia. However, it became possible to inflate the lungs immediately because of the respiratory effort decreased. SpO2 rapidly increased to normal range and heart rate recovered. The patient was suspected of having tracheomalacia as a result of flexible bronchoscopy performed through tracheostomy tube, revealing slight collapse of the trachea. Tracheomalacia can be a cause of sudden difficult ventilation in neurologically impaired children.

  13. Impaired movement timing in neurological disorders: rehabilitation and treatment strategies.

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    Hove, Michael J; Keller, Peter E

    2015-03-01

    Timing abnormalities have been reported in many neurological disorders, including Parkinson's disease (PD). In PD, motor-timing impairments are especially debilitating in gait. Despite impaired audiomotor synchronization, PD patients' gait improves when they walk with an auditory metronome or with music. Building on that research, we make recommendations for optimizing sensory cues to improve the efficacy of rhythmic cuing in gait rehabilitation. Adaptive rhythmic metronomes (that synchronize with the patient's walking) might be especially effective. In a recent study we showed that adaptive metronomes synchronized consistently with PD patients' footsteps without requiring attention; this improved stability and reinstated healthy gait dynamics. Other strategies could help optimize sensory cues for gait rehabilitation. Groove music strongly engages the motor system and induces movement; bass-frequency tones are associated with movement and provide strong timing cues. Thus, groove and bass-frequency pulses could deliver potent rhythmic cues. These strategies capitalize on the close neural connections between auditory and motor networks; and auditory cues are typically preferred. However, moving visual cues greatly improve visuomotor synchronization and could warrant examination in gait rehabilitation. Together, a treatment approach that employs groove, auditory, bass-frequency, and adaptive (GABA) cues could help optimize rhythmic sensory cues for treating motor and timing deficits. © 2014 New York Academy of Sciences.

  14. [neurologic Semiology In A Population Of Hearing Impaired Children].

    OpenAIRE

    V. M. Gonçalves; Piovesana, A M; Moura-Ribeiro, M V

    2015-01-01

    A random sample of 42 sensorineural hearing impaired children (severe and bilateral) was studied, from special classes in Campinas, with chronological ages varying between 4 and 7 years old. The children of this sample were compared with two control groups of 42 children of the same chronological age, from regular classes of private and public schools. All of them were submitted to the traditional neurological examination. Hearing impaired children showed differences as to head circumference ...

  15. Preputial calculus in a neurologically-impaired child.

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    Spataru, R I; Iozsa, D A; Ivanov, M

    2015-02-01

    Preputial calculi are rarely encountered in childhood. A 5-year-old boy with symptoms of chronic balanoposthitis. A preputial stone was documented and removed at circumcision. Uneventful postoperative recovery. In children, association between phimosis and neurologic impairment represent predisposing condition for preputial stone formation.

  16. Fundoplication in neurologically impaired children: Nissen or Thal?

    African Journals Online (AJOL)

    Keywords: fundoplication, gastroesophageal reflux disease, neurological impairment. aDepartment of Surgery, Pediatric Surgery Unit .... recordings were downloaded into the computer. Results were compared with the preset normal values ... A subjective assessment of the severity as mild, moderate, or severe was made in.

  17. Spiroergometric and spirometric parameters in patients with multiple sclerosis: are there any links between these parameters and fatigue, depression, neurological impairment, disability, handicap and quality of life in multiple sclerosis?

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    Rasova, K; Brandejsky, P; Havrdova, E; Zalisova, M; Rexova, P

    2005-04-01

    One-hundred and twelve patients with multiple sclerosis were selected as population-based sample and examined on impairment (Expanded Disability Status Scale), disability (Barthel Index), handicap (Environment Status Scale), the quality of life (Multiple Sclerosis Quality of Life), fatigue (Modified Fatigue Impact Scale), depression (Beck Depression Inventory Score), respiratory function (spirometric parameters on spirometry) and physical fitness (spiroergometric parameters on a bicycle ergometer). The aim of the study was to examine and analyse (descriptive statistics) spiroergometric and spirometric parameters in patients with multiple sclerosis. Firstly, we tested the hypothesis whether spiroergometric and spirometric parameters are decreased and whether there are any correlations between these parameters and measures of impairment, depression, disability, handicap and quality of life. Secondly, we tested the hypothesis whether there is any correlation between a possible deconditioning and fatigue, and between a possible respiratory dysfunction and fatigue in multiple sclerosis. It results from this study that many spiroergometric parameters in patients with multiple sclerosis are significantly lowered in comparison to the population norm. A link can be found between some spiroergometric parameters and neurological impairment, disability, handicap and quality of life. It is not possible to prove any correlation between spiroergometric parameters and depression. From the spirometric parameters, these are expiratory flows that are significantly lowered in MS patients. It is not possible to prove any correlation between spirometric parameters and fatigue, depression, neurological impairment, duration of the disease, disability, handicap and quality of life in multiple sclerosis.

  18. Clinimetric properties of lower limb neurological impairment tests for children and young people with a neurological condition: A systematic review

    National Research Council Canada - National Science Library

    Ramona Clark; Melissa Locke; Bridget Hill; Cherie Wells; Andrea Bialocerkowski

    2017-01-01

    .... Objective To determine the clinimetric evidence underpinning neurological impairment tests currently used in paediatric rehabilitation to evaluate muscle strength, tactile sensitivity, and deep...

  19. NEUROLOGICAL DISORDERS IN PATIENTS WITH HYPERTENSION AND THEIR CORRECTION

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    N. V. Vakhnina

    2016-01-01

    Full Text Available Neurological disorders in hypertensive patients can be caused by both brain injury and concomitant diseases. The elucidation of the causes of neurological disorders and their effective treatment contribute to hypertensive patients’ better adherence to long-term antihypertensive therapy, which normalizes blood pressure (BP and reduces the risk of cerebral complications Objective: to study of the causes of neurological disorders in hypertensive patients and the efficiency of their correction using a new dispersible vinpocetine formulation (Cavinton® Comforte in combined therapy.Patients and methods. A total of 80 patients (men (20% and women (80%; mean age 63±12.3  years with neurological complaints in the presence of hypertension were examined. All the patients were diagnosed with dyscirculatory encephalopathy or chronic brain ischemia, whether they had vascular cognitive impairment. The examination of patients revealed that the neurological complaints were mainly due to concomitant diseases, such as migraine (12%, tension-type headache (66%, and the latter concurrent with migraine (4%.Results and  discussion. The  effective treatment of concomitant diseases in  combination with antihypertensive therapy contributed to normalization of BP and regression of complaints. The most pronounced effect was noted in 40 patients whose combination therapy included Vinpocetine (Cavinton® Comforte 10 mg thrice daily.Conclusion. The therapy resulted in the less severity of both the symptoms of cerebrovascular disease (vascular cognitive impairment and comorbid neurological disorders (headache, dizziness, etc..

  20. [Neurologic semiology in a population of hearing impaired children].

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    Gonçalves, V M; Piovesana, A M; de Moura-Ribeiro, M V

    1993-09-01

    A random sample of 42 sensorineural hearing impaired children (severe and bilateral) was studied, from special classes in Campinas, with chronological ages varying between 4 and 7 years old. The children of this sample were compared with two control groups of 42 children of the same chronological age, from regular classes of private and public schools. All of them were submitted to the traditional neurological examination. Hearing impaired children showed differences as to head circumference and muscle tonus. In the other examined items we found motor hyperactivity, cerebellar and ocular syndromes although there were no significant differences between the groups.

  1. Dietary Intakes and Nutritional Issues in Neurologically Impaired Children

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    Francesca Penagini

    2015-11-01

    Full Text Available Neurologically impaired (NI children are at increased risk of malnutrition due to several nutritional and non-nutritional factors. Among the nutritional factors, insufficient dietary intake as a consequence of feeding difficulties is one of the main issues. Feeding problems are frequently secondary to oropharyngeal dysphagia, which usually correlates with the severity of motor impairment and presents in around 90% of preschool children with cerebral palsy (CP during the first year of life. Other nutritional factors are represented by excessive nutrient losses, often subsequent to gastroesophageal reflux and altered energy metabolism. Among the non-nutritional factors, the type and severity of neurological impairment, ambulatory status, the degree of cognitive impairment, and use of entiepileptic medication altogether concur to determination of nutritional status. With the present review, the current literature is discussed and a practical approach for nutritional assessment in NI children is proposed. Early identification and intervention of nutritional issues of NI children with a multidisciplinary approach is crucial to improve the overall health and quality of life of these complex children.

  2. Upper limb impairments associated with spasticity in neurological disorders

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    Mirbagheri Mehdi M

    2007-11-01

    Full Text Available Abstract Background While upper-extremity movement in individuals with neurological disorders such as stroke and spinal cord injury (SCI has been studied for many years, the effects of spasticity on arm movement have been poorly quantified. The present study is designed to characterize the nature of impaired arm movements associated with spasticity in these two clinical populations. By comparing impaired voluntary movements between these two groups, we will gain a greater understanding of the effects of the type of spasticity on these movements and, potentially a better understanding of the underlying impairment mechanisms. Methods We characterized the kinematics and kinetics of rapid arm movement in SCI and neurologically intact subjects and in both the paretic and non-paretic limbs in stroke subjects. The kinematics of rapid elbow extension over the entire range of motion were quantified by measuring movement trajectory and its derivatives; i.e. movement velocity and acceleration. The kinetics were quantified by measuring maximum isometric voluntary contractions of elbow flexors and extensors. The movement smoothness was estimated using two different computational techniques. Results Most kinematic and kinetic and movement smoothness parameters changed significantly in paretic as compared to normal arms in stroke subjects (p Conclusion The findings suggest that although the cause and location of injury are different in spastic stroke and SCI subjects, the impairments in arm voluntary movement were similar in the two spastic groups. Our results also suggest that the non-paretic arm in stroke subjects was not distinguishable from the normal, and might therefore be used as an appropriate control for studying movement of the paretic arm.

  3. Visual behaviours of neurologically impaired children with cerebral visual impairment: an ethological study

    OpenAIRE

    Porro, G.L.; Dekker, E.M.; van Nieuwenhuizen, O; Schilder, M.B.H.; Wittebol - Post, D.; Schenk-Rootlieb, A.J.F; Treffers, W.F.

    1998-01-01

    BACKGROUND/AIMS—Visual functions of neurologically impaired children with permanent cerebral visual impairment (CVI) can be difficult to determine. This study investigated the behavioural profile of CVI children by means of ethological observations in order to gain a better understanding of their visual functions.
METHODS—Video registrations of nine subjects who were unable to undergo more orthodox methods of visual function testing were observed and analysed by an ethologist.
RESULTS—A serie...

  4. EEG in Sarcoidosis Patients Without Neurological Findings.

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    Bilgin Topçuoğlu, Özgür; Kavas, Murat; Öztaş, Selahattin; Arınç, Sibel; Afşar, Gülgün; Saraç, Sema; Midi, İpek

    2017-01-01

    Sarcoidosis is a multisystem granulomatous disease affecting nervous system in 5% to 10% of patients. Magnetic resonance imaging (MRI) is accepted as the most sensitive method for detecting neurosarcoidosis. However, the most common findings in MRI are the nonspecific white matter lesions, which may be unrelated to sarcoidosis and can occur because of hypertension, diabetes mellitus, smoking, and other inflammatory or infectious disorders, as well. Autopsy studies report more frequent neurological involvement than the ante mortem studies. The aim of this study is to assess electroencephalography (EEG) in sarcoidosis patients without neurological findings in order to display asymptomatic neurological dysfunction. We performed EEG on 30 sarcoidosis patients without diagnosis of neurosarcoidosis or prior neurological comorbidities. Fourteen patients (46.7%) showed intermittant focal and/or generalized slowings while awake and not mentally activated. Seven (50%) of these 14 patients with EEG slowings had nonspecific white matter changes while the other half showed EEG slowings in the absence of MRI changes. We conclude that EEG slowings, when normal variants (psychomotor variant, temporal theta of elderly, frontal theta waves) are eliminated, may be an indicator of dysfunction in brain activity even in the absence of MRI findings. Hence, EEG may contribute toward detecting asymptomatic neurological dysfunction or probable future neurological involvement in sarcoidosis patients. © EEG and Clinical Neuroscience Society (ECNS) 2016.

  5. Avoiding Misdiagnosis in Patients with Neurological Emergencies

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    Pope, Jennifer V.; Edlow, Jonathan A.

    2012-01-01

    Approximately 5% of patients presenting to emergency departments have neurological symptoms. The most common symptoms or diagnoses include headache, dizziness, back pain, weakness, and seizure disorder. Little is known about the actual misdiagnosis of these patients, which can have disastrous consequences for both the patients and the physicians. This paper reviews the existing literature about the misdiagnosis of neurological emergencies and analyzes the reason behind the misdiagnosis by specific presenting complaint. Our goal is to help emergency physicians and other providers reduce diagnostic error, understand how these errors are made, and improve patient care. PMID:22888439

  6. Standardized patient outcomes trial (SPOT in neurology

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    Joseph E. Safdieh

    2011-01-01

    Full Text Available Background: The neurologic examination is a challenging component of the physical examination for medical students. In response, primarily based on expert consensus, medical schools have supplemented their curricula with standardized patient (SP sessions that are focused on the neurologic examination. Hypothesis-driven quantitative data are needed to justify the further use of this resource-intensive educational modality, specifically regarding whether using SPs to teach the neurological examination effects a long-term benefit on the application of neurological examination skills. Methods: This study is a cross-sectional analysis of prospectively collected data from medical students at Weill Cornell Medical College. The control group (n=129 received the standard curriculum. The intervention group (n=58 received the standard curriculum and an additional SP session focused on the neurologic examination during the second year of medical school. Student performance on the neurologic examination was assessed in the control and intervention groups via an OSCE administered during the fourth year of medical school. A Neurologic Physical Exam (NPE score of 0.0 to 6.0 was calculated for each student based on a neurologic examination checklist completed by the SPs during the OSCE. Composite NPE scores in the control and intervention groups were compared with the unpaired t-test. Results: In the fourth year OSCE, composite NPE scores in the intervention group (3.5±1.1 were statistically significantly greater than those in the control group (2.2±1.1 (p<0.0001. Conclusions: SP sessions are an effective tool for teaching the neurologic examination. We determined that a single, structured SP session conducted as an adjunct to our traditional lectures and small groups is associated with a statistically significant improvement in student performance measured 2 years after the session.

  7. Interventions for oropharyngeal dysphagia in children with neurological impairment.

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    Morgan, Angela T; Dodrill, Pamela; Ward, Elizabeth C

    2012-10-17

    Oropharyngeal dysphagia encompasses problems with the oral preparatory phase of swallowing (chewing and preparing the food), oral phase (moving the food or fluid posteriorly through the oral cavity with the tongue into the back of the throat) and pharyngeal phase (swallowing the food or fluid and moving it through the pharynx to the oesophagus). Populations of children with neurological impairment who commonly experience dysphagia include, but are not limited to, those with acquired brain impairment (for example, cerebral palsy, traumatic brain injury, stroke), genetic syndromes (for example, Down syndrome, Rett syndrome) and degenerative conditions (for example, myotonic dystrophy). To examine the effectiveness of interventions for oropharyngeal dysphagia in children with neurological impairment. We searched the following electronic databases in October 2011: CENTRAL 2011(3), MEDLINE (1948 to September Week 4 2011), EMBASE (1980 to 2011 Week 40)
, CINAHL (1937 to current)
, ERIC (1966 to current), PsycINFO (1806 to October Week 1 2011), Science Citation Index (1970 to 7 October 2011), Social Science Citation Index (1970 to 7 October 2011), Cochrane Database of Systematic Reviews, 2011(3), DARE 2011(3), Current Controlled Trials (ISRCTN Register) (15 October 2011), ClinicalTrials.gov (15 October 2011) and WHO ICTRP (15 October 2011). We searched for dissertations and theses using Networked Digital Library of Theses and Dissertations, Australasian Digital Theses Program and DART-Europe E-theses Portal (11 October 2011). Finally, additional references were also obtained from reference lists from articles. The review included randomised controlled trials and quasi-randomised controlled trials for children with oropharyngeal dysphagia and neurological impairment. All three review authors (AM, PD and EW) independently screened titles and abstracts for inclusion and discussed results. In cases of uncertainty over whether an abstract met inclusion criterion, review

  8. Dysphagia and cerebrovascular accident: relationship between severity degree and level of neurological impairment.

    Science.gov (United States)

    Itaquy, Roberta Baldino; Favero, Samara Regina; Ribeiro, Marlise de Castro; Barea, Liselotte Menke; Almeida, Sheila Tamanini de; Mancopes, Renata

    2011-12-01

    The aim of this case study was to verify the occurrence of dysphagia in acute ischemic stroke within 48 hours after the onset of the first symptoms, in order to establish a possible relationship between the level of neurologic impairment and the severity degree of dysphagia. After emergency hospital admission, three patients underwent neurological clinical evaluation (general physical examination, neurological examination, and application of the National Institute of Health Stroke Scale - NIHSS), and clinical assessment of swallowing using the Protocolo Fonoaudiológico de Avaliação do Risco para Disfagia (PARD--Speech-Language Pathology Protocol for Risk Evaluation for Dysphagia). One of the patients presented functional swallowing (NIHSS score 11), while the other two had mild and moderate oropharyngeal dysphagia (NIHSS scores 15 and 19, respectively). The service flow and the delay on the patients' search for medical care determined the small sample. The findings corroborate literature data regarding the severity of the neurological condition and the manifestation of dysphagia.

  9. MRI and neurological findings in patients with spinal metastases

    Energy Technology Data Exchange (ETDEWEB)

    Switlyk, M.D.; Hole, K.H.; Knutstad, K. [Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norwegian Radium Hospital, Oslo (Norway)], E-mail: marta.switlyk@radiumhospitalet.no; Skjeldal, S.; Zaikova, O. [Department of Orthopedics, Oslo University Hospital, Norwegian Radium Hospital, Oslo (Norway); Hald, J.K. [Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo (Norway); Seierstad, T. [Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norwegian Radium Hospital, Oslo (Norway); Faculty of Health Sciences, Buskerud University College, Drammen (Norway)

    2012-12-15

    Background. Magnetic resonance imaging (MRI) is the recommended primary investigation method for metastatic spinal cord compression (MSCC). Initiating treatment before the development of motor deficits is essential to preserve neurological function. However, the relationship between MRI-assessed grades of spinal metastatic disease and neurological status has not been widely investigated. Purpose. To analyze the association between neurological function and MRI-based assessment of the extent of spinal metastases using two different grading systems. Material and Methods. A total of 284 patients admitted to our institution for initial radiotherapy or surgery for symptomatic spinal metastases were included in the study. Motor and sensory deficits were categorized according to the Frankel classification system. Pre-treatment MRI evaluations of the entire spine were scored for the extent of spinal metastases, presence and severity of spinal cord compression, and nerve root compression. Two MRI-based scales were used to evaluate the degree of cord compression and spinal canal narrowing and relate these findings to neurological function. Results. Of the patients included in the study, 28 were non-ambulatory, 49 were ambulatory with minor motor deficits, and 207 had normal motor function. Spinal cord compression was present in all patients with Frankel scores of B or C, 23 of 35 patients with a Frankel score of D (66%), and 48 of 152 patients with a Frankel score of E (32%). The percentage of patients with severe spinal canal narrowing increased with increasing Frankel grades. The grading according to the scales showed a significant association with the symptoms according to the Frankel scale (P < 0.001). Conclusion. In patients with neurological dysfunction, the presence and severity of impairment was associated with the epidural tumor burden. A significant number of patients had radiological spinal cord compression and normal motor function (occult MSCC)

  10. Dumping syndrome: an unusual cause of severe hyperinsulinemic hypoglycemia in neurologically impaired children with gastrostomy.

    Science.gov (United States)

    Bizzarri, C; Cervoni, M; Crea, F; Cutrera, R; Schiavino, A; Schiaffini, R; Cappa, M

    2011-02-01

    This paper describes severe hyperinsulinemic hypoglycemia during bolus enteral feeding in two neurologically impaired children. Both children were affected by dysphagia with swallowing difficulties; caloric intake was inadequate. For these reasons, percutaneous endoscopic gastrostomy had been positioned during the first months of life. In one patient due to persisting vomiting, after a few months, a gastrojejunal tube (PEG-J) was inserted. Hypoglycemia was revealed by routine blood tests, without evidence of specific symptoms. Continuous subcutaneous glucose monitoring showed wide glucose excursions, ranging from hypoglycemia to hyperglycemia. Extremely high levels of insulin were detected at the time of hypoglycemia. A diagnosis of dumping syndrome (DS) was suspected in both children. In the child with PEG, the tip of the gastrostomy catheter was found to be lying in the bulbus duodeni. Once this had been pulled back, hypoglycemic episodes disappeared. The child with PEG-J needed continuous enteral feeding to reach a normal glucose balance. DS is a relatively common complication in children with gastrostomy, but extremely irregular glucose levels, ranging from hypoglycemia to hyperglycemia, and increased insulin secretion had not been previously demonstrated. The incidence of DS is probably underestimated in children receiving enteral feeding for neurological impairment. In these patients intensive monitoring of blood glucose levels should be performed to calibrate meals. Repeated underestimated hypoglycemic episodes could worsen neurological damage and cause a deterioration in clinical conditions.

  11. The visually impaired patient

    National Research Council Canada - National Science Library

    Rosenberg, EA

    2008-01-01

    ... and independent living for the visually impaired patient. In the United States, the four most prevalent etiologies of vision loss in persons 40 years and older are age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy...

  12. Candidate's Thesis: Laryngotracheal separation in neurologically impaired children: long-term results.

    Science.gov (United States)

    Cook, Steven P

    2009-02-01

    Fifty-six consecutive neurologically impaired pediatric children underwent laryngotracheal separation (LTS) for acute recurrent and chronic aspiration in the last 18 years. The population demographics, indications for surgery, and comorbidities are reviewed. This study reports early and late complications and survivorship including admissions for pneumonia/aspiration. Diagnosis related group (DRGs) and work relative value units (wRVUs) were measured to document the potential benefits before and after LTS. Retrospective review of patient charts and records in an electronic medical record during an 18 year period. Information was obtained by a chart review and utilization of the electronic medical record. Patient specific DRG and wRVU data on their hospitalizations and outpatient encounters at the Alfred I. duPont Hospital for Children of the Nemours Foundation and survival data were recorded. Data was analyzed using chi-square analysis, a two-tailed t test, and a Fisher's Exact test. Laryngotracheal separation achieved complete control of aspiration in all the children. A significant reduction in the number of hospital admissions for pneumonias after surgery was noted. After LTS there was a reduced average number of DRGs per month (p < .001) as well as wRVUs. Transient fistula formation (11%) was the most common complication. No patient had his or her procedure reversed to date. Laryngotracheal separation is 100% effective in controlling aspiration in all of neurologically impaired children in this study, It is a valuable procedure to prolong the life of children who have intractable aspiration. After LTS, a decrease in DRGs and wRVUs reduces health care costs for these patients. Prior to LTS, all medical and surgical treatment options for aspiration should be discussed and considered, based on the extent of the child's underlying neurologic status, ability to verbally communicate, degree of upper airway obstruction, and hope of recovery of neurologic function.

  13. [Neurologic manifestations in pediatric patients with AIDS].

    Science.gov (United States)

    Samudio-Domínguez, G; Dávila, G; Martínez-Aguilar, G; Santos-Preciado, J I

    1992-09-01

    Since the first cases of childhood AIDS were reported, the neurological involvement has been more frequently recognized. Several motor, intellectual and conductual changes as well as unexplained abnormalities have been described due to CNS infections. Findings have shown HIV to affect the CNS although it is unknown as to when the viral invasion actually occurs. This report describes the neurological manifestations found in pediatric patients with HIV infection at the Hospital Infantil de Mexico and their correlations with CT scans, EEGs, auditory evoked potentials, I.Q.s and postmortem findings. The medical records of 60 symptomatic HIV infected children, stages P0 to P2, are reviewed. Neurological abnormalities were found in 51 patients, 20 of which (39.2%) were due to perinatal infection with symptoms starting, on the average at 11 months 7 days (from the initial contact) taking into consideration in utero exposure. Nine cases (17.6%) were patients infected through transfusions with symptoms appearing on the average at 24 months 8 days; 2 cases (3.9%) were of unknown origin. The CT scans, EEGs and psychometric evaluations of the HIV infected patients correlated well with the clinical findings.

  14. Visual Scanning Strategies of Neurologically Impaired, Perceptually Impaired, And Normal Children Viewing the Bender-Gestalt Designs

    Science.gov (United States)

    Locher, Paul J.; Worms, Peter F.

    1977-01-01

    This study describes and compares visual encoding processes and copying performance of normal children and children with perceptual and neurological disabilities viewing the Bender-Gestalt designs. Designs of the neurologically impaired children were significantly different from those of either of the other two diagnostic groups. (Author)

  15. Alcohol Exposure after Mild Focal Traumatic Brain Injury Impairs Neurological Recovery and Exacerbates Localized Neuroinflammation

    Science.gov (United States)

    Teng, Sophie X; Katz, Paige S; Maxi, John K; Mayeux, Jacques P; Gilpin, Nicholas W; Molina, Patricia E

    2014-01-01

    Traumatic brain injury (TBI) represents a leading cause of morbidity and mortality among young individuals. Alcohol abuse is a risk factor associated with increased TBI incidence. In addition, up to 26% of TBI patients engage in alcohol consumption after TBI. Limited preclinical studies have examined the impact of post-injury alcohol exposure on TBI recovery. The aim of this study was to determine the isolated and combined effects of TBI and alcohol on cognitive, behavioral, and physical recovery, as well as on associated neuroinflammatory changes. Male Sprague-Dawley rats (~300 g) were subjected to a mild focal TBI by lateral fluid percussion (~30 PSI, ~25 ms) under isoflurane anesthesia. On day 4 after TBI, animals were exposed to either sub-chronic intermittent alcohol vapor (95% ethanol 14h on /10h off; BAL~200 mg/dL) or room air for 10 days. TBI induced neurological dysfunction reflected by an increased neurological severity score (NSS) showed progressive improvement in injured animals exposed to room air (TBI/air). In contrast, TBI animals exposed to alcohol vapor (TBI/alcohol) showed impaired NSS recovery throughout the 10-day period of alcohol exposure. Open-field exploration test revealed an increased anxiety-like behavior in TBI/alcohol group compared to TBI/air group. Additionally, alcohol-exposed animals showed decreased locomotion and impaired novel object recognition. Immunofluorescence showed enhanced reactive astrocytes, microglial activation, and HMGB1 expression localized to the injured cortex of TBI/alcohol as compared to TBI/air animals. The expression of neuroinflammatory markers showed significant positive correlation with NSS. These findings indicated a close relationship between accentuated neuroinflammation and impaired neurological recovery from post-TBI alcohol exposure. The clinical implications of long-term consequences in TBI patients exposed to alcohol during recovery warrant further investigation. PMID:25489880

  16. Diffusion-weighted imaging in chronic Behcet patients with and without neurological findings

    Energy Technology Data Exchange (ETDEWEB)

    Baysal, T.; Dogan, M.; Bulut, T.; Sarac, K. [Inonu University School of Medicine, Department of Radiology, Malatya (Turkey); Karlidag, R. [Inonu University School of Medicine, Department of Psychiatry, Malatya (Turkey); Ozisik, H.I. [Inonu University School of Medicine, Department of Neurology, Malatya (Turkey); Baysal, O. [Inonu University School of Medicine, Department of Physical Therapy and Rehabilitation, Malatya (Turkey)

    2005-06-01

    Our aim was to investigate whether neurological impairment in chronic Behcet's disease (BD) patients with normal appearing brain can be assessed by means of diffusion-weighted imaging (DWI). The averaged apparent diffusion coefficient (ADC) values were calculated in 22 different radiologically normal appearing brain regions in 32 patients with and without neurological findings and 20 control subjects. The ADC values in bilateral frontal, temporal and occipital normal appearing white matter were significantly higher in the patient groups compared with the control subjects (p<0.05). In these brain regions, DWI revealed differences in the ADC values between patients with neurological findings (including symptomatic and neuro-Behcet patients) and the asymptomatic patient group. The similarity of the ADC values of patients without symptoms to those of the control group allowed clear discrimination between patients with and without neurological findings. DWI may serve to assess subclinical neurological involvement in BD, even when structural changes are absent. (orig.)

  17. Mini-mental state examination in neurological patients.

    Science.gov (United States)

    Dick, J P; Guiloff, R J; Stewart, A; Blackstock, J; Bielawska, C; Paul, E A; Marsden, C D

    1984-01-01

    The Mini-Mental State examination has been found to be a quick and valuable test for simple bedside screening, and for serial assessment of cognitive function in a population of 126 neurological patients. Amongst those with cognitive impairment, there was a close relation between the Mini-Mental State examination and the conventional Weschler Adult Intelligence Scale (WAIS). However, the Mini-Mental test was not a sensitive indicator of focal versus diffuse hemisphere disease. Further refinement in the areas of language and visuo-spatial function may improve its value. PMID:6736981

  18. Measuring body composition and energy expenditure in children with severe neurologic impairment and intellectual disability

    NARCIS (Netherlands)

    Rieken, Rob; van Goudoever, Johannes B.; Schierbeek, Henk; Willemsen, Sten P.; Calis, Elsbeth A. C.; Tibboel, Dick; Evenhuis, Heleen M.; Penning, Corine

    2011-01-01

    Accurate prediction equations for estimating body composition and total energy expenditure (TEE) in children with severe neurologic impairment and intellectual disability are currently lacking. The objective was to develop group-specific equations to predict body composition by using

  19. Assessing body composition and energy expenditure in children with severe neurological impairment and intellectual disability

    NARCIS (Netherlands)

    R. Rieken (Rob)

    2010-01-01

    markdownabstract__Abstract__ Children with severe neurological impairment and intellectual disability are at increased risk of developing malnutrition. While in recent years increased use of gastrostomy feeding has turned this trend, children receiving tube feeding run the opposite risk of

  20. Perimetry in young and neurologically impaired children : The Behavioral Visual Field (BEFIE) Screening Test revisited

    NARCIS (Netherlands)

    Koenraads, Yvonne; Braun, Kees P J; Van Der Linden, Denise C P; Imhof, Saskia M.; Porro, Giorgio L.

    IMPORTANCE: Visual field examination in young or neurologically impaired children is a challenge. As a result, the Behavioral Visual Field (BEFIE) Screening Test was developed in 1995. OBJECTIVES: To evaluate the applicability of the BEFIE test in a large population of young or neurologically

  1. Caring for Patients With Intractable Neurological Diseases

    Directory of Open Access Journals (Sweden)

    Masako Nagase

    2014-08-01

    Full Text Available This is a qualitative descriptive study examining nurses’ attitudes about caring for patients with intractable neurological diseases, with a focus on dedication and conflicts. Semistructured interviews were conducted on 11 nurses with more than 5 years of clinical experience in addition to more than 3 years of experience in neurology wards. Senior nursing officers from each hospital selected the participants. In general, these nurses expressed distress over the inevitable progression of disease. Nurses talked about the “basis of dedication,” “conflicts with dedication,” “reorganization for maintaining dedication,” and “the reason for the change from conflict to commitment.” “Reorganization for maintaining dedication” meant that nurses were able to handle the prospect of rededicating themselves to their patients. Furthermore, “the reason for the change from conflict to commitment” referred to events that changed nurses’ outlooks on nursing care, their pride as nurses, or their learning experiences. They felt dedicated and conflicted both simultaneously and separately. While committing to their patients’ physical care, nurses were empowered to think positively and treat patients with dignity in spite of the care taking much time and effort, as well as entailing considerable risk.

  2. Pro/con clinical debate: Tracheostomy is ideal for withdrawal of mechanical ventilation in severe neurological impairment

    Science.gov (United States)

    Mascia, Luciana; Corno, Eleomore; Terragni, Pier Paok; Stather, David; Ferguson, Niall D

    2004-01-01

    Most clinical trials on the topic of extubation have involved patients outside the neurological intensive care unit. As a result, in this area clinicians are left with little evidence on which to base their decision making. Although tracheostomies are increasingly common procedures, they are not without complications and costs, and hence a decision to perform them should not be taken lightly. In this issue of Critical Care two groups debate the merits of tracheostomy before extubation in a patient with neurological impairment. What becomes very clear is the need for more high quality data for this common clinical problem. PMID:15469593

  3. Morbidity and Mortality Patterns among Neurological Patients in the ...

    African Journals Online (AJOL)

    ANNALS

    Abstract. Background/Objective: The morbidity and mortality of neurological patients managed in the intensive care unit reflect the causes of neurological disorders and the effectiveness of management. Method: The morbidity and mortality patterns of neurological patients admitted into the intensive care unit of the University ...

  4. Neurological manifestaions among Sudanese patients with multiple ...

    African Journals Online (AJOL)

    The study demonstrated that the most common non- neurological symptoms was locomotor symptoms (24%) ,while the most common neurological symptoms were backache and neck pain .The most common neurological findings were cord compression (8%) followed by peripheral neuropathy (2%) and CVA (2%). 22% of ...

  5. [Neurological soft signs in schizophrenic patients and their nonaffected siblings].

    Science.gov (United States)

    Mechri, A; Slama, H; Bourdel, M-C; Chebel, S; Mandhouj, O; Krebs, M-O; Gaha, L

    2008-10-01

    Neurological soft signs (NSS) are subtle neurological signs indicating non specific cerebral dysfunction. Several studies have found an excess of NSS in schizophrenic patients compared to healthy subjects. Although NSS have been consistently reported in schizophrenic patients, their clinical relevance and their relation to functional impairment and severity of this disease are not well-clarified. In addition, the presence of NSS in schizophrenic patient's relatives suggests that they could be associated with the genetic liability. To determine the prevalence and scores of NSS in schizophrenic patients and their nonaffected siblings and to examine the clinical correlates of NSS in the schizophrenic patients. Sixty-six schizophrenic patients (50 males and 16 females, mean age=31.16+/-7.17 years), were compared to 31 of their nonaffected siblings (22 males and nine females, mean age=32.19+/-5.88 years) and to 60 controls subjects (40 males and 20 females, mean age=30.70+/-6.54 years) without family psychiatric history. NSS were assessed with Krebs et al.'s neurological soft signs scale. It is a comprehensive and standardized scale consisting of 23 items comporting five factors: motor coordination, motor integration, sensory integration, quality of lateralization and involuntary movements or posture. The Simpson and Angus scale for extrapyramidal symptoms was also rated. Clinical assessment of the schizophrenic patients was conducted using the positive and negative syndrome scale (PANSS), clinical global impressions (CGI) and global functioning evaluation (GAF). Psychiatric disorders were ruled out among siblings of schizophrenic patients and control subjects by psychiatric review evaluation, according to the DSM-IV check list. When the total NSS score of 11.5 was considered the cut-off point, the prevalence of NSS was 96.9% in the schizophrenic patients versus 35.5% in the nonaffected siblings (ptotal score and subscores than the siblings and control groups. The NSS

  6. Perimetry in young and neurologically impaired children: the Behavioral Visual Field (BEFIE) Screening Test revisited.

    Science.gov (United States)

    Koenraads, Yvonne; Braun, Kees P J; van der Linden, Denise C P; Imhof, Saskia M; Porro, Giorgio L

    2015-03-01

    Visual field examination in young or neurologically impaired children is a challenge. As a result, the Behavioral Visual Field (BEFIE) Screening Test was developed in 1995. To evaluate the applicability of the BEFIE test in a large population of young or neurologically impaired children, its reliability and consistency of findings across time, and its potential diagnostic value compared with standard conventional perimetry. The BEFIE tests were performed at an academic tertiary center and measured the peripheral visual field extension in degrees by observing an individual's response to a stimulus on a graded arc that moved from the periphery to the center of the visual field along different meridians. Patient files from all children who underwent this test were retrospectively analyzed. In total, 1788 BEFIE tests were performed in 835 children (median age, 3.4 years). Reliability and results of all tests were longitudinally evaluated. The diagnostic value of the BEFIE test was assessed by comparing monocular BEFIE test results with those of standard conventional perimetry in children who underwent both. Of 1788 tests, 74% (95% CI, 72%-76%) were considered reliable from the age of 4 months and older, with increasing success with higher ages; 56% reliable in children younger than 1 year; 71% reliable in children between 1 and 2 years; and more than 75% reliable in children 2 years and older (Spearman r = 0.506; P = .11). Peripheral visual field defects were found in 28% (95% CI, 25%-31%) of all first reliable tests. In 75% of children who underwent serial testing, results were consistent and there were good explanations in the case of discrepancies. Comparison of monocular BEFIE tests with standard conventional perimetry results in 147 eyes yielded a positive predictive value of 98% (95% CI, 94%-100%), negative predictive value of 66% (95% CI, 56%-75%), specificity of 98% (95% CI, 95%-100%), sensitivity of 60% (95% CI, 50%-71%), and superior sensitivity of 80

  7. Patient satisfaction in neurological second opinions and tertiary referrals

    NARCIS (Netherlands)

    Wijers, D.; Wieske, L.; Vergouwen, M.D.I; Richard, E.; Stam, J.; Smets, E.M.A.

    2010-01-01

    Although the number of neurological second opinions (SOs) and tertiary referrals (TRs) is increasing, only little is known about expectations and patient satisfaction in this group of patients. Therefore, the purpose of this study was to explore expectations of patients who get a neurological SO or

  8. Participatory design of therapeutic video games for young people with neurological vision impairment

    OpenAIRE

    Waddington, Jonathan; Linehan, Conor; Gerling, Kathrin,; Hicks, Kieran; Hodgson, Timothy L

    2015-01-01

    Neurological Vision Impairment (NVI) detrimentally impacts upon quality of life, as daily activities such as reading and crossing the road often become significantly impaired. Therapy strategies for NVI based on visual scanning of on-screen stimuli have recently been demonstrated as effective at improving functional vision. However, these strategies are repetitive, monotonous and unsuitable for use with children and young adults. This project explores the design of a g...

  9. EPIDEMIOLOGY OF HOSPITALIZED PATIENTS IN NEUROLOGY ...

    African Journals Online (AJOL)

    Les principaux diagnostics étaient: un Accident vasculaire cérébral (42,1%), un abcès cérébral (17,9%) et une méningo-encéphalite (ME) dans 11,9%. ... Death risk was in the one hand higher for neurological infectious than for stroke and in the second hand higher for neurological infectious than for all other diseases.

  10. Disregard of neurological impairments associated with neglected tropical diseases in Africa

    Directory of Open Access Journals (Sweden)

    Emmanuel Quansah

    2016-06-01

    Full Text Available Neglected tropical diseases (NTDs affect people in the bottom billion poorest in the world. These diseases are concentrated in rural areas, conflict zones and urban slums in Africa and other tropical areas. While the World Health Organization recognizes seventeen priority NTDs, the list of conditions present in Africa and elsewhere that are eligible to be classified as NTDs is much longer. Although NTDs are generally marginalized, their associated neurological burden has been almost completely disregarded. However, reports indicate that trichuriasis, schistosomiasis and hookworm infection, among others, cause impairments in memory and cognition, negatively affecting school attendance rates and educational performance particularly among children, as well as agricultural productivity among adults. Consequently, the neurological impairments have substantial influence on education and economic productivity, thus aggravating and perpetuating poverty in affected societies. However, inadequate research, policy and public health attention has been paid to the neurological burdens associated with NTDs. In order to appropriately address these burdens, we recommend the development of policy interventions that focus on the following areas: (i the introduction of training programs to develop the capacity of scientists and clinicians in research, diagnostic and treatment approaches (ii the establishment of competitive research grant schemes to fund cutting-edge research into these neurological impairments, and (iii the development of public health interventions to improve community awareness of the NTD-associated neurological problems, possibly enhancing disease prevention and expediting treatment.

  11. The visually impaired patient.

    Science.gov (United States)

    Rosenberg, Eric A; Sperazza, Laura C

    2008-05-15

    Blindness or low vision affects more than 3 million Americans 40 years and older, and this number is projected to reach 5.5 million by 2020. In addition to treating a patient's vision loss and comorbid medical issues, physicians must be aware of the physical limitations and social issues associated with vision loss to optimize health and independent living for the visually impaired patient. In the United States, the four most prevalent etiologies of vision loss in persons 40 years and older are age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy. Exudative macular degeneration is treated with laser therapy, and progression of nonexudative macular degeneration in its advanced stages may be slowed with high-dose antioxidant and zinc regimens. The value of screening for glaucoma is uncertain; management of this condition relies on topical ocular medications. Cataract symptoms include decreased visual acuity, decreased color perception, decreased contrast sensitivity, and glare disability. Lifestyle and environmental interventions can improve function in patients with cataracts, but surgery is commonly performed if the condition worsens. Diabetic retinopathy responds to tight glucose control, and severe cases marked by macular edema are treated with laser photocoagulation. Vision-enhancing devices can help magnify objects, and nonoptical interventions include special filters and enhanced lighting.

  12. Neurologic emergencies in HIV-negative immunosuppressed patients.

    Science.gov (United States)

    Guzmán-De-Villoria, J A; Fernández-García, P; Borrego-Ruiz, P J

    HIV-negative immunosuppressed patients comprise a heterogeneous group including transplant patients, patients undergoing treatment with immunosuppressors, uremic patients, alcoholics, undernourished patients, diabetics, patients on dialysis, elderly patients, and those diagnosed with severe or neoplastic processes. Epileptic seizures, focal neurologic signs, and meningoencephalitis are neurologic syndromes that require urgent action. In most of these situations, neuroimaging tests are necessary, but the findings can be different from those observed in immunocompetent patients in function of the inflammatory response. Infectious disease is the first diagnostic suspicion, and the identification of an opportunistic pathogen should be oriented in function of the type and degree of immunosuppression. Other neurologic emergencies include ischemic stroke, cerebral hemorrhage, neoplastic processes, and pharmacological neurotoxicity. This article reviews the role of neuroimaging in HIV-negative immunodepressed patients with a neurologic complication that requires urgent management. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Cotard syndrome in neurological and psychiatric patients.

    Science.gov (United States)

    Ramirez-Bermudez, Jesus; Aguilar-Venegas, Luis C; Crail-Melendez, Daniel; Espinola-Nadurille, Mariana; Nente, Francisco; Mendez, Mario F

    2010-01-01

    The authors describe the frequency and characteristics of Cotard syndrome among neurological and psychiatric inpatients at a tertiary referral center. All inpatients from the National Institute of Neurology of Mexico (March 2007-May 2009) requiring neuropsychiatric consultation were reviewed. Among 1,321 inpatient consultations, 63.7% had neurological disease and one (0.11%) had viral encephalitis and Cotard syndrome. Of inpatients, 36.2% had pure psychiatric disorders and three (0.62%) had Cotard syndrome, associated with psychotic depression, depersonalization, and penile retraction (koro syndrome). This review discusses potential mechanisms for Cotard syndrome, including the role of a perceptual-emotional dissociation in self-misattribution in the deliré des negations.

  14. Management of male neurologic patients with infertility

    DEFF Research Database (Denmark)

    Fode, Mikkel; Sønksen, Jens

    2015-01-01

    Many aspects of fertility rely on intact neurologic function and thus neurologic diseases can result in infertility. While research into general female fertility and alterations in male semen quality is limited, we have an abundance of knowledge regarding ejaculatory dysfunction following nerve i...... the testis. Once viable sperm cells have been obtained, these are used in assisted reproductive techniques, including intravaginal insemination, intrauterine insemination, and in vitro fertilization/intracytoplasmic sperm injection....... of treatment is assisted ejaculation, preferably by penile vibratory stimulation. If vibratory stimulation is unsuccessful, then ejaculation can almost always be induced by electroejaculation. In cases where assisted ejaculation fails, sperm can be retrieved surgically from either the epididymis or from...

  15. [Sexuality of patients with neurological disability: Perception of healthcare professionals of a neurologic rehabilitation hospital unit].

    Science.gov (United States)

    Babany, F; Hamdoun, S; Denys, P; Amarenco, G

    2016-12-01

    Sexual disorders are common after neurological diseases. The reconstruction of sexuality is a major issue after neurologic disability. Why is this topic not covered in rehabilitation medicine except specialized service? The aim of this pilot study was to assess the perception of the healthcare professionals (HCPs) and to understand why this topic was not addressed. We conducted a pilot, observational, monocentric study from February to March 2016 in HCPs from a neurologic rehabilitation hospital unit. The sexuality was essential for 14/28 (50%) HCPs in general and for 7/28 (25%) in neurologic disability. The hospital inhibits sexuality rebuilding in 21/28 (75%). The question of exercise of sexuality in hospital was considered as legitimate question for 13/28 (46%). Twenty-third (82%) have talked about sexuality with patients or colleagues, 5/19 (27%) thought that their response was satisfactory when patient asked about it. The question of sexuality had been managed for 10/28 (36%) during their training; 22/28 (79%) considered it was a prime importance for their job. In this monocentric study, sexuality was often poorly managed in rehab center. The professionals did not dare talking about it with patients and answered with difficulties when they are asked about sexual disorders. They were not trained for this topic. A specialized medical education in hospital and during studies would be of great value to improve neurologic rehabilitation of these patients. 4. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. Specificity of Cognitive Impairment in Neurological Disease: A Methodological Critique of Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    H. J. Sagar

    1991-01-01

    Full Text Available Multiple cognitive deficits have been recognized in many neurological disorders but the specificity of the findings and the relationship to the underlying neuropathology remain obscure. Definitions of dementia have been proposed based on symptom profiles of the cognitive disorder and qualitative differences have been claimed between dementias of different aetiology. Some conditions have been claimed to show patterns of cognitive deficit that are distinguished from dementia and related to specific neuropathology or psychological processes, e.g. frontal lobe deficits in Parkinson's disease. Sometimes, a relationship has been established between certain cognitive deficits and particular neurochemical deficits which has led to the notion of specific drug treatment, e.g. cholinergic deficits and memory failure in Alzheimer's disease. However, these conclusions are often potentially flawed by methodological inadequacies. This critique presents some methodological issues relevant to the study of brain-behaviour and drug-behaviour relationships in syndromes of multiple cognitive deficit, using Parkinson's disease as the model. The following recommendations are made: rigid diagnostic criteria; representative patient groups; avoidance of arbitrary quantitative criteria to limit definitions of dementia; matching of groups for overall level of cognitive impairment in the search for qualitative cognitive differences related to neuropathology or effects of particular drugs; the use of suitable controls in patient groups, neuropsychological tests and treatment regimes; the use of specific quantitative tests of cognition, affect and motor disability; and longitudinal, compared with cross-sectional, study design.

  17. Neurological manifestations in HIV positive patients in Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Minoo Mohraz

    2014-02-01

    Full Text Available Objective: To evaluate the neurological complications among Iranian HIV-positive patients. Methods: This cross-sectional study was conducted among 428 patients diagnosed with HIV infection between 2006 and 2009 at Imam Khomeini hospital, Tehran, Iran. Demographic and clinical variables as well as laboratory tests were extracted and analyzed. Also, another 100 patients refereed to Voluntary Counseling and Testing center of the hospital were visited and evaluated for neurological complications. Results: Among the patients, neurologic manifestations were observed in 34 (7.94% patients. Twenty three percent of the patients received antiretroviral therapy. Identified causes included brain toxoplasmosis (14.7%, progressive multi-focal leuko encephalopathy (5.9%, HIV encephalopathy (5.9%, TB meningitis (5% and unknown etiologies (11.8%. Also, among 100 patients who were admitted and visited at the Voluntary Counseling and Testing center, no one was diagnosed for any neurological manifestations. Conclusions: According to our results, toxoplasmosis is the most frequent cause of neurological conditions among Iranian HIV infected patients and should be considered in any HIV/AIDS patient with neurological manifestations.

  18. Pharmacologic Considerations during the Preoperative Evaluation of Neurologic Patients.

    Science.gov (United States)

    Mabry, Christian

    2017-08-28

    Optimizing a patient for surgery is a central goal during the preoperative period. Patients with common neurological disorders, such as Alzheimer's disease, epilepsy, Parkinson's disease, and multiple sclerosis, may require special attention on the perioperative management of their neurologic medications. This review aims to organize the most current recommendations for neurologic medication management during the perioperative period to minimize the risk of postoperative neurologic decline. A review of current literature present on Pubmed and Medline of peer-reviewed research papers was conducted. The quality of the papers was assessed by their research methodology and many of their sources were further analyzed in the same manner. A focused review question for each disease type was used, and, at times, inclusion and exclusion criteria were applied. Manuscripts covered a wide range of medical subspecialties with the most common sources being anesthetic, neurologic, and pharmacologic journals. The systemic inflammation that occurs in the perioperative period is detrimental to a patient's neurologic status. It is important to recognize that the proper management of neurologic medications can limit the negative effects of these stresses on a patient. Most medications appear safe to continue until the morning of surgery. Consultation of a neurologist regarding continuation of specific medications may be necessary to ensure patient safety. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  19. Brain magnetic resonance imaging pattern and outcome in children with haemolytic-uraemic syndrome and neurological impairment treated with eculizumab.

    Science.gov (United States)

    Gitiaux, Cyril; Krug, Pauline; Grevent, David; Kossorotoff, Manoelle; Poncet, Sarah; Eisermann, Monika; Oualha, Mehdi; Boddaert, Nathalie; Salomon, Remi; Desguerre, Isabelle

    2013-08-01

    The aim of this study was to describe the magnetic resonance imaging (MRI) findings and the neurological and neuropsychological outcomes in paediatric, diarrhoea-associated haemolytic-uraemic syndrome (D+HUS) with central nervous system impairment treated with eculizumab, a monoclonal antibody. The 14-month single-centre prospective study included seven children (three males, four females; age range 16 mo-7 y 8 mo; median age 3 y 7 mo) with typical D+HUS and acute neurological impairment. In the acute phase of the disease, neurological assessment and brain magnetic resonance imaging (MRI), including measurement of the apparent diffusion coefficient (ADC), were performed, and neuropsychological evaluation and brain MRI were also carried out 6 months after disease onset. In the acute phase, basal ganglia and white matter abnormalities with ADC restriction were a common and reversible MRI finding. In all the surviving patients (5/7), follow-up MRI after 6 months was normal, indicating reversible lesions. Clinical and neuropsychological evaluations after 6 months were also normal. This specific brain MRI pattern consisting of an ADC decrease in basal ganglia and white matter without major T2/fluid-attenuated inversion recovery (FLAIR) injury may be a key finding in the acute phase of the disease in favour of a vasculitis hypothesis. These reversible lesions were associated with a good neurological outcome. These results call for further evaluation of the potential role of eculizumab in the choice of treatment for severe D+HUS, particularly in the case of early neurological signs. © 2013 Mac Keith Press.

  20. Safety and feasibility of countering neurological impairment by intravenous administration of autologous cord blood in cerebral palsy

    Directory of Open Access Journals (Sweden)

    Lee Young-Ho

    2012-03-01

    Full Text Available Abstract Backgrounds We conducted a pilot study of the infusion of intravenous autologous cord blood (CB in children with cerebral palsy (CP to assess the safety and feasibility of the procedure as well as its potential efficacy in countering neurological impairment. Methods Patients diagnosed with CP were enrolled in this study if their parents had elected to bank their CB at birth. Cryopreserved CB units were thawed and infused intravenously over 10~20 minutes. We assessed potential efficacy over 6 months by brain magnetic resonance imaging (MRI-diffusion tensor imaging (DTI, brain perfusion single-photon emission computed tomography (SPECT, and various evaluation tools for motor and cognitive functions. Results Twenty patients received autologous CB infusion and were evaluated. The types of CP were as follows: 11 quadriplegics, 6 hemiplegics, and 3 diplegics. Infusion was generally well-tolerated, although 5 patients experienced temporary nausea, hemoglobinuria, or urticaria during intravenous infusion. Diverse neurological domains improved in 5 patients (25% as assessed with developmental evaluation tools as well as by fractional anisotropy values in brain MRI-DTI. The neurologic improvement occurred significantly in patients with diplegia or hemiplegia rather than quadriplegia. Conclusions Autologous CB infusion is safe and feasible, and has yielded potential benefits in children with CP.

  1. Neurological Recovery after Amantadine Treatment in a Patient with Septic Arthritis: A Case Report

    Directory of Open Access Journals (Sweden)

    Esra Özayar

    2016-04-01

    Full Text Available SUMMARY In this case report a patient with septic arthritis who developed impaired consciousness that responded to amantadine sulfate treatment was presented. A 67 years old male patient who had high fever, leukocytosis, hypotension, and generalized organ failure findings after knee prosthesis revision surgery was accepted to intensive care unit. Patient was intubated and connected to mechanical ventilation as he lost consciousness during non-invasive mechanical ventilation. In the follow-up he was diagnosed with bone abscess and was started penicillin according to culture results. Despite of clinical and laboratory resolving of sepsis finding, patient had tonic-clonic seizures especially on the right upper extremity with normal cranial computerized tomography findings. Septic course of the patient improved with antibiotic treatment, while impaired consciousness and seizures continued. Radiological evaluation of the patient was within normal ranges; however he was diagnosed as organic neurological dysfunction that developed secondary to sepsis. Amantadine sulfate 200 mg/day was initiated after neurology department consultation. Neurological suppression and seizures started to improve after the 6th day and completely resolved after the 10th day of the treatment. Patient was discharged from intensive care unit after resolution of septic clinic after 57 days. As a result we believe that amantadine is an efficient agent in treatment of neurological patients with coma and significantly decrease rehabilitation duration

  2. Managing patients with neurologic disorders who participate in sports activities.

    Science.gov (United States)

    Crutchfield, Kevin E

    2014-12-01

    Patients with neurologic conditions have been discouraged from participating in organized sports because of theoretical detrimental effects of these activities to their underlying conditions. The purpose of this article is to review known risks associated with three specific clinical conditions most commonly encountered in a sports neurology clinic (epilepsy, migraines, and multiple sclerosis and to add to the neurologist's toolkit suggested interventions regarding management of athletes with these disorders. Increased participation in sports and athletics has positive benefits for patients with neurologic conditions and can be safely integrated into the lives of these patients with proper supervision from their treating neurologists. Patients with neurologic conditions can and should be encouraged to participate in organized sports as a method of maintaining their overall fitness, improving their overall level of function, and reaping the physical and psychological benefits that athletic competition has to offer.

  3. Patient satisfaction with outpatient neurology services: a momentum for improvement.

    Science.gov (United States)

    Geberemichael, Sisay Gizaw; Metaferia, Guta Zenebe; Takele, Getahun Mengistu; Johnston, James C

    2011-04-15

    Outcome measures of patient satisfaction are increasingly accepted as an integral component of the overall healthcare quality assessment. A survey of the outpatient neurology services in Addis Ababa, Ethiopia was performed to determine the overall patient satisfaction, provide an assessment of current services and form the foundation for improved expansion of neurological care. 233 patients were recruited from the Addis Ababa University Teaching Hospital outpatient general neurology clinic by a cross-sectional sample survey design. Data from structured interview and abstraction of medical records were analyzed by SPSS for Windows version 15.0 computer software. Visual analysis of mean satisfaction scores and Spearman's rho correlation coefficients generated priority indices serving to guide expansion of neurology services. 212 patients with mean age of 40.1 and a 1:1M: F ratio completed the survey. The variation of overall patient satisfaction (mean, 70.4; SD, 12.4) was independently predicted by patient clinical outcome expectations and satisfaction on waiting area, overall service of doctor and card room [R(2)=0.305; F (8,195)=10.685, p=0.000]. Mean satisfaction scores for specific dimensions of the outpatient general neurology clinic ranged from 57.2 for waiting time at the clinic to 74.0 for overall service of the guards. Waiting time at the clinic stood first among the top five priority indices. This survey demonstrates predictors of overall patient satisfaction with the outpatient neurology services, and delineates priority areas warranting further improvement. It is the first African study on patient satisfaction with neurology services, and provides a guide for neurological or other specialty clinics seeking to improve and expand medical services. Copyright © 2010 Elsevier B.V. All rights reserved.

  4. Advance care planning for patients with advanced neurology diseases.

    Science.gov (United States)

    Cheung, Ka-Chi; Lau, Vikki Wai-Kee; Un, Ka-Chun; Wong, Man-Sheung; Chan, Kwok-Ying

    2017-10-13

    Advanced neurology diseases including motor neuron disease (MND) are usually progressive life-limiting illness and could be devastating for patients, families and caregivers. Although medical technologies, such as enteral feeding and non-invasive ventilation, may prolong life expectancy of the patients, their utilization prompts important ethical questions in regard to their quality of life (QoL). Little attention had been paid on how ACP practice would practically help with patients suffering from different neurology diseases. We are unaware of any published studies on ACP practice among patients with different neurology diseases. In our study, we assessed end-of-life (EOL) care preferences, documentation, and communication in patients with various types of advanced neurology diseases. This was a retrospective chart review of all patients referred to the neuro-palliative care team (NPCT) in a local acute hospital in Hong Kong. The study was approved by the institutional review board of the University of Hong Kong. NPCT consultation was hand abstracted from the electronic health record if there was a subspecialty palliative care (PC) consultation note during the study period. Hand abstraction of data also included any content related to advance care planning (ACP) [advance directive (AD), resuscitation order, ventilator support, artificial feeding, patient wishes, legacy]. For patient who signed AD, items including cardiopulmonary resuscitation (100%), mechanical ventilation (100%), artificial nutrition and hydration (80%) were mentioned more frequently than other EOL interventions. For patients who had ACP but without AD, the most common diagnosis is bad stroke (60%). Place of death, artificial nutrition and hydration were most mentioned EOL interventions. EOL decision making in patients with advanced neurology disease is often delayed. This study showed that MND patients are readier to discuss their EOL issues and signed their AD. The NPCT can play a valuable

  5. Oro-facial impairment in stroke patients.

    Science.gov (United States)

    Schimmel, M; Ono, T; Lam, O L T; Müller, F

    2017-04-01

    Stroke is considered one of the leading causes of death and acquired disability with a peak prevalence over the age of 80 years. Stroke may cause debilitating neurological deficiencies that frequently result in sensory deficits, motor impairment, muscular atrophy, cognitive deficits and psychosocial impairment. Oro-facial impairment may occur due to the frequent involvement of the cranial nerves' cortical representation areas, central nervous system pathways or motoneuron pools. The aim of this narrative, non-systematic review was to discuss the implications of stroke on oro-facial functions and oral health-related quality of life (OHRQoL). Stroke patients demonstrate an impaired masticatory performance, possibly due to reduced tongue forces and disturbed oral sensitivity. Furthermore, facial asymmetry is common, but mostly discrete and lip restraining forces are reduced. Bite force is not different between the ipsi- and contra-lesional side. In contrast, the contra-lesional handgrip strength and tongue-palate contact during swallowing are significantly impaired. OHRQoL is significantly reduced mainly because of the functional impairment. It can be concluded that impaired chewing efficiency, dysphagia, facial asymmetry, reduced lip force and OHRQoL are quantifiable symptoms of oro-facial impairment following a stroke. In the absence of functional rehabilitation, these symptoms seem not to improve. Furthermore, stroke affects the upper limb and the masseter muscle differently, both, at a functional and a morphological level. The rehabilitation of stroke survivors should, therefore, also seek to improve the strength and co-ordination of the oro-facial musculature. This would in turn help improve OHRQoL and the masticatory function, subsequently preventing weight loss and malnutrition. © 2017 John Wiley & Sons Ltd.

  6. Suicide and patients with neurologic diseases. Methodologic problems

    DEFF Research Database (Denmark)

    Stenager, E N; Stenager, Egon

    1992-01-01

    OBJECTIVE: The suicide risk in patients with many neurologic diseases has been reported to be greater than that in the general population. Studies on the subject are, however, often encumbered with methodologic problems. We appraised these problems and, based on an evaluation, reappraised knowledge...... of the suicide risk in patients with specific neurologic diseases. DATA SOURCE: Using the computerized database MEDLINE, we identified all published reports with the key words suicide, attempted suicide, and neurologic diseases. STUDY SELECTION: We assessed and reviewed studies concerning the most common...... neurologic diseases for methodologic problems in the study design. DATA EXTRACTION: The following methodologic problems emerged during our review: (1) choice of study type, ie, autopsy study or follow-up study; (2) choice of study population; (3) choice of control groups; (4) epidemiologic...

  7. Compound mitochondrial DNA mutations in a neurological patient ...

    Indian Academy of Sciences (India)

    [Park J. H., Yoon B. R., Kim H. J., Lee P. H., Choi B.-O. and Chung K. W. 2014 Compound mitochondrial DNA mutations in a neurological patient with ataxia ... nuclear genes of the patient, from which two causative muta- tions in the 12S rRNA and .... Clinical and electrophysiological features. The patient (57-year-old man) ...

  8. Evaluation of motor imagery ability in neurological patients: a review

    OpenAIRE

    Heremans, Elke; Vercruysse, Sarah; Spildooren, Joke; Feys, Peter; Helsen, W.; Nieuwboer, Alice

    2013-01-01

    Motor imagery is a promising new intervention strategy within neurological rehabilitation. However, previous studies have shown that the ability to perform motor imagery is not well preserved in all neurological patients. Therefore, patients’ motor imagery ability needs to be thoroughly examined when they are included in motor imagery rehabilitation programs or studies. In the past, objective methods to evaluate motor imagery were lacking rigour, and participants’ imagery ability was often in...

  9. Self-imagining enhances recognition memory in memory-impaired individuals with neurological damage.

    Science.gov (United States)

    Grilli, Matthew D; Glisky, Elizabeth L

    2010-11-01

    The ability to imagine an elaborative event from a personal perspective relies on several cognitive processes that may potentially enhance subsequent memory for the event, including visual imagery, semantic elaboration, emotional processing, and self-referential processing. In an effort to find a novel strategy for enhancing memory in memory-impaired individuals with neurological damage, we investigated the mnemonic benefit of a method we refer to as self-imagining-the imagining of an event from a realistic, personal perspective. Fourteen individuals with neurologically based memory deficits and 14 healthy control participants intentionally encoded neutral and emotional sentences under three instructions: structural-baseline processing, semantic processing, and self-imagining. Findings revealed a robust "self-imagination effect (SIE)," as self-imagination enhanced recognition memory relative to deep semantic elaboration in both memory-impaired individuals, F(1, 13) = 32.11, p visual imagery, semantic processing, or emotional content of the materials. The findings suggest that the SIE may depend on unique mnemonic mechanisms possibly related to self-referential processing and that imagining an event from a personal perspective makes that event particularly memorable even for those individuals with severe memory deficits. Self-imagining may thus provide an effective rehabilitation strategy for individuals with memory impairment.

  10. Self-Imagining Enhances Recognition Memory in Memory-Impaired Individuals with Neurological Damage

    Science.gov (United States)

    Grilli, Matthew D.; Glisky, Elizabeth L.

    2010-01-01

    Objective The ability to imagine an elaborative event from a personal perspective relies on a number of cognitive processes that may potentially enhance subsequent memory for the event, including visual imagery, semantic elaboration, emotional processing, and self-referential processing. In an effort to find a novel strategy for enhancing memory in memory-impaired individuals with neurological damage, the present study investigated the mnemonic benefit of a method we refer to as “self-imagining” – or the imagining of an event from a realistic, personal perspective. Method Fourteen individuals with neurologically-based memory deficits and fourteen healthy control participants intentionally encoded neutral and emotional sentences under three instructions: structural-baseline processing, semantic processing, and self-imagining. Results Findings revealed a robust “self-imagination effect” as self-imagination enhanced recognition memory relative to deep semantic elaboration in both memory-impaired individuals, F (1, 13) = 32.11, p imagination were not limited by severity of the memory disorder nor were they related to self-reported vividness of visual imagery, semantic processing, or emotional content of the materials. Conclusions The findings suggest that the self-imagination effect may depend on unique mnemonic mechanisms possibly related to self-referential processing, and that imagining an event from a personal perspective makes that event particularly memorable even for those individuals with severe memory deficits. Self-imagining may thus provide an effective rehabilitation strategy for individuals with memory impairment. PMID:20873930

  11. Melatonin prevents blood vessel loss and neurological impairment induced by spinal cord injury in rats.

    Science.gov (United States)

    Jing, Yingli; Bai, Fan; Chen, Hui; Dong, Hao

    2017-03-01

    Melatonin can be neuroprotective in models of neurological injury, but its effects on blood vessel loss and neurological impairment following spinal cord injury (SCI) are unclear. Our goal herein was to evaluate the possible protective action of melatonin on the above SCI-induced damage in rats. Sixty-three female Sprague-Dawley rats were randomly divided into three equal groups: sham, SCI and melatonin groups. Melatonin (10 mg/kg) was injected intraperitoneally and further administered twice a day at indicated time after a moderate injury at T10 in melatonin group. Blood vessel was assessed by CD31staining and FITC-LEA, the permeability of blood-spinal cord barrier (BSCB) was detected by Evan's Blue. Neuron was assessed by NeuN staining and the expression of Nissl bodies in the neurons was assessed by Nissl staining. The expressions of brain-derived neurotrophic factor (BDNF), synapsin I, or growth associated protein-43 (GAP-43) in the spinal cord and hippocampus were evaluated by Western blotting. At 7 days post-injury, melatonin treatment rescued blood vessels, increased CD31 levels, ameliorated BSCB permeability. Additionally, melatonin significantly increased the number of neurons and the expression of Nissl bodies in neurons at the injury epicenter. Furthermore, our data showed that SCI reduced levels of the molecular substrates of neurological plasticity, including BDNF, synapsin I, or GAP-43 in the spinal cord and hippocampus. Melatonin treatment partially prevented these reductions. The neuroprotective effect of melatonin was associated with melioration of the microcirculation in the spinal cord and reduction of neurological impairment in the spinal cord and brain.

  12. Disease Patterns and Outcome for Medical Neurological Patients ...

    African Journals Online (AJOL)

    Aim: To review the disease pattern and outcome for neurological patients admitted to the intensive care unit (ICU) of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria was undertaken. Patients and Methods: The hospital records (case notes ICU records) were reviewed retrospectively for five years and the ...

  13. Prevention of cerebrovascular diseases and cognitive impairment in psychiatric and neurological practice: A literature review

    Directory of Open Access Journals (Sweden)

    A. G. Merkin

    2016-01-01

    Full Text Available Increased life expectancy and related demographic changes, as well as lifestyle modification in the population enhance a steady rise in the incidence of disorders in middle and later life. It increases the burden of diseases and overloads healthcare systems. Therefore prevention strategies are currently on the cutting edge and becoming more and more essential. The article discusses approaches to preventing the most common mental and neurological disorders in middle and old age. It also describes cerebrovascular disease, dementia, cognitive impairment, and stroke and outlines some state-of-the-art prevention strategies.

  14. Meeting the occupational needs of a neurologically impaired client for driving: a case review.

    Science.gov (United States)

    Rolland, Beth; Dickerson, Anne E; Brooks, Johnell

    2013-10-01

    Driving as a means of community mobility is an activity highly valued by individuals. When a medical condition impacts a person's ability to drive, occupational therapy practitioners should address this instrumental task of daily living with the client in order for the client to know if and when return to driving might be possible. This case review illustrates how the task of driving motivated a neurologically impaired client in therapy as well as how driving evaluation and driving rehabilitation intervention should not be done in isolation, but with the communication that will optimally assist the client to return to functional performance.

  15. A preliminary investigation of sleep quality in functional neurological disorders: Poor sleep appears common, and is associated with functional impairment.

    Science.gov (United States)

    Graham, Christopher D; Kyle, Simon D

    2017-07-15

    Functional neurological disorders (FND) are disabling conditions for which there are few empirically-supported treatments. Disturbed sleep appears to be part of the FND context; however, the clinical importance of sleep disturbance (extent, characteristics and impact) remains largely unknown. We described sleep quality in two samples, and investigated the relationship between sleep and FND-related functional impairment. We included a sample recruited online via patient charities (N=205) and a consecutive clinical sample (N=20). Participants completed validated measures of sleep quality and sleep characteristics (e.g. total sleep time, sleep efficiency), mood, and FND-related functional impairment. Poor sleep was common in both samples (89% in the clinical range), which was characterised by low sleep efficiency (M=65.40%) and low total sleep time (M=6.05h). In regression analysis, sleep quality was negatively associated with FND-related functional impairment, accounting for 16% of the variance and remaining significant after the introduction of mood variables. These preliminary analyses suggest that subjective sleep disturbance (low efficiency, short sleep) is common in FND. Sleep quality was negatively associated with the functional impairment attributed to FND, independent of depression. Therefore, sleep disturbance may be a clinically important feature of FND. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Neurological soft signs in persons with amnestic mild cognitive impairment and the relationships to neuropsychological functions

    Directory of Open Access Journals (Sweden)

    Li Hui-jie

    2012-06-01

    Full Text Available Abstract Background Neurological abnormalities have been reported in people with amnestic mild cognitive impairment (aMCI. The current study aimed to examine the prevalence of neurological soft signs (NSS in this clinical group and to examine the relationship of NSS to other neuropsychological performances. Methods Twenty-nine people with aMCI and 28 cognitively healthy elderly people were recruited for the present study. The NSS subscales (motor coordination, sensory integration, and disinhibition of the Cambridge Neurological Inventory and a set of neuropsychological tests were administered to all the participants. Results People with aMCI exhibited significantly more motor coordination signs, disinhibition signs, and total NSS than normal controls. Correlation analysis showed that the motor coordination subscale score and total score of NSS were significantly inversely correlated with the combined Z-score of neuropsychological tests in aMCI group. Conclusions These preliminary findings suggested that people with aMCI demonstrated a higher prevalence of NSS compared to healthy elderly people. Moreover, NSS was found to be inversely correlated with the neuropsychological performances in persons with aMCI. When taken together, these findings suggested that NSS may play a potential important role and serve as a tool to assist in the early detection of aMCI.

  17. EPIDEMIOLOGY OF HOSPITALIZED PATIENTS IN NEUROLOGY ...

    African Journals Online (AJOL)

    Méthodes: Analyse rétrospective des dossiers médicaux des patients admis dans le service de Neurologie du CHU de Cocody (Abidjan) entre le 1er décembre 1998 au 31 Décembre 2000. Résultats: Mille dix huit sujets âgés en moyenne de 45 ± 17,7 ans (extrêmes de 1 et 93 ans) avec un sexe ratio de 1,7 en faveur des ...

  18. Organ Support After Death by Neurologic Criteria in Pediatric Patients.

    Science.gov (United States)

    Lewis, Ariane; Adams, Nellie; Chopra, Arun; Kirschen, Matthew P

    2017-09-01

    We sought to 1) evaluate how pediatricians approach situations in which families request continuation of organ support after declaration of death by neurologic criteria and 2) explore potential interventions to make these situations less challenging. A survey on management and personal experience with death by neurologic criteria was distributed electronically to pediatric intensivists and neurologists. We compared responses from individuals who practice in states with accommodation exceptions (accommodation states where religious or moral beliefs must be taken into consideration when declaring death: California, Illinois, New Jersey, New York) to those from non-accommodation states. United States. The survey was opened by 254 recipients, with 186 meeting inclusion criteria and providing data about the region in which they practice; of these, 26% were from accommodation states. None. More than half of physicians (61% from both accommodation states and non-accommodation states) reported they cared for a pediatric patient whose family requested continuation of organ support after declaration of death by neurologic criteria (outside of organ donation; range, 1-17 times). Over half of physicians (53%) reported they would not feel comfortable handling a situation in which a pediatric patient's family requested care be continued after declaration of death by neurologic criteria. Nearly every physician (98%) endorsed that something needs to be done to make situations involving families who object to discontinuation of organ support after declaration of death by neurologic criteria easier to handle. Respondents felt that public education, physician education, and uniform state laws about these situations are warranted. It is relatively common for pediatricians who care for critically ill patients to encounter families who object to discontinuation of organ support after death by neurologic criteria. Management of these situations is challenging, and guidance for medical

  19. Compound mitochondrial DNA mutations in a neurological patient ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Genetics; Volume 93; Issue 1. Compound mitochondrial DNA mutations in a neurological patient with ataxia, myoclonus and deafness. Ji Hoon Park Bo Ram Yoon Hye Jin Kim Phil Hyu Lee Byung-Ok Choi Ki Wha Chung. Research Note Volume 93 Issue 1 April 2014 pp 173-177 ...

  20. Laparo-assisted jejunostomy in neurological patients with chronic malnutrition and GERD

    Directory of Open Access Journals (Sweden)

    C. Esposito

    2013-06-01

    Full Text Available Background: Feeding difficulties and gastroesophageal reflux (GER are major problems in severely neurologically impaired children. Many patients are managed with a simple gastrostomy, with or without fundoplication. Unfortunately, fundoplication and gastrostomy are not devoid of complications, indicating the need for other options in the management of these patients. Methods: Between January 2002 and June 2010, ten patients (age range,18 months–14 years have been treated by creating a jejunostomy with the laparoscopic-assisted procedure. The procedure was performed using 2-3 trocars. The technique consists of identifying the first jeujnal loop, grasping it 20–30 cm away from the Treitz ligament, and exteriorizing it to the trocar orifice under visual guide. The jejunostomy was created outside the abdominal cavity during open surgery. At the end of the jejunostomy, the correct position of the intestinal loops was evaluated via laparoscopy. Results: Surgery lasted 40 min on average, the laparoscopic portion about 10 min. Hospital stay was 3 or 7 days for all patients. At the longest follow-up (8 years, all patients had experienced a significant weight gain. One patient died 1 year after the procedure of unknown causes. As for the other complications: 4/10 patients experienced peristomal heritema, 2/10 device’s dislocation and 1 patient a peristomal granuloma.Conclusions: Laparoscopic-assisted jejunostomy is a safe and effective procedure to adopt in neurologically impaired children with feeding problems and GER. We advocate the use of this procedure in neurologically impaired patients with feeding problems and reflux due to its overall practicability and because there is minimal surgical trauma. The improvement in the quality of life of these children after the jejunostomy seems to be the major advantage of this procedure. However the management of jejunostomy can be difficult for parents above all in the first postoperative months.

  1. [Can music therapy for patients with neurological disorders?].

    Science.gov (United States)

    Myskja, Audun

    2004-12-16

    Recent developments in brain research and in the field of music therapy have led to the development of music-based methods specifically aimed at relieving symptoms of Parkinson's disease and other neurologic disorders. Rhythmic auditory stimulation uses external rhythmic auditory cues from song, music or metronome to aid patients improving their walking functioning and has been shown to be effective both within sessions and as a result of training over time. Melodic intonation therapy and related vocal techniques can improve expressive dysphasia and aid rehabilitation of neurologic disorders, particularly Parkinson's disease, stroke and developmental disorders.

  2. [Multimorbidity of neurological patients in palliative care units].

    Science.gov (United States)

    Lorenzl, S

    2014-04-01

    Multimorbidity in patients with neurological diseases needs enhanced attention. Especially the treatment with medication for comorbidities should be regularly evaluated and adapted to the current condition of the patient. The problem of how to deal with multimorbidity of neurological patients on palliative care units is discussed. This article gives a retrospective review of data and presentation of own results together with a discussion on basic knowledge and expert recommendations. Multimorbidity of patients with neurological diseases depends on the underlying disease and age. Multimorbidity is often associated with polypharmacy which should be critically evaluated during palliative care treatment. Long-term pharmacological treatment often needs to be terminated as the side effects outweigh the benefits. Our own data show that patients leaving the palliative care unit often have a reduced amount of drugs compared to those who have died. Multimorbidity at the end of life includes dementia, delirium and epileptic seizures as well as symptoms associated with tube feeding. Artificial nutrition should be regarded as a form of pharmacological treatment and its usefulness at the end of life carefully evaluated.

  3. Hippotherapy effects on trunk, pelvic, and hip motion during ambulation in children with neurological impairments.

    Science.gov (United States)

    Encheff, Jenna L; Armstrong, Charles; Masterson, Michelle; Fox, Christine; Gribble, Phillip

    2012-01-01

    This study investigated the effects of a 10-week hippotherapy program on trunk, pelvis, and hip joint positioning during the stance phase of gait. Eleven children (6 boys and 5 girls; 7.9 ± 2.7 years) with neurological disorders and impaired ambulation participated. Joint range of motion data were collected via 3-dimensional computerized gait analysis before and after the program. Paired t tests were performed on kinematic data for each joint. Significant improvements (P ≤ .008) and large effect sizes (ESs) for sagittal plane hip positions at initial contact and toe-off were found. No differences in pelvic or trunk positioning were determined, although sagittal plane pelvic positioning displayed a trend toward improvement with large ESs. Several trunk variables displayed moderate ESs with a trend toward more upright positioning. Improvements in pelvic and hip joint positioning and more normalized vertical trunk position may indicate increased postural control during gait after 10 sessions of hippotherapy.

  4. Prediction of the academic success of children with suspected neurological impairments.

    Science.gov (United States)

    Gold, P; Berk, R A

    1979-07-01

    Explored a multivariate approach to the prediction of 8-year academic achievement. Ss were black, of low socioeconomic status, and had been diagnosed as suspect neurologically impaired at age 7. A serial array of early predictors that included maternal education, sex, birth weight, 8-month and 4-year intelligence, and 3-year speech, hearing, and language were entered into multiple regression analyses to determine their value in predicting 8-year academic achievement in word recognition, arithmetic, spelling, and oral reading. The 4-year intelligence measure was the best overall predictor, although maternal education, sex, and birth weight contributed slightly to the predictions. The resulting equations, however, could not be used to predict accurately 8-year academic achievement.

  5. Neurological soft signs in aging, mild cognitive impairment and Alzheimer´s disease – the impact of cognitive decline and cognitive reserve

    OpenAIRE

    Nadja eUrbanowitsch; Christina eDegen; Pablo eToro; Johannes eSchröder

    2015-01-01

    Objectives: Neurological soft signs (NSS), i.e. minor motor and sensory changes, are a common feature in severe psychiatric disorders. We sought to establish the frequency of NSS in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) on basis of a large population based sample and to identify their neuropsychological correlates including cognitive reserve.Methods: NSS were examined using an abbreviated version of the Heidelberg NSS Scale in 221 old participants born bet...

  6. Coraco- or Costoclavicular Paraosteoarthropathies in Patients with Severe Central Neurological Disorders

    Energy Technology Data Exchange (ETDEWEB)

    Lacout, A.; Mompoint, D.; Perrier, Y.; Vallee, C.A.; Carlier, R.Y. (Service de Radiologie, Hopital Raymond Poincare, Garches (France))

    2008-03-15

    Background: Paraosteoarthropathy (POA) is a frequent disabling orthopedic complication after severe central neurological impairment. The hip is the most frequently affected joint (32.1%) followed by the elbow and the shoulder (25%). Purpose: To evaluate coraco- and costoclavicular paraosteoarthropathy in patients with severe central neurological disorders. Material and Methods: We report a series of five consecutive patients with severe central neurological disorders who developed a POA of the clavicular region (coracoclavicular or costoclavicular POA). Every patient underwent a clinical, radiological, and computed tomographic (CT) examination of the shoulder region. Results: Four patients had a history of traumatic brain injury (TBI), and one an acute disseminated encephalomyelitis (ADEM). They developed POA of the clavicular region, although not around the glenohumeral joint. The patients complained of shoulder pain and of moderate limitation of movements. Radiological and CT examinations showed the presence of a bony formation in the coracoclavicular space in four cases and extending from the clavicle to the first rib around the costoclavicular joint in one case. Conclusion: In patients with severe brain lesions suffering from shoulder pain and moderate limitation of joint movements, POAs of the clavicular region are rare but should be considered

  7. Quality measures in neurology consult care for epileptic patients.

    Science.gov (United States)

    de la Morena Vicente, M A; Ballesteros Plaza, L; Martín García, H; Vidal Díaz, B; Anaya Caravaca, B; Pérez Martínez, D A

    2014-06-01

    Epilepsy is one of the most frequently observed diseases in neurology outpatient care. We analysed our hospital's implementation of the 8 epilepsy quality measures proposed by the American Academy of Neurology: documented seizure types and seizure frequency, aetiology of epilepsy or the epilepsy syndrome, review of EEG, MRI, or CT results, counselling about antiepileptic drug side effects, surgical therapy referral for intractable epilepsy, and counselling about epilepsy-specific safety issues and for women of childbearing age. In most cases, the first four quality measures were documented correctly. In 66% of the cases, doctors had asked about any adverse drug effects during every visit. Almost all patients with intractable epilepsy had been informed about surgical options or referred to a surgical centre of reference for an evaluation at some point, although referrals usually took place more than 3 years after the initial proposal. Safety issues had been explained to 37% of the patients and less than half of women of childbearing age with epilepsy had received counselling regarding contraception and pregnancy at least once a year. The care we provide is appropriate according to many of the quality measures, but we must deliver more counselling and information necessary for the care of epileptic patients in different stages of life. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  8. Coping with chronic neurological impairment: a contrastive analysis of Parkinson's disease and stroke.

    Science.gov (United States)

    Herrmann, M; Freyholdt, U; Fuchs, G; Wallesch, C W

    1997-01-01

    This study aimed at a contrastive analysis of coping strategies and psychosocial alterations in patients with Parkinson's disease (PD) and stroke (CVA) and their relatives. Fifty-four PD and 50 CVA patients were investigated with a standardized semistructured interview to assess the severity of psychosocial changes following illness, the Freiburg Questionnaire on Coping with Illness, the Cornell Depression Scale and instruments to assess motor impairment. Psychosocial alterations were most prominent in the professional and emotional-cognitive domains. Degree of depression correlated with familial and emotional-cognitive alterations in both patient groups. Active problem-oriented coping and distraction predominated as coping styles. Religious relief and quest for sense were significantly more important for the PD patients. Coping styles did not correlate with degrees of depression, motor impairment or psychosocial alterations.

  9. Neurological impairment correlated to abnormal cerebral non-dominant transverse sinus drainage: a report of 12 cases

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    Bao-min LI

    2016-12-01

    Full Text Available Background Dominant venous sinus drainage of the brain is a common anatomic characteristic. Cortical venous partial retention that is due to slow non-dominant venous sinus drainage can increase local cerebral vein pressure, and cause related neurological impairment. This article is to investigate the diagnosis of local intracranial hypertension caused by abnormal non-dominant transverse sinus drainage and the effect of anticoagulation treatment. Methods From February 2008 to February 2016, there were 12 patients diagnosed as abnormal cerebral non-dominant transverse sinus drainage. Among these patients, 8 patients presented as dizziness and brain swelling; 2 presented as subarachnoid hemorrhage (SAH; one presented as cerebral cortex bleeding; 2 presented as blurred vision; 2 presented as ipsilateral pulsatile tinnitus; one presented as narcolepsy. Cerebrospinal fluid (CSF pressure of 2 patients were > 280 mm H2O. Nine patients were confirmed no abnormal characteristics by MRI. In DSA examination, 10 patients were confirmed non-dominant transverse sinus drainage and contrast agent retention on the left side, and 2 patients were confirmed on the right side. All patients were treated by anticoagulation, and 2 underwent stent implantation, 5 underwent thrombolysis through carotid artery. Results All patients were greatly improved after 7-day treatment. They were discharged within 2 weeks and were continuously treated by anticoagulation after discharge for one year. There was no recurrence or aggravation in all patients during the follow-up period ranging from 6 to 34 months. Two patients were confirmed less contrast agent retention by DSA after 6 months.  Conclusions Abnormal non-dominant transverse sinus drainage can increase local cerebral vein pressure, and presents non-specific clinical features such as dizziness, headache or tinnitus. Anticoagulation, thrombolysis or stent implantation can promote local cerebral venous drainage, relieve

  10. Diagnostic and prognostic role of MRI in spinal trauma, its comparison and correlation with clinical profile and neurological outcome, according to ASIA impairment scale

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    Umesh C Parashari

    2011-01-01

    Full Text Available Aims and objectives: To evaluate the role of magnetic resonance imaging (MRI as a non-invasive diagnostic tool in patients with acute and chronic spinal trauma and to compare and correlate the MRI findings with those of patients′ clinical profile and neurological outcome according to ASIA impairment scale to assess prognostic and clinical value of MRI. Materials and Methods: Sixty two patients of spinal trauma formed the study group in a prospective fashion. The patients undergoing MR imaging and magnetic resonance images were analyzed and correlated with findings on neurological examination according to American Spinal Injury Association (ASIA impairment scale (AIS at the time of MRI examination and subsequently at sub-acute interval to assess neurological outcome. Statistical Analysis : Sample profile was described in terms of 95% confidence limit and proportion. To describe strength of association between extent of spinal cord injury and outcome, odd′s ratio, bivariate and multi variant analysis, was used. Pearson′s chi square (χ 2 statistics was applied to test the association between two categorical variables. Data were analyzed using statistical software package, STATA 9.2 and the difference was considered to be significant if ′P′ value was <0.05. Observation and Results: The cord edema without hemorrhage was the most common MR finding (41.5%. The others were sizable focus of hemorrhage within the cord (33%, epidural hematoma (5.0%, and normal cord (26%. Majority of MR findings correlated well with clinical profile of the patient according to ASIA impairment scale. This study demonstrated that patients with presence of sizable focus of haemorrhage had larger cord edema and more severe grade of initial ASIA impairment scale( AIS with poor recovery at follow up (P=0.032.Improvement in upper extremity was more than lower extremity. Severe cord compression was also associated with poor neurological outcome; however it was not

  11. [Stereotaxic brain biopsy in AIDS patients with neurological manifestations].

    Science.gov (United States)

    Nasser, J A; Confort, C I; Ferraz, A; Esperança, J C; Duarte, F

    1998-06-01

    Prospective series showing the importance of computerized stereotactic brain biopsy in the management of AIDS patients neurologically symptomatic and confirmed by images. Patients undergone an algorithm step by step done by their own doctors and referred to us for stereotactic biopsy. Our protocol was opened in August 1995 and closed in December 1996. Twenty patients were biopsied. This protocol is similar to the Levy's one (Chicago IL, USA). We have got diagnosis in all cases. Lymphoma was predominant and followed by toxoplasmosis, progressive multifocal leukoencephalopathy and HIV encephalopathy. We included one patient with diploic giant cells lymphoma. Our mortality and morbidity was zero. By these results we conclude that stereotactic biopsy in AIDS patients is safe and effective.

  12. Feasibility of web-based decision aids in neurological patients

    NARCIS (Netherlands)

    van Til, Janine Astrid; Drossaert, Constance H.C.; Renzenbrink, Gerbert J.; Snoek, Govert J.; Dijkstra, Evelien; Stiggelbout, Anne M.; IJzerman, Maarten Joost

    2010-01-01

    Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of

  13. Report of seven neurological patients with misidentification syndrome

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    Edson José Amâncio

    2004-12-01

    Full Text Available Objective: To present clinical, neuropsychological and laboratorydata on 7 patients with misidentification syndrome and to discussits possible etiologies and pathophysiology. Methods: Sevenpatients presenting misidentification syndrome, 6 female and 1male, aged 64-78 years were studied. All had a brain diseasediagnosed by clinical and laboratory data. All patients weresubmitted to general clinical examination, neurological andneuropsychological examinations, and brain magnetic resonanceimaging. Results: All patients were capable to recognizephotographs of relatives or famous persons. They presented goodvisual acuity that allowed them reading texts with small print andpreserved visual field. The etiologies of brain lesions were ischemicstroke, left temporal lobe tumor, idiopathic hydrocephalus in elderlypatients, Parkinson’s disease and probable Alzheimer’s disease.None presented enough cognitive disorders to characterize seniledementia. Conclusion: Misidentification syndromes are notnecessarily related to one single psychogenic etiology; on thecontrary, many organic causes may be related with the clinicalpicture. Most patients improved when submitted to treatmentwith typical or atypical neuroleptic drugs.

  14. [Neurologic aspects of HIV infections--follow-up of pediatric patients].

    Science.gov (United States)

    Kollár, Katalin; Jelenik, Zsuzsanna; Hegelsberger, Edit

    2003-11-20

    Before the widespread introduction of combined antiretroviral therapy (1995) complications from HIV and AIDS in the central nervous system had been reported in larger proportion in infants and children than in adults: 80-90% versus 60-70%. Particular clinical manifestations tend to occur at different stages during the evolution of HIV infection. The authors review the neurological aspects of HIV infection. First, a summary of the protocol of the neurological examinations and related experience is given. Then authors present the evaluation of neuro-psychological development, prevalence of neurological impairment and neuro-imaging of nine HIV infected children (seven boys, two girls) for the period of ten years (1991-2001). Three/ten children had vertically transmitted HIV six/nine were infected by a nosocomial route in their early childhood. Children were regularly followed up from the diagnosis of HIV. The median follow up time has been 79 month (range: 18-144 month). Four patients died during the study period. The neurological status, the motor and mental development were examined at three month intervals or monthly under one year of age. EEG was performed every six month and CT/MRI once a year. All patients received combined antiretroviral treatment and immunoglobulin therapy continuously. Three/nine children have normal development, one/nine has hyperactive and attention deficit disorder with normal IQ range, two/nine have slight, one/nine moderate and two/nine serious mental retardation. Mild neurological signs were found in two children, various moderate and serious neuro/psychological symptoms were found in four patients, one of them was treated with benign epilepsy too. There was also dose correlation between the clinical symptoms and the results of EEG examination (diffuse background slowing) and results of neuroimaging studies (cortical atrophy, calcification of the basal ganglia, toxoplasma abscesses). According to the results of different examinations

  15. Neurological impairment in a surviving twin following intrauterine fetal demise of the co-twin: a case study.

    Science.gov (United States)

    Forrester, K R; Keegan, K M; Schmidt, J W

    2013-01-01

    It has been established that twin pregnancies are at an increased risk for complications, including the risk of morbidity or mortality for one or both of the infants. Cerebral palsy and other associated neurological deficits also occur at higher rates in twin pregnancies. This report examines two cases of intrauterine demise of one twin with subsequent survival of the co-twin. In both cases, the surviving infant suffered significant neurological sequelae. Impairments observed in these two cases include multicystic encephalomalacia and periventricular leukomalacia as well as the subsequent development of cerebral palsy. This case study explores the predisposing factors, incidence, pathophysiology, consequences, and future research implications of these findings.

  16. [Neurological deficits in patients with primary and secondary anticardiolipin syndrome].

    Science.gov (United States)

    Honczarenko, K; Ostanek, L; Grzelec, H; Fabian, A; Fiedorowicz-Fabrycy, I; Fryze, C

    2001-01-01

    27 patients (22 women, 5 men); age 17 to 56 yr. (mean age 37 yr.) were included in this study, 4 had primary antiphospholipid syndrome and 18 secondary antiphospholipid syndrome in the course of systemic connective tissue disease and in 5 cases increased levels of anticardiolipid antibodies were found which did not meet the criteria necessary for diagnosis of secondary antiphospholipid syndrome. The mean duration of the disease was 8 yrs. Among primary antiphospholipid syndrome patients two had ischaemic stroke, one migraine-like headache and seizures. 18 patients had lupus erythematosus, two mixed connective tissue disease, one rheumatoid arthritis, one Sjögren syndrome, one Behçet disease. In 55% of patients migraine-like headache, polyneuropathies, encephalophaties, stroke, seizures and vision disturbances were present. In 18.5% of patients EEG exam revealed focal lesions with tendency for generalisation. On brain stem auditory evoked potentials examination, in 11.1% of patients conductivity lesions in mesencephalon and pons were found, visual evoked potentials, in 11.1% of patients in visual tracts. In 37% of patients, neuropathy was found on EMG exam. Neurological symptoms are one of the most frequent disorders in systemic connective tissue disease associated with the presence of anicardiolipin antibodies.

  17. Postdiagnosis neurological care for patients with psychogenic nonepileptic spells (PNES).

    Science.gov (United States)

    Hill, Chloe E; Schwartz, Hannah; Dahodwala, Nabila; Litt, Brian; Davis, Kathryn A

    2017-09-01

    This study investigated continuity of neurological care for patients discharged from the epilepsy monitoring unit (EMU) with a diagnosis of psychogenic nonepileptic spells (PNES). Because PNES are seizure-like episodes that cannot be explained by abnormal electrical brain activity, they are challenging for patients to understand and accept. Consequently, after diagnosis, patients commonly fail to start recommended psychotherapy and instead pursue redundant medical care. As consistent relationships with healthcare providers may help, we instituted standard follow-up for patients diagnosed with PNES. We performed a retrospective observational cohort study of adults diagnosed with PNES in our EMU. In November 2013, we began routine scheduling of postdischarge follow-up neurology appointments. We compared preintervention (November 2010-October 2013) and postintervention (November 2013-May 2016) cohorts with regard to clinic attendance, understanding the diagnosis, compliance with recommendations, and event frequency. We identified 55 patients in the preintervention cohort and 123 patients in the postintervention cohort. We successfully implemented the intended practice changes; more patients had follow-up scheduled by discharge (preintervention 2% vs. postintervention 36%, p<0.001), time to follow-up decreased (46days vs. 29, p=0.001), and providers more consistently queried understanding of diagnosis (38% vs. 67%, p=0.03). Explicit planning for continued care did not produce the anticipated patient-provider relationships, as follow-up in clinic was low (38% vs. 37%). For patients who attended clinic, the intervention did not improve establishment of psychiatric care, compliance with medication recommendations, understanding of diagnosis, or event frequency. The odds of reduced event frequency were nonsignificantly increased with understanding the diagnosis (OR 3.75, p=0.14). Recommending antiepileptic drug (AED) discontinuation was associated with increased odds of

  18. The impact of preoperative neurological events in patients suffering from native infective valve endocarditis.

    Science.gov (United States)

    Wilbring, Manuel; Irmscher, Linda; Alexiou, Konstantin; Matschke, Klaus; Tugtekin, Sems-Malte

    2014-06-01

    Infective native valve endocarditis (NVE) complicated by a preoperative neurological event still remains a surgical challenge. Particularly, great uncertainty exists with regard to the optimal timing of surgery. We call for a multidisciplinary team approach for individualized risk estimation and analysed our experience obtained over the past decade. Between 1997 and 2012, a total of 495 patients underwent valve surgery for the treatment of NVE. Of these, 70 (14.1%) patients suffered from NVE complicated by an acute neurological event and formed the study group. The remaining 425 (85.9%) patients served as the control group. The mean age of the predominantly male (80.0%) study population was 54 ± 14 years. EuroSCORE and EuroSCORE II predicted a high surgical risk (24.9 ± 6.8 and 10.8 ± 8.1%, respectively). The mean follow-up time was 4.0 ± 3.1 years, ranging up to 15.6 years with an interquartile range from 1.7 to 5.4 years. An interdisciplinary team consisting of a cardiac surgeon, a cardiologist and a neurologist made the decision for surgery. Observed neurological deficits mainly consisted of ischaemic stroke (75.7%), meningoencephalitis (12.9%) and intracerebral haemorrhage (8.6%). The mean time interval between the neurological event and surgery was 8.7 ± 10.3 days for all patients, 8.0 ± 7.0 days for ischaemic stroke and 17 ± 24 days for intracerebral haemorrhage. Postoperatively, most of the patients experienced no change (22.9%) or even improvement (67.1%) of their neurological symptoms. Only 10.0% showed further deterioration of their neurological status. This was particularly true for patients suffering from intracerebral haemorrhage, with 33.3% experiencing further neurological impairment. The presence of a preoperative neurological event was identified as an independent risk factor for in-hospital mortality (OR 2.66; 95% CI: 1.02-6.78; P = 0.046) but not for mortality during further follow-up (P = 0.257). The hospital mortality rate was 17.2%; and

  19. Soft Robotic Haptic Interface with Variable Stiffness for Rehabilitation of Neurologically Impaired Hand Function

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    Frederick Sebastian

    2017-12-01

    Full Text Available The human hand comprises complex sensorimotor functions that can be impaired by neurological diseases and traumatic injuries. Effective rehabilitation can bring the impaired hand back to a functional state because of the plasticity of the central nervous system to relearn and remodel the lost synapses in the brain. Current rehabilitation therapies focus on strengthening motor skills, such as grasping, employ multiple objects of varying stiffness so that affected persons can experience a wide range of strength training. These devices have limited range of stiffness due to the rigid mechanisms employed in their variable stiffness actuators. This paper presents a novel soft robotic haptic device for neuromuscular rehabilitation of the hand, which is designed to offer adjustable stiffness and can be utilized in both clinical and home settings. The device eliminates the need for multiple objects by employing a pneumatic soft structure made with highly compliant materials that act as the actuator of the haptic interface. It is made with interchangeable sleeves that can be customized to include materials of varying stiffness to increase the upper limit of the stiffness range. The device is fabricated using existing 3D printing technologies, and polymer molding and casting techniques, thus keeping the cost low and throughput high. The haptic interface is linked to either an open-loop system that allows for an increased pressure during usage or closed-loop system that provides pressure regulation in accordance to the stiffness the user specifies. Preliminary evaluation is performed to characterize the effective controllable region of variance in stiffness. It was found that the region of controllable stiffness was between points 3 and 7, where the stiffness appeared to plateau with each increase in pressure. The two control systems are tested to derive relationships between internal pressure, grasping force exertion on the surface, and displacement using

  20. Treatment of Hyponatremia in Patients with Acute Neurological Injury.

    Science.gov (United States)

    Human, Theresa; Cook, Aaron M; Anger, Brian; Bledsoe, Kathleen; Castle, Amber; Deen, David; Gibbs, Haley; Lesch, Christine; Liang, Norah; McAllen, Karen; Morrison, Christopher; Parker, Dennis; Rowe, A Shaun; Rhoney, Denise; Sangha, Kiranpal; Santayana, Elena; Taylor, Scott; Tesoro, Eljim; Brophy, Gretchen

    2017-10-01

    Little data exist regarding the practice of sodium management in acute neurologically injured patients. This study describes the practice variations, thresholds for treatment, and effectiveness of treatment in this population. This retrospective, multicenter, observational study identified 400 ICU patients, from 17 centers, admitted for ≥48 h with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), intraparenchymal hemorrhage, or intracranial tumors between January 1, 2011 and July 31, 2012. Data collection included demographics, APACHE II, Glascow Coma Score (GCS), serum sodium (Na+), fluid rate and tonicity, use of sodium-altering therapies, intensive care unit (ICU) and hospital length of stay, and modified Rankin score upon discharge. Data were collected for the first 21 days of ICU admission or ICU discharge, whichever came first. Sodium trigger for treatment defined as the Na+ value prior to treatment with response defined as an increase of ≥4 mEq/L at 24 h. Sodium-altering therapy was initiated in 34 % (137/400) of patients with 23 % (32/137) having Na+ >135 mEq/L at time of treatment initiation. The most common indications for treatment were declining serum Na+ (68/116, 59 %) and cerebral edema with mental status changes (21/116, 18 %). Median Na+ treatment trigger was 133 mEq/L (IQR 129-139) with no difference between diagnoses. Incidence and treatment of hyponatremia was more common in SAH and TBI [SAH (49/106, 46 %), TBI (39/97, 40 %), ICH (27/102, 26 %), tumor (22/95, 23 %); p = 0.001]. The most common initial treatment was hypertonic saline (85/137, 62 %), followed by oral sodium chloride tablets (42/137, 31 %) and fluid restriction (15/137, 11 %). Among treated patients, 60 % had a response at 24 h. Treated patients had lower admission GCS (12 vs. 14, p = 0.02) and higher APACHE II scores (12 vs. 10, p = 0.001). There was no statistically significant difference in outcome when comparing treated and untreated

  1. Telomere Length, Proviral Load and Neurologic Impairment in HTLV-1 and HTLV-2-Infected Subjects

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    Benjamin Usadi

    2016-08-01

    Full Text Available Short or damaged telomeres have been implicated in degenerative conditions. We hypothesized that analysis of telomere length (TL in human T-cell lymphotropic virus (HTLV infection and HTLV-associated neuropathy might provide clues to the etiology of HTLV-associated disease and viral dynamics. A subset of 45 human T-cell lymphotropic virus type 1 (HTLV-1, 45 human T-cell lymphotropic virus type 2 (HTLV-2, and 45 seronegative subjects was selected from the larger HTLV Outcomes Study (HOST cohort, matched on age, sex and race/ethnicity. Telomere-to-single-copy gene (T/S ratio (a measure of TL and HTLV-1 and HTLV-2 proviral loads were measured in peripheral blood mononuclear cells (PBMCs using quantitative PCR (qPCR. Vibration sensation measured by tuning fork during neurologic examinations performed as part of the HOST study allowed for an assessment of peripheral neuropathy. TL was compared between groups using t-tests, linear and logistic regression. Mean T/S ratio was 1.02 ± 0.16 in HTLV-1, 1.03 ± 0.17 in HTLV-2 and 0.99 ± 0.18 in HTLV seronegative subjects (p = 0.322. TL was not associated with HTLV-1 or -2 proviral load. Shorter TL was significantly associated with impaired vibration sense in the HTLV-2 positive group only. Overall, we found no evidence that telomere length was affected by chronic HTLV-1 and HTLV-2 infection. That TL was only associated with peripheral neuropathy in the HTLV-2-positive group is intriguing, but should be interpreted cautiously. Studies with larger sample size and telomere length measurement in lymphocyte subsets may clarify the relationship between TL and HTLV-infection.

  2. Additional Virtual Reality Sitting Balance Training Using XBox Kinect™ in Patients with Neurological Disorders: A Pilot Study

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    Xina Henry Quadros

    2017-10-01

    Full Text Available Introduction: Sitting balance is a prerequisite to upper extremity function, standing and walking, which is affected in various neurological diseases. It is important to attain a good level of sitting balance before one can proceed to standing. In recent years, virtual reality game training has gained a widespread application. Aim: This pilot study aimed to examine the role of additional virtual reality sitting balance training using a commercial interactive virtual reality system- Xbox Kinect™ in patients with neurological disorders. Materials and Methods: Four patients with sitting balance impairments following neurological disorders received two weeks of virtual reality based therapy along with the conventional physiotherapy. Sitting balance was evaluated using FIST (Function In Sitting Test scores at baseline, one week and after two weeks of intervention. Results: All four patients showed clinically significant improvement in FIST score between the pre and post intervention. Percentage of improvement in FIST score was approximately 27% with a minimum change of 10 points in the FIST score Minimal Clinically Important Difference (MCID=6.5. Conclusion: Additional virtual reality training may improve sitting balance control in neurological patients with balance impairments. It can be used as an adjunct in routine neurorehabilitation.

  3. Compensatory recombination phenomena of neurological functions in central dysphagia patients

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    Xiao-dong Yuan

    2015-01-01

    Full Text Available We speculate that cortical reactions evoked by swallowing activity may be abnormal in patients with central infarction with dysphagia. The present study aimed to detect functional imaging features of cerebral cortex in central dysphagia patients by using blood oxygen level-dependent functional magnetic resonance imaging techniques. The results showed that when normal controls swallowed, primary motor cortex (BA4, insula (BA13, premotor cortex (BA6/8, supramarginal gyrus (BA40, and anterior cingulate cortex (BA24/32 were activated, and that the size of the activated areas were larger in the left hemisphere compared with the right. In recurrent cerebral infarction patients with central dysphagia, BA4, BA13, BA40 and BA6/8 areas were activated, while the degree of activation in BA24/32 was decreased. Additionally, more areas were activated, including posterior cingulate cortex (BA23/31, visual association cortex (BA18/19, primary auditory cortex (BA41 and parahippocampal cortex (BA36. Somatosensory association cortex (BA7 and left cerebellum in patients with recurrent cerebral infarction with central dysphagia were also activated. Experimental findings suggest that the cerebral cortex has obvious hemisphere lateralization in response to swallowing, and patients with recurrent cerebral infarction with central dysphagia show compensatory recombination phenomena of neurological functions. In rehabilitative treatment, using the favorite food of patients can stimulate swallowing through visual, auditory, and other nerve conduction pathways, thus promoting compensatory recombination of the central cortex functions.

  4. Virtual sensory feedback for gait improvement in neurological patients

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    Yoram eBaram

    2013-10-01

    Full Text Available We review a treatment modality for movement disorders by sensory feedback. The natural closed-loop sensory-motor feedback system is imitated by a wearable virtual reality apparatus, employing body-mounted inertial sensors and responding dynamically to the patient’s own motion. Clinical trials have shown a significant gait improvement in patients with Parkinson's disease using the apparatus. In contrast to open-loop devices, which impose constant-velocity visual cues in a treadmill fashion, or rhythmic auditory cues in a metronome fashion, requiring constant vigilance and attention strategies, and in some cases, instigating freezing in Parkinson’s patients, the closed-loop device improved gait parameters and eliminated freezing in most patients, without side effects. Patients with multiple sclerosis, previous stroke, senile gait and cerebral palsy using the device also improved their balance and gait substantially. Training with the device has produced a residual improvement, suggesting virtual sensory feedback for the treatment of neurological movement disorders.

  5. Maternal experiences of caring for an infant with neurological impairment after neonatal encephalopathy in Uganda: a qualitative study.

    Science.gov (United States)

    Nakamanya, Sarah; Siu, Godfrey E; Lassman, Rachel; Seeley, Janet; Tann, Cally J

    2015-01-01

    The study investigated maternal experiences of caring for a child affected by neurological impairment after neonatal encephalopathy (NE) ("birth asphyxia") in Uganda. Between September 2011 and October 2012 small group and one-on-one in-depths interviews were conducted with mothers recruited to the ABAaNA study examining outcomes from NE in Mulago hospital, Kampala. Data were analysed thematically with the aid of Nvivo 8 software. Mothers reported caring for an infant with impairment was often complicated by substantial social, emotional and financial difficulties and stigma. High levels of emotional distress, feelings of social isolation and fearfulness about the future were described. Maternal health-seeking ability was exacerbated by high transport costs, lack of paternal support and poor availability of rehabilitation and counselling services. Meeting and sharing experiences with similarly affected mothers was associated with more positive maternal caring experiences. Mothering a child with neurological impairment after NE is emotionally, physically and financially challenging but this may be partly mitigated by good social support and opportunities to share caring experiences with similarly affected mothers. A facilitated, participatory, community-based approach to rehabilitation training may have important impacts on maximising participation and improving the quality of life of affected mothers and infants. Implications for Rehabilitation Caring for an infant with neurological impairment after NE in Uganda has substantial emotional, social and financial impacts on families and is associated with high levels of emotional stress, feelings of isolation and stigma amongst mothers. Improved social support and the opportunity to share experiences with other similarly affected mothers are associated with a more positive maternal caring experience. High transport costs, lack of paternal support and poor availability of counselling and support services were barriers

  6. [Laparoscopy-assisted jejunostomy in neurological patients with chronic malnutrition and GERD. Technical considerations and analysis of the results].

    Science.gov (United States)

    Esposito, C; Alicchio, F; Escolino, M; Ascione, G; Settimi, A

    2013-01-01

    Feeding difficulties and gastroesophageal reflux (GER) are major problems in severely neurologically impaired children. Many patients are managed with a simple gastrostomy, with or without fundoplication. Unfortunately, fundoplication and gastrostomy are not devoid of complications, indicating the need for other options in the management of these patients. Between January 2002 and June 2010, ten patients (age range, 18 months-14 years) have been treated by creating a jejunostomy with the laparoscopic-assisted procedure. The procedure was performed using 2-3 trocars. The technique consists of identifying the first jeujnal loop, grasping it 20-30 cm away from the Treitz ligament, and exteriorizing it to the trocar orifice under visual guide. The jejunostomy was created outside the abdominal cavity during open surgery. At the end of the jejunostomy, the correct position of the intestinal loops was evaluated via laparoscopy. Surgery lasted 40 min on average, the laparoscopic portion about 10 min. Hospital stay was 3 or 7 days for all patients. At the longest follow-up (8 years), all patients had experienced a significant weight gain. One patient died 1 year after the procedure of unknown causes. As for the other complications: 4/10 patients experienced peristomal heritema, 2/10 device's dislocation and 1 patient a peristomal granuloma. Laparoscopic-assisted jejunostomy is a safe and effective procedure to adopt in neurologically impaired children with feeding problems and GER. We advocate the use of this procedure in neurologically impaired patients with feeding problems and reflux due to its overall practicability and because there is minimal surgical trauma. The improvement in the quality of life of these children after the jejunostomy seems to be the major advantage of this procedure. However the management of jejunostomy can be difficult for parents above all in the first postoperative months.

  7. Prevalence of depression, fatigue, and sleep disturbances in patients with myelopathy: Their relation with functional and neurological recovery.

    Science.gov (United States)

    Menon, Nitin; Gupta, Anupam; Khanna, Meeka; Taly, Arun B; Thennarasu, K

    2016-11-01

    To observe the prevalence of fatigue, depression, and sleep disturbance in patients with myelopathy and their correlation with neurological and functional recovery. Study conducted in a university tertiary research hospital with 127 patients with myelopathy (92 males) admitted to neurorehabilitation unit between January 2010 and December 2013. Mean age was 32.71 ± 13.08 years (range 15-65 years), and mean duration of injury was 76.22 ± 82.5 days (range 14-365 days). Functional status and impairments were assessed using Barthel Index and Spinal Cord Independence Measures. Depression, fatigue, and sleep disturbances were assessed using Hospital Anxiety and Depression Scale, Fatigue Severity Scale, and Pittsburgh Sleep Quality Index scales, respectively. Neurological recovery was assessed using American Spinal Injury Association's impairment scale. Forty-four out of 104 (42%) patients had borderline or confirmed depression, 36/108 (33%) had significant fatigue, and 62/106 (58%) had significant sleep disturbances at admission. Significant correlation was observed between change in fatigue and depression scores with change in functional status scores (P  0.05) between change in sleep disturbance scores and functional status score and neurological recovery (P > 0.05). Similarly, change in fatigue and depression scores had no correlation with neurological status improvement. Fatigue, depression, and sleep disturbance scores showed significant improvement, that is, admission vs. discharge scores (P < 0.05) with significant correlation between improvement in all three variables (P < 0.05). Study variables showed significant improvement in the present study with myelopathy patients but not necessarily correlating with functional and neurological recovery.

  8. [Ethics in neurology from the patient's view point].

    Science.gov (United States)

    Mukai, Shoko

    2008-11-01

    Medicine (medical care) is a study and technology backed by the high expertise human beings have created, passed down, and developed for human beings, to save sick people's lives and heal the pain and agony of illness. Because medicine is a specialized technology that is beyond the understanding of common people, medicine without expertise is not beneficial. Furthermore, medicine must essentially be evaluated in the actual field where people live. As long as medical science and medical care continue to be part of the social system, evaluation of medicine requires a social perspective. It is true that today, patients' rights are presented, ethics is pursued, and guidelines are provided. In reality, however, more than a few people are pushed into death without any "right of true self-determination" or "dignity." Particularly, in the field where "ethics of neurology" is required, the most difficult questions, including the decision to discontinue treatment, must be answered and conflicts can occur. The frightening thing is that words intentionally used from the political/economical aspect are penetrating into the general public without them realizing it. In these circumstances where expressions that can affect the content of treatment, such as "death with dignity" and "end-of-life (terminal)", are penetrating into society and being reflected in specific systems, while presenting a seemingly scientific, intellectual, ethical, and/or moral image, how should medical professionals handle the situation?

  9. Enteral feeding in neurologically impaired children with gastroesophageal reflux: Nissen fundoplication and gastrostomy tube placement versus percutaneous gastrojejunostomy.

    Science.gov (United States)

    Veenker, Erin

    2008-10-01

    Parents or caregivers of neurologically impaired children with gastroesophageal reflux who require enteral nutrition are often faced with the option of having their child undergo an antireflux surgery and placement of a gastrostomy tube or have a percutaneous gastrojejunostomy tube placed under fluoroscopic guidance. It is important that nurses have an understanding of these procedures and their associated risks and benefits as well as knowledge of the impact each might have on the daily life and care of these children to help support families during this decision-making process.

  10. Neurological sequelae of bacterial meningitis.

    Science.gov (United States)

    Lucas, Marjolein J; Brouwer, Matthijs C; van de Beek, Diederik

    2016-07-01

    We reported on occurrence and impact of neurological sequelae after bacterial meningitis. We reviewed occurrence of neurological sequelae in children and adults after pneumococcal and meningococcal meningitis. Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy. Adults with pneumococcal meningitis have the highest risk of developing focal neurological deficits, which are most commonly caused by cerebral infarction, but can also be due to cerebritis, subdural empyema, cerebral abscess or intracerebral bleeding. Focal deficits may improve during clinical course and even after discharge, but a proportion of patients will have persisting focal neurological deficits that often interfere in patient's daily life. Hearing loss occurs in a high proportion of patients with pneumococcal meningitis and has been associated with co-existing otitis. Children and adults recovering from bacterial meningitis without apparent neurological deficits are at risk for long-term cognitive deficits. Early identification of neurological sequelae is important for children to prevent additional developmental delay, and for adults to achieve successful return in society after the disease. Neurological sequelae occur in a substantial amount of patients following bacterial meningitis. Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  11. The self-imagination effect: benefits of a self-referential encoding strategy on cued recall in memory-impaired individuals with neurological damage.

    Science.gov (United States)

    Grilli, Matthew D; Glisky, Elizabeth L

    2011-09-01

    Knowledge of oneself is preserved in many memory-impaired individuals with neurological damage. Therefore, cognitive strategies that capitalize on mechanisms related to the self may be particularly effective at enhancing memory in this population. The present study investigated the effect of "self-imagining," imagining an event from a personal perspective, on short and long delayed cued recall in memory-impaired individuals with neurological damage. Sixteen patients intentionally encoded word pairs under four separate conditions: visual imagery, semantic elaboration, other person imagining, and self-imagining. The results revealed that self-imagining led to better performance than other-imagining, semantic elaboration, and visual imagery. Furthermore, the "self-imagination effect" (SIE) was preserved after a 30-min delay and was independent of memory functioning. These findings indicate that self-imagining provides a mnemonic advantage in brain-injured individuals, even those with relatively poor memory functioning, and suggest that self-imagining may tap into mnemonic mechanisms related to the self.

  12. Prediction and prognostication of neurological deterioration in patients with acute ICH

    DEFF Research Database (Denmark)

    Ovesen, Christian; Christensen, Anders Fogh; Havsteen, Inger

    2015-01-01

    OBJECTIVE: Patients with intracerebral haemorrhage (ICH) are at high risk of neurological deterioration (ND). We aimed at establishing predictors of early ND (END) as well as late ND (LND) and at exploring the impact of neurological stability during the first week on long-term prognosis. DESIGN: We...... conducted this study as a retrospective cohort study. ND was evaluated based on the consciousness and severity of neurological symptoms. ND during the first 24 h after admission was defined as early ND and from 24 h to 7 days as LND. Patients were followed up until February 2015. PARTICIPANTS: We included...... 300 patients with acute ICH (≤4.5 h from symptom onset) who were admitted to our institution from March 2009 to January 2015. SETTING: Section of Acute Neurology, Department of Neurology, Bispebjerg Hospital is a specialised referral centre receiving patients with acute stroke from the entire capital...

  13. Epidural steroid following discectomy for herniated lumbar disc reduces neurological impairment and enhances recovery: a randomized study with two-year follow-up

    DEFF Research Database (Denmark)

    Rasmussen, S.; Krum-Moller, D.S.; Lauridsen, L.R.

    2008-01-01

    STUDY DESIGN: We randomized 200 patients after lumbar discectomy to receive epidural steroid or none with a 2-year follow-up. OBJECTIVE: To evaluate the outcome, neurologic impairment and safety of epidural steroid following lumbar discectomy for herniated disc disease. SUMMARY OF BACKGROUND DATA...... of epidural steroid following lumbar discectomy. METHODS: Through 2001 and 2003 200 patients undergoing discectomy for herniated disc disease were randomly allocated to receive epidural methylprednisolone 40 mg or none. In the control group (62 males and 38 females, median age 41 years, 18-66) 48 L5, 50 L4......: Convalescence after discectomy for herniated disc disease is dependent on pain and the inflammatory response. Previous studies in arthroscopic and abdominal surgery demonstrate steroids, which reduce the inflammatory response and enhance recovery. Here we report a 2-year follow-up of a randomized trial...

  14. Impairment of intellectual functions after surgery and posterior fossa irradiation in children with ependymoma is related to age and neurologic complications

    Directory of Open Access Journals (Sweden)

    Kalifa Chantal

    2008-01-01

    Full Text Available Abstract Background To investigate the neuropsychological outcome of children treated with surgery and posterior fossa irradiation for localized infratentorial ependymoma. Methods 23 patients (age 0.3 – 14 years at diagnosis who were treated with local posterior fossa irradiation (54 Gy underwent one (4 patients or sequential (19 patients neuropsychologic evaluation. The last evaluation was performed at a median of 4.5 (1 to 15.5 years after RT. Results Mean last full scale IQ (FSIQ, verbal IQ (VIQ and PIQ were 89.1, 94.0, and 86.2 respectively. All patients had difficulties with reading, and individual patients showed deficits in visuospatial, memory and attentional tasks. There was no trend for deterioration of intellectual outcome over time. All 5 children with IQ scores ≤ 75 were under the age of four at diagnosis. There was a significant association between the presence of cerebellar deficits and impaired IQ (72.0 vs 95.2, p Conclusion Within the evaluated cohort, intellectual functions were moderately impaired. Markedly reduced IQ scores were only seen with early disease manifestation and treatment, and postoperative neurological deficits had a strong impact on intellectual outcome.

  15. Focal neurological signs in hepatic encephalopathy in cirrhotic patients: an underestimated entity?

    Science.gov (United States)

    Cadranel, J F; Lebiez, E; Di Martino, V; Bernard, B; El Koury, S; Tourbah, A; Pidoux, B; Valla, D; Opolon, P

    2001-02-01

    Focal neurological signs have been poorly documented in the course of hepatic encephalopathy in cirrhotic patients because they are not mentioned in any textbooks of liver diseases. Having the opportunity to observe such cases, we underwent a prospective study to determine incidence, characteristics, associated factors, prognostic significance, and outcome of this rare form of hepatic encephalopathy. Over a 12-month period, all cirrhotic patients hospitalized in the intensive care unit of our department for hepatic encephalopathy were prospectively studied. Patients with clinical and electroencephalogram evidences of hepatic encephalopathy were examined by a senior physician and, in cases of focal neurological signs, underwent examination by a neurologist, CT scan, lumbar punction, and cerebral magnetic resonance imaging and echo Doppler examination of neck and head vessels. Clinical and biological parameters were compared in patients during episodes with and without focal neurological signs, and outcome was noted. Thirty-four cirrhotic patients were hospitalized for 48 episodes of hepatic encephalopathy; two of these patients with cerebral hematoma were excluded. Twenty-four patients exhibited 38 hepatic encephalopathy episodes without focal neurological signs (82.6%), and eight patients exhibited eight hepatic encephalopathy episodes with focal neurological signs (17.4%) that were hemiplegia and hemiparesia in six patients (75%). In all patients, cerebral CT scan and cerebrospinal fluid examination disclosed no abnormalities, as neither did cerebral magnetic resonance imaging (n = 5) and echo Doppler examination of neck and head vessels (n = 5). Except for female sex, which was more often encountered in patients with focal neurological signs (p < 0.05), there were no differences between episodes with and without focal neurological signs for any of the parameters studied. In surviving patients who recovered from hepatic encephalopathy (7/8), focal neurological

  16. Improved neurologic prognosis for a patient with propionic acidemia who received early living donor liver transplantation.

    Science.gov (United States)

    Nagao, Masayoshi; Tanaka, Toju; Morii, Mayuko; Wakai, Shuji; Horikawa, Reiko; Kasahara, Mureo

    2013-01-01

    Despite medical therapy, patients with propionic academia (PA) still display a tendency to develop epilepsy. Patients with neonatal-onset PA who have received early living donor liver transplantation (LDLT) are limited in number, and the effect on neurologic prognosis, including epilepsy, is not clear. We report a patient with PA whose EEG findings improved dramatically after undergoing LDLT at age 7 months. The patient's neurologic development and brain MRI findings were quite satisfactory at age 2 years and 3 months. LDLT is effective not only in preventing metabolic decompensation, but also in improving neurologic function to ensure better quality of life. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Neurological Manifestations Hiv-Infected Patients Around Varanasi ...

    African Journals Online (AJOL)

    Opportunistic infections were the leading cause of neurological disorders in our study population. Apart from Central nervous ... There were equal responses to Amphoterecin B Cholesterol Dispersion (ABCD) and conventional Amphoterecin B therapies, and no significant differences in their side effect profiles. Keywords: ...

  18. Mobilization of patients in neurological Intensive Care Units of India: A survey.

    Science.gov (United States)

    Bhat, Anup; Chakravarthy, Kalyana; Rao, Bhamini K

    2016-06-01

    The rehabilitation needs of the patients in neurological Intensive Care Units (ICUs) vary from that of a medical ICU patient. Early mobilization is known to improve the various neurological outcomes in patients admitted to neurological ICUs, although little is known about the practice pattern among physiotherapists. The mobilization practice pattern may vary significantly than that of developed countries due to the reasons of differences in training of professionals, availability of equipment, and financial assistance by health insurance. To study the current mobilization practices by the physiotherapists in neurological ICUs of India. A cross-sectional survey was conducted with a content validated questionnaire about the mobilization practices. Online questionnaire was distributed to physiotherapists working in neurological ICUs of India. Descriptive statistics were used. Out of 185 e-mails sent, 82 physiotherapists completed the survey (survey response rate = 44%). Eighty participants (97.6%) mentioned that the patients received some form of mobilization during the day. The majority of the physiotherapists (58.5%), "always" provided bed mobility exercises to their patients when it was found appropriate for the patients. Many physiotherapists (41.5%) used tilt table "sometimes" to introduce orthostatism for their patients. Mobilization in various forms is being practiced in the neurological ICUs of India. However, fewer mobilization sessions are conducted on weekends and night hours in Indian Neurological ICUs.

  19. [Assessment of sociocognitive functions in neurological patients Presentation of a French adaptation of two tools and implementation in frontal dementia].

    Science.gov (United States)

    Ehrlé, Nathalie; Henry, Audrey; Pesa, Audrey; Bakchine, Serge

    2011-03-01

    This paper presents a French battery designed to assess emotional and sociocognitive abilities in neurological patients in clinical practice. The first part of this battery includes subtests assessing emotions: a recognition task of primary facial emotions, a discrimination task of facial emotions, a task of expressive intensity judgment, a task of gender identification, a recognition task of musical emotions. The second part intends to assess some sociocognitive abilities, that is mainly theory of mind (attribution tasks of mental states to others: false believe tasks of first and second order, faux-pas task) and social norms (moral/conventional distinction task, social situations task) but also abstract language and humour. We present a general description of the battery with special attention to specific methodological constraints for the assessment of neurological patients. After a brief introduction to moral and conventional judgments (definition and current theoretical basis), the French version of the social norm task from RJR Blair (Blair and Cipolotti, 2000) is developed. The relevance of these tasks in frontal variant of frontotemporal dementia (fvFTD is illustrated by the report of the results of a study conducted in 18 patients by the Cambridge group and by the personal study of a patient with early stage of vfFTD. The relevance of the diagnostic of sociocognitive impairment in neurological patients is discussed.

  20. Pro/con clinical debate: Tracheostomy is ideal for withdrawal of mechanical ventilation in severe neurological impairment

    OpenAIRE

    Mascia, Luciana; Corno, Eleomore; Terragni, Pier Paok; Stather, David; Ferguson, Niall D

    2004-01-01

    Most clinical trials on the topic of extubation have involved patients outside the neurological intensive care unit. As a result, in this area clinicians are left with little evidence on which to base their decision making. Although tracheostomies are increasingly common procedures, they are not without complications and costs, and hence a decision to perform them should not be taken lightly. In this issue of Critical Care two groups debate the merits of tracheostomy before extubation in a pa...

  1. Therapy for memory and attention impairments in young patients

    Directory of Open Access Journals (Sweden)

    Elena Glebovna Filatova

    2013-01-01

    Full Text Available Objective. To study the efficacy and tolerance of tanakan in the treatment of mild cognitive impairment in young patients. Patients and methods. The study enrolled 30 patients whose mean age was 33.5±7.5 years. It used clinical neurological examination; a test for rating general condition, activity, and mood; studies to evaluate aural short-term and verbal short-term memories and to estimate the level of attention using Schulte's tables, and questionnaires for the rating of autonomic disorders and nocturnal sleep quality, those for the patient subjective assessment of treatment efficiency and for the recording of adverse reactions. Results. Tanakan therapy led to the normalized emotional status in the patients, improved nocturnal sleep, and reduced autonomic disorders. There was a tendency towards improvement of all characteristics of attention. Aural and verbal memories became better. Conclusion. Tanakan is an effective and safe drug to treat cognitive impairment at any age.

  2. [The attitudes and behavior of the general primary-care physician towards the neurological patient].

    Science.gov (United States)

    Casabella Abril, B; Pérez Sánchez, J

    1995-04-15

    1) To find the opinion of general practitioners working in primary care (GP in PC) regarding how they deal with neurological patients. 2) To find the effect on this question of intern training in family and community medicine (FCM). A survey filled out by a representative sample of GP in PC working at PC public clinics in 1991 in a health region in Catalonia. 56 GP in PC. A self-administered selection questionnaire (multiple choice and scale of 5 points). MEASUREMENTS, MAIN RESULTS AND CONCLUSIONS: Less confidence handling neurological patients than patients with other common medical conditions. Greater need for recycling in neurology than in other basic areas of medicine. Positive impact of FCM intern training on doctors' approach to the examination of neurological patients and application of basic exploratory techniques (ophthalmoscope, reflex hammer, diapason and phonendoscope). The GP intern-trained in FCM lacks confidence in present out-patient specialised support (the area neuropsychiatrist).

  3. Severe hypernatremia: survival without neurologic sequelae

    National Research Council Canada - National Science Library

    Borrego Domínguez, R R; Imaz Roncero, A; López-Herce Cid, J; Seriñá Ramírez, C

    2003-01-01

    .... She had a convulsive crisis without subsequent neurologic impairment. The second patient, a 3-year-old girl with pseudohypoaldosteronism type I and encephalopathy, had hypernatremia (203 mEq/l...

  4. Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age

    Directory of Open Access Journals (Sweden)

    Patrick Mulligan

    2013-01-01

    Full Text Available Background: Subdural hematoma (SDH is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005, yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44% were discharged home, 16 (36% discharged to nursing home or rehab, 6 (13% to hospice and 3 (7% died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.

  5. Motor Imagery Impairment in Postacute Stroke Patients

    Directory of Open Access Journals (Sweden)

    Niclas Braun

    2017-01-01

    Full Text Available Not much is known about how well stroke patients are able to perform motor imagery (MI and which MI abilities are preserved after stroke. We therefore applied three different MI tasks (one mental chronometry task, one mental rotation task, and one EEG-based neurofeedback task to a sample of postacute stroke patients (n=20 and age-matched healthy controls (n=20 for addressing the following questions: First, which of the MI tasks indicate impairment in stroke patients and are impairments restricted to the paretic side? Second, is there a relationship between MI impairment and sensory loss or paresis severity? And third, do the results of the different MI tasks converge? Significant differences between the stroke and control groups were found in all three MI tasks. However, only the mental chronometry task and EEG analysis revealed paresis side-specific effects. Moreover, sensitivity loss contributed to a performance drop in the mental rotation task. The findings indicate that although MI abilities may be impaired after stroke, most patients retain their ability for MI EEG-based neurofeedback. Interestingly, performance in the different MI measures did not strongly correlate, neither in stroke patients nor in healthy controls. We conclude that one MI measure is not sufficient to fully assess an individual’s MI abilities.

  6. Neurological soft signs in juvenile patients with Asperger syndrome, early-onset psychosis, and healthy controls.

    Science.gov (United States)

    Mayoral, María; Merchán-Naranjo, Jessica; Rapado, Marta; Leiva, Marta; Moreno, Carmen; Giráldez, Marisa; Arango, Celso; Parellada, Mara

    2010-11-01

    The study of neurological soft signs (NSS) in patients with Asperger syndrome may help us to elucidate the neurological basis of this disorder and to clarify its relationship with other neurodevelopmental disorders. The goal of this study was to compare the prevalence of NSS in a sample of patients with Asperger syndrome, early-onset psychosis and healthy controls. NSS were assessed by means of the Neurological Evaluation Scale in a sample of 29 patients with Asperger syndrome (mean age = 12.86 ± 2.58 years), 30 patients with first-episode early-onset psychoses (mean age 14.17 ± 1.02 years) and 30 healthy controls (mean age 12.33 ± 2.69 years). Significant group differences were found between Asperger syndrome patients and healthy controls both in all the Neurological Evaluation Scale subscales and in the Neurological Evaluation Scale total score. There were no significant differences between both groups of patients in any of the Neurological Evaluation Scale scores. NSS are more prevalent in Asperger syndrome than in healthy controls. The NSS profile was not disorder-specific in our samples of patients with Asperger syndrome and early-onset psychoses. © 2010 Blackwell Publishing Asia Pty Ltd.

  7. Feasibility of the collection of patient-reported outcomes in an ambulatory neurology clinic.

    Science.gov (United States)

    Moura, Lidia M V R; Schwamm, Eli; Moura Junior, Valdery; Seitz, Michael P; Hsu, John; Cole, Andrew J; Schwamm, Lee H

    2016-12-06

    To determine whether patients could self-report physical and mental health assessments in the waiting room and whether these assessments would be associated with modified Rankin Scale (mRS) and Quality of Life in Epilepsy (QOLIE-10) scores. We offered iPad-based surveys to consecutive adult neurology patients at check-in to collect patient-reported outcome measures (PROMs). We collected demographic and clinical data on 6,075 patients through survey or administrative claims and PROMs from participating patients. We compared demographic characteristics of participants and nonparticipants and tested associations between physical and mental health scores and mRS and QOLIE-10. Of 6,075 patients seen by neurologists during the study period, 2,992 (49.3%) participated in the survey. Compared to nonparticipating patients, participating patients more often were privately insured (53.5% vs 42.7%, p neurology (nonsubspecialty) clinics (53.1% vs 46.6%, p Neurology.

  8. Long-term employment outcomes following rehabilitation for significant neurological impairment in UK military personnel: a 3-year study.

    Science.gov (United States)

    Bahadur, Sardar; McRann, J; McGilloway, E

    2017-08-09

    Returning to employment is a major modifiable factor affecting long-term health in brain injury which neurological and vocational rehabilitation attempts to address. In military patients, little is known about long-term employability, whether employment is sustained and how they fare in civilian roles. A telephone review was undertaken of every military patient having undergone inpatient neurorehabilitation between 2012 and 2014. This was compared to their employment outcomes one to three years post discharge. We further evaluated whether this employment was sustained over successive years in the same patients. Finally, we identify those rehabilitation interventions deemed most influential in improving employment outcomes in brain injury. During this period, an average of 57 (51-61) such patients were discharged each year. A review conducted by telephone successfully contacted 46% (43%-49% across cohorts) of all possible patients; 71.4% (64-81) returned to work increasing to 80.7% (76-85) including those training/actively seeking-work. Overall, 31.7% (24-40) returned to full-time military-in those leaving, 89.6% (85.4-90.9) were discharged for medical reasons. Severity of brain injury was unrelated to successful employment; 63.6%/78.6% had the same vocational outcome over two consecutive years while 36.3%/21.4% showed improved outcomes. Despite significant brain/neurological injury (graded by severity/Mayo Portland Adaptability Inventory 4), 80.7% (76-85) were working/training 2/3 years postdischarge from neurorehabilitation with 31.7% returning to full-time military role. Inability to continue within the military was not synonymous with inability to work. Return to work was independent of severity of brain/neurological injury and follow-up over consecutive years demonstrated sustained employment. The argument against inpatient neurorehabilitation has always been cost> This 3-year analysis reinforces that patients can and most likely will return to employment with

  9. Effciency of HIV-infected patients detection in neurological hospitals of large industrial center

    Directory of Open Access Journals (Sweden)

    Shmelev V.V.

    2012-06-01

    Full Text Available

    Aim of the study: to evaluate the effciency of detection for HIV-infection in patients of neurological departments of Saratov. Materials and methods. We retrospectively analyzed 25 250 medical histories of patients hospitalized into neurological departments of Saratov hospitals between January 2007 and April 2012. Results. Blood samples of 2010 patients (7,96 % were tested for the presence of HIV-antibodies. 37 patients were HIV-positive (1,84 % of examined patients and 0,15 % of the total number of patients. Conclusion. Increasing popularity and variety of clinical manifestations of HIV-infection requires the expansion of neurological patients whom serum test for antibodies against HIV is needed.

  10. Routine detection and management of neurocognitive impairment in HIV-positive patients in a UK centre

    OpenAIRE

    Haddow, L. J.; Accoroni, A.; Cartledge, J. D.; Manji, H; Benn, P; Gilson, R. J.

    2013-01-01

    We estimated the burden of HIV-associated neurocognitive disorders (HAND) in a UK clinic. From a random sample, and referrals to specialist services over one year (neurology, clinical psychology, hospital admissions), we determined whether patients were diagnosed with HIV-associated dementia (HAD) and whether they reported symptoms suggesting neurocognitive impairment (NCI). In the first sample, 2/150 (prevalence 1.3%; 95% confidence interval [CI] 0.2-4.7%) had documented HAD. Eleven patients...

  11. A procedure for testing prospective remembering in persons with neurological impairments.

    Science.gov (United States)

    Titov, N; Knight, R G

    2000-10-01

    A video-based procedure for assessing prospective remembering (PR) in brain-injured clients is described. In this task, a list of instructions is given, each comprising an action (buy a hamburger) and a cue (at McDonalds), which are to be recalled while watching a videotape segment showing the view of a person walking through a shopping area. A group of 12 clients with varying degrees of memory impairment undergoing rehabilitation completed both a video test and a comparable task in real-life. Significant correlations were found between the two measures, indicating that a video-based analogue can be used to estimate prospective remembering in real life. Scores on the PR task were associated with accuracy of recall on a word-list task, but not with the Working Memory Index of the Wechsler Memory Scale-III, suggesting that the task is sensitive to levels of amnesic deficit.

  12. Suicide in Neurologic Illness.

    Science.gov (United States)

    Arciniegas, David B.; Anderson, C. Alan

    2002-11-01

    The risk of attempted or completed suicide is increased in patients with migraine with aura, epilepsy, stroke, multiple sclerosis, traumatic brain injury, and Huntington's disease. Contrary to the general perception that the risk of suicide among patients with Alzheimer's disease and other dementing conditions is low, several reports suggest that the risk of suicide in these patients increases relative to the general population. Some patients at risk for neurologic disorders are also at increased risk for suicide; in particular, the risk of suicide is increased among persons at risk for Huntington's disease, independent of the presence or absence of the Huntington's gene mutation. The risk of attempted or completed suicide in neurologic illness is strongly associated with depression, feelings of hopelessness or helplessness, and social isolation. Additional suicide risk factors in persons with neurologic illness include cognitive impairment, relatively younger age (under 60 years), moderate physical disability, recent onset or change in illness, a lack of future plans or perceived meaning in life, recent losses (personal, occupational, or financial), and prior history of psychiatric illness or suicidal behavior. Substance dependence, psychotic disorders, anxiety disorders, and some personality disorders (eg, borderline personality disorder) may also contribute to increased risk of suicide among persons with neurologic illnesses. Identification and aggressive treatment of psychiatric problems, especially depression, as well as reduction of modifiable suicide risk factors among patients with neurologic illness is needed to reduce the risk of attempted and completed suicide in this population.

  13. Neurologic Semiology In A Population Of Hearing Impaired Children [semiologia Neurológica Numa População De Crianças Deficientes Auditivas.

    OpenAIRE

    Goncalves V.M.; Piovesana A.M.; De Moura-Ribeiro M.V.

    1993-01-01

    A random sample of 42 sensorineural hearing impaired children (severe and bilateral) was studied, from special classes in Campinas, with chronological ages varying between 4 and 7 years old. The children of this sample were compared with two control groups of 42 children of the same chronological age, from regular classes of private and public schools. All of them were submitted to the traditional neurological examination. Hearing impaired children showed differences as to head circumference ...

  14. Neurological symptoms, evaluation and treatment in Danish patients with achondroplasia and hypochondroplasia

    DEFF Research Database (Denmark)

    Doherty, Mia Aagaard; Hertel, Niels Thomas; Hove, Hanne Buciek

    2017-01-01

    Aim To investigate the prevalence of neurological symptoms and the types of complications in a cohort of Danish patients with mutation verified achondroplasia and hypochondroplasia and compare the results with previously reported findings. Methods Retrospective descriptive study by chart review...... of patients followed in three outpatients clinics in the period 1997-2014. Forty-eight patients with achondroplasia and a median age of 9,5 years old and 20 patients with hypochondroplasia and a median age of 12 years old were enrolled. Neurological manifestations, epidemiological variables and clinical data...... for referral to an MRI scan or neurosurgery. Conclusion Through investigation of phenotypes and genotypes in patients with achondroplasia and hypochondroplasia we report the frequencies of neurological symptoms, foramen magnum stenosis, spinal cord compression and neurosurgery in Danish patients. Variation...

  15. Effects of music and music therapy on mood in neurological patients.

    Science.gov (United States)

    Raglio, Alfredo; Attardo, Lapo; Gontero, Giulia; Rollino, Silvia; Groppo, Elisabetta; Granieri, Enrico

    2015-03-22

    Mood disorder and depressive syndromes represent a common comorbid condition in neurological disorders with a prevalence rate that ranges between 20% and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinson's disease. Notwithstanding, these conditions are often under-diagnosed and under-treated in the clinical practice and negatively affect the functional recovery, the adherence to treatment, the quality of life, and even the mortality risk. In addition, a bidirectional association between depression and neurological disorders may be possible being that depressive syndromes may be considered as a risk factor for certain neurological diseases. Despite the large amount of evidence regarding the effects of music therapy (MT) and other musical interventions on different aspects of neurological disorders, no updated article reviewing outcomes such as mood, emotions, depression, activity of daily living and so on is actually available; for this reason, little is known about the effectiveness of music and MT on these important outcomes in neurological patients. The aim of this article is to provide a narrative review of the current literature on musical interventions and their effects on mood and depression in patients with neurological disorders. Searching on PubMed and PsycInfo databases, 25 studies corresponding to the inclusion criteria have been selected; 11 of them assess the effects of music or MT in Dementia, 9 explore the efficacy on patients with Stroke, and 5 regard other neurological diseases like Multiple Sclerosis, Amyotrophic Lateral Sclerosis/motor neuron disease, Chronic quadriplegia, Parkinson's Disease, and Acquired Brain dysfunctions. Selected studies are based on relational and rehabilitative music therapy approaches or concern music listening interventions. Most of the studies support the efficacy of MT and other musical interventions on mood, depressive syndromes, and quality of life on neurological patients.

  16. Structural and Genetic Studies Demonstrate Neurologic Dysfunction in Triosephosphate Isomerase Deficiency Is Associated with Impaired Synaptic Vesicle Dynamics

    Energy Technology Data Exchange (ETDEWEB)

    Roland, Bartholomew P.; Zeccola, Alison M.; Larsen, Samantha B.; Amrich, Christopher G.; Talsma, Aaron D.; Stuchul, Kimberly A.; Heroux, Annie; Levitan, Edwin S.; VanDemark, Andrew P.; Palladino, Michael J.; Pallanck, Leo J.

    2016-03-31

    Triosephosphate isomerase (TPI) deficiency is a poorly understood disease characterized by hemolytic anemia, cardiomyopathy, neurologic dysfunction, and early death. TPI deficiency is one of a group of diseases known as glycolytic enzymopathies, but is unique for its severe patient neuropathology and early mortality. The disease is caused by missense mutations and dysfunction in the glycolytic enzyme, TPI. Previous studies have detailed structural and catalytic changes elicited by disease-associated TPI substitutions, and samples of patient erythrocytes have yielded insight into patient hemolytic anemia; however, the neuropathophysiology of this disease remains a mystery. This study combines structural, biochemical, and genetic approaches to demonstrate that perturbations of the TPI dimer interface are sufficient to elicit TPI deficiency neuropathogenesis. The present study demonstrates that neurologic dysfunction resulting from TPI deficiency is characterized by synaptic vesicle dysfunction, and can be attenuated with catalytically inactive TPI. Collectively, our findings are the first to identify, to our knowledge, a functional synaptic defect in TPI deficiency derived from molecular changes in the TPI dimer interface.

  17. Communication problems of hearing-impaired patients.

    Science.gov (United States)

    Hines, J

    The main objective of this national survey was to check the findings of an earlier pilot survey. This had found that patients who had a hearing-impairment and were in hospital were often seriously disadvantaged by their disability. The survey was conducted by questionnaire and the sampling frame confined to hearing-impaired patients who had been in hospital during the previous three years. A total of 359 completed and valid questionnaires were returned. The responses confirmed the finding of the pilot survey. They indicated that there were serious shortcomings in the ability of many hospital staff to cope with the problems of hearing-impaired patients. Common causes of the problems were identified. The major factor was inadequate training of both nurses and doctors in deaf awareness and the associated communication skills. Other significant factors included patients concealing their disability, pressure of work and poor communication between staff. Appropriate training at all staff levels should eliminate a high proportion of these problems.

  18. Epidural steroid following discectomy for herniated lumbar disc reduces neurological impairment and enhances recovery: a randomized study with two-year follow-up.

    Science.gov (United States)

    Rasmussen, Sten; Krum-Møller, David Stonor; Lauridsen, Lene Risbro; Jensen, Søren Erik Holst; Mandøe, Hans; Gerlif, Christian; Kehlet, Henrik

    2008-09-01

    We randomized 200 patients after lumbar discectomy to receive epidural steroid or none with a 2-year follow-up. To evaluate the outcome, neurologic impairment and safety of epidural steroid following lumbar discectomy for herniated disc disease. Convalescence after discectomy for herniated disc disease is dependent on pain and the inflammatory response. Previous studies in arthroscopic and abdominal surgery demonstrate steroids, which reduce the inflammatory response and enhance recovery. Here we report a 2-year follow-up of a randomized trial of epidural steroid following lumbar discectomy. Through 2001 and 2003 200 patients undergoing discectomy for herniated disc disease were randomly allocated to receive epidural methylprednisolone 40 mg or none. In the control group (62 males and 38 females, median age 41 years, 18-66) 48 L5, 50 L4, and 6 L3 discectomies were performed and in the intervention group (60 males and 40 females, median age 45 years, 15-53) 56 L5, 46 L4, and 3 L3 discectomies. Contemporary with randomization to epidural steroid or none both groups received preoperative prophylactic antibiotics and the same multimodal pain treatment. Hospital stay was reduced from 8 to 6 days (P = 0.0001) and the number of patients with neurologic signs were reduced more (70% vs. 44%, P = 0.0004) by epidural steroid. Incidence of reoperation at 1 year was 6% in both groups and 8% in the control group and 7% in the intervention group after 2 years. No infections were registered. Epidural methylprednisolone enhances recovery after discectomy for herniated disc disease without apparent side effects.

  19. Idiopathic detrusor sphincter dyssynergia in neurologically normal patients with voiding abnormalities

    DEFF Research Database (Denmark)

    Jørgensen, T M; Djurhuus, J C; Schrøder, H D

    1982-01-01

    Symptomatology and clinical manifestations of detrusor sphincter dyssynergia are described in 23 patients without neurological disease. Their cardinal symptoms were recurrent cystitis, enuresis, frequent voiding, back pain during voiding and anal discomfort. The major objective finding...... was vesicoureteral reflux in 11 cases with kidney scarring in 10. Bladder trabeculation was found in 13 patients, bladder hyperreflexia in 8, and significant residual urine in 16 patients. The etiology of detrusor sphincter dyssynergia in non-neurological patients is discussed. By means of exclusion it is most...

  20. MRI of neurologic complications in end-stage renal failure patients on hemodialysis: pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Muhtesem Agildere, A.; Kurt, A.; Yildirim, T. [Dept. of Radiology, Baskent Univ., Ankara (Turkey); Benli, S. [Dept. of Neurology, Baskent Univ., Ankara (Turkey); Altinoers, N. [Dept. of Neurosurgery, Baskent Univ., Ankara (Turkey)

    2001-06-01

    End-stage renal disease patients who have been on long-term hemodialysis tend to develop central nervous system complications. The most common neurologic complications in this patient group include white matter changes, cerebral atrophy, osmotic demyelination syndrome, dialysis encephalopathy, hypertensive encephalopathy, intracranial hemorrhage, infarct, sinus thrombosis, and infection. Clinical evaluation of these patients is somehow complicated and MRI is important before establishment of the therapy. The purpose of this article is to illustrate the range of MRI findings of neurologic complications in end-stage renal failure patients on hemodialysis with etiologic factors. (orig.)

  1. Neurological disorders and dependence of nursing care in patients with brain tumor

    OpenAIRE

    Guzzo Souza, Renata; K. Olm Cunha, Isabel Cristina; Franchini Reichert, Magaly Cecília; Diccini,Solange

    2008-01-01

    The aim of this study was to identify neurological disorders in 32 patients with diagnosis of brain tumor, and to evaluate the dependency of nursing care before and after the surgery. This study was carried out at the Neurosurgery Unit of São Paulo Hospital, Brazil, from June to December, 2004. One instrument was used to collect physical and neurological data, and another to evaluate the dependence degree. An increase of the dependence degree was observed after surgical intervention, which th...

  2. ETIOLOGY AND NEUROLOGICAL COMPLICATIONS OF BACTERIAL MENINGITIS IN 189 PATIENTS

    Directory of Open Access Journals (Sweden)

    P. Tabatabaie .

    1997-06-01

    Full Text Available Results of a seven year (April 1985 to March 1992 prospoective study of bacterial meningitis in 189 infants and children admitted to our Center indicate that: 1 Tiie Gram-negative bacilli, especially Klebsiella species, are the leading cause of bacterial meningitis in neonates and young infants (<2 months, group B Streptococcus meningitis is rare, and Listeria monocytogenes meningitis is not observed. 2 Haemophilus influenzae is the leading cause of bacterial meningitis in children under 4 years old and Streptococcus pneumoniae becomes the leading cause over 5 years old. 3 Nine percent of H. influenzae isolates were ampicillin - resistant and 5% of S. pneumoniae were penicillin G resistant. All but one Niesseria meningitidis isolates were penicillin - susceptible. Both penicillin G f chloramphenicol or ampicillin/chloramphenicol resistance among these isolates were 2 percent. 4 The neurological compilations and mortality were highest under two months of age, 39% of these neonates died due to complications as compared to 22% in all other age groups combined. 5 Dexamethasone improves outcome when used as an adjunctive therapy for bacterial meningitis in infants and children. Tlie immediate and long-term clinical profiles both indicate better outcomes for dexamethasone.

  3. Exploring patient and family satisfaction in pediatric neurological surgery

    OpenAIRE

    Barsoom, Randa R.; Maugans, Todd A.; Burrows, James F.; Rosen, Paul

    2017-01-01

    Introduction: Patient and family satisfaction during outpatient visits is correlated with a continuance of care and likelihood to recommend the practice to others. Additionally, patient-family satisfaction can determine the success of the practice and influence medical outcomes. Utilizing a well-validated surveys instrument, patient and family satisfaction can be explored in the office setting. Methods: During a consecutive 36 month period, a standardized and validated patient satisfaction...

  4. Visualizing the third dimension in virtual training environments for neurologically impaired persons: beneficial or disruptive?

    Directory of Open Access Journals (Sweden)

    van den Hoogen Wouter

    2012-10-01

    Full Text Available Abstract Background Many contemporary systems for neurorehabilitation utilize 3D virtual environments (VEs that allow for training patients’ hand or arm movements. In the current paper we comparatively test the effectiveness of two characteristics of VEs in rehabilitation training when utilizing a 3D haptic interaction device: Stereo Visualization (monoscopic vs stereoscopic image presentation and Graphic Environment (2.5D vs 3D. Method An experimental study was conducted using a factorial within-subjects design. Patients (10 MS, 8 CVA completed three tasks, each including a specific arm-movement along one of three directional axes (left-right, up-down and forward-backward. Results The use of stereoscopy within a virtual training environment for neurorehabilitation of CVA and MS patients is most beneficial when the task itself requires movement in depth. Further, the 2.5D environment yields the highest efficiency and accuracy in terms of patients’ movements. These findings were, however, dependent on participants’ stereoscopic ability. Conclusion Despite the performance benefits of stereoscopy, our findings illustrate the non-triviality of choices of using stereoscopy, and the type of graphic environment implemented. These choices should be made with the task and target group, and even the individual patient in mind.

  5. Anti-ganglioside antibodies in patients with Guillain Barré syndrome and other neurological disorders

    Directory of Open Access Journals (Sweden)

    C Vaishnavi

    2013-01-01

    Full Text Available A study was performed on 59 Guillain-Barré syndrome (GBS cases, 58 neurological controls (NC and 60 non-neurological controls (NNC to investigate the association of anti-ganglioside antibodies in GBS and other neurological disorders. Campylobacter jejuni was isolated from 5.7% of GBS patients. Anti-ganglioside immunoglobulin G was present in 82% and immunoglobulin M in 46% in acute inflammatory demyelinating polyneuropathy patients, 70% and 44% respectively in acute motor axonal neuropathy subgroup and 38% each in acute motor sensory axonal neuropathy subgroup. Though high intensity of anti-gangliosides was present in the GBS patients, the NC patients also had adequate anti-gangliosides compared with the NNC group.

  6. Identification of risk factors for neurological deficits in patients with pelvic fractures.

    Science.gov (United States)

    Schmal, Hagen; Hauschild, Oliver; Culemann, Ulf; Pohlemann, Tim; Stuby, Fabian; Krischak, Gert; Südkamp, Norbert P

    2010-08-11

    This multicenter register study was performed to define injury and fracture constellations that are at risk to develop pelvic associated neural lesions. Data of 3607 patients treated from 2004 to 2009 for pelvic fractures were evaluated for neurological deficits depending on Tile classification, pelvic injury configuration, and treatment.In 223 patients (6.5%), neurological lesions were diagnosed on the day of discharge from the hospital. The degree of instability of the pelvic fracture correlated with occurrence of nerve lesions. Rate of neurological dysfunction increased from 1.5% in type A fractures to 14.4% in type C fractures (P<.001). As the most endangered anatomical regions in pelvic fractures, the roots L5 (18.3%) and S1 (15.6%) and isolated peripheral nerves (19.2%) were identified. Patients sustaining complex pelvic trauma (7.85%) suffered from significantly more neurological dysfunctions (33.5%) compared to patients without peripelvic organ or soft tissue injuries (P<.001). Whereas stable type A3 sacral fractures were not associated with a different risk to develop neurological deficits (3.8%), unstable sacral fractures with the need for operative fixation showed an increased rate of accompanying nerve lesions (15.4%; P<.001). Twenty-one (11.5%) operative sacral stabilizations were supplemented with nerve root decompression (mainly S1). Neurological complications in the course of treatment were seen in 69 cases (1.9%).A high degree of instability, complex pelvic trauma, and unstable sacral fractures predispose for additional neurological deficits in patients with pelvic fractures. Copyright 2010, SLACK Incorporated.

  7. Occurrence of communication and swallowing problems in neurological disorders: analysis of forty patients.

    Science.gov (United States)

    Jani, Mansi Pankaj; Gore, Geeta Bharat

    2014-01-01

    Communication and swallowing problems are common as a result of neurological conditions like stroke, traumatic brain injury, neoplasms of the nervous systems, viral encephalitis, diseases affecting neuromuscular junction and neuro degenerative conditions. The most frequently encountered problems are dysarthria, aphasia, dysphagia and apraxia of speech. Although these disorders are mentioned in literature, very few studies describing the occurrence in different neurological conditions are available in Indian context. Hence, a need was felt to carry out such a study. A heterogenous group of forty patients with neurological conditions were assessed for presence of speech, language and swallowing problems. A percent analysis was carried out to determine the occurrence of aphasia, dysarthria and dysphagia in general, in specific diseases and also to describe type of aphasia and dysarthria according to the characteristics presented. It was seen that the most frequently occurring disorder was dysarthria (60%), followed by dysphagia (55%) and aphasia (18%). It was also noted that dysarthria and dysphagia co-existed in around 45% patients with neurological diseases. It can be concluded that speech, language and swallowing problems are frequent in individuals with neurological conditions. Speech language pathologist plays an important role as a member of the rehabilitation team in a neurological setup with respect to identifying these problems and initiating intervention at the earliest. Hence, it is necessary for speech language pathologist to be well versed with the features each disorder may present with in terms of communication and swallowing.

  8. Exploring patient and family satisfaction in pediatric neurological surgery

    Directory of Open Access Journals (Sweden)

    Randa R. Barsoom, BS

    2017-03-01

    Discussion and conclusions: Patient and family satisfaction surveys are useful for gaining insight into pediatric neurosurgical practices. Data from this cohort suggest that the environment in which patient care is delivered, timeliness of appointments and positive perceptions of the healthcare team correlate most strongly with overall satisfaction.

  9. Sleep disorders in neurological practice

    Directory of Open Access Journals (Sweden)

    Mikhail Guryevich Poluektov

    2012-01-01

    Full Text Available Sleep disorders are closely associated with both nervous system diseases and mental disorders; however, such patients prefer to seek just neurological advice. Insomnia is the most common complaint in routine clinical practice. It is characterized by different impairments in sleep and daytime awakening. Obstructive sleep apnea syndrome is less common, but more clinically important because of its negative impact on the cardiovascular and nervous systems. The common neurological disorders are restless legs syndrome and REM sleep behavior disorder, as well as narcolepsy, the major manifestations of which are impaired nocturnal sleep and daytime awakening.

  10. INFORMATIVE VALUE OF FRACTAL PORTRAIT OF PATIENTS WITH NEUROLOGICAL SYNDROMES OF OSTEOCHONDROSIS OF THE CERVICAL SPINE

    Directory of Open Access Journals (Sweden)

    D. V. Vakulenko

    2013-05-01

    Full Text Available Patients with neurological syndromes of degenerative disc disease of the cervical spine are characterized by decrease of the fractal dimension of electrocardiosignals compared to healthy. This indicates about a low level of energy, immune status, biorhythms harmonization of different organs and systems, psycho-emotional and physiological activity of the body of patients

  11. Routine detection and management of neurocognitive impairment in HIV-positive patients in a UK centre

    OpenAIRE

    Haddow, L. J.; Accoroni, A.; Cartledge, J. D.; Manji, H; Benn, P; Gilson, R. J. C.

    2013-01-01

    Summary We estimated the burden of HIV-associated neurocognitive disorders (HAND) in a UK clinic. From a random sample, and referrals to specialist services over one year (neurology, clinical psychology, hospital admissions), we determined whether patients were diagnosed with HIV-associated dementia (HAD) and whether they reported symptoms suggesting neurocognitive impairment (NCI). In the first sample, 2/150 (prevalence 1.3%; 95% confidence interval [CI] 0.2–4.7%) had documented HAD. Eleven ...

  12. Detection and analysis of Borna disease virus in Chinese patients with neurological disorders.

    Science.gov (United States)

    Li, Q; Wang, Z; Zhu, D; Xu, M; Chen, X; Peng, D; Iwata, Y; Xie, P

    2009-03-01

    Borna disease virus (BDV) is a neurotropic RNA virus that is known to cause neurological disturbances in various animal species, potentially even humans. However, the association between BDV infection and human neurological disorders remains unclear. Between August 2005 and March 2006, 65 patients with neurological disorders were enrolled into our study. The presence of BDV p24 RNA from peripheral blood mononuclear cells (PBMCs) was investigated by using nested reverse transcriptase PCR (RT-PCR) assay. Borna disease virus p24 RNA was detected from PBMCs in six patients with viral encephalitis by using nested RT-PCR assay. However, BDV p24 RNA was not detected in patients with multiple sclerosis or peripheral nerve diseases. There might be possible associations between BDV infection and human viral encephalitis.

  13. Advocacy in neurology

    National Research Council Canada - National Science Library

    Pauranik, Apoorva

    2008-01-01

    ...), launched the Neurological Alliance of Ireland, a nationwide coalition of patient advocacy groups and physicians and authored Standards of Care, the "blueprint" for the development of neurological...

  14. Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: Our experience.

    Science.gov (United States)

    Madurga Revilla, P; López Pisón, J; Samper Villagrasa, P; García Íñiguez, J P; Garcés Gómez, R; Domínguez Cajal, M; Gil Hernández, I

    2017-11-23

    Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990-1999), and those of the international multicentre PANGEA study. A total of 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60 vs. 2.1%, P=.0003, and 8.44 vs. 2.63%, P=.0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05 vs. 13.32%, P<.0001, and 10.47% vs. 23.79%, P<.0001, respectively). Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care. Copyright

  15. The Patient Activation Measure: a validation study in a neurological population.

    Science.gov (United States)

    Packer, Tanya L; Kephart, George; Ghahari, Setareh; Audulv, Åsa; Versnel, Joan; Warner, Grace

    2015-07-01

    To assess the validity of the Patient Activation Measure (PAM13) of patient activation in persons with neurological conditions. "The Everyday Experience of Living with and Managing a Neurological Condition" (The LINC study) surveyed 948 adults with neurological conditions residing in Canada in 2011 and 2012. Using data for 722 respondents who met coding requirements for the PAM-13, we examined the properties of the measure using principle components analysis, inter-item correlations and Cronbach's alpha to assess unidimensionality and internal consistency. Rasch modeling was used to assess item performance and scaling. Construct validity was assessed by calculating associations between the PAM and known correlates. PAM-13 provides a suitably reliable and valid instrument for research in patients with neurological conditions, but scaling problems may yield measurement error and biases for those with low levels of activation. This is of particular importance when used in clinical settings or for individual client care. Our study also suggests that measurement of activation may benefit from tailoring items and scaling to specific diagnostic groups such as people with neurological conditions, thus allowing the PAM-13 to recognize unique attributes and management challenges in those conditions. The PAM-13 is an internally reliable and valid tool for research purposes. The use of categorical activation "level" in clinical settings should be done with caution.

  16. Brain magnetic resonance imaging screening is not useful for HIV-1-infected patients without neurological symptoms.

    Science.gov (United States)

    Nishijima, Takeshi; Gatanaga, Hiroyuki; Teruya, Katsuji; Tajima, Tsuyoshi; Kikuchi, Yoshimi; Hasuo, Kanehiro; Oka, Shinichi

    2014-10-01

    We investigated the diagnostic usefulness of brain magnetic resonance imaging (MRI) screening in HIV-1-infected patients without neurological symptoms in detecting intracranial diseases at early stages. In this retrospective analysis, the study patients were HIV-1-infected patients who underwent brain MRI scan in clinical practice between 2001 and 2013. We excluded patients with MRI for (1) follow-up examination for prediagnosed intracranial diseases, (2) cancer staging, (3) screening mycobacterium/bacteria/fungi disease proliferation in the brain, and (4) evaluation for meningitis/encephalitis. The study patients (n=485) were classified into two groups: those who underwent brain MRI scan without any neurological symptoms/signs (asymptomatic patients, n=158) and those who underwent MRI due to such symptoms (symptomatic patients, n=327). Asymptomatic patients had lower CD4 counts than symptomatic patients (median 78 versus 241/μl). Intracranial diseases were detected in three (2%) of the asymptomatic patients [two toxoplasmosis and one progressive multifocal leukoencephalopathy (PML)] compared to 58 (19%) of the symptomatic patients (the χ(2) test, pMRI screening for HIV-1-infected patients without neurological symptoms is of little value.

  17. Inertial Sensors to Assess Gait Quality in Patients with Neurological Disorders: A Systematic Review of Technical and Analytical Challenges

    Directory of Open Access Journals (Sweden)

    Aliénor Vienne

    2017-05-01

    Full Text Available Gait disorders are major causes of falls in patients with neurological diseases. Understanding these disorders allows prevention and better insights into underlying diseases. InertiaLocoGraphy (ILG –the quantification of gait by using inertial measurement units (IMUs –shows great potential to address this public health challenge, but protocols vary widely and normative values of gait parameters are still unavailable. This systematic review critically compares ILG protocols, questions features extracted from inertial signals and proposes a semeiological analysis of clinimetric characteristics for use in neurological clinical routine. For this systematic review, PubMed, Cochrane and EMBASE were searched for articles assessing gait quality by using IMUs that were published from January 1, 2014 to August 31, 2016. ILG was used to assess gait in a wide range of neurological disorders – including Parkinson disease, mild cognitive impairment, Alzheimer disease, cerebral palsy, and cerebellar atrophy – as well as in the faller or frail older population and in people presenting rheumatological pathologies. However, results have not yet been driving changes in clinical practice. One reason could be that studies mainly aimed at comparing pathological gait to healthy gait, but there is stronger need for semiological descriptions of gait perturbation, severity or prognostic assessment. Furthermore, protocols used to assess gait using IMUs are too many. Likely, outcomes are highly heterogeneous and difficult to compare across large panels of studies. Therefore, homogenization is needed to foster the use of ILG to assess gait quality in neurological routine practice. The pros and cons of each protocol are emphasized so that a compromise can be reached. As well, analysis of seven complementary clinical criteria (springiness, sturdiness, smoothness, steadiness, stability, symmetry, synchronization is advocated.

  18. Inertial Sensors to Assess Gait Quality in Patients with Neurological Disorders: A Systematic Review of Technical and Analytical Challenges.

    Science.gov (United States)

    Vienne, Aliénor; Barrois, Rémi P; Buffat, Stéphane; Ricard, Damien; Vidal, Pierre-Paul

    2017-01-01

    Gait disorders are major causes of falls in patients with neurological diseases. Understanding these disorders allows prevention and better insights into underlying diseases. InertiaLocoGraphy (ILG) -the quantification of gait by using inertial measurement units (IMUs) -shows great potential to address this public health challenge, but protocols vary widely and normative values of gait parameters are still unavailable. This systematic review critically compares ILG protocols, questions features extracted from inertial signals and proposes a semeiological analysis of clinimetric characteristics for use in neurological clinical routine. For this systematic review, PubMed, Cochrane and EMBASE were searched for articles assessing gait quality by using IMUs that were published from January 1, 2014 to August 31, 2016. ILG was used to assess gait in a wide range of neurological disorders - including Parkinson disease, mild cognitive impairment, Alzheimer disease, cerebral palsy, and cerebellar atrophy - as well as in the faller or frail older population and in people presenting rheumatological pathologies. However, results have not yet been driving changes in clinical practice. One reason could be that studies mainly aimed at comparing pathological gait to healthy gait, but there is stronger need for semiological descriptions of gait perturbation, severity or prognostic assessment. Furthermore, protocols used to assess gait using IMUs are too many. Likely, outcomes are highly heterogeneous and difficult to compare across large panels of studies. Therefore, homogenization is needed to foster the use of ILG to assess gait quality in neurological routine practice. The pros and cons of each protocol are emphasized so that a compromise can be reached. As well, analysis of seven complementary clinical criteria (springiness, sturdiness, smoothness, steadiness, stability, symmetry, synchronization) is advocated.

  19. Impaired gastric relaxation in patients with achalasia.

    Science.gov (United States)

    Mearin, F; Papo, M; Malagelada, J R

    1995-03-01

    Achalasia is considered a primary motility disorder confined to the oesophagus. The lower oesophageal sphincter (LOS) in achalasia is frequently hypertonic and manifests absent or incomplete relaxation in response to deglution. On the other hand, the LOS and the proximal stomach act physiologically as a functional unit whereby relaxation of the LOS during deglution is associated with receptive relaxation of the proximal stomach. Thus, this study investigated the hypothesis that impaired LOS relaxation in patients with achalasia might be associated with impaired relaxation of the proximal stomach. The study consisted of 20 patients with achalasia and 10 healthy controls. Gastric tone variations were quantified using an electronic barostat. Firstly, the study established the basal gastric tone (intragastric volume at the minimal distending pressure+1 mm Hg) and gastric compliance (volume/pressure relation) during isobaric distension (increasing stepwise the intragastric pressure from 0 to 20 mm Hg up to 600 ml). Secondly, the gastric tone response to cold stress (hand immersion into ice water for five minutes) or to control stimuli (water at 37 degrees) was determined. Basal gastric tone mean (SEM) was similar in achalasia and in healthy controls (125 (9) ml v 138 (9) ml, respectively). Compliance was linear and similar in both groups, which also showed similar gastric extension ratios (58 (7) ml/mm Hg v 57 (6) ml/mm Hg). Cold stress induced a gastric relaxatory response that, as a group, was significantly lower in achalasia than in healthy controls (volume: 43 (20) ml v 141 (42) ml; p 100 ml) relaxatory responses whereas four of the 10 healthy controls did not. In conclusion, reflex gastric relaxation is impaired in most patients with achalasia showing that the proximal stomach, and not exclusively the oesophagus, may be effected by the disease.

  20. [Analgesia in patients with hepatic impairment].

    Science.gov (United States)

    Innaurato, Giovanni; Piguet, Valérie; Simonet, Martine Louis

    2015-06-24

    The lack of clear recommendations makes optimal pain management difficult in patients with hepatic function impairment. This article reviews the evidence on commonly used analgesics (paracetamol, NSAIDs, opiates). Paracetamol can be safely used at low doses (2-3 grams per day) for a period not exceeding a few days. NSAIDs should be avoided because of their direct hepatic toxicity and an increased risk of life-threatening side-effects (hemorrhagic, renal). Glucuronoconjugated opiates should be preferred but all must be used carefully because of the risk of side effects. Dosage reduction and/or increased dose interval are often required.

  1. Neurologic abnormalities in a patient with human ehrlichiosis.

    Science.gov (United States)

    Harkess, J R; Stucky, D; Ewing, S A

    1990-11-01

    Human ehrlichiosis is a tick-borne rickettsial disease characterized by fever, headache, myalgias, anorexia, and occasionally rash. In our patient, changes in mental status, upper motor neuron signs, cerebrospinal fluid pleocytosis, and increased serum protein levels were found in association with serologically confirmed ehrlichiosis and were most likely due to vasculitis involving the central nervous system. Intraleukocytic inclusions, although observed in our case, have been infrequently found in other reported cases of ehrlichiosis.

  2. Treatment of Stress Urinary Incontinence in Neurological Patients With an Injectable Elastomer Prosthesis: Preliminary Results.

    Science.gov (United States)

    Renard, Julien; Citeri, Marco; Zanollo, Lucia; Guerrer, Chiara; Rizzato, Luigi; Frediani, Luca; Iselin, Christophe; Spinelli, Michele

    2017-03-24

    Many treatment options for stress urinary incontinence are difficult to apply to neurological patients. Urolastic is a new agent that is primarily indicated for women with mild stress urinary incontinence or men after prostate surgery. In this report, we present a series of 5 cases describing the first use of Urolastic to treat neurological patients. All patients were evaluated with a voiding diary and the use of auxiliary devices as the main indicators of continence. The median operative time was 30.8 minutes, and no complications were observed. Of the 5 patients, 4 reported improved incontinence: 2 switched from diapers to small pads, while the other 2 patients were able to discontinue urinary condom use. The only instance of treatment failure occurred in a patient with a low-compliance bladder. The advantages of this procedure appear to include a soft-cuff effect, reversibility, and minimal invasiveness. However, a future randomized study would be necessary to validate this treatment option.

  3. Cervical Anterolisthesis: A Predictor of Poor Neurological Outcomes in Cervical Spondylotic Myelopathy Patients After Cervical Laminoplasty.

    Science.gov (United States)

    Oichi, Takeshi; Oshima, Yasushi; Taniguchi, Yuki; Matsubayashi, Yoshitaka; Chikuda, Hirotaka; Takeshita, Katsushi; Tanaka, Sakae

    2016-04-01

    A retrospective cohort study. To clarify the influence of cervical spondylolisthesis on neurological outcomes in cervical spondylotic myelopathy (CSM) patients after cervical laminoplasty. Studies focusing on the surgical outcomes in CSM patients with cervical spondylolisthesis are limited. We retrospectively reviewed 125 CSM patients after cervical laminoplasty. Neurological outcomes were evaluated by calculating the Japanese Orthopedic Association (JOA) recovery rate at 2 years after surgery. We defined anterolisthesis as a more than 3-mm anterior vertebral displacement in a flexion radiograph and retrolisthesis as a more than 3-mm posterior vertebral displacement in an extension radiograph. We further assessed potential risk factors for poor neurological outcomes after cervical laminoplasty, including cervical alignment, degree of spinal cord compression, duration of myelopathic symptoms, diabetes mellitus, and preoperative JOA score. Multivariate logistic regression analysis was performed to investigate the risk factors for poor outcomes (JOA recovery rate Anterolisthesis and retrolisthesis were observed in 13 and 24 patients, respectively. Multivariate logistic regression analysis revealed that the anterolisthesis was a significant risk factor for poor outcomes (JOA recovery rate Anterolisthesis, but not retrolisthesis, is a significant risk factor for and predictor of poor neurological outcomes after cervical laminoplasty. Cervical laminoplasty should not be considered in CSM patients with anterolisthesis. 2.

  4. Neurological soft signs in non-psychotic patients with cannabis dependence.

    Science.gov (United States)

    Dervaux, Alain; Bourdel, Marie-Chantal; Laqueille, Xavier; Krebs, Marie-Odile

    2013-03-01

    Psychomotor performance has consistently been found to be altered in chronic cannabis users. Neurological soft signs (NSS) reflect neurological dysfunction involving integrative networks, especially those involving the cerebellum, where cannabinoid receptors are particularly concentrated. Our objective was to study, for the first time, NSS in a group of patients with cannabis dependence compared with a of healthy control subjects, matched for age, gender and level of education. All outpatients seeking treatment for chronic cannabis use in the substance abuse department of Sainte-Anne Hospital in Paris between June 2007 and May 2009 and meeting the cannabis dependence DSM-IV criteria were included in the study (n = 45). Patients with psychotic disorders, bipolar 1 disorder and current alcohol, opioid or cocaine dependence were excluded. All patients and controls were assessed using the Diagnostic Interview for Genetic Studies, which screens for lifetime DSM-IV diagnoses, and the Standardized Neurological Examination of Neurological Soft Signs. NSS scores were significantly higher in patients with cannabis dependence compared with healthy subjects (8.90 ± 4.85 versus 6.71 ± 2.73, respectively, Mann-Whitney: U = 775.0, P = 0.05). Patients had particularly high scores on motor coordination and sensory integration NSS factors. Cannabis dependence is associated with more NSS and especially motor coordination and sensory integration signs. These results suggest that cannabinoids interact with the brain networks underlying NSS, known to be altered in schizophrenia. © 2010 The Authors, Addiction Biology © 2010 Society for the Study of Addiction.

  5. Prevalence and types of cognitive impairment among patients with ...

    African Journals Online (AJOL)

    Background Cognitive impairment is associated with short and long term adverse outcomes in stroke patients that may impair functional recovery during their rehabilitative process. Aims This study determined the prevalence, grades and demographic factors associated with cognitive impairment among patients with stroke ...

  6. Risk factors for cognitive impairment in elderly bipolar patients

    NARCIS (Netherlands)

    Schouws, S.N.T.M.; Stek, M.L.; Comijs, H.C.; Beekman, A.T.F.

    2010-01-01

    Objective: Cognitive impairment in elderly bipolar patients persists during euthymic state, yet the aetiology of such impairment is not well understood. The objective of this study is to identify factors contributing to cognitive impairment in elderly patients with bipolar disorder. Method: 119

  7. Neurological outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury.

    Science.gov (United States)

    Singhal, B; Mohammed, A; Samuel, J; Mues, J; Kluger, P

    2008-09-01

    Retrospective study based on a reference paper. Neurological outcome in patients who were managed surgically with closed traumatic cervical spine injury was evaluated using the ASIA motor scoring system and Frankel grading. To assess the accuracy of motor charting and Frankel grading as tools to evaluate neurological outcome in closed traumatic cervical spine injury, and also to evaluate how the surgically treated patients fared in their neurological recovery by measurement tools as in the reference paper. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. Fifty-seven patients were admitted within 2 days of the injury with closed traumatic cervical spine injuries (1997-2004). Thirty-seven (65%) met the inclusion criteria as per the referenced paper, that is, were treated surgically, were Frankel grade B and above and had at least 12 months follow up. The remaining 20 patients were not included as they did not meet the inclusion criteria. The breakdown of the 20 patients is given in Table 1. The mean recovery percentage (MRP) and mean deficit percentage (MDP) were calculated as per the referenced paper. An evaluation of 37 patients surgically treated, who had follow up of at least 12 months, showed that preservation of pin prick below the level of lesion, and preservation of anal tone and perianal sensation were good prognostic indicators. There was no correlation between degree of encroachment of canal or the degree of kyphosis to MDP or MRP. The mean time from injury to mobilization was 7.6 days in 25 out of 37 patients. Twelve of the 37 patients had prolonged immobilization because of ITU stay or because they were initially treated conservatively. Three out of the 37 patients developed DVT/PE. Mean hospital stay was 6.4 months. The neurological outcome in surgically treated patients is comparable to the conservatively treated patients. The Frankel grading and ASIA motor charting combined is a powerful tool in assessing the neurological

  8. [Neurologic complications of herpes zoster. A retrospective study in 100 patients].

    Science.gov (United States)

    Sánchez-Guerra, M; Infante, J; Pascual, J; Berciano, J; Polo, J

    2001-03-01

    The neurologic complications associated with herpes zoster are infrequent except for postherpetic neuralgia. The aim of this study was to review the clinical profile and the distribution of these complications in a retrospective series of patients. A retrospective analysis of the last 100 patients admitted with the diagnosis of herpes zoster with neurologic complications to our center from 1992 to 1999 by the Departments of Internal Medicine and Neurology was performed. The characteristics of the complications other than postherpetic neuralgia are reported. Aside from the 88 patients with postherpetic neuralgia, the 12 remaining patients presented other complications: seven different peripheral neuropathies, including three with Ramsay-Hunt syndrome, two meningitis, one encephalitis and one myelitis. In addition, one patient had ophthalmic herpes zoster with cerebral vasculopathy as ipsilateral Wallenberg's syndrome. Nine patients (75%) were males, four (25%) were under the age of 20 years and seven older than 60 years and only three were immunodepressed. The CSF was abnormal in six out of the eight patients in whom it was studied with lymphocytic pleocytosis being shown on analysis without qualitative or quantitative alteration in intrathecal synthesis of IgG. In the immunosuppressed patients the serology in the CSF of the varicela zoster virus was negative. All patients demonstrated regressive evolution following treatment with acyclovir. Neurologic complications other than postherpetic neuralgia occurred in 12% of the patients of this series, there was male predominance and peripheral neuropathies were the most frequent complications. Serology of the varicela zoster virus in immunosuppressed patients may be negative. In this series the prognosis was mainly satisfactory.

  9. The Role of Emotion in Decision-Making: Evidence from Neurological Patients with Orbitofrontal Damage

    Science.gov (United States)

    Bechara, Antoine

    2004-01-01

    Most theories of choice assume that decisions derive from an assessment of the future outcomes of various options and alternatives through some type of cost-benefit analyses. The influence of emotions on decision-making is largely ignored. The studies of decision-making in neurological patients who can no longer process emotional information…

  10. Population-based studies on risk of fracture in patients with neurological disorders

    NARCIS (Netherlands)

    Pouwels, S.|info:eu-repo/dai/nl/34158990X

    2014-01-01

    Introduction Patients with neurological disorders may be at an increased risk of fracture via multiple causal pathways, including increases in the risk of falls, changes in bone mineral density and quality of bone microarchitecture. Risk of fracture may be increased by the disease itself, by

  11. Identification of risk factors for neurological deficits in patients with pelvic fractures

    DEFF Research Database (Denmark)

    Schmal, Hagen; Hauschild, Oliver; Culemann, Ulf

    2010-01-01

    This multicenter register study was performed to define injury and fracture constellations that are at risk to develop pelvic associated neural lesions. Data of 3607 patients treated from 2004 to 2009 for pelvic fractures were evaluated for neurological deficits depending on Tile classification, ...

  12. The Ability of the Eating Assessment Tool-10 to Detect Aspiration in Patients With Neurological Disorders

    Science.gov (United States)

    Arslan, Selen Serel; Demir, Numan; Kılınç, Hasan E; Karaduman, Aynur A

    2017-01-01

    Background/Aims Dysphagia is common in patients with neurological disorders. There is a need to identify patients at risk early by a useful clinical tool to prevent its serious complications. The study aims to determine the ability of the Turkish version of Eating Assessment Tool-10 (T-EAT-10) to detect aspiration in patients with neurological disorders. Methods Two hundred fifty-nine patients with neurological disorders who had complaints about swallowing difficulty and referred for a swallowing evaluation were included. Oropharyngeal dysphagia was evaluated with the T-EAT-10 and videofluoroscopic swallowing study in the same day. The penetration-aspiration scale (PAS) was used to document the penetration and aspiration severity. Results The mean age of the patients was 59.72 ± 17.24 years (minimum [min] = 18, maximum [max] = 96), of which 57.1% were male. The mean T-EAT-10 of patients who had aspiration (PAS > 5) was 25.91 ± 10.31 (min = 1, max = 40) and the mean T-EAT-10 of patients who did not have aspiration (PAS < 6) was 15.70 ± 10.54 (min = 0, max = 40) (P < 0.001). Patients with a T-EAT-10 score higher than 15 were 2.4 times more likely to aspirate. A linear correlation was found between T-EAT-10 and PAS scores of the patients (r = 0.416, P < 0.001). The sensitivity of a T-EAT-10 higher than 15 in detecting aspiration was 81.0% and the specificity was 58.0%. A T-EAT-10 score of higher than 15 has a positive predictive value of 72.0% and a negative predictive value of 69.0%. Conclusion The T-EAT-10 can be used to detect unsafe airway protection in neurology clinics to identify and refer dysphagic patients for further evaluation. PMID:28545185

  13. Neurological soft signs in aging, mild cognitive impairment and Alzheimer´s disease – the impact of cognitive decline and cognitive reserve

    Directory of Open Access Journals (Sweden)

    Nadja eUrbanowitsch

    2015-02-01

    Full Text Available Objectives: Neurological soft signs (NSS, i.e. minor motor and sensory changes, are a common feature in severe psychiatric disorders. We sought to establish the frequency of NSS in patients with mild cognitive impairment (MCI and Alzheimer’s disease (AD on basis of a large population based sample and to identify their neuropsychological correlates including cognitive reserve.Methods: NSS were examined using an abbreviated version of the Heidelberg NSS Scale in 221 old participants born between 1930 and 1932 (63 with MCI, 15 with AD, 143 healthy old controls and 256 healthy young participants (born between 1950 and 1952 of the population-based Interdisciplinary Longitudinal Study of Ageing (ILSE. Subjects received thorough neuropsychological testing; years of school education were used as a proxy for cognitive reserve.Results: NSS scores were significantly (p<0.001 higher in the AD patients (5.6±3.11 than in the healthy old controls (2.8±1.90 and in the MCI patients (3.0±1.96. This result was confirmed after years of school education which were inversely correlated (r = - 0.25; p<0.001 with NSS were entered as a covariate. In the patients but not in the controls, NSS were significantly correlated with deficits in executive functioning and visuospatial functioning. Comparison of NSS scores between old (2.84 ± 1.9 and young (2.46 ± 1.97 controls yielded only minor, non-significant differences after education (13.86 ± 3.0 vs. 14.61 ± 2.48 years, respectively was controlled for.Conclusions: Our results demonstrate that NSS are frequently found in mild AD but not in MCI. NSS refer to frontal-executive deficits and visuospatial dysfunction rather than age per se and can be partly compensated for by cognitive reserve.

  14. Volumetric magnetic resonance imaging correlates of the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment neuropsychology protocols.

    Science.gov (United States)

    Wong, Adrian; Wang, Defeng; Black, Sandra E; Nyenhuis, David L; Shi, Lin; Chu, Winnie C W; Xiong, Yun-yun; Au, Lisa; Lau, Alexander; Chan, Anne Y Y; Wong, Lawrence K S; Mok, Vincent

    2015-01-01

    Vascular cognitive impairment (VCI) refers to the entire spectrum of cognitive dysfunction attributable to vascular changes in the brain. The objective of this study is to evaluate magnetic resonance imaging (MRI) correlates of performance on the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) VCI neuropsychology protocols. Fifty ischemic stroke patients and 50 normal elderly persons completed the VCI protocols and MRI. Relationships between the four cognitive domains (executive/activation, language, visuospatial, and memory) and three protocol (60-, 30-, and 5-min) summary scores with MRI measures of volumes of white matter hyperintensities (WMH) and global brain and hippocampal atrophy were assessed using linear regression. All cognitive domain scores were associated with WMH volume and, with the exception of language domain, with global atrophy. Additional relationships were found between executive/activation and language domains with left hippocampal volume, visuospatial domain with right hippocampal volume, and memory domain with bilateral hippocampal volumes. All protocol summary scores showed comparable relationships with WMH and hippocampal volumes, with additional relationships found between the 60- and 30-min protocols with global brain volume. Performance on the NINDS-CSN VCI protocols reflects underlying volumetric brain changes implicated in cognitive dysfunctions in VCI.

  15. Therapeutic plasma exchange in patients with neurological diseases: multicenter retrospective analysis.

    Science.gov (United States)

    Kaya, Emin; Keklik, Muzaffer; Sencan, Mehmet; Yilmaz, Mehmet; Keskin, Ali; Kiki, Ilhami; Erkurt, Mehmet Ali; Sivgin, Serdar; Korkmaz, Serdal; Okan, Vahap; Doğu, Mehmet Hilmi; Unal, Ali; Cetin, Mustafa; Altuntaş, Fevzi; Ilhan, Osman

    2013-06-01

    Therapeutic plasma exchange (TPE), is a procedure, changing pathologic substances in the plasma of patients with replacement fluid. TPE has an increasing list of indications in recent years such as neurological, connective tissue, hematological, nephrological, endocrinological and metabolic disorders. We report our multicenter data about therapeutic plasma exchange in patients with neurological diseases. Six University Hospitals' aphaeresis units medical records about neurologic diseases were reviewed retrospectively. Hundred and fifteen patients and 771 TPE sessions from six aphaeresis units' were included to this study. Of the 115 patients, 53 (46%) were men and 62 (54%) were women. The median age was 50 (range: 5-85) years. Of these patients 58.3% were Guillain-Barre syndrome (GBS), 17.4% were acute disseminated encephalomyelitis (ADEM), 10.4% were chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), 7% were multiple sclerosis, 6.1% were myasthenia gravis (MG) and 0.9% were Wilson disease (WD). The median number of TPE sessions per patient was 5 (range 1-72). Human albumin was used as a replacement fluid in 66% and fresh frozen plasma was used in 34% of cases. TPE was done through central venous catheters in 66%, and peripheral venous access in 34% of patients. Some complications were seen in patients (18.3%) during TPE sessions. These complications were, complications related to catheter placement procedure (8.7%), hypotension (3.5%), hypocalcaemia (3.5%) and allergic reactions (1.7%). The complication ratios were 2.7% in total 771 TPE procedures. TPE procedure was terminated in 6% of sessions depending on these complications. Overall responses to TPE were noted in 89.5% of patients. In conclusion; Therapeutic plasma exchange is an effective treatment option in several neurologic diseases. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Reflex cough PEF as a predictor of successful extubation in neurological patients.

    Science.gov (United States)

    Kutchak, Fernanda Machado; Debesaitys, Andressa Maciel; Rieder, Marcelo de Mello; Meneguzzi, Carla; Skueresky, Amanda Soares; Forgiarini Junior, Luiz Alberto; Bianchin, Marino Muxfeldt

    2015-01-01

    To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation. This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters. The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.

  17. Assessment of cognitive impairment in patients with Parkinson's disease: prevalence and risk factors

    Directory of Open Access Journals (Sweden)

    Wang Q

    2014-02-01

    Full Text Available Qiumei Wang,1 Zhenxin Zhang,2 Ling Li,2 Hongbo Wen,2 Qun Xu3,4 1Department of Geriatrics, 2Department of Neurology, 3School of Basic Medicine, Peking Union Medical College Hospital, 4Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, People's Republic of China Background: Although Parkinson's disease (PD is clinically characterized by motor symptoms, cognitive impairment is one of the most disabling non-motor symptoms. Despite it attracting increasing attention worldwide, less is known about its prevalence in the Chinese population. The objective of this study was to assess cognitive impairment and related risk factors in Chinese PD patients. Methods: We collected the demographic, diagnostic, and treatment information of 901 PD patients from 42 centers throughout the People's Republic of China, then administered a battery of neuropsychological tests, to assess motor, cognitive, and neuropsychiatric symptoms. Results: Overall, 193 of 901 (21.4% PD patients met the criteria for dementia (PD-D, and 206 (22.8% met the criteria for mild cognitive impairment (PD-MCI. Visuospatial dysfunction and attention/executive impairment predominated. Increased severity of cognitive impairment was associated with greater motor impairment. Patients with psychiatric symptoms, such as depression and hallucinations, were more likely to have dementia. Potentially, the younger-aged and more educated are shown less cognitive impairment, but age at onset, and levodopa equivalent dose, were not associated with the presence of cognitive dysfunction. Conclusion: The prevalence and profile of cognitive impairment in Chinese PD patients, as well as the risk factors, are similar as those reported for other races, but the frequency of nonamnestic cognitive domains differs. Keywords: cognitive impairment, risk factor, prevalence, Parkinson's disease

  18. European Academy of Neurology/European Association for Palliative Care Taskforce on Neurology Consensus recommendations on palliative care for patients with chronic and progressive neurological disease - acceptability for Belgian neurologists.

    Science.gov (United States)

    Vanopdenbosch, L J; Maes, E; Oliver, D J

    2017-07-01

    A Consensus document on palliative care and neurology has made recommendations on the care of people with chronic and progressive neurological disease. This study aimed to investigate whether these recommendations are understood by, acceptable to and used in practice by neurologists in Belgium. An online survey was undertaken of 100 neurologists in Belgium, asking for their opinion on all of the recommendations in the Consensus document. Sixty-four of the neurologists replied. Overall, they expressed support for the recommendations, in particular open communication with patients, open assessment of patient and family needs, and discussion of dying. There was less understanding of the role of palliative care in the implementation of palliative care early in disease progression and the role of palliative care multidisciplinary teams. The survey shows that many of the recommendations in the European Academy of Neurology/European Association for Palliative Care Taskforce on Neurology Consensus document are understood by neurologists, and several are now seen as part of normal clinical practice. However, there is still a need to develop a more collaborative approach between neurology and palliative care services, for the benefit of patients and families. © 2017 EAN.

  19. Neurologic patient safety: an in-depth study of malpractice claims.

    Science.gov (United States)

    Glick, Thomas H; Cranberg, Lee D; Hanscom, Robert B; Sato, Luke

    2005-10-25

    This in-depth study of neurologic malpractice claims indicated authentic, preventable patient harm in 24 of 42 cases, enabling comparison with larger but administratively abstracted summary reports. Principal findings included the common occurrence of outpatient events, lapses in communication with patients and other providers, the need for follow-through by the consultant neurologist even when not primarily responsible, the frequency of diagnostic errors, and pitfalls associated with imaging.

  20. Prognostic value of ICU-acquired hypernatremia in patients with neurological dysfunction

    OpenAIRE

    Hu, Bei; Han, Qianpeng; Mengke, Nashun; He, Kairan; Zhang, Yiqin; Nie, Zhiqiang; Zeng, Hongke

    2016-01-01

    Abstract Many studies have indicated that hypernatremia is associated with increased mortality. In this study, we aimed to explore the relationship between intensive care unit (ICU)-acquired hypernatremia and the prognosis of critically neurological patients. Based on serum sodium level in the ICU, 450 patients were divided into 3 groups: 222 had normal serum sodium, 142 had mild hypernatremia, and 86 had severe hypernatremia. Kaplan?Meier and multivariable binary logistic regression analyses...

  1. Impact on patient management of the implementation of a magnetic resonance imaging dedicated to neurological emergencies.

    Science.gov (United States)

    Girot, Marie; Marc, Jean-Baptiste; Wiel, Eric; Vilhelm, Christian; Leclerc, Xavier; Lenne, Xavier; Hubert, Hervé

    2017-05-04

    Neurological emergencies consumed a high amount of resources in emergency department (ED). We aimed to study the effect of the implementation of a magnetic resonance imaging (MRI) dedicated to emergencies on the management of patients admitted in ED for neurological emergencies. We enrolled consecutive patients who underwent computed tomography and/or MRI for neurological disorders categorized as the suspicion of stroke and other reasons, over 2 periods that differed according to the priority access to computed tomography in the first period versus priority access to MRI in the second one. Criteria used to evaluate the effectiveness of the management were door-to-imaging time, ED length of stay, diagnostic performance, patient orientation, and length of hospitalization stay. When priority access to MRI, the door-to-imaging time was 31 minutes longer (P = .005) for patients suspected of stroke or transient ischaemic attack (TIA) and 70 minutes for the others (P MRI optimized the quality of care and diagnostic accuracy for patients admitted in ED with a better identification of stroke mimics, avoiding unnecessarily hospitalizations. The management of stroke-TIA patients was not modified, but their length of hospital stay reduced. © 2017 John Wiley & Sons, Ltd.

  2. Blood levels of glial fibrillary acidic protein (GFAP in patients with neurological diseases.

    Directory of Open Access Journals (Sweden)

    Christoph A Mayer

    Full Text Available BACKGROUND AND PURPOSE: The brain-specific astroglial protein GFAP is a blood biomarker candidate indicative of intracerebral hemorrhage in patients with symptoms suspicious of acute stroke. Comparably little, however, is known about GFAP release in other neurological disorders. In order to identify potential "specificity gaps" of a future GFAP test used to diagnose intracerebral hemorrhage, we measured GFAP in the blood of a large and rather unselected collective of patients with neurological diseases. METHODS: Within a one-year period, we randomly selected in-patients of our university hospital for study inclusion. Patients with ischemic stroke, transient ischemic attack and intracerebral hemorrhage were excluded. Primary endpoint was the ICD-10 coded diagnosis reached at discharge. During hospital stay, blood was collected, and GFAP plasma levels were determined using an advanced prototype immunoassay at Roche Diagnostics. RESULTS: A total of 331 patients were included, covering a broad spectrum of neurological diseases. GFAP levels were low in the vast majority of patients, with 98.5% of cases lying below the cut-off that was previously defined for the differentiation of intracerebral hemorrhage and ischemic stroke. No diagnosis or group of diagnoses was identified that showed consistently increased GFAP values. No association with age and sex was found. CONCLUSION: Most acute and chronic neurological diseases, including typical stroke mimics, are not associated with detectable GFAP levels in the bloodstream. Our findings underline the hypothesis that rapid astroglial destruction as in acute intracerebral hemorrhage is mandatory for GFAP increase. A future GFAP blood test applied to identify patients with intracerebral hemorrhage is likely to have a high specificity.

  3. Neurological symptoms and signs in HTLV-1 patients with overactive bladder syndrome

    Directory of Open Access Journals (Sweden)

    Davi Tanajura Costa

    2012-04-01

    Full Text Available OBJECTIVE: To compare neurological symptoms and signs in HTLV-1 asymptomatic carriers and HTLV-1 patients with overactive bladder (OB syndrome. METHODS: We studied 102 HTLV-1 positive individuals without HAM/TSP (HTLV-1 associated myelopathy/tropical spastic paraparesis divided into two groups according to the presence or absence of OB syndrome. Clinical interview, neurological exam and proviral load was performed in all patients. RESULTS AND CONCLUSIONS: Individuals with OB were more commonly female (84.3 vs. 60.8% of asymptomatics, p=0.01. The prevalence of neurological complaints was higher in OB group, especially hand or foot numbness and arm or leg weakness. There was no difference between the groups in neurological strength and reflexes. Weakness complaint remained strongly associated with OB in multivariate logistic regression analysis adjusting for sex and age [adjusted odds ratio and 95%CI 3.59 (1.45-8.88 in arms and 6.68 (2.63-16.93 in legs]. Proviral load was also different between the two groups with higher level on OB individuals.

  4. Patient-reported financial barriers to adherence to treatment in neurology

    Directory of Open Access Journals (Sweden)

    Moura LMVR

    2016-11-01

    Full Text Available Lidia MVR Moura,1 Eli L Schwamm,1 Valdery Moura Junior,1 Michael P Seitz,1 Daniel B Hoch,1 John Hsu,2,3 Lee H Schwamm1 1Department of Neurology, 2Mongan Institute for Health Policy, Massachusetts General Hospital, 3Department of Medicine and Department of Health Care Policy, Harvard Medical School, Boston, MA, USA Objective: Many effective medical therapies are available for treating neurological diseases, but these therapies tend to be expensive and adherence is critical to their effectiveness. We used patient-reported data to examine the frequency and determinants of financial barriers to medication adherence among individuals treated for neurological disorders. Patients and methods: Patients completed cross-sectional surveys on iPads as part of routine outpatient care in a neurology clinic. Survey responses from a 3-month period were collected and merged with administrative sources of demographic and clinical information (eg, insurance type. We explored the association between patient characteristics and patient-reported failure to refill prescription medication due to cost in the previous 12 months, termed here as “nonadherence”. Results: The population studied comprised 6075 adults who were presented between July and September 2015 for outpatient neurology appointments. The mean age of participants was 56 (standard deviation: 18 years, and 1613 (54% were females. The patients who participated in the surveys (2992, 49% were comparable to nonparticipants with respect to gender and ethnicity but more often identified English as their preferred language (94% vs 6%, p<0.01. Among respondents, 9.8% (n=265 reported nonadherence that varied by condition. These patients were more frequently Hispanic (16.7% vs 9.8% white, p=0.01, living alone (13.9% vs 8.9% cohabitating, p<0.01, and preferred a language other than English (15.3% vs 9.4%, p=0.02. Conclusion: Overall, the magnitude of financial barriers to medication adherence appears to vary

  5. Progressive neurologic dysfunction in a psoriasis patient treated with dimethyl fumarate.

    Science.gov (United States)

    Bartsch, Thorsten; Rempe, Torge; Wrede, Arne; Leypoldt, Frank; Brück, Wolfgang; Adams, Ortwin; Rohr, Axel; Jansen, Olav; Wüthrich, Christian; Deuschl, Günther; Koralnik, Igor J

    2015-10-01

    Progressive multifocal leukoencephalopathy (PML) has recently been described in psoriasis or multiple sclerosis patients treated with fumaric acid esters (fumarates), who had developed severe and long-standing lymphocytopenia (psoriasis patient who presented with progressive neurologic dysfunction and seizures after 2.5 years of fumarate therapy. Despite absolute lymphocyte counts remaining between 500-1000/mm(3) , his CD4(+) and CD8(+) T-cell counts were markedly low. MRI showed right hemispheric and brainstem lesions and JC virus DNA was undetectable in his cerebrospinal fluid. Brain biopsy revealed typical features of PML as well as JC virus-infected neurons. Clinicians should consider PML in the differential diagnosis of fumarate-treated patients presenting with brain lesions or seizures even in the absence of severe lymphocytopenia. © 2015 American Neurological Association.

  6. Persistence with antiepileptic drugs in epilepsy patients treated in neurological practices in Germany.

    Science.gov (United States)

    Jacob, Louis; Hamer, Hajo M; Kostev, Karel

    2017-08-01

    The goal of this study was to analyze the persistence with antiepileptic drugs (AED) and associated factors in patients followed in neurological practices in Germany. This study included patients aged 18years or over who received two initial diagnoses of epilepsy and a first prescription of AED between 2007 and 2015 in a neurological practice (index date). The main outcome measure was the rate of AED persistence within five years of the index date. Kaplan-Meier analyses were performed to study treatment persistence as a function of age. A Cox proportional hazards regression model was used to estimate the relationship between non-persistence and demographic/clinical variables. A total of 8192 patients followed in neurological practices were included. After five years of follow-up, 41.1% (≤40years), 45.2%, (41-60years) and 50.1% (>60years) of patients followed in neurological practices were persistent (log-rank p-value60years: OR=1.19, 95% CI: 1.09-1.31; 41-60years vs. >60years: OR=1.10, 95% CI: 1.01-1.19). Furthermore, patients receiving old AED (OR=1.16, 95% CI: 1.01-1.34) or gabapentin (OR=1.46, 95% CI: 1.16-1.83) and those diagnosed with depression (OR=1.12, 95% CI: 1.03-1.21) were at a higher risk of non-persistence, whereas those receiving levetiracetam (OR=0.69, 95% CI: 0.60-0.80) or lamotrigine (OR=0.88, 95% CI: 0.79-0.97) and those with dementia (OR=0.74, 95% CI: 0.65-0.83) were at a lower risk. The rate of epilepsy patients persistent with AED was low after five years of treatment. Age, gender, co-morbidities, and drug characteristics were associated with this persistence. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Comparative Study of Neurological Soft Signs in Patients with Schizophrenia or Obsessive-compulsive Disorder, and Healthy Controls.

    Science.gov (United States)

    Tripathi, R; Soni, A; Tyagi, A; Mehta, S; Gupta, S

    2015-06-01

    The primary objective of this study was to examine neurological soft signs in patients with obsessive-compulsive disorder compared with patients with schizophrenia and a control group in the Indian setting. The secondary objective was to find any correlation between age at onset and neurological soft signs scores, as well as that between severity of obsessive-compulsive disorder symptoms (total Yale-Brown Obsessive Compulsive Scale score) and neurological soft signs scores. This was a cross-sectional hospital-based study of 135 individuals (45 patients with schizophrenia, 45 patients with obsessive-compulsive disorder who were attending the psychiatric outpatient department of Sawai Man Singh Medical College, Jaipur, India, and 45 matched healthy controls) from 20 June 2013 to 22 December 2014. After applying strict inclusion and exclusion criteria, the participants completed the study instruments (Cambridge Neurological Inventory [Part 2] and Yale-Brown Obsessive Compulsive Scale). Their socio-demographic data were also recorded. The neurological soft signs total score and domain scores (motor coordination, sensory integration, and disinhibition) were significantly higher in patients with schizophrenia (p disorder group or the control group. The obsessive-compulsive disorder group did not significantly differ from the control group in terms of neurological soft signs scores. No correlation was found between neurological soft signs scores and age at onset as well as that between neurological soft signs scores and total Yale-Brown Obsessive Compulsive Scale score. Neurological soft signs assessed by the Cambridge Neurological Inventory and Yale-Brown Obsessive Compulsive Scale, which discriminate patients with schizophrenia from controls, appear to be relatively specific to schizophrenia. Further studies are required to explore neurological soft signs in patients with obsessive-compulsive disorder.

  8. Prognostic value of ICU-acquired hypernatremia in patients with neurological dysfunction.

    Science.gov (United States)

    Hu, Bei; Han, Qianpeng; Mengke, Nashun; He, Kairan; Zhang, Yiqin; Nie, Zhiqiang; Zeng, Hongke

    2016-08-01

    Many studies have indicated that hypernatremia is associated with increased mortality. In this study, we aimed to explore the relationship between intensive care unit (ICU)-acquired hypernatremia and the prognosis of critically neurological patients.Based on serum sodium level in the ICU, 450 patients were divided into 3 groups: 222 had normal serum sodium, 142 had mild hypernatremia, and 86 had severe hypernatremia. Kaplan-Meier and multivariable binary logistic regression analyses were performed to evaluate the prognostic value of hypernatremia in critically neurological patients. Receiver operating characteristic (ROC) curve was constructed for serum sodium levels to determine their roles in predicting ICU mortality.Hypernatremia was significantly related with age, Glasgow Coma Scale (GCS) score, serum sodium, APACHE II score, and serum creatinine. Moreover, the different treatment outcome including mechanical ventilation, the days of stayed in ICU, and Glasgow Outcome Scale score had correlation with serum sodium levels. Old ages, GCS score, therapeutic intervention scoring system (TISS) score, APACHE II score, serum sodium peak, and so on were all associated with the mortality. In addition, hypernatremia was an independent prognostic factor for critically neurological patients by logistic regression analysis (odds ratio = 1.192, 95% confidence interval = 1.135-1.252, P = 0.000). Moreover, we got the sensitivity of 79.4% and specificity of 74.5% in the ROC analysis between peak serum sodium and the mortality. The area under the ROC curve was 0.844, and the optimal cutoff value was 147.55.Our results showed that ICU-acquired hypernatremia may be a potential prognosis marker for critically neurological patients.

  9. Injection of botulinum toxin type a to reduce saliva in patients with neurological diseases

    Directory of Open Access Journals (Sweden)

    Dayse Manrique

    2005-09-01

    Full Text Available Objective: To demonstrate the effect of local injection of Botox® inpatients with neurological diseases, following our protocol for thetreatment of sialorrhea. Study design: clinical prospective study.Methods: Twenty-one patients with neurological diseases seen atthe Otorhinolaryngology of the Associação de Assistência à CriançaDeficiente. They were all submitted to local injection of Botox® insalivary glands and followed up for one year. The protocol consistsof a clinical questionnaire about inability to swallow saliva and itsrepercussions in general health and quality of life. Patients must nothave periodontal disease or intolerance to adverse effects ofanticholinergic agents and must not have used Botox® at least inthe last six months. The injection was ultrasonographically guidedand the dose was 30 U in one site of the submandibular glands, and20 U in two sites in each parotid gland. Results: Twenty-one patientswith sialorrhea resulting from several neurological diseases (chronicencephalopathy, Parkinson’s disease, amyotrophic lateral sclerosis,neuromuscular diseases, cerebral tumor, trauma, aged 2 to 66 yearsold, were submitted to Botox® injection in their salivary glands. Weobserved a markedly improvement of sialorrhea in all but one patient.Seventeen patients had no complaints of sialorrhea or salivaaspiration for approximately four months with good repercussion intheir quality of life. No patient presented local or systemic effectswith local injection of Botox®. Conclusion: the injection of Botox® asindicated in the present study was able to reduce sialorrhea resultingfrom several neurological conditions.

  10. Neurological Adverse Effects in Patients of Advanced Colorectal Carcinoma Treated with Different Schedules of FOLFOX

    Directory of Open Access Journals (Sweden)

    Nusrat Bano

    2013-01-01

    Full Text Available The study is designed to assess the frequency and severity of few dose limiting neurological adverse effects of four different schedules of FOLFOX. Patients with histologically confirmed advanced colorectal carcinoma (CRC were included in the study. Toxicity was graded according to CTC v 2.0. The frequency of grade 3 and 4 adverse effects was comparatively assessed in each treatment arm. The difference in the pattern of toxicity between the treatment schedule was evaluated. The most frequent adverse symptom of neurological adverse effect was grade 1 paresthesia in the patients treated with FOLFOX4 schedule. Grade 4 peripheral neuropathy was reported in few patients of FOLFOX7 treatment arm. Frequency and onset of neurological adverse effects like paresthesia, dizziness, and hypoesthesia were significantly different (, whereas frequency and onset of peripheral neuropathy were highly significant ( in each treatment arm of FOLFOX. Peripheral neuropathy was associated with electrolyte imbalance and diabetes in few patients. Frequency of symptoms, for example, paresthesia, is associated with increased number of recurrent exposure to oxaliplatin (increased number of cycles even at low doses (85 mg/m2, whereas severity of symptoms, for example, peripheral neuropathy, is associated with higher dose (130 mg/m2 after few treatment cycles.

  11. Analysis of discrepancy between neurologic findings and CT findings in 60 patients with herniated nucleus pulposus

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    Lee, Hyun; Kim, Kab Tae; Sol, Chang Hyo; Kim, Byung Soo [College of Medicine, Pusan National University, Busan(Korea, Republic of)

    1987-06-15

    The herniated nucleus pulposus (HNP) is a major cause of low back pain and sciatica. High resolution computed tomography is the most accurate diagnostic tool to define a HNP, because it provides a complete in vivo analysis of bony framework of lumbar spine as well as the supporting soft tissue structures and neural elements. But the discrepancy between neurologic findings and CT findings is often confusing. From May 1983 to August 1986, sixty patients with HNP who had both CT and surgical intervention at Pusan National University Hospital were analyzed. The feasibility of the neurologic examination on HNP and the effect of HNP on nerve root were evaluated on the basis of CT findings. The results were as follows : 1. Thirty-four cases (56.7%) of clinical impression were matched to CT findings in determining level of HNP and affected nerve root. 2. In evaluation of affected level, there was high trend to cause discrepancy between neurologic findings and CT findings in multiple disc involvement than in single involvement. 3. There was no correlation between degree of nerve root compression determined by CT and pattern of neurologic signs (motor weakness, sensory deficit, and reflex change)

  12. Bedside screening to detect oropharyngeal dysphagia in patients with neurological disorders: an updated systematic review.

    Science.gov (United States)

    Kertscher, Berit; Speyer, Renée; Palmieri, Maria; Plant, Chris

    2014-04-01

    Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may le to outcomes of aspiration pneumonia ranging from hospitalization to death. Therefore, an early identification of risk followed by an accurate diagnosis of oropharyngeal dysphagia is fundamental. This systematic review provides an update of currently available bedside screenings to identify oropharyngeal dysphagia in neurological patients. An electronic search was carried out in the databases PubMed, Embase, CINAHL, and PsychInfo (formerly PsychLit), and all hits from 2008 up to December 2012 were included in the review. Only studies with sufficient methodological quality were considered, after which the psychometric characteristics of the screening tools were determined. Two relevant bedside screenings were identified, with a minimum sensitivity and specificity of ≥70 and ≥60 %, respectively.

  13. The Effects of Infection on Severe Stroke Patients in the Neurological Intensive Care Unit in China.

    Science.gov (United States)

    Mi, Heyin; Li, Shujuan; Li, Haiying; Hu, Wenli

    2017-12-05

    To study the effects of infection on severe stroke patients in the Neurological Intensive Care Unit (NICU) and to find the related risk factors for mortality of severe stroke patients. We conducted a retrospective study including 343 patients with ischemic or hemorrhagic stroke and staying more than 2 patient-days in the NICU at Beijing Chaoyang Hospital from January 2011 to December 2015 to analyze the infection features of patients with severe stroke in the Neurological Intensive Care Unit. The mortality rate, hospital staying time, hospital costs, infection time and different infection sources were analyzed and Logistic analysis was performed to find the related risk factors for mortality of severe stroke patients. All analysis were conducted using SPSS 18.0. The mortality rate, hospital staying time and hospital costs of stroke patients between infected and uninfected patients were higher in infected patients than the uninfected patients, P<0.05, and except for the hospital staying time, mortality rate and hospital costs were both significantly higher in infected patients. Respiratory tract infection was the most common infection type at all time periods, P<0.05. However, urinary tract infection increased at 72 h after stroke compared with the infection within 72 h after stroke. Blood sugar level, mean arterial pressure, scores of APACHE II, history of stoke, history of heart diseases, infections and respiratory tract infection were significantly different in dead patients compared with the alive patients, P<0.05. Logistic multivariate regression analysis showed that except for history of heart diseases, the other six factors were all associated with mortality of stroke patients and were independent risk factors for mortality of stroke patients. Infection can significantly influence the mortality rate, hospital costs of stroke patients and is an independent risk factors for mortality of stroke patients.

  14. Characteristics and prognosis of pulmonary infection in patients with neurologic disease and hypoproteinemia.

    Science.gov (United States)

    Li, Feng; Yuan, Mei-zhen; Wang, Liang; Wang, Xue-feng; Liu, Guang-wei

    2015-04-01

    To examine the characteristics and the prognostic influence of pulmonary infections in neurologic disease patients with mild-to-severe hypoproteinemia. We used a retrospective survey method to analyze the characteristics and prognoses of 220 patients with hypoproteinemia complicated with pulmonary infection in the Internal Medicine-Neurology Intensive Care Unit at the First Affiliated Hospital of Chongqing Medical University from January 2010 to December 2013. The patients were divided into mild, moderate and severe hypoproteinemia groups according to their serum albumin levels. The analysis included patient age, sex, acute physiology and chronic health evaluation (APACHE II score), and characteristics of the pulmonary infection, nutritional support and prognosis, among others. Differences in the general information of the 220 cases of hypoalbuminemia patients complicated with varying degrees of pulmonary infection (APACHE II score, age, disease distribution) were statistically significant. The pulmonary infection onset time and pathogen susceptibility in the patients with mild-to-severe hypoalbuminemia were not significantly different. Pulmonary infection onset was more frequently observed within the first 3-11 days following admission in all groups. The nutritional support method did not significantly influence serum albumin protein levels. However, the neurological intensive care unit stay length, total hospitalization cost and disease distribution were significantly different among the patient groups. Patients with cerebrovascular disease, intracranial infections and epilepsy complicated with pulmonary infection represent the high-risk groups for hypoalbuminemia. The Acinetobacter baumannii complex represents the main group of pathogenic bacteria causing lung infections, and the high-risk period for lung infections is 3-11 days after the occurrence of hypoalbuminemia. Patients with severe hypoalbuminemia complicated with pulmonary infection have the worst

  15. Effects of music and music therapy on mood in neurological patients

    OpenAIRE

    Raglio, Alfredo; Attardo, Lapo; Gontero, Giulia; Rollino, Silvia; Groppo, Elisabetta; Granieri, Enrico

    2015-01-01

    Mood disorder and depressive syndromes represent a common comorbid condition in neurological disorders with a prevalence rate that ranges between 20% and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinson’s disease. Notwithstanding, these conditions are often under-diagnosed and under-treated in the clinical practice and negatively affect the functional recovery, the adherence to treatment, the quality of life, and even the mortality risk. In addition, a bidirectional as...

  16. Pattern of traditional medicine use by adult Saudi patients with neurological disorders.

    Science.gov (United States)

    Mohammad, Yousef; Al-Ahmari, Ahmed; Al-Dashash, Fahad; Al-Hussain, Fawaz; Al-Masnour, Firas; Masoud, Abdullah; Jradi, Hoda

    2015-04-01

    Traditional medicine (TM) has been established as a two-edged sword. On one edge numerous forms of TM have been proven safe and effective, while on the other edge various modes of TM have been shown to be futile and potentially dangerous. Resorting to TM, especially for chronic diseases, is common world-wide and includes Saudi Arabia. Most neurological diseases are chronic. No data is available on the utilization of TM among patients with neurological disorders. We conducted this study to assess for the prevalence, pattern, perception and triggers for TM use by the adult Saudi patients with neurological disorders. A survey written in Arabic and comprised of 15 questions was used to collect data on the practice of TM among the neurology patients of King Saud University Ambulatory Clinic. The questions in the survey pertain mainly to the frequency of TM practice, its form and the patient's opinion of this practice. The data was collected through a face to face interview by three medical students who were instructed on the survey questions prior to the launch of the study. 292 patients completed the survey (35.9% males and 64.0% females). 67% (n = 196) of the sample used TM. Cupping or what is commonly known as "hojamah" was the most prevalent method (45.4%) followed by herbs, skin cauterization and the Reciting of the Holy Quran (42.3%, 33.7% and 20.4% respectively). The prevalence of TM use did not differ across gender (chi-sq = 2.02; p-value = 0.15), level of education (chi-sq = 4.02; p-value = 0.40), health status (chi-sq = 2.29; p-value = 0.68), age groups (chi-sq = 5.12; p-value = 0.16), or perception toward TM (chi-sq = 2.67; p-value = 0.26) in this population. The practice of TM is common among the neurology patients of Saudi Arabia. Cupping, herbs, and skin cauterization, which can be harmful when wrongly employed, are frequently utilized in this patient population. Measures and policies to endorse the appropriate use of TM by Saudi society must be

  17. Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis.

    Science.gov (United States)

    Marulli, Giuseppe; Schiavon, Marco; Perissinotto, Egle; Bugana, Antonella; Di Chiara, Francesco; Rebusso, Alessandro; Rea, Federico

    2013-03-01

    Thymectomy is a well-defined therapeutic option for patients with myasthenia gravis; however, controversies still exist about the surgical approach, indication, and timing for surgery. We reviewed our experience reporting surgical and neurologic results after robotic thymectomy in patients with myasthenia gravis. Between 2002 and 2010, 100 patients (74 female and 26 male; median age, 37 years) underwent left-sided robotic thymectomy using the da Vinci robotic system (Intuitive Surgical, Inc, Sunnyvale, Calif). The Myasthenia Gravis Foundation of America classification was adopted for pre- and postoperative evaluation. Preoperative Myasthenia Gravis Foundation of America class was I in 10% of patients, II in 35% of patients, III in 39% of patients, and IV in 16% of patients. Median operative time was 120 (60-300) minutes. No death or intraoperative complications occurred. Postoperative complications were observed in 6 patients (6%) (bleeding requiring blood transfusions in 3, chylothorax in 1, fever in 1, and myasthenic crisis in 1). Median hospital stay was 3 days (range, 2-14 days). Histologic analysis revealed 76 patients (76%) with hyperplasia, 7 patients (7%) with atrophy, 8 patients (8%) with small thymomas, and 9 patients (9%) with normal thymus; ectopic thymic tissue was found in 26 patients (26%). Clinical follow-up showed a 5-year probability of complete stable remission and overall improvement of 28.5% and 87.5%. Remission was significantly associated with preoperative I to II Myasthenia Gravis Foundation of America class (P = .02). A significant improvement rate was found in Myasthenia Gravis Foundation of America class I to II (P = .03) and AbAchR+ (P = .04). A high percentage of patients interrupted or reduced their medications. Robotic thymectomy is a safe and effective procedure. We observed a neurologic benefit in a great number of patients. A better clinical outcome was obtained in patients with early Myasthenia Gravis Foundation of America class

  18. [Assessment of the burden of adult wheelchair-bound patients with neurological disabilities on the caregiver].

    Science.gov (United States)

    Boaventura, Luiz Carlos; Borges, Heloise Cazangi; Ozaki, Armando Hitoshi

    2016-10-01

    The scope of this study was to evaluate factors that influence the burden of adult wheelchair-bound patients with neurological alterations on informal caregivers. Sixteen informal caregivers of adult wheelchair-bound patients with neurological alterations were evaluated, using the Zarit Burden Interview (ZBI) scale to evaluate the burden on caregivers, as well as gather data on the care and socio-demographic profile of the caregivers, on the socio-economic data and the degree of functional independence of adult wheelchair-bound patients with neurological alterations. Student's t-test, the one-way ANOVA with Tukey method and Pearson's product moment correlation coefficient were used for data analysis. The results associated lower education level of the caregiver (p = 0.01) and lower level of information of the affected pathology (p-value = 0.01) to a heavier burden on the caregiver. The therapeutic and social support provided by the support institutions, such as the Physiotherapy Clinic/School of CEUNSP, was revealed as being important to help caregivers to handle situations in an easier manner. Understanding the factors that influence the burden on the caregiver is important for planning and intervention for this specific population group.

  19. Frequency of Obstructive Sleep Apnea Syndrome Among Patients with Epilepsy Attending a Tertiary Neurology Clinic

    Directory of Open Access Journals (Sweden)

    Mohammed Al-Abri

    2015-01-01

    Full Text Available Objectives: Epilepsy is a common neurological disorder with a median lifetime prevalence of 14 per 1000 subjects. Sleep disorders could influence epileptic seizure. The most common sleep disorder is obstructive sleep apnea syndrome (OSAS which occurs in 2% of adult women and 4% of adult men in the general population. The aim of this study is to estimate the frequency of OSAS among patients with epilepsy and to study the seizure characteristics among those patients with co-morbid OSAS.  Methods: Patients with a confirmed diagnosis of epilepsy who attended the Sultan Qaboos University Hospital neurology clinic were recruited for the study between June 2011 and April 2012. Patients were screened for OSAS by direct interview using the validated Arabic version of the Berlin questionnaire. Patients identified as high-risk underwent polysomnography.  Results: A total of 100 patients with epilepsy (55 men and 45 women were screened for OSAS. Generalized and focal seizure was found in 67% of male and 27% of female patients. Six percent of the participants had epilepsy of undetermined type. Only 9% of the sample was found to have high risk of OSAS based on the Berlin questionnaire. No significant correlation was found between risk of OSAS, type of epilepsy, and anti-epileptic drugs.  Conclusion: The risk of OSAS was marginally greater in patients with epilepsy compared to the general population with the overall prevalence of 9%.

  20. Frequency of obstructive sleep apnea syndrome among patients with epilepsy attending a tertiary neurology clinic.

    Science.gov (United States)

    Al-Abri, Mohammed; Al-Asmi, Abdullah; Al-Shukairi, Aisha; Al-Qanoobi, Arwa; Rmachandiran, Nandhagopal; Jacob, Povothoor; Gujjar, Arunodaya

    2015-01-01

    Epilepsy is a common neurological disorder with a median lifetime prevalence of 14 per 1000 subjects. Sleep disorders could influence epileptic seizure. The most common sleep disorder is obstructive sleep apnea syndrome (OSAS) which occurs in 2% of adult women and 4% of adult men in the general population. The aim of this study is to estimate the frequency of OSAS among patients with epilepsy and to study the seizure characteristics among those patients with co-morbid OSAS.  Patients with a confirmed diagnosis of epilepsy who attended the Sultan Qaboos University Hospital neurology clinic were recruited for the study between June 2011 and April 2012. Patients were screened for OSAS by direct interview using the validated Arabic version of the Berlin questionnaire. Patients identified as high-risk underwent polysomnography.  A total of 100 patients with epilepsy (55 men and 45 women) were screened for OSAS. Generalized and focal seizure was found in 67% of male and 27% of female patients. Six percent of the participants had epilepsy of undetermined type. Only 9% of the sample was found to have high risk of OSAS based on the Berlin questionnaire. No significant correlation was found between risk of OSAS, type of epilepsy, and anti-epileptic drugs.  The risk of OSAS was marginally greater in patients with epilepsy compared to the general population with the overall prevalence of 9%.

  1. Cognitive impairment in patients with type 2 diabetes mellitus ...

    African Journals Online (AJOL)

    An understanding of the mechanisms of diabetes-‐related cognitive impairment and the resulting behaviors of patients can help healthcare professionals implement treatments to significantly improve health status and quality of life of patients with diabetes. KEYWORDS: Type 2 Diabetes Mellitus; Cognitive Impairment and ...

  2. Informed consent procedures with cognitively impaired patients: A review of ethics and best practices.

    Science.gov (United States)

    Fields, Lindy Marie; Calvert, James Douglas

    2015-08-01

    The objectives of this article are to discuss ethical issues of informed consent in cognitively impaired patients and review considerations for capacity determination. We will also discuss how to evaluate capacity, determine competence, and obtain informed consent when a patient is deemed incompetent. This review emphasizes how to carry out informed consent procedures when capacity is questionable and discusses measures supported for use when determining cognitively impaired patients' ability to consent. Information was gathered from medical and psychological codes of ethics, peer-reviewed journals, published guidelines from health-care organizations (e.g., American Medical Association), and scholarly books. Google Scholar and PsycINFO were searched for articles related to 'informed consent' and 'cognitive impairment' published in English between 1975 and 2014. Relevant sources referenced in retrieved publications were subsequently searched and reviewed. We selected 49 sources generated by our search. Sources were included in our review if they presented information related to at least one of our focus areas. These areas included: review of informed consent ethics and procedures, review of cognitive impairment evaluations, recommendations for measuring cognitive capacity, and alternative forms of informed consent. Patients' cognitive impairments can hinder the ability of patients to understand treatment options. Evaluating the capacity of patients with cognitive impairment to understand treatment options is vital for valid informed consent and should be guided by best practices. Thus, proper identification of patients with questionable capacity, capacity evaluation, and determination of competence, as well as reliance upon appropriate alternative consent procedures, are paramount. © 2015 The Authors. Psychiatry and Clinical Neurosciences © 2015 Japanese Society of Psychiatry and Neurology.

  3. IgG-index predicts neurological morbidity in patients with infectious central nervous system diseases

    Directory of Open Access Journals (Sweden)

    Deisenhammer Florian

    2010-07-01

    Full Text Available Abstract Background Prognosis assessment of patients with infectious and neoplastic disorders of the central nervous system (CNS may still pose a challenge. In this retrospective cross-sectional study the prognostic value of basic cerebrospinal fluid (CSF parameters in patients with bacterial meningitis, viral meningoencephalitis and leptomeningeal metastases were evaluated. Methods White blood cell count, CSF/serum glucose ratio, protein, CSF/serum albumin quotient and Immunoglobulin indices for IgG, IgA and IgM were analyzed in 90 patients with bacterial meningitis, 117 patients with viral meningoencephalitis and 36 patients with leptomeningeal metastases in a total of 480 CSF samples. Results In the initial spinal tap, the IgG-index was the only independent predictor for unfavorable outcome (GOS Conclusion The present study suggests that in infectious CNS diseases an elevated IgG-Index might be an additional marker for the early identification of patients at risk for neurological morbidity.

  4. A simple and useful coma scale for patients with neurologic emergencies: the Emergency Coma Scale.

    Science.gov (United States)

    Takahashi, Chiaki; Okudera, Hiroshi; Origasa, Hideki; Takeuchi, Eiichi; Nakamura, Kazuhito; Fukuda, Osamu; Date, Isao; Tokutomi, Takashi; Aruga, Tohru; Sakamoto, Tetsuya; Kobata, Hitoshi; Ohta, Tomio

    2011-02-01

    The Emergency Coma Scale (ECS) was developed in Japan in 2003. We planned a multicenter study to evaluate the utility of the ECS by comparison of the ECS and the Glasgow Coma Scale (GCS). Ten medical facilities, including 4 university hospitals in Japan, participated in this study. We evaluated and recorded the level of consciousness, using the ECS and GCS, of all patients transported to these medical facilities by ambulance. We then performed a statistical analysis of the level of rater agreement of each scale using the average weighted κ coefficient according to the types of diagnosis at time of discharge and the occupations of the raters. We then evaluated the relationship between outcome of patients and their scores on the ECS and GCS by logistic regression analysis. The ECS showed the greater agreement among raters in patient scoring (0.802). In patients with traumatic brain injury and cerebrovascular disease, the ECS also yielded the higher agreement (0.846 and 0.779, respectively). The ECS score appears to be more strongly related than the GCS to patient outcome as measured by the Glasgow Outcome Scale (GOS). Our results showed that the ECS is a simple and readily understandable coma scale for a wide range of professionals in the field of neurologic emergencies. Furthermore, ECS appears to be suitable for evaluating patients in neurologic emergency settings. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. The timed inspiratory effort: a promising index of mechanical ventilation weaning for patients with neurologic or neuromuscular diseases.

    Science.gov (United States)

    de Souza, Leonardo Cordeiro; Guimarães, Fernando Silva; Lugon, Jocemir Ronaldo

    2015-02-01

    The aim of this study was to evaluate the performance of the recently described timed inspiratory effort (TIE) index in comparison with 4 other previously reported indices as to the weaning outcome in patients with neurologic or neuromuscular disorders. This observational prospective study included subjects undergoing weaning from mechanical ventilation. The performance of the indices was evaluated by calculation of the area under the receiver operating characteristic curves. The areas under the curve were compared using the Hanley and McNeil method. P values<.05 were considered significant. Seventy-two subjects (57±20 y old) were selected for the study. Forty-three subjects were weaned, and 21 died during the study period. The mean duration of mechanical ventilation was 22.3±19.4 d. The areas under the curve of 5 weaning predictors (TIE index, integrative weaning index, noninvasive tension-time index, maximum inspiratory pressure, and breathing frequency/tidal volume index) were significantly higher than those of the other indices. The TIE index had the largest area under the curve (0.96±0.02) in comparison with the integrative weaning index (0.82±0.05, P=.009), noninvasive tension-time index (0.80±0.05, P=.001), maximum inspiratory pressure (0.77±0.06, P=.001), and breathing frequency/tidal volume index (0.72±0.06, P=.001). In patients with neurologic or neuromuscular impairment, the TIE index had a better performance than the best weaning indices used in clinical practice. Copyright © 2015 by Daedalus Enterprises.

  6. Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department

    Directory of Open Access Journals (Sweden)

    Regina Sierżantowicz

    2015-10-01

    Full Text Available Introduction: Nutritional disorders pose a huge health problem worldwide. In Poland, symptoms of malnutrition are found on admission to hospital in approximately 30% of patients. Among neurological disorders that predispose to malnutrition, brain injuries are the most frequent. The disease leads to difficulties with self-care, disorientation, reduced intellectual capacity, and dysphagia. Acute spinal pain syndromes affect weight loss because of persistent severe pain, and frequent dizziness and headaches accompanying cervical discopathy. Aim of the research: To assess the degree of malnutrition in patients with stroke and discopathy hospitalised in the neurology ward. Material and methods : The study group consisted of 141 patients, including 90 with stroke and 51 with discopathy, hospitalised in the neurology ward. Research material was collected based on medical records and a proprietary questionnaire. Body mass index (BMI was calculated and assessed for each patient on admission and after hospitalisation. Results and conclusions: The study sample consisted of a similar group of women (49% and men (51% aged from 30 to over 70 years. Ischaemic stroke was diagnosed more often in women (66.2%, whereas discopathy was more common in men (43.4%. The differences in BMI present on admission and after hospitalisation in men and women indicated a falling tendency. A slightly greater drop in BMI was found in women after hospital stay (from 24.1 to 23.3 kg/m 2 . The lowest BMI on admission was observed in students and pensioners. Long-term hospitalisation significantly affected weight reduction – the longer the patients were hospitalised, the lower their BMI was. Preliminary assessment of the nutrition status on admission to a hospital ward and customising individual diets may help reduce the effects of malnutrition.

  7. Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute

    Energy Technology Data Exchange (ETDEWEB)

    Alva-Sánchez, Héctor, E-mail: halva@ciencias.unam.mx [Unidad de Imagen Molecular PET/CT, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F. (Mexico); Reynoso-Mejía, Alberto [Unidad de Imagen Molecular PET/CT, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F., Mexico and Departamento de Neuroimagen, Instituto Nacional de (Mexico); Casares-Cruz, Katiuzka; Taboada-Barajas, Jesús [Departamento de Neuroimagen, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Insurgentes Sur 3877 Col. La Fama, 14269, México D.F. (Mexico)

    2014-11-07

    In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guide provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.

  8. Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute

    Science.gov (United States)

    Alva-Sánchez, Héctor; Reynoso-Mejía, Alberto; Casares-Cruz, Katiuzka; Taboada-Barajas, Jesús

    2014-11-01

    In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guide provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.

  9. Nutritional and Bioenergetic Considerations in Critically Ill Patients with Acute Neurological Injury.

    Science.gov (United States)

    Abdelmalik, Peter A; Dempsey, Susan; Ziai, Wendy

    2016-12-21

    The brain, due to intensive cellular processes and maintenance of electrochemical gradients, is heavily dependent on a constant supply of energy. Brain injury, and critical illness in general, induces a state of increased metabolism and catabolism, which has been proven to lead to poor outcomes. Of all the biochemical interventions undertaken in the ICU, providing nutritional support is perhaps one of the most undervalued, but potentially among the safest, and most effective interventions. Adequate provisions of calories and protein have been shown to improve patient outcomes, and guidelines for the nutritional support of the critically ill patient are reviewed. However, there are no such specific guidelines for the critically ill patient with neurological injury. Patients with primary or secondary neurological disorders are frequently undernourished, while data suggest this population would benefit from early and adequate nutritional support, although comprehensive clinical evidence is lacking. We review the joint recommendations from the Society for Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition, as they pertain to neurocritical care, and assess the recommendations for addressing nutrition in this patient population.

  10. Neurologic Decline in an Older Patient with Repaired Myelomeningocele Complicated with Lumbar Canal Stenosis.

    Science.gov (United States)

    Matsuda, Shingo; Yamaguchi, Satoshi; Kajihara, Yosuke; Takeda, Masaaki; Kolakshyapati, Manish; Kurisu, Kaoru

    2017-07-01

    Tethered cord syndrome is a well-known complication after myelomeningocele (MMC) repair in childhood. However, late complications in adults with a repaired MMC are not well understood. In particular, the influence of a degenerative spinal deformity on a sustained tethered cord is still unclear. A 63-year-old man with a repaired MMC exhibited a progressive gait disturbance and numbness in both lower limbs. Magnetic resonance imaging demonstrated that the tethered spinal cord was compressed by severe canal stenosis along the entire lumbar spine. After a multi-level lumbar decompression surgery, the patient recovered to baseline neurologic status. In adults with a repaired MMC, lumbar canal stenosis should be investigated as a possible cause of late neurologic decline. Clinical manifestations may be complicated by the coexistence of both the original and subsequent neurologic disorders. Because these additional disorders result from compressive myelopathy, early surgical decompression is indicated to avoid irreversible spinal cord dysfunction. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Comparison of neurological healthcare oriented educational resources for patients on the internet.

    Science.gov (United States)

    Punia, Vineet; Dagar, Anjali; Agarwal, Nitin; He, Wenzhuan; Hillen, Machteld

    2014-12-01

    The internet has become a major contributor to health literacy promotion. The average American reads at 7th-8th grade level and it is recommended to write patient education materials at or below 6th grade reading level. We tried to assess the level of literacy required to read and understand online patient education materials (OPEM) for neurological diseases from various internet resources. We then compared those to an assumed reference OPEM source, namely the patient education brochures from the American Academy of Neurology (AAN), the world's largest professional association of neurologists. Disease specific patient education brochures were downloaded from the AAN website. OPEM for these diseases were also accessed from other common online sources determined using a predefined criterion. All OPEM were converted to Microsoft Word (Microsoft Corp., Redmond, WA, USA) and their reading level was analyzed using Readability Studio Professional Edition version 2012.1 (Oleander Software, Vandalia, OH, USA). Descriptive analysis and analysis of variance were used to compare reading levels of OPEM from different resources. Medline Plus, Mayo clinic and Wikipedia qualified for OPEM analysis. All OPEM from these resources, including the AAN, were written above the recommended 6th grade reading level. They were also found to be "fairly difficult", "difficult" or "confusing" on the Flesch Reading Ease scale. AAN OPEM on average needed lower reading level, with Wikipedia OPEM being significantly (p<0.01) more difficult to read compared to the other three resources. OPEM on neurological diseases are being written at a level of reading complexity higher than the average American and the recommended reading levels. This may be undermining the utility of these resources. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature

    NARCIS (Netherlands)

    Kamps, M.J.; Horn, J.; Oddo, M.; Fugate, J.E.; Storm, C.; Cronberg, T.; Wijman, C.A.; Wu, O.; Binnekade, J.M.; Hoedemaekers, C.W.E.

    2013-01-01

    PURPOSE: To assess the sensitivity and false positive rate (FPR) of neurological examination and somatosensory evoked potentials (SSEPs) to predict poor outcome in adult patients treated with therapeutic hypothermia after cardiopulmonary resuscitation (CPR). METHODS: MEDLINE and EMBASE were searched

  13. A rare case of Niemann–Pick disease type C without neurological involvement in a 66-year-old patient

    Directory of Open Access Journals (Sweden)

    C.R. Greenberg

    2015-06-01

    Synopsis: An elderly female patient with confirmed NP-C and isolated splenomegaly has remained asymptomatic for neurological, cognitive, psychiatric or ophthalmologic abnormailities into her seventh decade of life.

  14. Regional cerebral blood flow in various pediatric neurological patients using /sup 123/I-IMP SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Konishi, Tohru; Naganuma, Yoshihiro; Hongou, Kazuhisa; Murakami, Miyako; Yamatani, Miwa; Okada, Toshio

    1988-03-01

    The recent development of a new radiopharmaceutical /sup 123/I-isopropyl-iodoamphetamine (IMP), which is taken up by the brain from the blood flow, has offered a possibility of constructing scintigraphy maps of regional cerebral blood flow (rCBF) using single photon emission CT. We used this mehtod in various pediatric neurological diseases. Six patients with cerebro-vascular disorders (moya-moya disease 2, infarction 3 and HHE syndrome 1), 6 patients with infectious diseases of CNS (acute encephalitis 4, septic meningitis 1 and SSPE 1) and a miscellaneous group of six patients were studied. The rCBF abnormalities in cerebro-vascular diseases were more extensive and frequent than x-ray CT abnormalities. Repeated studies of IMP-SPECT revealed usefulness for the understanding of changeable hemodynamic pathophysiology and for the judgment of theraptic effectiveness and prognosis. The rCBF decrease in infectious diseases tended to be more diffuse and slight than that in cerebro-vascular diseases. In almost all patients, the area of rCBF decrease coincided with the area of EEG slowing evaluated by EEG topographic analysis. Brain imaging using /sup 123/I-IMP SPECT may reveal functional abnormalities as well as organic lesions. /sup 123/I-IMP SPECT has introduced a new era for the useful application of nuclear medicine to the investigation of pediatric neurological diseases.

  15. International consensus statement for the use of botulinum toxin treatment in adults and children with neurological impairments--introduction.

    Science.gov (United States)

    Esquenazi, A; Novak, I; Sheean, G; Singer, B J; Ward, A B

    2010-08-01

    Botulinum neurotoxin (BoNT) is most commonly used to reduce focal over-activity in skeletal muscle, although newer indications such as management of drooling, pain and tremor are emerging. Treatment of spasticity incorporating BoNT is usually part of an integrated multidisciplinary rehabilitation programme. Prior to initiating this therapy, specific functional limitations, goals and expected outcomes of treatment should be discussed with the patient/carers. Muscle selection and the order/priority of treatment should be agreed. Treatment goals may involve increasing active or passive function or the avoidance of secondary complications or impairment progression. This paper describes the basic science mechanisms of the action of BoNT and subsequent nerve recovery and introduces a supplement comprising the best available evidence and expert opinion from international panels on questions of assessment, indications, BoNT regimen, adjunctive therapy, expected outcomes and recommended monitoring. Speciality areas reviewed include Paediatric Lower Limb Hypertonicity, Paediatric Upper Limb Hypertonicity, Adult Lower Limb Hypertonicity, Adult Upper Limb Hypertonicity, Cervical Dystonia, Drooling and Pain and Niche Indications. There is good quality scientific evidence to support the efficacy of BoNT to reduce muscle over-activity in the limbs secondary to central nervous system disorders in adults and children, to address primary or secondary cervical dystonia, to reduce saliva flow and to treat some pain syndromes. There is emergent evidence for the efficacy of BoNT to reduce focal tremor, to treat other types of pain including neuropathic pain and also to improve function following treatment of focal muscle over-activity.

  16. Psychiatric and neurological symptoms in patients with Niemann-Pick disease type C (NP-C): Findings from the International NPC Registry.

    Science.gov (United States)

    Bonnot, Olivier; Gama, Clarissa S; Mengel, Eugen; Pineda, Mercè; Vanier, Marie T; Watson, Louise; Watissée, Marie; Schwierin, Barbara; Patterson, Marc C

    2017-10-09

    Niemann-Pick disease type C (NP-C) is a rare inherited neurovisceral disease that should be recognised by psychiatrists as a possible underlying cause of psychiatric abnormalities. This study describes NP-C patients who had psychiatric manifestations at enrolment in the international NPC Registry, a unique multicentre, prospective, observational disease registry. Treating physicians' data entries describing psychiatric manifestations in NPC patients were coded and grouped by expert psychiatrists. Out of 386 NP-C patients included in the registry as of October 2015, psychiatric abnormalities were reported to be present in 34% (94/280) of those with available data. Forty-four patients were confirmed to have identifiable psychiatric manifestations, with text describing these psychiatric manifestations. In these 44 patients, the median (range) age at onset of psychiatric manifestations was 17.9 years (2.5-67.9; n = 15), while the median (range) age at NP-C diagnosis was 23.7 years (0.2-69.8; n = 34). Almost all patients (43/44; 98%) had an occurrence of ≥1 neurological manifestation at enrolment. These data show that substantial delays in diagnosis of NP-C are long among patients with psychiatric symptoms and, moreover, patients presenting with psychiatric features and at least one of cognitive impairment, neurological manifestations, and/or visceral symptoms should be screened for NP-C.

  17. Neurological findings and genetic alterations in patients with Kostmann syndrome and HAX1 mutations.

    Science.gov (United States)

    Roques, Gaëlle; Munzer, Martine; Barthez, Marie-Anne Carpentier; Beaufils, Sandrine; Beaupain, Blandine; Flood, Terry; Keren, Boris; Bellanné-Chantelot, Christine; Donadieu, Jean

    2014-06-01

    To describe the clinical profile and the prevalence of severe congenital neutropenia (SCN) and HAX1 mutations, so-called Kostmann syndrome, in France. Two pedigrees were identified from the French registry. The study included five subjects (three males), which represent 0.7% of the 759 SCN cases registered in France. The age at diagnosis was 0.3 years (range: 0.1-1.2 years) and the median age at the last follow-up was 7.3 years (range: 1.2-17.8 years). A novel large homozygous deletion of the HAX1 gene (exons 2-5) was found in one pedigree; while, a homozygous frameshift mutation was identified in exon 3 (c.430dupG, p.Val144fs) in the second pedigree. Severe bacterial infections were observed in four patients, including two cases of sepsis, one case of pancolitis, a lung abscess, and recurrent cellulitis and stomatitis. During routine follow-up, the median neutrophil value was 0.16 × 10(9)/L, associated with monocytosis (2 × 10(9)/L). Bone marrow (BM) smears revealed a decrease of the granulocytic lineage with no mature myeloid cells above the myelocytes. One patient died at age 2 from neurological complications, while two other patients, including one who underwent a hematopoietic stem cell transplantation (HSCT) at age 5, are living with very severe neurological retardation. SCN with HAX1 mutations, is a rare sub type of congenital neutropenia, mostly observed in population from Sweden and Asia minor, associating frequently neurological retardation, when the mutations involved the B isoform of the protein. © 2014 Wiley Periodicals, Inc.

  18. Contribution of refractive errors to visual impairment in patients at ...

    African Journals Online (AJOL)

    Objective: To determine the contribution of refractive error to visual impairment in visually impaired patients attending Korle-Bu Teaching Hospital, Ghana. Method: This study was conducted over a period of 1 year beginning October 2002 at Korle-Bu Teaching Hospital. Every 4th consecutive new case attending the eye ...

  19. A Quality Assessment of Patient-Reported Outcome Measures for Sexual Function in Neurologic Patients Using the Consensus-based Standards for the Selection of Health Measurement Instruments Checklist: A Systematic Review.

    Science.gov (United States)

    't Hoen, Lisette A; Groen, Jan; Scheepe, Jeroen R; Reuvers, Sarah; Diaz, David Castro; Fernández, Bárbara Padilla; Del Popolo, Giulio; Musco, Stefania; Hamid, Rizwan; Ecclestone, Hazel; Karsenty, Gilles; Phé, Veronique; Boissier, Romain; Kessler, Thomas M; Gross, Tobias; Schneider, Marc P; Pannek, Jürgen; Blok, Bertil F M

    2016-06-23

    Impaired sexual function has a significant effect on quality of life. Various patient-reported outcome measures (PROMs) are available to evaluate sexual function. The quality of the PROMs to be used for neurologic patients remains unknown. To systematically review which validated PROMs are available to evaluate sexual function in neurologic patients and to critically assess the quality of the validation studies and measurement properties for each identified PROM. A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. The included publications were assessed according to the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. Twenty-one studies for PROMs regarding sexual function were identified for the following patient groups: spinal cord injury (11 studies), multiple sclerosis (MS; 6 studies), Parkinson's disease (2 studies), traumatic brain injury (1 study), and epilepsy (1 study). The evidence for the quality of PROMs was found to be variable, and overall evaluation of measurement properties was lacking in 71% of the studies. The measurement error and responsiveness were not studied in any of the publications. Several PROMs have been identified to evaluate sexual function in neurologic patients. Strong evidence was found only for the Multiple Sclerosis Intimacy and Sexuality Questionnaire-15 and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 for patients with MS, although evidence was lacking for certain measurement properties as well. Future research should focus on identifying relevant PROMs and establishing adequate quality for all measurement properties in studies with high methodological quality. A quality assessment of patient-reported outcome measures (PROMs) for sexual function in neurologic patients was made. The evidence found for good PROMs was limited. Studies with high methodological quality are needed to improve the quality of

  20. Nested PCR for Rapid Detection of Mumps Virus in Cerebrospinal Fluid from Patients with Neurological Diseases

    OpenAIRE

    Poggio, Gustavo Palacios; Rodriguez, Claudia; Cisterna, Daniel; Freire, María Cecilia; Cello, Jerónimo

    2000-01-01

    In this study, we have developed a reverse transcription (RT)-nested polymerase chain reaction (n-PCR) for the detection of mumps virus RNA in cerebrospinal fluid (CSF) from patients with neurological infections. A specific 112-bp fragment was amplified by this method with primers from the nucleoprotein of the mumps virus genome. The mumps virus RT–n-PCR was capable of detecting 0.001 PFU/ml and 0.005 50% tissue culture infective dose/ml. This method was found to be specific, since no PCR pro...

  1. Can DMCO Detect Visual Field Loss in Neurological Patients? A Secondary Validation Study

    DEFF Research Database (Denmark)

    Olsen, Ane Sophie; Steensberg, Alvilda Thougaard; la Cour, Morten

    2017-01-01

    Unrecognized visual field loss is caused by a range of blinding eye conditions as well as serious brain diseases. The commonest cause of asymptomatic visual field loss is glaucoma. No screening tools have been proven cost-effective. Damato Multifixation Campimetry Online (DMCO), an inexpensive...... online test, has been evaluated as a future cost-beneficial tool to detect glaucoma. To further validate DMCO, this study aimed to test DMCO in a preselected population with neurological visual field loss. Methods : The study design was an evaluation of a diagnostic test. Patients were included...

  2. Neurological impairment among heterozygote women for X-linked Adrenoleukodystrophy: a case control study on a clinical, neurophysiological and biochemical characteristics.

    Science.gov (United States)

    Habekost, Clarissa Troller; Schestatsky, Pedro; Torres, Vitor Felix; de Coelho, Daniella Moura; Vargas, Carmen Regla; Torrez, Vitor; Oses, Jean Pierre; Portela, Luis Valmor; Pereira, Fernanda dos Santos; Matte, Ursula; Jardim, Laura Bannach

    2014-01-13

    Neurologic impairments in female heterozygotes for X-linked Adrenoleukodystrophy (X-ALD) are poorly understood. Our aims were to describe the neurological and neurophysiological manifestations of a cohort of X-ALD heterozygotes, and to correlate them with age, disease duration, mutations, X-inactivation and serum concentrations of a marker of neuronal damage, neuron-specific enolase (NSE). All 45 heterozygotes identified in our region, with previous VLCFA and molecular diagnosis, were invited to be evaluated through myelopathy scales JOA and SSPROM, nerve conduction studies and somatosensory evoked responses. X inactivation pattern was tested by HUMARA methylation assay. Serum NSE was measured by eletrochemiluminescense. Thirty three heterozygote women were recruited: 29 (87%) were symptomatic. Symptomatic and asymptomatic women presented different m ± sd ages (43.9 ± 10.2 versus 24.3 ± 4.6), JOA (14.5 ± 1.7 versus 16.6 ± 0.2) and SSPROM (86.6 ± 7.9 versus 98.4 ± 1.1) scores (p<0.05). Both JOA (r=-0.68) and SSPROM (r=-0.65) correlated with age, irrespectively of the disease status (p=0.0001, Spearman). Delayed latencies in the central ascending conduction studies on the lower limbs were present in 72% of all heterozygotes, and correlated with SSPROM (r=-0.47, p=0.018, Spearman). NSE values were higher in heterozygote than in control women (12.9 ± 7 and 7.2 ± 7 ng/ml, p=0.012, Mann-Whitney U). Mutation severity and inactivation patterns were not associated with neurologic status. Neurologic manifestations, clearly related to age, were quite common in the present cohort. JOA and SSPROM scales were able to discriminate the asymptomatic from the symptomatic heterozygotes. Both scales might be useful tools to follow disease progression, in future studies.

  3. Imaging findings of paediatric oncology patients presenting with acute neurological symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Chu, W.C.W. E-mail: winnie@med.cuhk.edu.hk; Lee, V.; Howard, R.G.; Roebuck, D.J.; Chik, K.W.; Li, C.K

    2003-08-01

    Paediatric oncology patients are prone to central nervous system (CNS) complications due to multiple factors including disorders of the blood cell counts (which include neutropenia, thrombocytopenia or hyperleukocytosis), immunosuppression, neurotoxicity of the treatment, CNS dysfunction due to failure of other organ systems, disease progression of the primary malignancy or metastases. Imaging plays an important role in the management of paediatric oncology patients presenting with acute neurological symptoms. This pictorial review is from our institutional experience on imaging children who are under the care of the Child Cancer Centre. The review consists of a spectrum of neurological complications in paediatric oncology patients. The complications can be classified as (1) cerebrovascular complications, (2) treatment-elated complications, (3) opportunistic infections and (4) tumoural involvement of the CNS. Computed tomography (CT) is the initial choice of investigation, which is easily available and helps to exclude major intracranial abnormality such as haemorrhage. If the CT is negative, magnetic resonance imaging (MRI) should be performed, which is more sensitive for detection of CNS lesions.

  4. Preventive physical therapy and care humanization in the treatment of a bedridden, home care, neurologic patient

    Directory of Open Access Journals (Sweden)

    Lina Faria

    Full Text Available Abstract Introduction: This case study investigated the impact of preventive physical therapy on shoulder problems and the prevention of pressure ulcers (PU in a bedridden, home care, post-neurological surgery patient. Objective: To highlight the importance of physical therapy in the prevention of comorbidities, chronic neurological sequelae, and PU. Materials and Methods: In the immediate post-surgical phase, the patient was treated with preventive measures against PU, according to the Pressure Ulcer Prevention Protocol of the University of São Paulo, the National Pressure Ulcer Advisory Panel, and the Braden Scale. In addition, we used the modified Ashworth scale to assess spasticity. A kinesiotherapy program based on the Bobath's concept was used to prevent subluxation of the plegic arm and help in the recovery of functional movements. Results: The use of preventive measures and delivery of humanized care during a six-month period helped prevent the development of stage 3 and 4 PU and physical, functional, and respiratory complications. By the end of six months, the patient was found to be at low risk of developing PU. Conclusion: Notwithstanding the difficulties experienced during treatment, especially for the positioning of the arm and performance of transferring and positioning techniques, the results of this study are in agreement with aspects considered important for treatment outcomes.

  5. Abnormal MRI in a patient with 'headache with neurological deficits and CSF lymphocytosis (HaNDL)'.

    Science.gov (United States)

    Yilmaz, A; Kaleagasi, H; Dogu, O; Kara, E; Ozge, A

    2010-05-01

    A 27-year-old woman was admitted to the Emergency Department with right upper-extremity numbness and mild weakness followed by a bifrontal throbbing headache for 30 min, which was similar to a headache lasting for 12 h that had occurred 3 days ago. Laboratory tests were unremarkable except for cerebrospinal fluid (CSF) lymphocytic pleocytosis. On the following day, a headache episode with left hemiparesis and hemihypoaesthesia, left hemifield visio-spatial inattention, anosagnosia and confusion recurred. The headache was diagnosed as headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome according to the criteria of the second edition of the International Classification of Headache Disorders. Simultaneously performed magnetic resonance imaging (MRI) revealed swelling of the grey matter, CSF enhancement in the sulci of the right temporal and occipital regions and hypoperfusion of the same brain regions. During the following 10 days two more similar episodes recurred and during the ensuing 12 months the patient remained headache free. Neuroimaging findings of the HaNDL syndrome are always thought as virtually normal. MRI abnormalities in our patient have not been reported in HaNDL syndrome previously, although they have been reported in hemiplegic migraine patients before. The findings in our case suggest that hemiplegic migraine and HaNDL syndrome may share a common pathophysiological pathway resulting in similar imaging findings and neurological symptoms.

  6. Pharmacokinetics of eslicarbazepine acetate in patients with moderate hepatic impairment.

    Science.gov (United States)

    Almeida, Luis; Potgieter, J Hendrick; Maia, Joana; Potgieter, M Alida; Mota, Fernando; Soares-da-Silva, P

    2008-03-01

    To evaluate the effect of moderate liver impairment on the pharmacokinetics of eslicarbazepine acetate (BIA 2-093, ESL), a novel voltage-gated sodium channel blocker currently in clinical development. The pharmacokinetics of ESL following an administration regimen of 800 mg once-daily for 8 days was characterized in patients with moderate liver impairment (n = 8) and in subjects with normal liver function (n = 8, control group). Eslicarbazepine acetate was rapidly and extensively metabolized by first-pass metabolism to its main active metabolite, eslicarbazepine (S-licarbazepine). There were more subjects with measurable plasma concentrations of the parent drug (ESL) in the hepatic impairment group than in the control group, suggesting that first-pass metabolism was slightly decreased by liver impairment. However, ESL plasma concentrations remained very low, representing only about 0.01% of total systemic exposure. No differences in the pharmacokinetics of eslicarbazepine or its metabolites were found between the hepatic impairment and control groups. Urinary excretion of eslicarbazepine and its glucuronide form was similar in the liver impaired and control subjects. The sum of drug moieties recovered in the urine corresponded to 91% of the administered dose in the control group and to 84% of the administered dose in the liver impairment group. The pharmacokinetics of ESL was not affected by moderate hepatic impairment. Therefore, patients with mild to moderate liver impairment treated with ESL do not require dosage adjustment.

  7. Palliative care nursing for patients with neurological diseases: what makes the difference?

    Science.gov (United States)

    Dieplinger, Anna; Kundt, Firuzan Sari; Lorenzl, Stefan

    2017-03-23

    Neurodegenerative diseases progress slowly, creating increasing physical disability with unpredictable disease trajectories. The disease's life-threatening nature often places these patients in palliative care. There are several factors that complicate the care of patients with neurodegenerative diseases in palliative care units. Owing to physical impairments, there are many communication barriers between patients and staff. Nurses are not able to duplicate the patient's meticulous daily routine leading to caregiver mistrust in the nurse's competencies. Even if the patient is hospitalised, caregivers may not take the much-needed time off to recuperate. The placement of patients with neurodegenerative diseases in palliative care is confusing, since they rarely die during in-hospital treatment but might even get better due to multidisciplinary treatment. Finally, patients and caregivers lack adequate knowledge about disease progression and available help and support programmes. Patients with neurodegenerative diseases urgently need palliative care and nurses and caregivers need better preparation to appropriately deal with these diseases.

  8. Markers of cognitive impairment in patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Cernea Simona

    2016-06-01

    Full Text Available Background. The study aimed to evaluate the correlations of cognitive function with metabolic, nutritional, hormonal and immunologic parameters in patients with type 2 diabetes (T2D, in order to identify markers of cognitive impairment.

  9. The patterning of test scores of children living in proximity to an inactive toxic waste disposal site who are classified as neurologically impaired

    Energy Technology Data Exchange (ETDEWEB)

    Licata, L.

    1992-01-01

    This study investigated the relationship between the pattern of impairment on test scores of the neurologically impaired children and proximity to an inactive toxic waste disposal site. Subjects (N = 147) were students, ages 6-16, classified as neurologically impaired. Seventy-six who lived within six miles of the site served as the experimental group and 71 who did not live near a site comprised the control group. Research was based on existing data available through the Child Study Team evaluation process. Attention was given to the ACID cluster of the WISC-R, the Arithmetic and Reading subtests on the WRAT, and the Koppitz scores of the Bender Visual Motor Gestalt Test. No significant difference was found between the experimental and control groups. Sex differences within the experimental group were not significant. Time of exposure and patterning of scores in the experimental group were investigated. Time had a significant main effect on WISC-R Arithmetic and Digit Span subtests, the ACID cluster and the Bender Test for the total group. Main effect for sex was significant for the WISC-R Information subtest. An interaction effect was found to be significant on the WRAT Arithmetic subtest WRAT. The longer the girls lived within the site area the lower they scored on the WISC-R Information subtest and the WRAT Arithmetic subtest. The variable exposure (interaction of distance and time) was related to lower scores on the WISC-R Arithmetic and Digit Span subtest. A two-way interaction was found on the WRAT Arithmetic subtest. The longer the females were exposed to the waste site area, the lower they scored on the WRAT Arithmetic subtest. A comparison of those children in the site area from birth and those in the area three years prior to the evaluation was done. A significant main effect was found for the Bender Gestalt.

  10. Impairment on theory of mind and empathy in patients with stroke.

    Science.gov (United States)

    Yeh, Zai-Ting; Tsai, Chung-Fen

    2014-08-01

    Impaired social function has been described in patients following stroke. The present study was designed to explore the degree of impairment in the ability to infer mental states in others, or cognitive and affective theory of mind, and empathy, in patients with stroke. A total of 34 patients with stroke were compared to 40 control subjects on tasks testing verbal and non-verbal theory of mind and empathy. Results indicated that patients with stroke were significantly impaired in both cognitive and affective theory of mind, even controlling for basic cognitive function and emotional processing. The patients with right stroke had poorer performance than those with left stroke on the cognitive component of non-verbal theory of mind. On the subscale of cognitive empathy, the right stroke group had poorer performance on perspective-taking than the control group. The right hemisphere may play an important role in decoding non-verbal cues to infer others' minds as well as the processing of empathy, especially the ability of perspective-taking. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

  11. Odor selectivity of hyposmia and cognitive impairment in patients with Parkinson’s disease

    Directory of Open Access Journals (Sweden)

    Mao CJ

    2017-10-01

    Full Text Available Cheng-Jie Mao,1 Fen Wang,2 Ju-Ping Chen,3 Ya-Ping Yang,1 Jing Chen,1 Juan-Ying Huang,1 Chun-Feng Liu1,21Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, 2Institute of Neuroscience, Soochow University, Suzhou, 3Department of Neurology, Hospital of Changshu Traditional Chinese Medicine, Changshu, People’s Republic of China Objective: Hyposmia is one of the earliest non-motor features of Parkinson’s disease (PD and can precede the onset of motor symptoms by years. Most of the current olfactory detection tests are targeted at Western populations. The exact relationship between hyposmia and cognitive impairment is unknown. The purpose of the study was to find bromines that can effectively identify olfactory dysfunction and investigate the relationship between hyposmia and cognitive function in early, non-demented, drug-naïve patients with PD in the People’s Republic of China.Methods: Sixty-three early, non-demented, drug-naïve patients with PD and 55 healthy controls were enrolled in the study. The T&T olfactometer and a Chinese version of Montreal Cognitive Assessment (MoCA were applied to assess subjects’ olfactory and cognitive functions. Patients with PD also completed the Modified Unified Parkinson’s disease-rating scale (UPDRS and Hoehn and Yahr (H&Y scale.Results: Patients with PD had lower scores of visuospatial and executive function (p=0.000, attention (p=0.03, and delayed recall (p=0.001 than controls. β-phenylethyl alcohol (floral smell, smell of rose petals and isovaleric acid (smell of sweat, stuffy socks were more sensitive for identifying hyposmia in patients with PD than three other odors. Multivariate logistic regression analysis showed that impaired visuospatial and executive function was associated with hyposmia (p=0.013, but was independent of other PD-associated variables.Conclusion: Hyposmia was common in early, non

  12. Static Balance in Patients with Vestibular Impairments: A Preliminary Study

    OpenAIRE

    Hossein Talebi; Mohammad Taghi Karimi; Seyed Hamid Reza Abtahi; Niloofar Fereshtenejad

    2016-01-01

    Aims. Vestibular system is indicated as one of the most important sensors responsible for static and dynamic postural control. In this study, we evaluated static balance in patients with unilateral vestibular impairments. Materials and Methods. We compared static balance control using Kistler force plate platform between 10 patients with unilateral vestibular impairments and 20 normal counterparts in the same sex ratio and age limits (50 ? 7). We evaluated excursion and velocity of center of ...

  13. Managing the care of patients who have visual impairment.

    Science.gov (United States)

    Watkinson, Sue; Scott, Eileen

    An ageing population means that the incidence of people who are visually impaired will increase. However, extending the role of ophthalmic nurses will promote delivery of a more effective health service for these patients. Using Maslow's hierarchy of needs as a basis for addressing the care of patients with visual impairment is a means of ensuring that they receive high quality, appropriate care at the right time.

  14. Impaired gastric relaxation in patients with achalasia.

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    Mearin, F; Papo, M; Malagelada, J R

    1995-01-01

    Achalasia is considered a primary motility disorder confined to the oesophagus. The lower oesophageal sphincter (LOS) in achalasia is frequently hypertonic and manifests absent or incomplete relaxation in response to deglution. On the other hand, the LOS and the proximal stomach act physiologically as a functional unit whereby relaxation of the LOS during deglution is associated with receptive relaxation of the proximal stomach. Thus, this study investigated the hypothesis that impaired LOS r...

  15. Finances in the Older Patient with Cognitive Impairment

    Science.gov (United States)

    Widera, Eric; Steenpass, Veronika; Marson, Daniel; Sudore, Rebecca

    2013-01-01

    Financial capacity is the ability to manage money and financial assets in ways that meet a person’s needs and which are consistent with his/her values and self-interest. Financial capacity is essential for an individual to function independently in our society; however, dementia eventually leads to a complete loss of financial capacity. Many patients with cognitive impairment and their families turn to their primary care clinician for help with financial impairment, yet most clinicians do not understand their role or how to help. We review the prevalence and impact of financial incapacity in older adults with cognitive impairment. We also articulate the role of the primary clinician which includes: (1) educating older adult patients and families about the need for advance financial planning; (2) recognizing signs of possible impaired financial capacity; (3) assessing financial impairments in cognitively impaired adults; (4) recommending interventions to help patients maintain financial independence; and (5) knowing when and to whom to make medical and legal referrals. Clearly delineating the clinician’s role in financial impairment can lead to the establishment of effective financial protections and can limit the economic, psychological, and legal hardships of financial incapacity on patients with dementia and their families. PMID:21325186

  16. Expanding the neurological examination using functional neurologic assessment: part II neurologic basis of applied kinesiology.

    Science.gov (United States)

    Schmitt, W H; Yanuck, S F

    1999-03-01

    Functional Neurologic Assessment and treatment methods common to the practice of applied kinesiology are presented. These methods are proposed to enhance neurological examination and treatment procedures toward more effective assessment and care of functional impairment. A neurologic model for these procedures is proposed. Manual assessment of muscular function is used to identify changes associated with facilitation and inhibition, in response to the introduction of sensory receptor-based stimuli. Muscle testing responses to sensory stimulation of known value are compared with usually predictable patterns based on known neuroanatomy and neurophysiology, guiding the clinician to an understanding of the functional status of the patient's nervous system. These assessment procedures are used in addition to other standard diagnostic measures to augment rather than replace the existing diagnostic armamentarium. The proper understanding of the neurophysiologic basis of muscle testing procedures will assist in the design of further investigations into applied kinesiology. Accordingly, the neurophysiologic basis and proposed mechanisms of these methods are reviewed.

  17. Anti-NMDA Receptor Encephalitis in a Patient with Previous Psychosis and Neurological Abnormalities: A Diagnostic Challenge

    Directory of Open Access Journals (Sweden)

    R. David Heekin

    2015-01-01

    Full Text Available Anti-N-methyl-D-aspartate (NMDA receptor encephalitis is an autoimmune disorder characterized by IgG autoantibodies directed against the NR1 subunit of the NMDA glutamate receptor. Psychiatric symptoms are common and include psychosis, mania, depressed mood, aggression, and speech abnormalities. Neurological symptoms such as seizures, decreased responsiveness, dyskinesias, and other movement abnormalities and/or autonomic instability are frequently seen as well. We present the case of a woman who was followed up at our facility for over 14 years for the treatment of multiple neuropsychiatric symptoms. Initially, she presented with paresthesias, memory loss, and manic symptoms. Nine years later, she presented to our facility again, this time with left sided numbness, left eyelid droop, and word finding difficulties. Finally, five years later, she presented with manic symptoms, hallucinations, and memory impairment. During her hospitalization, she subsequently developed catatonic symptoms and seizures. During her stay, it was discovered that she was positive for anti-NMDA receptor antibodies and her symptoms responded well to appropriate therapy. This case demonstrates that it may be useful for clinicians to consider screening for anti-NMDA receptor antibodies in long-term patients with neuropsychiatric symptoms that have not adequately responded to therapy.

  18. Neurological aspects of vibroacoustic disease.

    Science.gov (United States)

    Martinho Pimenta, A J; Castelo Branco, N A

    1999-03-01

    Mood and behavioral abnormalities are the most common early findings related to vibroacoustic disease (VAD). Other signs and symptoms have been observed in VAD patients. Brain MRI discloses small multifocal lesions in about 50% of subjects with more than 10 yr of occupational exposure to large pressure amplitude (> or = 90 dB SPL) and low frequency (< or = 500 Hz) (LPALF) noise. However, to date, there have been no studies globally integrating all the neurological, imaging and neurophysiological data of VAD patients. This is the main goal of this study. The 60 male Caucasians diagnosed with VAD were neurologically evaluated in extreme detail in order to systematically identify the most common and significant neurological disturbances in VAD. This population demonstrates cognitive changes (identified through psychological and neurophysiological studies (ERP P300)), vertigo and auditory changes, visual impairment, epilepsy, and cerebrovascular diseases. Neurological examination reveals pathological signs and reflexes, most commonly the palmo-mental reflex. A vascular pattern underlying the multifocal hyperintensities in T2 MR imaging, with predominant involvement of the small arteries of the white matter, is probably the visible organic substratum of the neurological picture. However, other pathophyisological mechanisms are involved in epileptic symptomatology.

  19. Visual impairment in stroke patients--a review.

    Science.gov (United States)

    Sand, K M; Midelfart, A; Thomassen, L; Melms, A; Wilhelm, H; Hoff, J M

    2013-01-01

    Approximately 30% of all stroke patients suffer from post-stroke visual impairment. Hemianopia is the most common symptom, but also neglect, diplopia, reduced visual acuity, ptosis, anisocoria, and nystagmus are frequent. Partial or complete recovery of visual disorders can occur, but many patients suffer permanent disability. This disability is often less evident than impairment of motor and speech functions, but is negatively correlated with rehabilitation outcome and can lead to a significant reduction in day-to-day functioning. To be visually impaired after stroke reduces quality of life and causes social isolation because of difficulties in navigating/orientating in the surroundings. A thorough diagnosis including targeted examination and later follow-up with eye examination and perimetry is essential in order to establish the extent of the visual impairment and to select the best rehabilitation strategy. Patients seem to profit from visual rehabilitation focused on coping strategies. © 2012 John Wiley & Sons A/S.

  20. CD163 promotes hematoma absorption and improves neurological functions in patients with intracerebral hemorrhage

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    Wen-jing Xie

    2016-01-01

    Full Text Available Clinical outcomes are positively associated with hematoma absorption. The monocyte-macrophage scavenger receptor, CD163, plays an important role in the metabolism of hemoglobin, and a soluble form of CD163 is present in plasma and other tissue fluids; therefore, we speculated that serum CD163 affects hematoma absorption after intracerebral hemorrhage. Patients with intracerebral hemorrhage were divided into high- and low-level groups according to the average CD163 level (1,977.79 ± 832.91 ng/mL. Compared with the high-level group, the low-level group had a significantly slower hematoma absorption rate, and significantly increased National Institutes of Health Stroke Scale scores and modified Rankin Scale scores. These results suggest that CD163 promotes hematoma absorption and the recovery of neurological function in patients with intracerebral hemorrhage.

  1. Aquatic rehabilitation for the treatment of neurological disorders.

    Science.gov (United States)

    Morris, D M

    1994-01-01

    Patients with neurological disorders present therapists with complex challenges for treatment, including weakness, hypertonicity, voluntary movement deficit, limited range of motion, sensory loss, incoordination, and postural instability. The presence of one or more of these impairments negatively influences these patients by contributing to problems in walking, transferring, and reaching. Aquatic rehabilitation offers a unique, versatile approach to the treatment of these disabilities. This article examines the problems encountered by patients with neurological disorders, general principles guiding neurotreatment, and aquatic neurorehabilitation approaches.

  2. [Cognitive and emotional impairments in patients with protracted anxiety-phobic disorders].

    Science.gov (United States)

    Chutko, L S; Surushkina, S Iu; Iakovenko, E A; Nikishena, I S; Anisimova, T I; Bondarchuk, Iu L

    2014-01-01

    To study cognitive and emotional impairments in patients with anxiety-phobic disorders (APDs), to comparatively analyze the clinical manifestations of acute (less than one-year) and protracted (1-to-5-year) forms of this disease, and to evaluate the efficacy of noofen used to treat this pathology. Sixty-two patients aged 18 to 50 years with APDs were examined. The investigators collected clinical history data, performed neurological examination, and assessed autonomic disorders in accordance with the questionnaire to reveal their signs, anxiety using the Hamilton anxiety rating scale, memory impairment employing the methods developed by A.R. Luria, attention disorders applying the test of variables of attention, and diagnosed emotional intelligence using the Mayer-Salovey-Caruso emotional intelligence test. Noofen 1000 mg/day was used to treat the patients. Protracted APDs were shown to be characterized by the higher degree of psychosomatic symptoms and by more pronounced impairments in attention, memory, and emotional intelligence. The data of posttreatment clinical and psychological studiesare indicative of improvements in 73.3% of cases. The findings may lead to the conclusion that noofen is highly effective in the treatment of patients with protracted APDs.

  3. Genetics of neurological disorders.

    Science.gov (United States)

    Faghihi, Mohammad Ali; Mottagui-Tabar, Salim; Wahlestedt, Claes

    2004-05-01

    Neurological diseases are defined as an inappropriate function of the peripheral or central nervous system due to impaired electrical impulses throughout the brain and/or nervous system that may present with heterogeneous symptoms according to the parts of the system involved in these pathologic processes. Growing evidence on genetic components of neurological disease have been collected during recent years. Genetic studies have opened the way for understanding the underlying pathology of many neurological disorders. The outcome of current intense research into the genetics of neurological disorders will hopefully be the introduction of new diagnostic tools and the discovery of potential targets for new and more effective medications and preventive measures.

  4. Red cell distribution width and neurological scoring systems in acute stroke patients

    Directory of Open Access Journals (Sweden)

    Kara H

    2015-03-01

    Full Text Available Hasan Kara,1 Selim Degirmenci,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Ali Dogru,1 Fikret Akyurek,2 Seyit Ali Kayis3 1Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey; 2Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey; 3Department of Biostatistics, Faculty of Medicine, Karabuk University, Karabuk, Turkey Objectives: The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW and the Glasgow Coma Scale (GCS, Canadian Neurological Scale (CNS, and National Institutes of Health Stroke Scale (NIHSS scores in patients who had acute ischemic stroke. Methods: This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW. Results: Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS. The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676–0.844. Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%. Conclusion: In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke

  5. [Precipitating factors of migraine attacks in patients attended in neurology services. The FACTOR study].

    Science.gov (United States)

    Mateos, Valentín; Guerrero-Peral, Ángel L; García, Margarida; Armengol-Bertolín, Silvia; Plazas, M José

    2012-06-01

    Patients with migraine often report factors or circumstances that precipitate or trigger their attacks. Yet few studies have been conducted to examine this matter. To explore the factors that precipitate migraine in our setting, as well is their possible relation with the intensity of the attacks or the overall repercussion of migraine. An epidemiological, cross-sectional, multi-centre study was conducted in neurology consultation services. Sociodemographic and clinical data were collected and the precipitating factors were identified from a closed list. The specific migraine disability questionnaire -Headache Impact Test (HIT-6)- and the measurement of the number of lost workday equivalents were used in the study. Altogether 817 patients were recruited (72.5% females, mean age: 34.6 ± 10.3 years). A total of 70.5% of the patients had severe disability according to the HIT-6. The mean monthly number of lost workday equivalents was 2.1 ± 2.5. A total of 96.6% of the patients identified some precipitating factor for the attacks, the most commonly reported being hormonal (75.2%), stress (70.9%) and those related with disorders affecting sleep patterns (68.4%). The FACTOR study confirms that most patients with migraine identify some circumstance that precipitates their attacks. Controlling or avoiding these factors, whenever possible, must be part of the programme of education received by patients suffering from migraine.

  6. Value of MRI of the brain in patients with systemic lupus erythematosus and neurologic disturbance

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    Jennings, J.E.; Sundgren, P.C.; Maly, P. [Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, MI 48109, Ann Arbor (United States); Attwood, J.; McCune, J. [Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, MI 48109, Ann Arbor (United States)

    2004-01-01

    Our objective was to review the frequency and pattern of signal abnormalities seen on conventional MRI in patients with suspected neuropsychiatric systemic lupus erythematosus (NP-SLE). We reviewed 116 MRI examinations of the brain performed on 85 patients with SLE, (81 women, four men, aged 21-78 years, mean 40.6 years) presenting with neurological disturbances. MRI was normal or nearly normal in 34%. In 60% high-signal lesions were observed on T2-weighted images, frequently in the frontal and parietal subcortical white matter. Infarct-like lesions involving gray and white matter were demonstrated in 21 of cases. Areas of restricted diffusion were seen in 12 of the 67 patients who underwent diffusion-weighted imaging. Other abnormalities included loss of brain volume, hemorrhage, meningeal enhancement, and bilateral high signal in occipital white-matter. The MRI findings alone did not allow us to distinguish between thromboembolic and inflammatory events in many patients. Some patients with normal MRI improved clinically while on immunosuppressive therapy. More sensitive and/or specific imaging methods, such as spectroscopy and perfusion-weighted imaging, should be investigated in these subgroups of patients with suspected NP-SLE. (orig.)

  7. Use of Machine Learning Classifiers and Sensor Data to Detect Neurological Deficit in Stroke Patients.

    Science.gov (United States)

    Park, Eunjeong; Chang, Hyuk-Jae; Nam, Hyo Suk

    2017-04-18

    The pronator drift test (PDT), a neurological examination, is widely used in clinics to measure motor weakness of stroke patients. The aim of this study was to develop a PDT tool with machine learning classifiers to detect stroke symptoms based on quantification of proximal arm weakness using inertial sensors and signal processing. We extracted features of drift and pronation from accelerometer signals of wearable devices on the inner wrists of 16 stroke patients and 10 healthy controls. Signal processing and feature selection approach were applied to discriminate PDT features used to classify stroke patients. A series of machine learning techniques, namely support vector machine (SVM), radial basis function network (RBFN), and random forest (RF), were implemented to discriminate stroke patients from controls with leave-one-out cross-validation. Signal processing by the PDT tool extracted a total of 12 PDT features from sensors. Feature selection abstracted the major attributes from the 12 PDT features to elucidate the dominant characteristics of proximal weakness of stroke patients using machine learning classification. Our proposed PDT classifiers had an area under the receiver operating characteristic curve (AUC) of .806 (SVM), .769 (RBFN), and .900 (RF) without feature selection, and feature selection improves the AUCs to .913 (SVM), .956 (RBFN), and .975 (RF), representing an average performance enhancement of 15.3%. Sensors and machine learning methods can reliably detect stroke signs and quantify proximal arm weakness. Our proposed solution will facilitate pervasive monitoring of stroke patients.

  8. Dysarthria and Quality of Life in neurologically healthy elderly and patients with Parkinson's disease.

    Science.gov (United States)

    Lirani-Silva, Camila; Mourão, Lúcia Figueiredo; Gobbi, Lilian Teresa Bucken

    2015-01-01

    To compare the speech and voice of Parkinson's disease (PD) patients and neurologically healthy elderly adults (control group, CG), to find out whether these features are related to the disease or the normal aging process, and investigate the impact that dysarthria has on the Quality of Life (QoL) of these individuals. This is a cross-sectional study involving 25 individuals, 13 patients with PD and 12 CG. All the participants underwent vocal assessment, perceptual and acoustic analysis, based on "Dysarthria Assessment Protocol" and analysis of QoL using a questionnaire, "Living with Dysarthria". The data underwent statistical analysis to compare the groups in each parameter. In the assessment of dysarthria, patients with PD showed differences in prosody parameter (p=0.012), at the habitual frequency for females (p=0.025) and males (p=0.028), and the extent of intensity (p=0.039) when compared to CG. In QoL questionnaire, it was observed that patients with PD showed more negative impact on the QoL compared to CG, as indicated by the total score (p=0.005) with various aspects influencing this result. The degree of modification of speech and voice of patients with PD resembles those seen in normal aging process, with the exception of prosody and the habitual frequency, which are related to the greatest negative impact on the QoL of patients with PD.

  9. End-tidal carbon dioxide as a measure of stress response to clustered nursing interventions in neurologic patients.

    Science.gov (United States)

    Genzler, Laura; Johnson, Pamela Jo; Ghildayal, Neha; Pangarakis, Sarah; Sendelbach, Sue

    2013-05-01

    Guidelines recommend rest periods between nursing interventions for patients with a neurologic diagnosis but do not specify a safe number of interventions. To examine the physiological stress response to clustered nursing interventions in neurologic patients receiving mechanical ventilation. Prospective, comparative, descriptive design to examine effects of clustered interventions (≥6 interventions in a single nursing interaction) versus nonclustered interventions on patients' stress. Stress response was defined as a 10% change in end-tidal carbon dioxide from before the interaction to (1) 5 and 10 minutes after the start of the interaction, (2) at the end of the interaction, and (3) 15 minutes after the interaction. The mean percent change in end-tidal carbon dioxide at 5 minutes differed significantly between patients with clustered interventions and patients with nonclustered interventions (6.7% vs -0.2%; P = .001). Patients with clustered interventions were significantly more likely than patients with low clustering to exhibit a stress response at 5 minutes (24.3% vs 0%; P = .01). Neurologic patients receiving mechanical ventilation who experienced 6 or more clustered nursing interventions showed a higher mean change in end-tidal carbon dioxide than did patients who received fewer than 6 clustered interventions. These findings suggest that providing fewer interventions during 1 nursing interaction may minimize induced stress in neurologic patients receiving mechanical ventilation.

  10. Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient.

    Science.gov (United States)

    Cleper, Roxana; Goldenberg-Cohen, Nitza; Kornreich, Liora; Krause, Irit; Davidovits, Miriam

    2007-09-01

    Patients on long-term hemodialysis undergo multiple interventions, including insertion of central catheters and arteriovenous anastomoses for creation of vascular access. The need for high-flow vessels to maintain hemodialysis efficiency leads to wear on the central veins and consequent stenosis and occlusion. In addition to local signs of impaired venous drainage, abnormal venous flow patterns involving the upper chest, face, and central nervous system might develop. We describe the first pediatric case of devastating intracranial hypertension presenting with visual loss in the eye contralateral to a high-flow vascular access in a patient on long-term hemodialysis. The literature on this rare complication of hemodialysis is reviewed.

  11. Episodic Memory Impairments in Primary Brain Tumor Patients.

    Science.gov (United States)

    Durand, Thomas; Berzero, Giulia; Bompaire, Flavie; Hoffmann, Sabine; Léger, Isabelle; Jego, Virginie; Baruteau, Marie; Delgadillo, Daniel; Taillia, Hervé; Psimaras, Dimitri; Ricard, Damien

    2018-01-04

    Cognitive investigations in brain tumor patients have mostly explored episodic memory without differentiating between encoding, storage, and retrieval deficits. The aim of this study is to offer insight into the memory sub-processes affected in primary brain tumor patients and propose an appropriate assessment method. We retrospectively reviewed the clinical and memory assessments of 158 patients with primary brain tumors who had presented to our departments with cognitive complaints and were investigated using the Free and Cued Selective Reminding Test. Retrieval was the process of episodic memory most frequently affected, with deficits in this domain detected in 92% of patients with episodic memory impairments. Storage and encoding deficits were less prevalent, with impairments, respectively, detected in 41% and 23% of memory-impaired patients. The pattern of episodic memory impairment was similar across different tumor histologies and treatment modalities. Although all processes of episodic memory were found to be impaired, retrieval was by far the most widely affected function. A thorough assessment of all three components of episodic memory should be part of the regular neuropsychological evaluation in patients with primary brain tumors.

  12. Barefoot Plantar Pressure Indicates Progressive Neurological Damage in Patients with Human T-Cell Lymphotropic Virus Type 1 Infection.

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    Beatriz Helena B Vasconcelos

    Full Text Available The human T-Cell Lymphotropic Virus Type 1 (HTLV-1 is a retrovirus associated with neurological alterations; individuals with HTLV-1 infection may develop HTLV-1 associated myelopathy / tropical spastic paraparesis (HAM/TSP. Frequent neurological complaints include foot numbness and leg weakness. In this study, we compared the distribution of the body weight on different areas of the foot in HTLV-1 patients with HAM/TSP, asymptomatic HTLV-1 patients, and healthy individuals.We studied 36 HTLV-1 infected patients, who were divided in two groups of 18 patients each based on whether or not they had been diagnosed with HAM/TSP, and 17 control subjects. The evaluation included an interview on the patient's clinical history and examinations of the patient's reflexes, foot skin tactile sensitivity, and risk of falling. The pressure distribution on different areas of the foot was measured with baropodometry, using a pressure platform, while the patients had their eyes open or closed.The prevalence of neurological disturbances-altered reflexes and skin tactile sensitivity and increased risk of falling-was higher in HTLV-1 HAM/TSP patients than in HTLV-1 asymptomatic patients. The medium and maximum pressure values were higher in the forefoot than in the midfoot and hindfoot in both HTLV-1 groups. In addition, the pressure on the hindfoot was lower in HAM/TSP patients compared to control subjects.The neurological disturbances associated with HTLV-1 infection gradually worsened from HTLV-1 asymptomatic patients to HAM/TSP patients. Baropodometry is a valuable tool to establish the extent of neurological damage in patients suffering from HTLV-1 infection.

  13. Regulatory T Cells in Peripheral Blood and Cerebrospinal Fluid of Syphilis Patients with and without Neurological Involvement

    Science.gov (United States)

    Li, Kang; Wang, Cuini; Lu, Haikong; Gu, Xin; Guan, Zhifang; Zhou, Pingyu

    2013-01-01

    Background Syphilis, a sexually transmitted disease caused by spirochetal bacterium Treponema pallidum, can progress to affect the central nervous system, causing neurosyphilis. Accumulating evidence suggest that regulatory T cells (Tregs) may play an important role in the pathogenesis of syphilis. However, little is known about Treg response in neurosyphilis. Methodology/Principal Findings We analyzed Treg frequencies and Transforming Growth Factor-β (TGF-β) levels in the blood and CSF of 431 syphilis patients without neurological involvement, 100 neurosyphilis patients and 100 healthy donors. Suppressive function of Tregs in peripheral blood was also assessed. Among syphilis patients without neurological involvement, we found that secondary and serofast patients had increased Treg percentages, suppressive function and TGF-β levels in peripheral blood compared to healthy donors. Serum Rapid Plasma Reagin (RPR) titers were positively correlated with Treg numbers in these patients. Compared to these syphilis patients without neurological involvement, neurosyphilis patients had higher Treg frequency in peripheral blood. In the central nervous system, neurosyphilis patients had higher numbers of leukocytes in CSF compared to syphilis patients without neurological involvement. CD4+ T cells were the predominant cell type in the inflammatory infiltrates in CSF of neurosyphilis patients. Interestingly, among these neurosyphilis patients, a significant decrease in CSF CD4+ CD25high Treg percentage and number was observed in symptomatic neurosyphilis patients compared to those of asymptomatic neurosyphilis patients, which may be associated with low CSF TGF-β levels. Conclusions Our findings suggest that Tregs might play an important role in both bacterial persistence and neurologic compromise in the pathogenesis of syphilis. PMID:24244772

  14. Different clinical utility of oropharyngeal bacterial screening prior to percutaneous endoscopic gastrostomy in oncological and neurological patients.

    Science.gov (United States)

    Kroupa, Radek; Jurankova, Jana; Dastych, Milan; Senkyrik, Michal; Pavlik, Tomas; Prokesova, Jitka; Jecmenova, Marketa; Dolina, Jiri; Hep, Ales

    2014-01-01

    The aim of this study was to monitor oropharyngeal bacterial colonization in patients indicated for percutaneous endoscopic gastronomy (PEG). Oropharyngeal swabs were obtained from patients prior to PEG placement. A development of peristomal infection was evaluated. The analysis of oropharyngeal and peristomal site pathogens was done. Consecutive 274 patients referred for PEG due to neurological disorder or cancer completed the study. Oropharyngeal colonization with pathogens was observed in 69% (190/274), dominantly in the neurologic subgroup of patients (P < 0.001). Peristomal infection occurred in 30 (10.9%) of patients and in 57% of them the correlation between oropharyngeal and peristomal agents was present. The presence of oropharyngeal pathogens was assessed as an important risk factor for the development of peristomal infection only in oncological patients (OR = 8.33, 95% CI: 1.66-41.76). Despite a high prevalence of pathogens in neurological patients, it did not influence the risk of peristomal infection with the exception for methicillin resistant Staphylococcus aureus (MRSA) carriers (OR 4.5, 95% CI: 1.08-18.76). During oropharyngeal microbial screening prior to the PEG insertion, the detection of pathogens may be a marker of the increased risk of peristomal infection in cancer patients only. In neurological patients the benefit of the screening is limited to the detection of MRSA carriers.

  15. Different Clinical Utility of Oropharyngeal Bacterial Screening prior to Percutaneous Endoscopic Gastrostomy in Oncological and Neurological Patients

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    Radek Kroupa

    2014-01-01

    Full Text Available Background. The aim of this study was to monitor oropharyngeal bacterial colonization in patients indicated for percutaneous endoscopic gastronomy (PEG. Methods. Oropharyngeal swabs were obtained from patients prior to PEG placement. A development of peristomal infection was evaluated. The analysis of oropharyngeal and peristomal site pathogens was done. Results. Consecutive 274 patients referred for PEG due to neurological disorder or cancer completed the study. Oropharyngeal colonization with pathogens was observed in 69% (190/274, dominantly in the neurologic subgroup of patients (P < 0.001. Peristomal infection occurred in 30 (10.9% of patients and in 57% of them the correlation between oropharyngeal and peristomal agents was present. The presence of oropharyngeal pathogens was assessed as an important risk factor for the development of peristomal infection only in oncological patients (OR = 8.33, 95% CI: 1.66–41.76. Despite a high prevalence of pathogens in neurological patients, it did not influence the risk of peristomal infection with the exception for methicillin resistant Staphylococcus aureus (MRSA carriers (OR 4.5, 95% CI: 1.08–18.76. Conclusion. During oropharyngeal microbial screening prior to the PEG insertion, the detection of pathogens may be a marker of the increased risk of peristomal infection in cancer patients only. In neurological patients the benefit of the screening is limited to the detection of MRSA carriers.

  16. Increased default-mode network centrality in cognitively impaired multiple sclerosis patients.

    Science.gov (United States)

    Eijlers, Anand J C; Meijer, Kim A; Wassenaar, Thomas M; Steenwijk, Martijn D; Uitdehaag, Bernard M J; Barkhof, Frederik; Wink, Alle M; Geurts, Jeroen J G; Schoonheim, Menno M

    2017-03-07

    To investigate how changes in functional network hierarchy determine cognitive impairment in multiple sclerosis (MS). A cohort consisting of 332 patients with MS (age 48.1 ± 11.0 years, symptom duration 14.6 ± 8.4 years) and 96 healthy controls (HCs; age 45.9 ± 10.4 years) underwent structural MRI, fMRI, and extensive neuropsychological testing. Patients were divided into 3 groups: cognitively impaired (CI; n = 87), mildly cognitively impaired (MCI; n = 65), and cognitively preserved (CP; n = 180). The functional importance of brain regions was quantified with degree centrality, the average strength of the functional connections of a brain region with the rest of the brain, and eigenvector centrality, which adds to this concept by adding additional weight to connections with brain hubs because these are known to be especially important. Centrality values were calculated for each gray matter voxel based on resting-state fMRI data, registered to standard space. Group differences were assessed with a cluster-wise permutation-based method corrected for age, sex, and education. CI patients demonstrated widespread centrality increases compared to both HCs and CP patients, mainly in regions making up the default-mode network. Centrality decreases were similar in all patient groups compared to HCs, mainly in occipital and sensorimotor areas. Results were robust across centrality measures. Patients with MS with cognitive impairment show hallmark alterations in functional network hierarchy with increased relative importance (centrality) of the default-mode network. © 2017 American Academy of Neurology.

  17. Neurological effects of inorganic arsenic exposure: altered cysteine/glutamate transport, NMDA expression and spatial memory impairment.

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    Lucio A Ramos-Chávez

    2015-02-01

    Full Text Available Inorganic arsenic (iAs is an important natural pollutant. Millions of individuals worldwide drink water with high levels of iAs. Chronic exposure to iAs has been associated with lower IQ and learning disabilities as well as memory impairment. iAs is methylated in tissues such as the brain generating mono and dimethylated species. iAs methylation requires cellular glutathione (GSH, which is the main antioxidant in the central nervous system. In humans, As species cross the placenta and are found in cord blood. A CD1 mouse model was used to investigate effects of gestational iAs exposure which can lead to oxidative damage, disrupted cysteine/glutamate transport and its putative impact in learning and memory. On postnatal days (PNDs 1, 15 and 90, the expression of membrane transporters related to GSH synthesis and glutamate transport and toxicity, such as xCT, EAAC1, GLAST and GLT1, as well as LAT1, were analyzed. Also, the expression of the glutamate receptor N-methyl-D-aspartate (NMDAR subunits NR2A and B as well as the presence of As species in cortex and hippocampus were investigated. On PND 90, an object location task was performed to associate exposure with memory impairment. Gestational exposure to iAs affected the expression of cysteine/glutamate transporters in cortex and hippocampus and induced a negative modulation of NMDAR NR2B subunit in the hippocampus. Behavioral tasks showed significant spatial memory impairment in males while the effect was marginal in females.

  18. Evolution of language assessment in patients with acquired neurological disorders in Brazil

    Directory of Open Access Journals (Sweden)

    Maria Alice de Mattos Pimenta Parente

    Full Text Available The objective of this paper was to describe the evolution of language assessments in patients with acquired neurological diseases over a period of around 45 years from 1970, when interdisciplinarity in Neuropsychology first began in Brazil, to the present day. The first twenty years of data was based on memories of Speech Pathology University Professors who were in charge of teaching aphasia. We then show the contributions of Linguistics, Cognitive Psychology, as well as Psycholinguistic and Psychometric criteria, to language evaluation. Finally, the current panorama of adaptations and creations of validated and standardized instruments is given, based on a search of the databases Pubmed, Scopus and Lilacs. Our closing remarks highlight the diversity in evaluation approaches and the recent tendency of language evaluations linked to new technologies such as brain imaging and computational analysis.

  19. Evolution of language assessment in patients with acquired neurological disorders in Brazil.

    Science.gov (United States)

    Parente, Maria Alice de Mattos Pimenta; Baradel, Roberta Roque; Fonseca, Rochele Paz; Pereira, Natalie; Carthery-Goulart, Maria Teresa

    2014-01-01

    The objective of this paper was to describe the evolution of language assessments in patients with acquired neurological diseases over a period of around 45 years from 1970, when interdisciplinarity in Neuropsychology first began in Brazil, to the present day. The first twenty years of data was based on memories of Speech Pathology University Professors who were in charge of teaching aphasia. We then show the contributions of Linguistics, Cognitive Psychology, as well as Psycholinguistic and Psychometric criteria, to language evaluation. Finally, the current panorama of adaptations and creations of validated and standardized instruments is given, based on a search of the databases Pubmed, Scopus and Lilacs. Our closing remarks highlight the diversity in evaluation approaches and the recent tendency of language evaluations linked to new technologies such as brain imaging and computational analysis.

  20. Visual Search Performance in Patients with Vision Impairment: A Systematic Review.

    Science.gov (United States)

    Senger, Cassia; Margarido, Maria Rita Rodrigues Alves; De Moraes, Carlos Gustavo; De Fendi, Ligia Issa; Messias, André; Paula, Jayter Silva

    2017-11-01

    Patients with visual impairment are constantly facing challenges to achieve an independent and productive life, which depends upon both a good visual discrimination and search capacities. Given that visual search is a critical skill for several daily tasks and could be used as an index of the overall visual function, we investigated the relationship between vision impairment and visual search performance. A comprehensive search was undertaken using electronic PubMed, EMBASE, LILACS, and Cochrane databases from January 1980 to December 2016, applying the following terms: "visual search", "visual search performance", "visual impairment", "visual exploration", "visual field", "hemianopia", "search time", "vision lost", "visual loss", and "low vision". Two hundred seventy six studies from 12,059 electronic database files were selected, and 40 of them were included in this review. Studies included participants of all ages, both sexes, and the sample sizes ranged from 5 to 199 participants. Visual impairment was associated with worse visual search performance in several ophthalmologic conditions, which were either artificially induced, or related to specific eye and neurological diseases. This systematic review details all the described circumstances interfering with visual search tasks, highlights the need for developing technical standards, and outlines patterns for diagnosis and therapy using visual search capabilities.

  1. Impaired coherence of life narratives of patients with schizophrenia.

    Science.gov (United States)

    Allé, Mélissa C; Potheegadoo, Jevita; Köber, Christin; Schneider, Priscille; Coutelle, Romain; Habermas, Tilmann; Danion, Jean-Marie; Berna, Fabrice

    2015-08-10

    Self-narratives of patients have received increasing interest in schizophrenia since they offer unique material to study patients' subjective experience related to their illness, in particular the alteration of self that accompanies schizophrenia. In this study, we investigated the life narratives and the ability to integrate and bind memories of personal events into a coherent narrative in 27 patients with schizophrenia and 26 controls. Four aspects of life narratives were analyzed: coherence with cultural concept of biography, temporal coherence, causal-motivational coherence and thematic coherence. Results showed that in patients cultural biographical knowledge is preserved, whereas temporal coherence is partially impaired. Furthermore, causal-motivational and thematic coherence are significantly impaired: patients have difficulties explaining how events have modeled their identity, and integrating different events along thematic lines. Impairment of global causal-motivational and thematic coherence was significantly correlated with patients' executive dysfunction, suggesting that cognitive impairment observed in patients could affect their ability to construct a coherent narrative of their life by binding important events to their self. This study provides new understanding of the cognitive deficits underlying self-disorders in patients with schizophrenia. Our findings suggest the potential usefulness of developing new therapeutic interventions to improve autobiographical reasoning skills.

  2. Dosage adjustment in medical patients with renal impairment at ...

    African Journals Online (AJOL)

    Background. Many drugs are eliminated by the kidneys and therefore may require dose adjustment in patients with renal impairment. The need for dose adjustment is frequently neglected by prescribers. Methods. We reviewed folders of patients admitted to the Groote Schuur Hospital general medical wards between ...

  3. Physical therapies as an adjunct to Botulinum toxin-A injection of the upper or lower limb in adults following neurological impairment

    Directory of Open Access Journals (Sweden)

    Kinnear Bianca Z

    2012-06-01

    Full Text Available Abstract Background Spasticity of muscles is a common consequence of central nervous system impairment. Traditionally, neurological rehabilitation for spasticity has involved occupational and physical therapy; however, increasingly Botulinum toxin–A injections may be provided. Injection effects are temporary. Consequently, understanding the effect of adjunct physical therapies will help inform multimodal rehabilitation decisions. Presently, these effects are not known. This systematic review will identify and summarize evidence on physical therapies used after Botulinum toxin-A injection to improve motor function in adults with neurological impairments. Method Systematic searching of seven electronic databases will occur to identify relevant randomized trials. Available trial data will be extracted into a list of pre-defined primary outcomes, including range of movement, spasticity and functional limb use. Pre-defined secondary outcomes will also be reviewed where trials have these data available for reporting. Effects will be expressed as mean differences or standardized mean differences with 95% confidence intervals (CI. Where possible, comparable results will be meta-analyzed, and a summary of the available pool of evidence produced. All randomized controlled trials will be rated using the PEDro methodological quality scale. Where possible, study data will be meta-analyzed using RevMan 5 Software. The protocol was registered in PROSPERO international prosepective register of systematic reviews (PROSPERO 2011:CRD42011001491. Discussion Review results will be the most comprehensive answer available to the following question: Are physical therapies clinically effective after Botulinum toxin-A injections in adults with neurological spasticity? Results will inform healthcare providers and managers who determine who gets access to and provision of Botulinum toxin-A injection and whether this is done with or without physical therapies. Results

  4. Neurological impairment among heterozygote women for X-linked Adrenoleukodystrophy: a case control study on a clinical, neurophysiological and biochemical characteristics

    Science.gov (United States)

    2014-01-01

    Background Neurologic impairments in female heterozygotes for X-linked Adrenoleukodystrophy (X-ALD) are poorly understood. Our aims were to describe the neurological and neurophysiological manifestations of a cohort of X-ALD heterozygotes, and to correlate them with age, disease duration, mutations, X-inactivation and serum concentrations of a marker of neuronal damage, neuron-specific enolase (NSE). Methods All 45 heterozygotes identified in our region, with previous VLCFA and molecular diagnosis, were invited to be evaluated through myelopathy scales JOA and SSPROM, nerve conduction studies and somatosensory evoked responses. X inactivation pattern was tested by HUMARA methylation assay. Serum NSE was measured by eletrochemiluminescense. Results Thirty three heterozygote women were recruited: 29 (87%) were symptomatic. Symptomatic and asymptomatic women presented different m ± sd ages (43.9 ± 10.2 versus 24.3 ± 4.6), JOA (14.5 ± 1.7 versus 16.6 ± 0.2) and SSPROM (86.6 ± 7.9 versus 98.4 ± 1.1) scores (p < 0.05). Both JOA (r = −0.68) and SSPROM (r = −0.65) correlated with age, irrespectively of the disease status (p = 0.0001, Spearman). Delayed latencies in the central ascending conduction studies on the lower limbs were present in 72% of all heterozygotes, and correlated with SSPROM (r = −0.47, p = 0.018, Spearman). NSE values were higher in heterozygote than in control women (12.9 ± 7 and 7.2 ± 7 ng/ml, p = 0.012, Mann-Whitney U). Mutation severity and inactivation patterns were not associated with neurologic status. Conclusion Neurologic manifestations, clearly related to age, were quite common in the present cohort. JOA and SSPROM scales were able to discriminate the asymptomatic from the symptomatic heterozygotes. Both scales might be useful tools to follow disease progression, in future studies. PMID:24410807

  5. Cerebral metabolic changes in neurologically presymptomatic patients undergoing haemodialysis: in vivo proton MR spectroscopic findings

    Energy Technology Data Exchange (ETDEWEB)

    Chiu, Ming-Lun; Chiang, I. Chan [Kaohsiung Medical University Hospital, Department of Medical Imaging (China); Li, Chun-Wei [Kaohsiung Medical University, Department of Medical Imaging and Radiological Sciences, College of Health Science (China); Chang, Jer-Ming [Kaohsiung Medical University, Department of Internal Medicine, Kaohsiung Hsiao-Kang Municipal Hospital (China); Kaohsiung Medical University, Department of Nephrology, School of Medicine, College of Medicine (China); Ko, Chih-Hung [Kaohsiung Medical University, Department of Psychiatry, School of Medicine, College of Medicine (China); Kaohsiung Medical University Hospital, Department of Psychiatry (China); Chuang, Hung-Yi [Kaohsiung Medical University, Faculty of Public Health, College of Health Science (China); Kaohsiung Medical University Hospital, Department of Environmental and Occupational Medicine (China); Sheu, Reu-Sheng [Kaohsiung Medical University, Department of Radiology, Kaohsiung Municipal Hsiao-Kang Hospital (China); Kaohsiung Medical University, Department of Radiology, Faculty of Medicine, College of Medicine (China); Lee, Chen-Chang [Kaohsiung Medical University, Department of Medical Imaging and Radiological Sciences, College of Health Science (China); Kaohsiung Medical Centre, Department of Radiology, Chang Gung Memorial Hospital (China); Hsieh, Tsyh-Jyi [Kaohsiung Medical University Hospital, Department of Medical Imaging (China); Kaohsiung Medical University, Department of Radiology, Faculty of Medicine, College of Medicine (China); Kaohsiung Municipal Ta-Tung Hospital, Department of Medical Imaging (China)

    2010-06-15

    To prospectively investigate and detect early cerebral metabolic changes in patients with end-stage renal disease (ESRD) by using in vivo proton MR spectroscopy (MRS). We enrolled 32 patients with ESRD and 32 healthy controls between the ages of 26 and 50 years. Short echo time single-voxel proton MRS was acquired from volumes of interest (VOIs) located in the frontal grey and white matter, temporal white matter and basal ganglia. The choline/phospatidylcholine (Cho), myo-inositol (mI), N-acetylaspartate (NAA) and total creatine (tCr) peaks were measured and the metabolic ratios with respect to tCr were calculated. In the ESRD group, significant elevations of the Cho/tCr and mI/tCr ratios were observed for the frontal grey matter, frontal white matter, temporal white matter and basal ganglia as compared with controls. There was no significant difference in the NAA/tCr ratios at all VOIs between the ESRD patients and the healthy controls. Proton MRS is a useful and non-invasive imaging tool for the detection of early cerebral metabolic changes in neurologically presymptomatic ESRD patients. (orig.)

  6. Sports neurology topics in neurologic practice

    Science.gov (United States)

    Conidi, Francis X.; Drogan, Oksana; Giza, Christopher C.; Kutcher, Jeffery S.; Alessi, Anthony G.; Crutchfield, Kevin E.

    2014-01-01

    Summary We sought to assess neurologists' interest in sports neurology and learn about their experience in treating sports-related neurologic conditions. A survey was sent to a random sample of American Academy of Neurology members. A majority of members (77%) see at least some patients with sports-related neurologic issues. Concussion is the most common sports-related condition neurologists treat. More than half of survey participants (63%) did not receive any formal or informal training in sports neurology. At least two-thirds of respondents think it is very important to address the following issues: developing evidence-based return-to-play guidelines, identifying risk factors for long-term cognitive-behavioral sequelae, and developing objective diagnostic criteria for concussion. Our findings provide an up-to-date view of the subspecialty of sports neurology and identify areas for future research. PMID:24790800

  7. Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

    Directory of Open Access Journals (Sweden)

    Chao-jin-zi Li

    2016-01-01

    Full Text Available Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6% was the primary stroke type found in the young group, while ischemic stroke (60.0% was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

  8. [Peculiarities of emotional-cognitive assessment of sensations by patients with neurological diseases].

    Science.gov (United States)

    Grigor'eva, V N; Tkhostov, A Sh

    2009-01-01

    To study peculiarities of emotional-cognitive assessment of color sensations and sensation descriptors in patients with autonomic dystonia and cerebrovascular diseases, 70 healthy subjects and 113 patients including 27 with autonomic dystonia, 48 - with discirculatory encephalopathy and 38 - with ischemic stroke have been studied in the rehabilitation period. Clinical-neurological examination, assessment of headache intensity on the Visual-Analogous scale, anxiety and depression levels on the Hospital anxiety and depression scale, the level of mental maladaptation on an author's scale as well as a study of emotional-cognitive assessment of color sensations and sensation descriptors have been carried out. Assessments of color sensations were studied using 20 color standards, indices of positive and negative assessment of all groups of colors and colors of certain categories were determined. The relation to sensation descriptors was studied by showing a list of 50 words; indices of positive and negative ratings of different categories of descriptors (% to the total number of words listed) were determined. It has been shown that the system of assessment of color sensations is most substantially changed in patients with autonomic dystonia that appeared in the more negative, compared to healthy people, perception of cold color tones, dark tones and chromatically non-saturated colors. These changes were less represented in patients with cerebrovascular diseases and disappear after stroke. Changes in the system of sensation descriptors rating are evenly expressed in patients with autonomic dystonia and cerebrovascular diseases: patients' ratings of sensation descriptors are more negative compared to healthy people. These changes are related to the increase of anxiety and depression levels and may contribute to mental health problems of patients.

  9. Essential elements for assessment of persons with severe neurological impairments for computer access utilizing assistive technology devices: a Delphi study.

    Science.gov (United States)

    Hoppestad, Brian Scott

    2006-01-01

    The objective of this study was to determine prospective elements that should comprise a comprehensive and valid assessment of persons with severe disabilities for access to computers utilizing assistive technology (AT). Currently, there is a lack of guidelines regarding areas that permit a satisfactory measure of a person's need for AT devices to enable computer access, resulting in substandard services. A list of criteria for elements that should be incorporated into an instrument for determining AT for computer access was compiled from a literature review in the areas of neuroscience, rehabilitation, and education; and a Delphi study using an electronic survey form that was e-mailed to a panel of experts in the field of AT. Only those areas rated as essential to the assessment process ('very important' or 'important' by 80% of the respondents) were chosen as important criteria for an assessment instrument. The initial Delphi survey contained 22 categories (54 subcategories or elements) for incorporation into an assessment for computer access. The second round of the survey completed the Delphi process resulting in a consensus for inclusion of 39 of the elements in an assessment instrument. There are inherent obstacles to prescribing the proper AT device to assist disabled persons with computer access due to the complexity of his/her condition, and the multitude of technological devices available to aid persons in accomplishing diverse tasks. This study reveals the intricacy of the assessment process, especially in persons with severe disabilities associated with neurological conditions. An assessment instrument should be broad ranging, integrating both intrinsic and extrinsic factors, considering the multidimensional nature of AT prescription for computer access.

  10. Malnutrition and Laboratory Markers in Geriatric Patients. A Comparison of Neurologic-psychiatric, Internal and Trauma Surgical Diseases.

    Science.gov (United States)

    Schreiber, F S; Becker, I; Deckert, P; Elsbernd, H; Isensee, C

    2016-04-01

    There is minimal information on malnutrition in neurologic-psychiatric patients compared to internal and trauma-surgical patients. The aim of the present study was to explore if there is a correlation of these different disease groups with the nutritional assessment and biochemical markers. Cross - sectional study. The study was done in a department of geriatric medicine with subspecialisation in neurologic diseases and stroke unit. 338 patients (m / f = 136 / 202, mean age 81.4 ± 7.3 years) were evaluated. The nutritional status was evaluated by using the short form of the Mini Nutritional Assessment (MNA-SF) and seven biochemical markers (hemoglobin, iron, ferritin, vitamin B 12, folic acid, albumin and cholinesterase) were measured. There were 74 (22%) patients with MNA ≤ 7 points (malnutrition), 148 (44%) patients with an MNA 8 - 11 points (risk of malnutrition) and 116 (34%) patients with an MNA ≥ 12 points (good nutritional status). The mean MNA score of the three major disease groups trauma-surgery, internal medicine and neurology-psychiatry was 9.1 ± 3.2 vs. 9.9 ± 3.1 vs. 10.0 ± 2.8 (p=0.236). There were significant differences of laboratory markers between the disease groups. A deficit of albumin, cholinesterase and hemoglobin was found more often in trauma-surgical and internal patients than in neurological-psychiatric patients (albumin: 21.4%, 15.7%, 5.3%; p=0.001; cholinesterase 16.7%, 16.9%, 6.3%; p=0.007; hemoglobin 78.6%, 61.4%, 50.0%; p=0.002). Following Mini Nutritional Assessment, the additional measurement of albumin, cholinesterase and hemoglobin allowed a more precise grading of malnutrition. There were significant differences between the disease groups. A deficit of albumin, cholinesterase and hemoglobin was found more often in multimorbid trauma-surgical and internal patients than in neurologic-psychiatric patients.

  11. Autonomic impairment in patients with migraine.

    Science.gov (United States)

    Matei, D; Constantinescu, V; Corciova, C; Ignat, B; Matei, R; Popescu, C D

    2015-10-01

    Heart rate variability analysis of electrocardiogram is becoming an increasingly common method to non-invasively evaluate autonomic nervous function. The aim of the study was to investigate cardiac autonomic function in subjects with and without migraine by using 24-hour ambulatory electrocardiographic recordings. We investigated 27 subjects with migraine (10 with migraine with aura and 17 without aura) during headache free periods and 10 age-matched healthy control subjects. The migraine was diagnosed using the International Classification of Headache Disorders 2nd Edition criteria. Beck Depression and Beck Anxiety Inventory forms were completed by all subjects. Time and frequency-domain of HRV was analyzed for two periods: diurnal and nocturnal. We found an increased frequency of anxiety and depressive symptoms in migraine patients, especially in migraine with aura group. The heart rate variability parameters SDNN, RMSSD, high frequency were decreased and low frequency was increased in migraine patients during night period compared with normal subjects, most affected were migraine with aura patients. During day period we found modification for SDNN, RMSSD and high frequency parameters only in migraine with aura group. Reduced parasympathetic activity with sympathetic predominance was found in migraine patients during the night period, most affected being migraine with aura patients.

  12. Cognitive impairment and antiretroviral treatment in a Peruvian population of patients with human immunodeficiency virus.

    Science.gov (United States)

    Guevara-Silva, E A

    2014-05-01

    HIV-associated cognitive impairment occurs even in the early stages of infection. Short-term memory, psychomotor speed, attention, and executive functioning are the main capacities affected. Controversy exists regarding whether highly active antiretroviral therapy (HAART) is helpful in combating this process. The objective of the present study is to determine the association between cognitive impairment and HAART in HIV-infected patients from Hospital Regional de Huacho. Prospective study of HIV patients meeting criteria to start HAART. Twenty-one HIV-positive patients were recruited between April and July 2011. Researchers administered a standardised neuropsychological test battery before and 4 weeks after onset of HAART. Psychomotor speed, executive function, short term memory (visual and verbal), attention, and visuospatial performance were evaluated. Nineteen patients completed the study (14 males and 5 females). In the pre-HAART evaluation, most patients scored below average on the executive function and psychomotor speed subtests. Psychomotor speed and immediate visual memory improved significantly after four months of treatment with HAART. Some degree of cognitive decline may present even in the early and asymptomatic stages of HIV infection. The benefits of antiretroviral treatment for cognitive performance can be detected after only a few weeks of follow-up. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  13. Impairment of bone health in pediatric patients with hemolytic anemia.

    Directory of Open Access Journals (Sweden)

    Michael M Schündeln

    Full Text Available INTRODUCTION: Sickle cell anemia and thalassemia result in impaired bone health in both adults and youths. Children with other types of chronic hemolytic anemia may also display impaired bone health. STUDY DESIGN: To assess bone health in pediatric patients with chronic hemolytic anemia, a cross-sectional study was conducted involving 45 patients with different forms of hemolytic anemia (i.e., 17 homozygous sickle cell disease and 14 hereditary spherocytosis patients. Biochemical, radiographic and anamnestic parameters of bone health were assessed. RESULTS: Vitamin D deficiency with 25 OH-vitamin D serum levels below 20 ng/ml was a common finding (80.5% in this cohort. Bone pain was present in 31% of patients. Analysis of RANKL, osteoprotegerin (OPG and osteocalcin levels indicated an alteration in bone modeling with significantly elevated RANKL/OPG ratios (control: 0.08+0.07; patients: 0.26+0.2, P = 0.0007. Osteocalcin levels were found to be lower in patients compared with healthy controls (68.5+39.0 ng/ml vs. 118.0+36.6 ng/ml, P = 0.0001. Multiple stepwise regression analysis revealed a significant (P<0.025 influence of LDH (partial r2 = 0.29, diagnosis of hemolytic anemia (partial r2 = 0.05 and age (partial r2 = 0.03 on osteocalcin levels. Patients with homozygous sickle cell anemia were more frequently and more severely affected by impaired bone health than patients with hereditary spherocytosis. CONCLUSION: Bone health is impaired in pediatric patients with hemolytic anemia. In addition to endocrine alterations, an imbalance in the RANKL/OPG system and low levels of osteocalcin may contribute to this impairment.

  14. Impairment of attention networks in patients with untreated hyperthyroidism.

    Science.gov (United States)

    Yuan, Lili; Tian, Yanghua; Zhang, Fangfang; Dai, Fang; Luo, Li; Fan, Jin; Wang, Kai

    2014-06-27

    Attention disorders are common symptoms in patients with untreated hyperthyroidism. Nevertheless, it is unknown whether they represent a global attention deficit or selective impairment of attention networks. Thirty-seven patients with hyperthyroidism were recruited and underwent the Attention Network Test (ANT), which provided measures of three independent attention networks (alerting, orienting and executive control), before being treated with methimazole. This study demonstrated that patients with untreated hyperthyroidism had significant deficits in the alerting and executive control networks. Interestingly, a significant positive association was also found between T4 level and the value of the executive network in patients with hyperthyroidism. These results suggest that the patients with hyperthyroidism may not just exist a specific impairment of attention networks, and there was some relationship between the level of T4, not T3 or TSH, and the value of the executive control network in patients with hyperthyroidism. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Computerized system to improve voluntary control of balance in neurological patients.

    Science.gov (United States)

    Cattaneo, D; Cardini, R

    2001-12-01

    The treatment of acquired impairments of balance is one of the most elusive problems that rehabilitative medicine faces. Computerized systems to measure how patients control their balance in static conditions were introduced long ago into clinical practice and proved to be useful; we have designed and developed a computerized system called "BioGP," which combines features of a classic stabilometric platform with those of a retraining device based on visual feedback The aim of this study was to identify homogeneous groups of patients and to provide objective proof of effectiveness for the rehabilitation of patients with balance disorders. The findings confirm that the new equipment provides clinically valid and sensitive information concerning subjects' ability to control voluntary shifts of center of pressure (COP) while standing. The information is relevant to applications using basically the same approach (1) and are encouraging for possible use of the system as a rehabilitation instrument.

  16. [Neurological disease and facial recognition].

    Science.gov (United States)

    Kawamura, Mitsuru; Sugimoto, Azusa; Kobayakawa, Mutsutaka; Tsuruya, Natsuko

    2012-07-01

    To discuss the neurological basis of facial recognition, we present our case reports of impaired recognition and a review of previous literature. First, we present a case of infarction and discuss prosopagnosia, which has had a large impact on face recognition research. From a study of patient symptoms, we assume that prosopagnosia may be caused by unilateral right occipitotemporal lesion and right cerebral dominance of facial recognition. Further, circumscribed lesion and degenerative disease may also cause progressive prosopagnosia. Apperceptive prosopagnosia is observed in patients with posterior cortical atrophy (PCA), pathologically considered as Alzheimer's disease, and associative prosopagnosia in frontotemporal lobar degeneration (FTLD). Second, we discuss face recognition as part of communication. Patients with Parkinson disease show social cognitive impairments, such as difficulty in facial expression recognition and deficits in theory of mind as detected by the reading the mind in the eyes test. Pathological and functional imaging studies indicate that social cognitive impairment in Parkinson disease is possibly related to damages in the amygdalae and surrounding limbic system. The social cognitive deficits can be observed in the early stages of Parkinson disease, and even in the prodromal stage, for example, patients with rapid eye movement (REM) sleep behavior disorder (RBD) show impairment in facial expression recognition. Further, patients with myotonic dystrophy type 1 (DM 1), which is a multisystem disease that mainly affects the muscles, show social cognitive impairment similar to that of Parkinson disease. Our previous study showed that facial expression recognition impairment of DM 1 patients is associated with lesion in the amygdalae and insulae. Our study results indicate that behaviors and personality traits in DM 1 patients, which are revealed by social cognitive impairment, are attributable to dysfunction of the limbic system.

  17. Recognition of patient-reported impairment in oral aesthetics

    DEFF Research Database (Denmark)

    Dannemand Jensen, Katrine; Øzhayat, Esben Boeskov

    2014-01-01

    Objective: The objectives of this study were to investigate the degree of effective recognition by professionals of patient-estimated oral esthetic impairment and the most reliable aspects in such recognition. Methods: Participants consisted of 95 patients with partial dentition in need of prosth......Objective: The objectives of this study were to investigate the degree of effective recognition by professionals of patient-estimated oral esthetic impairment and the most reliable aspects in such recognition. Methods: Participants consisted of 95 patients with partial dentition in need...... of prosthodontic replacements. The oral esthetics was professionally evaluated using the Prosthetic Esthetic Index (PEI), compiling 13 different esthetic aspects and an overall evaluation. The patient-reported impairment was evaluated using the Oral Health Impact Profile Aesthetic (OHIP-Aes) and the Oral Esthetic....... The multivariate analyses showed that up to 57 % of the patient-reported impairment could be explained by the professionally evaluated oral esthetic in combination with background variables. Discoloration of the teeth was the greatest explanatory variable, but also dental arch symmetry, and position and color...

  18. Delayed recall memory impairment in patients with Parkinson's disease

    Science.gov (United States)

    Schelp, Arthur Oscar; Mendes-Chiloff, Cristiane Lara; Paduan, Vanessa Cristina; Corrente, José Eduardo; de Lima, Fabrício Diniz; Marchette, Juliana Cristine Nunes; Luvizuto, Gustavo José; Bazan, Rodrigo

    2016-01-01

    ABSTRACT Age is one of the risk factors for dementia in patients with Parkinson's disease (PDD). Distinct cognitive syndromes of Parkinson's disease (PD) have been identified in previous studies. Questions about the role of such cognitive disorders in PD outcomes, especially memory dysfunction, in patients with PD remain unanswered. Objective: To establish possible correlations between delayed recall memory (episodic memory), age, and other demographic variables in patients with PD. Methods: A two-stage protocol was applied. Patients with delayed recall memory compromise, selected based on a brief battery of tests (BBRC-Edu), were classified as dementia cases and submitted to the Mattis Dementia Rating Scale (MDRS). Data from patients with memory disturbances were compared against individuals without episodic memory impairment, and correlated with age and demographic variables. Results: Except for identification and naming, all subtests in the screening battery showed a significant difference (p≤0.0001) between the memory-compromised group (case) and the group without memory impairment (no case). The results also correlated negatively with age (p≤0.0001) and positively with level of education (p=0.0874) in patients with PD. Conclusion: The analysis showed a significant relationship between age and dementia characterized by impaired episodic memory. The findings support reports of a wide spectrum of neuropsychological performance impairment in PD with age, particularly dementia associated with memory deterioration. No correlations between disease duration and cognitive dysfunction were evident. PMID:29213456

  19. Transient spurious intrathecal immunoglobulin synthesis in neurological patients after therapeutic apheresis.

    Science.gov (United States)

    Berger, Benjamin; Hottenrott, Tilman; Leubner, Jonas; Dersch, Rick; Rauer, Sebastian; Stich, Oliver; Prüss, Harald

    2015-12-11

    The analysis of cerebrospinal fluid (CSF) is usually done under steady-state conditions, when proteins (e.g., immunoglobulins) reach diffusion equilibrium between blood and CSF. However, little data has been published on CSF analysis under non-steady-state conditions after therapeutic apheresis. By reducing serum proteins (e.g., immunoglobulins), while leaving CSF unchanged, therapeutic apheresis might cause spuriously altered intrathecal immunoglobulin fractions. Based on the incidental finding of plasma exchange-induced increased intrathecal immunoglobulin fractions in a cohort of 12 unsystematically selected patients with various neurological disorders, we retrospectively investigated CSF results that had been raised during routine diagnostic work-up from 41 consecutive neurological patients (predominantly Guillain-Barré syndrome and autoimmune encephalitis) treated with plasmapheresis or immunoadsorption in a tertiary care university hospital in whom lumbar puncture (LP) was performed after a varying number of treatments of therapeutic apheresis. Only when LP was performed 1 day after therapeutic apheresis, spurious quantitative intrathecal immunoglobulin (Ig) synthesis of at least one subclass (IgG, IgA and/or IgM) was found in 68.4 % of the patients, irrespective of the number of treatments, in all age groups and independent of other previous immunotherapies (e.g., steroids). This phenomenon occurred only transiently and was almost always accompanied by an elevation of the IgG index. In one patient, an elevated IgG index was noticed even 2 days after plasmapheresis. Neither quantitative Ig synthesis, nor elevated IgG index was observed when the LP was performed three or more days after therapeutic apheresis. Spurious quantitative intrathecal Ig synthesis and increased IgG index are common findings shortly after plasmapheresis or immunoadsorption due to altered serum immunoglobulin levels. Knowledge of this phenomenon is needed for clinicians to prevent

  20. Albuminuria predicts early neurological deterioration in patients with acute ischemic stroke.

    Science.gov (United States)

    Kanamaru, Takuya; Suda, Satoshi; Muraga, Kanako; Okubo, Seiji; Watanabe, Yoko; Tsuruoka, Syuichi; Kimura, Kazumi

    2017-01-15

    Reduced glomerular filtration rate (GFR) and albuminuria have been independently associated with an increased risk of stroke and unfavorable long-term outcomes. However, the association between GFR, albuminuria, and early neurological deterioration (END) in patients with ischemic stroke has not been well studied to date. We therefore investigated the ability of estimated GFR (eGFR) and albuminuria to predict END in patients with acute ischemic stroke. We retrospectively enrolled 294 patients that were admitted to our stroke center with acute ischemic stroke between January 2011 and September 2012. General blood and urine examinations, including eGFR and urinary albumin/creatinine ratio (UACR) measurements, were performed on admission. Kidney dysfunction was defined by a low eGFR value (albuminuria (≥30mg/g creatinine). END was defined as a ≥2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score within 7days after admission. Kidney dysfunction was diagnosed in 200 of the 294 patients (68.0%). END was observed in 60 patients (20.4%). Age, blood glucose level on admission, UACR on admission, and NIHSS score on admission were significantly associated with END, while no relationship between eGFR on admission and END was identified. A multivariable logistic regression analysis showed that END was positively associated with high UACR (≥39.6mg/g creatinine) and a high NIHSS score (≥6 points). Our data suggest that high UACR on admission may predict END in patients with acute ischemic stroke. Larger prospective studies are required to validate the correlation between albuminuria and END. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Simple motor tasks independently predict extubation failure in critically ill neurological patients.

    Science.gov (United States)

    Kutchak, Fernanda Machado; Rieder, Marcelo de Mello; Victorino, Josué Almeida; Meneguzzi, Carla; Poersch, Karla; Forgiarini, Luiz Alberto; Bianchin, Marino Muxfeldt

    2017-01-01

    To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure. Data regarding duration of mechanical ventilation, length of ICU stay, length of hospital stay, mortality, and incidence of ventilator-associated pneumonia were collected. A total of 132 intubated patients who had been receiving mechanical ventilation for at least 24 h and who passed a spontaneous breathing trial were included in the analysis. Logistic regression showed that patient inability to grasp the hand of the examiner (relative risk = 1.57; 95% CI: 1.01-2.44; p Glasgow Coma Scale scores at extubation (p de tarefas motoras simples, tais como preensão de mão e protrusão da língua, para predizer extubação malsucedida em pacientes neurológicos críticos. Estudo prospectivo de coorte realizado na UTI neurológica de um hospital terciário em Porto Alegre (RS). Pacientes adultos que haviam sido intubados por motivos neurológicos e que eram candidatos ao desmame foram incluídos no estudo. O estudo avaliou se a capacidade dos pacientes de realizar tarefas motoras simples como apertar as mãos do examinador e pôr a língua para fora seria um preditor de extubação malsucedida. Foram coletados dados referentes ao tempo de ventilação mecânica, tempo de internação na UTI, tempo de internação hospitalar, mortalidade e incidência de pneumonia associada à ventilação mecânica. Foram incluídos na análise 132 pacientes intubados que haviam recebido ventilação mecânica durante pelo

  2. The perceptions of cognitively impaired patients and their caregivers of a home telecare system

    Directory of Open Access Journals (Sweden)

    Mehrabian S

    2014-12-01

    Full Text Available Shima Mehrabian,1 Jocelyne Extra,2 Ya-Huei Wu,2 Maribel Pino,2 Latchezar Traykov,1 Anne-Sophie Rigaud2 1Department of Neurology, University Hospital (UH “Alexandrovska”, Sofia, Bulgaria; 2Department of Gerontology, Hôpital Broca, Assitance Publique-Hôpitaux de Paris, EA 4468, Faculte de Médecine, Université Paris Descartes, Paris, France Abstract: Assistive and telecare technologies have been developed to support older adults with cognitive impairments, as well as their caregivers, from their homes. The way potential users perceive telecare and smart home systems plays a key role in their acceptance of this new technology. We evaluate the acceptance of home telecare technologies among patients suffering from cognitive impairment and their caregivers. Prototypes of telecare devices were developed to demonstrate their features and capabilities and to train patients, families, and health care professionals in their use. We conducted semistructured interviews to elicit the perceptions of 30 patients with mild cognitive impairment, 32 patients with Alzheimer’s disease, and 30 caregivers, regarding the risks and advantages of home telecare and smart houses. Survey results reflected participants' largely positive reactions to these technologies. Regarding home telecare, the cognitive stimulation program earned the highest proportion of positive responses, followed by the devices' care of emergencies. The participants generally agreed that home telecare and smart houses could significantly improve their quality of life. However, some technical and ethical concerns, such as the way of provision, installation, and monitoring of the systems, were reported to be in need of addressing before implementation of this system. Keywords: home telecare, Alzheimer’s disease, mild cognitive impairment, caregiver, cognitive stimulation

  3. Characteristics and dynamics of cognitive impairment in patients with primary and recurrent cerebral ischemic hemispheric stroke

    Directory of Open Access Journals (Sweden)

    A. A. Kozyolkin

    2014-08-01

    Full Text Available Acute cerebrovascular disease is a global medical and social problem of the modern angioneurology, occupying leading positions in the structure of morbidity and mortality among adult population of the world. Ischemic stroke – is one of the most common pathology. Today this disease took out the world pandemic. More than 16 million new cases of cerebral infarction recorded in the world each year and it “kills” about 7 million of people. About 111,953 cases of cerebral stroke were registered in 2013 in Ukraine. Cognitive impairment, t hat significantly disrupt daily activities and life of the patient, is one of the most significant post-stroke complications that have social, medical and biological significance. Aim. The purpose of this investigation was to study features and dynamics of cognitive impairments in patients with primary and recurrent cerebral hemispheric ischemic stroke (CHIS in the acute stage of the disease. Materials and methods. To achieve the aim, and the decision of tasks in the clinic of nervous diseases Zaporozhye State Medical University (supervisor - Doctor of Medicine, Professor Kozelkin A. based on the department of acute cerebrovascular disease were performed comparative, prospective cohort study, which included comprehensive clinical and paraclinical examinations of 41 patients (26 men and 15 women aged 45 to 85 years (mean age 66,4 ± 1,4 years with acute left-hemispheric (2 patients and right - hemispheric (39 patients CHIS . First up was a group of 28 patients (19 men and 9 women, mean age 65,6 ± 1,6 years, who suffered from primary CHIS. The second group consisted of 13 patients (7 men and 6 women, mean age 68,1 ± 2,5 years with recurrent CHIS. The groups were matched by age, sex, localization of the lesion and the initial level of neurological deficit. All patients underwent physical examination, neurological examination. Dynamic clinical neurological examination assessing the severity of stroke was conducted

  4. [Neurorehabilitation, neurology, rehabilitation medicine].

    Science.gov (United States)

    Urbán, Edina; Szél, István; Fáy, Veronika; Dénes, Zoltán; Lippai, Zoltán; Fazekas, Gábor

    2013-05-30

    We have read several publications of great authority on the neurological profession in the last two years in which were expressed assessments of the current situation combined with opinions about neurology and the necessity to reorganize neurological patient care. These articles took up the question of neurorehabilitation too. The authors, who on a daily basis, deal with the rehabilitation of people with disabilities as a consequence of neurological conditions, summarize some important definitions of rehabilitation medicine and the present system of neurological rehabilitation, as it is defined by the rehabilitation profession.

  5. Neurology at the bedside

    DEFF Research Database (Denmark)

    Kondziella, Daniel; Waldemar, Gunhild

    This updated and expanded new edition takes neurology trainees by the hand and guides them through the whole patient encounter - from an efficient neurological history and bedside examination through to differential diagnosis, diagnostic procedures and treatment. At each step the expert authors......, as have new chapters including neurogenetics, neurorehabilitation, neurocritical care and heuristic neurological reasoning. In addition, this second edition now includes more than 100 unique case histories. Neurology at the Bedside, Second Edition is written for neurologists in all stages of training....... Medical students, general practitioners and others with an interest in neurology will also find invaluable information here....

  6. Neurology and neurologic practice in China.

    Science.gov (United States)

    Shi, Fu-Dong; Jia, Jian-Ping

    2011-11-29

    In the wake of dramatic economic success during the past 2 decades, the specialized field of neurology has undergone a significant transformation in China. With an increase in life expectancy, the problems of aging and cognition have grown. Lifestyle alterations have been associated with an epidemiologic transition both in the incidence and etiology of stroke. These changes, together with an array of social issues and institution of health care reform, are creating challenges for practicing neurologists throughout China. Notable problems include overcrowded, decrepit facilities, overloaded physician schedules, deteriorating physician-patient relationships, and an insufficient infrastructure to accommodate patients who need specialized neurologic care. Conversely, with the creation of large and sophisticated neurology centers in many cities across the country, tremendous opportunities exist. Developments in neurologic subspecialties enable delivery of high-quality care. Clinical and translational research based on large patient populations as well as highly sophisticated technologies are emerging in many neurologic centers and pharmaceutical companies. Child neurology and neurorehabilitation will be fast-developing subdisciplines. Given China's extensive population, the growth and progress of its neurology complex, and its ever-improving quality control, it is reasonable to anticipate that Chinese neurologists will contribute notably to unraveling the pathogenic factors causing neurologic diseases and to providing new therapeutic solutions.

  7. Visually impaired patients' perceptions of their needs in hospital.

    Science.gov (United States)

    Waterman, H; Webb, C

    1992-01-01

    This article reports on a study of visually impaired patients' perceptions of their social and psychological needs in hospital. A qualitative approach was taken to explore and describe these perceptions, and 18 in-patients from one ophthalmic hospital took part in semi-structured interviews lasting approximately half an hour. Patients did not agree on their most important need. Many stresses and methods of coping were specific to individual patients. Patients reported on three areas in which most of them had problems: behavior of some staff, anxiety, and communication, but most felt their physical needs were met by nurses. Implications and recommendations for nursing practice are discussed. In particular, the results indicate a need for individualised care. It is also apparent that further research is needed to explore nurses' beliefs and feelings towards visual impairment.

  8. Impaired intuition in patients with major depressive disorder.

    Science.gov (United States)

    Remmers, Carina; Topolinski, Sascha; Dietrich, Detlef E; Michalak, Johannes

    2015-06-01

    In daily life, many decisions of minor and major importance have to be made. Thereby, intuitive judgments serve as useful guides and help us to adapt to our environment. People with major depressive disorder (MDD) often have difficulties to come to decisions. Is their intuition impaired? Since this question has not been addressed until now, the present study explored intuition in MDD. Depressed patients (n = 29) and healthy control participants (n = 27) completed the Judgment of Semantic Coherence Task, a well-established paradigm used in basic cognitive research to measure intuition. Furthermore, participants' severity of depressive symptoms (BDI-II), negative affect (PANAS), and rumination (RSQ) were assessed. All participants were interviewed with the SCID. Depressed patients showed impaired intuition compared to healthy control participants. In the depressed sample, negative affect accounts for the association between rumination and impaired intuition. Results further reveal that negative affect overall mediates the depression-intuition relationship. Patients with diminished ability to concentrate or indecisiveness had lower intuition indices compared to patients who did not fulfil this diagnostic criterion of MDD. The study introduces the phenomenon of intuition into depression research. Additionally, these results extent findings from basic research showing that induced negative mood as well difficulties to down-regulate negative affect impair intuitive coherence judgments. Current results indicate that the negative affectivity of patients is the crucial mediator in the association between depression and impaired intuition. Limitations of the study as well as the potential etiological role of intuition in MDD are discussed. The finding that intuition is impaired in depressed patients extends our knowledge as to the cognitive profile of patients with MDD. Patients who suffer from indecisiveness have lower intuition indices compared to patients who do not

  9. Is Further Examination Necessary in Patients with Behcets Disease Without Any Neurological Signs or Symptoms?

    Directory of Open Access Journals (Sweden)

    Halit YAsAR

    2015-09-01

    Conclusion: Visually evoked potential examination may be used as a conductive method to detect the subclinical neurological pathologies in Behcets disease. The possible silent neurological involvement should be evaluated with further neuro-screening methods. [Dis Mol Med 2015; 3(3.000: 29-34

  10. Structural and functional cerebral impairments in cirrhotic patients with a history of overt hepatic encephalopathy

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Hua-Jun [Jiangsu Key Laboratory of Molecular Imaging and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009 (China); Zhu, Xi-Qi [Jiangsu Key Laboratory of Molecular Imaging and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009 (China); Department of Radiology, The Second Hospital of Nanjing, Medical School of Southeast University, Nanjing 210002 (China); Shu, Hao [Department of Neurology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009 (China); Yang, Ming; Zhang, Yi; Ding, Jie; Wang, Yu [Jiangsu Key Laboratory of Molecular Imaging and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009 (China); Teng, Gao-Jun, E-mail: gjteng@vip.sina.com [Jiangsu Key Laboratory of Molecular Imaging and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009 (China)

    2012-10-15

    Objective: Diffuse brain atrophy has been observed in cirrhotic patients and recent reports have revealed the persistence of cognitive impairment after clinical resolution of overt hepatic encephalopathy. We sought to explore the continued influence of overt hepatic encephalopathy on neurological function by measuring brain resting-state inherent connectivity, based on an investigation of structural abnormalities. Methods: Neuropsychological tests and structural and functional magnetic resonance scanning were conducted in 20 healthy controls and 21 cirrhotic patients with a history of overt hepatic encephalopathy. The analysis of voxel-based morphometry and functional connectivity were performed to detect the alterations in brain structure and function, respectively. Results: Patients showed significantly worse performance in neuropsychological tests as compared with controls, despite apparently normal mental status. Analysis of voxel-based morphometry revealed a decrease in gray matter volume primarily in the midline regions, bilateral insular cortex and caudates, left parahippocampal gyrus, and right cerebellum posterior lobe, while the volume of the bilateral thalamus showed an increase. Of these regions, the posterior cingulate cortex with peak atrophy was selected as the origin for the analysis of functional connectivity. Typical patterns of a default mode network were identified in both groups. Decreased functional connectivity was found in the medial prefrontal gyrus, left inferior parietal lobule, and left middle temporal gyrus in the patients. Conclusions: Both functional and structural impairments were evident after apparent recovery from overt hepatic encephalopathy, demonstrating that brain dysfunction induced by hepatic encephalopathy persisted after clinical resolution and provided a basis for further evolution of the disease.

  11. Validation of the Persian version of the dysphagia handicap index in patients with neurological disorders

    Science.gov (United States)

    Barzegar-Bafrooei, Ebrahim; Bakhtiary, Jalal; Khatoonabadi, Ahmad Reza; Fatehi, Farzad; Maroufizadeh, Saman; Fathali, Mojtaba

    2016-01-01

    Background: Dysphagia as a common condition affecting many aspects of the patient’s life. The Dysphagia Handicap Index (DHI) is a reliable self-reported questionnaire developed specifically to measure the impact of dysphagia on the patient’s quality of life. The aim of this study was to translate the questionnaire to Persian and to measure its validity and reliability in patients with neurogenic oropharyngeal dysphagia. Methods: A formal forward-backward translation of DHI was performed based on the guidelines for the cross-cultural adaptation of self-report measures. A total of 57 patients with neurogenic dysphagia who were referred to the neurology clinics of Tehran University of Medical Sciences, Iran, participated in this study. Internal consistency reliability of the DHI was examined using Cronbach’s alpha, and test-retest reliability of the scale was evaluated using intraclass correlation coefficient (ICC). Results: The internal consistency of the Persian DHI (P-DHI) was considered to be good; Cronbach’s alpha coefficient for the total P-DHI was 0.88. The test-retest reliability for the total and three subscales of the P-DHI ranged from 0.95 to 0.98 using ICC. Conclusion: The P-DHI demonstrated a good reliability, and it can be a valid instrument for evaluating the dysphagia effects on quality of life among Persian language population. PMID:27648173

  12. Neurologic sequela in a patient with galactosemia potentially mediated by interleukin-11 dysfunction.

    Science.gov (United States)

    Winter, Gidon N; Ben-Pazi, Hilla

    2015-06-01

    A 16-year-old galactosemic patient, homozygous for the 5.5-kb gene deletion, suffered severe neurologic regression following streptococcal infection. Since the gene deletion includes the promoter of interleukin-11a receptor involved in neuronal apoptosis, we questioned whether this patient had no interleukin-11a receptor activity-resulting in neuronal toxicity during septicemia. We hypothesized that interleukin-11 levels would be elevated because of a loss of feedback induced by the absent interleukin-11Ra receptor complex. To assess this, we compared interleukin-11 levels in the proband and 2 of his siblings with the same genetic deletion, to age-matched controls. No differences were found in interleukin-11 levels between groups. Our study was not carried out during acute infective states, when the disrupted immunoregulation triggered by sepsis is relevant, and is thus limited. In conclusion, although interleukin-11 was not chronically elevated in individuals with galactosemia and 5.5-kb gene deletion, data do not rule out potential interleukin-11 dysfunction during acute infection. © The Author(s) 2014.

  13. Impairment of peripheral nervous system in patients with non-Hodgkin's lymphomas treated with CBVPM/AVBP and CHOP schedules.

    Science.gov (United States)

    Nowacki, P; Dolińska, D; Stankiewicz, J; Grzelec, H

    1992-01-01

    Clinical examination and conduction velocity measurements in peripheral nerves have been done on 56 patients with non-Hodgkin's lymphomas of high malignancy (NHL). It is suggested that: the evaluation of the influence of chemotherapy on peripheral nervous system (PNS) is possible by means of systematic neurological and electroneurographic studies; electroneurographic assessment is most important in the diagnosis of early subclinical stages of peripheral neuropathy; toxic influence of CBVPM/AVBP protocol on PNS is greater than CHOP schedule; impairment of PNS due to chemotherapy is reversible in patients during complete remission (CR).

  14. Characteristics of hearing-impairment among patients in Ghana ...

    African Journals Online (AJOL)

    The causes, and characteristics of hearing-impairment were determined prospectively among six thousand, four hundred and twenty-eight (6,428) patients who reported at the Komfo Anokye Teaching Hospital (KATH) with hearing problems. The purpose of the study was to determine the characteristics and some causes of ...

  15. Predictors of impaired renal function among HIV infected patients ...

    African Journals Online (AJOL)

    Predictors of impaired renal function among HIV infected patients commencing highly active antiretroviral therapy in Jos, Nigeria. ... Data were analysed for age, gender, weight, WHO clinical stage, CD4 count, HIV-1 RNA viral load, HBsAg and anti-HCV antibody status. Estimated glomerular filtration rate (eGFR) was ...

  16. Heterogeneity in executive impairment in patients with very mild Alzheimer's

    DEFF Research Database (Denmark)

    Stokholm, J.; Gade, Anders; Vogel, A.

    2006-01-01

    The presence of executive impairment in mild Alzheimer's disease (AD) has primarily been demonstrated by means of group comparison. Whether executive dysfunction is a common feature of mild AD or only present in a subgroup of patients remains unclear. The aim of this study was to describe the fre...

  17. CANTAB Explicit Memory Is Less Impaired in Addicted Schizophrenia Patients

    Science.gov (United States)

    Potvin, Stephane; Briand, Catherine; Prouteau, Antoinette; Bouchard, Roch-Hugo; Lipp, Olivier; Lalonde, Pierre; Nicole, Luc; Lesage, Alain; Stip, Emmanuel

    2005-01-01

    It has been suggested that in order to sustain the lifestyle of substance abuse, addicted schizophrenia patients would have less negative symptoms, better social skills, and less cognitive impairments. Mounting evidence supports the first two assumptions, but data lack regarding cognition in dual diagnosis schizophrenia. Seventy-six schizophrenia…

  18. Predictive value of neurological examination for early cortical responses to somatosensory evoked potentials in patients with postanoxic coma.

    Science.gov (United States)

    Bouwes, Aline; Binnekade, Jan M; Verbaan, Bart W; Zandbergen, Eveline G J; Koelman, Johannes H T M; Weinstein, Henry C; Hijdra, Albert; Horn, Janneke

    2012-03-01

    Bilateral absence of cortical N20 responses of median nerve somatosensory evoked potentials (SEP) predicts poor neurological outcome in postanoxic coma after cardiopulmonary resuscitation (CPR). Although SEP is easy to perform and available in most hospitals, it is worthwhile to know how neurological signs are associated with SEP results. The aim of this study was to investigate whether specific clinical neurological signs are associated with either an absent or a present median nerve SEP in patients after CPR. Data from the previously published multicenter prospective cohort study PROPAC (prognosis in postanoxic coma, 2000-2003) were used. Neurological examination, consisting of Glasgow Coma Score (GCS) and brain stem reflexes, and SEP were performed 24, 48, and 72 h after CPR. Positive predictive values for predicting absent and present SEP, as well as diagnostic accuracy were calculated. Data of 407 patients were included. Of the 781 SEPs performed, N20 s were present in 401, bilaterally absent in 299, and 81 SEPs were technically undeterminable. The highest positive predictive values (0.63-0.91) for an absent SEP were found for absent pupillary light responses. The highest positive predictive values (0.71-0.83) for a present SEP were found for motor scores of withdrawal to painful stimuli or better. Multivariate analyses showed a fair diagnostic accuracy (0.78) for neurological examination in predicting an absent or present SEP at 48 or 72 h after CPR. This study shows that neurological examination cannot reliably predict absent or present cortical N20 responses in median nerve SEPs in patients after CPR.

  19. Nested PCR for Rapid Detection of Mumps Virus in Cerebrospinal Fluid from Patients with Neurological Diseases

    Science.gov (United States)

    Poggio, Gustavo Palacios; Rodriguez, Claudia; Cisterna, Daniel; Freire, María Cecilia; Cello, Jerónimo

    2000-01-01

    In this study, we have developed a reverse transcription (RT)-nested polymerase chain reaction (n-PCR) for the detection of mumps virus RNA in cerebrospinal fluid (CSF) from patients with neurological infections. A specific 112-bp fragment was amplified by this method with primers from the nucleoprotein of the mumps virus genome. The mumps virus RT–n-PCR was capable of detecting 0.001 PFU/ml and 0.005 50% tissue culture infective dose/ml. This method was found to be specific, since no PCR product was detected in each of the CSF samples from patients with proven non-mumps virus-related meningitis or encephalitis. Mumps virus RNA was detected in all 18 CSF samples confirmed by culture to be infected with mumps virus. Positive PCR results were obtained for the CSF of 26 of 28 patients that were positive for signs of mumps virus infection (i.e., cultivable virus from urine or oropharyngeal samples or positivity for anti-mumps virus immunoglobulin M) but without cultivable virus in their CSF. Overall, mumps virus RNA was detected in CSF of 96% of the patients with a clinical diagnosis of viral central nervous system (CNS) disease and confirmed mumps virus infection, while mumps virus was isolated in CSF of only 39% of the patients. Furthermore, in a retrospective study, we were able to detect mumps virus RNA in 25 of 55 (46%) CSF samples from patients with a clinical diagnosis of viral CNS disease and negative laboratory evidence of viral infection including mumps virus infection. The 25 patients represent 12% of the 236 patients who had a clinical diagnosis of viral CNS infections and whose CSF was examined at our laboratory for a 2-year period. The findings confirm the importance of mumps virus as a causative agent of CNS infections in countries with low vaccine coverage rates. In summary, our study demonstrates the usefulness of the mumps virus RT–n-PCR for the diagnosis of mumps virus CNS disease and suggests that this assay may soon become the “gold standard

  20. Instrumental activities of daily living are impaired in Parkinson's disease patients with mild cognitive impairment.

    Science.gov (United States)

    Pirogovsky, Eva; Schiehser, Dawn M; Obtera, Kristalyn M; Burke, Mathes M; Lessig, Stephanie L; Song, David D; Litvan, Irene; Filoteo, J Vincent

    2014-03-01

    Although it is well known that Parkinson's disease (PD) with dementia results in functional decline, little is known about the impact of mild cognitive impairment in PD (PD-MCI) on day-to-day functioning. Forty-one individuals with PD-MCI, 56 PD patients with normal cognition (PD-NC), and 47 healthy older adults were administered two performance-based measures of instrumental activities of daily living (IADLs) that evaluated medication and financial management. Informants of the PD patients were also administered an IADL questionnaire. There were no significant differences between PD-NC and healthy older adults on the performance-based measures of medication and financial management. However, PD-MCI patients demonstrated significantly lower scores on the performance-based measures of medication and financial management compared with healthy older adults. PD-MCI patients were also impaired compared with PD-NC patients on performance-based medication management, but no difference between these groups was observed for ability to manage finances. Performance-based financial and medication management did not correlate with scores on neuropsychological measures in PD-MCI patients. PD-MCI and PD-NC patients showed comparable scores on the informant-based IADL questionnaire. Performance-based measures of IADLs, particularly medication management ability, are sensitive to subtle functional declines in PD-MCI. Although impairment in performance-based measures is associated with cognitive status in PD, IADLs may be a separate domain of functioning from cognitive functioning in PD-MCI as these measures did not correlate with performance on the neuropsychological measures. Overall, performance-based assessment of IADLs may add to the clinical evaluation of PD-MCI. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  1. Long-term reintegration and quality of life in patients with subarachnoid hemorrhage and a good neurological outcome: findings after more than 20 years.

    Science.gov (United States)

    Sonesson, Bengt; Kronvall, Erik; Säveland, Hans; Brandt, Lennart; Nilsson, Ola G

    2017-04-28

    OBJECTIVE The goal of this study was to examine long-term quality of life (QOL) and reintegration in patients with good neurological recovery after aneurysmal subarachnoid hemorrhage (aSAH) and SAH of unknown cause (SAH NUD). METHODS A long-term follow-up was performed in an original cohort of 113 individuals who had suffered SAH (93 with aSAH and 20 with SAH NUD) between 1977 and 1984. Self-reporting assessments, performed > 20 years after the bleeding episode, included the Quality of Life Scale (QOLS), Psychological General Well-Being (PGWB) index, and Reintegration to Normal Living (RNL) index, along with information on sleep disturbances and work status. RESULTS Seventy-one survivors were identified. Questionnaires were returned by 67 individuals who had suffered SAH 20-28 years previously. The QOL was rated in the normal range for both the QOLS score (aSAH 90.3 vs SAH NUD 88.6) and the PGWB index (aSAH 105.9 vs SAH NUD 102.8). Ninety percent of patients had returned to their previous employment. Complete RNL was reported by 40% of patients with aSAH and by 46% of patients with SAH NUD; mild to moderate readjustment difficulties by 55% and 38%, respectively; and severe difficulties by 5% of patients with aSAH and 15% of patients with SAH NUD. Self-rated aspects of cognition, mood, and energy resources in addition resulted in a substantial drop in overall reintegration. Sleep disturbances were reported by 26%. CONCLUSIONS More than half of patients with SAH who had early good neurological recovery experienced reintegration difficulties after > 20 years. However, the general QOL was not adversely affected by this impairment. Inability to return to work after SAH was associated with lower QOLS scores. Sleep disturbances were associated with lower PGWB scores.

  2. [Enteral nutrition in neurological patients: is there enough vitamin D content in commonly used formulas?].

    Science.gov (United States)

    Botella Romero, F; Alfaro Martínez, J J; Luna López, V; Galicia Martín, I

    2012-01-01

    Vitamin D deficiency produces inadequate bone mineralization, proximal muscle weakness, abnormal gait and increased risk of falls and fractures. Moreover, in epidemiological studies, has been associated with increased risk of cancer, autoimmune diseases, type 1 and 2 diabetes, rheumatoid arthritis, multiple sclerosis, infectious diseases, cardiovascular diseases and depression. When synthesis through the skin by sun exposure is not possible and the patient can not eat by mouth, as in the advanced stages of various neurological diseases, the supply of vitamin D has to be done by enteral nutrition. The aim of this study is to review the role of vitamin D in a common group of neurological conditions that often require artificial nutrition and analyze whether the vitamin D of different enteral nutrition formulas is adequate to meet the needs of this group of patients. Numerous studies have shown the association between vitamin D deficiency and increased incidence of dementia, stroke and other neurodegenerative diseases. Interventions aimed to increase levels of vit. D and its effects on functional (falls, pain, quality of life) and cardiovascular goals (cardiovascular death, stroke, myocardial infarction, cardiovascular risk factors) have obtained as highlight data a clear reduction of falls and fractures, while the evidence for the other parameters studied is still limited and inconsistent. The content of calcium and vitamin D of enteral formulas is legislated in our country. The total amount of vitamin D for a daily intake of 1,500-2,000 kcal ranges between 300 and 1,600 IU/d (mean ± SD: 32.9 ± 8.5 mg/100 kcal) in the complete formulas for enteral nutrition most commonly used. 50% of the diets studied, for an intake of 2,000 kcal/d, and 90% for an intake of 1,500 kcal/d, provide less than 600 IU/d of vitamin D. Some revised recently guidelines published recommendations of daily intake of vitamin D. The document published by the U.S. Institute of Medicine

  3. Effects of 14 Versus 21 Days of Nimodipine Therapy on Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage Patients.

    Science.gov (United States)

    Cho, Susan; Bales, James; Tran, Thao Kim; Korab, Gina; Khandelwal, Nita; Joffe, Aaron M

    2016-09-01

    Oral nimodipine is standard therapy for patients suffering an aneurysmal subarachnoid hemorrhage (aSAH). During a national drug shortage, nimodipine therapy was shortened from a 21-day course to a 14-day course at our institution. The objective of this study was to compare neurological outcomes among patients who had previously received the standard duration of therapy compared with those who received a shortened duration as a result of the national drug shortage. This retrospective cohort study evaluated adult patients receiving nimodipine for aSAH from January 2012 to August 2013. Neurological outcome, graded by Modified Rankin Scale (mRS) at hospital discharge, was compared between patients receiving a shortened course and those receiving the standard duration of nimodipine. A total of 199 aSAH patients were included in the analysis. There were 164 patients in the standard-duration and 35 patients in the shortened-duration group. Baseline patient severity of illness, assessed by SAPS II (Simplified Acute Physiology Score), and severity of aSAH, assessed by Fisher grade, and Hunt and Hess grade scores, did not differ between the treatment groups. A shortened duration of nimodipine was not associated with a higher risk of a poor neurological outcome defined by mRS (odds ratio = 1.85; 95% CI = 0.54-6.32; P = 0.32). Mortality rates were similar between the groups. A 14-day course of nimodipine therapy was not associated with worse neurological outcomes in aSAH patients at one institution. More studies are needed prior to recommending a shortened duration of nimodipine therapy in all aSAH patients. © The Author(s) 2016.

  4. Is number sense impaired in chronic pain patients?

    Science.gov (United States)

    Wolrich, J; Poots, A J; Kuehler, B M; Rice, A S C; Rahman, A; Bantel, C

    2014-12-01

    Recent advances in imaging have improved our understanding of the role of the brain in painful conditions. Discoveries of morphological changes have been made in patients with chronic pain, with little known about the functional consequences when they occur in areas associated with 'number-sense'; thus, it can be hypothesized that chronic pain impairs this sense. First, an audit of the use of numbers in gold-standard pain assessment tools in patients with acute and chronic pain was undertaken. Secondly, experiments were conducted with patients with acute and chronic pain and healthy controls. Participants marked positions of numbers on lines (number marking), before naming numbers on pre-marked lines (number naming). Finally, subjects bisected lines flanked with '2' and '9'. Deviations from expected responses were determined for each experiment. Four hundred and ninety-four patients were audited; numeric scores in the 'moderate' and 'severe' pain categories were significantly higher in chronic compared with acute pain patients. In experiments (n=150), more than one-third of chronic pain patients compared with 1/10th of controls showed greater deviations from the expected in number marking and naming indicating impaired number sense. Line bisection experiments suggest prefrontal and parietal cortical dysfunction as cause of this impairment. Audit data suggest patients with chronic pain interpret numbers differently from acute pain sufferers. Support is gained by experiments indicating impaired number sense in one-third of chronic pain patients. These results cast doubts on the appropriateness of the use of visual analogue and numeric rating scales in chronic pain in clinics and research. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.

  5. Computerized Functional Reach Test to Measure Balance Stability in Elderly Patients With Neurological Disorders.

    Science.gov (United States)

    Scena, Silvio; Steindler, Roberto; Ceci, Moira; Zuccaro, Stefano Maria; Carmeli, Eli

    2016-10-01

    The ability to maintain static and dynamic balance is a prerequisite for safe walking and for obtaining functional mobility. For this reason, a reliable and valid means of screening for risk of falls is needed. The functional reach test (FRT) is used in many countries, yet it does not provide some kinematic parameters such as shoulder or pelvic girdles translation. The purpose was to analyze video records measuring of distance, velocity, time length, arm direction and girdles translation while doing FRT. A cross-sectional, descriptive study was conducted where the above variables were correlated to the mini-mental state examination (MMSE) for mental status and the Tinetti balance assessment test, which have been validated, in order to computerize the FRT (cFRT) for elderly patients with neurological disorders. Eighty patients were tested and 54 were eligible to serve as experimental group. The patients underwent the MMSE, the Tinetti test and the FRT. LAB view software was used to record the FRT performances and to process the videos. The control group consisted of 51 healthy subjects who had been previously tested. The experimental group was not able to perform the tests as well as the healthy control subjects. The video camera provided valuable kinematic results such as bending down while performing the forward reach test. Instead of manual measurement, we proposed to use a cheap with fair resolution web camera to accurately estimate the FRT. The kinematic parameters were correlated with Tinetti and MMSE scores. The performance values established in this study indicate that the cFRT is a reliable and valid assessment, which provides more accurate data than "manual" test about functional reach.

  6. Correlation between neurological leg deficits and reaction time of upper limbs among low-back pain patients.

    Science.gov (United States)

    Venna, S; Hurri, H; Alaranta, H

    1994-06-01

    The purpose of the study was to examine how neurological deficits of the leg, i.e. sensory deficit, deficient reflexes and muscular weakness, correlate with reaction times of upper limbs in a group with chronic low-back pain. Thirty-two patients were studied. Three sets of measurements of simple reaction time and choice reaction time of upper limbs were conducted at one-week intervals. Neurological deficits of the leg were recorded by a physician and the subjects answered a questionnaire about the severity of their low-back symptoms (Oswestry's index). We also defined a neurological index which reflected the total sum of the three types of leg deficits experienced by each of the subjects. Sensory deficit of the leg and the neurological index correlated strongly with slower reaction times of upper limbs, while the other two neurological deficits did not reach a level of significance. Sensory deficits of the leg seem to be an indicator of much greater motor disability than has been thought so far. The motor disability not only appears distally from the lumbar radicular damage caused for example by an intervertebral herniation, it also seems to relate to psychomotor reaction more generally, even on upper limbs.

  7. Voice Recognition Impairment in a Blind Capgras Patient

    Directory of Open Access Journals (Sweden)

    I. Reid

    1993-01-01

    Full Text Available We report a case of a blind woman, M.N., who experienced the Capgras delusion. She thought that her pet cat had been replaced by a replica which was “ill-intentioned” towards her. M.N.'s case shows that the basis of the Capgras delusion cannot lie exclusively in damage to the visual system. However, testing of M.N.'s auditory recognition abilities revealed a deficit in the recognition of familiar voices. This impairment is consistent with the view that the Capgras delusion may arise in connection with damage to recognition mechanisms, and parallels findings of face processing impairments in sighted Capgras patients.

  8. Evaluation of Traumatic Spine by Magnetic Resonance Imaging and Correlation with Neurological Recovery.

    Science.gov (United States)

    Magu, Sarita; Singh, Deepak; Yadav, Rohtas Kanwar; Bala, Manju

    2015-10-01

    Prospective study. To compare magnetic resonance imaging (MRI) findings with clinical profile and neurological status of the patient and to correlate the MRI findings with neurological recovery of the patients and predict the outcome. Previous studies have reported poor neurological recovery in patients with cord hemorrhage, as compared to cord edema in spine injury patients. High canal compromise, cord compression along with higher extent of cord injury also carries poor prognostic value. Neurological status of patients was assessed at the time of admission and discharge in as accordance with the American Spine Injury Association (ASIA) impairment scale. Mean stay in hospital was 14.11±5.74 days. Neurological status at admission and neurological recovery at discharge was compared with various qualitative cord findings and quantitative parameters on MRI. In 27 patients, long-term follow-up was done at mean time of 285.9±43.94 days comparing same parameters. Cord edema and normal cord was associated with favorable neurological outcome. Cord contusion showed lesser neurological recovery, as compared to cord edema. Cord hemorrhage was associated with worst neurological status at admission and poor neurological recovery. Mean canal compromise (MCC), mean spinal cord compression (MSCC) and lesion length values were higher in patients presenting with ASIA A impairment scale injury and showed decreasing trends towards ASIA E impairment scale injury. Patients showing neurological recovery had lower mean MCC, MSCC, and lesion length, as compared to patients showing no neurological recovery (p<0.05). Cord hemorrhage, higher MCC, MSCC, and lesion length values have poor prognostic value in spine injury patients.

  9. Stroke occurring in patients with cognitive impairment or dementia

    Directory of Open Access Journals (Sweden)

    Solène Moulin

    Full Text Available ABSTRACT One in six patients admitted for stroke was previously demented. These patients have less access to appropriate stroke care, although little is known about their optimal management. Objective To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods Literature search. Results (i A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others. Conclusion Patients with cognitive impairment who develop a stroke have worse outcomes, but should be treated like others.

  10. Neurological Disorders in Adult Celiac Disease

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    2008-01-01

    Full Text Available Celiac disease may initially present as a neurological disorder. Alternatively, celiac disease may be complicated by neurological changes. With impaired nutrient absorption, different deficiency syndromes may occur and these may be manifested clinically with neurological changes. However, in patients with deficiency syndromes, extensive involvement of the small intestine with celiac disease is often evident. There are a number of reports of celiac disease associated with neuropathy, ataxia, dementia and seizure disorder. In these reports, there is no clear relationship with nutrient deficiency and a precise mechanism for the neurological changes has not been defined. A small number of patients have been reported to have responded to vitamin E administration, but most do not. In some, gluten antibodies have also been described, especially in those with ataxia, but a consistent response to a gluten-free diet has not been defined. Screening for celiac disease should be considered in patients with unexplained neurological disorders, including ataxia and dementia. Further studies are needed, however, to determine if a gluten-free diet will lead to improvement in the associated neurological disorder.

  11. Effect of adjuvant argatroban therapy on neurological function, endothelial injury and inflammation state in patient with acute cerebral infarction

    Directory of Open Access Journals (Sweden)

    Nan Che

    2016-08-01

    Full Text Available Objective: To analyze the effect of adjuvant argatroban therapy on neurological function, endothelial injury and inflammation state in patient with acute cerebral infarction. Methods: A total of 118 patients with acute cerebral infarction were divided into observation group and control group according to the random number table, control group received conventional treatment, observation group received argatroban + conventional treatment, and then differences in TCD cerebral blood flow, serum neurological function, endothelial injury and inflammatory marker levels were compared between two groups after treatment. Results: TCD MCA and ACA values of observation group after treatment were higher than those of control group (P<0.05; serum neurological function indexes copeptin, NT-proBNP, PAO and S-100B levels of observation group after treatment were lower than those of control group, endothelial injury index ET-1 level was lower than that of control group, NO and CGRP levels were higher than those of control group, and inflammatory markers hs-CRP, TNF-毩, IL-6, MMP-9 and Lp-PLA2 levels were lower than those of control group (P<0.05. Conclusions: Adjuvant argatroban therapy can optimize the overall condition in patients with acute cerebral infarction, and plays a positive role in improving the neurological function, reducing endothelial injury and inflammation state, etc.

  12. Screening for primary creatine deficiencies in French patients with unexplained neurological symptoms

    Science.gov (United States)

    2012-01-01

    A population of patients with unexplained neurological symptoms from six major French university hospitals was screened over a 28-month period for primary creatine disorder (PCD). Urine guanidinoacetate (GAA) and creatine:creatinine ratios were measured in a cohort of 6,353 subjects to identify PCD patients and compile their clinical, 1H-MRS, biochemical and molecular data. Six GAMT [N-guanidinoacetatemethyltransferase (EC 2.1.1.2)] and 10 X-linked creatine transporter (SLC6A8) but no AGAT (GATM) [L-arginine/glycine amidinotransferase (EC 2.1.4.1)] deficient patients were identified in this manner. Three additional affected sibs were further identified after familial inquiry (1 brother with GAMT deficiency and 2 brothers with SLC6A8 deficiency in two different families). The prevalence of PCD in this population was 0.25% (0.09% and 0.16% for GAMT and SLC6A8 deficiencies, respectively). Seven new PCD-causing mutations were discovered (2 nonsense [c.577C > T and c.289C > T] and 1 splicing [c.391 + 15G > T] mutations for the GAMT gene and, 2 missense [c.1208C > A and c.926C > A], 1 frameshift [c.930delG] and 1 splicing [c.1393-1G > A] mutations for the SLC6A8 gene). No hot spot mutations were observed in these genes, as all the mutations were distributed throughout the entire gene sequences and were essentially patient/family specific. Approximately one fifth of the mutations of SLC6A8, but not GAMT, were attributed to neo-mutation, germinal or somatic mosaicism events. The only SLC6A8-deficient female patient in our series presented with the severe phenotype usually characterizing affected male patients, an observation in agreement with recent evidence that is in support of the fact that this X-linked disorder might be more frequent than expected in the female population with intellectual disability. PMID:23234264

  13. [Neurological complications among patients with zoster hospitalized in Department of Infectious Diseases in Cracow in 2001-2006].

    Science.gov (United States)

    Biesiada, Grazyna; Czepiel, Jacek; Sobczyk-Krupiarz, Iwona; Mach, Tomasz; Garlicki, Aleksander

    2010-01-01

    Herpes zoster is an infectious disease caused by varicella zoster virus (VZV). After replication at the place of entry, VZV spreads via the blood into the skin and mucosa, causing the varicella. From these regions VZV migrates into the sensory ganglia where it establishes a latent infection. The aim of our study was to analyze the localization of the skin changes and correlations of neurological complications among patient with zoster. We have reviewed medical documentation of the 67 patients with herpes zoster, hospitalized in our Department during the years 2001-2006. We have studied localization of the herpes zoster changes and frequency of neurological complications among these patients. Neuralgia was less intensive and last shorter time, when antiviral treatment had been started earlier. Neuralgia, meningitis, encephalitis and complications of the eye zoster were present more often among patients over 65 years old.

  14. An update on hearing impairment in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Emamifar, Amir; Jensen Hansen, Inger Marie

    2018-01-01

    Rheumatoid arthritis (RA) is a systemic, autoimmune disease that present with intra-articular and extra-articular manifestations. Auditory system may be involved during the course of RA disease due to numbers of pathologies. The link between hearing impairment and RA has been discussed in the pre......Rheumatoid arthritis (RA) is a systemic, autoimmune disease that present with intra-articular and extra-articular manifestations. Auditory system may be involved during the course of RA disease due to numbers of pathologies. The link between hearing impairment and RA has been discussed...... in the previous literature. In this study we provide an update on the clinical aspect of hearing impairment in RA. We suggest to test hearing in all newly diagnosed RA patients at diagnosis as well as regularly during the course of disease....

  15. The value of oropharyngoesophageal scintigraphy in the management of aspiration into the tracheobronchial tree in neurological patients.

    Science.gov (United States)

    Grosso, M; Fattori, B; Volterrani, D; Chondrogiannis, S; Boni, G; Nacci, A; Marzola, M C; Rubello, D

    2015-01-01

    Dysphagia and bolus aspiration are two of the most frequent and invalidating symptoms of various neurological diseases. Swallowing disorders often lead to tracheobronchial aspiration with consequent pneumonia episodes. Aspiration pneumonia per se constitutes the most frequent cause of death in these patients, with mortality rate ranging from 20% to 62%. Oropharyngoesophageal scintigraphy (OPES) permits functional quantitative assessment of the different stages of swallowing, together with the detection and quantitative measurement of bolus aspiration. In this work, we analyzed the role of OPES in patients with different neurological conditions to evaluate swallowing and to detect and quantify bolus aspiration. We enrolled 43 neurological patients (25 women and 18 men, mean age 67.3±12.4 yr) complaining of dysphagia with suspected inhalation. All patients underwent OPES with (99m)Tc-nanocolloid using a liquid bolus first, followed by a semi-solid bolus. We evaluated the following parameters: Oral, Pharyngeal and Esophageal Transit Time, Oro-Pharyngeal Retention Index, Esophageal Emptying Rate, and Aspiration Rate (% AR). OPES detected some airway aspiration in 26/43 patients. 19 patients had tracheal aspiration (with a mean 18.1% AR) and the remaining 7 patients had bilateral broncho-pulmonary aspiration (mean 44.9% AR). OPES is a feasible, repeatable and noninvasive method that allows quantitative assessment of bolus aspiration into the tracheobronchial tract, thus representing a useful and accurate tool to guide the most appropriate treatment and to monitor response to therapy in neurological patients with dysphagia. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  16. Augmentative And Alternative Communication Systems For Post-Stroke Patients With Severe Communication And Motor Impairment

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    Talieh Zarifian

    2017-02-01

    Full Text Available Background and aims: Adults with acquired neurological disorders (stroke, Traumatic Brain Injury ... develop their verbal communication and literacy capabilities as typical speakers and writers. They use these skills to participate academically, vocationally, recreationally, and socially. Depending upon their neurological condition, they gradually or suddenly lose their speech or language capabilities and are required to rely on Augmentative and Alternative Communication (AAC systems to meet their communication needs. In addition to the loss of their spoken communication, the impact of their neurological condition on their participation patterns is potentially profound with reduced ability to care for themselves, a reduction or loss of employment, and usually a sudden or gradual restriction of their social networks. AAC is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. During the past five decades, AAC technologies have been developed to compensate for these natural communication losses.      Stroke is one of the main causes of disability in the world. About 20% of stroke patients experience aphasia, with 20-30% of these individuals exhibiting severe communication deficits for at least a portion of their recovery period. Augmentative and Alternative Communication (AAC encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production of spoken or written language.  Specifically designed Human Computer Interfaces (HCI, as an assistive technology, provides new channels of communication for patients with aphasia, dysarthria, and dyspraxia, when accompanied by movement impairments.       In this workshop after stating a science review of the following types of issues: AAC acceptance (individually, culturally; AAC availability

  17. Patient-specific finite element model of the spine and spinal cord to assess the neurological impact of scoliosis correction: preliminary application on two cases with and without intraoperative neurological complications.

    Science.gov (United States)

    Henao, Juan; Aubin, Carl-Éric; Labelle, Hubert; Arnoux, Pierre-Jean

    2016-01-01

    Scoliosis is a 3D deformation of the spine and rib cage. For severe cases, surgery with spine instrumentation is required to restore a balanced spine curvature. This surgical procedure may represent a neurological risk for the patient, especially during corrective maneuvers. This study aimed to computationally simulate the surgical instrumentation maneuvers on a patient-specific biomechanical model of the spine and spinal cord to assess and predict potential damage to the spinal cord and spinal nerves. A detailed finite element model (FEM) of the spine and spinal cord of a healthy subject was used as reference geometry. The FEM was personalized to the geometry of the patient using a 3D biplanar radiographic reconstruction technique and 3D dual kriging. Step by step surgical instrumentation maneuvers were simulated in order to assess the neurological risk associated to each maneuver. The surgical simulation methodology implemented was divided into two parts. First, a global multi-body simulation was used to extract the 3D displacement of six vertebral landmarks, which were then introduced as boundary conditions into the personalized FEM in order to reproduce the surgical procedure. The results of the FEM simulation for two cases were compared to published values on spinal cord neurological functional threshold. The efficiency of the reported method was checked considering one patient with neurological complications detected during surgery and one control patient. This comparison study showed that the patient-specific hybrid model reproduced successfully the biomechanics of neurological injury during scoliosis correction maneuvers.

  18. Balance Impairments in Different Subgroups of Patients With Migraine.

    Science.gov (United States)

    Carvalho, Gabriela F; Bonato, Paolo; Florencio, Lidiane L; Pinheiro, Carina F; Dach, Fabiola; Bigal, Marcelo E; Bevilaqua-Grossi, Debora

    2017-03-01

    Patients with migraine often experience balance impairments. However, the relationship between clinical features - like aura and chronicity - and the severity of balance impairments is not well established. The objective of this study was to assess balance impairments in different subgroups of migraine patients. One hundred five subjects diagnosed according to the ICHD-III were recruited in the study. They were uniformly distributed among three groups: migraine with aura, migraine without aura, and chronic migraine. Thirty-five controls were also recruited in the study. Balance impairments were assessed in all subjects via the modified Sensory Organization test and the Limits of Stability test. The results in the four groups were compared using ANCOVA tests with age, BMI, presence of dizziness, level of physical activity, time of migraine onset, and medication intake as covariates. Subjects in the migraine with aura and the chronic migraine groups showed poorer balance control than control subjects in three of the four conditions tested using the modified Sensory Organization test: FirmCE: CG: 1.5 cm2 , 95%CI 1.3 to 1.7; M: 2.1 cm2 , 95%CI 1.6 to 2.6; MA: 4.5 cm2 , 95%CI 3.2 to 5.8; CM: 4.5 cm2 , 95%CI 3.0 to 6.0; P migraine without aura group (P migraine groups were found in the reaction time, movement velocity, endpoint excursion, and maximal excursion parameters (P  .05). There is evidence of balance control impairments in subjects with all subtypes of migraine compared to control subjects. The presence of aura and frequent migraine attacks reflect negatively in the postural control performance and may have a significant clinical impact in patients with migraine that should be addressed with appropriate clinical interventions. © 2016 American Headache Society.

  19. Writing Impairments in Japanese Patients with Mild Cognitive Impairment and with Mild Alzheimer's Disease

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    Atsuko Hayashi

    2015-09-01

    Full Text Available Background/Aims: We investigated writing abilities in patients with the amnestic type of mild cognitive impairment (aMCI and mild Alzheimer's disease (AD. To examine the earliest changes in writing function, we used writing tests for both words and sentences with different types of Japanese characters (Hiragana, Katakana, and Kanji. Methods: A total of 25 aMCI patients, 38 AD patients, and 22 healthy controls performed writing to dictation for Kana and Kanji words, copied Kanji words, and wrote in response to a picture story task. Analysis of variance was used to test the subject group effects on the scores in the above writing tasks. Results: For the written Kanji words, the mild AD group performed worse than the aMCI group and the controls, but there was no difference between the aMCI group and the controls. For the picture story writing task, the mild AD and aMCI groups performed worse than the controls, but the difference between the AD and the aMCI groups was not significant. Conclusions: The mild AD group showed defects in writing Kanji characters, and the aMCI group showed impairments in narrative writing. Our study suggests that narrative writing, which demands complex integration of multiple cognitive functions, can be used to detect the subtle writing deficits in aMCI patients.

  20. Writing Impairments in Japanese Patients with Mild Cognitive Impairment and with Mild Alzheimer's Disease

    Science.gov (United States)

    Hayashi, Atsuko; Nomura, Hiroshi; Mochizuki, Ruriko; Ohnuma, Ayumu; Kimpara, Teiko; Suzuki, Kyoko; Mori, Etsuro

    2015-01-01

    Background/Aims We investigated writing abilities in patients with the amnestic type of mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD). To examine the earliest changes in writing function, we used writing tests for both words and sentences with different types of Japanese characters (Hiragana, Katakana, and Kanji). Methods A total of 25 aMCI patients, 38 AD patients, and 22 healthy controls performed writing to dictation for Kana and Kanji words, copied Kanji words, and wrote in response to a picture story task. Analysis of variance was used to test the subject group effects on the scores in the above writing tasks. Results For the written Kanji words, the mild AD group performed worse than the aMCI group and the controls, but there was no difference between the aMCI group and the controls. For the picture story writing task, the mild AD and aMCI groups performed worse than the controls, but the difference between the AD and the aMCI groups was not significant. Conclusions The mild AD group showed defects in writing Kanji characters, and the aMCI group showed impairments in narrative writing. Our study suggests that narrative writing, which demands complex integration of multiple cognitive functions, can be used to detect the subtle writing deficits in aMCI patients. PMID:26483830

  1. Leg pain location and neurological signs relate to outcomes in primary care patients with low back pain

    DEFF Research Database (Denmark)

    Hartvigsen, Lisbeth; Hestbæk, Lise; Leboeuf-Yde, Charlotte

    Background Low back pain (LBP) patients with related leg pain and signs of nerve root involvement are considered to have a worse prognosis than patients with LBP alone. However, it is unclear whether leg pain location above or below the knee and the presence of neurological signs are important...... in primary care patients. The objectives of this study were to explore whether the four Quebec Task Force categories (QTFC) based on the location of pain and on neurological signs have different characteristics at the time of care seeking, whether these QTFC are associated with outcome, and if so whether......, across LBP with leg pain above the knee and below the knee to LBP with nerve root involvement. However, the variation within the categories was considerable. Conclusion The QTFC identify different LBP subgroups at baseline and there is a consistent ranking of the four categories with respect to outcomes...

  2. Leg pain location and neurological signs relate to outcomes in primary care patients with low back pain

    DEFF Research Database (Denmark)

    Hartvigsen, Lisbeth; Hestbæk, Lise; Leboeuf-Yde, Charlotte

    2017-01-01

    BACKGROUND: Low back pain (LBP) patients with related leg pain and signs of nerve root involvement are considered to have a worse prognosis than patients with LBP alone. However, it is unclear whether leg pain location above or below the knee and the presence of neurological signs are important...... in primary care patients. The objectives of this study were to explore whether the four Quebec Task Force categories (QTFC) based on the location of pain and on neurological signs have different characteristics at the time of care seeking, whether these QTFC are associated with outcome, and if so whether......, across LBP with leg pain above the knee and below the knee to LBP with nerve root involvement. However, the variation within the categories was considerable. CONCLUSION: The QTFC identify different LBP subgroups at baseline and there is a consistent ranking of the four categories with respect to outcomes...

  3. Cerebral Oximetry for the Prediction of Neurological Dysfunction in Cardiosurgical Patients

    Directory of Open Access Journals (Sweden)

    A. N. Shepelyuk

    2011-01-01

    Full Text Available Objective: to study the efficiency of intraoperative transeosophageal echocardiography in the detection of indications for and contraindications to early activation in the operating room after myocardial revascularization under extracorporeal circulation. Subject and methods. One hundred and eighty-six patients aged 55.0±0.6 years were examined. A Sonos Agilent 5500 apparatus and a multipurpose Omni-2 transducer were used for ultrasound study. Left ventricular ejection fraction was determined in the four-chamber (Simpson and transgastric views (visualization of the left ventricle in cross-section at the level of the papillary muscles. To identify impaired myocardial contractility hindering immediate activation, the authors analyzed the data of examining 142 patients who might undergo tracheal extubation in the operating room. A decreased left ventricular ejection fraction of less than 50% in the transgastric view was considered to be a contraindication to activation. The sensitivity of echocardiography in the differential diagnosis of acute myocardial infarction _ was studied in 44 patients with echocardiographic signs of acute myocardial ischemic lesion. Results. A left ventricular ejection fraction of less than 50% (41.5±2.2% in the transgastric view was a refusal criterion for immediate patient activation. This group of patients, as compared with those having a left ventricular ejection fraction of 60.1±1.7%, had a longer duration of inotropic therapy (45.2±2.1 and 13±1.1 hrs; p<0.05 and a more prolonged length of postoperative intensive care unit stay (36.2±1.7 and 18.8±0.75 hrs; p<0.05. The correlation coefficient between the left ventricular ejection fraction at the end of surgery and the duration of inotropic therapy was 0.51 (p<0.0001 and that with an intensive care unit stay was 0.48 (p=0.00018. Among the patients with electrocardiographic signs of acute myocardial ischemic lesion, ultrasound study did not confirm the diagnosis

  4. Predictors of good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest patients undergoing therapeutic hypothermia.

    Science.gov (United States)

    Ahn, Shin; Lee, Byung Kook; Youn, Chun Song; Kim, Youn-Jung; Sohn, Chang Hwan; Seo, Dong-Woo; Kim, Won Young

    2017-04-07

    Neurologically intact survival after cardiac arrest is possible even after prolonged resuscitation efforts. However, the factors associated with good neurologic outcome in these patients remain unknown. This study identifies predictors associated with good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM). This multicenter, registry-based, retrospective cohort study conducted in 24 hospitals across South Korea between 2007 and 2012 includes adult (≥18 years) non-traumatic OHCA patients with prolonged (>30 min) downtime who underwent TTM treatment. Good neurologic outcomes were defined as cerebral performance category scores of ≤2. Of the 930 comatose adult cardiac arrest patients treated with TTM, 423 patients with prolonged downtime were included. A total of 76 (18.0%) had good neurologic outcome. Multivariable analysis reveal that age good neurologic outcome. The sensitivity and specificity for good neurologic outcome in patients with age <65 years, shockable rhythm, and witnessed arrest are 90.8% and 41.2, 67.6 and 79.5%, and 81.6 and 41.2%, respectively. In prolonged cardiac arrest patients, initial shockable rhythm, age <65 years, or witnessed arrest are predictors for neurologic intact survival.

  5. [Nursing diagnosis "impaired walking" in elderly patients: integrative literature review].

    Science.gov (United States)

    Marques-Vieira, Cristina Maria Alves; de Sousa, Luís Manuel Mota; de Matos Machado Carias, João Filipe; Caldeira, Sílvia Maria Alves

    2015-03-01

    The impaired walking nursing diagnosis has been included in NANDA International classification taxonomy in 1998, and this review aims to identify the defining characteristics and related factors in elderly patients in recent literature. Integrative literature review based on the following guiding question: Are there more defining characteristics and factors related to the nursing diagnosis impaired walking than those included in NANDA International classification taxonomy in elderly patients? Search conducted in 2007-2013 on international and Portuguese databases. Sample composed of 15 papers. Among the 6 defining characteristics classified at NANDA International, 3 were identified in the search results, but 13 were not included in the classification. Regarding the 14 related factors that are classified, 9 were identified in the sample and 12 were not included in the NANDA International taxonomy. This review allowed the identification of new elements not included in NANDA International Taxonomy and may contribute to the development of taxonomy and nursing knowledge.

  6. Chapter 38: American neurology.

    Science.gov (United States)

    Freemon, Frank R

    2010-01-01

    The great formative event in the history of North America, the Civil War of 1861 to 1865, was the stimulus for the development of clinical neurology and the neurosciences. The first neurological research center on the continent was the US Army hospital at Turner's Lane, Philadelphia, PA. Silas Weir Mitchell and his colleagues described causalgia (reflex sympathetic dystrophy), phantom limb sensation, and Horner's syndrome (before Horner). The medical leader of the Northern army was William Hammond. After the conclusion of hostilities, he began a huge clinical practice in New York City. In the United States, clinical neurology began in private practice, unlike Europe, where neurology began in institutions. Hammond's textbook, which first used the term athetosis, was used by a generation of physicians who encountered patients with neurological signs and symptoms. Early in the 20th century, neurological institutions were formed around universities; probably the most famous was the Montreal Neurological Institute founded by Wilder Penfield. The US federal government sponsored extensive research into the function and dysfunction of the nervous system through the Neurological Institute of Neurological Diseases and Blindness, later called the National Institute of Neurological Diseases and Stroke. The government officially classified the final 10 years of the 20th century as the Decade of the Brain and provided an even greater level of research funding.

  7. Cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis with EDSS < or = 3.5.

    Science.gov (United States)

    Ruggieri, R M; Palermo, R; Vitello, G; Gennuso, M; Settipani, N; Piccoli, F

    2003-11-01

    Previous papers have mainly demonstrated the presence and the frequency of cognitive impairment in patients suffering from relapsing-remitting multiple sclerosis. The purpose of this study was to investigate subjects with the relapsing-remitting form of the disease and mild clinical disability (EDSS Aphasie Test (AAT). They also underwent Clinical Depression Scale (CDQ) and State-Trait Anxiety Inventory (STAI). The results show the presence of significant memory impairment on both WMS (P = 0.000) and BVRT (P = 0.000) in patients compared with controls. Patients were also impaired in abstract reasoning and problem-solving deficit (KT P = 0.003; RCPM P = 0.000) and in FR (P = 0.019). Cognitive decline correlated with illness duration (r = 0.761), but was independent of EDSS (r = 0.085). Cognitive decline was present even when physical disability was not yet severe, but it was mild and did not limit patients' ability to work. The cognitive impairment outlined was of the subcortical type and correlated with illness duration. This study emphasizes the importance of cognitive examination in clinical practice. It is suggested that a complete neurological examination include tests on memory and abstract reasoning.

  8. Static Balance in Patients with Vestibular Impairments: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Hossein Talebi

    2016-01-01

    Full Text Available Aims. Vestibular system is indicated as one of the most important sensors responsible for static and dynamic postural control. In this study, we evaluated static balance in patients with unilateral vestibular impairments. Materials and Methods. We compared static balance control using Kistler force plate platform between 10 patients with unilateral vestibular impairments and 20 normal counterparts in the same sex ratio and age limits (50±7. We evaluated excursion and velocity of center of pressure (COP and path length in anteroposterior (AP and mediolateral (ML planes with eyes open and with eyes closed. Results. There was no significant difference between COP excursions in ML and AP planes between both groups with eyes open and eyes closed (p value > 0.05. In contrast, the difference between velocity and path length of COP in the mentioned planes was significant between both groups with eyes open and eyes closed (p value < 0.05. Conclusions. The present study showed the static instability and balance of patients with vestibular impairments indicated by the abnormal characteristics of body balance.

  9. Static Balance in Patients with Vestibular Impairments: A Preliminary Study.

    Science.gov (United States)

    Talebi, Hossein; Karimi, Mohammad Taghi; Abtahi, Seyed Hamid Reza; Fereshtenejad, Niloofar

    2016-01-01

    Aims. Vestibular system is indicated as one of the most important sensors responsible for static and dynamic postural control. In this study, we evaluated static balance in patients with unilateral vestibular impairments. Materials and Methods. We compared static balance control using Kistler force plate platform between 10 patients with unilateral vestibular impairments and 20 normal counterparts in the same sex ratio and age limits (50 ± 7). We evaluated excursion and velocity of center of pressure (COP) and path length in anteroposterior (AP) and mediolateral (ML) planes with eyes open and with eyes closed. Results. There was no significant difference between COP excursions in ML and AP planes between both groups with eyes open and eyes closed (p value > 0.05). In contrast, the difference between velocity and path length of COP in the mentioned planes was significant between both groups with eyes open and eyes closed (p value static instability and balance of patients with vestibular impairments indicated by the abnormal characteristics of body balance.

  10. Admission blood glucose levels and early change of neurological grade in poor-grade patients with aneurysmal subarachnoid haemorrhage.

    Science.gov (United States)

    Sato, M; Nakano, M; Asari, J; Watanabe, K

    2006-06-01

    The neurological grade of poor-grade subarachnoid haemorrhage (SAH) often changes soon after the patient is admitted to the hospital. It is important to closely monitor for such changes within a short period of time after admission; however, there are other problems that can occur during this time such as rebleeding. The aim of this study was to evaluate the relationship between admission blood glucose levels (ABGL) and early change of neurological grade after admission in patients with poor-grade SAH. Forty-six patients with poor-grade SAH (Hunt & Kosnik Grade IV or V), who were admitted within 3 hrs after SAH onset, and who did not have haematomas causing mass effect, or a history of diabetes mellitus, were included in the study. Patients were pretreated to control blood pressure and intracranial pressure, and they were monitored for early change of grade after admission. Blood glucose level was measured at the time of admission. Spontaneous grade improvement was observed in 9 of 17 Grade IV patients and 9 of 29 Grade V patients. The ABGL of the patients with grade improvement were significantly lower than the ABGL of the patients who did not improve or who got worse. ABGL were lower than 180 mg/dl in 15 of 18 patients who showed grade improvement. Our results showed that there was a relationship between ABGL and neurological grade changes which were observed after admission in patients with poor-grade SAH. These results suggest that ABGL might be a useful parameter for making therapeutic decisions.

  11. Epidemiology and trend of neurological diseases associated to HIV/AIDS. Experience of Mexican patients 1995-2009.

    Science.gov (United States)

    Ramírez-Crescencio, M A; Velásquez-Pérez, L; Ramírez-Crescencio, María Antonieta; Velásquez-Pérez, Leora

    2013-08-01

    The aim of this study was to identify the main neurological conditions associated with HIV/AIDS in Mexican patients treated at the National Institute of Neurology and Neurosurgery (NINN) in Mexico city, the main referral center for patients with disorders of the central and peripheral nervous system. An observational, transversal and descriptive analysis was performed. We reviewed the databases from the Department of Epidemiology and the medical records of patients with AIDS seen during the period from January 1st, 1995 to December 31, 2009. 320 patients were detected, the main conditions related to HIV/AIDS were brain toxoplasmosis (42%), cerebral criptoccocosis (28%), tuberculous meningitis (8.7%), linfoma no Hodking (3.75%), acute HIV infection (3.4%) and AIDS dementia complex (3%). No specific trend on morbility and mortality were detected during the period of study. In Mexico the most common neurological complications of HIV/AIDS are opportunistic infections. Copyright © 2013 Elsevier B.V. All rights reserved.

  12. Spectrum of findings on magnetic resonance imaging of the brain in patients with neurological manifestations of dengue fever.

    Science.gov (United States)

    Jugpal, Tejeshwar Singh; Dixit, Rashmi; Garg, Anju; Gupta, Swati; Jain, Virendra; Patel, Ronak; Agarwal, Shobhit

    2017-01-01

    To describe the spectrum of magnetic resonance imaging (MRI) findings in patients with neurological manifestations of dengue. We included nine patients with dengue fever (three females and six males; age range, 9-30 years), all of whom presented with neurological manifestations. The MRI examinations, performed in 1.5 T or 3 T scanners, included T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences. Diffusion-weighted imaging with apparent diffusion coefficient mapping was also employed. Fast low-angle shot and susceptibility-weighted gradient-recalled echo sequences, as well as contrast-enhanced T1-weighted scans, were also obtained in order to assess parenchymal enhancement. MRI scans were analyzed for lesion distribution and imaging features. All patients showed areas of altered signal intensity that appeared as hyperintensity on T2-weighted and FLAIR sequences. The most commonly affected site was the basal ganglia-thalamus complex. Other affected sites were the cerebellum, cerebral cortex, white matter, and brainstem. In all cases, we observed patchy areas of restricted diffusion and focal areas of hemorrhage. Dengue encephalitis commonly affects the basal ganglia, thalamus, cerebellum, cerebral cortex, and white matter. Therefore, MRI should be an indispensable part of the evaluation of patients with neurological complications of dengue fever.

  13. Impaired math achievement in patients with acute vestibular neuritis.

    Science.gov (United States)

    Moser, Ivan; Vibert, Dominique; Caversaccio, Marco D; Mast, Fred W

    2017-12-01

    Broad cognitive difficulties have been reported in patients with peripheral vestibular deficit, especially in the domain of spatial cognition. Processing and manipulating numbers relies on the ability to use the inherent spatial features of numbers. It is thus conceivable that patients with acute peripheral vestibular deficit show impaired numerical cognition. Using the number Stroop task and a short math achievement test, we tested 20 patients with acute vestibular neuritis and 20 healthy, age-matched controls. On the one hand, patients showed normal congruency and distance effects in the number Stroop task, which is indicative of normal number magnitude processing. On the other hand, patients scored lower than healthy controls in the math achievement test. We provide evidence that the lower performance cannot be explained by either differences in prior math knowledge (i.e., education) or slower processing speed. Our results suggest that peripheral vestibular deficit negatively affects numerical cognition in terms of the efficient manipulation of numbers. We discuss the role of executive functions in math performance and argue that previously reported executive deficits in patients with peripheral vestibular deficit provide a plausible explanation for the lower math achievement scores. In light of the handicapping effects of impaired numerical cognition in daily living, it is crucial to further investigate the mechanisms that cause mathematical deficits in acute PVD and eventually develop adequate means for cognitive interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy

    Directory of Open Access Journals (Sweden)

    Yen-Hsuan Hsu

    2015-06-01

    Conclusion: Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state.

  15. The Relationship of Paranasal Sinus Opacification to Hospital-Acquired Pneumonia in the Neurologic Intensive Care Unit Patient.

    Science.gov (United States)

    Huyett, Phillip; Rowan, Nicholas R; Ferguson, Berrylin J; Lee, Stella; Wang, Eric W

    2017-01-01

    The association between intensive care unit (ICU) sinusitis and the development of lower airway infections remains unclear. The objective of this study was to determine the correlation between the development of radiographic sinus opacification and pneumonia in the neurologic ICU setting. A retrospective review of head computed tomography or magnetic resonance imaging of 612 patients admitted to the neurocritical care unit at a tertiary care center from April 2013 through April 2014 was performed. Paranasal sinus opacification was measured using Lund-Mackay scores (LMS). A diagnosis of pneumonia was determined by the ICU team from radiographic, laboratory, and pulmonary data. Exclusion criteria included a history of endonasal surgery, sinonasal malignancy, facial fractures, ICU admission less than 3 days, or inadequate imaging. Worsening sinus opacification occurred in 42.6% of patients and pneumonia in 18.5% of patients during ICU admission. Of the patients who developed pneumonia, 71.7% also developed worsening sinus opacification ( P patients who developed pneumonia was 4.24 compared to 1.99 in patients who did not develop pneumonia ( P patients who developed pneumonia (46.9% vs 19.4%, P patients with no pneumonia or sinusitis, pneumonia only, sinusitis only, and sinusitis with pneumonia were 7.6%, 15.6%, 18.3%, and 25.9%, respectively ( P relationship between worsening sinus opacification in the neurologic ICU patient to the development of hospital-acquired pneumonia and increased mortality.

  16. Cognitive and psychosocial impairment in remitted bipolar patients

    Directory of Open Access Journals (Sweden)

    Flávia Moreira Lima

    2015-07-01

    Full Text Available There is growing evidence showing that bipolar disorder is associated with persistent cognitive deficits. However, the exact meaning and impact of cognitive deficits in bipolar disorder is still not entirely known, even though they have been associated with poor psychosocial functioning. This study aims to summarize cognitive and psychosocial functioning findings of remitted bipolar patients. We conducted an extensive Medline search of the published English literature for the period January 2000– March 2014 using a variety of search terms to find relevant articles. Bibliographies of retrieved papers were further analysed for publications of interest. Our results showed that: (1 all mood states of bipolar disorder are associated with cognitive impairment. However, the euthymic state is associated with less impairment than the other states; (2 there is a strong association between clinical factors (i.e, duration of illness, number of episodes, residual mood symptoms, comorbidities and cognitive impairment in euthymic bipolar patients, although these factors do not account fully for these deficits; (3 cognitive deficits, in particular, verbal learning and executive dysfunctions may contribute to poor functioning. In conclusion, our review suggests that cognitive deficits are strongly associated with mood episodes; such deficits persist, in lower degree, during remission. Impairment on cognitive performance may explain, in part, poor long–term functioning in remitted bipolar patients. It highlights that psychosocial interventions in combination with pharmacotherapy should be considered to improve cognition and enhance the level of functioning. Therefore, studies assessing the efficacy of novel strategies focused on cognitive and functional status are an important area of future investigation in bipolar disorder.

  17. The Association Between Spontaneous Hyperventilation, Delayed Cerebral Ischemia, and Poor Neurological Outcome in Patients with Subarachnoid Hemorrhage.

    Science.gov (United States)

    Williamson, Craig A; Sheehan, Kyle M; Tipirneni, Renuka; Roark, Christopher D; Pandey, Aditya S; Thompson, B Gregory; Rajajee, Venkatakrishna

    2015-12-01

    The frequency and associations of spontaneous hyperventilation in subarachnoid hemorrhage (SAH) are unknown. Because hyperventilation decreases cerebral blood flow, it may exacerbate delayed cerebral ischemia (DCI) and worsen neurological outcome. This is a retrospective analysis of data from a prospectively collected cohort of SAH patients at an academic medical center. Spontaneous hyperventilation was defined by PaCO2 7.45 and subdivided into moderate and severe groups. Clinical and demographic characteristics of patients with and without spontaneous hyperventilation were compared using χ (2) or t tests. Bivariate and multivariable logistic regression analyses were conducted to examine the association of moderate and severe hyperventilation with DCI and discharge neurological outcome. Of 207 patients, 113 (55 %) had spontaneous hyperventilation. Spontaneously hyperventilating patients had greater illness severity as measured by the Hunt-Hess, World Federation of Neurosurgical Societies (WFNS), and SAH sum scores. They were also more likely to develop the following complications: pneumonia, neurogenic myocardial injury, systemic inflammatory response syndrome (SIRS), radiographic vasospasm, DCI, and poor neurological outcome. In a multivariable logistic regression model including age, gender, WFNS, SAH sum score, pneumonia, neurogenic myocardial injury, etiology, and SIRS, only moderate [odds ratio (OR) 2.49, 95 % confidence interval (CI) 1.10-5.62] and severe (OR 3.12, 95 % CI 1.30-7.49) spontaneous hyperventilation were associated with DCI. Severe spontaneous hyperventilation (OR 4.52, 95 % CI 1.37-14.89) was also significantly associated with poor discharge outcome in multivariable logistic regression analysis. Spontaneous hyperventilation is common in SAH and is associated with DCI and poor neurological outcome.

  18. The Preferential Impairment of Pupil Constriction Stimulated by Blue Light in Patients with Type 2 Diabetes without Autonomic Neuropathy

    Directory of Open Access Journals (Sweden)

    Fukashi Ishibashi

    2017-01-01

    Full Text Available The main aim of the present paper is to examine whether the pupillary light reflex (PLR mediated by intrinsically photosensitive retinal ganglion cells (ipRGCs is impaired in type 2 diabetic patients. One hundred and three diabetic patients without diabetic autonomic neuropathy (DAN and 42 age-matched controls underwent a series of detailed neurological examinations. The patients were stratified into three groups: stage I, no neuropathy; stage II, asymptomatic neuropathy; stage III, symptomatic but without DAN. The PLR to 470 and 635 nm light at 20 cd/m2 was recorded. Small fiber neuropathy was assessed by corneal confocal microscopy and quantifying corneal nerve fiber (CNF morphology. The 470 nm light induced a stronger and faster PLR than did 635 nm light in all subjects. The PLR to both lights was impaired equally across all of the diabetic subgroups. The postillumination pupil response (PIPR after 470 nm light offset at ≥1.7 sec was attenuated in diabetic patients without differences between subgroups. Receiver operating characteristic analysis revealed that the PIPR mediated by ipRGCs in patients with stage II and stage III neuropathy was different from that of the control subjects. Clinical factors, nerve conduction velocity, and CNF measures were significantly correlated with PLR parameters with 470 nm light. PLR kinetics were more impaired by stimulation with blue light than with red light in diabetic patients without DAN.

  19. [Interobserver reliability of the Glasgow coma scale in critically ill patients with neurological and/or neurosurgical disease].

    Science.gov (United States)

    Sánchez-Sánchez, M M; Sánchez-Izquierdo, R; Sánchez-Muñoz, E I; Martínez-Yegles, I; Fraile-Gamo, M P; Arias-Rivera, S

    2014-01-01

    The Glasgow coma scale (GCS) is a common tool used for neurological assessment of critically ill patients. Despite its widespread use, the GCS has some limitations, as sometimes different observers may value differently the same response. To evaluate the interobserver agreement, among intensive care nurses with a minimum of 3 years experience, both in the overall estimate of GCS and for each of its components. Prospective observational study including 110 neurological and/or neurosurgical patients conducted in a critical care unit of 18 beds, from October 2010 until December 2012. Registered variables: Demographic characteristics, reason for admission, overall GCS and its components. The neurological evaluation was conducted by a minimum of 3 nurses. One of them applied an algorithm and consensual assessment technique and all, independently, valued response to stimuli. Interobserver agreement was measured using the intraclass correlation coefficient (ICC) for a confidence interval (CI) of 95%. The study was approved by the Ethics Committee for Clinical Trails. The intraclass correlation coefficient (confident interval) for scale was: Overall GCS: 0.989 (0.985-0.992); ocular response: 0.981 (0.974-0.986); verbal response: 0.971 (0.960-0.979); motor response: 0.987 (0.982-0.991). In our cohort of patients we observed a high level of consistency in the application of both the GCS as in each of its components. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.

  20. Technetium-99m HM-PAO SPECT in patients with delayed neurologic sequelae after carbon monoxide poisoning.

    Science.gov (United States)

    Choi, I. S.; Lee, M. S.; Lee, Y. J.; Kim, J. H.; Lee, S. S.; Kim, W. T.

    1992-01-01

    We used single photon emission computed tomography (SPECT) with technetium-99m hexamethylpropylene amine oxime (99mTc-HM-PAO) in 14 studies on 6 patients with delayed neurologic sequelae from carbon monoxide (CO) poisoning to determine whether any changes in cerebral blood flow could be correlated with clinical or computed tomographic evidence of delayed deficits. Among the six initial CT brain scans, two showed low density of both basal ganglia and two showed decreased density of the cerebral white matter. There was no correlation between the clinical outcome and the findings of the follow-up CT brain scans. Of the two SPECTS with 99mTc-HM-PAO performed during acute anoxic insult, one showed focal hypoperfusion which appeared 20 days prior to the onset of delayed neurologic sequelae after CO poisoning. Seven SPECTs in the six patients performing the delayed phase showed diffuse patched patterns of hypoperfusion which improved on follow-up images. There was good correlation between the clinical outcome and the findings of the 99mTc-HM-PAO SPECT. In preliminary conclusion, 9Tc-HM-PAO brain SPECT can be used for predicting or evaluating the outcome of delayed neurologic sequelae after CO poisoning. Cerebral vascular changes may be the possible cause of hypoperfusion in patients with CO poisoning. PMID:1418757

  1. [Community-based rehabilitation and outpatient care for patients with acquired brain injury and chronic neurological disability in Germany: continuing support for social participation and re-integration in the neurological care system?].

    Science.gov (United States)

    Reuther, P; Hendrich, A; Kringler, W; Vespo, E

    2012-12-01

    In Germany a number of patients who are suffering from acquired brain injury and chronic neurological disability are either undersupplied or exposed to inappropriate care in their social environment. The number of these patients is increasing due to the changes in the procedures of care and due to demographic factors. While acute medical care and early rehabilitative treatment is accessible throughout the German health care system the necessary multimodal and competent care is rare or absent in the social participative sites such as life and occupational environments of the patients. The complex impairment of the brain, the central organ for sensorial, executive and other cognitive functions of human beings, renders the affected patient an exception in the system of medical and social care - this has only inadequately been considered in the past. The authors explain the necessity to disclose the status of a "human-with acquired-brain damage (Mensch-mit-erworbener-Hirnschädigung, MeH)" explicitly as severely disabled. The paper recommends a number of structural and procedural elements that have proven to overcome the insufficient or inappropriate support in integrating the patients suffering from acquired brain injury and chronic neurological disability in their social environment as well as for a demand-focused support with sustainable rehabilitative and ambulant follow-up procedures. Comparisons with other developed health care systems and international guidelines show that with organizing of early-supported-discharge, community-ambulation, shared-care and community-based-rehabilitation these problems have long since been identified elsewhere. Community-based and resident-oriented concepts have already been systematically implemented. In order to achieve the necessary support for the individual patient, a nation-wide development is necessary in Germany to perform the principles of the German social code and the principles of the Convention on the Rights of

  2. Corneal Complications And Visual Impairment In Vernal Keratoconjunctivitis Patients.

    Science.gov (United States)

    Arif, Abdus Salam; Aaqil, Bushra; Siddiqui, Afsheen; Nazneen, Zainab; Farooq, Umer

    2017-01-01

    Vernal kerato-conjunctivitis (VKC) is an infrequent but serious form of allergic conjunctivitis common in warm and humid areas where air is rich in allergens. It affects both eyes asymmetrically. Although VKC is a self-limiting disease but visions affecting corneal complications influence the quality of life in school children. The aim of this study was to list the corneal complications due to this condition and to find out the extent of visual impairment among VKC patients. This cross-sectional study was conducted in the department of Ophthalmology, Benazir Bhutto Shaheed Hospital on 290 eyes of diagnosed cases of VKC. The diagnosis of VKC was made on the basis of history and examination. Visual acuity was recorded using Snellen's notation and visual impairment was classified according to World Health Organization classification for visual disabilities. The mean age of presentation was 10.83±6.13 years. There were 207 (71.4%) males and 83 (28.6%) females. Corneal scarring was observed in 59 (20.3%) eyes. Keratoconus was found to be in 17 (5.9%) eyes. Shield ulcer was detected in 09 (3.1%) eyes while 07 (2.4%) eyes had corneal neovascularization. Majority of the patients with visual loss had corneal scarring and the complication that led to severe visual loss in most of the eyes was Keratoconus. Vernal kerato-conjunctivitis in the presence of corneal complications is a sight threatening disease and can lead to severe visual impairment.

  3. The Neurological Wake-up Test—A Role in Neurocritical Care Monitoring of Traumatic Brain Injury Patients?

    Directory of Open Access Journals (Sweden)

    Niklas Marklund

    2017-10-01

    Full Text Available The most fundamental clinical monitoring tool in traumatic brain injury (TBI patients is the repeated clinical examination. In the severe TBI patient treated by continuous sedation in a neurocritical care (NCC unit, sedation interruption is required to enable a clinical evaluation (named the neurological wake-up test; NWT assessing the level of consciousness, pupillary diameter and reactivity to light, and presence of focal neurological deficits. There is a basic conflict regarding the NWT in the NCC setting; can the clinical information obtained by the NWT justify the risk of inducing a stress response in a severe TBI patient? Furthermore, in the presence of advanced multimodal monitoring and neuroimaging, is the NWT necessary to identify important clinical alterations? In studies of severe TBI patients, the NWT was consistently shown to induce a stress reaction including brief increases in intracranial pressure (ICP and changes in cerebral perfusion pressure (CPP. However, it has not been established whether these short-lived ICP and CPP changes are detrimental to the injured brain. Daily interruption of sedation is associated with a reduced ventilator time, shorter hospital stay and reduced mortality in many studies of general intensive care unit patients, although such clinical benefits have not been firmly established in TBI. To date, there is no consensus on the use of the NWT among NCC units and systematic studies are scarce. Thus, additional studies evaluating the role of the NWT in clinical decision-making are needed. Multimodal NCC monitoring may be an adjunct in assessing in which TBI patients the NWT can be safely performed. At present, the NWT remains the golden standard for clinical monitoring and detection of neurological changes in NCC and could be considered in TBI patients with stable baseline ICP and CPP readings. The focus of the present review is an overview of the existing literature on the role of the NWT as a clinical

  4. Association Between Comorbidities, Nutritional Status, and Anticlotting Drugs and Neurologic Outcomes in Geriatric Patients with Traumatic Brain Injury.

    Science.gov (United States)

    Okazaki, Tomoya; Hifumi, Toru; Kawakita, Kenya; Nakashima, Ryuta; Matsumoto, Atsushi; Shishido, Hajime; Ogawa, Daiske; Okauchi, Masanobu; Shindo, Atsushi; Kawanishi, Masahiko; Tamiya, Takashi; Kuroda, Yasuhiro

    2016-09-01

    Several studies using trauma data banks and registers showed that age, Glasgow Coma Scale (GCS), Injury Severity Score, and intraventricular hemorrhage were independent factors for neurologic outcomes in geriatric patients with traumatic brain injury (TBI). However, these analyses did not comprehensively evaluate factors particularly associated with geriatric patients. We aimed to identify factors particularly associated with geriatric patients that affect neurologic outcomes in TBI. Patients aged ≥65 years who were hospitalized consecutively in Kagawa University Hospital with severe TBI between 1 January 2008 and 31 October 2015 were retrospectively reviewed. We evaluated background factors particularly associated with geriatric patients, including comorbidities (Charlson Comorbidity Index [CCI]), nutritional status (serum albumin level), and presence/absence of antiplatelet and anticoagulant drugs, in addition to baseline characteristics. Multivariate analyses were performed to identify independent predictors of unfavorable neurologic outcomes (UO), as defined as a Glasgow Outcome Scale score of 1-3 at discharge from hospital. The association between CCI and UO was evaluated in a subgroup analysis. UO occurred in 65.0% of 140 patients. Multivariate analyses showed that the CCI (odds ratio, 1.91; 95% confidence interval, 1.21-3.29; P = 0.011), age, and GCS were independent predictors of UO. In subgroup analyses of patients with an initial GCS score of 13-15, the rate of UO significantly increased with CCI score (CCI 0, 35.5%; CCI 1 or 2, 39.4%; CCI >2, 83.3%; P geriatric patients with severe TBI. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. The Neurological Wake-up Test-A Role in Neurocritical Care Monitoring of Traumatic Brain Injury Patients?

    Science.gov (United States)

    Marklund, Niklas

    2017-01-01

    The most fundamental clinical monitoring tool in traumatic brain injury (TBI) patients is the repeated clinical examination. In the severe TBI patient treated by continuous sedation in a neurocritical care (NCC) unit, sedation interruption is required to enable a clinical evaluation (named the neurological wake-up test; NWT) assessing the level of consciousness, pupillary diameter and reactivity to light, and presence of focal neurological deficits. There is a basic conflict regarding the NWT in the NCC setting; can the clinical information obtained by the NWT justify the risk of inducing a stress response in a severe TBI patient? Furthermore, in the presence of advanced multimodal monitoring and neuroimaging, is the NWT necessary to identify important clinical alterations? In studies of severe TBI patients, the NWT was consistently shown to induce a stress reaction including brief increases in intracranial pressure (ICP) and changes in cerebral perfusion pressure (CPP). However, it has not been established whether these short-lived ICP and CPP changes are detrimental to the injured brain. Daily interruption of sedation is associated with a reduced ventilator time, shorter hospital stay and reduced mortality in many studies of general intensive care unit patients, although such clinical benefits have not been firmly established in TBI. To date, there is no consensus on the use of the NWT among NCC units and systematic studies are scarce. Thus, additional studies evaluating the role of the NWT in clinical decision-making are needed. Multimodal NCC monitoring may be an adjunct in assessing in which TBI patients the NWT can be safely performed. At present, the NWT remains the golden standard for clinical monitoring and detection of neurological changes in NCC and could be considered in TBI patients with stable baseline ICP and CPP readings. The focus of the present review is an overview of the existing literature on the role of the NWT as a clinical monitoring tool

  6. Theory of mind impairment in patients with behavioural variant fronto-temporal dementia (bv-FTD) increases caregiver burden.

    Science.gov (United States)

    Brioschi Guevara, Andrea; Knutson, Kristine M; Wassermann, Eric M; Pulaski, Sarah; Grafman, Jordan; Krueger, Frank

    2015-09-01

    Theory of mind (ToM), the capacity to infer the intention, beliefs and emotional states of others, is frequently impaired in behavioural variant fronto-temporal dementia patients (bv-FTDp); however, its impact on caregiver burden is unexplored. National Institute of Neurological Disorders and Stroke, National Institutes of Health. bv-FTDp (n = 28), a subgroup of their caregivers (n = 20) and healthy controls (n = 32). we applied a faux-pas (FP) task as a ToM measure in bv-FTDp and healthy controls and the Zarit Burden Interview as a measure of burden in patients' caregivers. Patients underwent structural MRI; we used voxel-based morphometry to examine relationships between regional atrophy and ToM impairment and caregiver burden. FP task performance was impaired in bv-FTDp and negatively associated with caregiver burden. Atrophy was found in areas involved in ToM. Caregiver burden increased with greater atrophy in left lateral premotor cortex, a region associated in animal models with the presence of mirror neurons, possibly involved in empathy. ToM impairment in bv-FTDp is associated with increased caregiver burden. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. Dose requirements for propofol anaesthesia for dental treatment for autistic patients compared with intellectually impaired patients.

    Science.gov (United States)

    Asahi, Y; Kubota, K; Omichi, S

    2009-01-01

    We had clinical grounds to suspect that patients with autism had greater propofol requirements during dental procedures than patients with intellectual impairment without autism. This hypothesis was tested by an audit of a standard anaesthetic technique. The audit was approved by our Hospital Ethics Committee. We compared the propofol requirements and effect using a standardised protocol during dental treatment in 56 autistic patients (age range three to 35 years) and 56 intellectually impaired patients (age range four to 42 years). Patients in each disability group were divided into three subgroups by age: six years or younger, seven to 19 years and 20 years or older. Combative patients received oral midazolam premedication, other patients received a single intravenous bolus of midazolam at induction. Otherwise, standardised propofol boluses and infusion were the only anaesthetic agents used. The propofol infusion rates of the intellectually impaired group showed significant decline with age (propofol rate of requirement mg x kg(-1) x h(-1), mean [SD]): 19 years group 8.5 (2.4) (P = 0.001 cf autism group than in the intellectual disability group, and the proportion of the cases where bolus propofol administration was needed after induction was significantly higher in the autistic patient group than in the intellectually impaired patients (P dental treatment compared with intellectually impaired patients.

  8. The patient journey of adults with hearing impairment: the patients' views.

    Science.gov (United States)

    Manchaiah, V K C; Stephens, D; Meredith, R

    2011-06-01

    The term 'patient journey' refers to the experiences and processes the patient goes through during the course of a disease and its treatment. The study explores the perspectives of adults with acquired hearing impairment and to further develop the patient journey template based on the Ida model. Qualitative approach using thematic analysis and process mapping. Support groups of people with hearing impairment. Thirty-two adults with acquired hearing impairment from two hearing impaired groups in Wales. All were hearing aid users. Participants worked in small groups to describe their experiences through hearing loss. These data were used to develop a template of the patients' perspective of the journey. This was then compared with the perspective of professionals, and a 'patient journey template for adults with acquired hearing impairment' was developed. This template identifies seven main phases as follows: (i) pre-awareness; (ii) awareness; (iii) movement; (iv) diagnostics; (v) rehabilitation; (vi) self-evaluation; and (vii) resolution. The study identified a number of new components. The self-evaluation component was not defined by professionals and reflects the need for patients to consider the costs, benefits and alternatives to the approach provided by audiologists. It is important for audiologists to be aware of this. The study highlighted the differences and commonalities in perspectives of professionals and patients. Use of the patient journey can help clinicians to understand the unique experiences their patients go through help them to develop patient-centred treatment. © 2011 Blackwell Publishing Ltd.

  9. Impaired body image in patients with multiple sclerosis.

    Science.gov (United States)

    Pfaffenberger, N; Gutweniger, S; Kopp, M; Seeber, B; Stürz, K; Berger, T; Günther, V

    2011-09-01

    Despite the growing research on body image disturbances in chronically ill patients, reports of such disturbances in patients with multiple sclerosis (MS) are scarce. The aim of this study was to assess the occurrence of different aspects of body image disturbances in patients with MS, taking into account the disability status as well as depressive symptoms. Forty patients with MS and 28 healthy controls were investigated with questionnaires assessing attractiveness/self-confidence, accentuation of external appearance, worries about possible physical deficits, sexual problems, vitality and depressive symptoms. In MS patients, medical parameters like the expanded disability status were assessed too. In comparison with healthy controls, the MS patients, being although only mildly disabled and in a quite stable mood, reported significantly higher worries about physical deficits, described a significantly worse body appraisal and significantly more sexual problems. While female MS patients predominantly suffered from worries concerning physical deficits and feelings of being less attractive, sexual problems were of particular concern in male MS patients. Even mildly impaired MS patients who are not markedly depressed have to deal with problems of body image. Improvement of body image perception in MS patients taking gender-specific differences into account represents a promising area of future psychological research. © 2011 John Wiley & Sons A/S.

  10. Neurological complications in chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Ria Arnold

    2016-10-01

    Full Text Available Patients with chronic kidney disease (CKD are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

  11. Lumbar spine and total-body dual-energy X-ray absorptiometry in children with severe neurological impairment and intellectual disability: a pilot study of artefacts and disrupting factors

    Energy Technology Data Exchange (ETDEWEB)

    Mergler, S.; Rieken, R.; Evenhuis, H.M.; Penning, C. [Erasmus University Medical Centre, Intellectual Disability Medicine, Department of General Practice, PO Box 2040, CA, Rotterdam (Netherlands); Tibboel, D. [Erasmus University Medical Centre, Department of Pediatric Surgery, Rotterdam (Netherlands); Rijn, R.R. van [Academic Medical Centre, Department of Radiology, Amsterdam (Netherlands)

    2012-05-15

    Children with severe neurological impairment and intellectual disability (ID) are susceptible for developing low bone mineral density (BMD) and fractures. BMD is generally measured with dual-energy X-ray absorptiometry (DXA). To describe the occurrence of factors that may influence the feasibility of DXA and the accuracy of DXA outcome in children with severe neurological impairment and ID. Based on literature and expert opinion, a list of disrupting factors was developed. Occurrence of these factors was assessed in 27 children who underwent DXA measurement. Disrupting factors that occurred most frequently were movement during measurement (82%), aberrant body composition (67%), small length for age (56%) and scoliosis (37%). The number of disrupting factors per child was mean 5.3 (range 1-8). No correlation was found between DXA outcomes and the number of disrupting factors. Factors that may negatively influence the accuracy of DXA outcome are frequently present in children with severe neurological impairment and ID. No systematic deviation of DXA outcome in coherence with the amount of disrupting factors was found, but physicians should be aware of the possible influence of disrupting factors on the accuracy of DXA. (orig.)

  12. Preoperative magnetic resonance imaging is associated with baseline neurological status and can predict postoperative recovery in patients with cervical spondylotic myelopathy.

    Science.gov (United States)

    Arvin, Babak; Kalsi-Ryan, Sukhvinder; Mercier, David; Furlan, Julio C; Massicotte, Eric M; Fehlings, Michael G

    2013-06-15

    A blinded observational study of consecutive patients, prospectively enrolled and followed up to 1 year postoperatively. To assess whether quantitative assessment of preoperative magnetic resonance imaging (MRI) predicts baseline patient status and postoperative neurological recovery. Factors that can predict neurological recovery in patients with cervical spondylotic myelopathy (CSM) postoperatively are of great interest. Currently, the literature regarding the significance of MRI signal changes in relation to prognosis is inconsistent and conflicting. A total of 57 consecutive patients with CSM were studied preoperatively and 1 year postoperatively. Modified Japanese Orthopaedic Association (mJOA), Nurick Grade, SF-36, neck disability index, 30-meter walk cadence (Wc) and time (Wt), grip strength, and Berg Balance Scale were administered at baseline and 1 year after surgery. Preoperative status and postoperative recovery were assessed in relation to quantitative MRI measurements pre- and postoperatively using univariate and multivariate analysis. Low T1 signal change preoperatively was associated with a lower mJOA (P = 0.0030), higher Nurick Grade (P = 0.0298), decreased grip (P = 0.0152), impaired Wt, Wc (P≤ 0.0001) and poor Berg Balance Scale (P = 0.0005) at baseline. Focal high T2 signal was associated with lower mJOA scores and higher Nurick Grade compared with diffuse T2 (P = 0.0035 P = 0.0079) or no T2 signal (P = 0.0680 P = 0.0122). Preoperative segmentation of T2 signal, showed a significant increase in Wt, Wc, and Berg Balance Scale (P = 0.0266; P = 0.0167; P = 0.0042). Preoperative T1 signal was associated with lower postoperative grip (P = 0.0260), greater Wt, Wc (P = 0.0360, P = 0.0090). Preoperative focal T2 signal had a significant association with poorer postoperative Wt, Wc (P = 0.0220) and Nurick Grade (P = 0.0230). Preoperative maximal cord compromise was negatively correlated with postoperative SF-36 mental score (P = 0.0130). MRI signal

  13. Efficacy of Cellex in patients with mild cognitive impairment

    Directory of Open Access Journals (Sweden)

    B. A. Abusueva

    2016-01-01

    Full Text Available Background. Cognitive disorders may often lead to professional invalidisation and increasing dependence on the external assistance in every day life. Identification of patients with preserved intellectual status and social adaptation but with mild cognitive impairment (MCI is considered to be an effective measure. MCI detection and timely initiation of treatment in most patients is essential to delay the onset of severe dementia.Objective. Investigating influence of Cellex in patients with chronic cerebral ischemia and MCI.Materials and methods. As a part of non-interventional observational comparative study we evaluated the results of Cellex administration in 90 patients with MCI. Patients were divided into 2 groups. Patients from both groups received 1 course of 10 subcutaneous injections of Cellex drug at the dose of 1 mL, and patients from group 2 received two identical courses with an interval of two months. The survey, which included psychometric testing by using special questionnaires (Mini-Mental State Examination, “Frontal Assessment Battery” and “Clock Drawing” tests, Schulte test was performed before treatment, and at months 1 and 2 after its completion.Results. Neuropsychological examination revealed improvement in the patients state, more pronounced after the 2nd course of therapy.Discussion. Our results provide a basis for using Cellex in patients with chronic cerebral ischemia and MCI, allowing to proceede with further studies on the optimal dosage of that drug.

  14. Detection of meningococcal meningitis in cerebrospinal fluid of patients with neurological disorders in government hospitals of Karachi.

    Science.gov (United States)

    Taj, Aneela; Jamil, Nusrat

    2016-11-01

    To investigate the microbiological yield from the apparently transparent cerebrospinal fluid samples of in-patients with suspected neurological disorders. Samples of CSF were collected from Neurology and Neurosurgery Wards of the Jinnah Postgraduate Medical Centre and the Civil Hospital, Karachi, from December 2007 to March 2012, and comprised cerebrospinal fluid samples collected from neurologically compromised patients through lumbar puncture. The processing of the samples was done at the Department of Microbiology, University of Karachi. Moreover, 10ml of each sample was streaked separately on different culture media, i.e. Nutrient Agar, Blood Agar and Chocolate Agar, for the isolation of both aerobic and anaerobic bacteria. Of the 92 samples, bacterial meningitis was found in 21(22.8%), whereas 71(77.1%) samples did not yield any bacterial aetiology. Besides, 1(4.7%) sample revealed Gram-positive rods of L. monocytogenes while Gram-negative kidney-shaped N. meningitidis was found in 20(95.24%) samples. Present study highlighted that apparently clear CSF samples predominantly revealed meningococcal meningitis. It is important to note that extracellular bacterial growth in CSF is not always the primary goal of pathogenesis, therefore establishing a fact that turbidity of CSF is not the cardinal symptom for the diagnosis of bacterial meningitis.

  15. Psoriasis: is the impairment to a patient's life cumulative?

    Science.gov (United States)

    Kimball, A B; Gieler, U; Linder, D; Sampogna, F; Warren, R B; Augustin, M

    2010-09-01

    Psoriasis is associated with significant physical and psychological burden affecting all facets of a patient's life--relationships, social activities, work and emotional wellbeing. The cumulative effect of this disability may be self-perpetuating social disconnection and failure to achieve a 'full life potential' in some patients. Health-related quality of life studies have quantified the burden of psoriasis providing predominantly cross-sectional data and point-in-time images of patients' lives rather than assessing the possible cumulative disability over a patient's lifetime. However, social and economic outcomes indicate there are likely negative impacts that accumulate over time. To capture the cumulative effect of psoriasis and its associated co-morbidities and stigma over a patient's life course, we propose the concept of 'Cumulative Life Course Impairment' (CLCI). CLCI results from an interaction between (A) the burden of stigmatization, and physical and psychological co-morbidities and (B) coping strategies and external factors. Several key aspects of the CLCI concept are supported by data similar to that used in health-related quality of life assessments. Future research should focus on (i) establishing key components of CLCI and determining the mechanisms of impairment through longitudinal or retrospective case-control studies, and (ii) assessing factors that put patients at increased risk of developing CLCI. In the future, this concept may lead to a better understanding of the overall impact of psoriasis, help identify more vulnerable patients, and facilitate more appropriate treatment decisions or earlier referrals. To our knowledge, this is a first attempt to apply and develop concepts from 'Life Course Epidemiology' to psoriasis research.

  16. Effect of the cognitive rehabilitation in patients with mild cognitive impairment and identified brain atrophy

    Directory of Open Access Journals (Sweden)

    Petr Nilius

    2015-12-01

    Full Text Available Aim: The main objective of this study was to analyse the development of cognitive functions and effect of cognitive rehabilitation on patients diagnosed with mild cognitive impairment (MCI, as a result of brain atrophy. Design: A quantitative non-randomized intervention study on a control sample of patients. Methods: The effect was observed in a group of patients ranging 59-91 years of age (N = 36. Only patients fulfilling the diagnostic criteria of mild cognitive disorder diagnosed by tomography (CT that had undergone 22 sessions, were involved in the clinical sample (n = 21. The control sample (n = 15 consisted of patients without any neurological diagnosis and who did not undergo cognitive sessions. Results: The effect of cognitive rehabilitation was measured by Addenbrooke's cognitive test, revised in 2010 (ACE-R; affective changes were measured by Beck´s scale of depression BDI-2 and by a scale used to detect anxiety and depression: the Hospital Anxiety and Depression Scale (HADS. Subjective change and improvement were observed using the Clinical Global Impression (CGI psychiatric scale. Changes in the functional state of patients were measured by means of the activities of daily living scale (ADL, including the instrumental version (IADL. The effect was examined in the form of entry and output tests, which were verified by statistical analysis, a significant level being p > 0.05. Conclusions: Significant differences in verbal tests and ACE-R were observed in the clinical sample of patients. Some significant changes were observed in the field of affective symptoms, according to the HADS and BDI-2. The clinical sample showed a significant improvement in subjective clinical state (CGI. The ADL and IADL questionnaires seem to have been inadequate for purpose due to their low sensitivity. The effect of cognitive rehabilitation in patients diagnosed with mild cognitive disorder can be seen and verified in comparison with the control sample

  17. Challenges facing palliative neurology practice: A qualitative analysis.

    Science.gov (United States)

    Gofton, T E; Chum, M; Schulz, V; Gofton, B T; Sarpal, A; Watling, C

    2018-02-15

    This study aimed to develop a conceptual understanding of the specific characteristics of palliative care in neurology and the challenges of providing palliative care in the setting of neurological illness. The study was conducted at London Health Sciences Centre in Canada using grounded theory methodology. Qualitative thematic analysis was applied to focus group (health care providers physicians, nursing, allied health, trainees) and semi-structured interview (patient-caregiver dyads) data to explore challenges facing the delivery of palliative care in neurology. Specific characteristics of neurological disease that affect palliative care in neurology were identified: 1) timelines of disease progression, 2) barriers to communication arising from neurologic disease, 3) variability across disease progression, and 4) threat to personhood arising from functional and cognitive impairments related to neurologic disease. Moreover, three key challenges that shaped and complicated palliative care in neurology were identified: 1) uncertainty with respect to prognosis, support availability and disease trajectory, 2) inconsistency in information, attitudes and skills among care providers, care teams, caregivers and families, and 3) existential distress specific to neurological disease, including emotional, psychological and spiritual distress resulting from loss of function, autonomy and death. These challenges were experienced across groups, but manifested themselves in different ways for each group. Further research regarding prognosis, improved identification of patients with palliative care needs, developing an approach to palliative care delivery within neurology and the creation of more robust educational resources for teaching palliative neurology are expected to improve neurologists' comfort with palliative care, thereby enhancing care delivery in neurology. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Perceptions of goal setting in a neurological rehabilitation unit: a qualitative study of patients, carers and staff.

    Science.gov (United States)

    Young, Carolyn A; Manmathan, Gavin P; Ward, James C R

    2008-03-01

    To explore perceptions of goal setting from the perspective of patients, lay carers and rehabilitation staff. Semi-structured interviews analysed independently by 2 researchers using content analysis. Neurological rehabilitation inpatient unit for adults. Four samples of 10 subjects each, comprising: (i) inpatients, (ii) patients discharged within the last 2 years, (iii) lay carers, (iv) staff. Patients, carers and staff had participated in at least 2 goal setting meetings, patients had any non-progressive neurological condition causing disability and need for inpatient rehabilitation. Goal setting meeting. Themes identified independently before results triangulated to produce consensus list presented as frequency tables across 4 subject groups. Quotations from narratives used to clarify themes. All 4 groups considered goal setting to be beneficial, increasing motivation and providing reassurance for patients and carers. Carers found goal setting alleviated some anxieties and assisted active problem-solving coping strategies. Staff believed that goal setting made their practice more focused and collaborative because they were working towards stated and shared goals. Specific improvements were suggested regarding education, nature of goals, conduct of meetings and feedback. Goal setting appears to provide psychological benefits to patients and carers.

  19. Paramedic assessment of pain in the cognitively impaired adult patient

    Directory of Open Access Journals (Sweden)

    Lord Bill

    2009-10-01

    Full Text Available Abstract Background Paramedics are often a first point of contact for people experiencing pain in the community. Wherever possible the patient's self report of pain should be sought to guide the assessment and management of this complaint. Communication difficulty or disability such as cognitive impairment associated with dementia may limit the patient's ability to report their pain experience, and this has the potential to affect the quality of care. The primary objective of this study was to systematically locate evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults and to identify those that have been recommended for use by paramedics. Methods A systematic search of health databases for evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults was undertaken using specific search criteria. An extended search included position statements and clinical practice guidelines developed by health agencies to identify evidence-based recommendations regarding pain assessment in older adults. Results Two systematic reviews met study inclusion criteria. Weaknesses in tools evaluated by these studies limited their application in assessing pain in the population of interest. Only one tool was designed to assess pain in acute care settings. No tools were located that are designed for paramedic use. Conclusion The reviews of pain assessment tools found that the majority were developed to assess chronic pain in aged care, hospital or hospice settings. An analysis of the characteristics of these pain assessment tools identified attributes that may limit their use in paramedic practice. One tool - the Abbey Pain Scale - may have application in paramedic assessment of pain, but clinical evaluation is required to validate this tool in the paramedic practice setting. Further research is recommended to evaluate the Abbey Pain Scale and to

  20. Clinical applicability of nursing outcomes in the evolution of orthopedic patients with Impaired Physical Mobility

    National Research Council Canada - National Science Library

    da Silva, Marcos Barragan; Almeida, Miriam de Abreu; Panato, Bruna Paulsen; Siqueira, Ana Paula de Oliveira; da Silva, Mariana Palma; Reisderfer, Letícia

    2015-01-01

    ...) in the evolution of orthopedic patients with Impaired Physical Mobility longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated...

  1. Abstract Word Definition in Patients with Amnestic Mild Cognitive Impairment

    Directory of Open Access Journals (Sweden)

    Soo Ryon Kim

    2015-01-01

    Full Text Available The aims of this study were to investigate concrete and abstract word definition ability (1 between patients with amnestic mild cognitive impairment (aMCI and normal adults and (2 between the aMCI subtypes (i.e., amnestic single-domain MCI and amnestic multidomain MCI; asMCI and amMCI and normal controls. The 68 patients with aMCI (29 asMCI and 39 amMCI and 93 age- and education-matched normal adults performed word definition tasks composed of five concrete (e.g., train and five abstract nouns (e.g., jealousy. Task performances were analyzed on total score, number of core meanings, and number of supplementary meanings. The results were as follows. First, the aMCI patients scored significantly poorer than the normal controls in only abstract word definition. Second, both subtypes of aMCI performed worse than the controls in only abstract word definition. In conclusion, a definition task of abstract rather than concrete concepts may provide richer information to show semantic impairment of aMCI.

  2. Abstract Word Definition in Patients with Amnestic Mild Cognitive Impairment

    Science.gov (United States)

    Kim, Soo Ryon; Baek, Min Jae; Kim, HyangHee

    2015-01-01

    The aims of this study were to investigate concrete and abstract word definition ability (1) between patients with amnestic mild cognitive impairment (aMCI) and normal adults and (2) between the aMCI subtypes (i.e., amnestic single-domain MCI and amnestic multidomain MCI; asMCI and amMCI) and normal controls. The 68 patients with aMCI (29 asMCI and 39 amMCI) and 93 age- and education-matched normal adults performed word definition tasks composed of five concrete (e.g., train) and five abstract nouns (e.g., jealousy). Task performances were analyzed on total score, number of core meanings, and number of supplementary meanings. The results were as follows. First, the aMCI patients scored significantly poorer than the normal controls in only abstract word definition. Second, both subtypes of aMCI performed worse than the controls in only abstract word definition. In conclusion, a definition task of abstract rather than concrete concepts may provide richer information to show semantic impairment of aMCI. PMID:26347214

  3. Impairment of visuospatial/visuoconstructional skills in multiple sclerosis patients: the correlation with regional lesion load and subcortical atrophy.

    Science.gov (United States)

    Marasescu, R; Cerezo Garcia, M; Aladro Benito, Y

    2016-04-01

    About 20% to 26% of patients with multiple sclerosis (MS) show alterations in visuospatial/visuoconstructive (VS-VC) skills even though temporo-parieto-occipital impairment is a frequent finding in magnetic resonance imaging. No studies have specifically analysed the relationship between these functions and lesion volume (LV) in these specific brain areas. To evaluate the relationship between VS-VC impairment and magnetic resonance imaging temporo-parieto-occipital LV with subcortical atrophy in patients with MS. Of 100 MS patients undergoing a routine neuropsychological evaluation, 21 were selected because they displayed VS-VC impairments in the following tests: Incomplete picture, Block design (WAIS-III), and Rey-Osterrieth complex figure test. We also selected 13 MS patients without cognitive impairment (control group). Regional LV was measured in FLAIR and T1-weighted images using a semiautomated method; subcortical atrophy was measured by bicaudate ratio and third ventricle width. Partial correlations (controlling for age and years of school) and linear regression analysis were employed to analyse correlations between magnetic resonance imaging parameters and cognitive performance. All measures of LV and brain atrophy were significantly higher in patients with cognitive impairment. Regional LV, bicaudate ratio, and third ventricle width are significantly and inversely correlated with cognitive performance; the strongest correlation was between third ventricle width and VC performance (Block design: P=.001; Rey-Osterrieth complex figure: P<.000). In the multivariate analysis, third ventricle width only had a significant effect on performance of VC tasks (Block design: P=.000; Rey-Osterrieth complex figure: P=.000), and regional FLAIR VL was linked to the VS task (Incomplete picture; P=.002). Measures of subcortical atrophy explain the variations in performance on visuocostructive tasks, and regional FLAIR VL measures are linked to VS tasks. Copyright © 2015

  4. Selective impairments of motor sequence learning in multiple sclerosis patients with minimal disability.

    Science.gov (United States)

    Tacchino, Andrea; Bove, Marco; Roccatagliata, Luca; Luigi Mancardi, Giovanni; Uccelli, Antonio; Bonzano, Laura

    2014-10-17

    Patients with Multiple Sclerosis (PwMS) with severe sensorimotor and cognitive deficits show reduced ability in motor sequence learning. Conversely, in PwMS with minimal disability (EDSS≤2), showing only subtle neurological impairments and no particular deficits in everyday life activities, motor sequence learning has been poorly addressed. Here, we investigated whether PwMS with minimal disability already show a specific impairment in motor sequence learning and which component of this process can be first affected in MS. We implemented a serial reaction time task based on thumb-to-finger opposition movements in response to visual stimuli. Each session included 14 blocks of 120 stimuli presented randomly or in ten repetitions of a 12-item sequence. Random (R) and sequence (S) blocks were temporally alternated (R1, R2, S1/S5, R3, S6/S10, R4). Random blocks were designed to evaluate the motor component; sequence blocks, beside the motor component, allowed to discriminate the procedural performance. Twenty-two PwMS and 22 control healthy subjects were asked to perform the task under implicit or explicit instructions (11 subjects for each experimental condition). PwMS with minimal disability improved motor performance in random blocks reducing response time with practice with a trend similar to control subjects, suggesting that short-term learning of simple motor tasks is nearly preserved at this disease stage. Conversely, they found difficulties in sequence-specific learning in implicit and explicit condition, with more pronounced impairment in the implicit condition. These findings could suggest an involvement of different circuits in implicit and explicit sequence learning that could deteriorate at different disease stages. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    Science.gov (United States)

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-06-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1-5) and 6 to 20 (area 6-20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function.

  6. Breakfast improves cognitive function in cirrhotic patients with cognitive impairment.

    Science.gov (United States)

    Vaisman, Nachum; Katzman, Helena; Carmiel-Haggai, Michal; Lusthaus, Michal; Niv, Eva

    2010-07-01

    Cognitive disturbances are relatively common in patients with liver disease. High protein load precipitates hepatic encephalopathy in cirrhotic patients. Minimal hepatic encephalopathy (MHE) is a prevalent neurocognitive complication of cirrhosis. Because the influence of nutritional factors on the progression of cognitive impairment has not been explored in depth, this study aimed to investigate the effect on cognition of acute metabolic changes induced by breakfast consumption. Twenty-one subjects (10 women) with Child A cirrhosis and 21 age- and sex-matched healthy controls were enrolled. Patients and controls were divided into 2 groups: those receiving a breakfast of 500 kcal and 21 g protein and those receiving no breakfast. Serum ammonia concentrations and cognitive functions were studied (Mindstreams; NeuroTrax, Fresh Meadows, NY) before and 2 h after breakfast. A mixed model was used to analyze the data. At baseline, cirrhotic patients had significantly lower total scores and significantly lower subscores (P cognitive score) in 4 of 7 cognitive categories, which is indicative of MHE. Patients with hyperammonemia (>85 mug/dL) scored significantly lower for attention than did patients with normal serum ammonia concentrations (P breakfast consumption with regard to attention and executive functions (P breakfast consumption, despite an increase in serum ammonia, healthy controls who continued to fast performed better. Chronic hyperammonemia may negatively affect attention. Eating breakfast improves attention and executive functions of patients with MHE. Prolonged periods of starvation may be partly responsible for these changes. This trial was registered at clinicaltrials.gov as NCT01083446.

  7. Vitamin B12 supplementation and cognitive scores in geriatric patients with Mild Cognitive Impairment

    Directory of Open Access Journals (Sweden)

    Komal Chauhan

    2016-09-01

    Full Text Available Background: The Neurodegenerative diseases are increasingly affecting the elderly with a severe impact on their brain health. There is a wide gap in supplementation based studies for increasing the cognition levels of the geriatric population, especially in developing countries like India which are at extreme risk of developing neurological disorders. And recently Vitamin B12 has drawn considerable attention due to its ability to improve the cognitive status. Current literature has linked the possibility of alleviating neurological disorders in the elderly with effective vitamin B12 management. Abundant animal and human models have proved that supplementation of vitamin B12 is beneficial for the restoration of cognitive functions. Objective: To supplement vitamin B12 deficient mild cognitively impaired geriatric patients with injectable doses of vitamin B12 followed by impact evaluation. Methods: Screening of the mild cognitively impaired patients was carried out using the Mini- Mental State Examination and Yamaguchi Fox Pigeon Imitation test. Baseline information was elicited from the patients residing in urban Vadodara (a district in the state of Gujarat, India. This included socio-demographic, medical and drug history, anthropometric and physical activity pattern, in addition to biochemical parameters comprising of serum vitamin B12 and glycated haemoglobin profile. A sub-sample of 60 patients with mild cognitive impairment (MCI demonstrating severe vitamin B12 deficiency were conveniently enrolled for injectable doses of Vitamin B 12 in the dosage of 1,000 µg every day for one week, followed by 1,000 µg every week for 4 weeks & finishing with 1,000 µg for the remaining 4 months. An intervention six- month after the experiment with all the parameters were elicited. Results: Vitamin B12 supplementation resulted in a significant (p<0.001 improvement in the MMSE scores of the patients with a rise of 9.63% in the total patients. Gender

  8. Fatigue versus activity-dependent fatigability in patients with central or peripheral motor impairments.

    Science.gov (United States)

    Dobkin, Bruce H

    2008-01-01

    In the rehabilitation literature, fatigue is a common symptom of patients with any neurological impairment when defined as a subjective lack of physical and mental energy that interferes with usual activities. Some complaints may, however, arise from fatigability , an objective decline in strength as routine use of muscle groups proceeds. By this refined definition of fatigue, exercise or sustained use reduces the ability of muscles to produce force or power, regardless of whether the task can be sustained. Fatigability may be masked clinically because (1) the degree of weakening is not profound, (2) activity-induced weakness rapidly lessens with cessation of exertion, and (3) clinicians rarely test for changes in strength after repetitive movements to objectively entertain the diagnosis. The repetitive movements that induce fatigability during daily activities are an iterative physiological process that depends on changing states induced by activation of spared central and peripheral neurons and axons and compromised muscle. Fatigability may be especially difficult to localize in patients undergoing neurorehabilitation, in part because no finite boundary exists between the central and peripheral components of motor reserve and endurance. At the bedside, however, manual muscle testing before and after repetitive movements could at least put some focus on the presence of fatigability in any patient with motor impairments and related disabilities. Reliable measures of fatigability beyond a careful clinical examination, such as physiological changes monitored by cerebral functional neuroimaging techniques and more standardized central and peripheral electrical and magnetic stimulation paradigms, may help determine the mechanisms of activity-dependent weakening and lead to specific therapies. Testable interventions to increase motor reserve include muscle strengthening and endurance exercises, varying the biomechanical requirements of repetitive muscle contractions

  9. Cardiomyopathy in neurological disorders.

    Science.gov (United States)

    Finsterer, Josef; Stöllberger, Claudia; Wahbi, Karim

    2013-01-01

    According to the American Heart Association, cardiomyopathies are classified as primary (solely or predominantly confined to heart muscle), secondary (those showing pathological myocardial involvement as part of a neuromuscular disorder) and those in which cardiomyopathy is the first/predominant manifestation of a neuromuscular disorder. Cardiomyopathies may be further classified as hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, or unclassified cardiomyopathy (noncompaction, Takotsubo-cardiomyopathy). This review focuses on secondary cardiomyopathies and those in which cardiomyopathy is the predominant manifestation of a myopathy. Any of them may cause neurological disease, and any of them may be a manifestation of a neurological disorder. Neurological disease most frequently caused by cardiomyopathies is ischemic stroke, followed by transitory ischemic attack, syncope, or vertigo. Neurological disease, which most frequently manifests with cardiomyopathies are the neuromuscular disorders. Most commonly associated with cardiomyopathies are muscular dystrophies, myofibrillar myopathies, congenital myopathies and metabolic myopathies. Management of neurological disease caused by cardiomyopathies is not at variance from the same neurological disorders due to other causes. Management of secondary cardiomyopathies is not different from that of cardiomyopathies due to other causes either. Patients with neuromuscular disorders require early cardiologic investigations and close follow-ups, patients with cardiomyopathies require neurological investigation and avoidance of muscle toxic medication if a neuromuscular disorder is diagnosed. Which patients with cardiomyopathy profit most from primary stroke prevention is unsolved and requires further investigations. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. An Actor-Partner Interdependence Model of Acquired Brain Injury Patient Impairments and Caregiver Psychosocial Functioning

    DEFF Research Database (Denmark)

    Perrin, Paul B; Norup, Anne; Caracuel, Alfonso

    2017-01-01

    OBJECTIVE: The purpose of this study was to use actor-partner interdependence modeling (APIM) to examine the simultaneous effects of both acquired brain injury (ABI) patient and caregiver ratings of patient impairments on both patient and caregiver ratings of caregiver psychosocial dysfunction. M...... are patients' views of their own impairments, pointing to caregivers' interpretations of their patients' impairments as a primary target for cognitive behavioral interventions....

  11. Glutamate receptor antibodies in neurological diseases: anti-AMPA-GluR3 antibodies, anti-NMDA-NR1 antibodies, anti-NMDA-NR2A/B antibodies, anti-mGluR1 antibodies or anti-mGluR5 antibodies are present in subpopulations of patients with either: epilepsy, encephalitis, cerebellar ataxia, systemic lupus erythematosus (SLE) and neuropsychiatric SLE, Sjogren's syndrome, schizophrenia, mania or stroke. These autoimmune anti-glutamate receptor antibodies can bind neurons in few brain regions, activate glutamate receptors, decrease glutamate receptor's expression, impair glutamate-induced signaling and function, activate blood brain barrier endothelial cells, kill neurons, damage the brain, induce behavioral/psychiatric/cognitive abnormalities and ataxia in animal models, and can be removed or silenced in some patients by immunotherapy.

    Science.gov (United States)

    Levite, Mia

    2014-08-01

    Glutamate is the major excitatory neurotransmitter of the Central Nervous System (CNS), and it is crucially needed for numerous key neuronal functions. Yet, excess glutamate causes massive neuronal death and brain damage by excitotoxicity--detrimental over activation of glutamate receptors. Glutamate-mediated excitotoxicity is the main pathological process taking place in many types of acute and chronic CNS diseases and injuries. In recent years, it became clear that not only excess glutamate can cause massive brain damage, but that several types of anti-glutamate receptor antibodies, that are present in the serum and CSF of subpopulations of patients with a kaleidoscope of human neurological diseases, can undoubtedly do so too, by inducing several very potent pathological effects in the CNS. Collectively, the family of anti-glutamate receptor autoimmune antibodies seem to be the most widespread, potent, dangerous and interesting anti-brain autoimmune antibodies discovered up to now. This impression stems from taking together the presence of various types of anti-glutamate receptor antibodies in a kaleidoscope of human neurological and autoimmune diseases, their high levels in the CNS due to intrathecal production, their multiple pathological effects in the brain, and the unique and diverse mechanisms of action by which they can affect glutamate receptors, signaling and effects, and subsequently impair neuronal signaling and induce brain damage. The two main families of autoimmune anti-glutamate receptor antibodies that were already found in patients with neurological and/or autoimmune diseases, and that were already shown to be detrimental to the CNS, include the antibodies directed against ionotorpic glutamate receptors: the anti-AMPA-GluR3 antibodies, anti-NMDA-NR1 antibodies and anti-NMDA-NR2 antibodies, and the antibodies directed against Metabotropic glutamate receptors: the anti-mGluR1 antibodies and the anti-mGluR5 antibodies. Each type of these anti

  12. Psychogenic nonepileptic spells in chronic epilepsy patients with moderate cognitive impairment: the need for video EEG monitoring for adequate diagnosis.

    Science.gov (United States)

    Robinson, Diana Mungall; Kirmani, Batool F

    2014-01-01

    The objective of our study was to emphasize the importance of intensive video EEG monitoring in patients with a well-established diagnosis of epilepsy with moderate cognitive impairment. The idea was to diagnose new onset frequent atypical events prompting the need for frequent emergency room and clinic visits and hospital admissions. Retrospective chart reviews were conducted on patients with chronic epilepsy with moderate cognitive impairment who had an increased incidence of new onset episodes different from the baseline seizures. Data were acquired from electronic medical records. The hospital's Institutional Review Board gave approval for this retrospective analysis of patient records. We retrospectively analyzed data from three patients with an established diagnosis of epilepsy. Extensive chart reviews were performed with emphasis on type and duration of epilepsy and description of baseline seizures and description of new events. There were two men and one woman with moderate cognitive impairment. One subject had generalized epilepsy and other two had temporal lobe epilepsy. The patients were on an average of two to three antiepileptic medicines. The duration of follow-up in our neurology clinic ranged from 9 months to 5 years. The occurrence of increased frequency of these atypical events as described by the caregivers, despite therapeutic anticonvulsant levels, prompted the need for 5-day intensive video EEG monitoring. New atypical spells were documented in all three patients and the brain waves were normal during those episodes. The diagnosis of pseudoseizures was made based on the data acquired during the epilepsy monitoring unit stay. Our data analysis showed that intensive video EEG monitoring is an important tool to evaluate change in frequency and description of seizures even in cognitively impaired patients with an established diagnosis of epilepsy for adequate seizure management.

  13. Elevated Serum Insulin-Like Growth Factor 1 Levels in Patients with Neurological Remission after Traumatic Spinal Cord Injury.

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    Arash Moghaddam

    Full Text Available After traumatic spinal cord injury, an acute phase triggered by trauma is followed by a subacute phase involving inflammatory processes. We previously demonstrated that peripheral serum cytokine expression changes depend on neurological outcome after spinal cord injury. In a subsequent intermediate phase, repair and remodeling takes place under the mediation of growth factors such as Insulin-like Growth Factor 1 (IGF-1. IGF-1 is a promising growth factor which is thought to act as a neuroprotective agent. Since previous findings were taken from animal studies, our aim was to investigate this hypothesis in humans based on peripheral blood serum. Forty-five patients after traumatic spinal cord injury were investigated over a period of three months after trauma. Blood samples were taken according to a fixed schema and IGF-1 levels were determined. Clinical data including AIS scores at admission to the hospital and at discharge were collected and compared with IGF-1 levels. In our study, we could observe distinct patterns in the expression of IGF-1 in peripheral blood serum after traumatic spinal cord injury regardless of the degree of plegia. All patients showed a marked increase of levels seven days after injury. IGF-1 serum levels were significantly different from initial measurements at four and nine hours and seven and 14 days after injury, as well as one, two and three months after injury. We did not detect a significant correlation between fracture and the IGF-1 serum level nor between the quantity of operations performed after trauma and the IGF-1 serum level. Patients with clinically documented neurological remission showed consistently higher IGF-1 levels than patients without neurological remission. This data could be the base for the establishment of animal models for further and much needed research in the field of spinal cord injury.

  14. Risk of psychiatric and neurological diseases in patients with workplace mobbing experience in Germany: a retrospective database analysis.

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    Kostev, Karel; Rex, Juliana; Waehlert, Lilia; Hog, Daniela; Heilmaier, Christina

    2014-01-01

    The number of mobbing experiences recorded has increased during recent years and it has now been established as global phenomenon among the working population. The goal of our study was to analyze the incidence of certain neurologic and psychiatric diseases as a consequence of mobbing as compared with a control group and to examine the possible influence of previous diseases that occurred within one year before the first mobbing documentation on the incidence of mobbing. We used a large database (IMS® Disease Analyzer, Germany) to collect data from general practitioners in Germany from 01/2003 until 12/2012. Based on age, gender, and health insurance, patients with experience of mobbing were matched with a control group of patients who had not reported workplace mobbing and who were being treated by the same physicians. At first, diseases that occurred within one year before the bullying experience took place ("index date") were noted and compared to a control group of similar composition in terms of gender, age, and health insurance. Subsequently, the prevalence of depression, anxiety, somatoform disorders, and sleep disorders following experiences of mobbing were determined. After adjustment to take into account the odds of bullying, the ratios of these diseases were assessed using a logistic regression model. The study population consisted of n=2,625 patients and n=2,625 controls, of which 33% were men. The number of cases of bullying documented rose continuously from 2003 to 2011 and remained high in 2012. Those who would later become victims of mobbing demonstrated a considerably higher prevalence of diseases in general - these diseases were not confined to the neurologic-psychiatric spectrum. Following experiences of bullying, depression, anxiety, somatoform disorders, and sleep disorders were significantly more prevalent than in the control group (for all, pmobbing has occurred, which underlines the importance of supporting (chronically) ill patients to

  15. Cognitive rehabilitation in patients with mild cognitive impairment.

    Science.gov (United States)

    Kurz, Alexander; Pohl, Corina; Ramsenthaler, Michaela; Sorg, Christian

    2009-02-01

    To explore the benefits of a multi-component cognitive rehabilitation programme in patients with mild cognitive impairment (MCI). Patients with MCI (n = 18) and patients with mild dementia in Alzheimer's disease (n = 10) participated in a 4-week cognitive rehabilitation programme in a day clinic setting. The intervention was provided in group format and included activity planning, self-assertiveness training, relaxation techniques, stress management, use of external memory aids, memory training, and motor exercise. After 4 weeks, MCI patients showed significant improvements on activities of daily living, mood, verbal and nonverbal episodic memory. In contrast, patients with mild dementia exhibited a non-significant increase in verbal memory but no other changes. MCI subjects allocated to the waiting list control condition (n = 12) showed a significant re-test effect on verbal episodic memory, but no improvement of everyday activities or mood. The study demonstrates that patients with MCI benefit from a multi-component cognitive rehabilitation programme with regard to activities of daily living, mood, and memory performance. (c) 2008 John Wiley & Sons, Ltd.

  16. Neurologic Complications of Celiac Disease

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    J Gordon Millichap

    2004-06-01

    Full Text Available Patients with celiac disease (CD [n=l 11] and controls (n=211 were questioned regarding neurologic disorders, their charts were reviewed, and they received neurologic evaluations, including brain imaging or EEG if indicated, in a study of neurologic complications of CD at Carmel Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.

  17. Predictive value of EndTidalCO2, lung mechanics and other standard parameters for weaning neurological patients from mechanical ventilation

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    Hala A. Mohammad

    2016-01-01

    Conclusion: We concluded that measurements of RSBI, MIP (maximum inspiratory pressure, EndTidalCO2 and dynamic compliance were more accurate predictors of extubation failure in patients with neurological insults than other standard weaning parameters.

  18. A guide to treating gait impairment with prolonged-release fampridine (Fampyra®) in patients with multiple sclerosis.

    Science.gov (United States)

    Ramió-Torrentà, L; Álvarez-Cermeño, J C; Arroyo, R; Casanova-Estruch, B; Fernández, O; García-Merino, J A; Hernández, M A; Izquierdo, G; Martínez-Yélamos, S; Meca, J; Moral, E; Olascoaga, J; Prieto, J M; Saiz, A

    2016-02-09

    Gait impairment, a frequent sign in multiple sclerosis (MS), places a major burden on patients since it results in progressive loss of personal and social autonomy, along with work productivity. This guide aims to provide recommendations on how to evaluate gait impairment and use prolonged-release fampridine (PR-fampridine) as treatment for MS patients with gait impairment in Spain. PR-fampridine dosed at 10mg every 12hours is currently the only drug approved to treat gait impairment in adults with MS. Additionally, PR-fampridine has been shown in clinical practice to significantly improve quality of life (QoL) in patients who respond to treatment. Treatment response can be assessed with the Timed 25-Foot Walk (T25FW) or the 12-item MS Walking Scale (MSWS-12); tests should be completed before and after starting treatment. The minimum time recommended for evaluating treatment response is 2 weeks after treatment onset. Patients are considered responders and permitted to continue the treatment when they demonstrate a decrease in their T25FW time or an increase in MSWS-12 scores. A re-evaluation is recommended at least every 6 months. The SF-36 (Short Form-36) and the MSIS-29 (MS Impact Scale-29) tests are recommended for clinicians interested in performing a detailed QoL assessment. This drug is generally well-tolerated and has a good safety profile. It should be taken on an empty stomach and renal function must be monitored regularly. These recommendations will help ensure safer and more efficient prescription practices and easier management of PR-fampridine as treatment for gait impairment in Spanish adults with MS. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  19. The Application of Neuromuscular Electrical Stimulation Training in Various Non-neurologic Patient Populations: A Narrative Review.

    Science.gov (United States)

    Herzig, David; Maffiuletti, Nicola A; Eser, Prisca

    2015-11-01

    In the last 2 decades, neuromuscular electrical stimulation has been used increasingly in deconditioned patients with the aim of increasing muscle force. Much basic research has been conducted in the area of increasing a muscle's fatigue resistance by neuromuscular electrical stimulation but similarly thorough research with regard to increasing maximal force is missing. Insufficient clinical and basic knowledge exists on the selection of stimulation parameters that will optimize muscle hypertrophy and gains in muscle force. For volitional training, established stimuli for muscle hypertrophy (which more or less parallels maximal muscle force) are muscle tension, metabolic stress, and muscle damage. The present review summarizes findings from clinical and basic research in terms of muscle mechanical as well as acute and chronic physiologic effects of different stimulation protocols, explains the role of the various stimulation parameters in determining the effect of NMES training protocols, and gives clinical recommendations for the choice of stimulation parameters for different patient populations with different training goals, such as increasing muscle force, mass, endurance, or energy consumption. We limit this review to non-neurologic patients, because training goals of neurologic patients are specific to their functional deficits. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  20. [Assessment of the influence of rehabilitation in patients treated in a hospital rehabilitation ward due to consequences of neurological diseases].

    Science.gov (United States)

    Liwocha, Małgorzata; Galus, Krzysztof; Kozak-Szkopek, Elzbieta; Kowal, Roman

    2013-07-01

    THE AIM OF THE STUDY was evaluation effects of rehabilitation in patients with consequences of neurological diseases. The study was conducted in the hospital department of rehabilitation. The study involved group of 30 patients consisting of 12 men aged from 48 to 76 years (mean age 64.3 +/- 7.9), and 18 women aged from 45 to 82 years (mean age 65.4 +/- 13,2). These were patients mostly after stroke, multiple sclerosis or Parkinson's disease enrolled in rehabilitation. TESTS were performed before and after 21 days rehabilitation, using the following scales and ratings: Activities of Daily Living (ADL), Instrumental Activities of Daily Living Scale (IADL), Scale Barthel, test Tinetti, Expanded "Get-Up-and-Go" Test (ETGUG) and Geriatric Depression Scale (GDS). RESULTS. In men, the average number of points in the scale of ADL, IADL, Barthel increased statistically significant, the results obtained in the test Tinetti, ETGUG, GSD were changed not significant statistically. In women, the average number of points in the IADL scale, Barthel scale and GDS increased, and the test ETGUG were reduced, all statistically significant. The results of the scale ADL and test Tinetti, improved statistically not significant. CONCLUSIONS. The physical rehabilitation in patients with neurological consequences had a positive impact on the ability to perform simple and complex activities of daily living, physical and mental condition. ADL, IADL, Barthel scale, GDS, test Tinetti and ETGUG can be used for evaluation of rehabilitation results.

  1. Neurological soft signs, dissociation and alexithymia in patients with obsessive-compulsive disorder (OCD) and healthy subjects.

    Science.gov (United States)

    Tapancı, Zafer; Yıldırım, Abdullah; Boysan, Murat

    2017-11-21

    A body of evidence has supported that patients with obsessive-compulsive disorder (OCD) have increased rates of various neurological soft signs (NSS) compared to controls. Various lines of research has documented robust relationships between OCD and dissociative symptomatology. The study aimed to examine the associations between obsessive-compulsive symptoms, dissociative experiences alexithymia, and NSS. The study included thirty OCD patients and thirty healthy controls, matched for age, marital status, education, and income. The Neurological Evaluation Scale (NES), Padua Inventory-Revised (PI-R), Dissociative Experiences Scale (DES) and Toronto Alexithymia Scale (TAS-20) were administered. In comparison to healthy controls, patients with OCD had difficulty sequencing for complex motor acts and greater absorption/ imaginative involvement. Using latent class analysis, the study sample was classified into two homogenous subsets as mild NSS (n = 45) and severe NSS (n = 15). Majority of the participants who were grouped into severe NSS latent class were OCD patient (n = 14, 93.3%). Furthermore, those with severe NSS reported greater levels of alexithymia and more severe obsessive-compulsive symptoms, particularly precision. We concluded that relationships between OCD severity and NSS appear to be of crucial importance. Our data along with accumulated evidence suggest that OCD associated with pronounced NSS may represent a specific subtype of the disorder. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Subtle cognitive impairments in patients with long-term cure of Cushing's disease

    NARCIS (Netherlands)

    Tiemensma, Jitske; Kokshoorn, Nieke E.; Biermasz, Nienke R.; Keijser, Bart-Jan S. A.; Wassenaar, Moniek J. E.; Middelkoop, Huub A. M.; Pereira, Alberto M.; Romijn, Johannes A.

    2010-01-01

    Active Cushing's disease is associated with cognitive impairments. We hypothesized that previous hypercortisolism in patients with Cushing's disease results in irreversible impairments in cognitive functioning. Therefore, our aim was to assess cognitive functioning after long-term cure of Cushing's

  3. The predictors of exercise capacity impairment in diabetic patients

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    Florina Frîngu

    2017-05-01

    Full Text Available Background. The exercise capacity is a key issue in a diabetic patient’s management, due to its well-known beneficial effects in terms of glycemic control, cardiovascular risk reduction and quality of life improvement. However the exercise capacity of diabetic patients is decreased many times and its determinants are sometimes less known. Our study aimed to assess the effort capacity in a cohort of diabetic patients and to find the main causative factors of its impairment. Method: 61 patients with type-2 diabetes mellitus were enrolled and underwent and transthoracic echocardiography and a cycloergometer exercise testing. Exercise performance was calculated and the influence of clinical data and ultrasound parameters was assessed. Sedentary status of each patient was established from total time/week of at least moderate physical activity. Results: the study group consisted of 48.4 % women, mean age 61.4 (±8.4 years. Disease median duration was 5 years and 21.3 % of the patients presented neuropathy, 4.5 % retinopathy and 6.5 % nephropathy. Exercise capacity was moderately and severe decreased (<5 METs in 37.7 % of patients and in this subgroup the diastolic dysfunction, sedentary behavior and old age has a significantly higher prevalence. Interestingly, by multivariate regression, the sedentary lifestyle was the main determinant of decreased effort capacity (beta-coefficient 1.37, p<0.001, suggesting the potential benefits of physical training in these patients. Conclusion. Our study found a decreased effort capacity in at least one third of the patients and this is mainly due to sedentary lifestyle and deconditioning, the diastolic dysfunction also contributes to decreased effort capacity in diabetic patients.

  4. Supraglotoplastia endoscópica em crianças com laringomalacia grave com e sem doença neurológica associada Endoscopic supraglottoplasty in children with severe laryngomalacia with and without neurological impairment

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    José C. Fraga

    2001-10-01

    children with or without neurological impairment. METHODS: Eight children with severe laryngomalacia submitted to endoscopic supraglottoplasty were retrospectively studied. Four had neurological impairment (male, mean age 6 years, and 4 did not present neurological problems (3 female, mean age 11.5 months. Surgery indications were respiratory distress, feeding difficulties, failure to thrive, and low oxygen saturation. Polysomnographic evaluation was carried out on the last 2 children, showing abnormal oxygen saturation, obstructive apnea, and hypoventilation. All children received preoperative antibiotics and corticosteroids. RESULTS: all children without neurological impairment had significant relief of symptoms. Children with neurological impairment had different outcome: one needed tracheotomy immediately after surgery due to edema and supraglottic granulation tissue. The other three children presented initial relief of symptoms, but subsequent follow-up showed progressive airway obstruction: one needed another endoscopic surgery 6 months later; other needed tracheotomy 7 months later. The children who were not submitted to tracheostomy presented persistent severe airway obstruction. No endoscopic surgery complication was observed. CONCLUSIONS: 1 Endoscopic supraglottoplasty is well tolerated and does not present complications when used in children; 2 Endoscopic supraglottoplasty was efficient in the treatment of children with severe laryngomalacia and in without neurological impairment; however, supraglottoplasty did not resolve airway obstruction in children with neurological impairment.

  5. Pulmonary function impairment in patients undergoing allogeneic hematopoietic cell transplantation.

    Science.gov (United States)

    Piesiak, Pawel; Gorczynska, Ewa; Brzecka, Anna; Kosacka, Monika; Jankowska, Renata

    2013-01-01

    Deterioration of pulmonary function can be the sole symptom of early stages of pulmonary complications following allogeneic hematopoietic cells transplantation (alloHCT). The aim of the study was to evaluate the prevalence and types of pulmonary function abnormalities in allogenic cells recipients. Twenty three (5 children and 18 adults) allogeneic hematopoietic cells recipients who underwent pulmonary function assessment before and 6-12 months after alloHCT were included in the study. Forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), total lung capacity (TLC), and lung diffusion capacity for carbon dioxide (D(L)CO) were determined. Values function impairment before alloHCT: obstructive lung disease (4%), restrictive lung disease (13%), and decreased D(L)CO (17%). In 19 patients (83%) pulmonary function abnormalities were demonstrated after alloHCT. The most common disturbance was a D(L)CO decrease that occurred in 16 patients (70%). In conclusion, frequency of pulmonary function abnormalities in patients after alloHCT is high. A diffusion capacity decrease and restrictive pattern of ventilation insufficiency develop in the majority of patients after alloHCT. It would be reasonable to include pulmonary function testing to standard periodic examination in patients qualified for, and after, alloHCT procedure.

  6. Neurologic complications of vaccinations.

    Science.gov (United States)

    Miravalle, Augusto A; Schreiner, Teri

    2014-01-01

    This chapter reviews the most common neurologic disorders associated with common vaccines, evaluates the data linking the disorder with the vaccine, and discusses the potential mechanism of disease. A literature search was conducted in PubMed using a combination of the following terms: vaccines, vaccination, immunization, and neurologic complications. Data were also gathered from publications of the American Academy of Pediatrics Committee on Infectious Diseases, the World Health Organization, the US Centers for Disease Control and Prevention, and the Vaccine Adverse Event Reporting System. Neurologic complications of vaccination are rare. Many associations have been asserted without objective data to support a causal relationship. Rarely, patients with a neurologic complication will have a poor outcome. However, most patients recover fully from the neurologic complication. Vaccinations have altered the landscape of infectious disease. However, perception of risk associated with vaccinations has limited the success of disease eradication measures. Neurologic complications can be severe, and can provoke fear in potential vaccines. Evaluating whether there is causal link between neurologic disorders and vaccinations, not just temporal association, is critical to addressing public misperception of risk of vaccination. Among the vaccines available today, the cost-benefit analysis of vaccinations and complications strongly argues in favor of vaccination. © 2014 Elsevier B.V. All rights reserved.

  7. Development of a patient reported outcome measure for fatigue in motor neurone disease: the Neurological Fatigue Index (NFI-MND

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    Gibbons Chris J

    2011-11-01

    Full Text Available Abstract Background The objective of this research was to develop a disease-specific measure for fatigue in patients with motor neurone disease (MND by generating data that would fit the Rasch measurement model. Fatigue was defined as reversible motor weakness and whole-body tiredness that was predominantly brought on by muscular exertion and was partially relieved by rest. Methods Qualitative interviews were undertaken to confirm the suitability of a previously identified set of 52 neurological fatigue items as relevant to patients with MND. Patients were recruited from five U.K. MND clinics. Questionnaires were administered during clinic or by post. A sub-sample of patients completed the questionnaire again after 2-4 weeks to assess test-retest validity. Exploratory factor analyses and Rasch analysis were conducted on the item set. Results Qualitative interviews with ten MND patients confirmed the suitability of 52 previously identified neurological fatigue items as relevant to patients with MND. 298 patients consented to completing the initial questionnaire including this item set, with an additional 78 patients completing the questionnaire a second time after 4-6 weeks. Exploratory Factor Analysis identified five potential subscales that could be conceptualised as representing: 'Energy', 'Reversible muscular weakness' (shortened to 'Weakness', 'Concentration', 'Effects of heat' and 'Rest'. Of the original five factors, two factors 'Energy' and 'Weakness' met the expectations of the Rasch model. A higher order fatigue summary scale, consisting of items from the 'Energy' and 'Weakness' subscales, was found to fit the Rasch model and have acceptable unidimensionality. The two scales and the higher order summary scale were shown to fulfil model expectations, including assumptions of unidimensionality, local independency and an absence of differential item functioning. Conclusions The Neurological Fatigue Index for MND (NFI-MND is a simple, easy

  8. Correlations between neurological signs and brain MR images of patients in consecutive stages of subacute sclerosing panencephalitis

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    Kulczycki, J.; Kryst-Widzgowska, T.; Sobczyk, W.; Bochynska, A.; Pilkowska, E.; Milewska, D. [Pracownia Rezonansu Magnetycznego, Inst. Psychiatrii i Neurologii, Warsaw (Poland)

    1994-12-31

    Correlations between neurological symptoms and brain MRI changes during the course of SSPE in 10 patients were studied. Visual agnosia and mental regression - very frequent symptoms at the early stages of the disease were caused by nearly symmetrical, focal involvement of the occipital and frontal white matter in all cases. Pyramidal and extrapyramidal disturbances reflected rather diffuse lesions of both cerebral hemispheres in late second stage of the illness. In cases with clinical improvement the brain changes disclosed an entire stability, but not diminishing intensity. (author) 9 refs, 8 figs, 3 tabs

  9. CNNM2 mutations cause impaired brain development and seizures in patients with hypomagnesemia.

    Science.gov (United States)

    Arjona, Francisco J; de Baaij, Jeroen H F; Schlingmann, Karl P; Lameris, Anke L L; van Wijk, Erwin; Flik, Gert; Regele, Sabrina; Korenke, G Christoph; Neophytou, Birgit; Rust, Stephan; Reintjes, Nadine; Konrad, Martin; Bindels, René J M; Hoenderop, Joost G J

    2014-04-01

    Intellectual disability and seizures are frequently associated with hypomagnesemia and have an important genetic component. However, to find the genetic origin of intellectual disability and seizures often remains challenging because of considerable genetic heterogeneity and clinical variability. In this study, we have identified new mutations in CNNM2 in five families suffering from mental retardation, seizures, and hypomagnesemia. For the first time, a recessive mode of inheritance of CNNM2 mutations was observed. Importantly, patients with recessive CNNM2 mutations suffer from brain malformations and severe intellectual disability. Additionally, three patients with moderate mental disability were shown to carry de novo heterozygous missense mutations in the CNNM2 gene. To elucidate the physiological role of CNNM2 and explain the pathomechanisms of disease, we studied CNNM2 function combining in vitro activity assays and the zebrafish knockdown model system. Using stable Mg(2+) isotopes, we demonstrated that CNNM2 increases cellular Mg2+ uptake in HEK293 cells and that this process occurs through regulation of the Mg(2+)-permeable cation channel TRPM7. In contrast, cells expressing mutated CNNM2 proteins did not show increased Mg(2+) uptake. Knockdown of cnnm2 isoforms in zebrafish resulted in disturbed brain development including neurodevelopmental impairments such as increased embryonic spontaneous contractions and weak touch-evoked escape behaviour, and reduced body Mg content, indicative of impaired renal Mg(2+) absorption. These phenotypes were rescued by injection of mammalian wild-type Cnnm2 cRNA, whereas mammalian mutant Cnnm2 cRNA did not improve the zebrafish knockdown phenotypes. We therefore concluded that CNNM2 is fundamental for brain development, neurological functioning and Mg(2+) homeostasis. By establishing the loss-of-function zebrafish model for CNNM2 genetic disease, we provide a unique system for testing therapeutic drugs targeting CNNM2 and

  10. Representing Diversity in the Dish: Using Patient-Derived in Vitro Models to Recreate the Heterogeneity of Neurological Disease

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    Layla T. Ghaffari

    2018-02-01

    Full Text Available Neurological diseases, including dementias such as Alzheimer's disease (AD and fronto-temporal dementia (FTD and degenerative motor neuron diseases such as amyotrophic lateral sclerosis (ALS, are responsible for an increasing fraction of worldwide fatalities. Researching these heterogeneous diseases requires models that endogenously express the full array of genetic and epigenetic factors which may influence disease development in both familial and sporadic patients. Here, we discuss the two primary methods of developing patient-derived neurons and glia to model neurodegenerative disease: reprogramming somatic cells into induced pluripotent stem cells (iPSCs, which are differentiated into neurons or glial cells, or directly converting (DC somatic cells into neurons (iNeurons or glial cells. Distinct differentiation techniques for both models result in a variety of neuronal and glial cell types, which have been successful in displaying unique hallmarks of a variety of neurological diseases. Yield, length of differentiation, ease of genetic manipulation, expression of cell-specific markers, and recapitulation of disease pathogenesis are presented as determining factors in how these methods may be used separately or together to ascertain mechanisms of disease and identify therapeutics for distinct patient populations or for specific individuals in personalized medicine projects.

  11. Blood biomarkers associated with neurological deterioration in patients with acute penetrating artery territory infarction: A multicenter prospective observational study.

    Science.gov (United States)

    Kawano, Tomohiro; Miyashita, Kotaro; Takeuchi, Mariko; Nagakane, Yoshinari; Yamamoto, Yasumasa; Kamiyama, Kenji; Manabe, Yasuhiro; Todo, Kenichi; Metoki, Norifumi; Akaiwa, Yasuhisa; Toyoda, Kazunori; Nagatsuka, Kazuyuki

    2018-02-01

    Background and purpose Neurological deterioration in acute penetrating artery territory infarction is unpredictable and associated with unfavorable clinical outcomes. The aim of this prospective study was to clarify the cause of neurological worsening and predict clinical outcomes using blood biomarkers. Methods Eight Japanese stroke centers participated. Blood samples were obtained within 24 h (the first sampling) and on day 7 in hospital (the second sampling) in patients with penetrating artery territory infarction, arriving within two days of stroke onset. Symptomatic worsening was defined as a minimum increase of one point on the National Institutes of Health Stroke Scale. Poor outcome was defined as a modified Rankin Scale score of ≥3 at 90 days after ictus. Results Of the 89 patients, 25 (28%) had symptomatic worsening, and 25 (28%) had a poor outcome. Although tumor necrosis factor-alpha, high-sensitivity C-reactive protein levels were significantly increased in both groups at the second sampling, soluble lectin-like oxidized low-density lipoprotein receptor-1, CD40 ligand, and pro-adrenomedullin levels were significantly increased and ADAMTS13 activity was decreased in symptomatic worsening patients ( p territory infarction.

  12. Identification of the predictors of cognitive impairment in patients with cancer in palliative care

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    Kurita, Geana Paula; Benthien, Kirstine Skov; Sjøgren, Per

    2017-01-01

    PURPOSE: Studies with neuropsychological assessments in patients with cancer are sparse, and the evidence is very limited regarding their status of cognitive function over time. This study aimed at assessing the prevalence and predictors of cognitive impairment in patients with cancer in palliative...... of the patients with complete MMSE at both assessments (n = 801) showed that 64.5% were not impaired, 12.5% remained cognitively impaired, 11.4% developed impairment, and 11.6% improved. Those who improved cognitively also reported reduced pain intensity and increased appetite. The predictive model (n = 1351......) showed that those with low KPS (OR = 1.6, 95% CI 1.0-2.5) most often developed cognitive impairment, while patients with breast cancer (OR = 0.4, 95% CI 0.2-0.7) had lower odds for impairment. CONCLUSIONS: During palliative care, a substantial number of patients remained cognitively impaired or developed...

  13. Breast Cancer Presents with a Paraneoplastic Neurologic Syndrome

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    Pedro Coelho Barata

    2012-11-01

    Full Text Available Background: Paraneoplastic neurologic syndromes (PNS pose quite an uncommon neurological complication, affecting less than 1% of patients with breast cancer. Nearly one third of these patients lack detectable onconeural antibodies (ONAs, and improvement in neurologic deficits with concomitant cancer treatments is achieved in less than 30% of cases. Case Presentation: A 42-year-old, premenopausal woman presented with facial paralysis on the central left side accompanied by a left tongue deviation, an upward vertical nystagmus, moderate spastic paraparesis, dystonic posturing of the left foot, lower limb hyperreflexia and bilateral extensor plantar reflex. After ruling out all other potential neurologic causes, PNS was suspected but no ONAs were found. A PET-CT scan detected increased metabolism in the right breast, as well as an ipsilateral thoracic interpectoral adenopathy. Core biopsy confirmed the presence of an infiltrating duct carcinoma. After breast surgery, the neurologic symptoms disappeared. One week later, the patient was readmitted to the hospital with a bilateral fatigable eyelid ptosis, and two weeks later, there was a noticeable improvement in eyelid ptosis, accompanied by a rapid and progressive development of lower spastic paraparesis. She started adjuvant treatment with chemotherapy with marked clinical and neurological improvement, and by the end of radiotherapy, there were no signs of neurologic impairment. Conclusion: This case study highlights the importance of a high level of vigilance for the detection of PNS, even when ONAs are not detected, as the rapid identification and treatment of the underlying tumor offers the best chance for a full recovery.

  14. Semantic Processing Impairment in Patients with Temporal Lobe Epilepsy

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    Amanda G. Jaimes-Bautista

    2015-01-01

    Full Text Available The impairment in episodic memory system is the best-known cognitive deficit in patients with temporal lobe epilepsy (TLE. Recent studies have shown evidence of semantic disorders, but they have been less studied than episodic memory. The semantic dysfunction in TLE has various cognitive manifestations, such as the presence of language disorders characterized by defects in naming, verbal fluency, or remote semantic information retrieval, which affects the ability of patients to interact with their surroundings. This paper is a review of recent research about the consequences of TLE on semantic processing, considering neuropsychological, electrophysiological, and neuroimaging findings, as well as the functional role of the hippocampus in semantic processing. The evidence from these studies shows disturbance of semantic memory in patients with TLE and supports the theory of declarative memory of the hippocampus. Functional neuroimaging studies show an inefficient compensatory functional reorganization of semantic networks and electrophysiological studies show a lack of N400 effect that could indicate that the deficit in semantic processing in patients with TLE could be due to a failure in the mechanisms of automatic access to lexicon.

  15. Neurological diseases and pain

    OpenAIRE

    Borsook, David

    2011-01-01

    Chronic pain is a frequent component of many neurological disorders, affecting 20–40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequentl...

  16. Cognitive impairments in patients with prior ischemic stroke

    Directory of Open Access Journals (Sweden)

    V. A. Parfenov

    2012-01-01

    Full Text Available The authors give the data available in the literature on and the results of their studies of the epidemiology, risk factors, pathogenesis, diagnosis, and treatment of poststroke cognitive impairment (PSCI. The latter occurs in 35—83% of patients; poststroke does in 6—40%. Different mechanisms of PSCI are under discussion; these are a single infarct in a strategic area of the brain; multiple focal lesion of the brain substance in restrokes; cerebral white-matter lesion as leukoaraiosis; the presence of concomitant Alzheimer’s disease (AD. The capacities for the diagnosis of concomitant AD in PSCI are analyzed. The treatment of the latter involves secondary prevention of stroke and specific therapy for cognitive, emotional-affective, and behavioral disorders. The experience with akatinol memantine used in postischemic dementia has been found to be positive.

  17. LMWH in cancer patients with renal impairment - better than warfarin?

    Science.gov (United States)

    Bauersachs, Rupert M

    2016-04-01

    Venous thromboembolism (VTE) is one of the leading causes of death in cancer patients, which are known to have a 5- to 7-fold increased risk for VTE. The anticoagulant treatment of VTE in cancer patients is less effective with a three-fold increased risk of VTE recurrence compared to non-cancer patients, and it is less safe with more than double rates of major bleeding. Compared to vitamin-K antagonists (VKA), long-term secondary prevention with low molecular weight heparin (LMWH) has been shown to reduce the risk of recurrent VTE in cancer-associated thrombosis (CAT), and therefore, current international guidelines recommend the use of LMWH over VKA. With increasing age, cancer prevalence and VTE incidence increase while renal function decreases. Anti-cancer treatment may impair renal function additionally. Therefore, renal insufficiency is a frequent challenge in CAT patients, which is associated with a higher risk of both bleeding and recurrent VTE. Both VKA and LMWH may be associated with less efficacy and higher bleeding risk in renal insufficiency. Unfortunately, there is a lack of prospective data on renal insufficiency and CAT. A recent sub-analysis from a large randomized controlled trial shows that the bleeding risk in patients with severe renal insufficiency in CAT is not elevated with the use of LMWH compared to VKA while efficacy is maintained. In addition, LMWH treatment has several practical advantages over VKA, particularly in patients with CAT while they are receiving anti-cancer treatment. © 2016 Elsevier Ltd. All rights reserved.

  18. Behavioural and psychiatric symptoms in cognitive neurology.

    Science.gov (United States)

    Robles Bayón, A; Gude Sampedro, F

    2017-03-01

    Behavioural and psychiatric symptoms (BPS) are frequent in neurological patients, contribute to disability, and decrease quality of life. We recorded BPS prevalence and type, as well as any associations with specific diagnoses, brain regions, and treatments, in consecutive outpatients examined in a cognitive neurology clinic. A retrospective analysis of 843 consecutive patients was performed, including a review of BPS, diagnosis, sensory impairment, lesion topography (neuroimaging), and treatment. The total sample was considered, and the cognitive impairment (CI) group (n=607) was compared to the non-CI group. BPS was present in 59.9% of the patients (61.3% in the CI group, 56.4% in the non-CI group). One BPS was present in 31.1%, two in 17.4%, and three or more in 11.4%. BPS, especially depression and anxiety, are more frequent in women than in men. Psychotic and behavioural symptoms predominate in subjects aged 65 and older, and anxiety in those younger than 65. Psychotic symptoms appear more often in patients with sensory impairment. Psychotic and behavioural symptoms are more prevalent in patients with degenerative dementia; depression and anxiety in those who suffer a psychiatric disease or adverse effects of substances; emotional lability in individuals with a metabolic or hormonal disorder; hypochondria in those with a pain syndrome; and irritability in subjects with chronic hypoxia. Behavioural symptoms are more frequent in patients with anomalies in the frontal or right temporal or parietal lobes, and antipsychotics constitute the first line of treatment. Leaving standard treatments aside, associations were observed between dysthymia and opioid analgesics, betahistine and statins, and between psychotic symptoms and levodopa, piracetam, and vasodilators. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases.

    Science.gov (United States)

    Gatica-Rojas, Valeska; Méndez-Rebolledo, Guillermo

    2014-04-15

    Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels (hearing, sight, touch, and smell), permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a defined interface. Virtual reality interface devices such as the Nintendo® Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addition, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases (chronic stroke and cerebral palsy) have been shown by changes in the reorganization of neural networks in patients' brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies.

  20. The predictive value of thyroid hormone levels on the neurological outcomes of patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Guo-dong CHEN

    2015-03-01

    Full Text Available Objective To explore the correlation between thyroid hormone levels in patients with acute ischemic stroke and the severity of disease and short-term prognosis. Methods According to the level of serum total triiodothyronine (TT3, 98 patients who presented first acute ischemic stroke and without history of thyroid abnormality were divided into low TT3 group and normal TT3 group. Thyroid hormone levels and neurological function defect of those patients were tested, and their neural functional recovery after 3 months was evaluated.  Results Low TT3 group had more severe neural function defect compared to normal TT3 group (χ2 = 58.134, P = 0.000. There were no significant differences on total thyroxine (TT4; t = 1.636, P = 0.105 and thyroid stimulating hormone (TSH; t = 1.059, P = 0.292 between 2 groups. There was a significantly negative correlation between TT3 levels and National Insititute of Health Stroke Scale (NIHSS score on admission (r = -0.672, P = 0.000. Patients with low TT3 showed a significantly smaller percentage of neurological function improvement on both NIHSS ( χ2 = 8.993, P = 0.003 and modified Rankin Scale (mRS; χ2 = 6.247, P = 0.012 scores compared to those with normal TT3 at 90 d after onset.  Conclusions Low T3 level is associated with the severity of acute ischemic stroke and neural functional recovery, suggesting serum T3 level may be a predictor of neural function improvement in patients with acute ischemic stroke. DOI: 10.3969/j.issn.1672-6731.2015.02.009

  1. Using a brain-machine interface to control a hybrid upper limb exoskeleton during rehabilitation of patients with neurological conditions.

    Science.gov (United States)

    Hortal, Enrique; Planelles, Daniel; Resquin, Francisco; Climent, José M; Azorín, José M; Pons, José L

    2015-10-17

    As a consequence of the increase of cerebro-vascular accidents, the number of people suffering from motor disabilities is raising. Exoskeletons, Functional Electrical Stimulation (FES) devices and Brain-Machine Interfaces (BMIs) could be combined for rehabilitation purposes in order to improve therapy outcomes. In this work, a system based on a hybrid upper limb exoskeleton is used for neurological rehabilitation. Reaching movements are supported by the passive exoskeleton ArmeoSpring and FES. The movement execution is triggered by an EEG-based BMI. The BMI uses two different methods to interact with the exoskeleton from the user's brain activity. The first method relies on motor imagery tasks classification, whilst the second one is based on movement intention detection. Three healthy users and five patients with neurological conditions participated in the experiments to verify the usability of the system. Using the BMI based on motor imagery, healthy volunteers obtained an average accuracy of 82.9 ± 14.5 %, and patients obtained an accuracy of 65.3 ± 9.0 %, with a low False Positives rate (FP) (19.2 ± 10.4 % and 15.0 ± 8.4 %, respectively). On the other hand, by using the BMI based on detecting the arm movement intention, the average accuracy was 76.7 ± 13.2 % for healthy users and 71.6 ± 15.8 % for patients, with 28.7 ± 19.9 % and 21.2 ± 13.3 % of FP rate (healthy users and patients, respectively). The accuracy of the results shows that the combined use of a hybrid upper limb exoskeleton and a BMI could be used for rehabilitation therapies. The advantage of this system is that the user is an active part of the rehabilitation procedure. The next step will be to verify what are the clinical benefits for the patients using this new rehabilitation procedure.

  2. Adult neurology training during child neurology residency.

    Science.gov (United States)

    Schor, Nina F

    2012-08-21

    As it is currently configured, completion of child neurology residency requires performance of 12 months of training in adult neurology. Exploration of whether or not this duration of training in adult neurology is appropriate for what child neurology is today must take into account the initial reasons for this requirement and the goals of adult neurology training during child neurology residency.

  3. Factors influencing cerebrospinal fluid and plasma HIV-1 RNA detection rate in patients with and without opportunistic neurological disease during the HAART era

    Directory of Open Access Journals (Sweden)

    Aleixo Agdemir W

    2007-12-01

    Full Text Available Abstract Background In the central nervous system, HIV replication can occur relatively independent of systemic infection, and intrathecal replication of HIV-1 has been observed in patients with HIV-related and opportunistic neurological diseases. The clinical usefulness of HIV-1 RNA detection in the cerebrospinal fluid (CSF of patients with opportunistic neurological diseases, or the effect of opportunistic diseases on CSF HIV levels in patients under HAART has not been well defined. We quantified CSF and plasma viral load in HIV-infected patients with and without different active opportunistic neurological diseases, determined the characteristics that led to a higher detection rate of HIV RNA in CSF, and compared these two compartments. Methods A prospective study was conducted on 90 HIV-infected patients submitted to lumbar puncture as part of a work-up for suspected neurological disease. Seventy-one patients had active neurological diseases while the remaining 19 did not. Results HIV-1 RNA was quantified in 90 CSF and 70 plasma samples. The HIV-1 RNA detection rate in CSF was higher in patients with neurological diseases, in those with a CD4 count lower than 200 cells/mm3, and in those not receiving antiretroviral therapy, as well as in patients with detectable plasma HIV-1 RNA. Median viral load was lower in CSF than in plasma in the total population, in patients without neurological diseases, and in patients with toxoplasmic encephalitis, while no significant difference between the two compartments was observed for patients with cryptococcal meningitis and HIV-associated dementia. CSF viral load was lower in patients with cryptococcal meningitis and neurotoxoplasmosis under HAART than in those not receiving HAART. Conclusion Detection of HIV-1 RNA in CSF was more frequent in patients with neurological disease, a CD4 count lower than 200 cells/mm3 and detectable plasma HIV-1. Median HIV-1 RNA levels were generally lower in CSF than in

  4. Risk of psychiatric and neurological diseases in patients with workplace mobbing experience in Germany: a retrospective database analysis

    Directory of Open Access Journals (Sweden)

    Kostev, Karel

    2014-05-01

    Full Text Available [english] Introduction: The number of mobbing experiences recorded has increased during recent years and it has now been established as global phenomenon among the working population. The goal of our study was to analyze the incidence of certain neurologic and psychiatric diseases as a consequence of mobbing as compared with a control group and to examine the possible influence of previous diseases that occurred within one year before the first mobbing documentation on the incidence of mobbing.Material & methods: We used a large database (IMS Disease Analyzer, Germany to collect data from general practitioners in Germany from 01/2003 until 12/2012. Based on age, gender, and health insurance, patients with experience of mobbing were matched with a control group of patients who had not reported workplace mobbing and who were being treated by the same physicians. At first, diseases that occurred within one year before the bullying experience took place (“index date” were noted and compared to a control group of similar composition in terms of gender, age, and health insurance. Subsequently, the prevalence of depression, anxiety, somatoform disorders, and sleep disorders following experiences of mobbing were determined. After adjustment to take into account the odds of bullying, the ratios of these diseases were assessed using a logistic regression model.Results: The study population consisted of n=2,625 patients and n=2,625 controls, of which 33% were men. The number of cases of bullying documented rose continuously from 2003 to 2011 and remained high in 2012. Those who would later become victims of mobbing demonstrated a considerably higher prevalence of diseases in general – these diseases were not confined to the neurologic-psychiatric spectrum. Following experiences of bullying, depression, anxiety, somatoform disorders, and sleep disorders were significantly more prevalent than in the control group (for all, p<0.05. Similarly, odds

  5. Schizophrenia patients have higher-order language and extralinguistic impairments.

    Science.gov (United States)

    Pawełczyk, Agnieszka; Kotlicka-Antczak, Magdalena; Łojek, Emila; Ruszpel, Anna; Pawełczyk, Tomasz

    2017-04-21

    The extralinguistic and paralinguistic aspects of the language refer to higher-order language functions such as lexical-semantic processes, prosody, indirect speech acts or discourse comprehension and production. Studies suggest that these processes are mediated by the Right Hemisphere (RH) and there is also some evidence of RH dysfunctions in schizophrenia. The aim of the paper is to investigate the extralinguistic and paralinguistic processing mediated by Right Hemisphere in schizophrenia patients using a validated and standardized battery of tests. Two groups of participants were examined: a schizophrenia sample (40 participants) and a control group (39 participants). Extralinguistic and paralinguistic processing was assessed in all subjects by the Polish version of the Right Hemisphere Language Battery (RHLB-PL), which measures comprehension of implicit information, naming, understanding humor, inappropriate remarks and comments, explanation and understanding of metaphors, understanding emotional and language prosody and discourse understanding. Schizophrenia patients scored significantly lower than controls in subtests measuring comprehension of implicit information, interpretation of humor, explanation of metaphors, inappropriate remarks and comments, discernment of emotional and language prosody and comprehension of discourse. No differences were observed in naming, understanding metaphors or in processing visuo-spatial information. Extralinguistic and paralinguistic dysfunctions appear to be present in schizophrenia patients and they suggest that RH processing may be disturbed in that group of patients. As the disturbances of higher-order language processes mediated by the RH may cause serious impairments in the social communication of patients, it is worth evaluating them during clinical examination. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Motor abnormalities and cognitive impairment in first-episode psychosis patients, their unaffected siblings and healthy controls.

    Science.gov (United States)

    Cuesta, Manuel J; Moreno-Izco, Lucia; Ribeiro, María; López-Ilundain, Jose M; Lecumberri, Pablo; Cabada, Teresa; Lorente-Omeñaca, Ruth; Sánchez-Torres, Ana M; Gómez, M Sol; Peralta, Victor

    2017-10-31

    Motor abnormalities (MAs) may be already evidenced long before the beginning of illness and are highly prevalent in psychosis. However, the extent to which the whole range of MAs are related to cognitive impairment in psychosis remains understudied. This study aimed to examine comparatively the relationships between the whole range of motor abnormalities and cognitive impairments in the first-episode of psychosis (FEP), their unaffected siblings and healthy control subjects. Fifty FEP patients, 21 of their healthy siblings and 24 age- and sex matched healthy controls were included. Motor assessment included catatonic, extrapyramidal and neurological soft signs (NSS) by means of standardized instruments. An exhaustive neuropsychological battery was also performed to extract the 7 cognitive dimensions of MATRICS initiative. Higher scores on NSS but not on extrapyramidal and catatonic signs showed significant associations with worse cognitive performance in the three study groups. However, the pattern of associations regarding specific cognitive functions was different among the three groups. Moreover, extrapyramidal signs showed significant associations with cognitive impairment only in FEP patients but not in their unaffected siblings and healthy controls. Catatonic signs did not show any significant association with cognitive functioning in the three study groups. These findings add evidence to the associations between motor abnormalities, particularly NSS and extrapyramidal signs, and cognitive impairment in first-episode psychosis patients. In addition, our results suggest that the specific pattern of associations between MAs and cognitive functioning is different in FEP patients from those of the unaffected siblings and healthy subjects. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Patients Without Intraoperative Neuromonitoring (IONM) Alerts During VEPTR Implantation Did Not Sustain Neurological Injury During Subsequent Routine Expansions: A Retrospective Multicenter Cohort Study.

    Science.gov (United States)

    LaGreca, Jaren; Flynn, Tara; Cahill, Patrick J; Samdani, Amer; Vitale, Michael G; El-Hawary, Ron; Smith, John T; Phillips, Jonathan H; Flynn, John M; Glotzbecker, Michael; Garg, Sumeet

    2017-03-21

    The purpose of this study was to determine the rate of intraoperative neurological monitoring (IONM) alerts and neurological injury during vertical expandable prosthetic titanium rib (VEPTR) treatment and evaluate the utility of IONM during VEPTR expansion procedures in patients who have not previously had neurological injury or IONM alerts. After institutional review board approval, VEPTR procedures and IONM records were reviewed at 17 institutions for patients treated with VEPTR from 2005 to 2011. All consecutive cases in patients with minimum 2-year follow-up were included. Patients with prior history of growing rods or other invasive spine-based surgical treatment were excluded. Surgeries were categorized into implant, revision, expansion, and removal procedures. Cases with IONM alerts or neurological injury had additional detailed review. Descriptive statistics were used for data analysis. In total, 2355 consecutive VEPTR procedures (352 patients) consisting of 299 implant, 377 revision, 1587 expansion, and 92 removal procedures were included. In total, 620 VEPTR procedures had IONM, and 539 of those had IONM records available for review. IONM alerts occurred in 9/539 procedures (1.7%): 3/192 implants (1.6%), 3/58 revisions (5.2%), and 3/258 expansions (1.2%). New neurological injury occurred in 3/2355 procedures (0.1%), 3/352 patients (0.9%). All 3 injuries were in implant procedures, only 1 had an IONM alert. All 3 had upper extremity motor deficits (1 had sensory deficit also). All had full recovery at 17, 30, and 124 days postinjury. One patient without prior neurological injury or IONM alert had an IONM alert during expansion that resolved after an increase in blood pressure. The remaining IONM alerts during expansions were all in children with prior IONM alerts during implant, revision, or exchange procedures. The highest rate of neurological injury in VEPTR surgery was found for implant procedures. There were no instances of neurological injury during

  8. Neurological sequelae in survivors of cerebral malaria | Oluwayemi ...

    African Journals Online (AJOL)

    Methods: This is a prospective study describing persisting neurological impairments post discharge among children treated for cerebral malaria. ... The persisting neurologic deficits among survivors at follow up were: memory impairment (1.5%), seizure disorders (0.8%), visual impairment (0.8%), speech impairment (0.8%), ...

  9. Physical Telerehabilitation in Patients with Multiple Sclerosis with Significant Mobility Impairment

    Science.gov (United States)

    2017-10-01

    Award Number: W81XWH-16-1-0704 TITLE: Physical Telerehabilitation in Patients with Multiple Sclerosis with Significant Mobility Impairment...29 Sep 2017 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Physical Telerehabilitation in Patients with Multiple Sclerosis with Significant Mobility...benefits of physical rehabilitation in patients with multiple sclerosis with significant mobility impairment (PwMSMI). The purpose of this project

  10. Evaluation of a wireless, portable, wearable multi-parameter vital signs monitor in hospitalized neurological and neurosurgical patients.

    Science.gov (United States)

    Weller, Robert S; Foard, Kristina L; Harwood, Timothy N

    2017-12-06

    Unrecognized changes in patients' vital signs can result in preventable deaths in hospitalized patients. Few publications or studies instituting routine patient monitoring have described implementation and the setting of alarm parameters for vital signs. We wanted to determine if continuous multi-parameter patient monitoring can be accomplished with an alarm rate that is acceptable to hospital floor nurses and to compare the rate of patient deterioration events to those observed with routine vital sign monitoring. We conducted a prospective, observational, 5-month pilot study in a 26-bed adult, neurological/neurosurgical unit (non-ICU) in an academic medical center. A patient surveillance system employing a wireless body-worn vital signs monitor with automated nursing notification of alarms via smartphones was used to gather data. Data collected included: alarm rates, rapid response team (RRT) calls, intensive care unit (ICU) transfers, and unplanned deaths before and during the pilot study. Average alarm rate for all alarms (SpO2, HR, RR, NIBP) was 2.3 alarms/patient/day. The RRT call rate was significantly reduced (p monitoring can be customized to reduce a high alarm rates, and may reduce rapid response team calls.

  11. Aciclovir-induced acute kidney injury in patients with 'suspected viral encephalitis' encountered on a liaison neurology service.

    Science.gov (United States)

    Bogdanova-Mihaylova, Petya; Burke, David; O'Dwyer, John P; Bradley, David; Williams, Jennifer A; Cronin, Simon J; Smyth, Shane; Murphy, Raymond P; Murphy, Sinead M; Wall, Catherine; McCabe, Dominick J H

    2018-01-06

    Patients with 'suspected viral encephalitis' are frequently empirically treated with intravenous aciclovir. Increasing urea and creatinine are 'common', but rapidly progressive renal failure is reported to be 'very rare'. To describe the clinical course and outcome of cases of aciclovir-induced acute kidney injury (AKI) encountered by the Liaison Neurology Service at AMNCH and to highlight the importance of surveillance and urgent treatment of this iatrogenic complication. Retrospectively and prospectively collected data from the Liaison Neurology Service at AMNCH on patients who received IV aciclovir for suspected viral encephalitis and developed AKI were analysed. Aciclovir-induced AKI was defined by a consultant nephrologist in all cases as a rise in serum creatinine of > 26 μmol/L in 48 h or by ≥ 1.5 times the baseline value. Renal function, haematocrit, and fluid balance were monitored following AKI onset. Data from 10 patients were analysed. Median time to AKI onset was 3.5 days (range: 1-6 days). Aciclovir was stopped or the dose adjusted. All patients recovered with IV normal saline, aiming for a urine output > 100-150 ml/h. The interval between first rise in creatinine and return to normal levels varied between 5 and 19 days. Liaison neurologists and general physicians need to be aware that aciclovir may cause AKI attributed to distal intra-tubular crystal nephropathy. Daily fluid balance and renal function monitoring are essential because AKI may arise even with intensive pre-hydration. Prognosis is good if identified early and actively treated.

  12. Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy.

    Science.gov (United States)

    Thirumala, Parthasarathy D; Muralidharan, Aditya; Loke, Yoon K; Habeych, Miguel; Crammond, Donald; Balzer, Jeffrey

    2016-03-01

    The primary aim of this study was to conduct a systematic review of reports of patients with cervical spondylotic myelopathy and to assess the value of intraoperative monitoring (IOM), including somatosensory evoked potentials, transcranial motor evoked potentials and electromyography, in anterior cervical procedures. A search was conducted to collect a small database of relevant papers using key words describing disorders and procedures of interest. The database was then shortlisted using selection criteria and data was extracted to identify complications as a result of anterior cervical procedures for cervical spondylotic myelopathy and outcome analysis on a continuous scale. In the 22 studies that matched the screening criteria, only two involved the use of IOM. The average sample size was 173 patients. In procedures done without IOM a mean change in Japanese Orthopaedic Association score of 3.94 points and Nurick score by 1.20 points (both less severe post-operatively) was observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia was seen in 2.71% of patients for studies without IOM and 0.91% of patients for studies with IOM. Variations persist in the existing literature in the evaluation of complications associated with anterior cervical spinal procedures. Based on the review of published studies, sufficient evidence does not exist to make recommendations regarding the use of different IOM modalities to reduce neurological complications during anterior cervical procedures. However, future studies with objective measures of neurological deficits using a specific IOM modality may establish it as an effective and reliable indicator of injury during such surgeries. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. A consensus review on the development of palliative care for patients with chronic and progressive neurological disease

    NARCIS (Netherlands)

    Oliver, D. J.; Borasio, G. D.; Caraceni, A.; de Visser, M.; Grisold, W.; Lorenzl, S.; Veronese, S.; Voltz, R.

    2016-01-01

    The European Association of Palliative Care Taskforce, in collaboration with the Scientific Panel on Palliative Care in Neurology of the European Federation of Neurological Societies (now the European Academy of Neurology), aimed to undertake a review of the literature to establish an evidence-based

  14. Glucokinase mutations in pediatric patients with impaired fasting glucose.

    Science.gov (United States)

    Aloi, C; Salina, A; Minuto, N; Tallone, R; Lugani, F; Mascagni, A; Mazza, O; Cassanello, M; Maghnie, M; d'Annunzio, G

    2017-10-01

    Our aim was to detect the frequency of glucokinase (GCK) gene mutations in a cohort of patients with impaired fasting glucose and to describe the clinical manifestations of identified variants. We also aimed at predicting the effect of the novel missense mutations by computational approach. Overall 100 unrelated Italian families with impaired fasting glucose were enrolled and subdivided into two cohorts according to strict and to mild criteria for diagnosis of maturity-onset diabetes of the young (MODY). GCK gene sequencing was performed in all participants. Fifty-three Italian families with 44 different mutations affecting the GCK and co-segregating with the clinical phenotype of GCK/MODY were identified. All mutations were in heterozygous state. In Sample 1, GCK defects were found in 32/36 (88.9%) subjects selected with strict MODY diagnostic criteria, while in Sample 2 GCK defects were found in 21/64 (32.8%) subjects selected with mild MODY diagnostic criteria. Our study enlarged the wide spectrum of GCK defects by adding 9 novel variants. The application of strict recruitment criteria resulted in 88.9% incidence of GCK/MODY, which confirmed it as the commonest form of MODY in the Italian population. In order to avoid misdiagnosis of GCK/MODY, it could be useful to perform molecular screening even if one or more clinical parameters for the diagnosis of MODY are missing. Computational analysis is useful to understand the effect of GCK defect on protein functionality, especially when the novel identified variant is a missense mutation and/or parents' DNA is not available.

  15. Brain White Matter Impairment in Patients with Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Weimin Zheng

    2017-01-01

    Full Text Available It remains unknown whether spinal cord injury (SCI could indirectly impair or reshape the white matter (WM of human brain and whether these changes are correlated with injury severity, duration, or clinical performance. We choose tract-based spatial statistics (TBSS to investigate the possible changes in whole-brain white matter integrity and their associations with clinical variables in fifteen patients with SCI. Compared with the healthy controls, the patients exhibited significant decreases in WM fractional anisotropy (FA in the left angular gyrus (AG, right cerebellum (CB, left precentral gyrus (PreCG, left lateral occipital region (LOC, left superior longitudinal fasciculus (SLF, left supramarginal gyrus (SMG, and left postcentral gyrus (PostCG (p<0.01, TFCE corrected. No significant differences were found in all diffusion indices between the complete and incomplete SCI. However, significantly negative correlation was shown between the increased radial diffusivity (RD of left AG and total motor scores (uncorrected p<0.05. Our findings provide evidence that SCI can cause not only direct degeneration but also transneuronal degeneration of brain WM, and these changes may be irrespective of the injury severity. The affection of left AG on rehabilitation therapies need to be further researched in the future.

  16. Neurological disorders in children with autism

    Directory of Open Access Journals (Sweden)

    N. N. Zavadenko

    2015-01-01

    Full Text Available During a clinical examination of children with autistic spectrum disorders, attention should be drawn to both their major clinical manifestations and neurological comorbidities. The paper considers the mechanisms of autism-induced neurological disorders, the spectrum of which may include manifestations, such as retarded and disharmonic early psychomotor development; the specific features of sensory perception/processing; rigidity and monotony of motor and psychic reactions; motor disinhibition and hyperexcitability; motor stereotypies; uncoordinated movements; developmental coordination disorders (dyspraxia; impaired expressive motor skills; speech and articulation disorders; tics; epilepsy. It describes the specific features of neurological symptoms in Asperger’s syndrome, particularly in semantic-pragmatic language disorders, higher incidence rates of hyperlexia, motor and vocal tics. The incidence rate of epilepsy in autistic spectrum disorders is emphasized to be greater than the average population one. At the same time, the risk of epilepsy is higher in mentally retarded patients with autism. Identification of neurological disorders is of great importance in determining the tactics of complex care for patients with autistic spectrum disorders. 

  17. Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases

    Science.gov (United States)

    Gatica-Rojas, Valeska; Méndez-Rebolledo, Guillermo

    2014-01-01

    Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels (hearing, sight, touch, and smell), permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a defined interface. Virtual reality interface devices such as the Nintendo® Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addition, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases (chronic stroke and cerebral palsy) have been shown by changes in the reorganization of neural networks in patients’ brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies. PMID:25206907

  18. The therapeutic effect of neurologic music therapy and speech language therapy in post-stroke aphasic patients.

    Science.gov (United States)

    Lim, Kil-Byung; Kim, Yong-Kyun; Lee, Hong-Jae; Yoo, Jeehyun; Hwang, Ji Youn; Kim, Jeong-Ah; Kim, Sung-Kyun

    2013-08-01

    To investigate the therapeutic effect of neurologic music therapy (NMT) and speech language therapy (SLT) through improvement of the aphasia quotient (AQ) in post-stroke aphasic patients. Twenty-one post-stroke, nonfluent aphasia patients who had ischemic/hemorrhagic stroke on radiologic evaluation were divided into the NMT and SLT groups. They received NMT and SLT for 1 month. Language function was assessed by Korean version-Western Aphasia Battery before and after therapy. NMT consisted of therapeutic singing and melodic intonation therapy, and SLT consisted of language-oriented therapy. Significant improvements were revealed in AQ, repetition, and naming after therapy in the NMT group and improvements in repetition in the SLT group of chronic stroke patients (p<0.05). There were significant improvements in language ability in the NMT group of subacute stroke patients. However, there was no significant improvement in the SLT group of subacute stroke patients. We concluded that the two therapies are effective treatments in the chronic stage of stroke and NMT is effective in subacute post-stroke aphasic patients.

  19. Aphasia, Just a Neurological Disorder?

    Directory of Open Access Journals (Sweden)

    Mehmet Ozdemir

    2016-02-01

    Full Text Available Hashimoto%u2019s encephalopathy (HE is a rare disorder associated with autoimmune thyroiditis. Etiology of HE is not completely understood. High levels of serum antithyroid antibodies are seen in HE. Presentation with otoimmune thyroiditis, cognitive impairment, psychiatric and neurologic symptoms and absence of bacterial or viral enfections are characteristics of HE. HE is a steroid responsive encephalopathy. 60 years old male patient admitted to hospital with forget fulness continuing for 9 months and speech loss starting 2 days ago. Strong positivity of antithyroid antibodies increases the odds for HE. Thyroid function tests showed severe hypothyroidism. Electroencephalography and magnetic resonance imaging results were compatible with HE. HE is diagnosed with differantial diagnosis and exclusion of other reasons. This uncommon disorder is not recognised enough. High titres of serum antithyroid antiboides are always needed for diagnosis. Correct diagnosis requires awareness of wide range of cognitive and clinical presentations of HE.

  20. Pain reporting and analgesia management in 270 children with a progressive neurologic, metabolic or chromosomally based condition with impairment of the central nervous system: cross-sectional, baseline results from an observational, longitudinal study

    Directory of Open Access Journals (Sweden)

    Friedrichsdorf SJ

    2017-07-01

    Full Text Available Stefan J Friedrichsdorf,1,2 Andrea C Postier,1 Gail S Andrews,3 Karen ES Hamre,4 Rose Steele,5 Harold Siden6,7 1Department of Pain Medicine, Palliative Care and Integrative Medicine, Children’s Hospitals and Clinics of Minnesota, MN, USA; 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA; 3Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; 4Department of Research and Sponsored Programs, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, USA; 5School of Nursing, Faculty of Health, York University, Toronto, ON, Canada; 6BC Children’s Hospital Research Institute, Vancouver, BC, Canada; 7Canuck Place Children’s Hospice, Vancouver, BC, Canada Abstract: Little is known about the prevalence, characterization and treatment of pain in children with progressive neurologic, metabolic or chromosomal conditions with impairment of the central nervous system. The primary aims of this study were to explore the differences between parental and clinical pain reporting in children with life-limiting conditions at the time of enrollment into an observational, longitudinal study and to determine if differences in pain experiences were associated with patient- or treatment-related factors. Pain was common, under-recognized and undertreated among the 270 children who enrolled into the “Charting the Territory” study. Children identified by their parents as experiencing pain (n=149, 55% were older, had more comorbidities such as dyspnea/feeding difficulties, were less mobile with lower functional skills and used analgesic medications more often, compared to pain-free children. Forty-one percent of children with parent-reported pain (21.8% of all patients experienced pain most of the time. The majority of clinicians (60% did not document pain assessment or analgesic treatment in the medical records of patients who were experiencing pain. Documentation of pain in the medical

  1. Mowat-Wilson syndrome: neurological and molecular study in seven patients

    Directory of Open Access Journals (Sweden)

    José Albino da Paz

    2015-01-01

    Full Text Available Objective To present a seven-cases serie of Mowat-Wilson syndrome (MWS. Method All patients with positive mutation for the ZEB2 were evaluated by a geneticist and a neurologist, with clinical and laboratorial characterization. Results A peculiar facies and mental retardation were present in all patients. The Denver II scale showed intense delay in all aspects, especially fine motor and adaptive. Acquired microcephaly was observed in five patients. Only one patient did not present epilepsy. Epilepsy was focal and predominating in sleep, with status epilepticus in three patients. The initial seizure was associated with fever in most patients (4/6. The EEG showed epileptic focal activity (5/7. The imaging studies revealed total agenesis (4/7 and partial agenesis of the corpus callosum (1/7. Conclusion Physicians who care for patients with mental retardation and epilepsy should be aware of SMW.

  2. Verbal Memory Impairment in Patients with Subsyndromal Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Tomiki Sumiyoshi

    2017-09-01

    Full Text Available BackgroundsSeveral domains of cognitive function, including learning memory and executive function, are impaired in mood disorders. Also, the relationship between disturbances of these two cognitive domains has been suggested. In line with the recent initiative to establish a standard measure of cognitive decline in bipolar disorder, the present study was conducted to (1 test the criterion-related validity and test–retest reliability of the California Verbal Learning Test (CVLT-II Japanese version, and (2 determine if type of word learning tasks (i.e., with or without a category structure affects severity of verbal memory deficits in patients with subsyndromal bipolar disorder.MethodsThirty-six patients with bipolar disorder with mild symptoms and 42 healthy volunteers participated in the study. We first compared effect sizes for memory deficits in patients among the CVLT-II, Brief Assessment of Cognition in Schizophrenia (BACS, and Hopkins Verbal Memory Tests-Revised (HVLT-R. We next evaluated the correlations between scores of the CVLT-II vs. those of the BACS and HVLT-R. Bipolar patients were re-assessed with the same (standard or alternate forms of the CVLT-II and HVLT-R 1 month later.ResultsScores on the CVLT-II 1–5 Free Recall and Long-delay Free Recall, as well as the HVLT-R Immediate Recall, but not the BACS List Learning were significantly lower for patients compared to control subjects. The effect sizes for cognitive decline due to the illness were comparable when measured by the CVLT-II and HVLT-R, ranging from 0.5 to 0.6. CVLT-II scores were significantly correlated with those of the HVLT-R and BACS. Test–retest reliability of the CVLT-II was acceptable, and no significant practice effect was observed when the alternate form was used. There was no consistent relationship between mood symptoms and performance on the CVLT-II.ConclusionThese results suggest the CVLT-II Japanese version is able to discriminate between bipolar

  3. Wikipedia and neurological disorders.

    Science.gov (United States)

    Brigo, Francesco; Igwe, Stanley C; Nardone, Raffaele; Lochner, Piergiorgio; Tezzon, Frediano; Otte, Willem M

    2015-07-01

    Our aim was to evaluate Wikipedia page visits in relation to the most common neurological disorders by determining which factors are related to peaks in Wikipedia searches for these conditions. Millions of people worldwide use the internet daily as a source of health information. Wikipedia is a popular free online encyclopedia used by patients and physicians to search for health-related information. The following Wikipedia articles were considered: Alzheimer's disease; Amyotrophic lateral sclerosis; Dementia; Epilepsy; Epileptic seizure; Migraine; Multiple sclerosis; Parkinson's disease; Stroke; Traumatic brain injury. We analyzed information regarding the total article views for 90 days and the rank of these articles among all those available in Wikipedia. We determined the highest search volume peaks to identify possible relation with online news headlines. No relation between incidence or prevalence of neurological disorders and the search volume for the related articles was found. Seven out of 10 neurological conditions showed relations in search volume peaks and news headlines. Six out of these seven peaks were related to news about famous people suffering from neurological disorders, especially those from showbusiness. Identification of discrepancies between disease burden and health seeking behavior on Wikipedia is useful in the planning of public health campaigns. Celebrities who publicly announce their neurological diagnosis might effectively promote awareness programs, increase public knowledge and reduce stigma related to diagnoses of neurological disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Neurologic Diseases and Sleep.

    Science.gov (United States)

    Barone, Daniel A; Chokroverty, Sudansu

    2017-03-01

    Sleep disorders and neurologic illness are common and burdensome in their own right; when combined, they can have tremendous negative impact at an individual level as well as societally. The socioeconomic burden of sleep disorders and neurologic illness can be identified, but the real cost of these conditions lies far beyond the financial realm. There is an urgent need for comprehensive care and support systems to help with the burden of disease. Further research in improving patient outcomes in those who suffer with these conditions will help patients and their families, and society in general. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Prognostic value of periodic electroencephalographic discharges for neurological patients with profound disturbances of consciousness

    DEFF Research Database (Denmark)

    Pedersen, Gyrithe L; Rasmussen, Stine; Gyllenborg, Jesper

    2013-01-01

    To examine if periodic EEG discharges (PDs) predict poor outcome and development of epilepsy in patients with acute brain illnesses irrespective of underlying cerebral pathology.......To examine if periodic EEG discharges (PDs) predict poor outcome and development of epilepsy in patients with acute brain illnesses irrespective of underlying cerebral pathology....

  6. Visual scanning and matching dysfunction in brain-damaged patients with drawing impairment.

    Science.gov (United States)

    Belleza, T; Rappaport, M; Hopkins, H K; Hall, K

    1979-03-01

    Visual matching and visual exploration were examined in 7 normal subjects and 20 brain-damaged patients with drawing impairment measured by the Bender Gestalt Visual-Motor Test. Right brain-damaged patients made significantly more errors of rotation and integration than left brain-damaged patients. Selecteded Bender figures were also used as stimuli for both visual matching and visual exploration tests. The ability to match Bender figures was found to be impaired in right but not left brain-damaged patients. All patients showed eye movement and fixation patterns different from those normals. Patients essentially had more fixations and shorter fixation durations. Significant intercorrelations were found between the total Bender Gestalt score and visual matching and visual exploration scores. These findings indicate that visual matching and visual exploration measures can be used to evaluate perceptual impairment in individuals who do not have adequate motor responses or where impaired motor responses may confound interpretations about visual cognitive impairment.

  7. HTLV-I associated myelopathy in patients from Brazil and Iran: neurological manifestations and cerebrospinal fluid findings

    Directory of Open Access Journals (Sweden)

    Marzia Puccioni-Sohler

    1995-06-01

    Full Text Available We analysed sera and cerebrospinal fluid (CSF of 20 cases of human T-cell lymphotropic virus type (HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP from Brazil and Iran and as controls, 16 Brazilian HTLVI seronegative individuals afflicted with other neurological diseases. It was observed in the HAM/TSP patients that: 1 all had an inflammatory reaction within the central nervous system (CNS; 2 95% (19/20 showed oligoclonal bands reflecting intrathecal IgG synthesis; 3 85% (17/20 presented a local synthesis of HTLVI antibodies; 4 35% (7/20 had a measurable immunoglobulin (Ig synthesis within the CNS. The CSF parameters of the HAM/TSP were compared with the clinical data (age at onset, duration of disease and disability level. Our data prove that CSF analysis is important for the diagnosis of HAM/TSP. There is no association between the severity of the disease and CSF findings.

  8. Forkhead box protein P3 (Foxp3) expression serves as an early chronic inflammation marker of squamous cell differentiation and aggressive pathology of urothelial carcinomas in neurological patients.

    Science.gov (United States)

    Phé, Véronique; Rouprêt, Morgan; Cussenot, Olivier; Chartier-Kastler, Emmanuel; Gamé, Xavier; Compérat, Eva

    2015-04-01

    To establish whether the expression of forkhead box protein P3 (Foxp3) provides specific diagnostic information about neurological patients with urothelial carcinoma of the bladder (UCB). UCB tissue samples from neurological patients were retrieved and compared with control samples. The expression of Foxp3 was analysed via immunohistochemistry of microarray tissue sections. The correlation between Foxp3 expression, histological parameters and tumour stage was assessed. Overall, 20 UCB tissue samples and 20 others without UCB from neurological patients, and 46 UCB tissue samples from non-neurological patients were analysed. The distribution of pT of UCB in the neurological patients was as follows: one low-grade pTa (5%), three high-grade pTa (15%), three pT1(15%), one pT2(5%), seven pT3(35%) and five pT4(25%). Squamous cell differentiation was seen in nine UCB samples (45%). Foxp3 expression was detected in tumour tissues, including one pTa high grade, one pT1, one pT2, five pT3 and five pT4 tumours. Foxp3 was expressed in 11/13 muscle-invasive tumours. All tumours displaying squamous cell differentiation expressed Foxp3. Foxp3 was not expressed in the pT3 tumours that displayed sarcomatoid and micropapillary properties. Among the bladder samples without UCB from neurological patients, no expression of Foxp3 was observed. Among the UCB samples from the non-neurological patients, only seven displayed squamous cell differentiation. All tumours that displayed squamous cell differentiation expressed Foxp3, including one pTa high grade, four pT3 and two pT4 tumours. Other tumours displaying urothelial differentiation did not express Foxp3. The expression of Foxp3 correlated to squamous cell differentiation in neurological (P = 0.004) and non-neurological UCB tissue (P differentiation. Targeting Foxp3 may represent a novel strategy to improve anti-tumour immunotherapy for UCB. © 2015 The Authors. BJU International © 2015 BJU International.

  9. Memory assessment in patients with temporal lobe epilepsy to predict memory impairment after surgery: A systematic review.

    Science.gov (United States)

    Parra-Díaz, P; García-Casares, N

    2017-04-19

    Given that surgical treatment of refractory mesial temporal lobe epilepsy may cause memory impairment, determining which patients are eligible for surgery is essential. However, there is little agreement on which presurgical memory assessment methods are best able to predict memory outcome after surgery and identify those patients with a greater risk of surgery-induced memory decline. We conducted a systematic literature review to determine which presurgical memory assessment methods best predict memory outcome. The literature search of PubMed gathered articles published between January 2005 and December 2015 addressing pre- and postsurgical memory assessment in mesial temporal lobe epilepsy patients by means of neuropsychological testing, functional MRI, and other neuroimaging techniques. We obtained 178 articles, 31 of which were included in our review. Most of the studies used neuropsychological tests and fMRI; these methods are considered to have the greatest predictive ability for memory impairment. Other less frequently used techniques included the Wada test and FDG-PET. Current evidence supports performing a presurgical assessment of memory function using both neuropsychological tests and functional MRI to predict memory outcome after surgery. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Harm to patients and others caused by impaired junior doctors ...

    African Journals Online (AJOL)

    Studies on sleep deprivation and impaired performance by medical interns in the US show that: • after 24 hours of continuous wakefulness impairments in perfor- mance are similar to those induced by a blood alcohol level of. 0.10%[8]. • medical interns working 24-hour shifts made 36% more serious medical errors and ...

  11. Cognitive impairment in patients with a schizoaffective disorder: a comparison with bipolar patients in euthymia

    Directory of Open Access Journals (Sweden)

    Studentkowski G

    2010-02-01

    Full Text Available Abstract Objectives Several studies have shown persistent neurocognitive impairment in patients with a bipolar affective disorder (BD even in euthymia as well as in patients with a schizoaffective disorder (SAD. The aim of our study was to compare the neuropsychological performance between these two groups. Confounding variables were controlled to enhance our understanding of cognitive dysfunction in both BD and SAD. Methods Several domains of neurocognitive function, executive function, memory, attention, concentration and perceptuomotor function were examined in 28 euthymic SAD patients and 32 BD patients by using a neuropsychological test battery. The Hamilton Depression Rating Scale (HAMD, Montgomery-Asberg Depression Rating Scale (MADRS and Young Mania Rating Scale (YMRS were used to evaluate the patients' clinical status. Data analysis was performed by using a multivariate analysis of covariance (ANCOVA/MANCOVA. Results Euthymic SAD patients showed greater cognitive impairment than euthymic BD patients in the tested domains including declarative memory and attention. Putative significant group differences concerning cognitive flexibility vanished when controlled for demographic and clinical variables. Age and medication were robust predictors to cognitive performance of both SAD and BD patients. Conclusions Our results point out the worse cognitive outcome of SAD compared to BD patients in remission. Remarkably, the variance is higher for some of the test results between the groups than within each group, this being discussed in light of the contradictive concept of SAD.

  12. Cognitive impairment in patients with AIDS – prevalence and severity

    Directory of Open Access Journals (Sweden)

    Watkins CC

    2015-01-01

    Full Text Available Crystal C Watkins,1,2 Glenn J Treisman2 1The Memory Center in Neuropsychiatry, Sheppard Pratt Health System, 2Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: The advent of highly active antiretroviral therapy has prolonged the life expectancy of HIV patients and decreased the number of adults who progress to AIDS and HIV-associated dementia. However, neurocognitive deficits remain a pronounced consequence of HIV/AIDS. HIV-1 infection targets the central nervous system in subcortical brain areas and leads to high rates of delirium, depression, opportunistic central nervous system infections, and dementia. Long-term HIV replication in the brain occurs in astrocytes and microglia, allowing the virus to hide from antiviral medication and later compromise neuronal function. The associated cognitive disturbance is linked to both viral activity and inflammatory and other mediators from these immune cells that lead to the damage associated with HIV-associated neurocognitive disorders, a general term given for these disturbances. We review the severity and prevalence of the neuropsychiatric complications of HIV including delirium, neurobehavioral impairments (depression, minor cognitive-motor dysfunction, and HIV-associated dementia. Keywords: HIV, delirium, depression, HAND, dementia; HIV-associated neurocognitive disorder

  13. Patients with Blunt Traumatic Spine Injuries with Neurological Deficits Presenting to an Urban Tertiary Care Centre in Mumbai: An Epidemiological Study

    Directory of Open Access Journals (Sweden)

    Anoop C Dhamangaonkar

    2013-03-01

    Full Text Available INTRODUCTION: Traumatic spine injuries are on the rise. The literature is sparse regarding epidemiology of patients with traumatic spine injuries from this part of the world. OBJECTIVES: To analyse the following in patients with traumatic spine injuries with neurological deficits: demographic and social profile, common modes of injury, pre-hospitalisation practices, region of spine affected, severity of neurological deficit and the lay individuals’ awareness about traumatic spine injuries. METHODS: The study sample comprised 52 adult patients with traumatic spine injuries with neurological deficits. We collected data on demographic and social characteristics, mode of injury, pre-hospitalisation treatment, interval between injury and presentation, spine region affected and severity of neurological deficits and patient's knowledge about such injuries. RESULTS: The average patient age was 31.32y. The male: female ratio was 2.25:1, and the most common modes of injury were fall from height, followed by traffic accident. More than half of the patients suffered cervical spine injuries, followed by dorsolumbar spine injuries. Only 9.61% of patients received pre-hospitalisation treatment. All patients understood there could be complete functional recovery after treatment for traumatic spine injuries. CONCLUSION: There is a growing need to improve railway and roadway safety equipment and to make it accessible and affordable to the susceptible economically weaker population. Attempts should be made to increase awareness regarding traumatic spine injuries.

  14. Patient with rapidly evolving neurological disease with neuropathological lesions of Creutzfeldt-Jakob disease, Lewy body dementia, chronic subcortical vascular encephalopathy and meningothelial meningioma.

    Science.gov (United States)

    Vita, Maria Gabriella; Tiple, Dorina; Bizzarro, Alessandra; Ladogana, Anna; Colaizzo, Elisa; Capellari, Sabina; Rossi, Marcello; Parchi, Piero; Masullo, Carlo; Pocchiari, Maurizio

    2017-04-01

    We report a case of rapidly evolving neurological disease in a patient with neuropathological lesions of Creutzfeldt-Jakob disease (CJD), Lewy body dementia (LBD), chronic subcortical vascular encephalopathy and meningothelial meningioma. The coexistence of severe multiple pathologies in a single patient strengthens the need to perform accurate clinical differential diagnoses in rapidly progressive dementias. © 2016 Japanese Society of Neuropathology.

  15. [Impairment in visual cognition in patients with Parkinson disease].

    Science.gov (United States)

    Hirayama, Kazumi; Ishioka, Toshiyuki

    2007-09-01

    Neural pathway for visual information processing involves retina, lateral geniculate body, primary visual cortex, and higher visual cortical areas, all of which have been reported to be disordered either functionally or pathologically in Parkinson disease (PD). As elementary visual disorders, there have been studies that reported reduced contrast sensitivity for middle to high spatial frequencies and impaired blue color perception. Most of those studies suggested retina as the damaged cite that is responsible for the impairments, whereas some studies pointed to the possible cortical involvement. Impairments of higher visual functions also have been reported. In the dorsal stream, impairments of object localization, depth perception, and mental rotation have been reported. In the ventral stream, object perception and visual integration of objects have been found to be impaired. A meta-analysis study, however, concluded that although there may be impairments in higher order functions like attention and problem solving capacity there is no firm evidence for the impairments of higher visual functions. Neuroimaging studies have found a relationship between reduced metabolism centered in the parietal lobe and impaired performance in higher visual functions. Impaired identification of overlapping figures has been reported in dementia with Lewy bodies a disease that is akin to PD. Capacity to discriminate textured areas has been found to be damaged in PD. We conducted a FDG-PET study to explore the relationship between brain metabolism and perception of overlapping figures, perception of shapes defined by texture differences and perception of subjective contours in PD. It revealed that there is a correlation between reduced activation in lateral occipital complex and impaired performance for these tasks, suggesting some compromised ventral rout functions.

  16. Perioperative Management of Neurological Conditions

    Directory of Open Access Journals (Sweden)

    Manjeet Singh Dhallu

    2017-06-01

    Full Text Available Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease. In this article, we emphasize on early diagnosis and management strategies of neurological disorders in the perioperative period to minimize morbidity and mortality of patients.

  17. [Patients with subarachnoid haemorrhage in poor grade neurological status: Study of prognostic factors].

    Science.gov (United States)

    Sosa-Pérez, Coralia; Morera-Molina, Jesús; Espino-Postigo, Carlos; Jiménez-O'Shanahan, Aruma

    2015-01-01

    To evaluate and predict factors influencing prognosis and/or clinical outcome at 6 months in patients with spontaneous subarachnoid haemorrhage, World Federation of Neurosurgical Societies (WFNS) grades iv and v. This was a retrospective study of a consecutive series of 394 patients admitted to our hospital with clinical and radiological diagnosis of spontaneous subarachnoid haemorrhage, from 1 January 1999 to 30 June 2009. We selected 121 patients who met the criteria of being in WFNS grades iv or v before treatment; 3 patients were excluded due to loss of tracking. The outcome variable was assessed 6 months after the event using the Glasgow Outcome Scale. A P valueGlasgow Coma Scale lower than 7 points (Pde Neurocirugía. Published by Elsevier España. All rights reserved.

  18. Impaired muscle strength is associated with fractures in hemodialysis patients.

    Science.gov (United States)

    Jamal, S A; Leiter, R E; Jassal, V; Hamilton, C J; Bauer, D C

    2006-01-01

    Fractures are extremely common among hemodialysis (HD) patients. To assess if bone mineral density (BMD) and/or tests of muscle strength were associated with fractures, we studied 37 men and 15 women, 50 years and older, on HD for at least 1 year. We excluded subjects with prior renal transplants and women taking hormone replacement therapy. We inquired about low-trauma fractures since starting dialysis. Subjects underwent BMD testing with a Lunar DPX-L densitometer. Tests of muscle strength included: timed up and go (TUG), 6-min walk, functional reach, and grip strength. Lateral and thoracic radiographs of the spine were obtained and reviewed for prevalent vertebral fractures. We used logistic regression to examine associations between fracture (prevalent vertebral, self-reported low trauma since starting dialysis and/or both) and BMD, and fracture and muscle-strength tests. Analyses were adjusted for age, weight, and gender. Mean age was 66+/-9.0 years, mean weight was 72.9+/-15.2 kg, and most (35 of 52) participants were Caucasian. Average duration of dialysis was 40.2 (interquartile range: 24-61.2) months. The most common cause of renal failure was diabetes (16 subjects). There were no differences by gender or fracture. Of the 52 subjects, 27 had either a vertebral fracture or low trauma fracture. There was no association between fractures, hip or spine BMD, or grip strength. In contrast, greater functional reach [odds ratio (OR) per standard deviation (SD) increase: 0.29; 95% CI: 0.13-0.69), quicker TUG (OR per SD decrease: 0.14; 95% CI: 0.11-0.23), and a greater distance walked in 6 min (OR per SD increase: 0.10; 95% CI: 0.03-0.36) were all associated with a reduced risk of fracture. Impaired neuromuscular function is associated with fracture in hemodialysis patients.

  19. Qualitative evidence of Ri specific IgG-synthesis in the cerebrospinal fluid from patients with paraneoplastic neurological syndromes.

    Science.gov (United States)

    Jarius, S; Stich, O; Rasiah, C; Voltz, R; Rauer, S

    2008-05-15

    The presence of Ri-specific oligoclonal IgG bands in the CSF was investigated in five patients with paraneoplastic anti-Ri associated neurological syndromes (PNS) and six controls. In 4/5 CSF samples reactivity of IgG bands with recombinant Ri antigen was found using isoelectrofocusing combined with affinity blotting; in one patient with absence of oligoclonal bands of total IgG in CSF Ri-specific oligoclonal bands were detected with the same sample, indicating a higher sensitivity of Ri-specific affinity blotting as compared to affinity blotting with anti-human IgG antibodies. Our results confirm previous studies demonstrating IgG synthesis against onconeuronal antigens by intrathecal B-cell clones in PNS and extend this observation to patients with anti-Ri syndrome. The pathogenic relevance of these antibodies, however, is further challenged by the finding that specific intrathecal IgG synthesis might not be a prerequisite of CNS involvement, because it was missed in one of our patients.

  20. Neurological complications in hyperemesis gravidarum.

    Science.gov (United States)

    Zara, Gabriella; Codemo, Valentina; Palmieri, Arianna; Schiff, Sami; Cagnin, Annachiara; Citton, Valentina; Manara, Renzo

    2012-02-01

    Hyperemesis gravidarum can impair correct absorption of an adequate amount of thiamine and can cause electrolyte imbalance. This study investigated the neurological complications in a pregnant woman with hyperemesis gravidarum. A 29-year-old pregnant woman was admitted for hyperemesis gravidarum. Besides undernutrition, a neurological examination disclosed weakness with hyporeflexia, ophthalmoparesis, multidirectional nystagmus and optic disks swelling; the patient became rapidly comatose. Brain MRI showed symmetric signal hyperintensity and swelling of periaqueductal area, hypothalamus and mammillary bodies, medial and posterior portions of the thalamus and columns of fornix, consistent with Wernicke encephalopathy (WE). Neurophysiological studies revealed an axonal sensory-motor polyneuropathy, likely due to thiamine deficiency or critical illness polyneuropathy. Sodium and potassium supplementation and parenteral thiamine were administered with improvement of consciousness state in a few days. WE evolved in Korsakoff syndrome. A repeat MRI showed a marked improvement of WE-related alterations and a new hyperintense lesion in the pons, suggestive of central pontine myelinolysis. No sign or symptom due to involvement of the pons was present.

  1. Performance of the Hack's Impairment Index Score: A Novel Tool to Assess Impairment from Alcohol in Emergency Department Patients.

    Science.gov (United States)

    Hack, Jason B; Goldlust, Eric J; Ferrante, Dennis; Zink, Brian J

    2017-10-01

    Over 35 million alcohol-impaired (AI) patients are cared for in emergency departments (EDs) annually. Emergency physicians are charged with ensuring AI patients' safety by identifying resolution of alcohol-induced impairment. The most common standard evaluation is an extemporized clinical examination, as ethanol levels are not reliable or predictive of clinical symptoms. There is no standard assessment of ED AI patients. The objective was to evaluate a novel standardized ED assessment of alcohol impairment, Hack's Impairment Index (HII score), in a busy urban ED. A retrospective chart review was performed for all AI patients seen in our busy urban ED over 24 months. Trained nurses evaluated AI patients with both "usual" and HII score every 2 hours. Patients were stratified by frequency of visits for AI during this time: high (≥ 6), medium (2-5), and low (1). Within each category, comparisons were made between HII scores, measured ethanol levels, and usual nursing assessment of AI. Changes in HII scores over time were also evaluated. A total of 8,074 visits from 3,219 unique patients were eligible for study, including 7,973 (98.7%) with ethanol levels, 5,061 (62.7%) with complete HII scores, and 3,646 (45.2%) with health care provider assessments. Correlations between HII scores and ethanol levels were poor (Pearson's R2  = 0.09, 0.09, and 0.17 for high-, medium-, and low-frequency strata). HII scores were excellent at discriminating nursing assessment of AI, while ethanol levels were less effective. Omitting extrema, HII scores fell consistently an average 0.062 points per hour, throughout patients' visits. The HII score applied a quantitative, objective assessment of alcohol impairment. HII scores were superior to ethanol levels as an objective clinical measure of impairment. The HII declines in a reasonably predictable manner over time, with serial evaluations corresponding well with health care provider evaluations. © 2017 by the Society for Academic

  2. Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome.

    Science.gov (United States)

    Huang, Wei; Zhang, Pei-Xun; Peng, Zhang; Xue, Feng; Wang, Tian-Bing; Jiang, Bao-Guo

    2015-10-01

    Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients (65 elbows) diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the McGowan scale as modified by Goldberg: 18 patients (28%) had grade IIA neuropathy, 20 (31%) had grade IIB, and 27 (42%) had grade III. Postoperatively, according to the Wilson & Krout criteria, treatment outcomes were excellent in 38 patients (58%), good in 16 (25%), fair in 7 (11%), and poor in 4 (6%), with an excellent and good rate of 83%. A negative correlation was found between the preoperative McGowan grade and the postoperative Wilson & Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.

  3. Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Wei Huang

    2015-01-01

    Full Text Available Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients (65 elbows diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the McGowan scale as modified by Goldberg: 18 patients (28% had grade IIA neuropathy, 20 (31% had grade IIB, and 27 (42% had grade III. Postoperatively, according to the Wilson & Krout criteria, treatment outcomes were excellent in 38 patients (58%, good in 16 (25%, fair in 7 (11%, and poor in 4 (6%, with an excellent and good rate of 83%. A negative correlation was found between the preoperative McGowan grade and the postoperative Wilson & Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.

  4. Aberrant functional connectome in neurologically asymptomatic patients with end-stage renal disease.

    Directory of Open Access Journals (Sweden)

    Xiaofen Ma

    Full Text Available This study aimed to investigate the topological organization of intrinsic functional brain networks in patients with end-stage renal disease (ESRD.Resting-state functional MRI data were collected from 22 patients with ESRD (16 men, 18-61 years and 29 age- and gender-matched healthy controls (HCs, 19 men, 32-61 years. Whole-brain functional networks were obtained by calculating the interregional correlation of low-frequency fluctuations in spontaneous brain activity among 1,024 parcels that cover the entire cerebrum. Weighted graph-based models were then employed to topologically characterize these networks at different global, modular and nodal levels.Compared to HCs, the patients exhibited significant disruption in parallel information processing over the whole networks (P < 0.05. The disruption was present in all the functional modules (default mode, executive control, sensorimotor and visual networks although decreased functional connectivity was observed only within the default mode network. Regional analysis showed that the disease disproportionately weakened nodal efficiency of the default mode components and tended to preferentially affect central or hub-like regions. Intriguingly, the network abnormalities correlated with biochemical hemoglobin and serum calcium levels in the patients. Finally, the functional changes were substantively unchanged after correcting for gray matter atrophy in the patients.Our findings provide evidence for the disconnection nature of ESRD's brain and therefore have important implications for understanding the neuropathologic substrate of the disease from disrupted network organization perspective.

  5. Quality of life in Mexican patients with primary neurological or musculoskeletal disabilities.

    Science.gov (United States)

    Estrella-Castillo, Damaris F; Gómez-de-Regil, Lizzette

    2016-01-01

    As the population with a disability increases both in number and life expectancy, so does its demand for health services. Very little original research has been done in Mexican populations regarding the effect of disability on quality of life. 1) Assessing the subjective quality of life of patients with neuromusculoskeletal and movement-related function disabilities and, 2) Analyzing the possible effect of the medical condition (diseases of the nervous system vs. diseases of the musculoskeletal system and connective tissue) and its interaction with sex and age. In a cross-sectional design 330 participants were recruited from a public institution in Mexico providing specialized outpatient rehabilitation. After signing informed consent they responded a brief sociodemographic questionnaire and the WHOQOL-BREF scale. In general quality of life levels were satisfactory. Female and elderly patients with diseases of the nervous system were particularly affected in the physical and psychological dimensions. Women with diseases of the nervous system also showed a negatively affected social quality of life. Elderly with diseases of the musculoskeletal system and connective tissue scored the lowest in general health perception. Even though most patients were quite satisfied with their quality of life, not all aspects or cases have such positive perceptions; both the physical and psychological dimensions were particularly negative in female and elderly patients with nervous system diseases. Clinicians would do well to thoughtfully assess patients in these groups and adjust treatment to achieve the greatest possible rehabilitation. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Visually impaired caregivers: perspectives from patient focus groups.

    Science.gov (United States)

    Martinez, Bethany S; Williams, Michael; Fuhr, Patti

    2009-01-01

    With the aging of the population, more persons who are severely visually impaired are now caring for a spouse or significant other. The purpose of this qualitative study is to learn more about this previously unreported, yet vulnerable, population of visually impaired caregivers. Focus groups and 1-on-1 interviews were conducted with legally blind U.S. English-speaking adults who served as informal caregivers of adults. Visually impaired caregivers discussed the challenges of caregiving and how their visual impairment affected their caregiving responsibilities. Interview transcripts were analyzed using grounded theory. Standardized questionnaires captured demographic and social characteristics. Fourteen adults participated. Seven major themes emerged from the interviews: (1) impact of lack of transportation, (2) concern over care recipient's quality of life, (3) utilization of support, (4) all encompassing demand, (5) cyclical adaptations, (6) anxieties of the caregivers, and (7) positive aspects of caregiving. Although visually impaired caregivers experience challenges similar to other caregivers, they differ in their report of added burden because of visual impairment, with extraordinary difficulty in transportation issues and the necessity of cyclical adaptations as their vision worsens. This is, to our knowledge, the first qualitative study of visually impaired caregivers and brings to light the unique problems faced by this special cohort of caregivers.

  7. Impairment of colour contrast sensitivity and neuroretinal dysfunction in patients with symptomatic HIV infection or AIDS.

    OpenAIRE

    Geier, S A; Kronawitter, U.; Bogner, J. R.; Hammel, G; Berninger, T; Klauss, V; Goebel, F D

    1993-01-01

    Ophthalmic and neurological complications are frequent findings in patients with AIDS. Little is known about neuroretinal dysfunction in patients with HIV infection. The purpose of this study was to measure and evaluate colour vision in patients with HIV infection or AIDS. Colour contrast sensitivity tests were performed on 75 patients (150 eyes) in different stages of HIV infection. A highly sensitive computer graphics system was used to measure tritan, deutan, and protan colour contrast thr...

  8. [Brain-machine interface (BMI) - application to neurological disorders].

    Science.gov (United States)

    Yoshimine, Toshiki; Yanagisawa, Takufumi; Hirata, Masayuki

    2013-01-01

    Brain-machine interface (BMI) is a new technology to receive input from the brain which is translated to operate a computer or other external device in real time. After significant progress during the recent 10 years, this technology is now very close to the clinical use to restore neural functions of patients with severe neurologic impairment. This technology is also a strong tool to investigate the mode of neuro-signal processing in the brain and to understand the mechanism of neural dysfunction which leads to the development of novel neurotechnology for the treatment of various sorts of neurological disorders.

  9. The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities.

    Science.gov (United States)

    Xie, Jing-Ming; Zhang, Ying; Wang, Ying-Song; Bi, Ni; Zhao, Zhi; Li, Tao; Yang, Hua

    2014-01-01

    To determine the risk factors of neurologic deficits during PVCR correction, so as to help improve safety during and after surgery. A consecutive series of 76 patients with severe and rigid spinal deformities who were treated with PVCR at a single institution between October 2004 and July 2011 were included in our study. Of the 76 patients, 37 were male and 39 female, with an average age of 17.5 years (range 10-48 years). There were 52 adolescent patients (with an age hyperkyphosis (X 5), level of vertebral column resected (X 6), number of segmental vessels ligated (X 7), preexisting neurologic dysfunction (X 8), and associated with intraspinal and brain stem anomalies (X 9). The multi-factor unconditional logistic regression analysis revealed that X 8 (OR = 49.322), X 9 (OR = 18.423), X 5 (OR = 11.883), and X 6 (OR = 8.769) were independent and positively correlated with the neurologic deficit. Preexisting neurologic dysfunction, associated with intraspinal and brain stem anomalies, scoliosis associated with thoracic hyperkyphosis and level of vertebral column resected are independent risk factors for neurologic deficits during PVCR procedure.

  10. Real-time closed-loop control of cognitive load in neurological patients during robot-assisted gait training.

    Science.gov (United States)

    Koenig, Alexander; Novak, Domen; Omlin, Ximena; Pulfer, Michael; Perreault, Eric; Zimmerli, Lukas; Mihelj, Matjaz; Riener, Robert

    2011-08-01

    Cognitively challenging training sessions during robot-assisted gait training after stroke were shown to be key requirements for the success of rehabilitation. Despite a broad variability of cognitive impairments amongst the stroke population, current rehabilitation environments do not adapt to the cognitive capabilities of the patient, as cognitive load cannot be objectively assessed in real-time. We provided healthy subjects and stroke patients with a virtual task during robot-assisted gait training, which allowed modulating cognitive load by adapting the difficulty level of the task. We quantified the cognitive load of stroke patients by using psychophysiological measurements and performance data. In open-loop experiments with healthy subjects and stroke patients, we obtained training data for a linear, adaptive classifier that estimated the current cognitive load of patients in real-time. We verified our classification results via questionnaires and obtained 88% correct classification in healthy subjects and 75% in patients. Using the pre-trained, adaptive classifier, we closed the cognitive control loop around healthy subjects and stroke patients by automatically adapting the difficulty level of the virtual task in real-time such that patients were neither cognitively overloaded nor under-challenged. © 2011 IEEE

  11. Neurological bypass for sensory innervation of the penis in patients with spina bifida

    NARCIS (Netherlands)

    Overgoor, Max L. E.; Kon, Moshe; Cohen-Kettenis, Peggy T.; Strijbos, Saskia A. M.; de Boer, Niels; de Jong, Tom P. V. M.

    2006-01-01

    Most male patients with spina bifida have normal sexual desires. During puberty they begin to realize that they can achieve erection and sexual intercourse but without any sensation in the penis. We hypothesized that restored sensation in the penis would greatly contribute to their quality of life

  12. Peripheral and central neurologic complications in type 2 diabetes mellitus: no association in individual patients.

    NARCIS (Netherlands)

    Manschot, S.M.; Biessels, G.J.; Rutten, G.E.H.M.; Kessels, R.P.C.; Gispen, W.H.; Kappelle, L.J.

    2008-01-01

    Diabetes mellitus is associated with end-organ complications in the peripheral and central nervous system. It is unknown if these complications share a common aetiology, and if they co-occur in the same patient. The aim of the present study was to relate different measures of peripheral neuropathy

  13. [Complete neurological recovery in a patient with decerebrate rigidity following cardiac arrest from acute airway obstruction by advanced laryngeal cancer].

    Science.gov (United States)

    Furukawa, Hajime; Takahashi, Shinji; Mizutani, Taro; Nakayama, Shin; Wada, Tetsuro; Toyooka, Hidenori

    2004-03-01

    A 59-year-old man presented with severe dyspnea caused by advanced laryngeal cancer. As he had disregarded the dyspnea for a month, we did not have enough information about the extent of the tumor. The pulse oximeter showed 88% with oxygen inhalation. Because of severe dyspnea, he could not maintain supine position. Fiberoptic laryngoscopy showed tumor bulk obstructing airway directly. In the operating room, at first, a cricothyroid membrane puncture was attempted under local anesthesia but the procedure was abandoned when the patient became hypoxic and unconscious. Immediately tracheostomy and cardiopulmonary resuscitation were performed. Tumor bulk had displaced the trachea and surrounding structures, making a tracheostomy difficult. Nine min after loss of consciousness, a secure airway was obtained. However, he was still unconscious and developed characteristic decerebrate rigidity. Therefore the patient was treated with infusion of thiamylal and free radical scavenger and mild hypothermia therapy (bladder temperature 34 degrees C). On the fifth day of this treatment, after rewarming and discontinuation of thiamylal, the patient responded to command. He recovered with no neurological deficits. This case suggests that combined treatment with barbiturate, free radical scavenger, and mild hypothermia therapy is effective to minimize ischemic brain damage after cardiopulmonary resuscitation.

  14. Intraoperative Epi-Aortic Scans Reduce Adverse Neurological Sequelae in Elderly, High Risk Patients Undergoing Coronary Artery Bypass Surgery - a Propensity Matched, Cumulative Sum Control Analysis.

    Science.gov (United States)

    Luthra, Suvitesh; Leiva Juarez, Miguel M; Tahir, Zaheer; Yiu, Patrick

    2017-07-01

    Adverse neurological sequelae are a major cause of morbidity and mortality after coronary artery bypass (CABG) surgery, due to manipulation of an atherosclerotic aorta. The purpose of this study is to measure the impact of intraoperative epi-aortic scanning in reducing neurologic sequelae after CABG, and the patient subgroups that are benefitted the most. Patients that underwent first-time CABG from July 2010 to March 2014 (n=1,989) were retrospectively reviewed and stratified by history of intraoperative epi-aortic scan (n=350) or no scan (n=1,639). Baseline characteristics, rates of adverse neurological events, and overall survival were compared among groups in both matched and unmatched cohorts and tested using Student's t-test, chi(2) test, or log-rank test, respectively. Multivariable analysis using logistic regression was performed to identify potential predictors for neurological sequelae. Cumulative summation plots (CUSUM) were constructed to display the number of preventable adverse neurological events per consecutive patient that underwent CABG. A p≤0.05 was considered statistically significant. The use of epi-aortic scan (OR: 0.29, 95% CI: 0.09-0.99, p=0.48) was an independent predictor of adverse events. Overall rates of stroke (0.29% vs 0.55%), postoperative confusional state (1.43% vs 3.42%), or both (1.71% vs 3.72%) were lower in those scanned. CUSUM scores were higher in scanned patients, especially