Management Of Neurological Disorders Research Articles

Acquired and Congenital Hemolytic Anemia.

1. Suzie A. Noronha, MD* 1. *Division of Pediatric Hematology/Oncology, University of Rochester, Golisano Children’s Hospital, Rochester, NY. 1. Pediatricians and other general practitioners may not be aware of the significance of central nervous system disease in children who have sickle cell disease, particularly the more subtle silent infarct. 2. Pediatricians frequently fail to order a reticulocyte count or detect splenomegaly on physical examination before referring a patient with anemia. These findings are critical to diagnosing hemolytic anemia. After completing this article, the reader should be able to: 1. Recognize clinical features of hemolysis, including reticulocytosis and splenomegaly. 2. List the different types of acquired autoimmune hemolytic anemias that can manifest throughout childhood. 3. Understand the role of transfusion in the management of neurologic disease in patients who have sickle cell disease. 4. Review the spectrum of disease of α- and β-thalassemias. 5. Recognize clinical findings associated with hereditary spherocytosis. 6. Determine when to suspect glucose-6-phosphate dehydrogenase deficiency and how to counsel families on triggers to avoid. Hemolytic anemia (HA) affects a substantial proportion of the pediatric population globally. Many children are hospitalized every year due to sequelae of this heterogeneous disease. Clinicians should be facile in recognizing its presentation. HA may be defined as increased destruction of red blood cells (RBCs). RBCs are cleared from the circulation via extravascular or intravascular mechanisms (Figure). HA can be caused by congenital or acquired RBC abnormalities (Table 1). Figure. Mechanism of extravascular versus intravascular hemolysis. RBC=red blood cell. Courtesy of Jessica Shand, MD. View this table: Table 1. Classification of Common Hemolytic Anemias Extravascular hemolysis is mediated by the reticuloendothelial system (RES) of the spleen and liver. Most HAs, such as warm autoimmune hemolytic anemia (AIHA), sickle cell disease (SCD), and hereditary spherocytosis (HS), are characterized by extravascular hemolysis. The hallmark of extravascular hemolysis is …

Neurogenic lower urinary tract dysfunction: Clinical management recommendations of the Neurologic Incontinence committee of the fifth International Consultation on Incontinence 2013

Evidence-based guidelines for the management of neurological disease and lower urinary tract dysfunction have been produced by the International Consultations on Incontinence (ICI). These are comprehensive guidelines, and were developed to have world-wide relevance. To update clinical management of neurogenic bladder dysfunction from the recommendations of the fourth ICI, 2009. A series of evidence reviews and updates were performed by members of the working group. The resulting guidelines were presented at the 2012 meeting of the European Association of Urology for consultation, and consequently amended to deliver evidence-based conclusions and recommendations in 2013. The current review is a synthesis of the conclusions and recommendations, including the algorithms for initial and specialized management of neurogenic lower urinary tract dysfunction. The pathophysiology is categorized according to the nature of onset of neurological disease and the part(s) of the nervous system affected. Assessment requires clinical evaluation, general investigations, and specialized testing. Treatment primarily focuses on ensuring safety of the patient and optimizing quality of life. Symptom management covers conservative and interventional measures to aid urine storage and bladder emptying, along with containment of incontinence. A multidisciplinary approach to management is essential. The review offers a pragmatic review of management in the context of complex pathophysiology and varied evidence base. Neurourol. Urodynam. 35:657-665, 2016. © 2016 Wiley Periodicals, Inc.

Risk factors for hemorrhage associated with external ventricular drain placement and removal

OBJECTIVE External ventricular drains (EVDs) have an important role in the management of neurological disease, and their placement is a frequently performed neurosurgical procedure. Hemorrhage is a common complication of EVD placement and occurs more frequently than originally believed. There is also risk of hemorrhage with removal of an EVD, which has not been well described. The authors investigated the risk factors associated with placement and removal of EVDs at their institution. METHODS A database was created including patients who required EVD placement from March 2008 to June 2014 at the University of Minnesota. A retrospective chart review was completed, and data were collected for each patient. All cranial imaging studies during the index hospitalization were reviewed to identify hemorrhages associated with either EVD placement or removal. The study was performed using a research protocol approved by the University of Minnesota's institutional review board. RESULTS Four hundred eighty-two EVDs were placed during the designated time period. Among the cases in which patients underwent imaging after the placement procedure, hemorrhage was found in 94 (21.6%). The hemorrhage volume ranged from 0.003 cm3 to 45.9 cm3 (mean [± SD] 1.96 ± 6.48 cm3). Two of these hemorrhages resulted in additional interventions: 1 surgical evacuation and 1 contralateral EVD. In 55 (22.5%) of the 244 cases in which imaging was performed after EVD removal, hemorrhage associated with removal was identified. The mean volume of these hemorrhages was 8.25 ± 20.34 cm3 (range 0.012-82.08 cm3). Two EVDs were replaced, and 1 patient died as a result of a large hemorrhage. Large hemorrhages (> 30 cm3) occurred in 2 patients on placement (0.46%) and in 5 patients on removal (2.0%). In this series, decreased platelet levels on admission and an increasing number of EVD placement attempts correlated with an increased risk of hemorrhage on placement. Only those with an EVD placed at bedside were more likely to have hemorrhage on EVD removal. CONCLUSIONS Multiple studies have reported varying EVD hemorrhage rates while very few studies have described hemorrhage secondary to EVD removal. This is the first reported analysis of risk factors associated with hemorrhage on EVD removal. Hemorrhages occur relatively frequently following EVD placement and removal, though clinical significance of these events seems to be low.

National characteristics and predictors of neurologic 30-day readmissions.

To examine national 30-day readmission rates for patients hospitalized with neurologic disorders. Using the University HealthSystem Consortium (UHC) database, we identified 554,399 index neurologic admissions from October 2011 through January 2015. We collected information regarding age, race, insurance payer, Medicare severity diagnosis-related group, and severity of illness. We examined readmission by diagnosis and performed multivariable logistic regression to determine predictors of readmission. The unplanned readmission rate was 11.0%. Rates of unplanned readmission were highest for patients with peripheral nerve disorders (21.9%), CNS neoplasms (21.0%), nonhypertensive encephalopathy (15.5%), arterial stenosis (15.4%), and bacterial CNS infections (14.5%). In multivariable analysis, higher severity of illness and public health insurance coverage predicted higher rates of 30-day readmission. We found significant variation in readmission rates for different neurologic disorders. These data provide insight into management of neurologic disease nationally, offering policymakers realistic goals for standards of care and challenging health care providers to develop systems-based solutions that will improve transitions of care for those at highest risk of readmission with neurologic disease.

Targeting neuronal nitric oxide synthase as a valuable strategy for the therapy of neurological disorders.

The management of neurological disorders have huge and increasing human and economic costs. Despite this, there is a scarcity of effective therapeutics, and there is an extreme urgency for new and real treatments. In this short review we analyze some promising advancements in the search of new bioactive molecules targeting neuronal nitric oxide synthase (nNOS), an enzyme deputed to the biosynthesis of nitric oxide (NO). In different conditions of neuronal damages, this molecule is overproduced, contributing to the pathogenesis and progression of neuronal diseases. Two main approaches to modulate nNOS are discussed: a first one consisting in the direct inhibition of the enzyme by means of small organic molecules, which can be also active against other different targets involved in such diseases. A second section is dedicated to molecules able to prevent the formation of the ternary complex N-methyl-D-aspartate (NMDA)-type glutamate receptors, postsynaptic density-95 (PSD95) protein-nNOS, which is necessary to activate the latter for the biosynthesis of NO.

Spectroscopic Investigations, DFT Calculations, and Molecular Docking Studies of the Anticonvulsant (2E)-2-[3-(1H-Imidazol-1-yl)-1-phenylpropylidene]-N-(4-methylphenyl)hydrazinecarboxamide

Drug discovery for the management of neurological disorders is a challenging arena in medicinal chemistry. Vibrational spectral studies of (2E)-2-[3-(1H-imidazol-1-yl)-1-phenylpropylidene]-N-(4-methylphenyl)hydrazinecarboxamide ((2E)-IPPMP) have been recorded and analyzed to identify the functional groups and intermolecular/intramolecular interactions of the title molecule. The blue shift of the C-H stretching wavenumber reveals the presence of improper C-H⋯O hydrogen bonding. The equilibrium geometry, harmonic vibrational wavenumbers, Frontier orbital energy, and natural bond orbital analyses have been carried out using density functional theory with a B3LYP/6-311++G(d,p) level of the basis set. The vibrational modes have been unambiguously assigned using potential energy distribution analysis. The scaled wavenumbers are in good agreement with the experimental results. Natural bond orbital analysis has confirmed the intermolecular/intramolecular charge transfer interactions. HOMO-LUMO analysis was carried out to explore charge delocalization on the (2E)-IPPMP molecule. A molecular docking study has supported the anticonvulsant activity of the title molecule.

General Physician\'s Viewpoints, about Educational Titles and Clinical Competencies in Diagnosis And Management of Neurological Diseases

General Physician\'s Viewpoints, about Educational Titles and Clinical Competencies in Diagnosis And Management of Neurological Diseases

Study on Weight of Cerebellum in Bangladeshi Cadaver

Context: Cerebellum is involved in the maintenance of balance and posture, coordination of voluntary movements, motor learning and cognitive functions. The weight of the human cerebellum at birth is only a fraction of the adult weight then weight increases up to certain age and decreases in old age. So, the present study was performed to observe the weight of the cerebellum in different age groups of Bangladeshi cadaver which will serve as a baseline data for clinicians regarding management of neurological disorders in our country.
 Materials and Methods: A cross sectional, analytical type of study was carried out in the department of Anatomy, Mymensingh Medical College, Mymensingh from April’ 2009 to September ’2009. A total of 63 cerebellums were collected from unclaimed Bangladeshi cadavers aged between 5 to 60 years and from dead fetuses obtained from caesarian section aged between 34 wks to 41 wks of gestation. The collected sample was grouped into three age groups like Group A (34 to 41 weeks of gestation), Group B (5 to 30 years) and Group C (31 to 60 years). Each cerebellum was weighed by means of a scientific balance.
 Results: The mean (±SD) weight was 17.91±3.05 gm in Group A, 125.91±15.24 gm in Group B and 115.29±18.06 gm in Group C.
 Conclusion: The present study shows that the mean weight of the cerebellum increases with age upto certain level then slightly decreases in the late age.
 Bangladesh J. Anat. 2015; 13(1) : 23-26

Dysregulacja szlaku mTOR i rola rapamycyny i jej analogów w leczeniu chorób neurologicznych

Dysregulacja szlaku mTOR i rola rapamycyny i jej analogów w leczeniu chorób neurologicznych

Spinal fluid biomechanics and imaging: an update for neuroradiologists.

Flow imaging with cardiac-gated phase-contrast MR has applications in the management of neurologic disorders. Together with computational fluid dynamics, phase-contrast MR has advanced our understanding of spinal CSF flow. Phase-contrast MR is used to evaluate patients with Chiari I malformation who are candidates for surgical treatment. In theory, abnormal CSF flow resulting from the abnormal tonsil position causes syringomyelia and other neurologic signs and symptoms in patients with Chiari I. CSF flow imaging also has research applications in syringomyelia and spinal stenosis. To optimize MR acquisition and interpretation, neuroradiologists must have familiarity with healthy and pathologic patterns of CSF flow. The purpose of this review is to update concepts of CSF flow that are important for the practice of flow imaging in the spine.

Radiolabeled neurogenesis marker imaging: A revolution in the neurological diseases management?

A reduced rate of neurogenesis occurs in the adult brain of patients with neurological diseases, with the rate of new neuron proliferation not sufficient to replace neuron loss. Neurogenesis can be induced by several factors, including basic fibroblast growth factor, epidermal growth factor, and brain-derived neurotrophic factor.Neurogenesis determination is a valuable parameter for determining disease progression and monitoring various treatments. Currently, neurogenesis detection is possible by invasive methods, such as bromodeoxyuridine (BrdU) cell labeling and immunohistological analysis of immature neuron markers. However, these are not compatible with alive model examination. Neurogenesis detection by noninvasive methods, such as radiolabeling of specific antibodies and scintigraphy imaging, could shed light on immature neuronal markers.We propose that brain scintigraphy after radiolabeling of a specific antibody of an immature neuronal marker is a useful new modality for neurogenesis detection and that it would aid the management of neurological diseases.

The practice of neuroimaging within a neurology office setting.

Imaging is an essential tool in the diagnosis and management of neurologic disorders, yet its adoption in the clinical neurology setting is limited. Perceived cost barriers and political pressures have caused undue apprehension for a community of experts that otherwise plays a leadership role in solving complex neurologic puzzles. Some private practice neurologists have integrated advanced imaging services into a comprehensive neuroservices model, demonstrating its plausibility together with a recipe for success. The purpose of this article is to explore the advantages, disadvantages, and considerations for integrating imaging into an outpatient neurology clinic. Clinical and business advantages are weighed against financial, regulatory, and political risks.

Etiological beliefs of patients with neurological disorders attending a tertiary care center: A cross-sectional study

Background:The understanding and management of neurological disorders is undergoing revolutionary changes over the last three decades in the background of ever increasing advances in medical technologies, diagnostic techniques, therapeutic processes and, molecular and genetic medicine. The fruits of these advances can reach patients only if the psychosocial hurdles in their delivery are identified, acknowledged and addressed.Aim:To explore the beliefs and practices of patients with neurological disorders in a tertiary care center in the eastern Nepal.Materials and Methods:One hundred patients attending neurology/medicine outpatient for neurological disorders were interviewed about their beliefs regarding the triggering factors, causation and treatment-seeking behavior particularly from traditional healers.Result:Of the 100 patients (49 males, 51 females) recruited in the study, 51% expressed having ‘no idea’ about their illness. Only 20% patients gave medically congruent explanation for their illness. Psychological factors were attributed as triggering factors by 16% of patients, of which two-thirds were females. Chance, destiny and ‘jadu tona’ topped the list of triggering factors. Forty-four percent patients had sought help of traditional faith healers (‘Dhami Jhakri’) before seeking medical help. Traditional faith healers were approached by patients irrespective of their educational background. Fifty-nine percent of patients who first sought traditional faith healers, believed in ‘jadu-tona’. Of those interviewed, 16% were planning to go to a faith healer in near future.Conclusion:The beliefs of patients with neurological disorders frequently do not conform to current medical opinion. There is need for greater communication and education of patients by their treating physicians.

Cardiomyopathy in neurological disorders

According to the American Heart Association, cardiomyopathies are classified as primary (solely or predominantly confined to heart muscle), secondary (those showing pathological myocardial involvement as part of a neuromuscular disorder) and those in which cardiomyopathy is the first/predominant manifestation of a neuromuscular disorder. Cardiomyopathies may be further classified as hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, or unclassified cardiomyopathy (noncompaction, Takotsubo-cardiomyopathy). This review focuses on secondary cardiomyopathies and those in which cardiomyopathy is the predominant manifestation of a myopathy. Any of them may cause neurological disease, and any of them may be a manifestation of a neurological disorder. Neurological disease most frequently caused by cardiomyopathies is ischemic stroke, followed by transitory ischemic attack, syncope, or vertigo. Neurological disease, which most frequently manifests with cardiomyopathies are the neuromuscular disorders. Most commonly associated with cardiomyopathies are muscular dystrophies, myofibrillar myopathies, congenital myopathies and metabolic myopathies. Management of neurological disease caused by cardiomyopathies is not at variance from the same neurological disorders due to other causes. Management of secondary cardiomyopathies is not different from that of cardiomyopathies due to other causes either. Patients with neuromuscular disorders require early cardiologic investigations and close follow-ups, patients with cardiomyopathies require neurological investigation and avoidance of muscle toxic medication if a neuromuscular disorder is diagnosed. Which patients with cardiomyopathy profit most from primary stroke prevention is unsolved and requires further investigations.

Diagnosis and Management of Neurological Disorders

Diagnosis and Management of Neurological Disorders

Diagnosis and a Key Point of the Management of Neurological Diseases Closely Related to Various Medical Condition

Diagnosis and a Key Point of the Management of Neurological Diseases Closely Related to Various Medical Condition

Profile of Neurological admissions at the University of Nigeria Teaching Hospital Enugu

The burden of Neurological diseases may be on the increase especially in developing countries. Improved outcome in these settings may require appreciation of the spectrum of Neurological diseases and the impediments to their management. We aim to determine the profile of neurological admissions and the challenges of managing these diseases at the University of Nigeria Teaching Hospital Enugu South East Nigeria. Analysis of Neurological admissions into the medical wards of the University of Nigeria Teaching Hospital Enugu from January 2003 to December 2007. Neurological admissions comprise about 14.8% of medical admissions. There were 640 (51%) males and 609 (49%) females. The spectrum of neurological diseases were stroke 64.9%, central nervous system infections (21.8% ), HIV related neurological diseases 3.5%, hypertensive encephalopathy (3.4%), dementia (3%), subarachnoid haemorrhage (2.2%), Guillian Barre syndrome (1.2%), Parkinson's disease (1.1%), myasthenia gravis (1.0%), motor neurone disease and peripheral neuropathy and accounted for 0.8% and 0.6% respectively. Overall, noninfectious disease accounted for 78.2% of neurological admissions while infectious diseases accounted for 11.8%. A wide spectrum of neurological diseases occurs in our setting. The high incidence of CNS infections indicates that efforts should be geared towards preventive measures. A major challenge to be addressed in the management of neurological diseases in our setting is the lack of specialized facilities.

Neurologic Complications of Critical Illness, Third Edition.

University of Maryland School of Medicine, Baltimore, Maryland. rdarwish@anes.umm.eduNeurologic Complications of Critical Illness, Third Edition. By Eelco F. M. Wijdicks, M.D., Ph.D. Series edited by Sid Gilman, M.D., and William J. Herdman, M.D. New York, Oxford University Press, 2009. Pages: 480. Price: $129.95.Diagnosis and management of neurologic disorders in the intensive care unit (ICU) are challenging. Advances in the knowledge and understanding of pathophysiology and clinical presentations of neurologic disorders, aided by the considerable effect of advanced imaging technologies, are reflected in this revised edition of a classic textbook. This third edition adds more than 100 new figures, tables, helpful management algorithms, and illustrations that are based on the understanding of pathophysiology and neurologic presentation of critical illness in the ICU.In the first of four parts, the author describes in detail general clinical neurologic problems in the ICU. Delirium and coma are common clinical states that confront intensive care physicians. With appropriate diagnosis and treatment, coma can often be treated successfully. Any delay in diagnosis and treatment can be detrimental. The author emphasizes that the clinician must determine whether the cause of impairment is structural or metabolic because diagnostic testing and treatment methods will differ accordingly.Recent technologic improvements in computed tomography, magnetic resonance imaging, and positron emission tomography have facilitated earlier intervention. The detailed description of neurologic examination of patients in coma is outstanding. The author then describes the effect of commonly used medications in clinical practice and their neurologic manifestations, with emphasis on the pharmacokinetics and pharmacodynamics of commonly used sedatives and narcotics in critical illness. The addition of ketamine and butyrophenones to this review would have made the chapter more comprehensive, however.Furthermore, the author describes in detail the differential diagnosis and management of seizure disorders in the ICU, with emphasis on early detection of structural lesions. For practicing intensivists, the reviews of drug-associated seizures as well as seizures associated with drug withdrawal and metabolic abnormalities provide an important resource in patient management. The author also evaluates the current knowledge of neuromuscular problems in the critically ill, peripheral neuropathy, critical illness polyneuropathy, acute motor neuropathy, neuromuscular junction dysfunction, and myopathy.In part two, the author reviews neurologic complications of commonly performed invasive procedures in the ICU. Then he provides a detailed review of the neurologic manifestations of acute bacterial and viral infections.In addition, the author offers practical advice on how to manage various forms of encephalopathy resulting, in the medical and surgical ICUs, from toxicity of endogenous products secondary to organ failure, with detailed reviews of liver and renal failure, endocrine dysfunction, and toxicity secondary to exogenous poisons (e.g. , sedative drugs, psychotropic drugs). He also addresses abnormalities secondary to electrolyte and acid-base disturbances. The author also provides a review of neurologic complications of hematologic disorders. The author's discussion of neurologic complications of cardiac arrest, resuscitation, and the use of therapeutic hypothermia is especially helpful.In part three, the book describes outcomes after various neurologic complications. The review of the outcomes of medical pathology was outstanding. It is extremely important that surgical pathology and stroke be well defined for timely consultation and intervention by neurosurgical and neurology services. However, I believe this section needs more detailed criteria for critical care physicians to obtain proper imaging for thorough and timely consultation. The end of the book details the challenges of consultation in the ICU, especially end-of-life decisions, brain death, and organ donation.In general, Neurologic Complications of Critical Illness provides very comprehensive coverage of neurologic diseases, including reviews on virtually all critical illness with serious neurologic complication. Certain chapters of this book are written for neurologists, however, and not for medical intensive care specialists, especially the chapter on consultations in the ICU. I believe defining the indications for neurologic service consultations should provide guidelines for the timely intervention of the neurologists in the management of critically ill patients.University of Maryland School of Medicine, Baltimore, Maryland. rdarwish@anes.umm.edu

Opioid system functional regulation in neurological disease management

There is increasing evidence to suggest a role for the opioid system in the control of pathophysiology of neurological disorders (Alzheimer's, Parkinson's, and Huntington's diseases, spinal cord injury, epilepsy, hypoxia, and autism). Resuscitation of the altered expression of the opioid system in various neurological disorders is of therapeutic importance. Such treatment may be beneficial in ameliorating the clinical symptoms of the disorder. This Mini-Review provides a brief update on opioid system regulation in neurological disorders and focuses on the opioids' pharmacological importance.

Application of Biomarkers for the Personalized Management of Neurological Disorders

Application of Biomarkers for the Personalized Management of Neurological Disorders