Neurological Signs Research Articles

Predictors of early intracerebral hemorrhage in patients with cerebral sinus venous thrombosis: Systematic review and meta-analysis

ObjectivesPatients with cerebral venous thrombosis (CVT) may present with early intracerebral hemorrhage (EICH). The objective of this study was to identify predictors for EICH in CVT patients via a systematic review and meta-analysis of observational studies. Additionally, we aimed to evaluate the clinical outcomes associated with the presence of EICH in these patients. MethodsLiterature search on PubMed, EMBASE and Cochrane Library databases from inception up to 1 February 2024 was conducted. Five studies with predictors of EICH were included in qualitative synthesis and meta-analysis. ResultsPooled analysis demonstrated a statistically significant association between female gender and EICH (odd ratios (OR) = 1.51, 95 % confidence interval (CI) = 1.23-1.85, p < 0.01). The ICH patients had higher likelihood of seizures (OR = 3.07, 95 % CI = 1.69-5.58, p < 0.01), focal neurological deficits (OR = 4.07, 95 % CI = 2.57-6.44, p < 0.01), and decreased level of consciousness (OR = 3.89, 95 % CI = 2.53-5.87, p < 0.01). Superior Sagittal Sinus thrombosis was associated with higher likelihood of EICH (OR: 1.49, 95 % CI 1.05-2.13, P = 0.03). No statistically significant association was demonstrated between presence of EICH and pregnancy, presence of hematological diseases or thrombophilia, or other site of venous thrombosis (deep venous system, or multiple sinuses involvement). Furthermore, patients who exhibited early EICH were notably less likely to attain a favorable functional outcome (mRS 0-2) (OR: 0.28; 95 % CI 0.16–0.49; p < 0.001). ConclusionThis meta-analysis demonstrates that among CVT patients, female patients with new onset seizures, focal neurological deficits and decreased level of consciousness are more likely to present with EICH

Case Report: Atypical post-COVID Cogan's syndrome

Background Cogan’s syndrome is a rare autoimmune disorder characterized by ocular inflammation, vestibulocochlear dysfunction, and systemic vasculitis. Case Presentation We report a 28-year-old female who experienced decreased visual acuity and ocular redness one month after a COVID-19 infection, with ophthalmological signs linked to keratitis, uveitis and retinal vascularitis. Two weeks later, she developed vertigo, tinnitus, and sudden hearing loss, leading to a diagnosis of Cogan’s disease. The patient received corticosteroid therapy, resulting in regression of ophthalmological signs, but progressed to complete deafness. One month later, she presented with lymphocytic meningitis and high intracranial pressure, which improved under treatment. The patient later received cochlear implants. Objective This case report aims to highlight an atypical presentation of Cogan’s syndrome with neurological involvement following a COVID-19 infection. This case contributes to the limited literature on such presentations. Conclusion Our case is one of only two reported instances of Cogan’s syndrome presenting with neurological signs post-COVID-19 infection, underscoring the rarity and complexity of this condition.

Cerebral Sinus Venous Thrombosis in Pediatric Acute Lymphoblastic Leukemia: Incidence, Clinical Characteristics, and Long-term Neurologic Outcomes.

To describe the incidence, clinical characteristics, and long-term outcomes of cerebral sinus venous thrombosis in children with acute lymphoblastic leukemia. This was a retrospective cohort study comprising pediatric patients with newly diagnosed or first-relapse acute lymphoblastic leukemia who developed cerebral sinus venous thrombosis at Texas Children's Hospital from 2002 to 2019. Nineteen cases (1.7%) with cerebral sinus venous thrombosis were identified in all pediatric patients with acute lymphoblastic leukemia (n = 1129). Increased risk of cerebral sinus venous thrombosis was observed with age >10 years (P = .006). Twelve cases (63%) occurred during the induction, 4 (21%) during maintenance, and 3 (16%) during the consolidation phases of leukemia therapy. Seizures (10/19) and headaches (9/19) were the most common presenting symptoms. After treatment with anticoagulation therapy, we observed full resolution of thrombosis in 10 (53%) and partial resolution in 8 patients (42%). Long-term neurologic outcomes at follow-up in the 14 patients who survived included normal neurologic examinations (n = 10), epilepsy (n = 3), and focal neurologic deficits (n = 2). The death occurred in 5 individuals. Cerebral sinus venous thrombosis is a notable complication of pediatric acute lymphoblastic leukemia therapy. Older age (>10 years) was a risk factor for developing cerebral sinus venous thrombosis. Despite variable patient presentations and treatment durations, favorable clinical outcomes were observed in most patients after the treatment with anticoagulation for a minimum of 3 months.

Clinical features, hemorrhage risk and epilepsy outcomes of familial cerebral cavernous malformation: A 20-year observational pragmatic single-center study

IntroductionFamilial Cerebral Cavernous Malformations (fCCMs) are rare, hereditary conditions characterized by multiple central nervous system lesions. Despite their rarity, CCMs can cause significant clinical challenges when symptomatic, manifesting as seizure and symptomatic hemorrhage (CASH). Guidelines suggest neurosurgical intervention for symptomatic or previously symptomatic lesions, while conservative management is recommended for new-onset epilepsy. However, the natural history and optimal management remain unclear, necessitating further research. ObjectiveThis study aims to provide a comprehensive analysis of the clinical features, hemorrhage risk, and epilepsy outcomes in fCCM patients over an extended follow-up period, offering a more precise estimate of CASH and epilepsy rates in this population. MethodsThis retrospective longitudinal cohort study included fCCM patients enrolled from 2001 to May 2024. Data collected included demographic information, new neurological symptoms, symptomatic hemorrhages, seizures, and modified Rankin Scale (mRS) scores. Incidence rates of first symptomatic events and Kaplan-Meier survival curves were calculated, with logistic and Cox-proportional hazard regression models used to evaluate outcomes. ResultsA total of 47 patients were included in this study, with a mean age at diagnosis of 37.51 years. At diagnosis, 68 % were symptomatic, with 30 % having CASH and 36 % experiencing seizures without CASH. During a median follow-up of 126.0 months (interquartile range, 110.5 months), 17 % had a new CASH event, 20 % had seizures without CASH, and 60 % remained asymptomatic. The bleeding rate was 1.02 % per patient-year, with new focal neurological symptoms at 2.045 per 1000 patient-years and new CASH at 10.225 per 1000 patient-years. Most patients maintained minimal or no disability (mRS 0 or 1). Presenting with epilepsy at baseline significantly increased the odds of future seizures (OR 18.13, p = 0.001). ConclusionThis study highlights the complex presentation and progression of fCCMs, emphasizing the necessity for long-term monitoring. Baseline epilepsy is a significant predictor of future seizures, underscoring the need for individualized management strategies. Future research with larger cohorts and standardized criteria is essential to refine the understanding and management of fCCMs.

Association of Encephalitozoon cuniculi with Clinical Signs and Abnormal Hematologic/Biochemical Changes in Pet Rabbits in Thailand.

Encephalitozoon cuniculi can cause serious disease and subclinical infection in rabbits and requires active surveillance to control the infection. This study investigated the association between anti-Encephalitozoon cuniculi antibody status and various health parameters in pet rabbits. A total of 90 rabbits were divided into healthy (N = 30), subclinical (N = 30), and clinical (N = 30) groups based on their anti-Encephalitozoon cuniculi antibody status and clinical presentations. The mean ages of the control (37 ± 40 months) and subclinical groups (38 ± 34 months) were notably lower compared to that of the clinical group (63 ± 38 months, p < 0.01). Serum titers for anti-Encephalitozoon cuniculi antibodies were significantly elevated in rabbits with subclinical and clinical infections compared to those of healthy rabbits (p < 0.05). Neurological signs were predominant in rabbits with active E. cuniculi infection (80.0%), with additional pathological features including urinary dysfunction (10.0%) and cataracts (10.0%). The source of rabbits was not associated with E. cuniculi infection (p = 0.159). Anemia was significantly linked to E. cuniculi infection (p = 0.026); however, no significant associations were found with leukocytosis, thrombocytopenia, or serum biochemistry parameters. Mature adult rabbits were more likely to be infected with E. cuniculi. Recognizing anemia and neurological signs facilitates in early diagnosis of E. cuniculi infection.

Characterizing neuroinvasion and neuropathology of SARS-CoV-2 by using AC70 human ACE2 transgenic mice.

COVID-19 presents with a plethora of neurological signs and symptoms despite being characterized as a respiratory disease, including seizures, anxiety, depression, amnesia, attention deficits, and alterations in consciousness. The olfactory nerve is widely accepted as the neuroinvasive route by which the etiological agent SARS-CoV-2 enters the brain, but the trigeminal nerve is an often-overlooked additional route. Based on this consensus, we initially conducted a pilot experiment investigating the olfactory nerve route of SARS-CoV-2 neuroinvasion via intranasal inoculation in AC70 human ACE2 transgenic mice. Notably, we found that the trigeminal ganglion is an early and highly efficient site of viral replication, which then rapidly spread widely throughout the brain where neurons were primarily targeted. Despite the extensive viral infection across the brain, obvious evidence of tissue pathology including inflammatory infiltration, glial activation, and apoptotic cell deaths were not consistently observed, albeit inflammatory cytokines were significantly induced. However, the expression levels of different genes related to neuronal function, including the neurotransmitter dopamine pathway as well as synaptic function, and markers of neuronal damage were altered as compared to mock-infected mice. Our findings suggest that the trigeminal nerve may serve as a neuroinvasive route complementary to the olfactory nerve and that the ensuing neuroinvasion presented a unique neuropathological profile. This study provides insights into potential neuropathogenic mechanisms utilized by coronaviruses.

Presentation and management of cerebral proliferative angiopathy: a systematic review and meta-analysis on treatment outcomes.

Cerebral Proliferative Angiopathy (CPA) is a rare brain vascular malformation, similar to Arteriovenous Malformations (AVM) but lacking of early venous drainage. Presentation and treatment outcomes were investigated, examining for morbidity, mortality and complications. A meta-analysis was conducted according to PRISMA guidelines. PubMed, Embase and Web Of Science were searched with keywords such as "cerebral proliferative angiopathy" and "management". We pooled and meta-analyzed outcomes on documented CPA cases. 11,079 studies were pooled as a result of manual citation searching, 50 studies were included, adding up to 115 CPA cases. The majority of patients were females (1.38:1), with a mean age of presentation of 26.9 (19.4) years. Headache (46%) and seizures (34%) were the most common presenting symptoms. 37% of patients presented with focal neurologic deficit. Patients managed conservatively from the surgical standpoint (i.e. nonoperative management) did not undergo homogenous treatment strategies, and major complications were at 47% (95% CI: 17%, 76%), with a 1% mortality (95% CI: 0%, 6%). Surgical and embolization interventions presented the highest proportion of major complications, 66% (95% CI: 33%, 99%) and 73% (95% CI: 42%, 100%), respectively. The embolization subgroup led in mortality, with 3% (95% CI: 0%, 10%). No death was documented in patients undergoing surgery. CPA has a similar presentation to brain arteriovenous malformations, but its treatment outcomes are potentially worse. This difference is not attributable to heterogeneity in assigning patient treatment strategies. This highlights the need for more accurate diagnostic methods.

Redefining the phenotype of alpha-methylacyl-CoA racemase (AMACR) deficiency

BackgroundAlpha-methylacyl-CoA racemase (AMACR) deficiency is a rare peroxisomal enzyme deficiency caused by biallelic variants in the AMACR gene. This deficiency leads to the accumulation of toxic bile acid intermediates (R)-trihydroxycholestenoic acid (THCA) and (R)-dihydroxycholestenoic acid (DHCA) and pristanic acid. With less than 20 patients described in literature, the phenotype of AMACR deficiency is poorly defined and no data on the natural history are available.ResultsHere we describe a cohort of 12 patients (9 adults and 3 children) with genetically confirmed AMACR deficiency (median age at diagnosis 56 years, range 3–69), followed for an average of 6 years (between 2015 and 2023). Five novel pathogenic variants are described. In 5/9 adult patients, retinitis pigmentosa was detected at a median age of 45 years (range 30–61). The median delay to diagnosis of AMACR deficiency after the diagnosis of retinitis pigmentosa was 24 years (range 0–33). All adult patients subsequently developed neurological signs and symptoms after the age of 40 years; most frequently neuropathy, ataxia and cognitive decline with prior normal cognitive functioning. One patient presented with a stroke-like episode. All adult patients showed a typical MRI pattern involving the thalami and gray matter structures of the pons and midbrain. One patient had a hepatocellular carcinoma at the time of the AMACR deficiency diagnosis and two patients suffered from gallstones. All three included children had elevated liver transaminases as single presenting sign and showed no brain MRI abnormalities.ConclusionAMACR deficiency can be considered as an adult slowly progressive disease with a predominant neurological phenotype. The main signs comprise retinitis pigmentosa, neuropathy, ataxia and cognitive decline; stroke-like episodes may occur. Recognition of typical MRI abnormalities may facilitate prompt diagnosis. In addition, there is a risk of liver fibrosis/cirrhosis and hepatocellular carcinoma in these patients, requiring active monitoring.

A Review on Stroke’s Pathophysiology, Associated Risk Factors, and Management

Background: Stroke is a medical disorder defined by focal neurological deficits caused by vascular impairment (hemorrhage or infarction) in the CNS (Central Nervous System). Currently the second biggest cause of morbidity worldwide, strokes continue to be a deadly disease. Objective: This review aimed to elucidate the stroke’s pathophysiology, both changeable and unchangeable risk factors associated with stroke, including prevention of stroke, its diagnosis, as well as treatment. Methods: The articles were collected involving the research on stroke with the help of different sources, like PubMed, Science Direct, and Google. Many manuscripts were collected and analyzed, and the relevant ones were considered for the present manuscript. Results: A brain CT scan has been found to be the first step in the management of Cerebrovascular Accident (CVA) in order to distinguish between ischemic and hemorrhagic stroke types. Beyond stroke classification, imaging has been observed to serve as a powerful tool for ruling out alternative diagnoses, predicting stroke outcomes, and facilitating appropriate treatment planning. Conclusion: Stroke is the second foremost cause of death as well as disability worldwide, leading to substantial economic losses. Therefore, better treatment and improved management after stroke are a global health priority. Modifying risk factors can decrease the chances of occurrence of stroke. Also, correct diagnosis should be done to diagnose the presence of stroke and its type. Proper treatment should be provided, like perfusion, glucose management, antiplatelet therapy, antihypertensive therapy, stem cell therapy, neural response and rehabilitation, increased awareness, lifestyle changes, stress management, etc. Exercise can also help positively to reduce the chances of stroke.

Clinical presentation, imaging characteristics, and short-term outcome of eight cats presented with suspected traumatic atlantoaxial hyperflexion.

Traumatic atlantoaxial hyperflexion is considered rare in cats, and only a few case reports have been published. There are other conditions that can result in a peracute onset of neurological signs localized to the cervical spinal cord segments, including acute noncompressive nucleus pulposus extrusion, ischemic myelopathy, or vertebral fractures. Appropriate treatment for these conditions can only be initiated after an accurate diagnosis has been obtained. The aim of this observational, retrospective, single-center, descriptive case series study was to describe the clinical presentation, imaging characteristics, and short-term outcome of eight cats presented with suspected traumatic atlantoaxial hyperflexion. Young male healthy domestic shorthair cats were overrepresented (7/8) and typically presented with a peracute, nonprogressive, nonpainful, nonlateralizing C1-C5 myelopathy (tetraplegia or nonambulatory tetraparesis) following a road traffic accident or head trauma. All MRI studies demonstrated a solitary, focal, ill-defined intramedullary lesion immediately dorsal to the dens of the axis, affecting both grey and white matter. All cats were treated medically. In 50% of the cats, the neurological grade improved at discharge or short-term follow-up, 25% of the cats recovered completely, one cat was static at short-term follow-up, and one cat was euthanized due to persistent forebrain signs and lack of neurological improvement.

Radiologic Evaluation of Developmental Anomalies of The Odontoid Process: A Cone-Beam-Compated Tomography Study

Background: The odontoid process is an anchoring pivot for the craniovertebral junction and has many congenital anomalies. Ossiculum Terminale Persistans (OTP) and Os Odontoideum (OO) are believed to be rare developmental anomalies of the odontoid process. The OTP is defined as an ossification center that gives rise to the tip of the dens failing to fuse properly with the body of the axis. OO is described as an oval-shaped, well-corticated bony ossicle that is positioned cephalad to the body of the axis. Both of these conditions may cause neurological signs and atlantoaxial instability.

Intestinal pathology in goats challenged with Clostridium perfringens type D strain CN1020 wild-type and its genetically modified derivatives.

Clostridium perfringens type D is the causative agent of enterotoxemia in sheep, goats, and cattle. Although in sheep and cattle, the disease is mainly characterized by neurological clinical signs and lesions, goats with type D enterotoxemia frequently have alterations of the alimentary system. Epsilon toxin (ETX) is the main virulence factor of C. perfringens type D, although the role of ETX in intestinal lesions in goats with type D enterotoxemia has not been fully characterized. We evaluated the contribution of ETX to C. perfringens type D enteric pathogenicity using an intraduodenal challenge model in young goats, with the virulent C. perfringens type D wild-type strain CN1020; its isogenic etx null mutant; an etx-complemented strain; and sterile, non-toxic culture medium. The intestinal tract of each animal was evaluated grossly, microscopically, and immunohistochemically for activated caspase-3. Both ETX-producing strains induced extensive enterocolitis characterized by severe mucosal necrosis, apoptosis, and diffuse suppurative infiltrates. No significant gross or microscopic lesions were observed in goats inoculated with the non-ETX-containing inocula. These results confirm that ETX is essential for the production of intestinal lesions in goats with type D disease. Also, our results suggest that the intestinal pathology of type D enterotoxemia in goats is, at least in part, associated with apoptosis.

Phaeohyphomycosis caused by Trematosphaeria grisea in an immunocompromised English springer spaniel

AbstractA 10‐year‐old, male, farm‐based springer spaniel that presented with subacute progressive left‐sided central vestibular signs was diagnosed with meningoencephalitis of unknown origin. The patient received prednisolone (2 mg/kg/day orally), ciclosporin (5 mg/kg orally twice a day) and a single infusion of cytarabine (200 mg/m2). Six weeks later, neurological signs had resolved, but multiple cutaneous nodules developed on the limbs, trunk and face. Lesions discharged a dark purulent material without tissue grains. A ‘filamentous fungus’ was isolated, but discarded without identification. Aspirates from nodules showed pigmented, septate fungal hyphae, and culture of aspirates yielded Trematosphaeria grisea. Itraconazole (5 mg/kg once a day) and gradual tapering of immunosuppressive drugs led to resolution of nodular lesions over 4 months without neurological relapse. A fungal granuloma developed transiently 8 months after starting itraconazole. Immunosuppressive drugs were stopped 15 months after introduction without neurological relapse. Itraconazole was withdrawn 8 weeks later, 5 months after last relapse of skin disease.

Acute nicotine exposure attenuates neurological deficits, ischemic injury and brain inflammatory responses and restores hippocampal long-term potentiation in ischemic stroke followed by lipopolysaccharide-induced sepsis-like state

Ischemic stroke is followed by an increased susceptibility to bacterial infections, which exacerbate histological stroke outcome, neurological deficits and memory impairment due to increased neuroinflammation and neurotransmitter dysfunction. Pharmacological activation of nicotinic acetylcholine receptors was suggested to mitigate brain inflammatory responses in ischemic stroke. The functional responses associated with nicotinic acetylcholine receptor activation were unknown. In this study, male NMRI mice subjected to transient intraluminal middle cerebral artery occlusion (MCAO) were intraperitoneally exposed to vehicle treatment or Escherichia coli lipopolysaccharide (LPS; 4 mg/kg)-induced sepsis-like state 24 h post-MCAO, followed by intraperitoneal administration of vehicle or nicotine (0.5 mg/kg) 30 min later. Over 96 h, rectal temperature, neurological deficits, spontaneous locomotor activity, working memory, ischemic injury, synaptic plasticity, and brain inflammatory responses were evaluated by temperature measurement, behavioral analysis, infarct volumetry, electrophysiological recordings, and polymerase-chain reaction analysis. LPS-induced sepsis induced hypothermia, increased general and focal neurological deficits, reduced spontaneous exploration behavior, reduced working memory, and increased infarct volume post-MCAO. Additional treatment with nicotine attenuated LPS-induced hypothermia, reduced neurological deficits, restored exploration behavior, restored working memory, and reduced infarct volume. Local field potential recordings revealed that LPS-induced sepsis decreased long-term potentiation (LTP) in the dentate gyrus post-MCAO, whereas concomitant nicotine exposure restored LTP in the contralateral dentate gyrus. LPS-induced sepsis increased microglial/ macrophage Iba-1 mRNA and astrocytic GFAP mRNA levels post-MCAO, whereas add-on nicotine treatment reduced astrocytic GFAP mRNA. Taken together, these findings indicate that acute nicotine exposure enhances functional stroke recovery. Future studies will have to evaluate the effects of (1) chronic nicotine exposure, a clinically relevant vascular risk factor, and (2) the cessation of nicotine exposure, which is widely recommended post-stroke, but might have detrimental effects in the early stroke recovery phase.

A - 39 The Physical and Neurological Examination of Subtle Signs (PANESS) as a Predictor of ADHD

Abstract Objective The Physical and Neurological Examination of Subtle Signs (PANESS) is a pediatric neuromotor exam. Prior research shows children with attention deficit hyperactivity disorder (ADHD) may exhibit neurological soft signs. This study investigates the predictability of PANESS performance on other ADHD measures. Methods Subjects included 52 children aged 8–16 seen clinically for evaluation at Austin Neuropsychology. Dependent variables included Digit Span (DS), Test of Everyday Attention (TeaCh), Conners Continuous Performance Test (CCPT-3), and Delis-Kaplan Executive Function System (DKEFS). The raw scores of PANESS tasks were the independent variables. Results DS was significantly predicted by the foot tap (FT) (p = 0.017), foot heel-toe tap (FH) (p = 0.028), hand pat (HP) (p = 0.018), finger tap (FinT) (p &amp;lt; 0.001), and appose finger succession (AFS) (p = 0.012) tasks on the PANESS. The Category Fluency (CF) subtest on DKEFS Verbal Fluency was also significantly predicted by the FT (p = 0.043), FH (p &amp;lt; 0.001), hand pronate/supinate (HPS) (p = 0.003), FinT (p = 0.003), FA (p &amp;lt; 0.001) tasks. All PANESS tasks significantly predicted performance on Trial 2 of DKEFS Color-Word (FT: p = 0.012; FH: p = 0.015; HP: p = 0.002; HPS: p = 0.009; FinT: p = 0.003; FA: p = 0.002). The FA task was a significant predictor of all trials of CWI (T1: p &amp;lt; 0.001; T2: p = 0.002; T3: p &amp;lt; 0.001; T4: p &amp;lt; 0.001). Conclusion The PANESS predicts performance on some ADHD tasks, though not others. This finding prompts further investigation into how PANESS can be integrated into clinical settings to enhance ADHD diagnosis and understanding.

B - 32 Neurological Problems in Boxers during the 20th Century: a Review and Synthesis

Abstract Objective There are no validated clinical diagnostic criteria for chronic traumatic encephalopathy or traumatic encephalopathy syndrome (TES). To understand the historical clinical condition, its applicability to modern day athletes, and the pathogenesis of clinical problems, we examined the literature in boxers from the 20th century, with specific attention to neurological findings and characteristics of clinical disease progression. Data Selection Data were extracted for 243 boxers included in 45 articles published between 1928 and 1999, including cases from articles originally published in German. The presence or absence of 22 neurological signs and features were extracted. Data Synthesis The most common neurological problems were slurring dysarthria (49%), gait disturbances (44%), and memory loss (36%), with several other problems that were less frequent, including hyperreflexia (25%), ataxia (22%), increased tone (19%), and extensor Babinski sign (16%). Frank dementia appeared in some cases (17%). There were significantly fewer neurological deficits reported in boxers who fought in the latter part of the 20th century compared to boxers who fought earlier in the century. For most cases, there were no comments about whether the neurological problems were progressive (145, 60%). A progressive condition was described in 71 cases (29%) and a stationary or improving condition was described in 27 cases (11%). Canonical neurodegenerative disease-like progression was described in 15 cases (6%). Conclusions Neurological problems associated with boxing-related neurotrauma during the 20th century are the foundation for present day TES. However, the clinical signs and features in the 20th century differ in most ways from the modern criteria for TES.

The relationship between sphingomyelin and ceramide levels and soft neurological signs in ADHD.

Attention deficit hyperactivity disorder (ADHD), characterized by attention deficit, hyperactivity, and impulsivity, has recently been associated with lipid metabolism. In particular, the roles of sphingomyelin, ceramide, andgalactosylceramidase in the pathophysiology of ADHD are being investigated. This study aims to explore the relationship between sphingolipid metabolism markers and soft neurological signs (SNS) in children diagnosed with ADHD who are not undergoing medication treatment. A cross-sectional analysis was conducted on 41 children and adolescents aged 7-12 years diagnosed with ADHD and 39 neurotypically developing controls. Plasma levels of ceramide, sphingomyelin, and galactosylceramidase were measuredusing Enzyme-Linked Immunosorbent Assay (ELISA). SNS were assessed using the Physical and Neurological Examination for Soft Signs (PANESS). Statistical analyses included Student's t-tests, Mann-Whitney U tests, and Multivariate Analysis ofCovariance (MANCOVA), along with logistic regression analysis. Plasma levels of ceramide and sphingomyelin in children with ADHD showed significant differences compared to the neurotypically developing control group; however, there were no significant differences in galactosylceramidase levels between the two groups. Positive correlations were found between plasma levels of ceramide and sphingomyelin and the PANESS subscales F1 (Total Gait and Station) and F3 (Total Dysrhythmia). Additionally, logistic regression analysis indicated that high ceramide levels were positively associated with ADHD. This study underscores a significant association between alterations in sphingolipid metabolism (specifically increased levels of ceramide and sphingomyelin) and the presence of SNS in children with ADHD. These findings elucidate the potential role of sphingolipid metabolism in the pathophysiology of ADHD and provide suggestions for future therapeutic research targeting sphingolipid metabolism in the treatment of ADHD.

Ocular Ultrasound in the Diagnosis of Optic Neuropathies: A Review of the Literature.

Optic neuropathies represent one of the most frequent causes of vision loss, and they can manifest alone or in conjunction with neurological or systemic symptoms and signs. In recent years, the diagnostic techniques used to detect optic neuropathies have significantly improved, facilitating diagnosis and improving treatment. Among these, ocular ultrasound has assumed a fundamental role, although with conflicting results in the published scientific literature. For this reason, the aim of this review is to analyze the role of ocular ultrasound in the precise and targeted diagnosis of optic neuropathies to better understand the presumed potential of this precious diagnostic tool in the management of these ocular and neurological disorders. We carried out a search on PubMed and Scopus utilizing terms related to optic neuropathies and ocular ultrasound, including only relevant English full-length research articles, case reports, or case series. Most of the papers published in the scientific literature use only the B-scan ultrasound technique without considering the more precise and objective standardized A-scan technique that allows for performing more accurate diagnostic tests, such as the "30-degree test" and the "optic nerve exercise test". Future clinical trials and research on optic neuropathies should also consider the use of the standardized A-scan technique in order to compare clinical findings not only with B-scan ultrasonography but also with other noninvasive procedures that could be helpful in reaching the correct diagnosis.

A New Variant of Avian Encephalomyelitis Virus Associated with Neurologic Signs in Turkey Poults.

Avian encephalomyelitis (AE) is a disease caused by the avian encephalomyelitis virus (AEV) of the genus Tremovirus in the family Picornaviridae. Recently, cases of turkey poults showing neurological signs were submitted to the veterinary diagnostic laboratories at South Dakota State University and the University of Minnesota. The affected birds were showing nervous neurological signs such as tremors, inability to stand, torticollis, and wing drop. Clinical signs were observed by 3 weeks of age. Necropsy of birds revealed no significant gross lesions in the internal organs, including the brain. There was no significant bacterial growth in the brains. Microscopic examination of various sections of the brain revealed multifocal lymphocplasmacytic perivascular cuffs in the cerebellum and cerebral cortex. The brain samples were processed for detection and whole genome sequencing by next-generation sequencing. Three full-length polyprotein sequences (6405 nt) of AEV were assembled. All three sequences shared 99.9-100% nucleotide and 100% amino acid identities with each other. Only 77.7-78.5% of nucleotide and 90.3-92.5% of amino acid identities with AEV field strains and vaccine sequences were available in GenBank. This indicates that a new divergent variant of AEV is circulating in the field and causing AE outbreaks in the Midwest region.

Successful Management of Ischemic Stroke : A Case Report and Literature Review

Introduction: Stroke is a clinical condition characterized by the sudden onset of focal (or global, in cases of coma) neurological symptoms that persist for over 24 hours or result in death, with no clear cause other than a vascular issue. Case Description: Male, 62 years old, with chief of complaint of mouth dropped to the right since 1 day before admission. Complaints made the patient speak more difficult, slow and unable to form sentences. Physical examination show parese CN. VII UMN dextra. Siriraj score -5 and Head NCCT show cerebral infarction in the internal capsula interna. Patient was diagnosed with ischemic stroke. Discussion: The use of a scoring system can be useful when there are no brain imaging facilities that can clearly distinguish the causative pathology of stroke. criteria for diagnosis of ischemic stroke are symptoms of global neurological deficits or one / several focal neurological deficits that occur suddenly with evidence of brain imaging images (CT scan or MRI). The most common differential diagnosis is hemorrhagic stroke. Conclusion. Early recognition and appropriate treatment is important to cure acute ischemic stroke to achieve good quality of life and prevent further infarct to brain tissue. Keyword: Craniotomy, Brain Metastases, Hepatocellular Carcinoma