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Background Inpatient stroke-codes (ISC) have traditionally seen low treatment rates with IV-thrombolytic (IVT). The purpose of this study was to identify the predictors of true stroke, prevalent IVT-treatment gap and study the factors associated with such missed treatment opportunities (MTO). Methods A retrospective chart review identified ISC from March 2017 to March 2018. Clinical, radiographic and demographic data were collected. Primary analysis was performed between stroke vs. non-stroke diagnoses. Dichotomous variables were analyzed using Chi-Square test of proportions and continuous variables with Wilcoxon-Ranked-Sum test. Significant factors were then tested in a multivariate logistic regression model for independence. Results From 211 ISC, 36% (n = 76) had an acute stroke. Hemorrhagic stroke (HS) was present in 5.7% (n = 12). Of the remaining 199, 44% (n = 87) were IVT-eligible but only 3.4% (n = 3) were treated. Of the remaining 84 IVT-eligible-but-untreated patients, 69(82.1%) were mimics, while 15 (17.9%) had an ischemic stroke (IS), constituting a MTO of 1 in 6 IVT-eligible patients, with National Institutes of Health Stroke Scale (NIHSS) ≤4 being the commonest deterrent. Independent predictors of stroke were ejection fraction (EF) less then 30% (p = 0.030, OR = 3.06), post-operative status (p = 0.001, OR = 3.71), visual field-cut (p = 0.008, OR = 3.70), and facial droop (p = 0.010, OR = 2.59). Conclusion In our study, one in three ISC were true strokes. IVT treatment rates were low with a MTO of 1 in 6 IVT-eligible patients. The most common reason for not treating was NIHSS ≤4. Knowing predictors of true stroke and the common barriers to IVT treatment can help narrow this treatment gap. Copyright © 2020 Topiwala, Tarasaria, Staff, Beland, Schuyler and Nouh.Background and Objective There remains an unmet clinical need for markers that predict outcomes in the hypothermia-treated (HT) infants with HIE. The aim of this meta-analysis was to investigate the prognostic accuracy of currently available clinical tests performed in the immediate post-natal period for predicting neurological outcomes between 18 months and 3 years of age in HT near-term and term infants with perinatal asphyxia and HIE. Methods A comprehensive review of the Embase, Cochrane library, and PubMed databases was performed to identify studies that evaluated the prognostic value of clinical tests for neurological outcomes in HT near-term and term infants with perinatal asphyxia and hypoxic-ischemic encephalopathy. Pooled sensitivity and specificity with corresponding 95% confidence intervals and area under the receiver operating characteristic (ROC) curve (AUC) were calculated. Results Of the 1,144 relevant studies, 26 studies describing four clinical tests conducted in 1458 HT near-term or term in prospective studies are essential to determine whether these benefits are maintained in later childhood. Copyright © 2020 Liu, Yang, Wei, Dong, Fan and Hua.Background Past research highlighted the benefits of personalized repetitive transcranial magnetic stimulation (rTMS) for the treatment of chronic subjective tinnitus. Objective/Hypothesis The objective was to investigate the feasibility of rTMS personalization by identifying individually optimal stimulation parameters in test sessions. Particularly, effectiveness and retest-reliability of different stimulation parameters were examined. Methods Via electric-field guided rTMS, five patients were stimulated with different frequencies on three positions of the left and right superior temporal gyrus on 2 separate days. After each stimulation, the patients had to evaluate tinnitus loudness and discomfort of the used protocol. Results Individualization of rTMS was possible in all five patients. Significant lower tinnitus loudness was found for 1 Hz stimulation. Positive correlations between 2 days were observed for hemisphere (left, right), position (mSTG, pSTG), and frequency (1, 10, 20 Hz). High-frequency stimulation produced high discomfort. Conclusion Personalization of rTMS is considered as feasible. Consistency of parameter-specific tinnitus suppression is demonstrated. Copyright © 2020 Schoisswohl, Langguth and Schecklmann.Spastic paraplegia type 7 (SPG7), which represents one of the most common forms of autosomal recessive spastic paraplegia (MIM#607259), often manifests with a complicated phenotype, characterized by progressive spastic ataxia with evidence of cerebellar atrophy on brain MRI. Recent studies have documented the presence of peculiar dentate nucleus hyperintensities on T2-weighted images and frontal executive dysfunction in neuropsychological tests in SPG7 patients. Therefore, we decided to assess whether any particular MRI pattern might be specifically associated with SPG7 mutations and possibly correlated with patients' cognitive profiles. For this purpose, we evaluated six SPG7 patients, studying the cerebello-cortical network by MRI voxel-based morphometry and functional connectivity techniques, compared to 30 healthy control subjects. In parallel, we investigated the cognitive and social functioning of the SPG7 patients. Our results document specific cognitive alterations in language, verbal memory, and executive function in addition to an impairment of social task and emotional functions. The MRI scans showed a diffuse symmetric reduction in the cerebellar gray matter of the right lobule V, right Crus I, and bilateral lobule VI, together with a cerebral gray matter reduction in the lingual gyrus, precuneus, thalamus, and superior frontal gyrus. The evidence of an over-connectivity pattern between both the right and left cerebellar dentate nuclei and specific cerebral regions (the lateral occipital cortex, precuneus, left supramarginal gyrus, and left superior parietal lobule) confirms the presence of cerebello-cortical dysregulation in different networks involved in cognition and social functioning in SPG7 patients. Copyright © 2020 Lupo, Olivito, Clausi, Siciliano, Riso, Bozzali, Santorelli, Silvestri and Leggio.Paroxysmal sympathetic hyperactivity (PSH) has predominantly been described after traumatic brain injury (TBI), which is associated with hyperthermia, hypertension, tachycardia, tachypnea, diaphoresis, dystonia (hypertonia or spasticity), and even motor features such as extensor/flexion posturing. Despite the pathophysiology of PSH not being completely understood, most researchers gradually agree that PSH is driven by the loss of the inhibition of excitation in the sympathetic nervous system without parasympathetic involvement. selleck chemical Recently, advances in the clinical and diagnostic features of PSH in TBI patients have reached a broad clinical consensus in many neurology departments. These advances should provide a more unanimous foundation for the systematic research on this clinical syndrome and its clear management. Clinically, a great deal of attention has been paid to the definition and diagnostic criteria, epidemiology and pathophysiology, symptomatic treatment, and prevention and control of secondary brain injury of PSH in TBI patients.