Cerebral Symptoms Research Articles

Lung-molGPA Index Predicts Survival Outcomes of Non-Small-Cell Lung Cancer Patients with Synchronous or Metachronous Brain Metastases.

BackgroundGraded prognostic assessment for lung cancer using molecular markers (Lung-molGPA) for brain metastases is a powerful prognostic tool. However, it has not been validated for non-small-cell lung cancer (NSCLC) patients with synchronous or metachronous brain metastases.MethodsA total of 1184 NSCLC patients with synchronous or metachronous brain metastases were reviewed in this study. Comparative clinicopathological variables and survival analysis for these two groups (synchronous vs metachronous), as well as complimentary analysis of prognostic factors for the entire patient cohort, were performed. Afterward, patients were stratified using Lung-molGPA to evaluate the accuracy of the survival estimates.ResultsA total of 763 patients (64.4%) had synchronous metastases while 35.6% (421 patients) had metachronous metastasis. Patients with synchronous metastases were more likely to have a smoking history, limited metastatic lesions, and absence of cerebral symptoms (P<0.05). Patients with metachronous metastatic NSCLC had an overall survival (OS) period of 16.5 (95% CI 14.5–18.6) months and were longer compared to patients with synchronous metastases (16.5 vs 13.5 [12.5–14.6] months, P=0.004). In Cox regression multivariable analysis, age (HR=1.25, P=0.008), Karnofsky performance status (HR=1.30, P=0.005), extracranial metastases (HR=1.57, P<0.001), number of brain metastases (HR=1.22, P=0.043), gene mutation (HR=1.40 [wild type vs mutation], P=0.050; HR=1.42 [unknown vs mutation], P=0.007), and treatment (including TKI, chemotherapy, and local brain treatment, P<0.05) were independent prognostic predictors of OS. Additionally, metachronous metastatic patients were at lower risk for disease-related death compared to synchronous metastatic patients (HR=0.69, P<0.001). Importantly, median OS stratified by Lung-molGPA of 0–1, 1.5–2, 2.5–3 and 3.5–4 scores were 11.0, 14.0, 24.9, and 26.3 months for synchronous brain metastases, and 13.1, 17.0, 37.2, and 66.5 months for metachronous metastases, respectively (P<0.001).ConclusionLung-molGPA could estimate the prognosis of NSCLC patients with synchronous or metachronous brain metastases. Hence, patients should be carefully stratified for consideration of aggressive therapy.

Endovascular treatment of superior cerebellar artery aneurisms

The study objective is to evaluate the effectiveness of various endovascular techniques for treatment of patients with superior cerebellar artery (SCA) aneurisms (depending on anatomical location of the aneurisms). Materials and methods . Between 2014 and 2018, 27 (7 men, 20 women) patients with saccular aneurisms underwent surgery implementing endovascular techniques. The patients’ mean age was 50.4 years. The relations between the basilar artery and the SCA, size, symptoms during manifestation were evaluated. For favorable aneurism geometry (neck diameter &lt;4 mm, neck/dome ratio &gt;2, absence of involvement of the parent artery branches in the pre-neck part of the aneurism) only microcoil occlusion was performed, in other cases various assisting techniques were used; if the aneurism deformed the distal part of the basilar artery, flow diversion stents (FDS) in combination with other techniques were used. Clinical results were evaluated using the modified Rankin Scale, occlusion grade — sing the Raymond—Roy scale immediately after the surgery and 6 months later. Results. Microcoil occlusion was performed in 4 (14.8 %) patients, in combination with balloon assistance — in 4 (14.8 %) patients, with stent assistance — in 13 (48.2 %) patients, with balloon and stent assistance — in 2 (7.4 %) patients, implantation of FDS — in 1 (3.7 %) patient, implantation of an assisting stent — in 1 (3.7 %) patient, microcoil occlusion with balloon an stent assistance and implantation of FDS — in 2 (7.4 %) cases. Total occlusion immediately after the surgery was achieved in 15 (55.5 %) patients, subtotal — in 7 (25.9 %). Long-term, total occlusion was observed in 82.3 % patients: in 2 (7.4 %) patients with preserved pre-neck contrast spontaneous thrombosing of the aneurism was observed, in 2 cases aneurisms were excluded after installation of FDS. Functional outcome of the surgery was favorable in 18 (66.7 %) patients, deterioration was observed in 4 (14.8 %) patients. Long-term, 6patients experienced improvement, condition of 11 patients did not change. In 1 (3.7 %) male patient, thromboembolism with occlusion of the posterior cerebral artery and hemianopsia developed during surgery; in 1 female patient cerebral subarachnoid hemorrhage occurred which led to death; 2 (7.4 %) patients developed ischemic complications associated with distal thromboembolism aggravating overall cerebral and neurological symptoms; in 1 (3.7 %) female patient, damage of the oculomotor nerve occurred. Conclusion. Endovascular treatment of SCA aneurisms using microcoil occlusion and/or other intravascular techniques is effective and sufficiently safe. Treatment tactics should be decided taking into account anatomical characteristics of the aneurism, structure of the Willis artery, condition of the precerebral vessels. Indication for use of FDS in SCA aneurisms require specification, but our results demonstrate their effective use in complex aneurisms of this localization.

ASTROCYTOMA OF THE BRAIN AND OPHTALMOLOGICAL SIGNS

Background: The central nervous system neoplasms frequency is 1 per 1700 children aged from 0 up to 15 years old. The problem of the early diagnostics has not been solved yet. The recognition of the pathology, especially in childhood and adolescence is considerably difficult and affects the patient’s life prediction and quality.Objective: To reveal the value of ophthalmological signs in the diagnosis of astrocytoma of the brain.Methods: The young man with the only complaint of the binocular horizontal diplopia during the last year. One month prior to the visit, the patient lost his consciousness. Standard ophthalmic examination, optical coherence tomography (Cirrus HD-OCT), computer perimetry (Humphrey), MRI of the head on (Siemens symphony) with contrast were carried out.Results: Visual acuities were 20/20 for both eyes, an outward motions limitation of both eyes, the presence of paracentral and peripheral scotomas in computer perimetry, the reduction of the visual evoked potentials, pallor of the optic disk, thinning of the nerve fiber layer and ganglion cell on OCT. MRI with contrast revealed the existence of large tumor with a with clear, hilly contours compressing the brain stem. After confirming the presence of a large tumor size, signs of development of occlusal internal and external hydrocephalus, compression of brain stem with the development of life-threatening condition, the patient was referred for neurosurgical consultation. According to the urgent indications the surgical resection of the intracerebral tumor was performed. Biopsy result: pilocytic astrocytoma of the fourth ventricle region.Conclusion: Thus, in the absence of specific cerebral and focal neurological symptoms, the appearance of oculomotor disorders, defects in field of vision and fundus changes can be decisive factors in establishing an accurate diagnosis and timely referral of the patient to a neurosurgeon.

Outcomes of Innominate Artery Revascularization Through Endovascular, Hybrid, or Open Approach

Atherosclerotic disease of the innominate artery (IA) is rare and can lead to cerebral, upper extremity, and vertebral steal symptoms. Nonocclusive lesions can be treated with endovascular interventions, often with a hybrid approach while performing a right carotid endarterectomy (RCEA). Calcified IA lesions have a high risk of embolization to bilateral cerebral hemispheres. Occlusive lesions may require treatment through a median sternotomy and bypass. The purpose of our study is to review our short-term and long-term outcomes of IA revascularization. Our operative database was used to identify patients who underwent IA revascularization between January 1998 and December 2018. Patients who underwent innominate artery stenting (IAS), combined with RCEA and IAS as well as aortoinnominate bypass (AIB), were identified. Our primary end points were freedom from neurologic event, all-cause mortality, and need for reintervention. Thirty-three patients (18 females [55%]) who underwent IA revascularization were identified. Average age was 67±8years, and mean clinical follow-up was 51±21months. Most patients (30 [91%]) were on a statin and antiplatelet therapy. Twenty-one patients (64%) were symptomatic. Twelve patients (36%) were asymptomatic and underwent combined RCEA with retrograde IAS for critical right carotid stenosis and IA stenosis. Preoperative imaging included a carotid duplex and computed tomography angiography. Eighteen patients (55%) underwent RCEA+IAS, 11 patients (33%) underwent isolated IAS, and 4 patients (12%) underwent AIB. In our attempt to protect bilateral hemispheres during IAS for heavily calcified lesions, we used right common carotid artery (CCA) clamping although open exposure and left CCA embolic protection filter was placed through transfemoral approach. Patients who underwent AIB had chronic heavily calcified IA occlusions or occluded IA stents with failed endovascular interventions. Perioperative stroke rate was 3%, involving 1 patient who developed reperfusion syndrome after RCEA+IAS. Perioperative mortality was 0%. Long-term stroke rate was 0%, and long-term mortality was 15% (5 of 33) because of cardiac disease. Overall restenosis rate was 9%, involving 3 patients who required secondary interventions for IA in-stent restenosis. IA interventions through a hybrid approach or an open approach are safe, with acceptable perioperative stroke and mortality rates. Long-term patency of these interventions is acceptable. Bilateral cerebral embolic protection can be accomplished by clamping the right CCA through an open exposure and placing a filter in the left CCA through a transfemoral approach. Patients undergoing IAS appear to have a higher rate of restenosis compared with AIB, and therefore, close follow-up with noninvasive imaging is recommended.

Creutzfeldt–Jakob disease in the Republic of Sakha (Yakutia)

Creutzfeldt–Jakob disease (CJD) is a rare neurodegenerative disease caused by the accumulation of the pathological isoform of prion protein. The classic clinical presentation of CJD is characterized by rapidly progressive dementia, ataxia, myoclonus, and akinetic mutism at the terminal stage of the disease. Of the instrumental techniques, brain magnetic resonance imaging plays a leading role in clinical practice. The authors followed up 4 patients with probable CJD in the Republic of Sakha (Yakutia) in 2014 to 2019. All the patients had approximately the same age (50–60 years) at disease onset and onset with non-specific cerebral symptoms. However, the subsequent development of rapidly progressive dementia and other characteristic features might suggest CJD. The patients were found to have characteristic neuroimaging signs as hyperintensity of the caudate nuclei and pulvinars in the fluid-attenuated inversion recovery (FLAIR) and diffusion weighted imaging (DWI) modes to form the typical signal of hockey sticks, as well as hyperintensity of the gray matter in the DWI mode (the symptom of the «Venus necklace»). In 3 patients, the disease ended fatally within a year of its onset. The fourth patient with a disease duration of 6 months is being supervised at home. The authors reason that the diagnosis of CJD is now insufficient due to the similarity of its clinical symptoms at the onset with other disorders, including cerebrovascular and neurodegenerative diseases.

Is Asian type MS an MS phenotype, an NMO spectrum disorder, or a MOG-IgG related disease?

BackgroundA specific particularity of neurological diseases in Asia is the relative commonality of neuromyelitis optica (NMO) and Asian type MS (OSMS). Both conditions also occur in South American patients. The Brazilian population differs from the European and the Asian populations due to the mixture of ancestralities between European colonizers and African slaves. To better know the clinical characteristics of Brazilian patients with Asian type MS this study aimed to analyze the clinical, radiological and serological data that would help to distinguish between OSMS and NMO and clarify, in a Non-Asian population, if OSMS is an MS phenotype, an NMO spectrum disorder by 2015 classification, or a complement activating antibody to myelin oligodendrocyte glycoprotein (MOG-IgG) antibody-related disease. MethodsWe selected cases retrospectively with NMO and OSMS in the medical registry of patients with idiopathic inflammatory demyelinating diseases under follow-up since 1997 in Federal Hospital da Lagoa, the principal reference center for MS treatment in Rio de Janeiro, Brazil. OSMS has selective involvement of the optic nerve and spinal cord with no cerebral or cerebellar symptoms associated with small spinal cord lesions and negativity for the aquaporin-4 antibody (AQP4-IgG). NMO full-filled the revised criteria (2006) associated with longitudinally extensive transverse myelitis (LETM). We recorded the following data: ethnicity/skin color, neurologic impairment “at nadir” and “at recovery” of the index events (optic neuritis and transverse myelitis), long term disability, mortality, health quality of life scores by the SF-36 questionnaire, CSF IgG oligoclonal bands and serological AQP4-IgG and MOG-IgG antibodies tested by Cell-based assay. The last brain MRIs were classified as either satisfying or not satisfying MAGNIMS radiologic criteria for MS or typical or not typical for NMOSD. The new classification of NMO spectrum disorders (2015) was applied. ResultsForty-one OSMS and 122 NMO cases were analyzed. OSMS affected mainly young white women, causing unilateral optic neuritis and partial myelitis with excellent recovery. After a mean disease duration of 20 years, 90% of the patients had free ambulation, and 70% had a mild disability or no disability. Only 7.2% presented a secondary progressive course, and no deaths occurred. All cases had negativity to AQP4-IgG and MOG-IgG biomarkers. 95% had resonance criteria for MS. OSMS differed from NMO by ethnicity, morbidity, and mortality: most were African descendants, with severe motor and visual dysfunction, and one third died. Only NMO cases full-filled the new NMOSD classification (52 AQP4-IgG positive, 29 AQP4-IgG negative, and 41 AQP4-IgG unknown). ConclusionIn Brazilian patients, OSMS and NMO are different immune-mediated diseases. OSMS is a milder MS phenotype.

Endovascular embolization of the left middle meningеal artery for residual chronic subdural hematoma (clinical case)

The objective is to describe the case of successful endovascular treatment of residual chronic subdural hematoma.Clinical case. Patient A., 77 years old, was admitted to the hospital with a directional diagnosis of stroke. During further examination, left hemispheric chronic subdural hematoma with a volume of 100 cm3 was revealed. The patient was twice performed closed external drainage of hematoma. And for each subsequent control computed tomography studies, a residual hematoma with a volume effect on the brain was determined. Endovascular selective embolization of the left middle meningеal artery was performed. During the examination after 5 months, a complete reduction of hematoma, cerebral and focal neurological symptoms was noted.Conclusion. Endovascular embolization of the middle meningeal artery may be a pathogenetically substantiated, minimally invasive alternative to repeated surgical interventions for residual and recurrent chronic subdural hematoma. It will be reasonable to continue research to assess the effectiveness and safety of the methodology.

Neuroradiological perspectives of severe preeclampsia and eclampsia spectrum - Correlation from posterior reversible encephalopathy syndrome.

Posterior reversible encephalopathy syndrome (PRES) is the neuroradiological appearance of eclampsia. This study was conducted to understand the neuroradiological aspects of severe preeclampsia by recognition of PRES. We hypothesized that posterior reversible encephalopathy syndrome is the sole background manifestation of neurological involvement in preeclampsia patients. Detecting and demonstrating the extent of PRES and hence, cerebral involvement of preeclampsia was the main objective. It was a prospective and observational study conducted in a tertiary referral center of northern India. A total of 75 women were recruited on admission to the emergency room, 30 of them with cerebral symptoms i.e., headache, visual disturbances and depressed consciousness, 30 patients of severe preeclampsia who were neurologically asymptomatic and 15 of eclampsia patients. Magnetic resonance imaging of the brain was performed in postpartum period within 48h of delivery. Correlation of the MRI brain picture with the neurological disease status of preeclampsia and the symptoms of cerebral involvement and identification of predictors in development of PRES. PRES was identified in 86.7% of patients in eclampsia group (P value - 0.001), also in 20% and 26.6% of symptomatic and asymptomatic severe preeclampsia patients too (P value - 0.06 and 0.195). There was a shorter mean duration of high blood pressure records in those who developed PRES. True cerebral involvement of preeclampsia believed to be translated as PRES was witnessed even in asymptomatic severe preeclampsia patients and hence, extending the indications of neuroimaging in such patients. Treatment focused on PRES would induce early reversibility and avoid long term neurological sequel.

Infectious Endocarditis with Neurological Symptoms

The article presents a clinical case of infectious endocarditis, the debut of which was cerebral symptoms. The history of the disease, its clinical manifestations, laboratory and instrumental features, and the methods of the therapy are described in detail.

Hypernatremia

Hypernatremia is acommon electrolyte disorder in daily clinical practice. In many cases hypernatremia is caused by alack of free water or an increased salt load. Out-of-hospital acquired hypernatremia is often caused by an increased loss of water or adecreased water intake. By contrast, hospital-acquired, nosocomial hypernatremia is often induced by an inadequate fluid balance with saline infusions, saline overload, or due to osmotic diuresis. The consequences are structural changes in the cell morphology such as cell shrinkage. Chronic hypernatremia affects all cell functions predominantly with cerebral symptoms and coma; the main complication is atoo-rapid compensation of an adapted electrolyte imbalance with development of cerebral edema. The overall osmolality should always be considered. Overall changes in osmolality correspond to the effect on the cellular stress situation and have to be taken into account and balanced slowly. In cases of unknown duration, achronic disorder should be assumed.

Cardiac tumours - a brief review.

This short review of cardiac tumours presents a case that clearly demonstrates the manifestation of embolic and cardiac symptoms of an intracardiac mass. Acute onset and rapid progression of a neoplastic process in the heart leading to arrhythmia, cardiac conduction disorders and heart failure combined with highly mobile fragments of tumour, which can cause emboli in cerebral vessels, are characteristic signs of an intracardiac mass. Early diagnosis and immediate treatment may improve the long-term prognosis, but overall the prognosis is poor. Cardiac tumours present to the cardiologist when the patient presents with cardiac symptoms, and the neurologist when there are cerebral symptoms. Most cardiac masses are not amenable to percutaneous biopsy; therefore, definitive diagnosis often awaits surgical excision.

The effects of massage therapy on symptoms related cerebral palsy in children with cerebral palsy: A systematic review

The purpose of this review was to systematically present the effectiveness of massage therapy on cerebral palsy related symptoms in children with cerebral palsy based on existing evidence. A comprehensive systematic literature search was conducted from inception to February 2020 using the following electronic databases: PubMed, Google Scholar, Science Direct, Cochrane Library Database of Reviews of Effectiveness, Physiotherapy Evidence Database. To evaluate the articles concerning eligibility, a screening process was carried out by two reviewers. Summary of the studies including outcomes, measures, and results, and methodological quality of the studies were described according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines. Five studies with different conducting design met inclusion criteria were included to document the current body of evidence of massage therapy in children with cerebral palsy. Almost all of the included articles reported that massage therapy (with or without conventional physiotherapy) is effective to improve spastic/hypertonic muscles and gross motor functions. Besides, it was also found that massage therapy could be effective on comorbidities including pain, sleep disorder, and lower perception of life satisfaction. Some of the included studies established the effects of massage therapy on comorbidities related to the cerebral palsy, whereas some of the studies directly demonstrated the effects of massage therapy on secondary problems related to The International Classification of Functioning, Disability and Health body structures/functions, and activity. Consequently, performing massage therapy (with or without physical therapy and/or routine therapy), would be effective to improve most of the symptoms related to cerebral palsy.

Developing retinal biomarkers for the earliest stages of Alzheimer's disease: What we know, what we don't, and how to move forward.

The last decade has seen a substantial increase in research focused on the identification, development, and validation of diagnostic and prognostic retinal biomarkers for Alzheimer's disease (AD). Sensitive retinal biomarkers may be advantageous because they are cost and time efficient, non-invasive, and present a minimal degree of patient risk and a high degree of accessibility. Much of the work in this area thus far has focused on distinguishing between symptomatic AD and/or mild cognitive impairment (MCI) and cognitively normal older adults. Minimal work has been done on the detection of preclinical AD, the earliest stage of AD pathogenesis characterized by the accumulation of cerebral amyloid absent clinical symptoms of MCI or dementia. The following review examines retinal structural changes, proteinopathies, and vascular alterations that have been proposed as potential AD biomarkers, with a focus on studies examining the earliest stages of disease pathogenesis. In addition, we present recommendations for future research to move beyond the discovery phase and toward validation of AD risk biomarkers that could potentially be used as a first step in a multistep screening process for AD risk detection.

Cerebral toxoplasmosis in HIV-infected patients over 2015-2018 (a case study of Russia).

Cerebral toxoplasmosis is a leading cause of the central nervous system disorders in acquired immune deficiency syndrome. This study aimed to investigate the clinical course of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected individuals. The study included 90 HIV-infected patients with cerebral toxoplasmosis, who underwent inpatient treatment. In case of positive enzyme immunoassay, HIV infection was confirmed with the immunoblot test. The HIV-1 ribonucleic acid level was determined using the polymerase chain reaction method. The flow cytometry was used for counting CD4 (cluster of differentiation 4 cells). Pathomorphological examination included the autopsy, gross and microscopic examination of internal organs, histological and other methods. The incidence of cerebral toxoplasmosis significantly increases at the CD4 count below 100 cells/μl, P < 0.001, and at the HIV viral load above 50 copies/ml, P < 0.05. The clinical picture of cerebral toxoplasmosis included focal symptoms, cognitive impairment, toxic syndrome, mild cerebral symptoms and a meningeal symptom. Given the absence of a specific clinical picture and the absence of abnormal laboratory and instrumental findings, the cerebral toxoplasmosis needs to be diagnosed with a number diagnostic methods combined: clinical examination, laboratory testing, immunological examination, molecular genetic testing and neuroradiological imaging.

Brain and Hepatic Glucose Utilization in Malarial Infection Does Not Depend on Cerebral Symptoms of the Disease

Cerebral malaria causes several deaths every year. Global metabolic alteration, specifically hypoglycemia and lactic acidosis are hallmarks of severe malaria. Glucose being the major fuel source for the brain, it is important to understand cerebral glucose utilization in the host during cerebral complications of the disease that may have a significant role in cerebral pathogenesis. We have used13C NMR spectroscopy to understand glucose utilization in the brain and liver of mice with cerebral malaria (CM), noncerebral malaria (NCM), and in control mice. Animals were challenged with intravenous glucose bolus followed by metabolic profiling of brain and liver extracts. Our result suggests a differential glucose utilization in the malaria group with respect to that of controls, while no difference between CM and NCM.

Clinical-hemodynamic efficiency of fixed combined hypotensin therapy for patients with heavy arterial hypertension

The efficacy of treatment was evaluated by the fixed combination drug «Exforge-H» in 40 patients suffering from grade 3 arterial hypertension. All patients underwent general clinical and laboratory and instrumental examination (electrocardiography, echocardiography, 24-hour blood pressure monitoring) before and after 6 months of treatment. It was established that treatment with «Exforge-H» statistically reliably reduces the level of blood pressure, normalizes the variability and daily blood pressure profile. So, two weeks after the start of treatment, the systolic and diastolic pressure levels during clinical measurement decreased by 32,1±2,7 and 30,4±1,9 mm Hg. Art. respectively. After 3 months of treatment, 60% of patients showed achievement of the target level of blood pressure, and after 6 months - 96%. High hypotensive efficacy of treatment was also demonstrated during the daily monitoring of blood pressure in all its indicators. A significant decrease in systolic and diastolic pressure was observed during the day and night hours. The amplitudes of systolic and diastolic pressure variability have also been improved. At the same time, the variability of systolic pressure during the day was reduced by 46%, diastolic - by 49%, and at night by 59,3 and 52,8%, respectively, indicating a normalization of blood pressure during the day. All this was also accompanied by a decrease in the clinical manifestations of the disease. So, after 6 months of treatment, 84% of patients had positive clinical dynamics: a decrease in cardiac and cerebral symptoms, as well as emotional lability, which positively correlated with a decrease in the level of clinical blood pressure. The cardioprotective effect of the drug is expressed in the form of regression of left ventricular hypertrophy. In general, the use of the three-component fixed drug «Exforge-H» (valsartan - 80 mg, amlodipine - 5 mg and hydrochlorothiazide - 12,5 mg) is manifested by an increased antihypertensive effect due to the influence of its constituents side effects and the development of metabolic changes.

Topical issues of the clinic of primary brain tumors

The article is devoted to the issue of clinical and neurological features of primary brain tumors (PBT). PBT account for 2% of the total number of human tumors. PBT represent an urgent social problem, causing disability and mortality. The incidence rate of primary tumors of the brain and other parts of the central nervous system in the United States from 2011 to 2015 amounted to 23.03 cases per 100,000 population. The most common histological types of PBT: meningioma (36.4%), pituitary tumors (15.5%) and glioblastoma (15.1%). The clinical picture of PBT is represented by cerebral and focal symptoms. Neurological deficit is determined by the location and volume of the neoplasm. The initial manifestations of tumor growth may be symptoms of irritation of the squeezed area of the brain tissue, which will be replaced later by symptoms of prolapse. Cerebral symptoms in most cases are associated with increased intracranial pressure and the development of cerebral edema. The subsequent development of the tumor process leads to the dislocation of brain structures and the formation of wedge syndromes. The most common clinical symptoms are: cognitive deficit (36%), convulsive syndrome (35%), headache (31%), ataxia (24%) and motor deficiency (22%). The article summarizes the data of world and domestic clinical studies aimed at determining the prevailing symptoms of primary brain tumors for the purpose of early diagnosis, timely medical care and assessment of the effectiveness of the treatment. Knowing the specifics of the clinical picture will significantly increase oncological alertness, which will lead to early diagnosis and timely treatment of PBT, which play a key role in improving the quality of life and increasing its duration.

Infective endocarditis caused by Capnocytophaga canimorsus; a case report

BackgroundCapnocytophaga canimorsus is a gram-negative bacterium and an oral commensal in dogs and cats, but occasionally causes serious infections in humans. Septicemia is one of the most fulminant forms, but diagnosis of C. canimorsus infection is often difficult mainly because of its very slow growth. C. canimorsus infective endocarditis (IE) is rare and is poorly understood. Since quite a few strains produce β-lactamase, antimicrobial susceptibility is pivotal information for adequate treatment. We herein report a case with C. canimorsus IE and the results of drug susceptibility test.Case presentationA 46-year-old man had a dog bite in his left hand 3 months previously. The patient was referred to our hospital for fever (body temperature > 38 °C), visual disturbance, and dyspnea. Echocardiography showed aortic valve regurgitation and vegetation on the leaflets. IE was diagnosed, and we initially administered cefazolin and gentamycin assuming frequently encountered microorganisms and the patient underwent aortic valve replacement. C. canimorsus was detected in the aortic valve lesion and blood cultures. It was also identified by 16S ribosome DNA sequencing. Ceftriaxone were started and continued because disk diffusion test revealed the isolate was negative for β-lactamase and this case had cerebral symptoms. The patient successfully completed antibiotic treatment following surgery.ConclusionsWe diagnosed C. canimorsus sepsis and IE by extended-period blood cultures and 16S ribosome DNA sequencing by polymerase chain reaction, and successfully identified its drug susceptibility.

Detection of delirium in three steps - From Screening to Verification to Etiology

Clinicians are commonly confronted with the differential diagnosis of altered mental status, impaired cognition and altered level of consciousness in hospitalized patients including those admitted to medical, geriatric, emergency, intensive and post-operative care units. Although delirium is the most common acute neuropsychiatric condition in the acute hospital setting this diagnosis is commonly delayed, made too late or missed altogether. The causes of delirious states are manifold. Both, direct damage to the brain tissue as well as encephalopathy as a result of other medical diseases, can be the cause of delirium. Depending on the predisposition delirious syndromes can be provoked by minor medical interventions. Clinical presentation is very variable, but remains largely independent of the triggering mechanisms. Purely catatonic, hypoactive, hyperactive and excitatory types as well as mixed forms can be distinguished.Immediate diagnosis of a delirious syndrome and rapid elucidation of its causes are keys for the implementation of curative therapy. There is a need to act fast because delirious phases are associated with significantly longer hospital stay and increased morbidity as a result of long-term cognitive deficits as well as increased mortality. As negative outcome is closely linked to the duration of a delirious episode, early diagnosis and rapid termination of the delirium constitute a significant positive predictor of outcome. In this respect, delirium represents an emergency, with or without concomitant cerebral or extracerebral symptoms.

The feasibility of robotic-assisted concomitant procedures during mitral valve operations.

In this study, we present our clinical experience and midterm results with the robotic-assisted concomitant procedures during mitral valve operations. Between March 2010 and February 2018, a total of 34 patients (8 males, 26 females; mean age 58.3 years; range, 34 to 78 years) who underwent robotic-assisted concomitant procedures during mitral valve surgery were retrospectively analyzed. Demographic characteristics of the patients, comorbidities, medical, and surgical histories, operative and laboratory results, electrocardiographic findings, postoperative intensive care unit and ward outcomes, and cardiac follow-up data were recorded. Atrial fibrillation-related medication use, stroke, or other thromboembolic events, and electrocardiographic reports in patients who underwent cryoablation were reviewed at three and 12 months after the operation. A total of 76 robotic-assisted concomitant procedures were performed during mitral valve repair (n=11) or replacement (n=23) in 34 patients. These procedures were cryoablation (n=29), tricuspid valve repair (n=6), tricuspid valve replacement (n=2), left atrial appendage ligation (n=32), atrial septal defect and patent foramen ovale closure (n=5), and left atrial thrombectomy (n=2). The mean preoperative EuroSCORE values were 5.1±2.5. The mean duration of cardiopulmonary bypass and cross-clamp was 156±69.4 min and 101±42 min, respectively. Normal sinus rhythm was restored in 85% of the patients (24/28) after cryoablation and two patients (5.8%) had permanent pacemaker within a year during follow-up. There was one (2.9%) mortality in the early postoperative period due to hemorrhage related to the posterior left ventricular wall rupture. No blood product was used in 82.4% of the patients. One patient had a transient cerebral event and symptoms regressed completely within two months. Technological improvements and growing experience can decrease the suspects related to prolonged operational duration during robotic-assisted cardiac surgery. Concomitant procedures in addition to mitral valve operations can be performed with low complication rates in centers with experience of robotic surgery.