Clinical Neurological Examination Research Articles

Clinical and neurophysiological aspects of peripheral neuropathy in patients with myelodysplastic syndromes.

Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal disorders, manifesting multiple clinical autoimmune inflammatory phenomena, including rarely peripheral neuropathy. Twenty-four patients diagnosed with MDS and 29 healthy subjects were enrolled in this prospective study in a 5-year period. Every subject was assessed by symptoms questionnaire and clinical neurological examination followed by nerve conduction studies, quantitative sensory testing and skin biopsy. Peripheral neuropathy was diagnosed in 12 subjects (50%). Our study indicated that peripheral neuropathy involving large and small nerve fibres, with a symmetrical length-dependent pattern, is not uncommon between patients with MDS.

Predictive Modeling and Early Detection of Parkinson's Disease Using Machine Learning

Parkinson's disease is a progressive neurodegenerative disorder that impacts millions of citizens in the USA, mainly targeting the motor system and causing debilitating symptoms such as rigidity, tremors, and bradykinesia. The diagnosis of Parkinson's disease is presently heavily dependent on clinical evaluations and neurological examinations, targeting the detection of motor dysfunction. The principal aim of this study was to use machine learning as a means for early detection and prediction of Parkinson's disease. The dataset utilized for this study was the Parkinson’s Disease Dataset, retrieved from the UCI Machine Learning Repository, which included comprehensive biomedical voice measurements from a cohort of individuals, 23 of whom are diagnosed with Parkinson’s disease and 8 who are healthy controls. This dataset included a set of features extracted from voice recordings. These include parameters like fundamental frequency (pitch), amplitude variation, jitter, shimmer, and several phonation-related measures known to reflect early vocal impairments associated with the disease in question. This research project deployed three credible and proven algorithms, namely, logistic regression, random forest, and the Support Vector Machines. Besides, this study employed a combination of metrics, including accuracy, precision, recall, F1-score, and ROC-AUC, which are more holistic toward the model performance. According to the metric performance results of the three models, several key insights were drawn into the early detection of Parkinson's Disease. Particularly, it was clear that the Random Forest model had superior accuracy and was the most reliable in classifying positive cases and healthy patients, which could be that this model turned out to be most reliable in an early detection setting. In that respect, predictive modeling in Parkinson's Disease is a capability frontier that has the potential to make much difference in clinical decision-making. Supported by Machine Learning algorithms, clinicians can trace the minute patterns in patient data, which are not easily visible through any other diagnostic means. In such cases, early detection of Parkinson's Disorder with vocal biomarkers or motor assessment may afford healthcare professionals opportunities for early interventions that might retard the disease process.

Resting state functional magnetic resonance imaging in patients with multiple sclerosis before and after high-dose immunosuppressive therapy and autologous hemopoietic stem cell transplantation

BACKGROUND: Multiple sclerosis is a chronic autoimmune disease characterized by multifocal foci of demyelination in the central nervous system, usually affecting people of working age. The disease causes damage to the blood-brain barrier, the development of multifocal inflammation, destruction of the myelin sheath of axons and various degrees of damage. It is clinically manifested by restriction of motor activity, visual acuity, as well as other symptoms leading to loss of performance and disability of the patient. AIM: determination of changes in the functional connectivity of brain neural networks in patients with multiple sclerosis before and after high-dose immunosuppressive therapy and autologous hematopoietic stem cell transplantation by performing functional magnetic resonance imaging at rest. MATERIALS AND METHODS: The data of functional magnetic resonance imaging of patients with multiple sclerosis were analyzed in dynamics before and after the use of high-dose immunosuppressive therapy followed by autologous hematopoietic stem cell transplantation. The study involved 25 patients with a verified diagnosis of multiple sclerosis. Each underwent complex magnetic resonance imaging at two time points (before and after high-dose immunosuppressive therapy followed by autologous hematopoietic stem cell transplantation) with a difference of 12 months, which included structural magnetic resonance imaging - in order to exclude the presence of pathological foci in the brain (in addition to foci of multiple sclerosis) and functional magnetic resonance imaging.-resonance imaging at rest — to assess functional connectivity. Also, according to the method generally accepted in classical neurology, a clinical neurological examination was performed. RESULTS: At the stage of comparing data on the two groups obtained using functional magnetic resonance imaging at rest, changes in functional activity were detected in various parts of the brain, presumably responsible for clinical differences in the studied groups. CONCLUSION: Currently, the links between brain structures and morphological changes that cause cognitive impairment in multiple sclerosis are being studied. To predict the progression of the disease, the development of biomarkers, including those based on functional magnetic resonance imaging, is required. Evaluating changes in the functional connectivity of brain neural networks can help personalize therapeutic and rehabilitation approaches.

Changes in the sensory regions of the brain in patients with multiple sclerosis after complex neurorehabilitation according to resting functional magnetic resonance imaging

BACKGROUND: Multiple sclerosis is the one of leading causes of non-traumatic disability in young adult patients. An in-depth understanding of the processes of neuroplasticity underlying rehabilitation measures will ensure full and effective recovery of patients with this disease. AIM: To evaluate changes in the brain connectome in patients with multiple sclerosis in response to complex rehabilitation. MATERIALS AND METHODS: A prospective cohort study included 20 patients with relapsing-remitting multiple sclerosis (EDSS 1.5–6.5) in remission. All patients underwent comprehensive inpatient neurorehabilitation in a volume corresponding to individual rehabilitation needs for 5 weeks. To assess changes in the connectome, resting-state functional magnetic resonance imaging (rs-fMRI) was performed at three points: before the start of rehabilitation, immediately after its completion, and one month after discharge from the hospital. Statistical analysis is carried out using the CONN 7 (based on MathLab). Clinical neurological examination included examination using functional tests, passing questionnaires, and determining scores on the EDSS scale before and after rehabilitation. RESULTS: A total of 20 patients were examined, 13 of them at three control points. According to rs-fMRI data, clusters of decreased connectivity were identified between the left parahippocampal gyrus and the lateral cortex of the right occipital lobe, and between the right parahippocampal gyrus and the precuneus (p-FWE, p-FDR of cluster size and mass 0.05). Clusters of increased connectivity were determined between the left inferior temporal gyrus and the lateral occipital cortex of the left hemisphere, between the left middle temporal gyrus and the right frontal field, between the pole of the left temporal lobe and the lateral cortex of the left hemisphere (p-FWE, p-FDR of cluster size and mass 0.05). Other clusters of sufficient size demonstrated borderline statistical significance (individual adjusted p values for cluster size and mass exceeded 0.05). CONCLUSION: The identified changes indicate a functional reorganization of brain structures responsible for the perception of complex visual information, the functioning of executive control systems, as well as the implementation of memory and sequential action planning.

How to deal with the variability of peripheral nerve lesion patterns after inguinal herniotomy? A descriptive approach for a new terminology in clinical practice

BackgroundInguinal hernia is one of the most common visceral surgical conditions in industrialised countries. The aim of the present observational clinical study was to investigate the dermatome patterns after nerve injury following inguinal hernia surgery and to demonstrate the marked individual anatomical and topographical variability of peripheral nerves in the inguinal region. Methods220 patients were followed up for one year after inguinal herniotomy. Surgical treatment was performed either with tension-free mesh techniques or open according (Lichtenstein). ResultsOne year after inguinal herniotomy, 25 patients (11.4 %) reported postoperative symptoms. Of these, 15 patients showed evidence of a distinct nerve lesion. The results of the clinical neurological examination sometimes differed considerably from the subjective perceptions of the patients. In addition, a marked individual variability in the dermatomes of surgically lesioned nerves was found, with discrepancies to the classical and conventional dermatome data in textbooks. ConclusionsThis study has shown that it is hardly possible to assign a specific lesional inguinal dermatome to a specific nerve, as nerves show a large individual variability in their anatomical, topographical location and thus in their dermatome boundaries. Therefore, we propose a descriptive approach to the terminology of peripheral inguinal nerve lesions using common regional landmarks. This will avoid a potentially erroneous dermatome assignment to a certain nerve and facilitate the reproducibility of lesion descriptions between different observers, thus facilitating communication in clinical practice.

A novel missense mutation in ISCA2 causes aberrant splicing and leads to multiple mitochondrial dysfunctions syndrome 4.

Iron-sulfur cluster assembly 2 (ISCA2) deficiency is linked to an autosomal recessive disorder known as multiple mitochondrial dysfunctions syndrome 4 (MMDS4). This disorder is characterized by leukodystrophy and neuroregression. Currently, most of the reported patients are from Saudi Arabia. All these patients carry a homozygous founder variant (NM_194279.2:c.229G>A:p.Gly77Ser) in ISCA2. We describe a patient who underwent full clinical evaluation, including metabolic, neurological, and radiological examinations. Standard genetic testing, including whole exome sequencing coupled with autozygome analysis, was undertaken, as were assessments of mitochondrial DNA (mtDNA) copy number and mtDNA sequencing on DNA extracted from blood and cultured fibroblasts. Functional workup consisted of splicing assessment of ISCA2 using RT-PCR, biochemical assessment of complex I status using dipstick assays, and mitochondrial respiration measurements using a Seahorse XFp analyzer. We present the clinical and functional characterization of a novel homozygous ISCA2 missense variant (NM_194279.3:c.70A>G:p.Arg24Gly), leading to aberrant splicing in a patient presenting with neuroregression, generalized spasticity with exaggerated deep tendon reflexes and head lag, and progressive loss of acquired milestones. The novel variant was fully segregated in a wider family and was absent in a large control cohort, ethnically matching in-house exomes, local databases such as CGMdb and Saudi Human Genome Program, and ClinVar. Our analyses revealed that the variant is pathogenic, disrupting normal ISCA2 splicing and presumably leading to a truncated protein that disturbs metabolic pathways in patient-derived cells.

The effectiveness of various approaches in the treatment of peripheral neuropathies in people with type 2 diabetes mellitus

Introduction. Optimal therapeutic tactics for diabetic peripheral neuropathy (DPN) can reduce the risk of complications and improve the quality of life of patients with diabetes mellitus (DM).Aim: To evaluate the effectiveness of various approaches to the treatment of DPN.Materials and Methods. 67 patients were examined (36 men and 31 women, mean age 59.4 ± 9.7 years), duration of diabetes was at least 7 years. Patients underwent general clinical examinations, neurological examination and diagnosis of DPN with assessment of pain, tactile and vibration sensitivity. All patients underwent ultrasound of the peroneal nerve (PN): the structure and cross-sectional area (CSA) were assessed (≤ 11 mm2 was taken as the norm). Patients with symptoms of PN compression received mini-invasive treatment by perineural administration of 20 mg methylprednisolone under ultrasound control.Results. Clinical manifestations of DPN were identified in 33 (49.3%) cases. Changes in ultrasound PN occurred in 62 (92.5%) patients. 29 patients with echographic changes in PN and asymptomatic DPN received α-lipolic acid and benfotiamine: the CSA of the PN before treatment was 13,2 ± 2,4 mm2, after 6 months –10,4 ± 1,6 mm2; the proportion of people with CSA PN ≥ 12 mm2 before treatment was 82,7%, after 6 months –27,6% (all p < 0.05). 19 patients with symptoms of DPN, but without signs of compression of the MBN, received additional drugs and techniques. The average pain intensity before treatment was 4,93 ± 1,07, after 6 months –2,47 ± 0,61; CSA PN before treatment –17,3 ± 3,8 mm2, after 6 months –13,2 ± 2,2 (all р < 0,017). 14 patients with PN compression underwent mini-invasive treatment under ultrasound control. In the first 24–48 hours after manipulation, in all cases there was a moderate increase in local manifestations of compression. Then the pain intensity decreased (5.74 ± 1.19 points – before manipulation, 3.18 ± 0.97 – after 6 months, р < 0,0125), CSA decreased (22.4 ± 4.3 mm2 – to 15.3 ± 3.6 mm2 – after 6 months, р < 0,0125) and echographic characteristics improved.Conclusions. Ultrasound of the nerves can be a valuable method for the early diagnosis of DPN and a tool for choosing treatment tactics. The use of pathogenetic pharmacotherapy alone or in combination with other drugs was associated with satisfactory tolerability, favorable clinical and ultrasound dynamics. The use of mini-invasive treatment with perineural administration of drugs for compartment syndrome was characterized by a positive effect on compression symptoms and ultrasound characteristics of the nerve.

Neurologic Clinical, Electrophysiologic, and Pathologic Characteristics of Primary vs Secondary Neurolymphomatosis.

Neurolymphomatosis (NL) is characterized by lymphomatous infiltration of the peripheral nervous system presenting as the initial manifestation of a lymphoma (primary NL [PNL]) or in relapse of a known lymphoma (secondary NL [SNL]). This report details and compares the neurologic clinicopathologic characteristics of these 2 groups. This retrospective study was performed on patients diagnosed with pathologically confirmed NL in nerve between January 1, 1992, and June 31, 2020. Patient clinical characteristics, neurologic examination, imaging studies, EMG, and nerve biopsy data were collected, analyzed, and compared between PNL and SNL. A total of 58 patients were identified (34 PNL and 24 SNL). Time from neurologic symptom onset to diagnosis was longer in PNL at 18.5 months compared with 5.5 months in SNL (p = 0.01). Neurologic symptoms were similar in both patient groups and included primarily sensory loss (98%), severe pain (76%), and asymmetric weakness (76%). A wide spectrum of EMG-confirmed different neuropathy patterns were observed, but patients with SNL had increased numbers of mononeuropathies (n = 8) compared with PNL (n = 1, p = 0.01). MRI studies detected NL more frequently (86%) compared with fluorodeoxyglucose (FDG)-PET CT imaging studies (60%) (p = 0.007). Nerve biopsies revealed B-cell lymphoma (PNL n = 32, SNL n = 22), followed by T-cell lymphoma (PNL n = 2, SNL n = 2), with increased demyelination in both groups and increased axonal degeneration (p = 0.01) and multifocal myelinated fiber loss (p = 0.04) significant in SNL vs PNL. Identifying SNL resulted in patient treatment modifications but a worse prognosis compared with PNL (p = 0.025). While PNL and SNL are both primarily painful and asymmetric neuropathies with axonal and demyelinating features on EMG and nerve biopsy, SNL presents somewhat differently than PNL with fulminant, asymmetric often mononeuropathies better detected on MRI than FDG-PET/CT. The focal pattern of SNL is likely a result of residual cancer cells that evaded initial chemotherapy, which does not cross the blood-nerve barrier, and these cells can later recur and result in fulminant disease. Although still resulting in a poorer prognosis, identifying SNL is important because this changed treatment and management in every SNL case.

Spinocerebellar ataxia type 7: A case report

Introduction: Spinocerebellar ataxia type 7 is part of a rare group of neurodegenerative diseases, characterized by lesions in the brainstem, cerebellum, spinal cord, and retina, manifesting as motor disturbances associated with signs of pyramidal involvement and amaurosis. The dysfunction is caused by autosomal dominant genetic alterations, with disease severity and the age of symptom onset being directly linked to the patient’s genetic expression. Case Report: We present the case of a 24-year-old woman, previously healthy, who denied smoking, drinking alcohol, or taking any other drugs. She reported that approximately nine months, she had experienced a decline in dexterity for tasks requiring fine motor skills. She also exhibited impaired gait, frequent falls, and difficulties in performing basic activities of daily living (ADLs). On neurological examination, she presented with an ataxic and staggering gait, tremor during movement, dysmetria, dysdiadochokinesia, movement decomposition, dysarthria (scanning speech), dysphagia, dystasia, dysbasia, and nystagmus, all of which are indicative of cerebellar impairment. A genetic panel revealed the presence of 44 cytosine-adenine-guanine nucleotide repeat expansions on allele 2 of the ATXN7 gene, confirming the diagnosis of spinocerebellar ataxia type 7. Conclusion: In this case report, the diagnosis of spinocerebellar ataxia was established through a comprehensive assessment of the patient’s clinical history, neurological examination, imaging studies, and genetic profiling, all of which are essential for reaching a definitive diagnosis. The prognosis for this disease varies due to ongoing research into its pathophysiology. Furthermore, discussions within the scientific community regarding potential cures for this condition continue

Opinions and experience of neurologists and neurology trainees in Saudi Arabia on functional neurological disorders: a survey based study

BackgroundFunctional Neurological Disorder (FND) is commonly encountered in clinical practice, causing functional impairment and poor quality of life. As there is limited data from Saudi Arabia, our study aims to explore the experience and opinions of Saudi neurologists and neurology trainees regarding FND.MethodsIn our cross-sectional observational study, we included 100 neurology consultants and trainees. Data was collected using an online questionnaire from March to August 2023.ResultsA total of one hundred neurologists participated in the survey. Although 41% of physicians encountered FND patients on a weekly basis or more frequently, only 41.7% of trainees reported receiving dedicated lectures on FND. Furthermore, only 46% of respondents felt comfortable providing a clear explanation of the FND diagnosis to their patients. While the majority (64%) used the term “Functional Neurological Disorder” in medical documentation, only 43% used this term when communicating the diagnosis to patients, with the terminology varying widely. Clinicians emphasized that inconsistent and variable neurological examinations were key indicators raising diagnostic suspicion, which aligns with the recommended reliance on detailed clinical history and neurological examination. Lastly, 61% of physicians stated that their approach to patients with FND lacked a structured management plan.ConclusionOur study findings emphasize that FND is commonly encountered in clinical practice and reveal a significant lack of targeted education on FND for neurology trainees. Enhancing educational programs for both trainees and practicing neurologists on this prevalent neurological condition is essential for improving patient care and outcomes.

UBE as a modern approach to the surgical treatment of intervertebral disc herniations with lumbar spinal stenosis

Aim. To improve the results of surgical treatment of lumbar disc herniation using biportal endoscopy.Material and Methods. We analysed the diagnostic data and surgical results of 23 patients diagnosed with disc herniation and stenosis in the lumbar spine. The study period covers the years 2021 to 2023. During the study, all 23 patients underwent a series of diagnostic procedures: clinical neurological examination, CT, MRI and functional radiography. The patients were divided into 2 groups according to the method of surgical intervention: the main group (n=23), where unilateral biportal endoscopy was used, and the control group (n=20), where endoscopic discectomy was used.Results. Long-term outcomes were assessed using the MacNab scale at 9 months after surgery. 82.6% of patients had excellent outcomes. In 2 (8.8%) cases, the results were good; these patients had moderate pain that had completely disappeared by the time they were discharged from hospital. One patient (4.3%) had a satisfactory result, but continued to have moderate nagging pain, which disappeared in the first seven days after discharge from the medical facility. Poor outcome was reported in 1 case (4.3%); this patient had persistent radicular pain due to the development of postoperative neuritis. There were no cases of recurrent disc herniation.Conclusion. The unilateral biportal endoscopic discectomy (UBE) is a minimally invasive and promising technique that can be used as an alternative to the traditional open surgical approach.

Clinical, magnetic resonance imaging and histopathological findings of a congenital hypomyelinating leukodystrophy in a Holstein Friesian calf

AbstractA 12‐day‐old, male Holstein Friesian calf was presented to the hospital due to progressive ataxia and tremors since birth. A diffuse central nervous system disorder primarily affecting white matter was suspected based on clinical neurological examination. Blood tests were unremarkable, except for positive serology for Schmallenberg virus. Magnetic resonance imaging of the brain demonstrated severe, diffuse abnormalities primarily affecting the white matter regions of the encephalon and cranial cervical spinal cord, consistent with leukoencephalomyelopathy. Euthanasia was performed at 8 weeks of age after no clinical improvement. A postmortem examination was performed. Histopathological examination of the central nervous system revealed changes compatible with hypomyelinating leukodystrophy, with no signs of infectious agents observed. The disorder was considered most likely to be hereditary, as Schmallenberg virus infections during pregnancy in cattle have not been reported to result in such clinical, magnetic resonance imaging or histopathological findings, and no viral genomic material was identified with polymerase chain reaction.

Features of clinical manifestations, diagnosis and treatment of Bertolotti syndrome: а clinical case

BACKGROUND: One of the causes of pain in the lumbar spine may be congenital spinal column malformations. Bertolotti syndrome is a clinical and radiological symptom complex associated with sacralization of the LV vertebra, leading to disruption of the biomechanics of the lumbosacral spine and accelerated degeneration of facet joints and intervertebral discs, followed by foraminal and central stenosis of the spinal canal. The clinical manifestations of the disease can be polymorphic, and their cause is multifactorial. Thus, along with pain in the lumbar spine, patients with sacralization of the LV vertebra suffer from numbness and paresthesia in the lower extremities. The incidence of pathology ranges from 4% to 8%, mainly affecting elderly and mature people. СLINICAL CASE DESCRIPTION: Patient S was born in 1982 with long-term nonspecific pain in the back and lower limb; she presented to the Neurosurgical Department of the Irkutsk Scientific Center for Surgery and Traumatology. During a clinical neurological examination and additional introscopic studies of the lumbar spine, dorsopathy diagnosed. Degenerative spondyloarthrosis LIV–LV grade III according to D. Weishaupt. Sacralization of the LV vertebra type IIa according to Castellvi A.E. Syndrome of lumbar ischialgia on the right. Persistent pain and muscle-tonic syndrome. Minimally invasive interventional treatment was performed: pulsed radiofrequency ablation of the dorsal ganglion and radicular nerve at the level of the foraminal openings LIV–LV on the right and thermal radiofrequency ablation of the recurrent nerve of Luschka at the level of LIV–LV and LV–SI on the right. In the postoperative period, the intensity of the pain syndrome decreased, and the patient was discharged to work. CONCLUSION: A promising method of minimally invasive surgery is radiofrequency ablation in the area of neoarthrosis for denervation and relief of pathological pain impulses. Assessing the patient’s complaints, carefully collecting anamnesis, interpreting data from a clinical and neurological examination, and introscopic methods of examining the lumbar spine enables establishing an accurate diagnosis and selecting the most effective treatment method.

Epidemiological, Clinical and Therapeutic Aspects of Neuropaediatric Emergencies in Children Aged 1 Month to 15 Years in the Paediatric Emergency Department of CHU-Gabriel Toure

Introduction: Paediatric neurological emergencies are a major public health problem worldwide, in Africa and in Mali. Despite the scale and complexity of paediatric neurological emergencies, there is little data in the literature in Africa and particularly in Mali on these neurological disorders in paediatrics. Aim: The aim of our study was to examine the epidemiological, clinical and therapeutic aspects of neuropaediatric emergencies in children aged between 1 month and 15 years in the paediatric department of the CHU-Gabriel Touré in 2021. Patients and Methods: This was a cross-sectional study conducted over a twelve-month period (01 January to 31 January 2021) in children aged 1 month to 15 years hospitalised in the paediatric emergency department for a neurological emergency. Results: The frequency of hospitalization was 18.35%. The age group 12 to 60 months accounted for 43.7%. The sex ratio was 1.44. Convulsion was the most frequent reason for hospitalisation (49.3%). Delayed psychomotor development was noted in 4%. Around 3% of the children had not been vaccinated. On clinical neurological examination, the signs observed were : Altered consciousness (88.3%), convulsion (61%), and axial hypotonia (29%). Focal convulsions accounted for 59%, and 45.7% were febrile. The main diagnoses were neuromalaria, hyperpyretic convulsion and meningitis (68.3%, 7% and 6.3% respectively). The death rate within the first 24 hours was 48%. The average length of hospitalisation was 5.03 +/-4.5 days, with extremes of 1 and 21 days. Conclusion: Neuropaediatric emergencies are a major paediatric health problem. They are frequent and contribute substantially to infant and child mortality in our context.

Exploring the Spectrum: An Original Observational Study of Posterior Reversible Encephalopathy Syndrome from Tertiary Center in Kerala

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a disorder of subcortical vasogenic edema causing reversible neurologic dysfunction which includes headache, altered sensorium, seizures, and visual disturbances. It is a relatively rare disease with a myriad of nonspecific symptoms with similar presentations to that seen in other diseases such as stroke and cortical venous thrombosis. Hence, accurate diagnosis is needed for early detection to guide the management of such patients. This is a single-center retrospective study from June 2022 to May 2024 to identify the demographic profile, etiologies, imaging features, and prognosis of patients diagnosed with PRES. Materials and Methods: Diagnosis of PRES was made on the basis of clinical history, neurological examination, and magnetic resonance imaging brain after ruling out other possible differential diagnoses. The patients who satisfied Fugate et al. criteria were included in the study. The data were collected from the hospital database. Patients with alternate diagnoses were excluded from the study. Results: There were 22 patients diagnosed with PRES. There were 20 (91%) females among the cohort. Eighteen (82%) patients had headache. Fourteen (64%) patients had seizures all of which were generalized tonic–clonic seizures. All had positive imaging findings with 2 patients having leptomeningeal enhancement in the presence of normal cerebrospinal fluid findings. Blood pressure (BP) was normal in 5 (22%) patients. Most of the patients were postpartum without a prior history of hypertension or preeclampsia. Conclusion: PRES is a reversible entity with the imaging findings primarily involving the posterior part of the brain. It can also involve anterior circulation and spinal cord. Normotensive PRES is possible and should not be overlooked if the patient has all features of PRES but has normal BP. It has a female predilection with the most vulnerable state being immediate postpartum. Although recurrence is possible, PRES does not require long-term medications. Complicated PRES presents with SAH and intracranial hemorrhage.

Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action.

Despite national pediatric postcardiac arrest care (PCAC) guidelines to improve neurological outcomes and survival, there are limited studies describing PCAC delivery in pediatric institutions. This study aimed to describe PCAC delivery in centers belonging to a resuscitation quality collaborative. An institutional review board-approved REDCap survey was distributed electronically to the lead resuscitation investigator at each institution in the international Pediatric Resuscitation Quality Improvement Collaborative. Data were summarized using descriptive statistics. A chi-square test was used to compare categorical data. Twenty-four of 47 centers (51%) completed the survey. Most respondents (58%) belonged to large centers (>1,000 annual pediatric intensive care unit admissions). Sixty-seven percent of centers reported no specific process to initiate PCAC with the other third employing order sets, paper forms, or institutional guidelines. Common PCAC targets included temperature (96%), age-based blood pressure (88%), and glucose (75%). Most PCAC included electroencephalogram (75%), but neuroimaging was only included at 46% of centers. Duration of PCAC was either tailored to clinical improvement and neurological examination (54%) or time-based (45%). Only 25% of centers reported having a mechanism for evaluating PCAC adherence. Common barriers to effective PCAC implementation included lack of time and limited training opportunities. There is wide variation in PCAC delivery among surveyed pediatric institutions despite national guidelines to standardize and implement PCAC.

Evaluation of the diagnostic value of transcranial electrical stimulation (TES) to assess neuronal functional integrity in horses.

To evaluate the ability of the TES technique to assess neuronal functional integrity in ataxic horses by recording TES-induced muscular evoked potentials (MEPs) in three different muscles and to structurally involve multiple ancillary diagnostic techniques, such as clinical neurological examination, plain radiography (RX) with ratio assessment, contrast myelography, and post-mortem gross and histopathological examination. Nine ataxic horses, showing combined fore and hindlimb ataxia (grades 2-4), were involved, together with 12 healthy horses. TES-induced MEPs were recorded bilaterally at the level of the trapezius (TR), the extensor carpi radialis (ECR), and tibialis cranialis (TC) muscles. Two Board-certified radiologists evaluated intra- and inter-sagittal diameter ratios on RX, reductions of dorsal contrast columns, and dural diameters (range skull-T1). Post-mortem gross pathological and segmental histopathological examination was also performed by a Board-certified pathologist. TES-MEP latencies were significantly prolonged in both ECR and TC in all ataxic horses as opposed to the healthy horses. The TR showed a mixed pattern of normal and prolonged latency times. TES-MEP amplitudes were the least discriminative between healthy and ataxic horses. Youden's cutoff latencies for ataxic horses were 24.6 ms for the ECR and 45.5 ms for the TC (sensitivity and specificity of 100%). For healthy horses, maximum latency values were 22 and 37 ms, respectively. RX revealed spinal cord compression in 8 out of 9 involved ataxic horses with positive predictive values of 0-100%. All ataxic horses showed multi-segmental Wallerian degeneration. All pathological changes recorded in the white matter of the spinal cord were widely dispersed across all cervical segments, whereas gray matter damage was more localized at the specific segmental level. TES-MEP latencies are highly sensitive to detect impairment of spinal cord motor functions for mild-to-severe ataxia (grades 2-4).

Neurodevelopmental profile in children born to mothers affected by systemic sclerosis

BackgroundSystemic sclerosis (SSc) is a chronic immune-mediated connective tissue disease that can affect women of childbearing age. The long-term outcomes of their offspring remain poorly explored. Aim of this study was to detail the neurodevelopmental profile of children born to SSc mothers. MethodsTwenty children (mean age: 96 ± 4.32 months; 10 males) born to SSc mothers were enrolled. We collected data on clinical history, neurological examination, cognitive profile and adaptive behavior in all subjects. According to the chronological age, we also investigated quality of life, behavioral characteristics, psychological functioning and self-image. ResultsAll the children had normal neurological examination, cognitive profile and adaptive functioning, except for one (5 %) who suffered from Autism Spectrum Disorder. An important discrepancy was observed between parental and child opinion regarding the perception of quality of life, more compromised in the latter. We documented a risk for internalizing behavioral problems in 2 cases (10 %), for externalizing problems in 3 (15 %), for both in 1 (5 %) and for social and out-of-school activities in 5 (25 %). As regards psychological functioning, evaluated in 11 children, three (28 %) were at risk for anxiety, 1 (9 %) for depressive disorders and other 4 (36 %) for somatic disturbances. Emotional fragility and poor competence in metabolizing one's emotional experiences were observed in 9 out of the 13 subjects assessed (70 %). ConclusionsChildren born to SSc women exhibit normal cognitive and adaptive abilities but an increased vulnerability to psychopathological problems and fragility in social functioning. These observations might reflect that children need to feel mature to accept maternal chronic disease that, in turn, may hinder support for offspring's social and emotional development.

Diagnostic validity and reliability of BT-RADS in the management of recurrent high-grade glioma

Background and purposeBT-RADS is a new framework system for reporting the treatment response of brain tumors. The aim of the study was to assess the diagnostic performance and reliability of the BT-RADS in predicting the recurrence of high-grade glioma (HGG). Materials and MethodsThis prospective single-center study recruited 81 cases with previously operated and pathologically proven HGG. The patients underwent baseline and follow-up contrast-enhanced MRI (CE-MRI). Two neuro-radiologists with ten years-experience in neuroimaging independently analyzed and interpreted the MRI images and assigned a BT-RADS category for each case. To assess the diagnostic accuracy of the BT-RADS for detecting recurrent HGG, the reference standard was the histopathology for BT-RADS categories 3 and 4, while neurological clinical examination and clinical follow up were used as a reference for BT-RADS categories 1 and 2. The inter-reader agreement was assessed using the Cohen's Kappa test. ResultsThe study included 81 cases of HGG, of which 42 were recurrent and 39 were non-recurrent HGG cases based on the reference test. BT-RADS 3B was the best cutoff for predicting recurrent HGG with a sensitivity of 90.5 % to 92.9 %, specificity of 76.9 % to 84.6 %, and accuracy of 83.9 % to 88.9 %, based on both readers. The BT-RADS showed a substantial inter-reader agreement with a K of 0.710 (P = 0.001). ConclusionsThe BT-RADS is a valid and reliable framework for predicting recurrent HGG. Moreover, BT-RADS can help neuro-oncologists make clinical decisions that can potentially improve the patient's outcome.

Newborn Neurological Assessment, Basics of Clinical Practices

The purpose of a neurological examination of the newborn is to determine a normal neurological condition and to detect abnormal conditions. The examination includes assessment of the central and peripheral nervous system and observation of posture, muscle tone, strength, reflexes and symmetry. Abnormal assessments may indicate neurological problems. As a rule, neurological maturity varies according to gestational age. Systematic physical examinations usually detect neurological defects. Early detection is crucial as plasticity is greater in early life. Despite developments in neuroimaging and neurophysiological technologies, clinical neurological examinations still have their importance. Performing a timely neurological assessment can speed up the diagnostic process and enable the swift administration of advantageous therapies. This is specifically applicable in situations that require therapeutic hypothermia to be initiated within six hours or sooner, as evaluation of neurologic status plays a crucial part in identifying the necessity for intervention. Neurophysiological technologies can be difficult due to immaturity and reduced myelination in neonates. This article aims to provide readers with a better understanding of the few basic concepts of neurological assessment in neonates.