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Ventriculopleural shunt: Review of literature and novel ways to improve ventriculopleural shunt tolerance
TimothyWongJustinGoldRyanHouserYehudaHerschmanRajaJaniIraGoldstein
doi : 10.1016/j.jns.2021.117564
Volume 428, 15 September 2021, 117564
Cerebrospinal fluid (CSF) diversion is among the most commonneurosurgical procedures that are performed worldwide. It is estimated thatapproximately 30,000 ventriculostomies are performed annually in the United States.Ventriculoperitoneal (VP) shunt malfunction rate within the first year of initialimplantation has been reported to be as high as 11–25%. In patients with abdominaladhesions, infections or multiple failed VP shunts, another bodily compartment shouldbe utilized as a substitute for the peritoneal cavity for distal shunt catheter placement.Ventriculopleural (VPL) shunting for hydrocephalus was first introduced by Heile in1914. Since the inception of this idea, VPL shunts have been utilized in select patientswith varying degrees of success. There have been a number of case reports andseries documenting unique complications with VPL shunting, with pleural effusion andpneumothorax being the most common complications. In our review article, we soughtto review the development of VPL shunting, pleuropulmonary physiology, insertiontechniques for VPL shunt, complications associated with VPL shunts, and uniquestrategies to improve VPL shunt tolerance.
Baló's concentric sclerosis – A rare entity within the spectrum of demyelinating diseases
Jim ShenchuXieaTrishalJeeva-PatelbEdwardMargolinbc
doi : 10.1016/j.jns.2021.117570
Volume 428, 15 September 2021, 117570
Baló's concentric sclerosis (BCS) is a rare, inflammatory demyelinating disease of the central nervous system (CNS). Historically, BCS was thought to be uniformly fatal and diagnosis was based on postmortem findings. With advances in modern neuroimaging, BCS is currently defined by the presence of concentric layered patterns composed of alternating rings of varying intensity. They are best appreciated on gadolinium-enhanced T1-weighted sequences and predominantly occur in the supratentorial cerebral white matter with sparing of cortical U-fibers. The lamellar pattern of the lesions likely reflects bands of demyelination and relative myelin preservation with minimal axonal loss. While BCS falls within the spectrum of atypical demyelinating diseases, there is ongoing debate over whether BCS is a phenotypical variant of multiple sclerosis (MS) or a separate entity. Corticosteroids comprise first-line therapy but there is ongoing controversy regarding appropriate maintenance therapy. First-line MS disease-modifying therapies such as interferon beta-1a are appropriate for patients who fulfill diagnostic criteria for relapsing-remitting MS. Fingolimod should likely be avoided as Baló-like lesions have been reported during its administration or after withdrawal. Monoclonal antibodies such as natalizumab and rituximab are potentially effective at reducing BCS relapses, but alemtuzumab may be relatively ineffective because humoral immunity does not play a central role in BCS pathogenesis.
Vaccine-induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis post COVID-19 vaccination; a systematic review
MaryamSharifian-DorcheabMohammadBahmanyarcAmirhosseinSharifian-DorchebPegahMohammadidMasoodNomovieAshkanMowlaf
doi : 10.1016/j.jns.2021.117607
Volume 428, 15 September 2021, 117607
The common reported adverse effects of COVID-19 vaccination consist of the injection site's local reaction followed by several non-specific flu-like symptoms. However, rare cases of vaccine-induced immune thrombotic thrombocytopenia (VITT) and cerebral venous sinus thrombosis (CVST) after viral vector vaccines (ChAdOx1 nCoV-19 vaccine, Ad26.COV2 vaccine) have been reported. Herein we systemically reviewed the reported cases of CVST and VITT following the COVID-19 vaccination.
Neurology of the acute hepatic porphyrias
MiguelOliveira SantosabMiguelLeal Ratoac
doi : 10.1016/j.jns.2021.117605
Volume 428, 15 September 2021, 117605
Porphyrias are a set of rare inherited metabolic disorders, each of them representing a defect in one of the eight enzymes in the haem biosynthetic pathway resulting in the accumulation of organic compounds called porphyrins. Acute hepatic porphyrias (AHP) are those in which the enzyme deficiency occurs in the liver, of which acute intermittent porphyria is by far the most common subtype. Neurology of the AHP is still challenging in practice, and patients rarely receive the correct diagnosis early in the disease course. For AHP, which primarily affects the central and peripheral nervous system, the cause of symptoms seems to be the increased production of neurotoxic precursors, in particular delta-aminolaevulinic acid and porphobilinogen. Neurological complications usually result from severe episodes of acute attacks. The neurologic hallmark of porphyrias is an acute predominantly motor axonal neuropathy resembling a Guillain-Barré syndrome that generally occurs after the onset of other clinical features such as abdominal pain and central nervous system manifestations. Neuropsychiatric syndromes, seizures, encephalopathy, and cerebrovascular disorders are among the possible central nervous system presentations. Therapeutic approach to AHP is divided into management and prophylaxis of an acute attack, including long standing options such as intravenous hematin and new therapeutic agents such as givosiran.
Emerging potential mechanisms and predispositions to the neurological manifestations of COVID-19
AaronJesuthasanaFlaviaMasseybHadiManjicMichael S.ZandicSarahWiethoffde
doi : 10.1016/j.jns.2021.117608
Volume 428, 15 September 2021, 117608
A spectrum of neurological disease associated with COVID-19 is becoming increasingly apparent. However, the mechanisms behind these manifestations remain poorly understood, significantly hindering their management. The present review subsequently attempts to address the evolving molecular, cellular and systemic mechanisms of NeuroCOVID, which we have classified as the acute and long-term neurological effects of COVID-19. We place particular emphasis on cerebrovascular, demyelinating and encephalitic presentations, which have been reported. Several mechanisms are presented, especially the involvement of a “cytokine storm”. We explore the genetic and demographic factors that may predispose individuals to NeuroCOVID. The increasingly evident long-term neurological effects are also presented, including the impact of the virus on cognition, autonomic function and mental wellbeing, which represent an impending burden on already stretched healthcare services. We subsequently reinforce the need for cautious surveillance, especially for those with predisposing factors, with effective clinical phenotyping, appropriate investigation and, if possible, prompt treatment. This will be imperative to prevent downstream neurological sequelae, including those related to the long COVID phenotypes that are being increasingly recognised.
Commercially available seizure detection devices: A systematic review
JenniferShumDanielFriedman
doi : 10.1016/j.jns.2021.117611
Volume 428, 15 September 2021, 117611
Epilepsy can be associated with significant morbidity and mortality. Seizure detection devices could be invaluable tools for both people with epilepsy, their caregivers, and clinicians as they could alert caretakers about seizures, reduce the risk of sudden unexpected death in epilepsy, and provide objective and more reliable seizure tracking to guide treatment decisions or monitor outcomes in clinical trials.
Patient-reported burden of symptoms in neuromyelitis optica: A secondary analysis on pain and quality of life
KazuoFujiharaaSatoshiHattoribIngoKleiterc1MichaelLevydYuyaMatsudaeAsakoMitsutakeeMasayukiHaramuraeJacquelinePalacefTakashiYamamuragon behalf of The Guthy-Jackson Charitable Foundation NMOSD Quality of Life Working Group
doi : 10.1016/j.jns.2021.117546
Volume 428, 15 September 2021, 117546
Relapses of neuromyelitis optica spectrum disorder (NMOSD) result in cumulative neurologic disabilities, are unpredictable, and are interspersed with remissions. Pain in NMOSD is often severe and intractable, with a significant impact on patient quality of life (QoL). We performed a more detailed analysis of previously published survey data on the association of pain and QoL, comparing patients who were seropositive and seronegative for antibodies against aquaporin-4 (AQP4-IgG).
Protein A immunoadsorption for the treatment of refractory anti-N-methyl-d-aspartate receptor encephalitis: A single-center prospective study
BingjunZhanga1DafanYua1QiangZhua1HengfangRuanaBoguangYubChunpingCuiaYuYangaWeiQiua
doi : 10.1016/j.jns.2021.117568
Volume 428, 15 September 2021, 117568
The aim of this study was to evaluate the efficacy and safety of protein A immunoadsorption (IA) for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis resistant to intravenous methylprednisolone (IVMP) and intravenous immunoglobulin (IVIG).
Influence of age on links between major modifiable risk factors and stroke occurrence in West Africa
Fred S.SarfoaOnojaAkpabBruceOvbiagelecAlbertAkpaludKolawoleWahabeMorenikejiKomolafefReginaldObiakogLukmanOwolabihGodwin O.OsaigbovoiCarolynJenkinsjGodwinOgbolebAdekunleFakunlebHemant K.TiwarikOyedunniArulogunbDonna K.ArnettlOsahonAsowatabOkechukwuOgahbRufus O.AkinyemibMayowa O.Owolabibon behalf of SIREN
doi : 10.1016/j.jns.2021.117573
Volume 428, 15 September 2021, 117573
The burden of stroke in Africa is high. Understanding how age associates with major modifiable stroke risk factors could inform tailored demographic stroke prevention strategies.
Impaired visual search in posterior cortical atrophy vs. typical Alzheimer's disease
Mario F.MendezabcYoussef I.KhattabaOlegYersteind
doi : 10.1016/j.jns.2021.117574
Volume 428, 15 September 2021, 117574
Posterior cortical atrophy (PCA) is a neurocognitive disorder characterized by difficulty localizing in space. Recognizing PCA is important because it is usually missed early in its course and may result from a number of neurological disorders other than Alzheimer's disease (AD).
TARDBP p.I383V, a recurrent alteration in Greek FTD patients
EiriniCharonitiaVasilikiPapastefanopoulouabChryseisFlorou-HatziyiannidouaChristosKorosbEvangeliaStanitsabJohn D.PapatriantafylloubcSokratis G.PapageorgioubChristosKroupisa
doi : 10.1016/j.jns.2021.117566
Volume 428, 15 September 2021, 117566
A significant proportion of FTD (Frontotemporal Degeneration) cases can be attributed to mutations in major genes such as GRN, MAPT and C9orf72. Our previous report on a Greek FTD cohort revealed the presence of the single nucleotide polymorphism (SNP) p.I383V (rs80356740) in the TARDBP gene in three unrelated patients. Our objective was to develop a novel, fast and accurate method for the detection of this particular SNP and evaluate the assay in a larger cohort.
Mild cognitive impairment, dementia and risk of mortality in essential tremor: A longitudinal prospective study of elders
NikkiDelgadoaDaniella IglesiasHernandezaKeithRadleraEdward D.HueybcdStephanieCosentinobcElanLouisa
doi : 10.1016/j.jns.2021.117563
Volume 428, 15 September 2021, 117563
There is evidence that the risk of mortality is increased in patients with essential tremor (ET), however, there are few longitudinal, prospective data on the predictors of mortality in ET. There is also evidence that ET is associated with cognitive impairment; yet, it is unknown whether this is associated with elevated risk of mortality.
IV tPA given in the golden hour for emergent large vessel occlusion stroke improves recanalization rates and clinical outcomes
RodicaDi LorenzoaMaherSaqqurbAndrew BlakeBuletkoaLacy SamHandshoeaBhageeradhMulpuraJulianHardmanaMeganDonohueaDoloraWiscoaKenUchinoaM. ShazamHussaina
doi : 10.1016/j.jns.2021.117580
Volume 428, 15 September 2021, 117580
Early thrombolysis for acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) is associated with better clinical outcome. This is thought to be due to greater tissue salvage with earlier recanalization. We explored whether ultra-early administration of intravenous tissue plasminogen activator (IV tPA) within 60 min (Golden Hour) of symptom onset for AIS due to ELVO is associated with a higher rate of recanalization.
Changes in autonomic tone during delirium in acute stroke patients assessed by pupillometry and skin conductance
JannikStokholmabLars Kristian HebsgaardBirkmoseabAbd Al Bari OmarAhmedabClaudioCsillagbcTroels WesenbergKjærbdThomasChristensenab
doi : 10.1016/j.jns.2021.117582
Volume 428, 15 September 2021, 117582
Delirium is a common complication in acute ischemic stroke, possibly caused by alterations in the regulation of the sympathetic autonomic nervous system. We investigated whether such an association could be demonstrated with two easy-to-use measurement techniques: Measurement of palmar skin conductance level (SCL) and pupillometry measuring the dilation velocity in the pupillary light reflex (PLRdil.vel.).
Paired cognitive flexibility task with symptom factors improves detection of sports-related concussion in high school and collegiate athletes
Amanda L.McGowanaAbigail C.BretzinbMorganAndersoncMatthew B.PontifexcTraceyCovassinc
doi : 10.1016/j.jns.2021.117575
Volume 428, 15 September 2021, 117575
Determining the sensitivity and specificity of short neurocognitive assessments to objectively detect concussion will help clinicians more confidently integrate such tools in clinical management decisions. This study quantified the sensitivity and specificity of a computerized cognitive flexibility task isolating shifts of visuospatial attention in combination with clinical symptoms acutely (< 72 h) following concussion. A total of 100 athletes (53 concussed; 47 non-injured control; 42% female) completed computerized neurocognitive testing and clinical symptom reports (Sport Concussion Assessment Tool 3rd edition: SCAT3). Separate discriminant function analyses were performed for individual, combination, and stepwise inclusion of neurocognitive and clinical symptomology assessments. Findings revealed the combination of neurocognitive outcomes (i.e., mean reaction time, response accuracy, and response accuracy cost) with clinical symptom factor scores exhibited the greatest sensitivity (95.7%) and specificity (88.7%) as well as the highest positive predictive value (95.9%) and negative predictive value (88%) relative to other approaches. Further, a stepwise approach predicting concussion status using the discriminant functions improved detection of concussion (98.2% sensitivity, 95.7% specificity, 96.4% positive predictive value, and 97.8% negative predictive value) when clinical symptom factors failed to indicate the presence of a concussion. Incorporating a cognitive flexibility task involving shifts of visuospatial attention combined with clinical symptom factor scores may improve clinical decision-making as this approach exceeds the sensitivity and specificity of widely popular neurocognitive test batteries and takes less than 10 min to administer.
Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India
RohitBhatiaa1P.N.Sylajab1M.V. PadmaSrivastavaa1SnigdhaKomakulaa1ThomasIypecRajsrinivasParthasarathydDheerajKhuranaeVibhorPardasanifVijayaPamidimukkalagS.KumaraveluhJeyarajPandianiSumanKushwahajDebashishChowdhurykSalilGuptalSrijithesh P.RajendranmRajshekarReddynJayantaRoyoArvindSharmap…PranjalGuptaa
doi : 10.1016/j.jns.2021.117583
Volume 428, 15 September 2021, 117583
As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected.
Evaluation and categorisation of individual patients based on white matter profiles: Single-patient diffusion data interpretation in neurodegeneration
MarleneTahedlabAizuriMuradaJasminLopeaOrlaHardimanaPeterBedeac
doi : 10.1016/j.jns.2021.117584
Volume 428, 15 September 2021, 117584
The majority of radiology studies in neurodegenerative conditions infer group-level imaging traits from group comparisons. While this strategy is helpful to define phenotype-specific imaging signatures for academic use, the meaningful interpretation of single scans of individual subjects is more important in everyday clinical practice. Accordingly, we present a computational method to evaluate individual subject diffusion tensor data to highlight white matter integrity alterations. Fifty white matter tracts were quantitatively evaluated in 132 patients with amyotrophic lateral sclerosis (ALS) with respect to normative values from 100 healthy subjects. Fractional anisotropy and radial diffusivity alterations were assessed individually in each patient. The approach was validated against standard tract-based spatial statistics and further scrutinised by the assessment of 78 additional data sets with a blinded diagnosis. Our z-score-based approach readily detected white matter degeneration in individual ALS patients and helped to categorise single subjects with a 'blinded diagnosis' as likely ‘ALS’ or ‘control’. The group-level inferences from the z-score-based approach were analogous to the standard TBSS output maps. The benefit of the z-score-based strategy is that it enables the interpretation of single DTI datasets as well as the comparison of study groups. Outputs can be summarised either visually by highlighting the affected tracts, or, listing the affected tracts in a text file with reference to normative data, making it particularly useful for clinical applications. While individual diffusion data cannot be visually appraised, our approach provides a viable framework for single-subject imaging data interpretation.
Abnormal sweating and “skin flushing” as possible predictive factor for treatment related fluctuations in Guillain-Barré syndrome: a case series and a review of the literature
ChiaraDemichelisaStefanoGrisantibFedericoMassabCarloSerratiaAlessandroBeroniodAntonioMannironidEmanuelaMobiliacChiaraBrianieAngeloSchenonebcLuanaBenedettic
doi : 10.1016/j.jns.2021.117589
Volume 428, 15 September 2021, 117589
Treatment related fluctuations (TRFs) in Guillain-Barré Syndrome (GBS) are described as one or more episodes of deterioration manifesting within two months after disease onset and following an initial improvement or stabilisation after treatment. They may be encountered in 8% to 16% of patients, but currently predictive factors of TRF occurrence and severity are poorly known. To this end, we evaluated the frequency and clinical features of TRFs in a cohort of GBS patients admitted to the Neurological unit of Sant'Andrea Hospital (La Spezia, Italy) from January 1st, 2003 to December 31st, 2017.
Neurology trial registrations on ClinicalTrials.gov between 2007 and 2018: A cross-sectional analysis of characteristics, early discontinuation, and results reporting
Brandon E.TurnerabChristopher J.MagnaniacAlexanderFrolovdBrannon T.WeeksaJecca R.SteinbergaeNaureenHudafLochan M.ShahfLeahZuroffgBen JiaheGugHannahRasmussenaJeffrey G.EdwardsaAkshay V.SavedMaxShendMarkRenfBarry R.BryanthQianMadAustin Y.FengaAmy C.LiangiVeronica E.Santinia
doi : 10.1016/j.jns.2021.117579
Volume 428, 15 September 2021, 117579
Increasing neurological disease burden and advancing treatment options require clinical trials to expand the evidence base of clinical care. We aimed to characterize neurology clinical trials registered between October 2007 and April 2018 and identify features associated with early discontinuation and results reporting.
Expanding the phenotype of AFG3L2 mutations: Late-onset autosomal recessive spinocerebellar ataxia
Han-LinChiangabJong-LingFuhabcYu-ShuenTsaidBing-WenSoongaefYi-ChuLiaoabcYi-ChungLeeabc
doi : 10.1016/j.jns.2021.117600
Volume 428, 15 September 2021, 117600
The AFG3L2 gene encodes AFG3-like protein 2, which is a subunit of human mitochondrial ATPases associated with various cellular protease activities (m-AAA). The clinical spectrum of AFG3L2 mutations is broad. Dominant AFG3L2 mutations can cause autosomal dominant spinocerebellar ataxia type 28 (SCA28), whereas biallelic AFG3L2 mutations may lead to spastic ataxia 5 (SPAX5). However, the role of AFG3L2 mutations in autosomal recessive spinocerebellar ataxia (SCAR) remains elusive. The aim of this study is to delineate the clinical features and spectrum of AFG3L2 mutations in a Taiwanese cohort with cerebellar ataxia. Mutational analyses of AFG3L2 were carried out by targeted resequencing in a cohort of 133 unrelated patients with molecularly undetermined cerebellar ataxia. We identified one single patient carrying compound heterozygous mutations in AFG3L2, p.[R632*];[V723M] (c.[1894C > T];[2167G > A]). The patient has suffered from apparently sporadic and slowly progressive cerebellar ataxia, ptosis, and ophthalmoparesis since age 55 years. These findings expand the clinical spectrum of AFG3L2 mutations and suggest a new subtype of late-onset SCAR caused by biallelic AFG3L2 mutations.
Prognostic factors in Tumefactive demyelinating lesions: A retrospective study
R. SkipperPlowmanabHemantVarmaab
doi : 10.1016/j.jns.2021.117591
Volume 428, 15 September 2021, 117591
Demyelinating lesions occasionally present as mass-like lesions on imaging, raising concern for malignancy. The disease course of such tumefactive demyelinating lesions (TDLs) is still being defined.
Confirmation of early non-bulbar onset of amyotrophic lateral sclerosis in Spanish league soccer players.
JosepGamezaFrancescCarmonab
doi : 10.1016/j.jns.2021.117586
Volume 428, 15 September 2021, 117586
Sports-related activity has been proposed as a risk factor for ALS, particularly among professionals playing American football and soccer, with a reported prevalence between two and forty times higher than the general population. Early onset (by two decades) was described among Italian soccer players as early as 2005. This study aims to characterise the phenotype of seven Spanish retired professional and semi-professional soccer players.
An implantable device to treat multiple sclerosis: A discrete choice experiment on patient preferences in three European countries
L.A.VisserabS.P.I.HulsabC.A.Uyl-de GrootaE.W.de Bekker-GrobabW.K.Redekopa
doi : 10.1016/j.jns.2021.117587
Volume 428, 15 September 2021, 117587
Persons with multiple sclerosis (MS) take their treatment via pills, injections or infusions. A novel mode of disease-modifying treatment administration, an implantable device, is under development. This study determined MS patient preferences for three modes of first-line treatment administration (implant, pills, injectables), and trade-offs regarding treatment characteristics.
Adjuvant radiotherapy for atypical meningiomas is associated with improved progression free survival
AnsleyUnterbergeragEdwinNgaAnjaliPradhanagAdityaKondajjiagDanielKulinichagCourtneyDuongaIsaacYangabcdefg
doi : 10.1016/j.jns.2021.117590
Volume 428, 15 September 2021, 117590
To assess the progression-free survival benefits of adjuvant radiotherapy (ART) following surgical resection compared to surgery alone in high-grade meningioma patients.
The VDR FokI (rs2228570) polymorphism is involved in Parkinson's disease
CristinaAgliardiaFranca RosaGueriniaMilenaZanzotteraaElisabettaBolognesiaMarioMeloniaGiulioRiboldazzibRobertaZangagliacAndreaSturchiodCarloCasalieCherubinoDi LorenzoeBrigidaMinafracMarioClericiaf
doi : 10.1016/j.jns.2021.117606
Volume 428, 15 September 2021, 117606
The etiology of Parkinson's disease (PD) is presumably multifactorial and likely involves interactions between genetic and environmental factors, as well as mitochondrial dysfunction, oxidative stress and inflammation. Among environmental factors, Vitamin D was reported to associate with the risk of PD. Vitamin D activity is mediated by its binding to the vitamin D Receptor (VDR), a transcriptional factor for almost 3% of human genes. We genotyped for ApaI, BsmI, TaqI, FokI and rs1989969 VDR single nucleotide polymorphisms (SNPs) a cohort of 406 PD and 800 healthy controls (HC) and found a strong association between the FokI (rs2228570) VDR SNP and PD. Thus, the TT genotype and the T allele resulted associated with PD in the overall analyzed PD population. Gender-based stratification of data indicated that results were maintained for FokI TT genotype and T allele in male PD patients, whereas the FokI T allele alone was confirmed as a risk factor for PD in females. Co-segregation analyses indicated the TaqI ApaI FokI rs1989969 GCTG as a “risk” haplotype for PD. In a subgroup of patients and controls neural Vitamin D and VDR concentration was analyzed in extravesicles (NDEVs) isolated from peripheral blood: no differences emerged between PD and HC. NDEVs results will need to be validated in ampler cohort but we can speculate that, if at neuronal level the amounts of Vitamin D and of VDR are comparable, than the bioavailability of vitamin D and the efficacy of the vitamin D/VDR axis is differentially modulated in PD by VDR SNPs.
Lesion topography of posterior cerebral artery infarcts
T.BenkeaF.DazingerbR.PechlaneraK.WilleitaJ.ClausencM.Knoflacha
doi : 10.1016/j.jns.2021.117585
Volume 428, 15 September 2021, 117585
This study analyzed the topography of acute ischemic stroke in the posterior cerebral artery (PCA) territory. We studied 84 patients with unilateral ischemic PCA stroke. Patients were classified according to lesion levels as cortico-subcortical (superficial), combined (cortical and mesodiencephalic) or isolated thalamic. To receive a lesion map, data from acute MR and CT imaging were normalized and labelled automatically by mapping to stereotaxic anatomical atlases. Cortical lesions accounted for 41.7%, combined for 36.9%, and isolated thalamic lesions for 21.4%. The maximum overlay of ischemia and, thus, highest occurrence of PCA ischemic stroke was found in the ventral and medial occipito-temporal cortex and adjacent white matter association tracts. Dorsal and peripheral segments of the occipito-temporo-parietal region were only rarely lesioned. This configuration was similar in both hemispheres. Consistent with this lesion pattern, visual field defects (VFD) were the most frequent signs, followed by sensorimotor signs, dizziness and sopor, cognitive and oculomotor deficits, and ataxia. The three vascular subgroups differed not only by their anatomical lesion profile and lesion load, but also by their clinical manifestation; although patients with combined and thalamic lesions were sigificantly younger, they were more disabled than participants with cortical lesions. VFD were only found in cortical and combined, and oculomotor deficits only in mesodiencephalic lesions. White matter lesions were common in the cortico-subcortical and the combined group. Basal occipito-temporal and calcarine regions, and neighbouring white matter tracts have the highest risk of ischemia in acute PCA stroke.
Effect of prior antiplatelet therapy on large vessel occlusion in patients with non-valvular atrial fibrillation newly initiated on apixaban
KouTokudaaYoshitakaYamadaaKazutakaUchidabFumihiroSakakibarabNobuyukiSakaicHirotoshiImamuracHiroshiYamagamidKantaTanakaeMasayukiEzurafTadashiNonakagYasushiMatsumotohMasunariShibataiHajimeOhtajMasafumiMorimotokNorihitoFukawalTaketoHatanomYukikoEnomotonMasatakaTakeuchioTakahiroOtapFuminoriShimizuqNaotoKimurarYukiKamiyasNoritoShimamuratTakeshiMorimotouShinichiYoshimurab
doi : 10.1016/j.jns.2021.117603
Volume 428, 15 September 2021, 117603
We evaluated the effect of prior antiplatelet therapy on large vessel occlusion (LVO) in patients with non-valvular atrial fibrillation (NVAF) newly initiated on apixaban.
Neurological comorbidities and COVID-19-related case fatality: A cohort study
AlbertoRomagnoloabGabrieleImbalzanoabCarlo AlbertoArtusiabRobertaBalestrinoaClaudiaLeddaabFrancesco GiuseppeDe RosacdFrancoRiccardinieElisaMontanaroabMarcoBozzaliafMario GiorgioRizzoneabMaurizioZibettiabLeonardoLopianoab
doi : 10.1016/j.jns.2021.117610
Volume 428, 15 September 2021, 117610
Neurological involvement in Coronavirus disease-2019 (COVID-19) is widely recognized. However, the role of pre-existing neurological comorbidities in modulating COVID-19-related mortality still remains unclear. This cohort study evaluates the COVID-19-related case fatality rate (CFR) of patients with pre-existing neurological diseases.
Electronic pill bottles to monitor and promote medication adherence for people with multiple sclerosis: A randomized, virtual clinical trial
Dylan R.RiceaTamara B.KaplanbcGladia C.HotandAndre C.VogelaMarceloMatielloacRebecca L.GillaniacSpencer K.HuttoacAndrew S.HameEric C.KlawiteracIlena C.GeorgeacKristinGalettabcFarrah J.Mateenac
doi : 10.1016/j.jns.2021.117612
Volume 428, 15 September 2021, 117612
We perform a randomized trial to test the impact of electronic pill bottles with audiovisual reminders on oral disease modifying therapy (DMT) adherence in people with MS (PwMS).
Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)
SabahRehmanaRonil V.ChandrabdLeon T.LaicdHamedAsadibArvindDubeygJensFroelichfNovaThanigLindaNicholshLeighBlizzardaKarenSmithimAmanda G.ThrifteChristineStirlinghMicheleCallisayaakMoniqueBreslinaMathew J.ReevesjSeanaGallal
doi : 10.1016/j.jns.2021.117613
Volume 428, 15 September 2021, 117613
There is limited research on the provision of evidence-based care and its association with outcomes after aneurysmal subarachnoid hemorrhage (aSAH).
Carotid artery angioplasty versus stenting for management of acute tandem occlusions
AayushiGargaMudassirFarooquiaCynthia B.ZevallosaDarkoQuispe-OrozcoaAlanMendez-RuizaOsamaZaidatbSantiagoOrtega-Gutierrezacd
doi : 10.1016/j.jns.2021.117588
Volume 428, 15 September 2021, 117588
The optimal approach to treat the cervical carotid artery lesion during endovascular thrombectomy (EVT) for acute strokes with tandem occlusions is unclear. While carotid artery stenting (CAS) might be a more definitive recanalization method, the potential risk of intracranial hemorrhage (ICH) limits its routine usage. In this study, we aimed to evaluate the safety outcomes of CAS and carotid artery angioplasty (CAA) in patients with acute tandem occlusions.
Screening indexes for cardiovascular autonomic failure in Parkinson's disease
F.Vallelonga1G.Sobrero1M.GiudiciM.ValenteV.MilazzoC.Di StefanoS.Maule
doi : 10.1016/j.jns.2021.117571
Volume 428, 15 September 2021, 117571
Autonomic failure (AF) is a common source of orthostatic hypotension (OH) in Parkinson's disease (PD). The diagnosis of AF is difficult on clinical grounds alone. We used autonomic testing and 24-h BP monitoring (ABPM) in 122 PD patients to evaluate the diagnostic accuracy of AF by (1) the reduced heart rate increase to fall in blood pressure (BP) ratio (?HR/?SBP), (2) reverse dipping (RD), and (3) increased diurnal systolic BP standard deviation (SD-SBP). Among patients with OH, ?HR/?SBP yielded the best accuracy (85%), with excellent sensitivity (92%) and acceptable specificity (67%). RD and, to a lesser extent, SD-SBP had high specificity (93% and 73%, respectively) but low sensitivity, resulting in overall moderate accuracy (66% and 55%, respectively). In patients with OH, the addition of ABPM indexes to ?HR/?SBP did not result in a significant improvement of accuracy. In patients without OH, RD and SD-SBP may be useful showing an accuracy of 72% and 81%, respectively, with high negative predictive value when both RD and increased SD-SBP are absent. The integration of bedside (?HR/?SBP) and ABPM-derived indexes can assist the clinician in screening PD patients for AF and guide referral to autonomic testing.
The development of a diversity, equity, and inclusion committee in a neurology department and residency program
Jasmin M.HarpeJoseph E.SafdiehSusanBronerGretaStrongMatthew S.Robbins
doi : 10.1016/j.jns.2021.117572
Volume 428, 15 September 2021, 117572
Diversity, Equity, and Inclusion (DEI) initiatives have been described in different academic and graduate medical education settings, but not specifically in neurology.
Increased telomere length in patients with frontotemporal dementia syndrome
Eun-JooKimaSeong-HoKohbJungsoonHabcDuk L.NadSang WonSeodHee-JinKimdKyung WonParkeJae-HongLeefJee HoonRohfJay C.KwongSoo JinYoonhNa-YeonJungiJee H.JeongjJae-WonJangkHee-JinKimlKee HyungParkmSeong HyeChoinSangYunKimo…Jeong-HwaJinb
doi : 10.1016/j.jns.2021.117565
Volume 428, 15 September 2021, 117565
Telomeres are repetitive DNA sequences of TTAGGG at the ends of chromosomes. Many studies have shown that telomere shortening is associated with aging-related diseases, such as cardiovascular diseases, hypertension, diabetes, cancer, and various neurodegenerative diseases, including Alzheimer's disease, vascular dementia, Parkinson's disease, and dementia with Lewy bodies. However, changes in telomere length (TL) in patients with frontotemporal dementia (FTD) syndrome are unclear. Accordingly, in this study, we assessed TL in blood samples from patients with FTD syndrome.
The evaluation of the swallow tail sign in patients with parkinsonism and gait disorders
Duk SooKimabGlenn A.TungbcUmerAkbarabdJoseph H.Friedmanad
doi : 10.1016/j.jns.2021.117581
Volume 428, 15 September 2021, 117581
Swallow tail sign (STS), which represents nigrosome-1 in the substantia nigra on 3 Tesla (T) susceptibility-weighted imaging (SWI), has attracted attention as a promising magnetic resonance imaging (MRI) biomarker for idiopathic Parkinson's disease (iPD). Some reports have shown high sensitivity and specificity—both above 94%—for distinguishing iPD from healthy controls. However, abnormal STS has been observed in many neurodegenerative parkinsonisms and even in multiple sclerosis.
Absence of papilledema in large intracranial tumours
LauraDonaldsonaEdwardMargolinab
doi : 10.1016/j.jns.2021.117604
Volume 428, 15 September 2021, 117604
Papilledema refers to optic disc edema occurring secondary to raised intracranial pressure. In patients with intracranial tumours, tumour size might be the expected predictor of whether or not papilledema will develop, however, this is not the case in clinical practice. We report a series of 5 patients with large intracranial tumours and no evidence of papilledema and discuss the potential factors which may contribute to the lack of optic disc edema in these cases. Development of papilledema depends on both the presence of elevated intracranial pressure and transmission of elevated pressure to the subarachnoid space within the optic nerve sheath and to the optic nerve itself. We discuss how intracranial tumours may influence the physiology of the surrounding tissues, cerebrospinal fluid dynamics and cerebral venous outflow and how individual anatomic variations, particularly within the optic nerve sheath and optic canal, likely play a role in development of papilledema.
Optic nerve atrophy and visual disturbance following PRNP Y162X truncation mutation
KosukeMatsuzonoaYounheeKimaHiroyukiHondabYuheiAnanaYutoHashimotocIchiyaSanocToruIwakibTetsuyukiKitamotodShigeruFujimotoa
doi : 10.1016/j.jns.2021.117614
Volume 428, 15 September 2021, 117614
Transient global amnesia and Covid-19
RalphWernerJohannes C.Woehrle
doi : 10.1016/j.jns.2021.117562
Volume 428, 15 September 2021, 117562
Reply to: Covid-19: Involvement of the nervous system. Identifying neurological predictors defining the course of the disease
NathanMitchell
doi : 10.1016/j.jns.2021.117578
Volume 428, 15 September 2021, 117578
Reply to: Letter to the Editor – N. Mitchell; Covid-19: Involvement of the nervous system. Identifying neurological predictors defining the course of the disease
UdoZifkoaTheresaSchmiedlechneraJohanSaelensbKatharinaZifkobMichaelWagnercOjanAssadiandWolfgangGrisoldeHaraldStinglc
doi : 10.1016/j.jns.2021.117577
Volume 428, 15 September 2021, 117577
