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Background: Electroacupuncture (EA) has been shown to promote functional recovery after cerebral ischemia–reperfusion (I/R) injury. However, the contribution of mitochondrial dynamics to recovery remains unclear. The aim of this study was to investigate whether mitochondrial dynamics are involved in the effects of EA on cerebral I/R injury. Methods: The rats with cerebral I/R injury were established by the middle cerebral artery occlusion/reperfusion. Subsequently, EA was applied to Baihui (GV20) and Dazhui (GV14) acupoints, with 2 Hz/5 Hz in frequency, 1.0 mA in intensity, 20 min each time, once a day for seven consecutive days. The therapeutic outcomes were assessed by modified neurological severity score (mNSS), 2,3,5-Triphenyte-trazolium chloride (TTC) staining, and hematoxylin-eosin (HE) staining. Mitochondrial morphology was observed under transmission electron microscopy. Adenosine triphosphate (ATP) content and ATP synthases (ATPases) activity were evaluated to measure mitochondrial function using ELISA. Finally, mitochondrial dynamics-related molecules, including dynamin-related protein 1 (Drp1), fission 1 (Fis1), mitofusin 1 (Mfn1), mitofusin 2 (Mfn2), and optic atrophy 1 (OPA1), were detected by Western blot and immunofluorescence staining. Results: Cerebral I/R injury induced neurological dysfunction, cerebral infarction and neuronal injury, all of which were ameliorated by EA. And EA improved mitochondrial morphology and function. Moreover, EA altered the balance of mitochondrial dynamics. Specifically, the data showed a significant decrease in the expression of Drp1 and Fis1, leading to the inhibition of mitochondrial fission. Additionally, Mfn1, Mfn2 and Opa1, which are related to mitochondrial fusion, were effectively promoted after EA treatment. However, sham EA did not show any neuroprotective effects in rats with cerebral I/R injury. Conclusions: In summary, our study indicates that the balance of mitochondrial dynamics is crucial for EA therapy to treat cerebral I/R injury.

Progressive Multifocal Leukoencephalopathy (PML), primarily affecting immunocompromised individuals due to the John Cunningham virus (JC), is common in HIV-positive adults but rare in paediatrics. We present a unique case of a 14-year-old female with PML as the initial manifestation of HIV, with MRI lesions isolated to the posterior fossa. Initial symptoms included fever and rash, progressing to neurological deficits and ataxia. Severe immune suppression due to HIV and JC virus in the cerebrospinal fluid were confirmed. Management included immune reconstitution therapy (antiretroviral treatment) and supportive care. Despite interventions, the patient had a slow recovery with significant residual neurological sequelae. Timely recognition of Immune Reconstitution Inflammatory Syndrome (IRIS) and steroid initiation proved helpful. Antiretroviral therapy improved the survival rate of HIV-related PML, but long-term neurological sequelae, especially in posterior fossa cases, significantly impact the patient's quality of life. This case highlights diagnostic and treatment challenges in paediatric PML, particularly with atypical lesions location.

Acute neurologic deficits in the postoperative period after carotid endarterectomy (CEA) can prompt extensive diagnostic evaluation. Reversible cerebral vasoconstriction syndrome (RCVS) is an underrecognized cause of acute neurologic deficit after CEA. We present the case of RCVS in an 84-year-old male patient who had experienced left limb weakness after CEA, prompting multiple code stroke activations. The present case is novel because the obtained computed tomography perfusion imaging studies demonstrated abnormalities that have not been previously described in patients with RCVS. These findings, combined with the cerebral angiography findings, led to the rapid diagnosis and delivery of intra-arterial vasodilator therapy. He experienced subsequent resolution of his symptoms and radiologic abnormalities.

Summary: Objective: Controversy exists in treatment of thoracolumbar fractures without neurologic deficits. Percutaneous pedicle screw implantation with external frame is a less invasive procedures. This study was conducted to compared outcomes of percutaneous pedicle screws with a novel external fixation (micro-motional adjustable external fixator-MAEF) and open surgery for thoracolumbar fracture without neurologic deficits. Methods: Between October 2017 to October 2018, 42 patients of thoracolumbar fractures without neurologic deficits treated at our trauma center were analyzed retrospectively. The mean age of the patients was 42 years old (range 17–65). Pedicle screw and a novel external frame or open surgery were performed by senior surgeons. Perioperative and radiographic data were collected. Results: There was no significant statistically difference between MAEF and open surgery in demographics and preoperative data. There were statistically significant differences in blood loss intraoperative between the two groups (44.3 ± 15.1 vs 291.1 ± 175.9, p < 0.05). There were statistically significant differences in local kyphosis (LK) (4.9 ± 5.1vs 8.8 ± 5.4, p < 0.05), regional kyphosis (RK) (4.2 ± 3.6 vs 8.3 ± 6, p < 0.05) and segmental kyphosis (SK) (4.3 ± 4.2 vs 8 ± 5.3, p < 0.05) after 12 month between the two groups. There were statistically significant differences in visual analogue scale（VAS） postoperative but 12 month postoperative between the two groups (3.7 ± 1 vs 5.4 ± 0.8, p < 0.05). There were no statistically significant differences in Oswestry disability index（ODI） after 12 months between the two groups (2 ± 1.8 vs 2.7 ± 2.8, p > 0.05). There are 1 complication in MAEF while 3 in open surgery group. Conclusion: The MAEF is a less invasive procedure, which provides reduced bleeding and no necessity of secondary surgery. The technique is effective in the management of thoracolumbar fractures as well as maintaining reduction. It may be a good choice for thoracolumbar fractures without neurological deficits. The translational potential of this article: This study showed that the new spinal external frame was as effective as open reduction and internal fixation in the treatment of thoracolumbar fractures, but had more advantages in postoperative kyphotic deformity. We will continue to investigate its advantages in open fractures, multiple jumping spine fractures and postoperative recovery.

Background: The efficacy of surgical intervention in ameliorating long-term prognosis for moderate volume of cerebral hemorrhage in the thalamus-internal capsule region remains unsubstantiated by clinical investigations. Consequently, the acquisition of credible evidence is imperative to authenticate the effectiveness of these methodologies., Methods: One hundred and three eligible patients with moderate-volume thalamus-internal capsule region cerebral hemorrhage. Twenty-seven pairs of successful matches after using the 1:1 propensity score matching method, totaling 54 patients, were analyzed. The short- and long-term treatment outcomes of patients in the stereotactic surgery and conservative treatment groups were compared. The prognosis of the 2 groups of patients was analyzed by logistic regression analysis and model comparison., Results: The primary outcome of this study was to assess the assessment of daily living scores after 6 months of treatment. Based on the analysis of this study, the assessment of daily living of the surgical group were significantly higher than those of the conservative treatment group after 6 months of treatment (P < 0.001), and the difference was statistically significant. The amount of residual hematoma was significantly lower in the stereotactic surgery group than in the conservative treatment group at 3 days, 7 days, and 2 weeks after the onset of the disease (P < 0.001), and the complication rate was lower than the conservative treatment group (P < 0.05). Univariate logistic regression showed that the risk of severe neurological dysfunction for patients in the surgery group was (odds ratio -0.27, 95% confidence interval: 0.08-0.86, P < 0.05). In multivariate logistic regression analysis, the odds ratio was 0.29 (95% confidence interval: 0.09-0.96, P < 0.05) after adjusting for all covariates., Conclusions: For moderate-volume thalamus-internal capsule region cerebral hemorrhage, stereotactic paracentesis has the advantage of a shorter hospital stay and a lower complication rate than conservative treatment. Moreover, it yields superior outcomes in terms of daily living assessment scores after six months of treatment and enhanced neurological recovery., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Anterior lumbar interbody fusion is a common and well-utilized approach to treatment of lower lumbosacral spondylolisthesis. The authors aim to assess the impact of perioperative neurological deficits on the in-hospital morbidity and mortality. As such, the clinical risk factors leading to perioperative neurological deficits in patients undergoing anterior lumbar interbody fusion are assessed in a large cohort sample from the national inpatient sample (NIS). Methods: Data was collected from the NIS-HCUP, a stratified sample of 20% of all community hospital discharges from the years 1999–2011 was analyzed. Patients who underwent anterior lumbar interbody fusion (ALIF) as their primary procedure were included. Results: The study cohort consisted of 67,900 patients with a mean age of 49.37 years. Approximately 54.96% of the patients were female, 83.60% were white, and 92.62% of the patients were operated on electively. The incidence of perioperative neurological deficit following ALIF was 1.02%. Perioperative neurological deficits were found to independently predict morbidity following ALIF in our multivariable analysis (OR 2.07; CI 1.688 – 2.541) but were not an independent predictor of mortality. Patients with increasing age (OR 1.034; CI 1.027–1.041) and high vWR 5–14 (OR 1.456; CI 1.065–1.990) had an increased risk of having perioperative neurological deficits. Conclusion: Overall, perioperative neurological deficits following ALIF are rare (1.02%), and mortality is extraordinarily rare (0.15%). Patients with older age and higher comorbidities are at increased risk for of perioperative neurological deficit and consequently in hospital morbidity. As such, these results serve to further illuminate the importance of preoperative screening and proper patient stratification.

Objective: The aim of this study is to introduce surgical technique of endoscopic decompression combined with percutaneous pedicle screw fixation (PPSF) for thoracolumbar burst fractures (TLBFs) with neurological deficits and evaluate its efficacy., Methods: A total of 32 patients with TLBFs and neurological deficits who were treated by endoscopic decompression combined with PPSF from June 2018 to August 2019 were included in this study. The effect of decompression was analyzed using canal encroachment ratio, while deformity correction was assessed using the sagittal Cobb angle and the percentage of anterior vertebral height. We also analyzed other clinical outcomes such as visual analog scale, Oswestry Disability Index, and American Spinal Injury Association impairment scale dose., Results: The patients were followed up for an average of 16 months. Our data showed that the patients' mean operation time was 153.75 minutes, the mean intraoperative blood loss was 48.84 mL, and the mean incision length was 7.78 cm. The canal encroachment ratio decreased from 55.91% ± 12.27% to 12.44% ± 3.91% (P < 0.05), sagittal Cobb angle decreased from 17.09° ± 5.46° to 5.72° ± 3.68° (P < 0.05), while the percentage of anterior vertebral height increased from 53.72% ± 8.99% to 83.22% ± 8.21% (P < 0.05). In addition, there was a significant improvement in the visual analog scale score, Oswestry Disability Index, and American Spinal Injury Association impairment scale classification (P < 0.05). Screw fracture occurred only in one patient during follow-up., Conclusions: Endoscopic decompression combined with PPSF in the treatment of TLBFs with neurological deficits is safe and effective, which is a new minimally invasive method for the treatment of such diseases., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

The respiratory and the nervous systems are closely interconnected and are maintained in a fine balance. Central mechanisms maintain strict control of ventilation due to the high metabolic demands of brain which depends on a continuous supply of oxygenated blood along with glucose. Moreover, brain perfusion is highly sensitive to changes in the partial pressures of carbon dioxide and oxygen in blood, which in turn depend on respiratory function. Ventilatory control is strictly monitored and regulated by the central nervous system through central and peripheral chemoreceptors, baroreceptors, the cardiovascular system, and the autonomic nervous system. Disruption in this delicate control of respiratory function can have subtle to devastating neurological effects as a result of ensuing hypoxia or hypercapnia. In addition, pulmonary circulation receives entire cardiac output and this may act as a conduit to transmit infections and also for metastasis of malignancies to brain resulting in neurological dysfunction. Furthermore, many neurological paraneoplastic syndromes can have underlying lung malignancies resulting in respiratory dysfunction. It is essential to understand the underlying mechanisms and the resulting manifestations in order to prevent and effectively manage the many neurological effects of respiratory dysfunction. This chapter explores the various neurological effects of respiratory dysfunction with focus on their pathophysiology, etiologies, clinical features and long-term neurological sequelae., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Intracerebral hemorrhage (ICH) is one of the most severe subtypes of stroke with high morbidity and mortality. Although a lot of drug discovery studies have been conducted, the drugs with satisfactory therapeutic effects for motor paralysis after ICH have yet to reach clinical application. Transient receptor potential vanilloid 4 (TRPV4), a Ca 2+ -permeable cation channel and activated by hypoosmolarity and warm temperature, is expressed in various cell types. The present study investigated whether TRPV4 would participate in the brain damage in a mouse model of ICH. ICH was induced by intrastriatal treatment of collagenase. Administration of GSK1016790A, a selective TRPV4 agonist, attenuated neurological and motor deficits. The inhibitory effects of the TRPV4 agonist in collagenase-injected WT mice were completely disappeared in TRPV4-KO mice. The TRPV4 agonist did not alter brain injury volume and brain edema at 1 and 3 days after ICH induction. The TRPV4 agonist did not show any differences with respect to the increased number of Iba1-positive microglia/macrophages, GFAP-positive astrocytes, and Gr1-positive neutrophils at 1 and 3 days after ICH induction. Quantitative RT-PCR experiments revealed that the TRPV4 agonist significantly upregulated the expression level of c-fos, a marker of neuronal activity, while the agonist gave no effects on the expression level of cytokines/chemokines at 1 day after ICH induction, These results suggest that stimulation of TRPV4 would ameliorate ICH-induced brain injury, presumably by increased neuronal activity and TRPV4 provides a novel therapeutic target for the treatment for ICH., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Please note that all Biochemical and Biophysical Research Communications authors are required to report the following potential conflicts of interest with each submission. If applicable to your manuscript, please provide the necessary declaration in the box above., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Surgical management of thoracolumbar burst fractures is controversial. While the goals of surgical treatment are well accepted (i.e., fracture reduction and stabilization, neural elements decompression, and segmental angular deformity correction), the choice of the best surgical approach (i.e., posterior vs. anterior vs. combined approach) remains controversial. Several studies have debated the advantages of each surgical approach but there is no definitive evidence available to date, particularly in young adult patients. The aim of this study was to assess whether posterior approach alone can be a valid surgical treatment for patient under the age of 40 affected by thoracolumbar burst fractures and incomplete neurological deficits., Material and Methods: A total of 10 consecutive patients affected by thoracolumbar burst fractures associated with incomplete neurological deficits treated at our institution from January 2015 to February 2017 were included in our study. All patients were under the age of 40 at the time of injury and underwent decompression and stabilization using the posterior surgical approach alone. Demographics, clinical, and radiographic parameters were recorded preoperatively, postoperatively and at the latest available follow-up. The minimum follow-up was set at 2 years post-operatively., Results: The mean operative time was 303.6 min (range, 138-486). Average blood loss was 756 mL (range, 440-2100). Nine out of ten patients returned to a normal neurological status after surgery while 1 patient showed some improvement but did not recover completely. Segmental kyphotic deformity improved from a mean of 21.8° before surgery to 14.8° at the time of the last follow-up. The anterior and posterior wall height of the fractured vertebra was restored with an average of 4 mm. The Visual Analogue Scale score reported an improvement from the mean preoperative value of 7.92 to 1.24 at the last follow-up; 8 out of 10 patients resumed physical activity while all of them returned to work., Conclusions: A single posterior surgical approach is an acceptable option in terms of clinical, radiological and functional outcomes at 2 years follow-up in patients under the age of 40 presenting with a thoracolumbar burst fracture and neurological deficit., Competing Interests: Declaration of Competing Interest The authors declare that they received no grants or funding. The authors have no conflicts of interest to disclose., (Copyright © 2019. Published by Elsevier Ltd.)

Introduction: Surgical management of thoracolumbar burst fractures is controversial. While the goals of surgical treatment are well accepted (i.e., fracture reduction and stabilization, neural elements decompression, and segmental angular deformity correction), the choice of the best surgical approach (i.e., posterior vs. anterior vs. combined approach) remains controversial. Several studies have debated the advantages of each surgical approach but there is no definitive evidence available to date, particularly in young adult patients. The aim of this study was to assess whether posterior approach alone can be a valid surgical treatment for patient under the age of 40 affected by thoracolumbar burst fractures and incomplete neurological deficits., Material and Methods: A total of 10 consecutive patients affected by thoracolumbar burst fractures associated with incomplete neurological deficits treated at our institution from January 2015 to February 2017 were included in our study. All patients were under the age of 40 at the time of injury and underwent decompression and stabilization using the posterior surgical approach alone. Demographics, clinical, and radiographic parameters were recorded preoperatively, postoperatively and at the latest available follow-up. The minimum follow-up was set at 2 years post-operatively., Results: The mean operative time was 303.6 min (range, 138-486). Average blood loss was 756 mL (range, 440-2100). Nine out of ten patients returned to a normal neurological status after surgery while 1 patient showed some improvement but did not recover completely. Segmental kyphotic deformity improved from a mean of 21.8° before surgery to 14.8° at the time of the last follow-up. The anterior and posterior wall height of the fractured vertebra was restored with an average of 4 mm. The Visual Analogue Scale score reported an improvement from the mean preoperative value of 7.92 to 1.24 at the last follow-up; 8 out of 10 patients resumed physical activity while all of them returned to work., Conclusions: A single posterior surgical approach is an acceptable option in terms of clinical, radiological and functional outcomes at 2 years follow-up in patients under the age of 40 presenting with a thoracolumbar burst fracture and neurological deficit., Competing Interests: Declaration of Competing Interest The authors declare that they received no grants or founding. The authors have no conflicts of interest to disclose., (Copyright © 2019. Published by Elsevier Ltd.)

Background: Recent literature strongly challenged indications to perform preventive surgery in unruptured arteriovenous malformation (AVM) claiming that invasive AVM treatment is associated with a significant risk of complications and thus conservative management may be a preferable alternative in many patients. On the other hand, the recent improvement of surgical instrumentation and treatment strategies (both surgical and interventional) yielded better outcomes than those achieved only a decade ago. Therefore, even among specialists, a wide variety of opinions, concerning the treatment of unruptured AVM, can be found., Methods: This multicenter retrospective study analyzes a consecutive series of 545 surgically treated AVMs in 10 different hospitals in Italy., Results: Patients with AVMs treated after hemorrhage had an unfavorable (modified Rankin Scale score >1) outcome in more than one third (37.69%) of the cases. Conversely, with proper indications, unruptured AVMs treated preventively have a good outcome in 93.8% of cases, increasing to 95.7%, with no death, if only Spetzler-Martin grades 1-3 are considered (P < 0.05). Outcomes on discharge significantly (P < 0.05) improve at 6 months with the disappearance of many of the initial neurologic deficits that turn out to be transient., Conclusions: In unruptured low-risk AVMs (Spetzler-Martin grades 1-3), over time, the risk of surgery-associated neurologic deficits becomes lower than that linked to spontaneous hemorrhage, with a crossover point at 6.5 years. Because the average bleeding age is less than 45 years, preventive surgery can be advocated to safeguard the patient and overcome the risks associated with the natural history of AVMs., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Neurological deficits noted immediately after childbirth are usually various obstetric neuropathies, but prospective studies are limited. The main study aim was to quantify and describe immediate postpartum neurological deficits of the lower extremity, including the buttocks., Methods: A prospective observational study of postpartum women delivering in a single maternity hospital during three months of 2016. Among 1147 eligible women, 1019 were screened for symptoms of lower extremity numbness or weakness within eight to 32hours of delivery. Consent to undergo a detailed neurological evaluation was sought from those reporting symptoms. Risk factors were identified using logistic regression., Results: Thirty five women (3.4%) reported symptoms, 27 entered the study and 23 (2.0%) had objective signs of a neurological deficit. The most common injuries were mild lumbosacral plexopathies and cluneal nerve compression. Most deficits were sensory, half of these also having a motor deficit that did not impact functionally. Based on analysis of 22 cases involving a likely intrapartum deficit, no association was found with parity, body weight, duration of labour, mode of delivery or neuraxial block. A past history of a neurological condition or a back injury was associated with odds ratios of 7.98 and 4.82 respectively. There were no neurological deficits that were clinically concerning or that were likely a complication of a neuraxial block., Conclusion: Transient neurological complications after labour and delivery are infrequent, mainly sensory involving multiple lumbosacral nerve roots or specific sacral cutaneous nerves, and they typically resolve within a short time., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: The current study compared clinical outcomes of two diverse therapeutic strategies for upper thoracic (T1-4) spinal tuberculosis with neurological deficits in elderly patients., Methods: A retrospective analysis was performed on 18 cases undergoing single-stage posterior transpedicular decompression, debridement, interbody fusion, and instrumentation (Group A). Sixteen cases underwent single- or two-stage anterior debridement, bone grafting, and posterior instrumentation (Group B). The clinical and radiographic results for these patients were analyzed and compared., Results: Patients were followed up for an average of 40.9 ± 4.0 months (range 36-48 months). Results demonstrated that the average operative duration, blood loss, hospital stays, and operative complication rate were lesser for Group A than for Group B. The average fusion time was 8.1 ± 1.5 months and 7.8 ± 2.9 months in Groups A and B, respectively (p>0.05). Cobb's angles were significantly corrected after surgical management, but loss of correction occurred in both groups. All patients had significant postoperative neurological improvement., Conclusions: Single-stage posterior transpedicular debridement, decompression, interbody fusion and instrumentation might be a better surgical treatment compared with combined posterior and anterior approaches. Such techniques may result in fewer complications and a better quality of life for elderly patients., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the efficacy of surgery with neuronavigation compared to conventional neurosurgical treatment of epilepsy in terms of safety and seizure outcomes and to assess the quality of the evidence base of neuronavigation in this clinical context., Method: Systematic review using the electronic databases of Cochrane, CRD, PubMed, Embase, SciELO and LILACS in Portuguese, English and Spanish. The [MeSH] terms included "epilepsy" and "neuronavigation"., Eligibility Criteria: Studies assessing surgery with neuronavigation for the surgical treatment of epilepsy or brain injuries associated with epileptic seizures., Results: We identified 28 original articles. All articles yielded scientific evidence of low quality. Outcome data presented in the articles identified was heterogeneous and did not amount to compelling evidence that epilepsy surgery with neuronavigation produces higher rates of seizure control, a reduced need for reoperations, or lower rates of complications or postoperative neurological deficits., Conclusion: We were unable to find any publications providing convincing evidence that neuronavigation improves outcomes of epilepsy surgery. Whilst this does not mean that neuronavigation cannot improve neurosurgical outcomes in this clinical setting, well-designed research studies evaluating the role of neuronavigation are urgently needed., (Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)