Search

Purpose: Participation in Brazilian jiu-jitsu and mixed martial arts has increased over the last three decades. These sports feature submission attacks, including strangles. These strangles, termed "chokes" in this context, primarily limit blood flow to the brain via compression of neck vasculature. There has been discussion in literature of the possibility of measurable cognitive effects following transient choking episodes. The present study used the King-Devick test (KDT) platform, a tablet-based reaction time and accuracy task designed to measure participants' number recognition, cognition, and verbal expression. This task requires functional vision, saccadic eye movements, comprehension, and expression., Methods: Volunteer participants were screened for exclusion (prior brain injury) criteria and survey information before testing. Athletes were tested with the KDT immediately before a Brazilian jiu-jitsu training session, again immediately after succumbing to either a choke ("Choke" arm) or nonchoke ("Non-Choke" arm) submission while sparring, and again after a 10-min rest period following the postsubmission test. Analysis was done on test failures, total test times, and individual difference scores between baseline and subsequent testing., Results: Sixty-two (32 Choke, 30 Non-Choke) participants were analyzed. There was no significant difference between Choke and Non-Choke in test failures ( χ2 (1,62) = 1.25, P = 0.263), total times ( t (60) = 0.62, P = 0.540; 95% CI, -3.44 to 6.51), and individual difference scores ( t (60) = 0.29, P = 0.776; 95% CI, -2.41 to 3.21)., Conclusions: There were no significant differences between study arms in any of the three analyzed measures. This suggests that cognitive functioning, as measured by the KDT, is not affected by transient choking episodes., (Copyright © 2024 by the American College of Sports Medicine.)

Purpose: Vascular neck compression techniques, referred to as 'chokes' in combat sports, reduce cerebral perfusion, causing loss of consciousness or voluntary submission by the choked athlete. Despite these chokes happening millions of times yearly around the world, there is scant research on their long-term effects. This pilot study evaluated whether repeated choking in submission grappling impacts the carotid intima media thickness (CIMT) and brain injury biomarkers (NFL, hGFAP, t-Tau, and UCH-L1)., Methods: Participants ( n  = 39, 29 male; ages 27-60 years) were assigned to one of two study arms: Grapplers ( n  = 20, 15 male) and 19 age/sex/body size matched controls. Grapplers had been exposed to >500 choke events while training for >5 years in a choke-inclusive sport. Exclusion criteria were recent TBI or deficits from a past TBI or stroke. Bilateral ultrasound measurement of the CIMT was performed, and blood was collected for quantitative analysis of four brain injury markers. Subgroup analyses were performed within the Grappler group to account for blunt head trauma as a possible confounder., Results: There was no overall difference in CIMT measurements between Grapplers (mean 0.55 mm, SD 0.07) and Controls (mean 0.57 mm, SD 0.10) p  = 0.498 [95% CI -0.04-0.08], nor were there CIMT differences between Grappler subgroups of blunt Trauma and No-Trauma. There were no significant differences in any biomarkers comparing Grapplers and Controls or comparing Grappler subgroups of Trauma and No-Trauma., Conclusion: This study found no significant difference in CIMT and serum brain injury biomarkers between controls and grapplers with extensive transient choke experience, nor between grapplers with extensive past blunt head trauma and those without.

A child with cursive and gelastic epilepsy is reported. This particular case in unique in that the patient had no underlying neurological disease, his running and laughing seizures represented his only seizure type; and recorded ictal episodes originated bilaterally and anteriorly.

Since the proposed mode of action of dipropylacetic acid, an anticonvulsant, is to increase central nervous system gamma-aminobutyric acid levels, we used this agent to treat identical twins with juvenile Huntington's chorea. Their clinical status did not improve immediately after they received dipropylacetic acid. Furthermore, long-term administration (over a year) of high doses of the agent (up to 2,400 mg per day; 92 mg per kilogram per day) did not seem to alter the slow progression of their disease. Prior to treatment with dipropylacetic acid, the twins had normal cerebrospinal fluid gamma-aminobutyric acid levels. In addition, cerebrospinal fluid 5-hydroxyindoleacetic acid and homovanillic acid were determined before and after 18 hours of high-dose probenecid. The former showed a normal threefold to fourfold increase after probenecid administration, but homovanillic acid had a distinctly subnormal turnover after probenecid, with only a threefold rather than the normal tenfold increase.

Ninety-eight consecutive patients with clinically suspected congenital heart disease were prospectively studied with electroencephalographic (EEG) recordings before cardiac catheterization. Twenty-five patients had abnormal EEGs. Fifty-five patients had acyanotic heart disease and normal neurologic examination results, of whom 15 had abnormal EEGs. Thirteen had spikes or spike and wave discharges and two had mildly abnormal EEGs. Twenty-seven patients had cyanotic heart disease and normal neurologic examination results, of whom four had abnormal EEGs. Seven patients (8%) had abnormal neurologic examination results, of whom four had abnormal EEGs. There was a higher incidence of seizures with increasing age. Based on their medical history two children with acyanotic heart disease had had seizures without EEG abnormalities. Five children with normal catheterization findings and four children with Down's syndrome (two with abnormal EEGs) were excluded from the total of 98. These findings suggest that subclinical nervous system involvement may occur in congenital heart disease.

There are no previous reports of glioblastoma occurring following central nervous system irradiation. This report describes a young girl with an ependymoma at age 13 months who was treated by radiotherapy following surgical removal. At age 6 years she presented with a new lesion in the same location. Histologically there was no evidence of recurrent ependymoma. Instead, the pathological picture suggested glioblastoma or a severe radiation-induced encephalopathy. In either case, it seems likely that the changes were radiation induced.

The author describes the case of a 14-year-old boy who developed Gilles de la Tourette's disorder during pemoline therapy. Unlike other reported cases, the boy's tics did not remit after the pemoline was discontinued.

Computerized axial tomography offers major advantages over air encephalography and angiography for studies of neurologic disorders in children. The low morbidity and the ease of the procedure permit the accurate diagnosis of intracranial pathology in situations where more invasive procedures would not be undertaken. The techniques of the procedure and its uses and limitations are emphasized in a number of neurologic problems of children.

A hydranencephalic infant lacking cerebral hemispheres and a normal twin were tested for associative learning. After repeated trials in which two stimuli were temporally paired, test trials were given in which the second stimulus was omitted. Cardiac orienting responses to stimulus omission indicated that learning had taken place in both infants.

Ninety-eight children with chronic seizure disorders were studied by computerized axial tomography (CAT). Structural abnormalities were identified in 30% of these children. The greatest incidence of abnormalities was in children with focal motor seizures (43%) and in those whose EEG demonstrated focal slowing together with focal spikes (38%). The most common abnormality was either focal or generalized atrophy (13%). Only about 2% of the abnormalities discovered by CAT were potentially of therapeutic significance. However, the demonstration of a static process, or the finding of a normal CAT, may be quite helpful to the family and physician in certain children with chronic seizure disorders.

Prolonged ambulatory electroencephalographic monitoring was evaluated in 38 children, aged five weeks to 20 years. Eleven children with known seizure disorders who also had additional episodic symptomatology of unknown etiology were monitored, in eight of these children the "spells" were recorded. For 38% of these cases (3/8) the symptoms were shown to be seizures, while for the other 62% the episodic symptomatology did not represent a seizure. In another 23 children without previously documented seizure disorders, the "spells" were recorded in 11 cases. Only two of these 11 (18%) children with episodic symptomatology were shown to have seizures. This study demonstrates the usefulness of outpatient electroencephalographic monitoring in pediatrics for evaluation of episodic symptomatology of unclear etiology.

The ACTH4-9 Analogue (ORG 2766) is an orally administered neuropeptide which has been showed to have behavioral effects in human subjects, but does not have any steroidogenic effects, nor other significant side effects. This study was a double-blind, crossover trial of the ACTH4-9 analogue in four children with intractable seizures. There was some slight improvement in seizure frequency in two patients, with an equivocal improvement in a third child. A fourth child was unchanged, while the fifth dropped out of the study. There were no side effects from the therapy. This questionable improvement in seizure frequency in some of the most intractable patients with seizure disorders indicates the need to further assess this ACTH4-9 analogue in a larger study over a longer period of time.

A patient is presented with "normal" pressure hydrocephalus including dementia, incontinence, and apraxic gait. He had a normal lumbar CSF pressure, hydrocephalus with lack of air over the convexities on pneumoencephalography, and ventricular filling with prolonged retention on cisternography. He did not receive a shunt and, nevertheless, showed spontaneous improvement in his mental function over the next few years. This cases emphasizes the necessity for a controlled study of shunting for "normal" pressure hydrocephalus.

Eleven cases of Hemophilus meningitis seen in the last year are reported. Three were H. parainfluenzae and eight were H. influenzae. The number of patients is small but probably indicates that there is little difference in the clinical or laboratory data in meningitis caused by these two organisms. The children with H. parainfluenzae tended to be less anemic and had more normal admission spinal fluid sugars and proteins, but this was probably because these patients were older and had shorter prodromes. As more cases of H. parainfluenzae meningitis are noted, it seems likely that there will not be any difference in the clinical or laboratory data. Two of the three cases of H. parainfluenzae meningitis had the complication of ataxia secondary to severe bilateral vestibular deficits. Finally, it should be noted that these two organisms will not be distinguished by routine bacteriological studies, and that differentiation must be carried out by an experimental laboratory.

Nineteen babies with infantile spasms were treated with valproic acid over a two-year period. Eleven of the patients were also treated with purified corticotropin, but in no cases were the two drugs used simultaneously. Approximately 40% of the patients had good control of their infantile spasms with valproic acid. Side effects from valproic acid in these babies were not frequent and were, for the most part, minor. Though the percentage of infants with infantile spasms responding to valproic acid may be less than the percentage responding to corticotropin, the incidence and severity of side effects are less with valproic acid.

Phasic changes in cardiac reactivity to innocuous stimuli, presented in a sensory disparity paradigm, were used to evaluate habituation and learning processes in five decerebrate subjects. Three subjects showed systematic changes over trials in the pattern of cardiac response to simple auditory or visual stimuli, indicative of habituation. In addition, tests for associative learning were given after repeated presentations of two paired stimuli. The appearance of a marked cardiac orienting response, to the unpredictable omission of the second stimulus, documented the development of a conditioned association in these same three subjects. One additional subject failed to show a consistent pattern of response to the stimuli, and another demonstrated a consistent response which was not subject to habituation. Overall, these findings support the view that learning processes are not solely the product of the cerebral hemispheres, but reflect general integrative features of the human neuraxis.

A 14-year-old boy with anophthalmia presented evidence of hypothalamic dysfunction. He was found to have a third-ventricular germinoma, probably pineal. This case is interesting in view of a previous case report of the association of anophthalmia and a germ-cell tumor (teratoma), and suggests a possible causal relationship between this malformation and germ-cell neoplasms, bith of which probably arise early in development.

In the monkey, the blood-brain barrier and the blood-aqueous and blood-vitreous barriers of the eye can be opened by internal carotid perfusion of solutions of 2 molar urea in a way compatible with survival and, in some few cases, without detectable neurological deficits. Urea presumably acts by osmotically shrinking the endothelial cells of the cerebrovascular vessels and opening their tight junctions. The high incidence of brain necrosis with neurological sequelae after perfusion of urea by the present technique precludes the use of osmotic opening of the blood-brain barrier for pharmacotherapy at this time.