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Landau R, Weiniger CF. Postdural puncture headache after intentional or unintentional dural punctures: time to think about risk reduction and acknowledge the burden of sequelae. Reg Anesth Pain Med 2024; 49:1-3. [PMID: 37918969 DOI: 10.1136/rapm-2023-104945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Ruth Landau
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Carolyn F Weiniger
- Division of Anesthesiology & Critical Care & Pain, Tel Aviv Ichilov-Sourasky Medical Center, Tel Aviv, Israel
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Schieber MR, Schubert AK, Hubner W, Volk T. Influence of antithrombotic medication on size and neurological outcome of spinal epidural hematoma after neuraxial anesthesia: a systematic review. Reg Anesth Pain Med 2023:rapm-2023-104864. [PMID: 38129095 DOI: 10.1136/rapm-2023-104864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Anticoagulation guidelines were developed to reduce the potential risk of epidural bleeding following neuraxial anesthesia. However, the influence of antithrombotic medication on size of spinal epidural hematoma and neurological outcome is unclear. Therefore, our aim was to analyze whether there is a correlation. METHODS The study was registered at Prospero (CRD42021285833). A systematic search in MEDLINE, EMBASE, CENTRAL, Web of Science and Google Scholar was conducted in August 2023 for studies reporting spinal epidural hematoma following neuraxial anesthesia. Primary endpoints were segmental extension and neurological outcome. Secondary endpoints were age, sex, body mass index, predisposition, American Society of Anesthesiologists physical status, complicated puncture, multiple punctures, bloody puncture, successful puncture, catheter usage, needle size and worst neurological deficit before treatment. Prespecified multivariate regression and propensity score matching was performed. Publications reporting on more than one patient were critically appraised. RESULTS A total of 345 cases reported in 304 publications were included. Size of hematoma was not significantly different (antithrombotic medication: OR 0.11, 95% CI (-0.67 to 0.89), p=0.78, 'non-guideline adherent' for puncture/removal: OR 0.13, 95% CI (-0.92 to 1.18), p=0.81). Patients receiving antithrombotic medication were more likely to have persistent neurological deficit (OR 2.00, 95% CI 1.24 to 3.23), p<0.01). Significance persisted after propensity score matching (p=0.04). Patients with non-guideline adherence had a 3.42 higher chance of persistent neurological deficit (95% CI 1.71 to 6.86, p<0.001). DISCUSSION Antithrombotic medication is not significantly associated with hematoma size; however, the use of antithrombotic medication doubled the risk for persistent neurological deficit after spinal epidural hematoma.
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Affiliation(s)
- Mirjam Ruth Schieber
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | | | - Wakiko Hubner
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
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Brenna CTA, Khan S, Poots C, Brull R. Association between perioperative neuraxial local anesthetic neurotoxicity and arachnoiditis: a narrative review of published reports. Reg Anesth Pain Med 2023:rapm-2023-104941. [PMID: 38050164 DOI: 10.1136/rapm-2023-104941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/16/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND/IMPORTANCE Arachnoiditis is a rare but devastating disorder caused by various insults, one of which is purported to be local anesthetic neurotoxicity following neuraxial blockade. However, the relationship between local anesthetics administered into the neuraxis and the development of arachnoiditis has not been clearly elucidated. OBJECTIVE We aimed to summarize the existing complex body of literature and characterize both the essential features and strength of any association between neuraxial local anesthetic neurotoxicity and arachnoiditis with a view toward mitigating risk, enhancing prevention, and refining informed consent discussions. EVIDENCE REVIEW We reviewed all published reports of arachnoiditis attributed to local anesthetic neurotoxicity following perioperative neuraxial anesthesia. This narrative review was based on a systematic search methodology, which included articles published up until December 2022. FINDINGS Thirty-eight articles were included, comprising 130 patients, over one-half of which were published prior to this century and inconsistent with modern practice. Neuraxial techniques included 78 epidurals, 48 spinals, and 5 combined spinal-epidurals, mostly for obstetrics. Reporting of essential procedural data was generally incomplete. Overall, at least 57% of patients experienced complicated needle/catheter insertion, including paresthesia, pain, or multiple attempts, irrespective of technique. The onset of neurological symptoms ranged from immediate to 8 years after neuraxial blockade, while the pathophysiology of arachnoiditis, if described, was heterogeneous. CONCLUSIONS The existing literature attributing arachnoiditis to local anesthetic neurotoxicity is largely outdated, incomplete, and/or confounded by other potential causes, and thus insufficient to characterize the features and strength of any association.
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Affiliation(s)
- Connor T A Brenna
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Poots
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Richard Brull
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
- Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada
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4
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Frost S, Rodrigues D, Amadeo RJJ, Wolfe S, Funk F, Ferguson C, Brown H, MacDonald P, Dufault B, Mutter TC. Postoperative neurological symptoms following arthroscopic shoulder surgery with interscalene block: an exploratory secondary analysis of pooled randomized controlled trial data. Reg Anesth Pain Med 2023; 48:553-560. [PMID: 37295793 DOI: 10.1136/rapm-2022-104086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/07/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Postoperative neurological symptoms (PONS) are recognized complications of regional anesthesia and orthopedic surgery. We aimed to better characterize prevalence and potential risk factors in a homogeneous population of randomized, controlled trial participants. METHODS Data were pooled from two randomized controlled trials of analgesia after interscalene block with perineural or intravenous adjuvants (NCT02426736, NCT03270033). Participants were at least 18 years of age and undergoing arthroscopic shoulder surgery at a single ambulatory surgical center. PONS were assessed by telephone follow-up at 14 days and 6 months postoperatively, and defined as patient report of numbness, weakness, or tingling in the surgical limb, alone or in combination, and regardless of severity or etiology. RESULTS At 14 days, PONS occurred in 83 of 477 patients (17.4%). Among these 83 patients, 10 (12.0%) continued to have symptoms a half-year after surgery. In exploratory univariate analyses, no patient, surgical or anesthetic characteristics were significantly associated with 14-day PONS except for lower postoperative day 1 Quality of Recovery-15 questionnaire total score (OR 0.97 (95% CI, 0.96 to 0.99), p<0.01). This result was driven largely by the emotional domain question scores (OR 0.90 95% CI 0.85 to 0.96, p<0.001). Report of all three of numbness, weakness and tingling at 14 days vs other 14-day symptom combinations was associated with persistent PONS at 6 months (OR 11.5 95% CI 2.2 to 61.8, p<0.01). CONCLUSION PONS are common after arthroscopic shoulder surgery performed with single injection ultrasound-guided interscalene blocks. No definitive mitigating risk factors were identified.
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Affiliation(s)
- Samantha Frost
- Anesthesiology, Perioperative and Pain Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Daniel Rodrigues
- Anesthesiology, Perioperative and Pain Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Ryan J J Amadeo
- Anesthesiology, Perioperative and Pain Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Scott Wolfe
- Anesthesiology, Perioperative and Pain Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Faylene Funk
- Anesthesiology, Perioperative and Pain Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Celeste Ferguson
- Orthopedics, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Holly Brown
- Orthopedics, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Peter MacDonald
- Orthopedics, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Brenden Dufault
- George and Fay Yee Centre for Health Care Innovation, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Thomas Charles Mutter
- Anesthesiology, Perioperative and Pain Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
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5
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Lee MC, Bartuska A, Chen J, Kim RK, Jaradeh S, Mihm F. Stellate ganglion block catheter for paroxysmal sympathetic hyperactivity: calming the 'neuro-storm'. Reg Anesth Pain Med 2023; 48:522-525. [PMID: 37230754 DOI: 10.1136/rapm-2023-104399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Paroxysmal sympathetic hyperactivity (PSH) is an autonomic disorder affecting patients with severe acquired brain injury characterized by intermittent sympathetic discharges with limited therapeutic options. We hypothesized that the PSH pathophysiology could be interrupted via stellate ganglion blockade (SGB). CASE PRESENTATION A patient with PSH after midbrain hemorrhage followed by hydrocephalus obtained near-complete resolution of sympathetic events for 140 days after SGB. CONCLUSION SGB is a promising therapy for PSH, overcoming the limitations of systemic medications and may serve to recalibrate aberrant autonomic states.
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Affiliation(s)
- Man-Cheung Lee
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andrew Bartuska
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jeffrey Chen
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Richard K Kim
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Safwan Jaradeh
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Fred Mihm
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Fettiplace M. Weight-based dosing of ropivacaine in erector spinae blocks. Reg Anesth Pain Med 2023; 48:437-438. [PMID: 37217259 PMCID: PMC10409255 DOI: 10.1136/rapm-2023-104628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Michael Fettiplace
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
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7
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Ashtari F, Djalalimotlagh S, Farbod Y, Tizmaghz A. A Case Report of an Atypical Neurological Presentation of COVID-19 in Pregnancy. Anesth Pain Med 2023; 13:e134925. [PMID: 38021329 PMCID: PMC10664158 DOI: 10.5812/aapm-134925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/06/2023] [Accepted: 02/22/2023] [Indexed: 12/01/2023] Open
Abstract
Symptomatic patients with coronavirus disease 2019 (COVID-19) mostly have flu-like symptoms. However, neurologic manifestations are common and may be the early findings of COVID-19. Data for COVID-19 do not indicate an increased risk of infection in pregnant individuals, but the risk of disease severity and mortality is high in this patient population. We report a case of a pregnant woman in the 10th gestational week, who presented with neurological symptoms of sudden impairment in walking, balance, speech, and consciousness, started the night before, and a seven-day history of fever, chills, myalgia, and general weakness before admission. The polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive for the cerebrospinal fluid sample a day before the positive nasopharyngeal sample. Axial brain magnetic resonance imaging revealed the involvement of the spinothalamic tract. Following treatment with intravenous immunoglobulin, the patient's neurological condition gradually recovered, except for lower limb muscle strength, and she was discharged from the hospital on the 10th day of admission. This case is unique as it emphasizes the importance of considering COVID-19 when uncommon neurologic manifestations with negative nasopharyngeal PCR are present.
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Affiliation(s)
- Fatemeh Ashtari
- Department of Intensive Care Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Djalalimotlagh
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Yasaman Farbod
- Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Adnan Tizmaghz
- Department of General Surgery, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Alves EV, Beber BC. Self-perception of cognitive sequels in post-COVID-19 individuals. Dement Neuropsychol 2023; 17:e20220080. [PMID: 37223832 PMCID: PMC10202328 DOI: 10.1590/1980-5764-dn-2022-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/28/2022] [Accepted: 12/15/2022] [Indexed: 05/25/2023] Open
Abstract
COVID-19 is an infection, primarily respiratory, caused by the SARS-CoV-2, which can also affect the central nervous system, causing neuropsychological damage. There are studies describing post-COVID-19 cognitive deficits, but it is important to know this outcome in populations with different social, biological, and cultural characteristics. Objective The aim of this study was to assess the self-perception of cognitive sequelae in post-COVID-19 individuals and identify whether there is a possible relationship between the outcome of the participants' self-perception and sociodemographic and clinical data. Methods This is a cross-sectional study, carried out through an online questionnaire on the Google Forms platform, in which sociodemographic data, general health data, clinical manifestations of COVID-19, and post-COVID-19 self-perception of the cognitive domains of memory, attention, language, and executive functions were collected. Results The final sample consisted of 137 participants, and it was possible to identify that memory and attention were the domains with the highest impression of worsening post-COVID-19, followed by executive functions and language. In addition, it was identified that being female may be related to a worse self-perception of all cognitive functions and that having depression or other psychiatric diseases and obesity can significantly affect at least half of the cognitive domains evaluated. Conclusions This study pointed to a post-COVID-19 cognitive worsening of the participants.
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Affiliation(s)
- Emily Viega Alves
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil
| | - Bárbara Costa Beber
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil
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9
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Yolcu G, Abacar KY, Kenis-Coskun O, Nevsun-Inanc G, Karadag-Saygi E, Gunduz OH. Comparison of cutaneous silent period parameters in patients with primary Sjögren's syndrome with the healthy population and determination of ıts relationship with clinical parameters. Rheumatol Int 2023; 43:355-62. [PMID: 36048188 DOI: 10.1007/s00296-022-05198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/23/2022] [Indexed: 02/07/2023]
Abstract
Small fiber neuropathy (SFN) is one of the main neurological manifestations in primary Sjögren's Syndrome (pSS). For the detection of SFN, cutaneous silent period (CSP) measurement is gaining popularity recently due to its non-invasiveness and practical application. Evaluating SFN involvement in patients with pSS using CSP and evaluating its relationship with clinical parameters. Patients with a diagnosis of pSS and healthy volunteers demographically homogeneous with the patient group were included in the study. The CSP responses were recorded over the abductor pollicis brevis muscle. The latency and duration values of the responses were obtained. In patient group, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Hospital Anxiety and Depression Scale (HADS), Short Form-36 (SF-36) questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and Central Sensitization Inventory (CSI) were applied for the evaluation of symptom severity, mood, quality of life, presence of neuropathic pain and central sensitization, respectively. The mean CSP latency was significantly longer in patient group compared to control group (p < 0.001). Mean CSP duration was also significantly shorter in patient group (p < 0.001). There were no significant differences in CSP parameters according to patients' neuropathic pain or central sensitization profile. There were significant correlations of CSP parameters (latency and duration, respectively) with ESSPRI dryness (ρ = 0.469, p = 0.004; ρ = -0.553, p < 0.001), fatigue (ρ = 0.42, p = 0.011; ρ = -0.505, p = 0.002), pain (ρ = 0.428, p = 0.009; ρ = -0.57, p < 0.001) subscores and mean ESSPRI score (ρ = 0.631, p < 0.001; ρ = -0.749, p < 0.001). When SF-36 subscores and CSP parameters were investigated, a significant correlation was found only between "bodily pain" subscore and CSP duration (ρ = -0.395, p = 0.017). In HADS, LANSS and CSI evaluations, a significant correlation was found only between HADS anxiety score and the CSP duration (ρ = 0.364, p = 0.02). As indicated by CSP measurement, SFN is more prominent in patients with pSS than in the healthy population. It is important to investigate the presence of SFN because of its correlation with the leading symptoms in the clinical spectrum of pSS.
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Gupta RK, Hussain N, Schwenk ES. Evaluating the incidence of spinal cord injury after spinal cord stimulator implant: an updated retrospective review - an infographic. Reg Anesth Pain Med 2022; 47:rapm-2022-103640. [PMID: 35534021 DOI: 10.1136/rapm-2022-103640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Rajnish K Gupta
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nasir Hussain
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric S Schwenk
- Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Zare Dehnavi A, Salehi M, Arab Ahmadi M, Asgardoon MH, Ashrafi F, Ahmadinejad N, Behkar A, Hamidi Farahani R, Hashemi H, Tafakhori A, Shahali H, Rahmani M, Ranjbar Naeini A. Clinical, Laboratory and Imaging Characteristics of Hospitalized COVID-19 Patients with Neurologic Involvement; a Cross-Sectional Study. Arch Acad Emerg Med 2022; 10:e10. [PMID: 35402993 PMCID: PMC8986495 DOI: 10.22037/aaem.v10i1.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Although neurologic involvement and neuroimaging abnormalities have been frequently identified in COVID-19 patients, the underlying factors remain unclear. In this study, we assessed the association of the neurological manifestations and neuroimaging features of hospitalized COVID-19 patients with their clinical, laboratory, and imaging characteristics. Methods This multicenter cross-sectional study was conducted between September 2020 and March 2021 at two large academic hospitals in Tehran, Iran. We used census sampling from medical records to enroll hospitalized patients with a positive COVID-19 Polymerase chain reaction (PCR) test who underwent brain imaging due to presenting any acute neurologic symptom during hospital stay. Results Of the 4372 hospitalized patients with COVID-19, only 211 met the inclusion criteria (35.5% with severe infection). Central nervous system and psychiatric manifestations were significantly more common in severe cases (p ≤ 0.044). Approximately, 30% had a new abnormality on their neuroimaging, with ischemic (38/63) and hemorrhagic (16/63) insults being the most common. The most frequent reasons that provoked cranial imaging were headache (27%), altered consciousness (25.6%), focal neurologic signs (19.9%), and delirium (18%). Analysis revealed a positive correlation for age, neutrophilia, lymphopenia, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) with the emergence of neuroimaging abnormalities (p ≤ 0.018). In addition, patients with new neuroimaging abnormalities had a significantly higher lung CT score than those without any pathologic findings (11.1 ± 4.8 vs. 5.9 ± 4.8, p < 0.001). Conclusion Approximately 30% of the study population had various acute neuroimaging findings. The lung CT score, neutrophil count, and age were strong predictors of acute neuroimaging abnormalities in hospitalized COVID-19 patients.
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Affiliation(s)
- Ali Zare Dehnavi
- Department of Neurology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Infectious Diseases and Tropical Medicines Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Arab Ahmadi
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farzad Ashrafi
- Functional Neurosurgery Research Center, Shohadaye Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Ahmadinejad
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Behkar
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hassan Hashemi
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Department of Neurology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamze Shahali
- Department of Aerospace and Sub Aquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammad Rahmani
- Department of Neurology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ranjbar Naeini
- Department of Neurology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran.,Corresponding Author: Alireza Ranjbar naeini; AJA University of medical sciences, Etemad zadeh street, Fatemi-Gharbi Street, Tehran, Iran. / Postal Code: 1411718541, E-mail: . Telephone: 021- 86096350,Mobile phone: 0098913 123 0360
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Asadollahi M, Maghsudloo F, Simani L, Pakdaman H. Factors predisposing patients with temporal lobe epilepsy to seizure cluster. Curr J Neurol 2022; 21:12-16. [PMID: 38011472 PMCID: PMC9527866 DOI: 10.18502/cjn.v21i1.9355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022]
Abstract
Background: We aimed to identify the potential risk factors associated with seizure clusters in patients with temporal lobe epilepsy (TLE). Methods: This retrospective cross-sectional study was performed on all the consecutive patients with TLE, who were admitted to the Epilepsy Monitoring Unit (EMU), Loghman-Hakim Hospital, Tehran, Iran. Seizure cluster was defined as three or more habitual seizures occurring within 24 hours, in over 50% of ictal events, with inter-seizure interval of less than 8 hours. The patients' demographic data, epilepsy duration, seizure frequency, frequency of interictal epileptiform discharges (IEDs), and brain magnetic resonance imaging (MRI) findings were collected. Results: Among a total number of 124 patients with TLE, 62 (50.0%) patients reported seizure clusters. In addition, 44 (37.9%), 42 (36.2%), and 30 (25.9%) patients had normal-appearing brain MRI, mesial temporal sclerosis (MTS), and other brain pathologies, respectively. In terms of IEDs frequency, 35 (29.4%), 43 (36.1%), 17 (14.3%), and 24 (20.2%) patients had respectively frequent, occasional, rare, and no spikes in one-hour of interictal scalp electroencephalography (EEG) recording. In our study, seizure clusters were not associated with the epilepsy duration (P = 0.100), the amount of IEDs (P = 0.764), or MRI findings (P = 0.112). Conclusion: In patients with TLE, seizure clustering had no correlation with the epilepsy duration, the amount of IEDs, or brain MRI findings.
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Affiliation(s)
- Marjan Asadollahi
- Epilepsy Monitoring Unit, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faezeh Maghsudloo
- Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Simani
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Pakdaman
- Brain Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ashrafi F, Ommi D, Zali A, Khani S, Soheili A, Arab-Ahmadi M, Behnam B, Nohesara S, Semnani F, Fatemi A, Salari M, Jalili Khoshnood R, Vahidi M, Ayoobi-Yazdi N, Hosseini Toudeshki S, Sobhrakhshankhah E. Neurological Manifestations and their Correlated Factors in COVID-19 Patients; a Cross-Sectional Study. Arch Acad Emerg Med 2021; 9:e34. [PMID: 34027429 PMCID: PMC8126358 DOI: 10.22037/aaem.v9i1.1210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: COVID-19 might present with other seemingly unrelated manifestations; for instance, neurological symptoms. This study aimed to evaluate the neurologic manifestations and their correlated factors in COVID-19 patients. Methods: This retrospective observational study was conducted from March 17, 2020 to June 20, 2020 in a tertiary hospital in Iran. The study population consisted of adult patients with a positive result for COVID-19 real-time reverse transcriptase polymerase chain reaction (RT-PCR) using nasopharyngeal swabs. Both written and electronic data regarding baseline characteristic, laboratory findings, and neurological manifestations were evaluated and reported. Results: 727 COVID-19 patients with the mean age of 49.94 ± 17.49 years were studied (56.9% male). At least one neurological symptom was observed in 403 (55.4%) cases. Headache (29.0%), and smell (22.3%) and taste (22.0%) impairment were the most prevalent neurological symptoms, while seizure (1.1%) and stroke (2.3%) were the least common ones. Patients with neurological manifestations were significantly older (p = 0.04), had greater body mass index (BMI) (p = 0.02), longer first symptom to admission duration (p < 0.001) and were more frequently opium users (p = 0.03) compared to COVID-19 patients without neurological symptoms. O2 saturation was significantly lower in patients with neurological manifestations (p = 0.04). In addition, medians of neutrophil count (p = 0.006), neutrophil-lymphocyte ratio (NLR) (p = 0.02) and c-reactive protein (CRP) (p = 0.001) were significantly higher and the median of lymphocyte count (p = 0.03) was significantly lower in patients with neurological manifestations. Conclusion: The prevalence of neurological manifestations in the studied cases was high (55.4%). This prevalence was significantly higher in older age, grated BMI, longer lasting disease, and opium usage.
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Affiliation(s)
- Farzad Ashrafi
- Functional Neurosurgery Research Center, Shohadaye Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Ommi
- Functional Neurosurgery Research Center, Shohadaye Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohadaye Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Khani
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirali Soheili
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Arab-Ahmadi
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behdad Behnam
- Department of Internal Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Nohesara
- Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farbod Semnani
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Fatemi
- Department of Infectious Diseases, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohadaye Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Jalili Khoshnood
- Functional Neurosurgery Research Center, Shohadaye Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Vahidi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Ayoobi-Yazdi
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Rezaei O, Ramezani M, Roozbeh M, Fazeli B, Hajiesmaeili M, Pakdaman H, Simani L. Does vitamin D administration play a role in outcome of patients with acute ischemic stroke? A randomized controlled trial. Curr J Neurol 2021; 20:8-14. [PMID: 38011419 PMCID: PMC8511603 DOI: 10.18502/cjn.v20i1.6374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/03/2020] [Indexed: 11/24/2022]
Abstract
Background: Clinical studies have reported improved neurological outcomes in patients who were taking vitamin D supplements. This study investigates the effect of intramuscular (IM) vitamin D supplementation in patients with acute ischemic stroke (AIS) on neurological outcomes and inflammatory marker levels. Methods: This study included patients diagnosed with AIS (n = 60) from the Neurology Unit of Loghman Hakim Hospital, Tehran, Iran, during the year 2019. Patients with AIS were allocated randomly into two groups who received a single dose of 300000 IU IM vitamin D and a control group that did not receive vitamin D supplementation. Serum vitamin D concentration, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) levels, as primary outcomes, and the Modified Rankin Scale (MRS), the National Institute of Health Stroke Scale (NIHSS), and the Mini-Mental State Examination (MMSE), as secondary outcomes, were measured at the baseline and the end of the study (6 weeks). Results: Eventually, 59 patients with AIS completed the intervention study. A single dose of 300000 IU increased vitamin D level; moreover, vitamin D supplementation improved MRS and IL-6 levels significantly (P = 0.01, P = 0.02, respectively). There were reverse correlations between serum vitamin D and NIHSS and TNF-α after vitamin D administration. However, no statistically significant effect of vitamin D on the TNF-α or NIHSS and MMSE was seen compared to the control group. Conclusion: Vitamin D probably due to a single dose and short duration of administration, as well as a short follow-up period, had no favorable effects on TNF-α level and NIHSS score.
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Affiliation(s)
- Omidvar Rezaei
- Skull Base Research Center, Loghman Hakim Hospital Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahtab Ramezani
- Skull Base Research Center, Loghman Hakim Hospital Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Roozbeh
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Fazeli
- Skull Base Research Center, Loghman Hakim Hospital Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Hajiesmaeili
- Anesthesiology Research Center, Loghman Hakim Hospital Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Pakdaman
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Simani
- Skull Base Research Center, Loghman Hakim Hospital Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Costa A, Silva-Pinto A. [Neurological Manifestations and COVID-19]. ACTA MEDICA PORT 2020; 33:787-788. [PMID: 33159725 DOI: 10.20344/amp.14504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/15/2020] [Accepted: 09/10/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Andreia Costa
- Serviço de Neurologia. Centro Hospitalar e Universitário de São João. Porto; Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - André Silva-Pinto
- Serviço de Doenças Infeciosas. Centro Hospitalar e Universitário de São João. Porto. Departamento de Medicina. Faculdade de Medicina. Universidade do Porto. Porto. Grupo I&D em Nefrologia e Doenças Infeciosas. I3S - Instituto de Investigação e Inovação em Saúde. Universidade do Porto. Porto. Portugal
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16
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Lee JM, Lee SJ. Olfactory and Gustatory Dysfunction in a COVID-19 Patient with Ankylosing Spondylitis Treated with Etanercept: Case Report. J Korean Med Sci 2020; 35:e201. [PMID: 32476306 PMCID: PMC7261700 DOI: 10.3346/jkms.2020.35.e201] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022] Open
Abstract
The neurologic manifestations concerning coronavirus disease 2019 (COVID-19) are highly penetrated. Anosmia and ageusia are one of the common acute neurologic symptoms, which develop in the early stage of COVID-19. However, it is not reported that how immunosuppressive agents affect these symptoms. We report olfactory and gustatory dysfunctions in a patient with ankylosing spondylitis (AS) treated with etanercept during COVID-19. A 53-year-old female showing AS controlled with tumor necrosis factor-α inhibitor, etanercept, had been diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, presenting cough and rhinorrhea. One month after diagnosis, she complained about hyposmia and hypogeusia two days before the seronegative conversion of SARS-CoV-2, which were confirmed by a neurological examination. We speculate that the etanercept may have delayed the development of olfactory and gustatory dysfunction in the patient.
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Affiliation(s)
- Jong Mok Lee
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Jin Lee
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
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TAVASOLI AR, ROSTAMI P, ASHRAFI MR, KARIMZADEH P. Neurological and Vascular Manifestations of Ethylmalonic Encephalopathy. Iran J Child Neurol 2017; 11:57-60. [PMID: 28698729 PMCID: PMC5493831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective Ethylmalonic encephalopathy (EE) is a severe mitochondrial disease of early infancy clinically characterized by a combination of developmental delay, progressive pyramidal signs, and vascular lesions including petechial purpura, orthostatic acrocyanosis, and chronic hemorrhagic diarrhea. Biochemical hallmarks of the disease are persistently high level of lactate, and C4-C5-acylcarnitines in blood, markedly elevated urinary excretion of methylsuccinic and ethylmalonic (EMA) acids. Here we report two patients with EE as a 16-months-old male infant and a 2-yr-old boy referred to Pediatric Neurology Clinic in Children's Medical Center, Tehran-Iran that in one patient genetic analysis revealed a homozygous mutation of the ETHE1 gene in favor of ethylmalonic acidemia.
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Affiliation(s)
- Ali Reza TAVASOLI
- Pediatric Neurology Division, Neurometabolic Registry Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parastoo ROSTAMI
- Division of Endocrinology and Metabolism, Department of Pediatrics, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahmoud Reza ASHRAFI
- Pediatric Neurology Division, Neurometabolic Registry Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvaneh KARIMZADEH
- Pediatric Neurology, Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Pediatric Neurology Excellence Center, Pediatric Neurology Department, Mofid Children Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
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Abstract
Enterovirus 71 frequently involves the central nervous system and may present with a variety of neurologic manifestations. Here, we aimed to describe the clinical features, magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) profiles of patients presenting with neurologic complications of enterovirus 71 infection. We retrospectively reviewed the records of 31 pediatric patients hospitalized with acute neurologic manifestations accompanied by confirmed enterovirus 71 infection at Ulsan University Hospital between 2010 and 2014. The patients' mean age was 2.9 ± 5.5 years (range, 18 days to 12 years), and 80.6% of patients were less than 4 years old. Based on their clinical features, the patients were classified into 4 clinical groups: brainstem encephalitis (n = 21), meningitis (n = 7), encephalitis (n = 2), and acute flaccid paralysis (n = 1). The common neurologic symptoms included myoclonus (58.1%), lethargy (54.8%), irritability (54.8%), vomiting (48.4%), ataxia (38.7%), and tremor (35.5%). Twenty-five patients underwent an MRI scan; of these, 14 (56.0%) revealed the characteristic increased T2 signal intensity in the posterior region of the brainstem and bilateral cerebellar dentate nuclei. Twenty-six of 30 patients (86.7%) showed CSF pleocytosis. Thirty patients (96.8%) recovered completely without any neurologic deficits; one patient (3.2%) died due to pulmonary hemorrhage and shock. In the present study, brainstem encephalitis was the most common neurologic manifestation of enterovirus 71 infection. The characteristic clinical symptoms such as myoclonus, ataxia, and tremor in conjunction with CSF pleocytosis and brainstem lesions on MR images are pathognomonic for diagnosis of neurologic involvement by enterovirus 71 infection.
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Affiliation(s)
- Kyung Yeon Lee
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Myoung Sook Lee
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Bin Kim
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Gupta A, Stokken J, Krakovitz P, Malhotra P, Anne S. Tracheostomy in neurologically compromised paediatric patients: role of starplasty. J Laryngol Otol 2015; 129:1009-12. [PMID: 26279145 DOI: 10.1017/S002221511500208X] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Starplasty tracheostomy is an alternative to traditional tracheostomy. This paper reviews neurologically compromised paediatric patients with tracheostomies and discusses the role of starplasty tracheostomy. METHOD A retrospective review was conducted of paediatric patients with a neurological disorder who underwent tracheostomy between 1997 and 2011. RESULTS Forty-eight patients, with an average age of 7.3 years, were identified. The most common indications for tracheostomy were: ventilator dependence (39.6 per cent), an inability to tolerate secretions or recurrent aspiration pneumonia (33.3 per cent), and upper respiratory obstruction or hypotonia (12.5 per cent). The most common underlying neurological diagnosis was cerebral palsy. There were no early complications. Eighteen (43 per cent) of 42 patients with follow up experienced at least 1 delayed complication. Only 12 patients (28.6 per cent) were decannulated. CONCLUSION Patients with primary neurological diagnoses have low rates of decannulation; starplasty tracheostomy should be considered for these patients. Patients with seizure disorder or acute neurological injury tended to have a higher short-term decannulation rate; traditional tracheostomy is recommended in these patients.
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20
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Quintana LM. Radiosurgery and Seizures in Cerebral Arteriovenous Malformation. World Neurosurg 2015; 84:616-7. [PMID: 25988539 DOI: 10.1016/j.wneu.2015.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Leonidas M Quintana
- Department of Neurosurgery, Valparaíso University School of Medicine, Valparaíso, Chile.
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21
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Akar Ö, Yaldiz C, Özdemir N, Yaman O, Dalbayrak S. Isolated Transverse Clivus Fracture without Neurodeficit: Case Report and Review of Literature. Pol J Radiol 2015; 80:151-4. [PMID: 25848439 PMCID: PMC4370353 DOI: 10.12659/pjr.893027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/27/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Clivus is a bony surface in the posterior cranial fossa, serving as the support of the brainstem and thus neighboring important structures because of its location. Skull base fractures that cannot be shown by conventional radiography can be clearly imaged by high-resolution bone window computed tomography. CASE REPORT A 44 years-old male referred to the emergency department because of a traffic accident in the car. His only complaint was a severe neckache. His X-ray examination showed no pathology. The computed tomographic examination showed no parenchymal pathology, but a isolated transverse fracture in the clivus. CONCLUSIONS The computed tomographic examination showed isolated transverse fracture in the clivus our case presented in this paper is the first case of transverse clivus fracture without additional cranial bone fracture and neurologic deficit in the literature.
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Affiliation(s)
- Ömer Akar
- Department of Neurosurgery, Necip Fazıl State Hospital, Kahramanmaras, Turkey
| | - Can Yaldiz
- Departmant of Neurosurgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Nail Özdemir
- Clinic of Neurosurgery, Specialist in Neurosurgery, Tepecik Education and Training Hospital, İzmir, Turkey
| | - Onur Yaman
- Department of Neurosurgery, University of Koç, Istanbul, Turkey
| | - Sedat Dalbayrak
- Department of Neurosurgery, Neurospinal Academy, Istanbul, Turkey
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22
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Park JS, Kwak SJ, Gil HW, Kim SY, Hong SY. Glufosinate herbicide intoxication causing unconsciousness, convulsion, and 6th cranial nerve palsy. J Korean Med Sci 2013; 28:1687-9. [PMID: 24265537 PMCID: PMC3835516 DOI: 10.3346/jkms.2013.28.11.1687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/15/2013] [Indexed: 11/20/2022] Open
Abstract
Although glufosinate ammonium herbicides are considered safe when used properly, ingestion of the undiluted form can cause grave outcomes. Recently, we treated a 34-yr-old man who ingested glufosinate ammonium herbicide. In the course of treatment, the patient developed apnea, mental deterioration, and sixth cranial nerve palsy; he has since been discharged with full recovery after intensive care. This case report describes the clinical features of glufosinate intoxication with a focus on sixth cranial nerve palsy. Our observation suggests that neurologic manifestations after ingestion of a "low-grade toxicity herbicide" are variable and more complex than that was previously considered.
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Affiliation(s)
- Jae-seok Park
- Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cheonan, Korea
| | - Soo-Jung Kwak
- Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cheonan, Korea
| | - Hyo-wook Gil
- Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cheonan, Korea
| | - So-Young Kim
- Department of Ophthalmology, Soonchunhyang University, College of Medicine, Cheonan, Korea
| | - Sae-yong Hong
- Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cheonan, Korea
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Etezadi F, Karimi Yarandi K, Ahangary A, Shokri H, Imani F, Safari S, Khajavi MR. The effect of needle type, duration of surgery and position of the patient on the risk of transient neurologic symptoms. Anesth Pain Med 2013; 2:154-8. [PMID: 24223352 PMCID: PMC3821142 DOI: 10.5812/aapm.6916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/01/2012] [Accepted: 10/09/2012] [Indexed: 11/25/2022] Open
Abstract
Background The incidence of transient neurologic symptoms (TNS) after spinal anesthesia with lidocaine is reported as high as 40%. Objectives This prospective clinical trial was designed to determine the incidence of TNS in patients who underwent spinal anesthesia with two different needles, in two different surgical positions. Patients and Methods The present randomized clinical trial was conducted on 250 patients (ASA I-II), who were candidates for surgery in supine or lithotomy positions. According to the needle type (Sprotte or Quincke) and local anesthetics (lidocaine and bupivacaine) all patients were randomly divided into four groups. After performing spinal anesthesia in sitting position, the position was changed into supine or lithotomy, according to surgical procedure. The patients were observed for complications of spinal anesthesia during the first five post-operative days. The primary end-point for this trial was to recognize the incidence of TNS among the four groups. Our secondary objective was to evaluate the effect of patient's position, needle type, and duration of surgery on the development of TNS following spinal anesthesia. Results TNS was most commonly observed when lidocaine was used as anesthetic drug (P = 0.003). The impact of needle type, was not significant (P = 0.7). According to multivariate analysis, the duration of surgery was significantly lower in cases suffering from TNS (P = 0.04). Also, the risk of TNS increased following surgeries performed in lithotomy position (P = 0.00). Conclusions According to the results of this clinical study, spinal anesthesia with lidocaine, and the lithotomy position in surgery increased the risk of TNS.
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Affiliation(s)
- Farhad Etezadi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Aylar Ahangary
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hajar Shokri
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farsad Imani
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Safari
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mohammad Reza Khajavi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Mohammad Reza Khajavi, Department of Anesthesiology, Sina Hospital, Hassan Abad Sq.,Tehran University of Medical Sciences, Tehran, Iran. Tel.: +98-9123837096, Fax: +98-2166509059, E-mail:
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Harirchian MH, Saberi H, Najafizadeh SR, Hashemi SA. Evaluation of brain and cervical MRI abnormality rates in patients with systemic lupus erythematosus with or without neurological manifestations. Iran J Radiol 2011; 8:157-60. [PMID: 23329933 PMCID: PMC3522326 DOI: 10.5812/kmp.iranjradiol.17351065.3138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/27/2011] [Accepted: 09/05/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Central nervous system (CNS) involvement has been observed in 14-80% of patients with systemic lupus erythematosus (SLE). Magnetic resonance imaging (MRI) is an appropriate method for evaluating CNS involvement in these patients. Clinical manifestations and MRI findings of CNS lupus should be differentiated from other mimicking diseases such as multiple sclerosis (MS). OBJECTIVES The aim of this study was to evaluate the prevalence and extent of brain and cervical cord MRI lesions of lupus patients. The relationship between neurological signs and symptoms and MRI findings were evaluated as well. PATIENTS AND METHODS Fifty SLE patients who had been referred to the rheumatology clinic of our hospital within 2009 were included in a cross sectional study. All patients fulfilled the revised 1981 American College of Rheumatology (ACR) criteria for SLE. We evaluated the neurological signs and symptoms and brain and cervical MRI findings in these patients. RESULTS Forty-one patients (82%) were female and nine (18%) were male. The mean age was 30.1 ± 9.3 years. Twenty eight (56%) patients had an abnormal brain MRI. No one showed any abnormality in the cervical MRI. The lesions in 20 patients were similar to demyelinative plaques. Seventeen patients with abnormal brain MRI were neurologically asymptomatic. There was only a significant relationship between neurological motor manifestations and brain MRI abnormal findings. CONCLUSIONS Unlike the brain, cervical MRI abnormality and especially asymptomatic cord involvement in MRI is quite rare in SLE patients. This finding may be helpful to differentiate SLE from other CNS disorders such as MS.
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Affiliation(s)
- Mohammad Hossein Harirchian
- Department of Neurology, Imam Khomeini Hospital, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Hazhir Saberi
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Hazhir Saberi, Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Keshavarz Blvd., Tehran, Iran. Tel.: +98-2166581577, Fax: +98-2166581580, E-mail:
| | - Seyed Reza Najafizadeh
- Department of Rheumatology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Hashemi
- Department of Neurology, Imam Khomeini Hospital, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran
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Ashjazadeh N, Shokouhyar S, Ostovan MA. Takayasu arteritis presenting as sudden onset vision loss simulates multiple sclerosis: a case report. J Res Med Sci 2011; 16 Suppl 1:S442-6. [PMID: 22247732 PMCID: PMC3252782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 04/04/2011] [Indexed: 12/02/2022]
Abstract
Neurological manifestation may complicate Takayasu arteritis (TA). A 23-year-old girl with sudden onset of vision loss was admitted to hospital. Her brain MRI showed abnormal T2-signal hyperintensity and visual evoked potential revealed prolonged P100 latency. Consequently, optic neuritis was diagnosed. A review on history of dizziness, falling, and weak pulses of upper extremities led to more investigation. Angiography revealed a total occlusion of right and left carotids, left vertebral arteries, aneurismal dilatation of innominate artery and critical stenosis of right vertebral artery. Following diagnosis of TA, stenting of right vertebral artery was done, but she passed away because of subarachnoid hemorrhage.
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Affiliation(s)
- Nahid Ashjazadeh
- Associate Professor, Department of Neurology, Shiraz Neurosciences Research Center, Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran., Corresponding Author E-mail:
| | - Shadi Shokouhyar
- Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
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Park KW, Im SB, Kim BT, Hwang SC, Park JS, Shin WH. Neurotoxic manifestations of an overdose intrathecal injection of gadopentetate dimeglumine. J Korean Med Sci 2010; 25:505-8. [PMID: 20191058 PMCID: PMC2826734 DOI: 10.3346/jkms.2010.25.3.505] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 01/31/2009] [Indexed: 12/04/2022] Open
Abstract
The intravenous administration of gadopentetate dimeglumine (GD) is relatively safe and rarely causes systemic toxicity in the course of routine imaging studies. However, the general safety of intrathecal GD has not been established. We report a very rare case of an overdose intrathecal GD injection presenting with neurotoxic manifestations, including a decreased level of consciousness, global aphasia, rigidity, and visual disturbance.
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Affiliation(s)
- Kwan-Woong Park
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Soo-Bin Im
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun-Chul Hwang
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jong-Sun Park
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Won-Han Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Lee EH, Kim YH, Hwang JS, Kim SH. Non-type I cystinuria associated with mental retardation and ataxia in a Korean boy with a new missence mutation(G173R) in the SLC7A9 gene. J Korean Med Sci 2010; 25:172-5. [PMID: 20052367 PMCID: PMC2800027 DOI: 10.3346/jkms.2010.25.1.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 07/18/2008] [Indexed: 11/20/2022] Open
Abstract
Cystinuria is an inherited renal and intestinal disease characterized by defective amino acids reabsorption and cystine urolithiasis. It is unusually associated with neurologic symptoms. Mutations in two genes, SLC3A1 and SLC7A9, have been identified in cystinuric patients. This report presents a 13-yr-old boy with cystinuria who manifested difficulty in walking, ataxia, and mental retardation. Somatosensory evoked potential of posterior tibial nerve stimulation showed the central conduction dysfunction through the posterior column of spinal cord. He was diagnosed non-type I cystinuria by urinary amino acid analysis and oral cystine loading test. We screened him and his family for gene mutation by direct sequencing of SLC3A1 and SLC7A9 genes. In this patient, we identified new missence mutation G173R in SLC7A9 gene.
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Affiliation(s)
- Eun Ha Lee
- Department of Pediatrics and Research Laboratory for Mitochondrial Disorders, Ajou University School of Medicine, Suwon, Korea
| | - Yeun Hee Kim
- Department of Pediatrics and Research Laboratory for Mitochondrial Disorders, Ajou University School of Medicine, Suwon, Korea
| | - Jin Soon Hwang
- Department of Pediatrics and Research Laboratory for Mitochondrial Disorders, Ajou University School of Medicine, Suwon, Korea
| | - Sung Hwan Kim
- Department of Pediatrics and Research Laboratory for Mitochondrial Disorders, Ajou University School of Medicine, Suwon, Korea
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