Neurological Admissions Research Articles

Evaluation of risk factors for postoperative neurologic intensive care admission after brain tumor craniotomy: A single-center longitudinal study.

Perioperative variable parameters can be significant risk factors for postoperative intensive care unit (ICU) admission after elective craniotomy for intracranial neoplasm, as assessed by various scoring systems such as Cranio Score. This observational study evaluates the relationship between these factors and early postoperative neurological complications necessitating ICU admission. In total, 119 patients, aged 18 years and above, of either sex, American Society of Anesthesiologists (ASA) grades I-III, scheduled for elective craniotomy and tumor excision were included. The primary objective was to evaluate the relationship between perioperative risk factors and the incidence of early postoperative complications as a means of validation of the Cranio Score. The secondary outcomes studied were 30-day postoperative morbidity/mortality and the association with patient-related risk factors. Forty-five of 119 patients (37.82%) required postoperative ICU care with the mean duration of ICU stay being 1.92 ± 4.91 days. Tumor location (frontal/infratemporal region), preoperative deglutition disorder, Glasgow Coma Scale (GCS) less than 15, motor deficit, cerebellar deficit, midline shift >3 mm, mass effect, tumor size, use of blood products, lateral position, inotropic support, elevated systolic/mean arterial pressures, and duration of anesthesia/surgery were associated with a higher incidence of ICU care. Maximum (P = 0.035, AOR = 1.130) and minimum systolic arterial pressures (P = 0.022, Adjusted Odds Ratio (AOR) = 0.861) were the only independent risk factors. Cranio Score was found to be an accurate predictor of complications at a cut-off point of >10.52%. The preoperative motor deficit was the only independent risk factor associated with 30-day morbidity (AOR = 4.66). Perioperative hemodynamic effects are an independent predictor of postoperative ICU requirement. Further Cranio Score is shown to be a good scoring system for postoperative complications.

The Effect of Delay Following the Clinical Decision to Perform Tracheostomy in the Critical Care Setting.

Tracheostomy in patients who are critically ill is generally performed due to prolonged mechanical ventilation and expected extubation failure. However, tracheostomy criteria and ideal timing are poorly defined, including equivocal data from randomized controlled trials and median intubation to tracheostomy times that range from 7-21 d. However, a consistent finding is that only ∼50% of late tracheostomy groups actually undergo tracheostomy, with non-performance due to recovery or clinical deterioration. Unlike in many jurisdictions, elective surgical procedures in our institution require a court-appointed guardian, which necessitates an approximately 1-week delay between the decision to perform tracheostomy and surgery. This offers a unique opportunity to observe patients with potential tracheostomy during a delay between the decision and the performance. ICU patients who were ventilated were identified for inclusion retrospectively by an application for guardianship relating to tracheostomy, the intention-to-treat point. The main outcomes of tracheostomy, extubation, or death/palliative care after inclusion were noted. Demographics, outcomes, and event timing were compared for the 3 outcome groups. Tracheostomy-related guardianship requests were made for 388 subjects. Of these, 195 (50%) underwent tracheostomy, whereas 127 (33%) were extubated and 66 (17%) either died before tracheostomy (46 [12%]) or were transitioned to palliative care (20 [5%]). The median time (interquartile range) from guardianship request until a defining event was the following: 6.2 (4.0-11) d for tracheostomy, 5.0 (2.9-8.2) d for extubation (P < .001 as compared to tracheostomy group), and 6.5 (2.5-11) d for death/palliative care (P = .55 as compared to tracheostomy). Neurological admissions were more common in the tracheostomy group and less common in the palliative group. Other admission demographics and hospitalization characteristics were similar. Hospital mortality was higher for subjects undergoing tracheostomy (58/195 [30%]) versus extubation (24/127 [19%]) (P = .03). Delay in performing tracheostomy due to legal requirements was associated with a 50% decrease in the need for tracheostomy. This suggests that decision-making with regard to ideal tracheostomy timing could be improved, saving unnecessary procedures.

Epidemiology and management of transient ischemic attack in Trieste district, how day hospital assessment improves outcomes: a five-year retrospective study.

Transient ischemic attack (TIA) is defined as a transient episode of neurologic dysfunction, without acute infarction or tissue injury lasting less than 24h. Previous data suggest TIA precedes 15% of ischemic strokes, with a higher risk in the first week. Current practice guidelines advise evaluation through rapid neurological visit or admission to hospital. We provide data on TIA incidence in Trieste, and we compare three different types of assessment: day hospital (DH), stroke unit (SU), and emergency department/outpatients (ED). This is a 5-year retrospective study of transient cerebrovascular events admitted in the University Hospital of Trieste (230.623 inhabitants), between 2016 and 2020. We calculated TIA prevalence in Trieste district's general population. Our primary endpoint is ischemic recurrences within 90days, and we evaluate the possible association between different types of management. TIA incidence rate was 0.54/1000 inhabitants. In the multivariate analysis remained significantly associated with primary endpoint: ABCD2 (OR 1.625, CI 95% 1.114-2.369, p = 0.012) and DH evaluation (OR 0.260, CI 95% 0.082-0.819, p = 0.021). Incidence of TIA in Trieste district is in line with previous data. We demonstrate the crucial role of DH evaluation over the outpatient/ED in reducing overall mortality and recurrence rate. Prompt recognition of patients at high risk for cerebrovascular events and specialist follow-up may reduce the incidence of major vascular events and death.

A retrospective analysis of 20,178 adult neurological infection admissions to United Kingdom critical care units from 2001 to 2020

BackgroundNeurological infection is an important cause of critical illness, yet little is known on the epidemiology of neurological infections requiring critical care.MethodsWe analysed data on all adults with proven or probable neurological infection admitted to UK (NHS) critical care units between 2001 and 2020 reported to the Intensive Care National Audit and Research Centre. Diagnoses, physiological variables, organ support and clinical outcomes were analysed over the whole period, and for consecutive 5-year intervals within it. Predictors of in-hospital mortality were identified using a backward stepwise regression model.ResultsWe identified 20,178 critical care admissions for neurological infection. Encephalitis was the most frequent presentation to critical care, comprising 6725 (33.3%) of 20,178 cases. Meningitis– bacterial, viral or unspecified cases - accounted for 10,056 (49.8%) of cases. In-hospital mortality was high, at 3945/19,765 (20.0%) overall. Over the four consecutive 5-year periods, there were trends towards higher Glasgow Coma Scale scores on admission, longer critical care admissions (from median 4 [IQR 2–8] to 5 days [IQR 2–10]), and reduced in-hospital mortality (from 24.9 to 18.1%). We identified 12 independent predictors of in-hospital death which when used together showed good discrimination between patients who die and those who survive (AUC = 0.79).ConclusionsAdmissions with neurological infection to UK critical care services are increasing and the mortality, although improving, remains high. To further improve outcomes from severe neurological infection, novel approaches to the evaluation of risk stratification, monitoring and management strategies are required.

Delirium and subsyndromal delirium in the intensive care unit: In-hospital outcomes and prognosis at discharge

Background and objectiveThe characteristics and outcomes of patients with subsyndromatic delirium (SSD) at hospitalization are still under discussion. The objectives were to describe the incidence of delirum and SSD in the intensive care unit care (ICU), to analyze the association with risk factors and to explore outcomes of delirium and subsyndromal delirium (SSD) at hospitalization and three months after discharge. Patients and methodsA prospective study, with telephone follow-up three months after discharge. The study included 270 patients over one year. Delirium and SSD were assessed with the CAM-ICU. Results22.96% developed delirium and 17.03% SSD. The main risk factors associated with the development of delirium were cognitive impairment (P=.000), age≥75 years (P=.019), neurological admission (P=.003), shock (P=.043), bedsores (P=.010), polypharmacy (0.017), ARM (P=.001) and fast (P=.028) and with the development of SSD were low schooling (P=.014), charlson>5 (P=.028), AIVD<8 (P=.001), enteral feeding (P=.000) and non-cardiovascular admission (P=.019). Overall mortality was 6% in the group without delirium (reference), 8% in SSD (P=.516) and 30% in delirium (P=.000). Median ICU length of stay was 2 (IQR, 1−2) days in the group without delirium, 3 (IQR, 2−4) days in SSD (P=.0001), and 3 (IQR, 2−7) days in delirium group (P=.0001). Three months after discharge, instrumental ADL were preserved in 50% of the group without delirium, 30% of SSD (P=.026) and 26% of delirium (P=.005). ConclusionsThe SSD group presented an intermediate prognosis between no delirium and delirium groups. It is advisable to promote its diagnosis for better risk classification.

Síndrome confusional agudo y confusional subsindromático en terapia intensiva: evolución intrahospitalaria y a los tres meses del alta

Background and objectiveThe characteristics and outcomes of patients with subsyndromal delirium (SSD) at hospitalization are still under discussion. The objectives were to describe the incidence of delirium and SSD in the intensive care unit (ICU), to analyze the association with risk factors and to explore outcomes of delirium and SSD at hospitalization and three months after discharge. Patients and methodsA prospective study, with telephone follow-up three months after discharge. The study included 270 patients over one year. Delirium and SSD were assessed with the CAM-ICU. Results22.96% developed delirium and 17.03% SSD. The main risk factors associated with the development of delirium were cognitive impairment (P=.000), age ≥75years (P=.019), neurological admission (P=.003), shock (P=.043), bedsores (P=.010), polypharmacy (P=.017), ARM (P=.001) and fast (P=.028), and with the development of SSD were low schooling (P=.014), Charlson >5 (P=.028), AIVD <8 (P=.001), enteral feeding (P=.000) and non-cardiovascular admission (P=.019). Overall mortality was 6% in the group without delirium (reference), 8% in SSD (P=.516) and 30% in delirium (P=.000). Median ICU length of stay was 2 (IQR, 1-2) days in the group without delirium, 3 (IQR, 2-4) days in SSD (P=.0001), and 3 (IQR, 2-7) days in delirium group (P=.0001). Three months after discharge, instrumental ADL were preserved in 50% of the group without delirium, 30% of SSD (P=.026) and 26% of delirium (P=.005). ConclusionsThe SSD group presented an intermediate prognosis between no delirium and delirium groups. It is advisable to promote its diagnosis for better risk classification.

Association between ambient BTEX mixture and neurological hospitalizations: A multicity time-series study in Taiwan

BackgroundBenzene, toluene, ethylbenzene, and xylenes, collectively known as BTEX, are hazardous chemical mixtures, and their neurological health effects have not been thoroughly evaluated. We examined the association between BTEX exposure and neurological hospital admissions. MethodsThis was a multicity time-series study conducted in five major Taiwanese cities. Daily hospital admission records for diseases of the nervous system from January 1, 2016, to December 31, 2017, were collected from the National Health Insurance Research Database. Ambient BTEX and criteria pollutant concentrations and weather factors were collected from Photochemical Assessment Monitoring Stations. We applied a Poisson generalized additive model (GAM) and weighted quantile sum regression to calculate city-specific effect estimates for BTEX and conducted a random-effects meta-analysis to pool estimates. ResultsWe recorded 68 neurological hospitalizations per day during the study period. The daily mean BTEX mixture concentrations were 22.5 µg/m3, ranging from 18.3 µg/m3 in Kaohsiung to 27.0 µg/m3 in Taichung, and toluene (13.6 µg/m3) and xylene (5.8 µg/m3) were the dominant chemicals. Neurological hospitalizations increased by an average of 1.6 % (95 % CI: 0.6–2.6 %) for every interquartile range (15.8 µg/m3) increase in BTEX at lag 0 estimated using a GAM model. A quartile increase in the weighted sum of BTEX exposure was associated with a 1.7 % (95 % CI: 0.6–2.8 %) increase in daily neurological hospitalizations. ConclusionWe found consistent acute adverse effects of BTEX on neurological hospitalizations in Taiwan, with toluene and xylene as the dominant chemicals. These findings aid the development of more targeted public health interventions.

Developing Predictive Models to Anticipate Shunt Complications in 33,248 Pediatric Patients with Shunted Hydrocephalus Utilizing Machine Learning

Introduction: Hydrocephalus is a common pediatric neurosurgical pathology, typically treated with a ventricular shunt, yet approximately 30% of patients experience shunt failure within the first year after surgery. As a result, the objective of the present study was to validate a predictive model of pediatric shunt complications with data retrieved from the Healthcare Cost and Utilization Project (HCUP) National Readmissions Database (NRD). Methods: The HCUP NRD was queried from 2016 to 2017 for pediatric patients undergoing shunt placement using ICD-10 codes. Comorbidities present upon initial admission resulting in shunt placement, Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining criteria, and Major Diagnostic Category (MDC) at admission classifications were obtained. The database was divided into training (n = 19,948), validation (n = 6,650), and testing (n = 6,650) datasets. Multivariable analysis was performed to identify significant predictors of shunt complications which were used to develop logistic regression models. Post hoc receiver operating characteristic (ROC) curves were created. Results: A total of 33,248 pediatric patients aged 6.9 ± 5.7 years were included. Number of diagnoses during primary admission (OR: 1.05, 95% CI: 1.04–1.07) and initial neurological admission diagnoses (OR: 3.83, 95% CI: 3.33–4.42) positively correlated with shunt complications. Female sex (OR: 0.87, 95% CI: 0.76–0.99) and elective admissions (OR: 0.62, 95% CI: 0.53–0.72) negatively correlated with shunt complications. ROC curve for the regression model utilizing all significant predictors of readmission demonstrated area under the curve of 0.733, suggesting these factors are possible predictors of shunt complications in pediatric hydrocephalus. Conclusion: Efficacious and safe treatment of pediatric hydrocephalus is of paramount importance. Our machine learning algorithm delineated possible variables predictive of shunt complications with good predictive value.

Osmotic Demyelinating Syndrome Secondary to Breast Cancer Chemotherapy: a Case Report (P10-5.024)

<h3>Objective:</h3> To report a case of osmotic demyelinating syndrome (ODS) secondary to chemotherapy for breast cancer. <h3>Background:</h3> ODS comprises both central pontine demyelination and extrapontine myelinolysis. This condition accounts for 0.4% to 0.56% of neurological admissions to tertiary referral hospitals and 0.06% of medical admissions. Although rapid correction of hyponatremia is the most common cause, other etiologies such as alcohol consumption, chronic renal failure, and organ transplantation are also reported. Chemotherapy can be an infrequent cause of this condition. Here we describe a case of ODS in a normonatremic patient in treatment with trastuzumab, pertuzumab, and docetaxel. <h3>Design/Methods:</h3> Not applicable. <h3>Results:</h3> A 71-year-old female with a history of breast cancer, with lung and brain metastases, is seen in the emergency room due to a decline in her functionality over the past three months, following the initiation of chemotherapy treatment with trastuzumab, pertuzumab and docetaxel. On neurological examination, she exhibited cognitive failures and a non-fluent aphasia without focal neurologic signs. In addition, right-sided focal seizures successfully managed with levetiracetam. On neuroimaging, there were signs of pontine myelinolysis and a reduction in the size of previous brain metastatic lesions. After discontinuing chemotherapy, the patient’s speech and gait significantly improved. <h3>Conclusions:</h3> ODS could be associated with combination chemotherapy treatment in the setting of a normonatremic patient. In 2014, Sungjae Lee and colleagues reported a similar case in a patient with colon cancer who received 5-fluorouracil, oxaliplatin, and leucovorin chemotherapy. In another study published by Cortes and colleagues, the development of osmotic demyelinating syndrome when using a combination of trastuzumab and pertuzumab for breast cancer was reported as a rare finding (one case of twenty-nine patients). To our knowledge, this is one of the first cases describing an ODS following therapy with pertuzumab, trastuzumab, and docetaxel. <b>Disclosure:</b> Dr. Gaitan Alfonso has nothing to disclose. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for BIIB. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Merck. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Novartis. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Biogen. Ms. Rodriguez has nothing to disclose. Dr. Salej has nothing to disclose. Dr. Otero has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GSK. Dr. Otero has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen . Dr. Otero has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for FICMAC. Dr. Toro has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Watch Neurology .

Posttraumatic Stress Symptoms Among COVID-19 Survivors After Hospitalization.

Limited data are available on posttraumatic stress symptoms (PTSS) among COVID-19 survivors. This study aimed to contribute to this knowledge base. PTSS among COVID-19 survivors who had been hospitalized were investigated. Patients were identified as COVID-19 positive at hospital admission. COVID-19 survivors were surveyed with the Posttraumatic Stress Disorder Checklist (PCL-5) between March and October 2020 at 5- and 12-month postdischarge follow-up points. Of 411 patients, 331 (81%) survived to hospital discharge. Of these survivors, 83 (25%) completed the PCL-5 at the 5-month follow-up. Of those patients, 12 (14%) screened positive for PTSS. At the 12-month follow-up, four of eight patients remained PTSS positive. Mean age of follow-up participants was 62±15 years; 47% were women, 65% were White, and 63% were Hispanic. PTSS-positive patients were predominantly non-White (67% vs. 30%, p=0.02), and although the differences were not statistically significant, these patients tended to be younger (56 vs. 63 years, p=0.08) and have shorter intensive care unit stays (2.0 vs. 12.5 days, p=0.06). PTSS-positive and PTSS-negative groups did not differ significantly in prehospitalization neurological diagnoses (11% vs. 8%), psychiatric diagnoses (17% vs. 21%), and intensive care admission status (25% vs. 25%). More patients in the PTSS-positive group had returned to the emergency department (50% vs. 14%, p<0.01) and reported fatigue at follow-up (100% vs. 42%, p<0.001). In the multivariate logistic regression model, non-White race (OR=11, 95% CI=2-91) and returning to the emergency department (OR=19, 95% CI=3-252) were associated with PTSS-positive status. PTSS were twice as common among hospitalized COVID-19 survivors than among those in the general population.

Inpatient resources used in organic versus functional neurological disorders

Patients with functional neurological symptoms (FNS) such as functional weakness and non‐epileptic attacks may present to acute hospital services. However, there are few good data on the proportion of neurological admissions they account for, or the utilisation of inpatient resources associated with them.

Prognostic significance of delirium subtypes in critically ill medical and surgical patients: a secondary analysis of a prospective multicenter study

BackgroundThe prognostic implication of delirium subtypes in critically ill medical and surgical patients is scarcely investigated. The objective was to determine how delirium subtypes are associated with hospital mortality and other clinical outcomes.MethodsWe performed a secondary analysis on data from a prospective multicenter study aimed at implementation of delirium-oriented measures, conducted between 2012 and 2015 in The Netherlands. We included adults (≥ 18 years) admitted to the medical or surgical intensive care unit (ICU). Exclusion criteria were neurological admission diagnosis, persistent coma or ICU readmissions. Delirium was assessed using the Confusion Assessment Method-ICU or Intensive Care Delirium Screening Checklist, and delirium subtypes (hypoactive, hyperactive, or mixed) were classified using the Richmond Agitation–Sedation Scale. The main outcome was hospital mortality. Secondary outcomes were ICU mortality, ICU length of stay, coma, mechanical ventilation, and use of antipsychotics, sedatives, benzodiazepines and opioids.ResultsDelirium occurred in 381 (24.4%) of 1564 patients (52.5% hypoactive, 39.1% mixed, 7.3% hyperactive). After case-mix adjustment, patients with mixed delirium had higher hospital mortality than non-delirious patients (OR 3.09, 95%CI 1.79–5.33, p = 0.001), whereas hypoactive patients did not (OR 1.34, 95%CI 0.71–2.55, p = 0.37). Similar results were found for ICU mortality. Compared to non-delirious patients, both subtypes had longer ICU stay, more coma, increased mechanical ventilation frequency and duration, and received more antipsychotics, sedatives, benzodiazepines and opioids. Except for coma and benzodiazepine use, the most unfavourable outcomes were observed in patients with mixed delirium.ConclusionsPatients with mixed delirium had the most unfavourable outcomes, including higher mortality, compared with no delirium. These differences argue for distinguishing delirium subtypes in clinical practice and future research.Trial registration ClinicalTrials.gov NCT01952899.

Numbers and types of neurological emergencies in England and the influence of socioeconomic deprivation: a retrospective analysis of hospital episode statistics data

ObjectivesIn this first large-scale analysis of neurological emergency admissions in England, we determine the number and types of emergency admissions with neurological emergency diagnostic codes, how many are under the...

Determination of the Prevalence of Postcovid Syndrome and Assessment of the Effectiveness of the Drug Cortexin in the Treatment of Neurological Disorders in Patients with Postcovid Syndrome. Results of the CORTEX Multicenter Clinical and Epidemiological Observational Program.

Objectives. To study the prevalence and clinical manifestations of postcovid syndrome (PCS) in out-patients and to assess the efficacy of treatment with the drug Cortexin at doses of 10 and 20 mg i.m. for 10 days. Materials and methods. A total of 979 patients with PCS from regions of the Russian Federation, Azerbaijan, Kyrgyzstan, and Kazakhstan were studied; mean age was 54.6 ± 4.5 years; duration of COVID-19 was from one month upwards. Investigations involved three visits. The first was on the day of consultation (assessment of complaints, analysis of scale indicators, prescription of drug Cortexin at a dose of 10 or 20 mg i.m. for 10 days). The second visit (telephone consultation) was on day 10–14. The third visit was on day 30 of out-patient treatment. Assessment of patients’ status used an asthenia assessment scale (MFI-20), a brief mental state assessment scale (MMSE), the Schulte test, and the Subjective Treatment Quality Assessment Scale. Results. The proportion of patients with PCS was up to 30% of all neurological admissions. The commonest manifestations were: fatigue, general weakness, decreased memory and concentration of attention, vertigo, sleep impairment, irritability, and aggression; less frequent were breathlessness, pain, increased sweating, anosmia, hyposmia, dysgeusia, paresthesia, hair loss, degradation of vision, tachycardia, allergic reactions, menstrual cycle impairments, erectile dysfunction, panic attacks, suicidal ideation, depression and refusal to eat meat. Conclusions: No associations were found between clinical symptomatology and the severity of COVID-19, the volume of lung tissue affected, or different periods of postcovid syndrome. Cortexin was found to be effective at doses of 10 and 20 mg for correcting the cognitive and asthenic manifestations of PCS. Cortexin was found to have anti-anxiety, antidepressant, and anxiolytic effects, which were more marked at the 20-mg dose.

The Cost Analysis of a 7-Year Cross-Section of Patients with Epilepsy in a Single-Center Child Neurology Outpatient Clinic: A Descriptive Retrospective Analysis

AbstractThe cost analysis of the 7-year cross-section of the patients in pediatric neurology outpatient clinic including patients with foreign nationality was investigated retrospectively. Between January 10, 2013 and January 10, 2020, the total number of applicants, the nationalities of the patients, and the hospital cost were analyzed. Of 3,338 patients, aged between 0 and 20 years with mean age of 8.7 years at admission to the child neurology had received 17,476 clinical examinations. Of these, 51.6% were male and 93.5% cases were Turkish patients (n = 3,122), with 6.5% foreign nationals (n = 216). There was no difference in terms of gender between nationalities (p &gt; 0.05). The total cost of cases with epilepsy was 1,312,427.73 Turkish Lira (TRY) and 6.2% account belonged to foreign nationals, mostly from Iraq (3.6%, n = 119) and Syria (2.4%, n = 80). The highest proportion of foreigner admissions due to epilepsy was in 2018 (11.1%). Mean average of health expenditures for foreign nationals diagnosed with epilepsy was 6.2% with the highest expenditure in 2019 (27.750,06 TRY). The proportion of admissions for epilepsy was 27.6% (17,476/63,173) among all neurological admissions. The proportion of Turkish patients was 25.6% (6,181/63,173), and 3.8% (1,295/3,398) accounted for foreigners' admissions. The proportion of total epilepsy costs compared with the total neurological admissions was 30% (1.312.427,73 TRY/4.347.592,80 TRY) and among them, the expenditure proportion for epilepsy in Turkish patients compared with that of total foreigner admissions was 3.9% (80.416,44 TRY/201.490,515 TRY). Expenditures for evaluating of epileptic children with foreign nationality cover an average of 6.5% of the entire section of the health expenditures made for patients with the diagnosis of epilepsy in the pediatric neurology outpatient clinic over the 7-year period. Epilepsy accounts for 30% admissions among all neurological admissions with 3.9% belonging to foreign national admissions.

Outcomes of a Neurohospitalist Program at an Academic Medical Center.

The purpose is to determine the impact of an academic neurohospitalist service on clinical outcomes. We performed a retrospective, quasi-experimental study of patients discharged from the general neurology service before (August 2010-July 2014) and after implementation of a full-time neurohospitalist service (August 2016-July 2018) compared to a control group of stroke patients. Primary outcomes were length of stay and 30-day readmission. Using the difference-in-difference approach, the impact of introducing a neurohospitalist service compared to controls was assessed with adjustment of patients' characteristics. Secondary outcomes included mortality, in-hospital complications, and cost. There were 2706 neurology admissions (1648 general; 1058 stroke) over the study period. The neurohospitalist service was associated with a trend in reduced 30-day readmissions (ratio of ORs: .52 [.27, .98], P = .088), while length of stay was not incrementally changed in the difference-in-difference model (-.3 [-.7, .1], P = .18). However, descriptive results demonstrated a significant reduction in mean adjusted LOS of .7 days (4.5 to 3.8days, P < .001) and a trend toward reduced readmissions (8.9% to 7.6%, P = .42) in the post-neurohospitalist cohort despite a significant increase in patient complexity, shift to higher acuity diagnoses, more emergent admissions, and near quadrupling of observation status patients. Mortality and in-hospital complications remained low, patient satisfaction was stable, and cost was not incrementally changed in the post-neurohospitalist cohort. Implementation of a neurohospitalist service at an academic medical center is feasible and associated with a significant increase in patient complexity and acuity and a trend toward reduced readmissions.

Characteristics and Outcomes of Paroxysmal Sympathetic Hyperactivity in Anti-NMDAR Encephalitis.

BackgroundTo explore the clinical characteristics and prognosis of autonomic dysfunction and paroxysmal sympathetic hyperactivity (PSH), and evaluate the efficacy of drugs used to suppress PSH episode in anti-NMDAR encephalitis patients.MethodsPatients who met the diagnostic criteria of anti-NMDAR encephalitis were enrolled from January 2012 to August 2018 and followed up for 2 years. PSH was diagnosed according to the PSH-Assessment Measure. The demographics data, clinical features, auxiliary tests results, treatments, and outcomes were prospective collected and analyzed.ResultsA total of 132 anti-NMDAR encephalitis patients were enrolled, of which 27.3% and 9.1% experienced autonomic dysfunction and probable PSH respectively. Cardiac autonomic dysfunction was the most common subtype (77.8%). Patients with a higher incidence of ovarian teratoma, mechanical ventilation, neurological intensive care unit admission, and elevated glucose and NMDAR antibody titer in the CSF were more likely to exhibit autonomic dysfunction or PSH. Episodes of PSH can be suppressed by monotherapy in patients without prior sedative drug use with an efficacy of 90%. No significant difference was observed between the prognosis of patients with or without autonomic dysfunction, or between the PSH versus non-PSH groups after 6 months and even during long-term follow-up. However, patients with cardiac autonomic dysfunction had poor prognosis at 6 months.ConclusionPSH is a common clinical condition in patients with anti-NMDAR encephalitis, especially in severe cases, and can be effectively managed by several drug monotherapies. Despite necessitating longer hospital stay, autonomic dysfunction or PSH do not seem to compromise the neurological recovery of patients.

Effects of Vertical Transmission of Respiratory Viruses to the Offspring.

Overt and subclinical maternal infections in pregnancy can have multiple and significant pathological consequences for the developing fetus, leading to acute perinatal complications and/or chronic disease throughout postnatal life. In this context, the current concept of pregnancy as a state of systemic immunosuppression seems oversimplified and outdated. Undoubtedly, in pregnancy the maternal immune system undergoes complex changes to establish and maintain tolerance to the fetus while still protecting from pathogens. In addition to downregulated maternal immunity, hormonal changes, and mechanical adaptation (e.g., restricted lung expansion) make the pregnant woman more susceptible to respiratory pathogens, such as influenza virus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Depending on the infectious agent and timing of the infection during gestation, fetal pathology can range from mild to severe, and even fatal. Influenza is associated with a higher risk of morbidity and mortality in pregnant women than in the general population, and, especially during the third trimester of pregnancy, mothers are at increased risk of hospitalization for acute cardiopulmonary illness, while their babies show higher risk of complications such as prematurity, respiratory and neurological illness, congenital anomalies, and admission to neonatal intensive care. RSV exposure in utero is associated with selective immune deficit, remodeling of cholinergic innervation in the developing respiratory tract, and abnormal airway smooth muscle contractility, which may predispose to postnatal airway inflammation and hyperreactivity, as well as development of chronic airway dysfunction in childhood. Although there is still limited evidence supporting the occurrence of vertical transmission of SARS-CoV-2, the high prevalence of prematurity among pregnant women infected by SARS-CoV-2 suggests this virus may alter immune responses at the maternal-fetal interface, affecting both the mother and her fetus. This review aims at summarizing the current evidence about the short- and long-term consequences of intrauterine exposure to influenza, RSV, and SARS-CoV-2 in terms of neonatal and pediatric outcomes.

Duration of deep hypothermic circulatory arrest for aortic arch surgery: is it a myth, fiction, or scientific leap?

The use of deep hypothermic circulatory arrest (DHCA) to provide aortic surgeons with a bloodless operative field while simultaneously protecting the brain and peripheries from ischemic damage revolutionized cardiac and aortic surgery, and is currently used in specialist centers across the globe. However, it is associated with manifold adverse outcomes, including neurocognitive dysfunction and mortality. This review seeks to analyze the relationship between DHCA duration and clinical outcome, and evaluate the controversies and limitations surrounding its use. We performed a review of available literature with statistical analysis to evaluate the relationship between DHCA duration (<40 min and >40 min) and key clinical outcomes, including mortality, permanent and temporary neurological deficit, renal damage, admission length, and reintervention rate. The controversies surrounding DHCA use and future directions for care are also explored. Statistical analysis revealed no significant association (P>0.05) between DHCA duration and clinical outcomes (early and late mortality rates, neurological deficit, admission length, and reintervention rate), both with and without adjunctive perfusion techniques. Available literature suggests that the relationships between DHCA duration (with and without adjunctive perfusion) and clinical outcomes are unclear, and at present not statistically significant. Alternative surgical and endovascular techniques have been identified as promising novel approaches not requiring DHCA, as have the use of biomarkers to enable early diagnosis and intervention for aortic pathologies.

Incidence of neurological deficit following road traffic accident with cervical spine immobilization compared to no cervical spine immobilization in patients visiting Taif hospitals

Background: Spinal collars were brought in 1967 into the administration of spinal injury care as it was believed that this procedure of immobilization would forestall any further neurological or spinal harm in high-risk patients. This study was done to assess the incidence of neurological deficit following road traffic accidents with cervical spine immobilization compared to no cervical spine immobilization in patients visiting Taif hospitals. Methods: A cross-sectional investigation of the patients who have encountered street car crashes was done from the time of July 2018 2022. The information was collected through a survey that assess the presence or non-attendance of neurological shortfalls in patients who had the cervical collar (CC) immobilization applied and the people who had not. Results: A total of 322 patients took part in our poll and cross-sectional review. The highest number of people were who did not utilize the CC when they own up to the emergency department (67.1%); accordingly, that significance (p = 0.009) demonstrated the powerlessness of the CC to diminish the deficiencies. Also, its presence did not diminish the complete number of patients in the Intensive care unit (ICU), however, the opposite occurred (p = 0.005). Conclusion: The utilization of a CC did not resist diminishing either the neurological deficiencies or admission to the ICU where most patients did not admit to the ICU unit which might be on the grounds that the greater part of patients did not confront cervical spine injury.