Neurological Risk Research Articles

Neurologic Complications of Babesiosis, United States, 2011-2021.

Babesiosis is a globally distributed parasitic infection caused by intraerythrocytic protozoa. The full spectrum of neurologic symptoms, the underlying neuropathophysiology, and neurologic risk factors are poorly understood. Our study sought to describe the type and frequency of neurologic complications of babesiosis in a group of hospitalized patients and assess risk factors that might predispose patients to neurologic complications. We reviewed medical records of adult patients who were admitted to Yale-New Haven Hospital, New Haven, Connecticut, USA, during January 2011-October 2021 with laboratory-confirmed babesiosis. More than half of the 163 patients experienced >1 neurologic symptoms during their hospital admissions. The most frequent symptoms were headache, confusion/delirium, and impaired consciousness. Neurologic symptoms were associated with high-grade parasitemia, renal failure, and history of diabetes mellitus. Clinicians working in endemic areas should recognize the range of symptoms associated with babesiosis, including neurologic.

Risks of neurological and psychiatric sequelae 2 years after hospitalisation or intensive care admission with COVID-19 compared to admissions for other causes

The association between COVID-19 and subsequent neurological and psychiatric disorders is well established. However, two important questions remain unanswered. First, what are the risks in those admitted to intensive care unit (ICU) with COVID-19? Admission to ICU is itself associated with neurological and psychiatric sequelae and it is not clear whether COVID-19 further increases those risks or changes their profile. Second, what are the trajectories of neurological and psychiatric risks in patients admitted to hospital or ICU with COVID-19, and when do the risks subside? We sought to answer these two questions using a retrospective cohort study based on electronic health records (EHR) data from the TriNetX Analytics Network (covering 89 million patients, mostly in the USA). Cohorts of patients admitted to hospital or ICU with COVID-19 were propensity score-matched (for 82 covariates capturing risk factors for COVID-19 and more severe COVID-19 illness) to patients admitted to hospital or ICU (respectively) for any other reason. Matched cohorts were followed for up to two years and the risk of 14 neurological and psychiatric outcomes were compared. A total of 280,173 patients admitted to hospital and 46,573 patients admitted to ICU with COVID-19 were successfully matched to an equal number of patients admitted to hospital or ICU for any other reason. Those hospitalised with COVID-19 were found to be at a greater risk of a range of neurological and psychiatric outcomes including seizure/epilepsy, encephalitis, myoneural junction/muscle disease, Guillain-Barré syndrome (GBS), dementia, cognitive deficits, psychotic disorder, mood and anxiety disorders, but not ischaemic stroke or intracranial haemorrhage. When risks were elevated after COVID-19, most remained so for the whole two years of follow-up (except for mood and anxiety disorders). Risk profiles and trajectories were substantially different among those admitted to ICU: compared to those admitted for any other reasons, those admitted with COVID-19 were at a greater risk of myoneural junction/muscle disease, GBS, cognitive deficits and anxiety disorder, but at a significantly lower risk of ischaemic stroke, intracranial haemorrhage, encephalitis, and mood disorder. When elevated, the risks in those admitted to ICU with COVID-19 were mostly short-lived. In summary, risks of neurological and psychiatric sequelae in patients hospitalised with COVID-19 are wide ranging and long standing whereas those in patients admitted to ICU with COVID-19 are similar to, or lower than, the risks observed post-ICU admission for any other cause. These contrasting risk trajectories are relevant for researchers, clinicians, patients, and policymakers.

Artificial Circulation Effect on Oxygen Saturation in the Brain Phantom

Cardiovascular surgery represents a field where the anesthetist frequently deals with quickly evolving conditions associated with anesthesia, perfusion, and the scope of surgery, that have a direct and indirect impact on the oxygen delivery to organs and tissues and its consumption ratio. The prospects of predicting the oxygen concentration influential factors on the brain create a possibility for effective decisions in the crucial moments of cardiac surgery during a cardiopulmonary bypass, to choose specific neuroprotection to decrease postoperative neurologic complication risk. Nowadays, near-infrared spectroscopy (NIRS) technology has been used to perform cerebral oximetry analysis. By reviewing available literature, the work on the possible dependence of artificial blood circulation on oxygen concentration in the brain is provided. This research aims to investigate how artificial circulation, specifically the flow and viscosity of the fluid equivalent to blood, affects oxygen concentration in the cerebral phantom. The thesis contains methodology for measuring the concentration of oxygen was considered, as well as the manufacture of a phantom of the brain and an equivalent blood fluid. The results illustrate that the artificial blood flow rate has a non-linear effect on the oxygen concentration in the brain phantom. This was confirmed through the value of the oxygen concentration in the brain phantom under conditions of artificial blood circulation rSO_2avg.= 85% with laminar flow and the value of rSO_2avg.= 78% with turbulent flow. Additionally, it was proven that as the viscosity of the blood-equivalent fluid increases, the oxygen concentration decreases almost linearly. The calculated average rSO₂ value at minimum viscosity η=2.0 mPa∙s and flow rate Q=0.5 l/min has maximum rSO_2avg.=85%, while at maximum viscosity η=4.2 mPa∙s, rSO₂ average value was the smallest rSO_2avg.=72%. The study demonstrates that the type and rate of flow, as well as viscosity of the cardiopulmonary bypass, affect the measurements of oxygen concentration in the brain phantom.

A-30 | Timing of Coronary Angiography for Patients Without ST-Segment Elevation After Cardiac Arrest

Early coronary angiography (CAG) is recommended in patients with out of hospital cardiac arrest (OHCA) with ST segment elevation (STE) on electrocardiogram (ECG), but less is known about early CAG in OHCA patients without STE. This meta-analysis aims to evaluate the association between timing of CAG and outcomes in patients with OHCA without STE. We performed a literature search for studies reporting an association between timing of CAG and study endpoints. The primary endpoint was all-cause mortality. Secondary endpoints included neurological outcome and need for hemodialysis (HD). The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. We did not restrict to time or publication status. A total of 17 studies with 8118 participants (3447 with early CAG vs 4671 with late/no CAG) were included. Mean duration of follow-up was 138 days. Early CAG showed a trend towards reduction in all-cause mortality but this was not significant (OR 0.83, 95% CI 0.60-1.14; p=0.25) (Figure 1). There was no difference associated with neurologic outcome (OR 0.75, 95% CI 0.48-1.18; p=0.21) nor risk for HD (OR 1.0, 95% CI 0.73-1.38; p=0.99). Subgroup analysis by time to CAG demonstrated that early CAG was associated with increased all-cause mortality if performed immediately (OR 1.3, 95% CI 1.02-1.66; p=0.03), but decreased all-cause mortality if performed within 6 hours or within 24 hours (OR 0.73, 95% CI 0.58-0.90; p<0.01; OR 0.34, 95% CI 0.14-0.79; p=0.01). Early CAG in patients with OHCA without STE may be beneficial compared to late/no CAG if performed after initial patient stabilization.

Supratotal Surgical Resection for Low-Grade Glioma: A Systematic Review.

Low-grade gliomas (LGGs) are optimally treated with up-front maximal safe surgical resection, typically defined as maximizing the extent of tumor resection while minimizing neurologic risks of surgery. Supratotal resection of LGG may improve outcomes beyond gross total resection by removing tumor cells invading beyond the tumor border as defined on MRI. However, the evidence regarding supratotal resection of LGG, in terms of impact on clinical outcomes, such as overall survival and neurologic morbidities, remains unclear. Authors independently searched the PubMed, Medline, Ovid, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases for studies evaluating overall survival, time to progression, seizure outcomes, and postoperative neurologic and medical complications of supratotal resection/FLAIRectomy of WHO-defined LGGs. Papers in languages other than English, lacking full-text availability, evaluating supratotal resection of WHO-defined high-grade gliomas only, and nonhuman studies were excluded. After literature search, reference screening, and initial exclusions, 65 studies were screened for relevancy, of which 23 were evaluated via full-text review, and 10 were ultimately included in the final evidence review. Studies were evaluated for quality using the MINORS criteria. After data extraction, a total of 1301 LGG patients were included in the analysis, with 377 (29.0%) undergoing supratotal resection. The main measured outcomes were extent of resection, pre- and postoperative neurological deficits, seizure control, adjuvant treatment, neuropsychological outcomes, ability to return to work, progression-free survival, and overall survival. Overall, low- to moderate-quality evidence was supportive of aggressive, functional boundary-based resection of LGGs due to improvements in progression-free survival and seizure control. The published literature provides a moderate amount of low-quality evidence supporting supratotal surgical resection along functional boundaries for low-grade glioma. Among patients included in this analysis, the occurrence of postoperative neurological deficits was low, and nearly all patients recovered within 3 to 6 months after surgery. Notably, the surgical centers represented in this analysis have significant experience in glioma surgery in general, and supratotal resection specifically. In this setting, supratotal surgical resection along functional boundaries appears to be appropriate for both symptomatic and asymptomatic low-grade glioma patients. Larger clinical studies are needed to better define the role of supratotal resection in LGG.

A Single-Center Evaluation of Responsive Neurostimulation as Treatment for Drug-resistant Epilepsy (P5-1.011)

<h3>Objective:</h3> To determine the efficacy and safety of RNS in the treatment of drug-resistant epilepsy and to determine the potential complications. <h3>Background:</h3> Epilepsy Surgery is an effective treatment for patients with drug-resistant epilepsy (DRE). Although resection/ablation of the epileptogenic zone is the preferred method to achieve seizure freedom, many patients are not appropriate for resection/ablation due to potential neurologic risks or limited benefits. Responsive Neurostimulation System (RNS) was approved by the US Food and Drug Administration FDA as an adjunctive treatment of drug-resistant focal epilepsy. <h3>Design/Methods:</h3> A database search was performed for patients who underwent RNS placement between 01/01/2014–04/01/2022 at our institution. Patients with &gt;12 months follow-up duration were included in the final data analysis. The primary outcome is seizure freedom as defined by Engel/ILAE seizure outcome classification systems. Variables were reported as mean or median for numerical variables and percentage for categorical variables. The Chi-square and Fisher’s exact tests were applied to compare independent groups for categorical variables. <h3>Results:</h3> A total of 50 patients fit the inclusion criteria during this time period. 19 were excluded as they had less than one-year follow-up. Overall, 22.6% reached a state of freedom from disabling seizures (Engel 1 or ILAE I/II). With 28 total patients getting RNS alone or as a final procedure, 21.4% achieved freedom from debilitating seizures (Engel 1 or ILAE I/II), and 60.7% had a &gt;50% reduction in seizure frequency (ILAE III/IV). There was no difference regarding seizure freedom in patients based on electrode placement (p = 0.645). Four patients (8%) had complications (1 encephalopathy, 2 scalp infections, and 1 scalp infection with meningitis). The other 92% had no major complications. <h3>Conclusions:</h3> Overall, RNS provides worthwhile seizure reduction in most of the population seen at the University of Kansas Medical Center. The outcome from our center is comparable to the outcomes reported in literature. <b>Disclosure:</b> Dr. Beattie has nothing to disclose. Dr. Ortiz Guerrero has nothing to disclose. Dr. Uysal has nothing to disclose.

Neurologic Implications of Spaceflight (P11-4.001)

<h3>Objective:</h3> Neurology in spaceflight has a rich history going back to the original days of the Gemini missions in the 1950s. With increased interest from governmental, commercial, and non-governmental entities the need to further address the integration of neurology and aerospace medicine as a burgeoning discipline. In preparation for the new Artemis generation, researchers and clinicians are attempting to understand better how changes to the nervous system are potentially hazardous and may compromise mission success. Long-duration spaceflight is associated with orthopedic, cardiovascular, urinary, immunologic, hematologic and neurologic changes. We aim to discuss several neurologic conditions that have been observed in astronauts, as well as discuss symptoms/syndromes which are limited to the spaceflight environment. According to NASA risk stratification, understanding particular neurologic conditions is critical as humanity sets its sights on the Moon and beyond. These conditions include cognitive changes, space motion sickness, space headache, and a progressively worsening visual acuity called Spaceflight-Associated Neuro-Ocular Syndrome (SANS). As more individuals representative of the average health of the population undergoes the rigors of spaceflight, more anticipated and unanticipated neurologic complications will occur. Patients with additional cardiovascular and neurologic risk factors will face different physiologic challenges than previous career astronauts and pilots. Primarily, neurologists will serve a vital role by applying knowledge of the central nervous system learned in the terrestrial equivalent patient to understand neuro-physiologic responses to spaceflight. This presentation aims to bring attention to and introduce this new area of neurology to help shape the future of humanity in space. <h3>Background:</h3> N/A <h3>Design/Methods:</h3> N/A <h3>Results:</h3> N/A <h3>Conclusions:</h3> N/A <b>Disclosure:</b> Dr. Rosenberg has nothing to disclose. Donna Roberts has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guerbet. Donna Roberts has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Guerbet. The institution of Donna Roberts has received research support from Guerbet. The institution of Donna Roberts has received research support from NASA. Dr. Grimberg has nothing to disclose. Dr. Edwards has received intellectual property interests from a discovery or technology relating to health care. Dr. Saway has nothing to disclose. Sami Al Kasab has nothing to disclose.

Hemiarch versus extended arch repair for acute type A dissection: Results from a multicenter national registry

ObjectiveWe compared perioperative outcomes of patients with acute type A aortic dissection undergoing hemiarch (HA) versus extended arch (EA) repair with or without descending aortic intervention. MethodsNine hundred twenty-nine patients underwent acute type A aortic dissection repair (2002-2021, 9 centers) including open distal repair (HA) with or without additional EA repair. EA with intervention on the descending aorta (EAD) included elephant trunk, antegrade thoracic endovascular aortic replacement, or uncovered dissection stent. EA with no descending intervention (EAND), included unstented suture-only methods. Primary outcomes were in-hospital mortality, permanent neurologic deficit, computed tomography malperfusion resolution, and a composite. Multivariable logistic regression was also performed. ResultsMean age was 66 ± 18 years, 30% (278 out of 929) were women, and HA was performed more frequently (75% [n = 695]) than EA (25% [n = 234]). EAD techniques included: dissection stent (39 out of 234 [17%]), thoracic endovascular aortic replacement (18 out of 234 [7.7%]), and elephant trunk (87 out of 234 [37%]). In-hospital mortality (EA: n = 49 [21%] and HA: n = 129 [19%]; P = .42), and neurological deficit (EA: n = 43 [18%] and HA: n = 121 [17%]; P = .74) were similar. EA was not independently associated with death (EA vs HA odds ratio, 1.09; 95% CI, 0.77-1.54; P = .63) or neurologic deficit (EA vs HA odds ratio, 0.85; 95% CI, 0.47-1.55; P = .59). Composite adverse events differed significantly (EA vs HA odds ratio, 1.47; 95% CI, 1.16-1.87; P = .001). Malperfusion resolved more frequently after EAD (EAD: n = 32 [80%], EAND: n = 18 [56%], HA: n = 71 [50%]; P = .004), although multivariable analysis was not significant (EAD vs HA odds ratio, 2.17; 95% CI, 0.83-5.66; P = .10). ConclusionsExtended arch interventions pose similar perioperative mortality and neurologic risks as Hemiarch. Descending aortic reinforcement may promote malperfusion restoration. Extended techniques should be approached with caution in acute dissection due to increased risk of adverse events.

A novel less invasive endoscopic-assisted procedure for complete reduction of low-and high-grade isthmic spondylolisthesis performed by anterior and posterior combined approach.

The optimal surgical management of low- and high-grade isthmic spondylolisthesis (LGS and HGS -IS) is debated as well as whether reduction is needed especially for high-grade spondylolisthesis. Both anterior and posterior techniques can be associated with mechanical disadvantages as hardware failure with loss of reduction and L5 injury. We purpose a novel endoscopic-assisted technique (Sled technique, ST) to achieve a complete reduction in two surgical steps: first anteriorly through a retroperitoneal approach to obtain the greatest part of correction and then posteriorly to complete reduction in the same operation. ST efficacy and complications rate were evaluated through a retrospective functional and radiological analysis. Thirty-one patients, 12 male (38.7%) and 19 female (61.3%), average age: 45.4years with single level IS underwent olisthesis reduction by ST. Twenty-three IS involved L5 (74.2%), 7 L4 (22.5%) and 1 L3 (3.3%). No intraoperative complications were recorded. One patient required repositioning of a pedicle screw. A significant improvement of functional and radiological parameters (L4-S1 and L5-S1 lordosis) outcomes was recorded (p < 0.001). ST provides a complete reduction in the slippage in LGS and HGS. The huge anterior release as well as the partial reduction in the slippage by the endoscopic-assisted anterior procedure, because of the cage is acting as a "guide rail", facilitate the final posterior reduction, always complete in our series, minimizing mechanical stresses and neurological risks. gov Identifier: NCT03644407.

The effect of the COVID-19 pandemic on pediatric physiatric health care in Croatia among children with neurological risk: A retrospective study.

Since the start of COVID pandemic, the Croatian government issued many recommendations and guidelines, imposed reorganization of health care system, and ordered two lock-downs to mitigate the spread of the disease. All of this may have had an unwanted effect on the standard of health care for non-COVID-19 patients, including children with neurological risk factors. To highlight the possibility that measures taken to mitigate the COVID-19 pandemic may lead to a substantial delay of examination by physical medicine specialists and timely rehabilitation programs for children with neurological risks. A retrospective medical history-based study between 2020 and 2021. The study was performed in Department of Physical and Rehabilitation Medicine at the University Hospital Centre of Split, Croatia. Children with neurological risk examined by pediatric physical rehabilitation specialists in the Department of Physical and Rehabilitation Medicine between January 2017 and December 2021. Case records of patients were reviewed, dividing them into groups according to severity of neurological risk and their age at the time of first examination. We also noted in what months of the year those examinations were performed. The outcome was change in the number of the first examinations and the age of the patients when the examination was first performed. During the pandemic year 2020, the total number of first examinations was lower by 244 (38%; 95% confidence interval [CI]: 34%-42%), and the number of first examinations of children with neurological risks was lower by 216 (36%; 95% CI: 33%-40%).On the contrary, in 2021, there was an increase in the total number of first examinations by 114 (18%; 95% CI: 15%-21%) and first examinations of children with neurological risks compared to the pre-pandemic years by 97 (16%; 95% CI: 13%-20%). Furthermore, the division of patients according to age at the time of first examination significantly differed in the pre-pandemic and pandemic 2021 periods (λ =11.8; p=.018). The greatest contributing factor to this difference was the group of patients older than 12 months. The study suggests that the chaotic initial stages of the COVID-19 pandemic during 2020 caused delay in examinations by physical medicine specialists for children with neurological risks that could potentially affect neurodevelopmental outcomes.

Risk of longer-term neurological conditions in the Deepwater Horizon Oil Spill Coast Guard Cohort Study – Five years of follow-up

BackgroundLong-term neurological health risks associated with oil spill cleanup exposures are largely unknown. We aimed to investigate risks of longer-term neurological conditions among U.S. Coast Guard (USCG) responders to the 2010 Deepwater Horizon (DWH) oil spill.MethodsWe used data from active duty members of the DWH Oil Spill Coast Guard Cohort Study (N=45224). Self-reported oil spill exposures were ascertained from post-deployment surveys. Incident neurological outcomes were classified using International Classification of Diseases, 9th Revision, codes from military health encounter records up to 5.5 years post-DWH. We used Cox Proportional Hazards regression to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for various incident neurological diagnoses (2010–2015). Oil spill responder (n=5964) vs. non-responder (n= 39260) comparisons were adjusted for age, sex, and race, while within-responder comparisons were additionally adjusted for smoking.ResultsCompared to those not responding to the spill, spill responders had reduced risks for headache (aHR=0.84, 95% CI: 0.74-0.96), syncope and collapse (aHR=0.74, 95% CI: 0.56-0.97), and disturbance of skin sensation (aHR=0.81, 95% CI: 0.68-0.96). Responders reporting ever (n=1068) vs. never (n=2424) crude oil inhalation exposure were at increased risk for several individual and grouped outcomes related to headaches and migraines (aHR range: 1.39-1.83). Crude oil inhalation exposure was also associated with elevated risks for an inflammatory nerve condition, mononeuritis of upper limb and mononeuritis multiplex (aHR=1.71, 95% CI: 1.04-2.83), and tinnitus (aHR=1.91, 95% CI: 1.23-2.96), a condition defined by ringing in one or both ears. Risk estimates for those neurological conditions were higher in magnitude among responders reporting exposure to both crude oil and oil dispersants than among those reporting crude oil only.ConclusionIn this large study of active duty USCG responders to the DWH disaster, self-reported spill cleanup exposures were associated with elevated risks for longer-term neurological conditions.

Acute posterior multifocal placoid pigment epitheliopathy: clinical presentation and risk of stroke and transient ischaemic attack

Background/aimsAcute posterior multifocal placoid pigment epitheliopathy is a rare but important disease that can be associated with life-threatening complications due to cerebral vasculitis. The primary objective was to determine the...

Machine Learning Models for Predicting Early Neurological Deterioration and Risk Classification of Acute Ischemic Stroke.

This study aimed to create machine learning models for predicting early neurological deterioration and risk classification in acute ischemic stroke (AIS) before intravenous thrombolysis (IVT). The study included 704 AIS patients categorized into END and non-END groups. The least absolute shrinkage and selection operator (LASSO) regression was employed to select the best predictors from clinical indicators, leading to the creation of Model 1. Univariate and multivariate logistic regression analyses identified independent predictive factors for END from inflammatory cell ratios. These factors were combined with clinical indicators, forming Model 2. Receiver operating characteristic (ROC) curves assessed the models' predictive performance. Key variables for Model 1 included the NIHSS score, systolic blood pressure, and lymphocyte percentage. Neutrophil-to-Lymphocyte ratio, Platelet-to-Neutrophil ratio, and Platelet-to-Lymphocyte ratio independently predicted END. Model 1 exhibited moderate predictive ability (AUC 0.721 in training, AUC 0.635 in test). Model 2, which integrated clinical indicators and inflammatory cell ratios, demonstrated strong performance in both training (AUC 0.862) and test (AUC 0.816). Machine learning models, combining clinical indicators and inflammatory cell ratios before IVT, accurately predict END and associated risk in AIS.

EXPANDABLE INTRAVERTEBRAL IMPLANTS IN POST-TRAUMATIC VERTEBRAL NECROSIS - NEW CLASSIFICATION SUGGESTION.

The progressive evolution of post-traumatic vertebral necrosis and consequent loss of structural integrity of the vertebral body along with neurological risk, makes it one of the most feared and unpredictable pathologies in spine traumatology. Several studies have addressed the role of vertebroplasty, kyphoplasty, and corpectomy in its treatment; however, it remains a controversial concept without a defined therapeutic algorithm. The recent emergence of expandable intravertebral implants, which allow, by a percutaneous transpedicular application, the capacity for intrasomatic filling and maintenance of the height of the vertebral body, makes them a viable option, not only in the treatment of acute vertebral fractures, but also in non-union cases. In this study, we present a review of the current evidence on the application of expandable intravertebral implants in cases of post-traumatic vertebral necrosis. Based on the available scientific literature, including previous classifications of post-traumatic necrosis, and on the mechanical characteristics of the main expandable intravertebral implants currently available, we propose a simplified classification of this pathology, considering parameters that influence surgical therapeutic guidance, the morphology and the dynamics of the necrotic vertebra's mobility. According to its stages and based on authors' experience and on the scarce literature, we propose an initial therapeutic algorithm and suggest preventive strategies for this disease, considering its main risk factors, that is, fracture comminution and impairment of vertebral vascularity. Therefore, expandable intravertebral implants have a promising role in this condition; however, large prospective studies are needed to confirm their efficacy, to clarify the indications of each of these devices, and to validate the algorithm suggestion regarding treatment and prevention of post-traumatic vertebral necrosis. Level of Evidence III, Systematic Review/Actualization.

Neurological Involvements in COVID-19: A hospital-based study.

The SARS-CoV-2 pandemic is the most challenging crisis in the contemporary world. Besides severe pulmonary involvement, the disease also has several extrapulmonary manifestations, and new signs and symptoms are associated with it every dayThe present study aimed to inquire about the frequency of neurological manifestations and risk factors of COVID-19. This retrospective, descriptive study included patients with neurological involvement admitted to the Alborz University of Medical Sciences academic hospitals from March 2020 to July 2020 with confirmed COVID-19 infection. The data included in the analysis were the patient's demographic information, underlying diseases, neurological manifestations, and laboratory findings. The study included ninety-five patients with a mean age of fifty-nine. Neurological symptoms and signs were observed in 91.6% and 10.5% of the patients, respectively. The most frequently associated neurological symptoms of COVID-19 were fatigue (49.5%), headache (47.4%), and dizziness (45.3%). Furthermore, the most common neurological involvements included gait disorders (6.3%), cerebellar dysfunction (4.2%), and cerebrovascular accidents (3.15%). Positive troponin was shown to be the strongest predictor of neurological signs (OR=21, P=0.017), followed by WBC≥15,000 (OR = 20.75, P=0.018) and a history of respiratory disease (OR=7.42, P=0.007). Neurological symptoms were observed in more than 91% of the patients, while neurological signs were present in 10.5% of the COVID-19 patients. Additionally, positive troponin, WBC≥15,000, and a history of respiratory disease were the strongest predictors of neurological signs.

Sensory-based motor processing in children with specific learning disabilities

IntroductionChildren with learning disabilities not only experience difficulties in academic performance but also exhibit neurological risks of motor and sensory processing. Evaluation of such a group might help identify their deficits even before early adolescence. The study aimed to assess sensory and motor problems in children with different types of specific learning disabilities.MethodsA cross-sectional study was performed in students of 4&lt;sup&gt;th&lt;/sup&gt;, 5&lt;sup&gt;th&lt;/sup&gt;, and 6&lt;sup&gt;th&lt;/sup&gt; grades in governmental schools, Cairo, Egypt. Overall, 200 children with poor scholastic achievement were screened with an intelligence quotient test (Raven’s Progressive Matrices). The learning disabilities were evaluated with the Fathi al-Zayyat battery. Then, the Quick Neurological Screening Test was used to indicate motor and sensory problems.ResultsA total of 50 out of 772 screened children were confirmed to have learning disabilities (dyscalculia: 29, dyslexia: 11, mixed: 10), which represented 6.47% of the sample. Neurological signs were positive in all children with specific learning disabilities, while 82% of them were below average.ConclusionsThe study revealed that 82% of children with specific learning disabilities at 4&lt;sup&gt;th&lt;/sup&gt;, 5&lt;sup&gt;th&lt;/sup&gt;, and 6&lt;sup&gt;th&lt;/sup&gt; grades were below age with a moderate discrepancy in the development of sensory and motor processes. The finger-to-nose test, double simultaneous stimulation of hand and cheek test, stand-on-leg test, and tandem walk test are associated with the type of specific learning disabilities (dyscalculia, dyslexia, or mixed).

Can carotid ultrasound predict neurological risk after carotid intervention?

<p>&nbsp;To prevent ischemic strokes caused by carotid artery stenosis, carotid artery stenting (CAS) and carotid endarterectomy (CEA) have been utilized. However, complications could be linked to either or both procedures. The pur&shy;pose of our study is to find the most efficient carotid ultrasound method to forecast peri&shy;pro&shy;cedural risk (embolization, new neu&shy;ro&shy;logical symptoms). &nbsp;</p>. <p>We used Pubmed, EMBASE, and the Cochrane Library to conduct a sys&shy;te&shy;ma&shy;tic literature search for the years 2000 to 2022.</p>. <p>The grayscale medium (GSM) scale of plaque is the most promising criterion for evaluating periprocedural complications. According to the published observations (relatively small cohorts), peri-procedural problems would be significantly predicted by &le; 20 of grayscale medium cut-off values. The diffusion-weighted MRI (DW-MRI) is the most sensitive method for assessing whether stenting or carotid endarterectomy resulted in peri-procedural ischemic lesions on diffusion-weighted MRI. &nbsp;</p>. <p>A future, large-scale, multi-center study should confirm which grayscale medium value is optimal to forecast periprocedural ischemic complications.</p>.

The epidemiological and neurological risk factors of Japanese encephalitis virus in the population of Assam, Northeast India

Japanese encephalitis is one of the world's most common public health issues, particularly it is prevalent in the north-eastern Indian states of Assam. This study aimed to find out the risk factors linked to clinical and epidemiological characteristics. A total of 245 cases were found as PCR-positive in Assam. The most common clinical symptoms were fever (87%), seizure (65%), altered sensorium (60%), cold with shivering (74%), vomiting (68%), throat irritation (31%), cough (67%), chest pain (10%), joint pain (18%), mouth ulcer (18%), diarrhea (29%), pain in the abdomen (42.9%), runny nose (64%), redness in eyes (78%), jaundice (25%), and blood in the sputum (25%). Further, the neurological symptoms included vision problems (66.5%), hearing difficulties (55 %), neck stiffness (62%), limb numbness (65%), dizziness (77%), headaches (75.5%), speaking difficulties (63%), hydrophobia (47%), and abnormal behavior (66%). The epidemiological risk factors included contact with pigs (57%), bats (21%), cattle (32%), and rates (66%). In addition, 24.5% of patients observed the death of animals/birds. The protection measure included window screening, sleeping under a mosquito net, and use of insect repellent while sleeping in open compounds (29%) and floods (63%) are considered important risk factors. JE-positive cases include daily habits like working in agriculture fields (28%), in standing water (16%), swimming in nearby lakes (24%), traveling outside their village (40%), and wearing shirts while working in the field (20%), storing water in open containers in or outside the house (62%). These were the epidemiological factors that affected the abundance of the potential mosquito vectors of the JE infection.

Concussion increases within-player injury risk in male professional rugby union

ObjectivesTo assess within-player change in injury risk and between-player subsequent injury risk associated with concussive and common non-concussive injuries in professional rugby union.MethodsThis prospective cohort study in Welsh professional male...

Post-COVID-19 prolonged neurological symptoms and characteristics: A face-to-face survey study

Background: COVID-19 was declared as a pandemic by World Health Organization on March 11, 2020, and still constitutes a serious health problem affecting millions of people across the world. The evaluation and follow-up of ongoing and/or newly developing neurological involvement after recovery from COVID-19 are important. This study aims to reveal post-COVID-19 neurological symptoms and risk factors for their development. Methods: Patients over the age of 18 years who applied to centers, at least 4 weeks after COVID-19 infection and agreed to participate in the study were included in this cross-sectional study between January 20 and March 15, 2021. The patients were evaluated face to face, and their sociodemographic data, medical history, post-COVID-19 neurological symptoms, treatments, and Beck Depression Inventory scores were recorded. All statistical analyses were performed using SPSS 23 for Windows software package (SPSS Inc., Chicago, IL). Results: Four hundred patients were included in this study, an average of 108+5.12 days had passed after the onset of COVID-19. The rate of post-COVID-19 neurological involvement was 73.3%, and the top 3 most common symptoms were headache (47%), myalgia (43%), and sleep disturbance (39%). Having depression (OR: 4.54, 95% Cl :1.88-10.96), female gender (OR:2.18, 95% Cl :1.36-3.49), hospitalization (OR: 2.01, 95% Cl :103-3.64), and usage of favipiravir (OR:2.07 95 Cl :1.15-3.72) were determined as independent predictors of developing prolonged neurological symptoms. Conclusion: The long-term consequences of COVID-19 remain uncertain. It should be remembered that neurological symptoms are very common in post-infectious patients and long-term follow-up may be required in the management of this condition.