Degree Of Neurological Deficit Research Articles

NCOG-47. CONGRUENCE BETWEEN PROVIDER REPORTED PERFORMANCE STATUS AND BOTH OBJECTIVE AND PERCEIVED COGNITION IN A GLIOMA POPULATION

Abstract Karnofsky performance status (KPS) scale, a clinician-reported measure, is used to assess patients’ functional ability and as a metric for trial eligibility. Glioma patients often have a degree of neurologic deficit which can invariably affect performance status. There is little research comparing KPS, patient-reported cognitive outcomes, and objective cognitive outcomes. 273 primary brain tumor patients enrolled in the NOB Natural History Study were included in this report. We evaluated Pearson correlations between KPS (range 40-100), dichotomized as Good KPS (KPS ≥ 90) and Poor KPS (KPS ≤ 80), and MDASI-BT cognitive symptom factor, NeuroQoL Cognitive Function t-score, EQ-5D-3L index score, and objective MoCA test. The majority of patients were white (81%), male (58%) with a median 50 years of age (range 24-79). Most had high grade gliomas (74%), 22% were on active treatment, and 55% had prior tumor recurrences. Providers reported a poor KPS in 37% of patients. KPS correlated with the MDASI-BT cognitive symptoms (r = -0.32), NeuroQoL (r = 0.39), and EQ-5D-3L index score (r = 0.55) (all p < 0.01). Patients with poor KPS reported moderate-severe cognitive symptoms on the Neuro-QoL Cognitive Function (40%), moderate-severe difficulty remembering on the MDASI-BT (37%), and difficulty with usual activities on the EQ-5D-3L (83%). In a subset of 27 patients, MoCA scores were assessed but no significant correlation was found with KPS (r = 0.19, p = 0.352). Patient-reported and objective cognitive dysfunction was seen in up to 36% of those with good KPS. These data demonstrate that perceived cognitive testing is associated with poor KPS but may also occur in those with good performance status. The results underscore the need for alternative measures of cognitive functioning to further explore the impact in those with good KPS and the use of the MoCA in a larger sample.

Neurological Deficit and Corrective Effect of Omega-3 Polyunsaturated Fatty Acids in Cerebral Ischemia in Rats: A case-control study

Objectives: It was to assess vasoprotective effects of ω-3 polyunsaturated fatty acids in cerebral ischemia. Materials and methods: The experiments were carried out on 42 male outbred white rats weighing 260 ± 20 g. modeling of cerebral ischemia was carried out under conditions of intravenous thiopental anesthesia (40-50 mg / kg). The studies used models of subtotal, partial and stepwise subtotal cerebral ischemia. The table shows the experimental groups and the number of animals in them. Subtotal cerebral ischemia (SCI) was modeled by simultaneous ligation of both common carotid arteries (CCA). Partial cerebral ischemia (PCI) was modeled by ligating one CCA on the right. Stepwise subtotal CI (SSCI) was performed by sequential ligation of both CCA with an interval of 1 day (subgroup 1), 3 days (subgroup 2), or 7 days (subgroup 3). To study the effects of omega-3 polyunsaturated fatty acids (ω-3 PUFA), animals with CI were injected intragastrically with the drug "Omegamed" (SCI+ω-3 PUFA) at a dose of 5 g / kg body weight for a week. The control group consisted of sham-operated rats of the same sex and weight. Neurological deficits were assessed in the "muscle strength", "swimming test" and "open field" tests after 5-6 hours of the ischemic period. The study was carried out 6 hours after the simulation of the CI. Quantitative continuous data were obtained, which were processed using the licensed computer program Statistica 10.0 for Windows (StatSoft, Inc., USA). Since the experiment used small samples that had an abnormal distribution, the analysis was carried out by methods of nonparametric statistics. Data are presented as Me (LQ; UQ), where Me is the median, LQ is the value of the lower quartile; UQ is the upper quartile value. Differences between groups were considered significant at p <0.05 (Regression Model). Results: With a stepwise bilateral ligation of both common carotid arteries with an interval of 1 day, neurological disorders were most pronounced, which indicates an aggravation of neurological deficit with a reduction in the time between CCA dressings. In rats with SCI, the changes were more pronounced than with PCI, but less than with SCI. The least pronounced changes were noted in the 3rd subgroup (the interval between CCA dressings was 7 days). Studies have shown the dependence of the severity of brain damage in SSCI on the interval between the cessation of blood flow in both CCA. At a 7-day interval between CCA dressings, compensatory mechanisms were activated, which prevented the development of morphological changes and neurological deficits. When CCA was ligated with an interval of 1 day, the degree of neurological deficit was maximal, which indicates insufficient implementation of compensatory mechanisms. Compared with the control group, the rats of the "SCI+ω3-PUFA" group retained neurological deficit, the muscle strength indicator was 86% less (p<0.05), the swimming duration - by 63% (p<0.05), the number of crossed squares - by 55% (p<0.05), the number of washes - by 62% (p<0.05), the number of racks - by 62.5% (p<0.05) and the number of bowel movements - by 60% (p<0.05). However, in comparison with the SCI group, the neurological deficit was less pronounced. There was an increase in muscle strength by 67% (p<0.05), swimming duration by 37.5% (p<0.05) and the number of squares crossed in the open field test by 31% (p<0.05), which indicates the presence of a corrective action in the ω-3 polyunsaturated fatty acids preparation. Conclusion: The introduction of the preparation of ω-3 polyunsaturated fatty acids has a corrective effect in conditions of subtotal cerebral ischemia, contributing to a lesser severity of manifestations of neurological deficit (an increase in muscle strength, duration of swimming and the number of squares crossed in the open field test).

Effect of Holistic Nursing Intervention Combined with Humanized Nursing Intervention on Activities of Daily Living and Limb Movement Ability of Elderly Patients with Cerebral Hemorrhage after Surgery.

Background To improve the nursing status, activities of daily living (ADL), and limb movement ability of elderly patients with cerebral hemorrhage and to actively explore the comprehensive nursing mode that can meet the rehabilitation needs of patients. Methods 128 elderly patients with cerebral hemorrhage admitted to our department (2019.01–2021.01) were included in the study and randomly divided into the reference group and the study group according to the numeration table, with 64 cases in each group. The reference group received routine nursing, while the study group received holistic nursing combined with humanized nursing. Statistical methods were used to analyze the nursing effect of the two intervention models. Results With better scores of the upper limb muscle strength, lower limb muscle strength, and total Fugl-Meyer Assessment (FMA) in both groups after nursing, the scores in the study group after nursing were higher than those in the reference group (P < 0.05). After nursing, the ADL scores of both groups were significantly improved and the score in the study group was better than that in the reference group (P < 0.05). After nursing, the degree of neurological deficit in both groups was significantly better than that before nursing and the degree in the reference group was more serious than that in the study group (P < 0.05). Compared with the reference group, the total infection rate in the study group was lower, while the nursing satisfaction was higher, with statistical significance (P < 0.05). Conclusion The holistic nursing combined with humanized nursing has a remarkable effect on the postoperative intervention of elderly patients with cerebral hemorrhage. It can improve the limb movement function, enhance the ADL, reduce the degree of neurological deficit, improve the quality of life, and enhance the nursing satisfaction of patients after intervention, which is worthy of clinical popularization.

Role of MRI in the evaluation of spinal trauma

Aim: Role of MRI in the Evaluation of Spina Trauma. Material and methods: The present prospective observational study was on 50 patients with clinical suspicion of spinal trauma referred to Department of Radio diagnosis, from OPD/IPD of C.S.S.Hospital, Subharti Medical College, Meerut. After obtaining clinical history relevant clinical examination was done. MRI examinations were done on GE – Signa HDe contour GE 1.5 Tesla Feiloversikt, whole body MR scanner with sense surface coil and then evaluation of M R Imaging was done by using different pulse sequences. The findings were viewed in the light of complete clinical and radiographic data. Results: 78%, subjects were male, hence there was male preponderance with age group of 31-40 years with compression fracture in 72% & retropulsion of vertebral body. Spinal cord oedema was found among78% with maximum no of cases, having cord oedema >3 cm. AIS grade A, B, C, D and E was found among 20%, 20%,16%, 22% and 22% of cases respectively. Sensory & Motor loss in 24% & 74% of cases. Sensory loss was corresponded with level of spinal cord oedema & level of vertebrae fracture. Discussion: MRI plays a crucial role in evaluating and detecting spinal trauma. Subtle bone marrow, soft-tissue, and spinal cord abnormalities, which may not be apparent on other imaging modalities, can be readily detected on MRI. Early detection often leads to prompt and accurate diagnosis, expeditious management, and avoidance of unnecessary procedures. The depiction of parenchymal SCI on MRI not only correlates well with the degree of neurologic deficit, but it also bears significant implications in regard to prognosis and potential for neurologic recovery. Conclusion: With this study we concluded that MRI findings in spinal trauma correlate with the clinical findings according to ASIA impairment scale and can be helpful to clinician in predicting the outcome.

EVALUATION OF NEUROLOGICAL DEFICIENCY IN RATS WITH CEREBRAL ISCHEMIA AND ADMINISTRATION OMEGA-3 POLYUNSATURATED FATTY ACIDS

Objectives. It was to assess the degree of neurological deficit in rats with cerebral ischemia and administration of omega-3 polyunsaturated fatty acids. Methods. The experiments were carried out on 42 male outbred white rats weighing 260 ± 20 g. Modeling of cerebral ischemia was carried out under conditions of intravenous thiopental anesthesia (40-50 mg / kg). The studies used models of subtotal, partial and stepwise subtotal cerebral ischemia. The table shows the experimental groups and the number of animals in them. Subtotal cerebral ischemia (SCI) was modeled by simultaneous ligation of both common carotid arteries (CCA). Partial cerebral ischemia (PCI) was modeled by ligating one CCA on the right. Stepwise subtotal CI (SSCI) was performed by sequential ligation of both CCA with an interval of 1 day (subgroup 1), 3 days (subgroup 2), or 7 days (subgroup 3). To study the effects of omega-3 polyunsaturated fatty acids (ω-3 PUFA), animals with CI were injected intragastrically with the drug "Omegamed" (SCI+ω-3 PUFA) at a dose of 5 g / kg body weight for a week. The control group consisted of sham-operated rats of the same sex and weight. Neurological deficits were assessed in the "muscle strength", "swimming test" and "open field" tests after 5-6 hours of the ischemic period. Results. With a stepwise bilateral ligation of both common carotid arteries with an interval of 1 day, neurological disorders were most pronounced, which indicates an aggravation of neurological deficit with a reduction in the time between CCA dressings. In rats with SCI, the changes were more pronounced than with PCI, but less than with SCI. The least pronounced changes were noted in the 3rd subgroup (the interval between CCA dressings was 7 days). Studies have shown the dependence of the severity of brain damage in SSCI on the interval between the cessation of blood flow in both CCA. At a 7-day interval between CCA dressings, compensatory mechanisms were activated, which prevented the development of morphological changes and neurological deficits. When CCA was ligated with an interval of 1 day, the degree of neurological deficit was maximal, which indicates insufficient implementation of compensatory mechanisms. Compared with the control group, the rats of the "SCI+ω3-PUFA" group retained neurological deficit, the muscle strength indicator was 86% less (p&lt;0.05), the swimming duration - by 63% (p&lt;0.05), the number of crossed squares - by 55% (p&lt;0.05), the number of washes - by 62% (p&lt;0.05), the number of racks - by 62.5% (p&lt;0.05) and the number of bowel movements - by 60% (p&lt;0.05). However, in comparison with the SCI group, the neurological deficit was less pronounced. There was an increase in muscle strength by 67% (p&lt;0.05), swimming duration by 37.5% (p&lt;0.05) and the number of squares crossed in the open field test by 31% (p&lt;0.05), which indicates the presence of a corrective action in the ω3-PUFA preparation. Conclusion. The introduction of the preparation of ω-3 polyunsaturated fatty acids has a corrective effect in conditions of subtotal cerebral ischemia, contributing to a lesser severity of manifestations of neurological deficit (an increase in muscle strength, duration of swimming and the number of squares crossed in the open field test). Key words: cerebral ischemia, rats, neurological deficiency, omega-3 polyunsaturated fatty acids.

Vasoprotective Effects of Omega-3 Polyunsaturated Fatty Acids in Cerebral Ischemia

Objective: It was to assess vasoprotective effects of ω-3 polyunsaturated fatty acids in cerebral ischemia. Methods: The experiments were carried out on 42 male outbred white rats weighing 260 ± 20 g. Modeling of cerebral ischemia was carried out under conditions of intravenous thiopental anesthesia (40-50 mg/kg). The studies used models of subtotal, partial and stepwise subtotal cerebral ischemia. The table shows the experimental groups and the number of animals in them. Subtotal cerebral ischemia (SCI) was modeled by simultaneous ligation of both common carotid arteries (CCA). Partial cerebral ischemia (PCI) was modeled by ligating one CCA on the right. Stepwise subtotal CI (SSCI) was performed by sequential ligation of both CCA with an interval of 1 day (subgroup 1), 3 days (subgroup 2), or 7 days (subgroup 3). To study the effects of omega-3 polyunsaturated fatty acids (ω-3 PUFA), animals with CI were injected intragastrically with the drug “Omegamed” (SCI+ω-3 PUFA) at a dose of 5g/kg body weight for a week. The control group consisted of sham-operated rats of the same sex and weight. Neurological deficits were assessed in the “muscle strength”, “swimming test” and “open field” tests after 5-6 hours of the ischemic period. Results: With a stepwise bilateral ligation of both common carotid arteries with an interval of 1 day, neurological disorders were most pronounced, which indicates an aggravation of neurological deficit with a reduction in the time between CCA dressings. In rats with SCI, the changes were more pronounced than with PCI, but less than with SCI. The least pronounced changes were noted in the 3rd subgroup (the interval between CCA dressings was 7 days). Studies have shown the dependence of the severity of brain damage in SSCI on the interval between the cessation of blood flow in both CCA. At a 7-day interval between CCA dressings, compensatory mechanisms were activated, which prevented the development of morphological changes and neurological deficits. When CCA was ligated with an interval of 1 day, the degree of neurological deficit was maximal, which indicates insufficient implementation of compensatory mechanisms. Compared with the control group, the rats of the “SCI+ω3-PUFA” group retained neurological deficit, the muscle strength indicator was 86% less (p&lt;0.05), the swimming duration - by 63% (p&lt;0.05), the number of crossed squares - by 55% (p&lt;0.05), the number of washes - by 62% (p&lt;0.05), the number of racks - by 62.5% (p&lt;0.05) and the number of bowel movements - by 60% (p&lt;0.05). However, in comparison with the SCI group, the neurological deficit was less pronounced. There was an increase in muscle strength by 67% (p&lt;0.05), swimming duration by 37.5% (p&lt;0.05) and the number of squares crossed in the open field test by 31% (p&lt;0.05), which indicates the presence of a corrective action in the ω-3 polyunsaturated fatty acids preparation. Conclusion The introduction of the preparation of ω-3 polyunsaturated fatty acids has a corrective effect in conditions of subtotal cerebral ischemia, contributing to a lesser severity of manifestations of neurological deficit (an increase in muscle strength, duration of swimming and the number of squares crossed in the open field test).

Risk Factors Related to Falling in Patients after Stroke.

Background:The aim of this study was to identify the risk factors associated with falling in post stroke patients.Methods:This retrospective case-control study included 561 neurology patients hospitalized for a stroke and divided into two groups: falling patients and non-falling patients. They referred to the Special Hospital for Cerebrovascular Diseases “Sveti Sava” in Belgrade, Serbia, from 2018–2019. Logistic regression analysis was applied to examine socio-economic factors associated with predictors of unmet healthcare needs.Results:A significant difference was seen in the length of hospitalization of falling patients compared to the non-falling (P<0.001). We established statistically significant differences in mental status (P<0.001), sensibility (P=0.016), depressed mood (P<0.001), early (P=0.001) and medium insomnia (P=0.042), psychomotor slowness (P=0.030), somatic anxiety (P=0.044) and memory (P<0.001).Conclusion:Cerebrovascular disease distribution and the degree of neurological deficit primarily altered mental status, which could be recognized as one of the more important predictors for falling after stroke. The identification of risk factors may be a first step toward the design of intervention programs for preventing a future fall among hospitalized stroke patients.

Fuzzy Clustering Algorithm-Segmented MRI Images in Analysis of Effects of Mental Imagery on Neurorehabilitation of Stroke Patients

The study focused on the automatic segmentation of Magnetic Resonance Imaging (MRI) images of stroke patients and the therapeutic effects of Mental Imagery on motor and neurological functions after stroke. First, the traditional fuzzy c-means (FCM) algorithm was optimized, and the optimized one was defined as filter-based FCM (FBFCM). 62 stroke patients were selected as the research subjects and randomly divided into the experimental group and the control group. The control group accepted the conventional rehabilitation training, and the experimental group accepted Mental Imagery on the basis of the control group. They all had the MRI examination, and their brain MRI images were segmented by the FBFCM algorithm. The MRI images before and after treatment were analyzed to evaluate the therapeutic effects of Mental Imagery on patients with motor and nerve dysfunction after stroke. The results showed that the segmentation coefficient of the FBFCM algorithm was 0.9315 and the segmentation entropy was 0.1098, which were significantly different from those of the traditional fuzzy c-means (FCM) algorithm. ( P &lt; 0.05 ), suggesting that the FBFCM algorithm had good segmentation effects on brain MRI images of stroke patients. After Mental Imagery, it was found that the patient’s Function Independent Measure (FIM) score was 99.04 ± 8.19, the Modified Barthel Index (MBI) score was 51.29 ± 4.35, the Fugl-Meyer (FMA) score was 61.01 ± 4.16, the neurological deficit degree in stroke (NFDS) score was 11.48 ± 2.01, the NIH Stroke Scale (NIHSS) score was 10.36 ± 1.69, and the clinical effective rate was 87.1%, all significantly different from those of the conventional rehabilitation training group ( P &lt; 0.05 ). Additionally, the brain area activated by Mental Imagery was more extensive. In conclusion, the FBFCM algorithm demonstrates superb capabilities in segmenting MRI images of stroke patients and is worth promotion in clinic. Mental Imagery can promote the neurological rehabilitation of patients by activating relevant brain areas of patients.

Secondary White Matter Injury and Therapeutic Targets After Subarachnoid Hemorrhage.

Aneurysmal subarachnoid hemorrhage (SAH) is one of the special stroke subtypes with high mortality and mobility. Although the mortality of SAH has decreased by 50% over the past two decades due to advances in neurosurgery and management of neurocritical care, more than 70% of survivors suffer from varying degrees of neurological deficits and cognitive impairments, leaving a heavy burden on individuals, families, and the society. Recent studies have shown that white matter is vulnerable to SAH, and white matter injuries may be one of the causes of long-term neurological deficits caused by SAH. Attention has recently focused on the pivotal role of white matter injury in the pathophysiological processes after SAH, mainly related to mechanical damage caused by increased intracerebral pressure and the metabolic damage induced by blood degradation and hypoxia. In the present review, we sought to summarize the pathophysiology processes and mechanisms of white matter injury after SAH, with a view to providing new strategies for the prevention and treatment of long-term cognitive dysfunction after SAH.

Correlations between preoperative clinical factors and treatment outcome of spinal meningiomas - A retrospective study of a series of 31 cases.

Background: The purpose of the current study is to identify the correlations between the most important preoperative clinical factors and the outcome of surgery of spinal meningiomas (SM).Methods: We performed a retrospective analysis of the medical history, clinical, paraclinical, neuroimaging, and surgical protocol data in 31 patients with SM who underwent surgical resection at our institution from January 2011 to July 2020. The degree of resection was assessed on the Simpson scale. The modified McCormick scale was used to monitor the effect and outcome of treatment at admission, discharge, and at further follow-up.Results: The average age of the patients was 65 years (37-78). Vertebral pain and motor deficits were the most common initial symptoms that occurred in 26 (89.6%) and 29 (93.5%) patients, respectively. Sphincter disorders were found in 9 (29%) patients. Total resection (Simpson Grade I – II) was achieved in 29 patients (93.5%). We achieved a favorable outcome (McCormick Gr. I to III) in 93.3% of patients. The degree of the neurological deficit (P = 0.026) and the presence of sphincter disorders (P = 0.009) were the preoperative clinical factors that most significantly correlated with the outcome of treatment.Conclusion: The outcome from the surgical treatment of SM correlated significantly with the degree of the preoperative neurological deficit. Therefore, patients presenting with more severe symptoms are expected to have worse outcomes.

ГЕМОСТАЗКОНТРОЛИРУЮЩАЯ АКТИВНОСТЬ И ВОДНЫЙ БАЛАНС ЛЕГКИХ В ДИНАМИКЕ ЭКСПЕРИМЕНТАЛЬНОЙ ИШЕМИИ МОЗГА

The study aims to investigate the system of hemostasis and fibrinolysis in venous and arterial blood, the features of blood filling and lung water balance, as well as the activity of lipid peroxidation (LPO) processes in the lung tissue iduring the acute cerebral ischemia. Material and methods. The experiments were performed on non-pedigree male rats, including control and sham operated ones. Acute cerebral ischemia was modeled by the bilateral occlusion of the common carotid arteries. Survived animals were assessed according to the degree of neurological deficit using the McGraw scale. Complex studies included determination of activated partial thromboplastin time, prothrombin time, time of XIIa-dependent fibrinolysis of arterial and venous blood, LPO intensity by the content of thiobarbituric acid active products and catalase activity in the lung tissue, the number of circulating endothelial cells; assessment of the lung blood filling and water balance by the gravimetric method. Results. In 24 hours after cerebral ischemia we found that the coagulation potential of blood increased in the systemic circulation and the pulmonary circulation affected by inhibition of the fibrinolysis system. On the 21st day of cerebral ischemia, dysregulation of hemostasis mechanisms in the pulmonary bloodstream was revealed in the form of hypercoagulation of blood and hyperfibrinolysis. At the same time the increase of malondialdehyde, blood circulation, and the content of the extravascular fluid in the lungs were noted. The correlation between the intensification of LPO processes with an imbalance of pro- and anticoagulants and hyperhydration of the lung tissue has been shown. The obtained results indicate a progressive course of disorders of the non-gas exchange functions of the lungs in the dynamics of acute experimental cerebral ischemia.

Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit.

A combined anterior decompression and stabilization followed by posterior instrumented fusion promotes fusion of the affected segment of spine and prevents further progression of deformity. The objective of this study is to report on outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity who underwent single-stage anterior corpectomy and fusion and posterior decompression with instrumented fusion. A total of 49 patients (29 males, 20 females) with varying grades of neurological deficit due to tuberculosis of the spine (thoracic, thoracolumbar, and lumbar) were included in this prospective study. The diagnosis of tubercular infection was established after clinical, hematological, radiological, and histological specimens taken at surgery. All were treated with combined anterior and posterior decompression, debridement, and stabilization with direct autologous bone grafting or wrapped bone graft in mesh or expandable cages. Neurological status and visual analog scale (VAS) pain score were recorded at each visit. X-rays, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and liver function were evaluated at 3, 6, and 12 months after surgery and then once a year thereafter. Results were analyzed in terms of neurological recovery (Frankel grade), bony union time, and correction of kyphotic deformity. The mean age was 37.8 years (range, 2-65 years). Mean preoperative VAS scores improved from 5.6 to 1.5. The average ESR and CRP returned to normal within 6 months in all patients. The mean time to fusion was 8.4 months for the whole group. The neurological deficit in 42 of 49 patients had excellent or good clinical outcome (P < .0001). A total of 10 of 17 patients improved from Frankel A and B to Frankel E (normal activity). Three patients each in the thoracic and thoracolumbar groups improved to Frankel D. Radiological measurements showed the mean kyphotic correction was 61%, 66%, and 67% in the thoracic, thoracolumbar, and lumbar/lumbosacral spine, respectively. Combined single-stage anterior decompression and stabilization followed by posterior instrumented fusion is safe and effective in the treatment of tuberculous spondylitis with neurological deficit in the thoracic and lumbar spine. This procedure helps to correct and maintain the deformity, abscess clearance, spinal-cord decompression, and pain relief as well as return to normal motor function. Bony fusion prevents further progression of deformity. 2.

Coronavirus disease 2019 is threatening stroke care systems: a real-world study

BackgroundSince the onset of the coronavirus disease 2019 (COVID-19) pandemic, the stroke care systems have been seriously affected because of social restrictions and other reasons. As the pandemic continues to spread globally, it is of great significance to understand how COVID-19 affects the stroke care systems in mainland China.MethodsWe retrospectively studied the real-world data of one comprehensive stroke center in mainland China from January to February 2020 and compared it with the data collected during the same period in 2019. We analyzed DTN time, onset-to-door time, severity, effects after treatment, the hospital length of stays, costs of hospitalization, etc., and the correlation between medical burden and prognosis of acute ischemic stroke (AIS) patients.ResultsThe COVID-19 pandemic was most severe in mainland China in January and February 2020. During the pandemic, there were no differences in pre-hospital or in-hospital workflow metrics (all p>0.05), while the degree of neurological deficit on admission and at discharge, the effects after treatment, and the long-term prognosis were all worse (all p<0.05). The severity and prognosis of AIS patients were positively correlated with the hospital length of stays and total costs of hospitalization (all p<0.05).ConclusionsCOVID-19 pandemic is threatening the stroke care systems. Measures must be taken to minimize the collateral damage caused by COVID-19.

Clinical effect of "Jin's three-needle" therapy and motor relearning regimen on the upper limb motor function in patients with ischemic stroke

To explore the clinical effect of "Jin's three-needle" therapy and motor relearning regime for the recovery of upper limb motor function in the patients with ischemic stroke. A total of 60 patients with ischemic stroke were randomly divided into an experiment group (30 cases) and a control group (30 cases). In the control group, the routine rehabilitation regimen was adopted. In the experimental group, on the base of the treatment regimen as the control group, the "Jin's three-needle" therapy was supplemented. The neurological function deficit score was used to assess the neurological function. The modified Fugel-Meyer assessment for upper extremities (FMA) and motor assessment scale (MAS) were adopted to assess the upper limb motor function in patients. The modified Barthel Index (MBI) was used to evaluate the activity of daily living (ADL) in patients. After treatment, the neurological function deficit score, the upper limb motor function (FMA and MAS) and ADL (MBI) were all improved obviously as compared with those before treatment (P<0.05). In the experimental group, the reducing range of neurological function deficit score (difference value) was larger than that in the control group (P<0.05). The increases of FMA score (upper arm function), the total score of MAS, the score for hand movement in MAS and the score for advanced hand activities of MAS, as well as MBI score in the experimental group were significantly larger than those in the control group successively (P<0.05). "Jin's three-needle" therapy combined with exercise relearning regimen effectively reduces the degree of neurological deficit and improve the upper limb motor function and ADL in patients with ischemic stroke.

SkQR1 Reduces Neurologic Deficit Caused by Rat Brain Compression Ischemia.

The protective effect of antioxidant SkQR1 was examined on the model of left-sided compression ischemia in rat sensorimotor cortex. The special tests aimed to determine the neurologic deficit in the limbs and assess performance of the forelimbs showed that a 2.5-min ischemia produced no disturbance in the limb functions on postsurgery days 1, 3, and 7. Elevation of compression time resulted in neurologic deficit in animals, and its severity depended on this time. A single intravenous injection of SkQR1 (250 nmol/kg body weight) performed 30 min after ischemia significantly reduced the degree of neurologic deficit. In vitro model of ischemia in surviving rat hippocampal slices showed that a 15-min-long ischemia significantly inhibited the population excitatory postsynaptic potentials, which did not restore during reperfusion. Preincubation of the slices with SkQR1 did not significantly affect recovery of these potentials.

Evaluation of cervical spine injury and predicting neurological deficit by magnetic resonance imaging

Background: The consequences of cervical spine injuries range from simple neck pain, to quadriplegia, or even death. MR imaging has become part of the diagnostic and prognostic tools for spinal cord injury. Aim: To prospectively evaluate cervical spine injuries by MR imaging and to find out association of MR imaging findings with degree of neurological deficit. Material and Methods: Descriptive longitudinal hospital based study was conducted on 30 patients with known or suspected cervical spine trauma who presented to the emergency department. Results: Mean age of the cases was about 42 years, with female to male ratio of 1:6.5. C6-C7 spinal level was most commonly involved. Proportions complete spinal cord injury (CSCI), incomplete spinal cord injury (ISCI) and neurologically normal (NN) were 23.33%, 60% and 16.67% respectively. Out of 12 MRI findings, cord haemorrhage, contusion, posterior element fracture, disc injury, prevertebral hematoma, subluxation and soft tissue injury was statistically associated with degree of neurological deficit. Cord contusion, cord haemorrhage and posterior element fracture were potential predictors of neurological status at admission. Cord contusion, cord haemorrhage and subluxation were potential predictors at 3 months. Conclusion: MRI proved a pivotal role in the diagnosis of SCIs, deciding prompt management and predicting neurological deficit and prognosis of neurological recovery. So, MRI is an excellent diagnostic modality for the evaluation of spinal trauma and predicting the degree of neurological deficit and recovery.

Lumbar spinal epidural hematoma without vertebral fracture causing cauda equina syndrome

Spinal epidural hematoma (SEH) is a rare disease and may lead to spinal cord compression. It could be caused by trauma, including iatrogenic procedures such as spinal surgery or spinal anesthesia or by spontaneous events related to coagulopathy or arteriovenous malformation. Once SEH is suspected clinically and confirmed by image modalities, it should be emergently decompressed by surgical intervention. Prognosis depends on the rate of symptoms development, interval from symptom onset to surgery, level of spinal involvement, and degree of neurological deficits. Here, we report the case of a 79-year-old female who sustained a fall months before admission, presented with a 3-day history of back and bilateral lower limbs weakness. Radiography and magnetic resonance imaging demonstrated epidural hematomas at the level of T12 to L2 without associated vertebral fracture. An urgent decompressive laminectomy with blood clot removal was performed immediately. Postoperatively, her neurologic deficits improved significantly except for residual numbness.

Relation between spasticity in patients with multiple sclerosis with the degree of disability, neurofunctional and neuropsychological disorders

Objective — to analyze the relationship between the level of spasticity in patients with MS with the degree of neurological deficit by the EDSS scale and the results of neurofunctional and neuropsychological research.Methods and subjects. We examined 100 patients with a clinical diagnosis of MS with spasticity symptoms. The Modified Ashwort Scale was used to quantify the severity of changes in muscle tone. The EDSS scale was used to assess the degree of disability. T25‑FW and 9‑HPT tests were performed to assess the functional status of the upper and lower extremities. Neuropsychological tests were performed to assess pain on the VAS scale, fatigue on the MFIS scale, and EuroQol‑5D quality of life.Results. The highest level of total spasticity score was in the group of patients with the highest degree of disability 5.5 — 7.0 points and was 6.29 ± 0.82 points. The correlation and regression analysis confirmed that the following factors have the greatest correlation with the total score of spasticity: the level of total EDSS (coefficient of determination D = 42.1 %), pyramidal disorders (D = 50.7 %) and pelvic dysfunction (D = 44.4 %).Conclusions. There was a significant strong correlation between total spasticity and the degree of disability of patients with MS on the EDSS scale (rs = 0.649; p &lt; 0.05), primarily pyramidal (rs = 0.712; p &lt; 0.05) and pelvic disorders. As spasticity increases, the quality of life decreases and the level of fatigue increases. Mean correlations with the level of total spasticity were found with the MFIS scales and 2 EuroQol scales (rs = 0.555, 0.53 and 0.583, respectively, p &lt; 0.05).The sensation of pain in patients increases (rs = 0.192; p &lt; 0.05) with increasing spasticity level.

Water treadmill training protects the integrity of the blood-spinal cord barrier following SCI via the BDNF/TrkB-CREB signalling pathway

Following spinal cord injury (SCI), destruction of the blood-spinal cord barrier (BSCB) leads to increased microvascular permeability and tissue oedema. The BSCB, formed by a dense network of tight junctions (TJs) and adhesion junctions (AJs) is considered a therapeutic target. Most studies have focused on the effect of drug therapy on the neurovascular system after SCI, ignoring the protection and functional recovery of the vascular system by exercise training. Previously, we indicated that water treadmill training (TT) has a protective effect on the BSCB after SCI, but the specific molecular mechanism of the effect of TT on BSCB is still not clear. In this study, we used a specific inhibitor of TrkB (ANA-12) to explore whether the BDNF/TrkB-CREB signalling pathway is involved in TT-mediated BSCB protection after SCI. A New York University (NYU) impactor was used to establish the SCI model. Rats in the SI (Sham + ANA-12), IM (SCI + ANA-12) and ITM (SCI + TT + ANA-12) groups were injected with ANA-12 (0.5 mg/kg) daily, and rats in TM (SCI + TT) and ITM (SCI + TT + ANA-12) groups were treated with water TT for 7 or 14 d. The degree of neurological deficit, water content, BSCB permeability, protein expression and ultrastructure of vascular endothelial cells were assessed by the Basso-Beattie-Bresnahan (BBB) motor rating scale, Evans blue (EB), Western blot (WB) experiments, immunofluorescence and transmission electron microscopy (TEM). Our results suggest that TT upregulates the BDNF/TrkB-CREB signalling pathway following SCI. The BDNF/TrkB-CREB signalling pathway is involved in the protection of the BSCB. Application of the inhibitor blocked the protective effect of TT on the BSCB. We concluded that TT ameliorated SCI-induced BSCB impairment by upregulating the BDNF/TrkB-CREB signalling pathways.

Surgical options for traumatic fractures of the thoracic and lumbar spine

Background context. Thoracolumbar fractures represent a large number of spine injuries in adults. Such fractures are a result of traumatic accidents with high-energy impacts, such as falls from height or following motor vehicle accidents, often resulting in some degree of neurological deficit. Purpose. To report a total of 20 cases of thoracolumbar fractures in young adults with various neurological manifestations. The majority had indications for transpedicular fixation. Study Design. Series of 20 cases and review of the literature. Patient Sample. A series of 20 patients with a history of falling from a height or after motor vehicle accidents (RTA) with complicated fractures at the level of the thoracolumbar vertebrae which present with neurological deficits. Methods. We report here on a total of 20 patients with a history of falls from height or following RTA. Patients presented to the hospital complaining of back and abdominal pain. Fractures at the thoracolumbar vertebral level were confirmed with imaging studies revealing post-traumatic spinal deformities. All cases were initially considered for conservative medical treatment. However, unstable complicated cases with bone fragment migration as well as spinal canal compression were deemed candidates for surgical intervention via posterior spinal fusion with transpedicular screw fixation. Written informed consent was gathered from all patients. Detailed history, clinical examination, as well as X-ray, computed tomography and magnetic resonance imaging of the dorsolumbar spine were obtained in all cases. Neurological status was assessed using the Frankel grading for spinal cord injury. Results. The patients tolerated the operations without complications and remained in stable postoperative condition. Conclusion. Surgical treatments via transpedicular fixation are extremely efficient for treating unstable and complicated thoracolumbar spinal fractures. Nevertheless, conservative medical treatment is still of high value and should be considered as the first treatment option, especially in stable cases. The patients who underwent surgery showed excellent outcomes and improvement of neurological deficits. The surgical procedure preferred in the present study was the posterior spinal fusion with pedicle screw fixation.