Neurological Causes Research Articles

Clinical and histopathological investigation of symmetrical alopecia with associated chronic pruritus in tufted capuchin monkeys (Sapajus apella apella).

Symmetrical alopecia is a common symptom of endocrine and autoimmune diseases, which are rarely manifested with pruritus. Increased levels of stress in primates have been presented with increased levels of pruritus and alopecia appearance. A pruritic and alopecic disease was investigated in a group of tufted capuchin monkeys (N = 12), but due to ethical reasons, four random animals were further investigated by numerous diagnostic methods. The impact of food and enclosure enrichment was assessed and observed over a 2-year period. Histopathology of four random tufted capuchin monkeys revealed lymphocytic perifolliculitis, with an appearance of a "swarm of bees" which was suggestive of alopecia areata. Etiological classification of pruritus excluded dermatological, systemic, and neurological causes, making it behavioral. Enclosure and food enrichment had a beneficial impact on pruritus (12/12) and alopecia (10/12). The findings were suggestive of alopecia areata, while the pruritus was considered behavioral in origin. Alopecia and pruritus improved upon enclosure and food enrichment.

Impact of Clinician Training Background and Stroke Location on Bedside Diagnostic Test Accuracy in the Acute Vestibular Syndrome - A Meta-Analysis.

Acute dizziness/vertigo is usually due to benign inner-ear causes but is occasionally due to dangerous neurologic ones, particularly stroke. Because symptoms and signs overlap, misdiagnosis is frequent and overuse of neuroimaging is common. We assessed the accuracy of bedside findings to differentiate peripheral vestibular from central neurologic causes. We performed a systematic search (MEDLINE and Embase) to identify studies reporting on diagnostic accuracy of physical examination in adults with acute, prolonged dizziness/vertigo ("acute vestibular syndrome" [AVS]). Diagnostic test properties were calculated for findings. Results were stratified by examiner type and stroke location. We identified 6,089 citations and included 14 articles representing 10 study cohorts (n = 800). The Head Impulse, Nystagmus, Test of Skew (HINTS) eye movement battery had high sensitivity 95.3% (95% confidence interval [CI] = 92.5-98.1) and specificity 92.6% (95% CI = 88.6-96.5). Sensitivity was similar by examiner type (subspecialists 94.3% [95% CI = 88.2-100.0] vs non-subspecialists 95.0% [95% CI = 91.2-98.9], p = 0.55), but specificity was higher among subspecialists (97.6% [95% CI = 94.9-100.0] vs 89.1% [95% CI = 83.0-95.2], p = 0.007). HINTS sensitivity was lower in anterior cerebellar artery (AICA) than posterior inferior cerebellar artery (PICA) strokes (84.0% [95% CI = 65.3-93.6] vs 97.7% [95% CI = 93.3-99.2], p = 0.014) but was "rescued" by the addition of bedside hearing tests (HINTS+). Severe (grade 3) gait/truncal instability had high specificity 99.2% (95% CI = 97.8-100.0) but low sensitivity 35.8% (95% CI = 5.2-66.5). Early magnetic resonance imaging (MRI)-diffusion-weighted imaging (DWI; within 24-48 hours) was falsely negative in 15% of strokes (sensitivity 85.1% [95% CI = 79.2-91.0]). In AVS, HINTS examination by appropriately trained clinicians can differentiate peripheral from central causes and has higher diagnostic accuracy for stroke than MRI-DWI in the first 24-48 hours. These techniques should be disseminated to all clinicians evaluating dizziness/vertigo. ANN NEUROL 2023;94:295-308.

Cobalamin C Deficiency, an Inborn Error of Metabolism presenting with Subacute Neuropsychiatric Symptoms (P9-4.001)

<h3>Objective:</h3> Inpatient Neurology teams are often consulted to rule out neurological causes for new-onset neuropsychiatric symptoms. This case highlights the importance of considering possible Inborn Errors of Metabolism (IEM) that require specific treatments, and avoiding premature closure on a primary psychiatric disorder. <h3>Background:</h3> A 15-year-old presented to a pediatric hospital with a 4–8 week onset of neuropsychiatric (psychosis, psychomotor slowing, catatonia, sleep cycle irregularities, and tremors) and systemic (acute on chronic kidney injury and hypertension) symptoms. Neurology was consulted for further evaluation. In addition to the abnormal higher mental function exam, the neurological exam was significant for hyperreflexia in both the upper and lower extremities. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> Neuroimaging (an initial non-contrast CT Head and MRI brain with and without contrast) did not reveal an intracranial abnormality. Analysis of cerebrospinal fluid, including an autoimmune encephalitis panel, was unremarkable. Metabolic testing was significant for elevated homocysteine and methylmalonic aciduria with normal Vitamin B12 levels. Genetics and metabolic consult recommended testing for Cobalamin C deficiency that returned positive with pathogenic mutations in MMACHC gene. Neuropsychiatric symptoms began to improve after the initiation of treatment with hydroxocobalamin, carnitine, betaine, and leucovorin. <h3>Conclusions:</h3> Cobalamin C deficiency (CblC) most commonly presents in infants less than 1 year, but is also known to present rarely in adolescence or adulthood, most commonly with subacute onset psychiatric symptoms, myelopathy, and cardiovascular disease. CblC is an autosomal recessive disorder caused most commonly by pathogenic variants within the MMACHC gene. Late-onset forms of IEM can present with isolated neuropsychiatric symptoms years after birth and thus are prone to be missed. Treatable metabolic disorders should be considered in the workup for new-onset neuropsychiatric symptoms. <b>Disclosure:</b> Dr. Engel has nothing to disclose. Dr. Rashid has nothing to disclose. Dr. Al-Beshri has nothing to disclose. Dr. Ananth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Reata Therapeutics. The institution of Dr. Ananth has received research support from Acadia Pharmaceuticals.

The relationship between dietary profile and adherence to the Mediterranean diet with EDSS and quality of life in multiple sclerosis patients: a retrospective cross-sectional study

ABSTRACT Background Multiple sclerosis (MS), one of the main neurological causes of disability seen at young ages, affects the quality of life of patients. Studies on which dietary pattern or consumption of food groups may have an impact on quality of life for MS patients are insufficient. The study was conducted to determine the relationship between adherence to Mediterranean diet and consumption levels of food groups on quality of life in multiple sclerosis patients. Methods This study was conducted with 95 patients, 76 females and 19 males, aged 18–65 years, who had been diagnosed with MS for at least 2 years and did not have any other chronic disease. Food Frequency Questionnaire, Mediterranean Diet Adherence Screener (MEDAS), Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Quality of Life-54 Instrument (MS-QoL-54) used as tools. Data were analyzed by SPSS 25.0. Results Adherence to the Mediterranean diet was associated with EDSS and physical and mental quality of life parameters (CPH and CMH), independent of progression. It was associated with EDSS and CMH in progressive MS. A statistically significant negative weak correlation was found between daily milk and oilseed consumption and EDSS. Daily fruit consumption was associated with CMH, and vegetable consumption was associated with both CPH and CMH. Conclusions The Mediterranean diet may be an effective nutritional model in MS patients and may be related to the disability level and quality of life of the patients. Some food groups can be associated with the quality of life and disability level of MS patients.

Association between smoking and all-cause mortality in Parkinson’s disease

We aimed to investigate the association between smoking status and all-cause mortality of Parkinson’s disease (PD). Among the whole nationwide population data from Korea National Health Insurance Service, newly diagnosed PD was selected, and all-cause mortality was evaluated. The systematic review was performed through a literature search on the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases. Among 26,080 individuals with PD, there was no significant association between smoking status and all-cause mortality in a nationwide cohort study (ex-smoker, HR 0.1.03, 95% CI 0.97–1.10; current smoker, HR 1.06, 95% CI 0.96–1.16). The systematic review, including six prospective cohort studies, also found a nonsignificant association. PD smokers tended to have fewer deaths from neurologic causes but were significantly more likely to die from smoking-related cancers such as lung cancer. We presented a nonsignificant association between smoking and mortality of PD, and cigarette smoking is not recommended in individuals with PD.

Clinical and Genetic Analysis of Metastatic Prostate Cancer to the Central Nervous System: A Single-Institution Retrospective Experience.

Prostate cancer (PC) rarely metastasizes to the central nervous system (CNS). In this retrospective single-institution study at a tertiary cancer center, we aimed to evaluate the clinical and genetic characteristics of advanced PC patients with CNS metastases. Between January 2010 and March 2020, 12 out of 579 patients with extracranial metastatic PC were identified to have CNS metastases based on imaging, including six patients with brain metastases (BMs), five patients with dural metastases, and one unknown. These patients were followed up through March 2022. Clinical data were compared to the overall cohort of patients evaluated at our cancer center during that decade. Genetics information was also analyzed for the patients with available data via cell-free DNA (cfDNA) blood samples. Median time from development of extracranial metastatic disease to development of CNS metastases was 5.5 years (95% CI, 1.8-7.0). Median overall survival (mOS) from diagnosis of CNS metastases was 6.1 months (95% CI, 5.8-8.2). Notably, there was no significant difference in mOS after development of extracranial metastases in patients with CNS metastases (6.4 years; 95% CI, 4.6-7.9) compared to the patients without known CNS metastases (5.2 years; 95% CI, 4.6-5.7) (P=.91). For the cohort with CNS metastases, nine patients had germline testing and seven patients had somatic testing via cfDNA. PC patients with CNS metastases did not often die from a neurological cause. With advancing therapies, the overall prognosis of metastatic PC continues to improve, and CNS metastases will become more common.

Neurologic Complications of Patients With COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis.

We searched MEDLINE, Embase, PsycINFO, Cochrane, and MedRxiv databases from inception to March 15, 2022. We identified studies that described acute neurological complications in adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring ECMO. Two authors independently performed study selection and data extraction. Studies with 95% or more of its patients on venovenous or venoarterial ECMO were pooled for meta-analysis, which was calculated using a random-effects model. Fifty-four studies (n = 3,347) were included in the systematic review. Venovenous ECMO was used in 97% of patients. Meta-analysis of ICH and ischemic stroke on venovenous ECMO included 18 and 11 studies, respectively. The frequency of ICH was 11% (95% CI, 8-15%), with intraparenchymal hemorrhage being the most common subtype (73%), while the frequency of ischemic strokes was 2% (95% CI, 1-3%). Higher anticoagulation targets were not associated with increased frequency of ICH (p = 0.06). In-hospital mortality was 37% (95% CI, 34-40%) and neurologic causes ranked as the third most common cause of death. The risk ratio of mortality in COVID-19 patients with neurologic complications on venovenous ECMO compared with patients without neurologic complications was 2.24 (95% CI, 1.46-3.46). There were insufficient studies for meta-analysis of COVID-19 patients on venoarterial ECMO. COVID-19 patients requiring venovenous ECMO have a high frequency of ICH, and the development of neurologic complications more than doubled the risk of death. Healthcare providers should be aware of these increased risks and maintain a high index of suspicion for ICH.

Comparison of Toxicities among Different Bumped Kinase Inhibitor Analogs for Treatment of Cryptosporidiosis.

Recent advances on the development of bumped kinase inhibitors for treatment of cryptosporidiosis have focused on the 5-aminopyrazole-4-carboxamide scaffold, due to analogs that have less hERG inhibition, superior efficacy, and strong in vitro safety profiles. Three compounds, BKI-1770, -1841, and -1708, showed strong efficacy in C. parvum infected mice. Both BKI-1770 and BKI-1841 had efficacy in the C. parvum newborn calf model, reducing diarrhea and oocyst excretion. However, both compounds caused hyperflexion of the limbs seen as dropped pasterns. Toxicity experiments in rats and calves dosed with BKI-1770 showed enlargement of the epiphyseal growth plate at doses only slightly higher than the efficacious dose. Mice were used as a screen to check for bone toxicity, by changes to the tibia epiphyseal growth plate, or neurological causes, by use of a locomotor activity box. These results showed neurological effects from both BKI-1770 and BKI-1841 and bone toxicity in mice from BKI-1770, indicating one or both effects may be contributing to toxicity. However, BKI-1708 remains a viable treatment candidate for further evaluation as it showed no signs of bone toxicity or neurological effects in mice.

Visual hallucinations: Differentiating psychiatric and neurologic causes

Visual hallucinations: Differentiating psychiatric and neurologic causes

Catatonia: Development of a neuropsychiatric entanglement through a clinical case

IntroductionCatatonia is a transnosographic and potentially fatal syndrome, most often associated with mood disorders or schizophrenia, but can also develop in autistic disorders, dementia, as well as in general medical conditions such as epilepsy, autoimmune encephalitis, hypercalcemia, hepatic encephalopathy, or diabetic ketoacidosis.Objectivesthe objective is to understand the semiology and treatment of catatonic syndrome in a clinical caseMethodsClinical caseResultsThe work we present is based on a clinical case of a patient with schizophrenia presenting a catatonic syndrome, of which a neurological cause was first evoked but after clinical investigations the diagnosis of schizophrenia was retained and currently the patient is stabilized on Clozapine. It is imperative to recognize a catatonic syndrome in order to treat it quickly, as some of the etiologies that cause this syndrome and the consequences of the syndrome itself can be life-threatening.ConclusionsCatatonia remains a subject of research for centuries, the diagnosis is clinical, based on a set of criteria grouped in the DSM5, its etiologies are psychiatric and organic including neurological. Rapid diagnostic and therapeutic management is essential to avoid life-threatening complications.Disclosure of InterestNone Declared

Secondary Mania in Older Adults: a case report and review of literature

IntroductionAlthough mania is commonly associated with bipolar disorder, it can have many etiologies. Thus, “primary mania” results from bipolar disorder, whereas “secondary mania” results from pharmacological, metabolic, or neurologic causes. Older adults are at risk for secondary mania because of increased medical comorbidities and neurological changes. In one retrospective study of 50 patients with mania who were older than 65 years, it was the first manic episode for 28% of the patients and 71% had a comorbid neurological disorder.ObjectivesThe etiology of mania is important because although acute symptomatic treatment of both primary and secondary mania may be similar, appropriate treatment of secondary mania includes addressing the cause. We present here two case histories of secondary mania in older adults, discuss their presentations and differential diagnosis in turn, and discuss treatment.MethodsWe will present a clinical case of a patient. Ms. A, a 63-year-old divorced woman with no prior medical or psychiatric history, was seen for an acute manic episode with mixed features. She was in her usual state of health until 2 weeks before admission, when she presented with a status epilepticus requiring a one-week hospitalization in the neurology département and treated by Carbamazepine. She then developed an abnormally excited and labile mood, motor excitability accompanied by rapid thoughts, with a total loss of desire and pleasure and thoughts of death.ResultsIn our study, the patient presented a manic episode with mixed characteristics secondary to a status epilepticus.The patient was treated both somatically and psychologically, and the evolution was positive. The patient was stabilised after being put on an antiepileptic drug associated with an antipsychotic drug.In our study, the patient presented with a manic attack with mixed characteristics secondary to a status epilepticus.The patient was treated both somatically and psychologically, and the evolution was favourable. The patient was stabilised after being put on an antiepileptic drug associated with an antipsychotic drug.ConclusionsLate onset psychiatric disorders often represent a challenge for the psychiatrists as far as the diagnosis and management issues are concerned. The elderly patients have generally been reported to have associated medical, especially neurological illnesses and are also prone to side effects of various psychotropic medications.Disclosure of InterestNone Declared

Diagnostic Challenges of Functional Cognitive Disorders

IntroductionFunctional cognitive disorders (FCD) denotes a complaint about memory function or, less commonly, another cognitive process, in the absence of relevant neuropathology and with evidence of inconsistency between symptoms reported and signs identified at assessment.Increasing numbers of people with FCD are being identified.Most are discharged back to primary care without a diagnosis or are given the label of mild cognitive impairment, which is not a synonym for FCD.ObjectivesThere is a multitude of terms in the clinic and in the research to describe this kind of complaints. Some terms seem to minimize and normalize the state, whereas others posit an underlying cause.Given this lack of order, it is a challenge to diagnose it and give it the proper clinical guidance.This literature-based review aims to fill this gap.MethodsData was obtained through an internet-based literature search, using the databases PubMed, Cochrane Library and NCBI. The World Health Organization was also utilized. Nine articles from the last two years were included.ResultsIt is listed a nosology in six categories and a selection of clinical features which may help with the discrimination of functional and neurological disease causes of memory disorders.ConclusionsPatients presenting with complaints about memory function require standard psychiatric and neurological history and examination.It should be emphasized that these conditions are not diagnoses of exclusion but have positive symptoms and signs that should become well-known.Nevertheless, we remain uncertain about prognosis and treatments, both psychological and pharmacological. Its development would reduce the burden of patients in the healthcare systems.Disclosure of InterestNone Declared

Survey study of the etiology of non-traumatic altered consciousness in the Emergency Department at Suez Canal University Hospital in Egypt.

Disorders of consciousness including coma in non-trauma patients can be caused by a wide variety of pathologies affecting the central nervous system. They represent a frequent challenge in emergency medicine and are combined with a very high in-hospital mortality. Hence, early treatment of these patients is vital and increases the likelihood of a good outcome. To identify the causes of altered consciousness presentation to the Emergency Department at Suez Canal University Hospital. This was a descriptive cross-sectional study conducted on 87 patients with acute non-traumatic disturbed level of consciousness (DLOC) at the Emergency Department. The mean age of the studied patients was 60.5 ± 13.6 years. Among them, 60% were males and 40% were females. The most common cause of acute non-traumatic DLOC was systemic infection, such as sepsis and septic shock (25.3%), followed by respiratory causes (24.1%) and neurological causes (18.4%). The most common cause of acute non-traumatic DLOC was systemic infections followed by respiratory and neurological causes.

Cardiovascular diseases worsen the maternal prognosis of COVID-19.

Cardiovascular diseases (CVD) are a risk factor for severe cases of COVID-19. There are no studies evaluating whether the presence of CVD in pregnant and postpartum women with COVID-19 is associated with a worse prognosis. In an anonymized open database of the Ministry of Health, we selected cases of pregnant and postpartum women who were hospitalized due to COVID-19 infection and with data regarding their CVD status. In the SIVEP GRIPE data dictionary, CVD is defined as "presence of cardiovascular disease", excluding those of neurological and nephrological causes that are pointed out in another field. The patients were divided into two groups according to the presence or absence of CVD (CVD and non-CVD groups). Among the 1,876,953 reported cases, 3,562 confirmed cases of pregnant and postpartum women were included, of which 602 had CVD. Patients with CVD had an older age (p<0,001), a higher incidence of diabetes (p<0,001) and obesity (p<0,001), a higher frequency of systemic (p<0,001) and respiratory symptoms (p<0,001). CVD was a risk factor for ICU admission (p<0,001), ventilatory support (p = 0.004) and orotracheal intubation in the third trimester (OR 1.30 CI95%1.04-1.62). The group CVD had a higher mortality (18.9% vs. 13.5%, p<0,001), with a 32% higher risk of death (OR 1.32 CI95%1.16-1.50). Moreover, the risk was increased in the second (OR 1.94 CI95%1.43-2.63) and third (OR 1.29 CI95%1.04-1.60) trimesters, as well as puerperium (OR 1.27 CI95%1.03-1.56). Hospitalized obstetric patients with CVD and COVID-19 are more symptomatic. Their management demand more ICU admission and ventilatory support and the mortality is higher.

Not All Postoperative Stridor in Infants Is Due to Endotracheal Tube-Induced Subglottic Edema

AbstractA 6-month-old infant presented with clinicoradiological features of a shunt dysfunction. Magnetic resonance imaging brain showed multiple leptomeningeal cysts in the posterior fossa, with the largest in the right cerebellopontine (CP) angle cistern causing compression on the brain stem and fourth ventricle. There was gross hydrocephalus with the malpositioned shunt tube. He underwent shunt revision followed by right retromastoid craniectomy and decompression of the right CP angle cyst. Following extubation, he developed stridor that was diagnosed initially as subglottic edema and treated with humidified oxygen, systemic corticosteroids, and nebulized adrenaline. Failure to resolve the symptoms warranted a video laryngoscopy that revealed right vocal cord palsy (VCP), and he was reintubated. He was started on steroids and got extubated on a nasal continuous positive airway pressure and was gradually weaned off. Intraoperative handling of the vagus nerve while decompressing the cyst led to a right VCP, which was communicated later to the anesthesiologist. Neurological cause and association need to be considered as one of the differentials while managing postoperative stridor after posterior fossa surgery in an infant. Timely communication between the surgeon and anesthesiologist is paramount for reducing morbidity.

Abstract TP110: Incident ICU Transfer Characteristics Among Ischemic Stroke Patients: A 4-year Retrospective Analysis

Background: Neurologic patients transferred to an intensive care unit (ICU) have increased length of stays, mortality, and healthcare cost. There is limited data regarding incident transfers in stroke-specific cohorts. We sought to identify clinical features, transfer timing, and outcomes of patients admitted with ischemic stroke who required ICU escalation. Methods: We identified all patients age &gt;18 admitted to our institution with a principle diagnosis of ischemic stroke between 2016 and 2019. We included patients requiring transfer to an ICU at any point in their hospitalization. We identified indications for transfer (IFT), time to ICU transfer (TTI), and outcomes at discharge and at 90-days post-discharge. We subdivided the IFT into neurologic and non-neurologic etiologies, and used chi-square testing and Kaplan-Meier curves with log-rank modeling to identify differences between patients with neurologic and non-neurologic transfer indications. Results: 3176 patients were admitted with a principle diagnosis of ischemic stroke across the four-year study period. 118 stroke patients (3.7%) underwent incident ICU transfer, 49 (41.5%) due to neurological causes and 69 (58.5%) due to non-neurological causes. The most common neurologic IFTs were cerebral edema (51.0%) and intracerebral hemorrhage (14.3%). The most common non-neurologic IFTs were respiratory decline (47.8%) and shock (21.7%). There were no differences in stroke characteristics (last known normal prior to arrival, baseline NIHSS, thrombolytic rates) between patients with neurologic vs. non-neurologic IFTs. Patients with neurologic IFTs had shorter mean TTI (2.45 vs. 4.80 days; p = 0.035) and were less likely to be discharged home compared to patients with non-neurologic IFTs (21.7% vs. 6.1%; p = 0.021). We corroborated differences in IFTs by adjusted log-rank comparisons on survival analysis. There were no significant difference in length of ICU stay (4.66 vs. 4.83 days) or total length of stay (12.37 vs 16.75 days). Conclusions: Most ischemic stroke patients’ incident ICU transfers occur in the first 48 hours, highlighting the need for early vigilance. Neurologic and non-neurologic etiologies for IFT may contribute to the patients’ disposition outcome.

Stroke in Parkinson's disease: a review of epidemiological studies and potential pathophysiological mechanisms.

Parkinson's disease (PD) is the fastest growing neurological disorder and one of the leading neurological causes of disability worldwide following stroke. An overall aging global population, as well as general changes in lifestyle associated with mass industrialization in the last century, may be linked to both increased incidencerates of PD and an increase in cumulative cardiovascular risk. Recent epidemiological studies show an increased risk of stroke, post-stroke complications, and subclinical ischemic insults in PD. PD patients have a host of characteristics that might contribute to increasing the risk of developing ischemicstroke including motor impairment, dysautonomia, and sleep disorders. This increases the urgency to study the interplay between PD and other neurological disorders, and their combined effect on mortality, morbidity, and quality of life. In this review, we provide a comprehensive overview of the studied etiological factors and pathological processes involved in PD, specifically with regard to their relationship to stroke. We hope that this review offers aninsight into the relationship between PD and ischemicstroke and motivates further studiesin this regard.

Upfront and Repeated Stereotactic Radiosurgery in Patients With Brain Metastases From NSCLC

IntroductionApproximately 40% of non-small-cell lung cancer (NSCLC) patients develop brain metastases (BM). Stereotactic radiosurgery (SRS) instead of whole-brain radiotherapy (WBRT) is increasingly administered as an upfront treatment to patients with a limited number of BM. We present outcomes and validation of prognostic scores for these patients treated with upfront SRS. MethodsWe retrospectively analyzed 199 patients with a total of 268 SRS courses for 539 brain metastases. Median patient age was 63 years. For larger BM, dose reduction to 18 Gy or hypofractionated SRS in 6 fractions was applied. We analyzed the BMV-, the RPA-, the GPA- and the lung-mol GPA score. Cox proportional hazards models with univariate and multivariate analyses were fitted for overall survival (OS) and intracranial progression-free survival (icPFS). ResultsSixty-four patients died, 7 of them of neurological causes. Thirty eight patients (19,3%) required a salvage WBRT. Median OS was 38, 8 months (IQR: 6-NA). In univariate analysis as well as multivariate analysis, the Karnofsky performance scale index (KPI) ≥90% (P = 0, 012 and P = 0, 041) remained as independent prognostic factor for longer OS. All 4 prognostic scoring indices could be validated for OS assessment (BMV P = 0, 007; RPA P = 0, 026; GPA P = 0, 003; lung-mol GPA P = 0, 05). ConclusionIn this large cohort of NSCLC patients with BM treated with upfront and repeated SRS, OS was markedly favourable, in comparison to literature. Upfront SRS is an effective treatment approach in those patients and can decidedly reduce the impact of BM on overall prognosis. Furthermore, the analysed scores are useful prognostic tools for OS prediction.

A rare complication of Escherichia coli induced urosepsis; is Guillain-Barre syndrome

Guillain Barre syndrome (GBS) is the most common neurological cause of acute flaccid paralysis worldwide. Early diagnosis and treatment of GBS are vital due to possible deadly consequences. Awareness of the silent neurological symptoms in patients preparing for upcoming surgery may have critically crucial for a urologist. Developing GBS after relieving urosepsis is rarely addressed in the literature. Therefore, this report presents an infrequent complication of Escherichia coli (E. coli)-induced urosepsis, GBS. A 47-year-old female patient was admitted to the emergency department in a septic state. During the intensive care unit management with the preliminary diagnosis of sepsis-related hypovolemic shock, a nephrostomy catheter was placed in an obstructed left kidney due to impacted upper ureteral calculus with 1.5 cm in size. Following the improvement of the patient’s condition in intensive care unit with proper management, the patient was transferred to the urology ward for definitive treatment. During the follow-up, however, the patient showed some neurological signs and symptoms considering GBS. An obtained cerebral spinal fluid analysis revealed an albumin-cytologic dissociation and examining the patient underpinned the diagnosis. The patient was treated with intravenous immunoglobulin for five days, according to the guidlines. After the treatment, the patient’s condition improved rapidly following two weeks. The left obstructed ureteral stones were removed with ureteroscopy. A stone-free status was achieved the following month. GBS is the most common cause of acute flaccid paralysis worldwide, and proper management is essential due to poor prognosis. GBS after a uroseptic condition is sporadic, but any surgery on patients who experience active GBS would bode for severe consequences, so awareness of the silent neurological symptoms in patients prepared for upcoming surgery is vital for a urologist. We aimed to remind with this report of the possibility of GBS for a patient who expresses neurological symptoms following a septic state.

Factors Associated with Unplanned Transfer of Patients with Brain Tumor from Inpatient Rehabilitation Unit to Primary Acute Care Units.

Inpatient rehabilitation should be assessed to improve each functional domain in patients with brain tumor. However, no previous study has reported risk factors for unplanned transfer of this patient population to primary acute care units during a comprehensive inpatient rehabilitation. The objective of this study was to investigate the percentage of unplanned transfer of brain tumor rehabilitation inpatients to primary acute care units compared with stroke patients and factors associated with such unplanned transfer. Data of 137 patients with brain tumor who were transferred to the department of physical and rehabilitation medicine were retrospectively reviewed. For comparison, data of 438 patients with subacute stroke were also obtained. Included patients were divided into an unplanned transfer group and a control group based on whether they required a transfer to another department for acute care before completing their comprehensive inpatient rehabilitation. Reasons for unplanned transfers were classified based on medical or surgical conditions. The incidence of unplanned transfers to the medical or surgical department was significantly higher in patients with brain tumor (15.3%) than in stroke patients (7.1%) (p < 0.05). Most of unplanned transfers occurred within two weeks of the comprehensive inpatient rehabilitation for patients with brain tumor. There was a significantly higher incidence of unplanned transfers in patients with a primary tumor than in those with a metastatic tumor (15.9% vs. 4.8%, p < 0.05). In addition, the frequency of chemotherapy or radiotherapy was significantly (p < 0.05) higher in the unplanned transfer group than in the control group. The most common cause of an unplanned transfer was a neurologic cause (90.0%) in patients with brain tumor and an infectious disease such as pneumonia (51.6%) in stroke patients. In conclusion, these results demonstrated a higher incidence of unplanned transfers in patients with brain tumor than in stroke patients during intensive inpatient rehabilitation. Proportions of those with neurological problems were relatively higher in patients with brain tumor than in patients with subacute stroke.