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Diffusion weighted imaging in acute ischemic stroke: A review of its interpretation pitfalls and advanced diffusion imaging application
NandakumarNagaraja
doi : 10.1016/j.jns.2021.117435
Volume 425, 15 June 2021, 117435
Diffusion weighted imaging (DWI) is a widely used imaging technique to evaluate patients with stroke. It can detect brain ischemia within minutes of stroke onset. However, DWI has few potential pitfalls that should be recognized during interpretation. DWI lesion could be reversible in the early hours of stroke and the entire lesion may not represent ischemic core. False negative DWI could lead to diagnosis of DWI negative stroke or to a missed stroke diagnosis. Ischemic stroke mimics can occur on DWI with non-cerebrovascular neurological conditions. In this article, the history of DWI, its clinical applications, and potential pitfalls for use in acute ischemic stroke are reviewed. Advanced diffusion imaging techniques with reference to Diffusion Kurtosis Imaging and Diffusion Tensor Imaging that has been studied to evaluate ischemic core are discussed.
Olfaction and anosmia: From ancient times to COVID-19
StéphaneMathisabcGwendalLe MassonabceAntoineSoulagesabcFannyDuvalabLouisCarlaaJean-MichelVallatdGuilhemSoléab
doi : 10.1016/j.jns.2021.117433
Volume 425, 15 June 2021, 117433
Olfaction, one of our five main qualitative sensory abilities, is the action of smelling or the capacity to smell. Olfactory impairment can be a sign of a medical problem, from a benign nasal/sinus problem up to a potentially serious brain injury. However, although clinicians (neurologists or not) usually test the olfactory nerves in specific clinical situations (for example, when a neurodegenerative disorder is suspected), they may omit such tests in many other situations. With the recent COVID-19 pandemic, the resurgence of anosmia has reminded us of the importance of testing this sensorineural function. We retrace here the main historical steps and discoveries concerning olfaction and anosmia.
Stroke risk associated with carotid and aortic atherosclerosis in patients with atrial fibrillation: A systematic review
Jean JacquesNoubiapaJosephKamtchum-TatuenebJohn L.FitzgeraldacPrashanthanSandersac
doi : 10.1016/j.jns.2021.117444
Volume 425, 15 June 2021, 117444
This review aimed to summarize the evidence on the risk of thromboembolism associated with carotid and aortic atherosclerosis in patients with AF, and the potential impact of their inclusion in current stroke risk stratification scores.
Cerebral venous thrombosis in spontaneous intracranial hypotension: A report of 8 cases and review of the literature
EnricoFerranteabc1MicheleTrimboliad1GiuseppePetreccaeFrancescoAllegrinif
doi : 10.1016/j.jns.2021.117467
Volume 425, 15 June 2021, 117467
The occurrence of cerebral venous thrombosis (CVT) in patients with spontaneous intracranial hypotension (SIH) raises difficult practical questions regarding the management of the two conditions. The first-line therapy for CVT is anticoagulation (AC); however, its potential benefit in SIH/CVT patients, especially if complicated by subdural haematoma, must be carefully evaluated taking account of the intracranial haemorrhage risk. Venous system recanalization and good prognosis in SIH/CVT patients treated with epidural blood patch (EBP), the main treatment option for SIH, have been already described.
Timing of diffusion weighted imaging lesions in spontaneous intracerebral hemorrhage
Rajeev K.GargaMohammadAlberawibBichunOuyangaSayonaJohnaIvan DaSilvaaStaraneShepherdaMehmetKocakcSudeepBhabadcDeborah A.HallaMiral D.JhavericThomas P.Bleckd
doi : 10.1016/j.jns.2021.117434
Volume 425, 15 June 2021, 117434
Diffusion weighted imaging (DWI) lesions are common after spontaneous intracerebral hemorrhage (sICH). However, their timing relative to a patient's admission to the hospital is unknown. The purpose of this study is to estimate the timing of new DWI lesions after admission for acute sICH.
Characteristics of improvements in balance control using vibro-tactile biofeedback of trunk sway for multiple sclerosis patients
J.H.J.Allumab1H.M.Rustab1N.LutzcC.SchouenborgcB.Fischer-BarnicolaV.HalleraT.DerfussaJ.KuhleaÖ.Yaldizlia
doi : 10.1016/j.jns.2021.117432
Volume 425, 15 June 2021, 117432
Previously, we determined that training with vibrotactile feedback (VTfb) of trunk sway improves MS patients' balance impairment. Here, we posed 5 questions: 1) How many weeks of VTfb training are required to obtain the best short-term carry over effect (CoE) with VTfb? 2) How long does the CoE last once VTfb training terminates? 3) Is the benefit similar for stance and gait? 4) Is position or velocity based VTfb more effective in reducing trunk sway? 5) Do patients' subjective assessments of balance control improve?
Covid-19: Involvement of the nervous system. Identifying neurological predictors defining the course of the disease
UdoZifkoaTheresaSchmiedlechneraJohanSaelensbKatharinaZifkobMichaelWagnercOjanAssadiandWolfgangGrisoldeHaraldStinglc
doi : 10.1016/j.jns.2021.117438
Volume 425, 15 June 2021, 117438
The main objective of this study was to analyse neurological symptoms during a Covid-19 infection and determine the pattern of symptoms by comparing outpatients with inpatients. A further goal was to identify possible predictors, such as pre-existing conditions and neurological symptoms.
Bedside video-oculographic evaluation of eye movements in acute supratentorial stroke patients: A potential biomarker for hemispatial neglect
YosukeKudoaKojiTakahashibErikoSugawaraaTomokiNakamizoacMihoKurokidYuichiHigashiyamadFumiakiTanakadKenJohkuraa
doi : 10.1016/j.jns.2021.117442
Volume 425, 15 June 2021, 117442
The presence of hemispatial neglect adversely affects functional outcomes in stroke patients; consequently, it warrants early targeted rehabilitative intervention. Nevertheless, hemispatial neglect in the acute phase of stroke has often been underdiagnosed. In this study, we aimed to detect hemispatial neglect at the bedside in acute stroke patients by measuring eye movements using video-oculography (VOG).
Neuroimaging patterns in paediatric onset hereditary spastic paraplegias
ClaudiaDosiaRosaPasquarielloaChiaraTicciaGujaAstreaaRosannaTrovatoaAnnaRubegniaAlessandraTessaaGiovanniCioniabFilippo MariaSantorellia1RobertaBattiniab1
doi : 10.1016/j.jns.2021.117441
Volume 425, 15 June 2021, 117441
Hereditary spastic paraplegias (HSPs) are a clinically and genetically heterogeneous group of neurodegenerative disorders characterized by progressive spasticity and weakness of the lower limbs with a notable phenotypic variation and an autosomal recessive (AR), autosomal dominant (AD), and X-linked inheritance pattern. The recent clinical use of next generation sequencing methods has facilitated the diagnostic approach to HSPs, but the diagnosis remains quite challenging considering its wide clinical and genetic heterogeneity. In this scenario, magnetic resonance imaging (MRI) emerges as a valuable tool in helping to exclude mimicking disorders and to guide genetic testing. The aim of this study is to investigate the presence of possible patterns of morphostructural MRI findings that may provide relevant clues for a specific genetic HSP subtype. In our cohort, for example, white matter abnormalities were the most common finding followed by the thinning of the corpus callosum, which, interestingly, presented different thinning characteristics depending on the HSP subtype.
Case fatality of hospital-treated intracerebral hemorrhage in Finland – A nationwide population-based registry study
Jussi O.T.SipiläabJori O.RuuskanenbPäiviRautavacVilleKytödefg
doi : 10.1016/j.jns.2021.117446
Volume 425, 15 June 2021, 117446
Case-fatality of Intracerebral hemorrhage (ICH) has been reported to have improved in some areas recently. Previous reports have shown that in Finland ICH survival has improved already from the 1980s. We aimed to investigate if this trend has continued and to assess possible predictors for death.
Preserved cholinergic forebrain integrity reduces structural connectome vulnerability in mild cognitive impairment
RokBerlotabBlažKoritnikbcdZvezdanPirtošekabNicola J.Raye
doi : 10.1016/j.jns.2021.117443
Volume 425, 15 June 2021, 117443
Neurodegeneration leads to redistribution of processing, which is reflected in a reorganisation of the structural connectome. This might affect its vulnerability to structural damage. Cortical acetylcholine allows favourable adaptation to pathology within the memory circuit. However, it remains unclear if it acts on a broader scale, affecting reconfiguration of whole-brain networks. To investigate the role of the cholinergic basal forebrain (CBFB) in strategic lesions, twenty patients with mild cognitive impairment (MCI) and twenty elderly controls underwent magnetic resonance imaging. Whole-brain tractograms were represented as network graphs. Lesions of individual nodes were simulated by removing a node and its connections from the graph. The impact of simulated lesions was quantified as the proportional change in global efficiency. Relationships between subregional CBFB volumes, global efficiency of intact connectomes and impacts of individual simulated lesions of network nodes were assessed. In MCI but not controls, larger CBFB volumes were associated with efficient network topology and reduced impact of hippocampal, thalamic and entorhinal lesions, indicating a protective effect against the global impact of simulated strategic lesions. This suggests that the cholinergic system shapes the configuration of the connectome, thereby reducing the impact of localised damage in MCI.
Real-world analysis of botulinum toxin (BoNT) injections in post-stroke spasticity: Higher doses of BoNT and longer intervals in the early-start group
JeanWooaManuel F.MasbcJulianaZhangcBonnyWongdArgyriosStampascGerard E.FranciscocShengLic
doi : 10.1016/j.jns.2021.117449
Volume 425, 15 June 2021, 117449
Our primary objective was to compare early-start vs. late-start Botulinum toxin (BoNT) injections in post-stroke spasticity management. This is an IRB approved retrospective chart review of patients who were admitted for inpatient rehabilitation within 6 months after first-ever stroke between January 2014 and December 2018 and received BoNT injections within 15 months. The total dose and interval between consecutive injections were used as objective outcomes. 2367 stroke admissions were reviewed. 189 patients metinclusion criteria. 68 out of 189 patients received BoNT injections within 12 weeks after stroke (EARLY group). 20 patients in the EARLY group who received at least three cycles were included for analysis. Out of 189 patients, 47 patients were categorized into the Early- and Late-start subgroups each by time from stroke onset to first BoNT injection (1st and 4th quartiles of time distribution) for comparisons. In the EARLY group, the first interval (Mean (M) = 7.6 weeks, standard deviation (SD) = 2.14) was significantly shorter than the second interval (M = 23.7, SD = 10.41) and the third interval (M = 20.0, SD = 11.23; p < 0.05). The dose at the first cycle (M = 492 units, SD = 201.5) was significantly lower than the dose at the third cycle (M = 605, SD = 82.6). In comparison between the Early- and Late-start subgroups, the time to first BoNT injection was 6.4 weeks (range: 4.7–8.6) after stroke for the Early-start subgroup and 49.6 weeks (range: 27.4–62.3) after stroke for the Late-start subgroup. The subsequent intervals after the first injection were significantly longer in the Early-start subgroup (M = 23.1 weeks) than in the Late-start subgroup (M = 14.6 weeks) (p = 0.008). The average total dose of BoNT was significantly higher in the Early-start subgroup (M = 561.9 units, SD = 143.1) than the Late-start subgroup (M = 470.0, SD = 164.8) (p = 0.012). The findings showed that higher doses of BoNT were used in the Early-start group, and often resulted in longer intervals between subsequent injections than in the Late-start group.
Identifying prognostic factors and developing accurate outcome predictions for in-hospital cardiac arrest by using artificial neural networks
Chen-ChihChungabcdWei-TingChiuabdeYao-HsienHuangabdfLungChanabdChien-TaiHongabd1Hung-WenChiucg1
doi : 10.1016/j.jns.2021.117445
Volume 425, 15 June 2021, 117445
Accurate estimation of neurological outcomes after in-hospital cardiac arrest (IHCA) provides crucial information for clinical management. This study used artificial neural networks (ANNs) to determine the prognostic factors and develop prediction models for IHCA based on immediate preresuscitation parameters.
Safety and efficacy of antiplatelet use before intravenous thrombolysis for acute Ischemic stroke
AshkanMowlaaMaryamSharifian-DorchebSandhyaMehlacNavdeep S.LaildAmirhosseinSharifian-DorcheeCaila B.VaughndRobert N.SawyerdPeymanShiranif
doi : 10.1016/j.jns.2021.117451
Volume 425, 15 June 2021, 117451
To study the effects of pretreatment with Antiplatelet (AP) before IV thrombolysis (IVT) on the rate of symptomatic intracranial hemorrhage (sICH) and functional outcome in patients with Acute Ischemic stroke (AIS).
Sex-related differences in stressful events precipitating transient global amnesia – A retrospective observational study
CarolinHoyerAnneEbertVesileSandikciMichaelPlattenKristinaSzabo
doi : 10.1016/j.jns.2021.117464
Volume 425, 15 June 2021, 117464
Physically or emotionally charged events have consistently been reported as precipitating an episode of transient global amnesia (TGA). In conjunction with evidence of hippocampal involvement from neuroimaging, this has promoted the hypothesis that TGA is a stress-related disorder.
Subclinical upper motor neuron involvement at the diagnosis may predict disease progression in a cohort of lower motor neuron syndromes from Southern Italy
StefanoZoccolellaaAlessandroIntronabGiammarcoMilellabAntonellaMastronardibGiovanniIlicetobEustachioD'ErricobAngelaFraddosiobIsabella LauraSimoneb
doi : 10.1016/j.jns.2021.117392
Volume 425, 15 June 2021, 117392
Only few epidemiological studies on survival of Lower Motor Neuron (LMN) phenotype (LMNP) are available and with controversial results.
Tuberculosis in Myasthenia Gravis patients on immunosuppressive therapy in a high-risk area: Implications for preventative therapy
Elizabeth C.SteynaTristan M.NaidoobSuzaanMaraisacJeannine M.Heckmannac
doi : 10.1016/j.jns.2021.117447
Volume 425, 15 June 2021, 117447
Data regarding the risk of tuberculosis (TB) in myasthenia gravis (MG) patients receiving immunosuppressive therapy is limited, and the benefit of TB preventative therapy in these patients is uncertain. We audited observational data collected at an MG clinic in South Africa over a ~ 10-year period, of cases who received immunosuppressive therapy. The total time that the cohort was at risk (patient-years) was used as the denominator to calculate TB incidence after immunosuppressive therapy initiation. Multivariate logistic regression analysis was performed to identify differences between patients who did, and those who did not, develop TB. Of 480 cases, only two received TB preventative therapy when starting immunotherapy. Seventeen of 282 (6%) patients tested, were HIV-infected. With a median follow-up of 3.6 years (interquartile range 1;7.5), 13 (3%) patients (all HIV-uninfected) developed TB (38% within 12 months of starting immunosuppressive therapy). The incidence rate of TB in the study population (?401/100000 person-years) was not higher than that for the hospital's catchment area during the same period (>500/100000 population). The maximum dose of prescribed prednisone was higher in patients who developed TB compared to those who did not (median: 0.6 mg/kg/day vs 0.4; 0.002); Odds ratio for TB increased 1.26-fold for every 0.1 mg/kg/day increase in maximum dose (p = 0.001). In our TB endemic setting, receiving immunosuppressive therapy was not associated with excess TB in MG patients. Preventative therapy may be considered in those who are at greatest risk of developing TB and receiving high-dose prednisone.
Clopidogrel underactivity is a common in patients with acute symptomatic severe carotid stenosis
A.HonigaT.SacagiuaA.FiliogloaN.SimaanaY.KalishbJ.M.GomoricA.HorevdR.R.LekeraJ.E.Cohene
doi : 10.1016/j.jns.2021.117450
Volume 425, 15 June 2021, 117450
Clopidogrel is commonly used for secondary stroke prevention in patients with large vessel stenosis. Reduced Clopidogrel high on treatment platelet reactivity (CR) can lead to Clopidogrel underactivity (CU) causing acute thrombosis. However, the prevalence of CU among patients with acute symptomatic carotid disease remains unknown. Therefore, we aimed to find the prevalence and identify the predictors for CU among patients with acutely symptomatic carotid stenosis.
A series of cases with Huntington-like phenotype and intermediate repeats in HTT
AntíaReguera AcuñaaEstherSuárez San MartínabCiaraGarcía FernándezabSantiagoFernández MenéndezabMartaBlázquez EstradaabcManuelAmorín DíazabManuelMenéndez GonzálezabcVictoriaÁlvarez Martínezbd
doi : 10.1016/j.jns.2021.117452
Volume 425, 15 June 2021, 117452
Intermediate Alleles (IAs) are expansions of CAG repeats in the HTT gene between 27 and 35 repeats which pathogenic meaning remains controversial. They are present in the general population but there is an increasing number of cases with Huntington-like phenotype reported.
Preparedness and impact of COVID 19 infection at tertiary care neurology centers in Pakistan
DureshshahwarKanwaraSafiaAwanaAliSajjadaAnjumFarooqbLalChandcAwais BashirLarakdAbdulMalikeMohammadWazirfAdnanAslamgHusnainHashimhFarheenNiaziiMohammad FateenRasheedjFozanKhankMazharHamdanilFahadSaleemmAtharIqbalnAhmedAsifoNailaShahbazpHarisMajidqMohammadWasaya
doi : 10.1016/j.jns.2021.117462
Volume 425, 15 June 2021, 117462
We aimed to assess the response and impact of covid 19 pandemic at tertiary care centers in Pakistan especially pertaining to neurological care, facilities and training.
Purine synthesis as a target for radiation resistance in molecular glioblastoma
Connor J.KinslowaKunal R.ChaudharyaPavan S.UpadhyayulaaTony J.C.WangaRamon C.SunbSimon K.Chenga
doi : 10.1016/j.jns.2021.117439
Volume 425, 15 June 2021, 117439
A case of progressive supranuclear palsy with predominant cerebellar ataxia diagnosed by [18F]PM-PBB3 tau PET
KeiIshizuchiaTsubasaTakizawaaToshikiTezukaaKeisukeTakahatabcMorinobuSekiaHajimeTabuchibRyoUedadMasahitoKubotaaMasaruMimurabJinNakaharaaDaisukeItoa
doi : 10.1016/j.jns.2021.117440
Volume 425, 15 June 2021, 117440
Impact of cerebral venous sinus thrombosis associated with COVID-19
ArchanaHindujaaKrishnaNalleballebSanjeevaOnteddubSukanthiKovvurubOmarHusseinc
doi : 10.1016/j.jns.2021.117448
Volume 425, 15 June 2021, 117448
Neurometabolic causes of dystonia: Sepiapterin reductase-deficient dopamine- and serotonin-responsive dystonia-plus syndrome
YoshiakiFurukawaabYujiTomizawabToshikiNakaharaab
doi : 10.1016/j.jns.2021.117468
Volume 425, 15 June 2021, 117468
Reply to: Neurometabolic causes of dystonia: Sepiapterin reductase-deficient dopamine- and serotonin-responsive dystonia-plus syndrome
Chun SengPhuaabKishore RajKumarcdefStanleyLevygh
doi : 10.1016/j.jns.2021.117469
Volume 425, 15 June 2021, 117469
Review of the neurological aspects of HIV infection
Hoosain FarukParukAhmed IqbalBhigjee
doi : 10.1016/j.jns.2021.117453
Volume 425, 15 June 2021, 117453
