Clinical Neurological Examination Research Articles

Prevalence of Carpal Tunnel Syndrome Symptoms Among Young Dentists.

Objectives Although age is a risk factor, carpal tunnel syndrome (CTS) can also affect younger individuals, particularly those involved in activities or occupations that require repetitive hand movements, forceful gripping, or prolonged wrist flexion/extension. This case-control study aimed to examine the prevalence of CTS symptoms and frequent object dropping among a group of young dentists who are exposed to CTS risk factors. Additionally, other reported risk factors for CTS, such as sex, obesity, and square wrist sign, were also investigated. Methods A total of 74 dentists (48 women, mean age 28.5 years), who are working at Istanbul Faculty of Dentistry, the largest dental school in Istanbul, which is the biggest city in Turkey, were included in the study. Additionally, 61 age- and sex-matched controls (38 women, mean age 27.9 years) were also recruited. The Edinburgh Hand Preference Questionnaire, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), a questionnaire for object dropping and occupational hand usage, anthropometric measurements of the hands, clinical neurologic examination, and electromyography intended for the detection of CTS were performed. Results The dentists had a higher total weekly hand usage duration compared to the controls (66.3 vs 44.8 hours, p<0.001). BCTQ scores and the frequency of object dropping were also significantly higher in dentists compared to controls (respective p values: 0.011, 0.003). Positive correlations were found between BCTQ scores, hand usage durations, and object dropping (respective p values: 0.001, <0.001). BCTQ scores were higher in women than in men (p=0.027). Electrophysiologic evidence of CTS was found in one dentist. Conclusions Symptoms of CTS may manifest in individuals at a younger age than predicted, primarily influenced by their occupation and the duration of hand usage. Dentists, in particular, report a higher incidence of complaints related to object dropping, which can be attributed to their frequent use of specialized tools and engagement in delicate tasks, resulting in heightened awareness. However, it can also potentially serve as an indicator of CTS.

Advanced biological ageing predicts future risk for neurological diagnoses and clinical examination findings.

Age is a dominant risk factor for some of the most common neurological diseases. Biological ageing encompasses interindividual variation in the rate of ageing and can be calculated from clinical biomarkers or DNA methylation data amongst other approaches. Here, we tested the hypothesis that a biological age greater than one's chronological age affects the risk of future neurological diagnosis and the development of abnormal signs on clinical examination. We analysed data from the Swedish Adoption/Twin Study of Aging (SATSA): a cohort with 3175 assessments of 802 individuals followed-up over several decades. Six measures of biological ageing were generated: two physiological ages (created from bedside clinical measurements and standard blood tests) and four blood methylation age measures. Their effects on future stroke, dementia or Parkinson's disease diagnosis, or development of abnormal clinical signs, were determined using survival analysis, with and without stratification by twin pairs. Older physiological ages were associated with ischaemic stroke risk; for example one standard deviation advancement in baseline PhenoAgePhys or KDMAgePhys residual increased future ischaemic stroke risk by 29.2% [hazard ratio (HR): 1.29, 95% confidence interval (CI) 1.06-1.58, P = 0.012] and 42.9% (HR 1.43, CI 1.18-1.73, P = 3.1 × 10-4), respectively. In contrast, older methylation ages were more predictive of future dementia risk, which was increased by 29.7% (HR 1.30, CI 1.07-1.57, P = 0.007) per standard deviation advancement in HorvathAgeMeth. Older physiological ages were also positively associated with future development of abnormal patellar or pupillary reflexes, and the loss of normal gait. Measures of biological ageing can predict clinically relevant pathology of the nervous system independent of chronological age. This may help to explain variability in disease risk between individuals of the same age and strengthens the case for trials of geroprotective interventions for people with neurological disorders.

An unusual presentation of epidermoid cyst in an adult male in India: A case report

The epidermoid cysts are true cysts that are often found in the face and less commonly in the trunk and back of the human body. These cysts often have a predilection toward the male gender with the third and fourth decades of age group. They generally arise from the follicular infundibulum, primarily due to plugging of the follicle. Often a part of genetic syndromes, they can also be post-traumatic where the ectodermal cells get stuck or reimplanted. Epidermoid cysts are often a slow-growing and painless lesion with few exceptions. The proper neurological examination, clinical examination, and investigations such as magnetic resonance imaging help in confirming the diagnosis and proceeding with the management. Clinically, epidermoid cysts may or may not present with the neurological impairment. The preferred intervention is total or subtotal resection with minimal chances of complications such as recurrence, swelling, and infection. However, these can very well be avoided by regular follow-up assessments. The clinical presentation in the lower back with massive dimensions is relatively uncommon, and therefore, authors have presented here an unusual case from the outpatient department of neurosurgery, where the patient presented with a large, soft, exophytic lesion at the level of (S4/S5), which gave rise to the suspicion of meningocele and meningomyelocele, but after complete local assessment and radiological investigations, it was diagnosed finally as an epidermoid cyst. Keeping in mind, the clinical profile, socioemographic factors, and metabolic profile, the intervention of surgical total resection was planned, and the patient was managed.

Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo

Non-traumatic coma (NTC) is a common medical condition often associated with poor outcomes. Identifying underlying causes is crucial for effective management and prognostication, particularly in resource-poor settings. This study aimed to identify the most common causes and prognostic factors of NTC in a tertiary hospital in Bukavu, in the eastern Democratic Republic of the Congo (DRC), using the Glasgow Coma Scale (GCS) as well as other simple and affordable clinical and paraclinical tools. This retrospective observational study included 219 consecutive patients admitted to the intensive care unit of the Provincial General Hospital of Bukavu between January 2016 and December 2018. Sociodemographic, clinical, and laboratory data were also collected. Bivariate and multivariate analyses were performed to identify different causes and factors associated with poor outcomes in these patients. The median age of the patients was 49 (interquartile range [IQR]: 33–61) years, and they were predominantly men (62.8%). The most common causes of NTC were stroke (25.7%), acute metabolic complications of diabetes (21.9%), and primary brain infections (meningoencephalitis, 16.0%; and cerebral malaria, 14.2%). The NTC-related in-hospital mortality rate was 35.2%. A high mortality was significantly and independently associated with a GCS<7 (adjusted odds ratio [OR]: 4.30, 95% confidence interval [CI]: 1.73–10.71), the presence of meningismus at clinical evaluation (adjusted odds ratio [aOR] 3.86, 95%CI: 1.41–10.55), oxygen saturation <90% (aOR 3.99, 95%CI: 1.71–9.28), the consumption of traditional herbal medicines prior to hospital admission (aOR 2.82, 95%CI: 1.16–6.86), and elevated serum creatinine (aOR 1.64, 95%CI: 1.17–2.29). In conclusion, clinical neurological examinations, along with simple and affordable paraclinical investigations, can provide sufficient information to determine the etiology of NTC and evaluate the prognosis of comatose patients, even in resource-poor settings. Physicians may use the GCS as a simple, reliable, and affordable tool to identify patients who require special attention and care.

Association of age with death and withdrawal of life-sustaining therapy after severe traumatic brain injury.

Compared to younger age, older age (≥ 65 yr) is associated with worse outcomes after severe traumatic brain injury (TBI). We sought to describe the association of older age with in-hospital death and aggressiveness of intervention. We conducted a retrospective cohort study of adult (age ≥ 16 yr) patients with severe TBI admitted to a single academic tertiary care neurotrauma centre between January 2014 and December 2015. We collected data through chart review as well as from our institutional administrative database. We provided descriptive statistics and used multivariable logistic regression to evaluate the independent association of age with the primary outcome, in-hospital death. The secondary outcome was early withdrawal of life-sustaining therapy. There were 126 adult patients (median age 67 yr [Q1-Q3, 33-80 yr]) with severe TBI during the study period who met our eligibility criteria. The most common mechanism was high-velocity blunt injury (55 patients [43.6%]). The median Marshall score was 4 (Q1-Q3, 2-6), and the median Injury Severity Score was 26 (Q1-Q3, 25-35). After controlling for confounders including clinical frailty, pre-existing comorbidity, injury severity, Marshall score and neurologic examination at admission, we observed that older patients were more likely than younger patients to die in hospital (odds ratio 5.10, 95% confidence interval 1.65-15.78). Older patients were also more likely to experience early withdrawal of life-sustaining therapy and less likely to receive invasive interventions. After controlling for confounding factors relevant to older patients, we observed that age was an important and independent predictor of in-hospital death and early withdrawal of life-sustaining therapy. The mechanism by which age influences clinical decision-making independent of global and neurologic injury severity, clinical frailty and comorbidities remains unclear.

Dysphagia and pulmonary complications in acute cerebrovascular disease: A retrospective observational study

IntroductionDysphagia is a common post-stroke complication, which may result in serious pulmonary sequelae. Early detection of dysphagia and aspiration risk can reduce morbidity, mortality and length of hospitalization. ObjectivesThis study aims to identify association between dysphagia and acute cerebrovascular disease, and evaluate the prevalence and impact of pulmonary complications on readmissions and mortality. Material and methodsRetrospective observational study based on 250 clinical records of patients with acute cerebrovascular disease: clinical history, neurological examination, imaging and Gugging Swallowing Screen in the first 48h. Patients were followed for 3 months via medical records to estimate 3-month mortality and readmissions. ResultsOut of 250 clinical records analyzed, 102 (40.8%) were evaluated for dysphagia. The prevalence of dysphagia was 32.4%. The risk was higher in older patients (p<0.001), in severe stroke (p<0.001) and in the hemorrhagic subtype (p=0.008). An association was found with dysarthria and aphasia (p=0.003; p=0.017). Respiratory tract infections occurred in 14.4% of all patients (GUSS group 11.8% versus no GUSS group 16.2%), and in 75% of those with severe dysphagia (p<0.001). Mortality at 3 months was 24.2% in dysphagic patients, especially high in the severe dysphagia group (75%, p<0.001). ConclusionsThe type of cerebrovascular disease, NIHSS and GCS scores, age, dysarthria, and aphasia were significant associated factors to dysphagia. The prevalence of respiratory tract infections was higher in patients with no GUSS record, and no statistical significance was observed in related readmissions. Mortality at 3 months was superior in the severe dysphagia group.

Cardiac autonomic neuropathy as risk factor of diabetic complications progression

Introduction. Diabetes mellitus (DM) is the most common and incapacitating endocrine disorder. Diabetic foot syndrome (DFS) is one of the most serious complications of DM, which is the main cause of nontraumatic lower-extremity amputations. Despite the efforts of the entire medical community, the survival rate of DFS patients with non-healing ulcers and after foot surgery does not exceed 50% over 5 years and is comparable to the survival rates of patients with colorectal cancer.Aim. It has been demonstrated that postsurgical diabetic foot wounds tend to chronization of inflammatory process. The diabetic autonomic neuropathy can be involved in diabetic foot damages. We hypothesized that progression of cardiovascular autonomic neuropathy (CAN) leads to aggressive microvascular complications of diabetes and delay the postsurgical wound healing in diabetic foot patients during 2 years of observation.Materials and methods. We examined 94 outpatients with postsurgical diabetic foot wounds and observation period of two years. The clinical neurological examination and standard cardiovascular autonomic reflex tests with identification of severe/advanced abnormalities were performed at baseline and after 2 years. The progression of CAN was diagnosed in cases of an increase in the amount of cardiovascular autonomic reflex tests by 1 score and more. The unsatisfactory result of wound treatment was detected in patients with wound healing delay and new cases of surgery debridement, foot amputations and Charcot foot during 2 years of observation.Results. The mean duration of diabetes was 10.7 year, HbA1c 8.3%, LDL-Chol 3.3 mmol/l, TG 1.8 mmol/l. The 51.1% patients had been amputated in the level of foot, 48.9% patients had surgery debridement. All patients had CAN, confirmed/severe forms in 57.4% cases. The progression of CAN was found in 22.3% patients, the most of them with functional stage at baseline. The aggressive course of CAN increased the risk of progression of diabetic sensomotor neuropathy (OR = 14.6; 95% CI 3.0–70.5; p = 0.0006), nephropathy (OR = 22.4; 95% CI 3.4–147.4; p = 0.0009) and unsatisfactory result of wound treatment (OR = 40; 95% CI 6.0–268.5; p = 0.0001).Conclusions. The patients with diabetic foot surgery wounds has high risk of confirmed/severe CAN and its progression during 2 years. The aggressive course of CAN associates with unsatisfactory result of wound treatment and progression of microvascular diabetic complications.

Perry syndrome: Novel DCTN1 mutation in a large kindred and first observation of prodromal disease

IntroductionPerry syndrome (PS) is a hereditary neurodegenerative disorder caused by mutations in the DCTN1 gene and characterized by TDP-43 pathology. As the diagnosis is usually made at the advanced stages of the disease, there are no studies on the asymptomatic mutation carriers and their conversion to overt disease. MethodsWe personally examined 27 members of the large kindred of 104 individuals with familial parkinsonism. We evaluated each case with clinical (neurological examination; motor and non-motor scales), genetic testing (whole-exome or Sanger sequencing), and laboratory (neurofilament light, NFL; glial fibrillary acidic protein, GFAP) measures. Autopsy study was done on two individuals. ResultsThe mean age at evaluation was 49 years. Comorbidities were present in 20 cases, including sleep problems (n = 15 total, sleep apnea in 7), dysautonomia (n = 10), weight loss (n = 8), and anxiety/depression (n = 8). Neurological abnormalities were present in 18, including parkinsonism (n = 7), isolated tremor (n = 2), and varied isolated signs in individual cases. Cognition and smell were preserved. Genetic testing revealed a novel c.200G > T (Gly67Val) mutation in the DCTN1 gene in 10 individuals. The mutation, segregated with the PS phenotype (n = 4), was absent in gnomAD, and in silico predictions indicated it was pathogenic. Three young mutation carriers were monosymptomatic (prodromal), and three were asymptomatic. Plasma NFL and GFAP values were similar among the cases. Autopsy studies showed typical PS neuropathological findings. ConclusionsWe identified a novel pathogenic Gly67Val DCTN1 mutation. We report prodromal disease of PS in some mutation carriers; however, more investigation is necessary to confirm this observation.

Head rebound test in the clinical neurological examination of veterinary patients: a case example and discussion of Stewart and Holmes' rebound phenomenon.

In human medical neurology, the clinical neurological examination is variably augmented by specific tests that may be either unsuitable for veterinary patients or not included in the clinical evaluation of veterinary neurological patients due to clinicians presumably being unfamiliar with these tests. An example of the latter can be found in testing for the Stewart and Holmes' rebound phenomenon ("rebound test"). In this article, a veterinary case example is presented in which a modified version of this test was performed ("head rebound test"). The interpretation of the results of this test is discussed, and the literature on the Stewart and Holmes' rebound phenomenon and testing thereof is reviewed.

Neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases at a Tertiary Care Cardiac Setup of Pakistan: A single center study.

Objective: To determine the neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases (CHDs) at a tertiary care cardiac setup of Pakistan. Study Design: Single Center Observational Cohort study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: November 2021 to October 2022. Material &amp; Methods: A total of 80 children of both genders, aged between 1 month to 12 years with known cyanotic CHD as per 2D transthoracic echocardiography were admitted in Pediatric Cardiology Department of NICVD, Karachi and were considered. At the time of enrollment, demographic characteristics along with presenting complaints were noted. Necessary baseline laboratory and radiological investigations were ordered and clinical neurological examination was done. Children were discharged and short term outcomes were labeled after 3 months follow up. Results: In a total of 80 children with cyanotic CHDs, most common underlying diagnosis was tetralogy of fallot, found in 41 (51.3%) children. The CT brain revealed ischemic infarct, brain abscess and gross oedema as the most frequent observations revealed in 47 (58.8%), 40 (50.0%) and 37 (46.3%) children. Surgical management of underlying neurological abnormality was advised in 23 (28.8%) children. After 3 months follow-up, complete recovery was observed among 43 (53.8%) children. CT findings at the time of enrollment as haemorrhagic infarct (p&lt;0.001), brain abscess (p=0.001) and atrophic changes (p=0.032) were significantly associated with incomplete recovery. Surgery as a mode of treatment for the underlying neurological disease was associated with good recovery outcomes (p&lt;0.001). Conclusion: Most common underlying diagnosis among children with cyanotic CHDs was tetralogy of fallot. CT findings at the time of enrollment as haemorrhagic infarct, brain abscess and atrophic changes, as well as hypotonia, down going plantars and developmental delay at the time of presentation were significantly linked with incomplete recovery.

Biomarkers of Spinal Cord Injury in Patients Undergoing Complex Endovascular Aortic Repair Procedures-A Narrative Review of Current Literature.

Complex endovascular aortic repair (coEVAR) of thoracoabdominal aortic aneurysms (TAAA) has greatly evolved in the past decades. Despite substantial improvements of postoperative care, spinal cord injury (SCI) remains the most devastating complication of coEVAR being associated with impaired patient outcome and having an impact on long-term survival. The rising number of challenges of coEVAR, essentially associated with an extensive coverage of critical blood vessels supplying the spinal cord, resulted in the implementation of dedicated SCI prevention protocols. In addition to maintenance of adequate spinal cord perfusion pressure (SCPP), early detection of SCI plays an integral role in intra- and postoperative patient care. However, this is challenging due to difficulties with clinical neurological examinations during patient sedation in the postoperative setting. There is a rising amount of evidence, suggesting that subclinical forms of SCI might be accompanied by an elevation of biochemical markers, specific to neuronal tissue damage. Addressing this hypothesis, several studies have attempted to assess the potential of selected biomarkers with regard to early SCI diagnosis. In this review, we discuss biomarkers measured in patients undergoing coEVAR. Once validated in future prospective clinical studies, biomarkers of neuronal tissue damage may potentially add to the armamentarium of modalities for early SCI diagnosis and risk stratification.

When To Use CSI (Combined Senory Index) in Electro-diagnostic Testing for Carpal Tunnel Syndrome (CTS) (P13-8.014)

<h3>Objective:</h3> The lack of a gold standard is the fundamental problem in diagnosing CTS. The objective of this study was to evaluate the utility and appropriate use of CSI in diagnosing mild CTS. <h3>Background:</h3> CTS accounts for 90% of neuropathies, with a prevalence of ~270/100,000. Diagnosis is based on clinical complaints, neurologic examination, provocative maneuvers, and electrodiagnostic studies. Treatment is conservative or surgical depending on severity of symptoms. CTS is the most common reason for EMGs in most labs and the most common EMG finding. NCS/EMG is helpful in diagnosing CTS, providing objective information regarding the median nerve’s physiologic health and degree of damage. The efficacy of CSI has been debated as a confirmatory test. <h3>Design/Methods:</h3> This is a retrospective, multi-center case series of 69 limb studies in 57 patients who were evaluated between July 2021 and June 2022 who underwent NCS/EMG and CSI testing to evaluate for mild CTS. Median nerve peak/distal latencies, conduction velocities, SNAPs, CSI parameters (median-radial latency comparison of digit I, median-ulnar latency comparison of digit IV, and trans-palmar median-ulnar latency comparison), and provocative maneuvers (Tinel’s and Phalen’s) were included. Patients who have abnormal NCS or who did not complete full CSI were excluded. <h3>Results:</h3> There was no correlation between normal CTS studies and a positive CSI. Tinel’s testing was nonspecific and nonsensitive with low PPV/NPV. Phalen’s testing had a relatively high specificity, but low sensitivity and low PPV/NPV. There was a relatively high correlation of positive CSI studies when each portion was performed in this population. 27/69 CSI’s were abnormal in this study. The overall yield was ~39% <h3>Conclusions:</h3> Our study showed a decent yield, identifying 39% of cases that would have otherwise been missed. While only speculative, this lab sees benefit in CSI, as positive findings may reduce further testing, quiet patient concerns, and direct surgical vs conservative management. <b>Disclosure:</b> Dr. Imbs has nothing to disclose. Dr. Ramzan has nothing to disclose. Mr. French has nothing to disclose. Dr. Ambe has nothing to disclose. Dr. Nguyen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Nguyen has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for ArgenX. Dr. Nguyen has received publishing royalties from a publication relating to health care.

Preoperative percutaneous Onyx embolization of carotid body paragangliomas with balloon test occlusion.

The study aims to analyze our first experience with direct percutaneous embolization of carotid body tumors (CBTs) using ethylene-vinyl alcohol copolymer (Onyx) along with balloon test occlusion (BTO). A retrospective preliminary single-center study was conducted at the Otorhinolaryngology and Head and Neck Surgery Department and the Medical Imaging Department of the University Teaching Hospital. A consecutive series of three patients with CBTs was treated at the local institution between October 2018 and June 2019. All three patients underwent preoperative percutaneous embolization using ethylene-vinyl alcohol copolymer (Onyx 18) with the addition of BTO. Outcome measures were the percentage of tumor devascularization, intraoperative blood losses, and operation times. BTO was evaluated by clinical neurological examination and neurosonological transcranial Doppler examination of the middle cerebral artery (MCA). Devascularization of all three tumors was complete or near complete. All three tumors were surgically extirpated with excellent surgical outcomes. The blood losses were minimal, and the average operation time was 2 h and 8 min. BTO was positive in one patient, which was valuable additional information on carotid branches ligation limitations. The other two patients showed negative BTOs with the result of safety of eventual carotid arteries ligations. Preoperative direct percutaneous embolization of CBT with Onyx is a highly effective procedure that significantly facilitates surgery. BTO provides valuable additional information on the most appropriate and safe surgical approach.

Oculocutaneous albinism: the neurological, behavioral, and neuro-ophthalmological perspective

Oculocutaneous albinism (OCA) is a group of rare, genetic disorders caused by absent/reduced melanin biosynthesis. The aim of this study was to explore the neurovisual, cognitive, adaptive, and behavioral profile of children affected by OCA, also evaluating any possible effect of the visual acuity deficit on the clinical profile and genotype–phenotype correlations. Eighteen children (9 males, mean age 84 months ± 41; range 18–181 months) with a molecular confirmed diagnosis of OCA were enrolled in the study. We collected data on clinical history, neurodevelopmental profile, neurological and neurovisual examination, and cognitive, adaptive, and emotional/behavioral functioning. A global neurodevelopmental impairment was detected in 56% of the children, without evolving into an intellectual disability. All the patients showed signs and symptoms of visual impairment. Low adaptive functioning was observed in 3 cases (17%). A risk for internalizing behavioral problems was documented in 6 cases (33%), for externalizing problems in 2 (11%), and for both in 5 (28%). Twelve children (67%) showed one or more autistic-like features. Correlation analyses revealed significant associations between the visual acuity level and performance intelligence quotient (p = 0.001), processing speed index (p = 0.021), Vineland total score (p = 0.020), Vineland communication (p = 0.020), and socialization (p = 0.037) domains. No significant correlations were found between genotype and phenotype.Conclusion: Children with OCA may present a global neurodevelopmental delay that seems to improve with age and emotional/behavioral difficulties, along with the well-known visual impairment. An early neuropsychiatric evaluation and habilitative training are recommended to improve vision-related performance, neurodevelopment, and any psychological difficulties.What is Known:• Children with oculocutaneous albinism show dermatological and ophthalmological problems.• An early visual impairment may have negative implications on motor, emotional, and cognitive processes that would allow the child to organize his or her experiences.What is New:• In addition to a variable combination of ocular signs and symptoms, children with oculocutaneous albinism may present an early neurodevelopmental delay and emotional/behavioral difficulties.• An early visual treatment is recommended to improve vision-related performance, neurodevelopment, and any psychological difficulties.

Neurological Complications in MIS-C: Case Report

COVID-19 has seriously affected children and the whole world. Pediatric multi-system inflammatory syndrome (MIS-C), a new syndrome that has not been known before, has been described. Although MIS-C may progress with different clinical manifestations in children, neurological involvement is reported relatively rarely. A 12-year-old girl with cerebral palsy and motor mental retardation was admitted to the emergency department with complaints of cough, fever, mouth sores and malnutrition. As a result of the evaluation, the patient was hospitalized to investigate the etiology of the fever and empirical antibiotic treatment was started, and she developed a rash on the 3rd day and tonic-clonic convulsions on the 5th day. The patient was hospitalized in the pediatric intensive care unit (PICU), and COVID-19 IgG and IgM were positive. Cerebral imaging of the patient was reported as normal. The patient with fever, rash, convulsions lasting longer than five days, and compatible laboratory results were diagnosed with MIS-C. Intravenous immunoglobulin (IVIG) and methylprednisolone treatments were started, and the patient was discharged on the 14th day of hospitalization, whose condition improved. This case is presented as an example of the rare neurological involvement of MIS-C. Detailed clinical investigation and neurological examination are required to exclude neurological sequelae of COVID-19 during the pandemic. The development of general guidelines that can combine them would be instructive.

Incidence, Clinical Significance, and Longitudinal Signal Characteristics of Ischemic Lesions Related to Diagnostic Cerebral Catheter Angiography

PurposeCerebral DSA is a routine procedure with few complications. However, it is associated with presumably clinically inapparent lesions detectable on diffusion-weighted MRI imaging (DWI lesions). However, there are insufficient data regarding incidence, etiology, clinical relevance, and longitudinal development of these lesions. This study prospectively evaluated subjects undergoing elective diagnostic cerebral DSA for the occurrence of DWI lesions, potentially associated clinical symptoms and risk factors, and longitudinally monitored the lesions using state-of-the-art MRI.Materials and MethodsEighty-two subjects were examined by high-resolution MRI within 24 h after elective diagnostic DSA and lesion occurrence was qualitatively and quantitatively evaluated. Subjects’ neurological status was assessed before and after DSA by clinical neurological examination and a perceived deficit questionnaire. Patient-related risk factors and procedural DSA data were documented. Subjects with lesions received a follow-up MRI and were questioned for neurological deficits after a median of 5.1 months.ResultsAfter DSA, 23(28%) subjects had a total of 54 DWI lesions. Significantly associated risk factors were number of vessels probed, intervention time, age, arterial hypertension, visible calcified plaques, and less examiner experience. Twenty percent of baseline lesions converted to persistent FLAIR lesions at follow-up. After DSA, none of the subjects had a clinically apparent neurological deficit. Self-perceived deficits were nonsignificantly higher at follow-up.ConclusionCerebral DSA is associated with a considerable number of postinterventional lesions, some persisting as scars in brain tissue. Presumably because of the small lesion size and inconsistent location, no clinically apparent neurological deficits have been observed. However, subtle self-perceived changes may occur. Therefore, special attention is needed to minimize avoidable risk factors.

Diagnostic criteria of sacroiliac joint dysfunction in children and adolescents with pain in the lumbosacral region of the spine

BACKGROUND: Back pain is addressed by physicians of many specialties. In many ways, it is associated with a decreased volume of dynamic motor activity and increased static loading. In patients with an active lifestyle, back pain often develops when the technique of physical exercises or habitual movements are violated, often leading to secondary osteoarticular disorders. One of the most common causes of non-specific back pain is sacroiliac joint dysfunction. The ambiguity of information on the types, severity and significance of sacroiliac joint dysfunction has urged us to systematize the existing data so as to create an optimal diagnostic algorithm for the discussed pathology.&#x0D; AIM: To develop a system for examining patients with back pain so as to make the diagnostics of sacroiliac joint dysfunction more accurate.&#x0D; MATERIALS AND METHODS: 54 patients aged 718 (mean age 14.63.32) with pain in the lumbosacral spine were included in the study. All of them had the confirmed dysfunction of sacroiliac joint; specific causes of pain were excluded. The patients were divided into 2 groups, comparable in the number, sex, and age. The patients underwent a clinical neurological and neuroorthopedic examination with additional functional muscle testing, including the assessment of their overall and local muscle strength, elasticity, coordination, biomechanical characteristics, and muscle control. The state of the respiratory muscles (tonus, type of pain, irradiation, elasticity of ribs, etc.) was evaluated during the manual testing, too. A particular attention was paid to testing using an unstable support (redcord/exarta, fitballs and balancing pads). For the better objectivity of the findings, AlterG, TecnoBody, Oxiterra test devices were used additionally.&#x0D; RESULTS: The anamnestic predictors for the development of sacroiliac joint dysfunction were revealed. The specifics of the postural and biomechanical disorders in children and adolescents with unspecific back pain were analyzed. Cervical disorders were found which promoted secondary osteoarticular dysfunction, including the sacroiliac joint block. A diagnostic algorithm has been developed to identify the underlying cause of back pain in the case of sacroiliac joint dysfunction.&#x0D; CONCLUSION: The proposed diagnostic algorithm simplifies and systematizes the treatment of patients with sacroiliac joint dysfunction and complaints of back pain. The effectiveness of rehabilitation is improved due to a possibility to precisely select the rehabilitation technique.

Horizontal Vestibulo-Ocular Reflex Deficit as a Biomarker for Clinical Disease Onset, Severity, and Progression of Machado-Joseph Disease.

Because of the crucial importance of finding a useful biomarker for further clinical trials in Machado-Joseph disease (MJD), and based on our previous studies, we aimed to evaluate whether the horizontal vestibulo-ocular reflex (VOR) gain could be a reliable neurophysiological biomarker for the clinical onset, severity, and progression of the disease. Thirty-five MJD patients, 11 pre-symptomatic genetically confirmed MJD subjects, and 20 healthy controls underwent a detailed epidemiological and clinical neurological examination including the Scale for the Assessment and Rating of Ataxia (SARA). Their VOR gain was measured using the video Head Impulse Test system. Twenty of the MJD patients were re-tested after a period of 1-3 years. Horizontal VOR gain was abnormal in 92% of MJD, 54% pre-symptomatic, and 0% healthy controls. Horizontal VOR gain in the MJD group was significantly negatively correlated with SARA score in the first (r=0.66, p<0.001) and second (r=0.61, p<0.001) examinations. There was also a significant negative correlation between the percentage of change in horizontal VOR gain and the percentage of change in SARA score across both examinations (r=-0.54, p < 0.05). A regression model of the SARA score with the horizontal VOR gain and disease duration as predictors demonstrated that both the horizontal VOR gain and the disease duration had an independent contribution to the prediction of the SARA score. The horizontal VOR gain seems to be a reliable biomarker for the clinical onset, severity, and progression of MJD and could be used in further clinical studies.

Hypothyroidism in dogs – prevalence, risk factors and neurological implications

Hypothyroidism is an endocrine pathology frequently encountered in dogs, whose diagnosis involves a series of difficulties due to the insidious onset of the disease and the non-specific clinical manifestations, which can mimic other diseases (metabolic, dermatological, neuromuscular, etc.). However, the development of modern diagnostic techniques and the widespread availability of specific determinations, such as total canine T4, free canine T4 and TSH, have led to an increase in diagnostic accuracy and the possibility of differentiating hypothyroidism from other diseases with similar manifestations. In recent years, numerous articles have investigated the etiology of the disease, however in our country there are few data regarding the prevalence and risk factors of this condition in the canine population. This article was carried out on 18 dogs diagnosed with hypothyroidism at the Emergency University Veterinary Hospital “Prof. Dr. Alin Bîrţoiu” between 2021 and 2022. All patients included in the study presented neurological manifestations. The diagnostic protocol included anamnesis, analysis of signalment, complete clinical examination, neurological examination and confirmation by serological investigations, the data obtained being compared with those provided by other similar studies.

Case study (A and B): a patient with Parkinson’s disease

Parkinson’s disease is a progressive and debilitating neurodegenerative disorder affecting millions of people worldwide. The disease is characterized by motor symptoms such as tremors, rigidity and postural instability, as well as non-motor symptoms such as depression and cognitive impairment. While there is no cure for Parkinson’s disease, there are various treatments available to manage symptoms and improve quality of life for patients. This case study examines a 65-year-old retired accountant, Mr. John Smith, who was diagnosed with Parkinson’s disease five years ago. Mr. Smith has been treated with a combination of medications, including levodopa and carbidopa and physical therapy to manage his symptoms. However, his symptoms have not significantly improved. This literature review explores the current research on Parkinson’s disease, including its pathophysiology, diagnosis and treatment. Parkinson’s disease is caused by the degeneration of dopamine-producing neurons in the brain, leading to a depletion of dopamine and the accumulation of alpha-synuclein protein, oxidative stress and inflammation. Diagnosis is based on clinical symptoms, neurological examination and response to dopaminergic therapy. Treatment focuses on managing symptoms, with medications and non-pharmacological interventions such as exercise and physical therapy. Deep brain stimulation is a surgical treatment option that has been shown to be effective in managing motor symptoms. While there is currently no cure for Parkinson’s disease, ongoing research into its pathophysiology and treatment holds promise for improving outcomes for patients. This case study highlights the importance of early diagnosis and personalized treatment plans for patients with Parkinson’s disease.