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Background and purpose: Among the most common post-COVID symptoms, many patients experienced subjective cognitive deficit, commonly named "brain fog," that might be present also in those individuals without severe acute COVID-19 respiratory involvement. Some studies have investigated some of the mechanisms that might be associated with the brain fog with objective techniques including transcranial magnetic stimulation and neuroimaging. Methods: The aim of this study was to investigate the presence of electroencephalographic (EEG) alterations in people with post-COVID self-reported cognitive deficit. Results: Out of the 90 patients attending the post-COVID neurology ambulatory service, twenty patients presenting brain fog at least 4 weeks after acute non-severe COVID-19 infection, and without previous history of epilepsy, were investigated with 19-channel EEG, Montreal Cognitive Assessment (MoCA), and magnetic resonance imaging (MRI). EEG was found altered in 65% of the sample, among which 69% presented a slowing activity and 31% were characterized by epileptic discharges principally in the frontal areas. None of the patients showed DWI MRI lesions. Conclusions: These findings highlight the usefulness of EEG analysis to objectively describe possible neurophysiological abnormalities in post-COVID patients presenting subjective cognitive deficit.

Swallowing disorders are common in neurological diseases, with dysphagia representing one of the most prevalent complications that may cause poor quality of life, reduce independence, and increase mortality. Rapid identification of dysphagia is necessary to reduce the risk of penetration and aspiration, and to early start rehabilitation protocols. Among the methods that can be used to evaluate dysphagia and its components, ultrasound imaging has been suggested to support the evaluation of dysphagia by providing measures of both static and dynamic anatomical components. The aim of this systematic review is to evaluate the usefulness of ultrasonography in neurogenic dysphagia according to current literature. From 2000 to 2020, 633 studies with the appropriate search terms for ultrasound and dysphagia were identified. After screening them, 10 studies were included in the qualitative analysis. Patients with the following neurologic conditions were studied with ultrasonography for dysphagia: Parkinson’s disease, muscle dystrophy, amyotrophic lateral sclerosis, and stroke. The main outcomes of ultrasonography were swallowing muscles thickness (e.g., tongue), and dynamic measures such as hyoid displacement. The different protocols used in the studies, as well as their outcomes, did not allow to provide standard procedures and normative or cut-off values in the presented diseases. Because there are a variety of tools, methods, and techniques that have been used in the studies that were reviewed, it is difficult to evaluate them using established standards. However, ultrasonography correlates well with clinical evaluation of dysphagia and therefore has prognostic and rehabilitation potential. Future studies should aim to develop and utilize a common interdisciplinary protocol that includes standard procedures and outcomes to define normative values applicable in the different conditions.

The autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9–31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p p p p p

This case series describes three patients affected by severe acute respiratory syndrome coronavirus 2, who developed polyradiculoneuritis as a probable neurological complication of coronavirus disease 2019 (COVID‐19). A diagnosis of Guillain Barré syndrome was made on the basis of clinical symptoms, cerebrospinal fluid analysis, and electroneurography. In all of them, the therapeutic approach included the administration of intravenous immunoglobulin (0.4 gr/kg for 5 days), which resulted in the improvement of neurological symptoms. Clinical neurophysiology revealed the presence of conduction block, absence of F waves, and in two cases, a significant decrease in amplitude of compound motor action potential cMAP. Due to the potential role of inflammation on symptoms development and prognosis, interleukin‐6 (IL‐6) and IL−8 levels were measured in serum and cerebrospinal fluid during the acute phase, while only serum was tested after recovery. Both IL‐6 and IL‐8 were found increased during the acute phase, both in the serum and cerebrospinal fluid, whereas 4 months after admission (at complete recovery), only IL‐8 remained elevated in the serum. These results confirm the inflammatory response that might be linked to peripheral nervous system complications and encourage the use of IL‐6 and IL‐8 as prognostic biomarkers in COVID‐19.

Context: Unlike palpable lumps, a large number of nonpalpable testicular lesions found incidentally at ultrasound in asymptomatic postpuberal males are either benign tumours or non-neoplastic lesions. The prevalence of malignancy, however, is appraised based on small case series. Dedicated studies report a large number of patients, and systematic review articles are lacking. Objective: This systematic review is aimed to assess, from the analysis of the pooled data of the available literature, the incidence of benign tumours, malignant tumours, and non-neoplastic lesions, and to identify predictive characteristics for malignancy. Evidence acquisition: A systematic review of PubMed, Scopus, Google Scholar, Turning Research Into Practice (TRIP) database, and the Cochrane Library was conducted on January 6, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Studies were retrieved reporting on adult asymptomatic men, with single, incidentally identified small testicular lesions, either fertile or infertile, with negative tumour markers and without specific risk factors for malignancy. Lesions ≤20 mm were considered small. Seventy-four studies were selected for inclusion in this analysis. Twenty-six additional publications have been retrieved by the bibliography quoted in the selected articles. Evidence synthesis: Pooled data of 1348 lesions in 1348 patients were collected. Of these lesions, 408 could be retrieved individually, 44.6% were benign, 27.2% were malignant, and 20.8% were non-neoplastic. Virtually all lesions 10 mm have a 38.14% probability of being benign. Hyperechoic lesions are likely benign. Fertility status does not affect the risk of malignancy. Conclusions: Very small (

Owing to the large inter-subject variability, early post-stroke prognosis is challenging, and objective biomarkers that can provide further prognostic information are still needed. The relation between quantitative EEG parameters in pre-thrombolysis hyper-acute phase and outcomes has still to be investigated. Hence, possible correlations between early EEG biomarkers, measured on bedside wireless EEG, and short-term/long-term functional and morphological outcomes were investigated in thrombolysis-treated strokes. EEG with a wireless device was performed in 20 patients with hyper-acute (

We report the case of a 70-year-old man coming to our attention for new onset refractory status epilepticus (NORSE) in a rapidly evolving CJD during SARS-CoV-2 co-infection. Our case report describes a fulminant CJD evolution associated with SARS-CoV-2 infection, which led to patient death after 15 days from admission. First EEG presented continuous diffuse spikes, sharp waves and sharp-and-slow wave complexes, pattern consistent with a non-convulsive status epilepticus (NORSE). Our case supports how CJD with SARS-CoV-2 co-infection could be characterized by an accelerated evolution, as already hypothesize for others microorganism infections, and how the diagnosis might be more challenging due to its uncommon presentations, such as NORSE.

Neural networks are dynamic, and the brain has the capacity to reorganize itself. This capacity is named neuroplasticity and is fundamental for many processes ranging from learning and adaptation to new environments to the response to brain injuries. Measures of brain plasticity involve several techniques, including neuroimaging and neurophysiology. Electroencephalography, often used together with other techniques, is a common tool for prognostic and diagnostic purposes, and cortical reorganization is reflected by EEG measurements. Changes of power bands in different cortical areas occur with fatigue and in response to training stimuli leading to learning processes. Sleep has a fundamental role in brain plasticity, restoring EEG bands alterations and promoting consolidation of learning. Exercise and physical inactivity have been extensively studied as both strongly impact brain plasticity. Indeed, EEG studies showed the importance of the physical activity to promote learning and the effects of inactivity or microgravity on cortical reorganization to cope with absent or altered sensorimotor stimuli. Finally, this chapter will describe some of the EEG changes as markers of neural plasticity in neurologic conditions, focusing on cerebrovascular and neurodegenerative diseases. In conclusion, neuroplasticity is the fundamental mechanism necessary to ensure adaptation to new stimuli and situations, as part of the dynamicity of life.

Neural networks are dynamic, and the brain has the capacity to reorganize itself. This capacity is named neuroplasticity and is fundamental for many processes ranging from learning and adaptation to new environments to the response to brain injuries. Measures of brain plasticity involve several techniques, including neuroimaging and neurophysiology. Electroencephalography, often used together with other techniques, is a common tool for prognostic and diagnostic purposes, and cortical reorganization is reflected by EEG measurements. Changes of power bands in different cortical areas occur with fatigue and in response to training stimuli leading to learning processes. Sleep has a fundamental role in brain plasticity, restoring EEG bands alterations and promoting consolidation of learning. Exercise and physical inactivity have been extensively studied as both strongly impact brain plasticity. Indeed, EEG studies showed the importance of the physical activity to promote learning and the effects of inactivity or microgravity on cortical reorganization to cope with absent or altered sensorimotor stimuli. Finally, this chapter will describe some of the EEG changes as markers of neural plasticity in neurologic conditions, focusing on cerebrovascular and neurodegenerative diseases. In conclusion, neuroplasticity is the fundamental mechanism necessary to ensure adaptation to new stimuli and situations, as part of the dynamicity of life.

New findings What is the central question of this study? Ageing impairs the skin's thermal and tactile sensitivity: does ageing also induce loss of skin wetness sensitivity? What is the main finding and its importance? Older adults show an average 15% loss of skin wetness sensitivity, with this sensory deficit being mediated by a combination of reductions in skin's tactile sensing and hydration status. These findings increase knowledge of wetness sensing mechanisms across the lifespan. Abstract Humans use sensory integration mechanisms to sense skin wetness based on thermal and mechanical cues. Ageing impairs the skin's thermal and tactile sensitivity, yet we lack evidence on whether wetness sensing also changes with ageing. We mapped local skin wetness and temperature sensitivity in response to cold-, neutral- and warm-wet stimuli applied to the forehead, neck, lower back, dorsal foot, index finger and thumb, in 10 Younger (22.4 ± 1.1 years) and 10 Older (58.2 ± 5.1 years) males. We measured local skin temperature and conductance (i.e., a marker of hydration status) at the tested sites, to establish the role of skin's thermal and mechanical parameters in ageing-induced changes in wetness sensing. Irrespective of body site, Older reported overall lower wetness perceptions than Younger across all wet-stimulus temperatures (mean difference: -14.6 mm; 95% CI: -4.3, -24.9; P = 0.008; ∼15% difference). When considering regional wetness sensitivity, the effect of ageing was more pronounced in response to the cold-wet stimulus over the lover back (mean difference Older vs. Younger: -36.8 mm; 95% CI: -68.4, -5.2; P = 0.014; ∼37% difference) and dorsal foot (mean difference: -37.1 mm; 95% CI: -68.7, -5.5; P = 0.013; ∼37% difference). We found no differences between age groups on overall thermal sensations (P = 0.744) nor local skin temperature (P = 0.372); however, we found that Older presented overall lower skin conductance than Younger (mean difference: -1.56 μS; 95% CI: -0.49, -2.62; P = 0.005), which corresponded to an ∼78% reduction in skin hydration. We conclude that skin wetness sensing decreases with ageing primarily due to age-induced changes in skin mechanics and tactile sensitivity.

Objective: Advanced neuroimaging has proved to be pivotal in the management of acute ischemic stroke. The use of CT perfusion (CTP) core and penumbra parameters to predict the outcome in wake-up stroke (WUS) patients in everyday clinical scenarios has not yet been investigated. The aim of our study was to investigate the predictive power of CTP parameters on functional and morphological outcomes in WUS patients treated with recombinant tissue plasminogen activator (rTPA). Approach: We analyzed clinical data and processed CTP images of 83 consecutive WUS patients treated with rTPA. The predictive power of whole-brain CTP features and of the clinical stroke-related parameters to predict the National Institutes of Health Stroke Scale (NIHSS) score at the seventh day and ischemic lesion volume outcome was investigated by means of multivariate regression analysis as well as least absolute shrinkage and selection operator (LASSO) modeling. Main results: Multivariate analysis showed that CTP core volume (β = 0.403, p = 0.000), NIHSS at admission (β = 0.323, p = 0.005) and Alberta Stroke Program Early CT (ASPECT) score (β = -0.224, p = 0.012) predict NIHSS at 7 days, while total hypoperfused volume (β = 0.542, p = 0.000) and core volume on CTP (β =0.441, p = 0.000) predict infarct lesion volume at follow-up CT. The LASSO modeling approach confirmed the significant predictive power of CTP core volume, total hypoperfused CTP volume, NIHSS at baseline and ASPECT score, producing a sparse model with adequate reliability (the root mean square error on a previously unseen testing dataset was 3.68). Significance: Our findings highlight the importance of CT multimodal imaging features for decision-making and prediction in the hyperacute phase of WUS. The predictive model supports the hypothesis that an irreversible necrotic core rather than the extent of the penumbra is the main prognostic factor in WUS patients treated with rTPA.

Background and purpose: Diagnosis of posterior circulation stroke may be challenged. National Institutes of Health Stroke Scale (NIHSS) and brain imaging (non-contrast brain computed tomography-CT) are used for diagnosis; evaluation on posterior circulation stroke remains a limit of NIHSS, and the value of non-contrast CT (NCCT) is limited due to artifacts caused by the bones of the base of the skull. We tested the validity and prognostic value of posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) in patients with posterior circulation stroke. Methods: Pc-ASPECTS allots the posterior circulation 10 points. We studied 50 patients with posterior circulation stroke. We applied pc-ASPECTS to NCCT, CT angiography, and CT Perfusion. We evaluated the correlation of pc-ASPECT with outcome parameters for stroke. Results: Out of 50 patients, CTP showed abnormalities in 34 cases. The pc-ASPECT score calculated on brain CT and on the brain CT + angio CT had a sensibility of 24%, calculated on brain CT, angio CT and CTPerfusion gain a sensibility of 72%. Pc-ASPECT MTT resulted to be the more reliable parameter: outcome given by NIHSS score at discharge, mRS at discharge, and at 3 months was more severe in patients with Pc-ASPECT MTT alteration. Outcome given by NIHSS score at discharge and mRS at discharge and 1 at 3 months was more severe in patients with higher NIHSS score at admission. Conclusion: We evaluated the usefulness of pc-ASPECTS on CTP in predicting functional outcome in acute posterior circulation stroke that appears to be a powerful marker for predicting functional outcome.

Purpose: Heat sensitivity is a common contraindication in people with Multiple Sclerosis (pwMS), and physical fatigue is one of the most frequently reported symptoms that can affect quality of life. Increases in body temperature may exacerbate fatigue and heat-related symptoms. Decreasing body temperature via cooling devices may mitigate disease symptoms and improve physical abilities and quality of life. This study evaluates the effects of a cooling vest with sham condition on walking capacity using a commercially-available cooling vest specifically designed for pwMS. Methods: A counter-balanced, cross-over design was used to assess the effects of a cooling vest (CryoVest Comfort, CryoInnov, France) (COLD) from a menthol-induced sham condition (CON) on ground walking time to exhaustion (Tex, s) and distance at exhaustion (Dex, m) in ambulatory pwMS. Secondary outcomes were heart rate (HR, bpm), thermal sensation (Tsens), skin chest (Tchest) and back (Tback) temperature. Results: Ten females with Multiple Sclerosis (59 ± 9 years, EDSS 3.0–5.5) participated to the study. During COLD, pwMS walked significantly longer (1896 ± 602 vs. 1399 ± 404 s, p < 0.001) and farther (1879 ± 539 vs. 1302 ± 318 m, p < 0.001) than CON. Importantly, Tsens and HR at exhaustion were not significantly different between conditions, although Tchest (− 2.7 ± 1.8 °C, p < 0.01) and Tback (− 3.9 ± 1.8 °C, p < 0.001) were lower at volitional fatigue during COLD. Conclusion: The lightweight cooling vest improved total walking time and distance in heat-sensitive pwMS. These physiological improvements were likely due to feeling perceptually cooler in the COLD trial, compared to the corresponding point of fatigue in the CON condition.

Prognosis in Wake-up ischemic stroke (WUS) is important for guiding treatment and rehabilitation strategies, in order to improve recovery and minimize disability. For this reason, there is growing interest on models to predict functional recovery after acute ischemic events in order to personalize the therapeutic intervention and improve the final functional outcome. The aim of this preliminary study is to evaluate the possibility to predict a good functional outcome, in terms of modified Rankin Scale (mRS ≤ 2), in thrombolysis treated WUS patients by Bayesian analysis of clinical, demographic and neuroimaging data at admission. The study was conducted on 54 thrombolysis treated WUS patients. The Variational Bayesian logistic regression with Automatic Relevance Determination (VB-ARD) was used to produce model and select informative features to predict a good functional outcome (mRS ≤ 2) at discharge. The produced model showed moderately high 10 × 5-fold cross validation accuracy of 71% to predict outcome. The sparse model highlighted the relevance of NIHSS at admission, age, TACI stroke syndrome, ASPECTs, ischemic core CT Perfusion volume, hypertension and diabetes mellitus. In conclusion, in this preliminary study we assess the possibility to model the prognosis in thrombolysis treated WUS patients by using VB ARD. The identified features related to initial neurological deficit, history of diabetes and hypertension, together with necrotic tissue relate ASPECT and CTP core volume neuroimaging features, were able to predict outcome with moderately high accuracy.

Objective A very high-resolution (70 MHz) ultrasound device (VHRUS) has recently been approved for use in humans. The aim of this study was to use VHRUS to collect data on healthy subjects to propose some reference values for the digital branches of the median nerves of the hand. Methods A VHRUS with 70 MHz linear array transducer was used to measure the cross sectional area of the median nerve at the wrist (CSAw) and digital branches (CSAf), largest and smallest fascicles, the fascicles number (Nfasc), the fascicle density (FD), the flattening ratio (FR) and CSAw/CSAf. Results Data from 20 healthy subjects were obtained for both hands. The median nerve at the wrist and digital branches were properly identified without anatomical alterations. No differences were found between the right and the left hand. In the dominant hand, CSAw was 9.35 mm2 (4.57–12.35) and Nfasc was 24 (18–38). FD and FR were respectively 2.94 (2.47–4.91) and 2.74 (1.70–4.90). Conclusion VHRUS technology can visualize the median nerves at the wrist, their internal structure and their small branches at the fingers, providing both a qualitative and quantitative assessment. Results from this study provide preliminary reference values in a young healthy sample. Significance Most conventional ultrasound devices are not able to properly visualize the distal branches of the median nerve. In contrast, VHRUS allows to detect and measure smaller structures of the nerve, assisting in clinical practice.