Abnormal Neurological Findings Research Articles

Children presenting with toe walking: when should concern arise?

Purpose: This study aimed to evaluate children who present with tiptoe walking (TW) and to identify potential indicators of underlying medical conditions. Materials and Methods: Out of the 248 patients who visited the Pediatric Neurology Outpatient Clinic for gait disturbances, 90 individuals aged 1-17 years were identified as exhibiting TW. After excluding those with systemic neurological diseases and pervasive developmental disorders (PDD), the study ultimately included 47 patients. Results: Among the participants, 19 were female (40.5%) and 28 were male (59.5%). The mean age of the patients was 4.9 years (SD ± 3.53). When evaluating the etiology of TW, 30 patients (63.8%) were found to have idiopathic tiptoe walking (ITW), 8 (17%) had cerebral palsy (CP), 6 (12.7%) had Achilles tendon shortness (ATS), 2 (4.2%) had hereditary spastic paraplegia (HSP), and 1 (2.1%) had syringomyelia. Imaging was not performed for 17 patients (36.1%), while cranial magnetic resonance imaging (MRI) was conducted for 13 (27.6%), spinal MRI for 2 (4.2%), and both cranial and spinal MRI for 15 (31.9%). Pathology was detected in 5 of the patients who underwent imaging (10.6%): 4 (8.5%) showed hypoxic-ischemic processes, and 1 (2.1%) showed syringomyelia. Conclusion: In cases where patients exhibit normal neurological examinations and neuromotor development, TW is often identified as idiopathic. However, for patients presenting with risk factors in their personal or family history, delays in neuromotor milestones, or abnormal neurological findings, a diagnosis should be pursued at an earlier stage.

Live Streaming of the Professor's Ward Rounds in Undergraduate Neurology Education: Usability Study.

Although neurology department ward rounds are among the most important medical education exercises in Japan, they have several issues. Patients may find it unpleasant to undergo repeated neurological tests, especially when in the presence of several students. Only the front row of students can closely observe the examination findings; moreover, students were prohibited from contacting patients altogether during the COVID-19 pandemic. One possible solution is to use commercial videoconferencing systems. However, Japanese patients are reluctant to have their medical information or video footage of them sent outside of the hospital via the internet. The study aimed to confirm the feasibility of conducting remote teaching rounds using an in-house web conferencing system in which the patients' personal data are securely protected. This study also explored whether using remote rounds alongside face-to-face participation would enhance learning. We created an on-premises videoconferencing system using an open-source app. To perform video ward rounds, the professor wore a wireless microphone while leading routine in-person rounds and the attending physician carried a tablet device linked to a web conference, allowing students in another room to watch the rounds on a live stream. In total, 112 of 5th-year students who entered their 1-week neurology rotation between 2021 and 2022 were instructed to participate in 1-hour in-person and remote rounds. Students were given questionnaires to evaluate their satisfaction and the educational effects of the remote rounds. The remote ward rounds were conducted easily with no interference with the in-person rounds, nor any complaints from the patients. Each examination technique was explained by another teacher to the students who participated in remote rounds in the conference room. Characteristic neurological findings, such as plantar reflexes (Babinski sign), which are usually seen only by close observers during in-person rounds, could be visualized under magnification by all students. The postexperience survey (82/112, 73% response rate) showed that the mean score of participants' satisfaction was 3.94 (SD 0.83; excellent 5 and poor 1). No participant scoring 1 was noted. The proportion of students who observed 6 representative abnormal neurological findings (Babinski sign, hyperreflexia, cerebellar ataxia, involuntary movement, muscular weakness, and abnormality in sensory examination) increased by 22% (18/82, range 13-24) compared to in-person rounds alone. When self-rating the learning value, 43% (35/82) of the students answered that remote rounds are equally as valuable as in-person rounds, while 32% (26/82) preferred remote rounds. Live-streaming of neurology ward rounds using a secure in-house web conferencing system provides additional learning experience without concerns regarding leakage of patient information. This initiative could enhance neurology learning before entering a clinical clerkship.

New-Onset Gaze Palsy in a Sports-Related Concussion.

Concussions are a common injury in pediatric sports medicine clinics. Occasionally, a patient presenting for concussion will demonstrate abnormal neurologic findings, but in this case, a gaze palsy was witnessed during the initial 2 weeks following closed head injury with subsequent complete resolution of symptoms. There are limited available studies or case reports demonstrating this atypical presentation; thus, this case study aims to provide sports medicine physicians a reference for future similar atypical presentations.

Idiopathic intracranial hypertension associated with SARS-CoV-2 infection in an adult male patient: a case report and review of the literature

BackgroundHeadache is a frequent symptom in coronavirus disease 2019 (COVID-19) patients, and idiopathic intracranial hypertension (pseudotumor cerebri) has been reported among patients who underwent lumbar puncture for persistent headaches.Case presentationA 45-year-old black man presented with dyspnea, cough, fever and headache for 05 days followed by blurring of vision associated with worsening of the headache. Physical examination was significant for tachypnea and oxygen desaturation and there were no abnormal neurologic findings. He tested positive for SARS-CoV-2 with nasopharyngeal swab PCR. His CSF opening pressure appeared high with normal CSF analysis and brain magnetic resonance imaging (MRI) revealed prominent subarachnoid space around the optic nerves and bilateral papilledema. He had significant improvement with medical therapy alone.ConclusionIdiopathic intracranial hypertension (IIH) may occur in association with SARS-CoV-2 infection and should be considered when making a differential diagnosis for headache and blurring of vision. COVID-19 may play a role in the development of intracranial hypertension, even in the absence of known risk factors. Early diagnosis and treatment of IIH has paramount importance to prevent vision loss and other morbidities.

Evaluation of the Patients with the Diagnosis of Pontocerebellar Hypoplasia: A Multicenter National Study

Pontocerebellar hypoplasia (PCH) is a heterogeneous group of neurodegenerative disorders characterized by hypoplasia and degeneration of the cerebellum and pons. We aimed to identify the clinical, laboratory, and imaging findings of the patients with diagnosed PCH with confirmed genetic analysis. We collected available clinical data, laboratory, and imaging findings in our retrospective multicenter national study of 64 patients with PCH in Turkey. The genetic analysis included the whole-exome sequencing (WES), targeted next-generation sequencing (NGS), or single gene analysis. Sixty-four patients with PCH were 28 female (43.8%) and 36 (56.3%) male. The patients revealed homozygous mutation in 89.1%, consanguinity in 79.7%, pregnancy at term in 85.2%, microcephaly in 91.3%, psychomotor retardation in 98.4%, abnormal neurological findings in 100%, seizure in 63.8%, normal biochemistry and metabolic investigations in 92.2%, and dysmorphic findings in 51.2%. The missense mutation was found to be the most common variant type in all patients with PCH. It was detected as CLP1 (n = 17) was the most common PCH related gene. The homozygous missense variant c.419G > A (p.Arg140His) was identified in all patients with CLP1. Moreover, all patients showed the same homozygous missense variant c.919G > T (p.A307S) in TSEN54 group (n = 6). In Turkey, CLP1 was identified as the most common causative gene with the identical variant c.419G > A; p.Arg140His. The current study supports that genotype data on PCH leads to phenotypic variability over a wide phenotypic spectrum.

Birth Asphyxia among Neonates Admitted to the Neonatal Intensive Care Unit of a Tertiary Care Hospital.

Birth asphyxia causes significant morbidity and mortality among neonates, especially in low-income and middle-income countries like Nepal. However, there is a paucity of data regarding its burden. This study aimed to find the prevalence of birth asphyxia among neonates admitted to the neonatal intensive care unit of a tertiary care hospital. This descriptive cross-sectional study was conducted among neonates at a tertiary care hospital between 15 January 2022 to 14 January 2023 after obtaining ethical approval from the Institutional Review Committee. Neonates with gestational age ≥35 weeks were included and those with major congenital anomalies were excluded. A convenience sampling method was used. A point estimate was calculated at a 95% Confidence Interval. Among 902 neonates, 120 (13.30%) (11.08-15.52, 95% Confidence Interval) had birth asphyxia. A total of 108 (90%) were outborn, and 84 (70%) were males. HIE stage-I, II and III were seen in 47 (39.17%), 64 (53.33%) and 9 (7.50%) of the asphyxiated neonates respectively. Poor suck 92 (76.67%), seizures 73 (60.83%) and lethargy 70 (58.33%) were common abnormal neurological findings. Death occurred in 15 (12.50%) neonates in the hospital. The prevalence of birth asphyxia was found to be similar to other studies done in similar settings. The high burden underscores an urgent need to implement better perinatal care and delivery room management practices. hypoxic-ischemic encephalopathy; neonates; prevalence.

Aicardi-Goutières Syndrome Type 1: A Novel Missense Variant and Review of the Mutational Spectrum.

Mutations in the TREX1 gene cause Aicardi-Goutières syndrome (AGS) 1, associated with a spectrum of autoimmune and neurodegenerative manifestations. AGS 1, the most severe neonatal type of AGS, is characterized by abnormal neurologic findings, visual inattention, hepatosplenomegaly, thrombocytopenia, skin rash, restlessness, and fever. The present study described two affected siblings from an Iranian family whose phenotypes overlap with intrauterine infections. They had almost similar presentations, including developmental delay, microcephaly, no fix and follow epileptic seizures and the same pattern of brain CT scan involvements. Following clinical and paraclinical assessments, whole-exome sequencing was employed to determine the disease-causing variant, and subsequently, PCR-Sanger sequencing was performed to indicate the segregation pattern of the candidate variant in family members. Genetic analysis revealed a novel homozygous missense variant (c.461A>C; p.D154A) in the TREX1 gene in affected family members. Sanger sequencing of other family members showed the expected zygosities. This study identifies a novel mutation in the TREX1 gene in this family and highlights the efficiency of next-generation sequencing-based techniques for obtaining a definite diagnosis in patients with early-onset encephalopathy.

Neurologic manifestations of Long COVID in Colombia: a comparative analysis of post-hospitalization vs. non-hospitalized patients.

To analyze patient-reported outcomes, cognitive function, and persistent symptoms in patients with neurologic post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) in Colombia. We recruited patients with laboratory-confirmed COVID-19 and PASC symptoms lasting more than 6 weeks at the CES University and CES Clinic (Medellín, Colombia). We included 50 post-hospitalization Neuro-PASC (PNP) and 50 non-hospitalized Neuro-PASC (NNP) patients. Long-COVID symptoms, cognitive (NIH Toolbox v2.1-Spanish for 18+), patient-reported (PROMIS) outcomes, and relevant medical history were evaluated. Statistical analyses were performed via generalized linear models. Overall, brain fog (60%), myalgia (42%), and numbness or tingling (41%) were the most common neurological symptoms, while fatigue (74%), sleep problems (46%), and anxiety (44%) were the most common non-neurological symptoms. Compared to NNP, PNP patients showed a higher frequency of abnormal neurological exam findings (64% vs. 42%, p = 0.028). Both groups had impaired quality of life (QoL) in domains of cognition, fatigue, anxiety depression and sleep disturbance, and performed worse on processing speed and attention than a normative population. In addition, NNP patients performed worse on executive function than PNP patients (T-score 42.6 vs. 48.5, p = 0.012). PASC symptoms of anxiety and depression were associated with worse QoL and cognitive outcomes. Brain fog and fatigue remained persistent symptoms across all durations of Long COVID. Our findings highlight the high incidence and heterogeneity of the neurologic symptoms and impacts of Long COVID even more than 2 years from disease onset. Early detection, emotional support and targeted management of Neuro-PASC patients are warranted.

Retrospective Evaluation of Patients Admitted to the Pediatric Neurology Outpatient Clinic with Headache: Experience of a Tertiary Hospital.

It was aimed to determine the etiological and clinical features of pediatric patients with headache complaints. The files of patients who were admitted to the pediatric neurology outpatient clinic with headache were reviewed retrospectively. Patients' age, gender, features of headache, symptoms accompanying headache, available blood tests, brain magnetic resonance (MR) and electroencephalography (EEG) results were recorded. Of the total 470 patients, aged between 3 and 17 years, 291 (61.9%) were female and 179 (39.1%) were male. The mean age of the patients was 12.38±3.45 years. According to age groups, there were 16 (3.4%) patients under the age of 5, 159 (33.8%) between the ages of 6-11, and 295 (62.8%) patients aged 12-17 years. While 289 (61.5%) patients were diagnosed with primary headache, 122 (26.0%) patients were diagnosed with secondary headache, and headaches of 59 (12.5%) patients could not be classified. The most common primary headaches were tension-type headache (TTN) (n=177, 37.7%) and migraine (n=111, 23.6%). The 86 (70.5%) of the patients with secondary headache were diagnosed with sinusitis. Abnormal neurological examination finding was determined in 8 (1.7%) patients. Brain MR was performed in 439 (93.4%) of all patients and abnormal brain MR findings were detected in 52 (11.8%) patients. EEG was performed in 205 (43.6%) of all patients and abnormal EEG findings were detected in 24 (11.7%) patients. According to age groups, headache was most common in the 12-17 age group. The most common causes of headache were TTN and migraine, respectively. The most common secondary headache cause was sinusitis. We think that physical and neurological examination still maintains its priority in determining the causes of headache.

Cauda equina syndrome in a patient with human immunodeficiency virus and secondary central nervous system lymphoma: a case report

BackgroundSecondary central nervous system lymphoma (SCNSL) is a known complication of immunocompromised patients with most cases involving the brain parenchyma. Reports of cauda equina syndrome (CES) caused by SCNSL are exceedingly scarce as involvement of this anatomical region is extremely uncommon.Case presentationWe report a case of a 46-years-old, African, female patient with human immunodeficiency virus (HIV) who developed CES in the context of SCNSL. There were no blasts present in the peripheral blood smear. We provide a review of the literature, discussion of the clinical evolution of this patient and the radiological/histopathological findings. The patient ultimately responded well to induction chemotherapy and high dose methotrexate.ConclusionThis case report demonstrates that CES, while a rare occurrence in this clinical context, should be considered in at-risk patients especially those presenting with abnormal neurological findings. Prompt recognition may prevent permanent neurological injury and obviate the need for more invasive therapeutic interventions.

Abnormal Neurologic Findings in Patients With Sickle Cell Disease Without a History of Major Neurologic Events.

Patients with sickle cell disease (SCD) are prone to symptomatic neurologic complications. Previous studies reported accrual of neural injury starting at early age, even without having symptomatic neurologic events. The aim of this study was to assess the prevalence and risk factors of abnormal neurologic findings in patients with SCD with no history of major symptomatic neurologic events. Our study extracted patients diagnosed with SCD from the Cooperative Study of Sickle Cell Disease. Patients who underwent a neurologic evaluation were included in our analysis. Patients with previous documented major symptomatic neurologic events were excluded. We compared patients with SCD with abnormal neurologic findings with those without in terms of clinical and laboratory parameters using multivariate binary logistic regression. A total of 3,573 patients with SCD were included (median age = 11 [IQR = 19] years, male = 1719 [48.1%]). 519 (14.5%) patients had at least one abnormal neurologic finding. The most common findings in descending order were abnormal reflexes, gait abnormalities, cerebellar dysfunction, language deficits, nystagmus, abnormal muscle tone and strength, Romberg sign, Horner syndrome, and intellectual impairment. History of eye disease (odds ratio [OR] = 2.76, 95% confidence interval [CI] = 1.63-4.68) and history of osteomyelitis (OR = 2.55, 95% CI 1.34-4.84) were the strongest predictors of abnormal neurologic findings, followed by smoking (OR = 1.59, 95% CI 1.08-2.33), aseptic necrosis (OR = 1.57, 95% CI 1.06-2.33), hand-foot syndrome (OR = 1.48, 95% CI 1.04-2.12), and male sex (OR = 1.42, 95% CI 1.01-2.02). Neurologic deficits are relatively common in patients with SCD, even without documented major neurologic insults. They range from peripheral and ophthalmic deficits to central and cognitive disabilities. Patients with SCD should have early regular neurologic evaluations and risk factor modification, particularly actively promoting smoking cessation.

Epilepsy Frequency and Risk Factors Three Years After Neonatal Seizures

BackgroundNeonatal seizures, one of the main risk factors for the development of epilepsy, remain a clinical concern. In children with neonatal seizures, early recognition of risk factors is important for the early diagnosis and appropriate treatment of epilepsy and for improving prognosis. In this study, we aimed to determine the frequency of and the risk factors for the development of epilepsy in patients with neonatal seizures. MethodsThe hospital files of 228 children who experienced seizures in the neonatal period were reviewed. The frequency of epilepsy and risk factors for the development of epilepsy were determined at age 36 months. ResultsEpilepsy was diagnosed in 40.8% of the cases. Univariate analysis revealed family history of epilepsy, parental consanguinity, abnormal neurological examination findings, microcephaly, unresponsiveness to antiepileptic drugs or antiseizure medication, use of more than one antiepileptic drugs to antiseizure medication at discharge, status epilepticus, electroencephalography abnormalities, abnormal neuroimaging findings, invasive ventilation requirement, myoclonic seizures, central nervous system malformation, and congenital metabolic disease as risk factors for the development of epilepsy. Of these, a family history of epilepsy, abnormal neurological examination findings at discharge, and use of at least two antiepileptic drugs to antiseizure medication at discharge were found as independent risk factors in multivariate analysis. ConclusionsNeonatal seizures appear to be associated with epilepsy in more than one-third of the patients. Of the newborns with seizures, those with a family history of epilepsy, abnormal neurological examination findings at discharge, and those using at least two antiepileptic drugs to antiseizure medication at discharge should be monitored more carefully for the development of epilepsy.

On-Field and Pitch-Side (Sideline) Assessment of Sports Concussion in Collision Sports: An Expert Consensus Statement Using the Modified Delphi Technique

To perform a Delphi consensus for on-field and pitch-side assessment of sports-related concussion (SRC). Open-ended questions in rounds 1 and 2 were answered. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤80% for an item, if panel members were outside consensus, or there were >30% neither agree/disagree responses, the results were carried forward into round 4. The level of agreement and consensus was defined as 90%. Loss of consciousness (LOC) or suspected LOC, motor incoordination/ataxia, balance disturbance, confusion/disorientation, memory disturbance/amnesia, blurred vision/light sensitivity, irritability, slurred speech, slow reaction time, lying motionless, dizziness, headaches/pressure in the head, falling to the ground with no protective action, slow to get up after a hit, dazed look, and posturing/seizures were clinical signs of SRC and indicate removal from play. Video assessment is helpful but should not replace clinical judgment. LOC/unresponsiveness, signs of cervical spine injury, suspicion of other fractures (skull/maxillo-facial), seizures, Glasgow Coma Scale score <14 and abnormal neurologic examination findings are indications for hospitalization. Return to play should only be considered when no clinical signs of SRC are present. Every suspected concussion should be referred to an experienced physician. Consensus was achieved for 85% of the clinical signs indicating concussion. On-field and pitch-side assessment should include the observation of the mechanism, a clinical examination, and cervical spine assessment. Of the 19 signs and red flags requiring removal from play, consensus was reached for 74%. Normal clinical examination and HIA with no signs of concussion allow return to play. Video assessment should be mandatory for professional games but should not replace clinical decision-making. Sports Concussion Assessment Tool, Glasgow Coma Scale, vestibular/ocular motor screening, Head Injury Assessment Criteria 1, and Maddocks questions are useful tools. Guidelines are helpful for non-health professionals. Level V, expert opinion.

Adverse Effects of Topiramate in Neonate with Moderate to Severe Perinatal Asphyxia: A Randomized Controlled Trial

Introduction: A harmful pregnancy condition that harms both the mother and the fetus is perinatal asphyxia. It frequently happens as a result of challenges during labour, including protracted or challenging delivery, concerns with the umbilical cord, placental abnormalities, or maternal health conditions. Topiramate, an anticonvulsant, works through a variety of different methods. Topiramate looks to be effective as a neuroprotective agent as well as an anti-seizure medication in animal models of newborn brain injury. Angiogenesis, neurogenesis, and neuronal anti-apoptotic pathways are all stimulated and regulated by topiramate. In light of this, this observational study was conducted to ascertain Topiramate's negative consequences in kids with mild to moderate neonatal hypoxia. Methods: This observational case-control study was carried out in the Neonatal ward and ICU of Dhaka Shishu Hospital from April 2015 to March 2016. A total of 64 neonates were enrolled in this study and were assigned Group A -the interventional group (n=32) received topiramate and standard treatment protocol, and Group B or the control group (n=32) received only standard treatment protocol. The data were analyzed according to standard procedure. Results: Among the study neonates, based on sex in case and control groups, respectively, seventeen (17,53%) and twenty-one (21,66%) neonates were male, and fifteen (15,47%) and eleven (11,44%) neonates were female. Statistically, the sex distribution between groups was not significant (p=0.44). USG finding of the neonates after treatment was normal in 12 (48%) and 13(41%), and abnormal in 20(32%) and 19 (59%) neonates in the control and case groups, respectively. Out of 27 neonates in the control group, 11 (41%) were neurologically normal, and 16 (59%) had abnormal neurological findings. Out of 29 neonates in the case group, 24 (73%) were neurologically normal, and 5(17%) showed abnormal neurological findings. Statistically, significant variation ..

Occult fractures detected on radiographs in young children with a concern for abusive head trauma.

To determine the incidence of children < 2 years old with suspected abusive head trauma, to evaluate usage of dedicated skeletal radiographs and the incidence of clinically occult fractures on dedicated skeletal radiographs. This is a retrospective single centre study of children < 2 years old with traumatic brain injury, referred to the University Hospital's Social Services Department between December 31, 2012 and December 31, 2020. Clinical and demographic data was retrieved from medical notes and imaging was reviewed by paediatric radiologists. 26 children (17 males), 2 weeks to 21 months of age (median age 3 months) were included. Eleven children (42%) had traumatic history, fourteen children (54%) had one or more bruises, eighteen children (69%) had abnormal neurological findings. 16 children (62%) had dedicated skeletal radiographs, 7 children (27%) had radiographs of part of the skeleton and 3 children (11%) had no skeletal radiographs. 5 out of 16 children (31%) with dedicated skeletal radiographs had a clinically occult fracture. 15 (83%) of clinically occult fractures had high specificity for abuse. The incidence of suspected abusive head trauma in children < 2 years old is low. Clinically occult fractures were detected in one third of children with dedicated skeletal radiographs. The majority of these fractures have high specificity for abuse. Dedicated skeletal imaging is not performed in more than one third of the children and hence fractures may be missed. Efforts should be taken to increase awareness of child abuse imaging protocols.

Neurologic Consultations and Headache during Pregnancy and in Puerperium: A Retrospective Chart Review.

Headache is a common symptom during pregnancy and in puerperium that requires careful consideration, as it may be caused by a life-threatening condition. Headaches in pregnant women and women in puerperium are classified as primary or secondary; acute, severe and newly diagnosed headaches should prompt further investigation. We aimed to further characterise the demographic features, symptoms, examination findings, and neuroimaging results of cases of headache during pregnancy and in puerperium. All pregnant women or women in postpartum conditions who attended neurological consultations at the emergency department of the clinic for Gynaecology, Obstetrics and Reproductive Medicine of Saarland University/Germany between 2001/2015 and 2012/2019 were enrolled in this retrospective chart review. Data collected from the charts included demographic/pregnancy characteristics, clinical features and imaging findings. Descriptive statistics as well as binary logistic regression were performed. More than 50% of 97 patients had abnormal findings in their neurological examination. Magnetic resonance imaging findings were pathological for almost 20% of patients-indicating conditions such as cerebral venous thrombosis, reversible posterior leukoencephalopathy, brain tumour and intracranial bleeding. The odds of abnormal neuroimaging results were 2.2-times greater among women with abnormal neurological examination findings than among those with normal examination results. In cases of headache during pregnancy and in puerperium, neuroimaging should be indicated early on. Further research is needed to determine which conditions indicate a need for immediate neuroimaging.

Sensitization of Hoffmann’s sign in response to a reverse Lhermitte’s sign: a case report

ABSTRACT Background Neurologic clustering of findings is recommended with Cervical Spondylotic Myelopathy (CSM). Hoffmann’s Sign and Reverse Lhermitte’s Sign have been associated with CSM, which, however, have not been discussed as the only objective findings that may cause clinical uncertainty. Case Description This case report describes how sensitizing Hoffmann’s Sign following a Reverse Lhermitte’s Sign guided reasoning, with a 66-year-old male presenting with a right lumbar radiculopathy diagnosis. Local lumbar symptoms and impairments were identified, however, a Reverse Lhermitte’s Sign with cervical extension was the only finding that reproduced right lower extremity (LE) pain. Hoffmann’s Sign, the only abnormal neurologic finding, became exaggerated when performed in cervical extension. Concern of an early presenting CSM accounting for right LE pain was considered. A neurosurgical consultation was initiated with concurrent guideline-based lumbar spine treatment and continued monitoring of neurologic status. Outcomes Seven weeks after evaluation, sudden worsening of right LE symptoms, hand numbness, ataxia, and grip weakness occurred. Cervical magnetic resonance imaging demonstrated C3-6 cord compression. A multi-level cervical decompression surgery was performed. Discussion Using a sensitized Hoffmann’s Sign-in response to a Reverse Lhermitte’s Sign aided differential diagnosis of an early presenting CSM with reports of LE pain. The diagnostic utility of a sensitized Hoffmann’s Sign is unknown.

Patterns of MRI Findings in Patients with Chronic Headache: A Retrospective Study from a Private Diagnostic Center in Addis Ababa, Ethiopia.

Headache is one of the most common complaints that lead the patient to seek medical advice however only a few patients with recurrent headaches have a secondary cause like intracranial mass. The appropriate utilization of neuroimaging is important to rule-out secondary cause of headache in resource-limited regions. The objective of this study is to describe the patterns of MRI findings in the evaluation of patients with chronic headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. This cross sectional study was conducted among 590 selected patients who underwent an MRI scan of the head from September 2016 to January 2018 at Wudassie Diagnostic center in Addis Ababa, Ethiopia. Siemens Magnetom 0.35T MRI was used. Out of 590 patients, 372 (63.1%) were females and 218 (36.9%) were males; 300 (50.8%) patients with the mean age of 38.6 ± 0.5 years and a median of 37 ± 16.7years have normal brain MRI and 290(49.2%) have abnormal brain MRI reports. The abnormal findings further divided into non-significant findings were 166(28%) that did not alter patient management and clinically significant findings were 124 (21%) which included by decreasing order of frequency tumors, infection, hydrocephalus, hemorrhage, and vascular abnormalities. It was 1.3 times higher rate of positive brain MR findings in patients who had headaches plus abnormal neurologic findings as compared to patients without neurologic abnormality (P-value = 0.01). There is a high rate of significant abnormal MRI findings in this study as compared to studies from developed nations.

Low-back pain in adolescents with an osteopathic component

Low-back pain (LBP) is a common symptom presenting in adolescents. Most back pain in adolescents is benign and musculoskeletal in nature, due to trauma or congenital anomalies. Other less common causes include infection, inflammatory conditions or neoplasm. A comprehensive history and physical focusing on posture, muscle tenderness, range of motion, muscle strength and neurological function is essential in understanding the cause of low-back pain. Identification of risk factors for low-back pain will help the clinician in managing their patient. Treatment includes rest, avoiding activities that cause pain, physical therapy, osteopathic manipulative treatment, limited use of non-steroidal anti-inflammatory drugs and family and patient education. Assessing for warning signs or red flags of serious causes of LBP is a fundamental part of the clinical assessment. Pain that awakens from sleep, pain lasting longer than 4 weeks, sudden onset pain, systemic findings such as fever or weight loss and abnormal neurological findings should warrant immediate evaluation as these may suggest serious infectious conditions, malignancy or fracture. This article presents a comprehensive review of the epidemiology, relevant anatomy, biomechanics, causes and major risk factors for adolescent low-back pain. A diagnostic algorithm utilizing a step-by-step approach is also introduced to aid the clinician in management of the patient. Finally, the article presents guidelines for management of the adolescent with low-back pain including conservative, pharmacologic, as well as the osteopathic approach to treatment. Evidence-based recommendations on osteopathic approach to treatment has been reviewed from meta-analysis data and randomized controlled trials.

Congenital Rubella syndrome cases (based on WHO criteria) one decade after Measle and Rubella vaccination campaign in Tehran; Iran.

Background: Active CRS surveillance is recommended strongly even in country with full rubella vaccination. Objective: Searching the CRS based on WHO criteria one decade after MR vaccination campaign (2003) Methods: a prospective case control study carried out in a third referral educational hospital (Rasoul Akram hospital) in Tehran, IRAN during five years (2013 -2018). From 89 CRS suspected infants (according to WHO criteria); serum samples were tested for rubella-specific IgG and IgM by ELISA method. Selected samples (positive Rubella IgM) were tested for rubella RNA by reverse transcriptase–polymerase chain reaction (RT–PCR). Findings: “Confirmed CRS” based on positive IgM was found in 5.6% (5/89) all were &lt; 4 months old. Positive RT–PCR detected in 1.2 % (1/89) of “CRS suspected” infants.Except a good correlation between abnormal neurologic findings and positive IgM in “Confirmed CRS “cases, other clinical findings were not related to serologic tests. The “Compatible CRS” cases in the 31 patients who had primary negative IgM serology and did not have sufficient laboratory evidence to confirm CRS, but clinical symptoms favoured CRS. Conclusion: Despite MR vaccination in Iran, after one decade “confirmed CRS” and “compatible CRS” were diagnosed in 5 and 31 from 89 CRS suspected cases. The incidence of “confirmed CRS” in every 100 CRS suspected infants (after campaign) is 5.6 %; and 31 CRS Compatible cases are so important. Without active CRS surveillance; mild infection such as IUGR, hearing loss,heart abnormalities, impaired vision, and mental retardation even in developed country might be missed.Fetal infection is persistent which impose additional costs on the country..Another mass vaccination in women and girls is needed. Also, the antirubella IgG testing before pregnancy in women who were not vaccinated; vaccination of women before marriage /preganacy should be obligatory in order to prevent the CRS.