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Context: Foot/ankle pain is common among runners. Inadequate management of runners with foot/ankle pain can lead to lost training time, competition removal, and other activity limitations. Neurodynamics, which refers to the integrated biomechanical, physiological, and structural function of the nervous system during movement, can be overlooked in patients with foot/ankle pain. Although a link between the cervical spine, neurodynamics, and upper quarter pain has been studied, less is known about the relationship between the lumbar spine and lower quarter. This case series describes the successful management of 3 runners with foot/ankle pain. Case Presentations: Three female runners (ages 23, 24, and 45 y) presented to physical therapy with foot/ankle pain and difficulty running. Each patient had positive examination findings with local foot/ankle testing. A comprehensive lumbar spine examination demonstrated impairments in range of motion and joint mobility that were hypothesized to be contributing. Positive lower quarter neurodynamic tests were also found. Management and Outcomes: All patients were treated with nonthrust lumbar spine mobilization and lower quarter neural tissue mobilization. Changes in the Patient-Specific Functional Scale, Numerical Pain Rating Scale, Lower Extremity Functional Scale, and Global Rating of Change occurred after intervention targeting the lumbar spine and lower-extremity neurodynamics in all patients. Conclusions: This case series demonstrates the importance of including a thorough lumbar spine examination and neurodynamic testing to identify appropriate interventions while managing patients with foot/ankle pain, even when patients have signs indicative of local ankle/foot pathology. These examination procedures should be performed particularly when a patient is not responding to management targeting local foot/ankle structures. [ABSTRACT FROM AUTHOR]

The present study aimed to clarify the development of motor unit (MU) firing properties and the association between those neural properties and force steadiness (FS)/neurological tests in 6- to 12-year-old children. Fifty-eight school-aged children performed maximal voluntary knee extension contraction, a submaximal FS test at 10% of maximal voluntary knee extension contraction, knee extension reaction time to light stimulus test, and single-leg standing test, and data from 38 children who passed the criteria were subject to analysis. During the FS test, high-density surface electromyography was recorded from the vastus lateralis muscle to identify individual MU firing activity. FS was improved with an increase in age (r = −.540, P <.001). The MU firing rate (MUFR) was significantly decreased with an increase in age (r = −.343, P =.035). MUFR variability was not associated with age. Although there was no significant correlation between FS and MUFR, FS was significantly correlated with MUFR variability even after adjustment for the effect of age (r =.551, P =.002). Neither the reaction time nor the single-leg standing test was correlated with any MU firing properties. These findings suggest that MUFR variability makes an important contribution to precise force control in children but does not naturally develop with age. [ABSTRACT FROM AUTHOR]

Introduction: This case report details the presentation of a patient who initially sought consultation at a psychiatric outpatient clinic with symptoms suggestive of Attention-Deficit/Hyperactivity Disorder (ADHD); however, further evaluation revealed a diagnosis of Cerebrotendinous Xanthomatosis (CTX). CTX, a genetic disorder impacting lipid metabolism, is often overlooked in differential diagnoses due to its rarity. This case underscores the importance of considering alternative diagnoses in adults exhibiting ADHD-like symptoms without a childhood history of the disorder, adding to the literature on diagnostic complexities in psychiatric practice. Case presentation: A 33-year-old man visited a psychiatric outpatient clinic with symptoms such as increasing distractibility and inattention, requesting an evaluation for adult ADHD. However, the absence of an ADHD history in childhood, coupled with progressive neurological symptoms and tendon xanthomas, led to further investigation. Comprehensive neurological assessments, including neuroimaging and genetic testing, ultimately diagnosed him with CTX. Treatment with chenodeoxycholic acid (CDCA) resulted in stabilization of cognitive function, although improvement in gait disturbances and tremors remained minimal. Conclusion: This case demonstrates that CTX can masquerade as adult ADHD, emphasizing the necessity for thorough assessments in atypical ADHD presentations. Psychiatrists should consider rare metabolic disorders like CTX in similar cases, which may enable timely intervention and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Neurological outcomes after out-of-hospital cardiac arrest (OHCA) depend on multiple factors, including the patient's baseline condition and post-arrest management. The SLANT, developed specifically for OHCA survivors treated with targeted temperature management (TTM), requires further validation, particularly in Asian populations. Methods: This multicenter retrospective cohort study analyzed data from 2016 to 2023, examining demographics, pre-arrest conditions, resuscitation events, and laboratory biomarkers following TTM. The primary outcome was defined as a poor neurological outcome at hospital discharge. Model performance was assessed using the area under the receiver operating characteristic curve. Multivariate logistic regression analysis was used to analyze the included variables. Results: A total of 448 eligible adult patients were included, of whom 77.9% experienced poor neurological outcomes at discharge. The performance of the current cohort was comparable to that of the original SLANT cohort, achieving an area under the curve of 0.797 (95% confidence interval: 0.746–0.849). All five factors of the SLANT score remained statistically significant in predicting poor neurological outcomes. At a cutoff of ≥ 6.5, the SLANT score demonstrated a specificity of 53.5% and positive predictive value (PPV) of 86.9%. Increasing the cutoff value to 8.5 improved the specificity to 66.7% and the PPV to 89.6%. Conclusion: The SLANT showed high PPV for predicting poor neurological outcomes at discharge in patients with OHCA undergoing TTM across a multicenter Asian cohort. Combining the score with other neurological assessments is recommended for improved neuroprognostication. [ABSTRACT FROM AUTHOR]

Cerebral sinus thrombosis, which constitutes a small percentage of all strokes, usually affects young individuals and can lead to venous stroke. Ischemic and hemorrhagic Stroke are associated with Spreading Depolarization (SD) waves in brain tissue, which propagate through the affected areas and cause a transient disruption of ionic homeostasis and neuronal function. This interaction highlights the complexity of the neurological consequences associated with SD. In this study, we investigated the occurrence of SDs following the occlusion of the superior sagittal sinus (SSS) in a gyrencephalic model, specifically swine. To instigate an occlusion, we surgically clipped the middle third of the SSS. The animals were grouped and monitored using one of three methods: electrocorticography (ECoG) alone, ECoG with intrinsic optical signal (IOS) imaging, or ECoG in conjunction with laser speckle contrast and oxygen imaging (LSCI). Post-mortem, the brains were analyzed using 2,3,5-triphenyl tetrazolium chloride (TTC) staining to check for venous infarction. Our results confirmed the spontaneous occurrence of SDs in the gyrencephalic swine brain after SSS occlusion, which was detectable via all monitoring methodologies. SD activity was most frequent in the first hour post-occlusion, subsequently diminishing. IOS imaging identified four unique hemodynamic responses, while TTC staining indicated no infarction. This research is the first to document SDs in the gyrencephalic swine brain following SSS occlusion, laying the groundwork for future investigations in both animal models and human clinical studies. [ABSTRACT FROM AUTHOR]

Background: Ofatumumab, a fully human monoclonal antibody targeting CD20, is approved for the treatment of relapsing multiple sclerosis. Comprehensive real-world safety data are crucial for informing clinical practice. Methods: The FDA Adverse Event Reporting System database was utilized to perform a disproportionality analysis, covering reports from Q3 2020 to Q2 2024, in which ofatumumab was identified as the primary suspected drug. Statistical approaches used included the Reporting Odds Ratio, Proportional Reporting Ratio, Bayesian Confidence Propagation Neural Network, and Multi-item Gamma Poisson Shrinker. The timing of adverse events was assessed using the Weibull distribution model to highlight temporal risk patterns. Results: Known adverse reactions, such as injection site reactions and upper respiratory tract infections, displayed positive signals. Additionally, novel off-label adverse events, including brain fog, muscle spasms, and mood alterations, were identified, marking the first real-world evidence of these potential risks. Temporal analysis revealed that most adverse events occurred within the first month of treatment, indicating an early risk phase. Subgroup analysis demonstrated notable differences in adverse event profiles by gender and age, with males more prone to hyperhidrosis and older patients more susceptible to neurological symptoms. Conclusion: This real-world analysis of ofatumumab provides important safety insights, confirming known adverse reactions and identifying additional potential risks. Early and tailored monitoring protocols during the initial treatment phase, including regular neurological and psychiatric assessments, are recommended to optimize patient safety and outcomes. Prospective studies are recommended to validate these results and explore the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: Repeat neurological assessment is standard in cases of severe acute brain injury. However, conventional measures rely on overt behavior. Unfortunately, behavioral responses may be difficult or impossible for some patients. As a result, patients who recover consciousness before the ability to express so may go undetected. Recent studies have demonstrated the efficacy of incorporating functional neuroimaging into clinical assessment protocols. The objective of the current study is to assess the feasibility of a multi-task, multimodal bedside technique to evaluate sensory and cognitive function in behaviorally non-responsive patients. Methods: We deployed a novel assessment paradigm to evaluate sensory and cognitive processing in one 63-year-old unresponsive patient with acute motor sensory axonal neuropathy (AMSAN). We collected parallel bedside EEG-fNIRS activity during hierarchical auditory processing, movie listening, and motor imagery. Results: We found appropriate hemodynamic activation in the patient's middle and superior temporal gyri to simple sounds and activation in their superior temporal gyrus, left angular and precentral gyri during speech. During movie listening, the patient produced patterns of EEG and fNIRS activity that were statistically indistinguishable from healthy controls. The patient also showed appropriate fNIRS and source-localized EEG activation of motor areas during motor imagery. Upon recovering, the patient correctly recalled multiple aspects of our assessment procedures. Conclusion: In sum, our assessment protocol effectively captures neural markers of sensory and cognitive function in behaviorally non-responsive patients. Crucially, while AMSAN is distinct from brain injury, the patient's assumed dissociation between behavior and awareness provided an ideal test case to validate our protocol. [ABSTRACT FROM AUTHOR]

Background: This study aimed to analyze the current status of brain death/death by neurologic criteria (BD/DNC) determination in Korea over a decade, identifying key areas for improvement in the process. Methods: We conducted a retrospective analysis of data from the Korea Organ Donation Agency spanning 2011 to 2021, focusing on donors whose donations were not completed. The study reviewed demographics, medical settings, diagnoses, and outcomes, with particular emphasis on cases classified as nonbrain death and those resulting in death by cardiac arrest during the BD/DNC assessment. Results: Of the 5047 patients evaluated for potential brain death from 2011 to 2021, 361 were identified as noncompleted donors. The primary reasons for noncompletion included nonbrain death (n = 68, 18.8%), cardiac arrests during the BD/DNC assessment process (n = 80, 22.2%), organ ineligibility (n = 151, 41.8%), and logistical and legal challenges (n = 62, 17.2%). Notably, 25 (36.8%) of them failed to meet the minimum clinical criteria, and 7 of them were potential cases of disagreement between the two clinical examinations. Additionally, most cardiac arrests (n = 44, 55.0%) occurred between the first and second examinations, indicating management challenges in critically ill patients during the assessment period. Conclusions: Our study highlights significant challenges in the BD/DNC determination process, including the need for improved consistency in neurologic examinations and the management of critically ill patients. The study underscores the importance of refining protocols and training to enhance the accuracy and reliability of brain death assessments, while also ensuring streamlined and effective organ donation practices. [ABSTRACT FROM AUTHOR]

Objective: Existing literature indicates that females generally demonstrate higher fatigue resistance than males during isometric contractions. However, when it comes to single-limb dynamic exercises, the intricate interplay between performance fatigability (PF), cardiovascular responses, and muscle metabolism in relation to sex differences remains underexplored. Purpose: This study investigates how sex affects the relationship between muscle oxidative characteristics and the development of PF during dynamic single-leg exercise. Methods: Twenty-four young healthy participants (12 males vs 12 females) performed a constant-load single-leg knee extension task (85% peak power output; 60 rpm) to exhaustion (TTE). Neuromuscular assessments via transcranial magnetic and peripheral stimulations were conducted before and after exercise to evaluate central and peripheral factors of PF. Vastus lateralis muscle biopsies were obtained for mitochondrial respiration and immunohistochemistry analyses. Results: Participants performed similar total work (28 ± 7 vs 27 ± 14 kJ, P = 0.81) and TTE (371 ± 139 vs 377 ± 158 s, P = 0.98); after the TTE, females' maximal isometric voluntary contraction (MVIC: −36% ± 13% vs −24% ± 9%, P = 0.006) and resting twitch (RT; −65% ± 9% vs −40% ± 24%, P = 0.004) force declined less. No differences were observed in supraspinal neuromuscular factors (P > 0.05). During exercise, the cardiovascular responses differed between sexes. Although fiber type composition was similar (type I: 47% ± 13% vs 56% ± 14%, P = 0.11), males had lower mitochondrial net oxidative capacity (61 ± 30 vs 89 ± 37, P = 0.049) and higher Complex II contribution to maximal respiration (CII; 59% ± 8% vs 48% ± 6%, P < 0.001), which correlated with the decline in MVIC (r = −0.74, P < 0.001) and RT (r = −0.60, P = 0.002). Conclusions: Females display greater resistance to PF during dynamic contractions, likely due to their superior mitochondrial efficiency and lower dependence on mitochondrial CII activity. [ABSTRACT FROM AUTHOR]

Objectives: Research on neurobehavioral abnormalities in neonates of mothers with subclinical hypothyroidism (SCH) is limited. The link between umbilical cord blood brain-derived neurotrophic factor (BDNF) levels and neurobehavioral outcomes in neonates has not been explored. This study investigates the correlation between alterations in umbilical cord blood BDNF levels and early neurobehavioral abnormalities in neonates born to pregnant women with SCH. Methods: This study recruited 72 pregnant women with SCH and 76 healthy controls (HC). The study collected general information for all subjects, including body mass index, parity, thyroid function assessed during early to late pregnancy, and neonatal birth weight. Neonatal behavioral and neural abilities were evaluated using the Neonatal Behavioral Neurological Assessment (NBNA). BDNF levels in umbilical cord blood were measured using the Enzyme-Linked Immunosorbent Assay method. Results: The results indicated that neonates with SCH during pregnancy had lower total NBNA scores, behavioral ability, passive muscle tone, active muscle tone, primitive reflexes, general assessment, and lower levels of cord blood BDNF compared to healthy controls. The cord blood BDNF of newborns with SCH during pregnancy was positively correlated with total NBNA score, behavioral ability, active muscle tone, and general assessment. Moreover, multiple linear regression analysis demonstrated an association between cord blood BDNF levels in pregnant patients with SCH and multiple measures of newborn health, including total NBNA score, behavioral ability, active muscle tone, and general assessment. Conclusion: Infants born to pregnant women with SCH exhibit reduced behavioral and neural abilities linked to BDNF levels in umbilical cord blood. [ABSTRACT FROM AUTHOR]

Background: Gantenerumab is a fully human anti-amyloid-β (Aβ) immunoglobulin G1 monoclonal antibody for subcutaneous (SC) administration. The efficacy and safety of low-dose (105 mg or 225 mg) gantenerumab were investigated in SCarlet RoAD (SR; NCT01224106), a Phase III, double-blind (DB), placebo-controlled study in participants with prodromal Alzheimer's disease. Following a pre-planned futility analysis, SR was converted into an open-label extension (OLE) study. Objective: To assess the long-term safety and tolerability of SC gantenerumab at doses of up to 1200 mg every 4 weeks (Q4W) in OLE participants who previously received placebo or gantenerumab in the DB part of SR. Methods: Participants of the DB part of SR, who met the eligibility criteria for the OLE, were offered the opportunity to receive gantenerumab up-titrated to 1200 mg Q4W according to prespecified titration regimens. Safety and tolerability were assessed using magnetic resonance imaging (MRI), physical and neurologic examinations, and adverse event monitoring. Results: Overall, 154 participants were rolled over from the DB part of SR and received at least one dose of gantenerumab in the SR OLE. The median duration of treatment was 2.9 years (152.9 weeks). Forty-seven (30.5%) participants had an amyloid-related imaging abnormalities – edema (ARIA-E) MRI finding, and 51 (33.1%) had an ARIA – hemorrhage MRI finding. Most ARIA-E findings were asymptomatic and manageable by MRI monitoring and dose intervention. There were no unexpected safety findings. Conclusions: SC gantenerumab at doses of up to 1200 mg Q4W was well tolerated with no unexpected safety findings in participants with prodromal Alzheimer's disease. Trial registration: ClinicalTrials.gov ID NCT01224106 [ABSTRACT FROM AUTHOR]

The article discusses a case of an 86-year-old woman with chronic lymphocytic leukemia who presented with symptoms of rhombencephalitis, an inflammatory disorder affecting the cerebellum, pons, and medulla oblongata. The patient's condition was diagnosed as progressive multifocal leukoencephalopathy (PML) caused by John Cunningham virus (JCV), leading to rhombencephalitis. Despite treatment attempts, the patient's condition worsened, and she ultimately chose palliative care and passed away. The article highlights the challenges in diagnosing and treating rhombencephalitis, particularly in immunocompromised patients like those with chronic lymphocytic leukemia. [Extracted from the article]

The prevalence and global health burden of dementia including Alzheimer's disease (AD) is rising, while patients living in remote and underserved areas face significant challenges in reaching specialized care. Telemedicine offers a valuable solution in bridging this widening gap, by providing equal and timely access to tertiary-specialized centers. Accumulating evidence highlights that most parts of the remote neuropsychological and neurological evaluation are feasible, with patients, healthcare professionals and caregivers being generally satisfied with this means of care. Herein, we provide an updated overview of the available evidence on the use of telemedicine for patients with cognitive disorders, focusing on the different applications and settings, the remote, video-based neurological and neuropsychological assessment, current recommendations, non-pharmacological interventions, as well as legal and ethical considerations. Based on the literature review and our three-year experience in the "Specialized Outpatient Clinic of Memory, Dementia and Parkinson's disease through the National Telemedicine Network" in the Aiginition University Hospital of Athens, we propose a brief guide for assessing patients with cognitive impairment via telemedicine and suggest future research directions for the more effective and appropriate use of telemedicine in dementia assessment and care. [ABSTRACT FROM AUTHOR]

Deep vein thrombosis and pulmonary embolism prophylaxis is an important part of trauma care. Despite an increased risk of thrombotic complications, the use of venous thrombosis chemoprophylaxis in penetrating traumatic brain injury (pTBI) patients is met with reluctance from neurosurgeons because of concern for the exacerbation of intracerebral hemorrhage. The objective of this study was to provide initial pre-clinical evidence of the effects of Lovenox (LVX) administration following pTBI with significant intracerebral hemorrhage. Sprague-Dawley rats received a penetrating ballistic-like brain injury. Animals were randomly divided into two groups following injury: LVX (25 mg/kg) or vehicle (VEH, saline). LVX or vehicle was administered subcutaneously beginning 24 h after the injury and continued daily for 7 days post-injury. A neurological assessment was performed daily and magnetic resonance imaging (MRI) was performed at baseline, 1, 2, 3, and 7 days post-injury. Following the final MRI, brains were isolated and prepared for histological analysis. Thromboelastography demonstrated dramatic anticoagulation effects which were confirmed by significant increases in partial thromboplastin time (p < 0.001). Daily neurological assessment revealed no worsening of functional deficits following LVX treatment. MRI analysis demonstrated no differences in cerebral edema or intracranial hemorrhage volumes between treatment groups at any tested post-injury time points. However, LVX elicited a significant reduction in fibrin deposition in the ipsilateral striatum and lesion site at 7 days post-injury (p < 0.05). Serum levels of beta-amyloid were decreased at 7 days following LVX treatment (p < 0.05) which may indicate neuroprotective effects but was not correlated to brain levels. The results presented indicate that administration of LVX at a dose capable of inducing anticoagulation is safe in a rodent model of pTBI without exacerbation of intracerebral hemorrhage within the first 7 days of injury. [ABSTRACT FROM AUTHOR]

The article discusses a case of a 3-year-old Golden Retriever presenting with progressive neurological signs after being treated for gastrointestinal disease. The dog showed symptoms such as ataxia, hypermetria, and tremors, which were attributed to severe hyponatremia and electrolyte imbalances. The neurological examination indicated potential lesions in the cerebellum, brainstem, and forebrain, leading to a diagnosis of osmotic demyelination syndrome. The article highlights the importance of careful correction of chronic hyponatremia and the need for vigilance in managing such conditions to optimize patient outcomes. [Extracted from the article]

This article from the journal "Thoracic & Cardiovascular Surgeon" explores the impact of the timing of cardiopulmonary bypass surgery on neurological injuries in premature infants with congenital heart disease. A 16-year retrospective study at Boston Children's Hospital found that the timing of CPB surgery in the first 2 months of age did not increase the risk of neurological injury or in-hospital mortality in these infants. The study suggests that future research should focus on determining the ideal timing for surgical intervention in this high-risk patient population. [Extracted from the article]

Purpose: To analyze the correlation between pharyngeal residue and penetration/aspiration in post-stroke individuals. Methods: Cross-sectional, descriptive, retrospective, clinical study with 157 post-stroke individuals, 71 females and 86 males, aged 26 to 92 years (mean age: 67.2 years), all diagnosed by neurological assessment and imaging exams (computed tomography or magnetic resonance imaging), who underwent fiberoptic endoscopic evaluation of swallowing (FEES) in a rehabilitation center. They were served 5 mL of moderately thick liquid (level 3 in the International Dysphagia Diet Standardization Initiative [IDDSI]) in a spoon three times. Two expert raters in dysphagia assessed them with the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) and Penetration Aspiration Scale (PAS). Their interrater sensitivity agreement was analyzed with the Kappa test, and Spearman's rank correlation (r) verified the correlation between pharyngeal residue and the PAS and calculated the effect size (r2). Results: YPRSRS in vallecula was positively correlated with PAS (r = 0.43; r2 = 0.18; p ≤ 0.000); YPRSRS in pyriform sinus, with PAS (r = 0.54; r2 = 0.29; p ≤ 0.000); and YPRSRS in both vallecula/pyriform sinus with PAS (r = 0.57; r2 = 0.32; p ≤ 0.000). Conclusion: The severity of pharyngeal residue in post-stroke individuals with dysphagia is correlated with the level of penetration-aspiration. [ABSTRACT FROM AUTHOR]

Introduction: The utility of the three-part bedside oculomotor exam HINTS (head impulse test, nystagmus, test of skew) in the hands of emergency physicians remains under debate despite being supported by the most recent literature. Educators historically lack consensus on how specifically to teach this skill to emergency medicine (EM) residents, and it is unknown whether and how EM residency programs have begun to implement HINTS training into their curricula. We aimed to characterize the state of HINTS education in EM residency and develop a needs assessment. Methods: In this cross-sectional study, we administered a survey to EM residency directors, the themes of which centered around HINTS education perceptions, practices, resources, and needs. We analyzed Likert scales with means and 95% confidence intervals for normally distributed data, and with medians and interquartile ranges for non-normally distributed data. Frequency distributions, means, and standard deviations were used in all other analyses. Results: Of 250 eligible participants, 201 (80.4%) responded and consented. Of the 192 respondents providing usable data, 149/191 (78.0%) believed the HINTS exam is valuable to teach; 124/192 (64.6%) reported HINTS educational offerings in conference; and 148/192 (77.1%) reported clinical bedside teaching by faculty. The most-effective educational modalities were clinical bedside teaching, online videos, and simulation. Subtopic teaching struggles with regard to HINTS were head impulse test and test-of-skew conduction and interpretation, selection of the correct patients, and overall HINTS interpretation. Teaching barriers centered around lack of faculty expertise, concern for poor HINTS reproducibility, and lack of resources. Leadership would dedicate a mean of 2.0 hours/year (SD 1.3 hours/year) to implementing a formal, standardized HINTS curriculum. Conclusion: Despite controversy surrounding the utility of theHINTS exam in EM, most residency directors believe it is important to teach. This needs assessment can guide development of formal educational and simulation curricula focusing on residency directors' cited HINTS exam educational struggles, barriers, and reported most-effective teaching modalities. [ABSTRACT FROM AUTHOR]

Background: Wilson’s disease (WD) and alkaptonuria (AKU) are genetic diseases. Case Report: A 12-year-old boy presented with tremors, dysarthric drooling, poor school performance, and dark urine. Neurologic examination showed ataxia and Kayser-Fleischer (KF) rings in the eye examination. Black pigment deposits were observed in the subconjunctival area and on the sclera. Brain magnetic resonance imaging (MRI) indicated high signal intensity in the basal ganglia and head of the caudate nucleus of both sides in T2WI serum ceruloplasmin. Pathogenic homozygous variants were reported in whole exome sequencing for WD and AKU. Discussion: There is diagnostic complexity of overlapping metabolic disorders, including WD and AKU, in a pediatric patient with neurological and systemic symptoms. Genetic testing and biochemical analyses played a critical role in identifying pathogenic abnormalities. Conclusion: Rare genetic diseases such as WD and AKU can happen simultaneously. [ABSTRACT FROM AUTHOR]

Background: Amplitude-integrated electroencephalography (aEEG) is a neurophysiology tool used at the bedside to show the trend of brain activity. Objectives: To evaluate the diagnostic and prognostic significance of aEEG neuromonitoring in al Hussein hospital PICU. Cairo, Egypt, and its usefulness in detecting seizures to aid in improved management and identification of unnecessary indications. Methods: This prospective observational study was carried out on 48 children aged from two months to 14 years of both sexes. The research took place from January 2022 to September 2023 .following approval from the Ethical Committee of Al Azhar University Hospitals. All patients with one or more of the following disorders,(encephalopathy. traumatic brain injury, poisoning, sepsis, post rescusitation, suffocation, post brain surgery, post ictel state and abnormal movements) were subjected to full history taking &complete clinical evaluation followed by lab..& radiological & C.T. exam. if indicated &then put into continuous aEEG monitoring. Lastly the studied patient were classified into two sub groups ; A- favorable aEEG which include Continuous normal voltage (CNV), discontinuous normal voltage (DC) B- unfavorable aEEG which include continuous low voltage (CLV), burst suppression (BS), and flat trace (FT) Results: The mean Glasgow Coma Scale significantly improved among children with subclinical seizure after treatment (P=0.006). Children with unfavorable aEEG showed significantly higher mortality, prolonged hospital stay, and multiple anti-epileptic drugs (AED) (P<0.05) compared to favorable aEEG. There was insignificant difference between children with or without favorable aEEG regarding the causes of admission. Severe disability, death were significantly higher among children with unfavorable aEEG (P<0.05) Conclusion: Implementing early aEEG monitoring can assist intensive care unit (ICU) providers in directing clinical care and confirmation of suspected seizure and detection of non-convulsive seizure and therapy guidance. Children with favorable aEEG associated with lower mortality rate, median days of hospital stay, less days on MV, need less anti-epileptic drug and less motor sequel on discharge compared to unfavorable aEEG. [ABSTRACT FROM AUTHOR]

Headaches in children are common, and can have a significant impact on children's school attendance and quality of life. Although most causes of headaches in children are benign, concern from clinicians and patient caregivers about missing a serious underlying cause can result in a high referral rate to secondary care. This article provides a succinct and practical approach to the assessment and management of a child presenting to general practice with a headache. This will include consideration of possible underlying pathology, diagnosis and management of primary headaches, with emphasis on managing lifestyle and psychosocial factors that negatively impact on headaches. [ABSTRACT FROM AUTHOR]

Background/Objectives: Our research aimed to assess if correlations could be found between items evaluated at the cerebral ultrasound performed at term-equivalent age (TEA) and neuro-motor outcomes evaluated at 12 and 24 months of corrected age in a group of preterm infants. Methods: The following were assessed: the Levine Index, the diagonals of the lateral ventricles, the size of the ventricular midbody, the sinocortical distance, the width of the basal ganglia, the cortical depth at the level of the cingular sulcus and the maturation of the gyral folding. The neurologic evaluation was performed at 12 and 24 months of corrected age, according to the Amiel Tison neurologic examination, and the items from the calendar of motor acquisitions were used as outcome measures of the study—gross and fine motor subsets. The comparisons between the different groups were performed using the FANOVA test, with a statistically significant association for a p < 0.05. Results: The abnormal gross motor acquisitions at 12 months were significantly associated with an increased size of the ventricular midbody (p < 0.009) and a significantly decreased diameter of the basal ganglia (p < 0.011) on the TEA cerebral ultrasound. At 24 months, a significant association was found with increased size of the ventricular midbody (>10.33 mm) (p < 0.001), a decreased diameter of the basal ganglia (<12.9 mm) (p < 0.016), a decreased cortical depth (p < 0.021) and an immature gyral maturation pattern (p < 0.001). In the case of severely abnormal fine motor outcomes, at 12 months, there were statistically significant associations with an increased size of the ventricular midbody (p < 0.001) and an immature gyral folding pattern (p < 0.0180); at 24 months, significant associations were noted with the size of ventricular midbody (p < 0.001), a decreased diameter of the basal ganglia (p < 0.016), a decreased cortical depth (p < 0.021) and an immature gyration folding (p < 0.001). Conclusions: The abnormal gross and fine motor outcome in former premature infants at 12–24 months corrected age is significantly associated with abnormal findings in the head ultrasound examination performed at TEA reflecting both white matter (increased midbody distance) and grey matter (decreased diameter of the basal ganglia, decreased cortical depth and an immature gyration pattern) involvement. [ABSTRACT FROM AUTHOR]

Introduction: Blood and cerebrospinal fluid biomarkers have gained prominence in dementia diagnosis; however, they are not always available. Objectives: To describe unconventional biomarkers identifiable during neurological examination. Methods: A narrative review was conducted, searching for cognitive impairment in relation to unconventional biomarkers in PubMed, EMBASE, and SciELO databases. Original and secondary studies describing this relationship were included, along with tools for clinical evaluation. Results: Neuropsychiatric symptoms are among the earliest manifestations and a marker of progression, present in approximately 97% of patients. Depression, anxiety, and apathy are three potential indicators, assessable through clinical expertise, scales, or new technologies. Other markers include bradyphrenia and executive function impairment, which affects motor function parameters in 8-13% of cases. Regarding cranial nerves, alterations in the optic nerve and retina, changes in eye movements, and hearing los may occur. Motor examination is one of the most promising areas, focusing on dual-task performance, gait speed, and grip strength. It has been estimated that these factors may influence the occurrence of dementia by more than 50%. Sensory alterations in pain perception may also be observed. astly, the appearance of two or more frontal release reflexes is a marker of cognitive decline. Conclusions: Evidence supporting the use of unconventional biomarkers was found, which may serve as an alternative for early detection of cognitive impairment.

Vestibular schwannoma (VS) is a benign peripheral nerve sheath tumor involving the vestibulocochlear nerve. Affected patients typically experience a gradual emergence of episodic imbalance and unilateral hearing loss, tinnitus, and headache. Less often, VS may be associated with facial pain; ocular, otic, and taste disturbance; paresthesia of the tongue and face; and temporomandibular disorder-like presentations. There is limited information in the dental literature relating the myriad of oral and maxillofacial manifestations of VS. The objective of this article is to underscore the importance for dental clinicians to seek clinicopathologic correlations with VS-related symptomatology, potentially resulting in a timelier diagnosis and improved patient outcomes. To convey this clinical challenge, a detailed narrative of a 45-year-old patient with an 11-year delay in diagnosis has been reported. In addition, the typical radiographic appearance of an implanted cranial device placed following VS resection has been provided. [ABSTRACT FROM AUTHOR]

Introduction: General practitioners (GPs) often face challenges in explaining to patients with persistent physical symptoms (PPS) why their symptoms persist. Providing an explanation of the central sensitisation (CS) mechanism to patients could be helpful, yet GPs do not routinely test for signs of CS in these patients. The aim of this study was to explore the value of applying a test to assess CS in enhancing explanations provided to patients. Methods: In this prospective study, 25 GPs applied three tests, selected through a Delphi study, to assess CS-related symptoms: (1) the Central Sensitisation Inventory (CSI); (2) an algometer for measuring pressure pain thresholds (PPT); and (3) a monofilament for assessing temporal summation. Following the tests, both the GP and the patient completed a short questionnaire. Subsequently, GPs shared their experiences in focus groups and interviews, while a sample of patients was interviewed individually. The questionnaires were analysed quantitatively, and the focus groups and interviews were analysed qualitatively. Results: GPs reported that all tests were feasible to perform during consultations; testing took less than 5 min in 25% of cases and between 5 and 10 min in 60% of cases. In approximately 50% of cases, an additional consultation was required to perform the test. The results of the CSI confirmed CS-related symptoms more frequently (74%) than the algometer (46%) and the monofilament (43%). Consequently, many GPs preferred the CSI. Patients did not show a preference for any specific test; two-third found the tests valuable and approximately 50% reported that the explanation of CS was clearer when a test was used. Conclusions: Testing during the consultation was feasible, although an additional consultation was required in 50% of the cases. GPs preferred the CSI because its results confirmed CS-related symptoms more frequently than those from the algometer and monofilament. [ABSTRACT FROM AUTHOR]

Introduction: Tumorous growths in the sellar region pose significant clinical challenges due to their proximity to critical visual structures such as the optic chiasm and optic nerves. Given their proximity to the optic system, these tumors are often diagnosed due to a progressive decrease in visual acuity. Thus, surgical intervention is crucial to prevent irreversible damage, as timely decompression can halt the progression of edema and subsequent optic atrophy. Although Quantitative Pupillometry (QP) has been employed in various clinical settings, its application in patients with sellar region neoplasms remains unexplored. This study aims to evaluate the utility of QP to enhance treatment approaches in patients undergoing surgical resection of these tumors. Methods: Pupillometry assessments were conducted prospectively using the automated NPi 200® Pupillometer on 45 patients who underwent surgical resection of tumors in the sellar region at our institution. The Neurological Pupil Index (NPi) was measured pre- and post-operatively, with a focus on correlations with visual acuity and tumor volume. Concurrently, MRI findings were analyzed to assess optic chiasm compression. Results: Of the patients, 73.3% were diagnosed with pituitary tumors, 22.2% with tuberculum sellae meningiomas, and 4.4% with craniopharyngiomas. 66.7% of patients presented with decreased visual acuity, and 42.2% demonstrated paresis of the third cranial nerve (CN III). Compression of the optic chiasm was noted in 55.6% of cases. Patients with visual disturbances and CN III paresis exhibited significantly reduced NPi scores compared to unaffected individuals. In patients with pituitary adenomas, pathological NPIs were observed exclusively in cases of optic chiasm compression; compression of cranial nerve III (CN III) did not significantly affect the NPIs. Conversely, in patients with tuberculum sellae meningiomas, pathological NPIs were associated specifically with CN III compression, while optic chiasm compression tended to show a difference, however the results are not significant. Postoperatively, NPi values normalized among those who had presented with decreased visual acuity. Conclusions: This study contributes to the field of skull base surgery by evaluating the utility of QP as a diagnostic tool for neurological assessment in patients with sellar region tumors. The findings suggest that QP may help in assessing the extent of tumor-related compression on the optic system. It particularly points to differences in the effects of optic chiasm and CN III compression, with observed variations in NPI scores corresponding to the type of compression in specific tumors, such as pituitary adenomas and tuberculum sellae meningiomas. By providing rapid and non-invasive assessments, QP supports enhanced correlation with clinical and radiological evaluations, potentially improving targeted interventions for these complex conditions. [ABSTRACT FROM AUTHOR]

Background: Methanol is a toxic alcohol that is often ingested accidentally or intentionally. Its metabolites can induce severe visual disturbances, metabolic acidosis, and neurological dysfunction, which can frequently become life-threatening. Case Report: A 44-year-old woman with a history of depression and alcohol use was hospitalized in the Intensive Care Unit after cardiopulmonary reanimation. According to relatives, an empty bottle of household chemicals was found next to the patient. The patient had symptoms of vomiting, headache, and vision loss. The patient had a hypertensive crisis, with blood pressure of 180/110 mmHg. Initially, on the computed tomography of the head, no conclusive acute changes were detected. However, a slight hypodensity in the basal nuclei was marked retrospectively. On day 4, magnetic resonance imaging of the head was performed, showing symmetrical acute ischemic changes in the basal nuclei with hemorrhage and spreading into the ventricles, and acute occlusive hydrocephalus. Bilateral acute symmetric ischemic changes of both optic nerves with cytotoxic edema were also detected on diffusion-weighted imaging. Dynamically, the condition did not improve, and all vital functions worsened. The patient's lethal outcome was confirmed. Conclusions: Cerebral hemorrhage is a rare and serious complication of methanol poisoning. Early sign detection of methanol intoxication is crucial due to the rapid progression of severe, irreversible complications. Neuroimaging has a significant role in diagnosing and understanding the extent of damage in methanol poisoning cases. [ABSTRACT FROM AUTHOR]

Purpose: Identify patient subgroups with different functional outcomes after SCI and study the association between functional status and initial ISNCSCI components. Methods: Using CART, we performed an observational cohort study on data from 675 patients enrolled in the Rick-Hansen Registry(RHSCIR) between 2014 and 2019. The outcome was the Spinal Cord Independence Measure (SCIM) and predictors included AIS, NLI, UEMS, LEMS, pinprick(PPSS), and light touch(LTSS) scores. A temporal validation was performed on data from 62 patients treated between 2020 and 2021 in one of the RHSCIR participating centers. Results: The final CART resulted in four subgroups with increasing totSCIM according to PPSS, LEMS, and UEMS: 1)PPSS < 27(totSCIM = 28.4 ± 16.3); 2)PPSS ≥ 27, LEMS < 1.5, UEMS < 45(totSCIM = 39.5 ± 19.0); 3)PPSS ≥ 27, LEMS < 1.5, UEMS ≥ 45(totSCIM = 57.4 ± 13.8); 4)PPSS ≥ 27, LEMS ≥ 1.5(totSCIM = 66.3 ± 21.7). The validation model performed similarly to the original model. The adjusted R-squared and F-test were respectively 0.556 and 62.2(P-value <0.001) in the development cohort and, 0.520 and 31.9(P-value <0.001) in the validation cohort. Conclusion: Acknowledging the presence of four characteristic subgroups of patients with distinct phenotypes of functional recovery based on PPSS, LEMS, and UEMS could be used by clinicians early after tSCI to plan rehabilitation and establish realistic goals. An improved sensory function could be key for potentiating motor gains, as a PPSS ≥ 27 was a predictor of a good function. IMPLICATIONS FOR REHABILITATION: After a traumatic Spinal Cord Injury (SCI), early neurological examination using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is recommended to determine initial injury severity and prognosis. This study identified three initial ISNCSCI components defining four subgroups of SCI patients with different expectations in functional outcomes, namely the initial pinprick sensory score, the Lower Extremity Motor Score, and the Upper Extremity Motor Score. Clinicians could use these subgroups early after tSCI to plan rehabilitation and set realistic therapeutic goals regarding functional outcomes. In clinical practice, careful and accurate assessment of pinprick sensation early after the SCI is crucial when predicting function or stratifying patients based on the expected function. [ABSTRACT FROM AUTHOR]

Objectives: Neurotoxic effects causing peripheral nerve damage have been reported for several chemotherapy agents. There is no established and standardized method to assess the presence of chemotherapy-induced peripheral neuropathy (CIPN). We compared patient-reported CIPN symptoms to neurophysiological findings and neurological assessments in patients receiving taxane-based chemotherapy. Methods: Patients scheduled to receive taxane-based chemotherapy for the treatment of gynecologic cancer were included and prospectively followed for up to 9 months after chemotherapy discontinuation, between May 2020 and January 2023. Patient-reported symptoms, using the EORTC-QLQ-CIPN20 questionnaire, and nerve conduction studies (NCSs) were performed at baseline, halfway through the treatment cycle, at the end of the treatment, 3 months after treatment, and 6–9 months after treatment. Results: A total of 149 patients were included. Overall, 47.0% of patients reported symptoms compatible with CIPN at any of the follow-ups. Subjective symptoms did not correlate with nerve conduction studies. SNAP amplitudes at baseline were lower in patients who developed CIPN compared to the group without CIPN. Conclusions: The overall diagnostic accuracy of electrophysiological parameters as a marker for CIPN was low. [ABSTRACT FROM AUTHOR]

Background: Meralgia paresthetica (MP), a common entrapment syndrome, presents with paresthesias in the anterolateral aspect of the thigh. Clinical tests used to diagnose MP are the pelvic compression test, neurodynamic testing, and Tinel's sign. The diagnostic accuracy of these three tests has not been analyzed to date. Hence, this study aims to analyze the sensitivity and specificity of these clinical tests. Case Study: This study was a hospital‐based case‐control study that included 30 electrophysiologically proven patients with MP. The data were gathered over a period of 6 months after obtaining institutional ethics committee clearance. Demographics and risk factors among our cases are in keeping with the global scenario. The sensitivity and specificity of the pelvic compression test were 86.7% and 93.0%, the Tinsel sign was 85.1% and 87.5%, and neurodynamic testing was 86.7% and 93.0%, respectively. Conclusion: Our study proves that these tests are a simple and accurate aid in the diagnosis of MP. These bedside clinical tests can be utilized to establish a diagnosis of MP in a setting of conflicting differentials such as lumbar canal stenosis or thoracolumbar junction disc pathologies and guide in choosing the next line of investigation. [ABSTRACT FROM AUTHOR]

The article discusses the challenges faced by oncologists and hematologists in diagnosing TP53 pathogenic variants using next-generation sequencing panels. It highlights the distinction between germline and somatic variants, emphasizing the importance of accurate diagnosis for appropriate management. The National Comprehensive Cancer Network (NCCN) guidelines provide recommendations for screening suspected mosaic Li-Fraumeni syndrome cases, but the complexity of these cases requires further tools for individualized management strategies. The study presents real-world cases illustrating the diagnostic dilemmas and the need for additional tools to differentiate between clonal hematopoiesis and mosaic Li-Fraumeni syndrome. [Extracted from the article]

The encoding of letter position appears to be relatively flexible. Transposed-letter pseudowords (e.g. CHOLOCATE) are more often misidentified as their base words (CHOCOLATE) compared to replacement-letter pseudowords (CHOTONATE) – transposed-letter effect. One plausible explanation for this effect is that it arises from visuospatial position uncertainty in letter position encoding. To test this account, we conducted two lexical decision experiments. Pseudowords were presented syllable-by-syllable in vertical and zigzag formats, making the position of the critical transposed or replaced letters more noticeable. In Experiment 1, we found a transposed-letter effect in both formats, which was sizeable in the error rates. Experiment 2 introduced a delayed 900-ms response cue to assess whether the transposed-letter effect fully vanishes in the absence of immediate time pressure. Results again showed a transposed-letter effect. Thus, while visuospatial uncertainty contributes to letter position flexibility during word recognition, an additional non-visual component is necessary to fully explain this phenomenon. [ABSTRACT FROM AUTHOR]

The prevalence of chronic polyneuropathy will increase due to the aging population, and therefore, it becomes ever so important to optimize the diagnostic process. However, it is uncertain which blood tests are required and when nerve conduction studies (NCS) should be done in the workup of chronic polyneuropathy. We aimed to investigate the methodology used to develop national polyneuropathy guidelines and to provide an overview and strength of evidence of the recommendations. We searched PubMed and websites of national neurological associations as listed on the website of the World Federation of Neurology to identify national guidelines pertaining to the workup of chronic polyneuropathy by neurologists in an outpatient clinic setting. We identified three national guidelines in the United States and seven national guidelines in Denmark, France, Germany, the Netherlands, Norway, Spain, and Turkey. The methodology used to develop the guidelines differed greatly. All guidelines recommend a series of blood tests. Some guidelines advise to conduct NCS in all patients, while other guidelines advise to conduct NCS when certain symptoms are present. There is variation in recommendations about the extensiveness of NCS, but all mention measuring the sural nerve and the motor peroneal nerve. The evidence for the recommendations is graded as low. Despite some overlap, there are disparities between guidelines regarding the workup that is advised to do in patients with chronic polyneuropathy. It remains unclear which combination of blood tests are to be strongly recommended. Furthermore, it is undetermined whether NCS are always necessary. [ABSTRACT FROM AUTHOR]

Background and Aims: Since 2016, biallelic mutations in the membrane metalloendopeptidase (MME) gene have been associated with late‐onset recessive CMT2 (CMT2T). More recently, heterozygous mutations have also been identified in familial and sporadic patients with late‐onset axonal neuropathy, ranging from subclinical to severe. This indicates that the heterozygous MME variants may not be fully penetrant, or alternatively, that they may be a potential risk factor for neuropathy. Here, we describe the clinical, neurophysiological, and genetic findings of 32 CM2T Italian patients. Methods: The patients were recruited from four different Italian referral centers. Following a comprehensive battery of neurological, electrophysiological, and laboratory examinations, the patients' DNA was subjected to sequencing in order to identify any variants in the gene. Bioinformatic and modeling analyses were performed to evaluate the identified variants' effects. Results: We observe a relatively mild axonal sensory‐motor neuropathy with a greater impairment of the lower extremities. Biallelic and monoallelic patients exhibit comparable disease severity, with an earlier onset observed in those with biallelic variants. When considering a subgroup with more than 10 years of disease, it becomes evident that biallelic patients exhibit a more severe form of neuropathy. This suggests that they are more prone to quick progression. Interpretation: CM2T has been definitively defined as a late‐onset neuropathy, with a typical onset in the fifth to sixth decades of life and a more rapidly progressing worsening for biallelic patients. CMT2T can be included in the neuropathies of the elderly, particularly if MME variants heterozygous patients are included. [ABSTRACT FROM AUTHOR]

The article discusses a case study of a 3.5-year-old spayed female Chihuahua presenting with progressive incoordination and weakness. The dog showed signs of cerebellar and proprioceptive ataxia, along with other neurologic abnormalities. Diagnostic tests revealed the presence of an epidermoid/dermoid cyst in the brain, leading to a presumptive diagnosis of meningoencephalitis. Treatment involved surgical debulking and immunosuppressive therapy, with a guarded prognosis due to the nature of the cyst. The study highlights the challenges and complexities of diagnosing and treating intracranial cysts in veterinary medicine. [Extracted from the article]

Background: Historically used as a marker for inherited disorders, the current interest in plasma homocysteine measurement lies in its ability to provide valuable information about the metabolic and nutritional status of patients. Specifically, nitrous oxide (N2O) abuse can lead to functional vitamin B12 deficiency by oxidation and increase oxidative stress, resulting in elevated plasma homocysteine levels, which mimic neurological conditions such as Guillain–Barré syndrome. Rapid identification of hyperhomocysteinemia is crucial for timely intervention and avoiding costly, unnecessary treatments. Objective: This study evaluates the performance of a rapid immunoassay technique (Snibe) compared to mass spectrometry (LC-MS/MS) for measuring plasma homocysteine levels in patients with nitrous oxide abuse and non-inherited caused of elevated homocysteine, aiming to enhance differential diagnosis related to oxidative stress. Methods: 235 patients from Lille University Hospital were included. EDTA blood samples were collected and analyzed using both rapid immunoassay (Snibe) and LC-MS/MS. Neurological assessment was performed using the peripheral neuropathy disability (PND) score. Results: Firstly, significant elevations in plasma homocysteine levels were observed in patients abusing nitrous oxide measured by LC-MS/MS. Secondly, the immunoassay provided rapid results, essential for early clinical decision-making, but tended to underestimate high values compared to LC-MS/MS. A good correlation was found between the methods for low and moderate values. Conclusion: The immunoassay tended to underestimate high-value samples compared to LC-MS/MS, which is a common problem with the competitive methodology. The rapid immunoassay technique is effective for initial screening and early intervention, aiding in the differential diagnosis of conditions related to oxidative stress. Therefore, it is recommended to use the CLIA method for initial screening and confirm with mass spectrometry if there are abnormal samples. Integrating both techniques can enhance diagnostic accuracy and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Neuromuscular junction (NMJ) disorders represent a heterogenous group of acquired and congenital disorders that present in variable and distinctive ways. The diagnosis is typically reached through a combination of clinical, serological, pharmacological and electrophysiological evaluation. While the diagnosis can be fairly straightforward in some cases, the overlap with other neurological disorders can make diagnosis challenging, particularly in pure ocular presentations and in seronegative patients. The over-reliance on serological tests and electrophysiological evaluation in isolation can lead to misdiagnosis. In this article, we provide an overview of the NMJ disorders, discuss red flags for the key differential diagnoses (mimics) and report the atypical ways in which NMJ disorders may present (chameleons). [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the clinical significance of anemia in patients with idiopathic intracranial hypertension (IIH). Patients and methods: This retrospective study was performed on 101 consecutive patients with IIH between January 2018 and January 2023. All patients had a complete blood count at the time of admission. Two groups were formed according to the presence of anemia: 32 female patients (mean age: 40±9.6 years; range, 24 to 62 years) with anemia were included in Group 1, and 69 patients (65 females, 4 males; mean age: 40±12.1 years; range 18 to 65 years) without anemia were included Group 2. The groups were analyzed to identify differences in demographic data and visual functions. Results: There was no statistically significant difference in the proportion of female patients (p=0.304), age (p=0.914), and body mass index (29.6±5 vs. 31.8±5.7 kg/m²; p=0.070) between Groups 1 and 2. Groups 1 and 2 were not statistically different in terms of visual acuity (0.9±0.2 vs. 0.9±0.2 logMAR; p=0.586), retinal nerve fiber layer thickness (128.4±60.8 vs. 136.8±64.8 μm; p=0.602), visual field mean deviation (-4.3±4.8 vs. -5.1±4.7 dB; p=0.280), and the need for medical treatment (32 of 32 vs. 68 of 69; p=0.715). Conclusion: The elucidation of the etiology of IIH is warranted given its propensity to induce severe visual impairment. This study suggested that there was no direct causal relationship between anemia and IIH. Prospective studies in the future could provide further confirmation of our findings [ABSTRACT FROM AUTHOR]

Aim: Spinal cord injury is an important problem, and a fully effective treatment for it has not yet been developed. Isotretinoin is a retinoid known for its anti-inflammatory effect. The present study aimed to evaluate whether isotretinoin has a positive impact on neural tissue in post-injury damage. Material and Methods: A total of 36 rats were randomly divided into 6 groups as control, sham, and injury with 14-day 7.5 mg/kg/day, 28-day 7.5 mg/kg/day, 14-day 15 mg/kg/day, and 28-day 15 mg/kg/day isotretinoin groups. Laminectomy was performed and spinal cord injury was produced by using the clip compression technique. Neurological examination was performed on days 1, 7, 14, and 28. After the treatment period, all rats were sacrificed, and their spinal cord samples were collected for histopathological assessment. Results: Groups receiving 7.5 mg/kg/day (p=0.048) and 15 mg/kg/day (p<0.001) isotretinoin showed a significantly increased inclined plane angle on day 14 compared with the sham group. In hematoxylin and eosin, and Luxol fast blue staining, the 28-day isotretinoin of 15 mg/kg/day group and the control group had similar histopathological findings in motor neurons and glial cells. The cleaved caspase 3 expression was significantly diminished in the groups of 28-day isotretinoin 7.5 mg/kg/day, 14-day isotretinoin 15 mg/kg/day, and 28-day isotretinoin 15 mg/kg/day, compared to the sham group, along with the reduction in apoptosis. Conclusion: Isotretinoin reduces neuronal apoptosis, diminishes pathological tissue damage, and improves functional recovery after injury. The observed prominent neuroprotective effects introduce isotretinoin as a promising therapy for spinal cord injury. [ABSTRACT FROM AUTHOR]

Introduction: Patients presenting with ataxia are at high risk of falling, however, there are limited studies evaluating fall factors restricted to patients presenting with ataxia due to stroke. Purpose: This study aimed to examine the characteristics of patients with ataxia after stroke based on their motor function to identify variables associated with fall occurrence. Methods: We divided 33 participants who presented with ataxia after stroke into fall and non-fall groups. Data on motor function, cognitive function, and daily functionality were extracted from their admission records. Walking ability was measured as comfortable walking speed and Stride Time Variability (STV). Independent sample t-tests, Mann – Whitney U tests, and multiple logistic regression analysis were performed. Results: There were significant differences between fallers and non-fallers in the STV (p <.001), Mini-Balance Evaluations Systems Test score (p <.014) and Scale for Assessment and Rating of Ataxia score assessment (p <.028). In the multiple logistic regression analysis, only STV was associated with an increased risk of falls (p <.02). The area under the receiver operating characteristic curve was 0.839; the cutoff value of gait cycle variability for falls was 6.345% (sensitivity, 80.0%; specificity, 74.0%). Conclusion: Increased stride time variability is a useful indicator that sensitively captures fall risk in patients with ataxia after stroke. [ABSTRACT FROM AUTHOR]

The absence of guidelines for managing gunshot wounds to the head (GSWH) with bihemispheric lesions in pediatric patients highlights the need for prompt and diverse damage control strategies. This article aims to systematically evaluate the evidence surrounding the management of GSWH in preschoolers and to report a novel approach. We present a case of a 4-year-old girl who sustained a gunshot wound to the left parietal region. She was admitted to a level 1 trauma center 90 min post-injury with stable vital signs, a Glasgow coma scale (GCS) of 12 (E3, V3, M6), and grade III hemiparesis in her right upper limb. Initial surgical management included left hematoma decompression and right frontotemporoparietal decompressive hemicraniectomy in two stages under the same anesthesia. Due to massive brain swelling during the left-sided procedure, it was converted to a left frontotemporoparietal decompressive hemicraniectomy. Both procedures included autologous pericranium augmentation duraplasty and watertight suturing. A right-side decompressive hemicraniectomy followed without exploring bullet lodging, using bilateral Kempe incisions. Bone flaps were stored under cryopreservation. During a 30-day hospital stay, neurological assessments showed a gradual recovery of right upper limb strength to grade IV + , with no other deficits or operative complications. Postoperative CT scans at 7, 14, and 28 days showed minor pseudomeningoceles and a reduction of intraparenchymal edema. Multidisciplinary care continued throughout the stay. The patient showed no signs of endocrinological, infectious, or residual neurological issues and underwent bilateral autologous cranioplasty on day 35. She was discharged on day 38 with a GCS extended of 8 (full recovery/minor deficits not affecting daily activities) and minor right upper limb apraxia. A systematic review identified nine patients under 6 years old with GSWH, with only one previously reported case of a 3-year-old patient with bihemispheric lesions undergoing bilateral craniectomies and achieving positive outcomes. Our case and the review suggest that bilateral decompressive hemicraniectomy is a feasible strategy for managing multilobar bihemispheric GSWH in preschoolers. However, the evidence of management for this population remains of low quality, highlighting the need for further research, and justifying this case report. [ABSTRACT FROM AUTHOR]

Background/Objectives: The Early Identification and Intervention for Infants (Ei3) Network is an interdisciplinary team dedicated to improving early detection and intervention of cerebral palsy (CP) in California. This paper describes the key (1) awareness-building and (2) capacity-building strategies utilized by the Ei3 Network in the first two years. Methods: Awareness-building methods included interactive conference discussions, resource deliverable creation, and the creation of a framework for dissemination. Capacity-building methods were hosting assessment training, gathering stakeholder feedback, and implementation training. All deliverables were created with a minimum of 3 review and revision cycles. We planned, hosted, and provided scholarships for training, including the Hammersmith Infant Neurological Examination (HINE), Prechtl's GMA, and an implementation conference. Preliminary descriptive statistics and paired samples t-tests were performed on HINE training surveys. Results: Seven resource deliverables were created and distributed. A professional website, @steps2home.org, was launched. Online channels gained followers (146, Instagram; 198, X; 298, Mailchimp). Providers participated in various trainings: the Sykes Symposium on early detection and intervention (70), HINE (211), GMA Basic or Advanced (46), and Implementation Conference (six facilities from April 2023 to June 2024). HINE training participants reported increased ability to identify CP (p = 0.001), knowledge of (p = 0.004) early detection, ability to implement early detection guidelines (p < 0.001), and confidence in performing the HINE on the post-test (79.87%). Conclusions: The first two years of Ei3 resulted in increased awareness of the early detection guidelines through resources to help providers and families navigate complex care systems and dissemination through online and in-person strategies. We built capacity by training an increased number of providers to identify infants at risk of CP and implement the early detection guidelines. Engagement of stakeholders in focus groups, reviewing documents, and including a parent panel throughout the process increased the value of this work and should support the expansion of the network in the next year. [ABSTRACT FROM AUTHOR]

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disorder because of NTRK1 gene mutations, leading to an inability to perceive pain and temperature and lack of sweating. Its rarity and unique clinical challenges, such as severe injuries from the inability to sense pain, make reporting cases critical. A 5‐year‐old boy, the third child of consanguineous parents, was referred for a fractured femur. His history includes recurrent fevers, pain insensitivity, self‐mutilation, and anhidrosis with compensatory hyperhidrosis. Examination showed multiple ulcers, dry skin, missing digits, dental issues, and corneal ulcers. The neurological assessment confirmed loss of pain and temperature sensation. Genetic testing confirmed NTRK1 mutations, diagnosing CIPA. The femur fracture was treated with a hip spica cast, and injury prevention and temperature management were advised to the parents. This case underscores the importance of early diagnosis and comprehensive management of CIPA, highlights the need for genetic counseling for at‐risk families, and provides insights into managing the condition's complex challenges. A multidisciplinary approach is essential to improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background: Head injuries (HI) are a major threat to public health. Initial management should involve careful evaluation and neurological assessment. We aim to evaluate the predictive value of trans cranial duplex and jugular venous oxygen saturation in patients with deep-seated brain lesions after Head Trauma. Methods: A prospective study on 60 patients with deep-seated brain lesions after head trauma was conducted at the neurosurgical department and intensive care unit in Zagazig University Hospital. Trans cranial duplex and Jugular Venous Oxygen Saturation Monitoring were assessed in all patients. Results: The best cutoff of TCD (PI) at week 2 that can predict unfavorable outcomes among patients is =0.95 cm with area under curve 0.838 with 73.1% sensitivity and 60% specificity. The best cutoff of TCD (MFV) at week 2 that can predict unfavorable outcomes among patients is =39.5 cm/sec with area under curve 0.831 with 84.6% sensitivity and 60% specificity. The best cutoff of baseline SjVO2 that can predict unfavorable outcomes among patients is =73.5% with an area under curve 0.908 with 80.8% sensitivity and 60% specificity. Conclusion: There is a statistically significant relation between outcome and SjVO2 at ER admission and at each point of the follow-up period till the end of the second week where all those with favorable outcomes were discharged (higher levels significantly associated with unfavorable outcomes). There is a statistically significant relation between outcome and TCD (MFV) and TCD (PI) at ER admission, first and third week (lower TCD (MFV) and higher TCD (PI) were significantly associated with unfavorable outcome). [ABSTRACT FROM AUTHOR]

Background Supratentorial intraventricular tumors, encompassing lateral and third ventricular tumors, are uncommon intracranial neoplasms, typically slow-growing and benign, manifesting symptoms only upon reaching a substantial size. This study aims to identify optimal surgical approaches, assess the prevalence and characteristics of these tumors, and evaluate postoperative outcomes among pediatric and adult age groups. Methods A retrospective comparative study at a tertiary care hospital from January 2014 to June 2020 included 165 patients (68 pediatrics, 97 adults) meeting inclusion criteria for intraventricular tumor management. Data covered demographic factors, clinical history, neurological assessments, neuroimaging, surgical approaches, histopathological diagnoses, immunohistochemical features, adjuvant therapies, follow-up status, postoperative complications, and morbidity/mortality. Results Ventricular tumor incidence showed male preponderance in both adults (M:F = 1.2:1) and pediatrics (M:F = 3:1). Lateral ventricles were the most common location. Pediatric cases exhibited more frequent calcifications on computed tomography scans (35.6% vs. 29.5%). Grade II and III tumors were more prevalent in adults within the lateral ventricle (27.1 and 1.9%) compared with pediatrics (6.5 and 8.4%). The third ventricle predominantly featured benign lesions, with pediatric patients experiencing significantly longer hospital stays (16.12 ± 21.94 days vs. 9.58 ± 6.21 days) (p = 0.006). Adults and pediatric patients showed a significant difference in high-grade lateral ventricle tumors (p -value = 0.002). Conclusions Supratentorial ventricular tumors are relatively more prevalent in children than adults, presenting challenges due to size and bleeding risks. Surgical resection is the primary treatment, with a focus on the optimal approach for gross total excision to reduce recurrence risk. [ABSTRACT FROM AUTHOR]

The article presents the case study of a 21-month-old boy who developed unsteady gait and bilateral leg weakness. Topics include the initial symptoms of ataxia and leg weakness following a recent Hepatitis A vaccination and minor gastrointestinal symptoms; the physical examination and imaging, which revealed acute spondylolysis and grade 1 spondylolisthesis; and the role of orthopedic consultation, which determined the spinal findings were likely acute on chronic in nature.

Background: Rhabdomyosarcoma is the most common soft-tissue sarcoma in children and is usually found in the head, neck, orbit, genitourinary tracts and extremities. An unusual pattern is diffuse bone marrow involvement by rhabdomyosarcoma. In such cases, the initial presentation of patients is similar to haematological malignancy like leukaemia, especially when the primary tumour is not evident. This pattern is rare; however, awareness of this pattern is important for radiologists for appropriate early diagnosis and treatment. Rhabdomyosarcoma involving the spine is extremely rare with very few case reports available in the literature. Case presentation: We present a case of a seven-year-old boy presenting with subacute paraplegia associated with high-grade fever following a genitourinary surgery. The differential diagnosis of post-surgical complications like infective spondylodiscitis, epidural abscess and transverse myelitis were considered clinically. Magnetic resonance imaging of the spine revealed heterogenous enhancement of the bone marrow of the vertebrae and the pelvic bones along with paravertebral and epidural enhancing soft tissues and the most likely differential diagnosis was leukaemia/lymphoma. Histopathology and immunohistochemistry of the soft tissue revealed an embryonal rhabdomyosarcoma. [1⁸F] Fluorodeoxyglucose PET-CT revealed extensive marrow lesions in the axial and appendicular skeleton. In view of extensive metastatic disease, the patient was given palliative therapy. The unusual primary site and presentation with multiple metastasis makes this case worth reporting. Conclusion: Spinal or bone marrow involvement in rhabdomyosarcoma is uncommon, and it provides a diagnostic challenge in view of the non-specific signs and symptoms. Haematological malignancy is often the primary diagnosis made clinically and on imaging. Spinal or bone marrow involvement in rhabdomyosarcoma implies an overall poor prognosis of the patient. Multimodality therapy is the mainstay of management in spinal rhabdomyosarcoma, which includes surgery, chemotherapy, radiotherapy and palliative treatment in cases of extensive metastasis. [ABSTRACT FROM AUTHOR]