Clinical Neurological Examination Research Articles

Possibilities of non-invasive diagnosis of diabetic peripheral polyneuropathy in children with type 1 diabetes

Background. Most diagnostic tests for diabetic peripheral polyneuropathy (DPNP) are not suitable for use in childhood, resulting in low diagnostic accuracy of this complication. Therefore, it is necessary to identify reliable and simple markers for early detection and monitoring of diabetic polyneuropathy progression in children. The purpose was to investigate the diagnostic value of the Clinical Neurological Examination (CNE), the pediatric-modified Total Neuropathy Score (ped-mTNS), and the Pediatric Balance Scale (PBS) in the non-invasive diagnosis of diabetic peripheral polyneuropathy in children with type 1 diabetes. Materials and methods. Ninety-one children with type 1 diabetes aged 10 to 17 years were examined. Group 1 included 57 patients with a duration of type 1 diabetes of up to 5 years, while group 2 consisted of 34 children with a disease duration of more than 5 years. To diagnose DPNP, a comprehensive neurological examination was conducted using the CNE, the ped-mTNS, and the PBS followed by determination of the diagnostic significance of each scale using ROC analysis. Results. It has been proven that two scales have diagnostic significance for identifying DPNP, the CNE and the ped-mTNS; based on the results of using both, DPNP was diagnosed in 50.5 % of patients. The clinical picture of DPNP was dominated by motor and sensory disorders, which are one of the first manifestations of this condition in children. The first signs of DPNP were registered already on the first years of illness. The frequency of development and stage of neurological disorders increased along with disease progression and the deterioration of glycemic control. Conclusions. Diabetic peripheral polyneuropathy is a common complication of diabetes in children, which is registered in 50.5 % of cases. Тhe CNE and the ped-mTNS allows to expand diagnostic capabilities regarding the detection of DPNP in children without the use of invasive diagnostic methods.

Quantitative measurement of regional brain imaging using computed tomography in canine with suspected stroke

Background and Aim: Brain stroke is increasingly being recognized in veterinary medicine and difficult to diagnosis. Computed tomography (CT) scan is a tool that can help the diagnosis more easily and rapidly. The objective of this study was to determine the clinical characteristics and quantitated CT images in terms of volume and histogram analysis of the ROIs (rostral cerebral artery, middle cerebral artery, caudal cerebral artery, and caudal cerebellar artery) in dogs with suspected stroke. Materials and Methods: Six dogs with suspected stroke and 3 healthy dogs were evaluated. General clinical neurological examinations and CT characteristic of the brain were performed on 9 dogs. CT imaging detected regions of brain change in suspected stroke dogs, observed in several regions including frontal, thalamus, and pituitary. We performed quantitative CT including Hounsfield unit (HU), histogram and volume of interest (VOI) of arteries of interested in the brain. Results: The HU value of the left and right caudal cerebellar artery of suspected stroke dogs were significantly higher than that of control dogs. The histogram of middle cerebral artery of suspected stroke dogs were also significantly higher than that of control dogs. Additionally, the VOI of caudal and cerebellar artery also trend to increase in suspected stroke dogs. Conclusion: our results demonstrated that CT finding abnormalities in several regions of the brain and in suspected stroke dogs, which helps in formulation of a treatment plan and determining prognosis.

Study of Thyroid Disorders in Patients of Stroke

To study the prevalence of thyroid disorders among patients of ischemic stroke and to correlate it with the severity of stroke on basis of NIHSS score and functional outcome after 3 months on basis of modified Rankin Scale (mRS).1 Method: This hospital based descriptive, randomized, single blinded, analytical study was done in the department of Medicine, SRIMSR hospital, Raipur from September 2023 to Dec2024. A total of 82 patients above 18 years of age who had ischemic stroke were included. Every patient was subjected to detailed clinical history and neurological examination. Two neurological scores, namely NIHSS (National Institutes of Health Stroke Scale) and modified Rankin Scale (mRS) was used. The severity distribution of NIHSS score on admission was divided into 3 categories, mild: NIHSS <8; moderate: 8-14; severe: >14. Neurological impairment and improvement were assessed using NIHSS, together with modified Rankin Scale (mRS)[1,2] from follow up OPD visits. Favorable outcome is defined as mRS<2[3]. The first OPD follow up usually occurs 2-4 weeks after discharge from hospital and we have assessed clinically after 3 months of discharge. Basic and clinical characteristics including demographic data such as sex, age, concurrent illness, medication was collected and categorized. We have divided patients into 5 group on the basis of serum free T3 (FT3), free T4 (FT4) and TSH; NTIS, Euthyroid, Hyperthyroid, Overt hypothyroid & Subclinical hypothyroid (SCH) [4]. Results: Among 82 patients with available laboratory data and relatively complete neurological impairment documentations met all inclusion criteria, 59 men and 23 women. Patients with subclinical hypothyroid had significantly mild neurological impairment at presentation on basis of NIHSS score (P = < .05) and have good functional outcome on follow up after 3 months on basis of mRS score. Conclusion: on the basis of this study it can be concluded that ischemic stroke patients with subclinical hypothyroid (SCH) at presentation has less stroke severity and these group of patients have better functional outcome at 3 months of follow up but further studies with large sample size are needed to validate our findings. Keywords: Thyroid disorder, stroke, cerebrovascular accident, modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS)

Cognitive-behavioral therapy in the treatment of patients with chronic migraine and emotional impairment: A prospective randomized trial with a two-year follow-up period

Background. Among patients with chronic migraine (CM), emotional disorders (anxiety, depression) are common, promoting the chronic course of migraine and making treatment challenging. Cognitive behavioral therapy (CBT) is promising in the complex treatment of patients with CM and emotional disorders. However, few randomized studies have been conducted to assess the effectiveness of CBT in this category of patients. Aim. To evaluate the effectiveness of an interdisciplinary program, including CBT, in the treatment of patients with CM and emotional disorders (anxiety, depression). Materials and methods. The study included 176 patients with CM and emotional disorders (55 males and 121 females), mean age 36.2 ±8.7 years. All patients underwent clinical interviews, neurological examinations, and testing using clinical and psychological techniques. Patients were randomized into two groups: Group 1 received the standard of care (preventive and acute treatment pharmacotherapy, lifestyle recommendations, physical activity during the day, detoxification therapy in the presence of drug-induced headache – HA) and CBT in the form of 10 individual face-to-face sessions aimed at treating pain, improving emotional state and daily activity; Group 2 received only the standard of care. All patients were evaluated for clinical and psychological parameters before treatment and at 3, 6, 12, and 24 months after the start of treatment. Results. After 3 months of treatment, a statistically significant (p0.05) improvement was observed in Group 1: a decrease in the HA frequency, the use frequency and daily doses of painkillers, points of the scale for assessing the effect of migraine on daily activity, the pain catastrophizing scale, the Spielberger-Khanin scale of personal and situational anxiety, the depression scale of the Center for Epidemiological Research. The improvements persisted after 6, 12, and 24 months from the start of treatment. After 3 months of treatment, Group 2 patients showed a statistically significant improvement in only four indicators at Month 3 of follow-up: the HA frequency, the use frequency and daily doses of painkillers, points of the scale for assessing the effect of migraine on daily activity. However, no improvements were observed after 6, 12, and 24 months of follow-up in Group 2. After 3 months of treatment, the clinical effect of CM (decrease in the HA frequency by 50% or more) in Group 1 was reported in 74% of patients vs 44% in Group 2, with a significant difference (p0.001). After 24 months of follow-up, 80% of patients in Group 1 had a clinical effect regarding CM, and 31% in Group 2. Conclusion. An interdisciplinary program that includes CBT is significantly more effective than the standard of care for CM and emotional disorders in the short and long term.

Development of a deep learning model for automatic detection of narrowed intervertebral disc space sites in caudal thoracic and lumbar lateral X-ray images of dogs.

Intervertebral disc disease is the most common spinal cord-related disease in dogs, caused by disc material protrusion or extrusion that compresses the spinal cord, leading to clinical symptoms. Diagnosis involves identifying radiographic signs such as intervertebral disc space narrowing, increased opacity of the intervertebral foramen, spondylosis deformans, and magnetic resonance imaging findings like spinal cord compression and lesions, alongside clinical symptoms and neurological examination findings. Intervertebral disc space narrowing on radiographs is the most common finding in intervertebral disc extrusion. This study aimed to develop a deep learning model to automatically recognize narrowed intervertebral disc space on caudal thoracic and lumbar X-ray images of dogs. In total, 241 caudal thoracic and lumbar lateral X-ray images from 142 dogs were used to develop and evaluate the model, which quantified intervertebral disc space distance and detected narrowing using a large-kernel one-dimensional convolutional neural network. When comparing veterinary clinicians and the deep learning model, the kappa value was 0.780, with 81.5% sensitivity and 95.6% specificity, showing substantial agreement. In conclusion, the deep learning model developed in this study, automatically and accurately quantified intervertebral disc space distance and detected narrowed sites in dogs, aiding in the initial screening of intervertebral disc disease and lesion localization.

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.

Diagnostic Clinical Tool in Trauma Patients to Rule out Thoracolumbar Fracture.

The primary objective of this study was to assess the effectiveness of the clinical decision tool (CDT) in trauma patients, providing a comparable ability to rule out thoracolumbar (TL) fractures as traditional imaging methods. The goal is to facilitate early clearance of the TL spine without an immediate requirement for radiological tests, thereby minimizing unnecessary utilization of TL-spine imaging. A prospective, observational study was conducted on trauma patients with suspected TL injury. To achieve early TL clearance, the CDT assessed criteria such as absence of pain, tenderness, and pain-free axial movement and flexion. The study enrolled alert trauma patients with thoracic and/or lumbar spine injuries, defined by the Glasgow Coma Scale of 15. The study excluded patients not aligning with CDT criteria, such as those who received intravenous opioid analgesia within 4 h and those unable to stand due to suspected pelvic or lower limb injuries. Following the completion of the CDT steps, there were 31 true negative cases, signifying the absence of TL fractures according to both CDT and imaging studies. The sensitivity of the CDT was 99.38% (95% confidence interval [CI]: 96.59%-99.98%), specificity 9.1% (95% CI: 6.30%-12.73%), negative predictive value (NPV) 96.87% (95% CI: 81.02%-99.56%), positive predictive value (PPV) 34.19% (95% CI: 33.38%-35.00%), negative likelihood ratio (LHR) 0.07 (95% CI: 0.01-0.49), and positive LHR 1.09 (95% CI: 1.06-1.13). The sensitivity, specificity, NPV, PPV, negative LHR, and positive LHR varied with each step in the CDT. Notably, the overall sensitivity was high; however, the stepwise sensitivity decreased, albeit with an improvement in specificity with each further step in the tool. The overall sensitivity in the study cohort (n = 500) was high; however, the stepwise sensitivity decreased, albeit with an improvement in the specificity. The CDT to rule out TL fracture is a feasible bedside stepwise tool in fully awake trauma patients after a thorough clinical neurological examination on arrival. The tool could help Level II or III trauma centers avoid secondary triage to the higher center.

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.