Neurological Sequelae In Patients Research Articles

Optic nerve sheath diameter measurements to predict delayed neurological sequelae after carbon monoxide poisoning

Objectives Delayed neurological sequelae are a major complication of carbon monoxide poisoning. However, today there is still no objective screening tool for predicting delayed neurological sequelae in patients with carbon monoxide poisoning. The present study aimed to assess the usefulness of optic nerve sheath diameter measurements in predicting delayed neurological sequelae after carbon monoxide poisoning. Methods In this retrospective study, patients with a diagnosis of carbon monoxide poisoning in the emergency department from 2010 to 2021 were included in the study. Right and left optic nerve sheath diameters were calculated based on cranial computed tomography scans, and the presence of delayed neurological sequelae was evaluated. Results The mean (± standard deviation) optic nerve sheath diameter in patients who developed delayed neurological sequelae was statistically significantly greater on both the right and left compared to patients who did not develop delayed neurological sequelae (right; 5.02 ± 0.06 mm versus 4.89 ± 0.07 mm, P < 0.001; left; 5.03 ± 0.09 mm versus 4.85 ± 0.10 mm, P < 0.001). A multivariate linear regression analysis revealed that carboxyhemoglobin and both right and left optic nerve sheath diameter were the factors associated with the delayed neurological sequelae. Discussion The present study revealed that optic nerve sheath diameter measurements may be a useful screening tool to predict delayed neurological sequelae after carbon monoxide poisoning. The ability to predict a poor neurological prognosis in carbon monoxide poisoning is important for initiating early rehabilitation interventions and make help future trials. Limitations of this study include that normal optic nerve sheath diameters are not well established, and that not every patient underwent computed tomography. Conclusions Optic nerve sheath diameters measurements may be a helpful screening tool for predicting delayed neurological sequelae after carbon monoxide poisoning.

Effects of a respiratory and neurological rehabilitation treatment plan in post Covid-19 affected university students. Randomized clinical study.

COVID-19 demonstrated the possibility of neurological complications such as loss of sense of smell and taste, together with respiratory problems. Respiratory training and rehabilitation of neurological sequelae are essential to improve respiratory function and thus quality of life, and the aim of this study is to evaluate the efficacy of a pulmonary and neurological rehabilitation program. To apply a treatment to reduce dyspnea, increase exertional capacity, increase vital capacity and respiratory muscle strength, together with an increase in olfactory and gustatory sensitivity in post-SARS-CoV-2 patients. A randomised controlled experimental study was conducted in 220 patients with a medical diagnosis of COVID-19 and more than 5months of evolution, dyspnoea or perceived fatigue, including olfactory and gustatory perception problems, of whom 200 patients completed the study. 100 patients were randomly assigned to the intervention group, consisting of an inspiratory training treatment plan (Powerbreathe Plus®) combined with aerobic exercise and olfactory gustatory treatment for 31days, and 100 patients to the control group, for 31days without any type of therapy. The study was conducted in post-Covid-19 patients for 5months. Two hundred patients were divided into an intervention group (n = 100) and a control group (n = 100). The comparison between the groups showed significant differences in spirometric variables; forced vital capacity (p < .001; Eta2 (0.439); Mean: 0,6135), the ratio between both FEV1/FVC (p < 0.01; Eta2 (0.728); Mean:9,313), peak inspiratory pressure (p < 0.01; Eta2 (0.906); Mean:4,526); changes were observed in dyspnoea measured with the modified Borg scale (p < 0.01; Eta2 (0.811); Mean:1,481) and the modified Medical Research Council scale (p < 0.01; Eta2 (0.881); Mean: 0.777); finally, changes were found in neurological variables, in the questions of the Singapore Smell and Taste Questionnaire, How was your sense of smell after treatment? (p < 0.01; Eta2 (0.813); Mean: 1,721) and How is your sense of taste after treatment? (p < 0.01; Eta2 (0.898); Mean: 1,088). The implementation of a respiratory rehabilitation treatment plan with the Powerbreathe Plus® device, aerobic exercise and neurorehabilitation with olfactory and gustatory training, is a therapeutic option against respiratory and neurological sequelae in patients who have suffered such sequelae due to the SARS-CoV-2 virus. Clinicaltrials.gov: NCT05195099. First posted 18/01/2022; Last Update Posted 29/06/2022.

The neutrophil-to-lymphocyte ratio is associated with the frequency of delayed neurologic sequelae in patients with carbon monoxide poisoning

Delayed neurologic sequelae (DNS) is a common complication in patients with carbon monoxide poisoning (COP). We aimed to investigate the association of the neutrophil-to-lymphocyte ratio (NLR) with the frequency of DNS in COP patients. A total of 371 COP patients were investigated in retrospective and prospective studies. A receiver operator curve (ROC) test was performed to evaluate the ability of the NLR to predict DNS in COP patients. The retrospective study included 288 COP patients, of whom 84 (29.2%) were confirmed to have DNS, and 1 (0.3%) died within 28 days. The NLR in the DNS group was significantly higher than that in the non-DNS group (6.84 [4.22–12.43] vs. 3.23 [1.91–5.60] × 109/L). NLR was a significant predictor of the frequency of DNS [odds ratio (OR): 1.130, 95% confidence interval (CI): 1.030, 1.240] in COP patients. The area under the ROC curve of NLR for predicting DNS was 0.766 (95% CI 0.701, 0.832), and the cut-off value was 3.745 (sensitivity, 83.3%; specificity, 58.8%). The prospective study included 83 COP patients, of whom 19 (22.9%) were confirmed to have DNS, and all patients survived. Moreover, the frequency of DNS in the patients with an NLR ≥ 3.745 was notably higher than that in the patients with an NLR < 3.745 [41.4% (12/29) vs. 13.0 (7/54)]. In conclusion, the NLR was a significant, independent predictor of the frequency of DNS in COP patients.

CKD Associates with Cognitive Decline in Middle-Aged and Older Adults with Long-Standing Type 1 Diabetes.

Key Points We found that development of both albuminuria and reduced eGFR was associated with clinically significant cognitive decline, particularly in the psychomotor and mental efficiency domain.There was also a significant interaction between worsened albuminuria and eGFR, the combination of which augmented cognitive deficits.A more comprehensive longitudinal phenotype of albuminuria showed that regressed albuminuria did not associate with worsened cognitive decline, as opposed to persistent albuminuria. Background Individuals with CKD or type 1 diabetes (T1D) are at risk for cognitive decline, but it is unclear whether these associations are with albuminuria, eGFR, or both. Methods We examined the longitudinal relationships between CKD and change in cognition in 1051 participants with T1D in the Diabetes Control and Complications Trial and its follow-up, the Epidemiology of Diabetes Interventions and Complications study. Albumin excretion rate and eGFR were measured every 1–2 years. Three cognitive domains were assessed repeatedly over a 32-year period: immediate memory, delayed memory, and psychomotor and mental efficiency. Associations between cognitive function and CKD were assessed: (1) longitudinally and (2) in models using eGFR and albuminuria measurements over the first 15–20 years with subsequent change in cognitive function over the ensuing 14 years (when decline in cognition was greatest). Results In fully adjusted longitudinal analyses, the magnitude of decline in the psychomotor and mental efficiency domain score was associated with eGFR &lt;60 ml/min per 1.73 m2 (β −0.449; 95% confidence interval [CI], −0.640 to −0.259) and sustained albumin excretion rate 30 to &lt;300 mg/24 hours (β −0.148; 95% CI, −0.270 to −0.026). This was equivalent to a decrease associated with approximately 11 and 4 years of aging, respectively. In analyses focused on changes in cognition between study years 18 and 32, eGFR &lt;60 ml/min per 1.73 m2 was associated with reduced psychomotor and mental efficiency (β −0.915; 95% CI, −1.613 to −0.217). Conclusions In T1D, development of CKD was associated with a subsequent reduction on cognitive tasks requiring psychomotor and mental efficiency. These data highlight the need for increased recognition of risk factors for neurologic sequelae in patients with T1D, as well as preventive and treatment strategies to ameliorate cognitive decline.

Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post‐acute sequelae of <scp>SARS‐CoV</scp>‐2 infection (<scp>PASC</scp>)

P35 Risk of Psychiatric and Neurological Sequelae after the COVID-19 Infection: A Retrospective Cohort Study Using Claim Data

Studies erstwhile have suggested that COVID-19 also had effects on brain health. In this study we intend to provide estimates of incidence rates, odd ratio, and risks of psychiatric and neurological sequelae in patients after a COVID-19 diagnosis.

Ferroptosis participates in neuron damage in experimental cerebral malaria and is partially induced by activated CD8+ T cells

Cerebral malaria is the most serious complication of malaria infection, with 26% of surviving children having neurological sequelae, which may be caused by neuron damage, but the mechanism is not clear. Ferroptosis has been reported to play an important role in neuron damage in several nervous system diseases. However, the occurrence of ferroptosis in experimental cerebral malaria (ECM) pathogenesis is still unknown. In this study, we firstly detected increased levels of malondialdehyde (MDA) and iron, which are indicators of ferroptosis, in the cerebrum of ECM mice. Some important regulators of ferroptosis, including upregulated expression of transferrin receptor 1 (TfR1) and acyl-CoA synthetase long-chain family member 4 (ACSL4), and downregulation of glutathione peroxidase 4 (GPX4) levels, were also confirmed in ECM mice. Consistently, neuron damage, which was detected in the cerebrum of ECM mice, was positively correlated with reduced GPX4 expression and furtherly rescued by administration of the ferroptosis inhibitor ferrostatin-1 (Fer-1). In addition, primary neurons were damaged by activated CD8+ T cells, an effect that was also partially rescued by Fer-1 on amyloid precursor protein expression and mitochondrial membrane potential levels in vitro. Activated CD8+ T cells were also shown to infiltrate the cerebrum of ECM mice and upregulate TfR1 expression in primary neurons, which may be an important event for inducing ferroptosis in ECM. Altogether, we show that ferroptosis contributes to neuron damage in ECM pathogenesis, and activated CD8+ T cells may be important inducers of neuronal ferroptosis. Hence, targeting ferroptosis may be a promising adjuvant therapeutic strategy for neurological sequelae in patients with cerebral malaria.

Subacute neurological sequelae in mild COVID-19 outpatients.

Neurological aspect of COVID-19 is less understood compared to its respiratory and systemic effects. We aimed to define subacute neurological sequelae in patients who recovered from mild COVID-19. This study enrolled long COVID patients who had mild infection, were non-hospitalized, and admitted to our hospital with neurological complaints occurring after COVID-19. The evaluation included detailed history of the symptoms, neurological examination, blood tests and necessary investigations relevant to their personal medical situation, and also a retrospective inquiry about their respiratory and neurological status during the acute phase of infection. Descriptive statistical measures, Chi-square and Student's t-test were utilized. We identified 50 patients (29F/21M) with a mean age of 36.9 ± 1.6 (mean ± SEM). The average time from COVID-19 to admission was 99 days(min-max= 15-247). Most frequent neurological complaints were headache (42%) and cognitive dysfunction (42%). Sleep disturbance (36%), prolonged anosmia (30%), prolonged ageusia (22%), fatigue (22%), and dizziness (8%) followed. Most patients with headache experienced headache also as an acute manifestation of COVID-19 (p= 0.02). Acute-stage sleep disorders were found to be more associated with subacute cognitive symptoms than other central symptoms (p= 0.008). The most common neurological symptom in the acute phase was headache (74%). Six patients, despite the absence of any acute-stage neurological symptoms, presented with emergence of subacute neurological sequela. There were only five patients with pulmonary involvement during the acute stage, who were not different from the rest of the cohort in terms of neurological sequelae. There was no increase of inflammatory markers in the blood tests at the subacute stage, or no association of the symptoms to biochemical parameters. This study gives a description of neurological sequelae of mild COVID-19 at the subacute stage, in a relatively young group, and reveals that cognitive disturbances, as well as headache, are quite frequent.

Objective predictors of delayed neurological sequelae in patients with altered mental status after carbon monoxide poisoning

Background and Purpose: Following carbon monoxide (CO) poisoning, altered mental status is an important predictor of poor neurological prognosis, including delayed neurological sequelae (DNS). However, it is difficult to interview CO-poisoned patients accurately about exposure intervals and loss of consciousness (LOC). Thus, we investigated whether DNS can be predicted using objective factors such as laboratory results and brain imaging in patients suffering CO poisoning with altered mental status. Methods: This was a prospective observational study involving all CO-poisoned patients who visited the university hospital emergency department (ED) in Bucheon, South Korea, between January 2019 and April 2020. All were registered in the CO registry. We excluded patients who were under 18 years of age, had no change in mental status, were lost to follow-up, had neurological deficits persisting at discharge from the ED, and/or were transferred from another hospital 24 hours after exposure. Results: A total of 21 (25.3%) of 82 patients had DNS with a median onset of 21 (12 to 30) days. Creatinine kinase (CK) (odds ratio 1.0002, 95% confidence interval 2.734-105.231) and brain imaging (odds ratio 3.206, 95% confidence interval 1.008-10.199) were independent prognostic factors of DNS. Conclusions: A high level of serum CK and abnormal brain-imaging results were significant predictors of the occurrence of DNS in CO-poisoned patients with altered mental status. Critically, these are objective rather than subjective factors such as CO exposure interval.

Long-Term Neurological Impact of COVID-19.

Introduction: Recent research has observed the ability of coronavirus disease 2019 (COVID-19) to spread in the brain from the respiratory system. The associated neurological disorder includes encephalopathies, inflammatory syndromes, stroke, peripheral neuropathies, and various other central nervous system disorders. This study aims to highlight the long-term neurological sequelae in patients with COVID-19 disease.Methods: This long-term study was carried out in the COVID-19 unit of a tertiary care hospital in Pakistan from July 2020 to July 2021. After obtaining informed consent, we enrolled 1000 patients who recovered from COVID-19 and were discharged. The participants were followed up after 30 and 90 days.Results: At the time of enrollment, there were 602 (60.2%) males and 398 (39.8%) females. The most common neurological symptom on 30-day follow-up was headache (8.8%), followed by insomnia. The most common neurological symptom on day 90 follow-up was insomnia (5.07%), followed by an altered sense of smell (3.3%).Conclusion: COVID-19 tends to produce a wide range of neurological symptoms, ranging from headache to anosmia to increased risk of stroke, that complicates clinical management. Potential neurologic effects and drug interactions have been reported secondary to the medications used to treat COVID-19. In light of the aforementioned facts, COVID-19 could potentially have a long-term effect on the brain. Therefore, it is important that the clinicians must be aware of the potential neurologic complications. Lastly, proper follow-up is recommended that would aid in timely recognition and management of the neurological disorder.

Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection

BackgroundCongenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. AimThe study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. Patients and methodsWe performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola’ scale. Imaging findings were compared with neurological alterations in the patients’ most recent follow-up evaluation at the paediatric neurology department. ResultsThirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P = .04) and 10 had neurological impairment (P = .008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P < .001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola’ scale values > 2 were correlated with psychomotor retardation (P < .001). ConclusionsOur findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits.

Use of hyperbaric oxygen therapy for preventing delayed neurological sequelae in patients with carbon monoxide poisoning: A multicenter, prospective, observational study in Japan.

The purpose of this study was to clarify the practical clinical treatment for acute carbon monoxide (CO) poisoning in Japan and to investigate the efficacy of hyperbaric oxygen (HBO2) therapy in preventing delayed neurological sequelae (DNS) in the acute phase of CO poisoning. We conducted a multicenter, prospective, observational study of acute CO poisoning in Japan. Patients with acute CO poisoning were enrolled and their treatment details were recorded. The primary endpoint was the onset of DNS within 2 months of CO exposure. Factors associated with DNS were assessed with logistic regression analysis. A total of 311 patients from 57 institutions were registered and 255 were analyzed: 171 received HBO2 therapy (HBO2 group) and 84 did not (normobaric oxygen [NBO2] group). HBO2 therapy was performed zero, once, twice, or three times within the first 24 h in 1.8%, 55.9%, 30.9%, and 11.3% of the HBO2 group, respectively. The treatment pressure in the first HBO2 session was 2.8 ATA (47.9% of the HBO2 group), 2.0 ATA (41.8%), 2.5 ATA (7.9%), or another pressure (2.4%). The incidence of DNS was 13/171 (7.6%) in the HBO2 group and 3/84 (3.6%) in the NBO2 group (P = 0.212). The number of HBO2 sessions in the first 24 h was one of the factors associated with the incidence of DNS (odds ratio, 2.082; 95% confidence interval, 1.101-3.937; P = 0.024). The practical clinical treatment for acute CO poisoning, including HBO2 therapy, varied among the institutions participating in Japan. HBO2 therapy with inconsistent protocols showed no advantage over NBO2 therapy in preventing DNS. Multiple HBO2 sessions was associated with the incidence of DNS.

The Other Side of SARS-CoV-2 Infection: Neurological Sequelae in Patients.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the globe causing coronavirus disease 2019 (COVID-19). Because it affects the respiratory system, common symptoms are cough and breathing difficulties with fever and fatigue. Also, some cases progress to acute respiratory distress syndrome (ARDS). The acute phase of COVID-19 has been also related to nervous system symptoms, including loss of taste and smell as well as encephalitis and cerebrovascular disorders. However, it remains unclear if neurological complications are due to the direct viral infection of the nervous system, or they appear as a consequence of the immune reaction against the virus in patients who presented pre-existing deficits or had a certain detrimental immune response. Importantly, the medium and long-term consequences of the infection by SARS-CoV-2 in the nervous system remain at present unknown. This review article aims to give an overview of the current neurological symptoms associated with COVID-19, as well as attempting to provide an insight beyond the acute affectation.

Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective.

Background: Neuroinvasive properties of SARS-CoV-2 have allowed the hypothesis of several pathogenic mechanisms related to acute and chronic neurological sequelae. However, neuropathological correlates have been poorly systematically investigated, being retrieved from reports of single case or limited case series still. Methods: A PubMed search was carried out to review all publications on autopsy in subjects with “COronaVIrus Disease-19” (COVID-19). Among them, we focused on histological findings of the brain, which were compared with those from the authors’ autoptic studies performed in some COVID-19 patients. Results: Only seven studies reported histological evidence of brain pathology in patients deceased for COVID-19, including three with reverse transcription–quantitative polymerase chain reaction evidence of viral infection. All these studies, in line with our experience, showed vascular-related and infection-related secondary inflammatory tissue damage due to an abnormal immune response. It is still unclear, however, whether these findings are the effect of a direct viral pathology or rather reflect a non-specific consequence of cardiovascular and pulmonary disease on the brain. Conclusions: Notwithstanding the limited evidence available and the heterogeneity of the studies, we provide a preliminary description of the relationship between SARS-CoV-2 and brain sequelae. Systematic autoptic investigations are needed for accurate detection and adequate management of these patients.

Neurological sequelae in patients with congenital cytomegalovirus

IntroductionThe infection due to cytomegalovirus is the most common congenital infection in developed countries, and one of the main causes of psychomotor impairment and neurosensory hearing loss of infectious origin.The present study has its objectives to describe the clinical-analytical and neuroimaging of patients with secondary neurological sequelae secondary to the congenital cytomegalovirus infection and then compare them with the group of patients with a congenital cytomegalovirus infection that did not have neurological symptoms during their follow-up. Material and methodsA retrospective, observational, cohort study was conducted that included all the cases of congenital cytomegalovirus infection from 2003 until 2018 and the short-medium term neurological sequelae were evaluated. Prenatal, perinatal, and postnatal data of patients with neurological sequelae were compared against those that did not present with any. ResultsA total of 60 patients with congenital cytomegalovirus infection were recorded during the study period, with 65% having neurological involvement during their follow-up period (62.2% with psychomotor impairment, 61.5% with microcephaly, 46.2% loss of hearing, 27.8% motor disorders, 20.5% epilepsy, and 5.6% with chorioretinitis). In the patient group that had sequelae, the presence of clinical symptoms during the neonatal period, as well as changes in the neuroimaging study, were the most common, with both being statistically significant compared to the asymptomatic group. The patients with neurological involvement also had a higher score on the Noyola et alneuroimaging scale. ConclusionsThe symptoms at birth, and certain findings in the neuroimaging, like the changes in the white matter or neuronal migration disorders, could predict neurocognitive sequelae in patients with congenital cytomegalovirus infection.

Demographic characteristics and delayed neurological sequelae risk factors in carbon monoxide poisoning.

Carbon monoxide (CO) is a colorless, odorless gas and tasteless. CO poisoning (COP) is one of the most frequently encountered inhalation poisonings. The most common cause of morbidity in COP is delayed neurological sequelae (DNS). DNS is the occurrence of neuropsychiatric findings within 2-240 days after discharge of patients with COP and there are no definitive diagnostic criteria. The aim of our study is; to determine the risk factors and incidence of DNS. Our study is a retrospective, observational study. Patients with the diagnosis of COP in the emergency department between 2015 and 2016 were included in the study. Patients age, gender, findings in the initial physical examination (PE) and neurological examination (NE), blood carboxyhemoglobin (COHb) level, relation between hyperbaric oxygen (HBO) treatment and DNS were assessed. Total of 72 patients were included in the study. Mean age was 33.43 ± 20.89. It was determined that pathological findings in the initial NE are a significant predictive factor for DNS (Odds ratio 18.600, p:0.004). Significant relation between NE and HBO treatment was present (p:00.1). There was no statistically significant relationship between initial COHb level and receiving HBO treatment (p:0.9). Median COHb level of patients with DNS was 30 (min:10, max: 43), median COHb level of patients without DNS was 25 (min:10, max:44) and there was no statistically significant relationship between the two groups according to COHb levels (p:0.7). Pathological findings in the initial neurological examination had a predictive value for delayed neurological sequelae in patients with carbon monoxide poisoning.

Decompressive craniectomy in malignant middle cerebral artery infarction: family perception, outcome and prognostic factors

BackgroundThe prognosis of one hemisphere malignant infarction creates doubt among neurosurgeons about decompressive hemicraniectomy indication. What results are achieved in the short to medium term? Are families satisfied with the surgery once the patient is at home? In the present study, we analyze our experience in this matter during the last thirteen years. MethodsIn our review, twenty-one patients were included from 2004 to 2017, according to the protocol for the management of ischaemic stroke that is implemented in our institution. The relatives were interviewed by telephone. The functional outcome at discharge, 3 months, 1year, and at present was measured using the modified Rankin scale (mRS). ResultsPatient age was shown to be directly related to the mRS (r=0.56; p=0.035) and 37.5% achieved a good outcome (mRS≤3). 78.9% of the interviewed relatives would repeat the surgical decision. ConclusionWe present a 21 patients group where the best outcome was achieved in patients ≤60 years old. The severe neurological sequelae in patients with malignant infarction subjected to decompressive hemicraniectomy are tolerated and accepted by most families to the benefit of survival. We must not let this family satisfaction hide the prognosis, having to contextualize it within the real ambulatory situation of the patients.

Neurocritical care monitoring of encephalopathic children with acute liver failure: A systematic review.

Research on non-invasive neuromonitoring specific to PALF is limited. This systematic review identifies and synthesis the existing literature on non-invasive approaches to monitoring for neurological sequelae in patients with PALF. A series of literature searches were performed to identify all publications pertaining to five different non-invasive neuromonitoring modalities, in line with PRISMA guidelines. Each modality was selected on the basis of its potential for direct or indirect measurement of cerebral perfusion; studies on electroencephalographic monitoring were therefore not sought. Data were recorded on study design, patient population, comparator groups, and outcomes. A preponderance of observational studies was observed, most with a small sample size. Few incorporated direct comparisons of different modalities; in particular, comparison to invasive intracranial pressure monitoring was largely lacking. The integration of current evidence is considered in the context of the clinically significant distinctions between pediatric and adult ALF, as well as the implications for planning of future investigations to best support the evidence-based clinical care of these patients.

Exposure Duration and History of Hypertension Predicted Neurological Sequelae in Patients with Carbon Monoxide Poisoning.

Carbon monoxide poisoning (COP) accounts for a large number of emergency department visits worldwide and is fatal in many cases. In surviving patients, neurological sequelae (NS) attributable to cerebral hypoxia are the most devastating outcome, but reliable predictors are limited. Therefore, we conducted a study to identify predictors of NS in patients with COP and evaluate their effects. In this retrospective case-control study, we identified patients with COP in a medical center in Southern Taiwan between January 2005 and December 2014. Cases were patients with NS, and controls were patients without NS. We obtained information on potential predictors of NS from medical records and evaluated their association with NS, including demographic characteristics, exposure source, suicide attempts, duration of exposure (by tertile), histories, symptoms, signs, laboratory data, treatment, and the length of hospital stay. We included 371 patients with COP. Of them, 93 developed NS, and their mean ages (41.4 ± 14.7 years vs. 39.7 ± 14.2 years) and proportions of males (59.1% vs. 58.6%) were similar to those in the 298 controls. Multivariate logistic regression showed that a history of hypertension (adjusted odds ratio = 2.1; 95% confidence interval = 1.0, 4.5) and a longer duration of carbon monoxide exposure (adjusted odds ratio = 1.7; 95% confidence interval = 1.1, 2.8; the longest tertile [>5 hours] vs. the other two tertiles [≤5 hours]) were independent predictors for NS, but not the level of carboxyhemoglobin. This study identified two independent predictors for NS that may be useful for public healthcare workers and physicians in predicting outcomes and deciding on treatment strategies for COP patients.

Identification and treatment of bacterial meningitis complications in children

A variety of neurological complications might occur during the course of childhood bacterial meningitis (BM). The incidence rate of neurological sequelae in patients with neurological complications is as high as 30%-50%.Therefore, in order to reduce the mortality and morbidity of childhood BM, it is of great importance to identify the complications as early as possible, standardize the treatment and enhance the understating of prevention and follow-ups. Key words: Bacterial meningitis; Complication; Identification; Treatment