Results Of Neurological Examination Research Articles

Prevalence of Neurological Symptoms and Imaging Findings in Von Hippel-Lindau Patients Referred to Rasool Akram Hospital, 2018-2021.

This study aimed to assess the prevalence of neurological symptoms and related imaging findings in patients with von Hippel-Lindau (VHL) at Rasool Akram Hospital from September 2018 to September 2021. This analytical observational study examined eligible patients over the period from September 2018 to September 2021. We collected demographic information (age, gender) along with imaging findings and results of neurological and eye examinations. Comparison between qualitative variables was also done using the Chi-square test or Fisher's exact test. Also, an independent t-test was used to compare quantitative variables between the two groups. SPSS version 22 software was used for statistical analysis of data. A significant level was considered less than or equal to 0.05. Of the 54 examined patients (48.1% were male and 51.9% were female) with an average age of 36.42 ± 13.37 years. A significant majority (87.0%) reported a positive family history of the disease. The most common type of disease was Type 1 observed in 94.4% of cases and Type 2A was the next most frequent (3.7%). The most common pattern of retinal pathological lesions seen in the examination was related to bilateral lesions (79.6%). The most common pathological finding was related to the presence of a mass in cerebellar magnetic resonance imaging (48.1%). Considering the findings of the present study, which highlight a significant frequency of bilateral retinal lesions as well as masses in the central nervous system and endocrine system, it is evident that patients require careful follow-up and various interventions after being diagnosed with the disease. This approach is essential to manage and potentially mitigate the complications associated with these conditions.

Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation

With the significant increase in the use of extracorporeal membrane oxygenation in patients with severe respiratory failure, cardiogenic shock, and cardiopulmonary resuscitation, complications related to extracorporeal membrane oxygenation are increasingly being taken seriously. Cerebral injury is one of the most serious complications during extracorporeal membrane oxygenation treatment, and is an important factor affecting the hospital mortality rate and long-term quality of life. Due to the use of analgesics, sedatives, and muscle relaxants interfering with neurological physical examination results, cerebral injury that occurs during extracorporeal membrane oxygenation therapy is not easily detected in a timely manner. Therefore, bedside cerebral monitoring has important value in quickly detecting cerebral injury in patients with extracorporeal membrane oxygenation and providing early intervention guidance. Therefore, Extracorporeal Life Support Professional Committee of Chinese Medical Doctor Association organized relevant experts across the country to develop the"Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation", this expert consensus is based on the pathological and physiological mechanisms of cerebral injury in patients with extracorporeal membrane oxygenation. It is based on the current application status of cerebral monitoring technologies such as neurological physical examination, plasma brain injury biomarkers, brain imaging, intracranial pressure, cerebral blood flow, brain oxygen, electroencephalogram, and somatosensory evoked potential. Combining the special clinical application scenarios of extracorporeal membrane oxygenation and integrating the latest evidence-based medical evidence, we have formed 15 consensus recommendations which can be referenced by professionals in critical care medicine, neurology, cardiovascular disease, respiratory and critical care, emergency medicine, and other fields. Given the particularity, complexity, and individual differences of critically ill patients, the recommendations formed by this expert consensus need to implement personalized strategies.

Multifocal motor neuropathy: long-term clinical and electrophysiological features of the disease

Little attention has been paid abroad to the problem of the long-term course of multifocal motor neuropathy (MMN). In our country, catamnestic studies of MMN have not been conducted at all. However, the results of such an analysis are extremely important for understanding the course and prognosis of the disease.Objective: to analyse the clinical and neurophysiological data of patients with MMN with a disease duration of more than 5 years.Material and methods. The study included 28 patients with MMN: 9 women (32%) and 19 men (68%); the median age at admission was 50 [44; 56] years; the median disease duration was 10 [8; 13] years. Medical documentation, medical history, complaints, neurological examination results (scored on the MRC and INCAT scales) and results of electroneuromyography (ENMG) of the long nerves of the hands were analysed.Results. The median time between onset of the disease and diagnosis was 5.5 [2; 10] years. Paresis <3 points on the MRC scale was found in the extensor muscles of the hand and fingers (12/28; 43%), in the median (15/28; 53%) and ulnar (20/28; 71%) muscle groups of the hands, in the extensors (11/28; 39%) and flexors (9/28; 32%) of the feet. The median total score for the degree of disability on the INCAT scale was 3 [2; 3] for the hands and 1 [0; 2] for the legs. The comparative analysis of the severity of the neurological deficits on the MRC and INCAT scales at the onset of the disease and in the long-term catamnesis revealed no significant differences (p>0.05). An objective assessment of sensory disorders revealed no changes when testing tactile, pain and temperature sensitivity, while half of the cases (14/28; 50%) showed a disturbance of vibration sensitivity in the lower extremities. The ENMG examination was consistent with the electrophysiological criteria of the disease, one third of the patients showed significant secondary damage to the axons of the motor fibers of the hand nerves, and in half of the cases a slight impairment of the axons of the sensory fibers was registered.Conclusion. MMN is a curable disease. Unfortunately, our retrospective analysis showed that in the Russian Federation there are problems with its diagnosis and quality care of this category of patients. Late diagnosis, delayed start of treatment and non-compliance with the schedule of pathogenetic therapy lead to persistent disability of patients.

Etiologic distribution of dizziness/vertigo in a neurological outpatient clinic according to the criteria of the international classification of vestibular disorders: a single-center study

ObjectiveThe study aimed to determine the etiological characteristics of patients with dizziness/vertigo attending a neurological clinic according to the criteria of the International Classification of Vestibular Disorders (ICVD), hoping to provide a valuable reference for clinicians to diagnose and treat dizziness/vertigo.MethodA total of 638 consecutive patients with a chief complaint of dizziness/vertigo who attended the vertigo clinic of our neurology department from January 2019 to January 2020 were included. Clinical data of patients, including baseline data, medical history, neurological, neuro-otological, and auxiliary examination results were collected. The etiologic distribution of dizziness/vertigo was determined by analyzing the diagnoses of patients.ResultsOf the 638 patients with dizziness/vertigo, 38.8% were males, 61.2% were females, with a male: female ratio of 1:1.58 and a mean age of 52.9 ± 16.9 years. Benign paroxysmal positional vertigo (BPPV) was the most common cause of dizziness/vertigo in both female (38.9%) and male patients (25.5%). Subgroup analysis based on sex showed that vestibular migraine (VM) and probable autoimmune inner ear disease (p-AIED) were more prevalent in female patients (10.7% and 3.8%, respectively), while vascular vertigo/dizziness was more common in male patients (10.1%). Subgroup analysis based on age showed that the most common diseases were VM in patients aged 0–30 years (27.4%), BPPV in patients aged 31–60 years (27.1%) and 61–100 years (46.0%). Episodic vestibular syndrome (EVS) was the most commonly observed, accounting for up to 60.6% (389/638) of all patients, and the most common diagnoses were BPPV (55.3%, 215/389), VM (15.2%, 59/389), primary unilateral peripheral vestibular dysfunction (p-UPVD) of unknown etiology (11.8%, 46/389), p-AIED (4.4%, 17/389), and vascular vertigo/dizziness (2.8%, 11/389) in these patients. Chronic vestibular syndrome (CVS) was found in 14.0% (90/638) of the patients, and the most common diagnoses were persistent postural-perceptual dizziness (PPPD, 35.6%, 32/90), psychogenic dizziness (18.9%, 17/90), p-UPVD of unknown etiology (15.6%, 14/90), vascular vertigo/dizziness (15.6%, 14/90), and bilateral vestibulopathy (7.8%, 7/90). Acute vestibular syndrome (AVS) was observed in 8.4% (54/638) of the patients, and the most common diagnoses were p-UPVD of unknown etiology (31.5%, 17/54), vestibular neuritis (24.1%, 13/54), probable labyrinthine apoplexy (16.7%, 9/54), stroke (13.0%, 7/54), and psychogenic dizziness (11.1%, 6/54). 16.4% (105/638) of the patients were found to have other disorders, including 15.2% (16/105) of patients with internal diseases, and 84.8% (89/105) of patients with unknown causes. In terms of localization diagnosis, 56.1%, 17.0%, 10.0%, and 16.4% of the patients were diagnosed with peripheral vestibular disorder, central vestibular disorder, psychiatric and functional vestibular disorders, and other disorders, respectively.Conclusion(1) Dizziness/vertigo was more common in females, which was frequently caused by damage to the vestibular system. Non-vestibular or unknown etiologies were also seen in some patients; (2) VM was more prevalent in women than in men, vascular vertigo/dizziness was more commonly observed in men; (3) EVS was more common in patients with dizziness/vertigo. The most common causes of dizziness/vertigo were peripheral vestibular disorders in patients with AVS and EVS, PPPD and psychogenic dizziness in patients with CVS. The most common causes were BPPV and p-UPVD of unknown etiology in patients with a peripheral vestibular disorder, VM and vascular vertigo/dizziness in patients with central vestibular disorder, PPPD and psychogenic dizziness in patients with psychiatric and functional vestibular disorders.

Neurophysiological Factors Associated with Compression and Reflex Mechanisms of Lower Back Pain

Introduction: Vertebrogenic pain syndromes (PSs) in the lower back (LB) are among the most common neurological disorders in the population. Currently, clinical, neurophysiological and neuroimaging characteristics are used as predictors of the course and effectiveness of the treatment for vertebrogenic PSs in the LB.
 Aim: To identify the neurophysiological factors associated with compression and reflex mechanisms of PSs in the LB for their differentiation in complicated diagnostic cases.
 Materials and methods: The study included 73 patients, 43 of them men and 30 women of the mean age 46.5 years. Based on the results of clinical neurological examination and the magnetic resonance imaging data, reflex vertebrogenic PSs (lumboischialgia) were verified in 40 cases, and radiculopathy of L5 and/or S1 (compression vertebrogenic PSs) in 33 cases. The patients underwent stimulation electroneuromyography with record of motor and sensory responses from the lower limbs, of F- and H-response, and examination of heart rate variability.
 Results: Logit regression analysis was used to create models permitting to divide patients into groups with different mechanisms of PSs based on the neurophysiological parameters. The first model demonstrated high sensitivity in the identification of predominantly compression vertebrogenic disorders with the independent factors being the mean F-wave latency and the sensory response amplitude. The second model was more sensitive in identification of reflex PSs with the main predictors being the F-response amplitude and heart rate variability parameters.
 Conclusion: The identified factors reflect the role of conduction disorders in compression PSs, as well as the involvement of segmental motor neuronal apparatus and autonomic regulatory mechanisms in the reaction in reflex PSs, which are additional sources of information in taking medical decisions in complicated diagnostic cases.

Treatment of acute and chronic cervical musculoskeletal pain

Pain in the cervical spine is a widespread condition that significantly disrupts the quality of life, often leads to disability and requires significant economic costs. The most common type of neck pain is nonspecific (vertebrogenic cervicalgia). The most frequent (in 36–67% of cases) anatomical source of nonspecific neck pain is considered to be the lesion of the intervertebral facet joints. Tests to determine the anatomical sources of nonspecific pain are unreliable, in addition, their detection does not significantly affect treatment. Degenerative changes of the spine are often detected during neuroimaging, depend on age, but do not correlate with clinical symptoms and severity of symptoms. In the absence of red flags of anxiety and negative results of neurological examination, neuroimaging or laboratory methods of research are not required. An assessment of prognostic factors is important. Factors contributing to chronization include: female sex, old age, high intensity of pain at the onset of the disease, the presence of psychosocial problems. Modern classifications, the basics of diagnosis, treatment and prevention of nonspecific neck pain are given. Modern effective methods of treatment are physical therapy, manual therapy and psychological programs, a multimodal approach to treatment is optimal. There is a very low level of evidence for electrotherapy, traction, laser therapy, acupuncture, dry needle treatment, thermal or cold procedures. The use of drug therapy is recommended, both separately and in combination with other methods of treatment. The most effective painkillers for neck pain are non-opioid analgesics – NSAIDs and paracetamol. The use of cervical orthosis is not recommended. Clinical cases of patients with acute and chronic nonspecific neck pain are described. The effectiveness of an integrated approach to the management of this category of patients, in accordance with modern recommendations, is shown. The treatment included drug and non-drug methods (therapeutic gymnastics, educational conversation). Dexketoprofen was used as pharmacotherapy according to a step-by-step regimen.

Novel Variants and Phenotypic Heterogeneity in Congenital Insensitivity to Pain (S23.002)

<h3>Objective:</h3> We present novel variants in the <i>SCN9A</i> gene in three cases with congenital insensitivity to pain (CIP), two of whom were siblings. <h3>Background:</h3> CIP is a rare disorder. Patients have no perception of pain against injurious stimuli but are otherwise normal. It is caused by loss-of-function mutations in the <i>SCN9A</i> gene encoding for the T voltage-gated sodium channel Nav1.7. <h3>Design/Methods:</h3> Case 1 was an 18 months old male with recurrent self-injurious behavior and insensitivity to pain and heat. Case 2 was a 15 years old male patient with insensitivity to pain, juvenile arthritis, and inability to gain weight. Case 3 (elder sister) had similar complaints. Parents reported insensitivity to pain decreased with time and that both siblings began to experience pain after age 10. All cases had a normal neurologic examination and electromyography (EMG) result, except they were unresponsive to pain. <h3>Results:</h3> Clinical exome sequencing (CES) from peripheral blood was performed for both cases. <h3>Case 1:</h3> A homozygous frameshift variant (c.2362dupG (c.2362_2363insG) (p.Asp788GlyfsTer4)) was detected in <i>SCN9A</i> which was predicted as pathogenic in <i>in silico</i> databases. <h3>Case 2:</h3> A homozygous frameshift variant (c.3143_3154delTCAGTGGTTTTGinsA (p.Ile1048LysfsTer13)) was detected in <i>SCN9A which</i> was predicted as likely pathogenic in <i>in silico</i> databases. Both variants were not reported previously. The segregation analysis was performed for both cases. Case 2 had an additional intronic SNP (rs4303728), which in one study associated this variant with severe postoperative pain. <h3>Conclusions:</h3> Homozygous and compound heterozygous mutations cause CIP. Partial regain of pain is a unique situation. The variants can be hypomorphic alleles, allowing low levels of Nav1.7- channel function. The inactivating mutation may have an attenuated effect on channel function. Further studies are required to understand the effect of the variants on Nav1.7 channel function. <b>Disclosure:</b> Ms. Ovunc has nothing to disclose. Dr. Kalayci Yigin has nothing to disclose. Dr. Kesriklioglu has nothing to disclose. Gizem Izgi has nothing to disclose. Fitnat Ulug has nothing to disclose. Sema Saltık has nothing to disclose. Prof. Seven has nothing to disclose. Dr. Agirbaslo has nothing to disclose.

Profiles of cognitive impairment in chronic heart failure-A cluster analytic approach.

Cognitive impairment is a major comorbidity in patients with chronic heart failure (HF) with a wide range of phenotypes. In this study, we aimed to identify and compare different clusters of cognitive deficits. The prospective cohort study "Cognition.Matters-HF" recruited 147 chronic HF patients (aged 64.5 ± 10.8 years; 16.2% female) of any etiology. All patients underwent extensive neuropsychological testing. We performed a hierarchical cluster analysis of the cognitive domains, such as intensity of attention, visual/verbal memory, and executive function. Generated clusters were compared exploratively with respect to the results of cardiological, neurological, and neuroradiological examinations without correction for multiple testing. Dendrogram and the scree plot suggested three distinct cognitive profiles: In the first cluster, 42 patients (28.6%) performed without any deficits in all domains. Exclusively, the intensity of attention deficits was seen in the second cluster, including 55 patients (37.4%). A third cluster with 50 patients (34.0%) was characterized by deficits in all cognitive domains. Age (p = 0.163) and typical clinical markers of chronic HF, such as ejection fraction (p = 0.222), 6-min walking test distance (p = 0.138), NT-proBNP (p = 0.364), and New York Heart Association class (p = 0.868) did not differ between clusters. However, we observed that women (p = 0.012) and patients with previous cardiac valve surgery (p = 0.005) prevailed in the "global deficits" cluster and the "no deficits" group had a lower prevalence of underlying arterial hypertension (p = 0.029). Total brain volume (p = 0.017) was smaller in the global deficit cluster, and serum levels of glial fibrillary acidic protein were increased (p = 0.048). Apart from cognitively healthy and globally impaired HF patients, we identified a group with deficits only in the intensity of attention. Women and patients with previous cardiac valve surgery are at risk for global cognitive impairment when suffering HF and could benefit from special multimodal treatment addressing the psychosocial condition.

Results of surgical treatment of children with Chiari I malformation using differentiated intraoperative tactics of choosing the volume of intervention

Despite the presence of numerous publications and analytical reviews in the foreign literature, there is no universally accepted algorithm for the surgical treatment of Chiari I malformation (MC I) in children. Moreover, in the domestic literature, the number of publications devoted to the problems of surgical treatment of MC I in children is significantly limited, which, in our opinion, this is the reason for the relevance of this work. To study the results of surgical treatment of children with MC I when applying differentiated tactics of intraoperative choice of intervention volume. The results of neurological examination and surgical treatment of 43 patients aged from 1 to 17 years (mean age 8.48 years) were analyzed. The decision on the need for duraplasty was made intraoperatively when signs of persisting compression of subarachnoid spaces after extradural decompression were detected. Clinical manifestations were assessed according to neurological data before discharge, as well as in long-term period with a follow-up from 6 months to 5 years via survey. Duraplasty was required in 28% of cases. Respiratory disorders disappeared in all patients immediately after surgery and were absent thereafter. Positive dynamics was noted in terms of restoration of the rate of speech development. Headache persisted in 7 (21%) patients, movement, sensation disorders and cerebellar symptoms - in 4 (12%), vomiting and bulbar symptoms - in 2 (6%) patients. There was no difference in the efficacy of surgery with and without duraplasty. None of the parameters evaluated preoperatively had a significant association with the intraoperative decision on the need for duraplasty. In our opinion, final decision on surgical strategy in children with Chiari malformation type I should be made considering intraoperative assessment of extradural decompression. The last one is probably associated with individual characteristics of patients.

Методы оценки деформации грудного отдела позвоночного столба при кифозе у собак

Kyphotic deformity of the vertebral column is determined by a significant decrease in the ability to support the pelvic limbs, the presence of pain syndrome, and in severe cases, pelvic limb plegia in dogs. The diagnostic component of this disease and the prognosis of surgical intervention, as well as the postoperative course, require the search for an algorithm for controlling the development of the pathological process and performing operations. The study was conducted in order to present a comparative characteristic of methods for measuring kyphotic deformity in the sagittal plane and is based on the observation and surgical treatment of 11 dogs of chondrodystrophic breeds for the period from 2017 to 2020 with a diagnosis of kyphosis of the thoracic spine. The following breeds were under observation: 4 pugs, 5 French bulldogs, 2 Boston terriers. All animals at the time of observation were aged from 9 months to 1,5 years. A comparative evaluation of the Cobb–Lipmann and Ferguson methods for dogs was performed. The analysis was carried out on the basis of the following data: breed, gender, age, body weight, duration of clinical signs until the moment of treatment at the clinic, the results of neurological examination at the initial consultation, the results of magnetic resonance imaging (MRI), computed tomography (CT) and radiography of the thoracic spine. As a result of the study, it was found that the average angles of kyphosis in animals with physiological kyphosis and the absence of neurological deficiency vary from 20 ° to 28 °. In the presence of pronounced deformity and manifestation of neurological deficit of varying degrees, the angle will be from 36 ° to 49 °.

Evaluation of babies with retinopathy of prematurity following intravitreal bevacizumab administration.

In Turkiye, the increased likelihood of survival of small premature babies has resulted in a higher incidence of retinopathy of prematurity (ROP), which causes severe visual impairment in childhood. Early diagnosis and timely and proper treatment of ROP can prevent vision loss. This paper discusses cases of ROP treated with bevacizumab. Patients treated with bevacizumab for ROP were evaluated retrospectively. Systolic and diastolic blood pressure values were recorded 1 day before and 2 weeks after bevacizumab administration. The Bayley III test, hearing test, eye examination, and neurological evaluation were performed. The mean composite Bayley III test scores for cognition, language, motor, social-emotional, and adaptive domains in 10 patients who received bevacizumab for ROP were 75±10.8, 73.4±15.4, 71.2±10.2, 88±23.7, and 65.4±13.8, respectively. The mean values of the day before the injection and the values of the 14 days after the injection were compared, it was seen that there was a significant increase in systolic blood pressure values, especially at the end of 1st day and 1st week after the surgery. Neurological examination results were abnormal in 50% of the cases. Vision problems were detected in 40% of the cases. About 30% of the babies failed the hearing test. Caution needs attention in the care of neonates until further studies of the long-term benefits and effects of bevacizumab therapy are completed.

Clinical course of pediatric gunshot wounds involving the spine and spinal cord: the Miami experience.

Civilian gunshot wounds (GSWs) involving the skeletal spine and spinal cord in pediatric patients are fortunately rare. Nevertheless, their presentation mandates judicious evaluation, and their clinical outcomes remain poorly defined. Thus, the authors aimed to characterize the clinical course of this traumatic presentation in the pediatric population based on their institutional experience. A retrospective review of a level I trauma center database was performed for the period 2011-2021. Clinical data were included for patients aged ≤ 18 years who had presented with radiographic and clinical evidence of a GSW to the spine and had at least one documented follow-up at least 6 months after injury. The primary outcomes of the study were the categorization of gunshot injuries and the results of neurological and functional examinations. A total of 13 patients satisfied the study selection criteria. The mean patient age was 15.7 ± 1.6 years, and all presentations were assault in nature. Most of the patients were male (n = 12, 92%) in gender, Black in race (n = 11, 85%), and from zip codes with a median household income below the local county average (n = 10, 77%). All patients presented with a minimum Glasgow Coma Scale score of 14. Examination at presentation revealed American Spinal Injury Association Impairment Scale (AIS) grade A in 3 cases (23%), grade B in 2 (15%), grade C in 1 (8%), grade D in 2 (15%), and grade E in 5 (38%). Gunshot injury involved all regions of the spine, most commonly the cervical and thoracic spine (n = 6 for each, 46%). In terms of skeletal injury, the most common injuries were to the facet (n = 10, 77%) and the pedicle (n = 8, 62%), with evidence of intracanal injury in 9 patients (69%). Neurosurgical intervention was pursued in 1 patient (8%). Overall, 7 patients (54%) experienced a complication during admission, and the median length of hospitalization was 12 days (range 1-88 days) without any mortality events. Within 90 days from discharge, 2 patients (15%) were readmitted to the hospital for further care. The mean follow-up was 28.9 months (range 6-74 months), by which only 1 patient (8%) had an improved AIS examination; all other patients remained at their initial AIS grade. Pediatric GSWs involving the spine are typically nonfatal presentations, and their long-term functional outlook appears contingent on clinical examination findings at initial presentation. Although neurosurgical intervention is not necessary in most cases, judicious evaluation of radiographic and clinical examinations by a neurosurgical team is strongly recommended to optimize recovery.

Нумулярний головний біль (клінічне спостереження, обговорення)

The purpose of the study was to show the importance of using international diagnostic criteria of headache in neurological practice through description of clinical case of nummular headache. Materials and methods. Complaints, medical history, life history, results of objective and neurological examination, data of laboratory and instrumental research methods in a patient with nummular headache. Results and discussion. Patient G., 53 years old, complained of constant, dull, local, moderate pain in the right parietal area. The headache appeared gradually 5–6 months ago, without any evident triggers. Patient denied autonomic trigeminal signs, nausea, photo- and phonophobia. Painkillers intake was accompanied by a temporary slight decrease of headache intensity. At examination patient pointed to local pain area in the right parietal region that had diameter about 3 cm, rounded shape and clear borders. Neurological status – without abnormalities, except for hyperalgesia in the pain area. The skin and hair in the pain area were not changed, touching the skin in this place caused unpleasant feeling. General and biochemical blood tests, blood glucose, general urine analysis were within reference values; magnetic resonance imaging of the brain was without abnormalities; magnetic resonance imaging of the cervical spine showed osteochondrosis, protrusion of intervertebral discs C5-C6, C6-C7. Additional examination was recommended to the patient: computer tomography of the head (skull bones were unchanged), consultation of a dermatologist (no pathology was found). Finally, it was concluded that patient's condition, according to the international classification of headache disorders of the 3rd revision, corresponds to the diagnosis of “nummular headache”. Gabapentin was prescribed 300 mg per day, followed by increasing of the drug dose by 300 mg every 3 days to a daily dose of 1200 mg or until a significant reduction (disappearance) of headache occurred at the lower gabapentin doses. After 1 week of gabapentin taking, patient reported significant decrease in headache intensity at a daily dose of 600 mg with subsequent headache disappearance at a daily dose of 900 mg. It was recommended to continue gabapentin taking at a dose of 900 mg per day for the next 3 months. After 3 months, the patient reported no headache during the entire period of gabapentin usage. It was recommended to reduce the daily dose of gabapentin by 300 mg every 5 days until the headache recurs or until total discontinuation of drug intake. 1 month later the patient reported no headache since stopping gabapentin intake. Conclusion. Neurologists need to know and actively use in their practice the international diagnostic criteria of nummular headache, that is the basis of adequate management of this rare primary headache

Neurological and Neuroradiological Manifestations in Neonates Born to Mothers With Coronavirus Disease 2019

BackgroundTo investigate the complications that occurred in neonates born to mothers with coronavirus disease 2019 (COVID-19), focusing on neurological and neuroradiological findings, and to compare differences associated with the presence of maternal symptoms. MethodsNinety neonates from 88 mothers diagnosed with coronavirus disease 2019 (COVID-19) during pregnancy were retrospectively reviewed. Neonates were divided into two groups: symptomatic (Sym-M-N, n = 34) and asymptomatic mothers (Asym-M-N, n = 56). The results of neurological physical examinations were compared between the groups. Data on electroencephalography, brain ultrasound, and magnetic resonance imaging abnormalities were collected for neonates with neurological abnormalities. ResultsNeurological abnormalities at birth were found in nine neonates (Sym-M-N, seven of 34, 20.6%). Decreased tone was the most common physical abnormality (n = 7). Preterm and very preterm birth (P < 0.01), very low birth weight (P < 0.01), or at least one neurological abnormality on physical examination (P = 0.049) was more frequent in Sym-M-N neonates. All infants with abnormalities on physical examination showed neuroradiological abnormalities. The most common neuroradiological abnormalities were intracranial hemorrhage (n = 5; germinal matrix, n = 2; parenchymal, n = 2; intraventricular, n = 1) and hypoxic brain injury (n = 3). ConclusionsNeonates born to mothers with symptomatic COVID-19 showed an increased incidence of neurological abnormalities. Most of the mothers (96.4%) were unvaccinated before the COVID-19 diagnosis. Our results highlight the importance of neurological and neuroradiological management in infants born to mothers with COVID-19 and the prevention of maternal COVID-19 infection.

Does Your Bedside Neurological Examination for Suspected Peripheral Neuropathies Measure Up?

SYNOPSIS: Neurological testing is essential for screening and diagnosing suspected peripheral neuropathies. Detecting changes in somatosensory and motor nerve function can also have direct implications for management decisions. Nevertheless, there is considerable variation in what is included in a bedside neurological examination and how it is performed. Neurological examinations are often used as screening tools to detect neurological deficits but not used to their full potential for monitoring progress or deterioration. Here, we advocate for better use of the neurological examination within a clinical reasoning framework. Constrained by the lack of research in this field, our Viewpoint is based on neuroscientific principles. We highlight 6 challenges for clinicians when conducting neurological examinations and propose ways to overcome these challenges in clinical practice. We challenge widely held ideas about how the results of neurological examinations for peripheral neuropathies are interpreted and how the examinations are performed in practice. J Orthop Sports Phys Ther 2023;53(3):107-112. Epub: 28 October 2022. doi:10.2519/jospt.2022.11281.

Neuroprotective Effects of Dexpanthenol on Rabbit Spinal Cord Ischemia/Reperfusion Injury Model

Dexpanthenol (DXP) reportedly protects tissues against oxidative damage in various inflammation models. This study aimed to evaluate its effects on oxidative stress, inflammation, apoptosis, and neurological recovery in an experimental rabbit spinal cord ischemia/reperfusion injury (SCIRI) model. Rabbits were randomized into 5 groups of 8 animals each: group 1 (control), group 2 (ischemia), group 3 (vehicle), group 4 (methylprednisolone, 30mg/kg), and group 5 (DXP, 500mg/kg). The control group underwent laparotomy only, whereas other groups were subjected to spinal cord ischemia by aortic occlusion (just caudal to the 2 renal arteries) for 20min. After 24h, a modified Tarlov scale was employed to record neurological examination results. Malondialdehyde and caspase-3 levels and catalase and myeloperoxidase activities were analyzed in tissue and serum samples. Xanthine oxidase activity was measured in the serum. Histopathological and ultrastructural evaluations were also performed in the spinal cord. After SCIRI, serum and tissue malondialdehyde and caspase-3 levels and myeloperoxidase and serum xanthine oxidase activities were increased (P<0.05-0.001). However, serum and tissue catalase activity decreased significantly (P<0.001). DXP treatment was associated with lower malondialdehyde and caspase-3 levels and reduced myeloperoxidase and xanthine oxidase activities but increased catalase activity (P<0.05-0.001). Furthermore, DXP was associated with better histopathological, ultrastructural, and neurological outcome scores. This study was the first to evaluate antioxidant, anti-inflammatory, antiapoptotic, and neuroprotective effects of DXP on SCIRI. Further experimental and clinical investigations are warranted to confirm that DXP can be administered to treat SCIRI.

NMOSD-Diagnostic Dilemmas Leading towards Final Diagnosis.

(1) Background: The emergence of white matter lesions in the central nervous system (CNS) can lead to diagnostic dilemmas. They are a common radiological symptom and their patterns may overlap CNS or systemic diseases and provoke underdiagnosis or misdiagnosis. The aim of the study was to assess factors influencing the underdiagnosis of neuromyelitis optica spectrum disorder (NMOSD) as well as to estimate NMOSD epidemiology in Lubelskie voivodeship, Poland. (2) Methods: This retrospective study included 1112 patients, who were made a tentative or an established diagnosis of acute or subacute onset of neurological deficits. The evaluation was based on medical history, neurological examination, laboratory and radiographic results and fulfilment of diagnosis criteria. (3) Results: Up to 1.62 percent of patients diagnosed with white matter lesions and up to 2.2% of the patients previously diagnosed with MS may suffer from NMOSD. The duration of delayed diagnosis is longer for males, despite the earlier age of onset. Seropositive cases for antibodies against aquaporin-4 have worse prognosis for degree of disability. (4) Conclusions: Underdiagnosis or misdiagnosis in NMOSD still remains a problem in clinical practice and has important implications for patients. The incorrect diagnosis is caused by atypical presentation or NMOSD-mimics; however, covariates such as gender, onset and diagnosis age may also have an influence.

Fiberoptic laryngoscopic neurological examination of amyotrophic lateral sclerosis patients with bulbar symptoms

ObjectiveBulbar symptoms in amyotrophic lateral sclerosis (ALS) are variable, reflecting bulbar and pseudobulbar palsy. The current study sought to characterize the pharyngeal findings in ALS using a fiberoptic laryngoscope and compare them with the findings of general neurological examination. MethodsWe enrolled ALS patients with bulbar symptoms who were admitted between 2014 and 2020. All participants were evaluated on salivary status, velopharyngeal movement during speech and swallowing, pharyngeal constriction, and vocal cord movement using fiberoptic laryngoscopy. The laryngoscopic findings were compared with general neurological examination results. ResultsA total of 50 patients (31 men; median age: 69 years) were enrolled. Salivary residue in the hypopharynx was the most common abnormal finding on laryngoscopy (40 patients; 80%). Twenty-three patients (46%) exhibited velopharyngeal insufficiency, 18 of which exhibited good velopharyngeal closure in swallowing and poor velopharyngeal closure in speech. Thus, these patients presented speech-swallow dissociation (SSD) in velopharyngeal closure. Five patients (10%) exhibited unilateral weakness of the pharyngeal constrictor muscles in phonation. Compared with general neurological examinations, emotional incontinence was more frequent in patients who presented with SSD in velopharyngeal movement, compared with those who did not. None of the five patients with unilateral weakness of pharyngeal constriction showed curtain movement on examination via the mouth. ConclusionThe specific findings of laryngoscopy in ALS patients, such as SSD in velopharyngeal closure and laterality in pharyngeal constriction, could not be evaluated by general neurological examination via the mouth.

The role of the venous system in the maintenance of cerebral perfusion pressure in acute ischemic stroke

The article analyzes the state of cerebral venous hemodynamics in the acute period of ischemic stroke based on the results of clinical neurological, Dopplerographic, neuroimaging and cerebrospinal fluid examination of patients with different amounts of brain matter damage. Factors for predicting the development of moderate or severe cerebral venous dyscirculation have been identified. Attention is paid to the importance of a comprehensive examination of patients with assessment of cerebral venous blood flow in the acute period of ischemic stroke.

Central cord syndrome: clinical features, etiological diagnosis, and outcome in 74 dogs.

To describe the clinical and neurologic signs, diagnostic investigations, definitive or presumptive diagnosis, treatment, and outcome of dogs presented with acute onset central cord syndrome (CCS). 74 client-owned dogs evaluated for CCS at 5 referral hospitals between January 2016 and March 2021. Data were collected from the medical records of each dog, including patient signalment, physical and neurologic examination results, presence of signs of respiratory failure, diagnostic imaging findings, definitive or presumptive diagnosis, treatment and follow-up information. Descriptive statistics were calculated and bivariable analysis was performed to identify associations between selected variables. 2 neuroanatomic locations for the CCS were identified: C1-C5 spinal cord segments in 65 of 74 (88%) dogs and C6-T2 in 9 (12%) dogs. Neurolocalization did not correlate with the imaging findings in 43 (58%) dogs. Different diseases were associated with CCS. The most common condition was Hansen type I disk herniation in 27 (36%) dogs and hydrated nucleus pulposus extrusion in 16 (22%) dogs. Main lesion locations within the vertebral column associated with CCS were C3-C4 and C4-C5 intervertebral disk spaces in 21 (28%) and 18 (24%) dogs, respectively. Outcome was favorable in 69 (93%) dogs. Patients presenting with hypoventilation were 14.7 times more likely to have a poor outcome. CCS in dogs may be seen with lesions in the C1-C5 and C6-T2 spinal cord segments. Etiologies are variable. Total or partial improvement was achieved in most dogs with the appropriate treatment. Hypoventilation was associated with death.