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Inciarte A, de la Mora L, Huaier-Arriazu E, Torres B, Cañizares S, Zamora E, Laguno M, Gonzalez-Cordón A, Foncillas A, Chivite I, Calvo J, Ambrosioni J, Martínez E, Blanco JL, Miro JM, Martinez-Rebollar M, Mallolas J. Toxic-Induced Encephalopathy Following Chemsex in a Young HIV-Positive Male: A Complex Case of Acute Cognitive Impairment with Anterograde Amnesia and Behavioral Alterations. Infect Dis Ther 2024; 13:647-658. [PMID: 38570445 PMCID: PMC11058740 DOI: 10.1007/s40121-024-00962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND A broadened clinical spectrum of concomitant complications emerges among the escalating incidence of substance use, particularly within the 'chemsex' context. This case exemplifies the profound neurotoxic repercussions and neurological risk of chemsex in a young HIV-positive male and addresses the multifaceted challenges of such evolving paradigms in substance utilization. CLINICAL FINDING After consuming cannabis, poppers, methamphetamine, and cocaine, a 28-year-old HIV-positive male exhibited significant neurological and cognitive impairment. The initial presentation included dysarthria and profound anterograde amnesia. Laboratory findings showed leukocytosis with a PCR of 3 mg/dl - elevated cerebrospinal fluid protein levels with no cells. Urine toxicology returned positive for cannabis and amphetamines. A brain CT scan revealed bilateral and symmetrical hippocampi and pale globes hypodensity, indicative of toxic-metabolic encephalopathy. MRI further identified lesions in the globus pallidus, cerebellum, and hippocampi. Following the detection of toxic encephalopathy, Initial neuropsychological was performed screening using the Montreal Cognitive Assessment (MoCA), which highlighted immediate memory deficits. An in-depth neuropsychological assessment conducted 3 weeks later included the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), the Rey Auditory Verbal Learning Test (RAVLT), and tests for visuospatial skills, motor functions, and memory recall. The evaluations revealed pronounced anterograde amnesia, persistent long-term memory inconsistencies, and notable executive function challenges, detailed in Table 1. CONCLUSIONS The detailed analysis of this case underpins the severe neurological consequences that can manifest from heavy substance use. Comprehensive diagnostic evaluations, including neuroimaging and neuropsychological assessments, are crucial in elucidating the full spectrum of substance-induced cognitive impairments. There is an urgent need for enhanced public awareness and preventative measures, especially in the context of chemsex, to bring forth multifaceted health, social, and government implications that modern society must adeptly navigate.
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Affiliation(s)
- Alexy Inciarte
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- University of Barcelona, Barcelona, Spain.
- Centro de Investigación Biomédica en Red, CIBERINFEC, Madrid, Spain.
| | - Lorena de la Mora
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Emilio Huaier-Arriazu
- Servicio de Infectología, Hospital Italiano de Buenos Aires, CABA, Buenos Aires, Argentina
| | - Berta Torres
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red, CIBERINFEC, Madrid, Spain
| | - Silvia Cañizares
- Psychiatry and Psychology Department, Hospital Clinic, Barcelona, Spain
| | | | - Montserrat Laguno
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red, CIBERINFEC, Madrid, Spain
| | - Ana Gonzalez-Cordón
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Alberto Foncillas
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Ivan Chivite
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Júlia Calvo
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan Ambrosioni
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red, CIBERINFEC, Madrid, Spain
| | - Esteban Martínez
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red, CIBERINFEC, Madrid, Spain
| | - Jose Luis Blanco
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red, CIBERINFEC, Madrid, Spain
| | - J M Miro
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red, CIBERINFEC, Madrid, Spain
| | - Maria Martinez-Rebollar
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Josep Mallolas
- HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red, CIBERINFEC, Madrid, Spain
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Sablaban IM, Stodolak D, Stallworth B. Apathy in Anoxic Brain Injury Treated With Bupropion. Am J Ther 2023; 30:e554-e555. [PMID: 37921682 DOI: 10.1097/mjt.0000000000001485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ibrahim M Sablaban
- Department of Psychiatry, Henry Ford Hospital / Wayne State University Detroit, MI; and
| | - Derek Stodolak
- Department of Psychiatry, Henry Ford Hospital / Wayne State University Detroit, MI; and
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Neisser J, Abreu G, Drane DL, Pedersen NP, Parsons TD, Cleary AM. Opening a conceptual space for metamemory experience. NEW IDEAS IN PSYCHOLOGY 2023; 69:100995. [PMID: 38223256 PMCID: PMC10786624 DOI: 10.1016/j.newideapsych.2022.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The experiences associated with remembering, including metamemory feelings about the act of remembering and attempts at remembering, are not often integrated into general accounts of memory. For example, David Rubin (2022) proposes a unified, three-dimensional conceptual space for mapping memory states, a map that does not systematically specify metamemory feelings. Drawing on Rubin's model, we define a distinct role for metamemory in relation to first-order memory content. We propose a fourth dimension for the model and support the proposal with conceptual, neurocognitive, and clinical lines of reasoning. We use the modified model to illustrate several cases, and show how it helps to conceptualize a new category of memory state: autonoetic knowing, exemplified by déjà vu. We also caution not to assume that memory experience is directly correlated with or caused by memory content, an assumption Tulving (1989) labeled the doctrine of concordance.
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Affiliation(s)
- Joseph Neisser
- Department of Philosophy, Grinnell College, 1120 Park St, Grinnell, IA, 50112, USA
| | - George Abreu
- Department of Philosophy, Grinnell College, 1120 Park St, Grinnell, IA, 50112, USA
| | - Daniel L Drane
- Department of Neurology, Emory University, 101 Woodruff Circle, Atlanta, GA, 30322, USA
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, 98105, USA
| | - Nigel P Pedersen
- Department of Pediatrics, Emory University, 101 Woodruff Circle, Atlanta, GA, 30322, USA
- Department of Biomedical Engineering, The Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Thomas D Parsons
- Simulation Science & Immersive Technology, Arizona State University, Tempe, AZ, 85281, USA
| | - Anne M Cleary
- Department of Psychology, Colorado State University, Fort Collins, CO, 80525, USA
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Watson RS, Beers SR, Asaro LA, Burns C, Koh MJ, Perry MA, Angus DC, Wypij D, Curley MA. Association of Acute Respiratory Failure in Early Childhood With Long-term Neurocognitive Outcomes. JAMA 2022; 327:836-845. [PMID: 35230393 PMCID: PMC8889465 DOI: 10.1001/jama.2022.1480] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Approximately 23 700 US children undergo invasive mechanical ventilation for acute respiratory failure annually, with unknown long-term effects on neurocognitive function. OBJECTIVE To evaluate neurocognitive outcomes of children who survive pediatric intensive care unit (PICU) hospitalization for acute respiratory failure compared with their biological siblings. DESIGN, SETTING, AND PARTICIPANTS Prospective sibling-matched cohort study conducted at 31 US PICUs and associated neuropsychology testing centers. Patients were 8 years or younger with a Pediatric Cerebral Performance Category score of 1 (normal) before PICU admission and less than or equal to 3 (no worse than moderate neurocognitive dysfunction) at PICU discharge, excluding patients with a history of neurocognitive deficits or who were readmitted and underwent mechanical ventilation. Biological siblings were aged 4 to 16 years at testing, with Pediatric Cerebral Performance Category score of 1 and no history of mechanical ventilation or general anesthesia. A total of 121 sibling pairs were enrolled from September 2, 2014, to December 13, 2017, and underwent neurocognitive testing starting March 14, 2015. The date of the final follow-up was November 6, 2018. EXPOSURES Critical illness and PICU treatment for acute respiratory failure. MAIN OUTCOMES AND MEASURES The primary outcome was IQ, estimated by the age-appropriate Vocabulary and Block Design subtests of the Wechsler Intelligence Scale. Secondary outcomes included measures of attention, processing speed, learning and memory, visuospatial skills, motor skills, language, and executive function. Evaluations occurred 3 to 8 years after hospital discharge. RESULTS Patients (n = 121; 55 [45%] female patients) underwent PICU care at a median (IQR) age of 1.0 (0.2-3.2) years, received a median (IQR) of 5.5 (3.1-7.7) days of invasive mechanical ventilation, and were tested at a median (IQR) age of 6.6 (5.4-9.1) years. Matched siblings (n = 121; 72 [60%] female siblings) were tested at a median (IQR) age of 8.4 (7.0-10.2) years. Patients had a lower mean estimated IQ than matched siblings (101.5 vs 104.3; mean difference, -2.8 [95% CI, -5.4 to -0.2]). Among secondary outcomes, patients had significantly lower scores than matched siblings on nonverbal memory (mean difference, -0.9 [95% CI, -1.6 to -0.3]), visuospatial skills (mean difference, -0.9 [95% CI, -1.8 to -0.1]), and fine motor control (mean difference, -3.1 [95% CI, -4.9 to -1.4]) and significantly higher scores on processing speed (mean difference, 4.4 [95% CI, 0.2-8.5]). There were no significant differences in the remaining secondary outcomes, including attention, verbal memory, expressive language, and executive function. CONCLUSIONS AND RELEVANCE Among children, survival of PICU hospitalization for respiratory failure and discharge without severe cognitive dysfunction was associated with significantly lower subsequent IQ scores compared with matched siblings. However, the magnitude of the difference was small and of uncertain clinical importance.
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Affiliation(s)
- R. Scott Watson
- Department of Pediatrics, University of Washington, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Sue R. Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lisa A. Asaro
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Cheryl Burns
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Min Jung Koh
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mallory A. Perry
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Derek C. Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Senior Editor, JAMA
| | - David Wypij
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Martha A.Q. Curley
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia
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Gao QS, Zhang YH, Xue H, Wu ZY, Li C, Zhao P. Brief inhalation of sevoflurane can reduce glial scar formation after hypoxic-ischemic brain injury in neonatal rats. Neural Regen Res 2021; 16:1052-1061. [PMID: 33269750 PMCID: PMC8224129 DOI: 10.4103/1673-5374.300456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Previous studies have demonstrated that sevoflurane postconditioning can provide neuroprotection after hypoxic-ischemic injury and improve learning and memory function in developing rodent brains. The classical Rice-Vannucci model was used to induce hypoxic-ischemic injury, and newborn (postnatal day 7) rats were treated with 2.4% sevoflurane for 30 minutes after hypoxic-ischemic injury. Our results showed that sevoflurane postconditioning significantly improved the learning and memory function of rats, decreased astrogliosis and glial scar formation, increased numbers of dendritic spines, and protected the histomorphology of the hippocampus. Mechanistically, sevoflurane postconditioning decreased expression of von Hippel-Lindau of hypoxia-inducible factor-1α and increased expression of DJ-1. Injection of 1.52 μg of the hypoxia-inducible factor-1α inhibitor YC-1 (Lificiguat) into the left lateral ventricle 30 minutes before hypoxic-ischemic injury reversed the neuroprotection induced by sevoflurane. This finding suggests that sevoflurane can effectively alleviate astrogliosis in the hippocampus and reduce learning and memory impairments caused by glial scar formation after hypoxic-ischemic injury. The underlying mechanism may be related to upregulated DJ-1 expression, reduced ubiquitination of hypoxia-inducible factor-1α, and stabilized hypoxia-inducible factor-1α expression. This study was approved by the Laboratory Animal Care Committee of China Medical University, China (approval No. 2016PS337K) on November 9, 2016.
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Affiliation(s)
- Qiu-Shi Gao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ya-Han Zhang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hang Xue
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zi-Yi Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Chang Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Griffith SP, Malpas CB, Alpitsis R, O'Brien TJ, Monif M. The neuropsychological spectrum of anti-LGI1 antibody mediated autoimmune encephalitis. J Neuroimmunol 2020; 345:577271. [PMID: 32480239 DOI: 10.1016/j.jneuroim.2020.577271] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022]
Abstract
Anti-Leucine Glioma Inactivated 1 (LGI-1) autoimmune encephalitis (AE) is a rare neuroinflammatory brain condition. Individuals afflicted with this condition can present with cognitive and psychological manifestations that can impact the individual's quality of life, day to day functioning, independence, return to work and interpersonal relationships. Our knowledge of the cognitive profiles and disease associated psychopathology is severely lacking. This review provides a comprehensive summary of the currently available literature, conceptualising our current understanding of the neuropsychological manifestations of anti LGI-1 AE and summarises methodological limitations of the current research to inform and improve future investigations. Key Terms: Autoimmune Diseases; Neuroimmunology; Autoimmune Encephalitis, Limbic Encephalitis; Anti-LGI1 Encephalitis, LGI1; Neuropsychology, Cognitive Assessment.
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Affiliation(s)
- Sarah P Griffith
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Charles B Malpas
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia; Department of Neurology, Melbourne Health, Parkville, VIC, Australia; Department of Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Rubina Alpitsis
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia; Department of Neurology, Melbourne Health, Parkville, VIC, Australia; Department of Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mastura Monif
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia; Department of Neurology, Melbourne Health, Parkville, VIC, Australia.
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Confortim HD, Deniz BF, de Almeida W, Miguel PM, Bronauth L, Vieira MC, de Oliveira BC, Pereira LO. Neonatal hypoxia-ischemia caused mild motor dysfunction, recovered by acrobatic training, without affecting morphological structures involved in motor control in rats. Brain Res 2018; 1707:27-44. [PMID: 30448443 DOI: 10.1016/j.brainres.2018.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/29/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
The aim of this study was to evaluated motor function and morphological aspects of the components involved in motor control (sensorimotor cortex, spinal cord, sciatic nerve, neuromuscular junctions and skeletal muscle) in male Wistar rats exposed to a model of neonatal hypoxic-ischemic encephalopathy (HIE) and the possible influence of different physical exercise protocols - treadmill and acrobatic. Male Wistar rats at the 7th post-natal day (PND) were submitted to the HIE model and from the 22nd until 60th PND the exercise protocols (treadmill or acrobatic training) were running. After the training, the animals were evaluated in Open Field, Ladder Rung Walking and Rotarod tasks and after samples of the motor control components were collected. Our results evidenced that the acrobatic training reversed the hyperactivity and anxiety, caused locomotion improvement and decreased brain atrophy in HIE animals. We did not find morphological differences on sensorimotor cortex, spinal cord, sciatic nerve, neuromuscular junctions and skeletal muscle in the animals submitted to HIE model. These intriguing data support the statement of the Rice-Vannucci model does not seem to reproduce, in structures involved in control function, the damage found in humans that suffer HIE. Regarding the protocols of exercise, we proposed that the acrobatic exercise could be a good therapeutic option especially in children affected by neonatal HIE and can be responsible for good results in cognitive and motor aspects.
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Affiliation(s)
- Heloísa Deola Confortim
- Programa de Pós-Graduação em Neurociências, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, sala 107, 90050-170 Porto Alegre, RS, Brazil; Departamento de Ciências Morfológicas, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil
| | - Bruna Ferrary Deniz
- Programa de Pós-Graduação em Neurociências, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, sala 107, 90050-170 Porto Alegre, RS, Brazil; Departamento de Ciências Morfológicas, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil
| | - Wellington de Almeida
- Programa de Pós-Graduação em Neurociências, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, sala 107, 90050-170 Porto Alegre, RS, Brazil; Departamento de Ciências Morfológicas, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil
| | - Patrícia Maidana Miguel
- Programa de Pós-Graduação em Neurociências, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, sala 107, 90050-170 Porto Alegre, RS, Brazil; Departamento de Ciências Morfológicas, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil
| | - Loise Bronauth
- Departamento de Ciências Morfológicas, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil
| | - Milene Cardoso Vieira
- Departamento de Ciências Morfológicas, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil
| | - Bruna Chaves de Oliveira
- Departamento de Ciências Morfológicas, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil
| | - Lenir Orlandi Pereira
- Programa de Pós-Graduação em Neurociências, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, sala 107, 90050-170 Porto Alegre, RS, Brazil; Departamento de Ciências Morfológicas, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil.
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8
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Haut MW, Hogg JP, Marshalek PJ, Suter BC, Miller LE. Amnesia Associated with Bilateral Hippocampal and Bilateral Basal Ganglia Lesions in Anoxia with Stimulant Use. Front Neurol 2017; 8:27. [PMID: 28228745 PMCID: PMC5296355 DOI: 10.3389/fneur.2017.00027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 01/20/2017] [Indexed: 12/27/2022] Open
Abstract
We report a case of a 55-year-old man with ischemic lesions of the bilateral hippocampus and bilateral basal ganglia following a myocardial infarction during an episode of multiple drug use with subsequent anoxia requiring resuscitation. He presented for a neuropsychological evaluation with an anterograde amnesia for both explicit and procedural memory. There are two main points to this case, the unique aspects of the bilateral multifocal lesions and the functional, cognitive impact of these lesions. We hypothesize that his rare focal bilateral lesions of both the hippocampus and basal ganglia are a result of anoxia acting in synergy with his stimulant drug use (cocaine and/or 3,4-methylenedioxy-methamphetamine). Second, his unique lesions produced an explicit and implicit/procedural anterograde amnesia.
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Affiliation(s)
- Marc W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA; Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, USA; Department of Radiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Jeffery P Hogg
- Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, USA; Department of Radiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Patrick J Marshalek
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine , Morgantown, WV , USA
| | - Blair C Suter
- West Virginia University School of Medicine , Morgantown, WV , USA
| | - Liv E Miller
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine , Morgantown, WV , USA
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Rimoldi SF, Rexhaj E, Duplain H, Urben S, Billieux J, Allemann Y, Romero C, Ayaviri A, Salinas C, Villena M, Scherrer U, Sartori C. Acute and Chronic Altitude-Induced Cognitive Dysfunction in Children and Adolescents. J Pediatr 2016; 169:238-43. [PMID: 26541425 DOI: 10.1016/j.jpeds.2015.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/31/2015] [Accepted: 10/02/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess whether exposure to high altitude induces cognitive dysfunction in young healthy European children and adolescents during acute, short-term exposure to an altitude of 3450 m and in an age-matched European population permanently living at this altitude. STUDY DESIGN We tested executive function (inhibition, shifting, and working memory), memory (verbal, short-term visuospatial, and verbal episodic memory), and speed processing ability in: (1) 48 healthy nonacclimatized European children and adolescents, 24 hours after arrival at high altitude and 3 months after return to low altitude; (2) 21 matched European subjects permanently living at high altitude; and (3) a matched control group tested twice at low altitude. RESULTS Short-term hypoxia significantly impaired all but 2 (visuospatial memory and processing speed) of the neuropsychological abilities that were tested. These impairments were even more severe in the children permanently living at high altitude. Three months after return to low altitude, the neuropsychological performances significantly improved and were comparable with those observed in the control group tested only at low altitude. CONCLUSIONS Acute short-term exposure to an altitude at which major tourist destinations are located induces marked executive and memory deficits in healthy children. These deficits are equally marked or more severe in children permanently living at high altitude and are expected to impair their learning abilities.
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Affiliation(s)
- Stefano F Rimoldi
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland
| | - Emrush Rexhaj
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland
| | - Hervé Duplain
- Department of Internal Medicine, University Hospital, Lausanne, Switzerland
| | - Sébastien Urben
- Research Unit, Child and Adolescent Psychiatric Service, University Hospital, Lausanne, Switzerland
| | - Joël Billieux
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Yves Allemann
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland
| | | | | | - Carlos Salinas
- Bolivian Institute of Altitude Biology (IBBA), La Paz, Bolivia
| | | | - Urs Scherrer
- Department of Cardiology and Clinical Research, University Hospital, Bern, Switzerland; Department of Biology, University of Tarapacá, Arica, Chile
| | - Claudio Sartori
- Department of Internal Medicine, University Hospital, Lausanne, Switzerland.
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10
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Schrieff-Elson LE, Thomas KGF, Rohlwink UK, Figaji AA. Low brain oxygenation and differences in neuropsychological outcomes following severe pediatric TBI. Childs Nerv Syst 2015; 31:2257-68. [PMID: 26337700 DOI: 10.1007/s00381-015-2892-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/24/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Preventing secondary injury by controlling physiological parameters (e.g. intracranial pressure [ICP], cerebral perfusion pressure [CPP] and brain tissue oxygen [PbtO2]) has a potential to improve outcome. Low PbtO2 is independently associated with poor clinical outcomes in both adults and children. However, no studies have investigated associations between low PbtO2 and neuropsychological and behavioural outcomes following severe pediatric TBI (pTBI). METHODS We used a quasi-experimental case-control design to investigate these relationships. A sample of 11 TBI patients with a Glasgow Coma Scale score ≤8 who had PbtO2 and ICP monitoring at the Red Cross War Memorial Children's Hospital underwent neuropsychological evaluation ≥1 year post-injury. Their performance was compared to that of 11 demographically matched healthy controls. We then assigned each TBI participant into one of two subgroups, (1) children who had experienced at least one episode of PbtO2 ≤ 10 mmHg or (2) children for whom PbtO2 > 10 mmHg throughout the monitoring period, and compared their results on neuropsychological evaluation. RESULTS TBI participants performed significantly more poorly than controls in several cognitive domains (IQ, attention, visual memory, executive functions and expressive language) and behavioural (e.g. externalizing behaviour) domains. The PbtO2 ≤ 10 mmHg group performed significantly worse than the PbtO2 > 10 mmHg group in several cognitive domains (IQ, attention, verbal memory, executive functions and expressive language), but not on behavioural measures. CONCLUSION Results demonstrate that low PbtO2 may be prognostic of not only mortality but also neuropsychological outcomes.
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Affiliation(s)
- L E Schrieff-Elson
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa.
| | - K G F Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - U K Rohlwink
- Division of Neurosurgery, Department of Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - A A Figaji
- Division of Neurosurgery, Department of Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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11
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Lai Z, Zhang L, Su J, Cai D, Xu Q. Sevoflurane postconditioning improves long-term learning and memory of neonatal hypoxia-ischemia brain damage rats via the PI3K/Akt-mPTP pathway. Brain Res 2015; 1630:25-37. [PMID: 26541582 DOI: 10.1016/j.brainres.2015.10.050] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/09/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Volatile anesthetic postconditioning has been documented to provide neuroprotection in adult animals. Our aim was to investigate whether sevoflurane postconditioning improves long-term learning and memory of neonatal hypoxia-ischemia brain damage (HIBD) rats, and whether the PI3K/Akt pathway and mitochondrial permeability transition pore (mPTP) opening participate in the effect. METHODS Seven-day-old Sprague-Dawley rats were subjected to brain HI and randomly allocated to 10 groups (n=24 each group) and treated as follows: (1) Sham, without hypoxia-ischemia; (2) HI/Control, received cerebral hypoxia-ischemia; (3) HI+Atractyloside (Atr), (4) HI+Cyclosporin A (CsA), (5) HI+sevoflurane (Sev), (6) HI+Sev+ LY294002 (LY), (7) HI+Sev+ L-NAME (L-N), (8) HI+Sev+ SB216763 (SB), (9) HI+Sev+Atr, and (10) HI+Sev+CsA. Twelve rats in each group underwent behavioral testing and their brains were harvested for hippocampus neuron count and morphology study. Brains of the other 12 animals were harvested 24h after intervention to examine the expression of Akt, p-Akt, eNOS, p-eNOS, GSK-3β, p-GSK-3β by Western bolting and mPTP opening. RESULTS Sevoflurane postconditioning significantly improved the long-term cognitive performance of the rats, increased the number of surviving neurons in CA1 and CA3 hippocampal regions, and protected the histomorphology of the left hippocampus. These effects were abolished by inhibitors of PI3K/eNOS/GSK-3β. Although blocking mPTP opening simulated sevoflurane postconditioning-induced neuroprotection, it failed to enhance it. CONCLUSIONS Sevoflurane postconditioning exerts a neuroprotective effect against HIBD in neonatal rats via PI3K/Akt/eNOS and PI3K/Akt/GSK-3β pathways, and blockage of mPTP opening may be involved in attenuation of histomorphological injury.
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Affiliation(s)
- Zhongmeng Lai
- Deparment of Anesthesiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou 350001, PR China.
| | - Liangcheng Zhang
- Deparment of Anesthesiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou 350001, PR China.
| | - Jiansheng Su
- Deparment of Anesthesiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou 350001, PR China.
| | - Dongmiao Cai
- Deparment of Anesthesiology, The First Affiliated Hospital of Xiamen University, 55 Zhen-Hai Road, Xiamen 3610003, PR China.
| | - Qingxiu Xu
- Deparment of Anesthesiology, Fujian Medical University Union Hospital, 29 Xin-Quan Road, Fuzhou 350001, PR China.
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12
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Green CR, Botha JA, Tiruvoipati R. Cognitive function, quality of life and mental health in survivors of our-of-hospital cardiac arrest: a review. Anaesth Intensive Care 2015; 43:568-76. [PMID: 26310406 DOI: 10.1177/0310057x1504300504] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There is growing interest in the long-term outcomes of patients surviving out-of-hospital cardiac arrest (OHCA). This paper aims to summarise the available literature on the long-term cognitive, health-related quality of life (QoL) and mental health outcomes of survivors of OHCA. Between 30% and 50% of survivors of OHCA experience cognitive deficits for up to several years post-discharge. Deficits of attention, declarative memory, executive function, visuospatial abilities and verbal fluency are commonly reported. Survivors of OHCA appear to report high rates of mental illness, with up to 61% experiencing anxiety, 45% experiencing depression and 27% experiencing post-traumatic stress. Fatigue appears to be a commonly reported long-term outcome for survivors of OHCA. Investigations of long-term QoL for these patients have produced mixed findings. Carers of survivors of OHCA report high rates of depression, anxiety and post-traumatic stress, with insufficient social and financial support. The heterogeneous range of instruments used to assess cognitive function and QoL prevent any clear conclusions being drawn from the available literature. The potential biases inherent in this patient population and the interaction between QoL, cognitive performance and mental health warrant further investigation, as does the role of post-discharge support services in improving long-term patient outcomes.
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Affiliation(s)
- C R Green
- Research Coordinator, Department of Intensive Care, Frankston Hospital, Frankston, Victoria
| | - J A Botha
- Director, Department of Intensive Care, Frankston Hospital, Frankston, and Adjunct Clinical Professor with the Faculty of Medicine, Nursing and Health Sciences, School of Public Health at Monash University, Melbourne, Victoria
| | - R Tiruvoipati
- Intensivist, Department of Intensive Care, Frankston Hospital, Frankston, and Adjunct Associate Professor with the Faculty of Medicine, Nursing and Health Sciences, School of Public Health at Monash University, Melbourne, Victoria
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13
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Thaler NS, Reger SL, Ringdahl EN, Mayfield JW, Goldstein G, Allen DN. Neuropsychological profiles of six children with anoxic brain injury. Child Neuropsychol 2013; 19:479-94. [DOI: 10.1080/09297049.2012.696602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Cullen NK, Weisz K. Cognitive correlates with functional outcomes after anoxic brain injury: a case-controlled comparison with traumatic brain injury. Brain Inj 2010; 25:35-43. [PMID: 21121706 DOI: 10.3109/02699052.2010.531691] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the effectiveness of inpatient rehabilitation in adults who have sustained an anoxic brain injury (AnBI). Secondly, to identify areas of cognition that predict functional outcomes at discharge. DESIGN Retrospective, matched case-controlled study. METHODS Ten patients with moderate-to-severe AnBI and 10 patients with traumatic brain injury (TBI), treated in an inpatient neurorehabilitation programme, were matched on age, acute care length of stay and admission Functional Independence Measure (FIM). Functional outcome was assessed using the FIM and Disability Rating Scale (DRS). RESULTS Patients with AnBI performed worse on all measures of functional outcome relative to patients with TBI. Patients with AnBI achieved significantly lower FIM motor and cognitive gain compared with patients with TBI (11.5, SD 13.6 vs. 31.0, SD 19.7 and 2.4, SD 3.9 vs. 7.5, SD 4.2, respectively (p < 0.02)). DRS data showed similar trends of functional improvement between the groups. Several neuropsychometric tests correlated with functional outcome (p < 0.01). CONCLUSIONS Patients with AnBI had worse functional outcomes following rehabilitation than patients with TBI, confirming the results of previous reports. Poor cognitive function predicted poor functional outcomes on the FIM and somewhat on the DRS. Research is needed to assess why these differences occur and to improve or develop new effective rehabilitation treatments for AnBI.
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Affiliation(s)
- Nora K Cullen
- Toronto Rehabilitation Institute, Toronto, ON, Canada.
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15
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FitzGerald A, Aditya H, Prior A, McNeill E, Pentland B. Anoxic brain injury: Clinical patterns and functional outcomes. A study of 93 cases. Brain Inj 2010; 24:1311-23. [DOI: 10.3109/02699052.2010.506864] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Torgersen J, Strand K, Bjelland TW, Klepstad P, Kvåle R, Søreide E, Wentzel-Larsen T, Flaatten H. Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia. Acta Anaesthesiol Scand 2010; 54:721-8. [PMID: 20236101 DOI: 10.1111/j.1399-6576.2010.02219.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evidence-based treatment protocols including therapeutic hypothermia have increased hospital survival to over 50% in unconscious out-of-hospital cardiac arrest survivors. In this study we estimated the incidence of cognitive dysfunctions in a group of cardiac arrest survivors with a high functional outcome treated with therapeutic hypothermia. Secondarily, we assessed the cardiac arrest group's level of cognitive performance in each tested cognitive domain and investigated the relationship between cognitive function and age, time since cardiac arrest and health-related quality of life (HRQOL). METHODS We included 26 patients 13-28 months after a cardiac arrest. All patients were scored using the Cerebral Performance Category scale (CPC) and Mini-Mental State Examination (MMSE). Twenty-five of the patients were tested for cognitive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB). These patients were tested using four cognitive tests: Motor Screening Test, Delayed Matching to Sample, Stockings of Cambridge and Paired Associate Learning from CANTAB. All patients filled in the Short Form-36 for the assessment of HRQOL. RESULTS Thirteen of 25 (52%) patients were classified as having a cognitive dysfunction. Compared with the reference population, there was no difference in the performance in motor function and delayed memory but there were significant differences in executive function and episodic memory. We found no associations between cognitive function and age, time since cardiac arrest or HRQOL. CONCLUSION Half of the patients had a cognitive dysfunction with reduced performance on executive function and episodic memory, indicating frontal and temporal lobe affection, respectively. Reduced performance did not affect HRQOL.
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Affiliation(s)
- J Torgersen
- Department of Anaesthesiology and Intensive Care Medicine, Haukeland University Hospital, Bergen, Norway.
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17
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Prohl J, Hundt B, Bodenburg S. Hypoxisch-ischämische Enzephalopathie (HIE) nach Herz-Kreislaufstillstand (HKS) – Pathophysiologie, Prognose und Outcome eines „vernachlässigten“ Krankheitsbildes. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2010. [DOI: 10.1024/1016-264x/a000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Durch die Fortschritte in der Reanimations- und Intensivmedizin steigt die Anzahl von Patienten mit einer Hypoxisch-ischämischen Enzephalopathie (HIE). Das klinische Ausprägungsspektrum dieses Krankheitsbildes reicht von milden kognitiven Dysfunktionen bis hin zum Versterben des Patienten. Der Übersichtsartikel beleuchtet mögliche Entwicklungsverläufe dieser Patientenpopulation vom Akutstadium der Erkrankung bis in die postrehabilitative Phase unter besonderer Gewichtung der zu Grunde liegenden pathophysiologischen Mechanismen, der Prognosestellung sowie des neuropsychologischen und psychosozialen Outcomes. Dabei wird verdeutlicht, dass Verbesserungen in der akuten Rettungs- und Intensivmedizin gleichsam mit Verbesserungen des rehabilitativen und vor allem des postrehabilitativen Versorgungssystems einhergehen müssen – sowohl für Patienten als auch deren Angehörigen.
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Affiliation(s)
- Jörn Prohl
- Abteilung für kognitive Rehabilitation, Neurologische Rehabilitationsklinik und Querschnittszentrum „Godeshöhe“, Bonn
- Abteilung Methodenlehre und Diagnostik, Institut für Psychologie, Universität Bonn
| | - Brenda Hundt
- Psychiatrische Abteilung, Bethesda AK Bergedorf, Hamburg
| | - Sebastian Bodenburg
- Neuropsychologische Praxis Hamburg
- Fachbereich Psychologie, Universität Hamburg
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18
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Johnson AR, DeMatt E, Salorio CF. Predictors of outcome following acquired brain injury in children. ACTA ACUST UNITED AC 2009; 15:124-32. [PMID: 19489083 DOI: 10.1002/ddrr.63] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acquired brain injury (ABI) in children and adolescents can result from multiple causes, including trauma, central nervous system infections, noninfectious disorders (epilepsy, hypoxia/ischemia, genetic/metabolic disorders), tumors, and vascular abnormalities. Prediction of outcomes is important, to target interventions, allocate resources, provide education to family or caregivers, and begin appropriate planning for the future. Researchers have identified several factors associated with better or worse outcomes after ABI, including variables related to the injury itself, postinjury factors related to intervention or trajectory of recovery, and preinjury or demographic factors. When examining the scientific literature, it is important to identify how "outcome" is defined, as the predictors may change depending on the outcome studied. In addition, key variables may be specific to the etiology of injury. Therefore, predictors of outcome cannot be generalized across the various etiologies of ABI, and this review will discuss predictors within the context of multiple etiologies of ABI. This article reviews the current literature on predicting outcomes after pediatric ABI, and areas in need of further research are discussed.
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Affiliation(s)
- Abigail R Johnson
- Department of Pediatric Rehabilitation, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205, USA
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19
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Umgang mit Prognosen bei komatösen Patienten im Zuge einer kardialen Hypoxisch-Ischämischen Enzephalopathie. Ethik Med 2009. [DOI: 10.1007/s00481-008-0583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Abstract
Two men, 56 and 33 years old, (case 1 and case 2) were examined neuropsychologically after successful resuscitation from circulatory arrest following extreme accidental hypothermia and near drowning. After submersion in ice water for at least 20 minutes they received CPR for 45 to 60 minutes. Body-core temperature at start of CPB was 24 degrees C and 22 degrees C, respectively. A neuropsychological examination was performed within two months after the accident and 1 year later. An additional follow-up interview was made 3 years after the accidents. Both had severe problems with memory, visuospatial performance, executive function, and verbal fluency. The follow-up demonstrated improvement in the visuospatial test in both and in the verbal learning, recall, and logical reasoning tests in case 2. Both still had problems with executive function, and case 2 also in verbal fluency. Case 1 also had problems with flexibility, planning and abstract ability. Despite the protective effects of hypothermia and gradual improvement of symptoms over time, some of the deficits were permanent. A thorough neuropsychological examination of patients suffered from anoxia is advisable, because gross neurological examination and MRI scans may not always reveal underlying brain dysfunction.
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21
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Giordani B, Hodges EK, Guire KE, Ruzicka DL, Dillon JE, Weatherly RA, Garetz SL, Chervin RD. Neuropsychological and behavioral functioning in children with and without obstructive sleep apnea referred for tonsillectomy. J Int Neuropsychol Soc 2008; 14:571-81. [PMID: 18577286 PMCID: PMC2561942 DOI: 10.1017/s1355617708080776] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adenotonsillectomy (AT) is among the most common pediatric surgical procedures and is performed as often for obstructive sleep apnea (OSA) as for recurrent tonsillitis. This study compared behavioral, cognitive, and sleep measures in 27 healthy control children recruited from a university hospital-based pediatric general surgery clinic with 40 children who had OSA (AT/OSA+) and 27 children who did not have OSA (AT/OSA-) scheduled for AT. Parental ratings of behavior, sleep problems, and snoring, along with specific cognitive measures (i.e., short-term attention, visuospatial problem solving, memory, arithmetic) reflected greater difficulties for AT children compared with controls. Differences between the AT/OSA- and control groups were larger and more consistent across test measures than were those between the AT/OSA+ and control groups. The fact that worse outcomes were not clearly demonstrated for the AT/OSA+ group compared with the other groups was not expected based on existing literature. This counterintuitive finding may reflect a combination of factors, including age, daytime sleepiness, features of sleep-disordered breathing too subtle to show on standard polysomnography, and academic or environmental factors not collected in this study. These results underscore the importance of applying more sophisticated methodologies to better understand the salient pathophysiology of childhood sleep-disordered breathing.
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Affiliation(s)
- Bruno Giordani
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan 48105-0716, USA.
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22
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Wallace MG, Hartle KD, Snow WM, Ward NL, Ivanco TL. Effect of hypoxia on the morphology of mouse striatal neurons. Neuroscience 2007; 147:90-6. [PMID: 17512672 DOI: 10.1016/j.neuroscience.2007.02.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 02/26/2007] [Accepted: 02/28/2007] [Indexed: 12/01/2022]
Abstract
Symptoms of high altitude sickness including headache and neuropsychological dysfunction are thought to result from prolonged exposure to hypoxia. In order to explain how the brain adapts to lower oxygen pressure at high altitude, CD1 mice were exposed to 3 weeks of hypobaric hypoxic conditions. Analyses of the neuronal morphology of striatal medium spiny neurons (MSNs) revealed a significant decrease in dendritic length, yet no change in dendritic volume, in hypoxic mice relative to normoxic mice. Vascular data indicated an increase in blood vessel area in the striatum of mice exposed to prolonged hypoxia. A mouse model of high altitude exposure may assist in elucidating the mechanisms of cerebral adaptation to high altitudes in humans, and therefore aid in developing successful prevention techniques and treatment of problems associated with high altitude disease.
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Affiliation(s)
- M G Wallace
- Department of Psychology, University of Manitoba, Canada
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23
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Prohl J, Röther J, Kluge S, de Heer G, Liepert J, Bodenburg S, Pawlik K, Kreymann G. Prediction of short-term and long-term outcomes after cardiac arrest: A prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations*. Crit Care Med 2007; 35:1230-7. [PMID: 17414735 DOI: 10.1097/01.ccm.0000261892.10559.85] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prognostic accuracy of biochemical, clinical, electrophysiological, and neuropsychological investigations in predicting outcomes after cardiac arrest. DESIGN Prospective study. SETTING Intensive care unit of the Hamburg-Eppendorf University Medical Center, Hamburg, Germany. PATIENTS A total of 80 patients (mean age, 63.79 +/- 15.85 yrs) after cardiopulmonary resuscitation. INTERVENTIONS Serial blood samples (days 2-4), clinical examinations (days 2 and 4), sensory-evoked potentials (day 4), and neuropsychological assessments (<or=1 and 6 months). MEASUREMENTS AND MAIN RESULTS We conducted a prospective study into the combined predictive efficacy of serum concentrations of neuron-specific enolase and protein S-100B, standardized clinical examinations, and short- and long-latency sensory-evoked potentials. For the prognostic validation, both the dichotomized 5-point Glasgow-Pittsburgh Cerebral Performance Categories (1-3, favorable outcome; 4-5, unfavorable outcome) and a comprehensive neuropsychological test battery were applied. A multivariate logistic-regression analysis resulted in a model in which 85% of the variance in the dichotomized Glasgow-Pittsburgh Cerebral Performance Categories was explained by neuron-specific enolase at day 4, clinical examination score at day 4, and age. This predictor index had a sensitivity of 92% and a specificity of 93%. In addition, 26 patients (out of 33) underwent neuropsychological testing at 6 months. Significant correlations were found with selected cognitive variables and S-100B at day 3, long-latency sensory-evoked potential at day 4, and neuropsychological bedside screening. CONCLUSIONS A multivariate assessment approach should be used to establish an early high-certainty prognosis after cardiac arrest. However, further prospective clinical studies are necessary to confirm this derived predictor index. In addition, an early recording of S-100B, long-latency sensory-evoked potential, and neuropsychological bedside screening reflect a cognitive long-term outcome.
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Affiliation(s)
- Jörn Prohl
- Department of Biological Psychology and Neuropsychology, University of Hamburg, Germany.
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