|x||y||x||Euc Dist (mm)||x||y||x||Euc Dist (mm)|
|Demberk et al.||12.50||-12.72||-5.38||3.96 ± 0.3||-12.68||-13.53||-5.38||4.57 ± 0.35|
|Horn et al.||12.42||-12.58||-5.92||3.67 ± 0.29||-12.58||-13.41||-5.87||4.29 ± 0.34|
|Bot et al.||11.83||-11.63||-5.80||4.23 ± 0.3||-12.02||-12.46||-5.78||4.46 ± 0.36|
|Akram et al.||10.83||-13.31||-7.01||3.42 ± 0.23||-11.00||-14.00||-7.00||3.52 ± 0.29|
Intracranial dural arteriovenous fistulas are rare, anomalous connections between a dural artery and a dural venous sinus or cortical vein. These fistulous connections often result in venous hypertension, and can cause headache, seizures, focal neurological deficits and intracranial hemorrhage. It is traditionally believed that these lesions were idiopathic, but a growing body of evidence has overturned this assumption, and now classify dAVFs as acquired lesion. The traditional risk factors of dAVF formation is trauma, intracranial infection, and prothrombotic states, however there have been reports in the literature of meningeal tumors being linked to dAVF formation. The purpose of this study was to examine the published literature on tumor-associated dAVFs, reviewing their presentations, interventions and clinical course, whilst highlighting a case at our own institution.
A comprehensive review of the literature was conducted utilizing Pubmed Medline, Ovid Embase, World of Science and Scholar Databases, with a combination of the following search terms: “dural arteriovenous fistula, sinus, sinus occlusion, tumor, meningioma”. Articles underwent a title/abstract, review, followed by a full text review. Analysis was conducted on the included articles. Areas of interest included tumor classification, sinus involvement, sinus patency, Borden classification, and type of intervention
A total of 38 cases of dural AVFs with concomitant intracranial tumors were identified. The median age was 60, with nearly equal distributions between men and women. (51:49%). The majority of tumors were meningiomas (71%), and involved primarily the transverse sigmoid sinus (52%) followed by the superior sagittal sinus (16%). The majority of cases involved an occlusion (39%) or partial occlusion (24%) of the related sinus. The DAVF were classified as Borden Types I (35%), II (32%) or III (24%). Endovascular treatment was the most common intervention (56%), followed by a combined approach (28%) vs surgery alone (16%). The vast majority underwent tumor resections, and nearly all made favourable recoveries
This is a case of a healthy woman with a history of known parasagittal meningioma followed by serial imaging presented with a generalized tonic-clonic seizure. An MRI revealed enlargement of her known meningioma with extension into the sagittal sinus, and radiographic evidence of a suspected dural AVF. A Borden Type III DAVF was confirmed by digital subtraction angiogram. She was treated through endovascular embolization, and subsequently discharged in stable condition.
The formation of DAVFs is a complex and not entirely understood process. Venous sinus thrombosis +/- venous hypertension have been invoked as precipitating factors. The proposed mechanism is that chronic venous hypertension leads to retrograde cortical venous drainage, venous ectasia, and local ischemia, which promotes angiogenesis.
We have found that involvement of intracranial tumors in this process is relatively rare, but some consistent trends are evident. All of these tumors were dural lesion, with a vast majority being meningiomas. The propensity for menigiomas may simply reflect the natural epidemiology of dural based intracranial lesion, but some authors have proposed that the presence of tumor secreted pro-angiogenic factors such as HIF-1 and VEGF may play a role. We also found that the majority of these cases involved at least a partial occlusion of an involved dural sinus. This underlines the importance of venous obstruction in the formation of these lesions. The majority of these lesions were of higher grade (Grades II or III) and were managed endovascularly, or in conjunction with tumor resection. Nearly all patients made an excellent clinical recovery.
Chronic subdural hematoma (CSDH), although common in the adult and geriatric populations, is a relatively rare condition in pediatric patients. In the pediatric age group, arachnoid cysts and congenital intra-arachnoid malformation of the meninges have been associated with CSDH formation. Treatment of CSDH often involves surgical decompression via burr hole or small craniotomy. The use of middle meningeal artery (MMA) embolization is an emerging endovascular technique being employed in the management of CSDH. Inhibiting blood flow to the outer membrane of the subdural hematoma through endovascular embolization has been shown to reduce recurrence and enhance spontaneous resolution of CSDHs. The use of MMA embolization in the pediatric population is limited and rarely reported. Herein, we describe the use of MMA embolization for symptomatic CSDH associated with an arachnoid cyst in a pediatric patient.
A 14 year old right-handed male presented to the pediatric hospital after a brief episode of dysarthria and word-finding aphasia witnessed by his father. This episode was accompanied by a tingling sensation periorally as well as to his right hand. He had been experiencing intermittent morning headaches over the past 2 weeks, associated with nausea and vomiting. 5 months prior to his presentation, he suffered a head injury while wakeboarding that resulted in what was believed to be a mild concussion. On examination he had a subtle right sided pronator drift, along with subjective complaints of numbness to his right index finger.
The patient was diagnosed with a multiloculated chronic subdural hematoma and was subsequently admitted to the pediatric neurosurgical service and started on Dilantin. He underwent a small left frontoparietal craniotomy for evacuation of the hematoma.
Intra operatively, a well developed, thick external chronic subdural membrane was appreciated. This membrane was incised, expressing a mostly gelatinous, septated chronic subdural hematoma with fluid components under tension. A well developed inner membrane was encountered, and a small window was made within it in order to verify that this did not represent a further loculation. The subdural space was then irrigated, and a drain was placed in the subdural space.
After considering the complex, multiloculated appearance of the CSDH, a middle meningeal artery embolization was offered. A Hybrid microguidewire(Balt Extrusion) within a Maratho microcatheter (Medtronic) for guidance was advanced into the left middle meningeal artery, first into the distal aspect of the posterior division.
The embolization was performed using Squid 12 and Squid 18 (Balt Extrusion, xx) under standard blank roadmap technique. A total of 1.8 cc of Squid was injected into both the left middle meningeal artery, first the posterior division followed by the anterior division. A left external and common carotid angiogram revealed complete obliteration of the left MMA with no residual filling from the adjacent collaterals.
The patient was discharged in stable condition. An MRI was performed as a one month follow up, and demonstrated ongoing resolution of the extra-axial fluid collection (Fig 1). He remains neurologically intact on all subsequent follow ups.
There have been very few reported cases of MMA embolization in the pediatric age group. One report from South Korea outlines a similar presentation of a young adolescent with a recurrent CSDH with an associated arachnoid cyst, the other an infant with bilateral CSDHs secondary to an implanted ventricular assist devise.
Chronic subdural hematoma in the pediatric population is rare. There is a growing body of literature that have identified arachnoid cysts as a risk factor for CSDH in children and young adults. These are intracranial lesions formed from congenital splitting of the arachnoid layers, resulting in accumulation of CSF within this potential space. It has been hypothesized that small bridging vessels travel between the dura and the outer membrane of arachnoid cysts, and this, paired with the relatively low compliance of these cysts compared to brain tissue result in reduced intracalvarial cushioning.
The use of MMA embolization has begun to gain popularity as a treatment for CSDH in adults. The proposed mechanism involved in CSDH recurrence is that local inflammation results in the formation of membranes around the initial acute subdural hematoma. These membranes undergo the process of neovascularization which recruits small, friable blood vessels that subsequently tear and rebleed, forming new and expansile subdural collections. These collections are supplied through the dural branches of the middle meningeal artery. Therefore, this process of neovascularization can be halted through the obliteration of the MMA. Several small case series and double-arm comparison studies have demonstrated a significant reduction in hematoma recurrence rates following embolization of the middle meningeal artery compared to groups treated with surgery alone, although only in adults
Here we report our experience with MMA embolization as an adjuvant therapy for the treatment of a pediatric CSDH. We have found that MMA embolization provides a safe adjuvant therapy in the treatment of CSDH in the pediatric population, lending support to the limited literature of the utility of MMA in this age group. We propose that MMA embolization is safe and potentially efficatious in reducing risk of recurrence in pediatric complex, multi-loculated CSDHs.
Trigeminal neuralgia (TN) is a highly debilitating facial pain that has a considerable negative impact on the quality of life of patients. Gamma Knife radiosurgery (GKRS) for the treatment of refractory trigeminal neuralgia is recognized as an efficient intervention. The CyberKnife radiosurgery (CKRS), a more recent frameless alternative, has not been studied as extensively for this condition.
T1WI MRI forms the basis for diagnosis at present but it faces several limitations. Machine learning algorithms requires less expertise and has comparable diagnostic accuracy.
This systematic review and meta- analysis was performed to compare the diagnostic performance of conventional MRI v/s Machine learning (ML) algorithms for brain tumors.
The study protocol was registered with PROSPERO CRD42021289726.
A Systematic Review of PubMed, EMBASE, Google Scholar and Cochrane databases along with registries (WHO ICTRP and Clinical trials) through 1980-2021 was done.
Inclusion criteria: Original articles in English evaluating Conventional MRI or ML algorithms with/without usage of reference standard (histopathological analysis) were included. The studies which reported sensitivity, specificity or information for creation of a 2 x 2 contingency table were included. Data was extracted by 2 independent reviewers. Meta-analysis was performed using a bivariate regression model.
Twelve studies with 1247 participants were included for systematic analysis and 3 studies for meta-analysis.
ML algorithms had better aggregate sensitivity and specificity (80%, 83.14%) than Conventional MRI (81.84%, 74.78%) in the systematic review.
The pooled sensitivity, specificity, DOR for the meta-analysis were 0.926 (95% CI, 0.840-0.926), 0.991 (95% CI, 0.955-0.998) and 1446.946 (312.634-6692.646) with AUC=0.904 under HSROC.
On comparing, the pooled sensitivity, specificity and DOR for Conventional MRI were 0.866 (95% CI, 0.785-0.920) ,0.995 (95 % CI, 0.927-1.00), and 1191.33 whereas that of Machine learning algorithms at 0.975 (95% CI, 0.920- 0.992) and 0.984 (95% CI, 0.913-0.997) , 2415.74.
Machine learning algorithm have superior diagnostic performance and accurate predictive capability than Conventional imaging for brain tumors.
Bae, S. et al. (2020). Robust performance of deep learning for distinguishing glioblastoma from single brain metastasis using radiomic features: Model development and validation. Scientific Reports, 10(1), 12110.
Gates EDH, Lin JS, Weinberg JS, Prabhu SS, Hamilton J, Hazle JD, et al. Imaging-Based Algorithm for the Local Grading of Glioma. AJNR Am J Neuroradiol. 2020 Mar;41(3):400–7.
One-third of epileptic patients suffer from drug resistant epilepsy (DRE). According to the latest epilepsy classification (2017) by the International League Against Epilepsy (ILAE), immune epilepsy is considered a distinct entity. However, tAutoimmune-associated epilepsy describes a chronic condition with an enduring predisposition to unprovoked seizures and evidence of an immune etiology. It is important to note, that there is no strict timeline to distinguish between acute provoked seizures caused by encephalitis and autoimmune associated epilepsy. In some cases, autoimmune associated epilepsy can develop without preceding autoimmune encephalitis, and can remain undiagnosed for months or years. This study aims to review the definition, diagnosis, risk factors, and treatment of the disease.
Web-based research using the advanced features of different databases such as PubMed, Google.Scholar, Embase, Scopus, and Cochrane electronic databases were done. Major MeSH and other keywords such as prevalence, diagnosis, antibodies, and treatment of temporal lobe epilepsy, autoimmune and encephalitis epilepsy were used. The search was from 2003-2022 limited to studies published in English.
||one point for each of these factors: cognitive decline, behavioral changes, autonomic changes, autoimmune disease, speech disorder, and hyperintense signal changes in the temporal lobe.A positive score of ≥ 2 should be followed by testing for autoimmune antibodies|
|Scoring system created by McGinty et al.||
Older age (≥ 54 years), mood changes, limbic system abnormality on MRI, poor attention, and ictal piloerection, excluding other epilepsy risk factors
was applied to new-onset focal epilepsy in adults to predict the presence of surface-directed antibodies and their effects on patient response to treatment
Noninflammatory, mild pleocytosis or CSF protein elevation may be present
May be normal
Temporal slowing and epileptiform discharges are common and often have a bilateral and beyond temporal distribution
Early in the presentation may demonstrate T2 or FLAIR hyperintensities enlargement of the amygdalae and hippocampi.
Later in the disease, hippocampal atrophy may develop.
FDG-PET may demonistrate hypermetabolism early in the disease
Table 1. summary for investigations.
ACES: The antibodies contributing to focal epilepsy symptoms is scoring system created by de Bruijnet al.
CSF: Cerebrospinal Fluid.
MRI: Magnetic resonance imaging
PET: Positron emission tomography
Multiple sclerosis (MS) is an immune mediated disease of the CNS, characterized by focal inflammatory demyelination, axonal loss and more diffuse neurodegeneration. MS is the most common cause of non-traumatic neurological disease in young adults, and Canada has one of the highest rates worldwide.
An unmet clinical need in the therapeutic management of MS remains the selection of initial treatment. Once patients have been diagnosed2, clinical practices may employ a “treat-to-target” approach, which begins with moderately efficacious drugs and escalates to highly-efficacious therapy3. In contrast, an “early-intensive” approach offers aggressive upfront treatment with high-efficacy therapy at the time of diagnosis. The theory and real-world evidence suggests that early aggressive control of relapsing activity will result in less CNS injury and a better long-term prognosis3. The ongoing prospective MS trials (TREAT-MS; DELIVER-MS) have demonstrated that “early-intensive” therapy results in a longer duration of time to disability and a reduced rate of conversion from RRMS to SPMS4,5.
The objective of this study was to determine whether short-term disability progression was influenced by various Disease Modifying Treatment (DMT) regimens within a Relapsing-Remitting MS (RRMS) patient cohort from the HITMS registry.
With a small population of MS patients and only a relatively short-term longitudinal follow-up, our cohort was unable to demonstrate a significant difference in disability progression in RRMS patients on different DMT regimens. Despite this, trends in the data suggest that RRMS patients on lower-efficacy medications are more susceptible to experience disability progression. Furthermore, this study demonstrates that a higher proportion of RRMS patients are now being prescribed high-efficacy DMT’s, but that a significant proportion of patients remain DMT naive.
|EEG Finding||CTS||PPR||Asymmetric PPD||Asymmetric SS||Overall||Controls|
|Age in years (mean ± SD)||8.0 ± 2.8||11 ± 4.2||8.0 ± 4.0||4.6 ± 4.5||7.9 ± 4.0||7.4 ± 4.3|
|Diagnosed with Epilepsy (%)||95 (92)||29 (85)||12 (50)||23 (77)||155 (81)||88 (90)|
|All children with centrotemporal spikes||1 (0.94-1)||0.70 (0.61-0.77)||0.58 (0.52-0.64)||1 (N/A)|
|Children with normal development and neurological examination and centrotemporal spikes||1 (0.94-1)||0.83 (0.75-0.89)||0.75 (0.66-0.81)||1 (N/A)|
|Children with normal development and neurological examination and unilateral centrotemporal spikes||1 (0.86-1)||0.88 (0.80-0.93)||0.63 (0.51-0.74)||1 (N/A)|
|Children with normal development and neurological examination and bilateral centrotemporal spikes||1 (0.90-1)||0.94 (0.88-0.98)||0.86 (0.73-0.93)||1 (N/A)|
|Genetic generalized epilepsy||0.76 (0.59-0.89)||0.92 (0.85-0.96)||0.76 (0.62-0.87)||0.92 (0.86-0.95)|
|Juvenile myoclonic epilepsy||0.92 (0.64-1.0)||0.82 (0.73-0.88)||0.35 (0.27-0.45)||0.99 (0.94-1.0)|
|Asymmetric photic driving||0.17 (0.07-0.31)||0.80 (0.68-0.90)||0.39 (0.21-0.60)||0.56 (0.52-0.61)|
|Asymmetric sleep spindles||0.44 (0.32-0.58)||0.98 (0.88-1.0)||0.97 (0.80-1.0)||0.56 (0.51-0.62)|
|Parameter||Study Population (n=102)|
|Sex||Male (79), female (23)|
|Presentation to Hospital||Emergency (99), Neurosurgery outpatient (2)|
|History of Trauma||75|
|Medication||Antiplatelet (26), anticoagulant (19)|
|Comorbidities||HNT (45), DM2 (29), CVA (17), CKD (29)|
|GCS on Admission||13.29±2.96|
|Social History||Alcohol (19), smoking (9)|
|Type of CSDH||Primary (94), recurrent (8)|
|Side of CSDH||R (33), L (33), bilateral (34)|
|Size of CSDH (mm)||R (19.09±6.81), L (15.4± 8.3)|
|Cerebral Atrophy Score||0.62±0.79|
|Anesthesia||General (71), conscious sedation (30), undocumented (1)|
||BHC (46, 37 with drain placement), Craniotomy (55, 52 with drain placement), Unknown (1)|
|Peri-procedural Complications (all)||48|
|Peri-operative Morbidity (mRS 4)*||20|
|Outcome||Risk Factors (Univariate Analysis)||Risk Factors (Multivariate Analysis)*|
|Peri-operative Complications||baseline mRS (p=0.006)
|baseline mRS (p=0.022)
|Peri-operative Mortality||anticoagulation (p=0.01)||anticoagulation (p=0.034)
baseline mRS (p=0.063)
|Recurrence||anticoagulation (p=0.09)||anticoagulation (p=0.077)|
Weakness is a frequent reason for consultation in neurological practice, which opens up a wide range of diagnostic hypothesis, where an extensive anamnesis and detailed neurological examination could guide the clinician, however cases such as the one presented here constitute an important diagnostic challenge due to its atypical presentation.
Thereafter, the motor impairment progressed slowly in the right side of the body with hyperreflexia, atrophy, and marked fasciculations in the distal region of the right upper limb and foot drop in the right lower limb.
Subsequently, bulbar and left hemibody deterioration was documented. And finally she died due to respiratory failure after four and a half years since the start of the first symptom. Her relatives decided to donate her brain to the Brainbank of the Neuroscience Group of Antioquia.
Neuropathological studies were performed and showed also a widespread white matter involvement and a significant loss of motor neurons in the primary motor cortex and also in the anterior horn in different levels of the spinal cord (See Figure 2).
The available data is insufficient to discard a motor neuron disease such as ALS. At the moment, neuropathological and imaging findings suggest ML or another atypical presentation of adult-onset leukodystrophies. In order to clarify this clinical scenario an in-depth genetic study could be useful.
Symptomatic carotid stenosis or "Hot Carotid" causes about 15-20% of ischemic stroke and transient ischaemic attacks and is associated with high risk of recurrent stroke
Peri-operative management of Hot Carotids is controversial.
Qualitative study; explore the peri-procedural anti-thrombotic management, imaging and revascularization choices in patients with Hot Carotids
Our findings underscore the heterogeneous management and community equipoise surrounding optimal management of Hot Carotids
Teams designing international carotid trials may wish to accommodate identified variations in practice patterns and take into consideration areas of uncertainty.
Recombinant tissue plasminogen activator safe and effective treatment for acute ischemic stroke.
There is an under-representation of patients with pre-stroke disability in large clinical trials
Thrombolysis vs No Thrombolysis in Patients with Pre-Stroke Disability
•Spinal muscular atrophy (SMA) is a genetic disorder which causes degeneration of the anterior horn cells, subsequently leading to muscle weakness and atrophy.
•In 2017, Health Canada approved intrathecal Nusinersen, to prevent degeneration of the motor neurons in the spinal cord.
•Repetitive injections of nusinersen may be challenging, patricularly in patients with spinal deformities and scoliosis.
•A new surgical technique has been proposed to overcome these challenges by combining two Health Canada approved devices: 1) a catheter designed for intrathecal baclofen pumps and 2) an implantable subcutaneous port designed for intravascular medication administration.
•We report six SMA patients in whom this strategy has been used. We will describe our experiences with these implants.
Our cohort consists of five who had scoliosis implants, therefore complicating repeated lumbar punctures. In one additional patient, there were no scoliosis implants, but due to the patient’s young age, the motivation to place the implant was to avoid the need for repeated sedation to perform the lumbar punctures.
The surgical technique was similar for every patient. A simple incision was made on the anterior chest wall to implant the port. The port used for our cohort was a Medcomp 5 french MRCTI5084SM. The port and catheter placement was individualized to suit the patient’s anatomy. A spinal incision is opened at the desired level and the Medcomp catheter is tunnelled to this spinal incision. For thoracic and cervical catheter placements, a hemi-laminectomy is carried out in order to expose the dura at that level. A Touhey needle is then used to puncture the dura under direct vision. Once CSF is obtained, a Medtronic 8598A is introduced into the thecal sac. Both catheters are then connected and then secured to the facsia using 3-0 vicryl stitches. The port is then accessed, in order to confirm that CSF can be aspirated without resistance, confirming a patent system. A nusinersen dose can be administered intraoperatively if desired. Both incisions are then closed in layers. Typical post-op stay was 2 nights in hospital. Patients may ambulate as tolerated immediately post-op.
|Patient||Age at OR||Catheter insertion||OR time||Scoliosis||Complications|
|Case 1||26||Cervical||186||Yes||Wound seroma requiring readmission and aspiration|
|Case 2||2||Lumbar||115 & 69||No||Catheter was pulled out and required a return to OR for replacement|
|Case 4||19||Thoracic||105||Yes||No CSF return but the system was patent on Myelogram|
•Intrathecal administration of Spinraza can be difficult in patients with spinal deformities and those needing general anesthesia for its administration.
•Administrating the drug through a subcutaneous port and intrathecal catheter is an alternative to repeated lumbar punctures and general anesthesia (for younger patients who require sedation). For patients who have scoliosis implants, this technique avoids the need for floroscopically-guided C1-C2 punctures.
•This case series demonstrated the benefits of using this method and highlighted some of the technical issues that may be encountered during or after the procedure.
•Catheters may be placed in the cervical, thoracic, or lumbar spine, depending on the patient’s anatomy.
Figure 1. Prescription treatment patterns of acute migraine-related medications for patients with ≥1 dispense
|Table 1. Characteristics of our Study Population|
|Quality of life||2.75||±1.39|
|Level of physical activity||1.50||±0.63|
|Mean Cv* of right ulnar nerve at diagnosis (m/s)||41.15||±16.79|
|Greatest reduction in Cv at diagnosis (m/s)||21.85||±10.56|
|Mean CSF** protein value (g/L)||1.21||±0.56|
|Comorbidities (number of patients)|
|Vitamin B12 deficiency||2||-|
|Cancer treated with chemotherapy||2||-|
18 months after the pandemic started:
|Table 2. Reasons Associated with Treatment Change|
|Reason||% of our population||p-value||Cramer's V|
|Worsening of neurological condition||18.8||0.055||0.480|
|Improvement of neurological condition||25||0.021||0.577|
|Perceived reduced treatment availability||6.3||0.302||0.258|
Tables. Poisson regression models for changes in daily stroke call volume, daily acute headache call volume, daily acute stroke <5 hours from symptoms onset call volume, and daily CPSS 3/3 stroke call volume to emergency medical services after each FAST public awareness campaign
Figure 2. Daily calls for stroke to emergency medical services after each individual FAST public awareness campaign
• EEfRT paradigm: generalized estimating equation model outcome variables2 (HR/HE versus LR/LE choices); subjective value (SV), reward (R), probability (P), effort (E), where h = 1
• Identified associations between brain regions related to effort discounting in normal cognitive aging
• Increased willingness to exert effort for reward was associated with enhanced connectivity between ACC and left AI, but not significantly at right AI
• Effect size of effort discounting was greater for connectivity at the ACC seed
• Increased effort discounting is correlated with reduced connectivity between ACC and left AI, as regions characterized in reward-based decision-making processing, to regions within the right superior parietal cortex
• Superior parietal cortex is involved in manipulation of information for working memory and visual attention, as it is closely located to the occipital lobe4
• AI is involved in switching between the salience and default mode network functions; both cluster 1 and 2 are proximal a region involved in the default mode network
• Cerebellar cluster is seeded in the somatosensory A network in parcellation map of the cerebellum5
|N=1,186||N=3,459||N=42,547||N=47,192||C vs G||SA vs G|
|50.7 ± 21.9||42.1 ± 19.2||47.6 ± 23.0||47.3 ± 22.8||<.001||<.001|
|Income(highest) Quintile 5||181 (15.3%)||284 (8.2%)||6,205 (14.6%)||6,670 (14.1%)||ns||<.001|
|Rural||6 (0.5%)||15 (0.4%)||1,528 (3.6%)||1,549 (3.3%)||<.001||<.001|
|Urban||1,177 (99.2%)||3,435 (99.3%)||40,867 (96.1%)||45,479 (96.4%)|
•This preliminary analysis reinforces the underrepresentation of women in neurosurgical trials
•Of the subspecialities, neurotrauma was the most reflective of the participants while spine and cerebrovascular were the least
•Standardized reporting of participant’s race would allow for comparison between authors and participants
•When designing trials, it is important to to consider inclusion of appropriate participants and patient outcomes that reflect the population that is being served
Quantitative and objective neurophysiological assessment can help to define the predominant phenomenology and provide diagnoses with prognostic and therapeutic implications.
To evaluate the indications and final diagnoses of movement disorder neurophysiological evaluations in a specialized movement disorders center.
Reports from 2003 to 11/2021 were reviewed.
A total of 525 reports were evaluated
The mean age of patients was 51 years (range 5 – 89 years), and 50% were women.
More standardized techniques will encourage the widespread use of neurophysiology to evaluate movement disorders.
The ability to detect prions using real-time quaking-induced conversion (RT-QuIC) assays has substantially improved recognition of patients with Creutzfeldt-Jakob disease (CJD), increasing prevalence estimates, broadening appreciation of the spectrum of clinical phenotypes, and permitting diagnoses to be established earlier in the clinical course. However, it is unclear how expanded recognition of affected patients may affect the diagnostic and prognostic relevance of clinical features and diagnostic tests historically associated with sporadic CJD (sCJD).
Mayo Clinic Enterprise search software was used to identify patients diagnosed with CJD from January 2014 to September 2021 at Mayo Clinic (Rochester, MN; Jacksonville, FL; Scottsdale, AZ). Electronic medical records were screened by two authors to identify patients who met criteria for probable (defined according to CDC Criteria) or definite CJD (pathologically- or genetically-confirmed; n=40). Patients with genetic familial prion disease (n=5) or sporadic fatal familial insomnia (n=3) were excluded, yielding 115 patients.
Chronic subdural hematoma (CSDH) is the accumulation of liquified blood products in the space between the dura and the arachnoid. CSDH is a common pathology, particularly in the elderly population, with an incidence of 17.6/100000/year that has more than doubled in the past 25 years in parallel with an aging population. Surgical treatment significantly decreases mortality even in the very elderly (age > 90) population; however, rates of recurrence of 10.1% - 29% are associated with poor outcomes –. Embolization of middle meningeal artery (EMMA) is a novel treatment for CSDH and as a method to decrease rates of CSDH recurrence. The purpose of our study is to report the laterality of EMMA for the management of CSDH in our experience of EMMA for the management of CSDH.
In our series of 20 patients undergoing 20 EMMAs, none of the patients had any clinical or technical complications. At the time of last follow up available, none of these patients had recurrence of the CSDH on the treated side requiring retreatment.
Our data demonstrates a strong predilection for left sided (65% on left vs 20% on right, p=0.005) CSDH. The disproportionate incidence of left sided CSDH has previously been noted in multiple studies across diverse populations , . In a large stroke and TIA population, the incidence of left sided stroke and TIA (57.8% left side) was significantly higher than the rate of left sided MRI evident infarcts (51.9% left side) . The left hemisphere is dominant in the majority of the population and presenting symptoms including dysphasia and confusion (which may be mistaken for expressive/receptive speech impairment) is a frequent presenting complaint. In contrast, non-dominant symptoms including hemineglect, coordination impairment and spatial orientation disturbance are more subtle symptoms that may be missed on examination or not recognized as easily by patients, family and care givers.
Our study demonstrates safety and efficacy of EMMA for management of CSDH in the Canadian health care system.
|Positive predictive value||71%||60%||67%||75%|
|Negative predictive value||84%||98%||94%||93%|
In Canada, 7% of children are born preterm between 29-36 weeks GA. Amongst them, 25-45% will present with developmental delays by 2 years CA. EEG is a non-invasive tool that allows for brain function evaluation and may aid in early identification of newborns at risk for developmental delay.
To determine the EEG features at term equivalent age (TEA) that correlate with the clinical evaluation at TEA, and neuromotor development at 3.5 and 8 months corrected age (CA) in children born preterm between 29-36 wks GA.
Ongoing prospective cohort study of preterm infants born between 29-36 wks GA. 1 hour EEG performed at TEA compared to neurodevelopmental evaluations.
Univariable regression analyses were used, adjusting for BW and PMA at time of EEG, and all variables with a p-value <0.2 were used in a multivariable regression analysis. Variables with a p-value <0.05 were considered significant.
In multivariable analysis, a greater mean EEG discontinuity index <25 mcV and lower occipital alpha power were associated with reduced GMOS at TEA (B -8.34, 95% CI -14.26 ⎯ -2.41, p=0.01; and B 47.30, 95% CI 10.73 ⎯ 83.87, p=0.01). No significant associations were identified between any of the EEG features evaluated at TEA with neuromotor delay at 3.5 or 8 mo. CA.
Further longitudinal neurodevelopmental assessments are needed to better evaluate the prognostic potential of TEA EEG. Comprehensive neurodevelopmental assessments are currently being evaluated at 2 years CA in this cohort.
Special thanks to the neurophysiology technologists and to our participants and their families.
5-aminolevulinic acid (5-ALA) enhances intraoperative high grade glioma (HGG) tissue visualization. Despite promising randomized clinical trial data suggesting survival benefit for 5-ALA-guided HGG surgery, patient outcome efficacy is not universally accepted.
Through systematic review of the literature, this study aims to determine the optimal surgical management of adult thalamic gliomas (ATGs).
Thalamic gliomas present a surgical challenge given their depth of location and proximity to eloquent brain regions. Though an abundance of literature regarding surgical management of thalamic lesions in pediatric populations has been published, little is dedicated solely to management of such lesions in adults.1-2 Currently a range of surgical approaches are employed for ATGs, however no consensus has been reached regarding optimal management.3-5
Literature regarding surgical management of thalamic gliomas in adult patients was reviewed according to the PRISMA guidelines. Four databases were searched for assorted combinations of the keywords “‘thalamic glioma’ AND ‘surgical intervention’ OR ‘thalamic glioma’ AND ‘surgical treatment’” in July 2021 for retrospective, prospective, and randomized clinical trials assessing surgical techniques of thalamic glioma resection.
|Extending anteromedially or mediosuperiorly||Anterior Transcorpus callosal8-10|
|Extending anterosuperiorly||Transfrontal transcortical8|
|Extending laterally||Transfrontal transcortical-transventricular9,10|
|Medial (DM, IML, LD, LP)||Transcorpus callosal8-10|
|Lateral (LD, LP, VL, VPM, VPL)||Precentral interhemispheric transcallosal interforniceal6
Trans-temporal middle gyrus7,8
Transparietal or Transparietal-occipital transcortical6,7
|Extending superiorly||Transparietal or Transparietal-occipital transcortical-transventricular88,9|
|Extending superior laterally||Transtemporal transcortical7|
|Placebo||No Efficacy||Low Efficacy||Moderate Efficacy||High Efficacy|