Clinical Neurological Examination Research Articles

Associations of physical activity, insomnia and cognitive impairment in older adults

primary neurodegenerative dementia, and vascular mild cognitive impairment (vMCI). We investigated the prevalence of VCI and its subtypes in a Korean elderly population.Methods: This study was a part of the Korean Longitudinal Study on Health and Aging (KLoSHA) which had been conducted on the residents aged 65 years or older in Seongnam, Korea from September 2005 to August 2006. A simple random sample (N1⁄41118) was drawn from the roster of 61,730 persons aged 65 years or older. Standardized clinical interviews, neurological and physical examinations and comprehensive neuropsychological assessments were administered. Diagnosis of vascular dementia was made according to NINDS-AIREN criteria. Diagnosis of mixed dementia was made according to DSM-IV-TR criteria. And, diagnosis of vMCI was made according to the MCI criteria proposed by the InternationalWorking Groupwith vascular risk factors (Modified Hachinski ischemic scale 4). Results: Ageand sex-standardized prevalence rate of VCI was 4.4% (95% CI1⁄42.9%-5.9%). Ageand sex-standardized prevalence of VD or mixed dementia was 1.4% (95% CI1⁄40.6%-2.3%), and that of vMCI was 3.0% (95% CI1⁄41.8%-4.3%). The prevalence of VCI increased with advancing age (2.3% in 65-69, 5.1% in 70-74, and 6.8% in 75 or older). Gender and educational level had no significant influence on the prevalence of VCI. Conclusions: The prevalence of VCI in Korean elders was comparable to other western countries (5% in Canada, 6.6% inUK) and older age was significantly associated with an increased risk of developing VCI. As operational criteria of VCI is still variable between studies, it is warranted to establish uniform operational criteria for VCI for ensuring validity and comparability in future researches.

Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature

To assess the sensitivity and false positive rate (FPR) of neurological examination and somatosensory evoked potentials (SSEPs) to predict poor outcome in adult patients treated with therapeutic hypothermia after cardiopulmonary resuscitation (CPR). MEDLINE and EMBASE were searched for cohort studies describing the association of clinical neurological examination or SSEPs after return of spontaneous circulation with neurological outcome. Poor outcome was defined as severe disability, vegetative state and death. Sensitivity and FPR were determined. A total of 1,153 patients from ten studies were included. The FPR of a bilaterally absent cortical N20 response of the SSEP could be calculated from nine studies including 492 patients. The SSEP had an FPR of 0.007 (confidence interval, CI, 0.001-0.047) to predict poor outcome. The Glasgow coma score (GCS) motor response was assessed in 811 patients from nine studies. A GCS motor score of 1-2 at 72 h had a high FPR of 0.21 (CI 0.08-0.43). Corneal reflex and pupillary reactivity at 72 h after the arrest were available in 429 and 566 patients, respectively. Bilaterally absent corneal reflexes had an FPR of 0.02 (CI 0.002-0.13). Bilaterally absent pupillary reflexes had an FPR of 0.004 (CI 0.001-0.03). At 72 h after the arrest the motor response to painful stimuli and the corneal reflexes are not a reliable tool for the early prediction of poor outcome in patients treated with hypothermia. The reliability of the pupillary response to light and the SSEP is comparable to that in patients not treated with hypothermia.

AB1251 Neurological manifestations associated with anti-tumor necrosis factor alpha treatment. A longitudinal study

BackgroundAnti-tumor necrosis factor-α (TNFα) agents have been successfully used for the treatment of rheumatic diseases including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Yet, several reports have...

SAT0325 Neurological Mechanisms of Chronic Pain in Knee Osteoarthritis

BackgroundIt is now known that OA pain is a complex interaction between many different pain mechanisms. A subset of adults with chronic, symptomatic knee OA may therefore, have neuropathic mechanisms...

Peripheral neuropathy electrophysiological screening in inflammatory bowel disease

Peripheral neuropathy is often described in inflammatory bowel disease (IBD). The aim of this study was to assess the need for neurophysiological testing in IBD patients without neurological symptoms or signs to detect early subclinical neuropathy and its possible correlations with clinical and demographic characteristics. Ninety-seven consecutive IBD patients were screened for neurological symptoms and clinical signs, and those without symptoms or signs were included. Also, patients with comorbidities associated with peripheral neuropathy or a history of neurological disease were excluded. The remaining 45 asymptomatic patients were tested electrophysiologically for peripheral nerve involvement. None of the examined patients showed evidence for subclinical neuropathy. IBD patients with a normal neurological clinical examination and no symptoms have no evidence for neuropathy. Therefore, proper electrophysiological testing is not considered necessary.

Нейропротекция мексидолом и комплексом L-аминокислот и полипептидов в составе базисной терапии больных с инфарктами мозга в вертебробазилярном бассейне

Проведено клинико-неврологическое обследование 34 пациентов с инфарктом мозга в вертебробазилярном бассейне в динамике его течения на фоне базисной терапии с использованием Мексидола (в суммарной курсовой дозе 5000 мг на протяжении 10 суток) и комплекса L-аминокислот и полипептидов (суммарная курсовая доза 100 мг на протяжении 10 суток). С целью изучения состояния интрацеребральной гемодинамики, очагового поражения в вертебробазилярных структурах и характера изменений тканей мозга тематическим больным было проведено клинико-лабораторно-инструментальное обследование. Выявлена положительная динамика вследствие проведенной терапии с использованием сочетанного применения Мексидола и комплекса L-аминокислот и полипептидов. Методом корреляционного анализа установлена прямая связь между неврологическим дефицитом, церебральными очагами поражения и терапевтической эффективностью у тематических больных при проведении терапии с использованием Мексидола и комплекса L-аминокислот и полипептидов.

INFORMATION AND DIGITAL TECHNOLOGIES IN PREVENTION OF HYPERTENSION

Objective. To determine the criteria for the application of preventive measures for individual computer program «Medical and psychological prevention of complications, and the normalization of physiological parameters in a hypertensive patient».Design and methods. With the financial support of the Government of the Russian Federation, the State contract № 6464r/9021 of 28.12.2008, we have developed and registered in the Federal Institute of Industrial Property preventive medical computer program «Medical and psychological prevention of complications, and the normalization of physiological parameters in a hypertensive patient» № 2011618469, state registration number 01200951860. We examined 180 patients (120 hypertensives and 60 controls) aged 20–70 years (mean age 35,5 ± 7,2 years), patients of the main group had a primary diagnosis of hypertension (I, II, III degree). We performed clinical neurological, standard laboratory and instrumental diagnostic examinations and psychodiagnostic testing, as well as the pulse measurements by cardiointervalography followed by mathematical analysis of the data by a special program.Results. Analysis of reactions in the interim period of adaptation (14–21 day) has shown its important role to predict the outcome of preventive measures. According to our data 88,2 % patients with hypertension III degree and 94,4 % patients with hypertension II degree demonstrated normalization of the blood pressure and improvement in general state, and the approach was beneficial in 100 % patients with hypertension I degree. Mean recovery time after hypertensive crisis was 15,0 ± 5,0 minutes in patients with hypertension I degree, 30,0 ± 10,0 minutes in patients with hypertension II degree (p < 0,001), and 45,1 ± 27,4 minutes in patients with III degree (p < 0,05). Patients, who used personal computer software, demonstrated the reduction of irritability, fatigue, improved sleep, memory, increased work effiiency, disappearance of sleepiness, and there was an increase in self-confidence.Conclusions. Thus, our results show that the use of individual computer program «B/P rate» leads to the reduction of the frequency and duration of hypertensive crises, as well as to the improvement of cognitive function and psychosocial parameters.

Clinical correlation of a new practical MRI method for assessing central lumbar spinal stenosis

To evaluate interobserver agreement and determine whether a new MRI grading system agrees with symptoms and neurological signs. We examined 160 patients (72 males and 88 females; mean age 57 years) who underwent MRI of the lumbar spine at our institution and were evaluated by two musculoskeletal radiologists. The presence and grade of central lumbar spinal stenosis (CLSS) at L3-4, L4-5 and L5-S1 were assessed according to a new grading system, the Lee system. The results were correlated with clinical manifestations and neurological examinations [positive neurological manifestation (PNM) and negative neurological manifestation (NNM)]. Statistical analyses were performed using kappa statistics and non-parametric correlation analysis (Spearman's correlation). Interobserver agreement in the grading of CLSS between the two readers was substantial (κ=0.780). Interobserver agreement of the L4-5 level and older age group was high (0.789, 0.814). The correlation coefficient (R) of Reader 1 between MRI Grades 0, 1, 2 or 3 and neurological manifestations (negative or positive) was 0.654; the R of Reader 2 was 0.591. In the younger age group (<57 years), the R of Reader 1 was 0.634 and the R of Reader 2 was 0.500. In the older age group (≥57 years), the R of Reader 1 was 0.650 and the R of Reader 2 was 0.645. Correlation coefficients were higher at the L3-4 level (0.612-0.678) than at other levels but did not show statistical significance (p>0.05). Interobserver agreement for the new CLSS grading system was substantial. Grade 0 was associated with NNMs and Grade 3 with PNMs in this cohort. Grade 2 demonstrates more cases of PNM than NNM but requires further evaluation. Correlations between MRI grades and clinical manifestations were moderate and slightly higher in older patients. The new practical MRI grading method can be useful in the categorisation of CLSS and shows strong clinical correlation.

Endothelium-dependent vascular tone regulation mechanisms in patients with ischemic stroke

Aim. To study the role of nitroxidergic reactions of the circulatory system in the development of ischemic stroke. Methods. 51 patients (both males and females) with the diagnosis of ischemic stroke were examined. All patients were distributed to 3 groups according to the severity of neurological deficit. All patients underwent brain computed tomography or magnetic resonance imaging. Cerebral blood flow was examined by extra and transcranial ultrasonic dopplerography. Central hemodynamics was evaluated by echocardiography. General clinical examination, neurological and neuroophthalmological examinations were also performed. Vasomotor endothelial function was assessed using a 7 MHz linear transducer on the ultrasound unit «Medison SonoAce X8». The level of nitric oxide was assessed using its stable metabolites, nitrite and nitrate definition in serum. Neurological status was assessed according to the USA National Institutes of Health Stroke Scale. Results. Disorders of nitroxidergic mechanisms of blood vessels regulation were observed in patients with ischemic stroke. Endothelium-dependent brachial artery dilation disorders and nitric oxide persistent metabolites level decrease were related to the severity of the disease and the neurological deficit degree. Conclusion. The study of endothelium-dependent vascular tone regulation mechanisms revealed that these mechanisms are involved in the pathogenesis of ischemic stroke; the study of these mechanisms can be used to clarify the severity of neurological deficit, and possible prognosis.

Craniocervical decompression in patients with mucopolysaccharidosis VI: development of a scoring system to determine indication and outcome of surgery

To analyse diagnostic value of somato-sensory evoked potentials (SEP), magnetic resonance imaging (MRI), and clinical neurological examination in the decision for decompression surgery in mucopolysaccharidosis (MPS) VI patients with craniocervical cord compression (CCJ). We retrospectively analysed neurological examination, SEP of the median nerve and MRI outcomes from 31 MPS VI patients. Individual scores for each test (based on severity of findings) and a sum of scores of all three procedures (CCJ score) were evaluated for their potential to measure the need for and improvement after surgery. Differences between rapidly and slowly progressive patients were also evaluated. Fourteen patients (45 %) aged 4-34 years underwent decompression surgery. Median age at first operation was lower in rapidly than in slowly progressive patients (12 vs. 24 years; P = 0.008). Neurological and SEP findings but not MRI results differed significantly between non-operated and operated patients (P < 0.001, P = 0.003 and P = 0.08, respectively). A significant relationship was found between MRI and clinical neurological examination (P < 0.001) and between SEP and clinical neurological examination (P = 0.01) but not between MRI and SEP (P = 0.06). The CCJ score discriminated between operated and non-operated patients (4-9 points vs. 0-3 points; P < 0.001) and decreased in 61.5 % of patients after surgery. CCJ is common in rapidly and slowly progressive MPS VI patients. The CCJ score is an objective and transparent tool for assessing pathology of the CCJ, the need for surgery, and improvement after surgery.

Perceived Stress Is Associated with Subclinical Cerebrovascular Disease in Older Adults

To examine the association of perceived stress with magnetic resonance imaging (MRI) markers of subclinical cerebrovascular disease in an elderly cohort. Using a cross-sectional study of a community-based cohort in Chicago, 571 adults (57% women; 58.1% African American; 41.9% non-Hispanic white; mean [SD] age: 79.8 [5.9] years) from the Chicago Health and Aging Project, an epidemiologic study of aging, completed questionnaires on perceived stress, medical history, and demographics as part of an in-home assessment and 5 years later underwent a clinical neurologic examination and MRI of the brain. Outcome measures were volumetric MRI assessments of white matter hyperintensity volume (WMHV), total brain volume (TBV), and cerebral infarction. Stress was measured with six items from the Perceived Stress Scale (PSS); item responses, ranging from never (0) to often (3), were summed to create an overall stress score (mean [SD]: 4.9 [3.3]; range: 0-18). Most participants had some evidence of vascular disease on MRI, with 153 participants (26.8%) having infarctions. In separate linear and logistic regression models adjusted for age, sex, education, race, and time between stress assessment and MRI, each one-point increase in PSS score was associated with significantly lower TBV (coefficient=-0.111, SE= 0.049, t[563]=-2.28, p= 0.023) and 7% greater odds of infarction (odds ratio: 1.07; 95% confidence interval: 1.01, 1.13; Wald χ(2)[1]= 4.90; p= 0.027). PSS scores were unrelated to WMHV. Results were unchanged with further adjustment for smoking, body mass index, physical activity, history of heart disease, stroke, diabetes, hypertension, depressive symptoms, and dementia. Greater perceived stress was significantly and independently associated with cerebral infarction and lower brain volume assessed 5 years later in this elderly cohort.

Diagnostic Tools of Early Brain Disturbances in an Asymptomatic Neonate with Maple Syrup Urine Disease

Maple syrup urine disease (MSUD) is a rare inherited metabolic disorder resulting from the defective activity of branched-chain 2-ketoacid dehydrogenase complex. Routine screening of newborn with tandem mass spectroscopy on the third day of life may detect elevated branched-chain amino acids in blood before the appearance of encephalopathic symptoms in MSUD cases. If undiagnosed by such a routine screening test, patients often present with encephalopathy and seizures. Clinical neurologic examination is supplemented by electroencephalography and imaging. Here, we report abnormal amplitude-integrated electroencephalography, electroencephalography, magnetic resonance imaging, and magnetic resonance imaging spectroscopy findings in a neurologically asymptomatic male newborn who was diagnosed with MSUD at the third week of life. These neurologic disturbances disappeared at the fourth month of life with appropriate special diet. Therefore, even in already asymptomatic cases, early neurologic deterioration of brain metabolism and structure can be detected with these early laboratory findings, indicating the importance of early diagnosis and management. Patients may also benefit from these investigations during the follow-up period.

Нейропсихологическая характеристика пациентов с ишемическим инсультом, обусловленным аномалиями церебральных артерий

Проведено нейропсихологическое обследование 67 пациентов с церебральным ишемическим инсультом (ЦИИ) с аномалиями интрацеребральных (ИЦА) и прецеребральных артерий (ПЦА), возраст больных от 21 года до 50 лет. Всем пациентам выполняли комплексное клинико-неврологическое, клинико-лабораторное и клинико-инструментальное исследование (включающее магнитно-резонансную томографию головного мозга в режиме ангиографии). У всех пациентов диагностировали аномалии ИЦА и ПЦА, а также их комбинацию. Нейропсихологические нарушения выявлены у всех пациентов с ЦИИ, обусловленным аномалиями ИЦА и ПЦА. В структуре нейропсихологических показателей поражения когнитивной сферы выявлены у 65 (97 %) пациентов в виде преддементных расстройств в 64,2 % случаев и в 28,4 % случаев — деменции легкой степени выраженности. Нарушения в эмоционально-личностной сфере выявлены у всех пациентов с ЦИИ, обусловленным ИЦА и ПЦА, в структуре которых наблюдался тревожный синдром у 31 (46,3 %) пациента, депрессивный — у 12 (17,9 %) и тревожно-депрессивный — у 24 (35,8 %).

Driving, Opioid-maintenance, and Co-medications: A Comprehensive Assessment of 22 Cases

Introduction: Patients in stable Opioid Maintenance Treatment (OMT) for opioid-dependence are, as a rule, considered fit to drive a car. Polypharmacotherapy, however, is common in opioid-dependent patients, and its association with driving fitness is not well known. Therefore, we examined driving fitness of 22 OMT patients of whom the majority were multidrug-treated patients. Material and methods: The assessment included a standard on-road driving test, clinical neurological examination, and cognitive driving-related tests. The OMT patients were grouped on the basis of their psychoactive medications into two groups. The first group was considered to have a low probability for drug-related driving impairment (n=10). This group included patients treated with opioid agonist alone or along with the second generation antidepressant or lithium. The second group included patients with probable drug-related driving impairment (n=12). All patients in this group were given at least one benzodiazepine (BZD) drug, Results: In neurological evaluation all OMT patients met the basic requirements for driving. In the driving test, all patients in the group with ‘improbable drug-related driving impairment’ and all except one in the group with ‘probable drug-related driving impairment’ were found fit to drive. However, in the driving test total score and two driving-related cognitive tests, the group with ‘probable drug-related driving impairment’ scored significantly lower than the improbable group (p=0.021, 0.001, and 0.028, respectively). Two cases with ‘probable drug-related driving impairment’ are described in detail. Conclusions: The results of this case series give support for the notion that OMT patients in stable treatment, in general, are fit to drive. When assessing the driving fitness of individual OMT patients with polypharmacy, combining pharmacological and non-pharmacological information is essential, as shown by two case descriptions.

Vogt-Koyanagi-Harada disease and fungal meningitis.

To describe a patient who initially presented with features of Vogt-Koyanagi-Harada disease and who eventually demonstrated symptoms of mycotic meningitis. An 18-year-old immunocompetent boy showed a disseminated uveitis with patchy thickening of the posterior choroid. A clinical neurologic examination and a microbiological assessment revealed neck stiffness as well as pleocytosis, increased protein content, a decreased concentration of glucose and chloride, and cryptococcal fungi in the cerebrospinal fluid. It led to the diagnosis of cryptococcal meningitis. Antifungal therapy was initiated and given for 2 months. After bilateral retrobulbar injections of 2.5 mg of dexamethasone and 20 mg of triamcinolone acetonide, choroidal edema regressed and visual acuity increased from 0.4 to 1.0 at 3 weeks after start of therapy. Microbiological examination of cerebrospinal fluid samples taken 30 days later was unremarkable. Ophthalmoscopy showed some fine pigment clumping and depigmentation in the macula. According to the International Nomenclature Committee for Vogt-Koyanagi-Harada diagnosis, the patient was diagnosed with incomplete Vogt-Koyanagi-Harada because he had not suffered any ocular trauma, had not undergone ocular surgery, and presented with bilateral multifocal choroiditis accompanied by signs of meningitis without skin abnormalities. Because skin changes can occur months to years after the initial symptoms, the patient may eventually fulfill the criteria for complete Vogt-Koyanagi-Harada disease.

Tynnfibernevropati

Small-fibre neuropathy is a neuropathy that mainly affects the small nerve fibres. Owing to doctors' inadequate knowledge of the condition and limited diagnostic methods, this type of neuropathy is probably under-diagnosed. Small-fibre neuropathy has many causes, but the symptoms are often relatively similar. This review article is intended to give doctors insight into the clinical expressions and diagnosis of the condition. The article is based on literature searches in PubMed and the authors' clinical and scientific experience of the subject. Small-fibre neuropathy generates a characteristic distribution of symptoms, particularly pain, and is associated with a number of common illnesses. Specific tests for small fibre neuropathy, such as skin biopsy and thermal testing, can be used to confirm the diagnosis. The treatment targets the symptoms, but complete pain relief is often difficult to achieve. The clinical neurological examination will not generally be able to detect small-fibre neuropathy, but will contribute primarily to excluding a more general polyneuropathy. Supplementary tests are often necessary to make a final diagnosis.

Free Floating Left Atrial Thrombus Disappearing during Echocardiography

An 82-year-old woman with a history of previous cerebral infarction and atrial fibrillation was hospitalized with aphagia. Brain magnetic resonance imaging showed a dot-like high signal intensity in the left occipital subcortex. With a working diagnosis of acute cerebral infarction due to cardiac emboli, trans-thoracic echocardiography (TTE) was performed. The TTE showed an oval shaped, mobile thrombus, approximately 1.9 × 1.5 cm in size within the left atrial appendage. For further evaluation of mobile thrombus in the left atrial appendage, a trans-esophageal echocardiography (TEE) was done. The TEE showed an oval shaped, mobile thrombus in the left atrial appendage (Fig. 1A). Subsequently, during follow-up TTE, the thrombus was found to be freely floating in the left atrial cavity during each cardiac cycle (Fig. 1B-F and Supplementary movie 1). After a number of cardiac cycles, the thrombus suddenly disappeared in TTE. The patient's overall clinical condition and neurologic examination continued to appear stable for the entirety of echocardiographic examination. Fig. 1 Trans-esophageal echocardiography showed a free floating thrombus in the left atrial appendage (A). Trans-thoracic echocardiography (TTE) showed free floating thrombus in the left atrial appendage (B). TTE showed the thrombus moving from left atrial appendage ... After one day, the patient complained claudication in the lower right limb. In physical examination, the patient's femoral pulses were not present to prompt a pulse exam. We performed a 3-dimensional (3D) femoral computer tomography (CT) to evaluate for occlusion. The 3D femoral CT showed a new filling defect in the right femoral artery in comparison with an abdominal enhanced CT performed for evaluation of fever 2 days ago (Fig. 2). Following the examination, the patient was placed on warfarin for anticoagulation therapy. The patient was discharged from the hospital with an uneventful recovery and has been doing well without additional embolic events after discharge and maintenance anticoagulation therapy. Fig. 2 Abdominal enhanced computer tomography (CT) for evaluation of fever did not show a filling defect in the right femoral artery in axial plane 2 days ago (A and C). 3-dimensional (3D) femoral CT showed a filling defect (arrow) in the right femoral artery ... Left atrial free floating thrombus is infrequent but predominantly associated with mitral valve disease, atrial fibrillation, as in our case, and hypertrophic cardiomyopathy.1-4) The presence of left atrial free floating thrombus is linked to higher embolic rates and the most common presentation of left atrial thrombus is, as in our case, peripheral embolization.5) This case is an interesting case of free-floating left atrial thrombus disappearing during echocardiography.

Facial Affect Recognition in Myasthenia Gravis

The assessment of facial expression is an important aspect of a clinical neurological examination, both as an indicator of a mood disorder and as a sign of neurological damage. To date, although studies have been conducted on certain psychosocial aspects of myasthenia, such as quality of life and anxiety, and on neuropsychological aspects such as memory, no studies have directly assessed facial emotion recognition accuracy. The aim of this study was to assess the facial emotion recognition accuracy (fear, surprise, sadness, happiness, anger, and disgust), empathy, and reaction time of patients with myasthenia. Thirty-five patients with myasthenia and 36 healthy controls were tested for their ability to differentiate emotional facial expressions. Participants were matched with respect to age, gender, and education level. Their ability to differentiate emotional facial expressions was evaluated using the computer-based program Feel Test. The data showed that myasthenic patients scored significantly lower (p < 0.05) than healthy controls in the total Feel score, fear, surprise, and higher reaction time. The findings suggest that the ability to recognize facial affect may be reduced in individuals with myasthenia.

Muscle ultrasound for early assessment of critical illness neuromyopathy in severe sepsis

IntroductionMuscle ultrasound is emerging as a promising tool in the diagnosis of neuromuscular diseases. The current observational study evaluates the usefulness of muscle ultrasound in patients with severe sepsis for assessment of critical illness polyneuropathy and myopathy (CINM) in the intensive care unit.Methods28 patients with either septic shock or severe sepsis underwent clinical neurological examinations, muscle ultrasound, and nerve conduction studies on days 4 and 14 after onset of sepsis. 26 healthy controls of comparable age underwent clinical neurological evaluation and muscle ultrasound only.Results26 of the 28 patients exhibited classic electrophysiological characteristics of CINM, and all showed typical clinical signs. Ultrasonic echogenicity of muscles was graded semiquantitatively and fasciculations were evaluated in muscles of proximal and distal arms and legs. 75% of patients showed a mean echotexture greater than 1.5, which was the maximal value found in the control group. A significant difference in mean muscle echotexture between patients and controls was found at day 4 and day 14 (both p < 0.001). In addition, from day 4 to day 14, the mean grades of muscle echotexture increased in the patient group, although the values did not reach significance levels (p = 0.085). Controls revealed the lowest number of fasciculations. In the patients group, fasciculations were detected in more muscular regions (lower and upper arm and leg) in comparison to controls (p = 0.08 at day 4 and p = 0.002 at day 14).ConclusionsMuscle ultrasound represents an easily applicable, non-invasive diagnostic tool which adds to neurophysiological testing information regarding morphological changes of muscles early in the course of sepsis. Muscle ultrasound could be useful for screening purposes prior to subjecting patients to more invasive techniques such as electromyography and/or muscle biopsy.Trial registrationGerman Clinical Trials Register, DRKS-ID: DRKS00000642.

Clinical neuropsychologists need a standard preliminary observational examination of cognitive functions

OPINION article Front. Psychol., 30 May 2013Sec. Psychology for Clinical Settings Volume 4 - 2013 | https://doi.org/10.3389/fpsyg.2013.00314