Neurology Service Research Articles

FRI647 Hemiballismus - A Rare Presentation Of Uncontrolled Diabetes Mellitus Type 2

Abstract Disclosure: C.L. Macrohon: None. M.L. Kanapi: None. Background: Diabetic Striatopathy is a rare disease with a prevalence of 1 in 100,000 and is more commonly seen in elderly women with poor glycemic control. It is an acute movement disorder characterized by sudden, non-purposeful jerking movements secondary to non-ketotic hyperglycemia. This is associated with high-intensity signals on T1-weighted magnetic resonance imaging of the brain noted at the basal ganglia. Case: We have a case of an 80-year old female who came in due to a four-day history of persistent involuntary, non-purposeful jerking of her right upper extremity accompanied by episodes of agitation and visual hallucinations. She has Diabetes Mellitus Type 2 for the past 20 years on Glibenclamide and Metformin. However, self-monitoring of blood glucose revealed fasting glucose levels as high as 300mg/dl. She was asymptomatic hence did not have regular follow-up with her primary care physician. She had no history of previous cerebrovascular disease. Family history was unremarkable. Upon examination, she was disoriented to place but answers appropriately to questions and did not have any speech abnormalities. On inspection it was noted that she had high amplitude involuntary flailing of the right upper extremity accompanied by non-purposeful jerking of her right lower extremity. Initial blood glucose level was 354mg/dl with an Hba1c of 13.7%. Serum ketones was within normal limits with a value of 0.1mmol/L. A plain Magnetic Resonance Imaging of the brain was done which showed a region of T1 weighted hyperintensity with no corresponding abnormal restricted diffusion nor increased susceptibility signals involving the left lentiform nucleus with no evidence of acute infarction nor intracranial hemorrhage noted. At this time, patient was co-managed by Endocrinology and Neurology service with an impression of a Diabetic Striatopathy. For the hemiballism and other neurologic manifestations such as agitation, visual hallucinations and disorientation patient was given risperidone and clonazepam. Blood glucose was then managed through cautious insulin therapy as well as hydration. On the third hospital day, there was noted resolution of right-sided hemiballismus and at this time glycemic control was improved. Conclusion: Proper identification and diagnosis is essential in managing Diabetic striatopathy. Although this may be a rare presentation of uncontrolled diabetes mellitus, clinicians should be aware of the possibility of an acute movement disorder as an unveiling symptom. This shows the importance of prompt blood glucose measurement in these acute cases. Once identified, adequate glycemic control through insulin therapy remains to be the center and most effective therapeutic management for the resolution of these hyperkinetic symptoms. Presentation: Friday, June 16, 2023

Evaluation of aspiration risk by relatives of inpatients in the neurology service: A metaphor analysis.

The risk of aspiration is high in stroke patients due to dysphagia/loss of swallowing. This problem can cause problems affecting the nutrition of patients. Due to the possible risk of aspiration during feeding, patient relatives are hesitant to feed their patients. Because of this fear, malnutrition and hospital readmissions may increase. It is important to evaluate the fear of aspiration risk of relatives of patients hospitalized in the neurology service. The aim of this study is to determine the views of the relatives of patients treated in the neurology service about the risk of aspiration through metaphors. This article analyzed metaphors of patients' relatives' about the risk of aspiration. The analysis uses metaphor identification and analysis. The research sample consisted of 31 patients. First of all, in the study, evaluation of the data was conducted by performing content analysis, as a result of which it was divided into metaphors and conceptual categories, and the relevant field was associated with the text (event, thought, feelings, related in speech or writing). In the reporting of research, the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used. It was seen that the patients' relatives produced 31 different metaphors in response to the statement 'Aspiration risk is like …, because it is …' The patients' relatives mostly compared the concept of 'fear of aspiration' to the concept of 'fear' (n: 24). In this study, relatives mostly described the concept of fear related to the risk of aspiration. According to this result, patients' relatives have a great fear of aspiration increasing the risk of readmission to hospital and of malnutrition. This result shows that informing patients' relatives will increase awareness and will allow them to provide informed care. Collaborated with patients and their relatives regarding the risk of aspiration and contributed to the planning of care for the risk of aspiration.

Using data to understand neurology services

Data, information and research are key to understanding health services and identifying areas for improvement. Without reliable, up-to-date data on activity, outcomes and spending, health and care services cannot be effectively monitored and held to account. Sue Thomas and George Lawton outline how data is currently used, giving examples of how one type of data, Hospital Episode Statistics, can be used. The current transformation of NHS services will require everyone to be data aware. In neurology, the launch of a new online national adult neurology data dashboard will support integrated care boards (ICBs) to monitor key neurological conditions. This is one of the ICB tools being developed for the NHS neurology transformation agenda, which will raise greater awareness of the need for ICBs to ensure neurology has a much greater profile in the future.

Use of Telestroke to Improve Access to Care for Rural Patients With Stroke Symptoms.

Cerebrovascular accident, or stroke, is a common cause of death or disability. Timely diagnosis and intervention are critical for improving survival rates and reducing the long-term effects of stroke. For patients with ischemic stroke, thrombolytic drugs and endovascular intervention are time-sensitive treatment options. Patients living in rural areas often do not have access to rapid consultation with specialized neurologic teams for diagnosis and treatment of stroke. The use of telemedicine in the form of a telestroke consultation can improve timely diagnosis and treatment for rural patients exhibiting stroke symptoms. A telestroke program was implemented in the upper Midwest. A team of 4 interventional neurologists provided telestroke consultation to a comprehensive stroke center and 5 other acute stroke-ready rural hospitals. A tiered stroke alert algorithm and telestroke workflow chart were developed to help health care professionals at rural sites determine eligibility for telestroke consultation. A teleneurologist connected with the originating site, and the National Institutes of Health Stroke Scale could be completed remotely with assistance from the originating site. Telestroke has increased the percentage of patients receiving thrombolytics in less than 60 minutes, and door-to-needle time has decreased. Rural patients with stroke symptoms may experience a delay in care or stroke diagnosis due to distance to specialized neurologic services. Telestroke consultation is a successful method for timely diagnosis of stroke and recommendation for treatment.

Misdiagnosis of Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome in the Emergency Department.

Background Cerebrovascular dysregulation syndromes, posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS), are challenging to diagnose because they are rare and require advanced neuroimaging for confirmation. We sought to estimate PRES/RCVS misdiagnosis in the emergency department and its associated factors. Methods and Results We conducted a retrospective cohort study of PRES/RCVS patients using administrative claims data from 11 states (2016-2018). We defined patients with a probable PRES/RCVS misdiagnosis as those with an emergency department visit for a neurological symptom resulting in discharge to home that occurred ≤14 days before PRES/RCVS hospitalization. Proportions of patients with probable misdiagnosis were calculated, characteristics of patients with and without probable misdiagnosis were compared, and regression analyses adjusted for demographics and comorbidities were performed to identify factors affecting probable misdiagnosis. We identified 4633 patients with PRES/RCVS. A total of 210 patients (4.53% [95% CI, 3.97-5.17]) had a probable preceding emergency department misdiagnosis; these patients were younger (mean age, 48 versus 54 years; P<0.001) and more often female (80.4% versus 69.3%; P<0.001). Misdiagnosed patients had fewer vascular risk factors except prior stroke (36.3% versus 24.2%; P<0.001) and more often had comorbid headache (84% versus 21.4%; P<0.001) and substance use disorder (48.8% versus 37.9%; P<0.001). Facility-level factors associated with probable misdiagnosis included smaller facility, lacking a residency program (62.2% versus 73.7%; P<0.001), and not having on-site neurological services (75.7% versus 84.3%; P<0.001). Probable misdiagnosis was not associated with higher likelihood of stroke or subarachnoid hemorrhage during PRES/RCVS hospitalization. Conclusions Probable emergency department misdiagnosis occurred in ≈1 of every 20 patients with PRES/RCVS in a large, multistate cohort.

Telehealth Use and Access to Neurology Outpatient Clinical Services for Children: An Observational Cohort Study.

Access to neurology services is important for children's well-being. We sought to evaluate the effects of telehealth on pedi-atric neurology appointment outcomes for children. Using electronic health record (EHR) data, information about children with pediatric neurology appointments in a tertiary care children's hospital in North Carolina was collected. Appointment outcomes (completion, cancellation, and no-show rates) were calculated for children who had a neurology appointment scheduled both in the pre-pandemic (March 10, 2019, to March 9, 2020) and pandemic (March 10, 2020, to March 9, 2021) periods. "Telehealth user" was a child who had at least one telehealth appointment scheduled between March 10, 2020, and March 9, 2021. In bivariate and multivariate analyses, we compared appointment outcomes for telehealth users and non-users. EHR data were limited to a single institution and could have missed children's clinical encounters elsewhere. Since this study used secondary data that were not collected for research purposes, it is possible that there were unmeasured confounders. Because of the observational nature of the study, the association between telehealth use and appointment outcomes does not indicate causation. A total of 2110 children had 11,194 pediatric neurology appointments scheduled. Telehealth users compared with non-users were more likely to be White, non-Hispanic, have private insurance, and live farther from the children's hospital. There was a statistically sig-nificant decrease in completion (66% versus 57%) and increase in cancellation (27% versus 33%) and no-show (7% versus 10%) rates in the pandemic when compared to the pre-pandemic period. In the pre-pandemic period, telehealth user and non-user groups had similar cancellation and no-show rates. In the pandemic period, there was a statistically significant decrease in cancellation and no-show rates in the telehealth user group when compared to the non-user group. Pediatric neurology outpatient clinic visits decreased substantially during the pandemic. Telehealth mitigated these problems. Children belonging to a minority race/ethnicity are less likely to use telehealth, increasing their risk of poor access to neurology services.

(Re)constructing identity following acquired brain injury: The complex journey of recovery after stroke.

People with poststroke acquired brain injury (ABI) face a complex and often troubled identity reconstruction journey. The literature is rich with studies related to the psychological and neuropsychological components involved in rehabilitation, but it is lacking with respect to the investigation of the existential dimensions and the challenges associated with finding new senses and meanings for one's identity and future perspectives, body and interpersonal relationships. The aim of this study is to investigate the narrative processes of identity reconstruction after brain damage. Through a qualitative approach, 30 autobiographical narratives about self, body and the relationships with others were collected and analyzed. Semistructured interviews were used for the data collection. Narrative and positioning analysis were applied. Four main positionings emerged: sanctioning a radical break with one's previous life; assuming a sense of salvation and compulsory as well as irreversible adaptation to the limitations associated with one's condition; feeling different and disabled; and considering new possibilities and active constructions of self-being in relationship with others. These results underline the narrative processes of construction of the injury and the identity and delineate possible resources and instruments to improve the clinical practice for health practitioners. They are also valuable for other professionals who deal with neurological services and rehabilitation, such as psychological counselling and support for persons who have experienced ABI and their families. This work resulted from a close collaboration between two universities and a hospital neurological rehabilitation department in the Veneto Region (Northern Italy). Three associations of people with stroke and their families living in the same area contributed to designing the research on the basis of the needs expressed by their members with the aim to identify strategies and devices to be implemented in the public service to improve the care pathway. They also participated in the interpretation of the data.

New Onset Seizures in Hospitalized COVID-19 Patients; A Systematic Review and Meta-Analysis.

Seizures in COVID-19 patients continue to be a common reason for consulting the neurology service in the inpatient setting. This paper assesses the frequency of new onset seizures in adult hospitalized COVID-19 patients. PubMed and EMBASE were searched, with fifteen cohort studies identified to calculate the primary outcome, which was the frequency of new onset seizures in hospitalized COVID-19 patients. An inverse variance meta-analysis of single proportions with a random effects model was applied to these cohort studies to calculate the primary outcome. Risk of bias in individual studies was assessed using the 10-item risk of bias tool for prevalence studies. The meta-analysis revealed a frequency of .71% (95% confidential interval: .32-1.25, I2 = 89%, 147/28242 patients) for acute symptomatic seizures in patients with COVID-19. For secondary outcomes, the risk of seizures in patients who had EEG completed was 8.49% (95% confidential interval: .62-24.07, I2 = 14%, 44/535 patients). Slightly less than half of patients with COVID-19 and seizures were reported to have acute imaging abnormalities (45.7%) with acute vascular insults being commonly reported. Only a small percentage of COVID-19 patients with seizures (2.8%) met the criteria for COVID-19 encephalitis as determined by the international encephalitis consortium. The frequency of seizures in COVID-19 was .71% (95% confidential interval: .32-1.25). Slightly less than half of COVID-19 patients had head imaging abnormalities as a complication of COVID-19 infection. Only a small percentage of patients with seizures and COVID-19 met the criteria for COVID-19 encephalitis.

Specialist epilepsy service input following an epilepsy related unscheduled care episode

BackgroundEmergency and unplanned epilepsy-related attendances are associated with an increased risk of subsequent death within 6 months. Although further work is required to provide a definitive explanation to account for these findings, in the interim it would seem reasonable that services are designed to ensure timely access and provide support at a time of greatest risk.We aim to determine the frequency of patients with epilepsy (PWE) accessing specialist neurology services following an epilepsy-related admission/unscheduled care episode. MethodsPatients were included in the cohort if they had at least 1 prescription for an anti-seizure medication and at least one epilepsy-related admission, emergency department attendance, or outpatient neurology clinic attendance between January 2011 and November 2021.We evaluated the rate of any outpatient neurology clinic attendance in the subsequent 6 months following an epilepsy related unscheduled care episode. ResultsOf the 6,449 PWE included in the cohort, 4,465 were included for analysis. At the end of the follow up period less than 40% were accessing specialist services within 6 months of an episode of admission/ unscheduled care episode. Around a third (31.1%) of deaths occurred within 6 months of an epilepsy-related admission, and in the majority of cases patients were not seen by an epilepsy specialist in the period between discharge and death.The frequency of mental health comorbidity in PWE accessing unscheduled care remains very high with almost 80% having a diagnosis of either depression or anxiety. ConclusionA significant proportion of PWE are not accessing specialist services in a timely manner following an episode of unscheduled care. Such provision may potentially provide an opportunity to reduce epilepsy related mortality by altering antiseizure medication doses and considering reversible factors associated with poor outcomes in PWE, such as poor medication adherence.

Overall and cause-specific mortality in patients with dementia: a population-based cohort study in Taiwan.

Information regarding the underlying causes of death (UCODs) and standardized mortality ratio (SMR) of dementia is instrumental in formulating medical strategies to prolong life in persons with dementia (PWD). We examined the leading UCODs among PWD and estimated the overall and cause-specific SMRs in relation to dementia in Taiwan. Data were retrieved from 2 national datasets: the Taiwan Death Registry and the medical claim datasets of the National Health Insurance program. The observed person-years for each study participant were counted from the date of cohort enrollment to either the date of death or the final day of 2016. Sex-specific and age-specific SMRs were then calculated. The leading UCOD was circulatory disease, accounting for 26.0% of total deaths (n=3,505), followed by respiratory disease at 21.3% (n=2,875). PWD were at significantly increased risk of all-cause mortality (SMR, 2.01), with SMR decreasing with advancing age. A cause-specific analysis revealed that the highest SMRs were associated with nervous system diseases (SMR, 7.58) and mental, behavioral, and neurodevelopmental disorders (SMR, 4.80). Age appeared to modify SMR, suggesting that younger age at cohort enrollment was linked to higher SMRs for nearly all causes of mortality. Circulatory and respiratory diseases were the leading UCODs among PWD. The particularly elevated mortality due to nervous system diseases and mental disorders suggests that allocating more resources to neurological and psychiatric services is warranted. The elevated SMRs of various UCODs among younger PWD underscore the need for clinicians to pay particular attention to the medical care provided to these patients.

Acute flaccid myelitis: not uncommon in rural Uganda?

Acute Flaccid Myelitis is a paralytic illness with significant similarities to poliomyelitis, and which affects predominantly children. It was first fully delineated only in 2014 in the USA, occurring in epidemic clusters with a likely overall increasing incidence. It has subsequently rapidly been identified in Europe, the UK, and Australasia and the Far East, confirming it to be an emerging, global, infectious neurological disease. It has, however, been very little studied in low- and middle-income countries-reflecting partly of the global imbalance in science and medical research, and partly the extremely low provision of neurological care in most low- and middle-income countries: Uganda currently has no specialized neurology services outside the capital Kampala. During extended visits over a 2-year period with involvement in acute adult and paediatric internal medicine, one of us (NS) encountered at least six new patients with acute flaccid myelitis, suggesting that both the geographical reach and the frequency of the disorder may be significantly greater than previously thought. Here, these cases are described together with their clinical features and, where available, course and (limited) investigation results. These observations have significant implications concerning the current, and potentially the future geographical spread of the disease, and its clinical phenomenology. In addition, they highlight serious problems concerning the global applicability of the current Acute Flaccid Myelitis diagnostic criteria.

Headache Disorders in VHA Primary Care: Prevalence, Psychiatric Comorbidity, and Health Care Utilization

Military veterans are at increased risk for headache disorders compared to the general population, yet the prevalence and burden associated with headache disorders among veterans is not yet well understood. In this electronic medical record study, we examined the prevalence of headache disorders among veterans seen in a northeastern network of Veterans Health Administration (VHA) primary care during 2017–2018. We also examined rates of psychiatric comorbidity and health care utilization of veterans with headache disorders for the year following the date of the first headache code in the medical record. Of the total population of veterans in the network, 1.3% had a headache disorder and another 3.5% had a possible headache disorder. Migraine and chronic migraine represented the majority of cases. Posttraumatic stress disorder was the most frequent psychiatric comorbidity. Having a headache disorder was associated with higher rates of primary care, neurology, pain clinic, and mental health service use but not higher rates of emergency department or Whole Health (e.g., patient-centered, holistic health services) use. Prevalence findings are comparable to those previously found among veterans, but a substantial proportion of veterans may have been misdiagnosed. Veterans with headache disorders have high rates of psychiatric comorbidity and use several types of health services at higher rates. Findings highlight the need for interdisciplinary care and further education and support for primary care providers. Primary care settings that integrate evidence-based behavioral and Whole Health services may be an optimal way of providing more holistic care for headache disorders.

Carpal tunnel syndrome in the workplace. Triggers, coping strategies, and economic impact: A qualitative study from the perspective of women manual workers

BackgroundCarpal tunnel syndrome (CTS) may lead to significant work limitations, especially in female manual workers. There is scarce evidence on the perspective of female manual workers with CTS. PurposeTo explore the perspective of female workers who suffer from CTS regarding triggers, coping strategies, and economic impact. Study designA qualitative phenomenological study was conducted involving 18 manual workers with CTS diagnosed by the neurology service of a public hospital. MethodsPurposive sampling was applied, and data were collected using in-depth interviews and researchers' notes. An inductive thematic analysis was applied to identify themes reflecting the participants' experience. Guba and Lincoln criteria were applied to establish the trustworthiness of the data. ResultsThe mean age of participants was 40.06 years (SD 9.86). Four themes were identified: (a) coping with work limitations; (b) work activities that aggravate symptoms; (c) relationships at work; and (d) the economic burden of CTS. The effect of work on CTS, daily constraints, work situations that trigger the symptoms, and the strategies used by participants to adapt to their work are described. In addition, they recounted how relationships with managers and coworkers are modified and how CTS affects family finances. ConclusionsThe findings describe aggravating factors among working women, coping strategies used, and the social and occupational impact of CTS.

Optimizing Neurology Inpatient Documentation: A Pilot Study of a Novel Discharge Documentation EHR Tool.

Clinical documentation of patient acuity is a major determinant of payer reimbursement. This project aimed to improve case mix index (CMI) by incorporating a novel electronic health record (EHR) discharge documentation tool into the inpatient general neurology service at the University of California, Los Angeles (UCLA) Medical Center. We used data from Vizient AMC Hospital: Risk Model Summary for Clinical Data Base (CBD) 2017 to create a discharge diagnosis documentation tool consisting of dropdown menus to better capture relevant secondary diagnoses and comorbidities. After implementation of this tool, we compared pre- (July 2017-June 2019) and post-intervention (July 2019-June 2021) time periods on mean expected length of stay (LOS) and mean CMI with two sample T-tests and the percentage of encounters classified as having Major Complications/Comorbidities (MCC), with Complication/Comorbidity (CC), and without CC/MCC with tests of proportions. Mean CMI increased significantly from 1.2 pre-intervention to 1.4 post-intervention implementation (P < .01). There was a pattern of increased MCC percentages for "Bacterial infections," "Other Disorders of Nervous System", "Multiple Sclerosis," and "Nervous System Neoplasms" diagnosis related groups post-intervention. This pilot study describes the creation of an innovative EHR discharge diagnosis documentation tool in collaboration with neurology healthcare providers, the clinical documentation improvement team, and neuro-informaticists. This novel discharge diagnosis documentation tool demonstrates promise in increasing CMI, shifting diagnosis related groups to a greater proportion of those with MCC, and improving the quality of clinical documentation.

Alcohol-Related Hospitalizations During the Initial COVID-19 Lockdown in Massachusetts: An Interrupted Time-Series Analysis.

The effect of initial COVID-19 pandemic-associated lockdowns on alcohol-related hospitalizations remains uncertain. This study compares alcohol-related hospitalizations at a US Department of Veterans Affairs (VA) system in Massachusetts before, during, and after the initial COVID-19 lockdown. This study is an interrupted time-series analysis at the VA Boston Healthcare System. Participants included all patients hospitalized on the medical, psychiatry, and neurology services at VA Boston Healthcare System from January 1, 2017, to December 31, 2020, excluding those under observation status. The period January 1, 2017, to March 9, 2020, was defined as prelockdown (the reference group); March 10, 2020, to May 18, 2020, was lockdown; and May 19, 2020, to December 31, 2020, was postlockdown. Alcohol-related hospitalizations were determined using International Statistical Classification of Diseases, Tenth Revision primary diagnosis codes. We identified 27,508 hospitalizations during the study periods. There were 72 alcohol-related hospitalizations per 100,000 patient-months during the prelockdown period, 10 per 100,000 patient-months during the lockdown, and 46 per 100,000 patient-months in the postlockdown period. Compared with the prelockdown period, the adjusted rate ratio for daily alcohol-related hospitalizations during lockdown was 0.20 (95% CI, 0.10-0.39) vs 0.72 (95% CI, 0.57-0.92) after the lockdown. A similar pattern was observed for all-cause hospitalizations. Our results suggest that COVID-19 pandemic lockdown measures were associated with fewer alcohol-related hospitalizations. Proactive outreach for vulnerable populations during lockdowns is needed.

The effect of discharge care plans on statin prescription rates.

Stroke discharge care bundles have been proposed to address inadequate provider statin prescription rates. Discontinuation of statins has been associated with a 37% relative risk increase in mortality in patients with a stroke diagnosis. The project site had a statin prescription rate of 86.2%. The project was initiated at a 641-bed regional community teaching medical center. Statin prescription rates upon discharge on patients with the diagnosis of transient ischemic attack or stroke were evaluated and noted to be below the benchmark of 95%. Possible interventions to improve this benchmark were discussed with key stakeholders such as the information technology team, stroke care outcomes team, and neurology service providers. The proposed intervention was incorporated into the electronic health record. Provider prescription rates were tracked monthly along with the use of the proposed intervention. A one-sided z-test was used to analyze the data collected. A stroke discharge power plan within an electronic health record was modified to increase the rate of statin prescriptions. The key modification included checking off the prescription of a statin on discharge. Reinforcement of its use was done through monthly reminders. Use of discharge care plan yielded 100% compliance. Overall compliance was 9.7%. The null hypothesis of the one-sided z-test was 89%. The p-value for all tests was <0.05. The use of a stroke discharge care plan within an electronic health record can positively affect secondary stroke prevention by increasing statin prescription rates.

Estudio de la situación actual del Teleictus en España

IntroductionIn recent years, Telestroke programmes have been established as a fundamental tool for extending acute stroke care to hospitals that lack an on-call neurology service. The main objective of this study is to describe the existence and functioning of the different Telestroke systems and networks (TS) in Spain. MethodWe conducted a cross-sectional study to analyse the current situation of TS in Spain using a structured survey distributed among the members of the Stroke Study Group of the Spanish Society of Neurology. ResultsResponses were received from 12 of the 17 Spanish autonomous communities, of which 10 had implemented TS. In addition, a literature search revealed that 2 other systems were in operation. Twelve of the 17 regions in the country have TS, achieving coverage of at least 20% of the Spanish population. Of these 10 TS, organisation was regional in 7, provincial in 2, and hospital-based in one. Most TS (9) included at least simple CT and angio-CT studies; 4 also included perfusion imaging. Nine TS operated with professional videoconferencing equipment. However, the suboptimal quality of examination via videoconferencing scan was the main problem identified in 50% of TS. Other problems detected are difficulty obtaining data from registries and the transfer of images between hospitals. ConclusionIn recent years, a significant expansion of TS has taken place in Spain, which has improved the accessibility of specialised care in patients with symptoms of acute stroke. This study allows us to describe the different types of TS in Spain and to detect areas for improvement and expansion, and could contribute to defining regional telestroke implementation strategies to offer quality care to the whole population.

Access to Pediatric Neurology training and services worldwide: A survey by the International Child Neurology Association.

Pediatric neurology is the medical subspecialty responsible for diagnosing and managing diseases and disorders of the nervous system in childhood and adolescence. In many, but not all, regions of the world the discipline of pediatric neurology is recognized as a specialty or subspecialty of either Neurology or Pediatrics. Significant knowledge and competencies in this area are necessary to be effective in clinical practice. The need for this is driven by the high burden of disease from neurological conditions in children and the impact on their families.As the first part of a multi-staged project under the auspices of the International Child Neurology Association, in collaboration with key stakeholders, a survey was undertaken to establish which countries have practicing child neurologists. For those countries that have child neurologists, the survey established the number of practitioners, and which countries have access to in-country child neurology training.Responses were obtained from 177 countries. Worldwide there is a median of 0.07 and mean of 0.39 child neurologists per 100 000 population. The greatest deficits in child neurology specialists and access to training were evident in countries which fell under the world bank rating of low income country status (range of 0 to 0.008 child neurologists per 100 000 population). Seventy-three percent of low income countries lack access to child neurologists: the majority are in the African and South-East Asia Regions. For the population of 1.37 billion in the continent of Africa there were 324 child neurologists, equating to median 0.01 per 100 000 population in comparison to a median of 0.59 child neurologists per 100 000 across high income countries. Ninety-four countries had capacity to support in-country pediatric neurology training.Worldwide there are inadequate numbers of child neurologists and great need for increased training capacity.

Studying the Affecting Factors in Patient Workflow and Outcome of Patients with Stroke Diagnosis in the Emergency Department

Objectives: To investigate the factors involved in the assignment and outcomes of patients with stroke referred to the Emergency Department of Imam Reza hospital in Tabriz in 2018. Design: A cross-sectional study. Setting (s): Imam Reza hospital, Tabriz, Iran. Participants: Patients over 60 years of age. Outcome measures: All patients were recorded for admission to discharge, admission to the first visit by the Emergency and Neurosurgery Department, admission to the patient assignment, and patient outcome. The intervals were then calculated from the baseline triage, and the intervals for which the patient was most likely to stay were reviewed and rooted. Results: There was a significant relationship between age, sex, type of stroke, outcome, and hyperlipidemia, but the correlation coefficient was weak. Further, there was a significant difference between triage to assignment and triage to emergency leave with a strong correlation, but there was a significant relationship with the type of stroke, and the correlation coefficient was weak. Moreover, there was a significant relationship between triage to emergency leave and the type of stroke, but the correlation coefficient was weak. Moreover, the relationship between the type of stroke and the outcome was significant with a weak correlation coefficient. Conclusions: One of the causes of delay in the workload of patients with stroke is the high time interval between requesting a neurologic visit to a neurological service visit. The duration of the assignment for stroke patients is less than 6 hours, but it takes more than 6 hours for the patient to leave the emergency room. There is a weak inverse relationship between the type of stroke, the duration of the assignment, and exit from the emergency, meaning that patients with hemorrhagic stroke are assigned with a delay and are discharged from the emergency room later.

Characteristics of cerebral venous thrombosis in patients from two university hospitals in Colombia between 2018-2020

Describir las características clínicas, demográficas y radiológicas, y los factores de riesgo de una serie de pacientes con trombosis venosa cerebral de dos hospitales de Colombia. Materiales y métodos. Es un estudio descriptivo retrospectivo de pacientes hospitalizados, atendidos en el servicio de neurología de dos hospitales de Bogotá desde diciembre de 2018 hasta diciembre del 2020. Se incluyeron 33 pacientes. Las frecuencias más altas correspondieron a mujeres en edad fértil, en puerperio (n=7; 33,3 %) y pacientes con patologías autoinmunes (n=10; 30,3 %). El síntoma inicial más común fue la cefalea (n=31; 93,9 %), seguido de focalización neurológica (n=9; 27,2%) y crisis epiléptica (n=8; 24,2 %). El 51 % (n=17) de los pacientes tuvo un examen físico normal. El infarto venoso cerebral se presentó en el 21,1 % (n=7), la hemorragia subaracnoidea en el 12,1 % (n=4) y el hematoma intraparenquimatoso en el 9 % (n=3) del total de pacientes. El 60,6 % (n=20) quedó con nivel independiente en la escala funcional de Barthel. Ningún paciente falleció. Se encontraron características sociodemográficas, clínicas y radiológicas similares a lo reportado en la literatura mundial. Con respecto a las diferencias, se encontró en nuestro estudio compromiso de la circulación venosa cerebral profunda en un porcentaje ligeramente mayor a lo descrito, pero sin aumento de complicaciones, ni mortalidad.